Exam 1 Lecture 5 Flashcards
Balloon pump is okay for what valve condition
Mitral regurgiation
What is the chemical symbol of the gas in inside the balloon pump?
He or helium
Is helium molecular weight atmospheric or subatmospheric
Subatmospheric
It weighs less than the atmosphere; this is why we have a short supply. It just floats away( much like my chances of passing)
When does the balloon pump inflate and deflate
Inflates during diastole
Deflates during systole
What is the purpose of the balloon pump inflating during diastole and deflating during systole
inflates during diastole- helps push blood down the aorta
deflates during systole- provides artificially low afterload
Now for our class, you have a patient that is dead, and you are doing CPR to save this poor fella. What valve issues would have the hardest time getting ROSC
Aortic Stenosis
in CPR heart doesn’t contract in sequence
CPR doesn’t fill ventricles as normal
it does affect the other valve issues and negatively impact patients with aortic stenosis
What happens to pulse pressure in aortic regurgitation
For our class, gets larger
What are the two variables for pulse pressure
Strength of contraction from LV
Stroke volume- increase in SV will increase pulse pressure
What is the pneumonic for auscultation of heart sounds
APTM
During the second heart sound if we have “splitting” what valve closes first
Aortic closes before the pulmonic valve normally
Sorry for the terrible question……
During inspiration, what happens to the timing of the pulmonic valve
During inspiration will reduce preload and afterload on right side, lowers pulmonary arterial pressure slows down pulmonic valve closure and keeps it open a little longer than it normally would
What is it called when we have an anastomosis between the RCA and LCA
Codominance
What is the X descent
X descent- after a and c wave, after atria contraction, point in time atria start getting filled back up and pretty empty
What is the Y descent
after V wave, sharp drop in pressure and AV valves open back up, ventricles filling here this is why rapid drop
What is the H plateau
immediately before an A wave, not a lot of pressure changes in middle 1/3 of diastole
What is the A wave
Atrial contraction
What is the C wave
C wave is bowing out backwards of AV valve
Why is the black line have a steeper slope
Steeper slope of black line is from decreased RVR and more volume added to solution
What is Schmidt defintion of shock
Shock is inability to get nutrients to the tissues
What if you are a hood rat on the streets, and get shot and lose 30% of your blood volume? What are your chances if you cant get to the hospital
Pretty much toast
If our SNS magically stops working how much blood can we lose before we are toast
10-15%
What is the 1st stage of hemorrhagic shock?
Non progressive stage- 1st step in shock, things wont be deadly just yet but can get worse
What is the second stage of shock
Progressive shock- worse off, can still be saved and will need immediate intervention.
What is the last stage of shock
Irreversible shock- point where CO and BP is so low and no intervention can save them
What are 2 conditions that reduce vein tone and make our shock wayyyy worse and causes vasodilation
Anaphylaxis and septic shock
I feel like this is kind of self explanatory but here is the chart out of the Lange
Which layer of coronary arteries has the least amount of wall stress and is most immune to stress
Epicardial CA
Which layer of CA is the deepest, most subject to wall tension and hardest to perfuse, also highest pressure
Subendocardial CA
What tissue of the CA depolarizes first and repolarizes last
Subendocardial CA
What is happening with Eccentric LVH
thinner walls
ventricles being over filled
systolic HF- cant produce enough pressure in systole to eject
Sarcomeres go end to end
What is happening in Concentric LVH
sarcomeres will grow on top of each other
“consent to get on top of each other”
diastolic HF problem
What is the formula for EF
What is the normal value for our class
EF=Stroke volume/ LVEDV
70/120= 58.3%
What happens to EF with Eccentric LVH
Goes down Jack
What drug class inhibits growth factors
ACEi
What drug class inhibits growth factors
ACEi
Balloon pump is okay for what valve condition.
Mitral regurgiation
what are the 2 variables are related to pulse pressure per lecture
Contractility and Stroke volume
what are the things that effect the amount of blood in mitral regurgitation
duration of systole
left ventricular after load
Why are IABP filled with helium
Helium is
Cheap
Innert
Non- toxic
Of the 4 valvular dysfunctions discussed in lecture, which of them makes CPR the least efficient? (terrible question sorry)
Aortic Stenosis, decreases the ability to get blood out of the ventricle even under the best conditions. Essentially you end up with an even further decreased SV of the heart than it would normally have.
