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Hemodynamics Flashcards

1
Q

CO

A

4-8 L/min
HR x SV

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2
Q

CI

A

2-4 L/min based on BSA

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3
Q

SV

A

50-100 mL
Amount of blood ejected with each beat
Affected by preload, afterload, and contractility

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4
Q

MAP

A

> 65

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5
Q

CVP

A

2-8 mmHg
The pressure of blood in the thoracic vena cava, near the right atrium

Reflects the amount of blood returning to the heart (PRELOAD) and the ability of the heart to pump the blood into the arterial system

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6
Q

Pulmonary Artery Pressure (PAP)

A

20–25 / 8–10 mmHg

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7
Q

PCWP

A

4-12 mmHg
Indirect estimate of L atrium pressure
L sided PRELOAD

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8
Q

SVR

A

900-1400 dynes/sec/cm
Pressure the Left ventricle encounters to push blood into the body
LEFT SIDED AFTERLOAD

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9
Q

PVR

A

150-300 dynes/sec/cm
Pressure the Right ventricle encounters to push blood into the pulmonary arteries
RIGHT SIDED AFTERLOAD

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10
Q

Subclavian venous saturation (ScVO2)

A

70%
Measured by central line

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11
Q

Mixed venous saturation (SvO2)

A

60-80%
Measured by Pa catheter

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12
Q

Beta 1 receptors

A

Located: heart
Agonism: Increases chronotropy (HR) and inotropy (contractility)

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13
Q

Beta 2 receptors

A

Located: Bronchioles and blood vessels
Agonism: Bronchodilates, vasodilates

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14
Q

Alpha 1 Receptors

A

Located: Blood vessels
Agonism: vasoconstrict

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15
Q

D1, D2 Receptors

A

Located: Heart
Agonism: Increase chronotropy and inotropy

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16
Q

D4, D5 Receptors

A

Located: blood vessels
Agonism: vasoconstrict

17
Q

Vasopressin 1 Receptors

A

Located: blood vessels
Agonism: vasoconstrict

18
Q

Preload

A

Blood returning to the heart and available for ejection (Ventricle filling)

Inadequate: Tachycardia, dysrhythmias, valvular stenosis, tamponade, hypovolemia, diastolic dysfunction
Tx–volume expanders

Excessive/increased: Bradycardia, tricuspid/mitral valve regurgitation, hypervolemia
Tx–Correct volume overload (diuretics, vasodilators, milrinone, nitroglycerine, hydralazine)

19
Q

Contractility

A

Squeeze of the heart
LV/RV ejection

Inadequate–CAD, ischemia/infarct causing RWA, negative inotropes (BB, CCB)

20
Q

Afterload

A

Pressure in the vasulature the heart must overcome to pump blood out
Measured by SVR and PVR

Increased afterload: systemic/pulm HTN, valvular stenosis

Decreased afterload: vasodilators

TX FOR INCREASED SVR: nitroprusside, carvedilol, labetalol (alpha-beta blockers), CCB, hydralazine, ACEI-ARBs

TX FOR INCREASED PVR: NO, inhaled prostaglandins, PDE-inhibitors, endothelin receptor antag

21
Q

VO2 (volume O2)

A

200-300 mL/min
Amount of oxygen extracted by peripheral tissues over one minute

Commonly indexed by patient’s BSA
Normal index 110-160 ml/min/m2

22
Q

Phenylephrine

A

MOA: Alpha 1 agonist –> peripheral vasoconstriction

Indications: Distributive shock, hypotension w/ tachycardia

ADE: Splanchnic hypoperfusion, peripheral vasoconstriction

23
Q

Norepinephrine

A

MOA: Mixed alpha-1 and beta-1 agonist –> peripheral vasoconstriction (a1), increased chronotropy and inotropy (B1)

Indications: Distributive shock

ADE: Arrhythmias, peripheral vasoconstriction

24
Q

Epinephrine

A

ADE: Mixed alpha-1 and beta-1 agonist –> peripheral vasoconstriction (a1), increased chronotropy and inotropy (B1)

Indications: Distributive shock
Cardiac arrest, anaphylaxis, heart blocks, bradycardia

ADE: Splanchnic hypoperfusion, increased myocardial O2 demand

25
Q

Dopamine

A

MOA: Mixed, dose dependent–
– dopaminergic agonist –> increased chronotropy and inotropy
– beta-1 agonist –> increased chronotropy and inotropy
– and alpha-1 agonist –> peripheral vasoconstriction

Indications: distributive shock, bradycardia

ADE: Tachycardia, cardiac dysrthymias

26
Q

Vasopressin

A

MOA: V1 receptor agonist –> peripheral vasoconstriction

Indications: Refractory septic shock, Diabetes insipidus, GI bleeding

ADE: Splanchnic hypoperfusion

27
Q

Dobutamine

A

MOA: Beta-1 agonist –> increased chronotropy and inotropy

Indication: Cardiogenic shock, decompensated heart failure

ADE: hypotension, increased myocardial oxygen demand

28
Q

Milrinone

A

ADE: Phosphodiesterase 3-inhibitor

Indication: Cardiogenic shock, decompensated heart failure

ADE: Hypotension
Thrombocytopenia
Arrhythmias

29
Q

Isoproterenol

A

MOA: Beta-1 and Beta-2 agonist –> increased chronotropy/inotropy, bronchodilator, peripheral vasodilator

Indication: Bradyarrhythmias, AV block

ADE: hypotension, arrhythmias

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