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Fiji School of Medicine MMed (Anaesthesia) CARDIOVASCULAR MODULE FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 1 This module is designed to be completed during tutorials and in your own time. It is important to keep a record of the time spent on these activities and also to record the various sources of your information in the box provided. Please hand this module to your tutor when you have completed the activities. It will be returned to you after marking. Complete the multiple choice test and submit for marking before moving on to this problem based learning case. Amendments 2004/Nargis Ahmad This module has been updated with suggestions for additional reading material Aspects of Myocardial Physiology Bulletin 20 and 21 Parts 1 and 2 Available from RCA website Current Concepts: Management of Anticoagulation before and after Elective Surgery Kearon C., Hirsh J. N Engl J Med 1997; 336:1506-1511, May 22, 1997. Review Article Care of Patients Receiving Long-Term Anticoagulant Therapy Schulman S. N Engl J Med 2003; 349:675-683, Aug 14, 2003. Clinical Practice Heart Failure Jessup M., Brozena S. N Engl J Med 2003; 348:2007-2018, May 15, 2003. Review Article Lowering Cardiac Risk in Noncardiac Surgery Fleisher L. A., Eagle K. A. N Engl J Med 2001; 345:1677-1682, Dec 6, 2001. Clinical Practice Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery Mangano D. T., Layug E. L., Wallace A., Tateo I., The Multicenter Study of Perioperative Ischemia Research Group N Engl J Med 1996; 335:1713-1721, Dec 5, 1996. Original Article FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 2 Current Concepts: Preoperative Assessment of Patients with Known or Suspected Coronary Disease Mangano D. T., Goldman L. N Engl J Med 1995; 333:1750-1756, Dec 28, 1995. Review Article Drug Therapy: Prevention of Infective Endocarditis Durack D. T. N Engl J Med 1995; 332:38-44, Jan 5, 1995. Review Article Medical Progress: Valvular Heart Disease N Engl J Med 1997; 337:32-41, Jul 3, 1997. Review Article Valvular Heart Disease in Pregnancy Reimold S. C., Rutherford J. D. N Engl J Med 2003; 349:52-59, Jul 3, 2003. Clinical Practice Special Article Cardiac Scoring Systems – What is their value? S.Ridley Anaesthesia Volume 58 Issue 10 Page 985 – October 2003 A Systematic Approach to cardiovascular pharmacology BJA/CEPD reviews/Vol 1 No 1 2001 One of the sessions in this module will be an ECG quiz, please revise your strategy for analysis of an ECG early on to get the most of this session. You will also formulate a protocol for investigation of cardiac disease, based on your reading. This will be a group exercise. Similarly you will devise protocols for antibiotic prophylaxis and management of patients who are anticoagulated. These are to be applicable to local needs and resources. There is lots of reading so you may not get through it all, but remember to read critically and bear in mind what you’ve being doing in Public Health! Nargis Ahmad FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 3 Loata is a 74 year old lady who lives with her daughter in law. She has difficulty walking because of her arthritis. She has come into hospital for an elective cholecystectomy. Tutorial 1: In your group, discuss the best way to assess this lady's cardiovascular fitness for anaesthesia. Make notes: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 4 Summarise your conclusions in the space below. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 5 In your own time, read the following article: Compile a list of any concepts you don't understand - these will become your learning issues. The aged cardiovascular risk patient British Journal of Anaesthesia; London; Nov 2000; H-J Priebe Available at http://bja.oupjournals.org/cgi/content/full/85/5/763 FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 6 Make notes on the learning issues you identified from reading the preceding article: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 7 Before you can understand the effects of age on cardiovascular function, you need to review your knowledge of normal cardiovascular physiology. Before your next tutorial complete the following tasks: 1. List the factors that determine cardiac output: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Define preload, afterload and myocardial contractility. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 8 3. Describe the factors that control preload, afterload and myocardial contractility. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 4. Explain Starling’s law of the heart. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 9 5. Describe Guyton’s cardiac output curves and explain factors that affect them. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 6. Describe and explain venous return curves and correlate these with the cardiac output curves. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 10 7. Describe the pressure-volume relationship of the ventricle and its clinical applications. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started FSM - M.Med (Anaesthesia) Time Finished Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Total Time Page 11 Resources Accessed (Textbook, Journal Article etc Tutorial 2: Problem Based Learning Case (continued): Loata tells you she gets breathless when she lies flat and when you examine her she has pitting oedema to her ankles and bilateral basal crepitations. With your group, review the set reading and the completed task and then discuss the pathophysiology of congestive cardiac failure. Make notes: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 12 _____________________________________________________________________ _____________________________________________________________________ Tutorial 2 (continued) Discuss various treatment options and explain the effects of each therapy on cardiovascular physiology. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 13 In your own time, research the learning issues identified during the previous tutorial and review those aspects of cardiovascular physiology which came up in the discussion. Complete the following activities before the next tutorial. 1. Explain the factors that determine systemic blood pressure and its regulation. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Describe total peripheral vascular resistance and factors that affect it. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 14 3. Describe the general mechanisms involved in local vascular control. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 4. Describe the essential features of the microcirculation in relation to its structure, fluid exchange (Starling forces) and control mechanisms present in the pre and post capillary sphincters. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 15 Tutorial 3 Loata tells you that her doctor started her on a Propranol for high blood pressure two months ago and she hasn't felt well ever since. 1. With your group discuss the pharmacology of beta blockers . Relate this to Loata's case. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ____________________________________ 2. Discuss the mechanisms and physiological consequences of 1, 2, 1 and 2 receptor blockade. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 16 3. Classify and receptor blocking agents according to their action, reversibility and chemical groups. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 4. Discuss the pharmacokinetics of receptor blocking agents and apply this to their clinical use. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 17 5. Discuss the pharmacodynamic and pharmacokinetic implications of receptor blocking agents. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ___________________________________________________________________ 6. Discuss the clinical uses of receptor blocking agents and their side effects. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 18 In your own time and before the next tutorial: 7. Classify the modes of action of the anti-hypertensive agents. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ____________________________________ 8. Describe the pharmacology of agents which block the release of transmitters at the adrenergic nerve ending. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 19 9. Describe the mechanism of action of vasodilators such as hydrallazine and diazoxide. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ __________________________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 20 Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 21 Tutorial 4: Review the completed tasks from the previous tutorial and the work you completed independently. Problem Based Learning Case (continued) You request a preoperative ECG for Loata and you notice frequent ventricular ectopic beats 1. With your group, discuss the ionic basis of spontaneous electrical activity of cardiac muscle cells (automaticity). _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Describe the normal and abnormal processes of cardiac excitation. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 22 3. Explain the physiological basis of the ECG. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 4. Describe the factors that may influence cardiac electrical activity. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 23 _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 24 In your own time and before the next tutorial: Describe the structure and functional significance of the contractile elements of cardiac muscle and how they differ from skeletal muscle. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Describe and explain the mechanical events of the cardiac cycle and correlate this with electrical and ionic events. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 25 Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 26 Tutorial 5: Review the completed tasks and any learning issues from the previous week's tutorial. Problem Based Learning Case (continued) Prior to surgery, Loata experiences palpitations and an ECG shows a run of ventricular tachycardia. With your group, complete the following tasks: 1. Classify antiarrhythmics by their electro-physiological actions. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Discuss the pharmacological basis of anti-arrhythmic properties of lignocaine, including its pharmacokinetics. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ___________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 27 3. Discuss the pharmacological basis of the use of digoxin as an anti-arrhythmic and its toxic effects. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 4. Discuss the side-effects and problems associated with the use of antiarrhythmics during anaesthesia. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 28 In your own time and before the next tutorial: 1. Describe the function and anatomical location of baroreceptors _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Explain the role of the autonomic nervous system in controlling systemic vascular resistance and redistribution of blood volume. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 29 3. Explain the neural and humoral regulation of blood volume. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Date: Time Started Time Finished Total Time Resources Accessed (Textbook, Journal Article etc FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 30 Tutorial 6: Review the completed tasks from the previous week. Problem Based Learning Case (continued) During Loata's surgery, you notice the appearance of ST depression on the cardiac monitor. When you reassess the circulation, her finger-tips are cool and her systolic blood pressure has fallen to 70 with a tachycardia of 130. 1. With your group discuss the cardiovascular changes resulting from haemorrhage and hypovolaemia. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2. Discuss the effect of positive pressure ventilation on cardiac output. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 31 _____________________________________________________________________ _____________________________________________________________________ 3. Discuss the cardiovascular effects of the anaesthetic agents you may have used. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Discuss the various methods of measuring blood pressure and the physical principles involved. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 32 Assignment: A number of scoring systems have been developed to assess cardiovascular risk related to anaesthesia and surgery. Discuss two scoring systems. These scoring systems may not be appropriate in your clinical setting. Design a scoring system that might work for you and discuss how you would test this system. OR Explain the cardiovascular changes accompanying the process of ageing. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 33 _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - M.Med (Anaesthesia) Cardiovascular Module Dr Bruce Lister Revised Dec 2003/ Dr Nargis Ahmad Page 34 _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FSM - 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