This document discusses cardiac arrhythmias that can occur after thoracic surgery. It identifies the most common arrhythmias as atrial fibrillation, supraventricular tachyarrhythmias, ventricular arrhythmias, and conduction disturbances. Potential mechanisms for these arrhythmias include surgical trauma, cardiac manipulation, reduced pulmonary function, effects of anesthetics and drugs, and autonomic nerve injury. Management involves identifying and treating the underlying causes, with electrical or pharmacological cardioversion used for more severe cases. Preventive measures include correcting electrolyte imbalances and using beta blockers to reduce the risk of atrial fibrillation.
Cardiac arrhythmia after thoracotomy.pptxGEMECHISAKUMA
This document provides an overview of cardiac arrhythmias that can occur after thoracic surgery. It discusses the most common arrhythmias including atrial fibrillation, sinus tachycardia, paroxysmal supraventricular tachycardia, ventricular arrhythmias, and atrial flutter. For each type of arrhythmia, it describes the potential mechanisms, risk factors, presentation, management options, and treatment approaches. The document emphasizes that arrhythmias are often due to surgical trauma, cardiac manipulation during surgery, underlying heart conditions, anesthetic effects, and metabolic abnormalities. It stresses the importance of identifying and correcting reversible causes of arrhythmias through optimization of electrolytes, oxygenation, and hemodynamics.
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
This document provides an overview of stroke, including:
- Stroke is defined as rapid neurological deficit caused by focal brain infarction or hemorrhage.
- Risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia, and smoking.
- Strokes are either ischemic (85%) due to thrombosis or embolism, or hemorrhagic (15%) due to bleeding.
- Clinical features depend on the location of brain injury but may include weakness, speech problems, visual issues, and headache.
- Investigations include brain imaging (CT or MRI), blood tests, and cardiac workup to determine the cause.
- Treatment involves supportive care, thrombolysis
Presentation about the hazards and potential complications that could happen in any cardiac or peripheral catheterization procedure and how to avoid them
This document defines cardiac dysrhythmias and discusses their incidence and causes in the perioperative period. It notes that dysrhythmias are common in patients undergoing surgery, occurring in over 70% of patients receiving general anesthesia. The causes include changes in cardiac ion channels from medications or clinical situations as well as pathological processes like injury or damage to the conduction system. Reentry and automaticity are two main mechanisms that can precipitate arrhythmias. Perioperative dysrhythmias are frequently benign but may become symptomatic in high-risk patients.
Post cardiac surgery monitoring & follow upRubayet Anwar
This document provides information on post-cardiac surgery monitoring and follow up. It discusses admission to the ICU, initial assessment, monitoring techniques, complications that can occur like bleeding and hemodynamic issues, and management strategies for those complications. The early focus is on stabilizing vital signs, addressing hypothermia, identifying potential issues like low cardiac output, and treating medical causes of bleeding through correcting coagulation abnormalities.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
This document provides information on thoracic injuries from both blunt and penetrating trauma. It discusses the anatomy of the chest wall and epidemiology of chest trauma. For evaluation and management, it emphasizes treating life-threatening injuries immediately, such as tension pneumothorax. It then covers specific injury types in depth, including chest wall injuries, lung injuries, cardiac injuries, diaphragm injuries, and injuries to aerodigestive structures. Diagnosis and treatment approaches are outlined for each type.
Cardiac arrhythmia after thoracotomy.pptxGEMECHISAKUMA
This document provides an overview of cardiac arrhythmias that can occur after thoracic surgery. It discusses the most common arrhythmias including atrial fibrillation, sinus tachycardia, paroxysmal supraventricular tachycardia, ventricular arrhythmias, and atrial flutter. For each type of arrhythmia, it describes the potential mechanisms, risk factors, presentation, management options, and treatment approaches. The document emphasizes that arrhythmias are often due to surgical trauma, cardiac manipulation during surgery, underlying heart conditions, anesthetic effects, and metabolic abnormalities. It stresses the importance of identifying and correcting reversible causes of arrhythmias through optimization of electrolytes, oxygenation, and hemodynamics.
The document summarizes various potential complications that can occur during or after cardiac catheterization. The major complications discussed include death, myocardial infarction, stroke, bleeding, vascular injury, and contrast induced nephrotoxicity. Risk factors for complications include patient demographics, cardiovascular anatomy, clinical situation, and operator experience. Local vascular complications like hematoma, pseudoaneurysm, arterial thrombosis are also described. Strategies to prevent complications involve careful technique, minimizing contrast and anticoagulation.
