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SEE NCE Boards CoreConcepts > SEE BASIC SCIENCES : A & P Review > Flashcards

SEE BASIC SCIENCES : A & P Review Flashcards

1
Q

Carotid sinus located where

A

internal carotid artery

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2
Q

Why is the carotid sinus important?

A

They have receptors that are responsible to normal BP to the brain

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3
Q

PEA causing factors include H & Ts

A 
Hypoxia
H+ (acidosi) 
Hyperkalemia
Hypovolemia
Hypothermia
PE
Tension Pneumothorax 
Tamponade
Toxins
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4
Q

Can PEA be treated with defibrillation

A

NO

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5
Q

Treatment options for PEA

A

Epi 1mg 3-5 minss

Vasopression 40 units IV

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6
Q

Drugs that can be give through ETT tube with people with no IV access? (LANE) or NEAL

A

Lidocaine
ATropine
Narcan
Epinephrine

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7
Q

Maximum delivery for monophasic defibrillation?

A

360 J

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8
Q

Adenosine given paroxysmal SVT, what may occur with admin of that drug?

A

Bradycardia with brief asystole

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9
Q

How does Adenosine work?

A

Slow the electrical conduction of signals through the AV node to afford a reset of heart rhythm to a normal rhythm

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10
Q

What is the best description of a 2nd degree HB type II (Morbitz II)

A

A constant and set PR interval, the ventricular is slower than the atrial rate.

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11
Q

In HB type 2 Mobitz type II , P-R interval is______but what about the P wave?

A

constant; not every P wave is followed by a QRS complex. , atrial rate is greater than ventricular rate.

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12
Q

3 tx options for 2nd degree HB

A

Isoproterenol
Dopamine
Trascutaneous pacemaker
Epi 2-10 mcg/min

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13
Q

What is the goal of treatment for a patient with Mobitz type II?

A

Increasing the HR, as needed to achieve adequate cardiac output

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14
Q

In 2nd degree type I (wenckebach) , where is the pathology ?

A

AV node

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15
Q

What describe 2nd degree type I?

A

Progressing lengthening or increase in P-R interval until a QRS is lost due to lack of impulse conduction through the AV node.

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16
Q

Torsades is a disturbance of the _____Phase of the cardiac cycle and is associated with ______QT

A

repolarization ; prolonged

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17
Q

Vfib , no pulse , no respiration, 1st action?

A

Defibrillate

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18
Q

How do you know when the pacemaker is not capturing?

A

Pacemaker is not followed by QRS and occur randomly .

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19
Q

What is the THRESHOLD potential?

A

Potential to which a membrane must be depolarized to initiate an action potential.

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20
Q

Cardiac membrane depolarization occurs at what phase?

A

phase 0

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21
Q

Threshold potential is achieved to produce an

A

action potential represented by the QRS complex.

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22
Q

In what phase of the cardiac action potential has a reduction in Na+ permeability , a transient outword K curent and an outward Cl- current?

A

Phase 1

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23
Q

Outflow of which ion that inactivates the fast Na+ channels?

A

K+ and Cl-

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24
Q

What is the mechanism of tachydysrhythmias?

A

Increased automaticity in normal conduction tissue or in ectopic focus rather than the SA node

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25
Q

Parasympathetic NS stimulation results in which of the following?

A

A decrease in the SLOPE of PHASE 4 depolarization resulting in a slower HR

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26
Q

Which of the following is true regarding dysrhythmias 2nd to an ectopic focus? (onset)

A

they have a gradual onset. It insidiously take over the normal generation of the cardiac cycle.

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27
Q

Which of the following are true about re-entrant dysrhythmias ?

A

They occur along embryological remnants of tissue around the AV node.

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28
Q

What is the most common of premature beats as well as tachydysrythmias, originate secondary to

A

re-entry pathways of electrical stimuli in the myocardium

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29
Q

In normal pacemaker sites within the heart, the conductime through the _____is the slowest in the heart?

A

Purkinje fibers

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30
Q

SA node is directly innervated by the

A

Vagus nerve

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31
Q

SA node stimulation rate

A

60-100

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32
Q

AV node stimulation rate

A

40-60

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33
Q

Purkinje stimulation rate

A

20-40

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34
Q

Variation of the HR in response to changes in intrathoracic pressure during inspiration and expiration is due to which of the following?

A

Bainbridge reflex

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35
Q

Bainbridge reflex aka

A

Atrial reflex

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36
Q

What is the Bainbridge (Atria) reflex?

A

Its a reflex that is triggered by input from atrial stretch receptors resulting in a compensatory increase in HR.

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37
Q

What is the most common supraventricular dysrhythmias associated with acute MI?

A

Sinus Tachycardia

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38
Q

What is GU symptoms associated with SVT?

