Wide Pulse Pressure and Quincke's Pulse in High-Output Heart Failure
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Cardiac Dysfunction and Lactic Acidosis During Hyperdynamic and Hypovolemic Shock
è - \-o(J THESIS FOR TIIE DEGREE OF DOCTOR OF MEDICINE CARDIAC DYSFUNCTION AND LACTIC ACIDOSIS DURING HYPERDYNAMIC AND HYPOVOLEMIC SHOCK DAVID JAMES COOPER DEPARTMENT OF ANAESTIIESIA AND INTENSIVE CARE FACULTY OF MEDICINE UNIVERSITY OF ADELAIDE Submitted: October,1995 Submitted in revised form: November, 1996 2 J TABLE OF CONTENTS Page 5 CH 1(1.1) Abstract (1.2) Signed statement (1.3) Authors contribution to each publication (1.4) Acknowledgments (1.5) Publications arising 9 CH2Introduction (2.1) Shock and lactic acidosis (2.2) Cardiac dysfunction and therapies during lactic acidosis (2.3) Cardiac dysfunction during hyperdynamic shock (2.4) Cardiac dysfunction during hypovolemic shock (2.5) Cardiac dysfunction during ionised hypocalcaemia l7 CH3 Methods (3. 1) Left ventricular function assessment - introduction (3.2) Left ventricular function assessment in an animal model 3.2.I Introduction 3.2.2 Anaesthesia 3.2.3 Instrumentation 3.2.4 Systolic left ventricular contractility 3.2.5 Left ventricular diastolic mechanics 3.2.6 Yentricular function curves 3.2.1 Limitations of the animal model (3.3) Left ventricular function assessment in human volunteers 3.3.7 Left ventricular end-systolic pressure measurement 3.3.2 Left ventricular dimension measurement 3.3.3 Rate corrected velocity of circumferential fibre shortening (v"¡.) 3.3.4. Left ventricular end-systolic meridional wall stress (o"r) 4 33 CH 4 Cardiac dysfunction during lactic acidosis (4.1) Introduction 4.7.1 Case report (4.2) Human studies 4.2.1 Bicarbonate in critically ill patients -
Cardiac Function and Haemodynamics in Alcoholic Cirrhosis and Evects of the Transjugular Intrahepatic Portosystemic Stent Shunt
Gut 1999;44:743–748 743 Cardiac function and haemodynamics in alcoholic cirrhosis and eVects of the transjugular Gut: first published as 10.1136/gut.44.5.743 on 1 May 1999. Downloaded from intrahepatic portosystemic stent shunt M Huonker, Y O Schumacher, A Ochs, S Sorichter, J Keul, M Rössle Abstract seem to be mainly responsible for the fur- Background—A portosystemic stent ther decrease in systemic vascular resist- shunt may impair cardiac function and ance. TIPS may unmask a coexisting haemodynamics. preclinical cardiomyopathy in patients Aims—To investigate the eVects of a tran- with alcoholic cirrhosis and portal hyper- sjugular intrahepatic portosystemic shunt tension. (TIPS) on cardiac function and pulmo- (Gut 1999;44:743–748) nary and systemic circulation in patients Keywords: alcoholic cirrhosis; portosystemic stent with alcoholic cirrhosis. shunt; cirrhotic cardiomyopathy; ventricular function; Patients/Methods—17 patients with alco- pulmonary circulation; systemic circulation holic cirrhosis and recent variceal bleed- ing were evaluated by echocardiography and catheterisation of the splanchnic and It has been known for more than four decades pulmonary circulation before and after that hepatic cirrhosis is associated with cardio- TIPS. The period of catheter measure- vascular abnormalities. The initial studies per- ment was extended to nine hours in nine of formed in the early 1950s documented the the patients. The portal vein was investi- existence of a hyperdynamic circulation in cir- gated by Doppler ultrasound before and rhosis, manifested by increased cardiac output nine hours after TIPS. and reduced systemic vascular resistance.1 Results—Baseline echocardiography Overt heart failure is generally not a prominent showed the left atrial diameter to be feature of hepatic cirrhosis, because the marked slightly increased and the left ventricular peripheral vasodilation reduces the afterload of volume to be in the upper normal range. -
Effect of Isoproterenol, Phenylephrine, and Sodium Nitroprusside on Fundus Pulsations in Healthy Volunteers
