Podcast
Questions and Answers
What is the location of the SA node in the cardiac conduction system?
What is the location of the SA node in the cardiac conduction system?
- Near the IVC
- Near the pulmonary artery
- Near the aorta
- Near the SVC (correct)
Which of the following heart sounds is normal in kids and adolescents?
Which of the following heart sounds is normal in kids and adolescents?
- S3 (correct)
- S1
- S2
- S4
What is the primary cause of S3 gallop?
What is the primary cause of S3 gallop?
- Diastolic heart failure
- Cardiac tamponade
- Systolic heart failure or ischemia (correct)
- Aortic stenosis
Which of the following is a characteristic of S4?
Which of the following is a characteristic of S4?
What is the best location to hear S1 splitting?
What is the best location to hear S1 splitting?
Which of the following conditions can cause an innocent/functional murmur?
Which of the following conditions can cause an innocent/functional murmur?
What is the approximate size of the heart?
What is the approximate size of the heart?
What is the main function of the mediastinum?
What is the main function of the mediastinum?
What is the outermost layer of the heart?
What is the outermost layer of the heart?
What is the formula for cardiac output?
What is the formula for cardiac output?
What is the term for the percentage of blood ejected from the heart during each beat?
What is the term for the percentage of blood ejected from the heart during each beat?
What is the term for the pressure the heart must work against to eject blood?
What is the term for the pressure the heart must work against to eject blood?
What is the location of the cardiac apex?
What is the location of the cardiac apex?
What is the primary cause of Bruit?
What is the primary cause of Bruit?
Where are thrills of aortic stenosis transmitted from?
Where are thrills of aortic stenosis transmitted from?
What is the normal location of the point of maximum impulse (PMI)?
What is the normal location of the point of maximum impulse (PMI)?
What is the characteristic of the PMI in left ventricular hypertrophy (LVH)?
What is the characteristic of the PMI in left ventricular hypertrophy (LVH)?
What is the characteristic of the PMI in right ventricular hypertrophy (RVH)?
What is the characteristic of the PMI in right ventricular hypertrophy (RVH)?
What is the timing of the murmur in aortic stenosis?
What is the timing of the murmur in aortic stenosis?
What is the best method for diagnosing cardiac tamponade?
What is the best method for diagnosing cardiac tamponade?
What is the treatment for cardiac tamponade?
What is the treatment for cardiac tamponade?
What is the primary objective of preoperative evaluation in patients with ischemic heart disease?
What is the primary objective of preoperative evaluation in patients with ischemic heart disease?
What is the significance of a pulsus parvus et tardus pulse?
What is the significance of a pulsus parvus et tardus pulse?
A patient with a history of heart failure presents with a preserved ejection fraction (HFpEF). What is the expected outcome?
A patient with a history of heart failure presents with a preserved ejection fraction (HFpEF). What is the expected outcome?
What is the definition of orthostatic hypotension?
What is the definition of orthostatic hypotension?
What is the significance of a carotid pulse in assessing cardiac function?
What is the significance of a carotid pulse in assessing cardiac function?
A patient presents with a history of angina. What is the characteristic of stable angina?
A patient presents with a history of angina. What is the characteristic of stable angina?
What is the significance of measuring JVD?
What is the significance of measuring JVD?
What is the primary risk factor for perioperative MI?
What is the primary risk factor for perioperative MI?
What is the characteristic of pulsus bisferiens?
What is the characteristic of pulsus bisferiens?
What is the mediastinum?
What is the mediastinum?
What is the most anterior structure of the mediastinum?
What is the most anterior structure of the mediastinum?
What is the primary purpose of the pericardium?
What is the primary purpose of the pericardium?
What arteries lie on the epicardial surface of the heart?
What arteries lie on the epicardial surface of the heart?
What is the correct arrangement of the heart layers from superficial to deep?
What is the correct arrangement of the heart layers from superficial to deep?
What is the typical allowable MAP range for healthy surgical patients?
What is the typical allowable MAP range for healthy surgical patients?
What are the three components of Beck's triad?
What are the three components of Beck's triad?
What type of pulse is seen in cardiac tamponade?
What type of pulse is seen in cardiac tamponade?
What is pulsus paradoxus?
What is pulsus paradoxus?
Increased intrapericardial pressure causes impaired ___ filling in cardiac tamponade
Increased intrapericardial pressure causes impaired ___ filling in cardiac tamponade
Electrical alterans and decreased voltage can be seen in cardiac tamponade
Electrical alterans and decreased voltage can be seen in cardiac tamponade
Which ventricle forms the cardiac apex?
Which ventricle forms the cardiac apex?
What is the normal diameter of the PMI?
What is the normal diameter of the PMI?
