10.29.08(a): Cardiac Hydraulics
-
Upload
openmichigan -
Category
Education
-
view
254 -
download
0
description
Transcript of 10.29.08(a): Cardiac Hydraulics
![Page 1: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/1.jpg)
Author(s): Louis D’Alecy, 2009
License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Non-commercial–Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material.
Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content.
For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use.
Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
![Page 2: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/2.jpg)
Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicy
Use + Share + Adapt
Make Your Own Assessment
Creative Commons – Attribution License
Creative Commons – Attribution Share Alike License
Creative Commons – Attribution Noncommercial License
Creative Commons – Attribution Noncommercial Share Alike License
GNU – Free Documentation License
Creative Commons – Zero Waiver
Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (USC 17 § 102(b)) *laws in your jurisdiction may differ
Public Domain – Expired: Works that are no longer protected due to an expired copyright term.
Public Domain – Government: Works that are produced by the U.S. Government. (USC 17 § 105)
Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain.
Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (USC 17 § 107) *laws in your jurisdiction may differ
Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair.
To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
{ Content the copyright holder, author, or law permits you to use, share and adapt. }
{ Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. }
{ Content Open.Michigan has used under a Fair Use determination. }
![Page 3: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/3.jpg)
3
Cardiac Hydraulics
M1 – Cardiovascular/Respiratory Sequence
Louis D’Alecy, Ph.D.
Fall 2008
![Page 4: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/4.jpg)
4
Wednesday 10/29/08, 11:00 Cardiac Hydraulics
30 slides, 50 min. 1. Contractility 2. Control of Stroke Volume 3. Ventricular function 4. Estimation of Preload 5. Measurement of stroke volume
![Page 5: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/5.jpg)
5
Terms Related to Cardiac Performance Preload - The ventricular wall tension at the end of diastole.
Afterload -- The ventricular wall tension during contraction; the resistance that must be overcome for the ventricle to eject its contents. Approximated by systolic ventricular or arterial pressure.
Contractility -- Property of heart muscle that accounts for changes in strength of contraction independent of preload and afterload.
![Page 6: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/6.jpg)
6
Stroke Volume
Contractility
Afterload
Preload
+
+
-- Complex interactions so
we will treat each separately with others held constant.
![Page 7: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/7.jpg)
7 2.10 MH
Increased Contractility = Positive Inotropic Effect Increased peak isometric
tension at each resting length.
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
![Page 8: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/8.jpg)
8
2.10 MH
Increased Contractility = Positive Inotropic Effect Increased shortening
Afterload & preload ~
CONSTANT
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
![Page 9: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/9.jpg)
9
3.6 MH
Afterload & preload ~
CONSTANT
Increased Contractility = Positive Inotropic Effect Increased stroke volume
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
![Page 10: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/10.jpg)
10 Beta adrenergic stimulation: increased force
(faster and more) and faster relaxation. Source Undetermined
![Page 11: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/11.jpg)
11
β (Beta) adrenergic effects
• Positive inotropic (strength) effect • Positive lusitropic (rate of relaxation) effect • Positive chronotropic (heart rate)effect • Positive dromotropic (conduction velocity) effect • Decreased duration (both AP and contraction)
Acetylcholine (cholinergic) has small negative inotropic effect.
![Page 12: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/12.jpg)
12
Cellular mechanism of positive inotropy and lusitropy
Lusitropy = Increased rate of relaxation by Ca++
Norepinephrine (beta)
Source Undetermined
![Page 13: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/13.jpg)
13
INOTROPIC
INOTROPIC
Frank- Starling
McGraw-Hill
![Page 14: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/14.jpg)
14 McGraw-Hill
![Page 15: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/15.jpg)
15
SV or Tension or LVP or CO LVEDV or LVEDP or
Length or Preload
McGraw-Hill
![Page 16: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/16.jpg)
16
HR effect **limited by
filling vol
**limited by fiber overlap
↑Afterload ↓Contractility ↓Heart Rate
↓Afterload ↑Contractility ↑Heart Rate
Source Undetermined
![Page 17: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/17.jpg)
17
M & H 3 -7 Summary of Determinants of CO
Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed.
