Cardiac Anesthesia Exam

Front 1

What is the normal CO?
What is the CO formula?

Back 1

5-6L/min
CO= SV * HR

Front 2

What is the normal CI?

Back 2

2-5L/min

Front 3

How does coronary vascularture drain into the right atrium?

Back 3

Coronary sinus

Front 4

What is normail coronary blood flow in cc/min; cc/gm/min?

Back 4

225-250cc/min
0.6-0.9cc/gm/min

Front 5

How much of the CO does the coronary arteries receive?

Back 5

4-7%

Front 6

What is normal myocardial O2 consumption (MVO2)?

Back 6

8-10cc/gm/min

Front 7

What are the average heart sizes for females and males?

Back 7

Males: 280-340
Females: 230-280

Front 8

What MAP does coronary artery autoregulation occur?

Back 8

50-150mmHg

Front 9

When O2 demand exceeds supply, what develops??

Back 9

Ischemia

Front 10

How much O2 does the heart extract from received blood?

Back 10

65-70%

Front 11

What happens to the autoregulation curve in an HTN patient?

Back 11

Shifts to the right

Front 12

What are some manifestations of ischemia?

Back 12

EKG changes
Angina
Impaired contractility
Dysrhythmias- RCA stenosis

Front 13

How do you treat coronary ischemia?

Back 13

Increase O2 supply (supplemental O2, bypass surgery, blood transfusion, vasodilator)

Decrease O2 demand (HR control, rest, MSO4)

Front 14

What is the formula for coronary perfusion pressure?

Back 14

CPP= DBP-LVEDP
LVEDP is the pressure in the LV at the end of diastole
DBP is the driving pressure in the aorta during diastole

Front 15

What are the complications of bare metal cardiac stents?

Back 15

Scar tissue can lead to reocclusion

Front 16

What is the most common stent and what regimen must the pt be on?

Back 16

Drug eluting stent are the most common.
Pt must be anticoagulated, on plavix for a year. Drug eluting stents heal more slowly and do not form scar tissue.

Front 17

What part of the heart does the LAD supply?

Back 17

Anterior 2/3 of vent septum
RBB
LBB
LV: apical wall, ant lateral wall
Anterior papillary muscle of MV (cX artery)

Front 18

What part of the heart does the RCA supply?

Back 18

RV
25-30% of LV
SA node

Front 19

What does it mean when someone is "right dominant"?

Back 19

PDA comes off of RCA. This occurs in 70-85% of population

Front 20

What part of the heart does the Cx supply?

Back 20

Posterolateral LV
Anterolateral Papillary muscle
SA node (38% of pop)
Left dominant: 45-50% LV

Front 21

What part of the heart does the PDA supply?

Back 21

Inferior wall
Ventricular septum (posterior 2/3)
Posteromedial papillary muscle (mitral valve)

Front 22

What is the most common papillary muscle damage during ischemia and why?

Back 22

Posteromedial papillary muscle because only one coronary artery (PDA) perfuses this muscle.

Front 23

In coronary dominance, what does "right dominant" mean?

Back 23

RCA gives rise to PDA to supply the posterior inferiior aspect of the LV (70-85% of population)

Front 24

In coronary dominance, what does "left" dominant mean?

Back 24

The posterior inferior portion of the LV is supplied by either the Cx (left dominant) or both RCA and Cx (co-dominant (15-20%))

Front 25

The mitral valve has two muscles, what are the muscles and what CA perfuse them?

Back 25

1. Anterolateral papillary muscle; two blood supplies (LAD and LCx)

2. Posteromedial papillary muscle; supplied only by the PDA

Front 26

Inferior wall MI; what EKG leads show changes; what are the S/S; and what rhythm changes will you see?

Back 26

Leads II, III, aVF
RCA blockage
1st degree heart block or 2nd degree type1
S/S: hypotension and JVD

Front 27

What leads will show changes for anterior wall MI?

Back 27

V3 and V4

Front 28

What leads will show changes for septal wall MI?

