SCAI CHAP 13 Hemodynamics Flashcards
Q1. What signals and initiates atrial contraction at the beginning of the cardiac cycle?
Q2. What pressure wave denotes atrial systole?
Q3. What pressure wave denotes atrial diastole?
Q4. Which wave signals depolarization of the ventricles?
Q5. What does the left ventricular end diastolic pressure (LVEDP) correspond to?
Q6. What happens about 15 to 30 ms after the QRS wave?
Q7. When does the aortic valve (AV) open?
Q8. What signals ventricular repolarization?
Q9. When does the aortic valve (AV) close?
Q10. When does the mitral valve (MV) open?
A1. The P wave.
A2. The “a” wave.
A3. The “x” descent.
A4. The QRS wave.
A5. The R wave intersection with LV pressure.
A6. Ventricles contract, and LV pressure rises rapidly.
A7. When LV pressure rises above aortic pressure.
A8. The T wave.
A9. When LV pressure falls below aortic pressure.
A10. When LV pressure falls below left atrial pressure.
Q1. The cardiac cycle begins with the ______ wave, which signals and initiates atrial contraction.
Q2. Atrial systole is denoted as the “______” wave.
Q3. Atrial diastole is denoted as the “______” descent.
Q4. The ______ wave signals depolarization of the ventricles.
Q5. The left ventricular end diastolic pressure (LVEDP) corresponds to the intersection of the ______ wave with LV pressure (point b in fig 1)
Q6. About 15 to 30 ms after the QRS, the ventricles contract and LV pressure increases rapidly during the ______ contraction period.
Q7. The aortic valve (AV) opens when LV pressure rises above ______ pressure.
Q8. Ventricular repolarization is signaled by the ______ wave.
Q9. The aortic valve closes when LV pressure falls below ______ pressure.
Q10. The mitral valve (MV) opens when LV pressure falls below ______ pressure.
Q11. “A/x” pressures, is followed by the ____ , signaling depolarization of the ventricles ( also point b in fig 1) .
Q12. Systolic ejection continues until _________ , signaled by the T wave (point d in fig 1).
Q13. Point e is when _______ closes, the LV pressure falls below the aortic pressures
Q14. Point f in fig 1, is when _____ opens and the LA empties into the LV.
A1. P
A2. a
A3. x
A4. QRS
A5. R
A6. isovolumetric ( point b to point c in fig 1 )
A7. aortic
A8. T
A9. aortic
A10. left atrial
A11. QRS
A12. repolarization
A13. Aortic valve
A14. Mitral valve
Q1. After the “a” wave, atrial pressure slowly ______ with atrial filling during systole.
Q2. Atrial pressure continues to increase until the end of ______.
Q3. At the end of systole, the pressure and volume of the left atrium (LA) are nearly ______.
Q4. The ventricular filling wave produced at the end of systole is called the “______” wave.
Q5. The “v” wave peak ( point 4 in fig 1) is followed by a rapid fall labeled the “______” descent.
Q6. The “Y” descent occurs when the ______ valve opens.
Q7. The peaks and troughs of the atrial pressure waves can be changed by ______ conditions.
Q8. Name one pathologic condition that can change atrial pressure waveforms.
Q9. Another pathologic condition affecting atrial pressure waves is ______.
Q10. Infarction is a pathologic condition that can alter the ______ pressure waveforms.
A1. rises
A2. systole
A3. maximal
A4. v ( The v wave is a peak in the atrial pressure curve that occurs during ventricular systole. It represents the increase in atrial pressure due to filling of the atrium while the mitral valve is closed. This wave reflects the accumulation of blood in the left atrium as it fills from the pulmonary veins before the mitral valve opens for ventricular filling.)
A5. Y
A6. mitral
A7. pathologic
A8. acute valvular regurgitation
A9. heart failure
A10. atrial
Q1. What happens to atrial pressure after the “a” wave?
Q2. Until when does atrial pressure continue to increase?
Q3. What is the state of the left atrium’s pressure and volume at the end of systole?
Q4. What is the name of the ventricular filling wave produced at the end of systole?
Q5. What follows the “v” wave peak?
Q6. When does the “Y” descent occur?
Q7. What can change the peaks and troughs of atrial pressure waves?
Q8. Name a pathologic condition that changes atrial pressure waves.
Q9. Name another pathologic condition affecting atrial pressure waves.
Q10. What kind of pressure waveforms can infarction alter?
A1. Atrial pressure slowly rises with atrial filling during systole.
A2. Until the end of systole.
A3. Nearly maximal.
A4. The “v” wave.
A5. A rapid fall labeled the “Y” descent ( The steepness and depth of the Y descent can provide information about right ventricular filling and compliance. A prominent or rapid Y descent may be seen in conditions like constrictive pericarditis or restrictive cardiomyopathy, where the ventricle fills quickly but then is limited by stiff walls.
A blunted or absent Y descent may indicate tricuspid stenosis or impaired right ventricular filling )
A6. When the mitral valve opens.
A7. Pathologic conditions.
A8. Acute valvular regurgitation.
A9. Heart failure.
A10. Atrial pressure waveforms.
Q1. RA pressure normally ______ with intrathoracic pressure during spontaneous inspiration.
Q2. In patients with congestive heart failure, RA pressure during inspiration may fail to ______.
Q3. RA pressure might even ______ during inspiration in certain conditions.
Q4. One condition causing impaired venous return to the right heart is ______ constriction.
Q5. The sign where RA pressure INCREASES during inspiration is called ______ sign.
Q6. This sign reflects impaired filling of the ______.
