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EDIC Part (1) Course Notes > ICU > Flashcards

ICU Flashcards

1
Q

Right ventricle determines?

A

Flow

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2
Q

Left ventricle determines?

A

Pressure

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3
Q

Adaptive changes in chronic heart failure?

A
  • Fluid retention
  • Increased oxygen extraction
  • Renin-Angiotensin up-regulation
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4
Q

Etiology of heart failure?

A
  • Ischaemic cardiomyopathy (dilation)
  • Aortic stenosis (Hypertrophy & dilation)
  • Hypertension (Hypertrophy & dilation)
  • AF & arrhythmias
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5
Q

Treatment for chronic heart failure?

A
  • ACE inhibitors
  • Diuretics
  • Calcium channel blockers
  • Beta-blockers
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6
Q

Etiology of Acute heart failure?

A
  • ACS
  • Post-op cardiac surgery
  • Sepsis
  • COPD/ARDS
  • Chest trauma
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7
Q

Hypotension is ?

A

SBP < 90 mmHg or decrease in baseline > 30mmHg

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8
Q

Forresters classification of heart failure?

A
  • Class 1 = < 18 (PCWP) > 2.2 (CI) - Normal
  • Class 2 = > 18 (PCWP) > 2.2 (CI) - Pulmonary congestion
  • Class 3 = < 18 (PCWP) < 2.2 (CI) - Cardiac failure
  • Class 4 = > 18 (PCWP) < 2.2 (CI) - Cardiogenic shock
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9
Q

Mortality in forresters classification?

A
  • Class 1 < 3%
  • Class 2 9%
  • Class 3 23%
  • Class 4 51%
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10
Q

Pulmonary artery occlusion pressure AKA?

A

Pulmonary Capillary Wedge Pressure

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11
Q

Determinants of LV function?

A
  • Contractility
  • Preload (End-diastolic volume)
  • Afterload (Wall stress)
  • Heart rate
  • Synchrony
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12
Q

Starling’s law?

A

Describes preload

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13
Q

Anrep effect ?

A

Describes contractility

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14
Q

Factors increasing contractiity ?

A
  • Autonomic tone / Increase - Exercise, stress / Decrease - Diabetes
  • Catecholamines/ Decreased n chronic HF
  • Catecholamine receptors / Decrased in sepsis
  • Coronary blood flow / Increases contractility
  • Serum calcium / Decreased contractility with hypocalcaemia
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15
Q

Compliance of the heart?

A

Determined by the change in volume to pressure

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16
Q

Causes of decrease in LV compliance ?

A

Primary

  • Ischaemia
  • LV hypertrophy
  • Stunned myocardium

Secondary

  • RV dilation (Pulmonary HTN, Volume overload)
  • Hyperinflation
  • Tamponade
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17
Q

Laplace’s law? Determinant of afterload

A
  • Wall stress

- Tension = P x r

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18
Q

Afterload reduction ? Functions?

A
  • Decreases wall stress
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19
Q

Chronotropy?

A

Increasing HR with increased contractility

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20
Q

HR and LVH?

A

Increasing HR decreases contractility

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21
Q

Factors affecting preload? in LV impairment

A
  • Hypovolaemia

- Diastolic dysfunction

22
Q

Factors affecting contractility? in LV impairment

A
  • Ishcaemia

- Septic cardiomyopathy

23
Q

Factors affecting afterload? in LV impairment

A
  • Aortic stenosis

- Malignant HTN

24
Q

Factors affecting chronotropy? in LV impairment

A

Brady & tachyarrhythmias

25
Factors affecting dyssychrony? in LV impairment
Usually MI | BBB
26
Effect of MI on LV pressure-volume relationship?
- Depression of the curve with MI - Increase in diastolic compliance curve - Increased filling pressures - Pulmonary oedema - Requires dobutamine for contractility - Increased contractility willl improve filling pressures - Nitroprusside for decreasing afterload
27
Management of Acute HF?
- Maintain coronary blood flow - Norad , Dopamine & balloon pump - Augment contractility - Dobutamine (Acute), Chronic (Phosphodiesterase inhibitors - ) - Treat reversible causes - Ischaemia, Aortic stenosis - Reverse arrhythmias - Decrease LV afterload (Nitrates & CCBs) - Maintain preload - VAD - Ventricular assist devices
28
Function of intra-aortic balloon pump?
- Maintain coronary perfusion | - Decrease in afterload
29
Indications for mechanical assist devices? | Bi-ventricular assist device / LVAD
- Severe symptomatic HF - CI < 2, Ppao > 20 mmHg & inotrope dependent - LV dysfunction with persistent arrhythmias - Hepatic & renal failure
30
PAC wave form and pressures ?
XY - CV - A - Based on location RA - 1 - 5 mmHg RV - 15 - 30 mmHg (systolic) / 1 - 7mmHg (Diastolic) PA - 15 - 30mmHg (Systolic)/ 4 - 12 mmHg (Diastolic) / 9 - 19 mmHg (mPAP) PCWP - 4 - 12mmHg
31
Variables from PAC?
- Mixed venous oxygen saturations - MAP - RAP - PAP/mPAP - PCWP - CO
32
Thermodilution measurement with PAC?
- Injectate to porximal port
33
Measurement Cardiac index?/
CI = CO (L/min) / BSA Normal range - 2.5 - 4 L/min/m2
34
Calculation of stroke volume?
SV = CO / HR Normal range - 0.06 - 0.1 L/beat
35
Calculation of stroke volume index?
SVI = SV / BSA Normal range - 0.033 - 0.047
36
When calculating indexes?
The variable divided by BSA (m2)
37
Calculation of MAP?
MAP = 2 (DBP) + SBP / 3 Normal range - 70 - 110 mmHg
38
Calculation of SVR?
SVR (Dyne/sec/cm -5) = MAP - mRAP / CO x 80 Normal range - 800 - 1200 dyne/sec/cm-5
39
Calculation of SVRI?
SVRI (dyne/scec/cm-5 / m2) = MAP - mRAP / CI x 80 Normal range - 1970 - 2390 dyne-sec-cm-5/m2
40
Calculation of PVR?
PVR = mPAP - PCWP / CO x 80 Normal range - < 250 dyne-sec-cm-5
41
Calculation of PVRI?
PVRI = mPAP - PCWP / CI x80 Normal range - 255 - 285 dyne-sec-cm-5/m2
42
Calculation of DO2?
DO2 = CO [(Hb x SaO2 x 1.34) + (PaO2 x 0.0031)] Normal range - 500-600ml/min
43
Normal VO2?
200 - 250 ml/min
44
Oxygen extraction ratio?
25 - 30%
45
Gold standard for CO measurement?
Pulmonary artery thermodilution
46
Indications for PAC
- Cardiothoracic surgery - Pulmonary HTN - Shock & Right ventricular failure
47
Pulse wave analysis components?
- Contractility - SV - Aortic compliance - Afterload - Vascular tone
48
Phases of ARDS?
- Exudative (1-7 days) - Acute inflammatory response of alveolar epithelium & endothelial damage - Proliferative phase (1-3 weeks) - Proliferation of type II pneumocytes, fibroblasts & myofibroblasts leading to widening of alveolar septae - Fibrotic phase (> 3 weeks) - Remodelling and fibrosis
49
Dead-space and fibrosis?
Fibrosis increase dead-space
50
What is driving pressure?
Plateau preassure - PEEP

EDIC Part (1) Course Notes (8 decks)

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