A Constricting Diagnosis

The heart, vasculature, and blood (pump, pipes, and fluid) work together to meet the metabolic demands of the body. End organs and tissue are not adequately perfused when the system fails, leading to injury and deranged physiology. Understanding the hemodynamic relations in normal cardiovascular physiology and how it changes in pathologic conditions helps us make the correct diagnosis and implement the right treatment.   Physical examination can provide indirect clues to hemodynamics, though invasive evaluation has been the traditional gold standard. This can include arterial and central venous pressure measurements, cardiac right and left heart catheterization, or bedside pulmonary artery catheter. Fortunately, a rapidly expanding toolbox of noninvasive and minimally-invasive assessment methods has been developed that allow us to evaluate the hemodynamics of our patients without the risk associated with the invasive techniques. These include formal and bedside 2-D and Doppler echocardiography, arterial pulse contour analysis, transpulmonary thermodilution, electrical bioimpedance, and tissue oxygenation monitoring.   I am going to discuss three classic diseases — pericardial tamponade, constrictive pericarditis, and restrictive cardiomyopathy — over the next several months to explore the basics of cardiovascular hemodynamics and to develop an understanding of the methods used for evaluation.   A 58-year-old man presented to the emergency department with two days of ex...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs