Non Invasive Hemodynamic Assessment

A patient's hemodynamic status can be evaluated noninvasively by performing a comprehensive cardiovascular assessment. This assessment should be conducted in addition to invasive monitoring.

The table below describes some cardiovascular assessment points and their rationale.

Take vital signs: Assess pulse for rhythm, strength and rate. Assess blood pressure. Blood pressure is determined by cardiac output, peripheral vascular resistance, circulating blood volume, blood viscosity, and vessel elasticity.

Precordium: Inspect the anterior chest for heaves and an increase in visible pulsatility.

Palpate the PMI (point of maximum impulse) for a normal 2+ pulse.

Heaves indicate ventricular hypertrophy due to an increased workload.

A PMI that is displaced down and to the left indicates ventricular hypertrophy which may be due to volume overload. An increase in force and duration of the pulse may indicate an increase in pressure without volume overload.

Percuss the chest to determine the size of the heart. Increase in heart size may indicate increased ventricular volume or wall thickness.
Auscultate the aortic, pulmonic, second pulmonic (Erb's point), mitral, and tricuspid areas of the precordium. Listen for normal S1S2 and for abnormal sounds such as S3 or S4, murmurs, clicks, or rubs which could indicate heart pathology.
Peripheral Vascular: Inspect and palpate the skin for color, texture, moisture and turgor. Changes in skin indicate a change in tissue perfusion and cardiac output.
Palpate the peripheral pulses and check nailbed capillary refill which is normally less than 3 seconds. Changes in pulses indicate a change in cardiac output and tissue perfusion.
Inspect the neck for jugular venous distention (JVD). Indicates CVP. Full distention as the patient sits at a 45 degree angle indicates an increase in CVP.
Auscultate and palpate the carotid arteries to assess arterial blood flow. A decrease in pulse amplitude indicates a decrease in stroke volume.
Assess for hepatojugular reflux. A positive hepatojugular reflux indicates heart failure.

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Tissue perfusion can be assessed by checking nailbed capillary refill. Normal refill should occur in less than 4 seconds.