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WorksheetsAnesthesia for cardiac patients
Total questions: 40
Worksheet time: 20mins
Which management priority best maintains the myocardial supply–demand balance in ischemic heart disease during anesthesia?
Allowing tachycardia to sustain cardiac output
Minimizing vasodilators to preserve afterload
Using deeper anesthesia or adrenergic blockade to control autonomic increases in heart rate and blood pressure
Avoiding all beta-blockers perioperatively
On the morning of elective surgery, which antihypertensive management strategy is most appropriate?
Withhold all antihypertensive drugs to avoid intraoperative hypotension.
Continue most antihypertensive therapy up to surgery; consider withholding ACE inhibitors and ARBs due to increased intraoperative hypotension risk.
Switch all patients to parenteral vasodilators the night before surgery.
Double the dose of ACE inhibitors and ARBs to prevent perioperative hypertension.
Which statement about the transplanted heart during anesthesia is most accurate?
It retains normal autonomic reflexes, making indirect vasopressors highly effective
It is totally denervated; reflex tachycardia is absent and direct-acting agents are preferred over indirect vasopressors
It responds strongly to ephedrine due to robust catecholamine stores
Rapid vasodilation is well tolerated because of preserved baroreflexes
A patient scheduled for noncardiac surgery has poor or unknown functional capacity (<4 METs). You judge that further testing will change perioperative decision-making. Based on the algorithm, which step is recommended next?
Proceed directly to surgery
Initiate coronary revascularization immediately
Order pharmacologic stress testing (Class IIa)
No further testing (Class III: No Benefit)
Which pre-intubation technique is specifically listed to attenuate the hypertensive response in hypertensive patients during airway manipulation?
Administering ketamine for its analgesic effect
Deepening anesthesia with a potent volatile agent
Avoiding opioids to prevent respiratory depression
Doubling the dose of muscle relaxant
Which intravenous agent is particularly useful for controlling postoperative hypertension accompanied by tachycardia, and should be considered in the recovery period when contributing causes have been corrected?
Labetalol
Hydralazine
Nitroglycerin
Esmolol
Which of the following surgeries carries the highest cardiovascular risk?
Emergency appendectomy
Carotid endarterectomy
Femoral–popliteal bypass surgery
Inguinal hernia repair
A 67-year-old patient with uncontrolled hypertension presents for an elective dialysis access creation. Which of the following techniques is not suited for attenuating the hypertensive response to intubation?
Administering 3 μg/kg of fentanyl intravenously
Administering topical airway anesthesia
Administering lidocaine 0.5 mg/kg intravenously
Administering esmolol 1 mg/kg intravenously
A 24-year-old female patient with a preoperative QTc interval of 550 ms is undergoing breast surgery under general anesthesia. Droperidol is administered to the patient for prevention of postoperative nausea, following which the patient goes into polymorphic-ventricular tachycardia. Which of the following drugs/therapies is best for the patient at this point?
Amiodarone
Lidocaine
magnesium
Diltiazem
Surgical electrocautery may cause a problem with an automated implantable cardioverter defibrillator (AICD) by all the following mechanisms, except
AICD interpreting a cautery current as ventricular fibrillation
Inhibition of pacemaker function due to cautery artifact
Increased pacing rate due to activation of a rate-responsive sensor
Cautery current generating too much heat at the location of AICD and
causing burns
Pulmonary capillary wedge pressure (PCWP) does not correspond to the left-ventricular end diastolic pressure (LVEDP) in all of the following situations, except
Mitral stenosis
Tricuspid regurgitation
Very high positive end–expiratory pressure (PEEP)
Left-atrial myxoma
Normal mixed venous oxygen tension is ______ (mm Hg):
75
40
45
560
Which of the following is most effective method of preventing the hemodynamic changes associated with intubation?
Brief laryngoscopy (<15 seconds)
Esmolol 1 mg/kg IV before intubation
Lidocaine 2 mg/kg before intubation
Deepen the anesthesia with propofol 1 mg/kg
The central venous pressure (CVP) waveform in cardiac tamponade is characterized by
Abolition of X descent
Abolition of Y descent
CV waveform
Tall C waves
Ventricular premature beats (VPCs) can be treated with lidocaine (1–2 mg/kg IV) when they
Are frequent (more than six premature beats/min)
Are multifocal
Take place during the ascending limb of the T wave (R-on-T phenomenon)
All of the above
What is a key anesthetic management goal for patients with tetralogy of Fallot?
Reduce systemic vascular resistance and increase pulmonary vascular resistance
Use high airway pressures to improve oxygenation
Maintain intravascular volume and systemic vascular resistance while avoiding increases in pulmonary vascular resistance
Promote right-to-left shunting to speed anesthetic uptake
On the morning of elective surgery, which antihypertensive management strategy is most appropriate?
Withhold all antihypertensive drugs to avoid intraoperative hypotension.
Continue most antihypertensive therapy up to surgery; consider withholding ACE inhibitors and ARBs due to increased intraoperative hypotension risk.
Switch all patients to parenteral vasodilators the night before surgery.
Double the dose of ACE inhibitors and ARBs to prevent perioperative hypertension.
A patient reports more than three anginal episodes per day over the last week, with some occurring at rest. Which classification best fits these characteristics?
Unstable angina
Chronic stable angina
Noncardiac chest pain
Silent ischemia
Which beta-adrenergic blocking agent is noted to have a very short half-life of approximately 9 minutes and high β1-receptor selectivity (++), making it suitable for acute intravenous control?
Atenolol
Metoprolol
Propranolol
Esmolol
A patient with previous PCI and drug-eluting stent (DES) implantation is planning elective noncardiac surgery. Which timing aligns with the recommendations?
