3 Cardiac Flashcards
S1: valve closure, what is happening in heart, sounds prop to
Mitral and tricuspid. Start of systole, end of lv fill and beginning of isovolumic contraction. Sounds louder w harder contraction
S2: valve closure, action in heart, sound prop to
Aortic and pulmonic. Onset of diastole, end of lv ejection. Sound louder w htn
S3: suggests what, heard when
Gallop rumble= flaccid and inelastico heart. After S2 mid diastole
S4: when it occurs and caused by what
Atrial systole, before s1
Layout of sarcomeres in stenosis v regurg
Stenosis= in parallel. Regurg= in series
How pressure vol loop changes w AS
Inc height and shift right q
When it is important to listen to murmur of AS and why
Elderly, before spinal. Pts asymptomatic until LV dysfunction develops
How a line waveform diff in AS
Slower systolic upstroke (pulsus tardus) and a delayed peak. SV reduction= narrow PP with small amplitude (pulsus parvus). May not have a dicrotic notch/look dampened
When mitral stenosis is severe
Valve area <1, LAP-LV p gradient >10, PAP SBP >50
What happens in mitral stenosis
LA overfilled, LV underfilled, lower SV/end diastolic volume, body compensates w inc SVR. LA overload leads to afib
Pressure vol loop mitral stenosis
Lower, same width, shift left
HR consid mitral stenosis
Tx tachyarrythmias. Avoid drugs that inc hr like ketamine, atra, or anticholinergic. Otherwise may lead to pulm edema
PAOP waveform in mitral stenosis. How to tx LAP issue
Diuretics. Prominent a wave and dec y descent
DOC for hypotension in MS, drug to avoid
Vaso or neo, not ephedrine
When it is ok to do a spinal in mitral stenosis
If INR <1.5. Epidural preferred
Mitral regurg pressure vol loop acute and chronic
Both lower, wider, shifted slightly right (acute more than chronic). Acute shorter, less width, and more right than chronic overall
Paop waveform mitral regurg
Large v wave
SAM is a risk after which valve repair, treatment
Mitral valve repair. Inc vol and afterload w alpha agonist
Conditions that inc PVR
Hypercarbia, hypoxia, tburg, nitrous, lung hyperinflation, acidosis
When cardiologia must be injected retrograde
Aortic regurg
Pressure vol loop aortic regurg
Wide, shifted right, slanted
Bad choices for hypotension in AI
Neo or vaso
AI: spinal fx
Will reduce afterload and regurg fraction
AI ABP waveform
Sharp upstroke, low DBP, wide PP. may have biphasic systolic peaks/bisferiens pulse
AS when murmur heard and where, how it can vary
Systole, right sternal border. May feel as a thrill and may dec with severity
AI: when murmur heard, wher
Diastolic, right sternal border. Blowing murmur less loud than AS
MS: when murmur heard and where
Diastolic, L apex and L Scilla. Snap/rumble
MR: when murmur heard and where
Systolic, l apex and l axilla. Swishing holosystolic murmur
Where sarcomeres are replicated in MS
Left atrium
Things to avoid in MV prolapse
SNS stim, dec SVR, low vol, upright positions. No ketamine
Primary determinant of RMP. What happens when it decreases or increases
K. Dec= RMP more neg, harder to depolarize. Inc= rmp more pos and easier to depolarize
Ventricular AP phases
Phase 0 na in (depolarization), phase 1 initial repol k out cl in, phase 2 plateau ca in k out, phase 3 final repol k out ca briefly in, phase 4 rmp k in na out