SAM - 17

What are the major anesthetic concerns in cardiac patients

Heart failure, fluid overload, arrhythmias, worsening disease

What reduces anesthetic risk in cardiac patients

Accurate diagnosis, preparation, reasonable plan, excellent monitoring

What is a normal sleeping respiratory rate goal before anesthesia

<30 breaths/min

Does murmur loudness indicate severity of cardiac disease

No

What happens to a failing heart when fluid load is increased

Congestion

Does increasing preload always increase cardiac output

No

What should be considered before anesthesia regarding cardiac medications

Benefits and risks

How should induction be approached in cardiac patients

Use lower doses and give slowly

What type of induction should be avoided in cardiac patients

Mask or chamber induction

What drugs are preferred during anesthetic maintenance

Short-acting, titratable, reversible drugs

What is the general fluid approach in hypovolemic cardiac patients

Balanced fluids but avoid IV boluses

What fluid rate may be used in normally hydrated cardiac patients

None or a low rate of 1-3 mL/kg/hr

What are especially important monitors during anesthesia

ECG, BP, SpO2, capnography, temperature

Why is recovery especially risky in cardiac patients

Pain, hypoventilation, hypothermia and stress

What is the anesthetic goal in MMVD

Maintain forward flow and minimize regurgitation

What drug is especially important in preoperative MMVD management

Pimobendan

What should be avoided in MMVD stage B2 or higher

Alpha2 agonists

What is the main concern with fluids in MMVD

Avoid IV fluid overload

What happens to HCM ventricles

They are hypertrophied with decreased compliance

Why is tachycardia poorly tolerated in HCM

It reduces ventricular filling and can worsen outflow obstruction

What should be maintained during anesthesia in HCM

Preload

What should be increased during anesthesia in HCM

Afterload

Which inotropes should be avoided in HCM

Dopamine and dobutamine

What are the major features of DCM

Ventricular dilation, poor performance, often CHF

How should HR be managed in DCM

Maintain or increase HR to maintain cardiac output

What should be done before anesthesia in pericardial tamponade

Pericardiocentesis and fluid pretreatment

What can develop 12-24 hours after traumatic myocarditis

Ventricular arrhythmias

What should be done with elective procedures in pulmonary hypertension

Postpone until pulmonary pressure is lowered

What is the important drug for pulmonary hypertension

Sildenafil

What is the Class Ib antiarrhythmic drug

Lidocaine

What is Class II antiarrhythmic therapy

Beta blockers such as propranolol, atenolol, esmolol

What is the Class III antiarrhythmic drug

Amiodarone

What are Class IV antiarrhythmics

Calcium channel blockers such as diltiazem and verapamil