1 / 48

HEMODYNAMIC ASSESSMENT: CARDIAC CATHETERIZATION LABORATORY

HEMODYNAMIC ASSESSMENT: CARDIAC CATHETERIZATION LABORATORY. William Hellenbrand MD Director, Pediatric Cardiology Morgan Stanley Children’s Hospital of New York - Presbyterian Columbia University Medical Center Komansky Center for Children’s Health Cornell University Medical Center.

seth-padilla
Télécharger la présentation

HEMODYNAMIC ASSESSMENT: CARDIAC CATHETERIZATION LABORATORY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HEMODYNAMIC ASSESSMENT: CARDIAC CATHETERIZATION LABORATORY William Hellenbrand MD Director, Pediatric Cardiology Morgan Stanley Children’s Hospital of New York - Presbyterian Columbia University Medical Center Komansky Center for Children’s Health Cornell University Medical Center

  2. CARDIAC CATHETERIZATION • Cardiac output • Shunt & Resistance • Oxygen transport • Pressure-Volume loops

  3. FICK PRINCIPLE • The amount of flow through an organ or any circuit may be determined if • 1 - that organ consumes or secrets a given substance • 2 - the concentration of that substance can be measured as it enters and leaves the organ • 3 - The total amount of the substance consumed or secreted can be measured per unit time ∆S/∆t C2S – C1S

  4. FICK PRINCIPLE

  5. OXYGEN IN BLOOD • When oxygen is exposed to blood it exists in 2 forms • Bound to hemoglobin Each gram of Hgb is capable of binding 1.36 ml O2. Therefore if the Hgb is 15 gm/100ml then the maximal amount of oxygen(Capacity) that can be taken up by Hgb is 20.4 ml/100ml(Vol%)

  6. OXYGEN IN BLOOD • When oxygen is exposed to blood it exists in 2 forms(cont) • In solution in plasma – At body temperature of 370 , there is .00003 ml of O2 per one ml of plasma at a partial pressure of oxygen of 1 mm Hg(1 torr) Thus the solubility coefficient of oxygen in plasma is 0.00003 ml/ml/mm Hg Therefore the amount of dissolved oxygen in plasma is equal to .003(PO2)

  7. OXYGEN IN BLOOD • Oxygen capacity = Hgb(gm/100ml)*1.36 ml O2/gm = ml O2/100ml (Vol%) • Oxygen saturation = proportion of O2 actually combined with hemoglobin to the total capacity • Oxygen content = Capacity*Saturation + .003*PO2 = ml/100ml (Vol%)

  8. OXYGEN CONSUMPTION • VO2 = VIFIO2 - VEFEO2 • If RER is 1 then VI = VE and all you need to measure is VEFEO2 • RER = VCO2 /VO2 • RER is close to 1 with carbohydrate metabolism • RER may be as low as 0.7 with mostly fat metabolism • Standard nomograms assume RER of 0.9

  9. Oxygen Consumption

  10. CARDIAC OUTPUTSYSTEMIC BLOOD FLOW • Qp = VO2 • CpvO2 - CpaO2 • Qs = VO2 • CaoO2 - CmvO2 If there is no shunt Qp = Qs

  11. SHUNT CALCULATIONS • Qs = VO2 CaoO2 - CmvO2 • Qp = VO2 CpvO2 - CpaO2 • Qep = VO2 CpvO2 - CmvO2

  12. SHUNT CALCULATIONS • SIMPLE SHUNT • Ql-r = Qp - Qs • Qr-l = Qs - Qp • BIDIRECTIONAL SHUNT • Ql-r = Qp - Qep • Qr-l = Qs - Qep

  13. RESISTANCE TO FLOW • Poiseuille equation Q = ∆Pπr4 1 = 8nl R ∆P = pressure drop r = radius Q = ∆P n = viscosity R l = length of tube πr4 8nl R = ∆P Q

  14. RESISTANCE • SVR = AO(MEAN) - RA(MEAN) Qs • PVR = PA(MEAN) - LA(MEAN) Qp

  15. SYSTEMIC OXYGEN TRANSPORT (SOT) SOT = Q X OXYGEN CONTENT SOT = Q X [(1.36 X Hgb X O2 SAT) + (.003 X PO2)]

  16. SYSTEMIC OXYGEN TRANSPORT (SOT) SOT = Q X [(1.36 X Hgb X O2 SAT) + (.003 X PO2)] Anemic Hypoxia:  Hgb SOT  Acute compensation  Q SOT  Chronic compensation  Hgb SOT 

