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Year 3 Cardiac physiology > CC12: Flow and valve area > Flashcards

CC12: Flow and valve area Flashcards

1
Q

Aortic valve normal area

A

2.5-3.5cm^2

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2
Q

Mitral valve normal area

A

4-6cm^2

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3
Q

Pulmonary valve normal area

A

2.5-3.5cm^2

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4
Q

Tricuspid valve normal area

A

5-10cm^2

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5
Q

Congenital defect that affects pulmonary valve

A

Tetralogy of Fallot

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6
Q

Why should A wave of PCW and LVEDP be the same?

A

A wave of PCW = atrial contraction
LVEDP = Ventricular diastole
Valve is open so pressure should be same

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7
Q

How does ASD affect A and V wave in atrium?

A

-Higher V wave
-Atria is relaxing during V wave
-ASD causes more atrial filling

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8
Q

What should a normal V wave be?

A

<12

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9
Q

Which valves are associated with diastolic filling period (DFP)?

A

-Mitral
-Tricuspid

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10
Q

Which valves are associated with systolic ejection period (SEP)

A

-Aortic
-Pulmonary

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11
Q

What is systolic ejection period (SEP)?

A

-SEP starts with the opening of the aortic valve and finishes at the dicrotic notch
-Amount of time the ventricles spend in systole per minute

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12
Q

What is the diastolic filling period (DFP)?

A

-DFP starts with the closure of the aortic valve and finishes at the start of systole
-Amount of time the ventricles spend in diastole per minute

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13
Q

What is the Hakki equation?

A
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14
Q

What variables affect pressure gradients?

A

Physiological
-Rate of blood flow
-Resistance to flow
-Proximal chamber pressure/compliance

Anatomical
-Shape/length of valve orifice
-Tortuosities of vessel
-Multiple/serial lesions

Artifactual
-Mis-calibrated pressure transducer
-Pressure leaks (catheter or manifold)
-Pressure tubing type/ length/ connectors
-Air in system
-Catheter size
-Fluid viscosity (contrast)
-Position of catheter holes

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15
Q

What are the pressures?

A

-Left side
-Femoral artery and LV
-100mmHg pressure gradient
-Severe aortic stenosis

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16
Q

What is the pathology?

A

HOCM

17
Q

What waveform is this?

A

-Left ventricle
-Left atrium (PCW)
-a wave and LVEDP should be the same

18
Q

What indicates regurgitation through valve

A

V wave >12

19
Q

Left atrial vs PCW waveform

A

-Left atrium descends sharper

20
Q

Use of PCW in assessment of mitral stenosis

A

-Using PCW instead of LA can increase area under the curve
-This falsely increases the mean gradient across the valve
-Pseudo mitral stenosis

21
Q

Formula for valve area?

A
22
Q

An individual undergoes left and right cardiac catheterisation for the evaluation of aortic stenosis. Measurements includes an aortic pressure of 120/60, LV pressure of 170/15, cardiac output of 3.5 litres/minute. What is the aortic valve area?

A
23
Q

Mean gradient across Tricuspid and Pulmonary valve

A

-Rare in adults
-Mean gradient of 5mmHg is enough to cause symptoms
-Gradients <50mmHg have been well tolerated

24
Q

What is constrictive pericarditis?

A

-Constriction of the heart due to a rim of fibrosed or calcified pericardium
-Causes inadequate filling of the heart
-There is a small volume pulse
-ECG is low voltage and with flat/inverted T waves, broad/notched P waves

25
Q

What is restrictive cardiomyopathy?

A

-Non-dilated rigid ventricle
-Causes severe diastolic dysfunction and restrictive filling
-Produces haemodynamic changes similar to constrictive pericarditis

26
Q

What do constrictive pericarditis and restrictive cardiomyopathy lead to?

A

-HFpEF
-Abnormal ventricular filling causes similar clinical and haemodynamic features
-Treatments are different so they must be differentiated from each other

27
Q

What causes changes in LV-RV pressure relationship?

A

Ventricular septal interaction

28
Q

What conditions can changes in LV-RV relationship occur in?

A

-Constrictive pericarditis
-BBB
-Pulmonary HTN
-MI
-RV volume overload

29
Q

How RV and LV pressure trace differ?

A

-Different end-diastolic pressure (EDP)
-Separate by >5mmHg in early and late diastole
-A waves differ in size due to lower compliance (stiffer) LV

30
Q

How does constrictive pericarditis affect LV-RV pressure trace?

A

-LV and RV have matching diastolic pressure

31
Q

What happens to ventricles in constriction defects?

A

-Discordant ventricles
-LV systolic pressure falls
-RV systolic pressure rises

32
Q

What happens to ventricles in restrictive defects?

A

-Concordant ventricles
-LV systolic pressure falls
-RV systolic pressure falls

33
Q

How does inspiration affect constrictive and restrictive defects?

A

Constrictive:
-Early diastolic gradient decreases with inspiration
Restrictive:
-No change

34
Q

Features of HOCM

A

-Often involves interventricular septum and obstructs the LVOT
-Familial and genetic
-ECG shows ST changes, LVH and LAE

35
Q

Features of HCM

A

-Massive thickening of ventricles
-LV is stiff with impaired filling
-LVEDP is raised
-Lungs become congested (SOB)

Year 3 Cardiac physiology (30 decks)

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