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Block 10 > Hemodynamic Disorders 1 > Flashcards

Hemodynamic Disorders 1 Flashcards

1
Q

Normal LV end diastolic pressure

A

10 mmHg

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2
Q

Normal LV systolic pressure

A

130 mmHg

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3
Q

Normal RA pressure

A

3 mmHg

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4
Q

Normal RV systolic pressure

A

25 mmHg

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5
Q

Normal LA pressure

A

8 mmHg

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6
Q

Preload is represented by

A

EDV and ED pressure

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7
Q

Frank-Starling mechanism

A

?

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8
Q

Afterload is sometimes referred to as

A

systolic ventricular wall tension or stress

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9
Q

Laplace relationship

A

Systolic ventricular wall stress = (systolic ventricular wall pressure x ventricular chamber radius)/(2 x ventricular wall thickness)

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10
Q

determinants of the force of ventricular contraction in systole

A

preload
afterload
contractility

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11
Q

inotropic state of the heart

A

contractility

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12
Q

Contractility is determined by

A 
sympathetic/parasympathetic nerve input
hormonal influences (epi, norepi, etc)
drugs (dobutamine, milrinone, etc)
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13
Q

compliance of the ventricle

A

stiffness of the ventricular wall

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14
Q

restrictive cardiomyopathy

A

ventricular compliance decreases below the ability of the atrium to fill it normally

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15
Q

diastolic dysfunction

A

impaired cardiac filling

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16
Q

systolic dysfunction

A

impaired cardiac pumping

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17
Q

impaired contractility or greatly increased afterload cause

A

systolic dysfunction

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18
Q

Systolic dysfunction decreases the

A

stroke volume

ejection fraction

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19
Q

The more stiff a ventricle is, the harder it is to _____.

A

fill

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20
Q

Diastolic dysfunction does not typically reduce

A

ejection fraction

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21
Q

THE 5 MAJOR CATEGORIES OF THE FACTORS DETERMINING THE HEART’S FUNCTION AS A PUMP (CO)

A
  1. PRELOAD
  2. AFTERLOAD
  3. CONTRACTILITY
  4. COMPLIANCE
  5. HEART RHYTHM
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22
Q

The inability of the heart to pump sufficient blood to meet the needs of the body.

A

Cardiac Failure

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23
Q

The most common cardiac hemodynamic disorder.

A

Cardiac Failure

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24
Q

Heart failure epidemiology

A

Old age

AA

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25
Q

Population attributable risk of heart failure due to_____(62%), _____(17%), _____(10%), _____(8%), _____(3%), and _____(2%).

A 
CAD
smoking
hypertension
overweight
diabetes mellitus
valvular heart disease
26
Q

The most common structural correlate with heart failure.

A

myocardial infarction

27
Q

Chronic heart failure is most frequently caused by

A

old myocardial infarctions (often multiple)

28
Q

ischemic cardiomyopathy

A

aka Chronic Ischemic Heart Disease; progressive heart failure secondary to ischemic myocardial damage

29
Q

Heart failure that typically lowers the ejection fraction.

A

Heart failure due to aortic stenosis, severe hypertension or CAD.

30
Q

Heart failure that typically preserves the ejection fraction.

A

Heart failure due to left ventricular hypertrophy, restrictive cardiomyopathy or pericardial disease. Transient myocardial ischemia can do this too.

31
Q

Non-congestive heart failure

A

There aren’t any! All heart failure is congestive.

32
Q

_____ heart failure is associated with cardiomegaly.

A

Most

33
Q

Cardiomegaly due to heart failure is caused by _____ more often than thickening of the walls.

A

dilation of the chambers

34
Q

The most common symptom of heart failure.

A

Dyspnea

35
Q

Pulmonary edema occurs when pulmonary venous pressure exceeds ___ mmHg.

A

20

36
Q

The condition in which one pillow is sufficient to prevent paroxysmal nocturnal dyspnea.

A

One-pillow orthopnea

37
Q

Two most common symptoms of heart failure.

A

Dyspnea

Fatigue

38
Q

Two most specific symptoms of heart failure.

A

Paroxysmal nocturnal dyspnea

orthopnea

39
Q

Signs of heart failure

A 
tachycardia
tachypnea
hypotension
pulmonary crackles
pulmonary wheezing
diaphoresis
gallops
40
Q

Tachycardia is a compensatory response to

A

reduced ejection fraction

41
Q

When pulmonary venous pressure exceeds ____ mmHg, transudate passes not only into the interstitium but also into airspaces.

A

25

42
Q

Crackles are (CHOOSE: inspiratory OR expiratory) sounds attributed to _____.

A

inspiratory; popping open of small airways occluded by edema

43
Q

Crackles are first heard _____

A

at lung bases

44
Q

cardiac asthma

A

wheezing caused by edema around large airways from hear failure

45
Q

Diaphoresis can be a sign of heart failure due to _____ stimulation

A

sympathetic nerve

46
Q

Chest xray findings of _____, _____, and _____ can help heart failure diagnosis.

A

cardiomegaly
pulmonary vascular congestion
interstitial or alveolar edema

47
Q

Level of ____ correlates with the severity of heart failure.

A

BNP

48
Q

BNP causes

A

excretion of Na and water
vasodilation
inhibition of renin secretion
antagonism of the effects of angiotensin II on aldosterone and ADH levels

49
Q

The most common cause of heart failure with preserved ejection fraction.

A

Hypertension

50
Q

Gallop associated with hypertensive heart disease

A

S4 gallop

51
Q

People who can have a physiologic S4

A

young people

52
Q

Myocardial fibrosis, decreased compliance and restrictive cardiomyopathy commonly accompany

A

decompensated hypertensive heart disease

53
Q

summation gallop

A

S3 plus S4 in tachycardic pt

54
Q

The prognosis of _____ heart failure is poor.

A

diastolic

55
Q

The 4 profiles of acute heart failure.

A

A: warm and dry
B: warm and wet
C: cold and wet
L: cold and dry

56
Q

The warm and dry profile of acute heart failure is most associated with _____ or _____.

A

transient myocardial ischemia

heart failure from lung disease

57
Q

Compensatory responses elicited by hypovolemia leading to shock.

A

rapid breathing
baroreceptors -> increased symp and decreased parasymp
ADH released by posterior pituitary

58
Q

5 consequences of sympathetic nervous activity

A 
increased HR
augmented myocardial contractility
peripheral vasoconstriction
release of renin from kidney (inc AII -> vasoconstriction)
epinephrine released by adrenal medulla
59
Q

Effect of epinephrine

A

peripheral and then splanchnic vasoconstriction

60
Q

Effects of ADH

A

water retention

vasoconstriction

61
Q

Mechanism of increased capillary oncotic pressure in hypovolemia.

A

Glycogenolysis in the liver induced by epi and norepi

62
Q

Normal central venous pressure

A

3 mmHg

Block 10 (16 decks)

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