Post Cath / post AICD complications Flashcards
sudden onset of back pain and hypotension post cardiac cath
RP bleed with arterial puncture above inguinal ligament may result in bleeding. bleeding doesn’t stop with manual compression.
Presentation and labs of RP bleed
drop in hgb and BP and high HR see flank or bakc pain.
Diagnosis of RP bleed
CT abd pelvis without contrast
Superior vena cava syndrome definition
See compression of superior venous cava vein so blood backs up
resulting in facial edema and plethora or headache or syncope with squatting;
body tries to offset the high venous pressure by creatining venous collaterals and central venous pressure remains high and causes symptoms
Common causes of SVC syndrome
tumor compression of vein
scarring and stenosis by endothelial damage wiht insertion of transvenous AICD placement.
Can also happen in thrombophilic state, and infections
when do symptoms of SVC syndrome start to happen
1-15 months after procedure.
symptoms of SVC syndrome
dyspnea, head fullness, facial arm swelling chest wall edema that worsens with bending or lying down or episode syncope or presyncope
Diagnosis of SVC syndrome
bilateral upper extremity venography and contrast enhanced CT scan can be done first to show extent of venous bloackage and visualize collaterals and identify the caustive factor
therapy of SVC syndrome
long term anticoagulation extensive clot burden and severe symptoms may need thrombolysis and stent implantation and bypass surgery or extraction of leads and re implantation
horner’s syndrome and hand weakness or muscle atrophy - consider
pancoast tumor - invades the brachial plexus and parietal pelural and surrounding fascia and ribs and vertebral bodies. See shoulder pain and weakness
Shoulder pain and smoker
make sure you get a CXR to rule out pancoast tumor.
what is this condition?
worsening peripheral edema and or anasarca and extreme fatigability with response to exertion. See JVD and pulses pardoxus and Kussmal’s sign and pericardial knock
Constrictive pericarditis
What is subclavian steal syndrome?
atherosclerotic narrowing of proximal subclavian artery which results in flow reversal in ipsilateral vertebral artery and this happens on left side though pts are asymptomatic. May see exercise induced fatigue, pain, numbness and coolness and fatigue. pts have vertebral basilar insufficiency (dizziness and vertigo and disequilibrium and drop attacks)
within first 24 hrs of MI what are the complications?
arrhythmias (VT, VF, accelerated idioventricular rhythm, afib)
when does acute pericarditis or Dressler syndrome or immune mediated percarditis occur?
2-4 days 2-10 weeks for Dressler syndrome Presents with chest pain worse with inspiration and sitting upright. See STE diffisuely and PR depression on EKG
when would you see a left ventricular aneurysm occur post MI
weeks to months
presentation of a left ventricular aneurysm?
no symptoms. See persistent STE without troponin elevation
When does left ventricular free wall rupture occur after a MI and how does it present?
3-5 days post MI and see sudden decompensation and death with acute cardiac tamponade on TTE
when does mitral valve regurgitation present post MI?
2-7 days and see hypotension, pulmonary edema and holosystolic murmur with wide spread radiation and thrill. -
When does VSD happen post MI?
3-5 days see new HDS and new onset heart fialure and holosystolic murmur at left lower sternal border. Reverse blood flow at interventricular septum
painful tender mass near puncture site below the inguinal ligament after a endovascular intervention
hematoma and possible pseudoaneurysm formation.
possible differentials for post cath complicaitons
RP hemorrhage, arterial dissection, arterial thrombosis and pseudoaneurysm and formation of AV fistula
to rule out hematoma or pseudoaneurysm formation post cath with symptoms, need to order a
doppler ultrasound.
what is an arterial pseudoaneurysm?
hematoma that remains in continuity with arterial lumen with blood flow into and out of hematoma cavity. Usually has a pulsatile mass with systolic bruit over the mass.
why do we worry about pseudoaneurysms?
risk for expansion and rupture and catastrophic bleeding . Need to be treated with ultrasound guided compression or a ultrasound guided thrombin injection in to the pseudoaneurysm cavity
if there’s a infection of ICD must
remove the entire device generator and leads
Any evidence of valve or lead vegetation or TTE positive blood cultures with an organism with high propensity for causing infective endocarditis (staph, strept, candida spp) evidence of pocket infection
need to remove it
(including localized pain/tenderness, erythema, swelling, purulent drainage or skin erosion)
people who have AICD and infection with suspected endocardial invovlement with pain, swelling and purulent drainage should get treatment for infective endocarditis:
6 weeks of therapy
pocket infection with AICD tx
needs to have removal of ACID and blood cultures if negative, blood cultures and unremarkable TTE need 2 weeks of antibiotics following removal.
after a pocket infection AICD how do you treat the infection?
reimplant new AICD on the contralateral side of chest once there’s source control
VSD post MI
see new onset of hypotension CHF (prodominantly of R heart failure)
hear a harsh loud holosystolic murmur with radiation best heard at left lower sternal border.
timeline of post MI conditions
when do you see MR as a complication of an inferior MI?
Can see acute mitral regurgitation due to papillary muscle rupture at 2-7 days after MI. See this due to rupture of posteromedial papillary muscle supplied by RCA or dominant left circumflex. More common than anterolateral papillary muscle since that has dual supply from LAD and left circumflex.
see acute onset of cardiogenic shock and pulmonary edema, systolic murmur and hyperdynamic precordium. Can see equalization of left atrial and left ventricular pressures.
Diagnosis is via TTE or TEE.
rupture of left ventricular free wall
catastrophic complication of MI.
seen days to 2 weeks after MI. see hemopericardium and cardiac tamponade and presents with sudden onset chest pain and profound shock and rapid progression to PEA and death.
sudden onset of chest pain after having nausea and diarrhea for two days. Two weeks ago had a inferior MI and had a bare metal stent placed. EKG has sinus bradycardia and STE in II, III, AVF
what happened?
Pt has a stent thrombosis; this happens within the 1st month most commonly but can happen at any time.
Most often due to result of premature discontinuation of DAPT; if someone wasn’t able to eat due to gastroenteritis.
long term side effects of left ventricular aneurysm
scarred myocardium due to prior MI and can cause progressive left ventricular enlargement leading to heart failure, angina, arrhythmias or mural thrombus embolization.
