This document provides information on Eisenmenger syndrome (ES), including its etiology, pathophysiology, natural history, clinical features, and management. ES is defined as severe pulmonary hypertension developing as a consequence of a large pre-existing left-to-right shunt that has reversed flow or become bidirectional. The causes of ES include simple defects like atrial septal defects (ASDs) or complex defects. Clinical features include fatigue, syncope, chest pain, stroke, and sudden cardiac death. Management focuses on treating secondary erythrocytosis, thrombotic diathesis, hemoptysis, arrhythmias, and using targeted therapies like endothelin receptor antagonists, phosphodiesterase 5 inhibitors, prost
This document provides information on anesthesia for congenital heart disease. It discusses the incidence and classification of congenital heart defects. Left-to-right shunts like atrial septal defects and ventricular septal defects are more common than right-to-left shunts like tetralogy of Fallot. Preoperative evaluation includes labs, EKG, chest x-ray, echocardiogram and possibly cardiac catheterization. Anesthetic management aims to manipulate pulmonary and systemic vascular resistances depending on the type of shunt. Inhalational agents, opioids, ketamine and etomide are used. Careful induction and maintenance are needed depending on the severity and complexity of the defect.
Congestive cardiac failure (CHF) refers to systemic and pulmonary congestion resulting from the heart's inability to pump enough blood for the body's needs. It has multiple causes in infants and children, including structural heart defects, arrhythmias, infections, and cardiomyopathies. Presentation depends on the degree of cardiac reserve but includes symptoms like tachypnea, tachycardia, poor feeding, and hepatomegaly. Diagnosis involves history, physical exam, chest x-ray, ECG, echocardiogram and other tests. Treatment focuses on correcting underlying causes, managing precipitants, and controlling heart failure through diuretics, inotropic drugs, afterload reducers, and other
Anesthesia for children with Congenital Heart Diseasecairo1957
This document provides an overview of congenital heart disease (CHD) in children, including:
- The incidence of CHD is 7-10 per 1000 live births, with some forms being more common in premature infants. The most common types are ventricular septal defects and atrial septal defects.
- CHD can be classified based on the direction of blood shunting (left-to-right or right-to-left), presence of mixing lesions, or obstructive lesions. Examples of different types of CHD are provided with diagrams.
- Management of CHD depends on whether the heart defect is uncorrected, partially corrected, or completely corrected. A multidisciplinary approach is needed and
This document discusses the classification and pathophysiology of congenital heart disease. It covers the different types of shunts including simple shunts with increased pulmonary blood flow, complex shunts with associated obstructive lesions, and the physiologic classification of acyanotic and cyanotic defects. Key aspects of anesthetic management are summarized, including preoperative evaluation and optimization of pulmonary and systemic vascular resistances to balance blood flow depending on the type of shunting present. Choice of induction agents, inhalational anesthetics, and postoperative care are also addressed.
- Pulmonary embolism (PE) is a blockage in the lung's arteries caused by blood clots that travel from deep veins, most often in the legs.
- Risk factors include recent surgery or trauma, cancer, older age, and genetic predispositions. Symptoms can range from mild to life-threatening depending on the size and location of the clots.
- Diagnosis involves blood tests, imaging like CT scans, ventilation-perfusion scans, or angiography. Treatment focuses on anticoagulation with blood thinners to prevent further clotting as well as supporting heart and lung function. For some patients, more aggressive options like thrombolysis or surgery may be considered.
This document provides an overview of medical management in patients with Eisenmenger syndrome. It discusses:
1. The history and pathophysiology of Eisenmenger syndrome, which develops when a pre-existing left-to-right shunt reverses direction due to high pulmonary vascular resistance, causing hypoxemia.
2. The clinical presentation and complications of Eisenmenger syndrome including pulmonary hypertension, heart failure, erythrocytosis, bleeding, cholelithiasis and others.
3. Evaluations including echocardiogram, cardiac catheterization and imaging studies to characterize the underlying anatomy and assess pulmonary pressures and resistance.
4. Medical management focuses on pulmonary vasodilators like
This document discusses pulmonary embolism (PE), including its risk factors, pathophysiology, diagnosis, and management. It notes that PE is a leading cause of cardiovascular death and hospital mortality. Rudolf Virchow identified three main factors that contribute to venous thrombosis and PE: venous stasis, hypercoagulability of blood, and endothelial injury. The pathophysiology of PE involves increased pulmonary vascular resistance and right heart strain or failure. Diagnosis involves assessing clinical risk factors, biomarkers like troponin and BNP, imaging tests like CTPA, and echocardiography. PE is classified as massive, submassive, or low-risk depending on the presence of hypotension and right heart dysfunction. Management involves he
This document discusses anesthesia considerations for children with congenital heart disease (CHD). It begins by classifying common CHD types as left-to-right shunts which increase pulmonary blood flow or right-to-left shunts which decrease it. The goal of anesthesia management is then to manipulate systemic and pulmonary vascular resistances to optimize blood flow based on the individual defect. Thorough preoperative evaluation and understanding of the child's specific anatomy and hemodynamics are essential to tailoring the anesthetic plan.
This document provides information on anesthesia for congenital heart disease. It discusses the incidence and classification of congenital heart defects. Left-to-right shunts like atrial septal defects and ventricular septal defects are more common than right-to-left shunts like tetralogy of Fallot. Preoperative evaluation includes labs, EKG, chest x-ray, echocardiogram and possibly cardiac catheterization. Anesthetic management aims to manipulate pulmonary and systemic vascular resistances depending on the type of shunt. Inhalational agents, opioids, ketamine and etomide are used. Careful induction and maintenance are needed depending on the severity and complexity of the defect.
Congestive cardiac failure (CHF) refers to systemic and pulmonary congestion resulting from the heart's inability to pump enough blood for the body's needs. It has multiple causes in infants and children, including structural heart defects, arrhythmias, infections, and cardiomyopathies. Presentation depends on the degree of cardiac reserve but includes symptoms like tachypnea, tachycardia, poor feeding, and hepatomegaly. Diagnosis involves history, physical exam, chest x-ray, ECG, echocardiogram and other tests. Treatment focuses on correcting underlying causes, managing precipitants, and controlling heart failure through diuretics, inotropic drugs, afterload reducers, and other
Anesthesia for children with Congenital Heart Diseasecairo1957
This document provides an overview of congenital heart disease (CHD) in children, including:
- The incidence of CHD is 7-10 per 1000 live births, with some forms being more common in premature infants. The most common types are ventricular septal defects and atrial septal defects.
- CHD can be classified based on the direction of blood shunting (left-to-right or right-to-left), presence of mixing lesions, or obstructive lesions. Examples of different types of CHD are provided with diagrams.
- Management of CHD depends on whether the heart defect is uncorrected, partially corrected, or completely corrected. A multidisciplinary approach is needed and
This document discusses the classification and pathophysiology of congenital heart disease. It covers the different types of shunts including simple shunts with increased pulmonary blood flow, complex shunts with associated obstructive lesions, and the physiologic classification of acyanotic and cyanotic defects. Key aspects of anesthetic management are summarized, including preoperative evaluation and optimization of pulmonary and systemic vascular resistances to balance blood flow depending on the type of shunting present. Choice of induction agents, inhalational anesthetics, and postoperative care are also addressed.
- Pulmonary embolism (PE) is a blockage in the lung's arteries caused by blood clots that travel from deep veins, most often in the legs.
- Risk factors include recent surgery or trauma, cancer, older age, and genetic predispositions. Symptoms can range from mild to life-threatening depending on the size and location of the clots.
- Diagnosis involves blood tests, imaging like CT scans, ventilation-perfusion scans, or angiography. Treatment focuses on anticoagulation with blood thinners to prevent further clotting as well as supporting heart and lung function. For some patients, more aggressive options like thrombolysis or surgery may be considered.
This document provides an overview of medical management in patients with Eisenmenger syndrome. It discusses:
1. The history and pathophysiology of Eisenmenger syndrome, which develops when a pre-existing left-to-right shunt reverses direction due to high pulmonary vascular resistance, causing hypoxemia.
2. The clinical presentation and complications of Eisenmenger syndrome including pulmonary hypertension, heart failure, erythrocytosis, bleeding, cholelithiasis and others.
3. Evaluations including echocardiogram, cardiac catheterization and imaging studies to characterize the underlying anatomy and assess pulmonary pressures and resistance.
4. Medical management focuses on pulmonary vasodilators like
This document discusses pulmonary embolism (PE), including its risk factors, pathophysiology, diagnosis, and management. It notes that PE is a leading cause of cardiovascular death and hospital mortality. Rudolf Virchow identified three main factors that contribute to venous thrombosis and PE: venous stasis, hypercoagulability of blood, and endothelial injury. The pathophysiology of PE involves increased pulmonary vascular resistance and right heart strain or failure. Diagnosis involves assessing clinical risk factors, biomarkers like troponin and BNP, imaging tests like CTPA, and echocardiography. PE is classified as massive, submassive, or low-risk depending on the presence of hypotension and right heart dysfunction. Management involves he
This document discusses anesthesia considerations for children with congenital heart disease (CHD). It begins by classifying common CHD types as left-to-right shunts which increase pulmonary blood flow or right-to-left shunts which decrease it. The goal of anesthesia management is then to manipulate systemic and pulmonary vascular resistances to optimize blood flow based on the individual defect. Thorough preoperative evaluation and understanding of the child's specific anatomy and hemodynamics are essential to tailoring the anesthetic plan.