This document provides an overview of stroke, including:
- Stroke is defined as rapid neurological deficit caused by focal brain infarction or hemorrhage.
- Risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia, and smoking.
- Strokes are either ischemic (85%) due to thrombosis or embolism, or hemorrhagic (15%) due to bleeding.
- Clinical features depend on the location of brain injury but may include weakness, speech problems, visual issues, and headache.
- Investigations include brain imaging (CT or MRI), blood tests, and cardiac workup to determine the cause.
- Treatment involves supportive care, thrombolysis
Presentation about the hazards and potential complications that could happen in any cardiac or peripheral catheterization procedure and how to avoid them
This document defines cardiac dysrhythmias and discusses their incidence and causes in the perioperative period. It notes that dysrhythmias are common in patients undergoing surgery, occurring in over 70% of patients receiving general anesthesia. The causes include changes in cardiac ion channels from medications or clinical situations as well as pathological processes like injury or damage to the conduction system. Reentry and automaticity are two main mechanisms that can precipitate arrhythmias. Perioperative dysrhythmias are frequently benign but may become symptomatic in high-risk patients.
Post cardiac surgery monitoring & follow upRubayet Anwar
This document provides information on post-cardiac surgery monitoring and follow up. It discusses admission to the ICU, initial assessment, monitoring techniques, complications that can occur like bleeding and hemodynamic issues, and management strategies for those complications. The early focus is on stabilizing vital signs, addressing hypothermia, identifying potential issues like low cardiac output, and treating medical causes of bleeding through correcting coagulation abnormalities.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
This document provides information on thoracic injuries from both blunt and penetrating trauma. It discusses the anatomy of the chest wall and epidemiology of chest trauma. For evaluation and management, it emphasizes treating life-threatening injuries immediately, such as tension pneumothorax. It then covers specific injury types in depth, including chest wall injuries, lung injuries, cardiac injuries, diaphragm injuries, and injuries to aerodigestive structures. Diagnosis and treatment approaches are outlined for each type.
A presentation was given on cerebrovascular accidents (strokes) and transient ischemic attacks (TIAs). The presentation defined strokes and TIAs, identified their risk factors and etiologies. It described the pathophysiology of ischemic and hemorrhagic strokes, their clinical manifestations and diagnostic studies. The presentation also discussed the management and prevention of strokes and TIAs.
This document provides an overview of sudden cardiac death, including its definition, epidemiology, risk factors, etiologies, clinical features, management, and prevention. Some key points include:
- Sudden cardiac death is defined as natural death from cardiac causes within 1 hour of symptom onset. It accounts for about 50% of cardiovascular deaths.
- Risk factors include increasing age, male sex, coronary heart disease, smoking, elevated cholesterol, emotional stress, depression, low socioeconomic status, and left ventricular dysfunction.
- Transient factors like ischemia, electrolyte abnormalities, drugs, and autonomic influences can trigger lethal arrhythmias in those with underlying structural heart issues. Antiarrhythmic drugs in particular carry
This document provides an overview of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for adults. It discusses how VA-ECMO can support patients with refractory cardiopulmonary failure for weeks. It describes the hemodynamics of cardiogenic shock and how VA-ECMO impacts pressure-volume loops. It outlines strategies to reduce pulmonary congestion on VA-ECMO and lists contraindications and predictors of mortality. It also discusses the use of ECMO for cardiac arrest (ECPR) and criteria for its use for refractory ventricular tachycardia or cardiogenic shock.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
pre and post transplant echo , contrast echo Leonardo Vinci
This document discusses the use of contrast echocardiography for pre- and post-operative evaluation of heart transplant patients. It outlines how echocardiography is used to evaluate donor hearts prior to transplantation, assess for complications immediately after transplantation, and monitor cardiac structure and function long-term. Contrast echocardiography helps improve endocardial border visualization and allows for more accurate assessment of parameters like ventricular volumes and ejection fraction both before and after transplantation. The document also discusses the role of echocardiography in diagnosing issues like rejection and transplant coronary artery disease.
The document provides a history and overview of intra-aortic balloon pumps (IABP). Some key points:
- IABP technology was first developed in the 1960s and improved to smaller catheter sizes over time. Current sizes are 7-7.5 French.
- IABPs work by inflating in diastole to increase coronary blood flow and deflating in systole to reduce left ventricular workload.
- Indications for IABP use include cardiogenic shock, high-risk PCI/CABG, and bridging to transplant. Contraindications include severe aortic insufficiency.
