Review of
Hemodynamics
MVI 2017
What is HEMODYNAMICS?
Is the study of forces involved in the flow of blood through
the cardiovascular and circulatory systems.
Components of hemodynamics are:
Blood pressure or cardiac output (CO) X systemic vascular
resistance, central venous pressure (CVP), and right and left
heart pressures.
Physiologic principles of hemodynamics include factors that
affect myocardial function, regulate BP, ,and determine
cardiac performance and output.
Understanding the basic concepts of pressure, flow, and
resistance provides an insight into the understanding of
hemodynamics.
The Circulatory System
a complex network of
veins and arteries within
a continuous circuit. The
heart pumps a constant
volume of blood through
this system to maintain
balance between oxygen
delivery and demand.
Regulation of Blood Flow
Mechanisms involved:
Bodys metabolic demands increase, the blood vessels
constrict in an attempt to force blood back to the
heart.
Bodys metabolic demand decreases, the veins dilate
that causes pooling of blood in the periphery and
reduces venous return to the heart.
Other mechanisms that control the flow are the result
of the ability of the heart to increase or decrease heart
rate (HR) and strength of contraction.
How does the heart work?
The electrical conduction system
Cardiac Cycle
Normal Impulse Conduction
SA
(60-100/min)
AV
(40-60/min)
BUNDLE OF HIS
(30-40/min)
BUNDLE BRANCHES
PURKINJE FIBERS 6
(20-30/min)
Cardiac Cycle
Systemic circulation - RA Blood - from lungs LA
Atria filled with blood , SA node fires , Depolarization Increase Atrial
pressure , AV valve opens , Ventricular filling (diastole) passively occurs,
After Atrial depolarization, Atrial contraction, force Atrial blood to
Ventricles. (called atrial kick responsible as much as a 30% contribution
of CO)
After Atrial contraction, begins atrial relaxation and pressure decreases
Electrical impulses from atria travels to the remainder of the conduction
system and cause Venticular Depolarization , Ventricular contraction,
Ventricular pressure exceeds Atrial pressure, AV valves close, Semilunar
valves open
Desaturated blood ejected from RV to lungs, drops CO2 and picks up O2
Oxygenated blood from LV is ejected into the systemic circulation via the
Aorta. The ejection of blood from the ventricles is referred to as Systole
Stroke volume (SV) is the volume of blood ejected during
systole.
Left ventricular end systolic volume (LVESV) amount of
blood that remains in the ventricle at the end of systole.
Left ventricular end diastolic volume (LVEDV) amount
of blood that is in the ventricle before ejection occurs.
The LV never ejects the entire volume it receives during
diastole.
Ejection fraction (EF) is the portion of the volume
ejected which is approximately 70% of the total volume
at the end of diastole.
Cardiac output: amount of blood pumped by each ventricle in
liters per minute; normal cardiac output is 5 L per minute in the
resting adult heart. (CO = SV x HR Normal values: 4 -8 L/min)
Systemic vascular resistance: resistance to left ventricle
ejection.
Systole: period of ventricular contraction resulting in ejection
of blood from the ventricles into the pulmonary artery and aorta
Diastole: period of ventricular relaxation resulting in ventricular
filling
stroke volume: amount of blood ejected from the ventricle
per heartbeat; normal stroke volume is 70 mL in the resting
heart
Preload: degree of stretch of the cardiac muscle fibers
at the end of diastole.
Afterload: the amount of resistance to ejection of blood
from the ventricle.
Normal heart sounds: sounds produced when the valves
close; normal heart sounds are S1 (atrioventricular
valves) and S2(semilunar valves).
Pulmonary vascular resistance: resistance
to right ventricle ejection of blood
Ejection fraction: percentage of the end diastolic blood
volume ejected from the ventricle with each heartbeat
Blood Pressure
Systemic arterial BP is the pressure exerted on the walls of the
arteries during ventricular systole and diastole. It is affected by
factors such as cardiac output, distention of the arteries, and the
volume, velocity, and viscosity of the blood.
Tension exerted by blood on the arterial walls.
Normal adult values ranging from 100/60 to 140/90 mm Hg.
Systolic: 100 139 mmHg, Diastolic: 60 90 mmHg
Average normal BP usually cited is 120/80 mm Hg.
Arterial Pulses
Factors to be evaluated in examining the pulse are rate, rhythm,
quality, configuration of the pulse wave, and quality of the
arterial vessel.
PULSE RATE
The normal pulse rate varies from a low of 50 bpm in healthy,
athletic young adults to rates well in excess of 100 bpm after
exercise or during times of excitement. Anxiety frequently raises
the pulse rate during the physical examination. If the rate is
higher than expected, it is appropriate to reassess it near the
end of the physical examination, when the patient may be more
relaxed.
PULSE RHYTHM
Minor variations in regularity of the pulse are normal. The
pulse rate, particularly in young people, increases during
inhalation and slows during exhalation. This is called sinus
arrhythmia.
For the initial cardiac examination, or if the pulse rhythm is
irregular, the heart rate should be counted by auscultating the
apical pulse for a full minute while simultaneously palpating
the radial pulse.
Disturbances of rhythm (dysrhythmias) often result in a pulse
deficit, a difference between the apical rate (the heart rate
heard at the apex of the heart) and the peripheral rate. Pulse
deficits commonly occur with atrial fibrillation, atrial flutter,
premature ventricular contractions, and varying degrees of
heart block.
PULSE PRESSURE
The difference between the systolic and the diastolic pressures
Is a reflection of stroke volume, ejection velocity, and systemic vascular
resistance.
Normal :30 to 40 mm Hg
Indicates how well the patient maintains cardiac output.
Increased: in conditions that elevate the stroke volume (anxiety, exercise,
bradycardia), reduce systemic vascular resistance (fever), or reduce
distensibility of the arteries (atherosclerosis, aging, hypertension).
Decreased: abnormal condition reflecting reduced stroke volume and ejection
velocity (shock, HF, hypovolemia, mitral regurgitation) or obstruction to blood
flow during systole (mitral or aortic stenosis). A pulse pressure of less than 30
mm Hg signifies a serious reduction in cardiac output and requires further
cardiovascular assessment.
PULSE QUALITY
The quality, or amplitude, of the pulse can be described as absent,
diminished, normal, or bounding. It should be assessed bilaterally.
Scales can be used to rate the strength of the pulse. The following is an
example of a 0-to-4 scale:
0 pulse not palpable or absent
+1 weak, thready pulse; difficult to palpate; obliterated with pressure
+2 diminished pulse; cannot be obliterated
+3 easy to palpate, full pulse; cannot be obliterated
+4 strong, bounding pulse; may be abnormal
The numerical classification is quite subjective; therefore, when documenting
the pulse quality, it helps to specify a scale range (eg, left radial +3/+4).
PULSE CONFIGURATION
The configuration (contour) of the pulse
conveys important information. In patients
with stenosis of the aortic valve, the valve
opening is narrowed, reducing the amount
of blood ejected into the aorta. The pulse
pressure is narrow, and the pulse feels
feeble.
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