British Journal of Ophthalmology 1996; 80: 217-223 217 Effect of isoproterenol, phenylephrine, and sodium nitroprusside on fundus pulsations in Br J Ophthalmol: first published as 10.1136/bjo.80.3.217 on 1 March 1996. Downloaded from healthy volunteers Leopold Schmetterer, Michael Wolzt, Alex Salomon, Alexander Rheinberger, Christian Unfried, Gabriele Zanaschka, Adolf Friedrich Fercher Abstract have not yet been carried out and quantitative Aims/Background-Recently a laser inter- pressure flow relations in human choroidal ferometric method for topical measure- vessels are as yet unknown. Linear choroidal ment of fundus pulsations has been pressure flow relations have been obtained in developed. Fundus pulsations in the macu- animal experiments in different species.5-8 In lar region are caused by the inflow and out- the rabbit, the choroidal blood flow has been flow ofblood into the choroid. The purpose shown to be pressure independent when IOP ofthis work was to study the influence of a was less than 20-25 mm Hg.9 peripheral vasoconstricting (the a,x adreno- Blood vessels can be considered as cylin- ceptor agonist phenylephrine), a predomi- ders filled with fluid at a pressure greater than nantly positive inotropic (the non-specific that outside the cylinders. The pressure dif- I adrenoceptor agonist isoproterenol), and ference between the inside and the outside of a non-specific vasodilating (sodium nitro- a vessel is called the transmural pressure P. prusside) model drug on ocular fundus The corresponding tension T in the vessel pulsations to determine reproducibility wall can be calculated by Laplace's law and sensitivity ofthe method. P=T/R, where R is the radius of the cylinder. -
The Pivotal Role of Adrenomedullin in Producing Hyperdynamic Circulation During the Early Stage of Sepsis
PAPER The Pivotal Role of Adrenomedullin in Producing Hyperdynamic Circulation During the Early Stage of Sepsis Ping Wang, MD; Zheng F. Ba; William G. Cioffi, MD; Kirby I. Bland, MD; Irshad H. Chaudry, PhD Background: Initial cardiovascular responses during sep- Results: Cardiac output, stroke volume, and microvas- sis are characterized by hyperdynamic circulation. Al- cular blood flow in the liver, small intestine, kidney, and though studies have shown that a novel potent vasodi- spleen increased, and total peripheral resistance de- latory peptide, adrenomedullin (ADM), is up-regulated creased 0 and 30 minutes after ADM infusion. In addi- under such conditions, it remains unknown whether ADM tion, plasma levels of ADM increased from the preinfu- is responsible for initiating the hyperdynamic response. sion level of 92.7 ± 5.3 to 691.1 ± 28.2 pg/mL 30 minutes after ADM infusion, which was similar to ADM levels ob- Objective: To determine whether increased ADM re- served during early sepsis. Moreover, 5 hours after the lease during early sepsis plays any major role in produc- onset of sepsis, cardiac output, stroke volume, and mi- ing hyperdynamic circulation. crovascular blood flow in various organs increased and total peripheral resistance decreased. Administration of Design, Intervention, and Main Outcome Measure: anti-ADM antibodies, however, prevented the occur- Synthetic rat ADM (8.5 µg/kg of body weight) was infused rence of the hyperdynamic response. intravenously in normal rats for 15 minutes at a constant rate.Cardiacoutput,strokevolume,andmicrovascularblood Conclusions: The results suggest that increased ADM flow in various organs were determined immediately as well production and/or release plays a major role in produc- as 30 minutes after ADM infusion. -
Regulation of the Cerebral Circulation: Bedside Assessment and Clinical Implications Joseph Donnelly1, Karol P
Donnelly et al. Critical Care 2016, 18: http://ccforum.com/content/18/6/ REVIEW Open Access Regulation of the cerebral circulation: bedside assessment and clinical implications Joseph Donnelly1, Karol P. Budohoski1, Peter Smielewski1 and Marek Czosnyka1,2* Abstract Regulation of the cerebral circulation relies on the complex interplay between cardiovascular, respiratory, and neural physiology. In health, these physiologic systems act to maintain an adequate cerebral blood flow (CBF) through modulation of hydrodynamic parameters; the resistance of cerebral vessels, and the arterial, intracranial, and venous pressures. In critical illness, however, one or more of these parameters can be compromised, raising the possibility of disturbed CBF regulation and its pathophysiologic sequelae. Rigorous assessment of the cerebral circulation requires not only measuring CBF and its hydrodynamic determinants but also assessing the stability of CBF in response to changes in arterial pressure (cerebral autoregulation), the reactivity of CBF to a vasodilator (carbon dioxide reactivity, for example), and the dynamic regulation of arterial pressure (baroreceptor sensitivity). Ideally, cerebral circulation monitors in critical care should be continuous, physically