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194 Cards in this Set
- Front
- Back
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Cardiac remodeling happens in response to
a) acute cardiac injury (only) b) chronic cardiac injury (only) c) both acute & chronic injury |
both acute & chronic injury
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Concentric Hypertrophy
a) r/t pressure overload b) r/t volume overload c) stacking sarcomeres d) sarcomeres end-to-end |
r/t pressure overload NO CHANGE IN VOLUME!!
(wall looks like a bagel) stacking sarcomeres |
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T/F Ventricular Hypertrophy is an increase in ventricular mass caused by either pressure overload or volume overload
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True
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Systolic function
a) ability of ventricle to contract & eject blood b) ability of ventricles to relax & accept inflowing blood |
ability of ventricle to contract & eject blood
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Preload
a) load on muscle BEFORE contraction b) load on muscle DURING contraction c) diastolic volume + filling pressure d) systolic volume + generated pressure |
load on muscle BEFORE contraction
diastolic volume + filling pressure = End Diastolic Stress |
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Afterload
a) load on muscle BEFORE contraction b) load on muscle DURING contraction c) diastolic volume + filling pressure d) systolic volume + generated pressure |
load on muscle DURING contraction
systolic volume + generated pressure = End-Systolic stress |
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In abnormal Diastolic function
a) filling pressures of ventricle have NO effect on diastolic volume b) ↑ filling pressures are needed to maintain normal diastolic volume c) ↓ filling pressures are needed to maintain normal diastolic volume |
↑ filling pressures are needed to maintain normal diastolic volume
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Both Systolic & Diastolic phases need energy which requires more?
a) Systolic b) Diastolic |
Systolic
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In the volume loop which area is the afterload represented by?
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Ejection
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Eccentric Hypertrophy
a) r/t pressure overload b) r/t volume overload c) stacking sarcomeres d) sarcomeres end-to-end |
r/t volume overload NO CHANGE IN wall thickness!!
(wall looks like a "O" ring) sarcomeres end-to-end |
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Valvular heart disease injury is caused by
a) volume overload b) pressure changes c) neurohumoral factors d) all of the above |
volume overload
pressure changes neurohumoral factors (cytokine, enzymes, ion channels, oxidative stress) |
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Aortic Stenosis causes
a) ↑ diastolic pressures b) ↓ diastolic pressures c) ↑ systolic pressures d) ↓ systolic pressures e) Hyperdynamic ventricle |
↑ diastolic pressures
↑ systolic pressures (preserved Stroke Volume) Hyperdynamic ventricle |
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Most common type of Congenital Aortic Stenosis
a) Valvular b) Subvalvular c) Supravalvular |
Valvular
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Most common type of Acquired Aortic Stenosis
a) Senile degeneration b) Rheumatic |
Senile degeneration
after the age of 70 rheumatic is rare but can lie dormant for 40 years |
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Congenital Aortic Stenosis valvular types include
a) unicuspid b) bicuspid c) tricuspid |
Unicuspid → single ventricle, evident in infancy, “hypoplastic ♥”, requires Norwood procedure
Bicuspid (most common) → valve calcifies after 30 yo (symptoms 15 – 65 years) Tricuspid with fusion |
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T/F Asymptomatic pts with Aortic Stenosis have a good prognosis & small risk of sudden death
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True
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The "Triad" of symptoms , angina, syncope, and CHF are only seen in which type valvular disease?
a) Aortic Stenosis b) Aortic Regurgitation c) Mitral Stenosis d) Mitral Regurgitation TEST? |
Aortic Stenosis
KNOW!! |
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The normal Aortic Valve area is
a) 2.6 - 3.5 cm2 b) 4 – 6 cm2 c) 0.3 – 0.4 cm2 |
2.6 - 3.5 cm2
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Aortic Stenosis
a) ↑ LVEDP b) ↓ LVEDP c) Concentric Hypertrophy d) Eccentric Hypertrophy |
↑ LVEDP
Concentric Hypertrophy (ventricle is non-compliant and results in POOR coronary filling) |
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When assessing severity of Aortic Stenosis an ECHO
a) uses Bernoulli equation to measure pressure gradient b) can measure remodeling c) determines the cause of LV dysfunction d) used in pt w/ poor transthoracic windows |
uses Bernoulli equation to measure pressure gradient
can measure remodeling (by looking at L atrial size, myocardial thickness, LVEDP/LVESP) |
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In a Dobutamine Stress Echo if valvular pressure gradient ↑’s & there is no change in area of valve
a) valve replacement is beneficial b) valve replacement is not beneficial TEST ? |
valve replacement is beneficial
KNOW!!! |
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Your pt is scheduled for a lap chole & has severe Aortic Stenosis
a) valve replacement must be done before lap chole b) b/c of low risk with lap chole surgery valve replacement can be done @ a later time TEST ? |
valve replacement must be done before lap chole
KNOW!! |
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T/F In a patient having a CABG who has Aortic Stenosis, valve replacement should be done at the same time
TEST ? |
True!!! b/c rate of progression of AS is very HIGH
KNOW!!! |
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Your pt who is going to have Aortic Valve replacement also has Severe CAD is it necessary to do a CABG @ the same time?
