High Cardiac Output State--Examples?

Editorial Team / Admin · Aug 31, 2015

Handy chart from WebMD which also provides a fair amount of other information:

[TABLE=width: 95%]

Causes of high-output heart failure[TR]

[TH]Cause

[/TH]

[TH]What is it?

[/TH]

[TH]How does it cause high-output heart failure?

[/TH]

[/TR]

[TR]

[TD]Severe anemia[/TD]

[TD]Blood contains too few oxygen-carrying red blood cells.[/TD]

[TD]Requires the heart to pump more blood each minute to deliver enough oxygen to the tissues of the body[/TD]

[/TR]

[TR]

[TD]Hyperthyroidism[/TD]

[TD]Thyroid gland produces too much thyroid hormone.[/TD]

[TD]Increases the body's overall metabolism, thus increasing the demand for blood flow[/TD]

[/TR]

[TR]

[TD]Arteriovenous fistula[/TD]

[TD]An abnormal connection between an artery and a vein[/TD]

[TD]Short-circuits the circulation and forces the heart to pump more blood overall to deliver the usual amount of blood to the vital organs[/TD]

[/TR]

[TR]

[TD]Beriberi[/TD]

[TD]Deficiency of thiamine (vitamin B1)

[/TD]

[TD]Leads to increased metabolic demand and increased need for blood flow[/TD]

[/TR]

[TR]

[TD]Paget's disease[/TD]

[TD]Abnormal breakdown and regrowth of bones, which develop an excessive amount of blood vessels[/TD]

[TD]Increased number of blood vessels requires increased cardiac output.[/TD]

[/TR]

[/TABLE]

So yes, there is a lack of enough oxygenated blood outflow, but the heart is functioning normally.

jena5111, ASN, RN · Aug 31, 2015

Rose_Queen, thank you so much for taking the time to answer my question!

In my faulty thinking, I equated an alteration in CO strictly with cardiac dysfunction. Clearly I was wrong. Thank you for pointing me in the right direction.

Handy chart from WebMD which also provides a fair amount of other information:
[TABLE=width: 95%]
[TR]
[TH]Cause[/TH]
[TH]What is it?[/TH]
[TH]How does it cause high-output heart failure?[/TH]
[/TR]
[TR]
[TD]Severe anemia[/TD]
[TD]Blood contains too few oxygen-carrying red blood cells.[/TD]
[TD]Requires the heart to pump more blood each minute to deliver enough oxygen to the tissues of the body[/TD]
[/TR]
[TR]
[TD]Hyperthyroidism[/TD]
[TD]Thyroid gland produces too much thyroid hormone.[/TD]
[TD]Increases the body's overall metabolism, thus increasing the demand for blood flow[/TD]
[/TR]
[TR]
[TD]Arteriovenous fistula[/TD]
[TD]An abnormal connection between an artery and a vein[/TD]
[TD]Short-circuits the circulation and forces the heart to pump more blood overall to deliver the usual amount of blood to the vital organs[/TD]
[/TR]
[TR]
[TD]Beriberi[/TD]
[TD]Deficiency of thiamine (vitamin B1)[/TD]
[TD]Leads to increased metabolic demand and increased need for blood flow[/TD]
[/TR]
[TR]
[TD]Paget's disease[/TD]
[TD]Abnormal breakdown and regrowth of bones, which develop an excessive amount of blood vessels[/TD]
[TD]Increased number of blood vessels requires increased cardiac output.[/TD]
[/TR]
[/TABLE]
So yes, there is a lack of enough oxygenated blood outflow, but the heart is functioning normally.

icuRNmaggie, BSN, RN · Aug 31, 2015

The first thing that comes to mind is the hyperdynamic phase of sepsis. The endotoxins are a powerful inotrope. The pt is warm and flushed with bounding heart sounds.

The pt may be tachypneic then hypoxic due to the

increased myocardial oxygen demands, vasodilation and hypotension.

Hemodynamics and the technology used to measure it are a complex topic. Kudos to the OP for being a thinker.

dah doh, BSN, RN · Sep 1, 2015

Late pregnancy state, sepsis, status post repair of a stenosed cardiac valve in an otherwise ok heart...

jena5111, ASN, RN · Sep 1, 2015

Thank you, ICU RN Maggie, for taking the time to answer my question.

I am so interested in finding out all possible scenarios for high CO and other cardiac issues. I'm humbled by how much the nurse must know and consider here.

Great news today--I found out that I will have two ICU days this clinical rotation (my final semester in nursing school)! We had the option of ER, ICU, or one day each. I've had the opportunity to experience ER in my previous three semesters, so I am THRILLED to observe in ICU this time around. I don't think nursing students can "do" anything in ICU but to me, observing is its own kind of doing/learning. I can't wait!

dah doh, BSN, RN · Sep 2, 2015

Great news today--I found out that I will have two ICU days this clinical rotation (my final semester in nursing school)! We had the option of ER, ICU, or one day each. I've had the opportunity to experience ER in my previous three semesters, so I am THRILLED to observe in ICU this time around. I don't think nursing students can "do" anything in ICU but to me, observing is its own kind of doing/learning. I can't wait!

Really, that would just stink! Hope your ICU rotation is better than that! I personally let students "do" as much as possible...how else ya gonna learn or become interested in workin' in the unit?

jena5111, ASN, RN · Sep 2, 2015

Haha, I hear you! At this point, I'm not totally sure what my "scope of practice" will be on my specialty days. I'll ask my instructor about it when the time comes--we're about a month out right now. We generally need our instructor or assistant instructor present when giving any meds or performing any skills on our normal floor. Since neither instructor will be with me in ICU, I don't yet know what my shifts will look like. I'm excited for the opportunity, though!

