Cardio-Resp Anesthesia

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Cardio-Resp Anesthesia
2014-02-08 20:30:58
VTHT Anesthesia Surgery

section 3
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  1. Functions of the cardiosystem:
    • 1. Carry O2 and nutrients
    • 2. Remove wastes (CO2)
    • 3. Maintain homeostasis
  2. The high pressure side of the heart
  3. The low pressure side of the heart
  4. This is the term given when a heart valve fails to close completely (stenosis) permitting a back flow of blood
    valvular insufficiency
  5. These two valves are most commonly affected by stenosis
    Mitral and Pulmonic
  6. This is any interruption of the impulse pathway in the heart
    Heart block
  7. 3 forces that act on the SA Node
    • 1. spontaneous originating impulses
    • 2. vagal nerve > acetylcholine > cholinergic bradycardia
    • 3. sympathetic fibers > norepinephrine > adernergic tachycardia
  8. This is the filling time of the ventricle on an ECG
    P-R interval
  9. This is the filling time for the atrium on an ECG
    S-T segment
  10. This is the measurement of the left ventricle
    Blood Pressure
  11. This is the percentage capacity at which is considered normal heart function
  12. This is the difference between the work capability at rest and that during maximum physical exertion
    Cardiac reserve
  13. O2 availability to the tissues depends on:
    • 1. cardiac output
    • 2. amount of O2 extracted from the blood
  14. What two systems generate blood pressure?
    • General vascular system - left ventricle
    • Pulmonary vascular system - right ventricle
  15. Blood pressure on the arterial side is maintained by:
    • 1. Cardiac output
    • 2. Total Peripheral Vascular Resistance (TPR)
  16. Mean Arterial Pressure is determined by:
    the product of the level of cardiac function (cardiac output) and the degree of arteriolar constricture (TPR)  MAP = CO x TPR
  17. These are released from the atria of the heart in response to increases in blood volume and atrial filling
    Atria Natriuretic Peptides
  18. The functions of ANPs are:
    • 1. Promote urinary excretion of Na+ and H2O by direct action on the tubules in the nephron
    • 2. Reduce TPR by relaxing arterioler vascular smooth muscle
  19. What are the two paracrine agents that regulate arteriolar pressure and cardiac output?
    • Nitric Oxide
    • Endothelin
  20. This is a local vasodilator released by endothelial cells in the linings of many blood vessels
    Nitric Oxide
  21. This is a peptide released by endothelial cells in blood vessels that constrict vascular smooth muscle
  22. These two agents are known to stimulate the release of endothelin
    • Angiotensin II
    • Nor-epinephrine
  23. This is where the blood flows is continuous and controlled by arteriolar sphincters in the wall
    Arterio-venous capillaries
  24. Another name for Arterio-venous capillaries
    "Thorough-fare" capillaries
  25. This type of capillary has no muscle where the change in flow is produced by tissue needs and pressure gradients via passive diffusion
    Secondary capillaries
  26. Secondary capillaries are also known as:
    "True" capillaries
  27. Venous return to the heart is controlled by:
    • Inspiration - negative intra-thoracic pressure acts like a vacuum to pull blood to the heart
    • Venous Contraction
    • Valves
    • Heartbeat
    • Muscular activity - walking
    • Peristalsis and intestinal activity
    • Gravity
  28. What is the percentage of chronic mitral disease in heart patients?
  29. What percentage has heart involvement in disease?
  30. What percentage of heart disease is related to Dilated Cardiomyopathy?
  31. This is the failure of the opening between the pulmonary artery and the aorta to close at birth that is the most common inherited pathology in companion animals
    Patent Ductus Arteriosus
  32. What is the Ductus Arteriosus supposed to become upon birth?
    Ligamentum Arteriosum
  33. A treatment for mitral value insufficiency that is associated with restricted amounts in the diet
    sodium restriction
  34. A treatment for mitral valve insufficiency that is associated with drugs that draw water from the body and increase urination.
    Diuretics - Furosemide (Lasix), spironolactone
  35. A treatment for mitral valve insufficiency that is associated with drugs that keep the blood pressure low which reduces the blood backing up into the lungs
    • ACE inhibitors:
    • Enalapril Maleate (Enacard - veterinary)
    • Benazepril (Fortekor - human)
  36. A treatment for mitral valve insufficiency that is associated with drugs that cause vessels to dilate and increase the afterload of the heart
    • Vasodilators:
    • Hydralazine
  37. A treatment for mitral valve insufficiency that is associated with drugs that promote cardiac contraction
    • Positive Inotrope:
    • Pimobendan (VetMedin)
  38. A treatment for mitral valve insufficiency that is associated with drugs that lower the heart rate
    Digitalis glycosides (Digoxin, Cardoxin)
  39. A treatment of mitral valve insufficiency that is associated with drugs that keep stimulation of the heart by catecholamines low.
    • Beta Blockers:
    • Carvedilol
  40. This is seen on an ECG as slightly wavy line with an occasional escape complex
    Sinus arrest
  41. This prohormone can give an indication of impending myocardial infarction in humans and myocardial condition in animals
    B-type Natriuretic Peptide (BNP)
  42. This is the process of excretion of sodium in the urine by action of the kidneys
  43. This is a peptide similar to ANP and is secreted by the left ventricle in response to wall stretch or stress which can be isolated by Idexx or Antech to predict heart failure
  44. What value of NT-proBNP is considered normal?
    0-900 pmol/L
  45. What value of NT-proBNP indicates heart disease?
    900-1800 pmol/L
  46. What value of NT-proBNP is indicative of heart failure?
    >1800 pmol/L
  47. This explains that some postganglionic receptors of the sympathetic nervous system release acetylcholine (are cholinergic)
    Grey Rami
  48. What 3 structures only have sympathetic innervation?
    • HAS
    • Hair folicles (piloerector muscles)
    • Adrenal Medulla
    • Sweat Glands
  49. This is the poison from toadstools that only activates the receptors at the postganglionic synapse of the parasympathetic system
  50. Epinephrine excites with receptors
    Alpha and Beta
  51. Norepinephrine excites which receptors?
    Mainly alpha
  52. What two effects do catecholamines produce?
    • Vasoconstriction
    • Vasodilation
  53. With the exception of intestinal smooth muscle alpha receptors are basically what?
  54. With the exception of cardiac muscle beta receptors are bascially what?
  55. A phase of shock where all the arterioles except coronary and cerebral constrict to shunt blood from the periphery to internal organ, maintain blood pressure, and increase cardiac output
  56. A phase of shock where the heart can no longer pump sufficiently due to fatigue which reduces cardiac output and O2 causing respiratory and vasodilation
  57. A phase of shock where damage to the heart is too great to be treated, resulting in death
  58. This is the reason why vessels vasodilate
    To reduce friction on the blood so it flows more easily.