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Cardiology Secrets > BEDSIDE HEMODYNAMIC MONITORING > Flashcards

BEDSIDE HEMODYNAMIC MONITORING Flashcards

1
Q

What is a Swan-Ganz catheter?

A

A Swan-Ganz catheter is a soft, flexible catheter with an inflatable balloon at its tip used in right-sided heart catheterization.

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2
Q

How many lumens does the most common Swan-Ganz catheter have?

A

The most common Swan-Ganz catheter has four lumens.

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3
Q

What is the function of the distal port in a Swan-Ganz catheter?

A

The distal port allows for measurement of pulmonary artery (PA) pressure when the balloon is deflated and pulmonary artery wedge pressure (PAWP) when inflated.

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4
Q

What is measured using the thermocouple in a Swan-Ganz catheter?

A

Cardiac output (CO) is measured using the temperature-sensing thermocouple.

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5
Q

What can be directly measured with a Swan-Ganz catheter?

A

Direct measurements include vascular pressures and oxygen saturations, CO, and systemic venous oxygen saturation (SvO2).

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6
Q

How is a Swan-Ganz catheter inserted?

A

Venous access is obtained by introducing an 8 French sheath into the internal jugular or subclavian vein, followed by passing a 7.5 French Swan-Ganz catheter through the sheath.

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7
Q

What does the a wave in pressure waveforms correspond to?

A

The a wave is produced by atrial contraction and follows the electrical P wave on ECG.

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8
Q

What indicates that the Swan-Ganz catheter is in the wedge position?

A

An atrial tracing reflecting left atrial pressure will be seen when the catheter is in the wedge position.

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9
Q

What does the PAWP approximate?

A

The pulmonary artery wedge pressure (PAWP) approximates left atrial pressure.

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10
Q

How is cardiac output determined using thermodilution?

A

10 mL of normal saline is injected into the right atrium, causing a drop in temperature that is measured continuously.

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11
Q

What is the Fick method used for?

A

The Fick method is used to calculate cardiac output based on oxygen consumption and arteriovenous oxygen difference.

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12
Q

What are normal values for right atrial pressure?

A

Normal values for right atrial pressure are 0–6 mm Hg.

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13
Q

What clinical situations indicate the use of a Swan-Ganz catheter?

A

Indications include heart failure/shock, acute myocardial infarction, and perioperative management in high-risk patients.

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14
Q

True or False: The Swan-Ganz catheter is indicated for routine management of pulmonary edema.

A

False

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15
Q

What is pulmonary hypertension defined as?

A

Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure ≥20 mm Hg.

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16
Q

Fill in the blank: The Swan-Ganz catheter is primarily used for _______.

A

right-sided heart catheterization.

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17
Q

What are the normal values for pulmonary artery wedge pressure?

A

Normal values for pulmonary artery wedge pressure are 6–12 mm Hg.

18
Q

What can cause discordance between pulmonary capillary wedge pressure and left ventricular end-diastolic pressure?

A

Common causes include mitral stenosis and pulmonary vein stenosis.

19
Q

What measurement is indicated by the v wave in pressure waveforms?

A

The v wave is caused by venous filling of the atrium during ventricular systole.

20
Q

What is the significance of the area under the curve in thermodilution?

A

The area under the curve is inversely related to cardiac output.

21
Q

What does the y descent in pressure waveforms indicate?

A

The y descent is produced by rapid atrial emptying when the tricuspid valve opens at the onset of diastole.

22
Q

What is the purpose of fluoroscopy during Swan-Ganz catheter placement?

A

Fluoroscopy is used to confirm that the catheter is in a distal pulmonary arteriole.

23
Q

What are the derived hemodynamic parameters from a Swan-Ganz catheter?

A

Derived parameters include cardiac index, stroke volume index, and vascular resistances.

24
Q

What is a major randomized trial regarding Swan-Ganz catheters in heart failure patients?

A

The ESCAPE trial showed no significant difference in mortality and days out of hospital at 6 months.

25
Q

What is pulmonary hypertension (PH) defined as?

A

A mean pulmonary artery pressure (mPAP) of ≥20 mm Hg

26
Q

What are the three types of pulmonary hypertension?

A
  • Precapillary PH
  • Postcapillary PH
  • Combined pre- and postcapillary PH
27
Q

What is required to diagnose and assess the severity of pulmonary arterial hypertension?

A

Swan-Ganz measurement

28
Q

How is pulmonary vascular resistance (PVR) calculated?

A

PVR = (mean PA - PCWP) / cardiac output

29
Q

In what situations are Swan-Ganz measurements particularly used?

A
  • Assess reversible PH
  • Determine eligibility for calcium-channel blockers
  • Diagnose heart failure with preserved ejection fraction (HFPEF)
30
Q

What defines a vasodilatory response in pulmonary arterial hypertension?

A

Reductions in mean PA pressures by ≥10 mm Hg to values ≤40 mm Hg

31
Q

What agents are used to assess response in pulmonary arterial hypertension?

A
  • Inhaled nitric oxide
  • Adenosine
  • Epoprostenol
32
Q

What is a characteristic finding in pericardial tamponade as seen on Swan-Ganz catheterization?

A

Equalization of diastolic pressures across all chambers

33
Q

What are absolute contraindications for placement of a Swan-Ganz catheter?

A
  • Right-sided endocarditis
  • Mechanical tricuspid or pulmonic valve prosthesis
  • Presence of thrombus or tumor in a right-sided heart chamber
34
Q

What are relative contraindications for placement of a Swan-Ganz catheter?

A
  • Coagulopathy
  • Recent implantation of a permanent pacemaker or cardioverter defibrillator
  • Left bundle branch block
  • Bioprosthetic tricuspid or pulmonic valve
35
Q

What hemodynamic parameters can differentiate different etiologies of shock?

A

Parameters vary by etiology, including RA, RV, PA, PCWP pressures and cardiac output

36
Q

What is a diagnostic indicator of an atrial septal defect using Swan-Ganz catheterization?

A

A step-up in mean oxygen saturation of 7% between the caval chambers and the right atrium

37
Q

What complications are associated with the use of a Swan-Ganz catheter?

A
  • Bleeding
  • Infection
  • Transient right bundle branch block
  • Complete heart block
  • Ventricular tachyarrhythmias
  • Pulmonary infarction
  • Thrombophlebitis
  • Endocarditis
  • Catheter knotting
38
Q

How can the complications of Swan-Ganz catheterization be minimized?

A
  • Use fluoroscopy for placement
  • Remove catheter after first data set
  • Minimize duration of catheter placement
  • Limit use of introducer side arm for medications
  • Ensure trained personnel manipulate the catheter
  • Obtain daily chest radiographs
39
Q

What should be checked if the wedge tracing is abnormal?

A
  • Check chest radiograph for catheter position
  • Aspirate and flush the catheter
  • Check all connecting lines and stopcocks
  • Confirm pressure transducers are zeroed
  • Check balloon inflation
40
Q

What should be checked if the cardiac output does not make sense?

A
  • Average at least three values
  • Verify catheter tip position via chest radiograph
  • Ensure computer calibration is correct

Cardiology Secrets (26 decks)

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