part one Flashcards
(137 cards)
1
Q
Where does deoxygenated blood go begin the cardiac cycle
A
into the right atrium
2
Q
what valve does blood go through to get from the right atrium to the right ventricle
A
the tricuspid valve
3
Q
Where does blood go from the right ventricle
A
through the pulmonic valve into the pulmonic artery
4
Q
the blood goes from the pulomonic artery to the
A
lungs to become oxygenated then back to the heart through the pulmonary veins
5
Q
where does the pulmonary veins drain
A
into the left atrium
6
Q
the blood moves from the left atrium through the
A
mitral valve into the left ventricle
7
Q
from the left ventricle the blood goes
A
through the aortic valve into the aorta to circulate
8
Q
describe systole
A
heart contraction. AO valve opens to allow blood to pass from the LV
9
Q
what marks the end of systole
A
ao valve closure
10
Q
when will ventricles be largest
A
at end diastole
11
Q
what happens during diastole
A
MV opens to allow blood to go from the LA to the LV
12
Q
what is end diastole used to calculate
A
stroke volume, preload, and EF
13
Q
what marks the end of diastole
A
MV closure
14
Q
What doe the X and Y axis represent on the Wiggers diagram
A
x= time y= pressures
15
Q
what pressures are seen on the wiggers diagram
A
aortic, LV, and LA
16
Q
what is ventricular preload
A
stretching of the cardiac muscle before contraction. greater the load = greater force of contraction
higher end diastolic volume= higher preload
17
Q
what can ventricular preload be increased by
A
ventricular systolic failure, AS, AR,PS, and PI
18
Q
ventricular preload can be decreased by
A
venous BP , AFIB, high HR, inflow stenosis (mitral and tricuspid), and ventricular diastolic failure
19
Q
what is afterload
A
the resistance that the ventricle has to pump against
20
Q
increase in afterload =
A
increase in end systolic volume and decrease in stroke volume
21
Q
what does afterload determine
A
the amount of tension the myocardium has to generate
22
Q
what increases afterload
A
htn,AS,PS, ventricular dilation, AO pressure, systemic vascular resistance
23
Q
What is phase one of the cardiac cycle
A
ventricular filling. pressure in the atria increases causing atrial systole= blood moves from the atria to the ventricles
24
Q
what valves are open and closed dureing phase one
A
MV and TV are open. AoV and PV are closed
25
what is phase 2 of the cardiac cycles
isovolumetric contraction, early systole, blood in the ventricles
26
what is the pressure like during phase 2
pressure of the ventricles is higher that that of the atria but less than the arteries on the other side of the AoV and PV
27
The first heart sound happens
during phase 2 when the atroventricular valves close (mv/tv)
28
Isovolumetric
all valves are closed and the volume of blood is constant
29
What is phase three of the cardiac cycle
ventricular ejection
30
what is phase three as far as systole/diasotle
ventricular systole
31
what is pressure like during the third phase
ventricular pressure increases until it exceeds the aorta or pulmonary trunk, then the semilunar valves open
32
what are the semilunar valves
pulmonary and aortic
33
when does ejection phase end
after the blood goes through the AoV and PV and into circulation. It officially ends when the AoV snaps shut
34
when is the second heart sound
when the AoV snaps shut
35
what is the end systolic volume
blood remaining in the LV after ejection
36
what is phase four of the cardiac cycle
isovolumetric relaxation
37
isovolumetric relaxation is the
beginning of diastole
38
what is the pressure like during phase four
semilunar valves are open so the pressure in the ventricles decreases as blood goes through them, causing the eventual close
39
isovolumetric relaxation can be used for
indicating diastolic dysfunction
40
Diastole in the cardiac cycle
w/ ventricular relaxation the pressure in the ventricles is less than the atria causes the atrioventricular valves to open starting the cycle over
41
what is the bernoulli equation for pressure estimation
P=4v2^2
p= pressure across the valve
v2=distal velocity
42
what is the continuity equation used for
