DOCSLIB.ORG

Cardiovascular Emergencies

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cardiovascular Emergencies Cardiovascular Emergencies Robert S. Kiken DDS Ocean Oral and Maxillofacial Surgery Santa Barbara, CA 1 Management of Office Anesthetic and Medical Emergencies – a Systems Approach Cardiovascular emergencies involving the conducting system Cardiovascular emergencies involving the vascular system Endocrine/Diabetic emergencies 2 Deliver Oxygen & Prevent Hypoxia Deficiency in the amount of oxygen reaching the tissues. Can cause dysrhythmias, cardiac arrest, brain damage, and death. We must have: Adequate Circulation pump and conducting system An unimpaired Airway Uncompromised Breathing 3 1 The Foundation 4 Cardiovascular emergencies involving the conducting system - EKG Interpretation 5 Conduction System: Basic Anatomy SA Node: Bundle of primary His pacemaker Internodal Bundle pathways branches and atria Purkinje AV fibers Node 6 2 SA Node Basic Electrophysiology Depolarization of the Ventricles AV Node Repolarization of the Ventricles Relationship of EKG to Anatomy of Cardiac Conduction system P QRS T 7 The Electrocardiogram Repolarization of Depolarization of the Ventricles the Ventricles Depolarization of the Atria Hypokalemia or other metabolic disturbance What does the EKG tell us? 8 Rules Of EKG Interpretation Look For: Rate Rhythm Regularity 9 3 Rate How fast is the heart beating? 80 beats per Start where an R wave minute falls on a heavy line 10 Another approach to find the rate is to divide 300 by the number of large boxes between R waves. 1 2 3 4 5 6 In this case we’ll divide 300 by 6: 300 ÷ 6 = 50 1 2 In this case we’ll divide 300 by 2: 300 ÷ 2 = 150 11 Automaticity Foci (Ectopic Foci) Foci throughout the heart have the property of “automaticity” i.e. they can initiate an action potential and become the heart’s pacemaker Automaticity foci may be located either: In the atria In the AV Junction In the ventricles 12 4 Automaticity Foci Foci in each of these areas has an inherent discharge rate SA Node 60-100/min INHERENT LEVEL RATE RANGE Atria 60 - 80/min. AV Junction 40 - 60/min. Ventricles 20 - 40/min. 13 As You Count The Boxes, Consider If The Rate Is A Problem. 2 Boxes When there are less than two boxes between R waves or 8 Boxes When there are more than five boxes between R waves (in this example 8 boxes) 14 Rhythm Do all the beats look the same? Is it like wallpaper? And, can you dance to it? 15 5 Rhythm If the beats all look the same… …do they look worrisome? 16 Rhythm Disturbances Arrhythmias may be either: Supraventricular Arrhythmias - above the level of ventricles Combined Arrhythmias -above and within the ventricles Ventricular Arrhythmias - within the ventricles 17 Regularity Are the beats evenly spaced? A ==B C = D { { { { 1 18 6 Principles of EKG : Helpful Hints 19 1. Identify the QRS Complexes Start 150 75 300 100 Can you identify them?...and • What is their rate? 20 2. Is the QRS complex width normal? ½ Normal is < 0.11 sec (no more than ½ large block) 21 7 3. Is there a P wave in front of each QRS? 22 4. Is the P-R interval normal? 3-5 small blocks Normal is 0.12 - 0.20 sec (3-5 small blocks) 23 EKG Interpretation of Cardiac Dysrhythmias Bradycardia Sinus tachycardia Stable tachycardias Unstable tachycardias Arrest rhythms: Ventricular fibrillation & pulseless ventricular tachycardia Asystole & PEA 24 8 Normal Sinus Rhythm and Sinus Dysrhythmias Normal Sinus Rhythm (NSR) Sinus Arrhythmia (Sinus Dysrhythmia) Sinus Bradycardia Sinus Tachycardia 25 Vagus Normal Sinus Rhythm (NSR) SA Defining characteristics: • All components present i.e. P, QRS and T waves • Regular rate and rhythm of AV 60 -100 bpm • PR = 0.12 – 0.20, QRS = < 0.12 Start 150 75 P QRS T 300 100 PR =.12 - .20 QRS < .11 83 26 Normal Sinus Rhythm (NSR) Rate Defining characteristics: • All components present i.e. P, QRS