![Page 18: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/18.jpg)
18 D’Alecy
![Page 19: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/19.jpg)
19
Swan-Ganz Catheter
Balloon Inflated Balloon Deflated
Distal Port for PCWP
Thermistor for Cardiac Output
Source Undetermined
![Page 20: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/20.jpg)
20
Source Undetermined
Balloon catheter Pulmonary branch
wedged
Distal port For PCWP D’Alecy
![Page 21: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/21.jpg)
21
Bartlett, Critical Care Physiology: Fig 2-3
LVEDP or LV Preload or PCWP
No More Frank-Starling
Left !!
Bartlett, Critical Care Physiology. Figure 2-3
![Page 22: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/22.jpg)
22
LV EDV LV EDP (Preload) LAP
Pulmonary Venous P
Pul Cap P
Pulmonary Capillary Wedge Pressure
PCWP is used as an index of LV EDP PRELOAD
![Page 23: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/23.jpg)
23
Pressure Changes as Catheter Moves
Through Right Heart
Lilly Box 3.1
Time Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1
![Page 24: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/24.jpg)
24
Dicrotic notch
Pulmonary Artery
Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1
![Page 25: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/25.jpg)
25
Dicrotic notch Pulmonary Artery
PA vs. RV
PA - has notch - > diastole - dn vs.. up
Pressure wave difference between PA and RV Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1
![Page 26: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/26.jpg)
26
Pressure Changes as Catheter Moves
Through Right Heart to PA & PCWP
Box 3.1
Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1
![Page 27: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/27.jpg)
27
Pressure Changes as Catheter Moves Through Right Heart
RA RV PA PCW Source Undetermined
![Page 28: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/28.jpg)
28
Right Ventricle Pulmonary Artery Pul. Cap Wedge
Swan-Ganz Catheter Pressure Recording
Balloon catheter Balloon catheter Pulmonary branch wedged
Distal port For PCWP
Source Undetermined
D’Alecy
![Page 29: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/29.jpg)
29
LV EDV LV EDP (Preload) LAP
Pulmonary Venous P
Pul Cap P
Pulmonary Capillary Wedge Pressure
PCWP is used as an index of LV EDP PRELOAD
![Page 30: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/30.jpg)
30
How do we determine??
?Transesophageal Echocardiogram? Source Undetermined
![Page 31: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/31.jpg)
31
Swan-Ganz Catheter
Balloon Inflated Balloon Deflated
Distal Port for PCWP
Thermistor for Cardiac Output
Source Undetermined
![Page 32: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/32.jpg)
32
Measure Cardiac Output by Thermal Dilution
HR X SV = CO b/min X mL/b = mL/min
Calculate SV
Heart Rate X Stroke Volume = Cardiac Output
![Page 33: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/33.jpg)
33
![Page 34: 10.29.08(a): Cardiac Hydraulics](https://reader033.fdocuments.in/reader033/viewer/2022060112/556d10d2d8b42ad34f8b50c0/html5/thumbnails/34.jpg)
Slide 7: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed. Slide 8: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed. Slide 9: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed. Slide 10: Source Undetermined Slide 12: Source Undetermined Slide 13: McGraw-Hill Slide 14: McGraw-Hill Slide 15: McGraw-Hill Slide 16: Source Undetermined Slide 17: Mohrman and Heller. Cardiovascular Physiology. McGraw-Hill, 2006. 6th ed. Slide 18: D’Alecy Slide 19: Source Undetermined Slide 20: Source Undetermined; D’Alecy Slide 21: Bartlett, Critical Care Physiology. Figure 2-3 Slide 23: Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1 Slide 24: Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1 Slide 25: Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1 Slide 26: Lilly, L. Pathophysiology of Heart Disease. Lippincott, 2007. 4th ed. Figure 3.1 Slide 27: Source Undetermined Slide 28: Source Undetermined; D’Alecy Slide 30: Source Undetermined Slide 31: Source Undetermined
Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy