DOCSLIB.ORG

Irregular Heart Beats/Palpitations

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Irregular Heart Beats/Palpitations Irregular Heart Beats/Palpitations Anjan S Batra, M.D Director of Electrophysiology Associate Professor of Pediatrics University of California-Irvine CASE 1 • A 12 year old presents with a fast heart rate. He is otherwise asymptomatic. A wide complex rhy thm is no te d a t a ra te o f 260 bpm. His bloo d pressure is 92/50. The next best course of action would be: January 14-15, 2011 SCA Conference 1 A. Adenosine B. Sotalol C. Amiodarone D. Verapamil E. DC cardioversion SVT • In a hemodynamically stable patient, a supraventitricu lar tac hycar dia w ith aberrant conduction is the most likely rhythm. • The best treatment for this patient would be administration of adenosine to terminate the tachycardia. January 14-15, 2011 SCA Conference 2 CASE 2 An 8 year old presents with a fast heart rate and difficulty breathing. Blood pressure is stable. An ECG is obtained and shown below. There is no change in the heart rate with adenosine. Your next course of action would be: A. DC cardioversion B. Sedation and atrial overdrive pacing C. Digoxin D. Beta blockers E. Verapamil January 14-15, 2011 SCA Conference 3 Fascicular Ventricular Tachycardia • Originating from the left ventricle. • Adenosine is usually not effective in terminating the tachycardia. • Calcium channel blockers are very effective and hence this tachycardia is also referred to as verapamil sensitive ventricular tachycardia. • This is usually amenable to ablation. CASE 3: A 12 year old boy is undergoing a stress test for frequent ectopy at baseline. The echocardiogram at rest was normal. You notice the following rhythm at stage 5 of the standard Bruce protocol. The diagnosis is most consistent with: January 14-15, 2011 SCA Conference 4 A. Brugada Syndrome B. CPVT C. Long QT type 3 D. Myocarditis E. Artifact Catecholaminergic ventricular tachycardia (CPVT). • Polymorphic ventricular tachycardia with exerc ise • Brugada syndrome and long QT type3 – polymorphic ventricular tachycardia ggyenerally at rest or during gp sleep. • Myocarditis: decrease in cardiac function. January 14-15, 2011 SCA Conference 5 CPVT • CPVT cannot be diagnosed on the basis of a resting ECG.1,2 • Exercise stress testing is an important part of a CPVT workup. – However, in as many as 20% of CPVT patients, formal exercise stress testing will not produce ventricular ectopy.1 • During exercise stress testing, bidirectional VT with a beat-to-beat 180- degree rotation of the QRS complex is often observed.1 References: 1. Mohamed U, Napolitano C, Priori SG. Molecular and electrophysiological bases of catecholaminergic polymorphic ventricular tachycardia. J Cardiovasc Electrophysiol. 2007;18:791-797. 2. Kontula K, Laitinen PJ, Lehtonen A, Toivonen L, Viitasalo M, Swan H. Catecholaminergic polymorphic ventricular tachycardia: recent mechanistic insights. Cardiovasc Res. 2005;67:379-387. Mutations in the Cardiac Ryanodine Receptor Gene (RYR2) Are the Major Cause of CPVT RYR2 • 60-65% of CPVT is caused by mutations of the car diac ryano dine receptor gene, which encodes a sarcoplasmic calcium ion channel.1,2 12 References: 1. Mohamed U, Napolitano C, Priori SG. Molecular and electrophysiological bases of catecholaminergic polymorphic ventricular tachycardia. J Cardiovasc Electrophysiol. 2007;18(7):791-797. 2. Hayashi M, Denjoy I, Extramiana F, et al. Incidence and Risk Factors of Arrhythmic Events in Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation. 2009;119:2426-34. January 14-15, 2011 SCA Conference 6 It Is Important to Differentiate Between CPVT and LQTS • CPVT is an LQTS mimicker.1 • As many as 30% of CPVT patients have been misdiagnosed as having “Long QT with normal QTc.”2,3 • Differentiating CPVT from LQTS is important for: - Developing a comprehensive treatment plan - Family-specific testing References: 1. Choi G, Kopplin LJ, Tester DJ, et al. Spectrum and frequency of cardiac channel defects in swimming-triggered 13 arrhythmia syndromes. Circulation. 2004;110:2119-2124. 2. Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation. 2002;106:69-74. 3. Napolitano C, Priori SG. Diagnosis and treatment of catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm. 2007;4:675-678. Beta-blockers Do Not Provide Reliable Protection Against Cardiac Arrhythmias Related to CPVT • “However, in light of incomplete protection afforded by beta-blockers in CPVT, its distinction from long-QT is clinically relevant.”1 • Nearly 50% of CPVT patients taking a beta- blocker continue experiencing cardiac arrhythmias and may require an ICD.1 14 Reference: 1. Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation. 2002;106:69-74. January 14-15, 2011 SCA Conference 7 Brugada Syndrome • The ECG of patients with BrS is characterized by – Coved- or saddleback-shaped ST-segment elevation in leads V1 through V31 – complete or incomplete right bundle-branch block – T-wave inversion1 • These ECG abnormalities may not be evident until unmasked by infusion of a sodium channel blocker (flecainide or procainamide).1 References: 1. Brugada R, Brugada P, Brugada J, Hong K. Brugada syndrome. Gene Reviews Web site. Available at: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=brugada. Accessed May 25, 2009. 2. Rossenbacker T and Priori SG. The Brugada Syndrome. Curr Opin Cardiol. 2007;22:163-70. BrS Typically Presents in Men 30-40 Years of Age • The most common presentation of BrS is a man 30-40 years of age with malignant arrhythmias and a history of syncope.1,2 – Men are 8-10 times more likely than women to have the BrS phenotype.1,2 – There is no difference between men and women in the prevalence of gene mutations associated with BrS.1,2 • Men with an abnormal ECG and inducible ventricular arrhythmias have a poor prognosis.1,2 • If untreated, men with BrS have a 45% chance of having a cardiac event over the course of their life.1 16 References: 1. Brugada R, Brugada P, Brugada J, Hong K. Brugada syndrome. Gene Reviews Web site. Available at: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=brugada. Accessed May 25, 2009. 2. Rossenbacker T and Priori SG. The Brugada Syndrome. Curr Opin Cardiol. 2007;22:163-70. January 14-15, 2011 SCA Conference 8 CASE 4 • A 14 year old patient with a history of WPW and SVT presents with this ECG. He is alert and hemodynamically stable. The MOST appropriate therapy is: A. Adenosine B. Lidocaine C.Observation D.DC cardioversion E. IV calcium channel blocker January 14-15, 2011 SCA Conference 9 WPW • Atrial fibrillation with rapid conduction over the accessory pa thway resu lts in a rapid ventricular response. • At risk for ventricular fibrillation and compromised circulation. • Adenosine can also induce atrial fibrillation. • DC Cardioversion should be readily available. CASE 5 • A 12 year old boy comes to you with palpitations with exercise. He also complains of occasional chest pain with exercise. You obtain an ECG which is shown below. The next most obvious recommendation would be to: January 14-15, 2011 SCA Conference 10 • a. Perform an exercise stress test. • b. Clear him for sports without any restrictions. • c. Perform an echocardiogram. • d. Perform a CXR. • e. Perform a 30 day event monitor. Left ventricular hypertrophy with a strain pattern. • At risk for ventricular tachycardia and sudden car diac dea th w ith exerc ise • Additional risk factors – family history of premature sudden death – extreme LV hypertrophy (> 30 mm) – NS ventricular tachycardia on Holter – unexplained (not neurally mediated) syncope January 14-15, 2011 SCA Conference 11 The Clinical Presentation of HCM • HCM is a progressive disease associated with varying degrees of LVH with no apparent cause.1 - Thickening typically develops during late childhood and throughout adolescence.1 23 Reference: 1. Keren A, Syrris P, McKenna WJ. Hypertrophic cardiomyopathy: the genetic determinants of clinical disease expression. Nature. 2008;5:158-168. Obstructive and Non-obstructive HCM LVH is usually maximal in the interventricular septum, but other localized variants have been documented.1 24 Reference: 1. Keren A, Syrris P, McKenna WJ. Hypertrophic cardiomyopathy: the genetic determinants of clinical disease expression. Nature. 2008;5:158-168. January 14-15, 2011 SCA Conference 12 The Clinical Diagnosis of HCM Relies Primarily on Echocardiogram Echocardiogram can help determine: • Location and extent of hypertrophy • Systolic and diastolic function • The presence and degree of systolic anterior motion • The severity of subaortic and/or midventricular obstruction • Direction and degree of mitral regurgitation • The presence or absence of additional mitral valve abnormalities • Left atrial size 25 QUESTIONS January 14-15, 2011 SCA Conference 13 CASE 6 A 21 year old patient with classic Fontan presents with palpitations and fast heart rates for 3 days. ECG shows an unvarying heart rate of 140 bpm. He usually has a heart rate between 60 to 90 bpm. His blood pressure is stable. The following ECG is obtained. The next most approp riate intervention would be: • a. Echocardiogram • b. Digoxin • c. Adenosine • d. Sotalol • e. Amiodarone January 14-15, 2011 SCA Conference 14.
