SESSION D5. The Heart of the Matter: Cardiac Disease in Pregnancy Brad M. Dolinsky, MD, MFM
|
|
- Dwight Mason
- 6 years ago
- Views:
Transcription
1 37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, :45 SESSION D5 Session Description: The Heart of the Matter: Cardiac Disease in Pregnancy Brad M. Dolinsky, MD, MFM S E S S I O N D5 Cardiac disease in pregnancy can be a complex milieu of physiology and seem overwhelming. The effects of the disease on the pregnancy, and the pregnancy on the disease can be complex. This lecture will attempt to review cardiac diseases seen in pregnancy, provide a tool for counseling patients with cardiac disease in pregnancy, and provide a tool for rapid management of hypertension in pregnancy. Learning Objectives: Following my presentation, participants will be able to: 1. Identify cardiac lesions that are amenable to drops in systemic vascular resistance. 2. Review a rapid assessment to risk stratify pregnant patients with cardiac disease. 3. Review management of hypertension in pregnancy.
2 Clinical Pearls for Cardiovascular Disease in Pregnancy The Heart of The Matter: Cardiac Disease in Pregnancy Provide general overview of cardiac physiologic changes in pregnancy Review common cardiac diseases seen clinically Provide a tool for counseling patients with known structural cardiac disease Review breakdown of lesions that are amenable to decrease in systemic vascular resistance Provide a rapid tool for management of hypertensive emergency Increase in Heart rate (about 20%) Increase in Cardiac Output (40%) Increase in Blood Volume (50%) Decrease in SVR(20%) Goals Physiologic adapatations Cardiac output INCREASES In Labor During Valsalva With pain With infection(chorio) High cardiac output state immediately after delivery of placenta and for 4 weeks Cardiac output decreases by 20% when supine, and 16% in dorsal lith Five principles of pregnancy that complicate cardiac disease of pregnancy Decreased SVR Increase in intravascular volume Postpartum increase in intravascular volume from auto-transfusion of blood from the contraction of uterus and mobilization of fluid Hypercoaguable Increase in CO during parturition 1
3 General management Activity modification (avoid bedrest though) Treat co-existing medical conditions(anemia/htn/thyroid disease) Collaborative care Labor in lateral decubitous Pain control, minimize hypotension O2 as necessary General management continued Invasive monitoring w/ PAC-reserve for sickest patients such as those with critical AS and Pulmonary HTN. TEE used more recently to guide fluid management. Cesarean delivery for obstetric indication (exception is a recent MI within 1 week) Class I-asymptomatic with greater than normal activity Class II-symptomatic with greater than normal activity(stairs) Class III-symptomatic with normal activity(walking) Class IV-symptomatic at rest New York Heart Association classification The Good-Minimal mortality (<1%) ASD VSD Pulmonic or Tricuspid valve disease Corrected TOF Bioprosthetic heart valve Mitral Stenosis NYHA I and II Marfan syndrome normal aorta Aortic or mitral insufficiency Hypertrophic cardiomyopathy (IHSS) The Good, Bad, and Ugly The Bad-5-15% mortality Mitral Stenosis NYHA III and IV Artifical heart valve Aortic stenosis Coarctation of aorta Uncorrected TOF MI The Ugly- >25% mortality Pulmonary Hypertension Coarctation-complicated Marfan aortic root dilation Dilated Cardiomyopathy The Good, Bad, and Ugly The Good, Bad, and Ugly 2
4 Marfan syndrome The Root of the Problem At risk for Aortic root aneurysm Aortic root >4cm, in preconception period, pregnancy is contraindicated <5 % vs about 10-25% risk for mortality Avoid hypertension Beta-blockade (long term use slows blockade), serial echocardiograms Early epidural use in labor Controversy on management of >4cm in pregnancy Eisenmenger s syndrome/pulmonary HTN 30% of women have a false diagnosis by echo (PA pressures >30mm Hg) When in doubt, in labor, pulmonary artery catheter Eisenmenger s-maternal death is high from hypoxemia and Pulmonary Embolism Cardiac Diseases Cardiac Diseases Eisenmenger s syndrome/pulmonary HTN Hypotension- reverse the shunt to right to