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PA 2 (RESP 262) > Module 3 Hemodynamics Crap > Flashcards

Module 3 Hemodynamics Crap Flashcards

1
Q

Generally Define:

Cardiac Output [CO]

A

Volume of blood pumped out of the heart per unit of time [L/min]

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2
Q

Generally Define:

Stroke volume [SV]

A

Amount of blood ejected from the left ventricle w/each contraction

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3
Q

Generally Define:

Blood Pressure [BP]

A

Pressure exerted by the blood upon the walls of the blood vessels

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4
Q

Generally Define:

Mean Arterial Pressure [MAP]

A

Average driving pressure that propels blood from the left ventricle to the body back into the right atrium during a cardio cycle

  • perfusion pressure seen by organs
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5
Q

Generally Define:

Central Venous Pressure [CVP]

A

Pressure of the blood within the superior and inferior vena cava during diastole when the tricuspid valve is open and unobstructed

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6
Q

Generally Define:

Pulmonary Arterial Pressure [PAP]

A

Blood pressure found in the pulmonary artery

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7
Q

Generally Define:

Mean Pulmonary Artery Pressure [MPAP]

A

Average blood pressure found in the pulmonary artery

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8
Q

Generally Define:

Systemic vascular resistance [SVR]

A

Pressure needed to produce blood pressure aka flow of blood

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9
Q

Cor Pulmonale

A

Condition that causes the right side of the heart to fail; usually bc of high blood pressure or right ventricle being really fucking big.

can’t efficiently pump blood

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10
Q

Generally Define:

Pulmonary Vascular Resistance [PVR]

A

Resistance against blood flow from the pulmonary artery to the left atrium

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11
Q

What are the 4 Anti Arrhythmic drug classes?

A
  1. Sodium channel blockers
  2. Beta blockers
  3. Potassium channel blockers
  4. Calcium channel blockers
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12
Q
  1. Mechanics of action for class I anti arrhythmic drugs?
  2. List a commonly used drug
A

Class I = Sodium Channel Blockers

  1. Suppress ventricular arrhythmias
  2. Lidocaine, carbamazepine, lamotrigine, topiramate
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13
Q

Why are sodium channel blockers at risk of causing cardiogenic shock, hypotension, respiratory depression, tachycardia, or bradycardia?

A

Blockade of sodium channels slows the rate and amplitude of initial rapid depolarization, reducing cell excitability and reduces conduction velocity.

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14
Q
  1. Mechanics of action for class II anti arrhythmic drugs?
  2. List a commonly used drug
A

Class II = Beta blockers

  1. Block beta adrenergic receptors; reducing effects of circulating catecholamines
  2. Metoprolol, propranolol, labetalol
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15
Q

Define Catecholamine

A

A type of neurohormone used in stress responses

  • Dopamine, norepinephrine , epinephrine
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16
Q
  1. Mechanics of action for class III anti arrhythmic drugs?
  2. List a commonly used drug
A

Class III = potassium channel blockers

  1. Anti arrhythmic (improper beating heart)
  • prolong duration of action potentials (repolarization delayed)
  • Vasodilator
  1. Amiodarone
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17
Q
  1. Mechanics of action for class IV anti arrhythmic drugs?
  2. List a commonly used drug
A

Class IV = calcium channel blocker

  1. Inhibit/Slow reuptake of calcium ions into smooth endothelial cells
  2. Diltiazem, Verapimil
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18
Q

What is pulse pressure?

A

Difference between systolic and diastolic pressure.

Reps the force that the heart generates each time it contracts.

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19
Q

Pulse pressure: what do the following values indicate?

  1. Greater than 60
  2. Less than 40
A
  1. Risk for CV disease
  2. Poor heart function
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20
Q

Why do we measure Mean Arterial Pressure (MAP)?

A

Best indicator of overall perfusion; determines afterload on the Left ventricle

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21
Q

Briefly describe afterload

A

Amount of pressure the heart needs to eject blood during contraction

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22
Q

Define preload

A

Amount of stretch when blood fills the ventricle

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23
Q

What is a abnormal MAP

A

MAP < 60 mmHg

Indicates impaired tissue perfusion

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24
Q

What represents aortic valve closure in a ECG?

