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A1 > Special populations shannon > Flashcards

Special populations shannon Flashcards

1
Q

The myocardium receives ___% of the oxygen delivered to it

A

70

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2
Q

If the heart requires more oxygen, it must ____

A

increase coronary blood flow, or CaO2 must increase

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3
Q

___ increases oxygen demand, and decreases oxygen delivery

A

Tachycardia

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4
Q

What can decrease CaO2?

A

Hypoxemia
Anemia

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5
Q

What can increase O2 demand?

A

Tachycardia
HTN
SNS
Increased LVEDV, inotropy, wall tension, afterload

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6
Q

What is the most useful measure of coronary perfusion?

A

MAP

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7
Q

BNP is release in response to ___

A

Wall stress, and is a marker for HF diagnosis

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8
Q

ANP is released in response to ____

A

FVO

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9
Q

Degree of HF as per EF

A

Normal >50%
Mild 41-49
Moderate 36-40
Severe <24%
“dont stress this”

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10
Q

Causes of SHF

A

CAD/ ischemia
Dilated CMP
FVO (from valve regurg)

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11
Q

Systolic HF anesthetic considerations (preload, afterload, inotropy, HR)

A

Preload- avoid FVO, diuretics if too high
Afterload- decrease but maintain CPP, SNP works well if volume adequate
Inotropy- augment with inotropes if needed, avoid reducing inotropy
HR- usually high, if EF is low, give anticholinergics?

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12
Q

What is the most common type of HF in women and the elderly?

A

Diastolic dysfunction

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13
Q

Causes of diastolic HF

A

MI
Stenoses valves
HCMP
HTN
Cor pulmonale
Obesity

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14
Q

Diastolic HF anesthetic considerations (preload, afterload, inotropy, HR)

A

Pre- Volume required (LVEDP does NOT correlate with LVEDV)
Afterload- already elevated, use phenyl to keep it high to maintain perfusion to thick myocardium
Inotropy- avoid depressing
HR- keep is slow to max CPP

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15
Q

What agents will increase PVR?

A

N2O and des

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16
Q

What states can increase PVR and worsen RV failure?

A

Hypoxemia, hypercarbia, acidosis

17
Q

Pericarditis is usually from ___

A

inflammation from a viral infection
Other causes- dresslers syndrome, TB, autoimmune, cardiac injury, radiation

18
Q

Treatment for acute pericarditis

A

Resolves spont
ASA, oral analgesics, steroids
But can progress to tamponade or constrictive pericarditis

18
Q

S&S acute pericarditis

A

Chest pain relieved by leaning forward
Pericardial friction rub
ST elevation with normal enzymes
Fever

19
Q

Constrictive pericarditis will cause ___

A

Abnormal diastolic filling time
Decrease SV and CO

20
Q

Cause of constrictive pericarditis

A

Radiation
Cardiac surgery
RA
TB used to be the most common cause, now its idiopathic
Uremia

21
Q

Symptoms of constrictive pericarditis

A

Fatigue and dyspnea
Kussmauls- JVD on inspiration
Pulsus paradoxus
Increased venous pressure
Atrial dysrhtyhmias
T wave inversion
Pericardial shock

22
Q

Treatment and management for constrictive pericarditis

A

Pericardiotomy
Avoid brady bc CO is dependant on HR
Preserve HR and inotropy (with ketamine and panc)
Opioids, benzos, and etom are OK
Caution with volatile anesthetics
Maintain afterload

23
Q

Causes of cardiac tamponade

A

Trauma
Cardiac surgery
Malignancy in the mediastinum
Pericardial effusions after pericarditis

24
Q

Signs of cardiac tamponade

A

BECKS triad- hotn, jvd, muffled heart tones
pulsus paradoxus
Kussmal sign

25
Q

What is the most sensitive method to detect tamponade or pericardial effusion

A

echo

26
Q

Tx of tamponade

A

cardiocentesis

27
Q

Anesthetic considerations for tamponade surgery (pericardiocentesis)

A

LA
AVOID volatile agents, prop, thio, high dose opioids, neuraxial anesthesia
SAFE are ketamine, n2o, benzos. opioids

28
Q

Hypertrophic obstructive CMP

A

LVOT obstruction by septum or SAM of anterior leaflet of mitral valve
Diagnosed by TEE
Can occur after MV repair (not replacement)

29
Q

Anesthetic management for hocm

A

maintain these things
low hr
high preload
low inotropy
high afterload

30
Q

HOCM, what can cause high hr, low preload, high inotropy, and low afterload?

A

hr- beta ag, ketmina, panc, des, light anesthesia, histmaine releasing drugs
inotropy- beta ag, dig, light anesthesia
preload- vasodilators, hypovolemia, ppv, neuraxial, valsalve
Afterload- neuraxial anesthesia, oxytocin

31
Q

whos at risk for endocarditis

A

previous history
prosthetic valve
iv drug user
unrepaired c heart disease
GIVE ABX

32
Q

What surgeries are high risk for endocarditis

A

dental
respiratory with a perf of mucosal lining
biopsy of infected skin or muscle

A1 (124 decks)

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