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Cardiology > Cardiac Output > Flashcards

Cardiac Output Flashcards

1
Q

MAP is proportional to?

A

HRSVSVR

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2
Q

CO=

A

HR*SV

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3
Q

Preload is defined as?

A

The amount of passive tension of the ventricular myocytes in the ventricles by the volume of blood just prior to contraction

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4
Q

Preload is proportional to?

A

LVEDV/P

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5
Q

Tension is proportional to?

A

Radius and pressure

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6
Q

Preload is defined by the law of __

A

Laplace

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7
Q

Stroke volume is dependent on which 3 factors?

A

Contractility, Preload, and (inversely proportional) to Afterload

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8
Q

Increasing preload does what to stroke volume?

A

It increases stroke volume only up until a certain point of optimal sarcomere length

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9
Q

Nitrates have what effects on HR, Preload, Afterload, contractility, Tone, and flow

A 
Nitrates will do the following:
HR: Increase
Preload: DECREASE
Afterload: Decrease
CTY: No change
Tone: Decrease or no change
Flow: Increase or no change
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10
Q

B-blockers have what effects on HR, Preload, Afterload, contractility, Tone, and flow

A 
B-blockers will do the following:
HR: Decrease
Preload: No change
Afterload: No change
CTY: Decrease
Tone: Increase
Flow: No change
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11
Q

Calcium channel-blockers have what effects on HR, Preload, Afterload, contractility, Tone, and flow

A 
CCBs will do the following: 
HR: Decrease or no change
Preload: No change
Afterload: Decrease
CTY: Decrease
Tone: Decrease
Flow: Increase
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12
Q

Increasing preload has what effect on oxygen demand?

A

Increasing preload will increase oxygen demand, thus myocardial oxygen demand is defined by preload

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13
Q

How is preload regulated?

A
  1. Venous tone (sympathetic activity increases tension in walls of veins and venules, thus increasing preload by forcing blood from veins into the heart)
  2. Blood volume (increasing blood volume through fluid intake, neurohormonal mechanisms (RAAS, sympathetic nervous system, ADH)
  3. Body position: Gravity affects venous return. Preload decreases when you stand up
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14
Q

Myocardial demand is proportional to

A

preload, which is proportional to stroke volume. So in a way, myocardial demand is also proporitonal to stroke volume

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15
Q

Afterload is determined by what 3 factors

A
  1. Systemic vascular resistance (Systolic bp)
  2. Aortic compliance
  3. Aortic valve resistance
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16
Q

Increasing afterload will do what to stroke volume?

A

Increasing afterload will decrease stroke volume

17
Q

Afterload is defined as

A

Ventricular the force against which the ventricle is working after initiation of contraction (i.e. the resistance against which the heart muscle works. Which is proportional to blood pressure and vascular stiffness/ SVR)

18
Q

Increasing afterload will have what effect on oxygen demand?

A

Increasing afterload will increase oxygen demand

19
Q

Acidosis will lead to vasoconstriction or vasodilation

A

vasodilation

20
Q

Hypoxia will lead to vasoconstriction or vasodilation

A

vasodilation

21
Q

Citrate/acetate will lead to vasoconstriciton or vasodilation

A

vasodilation

22
Q

Adenosine will lead to vasoconstriction or vasodilation

A

Vasodilation

23
Q

What are the 3 major determinants of oxygen demand?

A

Heart rate, wall tension, contractility. All are directly proportional to myocardial oxygen demand

24
Q

Chronic stable angina is mostly an issue with oxygen demand or oxygen supply?

A

Oxygen demand

25
Q

Acute coronary syndromes are treated by focusing on oxygen demand or oxygen supply?

A

Targeted at oxygen supply

26
Q

Catecholamines increased or decrease oxygen demand?

A

Increase

27
Q

Do B-blockers affect oxygen demand or oxygen supply? How do they affect either one?

A
  • Decreased contractiliy and heart rate leads to decreased oxygen demand
  • Increased diastolic time increases myocardial oxygen supply
28
Q

What are the non selective B-blockers for B1 and B2? What do they treat?

A

Propranolol and nadolol; used for hyperthyroidism and portal hypertension

29
Q

What are the mixed B-blockers for B1, B2, and a1? What do they treat?

A

Carvedilol and labetalol; They treat heart failure (carvedilol) and hypertension (labetalol)

30
Q

What are the cardioselective B-blockers (B1»B2)

A

Atenolol, metoprolol, and esmolol (antianginals)

31
Q

What are the contraindications for B-blockers?

A

Acute decompensated heart afilure, bradycardia/heart block (reflex tachycardia can be a problem in diabetics), bronchospasm, sexual dysnfunction, depression

32
Q

What are the AEs for non-dihydropyridines?

A

Worsening heart failure, bradycardia, AV nodal block, constipation (impairs smooth muscle function in gut)

33
Q

What are the AEs for dihydropyridines?

A

Hypotension, peripheral edema, headache, flushing ,dizziness

34
Q

What are the contraindications in general for calcium channel blockers?

A

Systolic heart failure, bradycardia, sinus node dysnfunction, AV nodal block

35
Q

Do Nitrates affect oxygen demand, oxygen supply, or both?

A

Both.

DEMAND: NO from nitrates causes venodilation, decreased venous return/LVEDV, and decreased wall tension, thus decreasing oxygen demand.

SUPPLY: Nitrates will causes arteriodilation, increased coronary blood flow, thus increasing oxygen supply

36
Q

What are the contraindications for nitrates?

A

Concomitant PDE5 inhibitor use (sildenafil, viagra)

37
Q

What are the side effects related to vasodilation and unrelated to vasodilation from nitrates?

A

Related to vasodilation: Hypotension, headaches (meningeal vessel dilatation), reflex tachycardia

Unrelated to vasodilatation: Met-hemoglobinemia (oxidation of hemoglobin, rare)

38
Q

How long does it take for nitrate tolerance to occur?

A

Over the course of 1-3 weeks. Can be prevented by daily withdrawal of nitrates and may be due to depletion of reduced glutathione

39
Q

Indications for CABG over PCI?

A
  • Left main stenosis>50%
  • 3-vessel CAD (LAD, LCx, RCA)
  • 2-vessel disease including LAD with low EF or Diabetes

Cardiology (18 decks)

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