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Cards > Cardiac haemodynamics > Flashcards

Cardiac haemodynamics Flashcards

1
Q

Describe the way a swan ganz trace should look, including basic pressure info

A

RA- should be 5 mmHg
RV- across tricuspid valve systolic 20-30 and diastolic should be same as RA if no tricuspid stenosis

PA- more M shaped. systolic pressure should be same as RV (low if pulmonary stenosis). Diastolic aboud half way up. If PR, PA trace looks like RV trace.

PCW- measuring the pressure transmitted back as a surrogate of left atrial pressure

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2
Q

What does the atrial waveform look like and what can you tell from it.

A

Double impulse with a wave, x descent, v wave, y descent.

a- atrial systole- not there in AF
x - atrial relaxation
v- ventricular contraction (less than a in RA and more than a in LA)
y- atrial emptying

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3
Q

M wave with prominent x and y descent?

A

Constrictive pericarditis

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4
Q

No a waves

A

AF

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5
Q

CHB

A

cannon a waves

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6
Q

Tricuspid regurg, RV failure

A

increase V wave

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7
Q

WHAT DOEs kussmaul’s sign mean?

A

Increased RA pressure with inspiration- should drop. As seen in constriction or RAV ischaemia

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8
Q

What does it mean if PCWP is greater than LVEDP?

A

mitral stenosis -severe espec if mean gradient over 10

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9
Q

What if LV pressure a lot higher than L atrial?

A

AS

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10
Q

Most common cause of intraventricular pressure gradient?

A

HOCM with obstruction

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11
Q

Treatment constrictive pericarditis vs restrictive cm?

A

Pericardial stripping

Medical therapy ?transplant

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12
Q

List 5 causes of constrictive pericarditis

A 
Uraemia
TB pericarditis
Recurrent pericarditis
Previous mediastinal RT
CT disease
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13
Q

List 6 causes of restrictive cardiomyopathy

A 
Sarcoidosis
Amyloidosis
Haemochromatosis
Idiopathic
Post radiation
Endocardial fibroelastosis
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14
Q

MAIN THING you have to remember to distinguish CP from RC?

A

Constriction- LV-RV interdependence (ie constriction binds together) See increase RV pressure with inspiration
Restriction- Absent LV-RV interdependence. Do not see increase RV pressure with inspiration.

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15
Q

Define pulmonary hypertension

A

mean PAP over 25mmHg

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16
Q

List the five causes of pulmonary hypetension

A
  1. Small arterioles (idiopathic, HIV, congenital, drugs)
  2. Left heart
  3. Lung disease- hypoxaemia
  4. Thromboembolic
  5. Multifactorial
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17
Q

What is the formula for pressure?

A

pr=4 x velocitysquared

(Bernoulli law)

Pressure in RV = (Pressure RV-RA) + RA pressure

The first bit is estimated by TR

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18
Q

How is PCWP used to tell between L heart failure and primary cause of pulm hypertension?

A

LA cause PCWP will he high

Lung cause, will be low (under 15)

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19
Q

What is the use of vasodilator testing in R heart cath>

A

PRedict response to vasodilator therapy like Ca channel blocker
?closure of shunt feasible

20
Q

How do you calculate mean pulmonary pressure?

A

systolic + 2 x diastolic all divided by three!!

21
Q

How do you calculate pulmonary vascular resistance?

A

(PA-LA) divided by (pulmonary blood flow which is cardiac output in L)

Normal is less than 3-5

ie seeing if pt can be listed for cardiac transplant or are lungs stuffed as well?

22
Q

Who gets oxygen in pulm hypertension?

A

Group 3 mortality benefit

23
Q

Who gets anticoagulation for pulmonary hypertension?

A

Group 1 and 4

24
Q

What improves your 6MWT more ?

A

Exercise training over advanced therapies

25
Q

Who gets advanced therapy?

