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PA 2 (RESP 262) > Mod 3 - Cardiovascular Assessment > Flashcards

Mod 3 - Cardiovascular Assessment Flashcards

1
Q

ECGs: if 1mm = 0.04 secs, how many little squares go into one “big box”?

A

1 big box equals 5mm and is 0.20 s.

5 large squares = 1sec.

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2
Q

What are the 6 standard limb leads on a basic ECG?

A

Leads 1,2,3, aVr, aVL, and aVf

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3
Q

Which ECG leads are bipolar?

what are bipolar leads?

A

Leads 1,2, and 3.

Bipolar leads uses 2 electrodes to record tracing
(compares voltage in 2 electrodes, 1 (+ and -)

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4
Q

Which ECG leads are unipolar?

What are unipolar leads?

A

Leads are AVR, AVL, and AVF.

Unipolar only record 1 electrode; ECG amps the signal.
-created via making 1 limb (+) and others (-)

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5
Q

what do the following inflections mean from an ECG:
-up
-down
-perpendicular (straight)

A

When electricity flows towards (+) electrode = upright image

When electricity flows toward (-) electrode = inverted image

perpendicular = no deflection.

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6
Q

What direction does the electrical current travel in the heart?

edit

A

Ap starts in the atria and is propagated down to ventricles

TLDR: from the base of the heart to the apex (R to L)

Bonus:

Apex is nearer to armpit

Base is closer to breast bone.

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7
Q

why are lead III’s flatter than I or IIs?

edit
-need to add images for leads 1 - 3

A

the leads have perpendicular placement to the dominant electrical current in the heart

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8
Q

Which lead will have the most negative deflection in a ECG?

and why?

A

Lead AVR

the lead deflects against the normal electrical activity in the heart

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9
Q

12 lead ECG; right axis deviation and causes

A

Lead 1; negative
AVF: positive

Causes:
-Cor Pulmonale
-RV hypertrophy
-pulmonary embolism (PE)
-right bundle branch block (RBBB)

Also; left tension pneumothorax

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10
Q

12 lead ecg: Left axis deviation and causes

A

Lead 1: positive
AVF: negative

Causes:
-abdominal obesity
-ascities
-third trimester pregnancy
-left ventricular hypertrophy
-LBBB

ALSO; right pneumothorax (tension)

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11
Q

Hemodynamics: what are the 3 main routes to collect data?

A

Arterial lines

Central lines

Pulmonary artery lines

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12
Q

Define Hemodynamics

A

study for forces (pressures) that influence the circulation of blood

i.e BP, CVP, PAP, PAWP, CO, PVR, SVR etc.

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13
Q

biggest veins in the body

A

inferior vena cava

superior vena cava

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14
Q

Arterial lines look at what?

A

what part pumps blood out to the body

-the left ventricles

(systemic ciruclation/systems and perfusion)

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15
Q

Central lines give information about which part of the body/blood flow?

A

fluid balance and function of the right heart

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16
Q

pulmonary artery lines give information about which system?

A

hybrid: left and right heart function

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17
Q

Slide 47

edit

A

Review heart anatomy and normal values for things like CVP, PAP, PAWP, and BP

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18
Q

Hemodynamics: Direct measurements

A

BP
MAP
CVP
RAP
PAP
Mean PAP
PAWP
CO

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19
Q

Hemodynamics: calculated values

A

SV / SVI
CI
SVR / SVRI
PVR / PVRI

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20
Q

The driving pressure (delta P) is reflective of what between pulmonary and systemic systems?

edit
slide 51 - needs review.

A

reflects the pressure of blood going into the pulmonary system and coming out of the systemic systems q

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21
Q

Cardiac index vs cardiac output?

A

CI = CO/ body surface area (BSA)

allows you to compare CO between different people.

  • i.e ppl have different blood volumes
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22
Q

main determinant of airway resistance?

A

radius (diameter of the blood vessel)

-constrict: resistance = higher
-dilation: resistance = lower

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23
Q

Hemodynamics: systemic vascular resistance (SVR)

what factors increase SVR?

A

Certain shocks (super dilation)

Compensatory vasoconstriction
-hypovolemia

vasoconstrictive drugs
-dopamine
-norepinephrine
- EPI

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24
Q

Axis of ECG leads?

Edit

A
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25
Q

Left axis deviation?

edit
know this for quiz’s

A

Things that shift the mediastinum
-i.e pneumothorax

Things that cause the diaphragm to be pushed up?
-pregnancy

left bundle branch block

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26
Q

Ascites

A

excess fluid in the abdominal cavity bc:
-liver failure
-third spacing
-pancreatic failure

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27
Q

Right axis deviation?