A

Polyuria

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39
Q

What is the mechanism of Polyuria with SVT?

A

Increase in the secretion of ANP in response to increase atrial pressure from contraction of the atria against closed AV valves.

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40
Q

Most common post operative tachydysrythmias after cardiac surgery?

A

Atrial fibrillation

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41
Q

Independent risk factors for afib after cardiac surgery?

A

DM
Valvular disease
CHF
Age, (elderly)

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42
Q

When giving anesthesia to a patient with a known hx of WPW , anesthesia provider should do the following? Avoid what medications

A

Avoid Digoxin, and CCB

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43
Q

When giving anesthesia to a patient with a known hx of WPW , anesthesia provider should do the following? Avoid what ?

A

Stimulation of SNS is avoided

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44
Q

When giving anesthesia to a patient with a known hx of WPW , anesthesia provider should do the following? What do you do with fluids?

A

Limit IV fluids because Atrial-ventricular dyssynchrony may cause acute fluid overload.

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45
Q

Wolff Parkisons white syndrome is characterized by inappriate

A

ANTEROGRADE conduction of cardiac impulses via an accessory pathway.

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46
Q

With WPW , anesthetist should avoid to

A

Enhanced aberrant conduction

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47
Q

Consideration for asthma patient with long QT syndromes

A

PREOP incremental loading dose of METOPROLOL 5mg IVP

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48
Q

Possible mechanisms of asystole during spinal and epidural anesthesia include which of the following.

A

The BEZOLD-JArisch response

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49
Q

The Bezold Jarisch reflex , results from

A

initiation of vagal reflex arcs by the decrease venous return associated with spinal or epidural to result in a REFLEX- induced bradycardia.

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50
Q

Profound bradycardia and cardiac arrest during neuraxial anesthesia is

A

Less common than cardiac arrest during GA

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51
Q

Characteristics of BBB: –> RBBB

A

rSR’ QRS complex in leads V1-V2

Deep S wave in I and V6

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52
Q

Does RBBB always imply cardiac disease?

A

No

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53
Q

Which is more common in patient without structural HD?

RBBB vs LBBB

A

RBBB

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54
Q

Characteristics of BBB: –> LBBB

A

Absence Q wave in I and V6

ST and T waves changes are already present (repolarization abnormality)

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55
Q

PA contraindicated in patients with

A

LBBB; may lead to RBBB

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56
Q

SVT combined with this BBB can be mistaken for ____

A

Left BBB; VTACH

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57
Q

Single MOST important factor that increases survical in patient with VFib

A

Defibrillaiton within 3-5 minutes of onset

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58
Q

Atrial systole (atrial kick) accounts for ______% of CA

A

20-30%

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59
Q

Maximization of CO occurs as the result of

A

Atrial contraction

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60
Q

Where is the Effective Refractory period?

A

Period that extends from the QRS complex to near the top of the T wave.

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61
Q

What is the Effective Refractory period?

A

Period of time when no contraction will occur no matter how strong the stimulus.

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62
Q

what is the relative refractory period?

A

Late stage of repolarization during which a second action potential may be generated by a sufficiently large stimulus.

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63
Q

In a normal distribution of blood volume, where does the major %of blood exist?

A

Venous circulation. Systemic circulatory circulation, the venous network is more compliant and distensible, with the greatest capability

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64
Q

Most of the deoxygenated blood from the myocardium drains into a large vascular sinus called the ________

A

Coronary sinus

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65
Q

The Coronary sinus empties in the

A

Right Atrium

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66
Q

The semilunar valves allow the ejection of blood from the _________ into the _______through valves that consists of ______cusps each

A

Ventricles: artery ; 3

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67
Q

How many cusps in semilunar valves

A

3 cusps

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68
Q

Which layer of the valve is responsible for the major pumping action of the ventricles?

A

Myocardium

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69
Q

What are the 2 most important preop risk factors for about about to have a surgical procedure?

A

Unstable Coronary syndrome

CHF

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70
Q

Assessment of which system is paramount for the patient going for surgery?

A

Cardiac

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71
Q

Pt SV of 70ml, HR 80, pulmonary artery mean pressure of 20mmHg. and a CVP of 15 will have which CO ?

A

5.6

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72
Q

Formula for CO

A

SV x HR

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73
Q

Which fibers primarily innervates the atria and conducting tissues?

A

Parasympathetic

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74
Q

Innervation of the SA comes via the

A

right vagus EFFERENT FIBERS

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75
Q

Stimulation of Parasympathetic system results in

A

negative chronotropic
dromotropic
inotropic effects

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76
Q

Vascular tone and autonomic influences on the HR are controlled by vasomotor centers in which area?R

A

Reticular formation of the medulla oblongata and lower pons

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77
Q

Chemoreceptors in the carotid and aortic bodies detect all the following except?