- Complications can include limb ischemia, infection, thrombosis, and a
The document summarizes a seminar presentation on arrhythmias. It discusses the classification, causes, clinical manifestations and management of arrhythmias. It covers topics like sinus rhythm, supraventricular tachycardia, ventricular arrhythmias, blocks, and preexcitation syndromes. Specific arrhythmias discussed in detail include sinus tachycardia, sinus bradycardia, sinus arrest, atrioventricular reentrant tachycardia, and Wolff-Parkinson-White syndrome. Treatment options for supraventricular tachycardia such as vagal maneuvers, adenosine, and beta-blockers are also summarized.
This document discusses myocarditis and various types of cardiomyopathy. It defines myocarditis as an acute inflammatory condition of the heart muscle that is usually due to infections, toxins, or autoimmune causes. The most common causes are viral infections. Myocarditis can lead to dilated cardiomyopathy over time in some cases. Dilated cardiomyopathy is characterized by enlarged, weakened heart ventricles. Causes include genetic factors, alcohol use, and prior viral myocarditis. Hypertrophic cardiomyopathy causes abnormal thickening of the heart muscle and can lead to heart failure or arrhythmias. Arrhythmogenic right ventricular cardiomyopathy primarily affects the right ventricle and can cause arrhythmias or sudden death.
A 35-year-old female presented with dyspnea and was found to have a giant coronary artery fistula originating from the proximal right coronary artery and draining into the right atrium, with the right coronary artery measuring up to 30mm in diameter. She underwent percutaneous closure of the fistula using an AVP II 16mm occlusion device. At 1-year follow up, echocardiography showed no residual shunting and improved cardiac function. Coronary artery fistulas are abnormal connections between a coronary artery and a cardiac chamber or vessel that may cause ischemia, heart failure, or pulmonary hypertension if large. Percutaneous closure is usually recommended for symptomatic large fistulas.
Cardiopulmonary bypass (CPB) is used to temporarily stop the heart and lungs during open-heart surgery and replace their function artificially. The heart is accessed via median sternotomy and the great vessels are cannulated before heparinization and connection to the bypass circuit. CPB is used for congenital heart defects, heart transplantation, valve repair, and coronary artery bypass grafting (CABG). CABG involves grafting a blood vessel to bypass a blocked coronary artery and improve blood flow to the heart. It is the standard treatment for multi-vessel coronary artery disease. Risks include bleeding, infection, embolism, neurological and pulmonary complications.
An aortic dissection is a tear in the inner layer of the aorta that allows blood to flow between the layers of the aortic wall, creating a false passageway. It is a medical emergency that requires prompt diagnosis and treatment. Type A dissections, which involve the ascending aorta, require emergency surgery while type B dissections, involving only the descending aorta, are generally treated medically with blood pressure control. Surgical treatment of type A dissections aims to remove the damaged aortic segment and restore blood flow through the aorta using a graft.
This document summarizes cerebrovascular disease and stroke. Stroke is the third leading cause of death and a common cause of disability. Imaging such as CT and MRI are used to distinguish between ischemic and hemorrhagic stroke and identify underlying vascular abnormalities. Risk factors include age, hypertension, cardiac sources of embolism, and other conditions. Treatment aims to reverse pathology, prevent complications, and reduce risk of further strokes.
This document summarizes cerebrovascular disease and stroke. Stroke is the third leading cause of death and a common cause of disability. Imaging such as CT and MRI are used to distinguish between ischemic and hemorrhagic stroke and identify underlying vascular abnormalities. Risk factors include age, hypertension, cardiac sources of embolism, and vascular diseases. Acute stroke is characterized by rapid onset neurological deficits localized to the brain region supplied by an occluded artery. Differential diagnosis includes tumors, infections, and seizures.
This document discusses recent advances in cardiac trauma management. It begins by noting that cardiac injuries continue to cause significant mortality despite trauma care improvements. Most injuries are from violence, with penetrating wounds having a better outcome than gunshots. Rapid diagnosis and surgery can save patients otherwise lost. The treatment of cardiac trauma is described, from ancient times to modern developments like cardiopulmonary bypass enabling complex injury repair. Initial trauma management priorities and diagnostic tests are outlined. Treatment depends on injury mechanism and stability, and may involve pericardiocentesis, thoracotomy, or cardiorrhaphy surgery. Advances in cardiac surgery have allowed for more successful management of traumatic cardiac injuries.
This document provides an overview of atrial fibrillation including its definition, pathophysiology, diagnosis, treatment options and the Cox-Maze procedure. Atrial fibrillation is characterized by rapid, irregular contractions that result in ineffective pumping. It is caused by either focal triggers or reentrant wavelets circulating in the atria. Treatment involves rate control, anticoagulation and procedures to restore normal sinus rhythm such as the Cox-Maze procedure which uses incisions and ablation to disrupt the pathways that support reentrant wavelets.
