Systemic vascular resistance - resistance of the systemic vascular bed - opposition encountered by the left ventricle

Pulmonary vascular resistance - resistance of the pulmonary vascular bed - opposition encountered by the right ventricle

Pulmonary artery wedge pressure - measurement of pulmonary capillary pressure - reflects left ventricular end-diastolic pressure under normal conditions - Norm: 6-12 mmHg

Hemodynamics Flashcards by Joseph ware

Hemodynamic monitoring

The measurement of pressure, flow, and oxygenation within the cardiovascular system

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CVP

term only

Central venous pressure

CVP = RAP

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PAWP

Term only

Pulmonary artery wedge pressure

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Cardiac output (CO)

The volume of blood in liters pumped by the heart in 1 minute.

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Cardiac index

The measurement of the CO adjusted for body surface area (BSA)

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Stroke volume (SV)

The volume ejected with each heartbeat

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Stroke volume index

The measurement of SV adjusted for BSA

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Term only

Stroke volume

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SVR

Systemic vascular resistance

resistance of the systemic vascular bed
opposition encountered by the left ventricle

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PVR

Pulmonary vascular resistance

resistance of the pulmonary vascular bed
opposition encountered by the right ventricle

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Preload

The volume within the ventricle at the end of diastole

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Left ventricular end diastolic pressure (LVEDP)

Left ventricular preload

- Not measured directly; measured in pulmonary artery (PAWP)

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PAWP

Pulmonary artery wedge pressure

measurement of pulmonary capillary pressure
reflects left ventricular end-diastolic pressure under normal conditions
Norm: 6-12 mmHg

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Contractility

Describes the strength of contractions of the heart

- said to increase when preload is unchanged yet the heart contracts more forcefully

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Drugs that increase/improve contractility (+ inotropes)

Epinephrine; norepinephrine [Levophed]
Isoproterenol (Isuprel)
Dopamine (Intropin)
Dobutamine (Dobutrex)
Digitalis-like drugs
Calcium
Milrinone

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Drugs that reduce contractility (negative inotropes)

Alcohol
Calcium channel blockers
Beta-adrenergic blockers 
Anesthetics, sedatives, barbiturates
Some chemo agents

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Impedance cardiography (ICG)

A continuous or intermittent, noninvasive method of obtaining CO and assessing thoracic fluid status.

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Ejection fraction

Amount of blood pumped out of heart compared to how much is remaining

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Normal CO value range

4-8 L/min

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HR norm range

60-100 beats/min

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Stroke volume (SV) normal range

60-150 mL/beat

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PAWP normal range

6-12 mm Hg

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CVP/RAP normal range

2-8 mmHg

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SVR = ?

[(MAP - RAP) / CO] x 80

Norm CVR: 800-1200 dynes/sec/cm-5

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SVR norm range

800-1200 dynes/sec/cm-5

CO = ?

SV x HR | Norm CO: 4-8 L/min ml/min) = (beats/min) x (ml/beat

What does PAWP correlate/equal to?

PAWP = lung pressure = pulmonary vein pressure = LAP = LVEDP

Normal MAP range

70-105 mm Hg

Normal CI range

2.5-4 liters/min/meter(2)

Drug(s) to reach for when HR is too low?

Atropine

Drug(s) to reach for if the HR is too high?

Beta blockers Ca Channel blockers Digoxin

How does the sympathetic nervous system act on the heart?

Will increase HR with intervention

What are the 3 levels of dopamine dosing?

Low -- dopaminergic effect -- (1-5 mcg/kg/min) Moderate -- beta effect -- (5-10 mcg/kg/min) High -- alpha effect -- (10-20 mcg/kg/min)

How will the parasympathetic nervous system act on the heart?

Will decrease HR with intervention

What are the 3 determinants of stroke volume?

Preload Afterload Myocardial contractility

What may cause a decreased preload?

Hypovolemia Loss of atrial kick (a-fib) Venous vasodilation (sepsis, anaphylactic shock)

What are some causes of increased preload?

Ventricular failure Hypervolemia renal disease (hyervolemia)

How is the preload measured

Not measured directly (in L ventricle) - catheter in pulmonary artery (PAWP) - Left ventricular end diastolic pressure (LVEDP)

PAWP of 18-20 mmHg; Clinical state?

Onset of pulmonary congestion

PAWP of 20-25 mmHg; clinical state?

Moderate pulmonary congestion

PAWP of 25-30 mmHg; clinical state?

Severe congestion

PAWP of > 30 mmHg; clinical state?

Pulmonary edema

What is the objective in treating low preload?

Increase circulating volume

What is the treatment of low preload?

``` Give fluids (crystalloids or colloids) blood products ```

What is the objective in treating high preload?

Decrease circulating volume OR venous return

How is high preload treated?

Diuretics (lasix) | Vasodilators

What are some causes of decreased afterload?

Vasodilation | sepsis, vasodilation tx, anaphylactic shock, hypotension

What are some causes of increased afterload?

HTN Aortic stenosis Vasoconstriction

Normal CVP/RAP range?

2-8 mm Hg

What is the objective in treating low afterload?

Vasoconstriction

How is low afterload treated?

Vasopressors | (epinephrine, norepinephrine, dopamine (>10), neosynephrine

In treating a patient with low afterload, what is done before drug therapy?

Fluid bolus

What is the objective in treating high afterload?

Decrease resistance to ejection of blood

How is high afterload treated?

``` Arterial vadodilators (nipride, Primacor (milrinone), nitroglycerin, Cardene) Surgery -- Aortic valve replacement ```

What are some causes of decreased contractility

Parasympathetic stimulation Negative inotropics Metabolic states (hyperK+, myocardial ischemia, hypoxia, acidosis)

What is the objective in treating low contractility?

Improve the force of contraction

How is low contractility treated?

Optimize preload - positive inotropic drugs - ventricular assist devices

What are some causes of increased contractility

Sympathetic stimulation Positive inotropic drugs Metabolic states (hyperthyroidism)

What is the objective in treating high contractility?

Decrease myocardial work & oxygen consumption

How is high contractility treated?

negative inotropic drugs

cardiac index (CI) = ?

CI = CO/BSA normal CI = 2.5-4 liters/min/meter(2)

What may interfere with reliable PAWP readings?

Mitral valve disease | High intra-alveolar pressure (ventilators)

In a pulmonary artery (PA) catheter with 4 ports, what are the ports?

- cardiac output balloon - PAWP distal port - PA pressure readings proximal port - CVP reading

Normal pulmonary artery pressures?

25/10 (quarter over dime)

What three things must you "tell a transducer"

Put it to pressure (300 mmHg of pressure in transducer ) Zero the transducer Line/level the transducer with the source

Important nursing care with an A-line

- Never put meds in an A-line - be able to See the line (provide some degree of modesty) - check connections -- make sure it is tight - ensure alarms on - infection prevention - Hemorrhaging

What are two invasive techniques for measuring cardiac output?

``` Intermittent Bolus thermodilution CO (TDCO) Continuous CO (CCO) ```