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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
Normal CVP for awake/ spont breathing
1-7 mmHg
26
Rate modulation occurs with: (4)
Vibration Motion Minute ventilation/ respiratory artifact Right ventricular pressure
27
Indications for CVP lines
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
28
Multisite pacing is used for what pts
Atrial fib or dilated cardiomyopathies?
29
CVP A wave
Atrial contraction Occurs after “P” wave Increases atrial pressure Provides “atrial kick”
30
Perioperative care for PM
Turn on pacmaker mode on monitor move grounding pags away from PM Interrogation pre/post op
31
CVP C wave
Interrupts the decreasing atrial pressure Isovolumetric contraction of the ventricle Tricuspid valve closed and ventricle bulges toward the atria Follows “R” wave
32
Monopolar bovies and PM
EMI interference a Monopolar; bovie -> grounding to pad will cause more emi
33
CVP x descent
Decrease in atrial pressure from a wave through ventricular systole Called systolic collapse Sometimes called X and X1
34
CVP V wave
Venous filling of the atrium During late systole…tricuspid valve remains closed Peaks just after the “T”
35
CVP Y descent
Tricuspid valve opens; initial blood flow into ventricle Called diastolic collapse
36
afibs affect on cvp
Absence of a wave Larger c wave (more volume)
37
Tricuspid regurg affect on CVP
No x descent…valve is incompetent
38
Tricuspit stenosis affect on CVP
Tall a wave Lose Y descent becuase it continues to leak for awhile
39
Lumens of pulmonary artery catheter
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
Preferred site for PAC
Preferred site: Right IJ
41
RA length with PAC
20-25 cm balloon deflated until reaching RA
42
RV length
30-35 cm
43
Pulmonary artery length with PAC
40-45 cm
44
wedge length with PAC
45- 55cm
45
AICD
implanted carioverter defibrillators capable of terminating VF or VT
46
What do ICD measure?
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
PAC length and markings
110 cm length; marked at 10 cm intervals
48
Using a PA catheter for a long period of time can cause what?
Transient RBBB or complete heart block, endocarditis Relative contraindications for PAC is a RBBB
49
Treatment for PA rupture
oxygen and intubate PEEP reverse anticoagulation
50
Pulmonary artery wedge pressure (PAWP) is indicative of what? What else can be used to measure? and where does it sit?
Indirect measurement of left atrial pressure PAD pressure often used as alternative PAC tip should be in “zone 3”
51
LVEDP can be influenced by (5)
aortic regurg PEEP VSD Mitral stenosis/ regurg compliance use as an estimate not absolute
52
Mitral regurgitation PAC waveform
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
Mitral stenosis PAC waveforms
Slurred, early y descent A wave may be absent d/t frequent assoc. with a-fib
54
Acute LV myocardial MI PAC waveforms
Tall a waves due to non-compliant LV LV systolic dysfunction increases LVEDV and LVEDP PAWP increases
55
Mixed Venous Oximetry equation
SvO2 = SaO2 - VO2 Q x 1.34 x Hgb
56
WHen to use SVO2
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
normal CO
4-6.5
58
normal stroke volume
60-90
59
Normal SVR
800-1600
60
Normal PVR
4-180 dynes/sec/cm5
61
Normal Mixed venous O2 sat
70-80
62
Bolus Thermodilution
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
Thermodilution inaccuracies (5)
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
What is more accurate during PPV?
continuous CO monitor
65
Pulse contour devices use ______ arterial pressure tractings to estimate ___,___,______
Use Area Under Curve arterial pressure tracings Estimate CO, pulse pressure and SVV
66
What does pulse contour devices indicate?
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
Pulse contour inaccuracies (5)
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
68
m mode echocardiography
Narrow beams to measure tissue planes ie. Ventricular wall mass
69
2D echocardiography
Real time motion Shows function
70
Doppler echocardiography
Can determine speed and direction (flow) Color
71
TTE views
5 views, Comprehensive exam: 28 views) *Anterior structures closest to transducer…..at the top of image
72
TTE 5 views
Parasternal Long Axis Parasternal Short Axis Apical Four Chamber Subcostal Four Chamber Subcostal IVC
73
TTE Windows
Parasternal: 3-5 ICS Apical: @PMI Subcostal: just below xiphoid
74
Parasternal Long Axis views
Great overall view Measures LA, LV, and Ao root
75
Parasternal short axis view
LV function LV volume assessment
76
Apical Four chamber view
RV vs LV size TV and MV function Descending Ao
77
Subcostal Four Chamber view
4 chambers Pericardial effusion often next to right heart
78
Subcostal IVC view
Diameter, collapsibility esp. in spontaneous respiration
79
Roles of TEE
Intraoperative monitor Rescue tool Assessment of valvular function Decision making *posterior structures are closer to transducer…at top of image
80

Principles (34 decks)

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