Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Anesthesia JB > ITE CA2 Cardiac > Flashcards

ITE CA2 Cardiac Flashcards

1
Q

dP/dt

A

dP/dt (the rate of rise in ventricular pressure) is a good measure of cardiac contractility. Pressures can be measured directly (in the cath lab) or estimated by echocardiography (using the simplified Bernoulli equation). Requires mitral regurg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sphericity index

A

Sphericity index (long axis/short axis) is normally >1.5. It is reduced in dilated cardiomyopathy (the LV becomes more globular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Factors that can result in variable ACT include

A

Factors that can result in variable ACT include: hemodilution, hypothermia, platelet counts below 30-50 k/mL, and concomitant administration of other medications which affect platelets (e.g. prostacyclin, aspirin, glycoprotein IIb/IIIa inhibitors).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens when ultrasound reaches an interface of two tissues with different acoustic impedance?

A

Acoustic impedance is the capacity of a tissue for transmitting sound. Water and soft tissues have intermediate acoustic impedances, while bone has a high acoustic impedance and air has a low acoustic impedance.

When ultrasound reaches an interface of two tissues with different acoustic impedance (soft tissue-air or soft tissue-bone), most of the ultrasound will be reflected.

Reflection is the basis for correct image formation. Reflection is maximal when the angle of incidence between the beam and the reflecting structure is 90 degrees (giving sharper images).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cranial nerve for carotid sinus baroreceptor reflex

A

IX Glossopharyngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What serum biomarker is first to reach peak after myocardial injury

A

myoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

acute STEMI best identified by wich leads

A

II, II, aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

EKG changes with hypocalcemia

A

prolong QT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

in 60% of population this artery supplies blood to SA node

A

R coronary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ST segment cahnges with sub-endocardial ischemia

A

ST segment depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

bainbridge reflex

A

causes increase in HR in response to increased RA fiber pressure and stretch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T wave corresponds to

A

ventricular repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NYHA class II

A

excessive fatigue and dyspnea with ordinary activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

concentric hypertrophy of heart ass’d with what type of overload

A

pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

sensitivity for combination of EKG leads II and V5 for detecting MI evnts

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

phase of cardiac myocyte action potential correspond to influx of calcium

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PEEP effect on venous return to heart

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

delta wave

A

wolff parkinson white

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

heart sound rapid ventricular filling

A

S3 - abnormal in all elderly patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Beck’s triad

A

for pericardial tamponade
hypotension
muffled heart sounds
JVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

EKG lead best detect right sided arrhythmogenic treacings

A

II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

which papillary muscle has a single-vessel blood supply

A

posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Refraction

A

Refraction is a source of artifact that occurs when the ultrasound direction is altered. Like reflection, it occurs when the ultrasound reaches an interface of two tissues of different acoustic impedance. Unlike reflection, refraction is most pronounced when the angle of incidence is acute. Thus, a 90 degree angle not only produces sharper images but also reduces artifacts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How to close or open a PDA

A

Prostaglandin E1 helps maintain a PDA whereas indomethacin (nonselective COX inhibitor) is the standard medical treatment for closure of a PDA by inhibiting prostaglandin synthesis. Ligation of a PDA is the surgical treatment of choice if medical therapy has failed. Closure results in higher systemic pressures (especially higher diastolic pressures) and patients may require antihypertensive therapy postclosure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How many people have pfo

A

25-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Multifocal atrial tachycardia

A

Multifocal atrial tachycardia (MAT) is defined by a heart rate greater than 100 and three or more distinct morphologies of the P wave on an electrocardiogram or rhythm strip. It is commonly seen in patients with pulmonary and cardiac pathologies, especially those resulting in atrial distention and pulmonary HTN. COPD exacerbation is the most common cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Indications for one lung ventilation

A

Absolute indications for one-lung ventilation include:

  • Protective isolation of each lung to prevent contamination of the healthy lung: infection (e.g. abscess, infected cyst), massive hemorrhage.
  • Control of distribution of ventilation to only one lung: bronchopleural fistula, bronchopleural cutaneous fistula, unilateral cyst or bullae, major bronchial disruption, or trauma.
  • Unilateral lung lavage (e.g. pulmonary alveolar proteinosis).
  • Video-assisted thoracoscopic surgery (VATS).

