CARDIAC ARREST DURING STRENUOUS EXERCISE IN A PATIENT WITH CONGENITAL HEART DISEASE

PEDIATRICS ◽  
1963 ◽  
Vol 32 (4) ◽  
pp. 776-777
Author(s):  
Albert A. Kattus
Keyword(s):  
Heart Disease ◽  
Medical Student ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrium ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Strenuous Exercise ◽  
Heart Catheterization ◽  
The Right

THE FOLLOWING CASE is presented in order to introduce a note of caution into consideration of the advisability of recommending unmonitored exercise for patients with heart disease. The patient is a 24 year old third year medical student who had been known to have a heart murmur since birth. He had lived a vigorously active life and had participated in high school football as well as snow skiing in more recent years. At the age of 19 he underwent a detailed cardiac work-up including right heart catheterization at another hospital. The findings at that time included a normal examination except for a grade III/VI blowing pansystolic murmur at the 4th left intercostal space. The chest x-ray disclosed a normal cardiac silhouette with normal pulmonary vascularity. The electrocardiogram disclosed right bundle branch block and left axis deviation. Cardiac catheterization disclosed systolic pressure of 30 mm. Hg. in the right ventricle and 23 in the pulmonary artery. There was O2 saturation of 78 per cent in the superior vena cava and 75 per cent in the inferior vena cava. In the high and mid right atrium O2 saturations ranged from 76 per cent to 80 per cent. Low in the atrium, just above the tricuspid valve, there was a small step-up of O2 saturation to 83 per cent and similar saturations were found in the right ventricle and pulmonary artery. The findings suggested a small shunt from left ventricle to right atrium of the type seen in the transitional form of atrio-ventricular communis. During the two weeks prior to the present event the patient and his roommate who was also a third year medical student, had undertaken to improve their physical conditioning by performing the Canadian Air Force series of calisthenic exercises.

scholarly journals P686 Right atrial, right ventricular and pulmonary cement embolism: a rare complication of percutaneous vertebroplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Akhunova ◽  
R Khayrullin ◽  
N Stekolshchikova ◽  
M Samigullin ◽  
V Padiryakov
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrium ◽  
Percutaneous Vertebroplasty ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Stable Condition ◽  
Right Atrial ◽  
Cement Embolism ◽  
The Right

Abstract A 68-year-old man was admitted to the hospital with complaints of pain in the lumbar spine. He had L5 disc herniation, Spinal stenosis of the L5 root canal - S1 on the right in the past medical history. Percutaneous vertebroplasty at the level of L3 and Th8 vertebral bodies was performed six months ago due to painful vertebral hemangioma. The man is suffering from arterial hypertension, receives antihypertensive therapy. During routine transthoracic echocardiography, a hyperechoic structure with a size of 9.5 x 0.9 cm was found in the right atrium and right ventricle. Chest computed tomography with contrast enhancement revealed signs of bone cement in the right atrium and right ventricle, in the right upper lobe artery, in the branches of the upper lobe artery, in the paravertebral venous plexuses. Considering the duration of the disease, the stable condition, the absence of clinical manifestations and disorders of intracardiac hemodynamics, it was decided to refrain from surgical treatment. Antiplatelet therapy and dynamic observation were recommended. Conclusion Percutaneous vertebroplasty is a modern minimally invasive surgical procedure for the treatment of degenerative-dystrophic diseases of the spine. However, the cement can penetrate into the paravertebral veins and migrate to the right chambers of the heart and the pulmonary artery. This clinical case demonstrates asymptomatic cement embolism of the right chambers of the heart and pulmonary artery after percutaneous vertebroplasty, detected incidentally during routine echocardiography. Abstract P686 Figure.

scholarly journals The Potential for Arrhythmia during Central Venous Catheter Insertion- to where does the guidewire migrate?

2021 ◽  
Author(s):  
Daphna Reichmann ◽  
Re'em Sadeh ◽  
Ori Galante ◽  
Yaniv Almog ◽  
Victor Novack ◽  
...  
Keyword(s):  
Intensive Care ◽  
Right Ventricle ◽  
Real Time ◽  
Right Atrium ◽  
Medical Center ◽  
Insertion Site ◽  
Vena Cava ◽  
Venous Catheter ◽  
Seldinger Technique ◽  
The Right

Abstract BackgroundCentral Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study1 observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown.ObjectiveIn this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration.DesignThis is a retrospective study of the prospectively and systematically collected data on CVC insertion under real time trans thoracic ultrasound.SettingThe medical Intensive Care Unit in Soroka Medical Center, among patients that have received CVC during the study years 2014–2020.Main outcome measures:The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well.ResultsOne hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC.ConclusionAbout a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.

