Hemodynamic assessment in cardiology

4,809 views

Published on

invasive and noninvasive assessment of hemodynamics

1 Comment
6 Likes
Statistics
Notes
No Downloads
Views
Total views
4,809
On SlideShare
0
From Embeds
0
Number of Embeds
83
Actions
Shares
0
Downloads
296
Comments
1
Likes
6
Embeds 0
No embeds

No notes for slide

Hemodynamic assessment in cardiology

  1. 1. HEMODYNAMICASSESSMENT
  2. 2. INTRODUCTIONConventionally hemodynamics wereobtained by cardiac catheterization.It is possible to determine the same byechocardiography. http://cardiologysearch.blogspot.in/
  3. 3. MethodsM-mode & 2D echo alone can provideonly indirect evidence of hemodynamicabnormalities.These signs are not highly specific /sensitive.Doppler echo is the best tool to assessintra cardiac hemodynamics. http://cardiologysearch.blogspot.in/
  4. 4. Doppler echo & the accuracy of dopplerderived hemodynamic measurementshas been validated by comparison withsimultaneously derived catheterizationdata. http://cardiologysearch.blogspot.in/
  5. 5. Stroke volume & COFlow across a fixed orifice is equal tothe product of the cross sectional areaof the orifice & flow velocity.Velocities varies during ejection in apulsatile system, individual velocities ofthe doppler spectrum need to besummed(TVI or VTI).Flow rate = CSA x FLOW VELOCITY SV = CSA X TVI CO = SV X HR http://cardiologysearch.blogspot.in/
  6. 6. STROKE VOLUMEIS THE PRODUCT OF CROSSSECTIONAL AREA AND THEFLOW VELOCITY INTEGRAL. http://cardiologysearch.blogspot.in/
  7. 7. CSAThe CSA of orifices in the heart isusually assumed to be a circle and it isdetermined from measurement of theorifice diameter(D).CSA = (D/2) ² X π = D ² X 0.785 SV = D ² X 0.785 X TVI http://cardiologysearch.blogspot.in/
  8. 8. MEASUREMENT OF STROKE VOLUME & CARDIAC OUTPUT http://cardiologysearch.blogspot.in /
  9. 9. Regurgitant orifice area (ROA)ESTIMATED BY PISA USING THEPRINCIPAL OF CONTINUITYEQUATION. http://cardiologysearch.blogspot.in/
  10. 10. http://cardiologysearch.blogspot.in/
  11. 11. PISA CALCULATION
  12. 12. PISA CALCULATION http://cardiologysearch.blogspot.in/
  13. 13. PISA CALCULATION
  14. 14. PISA CALCULATION
  15. 15. PISACALCULATION
  16. 16. REGURGITANT ORIFICE AREACALCULATION
  17. 17. REGURGITANT VOLUMEVOLUME OF BLOOD THAT REGURGITATESTHROUGH AN INCOMPETANT ORIFICEWITH EACH HEART BEATRV = TOTAL FORWARD _ SYSTEMIC FLOW (Q) FLOW(Qs). http://cardiologysearch.blogspot.in/
  18. 18. An example of regurgitant volumecalculation in MR.
  19. 19. REGURGITANT VOLUME CALCULATION BY PISA REGURGITANT INTEGRATEDRV = X VELOCITY ORIFICE AREA OF MR JET http://cardiologysearch.blogspot.in/
  20. 20. REGURGITANT FRACTION It is simply the percentage of regurgitant volume compared to flow across the regurgitant valve. REG VOL X 100Regurgitant fraction = Q valve flow http://cardiologysearch.blogspot.in/
  21. 21. Pulmonary to systemic flow ratio (Qp/Qs) In the presence of intracardiac shunt the flow ratio between the pulmonary & systemic circulation usually indicates the magnitude of shunt. Pulmonary flow (Qp) is calculated from the RVOT & systemic flow (Qs) , from the LVOT. http://cardiologysearch.blogspot.in/
