Case Study - Adult - High Output Cardiac Failure - Inotropes, Inotropy and SMII
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When the heart is unable to meet the needs of the body, then the heart has failed. Whether the cause is due to myocardial infarction, valvular disease or arrhythmia. Heart failure is inadequate maintenance of blood pressure and or blood flow. Potential Energy (PE) is blood pressure and Kinetic Energy (KE) is blood flow. SMII is a measure of the heart’s energy or power.
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Case Study - Pediatric - Septic Shock - Fluid Responsiveness and SMII
When the heart is unable to meet the needs of the body, then the heart has failed. Whether the cause is due to myocardial infarction, valvular disease or arrhythmia. Heart failure is inadequate maintenance of blood pressure and or blood flow. Potential Energy (PE) is blood pressure and Kinetic Energy (KE) is blood flow. SMII is a measure of the heart’s energy or power.
High output cardiac failure
High Output Cardiac Failure
The tissues, not the heart, determine cardiac output by controlling local blood flow through vasodilation in response to changes in oxygen and carbon dioxide levels. As vascular resistance decreases, stroke volume increases, maintaining blood pressure. A high cardiac output becomes "high output failure" when blood pressure cannot be maintained against low systemic vascular resistance, or oxygen delivery is insufficient. The diagnostic triad is high cardiac output, low blood pressure, and very low systemic vascular resistance. Treatment focuses on balancing oxygen delivery and demand by optimizing preload, contractility, and afterload through fluid administration and inotropic support tailored to individual hemodynamic parameters.
Cardiac A&P Review
(1) The document provides an overview of cardiac anatomy and physiology, including the layers of the heart, chambers, valves, blood vessels, and the pumping action.
(2) It describes the pericardium, myocardium, endocardium, atria, ventricles, valves, coronary arteries and veins, and how preload, contractility, afterload, and heart rate impact cardiac output.
(3) Key concepts covered are the Frank-Starling mechanism, factors that increase or decrease preload, contractility, and afterload, and how systemic vascular resistance impacts cardiac output.
Heart block
Atrioventricular heart block occurs when electrical signals between the atria and ventricles are interrupted or delayed. There are three types - first degree causes a prolonged PR interval, second degree is intermittent conduction with Mobitz types I and II, and third degree is complete block. Causes include myocardial infarction, medications, infections, degeneration. Symptoms range from none in first degree to bradycardia, hypotension, syncope in higher degrees. Treatment depends on symptoms but may include medication changes, temporary pacing, and permanent pacemaker for chronic cases.
Ventricular Rhythms - BMH/Tele
This document discusses various ventricular rhythms and arrhythmias:
- Ventricular rhythms originate from the ventricular conduction system and include bundle branch blocks, premature ventricular contractions, ventricular escape beats, idioventricular rhythms, ventricular tachycardia, and ventricular fibrillation.
- Bundle branch blocks involve slowed conduction through one of the bundle branches, resulting in a widened QRS complex.
- Premature ventricular contractions originate from ectopic sites in the ventricles and cause the ventricles to depolarize sequentially, resulting in a wide, bizarre QRS complex.
- Ventricular tachycardia is a regular, rapid rhythm originating from the ventricles that can
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1) Preeclampsia is associated with increased risk of future cardiovascular disease. It causes multisystem changes in the mother due to placental dysfunction and endothelial damage.
2) Maternal heart function adapts during preeclampsia and hypertension by showing diastolic dysfunction, increased total vascular resistance, and a shift toward a concentric left ventricular geometric pattern.
3) Women who develop complications during preeclampsia and hypertension have higher blood pressure, total vascular resistance, and are more likely to exhibit a concentric left ventricular geometry compared to those whose conditions remain uncomplicated.
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Ventricular pump function is often compromised during critical illness and for a variety of reasons. The most common cause of a limited cardiac output in acutely ill patients is right ventricular (RV) dysfunction. Exacerbations of chronic obstructive lung disease or the use of high end-expiratory pressure sin acute lung injury to support arterial oxygenation can result in acute elevations of pulmonary arterial pressure impeding RV ejection, causing RV dilation, decreased left ventricular (LV) diastolic compliance. All these effects limit cardiac output and LV stroke volume. Importantly, the treatment is to sustain mean arterial pressure greater than pulmonary artery pressure to prevent RV ischemia and balance RV fluid status to avoid both over-distention (acute cor pulmonale) and under-filling. This delicate fluid balance is greatly facilitated by the immediate and repeated use of bedside echocardiography. Attempts to minimize lung over distention should be a primary focus of therapy. If one focuses only on the LV, these patients would be said to have a reversible form of diastolic dysfunction, in that LV ejection fraction would be normal but the LV not able to increase its end-diastolic volume without excess filling pressures promoting pulmonary edema. The second most common etiology of impaired heart functional reserve is chronic LV hypertrophy secondary to hypertension, wherein systemic afterload reduction is the primary treatment. Third, decreased systolic pump function is often seen in sepsis owing to reduced myocardial adrenergic responsiveness. However, this is often under-appreciated because of the usually co-existent peripheral vasodilation. In septic patients, measures aimed primarily to increase mean arterial pressure, such as the use of vasopressors often results in a decrease in cardiac output because the septic heart is not able to handle the increased load. Importantly, this form of systolic dysfunction is reversible once the sepsis state resolves, but may require inotropes during its height to sustain flow under pressure. Finally both chronic heart failure patients can also get sick and acute myocardial infarction will impair both diastolic and systolic function. Their treatments include reversing coronary ischemia, if present, afterload reduction and a balanced fluid response. A clear and logical approach to all critically ill patients is needed to quickly separate these diverse forms of heart failure from each other as they have markedly different therapies and clinical trajectories. Recommended
Case Study - Pediatric - Septic Shock - Fluid Responsiveness and SMII
When the heart is unable to meet the needs of the body, then the heart has failed. Whether the cause is due to myocardial infarction, valvular disease or arrhythmia. Heart failure is inadequate maintenance of blood pressure and or blood flow. Potential Energy (PE) is blood pressure and Kinetic Energy (KE) is blood flow. SMII is a measure of the heart’s energy or power.
