Cardiac Cycle
Name the 4 Diastolic phases of the Cardiac Cycle
Atrial Systole, Isovolumic Relaxation time, Rapid Filling, reduced Filling (diastasis)
Name the term to describe the amount of blood that is in the ventricles before the heart contract
End Diastolic Volume
EDV - ESV = ?
Stroke Volume
70-100 ml
S1 and S2 represent what?
Closure of the AV and SL valve respectively
Aortic Stenosis could be represented by what murmur.
Systolic ejection
All of the valves remain closed during these two phases of the Cardiac Cycle
IVCT and ICRT
An increase in afterload will decrease the width of the pressure/volume loop curve. What does that width represent?
Stroke Volume
CO is calculated by HR X SV? True or False
What will then units typically be?
True
L/min
This can be normal in children but is abnormal if heard in adults, representing decrease ventricular compliance and resistance to early filling
S3
Most common diastolic, blowing decrescendo murmur represents what diagnosis?
Aortic regurgitation
What about MS? Why not most common?
Only 10% of ventricular Filling takes place during this phase
Atrial Systole (Phase 1)
This term is used to describe how easily a chamber of the heart or (the lumen of a blood vessel) expands when it is filled with a volume of blood.
* will effect preload
Compliance
The greater the ventricular volume, the great the force of contraction describes what principle
Frank-Starling
Click and Snap
A patient with significant Aortic stenosis and regurgitation or a patient with a PDA (patent ductus arteriosis) could present with what type of murmur)
Systolic, Diastolic or Continuous (To-fro)
Continuous or To and fro
Opening of the AV valves (atrioventricular valves) marks the end of what phase in the cardiac cycle?
Isovolumic relaxation time
Inotropy and preload have a direct or inverse relationship with stroke volume
Direct
EDV-ESV/EDV x 100 calculates what?
Ejection Fraction
Discuss how this is done on Echo...
This heart sound ______ may be soft due _________ on a semilunar valve.
S2 - calcification or significant stenosis (may have reduced EF or low output).
In detail describe the type, location, intensity and duration of a Severe Aortic Stenosis patient
RUSP, 5/6, mid-late peaking, systolic ejection, crescendo decrescendo, radiation to the carotid, reduced carotid upstroke, possible a quiet/soft S2
When ventricular Pressure slightly exceed that of the pressure in the aorta
systolic rapid ejection (Phase 3)
Name one thing that can increase each: Preload, Afterload, Inotropy
Preload - Decrease in inotropy, HR, inflow resistance, venous compliance or increase outflow resistance (afterload), increase atrial contraction, increase ventricular compliance, increase in venous pressure, increase venous blood volume(increase in venous return)
Afterload - valve resistance(AS), vascular resistance (hypertension), vascular impedance, blood viscosity
Inotropy - Increase afterload, SNS activation, catecholamines, heart rate
Myocardial O2 consumption can be calculated by the _____ principle.
Fick
** it can also be calculated by the RPP •This index can be measured noninvasively by multiplying heart rate and systolic arterial pressure
*afterload has a greater effect on myocardial o2 consumption than preload
This heart sound would represent a stiff LV heard in late diastole.
S4
What diagnosis would fit a mid systolic murmur that increases with Valsalva maneuver on a 22 year old patient?
Hypertrophic Obstructive Cardiomyopathy