Term
| List the three distinct waves of Right Atrial Pressures: 3 are (+) slope and 3 are (-) slope... |
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Definition
| (+) are a,..c,..v and (-) are x, x', y for the Right Atrial pressures |
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Term
| What do you call the small pressure rise that is produced by the action of atrial systole (RA pressure) |
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Definition
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Term
| Atrial relaxation (immediately following atrial systole)follows the a-wave...what is this decline in pressure called? |
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Definition
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Term
| How might the c wave appear during RA pressure readings and what does it correspond to? |
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Definition
| The c wave may appear as a distinct wave, or a notch on the downslope of the a wave, or upslope of the v wave. The c wave may even be absent altogether. It is associated with and produced by the CLOSURE OF THE TRICUSPID VALVE LEAFLETS. |
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Term
| What produces the x' descent? Where does it occur during RA pressure readings? |
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Definition
| The x' descent is produced by a downward pulling of the septum during ventricular systole. It might follow the c wave. ie. x,c,x' . However if the c wave appears only as a notch on the a wave, the single descent following the ac wave is termed the x descent. |
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Term
| What produces the v wave in RA pressure tracings? |
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Definition
| The V wave is an increase in atrial pressure produced by right atrial filling during concomitant right ventricular systole. This makes THE LEAFLETS OF THE CLOSED TRICUSPID VALVE ACTUALLY BULGE BACK INTO THE RIGHT ATRIUM. Producing the V wave. |
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Term
| When does the a wave occur with relation to the ECG? (RA-tracings) |
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Definition
| Just after the P wave of the ECG. (80 - 100 msecs after the P wave) The a wave represents mechanical atrial systole and immediately succeeds electrical atrial depolarization, that is, after the P wave of the ECG. |
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Term
| What wave reflects the closing of the tricuspid valve in RA tracings? |
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Definition
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Term
| The c wave corresponds to what ECG sections? |
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Definition
| the RS-T juction. Its timing following the a wave approximates the PR interval. |
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Term
| Which wave succeeds electrical ventricular depolarization and can be looked for at the end of the ECG T wave or any time in the TP interval? |
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Definition
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Term
| When do you have giant a waves or cannon a waves and why? |
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Definition
| In junctional rhythm or during certain beats of AV dissociation where THE ATRIA CONTRACT AGAINST A CLOSED TRICUSPID VALVE...giant a or cannon a wave are produced. They may be seen with PVCs also. |
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Term
| List 7 causes of Elevated RA pressures... |
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Definition
RV failure...
Chronic LV failure...
TS and TR..
Cardiac tamponade...
Constrictive pericarditis...
Pulmonary HTN......
volumne overoad. |
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Term
| What do you call a RISE rather than a fall in right atrial pressure during inspiration? |
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Definition
| Kussmaul's sign. It can be seen in CONSTRICTIVE disease (but rarely, if ever, in cardiac tamponade), RV infarct. |
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Term
| What is the normal RV systolic pressure? |
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Definition
| 20 - 30 mm HG, about one-sixth the pressure generated by the left ventricle (LV). This drops to zero while in diastole. |
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Term
| What causes elevated RV systolic pressure? |
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Definition
| Pulmonary HTN, VSD, or pulmonic stenosis. |
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Term
| How is RV systolic pressure monitored at the bedside? |
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Definition
| Indirectly...through evaluation of the PA systolic pressure, which equals RV systolic pressure, and the RA mean pressure, which approximates the RV end-diastolic pressure. |
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Term
| What is used at the bedside to monitor RV systolic pressure? |
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Definition
| PA systolic pressures. These equal RV systolic pressure. |
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Term
| What is used at the beside to monitor RV diastolic pressure? |
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Definition
| The mean RA pressure...which approximates the RV end-diastolic pressure. |
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Term
| The mean RA pressure approximates what other pressure? |
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Definition
| End-diastolic RV pressure. |
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Term
| The PA systolic pressure approximates what other pressure at bedside? |
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Definition
| the RV systolic pressure. |
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Term
| List the Systolic events of Right Ventricular Pressures? |
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Definition
| Isovolumetric contraction...Rapid ejection...Reduced ejection. |
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Term
| List the Diastolic events of Right Ventricular Pressures? |
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Definition
| Isovolumetric relaxation...Early diastole...Atrial systole (atrial kick)...End-diastole. |
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Term
| Where is the Seven Events of Right Ventricular Pressures does the pulmonic valve open? |
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Definition
| During the Systolic event: Rapid Ejection |
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Term
