Books on the topic 'Cardiac Functional Assessment'
To see the other types of publications on this topic, follow the link: Cardiac Functional Assessment.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 books for your research on the topic 'Cardiac Functional Assessment.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse books on a wide variety of disciplines and organise your bibliography correctly.
1
Stanford, William, Healthstream, and MD Stanford William. Functional Cardiac Imaging: Assessment of Heart Disease by Electron Beam Computed Tomography. Healthstream Inc., 1996.
Find full text
2
Torres, Río Aguilar, Luigi P. Badano, and Dimitrios Tsiapras. Cardiac transplant patients. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0050.
Full textAbstract:
Echocardiography has a pivotal role in the care of heart transplant (HT) recipients. This chapter discusses the use of echocardiographic techniques for the assessment of HT patients. In the early post-transplant period, echocardiography has demonstrated its utility to assess the normal and abnormal structural and physiological changes of the transplanted heart, as well as to detect complications such as graft failure. During follow-up, development of acute/chronic graft rejection and cardiac allograft vasculopathy remains the leading causes of mortality in HT recipients and the role of conventional and new echocardiographic techniques in detecting these complications is discussed. Finally, the role of stress echocardiography, which provides additional functional information to the anatomical data obtained with invasive coronary angiography and intravascular ultrasound, is highlighted. The last sections of the chapter are dedicated to the echocardiographic monitoring of endomyocardial biopsies and how to schedule serial echocardiograms during the follow-up of HT recipients.
3
Archer, Nick, and Nicky Manning. Cardiac function. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199230709.003.0014.
Full textAbstract:
Assessment 202Treatment 218Cardiac function, if severely compromised, will cause general markers of ill health such as: • Pericardial effusion larger than physiological ( see Table 5.1, p.56).• Hydrops.• Reduced movement.The purpose of the assessments discussed here is to identify the stressed or failing fetal heart at an earlier stage and to provide ways of monitoring changes objectively....
4
Sidhu, Kulraj S., Mfonobong Essiet, and Maxime Cannesson. Cardiac and vascular physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0001.
Full textAbstract:
This chapter discusses key components of cardiovascular physiology applicable to clinical practice in the field of anaesthesiology. From theory development to ground-breaking innovations, the history of cardiac and vascular anatomy, as well as physiology, is presented. Utilizing knowledge of structure and function, parameters created have allowed adequate patient clinical assessment and guided interventions. A review of concepts reveals the impact of multiple physiological variables on a patient’s haemodynamic state and the need for more accurate and efficient measurements. In particular, it is noted that a more reliable index of ventricular contractility is the end-systolic elastance rather than the ejection fraction. Constant direct preload assessment has not yet been achieved but continues to be determined through surrogate variables, and continuous cardiac output monitoring for oxygen delivery, although advancing, has limitations. Considering the effect of compound factors perioperatively, especially heart failure, modifies the goals and interventions of anaesthetists to achieve improved outcomes. Therefore, medical management prior to surgery and complete assessment through history, physical examination, and diagnostic tests are a priority. This chapter also details the expectations following volume expansion to augment haemodynamics during surgery, the concept of functional haemodynamic monitoring, and limitations to the parameters applied in assessing fluid responsiveness. Challenging the accuracy of conventional indices to predict volume status led to the use of goal-directed therapy, reducing morbidity and minimizing length of hospital stay. The mainstay of this chapter is to reinforce the relevance of advances in haemodynamic monitoring and homeostasis optimization by anaesthetists during surgery, using fundamental concepts of cardiovascular physiology.
5
Piepoli, Massimo F., and Pantaleo Giannuzzi. Secondary prevention and cardiac rehabilitation: principles and practice. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0008.
Full textAbstract:
Secondary prevention through cardiac rehabilitation is the intervention that contributes most to decreasing morbidity and mortality in coronary artery disease, in particular after myocardial infarction but after incorporating cardiac interventions and in chronic stable heart disease. Cardiac patients deserve special attention to restore their quality of life and to maintain or restore their functional capacity and require counselling to avoid recurrence by adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Components of CR include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation and psychosocial management. This chapter reviews the key components of a CR programme and summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.
6
Archer, Nick, and Nicky Manning. Cardiac function. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198766520.003.0018.
Full text
7
AlJaroudi, Wael. Risk Assessment Before Noncardiac Surgery. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0014.
Full textAbstract:
Perioperative risk assessment is essential in screening patients before noncardiac surgery. Cardiovascular complications such as fatal and non-fatal myocardial infarction (MI), ventricular arrhythmia, pulmonary edema, and stroke are important in-hospital causes of morbidity and mortality intra and post-operatively. The optimal approach is to identify patients at increased risk so that appropriate testing and therapeutic interventions are undertaken a priori to minimize such risk. The initial preoperative evaluation includes identification of surgery-specific risk, patient exercise functional capacity and clinical risk profile. Patients with major predictors of events such as acute coronary syndromes, recent MI, unstable arrhythmia, and severe valvular disease warrant further management and optimization that often lead to delaying surgery. Those with three or more predictors (history of ischemic heart disease, compensated heart failure, diabetes, renal insufficiency, or history of cerebrovascular disease) undergoing high- risk surgery often require stress testing. Although data from randomized prospective trials are lacking, numerous studies have demonstrated the utility of myocardial perfusion imaging (MPI) for determination of perioperative cardiac risk. The goal of this chapter is to review the use of MPI for preoperative risk assessment and the recommendations from the current guidelines. The focus will be on short-term and long-term prognosis including special groups such as after coronary stenting and before vascular surgery, liver and renal transplantation.
8
N, Ghista Dhanjoo, and Mihóczy László, eds. Noninvasive cardiac assessment technology. Basel: Karger, 1989.
Find full text
9
Prout, Jeremy, Tanya Jones, and Daniel Martin. Cardiovascular system. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0001.
