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*ACE's > Hall Ch11 > Flashcards

Hall Ch11 Flashcards

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1
Q

What type of patients should receive antibiotic prophylaxis for infective endocarditis?

A

Pts undergoing selected dental procedures with prosthetic valves, previous infective endocarditis, congenital heart disease, heart transplant with valvulopathy

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2
Q

Most sensitive indicator of left ventricular myocardial ischemia

A

Wall motion abnormalities on echocardiogram

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3
Q

2500 cc/min of oxygen consumption equates to how many METs?

A

10 METs. 1 MET equals energy expended during 1 minute of rest

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4
Q

Common reason for pulmonary artery pressure to suddenly increase during CPB

A

Distal migration of pulmonary artery catheter into a wedge position. Another reason is inadequate ventricular venting leading to ventricular distension

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5
Q

During CPB, facial or scleral edema is a sign of

A

Malposition of venous cannula

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6
Q

During CPB, unilateral facial blanching is a sign of

A

Improper positioning of aortic cannula

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7
Q

How does transposition of great vessels affect inhalation induction?

A

Slower than normal

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8
Q

How does transposition of great vessels affect IV induction?

A

Faster than normal

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9
Q

Fontan procedure (anastomosis of right atrial appendage to pulmonary artery treats which congenital cardiac defects?

A

Tricuspid atresia, pulmonary atresia, pulmonary stenosis, hypoplastic left heart

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10
Q

Tissue metabolic rate is reduced by how much for each degree body temperature is lowered?

A

5-8% for every degree of body temp lowered. CPB

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11
Q

Effective deflation of IABP occurs when?

A

Just before ventricular systole or midpoint of QRS complex

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12
Q

Effective inflation of IABP occurs when?

A

Immediately after closure of aortic valve or after T wave

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13
Q

Effects of afterload reduction on Tetralogy of Fallot

A

Increases right to left shunt which worsens systemic hypoxemia

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14
Q

Afterload reduction is beneficial for which cardiac conditions?

A

Aortic insufficiency, mitral regurgitation, congestive heart failure, patent ductus arteriosus

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15
Q

Protamine is a compound isolated from?

A

Fish sperm

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16
Q

Dose of protamine to reverse heparin

A

1.3 mg of protamine for each 100 units of heparin

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17
Q

Administering protamine to pt who hasn’t received heparin results in?

A

Anticoagulant effect by binding to platelets and soluble coagulation factors. Hypotension if given rapidly because of histamine release.

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18
Q

3 factors that determine myocardial O2 demand from most to least important

A

Heart rate > afterload > preload

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19
Q

Pulsus paradoxus is sign of

A

Cardiac tamponade, severe airway obstruction, RV infarction. (Inspiratory fall in SBP > 10 mmHg)

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20
Q

Pulsus parvus (diminished pulse wave) and pulsus tardus (delayed upstroke) are signs of

A

Aortic stenosis

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21
Q

Pulsus alternans (alternating smaller and larger pulse waves) is a sign of

A

Severe LV dysfunction

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22
Q

Bisferien pulse (pulse waveform with 2 systolic peaks) is a sign of

A

Significant aortic regurgitation

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23
Q

Drugs that can be administered down ETT?

A

ALONE: Atropine, Lidocaine, Oxygen, Naloxone, Epinephrine. Vasopressin too

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24
Q

Amiodarone is what class of antidysrhythmic?

A

Class 3, prolongs action potential and repolarization

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25
Q

Amiodarone metabolism

A

Liver

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26
Q

Amiodarone half life

A

58 days

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27
Q

Amiodarone excretion

A

Bile

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28
Q

Lidocaine is what class of antidysrhythmic?

A

Class 1B

29
Q

Lidocaine metabolism

A

Liver

30
Q

Lidocaine excretion

A

Urine 90%

31
Q

Lidocaine half life

A

1-8 hrs

32
Q

Antidysrhythmic drug that may cause hypothyroidism or hyperthyroidism

A

Amiodarone, a benzofurane derivative with similar chemical structure to thyroxine

33
Q

Equation for SVR

A

SVR = 80 * ((MAP-CVP)/CO)

34
Q

Beta 2 stimulation effects include…

A 
Relaxation of vascular, airway, and uterine smooth muscle tone.
Glycogenolysis
Gluconeogenesis
Insulin secretion
Renin secretion
35
Q

Which volatile agent causes the most direct myocardial depression?

