Clinical Hemodynamics

Question 1

diagnositic Indications for invasive asseessment

Answer 1

Diff of various etiologies of shock and pulm edema

Eval of pulm HTN

Diff of pericardial tamponade from const pericarditis and restrictive cariomyopathy

Dx of L-R shunt

Question 2

How to perform cath

Answer 2

Vascular sheath in internal jugular/femoral veins or radial and femoral arteries

Question 3

RA to RV
RV to PA
PCWP

Answer 3

RA to RV should have no diastolic change

RV to PA should have no systolic change

Should look like RA but at higher pressure….Reflects the preload

Question 4

Inspiration effect in RA

Answer 4

Raise systolic pressure

Question 5

Fick method of CO

Answer 5

A-Vo2 difference is vital

If higher - then means CO is lower because more extraction occuring

If low - CO is higher because less O2 being extracted

Question 6

Thermodilution method

Answer 6

Inject saline - quicker restoration to normal temp means increased CO

Question 7

Oximetry

Answer 7

Measure for intracardiac shunts

Pulm artery should be less than 75% …if inc then high CO or shunt

Normal variation within 7&

Question 8

Effect of ASD

Answer 8

Oxygenation of RA will be significantly higher than SVC

Question 9

Effect of VSD

Answer 9

Oxygenation of RV will be signifnactly higher than RA

Question 10

Tricuspid stenosis

Answer 10

Pressure differential between the RA and RV…diastolic pressure will drop between RA and RV

Question 11

LHC

Answer 11

Same principles but into the LV

Via retrograde arterial access (across aortic valve)
Or fossa ovalis and thru mitral valve

Question 12

LV to aorta

Answer 12

Systolic should stay the same

Diastolic will increase

If LV systolic pressure higher than aortic, then mitral stenosis