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RCIS > Junior Monitor > Flashcards

Junior Monitor Flashcards

1
Q

Causes of Overdamping

A 
•Bubble or clot in line or transducer
•Small lumen of tubing system
•Soft compliant tubing
•Loose catheter connection
•Kink in catheter
Overdamping system is not sensitive enough and yields flat or rounded tracings.
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2
Q

Causes of Underdamping

A 
•System tubing is too stiff
•System tubing is too long
•Hyperdynamic state
•Catheter tip in turbulent jet
Underdamping system is too sensitive and produces too much “ringing” or overshoot of tracings.
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3
Q

Select the appropriate uses of the PCWP

A
  • Closely approximates LA pressure
  • Overestimates LA pressure in patients with acute respiratory failure, COPD with pulmonary hypertenstion, pulmonary venoconstriction, or LV failure with volume overload.
  • Usually sufficient to estimate LV filling pressure
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4
Q

State the appropriate measures taken to obtain an accurate PCWP

A

•Position the catheter correctly
•Verify correct position by:
Confirming oxygen saturation greater than 95%
Confirm pressure is not a damped PA pressure by confirming A and V waveform timed against EKG or LV pressure.
During fluoroscopy when contrast material is injected the lack of washout 15 seconds after injection indicates proper position. A “fern” pattern of contrast seen of fluoroscopy may help when the hemodynamic tracing is in question.

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5
Q

State the appropriate measures taken to obtain an accurate PCWP

A
  • The system should be thoroughly flushed before accepting wedge pressure.
  • Connect the catheter to the manifold with stiff short pressure tubing.
  • A stiff large-bore end-hole catheter should be used.
  • For mitral valve area determinations the operator should correct for the time delay.
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6
Q

A wave, waveform abnormality, select the appropriate cause: A wave

A
  • Absent, during atrial fib/junctional rhythms
  • Elevated during MS, TS
  • Elevated during RVH
  • Elevated during PS, PHTN
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7
Q

V wave, waveform abnormality, select the appropriate cause:

A
  • Elevated with MR, TR

* Elevated with MS, TS

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8
Q

RVSP, waveform abnormality, select the appropriate cause:

A
  • Elevated in pulmonary stenosis

* Elevated in pulmonary hypertension

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9
Q

RVEDP, waveform abnormality, select the appropriate cause:

A

Initially in RV failure RV tracings would show a decreased systolic pressure and an increased EDP.
• Elevated in pulmonary hypertension.

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10
Q

PAEDP, waveform abnormality, select the appropriate cause:

A

•Conditions in which left atrial pressures are increased also increase pulmonary artery pressures.
Pad=mean Paw=mean LA= LVEDP

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11
Q

Given an event occurring during the electrocardiogram, match it to what it represents,

A

P wave – atrial deploarization
QRS – ventricular depolarization
T wave – rapid phase of ventricular repolarization
ST segment – plateau phase of ventricular repolarization.

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12
Q

Intima (tunica interna)

A

The inner coat of an arterial wall and is composed of a lining of endothelium and a basement membrane (elastic tissue or internal elastic lumina).

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13
Q

Tunica Media

A

usually the thickest layer. It consists of elastic fibers and smooth muscle.

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14
Q

Adventitia (tunica externa)

A

outer layer of the arterial wall. It is composed principally of elastic and collagenous fibers. An external elastic lamina may separate the tunica externa from the tunica media.

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15
Q

Describe the Wheatstone bridge principle,

A

Pressure signals exerted on a strain gauge converts mechanical pressure signal into an electrical signal.
Arrangement of electrical connections in a strain gauge such that pressure induced changes in resistance result in proportional changes in voltage across the bridge

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16
Q

Explain the findings that occur to pressure tracings on the monitor during coronary artery injections,

A

During coronary artery injections, the pressure is turned off at the manifold, thus displaying a flat pressure waveform on the hemodynamic monitor.

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17
Q

valvular disease of AS, AI, MS, or MR, list what pressures would be recorded as well as what scale and paper speed would be used to evaluate the severity of such a disease

A

AS & AI – simultaneous LV and AO pressures are recorded at a 200 mmHg pressure scale 100 cm/sec paper speed.
MS & MR – simultaneous LV and PCW pressures are recorded at a 40 mmHg pressure scale 100 cm/sec paper speed.

