Cardiovascular Anesthesia Practice Questions

Q: The best chances of recovery after successful cardiopulmonary resuscitation are seen in which cardiac rhythm?

Ventricular Tachycardia. **Explanation:** The prognosis of cardiac arrest is heavily dependent on the initial presenting rhythm. **Ventricular Tachycardia (VT)**, specifically pulseless VT, carries the best prognosis for recovery and neurologically intact survival. **Why Ventricular Tachycardia is the correct answer:** VT and Ventricular Fibrillation (VF) are "shockable" rhythms. However, VT represents a more organized electrical activity than VF. In VT, the myocardium often retains better metabolic status and a higher likelihood of returning to a perfusing rhythm (ROSC) immediately following defibrillation. Because the heart is often in a "fresher" state of ischemia compared to other rhythms, the chances of successful resuscitation are highest. **Analysis of Incorrect Options:** * **Ventricular Fibrillation (VF):** While also a shockable rhythm with a good prognosis compared to non-shockable rhythms, it represents chaotic electrical activity. The longer a patient stays in VF, the more myocardial energy stores are depleted, eventually deteriorating into asystole. * **Asystole:** This is a "non-shockable" rhythm representing the total absence of electrical and mechanical activity. It usually signifies a prolonged period of ischemia and has the poorest prognosis. * **Electromechanical Dissociation (PEA):** In Pulseless Electrical Activity, there is organized electrical activity but no mechanical contraction. It is often caused by reversible factors (the H’s and T’s), but the survival rates are significantly lower than shockable rhythms like VT. **High-Yield Clinical Pearls for NEET-PG:** * **Chain of Survival:** The most critical factor in VT/VF survival is the **time to defibrillation**. * **Shockable Rhythms:** VT and VF. * **Non-Shockable Rhythms:** Asystole and PEA. * **Drug of Choice:** Epinephrine is the primary vasopressor used in all cardiac arrests; Amiodarone or Lidocaine are used specifically for refractory VT/VF.

Q: According to the 2010 ACLS Guidelines by AHA, which of the following pharmacological agents is not used in the management of cardiac arrest?

Atropine. **Explanation:** The correct answer is **Atropine**. According to the 2010 AHA ACLS Guidelines, Atropine was officially removed from the Cardiac Arrest Algorithm. **Why Atropine is the correct answer:** Previously, Atropine was used for Pulseless Electrical Activity (PEA) and Asystole. However, clinical evidence demonstrated that its routine use during cardiac arrest does not improve outcomes or survival to hospital discharge. While Atropine remains a first-line drug for **symptomatic bradycardia** (with a pulse), it is no longer indicated for a patient in active cardiac arrest. **Analysis of Incorrect Options:** * **Epinephrine (Option A):** This remains the primary vasopressor used in all cardiac arrest rhythms (VF/pVT, PEA, and Asystole). It is administered every 3–5 minutes to improve coronary and cerebral perfusion pressure via its alpha-adrenergic effects. * **Vasopressin (Option B):** In the 2010 guidelines, a single dose of Vasopressin (40 units IV/IO) was permitted as a substitute for the first or second dose of Epinephrine. (Note: It was later removed in the 2015 update to simplify the algorithm). * **Amiodarone (Option C):** This is the preferred anti-arrhythmic agent for shock-refractory Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (pVT). **High-Yield Clinical Pearls for NEET-PG:** * **Asystole/PEA:** The only drugs indicated are Epinephrine and treating reversible causes (H’s and T’s). * **Shockable Rhythms (VF/pVT):** If shocks and Epinephrine fail, use Amiodarone (300mg bolus) or Lidocaine. * **Atropine Dosage:** For symptomatic bradycardia, the dose is 1 mg IV every 3–5 minutes (Max: 3 mg). * **Magnesium Sulfate:** Only indicated during cardiac arrest if **Torsades de Pointes** is suspected.

Q: All of the following are indicated in the management of a patient with the given ECG findings, except?

Sodium bicarbonate. ***Sodium bicarbonate*** - **NOT routinely indicated** in ventricular fibrillation cardiac arrest management unless specific conditions like **hyperkalemia** or **tricyclic antidepressant overdose** are present. - Can worsen **intracellular acidosis** and cause **hyperosmolarity**, potentially reducing the effectiveness of resuscitation efforts. *CPR for 60-90 seconds* - In older **ACLS protocols**, CPR for 60-90 seconds was recommended before attempting defibrillation in **witnessed VF arrest**. - Provides **coronary perfusion pressure** and **cerebral blood flow** to optimize the chance of successful defibrillation. *Epinephrine* - **Alpha-adrenergic effects** increase coronary and cerebral perfusion pressure during CPR in **VF/VT cardiac arrest**. - Standard dose is **1 mg IV/IO** every 3-5 minutes during cardiac arrest resuscitation. *Vasopressin* - **Vasoconstrictor** that increases coronary and cerebral perfusion pressure, similar to epinephrine in cardiac arrest. - Can be used as an alternative to epinephrine in **VF/VT cardiac arrest** with dose of **40 units IV/IO**.

