ITE Cardiology Flashcards
During Thoracic aortic aneurysm stenting, as a cardiac stent-graft begins to open, the ejection force of the heart can push the stent-graft and cause it to migrate distally. This is known as ________, and can be prevented by ___(3)___
the “windsock effect”
- Induced-hypotension (systolic 70-80 mmHg)
- Transient cardiac asystole (adenosine)
- Rapid ventricular pacing ( > 180 bpm will stop L ventricular ejection)
Adenosine should be cautiously used in pts with ____, because adenosine can cause _____.
asthma / upper respiratory disease
bronchoconstriction
______ is the preferred treatment for complete heart block.
____ mode > ____ mode if the pt is still undergoing a procedure with electrocautery present
Pacing
VOO > VVI
- VOO will pace the ventricles without sensing electrical interference
- Asynchronous pacing
Third degree heart block, or complete heart block, is an interruption in conduction of ______
the impulses from the atria to the ventricles
- SA node still continues to generate impulse
Pacemaker code meaning
I-IV
I: Chamber(s) paced
II: Chamber(s) sensed
III: Response to sensing
IV: Rate response
mneumonic: “PSR” (Pacer) - pace, sense, response
Pacemaker setting VOO
- Single chamber mode
Pacing in Ventricle, Sensing OFF, Response to sensing OFF - VOO will pace the ventricles without sensing electrical interference, and regardless of heart's intrinsic activity - Asynchronous pacing
Pacemaker setting VVI
- Single chamber mode
Pacing in ventricle,
Sensing in ventricle,
Response to sensing is to Inhibit
- Senses heart’s intrinsic activity and inhibiting pacing when unnecessary
Pacemaker setting AOO
- Single chamber mode
Pacing in Atria, Sensing OFF, Response to sensing OFF - will pace the atria without sensing electrical interference, and regardless of heart's intrinsic activity - Asynchronous pacing
Pacemaker setting AAI
- Single chamber mode
Pacing in Atria,
Sensing Atria,
Response to sensing is inhibit
- pacemaker will adapt to what the intrinsic atrial rate is doing
- pace when needed, and inhibit when not needed
Pacemaker setting DDD
- Dualchamber mode
- tracking mode
Pacing in Atrium + Ventricle,
Sensing Atrium + Ventricle,
Response to sensing is Inhibit or Trigger
- (Intrinsic P-wave and QRS can inhibit pacing)
- (Intrinsic P-wave or atrial pace can Trigger an AV delay)
- Pacemaker can truly adapt to what the heart is doing
- Pacemaker will mimic normal conduction as closely as possible
Pacemaker setting VDD
- Dualchamber mode
- tracking mode
Pacing in Ventricle,
Sensing Atrium + Ventricle,
Response to sensing is Inhibit or Trigger an AV delay, maintaining AV synchrony
- (Intrinsic QRS can inhibit ventricular pacing)
- (Intrinsic P-wave can Trigger an AV delay)
- No pacing in the atrium, but an intrinsic P-wave can trigger an AV delay, resulting in P-wave tracking and possibly maintaining AV synchrony
Pacemaker setting DDI
- Dualchamber mode
- nontracking mode
Pacing in Atrium + Ventricle,
Sensing Atrium + Ventricle,
Response to sensing is to Pace or Inhibit
- Like having an AAI and VVI pacemaker working together at same time, but independent of eachother
- Great for atrial tachyarrhythmias (not afib), and P wave tracking is great for AV synchrony
Pacemaker setting DOO
- Dualchamber mode
- nontracking mode
Pacing in Atrium + Ventricle,
Sensing is OFF
Response to sensing is OFF
- AV sequential pacing at lower rate limit regardless of hearts own intrinsic activity
- Useful when magnet is placed over pacemaker or during surgery
Lusitropy is defined as ______, and results in LV pressure (increase/decrease) and coronary perfusion pressure (Increase/decrease)
Myocardial relaxation.
decrease
Increase
(Positive/Negative) lusitropy occurs with diastolic dysfunction
Negative
*Lusitropy is defined as Myocardial relaxation.
Inodilator therapy results in an increase in (lusitropy/inotropy)
both
- ie. milrinone
*inotropy: anything that affects the strength of muscle contraction of the heart (can be positive/negative)
Positive lusitropy results in a (rightward/leftward) shift of the diastolic filling phase on the myocardia pressure-volume loop. Resulting in (increase/decrease) CPP, LVEDV, SV
rightward
Increased
The main goal of medical treatment in pts with aortic insufficiency (aka aortic regurgitation) is to ___ (3).
- Decrease afterload
- (allows for forward flow) - Augment contractility
- (more forward flow) - Avoid bradycardia
- (less time for regurgitation)
*Fast, Full (preload), Forward
The use of metoprolol and phenylephrine in pts with aortic insufficiency is (good/bad).
bad
- Metoprolol: increase time in diastole, allowing more time for regurgitant flow
- Phenylephrine: increases afterload, when you should really decrease it.
Following carotid endarterectomy, (hypertension/hypotension) is a more common predictor of adverse events
hypertension
- peak 2 hr post op
- stroke/death
Neurological dysfunction following carotid endarterectomy (CEA), is mostly d/t ____, and is prevented by ____
Thromboembolism
peri-procedure antiplatelet therapy
(On/Off)-pump coronary artery bypass is associated with greater incidence of hemodynamic instability during distal graft anastomosis
OFF
- d/t positioning of the heart (verticalization)
or
- ischemia related to ligation of a coronary artery
*no mortality difference
If a pt suffers refractory hemodynamic instability during Off-pump coronary artery bypass, you will need to ____
convert to full CPB
(Full median sternotomy / Minimally invasive direct CAB) usually requires a double lumen tube for lung isolation
Minimally invasive direct CAB
- performed thru smaller thoracotomy incision and require lung isolation
- DL tube allows for proper visualization w/in mediastinum