Low cardiac output syndrome (LCOS) is a transient reduction in cardiac output that can occur after cardiac surgery if not recognized and managed promptly. It can lead to multi-organ dysfunction and increased mortality. LCOS is caused by factors that decrease contractility, heart rate, preload, or afterload. It is assessed using physical exam, hemodynamics, labs, and echocardiography. Management involves optimizing preload, rhythm, afterload reduction, and use of inotropes like dobutamine or milrinone. Phosphodiesterase inhibitors and levosimendan are also used to increase contractility while reducing preload and afterload.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
This document discusses the echocardiographic assessment of diastolic dysfunction. It outlines key parameters used to evaluate diastolic function including mitral inflow patterns, tissue Doppler imaging of mitral annular velocities, and pulmonary venous flow. Normal values for these parameters are provided. Guidelines for grading diastolic dysfunction according to the 2016 ASE/EACVI guidelines are presented. Special considerations for evaluating diastolic function in conditions like HCM, mitral stenosis, mitral regurgitation, and atrial fibrillation are also reviewed. Novel indices using speckle tracking echocardiography to assess diastolic function are mentioned.
This document discusses low cardiac output syndrome (LCOS), including its causes, assessment, and management. It defines LCOS as a cardiac index less than 2 L/min/m2 and left sided filling pressures greater than 20mmHg. The key determinants of cardiac output are reviewed as heart rate, stroke volume, preload, afterload, and contractility. Etiologies of LCOS are discussed including preoperative, intraoperative, and postoperative factors. Assessment involves bedside examination, hemodynamic measurements, labs, and imaging like echocardiogram. Management focuses on optimizing preload, contractility, afterload, oxygen delivery, and treating underlying causes.
This document discusses techniques for localizing the site of origin of ventricular tachycardia based on electrocardiogram characteristics. It describes that right ventricular outflow tract tachycardias typically present with left bundle branch block morphology while left ventricular sites may present with either right or left bundle branch block depending on exit site. Specific leads are discussed that can provide clues about anterior vs posterior, septal vs free wall origin within the outflow tracts. Other areas like fascicles, papillary muscles and mitral/tricuspid annuli are also summarized.
Left ventricular diastolic dysfunction in echocardiographyYukta Wankhede
Left ventricular diastolic dysfunction refers to the heart's inability to properly relax and fill during diastole. It can be caused by primary myocardial diseases like cardiomyopathy, hypertension, or secondary issues like aortic stenosis. Diagnosis involves evaluating left ventricular mass, dimensions, and function using 2D echocardiography, Doppler ultrasound to assess mitral inflow and pulmonary vein patterns, and tissue Doppler imaging of mitral annular motion. Diastolic dysfunction is graded from mild to severe based on these evaluation findings.
Echo assessment of lv systolic function and swmaFuad Farooq
This document discusses various techniques for assessing left ventricular systolic function using echocardiography, including:
- Visual assessment of endocardial motion and wall thickening to evaluate global and regional function
- Quantitative measures like fractional shortening, ejection fraction, and volumes
- Tissue Doppler imaging of mitral annular velocities
- Tissue tracking and strain imaging to evaluate timing and extent of myocardial contraction
- Wall motion scoring to characterize regional abnormalities
Tissue Doppler echocardiography allows assessment of myocardial motion using Doppler ultrasound. It uses frequency shifts of ultrasound waves to calculate myocardial velocity, focusing on lower velocities than blood flow Doppler. There are two techniques: pulsed TDE uses a sample volume gate while color-coded TDE uses autocorrelation to display multigated velocity data superimposed on images. TDE is useful for evaluating systolic and diastolic left ventricular function by measuring velocities of the mitral annulus, and can help distinguish conditions like constrictive pericarditis from restrictive cardiomyopathy.
Echocardiographic Evaluation of LV Diastolic FunctionJunhao Koh
The document discusses methods for evaluating left ventricular diastolic function using echocardiography. It describes the four phases of diastole, parameters used to assess diastolic function including mitral inflow patterns, mitral annular tissue Doppler, pulmonary vein flow, left atrial size and the Tei index. Grades of diastolic dysfunction and approaches from ASE/EAE and Mayo Clinic are summarized. Continuous wave Doppler of aortic regurgitation is also presented as a noninvasive method to evaluate left ventricular relaxation.
This document provides an overview of echocardiographic assessment of mitral regurgitation. It describes the anatomy of the mitral valve including the leaflets, annulus, chordae, and papillary muscles. It discusses Carpentier's functional classification system for describing the mechanism of mitral valve dysfunction. Methods for assessing severity are covered, including color flow imaging, continuous wave Doppler, vena contracta width, proximal isovelocity surface area, and volumetric assessment. Key points are made about evaluating jet direction, duration, and velocity in context of blood pressure. The importance of assessing left ventricular and left atrial size and function is also highlighted.
This document discusses the echocardiographic assessment of diastolic dysfunction. It outlines key parameters used to evaluate diastolic function including mitral inflow patterns, tissue Doppler imaging of mitral annular velocities, and pulmonary venous flow. Normal values for these parameters are provided. Guidelines for grading diastolic dysfunction according to the 2016 ASE/EACVI guidelines are presented. Special considerations for evaluating diastolic function in conditions like HCM, mitral stenosis, mitral regurgitation, and atrial fibrillation are also reviewed. Novel indices using speckle tracking echocardiography to assess diastolic function are mentioned.