High output cardiac failure
High Output Cardiac Failure
The tissues, not the heart, determine cardiac output by controlling local blood flow through vasodilation in response to changes in oxygen and carbon dioxide levels. As vascular resistance decreases, stroke volume increases, maintaining blood pressure. A high cardiac output becomes "high output failure" when blood pressure cannot be maintained against low systemic vascular resistance, or oxygen delivery is insufficient. The diagnostic triad is high cardiac output, low blood pressure, and very low systemic vascular resistance. Treatment focuses on balancing oxygen delivery and demand by optimizing preload, contractility, and afterload through fluid administration and inotropic support tailored to individual hemodynamic parameters.
Cardiac A&P Review
(1) The document provides an overview of cardiac anatomy and physiology, including the layers of the heart, chambers, valves, blood vessels, and the pumping action.
(2) It describes the pericardium, myocardium, endocardium, atria, ventricles, valves, coronary arteries and veins, and how preload, contractility, afterload, and heart rate impact cardiac output.
(3) Key concepts covered are the Frank-Starling mechanism, factors that increase or decrease preload, contractility, and afterload, and how systemic vascular resistance impacts cardiac output.
Heart block
Atrioventricular heart block occurs when electrical signals between the atria and ventricles are interrupted or delayed. There are three types - first degree causes a prolonged PR interval, second degree is intermittent conduction with Mobitz types I and II, and third degree is complete block. Causes include myocardial infarction, medications, infections, degeneration. Symptoms range from none in first degree to bradycardia, hypotension, syncope in higher degrees. Treatment depends on symptoms but may include medication changes, temporary pacing, and permanent pacemaker for chronic cases.
Ventricular Rhythms - BMH/Tele
This document discusses various ventricular rhythms and arrhythmias:
- Ventricular rhythms originate from the ventricular conduction system and include bundle branch blocks, premature ventricular contractions, ventricular escape beats, idioventricular rhythms, ventricular tachycardia, and ventricular fibrillation.
- Bundle branch blocks involve slowed conduction through one of the bundle branches, resulting in a widened QRS complex.
- Premature ventricular contractions originate from ectopic sites in the ventricles and cause the ventricles to depolarize sequentially, resulting in a wide, bizarre QRS complex.
- Ventricular tachycardia is a regular, rapid rhythm originating from the ventricles that can
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1) Preeclampsia is associated with increased risk of future cardiovascular disease. It causes multisystem changes in the mother due to placental dysfunction and endothelial damage.
2) Maternal heart function adapts during preeclampsia and hypertension by showing diastolic dysfunction, increased total vascular resistance, and a shift toward a concentric left ventricular geometric pattern.
3) Women who develop complications during preeclampsia and hypertension have higher blood pressure, total vascular resistance, and are more likely to exhibit a concentric left ventricular geometry compared to those whose conditions remain uncomplicated.
Cardiovascular Effects, Dr. C Sedacca, 4/5/14
This document discusses the cardiovascular effects of various systemic diseases, including endocrine, metabolic, infectious/inflammatory, and neoplastic conditions. It provides details on the cardiac pathophysiology, diagnostics, therapy, and prognosis for hyperthyroidism, hypothyroidism, Addison's disease, Cushing's disease, and other conditions. For hyperthyroidism, it describes the enhanced contractility, tachycardia, and potential for heart failure. Hypothyroidism is noted to have opposite effects and rarely causes heart failure. Addison's disease can cause hypotension and arrhythmias due to hypoaldosteronism and hyperkalemia. Cushing's disease may induce hypertension and exacerbate underlying heart
Pathophysiology of acute heart failure in ICU by Professor Michael Pinsky
Pathophysiology of acute heart failure in ICU by Professor Michael PinskyCICM 2019 Annual Scientific Meeting
Ventricular pump function is often compromised during critical illness and for a variety of reasons. The most common cause of a limited cardiac output in acutely ill patients is right ventricular (RV) dysfunction. Exacerbations of chronic obstructive lung disease or the use of high end-expiratory pressure sin acute lung injury to support arterial oxygenation can result in acute elevations of pulmonary arterial pressure impeding RV ejection, causing RV dilation, decreased left ventricular (LV) diastolic compliance. All these effects limit cardiac output and LV stroke volume. Importantly, the treatment is to sustain mean arterial pressure greater than pulmonary artery pressure to prevent RV ischemia and balance RV fluid status to avoid both over-distention (acute cor pulmonale) and under-filling. This delicate fluid balance is greatly facilitated by the immediate and repeated use of bedside echocardiography. Attempts to minimize lung over distention should be a primary focus of therapy. If one focuses only on the LV, these patients would be said to have a reversible form of diastolic dysfunction, in that LV ejection fraction would be normal but the LV not able to increase its end-diastolic volume without excess filling pressures promoting pulmonary edema. The second most common etiology of impaired heart functional reserve is chronic LV hypertrophy secondary to hypertension, wherein systemic afterload reduction is the primary treatment. Third, decreased systolic pump function is often seen in sepsis owing to reduced myocardial adrenergic responsiveness. However, this is often under-appreciated because of the usually co-existent peripheral vasodilation. In septic patients, measures aimed primarily to increase mean arterial pressure, such as the use of vasopressors often results in a decrease in cardiac output because the septic heart is not able to handle the increased load. Importantly, this form of systolic dysfunction is reversible once the sepsis state resolves, but may require inotropes during its height to sustain flow under pressure. Finally both chronic heart failure patients can also get sick and acute myocardial infarction will impair both diastolic and systolic function. Their treatments include reversing coronary ischemia, if present, afterload reduction and a balanced fluid response. A clear and logical approach to all critically ill patients is needed to quickly separate these diverse forms of heart failure from each other as they have markedly different therapies and clinical trajectories. Blood pressure
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Cardiac arrhythmia.
