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STEP 1 > PVLs, Wegeners, S2 Splits > Flashcards

PVLs, Wegeners, S2 Splits Flashcards

1
Q

Starting from Bottom Right of the Pressure volume loop and moving counter clock-wise lable the points

1.

2.

3.

4.

A
  1. EDV
  2. Aortic Valve opens
  3. ESV
  4. Mitral Valve opens
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2
Q

On the Pressure Volume Loop what do the top curve and bottom curve represent?

A

Top: Contractility

Bottom: Compliance

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3
Q

On the PV Loop

what does the value between

Point 4 and Point 1

represent?

A

Stroke Volume

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4
Q

On the PVL

what does the top of the curve between Point 2 and 3

represent?

A

Afterload

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5
Q

What causes

  • decreased afterload
  • decreased preload
  • unchanged SV
  • unchanged contractility
A

Sodium nitroprusside is a short-acting agent that causes balanced vasodilation of the veins and arteries to decrease both left ventricular (LV) preload and afterload.

The balanced vasodilation allows for maintenance of stroke volume and cardiac output at a lower LV pressure (lower cardiac work).

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6
Q

What causes

  • decreased afteterload
  • increased preload
  • Increased SV
  • unchanged contractility
A

An arteriovenous fistula, which can be congenitalor acquired (trauma), allows blood to shunt from the arterial circulation to the venous circulation without passing through the high resistance of the systemic arterioles.

This has the following effects on the LV

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7
Q

What causes

  • increased afterload
  • Unchanged preload
  • increased SV
  • Increased Contractility
A

positive inotrope with minimal vasodilatory/vasoconstrictive effect

(eg, digoxin).

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8
Q

What causes

  • increased afterload
  • unchanged preload
  • decreased SV
  • unchanged contractility
A

Aortic Stenosis

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9
Q

What causes

  • Increased Afterload
  • Increased Preload
  • Increased SV
  • Increased Contractility
A

Exercise

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10
Q

What causes

  • Increases afterload
  • Increased Preload
  • Increased SV
  • Unchanged Contractility
A

IV saline

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11
Q

What causes

  • decreased afterload
  • decreased preload
  • decreased SV
  • Unchanged Contractility
A

Venous Vasodilation

These changes are expected with predominantly venous dilators such as nitrates (eg, nitroglycerin, isosorbide mononitrate, isosorbide dinitrate).

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12
Q

What causes

  • Increased Afterload
  • Increased Preload
  • Decreased SV
  • Unchanged Contractility
A

Vasoconstrictor affecting both the veins and arteries but with no effect on the myocardium (aka contractility)

(eg, the alpha-1 agonist phenylephrine).

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13
Q

On the PV Loop and Starling curve, what causes an:

  • Increased (Upward shift) to contractility
  • Decreased (Downward shift) to contractility
A

Increased:

  • Myocardial changes with catelcholamines,
  • positive ionotropes (Digoxin)

Decreased:

  • Loss of functional myocardium (MI),
  • Beta Blokers,
  • Dilated cardiac myopahty,
  • non-DHPR Ca2+ blockers
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14
Q

What are 3 examples that can cause the changes in Ionotropy seen in #1 and 3 examples for changes in #2

A

1: Catecholamines, digoxin, exercise⊕
2: HF with reduced EF, narcotic overdose, sympathetic inhibition⊝

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15
Q

What are 2 examples that can cause changes in Venous Return/ Blood volume seen in #3 & #4

A

3: Fluid infusion, sympathetic activity⊕

4; Acute hemorrhage, spinal anesthesia⊝

Intersection of curves = operating point of heart (ie,venous return and CO are equal, as circulatory system is a closed system).

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16
Q

Name one example that can cause the changes of TPR in #5 and 2 examples for changes in #6

A

5: Vasopressors⊕
6: Exercise, AV-shunt⊝

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17
Q

At What point in the PV Loop is S1 and S2 heard?

A

Point 1: S1 (Mitral closes)

Point 3: S2 (Aortic Closes)

18
Q

What causes this curve?

A

Mitral Regurgitation

Normally, characteristic “V wave” created at the end of passive filling peaks at 10 mmHg.

In MR, an incompetent mitral valve allows backflow of blood from the left ventricle during ventricular systole, leading to markedly elevated left atrial pressure during this time =

early & large V wave peaking at 40 mmHg.

This leads to atrial dilation and often precipitates atrial fibrillation, symptomatically manifesting with palpitations.

19
Q

What causes this curve?

A

Aortic Regurgitation

20
Q

What causes this curve?

A

Mitral Stenosis

21
Q

What causes this curve?

A

Aortic Stenosis

22
Q

What causes this curve?

A

Aortic Stenosis

23
Q

What causes this curve?

A

Mitral regurgitation

24
Q

What causes this curve?

A

Aortic regurgitation

25
Q

What causes this curve?

A

Mitral Stenosis

26
Q

What is this S2 split called?

A

Physiologic split

Inspiration: Increased delay in P2

27
Q

What is this S2 split called?

A

Wide Splitting

28
Q

What is this S2 split called?

A

Fixed Splitting

29
Q

What is this S2 split called?

A

Paradoxical Split

30
Q

Seen in conditions that delay RV emptying (eg,pulmonicstenosis, rightbundlebranchblock).

Causes delayed pulmonic sound (especially on inspiration). An exaggeration of normal splitting.

What split?

A

Wide Splitting

Delayed P2 WIDENS the normally small split between (1st) A2 and (2nd) P2

EX)

Norm: A2 —P2

Wide: A2 ———P2

31
Q

Heard in ASD.

ASD left-to-right shunt RA and RV volumes flow through pulmonic valve delayed pulmonic valve closure (independent of respiration).

A

Fixed Splitting

32
Q

Heard in conditions that delay aortic valve closure

(eg,aortic stenosis, left bundle branch block).

Normal order of semilunar valveclosure is reversed so that P2 sound occurs before delayed A2 sound.

On inspiration, P2 closes later and moves closer to A2, thus eliminating the split.

On expiration, the split can be heard (opposite to physiologic splitting).

A

Paradoxical split

Norm: I) A2—P2

Norm: E) A2/P2 @ same time

Pdox: E) P2—A2

Pdox: I) A2/P2 @ same time

33
Q

What causes this curve?

A

Aortic Stenosis

34
Q

What causes this curve?

A

Aortic Stenosis

35
Q

What causes this curve?

A

Mitral Regurgitation

*on PV loop, Regurgitation increases SV

&

Stenosis decreases SV

36
Q

What causes this curve?

A

Mitral Regurgitation

37
Q

What causes this curve?

A

Aortic Regurgitation

38
Q

What causes this curve?

A

Aortic Regurgitation

39
Q

What causes this curve?

A

Mitral Stenosis

40
Q

What causes this curve?

A

Mitral Stenosis

41
Q

With Time (0-8s) on the X- axis

and

Pressure (0-120 mmHg) on the Y-axis

crudely sketch:

Aortic pressure

LV pressure

LA Pressure

Denote location of:

Systole & Diastole

A

see attachment

STEP 1 (88 decks)

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