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Anesthesia 101 > ITE Cardiology > Flashcards

ITE Cardiology Flashcards

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1
Q

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)___

A

the “windsock effect”

  1. Induced-hypotension (systolic 70-80 mmHg)
  2. Transient cardiac asystole (adenosine)
  3. Rapid ventricular pacing ( > 180 bpm will stop L ventricular ejection)
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2
Q

Adenosine should be cautiously used in pts with ____, because adenosine can cause _____.

A

asthma / upper respiratory disease

bronchoconstriction

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3
Q

______ is the preferred treatment for complete heart block.

____ mode > ____ mode if the pt is still undergoing a procedure with electrocautery present

A

Pacing

VOO > VVI

  • VOO will pace the ventricles without sensing electrical interference
  • Asynchronous pacing
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4
Q

Third degree heart block, or complete heart block, is an interruption in conduction of ______

A

the impulses from the atria to the ventricles

- SA node still continues to generate impulse

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5
Q

Pacemaker code meaning

I-IV

A

I: Chamber(s) paced
II: Chamber(s) sensed
III: Response to sensing
IV: Rate response

mneumonic: “PSR” (Pacer) - pace, sense, response

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6
Q

Pacemaker setting VOO

- Single chamber mode

A 
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
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7
Q

Pacemaker setting VVI

- Single chamber mode

A

Pacing in ventricle,
Sensing in ventricle,
Response to sensing is to Inhibit
- Senses heart’s intrinsic activity and inhibiting pacing when unnecessary

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8
Q

Pacemaker setting AOO

- Single chamber mode

A 
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
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9
Q

Pacemaker setting AAI

- Single chamber mode

A

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

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10
Q

Pacemaker setting DDD

  • Dualchamber mode
  • tracking mode
A

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
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11
Q

Pacemaker setting VDD

  • Dualchamber mode
  • tracking mode
A

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
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12
Q

Pacemaker setting DDI

  • Dualchamber mode
  • nontracking mode
A

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
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13
Q

Pacemaker setting DOO

  • Dualchamber mode
  • nontracking mode
A

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
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14
Q

Lusitropy is defined as ______, and results in LV pressure (increase/decrease) and coronary perfusion pressure (Increase/decrease)

A

Myocardial relaxation.

decrease

Increase

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15
Q

(Positive/Negative) lusitropy occurs with diastolic dysfunction

A

Negative

*Lusitropy is defined as Myocardial relaxation.

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16
Q

Inodilator therapy results in an increase in (lusitropy/inotropy)

A

both
- ie. milrinone

*inotropy: anything that affects the strength of muscle contraction of the heart (can be positive/negative)

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17
Q

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

A

rightward

Increased

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18
Q

The main goal of medical treatment in pts with aortic insufficiency (aka aortic regurgitation) is to ___ (3).

A
  1. Decrease afterload
    - (allows for forward flow)
  2. Augment contractility
    - (more forward flow)
  3. Avoid bradycardia
    - (less time for regurgitation)

*Fast, Full (preload), Forward

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19
Q

The use of metoprolol and phenylephrine in pts with aortic insufficiency is (good/bad).

A

bad

  • Metoprolol: increase time in diastole, allowing more time for regurgitant flow
  • Phenylephrine: increases afterload, when you should really decrease it.
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20
Q

Following carotid endarterectomy, (hypertension/hypotension) is a more common predictor of adverse events

A

hypertension

  • peak 2 hr post op
  • stroke/death
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21
Q

Neurological dysfunction following carotid endarterectomy (CEA), is mostly d/t ____, and is prevented by ____

A

Thromboembolism

peri-procedure antiplatelet therapy

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22
Q

(On/Off)-pump coronary artery bypass is associated with greater incidence of hemodynamic instability during distal graft anastomosis

A

OFF
- d/t positioning of the heart (verticalization)
or
- ischemia related to ligation of a coronary artery

*no mortality difference

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23
Q

If a pt suffers refractory hemodynamic instability during Off-pump coronary artery bypass, you will need to ____

A

convert to full CPB

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24
Q

(Full median sternotomy / Minimally invasive direct CAB) usually requires a double lumen tube for lung isolation

