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NUNA 684 Advanced Pathophysiology > HTN and IHD > Flashcards

HTN and IHD Flashcards

1
Q

HTN is defined as SBP above ______ and DBP above ______

A

140
90

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2
Q

classic medicine involves sub-dividing any interval into ________ ______

A

smaller increments

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3
Q

HTN affects ____ of the global population

A

25%

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4
Q

_____ of surgical patients in the US will have HTN

A

1/3

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5
Q

______ ______ more frequently affected than caucasian

A

african american

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6
Q

prevalence is higher in men except at extremes of _____ where women are higher

A

age

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7
Q

HTN is an independent risk factor for _______ and ______ when left untreated

A

morbidity and mortality

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8
Q

small percentages of patients present with HTN r/t another _____ _____

A

system pathology

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9
Q

most of the time, it is not a _______ issue but we should be watching for unanticipated HTN

A

secondary

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10
Q

90-95% of pts with HTN have “_______ ______” which is unknown origin

A

essential HTN

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11
Q

if you consider the worsening of a pathology, a gradual progression of essential HTN should be ________ prior to presentation at the _____ _____

A

intercepted
severe level

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12
Q

diagnosis might include several readings to obtain an ______ (______) hypertensive state

A

average (sustained)

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13
Q

we know that there are several causes of HTN and a high reading might not reflect ________

A

pathology

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14
Q

3 essential systems that impact BP

A
  1. ANS
  2. RAAS
  3. vascular endothelium substance production
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15
Q

ANS encompasses:

A

HR x SV x SVR

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16
Q

primarily manages ______ term and ______ change

A

short
rapid

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17
Q

input from _____-______ and cardiac and peripheral receptors that automate cardiac and vascular function

A

baro-receptors

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18
Q

correlates with _____ and ______ response

[ANS]

A

inflammatory and stress

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19
Q

innervation of the sympathetic chain and subsequent peripheral nerves controls vasculature ________ and ______ ________ through input of the vasomotor center of the CNS

A

constriction and cardiac accelerators

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20
Q

stimulation of the ______ ______ can result in sympathetic hormone release

A

adrenal medulla

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21
Q

_____ _______ directly to an organ may result in excitatory changes

A

SNS stimulation

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22
Q

release by the _______ of sympathetic hormones _______ & _______ do the same thing but last longer because of metabolism

A

adrenals
NE and Epi

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23
Q

renal control of pressure includes control/excretion of ________ _______ and the ______ ______ ______ system

A

extracellular fluid
renin angiotensin aldosterone system

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24
Q

RAAS increases ______ ______ (intermediate term) and retention of _______ (long term)

A

vascular tone
fluid

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25
Q

renin from kidney is stimulated by ____ ______ ______

A

low arterial pressure

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26
Q

allows conversion of ________ to ________

A

angiontensinogen to angiotensin I

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27
Q

angiotensin I is converted to angiotensin II by ______ in the lung. It is _______ acting but a potent _______

A

ACE
short acting
potent vasoconstrictor

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28
Q

AT II also decreases excretion of _______ resulting in increased fluid retention in the _______

A

fluid
vasculature

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29
Q

AT reduces blood flow through the kidneys by _______ and thus decreased _______ and increased ________ ______

A

vasoconstriction
filtration
fluid retention

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30
Q

you cant lose fluid if it isnt _______ out, risk for _______

A

filtered
AKI

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31
Q

AT stimulates the adrenal glands to secrete ________. this results in increased reabsorption of fluid in the kidneys. ______ & ______ retention and _______ excretion

A

aldosterone
sodium and water
potassium

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32
Q

renal path

A

afferent arterioles > glomerulus > efferent arterioles > proximal tubules > loop > distal tubule > collecting duct

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33
Q

ANP is from the

A

atria

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34
Q

BNP is from the

A

ventricles

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35
Q

a high ANP does NOT

A

stimulate renin

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36
Q

low ANP

A

stimulates renin

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37
Q

renin cascade end result is higher systemic ______ and increased systemic ______-______ ________

A

pressure
fluid-volume retention

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38
Q

vascular growth can be the result of

A

hyperplasia
hypertrophy

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39
Q

vasoconstriction can be the result of

A

direct
via increased noradrenaline release from sympathetic nerves

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40
Q

salt retention can be the result of

A

aldosterone secretion
tubular Na+ reabsorption

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41
Q

VESP
nitric oxide results in _______ - produced naturally to counteract unopposed _______ forces

