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CRNA
Cardiovascular
| Question | Answer |
|---|---|
| What is the formula for cardiac output | CO=HR x SV.... Should be 4-8 L/min |
| Atrial Kick | 20% of cardiac cycle is provided by atrial kick.... This is the amount of CO supplied by atrial contraction.... Compromised by conditions of dysrythmias that impair the atrial contraction. |
| Ejection Fraction | Should be above 50%... The amount of blood ejected from the L. Ventricle compared to whats available in the L. Ventricle. i.e.. of 90mls 50mls are ejected represented as an EF of 55%...Percent of blood ejected during systole in LV |
| EF is similar to what other term | Left ventricular end diastolic pressure. This is the volume of blood left at the end of the contraction. |
| What makes up stroke volume | Preload, after load and contractility |
| What makes up afterload | blood volume, viscosity, impedance |
| What is the bainbridge reflex | A reflex tachycardia that occurs when the right side of the heart becomes overloaded. It equalizes the pressure on both sides. Occurs when the right atria receptors stretch. |
| Diastole | Comprises 2/3 of the cardiac cycle. The cardiac vessels and chambers fill with blood during this phase. |
| What is MAP | Mean arterial pressure. Must be maintained above 60 at least to ensure perfusion of the brain and kidneys. MAP= [2(DBP) + (SBP)]/3 |
| What is CI | Cardiac Index. Its more specific, as it includes body surface area, than CO. It ranges from 2.5-4.5L/min/m^2.....CI=CO / BSA |
| PVR (Pulmonary vascular resistance) | The resistance the right ventricle must push against. This pressure represents the mean pressure in the pulmonary vasculature. Ranges btwn 100-200dynes/sec/cm |
| Pulmonary artery pressure | PAS=20-30mm Hg PAD=4-10mm Hg, PAM 10-15mm Hg |
| SVT | the resistance the left ventricle must pump against. Ranges from 900-1400dynes/sec/cm |
| what is the formula for Blood pressure | CO x SVR |
| what is the formula for Stroke Volume.. Define | CO x HR....The amount of blood ejected by the left ventricle during systole. Normal range: 60-120 |
| What is the formula for Stroke Index ... | SV / BSA...Normal range: 30-65 |
| Right Atrial Pressure (RAP) | Normal Range: 2-8mm Hg...Equivalent to central venous pressure. |
| What causes RAP to be INCREASED | Right ventricular failure, tricuspid valve abnormalities (stenosis or regurgitation), cardiac tamponade, right ventricular infarct, VSD with left to right shunt. Pulmonary stenosis, positive pressure ventilation. Pulmonary htn |
| RAP increased with Pulmonary hypertension | Active: hypoxemic pulmonary vasoconstriction. PaO2 < 60mmHg (Pulmonary embolus, COPD, ARDS) Passive: mitral valve dysfunction either stenosis or regurgitation. |
| What causes RAP to be DECREASED | Hypovolema, anything that vasodilates the body: endogenous systemic vasodilation (septic, neurogenic and anaphylactic shock). venous vasodilation (nitro or morphine) |
| Pulmonary Artery Pressure (PAP or PAS/D[systolic or diastolic pressure]) | Systolic: 15-30mmHG Diastolic: 5-12mmHG Mean: 10-20 mmHG Equal to right ventricular pressure during systole while the pulmonary valve is open |
| Mean PAP | 10-20mmHG |
| PASP range | 15-30mmHG |
| PADP range | 5-12mmHG |
| What abnormalities cause PAP to be increased | hypervolemia, VSD (ventricular septal defect) with left to right shunt. pulmonary HTN, positive pressure ventilation, mitral valve dysfunction, tamponade. Left ventricular failure. |
| What abnormalities cause PAP to be decreased | hypovolemia, excessive vasodilation |
| What is s3 associated with? | Fluid status |
| What is s4 associated with? | Compliance or regurgitation. |
| Lead v1 is good for monitoring what | RBBB. Use this lead when inserting pulmonary artery catheter. |
| Tall peaked the waves indicate what. | Hyperkalemic. Vtach may occur with k+ level of 8. PR interval may become prolonged. Low pH and low ca and Na may also affect cardiac function |
| What does vecuronium do? | Paralytic that prevents shivers in hypothermia patients. |
| What are the signs and symptoms of myocarditis | Characteristic midline burning sensation worse when lying supine. Malaise, severe dyspnea, inspiratory pain, syncope. Possible pericardial rub, s3 &s4 sounds. |
| What is the only way to diagnose myocarditis | Endomyocardial biopsy |
| What volume of fluid is required to cause pericardial tamponade | 50-75ml. If pressure in the intracardial space exceeds atrial and ventricular diastolic pressures an acute tamponade will result. |
| What is becks triad and what is it used for | It's a combination of symptoms used to diagnose a tamponade.tachycardia will occur first, then narrowing pulse pressure followed by muffled heart sounds. |
| What hemodynamic changes occur with a cardiac tamponade? | Decreased contactility CO and SV, increased heart rate. |
| What does an X-ray show for a cardiac tamponade? | Dilated superior vena cava. Widened mediastinum. Jugular vein doesn't show on an xray |
| When a pulmonary artery cath is placed to monitor PAOP what does the A wave mean. | A large a wave indicates increased pressure with atrial contraction. May be caused by mitral stenosis, ischemic left ventricle or failed left ventricle. |
| What is quinckes sign? | Caused by rapid initial hard pulsation followed by sudden collapse as blood flows back through an incompetent valve. Press down on fingertip and observe visible pulsation in nailbed. Usually seen in aortic insufficiency. |
| What is demussetts sign? | Seen in patients with aortic insufficiency. Bobbing of head with forceful pulse. |
| In stable angina what remains true? | CK-MB isoenzymes and troponins will not increase. The treadmill test will miss up to 40% of single vessel disease. |
| What test is used to diagnose LV dysfunction. | The thallium test |
| How do beta blockers work | By increasing diastolic filling time. They decrease afterload, decrease heart rate, and decrease myocardial oxygen demand. |
| If there's an inferior wall infarct which leads will reflect injury? | II, aVF |
Created by:
Nana0904