Cardiac Left Ventricular Pressure-volume loops Flashcards Preview

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Flashcards in Cardiac Left Ventricular Pressure-volume loops Deck (94):
1

Label 

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  1. Aotic valve closes 
  2. Isovolumetric relaxation
  3. Mitral Valve opens
  4. Diastolic filling
  5. Mitral Valve closes 
  6. Isovolumetric contraction
  7. Aortic valve opens
  8. Ejection
  9. Stroke volume

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2

Where is ESV

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line from D-A

Isovolumetric reaxation line

3

Where is contractility measured at

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Point D

4

Where is Afterload measured at

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point C 

5

Where is EDV line 

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Line B-C

Isovolumetric contraction line

or Point B more specific

6

Where is peak systolic BP measured

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Very top point of curve on line C-D

7

Where Does Diastole begin/ systole end

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Point D

8

Where Does diastole end/ systole begin

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point B

9

Where is S1

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point B

Mitral Valve closure

10

Where is S2 heart sound

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Point D

Aortic valve closure

11

If the Loop gets taller what does that indicate

increased pressure

12

If the loop gets wider what does that mean 

Increased volume

13

where do the mitral and aortic valves open and close

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14

when does systole begin and end

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Begins at B

ends at D

15

When does diastole begin and end

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Begins at D 

ends at B

16

When does diastolic filling occur?

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Between A and B

 

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17

Where does ejection occur?

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Between C and D

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18

Acute Changes in PRELOAD:

With INCREASED PRELOAD What happens to

EDV and ESV 

SV? BP? HR? 

 

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

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19

Acute Changes in PRELOAD:

With DECREASED PRELOAD What happens to 

EDV and ESV 

SV? BP? HR? 

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

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20

Acute Changes in PRELOAD:

with increased Preload what does the Loop look like?

 

wider and taller

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21

Acute Changes in PRELOAD:

With decreasd Preload what does the loop look like?

Narrower and shorter

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22

Acute Changes in PRELOAD:

When preload increases what happend to EDV?

 

Increases

23

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

24

Acute Changes in PRELOAD:

When EDV decreases what happens to preload?

Decreases

25

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

26

Acute Changes in Afterload​:

With increased Afterload what happens to:

EDV and ESV

SV? BP? HR?

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

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27

Acute Changes in Afterload​:

With Decreased Afterload what happens to

EDV and ESV

SV? BP? HR?

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

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28

Acute Changes in Afterload​:

with increased afterload there is a shift where?

to the right

29

Acute Changes in Afterload​:

with decreaased afterload there is a shift where?

to the left

30

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

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31

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

32

Acute Changes in Afterload​:

what drug can decrease afterload?

Nitroprusside

33

Acute Changes in Afterload​:

What drug can increase afterload?

Phenylephrine

34

Acute Changes in PRELOAD:

what can increase preload

fluids

35

Acute Changes in PREload​:

What drugs decrease preload?

Nitro

Lasix

36

Acute Changes in Afterload​:

when afterload increased, does the heart empty more or less completely?

Less completely

37

Acute Changes in Afterload​:

When afterload increases, the heart empties less completely and what happens to SV

Decreases

38

Acute Changes in Afterload​:

when afterload increases SV decreases, what happens to EDV and ESV?

Both increase 

39

Acute Changes in Afterload​:

When afterload decreases, the heart empties more or less completely?

more completely

40

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 

41

Altered Contractilty:

with increased contractility what happens to EDV and ESV?

SV? BP? HR

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

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42

Altered Contractilty:

with decreased contractility what happens to EDV and ESV?

SV? BP? HR?

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

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43

Altered Contractilty:

what does the loop look with increased contractility and why?

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

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44

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

 

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45

Altered Contractilty:

When contractility increases what happens to ventricular emtying?

Increases ( the ventricles empty more completely)

46

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

47

Altered Contractilty:

when cntractility decreases what happens to ventricular emptying?

it empties less completely

48

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

49

Altered Contractilty:

what drugs can increase contractility?

DIgitalis

PDEIII inhibitor

50

Altered Contractilty:

what can cause a decrease in contractility

CHF

51

Summary of difficult concepts:

when preload increases or decreases what happens to EDV and ESV?

EDV increases or decreases repectively

ESV does not change

52

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

53

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

54

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

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55

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

 

56

see the chart again in relation to the last slide

 

 

 

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57

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

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58

Valve Problems:

Chronic AS

what is the problem with AS? (pressure or volume)

 

 

Pressure

Increased afterload

59

Valve Problems:

what would the loop look like for Chronic AS

it shift upward

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60

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

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61

Valve Problems:

What is the problem with chronic MS

Volume

Decreases Preload

62

Valve Problems:

what would the loop look like with chronic MS

shorter with left shift

Less preload less EDV less pressure 

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63

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)

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64

Valve Problems: AR

with AR, the volume in the LV increases when?

During early Diastole

65

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)

66

Valve Problems: AR

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

Small (makes a small A)

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67

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

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68

Valve Problems: AR

See the little A with Acute AR

 

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69

Valve Problems: AR

See the Large A with chronic AR

 

 

 

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70

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

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71

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

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72

Test: Name the loop

 

 

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Acute MR

 

73

Test: Name the loop

 

 

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Chronic Aortic Stenosis

74

Test: Name the loop

nitro/ nipride/ Dig/ VAA​/ Pheny

 

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Nitroprusside administration

 

75

Test: Name the loop

nitro/ nipride/ Dig/ VAA​/ Pheny

 

 

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Nitroglycerine administration

 

76

Test: Name the loop

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IHSS

77

Test: Name the loop

nitro/ nipride/ Dig/ VAA/ Pheny

 

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Administration on Phenylephrine

 

78

Test: Name the loop

 

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Chronic Aortic Regurgitation

79

Test: Name the loop

Adminstation of what drug:

nitro/ nipride/ Dig/ VAA/ Pheny

 

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Administration of Digatalis

 

80

Test: name that loop

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CHF

or VAA

81

what refles controls the BP

barorecptor reflex

82

Where are the baroreceptors located Arterial?

Carotid sinus and aortic arch

83

Baroreceptor reflex:

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

Vagus Nerve

84

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)

 

85

Baroreceptor reflex:

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

Carotid baroreceptors

86

Baroreceptor reflex:

what are the efferent pathways?

Vagus nerve to SA node

Sympathetic nerves- to the ventricles of the heart and systemic vasculature

87

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

88

Baroreceptor reflex:

What happens inreponse to Low blood pressure?

The fucking oppisite

89

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

the area under the curve divided by the time 

area / time

90

name 2 phosphodiesterase inhibitors.

Milrinone (primacor)

Inamrinone (Inocor)

 

91

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

positive inotropes

92

how do PDEIs work

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

93

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

Adinosine

94

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