Pressure Pathology Flashcards by Riyanna Day

What is a characteristic of a normal pressure waveform in a fluid-filled monitoring system?

A. Rounded contours with low-frequency oscillations
B. Sharp waveforms with visible high-frequency oscillations at low pressure
C. Overshooting waveforms at high pressure
D. Blunted upstroke with delayed deflection

B. Sharp waveforms with visible high-frequency oscillations at low pressure

How well did you know this?

Not at all

Perfectly

What waveform feature suggests underdamping in a pressure monitoring system?

A. Dull, rounded waveform
B. Blunted signal with delayed peak
C. Narrow spikes or exaggerated overshoot
D. Absence of oscillations

C. Narrow spikes or exaggerated overshoot

How well did you know this?

Not at all

Perfectly

What typically causes overdamping in a pressure transducer system?

A. A hypersensitive transducer
B. Increased arterial pressure
C. High-frequency filter settings
D. Problems in the fluid path or incorrect calibration

D. Problems in the fluid path or incorrect calibration

How well did you know this?

Not at all

Perfectly

What happens when a transducer is too sensitive in a fluid-filled pressure system?

A. The signal becomes flat and unresponsive
B. A small pressure wave causes a large deflection
C. The system becomes non-functional
D. The waveform becomes more accurate

B. A small pressure wave causes a large deflection

How well did you know this?

Not at all

Perfectly

Which of the following most likely indicates overdamping in a pressure tracing?

A. Rapid upstroke with multiple oscillations
B. Tall, narrow waveform peaks
C. Blunted, rounded waveform
D. High-frequency noise in the baseline

C. Blunted, rounded waveform

How well did you know this?

Not at all

Perfectly

What effect does an air bubble in a left ventricular (LV) pressure line typically have on the pressure tracing?

A. It flattens the waveform
B. It causes delayed waveform peaks
C. It produces exaggerated systolic and diastolic overshoot
D. It eliminates the pressure signal

C. It produces exaggerated systolic and diastolic overshoot

How well did you know this?

Not at all

Perfectly

What type of damping is associated with the presence of an air bubble in a pressure line?

A. Overdamping
B. Normal damping
C. Underdamping
D. Hyperdamping

C. Underdamping

How well did you know this?

Not at all

Perfectly

What is one method used to correct an underdamped waveform caused by an air bubble?

A. Replacing the catheter
B. Increasing ECG sensitivity
C. Flushing the line and instilling diluted contrast media
D. Decreasing the flush rate

C. Flushing the line and instilling diluted contrast media

How well did you know this?

Not at all

Perfectly

What waveform characteristic indicates a normal pressure tracing after flushing an air bubble from the line?

A. Tall and spiky waveform with excessive oscillations
B. Sharp, crisp upstroke with little systolic overshoot
C. Broad, flattened waveform with minimal signal change
D. High-frequency noise in the baseline

B. Sharp, crisp upstroke with little systolic overshoot

How well did you know this?

Not at all

Perfectly

What does a “noisy” pulmonary capillary wedge pressure (PCWP) waveform typically suggest?

A. Overdamping
B. Catheter obstruction
C. Electrical interference
D. Underdamping

D. Underdamping

How well did you know this?

Not at all

Perfectly

What is a common cause of an overdamped hemodynamic waveform?

A. Tubing that is too stiff
B. A hyperdynamic circulatory state
C. A bubble or clot in the transducer
D. Short tubing length

C. A bubble or clot in the transducer

How well did you know this?

Not at all

Perfectly

Which of the following can reduce overdamping in a pressure monitoring system?

A. Using softer tubing
B. Increasing the length of the tubing
C. Replacing with stiffer tubing
D. Introducing a small air bubble

C. Replacing with stiffer tubing

How well did you know this?

Not at all

Perfectly

What corrective action is recommended for underdamping due to a hyperdynamic state?

A. Shorten tubing
B. Increase filter on amplifier or introduce contrast media
C. Use stiffer tubing
D. Tighten catheter connection

B. Increase filter on amplifier or introduce contrast media

How well did you know this?

