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Principles > CV monitoring > Flashcards

CV monitoring Flashcards

1
Q

Diagnosis of right atrial hypertrophy

A

Initial component of P larger in V1
Height > 2.5mm in any limb lead

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2
Q

Precordial limb lead placement

A

V1 4th intercostal space, right of sternum
V2 4th intercostal space, left of the sternum
V3 between V4 and V2
V4 5th intercostal space, left of sternum- mid clavicular line
V5 5th intercostal space, left of sternum- anterior axillary line
V6 5th intercostal space, left of sternum- mid axillary line

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3
Q

dx Left atrial hypertrophy

A

Terminal portion of diphasic P in V1 larger
Occurs with mitral stenosis, systemic HTN

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4
Q

Right ventricular hypertrophy dx

A

Right ventricular wall very thick; more depolarization toward V1
QRS in V1 positive, R waves get smaller

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5
Q

Left ventricular hypertrophy dx

A

Large S wave V1; larger R wave V5
Depth of V1 and height of V5= 35mm

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6
Q

Myocardial ischemia

A

Reduced supply of O2 from the coronary arteries
Inverted, symmetrical T wave

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7
Q

Myocardial injury

A

st elevation

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8
Q

Myocardial infarct (transmural) dx

A

Q indicated necrosis and makes diagnosis of “old” infarction
Must be significant…1mm wide or 1/3 QRS tall and 2 related leads

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9
Q

energy source and electrical circuits

A

Generator

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10
Q

Components of a pacemeaker

A

pulse generator and electrode leads

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11
Q

Reasons to have a pacemaker

A

Elderly….SSS
Anti-bradycardic treatment

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12
Q

insulated wire from generator to electrode

A

Lead

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13
Q

exposed metal end in contact with endocardium
Or epicardial leads

A

Electrode

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14
Q

neg electrode in chamber; positive electrode (grounding)
More sensitive to EMI

A

Unipolar

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15
Q

both electrodes in chamber being paced
Common; uses less energy

A

Bipolar

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16
Q

multiple electrodes within 1 lead but multiple chambers

A

Multipolar

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17
Q

Generic Code for Pacemaker Function

A

1 = chamber paced
2 = chamber sensing
3= Response to sensing
4= Rate modulation
5= multisite backing

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18
Q

Requirement for Bi-V pacing

A

Moderate/severe heart failure
EF 30-35%

Intraventricular conduction delays (BBB)

History of cardiac arrest

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19
Q

What is Bi V pacing

A

3 chambers; Ra, LV, RV.

2 Lead with two electrodes, one in Ra and one in RV and then a 3rd wire to the septum to the LV, risk of tamponade and bleeding because going through septum.

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20
Q

if intrinsic activity is perceived, chamber is not paced

A

inhibited

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21
Q

What is the purpose of Bi V Pacing

A

“cardiac resynchronization” (CRT)
Improves RV-LV activation time
Increases EF%

Very sick pts.

Done for bad conduction and the ventricles stop working together. Goal is to resynchronize = improve

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22
Q

what is CVP dependent on

A

Highly dependent on blood volume and vascular tone

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23
Q

Where is CVP measured

A

Pressure measured at the junction of vena cava and right atrium

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24
Q

pacemaker discharges if intrinsic activity IS sensed; used currently only for testing of devices

A

Triggered

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25
Q

Normal CVP for awake/ spont breathing

A

1-7 mmHg

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26
Q

Rate modulation occurs with: (4)

A

Vibration
Motion
Minute ventilation/ respiratory artifact
Right ventricular pressure

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27
Q

Indications for CVP lines

A

CVP monitoring

PA catheter placement

Transvenous cardiac pacing

Temporary hemodialysis

Drug administration

Rapid infusion of fluids/blood

Aspiration of air emboli

Inadequate peripheral access

Repeated blood testing

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28
Q

Multisite pacing is used for what pts

A

Atrial fib or dilated cardiomyopathies?

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29
Q

CVP A wave

A

Atrial contraction
Occurs after “P” wave
Increases atrial pressure
Provides “atrial kick”

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30
Q

Perioperative care for PM

A

Turn on pacmaker mode on monitor
move grounding pags away from PM
Interrogation pre/post op

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31
Q

CVP C wave

A

Interrupts the decreasing atrial pressure
Isovolumetric contraction of the ventricle
Tricuspid valve closed and ventricle bulges toward the atria
Follows “R” wave

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32
Q

Monopolar bovies and PM

A

EMI interference a Monopolar; bovie -> grounding to pad will cause more emi

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33
Q

CVP x descent

A

Decrease in atrial pressure from a wave through ventricular systole
Called systolic collapse
Sometimes called X and X1

34
Q

CVP V wave

A

Venous filling of the atrium
During late systole…tricuspid valve remains closed
Peaks just after the “T”

35
Q

CVP Y descent

A

Tricuspid valve opens; initial blood flow into ventricle
Called diastolic collapse

36
Q

afibs affect on cvp

A

Absence of a wave
Larger c wave (more volume)

37
Q

Tricuspid regurg affect on CVP

A

No x descent…valve is incompetent

38
Q

Tricuspit stenosis affect on CVP

A

Tall a wave
Lose Y descent becuase it continues to leak for awhile

39
Q

Lumens of pulmonary artery catheter

A

Most distal; Monitors PAP

30 cm proximal; monitors CVP

3rd Lumen; Leads to a balloon near the tip, fills baloon

4th Lumen; Lies just proximal to balloon
Houses temperature thermistor

40
Q

Preferred site for PAC

A

Preferred site: Right IJ

41
Q

RA length with PAC

A

20-25 cm

balloon deflated until reaching RA

42
Q

RV length

A

30-35 cm

43
Q

Pulmonary artery length with PAC

A

40-45 cm

44
Q

wedge length with PAC

A

45- 55cm

45
Q

AICD

A

implanted carioverter defibrillators

capable of terminating VF or VT

46
Q

What do ICD measure?