A

Blood pressure

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78
Q

Receptors that detect change in BP

A

Baroreceptors

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79
Q

What stimulates chemoreceptors?

A

Decreasing O2 tension and increasing {H+} concentration , which results in increase pulmonary ventilation and BP with decreased HR

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80
Q

Chemoreceptors respond to

A

Alteration in chemical component, their concentration, and acidity and alkalinity to communicate.

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81
Q

Where are baroreceptors found?

A

Carotid sinus and aortic arch

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82
Q

What are baroreceptors innervated by ?

A

Sinus nerve of Herring

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83
Q

Role of baroreceptors? What do they monitor?

A

Regulate the autonomic control of heart and blood vessels.
They monitor pressure and volume changes and communicating those changes to the CNS via the sinus nerve of herring, CN IX , and CN X

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84
Q

3 nerves that baroreceptors communicate via

A

Sinus Nerve of Herring
CN IX
CN X

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85
Q

What is the CAUSE of the greatest myocardial O2 requirement?

A

Pressure work (to force blood through the body , 64%.

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86
Q

T/F As a determinant of myocardial blood flow, MAP is more important than Arterial diastolic pressure?

A

False; Coronary perfusion pressure is actually determined as the difference between aortic diastolic pressure ( ADP) and LVEDP. CPP = ADP-LVEDP

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87
Q

Coronary Artery blood flows from

A

Epicardial to ENDOCARDIAL

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88
Q

Coronary arteries receive blood for the myocardium as they emergy from the aorta and traverse the outside of the heart the _______ to branch and infiltrate the heart muscle, eventually terminally reaching the

A

Epicardium; inside of the heart, the endocardium

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89
Q

83 yo pt with HR of 46, and takes no medication that that would slow the HR. Which part of the electrical system is acting as the cardiac pacemaker?

A

AV nodes.

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90
Q

Right atrial pressure is

A

0-8 mmHg

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91
Q

Left atrial pressure is

A

3-12 mmHg

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92
Q

RV systolic pressure

A

15-25 mmHg

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93
Q

Pulmonary artery diastolic pressure

A

8-15 mmHg

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94
Q

Close approximation of the left atrial pressure is obtained through

A

Pulmonary capillary wedge.

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95
Q

What is the normal coronary artery blood flow at rest?

A

225- 250ml/min

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96
Q

When is the LV perfused?

A

Almost entirely during diastole

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97
Q

The RV is perfused when?

A

Both systole and diastole

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98
Q

Is coronary perfusion continous ?why or why not?

A

Not continuous ; it is interrupted with every contraction, Coronary perfusion is intermittent.

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99
Q

Which alpha receptor subtype is responsible for vasoconstriction?

A

Alpha 2B

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100
Q

Chief functions for alpha 2A adenoceptors are

A

Sedation
Hypnosis
Analgesia
And sympatholysis

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101
Q

Chief functions for alpha 2B adenoceptors are

A

Mediate vasoconstriction

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102
Q

Clonidine alpha 2 to alpha 1

A

200 time more specific for alpha 2 than alpha 1

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103
Q

Terminal elimination half life of Dexmedetomidine?

A

2 hours

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104
Q

What is elimination of Half life?

A

time required for 50% of a dose of medication to be removed from the plasma.

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105
Q

Clonidine and dexmedetomidine are part of which chemical class of Alpha 2 adrenergic agonists?

A

IMIDAZOLINES

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106
Q

IMIDAZOLINES compound found in precedex contain

A

Nitrogen andamine bonds.

act on CNS to decrease spasticity with significantly less muscle weakness.

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107
Q

Clonidine advantage prior to giving anesthesia reduces

A

Myocardial energy requirements and improves myocardial oxygen balance.

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108
Q

Clonidine and LA

A

Increase the duration of action when used with LA for neuraxial blockade.

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109
Q

Clonidine and TEMP

A

clonidine affect thermoregulatory control.

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110
Q

Clonidine and IV and VA

A

Decrease requirement , originally used from HTN crisis.

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111
Q

Abrupt discontinuation clonidine can lead to

A

Rebound HTN

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112
Q

Which medication can be given with patient with rebound HTN from clonidine?

A

Labetalol.

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113
Q

Following abrupt discontinuation of adrenergic blockers, which is beneficiai?

A

Labetalol is beneficial in a hyperadrenergic state following abrupt withdrawal of adrenergic blockers.

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114
Q

Class of dexmedetomidine?

A

It is a full alpha-2 agonist

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115
Q

Dexmedetomidine vs clonidine?

A

7-10 times more alpha 2 selective than clonidine.

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116
Q

Action of precedex ( in ICU or anesthesia)

A

Sedation

Analgesia

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117
Q

Action of precedex on sympathetic

A

Centrally mediated sympatholysis

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118
Q

CCB bind to voltage gated ion channels resulting in

A

A closed , inactive state

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119
Q

How does voltage gated ion channels work?