This document provides information about cardiac arrhythmias. It defines arrhythmias as any abnormal heart rate or rhythm and normal sinus rhythm as 60-100 bpm originating from the sinus node. Arrhythmias are classified as sinus, atrial, or ventricular based on origin. Common types include sinus tachycardia/bradycardia, atrial fibrillation, ventricular tachycardia, and heart blocks. Symptoms vary depending on type but can include palpitations, dizziness, and fainting. Diagnosis involves ECG, echocardiogram, and Holter monitoring. Treatment depends on type and may include medications, ablation, pacemakers, or defibrillators.
Atrial Rhythms - BMH/Tele
The document provides information about various types of atrial rhythms including:
1. Wandering atrial pacemaker rhythm which can occur in healthy young hearts and is caused by increased vagal effect slowing the sinus rate.
2. Premature atrial contractions which occur when an ectopic site discharges before the sinus node, and can have normal or abnormal ventricular conduction.
3. Supraventricular tachycardia including paroxysmal atrial tachycardia with a rate of 140-250 bpm.
4. Atrial flutter originating from one site at a rate of 250-400 bpm producing sawtooth waves, and variable ventricular conduction depending on the ratio.
Blood pressure
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This document discusses different types of arrhythmia including normotopic arrhythmia like sinus arrhythmia, sinus tachycardia, and sinus bradycardia. It also discusses ectopic arrhythmia which occurs when structures other than the SA node act as the pacemaker, leading to conditions like heart block, extrasystole, paroxysmal tachycardia, atrial flutter, atrial fibrillation, and ventricular fibrillation. Abnormal pacemakers can also develop from the AV node, atrial musculature, or ventricular musculature. Current of injury affects the ECG pattern through axis deviation when parts of the ventricle are affected.
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This document discusses different types of cardiac arrhythmias including bradyarrhythmias which are slow heart rhythms and tachyarrhythmias which are fast heart rhythms. It describes specific arrhythmias like sinus bradycardia, atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, ventricular fibrillation, and ventricular tachycardia. It also discusses diagnostic studies, management through lifestyle changes and medications, and treatment options like cardioversion, pacemakers, surgery, and ablation for various arrhythmias.
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Arterial pressure
The mean arterial pressure (MAP) is the average pressure in the arteries during one cardiac cycle and is a better indicator of tissue perfusion than systolic blood pressure. MAP is calculated based on cardiac output, systemic vascular resistance, and central venous pressure. Normal MAP is between 65-110 mmHg. Pulse wave velocity measures arterial stiffness and is influenced by arterial wall thickness and diameter. As pressure waves travel further from the heart, they become steeper and narrower due to vessel properties.
blood pressure
This document summarizes blood pressure, including defining it as the lateral pressure exerted by flowing blood on artery walls. It discusses types of blood pressure depending on the blood vessel, normal ranges, measurement methods, factors that affect blood pressure both physiologically and pathologically, complications of hypertension, and mechanisms that regulate arterial blood pressure over rapid, intermediate, and long term timescales.
Arrhythmia. Irregular Heartbeat
1. The document discusses different types of arrhythmias including tachycardia and bradycardia. It describes various causes of arrhythmias including functional, organic, hemodynamic, hormonal and congenital factors.
2. Types of arrhythmias are classified based on location in the heart as atrial, junctional, or ventricular. Common atrial arrhythmias include premature atrial contractions and atrial fibrillation.
3. Supraventricular tachycardia is a junctional arrhythmia and the most common type is atrioventricular nodal reentrant tachycardia. Symptoms can include a pounding heart, shortness of breath, chest pain and d
Blood pressure
Blood pressure is the force exerted by blood on the walls of arteries. It is measured as systolic over diastolic pressure in mmHg. Systolic pressure occurs when the heart contracts and diastolic when it relaxes. Blood pressure is regulated by the cardiovascular center in the brain through neural mechanisms like baroreceptor and chemoreceptor reflexes and hormonal factors like renin-angiotensin-aldosterone system and epinephrine. Local auto-regulation and factors like age, exercise and stress also affect blood pressure.
