Management of Hemodynamic Instability in Older People

Introduction

Hemodynamics is the measure of cardiovascular function and how much blood flows in the body. Hemodynamic instability is defined as the unstable movement of blood, which causes reduced blood flow through the body. In this condition, the person’s cardiovascular system becomes unreliable, insufficient, or problematic due to underlying conditions like increased blood pressure. This condition affects the cardiovascular system, and a person will not experience this condition without any underlying cause of the cardiovascular system. Hemodynamic instability can be a sign and symptom of any condition, such as heart disease or blood pressure. This condition is also referred as:

• Shock.

• Circulatory collapse.

• Heart failure.

• Low blood flow.

What Is Meant by Hemodynamics?

Hemodynamics means how the blood flows through the arteries and veins in the body and how it is affected by different forces. Blood flow is usually in a streamlined pattern, where the flow is fastest in the middle as the blood vessel wall causes no friction. Hemodynamics is important as it talks about cardiovascular health. Doctors use them to diagnose any leakage in the blood flow, or the surgery performed or the medication prescribed enhances the blood flow.

What Is the Condition Which Affects the Hemodynamics of the Body?

The condition which affects hemodynamics are

• Atherosclerosis is a condition where the arteries get thickened due to the accumulation of plaque in the inner walls of the arteries.

• Increased blood pressure.

• Decreased blood pressure.

• Any problem with the heart valve.

• Heart failure.

• Heart attack.

• Peripheral artery disease.

• Deep vein thrombosis is a blood clot in the vein, usually in the legs.

What Is the Condition That Determines the Hemodynamic Factor?

• The size and diameter of the blood vessels.

• The measure of friction the blood needs to overcome to keep flowing.

• Expansion and contraction of blood vessels.

• Pressure difference.

• Cardiac output.

• Heart rate.

What Are the Symptoms Related to Hemodynamic Instability?

Sure signs and symptoms occur when the blood flow is unstable, such as

• Chest pain.

• Loss of consciousness.

• Arrhythmia issues with the rhythm of the heartbeat.

• Restlessness.

• Short of breath.

• Reduced urine output.

• Confusion.

• Cold legs and hands.

• Bluish discoloration of the feet and hands.

• Reduced refilling of capillaries.

• Unstable blood pressure.

• No pulse in the extremities.

What Are the Causes of Hemodynamic Syndrome?

Hemodynamic instability can be caused by any underlying condition, especially those that affect the heart health or the circulatory system. Some common causes are

• Heart conditions.

• Increased or decreased blood pressure.

• Heart failure.

• Peripheral artery condition.

• Problems with the heart valves.

What Is the Fight or Flight Syndrome Caused Due to Hemodynamic Instability?

The body gives various signs indicating an underlying cause, displayed when the circulatory system fails. All these signs come from the sympathetic nervous system, the body’s accelerating device. Epinephrine, known as the fight or flight syndrome, drives this sympathetic nervous system. It is a natural process in the body when the person feels threatened as the body prepares itself to either fight or run away from the danger or predator. This syndrome is caused by circulation. When the sympathetic nervous system is triggered, the blood concentration will be more on the larger muscle group, such as the arms and legs, preparing them for fight or flight. The blood flow in the gastrointestinal system decreases and increases in the eyes, nose, and ears. The airflow in the lungs gets dilated, and the heartbeat increases to pump more blood to the lungs to keep them fresh and oxygenated.

What Is the Difference Between Shock and Hemodynamic Instability?

Hemodynamic instability is often confused with shock, as a shock is a defined medical condition with proper types and levels. The types of shock are:

• Cardiogenic shock.

• Distributive shock is a combination of neurogenic, septic, and anaphylactic shock.

• Hypovolemic shock, which involves hemorrhagic shock.

• Respiratory shock.

Shock is also further divided as:

• Compensated where the blood pressure is in the usual range.

• Decompensated where there is reduced blood flow.

Decompensated people are hemodynamically unstable patients.

What Are the Risk Factors Associated With Hemodynamic Instability?

Some conditions, treatments, or medication can be a causative factor for the occurrence of hemodynamic instability. In a study conducted in 2019, myocardial infarction, a form of heart attack, is one of the main causative factors for hemodynamic instability. This causes double the risk of developing unstable blood flow compared to other forms of heart condition. Treatment of certain health conditions can also be a causative factor for developing hemodynamic instability. Treating certain tumors like pheochromocytoma (a non-cancerous tumor that develops in the adrenal gland) and paraganglioma (abnormal growth of cells) can cause an increased risk of developing this condition. Hemodynamic instability can also be caused due to renal replacement procedures. Vasopressin is used in the management of septic shock. Discontinuing vasopressin can increase the risk of hemodynamic instability, causing low blood pressure. Certain medications used to treat other health conditions can also increase the risk of developing hemodynamic instability.

How Is Hemodynamic Instability Diagnosed?

Initially, a physical examination will be performed by the doctor, along with which the vitals such as blood pressure and pulse will be checked. The doctor may look for signs and symptoms such as cold extremities, color change of the skin, or pulmonary congestion. Laboratory tests will be recommended, such as

• Comprehensive metabolic panel.

• Measure of troponin levels.

If the doctor suspects any issue in the blood flow, they may recommend an ECG (electrocardiogram), waiting ten minutes in the initial stages of the occurrence of signs. They may also recommend other tests, such as,

• Blood count.

• Echocardiogram.

• Blood pressure.

How Is the Hemodynamic Instability Condition Managed?

The treatment of hemodynamic instability varies depending on the underlying cause. The main aim of the treatment is to stabilize the blood flow; this can be done by

• Introducing intravenous fluid.

• Giving oxygen to the person.

• Providing vasopressin.

Conclusion

Hemodynamic instability refers to unstable blood flow, which is usually caused due to some underlying heart condition. This condition needs to be considered as a sign of some underlying condition. Hemodynamic instability can be caused due to treatment or medication given to treat other conditions. This condition can be treated, but when left untreated, it can result in many complications.