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Year 3 Cardiac physiology > CC4: Abnormal pressures > Flashcards

CC4: Abnormal pressures Flashcards

1
Q

What are the 7 phases of the cardiac cycle?

A

-Ventricular diastole
-Isovolumetric ventricular contraction
-Ventricular ejection
-Isovolumetric ventricular relaxation
-Atrial filling
-Passive/active ventricular filling

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2
Q

What 2 things can cause abnormal pressures?

A

-Disease of muscle
-Disease of valve

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3
Q

What 2 things are used to assess the presence/severity of valvular stenosis?

A

-Pressure gradient
-Valve area

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4
Q

What factors affect flow rate in Poiseuille’s equation?

A

-Pressure gradient
-Lumen
-Length
-Blood viscosity

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5
Q

How do you assess aortic/pulmonary stenosis?

A

-LV to Ao pullback
-RV and PA

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6
Q

How do you assess mitral/tricuspid stenosis?

A

-LV and PCW
-RV and RA

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7
Q

What is the Hakki formula for valve area?

A
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8
Q

What is the Systolic Ejection Period (SEP)?

A

-SEP starts with the opening of the aortic valve and finished at the dichrotic notch
SEP=amount of time the ventricles spend in systole per minute

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9
Q

What is a major cause of aortic stenosis?

A

Rheumatic heart disease
-scarring and fusion of valve leaflets

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10
Q

Symptoms of aortic stenosis

A

-Angina
-Syncope
-Heart failure (LV dysfunction)

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11
Q

What is the normal area of aortic valve?

A

2.5-5.0 cm^2

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12
Q

Mild, moderate and severe aortic stenosis

A

Mild: 1.5-2.5cm^2
Moderate: 1.0-1.5cm^2
Severe: <1.0cm^2

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13
Q

Aortic stenosis on echo

A
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14
Q

What is the peak pressure gradient?

A

LV systolic is higher than Ao
150-100=50

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15
Q

What is mean gradient?

A

-Difference between LV/AO the entire time Aortic valve is open

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16
Q

Where can aortic stenosis occur?

A

-Usually at valvular level
-Subvalvular stenosis caused by narrowing in the LVOT
-Supravalvular stenosis caused by constriction above the valve

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17
Q

What would pressure trace of subvalvular stenosis look like?

A

-Ventriclular
-Stenosis is in ventricle
-Drop in pressure in ventricle
-Then aortic

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18
Q

What are some causes of aortic regurgitation?

A

-Rheumatic heart disease
-Scarring and fusion of valve leaflets
-Infective endocarditis

19
Q

Symptoms of aortic regurgitation

A

-SOB
-Chest pain
-Palpitations

20
Q

What is pressure trace for aortic regurgitation?

A

-Aortic trace doesn’t reach zero
-In AR valve is open during diastole
-Normal systolic, lower diastolic in AR

21
Q

What could wide pulse pressure indicate?

A

-Aortic regurgitation

22
Q

What is the most common cause of mitral stenosis?

A

-Rheumatic heart fever

23
Q

What is normal area of mitral valve?

A

4-6cm^2

24
Q

How do you calculate gradient across mitral valve?

A

-LV trace and A/V wave
A wave = 20
EDP = 5
Gradient = 15mmHg

25
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
-DFP = amount of time the ventricles spend in diastole per minute

26
Q

Which pressure do we examine for mitral regurgitation?

A

-PCW and LV

27
Q

Which part of the trace do we look at for mitral regurgitation?

A

-Valve is closed but blood is going back into atria
-Increased filling increases V wave

28
Q

What are normal right heart pressures?

A
29
Q

What pressure value indicates pulmonary hypertension?

A

-PA systolic pressure rises above 30mmHg

30
Q

What does pressure trace for pulmonary stenosis look like?

A
31
Q

During which part of cardiac cycle is tricuspid stenosis measured?

A

-Ventricular diastole - when Tricuspid valve is fully open
-Gradient measures difference in diastolic pressures across Tricuspid valve

32
Q

During which part of cardiac cycle is aortic/pulmonary stenosis measured?

A

-Ventricular systole
-Elevated LV/RV pressure

33
Q

During which part of cardiac cycle is aortic/pulmonary regurgitation measured?

A

-Ventricular diastole
-Decreased Ao/PA diastolic pressure

34
Q

What is the pericardium?

A

-Encloses the heart and covers a portion of the great vessels
-Adheres to heart surface and lines fibrous pericardial sac
-Reduces friction due to heart movement

35
Q

How many layers make up the pericardium?

A

3 layers
-Visceral - outer surface of heart/dense irregular connective tissue

-Serous - inner layer of mesothelium made up of 2 layers:
=>Parietal (lays under fibrous pericardium)
=>Visceral (epicardium, lays over heart)

36
Q

What is constrictive pericarditis?

A

-Constriction of heart due to rim of fibrosed or calcified pericardium
-Results in inadequate filling of the heart

37
Q

What causes changes in LV-RV pressure relationship?

A

-Ventricular septal interaction
Can occur in:
-Constrictive pericarditis
-BBB
-Pulmonary hypertension
-MI
-RV volume overload

38
Q

What pressure trace is this?

A

-Constrictive pericarditis
-LV and RV have same diastolic pressure

39
Q

What is meant by discordant ventricles?

A

-Occurs in constriction
-LV systolic pressure falls
-RV systolic pressure rises

40
Q

What is meant by concordant ventricles?

A

-Occurs in restrictive cardiomyopathy
-LV systolic pressure falls
-RV systolic pressure falls

41
Q

What pressure trace is this?

A

HOCM

42
Q

What pressure trace is this?

A

-Same systolic value in LVOT and Ao indicates that aortic valve is normal
-It is something in the LV

43
Q

During which part of cardiac cycle is mitral and tricuspid stenosis measured?

A

-Ventricular relaxation

Year 3 Cardiac physiology (30 decks)

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