Preoperative management
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The document discusses preoperative evaluation and management of patients undergoing cardiac surgery. It covers evaluating the patient's cardiovascular status through medical history, physical exam, tests like ECG, chest x-ray, stress testing, echocardiography and cardiac catheterization. Key aspects of preoperative evaluation are understanding the planned surgery, assessing medical conditions, identifying risks, advising on medication management, and determining a prognosis. The goals are to optimize the patient for surgery and form an intraoperative and postoperative plan.
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CARDIO-PULMONARY BYPASS
Cardiopulmonary bypass (CPB) temporarily takes over the function of the heart and lungs during surgery by circulating and oxygenating the blood. It allows correction of cardiac defects that were previously not surgically treatable. The basic CPB circuit involves draining blood from the veins into an oxygenator and reservoir before pumping it back into the arteries. Key components include cannulas, a pump, oxygenator, heat exchanger, and cardioplegia delivery system. CPB requires anticoagulation and precise monitoring to safely divert blood flow around the heart while surgical repairs are made before returning the patient to full cardiac function. Complications can include bleeding, infection, organ dysfunction, and neurological issues. Advances like centrifugal pumps
Cardiopulmonary bypass
This document provides information on cardiopulmonary bypass, including:
1. The history of cardiopulmonary bypass, beginning with the first operation using bypass in 1951 and the first successful open heart procedure using bypass in 1953.
2. The basic components of a bypass system, including how blood is drained, oxygenated, and returned to the body via cannulas in major veins and arteries.
3. Additional details on venous and arterial cannulation techniques and potential complications. Venting of the heart is also discussed to prevent ventricular distension during bypass.
CARDIOPULMONARY BYPASS
This document provides information about cardiopulmonary bypass (CPB), including its goals, components, and processes. It discusses how CPB circuits divert blood flow away from the heart and lungs using a pump and oxygenator, allowing for surgery on a bloodless field. Key components that are described include the pump, oxygenator, heat exchanger, cannulas, and filters used. The document outlines the steps of priming, anticoagulation, cannulation, initiation and maintenance of bypass, as well as weaning and termination from bypass. Potential complications are also briefly mentioned.
Cardioplegia
This document discusses various topics related to cardioplegia, including alternative arresting agents and additives, crystalloid versus blood cardioplegia, and potential new technologies. It provides details on adenosine receptors, minute work and oxygen demand, alternative arresting agents such as beta blockers and adenocaine, agents affecting calcium transport, and ways to avoid substrate depletion. It compares crystalloid and blood cardioplegia, outlining advantages and disadvantages of each. Finally, it discusses novel strategies for cardioprotection such as ischemic preconditioning, post-conditioning, and remote ischemic preconditioning.
Cardiac Evaluation Ppt!
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
Cardiopulmonary bypass
Cardiopulmonary bypass (CPB) involves diverting blood from the heart to an external circuit for oxygenation and pumping. The basic components are a venous reservoir, oxygenator, heat exchanger, pump, and arterial filter. Initiation requires careful monitoring as the patient is transitioned to bypass. Management on CPB maintains appropriate pump flow, mean arterial pressure, temperature, and organ perfusion through monitoring of multiple parameters.
cardioplegia delivery management, perfusion safety
This document discusses perfusion safety in cardioplegia delivery management. It covers:
1. The importance of safety in perfusion to protect patients' lives and avoid negative consequences.
2. Definitions of cardioplegia as the paralysis of the heart during cardiac surgery using chemicals or electricity.
3. Guidelines for safely managing cardioplegia delivery, including preparing accurate solutions, checking the cardioplegia circuit and roller pump calibration, and monitoring temperature, pressure, flow and volume during delivery.
Anesthesia Management in Aortic Regurgitation
1. Aortic regurgitation occurs when blood leaks backwards from the aorta into the left ventricle during diastole due to failure of the aortic valve leaflets to coapt properly.