- STEMI is a major cause of morbidity and mortality globally and in Saudi Arabia due to increasing risk factors. Only 42% of STEMI patients undergo primary PCI (PPCI) in Saudi Arabia, with only 62% achieving door-to-balloon times under 90 minutes. Mortality is influenced by factors like age, time to treatment, and presence of STEMI networks. PPCI is the preferred reperfusion strategy over fibrinolytics when possible. Guidelines recommend antiplatelet and anticoagulation medications during PPCI and secondary prevention medications like statins long-term.
This document defines ventricular tachycardia and ventricular fibrillation, and outlines the ACLS algorithms for cardiac arrest caused by VT/VF. VT is defined as too rapid myocardial contraction preventing adequate cardiac output, while VF is rapid, uncoordinated myocardial cell contraction preventing coordinated contraction. Causes include ischemia, structural heart issues, electrolyte disturbances, and others. Immediate CPR and defibrillation improve odds of return of spontaneous circulation (ROSC). If ROSC is achieved, post-cardiac arrest care is needed to manage ischemia/reperfusion injury risks like low blood pressure and cardiac dysfunction.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
A presentation was given on cerebrovascular accidents (strokes) and transient ischemic attacks (TIAs). The presentation defined strokes and TIAs, identified their risk factors and etiologies. It described the pathophysiology of ischemic and hemorrhagic strokes, their clinical manifestations and diagnostic studies. The presentation also discussed the management and prevention of strokes and TIAs.
This document provides an overview of sudden cardiac death, including its definition, epidemiology, risk factors, etiologies, clinical features, management, and prevention. Some key points include:
- Sudden cardiac death is defined as natural death from cardiac causes within 1 hour of symptom onset. It accounts for about 50% of cardiovascular deaths.
- Risk factors include increasing age, male sex, coronary heart disease, smoking, elevated cholesterol, emotional stress, depression, low socioeconomic status, and left ventricular dysfunction.
- Transient factors like ischemia, electrolyte abnormalities, drugs, and autonomic influences can trigger lethal arrhythmias in those with underlying structural heart issues. Antiarrhythmic drugs in particular carry
This document provides an overview of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for adults. It discusses how VA-ECMO can support patients with refractory cardiopulmonary failure for weeks. It describes the hemodynamics of cardiogenic shock and how VA-ECMO impacts pressure-volume loops. It outlines strategies to reduce pulmonary congestion on VA-ECMO and lists contraindications and predictors of mortality. It also discusses the use of ECMO for cardiac arrest (ECPR) and criteria for its use for refractory ventricular tachycardia or cardiogenic shock.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
pre and post transplant echo , contrast echo Leonardo Vinci
This document discusses the use of contrast echocardiography for pre- and post-operative evaluation of heart transplant patients. It outlines how echocardiography is used to evaluate donor hearts prior to transplantation, assess for complications immediately after transplantation, and monitor cardiac structure and function long-term. Contrast echocardiography helps improve endocardial border visualization and allows for more accurate assessment of parameters like ventricular volumes and ejection fraction both before and after transplantation. The document also discusses the role of echocardiography in diagnosing issues like rejection and transplant coronary artery disease.
The document provides a history and overview of intra-aortic balloon pumps (IABP). Some key points:
- IABP technology was first developed in the 1960s and improved to smaller catheter sizes over time. Current sizes are 7-7.5 French.
- IABPs work by inflating in diastole to increase coronary blood flow and deflating in systole to reduce left ventricular workload.
- Indications for IABP use include cardiogenic shock, high-risk PCI/CABG, and bridging to transplant. Contraindications include severe aortic insufficiency.
- Complications can include limb ischemia, infection, thrombosis, and a
The document summarizes a seminar presentation on arrhythmias. It discusses the classification, causes, clinical manifestations and management of arrhythmias. It covers topics like sinus rhythm, supraventricular tachycardia, ventricular arrhythmias, blocks, and preexcitation syndromes. Specific arrhythmias discussed in detail include sinus tachycardia, sinus bradycardia, sinus arrest, atrioventricular reentrant tachycardia, and Wolff-Parkinson-White syndrome. Treatment options for supraventricular tachycardia such as vagal maneuvers, adenosine, and beta-blockers are also summarized.
