CFRN Flashcards
What is CVP
Right atrial pressure/Right sided pre-load measurement
What causes increase in CVP
Left systolic failure, Volume overload, Pulmonary Hypertension, Cardiac Tamponade
What is normal right ventricle pressure
Systolic 20-30, Diastolic 0-5
What causes high RVP
Right Ventricular Failure, Chronic CHF, Pulmonary Hypertension, Hypoxemia, Cardiac Tamponade
Right Ventricular Waveform
Tall upstroke is ventricular systole passive filling. Anacrotic notch = atrial kick. Notch on left side of waveform.
If CVP migrates into RV
Inflate balloon, pull back until CVP waveform is present
What are normal Pulmonary Artery Pressures
PAS 15-25, PAD 8-15.
What does PA pressure measure
Measures RV systolic pressure, indirectly measures left ventricular end diastolic pressure
What causes increase in pulmonary artery pressure
Fluid overload, Atrial and Ventricular defects, Mitral valve regurgitation/stenosis, LV failure
What is normal PCWP
8-12
Right Failure
High CVP, Low PCWP/PAD
Dicrotic notch on right side of PA waveform
Closure of pulmonic valve closure
PCWP measures
Left atrial preload, indirect left ventricular end diastolic pressure
Increased PCWP
LV failure, Fluid overload, Cardiac Tamponade
What is overdampened waveform
Waveform slowly returns to baseline caused by cathether kink, tip of cathether against wall, high pressure in bag
What is underdampened waveform
Many oscillations before baseline. Air in system, altitude change, low pressure in bag
Large V wave in PA waveform and high PA pressure
Severe mitral regurgitation
Coronary Perfusion Pressure
Diastolic BP- PAWP
Pulmonary artery pressure reflects
right and left sided heart pressures
Systemic Vascular Resistance
Measures afterload of left side of heart
Pulmonary Vascular Resistance
Measures afterload right side of heart
Stroke Volume
Amount of blood ejected with each heart beat from the ventricles during systole
Atrial Waveforms
“Filling pressures” and include right and left atrial pressures
C wave
Rise in atrial pressure when AV valves close and bulge upward into atrium following valve closure
V wave
Rise in atrial pressure as it refills during ventricular contraction
A wave
Coincides with PR interval on EKG
C wave
Coincides with mid-late QRS on EKG
V wave
Appears immediately after peak of T wave in right pressure
Y descent
Downslope of V wave, decline in atrial pressure indicates atrial emptying
X descent
Downslope of A wave, decline in atrial pressure, indicates atrial relaxation
Isovolumetric contraction
When all 4 heart valves are closed due to depolarization.
Diastasis
Mid-diastole. When atrial and ventricular pressures are similar. Prior to atrial depolarization
Assess hemodynamic pressures
End of exhalation
Z point
End of QRS to waveform to measure atrial end-diastolic pressures
Aortic rupture
Loss of aortic knob shadow and widening mediastinum
Debakey 1
Ascending aorta and extends distally beyond aortic arch
Debakey 2
Ascending Aorta
Debakey 3
Distal to left subclavian artery and extends distally to abdominal aorta
Aortic Dissection Chest xray findings
Widening mediastinum, tracheal deviation, left pleural effusion, localized bulge on aortic arch, extension of aortic shadow beyond aortic wall
Pericardial friction rub
Still heard during pt holding breath
Coronary perfusion pressure
DBP-PCWP, normal 50-60
Cerebral perfusion pressure
MAP-ICP, normal 70-90
Graves Disease
Hyperthyroidism, A-fib, wt loss, anxiety, Exophthalmos
Myxedema Coma
Hypothroidism, women >60, winter months onset, fatigue, weight gain,
Addison’s disease
Adrenal insufficiency, hypotension. Do not give etomidate. Fatigue, weight loss
Cushing’s Disease
Hyperaldosteronism. Hypertension, moon face, buffalo hump, fatigue, upper body fat and skinny arms and legs,
G2B3A Inhibitors
Aggrastat, Reopro, Integrilin
Wellen’s Syndrome
Stenosis of proximal LAD and impending infarct. Large T wave inversion in V2 and V3
Kussmaul’s Sign
Rise in venous pressure with inspiration (JVD), indicates RVI or cardiac tamponade. Jugular vein becomes distended during inspiration
S3 heart tone
“Ventricular gallup” associated with CHF, mitral regurg, cardiomyopathy
S4 heart tone
“Atrial gallup” associated with aortic/pulmonic stenosis, dilated or restrictive cardiomyopathy,
Magnesium Sulfate contraindications
Myasthenia gravis and renal failure
Terbutaline contraindications
Tachycardia > 120, cardiac dysrhythmias
Terbutaline side effects
Hyperglycemia, cardiac dysrhythmias, MI, pulmonary edema, hypotension, tachycardia
Asherman’s Syndrome
Scar tissue forms inside the uterus and cervix
Couvelaire Uterus
Port wine amniotic fluid due to placental abruptio
Corrected Anion Gap
Na- (Cl+Bicarb) +K
Z point
Measures end diastolic pressure
X descent, decline in right atrial pressure
Atrial RelaXation
Y descent, decline in right atrial pressure
Atrial EmptYing
CVP
Right atrial pressure
PCWP/PAWP
Left atrial pressure
Tetrology of Fallot
Pulmonary stenosis
Right ventricular hypertrophy
Overriding Aorta
Ventricular septal defect
Newton’s First Law
An object in motion tends to stay in motion
Newton’s Second Law
Force= Mass x Acceleration
Newton’s Third Law
Every action has = and opposite reaction
Cardiac Index
2.5-4.3
CO2 and pH relationship
CO2 up 10, Ph down 0.08
Bicarb and pH
Bicarb up 10, ph up 0.15
PaO2 at altitude
PaO2 drops 5 every 1000 foot elevation
Choanal atresia
Congenital disorder caused by blocked nasal passage
Coronary artery perfusion is dependent on
Aortic end diastolic pressure
Ph and K relationship
Ph increase of 0.10, decrease in K of 0.06
Intussuception
Nausea, vomiting, jelly stools, sausage mass RUQ
Pyloric stenosis
Projectile vomiting with bile after feeding, Olive shaped mass RUQ, narrowing of stomach to first part of small intestine
Subarachnoid bleed
Circle of Willis, Berry aneurysm,
Pancreatitis Fistula
Causes metabolic acidosis due to loss of pancreatic fluid which is bicarb rich
Mesenteric ischemia/infarction
Occurs after AAA repair due to cross-clamping of mesenteric arteries. Blood in stool, fever, tachycardia, hypotension, tachypnea, AMS