Back 28

V1 and V2

Front 29

What leads will show changes for Lateral wall MI?

Back 29

I, aVL, V5 and V6

Front 30

Anterior wall MI will have blockage in what CA?

Back 30

LAD

Front 31

What arrhythmia will an anterior wall MI show?

Back 31

2nd degree type II or 3rd degree heart block.

Front 32

Septal wall MI will have blockage in what CA?

Back 32

LCA

Front 33

What arrhythmia will an septal wall MI show?

Back 33

2nd degree type II and Bundle branch blocks

Front 34

Lateral wall MI will have blockage in what CA?

Back 34

Cx and LCA

Front 35

What arrhythmia will an lateral wall MI show?

Back 35

2nd type II
3rd degree
BBB

Front 36

What leads will show changes for posterior wall MI?

Back 36

V1-3

Front 37

Posterior wall MI will have blockage in what CA?

Back 37

RCA

Front 38

What arrhythmias will show in a posterior wall MI?

Back 38

2nd degree type II
3rd degree
PVCs
VF
VT
LV failure with breathlessness

Front 39

What is the max Hespan ml/kg to give?

Back 39

20ml/kg

Front 40

What doesn't plasmoid contain that LR does contain?

Back 40

Calcium

Front 41

What are some indications for CVP

Back 41

Rapid fluid administration
Need for PA cath
Transvenous pacing
TPN
Hemodialysis
Operations at risk for VAE
Cardioactive drugs

Front 42

When do you inflate ballon on PA cath? At what cm?

Back 42

20cm

Front 43

SVO2 correlates with what other parameter as longs as O2 consumption is constant?

Back 43

Cardiac index

Front 44

What factors affect sVO2

Back 44

Arterial content
CO
O2 utilization

Front 45

What caused decreases in SVO2?

Back 45

ARDS
MI, CHF, Hypovolemia
Fever, exercise, agitation, shivering, thyrotoxicosis
Bleeding, hemolysis, abnormal Hgb
Hypoxia, vent changes

Front 46

What causes increased SVo2

Back 46

Sepsis, burns, L to R shunt, AV fistula, hepatitis, pancreatitis, inotropes
Cyanide toxicity, carbon monoxide poisoning, methemaglobin, hypothermia

Front 47

What is the most common cause of increased SVO2?

Back 47

Wedged catheter

Front 48

A-line waveform upstroke and downstroke show what?

Back 48

Upstroke- systole
Downstroke- diastole

Front 49

What does the anacrotic upstroke of aline waveform show?

Back 49

contractility

Front 50

Aline waveform, what does the area under the curve show?

Back 50

Stroke volume

Front 51

What does the entire aline waveform limb show?

Back 51

SVR

Front 52

CVP monitoring: What do the a,c, and v waves show?

Back 52

A- atrial contraction
C- ventricular contraction
V-filling of atrium

Front 53

CVP: what do large A waves indicate?

Back 53

Tricupsid stenosis, RVH, or junctional rhythm

Front 54

CVP: What do lare C waves indicate?

Back 54

Tricupsid regurg

Front 55

What do C waves correlate with on the eKG? A waves?

Back 55

QRS correlates with C wave
P correlates with A wave

Front 56

CVP monitoring: What does the x and y wave represent on a CVP waveform?

Back 56

X= atrial diastole
Y= Atrial emptying

Front 57

PA cath: Large V waves indicate:

Back 57

Mitral Regurg

Front 58

What two CA supply the anterolateral papillary muscle?

Back 58

LAD and Cx

Front 59

If a pt has a LBBB and you float a PA cath, what rhythm are you at risk for putting the pt in?

Back 59

Complete HB because you can cause a RBBB if the cath irritates the right ventricle wall.

Front 60

Why is TEE used in MV case and not AV cases?

Back 60

Because MV are repaired (they want to see if the repair has stopped the regurg) and AV are replaced.

Front 61

RCA stenosis places the pt at greatest risk for _____.

