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RCE Guidelines Studying > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

What is Fick CO formula?

A

O2 consumption / (1.36) x Hb x (SaO2 - MVO2)

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2
Q

For what 2 situations is Fick better than Thermodilution?

A

For low Cardiac Output and AF

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3
Q

What is calculation of BSA?

A

BSA = Square Root ((Ht CM) x (Wt KG) / 3600))

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4
Q

What is calculation of Cardiac Index?

A

CI = (HR x SV) / BSA

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5
Q

What is formula for TPG?

A

TPG = (mPAP - PCWP)

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6
Q

What is the Gorlin Equation for AVA?

A

AVA = CO / SEP x HR x 44.3(Square root(MG))

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7
Q

What is the Gorlin equation for MVA?

A

MVA = CO / DFP * HR * 0.85 * 44.3(Square Root)(MVG))

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8
Q

What is the Hakki Formula for AVA?

A

AVA = CO / Square root: MG

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9
Q

How to use Hakki formula when HR > 90

A

Divide AVA / 1.35

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10
Q

When to be concerned about shunt? (O2 step up)

A

> 8% step up

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11
Q

What is formula for MVO2?

A

MVO2 = 3(SVC O2) + (IVC O2) / 4

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12
Q

What is Pulmonary Blood Flow formula?

A

Qp = O2 consumption / 1.36 x Hb x (PvO2 - PaO2)

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13
Q

What is calculation for Systemic Blood Flow?

A

Qs = O2 Consumption / 1.36 x hb x (SaO2 - MVo2)

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14
Q

What is simplified way to calculate Qp/Qs (if no O2 consumption given) ?

A

Qp/Qs = (SaO2 - MvO2) / (PvO2 - PaO2)

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15
Q

What is large Shunt via Qp/Qs?

A

> 2

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16
Q

What is the Dicrotic notch for Aortic HD curve?

A

Dicrotic notch from elastic recoil of Ao after the AoV closes

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17
Q

What is the Anacrotic notch for Aortic HD curve?

A

Anacrotic notch from percussion wave of LV systole

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18
Q

What are 4 things you see on Aortic curve in Aortic Stenosis?

A

-Exaggerated Anacrotic notch
-Delayed upstroke
-Late peaking
-Persistent systolic gradient

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19
Q

What happens to Pulse Pressure post PVC?

A

No change (or increased)

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20
Q

What is Carabello’s sign?

A

> 10mmhg increase in arterial BP during pullback = critical Aortic Stenosis

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21
Q

What two thing seen in Acute AR in LV? 3 in Ao?

A

-LV: Rapid rise of LV DBP, Increased LVEDP

-Ao: Rapid decline in Ao DBP, No dicrotic notch, small increase in pulse pressure

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22
Q

What are seen in two things in chronic AR seen in LV? Ao?

A

-LV: Increased LV SBP, Normal LVEDP

-Ao: Low Ao DBP, Wide pulse pressure

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23
Q

What are two things seen in LA curve in Mitral Stenosis?

A

-Increased Mean LA Pressure
-Persistent LA-LV gradient

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24
Q

What is hallmark of Acute MR?

A

-Giant CV waves ( > 3x mean LA Pressure) and Increased PA pressure

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25
Q

What is difference between Acute and Chronic MR?

A

In Chronic MR: CV waves there but 2x mean LA pressure not 3x

-Normal LV/Ao curve where as systolic pressure lower in acute MR (decreased CO, more RF/Rvol)

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26
Q

What are three HD findings seen in RA during Constriction?

A

-M configuration (Prominent Y descent with preserved X descent)

-High pressures

-Respiratory change in pressure < 3mmhg (Kussmauls sign)

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27
Q

What are 4 ventricular findings and 1 PASP finding in CP?

A

-LVEDP - RVEDP < 5mmhg

-Rapid LV early diastolic filling > 7mmhg (square root sign)

-Ventricular interdependence

-High RVEDP (> 1/3 RVSP)

-PASP < 55mmhg

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28
Q

What are two things seen in Aortic tracing with HoCM?

A

-Spike and dome: Rapid upstroke with rapid decrease at onset of mid-systolic obstruction, then subsequent gradual increase during late systole

-Brochenbrough-Braunwald sign

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29
Q

Review normal BP and HR response with Valsalva

A
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30
Q

How is Valsalva BP different with Systolic dysfunction?

