Schmerler - 613 Cardio Monitoring

Front 1

What is the heart doing during the PR interval?

Back 1

atria contract

Front 2

What is the heart doing during the ST interval?

Back 2

ventricles contract

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

During potassium cardioplegia, a protein pump in the neuron cell membrane uses the energy of ____ to pump ____ out of the cell, and at the same time to pump ____ in.

Back 7

ATP, Na out, K in.

Front 8

During potassium cardioplegia, the cell membrane is leakier to ____ than it is to _____. Because more positive charges leak out of the cell than leak in, the inside of the cell becomes ____ charged w respect to the outside.

Back 8

leaker to K than it is to Na,
negatively charged

Front 9

This is the sampling of "normal subjects" at rest

Back 9

standard values

Front 10

______ was the first to to direct arterial canulation and glass column measurements of BP, _____ invented the pneumatic cuff, and _____ discovered arterial sounds and that indirect measurement was possible.

Back 10

Hales, Riva-Rocci, Korotkoff

Front 11

There are ____ phases of korotkoff sounds. Systolic pressure is during phase ____ and diastolic pressure is during phase ____.

Back 11

5 phases,
systole phase 1 and 2
diastole phase 5

Front 12

Mechanical systole starts between ___ and ___.

Back 12

R and S.

Front 13

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

Back 13

diastolic, systolic

Front 14

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

Back 14

oscillometry, error

Front 15

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

Back 15

driving vs opposing force

Front 16

This is the intrinsic contractility of the LV

Back 16

driving force

Front 17

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

Back 17

opposing force

Front 18

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

Back 18

SVR

Front 19

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

Back 19

distend, less

Front 20

As the pressure waveform extends into the peripheral arterial tree, the waveform becomes _____, the systolic and pulse pressures are _____, and the diastolic and mean pressures are _____ than central aortic pressures. _____ stays the same.

Back 20

narrower, greater, lower, MAP

Front 21

In small peripheral capillaries, pulse pressures narrow to __. The MAP is helpful in calculating ____ pressures.

Back 21

0, perfusion

Front 22

_____ 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 22

anacrotic notch

Front 23

Anacrotic notch is also called

Back 23

isovolumetric contraction

Front 24

This part of the arterial wave form indicates the inotropic component

Back 24

anacrotic rise

Front 25

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

Back 25

anacrotic peak

Front 26

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

Back 26

volume displacement portion

Front 27

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

Back 27

dicrotic notch

Front 28

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

Back 28

eject, pressures, aortic valve

Front 29

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

Back 29

anacrotic rise

Front 30

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

Back 30

dicrotic notch

Front 31

In this condition, there is delayed ejection due to resistance

Back 31

aortic stenosis

Front 32

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

Back 32

anacrotic peak

Front 33

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

Back 33

tidal/reflection waves

Front 34

A narrow arterial waveform indicates that the patient

Back 34

needs more volume

Front 35

Diastole begins at the ___ when the aortic valve closes.

Back 35

dicrotic notch

Front 36

Changes in _____ create changes in arterial waveform.

Back 36

volume

Front 37

What are the 3 components of arterial monitoring?

Back 37

transducer, amplifier, monitor

Front 38

Arterial catheters should be proportionate to the

Back 38

size of the artery

20 gage radial, 18 gage femoral

Front 39

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

Back 39

low compliance, 3-4 feet, bubbles

Front 40

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

Back 40

minimal

Front 41

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

Back 41

2 mmHg

Front 42

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

Back 42

the transducer should be changed q48 hrs

Front 43

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

Back 43

overdamped due to increased turbulence

Front 44

Flushing the art line creates a ____ waveform configuration.

Back 44

square

Front 45

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

Back 45

aortic stenosis

Front 46

This arterial waveform results from systolic pressure varying more than 10 mmHg, preload phenomenon, and pericardial pressure creating a venous pressure obstruction

Back 46

pulsus paradoxus

Front 47

Arterial waveform physiology is reversed in

Back 47

positive pressure ventillation

Front 48

With valvular abnormalities, the most important goal is to

Back 48

keep pt in sinus rhythm

Front 49

During inhalation, negative pressure is created in the chest, _____ preload

Back 49

increasing

Front 50

As you expand your lungs, you're also expanding

Back 50

pulmonary capillary distension

Front 51

BP is higher during this phase of breathing.

