Cardiovascular Hemodynamics for the Clinician by Stouffer, George A. -- Read -- Imperial Library of Trantor

Index

Cover Title Page Table of Contents List of contributors PART I: Basics of hemodynamics

CHAPTER 1: Introduction to basic hemodynamic principles

1. Energy in the blood stream exists in three interchangeable forms: pressure arising from cardiac output and vascular resistance, “hydrostatic” pressure from gravitational forces, and kinetic energy of blood flow 2. Blood flow is a function of pressure gradient and resistance 3. Resistance to flow can be estimated using Poiseuille’s law 4. Reynold’s number can be used to determine whether flow is laminar or turbulent 5. Force developed by the ventricles is a function of preload or stretch—the Frank–Starling law 6. Wall tension is a function of pressure and radius divided by wall thickness—the Laplace relationship 7. The normal venous system is a low pressure, large volume reservoir of blood which enables rapid increases in cardiac output 8. The pressure and velocity of a fluid in a closed system are related 9. The velocity of blood increases and pressure decreases as the cross‐sectional area of the blood vessel decreases 10. Resistance increases when blood vessels are connected in series and decreases when blood vessels are connected in parallel

CHAPTER 2: The nuts and bolts of right heart catheterization and PA catheter placement

The pulmonary artery catheter Brief review of physiology relevant to right heart and pulmonary artery catheterization Vascular access Right heart catheterization and placement of a PA catheter Ensuring that accurate data is obtained from a PA catheter Cardiac output Calculating systemic vascular resistance and pulmonary vascular resistance SvO2 monitoring Complications of pulmonary artery catheterization References

CHAPTER 3: Normal hemodynamics

Cardiac chambers Respiratory variation

CHAPTER 4: Arterial pressure

Aortic pressure Mean arterial pressure Pressure waveform Effects of respiration on aortic pressure Peripheral amplification Noninvasive measurement of blood pressure Oscillometric blood pressure devices References

CHAPTER 5: The atrial waveform

The components of the atrial wave Abnormalities in atrial pressures Physical exam Important points References

CHAPTER 6: Cardiac output

Fick method Thermodilution method Doppler echocardiographic measurement of cardiac output Cardiac output measurement in intensive care units References

CHAPTER 7: Detection, localization, and quantification of intracardiac shunts

Detection of an intracardiac shunt Oxygen saturation run Limitations of using oximetry to detect and quantify intracardiac shunts Diagnosis of intracardiac shunts at right heart catheterization Quantifying a left‐to‐right shunt Shunt management Right‐to‐left shunting References

PART II: Valvular heart disease

CHAPTER 8: Aortic stenosis

Physical exam Echocardiographic hemodynamics Determination of severity of AS by echocardiography Comparison between invasive and echocardiographic measurements of hemodynamics Invasive hemodynamics Common pitfalls The challenge of low‐gradient AS The challenge of estimating aortic valve area in patients with AS and significant AR Carabello’s sign Subaortic membrane References

CHAPTER 9: Hemodynamics of transcatheter and surgical aortic valve replacement

Selection of appropriate patients Low flow–low‐gradient aortic stenosis Using hemodynamics to avoid pitfalls during TAVR Assessing aortic insufficiency Expected residual gradients after surgical valve replacement Long term follow‐up after valve replacement References

CHAPTER 10: Mitral stenosis

Cardiac hemodynamics in patients with MS Cardiac output Quantification of severity of MS Calculating mitral valve area Physical examination in MS Echocardiography Hemodynamics of mitral valve surgery and percutaneous balloon mitral valvuloplasty (PBMV) References

CHAPTER 11: Aortic regurgitation

Hemodynamic changes of chronic aortic regurgitation Aortic pressures Left ventricular pressures Hemodynamic changes detected by physical exam Hemodynamic changes detected by echocardiography Acute aortic regurgitation Pharmacologic treatment of AR Hemodynamic tracings of a patient with severe AR References