calculate aortic valve area (effective orifice area)
43
General rule for the continuity equation
blood going into a chamber must be equal to the amount flowing out of the same chamber
44
continuity equation states that velocity of blood is inversely related to
the area
45
what is the continuity equation
a2=a1xv1/v2
or
a1xv1=a2xv2
46
What is the most common valvular disease in the US
aortic stenosis
47
about half of AS patients have
a bicuspid valve
48
What velocities to you need for an aortic valve area
prestenotic (in LV outflow just below the AoV)
in the stenotic valve
and lv outflow tract diameter
49
which velocity do you use for the AVA
The highest most accurate
50
Aortic valve ranges
normal = 3.0-4.0cm
mild >1.5cm
moderate 1.5-1.0cm
severe <1.0 m
51
LVOT assessment
v1- prestenotic velocity is calculated using PW lvot doppler measurements
52
Coarctation
narrowing of the thoracic aorta, seen in marfans patients
53
post stenotic dilatation may be seen
in AS patients
54
anuerysm measurment
>4cm
55
Risk factors for AO dissection
htn, aneurysm, post op, pregnancy, weightlifting, drugs
56
genetic risk factors for AO dissection
marfan's, turners, ether-danlos, AO coarctation, bicuspid AoV
57
How is AO dissection classified
Debakey 1 and 2 if the ascending AO is involved. If ascending isnt involved then Debakey 3
58
Ao regurgitation
diastolic reflux of blood from the ao into the LV
59
what can cause AO regurgitation
leaflet abnormalities, endocarditis, calcification, or changes in AO root or shape
60
What are the semiquantitive ways to anaylize AR
vena contracta width, proximal regurgitant jet width, absolute jet width
61
how do you measure vena contracta width
smallest flow diameter at the AO valve level, determine if the regurgitant orifice area is smaller than the regurgitant width in the LVOT
62
where do you measure vena contracta width
PLAX[
63
Proximal regurgitant jet width
ratio of jet to the LVOT diameter
less than 25% is mild
greater than 65% is severe
64
Absolute jet width
bigger than 10mm is severe
65
limitation of absolute jet width
eccentric jets going to the mv anterior leaflet or septum may look narrow and underestimate severity
66
Cross-sectional area
ratio to the lvot diameter (similar as prox regurgitant jet)
67
where do you do the cross sectional area
PSAX
68
what quantitive measurment do we use to measure AR
PISA, eroa
69
Mild AR PISA
eroa of less than 10mm^2 or AR regurgitant volume of less than 30
70
severe ar pisa
EROA of greaer than 30mm^2 or AR regurgitant volume of greater than 60
71
EROA equation
6.28xr^2X v aliasing/peak v AR
72
what does AR pulsed wave eval look like
diastolic flow reversal in descending thoracic or abdominal aorta
73
what is used to measure AR in continuous wave
deceleration time and pressure half time
74
what does deceleration time reflect
pressure difference between the ao and lv during diastole , done in apical 5
75
pressure half time
less than 200ms- severe
| greater than 500ms is mild
76
Chronic AR and LV function
slow LV dilation, LV adapts to overload, eventually will lead to increase in afterload and EF reduction
77
what happens in cases of acute AR
LV cant adapt, increase in diastolic flow= increase in end diastolic pressure= decreased forward cardiac output
78
what happens to pt with acute ar
tachycardia, cardiac shock, pulmonary edema
79
pulmonic stenosis may happen with
pulmonic regurgitation and tricuspid involvment
80
Mild pulmonic stenosis
>50mmhg
81
moderate pulmonic stenosis
30-50mmhg
82
severe pulmonic stenosis
less than 30mmhg
83
what is associated with noonan's syndrome
congenital dysplastic pulmonic valve
84
what do you need to look at in cases of pulmonic stenosis
right ventricular size, function, and pressure
85
what might be dilated in cases of pulmonic stenosis
PA, RVOT may be narrowed
86
What may be seen on mmode of pulmonic stenosis
increase in the pulmonic A dip of more than 7mm
87
when do you use the bernoulli equation in cases of PS
if the proximal velocity is more than 1M/S to calculate the max instantaneous gradient
88
is pulmonic valve area used in PS?