and T waves • Regular rate and rhythm of 60 -100 bpm • PR = 0.12 – 0.20, QRS = < 0.12 27 9 Sinus Arrhythmia Defining characteristics: • Similar to NSR except for irregular rate • Rate varies somewhat with inspiration and expiration • Decrease in PNS on inhalation results in an increase in heart rate • Usually a normal finding Start Start 48 150 75 60 150 75 50 300 100 60 300 100 60 28 Sinus Arrhythmia Rate Defining characteristics: • Similar to NSR except for irregular rate • Rate varies somewhat with inspiration and expiration • Usually a normal finding 29 Premature Atrial Contraction (PAC) Rate Defining characteristics: • Overall NSR except for isolated early P waves • Beat with early P wave usually followed by a beat containing a compensatory pause 30 10 Bradycardia 31 Sinus Bradycardia Defining characteristics: • Like NSR, but with rate < 60 • May be due to increased parasympathetic tone • Seen as a normal finding in athletes Start 150 75 50 50 300 100 60 32 Sinus Bradycardia RATE Defining characteristics: • Like NSR, but with rate < 60 • May be due to increased parasympathetic tone • Seen as a normal finding in athletes 33 11 78 year old medically compromised patient with bradycardia Pre-Op QRS Wider No P Intra-Op PVC 34 Persistent Bradycardia • Causing: • Hypotension • Altered mental status • Signs of shock • Ischemic chest discomfort • Acute heart failure • Treat… 35 Treat Persistent Bradycardia Causing: Symptoms Signs • Chest discomfort • Hypotension • Shortness of breath • CHF • Decreased level of • Ventricular consciousness arrhythmia related • Weakness to the bradycardia • Fatigue • Dizziness • Syncope 36 12 Bradycardia - Treatment Atropine effect takes “foot off of Vagus Nerve the brake” X Dopamine effect – puts “foot on the gas” 37 Diagnosis: Pulse < 60 is “bradycardia,” but treat patient, not monitor Position: Semi-seated, comfortable Initial Management: Observe, ABC’s, 02, IV, Monitor If Stable: • Continue to observe, ABC’s, 02, IV, Monitor If Unstable, Treat With: • Atropine • If atropine ineffective: • Transcutenous pacing • Dopamine • Epinephrine 38 Bradycardia - Atropine • Atropine 0.5 mg IV every 3-5 minutes to total dose of 3 mg. • A dose less than 0.5 mg may further decrease heart rate. • May worsen ischemia or increase infarction size. • Ineffective in cardiac transplant patient. • If type II/2 or 3rd degree block, atropine will likely be ineffective. 39 13 Bradycardia - Dopamine • Dopamine 2-10 mcg/kg/minute. • Has both α- and β-adrenergic actions. • Titrate to target heart rate or vasoconstriction. • Lower dose: inotropy and heart rate. • Higher dose: (>10) vasoconstriction. • Good choice if bradycardia and hypotension. • Adequate intravascular volume. 40 Bradycardia - Epinephrine • Epinephrine 2-10 mcg per minute. • α- and β-adrenergic actions. • Good choice if bradycardia and hypotension. 41 Tachycardia 42 14 Cardiac Dysrhythmias -Tachycardias • Sinus Tachycardia • Atrial Tachycardias - usually “Narrow Complex” • Ventricular Tachycardias - usually “Wide Complex” 43 SA Sinus Tachycardia Defining characteristics: • Similar to NSR except for increased rate of > 100 bpm AV • Frequently seen during adrenergic stimulation 115 Start 150 300 100 44 Sinus Tachycardia Rate Defining characteristics: • Similar to NSR except for increased rate of > 100 bpm • Frequently seen during adrenergic stimulation 45 15 Atrial Dysrhythmias – Usually “Narrow Complex” • Premature Atrial Contraction (PAC) • Paroxysmal Supraventricular Tachycardia (PVST) • Atrial Fibrillation (A. Fib.) • Atrial Flutter (A. Flutter) • Multifocal Atrial Tachycardia (MAT) 46 Ectopic focus Premature Atrial within the Contraction (PAC) atrium Defining characteristics: • Overall NSR except for isolated early P waves • Beat with early P wave usually followed by a beat containing a compensatory pause 2X Y + Z = 2X X X Y Z Compensatory Pause 47 An