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
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.
