Systems Review 1: Cardiac, Respiratory, Renal and Hepatic Flashcards
The heart pumps ___ quarts of blood every minute. The coronary arteries pump ____ gallons out every day.
The heart pumps 5 quarts of blood every minute. The coronary arteries pump 130 gallons out every day.
Main percentage of deaths from CVD?
No signs of CAD, but still have it
This is referred to as silent ischemia. Blood to your heart may be restricted due to CAD, but you don’t feel any effects.
Minor clinical predictors of heart failure
Advanced age
Abnormal ECG
Rhythm other than sinus
History of CVA
Uncontrolled HTN
Intermediate clinical predictors of heart failure
Remote MI ( >1 month)
Stable angina
Compensated CHF
Creatinine ³2.0
Diabetes
High clinical predictors of heart failure
Acute or recent MI (< one month)
Unstable or severe angina
Large ischemic burden
Positive stress test
Decompensated CHF
Significant arrhythmias
What is STEMI
STElevation Myocardial Ischemia
Abrupt occlusion/decrease in coronary perfusion
Inflammatory process
Mortality rate 15-20%
Reperfusion therapy decreases mortality to 6.5%
B Blocker side effects
Side effects – hypotension, bradycardia, bronchial spasm, masks hypoglycemia
Ca Channel Blockers
Dilate arteries – decreases SVR which decreases workload and O2consumption
Decrease heart rate and myocardial contractility – decreases O2consumption
Avoid in patients with severe heart failure
Antidote for heparin
Antidote – Protamine Sulfate
What do statins do?
Decrease the amount of “bad” (LDL) cholesterol
What do ACE inhibitors do?
Treat hypertension and may lower the risk of recurrent myocardial infarction
Normal pressures
Normal cardiac output
3-9 liters/min
What is cardiac index?
Vasodynamic parameter
Heart performance to the size of the individual
CI=CO/BSA
2.1-4.9 L/min/m2
What’s central venous pressure?
The pressure of blood in the thoracic vena cava, near the right atrium
Name some factors that increase CVP
Hypervolemia
Forced exhalation
Tension pneumothorax
Heart failure
Pleural effusion
Decreased cardiac output
Cardiac tamponade
Mechanical ventilation and the application of positive end-expiratory pressure (PEEP)
Factors that decrease CVP?
Hypovolemia
Deep inhalation
Distributive shock – Fluid remains in feet
How to control valvular stenosis?
Maintain BP
NSR 70-80 bpm, maintain atrial kick
Avoid arrhythmias, tachycardia
Maintain contractility (Do not use Propofol)
No chest compression
How to control valvular insuffeciency?
Keep blood pressure lower normal
Keep heart rate elevated (ideally 80-100 bpm)
Contractility – maintain or increase
Avoid:
Cardiac depression
Hypoxemia, hypercarbia and acidosis they increase SVR
Over-sedation preop
1 and million Americans live with this most common disorder, affects 8 out of every 1,000 newborns
Congenital heart defect
What can a ventricular heart defect lead too?
Leads to congestive heart failure, pulmonary hypertension, arrhythmia or stroke.
Dyspnea, what is it? What are common symptoms?
Shortness of breath (SOB)
Associated symptoms– night sweats, pain, chest pressure, discomfort, ankle edema, diaphoresis, cyanosis
What is a capacity compared to lung volumes?
It is useful to know that the “capacities” consist of the sums of two or more “volumes”. For example, FRC=ERV+ RV
Chart that plots the volume and flow of air coming in and out of the lungs from one inhalation and one exhalation.
Pneumotachographs generated by a spirometer
Maximum breathing capacity is also known as?
Maximum Voluntary Ventilation (MVV)
Normal FEV1 values?
Values of between 80% and 120% of the average value are considered normal
____________________is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration. What are normal values?
Forced Expiratory Flow (FEF)
The usual intervals are 25%, 50% and 75% (FEF25, FEF50 and FEF75), or 25% and 50% of FVC
Values ranging from 50-60% and up to 130% of the average are considered normal
Typical values for a patient with COPD?
What does the Gold Grade predict?
Measures the severity of COPD and grades it accordingly
The kidney can autoregulate at MAPs between ____ and ____mmHg
50 and 150mmHg
Hypotension shifts left, hypertension shifts right
The human response to stress does what to conserve water?
Shift of renal flood flow away from the cortical regions and towards the juxtamedullary nephrons, which conserves water
Normal urine output?
0.5cc/kg/hour
What is the mortality rate with ARF happens in the surgical setting?
~10%
What are the claims of Dopamine in renal failure, and does it help?
Dopamine, which increases renal blood flow, has been traditionally thought to decrease the incidence of renal failure
It’s vasodilating properties have been shown to partially reverse norepinephrine-induced renal vasoconstriction
Similarly, a randomized controlled trial of saline versus “low-dose” dopamine in 47 liver transplant patients showed no differences in urine output or creatinine clearance at one month after surgery. Thus, _Dopamine has no practical use in renally impaired patients_
How is Fenoldopam a renal protective drug?
Antihypertensive, arterial/arteriolar vasodilation
D1-selective agonist which has been shown to increase urine output as well as glomerular flow, without the hypertension associated with dopamine
Considered superior to Dopamine at 0.1 mcg/kg/min for 24 hours following surgery in high risk patients
What microbials are nephrotoxic?
Aminoglycosides (amikacin, gentamicin, tobramycin, neomycin) and amphotericin B are the most problematic antimicrobials, because they are nephrotoxic and their spectrum of activity cannot be replicated by other, less-toxic medications
If aminoglycosides or amphotericin B are used, potentially confounding factors such as hypovolemia, fever, renal vasoconstriction, and electrolyte disorders should be minimized.
Name three nephrotoxic drugs
NSAIDs
Antimicrobials of the Aminoglycosides class
Radiographic contrast
What affect do NSAIDs have on the kidney?
Hypertension, peripheral edema, sodium retention, hyperkalemia, and renal failure
Increased intra-abdominal pressure during laparoscopy can mimic what disorder?
Abdominal Compartment Syndrome, compressing the kidneys (retroperitoneal) and resulting in oliguria
Renal blood flow can fall by as much as ___% during preparation of the aorta for clamping, possibly due to spasm
50%
Cardiopulmonary bypass is associated with acute renal failure, with quoted incidences generally ranging from ___%
2-7%
SCh will increase K+ by ____ mEq/L regardless of renal status and can be safely given even when serum [K+] > ___mEq/L
SCh will increase K+ by ~ 0.6 mEq/L regardless of renal status and can be safely given even when serum [K+] > 5 mEq/L
Hepatic blood flow
70% Portal Vein
30% Hepatic artery
25% of cardiac output
Does NOT maintain autoregulation of blood flow with cirrhosis and exposure to volatile anesthetics
Decrease of hepatic blood flow _____% from volatiles and regional w/o stimulation
25-30%
Coagulopathies can be caused by?
Loss of vitamin K-dependent factors II, VII, IX, X
Alcohol withdrawal syndrome
48-72 hours dry
Delirium Tremors’s, seizures
Increased sympathetic tone
Versed until sedated
Esmolol for tachycardia
Mortality as high as 10%
Narcotics can sometimes cause spasm of the sphincter of oddi, what would be the appropriate treatment?
Relieved by naloxone or glucagon (1-3mg)
Effect of agents on Lower Esophogeal Tone