atrial pacemaker takes over Paroxysmal Supraventricular Tachycardia (PSVT) Defining characteristics: • Regular, narrow complex tachycardia (150- 250 bpm) • Sudden (paroxysmal) onset • Merged P-T waves Merged P-T waves Rate increased from 83 to187 Normal sinus beats 48 16 Paroxysmal Supraventricular Tachycardia (PSVT) Rate Defining characteristics: • Regular, narrow complex tachycardia (150-250 bpm) • Sudden (paroxysmal) onset • Merged P-T waves 49 Atrial Fibrillation (A. Fib.) Defining characteristics: • Multiple ectopic foci within the atria create a wavy baseline consisting of small erratic spikes • An ectopic focus near the AV node may conduct into the ventricles and generate a QRS. • Irregular ventricular rate Ventricular rate highly variable R R R Wavy baseline with small erratic spikes 50 Atrial Fibrillation (A. Fib.) Rate Defining characteristics: • Multiple ectopic foci within the atria create a wavy baseline consisting of small erratic spikes • An ectopic focus near the AV node may conduct into the ventricles and generate a QRS. • Irregular ventricular rate 51 17 An ectopic circular conduction loop Atrial Flutter (A. Flutter) Defining characteristics: • A chaotic circular conduction path creates a “saw tooth” baseline of “flutter waves.” • Slower ventricular rate, usually in a 3:1 or 4:1 ratio to flutter waves A “saw tooth” pattern of F waves F F F F 52 Atrial Flutter (A. Flutter) Rate Defining characteristics: • A chaotic circular conduction path creates a “saw tooth” baseline of “flutter waves.” • Slower ventricular rate, usually in a 3:1 or 4:1 ratio to flutter waves 53 Multifocal Atrial Tachycardia • Irregularly irregular • Distinguished from atrial fibrillation by the presence of P waves. • Pulmonary disease or multi-system issue (sepsis, shock, electrolyte abnormalities) 54 18 Ventricular Dysrhythmias – Usually “Wide Complex” (i.e. the QRS Complex is Wide ) • Premature
Load more

Recommended publications
  • Common Arrhythmias Disclosures
    Common Arrhythmias Disclosures • I work for Virginia Garcia Memorial Health Center. • And I am a medical editor for Jones & Bartlett Publishing. Jon Tardiff, BS, PA-C OHSU Clinical Assistant Professor What a 12-Lead ECG can help you do • Diagnose ACS / AMI • Interpret arrhythmias • Identify life-threatening syndromes (WPW, LGL, Long QT synd., Wellens synd., etc) • Infer electrolyte imbalances • Infer hypertrophy of any chamber • Infer COPD, pericarditis, drug effects, and more! Arabic, Somali, Mai Mai, Pashtu, Urdu, ASL, and more! For example… WPW with Atrial Fib 55 66 Wolff-Parkinson-WhiteWPW Graphic synd. Same pt, converted to SR Drs. Wolff, Parkinson, & White 77 Another example: Dr. William Stokes—1800s 71 y.o. man with syncope This patient is conscious and alert! Third Degree Block 9 Treatment: permanent pacemaker 10 Lots of ways to read ECGs… Limitations of a 12-Lead ECG • QRSs wide or narrow? • Is it sinus rhythm or not? • Truly useful only ~40% of the time • Regular or irregular? • If not, is it atrial fibrillation? • Each ECG is only a 10 sec. snapshot • Fast or slow? • BBB? • P waves? • MI? • Serial ECGs are necessary, especially for ACS • Other labs help corroborate ECG findings (cardiac markers, Cx X-ray) • Confounders must be ruled out (LBBB, dissecting aneurysm, pericarditis, WPW, Symptoms: digoxin, LVH, RVH) • Syncope is bradycardia, heart blocks, or VT • Rapid heart beat is AF, SVT, or VT Conduction System Lead II P wave axis …upright in L II II R T P R U Q S …upright in L II R wave axis SA Node AV Node His Bundle BBs Purkinje Fibers 14 13 Q S Normal Sinus Rhythm Triplicate Method: 6-second strip: 6 seconds 300, 150, 100, Count PQRST cycles in a 6 75, 60, 50 second strip & multiply x 10 Quick, easy, sufficient Easy, & more accurate 300 150 100 75 60 6 seconds What is the heart rate? Horizontal axis is time (mS); vertical axis is electrical energy (mV) 16 1.