A
  • right bundle branch block
  • Tension pneumothorax
  • cardiovascular problems (right sided)

-cor pulmonale? - second to lung condition?

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28
Q

why does hypoxemia cause thick blood

A

more hemoglobin

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29
Q

Formula for VR?

A

Change in Pressure / CO

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30
Q

PVR formula?

A

[MPAP - PCWP (wedge pressure) / CO] * 80

80 is for conversion

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31
Q

SVR formula ?

A

(MAP - CVP)/ CO

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32
Q

What increases pulmonary vascular resistance (PVR)?

A

Acidosis

hypoxmia

shock?

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33
Q

How do you calculate CO?

A

Stroke volume x HR

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34
Q

what factors makeup stroke volume

A

Preload

Aferload

Contractility

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35
Q

Clinical indicators for CO?

A

CVP/PAWP

MAP/MPAP

Ejection fraction

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36
Q

What measure preload?

A

RV = CVP

LV = PAWP

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37
Q

what measures afterload

A

RV = MPAP

LV = MAP

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38
Q

What measures contractility?

A

ejection fraction

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39
Q

Which factor gives us the best snapshot to CO?

A

preload.

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40
Q

Hemodynamics: Frank Starling Curve: what relationships are present, and what does it tell us?

A

Relation between ventricle stretch and stroke volume (and in turn CO)

As preload increases, contraction increases to a point
-aka it can over stretch.

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41
Q

Hemodynamics: Frank Starling Curve: what does the dip at the top of the curve describe?

edit
refer to slide 57.

A

fluid overload?

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42
Q

Hemodynamics: Arterial lines

A

determine systemic pressure via catheter in artery

continuous monitoring of blood pressure.

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43
Q

Hemodynamics: what are the insertion points for arterial lines?

A

1.radial
3. brachial
2.pedal
4. Femoral

Numbers indicate preference choices
-radial and pedal are preferred bc there is collateral circulation

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44
Q

Hemodynamics:

why do we use arterial lines?

A

continuous BP monitors

assess therapeutic interventions (i.e drugs)

Need for frequent ABGs

Fluids and meds ARE NOT admired via art lines.

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45
Q

Hemodynamics: how do you verify function of arterial lines?

A

Zerod q12h

Level with each patients position (even w/their heart)

Check diacrotic notch is visible on art. pres. waveform

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46
Q

What does a lack of diacrotic notch indicate?

A

Indicates hypotension
-SBP < 50 mmHg

-system is damped

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47
Q

Why are transducers liquid filled?

Edit

A
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48
Q

Hemodynamics: Arterial lines what is a damped system?

A

Reduction in amplitude of waveform (check scale of monitor)

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49
Q

Hemodynamics: Arterial lines; what are some causes of a damped system?

A

Air bubbles in the system or catheter

Thrombus in the system or catheter tip

Tubing kinked

Loss of pressure from the bag

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50
Q

Hemodynamics: Arterial lines normal values?

A

Normals:

BP: 100-140/ 60-90

MAP: 80-100mmHg

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51
Q

Hemodynamics: Arterial lines; what information do you get?

A

continuous systemic BP monitoring

Continuous MAP monitoring

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52
Q

MAP < 60 mmHg indicates what?

A

risk of kidney failure

Imparied tissue perfusion

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53
Q

Hypotension is a late sign of what?

A

deficits in blood volume or cardiac function

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54
Q

Continuous MAP monitoring reflects what?

A

best reflects the afterload on the left ventricle.

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55
Q

Hemodynamics: Arterial lines Reasons for increases in BP?

A

-Increased SVR

-Increased CO (improved circulatory volume, improved circulatory function)

  • Transducer placed below level of RA if on artline
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56
Q

Hemodynamics: Arterial lines Reasons for decreases in BP?

A

Hypovolemia (fluid or blood loss)

Shock

vasodilation (see decrease SVR)

transducer placed above level of RA on artline

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57
Q

Hemodynamics:

What does Central Venous Pressure (CVP)

A

Pressure of the blood in the right atrium and venacave

AND

right ventricle during diastole when the tricuspid valve is open and unobstructed.

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58
Q

Hemodynamics: P.I.C.C line?

A

peripherally inserted catheter

inserted peripherally (like the arm) up to the big veins?

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59
Q

Hemodynamics: CVP clinical indicator?

A

JVD = central venous pressure is elevated; Rt heart problem

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60
Q

JVD: Rt sided failure may be secondary to what?

A

left sided failure or chronic hypoxemia (pulmonary vasoconstriction)

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61
Q

How does CVP give indications to right heart function (and fluid function)?

edit
slide 68

A
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62
Q

Hemodynamics: Normal CVP values?

A

CVP < 6mmHg

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63
Q

Where is CVP placed?

