Flashcards in Cardiology Deck (22)
What is the most important determinant of myocardial oxygen supply?
Heart rate: this is because slower HR equals more diastolic filling and better coronary perfusion.
What at the ECG changes seen with LVH? RVH?
1) LVH: Add the R wave in aVL and the S wave in V3 and if >28 in M and >20 in F then LVH
2) RVH: R wave in V1 > 7 small squares in amplitude
When is aortic aneurysm repair indicated?
If the AA is >5.5 cm or has >1cm growth in a year
How do you decrease the windsock effect during TAA repair?
1) hypotension with SBP less than 70-80
2) transient cardiac arrest with adenosine
3) Rapid ventricular pacing via wires to >180
What does the dicrotic notch represent on the A line tracing?
Closure of the aortic valve
What are 7 hemodynamic changes seen with aortic cross clamping?
1. Increased arterial BP above the clamp (same amount of blood in a smaller space), decreased aterial BP below the clamp
2) Increased Pulm. A wedge pressure
3) Increased catecholamine's leading to vasoconstriction and INCREASED CVP
4) Increased coronary a. blood flow
5) Increased LV wall stress
6) Decreased CO
7) Decreased RBF
What is the Fick equation? What does it tell us?
Sv02 = Sa02 - [VO2/(CO*Hgb*1.36)]
Sv02: mixed venous
SaO2: arterial oxygen
V02: total body o2 consumption
** normal SvO2 is 75%, meaning that the body extracts 25%
** SV02 increases when you cannot extract O2 from the body, such as in sepsis, methemoglobinemia, CO or cyanide poisoning
Describe the values seen in Cardiogenic shock
1. Decreased CI
2. Increased PCWP, CVP, and SVR
What are the normal pressure values of the heart?
1. CVP: 2-6
2. PCWP: 6-12
3. CI: 2.5-4
4. SVR: 800-1200
Describe the values seen in distributive shock
Low SVR, Increased CI, no changes to the PCWP or CVP
Describe the values seen in hypovolemic shock
Increased SVR, Decreased CVP, Decreased or normal PCWP, Decreased CI
What coronary artery supplies the AV node?
The PDA, and in R dominant patients this means that an MI involving the RCA could lead to AVB
What does TAPSE stand for? What is it a marker of?
Tricuspid annular plane systolic excursion <1.6 shows that there is RV reduced fxn
What is the difference between a BiVAD and a total artificial heart?
BiVADs are short term, whereas total artificial hearts can be left in long term and are good for bridging a patient in severe heart failure to transplant
What is considered low risk when stopping warfarin?
Bicuspid aortic valve prosthesis who are in NSR with no other risk factors
Define Pulsus paradoxis
A drop in systolic BP >10 mmHg seen in inspiration aka pulsus paradoxis
What electrolyte abnormality will increase the effect of digoxin?
What are the sxs of neurogenic DI? what is the first line treatment
1. hypotension 2. polyria
1st line tx is vasopressin
D1 agonist that vasodilates and reduces both preload and afterload. Useful when you need to perfuse the kidneys and help with hypertension
Recombinant BNP: causes diuresis, naturesis, and vasodilation
How is esmolol metabolized?
By red blood cell esterases