Full textAbstract:
This chapter covers the assessment and investigation of perioperative cardiac risk, the principles of perioperative haemodynamic monitoring and physiological changes in cardiac comorbidity with their relevance to anaesthetic management. Perioperative cardiovascular risk includes assessment of cardiac risk factors, functional capacity and evidence-based guidelines for preassessment. Cardiovascular investigations such as cardiopulmonary exercise testing and scoring systems for cardiac risk are included. Management of the cardiac patient for non-cardiac surgery is detailed. Invasive monitoring with arterial, central venous and pulmonary artery catheters is described. Cardiac output measurement systems including dilution techniques, pulse contour analysis and Doppler are compared. The physiological changes, management and implications for anaesthesia of common cardiac comorbidity including ischaemic heart disease, heart failure, valvular heart disease, pacemakers and pulmonary hypertension are described.
10
Voigt, Jens Uwe, Peter Søgaard, and Emer Joyce. Heart failure: left ventricular dyssynchrony. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0026.
Full textAbstract:
Echocardiography plays a pivotal role in the management of patients with dilative cardiomyopathy and conduction disease, particularly in the setting of cardiac resynchronization therapy (CRT). Current CRT guidelines recommend the echocardiographic assessment of left ventricular size and function. Furthermore, echocardiography has the potential of analysing regional myocardial mechanics with high temporal resolution and without radiation burden or danger for the patient. Assessment of left ventricular dyssynchrony has therefore become the next challenge. Besides the visual approaches, newer methods of functional imaging such as tissue Doppler and speckle tracking allow the exact quantification of regional myocardial function. This chapter reviews the current status of left ventricular dyssynchrony assessment by echocardiography and introduces emerging techniques which can better link conduction abnormalities and mechanical events and, thus, potentially improve clinical decision-making in this field.
11
Diller, G. P., A. Kempny, and H. Baumgartner. Adult congenital heart disease. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0024.
Full textAbstract:
The heterogeneity of adult congenital heart disease requires a thorough understanding of cardiac anatomy as well as common surgical and interventional techniques. Echocardiographic studies should be comprehensive and performed in a structured fashion, to avoid missing important anatomical or functional information. The majority of clinical questions can be answered based on the results of echocardiographic studies, but the echocardiographer should be aware of the inherent limitations of the technique and additional image modalities such as cardiac magnetic resonance and computed tomography should be used when appropriate. Assessment of pulmonary artery pressure and pulmonary vascular resistance may be essential and still requires cardiac catheterization.
12
Lancellotti, Patrizio, and Bernard Cosyns. Cardiac Transplants. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0011.
Full textAbstract:
Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It provides comprehensive information about cardiac structure and function and may be of interest during cardiac biopsy. Precluded by a brief summary of orthotopic and heterotopic cardiac transplantation, this chapter highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. Normal echocardiographic findings in a transplanted heart are summarized alongside echocardiographic indicators of rejection.
13
Lancellotti, Patrizio, and Bernard Cosyns. Assessment of Diastolic Function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0005.
Full textAbstract:
Diastole is the part of the cardiac cycle starting at aortic valve closure and ending at mitral valve closure. Evaluation of diastolic function by echocardiography is useful to diagnose heart failure with preserved ejection fraction, and regardless of ejection fraction, echocardiography can be used to estimate left ventricular filling pressure. Assessment of diastolic function includes analysis of left ventricular relaxation and compliance, left atrial and left ventricular filling pressures. This chapter describes the phases of diastole and covers the integrated approach of LV diastolic function through M-Mode and 2D/3D echocardiography, pulsed-wave Doppler echocardiography, and pulsed-wave tissue Doppler echocardiography.
14
N, Ghista Dhanjoo, ed. Clinical cardiac assessment, interventions, and assist technology. Basel: Karger, 1990.
Find full text
15
Galderisi, Maurizio, Juan Carlos Plana, Thor Edvardsen, Vitantonio Di Bello, and Patrizio Lancellotti. Cardiac oncology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0064.
Full textAbstract:
Cancer therapeutics may induce cardiac damage in the left and the right ventricle. Radiotherapy most frequently induces valvular damage, carotid stenosis, and coronary artery disease. Pericardial disease may be due to both chemo- and radiotherapy. The manifestations of both chemo- and radiotherapy can develop acutely but also become overt years after their performance, in particular after radiotherapy. The main cardiac damage of cancer therapeutics-related cardiac dysfunction (CTRCD) corresponds to the reduction of left ventricular (LV) systolic function. The Expert Consensus document from ASE and EACVI has defined CTRCD as a decrease in LV ejection fraction (LVEF) of greater than 10 percentage points, to a value less than 53%. The accurate calculation of LVEF at baseline and during follow-up is extremely important. The assessment of LV longitudinal function, in particular of speckle tracking-derived global longitudinal strain (GLS), can provide additional information, allowing early, subclinical detection of CTRCD. The ideal strategy could be to compare the measurements of GLS obtained during chemotherapy, with the one obtained at baseline. An integrated approach with the use of echocardiography at standardized, clinical preselected intervals with biomarker (ultrasensitive troponin) assessment prior to each chemotherapy cycle could be suggested in patients at high risk of CTRCD. Follow-up after therapy should depend on the type of chemotherapy/radiotherapy and the presence/absence of on-therapy CTRCD. Long-term follow-up should be planned after radiotherapy.
16
D’Andrea, Antonello, André La Gerche, and Christine Selton-Suty. Systemic disease and other conditions: athlete’s heart. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0055.
