Hemodynamic Parameters
(From J Kent Garman, Stanford)

 

Parameter Formula Range
HR - 50-100
Cardiac Index = CO / BSA 2.8-4.2
Cardiogenic Shock
CO = HR x SV 4.5-9.0
CO = VO2 / (CaO2-CvO2)  
CI = CO / BSA 2.5-4.0
CVP   2-10
Diastolic Art Pressure   55-85
LVEDP 12 (5-12 mmHg)
MAP = (SBP-DBP / 3) + DBP 70-110
Mitral Valve Parameters  
Pulm Art Press Systolic - 15-30
Pulm Art Press Diastolic - 5-12
Pulm Art Press Mean - 11-18
Pulm Art Resistance 150-250
Pulm Vasc Resistance = [(PAM-PCWP) x 80] /CO 50-90
PVRI = [(PAM-PCWP) x 80] /CI < 400
Stroke Volume (SV) = CO / HR 60-120
Stroke Index (SI) = SV / BSA 36-56
Sys Art Pressure - 105-160 
SVR =[ (MAP-CVP) x 80] / CO 800-1200
SVRI =[ (MAP-CVP) x 80] / CI 1600-3000

Pulm. artery pressure:
  30/14 (10-25, 5-15 mm. Hg)

Mean pulm cap wedge press.: 12 (5-13 mm); approx. = to left atrial pressure and LVEDP. 

Post MI best @ 14-18 mm. If > 30 pulmonary edema is likely. If mitral valve OK this reflects LVEDP, which in turn reflects LVEDV and end diastolic fiber length (preload). For each mm of PEEP > 25 the PCWP will be increased by 1 mm over the true LVEDP/LAP. With low albumin CHF with lower PCWP.

PAD: Pressure in pulmonary artery, measured with balloon down. In ideal cases may approx. PCWP, pulm HTN dissociates PAD/PCWP.

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CVP: 1-5 mm; reflects RVEDP/preload, approx. = RAP. If CVP > 15 no resp to incr fluid.

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Cardiac index: normal 2.5-3.6 L/min/m2. Typical CO is 4-6 L/min. Hypoperfusion at 1.8-2.2, shock at < 1.8.

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PVR: 800-1200

Mitral valve parameters:
   Norm 4.5-6.0 cm2
   < 2.5: incr. atrial pressures
   < 1.5: over 25 mm LAP
   < 1.0: symptoms and pulm edema

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Typical cardiogenic shock: CI @ 1.8, BP @ 90, incr. PVR, oliguria, pulm vasc cong on CXR. If PCWP is low or normal give fluids and maintain PCWP @ 15-20 mm.

Venous Oxygen saturation and A-V O2 gradient:
   This is a measure of the balance between total body O2 supply and demand. Use with CO values.
   Mixed venous saturation: normal 70-80%, heart failure < 60%, shock < 40%.[18 ml/dl]
   A-V O2 gradient: normal 3.5-5.0. In cardiogenic shock the A-V gradient widens. In early sepsis it narrows (incr. CO and microvascular shunting), in late sepsis it widens.

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