Week 1 (Exam 1) Flashcards
SV equation:
EDV-ESV
Normal SV:
60-100ml
CO equation and normal amount:
SVxHR
3-9L/min
Increased LVEDP may be caused by:
Aortic stenosis
Pressure of blood in thoracic vena cava, near the right atrium:
Central venous pressure
8 factors that increase CVP:
- Hypervolemia
- Forced exhalation
- Tension pneumothorax
- HF
- Pleural effusion
- Decreased CO
- Cardiac tamponade
- Mechanical ventilation with PEEP
3 factors that decrease CVP:
- Hypovolemia
- Deep inhalation
- Distributive shock
Indirect measure of left atrial pressure:
Pulmonary capillary wedge pressure
Normal PCWP:
6-12mmHg
3 gold standard determining causes from PCWP:
- Acute pulmonary edema
- LV failure and mitral stenosis
- Failure of LV output
What is pulmonary edema with normal PCWP:
ARDS or non-cardiogenic pulmonary edema (opiate poisoning)
Vasodynamic parameter relating CO to body surface area (BSA)
Cardiac Index (CI)
Normal CI:
2.1-4.9 L/min/m2
PaO2 equation:
102-(age x .3)
Performance of cardiac muscle:
-frank starling’s law
Contractility
Force or enters of muscular contractions
Inotropic
Changes the HR
Chronotropic
Coronary blood flow inadequate to meet the demands of the myocardium:
Ischemic heart disease
6 things that decrease supply to heart:
- Tachycardia
- Decreased O2 content
- Anemia
- Arterial hypoxemia
- Hypocapnia
- Hypotension
3 things that increase demand to heart:
- Sympathetic nervous system (tachycardia and HTN)
- Increased myocardial contractility
- Increased preload and afterload
CorPP equation:
Arterial diastolic pressure - LVEDP
CPP of at least what is thought to be necessary for return of spontaneous circulation (ROSC):
15mmHg
Coronary filling during systole?
NO
Coronary filling during diastole?
Yes
Point where QRS ends and ST segment begins:
J-point
Is j-point more horizontal or vertical?
More horizontal
ST segment elevation with upward convexity:
Benign, especially in healthy, asymptomatic individuals
ST segment elevation with downward concavity:
Due to acute coronary syndrome
Leads that have inferior view of heart:
II, III, aVF
Leads that have lateral view of heart:
I, aVL, V5, V6
Leads that have anterior view of heart:
V3, V4
Leads that have septal view of heart:
V1, V2
4 EKG criteria for ischemia:
- 2mm depression, 8ms after J point in up slope ST segment
- 1mm depression, 60-80ms after J point in horizontal ST segment
- ST segment elevation
- T wave inversion
Which lead is more important tool for LV ischemia:
V5
Which lead is most important for RCA ischemia:
Lead II
Cardiac marker used to assist diagnoses of an acute myocardial infarction:
Troponin
BP increase because SVR increased
Work of heart and O2 demand increased because of increase in afterload
Increased ABP
3 treatment options for increased ABP:
- Increase anesthetic depth
- Give hydralazine
3 nitroprusside/NTG
Treatment to increased HR:
Beta antagonist
2 treatments for decreased ABP:
- Decrease anesthetic depth
2. Give vasoconstrictor (phenyl)
What event has occurred with decreased ABP and increased PCWP:
Heart failure; LV failure
3 treatments for decreased ABP and increased PCWP:
- Phenyl
- Positive inotrope
- NTG (dilate veins)
Difference between NTG and nitroprusside?
NTG: vasodilates veins
Nitroprusside: vasodilates veins and arteries
Treatment for normal hemodynamics:
NTG or Calcium channel blocker
3 things to do with normal hemodynamics to return heart:
- Slow rate
- Small state
- Perfused state
Definition of pulmonary HTN:
Mean PAP > 25mmHg at rest
Mean PAP > 30mmHg with exercise
What is normal mean PAP:
12-16mmHg
Normal pulmonary circulation can accommodate changes in flow rates from:
6 to 25 L/min
enlargement and failure of RV as a response to increased vascular resistance:
Cor Pulmonale
5 major categories of pulmonary HTN:
- Pulmonary arterial HTN
- Pulmonary venous HTN
- Pulmonary HTN associated with disorders of respiratory system and/or hypoxemia
- Chronic thrombotic and/or embolism disease
- Pulmonary HTN due to disorders directly affecting pulmonary vasculature
Occurs without L heart disease, myocardial disease, congenital heart disease, or any other clinically significant respiratory disease:
Idiopathic PAH or primary PAH
What can cause primary pulmonary HTN:
Ephedra in herbal diet drugs
What primary or secondary pulmonary HTN more common:
Secondary pulmonary HTN
11 secondary pulmonary HTN:
Pulmonary emboli COPD Connective tissue disorders OSA Congenital Heart Disease Sickle cell anemia Cirrhosis AIDS L HF Drug induced typically cocaine Altitudes higher than 8,000ft
PVR equation
80x(PAP-LAP)/CO
PAP equation:
LAP + (COxPVR)/80
What 2 things increase LAP:
- Left ventricular failure
2. Valvular heart disease
What 4 things can increase CO:
- Cirrhosis of liver
- Severe infection/anemia
- Pregnancy
- Hyperthyroidism
4 major categories of chronically increased PVR:
- Pulmonary disease
- Hypoxia without pulmonary disease
- Pulmonary arterial obstruction
- Idiopathic pulmonary arterial HTN
4 acute increases of PVR:
- Hypercarbia
- Acidosis
- Increased sympathetic tone
- Pulmonary vasoconstrictors (catecholamines, serotonin, thromboxane, endothelin)
4 common vague symptoms for pulmonary HTN:
- Breathlessness
- Weakness
- Fatigue
- Abdominal distention
Is there edema in ankles, legs and ascites with pulmonary HTN?
