CC4: Abnormal pressures Flashcards by Michael Amarin

What are the 7 phases of the cardiac cycle?

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

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What 2 things can cause abnormal pressures?

-Disease of muscle
-Disease of valve

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

-Pressure gradient
-Valve area

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What factors affect flow rate in Poiseuille’s equation?

-Pressure gradient
-Lumen
-Length
-Blood viscosity

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How do you assess aortic/pulmonary stenosis?

-LV to Ao pullback
-RV and PA

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How do you assess mitral/tricuspid stenosis?

-LV and PCW
-RV and RA

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What is the Hakki formula for valve area?

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What is the Systolic Ejection Period (SEP)?

-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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What is a major cause of aortic stenosis?

Rheumatic heart disease
-scarring and fusion of valve leaflets

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Symptoms of aortic stenosis

-Angina
-Syncope
-Heart failure (LV dysfunction)

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What is the normal area of aortic valve?

2.5-5.0 cm^2

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Mild, moderate and severe aortic stenosis

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

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Aortic stenosis on echo

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What is the peak pressure gradient?

LV systolic is higher than Ao
150-100=50

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What is mean gradient?

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

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Where can aortic stenosis occur?

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

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What would pressure trace of subvalvular stenosis look like?

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

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What are some causes of aortic regurgitation?

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

Symptoms of aortic regurgitation

-SOB
-Chest pain
-Palpitations

What is pressure trace for aortic regurgitation?

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

What could wide pulse pressure indicate?

-Aortic regurgitation

What is the most common cause of mitral stenosis?

-Rheumatic heart fever

What is normal area of mitral valve?

4-6cm^2

How do you calculate gradient across mitral valve?

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

What is the diastolic filling period (DFP)?

-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

Which pressure do we examine for mitral regurgitation?

-PCW and LV

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

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

What are normal right heart pressures?

What pressure value indicates pulmonary hypertension?

-PA systolic pressure rises above 30mmHg

What does pressure trace for pulmonary stenosis look like?

During which part of cardiac cycle is tricuspid stenosis measured?

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

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

-Ventricular systole -Elevated LV/RV pressure

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

-Ventricular diastole -Decreased Ao/PA diastolic pressure

What is the pericardium?

-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

How many layers make up the pericardium?

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)

What is constrictive pericarditis?

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

What causes changes in LV-RV pressure relationship?

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

What pressure trace is this?

-Constrictive pericarditis -LV and RV have same diastolic pressure

What is meant by discordant ventricles?

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

What is meant by concordant ventricles?

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

What pressure trace is this?

HOCM

What pressure trace is this?

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

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

-Ventricular relaxation