left - avoided Run wet Use agents that decrease pulmonary vascular resistance w/ sparing of SVR IV prostocycline, nitric oxide Mitral Stenosis Generally good prognosis if MV is >1.5cm Stenosis less than this LV filling limited Fixed cardiac output Pulmonary edema Cardiac Diseases Mitral Stenosis Tachycardia should be avoided (short acting beta blockade goal HR ). Improves diastolic filling Normal wedge is 6-9mm Hg, MS patients need predelivery target of 14mmHg to maintain left ventricular filling Patients with moderate stenosis and only mild fluid overload, can be managed w/ fluid restriction Mitral Stenosis percutaneous baloon valvuloplasty can safely be performed in pregnancy 3
5 Aortic Stenosis Mortality related to degree of stenosis- >100mm Hg shunt is associated w/ 15-20% mortality. Hypotension and decreased preload can lead to drop in cardiac output (avoid) May consider PAC for goal of 15-17mm Hg Hypovolemia is more dangerous than pulmonary edema Peripartum cardiomyopathy Cardiomyopathy with EF<45% during last 4 weeks and 5 months postpartum without an identifiable cause Management- serial echo Antepartum- diuretics, afterload reduction (hydralazine and or beta blockers) Postpartum-ACE inhibitors May need digoxin antepartum or postpartum Cardiac Diseases Cardiac Diseases Peripartum cardiomyopathy Consider PAC for severe patients antepartum with EF <35%, may also consider VTE prophylaxis Future- echo after recovery predicts outcome in subsequent pregnancy normal echo may have a 21% risk for CHF in future pregnancy, but less than 5% risk of maternal death Mrs Smith presents for preconception counseling 23 year-old Gravida 0 History of a cardiac disease structural Repaired as a child What are the risks to her getting pregnant? Case Patients have multiple problems Which problem is more important? How does the combined problem correlate with my patient sitting in front of me? How do you counsel this patient sitting in front of you? Case Case 4
6 N O P E Risk for an Event Event defined as pulmonary edema, arrhythmia, stroke, death N NYHA >2 Positive= 1 point O = Obstruction (Left heart obstruction) MV<2cm or AV<1.5cm or Gradient across valve >30mm Any of these positive =1 point P Prior event (prior to pregnancy) Any = 1 point E Ejection Fraction <40% Positive= 1 point 5
7 Risk for event with 0 points=5% 1 point=27% > 1 point= NOPE (Don t get pregnant) 75% Divide lesions that tolerate a decrease in systemic vascular resistance vs those that do not Why is this important? Can they get an epidural or spinal or not? Cardiac Lesions and Decrease in SVR But there are so many lesions C A T P I E Cardiac Lesions and Decerease in SVR Cardiac Lesions that do not tolerate epidural/spinal Coarctation of Aorta Aortic Stenosis Tetralogy of Fallot (uncorrected) Pulmonary hypertension IHSS (Idiopathic Hypertrophic Subaortic Stenosis) Eisenmenger syndrome CATPIE lesions Bad-go on leave, give to your partner Decrease in SVR(epidural, blood loss, hypotension) not well tolerated Run wet, risk of pulmonary edema, but worse risk for hypoperfusion(syncope, cardiac ischemia, stroke) 6
8 Blood pressure? What is this? What are the components of this? BP=Flow X Resistance Elevated flow is from too much volume Causes: Fluid Hypercontractility Corticosteroids Increased work of heart Resistance is from too much vasoconstriction Causes: Catecholemines Hypocarbia Pheo Thyroid Cocaine Pregnancy HTN is either a flow problem or a resistance problem How do you treat a flow/volume problem? How do you treat a resistance problem? Volume problem Beta blocker or diuretic 7
9 Resistance problem Afterload reduction or vasodilators Assumption of a normal pregnancy heart DBP reflects degree of vasoconstriction 130/100 suggests vasoconstriction as a cause of the hypertension Gestalt of the Blood Pressure SBP- DBP= Pulse pressure Increased PP suggests a volume problem(hyperdynamic or fluid overload) What is ELEVATED PULSE PRESSURE? Speed limit is 55 Decreased (Narrow)PP suggests a vasoconstriction problem Gestalt of the Blood Pressure Gestalt of the Blood Pressure Examples 160/110 What is the pulse pressure? How would you calculate? How would you treat this? 190/100 What is the pulse pressure? How would you calculate? How would you treat this patient? Gestalt of the Blood Pressure Gestalt of the Blood Pressure 8