A

Diacrotic notch

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25
How is CVP affected by spont. resp. and PPV?
Spont Resp = Decreased CVP PPV = Increased CVP due to elevated intrathoracic pressures
26
How is PAP monitoring performed?
Distal port of the millilumen catheter is placed in the pulmonary artery; continuously monitored
27
How is PAWP obtained?
Balloon port is in the same catheter for monitoring PAP; inflated until the pulmonary artery is blocked and pressure reading is taken.
28
Normal PAWP value?
6-12 mmHg
29
What do we correlate to confirm pulmonary edema?
PAWP Provides an estimate of pressure in the pulmonary capillaries and determines the amount of back pressure
30
Difference between PADP and PAWP?
PADP - estimates LV filling pressure; continous PAWP - can only be measured when PAC balloon is inflated
31
What measures preload for the right side of the heart?
PAP/CVP
32
What measures preload for the left side of the heart?
PAWP
33
Factors that determine afterload?
Any factors that affect - vasoconstriction = increase afterload - vasodilation = decrease afterload
34
Best measure of afterload for the left side of the heart?
MAP (continous)
35
Best measure of afterload for the right side of the heart
MPAP
36
What is the best indicator of perfusion?
MAP
37
Normal BP?
100-140/60-90 mmHg
38
BP would increased/decreased if the transducer for an artline is below the RA?
Increased
39
BP would increased/decreased if the transducer for an artline is above the RA?
Decreased
40
3 common causes of JVD?
RH failure LH failure Chronic hypoxemia (pulmonary vasoconstriction)
41
Normal CVP?
2 - 6 mmHg
42
CVP can give an indication of
Right heart function AND *Fluid balance*
43
CVP catheter is positioned in?
The right atrium or the vena cava
44
What would happen to CVP if... There was an increase in vascular space (vasodilation)?
CVP would decrease Because less blood is returning to the RA -hypovolemia
45
Distal lumen in a pulmonary artery catheter measures?
PAP sits in the pulmonary artery.
46
Normal PAP?
20-30/6-15 mmHg
47
normal MPAP?
10-20 mmHg
48
Normal wedge pressure?
4-12 mmHg
49
normal right atrium pressure?
2-6mmHg
50
normal right ventricle pressure?
20-30/6-15 mmHg
51
When should PAWP be measured?
*End*-exhalation and when pleural pressure @ o
52
When should PAWP be measured?
*End*-exhalation and when pleural pressure @ 0
53
What affect does epinephrine and dopamine have on CO?
They both increased inotrope [contraction] Overall CO and HR
54
how do you calculate CaO2?
55
where on the PA catheter is a mixed venous sample taken ?
distal port
56
What are some factors that increase SvO2?
-Increased CO -Decreased O2 consumption -Skeletal muscle relaxation -Peripheral shunting (clots) -hypothermia (shivering)
57
What are some factors that decrease SvO2?
-Decreased CO -Anemia -Decreased SaO2 -Exercise -Hyperthermia -Increased metabolic rate
58
Hemodynamic profiles: during a large pulmonary embolism [PE], what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
59
Hemodynamic profiles: during a mild pulmonary embolism [PE], what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
60
Hemodynamic profiles: during a myocardial infarction [MI] causing left ventricular failure, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
60
Hemodynamic profiles: during a severe pulmonic stenosis [RV and lungs], what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
61
Hemodynamic profiles: during a mild pulmonic stenosis, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
62
Hemodynamic profiles: During a Hypovolemic shock, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
63
Hemodynamic profiles: During a Cardiogenic shock, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
64
Hemodynamic profiles: During a Septic shock, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
65
Hemodynamic profiles: During a Neurogenic shock, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
66
Hemodynamic profiles: During a obstructive shock, what happens to your CVP, PAP, PAWP, BP, CO, HR, and, SVR
67
How does a increased pulmonary artery pressure affect the heart?
It strains the right ventricle. The RV will try to pump blood through a narrowed artery = more pressure/resistance.
68
How can conditions like a pulmonary embolism lead to heart failure?
Conditions that increase high blood pressure put a strain on the heart to work harder (more resistance or less O2 being delivered)
69
How does ventilation decrease hemodynamic pressures?
**Decreasing intrathoracic pressures** During inhalation, the diaphragm and other muscles involved in **breathing contract, causing the thoracic cavity to expand.** This **expansion leads to a decrease in intrathoracic pressure**, which in turn leads to an **increase in venous return to the heart.**
70
How can you improve v/q mismatch?
71
What happens when there is a increased venous return?
**Increases stroke volume** The amount of blood pumped out of the heart increases
72
How does intrathoracic pressure during inhalation affect the heart during inhalation? which section is most affected?
**Decreases Left ventricular afterload** => Decreased work to eject blood => decrease in BP
73