Load more

Recommended publications
  • Modified Bruce Protocol Mets
    Modified Bruce Protocol Mets entwining,Yttric and ropyhis decoupling Wilson cybernate mundifies almost imponed bleakly, onside. though Elwin Glynn pull-ups wites shamelessly.his artifices append. Squamulose Warden This suggests hibernating myocardium of fixed defects in modified protocol holds degrees of revascularization and lung function in asymptomatic patients ensuring privacy of cardiac output Gibbons RJ, Balady GJ, Beasley JW, et al. Cardiovascular Disease Risk Factors There are several factors that increase the risk for having CVD. If st segment: no other protocols present study based on protocol? We may share certain information about our users with our advertising and analytics partners. Bruce treadmill protocol mets vo2 Jottit. Unscrambling the anchor of METs Los Angeles Times. Ultimate Herpes Modified Bruce Protocol Mets Calculator. Pain in critically ill patients. Overall, fare with CMR is limited. In contrast, Myers et al. The test is your muscles use, children and the end of three categories. Infection Control Procedures Adhere to relevant Hospital and Health Service infection control protocols or procedures at all times and in all facets of EST. Prognostic Value of Functional Capacity for Different X-MOL. The bruce protocol remains as a given the american college of exercise stress testing may be instructed not drink caffeinated beverages can probably come up and age. Aerobic Fitness Testing iWorx. Abrupt disappearance of the delta wave is presumptive evidence of a longer anterograde effective refractory period of the accessory pathway. Degree of depression severity. What via the difference between Bruce protocol and modified Bruce protocol? Maximum Treadmill Cardiovascular Test ExRxnet. MODIFIED BRUCE are maximal protocol as they Employing these protocols under.
    [Show full text]
  • Exercise Stress Test
    Exercise Stress Test If test results are negative, then later after OVERVIEW discharge: symptom-limited at 3-6 weeks. The purpose of this document is to b. Soon after discharge: symptom-limited at 14-21 specifically identify the critical components days. involved in performing an exercise stress test. 3) Risk stratification of patients with chronic stable CAD This information serves as a standard for into a low-risk category that can be managed medical- all nuclear cardiology laboratories. ly or a high-risk category that should be considered for coronary revascularization. This document will cover indications, 4) Risk stratification of low-risk acute coronary syn- contraindications, limitations, testing drome patients (without active ischemia and/or heart procedure, and indications for early failure) 6-12 hours after presentation or intermediate- termination of exercise. risk acute coronary syndrome patients 1 to 3 days after presentation. 5) Risk stratification before noncardiac surgery in EXERCISE STRESS TEST patients with known CAD, diabetes mellitus, Exercise is the preferred stress modality in patients who peripheral or cerebrovascular disease. are able to achieve at least 85% of age-adjusted maximal 6) To evaluate the efficacy of therapeutic interventions predicted heart rate (MPHR) and five metabolic equivalents. (anti-ischemic drug therapy or coronary revasculariza- tion) and in tracking subsequent risk based on serial Exercise stress testing is a powerful risk stratification tool changes in myocardial perfusion in patients with and is useful in assessing the efficacy of anti-ischemic drug known CAD. therapy and/or coronary revascularization. CONTRAINDICATIONS The treadmill is the most widely used stress modality. The Contraindications are considered absolute or relative.