A

dilation
vasoconstrictive

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42
Q

endothelin results in ________ - produced naturally in vascular walls

A

constriction

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43
Q

endothelin is released primarily during vascular insult to _______ ______

A

control hemorrhage

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44
Q

ANP and BNP - released in the _______ and cause _______

A

heart
vasodilation

(we see high BNP in volume overload)

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45
Q

inflammatory and stress response on the vasculature can inhibit ______ ______ and result in positive feedback loop with _______ - progressively higher pressures

A

natural response
endothelin

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46
Q

actions or drugs can stimulate or inhibit the natural response of ______ and ______ effecting blood pressure

A

nitric or endothelin

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47
Q

competing forces are the _____ and _____

A

nitric and endothelin

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48
Q

bc short term manipulation is controlled by the ______, our anesthetic pharmacology often addresses manipulation of these componenets

A

ANS

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49
Q

stressors of surgery and anesthesia are not the same as

A

day to day life

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50
Q

BP is like other anesthesia goals - balance the effect of _______ against ______

A

surgery
normality

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51
Q

bc stress of surgery often stimulates ANS responses, our mitigation addresses these components:
1. _______ and sympathetic ______-______ fxns are concurrently stimulated
2. inhibition of PNS ______ _______ to the heart
3. both ______ and ______ are constricted

A

vasoconstrictor and sympathetic cardio-accelerators
vagal stimulation
arteries and veins

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52
Q

the resulting constriction increases ____ while an increased ____ and force of contraction increase ______

A

BP
HR
SV

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53
Q

increased stretch in the baroreceptors stimulates a reduction in __________

A

pressure

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54
Q

impact is a manipulation of the ______ elements of the ______. increased/decreased vagal stimulation results in the ability to change _____ and thus ______

A

parasympathetic elements of the ANS
HR and thus CO

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55
Q

practical example is change of body position when superior aspects of the body lose pressure and the ______ and _________ allow for reperfusion of brain and torso

A

CO and vasoconstriction

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56
Q

HR increases by inhibiting the baseline ______ _____

A

vagal stimulation

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57
Q

bainbridge reflex manipulates CO but not for the benefit of _____ _____ ______

A

blood pressure control

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58
Q

in response to an increase in atrial pressure, _________ stimulation results in increased or decreased stimulation to the heart for ______ ______

A

parasympathetic
rate control

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59
Q

this reflex addresses increases in blood volume to “_____” the heart

A

unload

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60
Q

effect of HTN on the general population correlates with:

A

vasculopathy/PVD
end organ damage
ischemic heart disease
cerebrovascular disease
stroke
aortic disease; specifically aneurysm
neuopathy

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61
Q

meaning that HTN results in all of these changes due to changes in vessel _______ and ______ _______

A

compliance
decreased flow

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62
Q

essential HTN addresses one or more of the primary ________ of BP

A

generators

“fixing the problem at its source”

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63
Q

ANS - drugs are used to blunt the _____, _____, and ______

A

HR, SV, and SVR

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64
Q

Renin/AT system - drugs reduce volume or intercede in one of the conversion processes to _____ ______

A

dilate vessels

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65
Q

endothelium vasodilation drugs - improve or enhance the direct acting dilation effect of ______

A

NO

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66
Q

as a general rule, beta blockers are reserved for _____ ____ _____ patients and not as a first line therapy for ______ ______

A

coronary artery disease
essential hypertension

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67
Q

some gains have been made by re-perfusing the kidney if _____ ______ ______ is thought to be the cause of renin/AT activation

A

renal artery stenosis

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68
Q

for long term control, renal blood ______ is increased or reabsorption of salt and water is _______

[addressing the problem]

A

flow
decreased

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69
Q

increased blood flow is accomplished by any number of

A

vasodilators

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70
Q

drugs that decrease reabsorption block the movement of ______ in ______

A

sodium in tubules (diuretics)

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71
Q

one thing to consider when choosing medications is the specific “______” being fixed or the _____ of intervention needed

A

problem
speed

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72
Q

general expectations are that the patient will continue their normally scheduled ___________ meds

A

anti-hypertensive

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73
Q

some exceptions are made with ______ and ______ drugs due to the likelihood of significant ________ intraop. UNLESS:

A

ACEIs and ATIIRBs
hypotension

UNLESS part of cardiac risk reduction

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74
Q

_____ ______ already scheduled are always continued bc they are primarily being used for ______ effect

A

beta blockers
cardioprotective effect

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75
Q

beta blockers are not routinely administered ________ in the absence of a schedule for ______ ______

