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.
2
Q
What are the 6 standard limb leads on a basic ECG?
A
Leads 1,2,3, aVr, aVL, and aVf
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 -)
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 (-)
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.
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.
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
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
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
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)
11
Q
Hemodynamics: what are the 3 main routes to collect data?
A
Arterial lines
Central lines
Pulmonary artery lines
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.
13
Q
biggest veins in the body
A
inferior vena cava
superior vena cava
14
Q
Arterial lines look at what?
A
what part pumps blood out to the body
-the left ventricles
(systemic ciruclation/systems and perfusion)
15
Q
Central lines give information about which part of the body/blood flow?
A
fluid balance and function of the right heart
16
Q
pulmonary artery lines give information about which system?
A
hybrid: left and right heart function
17
Q
Slide 47
edit
A
Review heart anatomy and normal values for things like CVP, PAP, PAWP, and BP
18
Q
Hemodynamics: Direct measurements
A
BP
MAP
CVP
RAP
PAP
Mean PAP
PAWP
CO
19
Q
Hemodynamics: calculated values
A
SV / SVI
CI
SVR / SVRI
PVR / PVRI
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
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
22
Q
main determinant of airway resistance?
A
radius (diameter of the blood vessel)
-constrict: resistance = higher
-dilation: resistance = lower
23
Q
Hemodynamics: systemic vascular resistance (SVR)
what factors increase SVR?
A
Certain shocks (super dilation)
Compensatory vasoconstriction
-hypovolemia
vasoconstrictive drugs
-dopamine
-norepinephrine
- EPI
24
Q
Axis of ECG leads?
Edit
A
25
Left axis deviation?
*edit*
know this for quiz’s
Things that shift the mediastinum
-i.e pneumothorax
Things that cause the diaphragm to be pushed up?
-pregnancy
left bundle branch block
26
Ascites
excess fluid in the abdominal cavity bc:
-liver failure
-third spacing
-pancreatic failure
27
Right axis deviation?
- right bundle branch block
- Tension pneumothorax
- cardiovascular problems (right sided)
-cor pulmonale? - second to lung condition?
28
why does hypoxemia cause thick blood
more hemoglobin
29
Formula for VR?
Change in Pressure / CO
30
PVR formula?
[MPAP - PCWP (wedge pressure) / CO] * 80
80 is for conversion
31
SVR formula ?
(MAP - CVP)/ CO
32
What increases pulmonary vascular resistance (PVR)?
Acidosis
hypoxmia
shock?
33
How do you calculate CO?
Stroke volume x HR
34
what factors makeup stroke volume
Preload
Aferload
Contractility
35
Clinical indicators for CO?
CVP/PAWP
MAP/MPAP
Ejection fraction
36
What measure preload?
RV = CVP
LV = PAWP
37
what measures afterload
RV = MPAP
LV = MAP
38
What measures contractility?
ejection fraction
39
Which factor gives us the best snapshot to CO?
preload.
40
Hemodynamics: Frank Starling Curve: what relationships are present, and what does it tell us?
Relation between ventricle stretch and stroke volume (and in turn CO)
As preload increases, contraction increases to a point
-aka it can over stretch.
41
Hemodynamics: Frank Starling Curve: what does the dip at the top of the curve describe?
*edit*
refer to slide 57.
fluid overload?
42
Hemodynamics: Arterial lines
determine systemic pressure via catheter in artery
continuous monitoring of blood pressure.
43
Hemodynamics: what are the insertion points for arterial lines?
1.radial
3. brachial
2.pedal
4. Femoral
Numbers indicate preference choices
-radial and pedal are preferred bc there is collateral circulation
44
Hemodynamics:
why do we use arterial lines?
continuous BP monitors
assess therapeutic interventions (i.e drugs)
Need for frequent ABGs
Fluids and meds ARE NOT admired via art lines.
45
Hemodynamics: how do you verify function of arterial lines?
Zerod q12h
Level with each patients position (even w/their heart)
Check diacrotic notch is visible on art. pres. waveform
46
What does a lack of diacrotic notch indicate?
Indicates hypotension
-SBP < 50 mmHg
-system is damped
47
Why are transducers liquid filled?
