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ACU COURSE > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

Hemodynamic Principles:

Flow of _____ and factors affecting it
Study of _____ circulation

A

Hemodynamic Principles:

Flow of BLOOD and factors affecting it
Study of BLOOD circulation

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2
Q

Evaluates:

  • Intravascular _______ and ______
  • Intracardiac _______
  • _______ function

These all affect the body’s ability to ensure adequate tissue ________ and _______

A

Evaluates:

  • Intravascular VOLUME and PRESSURES
  • Intracardiac PRESSURES
  • CARDIAC function

These all affect the body’s ability to ensure adequate tissue PERFUSION and OXYGENATION

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3
Q

Invasive vs Non-Invasive HD Monitoring

A

Non-invasive: no device inserted into the body - does not breach skin (BP, HR, O2, U/O, JVD)

Invasive: Breach of skin (Art line, pulm-art catheter, CVP)

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4
Q

Determinants of Oxygen Delivery

A

Cardiac output x Oxygen Content

  • Cardiac output: HR x SV (preload, afterload, contractility)
  • Oxygen content: oxygen saturation & hemoglobin
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5
Q

Cardiac Output:

Amount of blood pumped out of the ____ in a _____

CO: ____ x ____

HR: # of _____ of the _____ in a _____

SV: Amount of blood ___ out of the ___ per _____. It is the difference between ______ and ______

A

Cardiac Output:

Amount of blood pumped out of the LV in a MINUTE

CO: HR x SV

HR: # of CONTRACTIONS of the HEART in a MINUTE

SV: Amount of blood PUMPED out of the LV per BEAT. It is the difference between EDV and ESV

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6
Q

How to calculate EF?

Normal EF?

A

SV / EDV x 100

50-70%

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7
Q

3 factors that affect stroke volume?

A

Preload, afterload, and contractility

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8
Q

Contractility:

AKA _______

Ability of the cardiac muscle to _____

Strength of the cardiac muscle to ____ blood from the _____

Primary parameter that affects _____

Increased _______ = Increased ______ = Decreased _______

A

Contractility:

AKA INOTROPY

Ability of the cardiac muscle to CONTRACT

Strength of the cardiac muscle to PUMP blood from the VENTRICLES

Primary parameter that affects ESV

Increased CONTRACTILITY = Increased SV = Decreased ESV

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9
Q

Medications that Affect Contractility:

Positive Inotropes:

Negative Inotropes:

A

Digoxin, dopamine, atropine

BB, BBC, lidocaine, adenosine

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10
Q

Electrolytes that increase contractility
Electrolytes that decrease contractility

A

Increase: HyperMg, HyperCa

Decrease: HypoMg, HyperK, HypoNa

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11
Q

How does HR affect contractility?

A

Increased HR increases contractility, but sustained tachycardia leads to decompensation - decreased contractility

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12
Q

Vagal stimulation will ________ contractility

A

Decrease

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13
Q

EDV

ESV

SV

A

EDV - Amount of blood that fills the ventricles prior to contraction (affects preload)

ESV - Amount of blood that remains in the ventricles after contraction (affected by afterload)

Difference between EDV - ESV (amount of blood ejected)

Ie. If EDV is 100cc and SV is 60cc, then the ESV is 40cc

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14
Q

What is preload?

Degree to which cardiac muscle fibres are ______ prior to _________

Anything that affects ______ will affect preload

Increased ____ = increased ______ = increased _____ = increased ______ = increased _______ (up to a point)

A

The amount of stretch caused by the EDV

Degree to which cardiac muscle fibres are STRETCHED prior to CONTRACTION

Anything that affects VENOUS RETURN will affect preload

Increased EDV = increased STRETCH = increased PRELOAD = increased CX = increased CO (up to a point)

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15
Q

Frank-Starling Mechanism

  • Force of cardiac contraction is directly ______ to the length of the muscle fibre
  • The greater the _______, the stronger the ______ = increased ________
  • However, after a certain threshold, the stretch will _______ contractility
A

Frank-Starling Mechanism

  • Force of cardiac contraction is directly PROPORTIONAL to the length of the muscle fibre
  • The greater the STRETCH, the stronger the CX = increased SV
  • However, after a certain threshold, the stretch will DECREASE contractility
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16
Q

