Cardiac Surgery
Cardiac Physiology
Cardiac Anatomy
Cardiac Management
Cardiac Pharmacology
100
What are the two major determinants of coronary artery perfusion pressure?
Left ventricular end-diastolic pressure and aortic diastolic pressure.
100
Identify the cardiac rhythm
Third-degree block: often called complete heart block because no atrial impulses are conducted through the AV node
100
What is the surface area of the mitral, aortic, and tricuspid valves?
A. 4-6 square centimeters - Mitral valve
B. 2.5-3.5 square centimeters - aortic valve
C. 6.5-8 square centimeters - Tricuspid
100
What clinical signs would you expect to see in a patient with constrictive pericarditis?
pulsus paradoxus, Kussmaul's sign, Freidreich's sign, which is a prominent y-descent on the central venous pressure tracing.
100
Name three selective beta-1 adrenergic blockers
Metoprolol, atenolol, and esmolol are selective beta-1 adrenergic blockers
200
At what point will a patient with atherosclerotic coronary disease exhibit symptoms?
Coronary vessels that become 70% occluded will produce symptoms due to a reduction in blood flow to the coronaries (stable angina)
200
Name 3 conditions associated with the loss of the a wave on a CVP waveform?
Atrial fibrillation
Ventricular pacing
Asystole
200
What change in heart sound is associated with mitral regurgitation?
pansystolic(holosystolic) murmur, often with S3 and S4
200
Identify the left ventricular pressure-volume loops
A= Normal
B= Mitral stenosis
C= Aortic stenosis
D= mitral regurgitation
E= aortic regurgitation
200
Between verapamil, nifedipine, diltiazem, and nicardipine, which agent exerts the greatest negative inotropic effect?
Verapamil exerts the greatest negative inotropic effect
300
State two reasons why the blood pressure is lowered prior to cannulation of the aorta?
1.In order to reduce aortic wall tension
2.reduce the risk of aortic dissection
300
What leads on a 12-lead ECG monitor the lateral portion of the heart? Inferior? Anterior?
The lateral aspect of the heart is best evaluated using leads I, aVL, V5, and V6.
The inferior aspect is best monitored by leads II, III, and aVF
The anterior portion of the heart is best assessed using leads V1-V4.
300
From which spinal segments do cardioaccelerator fibers originate?
T1-T4
300
For every 1 degree C decline in core temperature, how much is the metabolic requirement for O2 reduced?
It is reduced by 8%
300
What is the first line of therapy used for PDAs?
The use of indomethacin (a nonselective cyclooxygenase inhibitor) is the first line of therapy used for PDA, and will treat the vast majority of PDAs
400
Name 4 benefits of hypothermia during cardiopulmonary bypass?
1. Reduced oxygen consumption
2. Reduced basal metabolic rate
3. Preservation of tissues and organs
4. Increased myocardial protection
400
Between sodium, potassium, phosphate, chloride, and bicarbonate, which cation plays a major role in cell membrane potentials and generation of action potentials in the cardiac system?
Potassium
It is a cation that plays a major role in cell membrane potentials and generation of action potentials in the central nervous and cardiac systems. Phosphate, chloride, and bicarbonate are anions. Knowing the charges on ions can help eliminate distractors on the exam.
400
What is the most common valvular lesion in the industrialized world?
Aortic stenosis is the most common valvular disorder in the industrialized world. Approximately 1-2% of the population has a bicuspid aortic valve. A bicuspid aortic valve undergoes excessive stress due to abnormal opening and closing.
400
What are the main anesthetic goals for a patient with aortic regurgitation?
The heart rate should be maintained normal to high
The afterload should be decreased
The preload should be normal to high
Myocardial depression should be avoided
400
Should calcium be administered to patients treated with digoxin and why?
No, calcium administration is contraindicated in these patients as it can produce cardiac arrest. Digoxin increases cardiac contractility by increasing the amount of calcium ions in the muscle cells.
500
List 3 complications that can arise from the placement of PA catheters
Dysrhythmias
Injury to cardiac valves
Rupture of the pulmonary artery.
500
State the phases and explain what happens at each phase of this cardiac action potential
Phase 0, also known as depolarization, involves action by the fast sodium channels. The fast sodium channels open and allow the influx of sodium.
Phase 1, the initial repolarization, indicates the closure of the sodium gates. The influx of sodium is halted and the slower influx of calcium begins.
Phase 2, called the plateau phase, maintains a relatively constant current due to the action of slow calcium channels. The influx of calcium delays repolarization and prolongs the absolute refractory period.
Phase 3, the terminal repolarization phase, represents the inactivation of the slow calcium channels. This phase is also sustained by an efflux of potassium.
Phase 4, the diastolic phase relies on the sodium-potassium pump to normalize the intracellular to extracellular ion concentrations prior to the next depolarization.
500
What areas of the heart does the LCA provide flow to? The RCA?
The left coronary artery supplies the anterior and left lateral aspect of the left ventricle.
The right coronary artery supplies the majority of the right ventricle. The right coronary artery also supplies the SA node in sixty percent of the population and the AV node in ninety percent of the population.
500
What are the primary anesthetic management goals for a patient with aortic stenosis?
Maintenance of normal sinus rhythm is very important
Hypotension must be avoided
Sustained increases in heart rate must be avoided
Severe bradycardia must be avoided as it can result in overfilling and ventricular distention
500
What class of drug is Milrinone? State the mechanism of action.
Milrinone is a phosphodiesterase inhibitor, which increases the available amount of cAMp and increases contractility and vasodilates.