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Which is longer, S1 or S2?
What does S1 signify?
systole, ejection, closure of mitral valve
What does S2 signify?
aortic valve closing, end of systole, beginning of diastole
What causes S3?
Failing LV, CHF, caused by rapid filling due to increased volume of blood in LV
What causes S4?
Blood being forced into stiff or hypertrophied ventricle, common with HTN, AS, hypertrophic CMP, MR, acute MI
T or F, an exercise EKG localizes and quantifies ischemia?
F, this is a limitation of it.
What's the benefit of an exercise EKG?
Assess functional capacity, safe
What's the benefit of a stress test with imaging (nuclear perfusion imaging)?
Sensitive and specific, can detect CAD and assess prognosis, can determine extent and location of ischemia
What are the cons of a nuclear stress test?
Expensive and radiation exposure, inaccurate with LBBB
What's the benefit of a stress echo? Cons?
Pros- sensitive and specific, no radiation, cheaper than nuclear imaging
Cons- poor imaging with obese or very thin, subjective interpretation
What are the cons to coronary calcium scoring?
no functional info, low specificity, data not reproducible
Is CT angiography good at identifying native coronary disease?
Yes, but no functional info, only anatomic.
What's a major limitation of all stress testing modalities?
Inability to identify plaques that are vulnerable to rupture and thus development of ACS (even coronary angiogram can't identify functional significance of lesion)
Name some of the causes of hypotension (DDD Vitamins).
Developmental (valvular heart lesions), Drugs, Degenerative (neuro), Vascular, Infectious / Iatrogenic, Toxic / Traumatic, Autoimmune, Anoxic, Metabolic / Medical, Endocrine (pregnancy), Neoplastic (ca), Special (post-op or deliberative)
T or F, IV contrast agents and methylmethacrylate can cause hypotension
What's a major SE with regional anesthesia (spinal or epidural)?
Why would we cause deliberate hypotension in the OR?
It's a technique in GA, give short acting hypotensive agent to reduce BP and thus bleeding intraop. Used when a tourniquet can't be applied to the area (shoulder, back)
What agent is commonly used for deliberate hypotension?
What are major causes of HYPERtension?
essential, endocrine, renal (bladder distention), neuro, existing disease, hypothermia
What are risk factors for CAD?
known CAD, age > 75, HTN, DM, hypercholesterolemia, smoker, family history of premature CAD, HF, CVA, renal insufficiency
What is considered to be hypertensive?
SBP > 140 or DBP > 90 mmHg
What type of anesthesia is contraindicated with AS?
What's considered moderate and severe AS?
Moderate 1.2 - 1.5 cm2
Severe < 1 cm2
Critical < 0.6 cm2
What are the different levels of evidence?
- Class I- benefit >>> risk
- Class IIa- benefit >> risk
- Class IIb- benefit > or = to risk
- Class 3- risk > or = benefit
When do pts need to have a non-invasive evaluation of LV function (ex: echo)
- Pts with dyspnea of unknown origin, current or prior HF (if not evaluated in last year)
- Class IIa
What pts need a 12 lead EKG?
- Class I- 1 or more risk factors having vascular surg.; pts with known CAD, PVD, or cerebrovasc. dz undergoing intermediate risk surg.
- Class IIa- no risk factors but having vasc. surg.
- Class IIb- 1 or more risk factors and having intermediate risk operation (ex: thyroidectomy)
What pts need an ETT?
- Class I- active cardiac conditions having non-cardiac surgery
- Class IIa- 3 or more risk factors and poor func. capacity having vasc surg.
- Class IIb- 1-2 risk factors and poor functional capacity having intermediate risk surg.; OR pt with 1-2 risk factors and good func. capacity having vasc. surg.
What pts need CAGB or PCI?
- Class I- stable angina and significant LM dz, OR stable angina and 3VD, OR stable angina and 2 VD with significant prox. LAD stenosis, EF < 50% or ischemia on stress test; OR high risk unstable angina or NSTEMI, OR acute STEMI
- Class IIa- PCI to mitigate cardiac symptoms in pts who need elective surg. in next year
When are beta blockers indicated?
- Class I- con't if pt already on med, OR pt undergoing vasc surg that are high cardiac risk
- Class IIa- pre-op testing identifies CAD, OR vasc. surg with 1 risk factor
What does the P wave represent?
Atrial depolarization and contraction of both atria
What does the QRS represent?
Ventricular depolarization and contraction
What does the T wave represent?
Where do leads V1 and V2 go?
L and R 4th IC space
Leads V3 - V6 are in what IC space?
What leads are the septal leads?
V3 and V4
What constitutes a BBB?
QRS > 0.12 sec.