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EDIC Part (1) Course Notes > ICU > Flashcards

ICU Flashcards

1
Q

Right ventricle determines?

A

Flow

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2
Q

Left ventricle determines?

A

Pressure

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3
Q

Adaptive changes in chronic heart failure?

A
  • Fluid retention
  • Increased oxygen extraction
  • Renin-Angiotensin up-regulation
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4
Q

Etiology of heart failure?

A
  • Ischaemic cardiomyopathy (dilation)
  • Aortic stenosis (Hypertrophy & dilation)
  • Hypertension (Hypertrophy & dilation)
  • AF & arrhythmias
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5
Q

Treatment for chronic heart failure?

A
  • ACE inhibitors
  • Diuretics
  • Calcium channel blockers
  • Beta-blockers
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6
Q

Etiology of Acute heart failure?

A
  • ACS
  • Post-op cardiac surgery
  • Sepsis
  • COPD/ARDS
  • Chest trauma
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7
Q

Hypotension is ?

A

SBP < 90 mmHg or decrease in baseline > 30mmHg

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8
Q

Forresters classification of heart failure?

A
  • Class 1 = < 18 (PCWP) > 2.2 (CI) - Normal
  • Class 2 = > 18 (PCWP) > 2.2 (CI) - Pulmonary congestion
  • Class 3 = < 18 (PCWP) < 2.2 (CI) - Cardiac failure
  • Class 4 = > 18 (PCWP) < 2.2 (CI) - Cardiogenic shock
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9
Q

Mortality in forresters classification?

A
  • Class 1 < 3%
  • Class 2 9%
  • Class 3 23%
  • Class 4 51%
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10
Q

Pulmonary artery occlusion pressure AKA?

A

Pulmonary Capillary Wedge Pressure

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11
Q

Determinants of LV function?

A
  • Contractility
  • Preload (End-diastolic volume)
  • Afterload (Wall stress)
  • Heart rate
  • Synchrony
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12
Q

Starling’s law?

A

Describes preload

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13
Q

Anrep effect ?

A

Describes contractility

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14
Q

Factors increasing contractiity ?

A
  • Autonomic tone / Increase - Exercise, stress / Decrease - Diabetes
  • Catecholamines/ Decreased n chronic HF
  • Catecholamine receptors / Decrased in sepsis
  • Coronary blood flow / Increases contractility
  • Serum calcium / Decreased contractility with hypocalcaemia
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15
Q

Compliance of the heart?

A

Determined by the change in volume to pressure

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16
Q

Causes of decrease in LV compliance ?

A

Primary

  • Ischaemia
  • LV hypertrophy
  • Stunned myocardium

Secondary

  • RV dilation (Pulmonary HTN, Volume overload)
  • Hyperinflation
  • Tamponade
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17
Q

Laplace’s law? Determinant of afterload

A
  • Wall stress

- Tension = P x r

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18
Q

Afterload reduction ? Functions?

A
  • Decreases wall stress
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19
Q

Chronotropy?

A

Increasing HR with increased contractility

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20
Q

HR and LVH?

A

Increasing HR decreases contractility

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21
Q

Factors affecting preload? in LV impairment

A
  • Hypovolaemia

- Diastolic dysfunction

22
Q

Factors affecting contractility? in LV impairment

A
  • Ishcaemia

- Septic cardiomyopathy

23
Q

Factors affecting afterload? in LV impairment

A
  • Aortic stenosis

- Malignant HTN

24
Q

Factors affecting chronotropy? in LV impairment

A

Brady & tachyarrhythmias

25
Q

Factors affecting dyssychrony? in LV impairment

A

Usually MI

BBB

26
Q

Effect of MI on LV pressure-volume relationship?

A
  • Depression of the curve with MI
  • Increase in diastolic compliance curve
  • Increased filling pressures - Pulmonary oedema
  • Requires dobutamine for contractility
  • Increased contractility willl improve filling pressures
  • Nitroprusside for decreasing afterload
27
Q

Management of Acute HF?