A

Halothane

36
Q

What is halothane’s effect on SVR?

A

Unchanged

37
Q

What is halothane’s effect on heart rate?

A

Decrease in heart rate.

38
Q

MC form of inherited long QT syndrome

A

Romano Ward

39
Q

Treatment for Romano Ward (long QT)

A

Left stellate ganglion block which shortens QT interval and temporarily abolishes the imbalance between right and left sides of the sympathetic nervous system that may play a role in the etiology of the syndrome

40
Q

Why is left stellate ganglion block used to treat long QT syndrome?

A

Long QT syndrome is thought to be caused by a left greater than right sympathetic activity so left stellate ganglion block will balance the activity

41
Q

What percent of cardiac output is dependent on atrial kick?

A

25%

42
Q

An arterial waveform with 2 systolic peaks is a sign of what cardiac disorder?

A

Severe aortic regurgitation. 2nd peak is a reflected pressure wave from the periphery

43
Q

Which volatile anesthetic provides most stable hemodynamics for hypertrophic cardiomyopathy

A

Halothane

44
Q

What type of induction would provide most stable hemodynamics for tetralogy of Fallot?

A

Ketamine, which maintains SVR and minimizes right to left shunt

45
Q

Under max stress, how much cortisol is produced per day?

A

150 mg

46
Q

Normal resting myocardial O2 consumption

A

8-10 mL/100g/min or 10% of total body consumption of O2

47
Q

Normal resting coronary artery blood flow

A

75 mL/100g/min or 225-250 mL/min or 4-5% of cardiac output

48
Q

Known risk factors for pulmonary artery rupture with PA catheter

A 
Elderly
Anticoagulation
Hypothermia (stiffens catheter)
Migration
Prolonged wedge time
49
Q

Why are IDDM pts at risk of allergic rxn to protamine with certain types of insulin?

A

These pts have been exposed to protamine which is in some types of insulin like NPH and PZI

50
Q

Half life of heparin

A

1.5 hrs

51
Q

Medication that inhibits breakdown of adenosine so dose of adenosine should be reduced

A

Dipyridamole

52
Q

The reason for measuring both bladder and PA catheter temperature

A

Helps evaluate adequacy of rewarming after CPB

53
Q

Best TEE view to monitor myocardial ischemia

A

Transgastric mid papillary left ventricular short axis view

54
Q

Most frequent initial rhythm in a witnessed sudden cardiac arrest

A

Ventricular fibrillation

55
Q

Mechanism of action of milrinone

A

PDE3 inhibitor

56
Q

Non immune HIT is which type?

A

Type I, transient and clinically insignificant

57
Q

Mechanism of action of hirudin

A

Direct thrombin inhibitor

58
Q

HIT type 2 is where a complex is formed consisting of?

A

Antibody, heparin, and platelet protein factor 4. This complex bonds to endothelial cells which then stimulate thrombin production

59
Q

Mechanism of action of clopidogrel

A

Noncompetitive irreversible inhibition of ADP receptor P2Y12.

60
Q

Type of WPW rhythm that is amenable to rate control

A

Narrow complex tachycardia, conduction is orthodromic (conduction passes through AV node)

61
Q

Type of WPW rhythm that is NOT amenable to rate control

A

Wide complex tachycardia, antidromic conduction. Rx is procainamide

62
Q

Procainamide is what class of antidysrhythmic

A

Class 1A, used to treat antidromic wide complex tachycardia in WPW patient

63
Q

What to do if pacemaker is set to DOO mode at 70 bpm and under GA the patient’s native HR increases to 85?

A

Give beta blocker to avoid R on T phenomenon.

64
Q

Main advantage of milrinone over amrinone in long term use is lack of what side effect?

A

Thrombocytopenia

65
Q

Dromotropy

A

Conduction of impulses along conduction tissue

66
Q

Bathmotropy

A

Muscular excitation in response to a stimulus

67
Q

Lusitropy

A

Myocardial relaxation or diastole

68
Q

At what lung volume is pulmonary vascular resistance the least?

A

FRC

69
Q

Cardiac risk factors for elective noncardiac surgery

A 
High risk surgery
CHF
Ischemic heart disease
Cerebrovascular disease
IDDM
Creatinine > 2mg/dL

*ACE's (27 decks)

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