NA620 MANAGEMENT OF THE CARDIAC PATIENT TEST 2 – Flashcards
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JOHN: Note that Professor Stone indicated: 1. Places in the notes that will be made into test questions. 2. Drawings about eccentric and concentric hypertrophy. Add these items to your Quizlet/study plan.
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JOHN: Note that Professor Stone indicated: 1. Places in the notes that will be made into test questions. 2. Drawings about eccentric and concentric hypertrophy. Add these items to your Quizlet/study plan.
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All of the following are goals for aortic stenosis EXCEPT: (a) Decreased heart rate (b) Increase or maintain afterload (c) Increase or maintain preload (d) Increase contractility ANSWER: (d) Increase contractility *Note: We do NOT want bradycardia or tachycardia in the setting of aortic stenosis.
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All of the following are goals for aortic stenosis EXCEPT: (a) Decreased heart rate (b) Increase or maintain afterload (c) Increase or maintain preload (d) Increase contractility
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Which of the following does NOT affect O2 supply? (a) Increased heart rate (b) Length at diastole (c) Hemoglobin (d) Contractility ANSWER: (d) Contractility
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Which of the following does NOT affect O2 supply? (a) Increased heart rate (b) Length at diastole (c) Hemoglobin (d) Contractility
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What dysrhythmia is most common with a mitral valve lesion (regurgitation or stenosis)? (a) Atrial Fibrillation (AF) (b) Superventricular Tachycardia (SVT) (c) Ventricular tachycardia (VT) (d) Sinus Tachycardia (ST) ANSWER: (a) Atrial Fibrillation (AF)
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What dysrhythmia is most common with a mitral valve lesion (regurgitation or stenosis)? (a) Atrial Fibrillation (AF) (b) Superventricular Tachycardia (SVT) (c) Ventricular tachycardia (VT) (d) Sinus Tachycardia (ST)
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What is the range of MAP in normotensive patients that cerebral autoregulation occurs? (a) 100-160 (b) 60-130 (c) 50-150 (d) 50-190 ANSWER: (c) 50-150
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What is the range of MAP in normotensive patients that cerebral autoregulation occurs? (a) 100-160 (b) 60-130 (c) 50-150 (d) 50-190
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The normal range for ejection fraction (EF) is: (a) 60-80 mL (b) 30-50 mL (c) 50-90 mL (d) 50-70 mL ANSWER: (a) 60-80 mL
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The normal range for ejection fraction (EF) is: (a) 60-80 mL (b) 30-50 mL (c) 50-90 mL (d) 50-70 mL
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An occlusion of the Right Coronary Artery (RCA) causes an infarction of: (a) the anterior wall (b) the lateral wall (c) the anteroseptal wall (d) the inferior wall ANSWER: (d) the inferior wall
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An occlusion of the Right Coronary Artery (RCA) causes an infarction of: (a) the anterior wall (b) the lateral wall (c) the anteroseptal wall (d) the inferior wall
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A hypertensive crisis is defined as: (a) DBP > 100 mmHg (b) DBP > 130 mmHg (c) SBP > 230 mmHg (d) MAP > 150 mmHg (b) DBP > 130 mmHg
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A hypertensive crisis is defined as: (a) DBP > 100 mmHg (b) DBP > 130 mmHg (c) SBP > 230 mmHg (d) MAP > 150 mmHg
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What percent of cardiac output (CO) is dependent on atrial kick in a normal patient? (a) 25% (b) 35% (c) 45% (d) 15% ANSWER: (a) 25%
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What percent of cardiac output (CO) is dependent on atrial kick in a normal patient? (a) 25% (b) 35% (c) 45% (d) 15%
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The easiest and fastest way to increase the O2 supply to a patient is: (a) Give PBRCs (b) Give narcotics (c) Start a dobutamine infusion (d) Give 100% O2 ANSWER: (d) Give 100% O2
