ECHO and CT provide great diagnostic tools in diagnosing complications associated with LVADs. The complications can further be subdivided into perioperative and late post-operative complications. In the perioperative period, low flow rates can cause hemodynamic stability which can be caused by an obstructing/malpositioned inflow cannula, hemorrhage, or tamponade (1-23). Later complications include thrombus of the inflow and outflow cannulas, bend relief malpositioning, aortic valve stenosis/insufficiency, and infection. Right sided heart failure can appear as an early or late complication (1).
Inflow obstruction/malpositioning is a fairly common complication usually detected in the perioperative period by Echocardiography. Several etiologies for inflow obstruction include malpositioned cannula directed towards the interventricular septum, left ventricular hypertrophy, and kinking of the inflow cannula. Findings diagnostic to inflow obstruction on Echo with Doppler include high velocity flow, and variations of flow during systole including cessation of flow
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Normally, the aortic valve should remained closed in a properly functioning LVAD. Given the continuous closure state, the aortic valve leaflets can become fused with resultant stenosis. In patients who receive an LVAD for bridge to transplantation or final destination therapy, the resultant stenosis is not of clinical concern; however, for patients who are utilizing an LVAD for myocardial recovery, the degree of stenosis can cause further potential problems in which patient's may not be able to undergo explantation. Preimplantantion aoritic insufficiency is quite problematic in patient's who receive LVAD. The backflow of blood into the left ventricular chamber decreases forward systemic flow; in addition, aortic insufficiency worsens during the course of LVAD
Ebstein’s Anomaly is a rare congenital condition, present at birth, in which the tricuspid valve is malformed and the valve itself is not in the correct anatomic place (Mayo Clinic Staff). This anomaly affects the right side of the heart – the tricuspid valve is located too deep into the ventricle, causing a smaller and weaker right ventricle. The space above the decreased right ventricle is made up of atrial tissue and this can be referred to as right ventricle dysplasia or an atrialized right ventricle (Reynolds). Typically the tricuspid valve has three freely moving leaflets, but in Ebstein’s anomaly one or two of those leaflets get fused to the heart walls causing regurgitation. Since the heart does not work as efficiently in those who have this anomaly, the heart usually compensates and becomes enlarged. It...
“Hypoplastic left heart syndrome accounts for 9% of all critically ill newborns with congenital cardiac disease, causing the largest number of cardiac deaths in the first year of life.(2) ” HLHS is a severe heart defect that is present at birth. HLHS combines different defects that result in an underdeveloped left side of the heart. This syndrome is one of the most challenging and difficult to manage of all of the congenital heart defects. Multiple portions on the left side of the heart are affected including the left ventricle, the mitral and aortic valve, and the ascending aorta. These structures are greatly reduced in size, or completely nonexistent causing the functionality of the left heart to be reduced, or non-functional all together.
There are four different categories of treatment: lifestyle changes, surgical procedures, non-surgical procedures, and medications. Lifestyle changes include having a healthy diet; increasing physical activity; eliminating cigarettes, alcoholic beverages, and illicit drugs; and getting enough rest and sleep; losing excess weight. These lifestyle changes are to lower the patient’s blood pressure, cholesterol, and reducing any other future medical conditions. There are also surgical options to help cure, prevent, or control cardiomyopathy. Surgical method include a septal myectomy, surgically implanted devices, and a heart transplant. A septal myectomy is used to specifically treat hypertrophy cardiomyopathy which is where the heart muscle cells enlarge and cause the walls of the ventricles to thicken. The thickening of the walls may not affect the size of the ventricles but instead may affect the blood flow out of the ventricle. Usually along with the ventricles swelling, the septum in between the ventricles can become enlarged and block the blood flow causing a heart attack. When medication is not working well to treat hypertrophic cardiomyopathy, a surgeon will open the chest cavity and remove part of the septum that is blocking blood flow. Surgically implanted devices include a pacemaker, a cardiac resynchronization therapy device, a left ventricular assist device, and an implantable
..., Welsh R, Feindel C, Lichtenstein S. Transcatheter aortic valve implantation: a Canadian Cardiovascular Society position statement. Can J Cardiol. 2012;28:520-8.
In a healthy individual receiving a general anaesthetic, the anaesthetist must be aware of the causes and treatment of acute onset AF, both intra-operatively and peri-operatively. Patients with AF often develop a decline in left ventricular performance and other hemodynamic instabilities including reduced diastolic filling and tachycardia mediated cardiomyopathy1, all of which can reduce cardiac output and pose difficulties for the anaesthetist.