A

Vena cava or right atrium

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64
Q

Venous tone determines venous vascular space “pipe”

edit
didn’t finish adding slide 70

A

Venous Tone = vasoconstriction?

more vascular space = lower CVP
-less blood is returning to the R heart

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65
Q

Hemodynamics: causes for increased CVP?

edit
slide 71

A

-Increased

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66
Q

Causes for right heart failure?

Edit

A
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67
Q

Hemodynamics: causes for decreased CVP

edit
slide 72

A

Hypovolemia
-dehydration
-blood loss
-third spacing

Vasodilation
-shock, drugs

Spontaneous breathing
-during inspiration

Technical
-misplaced transducer
-air bubbles in line

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68
Q

Hemodynamics: Pulmonary Artery Pressure

what do PAC catheters

A
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69
Q

Lead I placement and direction of electrical flow?

A

Left to right (across torso)

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70
Q

Lead II placement and direction of electrical flow?

A

Diagonal (left arm across to right leg)

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71
Q

Lead III placement and direction of electrical flow?

A

Perpendicular movement (it flattens)
-right arm, right leg.

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72
Q

Order of Leads 1-3 that have the biggest inflection

A

II = biggest
I = moderate
III = shallow

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73
Q

Hemodynamics

A
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74
Q

Fluids hemodynamics

Formula/relationship

A

Delta Pressure = Flow x Resistance

Delta pressure is the driving pressure

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75
Q

How do you calculate SVR?

A

[(MAP - CVP)/CO] * 80

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76
Q

How do you calculate PVR

A

[(MPAP - PCWP)/CO] * 80

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77
Q

What are factors that increase SVR?

A

Left heart failure:
-CHF, cardio, hypovolemic & obstructive shock

-Hypoveolemia; compensatory vasoconstriction
-Septic shock (late stages)

  • Decrease in PaCO2

Vasoconstriction drugs
-Dopamine
-Norepinephrine
-Epi

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78
Q

Factors that decreased SVR?

A

Vasodilators

Morphine

certain shocks

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79
Q

Factors that increase PVR?

A

Rt heart failure: pul. hypertension, pul embolism

-Hypoxemia; Decrease alveolar oxygenation
-Acidosis; Decrease pH

-Increase in PaCO2
-Hyperinflation of lungs; [PPV/PEEP]?

-Vasoconstrictors;Vascular blockage, destruction, compression

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80
Q

Factors that decrease PVR?

A

-Increased alveolar oxygenation
-Increased pH
-nitric oxide
-Decreased PaCO2 (alkalosis)

Pharmacological agents
-Ca++ channel blockers (lol) ; vasodilators

Humoral substances

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81
Q

CO is the amount of blood pumped out of each ventricle;

-CO of the RT and LT ventricle is equal and identical over a period of time

True or false?

A

True

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82
Q

Aside from heart function (preload, afterload, and contractility), what can CO tell us?

A

The response of the circulatory system to acute and chronic disease and the effect of therapeutic interactions

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83
Q

A sudden increase in afterload (in a healthy heart) drops SV for a couple of beats, what happens as a result of the increased blood levels

A

Increased stretch and pumping
-as a result SV is maintained.

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84
Q

Ejection fracture is a measure of?

A

contractility

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85
Q

A heart rate with increased contractility will produce what?

A

a greater SV for a given preload

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86
Q

Define the Frank starling Law

A

The more the heart is filled during diastole, the greater the following force of contraction.

Results:
-Increase in SV

Caveat:
-Stretch has diminishing returns

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87
Q

Are art. lines used to admin fluids/meds?

A

hell nah

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88
Q

Hemodynamics: Arterial lines; what are some causes behind a damped system?

edit
not tested material for THIS course

A

Air bubbles in the system or catheter

Thrombus in teh system or catheter tip

Tubing kinked

Loss of pressure from the bag

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89
Q

JVD indicates which sided heart failure?

A

Right sided heart failure; may be secondary to left sided failure

(or chronic hypoxemia via pulmonary vasoconstriction)

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90
Q

CVP reflects what on the right heart?

A

preload

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91
Q

Where is the CVP catheter normally placed

A

Vena cava or right atrium

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92
Q

Potential causes for Increased CVP?

A

-Increased intrathoracic pressure; via positive pressure ventilation ; tension pneumothorax

-Rt heart failure

-Hypervolemia

-Compression around the hard

-Technical; misplaced transducer

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93
Q

Potential causes for decreased CVP?

A

-Hypovolemia; blood loss, dehydration, third spacing

-Vasodilation

-Spontaneous breathing

-Misplaced transducer (above level of R. atria)

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94
Q

Spontaneous breathing causes what in CVP?

A

Decrease

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95
Q

Positive pressure ventilation causes what in CVP?

