PCCN Based on Barron Study Guide Questions and Answers

S1 Lub - start of systole Closure of AV (Mitral and tricuspid) S2 Dub Closure: Aortic and pulmonic louder with PE S3 heart failure and cor pulmonale, mitral, aortic, tricuspid insufficiency/regurg S4 cause by atrial contraction (not in afib) HTN, MI, aortic stenosis, and ventricular hypertrophy Insufficiency (regurg) occurs when valve is _______? Stenosis occurs when valve is ________? Insufficiency (regurg) = closed = chronic/acute Stenosis = open = chronic Systolic Murmurs: what valves are open? what valves are closed? Aortic and pulmonic stenosis (open) Mitral and tricuspid = insufficientcy (closed) Mitral regurg will cause giant V-waves PAOP Diastolic murmurs aortic/pulmonic regurgitation (closed) mitral/tricuspid stenosis (open) mitral stenosis associated with afib Normal CO Normal cardiac index? how to measure? 4-8 L/min 2.5-4 L/min/M2 Cardiac Index (CI) is an assessment of the cardiac output value. CO/pt's body surface area (BSA). SV normal? Factors that influence (3 things) 50-100 contractility, preload (volume), afterload (resistance) What is preload? What are right preload and left preload? What increases and decreases preload? volume/pressure in the ventricles at end of the diastole Right preload = RA/CVP = 2-6 = nickle (5) Left preload = pulmonary artery occlusive pressure (PAOP) = 8 -12 = dime (10) Decrease preload = hypovolemic or vasodilation Increase preload = increase volume = leads to heart failure and vasoconstrictors Afterload is? RV afterload? LV afterload/resistance? pressure/resistance to ventricular emptying RV = pulmonary vascular resistance (PVR) = 50-250 LV = systemic vascular resistance (SVR) = 800-1200 Blood flow through the heart R. atrium (deoxygenated), R. ventricle, pulmonary arteries, lungs, pulmonary veins (now oxygenated), L. atrium, L ventricle, aorta, body BP: causes of wide and narrow pulse pressure? Wide PP = increased ICP (Cushing triad + brady & irreg. breathing) & aortic dissection Narrow PP = shock Diastole is 1/3 longer than systole SV= 50-100 mL/beat stroke index 25-45 ml/beat/m2 SV/Body mass pulmonary artery pressure (PAP) 18-25 mmHg (mean 20) often looked at during cath SvO2: Mixed venous oxygen saturation