co-existing disease > exam 1 > Flashcards

exam 1 Flashcards

(85 cards)

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1
Q

What does an echo look at?

A
  1. size/shape of heart
  2. valve competency
  3. pumping capacity
  4. location and extent of tissue damage
  5. CO, EF, diastolic function
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2
Q

AS (preload/afterload)

A
  • increase/maintain afterload

- increase afterload

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3
Q

AR (preload/afterload)

A
  • decrease afterload

- increase preload

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4
Q

MS (preload/afterload)

A

-maintain after load and CO to prevent tachycardia (prevent dehydration AND fluid overload)

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5
Q

MR (preload/afterload)

A
  • decrease afterload

- decrease preload

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6
Q

MVP

A
  • increase after load

- increase preload

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7
Q

bare metal

A

wait 30-45 days before surgery

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8
Q

drug eluding

A

wait 1 year before surgery (aspirin 75-150mg/day pre-op except neurosurg)

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9
Q

AS murmur

A

2nd ICS, mid-systolic, radiates to carotids

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10
Q

AR murmur

A

3rd and 4th ICS, holo-diastolic, radiates to carotids

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11
Q

MS murmur

A

apex, mid-diastolic, radiates to axilla

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12
Q

MR murmur

A

apex, holo-systolic, radiates to axilla

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13
Q

MVP murmur

A

apex, late-systolic, mid-systolic click

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14
Q

assess coronary patency

A

angiography

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15
Q

Esmolol dose

A

0.5 mg/kg

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16
Q

vacuuming METS

A

3.5

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17
Q

6 cardiac risk factors

A
  1. IHD
  2. HF
  3. stroke/TIA
  4. DM requiring insulin
  5. CKD with Creatinine >2.0
  6. high risk surgery
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18
Q

breast surgery

A

low risk

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19
Q

monitor ischemia leads

A

II, V5 (95%)

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20
Q

Samter’s Triad

A
  1. Nasal Polyps
  2. Asthma
  3. Aspirin/NSAID intolerance
    (avoid Toradol with reactive airway disease)
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21
Q

H2 agonism

A
  • increase cAMP
  • smooth muscle relaxation/ bronchodilation
  • avoid H2 antagonists (Famotidine) with asthmatics
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22
Q

extubation criteria

A
  • sustained head lift (>5 sec)
  • NIF >-20cmH2O
  • VC >15ml/kg
  • PaO2 >60 mmHg with FiO2 <20
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23
Q

alpha-1 anti-trypsin deficiency

A
  • inherited or caused by smoking
  • inhibition of normal anti-proteases
  • increased protease activity
  • increased protein breakdown
  • emphysema
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24
Q