This document discusses myocarditis and various types of cardiomyopathy. It defines myocarditis as an acute inflammatory condition of the heart muscle that is usually due to infections, toxins, or autoimmune causes. The most common causes are viral infections. Myocarditis can lead to dilated cardiomyopathy over time in some cases. Dilated cardiomyopathy is characterized by enlarged, weakened heart ventricles. Causes include genetic factors, alcohol use, and prior viral myocarditis. Hypertrophic cardiomyopathy causes abnormal thickening of the heart muscle and can lead to heart failure or arrhythmias. Arrhythmogenic right ventricular cardiomyopathy primarily affects the right ventricle and can cause arrhythmias or sudden death.
A 35-year-old female presented with dyspnea and was found to have a giant coronary artery fistula originating from the proximal right coronary artery and draining into the right atrium, with the right coronary artery measuring up to 30mm in diameter. She underwent percutaneous closure of the fistula using an AVP II 16mm occlusion device. At 1-year follow up, echocardiography showed no residual shunting and improved cardiac function. Coronary artery fistulas are abnormal connections between a coronary artery and a cardiac chamber or vessel that may cause ischemia, heart failure, or pulmonary hypertension if large. Percutaneous closure is usually recommended for symptomatic large fistulas.
Cardiopulmonary bypass (CPB) is used to temporarily stop the heart and lungs during open-heart surgery and replace their function artificially. The heart is accessed via median sternotomy and the great vessels are cannulated before heparinization and connection to the bypass circuit. CPB is used for congenital heart defects, heart transplantation, valve repair, and coronary artery bypass grafting (CABG). CABG involves grafting a blood vessel to bypass a blocked coronary artery and improve blood flow to the heart. It is the standard treatment for multi-vessel coronary artery disease. Risks include bleeding, infection, embolism, neurological and pulmonary complications.
An aortic dissection is a tear in the inner layer of the aorta that allows blood to flow between the layers of the aortic wall, creating a false passageway. It is a medical emergency that requires prompt diagnosis and treatment. Type A dissections, which involve the ascending aorta, require emergency surgery while type B dissections, involving only the descending aorta, are generally treated medically with blood pressure control. Surgical treatment of type A dissections aims to remove the damaged aortic segment and restore blood flow through the aorta using a graft.
This document summarizes cerebrovascular disease and stroke. Stroke is the third leading cause of death and a common cause of disability. Imaging such as CT and MRI are used to distinguish between ischemic and hemorrhagic stroke and identify underlying vascular abnormalities. Risk factors include age, hypertension, cardiac sources of embolism, and other conditions. Treatment aims to reverse pathology, prevent complications, and reduce risk of further strokes.
This document summarizes cerebrovascular disease and stroke. Stroke is the third leading cause of death and a common cause of disability. Imaging such as CT and MRI are used to distinguish between ischemic and hemorrhagic stroke and identify underlying vascular abnormalities. Risk factors include age, hypertension, cardiac sources of embolism, and vascular diseases. Acute stroke is characterized by rapid onset neurological deficits localized to the brain region supplied by an occluded artery. Differential diagnosis includes tumors, infections, and seizures.
This document discusses recent advances in cardiac trauma management. It begins by noting that cardiac injuries continue to cause significant mortality despite trauma care improvements. Most injuries are from violence, with penetrating wounds having a better outcome than gunshots. Rapid diagnosis and surgery can save patients otherwise lost. The treatment of cardiac trauma is described, from ancient times to modern developments like cardiopulmonary bypass enabling complex injury repair. Initial trauma management priorities and diagnostic tests are outlined. Treatment depends on injury mechanism and stability, and may involve pericardiocentesis, thoracotomy, or cardiorrhaphy surgery. Advances in cardiac surgery have allowed for more successful management of traumatic cardiac injuries.
This document provides an overview of atrial fibrillation including its definition, pathophysiology, diagnosis, treatment options and the Cox-Maze procedure. Atrial fibrillation is characterized by rapid, irregular contractions that result in ineffective pumping. It is caused by either focal triggers or reentrant wavelets circulating in the atria. Treatment involves rate control, anticoagulation and procedures to restore normal sinus rhythm such as the Cox-Maze procedure which uses incisions and ablation to disrupt the pathways that support reentrant wavelets.
- STEMI is a major cause of morbidity and mortality globally and in Saudi Arabia due to increasing risk factors. Only 42% of STEMI patients undergo primary PCI (PPCI) in Saudi Arabia, with only 62% achieving door-to-balloon times under 90 minutes. Mortality is influenced by factors like age, time to treatment, and presence of STEMI networks. PPCI is the preferred reperfusion strategy over fibrinolytics when possible. Guidelines recommend antiplatelet and anticoagulation medications during PPCI and secondary prevention medications like statins long-term.
