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Therapeutics ID Ronald
Exam 3 Hemodynamic Monitoring
24
Accounting
Graduate
02/06/2010

Additional Accounting Flashcards

 


 

Cards

Term
Review Terms: Preload
Definition
  • Tension (stretching) of the left ventricle after diastole
  • Equivalent to Left Ventricle End Diastole Volume (LVEDV)
  • Depends on venous return to the heart

 

Term
Review Terms: Afterload
Definition
  • Resistance that the left ventricle must contract against to eject blood into the aorta
  • Determined by resistance in vasculature
  • Estimated by systemic vascular resistance (SVR)
Term
Review Terms: Inotropy
Definition
Ventricular contractility
Term
Types of Noninvasive Hemodynamic Monitoring
Definition
  • Vital signs (BP, HR, RR, temp)
  • Pulse Oximetry (arterial O2 saturation - provides info regarding delivery of O2 to tissues)
  • Transthoracic Echocardiography (functional status of the heart and heart valves - estimates ejection fraction)
Term
Types of Invasive Hemodynamic Monitoring
Definition
  • Arterial Line

Measures BP through a catheter

Meds cannot be administered through this line

  • Central Venous Catheter 

Measures central venous pressure (CVP)

Meds can be delivered through this line

  • Pulmonary Artery Catheter

AKA Swanz-Ganz catheter -- balloon flotation catheter inserted into pulomary artery

Allows assessment of right and left intracardiac pressure, CO, and provides IV access to draw mixed venous blood samples

Useful in diagnosing type of shock

  • Transesophageal Echocardiography

Functional status of the heart and heart valves

Estimates Ejection Fraction and can determine mitral/tricuspid valve regurgitation

Helpful for technically difficult TTEs and for more accurate view of valves

 

Term
Central Venous Pressure
Definition
  • Equivalent to right atrial pressure
  • Indicates the volume status of the right ventricle (right ventricular end diastolic pressure)
  • CVP can be inaccurate (falsely elevated) in patients:

W/ pulmonary or cardiac disease

On mechanical ventilation

Term
Pulmonary Artery Pressure
Definition
  • Pulmonary Artery Systolic Pressure

Press. measured when pulmonary valve opens and blood pumps from the right ventricle into the pulmonary artery

  • Pulmonary Artery Diastolic Pressure

Press. measured after pulmonary valve closes and blood travels from pulmonary artery into pulmonary capillaries

 

Elevation indicates pulmonary hypertension and/or pulmonary vascular resistance

Term
Pulmonary Capillary Wedge Pressure
Definition
  • PCWP equilibrates with distal pressure on left side
  • PCWP = Left Ventricular End Diastolic Pressure = Left Ventricular End Diastolic Volume
  • PCWP estimates Preload
  • Conditions that elevate PCWP:

Mitral stenosis

Pulmonary ven-occlusive disease

High levels of positive end-expiratory pressure w/ mechanical ventilation

Term
Mixed Venous Oxygen Saturation (SVO2)
Definition
  • Indicates tissue perfusion and can be used to calculate O2 consumption
  • Normal value ~ 70%
  • Levels > 75-80% can indicate hyperdynamic state (sepsis, hyperthyroidism, alcohol withdrawal)
  • Levels < 65% can indicate poor cardiac output states (cardiogenic shock)
Term
Systemic Vascular Resistance
Definition
  • SVR = change in pressure/CO
  • Estimates AFTERLOAD
  • Increased SVR = Vasoconstriction
  • Decreased SVR = Vasodilation
Term
When alpha1 receptors are stimulated:
Definition
  • Vasoconstriction of arteries and veins
  • Increase SVR
  • Increase MAP

 

Term
When beta1 receptors are stimulated:
Definition
  • Increase contractility (inotropy)
  • Tachycardia
  • Increase CO
  • Increase HR
Term
When beta2 receptors are stimulated:
Definition
  • Vasodilation of arteries and veins
  • Bronchodilation
  • Decrease SVR
Term
When Dopamine receptors are stimulated:
Definition
  • Vasodilation
  • Increase kidney perfusion
  • Increase urine output?
Term
When Vasopressin receptors are stimulated:
Definition
  • Vasoconstriction
  • Increase SVR
  • Increase urine output

 

Term
Vasopressors
Definition
  • Dopamine
  • Norepinephrine
  • Epinephrine
  • Phenylephrine
  • Vasopressin
Term
Inotropes
Definition
  • Dobutamine
  • Milrinone
Term
Dopamine: MOA, Primary Uses
Definition

MOA: stimulates DA, beta, and alpha receptors

As you increase the dose, DA -> Beta -> Alpha

 

Primary Uses:

  1. Septic Shock (first line)
  2. Cardiogenic Shock (usually with Dobutamine)
  3. Hypotension refractory to fluids
Term
Norepinephrine: MOA, Primary Uses
Definition

MOA: Potent Alpha1 agonist and some Beta1 activity

Alpha:Beta --> 2-3:1

 

Primary Uses:

  1. Septic Shock (first-line)
Term
Epinephrine: MOA, Primary Uses
Definition

MOA: Mixed alpha and beta-agonist (1:1)


Primary Uses:

  1. Refractory hypotension (LAST LINE)
  2. Anaphylaxis
  3. Cardiac arrest
Term
Phenylephrine: MOA, Primary Uses
Definition

MOA: Pure alpha agonist (No Beta)

 

Primary Uses:

  1. Hypotension in pts w/ myocardial hypoxia
  2. Refractory septic shock after NE or DA (2nd or 3rd line)
  3. Quickly increases MAP (neurological pts needing increase in cerebral perfusion pressure)
Term
Vasopressin: MOA, Primary Uses
Definition

MOA: Stimulates various subtypes of vasopressin receptors

V1 - arterial vasoconstriction

V2 - ADH (in shock - inc. urine output)

V3 - increase ACTH and cortisol production

 

Primary Uses:

  1. Adjunct to other vasopressors for septic shock
  2. Cardiac arrest
Term
Dobutamine: MOA, Primary Uses
Definition

MOA: Pure Beta-agonist

 

Primary Uses:

  1. Cardiogenic shock
  2. Acute decompensated HF (short term use)
  3. Septic shock if pt has poor ejection fraction
Term
Milrinone: MOA, Primary Uses
Definition

MOA: PDEI - vasodilation, increases contractility of heart


Primary Uses:

  1. Cardiogenic shock (use w/ caution)
  2. Acute decompensated HF
  3. May be preferred over dobutamine if patient recently on Beta-blocker
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