TEST ? |
YES!! the risk of doing AVR alone is much HIGHER than if do CABG @ same time
KNOW!! |
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The "mantra" for Aortic Stenosis is
a) Slow, Tight, Full b) Fast, Full, Forward c) Slow (slightly), Tight, Full |
Slow, Tight, Full
Want: ↑ LV preload ↓ (sinus) HR ↑ SVR (avoid HOTN) Constant → contractility & PVR |
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T/F Ntg is a good choice for use in patients with Aortic Stenosis to keep them "full" (preload)
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FALSE!!! it will decrease cardiac output!!
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What drug would be a good choice to control HOTN in a patient with Aortic Stenosis?
a) ephedrine b) phenylephrine c) NTG |
phenylephrine (b/c it is direct acting)
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Goals in a patient with Aortic Stenosis
a) Avoid HOTN b) Control Tachydysrhythmias c) Avoid Hypovolemia d) all of the above |
Avoid HOTN (Neo gtt)
Control Tachydysrhythmias (pacer, Esmolol) Avoid Hypovolemia (fluids) |
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T/F A patient with Aortic Stenosis is @ ↑ risk of ischemia which puts them in "Double Jeopardy"
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True,
there is ↑ MVO2 b/c of thick wall & ↑ afterload ↓ supply b/c of prolonged systolic ejection abn coronaries ↓ CPP d/t ↑ LVEDP KNOW ADBP - LVEDP = CPP |
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The equation for CPP is?
TEST ? |
AoDP - LVEDP = CPP
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Anesthetic technique for pt with Aortic Stenosis
a) light sedation b) cautious induction c) TEE d) treat arrhythmias aggressivley! |
light sedation
cautious induction TEE treat arrhythmias aggressivley! |
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Your patient has an EF of 55% and has been diagnosed with Aortic Regurgitation, is an EF of 55% reliable for this patient?
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NO!! b/c of regurgitation the blood is being "double counted"
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In ACUTE Aortic Regurgitation the stroke volume is
a) increased b) decreased |
decreased, b/c acute is a result of a traumatic dissection, body tries to compensate with SNS response (tachy, contractility)
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Chronic Aortic Regurgitation
a) asymptomatic for years b) Rheumatic fever c) Marfan's Syndrome d) Endocarditis |
asymptomatic for years
Rheumatic fever Marfan's Syndrome Endocarditis |
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In chronic Aortic Regurgitation the stroke volume is
a) increased b) decreased |
increased, b/c LV has slowly become eccentric d/t slow progression
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In Aortic Regurgitation once a patient is symptomatic what is survival rate if no intervention done?
a) 1-2 years b) 3-4 years c) 5-10 years |
5-10 years
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Normal Stroke Volume
a) 20 - 40 ml b) 50 - 70 ml c) 80 - 100 ml d) none of the above |
50 - 70 ml
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In Aortic Regurgitation if stroke volume is 20% of normal patient is considered to have
a) mild regurgitation b) moderate regurgitation c) severe regurgitation |
mild regurgitation
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In Aortic Regurgitation if stroke volume is 40% of normal patient is considered to have
a) mild regurgitation b) moderate regurgitation c) severe regurgitation |
moderate regurgitation
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In Aortic Regurgitation if stroke volume is 60% of normal patient is considered to have
a) mild regurgitation b) moderate regurgitation c) severe regurgitation |
severe regurgitation
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Which of the following types of Aortic Regurgitation require immediate surgery
a) acute b) chronic moderate c) chronic severe d) chronic mild |
acute
chronic moderate chronic severe |
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The "mantra" for Aortic Regurgitation
a) Fast, Full, Forward b) Slow, Tight, Full c) none of the above |
Fast, Full, Forward
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Aortic Regurgitation
a) concentric hypertrophy b) eccentric hypertrophy |
eccentric hypertrophy
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Why would you want to have a heart rate around 90 bpm in a patient with Aortic Regurgitation?
