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14 Cards in this Set
- Front
- Back
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What is the best sign of myocardial ischemia in an anesthetized patient?
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ST depression in V5
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If a patient develops signs of ischemia on EKG and has tachycardia what should you do?
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esmolol-titrate up to about 0.5mg/kg
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If a patient develops signs of ischemia on EKG and has tachycardia and hypertension what should you do?
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labetolol-titrate in 5-10mg increments
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If a patient develops signs of ischemia on EKG and has HTN what should you do?
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labetolol or hydralazine
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If a patient develops signs of ischemia on EKG and has hypotension what should you do?
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phenylephrine
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How do you decrease O2 demand in a patient with evidence of myocardial ischemia?
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treat preload increases with nitroglycerin, treat tachycardia with esmolol, treat afterload increases and excessive inotropy with verapamil(the only vasodilator which decreases blood pressure without increasing HR)
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What does T wave inversion tell you about ischemia?
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ischemia is subendocardial
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What does ST elevation tell you about ischemia?
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transmural myocardial ischemia
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When is myocardial reinfarction the most frequent?
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third postop day
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What constitutes a positive stress test?
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ST depression >2mm without a change in blood pressure or HR or the development of hypotension, if depression occurs within the first 3 min of the test it is indicative of high grade disease
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How does the thallium stress test work?
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thallium binds to K and is pumped into normal cells by the Na-K ion exchange pump, it is not pumped into ischemic tissue and these areas appear cold; during exercise coronaries vasodilate, this produces steal from already maximally dilated coronaries
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What does thallium stress test tell you?
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pre and post test thallium will tell you areas that may benefit from revascularization; redistricution indicates the presence of coronary steal and existence of coronary artery disease
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What is considered significant coronary stenosis?
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70% coronary occlusion or 50% left main occlusion
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What consistutes poor LV fxn?
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LVEF<40%, hypokinesis, LVEDP>15, CI<2.2
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