no
89
what is severe pulmonic regurgitaiton usually from in adults
prior heart disease interventions
90
what is seen in patients with long term PR
RV dilation, reduced systolic function, TR, arrythmias, eventually right heart failure
91
how is PR regurgitation usually determined by
jet width and duration
92
where do you evaluate PR
PSAX AND PLAX
93
mild pr
thing jet width
94
moderate pr
less than 50% of pulmonic valve annulus
95
severe PR
jet that fills the outflow tract and takes more than 50% of the pulmonic v annulus
96
CW of PR
rapid deceleration w/ a pressure 1/2 time of less than 100 is suggestive of PR
97
what do you mainly identify PHT
tricuspid regurgitation
98
what else do you use for PHT
pulmonary regurgitation profile and pulmonary accelaration time
99
pulmonary artery diastolic pressure =
4(end PR velocity)^2+RA pressure
100
PA mean pressure =
4(inital PR velocity)^2 + RA pressure
101
in pulmonary htn equations what does PR represent
pulmonic regurgitant velocity
102
what might be seen in cases of PHT
enhanced pulmonary ejection, short pulmonic acceleration time, and systolic notching of the doppler trace
103
What predicts pulmonary htn
pulmonary acceleration time of less than 90ms
104
how is pa pressure affected
age (1mm per decade), BMI (3mm w/ bmi greater than ) bp, pulse pressure, LV filling pressure
105
what happens with chronic RV pressure overload
ventricular septal deviation toward the left
106
what accounts for most of PHT
left heart disease
107
list the groups of PHT
pulmonary arterial hypertension, PHT due to left heart disease, PHT due to lung disease , chronic pulmonary thromboembolic disease, pht with mulifactorial cause
108
what is the mitral annulus
fibromuscular ring between the LA and LV that anchors the leaflets
109
what wall does the mitral annulus share a wall
anteromedial iwth teh aortic annulus at attachment of the NCC and LCC
110
which mitral valve leaflet is bigger
anterior, it is also attached the the anterior mitral annulus
111
what is the chordae tendinea
thing fibrous made of collagen and elastin. go from pap muscle to mitral leaflet
112
what does the chordae tendinea do
anchor the mitral valve leaflets during systole
113
papillary muscle
attach the chordae to the L. divided into posteromedial and anterolateral
114
primary MR aka
organic mitral valve disease
115
primary mr is from
degenerative mitral valve disease, like mvp and calcification and thickening of the leaflets
116
MVP
mitral valve prolapse, most common type of primary MR
117
what is mitral valve prolapse
displacement of the mitral leaflets during systole of at least 2mm
118
what can cause mitral valve prolapse
fibroelastic deficiency or barlow disease
119
what are congenital mitral valve regurg causes
parachute,cleft,double orifice
120
secondary MR aka
functional MR
121
what is secondary MR from
ischemic or myopathic process , more common than primary MR
122
whats associated with secondary MR
dilation or distortion of the myocardium
123
ischemic MR is from
CAD or myocardial ischemia
124
ischemic MR is more common in cases of
inferior myocardial infarction
125
what are the three components of color doppler of MR
prox flow convergence/ proximal isovelocity surface area, vena contracta, distal jet
126
peak e wave of more than 1.5
severe MR
127
Acute MR
LA cannot remodel, pulmonary edema, elevated rt pressures, decreased cardiac output
128
Chronic MR
LV remodels, hyperdynamic lv function due to lv dilation,
129
in chronic MR when the LV cannot compensate
hear failure begins, decreased EF and end systolic volume
130
Main cause of mitral stenosis
rheumatic heart disease
131
planimetry to evaluate MS
Done in PSAX in mid diastole
132
pressure half time in MS
slope of the E wave
133
continuity equation in MS
ratio between the stroke volume in the outflow tract and the VT of the mitral valve
134
mean/max gradient
bernoulli equation
135
when is leaflet thickening considered significant
5mm or more
136
moderate ms
1.0-1.5
137
severe ms
smaller than 1