Afterload:

The __________ or __________ ventricles must overcome to pump blood out

LV: ______
RV: ______

Any condition that increases the resistance (afterload) will require more ____ to open the semilunar valves and pump blood out

_____ in afterload = _______ SV = ______ ESV
_____ in afterload = _______ SV = ______ ESV

A

Afterload:

The RESISTANCE or PRESSURE ventricles must overcome to pump blood out

LV: SVR
RV: PVR

Any condition that increases the resistance (afterload) will require more FORCE to open the semilunar valves and pump blood out

INCREASE in afterload = DECREASED SV = INCREASED ESV

DECREASE in afterload = INCREASE SV = DECREASED ESV

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17
Q

How do hyper- and hypo-volemia affect afterload?

How do hyper- and hypo-tension affect afterload?

A

Hypervolemia = increased AL = decreased SV
Hypovolemia = decreased AL = increased SV

Same with BP

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18
Q

Ventricles create very ______ pressure vs the atria which has very _____ pressure

The bigger the difference between the two - the _______ a litre of blood will flow through your body

A

Ventricles create very HIGH pressure vs the atria which has very LOW pressure

The bigger the difference between the two - the FASTER a litre of blood will flow through your body

19
Q

The body maintains homeostasis, by monitoring the _____

The MAP needs to be high enough to ensure sufficient driving ___________ to deliver oxygenated blood to the body’s tissues

A

The body maintains homeostasis, by monitoring the MAP

The MAP needs to be high enough to ensure sufficient driving PRESSURE to deliver oxygenated blood to the body’s tissues

20
Q

What does the QRS complex represent?

A

Ventricular contraction - systole

21
Q

What does the time between each R-R represent?

A

Diastole

22
Q

Normal MAP

A

65-110 mmHg

23
Q

___________ respond to MAP, not ____ or ____ pressures

A

BARORECEPTORS respond to MAP, not SBP or DBP pressures

24
Q

Is MAP a sufficient indicator of perfusion?

A

NO - SBP and DBP also need to be monitored in conjunction with MAP

25
Q

What are the two main factors that affect MAP?

A

CO and TOTAL PERIPHERAL RESISTANCE (AFTERLOAD)

26
Q

Indications for arterial line

A

BP monitoring
Admin vasoactive meds
Frequent ABG monitoring

27
Q

Arterial Line sites: Radial vs Femoral - which is preferred?

A

Radial

28
Q

3 Elements of Arterial Monitoring

Where do you zero the transducer?

A

Pressure tubing
Transducer
Monitor

Zero at the phlebostatic axis - 4ICS

29
Q

Arterial Pressure Waveform:

Arterial pressure measures the ejection of blood from the ___, out the __ and into the _______ system

Blood ejected from the ____, generates pressure in a _________ manner

3 Components of Arterial Waveform:

1) Anacrotic limb: ________ upstroke - increase in pressure caused by blood ejected from ____ during ____. Reaches a peak = _______

2) Dicrotic limb: _______ decline - as pressure falls, aortic valve closes marking the end of ventricular ______ and onset of ________. As ______ progresses, the pressure falls to its lowest level = _______

3) Dicrotic notch: ______ of aortic valve

4) One wave = one ________ cycle

A

Arterial Pressure Waveform:

Arterial pressure measures the ejection of blood from the LV, out the AORTA and into the ARTERIAL system

Blood ejected from the AORTA, generates pressure in a PULSATILE manner

3 Components of Arterial Waveform:

1) Anacrotic limb: SYSTOLIC upstroke - increase in pressure caused by blood ejected from LV during SYSTOLE. Reaches a peak = SBP

2) Dicrotic limb: SYSTOLIC decline - as pressure falls, aortic valve closes marking the end of ventricular SYSTOLE and onset of DIASTOLE. As DIASTOLE progresses, the pressure falls to its lowest level = DBP

3) Dicrotic notch: CLOSURE of aortic valve

4) One wave = one CARDIAC cycle

30
Q

What term is used to describe the difference between SBP and DBP?