...ers. Numerous signs and symptoms occur with an aortic dissection, making it very difficult to diagnose. Chest x-ray and chest and abdomen CT angiograms are the two most common tests performed to confirm a diagnosis, with CT angiogram being the modality of choice. If the patient survives the initial onset of an aortic dissection long enough surgical repair may be done. Surgical repair is very risky and does not have a high success rate, however, if surgery proves to be successful a patient’s prognosis greatly increases after 30 days. Perhaps the next time one is faced with the familiar imagery of a man grasping his chest and collapsing due to “heart disease,” instead of assuming the man suffered from the usual heart attack, one will remember that there are countless conditions that heart disease encompasses, and that aortic dissection remains one of the most deadly.
Left Ventricular Systolic Dysfunction (LVSD, but commonly referred to as heart failure) is a chronic, progressive cardiac syndrome in which a damaged heart fails to beat efficiently and deliver enough blood to meet the body's needs. Although coronary heart disease (CHD) is the most common cause, for example, myocardial infarction, and many of the conditions are intertwined, there are several other causes of heart failure including cardiomyopathies, hypertension and valve disease.
... as the heart, major blood vessels, and airways) toward the other side of the chest. The shift can cause the other lung to become compressed, and can affect the flow of blood returning to the heart. This situation can lead to low blood pressure, shock, and death.
Acute pericarditis can vary with the regularity of auscultation also known as the classic Pericardial rub. The pericardial rub is when the patient is auscultated covering the left lower sternal frame and corresponds to the movement of the heart against the pericardial sac. When the patient breathes out and leaning forward It has a creaking sound (Tingle, Molina & Calvert, 2007). We can assume that this 57 year old patient was not showing creaking sounds within his chest. This is present in pericarditis patients, on the other hand with AMI it presents as absent. The symptoms the patient presents are also symptoms of AMI such as he was complaining of numbness in the left arm and chest pain (Zuzelo, 2002). Also the reason why this patient must be suffering from AMI is because he has ST- elevation myocardial infarction (STEMI) which is results from thrombotic blockage of epicardial coronary artery. Infarction of a significant part of the left ventricle can result in evidence of low cardiac output such as, sinus tachycardia which is exactly what the patient was showing on the monitor (Ardehali, Perez & Wang, 2011).
left ventricular function and heart failure.” Clinical Investigative Medicine. 31.2 (2008): E90-E97. Web. 15 Feb. 2014.
...m, and also a nuclear heart scan can all be performed. For treatment the women will need to stay in the hospital until the symptoms subside. The women might have to use a balloon heart pump; go through immunosuppressive therapy; and possibly a heart transplant if severe congestive heart failure continues.
According to the doctor, the patient might have developed congestive heart failure. Is it right-sided or
It is essential to the human body that the heart pump sufficient nutrient rich blood to the body’s cells, because the body won’t be able to function normally otherwise. When a heart muscle is unable to pump enough blood through to meet the body’s regular demand it is characterized as heart failure. Heart failure can usually be treated through conventional heart therapies and symptom management strategies, however conventional therapies don’t work for all patients with heart failure, this is what is depicted as advanced heart failure or end-stage heart failure. In other words “End stage” heart failure is when the condition becomes so severe that all conventional treatments no longer work, the only treatment that works for end stage heart failure is to have a heart transplantation-surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. However there are two large encompassing problems with this treatment. The first problem is that the patient is subject to shortages in donor organ availability and thus possible further decompensation and potential death while awaiting transplantation. According to the American Heart Association, there are over 500,000 new cases of end-stage heart failure in the United States every year. With only 2200 donor hearts available every year nearly 20-30% of the patients who die while they await a transplant. The second problem with this mode of treatment is that not all patients qualify for heart transplantation. Patients who have another disease in addition to end-stage heart failure do not qualify for heart transplantation. The discrepancy between the clinical need for donor hearts and the total number of hearts available, as well as the lack of treatment o...
You might need a TAH for one of two reasons: To keep you alive while you wait for a heart transplant; If you 're not eligible for a heart transplant, but you have end-stage heart failure in both ventricles. (https://www.nhlbi.nih.gov/health/health-topics/topics/tah)
“Despite worldwide softness in the sale of luxury goods, LVMH has cemented its position as the world’s largest and most profitable player in the category. To stay there it must keep its customers loyal and its brand strong and find new markets worldwide” (Hazlett C. 2004). That is why in its mission they state to represent the most refined qualities of Western “ art de vivre” all around the world. Their objective is to be the leader in the luxury market, continuing to transmit elegance and creativity. This poses some major challenges, the main one is to keep being the leader in the luxury market through a sustainable growth. The main problem to achieve it is the high dependency on three main countries, France, Japan and USA. This becomes a threat because if there is an economic downturn in one country it affects LVMH directly that is why.