10 QUIZ TIME What is NOPE? What are the lesions that can not get a spinal? Clinical pearl Type I DM presenting in DKA with end organ damage What should be considered??? 9
Maternal Cardiac Disease In Pregnancy. August 25, 2017 PREGNANCY ECHO CONFERENCE
Maternal Cardiac Disease In Pregnancy August 25, 2017 PREGNANCY ECHO CONFERENCE Maternal Physiology Cardiac Output = HR x SV Non-pregnant: 4.5 L/min Pregnant: 6.0 L/min Increase most acute in first 10
More informationMore History. Organization. Maternal Cardiac Disease: a historical perspective. The Parturient with Cardiac Disease 9/21/2012
The Parturient with Cardiac Disease Pamela Flood M.D. Professor of Anesthesia and Perioperative Care Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco Maternal Cardiac
More informationPregnancy and Heart Disease. Shilpa Kshatriya, MD, FACC Heartland Cardiology, PA
Pregnancy and Heart Disease Shilpa Kshatriya, MD, FACC Heartland Cardiology, PA Pregnancy and the Heart 2 % of pregnancies involve maternal CV disease CV disease does not preclude pregnancy but poses risk
More informationOutline. Maternal Congenital Heart Disease in Pregnancy. Maternal congenital heart disease. Cardiovascular disease in pregnancy 10/18/2017
I have no disclosures or conflicts of interest to report. Maternal Congenital Heart Disease in Pregnancy Jennifer A. Jolley, MD Associate Clinical Professor University of California, Irvine Department
More informationPregnancy and Heart Disease Sharon L. Roble, MD Echo Hawaii 2016
1 Pregnancy and Heart Disease Sharon L. Roble, MD Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Cardiovascular Effects of Pregnancy Anatomic Ventricular muscle mass increases
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationUC SF DISCLOSURES MANAGEMENT OF MATERNAL CONGENITAL HEART DISEASE OBJECTIVES. No financial disclosures CARDIOVASCULAR CHANGES ANTEPARTUM 6/10/2011
DISCLOSURES MANAGEMENT OF MATERNAL CONGENITAL HEART DISEASE No financial disclosures UC SF Lena H. Kim, MD AIM CONFERENCE June 10, 2011 spicecomments.com OBJECTIVES Physiologic cardiovascular changes of
More informationPREGNANCY AND CONGENITAL HEART DISEASE
PREGNANCY AND CONGENITAL HEART DISEASE SIDDHARTH JADHAV M.D. Assistant Professor of Radiology E.B. Singleton Department of Pediatric Radiology Texas Children's Hospital COMMERCIAL DISCLOSURE - None Objectives
More informationValve Disease in the Pregnant Patient
Valve Disease in the Pregnant Patient Julie B. Damp, MD December 6, 2012 VanderbiltHeart.com If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If
More informationEVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE. Karen Stout, MD University of Washington Seattle Children s Seattle, WA
EVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE Karen Stout, MD University of Washington Seattle Children s Seattle, WA CASE PRESENTATION 24 year old woman with aortic regurgitation referred for evaluation
More informationCongenital Heart Disease Patient and Pregnancy
Congenital Heart Disease Patient and Pregnancy Gurur Biliciler-Denktas, M.D. Assistant Professor Division of Pediatric Cardiology, Department of Pediatrics The University of Texas Health Science Center
More informationPregnancy and Heart Disease
Pregnancy and Heart Disease Heidi M. Connolly, MD No disclosures 2011 MFMER 3138928-1 Regitz-Zagrosek V, Lundqvist C, Borghi C, et al. Pregnancy and the Heart 2% of pregnancies involve maternal CV disease
More informationCardiac Disease in Pregnancy
Cardiac Disease in Pregnancy DATE: SEPTEMBER 11, 2016 PRESENTED BY: ABIGAIL KHAN, MD Outline Scope of the problem Physiology of pregnancy Cardiac risk in pregnancy Pregnancy management Contraception 1
More informationMiscellaneous Cardiology Topics pregnancy - congenital - myocarditis - pericardial disease. Pregnancy and Cardiovascular Disease MCQ
Miscellaneous Cardiology Topics pregnancy - congenital - myocarditis - pericardial disease Maan Jokhadar, MD, FACC Emory Center for Advanced Heart Failure Therapy Emory Adult Congenital Heart Center Pregnancy
More informationNothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acid base balance pregnancy-related changes to, 640 Acquired heart disease, 731 Acute fatty liver of pregnancy (AFLP), 618 Acute kidney
More informationUptofate Study Summary
CONGENITAL HEART DISEASE Uptofate Study Summary Acyanotic Atrial septal defect Ventricular septal defect Patent foramen ovale Patent ductus arteriosus Aortic coartation Pulmonary stenosis Cyanotic Tetralogy
More informationEjection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease Etiology General Principles Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
More informationPeripartum Cardiomyopathy. Lavanya Rai Manipal
Peripartum Cardiomyopathy Lavanya Rai Manipal Definition - PPCM - Dilated cardiomyopathy of unknown cause resulting in cardiac failure that occurs in the peripartum period in women without any preexisting
More informationEjection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease General Principles Etiology Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
More informationCardiac disease in pre pr gnancy
IN THE NAME OF GOD Cardiac disease in pregn nancy MITRAL STENOSIS 33 y/o G3L2(2c/s) GA 34 + 5 CC: LP & dyspnea PMHx: MS sinse 4 yrs ago due to Rheumatism PSHx: 2c/s DHx: metoral 50 mg q6h/ ASA/ Enoxaparin
More informationPregnancy and Heart Disease. Alexandra A Frogoudaki Adult Congenital Heart Clinic ATTIKON University Hospital
Pregnancy and Heart Disease Alexandra A Frogoudaki Adult Congenital Heart Clinic ATTIKON University Hospital Pregnancy is not a state Hemodynamic changes During pregnancy Estrogens 1. Renin 2.
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationMaternal Cardiac Disease Diagnosis and Management
Maternal Cardiac Disease Diagnosis and Management Dr. Şevki ÇELEN ZTB Maternity and Teaching Hospital Department of Perinatology Heart diseases in pregnancy Today, 0.2-4% of all pregnancies are accompanied
More informationCardiovascular disease complicates 1% to 3% of all
Pregnancy Complicated by Valvular Heart Disease: An Update Michael Nanna, MD; Kathleen Stergiopoulos, MD, PhD, FASE, FACC, FAHA Cardiovascular disease complicates 1% to 3% of all pregnancies and is responsible
More informationManagement of Heart Failure and Cardiomyopathies in Pregnancy
Management of Heart Failure and Cardiomyopathies in Pregnancy Professor Sanjay Sharma Disclosures: None Epidemiology of Cardiac Disease In Pregnancy Cardiovascular disease in pregnancy is increasing in
More informationCritical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials
Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials Pregnancy and Congenital Heart Disease Case Review Heidi M. Connolly, M.D. Professor of Medicine Chair for Education
More informationΈγκυος και συγγενής καρδιοπάθεια: Τι πρέπει να γνωρίζει ο Καρδιολόγος Ενηλίκων
Έγκυος και συγγενής καρδιοπάθεια: Τι πρέπει να γνωρίζει ο Καρδιολόγος Ενηλίκων Αντώνιος Π. Βλάχος Αναπληρωτής Καθηγητής Παιδοκαρδιολογίας Πανεπιστήμιο Ιωαννίνων No conflict of interest Pregnancy and CHD
More informationRF & RHD Workshop 22 nd March MANAGEMENT of RHEUMATIC HEART DISEASE in PREGNANCY. Dr Dorothy Radford
RF & RHD Workshop 22 nd March 2016 MANAGEMENT of RHEUMATIC HEART DISEASE in PREGNANCY Dr Dorothy Radford PREGNANCY PHYSIOLOGY Increased cardiac output 30%-50% Increased blood volume 30%-50% Increased heart
More informationSusan P. D Anna MSN, APRN BC February 14, 2019
Is there Equal Opportunity in Heart Failure?? Susan P. D Anna MSN, APRN BC February 14, 2019 Disclosures: I have no financial disclosures. I am not an expert on this topic, but see a lot of women with
More informationEuropean CMR Certification: LIST OF PROCEDURES FORM
European CMR Certification: LIST OF PROCEDURES FORM Application for: Level 2 Level 3 Candidate is requested to submit a list of 150 (Level 2) or 300 (Level 3) studies reported by her/him as detailed in
More informationPregnancy and Cardiovascular Disease
Pregnancy and Cardiovascular Disease Cindy M. Martin, M.D. Co-Director, Adult Congenital and Cardiovascular Genetics Center No Disclosures Objectives Discuss the hemodynamic changes during pregnancy Define
More informationHow to manage the pregnant woman with heart disease