A

They receive a chemical signal from a neurotransmitter presynaptically and delivers that signal rapidly by converting it to a post-synaptic electrical signal . action
may be affected by ligands, ions, membrane potentials

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120
Q

Endocarditis is 3 to 8 times more prevalent in

A

MVP

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121
Q

MVP put at risk for

A

Dysrhythmias, stroke, MR, sudden death.

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122
Q

Heart murmurs from valve insufficiency occur when the blood goes backwards and

A

The ventricles are contracting

The valve is closed.

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123
Q

What produces the heart murmur?

A

retrograde blood flow when ventricle contract to force blood out toward the lungs or systemic circulation. The retrograde flow results from the inability of the valves between the atria and the ventricles to withstand the pressure generated by the ventricles

124
Q

What is mitral regurgitation?

A

Retrograde back flow of blood , decreases quantity of blood flow pump to systemic circulation , small volume insignificant, larger volume, increase the work of the heart to maintain forward flows

125
Q

Implication of mitral regurgitation

A

increase the workload of the heart to maintain forward flow, may lead to changes in the heart and HF.

126
Q

Slightly FAST HR better for which heart condition?

A

Valve Regurgitation (help minimize the regurgitation)

127
Q

Mnemonic to remember mitral regurgitation treatment?

Mr. FAR

A

Fast HR
Adequate Intravascular volume (preload)
Reduction in Afterload

128
Q

Mnemonic to remember mitral regurgitation treatment?

MR. FAR

A

Fast HR
Adequate Intravascular volume (preload)
Reduction in Afterload

129
Q

Abrupt cessation of this drug can causes rebound HTN (2)

A

Propranolol

Alpha 2 agonists

130
Q

What can happen with abrupt cessation of beta blocking agents and/or Alpha 1 agonists

A

Rebound HTN possible HTN crisis

131
Q

What position are the valves of the heart in during ventricular filling with a DIASTOLIC MURMUR?

A

Aortic and pulmonic closed

mitral and tricuspid open

132
Q

What are the 2 types of Diastolic murmurs?

A

Early decrescendo

Rumbling diastolic murmur

133
Q

First type of diastolic murmur : EARLY DESCRECENDO is caused by what?

A

Significant retrograde flow through incompetent semilunar valves.

134
Q

2nd type of diastolic murmur : RUMBLING DIASTOLIC murmur caused by?

A

retrograde flow through stenotic mitral valve.

135
Q

What is the most common manifestation of hypertrophic obstructive Cardiomyopathy in patients younger than 30 years of age?

A

Sudden CARDIAC Death

136
Q

Sudden death among pre-adolescent and adolescent children is more often due to

A

Hypertrophyic Cardiomyopathy (HCM)

137
Q

Describe Hypertrophic cardiomyopathy?

A

Asymmetrical hypertrophy frequently involving any portion of the LV and even more involves the interventricular septum.

138
Q

A normal aortic valve area (cross-sectional area)

A

2.5- 3.5

139
Q

Aortic regurgitation, what happens to pulse pressure?

A

Widened pulse pressure.

140
Q

What is pulse pressure?

A

Difference between systolic and diastolic pressure.

141
Q

Widening pulse pressure in cardiac suggest

A

Aortic Regurgitation

142
Q

4 Treatment for acute MR with severe LV dysfunction ?

DDAMDS

A 
DDAMDS
Dobutamine
Decrease Afterload
Milrinone
Sodium Nitroprusside
143
Q

Main goals in Mitral Regurgitaiton

A

Effectively minimize the quantity of regurgitation by REDUCING AFTERLOAD to afford greater cardiac output

144
Q

3 main medication in the treatment of MR (NiMD)

A

Nitroprusside
Milrinone
Dobutamine

145
Q

Anesthetic management goals for Mitral stenosis are

Ms. Avoid (TPH

A

AVOID TACHYCARDIA
Avoid hypovolemia (loss of SV and CO)
Normal SR on the lower side of normal
Maximize effectivenss of each contraction

146
Q

Why is tachycardia best avoided in MS?

A

because decreased diastolic filling time, leading to decreased CO and increase in left atrial pressure.

147
Q

Continue those medication

A

Digoxin, CCBs, and Beta blockers

148
Q

Which of the following is the only cardiac valve stenotic or regurgitative state that necessitates a DECREASED preload?