*Edit*
48
Hemodynamics: Arterial lines what is a damped system?
Reduction in amplitude of waveform (check scale of monitor)
49
Hemodynamics: Arterial lines; what are some causes of a damped system?
Air bubbles in the system or catheter
Thrombus in the system or catheter tip
Tubing kinked
Loss of pressure from the bag
50
Hemodynamics: Arterial lines normal values?
Normals:
BP: 100-140/ 60-90
MAP: 80-100mmHg
51
Hemodynamics: Arterial lines; what information do you get?
continuous systemic BP monitoring
Continuous MAP monitoring
52
MAP < 60 mmHg indicates what?
risk of kidney failure
Imparied tissue perfusion
53
Hypotension is a late sign of what?
deficits in blood volume or cardiac function
54
Continuous MAP monitoring reflects what?
best reflects the afterload on the left ventricle.
55
Hemodynamics: Arterial lines Reasons for increases in BP?
-Increased SVR
-Increased CO (improved circulatory volume, improved circulatory function)
- Transducer placed below level of RA if on artline
56
Hemodynamics: Arterial lines Reasons for decreases in BP?
Hypovolemia (fluid or blood loss)
Shock
vasodilation (see decrease SVR)
transducer placed above level of RA on artline
57
Hemodynamics:
What does Central Venous Pressure (CVP)
Pressure of the blood in the right atrium and venacave
AND
right ventricle during diastole when the tricuspid valve is open and unobstructed.
58
Hemodynamics: P.I.C.C line?
peripherally inserted catheter
inserted peripherally (like the arm) up to the big veins?
59
Hemodynamics: CVP clinical indicator?
JVD = central venous pressure is elevated; Rt heart problem
60
JVD: Rt sided failure may be secondary to what?
left sided failure or chronic hypoxemia (pulmonary vasoconstriction)
61
How does CVP give indications to right heart function (and fluid function)?
*edit*
slide 68
62
Hemodynamics: Normal CVP values?
CVP < 6mmHg
63
Where is CVP placed?
Vena cava or right atrium
64
Venous tone determines venous vascular space “pipe”
*edit*
didn’t finish adding slide 70
Venous Tone = vasoconstriction?
more vascular space = lower CVP
-less blood is returning to the R heart
65
Hemodynamics: causes for increased CVP?
*edit*
slide 71
-Increased
66
Causes for right heart failure?
*Edit*
67
Hemodynamics: causes for decreased CVP
*edit*
slide 72
Hypovolemia
-dehydration
-blood loss
-third spacing
Vasodilation
-shock, drugs
Spontaneous breathing
-during inspiration
Technical
-misplaced transducer
-air bubbles in line
68
Hemodynamics: Pulmonary Artery Pressure
what do PAC catheters
69
Lead I placement and direction of electrical flow?
Left to right (across torso)
70
Lead II placement and direction of electrical flow?
Diagonal (left arm across to right leg)
71
Lead III placement and direction of electrical flow?
Perpendicular movement (it flattens)
-right arm, right leg.
72
Order of Leads 1-3 that have the biggest inflection
II = biggest
I = moderate
III = shallow
73
Hemodynamics
74
Fluids hemodynamics
Formula/relationship
Delta Pressure = Flow x Resistance
Delta pressure is the driving pressure
75
How do you calculate SVR?
[(MAP - CVP)/CO] * 80
76
How do you calculate PVR
[(MPAP - PCWP)/CO] * 80
77
What are factors that increase SVR?
Left heart failure:
-CHF, cardio, hypovolemic & obstructive shock
-Hypoveolemia; compensatory vasoconstriction
-Septic shock (late stages)
- *Decrease* in PaCO2
Vasoconstriction drugs
-Dopamine
-Norepinephrine
-Epi
78
Factors that decreased SVR?
Vasodilators
Morphine
certain shocks
79
Factors that increase PVR?
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
80
Factors that decrease PVR?
-Increased alveolar oxygenation
-Increased pH
-nitric oxide
-Decreased PaCO2 (alkalosis)
Pharmacological agents
-Ca++ channel blockers (lol) ; vasodilators
Humoral substances
81
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?
True
82
Aside from heart function (preload, afterload, and contractility), what can CO tell us?
