Adult CCRN Notes
What is preload? Correct AnswerPreload, also known as the left
ventricular end-diastolic pressure (LVEDP), is the amount of
ventricular stretch at the end of diastole. Think of it as the heart
loading up for the next big squeeze of the ventricles during
systole. Some people remember this by using an analogy of a
balloon - blow air into the balloon and it stretches; the more air
you blow in, the greater the stretch.
What is afterload? Correct AnswerAfterload, also known as the
systemic vascular resistance (SVR), is the amount of resistance
the heart must overcome to open the aortic valve and push the
blood volume out into the systemic circulation. If you think about
the balloon analogy, afterload is represented by the knot at the
end of the balloon. To get the air out, the balloon must work
against that knot.
Why would you want to increase preload? Correct AnswerAn
increase in preload allows for increased cardiac output via the
Frank-Starling mechanism; HOWEVER, in an already weak heart,
this mechanism does not augment cardiac output as much as it
causes excessive hypervolemia, leading to peripheral edema and
pulmonary congestion seen in clinical heart failure
,Why would you want to decrease afterload Correct
AnswerAfterload is the pressure against which the heart must
work to eject blood during systole (systolic pressure). The lower
the afterload, the more blood the heart will eject with each
contraction.
What medications decrease afterload Correct AnswerBeta 1
blockers
CCB
Diuretics
Vasodilators
Nitroglycerin
What medications decrease preload Correct AnswerNitrates
Diuretics
S1 Correct Answerthe first heart sound, heard when the
atrioventricular (mitral and tricuspid) valves close
Loudest at apex
Marks end of diastole, beginning of systole
S2 Correct Answerthe second heart sound, heard when the
semilunar (aortic and pulmonic) valves close
Loudest at base
Marks end of diastole, beginning of systole
,S3 Correct AnswerRapid rush of blood into dilated ventricle
heard best at apex
HF - may occur before crackles
can also be associated with Pulmonary HTN and cor pulmonale
Mitral, aortic, or tricuspid insufficiency
S4 Correct AnswerCaused by atrial contraction of blood into a non
compliant ventricle
occurs right before s1
heard best at apex
stenosis
"Tennessee"
Narrowing Pulse Pressure Correct Answera decrease in systolic
blood pressure with little change or even an increase in diastolic
blood pressure
most often seen with hypovolemia or a severe drop in cardiac
output, severe hypovolemia
Widening pulse pressure Correct AnswerDecrease in diastolic BP
that widens pulse pressure - vasodilation, a drop in SVR - often
seen in sepsis, septic shock (100/38)
, When do coronary arteries get perfused? Correct AnswerDuring
diastole
Systolic BP is an indirect measurement of ... Correct
AnswerCardiac Output
Diastolic BP is an indirect measurement of ... Correct AnswerSVR
What can cause a murmur Correct AnswerHF
CAD, MI
Dilated cardiomypoathy
degeneration
bicuspid aortic valve
genetics
rheumatic fever
infection
connective tissue diseases
Mitral Regurgitation Correct Answerback up of blood during
systole
Mitral Stenosis Correct Answerhard to push blood through during
diastole
What is preload? Correct AnswerPreload, also known as the left
ventricular end-diastolic pressure (LVEDP), is the amount of
ventricular stretch at the end of diastole. Think of it as the heart
loading up for the next big squeeze of the ventricles during
systole. Some people remember this by using an analogy of a
balloon - blow air into the balloon and it stretches; the more air
you blow in, the greater the stretch.
What is afterload? Correct AnswerAfterload, also known as the
systemic vascular resistance (SVR), is the amount of resistance
the heart must overcome to open the aortic valve and push the
blood volume out into the systemic circulation. If you think about
the balloon analogy, afterload is represented by the knot at the
end of the balloon. To get the air out, the balloon must work
against that knot.
Why would you want to increase preload? Correct AnswerAn
increase in preload allows for increased cardiac output via the
Frank-Starling mechanism; HOWEVER, in an already weak heart,
this mechanism does not augment cardiac output as much as it
causes excessive hypervolemia, leading to peripheral edema and
pulmonary congestion seen in clinical heart failure
,Why would you want to decrease afterload Correct
AnswerAfterload is the pressure against which the heart must
work to eject blood during systole (systolic pressure). The lower
the afterload, the more blood the heart will eject with each
contraction.
What medications decrease afterload Correct AnswerBeta 1
blockers
CCB
Diuretics
Vasodilators
Nitroglycerin
What medications decrease preload Correct AnswerNitrates
Diuretics
S1 Correct Answerthe first heart sound, heard when the
atrioventricular (mitral and tricuspid) valves close
Loudest at apex
Marks end of diastole, beginning of systole
S2 Correct Answerthe second heart sound, heard when the
semilunar (aortic and pulmonic) valves close
Loudest at base
Marks end of diastole, beginning of systole
,S3 Correct AnswerRapid rush of blood into dilated ventricle
heard best at apex
HF - may occur before crackles
can also be associated with Pulmonary HTN and cor pulmonale
Mitral, aortic, or tricuspid insufficiency
S4 Correct AnswerCaused by atrial contraction of blood into a non
compliant ventricle
occurs right before s1
heard best at apex
stenosis
"Tennessee"
Narrowing Pulse Pressure Correct Answera decrease in systolic
blood pressure with little change or even an increase in diastolic
blood pressure
most often seen with hypovolemia or a severe drop in cardiac
output, severe hypovolemia
Widening pulse pressure Correct AnswerDecrease in diastolic BP
that widens pulse pressure - vasodilation, a drop in SVR - often
seen in sepsis, septic shock (100/38)
, When do coronary arteries get perfused? Correct AnswerDuring
diastole
Systolic BP is an indirect measurement of ... Correct
AnswerCardiac Output
Diastolic BP is an indirect measurement of ... Correct AnswerSVR
What can cause a murmur Correct AnswerHF
CAD, MI
Dilated cardiomypoathy
degeneration
bicuspid aortic valve
genetics
rheumatic fever
infection
connective tissue diseases
Mitral Regurgitation Correct Answerback up of blood during
systole
Mitral Stenosis Correct Answerhard to push blood through during
diastole
