Hemodynamics Cardiac Output Module 3 PDF

Hemodynamics Cardiac Output: Part 1 “Commit to the Lord whatever you do and your plans will succeed” - Proverbs 16:3  Hemodynamics (Part 1 of 3) The pressures generated by the flow of blood Tell us a great deal about the function of the heart, fluid balance, and vessels Ensure o...

Hemodynamics Cardiac Output: Part 1 “Commit to the Lord whatever you do and your plans will succeed” - Proverbs 16:3  Hemodynamics (Part 1 of 3) The pressures generated by the flow of blood Tell us a great deal about the function of the heart, fluid balance, and vessels Ensure optimal tissue perfusion and oxygen delivery Indications: o Shock o Heart dysfunction o Fluid imbalance o Guide therapies during CV instability Urden, Stacy, & Lough, 2022 Hemodynamics (Part 2 of 3) Invasive technologies Non-invasive technologies Urden, Stacy, & Lough, 2022 Hemodynamics (Part 3 of 3) Pulmonary Artery Monitoring Pulmonary Artery Catheter Urden, Stacy, & Lough, 2022 Finger Cuff vs Arterial Waveform Urden, Stacy, & Lough, 2022 Heart Anatomy Urden, Stacy, & Lough, 2022 Heart Blood Flow Heart Blood Flow by Bruce Blaus licensed by Wikimedia Commons  Cardiac Output Volume of blood ejected by the heart over 1 minute CO = HR x SV Stroke Volume: amount of blood ejected by the ventricle each heartbeat Determinants of SV: o Preload o Afterload o Contractility o Also affected by patient's heart rate and rhythm  Preload, Afterload, Contractility, and Heart Rate Preload: o Ventricular compliance o Venous return Afterload: o SVR o Aortic impedance o Blood viscosity Contractility Heart Rate: o Sympathetic stimulation o Pharmacologic agents Urden, Stacy, & Lough, 2022 Cardiac Output Flow Chart Urden, Stacy, & Lough, 2022 Preload Stretch of myocardial muscle prior to contraction created by volume in the ventricle Preload = End Diastolic Volume Determined by: o Total circulating volume o Distribution of volume o Ventricular compliance o Atrial systole Human Heart Blood Flow Oxygenated and Deoxygenated by azwer licensed by Pixabay Frank-Starling Law Greater Stretch = Greater Contraction Urden, Stacy, & Lough, 2022 Preload (Part 1 of 6) Volume in the ventricle at end- diastole Reflected by: o LVEDP (PAOP, PCWP, POP, “wedge”)  5-12 mm Hg o RVEDP (CVP, RAP)  2-5 mm Hg Urden, Stacy, & Lough, 2022 Preload (Part 2 of 6) Urden, Stacy, & Lough, 2022 Preload (Part 3 of 6) Urden, Stacy, & Lough, 2022 Preload (Part 4 of 6) Assessing fluid responsiveness: o Echo Urden, Stacy, & Lough, 2022 Preload (Part 5 of 6) Assessing fluid responsiveness: o Stroke Volume Variation o Methods of Assessing Fluid Responsiveness Urden, Stacy, & Lough, 2022 Preload (Part 6 of 6) Assessing fluid responsiveness: o Passive Leg Raise Urden, Stacy, & Lough, 2022  Afterload Amount of resistance the left ventricle must overcome in order to eject its contents into the aorta: o Afterload = End Systolic Wall Stress (or resistance) Heart Blood Flow Arteries by OpenClipart-Vectors licensed by Pixabay An Office Building by Unknown licensed by Wikimedia Commons Diameter of the Vessel Affects the Flow Constrictor Dilator Influences Influences Vascular Tone Calculation of MAP SBP + 2 (DBP) 3  Left & Right Ventricular Afterload Left Ventricular Afterload: Right Ventricular Afterload: o Systemic vascular resistance o Pulmonary vascular resistance SVR = MAP – CVP x 80 PVR = MPAP – CAOP x 80 CO CO o Normal = 800-1400 o Normal = 100-250 dynes/sec/cm5 dynes/sec/cm5 Preload and Afterload Urden, Stacy, & Lough, 2022  Components of Cardiac Output Also known as Inotropy Reflected by LVSWI (amount of “work” performed by LV with each heartbeat): o 50-62 g-m/m2 RVSWI: o 7.9-9.7 g-m/m2 EF (Ejection Fraction): o 50-70% Measuring Cardiac Output CO Cardiac Index = BSA Normal = 2.2-4.0 L/min/m2 Cardiac output is indexed to reflect BSA Cardiac Output Guide Preload Afterload Contractility Right-side CVP PVR RVSWI Left-side PAOP SVR LVSWI References McGee, W. T., Young, C., & Frazier, J. A. (Eds.) (2018). Quick guide to cardiopulmonary care. (4rd ed.) Urden, L. D, Stacy, K. M., &. Lough, M. E. (2022). Critical care nursing: Diagnosis and management (9th ed). Elsevier Mosby, Inc. You’ve reached the end of the presentation