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- Common indications for a pacemaker include advanced heart block or symptomatic bradycardia.
- Potential problems include failure to sense or capture heartbeats correctly due to issues like lead displacement or battery failure.
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Arrythmia
Arrhythmias are abnormalities in heart rate or rhythm that arise from problems with the heart's electrical system. They can be caused by issues with impulse formation or conduction. Arrhythmias are classified as tachyarrhythmias, which involve fast heart rates, or bradyarrhythmias, which involve slow heart rates. Common arrhythmias include atrial fibrillation, atrial flutter, and various types of heart block. Diagnosis involves electrocardiography and other cardiac tests. Treatment may involve medications, cardiac ablation, implanted devices, or surgery depending on the type of arrhythmia.
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This document provides information about cardiac arrhythmias. It defines arrhythmias as any abnormal heart rate or rhythm and normal sinus rhythm as 60-100 bpm originating from the sinus node. Arrhythmias are classified as sinus, atrial, or ventricular based on origin. Common types include sinus tachycardia/bradycardia, atrial fibrillation, ventricular tachycardia, and heart blocks. Symptoms vary depending on type but can include palpitations, dizziness, and fainting. Diagnosis involves ECG, echocardiogram, and Holter monitoring. Treatment depends on type and may include medications, ablation, pacemakers, or defibrillators.
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The document provides information about various types of atrial rhythms including:
1. Wandering atrial pacemaker rhythm which can occur in healthy young hearts and is caused by increased vagal effect slowing the sinus rate.
2. Premature atrial contractions which occur when an ectopic site discharges before the sinus node, and can have normal or abnormal ventricular conduction.
3. Supraventricular tachycardia including paroxysmal atrial tachycardia with a rate of 140-250 bpm.
4. Atrial flutter originating from one site at a rate of 250-400 bpm producing sawtooth waves, and variable ventricular conduction depending on the ratio.
Blood pressure
Blood pressure is the pressure exerted by circulating blood on the walls of blood vessels. It is typically measured in millimeters of mercury (mmHg). Normal blood pressure is less than 120/80 mmHg. Blood pressure is regulated through both immediate mechanisms like baroreceptor reflexes and delayed mechanisms involving the kidneys, renin-angiotensin system, and other hormones. Factors that affect blood pressure include cardiac output, peripheral resistance, blood volume, vessel elasticity, and viscosity. Hypertension is defined as high blood pressure over 140/90 mmHg and can increase the risk of heart disease and stroke if left untreated.
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This document discusses different types of arrhythmia including normotopic arrhythmia like sinus arrhythmia, sinus tachycardia, and sinus bradycardia. It also discusses ectopic arrhythmia which occurs when structures other than the SA node act as the pacemaker, leading to conditions like heart block, extrasystole, paroxysmal tachycardia, atrial flutter, atrial fibrillation, and ventricular fibrillation. Abnormal pacemakers can also develop from the AV node, atrial musculature, or ventricular musculature. Current of injury affects the ECG pattern through axis deviation when parts of the ventricle are affected.
Arrhythmias
This document discusses different types of cardiac arrhythmias including bradyarrhythmias which are slow heart rhythms and tachyarrhythmias which are fast heart rhythms. It describes specific arrhythmias like sinus bradycardia, atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, ventricular fibrillation, and ventricular tachycardia. It also discusses diagnostic studies, management through lifestyle changes and medications, and treatment options like cardioversion, pacemakers, surgery, and ablation for various arrhythmias.
Arrythmia ratheesh
This document defines and describes various types of arrhythmias. It begins by defining arrhythmia as any change from the normal sequence of electrical impulses in the heart. Various cardiac and non-cardiac conditions can cause arrhythmias. The document then describes several specific types of arrhythmias in detail, including sinus bradycardia, sick sinus syndrome, sinus tachycardia, premature atrial contractions, atrial flutter, atrial fibrillation, junctional tachycardia, paroxysmal supraventricular tachycardia, premature ventricular contractions, ventricular fibrillation, pulseless electrical activity, asystole, and various types of heart block. Treatment options are provided for each type
Arterial pressure
The mean arterial pressure (MAP) is the average pressure in the arteries during one cardiac cycle and is a better indicator of tissue perfusion than systolic blood pressure. MAP is calculated based on cardiac output, systemic vascular resistance, and central venous pressure. Normal MAP is between 65-110 mmHg. Pulse wave velocity measures arterial stiffness and is influenced by arterial wall thickness and diameter. As pressure waves travel further from the heart, they become steeper and narrower due to vessel properties.
blood pressure
This document summarizes blood pressure, including defining it as the lateral pressure exerted by flowing blood on artery walls. It discusses types of blood pressure depending on the blood vessel, normal ranges, measurement methods, factors that affect blood pressure both physiologically and pathologically, complications of hypertension, and mechanisms that regulate arterial blood pressure over rapid, intermediate, and long term timescales.
Arrhythmia. Irregular Heartbeat
1. The document discusses different types of arrhythmias including tachycardia and bradycardia. It describes various causes of arrhythmias including functional, organic, hemodynamic, hormonal and congenital factors.
