Hemodynamic monitoring

1. FUNDAMENTALS OF
HEMODYNAMIC
MONITORING
VEERAPPAN
SIVASUBRAMANIAN

2. OVERVIEW
• Hemodynamics
• Blood pressure
• Classical BP measurement
• Cardiac cycle time
• Mean Arterial Pressure
• Arterial wave form
• Preload and Afterload
• Swan Ganz Catheter

3. INTRODUCTIONS
• Hemodynamic is concerned with the forces generated by the heart and
the resulting motion of blood through the cardiovascular system
• Hemodynamic monitoring is the intermittent or continuous
observation of physiological parameters pertaining to the circulatory
system with a view to early detection of need for therapeutic
interventions

4. Intravascular volume
Myocardial
contraction and heart
rate
Vaso activity
4 factors that affecting
the hemodynamic
conditions

5. BLOOD PRESSURE
• Force experienced by the lateral walls of the vessel, where the blood
flows.
• Systolic BP - Peak pressure present in the arteries when heart
contracts
• Diastolic BP - Pressure in the arteries between the pulses, when the
hearts dilates

6. CONCEPT OF MEASURING BP

7. GOLD STANDARD SPHYGMOMANOMETER
• Relative density/Specific gravity
• Mercury 13.6
• Water 1.0
• Mercury is used because of it’s higher relative density
• If no Mercury we require a separate apparatus of huge size to
measure the blood pressure
• Water is used to measure a very low pressure

8. CARDIAC CYCLE TIME
• Time taken for a complete heart beat
• Ideal cardiac cycle time as per theory 0.8 secs
• One third of this time is for Systolic – contraction
• Two third of it is for Diastolic – Relaxation

9. MEAN ARTERIAL PRESSURE AND PULSE PRESSURE
• Cardiac cycle time is a combination of 1 part systolic and 2 part
diastolic
• MAP = Systolic P + 2 Diastolic P/3
• Consider a normal BP 120/80
• MAP = 1(120) + 2(80)/3 = 280/3 = 93.3, It is a method for any
normal individual

10. • In case of patients, diastolic pressure plays a major role
• MAP = Diastolic + 1(pulse pressure)/3
• Pulse pressure is Systolic – Diastolic
• Consider BP – 120/80; Pulse P = 40
• In this case MAP = 80 + 1(40/3) = 93.3

11. CURRENT ARTERIAL MONITORING SYSTEM

12. PRESSURE TRANSDUCER
• Transducer is a electronic device converts one form of energy to
another form
• It contains a silicon diaphragm it moves in response to the
transmitted Pressure
• Zeroing transducer

13. PRESSURE-TIME WAVE FORMS

14. ARTERIAL WAVE FORM

15. DICROTIC NOTCH

16. PRELOAD AND AFTERLOAD

17. SWAN-GANZ CATHETER

18. Hemodynamic Waveforms- Normal Heart

19. CONCEPT OF INTRAAORTIC BALLOON PUMP

20. RIGHT ATRIAL PRESSURE MONITORING
COMPLICATIONS
• Pneumothorax
• Hemothorax
• Hemorrhage
• Cardiac tamponade
• Vessel, RA, or RV perforation
• Arrhythmias
• Air embolism
• Pulmonary embolism
• Thromboembolism
• Infection

21. RIGHT ATRIAL PRESSURE MONITORING
WAVEFORM ANALYSIS
• a wave: rise in pressure due to atrial
contraction
• x decent: fall in pressure due to atrial
relaxation
• c wave: rise in pressure due to ventricular
contraction and closure of the tricuspid valve
• v wave: rise in pressure during atrial filling
• y decent: fall in pressure due to opening of the
tricuspid valve and onset of ventricular filling

22. RIGHT ATRIAL PRESSURE MONITORING
WAVEFORM ANALYSIS
Elevated RAP
• RV failure
• Tricuspid regurgitation
• Tricuspid stenosis
• Pulmonary hypertension
• Hypervolemia
• Cardiac tamponade
• Chronic LV failure
• Ventricular Septal Defect
• Constrictive pericarditis
Decreased RAP
• Hypovolemia
• CVP line open

23. Reasons for elevated LA pressure
• Elevated systemic ventricular end diastolic pressure
• Mitral valve disease
• Intravascular volume overload
• Cardiac tamponade
• Artifactual

24. • Low intravascular fluid status
• Inadequate preload
• Artifactual
Reasons for reduced LA pressure

25. Reasons for elevated PA pressure
• Mechanical obstruction of pulmonary circulation
• Pulmonary arteriolar smooth muscle hypertrophy
• Inflammatory response to CPB
• Mechanical obstruction of the airways (for examples…)
• Elevated LA pressure
• Pulmonary hypertension

26. LEARNING IS NEVER ENDING PROCESS…..
What the eye doesn't see and the mind doesn't know,
doesn't exist
- DH Lawrence

27. THANK YOU