robust, allow for both regional and global CBF assessment, and be conducive to application at the bedside. Regulation of the cerebral circulation is impaired not only in primary neurologic conditions that affect the vasculature such as subarachnoid haemorrhage and stroke, but also in conditions that affect the regulation of intracranial pressure (such as traumatic brain injury and hydrocephalus) or arterial blood pressure (sepsis or cardiac dysfunction). Importantly, this impairment is often associated with poor patient outcome. At present, assessment of the cerebral circulation is primarily used as a research tool to elucidate pathophysiology or prognosis. -
Increased Pulse Pressure Is Associated with Reduced Baroreflex Sensitivity
Journal of Human Hypertension (2004) 18, 247–252 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Increased pulse pressure is associated with reduced baroreflex sensitivity R Virtanen1, A Jula2, H Huikuri3, T Kuusela4, H Helenius5, A Ylitalo6, L-M Voipio-Pulkki1,7, H Kauma3,8, YA Kesa¨niemi3,8 and J Airaksinen1 1Department of Medicine, University of Turku, Turku, Finland; 2Research Department of the Social Insurance Institution, Turku, Finland; 3Department of Medicine, University of Oulu, Oulu, Finland; 4Department of Physics, University of Turku, Turku, Finland; 5Department of Biostatistics, University of Turku, Turku, Finland; 6Division of Cardiology, Satakunta Central Hospital, Pori, Finland; 7Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; 8Biocenter Oulu, University of Oulu, Oulu, Finland Although pulse pressure (PP), heart rate variability significant when 24-h ambulatory diastolic blood pres- (HRV) and baroreflex sensitivity (BRS) have been shown sure, body mass index, smoking and alcohol intake were to predict cardiovascular events and mortality in various added as covariates in the multivariate analysis. In- populations, their relationships have not been clarified. creased ambulatory PP was also associated with We examined these associations in two separate increased beat-to-beat systolic arterial pressure varia- population-based samples of healthy middle-aged sub- bility. Associations between ambulatory PP and HRV jects. In population 1, data were obtained from 149 were not significant after controlling for age and gender. subjects (71 men and 78 women) aged 35–64 (mean 47.7) Our results suggest that elevated PP does not affect years, and in population 2, from 214 subjects (88 men overall HRV, but it interferes with baroreflex-mediated and 126 women) aged 40–62 (mean 50.5) years. -
Static and Dynamic Components of Right Ventricular Afterload Are Negatively Associated with Calf Survival at High Altitude1
Published September 29, 2016 Static and dynamic components of right ventricular afterload are negatively associated with calf survival at high altitude1 J. M. Neary,*2 R. D. Brown,† T. N. Holt,‡ K. R. Stenmark,† R. M. Enns,§ M. G. Thomas,§ and F. B. Garry‡ *Department of Animal and Food Sciences, College of Agricultural Sciences and Natural Resources, Texas Tech University, Lubbock 79409-2141; †Division of Pediatric Critical Care, School of Medicine, University of Colorado Denver, Aurora 80045; ‡Integrated Livestock Management, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins 80523-1678; and, §Department of Animal Sciences, The College of Agricultural Sciences, Colorado State University, Fort Collins 80523-1171. ABSTRACT: The purposes of this study were to pulse pressures (P = 0.03) at 3 mo of age than calves evaluate mean, systolic, and diastolic pulmonary that survived to 7 mo. Calves presumed to have died arterial pressures; pulmonary arterial pulse pres- tended to have greater systemic oxygen extraction sures; and systemic oxygen extraction fraction as fractions at 3 mo of age than calves that survived (P risk factors for the survival of suckling calves on one = 0.13). Diastolic pressure was not associated with ranch located at an altitude of 2,730 m in Colorado, survival (P = 0.27). Mean pulmonary arterial pres- USA. A prospective cohort study of 58 calves was sure is predominantly determined by static resistance performed. Pulmonary arterial pressures and sys- attributable to distal pulmonary arterial remodeling. temic oxygen extraction were measured when calves Pulse pressure and systolic pulmonary arterial pres- were approximately 3 mo (86 ± 7 d) and 7 mo (197 sure represents the dynamic or oscillatory resistance ± 6 d) of age. -