The response of the circulatory system to acute and chronic disease and the effect of therapeutic interactions
83
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
Increased stretch and pumping
-as a result SV is maintained.
84
Ejection fracture is a measure of?
contractility
85
A heart rate with increased contractility will produce what?
a greater SV for a given preload
86
Define the Frank starling Law
The more the heart is filled during diastole, the greater the following force of contraction.
Results:
-Increase in SV
Caveat:
-Stretch has diminishing returns
87
Are art. lines used to admin fluids/meds?
hell nah
88
Hemodynamics: Arterial lines; what are some causes behind a damped system?
*edit*
not tested material for THIS course
Air bubbles in the system or catheter
Thrombus in teh system or catheter tip
Tubing kinked
Loss of pressure from the bag
89
JVD indicates which sided heart failure?
Right sided heart failure; may be secondary to left sided failure
(or chronic hypoxemia via pulmonary vasoconstriction)
90
CVP reflects what on the right heart?
preload
91
Where is the CVP catheter normally placed
Vena cava or right atrium
92
Potential causes for Increased CVP?
-Increased intrathoracic pressure; via positive pressure ventilation ; tension pneumothorax
-Rt heart failure
-Hypervolemia
-Compression around the hard
-Technical; misplaced transducer
93
Potential causes for decreased CVP?
-Hypovolemia; blood loss, dehydration, third spacing
-Vasodilation
-Spontaneous breathing
-Misplaced transducer (above level of R. atria)
94
Spontaneous breathing causes what in CVP?
Decrease
95
Positive pressure ventilation causes what in CVP?
CVP
96
What does [PAP] measure?
Volume ejected by RV and resistance of flow through pulmonary vasculature.
97
*edit*
Slide 79
98
Insertion for pulmonary catheter?
ideally the right jugular vein
99
PAC catheter ports?
100
Important of of PCWP and CVP
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
101
increased muscle tone = what?
increased muscle contraction
102
Cardiac output measurement: Invasive measurements
-Thermodilution
-dye-dilution (not as common); drawing blood samples
-Ficks method
103
Cardiac output measurement: non invasive measurements
Echocardiography/TEE
-both basically ultrasounds of the heart
104
How does Thermodilution measure CO?
*edit*
add more later
Injects saline via catheter that is 2 deg. colder than blood.
105
Thermodilution CO curves
*edit*
insert images and study a big more
CO is inversely proportional to the area under the curve
106
Ficks method for CO
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
107
Add slide 79 - 96
108
Hemodynamics: putting it all together:
*understand the arrow diagram on slide 94*
Add the chart I edited on the CV slide
109
Define Shock
The inadequate delivery of oxygen and nutrients to the vital organs
(inadequate perfusion to organs)
110
Shock: Pipe
Distributive shocks
-septic
-anaphylactic
-neurogenic
the vasculature has changed
111
Shock: pump
Cardiogenic
obstructive
112
Shock: FLuid
hypovolemic
113
*edit*
Also add in more info for cardiac pharm slide 41
114
*edit*
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
115
what is the cardiac response to someone who is hypoxic?
Increased HR
116
*know shunting calculation*
117
What are 3 types of Electrical therapy?
Pacemakers
Defibrillation
Cardioversion
118
What is electrical therapy?
The use of electrical energy as a medical treatment
119
What is the purpose of the following: Pacemakers
Treat unstable bradyarrhythmias
120
What is the purpose of the following: Defbrillation
Treat pulsless VT/VFIB
121
What is the purpose of the following: Cardioversion
To treat unstable tachyarrhythmias
122
What are the indications for pacemakers?
For unstable/symptomatic bradyarrhythmias
-decreased BP
-decreased LOC
-Pain (Chest pain)
-SOB
123
Pacemakers: Delivery of an electrical stimulus to the heart via electrodes causes what?
Myocardial depolarization and myocardial contraction (goal)
124
Pacemakers: what are methods of pacing?
(5)
Transcutaneously
Transthoracically
Transesophageal
tranvenously
implanted
125
Pacemakers: Which methods are temporary pacing?
(4)
Transcutaneously
Transthoracically
Transesophageal
Tranvenously
126
Pacemakers: which are used for permanent pacing?