This document discusses low cardiac output syndrome (LCOS), including its causes, assessment, and management. It defines LCOS as a cardiac index less than 2 L/min/m2 and left sided filling pressures greater than 20mmHg. The key determinants of cardiac output are reviewed as heart rate, stroke volume, preload, afterload, and contractility. Etiologies of LCOS are discussed including preoperative, intraoperative, and postoperative factors. Assessment involves bedside examination, hemodynamic measurements, labs, and imaging like echocardiogram. Management focuses on optimizing preload, contractility, afterload, oxygen delivery, and treating underlying causes.
This document discusses techniques for localizing the site of origin of ventricular tachycardia based on electrocardiogram characteristics. It describes that right ventricular outflow tract tachycardias typically present with left bundle branch block morphology while left ventricular sites may present with either right or left bundle branch block depending on exit site. Specific leads are discussed that can provide clues about anterior vs posterior, septal vs free wall origin within the outflow tracts. Other areas like fascicles, papillary muscles and mitral/tricuspid annuli are also summarized.
Left ventricular diastolic dysfunction in echocardiographyYukta Wankhede
Left ventricular diastolic dysfunction refers to the heart's inability to properly relax and fill during diastole. It can be caused by primary myocardial diseases like cardiomyopathy, hypertension, or secondary issues like aortic stenosis. Diagnosis involves evaluating left ventricular mass, dimensions, and function using 2D echocardiography, Doppler ultrasound to assess mitral inflow and pulmonary vein patterns, and tissue Doppler imaging of mitral annular motion. Diastolic dysfunction is graded from mild to severe based on these evaluation findings.
Echo assessment of lv systolic function and swmaFuad Farooq
This document discusses various techniques for assessing left ventricular systolic function using echocardiography, including:
- Visual assessment of endocardial motion and wall thickening to evaluate global and regional function
- Quantitative measures like fractional shortening, ejection fraction, and volumes
- Tissue Doppler imaging of mitral annular velocities
- Tissue tracking and strain imaging to evaluate timing and extent of myocardial contraction
- Wall motion scoring to characterize regional abnormalities
Tissue Doppler echocardiography allows assessment of myocardial motion using Doppler ultrasound. It uses frequency shifts of ultrasound waves to calculate myocardial velocity, focusing on lower velocities than blood flow Doppler. There are two techniques: pulsed TDE uses a sample volume gate while color-coded TDE uses autocorrelation to display multigated velocity data superimposed on images. TDE is useful for evaluating systolic and diastolic left ventricular function by measuring velocities of the mitral annulus, and can help distinguish conditions like constrictive pericarditis from restrictive cardiomyopathy.
Echocardiographic Evaluation of LV Diastolic FunctionJunhao Koh
The document discusses methods for evaluating left ventricular diastolic function using echocardiography. It describes the four phases of diastole, parameters used to assess diastolic function including mitral inflow patterns, mitral annular tissue Doppler, pulmonary vein flow, left atrial size and the Tei index. Grades of diastolic dysfunction and approaches from ASE/EAE and Mayo Clinic are summarized. Continuous wave Doppler of aortic regurgitation is also presented as a noninvasive method to evaluate left ventricular relaxation.
Three sentences:
The document provides details on the anatomy and evaluation of aortic stenosis using echocardiography. It describes the normal aortic valve anatomy and how various types of aortic stenosis like calcific, rheumatic, bicuspid and subvalvular present on echo. Quantitative assessment of aortic stenosis severity is done using Doppler ultrasound to measure the maximum jet velocity and calculate the pressure gradient across the stenotic valve.
This document summarizes the evaluation of aortic valve stenosis using echocardiography. It describes the normal aortic valve anatomy and various types of aortic valve stenosis including calcific, bicuspid, rheumatic, and supravalvular or subvalvular stenosis. Doppler echocardiography is used to evaluate aortic valve stenosis severity based on valve area, mean gradient, and peak jet velocity. Stress echocardiography with dobutamine can help distinguish true severe from pseudo-severe low-flow, low-gradient aortic stenosis.
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
This document provides an overview of echocardiographic evaluation of restrictive cardiomyopathy. Key points include:
- Restrictive cardiomyopathy is characterized by a nondilated left ventricle with abnormal diastolic function and typically normal systolic function.
- Causes include infiltrative diseases like amyloidosis and storage diseases. Echocardiography can help diagnose but it is more difficult than other cardiomyopathies.
- Findings include low diastolic volume, normal ejection fraction, diastolic dysfunction with rapid early mitral inflow. Echocardiography helps differentiate restrictive cardiomyopathy from constrictive pericarditis.
Cardiac catheteriztion, Oximetery study in a patient with VSDPRAVEEN GUPTA
In this ppt i am going to discuss how to do cardiac catheterisation study, oximetry study and how to analyse its data in a patient with VSD who came to our hospital
This document provides an overview of pacemaker ECG interpretations with the following aims:
1) To determine the pacing mode and whether it is functioning normally or abnormally.
2) To define any abnormalities present and differentiate between true malfunctions versus pseudo-malfunctions.
3) To recognize ECG patterns that may appear abnormal but are actually due to the normal operation of complex pacemaker algorithms.
It describes the types of pacemakers, electrodes, identification systems, sensing and pacing functions, modes of ventricular and atrial pacemakers, dual chamber pacemaker ECG patterns, pacemaker-mediated tachycardia, and takes away the importance of determining pacing mode and diagnosing normal versus abnormal function.
This document summarizes the echocardiographic assessment of mitral stenosis (MS). It describes the anatomy of the mitral valve and causes of MS. Methods for assessing MS severity include measuring the pressure gradient, mitral valve area using planimetry and pressure half-time, and pulmonary artery pressure. Suitability for percutaneous transvenous mitral commissurotomy is evaluated. Concomitant valve lesions are also identified. Stress echocardiography may be used when symptoms are equivocal. Transesophageal echocardiography is recommended in some cases.