Relate each graph to one of the 4 valvular pathologies discussed in lecture.
Top Left: Aortic Stenosis
Bottom Left: Aortic Regurgitation
Top Right: Mitral Stenosis
Bottom Right: Mitral Regurgitation
Which side of the heart is usually associated with failure during mitral stenosis?
Right Heart failure would probably be the best answer for this class.
between the pulmonic and aortic valve which one is making more noise?
the Aortic valve
explain in crayon why the 2nd heart sound can sometimes be split
The aortic valve can close first due to the high pressure in the aorta, whereas the pulmonic valve can stay open during inspiration due to the reduced pulmonary pressure causing it to stay open just a little longer than normal.
gets your crayons ready! Describe what is happening at X, Y and H
X decent - just after the A and C wave this is just after the atria relaxes following this atrial filling should occur
Y decent- Ventricular filling after the AV valves open back up
H plateau- just the for the a wave - this wave is just the middle third of diastole, little filling occurring at this time
according to lecture what can cause your arterial waveform to be over damped?
something stuck in the line between the pressure source (the patient) and the transducer
According to lecture, what causes an arterial line to be under dampened.
“the gain of the amplifier is set to high and it is amplifying things that are not real.”
What are the 2 vascular locations in the body that dont have smooth muscle according to Schmiddy?
capillaries and “maybe some of the pulmonary blood vessels “
if you expand the volume of the system the _______ changes.
PSF
a steeper slope of the Venous return curve (PSF) would be indicative of?
a decrease in RVR
You have given a patient fluid to correct hypovolemia and then somehow were to magically get a CO/VR graph for that same patient. For arguments sake let’s say the patients PRa is 8 mmHg, is the patient….
A- hypovolemic
B - normovolemic
C- fluid overloaded
Fluid overloaded….
What percentage of blood volume is lost before we start to see a BP decrease?
Will Cardiac output decrease at the same time? If not at what percentage of blood loss can be had before we effects in Cardiac output?
Per Schmiddy’s graph….. approximately 20% and we will see BP decline
However, our Cardiac output should begin decreasing at approximately 15%.
Removal of the SNS would cause what percentage of blood loss to be Fatal?
10 - 15%
What would be the first stage of shock?
non progressive.
What is the second stage of shock?
Progressive shock – immediate intervention is required or you will die.
what is the last stage of shock?
irreversible shock.
Point where CO and BP were too low for too long and now your just not swell.. probably dead or will be soon.
according to lecture what is the short list that effects venous return?
1) volume
2) decreased tone (septic shock)
3) Obstruction
According to the lang book… name the 5 different kinds of shock.
1- cardiogenic
2- hypovolemic
3- anaphylactic
4- septic
5- neurogenic
True of False… Pericardial coronary arteries are subject to higher wall pressures than subendocardial wall pressures?
FALSE
Pericardial Coronary arteries are subject to lower wall pressure due to them sitting on top of the wall.
Both of the hearts below are hypertrophied, please label them as with eccentric or Concentric hypertrophy, and give an example of what could cause each type.
Left: Eccentric - dilated cardiomyopathy - Aortic Regurgitation, Mitral regurgitation.
Right: Concentric - Chronic HTN, or Aortic stenosis.
is concentric hypertrophy associated with systolic or diastolic HF?
Diastolic.- because we are having problems filling the ventricle due to a decrease in compliance.
what is the formula for Ejection Fraction?
SV/(LVEDV)
70/120= 0.583 x 100= 58.3%
normal EF for this class= 58.3%
Would a heart with Eccentric Heart failure be associated with systolic, or diastolic HF?
Systolic HF, due to a decrease in the ability to properly eject the blood from the ventricle with each beat.
what kind of drug can you use that Schmiddy thinks is super cool that can slowdown remodeling of the heart?
Ace inhibitors, due to them being a growth factor inhibitor.
