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ECHO > Cardiac Physiology > Flashcards

Cardiac Physiology Flashcards

1
Q

Normal electrical activation

A

1 SA node

  1. AV node
  2. Bundle of His
  3. Bundle branches (left and right)
  4. Purkinje fibers
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2
Q

Which is the fastest intrinsic rate

A

SA node

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3
Q

Primary pacemaker

A

SA node

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4
Q

What is the absolute refractory state

A

That period when a muscle cell is not excitable. From phase 1 until info phase 3.

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5
Q

What is the relative refractory period

A

During phase 3 and the muscle cell contract is the stimulus is strong

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6
Q

Electrocardiograph normal complex

A
  1. P wave
  2. P-R interval
  3. QRS complex
  4. T wave
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7
Q

What does the P wave represent

A

Atrial systole

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8
Q

What does P-R interval represent

A

From atrial to ventricular depolarization

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9
Q

What does the QRS complex represent

A

Ventricular systole (depolarization)

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10
Q

What does the T wave represent

A

Ventricular diastole (repolarization)

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11
Q

What is the normal duration for the QRS complex

A

.10sec

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12
Q

1 small box on the electrocardiograph is equal to

A

.04 seconds

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13
Q

1 big box on the echocardiogram is equal to

A

.2 seconds

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14
Q

5 big boxes on the electrocardiograph is equal to

A

1 second

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15
Q

Normal values for R-R interval

A

Between 3 to 5 big boxes (60-100 beats per min)

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16
Q

Normal values for QRS complex

A

Less than 3little boxes (less than .12 seconds)

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17
Q

Normal values for PR interval

A

Less than 1 big box (less than .2 seconds )

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18
Q

Frank starling law

A

Length tension relationship
-the more blood that enters the ventricle during diastole (preload) the greater the force of the contraction (systole) required to eject the blood. In other words, increased myocardial fiber length means increased tension

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19
Q

Increased volume preload =

A

Increased contractility

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20
Q

Increased myocardial fiber length =

A

Increased tension (river band theory)

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21
Q

Acute AI is _________ because we shift up the starling curve.

A

Hypercontractile

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22
Q

Chronic AI is ________ when we drop off the end

A

Failure

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23
Q

Preload definition

A

Load (volume) exerted on the ventricle at end diastole

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24
Q

Preload determines

A

Force of contraction

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25
Q

The greater the load

A

The greater the force of contraction (frank starling law)

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26
Q

Increased preload is increased by

A
  1. MR
  2. TR
  3. PI
  4. AI
  5. Ventricular and atrial septal defects
  6. Fluid overload
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27
Q

Afterload definition

A

Resistance against which the ventricle must pump

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28
Q

Afterload determines

A

The tension the myocardium must generate

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29
Q

Echo finishings for preload

A

Dilation

30
Q

Echo findings for afterload

A

Hypertrophy

31
Q

After load is increased by?

A

Any state of pressure overload such as

  1. Hypertension
  2. Aortic stenosis
  3. Pulmonic stenosis
32
Q

LV function indicators

A
  1. Stroke volume
  2. Ejection fraction
  3. Cardiac output
33
Q

Stroke volume equation

A

SV= end diastolic volume (EDV) - end systolic volume (ESV)

34
Q

Stroke volume varies with

A

End diastolic volume
Heart rate
Size

35
Q

Ejection fraction

A

EF= stroke volume divided by end diastolic volume (100)

Normal is > 55%

36
Q

Cardiac output definition

A

The volume of blood pumped from the LV each min

37
Q

Cardiac output equation and norm

A

CO= stroke volume X heart rate

Normal is 4-6 L/min

38
Q 
Which study does not allow for the calculation of ejection fraction 
A) 2D echo
B) cardiac angio
C) chest x Ray 
D) cardiac nuclear study
A

Cheat x Ray

39
Q

Bernoulli equation

A

4v squared

40
Q

Aliasing

A
  1. Occurs when the dipper shift excess the nyquist limit
  2. Nyquist limit = half the PRf (pulse repetition frequency
  3. A problem with higher velocities in pulsed Doppler (spectral and color flow)
  4. Occurs sooner with higher frequency transducers
41
Q