    [Show full text]
  • American Society of Echocardiography Recommendations for Performance, Interpretation, and Application of Stress Echocardiography
    GUIDELINES AND STANDARDS American Society of Echocardiography Recommendations for Performance, Interpretation, and Application of Stress Echocardiography Patricia A. Pellikka, MD, Sherif F. Nagueh, MD, Abdou A. Elhendy, MD, PhD, Cathryn A. Kuehl, RDCS, and Stephen G. Sawada, MD, Rochester, Minnesota; Houston, Texas; Marshfield, Wisconsin; and Indianapolis, Indiana dvances since the 1998 publication of the TABLE OF CONTENTS A Recommendations for Performance and Interpreta- tion of Stress Echocardiography1 include improve- Methodology....................................................1021 ments in imaging equipment, refinements in stress Imaging Equipment and Technique............1021 testing protocols and standards for image interpre- Stress Testing Methods...... ............................1022 tation, and important progress toward quantitative Training Requirements and Maintenance analysis. Moreover, the roles of stress echocardiog- of Competency...... .....................................1023 raphy for cardiac risk stratification and for assess- Image Interpretation......................................1024 ment of myocardial viability are now well docu- Table 1. Normal and Ischemic mented. Specific recommendations and main points Responses for Various Modalities are identified in bold. of Stress........................................................1025 Quantitative Analysis Methods.....................1025 Accuracy...... .....................................................1026 False-negative Studies...... ..............................1026
    [Show full text]
  • “Cardiac Solution” Program Tip Sheet
    “Cardiac Solution” Program Tip Sheet MYOCARDIAL PERFUSION IMAGING (MPI) vs. STRESS ECHOCARDIOGRAPHY (SE) Main Points about the Two Tests: Both tests have equal diagnostic accuracy for coronary artery disease, with MPI showing greater sensitivity and SE showing greater specificity. MPI is based upon the expectation of relatively reduced blood flow in a myocardial segment during exercise or pharmacologic coronary microvessel dilation, while SE is based upon development of wall motion abnormality provoked by myocardial ischemia during treadmill exercise or similar stress. In order to perform a SE, one would prefer to have a patient who could perform treadmill exercise well, along with a good acoustic imaging window, while MPI can be performed with either exercise or the pharmacologic option. Exercise can also provide the additional information from the EKG, when the baseline EKG does not already have substantial abnormality (e.g. a 1 mm ST segment depression at baseline, left bundle branch block, ventricular pacing, PVCs, or pre-excitation). Even with MPI, an exercise modality is preferred over pharmacologic vasodilation due to the additional functional and EKG information inherent in exercise testing. However, in some patients, such as those with a pre-existing wall motion abnormality, left bundle branch block, ventricular paced rhythms, frequent PVCs, or pre-excitation (WPW), the related cardiac contraction pattern during exercise could obscure the effects of ischemia, making a pharmacologic approach more helpful. The radiation exposure of SE is zero, while MPI incurs a radiation Radiation Exposure dose of 7-24 mSv (the equivalent of about 117-400 PA & lateral chest X-rays), with an increase in lifetime radiation exposure and its MPI: 7 - 24 mSv associated cancer risk.
    [Show full text]
  • Cardiovascular and Surgical Outcomes | 2016
    Cardiovascular and Surgical Outcomes | 2016 BayCareHeart.org Clinical Review Committee Dear Colleague, Augustine E. Agocha, MD, PhD Table of Contents We’re pleased to provide this summary of key 2016 cardiovascular national benchmarking along with patient-centered care, assures St. Joseph’s Hospital program highlights. BayCare’s cardiovascular programs are dedicated the best treatment for each patient. In addition to our volume and Mahesh Amin, MD New in 2016 ....................................................... 3 Morton Plant Hospital to providing the highest quality care and services throughout Florida outcomes data, we’re excited to highlight some of our world-class and beyond. Our advanced facilities permit us to care for complex programs including our fast-growing arrhythmia, structural heart Rodrigo Bolaños, MD Why Choose Us? ............................................... 5 Winter Haven Hospital cardiac disease with programs specializing in coronary artery disease, and percutaneous coronary intervention programs. As a system of Cardiovascular Surgery .................................... 7 George Dagher, MD heart failure, structural heart and valve disease, peripheral vascular community hospitals within West Central Florida, we’re committed to Morton Plant North Bay Hospital disease, arrhythmia, pediatric and congenital heart disease and being a leader in providing superior heart care. Advanced Structural Heart and Valve .........13 diseases of the aorta. David Evans, MD We hope you can utilize the information in this outcomes book to help Winter Haven Hospital Arrhythmia ......................................................17 BayCare off ers comprehensive forums for physicians, staff and with patient care and treatment decisions. For more information or to David W. Kohl, MD administrators to share clinical expertise, outcomes data, research and refer a patient to any of our programs, call (844) 344-1990.