Delay surgery optimally for 6-12 months after DES implantation.
Proceed with surgery 14 days after DES implantation.
Perform surgery within 30 days after bare-metal stent (BMS) implantation.
Schedule surgery the day of balloon angioplasty if aspirin will be discontinued.
During intraoperative management of patients with ischemic heart disease, which hemodynamic change increases myocardial oxygen demand and simultaneously reduces supply?
Bradycardia
Tachycardia
Hypotension
Hypertension
Which single ECG lead provides the greatest sensitivity when only one lead can be monitored for ischemia in the perioperative setting?
Lead II
Lead V5
Lead V3
Lead aVL
According to ACC/AHA guidance, which is the most appropriate strategy before elective cardioversion when the duration of atrial fibrillation exceeds 48 hours or is unknown?
Proceed with immediate synchronized electrical cardioversion without anticoagulation.
Administer β‑blockers for rate control only and avoid anticoagulation.
Use prophylactic amiodarone alone to reduce thromboembolic risk before cardioversion.
Provide anticoagulation for 3 weeks prior to cardioversion and 4 weeks following it, or perform TEE to exclude left atrial thrombus.
During surgery, which action is recommended when there is a greater risk of stray currents from electrocautery affecting an implantable cardioverter-defibrillator (ICD)?
Turn off pacemaker function before surgery and leave it off
Program the defibrillator function off immediately before surgery and reprogram it back on immediately afterward
Replace the ICD with external defibrillation pads permanently
Increase pacing rate to backup mode throughout the surgery
Which diagnostic evaluation helps distinguish heart failure from other causes of dyspnea due to its elevation being associated with impaired ventricular function?
Troponin I
C-reactive protein
D-dimer
B-type natriuretic peptide (BNP) concentration
During physical examination, which finding is most directly associated with left-sided heart failure?
Jugular venous distention
Hepatomegaly
S3 gallop or pulmonary rales
Pedal edema
Which physical examination sign is associated with right-sided heart failure in valvular disease?
Pulmonary rales
Jugular venous distention
S4 gallop
Cyanosis
Loss of normal atrial systole due to atrial fibrillation in mitral stenosis most directly causes which consequence?
Reduced ventricular filling by approximately 20–30%
Increased ventricular compliance
Improved cardiac output
Resolution of pulmonary hypertension
Which arrhythmia is particularly promoted by left atrial dilation and blood stasis in mitral stenosis?
Ventricular tachycardia
Atrial fibrillation
Wolff–Parkinson–White-mediated SVT
Atrioventricular nodal reentry tachycardia
Which hemodynamic goal is emphasized for patients with mitral stenosis undergoing anesthesia?
Increase cardiac output significantly
Induce mild hypovolemia to reduce preload
Maintain sinus rhythm and avoid tachycardia
Promote fluid overload to ensure adequate perfusion
In patients with severe mitral stenosis, what is a risk of overzealous fluid replacement during surgery?
Pulmonary edema
Systemic hypertension
Bradycardia
Brain edema
What is the recommended management for marked hemodynamic deterioration from sustained supraventricular tachycardia (SVT) in a patient with mitral stenosis?
Administer ephedrine
Immediate cardioversion
Increase intravenous fluids
IV adenosine rapid push
Which heart rate strategy is recommended to minimize regurgitant volume during anesthesia for mitral regurgitation?
Maintain bradycardia below 60 beats/min
Keep heart rate between 80 and 100 beats/min
Induce tachycardia above 120 beats/min
keep heart rate without intervention
In patients with mitral regurgitation and relatively well-preserved ventricular function, which statement best describes the tolerance of neuraxial anesthesia?
Spinal and epidural anesthesia are contraindicated due to afterload reduction
Spinal and epidural anesthesia are generally well tolerated if bradycardia is avoided
Only epidural anesthesia is acceptable; spinal is not recommended
Neuraxial anesthesia should always be combined with inodilators
Which maneuver accentuates the prolapse in mitral valve prolapse by decreasing ventricular volume (preload)?
Squatting
Handgrip exercise
Standing or Valsalva
Leg elevation
Which sustained arrhythmia is most commonly encountered in patients with mitral valve prolapse?
Ventricular fibrillation
Atrial flutter
Torsades de pointes
Paroxysmal supraventricular tachycardia
Over several years of chronic left-to-right shunting, which sequence best explains progression to Eisenmenger syndrome?
Reduced right ventricular afterload → decreased PVR → left-to-right shunt intensifies
Pulmonary vascular changes increase PVR → right ventricular hypertrophy and pressures rise → right heart pressures exceed left → shunt reverses to right-to-left
Left atrial dilation → mitral regurgitation → right-to-left shunt immediately
Increased SVR → decreased PVR → bidirectional shunt persists without reversal
Which clinical precaution is mandated by the presence of shunt flow between the right and left hearts?
Routine bronchodilator administration
Prophylactic antibiotics prior to dental procedures
Meticulous exclusion of air bubbles and particulate material from intravenous fluids to prevent paradoxical embolism
Strict fluid restriction to prevent pulmonary edema
In patients with VSDs, which anesthetic consideration is correct regarding systemic vascular resistance (SVR)?
Large increases in SVR are well tolerated and reduce shunting
Decreases in SVR worsen left-to-right shunting
SVR changes have no impact on shunting
Increases in SVR worsen left-to-right shunting
Which anesthetic induction agent is commonly used in Tetralogy of Fallot because it maintains or increases SVR and does not aggravate right-to-left shunting?
Propofol
Thiopental
Ketamine
Etomidate
