Term
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Definition
| the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, generating sufficient pressure to propel blood forward |
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Term
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Definition
| the ability to transmit an electrical stimulus from cell membrane to cell membrane. |
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Term
| What does Conductivity result in? |
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Definition
excitable cells depolarize in rapid succession from cell to cell until all cells have depolarized.
The wave of depolarization causes the deflections of the electrocardiogram (ECG) waveforms that are recognized as the P wave and the QRS complex |
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Term
| The conduction system consists of: |
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Definition
| the sinoatrial node, atrioventricular junctional area, and bundle branch system. |
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Term
| What is tissue perfusion dependent on? |
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Definition
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Term
| What two components make up cardiac output? |
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Definition
stroke volume and heart rate. |
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Term
What is Stroke volume dependent on?
3 |
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Definition
preload, afterload and contractility. |
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Term
What will happen to the cardiac output if there is an increase in preload?
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Definition
| it will increase the cardiac output |
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Term
If there is a high preload then it increases the cardiac output until what factor changes?
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Definition
| until very high end diastolic volumes are reached |
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Term
| What happens to cardiac output once very high end diastolic volumes are reached? |
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Definition
At this point cardiac output will not increase with any further increase in preload, and may even decrease after a certain preload is reached. |
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Term
What does hemodynamic monitoring measure
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Definition
Pressure created by blood movement through the vascular space to assess cardiovascular function.
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Term
| What happens to the pressure and flow with an increase in resistance? |
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Definition
The pressure will rise
Flow will decrease |
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Term
| What happens to the pressure and flow with an decrease in resistance? |
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Definition
The pressure will decrease
flow will increase (untill pressure falls to low) |
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Term
| What conditions affect heart rate |
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Definition
Thyroid disorders
HTN
DM
Stress
Fever
Pain anaemia
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Term
| What factors can affect preload |
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Definition
Blood volume
Heart rate
Body position
Phase of respiration (affects intrathoracic pressure)
Respiratory disease (affects intrathoracic pressure)
Muscular pumping of venous blood
Locomotion (affects intrathoracic pressure and venous return)
Atrial contraction
Valvular regurgitation |
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Term
| Factors affecting afterload |
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Definition
Heart rate
Vascular tone (and therefore blood pressure)
Aortic stiffness
Myocardial tension (affected by hypoxia, volume overload)
Metabolic rate
Preload
Valvular regurgitation |
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Term
| Factors affecting contractility |
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Definition
Noradrenaline release from sympathetic nerves (most important)
| Increased.circulating catecholamines |
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| Increased heart rate |
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Increased afterload
| hypoxia- |
increase |
| acidosis- |
decrease |
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Term
| How can you determin heart rate? |
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Definition
auscultate 60 sec
Puls oxcimitry
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Term
| How would you determine preload? |
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Definition
CVP catheters-
CVP- right atrium preload
PA (Pulmonary Artery) catheters
POAP (CWP)- left atrium preload |
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Term
| What does preload measure? |
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Definition
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Term
| How would you assess contractility? |
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Definition
PA (Pulmonary Artery) catheters
RVSWI- right side contractility
LVSWI- left side contractility
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Term
| How would you assess afterlaod |
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Definition
PA (Pulmonary Artery) catheters
right - PAP, PVR
Left- ABP, SVR |
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Term
What are the types of Hemodynamic Catheters |
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Definition
Intra-arterial catheters
CVP catheters
PA (Pulmonary Artery) catheters
L Atrial catheters
SvO2 catheters
ScVO2 Catheters- new |
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Term
| What type of pt would be best suited to use a Intra-arterial Catheter? |
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Definition
Compromised perfusion / CO
Vasopressor drugs
ABG draws (> 6 / day) |
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Term
| What measurements are gatherd by a Intra-arterial Catheter |
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Definition
Arterial systolic, diastolic, mean
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Term
| Your pt has a Intra-arterial Catheter what complications should you assess for? |
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Definition
Hemorrhage
Occlusion
Infection |
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Term
| In what types of pts is a CVP Catheter the best choice of hymodynamic monitering? |
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Definition
Pts that need:
Monitoring fluid imbalance
Large volume fluid replacement
Administration hypertonic fluids
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Term
| What do CVP Catheters measure? |
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Definition
Mean venous pressure (same as CVP) |
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Term
| what complications can arise from a CVP catheter? |
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Definition
Emboli (air or thrombus)
Hemorrhage
Vessel trauma
Infection |
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Term
| In what types of pts is a PA Catheter the best choice of hymodynamic monitering? |
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Definition
Shock states
Evaluation of myocardial function
Evaluation of fluid status |
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Term
What do PA catheters Measure?
(Direct values) |
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Definition
CVP / RA mean- R. preload
PAP- R. afterload
PCWP- L. preload
CO = (HR X SV)
Thermodilution
Continuous |
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Term
What do PA catheters Measure?
Indirect
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Definition
CI
SVR (SVRI)- L. afterload
PVR(PVRI)- R. afterlaod
SV- stroke volume = (preload, afterload, contractility)
SVI
RVSWI- R. contractility
LVSWI- L. contractility |
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Term
| What complications can arise fron PA Catheters |
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Definition
Emboli (air or thrombi)
Hemorrhage
Pulmonary Infarct (balloon wedge)
Infection |
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Term
Your pt is a post-op cardiac patient with significant pulmonary hypertension. What type of hemodynamic monitoring is most appropriate for this pt? |
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Definition
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Term
| What does a L Atrial Catheter measure? |
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Definition
|
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Term
| what complications can arise from a L atria catheter |
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Definition
Cardiac tamponade
Emboli (air or thrombi)
Hemorrhage |
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Term
What are the S/S of Cardiac tamponade |
|
Definition
Fatigue or drowsiness
Shortness of breath, rapid breathing, or difficulty breathing
Dizziness or light-headedness
Chest pain - worsened by coughing or deep breathing, Discomfort that can be relieved by sitting upright or leaning forward
Swelling of the abdomen, veins in the arms or legs, or other areas
Pale skin, or skin that is blue- or gray-tinted
Rapid heartbeat |
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Term
What are the indications of SvO2/ ScVO2/SJVO2 Catheters? |
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Definition
| Shock states to evaluate O2 supply and demand |
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Term
| What do SvO2/ ScVO2/SJVO2 Catheters measure? |
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Definition
SvO2 (O2 consumption)
Helps evaluate balance between Do2/Vo2 |
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Term
What complications may arise
form SvO2/ ScVO2/SJVO2 Catheters |
|
Definition
Emboli (air or thrombi)
Hemorrhage
Pulmonary Infarct (balloon wedge)
Infection
Vessel trauma |
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Term
What are the types of Mechanical Assist Devices for Cardiac Output? |
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Definition
IABP (Intra-aortic Balloon Pump)
Ventricular Assist Devices |
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Term
How does an IABP (Intra-aortic Balloon Pump) help the heart to function? |
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Definition
Augment Diastole (Increase coronary artery perfusion)
Decrease Afterload (Decrease LVSWI by reducing aortic resistance) |
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Term
| What are complications of the IABP |
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Definition
Aortic vessel damage
Poor perfusion of catheterized limb
Emboli from the balloon / catheter
Balloon rupture
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Term
What are the indications for Ventricular Assist Devices (VAD) |
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Definition
Bridge to Recovery
Destination Therapy
Bridge to transplantation |
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Term
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Definition
Poor LV function
PA Diastolic > 20
Cardiac Index < 2
Systolic ABP < 90
Maximum IABP support is insufficient
Maximum inotropic medication is insufficient |
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Term
| What are the difrent types of VAD Devices |
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Definition
|
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Term
What are the VAD Complications that may arise? |
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Definition
Hemorrhage / Anticoagulation
Device Failure
Emboli
Infection |
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