The document provides an overview of pacemaker components, physiology, and programming. It discusses the basic hardware components of pacemakers including the pulse generator, leads, and electrodes. It then covers pacing and sensing principles such as capture, impedance, and sensing thresholds. The remainder summarizes various pacing modes and algorithms for managing arrhythmias, rate response, and minimizing ventricular pacing.
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
This document discusses the use of echocardiography in evaluating various types of cardiomyopathies. It provides echocardiographic features of dilated cardiomyopathy including dilated chambers, normal wall thickness, and complications like mitral regurgitation. Hypertrophic cardiomyopathy features include unexplained hypertrophy, diastolic dysfunction, and left ventricular outflow tract obstruction. Restrictive cardiomyopathies show hypertrophy, enlarged atria, restricted filling, and elevated pressures. Left ventricular non-compaction and arrhythmogenic right ventricular cardiomyopathy also have distinct echocardiographic characteristics described.
1) The document describes methods for quantifying mitral regurgitation (MR), including Carpentier's classification of MR types and echocardiographic parameters for assessing MR severity.
2) Proximal isovelocity surface area (PISA) uses the conservation of mass principle to calculate regurgitant volume and orifice area based on measurements of the PISA radius and aliasing velocity.
3) Several limitations of PISA are discussed, but it provides a quantitative assessment of MR with acceptable reproducibility when used appropriately.
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
This document discusses the echocardiographic evaluation of mitral valve prolapse (MVP). It describes the use of M-mode, 2D, and 3D echocardiography to diagnose MVP and assess mitral regurgitation severity. Measurement of the vena contracta and use of the proximal isovelocity surface area method are emphasized for accurate regurgitant quantification. Surgical indications and repair techniques are also summarized.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
This document discusses the echocardiographic evaluation of left ventricular systolic function. It indicates that assessment of LV systolic function is important for diagnosing and managing heart disease and conditions that can affect the heart. The document outlines the indications for evaluating LV systolic function and describes techniques like M-mode, measurements of LV dimensions and volumes, wall motion scoring, and newer techniques using tissue Doppler imaging and speckle tracking echocardiography to assess systolic function parameters. Echocardiography is recommended as the initial imaging modality to evaluate LV systolic function.
This document discusses techniques for evaluating left ventricular function in patients with ischemic cardiomyopathy, including multigated angiography (MUGA), myocardial perfusion scintigraphy using thallium-201 or technetium-99m tracers, gated cardiac single photon emission computed tomography (SPECT), and positron emission tomography (PET). SPECT and PET can assess myocardial perfusion, function, volumes, and viability. Segmental analysis of wall motion and calculations of ejection fraction from gated imaging provide prognostic information. The identification of viable but ischemic tissue has implications for the potential benefits of revascularization.
Left ventricular systolic function can be assessed through several echocardiographic parameters such as ejection fraction, fractional shortening, mitral annular plane systolic excursion, tissue Doppler imaging, and more recently, deformation imaging including global longitudinal strain. Ejection fraction is considered the gold standard measurement but requires obtaining left ventricular volumes, while fractional shortening and mitral annular plane systolic excursion provide simpler alternatives. Deformation imaging such as global longitudinal strain provides a sensitive measure of subclinical changes in systolic function.
This document provides an overview of shock and its pathophysiology. It defines shock as a clinical syndrome resulting from inadequate tissue perfusion due to alterations in circulation. The stages of shock are described as compensatory, progressive, and irreversible. Compensatory mechanisms aimed at maintaining homeostasis in response to shock are discussed for various body systems. Nursing interventions for shock focus on treating its underlying cause, restoring circulating volume and hemodynamics through fluid resuscitation and vasoactive drugs, and minimizing oxygen consumption.
This document summarizes key concepts in cardiovascular physiology including:
1. Determinants of cardiac output which are stroke volume and heart rate. Stroke volume is determined by preload, afterload, and contractility as described by Frank-Starling law of the heart.
2. Control of arterial blood pressure involves immediate control by baroreceptors and chemoreceptors, intermediate control by the renin-angiotensin-aldosterone system and atrial natriuretic peptide, and long-term control through sodium and water retention in the kidneys.
3. Coronary physiology includes characteristics of coronary blood flow such as intermittent flow, autoregulation to maintain flow, and metabolic and
Three sentences:
The document provides details on the anatomy and evaluation of aortic stenosis using echocardiography. It describes the normal aortic valve anatomy and how various types of aortic stenosis like calcific, rheumatic, bicuspid and subvalvular present on echo. Quantitative assessment of aortic stenosis severity is done using Doppler ultrasound to measure the maximum jet velocity and calculate the pressure gradient across the stenotic valve.
This document summarizes the evaluation of aortic valve stenosis using echocardiography. It describes the normal aortic valve anatomy and various types of aortic valve stenosis including calcific, bicuspid, rheumatic, and supravalvular or subvalvular stenosis. Doppler echocardiography is used to evaluate aortic valve stenosis severity based on valve area, mean gradient, and peak jet velocity. Stress echocardiography with dobutamine can help distinguish true severe from pseudo-severe low-flow, low-gradient aortic stenosis.
The document discusses mitral regurgitation (MR), including the anatomy of the mitral valve, mechanisms and etiologies of MR, assessment of MR severity using echocardiography techniques like Doppler imaging, and consequences and management of MR. It provides details on evaluating MR severity based on vena contracta width, proximal isovelocity surface area, mitral-aortic time velocity integral ratios, and pulmonary venous flow. Primary causes of MR include degenerative diseases of the valve like Barlow's syndrome, while secondary MR is typically functional and due to left ventricular remodeling without structural valve abnormalities.