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b/c with a rate like this there is less time for regurg to occur
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T/F With Aortic Regurgitation the goal is to keep SVR low, using ACE Inhibitors would be a good choice to meet this goal
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True, they are vasodilators and would decrease the amount of regurgitation by decreasing SVR
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Would a regional anesthetic be a good choice for a patient with Aortic Regurgitation who was going to have a non-cardiac surgical procedure?
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YES! b/c sympathectomy FAVORS forward flow d/t the vasodilation
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T/F In Mitral Stenosis the RV becomes a pressure ventricle instead of a volume ventricle
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TRUE
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Which type of valve disorder is the ONLY one to cause A-Fib in 75% of all patients
a) Mitral Stenosis b) Aortic Stenosis c) Mitral Regurgitation d) Aortic Regurgitation TEST ? |
Mitral Stenosis
b/c there are a-fib foci all around the pulmonary veins) in her notes it also says Mitral Regurg so guess the key is the Mitral valve |
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In Mitral Stenosis
a) LVEDV is ↓ b) LVEDV is ↑ c) LVEDP is ↓ d) LVEDP is ↑ e) Stroke Vol is ↓ f) Stroke Vol is ↑ |
LVEDV is ↓
LVEDP is ↓ Stroke Vol is ↓ (pt with mitral stenosis will have CHF) |
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A "funnel shaped" mitral valve could be caused from?
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Rheumatic fever
it lies dormant for about 20 yrs Women > Men |
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Which type of valve disorder can cause hoarseness?
a) aortic regurgitation b) aortic stenosis c) mitral regurgitation d) mitral stenosis |
mitral stenosis
b/c the L atrium becomes dilated & pulmonary artery becomes enlarged it presses on the Left Recurrent Laryngeal nerve |
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Normal area of the Mitral valve is
a) 4 - 6 cm2 b) 2.6 - 3.5 cm2 c) are you serious? |
4 - 6 cm2
(smallest area compat. w/ life = 0.3 - 0.4 cm2) (this valve is bigger cause the ventricle is bigger & there is higher pressure that will be pressing back on it as the blood goes out to the body) |
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T/F An ↑ LAP = ↑ PVR = RV dilation/failure
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True!! then you end up with tricuspid regurgitation and peripheral congestion b/c the blood is backing up!
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Systole is what % of filling of ventricle?
a) 10% b) 20% c) 30% d) 40% |
30%
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The MAZE procedure is done to treat what?
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A-fib
a laser procedure that causes scarring that stops the re-entry circuits of A-Fib (used in pts with Mitral valve problems) |
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Mitral Stenosis
a) concentric hypertrophy b) eccentric hypertrophy |
Concentric hypertrophy
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The "mantra" for Mitral Stenosis
a) Slow, Tight, Full b) Fast, Full, Forward |
Slow, Tight, Full
keep HR sinus! blood flow to coronaries happens during diastole |
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T/F With Mitral Regurgitation patient ends up with both Left & Right Heart Failure
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True
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Which type of valve disease has NO Isovolumic Contraction
a) Aortic Stenosis b) Aortic Regurgitation c) Tricuspid Stenosis d) Mitral Regurgitation |
Mitral Regurgitation
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In Mitral Regurgitation
a) large stroke volume b) small end systolic volume c) no isovolumic contraction d) small stroke volume |
large stroke volume
small end systolic volume no isovolumic contraction |
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Most common cause of Mitral Regurgitation is ____________
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Mitral Valve Prolapse
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Mitral Regurgitation is an example of
a) concentric hypertrophy b) eccentric hypertrophy |
Eccentric hypertrophy ( of Left Ventricle)
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An EF of 50% in Mitral Regurgitation
a) severe b) mild c) reversible d) non-reversible |
severe
non-reversible |
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In Mitral Regurgitation an Echo measures regurgitant fraction as compared to normal stroke volume. Moderate MR is represented by what % of normal stroke volume?
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30-39%
mild = <30% Severe = 40-60% |
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A symptomatic patient with Mitral Regurgitation should have surgery when they have which NYHA classification?
a) NYHA I b) NYHA II c) NYHA III d) NYHA IV |
NYHA II
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In Mitral Regurgitation there is a concern about ↑ PVR, which of the following treatments can be helpful in ↓ing PVR
a) 100% FiO2 b) Nitric Oxide c) Milrinone d) Prostacycline |
100% FiO2
Nitric Oxide Milrinone Prostacycline |
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SVO2 is a great monitor, but when is it unreliable?