Yes
What 3 things do you see with chest X-ray for pulmonary HTN:
- Prominent pulmonary vessels
- RA enlargement
- RV enlargement
What is Cor Pulmonale?
Right sided heart failure (having to pump against narrowed arteries)
What is more prone to blood clots?
PAH
What 5 things treat pulmonary HTN?
- Supplemental O2
- Anticoagulation
- Diuretics
- Vasodilators
- Surgery (transplant)
With PAP >45% what is the mortality rate?
80%
What 5 things exacerbate (make worse) pulmonary HTN?
- Hypoxemia
- Hypercapnia
- Hypothermia
- Acidosis
- Sympathetic stimulation
Should you use sedatives with pulmonary HTN?
NO
7 steps of symptomatic therapy for pulmonary HTN:
- Improve O2 with 100% O2
- Avoid respiratory acidosis
- Correct metabolic acidosis
- Avoid V/Q mismatch
- Avoid over inflation of alveoli
- Avoid catecholamines release
- Avoid shiver
What to do with increased PVR to decrease PVR:
Hyperventilate with increased pH
No RV failure, can you use inhalational agents?
Yes
Yes RV failure, what 2 things should be used?
Narcotic and relaxant
What 5 things to avoid during induction of pulmonary HTN?
- N2O
- Ketamine
- Etomidate
- Nimbex
- Be careful with using regional
What treatment is preferred for pts with hypotension with chronic pulmonary HTN?
NorE over phenylephrine
Does NO play a large role in inflammation?
Yes
What do these release?
NTG, viagra, sodium nitroprusside
NO
Does CCB and ACE inhibitors increase or decrease NO bioavailability?
Increase
Does hydralazine enhance NO effects?
Yes
Does NSAID’s increase NO?
No, decreases
Are pts at risk of sudden death for pulmonary HTN?
Yes
Selective pulmonary vasodilator that improves ventilation-perfusion matching at low doses in pts with acute respiratory failure?
Inhaled nitric oxide
5 minor cardiac clinical predictors?
- Age
- Abnormal ECG
- Rhythm other than sinus
- History of CVA
- Uncontrolled HTN
5 intermediate cardiac clinical predictors?
- Remote MI (>1month)
- Stable angina
- Compensated CHF
- Creatinine <2.0
- Diabetes
5 high cardiac clinical predictors?
- Acute or recent MI (<1month)
- Unstable or severe angina
- Large ischemic burden
- Decompensated CHF
- Significant arrhythmias
Typical angina-like chest pain with evidence of MI in absence of flow-limiting stenosis on coronary angiography
- exercise induce angina
- NTG, CCB
Prinzmetal’s angina
3 peri operative MI risk predictors:
- Severity of underlying CAD
- Type of surgery (hemodynamic stress and duration)
- MET’s
3 perioperative MI mechanisms:
- Unstable plaque
- Catecholamines
- BP swings
How long to wait for surgery for bare metal stent?
> 6wks
How long to wait for surgery with drug induced stents?
> 12wks
Surgery specific risk of:
- Endoscopic (cholecystectomy, arthroplasty, urologic)
- breast
- skin
- cataracts
Low (<1% mortality)
Surgery specific risk of:
- intraperitoneal/intrathoracic
- orthopedic
- head & neck
- carotid endarterectomy
Intermediate (1-5% mortality)
Surgery specific risk of:
- emergent (in elderly)
- aortic
- peripheral vascular
High (>5% mortality)
Means of expressing the intensity & energy expenditure of activities in a way comparable among persons of different wts:
Metabolic Equivalent of Task (METs)
Energy consumption of an average person seated at rest:
1 MET
Walking at slow pace would require what energy?
2 METs
Light work around house like dusting or washing dishes or climb a flight of stairs of walk up a hill METs?
4
Low METs:
<4
Intermediate METs:
4-10
Excellent METs:
> 10
METs:
- eating
- walking around the house
- dressing
- dishwashing
Low METs
Does low METs increase surgical risk?
YES
METs:
- climbing a flight of stairs
- walking at 4mph
- scrubbing floors
- moving heavy furniture
- golf
Intermediate METs
METs:
- swimming
- singles tennis
- basketball
Excellent METs
What is more detrimental (HR or BP) when stopping beta blockers?
Increase in HR
3 things to prevent peri-op MI:
- Statin therapy (1-4wks before surgery)
- Alpha 2 agonist (if can’t tolerate BB)
- Sugar below 180
In summary for preop cardiac, non-cardiac surgery (6)
- Continue BB
- Alpha 2 agonists
- Continue CCB
- Continue nitrates
- Water sugar
- Sedation okay but give O2
Maintenance for cardiac, non-cardiac surgery (7):
- Deep intubation
- LTA
- Watch for hypotension
- Decrease cardiac O2 requirement
- Slow HR
- Regional okay
- Watch for arrhythmias