Right And Left Heart Pt 2 Flashcards
Right heart cath indications
Determination of the cause of shock (vasodilatory vs. cardiogenic vs. hypovolemic)
•Management of cardiogenic shock following acute MI
•Diagnosis of RV ischemia during MI
•Diagnosis and management of mechanical complications after acute MI
•Diagnosis and localization of intracardiac shunts
•Diagnosis and prognostic information in patients with valvular heart disease
•Determination of the cause of pulmonary edema (cardiogenic vs. noncardiogenic)
•Diagnosis and treatment of congestive heart failure
•Diagnosis of restrictive cardiomyopathy
•Diagnosis of constrictive pericarditis
•Determination of the hemodynamic significance of a pericardial effusion
•Diagnosis of pulmonary hypertension
•Determination of reversibility of pulmonary hypertension by vasodilator challenge
•Evaluation for heart, lung, or liver transplantation (because irreversible pulmonary hypertension provides information on potential benefit and risk of transplantation)
•Hemodynamic monitoring in certain high-risk patients undergoing peripheral vascular, aortic, or cardiac surgery
•Quantification of LV preload
Mitral stenosis
Increased LA pressure (PCWP) with a gradient between the LA (PCWP) and the LV (LVEDP) that persists throughout diastole.
Mitral regurgitation
Acute MR: elevated PCWP, elevated PA pressure, prominent v wave, hyperdynamic LV function; hemodynamics can mimic constrictive pericarditis.
Restrictive cardiomyopathy
PA systolic pressure may be >50 mm Hg, RV/LV systolic pressure concordant, RVEDP/LVEDP separation >5 mm Hg, pronounced y descent.
Constrictive pericarditis
Elevated RA pressure, elevated PCWP, PA systolic pressure usually <50 mm Hg, RV/LV systolic pressure discordant, RVEDP/LVEDP separation <5 mm Hg.
Cardiac tamponade
Elevated diastolic pressures and equalization of end-diastolic pressures, x descent preserved or prominent and y descent small or absent on RA pressure.
Dilated cardiomyopathy
Right and left heart filling pressures typically elevated, decreased CO and index, decreased mixed venous oxygen saturation, pulsus alternans.
Hypertrophic obstructive cardiomyopathy
Spike and dome arterial pulse, systolic intraventricular pressure gradient, elevated LVEDP, Brockenbrough sign.
Aortic stenosis
Pressure gradient between the LV and aorta, elevated LVEDP, elevated PCWP, elevated PA pressures as resultant heart failure progresses.
Aortic insufficiency
Wide pulse pressure, low aortic diastolic pressure, elevated LVEDP; in severe aortic insufficiency, the LV and aortic pressures will be equal.
Which technique is used to insert the venous sheath during right heart catheterization?
Modified Seldinger technique
How is the PA catheter advanced through the heart chambers?
By direct fluoroscopic visualization or pressure monitoring
What does the pulmonary capillary wedge pressure (PCWP) indicate when measured?
Left atrial and left ventricular diastolic pressure
After recording the PCWP, what is the next step with the PA catheter?
Deflate the balloon and withdraw it into the proximal pulmonary artery
What measurement is used to assess RV preload during right heart catheterization?
Right atrial (RA) pressure