(2)
Implanted and transvenously
127
when externally pacing a patient, where is the best pace to check for a pulse?
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
ECG from a pacemaker has what?
*edit*
Refer/add slide 9
little triggers (spikes) before a inverse WIDE qrs
129
Pacemakers: which stimulated sector reflects a narrow QRS follows p wave
Atrial Pacemaker
130
Pacemakers: which stimulation would cause a wide qrs?
ventricular pacemaker
131
Defibrillation shock is used for what?
Correct unsynchronized/wack ass rhythms
pulseless v.tach.
V. fib
132
Cardioversion delivers what kind of shock?
Synchronized electrical shock to restores normal rhythm
133
Cardioversion aims to hit what section of the heart?
The atrium; on the QRS.
134
Indications for a cardioversion?
Anything that causes a narrow QRS
135
When do you deliver shocks and when do you want to avoid delivering shocks to the heart?
*edit*
image from slide 16
Deliver during the Absolute refractory period
AVOID the relative refractory period
136
what is the function of a Ventricular assist device
External pumps that takes over the work of pumping the heart
external to the body
137
Indications for ventricular assist devices
Cardiogenic shock
-acute myocardial infarction (or post op)
Patients w/deteriorating chronic heart failure who are candidates for transplant
138
Ventricular assist devices: Intraaortic balloon pump (IABP)
*edit*
slide 24, 25 , 26
A balloon that inflates during diastole and deflated during diastole
Allows the heart to pump and perfuse the heart muscle
139
Where is the IABP inserted?
descending aorta w/tip inferior to left cubclavian artery branches off
140
Why is the gas used for inflation is helium?
low density, when inflating/deflating the balloon it can be done quickly
141
A increase in BP and HR has a consequential affect on what?
Myocardial oxygen demand;
-may cause myocardial ischemia
142
Receptors: A1
1. Response to receptor activation
2. Physiological effect
1. Constriction
2. *Increased SVR and increased BP*
(and increased myocardial O2 consumption)
143
Receptors: B1
1. Response to receptor activation
2. Physiological effect
1. Increased HR, contractility, and AV conduction
2. Increased HR, Increased SV
(increased myocardial irritability)
144
Receptors: B2
1. Response to receptor activation
2. Physiological effect
Arteries
1. Dilation
2. Decreased SVR and decreased BP
145
Receptors: B2
1. Response to receptor activation
2. Physiological effect
Bronchi
1. Dilation
2. Bronchodilation
146
Receptors: Dopaminergic
1. Response to receptor activation
2. Physiological effect
1. Dilation of renal vasculature
2. Increased Renal blood flow, increased U/O
147
Drugs for CO and SVR
Epinephrine
Norepinephrine
Dopamine
Phenylephrine
Dobutamine
148
Which receptors are affected by: Epinephrine?
A1, B1, B2
149
Which receptors are affected by: Norepinephrine?
A1 and B1
150
Which receptors are affected by: Dopamine (high dose)
A1
151
Which receptors are affected by: Dopamine (moderate dose)?
B1
152
Which receptors are affected by: Phenylephrine?
A1
153
Which receptors are affected by: Dobutamine?
B1
154
Which receptors are affected by: Dopamine (low dose)?
Dopaminergic
155
What is the order of pharmological treatments for hypovolemia
1. fluids/blood
2. Pressers
Body’s natural compensatory would already increased SVR
156
Cardiac Pharmacology Basics: Chronotrope affects
Agent that Affects HR
-Increase/Decrease HR
157
Cardiac Pharmacology Basics: Inotrope affects
Agent that affects myocardial contractility
Positive = increased contraction strength
Negative = decreased contraction strength
158
Cardiac Pharmacology Basics: Dromotrope affects
Agent that affects rate of conduction
Positive = increased conduction velocity
Negative = decreased conduction velocity
159
Cardiac Pharmacology function for: Vasoactive drugs
Affects blood vessel tone (dilation/contraction)
160
Cardiac Pharmacology function for: Vasopressors
Causes vasoconstriction (increased SVR)
*-used to increase BP*
-results in increased coronary perfusion pressure
161
Cardiac Pharmacology function for: Catecholamine
One group of similar compounds having sympathomimetic action
162
Where are Adrenergic Receptors located
peripheral vasculature.