- Pulmonary artery hypertension (PAH) is defined as a mean pulmonary artery pressure of ≥25 mmHg at rest. It is characterized by pre-capillary pulmonary hypertension with a pulmonary wedge pressure <15 mmHg and a pulmonary vascular resistance >3 Wood units.
- The pathophysiology involves sustained vasoconstriction, vascular remodeling, in situ thrombosis, and increased arterial stiffness. Genetic factors like BMPR2 mutations also contribute to PAH development.
- Clinical features range from mild breathlessness to signs of right heart failure. Diagnostic tests include echocardiography, CT scans, V/Q scans, right heart catheterization and lab tests.
- Treatment involves oxygen therapy, diure
Management of cyanotic congenital heart diseae3Sandip Gupta
1) The document discusses the management of various cyanotic congenital heart diseases that present in newborns including Tetralogy of Fallot (TOF), Transposition of the Great Arteries (TGA), Tricuspid Atresia (TA), Total Anomalous Pulmonary Venous Return (TAPVR), and Truncus Arteriosus.
2) It outlines the initial management of life-threatening presentations including shock, cyanosis, and heart failure as well as treatments for cyanosis including prostaglandin E1.
3) The long-term medical and surgical management strategies for each condition are described, including palliative procedures and definitive repairs. Shunt operations,
AR, or aortic regurgitation, occurs when the aortic valve does not close properly, allowing blood to flow backward into the left ventricle. It can be caused by damage to the aortic valve leaflets or distortion/dilation of the aortic root. In developed countries, the most common causes are aortic root dilation or a congenital bicuspid aortic valve. AR is more common in men than women. Symptomatic patients or asymptomatic patients with reduced ejection fraction or increased left ventricular dimensions require surgical treatment such as aortic valve replacement. The prognosis depends on symptoms and left ventricular function, with asymptomatic patients having normal ejection fraction having an excellent long-term prognosis.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
Cynotic congenital heart disease UG Class Dr Jyothi.pptxhamsinin16
Cyanotic congenital heart disease can cause reduced or increased pulmonary blood flow. Conditions with reduced flow include tetralogy of Fallot and pulmonary atresia. Clinical features include cyanosis, murmurs, and cyanotic spells treated with oxygen, morphine, and drugs to increase systemic vascular resistance. Conditions with increased pulmonary blood flow include transposition of the great arteries and total anomalous pulmonary venous return. Long-term management may involve staged surgical repairs throughout childhood and adulthood. Eisenmenger syndrome can develop from untreated ventricular septal defects, patent ductus arteriosus, or atrial septal defects.
Anesthesia For Children With Congenital Heart Disease1Ahmed Shalabi
This document discusses children with congenital heart disease and provides information on:
1. The incidence of congenital heart disease is 7 to 10 per 1000 live births, with certain populations having higher rates.
2. Congenital heart disease can range from simple defects like atrial septal defects to complex conditions like hypoplastic left heart syndrome.
3. Proper preoperative evaluation is important for anesthetic planning and involves understanding the child's specific cardiac anatomy and physiology.
Adult Congenital Heart Disease can affect over 1 million adults in the US. Common conditions include Atrial Septal Defects, Ventricular Septal Defects, Patent Ductus Arteriosus, Bicuspid Aortic Valve, Coarctation of the Aorta, Tetralogy of Fallot, and Transposition of the Great Arteries. Clinical presentation and treatment depends on the specific condition and degree of severity. Long term monitoring is important for complications. Pregnancy can also pose additional risks for some congenital heart conditions.
The main components of an intra-arterial blood pressure measuring system are:
1. Biological variable (arterial blood pressure)
2. Sensor (pressure transducer)
3. Integrator (computer for calibration and processing the signal)
4. Output (display of pressure waveform and numeric values)
This document discusses the medical management and long-term complications of tetralogy of Fallot (TOF). It covers cyanotic spell management, surgical correction including palliative procedures, and long-term sequelae following TOF repair such as residual lesions, pulmonary insufficiency, ventricular dysfunction, arrhythmias and conduction abnormalities.
