Workbook:

Cardiovascular Pathophysiology

Copyright 2016 APEX Anesthesia Review

General Risk Factors for CV M&M CV Risk for Surgical Procedures

MI risk in Patient with Previous MI

General population =

MI if > 6 months =

MI if 3 – 6 months =

MI if < 3 months =
Factors that Reduce O2 Delivery Factors that Increase O2 Demand
 Initial Elevation Peak Elevation Return To Baseline

CK-MB

Troponin-I

Troponin-T

Cause Intervention

Increased O2 Demand

Decreased O2 Supply
Diastolic Compliance

C ventricle =

Compliance is decreased by:

Compliance is increased by:

 Causes Systolic Failure Causes Diastolic Failure

Heart Failure
Compare and contrast systolic vs diastolic heart failure.

Chronic Systolic Chronic Diastolic

Failure Failure

End-diastolic
volume

End-diastolic
pressure

End-systolic volume

Stroke volume
Discuss right-sided heart failure.

LV mass

LV geometry
 Systolic HF Diastolic HF
Preload

Afterload

Contractility

Heart Rate

The Right Heart

Hypertension
SBP (mmHg) DBP (mmHg)
Normal

Prehypertension

Stage I HTN

Stage II HTN

Hypertensive crisis
Hypertension: Secondary
Clinical Findings Diagnostic Tests

Coarctation of
the aorta

Renovascular
disease

Cushing’s
syndrome

Conn’s
syndrome

Pheochromocy
toma

Pregnancy-
induced
hypertension
Antihypertensive Agents: Drugs that Target the Adrenergic Receptors
Drug Class Examples How BP is Reduced
Antihypertensive Agents: Drugs that Target the Myocardium and Vascular Smooth Muscle
Drug Class Examples How BP is Reduced
Antihypertensive Agents: Drugs that Target the Kidney
Drug Class Examples How BP is Reduced
Calcium Channel Blockers
Dihydropyridines Non-Dihydropyridines
Target

Clinical Effects

Examples

Control of HR Control of vascular tone

Control of contractility
 Constrictive Acute

Patho

Cause

S/Sx
 Constrictive Acute

Tx

Mgmt
Pericardial Tamponade
Describe the pericardium.

What is the difference between pericardial effusion and tamponade?

Unique Signs Cause HR
Becks Triad

1.
2.
3.

Rhythm

Pulsus paradoxus

Preload

Kussmaul’s sign

Contractility

Reduced EKG voltage

Afterload

Compression of heart,
lungs, trachea, and
esophagus
Cardiac Tamponade
Surgical treatment

Anesthetic Management

HR

Rhythm

Preload

Contractility

Afterload
Infective Endocarditis
Who is at risk?

What surgical procedures increase the risk?

What antibiotics do we use for prophylaxis?

Obstructive Hypertrophic Cardiomyopathy Conditions that Distend the LVOT Conditions that Narrow
the LVOT
List 3 other names for obstructive hypertrophic cardiomyopathy. Systolic LV
volume

Discuss the pathophysiology of OHC.

Force of LV
contraction

Transmural
pressure
gradient
Obstructive Hypertrophic Cardiomyopathy
Problem Treatment Things that Cause the Problem

↑ HR

↓ Preload

↑ Contractility

↓ Afterload
Percutaneous Coronary Interventions
What is dual antiplatelet therapy?

Timing of surgery after PCI When to discontinue therapy before surgery?

Procedure Time to Wait Until Elective Surgery

Angioplasty

Bare metal stent

Drug eluting stent

CABG
CPB: Key Points
Intra-Aortic Balloon Pump
Indications and contraindications. How is it placed?

How does it work?

Intra-Aortic Balloon Pump LVAD
Aortic Aneurysm: Classification
Abdominal Aortic Aneurysm
 After Placement After Removal

Venous return

Cardiac
output

MAP

SVR

PAOP

LV wall stress

MVO2

Coronary
blood flow

Renal blood
flow

Total body
VO2

SvO2
Aortic Surgery & Anterior Spinal Artery Syndrome
Discuss the spinal cord circulation.

How does AoX cause paralysis?

Anesthetic considerations for aortic surgery.

Carotid Endarterectomy
What is Amaurosis Fugax? Contrast the merits of regional vs general anesthesia for CEA.

Anesthetic Considerations. Post-operative Complications.

Monitoring Cerebral Perfusion and Neurologic Integrity
Awake patient

EEG

Increased Frequency (Hz) Decreased Frequency (Hz)

Cerebral oximetry

Transcranial
Doppler

SSEP
Subclavian Steal Syndrome

S/sx: Brain S/sx: Ipsilateral Arm