163
What is the main function of a-adrenergic receptors?
Regulate vascular smooth muscle tone
(For constriction)
164
Agonist stimulation of A-adrenergic receptors results in what?
Vasoconstriction
165
Vasoconstriction results in what?
Increased arterial BP;
resulting in:
-increased coronary and cerebral perfusion pressures
166
Alpha 1 receptors result primarily in?
Peripheral blood vessel constriction
I.E
regulate constriction of cardiac, vascular, bronchial or, and GI smooth muscle tone
167
Alpha 2 are presynaptic sympathetic neurons and CNS; what does stimulation of this receptor result in?
Inhibits the release of norepinephrine.
causing *vasodilation*
168
What are the 4 classes of Anti-arrhythmics?
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
Which areas of the 12 lead ECG is associated with: Inferior (3)
Leads II, III and aVf
170
Which areas of the 12 lead ECG is associated with: Septal (2)
Leads V1 and V2
171
Which areas of the 12 lead ECG is associated with: Anterior (2)
Leads V3 and V4
172
Which areas of the 12 lead ECG is associated with: Lateral
Leads V5, V6, I, and aVL
173
What lead is this?
Lead 1
174
What lead is this?
Lead 2
175
What lead is this?
Lead 3
176
What lead is this?
AVR
177
What lead is this?
AVF
178
What lead is this?
AVL
179
12 Lead ECGS:
Where is lead V1 placed (landmarking)?
4th intercostal, right sternal border
180
12 Lead ECGS:
Where is lead V2 placed (landmarking)?
4th intercostal, left sternal border
181
12 Lead ECGS:
Where is lead V3 placed (landmarking)?
Placed between V2 and V4
182
12 Lead ECGS:
Where is lead V4 placed (landmarking)?
5th intercostal, mid-clavicular line
183
12 Lead ECGS:
Where is lead V5 placed (landmarking)?
placed between v4 and v6
184
12 Lead ECGS:
Where is lead V6 placed (landmarking)?
5th intercostal, mid-axillary line
185
In a 12 Lead ECG, what leads are affected in a lateral injury?
Leads I, AVL, V5, V6
186
In a 12 Lead ECG, what leads are affected in a inferior injury?
Leads II, III, and AVF
187
In a 12 Lead ECG, what leads are affected in a septal injury
V1 and V2
188
In a 12 Lead ECG, what leads are affected in a anterior injury?
V3 and V4
189
You see a STEMI in leads I, AVL, V5, and AVL. Where is the infarcation
Lateral infarction
190
If there is a right axis deviation, what kind of deflection would leads I and AVF have?
Lead I: negative (downwards)
AVF: Positive (upwards)
191
QRS Axis deviation:
On a ECG; what does it mean when the impulse creates a upward/downward deflection?
Upward: Towards the lead
Downward: Away from the lead
192
If there is a extreme right axis deviation, what kind of deflection would leads I and AVF have?
Both negative (downward)
192
How do you calculate pressure?
Pressure = Flow x Resistance
193
Left heart: how do you calculate SVR?
SVR = [(MAP-CVP) / CO] 80
194
Left heart: What is a normal SVR?
1200-1600 dynes/sec/cm^5
195
Right Heart: How do you calculate PVR?
SVR = [(MAP-CVP) / PCWP] 80
196
How do you calculate MAP?
[Systolic + (2 x Diastolic)] / 3
197
How do you calculate systemic driving pressure?
MAP - CVP
198
How do you calculate pulmonary driving pressure?
MPAP - PCWP
199
How do you calculate MPAP (Mean pulmonary artery pressure)?
same as MAP
200
What is a normal MPAP
10-20
201
Does Norepi [Levophed] increase or decrease SVR?
Increase
202
Factors Affecting PVR:
What are some factors that increase PVR?
Hypoxemia
Acidosis
PPV/PEEP
Vasoconstrictors
203
Factors Affecting PVR:
What factors decrease PVR?
-Oxygen
-Nitric Oxide
-Alkalosis
-Vasodilators
204
Cardiac Output:
What is your right ventricular afterload measurement?
