ischemicPreconditioning

ischemicPreconditioning - Ischemic Preconditioning (IPC)...

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Unformatted text preview: Ischemic Preconditioning (IPC) Darko J. Vodopich MD Resident @ MHMC-CWRU Department of Anesthesiology Charles E. Smith MD, FRCPC Director of Cardiothoracic Anesthesia @ MHMC-CWRU Department of Anesthesiology Presented Apr 2003 Objectives Introduction to the topic of IP Risk factors for CAD Cardiac anatomy and ischemia Ischemic preconditioning (IPC) and anesthetic agents Summary Epidemiology CAD is the leading cause of death Direct cost of cardiovascular care > 260 billion ~ 1,000,000 deaths form CAD per year Every 29 seconds one American dies of AMI Cost of CABG > 12 billion (2% of all heath care costs) In US (1996) ~ 300,000 CABG; 400,000 PTCA Waiting time for CABG (UK, Sweden, Canada) > 9 mo. What is cardiac ischemia? Cardiac ischemia is a situation in which the blood flow within a coronary artery is limited to the point where the oxygen demands of the heart muscle cannot be met ( hypoxia ). * Impaired oxygen supply/demand ratio. Coronary artery distribution LV - Anterior - LAD Anterolateral - OM branch CxA Inferior - PDA branch of RCA, CxA Apex - Distal LAD Posterior / Posterolateral - CxA Septum - septal branches of LAD RV - RCA, and branches of LAD and CxA Sinus node - proximal RCA (55%), CxA (45%) A-V node - distal RCA (90%), CxA (10%) Chest pain if patient is awake ECG changes Hypotension Tachycardia Elevated pulmonary artery occlusion pressure (PAOP) Large v-waves on PAOP tracing Fall in cardiac output/index Detection with TTE/TEE Methods to Detect Ischemia Intraoperative ECG monitoring Computerized ST segment monitoring ST depression > 1 mm 60 msec after J-point Slope of the depression horizontal downsloping J-point Isoelectric point LAD CxA RCA V 1-V 4 I, aVL, V 5-V 6 II, aVF Anatomic location of ischemia on ECG Sensitivity of ECG lead combinations II / V 5 - 80 % II / V 4 - 82 % V 4 / V 5 - 90 % Two lead system London, Anesthesiology, 1998; Vol 69, 232 Sensitivity of ECG lead combinations V 3 /V 4 /V 5 - 94 % II/V 4 /V 5 - 96 % Three lead system London, Anesthesiology, 1998; Vol 69, 232 Five standard ASA monitors: POX BP EtCO 2 ECG Temperature Intraarterial catheter Pulmonary artery catheter (PAC) CO/CI (not truly continuous) CVP PCWP LVSWI SVR,PVR TTE/TEE (currently not routinely available @ MHMC) LidCO/Pulse CO* Continuous SV, MAP, SVR, CO, SPV** * integration of arterial pressure wave form ** systolic peak velocity Intraoperative Monitoring Treatment of ischemia...
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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ischemicPreconditioning - Ischemic Preconditioning (IPC)...

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