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Module 12 · Anaesthesia Blueprints

Cardiac and vascular anaesthesia: exam notes and MCQs

Prepare cardiac and vascular anaesthesia for postgraduate anaesthesia examinations with structured notes, exam-style questions and referenced explanations from standard textbooks and current guidelines.

Practise all 28 Cardiac and vascular anaesthesia questions free →

Exam notes in this module

Valvular heart disease and cardiopulmonary bypass basics
Haemodynamic goals for each lesion and anticoagulation for bypass.
Ischaemic heart disease and non-cardiac surgery
Risk stratification, investigations, medication management, stents and intra-operative goals.
Congenital heart disease and pressure–volume physiology
Shunt physiology, PVR/SVR balance, tetralogy of Fallot, Eisenmenger syndrome and the PV loop.
Heart failure and the surgical patient
Classification, medical therapy, risk assessment, anaesthetic goals and devices.
Anaesthesia for vascular surgery — aortic and carotid
Cross-clamp physiology, spinal cord and renal protection, EVAR, and carotid endarterectomy under GA or LA.

Sample questions

Q1. Before initiating cardiopulmonary bypass, the usual full heparin dose and target ACT are:

  1. 100 U/kg; ACT > 200 s
  2. 200 U/kg; ACT > 300 s
  3. 300–400 U/kg; ACT > 400–480 s
  4. 600 U/kg; ACT > 800 s
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Answer C: 300–400 U/kg; ACT > 400–480 s

Full-dose heparin for cardiac surgery is given as an IV bolus of 300–400 U/kg (via a central line, with aspiration of blood to confirm intravascular placement). An ACT greater than 400–480 s is usually considered safe for initiating and maintaining CPB.

Exam style: NEET-SS Anaesthesia

Q2. After CPB, protamine is generally dosed at:

  1. 0.1 mg per 100 U heparin
  2. 0.5 mg per 100 U heparin
  3. 1–1.3 mg per 100 U heparin
  4. 5 mg per 100 U heparin
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Answer C: 1–1.3 mg per 100 U heparin

Protamine, a strongly basic polycationic protein, neutralises heparin stoichiometrically: 1 mg inhibits about 100 U. It is usually dosed at 1–1.3 mg per 100 U of the total heparin given (or by heparin-dose–response titration), given slowly.

Exam style: AIIMS INI-SS

Q3. The MOST important haemodynamic goal during anaesthesia for a patient with severe aortic stenosis is to:

  1. Produce a mild tachycardia to increase cardiac output
  2. Reduce afterload with vasodilators
  3. Maintain sinus rhythm, avoid tachycardia and maintain SVR
  4. Keep the patient hypovolaemic to reduce LV wall stress
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Answer C: Maintain sinus rhythm, avoid tachycardia and maintain SVR

The hypertrophied, non-compliant LV depends on adequate diastolic filling time and the atrial kick, while coronary perfusion depends on diastolic pressure. Goals: sinus rhythm, normal-to-low heart rate, adequate preload, and preserved SVR (phenylephrine for hypotension).

Exam style: NEET-SS Anaesthesia

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