HEMODYNAMIC PARAMETERS AT REST IN A NORMAL INDIVIDUAL

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Basic Hemodynamic parameters at rest in a normal individual

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HEMODYNAMIC PARAMETERS AT REST IN A NORMAL INDIVIDUAL:

HEMODYNAMIC PARAMETERS AT REST IN A NORMAL INDIVIDUAL - DR. MOHAMMED SADIQ

OUTLINE:

OUTLINE CARDIAC OUTPUT Definition & Normal Values At Rest Factors Influencing C.O. Normal Distribution At Rest Methods Of Measuring C.O Cardiac Index VASCULAR RESISTANCE Systemic/Pulmonary NORMAL INTRACARDIAC PRESSURES AT REST Right Heart: RA/RV/PA Left Heart: LA/LV/AORTA CARDIAC CYCLE & ITS CORRELATION TO INTRACARDIAC PRESSURES

CARDIAC OUTPUT:

CARDIAC OUTPUT Co (or) q

CARDIAC OUTPUT (CO) - DEFINITION:

CARDIAC OUTPUT (CO) - DEFINITION “It is the volume of blood pumped out by the left ventricle during one minute.” Units: ml/min (or) lit/min Normal value at rest : 5.6 (+/- 1) lit/min (men) ; 4.9 (+/- 1)lit/min (women) It is also defined as the product of the Stroke Volume (SV) and Heart rate (HR). i.e.: CO = SV x HR SV: It the volume of blood pumped out by the heart in one cardiac cycle (heart beat). SV = EDV - ESV. Normal value: 70 (+/- 10) ml EF: It is the fraction of blood pumped out by the LV during systole. EF = (SV/EDV) x 100. Normal value: 55 – 70 %

FACTORS INFLUENCING CO:

FACTORS INFLUENCING CO

PRELOAD & AFTERLOAD:

PRELOAD & AFTERLOAD

FRANK STARLING’S LAW:

FRANK STARLING’S LAW “The force of contraction of a muscle fibre is directly proportional to its initial length, within physiological limits .”

DISTRIBUTION OF CO:

DISTRIBUTION OF CO

MEASUREMENT OF CARDIAC OUTPUT:

MEASUREMENT OF CARDIAC OUTPUT NON -INVASIVE METHODS INVASIVE METHODS DOPPLER USG (ECHO) TRANSCUTANEOUS DOPPLER TRANSESOPHAGEAL DOPPLER NON INVASIVE PULSE PRESSURE ( Sphygmomanometry /Tonometry) MRI ELECTRICAL CARDIOMETRY THERMODILUTION METHOD FICK’S PRINCIPLE INVASIVE PULSE PRESSURE IMPEDENCE CARDIOMETRY (can also be done noninvasively) USG dilution method

CARDIAC INDEX (CI):

CARDIAC INDEX (CI) It is the measure of left ventricular function with respect to the body surface area of the individual. It is a much better marker of LV function than CO alone as it correlates the LV function ( supply ) with respect to body mass ( demand ). CI = CO/BSA Units: lit/min/ sq m BSA Normal Value: 2.6 – 4.2 lit/min/ sq m Values < 2.2 lit/min/ sq m are usually associated with cardiogenic shock

VASCULAR RESISTANCE:

VASCULAR RESISTANCE Systemic vascular resistance ( svr ) pulmonary vascular resistance ( pvr )

RELATIONSHIP OF SVR & PVR TO CO:

RELATIONSHIP OF SVR & PVR TO CO SYSTEMIC VASCULAR RESISTANCE ( SVR ): SVR = (MAP – RAP) / CO Normal Value : 9 – 20 Wood Units (x 80 = Dynes) PULMONARY VASCULAR RESISTANCE ( PVR ): PVR = (MPAP – LAP) / CO Normal Value : 0.25 – 1.6 Wood Units So, CO = (MAP – RAP) / SVR CO = (MPAP – LAP) / PVR

INTRACARDIAC RESTING PRESSURES:

INTRACARDIAC RESTING PRESSURES And pressure tracings

BASELINE PRESSURES AT REST:

BASELINE PRESSURES AT REST

BASELINE PRESSURE RELATIONSHIPS:

BASELINE PRESSURE RELATIONSHIPS

JVP:

JVP a wave – due to atrial contraction x descent – transient wave due to atrial relaxation c wave – Due to bulging of TV ring into atria during IVCP of ventricular systole x’ descent – due to rapid emptying of neck veins during atrial filling v wave – rise of atrial pressure prior to opening of TV y descent – rapid ventricular filling after opening of TV

RA WAVEFORM:

RA WAVEFORM

RV WAVEFORM:

RV WAVEFORM

PA WAVEFORM:

PA WAVEFORM

PCWP WAVEFORM:

PCWP WAVEFORM

LV WAVEFORM:

LV WAVEFORM

AORTIC WAVEFORM:

AORTIC WAVEFORM

CARDIAC CYCLE:

CARDIAC CYCLE AND ITS CORRELATION TO INTRACARDIAC PRESSURES

THANK YOU:

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