This document defines ventricular tachycardia and ventricular fibrillation, and outlines the ACLS algorithms for cardiac arrest caused by VT/VF. VT is defined as too rapid myocardial contraction preventing adequate cardiac output, while VF is rapid, uncoordinated myocardial cell contraction preventing coordinated contraction. Causes include ischemia, structural heart issues, electrolyte disturbances, and others. Immediate CPR and defibrillation improve odds of return of spontaneous circulation (ROSC). If ROSC is achieved, post-cardiac arrest care is needed to manage ischemia/reperfusion injury risks like low blood pressure and cardiac dysfunction.
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In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Cardiac arrhythmia after thoracotomy.pptx
1. JIMMA UNIVERSITY INSTITUTE
OF HEALTH SCIENCE,
DEPARTMENTS OF ANESTHESIA
Cardiac Arrhythmia After Thoracic surgery
Gemechis Akuma
April 2023
2. Learning objectives
• At the end of this presentation we will be able to:
Identify the common post-thoracotomy cardiac arrhythmias
Discuss the potential mechanisms and risk factors for these
rhythm disturbances post thoracotomy
Describe treatment option and prevention of post
thoracotomy arrhythmia
2
9/16/2023
3. Introduction
• Postoperative cardiac dysrhythmias are common after
thoracic surgery; open thoracotomy or VAT
• The most common arrhythmia is atrial fibrillation,
although other forms of supraventricular arrhythmias
(AF, AT), ventricular tachyarrhythmias (VT,VF), and
conduction disturbances (high-degree AV block can
also occur
• Supraventricular dysrhythmias occur in as many as
20% following thoracotomy. (Vretzakis et al., 2013)
9/16/2023 3
4. • Abnormalities of rate, regularity, site of impulse
origin, and sequence of activation are some
documented complications.
• These arrhythmias usually have an uneventful
clinical course and revert to normal sinus
rhythm, before patent’s discharge.
• In some case this may associated with
immediate hemodynamic consequences, longer
hospital stay and higher cost
9/16/2023 4
5. Factors contributing to these dysrhythmias:
• Underlying cardiac disease,
• Degree of surgical trauma
• Intraoperative cardiac manipulation
• A reduced pulmonary function
• Effects of anesthetics and cardio-active drugs
• Metabolic abnormalities
• Male gender and old age
• Direct injury /stimulation of the ANS by pain
5
9/16/2023
6. Pathophysiology
• It is complex and their clinical manifestation requires both
the presence of a vulnerable cardiac substrate and a trigger
factors
• Changes in myocardial structure and electrical function
constitute the substrate for arrhythmias
– atrial fibroses (favoring AT,AF/AFI), myocardial hypertrophy
(prolongation of repolarization), chamber dilatation (favoring for,
ectopic automaticity), or a post myocardial infarction scar
(promoting sustained VT).
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7. • The arrhythmia trigger is defined as a single
incident that may set off an arrhythmia
• Many perioperative factors can be affect both
the arrhythmia substrate and trigger
– Patient related and surgery related factors
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8. Patient-related risk factors
• Increasing age
• Men
• Hx of arrhythmias
• Structural heart disease (CAD, valve disease,
LV hypertrophy, LV dysfunction)
• Extracardiac risk factors (obesity, sleep apnea
syndrome, previous stroke, and concomitant
lung disease)
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9. Surgery-related risk factors
• Surgical trauma (type of procedure, magnitude of lung resection,
dissection near atria, mechanical factors such as instrumentation,
direct injury/stimulation of the ANS by pain
• Hemodynamic stress (volume overload or depletion, HTN,
endogenous catecholamines)
• Metabolic changes (hypoxemia, hypercarbia, acid–base imbalance
• Electrolyte disturbances (particularly hypokalemia)
• Drug effects (BB withdrawal, digoxin, exo/catecholamines, etc.)
• Anesthesia technique and drugs
9/16/2023 9
10. The heart is innervated by both SNS and PS
filaments, accompanying the coronary arteries and
their branches.
• Autonomic cardiac nerves may be exposed,
retracted, and injured during thoracic surgery.
• cardiac plexus located between the aortic arch and
the tracheal bifurcation
– vulnerable to direct damage, especially in thoracotomies
implicating dissection of pulmonary hilum or sampling of
nodes located in this area
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11. • Injury to the PS branches of the SA node may
result in increased heart rate and affect AV
conduction.
• Surgically induced alterations in the efferent
sympathetic outflow to the heart may account
for postop cardiac arrhythmias.