A
  • Maintain coronary blood flow - Norad , Dopamine & balloon pump
  • Augment contractility - Dobutamine (Acute), Chronic (Phosphodiesterase inhibitors - )
  • Treat reversible causes - Ischaemia, Aortic stenosis
  • Reverse arrhythmias
  • Decrease LV afterload (Nitrates & CCBs)
  • Maintain preload
  • VAD - Ventricular assist devices
28
Q

Function of intra-aortic balloon pump?

A
  • Maintain coronary perfusion

- Decrease in afterload

29
Q

Indications for mechanical assist devices?

Bi-ventricular assist device / LVAD

A
  • Severe symptomatic HF - CI < 2, Ppao > 20 mmHg & inotrope dependent
  • LV dysfunction with persistent arrhythmias
  • Hepatic & renal failure
30
Q

PAC wave form and pressures ?

A

XY - CV - A - Based on location
RA - 1 - 5 mmHg
RV - 15 - 30 mmHg (systolic) / 1 - 7mmHg (Diastolic)
PA - 15 - 30mmHg (Systolic)/ 4 - 12 mmHg (Diastolic) / 9 - 19 mmHg (mPAP)
PCWP - 4 - 12mmHg

31
Q

Variables from PAC?

A
  • Mixed venous oxygen saturations
  • MAP
  • RAP
  • PAP/mPAP
  • PCWP
  • CO
32
Q

Thermodilution measurement with PAC?

A
  • Injectate to porximal port
33
Q

Measurement Cardiac index?/

A

CI = CO (L/min) / BSA

Normal range - 2.5 - 4 L/min/m2

34
Q

Calculation of stroke volume?

A

SV = CO / HR

Normal range - 0.06 - 0.1 L/beat

35
Q

Calculation of stroke volume index?

A

SVI = SV / BSA

Normal range - 0.033 - 0.047

36
Q

When calculating indexes?

A

The variable divided by BSA (m2)

37
Q

Calculation of MAP?

A

MAP = 2 (DBP) + SBP / 3

Normal range - 70 - 110 mmHg

38
Q

Calculation of SVR?

A

SVR (Dyne/sec/cm -5) = MAP - mRAP / CO x 80

Normal range - 800 - 1200 dyne/sec/cm-5

39
Q

Calculation of SVRI?

A

SVRI (dyne/scec/cm-5 / m2) = MAP - mRAP / CI x 80

Normal range - 1970 - 2390 dyne-sec-cm-5/m2

40
Q

Calculation of PVR?

A

PVR = mPAP - PCWP / CO x 80

Normal range - < 250 dyne-sec-cm-5

41
Q

Calculation of PVRI?

A

PVRI = mPAP - PCWP / CI x80

Normal range - 255 - 285 dyne-sec-cm-5/m2

42
Q

Calculation of DO2?

A

DO2 = CO [(Hb x SaO2 x 1.34) + (PaO2 x 0.0031)]

Normal range - 500-600ml/min

43
Q

Normal VO2?

A

200 - 250 ml/min

44
Q

Oxygen extraction ratio?

45
Q

Gold standard for CO measurement?

A

Pulmonary artery thermodilution

46
Q

Indications for PAC

A
  • Cardiothoracic surgery
  • Pulmonary HTN
  • Shock & Right ventricular failure
47
Q

Pulse wave analysis components?

A
  • Contractility
  • SV
  • Aortic compliance
  • Afterload
  • Vascular tone
48
Q

Phases of ARDS?

A
  • Exudative (1-7 days) - Acute inflammatory response of alveolar epithelium & endothelial damage
  • Proliferative phase (1-3 weeks) - Proliferation of type II pneumocytes, fibroblasts & myofibroblasts leading to widening of alveolar septae
  • Fibrotic phase (> 3 weeks) - Remodelling and fibrosis
49
Q

Dead-space and fibrosis?

A

Fibrosis increase dead-space

50
Q

What is driving pressure?

A

Plateau preassure - PEEP

EDIC Part (1) Course Notes (8 decks)

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