Exam I - Lecture V (🫀CVP, Coronaries, A. Line, Shock, etc.) Flashcards
Lolz. from IG 🤳🏼
Use of an IABP to reduce afterload on the LV can be used in mitral regurgitation and aortic regurgitation.
T/F?
False.
Although it can be used in mitral regurgitation, it CANNOT be used in AORTIC regurg. it is contraindicated.
13:00
An IABP _____ during diastole to increase blood down the aorta (⬆️ CO) and back into the ______.
It _____ during systole to _____ afterload.
inflates, coronaries
deflates, reduce
13:15 & 14:30
The IABP is filled with ______ bc it’s cheap, inert and _____.
Helium, non-toxic
The 🌎 is running out of helium, btw. 🎈
-It is a byproduct of oil and gas.⛽️
14:00
In aortic stenosis, why is coronary perfusion more difficult?
Bc of the higher LV pressures and lower aortic pressures (feeds coronaries).
18:00
What valvular disease is resistant to CPR and why?
Aortic stenosis
During CPR you are pushing on the ENTIRE heart at the SAME time. Normally, the heart pumps in sequence to allow for proper filling. You are also taking away the atrial kick.
20:00
Name this valvular disorder!
Aortic Stenosis!
-⬇️ aortic pressures
-skyrocketing LVP
-Schmidt says LAP should be elevated…
-crazy loud systolic murmur📢
23:00
Name this valvular disorder!
Mitral stenosis!
-⬆️ LAP
-loud diastolic murmur
*remember LV walls are normal in this disorder😅
23:00
Name this valvular disorder!
Aortic regurgitation!
-⬇️ diastolic aortic pressures (widened PP)
-diastolic murmur
23:00
Name this valvular disorder!
Mitral regurgitation!
-⬆️ LAP
-diastolic murmur
23:00
Increased SV and contractility will do what to PP?
Increase it…and vice versa.
29:00
Which valve problems would you expect ⬆️ LAP?
Technically, all.
But they will each vary.
*the most in mitral stenosis of course. 🙃
Increased filling pressures do what to the heart overtime?
Damage it ❤️🩹
(stretch, hypertrophy…etc)
1st heart sound is _____ closing.
2nd heart sound is _____ closing.
Which semilunar valve is louder? 🌙
AV valves; aortic & pulmonic valves
Aortic is louder; more pressure.
37:20
In the instance of a ‘split’ 2nd heart sound, which closes first?
When would this be exaggerated? Why?
Aortic - under more pressure = slams shut faster!
*Remember, valves function on differences in pressure. (delta P)
Exaggerated during inspiration - bc it would further ⬇️ preload and afterload on the R heart - reducing PAP & would slow down the pulmonary valve closure.
38:10
The LCA splits into to the ____ and ____.
RCA covers ____ heart and serves as the main source of the ____ in most people.
LAD and circumflex
Right, posterior descending artery. (determines coronary dominance)
41:00
This shows _____ coronary dominance.
What is the % this happens in people?
left coronary dominance
~15%
42:00
This shows _____ coronary dominance.
What is the % this happens in people?
right/balanced
~85%
42:30
This shows _____ coronary dominance.
What is the % this happens in people?
Co-dominance
*Schmidt explains of an anastomosis btwn the RCA and circumflex artery.
~15% / 85%
*this still falls under Right coronary dominance and contributes to the total of 85% bc the anastomosis is not very functional and mostly fed by the RCA.
44:00
Name the wave and its correspondence to the cardiac cycle.
H wave:
A wave:
C wave:
H wave/plateau: diastolic plateau, 2/3 (middle third) of diastole (not a lot of pressure changes)
A wave: atrial contraction, end diastole
C wave: bowing of AV/Tricuspid valve into RA, early systole
50:00
Name the wave and its correspondence to the cardiac cycle.
X wave:
V wave:
Y wave:
X wave: descent = atrial relaxation, beginning of ATRIAL FILLING, mid systole
V wave: ATRIA FULL, late systole
Y wave: AV valves open & empty into ventricles, VENT FILLING, early diastole
50:00
In A.fib, which wave would you expect to lose and which would you expect to see prominent?
A.fib - lose a wave, prominent C
52:30
Just a nice look at the table Schmidt flew over and said “might be useful”…
52:40
What results in an overdamped waveform?
Underdamped?
Overdamped: clog or air in line, could be over filtered
Underdamped: artifact bc gain is too high
53:00
Point out the dicrotic notch.
Which waveform is NOT ideal?
Why is this important to be accurate?
Boxed area; waveform 2 is not ideal (too much artifact); you want optimal data during your case and the computer won’t be able to do so if you have too much artifact.
54:30
What is the main controller of venous return & CO?
Psf (systemic filling pressure)
60:00
With spinal anesthesia, we take away the release of ____ thus the ____ of the blood vessels. This will cause a _____ in filling pressures and ____ in CO.
NE, tone
decrease, decrease
*Point B
63:00
If we keep the filling pressure normal but decrease the function of the heart with spinal anesthesia, where would that intersect on the graph?
What would your CO be?