  17. SYSTEMIC OXYGEN TRANSPORT (SOT) SOT = Q X [(1.36 X Hgb X O2 SAT) + (.003 X PO2)] Hypoxic Hypoxia:  02 SAT SOT  Acute compensation  Q SOT  Chronic compensation Hgb,  Q SOT 

  18. SYSTEMIC OXYGEN TRANSPORT (SOT) SOT = Q X [(1.36 X Hgb X O2 SAT) + (.003 X PO2)] Stagnant Hypoxia:  Q SOT  (Low Cardiac Output) Compensation  Hgb,  02 SAT SOT 

  19. VSD 80/50 M=65 95 80 80/40 M=60 70 80 M=8 M=6 70 80/6 85

  20. Hgb = 10.0 Vol% V02 = 150 ml/min/m2 Saturations Svc = 70 Ra = 70 Rv = 85 Pa = 80 Ao = 95 Pressures Ra = 6(mean) Rv = 80/6 Pa = 80/40 60(mean) La = 8(mean) Ao = 80/50 65(mean) VSDRoom Air

  21. Capacity = 1.36*10 = 13.6 Contents = Ao =13.6*.95=12.9 Mv = 13.6*.70=9.5 Pa = 13.6*.80=10.9 Pv = 13.6*.95=12.9 S(a-v)02 difference = 3.4 P(a-v)02 difference = 2.0 Qp = 150/2.0 = 7.5 l/min/m2 Qs = 150/3.4 = 4.4 l/min/m2 Ql-r = 7.5-4.4=3.1 Qp/Qs = 7.5/4.4=1.7 PVR =(60-8)/7.5 =6.9 SVR =(65-6)/4.4=13.4 VSDRoom Air

  22. Hgb = 10.0 Vol% V02 = 150 ml/min/m2 Saturations Svc = 75 (45) Ra = 80 Rv = 94 Pa = 95 (85) Ao = 100 (600) Pressures Ra = 6(mean) Rv = 80/6 Pa = 80/40 60(mean) La = 8(mean) Ao = 80/50 65(mean) VSDfI02 = 1.0

  23. Capacity = 1.36*10 = 13.6 Contents = Ao =13.6*1.0=13.6 Mv = 13.6*.75=10.2 Pa = 13.6*.95=12.9 Pv = 13.6*1.0=13.6 S(a-v)02 difference = 3.4 P(a-v)02 difference = 0.7 Qp = 150/0.7 = 21.4 l/min/m2 Qs = 150/3.4 = 4.4 l/min/m2 Ql-r = 21.4-4.4=17.0 Qp/Qs =21.4/4.4=>4/1 PVR =(60-8)/21.4 =2.4 SVR =(65-6)/4.4=13.4 VSDfI02 = 1.0(PO2 not included)

  24. Capacity = 1.36*10 = 13.6 Contents = Ao =13.6*1.0+1.8=15.4 Mv = 13.6*.75+.15=10.4 Pa = 13.6*.95+.25=13.2 Pv = 13.6*1.0+1.8=15.4 S(a-v)02 difference = 5.0 P(a-v)02 difference = 2.2 Qp = 150/2.2 = 6.8 l/min/m2 Qs = 150/5.0 = 3.0 l/min/m2 Ql-r = 6.8-3.0=3.8 Qp/Qs = 6.8/3.0=2.3 PVR =(60-8)/6.8 =7.6 SVR =(65-6)/3.0=20.0 VSDfI02 = 1.0(PO2 included)

  25. P02 not included Qp = 150/0.7 = 21.4 l/min/m2 Qs = 150/3.4 = 4.4 l/min/m2 Ql-r = 21.4-4.4=17.0 Qp/Qs =21.4/4.4=>4/1 PVR =(60-8)/21.4 =2.4 SVR =(65-6)/4.4=13.4 P02 included Qp = 150/2.2 = 6.8 l/min/m2 Qs = 150/5.0 = 3.0 l/min/m2 Ql-r = 6.8-3.0=3.8 Qp/Qs = 6.8/3.0=2.3 PVR =(60-8)/6.8 =7.6 SVR =(65-6)/3.0=20.0 VSD

  26. VALVE AREA CALCULATION

  27. VALVE AREA CALCULATION

  28. VALVE AREA CALCULATION

  29. OXYGEN DISSOCIATION CURVE

  30. OXYGEN DISSOCIATION CURVE

  31. OXYGEN DISSOCIATION CURVE

  32. PRESSURE-VOLUME LOOPS

  33. P-V LOOPS

  34. P-V LOOPSPump Failure

  35. P-V LOOPSPump Failure

  36. P-V LOOPS

More Related