A

prophylactically
essential HTN

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76
Q

general consensus is that essential HTN wont be cured in periop period and patient specific pressure should be maintained with the exception of _______ _______ pressure (____)

A

extraordinarily high pressure (> 180 SBP)

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77
Q

_____ pressure monitoring may be warranted, continuous ______ management of volume and heart fxn can be useful

A

arterial
TEE

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78
Q

_______ is of greater value than the absolute number and _______ is BETTER than _______ pressure

A

stability
higher is BETTER than lower pressure

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79
Q

drugs affecting HR/SV:

A

CCBs: cardizem, cleviprex, cardene
BBs: labetolol, esmolol, metoprolol

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80
Q

direct acting vasodilators

A

nitroglycerin, nitroprusside, hydralazine

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81
Q

pulm HTN value

A

mean PAP > 25 mmHg

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82
Q

PHTN diagnosed by _______ and clinically useful assessment by _____

A

RHC
TEE

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83
Q

PHTN can occur in several ways:

A

vascular abnormality and vasoconstriction
left heart failure leading to right heart failure
combined increase PVR with chronic disease (shunt response through HPV)

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84
Q

some of the more common causes are:

A

COPD/lung dz
OSA (as much as 50% of pts with OSA/hypoventilation have PHTN)
LVF
drug induced PHTN
parenchymal lung dz such as sarcoid and fibrosis

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85
Q

pa pressures - inflating the balloon captures the data on the ____ side of the balloon without the _____ side

A

distal
proximal

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86
Q

distal pressures can result in effects ______ (high PA may result in high ____/____)

A

proximally
RA/CVP

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87
Q

prostanoids treat PHTN - produce _______ and decrease ______ ______/_______ response

A

vasodilation and decrease platelet effect/inflammatory response

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88
Q

endothelin receptor antagonist treats PHTN - allow natural effect of NO to function by inhibiting _______

A

endothelin

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89
Q

nitric oxide treats PHTN - directly dilates by stimulating _____ in smooth muscle

A

cGMP

90
Q

NO is degraded by _______

A

PDE

91
Q

thus _____ _______ can increase the effect of NO

A

PDE inhibitors

92
Q

caution on cases to avoid natural _______ ______ ______ that might be stimulated by hypoxia, underventilation, high PEEP, or by surgical effects from one lung ventilation, etc

A

hypoxic pulmonary vasoconstriction

93
Q

following induction, pressure may _____ and then it takes a LOT of medication to to ____ ____ _____

A

drop
bring it up

94
Q

______ _______ may result as inhalation agent diminishes and heart rate acutely ______

A

emergence tachycardia
increases

95
Q

ex: in a patient that has been on a neo gtt to this point, the _______ will quickly increase HR

A

ANS

96
Q

______ dc’d and ______ given and within a minute heart rate will return to baseline

A

Neo
esmolol

97
Q

38 YOF w/ significant HTN arrives to OR for left leg revascularization. Her arrival pressure is 196/112. She takes 7 different classes of anti-hypertensives which she took as scheduled today. You plan an IV induction with standard dosing of medication for general endotracheal anesthetic. After administering the medications, your blood pressure when you look up from intubation is 65/32. Should you….

A

treat hypotension aggressively?? by reversing…..
beta agonists for beta blockade
calcium for calcium channel blockade
vasoconstrictors (alpha agonists) for alpha blockers and RAS blockade

98
Q

following an uneventful anesthetic for a total knee replacement, a patient is emerging from anesthesia and you notice a rapidly increasing pressure. you should know the patient has a history of essential HTN and is taking 3 meds. you should anticipate the blood pressure will continue to climb un-checked, particularly until extubation. note that HTN and intubation can coexist and extubation isnt always the best treatment for HTN you should address HTN with…..

A

short acting and titratable medications that manipulate the ANS (HR, SV, SVR) such as esmolol

99
Q

ischemia definition

A

lack of blood flow somewhere

100
Q

the heart muscle is the target organ via the _____ _____

A

coronary arteries

101
Q

IHD is often a _____ pathology

A

chronic

102
Q

_____ ______ is the leading cause of death globally. our patients are going to have it

A

CV disease

103
Q

IHD is often described as atherosclerotic _______ disease of the heart, ______ ______ disease, and _______ disease

A

vascular
coronary artery
coronary

104
Q

____ and _____ gender are the greatest risk factors

A

age and male gender

105
Q

modifiable risk factors for IHD:

A
  • high cholesterol
  • smoking
  • HTN
  • smoking
  • obesity
  • type A personality (haha)
106
Q

non-modifiable risk factors for IHD:

A
  • DM
  • family hx of IHD
107
Q

disease occurs when vasculature becomes impaired by ______ _______ or due to _______ from hypertrophy of the muscle or lack of flow from aortic valve disease

A

plaque development
narrowing

108
Q

______ vessels lie superficially and _________ vessels lie within the muscle

A

epicardial
subendocardial

109
Q

the three major coronary arteries divide into ______ and ______ branches proceed deeper into the muscle

A

epicardial
subendocardial

110
Q

generally, vessels are know to perfuse _____ _____ of the heart structure

A

specific portions

111
Q

diagnostic testing, such as (3), can isolate the area fed by a specific vessel to determine its individual status

A
  • EKG leads
  • TEE regions
  • LHC studies

these all look at specific areas

112
Q

clinical manifestations of poor perfusion can suggest which vessel is compromised based on knowledge of its _____ _____ ______

A

end perfusion site

113
Q

vessel that supplies anterior and septal walls of the LV, mitral valve, bundle branches

A

LAD

114
Q

vessel that supplies lateral wall of CV

A

circumflex

115
Q

vessel that predominately supplies the conduction system (SA, AV nodes), inferior wall of LV

A

RCA

116
Q

blood flows through the coronaries predominately during _______

A

diastole

117
Q

this picture describes what pathologic process

A

LVH

118
Q

increased wall stress leads to left ventricular ______

A

hypertrophy

119
Q

diagnostic testing (6)

A
  • stress testing
  • heart cath
  • echocardiography
  • CT scan
  • EKG
  • Clinical presentation
120
Q

exercise stress testing - requires _______ but can be mimicked with ______ _______ to stress the heart

A

exercise
dobutamine challenge

121
Q

exercise stress testing - looks for EKG changes so ideal candidate would have ______ ______ at the beginning

A

normal EKG

122
Q

exercise stress testing - achieved _____ _____ is desirable

A

target HR

123
Q

exercise stress testing - ______ ability is an obvious requirement

A

exercise

124
Q

exercise stress testing - utilizes a predicted _____ ______

A

max HR

125
Q

exercise stress testing - goal is to achieve predicted ____ without _____ changes

A

HR
EKG

126
Q

exercise stress testing - negative test correlates with _____ ______ _____

A

low cardiac risk

127
Q

exercise stress testing - long term predictions are more accurate with ________ stress than _______ stress tests

A

exercise
pharmacologic

128
Q

exercise stress testing - a normal baseline _____ is preferred for accuracy

A

EKG

129
Q

exercise stress testing - exercise stress can mimic ______/______ _______ stress and thus proves helpful in predictive values

A

surgical/anesthesia inductive

130
Q

exercise stress testing - several components of this stress test are: (2)

A
  • can the patient achieve the predicted HR without symptoms of cardiac incompetency? (SOB/angina/exhaustion)
  • are there EKG changes that occur at or before predicted heart rate?
131
Q

exercise stress testing - if ischemia occurs at HR < 100 =

A

HIGH risk and < 5 mets

132
Q

exercise stress testing - if pt tolerates HR > 130 without EKG changes =

A

LOW risk and > 7 mets

133
Q

exercise stress testing - the person unable to increase CO/HR in response to stress is at risk like the person who demonstrates ______ changes on the _____ in response to stress

A

ischemic
EKG

134
Q

nuclear testing - involves injection of dye while heart is _______

A

resting/ at rest, imaging the heart for uptake

135
Q

nuclear testing - after allowing clearance, the heart is ______ and injection of dye is again measured

A

stressed

136
Q

nuclear testing - under stress, if coronary disease is present, _____ uptake will occur in the diseased portion due to ______ and coronary ______

A

less
narrowing
steal

137
Q

nuclear testing - though sensitive, this test is _____ ______ as it can have _____ ______

A

not specific
false negatives

(not the most common screening tool)

138
Q

_____ is GOLD STANDARD for diagnosing IHD, but its not used for screening r/t high cost, risk, and untoward effects

A

LHC

139
Q

pts with high risk in anticipation of cardiac sx may receive a _____ or if they have previously failed a stress test

A

cath (LHC)

140
Q

_____ is a sensitive tool that can be used to identify the presence of ischemia and can regionalize diseased muscle but lacks ability to quantify vascular compromise which is knowledge needed for grafting