    [Show full text]
  • Stress Echocardiography in Ischemic Heart Disease: from the American Society of Echocardiography
    GUIDELINES AND STANDARDS Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography Patricia A. Pellikka, MD, FASE, Chair, Adelaide Arruda-Olson, MD, PhD, FASE, Farooq A. Chaudhry, MD, FASE,* Ming Hui Chen, MD, MMSc, FASE, Jane E. Marshall, RDCS, FASE, Thomas R. Porter, MD, FASE, and Stephen G. Sawada, MD, Rochester, Minnesota; New York, New York; Boston, Massachusetts; Omaha, Nebraska; Indianapolis, Indiana Keywords: Echocardiography, Stress, Guidelines, Imaging, Ischemic heart disease, Stress test, Pediatrics This document is endorsed by the following ASE International Alliance Partners: Argentine Federation of Cardiology, Argentine Society of Cardiology, ASEAN Society of Echocardiography, Association of Echocardiography and Cardiovascular Imaging of the Interamerican Society of Cardiology, Australasian Sonographers Association, Canadian Society of Echocardiography, Chinese Society of Echocardiography, Cuban Society of Cardiography Echocardiography Section, Department of Cardiovascular Imaging of the Brazilian Society of Cardiology, Indian Academy of Echocardiography, Indian Association of Cardiovascular Thoracic Anaesthesiologists, Indonesian Society of Echocardiography, Iranian Society of Echocardiography, Israeli Working Group on Echocardiography, Italian Association of CardioThoracic and Vascular Anaesthesia and Intensive Care, Japanese Society of Echocardiography, Korean Society of Echocardiography, Mexican Society of Echocardiography
    [Show full text]
  • Stress, Protocols, and Tracers
    ASNC IMAGING GUIDELINES ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers a b c Milena J. Henzlova, MD, W. Lane Duvall, MD, Andrew J. Einstein, MD, d e Mark I. Travin, MD, and Hein J. Verberne, MD a Mount Sinai Medical Center, New York, NY b Hartford Hospital, Hartford, CT c New York Presbyterian Hospital, Columbia University Medical Center, New York, NY d Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY e Academic Medical Center, Amsterdam, The Netherlands doi:10.1007/s12350-015-0387-x Abbreviations LEHR Low energy high resolution A2A Adenosine 2a LVEF Left ventricular ejection fraction AHA American Heart Association MBq Megabecquerels ALARA As low as reasonably achievable mCi Millicuries AV Atrioventricular MPI Myocardial perfusion imaging BP Blood pressure MRI Magnetic resonance imaging CBF Coronary blood flow mSv Millisievert CAD Coronary artery disease NE Norepinephrine CPET Cardiopulmonary exercise testing NET1 Norepinephrine transporter-1 DSP Deconvolution of septal penetration NPO Nil per os (nothing by mouth) ECG Electrocardiogram NYHA New York Heart Association EF Ejection fraction PET Positron emission tomography ESRD End-stage renal disease ROI Region of interest HF Heart failure SPECT Single-photon emission computed HFrEF Heart failure (with) reduced ejection tomography fraction TAVR Transcatheter aortic valve replacement HMR Heart-to-mediastinum ratio WR Washout rate ICD Implantable cardioversion defibrillator WPW Wolff-Parkinson White IV Intravenous
    [Show full text]
  • American College of Chest Physicians
    American Thoracic Society/ American College of Chest Physicians ATS/ACCP Statement on Cardiopulmonary Exercise Testing This Joint Statement of the American Thoracic Society (ATS) and the American College of Chest Physicians (ACCP) was adopted by the ATS Board of Directors,March 1, 2002 and by the ACCP Health Science Policy Committee, November 1, 2001 CONTENTS 3.2 Maximal Incremental Treadmill Protocols 3.3 Constant Work Rate Protocol Executive Summary 4. Conducting the Test . .......................226 I. Introduction 4.1 Preliminary Requirements for Exercise Testing Idelle M. Weisman 4.2 Day of the Test Purpose and Scope ............................212 4.3 Patient Safety 5. Personnel Qualifications . ..................227 II. Indications for Cardiopulmonary Exercise Testing Idelle M. Weisman, Darcy Marciniuk, Fernando J. Martinez, IV. Conceptual and Physiologic Basis of Cardiopulmonary Frank Sciurba, Darryl Sue, Jonathan Myers Exercise Testing Measurements 1. Evaluation of Exercise Intolerance ..............214 Bruce Johnson, Brian Whipp, Jorge Zeballos, Idelle M. Weisman, 2. Unexplained Dyspnea ........................215 Ken Beck, Donald Mahler, John Cotes, Kathy Sietsema, 3. Evaluation of Patients with Cardiovascular Disease. 