Relative indications for one-lung surgery:

  • Surgical exposure (high priority): thoracic aortic aneurysm, pneumonectomy, lung volume reduction, minimally invasive cardiac surgery, upper lobectomy.
  • Surgical exposure (low priority): esophageal surgery, middle and lower lobectomy, mediastinal mass resection, thymectomy, bilateral sympathectomy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

DAPT for BMS after ACS

A

1 year because ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Preop MI with no intervention. How long wait for surgery

A

60 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Medications to avoid in wolff parkinson white

A

The usual rate-slowing drugs used in atrial fibrillation are not effective, and digoxin and the nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) are contraindicated because they may increase the ventricular rate and cause ventricular fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Right coronary artery EKG leads

A

II, III, aVF (inferior)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

LAD EKG leads

A

septal (V1 and V2) and Anterior (V2-V4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Circumflex artery EKG leads

A

Lateral (V5, V6, aVL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

best lead for detecting arrhythmias

A

II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

best lead for dececting anterior and lateral wall ischemia

A

V5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Idiopathic Hypertrophic sub-aortic stenosis

  • pathophys
  • physical exam
  • management
  • factors that worsen it
A

(IHSS) Thickened interventricular septum/overgrowth of ventricular muscle -> usually antero-lateral; LVOT
Dynamic LVOT obstruction
anterior leaflet is pulled into LVOT during SYSTOLE
Bisferiense pulse: Early rapid peak followed by another peak (unobstructed flow followed by dynamic outflow obstruction)
-SOB, chest pain, syncope, orthopnea, CHF
-management: decrease myocardial contractility (B blocker), normal to slow HR (B blocker), INcrease preload (volume, phenylephrine), increase cardiac output, maintain or increase afterload (vasopressin), avoid arrhythmias
-worsened by increased HR, increased contractility, decreased preload, decreased afterload, arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q 
Chemotherapeutic agents:
Doxorubicin - MoA - Side effects
Bleomycin
Cyclophosphamide
Methotrexate
Vincristine
A

Doxorubicin - Decrease efficiency of topoisomerase - Cardiotoxicity (LV dysfxn)
Bleomycin - Add glycopeptides and increase free radicals - pulm toxic (avoid high FiO2)
Cyclophosphamide - pro-drug, active drug incorporated into DNA - Cystitis
Methotrexate - inhibition of dihydrofolate reductase - myelosuppression
Vincristine - degradation of microtubulin - peripheral neuropathy (stocking glove), SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Mitral valve postero-medial papillary muscle is supplied by what

A

Left circumfelx artery OR right coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Mitral valve antero-lateral papillary muscle blood supply

A

LAD and Diagonal OR marginal branch of left circumflex artery (dual blood supply)

40
Q

normal cardiac output

A

3-8 LPM

41
Q

Bathmotrophy

A

Bathmotropic often refers to modifying the degree of excitability specifically of the heart; in general, it refers to modification of the degree of excitability (threshold of excitation) of musculature in general, including the heart.

42
Q

Mixed venous oxygen equation

A

SvO2 = SaO2 – [(VO2) / (Hb x 1.36 x Q)]

SvO2: mixed venous saturation SaO2: arterial oxygen saturation VO2: oxygen consumption Hg: hemoglobin

Q: cardiac output

43
Q

Cardiac accelerator fibers originate from

A

Cardiac accelerator fibers originate from T1-T4

44
Q

V4 placement and what cardiac site evaluated

A

5th intercostal space, mid-clavicular line; anterior

45
Q

V5 placement and what cardiac site evaluated

A

5th intercostal space, anterior axillary line; lateral LV

46
Q

V1 placement and what cardiac site evaluated

A

4th intercostal space, right sternal border; septal

47
Q

V2 placement and what cardiac site evaluated

A

4th intercostal space, left sternal border; antero-septal

48
Q

PEEP cardiovascular effects

A
  • decrease venous return to heart (decrease RV preload)
  • decrease cardiac output (increase intrathoracic pressure)
  • increase pulm vasc resistance (increase RV volume -> increase RV afterload)
  • Leftward displacement of the intraventricular septum (decrease LV compliance)
49
Q

Mixed venous O2 sat
directly related to
indirectly related to

A

SVO2
directly related to O2 sat, cardiac output, hemoglobin
indirectly related to VO2 (O2 consumption)

50
Q 
Cardiac action potential
Phase 0
Phase 1
Phase 2
Phase 3
A

Phase 0 - sodium influx
Phase 1- potassium efflux
Phase 2 - calcium influx
Phase 3 - potassium efflux

51
Q

Sinoatrial node action potential and describe the numbering

A

Phase 0- calcium influx
Phase 3 - potassium efflux
Phase 4 - sodium influx
4 is the trough, 0 is steep up, 3 is steep down

52
Q

Increase contractility

A

exercise, pharmacologic, adrenergic stim, fever

53
Q

decrease contractility

A

acidosis, hypOthermia, pharmacologic (B blocker)

54
Q

U wave on EKG

A

hypokalemia

55
Q

Carotid sinus efferent branch

A

CN X

56
Q

Hemodynamic goals for aortic regurg

A

Sinus rhythm, HR slightly fast (80s), Reduce afterload, maintain preload, maintain contractility

57
Q

Protamine reaction types

A

1) brief hypotension (likely 2/2 histamine release)
2) anaphylactoid generalized reaction; and
3) Acute pulmonary hypertension, sudden rise PA pressure, RV failure, hypotension (2/2 LV underfilling consequent to RV dysfunction)
The severity of the reaction had no relation to the dose of protamine.

