Term
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Definition
| The place where the imaginary lines drawn to locate the right atrium (RA) intersect |
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Term
| A Right heart cath procedure is done to evaluate how the blood circulates in people who have what? |
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Definition
•Abnormal pressures in the heart arteries
•Burns
•Congenital heart disease
•Heart failure
•Kidney disease
•Leaky heart valves (valvular regurgitation)
•Shock |
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Term
| A right heart cath can also be used for what? |
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Definition
-monitor for complications of heart attack and to see how well certain medications are working
-to detect abnormal blood flow between two usually unconnected areas
-can also be used to diagnose or evaluate; Cardiac tamponade, Pulmonary hypertension, Restrictive cardiomyopathy |
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Term
| Risks of right heart cath |
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Definition
–Bruising around the area where the catheter was inserted
–Injury to the vein
–Puncture to the lung if the neck or chest veins are used, causing lung collapse (pneumothorax) |
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Term
| Very rare complications for right heart cath |
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Definition
–Cardiac arrhythmias
–Cardiac tamponade
–Embolism caused by blood
–Infection |
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Term
| What is the distal port on the Swan-Ganz used for? color? |
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Definition
–Measures pressure during insertion
–Measures PA or PCW pressures
–Infusion of medications at slow rate
–Sample of blood for mixed venous O2 content and related calculations
–Designated by yellow hub |
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Term
| What is the proximal port on the Swan-Ganz used for? color? |
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Definition
–Medication infusion
–Injection port for thermodilution cardiac output
–Designated by the blue hub
–Located 30 cm from the catheter tip |
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Term
| What is the thermister on the Swan-Ganz used for? |
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Definition
–Thermoelectrical transducer to measure temperature change
–Measures core temperature
–Measures temperature changes during thermodilution cardiac output |
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Term
| Describe the ballon on the Swan-Ganz catheter |
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Definition
–Located at the catheter tip
–Made of latex (allergy warning!!)
–Capacity of 1.5 cc of air
»In presence of shunt, use CO2 to inflate the balloon
»Do not ever force air into balloon or force expiration; inflate balloon only to allow passage or until PCWP waveform appears |
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Term
| Clinical uses for the Swan-Ganz catheter |
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Definition
–Right heart pressure monitoring
–Left heart pressure monitoring
–Mixed venous blood samples
–Cardiac output measurement
–Volume assessment and infusion
–Medication administration
–Pacing |
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Term
| Fluoroscopy is preferred for positioning when? |
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Definition
| femoral insertion or if there is an implanted device in the right heart |
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Term
| Pressure tubing should never be longer than what? |
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Definition
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Term
| What is the standard scale for AO and LV? |
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Definition
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Term
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Definition
-Pressure inside the fluid filled vessel
-To do this, the dynamic and hydrostatic pressure must be eliminated |
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Term
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Definition
-Kinetic energy of the moving fluid
–Encountered in arterial pressures when the catheter tip directly faces the flow of blood |
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Term
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Definition
-Difference in height between the ends of the fluid filled tube
–Difference in height between the ends of the fluid-filled tube
–Difference in height of the tip of the catheter and the air reference port of the transducer |
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Term
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Definition
| Senses a biophysical event and converts it to usable electrical signal |
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Term
| An electromechanical device that senses and converts a biophysical event (applied pressure) into an electrical signal |
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Definition
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Term
| Most common type of transducer |
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Definition
-Piezoelectric
–As the crystals are compressed they create voltages
–Voltages created are proportional to the pressure applied to the crystal |
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Term
| What is atmospheric pressure usually at sea level? |
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Definition
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Term
| Physiologic measurements are made relative to atmospheric pressure by doing what? |
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Definition
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Term
| For pressure tubing the tubing should be no smaller than? |
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Definition
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Term
| The amount of damping is _________ to the size of the clot or bubble |
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Definition
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Term
| How do you balance the monitor? |
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Definition
| with the transducer open to zero, it balances the monitor to the atmospheric pressure |
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Term
| The atrial waveform follows the P wave by how long? |
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Definition
.06 seconds
usually seen in the PR interval |
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Term
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Definition
| Bulging of the A-V valve leaflets into the atria during isovolumetric contraction |
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Term
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Definition
•Decline on atrial pressure following atrial kick
•Atrial relaxation
•A-V valves close |
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Term
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Definition
•Increased atrial pressure due to venous return
•Passive filling of the atria while A-V valves are closed
•A-V valves open – LV filling pressure lower than atrial pressure |
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Term
| 90% of VO2 is used where? |
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Definition
| Isovolumetric contraction |
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Term
| Reflection of the end diastolic volume (preload) |
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Definition
| Ventricular end diastolic pressure (VEDP) |
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Term
| Coronary artery perfusion occurs during this phase |
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Definition
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Term
| Transmembrane action potential Phases |
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Definition
–Phase 4 – immediately before excitation
