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Pathophysiology (RESP 212) > Module 9: Hemodynamics > Flashcards

Module 9: Hemodynamics Flashcards

1
Q

What is Hemodynamics?

A

The study if forces (pressure) that influence the circulation of blood

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2
Q

What are 3 routes (lines) to collect data?

A

Arterial lines

Central lines

Pulmonary artery lines

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3
Q

What do arterial lines tell us?

A

Collect information about the systemic system

TLDR:
Measures perfusion and how well oxygenated blood is carried from left ventricle to tissue and picks up CO2 + waste

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4
Q

Central lines elucidate information on…

A

fluid balance and function of the right heart

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5
Q

Pulmonary artery lines

A

Information on the pulmonary system fluid balance and the function of the left heart

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6
Q

Direct measurements

A

BP

MAP (mean arterial pressure)

CVP (central venous pressure)

RAP (right arterial pressure)

Mean pap (mean pulmonary wedge pressure)

PAWP (pulmonary artery wedge pressure)

CO (cardiac output)

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7
Q

Calculated values in hemodynamics

A

SV (stroke volume)
-SVI

CI (cardiac index)

SVR (system vascular resistance)
-SVRI

PVR (pulmonary vascular resistance)
-PVRI

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8
Q

Slide 4: how dynamic measurements and calculated values reflect blood flow path

A
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9
Q

Ohm’s Law physics is splint into two types, what are they?

A

Electrical
- voltage - current x resistance

Fluid
- change in pressure = Flow x Reistance
-change in pressure = driving pressure

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10
Q

What does Hemodynamics tells us at the tissue level?

A

Movement of blood at the tissue level tells us:

how much perfusion we are getting in to bring in oxygen and nutrients in addition to waste removal.

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11
Q

Where are the tricuspid and Mitral (bicuspid) valves located.

A

Tricuspid = between right atrium and right ventricle

Mitral = between left atrium and left ventricle

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12
Q

What is the order of valves does blood pass through?

A

Tricuspid -> Pulmonic -> mitral -> aortic

TPMA

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13
Q

Cardiac output: Define the frank-starling relationship

A

Show how changes in ventricular preload lead to changes in stroke volume.

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14
Q

where does the blood in the right atrium come from?

A

Superior vena cava
Inferior vena cave
Coronary sinus

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15
Q

What is the function of the coronary sinus?

A

To drain deoxygenated blood from the heart muscle into the right atrium

(the hearts supply of blood that was used)

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16
Q

What is arterial pressure monitoring?

A

A invasive blood pressure monitor done through the cannulation of a peripheral artery.

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17
Q

Indications for arterial pressure monitering?

A

Used for patients with severe hypotension/hypertension

patients who need frequent ABGs

Patients who exp’d respiratory failure

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18
Q

2 locations for a Arterial line

A

Radial artery (preferred + easy access)

Femoral artery (harder + less vasoconstriction)

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19
Q

Why is the radial artery preferred over the femoral artery?

A

Radial artery has collateral circulation while the femoral doesn’t

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20
Q

Arterial Pressure Wave forms:

What does the dicrotic notch represent?

A

Aortic valve closure

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21
Q

Expected vitals for hypertension

A

hypertension = > 160-90

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22
Q

Expected vitals for hypotension

A

Hypotension = < 90/60

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23
Q

What is hypotension a late sign of?

A

Low cardiac output

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24
Q

What causes hypotension?

A

Low blood volume

Poor cardiac function

Low vascular resistance

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25
Q

why is low diastolic pressure dangerous?

A

Compromised coronary artery perfusion

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26
Q

Complications of Arterial Pressure monitoring

A

Ischemia

Hemorrhage

Infection

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27
Q

what happens when arterial pressure monitoring result in Ischemia? why is it dangerous?

A

Occurs with embolism, thrombus, or arterial spasm

Can result in tissue necrosis

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28
Q

How can arterial pressure monitoring caused a hemorrhage?

A

occurs if line becomes disconnected

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29
Q

What is CVP?

A

Central venous pressure.

pressure in the thoracic vena cava near the right atrium

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30
Q

Why is CVP important?

A

Assess circulating blood volume and filling pressures of the heart.

and

**Gauge right ventricle function **

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31
Q

Normal CVP pressure?

A

8 - 12mmHg

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32
Q

Who would need a CVP catheter/monitoring ?

A

patients who had major surgery or trauma

+

Patients with pulmonary edema

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33
Q

Triple lumen (catheter) has 3 ports/functions. what are they?

