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145 Cards in this Set
- Front
- Back
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Define stroke volume
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Stroke volume is the amount of blood ejected in a single contraction.
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The formula for stroke volume
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SV = EDV - ESV
**Use biplane simpson to measure |
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The normal range for SV
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Stroke Volume = 70-100 cc
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3 ways to measure Stroke volume
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1) m-mode
2) biplane simpson 3) Doppler (CSA x VTI) |
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Define cardiac output
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The total amount of blood ejected per minute
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Formula for cardiac output
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CO = stroke volume x HR
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The normal range for cardiac output
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CO = 4-8 liter/min
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The formula for cardiac index
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CI = CO/BSA
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Normal range for Cardiac index
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CI = 2.4 to 4.2 liters/min/m2
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Define ejection fraction
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The % of blood ejected from a chamber with each contraction
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The normal range for Ejection Fraction
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EF = 55-75%
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The formula for ejection fraction
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EF = SV/EDV x 100
or EF = EDV-ESV/EDV (all cubed) |
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5 ways to measure ejection fraction
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1) M-mode LV
2) 2d PLAX 3) Biplane simpson 4) M-mode EPSS 5) eye ball it |
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Define afterload
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The tension or arterial pressure agaianst which the ventricle must contract
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An EPSS of 1 - 2 cm (high) will have what EF?
Greater than 2 cm? |
1-2 cm = 30-50% EF
> 2 cm = less than 30% EF |
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What is the effect of increased afterload on the velocity of cardiac fiber shortening?
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Slower contraction due to more resistence.
Ventricles must use more force to contract resulting on thickening of the myocardium (concentric hypertrophy) eventually leading to the muscle wearing out. |
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What is the effect of afterload on the cardiac performance?
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Performance will decrease.
Volume & pressure overloads are linked so an increase in one will lead to increase in the other and back-up (congestion) occurs |
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What heart diseases cause increase afterload
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1) Stenosis
2) hypertension 3) coarctation of aorta |
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The central venous pressure reflects the pressure in the _____
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Right atrium
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Define preload
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The volume of blood in the Left Ventricle @ end-diastole
- The amount of blood available to eject - The maximum stretch of the muscle fibers @ end-diastole |
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What is the effect of increased preload on the force of ventricular contraction?
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Within the physiological limits, the longer the fiber length (more stretch) the stronger the contraction.
Pass the physiological limit, it leads to dilation of LV and heart failure |
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What heart diseases cause increase preload?
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1) regurge
2)shunt 3) Volume overload |
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What is the predominant echo finding associated with increased afterload?
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Constrictive LVH
- thickening of the wall |
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What is the predominant echo finding associated with increased preload?
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Within physiological limits - increased contractility
Pass physiological limit - ventricular dilation |
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Describe the blood flow in the systemic circulation
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LA-->LV-->AoV--> all arteries/veins throughout body --> back through IVC/SVC/CS --> RA
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What is the frank starlings law of the heart?
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Preload increases = contractility increases
Adding more volume to the LV wall and the wall will stretch more (relax more) and contract longer and stronger. "LENGTH-TENSION RELATIONSHIP" |
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What is the effect of increased interval between each heart beat?
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LONGER interval = STRONGER contraction
The longer time between contractions (longer T wave) will result in stronger contraction |
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The peak velocity and peak pressure gradient of post premature ventricular contraction (PVC) with a compensatory pause will __________
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Increase the strength of the next contraction
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The strength of ventricular contraction in patient with sinus bradycardia will ____
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INCREASE
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3 factors affecting stroke volume
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1) preload
2) afterload 3) Contractility |
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If the SV is 70 ml, HR is 90 beat/min. What is CO?
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CO = SV X HR
70 x 90 = 630 ml/min |
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The left ventricular stroke volume is ____ to the right ventricular stroke volume
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EQUAL
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During the cardiac cycle, what VALVE event most closely follows the T-wave on ECG?
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The AV valves opening after IVRT
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What causes the heart valves to open and close?
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Pressure differences
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At what times of the cardiac cycle will the Mitral valve be closed?
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1) Systole
2) IVRT 3) IVCT |
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At what time during the cardiac cycle will the tricuspid valve be open?
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Diastole
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At what times during the cardiac cycle will the Aortic valve be closed?
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1) Diastole
2) IVRT 3) IVCT |
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At what time of the cardiac cycle will the pulmonic valve be open?