Full textAbstract:
The term ‘athlete’s heart’ refers to the structural, functional, and electrical adaptations that occur as a result of habitual exercise training. It is characterized by an increase of the internal chamber dimensions and wall thickness of both atria and ventricles. The athlete’s right ventricle also undergoes structural, functional, and electrical remodelling as a result of intense exercise training. Some research suggests that the haemodynamic stress of intense exercise is greater for the right heart and, as a result, right heart remodelling is slightly more profound when compared with the left heart. Echocardiography is the primary tool for the assessment of morphological and functional features of athlete’s heart and facilitates differentiation between physiological and pathological LV hypertrophy. Doppler myocardial and strain imaging can give additional information to the standard indices of global systolic and diastolic function and in selected cases cardiac magnetic resonance imaging may help in the diagnosis of specific myocardial diseases among athletes such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy.
17
De Deyne, Cathy, and Jo Dens. Neurological assessment of the acute cardiac care patient. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0016.
Full textAbstract:
Many techniques are currently available for cerebral physiological monitoring in the intensive cardiac care unit environment. The ultimate goal of cerebral monitoring applied during the acute care of any patient with/or at risk of a neurological insult is the early detection of regional or global hypoxic/ischaemic cerebral insults. In the most ideal situation, cerebral monitoring should enable the detection of any deterioration before irreversible brain damage occurs or should at least enable the preservation of current brain function (such as in comatose patients after cardiac arrest). Most of the information that affects bedside care of patients with acute neurologic disturbances is now derived from clinical examination and from knowledge of the pathophysiological changes in cerebral perfusion, cerebral oxygenation, and cerebral function. Online monitoring of these changes can be realized by many non-invasive techniques, without neglecting clinical examination and basic physiological variables such as invasive arterial blood pressure monitoring or arterial blood gas analysis.
18
De Deyne, Cathy, Ward Eertmans, and Jo Dens. Neurological assessment of the acute cardiac care patient. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0016_update_001.
Full textAbstract:
Many techniques are currently available for cerebral physiological monitoring in the intensive cardiac care unit environment. The ultimate goal of cerebral monitoring applied during the acute care of any patient with/or at risk of a neurological insult is the early detection of regional or global hypoxic/ischaemic cerebral insults. In the most ideal situation, cerebral monitoring should enable the detection of any deterioration before irreversible brain damage occurs or should at least enable the preservation of current brain function (such as in comatose patients after cardiac arrest). Most of the information that affects bedside care of patients with acute neurologic disturbances is now derived from clinical examination and from knowledge of the pathophysiological changes in cerebral perfusion, cerebral oxygenation, and cerebral function. Online monitoring of these changes can be realized by many non-invasive techniques, without neglecting clinical examination and basic physiological variables—with possible impact on optimal cerebral perfusion/oxygenation—such as invasive arterial blood pressure monitoring or arterial blood gas analysis.
19
Reich, David L., Stephan A. Mayer, and Suzan Uysal, eds. Neuroprotection in Critical Care and Perioperative Medicine. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190280253.001.0001.
Full textAbstract:
Clinicians caring for patients are challenged by the task of protecting the brain and spinal cord in high-risk situations. These include following cardiac arrest, in critical care settings, and during complex procedural and surgical care. This book provides a comprehensive overview of various types of neural injury commonly encountered in critical care and perioperative contexts and the neuroprotective strategies used to optimize clinical outcomes. In addition to introductory chapters on the physiologic modulators of neural injury and pharmacologic neuroprotectants, the topics covered include: imaging assessment; tissue biomarker identification; monitoring; assessment of functional outcomes and postoperative cognitive decline; traumatic brain injury; cardiac arrest and heart-related issues such as valvular and coronary artery bypass surgery, aortic surgery and stenting, and vascular and endovascular surgery; stroke; intracerebral hemorrhage; mechanical circulatory support; sepsis and acute respiratory distress syndrome; neonatal issues; spinal cord injury and spinal surgery; and issues related to general, orthopedic, peripheral vascular, and ear, nose and throat surgeries.
20
Buechel, Ronny R., and Aju P. Pazhenkottil. Basic principles and technological state of the art: hybrid imaging. Edited by Philipp Kaufmann. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0121.
Full textAbstract:
The core principle of hybrid imaging is based on the fact that it provides information beyond that achievable with either data set alone. This is attained through the combination and fusion of two datasets by which both modalities synergistically contribute to image information. Hybrid imaging is, thus, more powerful than the sum of its parts, yielding improved sensitivity and specificity. While datasets for integration may be obtained by a variety of imaging modalities, its merits are intuitively best exploited when combining anatomical and functional imaging, particularly in the setting of evaluation of coronary artery disease (CAD) as this combination allows a comprehensive assessment with regard to presence or absence of coronary atherosclerosis, the extent and severity of coronary plaques, and the haemodynamic relevance of stenosis. In clinical practice, the combination of CT coronary angiography (CCTA) with myocardial perfusion studies obtained by single-photon emission computed tomography (SPECT) and by positron emission tomography (PET) has been well established. Recent literature also reports on the feasibility of combining CCTA with cardiac magnetic resonance imaging. Finally, recent advances in CCTA and SPECT imaging have led to a substantial reduction of radiation exposure, now allowing for comprehensive morphological and functional diagnostic work-up by cardiac hybrid SPECT/CCTA imaging at low radiation dose exposures ranging below 5 mSv.
21
Al-Housni, Mohamad Bashar. The assessment of left ventricular function after cardic transplantation in Harefield Hospital. 2001.
Find full text
22
Stolker, Robert Jan, and Felix van Lier. Choice and interpretation of preoperative investigations. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0041.
Full textAbstract:
Preoperative risk assessment is one of the most important steps in perioperative management. In the last decades, considerable progress has been achieved. However, as more high-risk procedures are performed in more aged patients, suffering more morbidity, this may lead to an increased risk of adverse outcomes. The goal of preoperative assessment is to identify patients at extreme risk and discuss whether they should be operated on, or undergo an alternative procedure with a lower risk profile, or if conservative treatment should be continued. Furthermore, it gives the opportunity to optimize patients prior to surgery, adapt intraoperative anaesthetic management and monitoring, and select patients for postoperative treatment at an intensive care unit or post-anaesthesia care unit. The cornerstone of preoperative assessment is the estimation of functional capacity. Accurate anamnesis and physical examination are crucial. Several procedures have been used to optimize the preoperative risk stratification. In this chapter, the value of these additional preoperative investigations is reviewed. These investigations are to be performed only in patients with considerable co-morbidity undergoing high-risk surgery. As cardiovascular adverse events are a major determinant of postoperative outcome, the chapter focuses on the management of the two most important cardiac risk factors, that is, myocardial ischaemia and impaired left ventricular function.
