Hemodynamics Flashcards by Navraj Malhi

What is Fick CO formula?

O2 consumption / (1.36) x Hb x (SaO2 - MVO2)

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For what 2 situations is Fick better than Thermodilution?

For low Cardiac Output and AF

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What is calculation of BSA?

BSA = Square Root ((Ht CM) x (Wt KG) / 3600))

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What is calculation of Cardiac Index?

CI = (HR x SV) / BSA

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What is formula for TPG?

TPG = (mPAP - PCWP)

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What is the Gorlin Equation for AVA?

AVA = CO / SEP x HR x 44.3(Square root(MG))

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What is the Gorlin equation for MVA?

MVA = CO / DFP * HR * 0.85 * 44.3(Square Root)(MVG))

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What is the Hakki Formula for AVA?

AVA = CO / Square root: MG

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How to use Hakki formula when HR > 90

Divide AVA / 1.35

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When to be concerned about shunt? (O2 step up)

> 8% step up

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What is formula for MVO2?

MVO2 = 3(SVC O2) + (IVC O2) / 4

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What is Pulmonary Blood Flow formula?

Qp = O2 consumption / 1.36 x Hb x (PvO2 - PaO2)

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What is calculation for Systemic Blood Flow?

Qs = O2 Consumption / 1.36 x hb x (SaO2 - MVo2)

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What is simplified way to calculate Qp/Qs (if no O2 consumption given) ?

Qp/Qs = (SaO2 - MvO2) / (PvO2 - PaO2)

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What is large Shunt via Qp/Qs?

> 2

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What is the Dicrotic notch for Aortic HD curve?

Dicrotic notch from elastic recoil of Ao after the AoV closes

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What is the Anacrotic notch for Aortic HD curve?

Anacrotic notch from percussion wave of LV systole

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What are 4 things you see on Aortic curve in Aortic Stenosis?

-Exaggerated Anacrotic notch
-Delayed upstroke
-Late peaking
-Persistent systolic gradient

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What happens to Pulse Pressure post PVC?

No change (or increased)

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What is Carabello’s sign?

> 10mmhg increase in arterial BP during pullback = critical Aortic Stenosis

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What two thing seen in Acute AR in LV? 3 in Ao?

-LV: Rapid rise of LV DBP, Increased LVEDP

-Ao: Rapid decline in Ao DBP, No dicrotic notch, small increase in pulse pressure

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What are seen in two things in chronic AR seen in LV? Ao?

-LV: Increased LV SBP, Normal LVEDP

-Ao: Low Ao DBP, Wide pulse pressure

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What are two things seen in LA curve in Mitral Stenosis?

-Increased Mean LA Pressure
-Persistent LA-LV gradient

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What is hallmark of Acute MR?

-Giant CV waves ( > 3x mean LA Pressure) and Increased PA pressure

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What is difference between Acute and Chronic MR?

In Chronic MR: CV waves there but 2x mean LA pressure not 3x -Normal LV/Ao curve where as systolic pressure lower in acute MR (decreased CO, more RF/Rvol)

What are three HD findings seen in RA during Constriction?

-M configuration (Prominent Y descent with preserved X descent) -High pressures -Respiratory change in pressure < 3mmhg (Kussmauls sign)

What are 4 ventricular findings and 1 PASP finding in CP?

-LVEDP - RVEDP < 5mmhg -Rapid LV early diastolic filling > 7mmhg (square root sign) -Ventricular interdependence -High RVEDP (> 1/3 RVSP) -PASP < 55mmhg

What are two things seen in Aortic tracing with HoCM?

-Spike and dome: Rapid upstroke with rapid decrease at onset of mid-systolic obstruction, then subsequent gradual increase during late systole -Brochenbrough-Braunwald sign

Review normal BP and HR response with Valsalva

How is Valsalva BP different with Systolic dysfunction?

It's flat or increases with Valsalva

How does Valsalva response differ in HOCM?

There is no overshoot phase

What is Elastance on PV loops?

Pressure / Change in Volume

What is Compliance in PV loops?

Change in Volume / Pressure

What will increased Preload do to SV and LVESV?

-Increased SV and constant LVESV

What will increased Afterload do to SV and LVESV?

Decreased SV and Increased LVESV

What will increased Contractility do to SV and LVESV?

Increased SV and Decreased LVESV

What will Systolic dysfunction due to ESPVR?

It will bring it down/Decrease the slope

What will Diastolic dysfunction do to EDPVR?

It will decrease Compliance/ bring up the slope

What will HCM do to the PV loop?

Decreased LV volume will shift the curve to the left Increased contractility will shift the ESPVR left and upward Decreased Stroke Volume

What does Dilated CMO do to PV loop?

Increased LV volume -> EDPVR shifted right Decreased contractility -> ESPVR shifted right and downwards Decreased stroke volume

What does Restrictive CMO do to PV curve?

-Increased LVEDP -> EDPVR shifted upwards -Normal or slightly decreased contractility -Decreased stroke volume

What is this?

PA stenosis/PS/RVOT obstruction

What is this?

Tricuspid Stenosis

What is this?

Mitral Stenosis

What is this?

LV intracavitary obstruction

What is this?

Aortic Insufficiency

What is this?

Severe TR -> Ventriculization of the RA

What is this?

Constrictive Pericarditis

What is this?

Constrictive Pericarditis -> Square Root Sign Rapid filling sign > 7mmhg

What is this?

Prominent Y Descent/M Sign -> Constriction

What is this?

Aortic Stenosis

What is this?

Severe Tricuspid Stenosis

What is this?

Spike and dome pulse -> HoCM

What is this?

Severe PR

What is this?

LA tracing showing giant V waves -> Acute MR

What is this?

Severe Acute MR (Ventricularization of the LA waveform)

What is this?

Aortic waveform with IABP

What is this?

Giant cV waves -> MR, low pulse pressure -> Cardiogenic shock

What is this?

PA stenosis

What is this?

PA stenosis

What is this?

M sign + Kussmaul's -> Constrictive Pericarditis

What is this?

Aortic Coarctation

What is this?

Pulsus Paradoxus -> Shock

What is shown here? What procedure was done?

Pericardicentesis Note that Y descent was blunted and then becomes normal

What does the interval from the A -> C wave represent?

The PR interval

What should RAP equal?

RVEDP if no Tricuspid stenosis

What is the arrow pointing at?

Dicrotic notch of PA

What is different about the PCWP representing LA vs the RA waveform?

Indirect, there is a significant delay from electric signal to transmit the wave form

What lung zone does the PCWP most accurately reflect LA pressure?

Zone 3 (lower)

What is the most specific sign of a quality wedge?

O2 saturation > 90% Others: -Presence of well defined a and v waves -Distinct abrupt rise in mean pressure is observed when the balloon is deflated or the catheter is withdrawn

What is the relationship between PCWP and PADP?

about the same or PCWP is 0-5mmhg lower than PADP

Name 4 reasons that PCWP would not accurately represent LVEDP?

-MS -AR -MR -PV obstruction/stenosis

What are 4 things that affect Thermodilution and in which way?

-TR: Underestimate -Shunt: Underestimate -Low CO: Overestimate -Afib/Irregular R-R: Either way