Cv Preop Ap2

Front 1

Branches of the LM are?

Back 1

LAD
Cx

Front 2

Branches of the RCA are

Back 2

Conus
PDA

Front 3

Branches of the LAD are?

Back 3

Dx 1 & 2

Front 4

Branches of the Cx are?

Back 4

OM
Posterilateral

Front 5

What are the determinants of Coronary Perfusion?

Back 5

CPP= DBP- LVEDP
HR-filling time during diastole

Front 6

What is normal Coronary Perfusion Pressure?

Back 6

50-70 torr

Front 7

A result in an increase in LVEDP or decrease in DBP does what to CPP?

Back 7

decreases CPP

Front 8

Determinants of Myocardial O2 supply are?

Back 8

HR
CPP
CaO2
Coronary diameter

Front 9

Determinants of Myocardial O2 demand are?

Back 9

Basal requirements
HR
LV wall tension
Preload-further stretch the more force required to contract (Starlings Law)
Afterload-The higher the afterload the more force required to overcome pressure
Contractility

Front 10

The basic physiology of ischemia is?

Back 10

Demand > Supply

Front 11

This demand > supply relationship occurs how?

Back 11

Marked increase in demand
Marked decrease in delivery
Both

Front 12

What is normal CA O2 consumption?

Back 12

50-75%

Front 13

What is normal systemic O2 consumption?

Back 13

25%

Front 14

Why is the subendocardium more prone to ischemia?

Back 14

Because it has 20% more O2 demand than the other layers

Front 15

Primary cause of CAD?

Back 15

Atherosclerosis

Front 16

Overall incidence of CAD in sx pts?

Back 16

5-10%

Front 17

A good estimate of cardiac reserve is based on what preop question?

Back 17

Exercise tolerance

Front 18

Unstable angina has what characteristics?

Back 18

It is independent of exercise or stress

Front 19

Define the following New York Heart classifications:

Back 19

Class I-No limitations
Class II-Slight limitations (Comfortable at rest)
Class III-Marked limitation-(less than normal activity causes angina)
Class IV-Inability to carry on any physical activity (pain at rest)

Front 20

What characteristics you interested in, in a CXR with a pt with a recent or acute MI?

Back 20

Pulmonary edema

Front 21

A prolonged QT interval is indicative of what potential complications?

Back 21

Ventricular Arrythmia development

Front 22

Overall cardiac assessment should focus on what aspect?

Back 22

Cardiac reserve

Front 23

What will LV function indicate in the planning of Cardiac Sx?

Back 23

The support required for separation from bypass

Front 24

Describe exercise electrocardiography?

Back 24

Exercise treadmill to stress the HR (increase rate) with serial EKG to determine potential ischemia risks

Front 25

Thallium stress testing will reveal what two types of problems?

Back 25

Scarring-constant cold spot-prior infarct
Ischemia-occurs after stressing

Front 26

2-D Echo assessment is good for what aspect of evaluation?

Back 26

Global/Regional cardiac assessment
Detect regional wall motion abnormalities
EF evaluation

Front 27

What is the Gold Standard for evaluation of CAD?

Back 27

Coronary Angiography-used to quantify occlusions
**Must be reviewed prior to CABG by anesthesia personnel

Front 28

The purpose of heparin and ASA in PTCA is for?

Back 28

Prevention of distal balloon clotting when inflated

Front 29

What anticoagulation is used after PTCA?

Back 29

Integrilin, ASA, Plavix

Front 30

What is Plavix?

Back 30

Antiplatelet agent, which inhibits binding of ADP to platelet receptor and subsequent IIB/IIIA complex

Front 31

What is the success rate of PTCA?

Back 31

90%

Front 32

The risk % of abrupt vessel closure is how much?

Back 32

4-8%

Front 33

What is abrupt closure due to?

Back 33

Clot
Dissection
Spasm

Front 34

Risk of death from PTCA?

Back 34

1%

Front 35

Risk of MI?

Back 35

4%

Front 36

Emergency CABG risk?

Back 36

3%

Front 37

Why is PTCA not done on the LM?

Back 37

Because the catheter is not designed for a short vessel such as the LM

Front 38

What happens to the stent post PTCA?

Back 38

Becomes endothelized in several weeks (about 1 mth)

Front 39

Common poststenting anticoagulation includes what drug?

Back 39

Ticlopidine

Front 40

What is Ticlid?

Back 40

Antiplatelet agent, which inhibits binding of ADP to platelet receptor and subsequent IIB/IIIA complex

Front 41

Rotational Artherectomy?

Back 41

Diamond tipped burr that rotates over a guidwire pulverizing plaque into nothing
Good for calcified plaque

Front 42

The difference with directional and rotational artherectomy?