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When pt is anemic or hypoxic
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The "mantra" for Mitral Regurgitation
a) Fast-Full-Forward b) Slow-Tight-Full |
Fast-Full-Forward
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The primary cause of Tricuspid Stenosis is ________________
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Rheumatic Heart disease
(others include lupus & cancer) |
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S/S of Tricuspid Regurgitation
a) JVD b) Hepatomegaly c) Ascites d) Peripheral Edema |
JVD
Hepatomegaly Ascites Peripheral Edema |
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The "mantra" for Tricuspid Stenosis
a) Fast-Full-Forward b) Slow-Tight-Full |
Slow-Tight-Full
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T/F Tricuspid Regurgitation is usually due to drug abuse, r/t to contamination of valve by IV drugs
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True
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The "mantra" for Tricuspid Regurgitation
a) Fast-Full-Forward b) Slow-Tight-Full |
Fast-Full-Forward
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When choosing which type of cardiac valve to place in a patient what are the considerations?
a) age of pt b) life expectancy c) ability to stay anticoagulated |
age of pt
life expectancy ability to stay anticoagulated |
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T/F All pts receiving mechanical valves will require anticoagulation treatment
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True
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When it comes to Bioprosthetic valves (pig) & Human valves which type of valve requires coumadin therapy?
a) aortic b) mitral |
Mitral
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When it comes to Bioprosthetic valves (pig) which type of valve lasts longer?
a) aortic b) mitral |
aortic
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In Aortic Regurgitation an EF of what hails a need for surgery
a) 65% b) 60% c) < 55% |
< 55%
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Concerning cardiac failure, which of the following increases workload of heart
a) anemia b) HTN c) valve lesions d) congenital diseases |
anemia
HTN valve lesions congenital diseases |
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Causes of Cardiac failure include
a) increased workload b) disorders of the myocardium c) restriction to ventricular filling |
increased workload
disorders of the myocardium restriction to ventricular filling |
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T/F Right heart failure is most often caused by Left heart failure
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True
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Signs & symptoms of Cardiac failure
a) dyspnea b) fatigue @ rest c) confusion d) rales e) ↑ HR @ rest |
dyspnea
fatigue @ rest (↓ cardiac output) confusion (↓ oxygen to brain) rales ↑ HR @ rest also cool, pale extremities, peripheral edema |
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The hallmark sign of chronic LV failure is
a) ↑ LVEDP b) ↓ Ejection Fraction |
↓ Ejection Fraction
will have 3rd ♥ sound co-morbs HTN, DM, OSA, Obesity) |
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Systolic Heart Failure
a) Eccentric hypertrophy b) Concentric Hypertrophy c) found in 50 -70 yr olds d) found in > 70 yr olds |
Eccentric hypertrophy
found in 50 -70 yr olds |
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Diastolic Heart Failure
a) Eccentric hypertrophy b) Concentric Hypertrophy c) found in 50 -70 yr olds d) found in > 70 yr olds |
Concentric Hypertrophy
found in > 70 yr olds |
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Systolic Heart Failure is found more often in
a) Men b) Women |
Men
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↑ LVEDP is a hallmark sign of
a) Systolic Heart Failure b) Diastolic Heart Failure |
Diastolic Heart Failure
will have 4th ♥ sound co-morbs include COPD/Dialysis (in addition to HTN, DM, Obesity, OSA) |
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Treatment for Systolic Heart Failure would include (Test ?)
a) RAAS inhibitors b) β-blockers c) Diuretics d) Digoxin e) Statins |
RAAS inhibitors (ACEI's, Angiotensin II blockers, Aldosterone antagonists)
β-blockers (these are the best ways to treat) others include Diuretics Digoxin Statins |
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T/F Left Ventricular dysfunction regardless of cause → remodeling → dilation & a ↓ EF
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True
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Left Heart Failure caused by
a) pulmonary venous congestion b) systemic venous congestion |
pulmonary venous congestion
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Right Heart Failure caused by
a) pulmonary venous congestion b) systemic venous congestion |
systemic venous congestion
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Low output Cardiac failure d/t
a) CAD b) Myopathic c) anemia d) pregnancy e) severe ↑ thryoid |
CAD
Myopathic |
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High output Cardiac failure d/t
a) CAD b) Myopathic c) anemia d) pregnancy e) severe ↑ thryoid |
anemia
pregnancy severe ↑ thryoid |
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Acute responses by the body to Cardiac failure include
a) ↑ SNS b) ↑ SVR c) ↑ venous return d) ↑ Right atrium pressure |
↑ SNS
↑ SVR ↑ venous return ↑ Right atrium pressure |
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Activation of SNS promotes
a) arterial/venous constriction b) arterial/venous dilation |
arterial/venous constriction
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T/F Frank Starling law describes the ↑ in Stroke volume w/ ↑ LVEDV & ↑ LVEDP
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True, think about a sling shot the farther you pull it back the faster/farther (more volume) something will go
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T/F With the ↑ SNS there are more catechols released
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True, the problem is with chronic heart failure, the body will down-regulate β receptors so there will be alot of Norepi floating around which is Cardiotoxic!!!!
