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Co-Existing Disease 1 > Week 1 (Exam 1) > Flashcards

Week 1 (Exam 1) Flashcards

1
Q

SV equation:

A

EDV-ESV

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2
Q

Normal SV:

A

60-100ml

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3
Q

CO equation and normal amount:

A

SVxHR

3-9L/min

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4
Q

Increased LVEDP may be caused by:

A

Aortic stenosis

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5
Q

Pressure of blood in thoracic vena cava, near the right atrium:

A

Central venous pressure

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6
Q

8 factors that increase CVP:

A
  1. Hypervolemia
  2. Forced exhalation
  3. Tension pneumothorax
  4. HF
  5. Pleural effusion
  6. Decreased CO
  7. Cardiac tamponade
  8. Mechanical ventilation with PEEP
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7
Q

3 factors that decrease CVP:

A
  1. Hypovolemia
  2. Deep inhalation
  3. Distributive shock
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8
Q

Indirect measure of left atrial pressure:

A

Pulmonary capillary wedge pressure

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9
Q

Normal PCWP:

A

6-12mmHg

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10
Q

3 gold standard determining causes from PCWP:

A
  1. Acute pulmonary edema
  2. LV failure and mitral stenosis
  3. Failure of LV output
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11
Q

What is pulmonary edema with normal PCWP:

A

ARDS or non-cardiogenic pulmonary edema (opiate poisoning)

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12
Q

Vasodynamic parameter relating CO to body surface area (BSA)

A

Cardiac Index (CI)

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13
Q

Normal CI:

A

2.1-4.9 L/min/m2

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14
Q

PaO2 equation:

A

102-(age x .3)

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15
Q

Performance of cardiac muscle:

-frank starling’s law

A

Contractility

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16
Q

Force or enters of muscular contractions

A

Inotropic

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17
Q

Changes the HR

A

Chronotropic

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18
Q

Coronary blood flow inadequate to meet the demands of the myocardium:

A

Ischemic heart disease

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19
Q

6 things that decrease supply to heart:

A
  1. Tachycardia
  2. Decreased O2 content
  3. Anemia
  4. Arterial hypoxemia
  5. Hypocapnia
  6. Hypotension
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20
Q

3 things that increase demand to heart:

A
  1. Sympathetic nervous system (tachycardia and HTN)
  2. Increased myocardial contractility
  3. Increased preload and afterload
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21
Q

CorPP equation:

A

Arterial diastolic pressure - LVEDP

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22
Q

CPP of at least what is thought to be necessary for return of spontaneous circulation (ROSC):

A

15mmHg

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23
Q

Coronary filling during systole?

A

NO

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24
Q

Coronary filling during diastole?

A

Yes

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25
Q

Point where QRS ends and ST segment begins:

A

J-point

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26
Q

Is j-point more horizontal or vertical?

A

More horizontal

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27
Q

ST segment elevation with upward convexity:

A

Benign, especially in healthy, asymptomatic individuals

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28
Q

ST segment elevation with downward concavity:

A

Due to acute coronary syndrome

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29
Q

Leads that have inferior view of heart:

A

II, III, aVF

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30
Q

Leads that have lateral view of heart:

A

I, aVL, V5, V6

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31
Q

Leads that have anterior view of heart:

A

V3, V4

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32
Q

Leads that have septal view of heart:

A

V1, V2

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33
Q

4 EKG criteria for ischemia:

A
  1. 2mm depression, 8ms after J point in up slope ST segment
  2. 1mm depression, 60-80ms after J point in horizontal ST segment
  3. ST segment elevation
  4. T wave inversion
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34
Q

Which lead is more important tool for LV ischemia:

A

V5

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35
Q

Which lead is most important for RCA ischemia:

A

Lead II

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36
Q

Cardiac marker used to assist diagnoses of an acute myocardial infarction:

A

Troponin

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37
Q

BP increase because SVR increased

Work of heart and O2 demand increased because of increase in afterload

A

Increased ABP

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38
Q

3 treatment options for increased ABP:

A
  1. Increase anesthetic depth
  2. Give hydralazine
    3 nitroprusside/NTG
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39
Q

Treatment to increased HR:

A

Beta antagonist

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40
Q

2 treatments for decreased ABP:

A
  1. Decrease anesthetic depth

2. Give vasoconstrictor (phenyl)

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41
Q

What event has occurred with decreased ABP and increased PCWP:

A

Heart failure; LV failure

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42
Q

3 treatments for decreased ABP and increased PCWP:

A
  1. Phenyl
  2. Positive inotrope
  3. NTG (dilate veins)
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43
Q

Difference between NTG and nitroprusside?

