Hemodynamics and Ventricular Function: Clinical Application Flashcards Preview

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Flashcards in Hemodynamics and Ventricular Function: Clinical Application Deck (36):
1

pulmonary artery (PA) catheter

aka PA line or Swan-Ganz catheter

consists of:

balloon tip with thermistor

computer input

pulmonary artery pressure port

right atrial pressure port (medication infusion)

balloon port (inflate and deflate balloon)

2

uses of the PA catheter

determine cause of pulmonary edema (cardiogenic vs. non-cardiogenic)

determine type of shock (cardiogenic vs. hypovolemic vs. distributive)

determine cardiac output

3

contraindications for the PA line

vascular access issues

left bundle branch block

acuse pulmonary embolism, right atrial thrombus, or right ventricular thrombus or mass

4

process of inserting the PA line

can be done without x-ray guidance

look at pressure waves:

big step-up in ventricles

diastolic pressure steps up in PA

A and V waves in the pulmonary wedge

5

normal CO

4-8 L/min

6

normal CI

2.5-4.0 L/min/m2

7

normal SV

50-100 mL

8

normal SVI

25-50 mL/m2

9

normal SVR

800-1200 dynes-sec/cm5

10

normal PVR

<240 dynes-sec/cm5

11

tall atrial A waves

tricuspid stenosis

pulmonic stenosis

pulmonary HTN

cor pulmonale

12

cannon A waves

AV dissociation

13

absence of A waves

atrial fibrillation

14

prominent C wave

1st degree AV block

15

prominent C-V wave

tricuspid regurgitation

16

priminent X and Y descent

constrictive pericarditis

restrictive cardiomyopathy

17

blunting of the Y descent

cardiac tamponade

18

What is the pulmonary capillary pressure ann estimate of?

LA pressure, estimating LV EDP if the mitral valve is normal

19

Fick cardiac output

based on arteriovenous oxygen difference

CO = [O2 consumption]/[1.34 x 10 x Hgb x (arterial O2 sat - mixed venous O2 sat)

20

thermodilution (TD) cardiac output

thermistor on the distal tip of the PA line

cold saline injection at the RA and then temperature is measured over time

area under the curve = cardiac output

21

SVR equation

[(mean arterial pressure - central venous pressure)/cardiac output] x 80

22

PVR equation

[(mean pulmonary artery pressure - PCWP)/cardiac output)] x 80

23

RA pressure, CO, and SVR in cardiogenic shock

RA pressure increases

CO decreases

SVR increases

24

RA pressure, CO, and SVR in septic shock

RA pressure decreases

CO increases

SVR decreases

25

RA pressure, CO, and SVR in cardiogenic shock in hypovolemic shock

RA pressure decreases

CO decreases

SVR increases

26

mean arterial pressure equation

MAP = (SBP + 2*DBP)/3

27

pulse pressure equation

SBP - DBP

28

blood pressure, CO, and TPR

BP = CO x TPR

29

SV, CO, and HR

CO = HR x SV

30

pressure, resistance, and flow

resistance = pressure/flow

31

negative effects of too much preload

increased back pressure and congeestion

increased resistance to subendocardial blood flow

increased myocardial oxygen demand

32

determinants of ventricular compliance

filling volume (-)

wall thickness (-)

ventricular size (+)

33

core hemodynamic variables

SV - pump performance

CO - blood flow

RA pressure (CVP) - RV filling pressure

PCWP - LV filling pressure

SvO2 - tissue oxygenation

34

rule of 6s

RA < 6 mmHg

RV < 30/6 mmHg

PA < 30/12 mmHg

PCWP < 12 mmHg

35

SvO2 normal range

60% to 80%

any lower, threat to tissue oxygenation

higher can also represent thret to tissue oxygenation

36

causes of cardiogenic shock

acute MI, acute PE, cardiac tamponade, CHF exacerbation