    [Show full text]
  • Prolonged Asystole During Hypobaric Chamber Training
    Olgu Sunumları Anadolu Kardiyol Derg 520 Case Reports 2012; 12: 517-24 contraction/ventricular tachycardia’s originating from mitral annulus contractions arising from the mitral annulus: a case with a pure annular are rarely reported (1). origin. Pacing Clin Electrophysiol 2009; 32: 680-2. [CrossRef] PVCs arising from the mitral annulus frequently originate from 5. Kimber SK, Downar E, Harris L, Langer G, Mickleborough LL, Masse S, et al. anterolateral, posteroseptal and posterior sites (2). It has been reported Mechanisms of spontaneous shift of surface electrocardiographic configuration that 2/3 of the PVCs arising from the mitral annulus originate from during ventricular tachycardia. J Am Coll Cardiol 1992; 15: 1397-404. [CrossRef] anterolateral site (2). Furthermore, small part of these arrhythmias origi- Address for Correspondence/Yaz›şma Adresi: Dr. Ömer Uz nates from the anteroseptal site of the mitral annulus. Ablation of this Gülhane Askeri Tıp Akademisi Haydarpasa, Kardiyoloji Kliniği, İstanbul-Türkiye site may be technically very challenging. Cases have been reported that Phone: +90 216 542 34 65 Fax: +90 216 348 78 80 successful catheter ablation of the premature ventricular contraction E-mail: [email protected] origin from the anteroseptal site of the mitral annulus can be performed Available Online Date/Çevrimiçi Yayın Tarihi: 22.06.2012 either by a transseptal or transaortic approach in literature (3, 4). ©Telif Hakk› 2012 AVES Yay›nc›l›k Ltd. Şti. - Makale metnine www.anakarder.com web Anterolateral site of the mitral annulus is in close proximity to anterior sayfas›ndan ulaş›labilir. of the right ventricle outflow tract, left ventricular epicardium near to ©Copyright 2012 by AVES Yay›nc›l›k Ltd.
    [Show full text]
  • Unstable Angina with Tachycardia: Clinical and Therapeutic Implications
    Unstable angina with tachycardia: Clinical and therapeutic implications We prospectively evaluated 19 patients with prolonged chest pain not evolving to myocardiai infarction and accompanied with reversible ST-T changes and tachycardia (heart rate >lOO beats/min) in order to correlate heart rate reduction with ischemic electrocardiographic (ECG) changes. Fourteen patients (74%) received previous long-term combined treatment with nifedipine and nitrates. Continuous ECG monitoring was carried out until heart rate reduction and at least one of the following occurred: (1) relief of pain or (2) resolution of ischemic ECG changes. The study protocol consisted of carotid massage in three patients (IS%), intravenous propranolol in seven patients (37%), slow intravenous amiodarone infusion in two patients (lo%), and intravenous verapamil in four patients (21%) with atrial fibrillation. In three patients (16%) we observed a spontaneous heart rate reduction on admission. Patients responded with heart rate reduction from a mean of 126 + 10.4 beats/min to 64 k 7.5 beats/min (p < 0.005) and an ST segment shift of 4.3 k 2.13 mm to 0.89 k 0.74 mm (p < 0.005) within a mean interval of 13.2 + 12.7 minutes. Fifteen (79%) had complete response and the other four (21%) had partial relief of pain. A significant direct correlation was observed for heart rate reduction and ST segment deviation (depression or elevation) (f = 0.7527 and 0.8739, respectively). These patients represent a unique subgroup of unstable angina, in which the mechanism responsible for ischemia is excessive increase in heart rate. Conventional vasodilator therapy may be deleterious, and heart rate reduction Is mandatory.