A

Acute MR

149
Q

Acute MR and left atrial pressure

A

Acute MR leads to increase in LAP that cause a retrograde transmission of that pressure to the pulmonary vasculature to result in pulmonary edema

150
Q

Critical Aortic stenosis is when the valve area is less than

A

0.8 (0.7 some books)

151
Q

Critical Aortic stenosis is when the Transvalvular gradient (at rest) of

A

50 mmHg

152
Q

Mild stenosis is valve area

A

Greater than 1.5

153
Q

Mild stenosis mean gradient is

A

less than 25 mmHg

154
Q

With stenosis the greater the gradient

A

The worst

155
Q

Moderate stenosis valve area

A

between 1.0 and 1.5

156
Q

What happens with aortic stenosis ?

A

there is resistance when ventricles try to eject blood from the heart , and there is elevation of the left ventricular systolic pressure. initially, may compensate but eventually lead to elevated LVDP which is transmitted in retrograde fashion to the pulmonary cicuit and leads to reduction of CO

157
Q

Pressure elevated in Aortic stenosis

A

LVEDP (preload)

158
Q

What is 2nd cardiomyopathy?

A

when it results from other damage factors such as toxins, inflammatory process, autoimmune disease.

159
Q

Treatment goals for AS (aortic stenosis)

NCHAT

A 
NSR and Volume status 
Cardiac pacing should be considered(SVT ->direct current cardioversion)  
Hypotension AVOID (treat with neo)
Avoid tachycardia
Treatment of ischemia
160
Q

What is the only valvular lesions associated with an increase risk of perioperative ischemia, MI and death?

A

Aortic Stenosis

161
Q

Treating ischemia with AS goal

A

increase O2 delivery by raising Coronary perfusion pressure

Decrease O2 consumption (Increase BP and lower HR)

162
Q

Most common genetic cardiovascular disease?

A

Hypertrophic cardiomyopathy

163
Q

Pathophysiology of hypertrophyic cardiomyopathy?

A

excessive growth of heart muscle
particularly of the interventricular septum near the aortic valve, WALLS STIFFENED and the aortic and mitral valve function become impaired which impeded to normal blood flow from the heart.

164
Q

Hypertrophic Cardiomyopathy features(DSM)

A

Dynamic LV outflow tract obstruction
Systolic anterior movement of mitral valve
Myocardial ischemia

165
Q

If a patient with Hypertrophic Cardiomyopathy has HYPOTENSION, it should be treated with

A

Neosynephrine (phenylepherine)

166
Q

How does phenylephrine produces vasoconstriction?

A

direct action WITHOUT INCREASING HR (because increasing HR WOULD INCREASE LV OUTFLOW OBStRUCTION

167
Q

Vent setting for the patient with Hypertrophic Cardiomyopathy

A

Greater RR with decrease TV would give adequate ventilation and oxygenation without inducing a DECREASE IN PRELOAD (venous return)

168
Q

Volume status that can be DETRIMENTAL in HCM patients

A

Relative hypovolemia

169
Q

What are the characteristics of DILATED CARDIOMYOPATHY?

A

Systolic Dysfunction

LV dilation

170
Q

All the following are causes of dilated cardiomyopathy?

A

HIV (infectious disease)
Toxins
Viral Coxsackie B
Genetic

171
Q

Amyloidosis associated with what kind of cardiomyopathy?

A

restrictive

172
Q

Tx of restrictive cardiomyopathy?

A

Pacemaker/ICD Insertion

173
Q

Restrictive Cardiomyopathy main issue is

A

impaired effectiveness of contractions.

174
Q

Final common pathway in the pathophysiology of ESSENTIAL HTN is

A

Peripheral vascular resistance

175
Q

In essential HTN, factors leading to increase PVR

A 
SODIUM RETENTION
Altered transports
humoral factors
CNS factors
Increased vascular reactivity
176
Q

What is the most common cause of 2nd HTN?

A

Renal Artery stenosis

177
Q

Renal artery stenosis lead to ______. What compensatory change occur?

A

hypotension to the kidneys, compensatory increase in CO in order to maintain the nominal GFR. Enhanced CO cannot compensate for the structural issue and that results in chronic elevated CO through stenotic renal artery.

178
Q

If this drug is discontinued prior to surgery, you get REBOUND HTN ?

A

Atenolol (beta blockers do)

179
Q

All possible effects of abrupt withdrawal of beta blocker

A 
Tachycardia
Palpitations
HTN -> HTN crisis
angina
exacerbation of HF
180
Q

Why is a patient on long term ACEI therapy at risk for intraoperative hemodynamic instability and HoTN

A

More likely to have prolonged HoTN during GETA particularly when there is LARGE FLUID SHIFTS with the procedures

181
Q

ACEI can do this to RAAS

A

Blunt RAAS

182
Q

What is the only system intact to support BP in ACEI patients

A

Vasopressin system

183
Q

Ideal vasoconstrictor for patients with pulmonary hypertension

A

Vasopressin

184
Q

The most important physiological action of AVP (especially during normal physiology) is to

A

increase water reabsorption in the kidneys by increasing water permeability in the collecting duct, thereby permitting the formation of a more concentrated urine.