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The easiest and fastest way to increase the O2 supply to a patient is: (a) Give PBRCs (b) Give narcotics (c) Start a dobutamine infusion (d) Give 100% O2
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A patient's pacemaker code is VVI. This code indicates that the pacemaker: (a) Inhibits firing if it senses an atrial depolarization (b) Paces atrial and senses ventricular (c) Paces and senses in the ventricle (d) None of the above ANSWER: (c) Paces and senses in the ventricle
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A patient's pacemaker code is VVI. This code indicates that the pacemaker: (a) Inhibits firing if it senses an atrial depolarization (b) Paces atrial and senses ventricular (c) Paces and senses in the ventricle (d) None of the above
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A patient has an echocardiogram with an ejection fraction (EF) of 25%. This indicates: (a) Mild LV dysfunction (b) Cardiomyopathy (c) Mitral stenosis (d) Normal left ventricular (LV) function ANSWER: (b) Cardiomyopathy
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A patient has an echocardiogram with an ejection fraction (EF) of 25%. This indicates: (a) Mild LV dysfunction (b) Cardiomyopathy (c) Mitral stenosis (d) Normal left ventricular (LV) function
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Which of the following valve lesions would most likely result in concentric hypertrophy? (a) Aortic stenosis (b) Mitral stenosis (c) Aortic regurgitation (d) Mitral regurgitation ANSWER: (a) Aortic stenosis
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Which of the following valve lesions would most likely result in concentric hypertrophy? (a) Aortic stenosis (b) Mitral stenosis (c) Aortic regurgitation (d) Mitral regurgitation
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Mean arterial pressure is determined by: (a) SVR and CO (b) SV and HR (c) SVR and HR (d) SV and CO ANSWER: (a) SVR and CO
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Mean arterial pressure is determined by: (a) SVR and CO (b) SV and HR (c) SVR and HR (d) SV and CO
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Which valve problem may present with both a systolic and a diastolic murmur? (a) Mitral stenosis (b) Mitral regurgitation (c) Aortic stenosis (d) Aortic regurgitation ANSWER: (c) Aortic stenosis
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Which valve problem may present with both a systolic and a diastolic murmur? (a) Mitral stenosis (b) Mitral regurgitation (c) Aortic stenosis (d) Aortic regurgitation ("I don't think I put this one on your test" - was not covered in class but will see on boards).
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Q waves and ST elevation diagnostic for anterior wall infarction would be in what leads? (a) I and aVL (b) V1-V6 (c) V2-v6 (d) II, III, and AVF ANSWER: (c) V2-v6
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Q waves and ST elevation diagnostic for anterior wall infarction would be in what leads? (a) I and aVL (b) V1-V6 (c) V2-v6 (d) II, III, and AVF
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All of the following are true in chronic mitral valve regurgitation EXCEPT: (a) Signs of left ventricular (LV) overload (b) Left ventricular systolic pressure decrease (c) Pulmonary HTN (d) Concentric hypertrophy ANSWER: (d) Concentric hypertrophy *Note that concentric hypertrophy is characteristic of aortic stenosis and eccentric hypertrophy is characteristic of regurgitation/insufficiency.
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All of the following are true in chronic mitral valve regurgitation EXCEPT: (a) Signs of left ventricular (LV) overload (b) Left ventricular systolic pressure decrease (c) Pulmonary HTN (d) Concentric hypertrophy
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What are the most important hemodynamic goals for a patient with aortic stenosis? (a) A normal to high heart rate (HR) (b) Increased SVR (c) Maintain sinus rhythm (SR) ANSWER: (c) Maintain sinus rhythm (SR) *Note that we do NOT want bradycardia or tachycardia in the setting of aortic stenosis.