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Systole
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Define IVRT
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Isovolmetric relaxation time ... start of diastole. End T- Wave. No change in volume only in pressure. Before RELAXATION TIME
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Define IVCT
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Isovolmetric Contraction Time ... All valves closed at the start of systole. No change in volume only in pressure. Before CONTRACTION TIME
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What are the phases of ventricular diastole?
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IVRT - all valves closed
Rapid Filling/early - AV valves open Diastasis/mid - partial closure of MV Atrial kick - re-opening of MV with atrial contraction |
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What % of blood is ejected in the different stages of Diastole?
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IVRT = 0%
Rapid filling/early = 70% Diastasis = 0 - 10 % Atrial kick/late = 20-30% |
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Which component of the ECG tracing represents ventricular systole?
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QRS and T waves
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Define first heart sound
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Closure of the AV valves "lubb"
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Define 2nd heart sound
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Closure of the semi-lunar Valves "dubb"
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On ECG where does diastole start and end?
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Starts at end of T wave and ends at Q
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Flow from pulmonary veins to LA occurs when ....
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Diastole and systole ... constant flow
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Flow from IVC SVC to RA occurs ....
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Diastole and systole ... constant flow
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Filling of the coronary arteries with blood occurs during ....
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Diastole
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Myocardial blood flow occurs during ...
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Diastole
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The pulmonary capillary wedge pressure represents the pressure in the ___
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Left atrium
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Normal range for EPSS
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EPSS = 0.2 to 0.7 cm
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Normal range for MV D-E excursion
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MV D- E = 1.8 to 2.8 cm
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Normal range for MV E-F
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MV E-F = 7 to 15 cm/sec
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Normal range for LA (end S)
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LA 2.7 to 4 cm
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Normal range for ACS (early systole)
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ACS = 1.5 to 2.6 cm
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Normal range for AO Root (end D)
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AoR = 2 to 3.7 cm
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Normal range for RVID d
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RVIDd = 1.9 to 2.6 cm
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Normal range for LVIDd
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LVIDd = 3.9 to 5.9 cm
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Normal range for LVIDs
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LVIDS = 2 to 3.8
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Normal range for IVSd
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IVSd = 0.6 to 1 cm
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Normal range for LVPWd
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LVPWd = 0.6 to 1 cm
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When do the Mitral valve and tricuspid valve open?
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After IVRT
On ECG after T-wave |
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When do the Aov and PV open?
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After IVCT
On ECG after R-wave |
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When do MV and TV close?
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Before IVCT
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When do AoV and PV close
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Before IVRT
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What causes changes in atrium pressure?
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The constant filling from pulmonary system
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What causes changes in ventricular pressure?
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contraction and relaxation of the ventricles
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On ECG the IVCT is represented by
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IVCt = QRS
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On ECG the IVRT is represented by
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IVRT = Mid-T wave
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When is Systole on ECG
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QRS and T waves
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When is diastole on ECG
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End T wave to Q (includes P wave)
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SV, CO, CI, EF and FS all measure what?
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Systolic function of left ventricle
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Define Fractional shortening
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The percentage of shortening in left ventricle in systole
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Normal range of Fractional shortening?
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FS = 25-45%
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What does the cardiac cycle consist of?
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(refer to wiggers diagrahm)
- movement of blood flow - opening/closing of valves - pressure changes - Volume changes |
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What does the P wave represent
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Atrial contraction/ late diastole
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What does the end T wave represent
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IVRT/start of diastole
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What does the Q wave represent
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End of diastole/beginning of systole
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What does QRS represent
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IVCT/beginning of systole
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What does the ST segment represent
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Ventricular contraction/ejection
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On ECG when does the AoV open?
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After the R wave
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What causes 3rd heart sound?
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Oscillation of ventricle walls due to increased atrial pressure
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What causes the 4th heart sound?
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Atrial kick over a stiff ventricle
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What areas is auscultation heard on the chest
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1) Aortic
2) Pulmonic 3) Mitral 4) Tricuspid |
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Where is aortic auscultation heard?
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2nd intercostal space @ RT sternal border
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Where is pulmonic auscultation heard?
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2nd intercostal space @ LT sternal border
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Where is tricuspid auscultation heard?
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LT lower sternal border
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Where is mitral auscultation heard?
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apex
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What heart murmur is faintest?
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Grade 1
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What grade heart murmur is moderate?
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Grade 3
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What grade heart murmur is loudest?
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Grade 6
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What is a heart murmur?
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indicates valve disease/turbulent flow
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What causes heart murmurs?
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1) stenosis
2) regurge 3) shunt |
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What is a Thrill? and when is it heard?