185
Q

What is a demand-mode Pacemaker?

A

It senses the Electrical activity of the heart and provide either impulse or inhibition

186
Q

What pacemaker competed with the intrinsic rhythm of the heart?

A

Asynchronous

187
Q

Does asynchronous pacemaker recognize the instrinsic heart rate or rhythm of the patinet

A

NO

188
Q

How does the asynchronous pacemaker work?

A

initiates impulse at a designated rate without regard to the patient rate or rhythm

189
Q

What can permanently disable anti-tachycardia therapy in some ICD devices?

A

Magnet placement over the ICD over 30 seconds

190
Q

ICDs before induction of anesthesia: What should be done?

A

Antitachycardia features should be disabled,

191
Q

ICDs musc be

A

Reinterrogated and re-enabled immediately after surgery, either in surgery or in PACU

192
Q

What can happen if the ICDs is not disabled during surgery?

A

Inappropriate shock

193
Q

Insertion of CVC and ICD

A

the CVC guidewire may contact the leads of an ICD and cause the ICD to mistakenly sense a shockable rhythm and it will deliver an inappropriate shock

194
Q

The blood supply of the spinal cord and nerve roots is derived from

A

One anterior

2 posterior

195
Q

2 arteries contributing to the posterior blood supply of the

A

Radicular artery

Posterior longitudinal artery

196
Q

Segmental artery of the spinal cord divides into (RAP)

A

Radicular artery
Anterior longitudinal artery
Posterior longitudinal artery

197
Q

The anterior blood supply is the

A

Anterior longitudinal artery

198
Q

The anterior spinal artery provides the anterior

A

2/3 of the cord

199
Q

The posterior spinal arteries provide the posterior

A

1/3 of the cord

200
Q

Provide 75% of the blood supply of the spinal cord ?

A

75%

201
Q

The anterior artery supplies the

A

motor tracts

202
Q

What form the anterior artery?

A

Vertebral arteries and receives reinforcement of blood supply from 6 to 8 radicular arteries,

203
Q

Most important of the anterior artery?

A

the artery of Adamkiewicz is the most important of these

204
Q

Signs and symptoms of Anterior spinal artery syndrome manifests as

A

Flaccid paralysis of the lower extremities
Bowel and bladder dysfunction with sparing of proprioception and sensation, due to the selective ischemia to the anterior portion of the cord.

205
Q

Spared during anterior spinal artery syndrome

A

Proprioception and sensation

206
Q

A large artery that comes off the aorta and feeds the spinal column is called the

A

Artery of Adamkiewicz

207
Q

Artery of Adamkiewicz provides supply to the

A

Anterior, lower 2/3 of spinal cord.

208
Q

In vascular surgery, the risk of paralysis related to Anterior spinal artery syndrome, highest risk is with

A

40% in the setting of dissection or rupture involving the thoracic cord.

209
Q

During dissection or rupture involving the thoracici cord,______ is a key determinant of the risk of paraplegia.

A

The duration of cord clamping

210
Q

Artery of Adamkiewicz arises from ______ and enter a single intervertebral foramen somehwere between ______ to _____

A

T7 to L4; T9-T11

211
Q

What is the most common cause of RV failure ?

A

LV failure

212
Q

What is the hallmark of Chronic LV systolic dysfunction ?

A

Decrease LV EF

213
Q

When the LV does not completely effect the volume of blood it holds, what happens?

A

the workload on the ventricle and heart builds up with each heart beat leading to elevated LVEDV and decrease EF , decrease SV

214
Q

3 hallmarks of Decreased EF

A

Elevated LVEDV, decrease EF, decreased SV

215
Q

Symptomatic HF in patient with normal LV systolic function is most likely due to ?

A

Diastolic dysfunction

216
Q

What parameter is elevated with diastolic dysfunction? What does it cause?

A

LVEDP; elevated cardiac work ; back pressure increase in LA and Pulmonary veins.

217
Q

Causes of high cardiac output failure?

A 
AV fistulas
Pregnancy 
Anemia 
Hyperthyroidism
Glomerulonephritis
218
Q

Explain the adaptive mechanism of the failing ventricle to maintain normal CO

A

Atrial natriuretic peptide is released in response to increase atrial pressure.

219
Q

Increase pressure in atrium releases

A

ANP

220
Q

ANP secreted by _______ act as a vaso_______and leads to _______ of the heart

A

Atrial myocytes
Vasodilator
reducing afterload for the heart.

221
Q

Strategis to manage diastolic HF?

A

Beta blockrs
Diuretics
Digoxin

222
Q

What is the goal for management of diastolic heart failure?

A

Prevent remodeling of the LV , Which can deteriorate to HF.