Pulse and Blood Pressure Procedures Manual
NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY III CYCLE 2 PULSE AND BLOOD PRESSURE PROCEDURES FOR HOUSEHOLD INTERVIEWERS Prepared by: Westat, Inc. 1650 Research Boulevard Rockville, MD 20850 September 1989 Revised July 1993 TABLE OF CONTENTS Chapter Page 1 PULSE AND BLOOD PRESSURE PROCEDURES....................................... 1-1 1.1 Introduction to Pulse and Blood Pressure............................................. 1-1 1.2 Background on Pulse and Blood Pressure............................................ 1-1 1.2.1 The Circulatory System ........................................................... 1-1 1.2.2 Definition of Pulse ................................................................... 1-3 1.2.3 Definition of Blood Pressure................................................... 1-3 1.2.4 Meaning of Blood Pressure..................................................... 1-3 1.2.5 Method of Measuring Arterial Blood Pressure.......................................................................... 1-4 2 DESCRIPTION AND MAINTENANCE OF BLOOD PRESSURE EQUIPMENT ................................................................................. 2-1 2.1 Blood Pressure Equipment..................................................................... 2-1 2.1.1 Manometer................................................................................ 2-1 2.1.2 Inflation System........................................................................ 2-5 2.1.3 Stethoscope.............................................................................. -
The Impact of Arteriovenous Fistula Formation on Central Hemodynamic Pressures in Chronic Renal Failure Patients: a Prospective Study M
The Impact of Arteriovenous Fistula Formation on Central Hemodynamic Pressures in Chronic Renal Failure Patients: A Prospective Study M. Tessa Savage, PhD, Charles J. Ferro, MD, Antonio Sassano, MSc, and Charles R.V. Tomson, DM ● Background: The presence of an arteriovenous (AV) fistula creates permanently high cardiac output. This may cause an imbalance between available cardiac oxygen supply in response to greater demand and increased arterial stiffness. Methods: Surrogate markers of subendocardial perfusion (subendocardial viability ratio [SEVR]) and arterial stiffness (augmentation index [AIx]) can be measured noninvasively by using pulse wave analysis on the radial pulse to obtain central pressures. We prospectively followed up nine patients with chronic renal failure (CRF) undergoing creation of an AV fistula for vascular access at regular intervals over 6 months. Results: After surgery, blood pressure and heart rate remained unchanged throughout the study period. AIx stayed the same (baseline versus 6 months, 20% ؎ 11% versus 22% ؎ 15%), but there was a decrease in SEVR immediately after surgery (؊9% P < 0.05) that persisted for at least 3 months (؊14% ؎ 7%; P < 0.01). At 6 months, SEVR remained below ;5% ؎ ;baseline values in all but one patient (mean SEVR at baseline, 166% ؎ 22% versus 6 months, 150% ؎ 20%; P < 0.05 ؊9% ؎ 7%). Conclusion: Creation of an AV fistula may directly predispose patients with CRF to a risk for myocardial ischemia caused by an adverse imbalance between subendocardial oxygen supply and increased oxygen demand consequent to a greater cardiac output. © 2002 by the National Kidney Foundation, Inc. INDEX WORDS: Chronic renal failure (CRF); arteriovenous (AV) fistula; pulse wave analysis; augmentation index (AIx); subendocardial viability ratio (SEVR). -
Chapter 9 Monitoring of the Heart and Vascular System
Chapter 9 Monitoring of the Heart and Vascular System David L. Reich, MD • Alexander J. Mittnacht, MD • Martin J. London, MD • Joel A. Kaplan, MD Hemodynamic Monitoring Cardiac Output Monitoring Arterial Pressure Monitoring Indicator Dilution Arterial Cannulation Sites Analysis and Interpretation Indications of Hemodynamic Data Insertion Techniques Systemic and Pulmonary Vascular Resistances Central Venous Pressure Monitoring Frank-Starling Relationships Indications Monitoring Coronary Perfusion Complications Electrocardiography Pulmonary Arterial Pressure Monitoring Lead Systems Placement of the Pulmonary Artery Catheter Detection of Myocardial Ischemia Indications Intraoperative Lead Systems Complications Arrhythmia and Pacemaker Detection Pacing Catheters Mixed Venous Oxygen Saturation Catheters Summary References HEMODYNAMIC MONITORING For patients