This document provides an overview of tetralogy of Fallot (TOF), one of the most common cyanotic congenital heart diseases. It discusses the history, epidemiology, pathophysiology, clinical presentation, investigations, management, and prognosis of TOF. Key points include: TOF is characterized by pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. Clinical features include cyanosis, clubbing, and systolic murmur. Investigations include CXR, ECG, echocardiogram and cardiac catheterization. Management involves medical treatment of spells, palliative shunt procedures, and complete repair surgery. Long-term prognosis depends on severity of pulmonary stenosis and associated anomalies,
Critical Congenital Heart Disease (CCHD) refers to several heart defects present at birth that require intervention. Some key points:
- CCHD includes defects where blood flow depends on an open ductus arteriosus after birth, such as Tetralogy of Fallot.
- Clinical presentation varies but may include cyanosis, heart murmur, respiratory distress. Diagnosis involves tests like echocardiogram, EKG, chest x-ray.
- Management depends on the specific defect but may include prostaglandin E1 to keep the ductus arteriosus open, then surgery to repair the anatomical issues. Early detection through newborn pulse oximetry screening can help identify cases
Congenital heart disease (CHD) refers to structural heart defects present at birth. CHD encompasses a broad range of conditions detectable from the prenatal period to adulthood through tests like echocardiography. Approximately 6-8 per 1000 live births have CHD, for which palliative or corrective surgery is often needed. Common types of CHD discussed in the document include atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), and tetralogy of Fallot. The document outlines the pathophysiology, clinical presentation, diagnosis, and management of each condition.
Hepatopulmory syndrome in chronic liver disease patientDrRahulAmin
Hepatopulmonary syndrome (HPS) is characterized by liver disease, intrapulmonary vasodilatation, and impaired oxygenation. A 58-year-old male with liver disease presented with worsening dyspnea and was found to have severe HPS. Contrast echocardiography showed intrapulmonary shunting. He received supplemental oxygen and underwent successful liver transplantation, which improved his oxygenation over several weeks as the HPS resolved. Liver transplantation is the definitive treatment for severe HPS as it can reverse the intrapulmonary vascular abnormalities and improve survival rates compared to medical management alone.
1) Pulmonary hypertension is defined as a systolic pulmonary artery pressure >35mmHg or mean pulmonary artery pressure >25mmHg and is classified into 5 groups. Group 1 includes pulmonary arterial hypertension which can be idiopathic or associated with other conditions.
2) Pulmonary hypertension results from an imbalance between vasoconstrictors like endothelin-1 and vasodilators like nitric oxide leading to vascular remodeling and increased pulmonary pressures. Acute pulmonary hypertension in the ICU is often caused by conditions like pulmonary embolism, lung disease, heart disease or sepsis.
3) Diagnosis involves clinical exam, imaging like echocardiogram and right heart catheterization. Treatment goals are to reduce pulmonary pressures
A presentation by Ulf Thilén at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Coronary Artery Bypass Graft Under Cardiopulmonary BypassDharmraj Singh
This document discusses coronary artery bypass graft (CABG) surgery under cardiopulmonary bypass. It covers the preoperative evaluation, indications for CABG, intraoperative monitoring, cardiopulmonary bypass procedure, myocardial protection techniques, and considerations for weaning the patient off bypass.
This document discusses atrial fibrillation (AF), atrial flutter, and atrial tachycardia. It covers the electrocardiographic features of each condition and how to differentiate them. It also discusses the classification, epidemiology, mechanisms, causes, clinical features, diagnostic evaluation, and prevention of thromboembolism for AF based on the 2014 AHA/ACC/HRS guideline. Key points include that AF can be paroxysmal, persistent, long-standing persistent, or permanent; the CHA2DS2-VASc score is used to assess stroke risk; and anticoagulation options depend on stroke risk.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Pulmonary artery hypertension (PAH) is defined as a mean pulmonary artery pressure of ≥25 mmHg at rest. It is characterized by pre-capillary pulmonary hypertension with a pulmonary wedge pressure <15 mmHg and a pulmonary vascular resistance >3 Wood units.
- The pathophysiology involves sustained vasoconstriction, vascular remodeling, in situ thrombosis, and increased arterial stiffness. Genetic factors like BMPR2 mutations also contribute to PAH development.
- Clinical features range from mild breathlessness to signs of right heart failure. Diagnostic tests include echocardiography, CT scans, V/Q scans, right heart catheterization and lab tests.