2. It can be acute, caused by things like infective endocarditis or aortic dissection, or chronic, caused by conditions like bicuspid aortic valve or hypertension.
3. Chronic AR is often well-tolerated for years as the left ventricle dilates and hypertrophies to accommodate the increased volume, but acute AR can rapidly lead to heart failure and shock if not emergently treated.
Recommended
CARDIO-PULMONARY BYPASS
Cardiopulmonary bypass (CPB) temporarily takes over the function of the heart and lungs during surgery by circulating and oxygenating the blood. It allows correction of cardiac defects that were previously not surgically treatable. The basic CPB circuit involves draining blood from the veins into an oxygenator and reservoir before pumping it back into the arteries. Key components include cannulas, a pump, oxygenator, heat exchanger, and cardioplegia delivery system. CPB requires anticoagulation and precise monitoring to safely divert blood flow around the heart while surgical repairs are made before returning the patient to full cardiac function. Complications can include bleeding, infection, organ dysfunction, and neurological issues. Advances like centrifugal pumps
Cardiopulmonary bypass
This document provides information on cardiopulmonary bypass, including:
1. The history of cardiopulmonary bypass, beginning with the first operation using bypass in 1951 and the first successful open heart procedure using bypass in 1953.
2. The basic components of a bypass system, including how blood is drained, oxygenated, and returned to the body via cannulas in major veins and arteries.
3. Additional details on venous and arterial cannulation techniques and potential complications. Venting of the heart is also discussed to prevent ventricular distension during bypass.
CARDIOPULMONARY BYPASS
This document provides information about cardiopulmonary bypass (CPB), including its goals, components, and processes. It discusses how CPB circuits divert blood flow away from the heart and lungs using a pump and oxygenator, allowing for surgery on a bloodless field. Key components that are described include the pump, oxygenator, heat exchanger, cannulas, and filters used. The document outlines the steps of priming, anticoagulation, cannulation, initiation and maintenance of bypass, as well as weaning and termination from bypass. Potential complications are also briefly mentioned.
Cardioplegia
This document discusses various topics related to cardioplegia, including alternative arresting agents and additives, crystalloid versus blood cardioplegia, and potential new technologies. It provides details on adenosine receptors, minute work and oxygen demand, alternative arresting agents such as beta blockers and adenocaine, agents affecting calcium transport, and ways to avoid substrate depletion. It compares crystalloid and blood cardioplegia, outlining advantages and disadvantages of each. Finally, it discusses novel strategies for cardioprotection such as ischemic preconditioning, post-conditioning, and remote ischemic preconditioning.
Cardiac Evaluation Ppt!
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
Cardiopulmonary bypass
Cardiopulmonary bypass (CPB) involves diverting blood from the heart to an external circuit for oxygenation and pumping. The basic components are a venous reservoir, oxygenator, heat exchanger, pump, and arterial filter. Initiation requires careful monitoring as the patient is transitioned to bypass. Management on CPB maintains appropriate pump flow, mean arterial pressure, temperature, and organ perfusion through monitoring of multiple parameters.
cardioplegia delivery management, perfusion safety
This document discusses perfusion safety in cardioplegia delivery management. It covers:
1. The importance of safety in perfusion to protect patients' lives and avoid negative consequences.
2. Definitions of cardioplegia as the paralysis of the heart during cardiac surgery using chemicals or electricity.
3. Guidelines for safely managing cardioplegia delivery, including preparing accurate solutions, checking the cardioplegia circuit and roller pump calibration, and monitoring temperature, pressure, flow and volume during delivery.
Anesthesia Management in Aortic Regurgitation
1. Aortic regurgitation occurs when blood leaks backwards from the aorta into the left ventricle during diastole due to failure of the aortic valve leaflets to coapt properly.
2. It can be acute, caused by things like infective endocarditis or aortic dissection, or chronic, caused by conditions like bicuspid aortic valve or hypertension.
