Acute CHF ICU Essay

Submitted By Jessica-Ruiz
Words: 7316
Pages: 30
Open Document
CHEST

Postgraduate Education Corner
CONTEMPORARY REVIEWS IN CRITICAL CARE MEDICINE

Acute Left Ventricular Dysfunction in the Critically Ill
Anand Chockalingam, MD; Ankit Mehra, MD; Smrita Dorairajan, MD; and Kevin C. Dellsperger, MD, PhD

Acute left ventricular (LV) dysfunction is common in the critical care setting and more frequently affects the elderly and patients with comorbidities. Because of increased mortality and the potential for significant improvement with early revascularization, the practitioner must first consider acute coronary syndrome. However, variants of stress (takotsubo) cardiomyopathy may be more prevalent in ICU settings than previously recognized. Early diagnosis is important to direct treatment of complications of stress cardiomyopathy, such as dynamic LV outflow tract obstruction, heart failure, and arrhythmias. Global LV dysfunction occurs in the critically ill because of the cardio-depressant effect of inflammatory mediators and endotoxins in septic shock as well as direct catecholamine toxicity. Tachycardia, hypertension, and severe metabolic abnormalities can independently cause global LV dysfunction, which typically improves with addressing the precipitating factor. Routine troponin testing may help early detection of cardiac injury and biomarkers could have prognostic value independent of prior cardiac disease. Echocardiography is ideally suited to quantify LV dysfunction and determine its most likely cause. LV dysfunction suggests a worse prognosis, but with appropriate therapy outcomes can be optimized. CHEST 2010; 138(1):198–207
Abbreviations: ACS 5 acute cardiac syndrome; BNP 5 brain natriuretic peptide; LV 5 left ventricular; NT-proBNP 5 N-terminalpro-B-type natriuretic peptide; RWMA 5 regional wall motion abnormalities

left ventricular (LV) dysfunction occurs
Acute
in about one-third of critically ill hospitalized

patients.1-4 The increasing incidence of LV dysfunction in ICUs is likely related to both changing patient characteristics (advancing age, increased comorbidities) and practice patterns (widespread troponin, creatine kinase-MB, and brain natriuretic peptide [BNP] testing, as well as more frequent performance of bedside echocardiography).3,5-8 A determination as
Manuscript received August 22, 2009; revision accepted December
7, 2009.
Affiliations: From the Division of Cardiovascular Medicine,
Department of Internal Medicine (Drs Chockalingam, Mehra,
Dorairajan, and Dellsperger), University of Missouri School of
Medicine; and the Cardiology Section (Dr Chockalingam), Harry
S. Truman VA Medical Center, Columbia, MO.
FundingրSupport: This study was funded by Veterans Administration Research award [VISN 15] to Dr Chockalingam.
Correspondence to: Anand Chockalingam, MD, Division of
Cardiology, University of Missouri–Columbia, 5 Hospital Dr,
CE306, Columbia, MO 65212; e-mail: chockalingama@health. missouri.edu © 2010 American College of Chest Physicians. Reproduction of this article is prohibited without written permission from the
American College of Chest Physicians (www.chestpubs.orgր siteրmiscրreprints.xhtml). DOI: 10.1378/chest.09-1996
198

DownloadedFrom:htp:/journap
l.ublicationsc.hestneto.rgb
/yaUofICom-RockfordUseron07/21/2012

to whether the LV dysfunction is the cause, effect, or a coincidental finding has to be made and revisited periodically. Acute medical or surgical plans, ongoing management targets, outcome expectations, and prognosis must be reconciled. Recognizing that all the individual causes and complexities cannot be captured here, we will summarize the most important causes of LV dysfunction in the critically ill (Table 1) and present a unified management approach from the cardiac standpoint.
Diagnosis of LV Dysfunction
Angina, dyspnea, pulmonary crackles, murmurs, tachyarrhythmias, biomarker elevations, or ischemic
ECG changes suggest cardiac pathology in hospitalized patients. Because of variability in patient characteristics and study design, predictive
Show More

Related Documents: Acute CHF ICU Essay

Central Pontine Hyponatremia Case Paper

He was transferred to the ICU with a diagnosis of pneumonia. His chest x-ray revealed the finding of bilateral lower lung infiltrates, while a computed tomography angiography (CTA) showed no evidence of pulmonary embolism. The etiology of his pneumonia was mostly likely due to mucous plug that could not be cleared by the patient on his own. During his stay in the ICU, the patient continued to be on mechanical ventilation and had been treated with…

Words 1212 - Pages 5

Myocardial Infarction and Pullman Regional Hospital Essay

Cardiac Level I Activation & Acute Coronary Syndrome Protocols OBJECTIVE: To provide a systematic approach toward providing an immediate coordinated response to the management of the Cardiac patient and to provide a definite standard of care; preventing any further cardiac injury in the hospital. (ACLS Certified RNs may initiate ACLS medication protocol.) Definitions: Cardiac Level I (STEMI or ST elevation MI) ACS (Acute Coronary Syndrome) Process…

Words 2348 - Pages 10

Mechanical Ventilation and Positive Airway Pressure Essay

Respiratory Trauma (Chest Trauma) Incidence Chest trauma is often sudden and dramatic Major causes of trauma: Motor vehicle accidents – worse if unrestrained Deceleration injury from MVAs – ruptured vessels Penetrating trauma – gunshot, stabbing, impaled Blunt trauma – dropping free-weights on chest Medical procedure mistake – pneumo p CVP Fall from height Explosion Accounts for 25% of all trauma deaths 40-50% of deaths occur on scene 50-60% of deaths occur after reaching a hospital…

Words 1703 - Pages 7

International Classification of Diseases Coding Ii Essay

gastrointestinal bleeding. Stools were heme positive in the ED. He was transfused with packed red blood cells from the blood bank with good results. Patient indicates he had a colonoscopy with polypectomy hours before admission. Final diagnoses: (1) Acute posthemorrhagic blood loss anemia complication of polypectomy, (2) peripheral vein transfusion of packed red blood cells. Assign the appropriate codes. Codes:…

Words 10057 - Pages 41

Importance Of Palliative Care

Palliative care→ aims to prevent and relieve suffering and support the best possible QOL for pt and their family; regardless of stage of disease..just must be symptomatic ­can be given with curative care ­introducing palliative care early ^ QOL ­interdisciplinary approach CLOSED AWARENESS – PT. doesn’t know SUSPECTED AWARENESS – they know something is wrong but no one tells them MUTUAL PRETENSE AWARENESS – both the PT. & family knows but no one is talking about it OPEN AWARENESS – everyone knows & is talking about it…

Words 3686 - Pages 15

Open Heart Surgery Essay

Open Heart Surgery The story of a broken heart From day 1 to discharge THE TERMINOLOGY LIMA/ RIMA- left or right internal mammary artery EVH- Endovascular vein harvest OHS- open heart surgery POD- Post op day LAAL- Left atrial appendage Ligation PVI- Pulmonary Vein Isolation CABG- Coronary Artery Bypass Graft COMMON PRE-OP ORDERS **SEE BINDER IN UNIT FOR PAPER ORDERS OR FOLLOW THIS LINK TO VIEW ALL http:// phsintranet.pinnaclehealth.org/collectionCat egorized2.aspx?id=20737418239 PRE-OP…

Words 3670 - Pages 15