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Valley Need to knows > Cardiac Left Ventricular Pressure-volume loops > Flashcards

Cardiac Left Ventricular Pressure-volume loops Flashcards

1
Q

Label

A
  1. Aotic valve closes
  2. Isovolumetric relaxation
  3. Mitral Valve opens
  4. Diastolic filling
  5. Mitral Valve closes
  6. Isovolumetric contraction
  7. Aortic valve opens
  8. Ejection
  9. Stroke volume
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2
Q

Where is ESV

A

line from D-A

Isovolumetric reaxation line

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3
Q

Where is contractility measured at

A

Point D

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4
Q

Where is Afterload measured at

A

point C

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5
Q

Where is EDV line

A

Line B-C

Isovolumetric contraction line

or Point B more specific

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6
Q

Where is peak systolic BP measured

A

Very top point of curve on line C-D

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7
Q

Where Does Diastole begin/ systole end

A

Point D

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8
Q

Where Does diastole end/ systole begin

A

point B

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9
Q

Where is S1

A

point B

Mitral Valve closure

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10
Q

Where is S2 heart sound

A

Point D

Aortic valve closure

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11
Q

If the Loop gets taller what does that indicate

A

increased pressure

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12
Q

If the loop gets wider what does that mean

A

Increased volume

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13
Q

where do the mitral and aortic valves open and close

A
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14
Q

when does systole begin and end

A

Begins at B

ends at D

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15
Q

When does diastole begin and end

A

Begins at D

ends at B

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16
Q

When does diastolic filling occur?

A

Between A and B

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17
Q

Where does ejection occur?

A

Between C and D

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18
Q

Acute Changes in PRELOAD:

With INCREASED PRELOAD What happens to

EDV and ESV

SV? BP? HR?

A
  • Increased EDV no change in ESV
  • SV- Increased
  • BP- Increased
  • HR decreased
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19
Q

Acute Changes in PRELOAD:

With DECREASED PRELOAD What happens to

EDV and ESV

SV? BP? HR?

A
  • EDV decreased no change to ESV
  • SV- Decreased
  • BP- Decreased
  • HR- increased
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20
Q

Acute Changes in PRELOAD:

with increased Preload what does the Loop look like?

A

wider and taller

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21
Q

Acute Changes in PRELOAD:

With decreasd Preload what does the loop look like?

A

Narrower and shorter

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22
Q

Acute Changes in PRELOAD:

When preload increases what happend to EDV?

A

Increases

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23
Q

Acute Changes in PRELOAD:

when EDV increases, preload increases, the LV empties the previous EDV, consequestly, w/ greater filling but emptying back to the previous level, what happens to SV

A

Increases

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24
Q

Acute Changes in PRELOAD:

When EDV decreases what happens to preload?

A

Decreases

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25
Q

Acute Changes in PRELOAD:

When EDV decrease, preload decreases, the LV empties the previous ESV. Consequently, with decreased filling but emptying back to the previous level, what happens to SV

A

Decreases

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26
Q

Acute Changes in Afterload​:

With increased Afterload what happens to:

EDV and ESV

SV? BP? HR?

A
  • EDV and ESV increase
  • SV - decreased
  • BP- increased
  • HR- Decreased
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27
Q

Acute Changes in Afterload​:

With Decreased Afterload what happens to

EDV and ESV

SV? BP? HR?

A
  • EDV amd ESV decreases
  • SV- increased
  • BP- Decreased
  • HR- Increased
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28
Q

Acute Changes in Afterload​:

with increased afterload there is a shift where?

A

to the right

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29
Q

Acute Changes in Afterload​:

with decreaased afterload there is a shift where?

A

to the left

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30
Q

Acute Changes in Afterload​:

with Increased afterload what will the loop look like and why?

A

taller- increased BP

Skinny- decreased SV

shift to right- Increased EDV and ESV

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31
Q

Acute Changes in Afterload​:

With decreased afterload what will the loop look like and why?

A
  • Shorter- decreased BP
  • Wider- Increased SV
  • Left shift- Decreased EDV and ESV
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32
Q

Acute Changes in Afterload​:

what drug can decrease afterload?

A

Nitroprusside

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33
Q

Acute Changes in Afterload​:

What drug can increase afterload?

A

Phenylephrine

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34
Q

Acute Changes in PRELOAD:

what can increase preload

A

fluids

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35
Q

Acute Changes in PREload​:

What drugs decrease preload?