Great vessels enter in the cardiac apex
Great vessels enter in the cardiac apex
S1 heart sounds correspond with which action of the cardiac cycle?
S1 heart sounds correspond with which action of the cardiac cycle?
S2 heart sounds correspond with closure of what valves?
S2 heart sounds correspond with closure of what valves?
What sound occurs immediately after S4 sounds?
What sound occurs immediately after S4 sounds?
S4 heart sounds indicate which of the following?
S4 heart sounds indicate which of the following?
Split S1 sound is an abnormal finding
Split S1 sound is an abnormal finding
S2 splitting on inspiration indicates which of the following?
S2 splitting on inspiration indicates which of the following?
S2 splitting on expiration indicates which of the following?
S2 splitting on expiration indicates which of the following?
Which valve closure sound is loudest in S1 splitting?
Which valve closure sound is loudest in S1 splitting?
Which valve closure sound is loudest in S2 splitting?
Which valve closure sound is loudest in S2 splitting?
Where is S2 splitting best auscultated?
Where is S2 splitting best auscultated?
What are the normal values for the aortic valve?
What are the normal values for the aortic valve?
What is Pectus excavatum?
What is Pectus excavatum?
What is pectus carinatum?
What is pectus carinatum?
Functional murmurs require rapid intervention
Functional murmurs require rapid intervention
Unstable angina is associated with the highest risk of perioperative MI
Unstable angina is associated with the highest risk of perioperative MI
ST changes are present in stable angina
ST changes are present in stable angina
Distal pulses are best to evaluate vessels
Distal pulses are best to evaluate vessels
As pulse travels from aorta to peripheral arteries, the MAP and SBP decrease
As pulse travels from aorta to peripheral arteries, the MAP and SBP decrease
What type of pulse variation is seen in aortic insufficiency?
What type of pulse variation is seen in aortic insufficiency?
What is pulsus alterans?
What is pulsus alterans?
What type of pulse is seen in aortic stenosis?
What type of pulse is seen in aortic stenosis?
What is pulsus paradoxus?
What is pulsus paradoxus?
A patient has deep pitting where indentation briefly remains. What grade of pitting edema does this patient have?
A patient has deep pitting where indentation briefly remains. What grade of pitting edema does this patient have?
A patient has moderate pitting where indentation resolves rapidly. What grade of pitting edema does this patient have?
A patient has moderate pitting where indentation resolves rapidly. What grade of pitting edema does this patient have?
Mild pitting with only slight indentation and no appreciable extremity edema indicates what level of edema
Mild pitting with only slight indentation and no appreciable extremity edema indicates what level of edema
Patients with baseline HTN are more likely to develop intraop HYPOTENSION
Patients with baseline HTN are more likely to develop intraop HYPOTENSION
How does cardiomegaly affect the point of maximal impulse (PMI)?
How does cardiomegaly affect the point of maximal impulse (PMI)?
Ascites, pregnancy, and abdominal distention shift the PMI to which direction?
Ascites, pregnancy, and abdominal distention shift the PMI to which direction?
What is typically described in a murmur of aortic stenosis?
What is typically described in a murmur of aortic stenosis?
The intensity of aortic stenosis murmurs can be decreased by which of the following?
The intensity of aortic stenosis murmurs can be decreased by which of the following?
Where are aortic stenosis murmurs best heard?
Where are aortic stenosis murmurs best heard?
In dextrocardia, where is the PMI shifted?
In dextrocardia, where is the PMI shifted?
Thrills of aortic stenosis are transmitted to the carotid arteries from the suprasternal notch or 2nd ICS
Thrills of aortic stenosis are transmitted to the carotid arteries from the suprasternal notch or 2nd ICS
<1 cm^2 is indicative of severe aortic stenosis
<1 cm^2 is indicative of severe aortic stenosis
0.5-0.7 cm^2 is indicative of critical aortic stenosis
0.5-0.7 cm^2 is indicative of critical aortic stenosis
A minimum 4 METs are recommended for surgical optimization
A minimum 4 METs are recommended for surgical optimization
What is a MET (Metabolic Equivalent)?
What is a MET (Metabolic Equivalent)?
What is functional capacity as it relates to METs?
What is functional capacity as it relates to METs?
What medications are part of cardioprotective pharmacotherapy?
What medications are part of cardioprotective pharmacotherapy?
What considerations should an anesthesiologist take into account when treating patients with implanted cardiac devices?
What considerations should an anesthesiologist take into account when treating patients with implanted cardiac devices?
An alternate form of pacing and a magnet should be available when caring for patients with implanted cardiac devices
An alternate form of pacing and a magnet should be available when caring for patients with implanted cardiac devices
Monopolar cautery is preferred for patients with implanted cardiac devices
Monopolar cautery is preferred for patients with implanted cardiac devices
What causes S3 heart sounds?