3. Chronic AR is often well-tolerated for years as the left ventricle dilates and hypertrophies to accommodate the increased volume, but acute AR can rapidly lead to heart failure and shock if not emergently treated.
Basic principles of myocardial proctection
The document discusses various techniques for myocardial protection during cardiac surgery requiring aortic cross-clamping and cardioplegic arrest. It covers:
1. The evolution of techniques from hypothermic fibrillating heart to cold multidose cardioplegia, including important discoveries like cardioplegia solutions.
2. Key principles of myocardial protection including rapid induction of arrest, mild hypothermia, buffering solutions, and avoiding substrate depletion and edema.
3. Methods of delivery including antegrade and retrograde infusion of cold blood-cardioplegia every 20-30 minutes to prevent acidosis during ischemic periods.
4. Differences in techniques for neonates like single-dose oxygenated solutions to allow longer
OPCAB
Off-pump coronary artery bypass grafting (OPCAB) involves bypass surgery on a beating heart without use of cardiopulmonary bypass. Early reports used it for single or double vessel bypass in low risk patients. It is now used for multi-vessel bypass in higher risk patients. Key aspects of anesthesia management include maintaining hemodynamic stability, preventing arrhythmias and ischemia, and allowing for early emergence and recovery. Challenges include hypotension, arrhythmias, hypothermia, and myocardial ischemia which are managed through various pharmacological and technical interventions.
Cardiomyopathies
This document discusses dilated cardiomyopathy (DCM), the most common type of cardiomyopathy. It provides details on:
1) The causes, symptoms, signs, diagnostic tests and goals of treatment for DCM. The mainstay of therapy includes vasodilators, digoxin and diuretics.
2) The morphological and microscopic features of DCM which involve enlargement and spherical dilation of the heart chambers.
3) Disease progression can lead to marked left ventricular dilatation and circulatory failure if left untreated. Management aims to relieve symptoms and slow progression.
Mitral valve anatomy - ppt by kunwar sidharth
The mitral valve, also known as the bicuspid valve or left atrioventricular valve, lies between the left atrium and left ventricle. It is a dual flap valve made up of the mitral annulus, two leaflets (anterior and posterior), chordae tendineae connecting the leaflets to the papillary muscles of the left ventricle, and the left ventricular wall. The mitral valve apparatus works to ensure unidirectional blood flow from the left atrium to the left ventricle during diastole and prevent backflow during systole.
Anaesthesia for cardiopulmonary bypass surgery
1. The document discusses the process of cardiopulmonary bypass (CPB), which involves diverting blood away from the heart and lungs and using an external circuit to oxygenate and return the blood to the body.
2. It outlines the basic components of a CPB circuit and the surgical procedures that require CPB. It also discusses the roles and responsibilities of the perfusionist who manages the patient's circulatory and respiratory functions during CPB.
3. The document provides details on the pre-operative evaluation, intra-operative monitoring, myocardial protection, anticoagulation, induction of anesthesia, and hemodynamic changes that can occur during different stages of CPB.
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This document discusses M-mode echocardiography, including its physics, applications, and findings. M-mode provides high temporal resolution to evaluate cardiac structure movement and timing. It can be used to assess valves, walls, intervals, and morphology. Examples are given of M-mode findings in various cardiac pathologies at the mitral, aortic, pulmonary, and tricuspid valves as well as the left ventricle. Measurements like fractional shortening and ejection fraction are also reviewed.
Intracardiac shunts
I'm afraid I don't have enough information to answer these questions. The document provided is an overview of techniques for detecting intracardiac shunts and quantifying cardiac output and shunt flow. It does not include a specific patient case. Could you please provide more details about a patient for me to reference in answering your questions?
Basic Heart-Lung Machine in Cardiac Surgery
In Cardiac surgery , heart lung machine is a important equipment for Cardiopulmonary Bypass (CPB) / Extracorporeal Cardiopulmonary Bypass (ECPB).
