Principles- Cardio Monitoring

Front 1

What is the heart doing during the P phase?

Back 1

atria contract

Front 2

What is the heart doing during the QRS interval?

Back 2

ventricle depolarization

Front 3

During what part of the EKG cycle does systole occur?

Back 3

R-T interval

Front 4

During what part of the EKG cycle does diastole occur?

Back 4

end of T wave to R wave peak

Front 5

During which part of the CVP waveform does systole occur?

Back 5

between x' and v wave

Front 6

During which part of the CVP waveform does diastole occur?

Back 6

between the V wave and the following x'

Front 7

This is the sampling of "normal subjects" at rest

Back 7

standard values

Front 8

A decrease in ___ function is worse than a decrease in ____ function.

Back 8

diastolic, systolic

Front 9

_____ tends to overestimate the BP during hypotension and underestimates during hypertension. Improper cuff size leads to ___.

Back 9

oscillometry, error

Front 10

The arterial pulse is the ____ force vs the _____ force.

Back 10

driving vs opposing force

Front 11

This is the intrinsic contractility of the LV

Back 11

driving force (heart)

Front 12

This is the force dependent on
1. resistance - viscosity/geometry
2. inertia - mass vs accelleration
3. compliance - vascular distensibility

Back 12

opposing force
(volume, MAP or CO)

Front 13

This is the opposing force that describes how well the heart pumps against the vasuclar tree.

Back 13

SVR

Front 14

High compliance indicates that vessels are able to _____ as needed. With age, vessels become ____ compliant.

Back 14

distend, less

Front 15

_____ is rarely seen, and is the most stressful time that the myocardium faces. The more often the person is in this phase, the greater the stress is on the heart.

Back 15

anacrotic notch

Front 16

Anacrotic notch is also called

Back 16

isovolumetric contraction
(closure of mitral valve)

Front 17

This part of the arterial wave form indicates the inotropic component

Back 17

anacrotic rise
(ventricles contracting)

Front 18

This part of the arterial wave form is the peak systolic pressure position

Back 18

anacrotic peak
(blood ejected)

Front 19

The plateau portion of the arterial waveform is also called the ____.

Back 19

volume displacement portion

Front 20

At this point of the arterial waveform, aortic pressure exceeds LV pressure

Back 20

dicrotic notch

Front 21

When the heart contacts, its trying to _____. The heart must overcome other ____ to eject -- it must reach the opening pressure of the _____.

Back 21

eject, pressures, aortic valve

Front 22

This is the point where LV overcomes opening pressure of aortic valve and ejection occurs

Back 22

anacrotic rise

Front 23

This is the closing pressure of the aortic valve, and is higher than opening pressure

Back 23

dicrotic notch

Front 24

In this condition, there is delayed ejection due to resistance

Back 24

aortic stenosis

Front 25

This is the point of peak systolic pressure, as much as ejection can distend the arterial tree.

Back 25

anacrotic peak

Front 26

This is the point in art wave form where coronary vessels fill, creating a wave.

Back 26

tidal/reflection waves
(b/c vessels get smaller b/c blood is leaving vessels)

Front 27

A narrow arterial waveform indicates that the patient

Back 27

needs more volume

Front 28

Diastole begins at the ___ when the aortic valve closes.

Back 28

dicrotic notch

Front 29

The dicortic notch becomes ____ with increased resistance and vice versa.

Back 29

higher

Front 30

Changes in _____ create changes in arterial waveform.

Back 30

volume

Front 31

If the A line tracing is overdampened you could have a ____ problem or be ______.

Back 31

system, hypovolemic

Front 32

If the A line tracing is underdampened, you have a _____ problem.

Back 32

system
(transducer, wrong tubing)

Front 33

What are the 3 components of arterial monitoring?

Back 33

transducer, amplifier, monitor

Front 34

Arterial catheters should be proportionate to the

Back 34

size of the artery

20 gage radial, 18 gage femoral

Front 35

A-line tubing should have ____ compliance, no more than ____ in length, and free of ___.

Back 35

low compliance, 3-4 feet, bubbles

Front 36

Arterial lines should have _____ stopcocks and other devices because they lessen compliance.

Back 36

minimal

Front 37

A one inch difference in transducer height correllates w a ___ difference in art pressure.

Back 37

2 mmHg

Front 38

Because sensitivity and accuracy may be lost over time due to increasing compliance...

Back 38

the transducer should be changed q48 hrs

Front 39

If ideal characteristics of art line arent met, the values will be

Back 39

overdamped due to increased turbulence

Front 40

Flushing the art line creates a ____ waveform configuration.

Back 40

square

Front 41

This condition results in an arterial waveform w delayed upstroke, poorly formed dicrotic notch, and narrowed pulse pressure.

Back 41

aortic stenosis

Front 42

This is the end volumetric pressure that stretches the right or left ventricle of the heart to its greatst geometric dimensions under variable physiologic demand.

Back 42

preload

Front 43

This is the tension or stress developed in the wall of the LV during ejection.

Back 43

afterload

Front 44

During this cardiac pathology, the pt's arterial waveform will have all different morphologies because of all different fillings w each heartbeat (varying preloads, no atrial kick)

Back 44

atrial fibrillation

Front 45

When picking a spot for IJ central line placement...