What causes S3 heart sounds?
At what systolic blood pressure (SBP) and diastolic blood pressure (DBP) is stage 1 hypertension diagnosed?
At what systolic blood pressure (SBP) and diastolic blood pressure (DBP) is stage 1 hypertension diagnosed?
At what systolic blood pressure (SBP) and diastolic blood pressure (DBP) is uncontrolled hypertension typically defined?
At what systolic blood pressure (SBP) and diastolic blood pressure (DBP) is uncontrolled hypertension typically defined?
What are the elements of a pulse assessment?
What are the elements of a pulse assessment?
What characteristic of a pulse does the contour describe?
What characteristic of a pulse does the contour describe?
A normal carotid pulse can be described as smooth, relatively rapid upstroke, more gradual downstroke, interrupted briefly at the pulse peak
A normal carotid pulse can be described as smooth, relatively rapid upstroke, more gradual downstroke, interrupted briefly at the pulse peak
A normal radial pulse can be described as weak, irregular, and asymmetrical
A normal radial pulse can be described as weak, irregular, and asymmetrical
Bruit are diastolic sounds
Bruit are diastolic sounds
In which patient condition should prophylactic antibiotics be considered before undergoing dental procedures?
In which patient condition should prophylactic antibiotics be considered before undergoing dental procedures?
What are the current recommendations for use of perioperative β-blockade and statins for cardiovascular risk reduction?
What are the current recommendations for use of perioperative β-blockade and statins for cardiovascular risk reduction?
Does delaying elective surgery for patients with mild to moderate hypertension for the purpose of optimizing blood pressure reduce perioperative risk?
Does delaying elective surgery for patients with mild to moderate hypertension for the purpose of optimizing blood pressure reduce perioperative risk?
Should statins be continued intraoperatively for patients who have been on statins for 1 week-30 days preoperatively?
Should statins be continued intraoperatively for patients who have been on statins for 1 week-30 days preoperatively?
What is the primary cause of acute aortic insufficiency (AI)?
What is the primary cause of acute aortic insufficiency (AI)?
What pulse abnormalities can be seen in cardiac tamponade?
What pulse abnormalities can be seen in cardiac tamponade?
In which cardiac phase do S1 sounds typically occur?
In which cardiac phase do S1 sounds typically occur?
In which cardiac phase do S2 sounds occur?
In which cardiac phase do S2 sounds occur?
Flashcards
Emergent Surgery
Emergent Surgery
Surgery needed immediately to prevent life or limb loss within 6 hours.
Elective Surgery
Elective Surgery
Non-emergency surgical procedure.
Urgent Surgery
Urgent Surgery
Surgery needed within 24 hours to prevent life or limb loss.
Heart Size
Heart Size
Signup and view all the flashcards
Female Heart vs Male Heart
Female Heart vs Male Heart
Signup and view all the flashcards
Mediastinum
Mediastinum
Signup and view all the flashcards
Pericardium
Pericardium
Signup and view all the flashcards
Fibrous Layer of Pericardium
Fibrous Layer of Pericardium
Signup and view all the flashcards
Serous Layer of Pericardium
Serous Layer of Pericardium
Signup and view all the flashcards
Epicardium
Epicardium
Signup and view all the flashcards
Myocardium
Myocardium
Signup and view all the flashcards
Endocardium
Endocardium
Signup and view all the flashcards
Right Atrium
Right Atrium
Signup and view all the flashcards
Left Atrium
Left Atrium
Signup and view all the flashcards
Cardiac Output
Cardiac Output
Signup and view all the flashcards
Stroke Volume
Stroke Volume
Signup and view all the flashcards
Ejection Fraction
Ejection Fraction
Signup and view all the flashcards
Preload
Preload
Signup and view all the flashcards
Afterload
Afterload
Signup and view all the flashcards
Cardiac Base
Cardiac Base
Signup and view all the flashcards
Cardiac Apex
Cardiac Apex
Signup and view all the flashcards
Study Notes
Anesthesia and Surgery
- Anesthesia is a stress test that requires patients to be optimized prior to procedures to identify potential cardiac events.