Back 51

exhalation

Front 52

During positive pressure breathing, preload is ____, BP is ____ during inhalation, and BP is _____ during exhalation.

Back 52

decreased, higher, lower

Front 53

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 53

preload

Front 54

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

Back 54

afterload

Front 55

During tamponade, ____ patients lose waveform of pulsus paradoxus during inspiration.

Back 55

COPD

Front 56

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 56

atrial fibrillation

Front 57

In this pathology, arterial waveform changes are related to intrathoracic pressure changes and respiratory cycle reflects failing ventricular performance. Anesthesia case should be cancelled bc the heart is so bad that it cant handle any changes in afterload w respiration and pt is not ejecting properly -- needs a heart transplant!

Back 57

Pulsus alternans

Front 58

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

Back 58

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 59

The standard of care for placing a central line is

Back 59

ultrasound

Front 60

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

Back 60

Superior vena cava,
the heart below it

Front 61

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

Back 61

P wave

Front 62

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

Back 62

v wave

Front 63

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

Back 63

Y descent

Front 64

In CVP waveform, ____ reflects atrial contraction

Back 64

A wave

Front 65

In CVP waveform, _____ reflects atrial relaxation

Back 65

X' descent

Front 66

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 66

C wave

Front 67

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

Back 67

X descent

Front 68

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

Back 68

atria, ventricles

Front 69

______ law makes the filled ventricle want to eject

Back 69

frank starling law

Front 70

In CVP waveform, ____ is the ventricular ejection phase

Back 70

C wave

Front 71

Research has demonstrated a (good/poor) relationship between CVP and blood volume as well as the (ability, inability) of CVP to predict the hemodynamic response to a fluid challenge.

Back 71

poor, inability

CVP shouldnt be used to make clinical decisions regarding fluid mgmt

Front 72

PA cath use is most common in

Back 72

elderly trauma patients and pts in shock w multisystem organ failure

Front 73

PA cath measurements are less valid in

Back 73

septic shock

Front 74

Normal pressure of R atrium

Back 74

0-8 mmHg

Front 75

Normal pressure of R ventricle

Back 75

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

Front 76

Normal pressure of L atrium

Back 76

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

Front 77

Normal pressure of L ventricle

Back 77

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

Front 78

Normal pressure of aorta

Back 78

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

Front 79

CVP value reflects the pressure in

Back 79

the R atrium

Front 80

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

Back 80

systolic, diastolic

Front 81

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

Back 81

diastolic

Front 82

A PA cath wedge pressure reflects the pressure in

Back 82

the L atrium

Front 83

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 83

diastolic, AV valves

Front 84

None of the 5 large randomized trials of PA cath use have demonstrated a

Back 84

significant clinical benefit to patients

current guidelines reccomend against routine PA cath in shock and any other clinical scenario

Front 85

Pts managed w PA caths are more

Back 85

severely injured and have higher mortality

Front 86

Pulse pressure is proportional to ____ and inversely related to ____.

Back 86

stroke volume, aortic compliance

Front 87

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

Back 87

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

Front 88

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

Back 88

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

Front 89

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

Back 89

fiction! there is during descent and ascent of the base

Front 90

fact or fiction? coronary blood flow does not occur only during diastole

Back 90

fiction! only during diastole

Front 91

Regarding coronary blood flow, there is a _____ nature of left coronary artery blood flow. Flow is lower during phases of ______ and _____ than during diastole.

Back 91

pulsatile,
isovolumetric contraction and ejection

Front 92

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 92

isovolumetric contraction

Front 93

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

Back 93

early diastole, perfusion pressure

Front 94

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

Back 94

endocardium

Front 95

Pressure volume relationships relate all phases of

Back 95

the cardiac cycle

Front 96

Pressure volume relationships provide insight into

Back 96

cardiac work

Front 97

____ relates cardiac cycle to the Frank starling relationship

Back 97

pressure volume relationships

Front 98

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

Back 98

valvular morphology

Front 99

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 99

Frank Straub Starling Law of the heart

Front 100

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

Back 100

stroke work

Front 101

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

Back 101

aortic stenosis

Front 102

As wedge pressure increases, so does____

Back 102

cardiac output

Front 103

This type of graph representation reflects the relationships between LV volume and LV pressure during phases of cardiac cycle

Back 103

Pressure-Volume loops