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18
Q

Normal pressure waveform: A wave

A

atrial contraction

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19
Q

Normal pressure waveform: C wave

A

Closed TV bulging in the RA

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20
Q

Normal pressure waveform: X descent

A

Downslope of “a” wave caused by atrial relaxation

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21
Q

Normal pressure waveform: V wave

A

Atrial filling

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22
Q

Normal pressure waveform: Y descent

A

TV opening and subsequent RV filling

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23
Q

Describe the Left Heart Catheterization protocol and Left and Right Heart hemodynamic Measurements

A

Left Heart scale-200mmHg

Right Heart scale=40 or 50 mmHg

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24
Q

Right Heart Catheters: Cournand

A

all-purpose right heart catheter pressure measurements, blood sampling, single end hole

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25
Q

Right Heart Catheters: Lehman

A

thin wall version of Cournand with a slightly shorter distal curve.

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26
Q

Right Heart Catheters: Goodale Lubin

A

pressure measurement, blood sampling, 1 end hole and 2 oval side holes.

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27
Q

Right Heart Catheters: Grollman Pigtail

A

Right Ventriculography and PA angiography

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28
Q

Right Heart Catheters: Bynum Wilson

A

double lumen PVC catheter with side holes near the distal tip but distal to the balloon. PA angiography and measure PAWP

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29
Q

Angiographic Catheters: Gensini

A

retrograde L&R heart angiography, 6 oval side holes, within 1.5 cm of 1 end hole, tapered tip

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30
Q

Angiographic Catheters: NIH (National Institutes of Health)

A

4 or 6 side holes, no end hole, gentle curve RV/LV angiography

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31
Q

Angiographic Catheters: Eppendorf

A

only the area 20 cm proximal to the hub of the catheter is reinforced with nylon fibers., less stiff than NIH catheter, closed end 6 laterally opposed side holes.

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32
Q

Angiographic Catheters: Lehman Ventriculography

A

Thin walled, closed-end slightly curved catheter tip tapered to 5 Fr with four sides holes beginning 2.5 cm from tip.

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33
Q

Angiographic Catheters: Pigtail angiographic

A

with a tapered tip the terminal 5 cm of which is coiled back onto itself in a tight loop. 4-12 non-laterally opposed side holes, commonly used for LV and AO angiography

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34
Q

Angiographic Catheters: Judkins

A

preformed coronary catheters no side holes one end hole, used for the original is constructed of polyurethane, designed for coronary injections from the femoral with relatively little manipulation

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35
Q

Angiographic Catheters: Sones/Castillo

A

designed for a brachial approach 80 or 100 cm lengths

36
Q

Describe the pathway in which blood travels from the heart, throughout the body, and back to the heart

A

AO, Arteries, Arterioles, Capillaries, Venules, Veins, IVC/SVC, Heart, PA, Lungs, PV

37
Q

Baroreceptors

A

Located in the wall of the carotid sinus.
Sends impulses to the vasomotor center to vasodilate and decrease B/P.
Can stimulate vasomotor center to increase B/P and CO if the B/P falls too low.
Can vasoconstrict by increasing sympathetic stimuli.

38
Q

Chemoreceptors

A

Sensitive to chemicals.
Carotid/aortic bodies.
Sense levels of Oxygen, Carbon Dioxide and Hydrogen ions.
Stimulated by decreased levels of Oxygen or increased levels of Hydrogen and Carbon Dioxide.
Send impulses to vasomotor center to increase sympathetic tone.

39
Q

Blood Pressure

A

pressure exerted on arteries by LV in systole and pressure remaining when ventricle is in diastole

40
Q

Pulse Pressure

A

the difference between systolic and diastolic pressure.

41
Q

Scheme of drainage for right Internal Jugular Vein

A

is used in an endomyocardial biopsy, drains into the right brachiocephalic vein, to the SVC

42
Q

Scheme of drainage for right femoral vein

A

drains into the right external iliac vein into the right common iliac vein, into the IVC

43
Q

Explain and identify the difference between damping and ventricularization

A

Damping is a fall in overall catheter tip pressure while a fall in diastolic pressure only is ventricularization

44
Q

Name the changes that occur to the fetal circulation after birth,

A

Umbilical arteries vasoconstrict and atrophy to become medial umbilical ligaments.
Umbilical vein vasoconstricts to become round ligament of the liver.
Placenta is afterbirth.
Ductus venosus becomes the ligamentum venosum.
Foramen ovale becomes the fossa ovalis.
Ductus arteriosus closes to become ligamentum arteriosus.