How to manage the pregnant woman with heart disease Dr Fiona Walker, The Heart Hospital,UCLH, London Dr Sara Thorne, University Hospital Birmingham Dr Cathy Head, The Heart Hospital, UCLH, London Dr Kate
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More informationESC Guidelines on the Management of Cardiovascular Diseases during Pregnancy
ESC Guidelines on the Management of Cardiovascular Diseases during Pregnancy Task force on the management of CVD during pregnancy of the ESC Chair: Vera Regitz-Zagrosek, Charite, Berlin None DECLARATION
More informationHemodynamic Monitoring
Perform Procedure And Interpret Results Hemodynamic Monitoring Tracheal Tube Cuff Pressure Dean R. Hess PhD RRT FAARC Hemodynamic Monitoring Cardiac Rate and Rhythm Arterial Blood Pressure Central Venous
More informationCongenital Heart Disease
Congenital Heart Disease Mohammed Alghamdi, MD, FRCPC, FAAP, FACC Associate Professor and Consultant Pediatric Cardiology, Cardiac Science King Fahad Cardiac Centre King Saud University INTRODUCTION CHD
More informationFUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART
FUNDAMENTALS OF HEMODYNAMICS, VASOACTIVE DRUGS AND IABP IN THE FAILING HEART CINDY BITHER, MSN, ANP, ANP, AACC, CHFN CHIEF NP, ADV HF PROGRAM MEDSTAR WASHINGTON HOSPITAL CENTER CONFLICTS OF INTEREST NONE
More informationΚαρδιοπάθειες και κύηση. Υπάρχουν ενδείξεις διακοπής; Λαζαρίδου Φωτεινή, ΕΒ Καρδιολόγος Νοσοκομείο «Αγ Παύλος», Θεσσαλονίκη
Καρδιοπάθειες και κύηση. Υπάρχουν ενδείξεις διακοπής; Λαζαρίδου Φωτεινή, ΕΒ Καρδιολόγος Νοσοκομείο «Αγ Παύλος», Θεσσαλονίκη ~ 3% of women 18 44 years of age have cardiac disease ~ 1% of pregnancies are
More informationPhysical Exam Part II
Physical Exam Part II University of Michigan Cardiovascular Center Kim A. Eagle, MD Albion Walter Hewlett Professor Director Physical Exam: Part II Heart Sounds Heart Murmurs HEART SOUNDS S1 MITRAL + TRICUSPID
More informationCASE DISCUSSION. Dr JAYASREE VEERABOINA 2nd yr PG MS OBG
CASE DISCUSSION Dr JAYASREE VEERABOINA 2nd yr PG MS OBG Normal Cardiovascular changes in Pregnancy CARDIAC OUTPUT 5 th wk -- starts 12 wks -- 30-35% 30-32 wks -- 40% During labour -- 50% After delivery
More informationRate of CHD at birth: 4~12/1,000
Risk assessment and management for the pregnant ACHD woman Suk-Joo Choi Department of Obstetrics and Gynecology Samsung Medical Center Sungkyunkwan k University i School of Medicine i Cardiac diseases
More informationPre-discussion questions
Amanda Bartlett, PA-C Dustin Bartlett, PA-C Andrea Applegate, PA-C Leslie Yearta Brown, NP CHF Round Table Discussion Objectives ANDREA- Discuss the definition and different categories of CHF DUSTIN- Define
More informationValvular Heart Disease Mitral Stenosis
Valvular Heart Disease Mitral Stenosis A 75 year old woman with loud first heart sound and mid-diastolic murmur Chronic dyspnea Class 2/4 Fatigue Recent orthopnea/pnd Nocturnal palpitation Pedal edema
More informationInnovation therapy in Heart Failure
Innovation therapy in Heart Failure P. Laothavorn September 2015 Topics of discussion Basic Knowledge about heart failure Standard therapy New emerging therapy References: standard Therapy in Heart Failure
More informationADULT CONGENITAL HEART DISEASE. Stuart Lilley
ADULT CONGENITAL HEART DISEASE Stuart Lilley More adults than children have congenital heart disease Huge variety of congenital lesions from minor to major Heart failure, re-operation and arrhythmia are
More informationMaternal and Fetal Physiology
Background Maternal and Fetal Physiology Anderson Lo, DO Fellow, Maternal-Fetal Medicine Wayne State University School of Medicine SEMCME Fetal Assessment Course July 20, 2018 Oxygen pathway Mother Placenta
More informationPERIPARTUM CARDIOMYOPATHY
PERIPARTUM CARDIOMYOPATHY Dr.T.Venkatachalam. Professor of Anaesthesiology Madras Medical College, Chennai Peripartum cardiomyopathy is defined as the onset of acute heart failure without demonstrable
More informationHypertension in Aortic Valve Disease
Hypertension in Aortic Valve Disease Hanna M. Nosseir MRCP, FRCP Head of Cardiology department Galaa Military Medical Complex Aortic stenosis: Introduction Arterial hypertension and aortic stenosis are
