Notes for applied Cardiovascular Physiology II

Notes for applied Cardiovascular Physiology II - Notes for...

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Dr Paul Diprose March 2007 Notes for applied Cardiovascular Physiology II In this lecture we will discuss the causes and identification of myocardial ischaemia. We will look at some of the cardiac investigations commonly used and the physiology and practice behind some devices employed for cardiac disease. Finally the pathophysiology and management of some less common cardiac conditions will be discussed. 1. Cardiac ischaemia a) Causes of cardiac ischaemia Abnormal anatomy o Congenital or acquired valvular disease o Coronary artery disease Abnormal physiology o Reduced arterial oxygen content Anaemia Hypoxia o Haemodynamics Inappropriate tachycardia Inadequate coronary perfusion pressure b) Methods for the detection of cardiac ischaemia ECG changes ST segment analysis Systolic performance o Systolic blood pressure o CO monitoring Diastolic performance o PCWP (and RAP) Functional changes o Echocardiography 2. Cardiac Investigation a) ECG The ECG will provide information about the state of the myocardium and its conduction system, it can also provide clues to metabolic derangements (such as potassium or calcium imbalance), drug effects (such as digoxin), and even extra-cardiac pathology (such as pulmonary embolus). Continuous ambulatory ECG is used to identify paroxysmal arrhythmias and may also identify low heart rate variability (a risk factor for sudden cardiac death). Even minor resting ECG changes (such as 1 st or 2 nd degree heart block) are associated with a higher risk of experiencing major cardiovascular morbidity and mortality. [JAMA 2007;297] Continuous ECG monitoring can be used (often with ST analysis software packages) to identify peri-operative ischaemia. Inferior ischaemia is generally represented by ST changes in leads II, III and aVF and antero-lateral ischaemia by changes in I, aVL, V5 and V6.
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Dr Paul Diprose March 2007 b) Chest X-ray ‘The basics of looking at a chest x ray’ (Text from www.studentbmj.com/back_issues/1000/education/358.html) First look at the mediastinal contours - run your eye down the left side of the patient and then up the right. The trachea should be central. The aortic arch is the first structure on the left, followed by the left pulmonary artery; notice how you can trace the pulmonary artery branches fanning out through the lung. Two thirds of the heart lies on the left side of the chest, with one third on the right. The heart should take up no more than half of the thoracic cavity. The left border of the heart is made up by the left atrium and left ventricle. The right border is made up by the right atrium alone. Above the right heart border lies the edge of the superior vena cava. The pulmonary arteries and main bronchi arise at the left and right hila. Enlarged
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This note was uploaded on 09/19/2011 for the course BIOL 126-001B taught by Professor Hulbert during the Spring '10 term at Camosun College.

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Notes for applied Cardiovascular Physiology II - Notes for...

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