Anaesthesia for cardiopulmonary bypass surgery [autosaved]
This document discusses cardiopulmonary bypass (CPB), which involves diverting blood away from the heart and through an external circuit that oxygenates the blood and returns it to the body. CPB allows surgery to be performed on an unbeating heart while still providing circulation. The key components of a CPB machine and roles of the perfusionist in managing it are described. Steps in CPB like priming, hypothermia, myocardial preservation via cardioplegia, and monitoring techniques are summarized.
8.myocardial protection during cpb
This document discusses various strategies for myocardial protection during cardiac surgery. It describes how ischemia and reperfusion injury can damage the myocardium. The goals of myocardial protection are to reduce oxygen demand, maintain adequate perfusion, and minimize injury during reperfusion. Techniques discussed include cardioplegic arrest, hypothermia, venting, intermittent clamping, and pharmacological additives to cardioplegia solutions. The optimal method balances protection against procedural complexity and aims to prevent intraoperative damage and ensure postoperative cardiac function.
cardiac output measurment
This document discusses methods of measuring cardiac output. It begins with a brief history noting Adolf Fick first developed a technique for measuring cardiac output in 1870 using what is now called the Fick principle. It then describes several methods including invasive techniques using a pulmonary artery catheter and non-invasive options like echocardiography, esophageal Doppler, and impedance cardiography. The document emphasizes the importance of cardiac output for oxygen delivery and assessing cardiovascular function in critically ill patients.
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This document provides an overview of standard transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) views. It describes the imaging windows, planes, and positions for obtaining basic and modified TTE views such as parasternal, apical, and subcostal views. It also outlines TEE imaging levels and how to manipulate the probe to obtain standard midesophageal and transgastric views, including 4-chamber, 2-chamber, aortic valve, and left ventricular views. The document aims to guide practitioners in performing comprehensive TTE and TEE exams through appropriate patient positioning and transducer manipulation.
Cath hemodynamics vir
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.
Ventricular Assist Device
A ventricular assist device (VAD) is a mechanical pump that helps the failing heart pump blood. Some VADs are short-term, while others provide long-term support. The most common type is the left ventricular assist device (LVAD) which helps the left ventricle. VADs carry risks like infection, blood clots, and device malfunctions but can help patients live longer while waiting for a heart transplant or serve as permanent heart failure treatment. After surgery, patients recover in the hospital while taking medications and regaining strength. Living with a VAD requires ongoing monitoring but allows many to return to normal activities with doctor approval.
Transesophageal echocardiography
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
Cardiac transplantation
Heart transplantation involves surgically removing a failing heart and replacing it with a donor heart. Some key points about heart transplantation include:
- It was first successfully performed in humans in 1967 and involved overcoming major immunological barriers to transplantation.
- Candidate selection considers the severity of heart failure symptoms and prognosis without transplantation against risks of the procedure and long-term outcomes.
- With improvements in immunosuppression and care, 1-year survival rates now exceed 85% although long-term survival remains limited, with a median of 10-15 years.
- Over 4,000 heart transplants are performed annually worldwide, representing the standard of care for carefully selected patients with end-stage heart failure.
Transesophageal echocardiography
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
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This document discusses CVP and PCWP monitoring. It begins by outlining the cardiac cycle and then defines CVP as the pressure in the thoracic vena cava near the right atrium. Factors that can increase or decrease CVP are described. CVP monitoring involves inserting a catheter into a vein to measure pressure in the right atrium. The document then discusses PCWP monitoring, which involves advancing a catheter into the pulmonary artery to measure pressure. Normal ranges for various hemodynamic parameters are provided. Contraindications for PA catheter use are also outlined.
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, anacrotic notch, dicrotic limb, and dicrotic notch, which reflect events in the cardiac cycle and can be affected by conditions like vascular resistance.
Cardiopulmonary Bypass
- Check cardioplegia delivery
- Check for any air bubbles
- Check line pressures
Surgeon: Cross clamp!
