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Anes& Coex > PVD, Pericardial, HF > Flashcards

PVD, Pericardial, HF Flashcards

1
Q

Causes of pericardial inflammation

A

Infection (viral, bacterial, fungal, TB), MI (dressler’s syndrome), trauma/cardiology, metastatic disease, drugs, mediastinal radiation, systemic disease, RA, SLE, scleroderma

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2
Q

Acute pericarditis dx

A

Onset severe CP w insp especially. Diffuse ST seg elev, PR seg dec, T wave inversion. Pericardial friction rub

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3
Q

Tx acute pericarditis

In absence of what doesnt alter function

A

Salicylate/NSAIDS, analgesics, steroids.

Effusion

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4
Q

Most effective method to detect effusion

A

Echo- presence and size

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5
Q

Cardiac tamponade: exists when what. Filling related to what

A

Inc in pericardial pressure impairs diastolic filling. Filling r/t diastolic transmural pressure across each chamber

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6
Q

In tamponade what reduces filling

A

Any increase in pericardial pressure r/t pressure within chamber

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7
Q

S/s tamponade

A

Inc CVP, pulsus paradoxus, equalization of cv filling pressures, low BP/CO/SV/ecg voltage, SNS activ, tachypnea, Jvd, muffled heart sounds

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8
Q

Tamponade tx

A

Pericardiocentesis, subxiphoid pericardiostomy, thoracic pericardiostomy (open or thoroscopic)

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9
Q

Tamponade- anesthesia management

A

Volume, inc contractility, correct metabolic acidosis. Local or ketamine

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10
Q

What causes constrictive pericarditis

A

Idiopathic, previous cv surgery, exposure to radiotherapy, TB

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11
Q

Constrictive pericarditis s/s

A

CVP, RAP, PCWP high, CO low, tired, atrial dysrhythmias, edema, ascites, hepatomegaly, pulsus paradoxus, JVD

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12
Q

Constrictive pericarditis tx

A

Surgical stripping and removal of pericardium

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13
Q

Constrictive pericarditis anesthesia management

A

Minimize changes to HR/SVR/preload/contractility (ketamine, etomidate, panc). Avoid Brady. Maintain volume to avoid low BP (IV and a line). Blood transfusions, a lot of intraop blood loss.

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14
Q

PVD: ABI less than what

A

0.9. Ration SBP to DBP in ankle vs brachial artery

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15
Q

What causes PVD

A

Atherosclerosis most often, arterial embolism, vasculitis

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16
Q

Atherosclerosis RF: 9

A

DM, age, male, obese/sedentary, essential htn, smoking, dyslipidemia, family hx

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17
Q

Atherosclerosis: most common symptom

A

Intermittent claudication, angina of legs. Pain starts w exercise and stops w rest

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18
Q

Atherosclerosis: most severe symptom

A

Critical limb ischemia. Rest pain. Lack of 02 at rest, assoc w non healing ulcers and gangrene

19
Q

Atherosclerosis: ABI normal, claudication, rest pain, ischemic ulcer or impending gangrene

A

.95.

20
Q

Atherosclerosis: overall dx tests

A

Doppler, aBI, ultrasound duplex, transcutaneous oximetry, MRI, contract angio

21
Q

Atherosclerosis: transcutaneous oximetry normal vs abn

A

Normal 60 mmHg, <40 in pt w skin ischemia

22
Q

Peripheral revascularization surgery steps

A

Arteries exposed, tunnel created, graft passed. IV heparin given, anastomoses made, arteriogram to confirm flow. Heparin likely not reversed

23
Q

PVD anesthesia: risk

A

Atherosclerosis, esp in ischemic HD. PVD 3-5x greater risk MI/stroke/death.

24
Q

Anesthesia PVD: which skill most important

A

Monitoring hemodynamics and responding quickly more imp than specific agent used

25
Q

Peripheral revasc: pts commonly have what. Anesthesia consid

A

CAD, DM, HTN. Pts take BB/meds preop, A line, CVP/CO/foley, estimated BL, estimated 3rd space

26
Q

Benefits of regional in PV procedures

A

Inc graft blood flow, less inc SVR w cross clamp, postop pain relief, less activ of coag system

27
Q

PVD surg: assess for, which regional may be best, no diff in what, sig diff in what

A

Coagulopathy. Spinal- avoid hematoma. No diff in RA vs GA for cardiopulm complic, big diff in graft occlusion rate

28
Q

Anesthesia management PVD

A

Co-morbidities (CAD, htn), med hx impact on anesthesia, end organ perfusion/02 maintain, blood gas (lyte, ph), cross clamp- time, heparin admin, reversal

29
Q

Adaptive responses to heart failure

A

SNS, alt hr/afterload, humoral mediated. When they become maladaptive leads to remodeling

30
Q

In HF SNS response: arteriolar constriction does what, venous constriction does what

A

Arteriolar- maintains BP despite CO decrease. Redirects BF to coronaries and cerebral. Venous- inc preload

31
Q

HF adaptive responses that increase CO

A

Inc contraction velocity, reduce afterload, increase HR

32
Q

IN HF what release of ANP and BNP do

A

Promote BP control/protect from vol and pressure overload. Diuresis, natiuresis, vasodilation, anti inflammatory, inhibit RAS/SNS/remodeling

33
Q

HF meds/devices: 11

A

ACEi/Ang II blockers, aldosterone antag, diuretics, dig, inotropes, BB, vasodilator, biventricular pacing, natrecor, assist devices

34
Q

Anesthesia management HF 4 main

A

Overall prevent and avoid myocardial depression. HR- normal- elev. preload- normal-high. Afterload- low. Increase contractility

35
Q

HF anesthesia: hypotension tx w 3, GA doses may be ___, do what to decrease pulm congestion

A

Ephedrine, phenylephrine, vaso. Decreased. PPV.

36
Q

HF anesthesia: regional ___, avoid __ __

A

Ok, fluid overload

37
Q

Hypertrophic CM: __ __ __ obstruction from __ __ hypertrophy. __ dysfunction. __ ischemia and __

A

LV outflow tract, asymmetric septal. Diastolic. Myocardial, dysrhythmias

38
Q

Things that increase outflow obstruction in hypertrophic CM: 10

A

Inc contractility, B adrenergic stim, dig, dec preload, low volume, dilators, tachycardia, PPV, dec afterload, hypotension

39
Q

What decreases outflow obstruction in hypertrophic cardiomyopathy: 10

A

Dec contractility, b adrenergic blockage, VA, CCB, inc preload/volume overload, bradycardia, inc afterload, hypertension, a adrenergic stim

40
Q

Anesthesia management hypertrophic cardiomyopathy:

A

Mild contractility depression, VA good, tx hypotension w phenylephrine and volume. NO Bb. Prompt replacement of blood/fluid. Avoid dilators and maintain NSR.

41
Q

Dilated CM: anesthesia goals

A

Prevent myocardial depression. HR norm to high. Preload norm to high. Low afterload. Increase contractility

42
Q

Cor pulmonale: caused ny what

A

RV enlarge w/hypertrophy +/- dilation leading to RHF. Caused by pulm htn and chronic alveolar hypoxia

43
Q

Cor pulmonale management

A

Elim infection, reverse bronchospasm, improve expectoration, maintain good 02/hydration/lung mechanics, correct lyte imbalance

44
Q

Cor pulmonale: biggest thing to maintain. Avoid what 2 things. Give what preop

A

Oxygenation. Histamine releasors and high level block w regional. Give bronchodilators

Anes& Coex (15 decks)

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