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Anes101 > Ischemic heart disease (Vadlamudi) > Flashcards

Ischemic heart disease (Vadlamudi) Flashcards

1
Q

Angina

A

Myocardial ischemia which manifests as chest pain

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2
Q

Angina is usually caused by

A

CAD; Vasospasm, Low CO state

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3
Q

Angina

A

Occurs due to O2 supply and demand imbalance

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4
Q

Increased O2 demand

A

Tachycardia; HTN; Increased contractility

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5
Q

Decreased O2 supply

A

Anemia; hypoxemia; CAD and acute Thrombosis; Coronary vasospasm and HypoTN

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6
Q

Types of Angina

A

Stable and Unstable

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7
Q

Stable Angina

A

Exertional; relieved with rest and vasodilators; dzed Cartery is dilated post-stenosis (demand for blood supply to that area is inadequate with exertion

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8
Q

Stable Angina

A

Vasospasm possible cause

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9
Q

Unstable Angina

A

Inc in hz, severity, or duration of angina; angina occurs at rest (CA plaque rupture, partial thrombosis or vasospasm)

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10
Q

Unstable Angina

A

Can occur prior to or after MI

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11
Q

Acute Coranary Syndrome (ACS)

A

Unstable Angina; STEMI and NONSTEMI (these pts need further work up because they are at risk for MI

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12
Q

CAD

A

Most common cause of heart dz

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13
Q

CAD

A

Atherosclerotic plaque build up in CA, limiting blood flow to myocardium

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14
Q

Risk Factors for CAD

A

Male, HTN, Hypercholesterolemia, DM, Family Hx, tobacco abuse and Obesity

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15
Q

Treatment CAD

A

Lifestyle changes, Medical therapy, PTCA,

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16
Q

CABG

A

Gold std for revascularization

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17
Q

Medical Therapy

A

b blockers; CCB, Nitrates, ACE-I, ASA and antiplatelets and statins

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18
Q

How do we enure MI pt is optimized for surgery

A

Functional status (METS)and physical exam/ recent change

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19
Q

How do we enure MI pt is optimized for surgery

A

Hx and records, recent PCI with stent placement?, Dual antiplt therapy?, Prior CABG, significant comorbidities

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20
Q

recent PCI with stent placement?

A

balloon angioplasty - wait atleast 2 weeks before elective procedure

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21
Q

Dual antiplt therapy?

A

BMS = delay elective surgery by 6wks upto 6mnths

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22
Q

Dual antiplt therapy?

A

DES = delay elective surgery by 1 full yr

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23
Q

PCI with stent

A

Body endotheliolizes stent (covers it) dual therapy ensures a balance between endothelial growth and acute stenosis from too much endothelial growth

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24
Q

Patient with CAD

A

Should not ever be off ASA period

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25
Q

How do we enure MI pt is optimized for surgery

A

EKG, echo, stress test, LHC, cardiac MRI/PET, continue appropriate medication in perioperative period)

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26
Q

How do we know pt have MI

A

Symptoms, physical exam and labs

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27
Q

EKG MI (printout baseline EKG always)

A

ST segment elevation, depression, and T wave inversion

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28
Q

MI cardiac enzymes

A

CKmb and troponin I

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29
Q

Transmural MI

A

Involves all 3 layers of heart; 2o to obstruction in major CA ex L main Dz emergence; ST Elevation

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30
Q

Subendocardial

A

Ischemia to endocardium of heart; arteries external with hypertrophy and aortic stenosis so endocardium will not be perfused well

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31
Q

Subendocardial

A

ST depression

32
Q

Periop Management of MI

A

Echo ==wall abnormality (hypokinetic) or ischemia akinetic and also see valvular dysfunction

33
Q

ID Ischemia and MI in anesthetized pt

A

use your tools and tx (max o2 delivery and supply

34
Q

Max 02 delivery and reduce o2 demanda

A

Blood Xfusion, tx HTN and Tachy; Nitrates; stabilize Malignant arrrythmias and Communicate

35
Q

Heart Failure

A

Inability of the heart to provide adequate CO to maintain the needs of the body

36
Q

Etiology

A

Most coomon categories Ischemic, HTN (non compliant with medication), dilated cardiomyopathy

