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SEE Prep > Valley Cardiac > Flashcards

Valley Cardiac Flashcards

1
Q

What causes S1? S2?

A

S1 closure of the AV valves
S2 closure of the Aortic and Pulmonic valves

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2
Q

An S3 is an indicator of what condition?

A

congestive heart failure

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3
Q

What percentage of Ao Regurg is considered mild/mod/severe?

A

Mild < 20
Mod 20-40
Severe 40-60

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4
Q

What is the classic PDA murmur?

A

Mechanical continuous murmur, peaking at S2

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5
Q

What percentage of EF is provided by atrial kick?

A

30%

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6
Q

What is the normal range for SV index?

A

40-60 ml/beat/m2

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7
Q

What percentage of CO goes to the liver?

A

25%

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8
Q

What percentage of CO goes to the lungs?

A

100% (duh)

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9
Q

What percentage of CO goes to the kidneys?

A

20%

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10
Q

What percentage of CO goes to the brain?

A

15%

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11
Q

Where does bronchial circulation arise?

A

From the LEFT (off the thoracic aorta and intercostal arteries)

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12
Q

What is the normal pressures in the following:
RA, RV, LA, LV

A

RA 1-8
RV 15-30/0-8
LA 2-12
LV 100-140/0-12

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13
Q

How do you estimate MAP?

A

1-2-3 rule
(1 x SBP + 2xDBP)/3

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14
Q

What are the two determinants of arterial blood pressure? Which law does this represent?

A

CO and SVR
Ohm’s Law

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15
Q

What is the calculation for SVR?

A

[(MAP-CVP)/CO] x 80

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16
Q

What maintains systemic arterial blood pressure during diastole?

A

The elastic recoil of arterial blood vessels

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17
Q

What are the two determinants of pulse pressure?

A

SV and arterial compliance

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18
Q

Pulse pressure decreases when:

A

either cardiac output decreases or arterial compliance increases

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19
Q

Pulse pressure increases when:

A

cardiac output increases or arterial compliance decreases

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20
Q

When arterial vessels are less compliant, does pulse pressure increase or decrease?

A

It increases. This is why old people have super low diastolic pressure

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21
Q

Where are venous baroreceptors located?

A

Right atrium and great veins

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22
Q

What is the Bainbridge Reflex?

A

An increase in vascular volume causes an increase in heart rate

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23
Q

Where are arterial baroreceptors located?

A

Carotid sinus and aortic arch

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24
Q

Will pulse pressure be increased or decreased in a pedal pulse?

A

It will be increased. The more peripheral you get the higher the systolic and the lower the diastolic

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25
Q

What is the colloidal osmotic pressure of albumin?

A

22mmHg

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26
Q

What percentage of CO goes to the VRG?

A

75%

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27
Q

What are the determinants of blood flow to an organ?

A

Pressure gradient and resistance
Ohm’s Law

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28
Q

Blood flow to an organ is most directly related to _______

A

the organ’s metabolism
metabolites result in vasodilation, which increases perfusion

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29
Q

Fully saturated hemoglobin carries _______ molecules and _______ atoms of oxygen

A

4 molecules
8 atoms

30
Q

How does hypercapnia impact cerebral vasculature? Systemic Vasculature?

A

Causes vasodilation in both cerebral and systemic vasculature

31
Q

How does hypercarbia impact pulmonary vasculature?

A

Causes vasoconstriction

32
Q

How does acidosis impact PVR and SVR?

A

Increases PVR
Decreases SVR

33
Q

Describe systolic coronary artery flow in the right and left arteries

A

On the left side of the heart, flow ceases during systole
on the right, flow continues during systole

34
Q

What is the resting coronary blood flow in ml/min?

A

225-250 ml/min

35
Q

What is the resting coronary blood flow in ml/min?

A

225-250 ml/min

36
Q

What is the O2 extraction rate in cardiac muscle?

A

70%

37
Q

How is coronary perfusion pressure calculated?

A

The Aortic diastolic pressure - LVEDP

38
Q

What is the most potent vasodilator released by cardiac cells?