How do you eliminate aliasing on PW spectral Doppler

A

Switch to continuous wave Doppler

42
Q

Doppler stroke volume

A

SV = VTI(FVI) times CSA

43
Q

Doppler stroke volume

VTI

A

Is the velocity time integral as calculated by tracing the Doppler spectral display (sometimes called the flow velocity integral FVI) it represents how far the blood travels in centimeters with each ejection. Normally 12cm for the mitral and 20cm for aorta

44
Q

Doppler stroke volume

CSA

A

Is the Ross sectional area calculated one of two ways
1. CSA (cm sq)= 3.14 times (D divided by 2) sq
2CSA (cm sq)= 0.785 tines Dsq
D= the diameter of any office

45
Q

Maneuvers altering cardiac physiology

A
  1. Breathing2. Standing
  2. Squatting
  3. Hand grip
  4. Valsalva
  5. Sit ups
  6. Amyl nitrite inhalation
46
Q

Maneuvers altering cardiac physiology

- breathing

A

Inspiration: increases venous return

Expiration : decreases venous return

47
Q

Maneuvers altering cardiac physiology

- standing

A

Decreases venous return and stroke volume

48
Q

Maneuvers altering cardiac physiology

- squatting

A

Increased: venous return,SV,CO
(Increases AR)
(Decreases IHSS)

49
Q

Maneuvers altering cardiac physiology

- handgrip

A

Increased: HR, CO , arterial pressure

Decreases: AS. Increased:MR

50
Q

Maneuvers altering cardiac physiology

- valsalva

A

2 main phases-strain and release
1. During strain: decreases venous return,SV,CO
(Most murmurs decreases during straining,IHSS increases)
2. During release: increases venous return, CO, BP

51
Q

Maneuvers altering cardiac physiology

- sit ups

A

Increases HR,CO,and SV

52
Q

Maneuvers altering cardiac physiology

- amyl nitrite inhalation

A

Vasodilator
Decreases peripheral resistance
Increases HR
(Increases forward flow murmurs, decreases AR/MR)

53
Q

Does venous return increase or decrease with inspiration

A

Increases

54
Q

Inhalation of amyl nitrite causes

A

Decreases afterload

55
Q

Mitral vavlve velocity during inspiration

A

Decreases

56
Q

Between which heart sound will the murmur of aortic stenosis be heard?

A

S1-S2

57
Q

know isovolumetric timing with ECG
after R wave=
After T wave=

A

after r wavw= isovolumic contraction

after T wave= isovolumic relaxation

58
Q

on the wiggers diagram when is the mitral valve open

A

4-1

59
Q

whats the duration of IVRT and IVCT

A

70msec

60
Q

the duration of isovolumic relaxation time will increase with

A

bradycardia (slow heart rate)

61
Q

during the cardiac cycle this event never happens

A

aortic valve is open and mv is open

62
Q

correct order for cardiac cycle

A
  1. mechanical diastole
  2. electrical diastole
  3. electrical systole
  4. mechanical systole
63
Q

normal arterial pressure is approx. _____. thus the aortic pressure lives ____

A

120/80

lives high

64
Q

normal left atrial pressure is approx. ____. thus the atrial pressure lives___

A

10mmHg

low

65
Q

the left ventricular pressure bounces between ___ and ___.

A

aortic and atrial–> high and low

66
Q

the valve that lies between the left ventricle and the aorta is the ____ it lives___

A

Aortic valve and it lives high

67
Q

the valve that lives between the atrium and the left ventricle is the ___ and it lives____

A

MV lives low

68
Q

when a normal valve is open, there is very little ____________ between the chambers on either side of the valve

A

pressure differences

69
Q

when aortic valve is open , the LV and aortic pressures are?

A

nearly identical

70
Q

when the mitral valve is open, the atrial and LV pressures are

A

nearly identical

ECHO (12 decks)

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