2. Types of arrhythmias are classified based on location in the heart as atrial, junctional, or ventricular. Common atrial arrhythmias include premature atrial contractions and atrial fibrillation.
3. Supraventricular tachycardia is a junctional arrhythmia and the most common type is atrioventricular nodal reentrant tachycardia. Symptoms can include a pounding heart, shortness of breath, chest pain and d
Blood pressure
Blood pressure is the force exerted by blood on the walls of arteries. It is measured as systolic over diastolic pressure in mmHg. Systolic pressure occurs when the heart contracts and diastolic when it relaxes. Blood pressure is regulated by the cardiovascular center in the brain through neural mechanisms like baroreceptor and chemoreceptor reflexes and hormonal factors like renin-angiotensin-aldosterone system and epinephrine. Local auto-regulation and factors like age, exercise and stress also affect blood pressure.
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Cardiac arrest
Cardiac arrest is the abrupt cessation of cardiac pump function that requires prompt intervention to prevent death. The four rhythms that can cause pulseless cardiac arrest are ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulseless electrical activity. Immediate CPR and defibrillation are critical, along with identifying and treating reversible causes such as hypoxia, acidosis, hypothermia, tamponade, pulmonary embolism, or drug overdose. Management involves high-quality CPR, defibrillation for shockable rhythms, intravenous epinephrine and amiodarone, and treating underlying causes.
Tachyarrhythmias
The document discusses tachyarrhythmias and provides details about various types. It begins by defining tachyarrhythmia as an abnormal cardiac rhythm with a heart rate over 100 beats per minute. There are three main causes of tachyarrhythmia: abnormal automaticity, triggered activity, and re-entry. Several types of tachyarrhythmia are then described in detail, including sinus tachycardia, atrial tachycardia, ventricular ectopic beats, and supraventricular tachyarrhythmias. Diagnosis involves analyzing features of the electrocardiogram such as heart rate, rhythm, QRS width, and P wave morphology.
Cardiac Pacemakers - Basics
This document discusses pacemakers, including their components, types, functions, and potential problems. It provides the following key points:
- A pacemaker is a small, battery-operated device that senses irregular or slow heartbeats and sends electrical signals to make the heart beat at a proper pace.
- Common indications for a pacemaker include advanced heart block or symptomatic bradycardia.
- Potential problems include failure to sense or capture heartbeats correctly due to issues like lead displacement or battery failure.
- Pacemaker-mediated tachycardia is a re-entry dysrhythmia that can occur. Applying a magnet over the device can help treat it.
Arrythmia
Arrhythmia is also known as irregular heart beats. If SA node is not the pacemaker, any other part of the heart such as atrial muscle, AV node and ventricular muscle becomes the pacemaker. the beats may be fast, slow or miss beats.
Ventricular tachycardia
Ventricular tachycardia is a fast heart rhythm originating from the ventricles with a rate over 100 bpm. It is classified based on duration (sustained vs non-sustained), morphology (monomorphic, polymorphic, sinusoidal), and symptoms. Causes include structural heart disease, electrolyte abnormalities, drugs, and prolonged QT interval. Diagnosis involves ECG criteria showing ventricular origin. Treatment depends on hemodynamic stability and may include antiarrhythmic drugs, implantable cardioverter-defibrillator, catheter ablation, or surgery. Recurrent ventricular tachycardia is managed long term with devices, drugs, and treatment of underlying causes.
Sudden Cardiac Arrest
Sudden cardiac arrest (SCA) is an event caused by a problem with the heart's "electrical" system. SCA occurs when the heart suddenly stops beating. The heart’s electrical system sends signals to the heart to beat much too fast. The heart cannot beat that fast, so the heart muscle just quivers. Blood and oxygen do not reach vital organs like the brain. Then it stops altogether. The heart needs immediate treatment from an electrical shock (defibrillation) to restart the electrical system. If SCA is not treated within 7-10 minutes, it leads to sudden cardiac death.
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This case study documents the symptoms, lab results, diagnosis, and treatment for a patient with hypothyroidism. The patient presented with symptoms including dull facial expression, dry skin, constipation, and an enlarged heart. Lab tests found low levels of T4 and T3 and an elevated TSH. This led to a diagnosis of primary hypothyroidism caused by insufficient thyroid hormone production. Treatment involves lifelong thyroxine medication to regulate metabolism.
Hepatitis C Case Study
This document describes a case study of a 26-year-old female patient diagnosed with Hepatitis C. She presents with fatigue, anorexia, pale skin, and weakness. Lab tests show abnormalities indicating liver damage, vitamin K deficiency, anemia, and pre-diabetes. Her usual diet consists of juice, diet soda, and take-out providing only 57% of her estimated energy needs. The nutrition intervention aims to gradually increase calorie intake to meet requirements through a sample menu emphasizing protein, healthy fats, and carbohydrate control. Education focuses on nutrient needs, healthy choices, and monitoring will track outcomes like weight and blood glucose.
Case study Hepatitis
Mr. Grey, a 37-year-old unmarried man, presented with general weakness, headaches, restlessness, and loss of sleep for the past 6 months. His liver enzymes were elevated and he tested positive for HBsAg and anti-HBe, indicating hepatitis B. An ultrasound showed his liver was normal size with no masses but borderline splenomegaly. He is considered an inactive hepatitis B carrier based on being HBeAg negative, having normal ALT levels, and a low viral load. Follow up tests are needed to determine if he has chronic hepatitis B or is truly an inactive carrier.
