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GNURS627 Cardiac > Quiz 9 Coronary Circulation > Flashcards

Quiz 9 Coronary Circulation Flashcards

1
Q
  1. Know the major branches of the coronary arteries.
A

Left Main
-LAD
-Circumflex
Right Main

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2
Q
  1. What is the Ramus Intermedius? In what percentage of the population does it exist?
A

A trifurcation of the left main (37% of the population)

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3
Q
  1. Do the major epicardial arteries contribute significantly to coronary vascular resistance?
A

No, most resistance is at the Intramyocardial vessels (arterioles)

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4
Q
  1. What is capillary density? Is capillary density increased or decreased in the myocardium?
A

The # of capillaries per unit area

Increased

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5
Q
  1. What are the major determinants of myocardial oxygen demand?
A

HR
Contractility
Systolic Wall Tension

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6
Q
  1. What are the major determinants of myocardial oxygen supply?
A

O2 carrying capacity

Coronary Blood Flow

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7
Q
  1. Is resting oxygen consumption of the heart high or low relative to other organs in the body?
A

HIGH

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8
Q
  1. What is the formula for coronary perfusion pressure?
A

CPP= DBP - LVEDP (or PCWP)

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9
Q
  1. Is oxygen highly extracted from blood flowing through the heart?
A

Yes, the heart extracts O2 at a greater extent than any other organ

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10
Q
  1. What factors control coronary blood flow?
A 
Metabolic Control
Autoregulation
Endothelial Control of Vascular Tone
Extravascular Compressive Forces
Neural Control
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11
Q
  1. Does the majority of coronary blood flow occur during systole or diastole in the left ventricle? Why?
A

Diastole, Squeeze?

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12
Q
  1. Which layer of the myocardium is at greatest risk for ischemia?
A

Subendocardium (More wall tension & b/c it is deepest)

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13
Q
  1. What is coronary flow reserve?
A

Difference between baseline blood flow and maximal flow

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14
Q
  1. Which of the following places a greater oxygen cost on the heart? Pressure work versus volume work.
A

Pressure - Work

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15
Q
  1. How stenotic do coronary vessels have to be before there is a significant decrease in flow?
A

60-70% occlusion

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16
Q
  1. What is the final intracellular ion disturbance that leads to impaired myocardial contraction and cell death?
A

High levels of Calcium (Intracellularly)

17
Q
  1. What are the effects of myocardial ischemia on systolic function?
A

Minimal impairment to absence of movement (akinesis) to systolic lengthening & post systolic shortening (diskinesis)

18
Q
  1. What are the effects of myocardial ischemia on diastolic dysfunction?
A

LVEDP increases, relaxation is impaired & myocardial compliance decreases

19
Q
  1. What is myocardial stunning?
A

After a brief episode of severe ischemia, prolonged myocardial dysfunction with gradual return of contractile activity occurs

20
Q
  1. What is myocardial hibernation?
A

Presence of impaired resting LV function, owing to reduced CBF that can be restored toward normal by revascularization

21
Q
  1. What are some of the consequences of myocardial ischemia?
A

Systolic and Diastolic dysfunction, angina, CHF, Pulmonary Edema, Arrythmias, MI, Ventricular Rupture or VSD, Cardiogenic shock, Death

22
Q
  1. What are some of the drugs used for the treatment of ischemia?
A

O2, beta blockers, nitrates, antiplatelets/ anticoagulants, analgesics, calcium channel blockers

23
Q
  1. What are some of the interventions used in the treatment of ischemia?
A 
CABG
PCI
-coronary balloon angioplasty
-bare metal coronary stents
-drug eluting stents
24
Q
  1. How long should you wait before doing elective surgery on a patient who has had a drug-eluting stent inserted?
A

1 year is recommended

25
Q
  1. What are some of the drugs that are used to reduce cardiac ischemic events during surgery?
A 
Volatile anesthetics
Beta blockers
Statins
Alpha 2 agonists
Calcium Channel Blockers
26
Q
  1. Is isoflurane an appropriate anesthetic agent to use during cardiac surgery? Why or why not?
A

Yes, does not effect coronary steel syndrome

27
Q
  1. What are collateral blood vessels in the heart? How are they formed?
A

develop in response to impairment of coronary blood flow, they originate from pre-existing arterioles that undergo proliferative changes of the endocardium and smooth muscle

28
Q
  1. What is ischemic preconditioning in the heart?
A

a single or multiple brief periods of ischemia that can be protective against a subsequent prolonged ischemic insult

29
Q
  1. What is anesthetic preconditioning in the heart?
A

The use of anesthetic agents to have effects that mimic Ischemic preconditioning
K ATP channels play an important role

GNURS627 Cardiac (5 decks)

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