Perfusionist: Clamped!
Surgeon: Cardioplegia!
Perfusionist: Going in!
Surgeon: Flow down!
Perfusionist: Flowing down!
Surgeon: Line pressure?
Perfusionist: 80/40, no air, delivery looks good.
Surgeon: Thank you, let's proceed.
Preoperative assessment for cardio thoracic surgery
This document provides guidance on preoperative assessment for cardiothoracic surgery. It outlines key areas to evaluate including pulmonary function, lung mechanics, gas exchange, and cardiopulmonary reserve. A comprehensive assessment involves spirometry, arterial blood gases, exercise testing, imaging, and considering factors like predicted postoperative lung function. The goal is to identify risks for postoperative respiratory and cardiac complications so high-risk patients can be optimized or potentially alternative treatment considered.
Anasthesia during cpb
This document discusses anesthetic management during cardiopulmonary bypass. It covers preparations for bypass including the circuit design and cannulations. It describes maintenance of bypass including anticoagulation, perfusion pressures, blood gas monitoring, and fluid management. The document outlines weaning from bypass including rewarming, optimizing acid-base balance and oxygen levels. It provides the sequence of events for terminating bypass including reducing pump flow and clamping cannulas. Post-bypass care including measuring cardiac function, tissue perfusion and removing cannulas is also summarized.
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Basic principles of myocardial proctection
The document discusses various techniques for myocardial protection during cardiac surgery requiring aortic cross-clamping and cardioplegic arrest. It covers:
1. The evolution of techniques from hypothermic fibrillating heart to cold multidose cardioplegia, including important discoveries like cardioplegia solutions.
2. Key principles of myocardial protection including rapid induction of arrest, mild hypothermia, buffering solutions, and avoiding substrate depletion and edema.
3. Methods of delivery including antegrade and retrograde infusion of cold blood-cardioplegia every 20-30 minutes to prevent acidosis during ischemic periods.
4. Differences in techniques for neonates like single-dose oxygenated solutions to allow longer
OPCAB
Off-pump coronary artery bypass grafting (OPCAB) involves bypass surgery on a beating heart without use of cardiopulmonary bypass. Early reports used it for single or double vessel bypass in low risk patients. It is now used for multi-vessel bypass in higher risk patients. Key aspects of anesthesia management include maintaining hemodynamic stability, preventing arrhythmias and ischemia, and allowing for early emergence and recovery. Challenges include hypotension, arrhythmias, hypothermia, and myocardial ischemia which are managed through various pharmacological and technical interventions.
Cardiomyopathies
This document discusses dilated cardiomyopathy (DCM), the most common type of cardiomyopathy. It provides details on:
1) The causes, symptoms, signs, diagnostic tests and goals of treatment for DCM. The mainstay of therapy includes vasodilators, digoxin and diuretics.
2) The morphological and microscopic features of DCM which involve enlargement and spherical dilation of the heart chambers.
3) Disease progression can lead to marked left ventricular dilatation and circulatory failure if left untreated. Management aims to relieve symptoms and slow progression.
Mitral valve anatomy - ppt by kunwar sidharth
The mitral valve, also known as the bicuspid valve or left atrioventricular valve, lies between the left atrium and left ventricle. It is a dual flap valve made up of the mitral annulus, two leaflets (anterior and posterior), chordae tendineae connecting the leaflets to the papillary muscles of the left ventricle, and the left ventricular wall. The mitral valve apparatus works to ensure unidirectional blood flow from the left atrium to the left ventricle during diastole and prevent backflow during systole.
Anaesthesia for cardiopulmonary bypass surgery
1. The document discusses the process of cardiopulmonary bypass (CPB), which involves diverting blood away from the heart and lungs and using an external circuit to oxygenate and return the blood to the body.
2. It outlines the basic components of a CPB circuit and the surgical procedures that require CPB. It also discusses the roles and responsibilities of the perfusionist who manages the patient's circulatory and respiratory functions during CPB.