Asthma exacerbation case study in pediatrics
A case study on asthma exacerbation in a pediatric patient. The case details have been anonymized to protect the patient's true identity.
Case presentation on hypothyroidism
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
Case Study for Clinical Rotation
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Clinical correlation hyperlipidemia
This document summarizes two case studies of pediatric patients referred for hypercholesterolemia screening and management. Case 1 involves a 14-year-old male with a total cholesterol of 286 mg/dl referred due to his father's hypercholesterolemia. His diet and lifestyle are assessed. Case 2 involves an 11-year-old male with a total cholesterol of 250 mg/dl referred after his father had a myocardial infarction and was found to have hypercholesterolemia. His diet consists of fast food and snacks. Guidelines for pediatric cholesterol screening and dietary and lifestyle interventions are reviewed.
Clinical case study presentation
An 86-year-old male presented to the emergency room with dizziness and was admitted to the ICU for dehydration. Medical workup showed malignant neoplasms, hypovolemia, pancytopenia, and a bloodstream infection. Laboratory results indicated anemia, thrombocytopenia, and abnormalities consistent with liver and kidney disease. Stool and blood cultures grew Clostridium difficile and Escherichia coli. The patient was diagnosed with myelodysplastic syndrome and received multiple blood transfusions.
Case Studies Clinical pharmacy
Case Studies (Clinical Pharmacy Assignment)
Case Studies
Case Study 1. Drug Related Problem
Case Study 2. Alcohol Toxicity
Case Study 3. Patient Counseling
Case Study 4. Peptic Ulcer
Case Study 5. Drug and the Newborn
Case Study 6. Night time Anxiety
Case Study 7. Clostridium Difficile
Case Study 8. Epilepsy and Pregnancy
Case Study 9. Parkinsonism
Case Study 10. Treatment May Be Worse Than Condition
Clinical Case study
A 74-year-old African American female was admitted to the emergency department with signs of hypoglycemia, excessive anticoagulation, anemia, and infections. Laboratory tests found abnormal liver and kidney function along with hypothyroidism and rheumatoid arthritis. The patient received treatments including dextrose for hypoglycemia, antibiotics for infections, vitamin K to reverse anticoagulation, blood transfusions for anemia, and prognosis was poor due to multiple declining organ functions and infections.
10. asthma
MH, a 6-year-old Malay boy with a history of asthma and G6PD deficiency, presented with fever, cough, and vomiting for one day followed by shortness of breath and rapid breathing. On examination, he had a barrel-shaped chest with suprasternal and subcostal recession, prolonged expiratory breath sounds, and rhonchi bilaterally. He was given a provisional diagnosis of an asthma exacerbation based on his history of asthma and current respiratory symptoms and signs. Differential diagnoses and further investigations were pending.
Hypothyroidism
This document discusses hypothyroidism by defining it as an underproduction of thyroid hormones T4 and T3, listing its primary causes such as Hashimoto's thyroiditis and drugs like amiodarone, describing its clinical manifestations like fatigue, dry skin, and weight gain, noting its laboratory findings including elevated TSH and low FT4, and explaining that autoimmune hypothyroidism is associated with thyroiditis and elevated anti-TPO antibodies.
Dyslipidemia
This patient presents with multiple metabolic risk factors including obesity, elevated triglycerides and fasting blood glucose, and a family history of diabetes. While she does not meet the criteria for metabolic syndrome, her 10-year risk of heart disease is elevated. Her LDL cholesterol goal according to NCEP guidelines is less than 160 mg/dL. Fasting glucose would be most influential in determining her treatment plan given her risk factors.
Hyperthyroidism
This document discusses hyperthyroidism and Graves' disease. It provides details on:
- The causes of hyperthyroidism including circulating thyroid stimulators and thyroidal autonomy.
- The pathogenesis, clinical manifestations, and laboratory findings of Graves' disease. Common signs include diffuse goiter, ophthalmopathy, and localized dermopathy.
- The treatment options for hyperthyroidism including antithyroid drugs like methimazole, radioactive iodine, and surgery. Antithyroid drugs are usually the first line treatment.
Hyperthyroidism
Hyperthyroidism refers to excessive thyroid hormone production. Graves' disease is the most common cause. Symptoms include tremors, weight loss, palpitations, heat intolerance and eye changes. Diagnosis involves blood tests showing low TSH and high free T4 levels. Treatments include antithyroid drugs, radioactive iodine ablation, or surgery. Untreated hyperthyroidism can lead to thyroid storm, weight loss, osteoporosis, heart and eye complications. Follow-up care after treatment is needed to monitor for hypothyroidism or recurrence.
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CHF (Congestive Heart Failure)
Heart failure is the inability of the heart to maintain adequate cardiac output to meet the metabolic needs of the body because of impaired pumping ability.
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This document defines congestive heart failure and describes its types, causes, symptoms, signs, pathophysiology, nursing care, and management. Congestive heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It is classified as right-sided, left-sided, or bi-ventricular failure. Causes in infants include congenital heart defects and myocarditis. Symptoms include difficulty feeding, fast breathing, and fatigue. Management focuses on reducing cardiac workload, improving contractility with drugs, reducing preload with diuretics, and treating the underlying cause.
