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_MS2 Cardio > 8/3- How to Msr Cardiac Fct at the Bedside > Flashcards

8/3- How to Msr Cardiac Fct at the Bedside Flashcards

1
Q

Pulmonary artery pressure? (mmHg)

A

15-30/3-12

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2
Q

Right ventricular pressure? (mmHg)

A

15-30/0-8

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3
Q

Aortic pressure? (mmHg)

A

100-140/60-90

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4
Q

Left ventricular pressure? (mmHg)

A

100-140/5-12

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5
Q

Pulmonary capillary wedge pressure? (mmHg)

A

5-`1

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6
Q

The right atrial pressure waveform has:

  • _(#)_ positive waves (examples)
  • _(#)_ negative deflations (examples)
A

Three positive waves:

- a wave: atrial systole (follows ECG ā€œPā€ wave)

- c wave: TV closure

- v wave: atrial filling (followed by TV opening)

Two negative deflations:

- x-descent: atrial relaxation

- y-descent: rapid atrial emptying

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7
Q

Right ventricular pressure has:

  • ______ peak pressure
  • ______ pressure phases (examples)
A

Systolic Peak Pressure

Diastolic Pressure Phases

  • Rapid filling phase
  • Slow filling phase
  • Atrial contraction
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8
Q

What is this? Label?

A

a wave- atrial kick

c wave- closure of AV valve

x descent- atrial relaxation

v wave- atrial filling from jugular vein (peaks when AV valve closes)

y descent- rapid early emptying of atrium (atrial counterpart of rapid early filling phase of ventricle) Which descent(s) is/are clinically useful?

**Change in y descent is very important sign of abnormality!! Critical!

** x descent abnormality (steeper/shallower) has no specificity for cardiac disease

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9
Q

Measurements of systolic function (4)?

A
  • Hemodynamic measurements (4)
  • Regional ventricular function
  • Left ventricular mass
  • Ventricular response to stress
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10
Q

What are hemodynamic measurements of cardiac function?

A
  • Ventricular volume
  • Ejection fraction
  • Cardiac output
  • Vascular resistance
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11
Q

How do we measure ventricular volumes?

A

Systolic and diastolic volumes can be measured by echocardiography or angiography (nuclear or contrast dye)

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12
Q

What is typical LV end-diastolic volume?

(donā€™t need to memorize)

A

79 +/- 11 mL/m2

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13
Q

What is typical LV end-systolic volume?

(donā€™t need to memorize)

A

28 +/- 6 mL/m2

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14
Q

Equation for stroke volume?

A

EDV - ESV

(Typically LV: 79 - 28 ~ 51 mL/m2)

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15
Q

What is left ventricular ejection fraction?

What does it indicate?

What increases/decreases it?

A

Ratio of stroke volume to end-diastolic volume: SV/EDV

  • Measure of cardiac performance
  • Increases with increase in preload and contractility or decrease in afterload
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16
Q

What is normal LVEF?

A

67 +/- 7% (> 50%)

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17
Q

What is cardiac output?

A

Blood flow to systemic circulation in every minute

CO = SV x HR

(SV: blood ejected per beat)

18
Q

What is cardiac index?

A

Cardiac output/body surface area

CI = CO/BSA

19
Q

How can we measure CO? (2 main methods)

Which is used more often?

A
  • Thermodilution method using a Swan Ganz catheter** more common
  • Doppler echocardiography (complicated)
20
Q

Method behind measuring CO by Swan Ganz catheterization?

A

Thermodilution method using a Swan Ganz catheter:

  • Balloon-tipped catheter floated into the pulmonary artery from a systemic vein
  • 10 mL saline injected into the RA and resultant change in PA blood temperature (detected by a thermal sensor) is used to compute the cardiac output
  • Then we infer left side CO from right side (they are equal!!!)
21
Q

T/F: Left sided cardiac output can be estimated from the right side (via Swan Ganz catheterization)?

A

True

Right side cardiac output approximates the left

22
Q

What can we measure by Swan Ganz catheterization?

A
  • Cardiac output
  • Pulmonary capillary wedge pressure

As the balloon is occluded, the P measured at the catheter tip is the pulmonary cap wedge P which reflects the left atrial pressure transmitted through the pulmonary circulation into the pulmonary caps

23
Q

What is vascular resistance? Types?

A

Ratio of pressure gradient to blood flow

  • Systemic vascular resistance
  • Pulmonary vascular resistance
24
Q

Equations for:

  • Systemic vascular resistance
  • Pulmonary vascular resistance

Relative relationship?

A

Systemic vascular resistance: SVR = (AO-RA)/CO Pulmonary vascular resistance: PVR = (PA-LA)/CO

SVR is ~10x higher than PVR

25
Q

What is regional ventricular function?