45
Q

Adverse effects of coronary angiography and its treatment: Bradycardia or Asystole

A

prophylactic insertion of temporary pacing electrodes is not necessary since most episodes of bradycardia and asystole are brief and are resolved promptly by forceful coughing which elevates central aortic pressure and probably helps wash residual contrast out of the capillary bed.

46
Q

Adverse effects of coronary angiography and its treatment: Provocation of Myocardial Ischemia

A

One of the most common adverse effects seen during coronary angiography. Pull catheter back from the coronary ostium and suspend injections until ischemia resolves.

47
Q

Adverse effects of coronary angiography and its treatment: Marked Arterial Hypertension

A

if fails to respond to nitroglycerine may administer other vasodilators as needed to bring blood pressure down.

48
Q

Adverse effects of coronary angiography and its treatment: Allergic reaction to contrast

A

although uncommon they are best prevented by 18 to 24 hours of premedication (prednisone and cimetidine) and/or the use of non-ionic contrast. If a severe unexpected reaction does occur it usually responds to IV epinephrine. Avoid large bolus doses they may provoke tachycardia, hypertension, and arrhythmia

49
Q

Adverse effects of coronary angiography and its treatment: Renal Insufficiency

A

every effort should be made to give adequate hydration both pre and post procedure

50
Q

A wave

A

occurs in NSR and follows the P wave; atrial contraction

51
Q

Peak LV ejection

A

follows isovolumic contraction on the LV pressure waveform

52
Q

Isovolumic contraction

A

follows atrial systole; first component of the LV pressure

53
Q

C wave

A

atrioventricular valves bowing(bulging) into the atria during systole

54
Q

Isovulmic relaxation

A

follows peak ejection on the LV pressure waveform (Page 588)

V wave=represents atrial filling

55
Q

The Autonomic Nervous System

A

regulates vital functions of all organs by both central nervous system and reflex control, but not by conscious control

56
Q

Sympathetic System

A

Stimulates the heart by secreting Norepinephrine onto the B1 receptors.
Increases the force of myocardial contraction.
Increases the speed of conduction through the AV node, atria, ventricles and the myocardium.
Stimulates the SA node to pace faster. (Page 57)
Increases irritability of atrial and junctional automaticity foci.
Stimulation of A1 receptors, constrict the arteries through the body increasing blood pressure and blood flow.

57
Q

Parasympathetic System

A

Parasympathetic nerves release acetylcholine which activates cardiac cholinergic receptors to produce a cardiac inhibitory effect.
The GI tract is stimulated by its parasympathetic nervous system.
Vagal stimulation = parasympathetic stimulation.
Inhibits SA node, decreasing the heart rate.
Depresses the irritability of automaticity foci, particularly those in the atria and the LV junction. (Page 58)
Diminishes the force of myocardial contraction.
Decreases the speed of conduction, particularly in the AV node.
Stimulation of arterial (cholinergic) receptors dilates arteries reducing blood pressure and flow.

58
Q

Area of the heart that has suffered a myocardial infarction, select the leads in which this could be seen: Inferior Infarction

A

ST elevation with/without abnormal Q wave in leads II, III, aVF
Usually associated with RCA occlusion.

59
Q

Area of the heart that has suffered a myocardial infarction, select the leads in which this could be seen: Lateral Infarction

A

ST elevation with/without abnormal Q wave in leads I, aVL, V5, V6
May be a component of a multiple site infarction.
Usually associated with obstruction of left circumflex artery.

60
Q

Area of the heart that has suffered a myocardial infarction, select the leads in which this could be seen: Posterior infarction

A

Tall R wave and ST depression in V1, V2 and V3 (reciprocal changes).
May be a component of a multiple site infarction.
Usually associated with obstruction of RCA and or left circumflex artery.

61
Q

Area of the heart that has suffered a myocardial infarction, select the leads in which this could be seen: Anterior Infarction

A

ST elevation with/without abnormal Q wave in leads V1, V2, V3, V4
Usually associated with occlusion of the left anterior descending branch of the left coronary artery.