–Phase 0 – depolarization
–Phase 1 – repolarization begins
–Phase 2 – depolarization
–Phase 3 – repolarization
–Phase 4 – restoration of ionic balance |
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Term
| Normal range for pulse pressure |
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Definition
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Term
| Pulsus Bisferiens caused by? |
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Definition
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Term
•One large pulse followed by one small pulse
•Amplitude varies from beat to beat with weak and strong pulse beats; no gap between beats |
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Definition
Pulsus Alternans
•Associated with:
–Congestive heart failure
–Cardiomyopathy |
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Term
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Definition
•Two beats in rapid succession followed by longer interval
•Beat after compensatory pause is accentuated due to increased diastolic filling time (preload) and subsequent increase in contractile force
•Easily confused with pulsus alternans (differentiated by gap between sets of beats)
•Regularly occurring premature ventricular contractions |
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Term
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Definition
•Decrease in amplitude and increase in systolic ejection rate
•“Low and slow”
•Associated with aortic stenosis |
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Term
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Definition
Aortic insufficiency
–Widened pulse pressure
–Rapid upstroke followed by rapid collapse early in diastole with absence of dicrotic notch |
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Term
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Definition
-Change in morphology of aortic pressure tracing to that of a ventricular pressure tracing
-Also associated with lower systolic and diastolic pressures
-Occurs when cardiac catheter is inserted too far into the coronary artery during catheterization, thus limiting flow and resulting in a tracing resembling that of what is “ahead”
-Should prompt the operator to withdraw the catheter; “hit and run” for coronary angiographic shots |
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Term
| What can cause elevated "a" waves in the RA? |
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Definition
Ventricular failure
Decreased ventricular compliance
Tricuspid stenosis (most common)
Pulmonic stenosis
Pulmonary hypertension |
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Term
| What can cause elevated "v" waves in the RA? |
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Definition
Tricuspid regurgitation
Ruptured papillary muscle
Increased flow (ASD, VSD)
Atrial fibrillation |
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Term
| What can cause elevated "v" waves in the LA/PCWP? |
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Definition
Mitral regurgitation
Aortic insufficiency
Ruptured papillary muscle
Increased flow (ASD, VSD)
Atrial fibrillation |
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Term
| What can cause an overall elevation in RA pressures? |
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Definition
RV failure w/ TR or TS
LV failure, CHF
Hypervolemia
Cardiac tamponade (Xy)
Constrictive pericarditis (xY)
Pulmonary hypertension |
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Term
| What can cause an overall elevation in LA/PCWP pressures? |
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Definition
LV failure
Mitral regurgitation
Mitral stenosis
Hypervolemia
Cardiac tamponade (Xy)
Constrictive pericarditis (xY) |
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Term
| Elevated “a” and “v” with very prominent “x” and “y” descent seen in what? |
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Definition
| constrictive pericarditis (may also see Kussmaul’s sign) |
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Term
| Very short “y” descent seen in what? |
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Definition
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Term
| What are causes for increased RV systolic pressures? |
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Definition
Pulmonary hypertension
Pulmonic stenosis
ASD / VSD (L→R shunt)
Increased PVR |
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Term
| What are causes for increased LV systolic pressures? |
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Definition
Systemic hypertension
Aortic stenosis
ASD / VSD (L→R shunt)
Increased SVR |
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Term
| What are causes for increased RV diastolic pressures? |
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Definition
RV failure
Constrictive pericarditis
Cardiac tamponade
LV failure w/ pulmonary edema or congestion
Any systolic factors |
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Term
| What are causes for increased LV diastolic pressures? |
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Definition
LV failure
Constrictive pericarditis
Cardiac tamponade
Any systolic factors |
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Term
| What are causes for increased EDP? |
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Definition
Heart failure
Hypervolemia
Hypertrophy
Decreased compliance
Cardiac tamponade
Constrictive pericarditis |
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Term
| What are causes for decreased EDP? |
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Definition
Hypovolemia
Tricuspid stenosis
Mitral stenosis |
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Term
| What are causes for increased AO pressures? |
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Definition
Systemic hypertension
Aortic insufficiency
Arteriosclerosis |
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Term
| What are causes for decreased AO pressures? |
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Definition
Low cardiac output states
Shock
Arrhythmias (i.e., PVC’s)
LV failure
Aortic stenosis
Coarctation of the aorta |
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Term
| If PCWP is greater than LVEDP think what? |
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Definition
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Term
| What can cause wide pulse pressures? |
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Definition
Arterial hypertension
Aortic insufficiency
Large left-to-right shunt |
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Term
| What can cause narrow pulse pressures? |
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Definition
Aortic stenosis
Heart failure
Cardiac tamponade
Shock |
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Term
| What causes bigeminal pulse? |
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Definition
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Term
| What is Pulsus Alternans associated with? |
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Definition
-congestive heart failure
-cardiomyopathy |
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Term
| What is pulsus parvus e tarvus associated with? |
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Definition
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Term
| What is associated with the square root sign in the waveforms? |
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Definition
-Restrictive cardiomyopathy
-Constrictive pericarditis
-Underdampened CHF
-Artifact (e.g., bradycardia) |
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Term
| Why do you not normally see a "c" wave in PCWP waveform? |
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Definition
| Due to the retrograde pressure reading it is absorbed by the pulmonary vasculature |
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Term
| If atrial contraction occurs during ventricular contraction, results in what? |
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Definition
cannon “a” wave
–2nd or 3rd degree heart blocks |
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