A
  1. allow infusion of meds
  2. has a port to obtain blood samples.
  3. internal jugular = site for insertion
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34
Q

CVP waveforms reflect pressures in the right atrium.

What are the three waves?

A

A = occurs with atrial contraction

C = occurs with AV valves back towards atrium during
systole

V = Occurs with atrial filling during ventricular systole.

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35
Q

How does respiratory function affect CVP waveforms?

A

Spontaneous inspiration cause CVP to decrease.

Positive pressure breaths cause CVP to increase.

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36
Q

Factors that increase CVP

A

Fluid overload

Right/left heart failure

Pulmonary hypertension

Tricuspid valve stenosis

Pulmonary embolism

Increased venous return

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37
Q

Causes of decreased CVP

A

Reduced circulating blood volume

Vasodilation (reduced venous return)

Leaks in the pressure system

Spontaneous inspiration

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38
Q

Complications during placement of CVP monitoring process

A

Bleeding

Pneumothorax

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39
Q

Complications for CVP monitoring over time

A

Infection

Embolus

Air embolus

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40
Q

Catheter insertion: what is the path it is “floated” through?

A

Right atrium -> right ventricle -> pulmonary artery -> wedge position

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41
Q

What happens when the catheter wedges into place?

A

The balloon inflates

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42
Q

Normal pressure: Right atrium

A

2 - 6 mmHg

43
Q

Normal pressure: right ventricle

A

Systolic: 20-30 mmHg

Diastolic: 0 - 5 mmHg

44
Q

Normal pressure: Pulmonary artery

Mean pressure?

A

Systolic: 20 - 30 mmHg

Diastolic: 6 - 15 mmHg

Mean pressure: 10 - 20mmHg

45
Q

Normal pressure:
Pulmonary capillary wedge pressure

A

4 - 12 mmHg

46
Q

PA systolic pressure

A

20 - 30 mmHg

47
Q

PA diastolic pressure

A

8 - 15 mmHg

48
Q

what increases PA systolic pressure?

A

high pulmonary vascular resistance

49
Q

what decreases PA systolic pressure

A

poor right heart function

pulmonary vasodilation

50
Q

what does PA diastolic pressure reflect?

what condition does it not reflect it?

A

Left heart filling pressures.

it cannot be accurately interpreted when pulmonary vascular resistance is elevated.

51
Q

What is normal wedge pressure?

A

4 - 12mmHg

52
Q

What does wedge pressure increase/decrease?

A

Increase: with left heart failure or mitral stenosis

Decrease: hypovolemia

53
Q

What does elevated CVP, PAP, and increased wedge indicate?

A
54
Q

What does elevated CVP, PAP, and normal wedge indicate?

A
55
Q

Best procedure for accurate wedge pressure?

A

measure at end exhalation

catheter tip must be in west zone III where blood flow is continuous.

56
Q

What can cause an inaccurate wedge pressure reading?

A

low blood volume

high alveolar pressure

57
Q

PCWP?

A

Pulmonary capillary wedge pressure

58
Q

What does this image tell you about West zone III ?

A

Both the arterial and the venous pressures are higher than the alveolar.

meaning there is an uninterrupted column of blood in the vessels between the right ventricle and left atrium

59
Q

PA monitoring issues

A

During cannulation blood vessels damage is possible along with hemothorax and pneumothorax.

Dysarthria’s (when catheter passes in heart)

Pulmonary infarction (basically any embolism type)

an catheter could be an infection source

60
Q

Normal MAP

A

Mean atrial pressure:

80 - 100 mmHg

61
Q

Insert slide 33 for normal ranges for pulmonary artery catheters

A
62
Q

What is cardiac output (CO)

A

Amount of blood pumped out the left ventricle in 1 minute

CO = stroke volume x Heart Rate

63
Q

What is stroke volume

A

amount of blood ejected from the left ventricle with each contraction

64
Q

Normal stroke volume range

A

60 - 130 mLs

65
Q

Normal CO at rest

A

4 - 8 L/min

66
Q

What is venous return?

A

amount of blood returning to the right atria each minute.

67
Q

Similarities between Venous return and Cardiac Output?

A

Same range.

In healthy hearts: venous return increases and CO does too.

68
Q

What causes venous return to increase?

A

peripheral vasodilation

69
Q

what does vasoconstriction do to venous return?

A

decrease venous return.

70
Q

What is Cardiac Index (CI)

A

A measurement standard to determine the cardiac function despite different body sizes.