Not at all

Perfectly

What should be done if the catheter is producing an underdamped waveform due to being placed in a turbulent jet?

A. Flush the system
B. Reposition the catheter
C. Replace the amplifier
D. Lengthen the tubing

B. Reposition the catheter

How well did you know this?

Not at all

Perfectly

If there is a complete loss of signal in the monitoring system, which of the following is NOT a potential cause?

A. Bad cable
B. Catheter obstruction
C. Overdamping
D. Disconnected catheter

C. Overdamping

How well did you know this?

Not at all

Perfectly

What should be done if pressures do not return to zero when expected?

A. Introduce a small bubble into the system
B. Recalibrate and check zero at mid chest
C. Switch to a softer tubing
D. Increase the internal diameter of the tubing

B. Recalibrate and check zero at mid chest

How well did you know this?

Not at all

Perfectly

What can result from partial withdrawal of the pigtail catheter out of the LV during pressure measurement?

A. Increased LV-Ao gradient
B. Loss of all waveform data
C. Contamination of LV pressure by Ao pressure
D. Normal diastolic waveform with decreased upslope

C. Contamination of LV pressure by Ao pressure

How well did you know this?

Not at all

Perfectly

What artifact is observed in the diastolic waveform when the pigtail catheter is malpositioned?

A. Diastolic plateau with no change
B. Continued decline (downslope) in diastolic pressure
C. Early systolic notch
D. Pulsus alternans

B. Continued decline (downslope) in diastolic pressure

How well did you know this?

Not at all

Perfectly

What is the correct catheter position for accurate measurement of LV and Ao pressures across the aortic valve?

A. Just at the aortic root
B. With side holes above the Ao valve
C. All side holes under the Ao valve
D. In the descending aorta

C. All side holes under the Ao valve

How well did you know this?

Not at all

Perfectly

What diagnostic error can result from failing to recognize catheter malposition during LV-Ao gradient measurement?

A. Overestimation of aortic valve disease
B. False diagnosis of ventricular septal defect
C. Underestimation of aortic valve stenosis
D. Missed detection of mitral regurgitation

C. Underestimation of aortic valve stenosis

How well did you know this?

Not at all

Perfectly

How is the true LV-Ao gradient revealed after catheter malposition is corrected?

A. By decreasing amplifier sensitivity
B. By advancing the catheter slightly into the LV
C. By switching to a different transducer
D. By flushing the catheter with contrast

B. By advancing the catheter slightly into the LV

How well did you know this?

Not at all

Perfectly

What is a common mechanical cause of loss of pressure in a hemodynamic monitoring system?

A. Catheter tip in turbulent flow
B. Loose connections among tubing, catheter, manifold, or transducer
C. Small internal diameter of the tubing
D. Use of stiff tubing in a hyperdynamic patient

B. Loose connections among tubing, catheter, manifold, or transducer

How well did you know this?

Not at all

Perfectly

What hemodynamic artifact may result from loose connections in the pressure monitoring system?

A. LV pressure appearing higher than Ao pressure
B. Complete loss of signal
C. LV pressure falsely appearing lower than Ao pressure
D. Pulsus paradoxus waveform

C. LV pressure falsely appearing lower than Ao pressure

How well did you know this?

Not at all

Perfectly

Which condition must be ruled out before concluding that low LV pressure is due to a technical issue like loose connections?

A. Septic shock
B. Cardiac tamponade
C. Heterotopic heart transplant or extracardiac hemodynamic support
D. Pulmonary embolism

C. Heterotopic heart transplant or extracardiac hemodynamic support

How well did you know this?

