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Principles in Hemodynamic
Monitoring
Dr.Irmalita SpJP
a) systole and diastole of both the atria and ventricles related to time
Siklus jantung
b) pressures in the aorta, atria and ventricles
Aortic Pressure
80
40 Identify
Atrial Systole
20 ISV Contraction
Rapid Ejection
0
Reduced Ejection
Left Atrial Pressure
ISV Relaxation
Rapid Vent. Filling
Reduced Vent. Filling
Mean (MRAP) 4
Right Ventricle
Systolic (RVSP) 15 to 25
Diastolic (RVDP) 0 to 8
Pulmonary Artery
re 18
tery Waveform Systolic (PASP) 15 to 25
Diastolic (PADP) 8 to 15
still inflated, is now advanced
in a central branch of the Mean (MPAP) 10 to 20
t, right heart pressures and Wedge (PAWP) 6 to 12
uded. The catheter tip is
Left Atrial (LAP) 6 to 12
es. The waveform reflected
The pressures recorded will
ht atrium (6 mm Hg to Once the wedge position has been identified, the balloon is
deflated by removing the syringe and allowing the back
Arterial Pressure Monitoring
The intra-arterial pressure is a dynamic pressure that has volume
displacement and energy wave components
.
The arterial pressure wave is a result of the pressure and volume
changes produced by the cardiac cycle.
Pressure = Flow X Resistance
result of mechanical function. Arterial waveforms are
produced after electrical activation of the heart. When
ynamic status of the
essures include
ppler devices. If
reflect the patients
However, it is
ese methods may
er the transmission
sed to determine
. It is thought that
of the vibration of
w from the cuff that
nder optimal
underestimate the
iastolic pressure by
Figure 39
Peak systolic pressure menggambarkan tekanan maksimum
sistolik ventrikel kiri. Dimulai dengan pembukaan katup
aorta. Peningkatan yang tajam dari kurva menggambarkan
aliran darah keluar dari ventrikel ke sis>m arteri.
Dicro8c notch pada kurva adalah tempat katup Aorta
menutup. Ini merupakan akhir sistole dan mulainya
diastole.
Diastolic pressure tergantung kepada vessel recoil atau
vasokonstriksi dari sis>m arteri. Juga ada hubungan antara
tekanan diastolic dan waktu diastolic dari siklus jantung.
Bila waktu diasolic pendek, tekanan diastolic akan lebih
>nggi.
Anacro8c Notch terjadi sebelum pembukaan
katup Aorta. This wave typically will be seen only
in central aor>c pressure monitoring, an aor>c
root tracing, or in some pathological condi>ons.
Pulse Pressure adalah beda antara sistolik dan
diastolik. Faktor yang dapat mempengaruhinya
adalah stroke volume, as noted in the systolic
pressure, and also changes in vascular
compliance, as seen in the diastolic pressure.
difference between the two called electro-mechanical myocardium is
Electrical vs. Mechanical Cycle
coupling, or the excitation-contraction phase. When looking
The second ph
at a simultaneous recording of the electrocardiogram and
Once the pulm
pressure tracing, the ECG will show the appropriate wave
before the mechanical tracings will. shorten even m
volume out of
approximately
ECG correlati
As the pressur
ventricular sys
phase, begins.
less volume.
During this ph
increase in atr
inflow. This ri
resultant rise i
atrial wavefor
Figure 2
Electrical vs. Mechanical C ycle
diastolic pressure in the aortic root for both the coronary
arteries to be perfused.
Perfusi Arteri Koroner
Figure 10
C oronary Artery Perfusion
umption can be
Through hemodynamic monitoring, demand factors such as
. Since oxygen
preload, afterload, contractility, and heart rate can be altered
n the demand or
by various therapeutic interventions. These interventions
nsate is to
and their effects will be addressed in a later section.
icle occurs
entricular wall
such an extent
endocardium. The
erefore less wall
stance, there is
y artery and into
ust be adequate
h the coronary
Figure 11
Pen>ng untuk diingat bahwa Tekanan Darah
>dak akan berubah karena ada respons
simpa>s sebagai kompensasi tubuh sampai
kekurangan darah yang cukup dari sirkulasi
yang menunjukkan tubuh sudah >dak dapat
mengkompensasi keadaan itu.
storing potential energy that is released with the springing back of the aorta to its
diastolic dimension. This energy ensures that blood flow is maintained in diastole.
As systolic run-off to the peripheries continues it eventually exceeds the input of
volume from the ventricle. As a result pressure falls in the aorta and the aortic valve
closes the washback of pressure against the closed aortic valve results in a small
pressure rise called the dicrotic notch. (refer to the figure below)
Dicrotic notch
Inotropic component
Reflection waves
As the pressure wave and volume displacement wave move peripherally the waveform
changes as a result reflection waves off the periphery. This causes the character of
the dicrotic notch to change. Its position and shape, when measured in a peripheral
Haemodynamic Monitoring Learning Package
Dicrotic notch
Dicrotic notch
Vasoconstricted Vasodilated
P wave
arterial catheter
central venous catheter
Fluid responsiveness ?
(low CVP ?)
present absent
echocardiography
HIGH LOW
SvO2 SvO2