Complex CVS and Resp Flashcards
In most patients how is the RV perfused?
The RCA
In 15% of the population how is the RV perfused?
The LCX
Name the key Components of the RV
- Tricuspid valve
- Chordae tendinae
- atleast three papillary muscles
- trabeculated apex
- Infundibulum
What is the infundibulum?
A muscular structure supporting the pulmonary valve?
Is the RV pre or after load dependent?
Pre-load dependant
How does the RV compare to the LV?
The RV is thinner walled when compared to the LV
What role does the septum play between the R and L ventricle?
The septum assists in contractility
How is a RV STEMI identified on ECG?
- ST elevation in V1
- ST elevation in V1 and depression in V2
- Isoelectric ST segment in V1 with marked depression in V2
- ST elevation in 3 and 2 (>3)
- V4R
What is RV failure often accompanied with (arrhythmias)
Atrial flutter or AF
How sensitive and sepcific is the V4R lead?
88% Sensitive, 78% specific
83% accurate in diagnosing RV MI
Key concept of ARDS Managment
- Limit Vt (8ml/kg)
- Decrease MVO2
- Optimize DO2 (positioning, PEEP, FIO2)
What are the three categories of myocardial complications following an acute MI?
- Mechanical
- Pericardial
- Conduction
Name three mechanical complications of OMI
- Rupture of the left ventricular free wall
- Rupture of the intraventricular septum
- Acute Mitral regurgitation
Name three pericardial complications following OMI
- Early infarct associate pericarditis
- Pericardial effusion
- Post cardiac Injury
Name some common Arrhythmias associated with OMI
- Bradyarrhtymias (AV blocks, sinus/Junctional, IVR).
- Ventricular tachyarrhythmias
Recall the ranges of incidence for ventricular arrhythmias
PVC-10 to 93%
VT-3 to 39%
VF- 4 to 20%
Define Cardiogenic Shock
Cardiogenic shock is a result of inadequate tissue perfusion due to cardiac dysfunction
What is the most common cause of cariogenic shock?
Acute MI (Mechanical, pericardial, conduction secondary to MI)
What are the 6 components to treating cariogenic shock?
- Assessment and Evaluation
- Treat the Lungs
- Optimize Volume
- Optimize MAP
- Consider inotropes/vasoactives
- Attack dysrhythmias
Other than Asthma, what are six other conditions that could cause wheezing?
- CHF
- Emphysema
- Pneumonia
- Upper airway obstruction
- Anaphylaxis
- Pulmonary Embolism
What are the three pathophysiologic abnormalities in asthma?
- Bronchoconstriction
- Airway inflammation
- Mucous production
Effects of hypercapnia
- DLOC
- Increased ICP, Cerebral blood flow
- Respiratory acidosis
- Reduced cardiac output
- Vasodilation
What are some secondary consequences to dynamic hyperinflation?
- compliance decreases
- Shunting
- Obstructive shock
- Right heart failure
What is Auto-PEEP?
resistance to exhalation increases, invetiably causing air-trapping(breathe stacking).
Describe two respiratory changes that occur with PE?
- V/Q mismatch
- Increased RV after load
