35 Shock

_..

• RV: contracts, generate high systolic

• PA: same systolic, PV close and stop pressure drop at 10

• can also take blood sample and measure O2 sat

Image result for heart chamber pressure

Swan-Ganz Catheter

_..

• usually inserted into jugular vein or subclavian. Or femoral vein up to IVC

• can be stopped in different chamber and measure pressure: RA, RV, PA, wedge pressure

• PCWP: push balloon until it can't go any further, stuck in PA, tip of catheter just beyond balloon, measures LAP

• total hemodynamic assessment from swan-ganz

• O2 consumption, arterial and venous O2 can all be found from swan ganz catheter

• MAP: pressure leaving heart

• RAP: pressure returning to heart

Shock

_..

• cardiogenic: weak heart can't pump

• insensible loss: lose fluid in lungs/diarrhea/vomiting, not sensed by body compared to flood loss through kidney

• high HR: body response to increased sympathetic drive

• cardiogenic: hallmark low CO from weak muscle, blood back flow to all heart chambers

• hypovolemic: low CO, all low chamber pressure from low blood volume

• septic: hallmark low SVR, early dilation of veins = all low pressure, in hospital may be normal from IV fluid

Equalization of Pressures

_..

• tamponade: effusion of blood

• pericardial constriction: constricting sac

• restrictive cardiomyopathy: infiltrative substance

Valvular Disease

_..

• mitral stenosis

• aortic stenosis, high LV systolic pressure

• wide pulse pressure

• blood spilling out of aorta in diastole

• RV and PA systolic should be equal

• start with aorta and work backwards, find first chamber with high pressure

• MR: no aortic regurgitation with low diastolic pressure

Shunt Run

_