    [Show full text]
  • Respiration Driven Excessive Sinus Tachycardia Treated with Clonidine Matthew Emile Li Kam Wa,1 Patricia Taraborrelli,1 Sajad Hayat,2 Phang Boon Lim1
    Novel treatment (new drug/intervention; established drug/procedure in new situation) BMJ Case Reports: first published as 10.1136/bcr-2016-216818 on 28 April 2017. Downloaded from CASE REPORT Respiration driven excessive sinus tachycardia treated with clonidine Matthew Emile Li Kam Wa,1 Patricia Taraborrelli,1 Sajad Hayat,2 Phang Boon Lim1 1Department of Cardiology, SUMMARY no evidence of dual AV node physiology, accessory Imperial College Healthcare A 26-year-old man presented to our syncope service pathway or inducible supraventricular tachycardia. NHS Trust, London, UK 2Department of Cardiology, with debilitating daily palpitations, shortness of breath, A subsequent permanent pacemaker led to no University Hospitals Coventry presyncope and syncope following a severe viral further episodes of frank syncope. However his and Warwickshire NHS Trust, respiratory illness 4 years previously. Mobitz type II block ongoing debilitating exertional and respiratory- Coventry, UK had previously been identified, leading to a permanent driven palpitations with presyncope remained. pacemaker and no further episodes of frank syncope. Conservative measures including increased fluid Correspondence to Dr Phang Boon Lim, Transthoracic echocardiography, electophysiological study intake and compression stockings had no effect. [email protected] and repeated urine metanepherines were normal. His Trials of medication including fludrocortisone, fle- palpitations and presyncope were reproducible on deep cainide, β blockers and ivabradine were either not Accepted 18 December 2016 inspiration, coughing, isometric hand exercise and tolerated or had no significant effect on his passive leg raises. We demonstrated rapid increases in symptoms. heart rate with no change in morphology on his 12 lead During a simple active stand over 3 min, his ECG.
    [Show full text]
  • Basic Rhythm Recognition
    Electrocardiographic Interpretation Basic Rhythm Recognition William Brady, MD Department of Emergency Medicine Cardiac Rhythms Anatomy of a Rhythm Strip A Review of the Electrical System Intrinsic Pacemakers Cells These cells have property known as “Automaticity”— means they can spontaneously depolarize. Sinus Node Primary pacemaker Fires at a rate of 60-100 bpm AV Junction Fires at a rate of 40-60 bpm Ventricular (Purkinje Fibers) Less than 40 bpm What’s Normal P Wave Atrial Depolarization PR Interval (Normal 0.12-0.20) Beginning of the P to onset of QRS QRS Ventricular Depolarization QRS Interval (Normal <0.10) Period (or length of time) it takes for the ventricles to depolarize The Key to Success… …A systematic approach! Rate Rhythm P Waves PR Interval P and QRS Correlation QRS Rate Pacemaker A rather ill patient……… Very apparent inferolateral STEMI……with less apparent complete heart block RATE . Fast vs Slow . QRS Width Narrow QRS Wide QRS Narrow QRS Wide QRS Tachycardia Tachycardia Bradycardia Bradycardia Regular Irregular Regular Irregular Sinus Brady Idioventricular A-Fib / Flutter Bradycardia w/ BBB Sinus Tach A-Fib VT PVT Junctional 2 AVB / II PSVT A-Flutter SVT aberrant A-Fib 1 AVB 3 AVB A-Flutter MAT 2 AVB / I or II PAT PAT 3 AVB ST PAC / PVC Stability Hypotension / hypoperfusion Altered mental status Chest pain – Coronary ischemic Dyspnea – Pulmonary edema Sinus Rhythm Sinus Rhythm P Wave PR Interval QRS Rate Rhythm Pacemaker Comment . Before . Constant, . Rate 60-100 . Regular . SA Node Upright in each QRS regular . Interval =/< leads I, II, . Look . Interval .12- .10 & III alike .20 Conduction Image reference: Cardionetics/ http://www.cardionetics.com/docs/healthcr/ecg/arrhy/0100_bd.htm Sinus Pause A delay of activation within the atria for a period between 1.7 and 3 seconds A palpitation is likely to be felt by the patient as the sinus beat following the pause may be a heavy beat.
