Therapy of acute myocardial infarction
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
The causes of cardiogenic shock complicating acute MI are similar to the causes of HF and hypotension. Since a minority of patients survive cardiogenic shock in the absence of a treatable underlying disorder, immediate evaluation for a potentially correctable problem is critical. Emergent echocardiography should be performed to assess overall left ventricular function and to rule out valvular lesions, pericardial disease, and septal or ventricular free wall perforation (16). Pulmonary artery catheterization is occasionally indicated to facilitate diagnosis and for guiding therapy. Cardiac catheterization may be necessary in some cases if the diagnosis remains in doubt, as a prelude to PCI or corrective surgery, or to assess for stent thrombosis or related occlusion of a recent PCI or bypass graft.
Acute Coronary Syndromes
Karim Ratib, Gurbir Bhatia, Neal Uren, James Nolan in Emergency Cardiology, 2010
Improving outcome in patients with right ventricular infarction depends on increasing right ventricular preload by fluid loading and avoiding vasodilator drugs, correcting arrhythmias and using inotropes only when fluid balance has been optimized. Treatment therefore consists of: insertion of a pulmonary artery catheter to confirm diagnosis and guide treatmentavoiding treatment with diuretics or vasodilators, which will exacerbate the haemodynamic problem by reducing preloadfluid loading with 200 mL of physiological saline over 10 minutes, followed by 1–2 litres over 2–4 hours, followed by 200 mL/h. The infusion rate should be carefully titrated to maintain an optimal wedge pressure of 15 mmHgif hypotension persists despite an optimal wedge pressure, treating with intravenous inotropesif complete heart block occurs, restoring AV synchrony with temporary dual chamber pacingif AF occurs, restoring AV synchrony with cardioversion.
Cardiac diseases in pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Continuous EKG and pulse oximetry monitoring is recommended to monitor for hypotension, hypoxemia, myocardial ischemia, and arrhythmias. The role of pulmonary artery catheter is controversial and should be decided on a case-by-case basis. Women in functional class IV and selected cases in functional class III, pulmonary hypertension, may benefit from a pulmonary artery catheter insertion before the process of labor and delivery is started (8). In some conditions, such as mitral stenosis, controlling the heart rate with a beta blocker infusion may be indicated to avoid tachycardia and decrease in cardiac output (113).
Effects of remote ischemic preconditioning on platelet activation and reactivity in patients undergoing cardiac surgery using cardiopulmonary bypass: a randomized controlled trial
Published in Platelets, 2022
Youn Joung Cho, Karam Nam, Sol Ji Yoo, Seohee Lee, Jinyoung Bae, Ji-Young Park, Hang-Rae Kim, Tae Kyong Kim, Yunseok Jeon
Without premedication, patients were monitored with 5-lead electrocardiography, noninvasive sphygmomanometry, pulse oximetry, bispectral index, and cerebral oximetry. After local anesthesia with 1% lidocaine, peripheral arterial catheterization was established at the radial artery for continuous invasive arterial blood pressure monitoring. General anesthesia was induced with intravenous injection of midazolam (0.1 mg/kg) and sufentanil (1 µg/kg). Endotracheal intubation was facilitated with administration of rocuronium (0.6 mg/kg); patient’s lungs were ventilated in volume-controlled mode using an anesthesia machine. A central venous catheter was placed at the internal jugular vein under ultrasonographic guidance; a pulmonary artery catheter was introduced through the jugular catheter to monitor pulmonary artery pressure, cardiac index, and mixed venous oxygen saturation. Anesthesia was maintained using target-controlled infusion of propofol (effect site concentration: Ce of 1–4 µg/mL) and remifentanil (Ce of 4–8 ng/mL). Concentrations of propofol and remifentanil were adjusted to maintain the bispectral index below 40 and to maintain adequate hemodynamics in response to surgical stimuli.
The use of bronchoscopy in critically ill patients: considerations and complications
Published in Expert Review of Respiratory Medicine, 2018
Begum Ergan, Stefano Nava
Critically ill patients are often vulnerable to cardiovascular and hemodynamic compromise, especially in the presence of severe hypoxemia. Close monitoring of oxygen saturation, pulse rate, electrocardiography (ECG) and blood pressure is the key for early recognition and timely intervention. After initiation of FB, heart rate and cardiac output are usually transiently increased [16]. In a study performed in mechanically ventilated patients, approximately 20% of patients experienced hemodynamic instability, which was associated with preexisting cardiovascular comorbidity [21]. Papazian et al. evaluated the hemodynamic effects of FB and BAL with pulmonary artery catheterization in patients who were hemodynamically unstable [17]. The patients were receiving PEEP of at least 10 cmH2O and intravenous vasoactive and/or inotropic support. Mean arterial and mean pulmonary artery pressure were both increased, whereas mixed venous oxygen saturation was decreased, from baseline during FB.
Hemolysis during short-term mechanical circulatory support: from pathophysiology to diagnosis and treatment
Published in Expert Review of Medical Devices, 2022
Tim Balthazar, Johan Bennett, Tom Adriaenssens
Insufficient preload should be detected early to prevent ‘suction alarms’ and hemolysis by adequate hemodynamic monitoring. Accruing data suggest that use of pulmonary artery catheters is associated with improved outcomes in severe cardiogenic shock (which are often pVAD supported) patients [51,52]. Hemodynamic monitoring allows following of trends in cardiac filling pressures and relates these to changes in cardiac output as well as mixed venous oxygen saturation, which might lead to earlier intervention. The ability to trend filling pressures during changes in pVAD flow as well as fluid challenges is probably the most important use of the pulmonary artery catheter. The ‘normal’ for filling pressures is variable, and depends on pVAD flow as well as patient physiology. For a more detailed discussion on hemodynamic optimization during pVAD support, we refer to recent review articles [6,53].
Related Knowledge Centers
- Arrhythmia
- Cardiogenic Shock
- Myocardial Infarction
- Pulmonary Artery
- Pulmonary Wedge Pressure
- Pulmonary Embolism
- Pulmonary Edema
- Ventricular Tachycardia
- Catheter
- Heart Failure