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Midterm Elizabeth > part one > Flashcards

part one Flashcards

1
Q

Where does deoxygenated blood go begin the cardiac cycle

A

into the right atrium

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2
Q

what valve does blood go through to get from the right atrium to the right ventricle

A

the tricuspid valve

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3
Q

Where does blood go from the right ventricle

A

through the pulmonic valve into the pulmonic artery

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4
Q

the blood goes from the pulomonic artery to the

A

lungs to become oxygenated then back to the heart through the pulmonary veins

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5
Q

where does the pulmonary veins drain

A

into the left atrium

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6
Q

the blood moves from the left atrium through the

A

mitral valve into the left ventricle

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7
Q

from the left ventricle the blood goes

A

through the aortic valve into the aorta to circulate

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8
Q

describe systole

A

heart contraction. AO valve opens to allow blood to pass from the LV

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9
Q

what marks the end of systole

A

ao valve closure

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10
Q

when will ventricles be largest

A

at end diastole

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11
Q

what happens during diastole

A

MV opens to allow blood to go from the LA to the LV

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12
Q

what is end diastole used to calculate

A

stroke volume, preload, and EF

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13
Q

what marks the end of diastole

A

MV closure

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14
Q

What doe the X and Y axis represent on the Wiggers diagram

A

x= time y= pressures

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15
Q

what pressures are seen on the wiggers diagram

A

aortic, LV, and LA

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16
Q

what is ventricular preload

A

stretching of the cardiac muscle before contraction. greater the load = greater force of contraction
higher end diastolic volume= higher preload

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17
Q

what can ventricular preload be increased by

A

ventricular systolic failure, AS, AR,PS, and PI

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18
Q

ventricular preload can be decreased by

A

venous BP , AFIB, high HR, inflow stenosis (mitral and tricuspid), and ventricular diastolic failure

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19
Q

what is afterload

A

the resistance that the ventricle has to pump against

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20
Q

increase in afterload =

A

increase in end systolic volume and decrease in stroke volume

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21
Q

what does afterload determine

A

the amount of tension the myocardium has to generate

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22
Q

what increases afterload

A

htn,AS,PS, ventricular dilation, AO pressure, systemic vascular resistance

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23
Q

What is phase one of the cardiac cycle

A

ventricular filling. pressure in the atria increases causing atrial systole= blood moves from the atria to the ventricles

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24
Q

what valves are open and closed dureing phase one

A

MV and TV are open. AoV and PV are closed

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25
Q

what is phase 2 of the cardiac cycles

A

isovolumetric contraction, early systole, blood in the ventricles

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26
Q

what is the pressure like during phase 2

A

pressure of the ventricles is higher that that of the atria but less than the arteries on the other side of the AoV and PV

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27
Q

The first heart sound happens

A

during phase 2 when the atroventricular valves close (mv/tv)

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28
Q

Isovolumetric

A

all valves are closed and the volume of blood is constant

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29
Q

What is phase three of the cardiac cycle

A

ventricular ejection

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30
Q

what is phase three as far as systole/diasotle

A

ventricular systole

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31
Q

what is pressure like during the third phase

A

ventricular pressure increases until it exceeds the aorta or pulmonary trunk, then the semilunar valves open

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32
Q

what are the semilunar valves

A

pulmonary and aortic

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33
Q

when does ejection phase end

A

after the blood goes through the AoV and PV and into circulation. It officially ends when the AoV snaps shut

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34
Q

when is the second heart sound

A

when the AoV snaps shut

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35
Q

what is the end systolic volume

A

blood remaining in the LV after ejection

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36
Q

what is phase four of the cardiac cycle

A

isovolumetric relaxation

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37
Q

isovolumetric relaxation is the

A

beginning of diastole

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38
Q

what is the pressure like during phase four

A

semilunar valves are open so the pressure in the ventricles decreases as blood goes through them, causing the eventual close

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39
Q

isovolumetric relaxation can be used for

A

indicating diastolic dysfunction

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40
Q

Diastole in the cardiac cycle

A

w/ ventricular relaxation the pressure in the ventricles is less than the atria causes the atrioventricular valves to open starting the cycle over

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41
Q

what is the bernoulli equation for pressure estimation

A

P=4v2^2
p= pressure across the valve
v2=distal velocity

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42
Q

what is the continuity equation used for

A

calculate aortic valve area (effective orifice area)

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43
Q

General rule for the continuity equation

A

blood going into a chamber must be equal to the amount flowing out of the same chamber