- Treatment involves oxygen therapy, diure
Management of cyanotic congenital heart diseae3Sandip Gupta
1) The document discusses the management of various cyanotic congenital heart diseases that present in newborns including Tetralogy of Fallot (TOF), Transposition of the Great Arteries (TGA), Tricuspid Atresia (TA), Total Anomalous Pulmonary Venous Return (TAPVR), and Truncus Arteriosus.
2) It outlines the initial management of life-threatening presentations including shock, cyanosis, and heart failure as well as treatments for cyanosis including prostaglandin E1.
3) The long-term medical and surgical management strategies for each condition are described, including palliative procedures and definitive repairs. Shunt operations,
AR, or aortic regurgitation, occurs when the aortic valve does not close properly, allowing blood to flow backward into the left ventricle. It can be caused by damage to the aortic valve leaflets or distortion/dilation of the aortic root. In developed countries, the most common causes are aortic root dilation or a congenital bicuspid aortic valve. AR is more common in men than women. Symptomatic patients or asymptomatic patients with reduced ejection fraction or increased left ventricular dimensions require surgical treatment such as aortic valve replacement. The prognosis depends on symptoms and left ventricular function, with asymptomatic patients having normal ejection fraction having an excellent long-term prognosis.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
A 76-year-old male is admitted to the ICU for recovery after lung surgery. His BP is 168/96 mmHg without end-organ damage, so this represents a hypertensive urgency rather than emergency. Fundoscopic exam is not needed for this transient postoperative hypertension. Starting IV antihypertensives or consulting a hypertension specialist are not necessary actions at this time. The patient should be reassessed later since there is no end-organ damage currently.
Cynotic congenital heart disease UG Class Dr Jyothi.pptxhamsinin16
Cyanotic congenital heart disease can cause reduced or increased pulmonary blood flow. Conditions with reduced flow include tetralogy of Fallot and pulmonary atresia. Clinical features include cyanosis, murmurs, and cyanotic spells treated with oxygen, morphine, and drugs to increase systemic vascular resistance. Conditions with increased pulmonary blood flow include transposition of the great arteries and total anomalous pulmonary venous return. Long-term management may involve staged surgical repairs throughout childhood and adulthood. Eisenmenger syndrome can develop from untreated ventricular septal defects, patent ductus arteriosus, or atrial septal defects.
Anesthesia For Children With Congenital Heart Disease1Ahmed Shalabi
This document discusses children with congenital heart disease and provides information on:
1. The incidence of congenital heart disease is 7 to 10 per 1000 live births, with certain populations having higher rates.
2. Congenital heart disease can range from simple defects like atrial septal defects to complex conditions like hypoplastic left heart syndrome.
3. Proper preoperative evaluation is important for anesthetic planning and involves understanding the child's specific cardiac anatomy and physiology.
Adult Congenital Heart Disease can affect over 1 million adults in the US. Common conditions include Atrial Septal Defects, Ventricular Septal Defects, Patent Ductus Arteriosus, Bicuspid Aortic Valve, Coarctation of the Aorta, Tetralogy of Fallot, and Transposition of the Great Arteries. Clinical presentation and treatment depends on the specific condition and degree of severity. Long term monitoring is important for complications. Pregnancy can also pose additional risks for some congenital heart conditions.
The main components of an intra-arterial blood pressure measuring system are:
1. Biological variable (arterial blood pressure)
2. Sensor (pressure transducer)
3. Integrator (computer for calibration and processing the signal)
4. Output (display of pressure waveform and numeric values)
This document discusses the medical management and long-term complications of tetralogy of Fallot (TOF). It covers cyanotic spell management, surgical correction including palliative procedures, and long-term sequelae following TOF repair such as residual lesions, pulmonary insufficiency, ventricular dysfunction, arrhythmias and conduction abnormalities.
This document provides an overview of tetralogy of Fallot (TOF), one of the most common cyanotic congenital heart diseases. It discusses the history, epidemiology, pathophysiology, clinical presentation, investigations, management, and prognosis of TOF. Key points include: TOF is characterized by pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. Clinical features include cyanosis, clubbing, and systolic murmur. Investigations include CXR, ECG, echocardiogram and cardiac catheterization. Management involves medical treatment of spells, palliative shunt procedures, and complete repair surgery. Long-term prognosis depends on severity of pulmonary stenosis and associated anomalies,
Critical Congenital Heart Disease (CCHD) refers to several heart defects present at birth that require intervention. Some key points:
- CCHD includes defects where blood flow depends on an open ductus arteriosus after birth, such as Tetralogy of Fallot.