37
Q

Systolic HF (impaired contractility)

A

Contractility is inadequate maintain needed CO (cold in the extremities)

38
Q

Diastolic HF (impaired stretch)

A

Impaired relaxation leadign to impaired filling and therefore dec CO; inadequate preload

39
Q

AHA Class I

A

Symptoms of HF at activity levels would limit normal individuals

40
Q

AHA Class 2

A

Symptoms of HF with ordinary exertion

41
Q

AHA Class 3

A

Symptoms of HF with less than ordinary exertion

42
Q

AHA class 4

A

Symptoms of HF at rest

43
Q

LVAD

A

Continuous flow LVAD

44
Q

Many patients with ESHF

A

LVAD, IABP, Ionotrope dependent, CIED

45
Q

Anesthetic management HF

A

Severity of HF and surgical procedure; less reserve than other patients = avoid significant shift (20% of baseline)

46
Q

How can you monitor BP in a patient with LVAD?

A

A-line, doppler, sphygomonameter; VAD cordinator

47
Q

IABP

A

increase perfusion pressure in diastole to increase coronary blood flow ==inflates in diastole

48
Q

IABP

A

Decrease afterload==Deflates in systole

49
Q

IABP counter pulsation

A

Deflates in systole and inflates in diastole

50
Q

How do you know that the balloon is in the appropriate position?

A

Chest Xray and Echo balloon distal to left subclavian (2cm)because when it inflates and covers the subclavian can cause ischemia to the left arm

51
Q

CIED

A

Conduction issue and malignant arrythmia (vtach and vfib) with ESHF

52
Q

Pacemaker

A

Complete heart block, AV block, symptomatic Brady; do not defibrillate

53
Q

Pacemaker

A

i. chamber paced, 2. Chmaber sensed, iii. Response to sensing, iv.

54
Q

AICD

A

ability to pace, anti-tachy pace (to come out of vtach), and defibrillate

55
Q

AICD

A

indicated for pt with certain cardiomyopathies, low EF, and Hx of malignant arrythmias

56
Q

CRT-D

A

Pts with HF can have significant conduction delay leads to less effective systole (QRS >120ms) due to ventricular dyssynchrony

57
Q

CRT-D

A

3 leads=involves RA, RV, coronary sinus leads (resynchronize rv and lv) improves EF from 15% to 35%

58
Q

CIED perop mangmt

A

magnet off not approriate

59
Q

Is patient pacemaker dependent

A

100% paced or is it backup

60
Q

what are the current settings

A

paced at 70 or back up, defib technology==below 40

61
Q

rate responsiveness enabled?

A

monopolar sensing

62
Q

Monopolar can lead to oversensing

A

Pacing not delivered when needed or defibrillation when not needed

63
Q

beta blockers

A

inhibit catecholamine mediated symp stimulation by blocking b adre receptor

64
Q

beta blockers

A

for HTN, Arrhtmias and HF

65
Q

what are the guidelines

A

if pt is on a beta blocker keep them on it, if they are not don?t give it

66
Q

valvular disoders

A

slow hr bad, a fib slow HR bad

67
Q

CCb (PINE)

A

Dec SVR and vasodilate; reflex tachy which might be a problem with heart dz

68
Q

Nimodipine

A

used in patients with Sub arachnoid Hemo to prevent cerebral vasospasm

69
Q

Clevidipine

A

looks like propofol (ultrashort acting IV CCB,) cardiac surgical

70
Q

Nitrates

A

cause smooth muscle relaxation, dilate CA reducing ischemia with CAD

71
Q

Nitrates

A

caution with extended use = tachyphylaxis

72
Q

ACEI

A

angitensin converting enzyme inhibitor

73
Q

ACEI contraindications

A

Cough (kalokrein interaction) significant angioedema (airway issues)

74
Q

Dual antiplt therapy?

A

ASA and plavix

75
Q

Statin

A

HMG - Coa reductase inhibitor (prevent production of cholesterol), anti-inflammatory properties particularyly in vasculature and myocardium

Anes101 (10 decks)

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