NCMB 418 Hemodynamics Week 7

Hemodyamics and
Cardiophysiology
ROXAN R. VALLEJERA RN, MAN
Unit Expected Outcome:
At the end of the course unit (CU), learners will be able to:
1. Discuss the pathophysiologic responses of clients with life- threatening conditions,
acutely ill,
high acuity and emergency situation due to hemodynamic and cardio physiologic
compromise.
2. Analyze the health status/competence of an adult client with hemodynamic and
cardio
physiologic compromise.
3. Formulate a plan of care based on client’s priorities to address the needs/ problems.
4. Institute appropriate corrective actions to prevent or minimize harm arising from
adverse
effects.
5. Apply safe and quality interventions to address the client’s identified needs/
problems.
Hemodynamics
The study of forces involved in the flow of blood through the cardiovascular and
circulatory system.
The circulatory system is controlled by homeostatic mechanisms. The
hemodynamic response continuously monitors and adjusts to conditions in the
body and its environment.
Physiologic principles of hemodynamics:

1. Factors that affect myocardial function
2. Regulate BP
3. Determine cardiac performance and cardiac output.
Hemodynamic Monitoring
Hemodynamics or pressure of the cardiovascular and
circulatory system can be measure by invasive
methods such as direct arterial BP monitoring, CVP
monitoring and indirect measurements of left
ventricular pressures via a flow directed, balloon-
tipped catheter
EXAMPLE: Swan-Ganz catheter = PAC,

“A-line”catheter = Arterial catheter
GOALS OF
HEMODYNAMIC
MONITORING
1. Ensure adequate perfusion
2. Detecting inadequate perfusion
3. Measure tissue O2
4. Qualifying the severity of the illness
5. Differentiating system dysfunction
Pulmonary Artery
Catheter (PAC)
PURPOSE:
a tool for observing Standard PAC
fluid balance to detect adequate
(cardiopulmonary 7.0, 7.5 or 8.0 French perfusion, to
problems). A in circumference and diagnose and
balloon-tipped 110 cm in length evaluate the effects
Swan-Ganz divided in 10 cm of therapy
catheter is intervals
commonly used.
PAC has 4-5
lumens:
Temperature thermistor located proximal to balloon to
01 measure pulmonary artery blood temperature
Proximal port located 30 cm from tip for CVP monitoring,

02 fluid and drug administration
03 Distal port at catheter tip for PAP monitoring
+/- Variable infusion port (VIP) for fluid and drug

04 administration
05 Balloon at catheter tip

Parameters measure
Central Venous Pressure

(CVP)
The blood pressure in the vena cava;
reflects the amount
of blood returning to the heart and
the ability of the heart to pump the
blood back into the
arterial system
A Picture is
Worth a
Thousand Words
Pulmonary Artery Pressure (PAP)
Reflects RV function, pulmonary vascular

resistance, and
LA filling pressures (measured at the tip of the PAC
with balloon deflated)
Pulmonary Capillary Wedge
Pressure (PCWP)
also known as the pulmonary artery occlusion
pressure (PAOP); provides an indirect estimate of
left atrial pressure
Pulmonary Artery Catheter (PAC)
Complications:
1. Dysrhythmias
2. Thromboembolism
3. Mechanical, catheter knots
4. Pulmonary Infarction
5. Infection, Endocarditis
6. Endocardial damage, cardiac valve injury
7. Pulmonary Artery Rupture
Dysrhythmias - an abnormal or irregular heartbeat. If you have a
dysrhythmia, your heart might beat too fast or too slowly. Or your heart's
rhythm might be disrupted, leading you to feel like your heart skipped a beat.
Thromboembolism obstruction of a blood vessel by a blood clot that has

become dislodged from another site in the circulation.
Mechanical, catheter knots

Pulmonary Infarction
also called lung infarction,

occurs when a section of
lung tissue dies because its
blood supply has become
blocked
Infection, Endocarditis a life-threatening inflammation of the inner
lining of the heart's chambers and valves. This lining is called the
endocardium.
Endocarditis is usually caused by an infection. Bacteria, fungi or
other germs get into the bloodstream and attach to damaged areas
in the heart. Things that make you more likely to get endocarditis are
artificial heart valves, damaged heart valves or other heart defects.
Mercury is the closest planet to the Sun

Endocardial damage, cardiac valve
injury
PULMONARY ARTERY
RUPTURE
Nursing Care/ Intervention
➢ During PAC insertion: check for the signed consent and follow aseptic techniques
➢ Tubing is a source of infection (follow hospital protocol in changing the tubing;

usually after 3-5 days)
➢ Educate client regarding the procedure and catheter care
➢ Monitor the pressures regularly or as indicated
➢ During removal
Depolarization – the electrical activation of the muscle cells of the heart and stimulates
cellular contraction.
Repolarization – they return to their original state of electrolyte balance.

The Heart’s Electrical
Conductivity
Starts with the sino-atrial (SA) node – the pace maker; the one that initiates an impulse
Then the impulse travel to the AV node, then to the Bundle of His, to the left
and right branches
and finally to the Purkinje fibers
These electrical activities stimulate the heart to contract (in the cardiac muscle,
impulses are
transmitted by action potential)
Process of Conduction
✓ One contraction of the atria and one contraction of the ventricle is one
heartbeat.
✓ One heart beat represents one cardiac cycle.
Cardiac cycle
 Refers to events taking place in the heart in one heartbeat.
 The right atrium receives venous blood from the systemic circulation while the
left atrium receives reoxygenated blood from the lungs
1. Stroke volume (SV)

 the volume of blood that is ejected during systole
Factors affecting the stroke volume

a. Preload – this refers to the volume of blood that is already in the heart before it
contracts. This is all the venous return.
✓ Factors affecting preload

1) Position – standing will cause pulling of blood into the lower extremities causing
a decrease preload while supine position increases venous return
2) Breathing – deep inspiration causes an increase in venous return while the
Valsalva maneuver decreases venous return
b. Afterload this refers to the pressure that must

be exceeded by the heart before it contracts,
such pressure is the blood pressure in the aorta.
Therefore, if BP increases, the heart must exert too
much pressure to pump blood into the aorta.
✓ Factors affecting afterload

1) Hypertension
2) Atherosclerosis of the aorta
2. Contractility – increase contraction also increases stroke volume and decrease

contraction decreases stroke volume
3. Left ventricular end-systolic volume (LVESV) – the amount of blood that remains in
the left ventricle at the end of systole.
4. Left Ventricular end- diastolic volume (LVEDV) – the amount of blood that is in the
ventricle just before ejection occurs.
5. Ejection Fraction – the portion of the volume it does eject, which is approximately 70
% of the total volume at the end of diastole.
6. Blood Pressure – defined as the tensionn exerted by blood on the arterial walls
7. Systemic vascular resistance (SVR) – it is the peripheral vascular resistance that is

elevated when there is vasoconstriction (elevations of SVR increase the workload of
the heart and myocardial oxygen consumption, but when SVR decreases, CO
increases in an attempt to maintain BP)
✓ BP = CO x SVR (Pressure = Flow x Resistance)
✓ Mean Arterial Pressure (MAP) = CO x Total Peripheral Resistance (TPR) or
Systemic vascular resistance (SVR); the average BP
✓ MAP = SP + 2DP BP = CO x TPR or SVR
3
8. Cardiac Output (CO) – the amount of blood ejected from the heart in 1 minute.
9. Stroke Volume (SV) – the amount of blood ejected from the heart with each beat.
➢ Three factors that influence SV:
Preload – the filling volume of the ventricle at the end of diastole
Afterload – the amount of resistance against which the left ventricle pumps
Contractility – defined as the strength of myocardial fiber shortening during systole
✓ Frank-Starling law states “the greater the stretch, the greater the force of next
contraction.”
✓ SVR – Reflection of peripheral vascular resistance and is the opposition to blood
flow from the blood vessels.
Factors affecting Heart Rate
a. Sympathetic & parasympathetic Nervous Systems
b. Thyroid hormones
c. Temperature and exercise

NCMB 418 Hemodynamics Week 7

Uploaded by

Copyright:

Available Formats

NCMB 418 Hemodynamics Week 7

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCMB 418 Hemodynamics Week 7

Uploaded by

Copyright:

Available Formats

Hemodyamics and

Physiologic principles of hemodynamics:

EXAMPLE: Swan-Ganz catheter = PAC,

Proximal port located 30 cm from tip for CVP monitoring,

03 Distal port at catheter tip for PAP monitoring

+/- Variable infusion port (VIP) for fluid and drug

05 Balloon at catheter tip

Central Venous Pressure

Reflects RV function, pulmonary vascular

Thromboembolism obstruction of a blood vessel by a blood clot that has

Mechanical, catheter knots

also called lung infarction,

Mercury is the closest planet to the Sun

➢ Tubing is a source of infection (follow hospital protocol in changing the tubing;

➢ Educate client regarding the procedure and catheter care

➢ Monitor the pressures regularly or as indicated

Repolarization – they return to their original state of electrolyte balance.

1. Stroke volume (SV)

Factors affecting the stroke volume

✓ Factors affecting preload

b. Afterload this refers to the pressure that must

✓ Factors affecting afterload

2. Contractility – increase contraction also increases stroke volume and decrease

7. Systemic vascular resistance (SVR) – it is the peripheral vascular resistance that is

You might also like