A

CVP

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96
Q

What does [PAP] measure?

A

Volume ejected by RV and resistance of flow through pulmonary vasculature.

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97
Q

edit

Slide 79

A
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98
Q

Insertion for pulmonary catheter?

A

ideally the right jugular vein

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99
Q

PAC catheter ports?

A
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100
Q

Important of of PCWP and CVP

A

Both reflect:
-vascular volume
-vascular volume to venous tone relationship
-ability of the ventricles to pump blood

Pressures can be used to guide fluid changes

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101
Q

increased muscle tone = what?

A

increased muscle contraction

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102
Q

Cardiac output measurement: Invasive measurements

A

-Thermodilution

-dye-dilution (not as common); drawing blood samples

-Ficks method

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103
Q

Cardiac output measurement: non invasive measurements

A

Echocardiography/TEE
-both basically ultrasounds of the heart

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104
Q

How does Thermodilution measure CO?

edit
add more later

A

Injects saline via catheter that is 2 deg. colder than blood.

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105
Q

Thermodilution CO curves

edit
insert images and study a big more

A

CO is inversely proportional to the area under the curve

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106
Q

Ficks method for CO

A

VO2 = CO * C(a-v)O2 x 10

units are ml/min the 10 above converts it out of decimal

CO VO2 / (C(a -)) O2 * 10

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107
Q

Add slide 79 - 96

A
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108
Q

Hemodynamics: putting it all together:

understand the arrow diagram on slide 94

A

Add the chart I edited on the CV slide

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109
Q

Define Shock

A

The inadequate delivery of oxygen and nutrients to the vital organs

(inadequate perfusion to organs)

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110
Q

Shock: Pipe

A

Distributive shocks
-septic
-anaphylactic
-neurogenic

the vasculature has changed

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111
Q

Shock: pump

A

Cardiogenic
obstructive

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112
Q

Shock: FLuid

A

hypovolemic

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113
Q

edit

A

Also add in more info for cardiac pharm slide 41

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114
Q

edit

A

PAP and PAWP for obstructive shock could go either way depending on the obstructive shock; apparently it could even be normal.
-think tamponade for increase
-decrease ___He’ll get back to us lol

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115
Q

what is the cardiac response to someone who is hypoxic?

A

Increased HR

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116
Q

know shunting calculation

A
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117
Q

What are 3 types of Electrical therapy?

A

Pacemakers

Defibrillation

Cardioversion

118
Q

What is electrical therapy?

A

The use of electrical energy as a medical treatment

119
Q

What is the purpose of the following: Pacemakers

A

Treat unstable bradyarrhythmias

120
Q

What is the purpose of the following: Defbrillation

A

Treat pulsless VT/VFIB

121
Q

What is the purpose of the following: Cardioversion

A

To treat unstable tachyarrhythmias

122
Q

What are the indications for pacemakers?

A

For unstable/symptomatic bradyarrhythmias
-decreased BP
-decreased LOC
-Pain (Chest pain)
-SOB

123
Q

Pacemakers: Delivery of an electrical stimulus to the heart via electrodes causes what?

A

Myocardial depolarization and myocardial contraction (goal)

124
Q

Pacemakers: what are methods of pacing?
(5)

A

Transcutaneously

Transthoracically

Transesophageal

tranvenously

implanted

125
Q

Pacemakers: Which methods are temporary pacing?
(4)

A

Transcutaneously

Transthoracically

Transesophageal

Tranvenously

126
Q

Pacemakers: which are used for permanent pacing?
(2)

A

Implanted and transvenously

127
Q

when externally pacing a patient, where is the best pace to check for a pulse?

A

Femoral pulse;

if we look higher up the body, we might mistake movement (twitches) for a pulse.

If we look anywhere else, the pulse may no be hard enough.

128
Q

ECG from a pacemaker has what?

edit
Refer/add slide 9

A

little triggers (spikes) before a inverse WIDE qrs

129
Q

Pacemakers: which stimulated sector reflects a narrow QRS follows p wave

A

Atrial Pacemaker

130
Q

Pacemakers: which stimulation would cause a wide qrs?

A

ventricular pacemaker

131
Q

Defibrillation shock is used for what?

A

Correct unsynchronized/wack ass rhythms

pulseless v.tach.

V. fib

132
Q

Cardioversion delivers what kind of shock?

A

Synchronized electrical shock to restores normal rhythm

133
Q

Cardioversion aims to hit what section of the heart?

A

The atrium; on the QRS.

134
Q

Indications for a cardioversion?

