SVC and IVC to...
right atrium...tricuspid.....right ventricle
right ventricle to
pulmonary semi-lunar valve....Right and Left Pulmonary ARTERY
pulmonary arteries to..
LUNGS...Right and Left Pulmonary VEINS
Pulmonary Veins to
Left atrium...mitral valve...left ventricle
Left ventricle to...
Aortic semi-lunar valve...to aorto to BODY
Systole
heart contraction
diastole
heart relaxation
preload
ventricular filling...volume of blood...degree of contraction
afterload
force against which the ventricles must work to pump the blood(resistance)
stroke volume
volume of blood ejected by ventricles with each contraction.
normal stroke volume
40-80 ml
ejection fraction
% of blood ejected by ventricles with each contraction
normal ejection fraction
60 %..can go up to 90% with exercise
Cardiac Output CO or Q
total volume of blood pumped from ventricles per minute
Normal CO
4-5 L /min
CO=
HR x SV
Cardiac Index CI
Takes into account size of person...CI = CO/BSA....correlateds CO to body size
Normal CI
2.5-4 L/min/m2
BP
measure of force against arterial wall that blood flows through the artery
Systolic BP
max pressure when ventricles contract
Diastolic BP
lowest pressure when ventricles relax
Mean Arterial Pressure MAP
Average pressue in the artery throughout cardiac cycle
Heart in systole..
1/3 cardiac cycle
Heart in Diastole
2/3 cardiac cycle
MAP =
Systole pressure + 2(diastole) / 3 answer in mmHg
Normal MAP
93.3 mmHg
Pulse Pressure
the difference between Systolic and Diastolic...120-80=40mmHg
Karotkaff sounds
vascular vibrations...the sound you here when taking BP
Areterial Cannulation..."A LINE
Measure systemic BP
Indications for an A LINE
1. Continous BP Monitoring (Heart, cardiac disorders, fluid problems(hypovolemia), CABG, Kidney, BP meds)
2. ABG Sampling
Lower pressure reading...Cuff or A LINE?
Cuff,. Cuff can be 20 mmHg lower than the A LINE
ArterialCatheter placement
Radial, femoral, brachial, dorsalis pedis and axillary ARTERIES
Complications of having an A LINE
1 Embolism 2Bleedback(pressure bag), 3 Hemorrhage(bleeding disorders, anticoagulants) 4Infections 5Loss of distal perfusion 6 Accidental drug injection (drugs go into vein, then heart....not Artery.
What determines Arterial Pressure?
SV, Arterial Compliance and Arterial Resistance
Hypertension Def. (HTN)
140/90 or MAP>110mmHg
Causes of HTN
Arteriosclerosis, kidney problems, sodium, heart disease and smoking
Problems associated with HTN
CVA, kidney damage
Causes of LOW arterial pressure
Hypovolemia/shock...arrhythmia(Increased HR, Decreased SV, Decreased BP)
Problems with LOW arterial pressure
Decreased perfusion and Decreased oxygenation
Inatropic Drugs
increases hearts contractility...ex:digoxin, digitalis, dopamine, doputamine, isoproterdol
Vasopressors
Constricts vessels Ex: vasopressin, phenylephrine, epinephrine and norepinephrine
Vasodilators
relax arterial smooth muscle..Ex:nitroglycerine(nitrates), sodium nitroprusside(nipride) and hydralazine
Anti Hypertensive Drugs
A Diuretics (Thiazides) B Sympatholytics (indoral, metro) C Direct vasodilators
Anti arrhythmia Drugs
Amiodarone, lidocaine, atropine, epinephrine,propalol,procainimide
Central Venous Pressure CVP
Catheter sits in superior vena cava(VEIN), measures pressure in right atrium (RAP) so...CVP=RAP..
Normal CVP
2-6mmHg or 4-12 cmH20
CVP Catheter locations
External/Internal jugular.. Subclavien, Femoral, Basilic, Cephalic ALL VEINS
Indications for CVP
Assess R heart function, Administer fluids, Drug administration, Administer blood, Withdrawl venous blood sample
Hypovolemia Increase or decrease CVP?
Decrease
Hypervolemia Increase or decrease CVP?
Increase
Limitatons of CVP monitoring
Systemic veins constricted, decrease RV compliance, Venous patency, tricuspid valve disease(stenosis)
Complications of CVP
hemorrhage, arrythmias, vascular erosions, infections, fluid overload, hypothermia(from giving cold fluid), thrombus(blood clot), air embolism, perforation of cardiac chambers
Pulmonary Artery Cather PAC AKA
Swan Ganz Catheter.
Distol Port
Sits in pulmonary artery...Measures PAP..Measures PCWP..Can draw MIXED venous blood sample collected from this port NO Drugs given through this port
Normal Mixed Venous Blood Sample
pH 7.35, PvO2 40, SvO2 70-75%, PvCO2 46
Proximal Port
Sits back in the Right Atrium...Measure CVP..RAP Can administer fluids/meds through this port
Balloon inflation port
allows inflation/deflation of balloon
Thermister port
lies in pulm. artery, used to measure cardiac output.
Indications for PAC
Swan Ganz....Heart disorders(CHF, Cardiac surgery,Congenital Heart defects, cor pulmonale).....LUNG disorders(Pulm hypertension, ARDS, pulm edema(CHF), Pulm embolism AND Assess/Monitor fluids
PCWP=
LAP=LVEDP....Balloon is inflated to read this pressure
RAP=
RVEDP...Can be measured with Swan Ganz AND CVP
Decreased SV means..
Decreased CO....Compensation can occur, If SV is low, HR would increase to maintain CO...Compensation does not occur with advanced heart disease.
Preload
Ventricular filling..Pressure from atrium will give a volume to the ventricle...Increased pressure...Increased volume
Increased PCWP=
Increased volume of blood in LA and LV....PCWP is the preload of LV.
PVR Pulmonary Vascular Resistance
Whats AFTER the RV? Pulm artery so....RV afterload is determined by Pulmonary Vascular Resistance.
SVR Systemic Vascular Resistance
Whats AFTER LV? Aorta, Body....so...LV afterload is determined by Systemic Vascular Resistance.
Pulmonary Vascular Resistance Def..
Resistance to blood flow through pulmonary circulation.
Systemic Vascular Resistance Def.
Resistance to blood flow through systemic circulation.
SVR Formula
MAP-RAP / CO....To convert to dynes/sec/cm....need to multipy by 80
PVR Formula
MPAP-PCWP / CO
Normal SVR
1200-1600 dynes/sec/cm
Normal PVR
20-250 dynes/sec/cm
PPV does what to hemodynamics?
All this + pressure squeezes the heart, increasing pressure in heart and limiting blood flow.