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12.
13. Routine measure for all intraop
arrhythmia
• Assure adequate oxygenation and ventilation
• Alteration in depth of anesthesia
• Assume optimum O2,CO2, acid/base/, electrolyte,
temp.
• Reevaluate cardiac hx/pathology
• Get ready for
– ant arrhythmia drugs
– Anti-ischemic drugs
– Pacing and DC shock
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14.
15. 1. Bradycardia after thoracic
surgery
• Bradyarrhythmia's are common after cardiac
surgery (particularly after valve surgery), but
are relatively rare after noncardiac thoracic
surgery
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16.
17. Management
• In asymptomatic no t/t required
• For mildly symptomatic pt eliminate
underlined factors
• Atropine 0.5 mg iv may used??
• In severely symptomatic those with chest pain
/syncope immediate pacing required
• Epinephrine or dopamine
9/16/2023 17
18.
19. 2. Sinus Tachycardia after thoracic
surgery
• Regular and 100-160 rate?
• Increased SA node discharge
• 20 to symphatatic stimulation/physiology,
patho, pharm response/
9/16/2023 19
20.
21.
22. 3. Paroxysmal Supraventricular
Tachycardia
• Postop PSVT is relatively rare, it may occur
from time to time.
• related symptoms include palpitations,
fatigue, chest discomfort, and dyspnea.
• are usually young (<60 years of age) and not
have structural heart disease.
• The arrhythmia has an abrupt onset, 160 - 220
beta/min.
9/16/2023 22
23. • The most common form of PSVT is AV-nodal
reentrant tachycardia.
– arrhythmia involves dual electrical pathways in or
near the AV node.
• The second most common form is AV- re-
entrant tachycardia involving an extranodal
accessory pathway
9/16/2023 23
24. • Vagal maneuvers (breath holding or the
Valsalva maneuver) are not always successful;
• Adenosine 6 mg can be used in increasing
doses.
• Success rates are exceed 95% and Electrical
cardioversion is rarely needed.
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25. 4. VENTRICULAR ARRYTHYMIA
• Postop Ventricular arrhythmia do not indicate an
increased risk for the development of malignant
ventricular tachyarrhythmias (i.e., sustained VT, Vf
and PVT)
• May not need for further evaluation or treatment.
• Reported incidences after surgery range from 0.5 to
1.5%
9/16/2023 25
26. • When frequent and complex premature beats and
nonsustained VT occur, the correction of any reversible
cause in mandatory.
• Antiarrhythmic drugs may be indicated when longer
and/or repeated ventricular tachycardia develop.
– amiodarone 150 mg over 10 minutes
– Class I antiarrhythmic drugs e.g., lidocaine or procaine amide
• PVT need immediate cardio version /defirlibration and
CPR.
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27.
28. 5. Atrial fibrillation
• POAF is the most common periop cardiac
arrhythmia.
• Commonly occur within 2–4 days postop(12 to 44%)
• Advanced age is major risk both
Thoracic surgical procedures risk were divided based
on expected incidence of POAF
multiple effects on cardiopulmonary hemodynamics,
tachyarrhythmia is most common presentation.
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29. rapid irregular rate cause insufficient coronary
flow to compensate myocardial O2 demand
Decreased diastolic filling time and CO
increased risk of stroke, mortality, and LoS in hospital
AF presents as a brady → lead to ↓ CO in fixed SV.
loss of atrial contraction, mainly in patients with HT and
diastolic dysfunction, increases PA pressures
These effect can lead to hypotension, HF, and MI.
9/16/2023 29
30. Periop management
• New onset AF before surgery postpon and correct
• T/t during sx depend on hemodynamic of stability
• If hemo-dynamicaly significant t/t cardio version
– Synchronized elect. cardio version 100-200J effective
– Pharm. Cardio version IV amiodarone (pref),
diltiazem, verapamil may used
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31. • Chronic AF maintain their antiarrhythmic
drugs and close follow electrolyte (K and Mg)
• Manage the transition on and off IV and oral
anticoagulant
correct reversible conditions like electrolytes
imbalances to prevent the POAF.
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32. • Immediate electrical cardioversion is indicated
in severe hemodynamic deterioration in
response to POAF.
– The administration of phenylephrine will support
cardiac output.
– impaired CO vs effect pulmonary function in
volume depletion.
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33. • Amiodarone IV should be preferred in patients
with known severe systolic dysfunction.
• CCB and digitalis to treat POAF
– Verapamil has been reported to be effective.
• hypotension from vasodilatory and negative inotropic.
