PVD, Pericardial, HF Flashcards
Causes of pericardial inflammation
Infection (viral, bacterial, fungal, TB), MI (dressler’s syndrome), trauma/cardiology, metastatic disease, drugs, mediastinal radiation, systemic disease, RA, SLE, scleroderma
Acute pericarditis dx
Onset severe CP w insp especially. Diffuse ST seg elev, PR seg dec, T wave inversion. Pericardial friction rub
Tx acute pericarditis
In absence of what doesnt alter function
Salicylate/NSAIDS, analgesics, steroids.
Effusion
Most effective method to detect effusion
Echo- presence and size
Cardiac tamponade: exists when what. Filling related to what
Inc in pericardial pressure impairs diastolic filling. Filling r/t diastolic transmural pressure across each chamber
In tamponade what reduces filling
Any increase in pericardial pressure r/t pressure within chamber
S/s tamponade
Inc CVP, pulsus paradoxus, equalization of cv filling pressures, low BP/CO/SV/ecg voltage, SNS activ, tachypnea, Jvd, muffled heart sounds
Tamponade tx
Pericardiocentesis, subxiphoid pericardiostomy, thoracic pericardiostomy (open or thoroscopic)
Tamponade- anesthesia management
Volume, inc contractility, correct metabolic acidosis. Local or ketamine
What causes constrictive pericarditis
Idiopathic, previous cv surgery, exposure to radiotherapy, TB
Constrictive pericarditis s/s
CVP, RAP, PCWP high, CO low, tired, atrial dysrhythmias, edema, ascites, hepatomegaly, pulsus paradoxus, JVD
Constrictive pericarditis tx
Surgical stripping and removal of pericardium
Constrictive pericarditis anesthesia management
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.
PVD: ABI less than what
0.9. Ration SBP to DBP in ankle vs brachial artery
What causes PVD
Atherosclerosis most often, arterial embolism, vasculitis
Atherosclerosis RF: 9
DM, age, male, obese/sedentary, essential htn, smoking, dyslipidemia, family hx
Atherosclerosis: most common symptom
Intermittent claudication, angina of legs. Pain starts w exercise and stops w rest
Atherosclerosis: most severe symptom
Critical limb ischemia. Rest pain. Lack of 02 at rest, assoc w non healing ulcers and gangrene
Atherosclerosis: ABI normal, claudication, rest pain, ischemic ulcer or impending gangrene
.95.
Atherosclerosis: overall dx tests
Doppler, aBI, ultrasound duplex, transcutaneous oximetry, MRI, contract angio
Atherosclerosis: transcutaneous oximetry normal vs abn
Normal 60 mmHg, <40 in pt w skin ischemia
Peripheral revascularization surgery steps
Arteries exposed, tunnel created, graft passed. IV heparin given, anastomoses made, arteriogram to confirm flow. Heparin likely not reversed
PVD anesthesia: risk
Atherosclerosis, esp in ischemic HD. PVD 3-5x greater risk MI/stroke/death.
Anesthesia PVD: which skill most important
Monitoring hemodynamics and responding quickly more imp than specific agent used
Peripheral revasc: pts commonly have what. Anesthesia consid
CAD, DM, HTN. Pts take BB/meds preop, A line, CVP/CO/foley, estimated BL, estimated 3rd space
Benefits of regional in PV procedures
Inc graft blood flow, less inc SVR w cross clamp, postop pain relief, less activ of coag system
PVD surg: assess for, which regional may be best, no diff in what, sig diff in what
Coagulopathy. Spinal- avoid hematoma. No diff in RA vs GA for cardiopulm complic, big diff in graft occlusion rate
Anesthesia management PVD
Co-morbidities (CAD, htn), med hx impact on anesthesia, end organ perfusion/02 maintain, blood gas (lyte, ph), cross clamp- time, heparin admin, reversal
Adaptive responses to heart failure
SNS, alt hr/afterload, humoral mediated. When they become maladaptive leads to remodeling
In HF SNS response: arteriolar constriction does what, venous constriction does what
Arteriolar- maintains BP despite CO decrease. Redirects BF to coronaries and cerebral. Venous- inc preload
HF adaptive responses that increase CO
Inc contraction velocity, reduce afterload, increase HR
IN HF what release of ANP and BNP do
Promote BP control/protect from vol and pressure overload. Diuresis, natiuresis, vasodilation, anti inflammatory, inhibit RAS/SNS/remodeling
HF meds/devices: 11
ACEi/Ang II blockers, aldosterone antag, diuretics, dig, inotropes, BB, vasodilator, biventricular pacing, natrecor, assist devices
Anesthesia management HF 4 main
Overall prevent and avoid myocardial depression. HR- normal- elev. preload- normal-high. Afterload- low. Increase contractility
HF anesthesia: hypotension tx w 3, GA doses may be ___, do what to decrease pulm congestion
Ephedrine, phenylephrine, vaso. Decreased. PPV.
HF anesthesia: regional ___, avoid __ __
Ok, fluid overload
Hypertrophic CM: __ __ __ obstruction from __ __ hypertrophy. __ dysfunction. __ ischemia and __
LV outflow tract, asymmetric septal. Diastolic. Myocardial, dysrhythmias
Things that increase outflow obstruction in hypertrophic CM: 10
Inc contractility, B adrenergic stim, dig, dec preload, low volume, dilators, tachycardia, PPV, dec afterload, hypotension
What decreases outflow obstruction in hypertrophic cardiomyopathy: 10
Dec contractility, b adrenergic blockage, VA, CCB, inc preload/volume overload, bradycardia, inc afterload, hypertension, a adrenergic stim
Anesthesia management hypertrophic cardiomyopathy:
Mild contractility depression, VA good, tx hypotension w phenylephrine and volume. NO Bb. Prompt replacement of blood/fluid. Avoid dilators and maintain NSR.
Dilated CM: anesthesia goals
Prevent myocardial depression. HR norm to high. Preload norm to high. Low afterload. Increase contractility
Cor pulmonale: caused ny what
RV enlarge w/hypertrophy +/- dilation leading to RHF. Caused by pulm htn and chronic alveolar hypoxia
Cor pulmonale management
Elim infection, reverse bronchospasm, improve expectoration, maintain good 02/hydration/lung mechanics, correct lyte imbalance
Cor pulmonale: biggest thing to maintain. Avoid what 2 things. Give what preop
Oxygenation. Histamine releasors and high level block w regional. Give bronchodilators