A

Group 1 yes
3 4 5 maybe
NOT group 2 -if vasodilate can put into pulm oedema

26
Q

Where is the most evidence for use of advanced therapies?

A

Idiopathic and scleroderma

27
Q

What are the types of advanced therapies?

A

Endothelin receptor antagonists eg bosentan, macitentan, ambrisentan (symptoms, 6MWT)

Phosophodiesterase inhibitors eg sildenafil, tadalafil (symptoms, 6MWT)

Guanylate cyclase inhibitors eg Riociguat

Prostacyclin (epoprostenol), inhaled iloprost, sc trepostinil

28
Q

What is “shunt size”

A

Qp:Qs = (ratio aortic valve oxygen- mixed venous)/ (PV oxygen- PA)

USING SATURATIONS not pressures

29
Q

When to close an ASD?

A

When haemodynamically significant shunt- with symptoms, RV enlargement, Qp:Qs over 1.5
When getting paradoxical embolism
Platypnea orthodeoxia syndrome

DO NOT Close when eisenmenger physiology - this would convert some one to primary pulmonary hypertension which has worse prognosis if dont kill in process (PAP over 2/3 systemic BP or PVR more than 2/3 SVR)

30
Q

Most common type ASD?

A

Ostium secundum

primum more common in Downs

31
Q

ASD loads the…
VSD loads the…
PDA loads the,…

A

ASD loads right heart
VSD loads left heart
PDA loads the LV

32
Q

Most common type VSD

A

membranous - bordered by fibrous continuity of AV valve and aortic valve
Get aneurysm formation and AR

33
Q

VSD in adults close spontaneously…

A

50%

34
Q

Why close PDA?

A

Endocarditis risk
But don’t close if murmur inaudible and asymptomatic or if Eisenmengers

PDA is connection between aorta and pulmonary artery

35
Q

DDx continuous murmur

A

Coronary fistula
PDA
Ruptured sinus of valsalva anuerysm

36
Q

PDA with eisenmengers see?

A

May see clubbing in feet with cyanosis but not hands

37
Q

How does eisenmengers syndrome happen?

A

Left to right shunt puts volume pressure on pulm circulation and shear stress–>increase PVR–>change to R to L shunt

38
Q

Most common cause of Eisenmengers

A

Uncorrected PDA>VSD>ASD

BUT prognosis way better than PPAH

39
Q

Treatment Eisenmengers?

A

AVOID iron def–>increase micro red cells–>increase viscosity
Avoid warfarin as bleed risk more than thrombus risk
Pulm vasodiliator therapy does work- bosentan, sildenafil
heart lung transplant if syncope, refractory RHF
Endocarditis prophylaxis
Phlebotomy for hyper-viscosity symptoms

40
Q

What does Ebstein anomaly look like?

A

Tricuspid valve shifted right down towards apex- tiny LV
AND 80% have ASD or PFO
Usually normal PAP

41
Q

What is in tetrallogy

A

VSD
Over riding aorta
RVH
RVOTO either subpulm stenosis or pulmonary atresia

42
Q

What should you look for when following up Tetrallogy?

A

On cardiac MRI, size of RV is an indication to treat pulmonary regurg

More likley SCD post repair if LV EDP over 12, if NSVT, or QRS over 180

43
Q

What tends to happen with peripartum CM?

A

50% improvement in LVEF at 6 months
High recurrence risk
see in last trimester, early PP

44
Q

Bernoulli equation-

A

Change in pressure = 4 x PEAK NOT MEAN velocity squared

So can work out pressure difference without a catheter in the lungs

If know velocity across tricuspid valve. (70-100% people do have a bit of this) so can work out pressure difference RA and RV

RV pressure = 4 x (TR velocity)squared

45
Q

Continuity equation for finding out valve area?

A

Flow = area of valve x velocity across valve

46
Q

constrictive pericarditis vs tamponade

A

tamponade -prominent x and absent y descent

constrictive- prominent x and Y

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