A

Pulse Pressure

31
Q

What does increased pulse pressure mean?

A

Increased blood flow - it is the force the heart generates each time it contracts

32
Q

__________ stimulation (____) is always first and then the _______ waveform

Ie - the peak ________ pressure occurs immediately following ventricular depolarization (____)

A

ELECTRICAL stimulation (QRS) is always first and then the ARTERIAL waveform

Ie - the peak SYSTOLIC pressure occurs immediately following ventricular depolarization (QRS)

33
Q

Fast-Flush Test:

Normal: __-__ bounces

Underdamped: _____ SBP, _____ bounces, narrow/pointy waveform

Overdamped: _____ SBP, no more than ____ bounce, wide/round waveform

A

Fast-Flush Test:

Normal: 1-2 bounces

Underdamped: OVERESTIMATES SBP, 3 bounces, narrow/pointy waveform

Overdamped: UNDERESTIMATES SBP, no more than 1 bounce, wide/round waveform

34
Q

Is cuff pressure and arterial pressure related?

Non-invasive measures ________. Invasive measures __________.

When is cuff pressure indicated?

A

No, there is no relationship.

Non-invasive measures FLOW. Invasive measures PRESSURE.

Insertion of art line + if art line becomes unreliable/dislodged

35
Q

CVP: Pressure in the ______. Measured at the junction of the ____ & ______.

Represents the driving force for filling the ______

Used as a marker of __________ or ________

A

CVP: Pressure in the RA. Measured at the junction of the SVC & RA.

Represents the driving force for filling the RA/RV

Used as a marker of FLUID VOLUME or PRELOAD

36
Q

CVP Waveform Components:

A - “______” - ____ contraction + correlates with ____-_____ on ECG

X - atrial ________

C - “_________” - closure of the ______ valve as ________ contract (_____ complex on ECG)

V - Blood filling the ________, just after the ___-______ on ECG

Y - _______ valve opening and blood filling the ventricles

A

CVP Waveform Components:

A - “ATRIUM” - ATRIAL contraction + correlates with P-WAVE on ECG

X - atrial RELAXATION

C - “CUSP CLOSURE” - closure of the TRICUSPID valve as VENTRICLES contract (QRS complex on ECG)

V - Blood filling the ATRIUM, just after the T-WAVE on ECG

Y - TRICUSPID valve opening and blood filling the ventricles

37
Q

CVP Abnormalities:

Loss of an ‘a’ wave: no _______ __________

Dominant ‘a’ wave: increased _______ of flow from the atrium to the ventricle. Seen with _____ and ______ stenosis

Steep X and Y descent: increased ______ pressures

Fused “a” and “c” waves: atrial _____ and ventricular ____ occur at _____

Fused “c” and “v” waves: backflow of blood out of the right ________

A

CVP Abnormalities:

Loss of an ‘a’ wave: no ATRIAL CX

Dominant ‘a’ wave: increased RESISTANCE of flow from the atrium to the ventricle. Seen with PULMONARY and TRICUSPID stenosis

Steep X and Y descent: increased ATRIAL pressures

Fused “a” and “c” waves: atrial CX and ventricular CX occur at SAME

Fused “c” and “v” waves: backflow of blood out of the right VENTRICLE

38
Q

How to measure CVP:

1) Find top of __ wave

2) Find bottom of __ descent

3) Add values and / by ____

A

How to measure CVP:

1) Find top of A wave

2) Find bottom of X descent

3) Add values and / by 2

39
Q

Which are the lowest points of pressure?

Which are the highest points of pressure?

A

Lowest - RA/LA

Highest - Pulmonary artery and Aorta

40
Q

What does the surface area under an arterial waveform represent?

A

MAP

41
Q

Can you use a femoral CVAD to obtain a CVP reading?

A

Yes - but the reading will not be as accurate as the tip will be too far from the RA to provide pressure readings

42
Q

What 2 things might be ordered to help lower a patient’s preload?

A

Diuretics
Fluid Restriction

43
Q

In what situations can venous return be greater than cardiac output?

A

NEVER - venous return must always = CO

ACU COURSE (8 decks)

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