mizz
Forum Newbie
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can someone tell me the conditions in which cardiac index and PCWP changes.I mean the conditions in which they increase or decrease.Also, how do we measure PCWP.
Thanks.
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| amitjosh
Forum Senior
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Hi,
On an PA view chest X-ray, going inferiorly, the right border of the heart is made by superior vena cava, right atrium and inferior vena cava and the left border of the heart is made by aortic arch, pulmonary artery, left atrial appendage and the left ventricle (apex). Any condition which causes enlargement of any of these structures will cause an increase in cardiac index.
Note that right ventricle and left atrium do not form the borders and their enlargment cannot be appreciated on a PA view.
So for all practical purposes we can say that an increase in the cardiac index could be due to right atrial enlargement (TR,TS,RVF) or left ventricular hypertrophy (hypertension, AS, IHSS) or in general due to pericardial effusion or dilated cardiomyopathy.
PCWP is measured using a Swan-Ganz catheter.
Criticisms welcome,
Thanks,
Amit Joshi.
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| amitjosh
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In the previous post I forgot to mention causes of decreased cardiac index - I guess they would be 1) Tension pneumothorax 2) Pulmonary embolism - or any other causes that causes pooling of systemic blood in the pulmonary circuit.
Also PCWP is a direct reflection of the left atrial pressure - since there are no valves in pulmonary veins. So in conditions which cause an increase in Left atrial pressure like MS, MR, LVF, etc. the PCWP will rise. In conditions where the Left atrial pressure decreases - like hypovolemic or septic shock (cardiogenic shock will increase PCWP) or right ventricular infarction.
Thanks,
Amit Joshi
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| Laleh56
Forum Junior
Topics: 5
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| | 05/25/05 - 08:07 PM
1 of 1 forum leaders found this post helpful
| #4 |
cardiac index: (CI) cardiac output per unit time divided by body surface area; normally calculated in liters per minute per square meter.
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| Laleh56
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| | 05/25/05 - 08:12 PM
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| #5 |
Cardiothoracic ratio: the ratio between the maximal transverse diameter of the heart and the thoracic cage at the same level, as measured on an AP chest radiograph. The appearance of the mediastinum is very much dependent on the size and shape of the cardiac silhouette.
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| mizz
Forum Newbie
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Thanks for the replies.They are really useful. I wanted to add some more points and confirm it with you:
Cardiogenic shock: C.I.-decreases, PCWP-inc.
Septic shock: C.I.- dec, PCWP-dec.
Hypovolemic shock: C.I.-dec.,PCWP-dec.
Neurogenic shock: C.I.-dec,PCWP-dec.
Am i right?
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| amitjosh
Forum Senior
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Thanks Laleh. Sorry, got mixed up
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| Laleh56
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Table 1. Pulmonary Artery Catheter Findings in Common Shock States Diagnosis Pulmonary Capillary Wedge Pressure Cardiac Output Cardiogenic shock* Increased Decreased Extracardiac obstructive shock
1. Pericardial tamponade†
2. Pulmonary embolism
Increased
Normal or decreased
Decreased
Decreased Hypovolemic shock Decreased Decreased Distributive shock
1. Septic shock
2. Anaphylactic shock
Normal or decreased
Normal or decreased
Increased or normal
Increased or normal
Table is from below link:
http://www.emedicine.com/med/topic2114.htm
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| Laleh56
Forum Junior
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Posts: 28
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Hi Mizz
I guess we can't copy and paste tables, because it doesn't show the table correctly in my previous reply , so you better go to the link http://www.emedicine.com/med/topic2114.htm and see the table there properly...
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| mizz
Forum Newbie
Topics: 4
Posts: 10
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Thanks aloy laleh56,this was very useful.
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