Cardiovascular Hemodynamics for the Clinician

576 Pages·2017·75.3 MB·English

by  George A. Stouffer

Table of Contents
Cover
Title Page
List of contributors
PART I: Basics of hemodynamics
CHAPTER 1: Introduction to basic hemodynamic principles
1. Energy in the blood stream exists in three interchangeable forms:
pressure arising from cardiac output and vascular resistance,
“hydrostatic” pressure from gravitational forces, and kinetic energy
of blood flow
2. Blood flow is a function of pressure gradient and resistance
3. Resistance to flow can be estimated using Poiseuille’s law
4. Reynold’s number can be used to determine whether flow is
laminar or turbulent
5. Force developed by the ventricles is a function of preload or
stretch—the Frank–Starling law
6. Wall tension is a function of pressure and radius divided by wall
thickness—the Laplace relationship
7. The normal venous system is a low pressure, large volume
reservoir of blood which enables rapid increases in cardiac output
8. The pressure and velocity of a fluid in a closed system are related
9. The velocity of blood increases and pressure decreases as the
cross-sectional area of the blood vessel decreases
10. Resistance increases when blood vessels are connected in series
and decreases when blood vessels are connected in parallel
CHAPTER 2: The nuts and bolts of right heart catheterization and PA
catheter placement
The pulmonary artery catheter
Brief review of physiology relevant to right heart and pulmonary
artery catheterization
Vascular access
Right heart catheterization and placement of a PA catheter
Ensuring that accurate data is obtained from a PA catheter
Cardiac output
Calculating systemic vascular resistance and pulmonary vascular
resistance
SvO2 monitoring
Complications of pulmonary artery catheterization
References
CHAPTER 3: Normal hemodynamics
Cardiac chambers
Respiratory variation
CHAPTER 4: Arterial pressure
Aortic pressure
Mean arterial pressure
Pressure waveform
Effects of respiration on aortic pressure
Peripheral amplification
Noninvasive measurement of blood pressure
Oscillometric blood pressure devices
References
CHAPTER 5: The atrial waveform
The components of the atrial wave
Abnormalities in atrial pressures
Physical exam
Important points
References
CHAPTER 6: Cardiac output
Fick method
Thermodilution method
Doppler echocardiographic measurement of cardiac output
Cardiac output measurement in intensive care units
References
CHAPTER 7: Detection, localization, and quantification of intracardiac
shunts
Detection of an intracardiac shunt
Oxygen saturation run
Limitations of using oximetry to detect and quantify intracardiac
shunts
Diagnosis of intracardiac shunts at right heart catheterization
Quantifying a left-to‐right shunt
Shunt management
Right-to‐left shunting
References
PART II: Valvular heart disease
CHAPTER 8: Aortic stenosis
Physical exam
Echocardiographic hemodynamics
Determination of severity of AS by echocardiography
Comparison between invasive and echocardiographic measurements
of hemodynamics
Invasive hemodynamics
Common pitfalls
The challenge of low-gradient AS
The challenge of estimating aortic valve area in patients with AS and
significant AR
Carabello’s sign
Subaortic membrane
References
CHAPTER 9: Hemodynamics of transcatheter and surgical aortic valve
replacement
Selection of appropriate patients
Low flow–low-gradient aortic stenosis
Using hemodynamics to avoid pitfalls during TAVR
Assessing aortic insufficiency
Expected residual gradients after surgical valve replacement
Long term follow-up after valve replacement
References
CHAPTER 10: Mitral stenosis
Cardiac hemodynamics in patients with MS
Cardiac output
Quantification of severity of MS
Calculating mitral valve area
Physical examination in MS
Echocardiography
Hemodynamics of mitral valve surgery and percutaneous balloon
mitral valvuloplasty (PBMV)
References
CHAPTER 11: Aortic regurgitation
Hemodynamic changes of chronic aortic regurgitation
Aortic pressures
Left ventricular pressures
Hemodynamic changes detected by physical exam
Hemodynamic changes detected by echocardiography
Acute aortic regurgitation
Pharmacologic treatment of AR
Hemodynamic tracings of a patient with severe AR
References
CHAPTER 12: Mitral regurgitation
Pathology
Acute MR
Hemodynamic concepts in patients with chronic MR
Compensatory mechanisms in chronic MR
Cardiac catheterization and MR hemodynamics
Physical examination
Echocardiography
Important points
Hemodynamics of mitral regurgitation
Reference
CHAPTER 13: The tricuspid valve
Tricuspid regurgitation
