Hemodynamic Disorder Word Documents 1, 2, and 3 Flashcards
What is the pressure of the right atrium?
Lest atrium?
Right ventricle (systolic)?
Left ventricle (systolic)
right atrium: 3 mmHg
Lest atrium: 8 mmHg
Right ventricle (systolic): 25 mmHg
Left ventricle (systolic): 130 mmHg
What 2 things represent preload
end diastolic pressure and volume
the resitance the ventricle must overcome to pump out all of its contents is…
afterload
systolic ventricular wall tension is _____ and diastolic ventricular wall tension is _____
afterload
preload
What is the laplace relationship?
ventricular wall stress is proportional to the pressure and radius of the camber and inversely proportional to the thickness of the wall
S = Pv x R / 2t
If the thickness of the ventricular wall increases (while pressure and radius of ventricular chamber stays constant), will the stress on the ventricular wall increase or decrease?
stress will decrease
during diastole
What are examples of endogenous “inotrophic” substances and exmaples of drugs that are “inotrophic”
epi and nor epi
dobutamine and milrinone
What condition is being describe below?
What can cause this condition?
When ventricular compliance decreases below the ability of the atrium to fill normally
restrictive cardiomyopathy
caused by fibrosis, amyloidosis, interstitial infiltration by anything that is more rigid
Impaired cardiac filling is called ____ and impaired cardiac pumping is ____
diastolic dysfunction and systolic dysfunction
Will diastolic dysfunction typically reduce the ejection fraction?
no
EF = SV / EDV (they decrease proportionally)
What are the 5 major categories of the factors that determine the CO?
Imp concept
preload afterload contractility compliance heart rhythm
Are there more pts with chonic or acute HF?
chronic
CAD as a causes of HF by _____
dec contractility
Uncontrolled/severe HTN causes HF by _____
increasing afterload
Aortic stenosis causes HF by _____
increasing afterload
What can cause HF without changing ejection fraction?
What can causes HF by decreasing ejection fraction?
Why is there a difference?
No change to EF:
- left ventricular hypertrophy
- restrictive cardiomyopathy
- pericardial disease
Decreasing EF:
- aortic stenosis
- severe HTN
- CAD
those that decrease EF all increase the afterload (dec SV with Inc EDV), while those that have no change in EF decrease both the SV and the EDV!
EF = SV/EDV
What are the 2 most common symptoms of HF?
What are the 2 most specific symptoms of HF?
What 7 signs of HF?
common: dyspnea and fatigue
specific: paroxysmal nocturnal dyspnea and orthopnea
signs: tachycardia, tachypnea, hypotension, pulmonary crackles, wheezing, diaphoresis, and gallops
How does HF cause dyspnea? (what is the mechanism)
congestion of blood causes inc pulmonary pressure which increases filtration of fluid into interstitium. this inc in ISF compresses the alveoli and increases their resistance to airflow
How does HF cause paroxysmal nocturnal dyspnea? (what is the mechanism)
lying down causes a redistribution of the blood volume such that venous return is increased. the heart in failure cannot pump out this inc venous BV so there is a back up of it into the lungs –> pulmonary HTN and edema
How does HF cause tachycardia? (what is the mechanism)
CO = SV x HR
to compensate for the dec in SV, the HR will increase to try to maintain CO/Ejection fraction
What happens when pulmonary venous pressure goes over 25 mmHg?
tansudate passes not only into interstitium but also into the airspaces
How does HF cause diaphoresis? (what is the mechanism)
dec in CO causes a stimulation of SNS = sweating increased
When is an S3 gallop heard (what part of cardiac cycle)?
What is it attributed to?
low or high pitched?
early diastole
rapid filling of ventricle
low pitched
______ is a biomarker of HF and the level correlates with _____
BNP correlates with severity of HF
What are the effects of BNP? (3)
How is this counter-regulatory?
