The volume coming into the heart is the?
What hemodynamic parameters measure the PRELOAD?
What is the normal range for CVP/RAP?
2-6 mm Hg
What is the ultimate goal of hemodynamics?
make the Cardiac Output (CO) happy (stable)
the pressure against which the heart must work to eject blood during systole?
Used to determine volume status and right ventricular function, reflects the right hearts preload?
CVP / RAP
Used to determine state of resistance in pulmonary vasculature and right ventricular function?
What are the normal parameters of PAP?
- Systolic: 15-25 mm Hg
- Diastolic: 8-15 mm Hg
Used to determine left ventricular function; reflects left hearts preload?
PCWP (pulmonary artery wedge pressure)
What are the normal parameters of PCWP?
6-12 mm Hg
Amount of blood ejected by the heart per minute; a product of SV x HR
cardiac output (CO)
Cardiac output adjusted for patient's body surface area?
cardiac index (CI)
Describes the state of stystemic vasculature; reflects the left heart's afterload
systemic vascular resistance (SVR)
What are the normal parameters of cardiac output (CO)?
What are the normal parameters of cardiac index?
What are the normal parameters of systemic vascular resistance (SVR)?
If the BP is <90/60 what do we treat first?
- + inotrope (dobutamine, milirinone)
- then treat preload
- then treat afterload
If the BP is >90/60 what do we do first?
- treat preload
- then treat afterload
If preload is high what do we do?
too much volume - give diurectics
If preload is low what do we do?
tank is low - give fluids
If afterload is high what do we do, once preload is treated?
Give vasodilator - nitro/nipride
With hemodynamics what are 4 items to initially pay attention to to treat quickly?
Why give an ACE-I for life with EF <40%?
prevents ventricular remodeling
What does a beta-blocker do to the heart?
- slows heart down - to prevent more damage to the heart
- decreases force of contraction
A study of the forces involved in circulating blood through the body?
What is the catheter used to monitor hemodynamics?
Pulmonary artery catheter (Swan-Ganz)
What is the formula for cardiac output (CO)?
SV x HR = CO
The amount of blood pumped by the left ventricle of the heart per minute?
What factors affect cardiac output (CO)?
- muscular synchrony (we cannot manipulate this)
Which ventricle does the CVP (central venous pressure) measure?
Which ventricle does the PCWP (pulmonary artery wedge pressure) measure?
Sum of all forces against which the ventricle muscle must contract to eject blood into the pulmonary and systemic circulation?
systemic vascular resistance (SVR) - measures afterload
what factors affect afterload?
- size of the heart
- how much resistance the heart must overcome to eject blood
- how much disease is present
- whether the tank is full or dry
when afterload is high what happens to O2 demand?
increased myocardial O2 consumption
what factors affect contractility?
- metabolic states - acidosis
- depressant drugs - tricyclic antidepressants (too much/OD)
What is the normal ejection fraction (EF)?
What is the normal mean arterial pressure (MAP)?
>60 mm gH - for tissues to get profused
If NIBP >90/60 what do we do first?
treat preload and see if it positively affects afterload
If NIBP >90/60 and we treated preload and afterload remains elevated then do what?
add afterload reducer (NTG)
If NIBP is <90/60 what do we do first?
- start a positive inotrope (dobutamine, milrinone)
- then deal with elevated or low preload, then afterload
What is IABP and why is it used?
- IABP = intra-aortic balloon pump
- used in cardiogenic shock (HF) that cannot be corrected by any other means
When does the IABP inflate?
onset of diastole
When does the IABP deflate?
onset of systole - acts as a suction to help eject blood from left ventricle
What are the HF core measures/GWTG at discharge?
- Lipid management
- Weight management
- Smoking cessation
- Antiplatelet therapy
- ACEI/ARB especially in pts with EF of 40% or less
- Blood pressure control
- Diabetes management
- Physical activity 30 minutes 7 days a week (5 minimum)
- Post-discharge appointment
- Influenza during flu
- Pneumococcal vaccination
What are some health promotion nursing interventions for a patient with CAD?
- Assist to set realistic goals
- Educate about diet: low salt, trans fat, minimum sugar
- Physical activity: low to moderate intensity, 30 min/day
- take statins - there are some risks