CHAPTER 12: Mitral regurgitation

Pathology Acute MR Hemodynamic concepts in patients with chronic MR Compensatory mechanisms in chronic MR Cardiac catheterization and MR hemodynamics Physical examination Echocardiography Important points Hemodynamics of mitral regurgitation Reference

CHAPTER 13: The tricuspid valve

Tricuspid regurgitation Tricuspid stenosis References

CHAPTER 14: Hemodynamic findings in pulmonic valve disease

Pulmonic valve stenosis Non‐invasive imaging Cardiac catheterization and invasive hemodynamics Treatment of PS Pulmonic regurgitation Hemodynamic changes in chronic PR Right ventricular function in chronic PR Hemodynamic changes detected by non‐invasive imaging in chronic PR Natural history of chronic PR Pregnancy References

PART III: Cardiomyopathies

CHAPTER 15: Hypertrophic cardiomyopathy

Physical exam Hemodynamics Findings at cardiac catheterization Left atrium or pulmonary capillary wedge pressure LV pressure Aortic pressure Outflow tract gradient Echocardiography Septal reduction for refractory symptoms References

CHAPTER 16: Heart failure

Directly measured intracardiac pressures Derived parameters from measured intracardiac pressures Important points: Hemodynamics in HF References

CHAPTER 17: Restrictive cardiomyopathy

Hemodynamic principles Differentiating restrictive cardiomyopathy from constrictive pericarditis Echocardiography References

PART IV: Pericardial disease

CHAPTER 18: Constrictive pericarditis

Hemodynamics of constrictive pericarditis Hemodynamic principles Physical exam Pericardial imaging techniques Findings at cardiac catheterization Sensitivity and specificity of various hemodynamic findings in constrictive pericarditis Findings on echocardiography Differentiation of constrictive pericarditis and restrictive cardiomyopathy References

CHAPTER 19: Cardiac tamponade

Hemodynamic pathophysiology Hemodynamic findings Physical exam findings Hemodynamics of cardiac tamponade as measured with echocardiography References

CHAPTER 20: Effusive–constrictive pericarditis

Hemodynamics of effusive–constrictive pericarditis Physical examination Pericardial imaging techniques Findings on echocardiography References

PART V: Hemodynamic support

CHAPTER 21: Hemodynamics of intra‐aortic balloon counterpulsation

History and uses Description Hemodynamic effects Intra‐aortic balloon pump timing Conclusion References

CHAPTER 22: Hemodynamics of left ventricular assist device implantation

Initial evaluation Early post‐implantation period The chronic LVAD patient Conclusion References

PART VI: Coronary hemodynamics

CHAPTER 23: Coronary hemodynamics

Basic principles of coronary blood flow Regulation of coronary blood flow Clinical measurement of coronary hemodynamics in the cardiac catheterization laboratory: Doppler and pressure wires Measurement of coronary blood flow Doppler wire and coronary flow reserve Pressure wire and fractional flow reserve References

CHAPTER 24: Fractional flow reserve

Concept of fractional flow reserve Key clinical studies of FFR Limitations of FFR measurement Instantaneous wave‐free ratio References

PART VII: Miscellaneous

CHAPTER 25: Right ventricular myocardial infarction

The effects of ischemia on the right ventricle Clinical presentation, ECG changes, and echocardiographic findings in RV infarction Hemodynamics of RV infarction Findings at cardiac catheterization Diagnosis of RV infarction with hemodynamics Management References

CHAPTER 26: Pulmonary hypertension

Hemodynamic changes associated with pulmonary hypertension Special population: Pulmonary hypertension in patients being evaluated for cardiac transplantation Hemodynamic changes detected by history and physical exam Two‐dimensional echocardiography in pulmonary hypertension Take‐home message References

CHAPTER 27: Hemodynamics of arrhythmias and pacemakers

Premature atrial and ventricular contractions Heart block Cannon A waves Ventricular tachycardia Junctional rhythm Atrial fibrillation and atrial flutter Sinus bradycardia or tachycardia Cardiac pacing Physiology and pathophysiology of AV synchrony Pacemakers in specific patient populations References

CHAPTER 28: Systematic evaluation of hemodynamic tracings

Unknowns Reference

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