docLa diagnosi dello scompenso cardiaco acuto. - Area-c54
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La diagnosi dello scompenso cardiaco acuto. - Area-c54
La diagnosi dello scompenso cardiaco acuto. Fabio Guarracino U.O.C. Anestesia e T.I. Cardiotoracica Azienda Ospedaliero Universitaria Pisana Pisa, Italy INDICE INDICE INDICE ANMCO 2004 INDICE INDICE INDICE INDICE INDICE INDICE INDICE Assessment of heart function ¾ PAC - Thermodilution ¾ contrast ventriculography ¾ radionuclide ventriculography ¾ echocardiography ¾ CT scan ¾ magnetic resonance INDICE Systolic dysfunction Diastolic dysfunction INDICE (Braunwald’s HEART DISEASE, 7th edition 2005, page 604) INDICE INDICE • • • • • Cardiac size and shape Pulmonary congestion Major pulmonary embolism Aortic dissection Differential diagnosis (inflamm./infectious) INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE Troponin in myocardial ischemia Cx LDA INDICE INDICE INDICE • • • • • • • • Regional and global LV and RV function Valvular structure and function Pericardial pathology Mechanical complications of AMI Aortic pathology CO PAP (from tricuspid regurgitant jet) Preload INDICE 1. EF EDV ESV 2. FAC EDA ESA LV SYSTOLIC FUNCTION 3. STROKE VOLUME 4. MPI INDICE RCA Cx LDA INDICE RCA Cx LDA INDICE Cx LDA RCA LDA Cx LDA RCA Cx LDA INDICE DIMENTION: edd > 3.5 cm KINESIS: hypokinesia TAPSE: <1.4 cm: moderate <1.0 cm: severe RV dysfunction ITR: 3-4 TDI: Sa < 8 cm/s INDICE IMPAIRED RELAXATION Dependence of filling on atrial systole IMPAIRED FILLING Higher P needed to fill the LV ↓ subendocardial flow INDICE ¾Pulmonary venous pulsed Doppler: S/D ratio < 1, A wave > 30 cm/sec ¾ Transmitral pulsed Doppler: high E wave, E/A ratio > 1, DT 150- 220 msec ¾Color M-mode: Vp < 45 cm/sec. ¾Tissue Doppler Echo: Em < 8 cm/sec. Em INDICE Tissue Doppler Echocardiography INDICE Color M-mode Vp > 55 cm/sec. E A INDICE Diastolic dysfunction by integrating PAC & ECHO Small EDA High WP INDICE INDICE INDICE INDICE INDICE Fast response PAC ¾right side pressures ¾RV output ¾RVEF and RV vol. ¾SVO2 INDICE Major pitfalls of PAC ¾diastolic dysfunction ¾LVOT dynamic obstruction INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE INDICE Diagnosis of myocardial ischemia Cx LDA INDICE INDICE Echocardiography and PAC data & BNP – Troponin INDICE La diagnosi dello scompenso cardiaco acuto. INDICE Atti del Corso di Aggiornamento Insufficienza cardiaca nel paziente cardiochirurgico: dalla fisiopatologia alle nuove opzioni terapeutiche CLICCARE PER TORNARE ALL’INDICE DELLE RELAZIONI INDICE