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
This document provides an overview of echocardiographic evaluation of restrictive cardiomyopathy. Key points include:
- Restrictive cardiomyopathy is characterized by a nondilated left ventricle with abnormal diastolic function and typically normal systolic function.
- Causes include infiltrative diseases like amyloidosis and storage diseases. Echocardiography can help diagnose but it is more difficult than other cardiomyopathies.
- Findings include low diastolic volume, normal ejection fraction, diastolic dysfunction with rapid early mitral inflow. Echocardiography helps differentiate restrictive cardiomyopathy from constrictive pericarditis.
Cardiac catheteriztion, Oximetery study in a patient with VSDPRAVEEN GUPTA
In this ppt i am going to discuss how to do cardiac catheterisation study, oximetry study and how to analyse its data in a patient with VSD who came to our hospital
This document provides an overview of pacemaker ECG interpretations with the following aims:
1) To determine the pacing mode and whether it is functioning normally or abnormally.
2) To define any abnormalities present and differentiate between true malfunctions versus pseudo-malfunctions.
3) To recognize ECG patterns that may appear abnormal but are actually due to the normal operation of complex pacemaker algorithms.
It describes the types of pacemakers, electrodes, identification systems, sensing and pacing functions, modes of ventricular and atrial pacemakers, dual chamber pacemaker ECG patterns, pacemaker-mediated tachycardia, and takes away the importance of determining pacing mode and diagnosing normal versus abnormal function.
This document summarizes the echocardiographic assessment of mitral stenosis (MS). It describes the anatomy of the mitral valve and causes of MS. Methods for assessing MS severity include measuring the pressure gradient, mitral valve area using planimetry and pressure half-time, and pulmonary artery pressure. Suitability for percutaneous transvenous mitral commissurotomy is evaluated. Concomitant valve lesions are also identified. Stress echocardiography may be used when symptoms are equivocal. Transesophageal echocardiography is recommended in some cases.
The document provides an overview of pacemaker components, physiology, and programming. It discusses the basic hardware components of pacemakers including the pulse generator, leads, and electrodes. It then covers pacing and sensing principles such as capture, impedance, and sensing thresholds. The remainder summarizes various pacing modes and algorithms for managing arrhythmias, rate response, and minimizing ventricular pacing.
The document discusses the history, anatomy, angiographic views, variations, and clinical relevance of coronary arteries. It provides a detailed overview of the typical anatomy and branches of the left main, left anterior descending, left circumflex, and right coronary arteries. It also describes common anatomical variations and anomalies seen in coronary arteries and their clinical implications. Angiographic classification methods for different coronary artery segments are presented.
This document discusses the use of echocardiography in evaluating various types of cardiomyopathies. It provides echocardiographic features of dilated cardiomyopathy including dilated chambers, normal wall thickness, and complications like mitral regurgitation. Hypertrophic cardiomyopathy features include unexplained hypertrophy, diastolic dysfunction, and left ventricular outflow tract obstruction. Restrictive cardiomyopathies show hypertrophy, enlarged atria, restricted filling, and elevated pressures. Left ventricular non-compaction and arrhythmogenic right ventricular cardiomyopathy also have distinct echocardiographic characteristics described.
1) The document describes methods for quantifying mitral regurgitation (MR), including Carpentier's classification of MR types and echocardiographic parameters for assessing MR severity.
2) Proximal isovelocity surface area (PISA) uses the conservation of mass principle to calculate regurgitant volume and orifice area based on measurements of the PISA radius and aliasing velocity.
3) Several limitations of PISA are discussed, but it provides a quantitative assessment of MR with acceptable reproducibility when used appropriately.
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
This document discusses the echocardiographic evaluation of mitral valve prolapse (MVP). It describes the use of M-mode, 2D, and 3D echocardiography to diagnose MVP and assess mitral regurgitation severity. Measurement of the vena contracta and use of the proximal isovelocity surface area method are emphasized for accurate regurgitant quantification. Surgical indications and repair techniques are also summarized.
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
This document discusses the echocardiographic evaluation of left ventricular systolic function. It indicates that assessment of LV systolic function is important for diagnosing and managing heart disease and conditions that can affect the heart. The document outlines the indications for evaluating LV systolic function and describes techniques like M-mode, measurements of LV dimensions and volumes, wall motion scoring, and newer techniques using tissue Doppler imaging and speckle tracking echocardiography to assess systolic function parameters. Echocardiography is recommended as the initial imaging modality to evaluate LV systolic function.
This document discusses techniques for evaluating left ventricular function in patients with ischemic cardiomyopathy, including multigated angiography (MUGA), myocardial perfusion scintigraphy using thallium-201 or technetium-99m tracers, gated cardiac single photon emission computed tomography (SPECT), and positron emission tomography (PET). SPECT and PET can assess myocardial perfusion, function, volumes, and viability. Segmental analysis of wall motion and calculations of ejection fraction from gated imaging provide prognostic information. The identification of viable but ischemic tissue has implications for the potential benefits of revascularization.
Left ventricular systolic function can be assessed through several echocardiographic parameters such as ejection fraction, fractional shortening, mitral annular plane systolic excursion, tissue Doppler imaging, and more recently, deformation imaging including global longitudinal strain. Ejection fraction is considered the gold standard measurement but requires obtaining left ventricular volumes, while fractional shortening and mitral annular plane systolic excursion provide simpler alternatives. Deformation imaging such as global longitudinal strain provides a sensitive measure of subclinical changes in systolic function.