A

Echo

141
Q

echo would be helpful for ______/______ but less for _______

A

management/screening
intervention

142
Q

_______ ______ testing can be used to identify ischemic events and compare with baseline

A

12-lead EKG

143
Q

like echo, this test can be regionalized

A

12-lead EKG

144
Q

______ is less expensive and readily available but disease can be masked by electrical abnormalities and is generally less sensitive to ischemic events than other testing materials

A

EKG

145
Q

the underlying premise of treatment is to achieve ______ _____ > ______ ______

A

oxygen supply > oxygen demand

146
Q

“____ _____” is a catch phrase being used for patients who have ischemia during stress that is not considered to be warranting an intervention

A

demand ischemia

147
Q

in anesthesia, our short term goals revolve around decreasing ______ _____ and increasing ______

A

oxygen demand
supply

148
Q

IMPORTANT
we work by increasing _____, ______ and _____ ______ pressure

A

FiO2, Hct, and coronary perfusion pressure

149
Q

IMPORTANT
we also work by decreasing ______, ______, _______ wall stress, and ________.

A

HR, contractility, LV wall stress, and pre-load

150
Q

in the overarching scenario, a patient with identified IHD would receive a therapy to increase supply significantly and in a sustained fashion by such things as: (3)

A

coronary stent, re-vascularization, CABG

151
Q

for an acute event, prognosis correlates with ____ _____ of the LV such that poor pumping from acute coronary ischemia results in poorer prognosis

A

ejection fraction

152
Q

when to do elective case following a stent placement -
bare metal stents

A

minimum 30 days

153
Q

when to do elective case following a stent placement -
drug eluting stents

A

wait 1 whole year

154
Q

when to do elective case following a stent placement -
post-CABG

A

at least 6 weeks

155
Q

when drug stoppage is appropriate following a stent (ASA/plavix) - (ideally you dont ever come off)
bare metal stents

A

> 6 weeks

156
Q

when drug stoppage is appropriate following a stent (ASA/plavix) - (ideally you dont ever come off)
drug eluting stents

A

> 1 year

157
Q

3 elements that cause worsening of existing coronary atherosclerosis

A
  1. inflammation of surgery
  2. stress of surgery
  3. initiation of the clotting cascade
158
Q

inflammatory response increases the ______ ______ ______

A

systemic oxygen consumption (greater demand)

159
Q

increased oxygen demand is normally compensated for by an inherent increase in _____ _____

A

cardiac output (greater demand)

160
Q

moderate disease under the effects of surgery can result in increased cardiac oxygen consumption with less supply and subsequent _____

A

ischemia (higher demand with acute decrease in cardiac blood flow)

161
Q

goal of pre-op cardiac eval is to identify ______, ________, and ________ of IHD

A

presence, quantification, implications

162
Q

clues to a high risk patient (2)

A
  1. dyspnea on exertion
  2. inability to climb 2 flights of stairs (4 mets)
163
Q

what is a met

A

amount of oxygen consumed while at rest (3-5ml O2/kg/min)

164
Q

remember that 1 met is basal oxygen consumption and surgical stress may result in higher O2 consumption than 1 met which is why ___ ______ tolerance is a good predictor for low complication risk

A

4 met

165
Q

patient is high risk if surgical procedure is _______ following an MI

A

< 1 month

166
Q

risk to patient is 6% if MI within

A

> 6 months

167
Q

risk to patient is 15% if MI within

A

last 3-6 months

168
Q

risk to patient is 30% if MI within

A

past three months

169
Q

ejection fraction equation

A

EF = (EDV-ESV) / EDV x 100

170
Q

normal EF is

A

60-70 (sometimes quoted 50-60)

171
Q

EF < ____ is impaired

A

40

172
Q

peri-op mngmnt of IHD - greatest recommendation is continuation of _____ ______ therapy

A

beta blocker

173
Q

peri-op mngmnt of IHD - _____ therapy for lipid lowering effect and anti-inflammatory

A

statin

174
Q

peri-op mngmnt of IHD - _____ management to maintain less than 180

A

glucose

175
Q

peri-op mngmnt of IHD - support _____ ____

A

oxygen supply

176
Q

peri-op mngmnt of IHD - minimizing unnecessary oxygen demand such as (3)

A
  • tachycardia
  • hyperdynamic fluctuation
  • shivering
177
Q

peri-op mngmnt of IHD - keeping BP within _____ of baseline for that specific patient

A

20%

178
Q

peri-op mngmnt of IHD - blunt SNS response to ______

A

layngoscopy

179
Q

peri-op mngmnt of IHD - monitor AT LEAST lead ____ and _____. or optimally lead _____, _____, and ______