3. The document provides details on the pre-operative evaluation, intra-operative monitoring, myocardial protection, anticoagulation, induction of anesthesia, and hemodynamic changes that can occur during different stages of CPB.
M mode echo
This document discusses M-mode echocardiography, including its physics, applications, and findings. M-mode provides high temporal resolution to evaluate cardiac structure movement and timing. It can be used to assess valves, walls, intervals, and morphology. Examples are given of M-mode findings in various cardiac pathologies at the mitral, aortic, pulmonary, and tricuspid valves as well as the left ventricle. Measurements like fractional shortening and ejection fraction are also reviewed.
Intracardiac shunts
I'm afraid I don't have enough information to answer these questions. The document provided is an overview of techniques for detecting intracardiac shunts and quantifying cardiac output and shunt flow. It does not include a specific patient case. Could you please provide more details about a patient for me to reference in answering your questions?
Basic Heart-Lung Machine in Cardiac Surgery
In Cardiac surgery , heart lung machine is a important equipment for Cardiopulmonary Bypass (CPB) / Extracorporeal Cardiopulmonary Bypass (ECPB).
Anaesthesia for cardiopulmonary bypass surgery [autosaved]
This document discusses cardiopulmonary bypass (CPB), which involves diverting blood away from the heart and through an external circuit that oxygenates the blood and returns it to the body. CPB allows surgery to be performed on an unbeating heart while still providing circulation. The key components of a CPB machine and roles of the perfusionist in managing it are described. Steps in CPB like priming, hypothermia, myocardial preservation via cardioplegia, and monitoring techniques are summarized.
8.myocardial protection during cpb
This document discusses various strategies for myocardial protection during cardiac surgery. It describes how ischemia and reperfusion injury can damage the myocardium. The goals of myocardial protection are to reduce oxygen demand, maintain adequate perfusion, and minimize injury during reperfusion. Techniques discussed include cardioplegic arrest, hypothermia, venting, intermittent clamping, and pharmacological additives to cardioplegia solutions. The optimal method balances protection against procedural complexity and aims to prevent intraoperative damage and ensure postoperative cardiac function.
cardiac output measurment
This document discusses methods of measuring cardiac output. It begins with a brief history noting Adolf Fick first developed a technique for measuring cardiac output in 1870 using what is now called the Fick principle. It then describes several methods including invasive techniques using a pulmonary artery catheter and non-invasive options like echocardiography, esophageal Doppler, and impedance cardiography. The document emphasizes the importance of cardiac output for oxygen delivery and assessing cardiovascular function in critically ill patients.
TEE VIEWS
This document provides an overview of standard transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) views. It describes the imaging windows, planes, and positions for obtaining basic and modified TTE views such as parasternal, apical, and subcostal views. It also outlines TEE imaging levels and how to manipulate the probe to obtain standard midesophageal and transgastric views, including 4-chamber, 2-chamber, aortic valve, and left ventricular views. The document aims to guide practitioners in performing comprehensive TTE and TEE exams through appropriate patient positioning and transducer manipulation.
Cath hemodynamics vir
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.
Ventricular Assist Device
A ventricular assist device (VAD) is a mechanical pump that helps the failing heart pump blood. Some VADs are short-term, while others provide long-term support. The most common type is the left ventricular assist device (LVAD) which helps the left ventricle. VADs carry risks like infection, blood clots, and device malfunctions but can help patients live longer while waiting for a heart transplant or serve as permanent heart failure treatment. After surgery, patients recover in the hospital while taking medications and regaining strength. Living with a VAD requires ongoing monitoring but allows many to return to normal activities with doctor approval.
Transesophageal echocardiography
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
Cardiac transplantation
Heart transplantation involves surgically removing a failing heart and replacing it with a donor heart. Some key points about heart transplantation include:
- It was first successfully performed in humans in 1967 and involved overcoming major immunological barriers to transplantation.