23
Kaufmann, Philipp A., and Oliver Gaemperli. Hybrid Cardiac Imaging. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0028.
Full textAbstract:
Assessment of both coronary anatomy and myocardial perfusion are equally important for the appropriate treatment of patients with stable coronary artery disease. Cardiac hybrid imaging allows integration of coronary anatomy and perfusion in one all-in-one image, thereby avoiding mental integration of findings. In selected subgroups of patients, cardiac hybrid imaging has demonstrated superior diagnostic accuracy compared to single modalities. The combination of coronary anatomy and function provides incremental prognostic information and improves risk stratification of patients with suspected or known CAD. Aside from CT coronary angiography, coronary artery calcium score (CACS) scans obtained from native ECG-triggered CT are used for hybrid imaging. They are used either for attenuation correction, or can be combined with radionuclide information to improve CAD detection and risk stratification. A large number of integrated hybrid scanners are commercially available and offer advantages for cardiac hybrid imaging. However, these devices are not mandatory, and hybrid imaging is perfectly feasible from two separate datasets using appropriate image fusion software. Cardiac magnetic resonance has entered the arena of hybrid imaging and several integrated PET/MRI devices are already commercially available. Its advantages include the lack of ionizing radiation and a high spatial resolution, particularly for soft tissue structures. In research, hybrid imaging moves beyond its conventional borders of perfusion imaging to target specific molecular or biological pathways that underlie cardiac disease, a concept known as molecular imaging. The combination of radionuclide imaging with CT or MRI offers attractive features to co-localize biological signals from radiolabeled targeted compounds with microanatomical structures.
24
Donal, Erwan, Seisyou Kou, and Partho Senguptadd. Left ventricle: cardiac mechanics and left ventricular performance. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0019.
Full textAbstract:
The complexity of left ventricular (LV) function(s) assessment in heart failure patients is related to the complexity of heart anatomy, but also to the complexity of electromechanical interaction, and to the load dependency of all the parameters that could be applied in clinical practice. Three perpendicular axes orienting the global geometry of the LV define the local cardiac coordinate system: radial, circumferential, and longitudinal. Speckle tracking is the technique of choice for quantifying myocardial deformation (regional and global). Longitudinal LV deformation, which is predominantly governed by the subendocardial region, is the most vulnerable component of LV mechanics and therefore most sensitive to the presence of myocardial disease.
25
Hagendorff, Andreas, Elie Chammas, and Mohammed Rafique Essop. Diseases with a main influence on heart valves. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0058.
Full textAbstract:
The high spatial and temporal resolution, widespread availability, and non-invasive nature of echocardiography make it the imaging modality of choice for assessment of cardiac valvular disease. Echocardiography allows not only detailed evaluation of valve morphology, but also makes possible assessment of the haemodynamic consequences and impact on left and right ventricular size and function. Based on this data, a more informed decision may be made on the nature and timing of surgical or percutaneous intervention. A wide variety of diseases may afflict the cardiac valves. In some such as rheumatic heart disease and degenerative disease, abnormality of valve function is the most important manifestation. Many systemic diseases, however, may affect the cardiac valves and not infrequently, echocardiography may be the first clue to a systemic illness. The salient points of diseases affecting mainly the cardiac valves are discussed in this chapter.
26
Hagendorff, Andreas, and Laura Ernande. Diseases with a main influence on pericardium. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0059.
Full textAbstract:
The high spatial and temporal resolution, widespread availability, and non-invasive nature of echocardiography make it the imaging modality of choice for assessment of cardiac valvular disease. Echocardiography allows not only detailed evaluation of valve morphology, but also makes possible assessment of the haemodynamic consequences and impact on left and right ventricular size and function. Based on this data, a more informed decision may be made on the nature and timing of surgical or percutaneous intervention. A wide variety of diseases may afflict the cardiac valves. In some such as rheumatic heart disease and degenerative disease, abnormality of valve function is the most important manifestation. Many systemic diseases, however, may affect the cardiac valves and not infrequently, echocardiography may be the first clue to a systemic illness. The salient points of diseases affecting mainly the cardiac valves are discussed in this chapter.
27
Saeed, Sahrai, and Eva Gerdts. Echocardiography. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.003.0010.
Full textAbstract:
Current guidelines recommend extensive cardiovascular imaging in patients who experience ischaemic stroke or a transient ischaemic attack to prevent recurrent stroke. High-quality echocardiography is crucial for detection of the wide range of cardiac and proximal aortic conditions that can predispose to cerebral embolism. These conditions may be classified as major, minor, or uncertain risk sources of embolism. Although both transthoracic (TTE) and transoesophageal echocardiography (TOE) have substantial clinical utility in patients with cryptogenic stroke, these methods offer complementary information. TOE is typically used for assessment of defects in the atrial septum or detection of thrombus in the left atrial appendage. In contrast, TTE is the recommended method for assessment of cardiac chamber structure and function, and valvular disease. Furthermore, assessment of aortic stiffness and electrocardiography may offer additional insight to cardiac function. This chapter gives an overview of the use of echocardiography in ischaemic stroke patients.
28
Kallmeyer, Andrea, José Luis Zamorano, G. Locorotondo, Madalina Garbi, José Juan Gómez de Diego, and Miguel Ángel García Fernández. Non-invasive haemodynamic assessment. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0005.
