Various rhythms with arterial blood pressure waveform
1.
The arterial blood pressure is measured by a sensor that is placed in either the radial artery or the femoral artery. It should correlate closely with the peripheral cuff pressure. In this strip, there is a slight delay between the arterial waveform and the cardiac waveform. This reflects the time that it takes for the pressure produced by the cardiac contraction to travel from the heart to the radial artery where the arterial blood pressure sensor is positioned. Notice how the arterial waveform flattens out and the blood pressure drops during the ventricular beats.
2.
The scale on the left is used to measure the arterial pressure. In this strip the arterial pressure is between 180/80 and 200/100. The small indentation on the down slope of the arterial waveform, called the dichrotic notch, correlates with closure of the aortic valve.
3.
The arterial pressure is low, around 80/50. As in the analysis of any cardiac rhythm, you want to check the patient first. The dampened waveform may be the caused by an air bubble or clot in the tubing, a malpositioned transducer, or a kinked catheter.
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Again, observe the changes in the arterial waveform with the ventricular beats. The arterial systolic pressure drops from 110 to 60 during the runs of ventricular tachycardia. Can you see how sustained ventricular tachycardia might lead to a pulseless event?
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These next strips are great examples of PEA rhythms. Notice that there is an identifiable rhythm on the monitor. However, the arterial blood pressure reading is around 20 mm Hg and is nearly absent, hence there is no pulse and no cardiac output. What medications are indicated during the treatment of PEA?
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The patient was treated with Epinephrine 1mg IV. Observe the effects of the epinephrine on the arterial pressure as well as the heart rate.
The arterial blood pressure is measured by a sensor that is placed in either the radial artery or the femoral artery. It should correlate closely with the peripheral cuff pressure. In this strip, there is a slight delay between the arterial waveform and the cardiac waveform. This reflects the time that it takes for the pressure produced by the cardiac contraction to travel from the heart to the radial artery where the arterial blood pressure sensor is positioned. Notice how the arterial waveform flattens out and the blood pressure drops during the ventricular beats.
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| PEA rhythm with flat arterial BP waveform |
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| PEA rhythm with flattened arterial BP waveform |
11.
The patient was treated with Epinephrine 1mg IV. Observe the effects of the epinephrine on the arterial pressure as well as the heart rate.
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