58
Q

intra aortic balloon pump inflates at

A

onset of diastole

59
Q

HOCM hemodynamic goals

A

Anesthetic goals should be to minimize sympathetic stimulation, expand intravascular volume, and minimize decreases in left ventricular afterload.
(decrease HR, increase pre-load, increase afterload)

60
Q

most sensitive non-invasive modality for detecting a venous gas embolism

A

doppler ultrasound

61
Q

electrolyte risk factors for torsades de pointes

A

hypokalemia, hypomagnesemia

62
Q

Dissection stanford classification

A

A - involves the ascending aorta and/or aortic arch, and possibly the descending aorta
B - involves the descending aorta or the arch (distal to subclavian), without involvement of the ascending aorta

63
Q

Which cardiovascular medication has a known antidote

A

digoxin

64
Q

BP changes after placing aortic cross clamp during aortic aneurysm repair

A

hypertension above the clamp and hypotension below the clamp

65
Q

where place a-line and pulse ox during mediastinoscopy

A

R rad a-line and L finger pulse ox

R a-line allows you to be aware of surgical compression on the inominnate artery. Pulse ox on right hand to monitor same thing

66
Q

when measuring cardiac output by thermodilution, increased injection volume will over/under estimate output

A

underestimate

67
Q

red vs blue doppler

A

For red vs blue Doppler, BART: Blue Away, Red Towards.

68
Q

Obstructive shock

  • findings
  • causes
A

Obstructive shock presents with
decreased CI,
increased CVP, and
increased SVR,

but additional context information or additional tests such as echocardiography are usually required for diagnosis.

Obstructive shock is due to an obstruction to cardiac output, most likely due to pericardial tamponade, pulmonary embolism, or a tension pneumothorax.

69
Q 
normal values
CVP:  
PCWP:  
CI:  
SVR:
A

CVP: 2-6 mm Hg
PCWP: 6-12 mm Hg
CI: 2.5-4 L/min/m2
SVR: 800-1200 dynes*sec/cm5

70
Q

main blood supply for anterior wall

A

LAD

71
Q

main blood supply for inferior wall

A

right coronary

72
Q

main blood supply for lateral wall

A

circumflex

73
Q

main blood supply for interventricular septum

A

R coronary and LAD

74
Q

According to the POCA registry, the patients at highest to lowest risk of perioperative events is:

A

According to the POCA registry, the patients at highest to lowest risk of perioperative events is:

1) Unrepaired hypoplastic left heart syndrome (HLHS) due to elevated pulmonary artery pressures
2) Hypoplastic left heart syndrome (HLHS) who has undergone a total cavopulmonary anastomosis (Fontan)
3) Hypoplastic left heart syndrome (HLHS) who has undergone a superior cavopulmonary anastomosis (Glenn)
4) Unrepaired restrictive ventricular septal defect and left-to-right shunting

75
Q

anterior mediastinal mass

The four features predictive of perioperative anesthetic complications include:

A

The four features predictive of perioperative anesthetic complications include:
Great vessel compression
Main-stem bronchial compression
Orthopnea
Upper body edema, suggestive of superior vena cava syndrome

76
Q

papillary muscle with single blood supply

what is the blood supply

A

posteromedial

RCA

77
Q

papillary muscle with dual blood supply

and what is the blood supply

A

anterolateral

LAD and LCCA

78
Q

rupture of papillary muscle result in

A

mitral regurg

79
Q

Most common primary tumor of the heart
Typical location
Metastatic disease more or less common?
Cardiac tumors have the potential to cause:

A

The most common primary tumor of the heart is a cardiac myxoma, which is typically located in the left atrium.

However, metastatic disease to the heart is not uncommon from adjacent lung or renal cancer. Metastatic lung cancer to the heart is more commonly occurring than primary cardiac malignancy and renal cell carcinoma is well described as having potential to spread to the inferior vena cava and right atrium.

Cardiac tumors have the potential to cause arrhythmias, ventricular obstruction, heart failure, pulmonary edema, pulmonary hypertension, arterial hypoxemia, dyspnea, positional hemodynamic compromise and embolism.