A

It’s flat or increases with Valsalva

31
Q

How does Valsalva response differ in HOCM?

A

There is no overshoot phase

32
Q

What is Elastance on PV loops?

A

Pressure / Change in Volume

33
Q

What is Compliance in PV loops?

A

Change in Volume / Pressure

34
Q

What will increased Preload do to SV and LVESV?

A

-Increased SV and constant LVESV

35
Q

What will increased Afterload do to SV and LVESV?

A

Decreased SV and Increased LVESV

36
Q

What will increased Contractility do to SV and LVESV?

A

Increased SV and Decreased LVESV

37
Q

What will Systolic dysfunction due to ESPVR?

A

It will bring it down/Decrease the slope

38
Q

What will Diastolic dysfunction do to EDPVR?

A

It will decrease Compliance/ bring up the slope

39
Q

What will HCM do to the PV loop?

A

Decreased LV volume will shift the curve to the left

Increased contractility will shift the ESPVR left and upward

Decreased Stroke Volume

40
Q

What does Dilated CMO do to PV loop?

A

Increased LV volume -> EDPVR shifted right

Decreased contractility -> ESPVR shifted right and downwards

Decreased stroke volume

41
Q

What does Restrictive CMO do to PV curve?

A

-Increased LVEDP -> EDPVR shifted upwards

-Normal or slightly decreased contractility

-Decreased stroke volume

42
Q

What is this?

A

PA stenosis/PS/RVOT obstruction

43
Q

What is this?

A

Tricuspid Stenosis

44
Q

What is this?

A

Mitral Stenosis

45
Q

What is this?

A

LV intracavitary obstruction

46
Q

What is this?

A

Aortic Insufficiency

47
Q

What is this?

A

Severe TR -> Ventriculization of the RA

48
Q

What is this?

A

Constrictive Pericarditis

49
Q

What is this?

A

Constrictive Pericarditis -> Square Root Sign Rapid filling sign > 7mmhg

50
Q

What is this?

A

Prominent Y Descent/M Sign -> Constriction

51
Q

What is this?

A

Aortic Stenosis

52
Q

What is this?

A

Severe Tricuspid Stenosis

53
Q

What is this?

A

Spike and dome pulse -> HoCM

54
Q

What is this?

A

Severe PR

55
Q

What is this?

A

LA tracing showing giant V waves -> Acute MR

56
Q

What is this?

A

Severe Acute MR (Ventricularization of the LA waveform)

57
Q

What is this?

A

Aortic waveform with IABP

58
Q

What is this?

A

Giant cV waves -> MR, low pulse pressure -> Cardiogenic shock

59
Q

What is this?

A

PA stenosis

60
Q

What is this?

A

PA stenosis

61
Q

What is this?

A

M sign + Kussmaul’s -> Constrictive Pericarditis

62
Q

What is this?

A

Aortic Coarctation

63
Q

What is this?

A

Pulsus Paradoxus -> Shock

64
Q

What is shown here? What procedure was done?

A

Pericardicentesis

Note that Y descent was blunted and then becomes normal

65
Q

What does the interval from the A -> C wave represent?

A

The PR interval

66
Q

What should RAP equal?

A

RVEDP if no Tricuspid stenosis

67
Q

What is the arrow pointing at?

A

Dicrotic notch of PA

68
Q

What is different about the PCWP representing LA vs the RA waveform?

A

Indirect, there is a significant delay from electric signal to transmit the wave form

69
Q

What lung zone does the PCWP most accurately reflect LA pressure?

A

Zone 3 (lower)

70
Q

What is the most specific sign of a quality wedge?

A

O2 saturation > 90%

Others:
-Presence of well defined a and v waves
-Distinct abrupt rise in mean pressure is observed when the balloon is deflated or the catheter is withdrawn

71
Q

What is the relationship between PCWP and PADP?

A

about the same or PCWP is 0-5mmhg lower than PADP

72
Q

Name 4 reasons that PCWP would not accurately represent LVEDP?

A

-MS
-AR
-MR
-PV obstruction/stenosis

73
Q

What are 4 things that affect Thermodilution and in which way?

A

-TR: Underestimate
-Shunt: Underestimate
-Low CO: Overestimate
-Afib/Irregular R-R: Either way

RCE Guidelines Studying (52 decks)

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