Not at all

Perfectly

If LV pressure reads lower than Ao pressure due to a technical error, what is the first step to take? A. Replace the catheter B. Increase amplifier gain C. Check all connections in the monitoring setup D. Administer inotropic support

C. Check all connections in the monitoring setup

Which wave corresponds to atrial filling in the RA pressure waveform? A. v wave B. a wave C. x descent D. y descent

B. a wave

What pressure event occurs after the a wave in the RA pressure tracing? A. v wave B. y descent C. x descent D. RV systolic rise

C. x descent

What does the v wave in the RA pressure tracing represent? A. Atrial contraction B. Ventricular systole C. Atrial filling during ventricular systole D. Atrial relaxation

C. Atrial filling during ventricular systole

Which component follows the v wave and represents early ventricular filling? A. a wave B. x descent C. y descent D. RV upstroke

C. y descent

What does a notch at the top of the RV pressure tracing likely indicate? A. Tricuspid valve prolapse B. Underdamped ringing artifact C. Third-degree AV block D. Normal atrial contraction

B. Underdamped ringing artifact

In the presence of an underdamped system, what artifact may be seen in the early diastolic part of the RV pressure waveform? A. x descent prolongation B. y descent obliteration C. Ringing or oscillatory artifact D. Blunted dicrotic notch

C. Ringing or oscillatory artifact

In tricuspid regurgitation, what happens to the right atrial (RA) pressure during right ventricular (RV) systole? A. It decreases gradually B. It remains unchanged C. It rises throughout RV systole D. It falls abruptly at mid-systole

C. It rises throughout RV systole

Which waveform feature is most striking on the RA tracing in a patient with tricuspid regurgitation? A. Prominent a waves B. Sharply defined x and y descents C. Striking regurgitant v waves D. Absence of v waves

C. Striking regurgitant v waves

What does the absence of a diastolic gradient between RA and RV pressures indicate in a patient with tricuspid regurgitation? A. Severe tricuspid stenosis B. No tricuspid stenosis C. Ventricular septal defect D. Increased pulmonary vascular resistance

B. No tricuspid stenosis

In the described patient, the RV systolic pressure is 70 mm Hg and the RA mean pressure is 17 mm Hg. What does a small diastolic pressure gradient (with RA tracing higher than RV) suggest? A. Normal hemodynamics with isolated regurgitation B. Mild tricuspid stenosis in addition to regurgitation C. A measurement error in the pressure transducers D. Severe right ventricular dysfunction

B. Mild tricuspid stenosis in addition to regurgitation

When evaluating a patient with suspected tricuspid regurgitation, why is it important to assess the diastolic pressure relationship between the RA and RV? A. To determine if there is concurrent left-sided heart disease B. To confirm the presence of a regurgitant murmur C. To exclude or detect concomitant tricuspid stenosis D. To measure the pulmonary capillary wedge pressure

C. To exclude or detect concomitant tricuspid stenosis

What causes the formation of a giant a wave (also called a cannon wave) in AV dissociation? A. Atrial contraction during diastole B. Ventricular contraction before atrial filling C. Atrial contraction against a closed tricuspid valve D. Simultaneous contraction of atria and ventricles

C. Atrial contraction against a closed tricuspid valve

In a patient with AV block, when might atrial contraction occur relative to the QRS complex? A. Just before the QRS B. Simultaneous with the T wave C. After the QRS, during ventricular systole D. Only during diastole

C. After the QRS, during ventricular systole

What happens to the a wave when AV synchrony is restored? A. It disappears entirely B. It becomes an exaggerated v wave C. It returns to its normal timing before the QRS D. It fuses with the y descent

C. It returns to its normal timing before the QRS

Which of the following may also cause AV dissociation and giant a waves on the RA pressure tracing? A. Left bundle branch block B. Dual-chamber pacing C. Ventricular pacing without atrial capture D. Sinus bradycardia

C. Ventricular pacing without atrial capture

What percentage of cardiac output may be contributed by proper atrial contraction? A. 10–15% B. 20–25% C. 25–30% D. Over 40%

C. 25–30%

What is the typical time delay between the rise of LA pressure and PCWP in simultaneous tracings? A. 10–30 ms B. 50–75 ms C. 100–150 ms D. 200–250 ms

C. 100–150 ms

What type of catheter is used to measure pulmonary capillary wedge pressure? A. Swan-Ganz catheter B. Brockenbrough catheter C. Pigtail catheter D. Multipurpose A catheter

A. Swan-Ganz catheter

What catheter is commonly used to directly measure left atrial pressure during transseptal access? A. Pigtail catheter B. Swan-Ganz catheter C. Judkins catheter D. Brockenbrough catheter