223
Q

Medication that decrease the progress of HF

A 
Beta blockers,
Digozin
Diuretics
Aldosterone antagonists
ACEI
224
Q

Opioids seem to have a particularly beneficial effect in HF patients because of their effects on the

A

delta on the ventricles.

225
Q

associated with an increased risk of surgical mortality [

A

Known CHF is

226
Q

New York Heart Association Functional Class Class I: Class III: Major limitation of physical activities; comfortable at rest; minimal physical activity results in dyspnoea, fatigue, or angina

A

Patient has no limitation of regular physical activities

227
Q

NYHA Class ______Mild limitation of physical activities; comfortable at rest; normal physical activity results in dyspnea, fatigue or angina

A

NYHA Class II

228
Q

NYHA Class ____Major limitation of physical activities; comfortable at rest; minimal physical activity results in dyspnoea, fatigue, or angina

A

NYHA Class III

229
Q

Inability to perform any physical activity without symptoms; symptoms are present at rest, and are worsened with any activity? NYHA which class?

A

NYHA Class IV:

230
Q

One of the fundamental concepts when considering how to protect and optimize cardiac performance is the concept of

A

myocardial oxygen supply and demand.

231
Q

Oxygen supply delivered to the myocardium is represented by the

A

oxygen content of the blood multiplied by the cardiac output

232
Q

What is demand?

A

Demand is the consumption of oxygen by the myocardium.

233
Q

The determination of the amount of blood delivered to tissue is described in a way that is analogous to the mathematical description of ________

A

OHM’s LAW electrical current driven by voltage, Ohm’s law, where current equals voltage divided by resistance.

234
Q

In the biologic blood flow model, this equates to:Ohm’s law

A

Q (flow ) = △P / Resistance

235
Q

The subendocardial vessels are compressed during systole so that coronary perfusion only occurs during

A

the diastolic phase.

236
Q

Conditions that may result in decreased oxygen supply to the left ventricle,

A

decrease the diastolic blood pressure, decrease diastolic filling time, or increase the diastolic pressure of the left ventricle

237
Q

The primary determinants of arterial blood oxygen content (CaO2) are

A

hemoglobin concentration (HgB) and O2 saturation (SaO2):

238
Q

The relationship between hemoglobin (Hb) and oxygen (O2) is described by the

A

oxyhemoglobin dissociation curve.

239
Q

Flow per poiseuille’s Law

A

Flow is affected by decreases in the arterial radius to the fourth power, so even small decreases can cause significant flow limitation that can impede regional myocardial blood flow significantly.

240
Q

CaO2 formula is

A

CaO2 = (HgB x 1.39) (SaO2)+ (PaO2) (0.003)

241
Q

Factors that affect oxygen demand are the following:

A

Contractility
Heart rate
Wall tension

242
Q

is also a key component of the oxygen consumption because this determines the frequency at which work is being done by the myocardium.

A

Heart rate

243
Q

According to LaPlace’s law,

A

ventricular wall tension is directly proportional to the pressure in the chamber multiplied by the radius of the chamber and is inversely proportional to the wall thickness:

244
Q

La place formula

A

P x P / 2h (Wall thickness)

245
Q

Amount of blood delivered to the tissue in 1 min.

A

Cardiac output (CO)

246
Q

CO formula

A

HR x SV

247
Q

amount of blood ejected by the ventricle with each contraction

A

SV

248
Q

SV is determined by

A

preload, afterload, and contractility.

249
Q

follows Starling’s law in enhancing the contractile force of the ventricle

A

Preload, the precontractile fiber length of myocardial fiber augmented by end-diastolic volume (EDV),

250
Q

Venous return is directly proportional to

A

EDV

251
Q

main mechanism which influences the binding strength of actin and myosin filaments that determine the force of myocardial contraction.

A

Intracellular calcium ion

252
Q

What is a normal CI?

A

2.5 to 3.5

253
Q

Determinants of HR

A

HR is determined primarily by the rate of spontaneous phase 4 depolarization of the sinoatrial node pacemaker cells, which are influenced by neural and humoral mechanisms.

254
Q

3 factors that determine preload

A

Venous return
Ventricular filling
Intrathoracic pressure

255
Q

SV formula

A

EDV- ESV

256
Q

EDV is determined by________while ESV is determined by ______And ______

A

preload; Afterload and contractility

257
Q

3 factors that determined afterload?

A

SVR
Wall tension
Blood Viscosity

258
Q

3 factors that determine contractility

A

SNS

Catecholamine drugs

259
Q

If no obstruction or loss of volume in circulating pathways is present, venous return should equal

A

CO.

260
Q

Impedance to ejection is

A

Afterload is defined

261
Q

What is the formula for SVR?

A

80 x (MAP-RAP)/ CO

262
Q

Afterload, as defined by ventricular wall stress, is represented by which law ?

