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Hemodynamics
RA, RV, PA, PCW
Question | Answer |
---|---|
Comparing a PA waveform to a simultaneous ECG tracing: | Diastole is measured after the QRS complex |
PA= 36/22, PCW = 10/12/10. What abnormality could cause such a gradient? | COPD |
For the last hour your patient has been in normal sinus rhythm with a PA pressure of 25/15/18. Now she has frequent PVC's and a pressure reading of 25/0/8. What should you consider the cause? | Swan has pulled back to RV position |
What indicates the opening of the semilunar valves? | Anacrotic notch |
PA pressures vary with: | the respiratory cycle |
What cardiac catheterization waveform would represent pulmonic stenosis? | systolic gradient between PA and RV |
What is a sign of PA hypertension on the waveform? | late dicrotic notch in PA due to pushing blood against resistance. it takes longer to close the valve. |
What pressures would you need to see in order to determine constrictive pericarditis | RA and RV |
What would the pressure tracing in the RV and PA look like with pulmonic stenosis? | RV pressure up, PA pressure, down |
In pulmonary capillary wedge tracings the: | V- wave is due to atrial filling during ventricular contraction |
PC wedge pressure is measured during what phase of the respiratory cycle? | end expiratory |
Under normal conditions PCW pressures should approximate what three other pressures? | LA mean, LV edp, PA diastolic |
Large V waves in the PCW waveform indicate what valve disorder? | mitral regurgitation |
Normally the END diastolic gradient between the PA pressure and the PAWP(wedge) is small (1-4mmHg). What two conditions increase this gradient? | COPD and high cardiac output |
Considering all types of shock, only one results in an elevated wedge pressure: It is: | cardiogenic shock (LV failure) |
Large "a" waves in the PCW waveform indicate what valve disorder? | mitral stenosis |
The "M" or "W" sign in the RA waveform is caused by the rapid X and y descents during atrial and ventricular emptying. This is consistent with: cardiac tamponade, normal pressures, constrictive pericarditis, HOCM, RV failure | Constrictive Pericarditis |
What is likely when you see respiratory respiration where you're not supposed to see it? | tamponade |
The paradoxical increase in RA pressure during in cases of constrictive pericarditis is called: | Kussmaul's sign (respiratory variation |
Where is diastolic dip and plateau seen and what does it resemble? | ventricles, a square root sign |
the characteristic feature of the ventricular pressure waveforms in either restrictive cardiomyopathy and constrictive pericarditis is the: | Square root sign or dip and plateau |
Regarding the timing of RA pressure waves with the ECG tracing: | A-waves follow just after the P wave |
To measure the RA mean pressure: | Measure the highest and lowest points of the wave and average |
Normal mean RA pressure should not exceed: | 8mmHg |
RA= 12/10/8, RV = 24/2/3, PA = 24/14. What abnormality could cause such a gradient? | Tricuspid stenosis |
Post PTCA your patient's Swan readings are CVP= 28, PA = 40/22, PCW = 28. You should suspect: | Cardiac tamponade |
The a wave in the RA tracing represents | atrial contraction |
The V wave in the RA tracing represents | Ventricular contraction during atrial filling |
Your patient had an RV pressure of 50/2/10 and PA pressures of 20/12. What abnormality could cause such a gradient? | pulmonic stenosis |
RV failure is identified by: | elevated EDP |
Kussmal's sign represents: | respiratory variation in the RA because it's being crushed (tamponade) |
An interventricular gradient is present in | infundibular stenosis |
What hemodynamic sign is characteristic of pulmonic stenosis? | systolic gradient in PA to RV pullback |
What hemodynamic sign is representative of restrictive cardiomyopathy and constrictive pericarditis? | square root sign in the RV diastolic pressure |
What are some conditions that can cause RV systolic pressure to be elevated? | COPD, LV Failue, VSD, Primary pulmonary hypertension |
What would the PCW look like in Mitral stenosis? | high, along with a big diastolic gradient |
Hypertrophic obstructive cardiomyopathy sometimes involves both ventricles. If it affected the RV side of the septum as well, what hemodynamic anomaly would you be looking for? | Intraventricular gradient between RV apex and RV outflow tract |
Your patient shows the following pressures: PA= 35/20/25; RV = 35/2/15; RA = 23/22/15 | RV failure |
In a left to right ASD, what is the effect on the RV pressures? they: | increase |
What can cause the square root sign in an RV tracing? | noncompliant myocardium resisting passive filling |
In cardiac tamponade the RV free wall collapses due to accumulated fluid in the pericardial space. What is the effect on RV pressure? | RV diastole rises and equalizes with PA diasole |
Patient developed pulmonary embolus, what hemodynamic finding is most likely? | PAD exceeds wedge pressure |
Acute septal MI with VSD what hemodynamic finding is most likely? | RV and PA systolic pressures rise |
When the fluoroscopic C arm is angled into a cardiac view so that the X-rays exit from the patient's left abdominal area, what angiographic view is this? | Caudal LAO |
Which artery is sometimes seen branching directly from the aorta? The: | Conus |
Pulseless pt in vtach | deliver an unsynchronized shock |
Mag sulfate - recommended dose: | 1 to 2 g diluted in 10ml slow iv push |