This document provides an overview of shock and its pathophysiology. It defines shock as a clinical syndrome resulting from inadequate tissue perfusion due to alterations in circulation. The stages of shock are described as compensatory, progressive, and irreversible. Compensatory mechanisms aimed at maintaining homeostasis in response to shock are discussed for various body systems. Nursing interventions for shock focus on treating its underlying cause, restoring circulating volume and hemodynamics through fluid resuscitation and vasoactive drugs, and minimizing oxygen consumption.
This document summarizes key concepts in cardiovascular physiology including:
1. Determinants of cardiac output which are stroke volume and heart rate. Stroke volume is determined by preload, afterload, and contractility as described by Frank-Starling law of the heart.
2. Control of arterial blood pressure involves immediate control by baroreceptors and chemoreceptors, intermediate control by the renin-angiotensin-aldosterone system and atrial natriuretic peptide, and long-term control through sodium and water retention in the kidneys.
3. Coronary physiology includes characteristics of coronary blood flow such as intermittent flow, autoregulation to maintain flow, and metabolic and
Hemodynamics of cardiac tamponade, constrictive pericarditis & restrictive ca...Dr. Rajesh Das
The document provides information on the anatomy, physiology, and pathophysiology of the pericardium and pericardial diseases. It discusses the layers of the pericardium, functions of restraining cardiac volume and lubricating the heart. In pathophysiology, it describes cardiac tamponade, constrictive pericarditis, and their differences from restrictive cardiomyopathy. Diagnostic tools including echocardiography and cardiac catheterization are outlined for evaluating pericardial diseases and distinguishing constrictive pericarditis from restrictive cardiomyopathy.
Congestive heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It has multiple causes and symptoms including shortness of breath, fatigue, fluid retention, and arrhythmias. Treatment focuses on controlling symptoms with diuretics, and improving the heart's function with ACE inhibitors, beta blockers, and other vasodilators. For severe cases, inotropic drugs or even advanced therapies like ventricular assist devices or transplant may be needed. The goals are to improve quality of life and survival through controlling risk factors and compensatory mechanisms that can worsen the condition over time.
Congestive heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It has multiple causes and symptoms including shortness of breath, fatigue, swelling, and coughing up pink mucus. Treatment focuses on controlling symptoms with diuretics, and improving the heart's function with ACE inhibitors, beta blockers, and other medications. For severe cases, devices or surgery such as defibrillators, resynchronization therapy, or transplantation may be needed. The long-term goal is to improve quality of life through lifestyle changes and optimal medical management.
This document provides an overview of hemodynamic monitoring principles in the ICU. It discusses the steps for assessing global and regional perfusion, including initial clinical assessment and basic monitoring of vital signs and lactate levels. It then covers monitoring of preload and fluid responsiveness, methods for measuring cardiac output, assessing cardiac contractility and tissue perfusion. A variety of invasive and non-invasive monitoring techniques are explained, from pulmonary artery catheters and arterial waveform analysis to echocardiography, near-infrared spectroscopy and analysis of the microcirculation. Key principles emphasized are that no single monitor determines outcomes, and monitoring needs may change over time based on equipment and integrating multiple variables.
Heart failure is defined as the inability of the heart to pump enough blood to meet the body's needs. It can be caused by conditions that overload or restrict the heart. The main symptoms are shortness of breath, fatigue, and fluid retention. Treatment focuses on managing symptoms with diuretics, ACE inhibitors, beta-blockers, and controlling underlying conditions. Prognosis depends on the severity and cause of heart failure.
1. The purpose of invasive hemodynamic monitoring is to detect and treat life-threatening conditions such as heart failure and cardiac tamponade by evaluating a patient's cardiovascular function and response to treatment.
2. Indications for hemodynamic monitoring include decreased cardiac output from various causes, shock, loss of cardiac function, and coronary artery disease.
3. A pulmonary artery catheter allows for continuous monitoring of pressures, flows, oxygen saturation and calculation of cardiac output, and helps precisely manage fluid balance and hemodynamics.
Swan-Ganz catheters are balloon-tipped catheters inserted into the heart to measure pressures and collect blood samples from the right atrium, right ventricle, and pulmonary artery. This allows clinicians to assess conditions like shock, respiratory distress, and complications of myocardial infarction. Measurements of pressures, oxygen saturations, and cardiac output can guide therapy for critical illnesses and help evaluate the effects of treatments. While useful for management, the procedure does carry risks of complications if not performed carefully.
This presentation gives you a brief, understandable, captivating and presentable idea on the physiology of blood pressure regulation both on hypertension and hypotension cases.
SHOCK SYNDROMESHOCK SYNDROME
• Shock is a condition in which the cardiovascular system
fails to perfuse tissues adequately
• An impaired cardiac pump, circulatory system, and/or
volume can lead to compromised blood flow to tissues
• Inadequate tissue perfusion can result in:
– generalized cellular hypoxia (starvation)
– widespread impairment of cellular metabolism
– tissue damage organ failure
– death
ATHOPHYSIOLOGYPATHOPHYSIOLOGY
Cells switch from aerobic to anaerobic metabolism
lactic acid production
Cell function ceases & swells
membrane becomes more permeable
electrolytes & fluids seep in & out of cell
Na+/K+ pump impaired
mitochondria damage
cell death
1) Shock is a condition where the cardiovascular system fails to adequately perfuse tissues due to impaired cardiac pump function, circulatory issues, or low blood volume.
2) The main types of shock are hypovolemic (low blood volume), cardiogenic (impaired heart function), and distributive (blood vessel problems).
3) Hypovolemic shock results from internal or external fluid loss leading to decreased circulating volume and tissue perfusion. Cardiogenic shock occurs due to impaired left ventricular pumping ability despite normal blood volume.