MPAP
205
Cardiac Output:
What is your left ventricular afterload measurement?
MAP
206
Cardiac Output:
What is your right ventricular preload measurement?
CVP
207
Cardiac Output:
What is your left preload measurement?
wedge pressure
208
What are 3 things your stroke volume is determined by?
Preload
Afterload
Contractility
209
CO of the left ventricle is higher than the CO of the right ventricle?
CO is equal and identical over a period of time
(slide 56)
210
Increased afterload means *[increased/decreased]* myocardial work and *[increased/decreased]* oxygen consumption
Increased afterload means [increased] myocardial work and [increased] oxygen consumption
211
Does an increased afterload mean decreased myocardial work and decreased oxygen consumption?
False
212
What does the boxed section indicate?
Fluid overload
*CO is decreased*
213
What hemodynamic value is used to represent preload of the Right/Left ventricles?
RV: CVP
LV: Wedge Pressure
214
What hemodynamic value is used to represent afterload of the RV? LV?
RV: PAP
LV: MAP
215
Arterial Lines:
What are 4 spots for arterial lines insertions?
Radial (most common)
Brachial
Femoral
Pedal (second pick spot)
216
What is a consideration to keep in mind when choosing arterial line sites?
Collateral circulation
Larger arteries preferred
217
Can trust this line waveform?
No, dicrotic notch and looks damped
218
What could no dicrotic notch indicate?
extreme hypotension SBP < 50mmHg
219
How often should you verify function in your arterial lines
zeroed q12h
(or when troubleshooting)
220
Differences in values amongst invasive and non-invasive BP is normal as long as?
Artline pressure is higher than the cuff pressure
221
Normally between invasive and non-invasive BP the cuff pressure should be *higher/lower* than the cuff pressure?
Lower than the cuff pressure
222
What does it mean if the artline blood pressure is lower than the manual blood pressure?
system is damped or transducer is not leveled
223
*True or False:*
Artlines can be used to administer fluids or medications.
False
224
*True or False:*
Hypotension is early sign of deficits in blood volume or cardiac function
False; it is a late sign.
225
What is the best hemodynamic indicator of overall perfusion?
MAP
226
A MAP < 60mmHg indicates what?
impaired tissue perfusion
227
What is a normal MAP?
80-100mmHg
228
BP would be increased or decreased if the transducer for an artline if below the RA
Increased BP
229
BP would be increased or decreased if the transducer for an artline if above the RA?
Decreased BP
230
What are 3 common causes of JVD?
Right heart failure
Left heart failure
Chronic hypoxemia (pulmonary vasoconstriction)
231
CVP can give an indication of what functions?
Right heart function
Fluid balance
232
Where are CVP catheters positioned?
Right atrium
OR
Vena cava
233
if there is an increase in vascular space (vasodilation), What would happen to CVP?
Decrease because less blood is returning to the RA
234
If there is less blood volume returning (hypovolemia) to the heart, CVP would?
Decrease
235
Does hypovolemia increase or decrease CVP?
Decrease
236
Does hypervolemia decrease or increase CVP
Increase
237
Does positive pressure ventilation increase or decrease CVP?
Increase
238
*True or False*
Positive pressure ventilation [PPV]
True
239
Does a tension pneumothorax increase or decreases CVP?
Increases CVP
240
Does cardiac tamponade increase or decrease CVP?
Increase
(fluid builds up around pericardial sac)
241
What factors increase CVP?
Hypervolemia
PPV
Cardiac Tamponade
242
What factors decrease CVP?
Hypovolemia
Vasodilation
Spontaneous breathing (during inspiration)
243
When should pressure readings be recorded?
At end-expiration
244
What are points A and B?
A: Positive pressure breaths
B: Spontaneous Breath
245
A thermistor lumen port on pulmonary artery catheters measure what?
Cardiac output
246
The proximal connector on pulmonary artery catheters measure what?
CVP
247
Where does the proximal lumen on a pulmonary artery sit?
Right atrium
248
The distal lumen in a pulmonary artery catheter measures what?
Pulmonary artery pressure
249
What is a normal right atrium pressure?
2-6mmHg
250
What is a normal right ventricle pressure?