A

Minimally invasive direct CAB

  • performed thru smaller thoracotomy incision and require lung isolation
  • DL tube allows for proper visualization w/in mediastinum
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25
Q

Benefits of Off-pump coronary artery bypass (5)

A
  1. decreased incidence of low cardiac output syndrome
  2. shorter length of ventilation
  3. Shorter hospital stay, cost, infection
  4. less stroke
  5. less blood transfusions
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26
Q

Major disadvantage of Off-pump coronary artery bypass

A

higher incidence of repeat revascularization

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27
Q

Essential hypertension

- explain stages of cardiac output

A

Initial stages: increase in cardiac output
->
Cardiac output normalizes
(systemic venous resistance increases)

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28
Q

How does Essential hypertension affect the body’s sympathetic tone?

A

Increase

  • contributes to increased BP
  • labile response to sympathetic agonists and vasodilators
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29
Q

According to the AHA, pts should be administered supplemental O2 if the RA is < __%

A

94%

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30
Q

Initial dose of aspirin during suspected MI: __ mg

A

162-325 mg PO

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31
Q

Nitroglycerin is contraindicated when pt has evidence of (right/left) sided MI

A

Right

- pts are very sensitive to decreases in cardiac preload

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32
Q

The addition of _____ to priming solutions used in CPB will improve urine output.

A

Mannitol

- direct diuretic action

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33
Q

(True/False) b/l carotid endarterectomy (CEA) may be associated with loss of normal ventilatory responses to acute hypoxemia

A

True

- carotid body denervation may occur

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34
Q
  • Carotid SINUS is located in the _________, and is responsible for maintaining BP through the ________ reflex.
A

adventitia of the carotid bulb of the internal carotid artery

baroreceptor

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35
Q

The carotid BODIES are located at the ________, and are responsible for respiratory stimulation through the ________ reflex.

A

bifurcation of the common carotid artery

chemoreceptor

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36
Q

Chemosensitive cells are located in the ______, and respond to changes in ______ by stimulating respiratory centers, increasing ventilatory drive

A

carotid bodies

pH status and blood oxygen tension

  • (makes sense, both carotid bodies and chemosensitive cells stimulate respiratory/ventilatory response)
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37
Q

Type III protamine reaction

Tx?

A

Catastrophic Pulmonary HTN
RV failure mediated by heparin-protamine complexes and thromboxane A2

Tx: Inhaled NO, IV heparin, milrinone

  • NOT mediated by histamine, and diphenhydramine not useful
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38
Q

Type I protamine reaction

Tx?

A

rapid infusion of protamine -> decrease in SVR -> direct histamine or NO release

  • Myocardial depression not seen
  • Inc PVR not seen

Tx: volume

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39
Q

Type II protamine reaction

A

IgE mediated anaphylaxis/anaphylactoid rxn

  • hypotension
  • rash
  • vasodilation
  • bronchoconstriction
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40
Q

Hyperthyroidism increases __ adrenoceptor density on the surface of cardiac myocytes

A

B1 and B2

  • positive inotropic, chronotropic, and dromotropic effects
  • hyperadrenergic state

*dromotropic = affects electrical impulse conduction

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41
Q

Chronic CHF causes B adrenoreceptors to (increase/decrease) on cardiac myocytes

A

Decrease

- prolonged activation of SNS -> downregulartion -> decrease contractile ability to respond to sympathetic stimulation

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42
Q

The main goal of CPB is to _______. The CPB circuit will drain deoxygenated blood from the R side of the heart, oxygenate the blood and return blood distal to where the surgeon is working on the aorta.

A

allow a surgeon to operate on a quiet, non beating heart while oxygenation and circulation are supported

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43
Q

Main components of full Cardiopulmonary bypass circuit (7)

A
  1. Venous limb
  2. Cardiotomy filter and venous reservoir
  3. Pump
  4. Oxygenator
  5. Heat exchanger
  6. Arterial limb
  7. Cardioplegia delivery system
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44
Q

Main goal of treating mitral regurgitation

A
  1. increasing HR
    - Reduce systolic time
  2. Reduce afterload
  3. Maintain NSR and normovolemia
  • in early stages of MR: compensatory mech can reduce afterload, and increase LV compliance
  • in severe stages: reduced EF, increased LV pressures/regurgitant vol
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45
Q

What blood produce is approved for AT III deficiency?