A

LaPlace’s law:

263
Q

intrinsic ability of the myocardium to generate force at given end-diastolic fiber length

A

Contractility

264
Q

Coronary blood flow formula is

A

CBF = DBP (aorta) - LVEDP

265
Q

Neurohormonal Systems Activated in Patients with Heart Failure

A

SNS
RAAS
ADH
Endothelin

266
Q

Systolic HF and EF

A

Systolic function, with a reduced ejection fraction (EF).

267
Q

Diastolic HF and EF

A

(HF with preserved EF).

268
Q

PAD is

A

narrowed arteries reduce blood flow to your limbs.

269
Q

PAD associated with this symptoms

A

Claudication symptoms include muscle pain or cramping in your legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest.

270
Q

CRPS-1 is a syndrome where chronic pain (normally in an extremity) appears to be associated

A

with sympathetic nervous system dysfunction after trauma.

271
Q

Raynaud’s phenomenon

A

cold temperatures or stress can trigger “Raynaud’s attacks.” During an attack, little or no blood flows to affected body parts.

272
Q

Cardiac TAMPONADE: VERY IMPORTANT TO KNOW

A

positive pressure ventilation, combined with tamponade, can further reduce preload and actually cause catastrophic hypotension and even cardiac death.

273
Q

NEVER to this with TAMPONADE?

A

initiate positive pressure ventilation until the pericardial space has been drained –

274
Q

With cardiac tamponade, if general anesthesia is needed, what do you do?

A

spontaneous ventilation is mandatory, thus ketamine (or sevoflurane) is the drug of choice.

275
Q

When to Induce with cardiac tamponade?

A

Induction should not take place until the surgical team is ready to make incision.

276
Q

Signs of Cardiac tamponade

A

Beck’s triad
Muffled heart sounds, elevated jugular venous pressure (JVD), HYPOTENSION
ALSO pulsus paradoxus.

277
Q

The pericardial sac typically has

A

15-30 ml fluid.

278
Q

The classic cause of pulsus paradoxus,

A

Cardiac tamponade

279
Q

Cardiac tamponade keep the heart

A

Fast full and strong

280
Q

Underlying pathology of cor pulmonale?

A

Pulm HTN

281
Q

When alpha 1 receptors are activated , what ion increase

A

Intracellular Calcium

282
Q

Alpha 2 receptors located

A

Presynaptically

283
Q

What are the 3 most common drugs used in treating ISCHEMIC HD

A

Nitrates
Beta Blockers
CCBs

284
Q

Mitral stenosis with severe hemodynamic instability with SVT, immediately should undergo

A

Cardioversion

285
Q

What is the formula of EF

A

SV/EDV

286
Q

Classic triad of AS with critical valve stenosis of less than 1

A

SAD
Syncope
Angina
Dyspnea

287
Q

Critical aortic stenosis Anesthesia contraindicated?

A

SPinal

288
Q

Which valvular disease is the PCWP and overestimation of LVEDP

A

Mitral stenosis (because of the abnormal transvalvular gradient)

289
Q

2 things that decrease coronary perfusion pressure?

A

Decrease in aortic pressure

Increase in ventricular end-diastolic pressure.

290
Q

most common cause of myocardial remodeling

A

Myocardial ischemic injury

291
Q

Pulse BiSFERIENS associated with

A

Associated with Severe AR, because of rapid ejection of large SV>

292
Q

S3 is associated with

A

heart failure.

293
Q

Develop as compensatory mechanism of AR

A

Eccentric Hypertrophy

294
Q

Eccentric Hypertrophy mnemoic

A

VES (Volume, Eccentric , series)

295
Q

MVP most common arrhythmia

A

Paroxysmal SVT

296
Q

Cardiac sympathetic or accelerated fibers located where

A

T1-T4

297
Q

Aortic pressure has a direct relationship with

A

Coronary perfusion pressure.

298
Q

LV perfused almost entirely during

A

Diastole

299
Q

THe RV is perfused when

A

Both systole and diastole

300
Q

Which factor most NEGATIVELY affect MYOCARDIAL O2 CONSUMPTION?

A

Heart rate.

301
Q

Which paradoxical cardiac wall motion is indicative of Myocardial iNFARCTION

A

Dyskinesia

302
Q

Relative contraindications to PA catheterization

A

LBBB

303
Q

Pa a wave produce by

A

Atrial contraction

304
Q

ABsent with afib on PAC

A

A wave

305
Q

Giant CANNON a wave on CVP with this heart valve issue

A

Tricuspid Stenosis
Mitral stenosis
Ventricular hypertrophy

306
Q

With PE, CVP is ______ , PCWP is _____

A

high ; normal

307
Q

LV failure, CVP _____and PCWP is ______

A

HIgh ,High

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