- Candidate selection considers the severity of heart failure symptoms and prognosis without transplantation against risks of the procedure and long-term outcomes.
- With improvements in immunosuppression and care, 1-year survival rates now exceed 85% although long-term survival remains limited, with a median of 10-15 years.
- Over 4,000 heart transplants are performed annually worldwide, representing the standard of care for carefully selected patients with end-stage heart failure.
Transesophageal echocardiography
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
CVP Pulmonary artery wedge pressure monitoring: Physiology
This document discusses CVP and PCWP monitoring. It begins by outlining the cardiac cycle and then defines CVP as the pressure in the thoracic vena cava near the right atrium. Factors that can increase or decrease CVP are described. CVP monitoring involves inserting a catheter into a vein to measure pressure in the right atrium. The document then discusses PCWP monitoring, which involves advancing a catheter into the pulmonary artery to measure pressure. Normal ranges for various hemodynamic parameters are provided. Contraindications for PA catheter use are also outlined.
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, anacrotic notch, dicrotic limb, and dicrotic notch, which reflect events in the cardiac cycle and can be affected by conditions like vascular resistance.
Cardiopulmonary Bypass
- Check cardioplegia delivery
- Check for any air bubbles
- Check line pressures
Surgeon: Cross clamp!
Perfusionist: Clamped!
Surgeon: Cardioplegia!
Perfusionist: Going in!
Surgeon: Flow down!
Perfusionist: Flowing down!
Surgeon: Line pressure?
Perfusionist: 80/40, no air, delivery looks good.
Surgeon: Thank you, let's proceed.
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Anasthesia during cpb
This document discusses anesthetic management during cardiopulmonary bypass. It covers preparations for bypass including the circuit design and cannulations. It describes maintenance of bypass including anticoagulation, perfusion pressures, blood gas monitoring, and fluid management. The document outlines weaning from bypass including rewarming, optimizing acid-base balance and oxygen levels. It provides the sequence of events for terminating bypass including reducing pump flow and clamping cannulas. Post-bypass care including measuring cardiac function, tissue perfusion and removing cannulas is also summarized.
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The document summarizes the key components and functions of an anesthetic machine. It describes the high pressure and low pressure systems, including gas supplies, cylinders, manifolds, regulators and flow meters. It explains the purpose and mechanisms of vaporizers and breathing circuits. Safety features like oxygen failure alarms and leak tests are also summarized.
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Valvular heart disease refers to disorders of the cardiac valves that cause stenosis or regurgitation. Common types include mitral stenosis and regurgitation, aortic stenosis and regurgitation. Anesthesia management focuses on maintaining normal heart rate and rhythm, preload, afterload, and contractility based on the specific valve affected to optimize cardiac output. Regional techniques like epidurals are generally preferred over general anesthesia when possible.
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Anaphylaxis is a severe, potentially life-threatening allergic reaction affecting multiple organs. It is considered present when there is acute onset of symptoms involving the skin and mucosa along with respiratory or cardiovascular symptoms, or just two or more symptoms rapidly after exposure to a trigger. Adrenaline is the first line treatment and should be administered immediately to prevent progression of symptoms. Antihistamines and steroids are adjunctive but do not treat the underlying cause. Patients require monitoring for biphasic reactions and should receive training and a prescription for epinephrine auto-injectors for future reactions.
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This document provides an overview of coarctation of the aorta, including its definition, pathophysiology, classification, diagnosis, treatment, and prognosis. It defines coarctation as a narrowing of the aorta that most commonly occurs just below the origin of the left subclavian artery. Clinical features may include high blood pressure in the arms and low blood pressure in the legs. Diagnosis is typically made through imaging like echocardiography. Treatment involves surgical repair through techniques like excision and primary anastomosis or patch aortoplasty. Complications can include rebound hypertension. Prognosis is generally good if repaired, but risks remain like recoarctation or aneurysm formation.
