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PCCN 2024 EXAM QUESTIONS WITH 100- CORRECT ANSWERS.
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PCCN 2024 EXAM QUESTIONS WITH 100- CORRECT ANSWERS.
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PCCN 2024 EXAM QUESTIONS WITH100% CORRECT ANSWERS
S1 i- i✔✔Mitral iand itricuspid i"lub" iof i"lub idub"
S2 i- i✔✔Aortic iand ipulmonic i"dub" iof i"lub idub"
S3 i- i✔✔Ventricular iGallup. iBeginning iof idiastole iafter iS2. iToo imuch ivolume
S4 i- i✔✔Rare. iAtrial iGallup. iResistance ito ifilling. iEnd iof idiastole
1/avl/V5/v6 i- i✔✔Lateral i(Circumflex): iAVL- iHigh iLateral iV6 iLow iLateral
Less icommon/ iless isevere
II/III/avf i- i✔✔Inferior
V1/v2/ iv3/ iv4 i- i✔✔Anterior
V4R/ iV5R i- i✔✔RV
CO i- i✔✔HRXSV
SV i- i✔✔Preload/ iafter iload/ icontractility
SVO2 ifrom icentral iline i- i✔✔~=70%
Is iincreased iSVO2 igood ior ibad? i- i✔✔Bad- iit imeans ithat ithe itissues iare inot iup itaking
iO2. iThis ishould ibe i"used iblood" iso ithe inumber ishould ibe ilower
Parasympathetic iresponse i- i✔✔Slows ithings idown/ ivagal iresponse/ iatropine iblocks
ithe ivagas inerve iand ispeeds iup iHR
Betablockers i- i✔✔⬇️HR i⬇️ contractility=⬇️ BP/ i⬇️
myocardial iO2 idemand
Used iin iacute icoronary isyndrome. iCan icause iHF. iLook ifor icrackles iand iS3
One iof ithe ifirst idrugs iwe igive iwith iangina ibecause iit idecreases imyocardial iO2
iconsumption
Sympathetic iresponse i- i✔✔Speeds ithings iup/ iepi/ idopamine
, Calcium iChannel iBlockers i- i✔✔⬇️HR iand icontractility ius iin irapid irhythm. iDon't iuse iin
iACS. iAmlodapine, idilt, inicardipine
Reduce iafterload iby ilowering iintracellular iCa+ iwhich iinhibits ismooth imuscle
icontraction.
Decreases icontractility
Digoxin i- i✔✔Increase icontractility= iincreased imyocardial iO2 idemand. iTakes i6 ihrs ito
iwork. iDon't iuse iin iACS
Pulse iPressure i- i✔✔Difference ibetween iDiastolic iand iSystolic ipressures. iMust ibe iat
ileast i40. i<40 ipatient iis inot ibeing ifilled iproperly i(dry) ior ihas ivasoconstriction.
Preload i- i✔✔Volume. iMeasured iby iCVP. iHow ifull iin ithe iventricle ibefore icontraction.
How ito ireduce iPreload i- i✔✔Reduce ivolume i(diuretics)/ ivasodilation i(when iyou icant
iget irid iof ivolume: iNitro, idilt, imorphine)/ idialysis
Replace ipreload i- i✔✔Crystalloids: iNS, iisotonic, ifluid ibolus
Colloids: iHetastarch, ialbumin, iblood iproducts:Expand iintravascular ivolume. iUse iwith
icaution iin ipulmonary iedema
Blood: i⬇️ H&H, ican iincrease iafterload.
Potential iblood iadmin iproblems i- i✔✔Can iincrease iafterload
Hyperthermia iand icoagulopathy iin imassive itransfusions
Hyperkalemia i(RBCs ibreak) iand ihypocalcemia i(preservative iin iblood ibinds iwith iCa+)
Afterload i- i✔✔SVR i(800-1200), iresistance ito iventricular iejection
The imore iresistance ithe ihigher ithe imyocardial iO2 idemand
BP iis iindicator iin itele
How ito ireduce iafterload i- i✔✔Reduce iresistance: iACE, iARBs, iAlpha iagonists
i(prazosin, iphentolamine, iclonidine) iBeta iBlockers, iCalcium iChannel iBlockers
i(Nicardipine, idiltiazem)
Negative iInotropes i- i✔✔Decrease iHR iand iforce iof icontraction: ibeta iblockers, icalcium
ichannel iblockers
Positive iinotropes i- i✔✔Whip ithe iheart iinto ishape. iIncrease iContractility: iDigoxin,
iDopamine, iDobutamine, iMilrinone, iAmrinone ilactate
Last ichoice, itry ito idecrease ipre i& iafterload ifirst
Drug icommonly iused ifor ivasospasm i- i✔✔Calcium iChannel iBlockers
Intended iconsequences iof i+Inotrope itherapy i- i✔✔Increased iSV, iIncreased iEF,
iIncreased iCO, iincreased itissue ioxygenation
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