Hemodynamics Help

[I-C-U-shakin'that'arse]

I need some help. I'm somewhat of a new ICU nurse. I'm having some difficulties with putting together hemodynamic monitoring values and how the piece together. I have this question on this patient:

A 57-year-old man with an acute anterior myocardial infarction has the following vital signs and hemodynamic parameters:

[TABLE]

[TR]

[TD] Blood pressure [/TD]

[TD] 102/60 mm Hg [/TD]

[/TR]

[TR]

[TD] Heart rate [/TD]

[TD] 116 beats/min [/TD]

[/TR]

[TR]

[TD] Respiratory rate [/TD]

[TD] 24 breaths/min [/TD]

[/TR]

[TR]

[TD] Right atrial pressure [/TD]

[TD] 8 mm Hg [/TD]

[/TR]

[TR]

[TD] Pulmonary artery occlusive pressure [/TD]

[TD] 22 mm Hg [/TD]

[/TR]

[TR]

[TD] Cardiac index [/TD]

[TD] 1.6 L/min/m² [/TD]

[/TR]

[TR]

[TD] Systemic vascular resistance index [/TD]

[TD] 3300 dynes/sec/cm^−5 [/TD]

[/TR]

[/TABLE]

Which of the following did not occur by sympathetic nervous system (SNS) innervation in an attempt to compensate for the decreased cardiac output and index?

Increased HR

Increased afterload

Increased contractility

Increased ectopy

I'm not sure what parameter shows ectopy? and does SNS cause decreased contractility?

Help please :)

[KatieMI, BSN, MSN, RN]

Technically, ectopy. It is not caused by sympathetic INNERVATION (although it is caused by effects directly related to SNS such as neurohumoral) but it is not in table numbers, so it might be wrong.

SNS also does not increase contractility BY ITSELF. Contractility increases after increase of afterload (your SVR, norm 700 to 1500) by Frank-Starling mechanism and cathecholamines. Your contractility is low (CI below 2.5). So, I think that contractility is the right answer, and ectopy is " fool's catch".

[CharleeFoxtrot, BSN, RN]

Technically, ectopy. It is not caused by sympathetic INNERVATION (although it is caused by effects directly related to SNS such as neurohumoral) but it is not in table numbers, so it might be wrong.

SNS also does not increase contractility BY ITSELF. Contractility increases after increase of afterload (your SVR, norm 700 to 1500) by Frank-Starling mechanism and cathecholamines. Your contractility is low (CI below 2.5). So, I think that contractility is the right answer, and ectopy is " fool's catch".

Totally off topic, but I just want to say KatieMI your teaching posts are always spot on amazing. /end compliment resume thread content