62
Q

The correct method in which a pressure waveform is created

A

A pressure wave is created by cardiac muscular contraction, and is transmitted along a closed, fluid filled column, to a pressure transducer, converting the mechanical pressure to an electrical signal that is displayed on a video monitor

63
Q

List indications for a right heart catheterization

A

Dyspnea
Valvular Heart Disease
Intracardiac Shunts

64
Q

Select the complications of a right heart catheterization

A

The most common is the stimulation of the RVOT which results in
Arrhythmias
Advanced AV Block
Rare Right Bundle Branch Block
Significant but transient arrhythmias in 30% - 60% of patients

65
Q

Select the complications of a right heart catheterization: Access

A

Major: Pneumothorax, Hemothorax, Tracheal perforation (subclavian route), Sepsis.
Minor: Hematoma, thrombosis, cellulites

66
Q

Select the complications of a right heart catheterization: Intracardiac

A

Major: Right ventricular perforation, Heart Block (RBBB), Pulmonary rupture, Pulmonary infarction.
Minor: Ventricular arrhythmias

67
Q

Name the catheters used during an Aortic Stenosis case

A 
Pigtail Ventriculography Catheter
Amplatz Left
Amplatz Right
Judkins Right
Multipurpose
Other specially designated catheters
68
Q

Cardiac Output CO

A

(AO-MV) x Hgb x 1.36 x 10

69
Q

Stroke Volume SV

A 
             HR
70
Q

Cardiac Index CI

A 
             BSA
71
Q

Select the appropriate points to remember when crossing the Aortic Valve with guidewires,

A

Adequate Heparin ( 5000 Units Bolus), frequent catheter flushing
Maximum time of 3 minutes per attempt to cross.
Use 0.038” guidewire instead of 0.035” guidewire for calcific valves.
Manipulate wires gently.
Avoid guidewire configurations leading to the coronary ostia to prevent dissection.
If great difficulty is encountered, a transseptal approach should be considered early.

72
Q

Select the consequences, if a steady state is not achieved during a Fick Cardiac Output determination,

A

If steady state is not achieved due to dyspnea, anxiety or elevated O2 level then, Oxygen Consumption will go up and so will the Cardiac Output.
Shallow breathing and oversedation result in a falsely low cardiac output and therefore, a low Cardiac Output measurement.

73
Q

State the use of the proximal port, distal port, thermistor, and balloon on the Swan Ganz catheter used in Thermodilution Cardiac Output determinations

A

Proximal – RA pressure measurement, rapid injection of saline for CO.
Distal – Pressure measurement.
Thermistor – measure blood temperature.
Balloon – positioning aid, facilitates PCW measurements.

74
Q

Select the differences between the Cardiac Output determination techniques

A

Fick is the best and most accurate during low cardiac output states.
Thermodilution is inaccurate in low CO states, TR or shunts.
Thermodilution is preferred to the Indocyanine green.

75
Q

Right Atrium Pressures

A 
a-wave =	2-10 mmHg		
v-wave =	2-10 mmHg		
mean =	0-8 mmHg
76
Q

Right Ventricle Pressures

A 
systolic =	15-30 mmHg		
diastolic =	 0-8 mmHg
77
Q

Pulmonary Artery Pressures

A 
systolic =	15-30 mmHg		
diastolic =	5-14 mmHg		
mean =	10-22 mmHg
78
Q

PCW Pressure

A 
a-wave= 5-15 mmHg		
v-wave = 5-15 mmHg		
mean = 4-12 mmHg
79
Q

Left Ventricle Pressure

A 
systolic =	90-150 mmHg	
diastolic =	4-12 mmHg
80
Q

Aortic Pressure

A 
systolic =	90-150 mmHg	
diastolic =	60-90 mmHg		
mean = 70-105 mmHg
81
Q

Systemic Vascular Resistance SVR

A

1170 +- 270 dynes/sec/cm^-5

82
Q

Systemic Vascular Resistance Index SVRI

A

2130 +- 450 dynes/sec/cm-5/M2

83
Q

Pulmonary Vascular Resistance PVR

A

67 +- 30 dynes/sec/cm-5

84
Q

Pulmonary Vascular Resistance Index PVRI

A

123 +- 54 dynes/sec/cm-5/M2

85
Q

Describe the procedure of recording left heart pressures

A

AO / AO mean / AO / LV / LVEDP / LV/ Pullback to AO /AO mean/ AO/ Air zero.

86
Q

Describe the procedure of recording right heart pressures

A

PCWP / PCWP mean w/step up to PA Mean / PA / RV / RA / RA mean / RA / Air zero.

RCIS (4 decks)

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