A

Fresh frozen plasma

  • has AT III present (2-3 units)
  • Correction of Antithrombin levels allows heparin to exert its full antithrombotic effect
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46
Q

ACT goal for CPB

A

400 - 480

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47
Q

most frequent side effects of amiodarone

A 
bradycardia
hypotension
AV node block
Prolong QT
Hyperthyroid storm
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48
Q

Bivalruding is a ______ that exerts its clinical action by binding thrombin at 2 specific sites: ____ and _____

A

short acting direct thrombin inhibitor

  • half-life 25 min
  • can go stagnant in CPB circuit

fibrinogen recognition site
active catalytic site

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49
Q

_________ is the gold standard anticoagulant used during CPB

A

unfractionated heparin

- reversed with protamine

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50
Q

What is HIT?

A

Formation of IgG antibodies to heparin-platelet factor 4 complex that forms on the surface of platelets –> hyperaggregability of platelets

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51
Q

FDA approved alternatives to heparin

A

Hiruden and Argatroban
- bind active site of thrombin irreversibly

However, bivalrudin can be used in place of heparin for CPB

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52
Q

What is the best way to monitor oxygenation status in a pt with an LVAD?

A

Cerebral oximeter

  • LVADS eject blood in a non-pulsatile manner
  • Cerebral oximeters do not rely on pulsatile flow and can detect rapid changes in oxygenation
53
Q

Stroke

  • Fibrinolysis should be performed within ____ of arrival and ____ of symptom onset
  • CT should be done within ____ of arrival
A

60 min
3 hours

25 min

54
Q

At any given time __% of the patients blood is extracorporeal when CPB is being utilized and cause hypothermia

A

20-35%

- need heat exchanger and oxygenator

55
Q

Two types of arterial pumps that draws blood from the venous reservoir and propels it into the oxygenator

A
  1. Roller pump

2. Centrifugal pump

56
Q

During CPB, ______ pumps occludes a portion of the tubing and rolling the point of the occlusive contact along the length of the tubing itself –> forces blood forward in front of the point of occlusion while drawing blood in behind the occlusion point

A

Roller pumps

57
Q

During CPB, ______ pumps are non-occlusive pumps and use spinning fins or channels on the inside of a cone to force blood forward

A

centrifugal pumps

  • less traumatic than roller pumps
  • less likely to generate air emboli
58
Q

Intraaortic baloon pumps (IABPs) increase cardiac output by ___%. Balloon inflates during the beginning of diastole, and deflates right when ventricle is about to eject blood (end of diastole)

A

25%

  • useful in cardiogenic shock
  • Increase CO, MAP, EG, coronary blood flow
59
Q

Intraaortic balloon pumps will cause the (systolic/diastolic pressure) to be higher in an assisted beat

A

diastolic pressure

- greatly augmented d/t inflation of the balloon

60
Q

On EKG, Lead II is used to detect ______ ischemia and cardiac arrhythmias

A

R coronary artery

- Inferior leads

61
Q

On EKG, Lead V3, V4 is used to detect ______ ischemia

A

L anterior descending (LAD) coronary artery
- Anterior leads

*LAD artery supplies apex of LV and anterior 2/3 of interventricular septum

62
Q

On EKG, Lead II, III, aVF is used to detect ______ ischemia

A

R coronary artery:

  • R atrium
  • R ventricle
  • Inferior aspect of L ventricle
  • SA and AV node
63
Q

On EKG, Lead I, aVL, V5, V6 is used to detect ______ ischemia

A

L Circumflex coronary artery or diagonal

- Lateral leads (supplies lateral wall of L ventricle)

64
Q

On EKG, Lead V1, V2 is used to detect ______ ischemia

A

LAD

- Septal leads

65
Q

Contraindications to intraaortic balloon pump (3)

A
  1. Mod-severe AI
  2. Aortic disease (dissection)
  3. Severe peripheral vascular disease
66
Q

indications to intraaortic balloon pump (5)

A
  1. cardiogenic shock
  2. failure to wean form CPB
  3. severe MR
  4. augmentation during PCI
  5. bridge to transplant or VAD placement
67
Q

The gas typically used during inflation of the IABP is typically ____

A

helium

- inert gas with laminar flow, which passes readily into and out of balloon

68
Q

The IABP helium balloon should remain inflated during which part of the cardiac cycle?

