Cardiac Left Ventricular Pressure-volume loops Flashcards by Josh Newby

Label

Aotic valve closes
Isovolumetric relaxation
Mitral Valve opens
Diastolic filling
Mitral Valve closes
Isovolumetric contraction
Aortic valve opens
Ejection
Stroke volume

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Where is ESV

line from D-A

Isovolumetric reaxation line

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Where is contractility measured at

Point D

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Where is Afterload measured at

point C

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Where is EDV line

Line B-C

Isovolumetric contraction line

or Point B more specific

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Where is peak systolic BP measured

Very top point of curve on line C-D

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Where Does Diastole begin/ systole end

Point D

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Where Does diastole end/ systole begin

point B

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Where is S1

point B

Mitral Valve closure

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Where is S2 heart sound

Point D

Aortic valve closure

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If the Loop gets taller what does that indicate

increased pressure

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If the loop gets wider what does that mean

Increased volume

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where do the mitral and aortic valves open and close

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when does systole begin and end

Begins at B

ends at D

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When does diastole begin and end

Begins at D

ends at B

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When does diastolic filling occur?

Between A and B

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Where does ejection occur?

Between C and D

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Acute Changes in PRELOAD:

With INCREASED PRELOAD What happens to

EDV and ESV

SV? BP? HR?

Increased EDV no change in ESV
SV- Increased
BP- Increased
HR decreased

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Acute Changes in PRELOAD:

With DECREASED PRELOAD What happens to

EDV and ESV

SV? BP? HR?

EDV decreased no change to ESV
SV- Decreased
BP- Decreased
HR- increased

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Acute Changes in PRELOAD:

with increased Preload what does the Loop look like?

wider and taller

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Acute Changes in PRELOAD:

With decreasd Preload what does the loop look like?

Narrower and shorter

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Acute Changes in PRELOAD:

When preload increases what happend to EDV?

Increases

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Acute Changes in PRELOAD:

when EDV increases, preload increases, the LV empties the previous EDV, consequestly, w/ greater filling but emptying back to the previous level, what happens to SV

Increases

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Acute Changes in PRELOAD:

When EDV decreases what happens to preload?

Decreases

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Acute Changes in PRELOAD: When EDV decrease, preload decreases, the LV empties the previous ESV. Consequently, with decreased filling but emptying back to the previous level, what happens to SV

Decreases

Acute Changes in Afterload: With increased Afterload what happens to: EDV and ESV SV? BP? HR?

* EDV and ESV increase * SV - decreased * BP- increased * HR- Decreased

Acute Changes in Afterload: With Decreased Afterload what happens to EDV and ESV SV? BP? HR?

* EDV amd ESV decreases * SV- increased * BP- Decreased * HR- Increased

Acute Changes in Afterload: with increased afterload there is a shift where?

to the right

Acute Changes in Afterload: with decreaased afterload there is a shift where?

to the left

Acute Changes in Afterload: with Increased afterload what will the loop look like and why?

taller- increased BP Skinny- decreased SV shift to right- Increased EDV and ESV

Acute Changes in Afterload: With decreased afterload what will the loop look like and why?

* Shorter- decreased BP * Wider- Increased SV * Left shift- Decreased EDV and ESV

Acute Changes in Afterload: what drug can decrease afterload?

Nitroprusside

Acute Changes in Afterload: What drug can increase afterload?

Phenylephrine

Acute Changes in PRELOAD: what can increase preload

fluids

Acute Changes in PREload: What drugs decrease preload?

Nitro Lasix

Acute Changes in Afterload: when afterload increased, does the heart empty more or less completely?

Less completely

Acute Changes in Afterload: When afterload increases, the heart empties less completely and what happens to SV

Decreases

Acute Changes in Afterload: when afterload increases SV decreases, what happens to EDV and ESV?

Both increase

Acute Changes in Afterload: When afterload decreases, the heart empties more or less completely?

more completely

Acute Changes in Afterload: When afterload decreases the heart empties more completelty and SV increases, what happens to EDV and ESV when afterload decreases

both decrease

Altered Contractilty: with increased contractility what happens to EDV and ESV? SV? BP? HR

* EDV and ESV decrease * SV- increased * BP- increased * HR- decreased

Altered Contractilty: with decreased contractility what happens to EDV and ESV? SV? BP? HR?

* EDV and ESV increase * SV- decrease * BP- decreased * HR- increased

Altered Contractilty: what does the loop look with increased contractility and why?

* Left shift- decreased ESV and EDV * Wider- Increased SV * Taller Increased BP

Altered Contractilty: what does the loop look like and why with decreased contractility?

* Right shift- increased EDV and ESV volume * Skinnier- decreased SV * Shorter- Decreased BP

Altered Contractilty: When contractility increases what happens to ventricular emtying?

Increases ( the ventricles empty more completely)

Altered Contractilty: when contractilty INCREASES the ventricles empty more completely, EDV decreases but not as much as ESV thus what happens to SV

SV- increases

Altered Contractilty: when cntractility decreases what happens to ventricular emptying?

it empties less completely

Altered Contractilty: When contractility decreases, the ventricles empty less completely, EDV increases just not as much as ESV so what happens to SV

SV decreases

Altered Contractilty: what drugs can increase contractility?

DIgitalis PDEIII inhibitor

Altered Contractilty: what can cause a decrease in contractility

CHF

Summary of difficult concepts: when preload increases or decreases what happens to EDV and ESV?