D. Brockenbrough catheter

How closely do PCWP and direct LA pressure measurements usually correspond in standard clinical settings? A. They often differ significantly and are not interchangeable B. They correspond closely and can generally be used interchangeably C. PCWP is always higher than LA pressure D. LA pressure is only used in pediatrics, not adults

B. They correspond closely and can generally be used interchangeably

Why is PCWP a clinically useful surrogate for LA pressure in most cases? A. It directly measures pulmonary artery diastolic pressure B. It bypasses the need for transseptal catheterization C. It reflects systemic venous return D. It avoids the need for balloon inflation

B. It bypasses the need for transseptal catheterization

How do femoral arterial (FA) pressures typically compare to central aortic (Ao) pressures? A. FA pressures are always lower B. FA pressures are identical to Ao pressures C. FA pressures show a slight overshoot compared to central Ao D. FA pressures lag behind Ao with lower mean pressure

C. FA pressures show a slight overshoot compared to central Ao

How can an operator distinguish between the femoral arterial and central aortic pressure tracings? A. By comparing dicrotic notch height B. By identifying the first signal to rise (central Ao) during upstroke C. By measuring the amplitude of the v wave D. By observing respiratory variation

B. By identifying the first signal to rise (central Ao) during upstroke

What is typically true about the mean pressure between femoral arterial and central aortic recordings? A. Mean pressure is higher in the FA B. Mean pressure is lower in the FA C. Mean pressures are nearly identical D. Mean pressure cannot be reliably compared

C. Mean pressures are nearly identical

In the example from Figure 4.27, which catheter is used to measure central aortic pressure above the aortic valve? A. Swan-Ganz catheter B. Pigtail catheter (7 F) C. Brockenbrough catheter D. Multipurpose catheter

B. Pigtail catheter (7 F)

Why might femoral arterial pressure show a slight overshoot compared to central aortic pressure? A. Because of greater damping in the central Ao B. Due to peripheral waveform amplification C. Due to valve resistance D. Because the catheter is underdamped

B. Due to peripheral waveform amplification

What does a large v wave on a PCWP tracing commonly suggest? A. Severe tricuspid stenosis B. Significant mitral regurgitation C. Aortic valve insufficiency D. Normal left atrial compliance

B. Significant mitral regurgitation

Are large v waves on PCWP tracings highly sensitive and specific for mitral regurgitation? A. Yes, they are both highly sensitive and specific B. No, they are neither highly sensitive nor specific C. They are sensitive but not specific D. They are specific but not sensitive

B. No, they are neither highly sensitive nor specific

Besides mitral regurgitation, which of the following conditions can cause large v waves on PCWP? A. Ventricular septal defect B. Rheumatic heart disease C. Postcardiac surgery changes D. All of the above

D. All of the above

What effect can giant v waves on PCWP have on pulmonary artery (PA) pressure tracings? A. Cause flattening of the systolic upstroke B. Cause a notch on the diastolic downslope C. Lower mean PA pressure D. Eliminate the dicrotic notch

B. Cause a notch on the diastolic downslope

Large v waves on PCWP may be seen in congestive heart failure (CHF) without which of the following? A. Mitral stenosis B. Mitral regurgitation C. Left ventricular hypertrophy D. Pulmonary hypertension

B. Mitral regurgitation

What is postextrasystolic potentiation in the context of LV pressure? A. Decreased LV pressure after a PVC B. Increased LV pressure following an extrasystolic beat C. Loss of atrial contraction after a PVC D. Equalization of LV and Ao pressure after an extrasystole

B. Increased LV pressure following an extrasystolic beat

How does atrial contraction affect LV and aortic pressures in aortic stenosis? A. It causes no significant change B. It decreases LV and Ao pressures C. It increases both LV and Ao pressures, augmenting systolic pressure by about 25% D. It increases Ao pressure but decreases LV pressure

C. It increases both LV and Ao pressures, augmenting systolic pressure by about 25%

What does the absence of atrial contraction (e.g., junctional beat) cause in a patient with aortic stenosis? A. Higher LV and Ao systolic pressures B. Lower LV and Ao systolic pressures C. No change in LV and Ao systolic pressures D. Elevated diastolic Ao pressure