What is afterload?
The pressure the heart most overcome in order to eject blood from the left ventricle into the aorta
74
Why would a decrease in afterload drop BP?
The work needed to eject blood from the hard decreases, and so does the pressure against the arterial walls
75
Ventilation can decrease hemodynamic pressure through a combination of which 2 elements?
1. Increased venous return 2. Decreased left ventricular afterload.
76
What is intrathoracic pressure?
The pressure inside the thoracic cavity, which is the chest cavity that contains the heart, lungs, and other structures. Intrathoracic pressure = pressure exerted by the air/tissues within the thoracic cavity on its walls.
77
When we inhale, the diaphragm and other muscles involved in breathing contract, causing the chest cavity to....
Expand and intrathoracic pressure to decrease
78
When we exhale, the diaphragm and other muscles relax, causing the chest cavity to....
contract and the intrathoracic pressure to increase
79
How do changes in intrathoracic pressure [Intr.P] can affect blood flow? -Inhalation vs exhalation?
**Affect venous return to the heart** [Intr.P] decreases during inhalation, it can increase the pressure gradient between the peripheral veins and the right atrium of the heart, which can increase venous return to the heart. This can lead to an increase in cardiac output and blood pressure. [Intr.P] increases during exhalation, it can decrease venous return to the heart, which can decrease cardiac output and blood pressure.
80
Where is the arterial catheter inserted, what information does it provide?
Inserted into an artery, **usually in the wrist** monitor blood pressure and arterial waveform. Provides: -systolic/diastolic pressure -mean arterial pressure **Indicator of cardiovascular function**
81
Where is the central venous catheter inserted, what information does it provide?
Inserted into a large vein in the neck, chest, or groin Provides: -CVP -Indicators of right atrium pressure, fluid status and cardiac function
82
What does CVP monitoring tell you?
**Right Atrium pressure** *used to monitor:* -oxygen saturation, blood flow, and temp
83
Where is the Pulmonary artery catheter [PAC] inserted, what information does it provide? (swan-ganz catheter)
Inserted via neck, chest, groin -> guided into pulmonary artery Provides: -measure pulmonary artery pressure [mpap] - pulmonary capillary wedge pressure (PCWP) - CO
84
Why is a pulmonary artery catheter important
indicates function of heart and lungs
85
What is the main function of pulmonary wedge pressure?
To measure the pressure within the left atrium of the heart. Which reflects the pressure that the left ventricle must overcome to pump blood into the systemic circulation *[Cardiac output]*
86
PCWP is an important indicator of:
left ventricular filling pressure and left ventricular end-diastolic pressure. Bonus: -Also guides fluid management for things like pulmonary edema -helps therapies for heart diseases.
87
Define pulmonary vascular resistance [PVR]
PVR is resistance to blood flow in pulmonary circulation. PVR is a critical determinant of pulmonary blood flow and plays a role in maintaining oxygenation and cardiac function.
88
Positive Pressure Ventilation [PPV] affects the following: pulmonary vascular resistance [PVR]
PVR can be affected by changes in intrathoracic pressure, alveolar recruitment, and alteration of lung mechanics. - **When PVR is applied, intrathoracic pressure increases resulting in a decrease in the diameter of pulmonary blood vessels increasing PVR** - Also reduces pulmonary blood flow.
89
Why is the right side of the heart affected by increased pulmonary vascular resistance?
**When PVR increases, it creates resistance to blood flow in the pulmonary circulation. Increased resistance causes the *[RV]* of the heart to work harder** to pump blood through the pulmonary circulation, leading to an increase in *[RV]* afterload. Over time, this can lead to *[RV]* hypertrophy, dilatation, and eventually right-sided heart failure.
90
when should PAWP be mesasured?
- When pleural pressure is near 0 - **end of exhalation**
91
Pulmonary artery pressures (PAP) increase due to?
1. Increased pulmonary blood flow 2. Increased PVR
92
What is the Importance of PCWP and CVP?
1. Vascular volume 2. Vascular volume to venous tone relationship 3. Ability's of the ventricles to pump blood
93
PAC catheter: proximal lumen opening rests in the RA, what measurements are gathered through this port?
1. Blood samples 2. Injection drugs 3. thermal bolus
94
PAC catheter: 1. where does the distal lumen opening rest? 2. what measurements are gathered through this port?
1. Opening rests in the PA 2. Measures: PAP, PCWP, Mixed venous samples (Svo2)
95
When should PCWP be measured?
- When pleural pressure is near 0 - at end exhalation - mech. ppv or PEEP can overestimate pcwp bc PEEP increases lung compliance
96
Which med would dilate the large coronary arteries, therefore improving myocardium blood supply?
Nitroglycerin - lowers preload and afterload.

PA 2 (RESP 262) (14 decks)

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