A

II and V5
II, V4, and V5 (practically this is difficult with most machines)

180
Q

peri-op mngmnt of IHD - maintain _____

A

Hct

181
Q

peri-op mngmnt of IHD - overarching goal is optimizing oxygen ______ and ______ while decreasing oxygen ______

A

supply and delivery
demand

182
Q

the MOST important factor for reducing myocardial oxygen consumption is ____

A

HR

183
Q

HR increases demand for ______

A

oxygen

184
Q

HR reduces time in _______ which reduces ______

A

diastole
supply

185
Q

oxygen extraction is high in the _______

A

myocardium

186
Q

in the presence of ischemia, the options are increase ______ or decrease ______

A

supply
demand

187
Q

additional measures to reduce oxygen consumption (3)

A
  1. contractility reduction
  2. wall stress reduction
  3. volume reduction
188
Q

normal coronary blood flow is about _____ of CO with ______ extraction

A

5%
70%

189
Q

coronary perfusion pressure =

A

DBP - LVEDP

190
Q

IMPORTANT
things that affect supply:

A
  • coronary artery anatomy
  • diastolic pressure
  • diastolic time
  • O2 extraction (Hct, SaO2)
191
Q

IMPORTANT
things that affect demand:

A
  • HR
  • preload
  • afterload
  • contractility
192
Q

_____ ______ has direct correlation to oxygen consumption

A

wall tension

193
Q

wall tension and the duration of that tension can be ______ ______

A

directly manipulated

194
Q

wall tension equation

A

T = LV pressure X LV radius (like a balloon)

195
Q

to reduce oxygen consumption during ischemic events we can do several things:

A
  • reduce LV pressure by reducing afterload
  • reduce duration of contraction by beta blockers/Ca++ channel blockers
  • reduce pre-load to have less stretch and thus more contractility
196
Q

be aware that dilated ventricles will have ______ oxygen consumption (even with low systolic function)

A

increased

197
Q

be aware that a hyperdynamic LV and LVH may have increased _____ _____

A

wall stress

198
Q

risk reduction strategies: maintain normothermia by (2)

A
  1. active warming with forced air
  2. IV fluid/breathing circuit warming/room temp
199
Q

risk reduction strategies: avoidance of extreme ______

A

anemia

200
Q

risk reduction strategies: control of post-op _____ and _____

A

pain and shivering

201
Q

risk reduction strategies: avoidance of _______ moreso than _______

A

hypotension
hypertension

202
Q

risk reduction strategies: maintenance of _______

A

normovolemia

203
Q

risk reduction strategies: post-op ______ management

A

glucose

204
Q

risk reduction strategies: NO recommendation toward use of _____, continuous _____, or _______

A

PAC
TEE
IV NTG

205
Q

risk reduction strategies: the use of PAC can be considered when the disease affects ________ and cannot be corrected before surgery

A

hemodynamics

206
Q

risk reduction strategies: TEE is for _____ events or persistent ________ instability or known ______ disease

A

acute
hemodynamic
valve

207
Q

risk reduction strategies: _______ ______ are acceptable

A

inhalation agents (no change vs TIVA)

208
Q

risk reduction strategies: recommend against high dose _____ technique due to secondary post op ventilation issues

A

opioid

209
Q

risk reduction strategies: regional anesthesia showed ____ ________ in cardiac risk and may _______ pulm outcomes

A

no difference
improve

210
Q

risk reduction strategies: avoidance of _______ with AI

A

bradycardia

211
Q

risk reduction strategies: for AI/MR, maintain the ______ and avoid increased ______

A

preload
SVR

212
Q

risk reduction strategies: place pacers in _______ mode and interrogate

A

asynchronous

213
Q

risk reduction strategies: keep ext defib available for AICD and disable if ______ _______

A

above umbilicus

214
Q

risk reduction strategies: early utilization of ______ for control of ischemia

A

IABP

215
Q

risk reduction strategies: monitoring of ______ if EKG changes are noted/cardiac symptoms present

A

troponin

216
Q

IHD, like _____ is present

A

HTN

217
Q

______ ______ can recognize IHD

A

screening tools

218
Q

whether resolved or not, _____ _____ can result in coronary ischemia during anesthesia

A

surgical stress

219
Q

a primary goal is to keep the oxygen supply and delivery ______

A

nominal

220
Q

a second goal is to minimize the stimulation of oxygen demanding ____ and ______

A

events and processes

NUNA 684 Advanced Pathophysiology (16 decks)

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