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critical care > hemodynamics > Flashcards

hemodynamics Flashcards

1
Q

cardiac output

A
  • best indicator of the condition of the hearts contractile (inotropic ability)
  • volume of blood ejected by the heart in 1 min into the systemic circuit
  • does not equate for differences in body size
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2
Q

normal CO

A

4-8 l/min

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3
Q

cardiac index

A

CO divided by an indiviuals body surface area

normal: 2.2-4

measured by PA cath

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4
Q

CO = ____ x ____

A

SV x HR

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5
Q

what is stroke volume

A
  • volume of blod ejected by the left ventricle during each systole
  • affected by three factors: preload, afterload, and contractility
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6
Q

normal SV

A

60-100 ml

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7
Q

what is preload

A
  • The amount of stretch placed on cardiac muscle fibers just before systole.
  • Volume of blood in the ventricle at the end of diastole
  • Amount of myocardial stretch placed on the ventricular muscle fibers prior to systole application of Frank-Starling law of the heart
  • Volume of blood creates a filling pressure
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8
Q

causes of elevated preload

A
  • volume overload
  • LV dysfunction
  • RV dysfunction
  • valvular defects
  • cardiac tamponade
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9
Q

effects of increase preload on the heart

A

Increases stroke volume
Increases ventricular work
Increases myocardial oxygen requirements

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10
Q

assessment of right sided elevated preload

A

JVD
Edema
Hepato-jugular reflux(HJR)

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11
Q

assessment of left sided elevated preload

A

Orthopnea
Dyspnea
Cough
Crackles
S3

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12
Q

ways to reduce preload

A
  • Drugs that directly reduce blood volume, e.g. diuretics
  • Drugs that promote vasodilation, e.g.
    Nitrates
  • Patient positioning (semi/high fowlers)
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13
Q

causes of decreased preload

A

Hypovolemia
Hemorrhage
Third spacing
Diuresis
Vasodilation

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14
Q

assessment findings of a decreased preload

A

Tachycardia/hypotension
Dry, cool skin
Dry mucous membranes
Poor skin turgor
Alteration in LOC
Decreased urine output/vital organ perfusion

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15
Q

right sided preload assessment

A

Right Ventricular End-Diastolic Pressure (RVEDP)
Right Atrial Pressure (RAP)
Central Venous Pressure (CVP)

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16
Q

left sided preload assessment

A

Left Ventricular End-Diastolic Pressure (LVEDP)
Pulmonary Artery Wedge Pressure (PCWP) aka
Pulmonary Artery Occlusive Pressure (PAOP)
Pulmonary Artery Diastolic Pressure (PADP

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17
Q

treatment to increase preload

A

volume administration
patient positioning - modified trendelenburg

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18
Q

what is afterload

A

Increased ventricular wall tension or stress during systolic ejection

Pressure that the ventricle has to pump against to eject blood into the circulation during systole.

Most critical factor determining afterload is vascular resistance.
- Systemic vascular resistance (SVR)

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19
Q

assessment of afterload

A

Mean arterial pressure (MAP) *not always correlated

Systemic Vascular Resistance (SVR)
- must have an invasive catheter to calculate SVR (must know cardiac output)

Pulmonary Vascular Resistance (PVR)

20
Q

what causes an elevated afterload

A

Vasoconstriction (increased SVR)

Medications
- Alpha 1 agonists

Catecholamine release (compensatory mechanisms)
- Hypovolemia
- Pain
- Hypoxia
- Hypothermia

Hypertension

Increased aortic impedance

21
Q

afterload reduction therapy

A

Vasodilator therapy
- Nitroprusside (Nipride)
- Calcium Channel Blockers (Nicardipine)
- ACE-Inhibitors (-pril)
- Angiotension Receptor Blockers (-sartan)

22
Q

what causes a decreased afterload

A

Vasodilation (decreased SVR)
Inadequate aortic valve function
Inflammatory response
Hyperthermia

23
Q

therapy to increase afterload

A

Vasopressor therapy e.g. Adrenergic stimulants
- Norepinephrine (Levophed)
- Phenylephrine (Neo-synephrine)
- Dopamine
- Vasopressin

24
Q

what is contractility

A

The inotropic action of the heart muscle during systole or the force of each ventricular contraction

25
Q

what factors influence contractility

A

Intracellular calcium and ATP availability
Coronary artery perfusion
Cardiac oxygen supply/demand balance
Heart rate
Blood pressure
Valve competence

26
Q

assessment findings with low contractility

A

Tachycardia
Cool, pale skin
Decreased urine output
Mental status changes
Poor peripheral circulation

27
Q

how do we measure contractility

A

Cardiac output (CO)
Cardiac Index (CI)
Ejection Fraction (EF)

28
Q

interventions to increase contractility

A

increase preload

positive inotropic agents

29
Q

interventions to decrease conractility

A

negative inotropic agents

30
Q

inotropic

A

myocardial contractility

31
Q

chronotropic

A

heart rate

32
Q

dromotropic

A

rate of electrical conduction

33
Q

beta 1 receptors

A

Located primarily in the heart.

Stimulation produces:
altered ventricular function
+ chronotropic
+ inotropic

34
Q

beta 2 receptors

A

Located in bronchial and vascular smooth muscle.

Stimulation produces:
bronchodilation

35
Q

alpha 1 receptors

A

Located primarily in vascular smooth muscle

Stimulation produces vasoconstriction
Increased SVR

36
Q

what is the phlebostatic axis

A

Reference level for placement of the transducer to ensure accuracy of measurements

Point is located at the intersection of two imaginary reference lines:
1st line - 4th ICS at sternum drawn to side of body
2nd line - drawn midway between anterior and posterior chest (mid-axillary line)

37
Q

what MAP is needed to perfuse coronary arteries

A

> 60

38
Q

ideal MAP

A

70-90

39
Q

arterial lines

pre procedure

A

allens test

40
Q

arterial lines

maintenance

A

Leveling & Zeroing
Phlebostatic Axis
Compare cuff pressure
Check circulation
Complications
IF BP CHANGES QUICKLY: CHECK PT, CONNECTIONS & LEVEL OF TRANSDUCER

41
Q

what does CVP measure

A

CVP measures the pressure in the right atrium or vena cava.

Provides information regarding intravascular blood volume

Indirectly reflects right ventricular end-diastolic pressure (RVEDP)

Measures right ventricular preload

42
Q

normal CVP

A

8

43
Q

which port is used to measure CVP

A

distal

closest to right atrium

44
Q

complications to CVP monitoring

A

Infection
Dislodgement
Pneumothorax
Thrombosis
Air embolism

45
Q

PA pressure monitoring

A

Flow Directed Pulmonary Artery Catheter
“AKA” Swan-Ganz Catheter

Used to obtain intra cardiac data to diagnose/evaluate heart disease, shock states and any medical or surgical condition that compromises cardiac function and output;

To evaluate patient response to treatment

46
Q

complications with PA monitoring

A

Pneumothorax
Infection
Ventricular dysrhythmias
Pulmonary artery rupture or perforation
Air embolus

47
Q
A

critical care (14 decks)

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