Back 61

Arrhythmias

Front 62

If a patient has LMCA stenosis or proximal LAD, what must their MAP be maintained at?

Back 62

80-90.. increases perfusion pressure

Front 63

Pt with EF<25% most often requires what?

Back 63

IABP

Front 64

What is dyskinesis?

Back 64

Dyskinesis- when contracts moves muscle down. Working against normal contraction of the heart muscle

Front 65

What are the most stimulating points of cardiac anesthesia?

Back 65

laryngoscopy, incision, sternomy, retraction, opening of pericardium

Front 66

PA cath: Large V waves indicate:

Back 66

Mitral Regurg

Front 67

What two CA supply the anterolateral papillary muscle?

Back 67

LAD and Cx

Front 68

If a pt has a LBBB and you float a PA cath, what rhythm are you at risk for putting the pt in?

Back 68

Complete HB because you can cause a RBBB if the cath irritates the right ventricle wall.

Front 69

Why is TEE used in MV case and not AV cases?

Back 69

Because MV are repaired (they want to see if the repair has stopped the regurg) and AV are replaced.

Front 70

RCA stenosis places the pt at greatest risk for _____.

Back 70

Arrhythmias

Front 71

If a patient has LMCA stenosis or proximal LAD, what must their MAP be maintained at?

Back 71

80-90.. increases perfusion pressure

Front 72

Pt with EF<25% most often requires what?

Back 72

IABP

Front 73

What is dyskinesis?

Back 73

Dyskinesis- when contracts moves muscle down. Working against normal contraction of the heart muscle

Front 74

What are the most stimulating points of cardiac anesthesia?

Back 74

laryngoscopy, incision, sternomy, retraction, opening of pericardium

Front 75

PA cath: Large V waves indicate:

Back 75

Mitral Regurg

Front 76

What two CA supply the anterolateral papillary muscle?

Back 76

LAD and Cx

Front 77

If a pt has a LBBB and you float a PA cath, what rhythm are you at risk for putting the pt in?

Back 77

Complete HB because you can cause a RBBB if the cath irritates the right ventricle wall.

Front 78

Why is TEE used in MV case and not AV cases?

Back 78

Because MV are repaired (they want to see if the repair has stopped the regurg) and AV are replaced.

Front 79

RCA stenosis places the pt at greatest risk for _____.

Back 79

Arrhythmias

Front 80

If a patient has LMCA stenosis or proximal LAD, what must their MAP be maintained at?

Back 80

80-90.. increases perfusion pressure

Front 81

Pt with EF<25% most often requires what?

Back 81

IABP

Front 82

What is dyskinesis?

Back 82

Dyskinesis- when contracts moves muscle down. Working against normal contraction of the heart muscle

Front 83

What are the most stimulating points of cardiac anesthesia?

Back 83

laryngoscopy, incision, sternomy, retraction, opening of pericardium

Front 84

What are some effects of N20?

Back 84

Second gas effect
Analgesic
Stimulates SNS- ischemia
Increases PVR
Limits O2 concentration
Increased Truncal Rigidity
ELARGES INTRAVASCULAR AIR BUBBLES

Front 85

what are some effects of isoflurane?

Back 85

Maintains CO
Lowers SVR
Myocardial Steal Phenomenon
Potentiates MR
Reflex Tachycardia
Inhibits Hypoxic pulmonary vasoconstiction

Front 86

what are some effects of desflurance

Back 86

Similar to Isoflurane
Rapid increases in concentrations lead to tachycardia.
Does not increase coronary artery blood flow ( steal phenomenon not an issue)

Front 87

What are some of the effects of sevoflurane

Back 87

Nonpungent- great for inhalational induction.
SVR declines slightly less than ISO and DES
Causes little rise in HR
No evidence of Steal Phenomenon.
Metabolite flouride may potentially cause nephrotoxicity.
Long duration and low flow anesthesia potentiate Compound A accumulation

Front 88

Name some of the effects of ketamine

Back 88

Dissociative anesthetic
Analgesia
Increased MVO2
Increase secreations
Increases BP, HR and CO
Myocardial depression compensated by Sympathetic tone.