More informationClosing ASDs with pulmonary hypertension. Shakeel A Qureshi Evelina Children s Hospital London
Closing ASDs with pulmonary hypertension Shakeel A Qureshi Evelina Children s Hospital London Ho Chi Minh, Vietnam, January 2012 ACC/AHA 2008 Guidelines ASD closure Closure is indicated for right atrial
More informationEchocardiography as a diagnostic and management tool in medical emergencies
Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications
More informationPathophysiology: Heart Failure
Pathophysiology: Heart Failure Mat Maurer, MD Irving Assistant Professor of Medicine Outline Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology Heart Failure: Definitions
More informationThe Causes of Heart Failure
The Causes of Heart Failure Andy Birchall HFSN Right heart failure LVSD - HFREF Valve regurgitation or stenosis Dropsy CCF congestive cardiac failure Cor pulmonale Pulmonary hypertension HFPEF LVF Definitions
More informationValvular Heart Disease. Dr. HANAN ALBACKR
Valvular Heart Disease Dr. HANAN ALBACKR Valvular Heart Disease Format for this lecture IMPORTANT CLINICAL INFO know for boards, tests and clinical practice Spectrum of VHD Aortic Valve Mitral Valve Tricuspid
More informationWhat to do when a heart failure patient becomes pregnant
BSH Heart Failure Day for Revalidation and Training 2017 What to do when a heart failure patient becomes pregnant Dr Diane Barker Consultant Cardiologist Royal Stoke Hospital Conflicts of interest - sponsorship,
More informationThe Ross Procedure: Outcomes at 20 Years
The Ross Procedure: Outcomes at 20 Years Tirone David Carolyn David Anna Woo Cedric Manlhiot University of Toronto Conflict of Interest None The Ross Procedure 1990 to 2004 212 patients: 66% 34% Mean age:
More informationPathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
More informationPregnancy, Heart Disease and Imaging. Hemodynamics. Decreased systemic vascular resistance. Physiology anemia
Pregnancy, Heart Disease and Imaging Sangeeta Shah, MD, FASE, FACC Associate Professor, Ochsner Clinical School of Medicine Advanced CV Imaging and Adult Congenital Heart Disease New Orleans, LA Hemodynamics
More informationHeart disease complicating pregnancy management strategies
www.slcog.lk/sljog LEADING ARTICLE Heart disease complicating pregnancy management strategies Priyadharshan P¹ Introduction Heart disease is the third most common cause of maternal death and the leading
More informationEchocardiography in Adult Congenital Heart Disease
Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease CHD missed in
More informationEffect of maternal heart disease on pregnancy outcomes
Expert Review of Obstetrics & Gynecology ISSN: 1747-4108 (Print) 1747-4116 (Online) Journal homepage: http://www.tandfonline.com/loi/ierb20 Effect of maternal heart disease on pregnancy outcomes Emily
More informationPathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
More informationOutline. Pathophysiology: Heart Failure. Heart Failure. Heart Failure: Definitions. Etiologies. Etiologies
Outline Pathophysiology: Mat Maurer, MD Irving Assistant Professor of Medicine Definitions and Classifications Epidemiology Muscle and Chamber Function Pathophysiology : Definitions An inability of the
More informationTSDA Boot Camp September 13-16, Introduction to Aortic Valve Surgery. George L. Hicks, Jr., MD
TSDA Boot Camp September 13-16, 2018 Introduction to Aortic Valve Surgery George L. Hicks, Jr., MD Aortic Valve Pathology and Treatment Valvular Aortic Stenosis in Adults Average Course (Post mortem data)
More informationDiagnosis & Management of Heart Failure. Abena A. Osei-Wusu, M.D. Medical Fiesta
Diagnosis & Management of Heart Failure Abena A. Osei-Wusu, M.D. Medical Fiesta Learning Objectives: 1) Become familiar with pathogenesis of congestive heart failure. 2) Discuss clinical manifestations
More informationValvular heart disease : Role of medication ( drug and intervention ) Pol.Col.Dr.Kasem Ratanasumawong
Valvular heart disease : Role of medication ( drug and intervention ) Pol.Col.Dr.Kasem Ratanasumawong Management of valvular heart disease Accurate diagnosis and disease severity Prevention and treatment