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What are the most important hemodynamic goals for a patient with aortic stenosis? (a) A normal to high heart rate (HR) (b) Increased SVR (c) Maintain sinus rhythm (SR)
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The minimum recommended UOP during a vascular procedure is: (a) 0.5 mL/kg/hr (b) 0.15 mL/kg/hr (c) 0.05 mL/kg/hr (d) 5 mL/kg/hr *In patients with normal renal function ANSWER: (a) 0.5 mL/kg/hr
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The minimum recommended UOP during a vascular procedure is: (a) 0.5 mL/kg/hr (b) 0.15 mL/kg/hr (c) 0.05 mL/kg/hr (d) 5 mL/kg/hr *In patients with normal renal function
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Which is NOT considered to be a free radical scavenger? (a) lasix (b) mannitol (c) hespan (d) albumin ANSWER: (c) hespan
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Which is NOT considered to be a free radical scavenger? (a) lasix (b) mannitol (c) hespan (d) albumin
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Possible s/s of abdominal aortic aneurysms include: (a) dull back pain in the low back/groin (b) syncope (c) tearing pain (d) all are correct ANSWER: (d) all are correct
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Possible s/s of abdominal aortic aneurysms include: (a) dull back pain in the low back/groin (b) syncope (c) tearing pain (d) all are correct
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The systemic vasculitis most closely associated with smoking is: (a) Thromboangitis Obliterans (Bruerger's disease) (b) Klippel-Trenaunay-Weber Syndrome (c) Wegner's Granulomatosis (d) Kawasaki Disease ANSWER: (a) Thromboangitis Obliterans (Bruerger's disease)
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The systemic vasculitis most closely associated with smoking is: (a) Thromboangitis Obliterans (Bruerger's disease) (b) Klippel-Trenaunay-Weber Syndrome (c) Wegner's Granulomatosis (d) Kawasaki Disease
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Anesthetic management of a patient with Moyamoya disease include all of the following EXCEPT: (a) deep anesthesia (b) normovolemia (c) hyperventilation (d) verification of preoperative coagulation levels ANSWER: (c) hyperventilation
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Anesthetic management of a patient with Moyamoya disease include all of the following EXCEPT: (a) deep anesthesia (b) normovolemia (c) hyperventilation (d) verification of preoperative coagualation levels
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True or False: Hemodynamic responses to aortic cross clamping include: (a) increasing SVR (b) increasing BP (c) increasing HR All responses are True. NOTE →The answer would be false if we were RELEASING the cross clamp. When clamping everything will increase ABOVE the clamp. Everything below the clamp will become hypotensive.
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True or False: Hemodynamic responses to aortic cross clamping include: (a) increasing SVR (b) increasing BP (c) increasing HR
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Spinal cord blood flow and GFR are increased or decreased when the thoracic aorta is clamped? Decreased
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Spinal cord blood flow and GFR are increased or decreased when the thoracic aorta is clamped?
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You are preparing for a carotid endarterectomy. You should: (a) Ensure vasopressors are available consider (b) Consider a LITA tube (c) Have antithrombotics available (d) All are correct ANSWER: (d) All are correct *LITA = Laryngotracheal instillation of Topical Anesthetic
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You are preparing for a carotid endarterectomy. You should: (a) Ensure vasopressors are available (b) Consider a LITA tube (c) Have antithrombotics available (d) All are correct
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The carotid sinus reflex causes: (a) hypotension and tachycardia (b) hypertension and bradycardia (c) hypotension and bradycardia (d) hypertension and tachycardia ANSWER: (c) hypotension and bradycardia
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The carotid sinus reflex causes: (a) hypotension and tachycardia (b) hypertension and bradycardia (c) hypotension and bradycardia (d) hypertension and tachycardia
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A fat embolism usually appears how many hours after a long bone surgery repair? (a) 12-72 hours (b) 6-12 hours (c) 80-120 hours (d) 1-6 hours ANSWER: (a) 12-72 hours
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A fat embolism usually appears how many hours after a long bone surgery repair? (a) 12-72 hours (b) 6-12 hours (c) 80-120 hours (d) 1-6 hours
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True or False: Nipride will reduce aortic cross clamp induced decreases in CO. True *John--be careful here. You may want to research this one, email professor Stone, whatnot.
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True or False: Nipride will reduce aortic cross clamp induced decreases in CO.
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Each of the following are causes of post-operative respiratory depression after carotid surgery EXCEPT: (a) bilateral laryngeal nerve injury (b) massive hematoma (c) high SBP (d) deficient carotid body function ANSWER: (c) high SBP
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Each of the following are causes of post-operative respiratory depression after carotid surgery EXCEPT: (a) bilateral laryngeal nerve injury (b) massive hematoma (c) high SBP (d) deficient carotid body function
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All are advantages of measuring stump pressure EXCEPT: (a) inexpensive (b) extremely accurate (c) continually available (d) relatively easy to obtain ANSWER: (b) extremely accurate *Per Professor Stone, remember that nothing is as accurate as an awake patient. *Also remember that some of these Kahoot questions from Professor Stone are kind of sloppy. Review them, but use the vague ones as guides rather than certainties. *Carotid stump pressure estimates hemispheric blood flow by measuring pressure in the stump distal to the clamp.
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All are advantages of measuring stump pressure EXCEPT: (a) inexpensive (b) extremely accurate (c) continually available (d) relatively easy to obtain
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The artery of adamkiewicz is major blood source to which part of the spinal cord? (a) upper and lower (b) lower 1/3 (c) upper 2/3 (d) lower 2/3 ANSWER: (d) lower 2/3
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The artery of adamkiewicz is major blood source to which part of the spinal cord? (a) upper and lower (b) lower 1/3 (c) upper 2/3 (d) lower 2/3
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All of the following are true regarding pulmonary embolisms (PE) EXCEPT: (a) hemoptysis is always present (b) hypotension occurs (c) hypoxemia occurs (d) chest pain is usually present ANSWER: (a) hemoptysis is always present *Note that hemoptysis can be present, but not necessarily and not always. *Be able to distinguish between a fat embolism and a pulmonary embolism
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All of the following are true regarding pulmonary embolisms (PE) EXCEPT: (a) hemoptysis is always present (b) hypotension occurs (c) hypoxemia occurs (d) chest pain is usually present
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Know the different types of classifications for aortic dissections. *Note: A = ascending B = not ascending
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Know the different types of classifications for aortic dissections. *Note: A = ascending B = not ascending
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The most important technique for renal protection during a AAA repair is: (a) low dose dopamine (b) adequate hydration (c) NTG administration (d) albumin administration ANSWER: (b) adequate hydration
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The most important technique for renal protection during a AAA repair is: (a) low dose dopamine (b) adequate hydration (c) NTG administration (d) albumin administration
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What is the area of the aortic valve? 2.5-3.4 cm2 *The aortic valve is a semilunar valve
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What is the area of the aortic valve?
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What is the area of the pulmonic valve? 2.5-3.8 cm2 *The pulmonic valve is a semilunar valve
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What is the area of the pulmonic valve?
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What is the area of the tricuspid valve? 7 cm2 *The tricuspid valve is an AV valve
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What is the area of the tricuspid valve?
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What is the area of the mitral valve? 4-6 cm2 *The mitral valve is an AV valve
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What is the area of the mitral valve?
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The atrial pressure wave is also known as the __________ wave. CVP
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The atrial pressure wave is also known as the __________ wave.
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The a-wave of the CVP is associated with the __________. atrial contraction Think "A" for "atrial contraction"
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The a-wave of the CVP is associated with the __________.
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For the atrial pressure wave (CVP), normal values are between __________ on the right side of the heart and __________ on the left side of the heart. 0-8 mmHg (right side) 1-10 mmHg (left side)
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For the atrial pressure wave (CVP), normal values are between __________ on the right side of the heart and __________ on the left side of the heart.
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For the atrial pressure wave (CVP), the c-wave is associated with: The back flow of blood from the ventricles/ventricular contraction *Think "C" for "Contraction"
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For the atrial pressure wave (CVP), the c-wave is associated with:
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For the atrial pressure wave (CVP), the v-wave represents: The end of systole and the filling of the atria while the AV valves are shut.
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For the atrial pressure wave (CVP), the v-wave represents:
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Normal stroke volume is approximately: 70 ml
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Normal stroke volume is approximately:
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SV/EDV = EF = __________%. 60%
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SV/EDV = EF = __________%.
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True or False: The difference in EXTERNAL workload is why the left heart is more muscular. True The left side of the heart does 5 to 6 times the work of the right, because it is pumping against 5 to 6 times the pressure (i.e., afterload). The difference in EXTERNAL work is why the left heart is more muscular. The left heart is bigger because it pushes against more.
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True or False: The difference in EXTERNAL workload is why the left heart is more muscular.
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The kinetic work of the heart is different than the external work of the heart. Kinetic energy = the energy a body possesses by virtue of its motion. Kinetic work = (1/2) mv2 Kinetic work = (1/2)(mass)(volume)²
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The kinetic work of the heart is different than the external work of the heart. Kinetic energy = the energy a body possesses by virtue of its motion. Kinetic work = (1/2) mv2 Kinetic work = (1/2)(mass)(volume)²
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True or False: With regard to the kinetic work of the heart, the left and right side of the heart are the same. True Slide 26
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True or False: With regard to the kinetic work of the heart, the left and right side of the heart are the same.
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True or False: Measurement of O₂ consumption per time is a good measurement of the work of the heart. True Slide 27
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True or False: Measurement of O₂ consumption per time is a good measurement of the work of the heart.
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Cardiac function and energy expenditure are influenced by four things. Name them: 1. Preload 2. Afterload 3. Contractility 4. Heart rate Slide 28
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Cardiac function and energy expenditure are influenced by four things. Name them:
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With electrocardiograms (EKGs), the sum of all electrical activity in the heart reflects __________ and not __________. EXCITATION; CONTRACTION Slide 35
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With electrocardiograms (EKGs), the sum of all electrical activity in the heart reflects __________ and not __________.
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With electrocardiograms, the limb leads are composed of leads: Limb leads: I, II, III Slide 36
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With electrocardiograms, the limb leads are composed of leads:
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With electrocardiograms, the chest leads are composed of leads: V1 - V6 Slide 36
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With electrocardiograms, the chest leads are composed of leads:
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With electrocardiograms, the augmented leads are composed of leads: AVR, AVF, AVL Slide 36
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With electrocardiograms, the augmented leads are composed of leads:
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Contraindications to elective surgery: How long should a patient wait to have elective surgery after a METAL stent placement? 4-6 weeks Slide 50
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Contraindications to elective surgery: How long should a patient wait to have elective surgery after a METAL stent placement?
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Contraindications to elective surgery: How long should a patient wait to have elective surgery after the placement of a drug-eluting stent? 1 year/12 months Slide 50
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Contraindications to elective surgery: How long should a patient wait to have elective surgery after the placement of a drug-eluting stent?
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Lead II is associated with: RCA and P-wave/dysrhythmias Slide 37
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Lead II is associated with:
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What EKG lead is used to look for ischemia? V5 at the 5th intercostal space Slide 37
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What EKG lead is used to look for ischemia?
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How is ischemia defined? Ischemia is defined as > 1 mm ST depression or elevation. Slide 37
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How is ischemia defined?
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What is the conversion of mmHg to H₂O? 1 mmHg = 1.36 mm H₂O Slide 40
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What is the conversion of mmHg to H₂O?
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EKG: What 3 (three) leads are associated with the RCA? II, III, AVF *Leads II, III, and AVF are associated with the RCA and covers the right atrium (RA), the SA node, the AV node, and the RV. Slide 60
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EKG: What 3 (three) leads are associated with the RCA?
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EKG: What areas of the heart are covered by leads II, III, and AVF? Right Atrium (RA) SA node AV node Right Ventricle (RV) Slide 60
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EKG: What areas of the heart are covered by leads II, III, and AVF?
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What coronary artery is associated with the "inferior wall?" RCA The RCA feeds the SA node, AV node, RA, and RV. The RCA is monitored by the II, III, and AVF leads. Slide 60
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What coronary artery is associated with the "inferior wall?"
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EKG: What leads are associated with the LAD? V2-V5 (or V6) Slide 60
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EKG: What leads are associated with the LAD?
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EKG: What areas of the heart are covered by leads V3-V5? 1. LAD 2. Anterolateral left ventricle Slide 60
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EKG: What areas of the heart are covered by leads V3-V5?
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What three (3) leads are associated with the LAD? V2-V5 *Leads V2-V5 monitor the anterolateral left ventricle (LV) Slide 60
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What three (3) leads are associated with the LAD?
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EKG: Which two (2) leads monitor the circumflex artery? Lead 1 Lead AVL Slide 60
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EKG: Which two (2) leads monitor the circumflex artery?
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Which two leads monitor the left lateral ventricle? Lead 1 Lead AVL *Note that the left lateral ventricle is supplied by the circumflex artery (Cx). Slide 60
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Which two leads monitor the left lateral ventricle?
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The left lateral ventricle is supplied by which coronary artery? The circumflex artery *The circumflex artery and the left lateral ventricle are monitored by lead I and the AVL lead. Slide 60
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The left lateral ventricle is supplied by which coronary artery?
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Which inhaled (volatile) anesthetic causes coronary steal? Isoflurane *Diseased coronary arteries do not dilate as much as normal coronary arteries, and blood follows the path of least resistance. Coronary steal occurs with isoflurane Slide 75
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Which inhaled (volatile) anesthetic causes coronary steal?
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To avoid sympathetic stimulation and an unwanted spike in blood pressure, Direct Visual Laryngoscopy (DVL) should be limited to < __________ seconds. 15 seconds Slide 100
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To avoid sympathetic stimulation and an unwanted spike in blood pressure, Direct Visual Laryngoscopy (DVL) should be limited to < __________ seconds.
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What NNMB is known to increase BP/HR? Pancuronium Slide 103
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What NNMB is known to increase BP/HR?
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What volatile anesthetics are known to cause histamine release and are therefore associated with hypotension? 1. Atracurium 2. Mivacurium Slide 103
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What volatile anesthetics are known to cause histamine release and are therefore associated with hypotension?
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Systolic murmurs are associated with: Aortic and pulmonary STENOSIS. Mitral and tricuspid INSUFFICIENCY. Slide 121
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Systolic murmurs are associated with: Aortic and pulmonary __________. Mitral and tricuspid __________.
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Diastolic murmurs are associated with: Aortic and pulmonary INSUFFICIENCY. Mitral and tricuspid STENOSIS. Slide 121
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Diastolic murmurs are associated with: Aortic and pulmonary __________. Mitral and tricuspid __________.
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What is the "classic triad" of symptoms associated with aortic stenosis? 1. Angina 2. Dyspnea on exertion 3. Syncope Slide 123
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What is the "classic triad" of symptoms associated with aortic stenosis?
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Aortic stenosis (AS) is associated with __________ ventricular hypertrophy. CONCENTRIC Slide 124
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Aortic stenosis (AS) is associated with __________ ventricular hypertrophy.
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Anesthetic management of aortic stenosis includes: 1. Avoid atrial fibrillation--you need the atrial kick. 2. Maintain sinus rhythm 3. Avoid decreases in CO 4. Avoid bradycardia: a rate of 50 to 60 is the goal 5. Avoid tachycardia, because tachycardia decreases diastolic filling time and also decreases coronary perfusion time. 6. Avoid sudden changes in SVR, CPP 7. Optimize fluid volume to maintain venous return and LV filling *SLOW, FULL, AND FORWARD Slide 126-127
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Anesthetic management of aortic stenosis includes:
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Anesthetic management of aortic stenosis: True or False: A defibrillator should be kept in the room for patients with aortic stenosis due to ineffective chest compression. True Slide 127
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Anesthetic management of aortic stenosis: True or False: A defibrillator should be kept in the room for patients with aortic stenosis due to ineffective chest compression.
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When inducing anesthesia on a patient with aortic stenosis (AS), what type of anesthesia is preferred? General anesthesia is preferred *IV induction agents are not contraindicated *Avoid succinylcholine-induced bradycardia *Consider anticholinergic (e.g., glycopyrrolate) if succinylcholine is needed. Slide 128
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When inducing anesthesia on a patient with aortic stenosis (AS), what type of anesthesia is preferred?
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What type of anesthesia is contraindicated in the setting of severe aortic stenosis? Spinal anesthesia--spinals can drop the blood pressure very quickly. Slide 129
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What type of anesthesia is contraindicated in the setting of severe aortic stenosis?
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List common anesthetic maintenance precautions taken in the setting of aortic stenosis (AS): 1. Maintain CO. Treat persistent tachycardia with esmolol. 2. Convert SVT right on the table. 3. Treat hypotension with neosynephrine 4. Mild aortic stenosis can be treated with an epidural, but NOT SPINAL ANESTHESIA. *Epidural anesthesia has a slower onset that allows treatment of hypotension. Slide 129
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List common anesthetic maintenance precautions taken in the setting of aortic stenosis (AS):
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Anesthetic management of Aortic Stenosis: Describe the strategy of "Slow, Full, and Forward" with regard to the anesthetic management of aortic stenosis. 1. Slow HR, less than 80 BPM. 2. Adequate preload 3. Maintain BP and contractility at all times Slide 130
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Anesthetic management of Aortic Stenosis: Describe the strategy of "Slow, Full, and Forward" with regard to the anesthetic management of aortic stenosis.
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Patients with aortic regurgitation/insufficiency will have __________ hypertrophy of the LV. eccentric (i.e., a big volume hole, and less muscle) Slide 133
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Patients with aortic regurgitation/insufficiency will have __________ hypertrophy of the LV.
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Anesthetic management of aortic insufficiency/regurgitation involves the concepts of "fast, full, and forward." Describe: Fast: Sinus tachycardia Full: Adequate preload Forward: Vasodilators and positive inotropes *Thus, AS = Slow, Full, Forward AI = Fast, Full, Forward
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Anesthetic management of aortic insufficiency/regurgitation involves the concepts of "fast, full, and forward." Describe:
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The cause of mitral stenosis is almost always RHEUMATIC FEVER. *The mitral valve orifice is normally 4-6 cm2. *Patients become symptomatic when the valve orifice is <50% of normal. Slide 138
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The cause of mitral stenosis is almost always __________.
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Mitral stenosis is almost always caused by rheumatic fever. In which gender is mitral stenosis more common? 2/3 of mitral stenosis cases are female. Slide 138
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Mitral stenosis is almost always caused by rheumatic fever. In which gender is mitral stenosis more common?
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Describe the five (5) letter coding system for pacemakers: The first letter is the chamber paced The second letter is the chamber sensed The third letter is the mode of activity Activity = response (R), inhibited (I), triggering (T), and dual (D) Slide 155-156
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Describe the five (5) letter coding system for pacemakers:
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What are the four (4) pathophysiologic hallmarks of congestive heart failure (CHF)? 1. Decreased cardiac output 2. Increased ventricular end-diastolic pressure 3. Peripheral vasoconstriction 4. Metabolic acidosis Slide 164
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What are the four (4) pathophysiologic hallmarks of congestive heart failure (CHF)?
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True or False: In the setting of CHF, pancuronium can cause dysrhythmias. True Slide 169
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True or False: In the setting of CHF, pancuronium can cause dysrhythmias.
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True or False: Calcium increases the effects of digoxin. True Slide 169
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True or False: Calcium increases the effects of digoxin.
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Carotid assessments are BEST performed with what kind of gadget? Duplex ultrasound
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Carotid assessments are BEST performed with what kind of gadget?
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True or False: You should always do a baseline neurological assessment prior to a carotid procedure. True
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True or False: You should always do a baseline neurological assessment prior to a carotid procedure.
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True or False: Antithrombotics are usually continued during carotid procedures. True
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True or False: Antithrombotics are usually continued during carotid procedures.
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Symptoms of carotid disease include: TIA Stroke Asymptomatic bruit Amaurosis fugax What is amaurosis fugax? Loss of vision
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Symptoms of carotid disease include: TIA Stroke Asymptomatic bruit Amaurosis fugax What is amaurosis fugax?
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True or False: Carotid patients are likely to be SYSTEMIC vasculopaths. True
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True or False: Carotid patients are likely to be SYSTEMIC vasculopaths.
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True or False: An arterial line is MANDATORY for carotid procedures. Why? Blood pressure MUST be controlled, and they like these patients somewhat hypertensive to perfuse the brain well.
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True or False: An arterial line is MANDATORY for carotid procedures. Why?
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CPP = MAP - ICP *Internal carotid stump pressure (i.e., the pressure distal to the clamp) must have a minimum of __________ mmHg, or a shunt needs to be placed. 50
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CPP = MAP - ICP *Internal carotid stump pressure (i.e., the pressure distal to the clamp) must have a minimum of __________ mmHg, or a shunt needs to be placed.
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True or False: With carotid procedures, the ability to continuously monitor neurologic status (e.g., by giving the patient a squeaky ball to squeeze) is the ONLY reliable indicator of neurological status.
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True or False: With carotid procedures, the ability to continuously monitor neurologic status (e.g., by giving the patient a squeaky ball to squeeze) is the ONLY reliable indicator of neurological status.
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Isoflurane will provide neurological protection. Desflurane has fast onset/offset, but causes coughing. General anesthesia decreases CMRO2 to protect the brain from ischemia. Propofol allows for early neurological assessment
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Isoflurane will provide neurological protection. Desflurane has fast onset/offset, but causes coughing. General anesthesia decreases CMRO2 to protect the brain from ischemia. Propofol allows for early neurological assessment
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Clamping the carotid (give heparin first) and applying traction on the vessel may cause stimulation of the baroreceptor reflex (e.g., the carotid sinus reflex) which can result in __________ and __________. HYPOTENSION; BRADYCARDIA
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Clamping the carotid (give heparin first) and applying traction on the vessel may cause stimulation of the baroreceptor reflex (e.g., the carotid sinus reflex) which can result in __________ and __________.
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During carotid procedures, EEGs and SSEPs can help determine if the brain is being adequately perfused. However, EEGs and SSEPs are NOT sensitive and/or specific to neurological damage from embolic events, whatnot. What is the ONLY reliable neurological test? An awake patient
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During carotid procedures, EEGs and SSEPs can help determine if the brain is being adequately perfused. However, EEGs and SSEPs are NOT sensitive and/or specific to neurological damage from embolic events, whatnot. What is the ONLY reliable neurological test?
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Brain protective practice during carotid procedures includes: 1. Mild HTN 140-150, MAP 60-80 2. Mild hypercarbia to dilate the cerebral vasculature 3. General anesthesia will decrease CMRO2 and thus decrease the potential for ischemia.
