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CV > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Kuassmaul’s sign

A

distention of jugular vein during inspiration (intrathoracic psi increase) present in constrictive pericardiits

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2
Q

pulsus paradoxus

A

pulsus paradoxus when the SBP changes >10mm during inspiration. common in acute tamponade.

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3
Q

dobutamine class

A

a selective beta 1 agonist
causes greater vasodilation of the pulmonary and systemic vasculature. predominantly affects HR compared to SV
ionotropic
used in acute heart failure to increase CO

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4
Q

epi gtt low dose < ___ -___ ng/kg/min for beta effects only

A

at low doses it’s a beta agonist <10-30 nanogram/kg/min . alpha observed after this

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5
Q

isoproterenol is used in what patient population?

A

used primarily in previous cardiac transpolant pts

It is also used in 3rd degree BBB

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6
Q

flecainide is used to treat what condition?

A

effective for treating WPW pts

1C sodium channel blocker

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7
Q

tissues that are Ca2+ dependent

A

pacemaker cells

AV node. affected the most by this class

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8
Q

how to thrombolytics act?

A

they initiate plaminogen’s conversion to plasmin. plasmin causes degradation of thrombin.

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9
Q

what are platelets activated by?

A

von Willebrand factor

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10
Q

desmopressin is a V2 receptor agonist. what does it do?

A

increases vWf and factor VIII.

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11
Q

aminocaproic acid and tranexemic acid are antiplamin agents that…

A

inhibit fibrinolysis by inhibiting plasminogen activation

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12
Q

resistant HTN

A

when PT taking 3-4 antihypertensives of different classes.

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13
Q

refractory HTN

A

when PT taking 5 or moreantihypertensives of different classes. (0.5% of HTN pts…time to r/o 2ndary causes)

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14
Q

10kg of weight loss decreases SBP and DBP by

A

SBP- 6 mmHg

DBP- 4.6 mmHg

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15
Q

epi boluses for hypotension

A

10mcg (double dilution)

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16
Q

LCA divides into the

A

LAD and circumflex arteries

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17
Q

LAD divides into the

A

diagonal branches

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18
Q

circumflex artery gives rise to the

A

obtuse marginal arteries

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19
Q

where is the coronary sinus?

A

it is the venous drainage of the heart and is located at the right atrium bw inferior vena cava and tricuspid valve

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20
Q

unstable angina defn.

A

at rest, new onset, or increasing severity or frequency from previous stable angina

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21
Q

etiology of CAD

A

endothelial damage w cholesterol deposition, LDL formation, and macrophage infiltration

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22
Q

NSTEMI comes from…

A

coronary plaque rupture, vasoconstriction, luminal narrowing, inflammation or excessive O2 demand. Only 50% of NSTEMI patient have significant ECG findings.

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23
Q

___-___ days post MI, when is the tissue very soft, increasing the risk of rupture and aneurysm formation

A

4-7 days

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24
Q

how long does it take to heal after MI to heal and leave behind a fibrous, noncontracting region of thin wall myocardium? ventricular remodeling continues after this time.

A

3 months

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25
Q

coronary artery perfusion psi =

A

diastolic (aortic) - LVEDP

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26
Q

time to wait for elective surgery: angioplasty w/o stenting

A

2-4 weeks

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27
Q

time to wait for elective surgery: bare metal stent placement

A

at least 30 days

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28
Q

time to wait for elective surgery: CABG

A

at least 6 weeks

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29
Q

time to wait for elective surgery: DES stent placement

A

at least 12 months

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30
Q

early stent thrombus occurs

A

within 24 hours

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31
Q

late stent stenosis occurs

A

30days -1 yr and is usually from malposition or neointimal growth .

32
Q

things beta blockers do

A

reduce O2 consumption in heart tissue, improve CA blood flow, improve supply/demand ratio, stabilize myocardial membranes, and inhibit platelet aggregation.

33
Q

HAD2SUE

the prebypass checklist

A

heparin, ACT, Drugs(NMB, amnestic), drips(turned off), Swan pulled back, urine accounted for pre, during and after bypass, and emboli check (deairing the cannula inserted into the patient) .

Heparin is given at 300-400 units/kg body weight prior to blood being sent into the
circuit. THE PATIENT MUST BE ANTICOAGULATED.

Confirm with ACT 3-5 minutes after
anticoagulation. ACT must be >400 (or 450).

34
Q

what should SBP be before cannulation

A

90-100 or MAP< 70….or else aorta dissects.

35
Q

CPB flow is __-___ ml/kg/min with a psi of __-__ mmHg.

A

50-60 mL/kg/min

50-70mm Hg

36
Q

coming off pump….Wide Receive Most Valuable Player(mneumonic)

A 
Warm: is the patient and heart warm?
Rhythm-NSR or do we need to pace?
Monitors-turn them back on
Ventilation-turn on the ventilator
Perfusion-what is the pump flow?
37
Q

cardioplegia can be given antegrade through_______ or retrograde through_________

A

cardioplegia can be given antegrade through the coronary arteries or retrograde through_ the coronary sinus and cardiac veins

38
Q

type I brain injury outcomes in cardiac surgery

A

death, stroke, coma, and TIA

39
Q

type 2 brain injury outcomes in cardiac surgery

A

cognitive deterioration

40
Q

what is sandblasting?

A

when the cannulae punctures the aorta where a large arthroma exists, emboli are created a

41
Q

how are stenotic valves treated medically?

A

by suppressing heart rate to prolong diastole

42
Q

how are regurgitant valves treated?

A

by reducing afterload to reduce the regurgitant fraction.

43
Q

bioprosthetic valves are

A

porcine, bovine hererografts or human homografts

44
Q

how long do mechanical valves last?

A

20-30 years but form clots and therefore require lifelong anticoagulation.

45
Q

bioprosthetic valves last how long?

A

tissue valves last 10-15 years and do not require anticoagulation and as such are typically reserved for the elderly.

46
Q

what valve disorder is from rheumatic heart fever?

A

mitral stenosis…it is very rare and more common in developing countries. F>M. takes 20-30 yrs for the process to become symptomatic following rheumatic fever

47
Q

what increases PVR?

A

N2O
hypercarbia
hypoxemia
trendelenberg position

48
Q

what is the most common cause of mitral regurg?

A

IHD
structural if the issue is from the leaflets or chordae
functional if coming from VL stretching

49
Q

volumes of ____ or more are severe MR

A

60%

survival is better if surgery is undertaken when EF is >60%

50
Q

the goals of anesthesia in patients with MVR

A 
FAST, FULL, FORWARD!!!!!!!!!
prevent bradycardia
prevent increases in SVR
minimize cardiac depression
monitor the regurgitant volume.
51
Q

what is mitral valve prolapse?

A

it is when 1 or both of the mitral leaflets prolapse into the LA during LV systole. it is a midsystolic click and late systolic murmur. and the most common valvular disorder

52
Q

What is a normal ACT?

A

80-120 seconds

53
Q

the CPB circuit can absorb up to 90% of what drug circulating during bypass?

A

NTG

54
Q

RBCs are concentrated into a cellsaver bag

(platelets and coagulation factors are removed) with a HCT of ___-___%

A

55-70%!

55
Q

If MR is present, what MAC is associated with reductions in regurg fractions

A

0.5 MAC

56
Q

Classic critical AS symptoms are…..

A

angina, syncope, DOE, and CHF symptoms with a less than 5 yr life expectancy

57
Q

normal AV area is 2.5-3.5cm2. What is critical?

A

Critical AS is

either 0.8 or 0.7cm2

58
Q

goals during aortic regurg/

A

fast, full, forward (hint: all regurges are this!!!!!)

Goal HR>80
fluid status at normal volumes

59
Q

TS is extremely rare and caused by…

A

RHD or carcinoid syndrome.

60
Q

Early afterdepolairzations (EAD) more commonly occur in where?

A

in Purkingje fibers. They are

enhanced by slow heart rate and are treated by speeding up the heart rate.

61
Q

what is a Stokes-Adams attack?

A

3rd degree AVB causes it. CHF, SOB, bradycardia. Isoproterenol to treat, pacers to definitively treat

62
Q

bainbridge reflex

A

when the intrathoracic psi increases, so does the HR with inspriation. Opposite, the heart rate slos as intrathoracic psi lowers.

63
Q

paroxysmal supraventricular tachycardia is a HR of 160-220 that begins and ends spontaneously. What is orthodromic and what is antidromic?

A

orthodromic if QRS is narrow.(more common)

antidromic if QRS is wide.

64
Q

asynchronous pacing is the simplest form of pacing. Modes are….

A

AOO, VOO, DOO, (meaning atria are paced with no sensing and not response, since there is no sensing)

65
Q

What are the pacing positions for I, II, III

A

pacing chamber, sensing chamber, response to sensing.

66
Q

Dressler syndrome

A

1-2 days post MI. thought to be an autoimmune response.

67
Q

pericardial effusion defn

A

more fluid is in the pericardial sac than normal

68
Q

pericardial tamponade defn

A

that fluid is under psi.

69
Q

Beck’s triad

A

muffled/distant heart sounds
increasing JVD
hypotension

70
Q

what is levosimendan

A

a calcium sensitizer, enhances endogenous calcium to increase contractility. no increase in O2 consumption. some dilation of systemic pulmonary and CA arteries.

71
Q

Nesiritide is a BNP analogue that works at the …

A

A and B-type receptors. inhibits RAAS, causes vasodilation and promotes diuresis. acts similarly to NGT w/o prounounced hypotension effects.

72
Q

IABP…when does the balloon inflate?

A

during diastole(as the R wave occurs, creating a vacuum effect that reduces afterload and enhances ventricular ejection.)

73
Q

which ECMO type is for respiratory pts?

A

venovenous

74
Q

how long from donor to recepient for a heart?

A

4 hours.

75
Q

what drugs are ineffective in a transplanted heart?

A

ephedrine, anticholinergic drugs or cholinesterase drugs.

Vasopressin may be needed to treat hypotension.

76
Q

agents that lower PVR

A

NO, isoproteronol, prostaglandins, of PDEI

CV (2 decks)

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