SHOCK
This document defines and describes the different types of shock, including cardiogenic, hypovolemic, distributive, and obstructive shock. It outlines the causes, presentations, diagnostics including Swan-Ganz catheter interpretation, and management approaches for each type of shock. Key diagnostics and treatments discussed include fluid resuscitation, vasopressors, inotropes, intra-aortic balloon pump, antibiotics for septic shock, and steroids for adrenal insufficiency. The goal of management is to support perfusion and increase blood pressure to improve tissue oxygen delivery.
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This document provides information on heart failure, including its causes, types, diagnosis, management, and rehabilitation. Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It can be caused by systolic or diastolic dysfunction. Management may include medications, surgery such as transplantation, or devices. Cardiac rehabilitation aims to help patients adopt healthy lifestyle changes to optimize their health and reduce risk of further heart issues. It involves education and exercise programs divided into phases from inpatient to outpatient.
Cardiac Failure .pdf
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1) Exercise stress testing is used to detect myocardial ischemia through monitoring changes in the ECG and physiological parameters during exercise.
2) Key parameters include heart rate, blood pressure, oxygen consumption and the presence of ECG changes like ST segment depression or elevation.
3) Abnormal responses include inadequate heart rate or blood pressure increase, chest pain, significant ST changes and ventricular arrhythmias, which can indicate coronary artery disease.
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CO
Cardiac output can be measured directly or indirectly using various methods. Direct methods involve placing a flow meter in the aorta, while indirect methods include the Fick method (measuring oxygen consumption), indicator dilution (injecting a dye), and thermodilution (injecting cold saline). Cardiac output is affected by factors like exercise, which increases it through sympathetic stimulation and increased venous return, and posture, as standing decreases it by pulling blood to the lower extremities. Normal cardiac output is 5-6 L/min in adults but varies based on age, gender, body size, and physiological conditions.
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Shock in neonates can be caused by several factors that result in inadequate tissue perfusion. The main types of shock include hypovolemic, cardiogenic, distributive, and obstructive shock. Untreated shock can progress from compensated to uncompensated to irreversible stages. Management of neonatal shock involves identifying the cause, assessing severity, providing fluid resuscitation, administering vasopressors and inotropes as needed, and treating any underlying conditions. While neonatal shock continues to impact mortality, improved treatment strategies including pharmacologic interventions have led to better outcomes.
Heart failure
Heart failure is a clinical syndrome that develops when –
The heart can not maintain adequate output
or
Can do so only at the expense of elevated ventricular filling pressure
Shock: A review of hypovolemic, septic, cardiogenic and neurogenic shock.
A review of different types of shock encountered in patients. Hypovolemic, septic, cardiogenic and neurogenic shock. We review etiology, pathophysiology, diagnosis, treatment and how to differentiate between them.
Heart failure
This presentation provides an overview of heart failure, including:
1. It defines heart failure as when the heart is unable to pump sufficiently to meet the body's needs, which can result from systolic or diastolic dysfunction.
2. Some key statistics on the incidence and prevalence of heart failure worldwide and in India are presented.
3. Heart failure is classified in different ways such as whether it affects the left or right side of the heart, and whether it involves forward or backward failure.
4. The etiology, clinical presentation, diagnostic assessment, medical management including medications, and surgical options for treatment are discussed at a high level.
Cardiac rehab
Cardiac rehabilitation aims to restore patients with cardiovascular disease to their optimal physical, psychological and social status. It involves exercise training and lifestyle modification to improve cardiovascular fitness and quality of life. A typical program has multiple phases from inpatient to outpatient. Exercise is prescribed based on results of stress testing and individualized to the patient's abilities and needs. The goals are to improve exercise capacity and reduce risk factors through supervised rehabilitation.
Shock in neonates
This document discusses shock in neonates. It defines shock and describes its consequences as inadequate tissue and organ perfusion. It outlines factors that influence adequate tissue perfusion like cardiac output, vascular tone, and blood's ability to deliver oxygen. It then describes types of shock including hypovolemic, cardiogenic, distributive, and obstructive shock. For hypovolemic shock, common causes in neonates are discussed. The document provides details on evaluating and managing neonatal shock, including fluid resuscitation, vasopressor and inotropic drug use, and investigational tests. It concludes that while neonatal shock significantly impacts mortality, management strategies have improved survival rates.
Implanted devices
This document summarizes various implanted medical devices. It discusses pacemakers, implantable cardioverter defibrillators, coronary stents, and techniques for treating brain aneurysms. Pacemakers are used to treat heart rhythm issues and maintain suitable heart rate. ICDs monitor heart rhythm and deliver shocks to restore normal rhythm if needed. Coronary stents prop open arteries and may be bare metal or coated to prevent reblockage. Aneurysms can be treated with surgical clipping or endovascular coiling to isolate the aneurysm from blood flow.
VITAL SIGNS.pptx
The complete vital signs by a Nurse for every patient at every contact ranging from first contact at the out-patient department to the assessment of residents on admission.