EDV increases or decreases repectively ESV does not change

Summary of difficult concepts: When SV falls either as a result of an increase in afterload or decrease in contractility what happens to EDV

Increases (you can't pump the blood forward so it stays behind

Summary of difficult concepts: When SV increases either as a result of decrease in afterload or increase in contractility what happens to EDV?

it decreases The blood is being pumped forward

# Fill this out memorize it and write it down when u take the boards

with pressure loop hemodynamics answer the following based off the last chart 1. What happens to PCWP in relation to EDV 2. what happens to LV chamber size in relation to ESV 3. What happens to SVR in relation to SV 4. What happens to HR in relation to MAP

1. As one increases the other increases and vise versa 2. As one increases the other increases and vise versa 3. If SV increases SVR has to decrease and Vise versa 4. If MAP increases HR decreases (reflex) and vse versa

see the chart again in relation to the last slide

Valve Problems: Idiopathic Hypertrophc Subaortic stenosis is unique. what does the pressure loop look like? Only IHSS can cause a pressure loop like this!

Smaller volumes and larger pressures empty heart

Valve Problems: Chronic AS what is the problem with AS? (pressure or volume)

Pressure Increased afterload

Valve Problems: what would the loop look like for Chronic AS

it shift upward

Valve Problems: with Chronic AS concentric hypertrophy permits the LV to generate HIGHER pressure, what happens to the Volume in the LV?

The volume remains about the same thus the pressure loop shifts upward

Valve Problems: What is the problem with chronic MS

Volume Decreases Preload

Valve Problems: what would the loop look like with chronic MS

shorter with left shift Less preload less EDV less pressure

Valve Problems: With chronic MS LV filling is diminished, the shift in the P-V to the left reflect what?

Decreased preload (reduced filling, but emptying is about the same)

Valve Problems: AR with AR, the volume in the LV increases when?

During early Diastole

Valve Problems: AR with AR the volume in the LV increases during early diastole, where on the P-V loop should u look and what should you see?

On the isovolumetric Relaxation line D-A should see increase in volume (right slant)

Valve Problems: AR In ACUTE AR is the P-V loop large or small?

Small (makes a small A)

Valve Problems: AR with CHRONIC AR the left ventricular chamber dilates and what happens to the P-V loop does it get large or small? and why?

Large b/c SV is large

Valve Problems: AR See the little A with Acute AR

Valve Problems: AR See the Large A with chronic AR

Valve Problems: MR What does the Loop look like with MR ACUTE?

the isovolumetric contraction phase loses volume prior to contraction. ESV and EDV are increased

Valve Problems: MR What does the loop look like for MR Chronic?

Again the Isovolumetric line B-C loses volume aka the line is slanted D/t th LV hypertrophying the SV is increased and although the EDV increases the ESV decreases

Test: Name the loop

Acute MR

Test: Name the loop

Chronic Aortic Stenosis

Test: Name the loop nitro/ nipride/ Dig/ VAA/ Pheny

Nitroprusside administration

Test: Name the loop nitro/ nipride/ Dig/ VAA/ Pheny

Nitroglycerine administration

Test: Name the loop

IHSS

Test: Name the loop nitro/ nipride/ Dig/ VAA/ Pheny

Administration on Phenylephrine

Test: Name the loop

Chronic Aortic Regurgitation

Test: Name the loop Adminstation of what drug: nitro/ nipride/ Dig/ VAA/ Pheny

Administration of Digatalis

Test: name that loop

CHF or VAA

what refles controls the BP

barorecptor reflex

Where are the baroreceptors located Arterial?

Carotid sinus and aortic arch

Baroreceptor reflex: Afferent action potentials from the barorecptors of the AORTIC ARCH are carried to the brainstem via what nerve?

Vagus Nerve

Baroreceptor reflex: AFFERENT action potentials from the barorecptors of the CAROTID SINUS are carried to the brainstem centers via what nerve?

Hering's nerve (a branch of the glossopharyngeal)

Baroreceptor reflex: which barorecptors are physiologically more important and are primarially responsible for minimizing acute blood pressure alterations?

Carotid baroreceptors

Baroreceptor reflex: what are the efferent pathways?

Vagus nerve to SA node Sympathetic nerves- to the ventricles of the heart and systemic vasculature

**Baroreceptor reflex:** Explain the whole thing r/t to INCREASED BP

* Increased Arterial BP * INCREASED stretch of baroreceptors in carotid sinus and aortic arch * INCREASED action potential in AFFERENTS of VAGUS nerve (arotic arch) and HERING's NERVE (carotid sinus) to the CV centers in th medulla of brainstem * Increased action potentials in VAGUS nerve (EFFERENT)=\> decreased HR and Decreased CO * DECREASED action potentials to SYMPATHETIC Nerves to: 1) HEART (decreased contractility, decreased SV, decreased CO) 2) Venous blood vessels (venodilation, decreased venous return, decreased CO) 3) Arterial blood vessels (Decreased SVR) * Decreased Arterial BP

Baroreceptor reflex: What happens inreponse to Low blood pressure?

The fucking oppisite

How do u get the MAP using a arterial pressure curve?

the area under the curve divided by the time area / time

name 2 phosphodiesterase inhibitors.

Milrinone (primacor) Inamrinone (Inocor)

what are PDEI's classified as (what's their drug class)

positive inotropes

how do PDEIs work

inhibit phosphodiesterase thus blocking the breakdown of cAMP- this cause increased cAMP and increased myocardial contractility and decreases SVR

what is an endogenous nucleotide occuring in all cells of the body

Adinosine

Adensodine can be administered and should be administered for what 3 reasons?

1. Slow conduction through AV node 2. interrupt reentry pathways through the AV node 3. Restore NSR in pts with SVT

Cardiac Left Ventricular Pressure-volume loops Flashcards

(94 cards)