Really, that would just stink! Hope your ICU rotation is better than that! I personally let students "do" as much as possible...how else ya gonna learn or become interested in workin' in the unit?

nurseprnRN, BSN, RN · Sep 2, 2015

Haha, I hear you! At this point, I'm not totally sure what my "scope of practice" will be on my specialty days. I'll ask my instructor about it when the time comes--we're about a month out right now. We generally need our instructor or assistant instructor present when giving any meds or performing any skills on our normal floor. Since neither instructor will be with me in ICU, I don't yet know what my shifts will look like. I'm excited for the opportunity, though!

Once again, I am so happy to see a student excited by an opportunity. So many posters here talk about terror, fear, and freaking out without seeing how limiting that kind of self-talk is. Go, you!

Since your time will be so limited, and realizing that fortune favors the prepared mind, plan ahead. If you can visit the unit beforehand, introduce yourself to the charge nurse and say you want to know what kind of patients they see the most if so you can study up a bit before you come for your observation days. Then when you do that, have some general goals in mind-- like, oh, learn about high-output states :) . Or see how vent management involves nursing assessment and ABGs. Or you could look at psychosocial aspects, like teamwork, roles, interacting with house staff, or how to interact with families of critical patients.

Watch and listen. Ask what assessments or clues went into an action-- small things can mean more than you think. Ask about the big picture and how small things fit into it. Ask your assigned staff nurse why s/he does this job, and why s/he didn't do another job in nursing (this last is a question for coffee break or lunch). Ask what questions you should be asking :).

Come back and tell us what happens!

icuRNmaggie, BSN, RN · Sep 2, 2015

Know this equation:

Stroke volume X heart rate = cardiac output

There are arterially based cardiac output technologies, or attached to an arterial line, such as the Lidco and Vigeleo which provide continuous cardiac output monitoring and stroke volume variation. The stroke volume is the upstroke on the a line waveform. Remember that high, or > 14, is dry with SVV.

A MAP or mean arterial pressure of 65 is needed to perfuse the vital organs. A urine output of 30 cc per hour or 0.5 cc per kg per hour represents adequate perfusion.

LiDCO - Normal Hemodynamic Parameters

There is a lot you can eyeball and learn in the ICU.

jena5111, ASN, RN · Sep 4, 2015

Wow, GrnTea, thank you for the thoughtful response!

I was a bit delayed in getting back to AN, having just completed the first clinical day of my LAST semester of nursing school (yay!)--and I can't wait to go back tomorrow. I work on an adult cardiac/tele floor. The patients are so, so sick. It is sad to see, but I hope I can help them in some small or big way by providing excellent care.

The clinical homework load for the first several weeks is...shall we say...immense. And I forgot to request an extra day off from my non-nursing-related job this weekend. Whoops! Oh well, everything will get done with the help of Starbucks.

Regardless of where I'm working, I want to hone assessment skills (as you mentioned). In my limited experience, assessment seems like one of the most important tools in the RN's toolbox. Also, vents are pretty fascinating. One of my teachers lectured on vents last week and actually brought one to class to demonstrate its use. We had an optional after-class opportunity to play with the vent and ask questions--yes, I was there! So cool!

I will certainly return to AN after my ICU days and let you know what happened.

The biggest things you mentioned--planning ahead, watching, and listening--are very important to me nursing-wise...and life-wise :)

Once again, I am so happy to see a student excited by an opportunity. So many posters here talk about terror, fear, and freaking out without seeing how limiting that kind of self-talk is. Go, you!
Since your time will be so limited, and realizing that fortune favors the prepared mind, plan ahead. If you can visit the unit beforehand, introduce yourself to the charge nurse and say you want to know what kind of patients they see the most if so you can study up a bit before you come for your observation days. Then when you do that, have some general goals in mind-- like, oh, learn about high-output states :) . Or see how vent management involves nursing assessment and ABGs. Or you could look at psychosocial aspects, like teamwork, roles, interacting with house staff, or how to interact with families of critical patients.
Watch and listen. Ask what assessments or clues went into an action-- small things can mean more than you think. Ask about the big picture and how small things fit into it. Ask your assigned staff nurse why s/he does this job, and why s/he didn't do another job in nursing (this last is a question for coffee break or lunch). Ask what questions you should be asking :).
Come back and tell us what happens!

jena5111, ASN, RN · Sep 4, 2015

Thank you, icuRNmaggie!

I honestly didn't expect this level of support when I started the thread. I appreciate your thought and effort here. It's very gratifying. I will put this information to use during my ICU rotation.

I can't wait for my ICU days. In second semester, my clinical instructor, a former ICU nurse, asked me about my areas of interest during my final evaluation. She suggested ICU might be a good fit for me after I suggested diabetes educator. I don't know, I love patient education and areas like diabetes education and postpartum, which I discovered last/third semester, revolve around it.

So we'll see. I'm thrilled to be in a field where the opportunities are so varied.

Know this equation:
Stroke volume X heart rate = cardiac output
There are arterially based cardiac output technologies, or attached to an arterial line, such as the Lidco and Vigeleo which provide continuous cardiac output monitoring and stroke volume variation. The stroke volume is the upstroke on the a line waveform. Remember that high, or > 14, is dry with SVV.
A MAP or mean arterial pressure of 65 is needed to perfuse the vital organs. A urine output of 30 cc per hour or 0.5 cc per kg per hour represents adequate perfusion.
LiDCO - Normal Hemodynamic Parameters
There is a lot you can eyeball and learn in the ICU.