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Cardiomegaly is a condition where the heart becomes enlarged. It is usually caused by underlying conditions that make the heart work harder like obesity, heart valve disease, and high blood pressure. An enlarged heart may not pump blood effectively, potentially leading to congestive heart failure. Diagnosis involves tests like chest x-rays, EKGs, echocardiograms and cardiac catheterization. Treatment focuses on managing the underlying cause with medications, lifestyle changes, and sometimes surgery. Complications include heart failure, blood clots, and sudden cardiac death if not properly treated.
Exercise prescription for CVD
Cardiovascular diseases are conditions that affect the heart and blood vessels. Exercise can positively impact CVD by addressing lifestyle factors. Monitoring exercise intensity involves tracking heart rate, metabolic equivalents, and perceived exertion. Common forms of CVD include myocardial infarction, revascularization procedures like bypass surgery and angioplasty, chronic heart failure, and peripheral artery disease. Supervised exercise programs after cardiovascular events and procedures provide benefits like improved cardiac function and quality of life.
CONGESTIVE HEART FAILURE.pptx
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
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Shock: A review of hypovolemic, septic, cardiogenic and neurogenic shock.
Shock: A review of hypovolemic, septic, cardiogenic and neurogenic shock.
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Case Study - Adult - High Output Cardiac Failure - Inotropes, Inotropy and SMII
- 1. The Measure of Lifewww.uscom.com.au Inotropes, Inotropy, SMII and Heart Failure High Output Cardiac Failure
- 2. The Measure of Lifewww.uscom.com.au Smith Madigan Inotropy Index (SMII) • When the heart is unable to meet the needs of the body, then the heart has failed • Whether the cause is due to myocardial infarction, valvular disease or arrhythmia • Heart failure is inadequate MAINTENANCE of blood pressure and or blood flow - CI < 2.4 l/min/m2 • Potential Energy (PE) is blood pressure and Kinetic Energy (KE) is blood flow. • PE + KE = SMI ; SMI / BSA = SMII • SMII is a measure of the heart’s energy or power
- 3. The Measure of Lifewww.uscom.com.au Septic Shock Presentation to ED 84 year old BP 74/38 mmHg MAP 50 mmHg Treatment decision • Should the patient be started on fluids? • Is this patient a fluid responder? • How will this patient respond to a vasopressor?
- 4. The Measure of Lifewww.uscom.com.au Septic Shock USCOM Exam Results • SVI 86 ml/m2 • HR 113 • CI 9.1 l/min/m2 • SVR 181 d.s.cm-5 • DO2 2609 ml/min
- 5. The Measure of Lifewww.uscom.com.au Cardiac Reserve • To treat low BP with a vasopressor (e.g. phenylephrine) it is important to know the SMII and if there is myocardial inotropic reserve to cope with the increase in afterload, otherwise the ventricle will fail.
- 6. The Measure of Lifewww.uscom.com.au Septic Shock USCOM Exam Results • SVI 86 ml/m2 • HR 113 • CI 9.1 l/min/m2 • SMII 0.77 W/m2 • SVR 181 d.s.cm-5 • DO2 2609 ml/min
- 7. The Measure of Lifewww.uscom.com.au Underlying Heart Failure • High SVI, Low SMII, Low SVR • SMII 0.77 = Left ventricular failure • SVR 181 = Decompensated vascular collapse • High output heart failure - septic shock • This shows severe myocardial depression, but with such a low afterload the underlying heart failure was not obvious!
- 8. The Measure of Lifewww.uscom.com.au Heart Failure • SMII of 0.77 W/m2 is typical for LVF patients • It means that the heart is on a flat Starling curve and is essentially unresponsive to volume expansion alone • Management must increase the inotropy of the heart simultaneously with volume expansion if fluid is required
- 9. The Measure of Lifewww.uscom.com.au High Output Heart Failure • To raise BP we must use a vasoconstrictor with positive inotropic properties Treatment • Start Noradrenaline at • 200 ng/kg/min
- 10. The Measure of Lifewww.uscom.com.au Low Output Heart Failure USCOM • BP 114/62 mmHg • MAP 79 mmHg • SVI 23 ml/m2 • SMII 1.1 W/m2 • DO2 652 ml/min SVI low, SMII low, SVR high Add dobutamine at 8 mcg/kg/min
- 11. The Measure of Lifewww.uscom.com.au Normalizing Hemodynamics USCOM • BP 122/66 mmHg • MAP 85 mmHg • SVI 34 ml/m2 • SMII 1.48 W/m2 • DO2 1018 ml/min ↑Dobutamine 10mcg/kg/min ↓NA to 150ng/Kg/min
- 12. The Measure of Lifewww.uscom.com.au Hemodynamic stability USCOM • BP 124/62 mmHg • MAP 83 mmHg • CO 6.1 l/min • SMII 1.56 W/m2 • SVR 744 d.s.cm-5 • DO2 1162 ml/min
- 13. The Measure of Lifewww.uscom.com.au Summary • Optimizing hemodynamics in septic shock saves lives • Use of inotropes is a difficult clinical skill • Accurate and advanced hemoydnamics improves guidance of inotropes and supporting therapy
- 14. The Measure of Lifewww.uscom.com.au Conclusion USCOM • Measures the total energy or load on the heart • Identifies patients who need inotropes for SVI and CI optimization • Determines which inotrope to use • SVI, SMII and SVRI values guide appropriate, effective and rapid treatment