BLOOD PRESSURE
BY: SAIYED FALAKAARA
ASSISTANT PROFESSOR
DEPARTMENT OF PHARMACY
SUMANDEEP VIDYAPEETH
Definition
Arterial blood pressure can be defined as the lateral pressure exerted by moving the column of blood on the walls of the arteries.
Significance
To ensure the blood flow to various organs
Plays an important role in exchange of nutrients and gases across the capillaries
Required to form urine
Required for the formation of lymph
Normal values
Normal adult range can fluctuate within a wide range and still be normal
Systolic/diastolic
100/60 – 140/80
Unit - mmHg
Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It has many potential causes, but is often due to problems with the heart muscle itself or valves. Treatment focuses on managing symptoms with diuretics, and slowing progression with ACE inhibitors, beta-blockers, and aldosterone antagonists. Other therapies aim to improve heart function or treat underlying causes. Prognosis depends on severity but ranges from 5-50% annual mortality.
A 22-year-old male presented with complaints of easy fatigability, abdominal discomfort, leg swelling, and shortness of breath with exertion over the past 6-8 months. Examination found edema, elevated jugular venous pressure, hepatomegaly, and cachexia. Testing showed elevated liver enzymes and BNP. Echocardiogram demonstrated thickened pericardium with ventricular interdependence and equal diastolic pressures, consistent with constrictive pericarditis. The patient was diagnosed with constrictive pericarditis likely due to a prior unknown infection or inflammatory process causing thickening and scarring of the pericardium.
Day 1 -RESERVE CONPENSATION FAILURE2wb.pptxMkindi Mkindi
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#CELL MEMBRANE TRANSPORT#PHYSIOLOGY#BODY FLUIDS#RENAL PHYSIOLOGY#
The document discusses the pathophysiology and management of shock in neonates. It describes how shock results from inadequate tissue perfusion and oxygen delivery due to failure of circulatory function. Early recognition of shock is important to prevent progression to hypotension, cardiac arrest and end organ damage. Management involves addressing the underlying cause, restoring circulating volume, and increasing cardiac output and tissue perfusion through the use of inotropic medications and vasopressors as needed. Hemodynamic monitoring tools like echocardiography and lactate levels can help guide optimal management to prevent further deterioration.
Shock is a severe pathophysiological insult associated with mitochondrial and cellular energetic failure due to reduced oxygen and nutrient delivery or ineffective utilization. It can occur with or without hypotension. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, septic, neurogenic, anaphylactic, and endocrine shock. Organ system consequences include effects on the CNS, CVS, respiratory system, kidneys, GI tract, liver, hematological system, and immune system. Pulmonary embolism can cause shock by increasing pulmonary vascular resistance and right ventricular afterload, potentially leading to right heart failure.
This document provides information on congestive cardiac failure (CCF), including its definition, pathophysiology, clinical features, investigations, and management. CCF occurs when the heart muscle is weakened and cannot maintain adequate cardiac output. The pathophysiology involves changes in preload, afterload, and contractility that decrease cardiac output. Compensatory mechanisms initially help but later worsen symptoms. Clinically, CCF presents with dyspnea, edema, elevated JVP, hepatomegaly, and other signs. Investigations include BNP, ECG, echocardiogram. Management focuses on treating the underlying cause, reducing preload/afterload, and improving contractility. Diuretics, ACE inhibitors, beta
Similar to Dr jeevraj Low Cardiac Output In cardiac surgery (20)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Osteoporosis is an increasing cause of morbidity among the elderly.
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We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. LCOS
• A transient and often reversible reduction in cardiac
output–low cardiac output state (LCOS) with an
associated decrease in systemic oxygen delivery
often occurs following cardiac surgery
• The LCOS if not recognized in time and managed
appropriately may be “progressive” leading to multi -
organ dysfunction, increased morbidity, prolonged
ICU and hospital stay, and even mortality.
3. CO & its determinants
• CO = HR X SV
• = HR X (EDV – ESV)
• ↓ ↓
• Preload Afterload
• Distentibility Contractility
• Preload is the dominant regulator of CO in
normal cardiovascular system but afterload
dominates flow regulation when myocardium is
failing
4. Determinants of Cardiac Output-
cascade of events
DEC VENT
CONTRACTILITY
DEC VENT
PRELOAD
VENOUS
CONSTRICTION
ARTERIAL
CONSTRICTION
VENT OUTFLOW
IMPEDANCE – AFTERLOAD
INC
DEC CARDIAC
PUTPUT
DEC LVEDP
ISCHEMIA INC O2
DEMAND
INC SYMPTH NS
ACTIVITY
INC HR
# O2 DEMAND
SUPPLY
INC WALL
TENSION
9. Preoperative factors
• Age
• Hypoxia
• cyanotic HEART appear to be more susceptible to ischemia and re-
perfusion injury than normal hearts.
• Hypertrophy
• Ischemia ---------myocardial dysfunction.