215 Kieran Killian 4. Evaluation of Patients with Respiratory Disease . 216 1. Oxygen Uptake . .............228 4.1 Chronic Obstructive Pulmonary Disease (COPD) 1.1 V˙ o2 Work Rate Relationship 4.2 Interstitial Lung Disease (ILD) 1.2 V˙ o2 max–V˙ o2 peak 4.3 Chronic Pulmonary Vascular Disease (PVD) 2. CO2 Output . .....229 4.4 Cystic Fibrosis 3. Respiratory Exchange Ratio . ......230 4.5 Exercise Induced Broncospasm (EIB) 4. Anaerobic Threshold . .....230 5. Preoperative Evaluation ......................216 4.1Clinical Applications of the Anaerobic Threshold 5.1 Preoperative Evaluation for Lung Cancer Resectional 4.2 Determination of the Anaerobic Threshold Surgery 4.3 Noninvasive Determinations 5.2 Lung Volume Reduction Surgery (LVRS) 5.
    [Show full text]
  • Practice Guidelines for the Diagnosis and Management of Systolic Heart Failure in Low- and Middle-Income Countries Ragavendra R
    j WHITE PAPER gRECS Practice Guidelines for the Diagnosis and Management of Systolic Heart Failure in Low- and Middle-Income Countries Ragavendra R. Baliga*, G. William Decy, Jagat Narulaz Columbus, OH, USA; Boston, MA, USA; and New York, NY, USA TABLE OF CONTENTS Conclusions ..................................................166 Clinical assessment..........................................141 References ....................................................166 Symptoms of HF and relevant facets in history ... 141 Heart failure (HF) occurs when the cardiac output is Physical examination ..................................144 not adequate to meet the metabolic demands of the tissues or is able to do so only at an elevated ventricular filling Diagnostic tests ..............................................150 pressure. Laboratory...............................................150 BNP and amino-terminal proBNP ...................150 ECG......................................................150 CLINICAL ASSESSMENT Chest x-ray ..............................................152 Echocardiography and Doppler ......................152 Symptoms of HF and relevant facets in history Stress testing ............................................153 Compiling the history of a patient with heart failure should Six-minute walk test, cardiopulmonary stress test/ focus on establishing the diagnosis; determining the regular stress test .....................................154 etiology; evaluating functional status including shortness of fl Right heart catheterization
    [Show full text]
  • Constriction Vs Restriction
    Pericardial Diseases Constriction vs Restriction Jae K. Oh, MD ASE Board Review 2017 ©2012 MFMER | 3200268v3(2010)-1 Echo Evaluation of Pericardial Diseases • Constriction vs Restriction • Typical Constriction • Effusive CP • Transient CP • CP and Tricuspid Regurgitation • Multi-modality Imaging • Cases • Tamponade ©2016 MFMER | slide-2 Restriction vs Constriction Paradoxical DHF or HFpEF No paradoxical Pulse Paradoxical No variation Diastolic Filling Variation Decreased Relaxation (e’) Paradoxical Inspiration HV reversal Expiration Concordant LV/RV SP Discordant Diagnosis should be based on their characteristic HEMODYNAMICS CP983059-3 ©2016 MFMER©2011 | slide-3 MFME R | slide-3 Mayo Echo Diagnostic Criteria Septal motion abnormality MV Flow Velocity Medial e’ ≥ 8 cm/s Restrictive (E/A >1) Hepatic Vein Diastolic reversal with expiration Sensitivity 87 % Specificity 91 % Welch et al Circ Imaging 2014 ©2016 MFMER | slide-4 Hemodynamics of Myocardial Disease Concordant change in PCWP and LVDP 80 LV 40 PCW Inspiration Expiration Inspiration 0 Hatle et al. Circ 1989 ©2011 CP1105201MFMER-1 | slide-5 ©2016 MFMER | slide-5 Constrictive Pericarditis E E Mitral Inflow vs Cath 1.Dissociation between intrathoracic and intracardiac pressures 2.Interventricular Dependence CP992397-39 ©2016 MFMER | slide-6 Hemodynamics in Constriction Intracardiac pressure Δ < intrathoracic pressure Δ Interventricular dependence CP1051850-19 ©2016 MFMER | slide-7 Constriction Abnormal septal motion Interventricular Dependence “Consider constriction if there is septal