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T/F Vasodilating drugs will worsen LVSV in heart failure
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True
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Altace, lisinopril, enalapril, ramparil, Zestril are examples of what class of drugs?
TEST? |
ACE inhibitors
these drugs lower blood pressure by blocking conversion of angiotensin I to angiotensin II so without angiotensin II blood vessels are allowed to relax / dilate which are the #1 therapy for Systolic heart failure they are good for tx of DILATED CARDIOMYOPATHY |
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What is the #1 predictor of surgical mortality?
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The presence of HEART FAILURE
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Prior to surgery on a patient with Heart Failure which drugs would you want to continue
a) RAAS b) ACEIs c) Digoxin d) β-blockers |
Digoxin
β-blockers |
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Symptoms & Treatment of a NYHA class II patient
a) Pulmonary congestion/ Vasodilators & diuretics b) Peripheral Hypo-perfusion/ Volume replacement c) Congestion & Hypo-perfusion / Inotropes, Vasodilators & IABP |
Pulmonary congestion/ Vasodilators & diuretics
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Symptoms & Treatment of a NYHA class III patient
a) Pulmonary congestion/ Vasodilators & diuretics b) Peripheral Hypo-perfusion/ Volume replacement c) Congestion & Hypo-perfusion / Inotropes, Vasodilators & IABP |
Peripheral Hypo-perfusion/ Volume replacement
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Symptoms & Treatment of a NYHA class IV patient
a) Pulmonary congestion/ Vasodilators & diuretics b) Peripheral Hypo-perfusion/ Volume replacement c) Congestion & Hypo-perfusion / Inotropes, Vasodilators & IABP |
Congestion & Hypo-perfusion / Inotropes, Vasodilators & IABP
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In a myopathic heart stroke volume will be
a) increased b) decreased |
decreased
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TEST ?
End Stage Heart disease is caused by what in 90% of all patients a) CAD b) Cardiomyopathy c) Valve disease d) Congenital disease |
CAD
Cardiomyopathy |
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5 year Mortality rate for a patient in End Stage Heart Disease with CHF is
a) 30% b) 50% c) 70% |
70%
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1 year mortality rate in patient with End Stage Heart Disease is
a) 30% b) 50% c) 70% |
50%
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Pathophysiology of End Stage Heart disease includes
a) ↓ Cardiac Output b) Poor end organ perfusion c) preserved Stroke Volume d) ↓ Stroke Volume |
Cardiac Output
Poor end organ perfusion preserved Stroke Volume (eventually it becomes fixed, but doesn't ↓ because it is preserved by ↑ LVEDV & ECCENTRIC Hypertrophy |
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Goals of treatment of a patient in End Stage Heart Disease include
a) ↑ Cardiac Output b) ↓ SVR c) ↓ Na & H2O retention d) Prevention of thromboembolism |
↑ Cardiac Output
↓ SVR (afterload) ↓ Na & H2O retention Prevention of thromboembolism (d/t sluggish blood flow) |
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Treatment of patients in End Stage Heart Disease includes
a) Inotropes b) Vasodilators c) Anticoagulants d) Diuretics e) β-blockers |
Inotropes (to ↑ contractility)
Vasodilators (to ↓ SVR) Anticoagulants Diuretics β-blockers |
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Contraindications for heart transplant include
a) irreversible pulm HTN b) ETOH abuse c) HIV d) terminal malignancy |
irreversible pulm HTN
ETOH abuse HIV terminal malignancy |
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A heart donor is contraindicated if they have
a) CAD b) valve disease c) EF < 40% d) Syphillis |
CAD
valve disease EF < 40% Syphillis |
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In heart transplants determination for acceptable compatibility is set by
a) ABO compatibility b) Rh factor c) Weight ratio |
ABO compatibility
Weight ratio |
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During donor harvest of a heart is it necessary to use a muscle relaxant on a dead person?