More informationM2 TEACHING UNDERSTANDING PHARMACOLOGY
M2 TEACHING UNDERSTANDING PHARMACOLOGY USING CVS SYSTEM AS AN EXAMPLE NIGEL FONG 2 JAN 2014 TODAY S OBJECTIVE Pharmacology often seems like an endless list of mechanisms and side effects to memorize. To
More informationPolicy REVISED: 6/30/2016 3:30 PM. Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016
Title: Antihypertensive Treatment for Severe Hypertension During Pregnancy Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016 Policy POLICY STATEMENT: Pregnant or postpartum patients
More informationCatherine Nelson-Piercy. Guy s & St Thomas Hospitals & Queen Charlotte s Hospital London, UK
Cardiac Disease and Pregnancy Catherine Nelson-Piercy Guy s & St Thomas Hospitals & Queen Charlotte s Hospital London, UK Physiological changes in pregnancy Cardiac Output (CO) increases by 40% Further
More informationCardiomyopathy. Jeff Grubbe MD FACP, Chief Medical Director, Allstate Life & Retirement
Cardiomyopathy Jeff Grubbe MD FACP, Chief Medical Director, Allstate Life & Retirement Nebraska Home Office Life Underwriters Association March 20, 2018 1 Cardiomyopathy A myocardial disorder in which
More informationSteel vs Alcohol. Or Neither. Management of Hypertrophic Cardiomyopathy. Josh Doll, MD January 24, 2015
Steel vs Alcohol Or Neither Management of Hypertrophic Cardiomyopathy Josh Doll, MD January 24, 2015 47yo Male, Mr. L Severe progressive dyspnea on exertion and weight gain Previous avid Cross-Fit participant
More informationIs it HF secondary to rheumatic heart disease???
Is it HF secondary to rheumatic heart disease??? Is mitral regurg. Is complication of CHF??? Cardiomyopathy Definition The term cardiomyopathy is purely descriptive, meaning disease of the heart muscle
More informationCritical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials
Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials Pregnancy and Congenital Heart Disease Heidi M. Connolly, M.D. Professor of Medicine Chair for Education Division
More informationEcho Doppler Assessment of Right and Left Ventricular Hemodynamics.
Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP Northwell, Lenox Hill Hospital, New York Professor of Cardiology Hofstra University
More informationIndex of subjects. effect on ventricular tachycardia 30 treatment with 101, 116 boosterpump 80 Brockenbrough phenomenon 55, 125
145 Index of subjects A accessory pathways 3 amiodarone 4, 5, 6, 23, 30, 97, 102 angina pectoris 4, 24, 1l0, 137, 139, 140 angulation, of cavity 73, 74 aorta aortic flow velocity 2 aortic insufficiency
More informationMitral Valve Disease. Prof. Sirchak Yelizaveta Stepanovna
Mitral Valve Disease Prof. Sirchak Yelizaveta Stepanovna Fall 2008 Mitral Valve Stenosis Lecture Outline Mitral Stenosis Mitral Regurgitation Etiology Pathophysiology Clinical features Diagnostic testing
More informationCandice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada
PVR Following Repair of TOF Now? When? Candice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada Late Complications after TOF repair Repair will be necessary
More informationE/Ea is NOT an essential estimator of LV filling pressures
Euroecho Kopenhagen Echo in Resynchronization in 2010 E/Ea is NOT an essential estimator of LV filling pressures Wilfried Mullens, MD, PhD December 10, 2010 Ziekenhuis Oost Limburg Genk University Hasselt
More informationHeart Failure. Dr. William Vosik. January, 2012
Heart Failure Dr. William Vosik January, 2012 Questions for clinicians to ask Is this heart failure? What is the underlying cause? What are the associated disease processes? Which evidence-based treatment
More informationMITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT. Irene Frantzis P year, SGUL Sheba Medical Center
MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT Irene Frantzis P year, SGUL Sheba Medical Center MITRAL VALVE DISEASE Mitral Valve Regurgitation Mitral Valve Stenosis Mitral Valve Prolapse MITRAL REGURGITATION
More informationFocused. se with 2008 F. lar Heart Diseas. date. ents With Valvul. Upd. gement of Patie. lines for Manag. HA 2006 Guidel ACC/AH. Fig.