Full textAbstract:
The diagnostic power of two-dimensional (2D) echocardiography resides not only in its capability of providing anatomical information and of studying myocardial contractile function, but also in the possibility of performing a non-invasive haemodynamic assessment. Such non-invasive haemodynamic assessment is the subject of this chapter.2D echocardiography, colour flow imaging, and Doppler modality make this haemodynamic assessment possible, by studying the following parameters: ◆ Blood flow velocities. ◆ Transvalvular pressure gradients. ◆ Valvular areas. ◆ Stroke volume, regurgitant volume, and regurgitant fraction. ◆ Cardiac function.The application of these concepts in clinical practice will be explained through this chapter. They can be summarized in the following points: ◆ The study of valvular insufficiencies. ◆ The study of the valvular stenosis. ◆ The study of intracardiac shunts. ◆ The study of myocardial systolic and diastolic function. ◆ The estimation of intracardiac pressures.Finally, non-invasive haemodynamic study represents an alternative to invasive procedures in some clinical circumstances and it is very important in the diagnostic and therapeutic decision making. Therefore, it is necessary for the cardiologist to understand how this echocardiographic study is performed, as well as its advantages and limitations.
29
Dilsizian, Vasken, Ines Valenta, and Thomas H. Schindler. Myocardial Viability Assessment. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0021.
Full textAbstract:
Heart failure may be a consequence of ischemic or non-ischemic cardiomyopathy. Etiologies for LV systolic dysfunction in ischemic cardiomyopathy include; 1) transmural scar, 2) nontransmural scar, 3) repetitive myocardial stunning, 4) hibernating myocardium, and 5) remodeled myocardium. The LV remodeling process, which is activated by the renin-angiotensin system (RAS), stimulates toxic catecholamine actions and matrix metalloproteinases, resulting in maladaptive cellular and molecular alterations5, with a final pathway to interstitial fibrosis. These responses to LV dysfunction and interstitial fibrosis lead to progressive worsening of LV function. Established treatment options for ischemic cardiomyopathy include medical therapy, revascularization, and cardiac transplantation. While there has been continuous progress in the medical treatment of heart failure with beta-blockers, angiotensin-converting enzyme (ACE) inhibition, angiotensin II type 1 receptor (AT1R) blockers, and aldosterone to beneficially influence morbidity and mortality, the 5-years mortality rate for heart failure patients remains as high as 50%. Revascularization procedures include percutaneous transluminal coronary artery interventions (PCI) including angioplasty and endovascular stent placement and coronary artery bypass grafting (CABG). Whereas patents with heart failure due to non-coronary etiologies may best benefit from medical therapy or heart transplantation, coronary revascularization has the potential to improve ventricular function, symptoms, and long term survival, in patients with heart failure symptoms due to CAD and ischemic cardiomyopathy.
30
Voigt, Jens-Uwe. Quantification of left ventricular function and synchrony using tissue Doppler, strain imaging, and speckle tracking. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0006.
Full textAbstract:
Modern echocardiographic systems allow the quantitative and qualitative assessment of regional myocardial function by measuring velocity, motion, deformation, and other parameters of myocardial function.Both colour Doppler (CD) and spectral Doppler modes provide one-dimensional estimates of velocity. From CD data only, further parameters can be derived. Tracking techniques have recently been introduced which provide all parameters two-dimensionally, but at the cost of lower temporal resolution.Several clinical applications have been proposed, including regional and global systolic function assessment, evaluation of diastolic cardiac properties, and assessment of ventricular dyssynchrony.This chapter provides an introduction to the method of Doppler- and tracking-based function assessment and provides a basis for understanding its different clinical applications.
31
Cosyns, Bernard, Thor Edvardsen, Krasimira Hristova, and Hyung-Kwan Kim. Left ventricle: systolic function. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0020.
Full textAbstract:
The assessment of left ventricular (LV) systolic function is one of the most important parts of correct diagnosis, selection of treatment strategy or medications, and prediction of prognosis. Although cardiac magnetic resonance imaging is generally accepted as the gold standard in vivo imaging modality for assessing LV systolic function, its practical use is limited due to its limited availability, high cost, and the presence of conditions precluding its performance such as a pacemaker, claustrophobia, and severe arrhythmia. Thus, transthoracic echocardiography is a first-line imaging modality employed in daily practice and has been widely used. Since the first attempts with M-mode approach, remarkable improvements have been made with the advent of two-dimensional echocardiography, and more recently three-dimensional echocardiography, with high accuracy and reproducibility. More sophisticated methodologies such as strain imaging, based on Doppler or speckle tracking techniques, provide a more sensitive and quantitative measurement of myocardial contractility, and are gaining a place in common daily practice. This chapter describes different modalities that have been used for assessment of LV systolic function based on echocardiography, and is grossly composed of two parts: LV global systolic function and LV regional or segmental systolic function. For better application of these conventional and novel methods of assessing LV systolic function, strengths and pitfalls of these techniques should be acknowledged.
32
Roberto, Maggi, ed. Arene candide: A functional and environmental assessment of the holocene sequence : excavations Bernabò Brea-Cardini 1940-50. Roma: Il calamo, 1997.
Find full text
33
Monaghan, M., and S. Adhya. Three dimensional echocardiography. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0003.
Full textAbstract:
Three-dimensional (3D) echocardiography allows the real-time acquisition of volumes containing entire cardiac structures. The analysis of 3D volumes does not require any assumptions as to the shape of structures.3D echocardiography is more accurate than two-dimensional (2D) in the assessment of left ventricular (LV) volumes, mass, and function, and is comparable to cardiac magnetic resonance imaging. This makes it an ideal modality for measuring LV function particularly when this will determine significant interventions such as implanting of cardioverter/defibrillators, biventricular pacing, and the commencement and continuation of cancer chemotherapy. 3D echocardiography makes it easy to visualize valves and define pathological mechanisms. 3D assessment of dyssynchrony, myocardial strain, and stress imaging are attractive.However, 3D echocardiography is limited by the need for specialist software and lower spatial and temporal resolution when compared to 2D echocardiography.