| Where in the Seven Events of Right Ventricular Pressures does the Tricuspid valve open? |
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Definition
| During the Diastolic event: Early Diastole. |
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Term
| Where is the Seven Events of Right Ventricular Pressures are both the pulmonic valve and the tricupid valve closed? |
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Definition
| Isovolumetric contraction. |
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Term
| What determins the Extent of Fiber Shortening and the subseqent Stroke Volume according to the Starling law? |
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Definition
| Ventricular End-Diastolic volume. |
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Term
| When the ventricular diastolic pressure falls below the RA pressure what happens? |
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Definition
| The Tricuspid Valve opens. This results in passive filling of the right ventricle. This period is termed EARLY DIASTOLE or the rapid filling phase. |
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Term
| What phase preceeds the opening of the tricuspid valve? |
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Definition
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Term
| What phase preceeds the opening of the pulmonic valve? |
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Definition
| Isovolumetric Contraction |
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Term
| During Isovolumetric contraction which valve opens. |
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Definition
| None...however just after Isovolumetric contraction during Rapid ejection the Pulmonic valve opens...this is the beginning of the Rapid ejection phase. |
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Term
| The Pulmonary Artery Pressure is divided into how many pahses? |
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Definition
| TWO: Systole and Diastole. Systole begins with the opening of the pulmonic valve, resulting in rapid ejection of blood into the pulmonary artery. On the PA pressure tracing this is seen as a sharp rise in pressure, followed by a decline in pressure as the volume decreases. |
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Term
| What causes the notch on the downslope of the PA pressure termed the dicrotic notch? |
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Definition
| the Pulmonic Valve SNAPS SHUT. |
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Term
| The Pulmonary Artery Pressure is divided into two phases...what marks the division of these two phases? |
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Definition
| Systole and Diastole is divided by CLOSURE OF THE PULMONIC VALVE. Diastole follows closure of the pulmonic valve. |
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Term
| What causes the dicrotic notch in the Pulmonary Artery Pressure tracing? |
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Definition
| the PULMONIC Valve SNAPS SHUT. |
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Term
| The PA diastolic value is the end-diastolic pressure just prior to the next systole. What does this value correspond to and what is the normal range? |
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Definition
| The end-diastolic PA pressure correspond closely to the LV end-diastolic pressure (L-Vedp)in the absence of pulmonary disease or mitral valve disease. Normal PA end-diastolic pressure is 8-12 mm Hg. |
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Term
| What is the ECG correlation for the Pulmonary Artery Pressures? |
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Definition
| The PA pressure should occur in the QT interval of the ECG and the Dicrotic notch should occur after the T wave. |
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Term
| The PAedp correlates closely with what other pressure? |
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Definition
| The PAW pressure. This allow one to safely monitor the the PAedp as a reflection of the LVedp and avoid obtaining repeated PAW pressures with its inherent risks of damage to the pulmonary vasculature, including hemorrhage, ischemia, and pulmonary infarction. |
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Term
| What does the PAWP (wedge pressure) reflect? |
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Definition
| The LEFT ATRIAL (LA) pressure and has similar contour and characteristics as the right atrial pressure (a, c, and v waves with x and y descents). The contours are the same however the pressure of the PAW pressure is normally higher. |
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Term
| What is the normal resting PAW mean pressure? |
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Definition
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Term
| List causes of an ELEVATE PAW pressure>>> |
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Definition
| LV failure; MS and/or MR; Cardiac tamponade; Constrictive pericarditis; Volume overload. |
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Term
| What is the normal "MAP" (mean arterial pressure? |
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Definition
70-90 mm (80mm).
MAP = Cardiac output X Systemic Vascular Resistance. |
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Term
| Describe Pulsus bisferiens... |
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Definition
an arterial pulse with two distinct systolic peaks found in pts with
aortic regurgitation or , more commonly, HOCM. |
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Term
| Describe Pulsus alternans... |
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Definition
a REGULAR ALTERNATING PATTERN of changes in pressure pulse amplitude, WITH EVERY OTHER PULSE being slighgly greater than the previous one. It is usually a result of alternating ventricular contractility and subsequent stroke volume.
LV FAILUE pts have this. and temporary dysrhythmic periods. |
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Term
| Describe Pulsus paradoxus... |
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Definition
first described by Kussmaul...
a paradoxical disappearance of peripheral arterial pulsations during inspiration despite continued regular heart beats. When the Systolic pressure declines MORE THAN 10mm Hg during INSPIRATION then Pulsus paradoxus exists. CARDIAC TAMPONADE is classic. |
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Term
| In severe Aortic Stenosis what is the peak gradient across the valve? |
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Definition
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