Hemodynamics review

Question 1

Define Preload

Answer 1

How much the ventricles have to stretch in order for the heart to fill up

Question 2

What are the two types of preloads we measure?

Answer 2

Preload of right ventricle

Preload of left ventricle

Question 3

When measuring the right ventricle’s preload, what do we call it?

Answer 3

CVP = right ventricle preload

Question 4

If we measure the left ventricles preload, what do we refer to it as?

Answer 4

PCWP (wedge pressure) of left ventricle

Question 5

Your patient says they were exercising outside today. What did that to the heart function?

Answer 5

Due to them exercising, their preload would increase.

Question 6

The doctor says your patient is hypervolemic. What does this do their heart functioning?

Answer 6

Being hypervolemic means having too much fluid - which increases preload.

Question 7

Your patient reports that someone scared them and caused them to fall. What did this do to the heart functioning?

Answer 7

Due to being scared, their sympathetic tone was increased and so the preload increased.

Question 8

You have a patient with an AV fistula. What does this do to their heart functioning?

Answer 8

The AV fistula allows blood to bypass and shunt. So, this overall increases preload.

Question 9

What examples increase preload?

Answer 9

Exercise

Hypervolemia

Fight or flight/sympathetic tone

AV fistulas

Question 10

Your read that the patient is hypovolemic. What does this do their heart’s functioning?

Answer 10

Due to being dry, their preload is decreased.

(note: it can also decrease afterload as well)

Question 11

Patient has a history of stenotic valves. What does this do their hearts functioning?

Answer 11

The stenosis causes less blood to be able to pass into the heart’s ventricles, so it decreases preload.

Question 12

You are taking care of an A.fib patient. What does this mean for their heart functioning?

Answer 12

Their preload is decreased due to loss of the ability to fill adequately

Question 13

Examples that decrease preload

Answer 13

Hypovolemia

Stenosis of tricuspid/mitral valves

A. fib

Question 14

Define Afterload

Answer 14

Afterload is the force the left ventricle has to overcome in order to eject blood

Question 15

Patient comes in with hypertension. What does this mean for their heart functioning?

Answer 15

Due to a high BP, the afterload requirements increase.

Question 16

Results come back from the echo that the patient has Aortic Stenosis. What will this do the heart functioning? (be specific)

Answer 16

Since the aorta is directly tied to afterload, it being stenotic means there will be an increase in afterload needed.

Question 17

Patient labs show the patient recently suffered an MI. What does this mean for their heart functioning?

Answer 17

An MI causes the heart to not be able to push the body with blood as well. This means the afterload increases.

Question 18

Patient of yours has polycythemia. What does this do to their heart functioning?

Answer 18

This means their blood is thicker. And that would require an increase in afterload.

Question 19

Examples that increase afterload?

Answer 19

High SVR or Blood pressure

Aortic stenosis

Myocardial Infarction

Polycythemia

Question 20

Your patient has hypovolemia. What does this to to their afterload?

Answer 20

Hypovolemia will cause a decrease in afterload.

(it can also cause an decrease in preload)

Question 21

Your patient has septic shock. What does this do to their heart functioning?

Answer 21

The septic shock causes a decrease in resistance so afterload will decrease.

Question 22

Patient has hx of end stage cirrhosis. What does this do to their heart functioning?

Answer 22

End stage cirrhosis is of the liver but it can affect the kidneys. And so, the afterload will decrease.

Question 23

You have a patient taking nitrates/CBB/ace/arbs/ what does this do to heart functioning?

Answer 23

The vasodilators will decrease afterload due to lowering the resistance.

Question 24

If your patient has cirrhosis, what symptoms can you look for ?

Answer 24

Jaundice

Decrease UO

Anemic

Bilirubin scabs

Question 25

If your patient has any form of shock, what symptoms can you look for?

Answer 25

Hypotension paired with Tachycardia

Decreased cap refill

Decrease UO

Edema

Question 26

Labs to check for cirrhosis

Answer 26

ASLT

BUN

CR

WBC

Lact

Question 27

Define Contractility

Answer 27

The contraction’s strength

Question 28

Define Inotropic

Answer 28

Force of energy of the contraction

Question 29

Define Chronotropic

Answer 29

Time related, HR

Question 30

Define stroke volume

Answer 30

Amount of blood ejected by the ventricles during during a contraction

Question 31

Define Cardiac Output

Answer 31

Amount of blood pumped by the heart measured in Liters for one minute

Question 32

Define Cardiac Index

Answer 32

Amount of blood pumped by the heart in L/minute but is more accurate due to surface area being used