Term
| Cardiac myocytes are refractory to depolarizatoin until what phase in their cycle |
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Definition
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Term
| what the difference in the CA channels active during the cardiac myocyte action potential |
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Definition
| T-type Ca channels work on Phase 0. L-Type Ca channels work on phase 2. |
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Term
| What phase in the AP of a rhythmic cell contributes to how fast its rate will be |
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Definition
| Phase 4 and the more steep of an angle the faster the rate. |
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Term
| what is the delay at the AV node |
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Definition
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Term
| the fastest conducting tissue in the heart is |
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Definition
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Term
| marcaine has most specificity for what tissue in the heart |
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Definition
| HIS bundle and purkinje fibers |
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Term
| Ca blockers interfere with what type of Ca channels |
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Definition
| L-Type. L type contribute most to phase 2 of the cardiac myocyte AP |
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Term
| calcium binds to what part of the actin/myosin components |
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Definition
| Ca binds directly to troponin C |
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Term
| the vagus nerve innervates the heart via what M receptors |
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Definition
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Term
| atrial contraction contriubtes to what % of ventricular filling |
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Definition
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Term
| Name the three waves of the atrial presusre tracing and what they represent |
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Definition
a - c - v waves
a: Atrial systole
c: ventricular contraction
v: Venous filling of atrium. |
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Term
| whats the expected patients CO if they are 90kg |
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Definition
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Term
| whats the expected patients CO if they are 100 kg |
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Definition
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Term
| The best determination of adequacy of CO is |
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Definition
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Term
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Definition
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Term
| What is the SVR if patients bp is 120/80. CVP is 5, kg 90 |
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Definition
CO=KG^3/4 x 0.2
SVR= 80 x (MAP-CVP/CO)
MAP = (2x DBP + SBP)/ 3
MAP=93
CO = 5.8
SVR= 1,213 |
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Term
| does coronary blood flow from the epicardium to endocardium or endocardium to epicardium |
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Definition
| coronary blood flow is from epicardium to endocardium |
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Term
| how does coronary blood return to the heart |
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Definition
1. Majority vein coronary sinus to right atrium
2. To both ventricles by thesbesian veins |
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Term
| in 60% of adults the SA node is supplied by blood via what coronary artery? The remainder of blood is supplied via the? |
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Definition
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Term
| The AV node is supplied by blood from what coronary in 75-90% of individuals |
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Definition
| POosterior descending artery which comes off the RCA |
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Term
| The most vulnerable area of the heart to ischemia is what layer |
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Definition
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Term
| what is coronary blood flow at rest |
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Definition
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Term
| What is the normal coronary perfusion pressure |
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Definition
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Term
| If tissues extract 25% of oxygen then how much o2 extracted in coronaries |
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Definition
| Heart needs lots of o2 so it extracts nearly 65% of O2. That doesnt leave a large reserve! |
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Term
| Does sevoflurane have coronary artery dilation properties |
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Definition
| NO ITS THE ONLY volatile that doesnt |
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Term
| ventricular hypertrophy results eventually in what form of HF |
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Definition
| Diastolic HF becuase ventricles thick and cant fill with blood |
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Term
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Definition
1. Renal disease
2. Hyperaldosteronism
3. Cushings
4. Acromegaly
5. Pheochromocytoma
6. Pregnancy or estrogen therapy |
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Term
| At what diastolic would you consider too high and cancel a case |
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Definition
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Term
| list three definitoins of unstable angina |
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Definition
1. at rest
2. new onset in last two months
3. abrupt increase in freq > 3 /day |
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Term
| variant angina also known as prinzmetals angina is worsened by what common cardiac drug |
