Cardio Anesthesia Questions

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Cardio Anesthesia Questions
2013-02-07 18:17:54
Cardio Anesthesia

Cardio Anesthesia
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  1. What type of murmur would you hear with aortic stenosis?
    Systolic murmur – creshendo-decreshendo
  2. If you heard a systolic crescendo-decreshendo murmur, what type of valve dz would you have?
    Aortic stenosis
  3. What acts as the resistance for afterload in aortic stenosis?
    The tight valve
  4. What do you not want to have happen to Pt’s with aortic stenosis?
    NO HYPOTENSION (specifically with diastolic pressures)
  5. Do you want to increase or decrease preload in aortic stenosis?
    Increase to maintain SV
  6. Should you use NTG in aortic stenosis patients?
  7. What is the HR range in aortic stenosis?
  8. What is CPP dependent on in aortic stenosis?
  9. Do you want to increase, decrease, or maintain PVR in aortic stenosis?
  10. Do you give Beta antagonists to someone with aortic stenosis?
    No – will affect contractility (want to maintain)
  11. Do you want to increase, decrease, or maintain contractility in a Pt with aortic stenosis?
  12. What do you have to maintain in order to maintain a DBP for coronary perfusion?
    SVR (most important thing)
  13. What percent of stroke volume (SV) does the atrial kick contribute in a Pt with aortic stenosis?
    40% - Big, thickened ventricles that are non-compliant (kick supplies more than in a normal Pt)
  14. Do you want to depress contractility in a Pt with aortic stenosis?
  15. Do you want to increase or decrease preload in Pt’s with aortic stenosis?
    Increase – a reduced amount of blood passes through the calcified valve, so need to increase the amount
  16. Why do you not want a high HR in aortic stenosis?
    CPP during diastole is reduced
  17. Why do you want to avoid a low HR(<70) in Pt’s wit aortic stenosis?
    You lose stroke volume (and CO) & with the stenosis, you need to maintain the SV for perfusion
  18. ***
    • What kinds of things can cause mitral stenosis?
    • Rheumatic fever or staph infections
  19. What kind of murmur is associated with mitral stenosis?
  20. What does a mitral stenosis murmur sound like?
    Diastolic “opening & snap”
  21. What happens to LV volume in mitral stenosis?
  22. Do you want to increase, maintain, or decrease preload in mitral stenosis?
    Increase gently (want to maintain SV but avoid volume overload or pulmonary edema)
  23. Why do you want to avoid a low HR in mitral stenosis?
    To maintain SV (and CO)
  24. Why do you want to avoid a high HR in mitral stenosis?
    To allow enough time to fill the LV during diastole
  25. Why would you increase the PR of AV pacing to 150-200 secs?
    To allow the atria to fill completely so it can pump more blood through the tight valve & into the LV
  26. What % does the atria contribute to the SV in mitral stenosis?
  27. What % does the atria contribute to the SV in aortic stenosis & mitral stenosis?
    40 & 30% respectively
  28. What do you need to watch for regarding the ventricles in mitral stenosis?
    LV deconditioning & RV failure
  29. Which side of the heart are you most concerned with regarding contractility in mitral stenosis?
    Right side – works against the tight left side
  30. What kind of murmur do you hear with aortic insufficiency?
    Diastolic (decreshendo – best heard when Pt sitting up and leaning forward)
  31. If you hear a loud, diastolic murmur (decreshendo), what kind of heart problem do you have?
    Aortic insufficiency
  32. What is aortic insufficiency also called?
    Aortic regurgitation
  33. What is aortic insufficiency?
    leaking of the aortic valve that causes blood to flow in the reverse direction during ventricular diastole
  34. What is the pathophysiology of aortic regurgitation?
    the aortic valve is not able to completely close
  35. Does aortic insufficiency increase or decrease preload?
    Increase (due to volume overload – blood flowing back into left ventricle
  36. Does aortic insufficiency increase or decrease afterload?
    Increase (elevated afterload due to increased stroke volume of the heart)
  37. Does LV pressure go up or down in aortic regurgitation?
    • Up
    • Does LV volume go up or down in aortic regurgitation?
    • Up
  38. Do you want to use NTG in aortic insufficiency?
    No – want to maintain preload in order to maintain SV
  39. Do you want to decrease or increase preload in aortic insufficiency?
  40. Do you want to increase or decrease HR in aortic insufficiency?
    Increase to decrease diastolic time (or time for regurgitation)
  41. Do you want to increase, decrease, or maintain contractility in aortic insufficiency?
  42. Do you want to decrease, maintain, or increase SVR in aortic insufficiency?
    Decrease so you can increase forward flow
  43. What heart issue does “fast, full, forward” pertain to?
    Aortic insufficiency
  44. What kind of murmur do you hear in mitral regurgitation?
  45. In mitral regurgitation, do you want to decrease, increase, or maintain preload?
    Increase or decrease based on response to fluid challenge
  46. Why do you want to maintain or increase the HR in mitral regurgitation?
    To decrease diastolic filling time (decrease the amount of time blood has to flow back into the atria)
  47. Do you want to increase, decrease, or maintain HR in mitral regurgitation?
    Maintain or increase to decrease diastolic filling time
  48. Do you want to increase, maintain, or decrease contractility in mitral regurgitation?
  49. Do you want to increase or decrease SVR in mitral regurgitation?
    Decrease to increase forward flow (the less resistance, the less likely to backflow)
  50. ***
    • Which internal jugular is preferred for a central line and why?