- Clinical presentation varies but may include cyanosis, heart murmur, respiratory distress. Diagnosis involves tests like echocardiogram, EKG, chest x-ray.
- Management depends on the specific defect but may include prostaglandin E1 to keep the ductus arteriosus open, then surgery to repair the anatomical issues. Early detection through newborn pulse oximetry screening can help identify cases
Congenital heart disease (CHD) refers to structural heart defects present at birth. CHD encompasses a broad range of conditions detectable from the prenatal period to adulthood through tests like echocardiography. Approximately 6-8 per 1000 live births have CHD, for which palliative or corrective surgery is often needed. Common types of CHD discussed in the document include atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), and tetralogy of Fallot. The document outlines the pathophysiology, clinical presentation, diagnosis, and management of each condition.
Hepatopulmory syndrome in chronic liver disease patientDrRahulAmin
Hepatopulmonary syndrome (HPS) is characterized by liver disease, intrapulmonary vasodilatation, and impaired oxygenation. A 58-year-old male with liver disease presented with worsening dyspnea and was found to have severe HPS. Contrast echocardiography showed intrapulmonary shunting. He received supplemental oxygen and underwent successful liver transplantation, which improved his oxygenation over several weeks as the HPS resolved. Liver transplantation is the definitive treatment for severe HPS as it can reverse the intrapulmonary vascular abnormalities and improve survival rates compared to medical management alone.
1) Pulmonary hypertension is defined as a systolic pulmonary artery pressure >35mmHg or mean pulmonary artery pressure >25mmHg and is classified into 5 groups. Group 1 includes pulmonary arterial hypertension which can be idiopathic or associated with other conditions.
2) Pulmonary hypertension results from an imbalance between vasoconstrictors like endothelin-1 and vasodilators like nitric oxide leading to vascular remodeling and increased pulmonary pressures. Acute pulmonary hypertension in the ICU is often caused by conditions like pulmonary embolism, lung disease, heart disease or sepsis.
3) Diagnosis involves clinical exam, imaging like echocardiogram and right heart catheterization. Treatment goals are to reduce pulmonary pressures
A presentation by Ulf Thilén at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Coronary Artery Bypass Graft Under Cardiopulmonary BypassDharmraj Singh
This document discusses coronary artery bypass graft (CABG) surgery under cardiopulmonary bypass. It covers the preoperative evaluation, indications for CABG, intraoperative monitoring, cardiopulmonary bypass procedure, myocardial protection techniques, and considerations for weaning the patient off bypass.
This document discusses atrial fibrillation (AF), atrial flutter, and atrial tachycardia. It covers the electrocardiographic features of each condition and how to differentiate them. It also discusses the classification, epidemiology, mechanisms, causes, clinical features, diagnostic evaluation, and prevention of thromboembolism for AF based on the 2014 AHA/ACC/HRS guideline. Key points include that AF can be paroxysmal, persistent, long-standing persistent, or permanent; the CHA2DS2-VASc score is used to assess stroke risk; and anticoagulation options depend on stroke risk.
Similar to Approach to Eisenmenger's syndrome UPDATED .pptx (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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4. Mr PAUlWOOD
He was born in Coonoor . Studied in Australia . But
celebrated as the Gale force of British Cardiology
5. What is Eisenmenger syndrome?
• Defined as pulmonary vascular obstructive disease that
develops as a consequence of a large pre-existing left-to-right
shunt due to High PVR with reversal or bidirectional shunt.
• Hemodynamically ES is defined as an elevation of the PVR
to > 10 Wood units or
• PVR/SVR ratio equal to or greater than 1.0.
6. • Eisenmenger Reaction- It is the gradual proces of development
of pulmonary hypertension & PVR in a large left to right shunt
lesion sooner or later leading to bidirectional shunt or reversal of
shunt
• Eisenmenger’s complex- VSD with reversed shunt in the absence
of PS. Term coined by MAUDE ABOTT (1927)
• Eisenmengers syndrome- Includes all defects.
7. Causes of ES
1. SIMPLE :
• PRETRICUSPID- ASD/TAPVC/PAPVC
• POST TRICUSPID- VSD/PDA/AP WINDOW
2. COMPLEX :
• VENTRICULAR-SINGLE VENTRICLE,DORV
• GREAT VESSELS-TRUNCUS ARTERIOSUS
• D-TGA
3. POST PALLIATION SURGERY :
• WATERSTON SHUNT
• POTTS SHUNT
12. Clinical classification of congenital systemic-to-pulmonary shunts
associated to pulmonary arterial hypertension
4 subsets
NICE / Dana point classification
13.
14. CLINICAL FEATURES OF ES
CLINICAL FEATURES DUE TO
FATIGUE LOW/FIXED CARDIAC OUTPUT
SYNCOPE ARRHYTHMIA/LOW CO
CHEST PAIN RV ISCHEMIA
STROKE PARADOXICAL EMBOLISM/
ICH/
THROMBOSIS
PALPITATIONS ARRHYTHMIA
SUDDEN CARDIAC DEATH ARRHYTHMIA
15. SHUNT ESTABLISHED AT PRESENTATION AT
PDA >2 YRS 19 YRS
VSD >2 YRS 22 YRS
ASD >20 35 YRS
AVSD MUCH EARLIER
COMPARATIVE ANALYSIS
16. • Pretricuspid lesion :
• Soon after birth, shunting of low pressure blood occurs into the non compliant
neonatal RV.
• Low pressure shunt flow at rest is not sufficient to maintain the pulmonary
pressure at systemic level.
• PVR falls to normal before the relatively slow involution of the right ventricle
after birth.
• So after RV involution L→ R shunted high volume blood now actually goes into
a low resistance compliant pulmonary circulation, and does not promote
hypertensive changes till late in life.
• Once the PVR falls appreciably, much larger flows are necessary to maintain
high pulmonary pressure.
17. • Post tricuspid lesion :
• Soon after birth , direct shunting of blood at systemic arterial pressure before
neonatal PAH has regressed.
• Lowering of PVR to normal is prevented by a sufficient increase of flow to keep
the pressure at systemic level.
• So long as pulmonary hypertension is maintained, vasoconstrictor tone is not
inhibited and the muscular pulmonary arteries do not involute.
• This Not only delays the natural fall in pulmonary vascular resistance,
• But also promotes hypertensive changes.
19. • NATURAL HISTORY
• In the absence of complications, these patients generally have a good
functional capacity up to their third decade and thereafter usually experience
a slowly progressive decline in their physical abilities.
>Most patients survive to adulthood, with reported survival rates of 77% at 15
years of age and 42% at 25 years of age.
>Congestive heart failure in patients with Eisenmenger syndrome usually occurs
after 40 years of age.
>The most common modes of death are
• sudden death (≈30%),
• congestive heart failure (≈25%), and
• pulmonary hemorrhage/Hemoptysis (≈15%).
• Pregnancy, perioperative death at the time of noncardiac surgery, and
infectious causes (brain abscesses and endocarditis) account for most of the
remainder.
• Hemoptysis is usually due to bleeding bronchial vessels or pulmonary
infarction.
Physical examination reveals central cyanosis and clubbing of the nail beds
23. COMPARATIVE ANALYSIS ECG
ASD VSD PDA
RAE 50 % 50 % 50 %
RAD + + +
RVH + + +
q R IN V1 25 % - -
SV ARRHYTHMIAS + - -
24. COMPARATIVE ANALYSIS CXR
ASD VSD PDA
CARDIOMEGALY + - -
LARGE MPA + + +
RDPA ++ + +
DUCTAL
CALCIFICATION - - +
AORTA SMALL NORMAL LARGE
25. • Chest Radiography.
• Chest radiography shows dilated central pulmonary arteries with rapid tapering
of the peripheral pulmonary vasculature (the radiographic hallmarks of
Eisenmenger syndrome).
• Pulmonary artery calcification may be seen and is diagnostic of long-standing
pulmonary hypertension.
• Eisenmenger syndrome due to an ASD typically has a large cardiothoracic ratio
because of right atrial and ventricular dilation.
27. • Echocardiography.
• The intracardiac defect should be seen readily, along with bidirectional shunting.
• Evidence of pulmonary hypertension is found.
• Assessment of right ventricular function adds prognostic value.
28. • Cardiac Catheterization.
• Cardiac catheterization not only provides direct measurement of the
pulmonary artery pressure, documenting the existence of severe pulmonary
hypertension, but can also allow assessment of the reactivity of the pulmonary
vasculature.
• Administration of pulmonary arterial vasodilators (O2, nitric oxide,
prostaglandin I2 [epoprostenol]) can determine which patients have
contraindications to surgical repair and which patients have reversible
pulmonary hypertension and may benefit from surgical or even catheter repair.
29. • Open-Lung Biopsy.
• Open-lung biopsy is seldom used in the current era, and should be considered
only when reversibility of the pulmonary hypertension is uncertain from the
hemodynamic data.
• An expert opinion will be necessary to determine the severity of the changes,
often using the Heath-Edwards classification.
30. • MANAGEMENT
• Secondary erythrocytosis-
No place for routine venesections
In patients with hemoglobin >22 g/dL and hematocrit >65% presenting
with severe hyperviscosity symptoms in the absence of dehydration
At small volumes (250-500 mL) with simultaneous fluid replacement to
avoid hemodynamic imbalance .
Iron deficiency
• Transferrin saturation <20% is the best marker & peripheral microcytosis
Oral iron supplementation
Intravenous supplementation (Administer at a slow rate).
• Thrombotic diathesis
Oral anticoagulation should be recommended only in cases of atrial arrythmia and
in the presence of PA thrombus or emboli.
Vitamin K antagonists remain the oral anticoagulants of choice pending
safety and efficacy data on direct oral anticoagulants
31. • Hemoptysis
• Anticoagulation is not recommended in patients with active or recurrent
hemoptysis & Supportive treatment to be given
Manage concomitant respiratory tract infections, suppress coughing,
reduce physical activity, treat hypovolemia and (relative) anemia
CTPA to determine the presence and location/origin of intrapulmonary
hemorrhage
• Coil embolization of causative bronchial arteries in selected patients
Inhaled tranexamic acid may be considered
• Arrhythmias
Prompt restoration and maintenance of sinus rhythm recommended
Catheter ablation in specialized centers may be considered in patients with
intractable arrhythmia
ICD may be considered for secondary prevention of sudden cardiac death
50. • Endothelin receptor antagonists )ERA):
• Ambrisentan, Bosentan, Macitentan
• BOSENTAN
• Competitive antagonist of endothelin-1;
• Blocks endothelin receptors on vascular endothelium and smooth muscle
resulting in inhibition of vasoconstriction
• BREATH-5 trial showed improved hemodynamics, exercise capacity & functional
class.
• Ambrisentan & Sitaxentan are also used but evidence is less.
• Bosentan (non selevtive)-1Mg/Kg twice daily
• Ambrisentan (selective)- 5 Mg once daily
51. • PHOSPHODIESTERASE 5 INHIBITORS (PDE5-I) :
• Inhibits PDE-5, increasing cyclic guanosine monophosphate cGMP to allow
smooth-muscle relaxation.
• Reduces PVR, Mean PA pressre, Improves 6MWD,SpO2
• Sildenafil & Tadalafil.
• STARTS 1 study showed improved functional class and hemodynamics with
medium to high doses OF SILDENAFIL.
• STARTS 2 showed decreased survival with high dose of sildenafil.
• Sildenafil-0.2- 0.3 mg/kg P.O in 6-8 hrly
• IV-2.5-10 mg bolus TID
• Tadalafil- 40mg daily (adult)
52. • Prostanoids
• PGI2 and its analogues bind the IP receptor on the cell surface membrane.
Once engaged, the IP receptor couples the G-protein Gs and activates adenylyl
cyclase, producing cyclic adenosine monophosphate (cAMP) and leading to
relaxation in smooth muscle cells and antithrombosis in platelets.
• Beyond vasodilation, PGI2 also has proapoptotic properties via
the IP receptor
• Epoprostenol, a synthetic prostacyclin, and iloprost and treprostinil, synthetic
prostacyclin analogues, are currently used to treat patients with Eisenmenger
Syndrome.
• Continuous i.v. infusion of prostacyclin, continuous s.c. infusion of treprostinil,
p.o. application of beraprost, and inhaled application of iloprost.
• 0.25 ng/kg/min for inhaled iloprost
• 30–50 ng/kg/min for i.v. prostacyclin.
• 60 mcg/day in 3 divides doses of oral Beraprost
53. • Soluble guanylate cyclase (sGC) stimulators
• Riociguat sensitizes sGC to endogenous NO, and it directly stimulates sGC
receptors independent of NO availability, resulting in vasorelaxation and
antiproliferative effects.
• Riociguat significantly reduced PVR, mean pulmonary arterial pressure, systolic
blood pressure, and systemic vascular resistance in addition to increasing the
cardiac index in a dose-dependent manner.
• Doses of 1 mg or 2.5 mg tid p.o
54. • IP Receptor Agonists
• The novel oral IP receptor agonist selexipag was tested in the multicenter
GRIPHON study of patients who were either treatment naïve or on stable
background therapy of an ERA, PDE-5i, or both.
• It demonstrated a 40% reduction in a composite endpoint of death or
worsening PAH for selexipag versus placebo.