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
PNS vs sns tone in heart
PNS vagus n, rt= sa and left= av node. SNS= T1-4
How av node AP looks diff from SA node
Lower slope during phase 4 which leads to slower intrinsic firing rate
SA node AP phases
4 spont depol (na in ca in, funny current, -60), 0 depol ca in, phase 3 k out repolarization
How heart rate changes
Rate of spont 4 depol (can inc w sns stim), tp (more neg= shorter distance), rmp (less neg= shorter distance). PNS fx phase 4 and rmp
How to calc DO2
CO x ((hgb x sao2 x 1.34) + (pao2 x 0.003)) x 10
Normal do2, normal o2 extraction, extraction ratio
1000 ml/min, 250 ml/min, 25%
Normals: Ca02, EO2, VO2, CvO2
- 25%. 250 ml/min. 15 ml/dl
How to calc map
(CO X SCR)/80 + CVP
Pouiseilles law
Flow= pi x r4 x change in pressure / 8xnxl
Effect of doubling radius on flow
16 fold
How reynolds number correlates to flow type
<2000= laminar, >4000= turbulent, in between= transitional
Dihydropyrodines v non
Dyhydro targets vascular smooth muscle. Non dihydro targets myocardium
More likely in constrictive than in acute pericarditis
Kussmauls sign, pulsus paradoxus, atrial dysrhythmias
Pulsus ____ more likely in pericardial tamponade
Pulsus paradoxus, SBP decreases on insp
How long to delay elective sx after a BMS V drug eluding
Bare= 30 days. Des= 6 mo if current, 12 months if 1st gen
Act goal before bypass
400 seconds
Protamine dose
1 mg per 100u of heparin
When to wait for elective surgery after an mi
4-6 weeks
Factors that dec myo 02 delivery
Hi hr, dec aortic p, dec vessel diameter, inc edp, dec CaO2, l shift 02 dissoc curve/dec p50
Best leads to monitor for st changes on nml ekg
V3 >v4 >v5>II>avf
Pts w cad: 5 lead v 3 lead best to watch for st
5: v4, avf, mcl5, or III. 3: avf, mcl5
Ventricular compliance
Ventricle vol / ventricular pressure
How compliance effects the curve
Decreased shifts up and left, increased shifts down and right
Hallmark of systolic HF
Decreased EF with an inc EDV
Hallmark diastolic HF
Symptomatic Hf w normal EF
Systolic HF causes
MI, regurg, dilated cm
Diastolic HF causes
Mi, stenosis of valves, htn, HOCM, cor pulm, obesity
Suffix that goes w: ang II receptor antag, ARB
ANG II= Spartan, arb- zosin
Dilator that targets A and V equally
SNP
Dihydropyridine ending and types of rx
Dipine, vasculature
Ccb contractility impair most to least
Verapamil, nifedipine, dilt, nicardipine
What cardiac tamponade looks like on pressure volume loop
Shift left, narrower, smaller. Dec volume and compliance
Kussmauls sign
Inc cvp and JVD on inspiration
Drugs to avoid in tamponade
IAs, prop, tpl, opioids, regional
Safer drugs in tamponade
Ketamine, nitrous, benzos, low dose opioids
Hemodynamic goals in tamponade
Maintain HR, Maintain/inc preload, maintain/inc contractility, maintain afternload
Conditions that distend LVOT/make HOCM better
Inc volume, dec contractility, inc AO pressure
Conditions that make HOCM worse
Dec vol, inc contractility, dec AO pressure
How long to wait after angioplasty without stent
2-4 weeks
How long to wait for sx after a cabg
6 weeks
When to d/c before sx: asa, plavix, ticlid
3 days, 7 days, 14 days
Where distal tip IABP should be
2cm distal to L subclavian A
IABP balloon deflation occurs when on ekg
R wave
Aortic pressure differences with and without IABP
IABP decreases EDP and SBP
Coronary perf pressure
Aortic DBP - LVEDP
CBF autoreg range
60-140
Things that decrease 02 delivery
Tachycardia, dec aortic pressure, dec vessel diameter, inc edp, hypoxemia, anemia, L shift/dec p50, dec capillary density
Things that inc 02 demand
Tachy, htn, sns, inc wall tension, inc EDV, inc afterload, inc contractility