34
Orlikowski, David, and Tarek Sharshar. Epidemiology, diagnosis, and assessment of neuromuscular syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0243.
Full textAbstract:
Admission to ICU with severe limb weakness, or the occurrence of a respiratory or motor deficit, and failure to wean from mechanical ventilation while in the intensive care unit are common presentations of a neuromuscular disease. Neuromuscular diseases include neuronopathies, neuropathies, myasthenic syndromes, and myopathies. An accurate neurological examination and complementary investigations are necessary for both diagnosis and for evaluating the severity of the disease. Assessment of respiratory muscle function is a key step in deciding the need for mechanical ventilation and subsequently its weaning. Hypercapnia often indicates an impending respiratory arrest, but normocapnia, which can be seen in a patient with severe reduction in vital capacity is not reassuring. Hypoxaemia can be due to hypercapnia, pulmonary injury (atelectasis or pneumonia), or pulmonary embolism. Cardiac evaluation is important as cardiomyopathies are frequent in myopathies.
35
Sabharwal, Nikant, Parthiban Arumugam, and Andrew Kelion. Introduction to nuclear cardiology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198759942.003.0001.
Full textAbstract:
The cardiologist of the early twenty-first century takes for granted the wide range of imaging modalities at his/her disposal, but it was not always so. At the beginning of the 1970s, invasive cardiac catheterization was the only reliable cardiac imaging technique. Subsequently, nuclear cardiology investigations led the way in the non-invasive assessment of cardiac disease. This chapter covers the history of nuclear cardiology, including important milestones in the development of nuclear medicine. It details the relation of nuclear cardiology to other imaging modalities, covering the common imaging modalities used to evaluate left ventricular function and coronary artery disease, and the challenges of multislice X-ray computed tomography.
36
Masuda, Atsuro, Masanao Naya, Keiichiro Yoshinaga, and Nagara Tamaki. Imaging of Myocardial Innervation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0023.
Full textAbstract:
Cardiac autonomic innervation imaging has been focused on assessing molecular, electrophysiologic, and pathophysiologic processes of various cardiac disorders. Iodine radiotracer (I-123)-labeled metaiodobenzylguanidine (MIBG), as a marker of adrenergic neuron function, plays an important role in risk stratification and treatment monitoring of heart failure patients. In addition, MIBG has a potential value for predicting fatal arrhythmias that may require implantable cardioverter-defibrillator treatment. Among various positron emission tomography (PET) tracers for probing autonomic neuronal function, C-11 hydroxyephedrine (HED), has been used for precise assessment of heart failure and arrhythmias, similar to MIBG. More studies are needed to confirm the clinical utility of these molecular imaging modalities for the management of patients with heart failure, coronary artery disease and arrhythmias.
37
Ferrari, Victor. The EACVI Textbook of Cardiovascular Magnetic Resonance. Edited by Massimo Lombardi, Sven Plein, Steffen Petersen, Chiara Bucciarelli-Ducci, Emanuela Valsangiacomo Buechel, and Cristina Basso. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198779735.001.0001.
Full textAbstract:
Cardiovascular magnetic resonance imaging (CMR) has become one of the great pillars of cardiac imaging. Modern CMR, as we now practise it, is the result of an enormous method and application development effort that has occurred over the past 25 years and has taken CMR from its humble beginnings of anatomical T1- and T2-weighted imaging to the extremely versatile, accurate, and robust technique it is now. The main developments over this time, building on the anatomical imaging, were the establishment of cine imaging for assessment of cardiac function, first-pass perfusion imaging for measurement of perfusion reserve, as well as myocardial blood flow (in millilitres per minute and gram), late gadolinium enhancement for imaging of scar and patchy fibrosis, and two-dimensional flow velocity imaging for assessment of valve and shunt lesions. This textbook intends to explore and evaluate all areas of this fascinating subject.
38
Magder, Sheldon. Central venous pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0132.
Full textAbstract:
Central venous pressure (CVP) is at the crucial intersection of the force returning blood to the heart and the force produced by cardiac function, which drives the blood back to the systemic circulation. The normal range of CVP is small so that before using it one must ensure proper measurement, specifically the reference level. A useful approach to hypotension is to first determine if arterial pressure is low because of a decrease in vascular resistance or a decrease in cardiac output. This is done by either measuring cardiac output or making a clinical assessment blood flow. If the cardiac output is decreased, next determine whether this is because of a cardiac pump problem or a return problem. It is at this stage that the CVP is most helpful for these options can be separated by considering the actual CVP or even better, how it changed with the change in cardiac output. A high CVP is indicative of a primary pump problem, and a low CVP and return problem. Understanding the factors that determine CVP magnitude, mechanisms that produce the components of the CVP wave form and changes in CVP with respiratory efforts can also provide useful clinical information. In many patients, CVP can be estimated on physical exam.
39
Lancellotti, Patrizio, and Bernard Cosyns, eds. The EACVI Echo Handbook. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.001.0001.
Full textAbstract:
Echocardiography has become the most requested imaging modalities. It is the first line imaging in the diagnostic work-up and monitoring of most cardiac diseases. Echocardiography is harmless and combines low-cost high technology with easy accessibility. The advent of the new modalities such as harmonic imaging, tissue Doppler imaging, speckle tracking, real time 3-dimensional imaging, ad contrast cavity enhancement have also contributed to expand the role of echocardiography. It provides rapid quantitative information about cardiac structure and function, valvular motion, vascular system and haemodynamics at bedside. This imaging technique is considered an extension of the physical examination. Proper technical skills and knowledge are required for the optimal application of echocardiography. Disease-focused and succinct, the present handbook covers the information needed to perform and interpret echocardiogramsaccurately, including how to set up the echomachine to optimize an examination and how to perform echocardiographic disease assessment, and the clinical indicators, procedures, and contraindications. Sections include assessment of the left ventricular systolic dysfunction and diastolic function, discussion on ischaemic heart disease, heart valve disease, cardiomyopathies, pericardial disease, congenital heart disease, and many other aspects of echocardiology. Many talented people have contributed to the present handbook, which represents the pocket echocardiography book flagship of the European Association of Cardiovascular Imaging. This book is intended principally as a clinical guide to the broad field of echocardiography at a glance.
