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Cardiology - Dr Constable > Quiz 4 Anesthesia for Off Pump Coronary > Flashcards

Quiz 4 Anesthesia for Off Pump Coronary Flashcards

1
Q

What are the four cardiac function and metabolism concerns?

A
  • Coronary Anatomy
  • Utilization of O2
  • Supply of O2 and nutrients
  • Demand of O2 and nutrients
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2
Q

How much oxygen does the heart extract?

A

65 - 75 %

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3
Q

T/F: The brain extracts more oxygen than any other organ of the body?

A

FALSE (Heart extracts the most O2)

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4
Q

What does VO2 mean?

A

Oxygen consumption

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5
Q

What does MVO2 mean?

A

Myocardial oxygen consumption

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6
Q

What does SVO2 mean?

A

Venous Oxygen saturation (mixed venous oxygen)

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7
Q

Using a Frank Starling Curve what would you expect to see in a normal during exercise?

A

The curve shifting up and to the left.

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8
Q

Using a Frank Starling Curve what would you expect to see in a normal heart that is in a state of heart failure?

A

The curve shifting down and to the right.

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9
Q

What is the most sensitive cardiac function test?

A

TEE

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10
Q

What is the benefit of doing a MIDCAB?

A

-Thoracotomy approach (NO incision through the sternum)

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11
Q

What vessels are involved in a MIDCAB?

A

-LIMA to LAD

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12
Q

What contributes the most to cardiac O2 demand?

A

-Heart Rate (MOST)

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13
Q

What are three things to look at for anesthetic concerns for cardiac surgery?

A
  • Culprit lesion
  • Collateral Circulation
  • Ventricular function
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14
Q

Which has more O2 extraction the SVC or the IVC?

A

-SVC

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15
Q

What are a few things that affect mixed venous oxygen?

A
  • Anemia
  • FiO2
  • PEEP
  • Temperature
  • CO
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16
Q

What are the two main coronary arteries?

A
  • Left Main Coronary Arteries

- Right Coronary Artery

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17
Q

What arteries branches off the Left Main Coronary Artery?

A
  • Left Anterior Descending (LAD)

- Circumflex

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18
Q

The Circumflex perfuses the SA node in ___% of people

A

40

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19
Q

The circumflex branches into the ______ marginal and supplies the _________ free wall.

A

Obtuse, lateral

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20
Q

The ______ marginals supplies the anterior wall of the _______ ventricle.

A

Acute, right

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21
Q

The right coronary artery perfuses the S.A. node in __% and the AV node in __%

A

60 %, 80 - 90%

22
Q

What is the percent of people that have a Posterior descending artery perfused by the RCA or referred to as the “________________”.

A

85 % , right dominate system

23
Q

What is the equation to determine the O2 content of the blood?

A

CaO2 = 1.31 x Hgb x SaO2 + (0.003 x PaO2)

24
Q

What are the goals to get the maximal O2 content?

A
  • High hemoglobin
  • Highly saturated blood
  • High PO2
25
Q

What shift would you see on the oxyhemoglobin curve if the patient had warm temperature, normal pH, and high levels of 2,3 -DPG which favors release of oxygen.

A

RIGHT shift

26
Q

Coronary Blood Flow varies __________ with coronary perfusion pressure.

A

directly

27
Q

Coronary blood flow varies ________with coronary resistance

A

indirectly

28
Q

Coronary vascular resistance will _______, if there is an increase in O2 and a decrease in CO2 and H+.

A

Increase

29
Q

Coronary vascular resistance will _______, if there is and increase in CO2 and H+ and a decrease in O2.

A

Decrease

30
Q

T/F: Adenosine (from ATP breakdown) is probably the MOST important metabolic blood flow regulator.

A

TRUE

31
Q

What will adenosine cause to the coronary vascular resistance?

A
  • Dilate

- Increase blood flow

32
Q

What will an increase in Alpha adrenergic (Norepi) tone and cholinergic (ACH) do to the coronary vascular resistance?

A

Increase

33
Q

What will a increase in the beta-adrenergic tone do to the coronary vascular resistance?

A

Decrease

34
Q

What will and increase in vasopressin, angiotensin, and throomboxane do the the coronary vascular resistance?

A

INCREASE

35
Q

What will an increase in prostacyclin do to the coronary vascular resistance?

A

Decrease

36
Q

What will happen to the coronary vascular resistance when the blood viscosity increases and hyporthermia decrease.

A

INCREASE

37
Q

What is the most at risk layer of tissue in the heart for ischemia?

A

Subendocardium

38
Q

What will stenosis of the coronaries do to blood flow?

A

Increase in CVR

Decrease in CBF

39
Q

T/F: Dynamic stenoses is a atherosclerotic plaque.

A

FALSE (Fixed stenoses is and atherosclerotic plaque.)

40
Q

What is Dynamic stenoses?

A

When the coronary artery goes into vasospasm or Prinzmetal’s variant angina

41
Q

What determines myocardial O2 demand?

A
  • Heart Rate
  • Contractility
  • Wall Stress
42
Q

What three things determine wall stress?

A
  • Afterload
  • Preload
  • Wall Thickness
43
Q

ST segment depression denotes ___________ ischemia.

A

endocardial

44
Q

ST segment elevation denotes ________ ischemia.

A

transmural

45
Q

T/F: Milrinone is the most potent smooth muscle vasodilator and is an inotrope.

A

TRUE

46
Q

How is significant changes determined on an EKG?

A

0.1 mV or 1 mm of ST segment elevation or depression at normal gain

47
Q

What is your ACT goal for off-pump vs on-pump?

A

Off-pump > 300

On-pump > 450-600

48
Q

When giving Protamine at the end of a cardiac case, should you give a “test dose”?

A

Yes - Give 10mg test dose. Pt’s can have allergic reaction

49
Q

How fast should you give Protamine?

A

SLOW. Protamine can cause hypotension and cardiopulmonary collapse.

50
Q

Should you give Protamine while the pt is still on the CPB?

A

No, can cause the machine to clot

51
Q

What is the formula for Cardiac Perfusion Pressure?

A

CPP = AoDBP - LVEDP

Aortic pressure during diastole minus the back pressure in the LV

Cardiology - Dr Constable (9 decks)

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