A

Early diastole to late diastole

69
Q

______ is the most common method to determine cardiac output. Ice cold injectate is inserted into CVP port of PA catheter and travels towards thermistor.

A

Thermodilution

70
Q

In thermodilution, any technical error resulting in LESS of a temp change during CO measurement results in (overestimation/underestimation) of CO

A

Overestimation

- Assume blood is warming up faster than it actually is if programmed for ice cold water

71
Q

In thermodilution, a R-to-L intracardiac shunt results in (overestimation/underestimation) of CO

A

False overestimation

- shunt will divert injectate away from thermistor

72
Q

ACC/AHA guidelines state that pts undergoing PCI for stable ischemic heart disease should receive what medications and for how long after Bare Metal Stents and Drug Eluting Stents?

A

BMS: dual antiplatelet therapy for at least 1 mo after

DES: dual antiplatelet therapy for at least 6 mo after (or 3 mo in pts at high risk of severe bleeding)

73
Q

Metoprolol is contraindicated in acute heart failure d/t ____

A

its negative inotropic effects

  • B1 adrenergic receptor antagonist
  • improves diastolic LV filling time
74
Q

Diuretics improve symptoms of CHF by ______

A

reducing cardiac filling pressures along same frank-starling ventricular function curve

75
Q

Administering muscle relaxants in a pt with an anterior mediastinal mass poses significant risk for airway collapse d/t _____

A

paralysis of skeletal muscles that were previously maintaining airway patency

76
Q

Why doesn’t central venous pressure decrease with aortic cross-clamping?

A

With the increase in catecholamine levels, there is increased venoconstriction distal to the clamp driving central venous pressure higher

77
Q

“Holliday heart syndrome” aka alcohol-induced cardiomyopathy (systolic HF) shows a ______ shift in the Frank-Starling curve

A

Downward shift
- poor contractile fxn

(Graph is SV vs LVEDP)

78
Q

Epinephrine, a positive inotropic agent, will shift in the Frank-Starling curve _____

A

upward

79
Q

Mitral stenosis murmur

A

low pitched mid diastolic rumble

- best heard at maximum impulse during exhalation

80
Q

Mitral stenosis is most commonly d/t _____

A

a sequela of rheumatic fever

81
Q

Diastolic murmurs

A

mitral stenosis
and
aortic regurgitation

82
Q

Systolic murmurs

A

MR. Ass

Mitral regurgitation

Aortic stenosis

83
Q

During CPB, optimal hemodynamic goals include:

  1. Pump blood flow:
  2. Arterial blood pressure of:
  3. Oxygen Sat in the venous cannula of:
A
  1. Pump blood flow: 1.6 - 3 L/min/m2
  2. Arterial blood pressure of:50-90 mmHg
  3. Oxygen Sat in the venous cannula of: > 65%
84
Q

If a pt with a ventricular assist device suffers cardiac arrest, chest compressions should be started if MAPs are < ____mmHg

A

50 mmHg, bc the VAD is not providing adequate forward flow

85
Q

Common reversible causes of cardiac arrest

A

5 H’s

Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypo/hyperkalemia
Hypothermia
5 T's
Toxins
Tamonpade
Tension pneumo
Thrombosis-heart
Thrombosis-lung
86
Q

Function of ventricular assists devices are based on what 3 main principles?

A
  1. Preload (hypovolemia)
  2. Rotational speed (RPM) (setting)
  3. Afterload (SVR/PVR)
  • extremely sensitive to changes to all.
87
Q

In pts with an ongoing intracranial hemorrhage, target SPB should be?

A

< 140 mmHg to minimize ongoing bleeding w/o compromising blood flow

88
Q

In pts with an ongoing ischemic stroke, target SPB should be?

A

140-150 mmHg

- U shaped association, above and blow = worse outcomes

89
Q

What is the “inverse-steal” or “robin-hood phenomenon?”