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yes! there will still be spinal reflexes that can cause HTN, ↑ HR, muscle movement
Pavulon is drug of choice |
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Why would you not want to use Neo to maintain hemodynamics in a donor heart pt?
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B/c α agonists cause vasoconstriction!!
Treat HOTN with volume! Dopamine & Albumin are good choices |
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How long between harvest of heart to placement of heart in recipient is optimal for success?
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4 hours clamp to clamp
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98% of heart transplants are
a) orthotopic b) heterotopic |
orthotopic
atrial appendages are thrown out to ↓ clot formation PFO is closed |
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Induction recipe for recipient heart patient
a) Maintain HR, contractility, pre-load & afterload b) Etomidate, Pavulon, Fentanyl c) Steroids d) TEE |
Maintain HR, contractility, pre-load & afterload
Etomidate, Pavulon, Fentanyl Steroids (before ACC comes off) TEE |
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T/F RV dysfunction post bypass is common
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True, because heart is not used to ____________
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In the denervated heart will there be SNS & PNS functions?
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NO!!!
the heart will respond to catechols only Isuprel, Dopamine, Dobutamine, Epinephrine are good drug choices |
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T/F The denervated heart will respond to Atropine
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False!!!
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T/F 90% of all heart recipients will develop HTN
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True
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Survival rates after cardiac transplant: Match the following rates with the years of survival
1 year ........ 79% 3 years ........ 86% 5 years ........ 72% |
1 year ...... 86%
3 years ...... 79% 5 years ...... 72% |
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Cardiomyopathy
a) associated with mechanical dysfunction b) associated with electrical dysfunction c) frequently genetic d) Caused by CAD, HTN, or abnormal valves |
associated with mechanical dysfunction
associated with electrical dysfunction frequently genetic |
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T/F Primary Cardiomyopathy
is confined to the myocardium |
True
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Genetic Cardiomyopathy
a) Hypertrophic b) Dilated only c) Hypertrophic + Dilated (Acquired cause) |
Hypertrophic
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T/F Mixed Primary Cardiomyopathy
is a dilated CM caused by genetic + acquired causes |
True
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Acquired Cardiomyopathy (CM) can be caused by
a) myocarditis b) stress CM c) pregnancy |
myocarditis
stress CM pregnancy |
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Treatment for Hypertrophic Cardiomyopathy includes (choose all that apply)
a) Vasoconstrictors b) Vasodilators c) Calcium Channel Blockers d) β-blockers e) ICDs Test ? |
Vasoconstrictors
Calcium Channel Blockers β-blockers ICDs |
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What is the most common genetic heart disease?
____________________ |
Hypertrophic Cardiomyopathy
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In Hypertrophic Cardiomyopathy myofibril disarray leads to
a) many arrhythmias b) a ventricle that won't relax c) both of the above Test ? |
many arrhythmias
a ventricle that won't relax |
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Mantra for Hypertrophic Cardiomyopathy
a) Fast- Full- Forward b) Slow - Tight - Full c) Slow - Tight - Full - ↓ Contractility |
Slow - Tight - Full - ↓ Contractility
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The venturi effect is seen in which type of Cardiomyopathy
a) Hypertrophic b) Dilated |
Hypertrophic
there is ↓ cardiac output r/t Mitral leaflet being sucked into LV outflow tract Vasoconstrictors will keep valve open & ↓ MR to allow blood to flow AVOID ↓ SVR, sm Vt, ↑ RR Want ↓ contractility |
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T/F In Hypertrophic Cardiomyopathy angina is relieved when pt lays down
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True, when pt lays down it changes cardiac filling (↑’s preload)
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Why is the valsalva maneuver bad in Hypertrophic Cardiomyopathy?
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b/c it ↑’s Left Ventricular Outflow Tract Obstruction (LVOTO)
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In Hypertrophic Cardiomyopathy you would expect the EF to be
a) 25% b) 50% c) 80% |
80%
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Definitive diagnosis for Hypertrophic Cardiomyopathy
a) EF 50% b) Biopsy of myocardium c) Echo |
Biopsy of myocardium
b/c it's GENETIC you would need this to prove it |
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Goal for Hypertrophic Cardiomyopathy would include
a) ↑ preload b) maintain afterload c) ↓ LVOTO |
↑ preload
maintain afterload ↓ LVOTO |
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Anesthetic Considerations for a pt with Hypertrophic Cardiomyopathy
a) use of Neosynephrine for HOTN b) Small Vt, ↑ RR c) TEE use |
use of Neosynephrine for HOTN
Small Vt, ↑ RR TEE use |
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Peripartum Cardiomyopathy is treated just like
a) Hypertrophic CM b) Dilated CM TEST ? |
Dilated CM
b/c these patients have the same symptoms as Dilated CM (SOB, ankle edema etc) in other words same symptoms as Heart Failure pt |
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Mortality r/t Peripartum Cardiomyopathy
a) 10% b) 50% c) 75% TEST ? |
50%
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When does Peripartum Cardiomyopathy usually show up? _______________
|
3rd trimester to 5 months after delivery
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Cardiac output ↑'s the most in a pregnant woman when?
|
72 hours post delivery CO ↑'s by 80% !!!!
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What is the most common type of Cardiomyopathy
a) Hypertrophic b) Dilated |
Dilated
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You would expect EF in a pt with Dilated Cardiomyopathy to be
a) high b) low |
low
|
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T/F CAD & ETOH abuse can cause Dilated Cardiomyopathy
|
True
|
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Systolic function in a pt with Dilated Cardiomyopathy
a) normal b) abnormal |
abnormal
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Signs & Symptoms of Dilated Cardiomyopathy
a) Angina b) ventricular arrhythmias c) MR d) thrombus formation |
Angina
ventricular arrhythmias MR (b/c leaflet is stretched out) thrombus formation (d/t stagnant blood flow) |
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How would Dilated Cardiomyopathy be treated surgically? _____________
|
It can't be treated that way silly!
Even then Medical treatment is only palliative |
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Medical management of Dilated Cardiomyopathy includes
a) digoxin b) Diuretics c) ACEIs d) Anticoagulants e) ICDs |
digoxin
Diuretics ACEIs Anticoagulants ICDs treat them like Heart Failure pt Propofol gtts work well (20mcg/kg/min) |
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What is the most common type of Restrictive Cardiomyopathy?
_______________ TEST ? |
AMYLOIDOSIS
plaque builds up in tissue makes myocardium stiff |
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Patients with Hypertrophic Cardiomyopathy have
a) diastolic dysfunction b) systolic dysfunction c) normal diastolic function TEST ? |
diastolic dysfunction
|
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Systolic anterior movement causes
a) LVOTO b) venturi effect @ LVOT c) mitral regurgitation |
LVOTO
venturi effect @ LVOT mitral regurgitation |
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Absolute Contraindications for using TEE (choose all that apply)
a) Un-repaired TE fistula b) Esophageal obstruction/stricture c) Perforated esophagus d) Coagulopathy e) GI bleeding |
Un-repaired TE fistula
Esophageal obstruction/stricture Perforated esophagus (also poor airway control, uncooperative pt) the other choices are RELATIVE contraindications |
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Is the TEE a good tool to use when need to see behind the trachea?
|
NO!! it cannot penetrate air
won't be able to see aortic arch, aortic isthmus very well |
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#1 Complication of TEE use include
a) Dysphagia & Hoarseness b) Thermal or pressure injury c) Vascular Compression d) inadvertent extubation e) dental trauma TEST? |
dental trauma
|
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TEE can be used in which of the following clinical situations (choose all that apply)
a) Atrial Septal Defect detection b) PFO detection c) During amplatzer device placement |
Atrial Septal Defect detection
b) PFO detection c) During amplatzer device placement |
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Becks Triad includes
a) ↑ CVP b) sm quiet heart sounds c) HOTN TEST ? |
↑ CVP (in other words ↑ jugular venous pressure)
sm quiet heart sounds HOTN |
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T/F Constrictive Pericarditis restricts ventricular filling
TEST ? |
True
|
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Dilated or Hypertrophic Cardiomyopathy would be the most likely diagnosis if a patient between the ages of 10 - 30yrs had an MI
TEST ? |
Hypertrophic because it's genetic, young people don't typically have MI's unless they have bad genes or are snorting coke or doing some other drug
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T/F Treatment of Dilated cardiomyopathy would include ACEIs
TEST ? |
True b/c these drugs cause vasodilation and will improve the blood flow from heart because it won't have to pump so hard with the floppy ventricle to get blood out
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T/F Medical treatment of Dilated Cardiomyopathy includes anticoagulants
TEST ? |
True
|
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T/F Transplant is an option in patients with Restrictive Cardiomyopathies
|
False!!