It is determined by dividing the CO by body surface area.

TLDR: measure of cardiac output and pump function.

71
Q

Normal Cardiac Index (CI)

A

4.0 L/min/m^2

72
Q

What is ventricular stroke work a measure of?

A

A measure of myocardial work per contraction.

73
Q

What is ventricular stroke work

A

The product of:

stroke volume x the pressure across the vascular bed

74
Q

Ventricular volume

A

estimated by measuring end diastolic pressure

75
Q

Ejection fraction

A

Fraction of end-diastolic volume with each systole.

76
Q

What is ejection fractions normal range?

A

60-70% but drops with cardiac failure.

77
Q

Determinants of pump function

A

Specifically:
-Heart rate
-Preload
-Afterload
-contractility

General:
HR and SV

78
Q

What is Tamponade?

A

Compression of heart by an accumulation of fluid in the pericardial sac

79
Q

Heart rate effects on CO

A

Low HR is normally compensated by an increase in stroke volume (SV)

elevated HR causes SV to drop in ppl with heart diseases -> it reduces fill time.

80
Q

Preload effects on pump function

A

The greater the stretch on myocardium before contraction = greater the following contraction.

Too much = reduce SV

Too slow = SV and CO drop

81
Q

When does a drop in SV and CO typically occur?

A

Hypovolemia or whenever cardiac functions are slow.

82
Q

What is created by end-diastolic volume

A

Preload

83
Q

What is end-diastolic volume?

A

Amount of blood that is in the ventricles before the heart contracts.

84
Q

Factors that affect venous return, preload, and CO

A

Circulating blood volume

Distribution of blood volume

Atrial contraction (adds 30% to following ventricular SV)

85
Q

Effect of mechanical ventilation (3)

A

Spontaneous inspiration lowers intrapleural pressure:
-Improves venous return and CO:

Positive pressure breaths
-Increase intrapleural pressures and reduces venous return and CO

Can adjust to ppls level of lung/chest compliance.

86
Q

2 components of Afterload

A

Peripheral Vascular Resistance and Tension in the ventricular wall

87
Q

As afterload increases, what demand is needed in the heart?

A

Oxygen

88
Q

what is SVR?

A

Systemic vascular resistance = amount of force exerted (resistance) on systemic circulation.

89
Q

What happens in the heart when there is peripheral vasoconstriction?

A

systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) increase

90
Q

What is PVR?

A

measure of pulmonary vascular resistance

91
Q

What is an example of pulmonary vasoconstriction that increases PVR?

A

Hypoxemia and acidosis

92
Q

what factors reduce contractility?

A

hypoxia, acidosis, electrolyte abnormalities, and myocardial ischemia

93
Q

Contractility is determined by

A

stretch before contraction

inotropic state of the heart

94
Q

Inotrope class drugs can improve contraction, but what does it require as a result?

A

increase in myocardial oxygen demand.

95
Q

Thermodilution

A

A method to measure CO (old) with a pulmonary artery catheter + computer

Specfically:
A coldish bolus of saline is injected into a proximal port; temperature change over time measured by a thermometer at the distal tip of the PAC.

96
Q

Ficks method: what assumptions need to be met to measure CO?

A

Based on the idea that blood flow to an organ can be calculated using:

O2 consumption, arterial oxygen content and mixed venous oxygen content are simultaneously measured.

Not popular

97
Q

Premise of Ficks method

A

The total uptake of oxygen is equal to the product of the cardiac output and the arterial-venous oxygen content difference.

98
Q

Difference between systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR)

A

SVR describes resistance from peripheral circulation (transport/distribution, exchange, and storage of blood between tissue in the venous system)

PVR describes resistance offered by vasculature of the lungs.

99
Q

West zones: Perfusion (Q) is highest in zone 3 and lowest in zone 1. If V/Q is highest in zone 1 and lowest in 3, where is ventilation the highest?

A

Ventilation and perfusion are highest Zone 3.

the ratio is highest in zone 1.

100
Q

V/Q mismatch?

A

When the lungs receive oxygen without blood flow or blood flow without oxygen

101
Q

What is V/Q ratio?

A

The amount of air that reaches your lungs divided by the amount of blood flow in the capillaries in your lungs.

102
Q

What does an increase in v/q ratio mean?

A

decreased perfusion in the lungs.

103
Q

Decrease in v/q ratio mean?

A

impaired airflow = low ventilation w/normal perfusion.

Examples: COPD or asthma

Pathophysiology (RESP 212) (14 decks)

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