A

NTG: vasodilates veins
Nitroprusside: vasodilates veins and arteries

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44
Q

Treatment for normal hemodynamics:

A

NTG or Calcium channel blocker

45
Q

3 things to do with normal hemodynamics to return heart:

A
  1. Slow rate
  2. Small state
  3. Perfused state
46
Q

Definition of pulmonary HTN:

A

Mean PAP > 25mmHg at rest

Mean PAP > 30mmHg with exercise

47
Q

What is normal mean PAP:

A

12-16mmHg

48
Q

Normal pulmonary circulation can accommodate changes in flow rates from:

A

6 to 25 L/min

49
Q

enlargement and failure of RV as a response to increased vascular resistance:

A

Cor Pulmonale

50
Q

5 major categories of pulmonary HTN:

A
  1. Pulmonary arterial HTN
  2. Pulmonary venous HTN
  3. Pulmonary HTN associated with disorders of respiratory system and/or hypoxemia
  4. Chronic thrombotic and/or embolism disease
  5. Pulmonary HTN due to disorders directly affecting pulmonary vasculature
51
Q

Occurs without L heart disease, myocardial disease, congenital heart disease, or any other clinically significant respiratory disease:

A

Idiopathic PAH or primary PAH

52
Q

What can cause primary pulmonary HTN:

A

Ephedra in herbal diet drugs

53
Q

What primary or secondary pulmonary HTN more common:

A

Secondary pulmonary HTN

54
Q

11 secondary pulmonary HTN:

A 
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
55
Q

PVR equation

A

80x(PAP-LAP)/CO

56
Q

PAP equation:

A

LAP + (COxPVR)/80

57
Q

What 2 things increase LAP:

A
  1. Left ventricular failure

2. Valvular heart disease

58
Q

What 4 things can increase CO:

A
  1. Cirrhosis of liver
  2. Severe infection/anemia
  3. Pregnancy
  4. Hyperthyroidism
59
Q

4 major categories of chronically increased PVR:

A
  1. Pulmonary disease
  2. Hypoxia without pulmonary disease
  3. Pulmonary arterial obstruction
  4. Idiopathic pulmonary arterial HTN
60
Q

4 acute increases of PVR:

A
  1. Hypercarbia
  2. Acidosis
  3. Increased sympathetic tone
  4. Pulmonary vasoconstrictors (catecholamines, serotonin, thromboxane, endothelin)
61
Q

4 common vague symptoms for pulmonary HTN:

A
  1. Breathlessness
  2. Weakness
  3. Fatigue
  4. Abdominal distention
62
Q

Is there edema in ankles, legs and ascites with pulmonary HTN?

A

Yes

63
Q

What 3 things do you see with chest X-ray for pulmonary HTN:

A
  1. Prominent pulmonary vessels
  2. RA enlargement
  3. RV enlargement
64
Q

What is Cor Pulmonale?

A

Right sided heart failure (having to pump against narrowed arteries)

65
Q

What is more prone to blood clots?

A

PAH

66
Q

What 5 things treat pulmonary HTN?

A
  1. Supplemental O2
  2. Anticoagulation
  3. Diuretics
  4. Vasodilators
  5. Surgery (transplant)
67
Q

With PAP >45% what is the mortality rate?

A

80%

68
Q

What 5 things exacerbate (make worse) pulmonary HTN?

A
  1. Hypoxemia
  2. Hypercapnia
  3. Hypothermia
  4. Acidosis
  5. Sympathetic stimulation
69
Q

Should you use sedatives with pulmonary HTN?

A

NO

70
Q

7 steps of symptomatic therapy for pulmonary HTN:

A
  1. Improve O2 with 100% O2
  2. Avoid respiratory acidosis
  3. Correct metabolic acidosis
  4. Avoid V/Q mismatch
  5. Avoid over inflation of alveoli
  6. Avoid catecholamines release
  7. Avoid shiver
71
Q

What to do with increased PVR to decrease PVR:

A

Hyperventilate with increased pH

72
Q

No RV failure, can you use inhalational agents?

A

Yes

73
Q

Yes RV failure, what 2 things should be used?

A

Narcotic and relaxant

74
Q

What 5 things to avoid during induction of pulmonary HTN?