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Calcium released from the sarcoplasmic reticulum in cardiac myocytes stimulates contraction. Calcium is reuptaken into the sarcoplasmic reticulum and effluxed from the cell, lowering intracellular calcium as contraction peaks. Heart failure is defined by symptoms such as breathlessness and signs such as elevated jugular venous pressure. It requires evidence of structural heart abnormality and impaired function.
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This document discusses preparation for weaning a patient from cardiopulmonary bypass (CPB) during cardiac surgery. It emphasizes the importance of general preparations like ensuring rewarming, optimizing blood chemistry, and removing air from the heart. Preparing the lungs and heart is also important. This involves reinflating the lungs, optimizing the heart's rhythm, rate, contractility, afterload and preload. Electrical pacing may be needed to establish an effective cardiac rhythm before terminating CPB. Inotropic support can be provided if low contractility is detected. The goal is to have the heart in the best condition possible before ending CPB support.
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1. Preparation for weaning a patient from cardiopulmonary bypass (CPB) involves optimizing several physiological parameters including temperature, blood pressure, cardiac rhythm and contractility, blood gases, and fluid balance.
2. The heart is prepared for weaning through steps like ensuring adequate rewarming, optimizing heart rate and rhythm, increasing contractility if needed, and adjusting preload and afterload.
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Preoperative management
- 1. Anesthesia For Cardiac Surgery Preoperative management 1 Abeer elnakera Anesthesia lecturer 2010
- 8. Cardiovascular evaluation 1- history the severity of the pathologic condition
- 9. AHA/ACC classification of chronic heart failure Marked symptoms at rest despite maximal medical therapy D. Refractory end-stage heart failure Structural heart disease, dyspnea and fatigue, impaired exercise tolerance C. Symptomatic heart failure Previous myocardial infarction left ventricular dysfunction, valvular heart disease B. Asymptomatic heart failure Hypertension, diabetes mellitus, coronary artery disease, family history of cardiomyopathy A. High risk for developing heart failure
- 44. Thank you
Editor's Notes
- Normal finding in rest and stress CT study
- Good wall thickening and motion
- LV dilatation and multiple perfusion abnormalities both with stress and rest .
- extensive regional and global dysfunction and LV dilatation .
- Radionuclide Ventriculography using gamma camera
- Stunned myocardium refers to transient depression of contractile function secondary to an acute ischemic insult. Hibernating myocardium is a form of contractile dysfunction of living myocytes in the setting of chronic ischemia or chronically reduced flow reserve Myocardial stunning is a temporary condition, a relatively short period (days, weeks) of postischaemic left ventricular dysfunction following a short episode of profound ischaemia [1]. The delay in recovery of the contractile deficit is not related in any way to residual regional hypoperfusion or irreversible cellular damage, but rather a consequence of a slow repair process of the minimal damage inflicted to the contractile proteins during the ischaemic episode. It is now well accepted that free radical production and intracellular calcium overload occurring typically at the time of reperfusion are to be blamed for this cellular damage [2, 3]. This phenomenon, first described in a controlled experimental setting was found to occur clinically as frequently as ischaemia itself in many patients with various ischaemic syndromes Hibernating myocardium, a clinical concept popularized by Rahimtoola, describes a more chronic (months, years) and supposedly stable condition of regional segmental dysfunction in patients with documented coronary obstructive lesions, in which revascularization procedures (CABG or PTCA) result more often in a partial rather than complete functional recovery [5]. In contrast to myocardial stunning where no histopathological abnormalities at the cellular level are demonstrable, biopsies of hibernating segments taken at the time of surgery have revealed marked structural alterations including substantial loss of myofibrillar content, cellular swelling and increased glycogen content [6]. Despite these alterations the dysfunctioning segments retain some contractile reserve when stimulated with inotropic agents. This characteristic of hibernating myocardium is used to advantage for diagnostic purposes.[