Front 89

Name some of the effects of etomidate

Back 89

Sedative
Hypnotic
Rapid Onset
Hemodynamic stability
Myoclonus
Propylene Glycol- pain on injection
Lacks analgesia properties
Adreno-cortical suppression (long-term only)

Front 90

Name anesthetic drugs from greatest to least myocardial depressant effects

Back 90

PROPOFOL is most depressant
MIDAZOLAM & PENTOTHAL are intermediate
ETOMIDATE is least depressant

Front 91

What are the effects of pancuronium

Back 91

Vagolytic
Symathomimetic
Prevents brady from narcotics
Aides in prevention of truncal rigidity when high dose narcotics are used

Front 92

what are the effects of vecuronium

Back 92

Hemodynamic stable
No vagolytic effect – bradycardia may result.
Significant hepatic metabolism – safe for renal dysfunction patients
Requires more frequent dosing than pavulon

Front 93

What are the effects of rocuronium?

Back 93

Faster onset than vecuronium of pancuronium.
Hemodynamic stability
Prolonged duration in hepatic dysfunction- OK in renal patients.

Front 94

What are some the effects of atracium?

Back 94

Does not relay on hepatic or renal elimination.
Hoffman elimination and ester hydrolysis makes safe for hepatic and renal patients.
No vagolytic action
Hypotension from histamine release

Front 95

If opiates cause bradycardia, how do you treat it?

Back 95

Vagolytics and IVF

Front 96

What should you do after post intubation while waiting for incision?

Back 96

Reduce inhaled agents
Small doses of vasoconstritor
Adequate volume

Front 97

When do 50% of ischemia events occur?

Back 97

Prior to CPB

Front 98

What are some signs of myocardial ischemia?

Back 98

ST segment abnormality
Dysrhythmias
Conduction abnormality
PA waveform abnormality
Decreased myocardial performance (low cardiac index or blood pressure)
Wall motion abnormality (echo, visual)

Front 99

What may a bovie cause? When is the best time to bovie?

Back 99

Ventricular fib. As electrical stimulation of the epicardium with the bovie may induce ventricular fibrillation, certain of the more skilled surgeons will only bovie during systole. Unfortunately, since the window of opportunity is rather narrow (0.04 seconds), the incidence of misadventure is somewhat high.

Front 100

What may heparin (30,000 units) cause?

Back 100

Hypotension

Front 101

When should lungs be deflated?

Back 101

Before sternotomy

Front 102

When is risk for intraoperative awareness the highest?

Back 102

Prior to sternotomy

Front 103

What are some treatments for sympathetic response to sternotomy?

Back 103

Deepen anesthesia prior to these events.
Vasodilators may be necessary

Front 104

What are some causes of intra-op hypotension during cardiac surgery?

Back 104

Surgical compression
Dysrhythmias
Hypovolemia
Decreased contractility

Front 105

How would you treat intra op hypotension?

Back 105

Lighten anesthesia
Vasopressors
Volume
Correct ischemia
Ask surgeon to reposition heart
Restoring HR and rhythm

Front 106

If a patient has left main equivalent, what does this mean?

Back 106

LAD and cx are occluded

Front 107

What pts require a higher perfusion pressure?

Back 107

Acute/Ongoing MI
Renal/Cerebral insufficency
Left main/left main equivalent
Aortic stenosis
Chronic hypertension

Front 108

What are some cause of HTN during the intra-op period?

Back 108

Light anesthesia,
Sympathetic nerve stimulation while dissecting pericardium and aorta, Hypoxia/hypercarbia,
Thyroid storm,
Hypervolemia,
MH,
Withdrawl of B-Blockers

Front 109

What is the treatment of HTN intra-op?

Back 109

Nitroglycerin ,
SNP,
Esmolol,
increased ventilation, narcotics,
increased anesthetic level.

