Ischemic HD

Question 1

Causes of ischemic HD, which most common

Answer 1

Narrowing of coronaries most common. Atherosclerosis, severe htn or tachycardia, CA vasospasm, severe hypotension, hypoxia, anemia, AI or AS

Question 2

CM of ischemic HD

Answer 2

Angina, ischemia, myocardial necrosis/infarction, arrhythmias, ventricular dysfunc, sudden death

Question 3

Stable angina

Answer 3

No change in precipitating factors (duration and frequency of pain) for at least 60 days

Question 4

Unstable angina

Answer 4

Less than normal activity, new onset, prolonged duration, occurs more often and severely

Question 5

When most periop MIs occur

Answer 5

24-48 hrs postop

Question 6

Decreased supply factors 7

Answer 6

High hr, low bp (2 most common), vasoconstriction, 02 carrying (ph, anemia, hypoxia), viscosity, arterial patency, CA spasm

Question 7

Increased demand signs 7

Answer 7

Tachycardia, inc contractility/preload/afterload, shivering, high bg and bp

Question 8

Regional considerations

Answer 8

Tx hypotension w phenylephrine, tx Brady w ephedrine

Question 9

General consideration

Answer 9

BP within 20% of baseline, no prolonged periods of hypotension

Question 10

Leads II, III, avf: CA and myocardium involved

Answer 10

RCA. RA/RV, SA node, inferior LV, AV node

Question 11

Lead I, AVL: CA and myocardium involved

Answer 11

Circumflex. Lateral LV

Question 12

V3-V5: coronary artery and myocardium involved

Answer 12

LAD, anterolateral LV

Question 13

Best leads to see ischemia

Answer 13

II and V5

Question 14

Induction

Answer 14

Minimize laryngoscopy time and response. Etomidate and high opioid

Question 15

Maintenance

Answer 15

Avoid tachycardia. Normal pre and afterload. Dec contractility if LVF normal. NSR. MVO2 control demand easier, attenuate SNS