A

Opposite of cerebral steal

Preferential shunting:

  • INTERVENTIONS that cause normal cerebral vasculature to preferentially vasoconstrict, while impaired areas of the brain will vasodilate.
  • Take advantage with hyperventilation (hypocapnea)
90
Q

What is “intracerebral steal phenomenon”?

A

When an intervention causes the normal cerebral vasculature to dilate in the setting of a focal obstructive lesion.

  • vasculature around and downstream the lesion will maximally dilate in effort to preserve flow.
  • steals blood from impaired areas of brain and worsening ischemia
91
Q

What is a Maze procedure? (3)

A
  1. incision made into both atria
  2. endothelium of pulmonary veins is isolated from the atrial myocardium
  3. L atrial appendage ligation
  • CPB is required
92
Q

The LV is perfused during ______ and the RV is perfused during ____

A

diastole only

throughout the coronary cycle

93
Q

In CPB, the _____ acts as a substitute for the pts lungs, while the _____ acts as a substitute for the pts heart

A

Oxygenator

Arterial pump

94
Q

ACC/AHA guidelines for heart failure staging

  • Stage A
  • Stage B
  • Stage C
  • Stage D
A
  • Stage A: High risk for HF
  • Stage B: Asymptomatic HF
  • Stage C: Symptomatic HF
  • Stage D: Refractory ESHF
95
Q

NYHA classification for heart failure

  • Class I
  • Class II
  • Class III
  • Class IV
A
  • Class I: Physical activity not limited by HF
  • Class II: Physical activity somewhat not limited by HF
  • Class III: Exercise is limited by dyspnea during modest exertion
  • Class IV: Dyspnea at rest or with minimal exertion
96
Q

What is the primary MOA of epinephrine that is desired in cardiac arrest?

A

Alpha-1 agonism

- contraction of vascular sm -> vasoconstriction -> inc BP -> restore coronary perfusion

97
Q

Why is alpha 2 agonism undesirable in cardiac arrest?

A

Sympatholytic effect

- reduce central and peripheral sympathetic outflow -> hypotension and bradycardia

98
Q

Why is beta 1 agonism undesirable in cardiac arrest?

A

Inc cardiac contractility and inotropy ->

increase myocardial oxygen demand

99
Q

Why is beta 2 agonism undesirable in cardiac arrest?

A

systemic vasodilation -> hypotension ->

decrease myocardial perfusion

100
Q

An increase in systemic blood pressure results in a decrease in systemic vascular resistance through __________

A

carotid sinus baroreceptors
- located at bifurcation of INTERNAL and EXTERNAL carotids
- elevated BP -> causes stretching of arterial wall -> baroreceptors expand ->
increase parasympathetic output

101
Q

Which is more sensitive, carotid baroreceptors or aortic arch baroreceptors?

A

Carotid baroreceptors

102
Q

The carotid chemoreceptors and carotid baroreceptors are both innervated by ____

A

the sinus nerve of hering

- branch of glossopharyngeal n. (IX CN)

103
Q

Biventricular pacing can be used for cardiac resynchronization in pts with NYHA class ___ or
Heart failure symptoms with an EF of ___,
and QRS of ___
to prevent sudden cardiac death.

A
  • Class III: Exercise is limited by dyspnea during modest exertion
    or
  • Class IV: Dyspnea at rest or with minimal exertion

EF: < 35%

QRS > 120 ms

104
Q

Placing a magnet over an ICD will ______

A

suspect arrhythmia detection but will leave intrinsic pacemaker function intact

105
Q

(True/False) LVADs are just as good as cardiac transplantation

A

true - at one year

- and complications are typically not life-threatening

106
Q

Status 1 (most urgent) need for cardiac transplant (3)

A
  1. VA ECMO < 7 days
  2. Non-dischargeable BiVAD
  3. Mechanical Cardiac Support Device (MCSD) with ongoing life threatening ventricular arrythmia
  • Will die without transplant
107
Q

Status 2 pts (second most urgent) need for cardiac transplant (4)

A
  1. RVAD, Total artificial heart, or VAD in pts with single ventricle physiology
  2. Non-dischargeable implanted LVAD (complicated)
  3. Mechanical Cardiac Support Device (MCSD) < 14 days
  4. Intermitted Vtach or V fib
  • Unable to be discharged from hospital w/ current lvl of circulatory support they require
108
Q

