Cardiac Quintessentials

Question 1

Quintessentials for SHF & DCM

Answer 1

Emptying problem
Inotropy: give them inotropy to help them move volume (high LVEDP in SHF will decrease CorrPP) so move that fluid
Preload: careful titration of volume; overload can cause over-engagement of F/S & pulmonary congestion
HR: keep NSR b/c need atrial kick; do not decrease HR b/c increases filling time & decreases CO
Afterload: slight drop in afterload can increase SV and CO; do not allow for hypotension as this decreases CorrPP
(CorrPP= ADBP-LVEDP)

Question 2

Quintessentials for Aortic stenosis

Answer 2

Very similar to SHF & DCM but key difference is
do not decrease afterload as they are stroke volume limited and cannot compensate for decreased afterload
careful titration of preload as too much can overload but need to maximize F/S
Give them/maintain inotropy to increase CO
HR: do not allow for SB as it increases filling time & increases LVEDP; keep NSR
**high ischemia risk

Question 3

Quintessentials for pulmonic stenosis:

Answer 3

Preload: Maintain preload for F/S but do not overload; do not hinder VR
HR: maintain NSR; bradycardia leads to volume overload
Inotropy: maintain or increase but recognize it increases MVO2
afterload: maintain afterload to maintain CorrPP
do not increase PVR as this can make right conestion worse

Question 4

High ischemia risks include:

Answer 4

AVS, AR, HCM w/ LVOTO, Cardiac tamponade

Question 5

Baseline elevated afterload is present in:

Answer 5

SHF & Aortic stenosis

Question 6

Baseline elevated inotropy exists in:

Answer 6

Constrictive pericarditis, cardiac tamponade, tricuspid valve stenosis, pulmonary stenosis, aortic stenosis

Question 7

Quintessentials for RCM, Cardiac tamponade, DHF, tricuspid valve stenosis, and constrictive pericarditis:

Answer 7

-SV limited so do not drop afterload as they cannot maintain BP without it
-Maintain NSR b/c stroke volume limited; increased HR decreases filling time (which they need)
-Careful w/ preload- really need it but don’t overdo it
-inotropy- already have this as part of disease process so just maintain it
Ischemia- high ischemic risks d/t high LVEDP

Question 8

Quintessentials for HCM w/ LVOTO

Answer 8

Emptying & filling problem

• DO NOT decrease afterload b/c this makes LVOTO worse d/t Venturi effect
• do not increase inotropy b/c causes worsening LVOTO
• avoid increase in HR as this will decrease filling time
• Maintain preload; don’t overload

Question 9

Quintessentials for aortic & mitral regurgitation:

Answer 9

Maintain HR >80 (decreases filling time which decreases regurgitant volume)

• Maintain preload- don’t overload
• Afterload- avoid increased SVR; if can tolerate decreased SVR it is good b/c blood flows path of least resistance
• Maintain inotropy or may need to increase to maintain perfusion
• LVEDP is high in aortic regurg so decreased CorrPP