Q: What is the anesthetic of choice for cardiac anesthesia?

Isoflurane. **Explanation:** **Isoflurane (Option A)** is considered the anesthetic of choice for cardiac anesthesia among the given options due to its favorable hemodynamic profile. Its primary advantage is the **preservation of cardiac output** and its unique property of **"Ischemic Preconditioning,"** which protects the myocardium against ischemic injury. While it causes a decrease in systemic vascular resistance (SVR) leading to a drop in blood pressure, it does not significantly depress myocardial contractility compared to older agents. Furthermore, it is less likely to sensitize the myocardium to catecholamines. **Why other options are incorrect:** * **Ketamine (Option B):** While often used in hemodynamically unstable patients, it is generally avoided in patients with coronary artery disease (CAD) because it increases sympathetic outflow, leading to tachycardia and hypertension, which significantly increases myocardial oxygen demand. * **Methoxyflurane (Option C):** It is highly nephrotoxic due to the release of inorganic fluoride ions and has a very slow onset/offset, making it obsolete in modern cardiac anesthesia. * **Halothane (Option D):** It is a potent myocardial depressant and sensitizes the myocardium to endogenous and exogenous catecholamines, increasing the risk of fatal ventricular arrhythmias. It also lacks the protective preconditioning effects of isoflurane. **High-Yield Clinical Pearls for NEET-PG:** * **Coronary Steal Phenomenon:** Historically associated with Isoflurane (potent coronary vasodilator), but clinically insignificant at standard anesthetic doses (0.5–1.5 MAC). * **Sevoflurane vs. Isoflurane:** Sevoflurane is also widely used due to its rapid onset and lack of airway irritability, but Isoflurane remains a classic "textbook" answer for its stability and cost-effectiveness. * **Etomidate:** Often the induction agent of choice for cardiac surgery due to its superior hemodynamic stability.

Question 1

Which of the following is most cardiostable?

Accepted Answer

Etomidate

Answer

Thiopentone sodium

Answer

Ketamine

Answer

Propofol

Question 2

The best chances of recovery after successful cardiopulmonary resuscitation are seen in which cardiac rhythm?

Accepted Answer

Ventricular Tachycardia

Answer

Ventricular Fibrillation

Answer

Asystole

Answer

Electromechanical dissociation

Question 3

According to the 2010 ACLS Guidelines by AHA, which of the following pharmacological agents is not used in the management of cardiac arrest?

Accepted Answer

Atropine

Answer

Epinephrine

Answer

Vasopressin

Answer

Amiodarone

Question 4

A 40-year-old lady intraoperatively develops a heart rate of 220 bpm and a blood pressure of 70/40 mmHg. The ECG shows a QRS complex of 120 milliseconds. What is the best management?

Accepted Answer

DC cardioversion

Answer

Adenosine 6 mg/12 mg

Answer

Amiodarone

Answer

Esmolol

Question 5

What is the most common arrhythmia after sinus tachycardia in an ICU patient?

Accepted Answer

Atrial flutter

Answer

A-V block

Answer

Non-paroxysmal junctional tachycardia

Answer

Paroxysmal supraventricular tachycardia

Question 6

During the surgical removal of an invasive glioma from the base of the skull, cranial nerves IX and X are accidentally cut bilaterally. What would be the immediate change in the patient's hemodynamic condition?

Accepted Answer

Tachycardia with hypertension

Answer

Bradycardia with hypertension

Answer

Bradycardia with hypotension

Answer

Sinus arrhythmia with hypotension

Question 7

What is the vasopressor of choice in anesthesia for a patient with aortic stenosis who develops hypotension during surgery?

Accepted Answer

Phenylephrine

Answer

Ephedrine

Answer

Dopamine

Answer

Dobutamine

Question 8

All of the following are indicated in the management of a patient with the given ECG findings, except?

Accepted Answer

Sodium bicarbonate

Answer

CPR for 60-90 seconds

Answer

Epinephrine

Answer

Vasopressin

Question 9

After effective cardiopulmonary resuscitation, what physiological change is observed?

Accepted Answer

Constriction of pupil

Answer

Dilation of pupil

Answer

Elevation of blood pressure

Answer

None of the above

Question 10

What is the anesthetic of choice for cardiac anesthesia?

Accepted Answer

Isoflurane

Answer

Ketamine

Answer

Methoxyflurane

Answer

Halothane

Cardiovascular Anesthesia — MCQs

Cardiovascular Anesthesia — MCQs

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