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Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter) 

Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter)
Chapter:
Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter)
Author(s):

Romain Barthélémy

, Etienne Gayat

, and Alexandre Mebazaa

DOI:
10.1093/med/9780199687039.003.0014

February 22, 2018: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 15 October 2019

Haemodynamic instability in acute cardiac care may be related to various mechanisms, including hypovolaemia and heart and/or vascular dysfunction. Although acute heart failure patients are often admitted for dyspnoea, many mechanisms can be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography often helps to assess the mechanism of cardiac dysfunction, it cannot be considered as a monitoring tool. In some cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), pulmonary artery catheter can help to assess and monitor cardiovascular status and to evaluate response to treatments. Last, macro- and microvascular dysfunctions are also important determinants of haemodynamic instability.

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