Advanced Hemodynamics - Orlando Health

Advanced Hemodynamic Monitoring
Altered V waves
Large V waves are most frequently caused by tricuspid and mitral insufficiency. Other causes
include such conditions as ventricular ischemia/failure, decreased atrial compliance, increased
pulmonary or systemic resistance, and ventricular septal defect. The large V wave is produced when
there is increased blood volume entering the atria during the period of rapid atrial filling in the
cardiac cycle. On the monitor, the V wave will be taller than the A wave.
Obtaining an accurate PAOP/PAWP measurement in the presence of large V waves can be
challenging. The challenge is that the large V wave can be mistaken for the systolic PA pressure
wave. To avoid this mistake the clinician must continue to consistently look to measure the V wave
in relation to the patient’s ECG.
Calculated Values
Cardiac Output
Monitoring the cardiac output (CO) may be indicated if there are concerns regarding adequate
oxygenation of the tissues. As stated previously the normal CO is 4-8 L/min and it is directly
influenced by the heart rate and stroke volume. Cardiac Index (CI) is the CO corrected for body
surface area and is a more accurate parameter to monitor than CO. Normal CI is 2.5-4.0 L/min/m2.
A low CO may be an indication of hypovolemia or heart failure, while a high CO may indicate
hypermetabolic conditions such as sepsis, burns, trauma, or certain forms of shock.
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