B. Lower LV and Ao systolic pressures

What does a wide pulse pressure (Ao systolic minus diastolic pressure >50–60 mm Hg) suggest in aortic stenosis? A. Severe mitral stenosis B. Presence of aortic regurgitation C. Normal valve function D. Pulmonary hypertension

B. Presence of aortic regurgitation

What is the least accurate method for measuring the LV-to-aortic pressure gradient in aortic stenosis? A. Dual catheter simultaneous measurement B. Transseptal approach C. Single catheter pullback D. Non-invasive Doppler echocardiography

C. Single catheter pullback

What causes the pressure gradient inside the LV in hypertrophic obstructive cardiomyopathy (HOCM)? A. Aortic valve stenosis B. Thickened heart muscle obstructing outflow tract C. Mitral valve regurgitation D. Pulmonary hypertension

B. Thickened heart muscle obstructing outflow tract

What happens to the Ao-LV pressure gradient when the catheter is pulled back just beneath the aortic valve in HOCM? A. The gradient increases B. The gradient disappears C. The gradient remains unchanged D. The Ao pressure decreases below LV pressure

B. The gradient disappears

After a premature ventricular contraction (PVC) in a patient with HOCM, which of the following is not a typical post-PVC change? A. Increased LV-Ao gradient B. Narrower Ao pulse pressure C. Ao waveform with spike and dome pattern D. Decreased LV contractility

D. Decreased LV contractility

How does the post-PVC Ao pulse pressure change in aortic stenosis (AS), compared to HOCM? A. It decreases in AS and HOCM B. It increases in AS but decreases in HOCM C. It increases in both AS and HOCM D. It remains unchanged in both AS and HOCM

B. It increases in AS but decreases in HOCM

Which pattern on the Ao waveform after PVC is characteristic of early LV outflow obstruction in HOCM? A. Flattened upstroke B. Spike and dome pattern C. Dicrotic notch disappearance D. Prolonged diastolic plateau

B. Spike and dome pattern

What is a characteristic feature of the arterial pressure waveform in aortic regurgitation? A. Narrow pulse pressure with slow upstroke B. Wide pulse pressure with brisk arterial pressure upstroke C. Flat arterial waveform with no dicrotic notch D. Low systolic and high diastolic pressures

B. Wide pulse pressure with brisk arterial pressure upstroke

What does a rapidly increasing LV diastolic pressure with near equilibration of Ao and LV pressures at end diastole indicate? A. Mild aortic regurgitation B. Severe aortic regurgitation C. Normal valve function D. Aortic stenosis

B. Severe aortic regurgitation

How does chronic aortic regurgitation typically affect pulse pressure? A. It causes a narrow pulse pressure B. It causes a wide pulse pressure C. It causes no change in pulse pressure D. It causes alternating pulse pressure

B. It causes a wide pulse pressure

Why might pulse pressure not be wide in acute aortic regurgitation despite severe leakage? A. Because LV compliance is increased acutely B. Because LV diastolic pressure does not have time to rise C. Because Ao pressure is elevated D. Because atrial contraction compensates

B. Because LV diastolic pressure does not have time to rise

In aortic regurgitation, what effect does first-degree AV block have on LV pressure? A. Prominent a wave on LV pressure tracing B. Loss of the a wave C. Decreased LV systolic pressure D. No effect on LV pressure waveform

A. Prominent a wave on LV pressure tracing

What do large v waves in the PCW tracing typically represent in mitral regurgitation? A. LV volume transmitted backward through an incompetent mitral valve B. Increased LA compliance C. Decreased LV systolic pressure D. Normal atrial filling

A. LV volume transmitted backward through an incompetent mitral valve

When do v waves occur aside from mitral regurgitation? A. Only in mitral stenosis B. Any time there is decreased left atrial compliance C. Only during ventricular systole D. Only in the presence of pulmonary hypertension