A

Anything that causes a narrow QRS

135
Q

When do you deliver shocks and when do you want to avoid delivering shocks to the heart?

edit
image from slide 16

A

Deliver during the Absolute refractory period

AVOID the relative refractory period

136
Q

what is the function of a Ventricular assist device

A

External pumps that takes over the work of pumping the heart

external to the body

137
Q

Indications for ventricular assist devices

A

Cardiogenic shock
-acute myocardial infarction (or post op)

Patients w/deteriorating chronic heart failure who are candidates for transplant

138
Q

Ventricular assist devices: Intraaortic balloon pump (IABP)

edit
slide 24, 25 , 26

A

A balloon that inflates during diastole and deflated during diastole

Allows the heart to pump and perfuse the heart muscle

139
Q

Where is the IABP inserted?

A

descending aorta w/tip inferior to left cubclavian artery branches off

140
Q

Why is the gas used for inflation is helium?

A

low density, when inflating/deflating the balloon it can be done quickly

141
Q

A increase in BP and HR has a consequential affect on what?

A

Myocardial oxygen demand;
-may cause myocardial ischemia

142
Q

Receptors: A1

  1. Response to receptor activation
  2. Physiological effect
A
  1. Constriction
  2. Increased SVR and increased BP
    (and increased myocardial O2 consumption)
143
Q

Receptors: B1

  1. Response to receptor activation
  2. Physiological effect
A
  1. Increased HR, contractility, and AV conduction
  2. Increased HR, Increased SV
    (increased myocardial irritability)
144
Q

Receptors: B2

  1. Response to receptor activation
  2. Physiological effect

Arteries

A
  1. Dilation
  2. Decreased SVR and decreased BP
145
Q

Receptors: B2

  1. Response to receptor activation
  2. Physiological effect

Bronchi

A
  1. Dilation
  2. Bronchodilation
146
Q

Receptors: Dopaminergic

  1. Response to receptor activation
  2. Physiological effect
A
  1. Dilation of renal vasculature
  2. Increased Renal blood flow, increased U/O
147
Q

Drugs for CO and SVR

A

Epinephrine
Norepinephrine
Dopamine
Phenylephrine
Dobutamine

148
Q

Which receptors are affected by: Epinephrine?

A

A1, B1, B2

149
Q

Which receptors are affected by: Norepinephrine?

A

A1 and B1

150
Q

Which receptors are affected by: Dopamine (high dose)

A

A1

151
Q

Which receptors are affected by: Dopamine (moderate dose)?

A

B1

152
Q

Which receptors are affected by: Phenylephrine?

A

A1

153
Q

Which receptors are affected by: Dobutamine?

A

B1

154
Q

Which receptors are affected by: Dopamine (low dose)?

A

Dopaminergic

155
Q

What is the order of pharmological treatments for hypovolemia

A
  1. fluids/blood
  2. Pressers

Body’s natural compensatory would already increased SVR

156
Q

Cardiac Pharmacology Basics: Chronotrope affects

A

Agent that Affects HR

-Increase/Decrease HR

157
Q

Cardiac Pharmacology Basics: Inotrope affects

A

Agent that affects myocardial contractility

Positive = increased contraction strength

Negative = decreased contraction strength

158
Q

Cardiac Pharmacology Basics: Dromotrope affects

A

Agent that affects rate of conduction

Positive = increased conduction velocity

Negative = decreased conduction velocity

159
Q

Cardiac Pharmacology function for: Vasoactive drugs

A

Affects blood vessel tone (dilation/contraction)

160
Q

Cardiac Pharmacology function for: Vasopressors

A

Causes vasoconstriction (increased SVR)
-used to increase BP
-results in increased coronary perfusion pressure

161
Q

Cardiac Pharmacology function for: Catecholamine

A

One group of similar compounds having sympathomimetic action

162
Q

Where are Adrenergic Receptors located

A

peripheral vasculature.

163
Q

What is the main function of a-adrenergic receptors?

A

Regulate vascular smooth muscle tone
(For constriction)

164
Q

Agonist stimulation of A-adrenergic receptors results in what?

A

Vasoconstriction

165
Q

Vasoconstriction results in what?

A

Increased arterial BP;

resulting in:
-increased coronary and cerebral perfusion pressures

166
Q

Alpha 1 receptors result primarily in?

A

Peripheral blood vessel constriction

I.E
regulate constriction of cardiac, vascular, bronchial or, and GI smooth muscle tone

167
Q

Alpha 2 are presynaptic sympathetic neurons and CNS; what does stimulation of this receptor result in?

A

Inhibits the release of norepinephrine.

causing vasodilation

168
Q

What are the 4 classes of Anti-arrhythmics?