    • RIJ – LIJ has thoracic duct
  51. What kind of hemodynamic measures can a pulmonary artery catheter measure?
    • PCWP “wedge”
    • CO
    • SVR
    • Indexed Values
    • SvO2 (optional)
  52. Can you see ventricular size, filling, and FX with a TEE?
  53. What kind of hemodynamics can you see with a TEE?
    • CO
    • PASP
    • LVEDP (sometimes)
    • PADP
  54. Can you see pericardial and pleural effusions with a TEE?
  55. You can’t see calcifications & dissections of the aorta using a TEE? True or False
    False – you can
  56. Is the rSO2 the same thing as a BIS monitor?
  57. What does the rSO2 measure?
    Cerebral perfusion
  58. What is a backup to the pulse oximeter?
    rSO2 – cerebral oximeter
  59. What kind of scale does the cerebral oximeter use?
  60. What is the normal baseline for the rSO2?
  61. What do you look for when evaluating the rSO2?
    The “trend”
  62. What major electrolyte is found in CPB cardioplegia?
  63. What happens when the potassium load is given to a Pt during CPB cardioplegia?
    Hyperkalemic arrest
  64. What would you see on the EKG when the Pt undergoing CPB is given the K+ load of cardioplegis?
    Peaked T-waves
  65. Why is the heart and cardioplegia made cold?
    To decrease metabolic demands
  66. Does the cardioplegia given during CPB contain nutrients?
  67. What 2 types of cannulas are placed during CPB?
    Antegrade & Retrograde
  68. Where is the antegrade cannula placed in CPB?
  69. Where does the retrograde canula placed in CPB?
    Coronary sinus
  70. What is the most stimulating part of CPB?
    • Sternotomy
    • How much Heparin is given during CPB anticoagulation?
    • 300-400 units/kg
  71. What does ACT measure during CPB?
    Activated clot time measure effects of heparinization
  72. What does heparin bind to in order to work?
  73. What’s some adverse reactions of protamine?
    • Hypotension from giving too fast
    • Severe pulmonary HTN
    • Anaphylaxis
  74. Why is promatine given during CPB?
    To reverse the effects of heparin
  75. What effects does CBP have on the blood?
    • Hemolysis
    • Hemodilution
    • Inflammatory response (resolves after bypass)
    • Clotting factor consumption
    • Platelet dysfunction
  76. Does hypoglycemia or hyperglycemia occur to Pt’s undergoing CPB?
  77. Does the matter of platelets matter immediately after CBP?
    No – it’s more about platelet dysfunction
  78. Which part of the heart is most exposed during open heart surgery?
    Right ventricle
  79. Which coronary artery is more susceptible to air emboli?
  80. Do you expect to see cognitive deficits on Pt’s who’ve undergone CPB?
  81. What kind of affects does CPB have on the kidneys?
    Acute kidney injury (AKI), ARF, hemoglobinuria
  82. What 3 types of pulmonary issues do you see with CPB?
    Atelectasis, pulmonary edema, ARDS
  83. What 3 things determine myocardial oxygen demand?
    • HR
    • Wall stress (LVEDV & afterload)
    • Contractility
  84. Do you want to prevent bradycardia or tachycardia when trying to decrease myocardial oxygen demand?
  85. How do you calculate coronary perfusion pressure (CPP)?
  86. What 2 ways is cardioplegia given?
    Via antegrade (in top of aorta and the bottom is cross-clamped & cardioplegia ends up in coronary arteries) & retrograde (coronary sinus)
  87. Why is retrograde cardioplegia given?
    Antregrade cardiplegia goes to coronary arteries but if a Pt has DZ’d CA’s, retrograde is needed
  88. Do you want to give positive pressure ventilation during the sternostomy?
    No- you want to “take the lung down” (take limb off circuit to avoid back pressure)
  89. What is the goal for systolic blood pressure before cannulating the aorta?
  90. What does a HR >100 increase the risk of after cannulating the aorta during CPB?
    Aorta dissection
  91. What kinds of cardiac tests might you want to see before CPB?
    Cath lab report (where are the lesions & any left main coronary artery issues) & Echo
  92. What would an Echo tell you prior to a CPB?
    Left/right heart function, PA pressures
  93. What are you primarily looking for on an Echo before CPB?
    Valve stenosis
  94. What kind of induction should occur for a CPB?
    Opiod-heavy (fentanyl & sufentanil)
  95. Which IV induction agent is usually used for CPB?
  96. Which NMB is routinely used for CPB & why?
    Pancuronium (increased heart rate)
  97. Are you monitoring systolic, diastolic, and/or MAP during CPB?
    Only MAP as there will be no pulsatile flow
  98. What do you want to keep the PA diastolic pressure at during CPB?
  99. How is coronary blood flow calculated?
  100. What is arterial oxygen content dependent upon?
    Hgb & Oxygen saturation