  22. 22. RVOT TVI X RVOT CSAQp/Qs = LVOT TVI X LVOT CSA.
  23. 23. DOPPLER ESTIMATION OF INTRA-CARDIAC PRESSURES http://cardiologysearch.blogspot.in/
  24. 24. RIGHT ATRIAL PRESURE•IVC diameter measurement adjacent toright atrium•Subcostal view•During quite respiration & forcedinspiration http://cardiologysearch.blogspot.in/
  25. 25. RV SYSTOLIC PRESSURE BY TR VELOCITY JET •Reflects pressure difference between RV &RA •TR present in 75% normal adults •Normal velocity 2- 2.5m/sec •Higher velocity –PS or PHT http://cardiologysearch.blogspot.in/
  26. 26. ESTIMATION OF SYSTOLICPAP IN THE ABSENCE OF PSPAP = 4( V TR)² + RAP systolic http://cardiologysearch.blogspot.in/
  27. 27. ESTIMATION OF SYSTOLIC PAP IN THE PRESENCE OF PSPAP = RVSP – 4(V PS) ² systolicPAP = (4 (VTR)² + RAP ) – 4(V PS) ² systolic http://cardiologysearch.blogspot.in/
  28. 28. RVOT FLOW ACCELERATION TIME•Pulse wave doppler•Sample volume at valve annulus•Ac T=Time between beginning offlow & peak velocity•Normal 120 m Sec or higher•PHT –Ac T Shortened http://cardiologysearch.blogspot.in/
  29. 29. Fig. 4-43.Pulmonaryarteryflow inthreepatientswith dif-feringpulmonaryartery pres-sures. Theaccelerationtime(AT)becomesshorter asthepulmonaryarterypressurerises.
  30. 30. ESTIMATION OF MEAN PAP FROM RVOT Ac TMAHAN’S regression equation MPAP = 79 - ( 0.45 X Ac T) http://cardiologysearch.blogspot.in/
  31. 31. PULMONARY REGURGITATION VELOCITY•Reflects end diastolic pressure gradientbetween PA & RV•At end diastole RV pressure = RAP•Used to calculate PAEDP & mean PAP http://cardiologysearch.blogspot.in/
  32. 32. ESIMATION OF END DIASTOLIC PAP FROM PR VELOCITYPAEDP – RVEDP = 4 X PR EDV ²PAEDP = 4 X PR EDV ² + RVEDP = 4 X PR EDV ² + RAP http://cardiologysearch.blogspot.in/
  33. 33. ESIMATION OF MEAN PAP FROM PR VELOCITY According to MasuyamaMean PAP = 4 X peak PR velocity ² http://cardiologysearch.blogspot.in/
  34. 34. LVEDPLVEDP & LV diastolic function are closelyrelated phenomenon.Changes in mitral flow velocities in early &late diastole reflect changes in LVEDP.In presence of AR the LVEDP is easilycalculated.AR velocity reflects the diastolic pressuredifference between AO & LV. http://cardiologysearch.blogspot.in/
  35. 35. LA PRESSUREMR velocity represents the systolicpressure difference between the LV &the LA.In patients without LV outflowobstruction systolic BP is practicallysame as LV systolic pressure.LA pressure = SBP – 4 x MRV² http://cardiologysearch.blogspot.in/
  36. 36. Relation of PVF with LAPLAP = 35 - 0.39 X ( SYSTOLIC FRACTION )SYSTOLIC FRACTION = Si X 100 Si+Di http://cardiologysearch.blogspot.in/
  37. 37. PCWP by MITRAL & TISSUE DOPPLERPCWP = 1.24 X E + 1.9 E’ http://cardiologysearch.blogspot.in/
  38. 38. LVEDP by MITRAL & TISSUE DOPPLER E > 15 E’ LVEDP > 12 mmHg http://cardiologysearch.blogspot.in/
  39. 39. THANK YOUhttp://cardiologysearch.blogspot.in/
  40. 40. Kindly send your suggestions toimprove this siteVisit us regularly for updatesSend your articles/ ppt/pdf to publish inthis site . http://cardiologysearch.blogspot.in / http://cardiologysearch.blogspot.in/

×