• BB may be necessary for rapid supraventricular
dysrhythmias associated with HTN and MI, but
may cause bronchospasm.
– Esmolol is effective but short acting
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34. • Patients who develop atrial fibrillation after
surgery are at risk of thromboembolic events,
including stroke
– weighed against the risk of postoperative bleeding
and a reduction of thromboembolic event
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35. Prevention and treatment of postthoracotomy
arrhythmias is an important issue
Prophylactic metoprolol can decrease the
incidence of AF.
Prophylactic digitalization has long been
recommended, but recent studies have
reported either no difference or a higher
incidence of arrhythmias in thoracic surgical
patients receiving digoxin.
9/16/2023 35
36. 6. Atrial flutter
• relatively uncommon compared to atrial
fibrillation.
• It is sometimes confused with atrial
fibrillation.
• atrial flutter is more organized and less chaotic
than the abnormal pattern common with AF
9/16/2023 36
37. • The approach to patients with atrial flutter is
similar with the exception that class I
antiarrhythmic agents should not be used in
patients with atrial flutter.
• Electrical cardioversion is the preferred
method to achieve sinus rhythm
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38.
39.
40. 1. Class I: Sodium Channel Blockers: e.g.
– Class IA :procainamide,
– Class IB: lidocaine and phenytoin, and
– Class IC: flecainide.
2. Class II: Beta Blockers e.g. metoprolol,
propranolol, esmolol, atenolol, and timolol.
3. Class III: Potassium Channel Blockers e.g.
amiodarone
4. Class IV: Calcium Channel Blockers e.g. verapamil
and diltiazem
40
9/16/2023
45. References
1. Miller’s Anesthesia 9th edition volume 2
2. Morgan & Mikhail’s Clinical Anesthesiology 6th Edition
3. Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy
period: Volume 23, Issue 3, March 2003, Pages 384–389
4. Haverkamp W, Hachenberg T. Post-thoracotomy dysrhythmia. Curr Opin Anaesthesiol.
2016
5. Vaporciyan AA, Correa AM, Rice DC, et al. Risk factors associated with atrial
fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac
Cardiovasc Surg 2004; 1
6. American Association for Thoracic Surgery. 2014 AATS guidelines for the prevention
and management of perioperative atrial fibrillation and flutter for thoracic surgical
procedures. J Thorac Cardiovasc.
45
9/16/2023
Editor's Notes
with a frequency and severity proportional to both their age and the magnitude of the surgical procedure.
Cardiac arrhythmias are a significant cause of morbidity and mortality in the periop period.
for surgical treatment of intrathoracic pathology
PATIENT OR POCEDURE FACTORoccurring more frequently after pneumonectomy than after lobectomy
surgical factors (irritation of the atria per se or on the ground of chronic inflammation of aged atria), direct injury to the anatomic structure of the ANS in the thoracic cavity, and postthoracotomy pain may contribute
The pathophysiology of arrhythmias is complex.
It is generally accepted that their clinical manifestation requires both the presence of a vulnerable cardiac substrate and a trigger that initiates the Arrhythmia
Changes in myocardial structure and electrical function constitute the substrate for arrhythmias
atrial fibroses (favoring atrial tachycardia, atrial flutter, and atrial fibrillation), myocardial hypertrophy (resulting in prolongation of myocardial repolarization), chamber dilatation (favoring the development of ectopic automaticity), or a post myocardial infarction scar (promoting sustained ventricular tachycardia).
The substrate is patients specific, but may be modified by the below-discussed risk factors.
The role of direct injury to the autonomic cardiac innervation during thoracotomies is speculated by a number of reports
Common causes of perioperative arrhythmiasAnesthetic agents (volatile or intravenous agents, neuromuscular blockers, opioids)
Local anesthetics
Hypotermia
Acid - base or electrolyte imbalance
Hypoxia - hypercarbia
Anesthesia depth
Surgery types (ocular - cranial interventions, peritoneal traction…)
Comorbidities (cardiac, endocrin, others)
Laryngoscopy, intubation, other irritating factors
Alternative drugs (adrenaline…)
Variations from the normal rhythm of the heartbeat, encompassing abnormalities of rate, regularity, site of impulse origin, and sequence of activation are well-documented complications following thoracotomies.
in order to facilitate the preoperative risk stratification of patients
Decreased diastolic filling time and CO are important physiological consequences of tachyarrhythmias
Any impaired CO may require fluid loading to enhance preload, which in turn can adversely affect pulmonary function.
The drug also exerts antiarrhythmic effects, which may lead to termination of the arrhythmia.