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Pressures
Hemodynamics
Cardiac function Pulmonary and systemic blood pressures Resistance throughout the entire Cardiovascular system
Brain
Circulation:
AORTA
(13) (7)
(90)
SYSTEMIC ARTERIES
low compliance 13% of blood volume
VEINS (8)
high compliance 64% of blood volume
(40) ARTERIOLES
Arterial Blood Pressure Central Venous Pressure Pulmonary Artery Pressure Left Atrial Pressure
Flow = how fast stroke volume exits heart Resistance =diameter of vessels (SVR)
Measurements can be
Normal Values:
Ej ect ion
If unable to see dicrotic notch may be dampened, pressure may be falsely low
Pulse Pressure
Difference between Systolic and Diastolic pressure NORMAL = 30-40 Depends on SV and arterial compliance
A Catheter is placed with the tip lying in the Superior vena cava or Right Atrium Measures mean Right Atrial Pressure (RAP)
Indications:
blood volume and guide fluid replacement
To assess circulating
Volume must be enough to fill vascular space If right heart pump is OK, CVP reflects vascular volume
Heart capabilities how well can it pump? Venous tone (which changes vascular Resistance and space)
LUN GS RV
RA
LV
LA
Tissue
LUN GS RV
RA
LV
LA
Tissue
Fluid overload Right heart failureSevere left heart failureLarge Pulmonary EmboliPulmonary hypertension PEEP - how much?
LUNGS
RV
LV
R A
L A
Tissue
At ri al c
on t ra ct i
Cl Va osur lve e o f
on
AV
CVP waveform
Ve ntr i cu lar sy st o le
CVP
Complications:
PA Catheter
Balloon tipped catheter placed with the tip lying in the Pulmonary Artery
Can obtain both right and left heart pressures Used for CO determination Can obtain Mixed Venous samples Some have SvO2 and pacing capabilities
Thermister
Pressures obtainable:
CVP (RAP) PA (Systolic, diastolic and mean) PCWP (PAOP) This reflects Left heart fuiinction
(CVP)
CVP 2-6
RV 2030
PCWP 4-12
Stroke volume, rate of blood flow (force of contraction), and resistance of pulmonary vasculature
Its used to help determine Pulmonary Vascular Resistance (PVR) and is used to assess how much work the R ventricle must push against (Afterload)
Indications
Hemodynamically unstable patients Cardiogenic shock, sepsis Unstable thoracic surgery patients Same as CVP but with the additional: Dys-rhythmia (mostly during placement) Pulmonary infarct if it wedged in PA
Complications
With the balloon inflated, the wedged PAC creates a channel with no blood flow from the catheter tip to the left atrium, thus allowing indirect measurement of the left atrial pressure.
PCWP, PAOP
LUN GS RV
RA
LV
LA
Tissue
Definitions
the amount of pressure the left ventricle must generate to squeeze blood into the aorta. RV afterload = ____________ (Pressure) LV afterload = _____________(Pressure)
SV
(left ventricular performance)
u contractility
normal contractility
SV at Preload X - u contractility SV at Preload X - N contractility SV at Preload X - d contractility
State of Myocardial Contractility: Determines the amount of blood (SV) that comes out of the heart at a given preload
Preload X
Preload
(venous return or EDV)
Resistance - the sum of all forces that oppose blood flow due to:
Length of vasculature (L) Blood viscosity (V) The largest variable is Vessel RADIUS Vessel radius (r) (MAP RAP) * 80 / CO
Similarities
(2)
(13)
(3)
9% of blood volume
(90)
SYSTEMIC ARTERIES
low compliance 13% of blood volume
VEINS
high compliance 64% of blood volume
CAPILLARY BEDS
ARTERIOLES
SVR
PVR
Notice the SVR is about 9 times as high as the PVR, hence the thicker left ventricle does more work
ED V
Systole
Homework state whether the pressures in each will go up, down or stay the same.
CVP PAP PCWP
Normal = Right ventricular failure Left ventricular failure Pulmonary hypertension Non-cardiogenic pulmonary edema (ARDS) Mitral valve stenosis or insufficiency Pulmonary Embolism