    [Show full text]
  • Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: from the American Society of Echocardiography
    GUIDELINES AND STANDARDS Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography Patricia A. Pellikka, MD, FASE, Chair, Adelaide Arruda-Olson, MD, PhD, FASE, Farooq A. Chaudhry, MD, FASE,* Ming Hui Chen, MD, MMSc, FASE, Jane E. Marshall, RDCS, FASE, Thomas R. Porter, MD, FASE, and Stephen G. Sawada, MD, Rochester, Minnesota; New York, New York; Boston, Massachusetts; Omaha, Nebraska; Indianapolis, Indiana Keywords: Echocardiography, Stress, Guidelines, Imaging, Ischemic heart disease, Stress test, Pediatrics This document is endorsed by the following ASE International Alliance Partners: Argentine Federation of Cardiology, Argentine Society of Cardiology, ASEAN Society of Echocardiography, Association of Echocardiography and Cardiovascular Imaging of the Interamerican Society of Cardiology, Australasian Sonographers Association, Canadian Society of Echocardiography, Chinese Society of Echocardiography, Cuban Society of Cardiography Echocardiography Section, Department of Cardiovascular Imaging of the Brazilian Society of Cardiology, Indian Academy of Echocardiography, Indian Association of Cardiovascular Thoracic Anaesthesiologists, Indonesian Society of Echocardiography, Iranian Society of Echocardiography, Israeli Working Group on Echocardiography, Italian Association of CardioThoracic and Vascular Anaesthesia and Intensive Care, Japanese Society of Echocardiography, Korean Society of Echocardiography, Mexican Society of Echocardiography
    [Show full text]
  • Death During Exercise Testing in a Patient with Asymptomatic Severe Aortic Stenosis
    Edorium J Cardiol 2018;4:100009C03MS2018. Shah et al. 1 www.edoriumjournalofcardiology.com CASEORIGINAL REPORT ARTICLE PEER REVIEWED |OPEN OPEN ACCESS ACCESS Death during exercise testing in a patient with asymptomatic severe aortic stenosis Mahek Shah, Anuraj Sudhakaran, Baburaj Aparna, Muhammad Qasim, Brijesh Patel, Lohit Garg, Bruce Feldman ABSTRACT hemodynamic instability leading to death. A comprehensive registry of safety data is needed. Introduction: Patients with symptomatic severe Clinical vigilance and physician supervision aortic valve stenosis (AS) experience short during stress testing may minimize the risk of and long-term survival benefit with aortic serious adverse events. valve replacement (AVR). Among patients with asymptomatic severe AS (ASAS) current Keywords: Asymptomatic severe aortic stenosis, guidelines recommend exercise stress testing Exercise treadmill testing, Mortality, Safety (ETT) as a safe and effective method to risk stratify patients and to assist with the timing How to cite this article of AVR. We discuss the course of disease in AS, review the role of ETT and express concerns Shah M, Sudhakaran A, Aparna B, Qasim M, Patel B, about the safety of performing stress tests in Garg L, Feldman B. Death during exercise testing in asymptomatic patients with severe AS. Case a patient with asymptomatic severe aortic stenosis. Report: We describe the case of a 69-year-old Edorium J Cardiol 2018;4:100009C03MS2018. male with left bundle branch block and ASAS who underwent ETT with echocardiographic imaging. We describe the details of the patient’s Article ID: 100009C03MS2018 clinical, ECG and echo doppler parameters prior, during and following the test. Patient developed pulseless electrical activity during ********* early recovery with eventual resuscitation and mechanical support.
    [Show full text]