40
Alonso Salinas, Gonzalo Luis, Marina Pascual Izco, Covadonga Fernández-Golfín, Luigi P. Badano, and José Luis Zamorano. Ischaemic heart disease: acute coronary syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0029.
Full textAbstract:
Transthoracic echocardiography (TTE) is a non-invasive and accessible tool that should be widely used in the evaluation of patients with suspected or known acute coronary syndrome (ACS). Its role is crucial in the management of patients with suspected ACS without electrocardiographic changes or elevation of cardiac markers, allowing the formulation of differential diagnosis between cardiac and extracardiac aetiologies. If the ACS is confirmed, initial assessment of regional and global left and right ventricle contractile function is fundamental in establishing the management strategy and may help in the risk stratification of these patients. TTE can also characterize the ischaemic myocardium in the acute phase, exposing any myocardial regional wall motion abnormalities. Furthermore, TTE is an excellent tool for the initial assessment of the aetiology of cardiogenic shock. It provides additional information regarding the haemodynamic status of the patient, including filling pressures and stroke volume, and it may rule out other causes of shock; thus, immediate TTE, or transoesophageal echocardiography if necessary, should be performed when cardiogenic shock is suspected. In the chronic phase, TTE plays an important role in characterizing myocardial infarction scar and its extent. TTE can accurately differentiate viable myocardium from scar tissue, and may guide revascularization if needed, improving patient care.
41
Lancellotti, Patrizio, and Bernard Cosyns. Pericardial Disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713623.003.0010.
Full textAbstract:
Echocardiography is the first line examination for the diagnosis of suspected pericardial disease. Assessment of pericardial disease is of critical importance for the management of patients in a number of clinical scenarios. This chapter discusses the definition of these scenarios and their associated echocardiographic findings. It shows the definition and echocardiographic findings of pericardial effusion and constrictive pericarditis. Constrictive pericarditis is characterized by impaired cardiac diastolic function due to a thickened, inflamed or adherent, frequently calcified pericardium. It is often post-surgery, radiotherapy, or as evolution of effusive pericarditis. The chapter also chapter shows the definition and echocardiographic findings of pericardial cysts and congenital absence of pericardium.
42
Ramsay, Michael A. E. Anaesthesia for transplant surgery. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0067.
Full textAbstract:
The provision of anaesthesia for organ transplantation requires a team of specialist anaesthetists who are available 24 hours a day. The cold and warm ischaemia times may have very deleterious effects on the graft. The team must have a basic understanding of the immune system and the strategies of immunosuppression therapy. The preoperative assessment of the patient requires an understanding of the cause and effects of the compromised organ that is to be replaced. The procedure in many instances will result in a reperfusion syndrome when the graft is revascularized and also an ischaemia–reperfusion injury. The understanding of these entities is essential as is the preparation and protocols to treat or ameliorate the effects of these syndromes if they occur. The preparation for many organ transplants includes invasive monitoring of haemodynamics, cardiac function, pulmonary function, and acid–base balance. Access for massive transfusion therapy and coagulation assessment is essential for many transplant procedures. The maintenance of body temperature and fluid balance may be challenging. The protection and monitoring of the function of major organs such as the brain, heart, lungs, and kidneys is essential but the homeostasis of endocrine function and electrolytes is also important. The provision of excellent anaesthesia is a key component of a successful transplant programme. A small team of highly trained professionals with extensive training and experience in transplant anaesthesia provide the best results.
43
Sicari, Rosa, and Raluca Dulgheru. Stress echocardiography: introduction and pathophysiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0011.
Full textAbstract:
Stress echocardiography is the combination of two-dimensional echocardiography with a physical, pharmacological, or electrical stress. The diagnostic end point for the detection of myocardial ischaemia is the induction of a transient worsening in left ventricular regional function during stress. Among different stress modalities of comparable diagnostic and prognostic accuracy available, semisupine exercise is the most frequently used; dobutamine-the best test for viability assessment; dipyridamole-the safest and simplest pharmacological stress test; and the most suitable for combined wall motion-coronary flow reserve assessment. Identification of viable myocardium and evaluation of severity of valvular heart disease are additional recognized applications of stress echocardiography. In spite of its dependence upon operators’ training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging modality to achieve the still elusive target of sustainable cardiac imaging in the field of non-invasive diagnosis of coronary artery disease.
44
Mc Ardle, Brian A., Jennifer M. Renaud, Robert A. deKemp, and Rob S. B. Beanlands. Role of PET in Diagnosis and Risk Assessment in Patients with Known or Suspected CAD. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0020.
Full textAbstract:
Cardiac PET enables evaluation of multiple aspects of myocardial perfusion, metabolism, cell signaling and function that are of value both for diagnosis and prognostication in patients with known or suspected CAD and its use has increased in the past three decades. PET myocardial perfusion imaging (MPI) offers several technological advantages over SPECT including; higher photon energy, higher count sensitivity, more consistent attenuation correction and the ability to measure myocardial blood flow in absolute terms. These result in faster imaging times, lower patient radiation exposure and increased diagnostic accuracy. However the availability of PET MPI remains limited, predominantly due to expense. Efforts are underway to expand the use of PET MPI beyond larger centers, with lower-cost scanners and more widely available radiotracers. In this chapter we describe the latest advances in PET camera technology and image reconstruction as well as potential image artifacts specific to PET MPI. We go on to discuss diagnostic accuracy and prognostic value of PET MPI as well as its role in clinical practice.