20-30 / 0-5 mmHg
251
What is a normal pulmonary artery pressure?
20-30/60-15mmHg
252
What is a normal pulmonary artery wedge pressure?
4-12mmHg
253
Normal Cardiac output [CO]
4-8 L/min
254
Normal cardiac index [CI]
2.5 - 4 L/min/meter^2
255
What are 3 major symptoms of Aortic stenosis?
Chest pain
Fatigue
SOB
256
What is aortic stenosis and what is affected?
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
Define Burst Abdominal Aortic Aneurysm
Massive internal bleeding, causing severe pain in the abdomen
258
Define pulmonary embolism [PE]
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
Define hypoxic pulmonary vasoconstriction [HPV]
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
Where are CVP lines placed/measured?
RA
measures venous return and filling pressure of the RA
261
Where are PAP lines placed/measured
In between RV and pulmonic valve (towards lung)
262
Where are PCWP lines measures/placed?
LA filling pressure.
aka reflects things from lungs to heart
263
What does PCWP measure
Used to assess left ventricular filling, represent left atrial pressure, and assess mitral valve function.
264
What does BP measure?
Arterial circulation [from heart to whole body]
265
Does low oxygen cause vasodilation or vasoconstriction?
Vasoconstriction (smooth muscles squeeze as a result of alveoli signals)
-Causing a increase in resistance.
266
Describe briefly what happens w/hypoxic pulmonary vasoconstriction
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
Hemodynamic pressures:
What affect will a Large pulmonary embolism [PE] have?
Increased:
-CVP
-PAP
-HR
-SVR
Decreased:
-BP
-CO
268
2 ways a pacemaker can initiate impulses?
Triggered: Fixed rate
Inhibited: Fire only when needed
269
What are the arrhythmias that you can defibrillate?
Pulseless VTach
Vfib
270
Is defibrillation a synchronized or unsynchronized shock?
unsynchronized
271
What is external defibrillation?
Electrical shock applied to the heart via the chest wall
272
What is internal Defib?
Electric shock applied directly to the heart.
lower energy required cause it doesn't need to bypass the chest wall
273
Why is biphasic shocks more effective than a monophasic shock?
Biphasic delivers one shock in one direction than its reversed.
-so, it uses less energy
monophasic delivers one shock
274
what shock delivery is synchronous?
Cardioversion
275
What arrhythmias are indicative for cardioversion?
- Afib and Aflutter
- SVT
- Junctional tach
- atrial tach
- unstable tachyarrhythmias
276
When during a ECG waveform does cardioversion shock?
QRS; avoids delivering on downslope of T wave to reduce risk of Vfib
277
How to implantable cardioverter defibrillators [ICD] work?
Detects tachyarrhythmias
Delivers shock to myocardium through transvenous wires
278
Which shocks would be delivered for the following:
1. Synchronous
2. Unsynchronized
1. Cardioversion
2. Defibrillation
279
What are the following leads?
A: Atrial
B: Ventricular
280
What is Cardiogenic shock?
Heart cannot pump enough blood and oxygen to the brain + other organs
281
What is hypovolemic shock?
Caused by too little blood volume
282
What is Anaphylactic shock?
Caused by allergic reaction
BP drops and the airways narrow; blocking breathing
283
What is Septic Shock?
BP drops to a low level after an infection.
284
What is Neurogenic shock?
Trouble keeping your HR, BP, and Temp stable after damage to the nervous system & spinal cord (blood flow is too low)
285
Review Cerebral perfusion, ICP, and CO2/O2
286
A decrease in ICP results in a increase/decrease in CPP?
Increase in CPP
287
Are alpha 2 pre or post synaptic CNS neurons?
Presynpatic.
Stimulation of A2 = inhibits norepinephrine
288
A-Adrenergic receptors are usually associated w/A1 in our course.
what are we generalizing their function as?
Regulation of vascular smooth muscle tone
289
B1 vs. B2
B1 = Excite
B2 = Relax
290
What type of stimulation causes Dopaminergic receptors to result in vasodilation
(increased blood flow)
Agonist stimulation
291
How do right bundle branch blocks (RBBB) lead to right axis deviation?
If action potential is slow it takes mores time to diffuse around right.
