cardiovascular haemodynamics 2
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Transcript cardiovascular haemodynamics 2
Cardiovascular Assessment
Cardiac Output
• Blood Pressure
– Systolic / Diastolic
• Pulse
Perfusion
Blood Pressure
Systolic - Normal 95 - 140 mmHg
Diastolic - Normal 60 - 90 mmHg
Children vary with age
Neonate 60 - 90 over 30 - 60
mmHg
Systolic
Maximum pressure exerted on
arterial wall during ventricular
contraction
Diastolic
Pressure in vasculature during
ventricular relaxation
Indirect Blood Pressure
Measurement via Cuff
Wrap blood pressure cuff around
upper arm
Auscultate over artery in antecubital
fossa
Inflate cuff rapidly
Deflate cuff slowly while listening
Mechanism
Cuff inflated - occludes artery - no
sound
Slowly deflate cuff - first sound =
systolic
Continue to deflate cuff until
sound disappears = diastolic
Tapping sounds heard with each
heart beat called Korotkoff’s
sounds (Ko rot kof)
Technique
Usually use non-dominant arm
Inflate to approx 160 mmHg
Drop pressure approximately 3
mmHg/sec
Standard adult cuff 5 inches wide
Pediatric 3 inches wide
Sources of Error Resulting in
High BP Measurements
Cuff too narrow
• Width of cuff approx 40% circumference
of arm
Applied too tight or too loose
Excessive cuff pressure
• should start 30 mmHg above systolic
Pressing stethoscope too tightly over
artery will affect diastolic pressure
Hypertension
BP persistently > 140-160 / 90
Secondary means cause is known
• May be a side-effect of medication
Primary Hypertension means cause
is unknown
Hypotension
BP < 95 / 60
Late sign of hypovolemia, cardiac
failure, shock
90 / 60 not uncommon in young
females
Low blood pressure results in
inadequate perfusion
Brain
Heart - (70% coronary artery
perfusion occurs during diastole)
(Diastolic pressure < 50 mmHg
compromises perfusion of heart)
Kidneys
Low blood pressure a late sign
of circulatory problems
Normal compensatory mechanisms
maintain blood pressure initially
When these fail - pressure falls
Use blood pressure to
calculate Mean Arterial
Pressure
S-D+D
3
MAP is average pressure for circulation
Indicator of adequate tissue perfusion
Normally 70 - 105; 90 average
Mean arterial pressure (MAP)
MAP < 60 mmHg inadequate
Resistance = Pressure gradient /
Flow
or re-arranged: MAP = C.0. x SVR
Two factors determine blood
pressure
Cardiac output = stroke volume x
heart rate
Systemic vascular resistance (SVR)
Stroke Volume (SV) determined
by
Preload
Contractility
Afterload
Increased Preload Increases
SV
Preload = filling volume of ventricles
Increased blood volume stretches
muscle fibers
Increases strength of contraction
Requires longer time for ventricular
filling
Increased Contractility
Increases SV
Contractility = force of muscle
contraction
No change in muscle fiber length
Increase force of contraction over
same time period
Inotropic drugs
Decreased Afterload Increases
SV
Afterload = resistance ventricles
contract against
Primarily systemic vascular
resistance
Systemic vasodilation reduces
afterload
Factors afftecting Systemic
Vascular Resistance
Radius of arterioles
Blood volume
Blood viscosity (Hematocrit)
Factors affecting Cardiac Output
primarily affect systolic blood
pressure
Ex. Exercise using large muscle mass
(legs) will require increase in cardiac
output to supply more oxygen to
working muscles
Will see an increase in systolic
Diastolic will stay the same or
decrease since arteries of large
muscle mass dilated
Factors affecting Systemic
Vascular Resistance will primarily
affect diastolic pressure
Ex. Exercise using small muscle
mass (arms)
Vasoconstriction of large muscle
mass not being used
Vasoconstriction increases
vascular resistance
Diastolic will increase
Maximal Heart Rate correlates
with Maximal O2 Consumption
HR max = 220 - age
75% HR max ------ 60 % VO2 max
80
------- 70
90
------- 82
Aerobic exercise 75 - 80% HR max
Heart Rate or Pulse - Evaluate
for
Rate
Rhythm
Strength
Normal Heart Rate
60 - 100 Adults
90 - 120 Children
70 - 170 Newborns
< normal = bradycardia
> normal = tachycardia
Tachycardia
One of the cardinal signs of
hypoxemia
Increasing heart rate increases
cardiac output
Increase oxygen delivery to
tissues
Increasing HR increases C.O.
Until HR > 150
C.O. decreases due to inadequate
filling time
Rhythm
Regular or irregular
Irregular beat may
indicate arrhythmias
Strength
Bounding?
• Arteriosclerosis
Weak and thready?
• shock
Pulsus Paradoxus
Strength decreases with
spontaneous inhalation
Increases with exhalation
normal unless extreme
Common in COPD
Seen in 50% patients with
pericarditis
Pulsus Alterans
Alternating strong and weak
pulses
May be sign of left ventricular
failure
Not related to respiratory disease
Pulse Pressure
Systolic - Diastolic
Normal 35 - 40 mmHg
< 30 mmHg pulse hard to detect
Decreasing pulse pressure early
sign of inadequate circulating
blood volume
Can estimate systolic blood
pressure if can palpate
Carotid pulse - then systolic is at
least 60 mmHg
Femoral
70 mmHg
Radial
80 mmHg
Pulse sites
Radial
Brachial
Carotid
Femoral
Dorsalis pedis
Check radial pulse before and
after administering therapy
Aerosol medication may produce
side-effects
First cardinal sign of hypoxemia is
tachycardia
After taking pulse, continue
palpating pulse as count respiratory
rate
Assessment of Perfusion
(microcirculation)
Peripheral skin temperature
• cold extremities indicate reduced
perfusion
Urine Output
• one of the best indicators of C.O.
and arterial pressure
• < 20 ml/ hr oliguria ( o lig uria)
Sensorium
• Brain sensitive to lack of oxygen
and/or lack of glucose
• Both depend on blood supply to
the brain - perfusion
• Confusion may signal inadequate
perfusion or hypoxemia
Determine patient’s level of
consciousness (LOC)
Oriented to person - know who they
are
Oriented to place - know where they
are
Oriented to time - know what today
is, what year
Will typically see “Alert and oriented
to PPT” in chart
Summary
Patient assessment includes
evaluating patient’s
cardiovascular system
• Cardiac Output
• BP/Pulse
• Perfusion
Many of the therapeutic
interventions of respiratory care
will affect the cv system