A

Nitro

Lasix

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36
Q

Acute Changes in Afterload​:

when afterload increased, does the heart empty more or less completely?

A

Less completely

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37
Q

Acute Changes in Afterload​:

When afterload increases, the heart empties less completely and what happens to SV

A

Decreases

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38
Q

Acute Changes in Afterload​:

when afterload increases SV decreases, what happens to EDV and ESV?

A

Both increase

39
Q

Acute Changes in Afterload​:

When afterload decreases, the heart empties more or less completely?

A

more completely

40
Q

Acute Changes in Afterload​:

When afterload decreases the heart empties more completelty and SV increases, what happens to EDV and ESV when afterload decreases

A

both decrease

41
Q

Altered Contractilty:

with increased contractility what happens to EDV and ESV?

SV? BP? HR

A
  • EDV and ESV decrease
  • SV- increased
  • BP- increased
  • HR- decreased
42
Q

Altered Contractilty:

with decreased contractility what happens to EDV and ESV?

SV? BP? HR?

A
  • EDV and ESV increase
  • SV- decrease
  • BP- decreased
  • HR- increased
43
Q

Altered Contractilty:

what does the loop look with increased contractility and why?

A
  • Left shift- decreased ESV and EDV
  • Wider- Increased SV
  • Taller Increased BP
44
Q

Altered Contractilty:

what does the loop look like and why with decreased contractility?

A
  • Right shift- increased EDV and ESV volume
  • Skinnier- decreased SV
  • Shorter- Decreased BP
45
Q

Altered Contractilty:

When contractility increases what happens to ventricular emtying?

A

Increases ( the ventricles empty more completely)

46
Q

Altered Contractilty:

when contractilty INCREASES the ventricles empty more completely, EDV decreases but not as much as ESV thus what happens to SV

A

SV- increases

47
Q

Altered Contractilty:

when cntractility decreases what happens to ventricular emptying?

A

it empties less completely

48
Q

Altered Contractilty:

When contractility decreases, the ventricles empty less completely, EDV increases just not as much as ESV so what happens to SV

A

SV decreases

49
Q

Altered Contractilty:

what drugs can increase contractility?

A

DIgitalis

PDEIII inhibitor

50
Q

Altered Contractilty:

what can cause a decrease in contractility

51
Q

Summary of difficult concepts:

when preload increases or decreases what happens to EDV and ESV?

A

EDV increases or decreases repectively

ESV does not change

52
Q

Summary of difficult concepts:

When SV falls either as a result of an increase in afterload or decrease in contractility what happens to EDV

A

Increases

(you can’t pump the blood forward so it stays behind

53
Q

Summary of difficult concepts:

When SV increases either as a result of decrease in afterload or increase in contractility what happens to EDV?

A

it decreases

The blood is being pumped forward

54
Q

Fill this out memorize it and write it down when u take the boards

55
Q

with pressure loop hemodynamics answer the following based off the last chart

  1. What happens to PCWP in relation to EDV
  2. what happens to LV chamber size in relation to ESV
  3. What happens to SVR in relation to SV
  4. What happens to HR in relation to MAP
A
  1. As one increases the other increases and vise versa
  2. As one increases the other increases and vise versa
  3. If SV increases SVR has to decrease and Vise versa
  4. If MAP increases HR decreases (reflex) and vse versa
56
Q

see the chart again in relation to the last slide

57
Q

Valve Problems:

Idiopathic Hypertrophc Subaortic stenosis is unique. what does the pressure loop look like? Only IHSS can cause a pressure loop like this!

A

Smaller volumes and larger pressures

empty heart

58
Q

Valve Problems:

Chronic AS

what is the problem with AS? (pressure or volume)

A

Pressure

Increased afterload

59
Q

Valve Problems:

what would the loop look like for Chronic AS

A

it shift upward

60
Q

Valve Problems:

with Chronic AS concentric hypertrophy permits the LV to generate HIGHER pressure, what happens to the Volume in the LV?

A

The volume remains about the same

thus the pressure loop shifts upward

61
Q

Valve Problems:

What is the problem with chronic MS

A

Volume

Decreases Preload

62
Q

Valve Problems:

what would the loop look like with chronic MS

A

shorter with left shift

Less preload less EDV less pressure

63
Q

Valve Problems:

With chronic MS LV filling is diminished, the shift in the P-V to the left reflect what?

A

Decreased preload

(reduced filling, but emptying is about the same)

64
Q

Valve Problems: AR

with AR, the volume in the LV increases when?

