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Acute coronary syndrome with haemodynamic instability
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Davinder Singh Chadha, Keshavamurthy Ganapathy Bhat
Laboratory testing including complete blood count, biochemistry (including blood sugar, renal function and electrolyte status), prothrombin and partial thromboplastin times, quantitative troponin measurements, acid base gas (ABG) analysis and a chest radiograph should be done in all patients. Patients who present with acute MI with electrocardiographic abnormalities should undergo a quick echocardiogram to determine the ventricular function and also to detect any associated mechanical complications (tamponade, severe mitral regurgitation, ventricular septal or free-wall rupture). The diagnosis of right ventricular MI is suspected in patients with inferior MI, clear lung fields and shock. Placement of a Swan-Ganz catheter to confirm diagnosis, guide management and assess the need for more aggressive mechanical cardiac support if the patient has not responded to initial resuscitative efforts [2,13,21,22] is recommended.
Cardiomyopathies in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
During delivery, noninvasive telemetry monitoring is useful to assess for arrhythmias, point-of-care echocardiogram can give information about volume status, and arterial line pulse wave analysis may provide information on cardiac output and stroke volume variation. Placement of a Swan-Ganz catheter remains the gold standard for measuring cardiac output and filling pressure but has not been shown to have mortality benefit and is not frequently used during delivery, although may be used for patient stabilization and assessment. Whether a patient should be monitored in L&D or the ICU is patient and institution dependent. If medications are being titrated for optimization of hemodynamic status or are rarely used in L&D, this may be more readily achieved in an ICU; alternatively, if urgent delivery is anticipated, this may be more readily performed on L&D with a “borrowed” cardiac/critical-care nurse monitoring parameters on L&D.
Intervention: Nanotechnology in Reconstructive Intervention and Surgery
Published in Harry F. Tibbals, Medical Nanotechnology and Nanomedicine, 2017
Catheters can also be used for diagnostic and treatment procedures as probes and carriers for very small surgical and imaging instruments. The Swan-Ganz catheter is inserted into the pulmonary artery to monitor critical heart functions, for example. Instruments and procedures have been developed for insertion of catheters into blood vessels and the heart, where they can deliver imaging enhancement agents, drugs, or electrical stimulation. Vascular catheters can also be tipped with ablative tools, balloons, or stents to clear blocked vessels. Miniaturization of transducers has made possible catheters equipped to deliver laser, radiofrequency, or ultrasonic ablative energy to remove plaques, clots, or other obstructions [109-112].
Clinical presentation and outcomes in women and men with advanced heart failure
Published in Scandinavian Cardiovascular Journal, 2020
Julie K. K. Vishram-Nielsen, Tania Deis, Kasper Rossing, Emil Wolsk, Ana Carolina Alba, Finn Gustafsson
Right heart catheterization was performed in a designated catheterization laboratory using a Swan-Ganz catheter, which was inserted in either the right internal jugular vein or the femoral vein. Appropriate zeroing of the transducer was confirmed, and correct placement of the Swan-Ganz catheter was evaluated by fluoroscopy and by visualization of pressure curves on a monitor. Pressure measurements were recorded during end-expiration. Cardiac output (CO) was measured by thermodilution and recorded as an average of three measurements with < 10% variation. In case of greater variability in the thermodilution measurements, CO estimation was supplemented using the indirect Fick’s method. Hemodynamic measurements included mean right atrial pressure (mRAP), right ventricular systolic pressure (RVSP), right ventricular diastolic pressure (RVDP), pulmonary artery systolic pressure (PASP), pulmonary artery diastolic pressure (PADP), mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWP), pulmonary vascular resistance (PVR), CO, cardiac index (CI) and mean arterial pressure (MAP). Cardiac output was measured using thermodilution. Cardiac index = CO/body surface area (BSA). Body surface area was determined using the DuBois method. Mean arterial pressure = systolic BP (SBP)/3 + 2 × diastolic BP (DBP)/3.
Relation between invasive hemodynamics and measured glomerular filtration rate by 51Cr-EDTA clearance in advanced heart failure
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2019
Tania Deis, Louise Balling, Søren Boesgaard, Kasper Rossing, Morten Schou, Peter Oturai, Emil Wolsk, Finn Gustafsson
The invasive protocol was not modified from routine diagnostic procedure. Right heart catheterization was performed with a Swan–Ganz catheter by four different experienced physicians. The catheter was inserted in the right internal jugular or the right femoral vein. The correct placement of the Swan-Ganz catheter was evaluated by fluoroscopy and by visualization of pressure curves on a monitor. Hemodynamic measurements included pulmonary capillary wedge pressure (PCWP), mean right atrial pressure as an indicator of central venous pressure (CVP), cardiac output (CO), cardiac index (CI), and mean arterial pressure (MAP). Cardiac output was measured by the thermodilution technique. CI was determined as cardiac output divided by the body surface area (BSA). BSA was determined using DuBois method. MAP was estimated using the formula MAP = ((2 × diastolic blood pressure (DBP)) + systolic blood pressure(SBP))/3.
Relationship between invasive hemodynamics and liver function in advanced heart failure
Published in Scandinavian Cardiovascular Journal, 2019
Julie K. K. Vishram-Nielsen, Tania Deis, Louise Balling, Muhammad Sabbah, Søren Boesgaard, Kasper Rossing, Emil Wolsk, Finn Gustafsson
Right heart catheterization was performed with a Swan-Ganz catheter which was inserted in either the right internal jugular vein or the femoral vein. The correct placement of the Swan-Ganz catheter was evaluated by fluoroscopy and by visualization of pressure curves on a monitor. Hemodynamic measurements included pulmonary capillary wedge pressure (PCWP), mean right atrial pressure as an indicator of central venous pressure (CVP), CO, cardiac index (CI) and mean arterial pressure (MAP). Cardiac output was measured using thermodilution. Cardiac index = CO/body surface area. Body surface area was determined using DuBois method. Mean arterial pressure = systolic blood pressure (SBP)/3 + 2 × diastolic blood pressure (DBP)/3.