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Cardiac output graph

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Pulmonary artery catheter (PAC), an invasive clinical standard, is used for cardiac output monitoring in critically ill patient as to ensure tissue oxygenation. This continuous cardiac output monitoring also monitors central temperature. In addition, it measures pulmonary artery pressure, measures mixed venous saturations and estimates diastolic filling of left heart. PAC is used when a patient has right ventricular failure, pulmonary hypertension, weaning failure of cardiac origin or post-cardiac surgery.

Minimally invasive cardiac output monitoring devices uses one of these main principles to measure cardiac output - pulse contour analysis, pulsed Doppler technology, applied Fick principle and bioimpedance/bio-reactance.

Pulse contour anaylsis is based on the principle that area under the systolic part of the arterial pressure waveform is proportional to the SV.  In this method the area is measured post diastole to end of ejection phase divided by aortic impedance that measures SV. It also measures SVV and pulse pressure variation (PVV) which is useful in predicting fluid responsiveness. SVV is the difference between maximum and minimum SV over the respiratory cycle and is caused by changes in preload with alteration in intrathoracic pressure. The first pulse contour device invented was the PiCCO system which was later on replaced with PiCCO2.

Link:
http://lifeinthefastlane.com/ccc/pulmonary-artery-catheters/
https://ccforum.biomedcentral.com/articles/10.1186/cc9996
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176793/
-Paula

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An electrocardiogram is used to determine the cardiac output of a person by measuring the heart’s electrical rhythm over a period of time. Each beat of the heart triggers an electrical impulse generated from special cells in the upper right chamber of your heart which is then recorded by the electrocardiogram when it travels through the heart. This can be helpful in determining whether the heart muscle has been damaged.

The electrocardiogram can be used on anyone but many times it’s the first test a doctor may order when trying to diagnose a heart problem.  Doctors can use it to measure the heart’s rate and how regular its beats are. By looking for patterns among heartbeats and rhythms, various heart conditions can be diagnosed or a healthy heart can be determined.

Links:
http://www.mayoclinic.org/tests-procedures/electrocardiogram/basics/definition/prc-20014152
https://www.adclinic.com/electrocardiogram-why-do-i-need-an-ekg/#.WFnQJIVOJPY
-Nelson

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Q1. Cardiac Output (How to read the graph?)

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Q1. Cardiac Output (How to read the graph?)

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Cardiac function curves, also known as cardiac output curves, are usually plotted as cardiac output (L/min) against right atrial pressure, PRA (mmHg).

In a controlled experimental model,  right atrial pressure can be varied (independent variable) and the cardiac output measured is recorded subsequently (dependent variable). When PRA increases, the cardiac output (CO) increases. However, as the mean PRA is about 0 mmHg (note that PRA normally fluctuates with atrial contraction and respiration), the cardiac output in an adult human is about 5 L/min. Since the cardiac function curve is quite steep at PRA increases, very small changes in PRA (just a few mmHg) can lead to large changes in CO.

Similar to Frank-Starling curves (usually plotted as stroke volume (mL) against left ventricular end-diatolic pressure (mmHg)), there is no single cardiac function curve. Instead, there is a family of curves that can shift upward when cardiac performance is enhanced or shift downward when cardiac performance is depressed.
Performance is enhanced by increased inotropy (contraction of heart muscles), increased heart rate, and reduced afterload (ventricular wall stress, closely related to arotic pressure). Performance is depressed by decreased inotropy, decreased heart rate, and by increased afterload.

Link: http://www.cvphysiology.com/Cardiac%20Function/CF027
http://www.cvphysiology.com/Cardiac%20Function/CF008
http://www.cvphysiology.com/Cardiac%20Function/CF003
http://www.cvphysiology.com/Cardiac%20Function/CF010
-Camelia

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Cardiologists study the heart and how it functions so they can determine whether the patient is healthy or not. This can be done by understanding the ability of a patient's heart to distribute blood while at rest so that they are able to better recognise any unusual signs.
Cardiac output is a term which describes the volume of blood that a patient's heart can pump each minute while they are at rest. It tells doctors how efficient the heart is.
Cardiac output = stroke volume x heart rate (usually expressed in litres/min)
*Stroke volume is the volume of blood that the hear pumps at each heartbeat. Echocardiology is often used to calculate stroke volume.
*Heart rate is the amount of time the heart beats in a minute.
On average, a healthy adult's heart will pump 5 L every minute, which means the average cardiac output (or CO) is approximately 5 L/min. The workload of the heart will increase when there is an increase in physical or strenuous activities, thus its is not uncommon for cardiac output to increase 5 fold during exercise. In addition, every person is different, thus some people may have a cardiac output slightly higher or lower on average. (e.g. based on person's size)

To determine someone's cardiac output, their cardiovascular function should be monitored over time. Cardiologist has to calculate cardiac output to provide patients with information about how efficiently their hearts are pumping blood and delivering oxygen rich blood. Changes in cardiac output over months or years could indicate a change in the heart's ability to pump blood. It is important to first determine how well a person's heart pumps blood while they are at rest.

Links: http://www.webmd.com/heart-disease/tc/cardiac-output-topic-overview
http://study.com/academy/lesson/cardiac-output-definition-formula-calculation-normal-range.html
-Steffany

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By week 11
2 members to share Q2-3
2 members to share Q4-5
Q6 is to be done by all 4 members

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*each group member take 1 point*
By week 9
- What is it?
- How to read the graph?
- Who needs it? Why?
- Application & diagram

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Nelson Yeo Ming Xuan
Yen See Wai, Steffany
Camelia Wang Shi Yun
Paula-Teresa Chua Hui Yee