Hemodynamics Flashcards
HD instability is a mismatch
between 02 delivery and demand
CO=
SV x HR
Normal CO/CI
CO: 4-8
CI: 2-4
normal SvO2
60-80% mixed venous saturation
Normal CVP
2-8 (central venous pressure)
Normal PAP
20-25/8-10 (pulmonary artery pressure)
Normal PCWP
4-12
Normal SVR
900-1400 (systemic vascular resistance)
Normal PVR
150-300 (pulmonary vascular resistance)
Normal ScVO2
70% subclavian venous saturation
Beta 1
acts on the heart, agonist, increase chronotropy (HR) and inotropy (contractility)
Beta 2
acts on bronchioles/blood vessels- agonist- vasodilator
Alpha 1
works on blood vessels- agonist- vasoconstrictor
Dopaminergic 1, D2
works on the heart- agonist- increase chronotropy and inotropy
Dopaminergic D4 D5
acts on the blood vessels, agonist vasoconstriction
Vasopressin 1
acts on the blood vessels agonist causing vasoconstriction
causes of inadequate LV filling (preload)
tachycardia/dysrhythmias, valvular stenosis, tamponade, pericarditis, hypovolemia
causes of inadquate LV ejection (contractility)
coronary artery disease: ischemia, infarct causing regional wall motion abnormality, negative inotropes: BB, CCB
right ventricular hemodynamic
CVP, RAP: normal 2-8
left ventricular hemodynamics
PCWP/PAD
causes of increase in preload
bradycardia
tricuspid/mitral valve regurg
hypervolemia
cause of decrease in preload
tachycardia
tricuspid/mitral valve stenosis
hypovolemia
systemic vasodilators; decrease SVR
- ace/arbs
- hydralazine
- carvedilol, labetaolol (with alpha receptor antagonistic)
- nitroprusside
- calcium channel blockers
pulmonary vasodilators; decrease PVR
- nitric oxide; inhaled
- prostaglandins- inhaled; flolan, velitri, tyvaso
- phosphodieterase inhibitors- sildenafil, tadalfil (oral)
- endothelin receptor antagonist (relax vascular in pulmonary bed) : bosenten, macitentan
PA catheter uses
- gives information on filling pressures, cardiac function and SVO2 (head and feet)– mixed venous
- utilized for differentiating shock states
- titration of IV/inhaled vasodilators for pulmonary HTN
- after CT surgery or management of cardiogenic shock
- massive or submassive PE for CDL (catheter directed lysis)
Phenylephrine
- alpha 1 adrenergic agonist
- uses: distributive shock, hypotension with tachycardia
- good for post anesthesia can give IVP
- adverse effects: splanchnic hypoperfusion
Norepinephrine
- mixed alpha 1 and beta 1 adrenergic agonist
- uses: distributive shock
- adverse effects: arrhythmias, peripheral vasoconstriction
epinephrine
- mixed alpha 1 and beta 1 adrenergic agonist
- uses: distributive shock, cardiac arrest, anaphylaxis, heart block, bradycardia
- adverse effects: splanchnic hypoperfusion, increased myocardial oxygen demand
Dopamine
- mixed dopaminergic, beta 1, alpha 1 adrenergic agonist (dose dependent)
- uses: distributive shock, bradycardia
- adverse effects: tachycardia, cardiac arrhythmias
Vasopressin
- V1 receptor agonist
- uses: refractory septic shock, GI bleeding, DI
- adverse effects: splanchic hypoperfusion
Dobutamine
- beta 1 adrenergic receptor agonist
- uses: cardiogenic shock, decompensated HF
adverse effects: hypotension, increase myocardial oxygen demand
Milrinone
- phospdiasterase 3 inhibitor
- uses: cardiogenic shock, decompensated HF
- adverse effects: hypotension, thrombocytopenia, arrhythmias
isoproterenol
- beta 1 and beta 2 adrenergic receptor agonist
- uses: bradyarrthymias, AV block
- adverse effects: hypotension, arrhythmias