- Surgical types:
- Emergent surgery: risk of life or limb in 6 hours
- Elective surgery: non-emergency surgery
- Urgent surgery: risk of life or limb in 24 hours
Cardiovascular Anatomy
- Heart size: roughly the size of a fist
- Heart differences between males and females: female hearts are smaller than male hearts
- Mediastinum: connective tissue lined compartment bordered by the lungs, sternum, and thoracic vertebral bodies
- Contains: heart, aorta, PA, SVC, IVC, trachea, esophagus, thoracic duct, and thoracic lymph nodes
- RV is the most anterior structure
- Pericardium: fibrous outer layer and inner serous layer
- Fibrous layer: affixes heart to mediastinum
- Serous layer: consists of parietal and visceral layers
- Epicardium: outermost layer where right and left coronary arteries lie
- Myocardium: muscle middle layer of the heart
- Endocardium: innermost layer that lines the heart
Heart Chambers and Valves
- Right atrium (RA) and right ventricle (RV):
- Receive deoxygenated blood from the SVC, IVC, and coronary sinus
- Coronary sinus receives blood from cardiac veins and drains the myocardium
- Left atrium (LA) and left ventricle (LV):
- Receive oxygenated blood from the lungs
- Heart valves:
- Atrioventricular (AV) valves: tricuspid and bicuspid/mitral valves
- Semilunar valves: pulmonic and aortic valves
- Valve sounds:
- S1: AV valve closure
- S2: semilunar valve closure
Cardiac Output and Function
- Cardiac output: volume of blood ejected from the heart each minute (SV x HR)
- Stroke volume (SV): volume of blood ejected from the heart each beat
- Ejection fraction: percentage of blood ejected during each beat
- Preload: volume of blood remaining in the ventricles at the end of diastole
- Contractility: ability of the muscle cells to stretch and recoil
- Afterload: pressure the heart has to work against to eject blood
Cardiac Base and Apex
- Cardiac base: formed by the posterior surface of the heart, located at the right and left 2nd intercostal space (ICS)
- Cardiac apex: formed by the tip of the LV, located at the 5th ICS, just medial to the left midclavicular line (MCL)
Cardiac Conduction
- SA node: located near the superior vena cava (SVC)
- AV node: located between the atria and ventricles
- Bundle of His: only direct connection for electrical impulses to move from atria to ventricles
- Bundle branches: extend from the Bundle of His to the ventricles
Heart Sounds
- S1 and S2 sounds: normal heart sounds
- S3 sound: normal in kids and adolescents, but pathologic in adults
- S4 sound: pathologic, indicating ventricular dysfunction and decreased compliance
- Heart sound splitting: defined by the time difference between the closure of the mitral and tricuspid valves
Heart Murmurs
- Heart murmur: distinct heart sounds attributed to turbulent blood flow
- Graded by intensity (1-6) and can be indicative of valvular disease
- Innocent/functional murmur: due to increased blood flow through the heart (e.g., anemia, fever, pregnancy, hyperthyroidism)
Pre-Operative Cardiac Assessment
- Pre-operative EKG: guidelines vary between facilities
- Risk of MI increases with proximity to MI
- Patient history: pre-existing heart disease, disease severity, stability, comorbidities, functional capacity, surgical procedure
Hypertension
- Definition: SBP > 140 or DBP > 90
- Uncontrolled hypertension: SBP > 180 or DBP > 110
- Complications: MI, end-organ damage, AKI, etc.
Ischemic Heart Disease and MI
- Risk factors: advanced age, smoking, DM, HTN, pulmonary disease, previous MI, LV dysfunction, PVD
- Signs and symptoms: fatigue, angina, palpitations, syncope, dyspnea
- Pre-operative evaluation: determining severity, progression, and functional limitations
Angina and Heart Failure
- Angina: substernal discomfort
- Stable angina: brought on by exertion, relieved by rest or nitroglycerin in <30 minutes
- Unstable angina: newly developed or progressively worsening
- Heart failure: symptoms = CHF, pulmonary edema, paroxysmal nocturnal dyspnea; clinical findings = S3 gallop, rales, tachypnea, resting tachycardia, JVD, peripheral edema
Assessment of Pulses
- Rate, rhythm, contour, amplitude
- Pulse wave amplification: arterial pulse changes as it travels from the aorta to peripheral arteries
- Normal findings: carotid pulse is smooth, rapid upstroke with a gradual downstroke, briefly interrupted by the pulse peak; radial pulse is strong, regular, and asymmetrical
Pulse Abnormalities
- Pulsus bisferiens: double pulse
- Pulsus bigeminus: alteration in pulse amplitude that follows a ventricular premature beat
- Pulsus alterans: regular alternating pulse amplitude due to alternating LV contractile force
- Pulsus parvus et tardus: small and slow-rising pulse, representing a delayed systolic peak due to obstruction of LV ejection
Orthostatic Hypotension
- Definition: BP falls when standing up or stretching
- Criteria: 20mmHg drop in SBP or 10mmHg drop in DBP within 3 minutes of standing
- Causes: blood pooling in the lower extremities
Measuring JVD
- Find highest point of oscillation in the internal jugular vein and measure the distance above the sternal angle
- JVP > 3 cm is indicative of elevated CVP
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