COPD loop

A
  • scooped out
  • baby carriage
  • pork chop
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25
FEV1/FVC normal
0.8
26
obstructive (FEV1/FVC)
<0.7, FEV1 decreased
27
restrictive (FEV1/FVC)
normal or increased, FEV1 decreased
28
normal aortic valve size
2.5-3.5cm2
29
aortic stenosis A. Line waveform
- pulsus tardus | - pulsus parvus
30
aortic stenosis time to death 1. angina pectoris 2. syncope 3. dyspnea on exertion
1. 5 years 2. 3 years 3. 2 years
31
aortic stenosis decrease murmur intensity
valsalva and sustained handgrip
32
aortic stenosis peri-op goals (4)
1. maintain NSR 2. avoid tachy or brady 3. avoid hypotension 4. optimize intravascular fluid volume
33
aortic stenosis CPR
- not effective | - can't create adequate stoke volume against stenotic valve
34
mitral stenosis
increases LA pressure and volume, pulmonary HTN, stress induced pulmonary edema, right CHF
35
at risk for mitral stenosis
- females | - rheumatic heart disease
36
normal mitral valve
4-6
37
mitral stenosis EKG
broad notched P wave (A. Fib 1/3)
38
mitral stenosis peri-op goals
- maintain CO (avoid increased HR) - maintain NSR - maintain euvolemia - avoid hypercarbia, hypoxemia - epidural>spinal for HR/BP control
39
aortic regurg
- eccentric and concentric LV gypertophy - decreased coronary blood flow - LVF and pulmonary edema
40
risk factors aortic regurg
- Acute (endocarditis, aortic dissection, trauma) | - Chronic (rheumatic fever, bicuspid aortic valve, idiopathic aortic root dilation)
41
severe aortic regurg
>50%
42
severity of regurg is a function of...
- time (HR) | - pressure gradient (SVR)
43
AR meds
- PO (nifedipine, hydralazine) | - IV (nitroprusside, dobutamine)
44
AR assessment
- dyspnea, fatigue, angina - widening pulse pressure - bounding peripheral pulses
45
AR peri-op goals
FAST-FULL-FORWARD - HR >80, consider IVF bolus and afterload reduction - avoid decreased HR and sudden increase SVR - GA>neuraxial
46
AR induction
consider panc
47
mitral regurg
-decreased SV and CO -LA becomes volume overloaded (pulmonary congestion, LV hypertrophy, impaired contractility) (chronic or acute)
48
risks for MR
MVP, ischemic HD, LVH, previous rheumatic fever, congenital HD, lupus, rheumatoid arthritis
49
severe MR
>50%
50
MR PA waveform
large V wave
51
MR surgery
EF >60 beneficial | EF <30 futile
52
MR anesthesia
1. kep HR 80-100 (decrease ventricular filling time) 2. slightly decrease SVR (maximize forward flow, reduce afterload, avoid further drop CO) 3. caution with myocardial depressant drugs (my have ventricular impairment)
53
MVP
(common, often benign) 1. systole (one or both leaflets prolapse back into LA, with or w/o regurg) 2. primary MVP (leaflets thickened d/t connective tissue dz) 3. functional MVP (leaflets have mid bowing- normal variant)
54
risk factor MVP
- female - marfan's - previous rheumatic fever - thyrotoxicosis - lupus
55
diagnosis MVP
ECHO: valve prolapse of 2mm or more above the mitral annulus most patients asymptomatic
56
MVP anesthesia
want to increase LV filling and decrease LV emptying (a larger ventricle will have less prolapse) 1. avoid prolonged SVR 2. minimize SNS stimulation (avoid arrythmias) avoid ketamine, no beta-agonists (ephedrine)
57
normal aortic valve size
2.5-3.5cm2
58
aortic stenosis A. Line waveform
- pulsus tardus | - pulsus parvus
59
aortic stenosis time to death 1. angina pectoris 2. syncope 3. dyspnea on exertion
1. 5 years 2. 3 years 3. 2 years
60
aortic stenosis decrease murmur intensity
valsalva and sustained handgrip
61
aortic stenosis peri-op goals (4)
1. maintain NSR 2. avoid tachy or brady 3. avoid hypotension 4. optimize intravascular fluid volume
62
aortic stenosis CPR
- not effective | - can't create adequate stoke volume against stenotic valve
63
mitral stenosis
increases LA pressure and volume, pulmonary HTN, stress induced pulmonary edema, right CHF
64
at risk for mitral stenosis
- females | - rheumatic heart disease
65
normal mitral valve
4-6
66
mitral stenosis EKG
broad notched P wave (A. Fib 1/3)
67
mitral stenosis peri-op goals
- maintain CO (avoid increased HR) - maintain NSR - maintain euvolemia - avoid hypercarbia, hypoxemia - epidural>spinal for HR/BP control
68
aortic regurg
- eccentric and concentric LV gypertophy - decreased coronary blood flow - LVF and pulmonary edema
69
risk factors aortic regurg
- Acute (endocarditis, aortic dissection, trauma) | - Chronic (rheumatic fever, bicuspid aortic valve, idiopathic aortic root dilation)
70
severe aortic regurg
>50%
71
severity of regurg is a function of...
- time (HR) | - pressure gradient (SVR)
72
AR meds
- PO (nifedipine, hydralazine) | - IV (nitroprusside, dobutamine)
73
AR assessment
- dyspnea, fatigue, angina - widening pulse pressure - bounding peripheral pulses
74
AR peri-op goals
FAST-FULL-FORWARD - HR >80, consider IVF bolus and afterload reduction - avoid decreased HR and sudden increase SVR - GA>neuraxial
75
AR induction
consider panc
76
mitral regurg
-decreased SV and CO -LA becomes volume overloaded (pulmonary congestion, LV hypertrophy, impaired contractility) (chronic or acute)
77
risks for MR
MVP, ischemic HD, LVH, previous rheumatic fever, congenital HD, lupus, rheumatoid arthritis
78
severe MR
>50%
79
MR PA waveform
large V wave
80
MR surgery
EF >60 beneficial | EF <30 futile
81
MR anesthesia
1. kep HR 80-100 (decrease ventricular filling time) 2. slightly decrease SVR (maximize forward flow, reduce afterload, avoid further drop CO) 3. caution with myocardial depressant drugs (my have ventricular impairment)
82
MVP
(common, often benign) 1. systole (one or both leaflets prolapse back into LA, with or w/o regurg) 2. primary MVP (leaflets thickened d/t connective tissue dz) 3. functional MVP (leaflets have mid bowing- normal variant)
83
risk factor MVP
- female - marfan's - previous rheumatic fever - thyrotoxicosis - lupus
84
diagnosis MVP
ECHO: valve prolapse of 2mm or more above the mitral annulus most patients asymptomatic
85
MVP anesthesia
want to increase LV filling and decrease LV emptying (a larger ventricle will have less prolapse) 1. avoid prolonged SVR 2. minimize SNS stimulation (avoid arrythmias) avoid ketamine, no beta-agonists (ephedrine)
co-existing disease
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