35 Shock

• RV: contracts, generate high systolic
• PA: same systolic, PV close and stop pressure drop at 10
• can also take blood sample and measure O2 sat

Swan-Ganz Catheter

• usually inserted into jugular vein or subclavian. Or femoral vein up to IVC
• can be stopped in different chamber and measure pressure: RA, RV, PA, wedge pressure
• PCWP: push balloon until it can't go any further, stuck in PA, tip of catheter just beyond balloon, measures LAP

• total hemodynamic assessment from swan-ganz

• O2 consumption, arterial and venous O2 can all be found from swan ganz catheter

• MAP: pressure leaving heart
• RAP: pressure returning to heart

Shock

• cardiogenic: weak heart can't pump
• insensible loss: lose fluid in lungs/diarrhea/vomiting, not sensed by body compared to flood loss through kidney

• high HR: body response to increased sympathetic drive
• cardiogenic: hallmark low CO from weak muscle, blood back flow to all heart chambers
• hypovolemic: low CO, all low chamber pressure from low blood volume
• septic: hallmark low SVR, early dilation of veins = all low pressure, in hospital may be normal from IV fluid

Equalization of Pressures

• tamponade: effusion of blood
• pericardial constriction: constricting sac
• restrictive cardiomyopathy: infiltrative substance

Valvular Disease

• mitral stenosis

• aortic stenosis, high LV systolic pressure

• wide pulse pressure
• blood spilling out of aorta in diastole

• RV and PA systolic should be equal

• start with aorta and work backwards, find first chamber with high pressure
• MR: no aortic regurgitation with low diastolic pressure

Shunt Run