Front 110

How much autologous blood removal is removed prior to CPB and how much is returned?

Back 110

500-1000

Front 111

How do you hypotension from CPB?

Back 111

Hypotension from decreased preload is treated with decreasing rate of withdrawal and give volume (crystalloid)

Front 112

What factors do antithrombin 3 work on?

Back 112

Antithrombin III works on 2 9 10 11 12

Front 113

How does heparin work ?

Back 113

It accelerates the action of AT-3

Front 114

When should a patient be heparinized?

Back 114

Prior to CPB

Front 115

What time of reaction does heparin and AT-3 create when they combine?

Back 115

Neutralization reaction

Front 116

A patient with AT-3 70-100% is considered what?

Back 116

Normal

Front 117

A patient with less than 40% AT-3 is considered to be what?

Back 117

Heparin resistant

Front 118

How do you treat AT-3 deficiency?

Back 118

FFP restores levels of AT-3 and promotes anticoagulation effects of heparin.

Front 119

What is the dosage of heparin?

Back 119

300-400units/kg

Front 120

What is the duration of heparin?

Back 120

Dependent on body temp but approximately 100units/kg in 56 min.

Front 121

What is the normal ACT level?

Back 121

90-120 seconds

Front 122

What level must the ACT be before CPB is initiated?

Back 122

>400-450 seconds

Front 123

How often should an ACT be checked? How much heparin should be admin in boluses?

Back 123

Every 15 min on CPB.
Given in 5,000-10,000.

Front 124

Rapid administration of heparin may cause what?

Back 124

A decrease in MAP or PAP. Get an decrease in PVR due to relaxant effect on smooth muscle.

Front 125

When you bolus amicar what else should you bolus?

Back 125

Heparin

Front 126

What class of drug is amicar and what is the dosage?

Back 126

Anitfibrinolytic
150mg/kg bolus over 20-30 minutes.
10.5G for 70kg
4ml=1G
Normal bolus 10.5g= 44ml
Then 10mg/kg/hour for 5 hours

Front 127

Before cannulation what should you do?

Back 127

Decrease BP it also help prevent blood loss

Front 128

Why is pericardial sling placed prior to cannulation?

Back 128

It increase the work space. Sling may lift the heart decreasing venous return leading to hypotension.

Front 129

How does blood flow into oxygenator?

Back 129

By gravity

Front 130

How far should the PAC be pulled back when the aorta is cross clamped?

Back 130

Pull back PAC 2-3 cm

Front 131

Explain the process of arterial cannulation.

Back 131

Arterial cannula is placed in ascending aorta (femoral can be used).
Aortic cannula is inserted first to allow for infusion of volume in case of hemorrhage during venous cannulation.
SBP is decreased to 90-100 mmhg to reduce risk of aortic dissection.
Emergent CPB can be innitiated using cardiotomy suckers.
Air bubbles must removed prior to infusing volume

Front 132

What are the complications of arterial cannulation?

Back 132

Embolic from air or plaque
Blood loss – hypotension
Aortic dissection- face/ head must be inspected to ensure proper placement
Unilateral blanching of right side indicates inominate artery cannulation.

Front 133

What are the complications from venous cannulation?

Back 133

Hypotension
Bleeding
Dysrhythmia
Superior vena cava obstruction – face should be inspected for plethera and edema

Front 134

After arterial cannulation, how can you tell if there is obstruction of the aorta?

Back 134

Unilateral blanching of the face

Front 135

When on pump, what should the MAP be kept?

Back 135

50-80mmHg

Front 136

How much crystalloid is the pump primed with ?

Back 136

2000ml crystalloids, colloid, mannitol, heparin, bicarb, and K+

Front 137

What should the PaO2 be maintained @?

Back 137

200-400mmHg

Front 138

Why does blood accumulate in LV during CPB?

Back 138

Incompetent aortic valve
Non-coronary blood flow
Thesbian veins empty to left atrium.

Front 139

How is a LV vent placed?