Back 42

Opening on one side with Ballon and cutter on the other-outcomes were worse but less restenosis

Front 43

Translumenal artherectomy extraction?

Back 43

Cuts and sucks out plaque. Good for thrombus that contains plaque in it

Front 44

Excimer Laser uses what type of laser?

Back 44

Xenon

Front 45

IABP is used for what problem?

Back 45

LV failure

Front 46

Where is the balloon placed?

Back 46

Tip at distal aortic arch and above the renal arteries

Front 47

When does inflation occur?

Back 47

At the onset of diastole to propel blood back thru the coronaries and forward systemically

Front 48

When does deflation occur?

Back 48

Just prior to systole

Front 49

Why use MAP during IABP?

Back 49

Because the BP will not be accurate

Front 50

Deflation of the balloon produces what beneficial effect?

Back 50

Reduces impedance to LV ejection by actually pulling blood downward with deflation which will help decrease MVO2 and workload of the heart, and increase CO

Front 51

What will occur with inflation during systole?

Back 51

LV failure
MI
Damage to valve
Arrythmias

Front 52

Goals of IABP use?

Back 52

increase O2 supply
increase CO/EF
increase CPP, Systemic Perfusion
decrease MVO2
decrease HR/PCWP/SVRI

Front 53

Inflation of the balloon produces what beneficial effect?

Back 53

increased Coronary blood flow

Front 54

Triggers for the IABP include?

Back 54

ECG
Arterial Waveform

Front 55

Indications for IABP?

Back 55

LV failure MI
Unstable angina Support for PTCA
Failed PTCA Failure to wean from CPB
Bridge to transplant Stunned Myocardium

Front 56

Triggers for the IABP include?

Back 56

ECG
Arterial Waveform

Front 57

Indications for IABP?

Back 57

LV failure MI
Unstable angina Support for PTCA
Failed PTCA Failure to wean from CPB
Bridge to transplant Stunned Myocardium

Front 58

Contraindications to IABP?

Back 58

Incompetent AV
Aortic Dissection
Severe PVD

Front 59

Complications to IABP?

Back 59

Vascular
Bleeding-Platelets are damaged
Hemodynamic abnormalities
Arrhythmias
Dissection of femoral/iliac arteries
AV fistula
Pseudoaneurysm
Cholesterol embolization

Front 60

How does Integrillin work?

Back 60

By reversibly blocking the IIB/IIIA receptor binding site for fibrinogen, VwF, and other ligands

Front 61

Bleeding complications from IABP will most likely occur where?

Back 61

Cranial
Retroperitoneal
Groin

Front 62

Hemodynamic complications occur from what etiology?

Back 62

HOTN from:
Hypovolemia
Contrast dye-osmotic effect
LV dysfunction due to dye induced toxicity
Evolving MI
Improper timing

Front 63

Describe tx for the following arrhythmia complications with IABP?

Back 63

Bradycardia-Atropine/Pacemaker
Ventricular-Defibrillation/Pharmacological mgmt
SVT-Adenosine

Front 64

Where should PaO2 and Hgb be kept for cardiac sx?

Back 64

Hgb->9-10mg/dl
PaO2->60 torr

Front 65

Complications from ischemia/MI?

Back 65

Papillary muscle rupture
MV dysfunction
Septal infarction/VSD
Rupture of ventricular aneurysm

Front 66

Complications from valve disease?

Back 66

Dislodged throbus
Aortic Disection-Acute AI

Front 67

The need for an emergency reoperation would include?

Back 67

Bleeding
Perivavlular leak
Acute CHF/Pulm edema

Front 68

Emergency cardiac sx with immediate prior interventional cardiac procedures include?

Back 68

Anticoagulation
Acute ischemia
CHF
Cardiac Arrest

Front 69

Evaluation of Ventricular function should include what aspects?

Back 69

CO/CI
EF
LVEDP (normal 4-12)

Front 70

What are the ranges for moderate and severe EF issues?

Back 70

Moderate-35-50%
Severe-<35%

Front 71

CHF is compensated how?

Back 71

By increasing sympathetic tone and increase circulating Catecholamines
Under anesthesia need to maintain this tone

Front 72

When is recommended intervention indicated for pts who have to have their coronaries repaired?

Back 72

4-7 days

Front 73

Complications of an AWMI?

Back 73

LV failure

Front 74

Complications of an IWMI?

Back 74

Bradycardia/Heart Block

Front 75

What body systems will have the worst insults in pts with hx of HTN?

Back 75

Cardiac-exacerbate ischemia with decreased BP
Neuro-CVA with CVA hx or occlusions
Renal-failure with inadequate flow

Front 76

What is a correlated predictor of outcome?

Back 76

Creatinine
1-6-1-9-Moderate risk
>1.9 severe risk

Front 77

Renal protection can be offered how during sx?

Back 77

Mannitol-osmotic diuresis
Lasix-Fluid secretion via the ascending loop
Dopamine-controversial renal DA1 perfusion
Fenoldopam-DA1 agonist-dilation
Maintaining preload and BP

Front 78

Associated comorbidites with Renal failure?

Back 78

Anemia-inability to produce erythropoitin
Cerbrovascular disease-CVA
DM
HTN-decrease perfusion leads to increased Rennin
Plt dysfunction-# may be good but inability to stick is poor

Front 79

Associated comorbidites with DM?

Back 79

Neuropathies
Silent MI
Asymptomatic ST-T wave changes
Autonomic Dysfunction
Decreased Compensatory mechanisms-Labile BP
NPH allergy-Protamine reaction
High BGM-Decreased healing
Poor outcomes for head cases

Front 80

PVD comorbidites in CV sx?

Back 80

Risk of dissection with cannulation
Embolization
Mesenteric Ischemia

Front 81

COPD comorbidites with CV sx?

Back 81

With LV dysfunction
Pulm HTN
Increased PVR

Front 82

Hepatic dysfunction is gauged by what lab values?

Back 82

Serum Albumin cut off is 3

Front 83

Comorbidities with Hepatic dysfunction?

Back 83

Prolonged PT due to coag factor deficiency
decreased Metabolism of drugs
Metabolic Acidosis

Front 84

Lab evaluations for coagulopathies

Back 84

CBC-H/H, Plts
PT/PTT/INR
Bleeding Time
Evaluation of clotting factors
VII, IX,XI, to exclude hemophilia

Front 85

Disease states associated with coagulopathies include?

Back 85

Liver failure
Renal Failure
Congenital blood diseases
von Willebrands disease
Sickle Cell
Leukemia

Front 86

Which is the most undx bleeding disorder?

Back 86

von Willebrand’s disease

Front 87

How is Von Willebrand's tx’d?

Back 87

DDAVP-0.3mcg/kg

Front 88

How does DDAVP work?

Back 88

Will increase efficacy of existing vWf
Will stimulate the release of factors 8, and vWf from the vascular endothelium
Will increase reabsorption of water by increase cellular permeablility in the collecting ducts
Has a greater affinity for V2 receptors (kidneys) than V1 receptors (periphery) (3000:1) so will
have little direct vasopressor activity

Front 89

Which leads monitor the Inferior wall?

Back 89

II, III, avF

Front 90

Which leads monitor the Anterioseptal wall?

Back 90

V1,V2,V3

Front 91

Which leads monitor the Anteroapical wall?

Back 91

V3, V4, V5

Front 92

Which leads monitor the Anterolateral wall?

Back 92

V4, V5, V6

Front 93

Which leads monitor the Posterior wall?

Back 93

VL, V1

Front 94

Which leads monitor the Lateral Wall?

Back 94

I, aVL

Front 95

Which artery is commonly used for arterial monitoring?

Back 95

Right radial b/c the left may give false decrease readings following sternal retraction

Front 96

PA catheter placement may be best placed where?

Back 96

Right IJ as it has direct shot to the heart and less likely to be compromised from retraction

Front 97

What must be done prior after initial CO is done after PA placement?

Back 97

Pull back 2-3 cm at the initiation of CPB because of migration and spontaneous wedge issues
during CPB-must be documented

Front 98

Testing to see if PA cath is in too far?

Back 98

Wedging with <1.5 cc/air in balloon

Front 99

U/O is measured in what stages?

Back 99

Pre/Peri/Post CPB- done every 30 min.

Front 100

What can occur that will be noticed in the UO with CPB times?

Back 100

The longer the run the increased likelihood of hemolysis-can be noticed in the urine

Front 101

Why is the PA inaccurate during CPB?

Back 101

B/C no flow thru the PA- don’t record numbers

Front 102

What extra piece of equipment must be placed on the pt with Re-do pts?

Back 102

External defib pads

Front 103

TEE will provide what information?

Back 103

Qualitative info re: anatomy and function

Front 104

TEE colors indicate what?

Back 104

Blue-flow away from the probe
Red-flow towards the probe

Front 105

TEE provides what valvular assessment?

Back 105

Pressure gradients
Stenosis/Regurgitations

Front 106

BIS is helpful in cardiac sx why?

Back 106

Because the mostly narcotic technique increases risk of recall
Will want electrical silence prior to circulatory arrest