Slide set 3

Question 1

Lack of sympathetic tone or heart failure would do what to a CO curve?

Answer 1

Right shift and decreased plateau

Question 2

Increase in sympathetic stimulation or increased pumping effectiveness will cause what in a CO curve?

Answer 2

Left shift and increased plateau

Question 3

An increase in SVR also causes an increase in

Answer 3

RVR

Question 4

SVR is also

Answer 4

Afterload

Question 5

An increased preload will show what variables on the PV loop

Answer 5

Increased SV and EDV; ESV stays the same

Question 6

A decreased preload will show what variables on the PV loop

Answer 6

Decreased SV and EDV; ESV stays the same

Question 7

Increased afterload will show what variables on the PV loop

Answer 7

Decreased ejection time and SV; increased time spent in phase II; increased ESV; EDV remains the same

Question 8

Decrease afterload will show what variables on the PV loop

Answer 8

More time spent in ejection; Increased SV and reduced ESV

Question 9

Contractility is denoted by what on the PV loop

Answer 9

Upper left hand corner

Question 10

Increased contractility will show what on the PV loop

Answer 10

Steeper slope with leftward loop shift; increased SV and decreased ESV

Question 11

Decreased contractility will show what on the PV loop

Answer 11

Reduced slope; reduced SV and increased ESV

Question 12

What is happening during mitral regurgitation

Answer 12

Any time the pressure is higher in the ventricle than the left atria, blood is backflowing

Question 13

Why is EF not a good diagnostic for MR

Answer 13

SV is increased

Question 14

A temporary enhanced filling will eventually cause ______ in MR

Answer 14

eccentric hypertrophy over time

Question 15

Mild MR

Answer 15

<30 mL backflow

Question 16

Moderate MR

Answer 16

30-60 mL regurg flow

Question 17

Severe MR

Answer 17

> 60 mL regurg flow

Question 18

IABP inflates during

Answer 18

Diastole to help push blood down the atria and perfuse the CAs

Question 19

IABP deflates during

Answer 19

Systole to create an artificially low afterload

Question 20

What medications might we give to someone with MR and what considerations should we have

Answer 20

Afterload reducers; caution in patients with CAD and they may have trouble perfusing the CAs

Question 21

We want to decrease the ________ to reduce regurgitant flow in MR

Answer 21

Delta P

Question 22

Time spent in ______ can increase mitral regurgitant flow. To combat this we would allow

Answer 22

Systole; permissive slight tacycardia

Question 23

Mitral regurgitation will show what on a PV loop

Answer 23

Increased SV and EDV; decreased ESV; longer ejection time

Question 24

Mitral stenosis will show what on a PV loop

Answer 24

Lower SV, EDV, and ESV; left shift - similar to decreased preload

Question 25

The body compensates for mitral stenosis by

Answer 25

Increasing filing pressures and CVP

Question 26

Increasing filling pressures of the right heart for MS can cause

Answer 26

Increase in pulmonary pressures, prolonged P wave and a right axis deviation

Question 27

Mitral stenosis does not have a big effect on

Answer 27

the left ventricle

Question 28

We want to avoid what intraoperatively with mitral stenosis? Why?

Answer 28

Tachycardia; need as much time in diastole as possible

Question 29

MS was attributed to rheumatic fever years ago - what might cause it now?

Answer 29

A bad strep infection

Question 30

Why do we want to avoid a fib in patients with MS

Answer 30

Loss of atrial kick to help filling

Question 31

What happens during aortic regurgitation

Answer 31

Blood backflows in LV anytime the pressure is higher in the aorta

Question 32

Compensation for aortic regurg

Answer 32

Fill the heart with more blood

Question 33

What compensation for aortic regurg may make the backflow even worse

Answer 33

Constricting of vessels to maintain ABP; increased SVR and afterload will further increase delta P

Question 34

What will you see on a PV loop in AR

Answer 34

Increased SV, EDV, and ESV

Question 35

What kind of hypertrophy would you find in someone with AR

Answer 35

Eccentric

Question 36

What medications would we consider in someone with AR

Answer 36

afterload reducers

Question 37

Pulse pressure is _____ in aortic stenosis

Answer 37

Reduced

Question 38

What is happening during aortic stenosis

Answer 38

the heart is having to pump against a non compliant valve

Question 39

Compensation for AS

Answer 39

Increase in filling pressures or an increase in HR

Question 40

What would see on a PV loop for aortic stenosis

Answer 40

Decreased SV; increased preload and ejection pressures; increased EDV and ESV

Question 41

Concentric hypertrophy is

Answer 41

Thickening of the heart wall via addition of parallel sarcomeres

Question 42

Why is preload increased in AS

Answer 42

Thicker heart wall is less compliant to filling

Question 43

Tachycardia is bad for someone with AS because

Answer 43

Less time spent in diastole; therefore less time perfusing CA

Question 44

Why is aortic stenosis resistant to CPR

Answer 44

The sequence has been taken out of the contraction; pushing on everything at once

Question 45

In someone with bad CO and contractility how might we help them out?

Answer 45

Afterload reducer

Question 46

During early inspiration, what occurs

Answer 46

R heart CO increases 2 fold, L heart CO decreases, PAP decreases due to pulm vessels being pulled open, MAP decreases

Question 47

PPV affects thoracic pressure and hemodynamics by

Answer 47

Increasing thoracic pressure causing a temporary increase in R and L CO, MAP, and PAP; over time, this decreases VR

Question 48

Coronary blood flow is equivalent to

Answer 48

70mL/min/100 grams of heart muscle

Question 49

Normal coronary blood flow rate

Answer 49

225 mL/min

Question 50

Delta P of aortic pressure and ventricular wall pressure tells us

Answer 50

Coronary blood flow

Question 51

Temporary retrograde flow of the LCA is caused by

Answer 51

the beginning of systole

Question 52

X descent

Answer 52

occurs after A wave; drop in pressure during atrial relaxation of mid systole

Question 53

Y descent

Answer 53

occurs after V wave; drop in pressure d/t ventricular filling at the start of diastole

Question 54

H plateau

Answer 54

Immediately before A wave; occurs during the middle third of diastole

Question 55

Overdampening of an A line may be due to

Answer 55

Occlusion or partial occlusion

Question 56

Underdampening of an A line may be due to

Answer 56

Artifact

Question 57

When we place a spinal block we are at risk for causing

Answer 57

sympathetic block and knocking out the nerves that pace the heart

Question 58

The "shortcut" from an AV fistula will cause a decrease in

Answer 58

RVR

Question 59

At what percentage of blood loss is our CO affected

Answer 59

15%

Question 60

At what percent of blood loss is our ABP affected

Answer 60

20%

Question 61

At percent of blood loss would cause fatality if the SNS was knocked out

Answer 61

10-15%