Hemodynamics

Question 1

HD instability is a mismatch

Answer 1

between 02 delivery and demand

Question 2

CO=

Answer 2

SV x HR

Question 3

Normal CO/CI

Answer 3

CO: 4-8
CI: 2-4

Question 4

normal SvO2

Answer 4

60-80% mixed venous saturation

Question 5

Normal CVP

Answer 5

2-8 (central venous pressure)

Question 6

Normal PAP

Answer 6

20-25/8-10 (pulmonary artery pressure)

Question 7

Normal PCWP

Answer 7

4-12

Question 8

Normal SVR

Answer 8

900-1400 (systemic vascular resistance)

Question 9

Normal PVR

Answer 9

150-300 (pulmonary vascular resistance)

Question 10

Normal ScVO2

Answer 10

70% subclavian venous saturation

Question 11

Beta 1

Answer 11

acts on the heart, agonist, increase chronotropy (HR) and inotropy (contractility)

Question 12

Beta 2

Answer 12

acts on bronchioles/blood vessels- agonist- vasodilator

Question 13

Alpha 1

Answer 13

works on blood vessels- agonist- vasoconstrictor

Question 14

Dopaminergic 1, D2

Answer 14

works on the heart- agonist- increase chronotropy and inotropy

Question 15

Dopaminergic D4 D5

Answer 15

acts on the blood vessels, agonist vasoconstriction

Question 16

Vasopressin 1

Answer 16

acts on the blood vessels agonist causing vasoconstriction

Question 17

causes of inadequate LV filling (preload)

Answer 17

tachycardia/dysrhythmias, valvular stenosis, tamponade, pericarditis, hypovolemia

Question 18

causes of inadquate LV ejection (contractility)

Answer 18

coronary artery disease: ischemia, infarct causing regional wall motion abnormality, negative inotropes: BB, CCB

Question 19

right ventricular hemodynamic

Answer 19

CVP, RAP: normal 2-8

Question 20

left ventricular hemodynamics

Answer 20

PCWP/PAD

Question 21

causes of increase in preload

Answer 21

bradycardia
tricuspid/mitral valve regurg
hypervolemia

Question 22

cause of decrease in preload

Answer 22

tachycardia
tricuspid/mitral valve stenosis
hypovolemia

Question 23

systemic vasodilators; decrease SVR

Answer 23

• ace/arbs
• hydralazine
• carvedilol, labetaolol (with alpha receptor antagonistic)
• nitroprusside
• calcium channel blockers

Question 24

pulmonary vasodilators; decrease PVR

Answer 24

• nitric oxide; inhaled
• prostaglandins- inhaled; flolan, velitri, tyvaso
• phosphodieterase inhibitors- sildenafil, tadalfil (oral)
• endothelin receptor antagonist (relax vascular in pulmonary bed) : bosenten, macitentan

Question 25

PA catheter uses

Answer 25

- gives information on filling pressures, cardiac function and SVO2 (head and feet)-- mixed venous - utilized for differentiating shock states - titration of IV/inhaled vasodilators for pulmonary HTN - after CT surgery or management of cardiogenic shock - massive or submassive PE for CDL (catheter directed lysis)

Question 26

Phenylephrine

Answer 26

- alpha 1 adrenergic agonist - uses: distributive shock, hypotension with tachycardia - good for post anesthesia can give IVP - adverse effects: splanchnic hypoperfusion

Question 27

Norepinephrine

Answer 27

- mixed alpha 1 and beta 1 adrenergic agonist - uses: distributive shock - adverse effects: arrhythmias, peripheral vasoconstriction

Question 28

epinephrine

Answer 28

- mixed alpha 1 and beta 1 adrenergic agonist - uses: distributive shock, cardiac arrest, anaphylaxis, heart block, bradycardia - adverse effects: splanchnic hypoperfusion, increased myocardial oxygen demand

Question 29

Dopamine

Answer 29

- mixed dopaminergic, beta 1, alpha 1 adrenergic agonist (dose dependent) - uses: distributive shock, bradycardia - adverse effects: tachycardia, cardiac arrhythmias

Question 30

Vasopressin

Answer 30

- V1 receptor agonist - uses: refractory septic shock, GI bleeding, DI - adverse effects: splanchic hypoperfusion

Question 31

Dobutamine

Answer 31

- beta 1 adrenergic receptor agonist - uses: cardiogenic shock, decompensated HF adverse effects: hypotension, increase myocardial oxygen demand

Question 32

Milrinone

Answer 32

- phospdiasterase 3 inhibitor - uses: cardiogenic shock, decompensated HF - adverse effects: hypotension, thrombocytopenia, arrhythmias

Question 33

isoproterenol

Answer 33

- beta 1 and beta 2 adrenergic receptor agonist - uses: bradyarrthymias, AV block - adverse effects: hypotension, arrhythmias