ACC/AH HA 2006 Guidel nic severe AI (Fig. 4). ned by age, ay also be helpful nd echo. For AI, ollow up may be or MRI rather than mension; SD, end lines for Manag gement of Patie Upd ents With Valvul date
More informationCardiac Emergencies in Infants. Michael Luceri, DO
Cardiac Emergencies in Infants Michael Luceri, DO October 7, 2017 I have no financial obligations or conflicts of interest to disclose. Objectives Understand the scope of congenital heart disease Recognize
More informationCongestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption
Congestive Heart Failure Patient Profile Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Chief Complaint - SOB - When asked: Increasing difficulty
More informationCARDIAC DISEASE IN PREGNANCY: TUTORIAL 2 TUTORIAL OF THE WEEK TH NOVEMBER 2008
CARDIAC DISEASE IN PREGNANCY: TUTORIAL 2 TUTORIAL OF THE WEEK 118 10 TH NOVEMBER 2008 Dr. Abbi Walker, Christchurch Hospital, New Zealand Dr. Matt Rucklidge, Royal Devon & Exeter Hospital, UK mattrucklidge@yahoo.co.uk
More informationAdult Congenital Heart Disease: A Growing Problem. Dr. Gary Webb Cincinnati Children s Hospital Heart Institute
Adult Congenital Heart Disease: A Growing Problem Dr. Gary Webb Cincinnati Children s Hospital Heart Institute ACHD Resources in Ohio ACHAHEART.ORG Situations When We Might Help When you don t know a
More informationDefinition of Congestive Heart Failure
Heart Failure Definition of Congestive Heart Failure A clinical syndrome of signs & symptoms resulting from the heart s inability to supply adequate tissue perfusion. CHF Epidemiology Affects 4.7 million
More informationPeripartum management of Rheumatic Heart Disease
Peripartum management of Rheumatic Heart Disease Dr James Sartain Director of Anaesthesia & Perioperative Medicine Cairns & Hinterland Hospital & Health Service Talk outline Why (still) talk about RHD
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationDetailed Order Request Checklists for Cardiology
Next Generation Solutions Detailed Order Request Checklists for Cardiology 8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 www.aimspecialtyhealth.com Appropriate.Safe.Affordable 2018
More informationHeart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)
Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationPulmonary Hypertension: Another Use for Viagra
Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A
More informationPhysiologic Based Management of Circulatory Shock Kuwait 2018
Physiologic Based Management of Circulatory Shock Kuwait 2018 Dr. Yasser Elsayed, MD, PhD Director of the Targeted Neonatal Echocardiography, Point of Care and Hemodynamics Program Staff Neonatologist
More informationRight-Sided Congestive Heart Failure Basics
Right-Sided Congestive Heart Failure Basics OVERVIEW Failure of the right side of the heart to pump blood at a sufficient rate to meet the needs of the body or to prevent blood from pooling within the
More informationMRI (AND CT) FOR REPAIRED TETRALOGY OF FALLOT
MRI (AND CT) FOR REPAIRED TETRALOGY OF FALLOT Linda B Haramati MD, MS Departments of Radiology and Medicine Bronx, New York OUTLINE Pathogenesis Variants Initial surgical treatments Basic MR protocols
More informationImpedance Cardiography (ICG) Application of ICG for Hypertension Management
Application of ICG for Hypertension Management 1mA @ 100 khz Impedance Cardiography (ICG) Non-invasive Beat-to-beat Hemodynamic Monitoring Diastole Systole Aortic valve is closed No blood flow in the aorta
More informationImpedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency
Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency Aim of haemodynamic monitoring in ICU and ED Detection and therapy of insufficient organ perfusion Answers to common cardiovascular
More informationIntroduction. Invasive Hemodynamic Monitoring. Determinants of Cardiovascular Function. Cardiovascular System. Hemodynamic Monitoring
Introduction Invasive Hemodynamic Monitoring Audis Bethea, Pharm.D. Assistant Professor Therapeutics IV January 21, 2004 Hemodynamic monitoring is necessary to assess and manage shock Information obtained
More information