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44
Q

continuity equation states that velocity of blood is inversely related to

A

the area

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45
Q

what is the continuity equation

A

a2=a1xv1/v2
or
a1xv1=a2xv2

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46
Q

What is the most common valvular disease in the US

A

aortic stenosis

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47
Q

about half of AS patients have

A

a bicuspid valve

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48
Q

What velocities to you need for an aortic valve area

A

prestenotic (in LV outflow just below the AoV)
in the stenotic valve
and lv outflow tract diameter

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49
Q

which velocity do you use for the AVA

A

The highest most accurate

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50
Q

Aortic valve ranges

A

normal = 3.0-4.0cm
mild >1.5cm
moderate 1.5-1.0cm
severe <1.0 m

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51
Q

LVOT assessment

A

v1- prestenotic velocity is calculated using PW lvot doppler measurements

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52
Q

Coarctation

A

narrowing of the thoracic aorta, seen in marfans patients

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53
Q

post stenotic dilatation may be seen

A

in AS patients

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54
Q

anuerysm measurment

A

> 4cm

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55
Q

Risk factors for AO dissection

A

htn, aneurysm, post op, pregnancy, weightlifting, drugs

56
Q

genetic risk factors for AO dissection

A

marfan’s, turners, ether-danlos, AO coarctation, bicuspid AoV

57
Q

How is AO dissection classified

A

Debakey 1 and 2 if the ascending AO is involved. If ascending isnt involved then Debakey 3

58
Q

Ao regurgitation

A

diastolic reflux of blood from the ao into the LV

59
Q

what can cause AO regurgitation

A

leaflet abnormalities, endocarditis, calcification, or changes in AO root or shape

60
Q

What are the semiquantitive ways to anaylize AR

A

vena contracta width, proximal regurgitant jet width, absolute jet width

61
Q

how do you measure vena contracta width

A

smallest flow diameter at the AO valve level, determine if the regurgitant orifice area is smaller than the regurgitant width in the LVOT

62
Q

where do you measure vena contracta width

A

PLAX[

63
Q

Proximal regurgitant jet width

A

ratio of jet to the LVOT diameter
less than 25% is mild
greater than 65% is severe

64
Q

Absolute jet width

A

bigger than 10mm is severe

65
Q

limitation of absolute jet width

A

eccentric jets going to the mv anterior leaflet or septum may look narrow and underestimate severity

66
Q

Cross-sectional area

A

ratio to the lvot diameter (similar as prox regurgitant jet)

67
Q

where do you do the cross sectional area

A

PSAX

68
Q

what quantitive measurment do we use to measure AR

A

PISA, eroa

69
Q

Mild AR PISA

A

eroa of less than 10mm^2 or AR regurgitant volume of less than 30

70
Q

severe ar pisa

A

EROA of greaer than 30mm^2 or AR regurgitant volume of greater than 60

71
Q

EROA equation

A

6.28xr^2X v aliasing/peak v AR

72
Q

what does AR pulsed wave eval look like

A

diastolic flow reversal in descending thoracic or abdominal aorta

73
Q

what is used to measure AR in continuous wave

A

deceleration time and pressure half time

74
Q

what does deceleration time reflect

A

pressure difference between the ao and lv during diastole , done in apical 5

75
Q

pressure half time

A

less than 200ms- severe

greater than 500ms is mild

76
Q

Chronic AR and LV function

A

slow LV dilation, LV adapts to overload, eventually will lead to increase in afterload and EF reduction

77
Q

what happens in cases of acute AR

A

LV cant adapt, increase in diastolic flow= increase in end diastolic pressure= decreased forward cardiac output

78
Q

what happens to pt with acute ar

A

tachycardia, cardiac shock, pulmonary edema

79
Q

pulmonic stenosis may happen with

A

pulmonic regurgitation and tricuspid involvment

80
Q

Mild pulmonic stenosis

A

> 50mmhg

81
Q

moderate pulmonic stenosis

A

30-50mmhg

82
Q

severe pulmonic stenosis

A

less than 30mmhg

83
Q

what is associated with noonan’s syndrome

A

congenital dysplastic pulmonic valve

84
Q

what do you need to look at in cases of pulmonic stenosis

A

right ventricular size, function, and pressure

85
Q

what might be dilated in cases of pulmonic stenosis

A

PA, RVOT may be narrowed

86
Q

What may be seen on mmode of pulmonic stenosis

A

increase in the pulmonic A dip of more than 7mm

87
Q

when do you use the bernoulli equation in cases of PS

A

if the proximal velocity is more than 1M/S to calculate the max instantaneous gradient

88
Q

is pulmonic valve area used in PS?

