Hemodynamics Flashcards
What is Fick CO formula?
O2 consumption / (1.36) x Hb x (SaO2 - MVO2)
For what 2 situations is Fick better than Thermodilution?
For low Cardiac Output and AF
What is calculation of BSA?
BSA = Square Root ((Ht CM) x (Wt KG) / 3600))
What is calculation of Cardiac Index?
CI = (HR x SV) / BSA
What is formula for TPG?
TPG = (mPAP - PCWP)
What is the Gorlin Equation for AVA?
AVA = CO / SEP x HR x 44.3(Square root(MG))
What is the Gorlin equation for MVA?
MVA = CO / DFP * HR * 0.85 * 44.3(Square Root)(MVG))
What is the Hakki Formula for AVA?
AVA = CO / Square root: MG
How to use Hakki formula when HR > 90
Divide AVA / 1.35
When to be concerned about shunt? (O2 step up)
> 8% step up
What is formula for MVO2?
MVO2 = 3(SVC O2) + (IVC O2) / 4
What is Pulmonary Blood Flow formula?
Qp = O2 consumption / 1.36 x Hb x (PvO2 - PaO2)
What is calculation for Systemic Blood Flow?
Qs = O2 Consumption / 1.36 x hb x (SaO2 - MVo2)
What is simplified way to calculate Qp/Qs (if no O2 consumption given) ?
Qp/Qs = (SaO2 - MvO2) / (PvO2 - PaO2)
What is large Shunt via Qp/Qs?
> 2
What is the Dicrotic notch for Aortic HD curve?
Dicrotic notch from elastic recoil of Ao after the AoV closes
What is the Anacrotic notch for Aortic HD curve?
Anacrotic notch from percussion wave of LV systole
What are 4 things you see on Aortic curve in Aortic Stenosis?
-Exaggerated Anacrotic notch
-Delayed upstroke
-Late peaking
-Persistent systolic gradient
What happens to Pulse Pressure post PVC?
No change (or increased)
What is Carabello’s sign?
> 10mmhg increase in arterial BP during pullback = critical Aortic Stenosis
What two thing seen in Acute AR in LV? 3 in Ao?
-LV: Rapid rise of LV DBP, Increased LVEDP
-Ao: Rapid decline in Ao DBP, No dicrotic notch, small increase in pulse pressure
What are seen in two things in chronic AR seen in LV? Ao?
-LV: Increased LV SBP, Normal LVEDP
-Ao: Low Ao DBP, Wide pulse pressure
What are two things seen in LA curve in Mitral Stenosis?
-Increased Mean LA Pressure
-Persistent LA-LV gradient
What is hallmark of Acute MR?
-Giant CV waves ( > 3x mean LA Pressure) and Increased PA pressure
What is difference between Acute and Chronic MR?
In Chronic MR: CV waves there but 2x mean LA pressure not 3x
-Normal LV/Ao curve where as systolic pressure lower in acute MR (decreased CO, more RF/Rvol)
What are three HD findings seen in RA during Constriction?
-M configuration (Prominent Y descent with preserved X descent)
-High pressures
-Respiratory change in pressure < 3mmhg (Kussmauls sign)
What are 4 ventricular findings and 1 PASP finding in CP?
-LVEDP - RVEDP < 5mmhg
-Rapid LV early diastolic filling > 7mmhg (square root sign)
-Ventricular interdependence
-High RVEDP (> 1/3 RVSP)
-PASP < 55mmhg
What are two things seen in Aortic tracing with HoCM?
-Spike and dome: Rapid upstroke with rapid decrease at onset of mid-systolic obstruction, then subsequent gradual increase during late systole
-Brochenbrough-Braunwald sign
Review normal BP and HR response with Valsalva
How is Valsalva BP different with Systolic dysfunction?
It’s flat or increases with Valsalva
How does Valsalva response differ in HOCM?
There is no overshoot phase
What is Elastance on PV loops?
Pressure / Change in Volume
What is Compliance in PV loops?
Change in Volume / Pressure
What will increased Preload do to SV and LVESV?
-Increased SV and constant LVESV
What will increased Afterload do to SV and LVESV?
Decreased SV and Increased LVESV
What will increased Contractility do to SV and LVESV?
Increased SV and Decreased LVESV
What will Systolic dysfunction due to ESPVR?
It will bring it down/Decrease the slope
What will Diastolic dysfunction do to EDPVR?
It will decrease Compliance/ bring up the slope
What will HCM do to the PV loop?
Decreased LV volume will shift the curve to the left
Increased contractility will shift the ESPVR left and upward
Decreased Stroke Volume
What does Dilated CMO do to PV loop?
Increased LV volume -> EDPVR shifted right
Decreased contractility -> ESPVR shifted right and downwards
Decreased stroke volume
What does Restrictive CMO do to PV curve?
-Increased LVEDP -> EDPVR shifted upwards
-Normal or slightly decreased contractility
-Decreased stroke volume
What is this?
PA stenosis/PS/RVOT obstruction
What is this?
Tricuspid Stenosis
What is this?
Mitral Stenosis
What is this?
LV intracavitary obstruction
What is this?
Aortic Insufficiency
What is this?
Severe TR -> Ventriculization of the RA
What is this?
Constrictive Pericarditis
What is this?
Constrictive Pericarditis -> Square Root Sign Rapid filling sign > 7mmhg
What is this?
Prominent Y Descent/M Sign -> Constriction
What is this?
Aortic Stenosis
What is this?
Severe Tricuspid Stenosis
What is this?
Spike and dome pulse -> HoCM
What is this?
Severe PR
What is this?
LA tracing showing giant V waves -> Acute MR
What is this?
Severe Acute MR (Ventricularization of the LA waveform)
What is this?
Aortic waveform with IABP
What is this?
Giant cV waves -> MR, low pulse pressure -> Cardiogenic shock
What is this?
PA stenosis
What is this?
PA stenosis
What is this?
M sign + Kussmaul’s -> Constrictive Pericarditis
What is this?
Aortic Coarctation
What is this?
Pulsus Paradoxus -> Shock
What is shown here? What procedure was done?
Pericardicentesis
Note that Y descent was blunted and then becomes normal
What does the interval from the A -> C wave represent?
The PR interval
What should RAP equal?
RVEDP if no Tricuspid stenosis
What is the arrow pointing at?
Dicrotic notch of PA
What is different about the PCWP representing LA vs the RA waveform?
Indirect, there is a significant delay from electric signal to transmit the wave form
What lung zone does the PCWP most accurately reflect LA pressure?
Zone 3 (lower)
What is the most specific sign of a quality wedge?
O2 saturation > 90%
Others:
-Presence of well defined a and v waves
-Distinct abrupt rise in mean pressure is observed when the balloon is deflated or the catheter is withdrawn
What is the relationship between PCWP and PADP?
about the same or PCWP is 0-5mmhg lower than PADP
Name 4 reasons that PCWP would not accurately represent LVEDP?
-MS
-AR
-MR
-PV obstruction/stenosis
What are 4 things that affect Thermodilution and in which way?
-TR: Underestimate
-Shunt: Underestimate
-Low CO: Overestimate
-Afib/Irregular R-R: Either way