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A tremor or vibration felt of palpation. Heard in grade 4, 5, 6 heart murmurs
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Left heart failure
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The heart does not adequately circulate blood to systemic system. Due to pressure overload or volume overload
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What grade heart murmur is moderate?
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Grade 3
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Effects of left heart failure
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blood backs up to lungs and patient has shortness of breath
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What grade heart murmur is loudest?
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Grade 6
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Right heart failure
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The heard does not adequately circulate blood to the pulmonic system. Can be due to volume overload or regurge in TV or PV.
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What is a heart murmur?
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indicates valve disease/turbulent flow
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Effects of right heart failure
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Can lead to systemic edema, back up of blood in liver and lower extremities
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What causes heart murmurs?
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1) stenosis
2) regurge 3) shunt |
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Valves open and close related to change in ....
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PRESSURE
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What is a Thrill? and when is it heard?
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A tremor or vibration felt of palpation. Heard in grade 4, 5, 6 heart murmurs
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Left heart failure
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The heart does not adequately circulate blood to systemic system. Due to pressure overload or volume overload
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Effects of left heart failure
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blood backs up to lungs and patient has shortness of breath
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Right heart failure
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The heard does not adequately circulate blood to the pulmonic system. Can be due to volume overload or regurge in TV or PV.
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Effects of right heart failure
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Can lead to systemic edema, back up of blood in liver and lower extremities
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Valves open and close related to change in ....
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PRESSURE
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When are all 4 valves closed?
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During IVRT and IVCT
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During IVRT and IVCT, no change in ______ occurs, only change in _______
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No change in volume, only change in pressure
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MV opens when....
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LA pressure exceeds LV
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Aov opens when ...
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LV pressure exceeds AoR
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TV opens when
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RA pressure exceeds RV
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PV opens when
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RV pressure exceeds Pulmonic trunk
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MV closes when
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LV pressure exceeds LA
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AoV closes when
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AoR pressure increases LV
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TV closes when
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RV pressure exceeds RA
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PV closes when
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Pulmonic truck pressure exceeds RV
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The fetal heart tube appears by the end of week
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Three
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The fetal heart tube begins to beat by day
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23
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The heart is completely formed by week
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Seven (42 days)
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The heart tube loops _______ at day ____
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The heart tube loops ANTERIORLY and RIGHTWARD at day 22
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The looping of the heart tubes creates the ________
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Bulboventricular loop
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The bulboventricular loop forms the ____
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Great arteries and ventricles
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The 7 distinct section fo the heart tube (in cephalad order)
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1) sinus venosus
2) primitive atria 3) AV canal 4) primitive ventricle 5) bulbus cordis 6) truncus arteriosus 7) aortic sac and arches |
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The sinus venosus consists of 2 horns, right and left, and contributes to the formation of _______
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The IVC, SVC, CS and posterior wall of atrium
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The septum primum, septum secundum, and foramen ovale are associated with the developement of the _____
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Interatrial septum IAS
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The AV canal is a large communication between the __________ and ________
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Primitive atria and primitive ventricle
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The ________ divides the AV canal into right and left AV orificies
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endocardial cushions
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The endocardial cushions contribute to the closure of the ostium primum and the membranous septum and form the ______ and ______ leaflets
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Anterior mitral valve leaflet and septal tricuspid leaflet
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The primitive ventricle is usually a morphologic ______
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Left ventricle
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The bulbos cordis contributes to the formation of the _____
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RT ventricle, both ventrical out-flow tracts and the truncus arteriosus
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The truncus arteriosus contributes to the formation of the _____
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Aortic and pulmonary trunks
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How many paired aortic arches?
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6
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Which aortic arches disappear?
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#1, 2 and 5
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The 3rd aortic arch contribules to the formation of _____
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Internal Carotid artery
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The 4th aortic arch contribules to the formation of the ______
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aortic arch
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The 6th aortic arch contributes to the formation of _______
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Left and RT pulmonary artery and ductus arteriosus
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The aortic sac contributes to the formation of the ______
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Ascending aorta
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The central portion of the interatrial septum is calle dthe _________
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foramen ovale
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What 5 things occur after birth?
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1) systemic pressure increases
2) pulmonary vascular resistence decreases 3) RT heart pressure decreases 4) LT heart pressure increases 5) 3 channels of communication in fetal circulation close ... a) ductus arteriosus b) foramen ovale c) ductus venosus |
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The foramen ovale closes after birth due to the increase in left heart pressure and becomes the ______
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Fossa ovallus
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The ductus arteriosus closes after birth due to increased systemic pressure and becomes the _______
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ligamentum arteriosum
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