Cardiovascular Module 3 Flashcards
What drugs are safest to use with heart disease
Alfaxalone, BZPs, Opioids Iso/Sevo
What are causes of pericardial effusion?
- Idiopathic
- Neoplastic
- SIRs
- Septic peritonitis
- RHF
- Coagulopathy
- Atrial rupture (MVD)
What is cardiac tamponade?
Encompasses the clinical signs associated with pericardial effusion
CS of right heart disease
- ascites +/- pleural fluid
- hepatic venous distention
Heart only fills at expiration properly
Amount of fluid can give an idea of chronicity - larger volume (chronic), small volume with CS sudden
How to stabilise a pericardial effusion
- Echo first - check for RA masses
- Left lateral recumbency: drain
from the right side, avoids the
left coronary arteries (will die if
bleed) - Sedate - buptorphanol (0.2-
0.4mg/kg)/midazolam
(0.25mg.kg) top up with propofol - Aseptic prep, place ECG - VPC if
you hit heart - Ultrasound guidance: 12-15f chest tube kit (3 way tap, mila chest kit and scalpel blade)
- If no chest tube, 12g catheter + 8f urinary cath - LA lidocaine (skin and intercostal
space - orange needle into
intercostal space and instill as
withdrawing - 11 scalpel blade to nick skin for
the tube - Echo and mark rib space to go
over - Insert cannula and thumb over
end and go perpendicular to skin - remove stylet and place thumb
over catheter - Pass guidewire through to the
20cm and then pull catheter
over wire and insert mila chest
drain
Fluids v. diuretics with pericardial effusion
Give neither!
Fluid will increase the pressure within the right atrium of the heart and will worsen failure
(with Peri. E enough fluid is present but not being pushed through due to shit CO so more fluid will just increase pressure and worsen failure)
Diuretics will reduce fluid volume but also further decrease CO leading to more hypovolaemia
what are complications and contraindications to pericardial draining?
Complications
- Hit the heart
- Incomplete drainage - only go in once
- AF post pericardiocentesis
- Cardiac puncture
- Infection (rare)
- Death (rare)
Contraindications
- Left atrium enlargement - atrial rupture
What are the main differentials for pericardial effusion
- Idiopathic - 48%
- Small right atrial mass - 50% mesothelioma
- Septic
- Other - coags