|
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Constrictive Pericarditis
a) stiff, fibrosed pericardium b) caused by radiation, scarring c) maintains Stroke Volume d) Decreased Stroke Volume |
stiff, fibrosed pericardium
caused by radiation, scarring maintains Stroke Volume rapid filling of ventricle which shows up on wave form as a "square root" sign |
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Pericarditis & Cardiac Tamponade are examples of
_______________ |
Pericardial Membrane Disease
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Acute Cardiac Tamponade mantra ____________________
|
Fast - Tight - Full
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What happens to preload in Tamponade?
|
decreases because there is no atrial/ventricular filling
Ketamine is drug of choice!! |
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T/F In Cardiac Tamponade Stroke Volume becomes fixed & Cardiac Output becomes rate dependent
|
True
|
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Kussmaul's sign, Pulsus Paradoxus & Beck's Triad are all signs of ________________
|
Cardiac Tamponade
|
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Pericardial Effusion
a) chronic ↑ in pericardial fluid b) acute ↑ in pericardial fluid |
chronic ↑ in pericardial fluid
Etomidate, Neo, Albumin, Pavulon good drugs to use |
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Normal amount of pericardial fluid is_______________
|
15 - 50 ml
|
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T/F all pressure volume loops for patients with valve disorder have prolonged systolic ejection phases except Mitral Stenosis
TEST ? |
True
|
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T/F Changes associated with CHF include down regulation of β receptors
TEST ? |
True
|
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T/F From onset of symptoms of angina, the average survival time for a pt with Aortic Stenosis is < 5yrs
TEST ? |
True
|
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T/F you would not want to do a valsalva maneuver on a patient with Aortic Regurgitation
TEST ? |
True
|
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T/F Treat patients with low Cardiac Index & high PCWP with inotropes & vaodilators
TEST ? |
True
|
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T/F ACEI's are a good choice for pts with Hypertrophc CM
TEST ? |
False!!!
|
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T/F Vasoconstrictors are good for pts with Hypertrophic Cardiomyopathy
TEST ? |
True
|
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Beating Heart Coronary
a) aka OPCAB b) requires sternotomy c) does not require sternotomy d) requires bypass e) does not require bypass |
aka OPCAB
requires sternotomy does not require bypass |
|
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Port Access Surgery
a) aka MIDCAB, Keyhole b) requires sternotomy c) does not require sternotomy d) requires bypass e) does not require bypass |
aka MIDCAB, Keyhole
does not require sternotomy requires bypass |
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Transmyocardial Laser Revascularization (TMLR) patient
a) must have EF >25% to do well b) will actually feels worse right after surgery c) has intractable angina d) must have reversible ischemia |
must have EF >25% to do well
will actually feels worse right after surgery has intractable angina must have reversible ischemia |
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T/F TMLR is a laser procedure that makes channels in the myocardium that allows blood flow from ventricle to feed the muscle
|
True, this is known as neocapillarization & is responsible for the palliative outcome (medical tx has not worked on these peeps)
|
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Hoarseness is associated with
a) mitral stenosis b) mitral regurgitation c) aortic stenosis d) aortic regurgitation TEST ? |
Mitral Stenosis
|
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With the onset of angina, the survival rate is what?
a) 1 year b) 2 years c) 5 years d) 10 years TEST ? |
5 years
|
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Moderate Aortic Regurgitation is defined as
a) 10-20% b) 20-40% c) 40-60% |
20-40%
|
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Poor diastolic function is associated with
a) mitral stenosis b) mitral regurgitation c) aortic stenosis d) aortic regurgitation TEST ? |
Aortic Stenosis
|
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Atrial Systole is important with
a) mitral stenosis b) mitral regurgitation c) aortic stenosis d) aortic regurgitation TEST ? |
aortic stenosis
|
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|
Bioprosthetic valves
come stented & non-stented TEST? |
that's the answer
|
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|
Valves preserved in liquid nitrogen can last how long?
a) 5 years b) 7 years c) 10 years d) 15 years TEST ? |
10 years
|
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Hypertrophic Cardiomyopathy is
Genetic & responds best to vasoconstrictors TEST ? |
that's the answer
|
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|
Peripartum cardiomyopathy is treated like
DILATED CARDIOMYOPATHY TEST ? |
that's the answer
|
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|
Hypertrophic cardiomyopathy is suspected in young people with MI's
TEST ? |
that's the answer
|
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|
Peripartum Cardiomyopathy has what mortality rate
a) 10% b) 25% c) 30% d) 50% TEST ? |
50%
|
