Mechanical Aspects of Cardiac Performance
This chapter is a review of commonly utilized monitoring techniques to assess the function of the general cardiovascular system. Specifically, means to assess arterial blood pressure, central venous pressure, pulmonary artery pressure, mixed venous oxygen
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20
Michael K. Loushin, Jason L. Quill, and Paul A. Iaizzo
Abstract
This chapter is a review of commonly utilized monitoring techniques to assess the function of the general cardiovascular system. Specifically, means to assess arterial blood pressure, central venous pressure, pulmonary artery pressure, mixed venous oxygen saturation, cardiac output, pressure-volume loops, and Frank-Starling curves are described. Basic physiological principles underlying cardiac function are also briefly discussed. Keywords
Cardiac pressure-volume loops • Blood pressure monitoring • Central venous pressure monitoring • Pulmonary artery pressure monitoring • Cardiac output • Cardiac index monitoring • Mixed venous saturation monitoring • Flow monitoring • Implantable monitoring
Under normal physiologic conditions, the human heart functions as two separate pumps working in series; the right heart pumps blood through the pulmonary circulation and the This chapter is a review of commonly utilized monitoring left heart pumps blood through the systemic circulation. Each techniques to assess the function of the general cardiovascu- contraction of the heart and subsequent ejection of blood crelar system. Specifically, means to assess arterial blood pres- ates pressures that can be monitored clinically to assess the sure, central venous pressure, pulmonary artery pressure, function of the heart and its work against resistance. In genmixed venous oxygen saturation, cardiac output, pressure- eral, the mechanical function of the heart is described by the volume loops, and Frank-Starling curves are described. changes in pressure, volume, and flow that occur within each Basic physiological principles underlying cardiac function phase of the cardiac cycle, which is one complete sequence of are also briefly discussed. myocardial contractions and relaxations.
20.1 Introduction
Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-319-19464-6_20) contains supplementary material, which is available to authorized users. M.K. Loushin, MD (*) Department of Anesthesiology, University of Minnesota, MMC 294, 420 Delaware Street SE, Minneapolis, MN 55455, USA e-mail: [email protected] J.L. Quill, PhD Medtronic, Inc., Minneapolis, MN, USA P.A. Iaizzo, PhD Department of Surgery, University of Minnesota, Minneapolis, MN, USA
20.2 Cardiac Cycle The normal electrical and mechanical events of a single cardiac cycle of the left heart are correlated in Fig. 20.1. The mechanical events of the left ventricular pressure-volume curve are displayed in Fig. 20.2. During a single cardiac cycle, the atria and ventricles do not beat simultaneously; rather the atrial contraction occurs prior to ventricular contraction. This timing delay allows for proper filling of all four chambers of the heart. Recall that the left and right heart pumps function in series but contract simultaneously. The diastolic phase of the cardiac cycle begins with the opening
© Springer International Publishing Switzerland 2015 P.A. Iaizzo (ed.), Handbook of
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