A

Adenosine

39
Q

What is the O2 consumption rate of the heart?

A

8-10 ml/100g/min

40
Q

What determinant of cardiac output most determines oxygen consumption?

A

Heart rate. Tachycardia will increase myocardial oxygen demand more than preload or afterload. This means increasing preload is the LEAST costly way of increasing cardiac ouput

41
Q

Where in the coronary vasculature are alpha 1 receptors found?

A

In the endocardium, where they vasoconstrict

42
Q

Where in the coronary vasculature are beta 2 receptors found?

A

In the subendocardium and intramuscular, where they vasodilate

43
Q

What layer of cardiac muscle is most susceptible to ischemia?

A

the subendocardium, because it has the greatest metabolic demands and is most compressed during systole

44
Q

What is myocardial preconditioning?

A

Anytime you have a brief ischemic period, the heart adapts so that subsequent more severe periods of ischemia are less detrimental

45
Q

Which anesthetic agents can trigger or modulate the myocardial conditioning response?

A

All of the volatile anesthetics mimic ischemic preconditioning. Adenosine or opioid agonists may also.

46
Q

Which anesthetic agent antagonizes cardiac preconditioning?

A

Ketamine

47
Q

What is phase 0 of cardiac conduction

A
48
Q

What is phase 1 of cardiac conduction

A
49
Q

What is Phase 2 of cardiac conduction

A
50
Q

What is Phase 3 of cardiac conduction

A
51
Q

What is Phase 3 of cardiac conduction

A
52
Q

What does the SNS innervate in the heart?

A

atria, ventricles, and conduction system

53
Q

What does the PNS innervate in the heart?

A

SA, AV, and atria

54
Q

Does acute hypokalemia increase or decrease cardiac excitability?

A

Decreases
If there’s less potassium outside the cell, the gradient is even higher, causing hyperpolarization

55
Q

What are the characteristics of sick sinus syndrome?

A

bradycardia punctuated by episodes of SVT, usually in the elderly patient

56
Q

What is the most common pre-excitation syndrome?

A

WPW

57
Q

What is the difference between eccentric and concentric hypertrophy?

A

With concentric, the volume of the ventricle remains the same. With eccentric, the volume increases from dilation

58
Q

What causes concentric hypertrophy?

A

Increased afterload

59
Q

What causes eccentric hypertrophy?

A

Increased preload

60
Q

Diastolic dysfunction means there is a decrease in ventricular _________

A

Compliance

61
Q

Systolic dysfunction means there is a decrease in ventricular _______

A

Contractility

62
Q

Which valvular abnormality is associated with a systolic and diastolic murmur?

A

Aortic Stenosis

63
Q

What are the five hemodynamic goals of aortic stenosis management?

A

Slow (50-70 bpm)
Full (maintain preload)
Tight (Maintain afterload)
Regular (Maintain SR)
Not too strong (maintain contractility)

64
Q

Why is afterload maintenance so important in the patient with aortic stenosis?

A

Afterload is fixed by the stenotic valve, and any decrease in arterial afterload can worsen coronary perfusion pressure

65
Q

What are the hemodynamic goals for mitral regurgitation?

A

Maintain preload
Decrease afterload
increase heart rate
maintain SR
avoid increasing PVR

66
Q

What are the hemodynamic goals in HOCM?

A

Increase Preload
Increase afterload
Maintain SR
Slightly depress contractility

67
Q

What four changes will cause LVOT obstruction in HOCM patients?

A

A decrease in preload
A decrease in afterload
An increase in contractility
An increase in HR

68
Q

What is the first line treatment for hypotension in the patient with HOCM?

A

Fluid! increase preload!

69
Q

Which vasopressor would you use in a HOCM patient?

A

an alpha agonist. don’t want any beta agonism

70
Q

What is the probability a patient will have their first MI in the perioperative period?

A

less than 10%

71
Q

What is Beck’s triad?

A

The pericardial tamponade trio:
hypotension
muffled heart sounds
JVD

72
Q

What are the first signs of tamponade?

A

hypotension with reflex tachycardia

SEE Prep (2 decks)

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