Q7. The sign also indicates elevated ______.
Q8. Rapid “Y” descents during inspiration are shown in ______.
Q9. During inspiration, there may be no change in mean ______ pressure.
Q10. Impaired venous return affects the ______ side of the heart.
A1. decreases
A2. decrease
A3. increase
A4. pericardial
A5. Kussmaul
A6. right ventricle (RV)
A7. pressures
A8. Fig. 13.4
A9. RA
A10. right
Q1. How does RA pressure normally change during spontaneous inspiration?
Q2. What happens to RA pressure during inspiration in patients with congestive heart failure?
Q3. What condition can impair venous return to the right side of the heart?
Q4. What happens to RA pressure during inspiration in pericardial constriction?
Q5. What is the name of the sign when RA pressure fails to decrease OR increases during inspiration?
Q6. What does the Kussmaul sign reflect?
Q7. What part of the heart has impaired filling in these conditions?
Q8. What happens to pressures in the right ventricle during impaired filling?
Q9. What does Fig. 13.4 show during inspiration?
Q10. Is there a change in mean RA pressure during inspiration in these patients?
Q11. a wave = ?, x = ? , V=? and y =?
A1. RA pressure normally decreases.
A2. RA pressure may fail to decrease or increase ( kussmaul )
A3. Pericardial constriction.
A4. RA pressure may fail to decrease OR increase ( mean RA pressure )
A5. Kussmaul sign.
A6. Impaired filling of the RV and elevated pressures.
A7. Right ventricle (RV).
A8. Pressures are elevated.
A9. Rapid “Y” descents during inspiration (The steepness and depth of the Y descent can provide information about right ventricular filling and compliance. A prominent or rapid Y descent may be seen in conditions like constrictive pericarditis or restrictive cardiomyopathy, where the ventricle fills quickly but then is limited by stiff walls.
A blunted or absent Y descent may indicate tricuspid stenosis or impaired right ventricular filling. )
A10. No change in mean RA pressure.
A11. [ a= atrial systole ], [ x = atrial diastole] , [ v= v wave is a peak in the atrial pressure curve that occurs during ventricular systole. It represents the increase in atrial pressure due to filling of the atrium while the mitral valve is closed. This wave reflects the accumulation of blood in the left atrium as it fills from the pulmonary veins before the mitral valve opens for ventricular filling ], [ y= rapid fall when mitral valve opens ].
Hints ( me ):
- a wave occurs shortly after p wave ( EKG ) and v wave occurs shortly after QRS.
- CHF/constrictive pericarditis : RA pressure fails to decrease with inspiration and mean RAP either fails to decrease or it will increase during inspiration ( kussmaul ). This occurs because of higher right chambers pressures and also suggested by a rapid y descent because of the rapid filling of the Right ventricle as RVP ( and RAP) is higher.
- poor complinace of a chamber = stiff chamber
- stiff atrium ( poor compliance ) leads to a larger v wave for example.
- i think if blood flowing TOWARDS a stiff chamber, the corresponding waveform is large e.g. large V wave when the LA is stiff or rapid and deep y descent because of a stiff noncompliant RV.
Q1. What determines pressure waves in the atria?
Q2. What might a poorly compliant atrial chamber demonstrate despite normal flow?
Q3. How does a very compliant atrial chamber respond in terms of pressure wave changes?
Q4. What condition is associated with a low-compliance left atrium?
Q5. What causes high left atrial pressure in the example given ( fig 13.5) ?
Q6. What does the “v” wave in the left atrial pressure waveform indicate in this example?
Q7. Is the large “v” wave due to mitral regurgitation in this example?
Q8. What arrhythmia is present in the example?
Q9. What wave is absent due to atrial fibrillation?
Q10. What notch is present preceding the large “v” wave in atrial fibrillation?
A1. The pressure/flow relationship or compliance of the atrial chamber.
A2. A large “v” wave.
A3. It may not register marked pressure wave changes despite torrential flow.
A4. Mitral stenosis (MS).
A5. Both mitral stenosis and a stiff left atrium after rheumatic inflammation.
A6. It indicates poor compliance of the atrium ( catheter sitting inside the LA showing large v waves due to poor LA compliance, while v wave of the RA pressure is normal )
A7. No, it is not due to regurgitation.
A8. Atrial fibrillation.
A9. The “a” waves.
A10. The “c” notch ( arrhythmia may distort pressure waveform )
Q1. How do normal RA “a” and “v” waves compare to those in the left atrium?
Q2. What happens to the RA waveforms in significant valve dysfunction?
Q3. What condition causes the RA wave to lose its characteristic “a” and “v” waves?
Q4. What wave replaces the “a” and “v” waves in tricuspid regurgitation?
Q5. What does the “s” wave represent in tricuspid regurgitation?
Q6. What symptom did the 67-year-old woman have in the example fig 13.6 ?
Q7. What physical exam finding did the woman have?
Q8. How does the murmur vary in the woman’s case?
Q9. What does Fig. 13.7A show in the patient with severe tricuspid regurgitation?
Q10. What imaging is shown in Fig. 13.7B?
A1. Normal RA “a” and “v” waves are smaller than those in the left atrium.
A2. RA waveforms become distorted.
A3. Tricuspid regurgitation.
A4. A large and broad “s” (systolic) wave.
A5. Blood reflux from the right ventricle back into the right atrium.
A6. Dyspnea at rest.
A7. Systolic murmur.
A8. The murmur varies with respiration.
A9. The corresponding pattern of right ventricular and right atrial pressures.
A10. Right ventricular angiogram.
