Hemodynamics #3 Flashcards Preview

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Flashcards in Hemodynamics #3 Deck (31)
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0
Q

Law of LaPlace

A

Tension is directly related to diameter, inversely related to the thickness of the container.

Increased tension: increased O2 demand
Decreased tension: decreased O2 demand

**primary determinant of O2 consumption, followed by contractility.

1
Q

Dilated Cardiomyopathy

A
  • Systolic failure: fails to clear or evacuate ventricles. No issues w/ diastolic filling.
  • Heart is stretched, muscle tissue thin, increased tension.
  • Law of LaPlace
  • secondary or volume overload (not pressure)
  • CHF, status post AMI
2
Q

Treatment for dilated cardiomyopathies

A

Cardiac glycosides*, inotropes (dopamine / dobutamine**) & diuretics

  • Digitalis
    • decrease in after load w/ vasodilation desired.
3
Q

Digitalis mechanism

A
  • poisons Na/K pump
  • heart retains Na
  • Antiporter channel forced to secrete Na out
  • as Na is forced out, Ca is introduced
  • Ca enhances work ability of cardiac cells
4
Q

Hypertrophic Cardiomyopathy

A
  • Diastolic Failure
  • muscle has become thick and large
  • muscle built on inside, not outside
  • decreased intraventricular space
  • great squeeze, limited diastolic filling.
  • preload becomes critical
  • secondary to pressure overload (HTN) not volume.
5
Q

Hypertrophic Cardiomyopathy Tx

A
  1. Fluid to increase preload
  2. Increase diastolic filling time
    - beta blockers (decrease HR=longer ventricular fill time.
    - Ca Channel blockers
    - Amiodarone (primarily blocks K)
6
Q

IHSS define and how to recognize

A

Idiopathic Hypertrophic Subaortic Stenosis

  • Hypertrophic Cardiomyopathy
  • Systolic murmur at level w aortic valve (2nd intercostal space, R border of manubrium)
7
Q

Restrictive Cardiomyopathy

A
  • Systolic failure
  • heart looks relatively normal
  • muscle thickened, fibrotic, stiff
  • hypodynamic heart, hypoplastic
  • Trasmural ischemic tissue fibrosis
  • no movement or ejection
8
Q

Restrictive Cardiomyopathy Treatment

A

Diuretics, anti-coagulation*, and cardiac glycosides**.

  • Fluid resuscitate with caution, as fluid cannot be cleared.
  • stagnant blood flow increases clot formation.
  • *supercharges muscle that is functioning
9
Q

Primary vs secondary hypertrophic disease

A

Primary: heart was first problem, desease characteristics are secondary to heart
-AMI, pulmonary edema

Secondary: heart disease is secondary to another problem
-HTN

10
Q

Multi valvular disease suggests what illness was suffered?

A

Rheumatic fever

  • Autoimmune disorder triggered by strep a
  • bulbous lesions develop on leaflet cusp edges
  • scarring and fusion develop
  • stenosis and regurgitation follow
11
Q

Where do you hear the aortic heart tone?

A

2nd intercostal space, just R of Sternum

12
Q

Where do you hear the pulmonic heart tone?

A

2nd intercostal space, just L of Sternum

13
Q

Where do you hear the tricuspid heart tone?

A

4th intercostal space, just L of sternum

14
Q

Where do you hear the mitral heart tone?

A

5th intercostal space, mid-clavicular line
Apex or heart
Point of maximal impulse

15
Q

Systolic murmur

A

Lub murmur dub… Lub murmur dub

16
Q

Diastolic murmur

A

Lubb dub murmur… Lubb dub murmur

17
Q

Aortic stenosis

A

Aortic valve won’t open
Aortic valve is open during systole
-systolic murmur

18
Q

Aortic regurgitation

A

Aortic valve incompetent

  • aortic valve closes during diastole to prevent blood from backing up into heart.
  • diastolic murmur
  • back pressure into the LV, LA, lungs… Pulmonary congestion, heart overloaded, stretching of heart muscles.
19
Q

Mitral stenosis

A

Mitral valve won’t open smoothly

  • mitral valve opens during diastole to allow the ventricles to fill
  • diastolic murmur
20
Q

Mitral regurgitation

A
  • mitral valve is incompetent and leaks
  • mitral valve closes during Systole to prevent blood from entering LA during LV contraction.
  • systolic murmur
  • blood will back in to the LA, lungs resulting in pulmonary congestion
21
Q

Pulmonary stenosis

A

Pulmonary valve won’t open smoothly

  • pulmonary valve is open during systole to allow blood into the lungs
  • systolic murmur
22
Q

VSD murmur

A

Ventriculoseptal defect

  • hole between R and L ventricles
  • L to R shunt
  • overloads the lungs
  • predominately systolic murmur
  • loud murmur equals small defect
  • silent murmur equals large defect
  • auscultated primarily over apex of heart
23
Q

RN/WT murmur

A
  • Auscultated over all valvular areas
  • biphasic murmur (lub murmur dub murmur)
  • predominantly found in south eastern Caucasian population
  • depressed socioeconomical status frequently living in mobile homes
24
Q

Type one aortic dissection

A

Ascending aorta and extending distally beyond Aortic Arch

  • worst type worse prognosis
  • involves whole aorta
  • can cause heart attacks. Bulging in aorta impedes aortic valve and vessels coming off the beginning of the aorta / coronary arteries
  • can cause back pressure cardiac overload and pulmonary congestion
25
Q

Type 2 aortic dissection

A

Limited to ascending aorta

  • jet erosions and Marfan’s syndrome
  • can proceed to coronary arteries =AMI
  • can proceed to carotid arteries = CVA
  • pain and hemodynamic change equals hypertension
26
Q

Type 3 aortic Dissection

A

Dissection distal to the origin of the left subclavian artery and extends distally to abdominal aorta.
-Best prognosis

27
Q

Aortic dissection diagnosis

A

Widened mediastinum on x-ray with diffuse infiltrates

28
Q

Aortic dissection treatment

A

Lower systolic blood pressure to 100 -110 mmHG with vasodilators.
-managed BP and HR at same time
-don’t want a sudden change in hemodynamics
-aggressive pain relief
(Pain=sympathetic nervous system= catecholamines. MS can complicate BP, fentanyl is appropriate)

29
Q

Vasodilators to be used with aortic dissection’s

A

Nipride (nitro press)

  • easily titrated
  • start minimal, titrate small incriments
  • q 2-5 min
  • immediate response

Beta blockers (slow HR & decrease ejection fraction)

  • esmolol burns off relatively quickly
  • metropolol longer lasting (caution)
30
Q

HTN treatment

A

Dial pressure to their normal within 30 to 60 minutes. Not immediately.

  • dropping pressure to fast risks CVA or AMI
  • chronic- diuretics & ace inhibitors