Lecture #6-1 Flashcards
What can we learn from catheterization?
Information about intracardiac hemodynamics and coronary circulation by injecting radio-contrast substance
Name of catheter with balloon at end.
Swan-Ganz Catheter
CO is increased by… (2)
Symp. stimulation
Myocardial Hypertrophy w/ SV increase
CO is reduced by… (5)
Arrythmias Valvular insufficiency Inc. afterload Reduced contractility Preload elecation beyond starling law
Name the Gold Standard for CO measurement.
The Fick Method
What happens in the Fick Method?
Measure Oxygen Consumption
Measure O in mixed venous blood
Measure O in arterial blood
Mixed venous blood oxygen equation
(2SVC+IVC)/3
Equation used with Fick’s Ingo
CO = (Oxygen Consumption)/Arteriovenous Oxygen Difference)
Equation for cardiac index.
CI = CO / Body Surface Area
Most commonly used method to measure CO?
Thermal Dilution
How does thermal dilution work?
Injection of cold saline
Degree of warming measured downstream
Area Under Curve = Flow In Pulmonary/LV Output
benefits of CO measurement with cold saline?
No recirculation bump
Alternative ways of measuring CO
Doppler Method
What measurements are performed in the doppler method?
Echo used to measure aortic root cross sectional area
ultrasound used to measure doppler shift/blood velocity
Flow = V X Area
Doppler velocity profile can also help estimate…
Inotropic State, Preload, and Afterload
Double alternative method of measuring CO?
3D Echo Ventriculography
How can intracardiac pressures be measured?
Swan-Ganz catheter
What is pulmonary capillary wedge pressure?
Catheter is passes into br. of Pulmonary Artery, Balloon expanded
Approximates Atrial Pressure
Intracardiac pressure measurements should be performed while patient is….
finishing expiration
Pulmonary Artery Occlusion Presure (PAOP) is ________ related to Pulmonary Capillary Wedge Pressure
Closely
Relationship of flow through tube to radius of tube?
to length of tube?
to viscosity?
to change in pressure?
r^4
Inverse
Inverse
Proportional
In Vascular System…Resistance= (equation)
Again with new words.
(MAP-MVP)/Blood Flow
(Pulm Art - Wedge Pressure) / Flow
Systemic Vascular Resistance =
(Pa-Pv)/CO
PVR =
(Ppulm-Pla) / CO
With a constant CO, any change in resistance will….
Change the pressure drop across the circuit
Five examples of pressure drop…
Pulmonary Hypertension Systemic Hypertension Mitral Stenosis Aortic Stenosis Hepatic Portal Hypertension
Equation or Pulmonary Artery Pressure with elevated resistance.
PA - PAWP = CO x Rp = Differential
PA = PAWP + Differential
Perks of echocardiography?
Widely Available
Inexpensive
Performed at Bedside
Transthoracic M-Mode Echo used to observe…(3)
Mitral Valve Leaflets
Myocardial Shortening
Radial Thickening
Transthoracic 2-dimensional echo used to observe…
Pie shaped heart section
Why do 3D Echo?
Quantification of LV volume and EF
Quantification of Mitral Valve Area
Doppler echo is used to show?
Blood Turbulence and Flow
Ventricular Wall motion and valve function
Pressure gradient across a stenosis is ____ times the maximum velocity across the stenosis.
4 X the square of Vmax
What should you look for when nuclear imaging?
Hemodynamically significant coronary artery stenoses
What does gated radionuclide imaging show?
Visualization of heart chambers by detecting gamma emissions from blood after isotope injection
Evaluates CAD, Valvular Heart Disease, Conjenital Heart Disease, Cardiomyopathy.
What does Radionuclide myocardial perfusion imaging (MPI) do?
Heart cells take up radionuclide (SPECT, Thallium)
Shows regional variation in myocardial perfusion/viability
Often done with stress test
Review Pics on 14
Pretty please.
Gold standard test for EJF?
MRI
What does PET imaging show?
Blood flow through specific regions of the heart.
Myocardial Metabolism
What is a CT?
Many X ras used in morphoogical analysis of an organ
What is an MRI?
Measures H1 activity when exposed to a large magnet.
What is the gold-standard for myocardial viability assessment?
PET scan
What is heard in the 4 heart sounds
S1 – Closure of AV
S2 – Closure of Semilunar Valves
S3 – Rumble of distending ventricles pulling AV taut
S4 – Atrial Contraction
Distance between two S1 or two S2 sounds may indicate…
Right Bundle Branch Block
Who should have an audible S3?
People age 20-25
S3 sounds like? S4 sounds like?
S3 – Tennessee
S4 – Kentucky
Which patients do you hear S4 in?
Individuals with ventricles with low compliances.
What is an opening snap?
A sound from stenotic AV valves opening during diastole
When are murmurs normal?
Small children and exercise.
Blood flows through fast enough to generate turbulence.
Typical cause of murmurs?
Turbulent Blood Flow
How would you distinguish a regurg. vs a stenotic murmur?
Regurg would be heard with valves closed
Stenotic with valves open
Example of a systolic murmur? a diastolic murmur?
Mitral valve fails to close fully
Aortic valve fails to close fully
Another way of saying insufficient mitral valve?
Insufficient Mitral Valve
Aortic Valve Stenosis causes an increase in ____ pressure. Mitral valve stenosis causes an increase in ______ pressure.
Left Ventricular Pressure
Left Arterial Pressure
Mitral Valve regurg. causes ______
Aortic Valve regurg causes ________
Tall V Wave in Arterial Pressure
Tall LVP, higher systolic (Austin Flint mid-diastolic Murmur)
Machinery Murmur relates to…
Patent Ductus Arteriosus
Review PV loops on Pg. 25
You’ll be glad you did.
Four types of Systolic Murmur
Aortic Stenosis/Pulmonic Stenosis
Atrial Septal
Mitral Regurg/Tricuspid Regurg
Mitral Valve Prolapse
Four Types of Diastolic Murmur
Aortic/Pulmonic Regurg
Austin-Flint
Mitral/Tricuspid Stenosis
Patent Ductus Arterosus
Mitral Valve Prolapse Makes what sound?
Click
What is Austin Flint Mid Diastolic Murmur
In aortic regurg, blood pushes back agains mitral valve, creating a mitral stenosis effect
Murmur heard through systole and diastole?
Patent Ductus Arteriosus