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Brain protective practice during carotid procedures includes:
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Medications for brain protection include: Decrease CMRO2: 1. Pentothal (but barbiturates last a long time) 2. Propofol 3. Hypothermia 4. Free radical scavenger
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Medications for brain protection include:
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Keep blood pressure slightly greater than baseline, or __________% above the patient's normal level during carotid procedures. 20% *AVOID HYPOTENSION AT ALL COSTS *USE PHENYLEPHRINE GTT IF NECESSARY
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Keep blood pressure slightly greater than baseline, or __________% above the patient's normal level during carotid procedures.
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During surgical intervention for renal artery stenosis, what two things are vital? 1. Control of intravascular volume 2. Control of intraoperative blood pressure
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During surgical intervention for renal artery stenosis, what two things are vital?
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What are the characteristics of Takayasu's Arteritis? 1. Rare, idiopathic, chronic progressive occlusive vasculitis of the large vessels 2. Usually affects Asian women < 40 3. Treatment is corticosteroids 4. Can effect CNS, CVS, Lungs, kidneys, and muscles 5. Affects the AORTA***** Anesthetic considerations include: Steroid therapy Anticoagulation Caution with head extension Keep BP normal or slightly increased
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What are the characteristics of Takayasu's Arteritis?
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What major vessel does Takayasu's Arteritis affect? The aorta, and usually in Asian women < 40
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What major vessel does Takayasu's Arteritis affect?
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Thromboangiitis Obliterans (Buerger's disease) is usually associated with the use of __________. Tobacco This disease is characterized by occlusion of medium and small vessels of the extremities and claudication. *Keep them warm
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Thromboangiitis Obliterans (Buerger's disease) is usually associated with the use of __________.
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Wegner's granulomatosis is associated with what type of bad news for anesthesia providers? Airway narrowing *Necrotizing granulomas in airway, CNS, renal, and CV. *Multiple organ involvement *Usually on chronic steroids *Difficult intubation
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Wegner's granulomatosis is associated with what type of bad news for anesthesia providers?
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What organ system is polyarteritis nodosa particularly associated with? Kidneys Polyarteritis nodosa is a vasculitis involving small and medium-sized arteries, especially the KIDNEYS *Patients are usually 30-40 years old *Occurs in men more than women *Associated with Hepatitis B infection *HTN is usually present
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What organ system is polyarteritis nodosa particularly associated with?
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Hepatitis B infection is associated with what rare, weird disease? Polyarteritis nodosa--which is a vasculitis of the KIDNEYS and usually affects men between the ages of 30 and 40.
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Hepatitis B infection is associated with what rare, weird disease?
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Henoch-Schonlein purpura is an inflammation of the arterioles and capillaries of the skin, kidneys, GI tract, and large joints. What age group is Henoch-Schonlein purpura associated with and when does it typically occur? *Henoch-Schonlein purpura occurs in KIDS after RESPIRATORY INFECTIONS. It is treated with steroids.
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Henoch-Schonlein purpura is an inflammation of the arterioles and capillaries of the skin, kidneys, GI tract, and large joints. What age group is Henoch-Schonlein purpura associated with and when does it typically occur?
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Describe Kawasaki disease: 1. Vasculitis with involvement of the coronary arteries 2. Occurs in kids 3. CV is frequently involved 4. Also affects medium-sized muscular arteries 5. Caused by noncontagious infections Symptoms include: 1. Pink-eye 2. Oral mucosa change 3. Enlarged lymph nodes 4. Patchy rashes 5. Peeling skin
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Describe Kawasaki disease:
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Neuraxial blockade is contraindicated in Klippel-Trenaunay-Weber syndrome.
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In which weird disorder is neuraxial blockade contraindicated?
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What are the characteristics of Klippel-Trenaunay-Weber syndrome? 1. "Local giantism" 2. Venous malformations of the extremities, neck, and trunk. 3. Risk of bleeding 4. No neuraxial blockade due to spinal AVMs
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What are the characteristics of Klippel-Trenaunay-Weber syndrome?
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What is the treatment for pulmonary embolism? 1. Heparin 2. Coumadin
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What is the treatment for pulmonary embolism?
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What is a distinguishing characteristic between pulmonary embolisms and fat embolisms? 1. Fat embolisms are associated with petechiae over the neck, shoulders, and chest.
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What is a distinguishing characteristic between pulmonary embolisms and fat embolisms?
