MICRO
CARDIOVASCULAR SYSTEMppt.pptx

Electrical alternans is sometimes associated with

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ELECTRICAL ALTERNANS IS SOMETIMES ASSOCIATED WITH PERICARDIAL EFFUSION. THE HEART CAN SOMETIMES BE SEEN "SWINGING" BACK AND FORTH WITHIN THE PERICARDIAL SPACE. THIS SWINGING BACK AND FORTH MECHANISM IS RESPONSIBLE FOR ELECTRICAL ALTERANS. 218
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219
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220 A
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221 C
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222
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THE CLASSICAL FINDINGS OF:- - FALLING ARTERIAL PRESSURE - INCREASED VENOUS PRESSURE AND - FAINT HEART SOUNDS 223
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INDICATE SEVERE OR ACUTE TAMPONADE AS SEEN AFTER CARDIAC TRAUMA OR RUPTURE. IN CASE OF TAMPONADE, PERICARDIOCENTESIS (PERICARDIAL TAP) SHOULD BE CARRIED OUT AT ONCE, AS THE RELEASE OF INTRAPERICARDIAL PRESSURE IS LIFE SAVING. BLOOD TRANSFUSION BEFORE CORRECTING PERICARDIAL TAMPONADE HAS NO VALUE AS THE BLOOD WILL NOT BE ABLE TO ENTER THE VENTRICLES . (PERICARDIAL TAMPONADE IS A FILLING DEFECT). THE AIR ENTRY IN BOTH THE LUNGS IS ADEQUATE AND OTHER SIGNS OF HAEMOTHORAX ARE ALSO ABSENT SO THERE IS NO USE OF INTERCOSTAL TUBE DRAINAGE. FIXATION OF FEMUR IS NOT AN IMMEDIATE PRIORITY . OTHER LIFE SAVING PROCEDURES MUST BE DONE BEFORE IT. 224
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225
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226 A
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CONSTRICTIVE PERICARDITIS: CONSTRIVE PERICARDITIS IS A CONDITION IN WHICH THE PERICARDIUM BECOMES THICKENED SCARRED AND OFTEN CALCIFIED. THIS LEADS TO INCREASE IN PERICARDIAL PRESSURE WHICH LIMITS DIASTOLIC FILLING OF THE VENTRICLES. THOUGH THIS CONDITION IS QUITE SIMILAR TO CARDIAC TAMPONADE, THERE ARE CERTAIN, CHARACTERISTIC DIFFERENCES. 227
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THE PERICARDIAL PRESSURE IS DECREASED IN CARDIAC TAMPONADE ON & ONCE DURING THE BEGINNING OF VENTRICULAR SYSTOLE . THUS THE SYSTOLIC PHASE OF VENOUS FILLING IS PRESERVED AND THE X DESCENT IS MAINTAINED. IN CONSTRICTIVE PERICARDITIS THE PERICARDIAL PRESSURE ARE DECREASED TWICE DURING THE CARDIAC CYCLE. 228
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I) ONCE DURING THE BEGINNING OF VENTRICULAR SYSTOLE , SIMILAR TO CARDIAC TAMPONADE. "THUS THE SYSTOLIC PHASE OF VENOUS RETURN AND THE X DESCENT IS MAINTAINED“. II) IN CONSTRICTIVE PERICARDITIS, THE PERICARDIAL PRESSURES ALSO DECREASES DURING THE INITIAL 1/3RD OF THE DIASTOLE. "AT THIS TIME THE RIGID THICKENED PERICARDIUM ALLOWS THE HEART TO REMAIN RELAXED". 229
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IN CONSTRICTIVE PERICARDITIS THE PERICARDIUM IS RIGID AND THICKENED AND IT ALLOWS A LIMITED EXPANSION OF THE HEART. ONCE THE HEART REACHES THIS POINT, THERE IS NO FURTHER EXPANSION DUE TO THE PRESSURE APPLIED BY THE RIGID PERICARDIUM. THUS THE EARLY DIASTOLIC FILLING CONTINUES UNIMPEDED. "THIS IS THE REASON FOR PROMINENT Y DESCENT SEEN IN CONSTRICTIVE PERICARDITIS" 230
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231
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THUS IN A CASE OF CONSTRICTIVE PERICARDITIS THE VENTRICULAR DIASTOLE CAN BE DIVIDED INTO THREE PHASES – I) EARLY DIP IN DIASTOLIC PRESSURE DUE TO ISOVOLUMETRIC RELAXATION OF THE VENTRICLE . (THIS DECREASE OCCURS IN NORMAL INDIVIDUALS TOO, BUT IT IS MORE PROMINENT IN CONSTRICTIVE PERICARDITIS).
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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