Back 139

Catheter in pulmonary vein, left atrium or apex of heart to prevent ventricular distention and myocardial injury
Decreasing wall tension reduces O2 consumption
PAP is good reflection of LV filling pressure and LV distention ( >15 mmhg)

Front 140

When beginning bypass, low perfusion pressure is associated with? What should the perfusion pressure range be?

Back 140

Low perfusion flow rate
profound vasodilation
hemodilution

60-80 torr

Front 141

What is the normal perfusion flow rate while on CPB? What is the minimum allowable flow rate?

Back 141

2.2 to 2.4L/min/M3
1.6L/min/M3

Front 142

What is the source of most blood trauma while on CPB?

Back 142

Suction

Front 143

When should ABGs be drawn?

Back 143

5 min after starting bypass, then once every hour.

Front 144

During CPB, what is acidosis a result of?

Back 144

Acidosis (metabolic) is a result of inadequate perfusion.
Acidosis (respiratory) is a result of inadequate CO2 removed.

Front 145

What are the causes of low venous return?

Back 145

Hypovolemia
Malposition of caval catheters
Kinked venous return line
Excessive pressure gradient

Front 146

What does respiratory alkalosis do to cerebral blood flow?

Back 146

Diminishes blood flow. pCO2 is the main factor controlling cerebral blood flow

Front 147

Why must the LV be vented?

Back 147

The left heart must be vented to prevent pooling of this blood and distention of the heart
If not done, pulmonary edema and interstitial hemorrhage may occur

Front 148

IF no urine output for 15 minutes after the intiation of CPB, what should you do?

Back 148

Diuretic agents (Mannitol or Lasix) may be required after 15 minutes of no urine output in the presence of acceptable flow rates and pressures

Front 149

How can inferior venous cannula placement affect the liver?

Back 149

The inferior venous cannula must be positioned properly to prevent hepatic congestion

Front 150

By what percentage does hypothermia reduce oxygen requirements? What are some other benefits of hypothermia?

Back 150

Reduces oxygen requirements
…to 50% at 28° C
…to 25% at 20° C
Lower blood flows are required
Heparin metabolism is reduced

Front 151

Explain the antegrade and retrograde cardioplegia administration.

Back 151

Antegrade –via aortic root into coronary ostia. Flow is forward thru coronary arteries.

Retrograde – via coronary veins positioned in coronary sinus (right atrium). Flow is backward thru venous system to myocardium.

Direct cardioplegia via conduit to distal anastomosis.

Front 152

What should HCT be maintained at during CPB?

Back 152

20-30% due to hemodilution

Front 153

How often should urine output be measured?

Back 153

every 15 min

Front 154

What should be increased due to the dilution effect?

Back 154

IV anesthetics should be increased.

Front 155

When should lung ventilation cease?

Back 155

When CPB is full flow.

Front 156

During rewarming, why does the patient lose the anesthetic effect?

Back 156

Patient losses anesthetic effect of hypothermia due to warm cerebral blood flow

Front 157

How do you remove entrapped air after reexpansion of the lungs?

Back 157

valsalva maneuver

Front 158

IF the HR is slow due to a AV block, what is the treatment?

Back 158

Pacing DDD at 100

Front 159

If inotropic support is needed, when does it need to be initated?

Back 159

Start inotropic support when Aortic cross clamp comes off after we have started rewarming

Front 160

What are some inotropes?

Back 160

CaCl
Epinephrine
Dobutamine
Amrinone
Milrinone

Front 161

What is amrinone? How does it work? What are some of the side effects?

Back 161

Positive inotropic and vasodilator
Inhibits CamP (phosphodiasterase inhib)
Reduces afterload and preload
Increases CO
S/E: thrombocytopenia
hypotension

Front 162

What is milrinone and how does it work?

Back 162

Inotropic /vasodilator
Phosphodiasterase inhib
No thrombocytopenia S/E

Front 163

What side effect does amrinone have that milrinone doesn't have?

