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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
Who gets advanced therapy?
Group 1 yes 3 4 5 maybe NOT group 2 -if vasodilate can put into pulm oedema
26
Where is the most evidence for use of advanced therapies?
Idiopathic and scleroderma
27
What are the types of advanced therapies?
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
What is "shunt size"
Qp:Qs = (ratio aortic valve oxygen- mixed venous)/ (PV oxygen- PA) USING SATURATIONS not pressures
29
When to close an ASD?
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
Most common type ASD?
Ostium secundum primum more common in Downs
31
ASD loads the... VSD loads the... PDA loads the,...
ASD loads right heart VSD loads left heart PDA loads the LV
32
Most common type VSD
membranous - bordered by fibrous continuity of AV valve and aortic valve Get aneurysm formation and AR
33
VSD in adults close spontaneously...
50%
34
Why close PDA?
Endocarditis risk But don't close if murmur inaudible and asymptomatic or if Eisenmengers PDA is connection between aorta and pulmonary artery
35
DDx continuous murmur
Coronary fistula PDA Ruptured sinus of valsalva anuerysm
36
PDA with eisenmengers see?
May see clubbing in feet with cyanosis but not hands
37
How does eisenmengers syndrome happen?
Left to right shunt puts volume pressure on pulm circulation and shear stress-->increase PVR-->change to R to L shunt
38
Most common cause of Eisenmengers
Uncorrected PDA>VSD>ASD BUT prognosis way better than PPAH
39
Treatment Eisenmengers?
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
What does Ebstein anomaly look like?
Tricuspid valve shifted right down towards apex- tiny LV AND 80% have ASD or PFO Usually normal PAP
41
What is in tetrallogy
VSD Over riding aorta RVH RVOTO either subpulm stenosis or pulmonary atresia
42
What should you look for when following up Tetrallogy?
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
What tends to happen with peripartum CM?
50% improvement in LVEF at 6 months High recurrence risk see in last trimester, early PP
44
Bernoulli equation-
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
Continuity equation for finding out valve area?
Flow = area of valve x velocity across valve
46
constrictive pericarditis vs tamponade
tamponade -prominent x and absent y descent | constrictive- prominent x and Y

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