    [Show full text]
  • Ventricular Rhythms Originate Below the Branching Portion of The
    Northwest Community Healthcare Paramedic Program VENTRICULAR DYSRHYTHMIAS Pacemakers Connie J. Mattera, M.S., R.N., EMT-P Reading assignments: Bledsoe Vol 3; pp. 96-109 SOPs: VT with pulse; Ventricular fibrillation/PVT; Asystole/PEA Drugs: Amiodarone, magnesium, epinephrine 1mg/10mL Procedure manual: Defibrillation; Mechanical Circulatory Support (MCS) using a Ventricular Assist Device KNOWLEDGE OBJECTIVES: Upon completion of the reading assignments, class and homework questions, reviewing the SOPs, and working with their small group, each participant will independently do the following with at least an 80% degree of accuracy and no critical errors: 1. Identify the intrinsic rates, morphology, conduction pathways, and common ECG features of ventricular beats/rhythms. 2. Identify on a 6-second strip the following: a) Idioventricular rhythm b) Accelerated idioventricular rhythm c) Ventricular tachycardia: monomorphic & polymorphic d) Ventricular escape beats e) Premature Ventricular Contractions (PVCs) f) Ventricular fibrillation g) Asystole h) Paced rhythms i) Intraventricular conduction defects (Bundle branch blocks) 3. Systematically evaluate each complex/rhythm for the following: a) Rate (atrial and ventricular) b) Rhythm: Regular/irregular - R-R Interval, P-P Interval c) Presence/absence/morphology of P waves d) Presence/absence/morphology of QRS complexes d) P-QRS relationships f) QRS duration 4. Correlate the cardiac rhythm with patient assessment findings to determine the emergency treatment for each rhythm according to NWC EMSS SOPs. 5. Discuss the action, prehospital indications, side effects, dose and contraindications of the following during VT a) Amiodarone b) Magnesium 6. Describe the indications, equipment needed, critical steps, and patient monitoring parameters for cardioversion and defibrillation. 7. Identify the management of a patient with an implanted defibrillator and/or pacemaker.
    [Show full text]
  • The Unsuspected Complications of Bacterial Endocarditis Imaged by Gallium-67 Scanning
    The Unsuspected Complications of Bacterial Endocarditis Imaged by Gallium-67 Scanning Shobha P. Desai and David L. Yuille Nuclear Medicine Department, St. Luke's Medical Center, Milwaukee, @V&sconsin tivity in the region of the aortic valve which extended into the In this case report, we present a patient with bacterial endocar right atrium (Fig. 1)but was better appreciated on an axial SPECF ditiswho was evaluatedby 67(@imagingfor persistentfever image (Fig. 2). despitetreatmentwith multipleintravenousantibiotics.Afthough cardiac catheterizationconfirmeda densely calcified bicuspid evidence of bactenal endocarditiswas absent wfth @“Gaimag aorticvalve with both stenosis and insufficiencyas well as what ing,the studydemonstratedfindingsthat representcomplica was thoughtto be aveiy largerightsinus ofvalsalva aneurysm.At tions of bacterial endocarditis. The procedure demonstrated surgery, there was evidence of epicarditisand pericarditisand a moderatepencardialuptakeof isotopeandthus pro@4dedthe hugerightsinus of valsalva abscess was foundwhich was eroding first evidence of pehcardi@swhich was later confirmed at sur into the aortic wall. The aortic valve annuluswas debrided, the gery.The studyalsodemonstratedmi@ increasedactivityin abscess cavity was drainedandthe patient's diseased aorticvalve thevicinityoftheaorticrootandnghtattium.A sinusofvalsalva was replacedwith a no. 25 St. Jude's prosthesis (St. JudeMedical abscess, complicatingthe underlyingdiagnosis of bacterialen Inc., St. Paul, MN). The immediatepostoperativeperiodwas docarc@bs,was
    [Show full text]
  • Basic Cardiac Rhythms – Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives
    Basic Cardiac Rhythms – Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives ▪ Describe the normal cardiac anatomy and physiology and normal electrical conduction through the heart. ▪ Identify and relate waveforms to the cardiac cycle. Cardiac Anatomy ▪ 2 upper chambers ▪ Right and left atria ▪ 2 lower chambers ▪ Right and left ventricle ▪ 2 Atrioventricular valves (Mitral & Tricuspid) ▪ Open with ventricular diastole ▪ Close with ventricular systole ▪ 2 Semilunar Valves (Aortic & Pulmonic) ▪ Open with ventricular systole ▪ Open with ventricular diastole The Cardiovascular System ▪ Pulmonary Circulation ▪ Unoxygenated – right side of the heart ▪ Systemic Circulation ▪ Oxygenated – left side of the heart Anatomy Coronary Arteries How The Heart Works Anatomy Coronary Arteries ▪ 2 major vessels of the coronary circulation ▪ Left main coronary artery ▪ Left anterior descending and circumflex branches ▪ Right main coronary artery ▪ The left and right coronary arteries originate at the base of the aorta from openings called the coronary ostia behind the aortic valve leaflets. Physiology Blood Flow Unoxygenated blood flows from inferior and superior vena cava Right Atrium Tricuspid Valve Right Ventricle Pulmonic Valve Lungs Through Pulmonary system Physiology Blood Flow Oxygenated blood flows from the pulmonary veins Left Atrium Mitral Valve Left Ventricle Aortic Valve Systemic Circulation ▪ Blood Flow Through The Heart ▪ Cardiology Rap Physiology ▪ Cardiac cycle ▪ Represents the actual time sequence between
    [Show full text]
  • Acute Non-Specific Pericarditis R
    Postgrad Med J: first published as 10.1136/pgmj.43.502.534 on 1 August 1967. Downloaded from Postgrad. med. J. (August 1967) 43, 534-538. CURRENT SURVEY Acute non-specific pericarditis R. G. GOLD * M.B., B.S., M.RA.C.P., M.R.C.P. Senior Registrar, Cardiac Department, Brompton Hospital, London, S.W.3 Incidence neck, to either flank and frequently through to the Acute non-specific pericarditis (acute benign back. Occasionally pain is experienced on swallow- pericarditis; acute idiopathic pericarditis) has been ing (McGuire et al., 1954) and this was the pre- recognized for over 100 years (Christian, 1951). In senting symptom in one of our own patients. Mild 1942 Barnes & Burchell described fourteen cases attacks of premonitory chest pain may occur up to of the condition and since then several series of 4 weeks before the main onset of symptoms cases have been published (Krook, 1954; Scherl, (Martin, 1966). Malaise is very common, and is 1956; Swan, 1960; Martin, 1966; Logue & often severe and accompanied by listlessness and Wendkos, 1948). depression. The latter symptom is especially com- Until recently Swan's (1960) series of fourteen mon in patients suffering multiple relapses or patients was the largest collection of cases in this prolonged attacks, but is only partly related to the country. In 1966 Martin was able to collect most length of the illness and fluctuates markedly from of his nineteen cases within 1 year in a 550-bed day to day with the patient's general condition. hospital. The disease is thus by no means rare and Tachycardia occurs in almost every patient at warrants greater attention than has previously some stage of the illness.
    [Show full text]
  • Recurrent Takotsubo Cardiomyopathy: a Rare Diagnosis with a Common Emergency Department Presentation Emily M Miner, Harini Gurram, Tennie Renkens and Julie L
    Case Report iMedPub Journals ARCHIVES OF MEDICINE 2017 http://www.imedpub.com/ Vol.9 No.4:8 ISSN 1989-5216 DOI: 10.21767/1989-5216.1000229 Recurrent Takotsubo Cardiomyopathy: A Rare Diagnosis with a Common Emergency Department Presentation Emily M Miner, Harini Gurram, Tennie Renkens and Julie L. Welch* Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA *Corresponding author: Julie L Welch, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA, Tel: 317-962-8880; E-mail: [email protected] Received date: August 08, 2017; Accepted date: August 14, 2017; Published date: August 16, 2017 Citation: Miner EM, Gurram H, Renkens T, Welch JL. Recurrent Takotsubo Cardiomyopathy: A Rare Diagnosis with a Common Emergency Department Presentation. Arch Med. 2017, 9:4 Copyright: © 2017 Miner EM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The incidence of recurrent Takotsubo cardiomyopathy after initial diagnosis is about 5% at 6 years with recurrence being Abstract more common when the initial episode has more severe left ventricular dysfunction [4]. While the long-term prognosis of Takotsubo cardiomyopathy is a non-ischemic Takotsubo is favorable in >95% of cases, acute symptoms of an cardiomyopathy that is often triggered by a physical or episode can be life-threatening and lead to cardiogenic shock emotional stressor and commonly affects post-menopausal [5]. Proper diagnosis is crucial in these life-threatening women. A 57 year old female with a significant past medical history for atrial fibrillation, anxiety, and Takotsubo situations.