Back 45

imaginary line from sternum to mastoid (along sternocleidomastoid) -- go 2 fingers lateral and draw line fwhere spine should be -- where lines cross is location of IJ

Front 46

The standard of care for placing a central line is

Back 46

ultrasound

Front 47

CVP cath sits in the _____ -- serves as a point of reference because you want to measure the reflection of pressures in

Back 47

Superior vena cava,
the heart below it

Front 48

In the end of diastole, the A wave of the CVP correlates w the ___ wave of the EKG.

Back 48

P wave
(if you have no P wave, you have no A wave)

Front 49

In CVP waveform, the ____ reflects passive filling of the atrium, beginning of diastole

Back 49

v wave

Front 50

In CVP waveform, the ____ reflects tricuspid valve opening and ventricle filling.

Back 50

Y descent

Front 51

In CVP waveform, ____ reflects atrial contraction

Back 51

A wave

Front 52

In CVP waveform, _____ reflects atrial relaxation

Back 52

X' descent

Front 53

In CVP waveform, ____ is a combination wave, during which tricuspid valve closes, tricuspid apparatus bows back into the atrium, and carotid pulse is transmitted.

Back 53

C wave

Front 54

In CVP waveform, ___ reflects descent of the base of the heart.

Back 54

X descent

Front 55

In the CVP waveform, tricuspid regurg has no ___ wave because the tricuspid valve is not closing.

Back 55

C
-atrium never fully empties

Front 56

In the CVP waveform, when there is no A wave, you have ____ ____.

Back 56

atrial fibrilation

Front 57

In the CVP waveform, when you have high A waves (cannon A waves) you have _____ _____.

Back 57

tricuspid stenosis

Front 58

The ____ are passively filled, but the _____ are not, they are active!

Back 58

atria, ventricles

Front 59

______ law makes the filled ventricle want to eject

Back 59

frank starling law

Front 60

In CVP waveform, ____ is the ventricular ejection phase

Back 60

C wave

Front 61

Normal pressure of R atrium

Back 61

0-8 mmHg

Front 62

Normal pressure of R ventricle

Back 62

sys- 15-25 mmHg
dias- 0-8 mmHg

Front 63

Normal pressure of L atrium

Back 63

sys- 15-25 mmHg
dias- 8-15 mmHg

Front 64

Normal pressure of L ventricle

Back 64

sys- 110-130 mmHg
dias- 4-12 mmHg

Front 65

Normal pressure of aorta

Back 65

sys- 110-130 mmHg
dias- 70-80 mmHg

Front 66

CVP value reflects the pressure in

Back 66

the R atrium

Front 67

When the PA cath is In the R ventricle, _____ pressure goes up but ___ stays the same.

Back 67

systolic, diastolic

Front 68

When the PA cath is in the pulm artery, ____ pressures rise bc valve has a closing pressure, creating a notch.

Back 68

diastolic

Front 69

A PA cath wedge pressure reflects the pressure in

Back 69

the L atrium

Front 70

When advancing a PA cath, ____ numbers will increase as you advance through the heart because of closing pressure of the valve, except when going through the ____.

Back 70

diastolic, AV valves

Front 71

Fact or fiction? there is a right and left ventricle, and the pulm artery is really an artery

Back 71

fiction! - there is a front and back ventricle, and pulm artery behaves more like a vein

Front 72

Fact or fiction? the apex of the left(back) ventricle is stationary during systole

Back 72

fiction! - the right ventricle is not a part of the apex and there is no upward movement -- only base moves

Front 73

fact or fiction? there is no passive filling of the ventricles during diastole

Back 73

fiction! there is during descent and ascent of the base

Front 74

coronary blood flow occurs during _____ and ____ in the Right heart and mainly _____ in the Left heart.

Back 74

systole and diastole
diastole

Front 75

Contraction without ejection is called ______. During this, there is increased tension in muscle to overcome the aortic valve, and there is the lowest coronary blood flow of the whole cycle.

Back 75

isovolumetric contraction

Front 76

Coronary blood flow is highest during _____. As diastolic pressure falls, so does _____.

Back 76

early diastole, perfusion pressure

Front 77

Which part of the heart requires the greatest amt of blood flow, and is the most often to infarct?

Back 77

endocardium

Front 78

Pressure volume relationships relate all phases of

Back 78

the cardiac cycle

Front 79

Pressure volume relationships provide insight into

Back 79

stroke work

Front 80

____ relates cardiac cycle to the Frank starling relationship

Back 80

pressure volume relationships

Front 81

Pressure volume relationships are imperative to understand _____ and their effects on cardiac dynamics.

Back 81

valvular morphology

Front 82

This principle states that the force of contraction of teh cardiac muscle is proportional to its initial length. The energy set free at each contraction is a simple function of cardiac filling. When diastolic filling is increased or decreased w a given volume, the displacement of the sarcomere length increases or decreases w this volume.

Back 82

Frank Straub Starling Law of the heart

Front 83

This is the work that is required of the ventricle to eject and overcome the forces

Back 83

stroke work

Front 84

In _____, there is increased afterload and subsequently increased aortic pressure.

Back 84

aortic stenosis
curve shifts up and to the right

Front 85

SV=

Back 85

EDV-ESV

Front 86

In aortic insufficiency, the curve does not have ____ _____ and your end systolic pressure is high

Back 86

isovolumetric relaxation

Front 87

In mitral regurg, the blood leaves the loop sooner because the blood is able to leave through the ____ ___ and the aorta.

Back 87

mitral valve.
-ESV is almost 0 because blood is leaving in two ways.