Yellow circle 🟡
CO: ~4.8L/min still
(basically pointing out that affecting only the heart won’t change CO much but changing the circulation (Psf) will change CO a lot, down to ~3 L/min, which our anesthetics do 😅)
66:00
During a case, what could happen to lower our Psf and CO?
Vasodilating via anesthetics or losing volume (EBL???)
68:00
What are the two variables taken into account with venous return? Which is more significant?
RVR (resistance to venous return) & Psf (more significant)
82:00
What is the primary change with volume infusion and the CO/VR curve?
Secondary?
Primary: ⬆️ Psf (MVP)
Secondary: change in slope from ⬇️ RVR (walls are wider than normal thanks to added volume of your fluid bolus)
86:00
According to the graph, do you think they put in too much volume or too little?
Explain your answer.
Too much.
The RAP is high at 7-8mmHg with CO of 13L/min = returning more than the heart can handle.
87:00
In the circumstance of an AV fistula, do you think it’s easier to get blood back to the heart?
Yes.
Notice the steep slope of the filling lines and ⬆️ CO.
88:00
The inability to get nutrients to tissues in need defines what?
SHOCK!
89:00
During hemorrhagic shock, the body is able to maintain CO better than arterial pressure.
T/F?
False.
The body can maintain arterial pressure better than CO.
⚠️This can provide a false sense of information on the progression of shock, so BEWARE!
91:30
In hemorrhagic shock, when does CO begin to be affected?
BP?
CO becomes affected ~ >15% blood loss.
BP ~20%
91:15
CO ⬇️ by 50% when you lose how much blood?
When is CO & arterial pressure = 0?
~35% blood loss.
~45% blood loss.
93:30
Why are we able to maintain arterial pressure (up to ~20%) even though we are losing blood?
What would happen if we lost that ability?
Our SNS!
If we lost that ability, this could be fatal at around 10-15% loss.
94:30
What are the priority organs/tissue during shock?
🧠 🫀 🫘
90:00
What is the 1st stage in shock that is not fatal unless untreated?
What stage required immediate intervention to avoid being fatal?
Is there anything you can do during irreversible shock to avoid fatality?
Non-progressive shock
Progressive shock
🙏 Pray… but no. Hence, ‘irreversible’. 🪦
95:30
What are the 3 things discussed in class that can impede VR? (in the discussion of shock)
1) ⬇️ volume
2) ⬇️ tone (anaphylactic or septic shock)
3) obstruction (venous clot)
98:00
In shock progression, MAP will ____ which will cause decreased coronary perfusion. This will cause a ___ feedback loop worsening shock.
decrease, positive (+)
99:00
What 3 things mentioned in class can we do to fix shock?
-Fix tone, Phenylephrine - arterial constriction
-Give volume
-Clear obstruction
100:30
Define cardiogenic shock and give examples of causes.
Pump problem ❤️🩹
MI’s, valve problems, deadly arrhythmias, coronary occlusion
101:30; Lange Ch. 11 pg. 224
What is the most common type of shock?
Hypovolemic!
(dehydration or hmg)
102:45
What type of shock do you think deep general anesthesia or deep spinal anesthesia could cause?
Neurogenic.
103:40, Lange Ch. 11
The compensatory mechanisms depend on what is causing the shock.
For example, if we’re in neurogenic shock, the SNS and PSNS are offline. :(
What would be the issue with compensatory mech’s in cardiogenic shock?
Pg. 223
105:30
Which CA are subject to MI’s?
Subendocardial arterial plexus (specifically LV) - subject to most pressure and hardest to perfuse.
108:00
Which depolarizes first and repolarize last?
Subendocardial arterial plexus
110:00
In reduced ventricular compliance, we can achieve the same volume but at the cost of _____.
Pressure!
111:00
Increased pressure in the LA will increase the risk for what in the R heart?
Heart failure 🥲
112:30
As CO reduces, what is one of the first things the body (kidneys) do to compensate?
Increase blood volume.
*So, careful removing too much fluid (its a fine balance)
113:45
In general anesthesia, we are producing an artificial ‘sympathectomy’. If your patient has CHF, this could be really bad.
What would you want to do pre-op?
Give a little volume (not too much) but anticipate the drop in CVP and loss in tone during surgery.
115:30
Concentric = _____ HF
Eccentric = _____ HF
concentric = diastolic
eccentric = systolic
118:30
What is the formula for EF?
121:00
What is a antihypertensive med class you give to reduce cardiac remodeling in HF? Why?
ACE-i’s - growth factor inhibitor
(it will reduce afterload too)
123:30
What is this congenital defect? What type of shunt is it?
PDA (patent ductus arteriosus)
Left –> Right shunt
124:30
Name the 4 defects of a TOF heart? What type of shunt is it?
1) overriding aorta
2) VSD
3) pulmonary stenosis
4) RV hypertrophy
Right –> Left shunt (ignore arrow)
TMI: *you will see unrepaired kids often squat to increase their SVR to increase blood flow to their lungs
*you can also have a pink or blue TET depending on how much mixing is going on.
125:00
