Hemodynamics causes CC

Question 1

Static measures of fluid responsiveness

Answer 1

• CVP
• Pulmonary capillary wedge pressure
• Clinical static endpoints (heart rate, blood pressure, etc).

Question 2

Dynamic measures of fluid responsiveness

Answer 2

• Pulse pressure variation
• Stroke volume variation
• IVC collapsibility
• Response to passive leg raise
• Fluid challenge

Question 3

Causes of false positive IVC collapse

Answer 3

• Elevated intra abdominal pressure

Question 4

Causes of false positive IVC distention

Answer 4

• Pneumothorax
• Pericardial effusion

Question 5

Elevations in RA pressure

Answer 5

• Diseases of the right ventricle (eg, right ventricular infarction or cardiomyopathy)
• Pulmonary hypertension
• Pulmonic stenosis
• Left-to-right shunts
• Tricuspid valvular disease
• Cardiac tamponade
• Constrictive pericardial disease
• Restrictive cardiomyopathies
• Left ventricle systolic heart failure
• Hypervolemia

Question 6

Conditions in which PAW>LVEDP

Answer 6

• Mitral stenosis
• Left atrial myxoma
• Pulmonary embolus
• Mitral valve regurgitation
• Pulmonary venocclusive disease
• Pulmonary vein stenosis

Question 7

Conditions in which PAW

Answer 7

• Decreased LV compliance
• High (>25 mmHg) LVEDP
• Aortic valve regurgitation

Question 8

Conditions in which PAW does not approximate PCWP (More than 1-4 mmHg difference)

Answer 8

• Increased pulmonary vascular resistance
• Pulmonary hypertension
• Cor pulmonale
• Pulmonary embolus
• Eisenmenger’s syndrome

Question 9

Conditions that cause elevated left ventricular end diastolic pressure LVEDP

Answer 9

• Left ventricular systolic heart failure
• Left ventricular diastolic heart failure
• Mitral and aortic valve disease
• Hypertrophic cardiomyopathy
• Hypervolemia
• Large right-to-left shunts
• Cardiac tamponade, constrictive and restrictive cardiomyopathies

Question 10

Conditions that cause a low wedge pressure

Answer 10

• Hypovolemia (eg, hemorrhagic shock, severe intravascular volume depletion)
• Pulmonary venoocclusive disease (variably normal or low)
• Obstructive shock due to large pulmonary embolism

Question 11

Causes that would consistently overestimate cardiac output in hemodilution method

Answer 11

• Injectate that is warmer than programmed into the computer

Question 12

Causes that would consistently underestimate cardiac output in hemodilution method

Answer 12

• A larger than programmed injectate

Question 13

Obstructive shock

Answer 13

Decreased venous return:

• Cardiac tamponade
• Abdominal compartment syndrome
• Tension pneumothorax
• Increased resistance to venous return
  
  • Tumor compression
  • Venous thrombosis
  • Increased PEEP/PEEP
  • Pregnancy

Increased ventricular afterload:

• Increased PVR- Pulmonary embolism
• Hypertensive crisis
• Aortic dissection

Question 14

Wide pulse pressure

Answer 14

• Thyrotoxicosis
• Arteriovenous fistula
• Aortic insufficiency

Question 15

Narrow pulse pressure

Answer 15

• Significant tachycardia
• Early hypovolemic shock
• Pericarditis
• Pericardial effusion or tamponade
• Ascites
• Aortic stenosis

Question 16

Systolic hypertension

Answer 16

• Increased cardiac output
• Thyrotoxicosis
• Generalized response to stress
• Anemia
• Pain, anxiety, or both

Question 17

Diastolic hypertension

Answer 17

• Intrinsic renal disease
• Endocrine disorders
• Renovascular hypertension
• Neurologic disorders

Question 18

Management options which decrease preload

Answer 18

• Diuretics (e.g., furosemide): decrease systemic venous tone and extracellular volume/volume overload
• Opiates (e.g., morphine sulfate) reduce sympathetic tone
• Nitrates (e.g., nitroglycerin): venous and arterial vasodilator, reduce myocardial oxygen demand
• Nesiritide: recombinant BNP that results in vasodilation and diuresis
• Ultrafiltration (volume removal)

Question 19

Management options which decrease afterload

Answer 19

• ACE inhibitor/ARB: reduce preload and afterload
• Nitroprusside (decreases venous return and afterload)
• Nitrate
• Hydralazine
• Intraaortic balloon pump

Question 20

Vasoactive drugs working on β1 receptors

Answer 20

• Dobutamine
• Epinephrine (LD)
• Norepinephrine

Question 21

Vasoactive drugs working on α1 receptors

Answer 21

• Phenylephrine
• Norepinephrine
• Epinephrine

Question 22

Vasoactive drugs working on β2/PDEi receptors

Answer 22

• Dobutamine
• Dopamine (Low Dose)
• Milrinone
• Isoproterenol

Question 23

List of pulse contour analysis devices

Answer 23

• PiCCO
• LiDCO
• FloTrac/Vigileo

Question 24

Causes of overdamped arterial line

Answer 24

• Clot
• Air
• kinks
• Loose connections
• Arterial spasm
• Narrow tubing

Link

Question 25

Correctable metabolic causes of depressed contractility

Answer 25

• Hypoxia
• Acidosis (pH<7.3)
• Hypophosphatemia
• Adrenal insufficiency
• Hypothermia

Question 26

Causes of underdamped arterial line

Answer 26

• Catheter whip or artefact
• Stiff non-compliant tubing
• Hypothermia
• Tachycardia or dysrhythmia