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Medical Physiology > Cardiac Pressure Volume Loops > Flashcards

Cardiac Pressure Volume Loops Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the Wiggers diagram?

A

Wave form diagram noting pressure changes throughout the cardiac cycle.

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2
Q

What is the primary cause of decreased inotropy?

A

Pure diastolic heart failure

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3
Q

What are the results of Increased preload?

A
  • Increased SV
  • Hypervolemia
  • Mitral insufficiency
  • Aortic Insufficiency
  • HF
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4
Q

How does Increased preload affect the P-V loop?

A
  • Shifts everything right
  • Increase in SV
  • Increased EF
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5
Q

What results from increased afterload?

A
  • Increased aortic pressure
  • Decreased SV
  • Increased ESV
  • Increased vascular resistance
  • Semilunar valve damage
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6
Q

What is the affect n the PV curve from increased afterload?

A
  • INC Ventricular pressure —> Graph shifts up
  • slight decrease in SV
  • slight decrease EF
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7
Q

How does a hypertrophic heart affect the P-V Loop?

A
  • Reduced Stroke Volume
  • Reduced EF
  • Reduced EDV
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8
Q

How does a Dilated heart affect the P-V Loop?

A
  • Shifts right (INC EDV)
  • DEC SV
  • DEC EF
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9
Q

What is characteristic of Aortic Stenosis on the P-V loop?

A
  • Aortic increases and then decreases
  • “Crescendo-Decrescendo”
  • INC LV Pressure
  • INC ESV
  • *NO CHANGE EDV
  • DEC SV
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10
Q

What is characteristic of Mitral valve insufficiency/regurgitation?

A
  • Left atrium adapts (dilates)
  • Systolic volume entering LA significantly elevates
    LAP

*Sudden rupture Of chordate tendinae

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11
Q

What is characteristic of mitral stenosis?

A
  • INC LAP —> INC pressure gradient

- Pulmonary edema

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12
Q

How does Aortic stenosis affect eh P-V loop?

A
  • INC LVP
  • INC ESV
  • DEC SV
  • No change in EDV
  • Graph gets taller and thinner
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13
Q

How does mitral stenosis affect the P-V Loop?

A
  • Same heights
  • Less wide
  • Slightly to the left
  • INC LAP
  • DEC EDV
  • DEC ESV
  • DEC SV
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14
Q

How does Aortic regurgitation affect the P-V Loop?

A
  • NO ISOVOLEMIC PHASE
  • INC EDV
  • INC SV
  • INC PP
  • “Ballooning”
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15
Q

How dose Mitral regurgitation affect the P-V Loop?

A
  • No True isovolemic phase
  • DEC ESV
  • INC EDV
  • INC SV
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16
Q

What is characteristic of Hypovolemic shock? How is it treated?

A
  • DEC Preload
  • DEC CO
  • INC Afterload
  • Treated with IV fluids
17
Q

What is characteristic of Cardiogenic shock, and how is it treated?

A
  • DEC or INC preload
  • DEC CO
  • INC Afterload
  • Treat with Inotrophy and Diuresis
18
Q

What is characteristic of Obstructive Shock, and how is it treated?

A
  • DEC preload
  • INC CO
  • DEC Afterload
  • Treated by relieving obstruction
19
Q

What is characteristic of Distributive shock, and how is it treated?

A
  • DEC Preload
  • DEC CO
  • DEC Afterload
  • Treated with IV fluids, Pressors, Or Epi for anaphylaxis
20
Q

What is the action of Hydralazine?

A

INC cGMP —> Smooth muscle relaxation —> Vasodilation —> DEC afterload

21
Q

What is the action of Milrinone?

A

PDE-3 inhibitor —> INC cAMP —> INC calcium + Vasodilation —> INC ionotrope and chronotrope

22
Q

What is the action of Sacubitral?

A
  • Prevents degradation of ANP/Angiotensin II, substance P
  • INC vasodilation
  • DEC EC fluid volume
23
Q

What is heart failure?

A

Inability to meet the metabolic needs of the heart

24
Q

What is the most common cause of heart failure?

A

Ischemic heart disease and dilated cardiomyopathy

25
Q

What three factors determine SV?

A
  • Contractility
  • Preload
  • afterload
26
Q

Describe pathology of Hypertrophic cardiomyopathy.

A
  • Myocardial enlargement
  • Leading cause of sudden death in young athletes
  • Disrupted myocytes —> Cellular structure disorganization and fiber hypertrophy —> Thickening of ventricular wall
27
Q

How does Systolic dysfunction affect the P-V loop?

A
  • End systolic P-V loop is shifted downward and rightward resulting in DEC SV.
  • EDV is INC which INC EDP
  • DEC n SV —> DEC CO
  • INC LVEDP (Preload) —> Pulmonary edema
28
Q

What are the three compensatory mechanisms for systolic dysfunction?

A
  1. Ventricular Hypertrophy: INC Ventricular wall stress —> new myocardial sarcomere and Ventricular mass.
    - Pressure Overload —> parallel sarcomeres and INC wall thickness w/ no chamber dilation
    - Volume overload —> Series Sarcomeres and chamber enlargement/dilation
  2. Neuroendocrine response: CO declines
    - Sympathetic tone INC HR, Contractility, Vasodilation
    - RAAS INC Preload
    - ADH INC Fluid retention
  3. Frank-Starling Response: INC in Preload —> INC SV —> INC CO
29
Q

Differentiate Left and Right sided heart failure.

A

Left Heart failure: Every Person Can Touch the Chest and Pelvis 3x or 4x

Enlargement/Dilated cardiomyopathy
Pressure - HTN/Aortic stenosis
Cool skin/Cyanosis/Capuillary refill 
Tachycardia/Tachypnea - Sympathetic Tone
Cheyne-Stokes breathing
Pulmonary Rhonchi/Rales - Left atrial pressure
3rd Heart Sound
4th Heart Sound

Right Heart Failure: Jim Electrocuted His Aunt’s Heart

Jugular Venous pulsation elevated
Edema
Hepatomegaly
Ascites
Hepatojugular Reflux

Medical Physiology (43 decks)

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