A

no

89
Q

what is severe pulmonic regurgitaiton usually from in adults

A

prior heart disease interventions

90
Q

what is seen in patients with long term PR

A

RV dilation, reduced systolic function, TR, arrythmias, eventually right heart failure

91
Q

how is PR regurgitation usually determined by

A

jet width and duration

92
Q

where do you evaluate PR

A

PSAX AND PLAX

93
Q

mild pr

A

thing jet width

94
Q

moderate pr

A

less than 50% of pulmonic valve annulus

95
Q

severe PR

A

jet that fills the outflow tract and takes more than 50% of the pulmonic v annulus

96
Q

CW of PR

A

rapid deceleration w/ a pressure 1/2 time of less than 100 is suggestive of PR

97
Q

what do you mainly identify PHT

A

tricuspid regurgitation

98
Q

what else do you use for PHT

A

pulmonary regurgitation profile and pulmonary accelaration time

99
Q

pulmonary artery diastolic pressure =

A

4(end PR velocity)^2+RA pressure

100
Q

PA mean pressure =

A

4(inital PR velocity)^2 + RA pressure

101
Q

in pulmonary htn equations what does PR represent

A

pulmonic regurgitant velocity

102
Q

what might be seen in cases of PHT

A

enhanced pulmonary ejection, short pulmonic acceleration time, and systolic notching of the doppler trace

103
Q

What predicts pulmonary htn

A

pulmonary acceleration time of less than 90ms

104
Q

how is pa pressure affected

A

age (1mm per decade), BMI (3mm w/ bmi greater than ) bp, pulse pressure, LV filling pressure

105
Q

what happens with chronic RV pressure overload

A

ventricular septal deviation toward the left

106
Q

what accounts for most of PHT

A

left heart disease

107
Q

list the groups of PHT

A

pulmonary arterial hypertension, PHT due to left heart disease, PHT due to lung disease , chronic pulmonary thromboembolic disease, pht with mulifactorial cause

108
Q

what is the mitral annulus

A

fibromuscular ring between the LA and LV that anchors the leaflets

109
Q

what wall does the mitral annulus share a wall

A

anteromedial iwth teh aortic annulus at attachment of the NCC and LCC

110
Q

which mitral valve leaflet is bigger

A

anterior, it is also attached the the anterior mitral annulus

111
Q

what is the chordae tendinea

A

thing fibrous made of collagen and elastin. go from pap muscle to mitral leaflet

112
Q

what does the chordae tendinea do

A

anchor the mitral valve leaflets during systole

113
Q

papillary muscle

A

attach the chordae to the L. divided into posteromedial and anterolateral

114
Q

primary MR aka

A

organic mitral valve disease

115
Q

primary mr is from

A

degenerative mitral valve disease, like mvp and calcification and thickening of the leaflets

116
Q

MVP

A

mitral valve prolapse, most common type of primary MR

117
Q

what is mitral valve prolapse

A

displacement of the mitral leaflets during systole of at least 2mm

118
Q

what can cause mitral valve prolapse

A

fibroelastic deficiency or barlow disease

119
Q

what are congenital mitral valve regurg causes

A

parachute,cleft,double orifice

120
Q

secondary MR aka

A

functional MR

121
Q

what is secondary MR from

A

ischemic or myopathic process , more common than primary MR

122
Q

whats associated with secondary MR

A

dilation or distortion of the myocardium

123
Q

ischemic MR is from

A

CAD or myocardial ischemia

124
Q

ischemic MR is more common in cases of

A

inferior myocardial infarction

125
Q

what are the three components of color doppler of MR

A

prox flow convergence/ proximal isovelocity surface area, vena contracta, distal jet

126
Q

peak e wave of more than 1.5

A

severe MR

127
Q

Acute MR

A

LA cannot remodel, pulmonary edema, elevated rt pressures, decreased cardiac output

128
Q

Chronic MR

A

LV remodels, hyperdynamic lv function due to lv dilation,

129
Q

in chronic MR when the LV cannot compensate

A

hear failure begins, decreased EF and end systolic volume

130
Q

Main cause of mitral stenosis

A

rheumatic heart disease

131
Q

planimetry to evaluate MS

A

Done in PSAX in mid diastole

132
Q

pressure half time in MS

A

slope of the E wave

133
Q

continuity equation in MS

A

ratio between the stroke volume in the outflow tract and the VT of the mitral valve

134
Q

mean/max gradient

A

bernoulli equation

135
Q

when is leaflet thickening considered significant

A

5mm or more

136
Q

moderate ms

A

1.0-1.5

137
Q

severe ms

A

smaller than 1

Midterm Elizabeth (1 decks)

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