Most common indication for retrograde cardioplegia is ____

A

aortic valve insufficiency

109
Q

The cardioplegia solution is _________

A

a cold, potassium rich solution that decreases myocardial oxygen consumption by 97%

  • anterograde flow stops at coronary restriction and doesn’t cover all of the myocardium, and risk ischemia
  • retrograde flow can cover the other side
110
Q

Minimally invasive mitral valve repair would require one- lung ventilation of (Right/Left) lung

A

Left lung ventilation

- R lung is deflated via either bronchial blocker or DL ET

111
Q

In 85%of pts, the atrioventricular nodal branch of the coronary arterial system is supplied by the _____, which is represented in the EKG leads ______

A

RCA (R dominant coronary circulation)

II, III, aVF
- inferior leads

112
Q

On EKG, Lead aVR is used to detect ______ ischemia

A

R ventricular outflow tract

113
Q

What three drugs are utilized when considering antifibrinolytic therapies for CPB?

A
  1. Aminocaproic acid (ACA)
  2. Tranexamic acid (TXA)
  3. Protease inhibitor aprotinin
    - used to inhibit activation of plasminogen to plasmin
114
Q

Are antifibrinolytic therapies for CPB associated with improved mortality?

A

No.

- It decreases bleeding and blood product transfusions

115
Q

(MEPs/SSEPs) are the best for detecting spinal cord ischemia in aortic surgery

A

MEPs

116
Q

Spinal cord perfusion equation

A

SCPP = MAP - ICP

*by using spinal drain to remove CSF and lowering ICP, spinal cord perfusion increases

117
Q

In aortic stenosis, why do pts benefit from higher SVR and low HR?

A

Slow HR allows for longer diastolic filling times ->
adequate filling/perfusion in thickened LV

Higher SVR (counter intuitive), but stenotic aortic valve provides much greater resistance to LV outflow than any physiologic SVR that can be generated.
- Inc in SVR -> only increases coronary perfusion
118
Q

In aortic insufficiency and mitral regurgitation, why do pts benefit from lower SVR and higher HR?

A

Low SVR and Higher HR: less time in diastole -> promote forward flow out of LV outflow tract instead of back through regurgitant LV

119
Q

In mitral stenosis, why do pts benefit from lower HR and lower PVR (pulmonary vascular resistance)?

A

Slow HR allows for longer diastolic filling times ->
(support RV and ensure adequate LV preload)

Most pts with clinically sig MS, have pulmonary HTN. Need Low PVR (support RV and ensure adequate LV preload)

120
Q

Pt has QT prolongation, what is the treatment?

A

IV magnesium

121
Q

What is considered prolonged QT?

A

440-470 ms

122
Q

Cardiac resynchronization therapy (CRT) is indicated if ALL of the following are present: (5)

A
  1. Sinus rhythm
  2. EF < 35%
  3. NYHA class II-IV
  4. QRS > 150
  5. LBBB
123
Q

Aortic valve closure occurs ____ wave on CVP, and ____ wave on ECG

A

just before the v-wave

just after the T-wave

124
Q

Mitral valve closure occurs ____ on CVP, and ____ on ECG

A

after the a-wave

during the QRS complex

125
Q

Mitral valve opening ____ on CVP, and ____ on ECG

A

occurs after the v wave

after the T-wave

126
Q

Aortic valve opening occurs ____ wave on CVP, and just after the ____ wave on ECG

A

after the c-wave

QRS complex

127
Q

An S4 sound is heard during _____, and is caused by the ____. It is generally seen with diastolic dysfunction and LVH

A

atrial contraction

vibration of the ventricular wall during this phase

128
Q

Second most common EKG change

A

Prolonged QRS complex

129
Q

Why does hyperkalemia result in prolonged PR intervals and widened QRS complexes?

A

Potassium is critical in maintaining precise cardiac myocyte resting potential

Hyperkalemia will depress conduction of electrical signals btwn myocytes
- *but initially accelerates repolarization - peaked t waves

Anesthesia 101 (38 decks)

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