• Left to right shunts
• Large L R shunts -----------------postoperative LCOS when the left
ventricular run-off across the VSD is closed
10. Intra Operative Factors
Hypertrophic myocardium….more risk
Sudden decreased SVR as after induction may lead to a spell in cyanotic patients.
inadequate Myocardial protection during cardiac surgery
CPB mediated
Avoid Factors associated with myocardial injury during CPB
Persistent VF
Ventricular distension
Coronary embolism
Reperfusion
Aortic cross clamp
Long aortic cross clamp leads to more chances of reperfusion injury -------------a direct
predictor of postoperative LCOS and death
11. Factors Influencing LCOS (POSTOP)
Preload
After load
Contractility
Heart rate & rhythm
Residual lesions (pulm regurg after transannular patch repair of TOF
Residual VSD
Residual outflow obstruction )
All predispose to post op LCOS d/t vol & pressure overload on the
myocardium
Pulmonary factors like tension pneumothorax
Pulmonary hpertension crisis
Extra cardiac causes like temponade
Severe sepsis
12. Assessment
Bedside physical examination (breath sounds,
murmurs, warmth of extremities, peripheral pulses)
Hemodynamic measurements: assess filling
pressures & determine CO with PAC, calculate SVR,
measure SvO2
ABG (hypoxia, hypercarbia, acidosis/alkalosis),
hematocrit (anemia), and serum potassium (hypo or
hyperkalemia)
13. Assessment of lcos
• Pulse Rate – tachycardia
volume – low
• Blood pressure - borderline or low
• Skin - pale, cool to touch
• Rapid shallow breathing
• Urine output <1ml/kg/hr
• Reduced peripheral temperature
• Capillary refill
May be useful marker of hypovolemia and myocardial
function
• Core temp vs peripheral temp difference is >3
degrees associated with LCO
16. Role of Echocardiography
Intraoperative and postoperative transoesophageal
echocardio graphy (TOE) and postoperative transthoracic
echocardiography enable bedside visualization of the heart.
Echo cardio graphy may immediately identify causes of cardio
vascular failure, including cardiac and valvular dysfunction,
obstruction of the RV (pulmonary embolism) or LV outfl ow
tract (for example, systolic anterior motion of the anterior
mitral valve leafl et), or obstruction to cardiac filling in
tamponade.
It might diff erentiate between acute right, left and global HF
as well as between systolic and diastolic dysfunction.
17. Monitoring Of Low CO State
Central venous, pulmonary artery, RA and LA Pressures
Central venous or right atrial lines -------- RV filling or preload in the presence
of AV concordance.
Low CVP indicate inadequate preload ----- Need for volume
High CVP indicate Fluid overload
Diminished RV systolic or diastolic
function (in the absence of TV disease or shunts)
Persistently elevated PAP in relation to systemic BP---- RV dysfunction
Continuous CO measurement to diagnose LCOS
PA catheter,
FloTrac,
Picco
18. LACTATE IN Low CO State
In LCOS there is impaired global perfusion which cause
anaerobic metabolism and ↑ metabolic acidosis.
Serial ABG analysis reveal ↑ levels of base deficit and ↓ HCO3-
levels
↑ in arterial lactate levels from 2 to 8 mmol/L; remaining near
8mmol/l for 2 hrs or more ↓ survival to 10% in acute LOS.
Normal plasma values for lactate 0.7-2.1 meq/l.
Mild to moderate metabolic acidosis 5 meq/L
Severe metabolic acidosis 10 meq/L
19. Mixed Venous Oxygen saturation
• It is percentage of oxygen bound to hb in
blood returning to the right heart
• Normal is > 70 %
• Useful index of circulatory adequacy it reflects
to some extent near tissue oxygen levels.
• Relation b/w CO & SVO2 is not linear; a ↓ in
SVO2 ----------proportionately larger ↓ in CO
• Sample for SVO2 should be taken from PA
catheter or central vein
20. MANAGEMENT OF HEMODYNAMIC PROBLEMS
BP PCWP CO SVR Plan
↓ ↓ ↓ ↓ Volume
N ↑ N ↑ Diuretic
↓ ↑ ↓ ↑ Inotrope
↑ ↑ ↓ ↑ Vasodilator
V ↑ ↓ ↑ Ino/vaso/IABP
↓ N N ↓ Alpha-agent
21. Management------------
Optimize preload – + & curvilinear relation b/w EDV & contractility &
appropriate vol loading remains the easiest, most rapid & most effective method
of improving CO & tissue perfusion
a) Ideal LA pressure
Pts with preserved Pts with poor
LV function LV function
↓ ↓
15 mmHg Low 20’s
(Stiff hypertrophied LV with diastolic dysfunction
Small LV Chamber –MS: after LV
resection
Pre existing pulm HTN from MV ds)
22. Management------
b) Response to volume infusion
• Failure of filling pressures to rise with
volume
Capillary leak present in the early postop
period
Vasodilatation associated with re-
warming
• Rise in filling pressures without ↑ CO
INOTROPIC SUPPORT NECESSARY
• Harmful effects of excessive preload
- LV wall tension ↑ myocardial ischemia
(↓ Trans – myocardial gradient for CBF
↑ myocardial o2 demand.)
- Interstitial edema of lungs
V/Q abnormalities
hypoxemia
- Systemic venous HTN ↓ Perfusion pressure to
other organs.
Kidneys – diuresis
GIT – splanchnic congestion
Brain – mental state altered
23. Heart Rate and Rhythm
• Sinus rhythm and optimal heart rate are essential.
• the tachycardia limits diastolic filling of the ventricle
and may reduce coronary blood flow to the left
ventricle. Atrial pacing can be beneficial if the patient
has a slow sinus rate.
• Sequential atrioventricular pacing may be necessary if
the rhythm is other than sinus.
• Synchrony between the atria and ventricles becomes
particularly important in the postbypass setting
because ventricular compliance is poor and ventricular
filling becomes more dependent on the atrial kick
24. Afterload reduction
Vasodilators cause reduction in LV afterload will improve cardiac
output, as long as an adequate diastolic pressure is maintained for
coronary perfusion
Marginal C.O------avoid hypotension
Poor C.O-----------------Cautions use of Vasodilators coz ↑ SVR
from intense vasoconstriction is a compensatory mechanism to
maintain perfusion to vital organs.
( SVR > 1500, vasodilators indicated
25. Ionotropic support in locs
• Among catecholamines, consider low-to-moderate doses of
dobutamine and epinephrine: they both improve stoke volume and
increase heart rate while PCWP is moderately decreased;
catecholamines increase myocardial oxygen consumption
• Milrinone decreases PCWP and SVR while increasing stoke volume;
milrinone causes less tachycardia than dobutamine
• Levosimendan, a calcium sensitizer, increases stoke volume and
heart rate and decreases SVR
• Norepinephrine should be used in case of low blood
pressure due to vasoplegia to maintain an adequate
perfusion pressure. Volaemia should be repeatedly
assessed to ensure that the patient is not hypovolaemic
while under vasopressors
26. Choice of ionotrops
• when stoke volume was increased comparably,
dobutamine increased heart rate more than
epinephrine.
• Epinephrine, dobutamine and dopamine all
increase myo cardial oxygen consumption
(MVO2) postoperatively
• However, only with dobutamine is this matched
by a proportional increase in coronary blood flow
suggesting that the other agents may impair
coronary vasodilatory reserve postoperatively.
27. Phosphodiesterase III inhibitors
• Phosphodiesterase III inhibitors, such as amrinone, milrinone or
enoximone, are all potent vasodilators that cause reductions in
cardiac filling pressures, pulmonary vascular resistance and SVR
• they are commonly used in combination with β1-adrenergic
agonists.
• Compared to dobutamine in postoperative low CO,
phosphodiesterase III inhibitors caused a less pronounced increase
in heart rate and decreased the likelihood of arrhythmias also, the
incidence of postoperative myocardial infarction was signifi cantly
lower with milrinone compared to dobutamine
• This could be explained by phosphodiesterase III inhibitors
decreasing LV wall tension without increasing MVO2, despite
increases in heart rate and contractility, in contrast to
catecholamines
28. Levosimendan
• Calcium sensitising inodilator
• Inc CO by improving both stroke volume &HR and dec preload and
afterload
• Dose 12 µg/kg over 10 min, 0.1 µg/kg/min
• Levosimendan has been recommended for the treatment of acute
HF and was recently used for the successful treatment of low CO
after cardiac surgery
• Th e eff ects of levosimendan have been compared to those of
dobu tamine and milrinone . Levosimendan has been shown to
decrease the time to extubation com pared to milrinone .Compared
to dobutamine, levosimendan decreases theincidence of
postoperative atrial fi brillation andmyocardial infarction, ICU
length of stay , acuterenal dysfunction, ventricular arrhythmias, and
mortality in the treatment of post operative LV dysfunction.
• .
29. refractory hypotension – vasoplegia
MAP< 50,
Low filling pressures – CVP < 5, PCWP<10
Normal or elevated CI >2.5L/min/m2
Low SVR < 800
Vasopressor
Methylene blue 1.5 – 2mg/kg
Vasopressin 0.1- 0.4 U/min
30. Calcium Chloride
• Provides ionized Ca2+ which produces a
strong but transient inotropic effect if
hypocalcaemia is present and more sustained
↑SVR even if normocalcemia is present
• Dose : 0.5 -1g slow iv
31. Tri lodo thyronine (T3)
• ↑ CO & ↓ SVR in patients with depressed ventricular
function.
• Randomized studies have not demonstrated a ↓ in
inotropic requirement or an improvement in overall
outcome with use of T3 upon weaning from CPB.
• It may ↓ incidence of post-op AF through an unknown
mechanism.
• Current role of ------as salvage when CPB cannot be
terminated with maximal inotropic support and IABP.
• Dose : 0.05 – 0.08 ug/kg iv
32. Other drug
• Nesritide
• Recombinant B type natriuretic peptide
• ↓ sympathetic responses & inhibits neurohumoral
response in HF
• ↓ preload (PAP) & afterload (SVR)
• Indirectly inc CO without inc HR or myocardial O2
demand
• lusitropic, dilates native coronaries, arterial conduits,
has no proarrhythmic activity
• Dilates renal afferent & efferent arterioles, inc GFR –
strong diuretic synergistic with loop diruretics
33. PAH CRISIS AND LCOS
• optimal sedation
• -neuromuscular blockade
• -induced respiratory or metabolic
alkalosis
• -hyper-oxygenation
• -Avoiding or ablating stimuli
• (trigger pulmonary hypertensive
crises(e.g. administering fentanyl
bolus prior to airway suction).
• -Nitric oxide
34. Mechanical circulatory support
• In case of heart dysfunction with suspected
coronary hypoperfusion, IABP is highly
recommended
• Ventricular assist device should be considered
early rather than later, before end organ
dysfunction is evident
• Extra-corporeal membrane oxygenation is
solution as a bridge to recovery or decision
making
35. IABP
IABP is the fi rst choice device in intra- and perioperative
cardiac dysfunction.
Its advantages include easy insertion , the modest
increase in CO and coronary perfusion, with low
complication rate.
IABP’s main mechanism of action is a reduction
of afterload and increased diastolic coronary perfusion
via electro cardiogram triggered counterpulsation.
IABP reduces heart work and myo cardial oxygen
consumption, favourably modifying the balance of oxygen
demand/supply
36. Extra-corporeal membrane
oxygenation
• Extra-corporeal membrane oxygenation (ECMO)
is increa singly used for temporary mechanical
circulatory support
• Indications include all types of ventricular failure,
for example, intraoperative or postoperative low
CO syn drome, severe acute myocardial
infarction, and cardiac resusci tation.
• An additional advantage is its versatile use not
only in LV, RV or biventricular support, but also
for respiratory assistance and even renal support
by addition of a haemofilter