My Littmann Cardiology III black edition served me well for all of medical school and residency, and over eight years later, I’m now replacing it for my second stethoscope – the Littmann Master Cardiology black edition.
Our thoracic ICU rotation is perhaps the most difficult rotation we have as anesthesia critical care fellows. For two weeks, we’re q2 call (meaning on call every other day). The patients are super sick, but the pathologies are incredibly fascinating.
As a critical care fellow, I’ll spend a total of two months (four, 2-week rotations) in the cardiac intensive care unit (ICU). I just finished my first rotation there and got to befriend many of the cardiac surgery attendings and fellows who I’ll be working alongside in the operating room…
It’s possible to utilize transthoracic echocardiography (TTE), a noninvasive technique, to estimate a patient’s cardiac output. I’ll use some images from an echo I performed on a patient with a depressed left ventricular ejection fraction on low dose pressors. Yes, I know the echo images aren’t perfect. :-PWe know that cardiac…
Due to the right ventricle’s (RV) unique geometry and cylindrical contraction pattern, assessing its function in echocardiography can be difficult. One of the more simple and reproducible techniques used to determine RV function is the tricuspid annular plane systolic excursion (TAPSE). This is easy to do at the bedside using…
It’s important for me to consider the surgical steps and potential areas of difficulty/complications which may arise intraoperatively. Although each procedure must be tailored to a patient’s unique set of comorbidities and surgical factors, I wanted to outline the basic steps involved in routine coronary artery bypass grafting (CABG). First,…
The intra-aortic balloon pump (IABP) is a form of mechanical circulatory support used in cardiogenic shock, facilitating separation from cardiopulmonary bypass, percutaneous coronary interventions, unstable angina, and thrombolytic therapy following myocardial infarction. The device is introduced from the femoral artery and guided into the aorta until its tip is distal…
The Frank-Starling law of the heart is one of the most important intrinsic properties of cardiac muscle. It states that a change in venous return (preload) confers a change in the force of cardiac contraction (stroke volume or cardiac output) through increased sarcomere lengthening and excitation-contraction coupling of the muscle fibers.
Cardiopulmonary physiology has always been an interest of mine. I’ve previously written about how cardiac output is affected by spontaneous versus positive pressure ventilation, and now I want to discuss how pulmonary vascular resistance (PVR) is affected by ventilation.
Take a deep breath. Your diaphragm is contracting downward increasing your intrathoracic volume with a resulting decrease in pressure according to Boyle’s Law. This new pressure is less than that of atmospheric pressure (“negative intrathoracic pressure”), so a gradient is created driving air into your lungs.