A
  1. N2O
  2. Ketamine
  3. Etomidate
  4. Nimbex
  5. Be careful with using regional
75
Q

What treatment is preferred for pts with hypotension with chronic pulmonary HTN?

A

NorE over phenylephrine

76
Q

Does NO play a large role in inflammation?

A

Yes

77
Q

What do these release?

NTG, viagra, sodium nitroprusside

A

NO

78
Q

Does CCB and ACE inhibitors increase or decrease NO bioavailability?

A

Increase

79
Q

Does hydralazine enhance NO effects?

A

Yes

80
Q

Does NSAID’s increase NO?

A

No, decreases

81
Q

Are pts at risk of sudden death for pulmonary HTN?

A

Yes

82
Q

Selective pulmonary vasodilator that improves ventilation-perfusion matching at low doses in pts with acute respiratory failure?

A

Inhaled nitric oxide

83
Q

5 minor cardiac clinical predictors?

A
  1. Age
  2. Abnormal ECG
  3. Rhythm other than sinus
  4. History of CVA
  5. Uncontrolled HTN
84
Q

5 intermediate cardiac clinical predictors?

A
  1. Remote MI (>1month)
  2. Stable angina
  3. Compensated CHF
  4. Creatinine <2.0
  5. Diabetes
85
Q

5 high cardiac clinical predictors?

A
  1. Acute or recent MI (<1month)
  2. Unstable or severe angina
  3. Large ischemic burden
  4. Decompensated CHF
  5. Significant arrhythmias
86
Q

Typical angina-like chest pain with evidence of MI in absence of flow-limiting stenosis on coronary angiography

  • exercise induce angina
  • NTG, CCB
A

Prinzmetal’s angina

87
Q

3 peri operative MI risk predictors:

A
  1. Severity of underlying CAD
  2. Type of surgery (hemodynamic stress and duration)
  3. MET’s
88
Q

3 perioperative MI mechanisms:

A
  1. Unstable plaque
  2. Catecholamines
  3. BP swings
89
Q

How long to wait for surgery for bare metal stent?

A

> 6wks

90
Q

How long to wait for surgery with drug induced stents?

A

> 12wks

91
Q

Surgery specific risk of:

  • Endoscopic (cholecystectomy, arthroplasty, urologic)
  • breast
  • skin
  • cataracts
A

Low (<1% mortality)

92
Q

Surgery specific risk of:

  • intraperitoneal/intrathoracic
  • orthopedic
  • head & neck
  • carotid endarterectomy
A

Intermediate (1-5% mortality)

93
Q

Surgery specific risk of:

  • emergent (in elderly)
  • aortic
  • peripheral vascular
A

High (>5% mortality)

94
Q

Means of expressing the intensity & energy expenditure of activities in a way comparable among persons of different wts:

A

Metabolic Equivalent of Task (METs)

95
Q

Energy consumption of an average person seated at rest:

A

1 MET

96
Q

Walking at slow pace would require what energy?

A

2 METs

97
Q

Light work around house like dusting or washing dishes or climb a flight of stairs of walk up a hill METs?

A

4

98
Q

Low METs:

A

<4

99
Q

Intermediate METs:

A

4-10

100
Q

Excellent METs:

A

> 10

101
Q

METs:

  • eating
  • walking around the house
  • dressing
  • dishwashing
A

Low METs

102
Q

Does low METs increase surgical risk?

A

YES

103
Q

METs:

  • climbing a flight of stairs
  • walking at 4mph
  • scrubbing floors
  • moving heavy furniture
  • golf
A

Intermediate METs

104
Q

METs:

  • swimming
  • singles tennis
  • basketball
A

Excellent METs

105
Q

What is more detrimental (HR or BP) when stopping beta blockers?

A

Increase in HR

106
Q

3 things to prevent peri-op MI:

A
  1. Statin therapy (1-4wks before surgery)
  2. Alpha 2 agonist (if can’t tolerate BB)
  3. Sugar below 180
107
Q

In summary for preop cardiac, non-cardiac surgery (6)

A
  1. Continue BB
  2. Alpha 2 agonists
  3. Continue CCB
  4. Continue nitrates
  5. Water sugar
  6. Sedation okay but give O2
108
Q

Maintenance for cardiac, non-cardiac surgery (7):

A
  1. Deep intubation
  2. LTA
  3. Watch for hypotension
  4. Decrease cardiac O2 requirement
  5. Slow HR
  6. Regional okay
  7. Watch for arrhythmias

Co-Existing Disease 1 (8 decks)

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