Cardiovascular Anesthesia Practice Questions for AA Boards

A patient takes a stable chronic beta-blocker dose and is undergoing noncardiac surgery. There is no new bradycardia, hypotension, or other contraindication. What is the usual perioperative plan?

1. Stop it routinely to avoid all anesthetic interactions
2. Double the dose on the morning of surgery
3. Continue the established regimen as clinically appropriate
4. Replace it with a newly started high-dose beta blocker on the day of surgery

Correct answer: C

Continue stable chronic beta-blocker therapy when clinically appropriate. If a new indication exists, treatment may be started sufficiently before elective surgery, optimally more than 7 days beforehand, to assess tolerability and titrate. Routine initiation on the day of surgery is harmful; this does not mean all new beta-blocker therapy is prohibited.

Source: AHA/ACC et al. Perioperative Cardiovascular Management for Noncardiac Surgery, 2024, perioperative beta blockers. https://www.jacc.org/doi/10.1016/j.jacc.2024.06.013 ; Official guideline slide set: https://professional.heart.org/-/media/PHD-Files-2/Science-News/Clinical-Update-Slides/2024-Guideline-for-Perioperative-Cardiovascular-Management-slide-set.pdf?sc_lang=en

An IV induction agent is being considered for an adult with markedly reduced left ventricular systolic function. Which agent is commonly selected for relatively limited cardiovascular depression but can transiently suppress adrenal steroid synthesis?

1. Thiopental
2. Ketamine
3. Propofol
4. Etomidate

Correct answer: D

Etomidate generally produces relatively limited cardiovascular depression and can be useful when ventricular reserve is poor. It inhibits adrenal steroid synthesis and may cause myoclonus. Its hemodynamic profile does not guarantee stability or establish it as the best agent for every patient with heart failure; dose, volume status, comorbidities, and the entire anesthetic plan remain important.

Source: DailyMed. Etomidate prescribing information, Clinical Pharmacology. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=75467058-da52-48fa-8d4e-e1025ec7d461

For a patient with compensated chronic mitral regurgitation undergoing general anesthesia, which hemodynamic approach best supports forward flow?

1. Give large fluid boluses routinely and deliberately raise systemic vascular resistance
2. Maintain adequate filling without volume overload and avoid excessive afterload while preserving perfusion pressure
3. Produce marked hypovolemia and severe hypotension
4. Induce pronounced bradycardia and hypertension

Correct answer: B

The aim is to maintain effective forward output. Adequate filling is needed, but excess volume can worsen congestion and regurgitation. Excessive systemic resistance can increase the burden on the ventricle; treating hypertension may improve forward flow, while excessive hypotension threatens organ and coronary perfusion. Goals must be adjusted for ventricular function, pulmonary pressures, and acute decompensation.

Source: OpenAnesthesia. Mitral Regurgitation Part 3: Surgical Management and Hemodynamic Considerations. https://www.openanesthesia.org/keywords/mitral-regurgitation-part-3-surgical-management-and-hemodynamic-considerations/

Which cardiovascular topics should AA students prioritize?

Prioritize valvular lesions, ischemic heart disease, ventricular function, arrhythmias, vasoactive drugs, blood pressure goals, and the hemodynamic effects of common anesthetics.

Are these cardiovascular questions from the Anesthesia Review question bank?

Yes. The previews use selected questions from the Anesthesia Review practice bank with their answer choices, rationales, and references.

How should I review a missed cardiac question?

Write down the lesion or physiology, the intended preload, afterload, heart-rate, and contractility goals, then explain why each distractor would move the patient away from those goals.