with severe cardiovascular disease and those undergoing surgery associ- ated with rapid hemodynamic changes, adequate hemodynamic monitoring should be available at all times. With the ability to measure and record almost all vital physi- ologic parameters, the development of acute hemodynamic changes may be observed and corrective action may be taken in an attempt to correct adverse hemodynamics and improve outcome. Although outcome changes are difficult to prove, it is a rea- sonable assumption that appropriate hemodynamic monitoring should reduce the incidence of major cardiovascular complications. This is based on the presumption that the data obtained from these monitors are interpreted correctly and that thera- peutic decisions are implemented in a timely fashion. Many devices are available to monitor the cardiovascular system. These devices range from those that are completely noninvasive, such as the blood pressure (BP) cuff and ECG, to those that are extremely invasive, such as the pulmonary artery (PA) catheter. To make the best use of invasive monitors, the potential benefits to be gained from the information must outweigh the potential complications. -
Echocardiography in Pregnant Women Gebelikte Ekokardiyografinin Yeri
Education E¤itim 169 Echocardiography in pregnant women Gebelikte ekokardiyografinin yeri Nurgül Keser University of Maltepe, Istanbul, Turkey ABSTRACT Beyond evaluating physiologic alterations encountered during pregnancy quantitative pulsed- and continuous Doppler and qualitative co- lor Doppler technology can be used for cardiovascular assessment of the pregnant woman with heart disease or suspected cardiac ab- normality. Echocardiography provides information about disease etiology, leads to accurate and non- invasive assessment of disease se- verity and is a powerful means of monitoring progression. Only with echocardiography it has been clearly demonstrated that during preg- nancy congenital heart disease is the first leading abnormality followed by rheumatic heart disease. Doppler and qualitative color Dopp- ler are useful to illuminate the pathophysiology of the hemodynamic consequences of fixed valve stenosis during pregnancy with respect to the labile nature of gradients resulting from variable loading conditions of pregnancy. Accurate cardiac diagnosis leads to accurate es- timation of prognosis, illuminates the necessity of noninvasive monitoring throughout pregnancy and labor, and leads to determine whet- her surgical or medical intervention should be performed. Need for Fetal echocardiography should also be considered after maternal ec- hocardiography is undertaken. Although there are no strictly defined limits established for the use of Doppler ultrasound in the early preg- nancy there is an unequivocal demand for carefulness -
Monitoring of the Central Blood Pressure Waveform Via a Conformal Ultrasonic Device
HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Nat Biomed Manuscript Author Eng. Author Manuscript Author manuscript; available in PMC 2019 March 21. Published in final edited form as: Nat Biomed Eng. 2018 September ; 2(9): 687–695. doi:10.1038/s41551-018-0287-x. Monitoring of the central blood pressure waveform via a conformal ultrasonic device Chonghe Wang#1, Xiaoshi Li#2, Hongjie Hu#2, Lin Zhang1, Zhenlong Huang1, Muyang Lin7, Zhuorui Zhang1, Zhenan Yin3, Brady Huang5, Hua Gong1, Shubha Bhaskaran3, Yue Gu2, Mitsutoshi Makihata6, Yuxuan Guo1, Yusheng Lei1, Yimu Chen1, Chunfeng Wang8, Yang Li1, Tianjiao Zhang1, Zeyu Chen4, Albert Pisano6, Liangfang Zhang1, Qifa Zhou4, and Sheng Xu1,2,3,9,* 1Department of Nanoengineering, University of California San Diego, La Jolla, CA, 92093-0448, USA. 2Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, 92093-0418, USA. 3Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, 92093-0407, USA. 4Department of Ophthalmology and Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089-1111, USA. 5Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, 92103, USA. 6Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, 92093-0411, USA. 7School of Precision Instrument and Optoelectronic Engineering, Tianjin University, Tianjin, 300072, China. 8The Key Laboratory of Materials Processing and Mold of Ministry of Education, School of Materials Science and Engineering, School of Physics & Engineering, Zhengzhou University, Zhengzhou, 450001, Henan, China. 9Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093-0412, USA.