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Critical Care Hemodynamics Flashcards

(61 cards)

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1
Q

What causes “damped” arterial pressure waveforms?

A
  1. Clot in catheter
  2. Tip of catheter against vessel wall
  3. Clot in transducer
  4. Air bubbles in the line
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2
Q

Conditions that can cause an increased CVP

A

Hypervolemia, pulmonary hypertension, right ventricular failure, pulmonary valve stenosis, tricuspid valve stenosis, pulmonary embolism, arteial vasodilation, left side heart failure, improper transducer placement, positive pressure ventilator breath, severe flail chest, pneumothorax

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3
Q

Conditions that can cause a decreased CVP

A

Hypovolemia, vasodilation, leaks or air in line, improper transducer placement

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4
Q

Conditions that can cause increased PAP

A

Pulmonary hypertension, mitral valve stenosis, left ventricular failure

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5
Q

Conditions that can cause a decreased PAP

A

Decreased PVR, hypovolemia

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6
Q

PAWP is a measure of what function?

A

Left atrial pressure

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7
Q

Conditions that cause increased PCWP

A

Left ventricular failure, mitral valve stenosis, aortic stenosis, systemic hypertension

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8
Q

Conditions that cause a decreased PCWP

A

Hypovolemia, pulmonary embolus (PCWP could also be normal)

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9
Q

What is the normal value for CVP?

A

Less than 8 cmH2O or less than 6 mmHg

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10
Q

What is the normal value for PAP?

A

20 to 30 mmHg/5 to 15 mmHg

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11
Q

What is a normal Mean PAP?

A

10 to 20 mmHg

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12
Q

What is the normal value for PAWP?

A

4 to 12 mmHg

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13
Q

What % of cadiac output makex up the intrapulmonary shunt in a healthy individual?

A

2% - 5%

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14
Q

What are some conditions that increase physiologic shunting?

A

Pneumonia, pneumothorax, pulmonary edema, atelectasis

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15
Q

What are some factors that cause an increased SVR?

A

Vasoconstrictors (dopamine, epinephrine), hypovolemia, decreased PaCO2, septic shock (late stages)

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16
Q

What are some factors that cause a decreased SVR?

A

Vasodilators, increased PaCO2, septic shock (early stages)

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17
Q

What are some factors that cause an increased PVR?

A

Vasoconstrictors, increased PaCO2, hypoxemia, pulmonary embolism, pneumothorax, positive pressue ventilation, PEEP, CPAP

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18
Q

What are some factors that can cause a decreased PVR?

A

Vasodilators, hyperoxemia, decreased PaCO2, alkalemia

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19
Q

What can cause increased O2 consumption?

A

Hyperthermia, exercise, seizures, shivering

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20
Q

What can cause decreased O2 consumption?

A

Hypothermia, cyanide poisoning, musculoskeletal relaxation

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21
Q

Define hemodynamics

A

The measurement and monitoring of factors that influence the force and flow of blood through the body; especially the heart and lungs.

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22
Q

What is preload?

A

The prezsure or volume of blood in the ventricles at end diastole. Right ventricle preload is RAP, Left ventricle preload is PCWP.

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23
Q

What is afterload?

A

Total force (diastolic pressure and resistance) opposing ventricular ejection. Right afterload is PVR, left afterload is SVR

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24
Q

What is stroke volume?

A

The volume of blood ejected from the ventricles with each contraction.

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25
Define inotropic
An agent that alters cardian contractility
26
Define chronotropic
An agent that alters heart rate
27
What does the dicrotic notch represent when measuring PAP?
The closure of the pulmonic valve. It is used to determine tbe conclusion of systole and the begining of ventricular diastole.
28
What does the dicrotic notch represent when measuring systemic arterial pressure?
The closure of the aortic valve
29
What is atrial kick?
Atrial systole; atria contract and push remaining blood into ventricles
30
What is PVR?
Pulmonary vascular resistance. A number that can be usdd to evaluate the vascular component of the afterload of the right ventricle.
31
What is systemic vascular resistance?
A number that can be used to evaluate the vascular component of the afterload of the left ventricle.
32
Define ejection fraction
% of end diastolic blood volume ejected with each heartbeat that providez an estimate of ventricular contractility.
33
What is the normal ejection fraction range?
65 - 75% At less than 30% exercise tolerance is limited and heart cannot maintain adequate cardiac output.
34
How do you calculate cardiac index?
cardiac output divided by BSA
35
What is Starlings law?
The more the heart is filled, the greater the contractile force and stroke volume, within physiological limits.
36
What is venous return?
The blood returning to the heart via the inferior and superior vena cave and the coronary sinus.
37
What is pulse pressure?
The difference between systolic and diastolic pressure.
38
What is the normal value for pulse pressure?
40 mmHg - less than 40 mmHg may indicate hypovolemia.
39
What ate the indications for placing an arterial line?
severe hypotension (shock) severe hypertension unstable respiratory failure patients needing frequent ABGs
40
Define hypertension
Pressures greater than 140/90
41
Define hypotension
Pressures less than 90/60
42
What are some causes of hypotension?
hypovolemia cardiac failure vasodilation
43
What are some causes of hypertension?
hypervolemia increased contractility vasoconstriction
44
What is Mean Arterial Pressure?
The average pressure pushing blood through the systemic system.
45
How do you calculate MAP?
stystolic pressure + (diastolic pressure x 2) divided by 3
46
What is the normal range for MAP?
80 - 100 mmHg | Circulation compromised if MAP is less than 60 mmHg, can lead to vital organ failure.
47
Complications of decreased MAP
ischemia hemorrhage infection
48
What are the indications for placing a CVP catheter?
assess the circulating blood volume evaluate right ventricular function assess venous return guide fluid therepy in CHF and hypovolemic patients
49
What waves are found in a CVP waveform?
a waves - result from atrial contraction (large a waves called "cannon waves" occur in 3rd degree heart block) c waves - occur during ventricular systole at the completion of AV (tricuspid) valve closure. v waves
50
How does mechanical ventilation affect CVP waveforms?
Pressures on the CVP waveform increase with mechanical vetilation, and decrease during spontaneous breathing.
51
What other pressure does CVP correlate to?
RAP (right atrial pressure)
52
What information does CVP give us?
It reflects the balance between the ability of the right ventricle to pump blood out of the right atrium and ventricle and the amount of venous return.
53
What is the normal CVP value?
2 - 6 mmHg
54
What causes an elevated CVP?
Right heart failure and increased venous return. * hypervolemia * positive pressure or pneumothorax * constrictive pericarditis or cardiac tamponade * pulmonary hypertension * chronic left ventricular failure * stenosis * pulmonary embolism
55
What causes a low CVP?
Increased pumping of the right heart and decreased venous return. * vasodilation * hypovolemia
56
What is CVP?
pressure of the blood in the right atrium or superior vena cava, where blood is returned to the heart from the venous system.
57
What happens to CVP when the ability of the right heart to move blood thru the lung decreases?
It rises
58
What other pressure does CVP parallel?
PCWP in patients with a HEALTHY heart.
59
What are the complications associated with placing a CVP line?
* bleeding and pneumothorax during insertion | * infection is the most common problem over time
60
What are the indications for placing a PA catheter?
The decision to place a PA catheter is decided on a case by case basis, no set group. Possible candidates are those with cardiogenic pulmonary edema and shock, ARDS, and those who have had major thoracic surgery.
61
PA catheter description
multiple lumens and a balloon at the distal tip. The balloon helps float the catheter in place.

Respiratory (2 decks)

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