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Cardiac Catheterization-Hemodynamics

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What is hemodynamics?
The study of forces related to blood circulation in the body.
Examples of things studied in hemodynamics . . .
Blood pressure, arterial, venous
Hemodynamics is used to evaluate ...
Heart function
Pressures are measured in a ...
Right heart cath
Pressures can be measured two ways. Those are ____ and _____.
Invasive, non-invasive
To read pressures, we have ____signals and ____ signals.
Input, output
Pressure exerted via the fluid in the catheter is the _____. This is connected to a transducer or ___ ____ that changes the signal. This results in an electrical expression, ___, of the force exerted and is displayed as ___.
Input, wheatstone bridge, output, waveforms
CVP or ____ _____ ______ i the pressure within the SVC. It reflects the amount of blood ____ to the hrart. It is often read via catheter inserted into the ____ vein.
Central venous pressure, returning, subclavian
Because there are no valves between the RA and SVC or IVC, the CVP and pressure of the RA should be ___.
The same
RA pressures are often reported as a ___ pressure because of the small difference between ___ and ___ measurements.
Mean, systolic, diastolic
RA pressure is expressed in a waveform represented by the letters
a, c, x, v, y
The mean pressure of the RA is ___ and the O2 saturation is ____.
2-5 mmHg, 65-80%
Elevated RA pressures could mean:
RV failure, tricuspid disease (TR or TS), cardiac tamponade, pulmonary hypertension, chronic LV failure, Volume overload
The pressure of the ___ ___ is higher than that of the RA.
Right ventricle
RV pressures are expressed as ___, ___, and ___ ___. Those number ranges are ___, ___, and ___. The O2 saturation is ___.
Systolic, diastolic, end diastolic, 15-28 mmHg, 0-8 mmHg, 2-6 mmHg, 65-80%
High RV pressures can indicate
Pulmonary congestion, pulmonary HTN, PV stenosis, L-R shunt, COPD, peripheral PA stenosis
High RV-EDP can indicate
Valve insufficiency, fibrosis, pericarditis, tamponade
During ventricular ____ the blood that is in the PA is distributed throughout the ___ ____.
Diastole, pulmonary vasculature
In the PA, the ranges for systolic, diastolic, and mean pressure are . . . And o2 sat is:
15-18 mmHg, 5-16 mmHg, 10-22 mmHg, 65-80%
Elevated pressures in the PA can indicate:
Pulmonary emboli, mitral valve stenosis, COPD, pulmonary HTN, LV failure, PA stenosis
Low PA pressures can indicate:
Pulmonary valve stenosis (insufficiency)
PCWP or PAWP pressures are obtained using a ____-____ ____ floated in the ___ ___.
Swan-Ganz catheter, pulmonary artery
The PWCP allows for indirect pressure measurement of the ___ ____.
Left atrium
Normal ranges for PWCP are:
Mean- 6-14mmHg
A wave- 9-18 mmHg
V wave- 9-18 mmHg
O2 sat- 95-100%
Low PWCP can indicate
Hypovolemia
High PWCP can indicate
LV failure, mitral stenosis, tamponade, hypervolemia, ischemia, cardiomyopathy, valve disease
Left ventricular pressure is measured ___ with a catheter placed in the ___ ___.
Directly, left ventricle
Normal LV pressure measurements are:
Systolic 90-140 mmHg
End diastolic 4-12 mmHg
O2 95-100%
AO pressures will vary depending on _____.
Location
Normal values for the AO are
120/80
How is mean pressure calculated?
Mean= systolic + (2 x diastolic)
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3
Gradients are pressure differences caused by an ______. They occur with ___ or ____ ____ ____.
Obstruction, stenosis, valve function problem
Gradient=
Blood flow x resistance
Calculation of the size of the opening of a valve helps ...
Determine the level of stenosis in the valve
There are 2 primary methods to calculate AoV and MV stenosis. These are . . .
Gorlin formula and Haaki formula
The ___ formula is the most accurate way to calculate blood flow.
Gorlin
The ____ formula is a shortcut method for determining blood flow.
Haaki
Haaki formula=
Cardiac output/ square root of pressure gradient
Cardiac output =

Normal range
SV x HR

4-8 LPM
Cardiac index is CO that takes into account ____. Its formula is _____ or ____.
BSA, CO/BSA, (SV x HR)/BSA
There are 3 primary ways to obtain cardiac output:
All three are _____ ______ calculations
Fick formula, thermodilution, angiographic, forward motion
The ____ formula is based on estimated oxygen consumption and blood saturations.
Fick
Rquired parameters for Fick calculations are:
Hgb, age, sex, height, weight
______ calculates CO by measuring temperature changes detected by a thermistor.
Thermodilution
SV=
LVEDV-LVESV
The angiographic method uses ____ to measure CO
Contrast
Regurgitation fraction=
SV (angiographic) - SV (Fick or Thermo)/Angiographic SV
shunts can be either _-_ or _-_. They can be caused by congenital defect: ___, ___, ___, ___
L-R, R-L, ASD, PFO, VSD, anomalous venous return
Severity of a shunt is determined by:
Blood saturation tests and cardiac output/indexes