45
Sidebotham, David, Alan Forbes Merry, Malcolm E. Legget, and I. Gavin Wright, eds. Practical Perioperative Transoesophageal Echocardiography. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198759089.001.0001.
Full textAbstract:
Practical Perioperative Transoesophageal Echocardiography, 3rd edition, is a concise guide to the use of transoesophageal echocardiography (TOE) for patients undergoing cardiac surgical and interventional cardiological procedures. The text is aimed at anaesthetists and cardiologists, particularly those in training and those preparing for examinations. Three-dimensional imaging is integrated throughout the text. New to the third edition are chapters on mitral valve repair, aortic valve repair, TOE in the interventional catheter laboratory, and TOE assessment of pericardial disease. The first three chapters address the fundamentals of ultrasound imaging: physical principles, artefacts, image optimization, and quantitative echocardiography. Chapters 4 and 5 cover standard views, anatomical variants, and cardiac masses. Chapters 6 and 7 address left ventricular systolic and diastolic function, respectively. The subsequent eight chapters form the core of the book and deal with the cardiac valves and the thoracic aorta. Emphasis is placed on those aspects relevant to cardiac surgery; therefore, the mitral and aortic valves are afforded particular prominence. The role of three-dimensional imaging for the mitral valve is highlighted. Chapter 17 covers the emerging role of TOE for patients undergoing procedures in the catheter laboratory and covers topics such as transcatheter aortic valve replacement and edge-to-edge mitral valve repair. Chapter 18 provides an overview of the common congenital abnormalities encountered in adults. Two chapters address the important subjects of thoracic transplantation and mechanical cardiorespiratory support. Finally, Chapter 21 brings many threads from previous chapters together to describe the role of TOE in assessing haemodynamic instability.
46
Tourneau, Thierry Le, Luis Caballero, and Tsai Wei-Chuan. Right atrium. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0024.
Full textAbstract:
The right atrium (RA) is located on the upper right-hand side of the heart and has relatively thin walls. From an anatomical point of view, the RA comprises three basic parts, the appendage, the vestibule of the tricuspid valve, and the venous component (superior and inferior vena cava, and the coronary sinus) receiving the deoxygenated blood. The RA is a dynamic structure dedicated to receive blood and to assist right ventricular (RV) filling. The three components of atrial function are the reservoir function during ventricular systole, the conduit function which consists in passive blood transfer from veins to the RV in diastole, and the booster pump function in relation to atrial contraction in late diastole to complete ventricular filling. Right atrial function depends on cardiac rhythm (sinus or atrial fibrillation), pericardial integrity, RV load and function, and tricuspid function. Right atrial dimension assessment is limited in two-dimensional (2D) echocardiography. Right atrial planimetry in the apical four-chamber view is commonly used with an upper normal value of 18-20 cm2. Minor and major diameters can also be measured. Three-dimensional (3D) echocardiography could overcome the limitation of conventional echocardiography in assessing RA size. Right atrial function has been poorly explored by echocardiography both in physiological and pathological contexts. Although tricuspid inflow and tissue Doppler imaging of tricuspid annulus can be used in the exploration of RA function, 2D speckle tracking and 3D echocardiography appear promising tools to dissect RA function and to overcome the limitations of standard echocardiography.
47
Edvardsen, Thor. Cardiomyopathies, myocarditis, and the transplanted heart. Edited by Frank Flachskampf. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0094.
Full textAbstract:
Echocardiography is an excellent tool for the diagnosis and follow-up of patients with cardiomyopathies, myocarditis, and the transplanted heart. It is the preferred method for assessment of ventricular function and valvular dysfunction and is of great value in decision-making in these patients. The different types of cardiomyopathies can usually be differentiated by echocardiography. Speckle tracking echocardiography has increased our awareness on early staging of the disease and the progress of cardiomyopathies. This chapter will explain important features of the most common cardiomyopathies and how echocardiography should be utilized. Echocardiographic findings in myocarditis include non-specific features such as decreased left ventricular function, wall motion abnormalities, and texture changes. These findings will in certain circumstances often prompt the awareness of myocarditis. Echocardiography has an important diagnostic position in patients with end-stage heart failure. The chapter will explain how echocardiography can be used in the screening period of recipients and donors, and how it can be an essential diagnostic tool in the perioperative and postoperative phases of cardiac transplantation.
48
Marek, Jan, and Folkert Meijboom. Echocardiography. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0173.
Full textAbstract:
Echocardiographic techniques have revolutionized the practice of congenital cardiology over the last three decades. Due to its non-invasive nature and high temporal resolution, echocardiography enables cardiac structures to be imaged as early as the 14th gestational week and it remains the superior diagnostic modality in small children. While transoesophageal (TOE) two-dimensional echocardiography has become an integral part of almost all cardiac interventions, real-time three-dimensional TOE used in older children and adults may help surgeons to understand dynamic spatial relationships of intracardiac structures, enabling them to achieve the best result of an operation. Post bypass, two- and three-dimensional TOE studies significantly reduce the number of reoperations, unnecessary bypass procedures, and general anaesthetics. A developing technique known as tissue deformation imaging enables the assessment of global and regional myocardial systolic and diastolic function even in small hearts. Although mainly used for research, in some specific situations these techniques may modify further diagnostic management, optimize medication, or even change clinical management. Despite its known limitations, echocardiography remains a routine imaging modality for all patients with congenital heart disease, being a definitive imaging modality prior to intervention for many children and screening imaging for older children and adults with congenital heart disease.
49
Mannucci, Pier Mannuccio. Bleeding and haemostasis disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0070.
Full textAbstract:
The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.
50
Mannucci, Pier Mannuccio. Bleeding and haemostasis disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0070_update_001.
Full textAbstract:
The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.