Calcific aortic valve stenosis causes the left ventricle (LV) to adapt to chronic pressure overload over time. Classically, this involves left ventricular hypertrophy resulting in diastolic dysfunction. After a transcatheter aortic valve replacement (TAVR), the new valve instantaneously alleviates the fixed obstruction. As a result, the LV can eject more…
The left ventricle’s (LV) variously arranged muscle fibers twist and contract during systole, storing potential energy as blood is ejected (imagine wringing water out of a towel). This stored energy is released in diastole: an energy-dependent myocardial relaxation divided into four phases.
Pulmonary hypertension (PH) is a broad topic encompassing primary and secondary etiologies. Like systemic hypertension, PH refers to elevated pressures in the pulmonary vessels. It’s essential to understand how PH is classified and which specific vessels are involved: pulmonary arteries → pulmonary capillaries → pulmonary veins. PRE-capillary PH refers to…
As a cardiothoracic anesthesiologist and intensivist, I routinely place large central lines for resuscitation, vasoactive/inotrope administration, and to facilitate additional monitoring (e.g., Swan Ganz catheter). Over the years, I’ve heard “MAC,” “sheath introducer,” “Cordis,” etc., used interchangeably but incorrectly. Let’s break these terms down!
Synthetic human angiotensin II (Giapreza) is an intravenous vasopressor approved in late 2017 for septic or other distributive shock states. Normally, renin is released by the kidneys in response to decreased perfusion pressure in the renal arterioles, decreased salt concentration at the macula densa, and increased sympathetic stimulation. Renin cleaves…
In this video, I go over how I approach hypotension/hypertension considering the factors that contribute to mean arterial pressure. Often times, many of these variables affect overall forward flow, so it’s important to have a methodical approach to blood pressure management.
In pursuit of evidence-based rationales for my hatred of dopamine, I turned to PubMed and queried the database for “dopamine shock” filtered for meta-analyses, randomized controlled trials, and systematic reviews in adult patients since 2009. I then ventured into the PubMed black hole. 😛
Central venous pressure (CVP) or right atrial pressure (RAP) waveform tracings can oftentimes provide useful insight into a patient’s right ventricle (RV), tricuspid valve (TV), and overall cardiopulmonary status. The waveform morphology is easier to identify at slower heart rates and consists of three waves and two descents:
Midodrine (ProAmantine) is an oral and intravenous prodrug. Its active metabolite, desglymidodrine, activates α-1 receptors to produce vaso and venoconstriction with resulting increase in blood pressure (BP). This medication has excellent oral bioavailability and is FDA approved for the treatment of symptomatic orthostatic hypotension. Since midodrine increases BP, it makes…
Over the course of my training as a cardiac anesthesiologist and intensivist, I’ve come across many manifestations of cardiac compression ranging from hemorrhagic pericardial effusions to massive clots. Although the general teaching is to keep these patients “fast, full, and forward” by increasing the heart rate and intravascular volume status,…