A

Extent of myocardial thickening and wall motion of various myocardial segments

26
Q

How is regional ventricular function measured?

A
  • Echocardiography
  • Radionuclide angiography
  • Cardiac catheterization with contrast dye angiography
27
Q

How may wall motion be described?

A
  • Normal
  • Hypokinetic
  • Akinetic
  • Dyskinetic
28
Q

How is left ventricular mass most commonly measured?

A

Echocardiography

29
Q

What can increase LVM (left ventricular mass)?

A

HYPERTROPHY

  • Either concentric or eccentric due to pressure or volume load
30
Q

Left ventricular hypertrophy predicts what?

A

Left ventricular hypertrophy predicts a worse clinical prognosis in patients with hypertension and various cardiac diseases

31
Q

Why do we measure ventricular response to stress?

A
  • To assess overall ventricular reserve
  • To determine functional significance of coronary stenosis in pts with CAD
32
Q

Types of stress tests (3)? Examples?

A

- Isotonic exercise: treadmill and bike

- Isometric exercise: handgrip

- Pharmacologic: dobutamine, adenosine, or dipyridamole

33
Q

What is a key predictor of significant coronary artery disease?

A
  • Development of a regional wall motion abnormality INDUCED during any stress test is a HALLMARK of ischemia due to coronary artery disease (CAD)
  • This is a major reason for using stress tests to assess regional ventricular function response to stress
34
Q

What are measurements of diastolic function?

A
  • Measure end-diastolic pressures in LV and RV during cardiac catheterization
  • Diastolic filling parameters by Doppler echocradiography
35
Q

Key points of measurements of cardiac function:

  • Atrial waveforms:
  • Ventricular waveforms:
  • Ventricular Diastolic Pressure = ____
  • RAP= __; RVP= __
  • LAP= __; LVP= __
  • Cardiac performance vs. contractility
  • Systolic function: _____________
  • Cardiac performance: measured by _________ & influenced by _______
  • Contractility: ___________- conditions=inotropic state
  • Systolic function: _______
  • LVEDV= ___ ;LVESV=____; SV= ___
  • EF= ___(%); EF= ______
  • CO= ___; CI= ___
  • SVR= _______
  • Resistance= _____
A

Key points of measurements of cardiac function:

  • Atrial waveforms: a, c & v (+); x & y (-)
  • Ventricular waveforms: early/late filling
  • Ventricular Diastolic Pressure = Atrial Pressure
  • RAP=0-8; RVP=15-30/0-8 mm Hg
  • LAP=3-12; LVP=100-140/3-12 mm Hg
  • Cardiac performance vs. contractility
  • Systolic function: volumes, EF, CO, SVR
  • Cardiac performance: measured by EF, SV & CO & influenced by contractility
  • Contractility: inherent ability to generate power independently of loading conditions=inotropic state
  • Systolic function: volume, EF, CO, SVR
  • LVEDV=79+11; LVESV=28+6; SV=D-S
  • EF= SV/EDV (%); EF= 67+7 (>50%)
  • CO= SV x HR (volume ejected/beat x number of heart beats); CI= CO/BSA
  • SVR= pressure drop (AP-RAP)/flow (CO)
  • Resistance = pressure/flow
36
Q

All of the following are associated with pressure overload concentric LVH except:

A. Systemic hypertension

B. Aortic stenosis

C. Mitral regurgitation

D. Pulmonary hypertension

A

All of the following are associated with pressure overload concentric LVH except:

A. Systemic hypertension

B. Aortic stenosis

C. Mitral regurgitation

D. Pulmonary hypertension

37
Q

Which of the following has the highest wall stress?

A. HTN with concentric LVH

B. Aortic stenosis with concentric LVH

C.

D.

A

Which of the following has the highest wall stress?

A. HTN with concentric LVH

B. Aortic stenosis with concentric LVH

C.

D. ***

38
Q

which of the following is the correct way of calculating cardiac output?

A. SV x VR

B. HR x EDV

C. SV x HR

D. HR x CI

A

which of the following is the correct way of calculating cardiac output?

A. SV x VR

B. HR x EDV

C. SV x HR

D. HR x CI

39
Q

All of the following affect wall stress except:

A. IVP

B. HR

C. Ventricular size

D. Wall thickness

A

All of the following affect wall stress except:

A. IVP

B. HR

C. Ventricular size

D. Wall thickness

40
Q

Which of the following phases of diastole occurs first?

A. Atrial kick

A

Which of the following phases of diastole occurs first?

A. Atrial kick

41
Q

True/False questions

A

?

_MS2 Cardio (35 decks)

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