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Definition
| beta blockers will worsen! |
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Term
| what is a normal end diastolic and end systolic volume |
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Definition
end diastolic volume - 140 mL
End systolic volume - 70 mL |
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Term
| when is ABX therapy needed for someone with heart disease |
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Definition
| if known valvular disease then given ABX |
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Term
| which valve disease is almost always related to rheumatic fever |
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Definition
| mitral stenosis and Mitral regurgitation |
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Term
| Normal mitral valve area is? Critical stenosis if valve area < ? |
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Definition
Mitral valve normal area is 4-6 cm2
Critical stenosis if < 1 cm2 |
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Term
| what is the anesthetic management for mitral stenosis |
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Definition
1. maintain sinus avoid tachy
2. avoid nitrous
3. give neo not ephedrine |
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Term
| describe the anesthetic managment for a patient with mitral regurigtation |
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Definition
1. HR 80 - 100
2. avoid increase SVR
3. maintain sinus
4. avoid excessive preload |
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Term
| two most comomn causes of aortic stenosis |
|
Definition
1. congenital (bicupsid valve
or
2. rheumatic |
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Term
| Normal Aortic valve size? Critical stenosis is |
|
Definition
Normal aortic valve: 2.5-3.5 cm2
Critical stenosis <0.7 cm2 |
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Term
| describe the cardiac output in a patient with severe AS |
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Definition
| CO IS FIXED and maintened by changes in SVR |
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Term
| What is the anesthetic management for AS |
|
Definition
1. maintain sinus, avoid tachy
2. intravascular volume is key
3. neo for bp support |
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Term
| the largest end diastolic volumes of left ventricle is seen in what valve disorder |
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Definition
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Term
| which valve issue benefits from spinals while this one is really bad with spinals |
|
Definition
AS: NO SPINALS
AR: Spinals are good. helps with vasodilation |
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Term
| anesthetic managment for AR |
|
Definition
1. ephedrine is drug of choice
2. maintan HR 80-100
3. maintain preload. |
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Term
| factors that worsen hypertrophic cardiomyopathy |
|
Definition
hypertrophic cardiomyopathy worsened by
1. low preload
2. increased inotoropic agents
3. decreased afterload.
4. spinals make worse too |
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Term
| Treat hypertrophic cardiomyopathy with what agents? avoid what agents |
|
Definition
Treat hypertrophic cardiomyopathy with:
1. beta blockers
2. CCB
AVoid:
1. ntirates
2. digoxin
3. diuretics |
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|
Term
| cardiopulmonary bypass mahine is primed with? |
|
Definition
| 1200 to 1800 mL of crsytalloid, heparin and mannitol |
|
|
Term
| carbon dioxide eliminaition in the CPB is decided by |
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Definition
|
|
Term
| what decides blood flow in centrifugal pumps compared to roller pumps. Whats dependent on resistance for forward flow |
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Definition
Roller Pumps: blood flow proportional to roller speed. Independent of resistance.
Centrifugal pumps: internal rotation. Depends on resistance. |
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Term
| are centrifugal or roller pumps less damaging to blood cells |
|
Definition
| Centrifugal pumps least damaging |
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Term
| metabolic oxygen requirements are ddecreased by half for every ---- decrease in Celsius |
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Definition
| 1/2 o2 requirements for every drop in 10 Celsiuss |
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|
Term
| the arteriolar filter is what size on the CPB |
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Definition
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|
Term
| inflammatory response from CPB mediated by |
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Definition
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Term
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Definition
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|
Term
| How much heparin given prior to bypass to obtain appropriate ACT |
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Definition
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Term
| does intraoperative HTN or hypotension carry a greater mortality risk |
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Definition
|
|
Term
| what percentage of HTN is essential |
|
Definition
| Primary aka essential is 90% of all HTN cases |
|
|
Term
| describe 2nd causes of HTN |
|
Definition
1. renal disease
2. hyperaldosteronism
3. cushing's syndrome
4. acromegaly
5. pheochrocytoma
6. pregnancy
7. estrogen therapy. |
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Term
| sx rarely seen until stenosis greater than |
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Definition
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|
Term
| variant angina (AKA prinzmetal's angina) is worsened by what drugs do we commonly give |
|
Definition
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|
Term
| critical stenosis creates a valve gradient of about ____ mm Hg |
|
Definition
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|
Term
| if you see two sets of P waves on the ECG what doe sthis likely indicate |
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Definition
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