B. Any time there is decreased left atrial compliance

In patients with mixed mitral regurgitation and mitral stenosis, how do the v waves in PCW tracings differ? A. They are sharper and steeper than in isolated mitral regurgitation B. They are flatter and have a persistent LV-PCW gradient C. They disappear completely D. They occur only during diastole

B. They are flatter and have a persistent LV-PCW gradient

What diagnostic test confirms significant mitral regurgitation when large v waves and persistent LV-PCW gradients are seen? A. Right heart catheterization B. Left ventriculography C. Echocardiography only D. Electrocardiogram (ECG)

B. Left ventriculography

What does a diastolic pressure gradient between the PCW and LV indicate in mitral stenosis? A. Severity of LA outflow obstruction B. Severity of aortic stenosis C. Presence of mitral regurgitation D. Normal valve function

A. Severity of LA outflow obstruction

In mitral stenosis, what happens when atrial contraction is delayed and follows the QRS complex? A. Giant v wave appears B. Giant a wave appears C. No change in pressure waves D. Decreased mitral valve gradient

A. Giant v wave appears

How should mitral valve gradients be calculated in patients with atrial fibrillation (AF)? A. From a single beat B. From the average of 10 beats C. From the beat with the shortest R-R interval only D. Gradients are not calculated in AF

B. From the average of 10 beats

What is one therapeutic intervention used to open a narrowed mitral orifice in mitral stenosis? A. Aortic valve replacement B. Balloon catheter valvuloplasty C. Pacemaker implantation D. LV assist device

B. Balloon catheter valvuloplasty

What is a typical finding of right atrial (RA) pressure in constrictive pericarditis? A. Normal RA pressure with single waveform B. Elevated RA pressure with M or W configuration C. Low RA pressure with flat waveform D. Elevated RA pressure with no descents

B. Elevated RA pressure with M or W configuration

What characteristic diastolic pressure pattern is seen in constrictive pericarditis? A. Gradual rise and fall of diastolic pressures B. Dip and plateau pattern with early rapid filling followed by abrupt cessation C. No changes in diastolic pressures D. Elevated diastolic pressure with no dip

B. Dip and plateau pattern with early rapid filling followed by abrupt cessation

Which hemodynamic sign is most specific for diagnosing constrictive pericarditis compared to restrictive cardiomyopathy? A. Elevated RA pressure B. Concordant increase and decrease in RV/LV systolic pressures during respiration C. Discordant respiratory variation of RV and LV systolic pressures D. Low LV end-diastolic pressure

C. Discordant respiratory variation of RV and LV systolic pressures

What clinical sign corresponds to an inspiratory increase in RA pressure seen in constrictive pericarditis? A. Kussmaul sign B. Pulsus paradoxus C. Beck’s triad D. Corrigan’s pulse

A. Kussmaul sign

How does tachycardia affect the classic dip-and-plateau pattern in constrictive pericarditis? A. It enhances the pattern B. It obscures the pattern C. It reverses the pattern D. No effect

B. It obscures the pattern

What happens to the right atrial (RA) pressure waveform in cardiac tamponade? A. Elevated RA pressure with prominent y descent B. Elevated RA pressure with blunted y descent C. Normal RA pressure with sharp y descent D. Low RA pressure with no y descent

B. Elevated RA pressure with blunted y descent

What characteristic arterial pressure finding is seen in cardiac tamponade? A. Pulsus alternans B. Pulsus paradoxus (>20 mm Hg inspiratory drop) C. Narrow pulse pressure without respiratory variation D. Wide pulse pressure without respiratory variation

B. Pulsus paradoxus (>20 mm Hg inspiratory drop)

What does two-dimensional echocardiography typically show in tamponade? A. Normal pericardium and no chamber collapse B. Pericardial fluid with diastolic RA and RV collapse C. Thickened myocardium with no fluid D. Enlarged left atrium with normal right heart

B. Pericardial fluid with diastolic RA and RV collapse

The elevated pericardial pressure in tamponade primarily affects which phase of cardiac filling? A. Late diastolic filling B. Early diastolic filling C. Systolic ejection D. Isovolumetric contraction

B. Early diastolic filling

Pressure Pathology Flashcards

(89 cards)