Hemodynamics and Ventricular Function: Clinical Application

Question 1

pulmonary artery (PA) catheter

Answer 1

aka PA line or Swan-Ganz catheter

consists of:

balloon tip with thermistor

computer input

pulmonary artery pressure port

right atrial pressure port (medication infusion)

balloon port (inflate and deflate balloon)

Question 2

uses of the PA catheter

Answer 2

determine cause of pulmonary edema (cardiogenic vs. non-cardiogenic)

determine type of shock (cardiogenic vs. hypovolemic vs. distributive)

determine cardiac output

Question 3

contraindications for the PA line

Answer 3

vascular access issues

left bundle branch block

acuse pulmonary embolism, right atrial thrombus, or right ventricular thrombus or mass

Question 4

process of inserting the PA line

Answer 4

can be done without x-ray guidance

look at pressure waves:

big step-up in ventricles

diastolic pressure steps up in PA

A and V waves in the pulmonary wedge

Question 5

normal CO

Answer 5

4-8 L/min

Question 6

normal CI

Answer 6

2.5-4.0 L/min/m²

Question 7

normal SV

Answer 7

50-100 mL

Question 8

normal SVI

Answer 8

25-50 mL/m²

Question 9

normal SVR

Answer 9

800-1200 dynes-sec/cm⁵

Question 10

normal PVR

Answer 10

<240 dynes-sec/cm⁵

Question 11

tall atrial A waves

Answer 11

tricuspid stenosis

pulmonic stenosis

pulmonary HTN

cor pulmonale

Question 12

cannon A waves

Answer 12

AV dissociation

Question 13

absence of A waves

Answer 13

atrial fibrillation

Question 14

prominent C wave

Answer 14

1st degree AV block

Question 15

prominent C-V wave

Answer 15

tricuspid regurgitation

Question 16

priminent X and Y descent

Answer 16

constrictive pericarditis

restrictive cardiomyopathy

Question 17

blunting of the Y descent

Answer 17

cardiac tamponade

Question 18

What is the pulmonary capillary pressure ann estimate of?

Answer 18

LA pressure, estimating LV EDP if the mitral valve is normal

Question 19

Fick cardiac output

Answer 19

based on arteriovenous oxygen difference

CO = [O₂ consumption]/[1.34 x 10 x Hgb x (arterial O₂ sat - mixed venous O₂ sat)

Question 20

thermodilution (TD) cardiac output

Answer 20

thermistor on the distal tip of the PA line

cold saline injection at the RA and then temperature is measured over time

area under the curve = cardiac output

Question 21

SVR equation

Answer 21

[(mean arterial pressure - central venous pressure)/cardiac output] x 80

Question 22

PVR equation

Answer 22

[(mean pulmonary artery pressure - PCWP)/cardiac output)] x 80

Question 23

RA pressure, CO, and SVR in cardiogenic shock

Answer 23

RA pressure increases

CO decreases

SVR increases

Question 24

RA pressure, CO, and SVR in septic shock

Answer 24

RA pressure decreases

CO increases

SVR decreases

Question 25

RA pressure, CO, and SVR in cardiogenic shock in hypovolemic shock

Answer 25

RA pressure decreases CO decreases SVR increases

Question 26

mean arterial pressure equation

Answer 26

MAP = (SBP + 2\*DBP)/3

Question 27

pulse pressure equation

Answer 27

SBP - DBP

Question 28

blood pressure, CO, and TPR

Answer 28

BP = CO x TPR

Question 29

SV, CO, and HR

Answer 29

CO = HR x SV

Question 30

pressure, resistance, and flow

Answer 30

resistance = pressure/flow

Question 31

negative effects of too much preload

Answer 31

increased back pressure and congeestion increased resistance to subendocardial blood flow increased myocardial oxygen demand

Question 32

determinants of ventricular compliance

Answer 32

filling volume (-) wall thickness (-) ventricular size (+)

Question 33

core hemodynamic variables

Answer 33

SV - pump performance CO - blood flow RA pressure (CVP) - RV filling pressure PCWP - LV filling pressure SvO₂ - tissue oxygenation

Question 34

rule of 6s

Answer 34

RA \< 6 mmHg RV \< 30/6 mmHg PA \< 30/12 mmHg PCWP \< 12 mmHg

Question 35

SvO₂ normal range

Answer 35

60% to 80% any lower, threat to tissue oxygenation higher can also represent thret to tissue oxygenation

Question 36

causes of cardiogenic shock

Answer 36

acute MI, acute PE, cardiac tamponade, CHF exacerbation