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Concepts in Critical care > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

Define blood pressure

A

Amount of pressure exerted against the inside walls of the arteries as blood travels through the systemic and pulmonary circuits

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2
Q

What are the factors that determine blood pressure mathematically?

A

Flow x resistance = pressure

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3
Q

What determines flow in blood pressure?

A

Cardiac output

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4
Q

What determines resistance in blood pressure?

A

Vascular tone

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5
Q

What are the three components that ultimately control blood pressure?

A

Heart
Blood
Vessels

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6
Q

How does the heart affect blood pressure?

A

Controls cardiac output

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7
Q

How does the blood affect blood pressure?

A

Amount of fluid in the circulatory system will affect blood pressure
Thickness of said blood will also affect blood pressure

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8
Q

How do the vessels affect blood pressure?

A

Vessel diameter affects the pressure required to move blood through them

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9
Q

Define systolic blood pressure

A

Pressure exerted against the walls of the arteries when the heart contracts during systole

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10
Q

Define diastolic blood pressure

A

The pressure exerted against the walls of the arteries when the heart relaxes during asystole

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11
Q

What is the normal difference between systolic and diastolic blood pressure?

A

40 mmHg

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12
Q

When the difference between systolic and diastolic BP is less than 40, what is that called?

A

Narrowed

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13
Q

When the difference between systolic and diastolic BP is greater than 40, what is that called?

A

Widened

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13
Q

What is the difference between diastolic and systolic BP called?

A

Pulse pressure

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14
Q

What is pulse pressure used for?

A

Good indicator of cardiovascular events

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15
Q

What does an increased pulse pressure indicate?

A

More stress on artery
More stress on left ventricle
Potential limitation in coronary perfusion

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16
Q

What does a decreased pulse pressure indicate?

A

Cardiac tamponade
Decrease in left ventricular stroke volume

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17
Q

What can cause a strong pulse?

A

Increased stroke volume
Hypertension

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18
Q

What can cause a bounding pulse?

A

Aortic insuffiency
Atherosclerosis

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18
Q

What can cause a weak/thready pulse?

A

Decreased contractility
Hypovolemia
Low systemic vascular resistance

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19
Q

What does a bounding pulse feel like?

A

rapid/strong initial pressure follow by a quick fall off

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20
Q

What can cause pulsus alternans?

A

CHF

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21
Q

What can cause pulsus paradoxus?

A

Severe airway obstruction
Cardiac tamponade

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22
Q

What does pulsus alternans feel like?

A

Pulse strength alternates from beat to beat

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23
Q

What blood pressure indicates hypotension?

A

<90/60

24
Q

What blood pressure indicates hypertension

A

> 140/90

25
Q

What are the risks associated with a significantly low MAP?

A

Shock
Failure to perfuse vital organs

26
Q

What is the minimum MAP required to perfuse vital organs?

A

60

27
Q

What is a normal PAP?

A

25/8

28
Q

What is the normal range for diastolic PAP?

A

15-5

28
Q

What is the normal range for systolic PAP?

A

30-15

29
Q

What is a normal mean PAP?

A

14 mmHg

30
Q

What is the normal range for cardiac output?

A

4-8 liters per minute

31
Q

How can we measure PAP?

A

Pulmonary artery catheter
Echocardiogram
Transesophogeal echocardiogram

32
Q

Define preload

A

The stretch or wall stress within the myocardium at the end of systole

32
Q

What is the normal range for cardiac index?

A

3-4 liters/minute/meter^2

33
Q

What is preload a measure of?

A

The pressure of blood in the ventricle at the end of diastole

34
Q

How do we determine preload in the right heart?

A

Central venous pressure
Right atrial pressure

35
Q

What is normal preload in the right heart?

A

2-6 mmHg

36
Q

What is the preload in the right heart in ICU patients?

A

6-12

37
Q

How do we determine preload in the left heart?

A

Pulmonary capillary wedge pressure

38
Q

What is the normal preload in the left heart?

A

4-12 mmHg

39
Q

What factors affect afterload?

A

Diameter of blood vessel
Volume of blood being ejected from the ventricle
Compliance of the vasculature
Mass of blood

39
Q

What is the normal preload in the left heart in ICU patients?

A

12-18 mmHg

40
Q

Describe afterload

A

The amount of resistance offered by the vasculature to the outflow of blood as it tries to leave the heart from the ventricles

41
Q

What is the formula for calculating pulmonary vascular resistance?

A

(Mean PAP-PCWP) / Cardiac output x 80

41
Q

What is the afterload the right heart experiences called?

A

Pulmonary vascular resistance

42
Q

What is the afterload the left heart experiences called?

A

Systemic vascular resistance

43
Q

What is the formula for calculating systemic vascular resistance?

A

(MAP-Central venous pressure) / Cardiac output x 80

44
Q

What are the normal value for afterload for the right heart?

A

PVR = 0-250 dynes/sec/cm^2

45
Q

What are the normal values for afterload of the left heart?

A

SVR = 800-1400 dynes/sec/cm^2

46
Q

What is the gist of the frank starling law?

A

The greater the venous return to the heart, the greater the end diastolic stretch (preload) and the greater the cardiac output

47
Q

What factors does the frank starling law take into consideration?

A

End diastolic volume
Preload
Stroke volume

48
Q

Describe contractility

A

The strength of the contraction of the myocardium

49
Q

What is the equation for PAO2?

A

PAO2 = (713)FiO2 -(PaCO2/.8)

50
Q

What ion plays an important role in cardiac cell contraction?

A

Ca++

51
Q

What is the equation for CaO2?

A

(Hgb x 1.34 x SaO2) + (PaO2 x 0.0031)

52
Q

What is the equation for CvO2?

A

(Hgb x 1.34 x SvO2) + (PvO2 x 0.0031)

53
Q

What is the equation for Ficks Cardiac output?

A

CO = VO2 / (C(a-v)O2) x 10

54
Q

What is the equation for VO2

A

Cardiac output x C(a-v) x 10

55
Q

What is the equation for Qs/Qt?

A

CcO2 - CaO2 / CcO2 -CvO2

Concepts in Critical care (5 decks)

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