A

Measure R-R intervals
Too short??? = HR is too high
10% inappropriate….SVT most common
Onset abrupt or gradual
R-R interval consistent or variable
QRS width normal or wide

47
Q

PAC length and markings

A

110 cm length; marked at 10 cm intervals

48
Q

Using a PA catheter for a long period of time can cause what?

A

Transient RBBB or complete heart block, endocarditis

Relative contraindications for PAC is a RBBB

49
Q

Treatment for PA rupture

A

oxygen and intubate
PEEP
reverse anticoagulation

50
Q

Pulmonary artery wedge pressure (PAWP) is indicative of what? What else can be used to measure? and where does it sit?

A

Indirect measurement of left atrial pressure
PAD pressure often used as alternative
PAC tip should be in “zone 3”

51
Q

LVEDP can be influenced by (5)

A

aortic regurg
PEEP
VSD
Mitral stenosis/ regurg
compliance

use as an estimate not absolute

52
Q

Mitral regurgitation PAC waveform

A

Tall V wave
C wave fused with V wave
No X descent
No specificity/sensitivity to severity of MR d/t:
LA compliance
LA volume

53
Q

Mitral stenosis PAC waveforms

A

Slurred, early y descent
A wave may be absent d/t frequent assoc. with a-fib

54
Q

Acute LV myocardial MI PAC waveforms

A

Tall a waves due to non-compliant LV
LV systolic dysfunction increases LVEDV and LVEDP
PAWP increases

55
Q

Mixed Venous Oximetry equation

A

SvO2 = SaO2 - VO2
Q x 1.34 x Hgb

56
Q

WHen to use SVO2

A

If Hgb, arterial saturation, and oxygen consumption stay the same then
Mixed venous oximetry is an indirect indicator of CO
so If CO falls, mixed venous saturation decreases
Then Low venous saturation may signal anemia/blood transfusion need

57
Q

normal CO

A

4-6.5

58
Q

normal stroke volume

A

60-90

59
Q

Normal SVR

A

800-1600

60
Q

Normal PVR

A

4-180 dynes/sec/cm5

61
Q

Normal Mixed venous O2 sat

A

70-80

62
Q

Bolus Thermodilution

A

Cold injected (10ml)and a change in temperature measured downstream

Injected RA lumen, measured PA blood by thermister

CO inversely proportionate to degree of change

63
Q

Thermodilution inaccuracies (5)

A

Intra-cardiac shunts

Tricuspid/pulmonic regurgitation

Mishandling of the injectate (don’t have steady injection)

Fluctuations in temperature Following bypass

Rapid fluid infusion (cold blood)

64
Q

What is more accurate during PPV?

A

continuous CO monitor

65
Q

Pulse contour devices use ______ arterial pressure tractings to estimate ___,___,______

A

Use Area Under Curve arterial pressure tracings
Estimate CO, pulse pressure and SVV

66
Q

What does pulse contour devices indicate?

A

Indicates whether hypotension is likely to respond to fluid
If SVV is > 10%

Rely on algorithm
From end diastole to end systole
Calculates ventricular compliance
+/- 0.5 L/min compared to thermodilution
less invasive

67
Q

Pulse contour inaccuracies (5)

A

Atrial fibrillation

Site of arterial puncture; femoral more accurate than radial

Quality of arterial trace (vasopressors)

Requires frequent re-calibration
Ideally calibrated initially with a known CO

68
Q
A
68
Q

m mode echocardiography

A

Narrow beams to measure tissue planes
ie. Ventricular wall mass

69
Q

2D echocardiography

A

Real time motion
Shows function

70
Q

Doppler echocardiography

A

Can determine speed and direction (flow)
Color

71
Q

TTE views

A

5 views, Comprehensive exam: 28 views)
*Anterior structures closest to transducer…..at the top of image

72
Q

TTE 5 views

A

Parasternal Long Axis
Parasternal Short Axis
Apical Four Chamber
Subcostal Four Chamber
Subcostal IVC

73
Q

TTE Windows

A

Parasternal: 3-5 ICS
Apical: @PMI
Subcostal: just below xiphoid

74
Q

Parasternal Long Axis views

A

Great overall view
Measures LA, LV, and Ao root

75
Q

Parasternal short axis view

A

LV function
LV volume assessment

76
Q

Apical Four chamber view

A

RV vs LV size
TV and MV function
Descending Ao

77
Q

Subcostal Four Chamber view

A

4 chambers
Pericardial effusion often next
to right heart

78
Q

Subcostal IVC view

A

Diameter, collapsibility esp. in
spontaneous respiration

79
Q

Roles of TEE

A

Intraoperative monitor
Rescue tool
Assessment of valvular function
Decision making

*posterior structures are closer to transducer…at top of image

80
Q
A

Principles (34 decks)

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