quarter 1 basics

CO equation

co = HR x SV

HR and SV relationship

inverse so inc HR dec SV to maintain the CO

normal CO indexed

2.5 - 4

Tachycardia (inc HR so dec SV) is caused by 

Hypovolemia, low BP, fight/flight or a fever

bradycardia (dec HR so inc SV) is caused by

arrhythmias, heart blocks or MI

if the HR >180 in a healthy person

the heart is beating too fast leaving no time for the ventricles to fill so SV cant compensate and CO will dec

SV depends on

preload, afterload and contractility

preload

how much the ventricles can fill/stretch so its affected by blood Volume/distribution and will inc with Fluid Overload (regurgitation)

inc preload causes 

dilation and volume overload patterns

Frank Starling Law

inc Preload = inc Stretch = Inc Contraction so if more blood enters the ventricle more
contraction force is required to eject that blood

afterload

resistance the heart faces so it inc with systemic HTN (LV), pulmonary HTN/COPD (RV) or stenosis and causes hypertrophy which can lead to enlargement as the muscles give out

how afterload affects the atria

anything that inc LVEDP can cause the atria to dilate

VTI measures

how far blood travels back in a time period

PAP should be

<25 (>35 is abnormal)

if the heart is boot shaped

move up

continuity equation (gives AVA)

AVA = lvot x lvot VTI / AV VTI

TAPSE vs TDI of the Right heart

tapse measures how far the annulus moves toward the apex in systole while TDI measures the velocity of the annulus toward the apex

MCConnell's Sign indicates

acute PE (hypokinetic RV but the apex dips down)

CVP (central venous P) is the same as

RAP

TV vs MV

the TV is more apical 

Bernoulli Equation (finds PAP)

PAPs = 4 V^2 + RAP

max normal aov velocity 

<2.5m/s (severe >400)

HF findings

dec ventricular function, ventricular enlargement and possible regurgitation

left heart failure symptoms

breathing symptoms and fluid retention (from a backup of blood) causing weight gain/edema

how the heart will compensate for HF

inc HR to maintain co, hypertrophy from inc P or LVE to inc preload

hypertrophy is usually associated with 

HFpEF since the large ventricles leave little room to fill causing diastolic dysfunction

enlargement is usually associated with

HFrEF since the walls are thin and cant contract to push more blood out causing systolic dysfunction

exertional angina is associated with a 

70% reduction 

resting angina is associated with a

90% reduction

Prinzmetal’s Variant Angina is caused by

coronary spasm (usually from drug use)

Prinzmetal’s Variant Angina can occur in

normal coronaries or adjacent to atherosclerosis

ST depression is associated with 

acute coronary syndrome, hypertrophy or bundle branch blocks

STEMI will have inc

enzymes, creatine kinase and troponin

MI can cause

MR, pericardial effusion, aneurysm or VSD

% of people with Sudden cardiac death who die

80%

4-6 weeks after a MI can cause

LV wall thinning with inc echogenicity

Plaque vs thrombus

Plaque forms on artery walls while thrombus forms in areas of stasis

complete occlusion causes a

STEMI

LA

RA

RV

most severe arrhythmia

vent fib

arrhythmia with a sawtooth pattern

a flutter

where should you measure for patients with a Sigmoid Septum

slightly apically

systolic click murmur indicates

MVP

what week is the heart fully developed

week 7

grade 3 diastolic dysfunction occurs when

E/A >2 (should be <0.8)

E/e’ should be

<14

septal e’ should be

>7 and lateral e’ should be >10

TR velocity should be 

<2.8m/s

HFpEF parameters for diastolic dysfunction (only need 50% or more to occur)

E/e’ >14, septal e’ <7, lateral e’ <10, TR >2.8 and LA >34

grade II diastolic dysfunction occurs when (only need 2-3 to occur)

E/e’ >14, TR >2.8 or LA >34 (if only 1 is true then grade I)

AR PHT

>500 is mild but <200 is severe

AS AVA

>1.5 is mild but <1 is severe

mild MR/TR eroa is

<0.2 but severe is >0.4

systolic heart failure is caused by

dec contractility causing the heart to dilate (from MI, DCM or myocarditis)

diastolic heart failure is caused by

inc afterload causing the heart to hypertrophy (from HTN or AS)

both systolic and diastolic HF will

dec CO

E wave coordinates with

early filling

when measuring E wave use

time not slope

normal e wave decel time

>160

e’ refers to the 

peak velocity of the MV annulus (LV dysfunction causes dec annular motion)

e’ is affected by

LV relaxation and filling P

if E/e’ is >14 there is 

elevated LV filling P

elevated RVSP can indicate elevated

LAP

normal or grade 2 (pseudonormal)

grade 1

grade 3 restrictive (fuses with valsalva)

grade 4 fixed restrictive (doesnt change with valsalva)

valsalva

normal

equation used to find PAP is called

Bernoulli

equation used to find AVA is called

continuity