Back 163

No thrombocytopenia

Front 164

When shouldn't CaCl be delivered?

Back 164

Never give until cross clamp is off.

Front 165

How is the aortic valve opened after coming off of bypass?

Back 165

This is accomplished by placing a clamp on the venous line. This effectively redirects the blood flow to the right heart

Front 166

At what systolic torr, should the patient be volume loaded?

Back 166

100 torr

Front 167

How do you treat hyperkalemia?

Back 167

10u insulin and ½ d50, calcium, sodium bicarb

Front 168

What should pt body temp be before separation from bypass?

Back 168

>37 degrees

Front 169

What is the formula for BP?

Back 169

BP= CO*SVR
If BP and CO is known, then decision may be made as to whether fluid or vasopressors should be utilized

Front 170

What is the protamine dosage?

Back 170

1mg/100units

Front 171

What are some side effects of protamine ?

Back 171

Pulmonary HTN or systemic HTN

Front 172

What does FFP contain? What does Cryo contain?

Back 172

FFP contains all factors and fibrinogen
Cryo contain factor VIII and fibrinogen

Front 173

What is the mechanism of action of amicar?

Back 173

Impedes fibrinolysis by inhibiting plasminogen activator substrates. Antagonizing antiplasmin activity. Enhases hemostasis

Front 174

What does DDAVP do? What patients is it indicated for?

Back 174

Increases platelet aggregation in CRF pts, Von Willibrands disease

Front 175

What factors does DDAVP increase?

Back 175

Increases factor VIII

Front 176

What is the limit of time on CPB?

Back 176

About 2 hours

Front 177

What dosages decrease during OP CABG?

Back 177

Heparin and protamine doses

Front 178

What isn't given during OP CABG that is given with on pump CABG?

Back 178

Amicar and aprotinin

Front 179

When are external defib pads place in OP CABG?

Back 179

prior to incision

Front 180

What body temp must be maintained for OP CABG?

Back 180

normothermia

Front 181

What type of fluid status is key to OP CABG?

Back 181

Fluid loading

Front 182

What ACT value do you want for OP CABG?

Back 182

>300

Front 183

Aortic stenosis cause the heart to become concentric or eccentric?

Back 183

concentric

Front 184

Regurg causes the heart to become eccentric or concentric?

Back 184

Eccentric

Front 185

What are some S/S of Aortic Stenosis?

Back 185

Angina, syncope, chf

Front 186

What are the hemodynamic goals for Aortic Stenosis?

Back 186

Slow to NSR.
Increase preload
Afterload increases to maintain CPP

Front 187

What are hemodynamic goals for MS?

Back 187

HR-slow
Preload- increased
SVR- maintain
PVR- decrease

Front 188

What are the hemodynamic goals for AR?

Back 188

HR- normal to increase
Preload- normal to increase
SVR- decrease
Contractility- increase

Front 189

What are some causes of MR?

Back 189

Degenerative, coronary artery disease (ischemia, infarc), infection and cardiomyopathy

Front 190

What is the normal orifice size for aortic orifice?

Back 190

>2cm

Front 191

What is the pressure gradient at the orifice of the aorta?

Back 191

No gradient is normal.
<20mmhg mild;
20-40mmhg mod;
>40mmhg severe;
>70mmhg critical

Front 192

What are S/S of mitral valve disease?

Back 192

Waking up short of breath or coughing
Becoming short of breath when you exert yourself, lie down or are emotionally stressed
Excessive tiredness, with activity or as the day goes on
Dizziness or lightheadedness
Swollen ankles or feet
A fast, pounding or irregular heartbeat
A fluttering feeling in your chest

Front 193

Minimally invasive CABG uses what type of breathing tube?

Back 193

Single lumen ETT with bronchial blocker under fiber optic visualization
Bronchial blocker removed before ICU
Usually extubated soon after arrival to ICU
Use low TVs when anastamosis, when req by surgeon

Front 194

Aortic stenosis will cause what type of PAC waveform?

Back 194

Prominent A waves.