80
Q

Acoustic impedance depends on what 2 things

A

Acoustic impedance is the product of the density of a medium and the propagation speed of sound through that medium. Ultrasound reflections that occur at the interface of different mediums are due to the changes in acoustic impedance. Since propagation speed changes slightly between biological mediums, acoustic impedance is primarily dependent upon density.

81
Q

How ensure adequate cerebral cooling prior to stopping circulation?

Goal temp?

A

Full flow CPB is maintained 20-30 minutes after reaching goal temperature to ensure adequate cerebral cooling prior to stopping circulation. Operative time is aimed at 45-60 minutes or less and is the only factor shown to improve outcomes.

The goal temperature is between 15-22 degrees, although slightly higher temperatures may be acceptable for periods of arrest shorter than 30 minutes.

82
Q

Valve better seen on TTE than TEE

A

Pulmonic

83
Q

etCO2 in septic shock

A

Decreased

84
Q

Pacemaker placement is indicated in

A

Second degree AV block
Third degree AV block
Any symptomatic bradyarrhythmia
Refractory supraventricular tachyarrhythmia

85
Q

HFpEF
EF
left ventricular end-diastolic volume
left ventricular end-diastolic pressure

A

Patients with heart failure with preserved ejection fraction (HFpEF) have EF greater 50% with a normal left ventricular end-diastolic volume and an elevated left ventricular end-diastolic pressure.

86
Q

considerations specific for minimally invasive coronary artery bypass

A

MIDCAB is performed through a small thoracotomy incision on a beating heart which may or may not require single lung ventilation in order to optimize surgical conditions during dissection of the internal mammary artery or anastomosis of the LIMA to the LAD.

Considerations specific for MIDCAB: external defibrillation pads, thoracotomy incision, limited surgical exposure, no CPB (avoids deleterious effects), no cardioplegia, requires anticoagulation, no antifibrinolytics, typically LIMA to LAD, possible need for one lung ventilation or pharmacologic bradycardia, and possible hypotension during ligation of a coronary artery.

87
Q

Pulmonary embolism on TEE

A

Pulmonary embolism on TEE:
McConnell’s sign (RV mid-free wall akinesia, spared apex)
60/60 sign,
increased PVR and estimated PA pressures,
enlarged RA / RV / IVC / coronary sinus / hepatic veins,
septal flattening or bowing, and
tricuspid regurgitation.

88
Q

moderate range for aortic stenosis

A

peak velocity 3-4
mean gradient 20-40
aortic valve area 1-1.5

89
Q

Sympathetic activation effect on SA node

A

Sympathetic activation leads to a sharper, or increased, slope of phase 4 which causes the triggering threshold of the membrane potential to be reached quicker thus leading to depolarization.

90
Q

Factors the increase the SA node firing rate include the following:

A

Factors the increase the SA node firing rate include the following: sympathetic stimulation, muscarinic receptor antagonism, beta receptor agonism, catecholamines, hypokalemia, hyperthyroidism.

91
Q

The two methods of managing acid-base balance during CPB

A

The two methods of managing acid-base balance during CPB are noted as pH-stat and alpha-stat management. A pH-stat management technique corrects the alkaline drift by maintaining a neutral pH during hypothermia. Alpha-stat management allows the natural alkaline drift to occur without correction.

92
Q

pH-stat management

A

During pH-stat management, CO2 is added to the oxygenator or the CPB “sweep” may be reduced (the sweep mechanism removes CO2 from the CPB circuit). The addition of CO2 to the circuit increases total body CO2 in order to maintain pH neutrality despite the continuous reduction in core temperature

Advantages of pH-stat management include increased speed of homogenous cerebral cooling through cerebral vasodilatation, reduced CMRO2, increased CBF, and improved oxygen delivery to tissue. Disadvantages include increased delivery of embolic load to the brain and loss of cerebral autoregulation.

93
Q

Frank-Starling shifts

A

A shift in the Frank-Starling curve up or down depicts changes in contractility, with upward shifts showing positive inotropy and downward shifts suggesting negative inotropy.

94
Q

the most common etiology of hypotension following initiation of CPB

A

The acute hemodilution of the patient’s blood with the large volume of crystalloid solution is the most common etiology of hypotension following initiation of CPB

95
Q

The leads of a permanent transcutaneous pacemaker are implanted into the ______

A

The leads of a permanent transcutaneous pacemaker are implanted into the endocardium.

96
Q

IABP inflation/deflation timing

A

Because the balloon inflates during diastole, it increases coronary perfusion pressure (increases supply) and because it deflates suddenly right at the time the ventricle is about to eject blood, it decreases afterload (decreased wall tension -> decreased oxygen demand).

*Anesthesia JB (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions