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

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