    [Show full text]
  • Inappropriate Sinus Tachycardia Following Viral Illness
    Case Report Inappropriate Sinus Tachycardia Following Viral Illness Khalid Sawalha 1,* , Fuad Habash 2 , Srikanth Vallurupalli 2 and Hakan Paydak 3 1 Internal Medicine Division, White River Health System, Batesville, AR 72501, USA 2 Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; [email protected] (F.H.); [email protected] (S.V.) 3 Electrophysiology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-984-364-1158 Abstract: A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycar- dia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion. Keywords: inappropriate sinus tachycardia; viral infection; palpitations 1. Introduction Inappropriate sinus tachycardia, also called chronic non-paroxysmal sinus tachycardia, is an unusual condition that occurs in individuals without apparent heart disease or other cause of sinus tachycardia, such as hyperthyroidism or fever, and is generally considered a diagnosis of exclusion [1–4]. Inappropriate sinus tachycardia is defined as a resting heart Citation: Sawalha, K.; Habash, F.; rate >100 beats per minute associated with highly symptomatic palpitations [5,6]. Vallurupalli, S.; Paydak, H. Commonly used criteria to define inappropriate sinus tachycardia include [7] P-wave Inappropriate Sinus Tachycardia axis and morphology similar to sinus rhythm, and a resting heart rate of 100 beats per Following Viral Illness.
    [Show full text]
  • Cardiac Arrhythmias in Survivors of Sudden Cardiac Death Requiring Impella Assist Device Therapy
    Journal of Clinical Medicine Article Cardiac Arrhythmias in Survivors of Sudden Cardiac Death Requiring Impella Assist Device Therapy Khaled Q. A. Abdullah 1,2, Jana V. Roedler 1, Juergen vom Dahl 1, Istvan Szendey 1, Dimitrios Dimitroulis 1, Lars Eckardt 3, Albert Topf 4, Bernhard Ohnewein 4, Lorenz Fritsch 4, Fabian Föttinger 4, Mathias C. Brandt 4, Bernhard Wernly 4,5,6 , Lukas J. Motloch 4 and Robert Larbig 2,3,* 1 Department of Cardiology, Hospital Maria Hilf Moenchengladbach, 41063 Moenchengladbach, Germany; [email protected] (K.Q.A.A.); [email protected] (J.V.R.); [email protected] (J.v.D.); [email protected] (I.S.); [email protected] (D.D.) 2 Department of Cardiology, University Hospital Aachen, RWTH University Aachen, 52062 Aachen, Germany 3 Department of Cardiovascular Medicine, Division of Electrophysiology, University of Muenster, 48149 Muenster, Germany; [email protected] 4 Department of Cardiology, Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; [email protected] (A.T.); [email protected] (B.O.); [email protected] (L.F.); [email protected] (F.F.); [email protected] (M.C.B.); [email protected] (B.W.); [email protected] (L.J.M.) 5 Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, 5026 Salzburg, Austria 6 Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, 5026 Salzburg, Austria Citation: Abdullah, K.Q.A.; Roedler, * Correspondence: [email protected]; Tel.: +49-216-1892-4770 J.V.; vom Dahl, J.; Szendey, I.; Dimitroulis, D.; Eckardt, L.; Topf, A.; Abstract: In this retrospective single-center trial, we analyze 109 consecutive patients (female: 27.5%, Ohnewein, B.; Fritsch, L.; Föttinger, F.; median age: 69 years, median left ventricular ejection fraction: 20%) who survived sudden cardiac et al.
    [Show full text]