A

During early Diastole

65
Q

Valve Problems: AR

with AR the volume in the LV increases during early diastole, where on the P-V loop should u look and what should you see?

A

On the isovolumetric Relaxation line D-A

should see increase in volume (right slant)

66
Q

Valve Problems: AR

In ACUTE AR is the P-V loop large or small?

A

Small (makes a small A)

67
Q

Valve Problems: AR

with CHRONIC AR the left ventricular chamber dilates and what happens to the P-V loop does it get large or small? and why?

A

Large

b/c SV is large

68
Q

Valve Problems: AR

See the little A with Acute AR

69
Q

Valve Problems: AR

See the Large A with chronic AR

70
Q

Valve Problems: MR

What does the Loop look like with MR ACUTE?

A

the isovolumetric contraction phase loses volume prior to contraction.

ESV and EDV are increased

71
Q

Valve Problems: MR

What does the loop look like for MR Chronic?

A

Again the Isovolumetric line B-C loses volume aka the line is slanted

D/t th LV hypertrophying the SV is increased and although the EDV increases the ESV decreases

72
Q

Test: Name the loop

73
Q

Test: Name the loop

A

Chronic Aortic Stenosis

74
Q

Test: Name the loop

nitro/ nipride/ Dig/ VAA​/ Pheny

A

Nitroprusside administration

75
Q

Test: Name the loop

nitro/ nipride/ Dig/ VAA​/ Pheny

A

Nitroglycerine administration

76
Q

Test: Name the loop

77
Q

Test: Name the loop

nitro/ nipride/ Dig/ VAA/ Pheny

A

Administration on Phenylephrine

78
Q

Test: Name the loop

A

Chronic Aortic Regurgitation

79
Q

Test: Name the loop

Adminstation of what drug:

nitro/ nipride/ Dig/ VAA/ Pheny

A

Administration of Digatalis

80
Q

Test: name that loop

A

CHF

or VAA

81
Q

what refles controls the BP

A

barorecptor reflex

82
Q

Where are the baroreceptors located Arterial?

A

Carotid sinus and aortic arch

83
Q

Baroreceptor reflex:

Afferent action potentials from the barorecptors of the AORTIC ARCH are carried to the brainstem via what nerve?

A

Vagus Nerve

84
Q

Baroreceptor reflex:

AFFERENT action potentials from the barorecptors of the CAROTID SINUS are carried to the brainstem centers via what nerve?

A

Hering’s nerve (a branch of the glossopharyngeal)

85
Q

Baroreceptor reflex:

which barorecptors are physiologically more important and are primarially responsible for minimizing acute blood pressure alterations?

A

Carotid baroreceptors

86
Q

Baroreceptor reflex:

what are the efferent pathways?

A

Vagus nerve to SA node

Sympathetic nerves- to the ventricles of the heart and systemic vasculature

87
Q

Baroreceptor reflex:

Explain the whole thing r/t to INCREASED BP

A
  • Increased Arterial BP
  • INCREASED stretch of baroreceptors in carotid sinus and aortic arch
  • INCREASED action potential in AFFERENTS of VAGUS nerve (arotic arch) and HERING’s NERVE (carotid sinus) to the CV centers in th medulla of brainstem
  • Increased action potentials in VAGUS nerve (EFFERENT)=> decreased HR and Decreased CO
  • DECREASED action potentials to SYMPATHETIC Nerves to: 1) HEART (decreased contractility, decreased SV, decreased CO) 2) Venous blood vessels (venodilation, decreased venous return, decreased CO) 3) Arterial blood vessels (Decreased SVR)
  • Decreased Arterial BP
88
Q

Baroreceptor reflex:

What happens inreponse to Low blood pressure?

A

The fucking oppisite

89
Q

How do u get the MAP using a arterial pressure curve?

A

the area under the curve divided by the time

area / time

90
Q

name 2 phosphodiesterase inhibitors.

A

Milrinone (primacor)

Inamrinone (Inocor)

91
Q

what are PDEI’s classified as (what’s their drug class)

A

positive inotropes

92
Q

how do PDEIs work

A

inhibit phosphodiesterase thus blocking the breakdown of cAMP- this cause increased cAMP and increased myocardial contractility and decreases SVR

93
Q

what is an endogenous nucleotide occuring in all cells of the body

94
Q

Adensodine can be administered and should be administered for what 3 reasons?

A
  1. Slow conduction through AV node
  2. interrupt reentry pathways through the AV node
  3. Restore NSR in pts with SVT

Valley Need to knows (25 decks)

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