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hemodynamic monitoring

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Diastole:
4 aspects:
1. The heart is at rest and the myocardium is relaxed.
2. The atria and ventricles passively fill. AV valves allow blood to pass
3. The aortic and pulmonary artery semilunar valves are closed because the blood in those vessels is at a higher pressure than the ventricles.
4. Blood continues to fill atria and ventricles, stretching the compliant heart cells.
Systole:4 aspects:
1. The atria contract and eject the final amount of blood into the ventricles.
2. Atria relaxation causes atrial pressure to be lower than ventricular pressure.
3. High ventricular pressure relative to the atria causes the AV valves to close, preventing backflow while the ventricles contract.
4. The ventricles continue to contract, ejecting blood through the semilunar valves out to the lungs and rest of the body.
CVP (Central Venous Pressure)
What does it measure?
The pressure of blood within the right atrium.
Used to approximate the right ventricular end diastolic pressure (RVEDP)
Right Ventricular End Diastolic Pressure:
What does it assess?
Assesses right ventricular function and general fluid status.
Measured by CVP.
CVP:
Normal values?
High indicates?
Low indicates?
Normal 2-6 mmHg
High=overhydration, increased venous return or right sided cardiac failure.
Low=hypovolemia or decreased venous return
CO (cardiac output):
What is it?
Normal?
High means?
Low means?
The volume of blood pumped by the heart in one minute.
Normal=4-8 L/min
High=high circulating volume
Low=a decrease in circulating volume or a decrease in the strength of ventricular contraction.
CI (cardiac index):
What is it?
Normal range?
Cardiac output (CO) divided by meter square of body surface area.
2.5-4 L/min/m2
Afterload:
What is it?
The resistance that the heart has to overcome, during every beat, to send blood into the aorta. These resistive forces include vasoactivity and blood viscosity.
Mean Arterial Pressure(MAP):
What is it?
Normal range?
Reflects changes in the relationship between cardiac output (CO) and systemic vascular resistance (SVR) and reflects the arterial pressure in the vessels perfusing the organs.
70-100 mmHg
PA (pulmonary artery pressure):
What is it?
High means?
Blood pressure in the pulmonary artery.
Increased pulmonary artery pressure may indicate: a left-to-right cardiac shunt, pulmonary artery hypertension, COPD or emphysema, pulmonary embolus, pulmonary edema, left ventricular failure.
PA normal ranges:
PAS?
PAD?
PAM?
Systolic 20-30 mmHg (PAS)
Diastolic 8-12 mmHg (PAD)
Mean 25 mmHg (MAD)
Pulmonary Capillary Wedge Pressure (PCWP or PAWP):
Used for?
High means?
PCWP pressures are used to approximate LVEDP (left ventricular end diastolic pressure).
High PCWP may indicate left ventricle failure, mitral valve pathology, cardiac insufficiency, cardiac compression post hemorrhage.
PCWP/PAWP
normal range?
4-12 mmHg
Pulmonary Vascular Resistance (PVR):
Used for?
High means?
Low means?
The measurement of resistance or the impediment of the pulmonary vascular bed to blood flow.
An increased PVR or "Pulmonary Hypertension" is caused by pulmonary vascular disease, pulmonary embolism, or pulmonary vasculitis, or hypoxia.
decreased PVR is caused by medications such as calcium channel blockers, aminophylline, or isoproterenol or by the delivery of O2.
PVR normal range?
37-250 dynes/sec/cm2
Right Ventricular Pressure (RV Pressure):
High means?
A direct measurement that indicates right ventricular function and general fluid status.
High RV pressure may indicate: pulmonary hypertension, right ventricle failure, congestive heart failure.
RV pressure normal range?
Systolic-20-30 mmHg
Diastolic 0-5 mmHg
Stroke Volume:
Low means?
High means?
The amount of blood pumped by the heart per cardiac cycle. It is measured in ml/beat.
decreased SV may indicate impaired cardiac contractility or valve dysfunction and may result in heart failure.
increased SV may be caused by an increase in circulating volume or an increase in inotropy
SV normal range?
50-100 mL
Stroke Index or Stroke Volume Index: (SI or SVI):
High means?
Low means?
The amount of blood ejected from the heart in one cardiac cycle, relative to Body Surface Area (BSA). It is measured in ml per meter square per beat.
increased SVI may be indicative of early septic shock, hyperthermia, hypervolemia or be caused by medications such as dopamine, dobutamine, or digitalis.
decreased SVI may be caused by CHF, late septic shock, beta blockers, or an MI.
SVI (SI) normal range?
25-45 mL/m2
Systemic Vascular Resistance (SVR):
High means?
Low means?
The measurement of resistance or impediment of the systemic vascular bed to blood flow.
increased SVR can be caused by vasoconstrictors, hypovolemia, or late septic shock.
decreased SVR can be caused by early septic shock, vasodilators, morphine, nitrates, or hypercarbia
SVR normal range?
800-1200 dynes/sec/cm2
Diastole:
4 aspects:
1. The heart is at rest and the myocardium is relaxed.
2. The atria and ventricles passively fill. AV valves allow blood to pass
3. The aortic and pulmonary artery semilunar valves are closed because the blood in those vessels is at a higher pressure than the ventricles.
4. Blood continues to fill atria and ventricles, stretching the compliant heart cell


Systole:4 aspects
1. The atria contract and eject the final amount of blood into the ventricles.
2. Atria relaxation causes atrial pressure to be lower than ventricular pressure.
3. High ventricular pressure relative to the atria causes the AV valves to close, preventing backflow while the ventricles contract.
4. The ventricles continue to contract, ejecting blood through the semilunar valves out to the lungs and rest of the body.
CVP (Central Venous Pressure)
What does it measure?
The pressure of blood within the right atrium.
Used to approximate the right ventricular end diastolic pressure (RVEDP)
Right Ventricular End Diastolic Pressure:
What does it assess?
Assesses right ventricular function and general fluid status.
Measured by CVP.
CVP:
Normal values?
High indicates?
Low indicates?
Normal 2-6 mmHg
High=overhydration, increased venous return or right sided cardiac failure.
Low=hypovolemia or decreased venous return
CO (cardiac output):
What is it?
Normal?
High means?
Low means?
The volume of blood pumped by the heart in one minute.
Normal=4-8 L/min
High=high circulating volume
Low=a decrease in circulating volume or a decrease in the strength of ventricular contraction.
CI (cardiac index):
What is it?
Normal range?
Cardiac output (CO) divided by meter square of body surface area.
2.5-4 L/min/m2
Afterload:
What is it?
The resistance that the heart has to overcome, during every beat, to send blood into the aorta. These resistive forces include vasoactivity and blood viscosity.
Mean Arterial Pressure(MAP):
What is it?
Normal range?
Blood pressure in the pulmonary artery.
Increased pulmonary artery pressure may indicate: a left-to-right cardiac shunt, pulmonary artery hypertension, COPD or emphysema, pulmonary embolus, pulmonary edema, left ventricular failure.
PA (pulmonary artery pressure):
What is it?
High means?
Blood pressure in the pulmonary artery.
Increased pulmonary artery pressure may indicate: a left-to-right cardiac shunt, pulmonary artery hypertension, COPD or emphysema, pulmonary embolus, pulmonary edema, left ventricular failure.
PA normal ranges:
PAS?
PAD?
PAM?
Systolic 20-30 mmHg (PAS)
Diastolic 8-12 mmHg (PAD)
Mean 25 mmHg (MAD)
Pulmonary Capillary Wedge Pressure (PCWP or PAWP):
Used for?
High means?
PCWP pressures are used to approximate LVEDP (left ventricular end diastolic pressure).
High PCWP may indicate left ventricle failure, mitral valve pathology, cardiac insufficiency, cardiac compression post hemorrhage.
PCWP/PAWP
normal range?
4-12 mmHg
Pulmonary Vascular Resistance (PVR):
Used for?
High means?
Low means?
The measurement of resistance or the impediment of the pulmonary vascular bed to blood flow.
An increased PVR or "Pulmonary Hypertension" is caused by pulmonary vascular disease, pulmonary embolism, or pulmonary vasculitis, or hypoxia.
decreased PVR is caused by medications such as calcium channel blockers, aminophylline, or isoproterenol or by the delivery of O2.
PVR normal range?
37-250 dynes/sec/cm2
Right Ventricular Pressure (RV Pressure):
High means?
A direct measurement that indicates right ventricular function and general fluid status.
High RV pressure may indicate: pulmonary hypertension, right ventricle failure, congestive heart failure.
Stroke Volume:
Low means?
High means?
The measurement of resistance or impediment of the systemic vascular bed to blood flow.
increased SVR can be caused by vasoconstrictors, hypovolemia, or late septic shock.
decreased SVR can be caused by early septic shock, vasodilators, morphine, nitrates, or hypercarbia
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