Why is that important?
it causes (1) an excretion of Na and water, vasodialtion
(2) inhibition of renin secretion (therefore also dec angio II and aldo),
(3) inhibits ADH
BNP compensates for/opposes the actions that low BP has on the kidney
helps to maintain homeostasis
What is the most common cause of HF with preserved ejection fraction?
HTN
What is an S4 gallop assc with?
What causes this sound?
What state name does this sound like (imp concept
HF due to HTN
the sound of left atrial contraction as it works to inject blood into a stiffened left ventricle
Tennessee
What are the profiles of acute HF?
A: Warm and dry: perfused extremities (normal or due to vasodialtion) and no edema, no JVD, no crackles
B: Warm and Wet: perfused extremities, edema, JVD, crackles
C: Cold and dry: poor perfusion of extremities (due to dec CO or abn vasoconstriction), no edema JVD, or crackles
D: Cold and wet: poor perfusion of extremities, edema JVD, or crackles
What commonly causes warm and dry HF profile?
transient myocardial ischemia
HF due to lung disease (RT heart failure)
Cold and dry is most commonly caused by
hypovolemia
Mitral regurg + left ventricular dilation + exercise would produce what acute HF profile?
cold and dry
Describe the action of the “respiratory pump”
rapid breathing promotes negative intrathorasic pressure during inspiration which promotes the movement of blood into the heart
What CN does info from the carotid body travel on to get tot he CNS?
9 and 10
What effect does the presence of epi have on the liver?
induced glycogenolysis and raises the blood glc level = causes a shift of of water into the plasma/intravasular space
What 2 process result in “autotransfusion”
epi inc glycogenolysis in liver to inc blood glc to inc OPc = fluid into PV
vasopressin (arteriole contriction dec HPc and fluid moves into PV)
How can cardiogenic shock be distinguished from hypovolemic shock?
the central venous pressure will be elevated in CS and low in HS
What is the most common cause out aortic stenosis in pts younger than 65? older than 65?
congenital anomalous bicuspid valve
senile degeneration
crecendo-decrecendo systolic murmur + weak or delayed pulse + atrial (S4) gallup
aortic stenosis
What are the pathophysiologic consequences of mitral regurgitation?
- decreased forward SV
- inc left atrial volume and pressure –> dilation (if chronic)
- volume related stress on left ventricle
“Flash pulmonary edema” is assc with …
What is the mechanism of developing it?
sudden mitral regurgitation
inc left atrial pressure which is transmitted back to the lungs = rapud pulmonary congestion and edema
**medical emergency
What is the most common symptom of acute mitral regurg? chronic mitral regurg?
acute: dyspnea
chronic: fatigue + paroxysmal nocturnal dyspnea
apical holosytoic (pan systolic) murmur
mitral regurgitation
In terms of SV, how is actue and chronic mitral regurgitation different?
in chronic there is more blood going backwards than acute bc the left atrium dilates and pressure falls (favoring the movement of blood backwards to the left atrium)
What drug can be given to decompensated mitral regurgitation pts?
ACEi
assc with Marfan syndrome
mitral valve prolapse
mitral valve prolapse heart sound
mid systolic click and late systolic murmur
RHF follows what kind of infection
group A beta-hemolytic streptocoocal pharyngitis
What are Aschoff bodies and what disease are they assc with?
foci of fibrinoid necrosis with histiocyes and anitschkow cells
sign of RHD
systolic and diastolic murmur + pericardial friction rub
When do symptoms of RHD appear? I.e what age group does it affect?!
20 years after childhood infection ~ 30s
Complications of RHD
mitral stenosis (fused and shortened chordae)
and/or
aortic regurgitation which lead to…
left atrial HTN
left atrial dilation
atrial fibrillation
left atrial thrombus formation
pulmonary HTN
right ventricular hypertrophy and right heart failure
***basically the compications are anything that will result from not being able to get blood into the left ventricle/overloading the left atrium
WHat are MacCallum patches?
What are they assc with
RHD
maplike areas of atrial endocardial thickening and fibrosis
