Cardiovascular Module 3 Flashcards

1
Q

What drugs are safest to use with heart disease

A

Alfaxalone, BZPs, Opioids Iso/Sevo

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2
Q

What are causes of pericardial effusion?

A
  1. Idiopathic
  2. Neoplastic
  3. SIRs
  4. Septic peritonitis
  5. RHF
  6. Coagulopathy
  7. Atrial rupture (MVD)
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3
Q

What is cardiac tamponade?

A

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

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4
Q

How to stabilise a pericardial effusion

A
  1. Echo first - check for RA masses
  2. Left lateral recumbency: drain
    from the right side, avoids the
    left coronary arteries (will die if
    bleed)
  3. Sedate - buptorphanol (0.2-
    0.4mg/kg)/midazolam
    (0.25mg.kg) top up with propofol
  4. Aseptic prep, place ECG - VPC if
    you hit heart
  5. 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
  6. LA lidocaine (skin and intercostal
    space - orange needle into
    intercostal space and instill as
    withdrawing
  7. 11 scalpel blade to nick skin for
    the tube
  8. Echo and mark rib space to go
    over
  9. Insert cannula and thumb over
    end and go perpendicular to skin
  10. remove stylet and place thumb
    over catheter
  11. Pass guidewire through to the
    20cm and then pull catheter
    over wire and insert mila chest
    drain
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5
Q

Fluids v. diuretics with pericardial effusion

A

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

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6
Q

what are complications and contraindications to pericardial draining?

A

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

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7
Q

What are the main differentials for pericardial effusion

A
  1. Idiopathic - 48%
  2. Small right atrial mass - 50% mesothelioma
  3. Septic
  4. Other - coags
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