Tricuspid stenosis
References
CHAPTER 14: Hemodynamic findings in pulmonic valve disease
Pulmonic valve stenosis
Noninvasive imaging
Cardiac catheterization and invasive hemodynamics
Treatment of PS
Pulmonic regurgitation
Hemodynamic changes in chronic PR
Right ventricular function in chronic PR
Hemodynamic changes detected by non-invasive imaging in chronic
PR
Natural history of chronic PR
Pregnancy
References
PART III: Cardiomyopathies
CHAPTER 15: Hypertrophic cardiomyopathy
Physical exam
Hemodynamics
Findings at cardiac catheterization
Left atrium or pulmonary capillary wedge pressure
LV pressure
Aortic pressure
Outflow tract gradient
Echocardiography
Septal reduction for refractory symptoms
References
CHAPTER 16: Heart failure
Directly measured intracardiac pressures
Derived parameters from measured intracardiac pressures
Important points: Hemodynamics in HF
References
CHAPTER 17: Restrictive cardiomyopathy
Hemodynamic principles
Differentiating restrictive cardiomyopathy from constrictive
pericarditis
Echocardiography
References
PART IV: Pericardial disease
CHAPTER 18: Constrictive pericarditis
Hemodynamics of constrictive pericarditis
Hemodynamic principles
Physical exam
Pericardial imaging techniques
Findings at cardiac catheterization
Sensitivity and specificity of various hemodynamic findings in
constrictive pericarditis
Findings on echocardiography
Differentiation of constrictive pericarditis and restrictive
cardiomyopathy
References
CHAPTER 19: Cardiac tamponade
Hemodynamic pathophysiology
Hemodynamic findings
Physical exam findings
Hemodynamics of cardiac tamponade as measured with
echocardiography
References
CHAPTER 20: Effusive–constrictive pericarditis
Hemodynamics of effusive–constrictive pericarditis
Physical examination
Pericardial imaging techniques
Findings on echocardiography
References
PART V: Hemodynamic support
CHAPTER 21: Hemodynamics of intra-aortic balloon counterpulsation
History and uses
Description
Hemodynamic effects
Intra-aortic balloon pump timing
Conclusion
References
CHAPTER 22: Hemodynamics of left ventricular assist device
implantation
Initial evaluation
Early post-implantation period
The chronic LVAD patient
Conclusion
References
PART VI: Coronary hemodynamics
CHAPTER 23: Coronary hemodynamics
Basic principles of coronary blood flow
Regulation of coronary blood flow
Clinical measurement of coronary hemodynamics in the cardiac
catheterization laboratory: Doppler and pressure wires
Measurement of coronary blood flow
Doppler wire and coronary flow reserve
Pressure wire and fractional flow reserve
References
CHAPTER 24: Fractional flow reserve
Concept of fractional flow reserve
Key clinical studies of FFR
Limitations of FFR measurement
Instantaneous wave-free ratio
References
PART VII: Miscellaneous
CHAPTER 25: Right ventricular myocardial infarction
The effects of ischemia on the right ventricle
Clinical presentation, ECG changes, and echocardiographic findings
in RV infarction
Hemodynamics of RV infarction
Findings at cardiac catheterization
Diagnosis of RV infarction with hemodynamics
Management
References
CHAPTER 26: Pulmonary hypertension
Hemodynamic changes associated with pulmonary hypertension
Special population: Pulmonary hypertension in patients being
evaluated for cardiac transplantation
Hemodynamic changes detected by history and physical exam
Two-dimensional echocardiography in pulmonary hypertension
Take-home message
References
CHAPTER 27: Hemodynamics of arrhythmias and pacemakers
Premature atrial and ventricular contractions
Heart block
Cannon A waves
Ventricular tachycardia
Junctional rhythm
Atrial fibrillation and atrial flutter
Sinus bradycardia or tachycardia
Cardiac pacing
Physiology and pathophysiology of AV synchrony
Pacemakers in specific patient populations
References
CHAPTER 28: Systematic evaluation of hemodynamic tracings
Unknowns
Reference
Index
End User License Agreement
List of Tables
Chapter 02
Table 2.1 Sample of trials that have examined the effect of PA catheter
use on mortality in critically ill patients.
Table 2.2 Complications of PA catheters.
Table 2.3 Advantages and disadvantages of venous access sites.
Chapter 03
Table 3.1 Normal hemodynamic values.
Chapter 04
Table 4.1 Definition of terms used to describe blood pressure.
Table 4.2 Recommendations for the management of hypertension by the
Panel Members Appointed to the Eighth Joint National Committee (JNC
8).
Table 4.3 Disease states associated with various pulse characteristics.
Chapter 05
Table 5.1 Conditions associated with abnormal right atrial pressure
tracings.