A

Class I: Sodium channel blockers (Lidocaine)

Class II: β-Blockers (Metoprolol, Propanolol, Lobetalol…)

Class III: Potassium channel blockers (Amiodarone)

Class IV: Calcium channel blockers (Diltiazem, Verapamil)

169
Q

Which areas of the 12 lead ECG is associated with: Inferior (3)

A

Leads II, III and aVf

170
Q

Which areas of the 12 lead ECG is associated with: Septal (2)

A

Leads V1 and V2

171
Q

Which areas of the 12 lead ECG is associated with: Anterior (2)

A

Leads V3 and V4

172
Q

Which areas of the 12 lead ECG is associated with: Lateral

A

Leads V5, V6, I, and aVL

173
Q

What lead is this?

A

Lead 1

174
Q

What lead is this?

A

Lead 2

175
Q

What lead is this?

A

Lead 3

176
Q

What lead is this?

A

AVR

177
Q

What lead is this?

A

AVF

178
Q

What lead is this?

A

AVL

179
Q

12 Lead ECGS:
Where is lead V1 placed (landmarking)?

A

4th intercostal, right sternal border

180
Q

12 Lead ECGS:
Where is lead V2 placed (landmarking)?

A

4th intercostal, left sternal border

181
Q

12 Lead ECGS:
Where is lead V3 placed (landmarking)?

A

Placed between V2 and V4

182
Q

12 Lead ECGS:
Where is lead V4 placed (landmarking)?

A

5th intercostal, mid-clavicular line

183
Q

12 Lead ECGS:
Where is lead V5 placed (landmarking)?

A

placed between v4 and v6

184
Q

12 Lead ECGS:
Where is lead V6 placed (landmarking)?

A

5th intercostal, mid-axillary line

185
Q

In a 12 Lead ECG, what leads are affected in a lateral injury?

A

Leads I, AVL, V5, V6

186
Q

In a 12 Lead ECG, what leads are affected in a inferior injury?

A

Leads II, III, and AVF

187
Q

In a 12 Lead ECG, what leads are affected in a septal injury

A

V1 and V2

188
Q

In a 12 Lead ECG, what leads are affected in a anterior injury?

A

V3 and V4

189
Q

You see a STEMI in leads I, AVL, V5, and AVL. Where is the infarcation

A

Lateral infarction

190
Q

If there is a right axis deviation, what kind of deflection would leads I and AVF have?

A

Lead I: negative (downwards)

AVF: Positive (upwards)

191
Q

QRS Axis deviation:
On a ECG; what does it mean when the impulse creates a upward/downward deflection?

A

Upward: Towards the lead

Downward: Away from the lead

192
Q

If there is a extreme right axis deviation, what kind of deflection would leads I and AVF have?

A

Both negative (downward)

192
Q

How do you calculate pressure?

A

Pressure = Flow x Resistance

193
Q

Left heart: how do you calculate SVR?

A

SVR = [(MAP-CVP) / CO] 80

194
Q

Left heart: What is a normal SVR?

A

1200-1600 dynes/sec/cm^5

195
Q

Right Heart: How do you calculate PVR?

A

SVR = [(MAP-CVP) / PCWP] 80

196
Q

How do you calculate MAP?

A

[Systolic + (2 x Diastolic)] / 3

197
Q

How do you calculate systemic driving pressure?

A

MAP - CVP

198
Q

How do you calculate pulmonary driving pressure?

A

MPAP - PCWP

199
Q

How do you calculate MPAP (Mean pulmonary artery pressure)?

A

same as MAP

200
Q

What is a normal MPAP

A

10-20

201
Q

Does Norepi [Levophed] increase or decrease SVR?

A

Increase

202
Q

Factors Affecting PVR:

What are some factors that increase PVR?

A

Hypoxemia

Acidosis

PPV/PEEP

Vasoconstrictors

203
Q

Factors Affecting PVR:

What factors decrease PVR?

A

-Oxygen
-Nitric Oxide
-Alkalosis
-Vasodilators

204
Q

Cardiac Output:
What is your right ventricular afterload measurement?

A

MPAP

205
Q

Cardiac Output:
What is your left ventricular afterload measurement?

A

MAP

206
Q

Cardiac Output:
What is your right ventricular preload measurement?

A

CVP

207
Q

Cardiac Output:
What is your left preload measurement?

A

wedge pressure

208
Q

What are 3 things your stroke volume is determined by?

A

Preload

Afterload

Contractility

209
Q

CO of the left ventricle is higher than the CO of the right ventricle?

A

CO is equal and identical over a period of time
(slide 56)

210
Q

Increased afterload means [increased/decreased] myocardial work and [increased/decreased] oxygen consumption

A

Increased afterload means [increased] myocardial work and [increased] oxygen consumption

211
Q

Does an increased afterload mean decreased myocardial work and decreased oxygen consumption?

A

False

212
Q

What does the boxed section indicate?

A

Fluid overload

CO is decreased

213
Q

What hemodynamic value is used to represent preload of the Right/Left ventricles?

A

RV: CVP

LV: Wedge Pressure

214
Q

What hemodynamic value is used to represent afterload of the RV? LV?

A

RV: PAP

LV: MAP

215
Q

Arterial Lines:

What are 4 spots for arterial lines insertions?

A

Radial (most common)

Brachial

Femoral

Pedal (second pick spot)

216
Q

What is a consideration to keep in mind when choosing arterial line sites?

A

Collateral circulation

Larger arteries preferred

217
Q

Can trust this line waveform?

A

No, dicrotic notch and looks damped

218
Q

What could no dicrotic notch indicate?

A

extreme hypotension SBP < 50mmHg

219
Q

How often should you verify function in your arterial lines

A

zeroed q12h

(or when troubleshooting)

220
Q

Differences in values amongst invasive and non-invasive BP is normal as long as?

A

Artline pressure is higher than the cuff pressure

221
Q

Normally between invasive and non-invasive BP the cuff pressure should be higher/lower than the cuff pressure?

A

Lower than the cuff pressure

222
Q

What does it mean if the artline blood pressure is lower than the manual blood pressure?

A

system is damped or transducer is not leveled

223
Q

True or False:
Artlines can be used to administer fluids or medications.

A

False

224
Q

True or False:

Hypotension is early sign of deficits in blood volume or cardiac function

A

False; it is a late sign.

225
Q

What is the best hemodynamic indicator of overall perfusion?

A

MAP

226
Q

A MAP < 60mmHg indicates what?

A

impaired tissue perfusion

227
Q

What is a normal MAP?

A

80-100mmHg

228
Q

BP would be increased or decreased if the transducer for an artline if below the RA

A

Increased BP

229
Q

BP would be increased or decreased if the transducer for an artline if above the RA?

A

Decreased BP

230
Q

What are 3 common causes of JVD?

A

Right heart failure
Left heart failure
Chronic hypoxemia (pulmonary vasoconstriction)

231
Q

CVP can give an indication of what functions?

A

Right heart function

Fluid balance

232
Q

Where are CVP catheters positioned?

A

Right atrium

OR

Vena cava

233
Q

if there is an increase in vascular space (vasodilation), What would happen to CVP?

A

Decrease because less blood is returning to the RA

234
Q

If there is less blood volume returning (hypovolemia) to the heart, CVP would?

A

Decrease

235
Q

Does hypovolemia increase or decrease CVP?

A

Decrease

236
Q

Does hypervolemia decrease or increase CVP

A

Increase

237
Q

Does positive pressure ventilation increase or decrease CVP?

A

Increase

238
Q

True or False
Positive pressure ventilation [PPV]

A

True

239
Q

Does a tension pneumothorax increase or decreases CVP?

A

Increases CVP

240
Q

Does cardiac tamponade increase or decrease CVP?

A

Increase

(fluid builds up around pericardial sac)

241
Q

What factors increase CVP?

A

Hypervolemia
PPV
Cardiac Tamponade

242
Q

What factors decrease CVP?

A

Hypovolemia
Vasodilation
Spontaneous breathing (during inspiration)

243
Q

When should pressure readings be recorded?

A

At end-expiration

244
Q

What are points A and B?

A

A: Positive pressure breaths

B: Spontaneous Breath

245
Q

A thermistor lumen port on pulmonary artery catheters measure what?

A

Cardiac output

246
Q

The proximal connector on pulmonary artery catheters measure what?

A

CVP

247
Q

Where does the proximal lumen on a pulmonary artery sit?

A

Right atrium

248
Q

The distal lumen in a pulmonary artery catheter measures what?

A

Pulmonary artery pressure

249
Q

What is a normal right atrium pressure?

A

2-6mmHg

250
Q

What is a normal right ventricle pressure?

A

20-30 / 0-5 mmHg

251
Q

What is a normal pulmonary artery pressure?

A

20-30/60-15mmHg

252
Q

What is a normal pulmonary artery wedge pressure?

A

4-12mmHg

253
Q

Normal Cardiac output [CO]

A

4-8 L/min

254
Q

Normal cardiac index [CI]

A

2.5 - 4 L/min/meter^2

255
Q

What are 3 major symptoms of Aortic stenosis?

A

Chest pain

Fatigue

SOB

256
Q

What is aortic stenosis and what is affected?

A

The valve between the left ventricle and the aorta doesn’t fully open.

Causes reduced/blocked blood flow from the heart->aorta->rest of body.

257
Q

Define Burst Abdominal Aortic Aneurysm

A

Massive internal bleeding, causing severe pain in the abdomen

258
Q

Define pulmonary embolism [PE]

A

Occurs when a blood clot get stuck in an artery in the lung; blocking flow to part of the lung.

A Classic Example: Deep Vein Thrombosis
Clots most often start in the legs and travel up through the rights side of the heart and into the lungs

259
Q

Define hypoxic pulmonary vasoconstriction [HPV]

A

homeostatic mech. that is intrinsic to pulmonary vasculature.

-intrapulmonary arteries constrict in response to alveolar hypoxia. (low O2)

-Diverts blood to better oxygenated lung segments, optimizing v/q matching and systemic O2 delivery

260
Q

Where are CVP lines placed/measured?

A

RA

measures venous return and filling pressure of the RA

261
Q

Where are PAP lines placed/measured

A

In between RV and pulmonic valve (towards lung)

262
Q

Where are PCWP lines measures/placed?

A

LA filling pressure.

aka reflects things from lungs to heart

263
Q

What does PCWP measure

A

Used to assess left ventricular filling, represent left atrial pressure, and assess mitral valve function.

264
Q

What does BP measure?

A

Arterial circulation [from heart to whole body]

265
Q

Does low oxygen cause vasodilation or vasoconstriction?

A

Vasoconstriction (smooth muscles squeeze as a result of alveoli signals)

-Causing a increase in resistance.

266
Q

Describe briefly what happens w/hypoxic pulmonary vasoconstriction

A

Basically: you are shunting blood from an area (alveoli) of low oxygenation to an area of higher oxygenation, so that you increase gas exchange in an attempt to maintain good oxygen saturation.

TLDR:
Take blood from where there is no oxygen to an area where the blood can pick up more oxygen and give it to the rest of the body!

267
Q

Hemodynamic pressures:
What affect will a Large pulmonary embolism [PE] have?

A

Increased:
-CVP
-PAP
-HR
-SVR

Decreased:
-BP
-CO

268
Q

2 ways a pacemaker can initiate impulses?

A

Triggered: Fixed rate

Inhibited: Fire only when needed

269
Q

What are the arrhythmias that you can defibrillate?

A

Pulseless VTach

Vfib

270
Q

Is defibrillation a synchronized or unsynchronized shock?

A

unsynchronized

271
Q

What is external defibrillation?

A

Electrical shock applied to the heart via the chest wall

272
Q

What is internal Defib?

A

Electric shock applied directly to the heart.

lower energy required cause it doesn’t need to bypass the chest wall

273
Q

Why is biphasic shocks more effective than a monophasic shock?

A

Biphasic delivers one shock in one direction than its reversed.
-so, it uses less energy

monophasic delivers one shock

274
Q

what shock delivery is synchronous?

A

Cardioversion

275
Q

What arrhythmias are indicative for cardioversion?

A
  • Afib and Aflutter
  • SVT
  • Junctional tach
  • atrial tach
  • unstable tachyarrhythmias
276
Q

When during a ECG waveform does cardioversion shock?

A

QRS; avoids delivering on downslope of T wave to reduce risk of Vfib

277
Q

How to implantable cardioverter defibrillators [ICD] work?

A

Detects tachyarrhythmias

Delivers shock to myocardium through transvenous wires

278
Q

Which shocks would be delivered for the following:

  1. Synchronous
  2. Unsynchronized
A
  1. Cardioversion
  2. Defibrillation
279
Q

What are the following leads?

A

A: Atrial

B: Ventricular

280
Q

What is Cardiogenic shock?

A

Heart cannot pump enough blood and oxygen to the brain + other organs

281
Q

What is hypovolemic shock?

A

Caused by too little blood volume

282
Q

What is Anaphylactic shock?

A

Caused by allergic reaction

BP drops and the airways narrow; blocking breathing

283
Q

What is Septic Shock?

A

BP drops to a low level after an infection.

284
Q

What is Neurogenic shock?

A

Trouble keeping your HR, BP, and Temp stable after damage to the nervous system & spinal cord (blood flow is too low)

285
Q

Review Cerebral perfusion, ICP, and CO2/O2

A
286
Q

A decrease in ICP results in a increase/decrease in CPP?

A

Increase in CPP

287
Q

Are alpha 2 pre or post synaptic CNS neurons?

A

Presynpatic.

Stimulation of A2 = inhibits norepinephrine

288
Q

A-Adrenergic receptors are usually associated w/A1 in our course.

what are we generalizing their function as?

A

Regulation of vascular smooth muscle tone

289
Q

B1 vs. B2

A

B1 = Excite

B2 = Relax

290
Q

What type of stimulation causes Dopaminergic receptors to result in vasodilation
(increased blood flow)

A

Agonist stimulation

291
Q

How do right bundle branch blocks (RBBB) lead to right axis deviation?

A

If action potential is slow it takes mores time to diffuse around right.

PA 2 (RESP 262) (14 decks)

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