Current understanding and perioperative management of pediatric pulmonary hypertension

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Source: Pediatric Anesthesia - Category: Anesthesiology Authors: Tags: Educational review Source Type: research

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By ANISH KOKA, MD Mr. Smith has a problem.  He can’t see.  Even this cardiologist knows why.  The not so subtle evidence lies in the cloudy lens in front of his pupils.  He is afflicted with cataracts that obstruct his vision to the point he can’t really do his job refurbishing antique furniture safely.  His other problem is that he hates doctors. He hasn’t had reason to see one for more than a decade.  He’s 68, takes no medications, smokes a pack of cigarettes a day, and is a master of one word answers. He’s in my office because he needs a medical eval...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Medical Practice Patients Physicians Anish Koka cardiology low-value testing Source Type: blogs
The objective of the study is to compare the immediate postoperative cardiac complications in patients undergoing off-pump coronary artery bypass grafting (OPCABG) using mixed (arterial and venous grafts) versus only venous grafts and to compare the requirement of packed red cell units and intra-aortic balloon pump (IABP) in both the groups. Materials and Methods: This was an observational, analytical, prospective study. Sample Size: Fifty new patients were included in the study. Inclusion/Exclusion Criteria: Patients diagnosed with triple-vessel coronary artery disease (CAD) undergoing OPCABG with an ejecti...
Source: Annals of Cardiac Anaesthesia - Category: Anesthesiology Authors: Tags: Ann Card Anaesth Source Type: research
Exertional dyspnea disproportional to the effort is the most common (cardinal)symptom of heart disease. Whenever we discuss the mechanism of cardiac dyspnea , we primarily attribute it to left heart disease, elevated LVEDP and the resultant pulmonary congestion.Conventional teaching in the past (may be in the present too !) doesn’t implicate raised RVEDP in the genesis of dyspnea. It’s good to recall , the sensation of dyspnea is felt at the peri -Amygdala nuclear zone after complex processing with various cortical and sub-cortical level .It is subjected to as many afferent triggers other than J receptors in pu...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiology - Clinical Clinical cardiology Uncategorized does raised rvedp cause dyspnea dyspnea in pulmonary hypertension mechanism of dyspnea Source Type: blogs
Abstract Pulmonary hypertension is a term used to describe a complex multifactorial group of conditions diagnosed by an elevated mean pulmonary artery pressure of 20 mm Hg or higher on right heart catheterization. The diagnosis of pulmonary hypertension in pregnancy is important, as it is associated with high rates of maternal morbidity and mortality, even with modern management. Diagnostic testing is important for establishing the diagnosis, type, and severity of pulmonary hypertension, which in turn, dictates treatment options. Echocardiographic assessment is the first step in diagnosis and the gold standard for...
Source: Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Obstet Gynecol Source Type: research
Pulmonary hypertension, defined as a resting mean pulmonary artery pressure greater than or equal to 25 mmHg, results from a myriad of conditions. The Fifth World Symposium on Pulmonary Hypertension proposed a classification system that organizes pulmonary hypertension into five groups based on common hemodynamic, pathophysiologic, and therapeutic parameters.1 This review focuses on pulmonary arterial hypertension (Group 1 pulmonary hypertension), a disease in which progressive pulmonary vascular obstruction, remodeling, and destruction lead to increased right ventricular afterload and hypertrophy, right heart failure, and...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 20 August 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Amanda Zacharzewski, Ross MacnabAbstractCardiac disease is a significant cause of maternal mortality. In the UK in the last maternal mortality report, it was the leading cause of indirect maternal deaths (2.39 deaths per 100,000 maternities). The overall rate of maternal mortality from cardiac disease has significantly increased over the last three decades, with this increase being mostly attributable to deaths from ischaemic heart disease, myocardial infarction and peripartum cardiomyopathy. Conditions such as pulmo...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
[Relevant aspects of the ESC guidelines for the management of cardiovascular diseases during pregnancy for obstetric anaesthesia (update 2018)]. Anaesthesist. 2019 Jul 02;: Authors: Brück S, Seeland U, Kranke E, Kranke P Abstract The current update of the ESC (European Society of Cardiology) guidelines on managing cardiovascular diseases during pregnancy provides instructions for doctors in daily practice. Heart diseases are the most common reason for maternal death during pregnancy in western countries. Among other things, the following topics are dealt with: congenital heart disease, pulmo...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
Right ventricular (RV) failure with pulmonary hypertension (PH) is frequently encountered in patients with advanced left-sided heart disease (LHD). However, RV energetics in patients with postcapillary PH because of LHD has not been well studied. The authors investigated intraoperative RV energetics in patients with PH due to LHD based on pressure –volume curves with three-dimensional transesophageal echocardiography and pulmonary artery catheterization.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Cardiac sympathetic blockade with high-thoracic epidural anesthesia is considered beneficial in patients undergoing major surgery because it offers protection in ischemic heart disease. Major outcome studies have failed to confirm such a benefit, however. In fact, there is growing concern about potential harm associated with the use of thoracic epidural anesthesia in high-risk patients, although underlying mechanisms have not been identified. Since the latest review on this subject, a number of clinical and experimental studies have provided new information on the complex interaction between thoracic epidural anesthesia &n...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
This article is protected by copyright. All rights reserved. PMID: 30710405 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
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