Advanced Hemodynamics Flashcards
left heart monitors
arterial line
right heart monitors
central venous catheter
swan ganz
pulmonary artery catheter
left heart vs right heart
right: pushes blood from RV out to lungs
right: deoxygenated and low pressure
left: pushes blood to muscles/circulation
left: oxygenated and high pressure
non-compliant tubing
aka low compliant, aka rigid
tubing doesn’t expand with fluid pushing through it
phlebostatic axis
at the level of the right atrium
midpoint between anterior and posterior chest, 4th intercostal space
square waveform
produced by a fast flush
over-damped system
caused by clot or air bubble
sluggish, short wave-form
one oscillation after releasing pigtail
under-damped
hyper-responsive
tall wave-form
sometimes caused by excessive tubing
many oscillations after releasing pigtail
dual/triple lumen central venous catheter
primary catheter used to interrogate right heart space
superior or inferior vena cava
pulmonary artery catheter (Swan-ganz)
distal tip in pulmonary vasculature
yellow port: stay away (PA distal lumen)
red port: stay away (balloon port)
blue port: measures CVP/RAP and CO
White: for fluid infusions
measurements on tubing need to be measured during transport to make sure catheter doesn’t move.
hypovolemic shock (hemodynamics)
hemorrhage/exsanguination
free water loss (DKA)
plasma loss
low volume
cardiogenic shock
Left ventricular dysfunction
…diastolic failure
…systolic failure
…apical ballooning
…myocarditis
Obstructive shock
cardiac tamponade
PE
Tension pneumothorax (compression)
congenital disease
Distributive shock
container fail - leak (vasodilation)
Low volume back to right side of heart
sepsis
anaphylaxis
neurogenic shock
Hemodynamic numbers (equations and norms)
Systemic vascular resistance:
[(MAP - CVP) / Q] x 80. Normal = 800-1200
Less than 800 = vasodilated
Over 1200 = vasoconstricted
Pulmonary vascular resistance:
[(mean PAP / Q) - PCWP x 80.
Normal 100-200
Over 200 = vasoconstricted
under 100 = vasodilated
Cardiac Output (Q)
Q = (SV x HR) / 1000. Normal 4-8L/min
Cardiac index (CI)
CI = Q/BSA. Normal 2-4 L/min/m3
pulmonary artery catheter measurements
Right side of heart
CVP aka right atrial pressure (2-6 mmHg)
Right ventricular pressure
Systolic 20-30 mmHg
diastolic 0-5 mmHg
Pulmonary artery pressure
Systolic 15-25 mmHg
diastolic 8-15 mmHg
Wedge pressure
Central venous pressures (right heart)
Monitor blood volume
monitor CV return and right ventricle function
administration of IV meds, fluid blood, TPN
Normal CVP 2-6 mmHg
A wave - atrial contraction
C wave - tricuspid valve bulging (starting to close)
X descent - right ventricle contracting
V wave - passive atrial filling
Y wave - tricuspid valve opens
Abnormal Right atrial pressure / Central venous pressure
Decreased CVP
…right atrial pressures
…vasodilation
Increased CVP
RV failure/infarct
Tricuspid valve insufficiency
COPD
Left-sided failure
…Left systolic failure, volume overload
Pulmonary hypertension
Cardiac tamponade
PEEP
Right ventricle pressure (right heart)
measured during insertion - no dicrotic notch
Notch on ascending side - anacrotic notch
Indicates atrial kick
Normal RVP
Systolic: 20-30 mmHg
Diastolic: 0-5 mmHg
Increased RVP
RV failure/chronic CHF
pulmonary hypertension/hypoxemia
Cardiac tamponade
Pulmonary artery pressure (right heart)
Measure PA systolic pressure
Normal: 15-25 mmHg
Measure PA diastolic pressure
Normal: 8-15 mmHg
Reflects RV systolic pressure
Indirectly reflects LV and-diastole pressure
…can be used to estimate wedge pressure; 2-4 mmHg higher than mean wedge pressure
dicrotic notch = closure of pulmonic valve
dicrotic notches are on descending (right) side
Abnormal pulmonary artery pressure (PAP) / PCWP (right heart)
Normal: 15-25 mmHg
Decreased PAP
hypovolemia
dampened waveform
Increased PAP
Fluid overload
atrial and ventricular defects
pulmonary problems
mitral valve regurgitation/stenosis
LV failure
PAP waveform
Similar to right ventricular waveform
Dicrotic notch denotes closure of pulmonic valve
Abnormal PCWP
Normal: 4-12 mmHg
Decreased PCWP
hypovolemia
vasodilator medications
Increased PCWP
LV failure
Mitral valve disease
Cardiac tamponnade
fluid overload
circle of resuscitation
Volume status
HR
SVR (systemic vascular resistance)
If bradycardia, generally compensated though increased stroke volume. As stroke volume increased, SVR increases.
low SVR = vasodilated
high SVR = vasoconstricted
More vasodilated = lower preload = lower cardiac output = higher HR
More vasoconstrcited = more preload = better cardiac output (ie better stroke volume)
For example:
Low volume –> increased HR –> pt may normalize, or pt becomes vasoconstricted
For example:
Volume overload –> decreased HR –> vasodilated
Distrubutive shock
ie sepsis, anaphylaxis
(Vasodilated)
CVP: low Normal: 2-6 mmHg
CI: low Normal 2-4 L/min
SVR: low Normal 800-1200
PCWP: low Normal: 4-12 mmHg
Obstructive shock
Same as cardiogenic
Usually trauma induced (cardiac tamponade, tension pneumothorax), or PE
Contraction (output) and relaxation (filling) of left ventricle are impeded
Vasoconstricted
CVP: high Normal: 2-6 mmHg
CI: low Normal 2-4 L/min
SVR: high Normal 800-1200
PCWP: high Normal: 4-12 mmHg
Neurogenic shock
(Vasodilation)
CVP: low Normal: 2-6 mmHg
CI: normal/low Normal 2-4 L/min
SVR: low Normal 800-1200
PCWP: low Normal: 4-12 mmHg
Cardiogenic shock
Same as obstructive
Vasoconstricted
ie myocarditis, acute MI, valvular issues
Not able to move volume out of LV
CVP: high Normal: 2-6 mmHg
CI: low Normal 2-4 L/min
SVR: high Normal 800-1200
PCWP: high Normal: 4-12 mmHg
Hypovolemic shock
Many compensatory mechanisms are impeded
CVP: low Normal: 2-6 mmHg
CI: low Normal 2-4 L/min
SVR: high Normal 800-1200
PCWP: low Normal: 4-12 mmHg
Right ventricular failure shock
Right ventricle not able to move volume out
CVP: high Normal: 2-6 mmHg
CI: low Normal 2-4 L/min
SVR: high Normal 800-1200
PCWP: low Normal: 4-12 mmHg
