Pulmonary Artery Catheters 3 Flashcards
What causes decreased preload?
- hypovolemia
- vasodilation
What causes increased preload?
- hypervolemia
- vasoconstriction
What causes increased afterload?
- hypovolemia
- vasoconstriction
What causes decreased afterload?
- hypervolemia
- vasodilation
What pressure determines the preload in the right heart and what is the normal value?
CVP 2-6
What pressures determine afterload of the right heart and what are the normal values?
PAP 20-30/6-15
MAP 10-20
What resistances determine afterload of the right heart and what are the normal values?
PVR 50-150
PVRI 100-240
What pressure determines the preload of the left heart and what is the normal value?
PCWP 4-12
What pressures determine the afterload of the left heart and what are the normal values?
BP 120/80
MAP 80-100
What resistances determine the afterload of the left heart and what are the normal values?
SVR 900-1300
SVRI -100-500
What flows affect the contractility of the left heart and what are the normal values?
CO 4-8
CI 2.5-5
SV 60-130
SI 30-50
What affects the contractility/work of the right heart and what are the normal values?
LVSWI 50-60
RVSWI 8-10
What are the measured hemodynamic variables?
CVP (RA) PAPS/D PCWP CO HR
What are the derived hemodynamic variables?
CI SV/SVI/SVR PAM PVR/PVRI LVSWI RVSWI
What falls under category 1 in the table?
Normal or hyperdynamic state (septic shock)
What falls under category 2 in the table?
Fluid overload (normal contractility)
What falls under category 3 in the table?
Hypovolemia (hemorrhage) or dehydration
What falls under category 4 in the table?
Acute left heart failure (decreased contractility)
How do you determine CMO and what is it affected by?
CO = HR x SV
CO = VO2/C(a-v)O2
Affected by circulating blood volume, contractility, valve function, pericardial function, metabolic rate, vascular resistance
What causes an increased CMO (up to 5 times normal)?
Increased metabolism Septic shock Exercise Stress Pregnancy Intracardiac shunt Systemic vasodilation
What causes a decreased CMO?
Shock Hypovolemia Left cardiac dysfunction Decrease metabolism Chronic hypotension Vascular disease Cardiomyopathies
What are the three ways to measure CMO?
Thermodilution
Fick equation
Dilution method echo
What causes a decreased preload?
Hypovolemia - sepsis
< 4 CVP and < 6 PCWP
What are the treatments for decreased preload?
NSS Albumin Whole blood Ringers lactate Colloids
What causes an increased preload?
Hypervolemia vs failure
> 10 CVP
> 20 PCWP
What are the treatments for increased preload?
Diuretics for hypervolemia
Vasodilators, ionotropics, nitroglycerine for failure
What are the treatments for decreased afterload?
Norepinephrine
Dopamine
Phenylephrine
What are the treatments for increased afterload?
Vasodilators such as sodium nitroprusside
Alpha inhibitors such as clonidine
What are the treatments for increased contractility?
Negative ionotropic agents
Propranolol
Diltiazem
What are the treatments for decreased contractility?
Digoxin Dopamine Dobutamine Epinephrine Isoproterenol
