Afterload, Fluid Responsivness, PAC Flashcards
Four factors that increase LEFT ventricular afterload
Anatomic obstruction
Increased SVR
Decreased elasticity of aorta and great vessels
Increased ventricular volume
Three factors that increase RIGHT ventricular afterload
Anatomic obstruction
Raised PVR
Increased ventricular volume
What are two factors that can decrease afterload
Hypotension
Mitral regurgitation
What are the two most common indicators of afterload
SVR and PVR
What are the two main components of vascular resistance
Flow and frequency
What are some consequences of inappropriate fluid therapy
Pulmonary edema, impaired gas exchange, cardiac failure
What are two static indicators of fluid responsiveness
CVP or PAOP (poor predictors)
What are two volumetric indicators for fluid responsiveness?
EDV (indicates preload, poor predictor of volume)
Extravascular lung water (can’t preform on living subject)
What are four dynamic indicators for fluid responsiveness?
SVV (Stroke volume variation)
PPV (pulse pressure variation)
SPV (systolic pressure variation)
PVi (pleth variability index)
What is passive leg raise and its uses
Leg is lifted to 45 degrees and 150mls of blood returns to heart (must be done using a swan ganz and measuring cardiac output)
What percentage of and increase in stroke volume indicates a positive fluid response?
10-20% increase
What are the drawbacks to using arterial blood pressure to measure fluid responsiveness?
No direct relationship between pressure and flow
What is the gold standard to measure blood flow?
Thermodillution
PAC indicators (5)
Severe circulatory shock
Right ventricular failure
Acute respiratory failure due to pulmonary edema
Complex fluid management
Dynamic assessment of cardiac function
PAC complications (9)
Access hematoma
Arrhythmia (keep lidocaine nearby)
Complete AV block
Knot formation
Thrombotic complications
Endocarditis
Valvular damage
Infection
Pulm artery rupture