Abstract 17391: Use of Contrast-Enhanced Echocardiography for Evaluating Pulmonary Artery Pressure

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Lauren Lee ◽  
Menhel Kinno ◽  
Robert Schultz ◽  
Bonnie Kane ◽  
Gregory Cascino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Correlation Coefficient ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Mean Difference ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Number Of Patients ◽  
Contrast Enhanced Echocardiography

Introduction: Pulmonary artery systolic pressure (PASP) can be derived from maximum tricuspid regurgitation velocity (TRV) obtained from echo using a modified Bernoulli equation. However, PASP from an unenhanced echo only modestly correlates to invasively measured PASP. This study evaluates whether the accuracy of PASP from an echo can be improved by using contrast agents. Methods: Ninety consecutive patients undergoing clinically indicated right heart catheterization were recruited to perform simultaneous echo. TRV was measured in an echo unenhanced (UE), with agitated saline (AgS), and with echo contrast (EC) (routinely injected centrally, and peripherally in 21 patients). PASP was then calculated using the formula PASP=4(TRV 2 )+RAP, where RAP was estimated on echo by inferior vena cava collapsibility. Data was analyzed using paired t-test and linear regression (JMP Pro13). Results: Average age was 54 (±13) years with 58% males, 73% heart transplant recipients, and 38% with pulmonary hypertension. UE PASP was significantly lower than RHC PASP with a mean difference of -6.09 mm Hg (p<0.001) and correlation coefficient of 0.57 (p<0.001). In comparison, AgS PASP had a smaller mean difference of 0.41 mm Hg (p=0.641) and a higher correlation coefficient of 0.73 (p<0.001). EC-enhanced echo also yielded a smaller mean difference (central: -1.82 mm Hg with p=0.049; peripheral: -3.21 mm Hg with p=0.095) and an even higher correlation coefficient (central: r=0.74; peripheral: r=0.81). Number of patients with accurate PASP from echo (defined as PASP difference <10 mm Hg between echo and RHC) was improved from 65% (UE) to 77% (AgS), 82% (EC-central), and 71% (EC-peripheral). Conclusion: Echo with agitated saline yielded the closest mean PASP compared to invasivePASP, whereas echo with peripherally administered EC yielded the highest correlation coefficient. Echo enhancement with either Ags or EC can improve the accuracy of the estimated PASP compared to UE studies.

Successful Retrieval of a Knotted Pulmonary Artery Catheter Trapped in the Right Ventricle Using a Dormier Basket

1997 ◽  
Vol 42 (6) ◽  
pp. 184-184 ◽  
Author(s):  
S. Hood ◽  
H.M. McAlpine ◽  
J. A. H. Davidson
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Catheter ◽  
Tricuspid Valve ◽  
Right Atrium ◽  
Femoral Vein ◽  
Tricuspid Valve Annulus ◽  
Valve Annulus ◽  
Successful Retrieval ◽  
The Right

We report the case of a 71 year old patient in whom a pulmonary artery catheter (Swan Ganz) formed a knot which was fixed within the right ventricle in the region of the tricuspid valve annulus. The catheter was successfully dislodged to the right atrium, subsequently snared by a dormier basket advanced from the right femoral vein and retrieved by localised cut down of the femoral vein.

Limitations of thermodilution cardiac output measurements in the rat

1984 ◽  
Vol 246 (6) ◽  
pp. H754-H760 ◽  
Author(s):  
B. E. Hayes ◽  
J. A. Will ◽  
W. C. Zarnstorff ◽  
G. E. Bisgard
Keyword(s):  
Cardiac Output ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Heat Loss ◽  
Thoracic Aorta ◽  
Vascular System ◽  
Vena Cava ◽  
Right Atrial ◽  
Thermodilution Cardiac Output ◽  
The Right

Heat loss from the vascular system could introduce an error in thermodilution cardiac output determinations. Cardiac output measured in the rat via the thermodilution technique following right atrial injection yielded different values (P less than 0.001), depending whether sampling was from the pulmonary artery (460 +/- 31 ml X min-1 X kg-1), right ventricle (311 +/- 19), or thoracic aorta (245 +/- 15). Recirculation errors could not account for the differences. Heat loss from the vascular system was measured from extravascular thermistors within both the thorax and the abdomen. These dilutions were 22-57% in peak height of aortic curves recorded at approximately the same location. Differences in calculated cardiac output between sampling sites could be attributed to rapid heat conduction directly from the right atrium and inferior vena cava to the thoracic aorta with progressive loss of indicator from both the right ventricle and pulmonary artery.

scholarly journals 60 Primary mediastinal large B-cell lymphoma: how to manage it during pregnancy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rita Cristina Myriam Intravaia ◽  
Benedetta De Chiara ◽  
Francesco Musca ◽  
Francesca Casadei ◽  
Giuseppina Quattrocchi ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
B Cell ◽  
Cell Lymphoma ◽  
Vena Cava ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
The Right ◽  
Large B Cell

Abstract A 33 years old patient came to our attention, pregnant in her 26th week. She had dyspnoea, cough and weight loss (up to 45 kg of weight) in the previous two weeks. During urgent gynecological check-up she was found in poor general conditions, tachypnoic (respiratory rate &gt;30 acts/minutes) with pale skin and bilateral jugular turgor. There was nothing relevant in her past medical history except for a thrombocytopenia appeared 2 months before. She consulted a haematologist who recommended to look for JAK2 mutation that was excluded. Echocardiography revealed a voluminous hypoechoic mass extrinsically imprinting the roof and the anterior wall of the right atrium that also involved inferior vena cava as a sleeve; a flow acceleration with an average gradient of 6 mmHg was documented at the level of right lower pulmonary vein and a possible infiltration of atrial wall was seen. Left ventricle was normal in size and kinesis; right ventricle also showed preserved contractility of the free wall with reduction in the distal outflow portion due to diffuse soft thickening that surrounded this portion and that extended cranially towards the trunk of pulmonary artery and ascending aorta. There also was a layer of circumferential pericardial effusion, apparently organized, with irregular profile of visceral pericardial sheet adjacent to diaphragmatic wall of right ventricle. On chest contrast computed tomography (CT) a voluminous mediastinal solid mass (13 × 16 × 18 cm) was confirmed with inhomogeneous enhancement for central necrotic components determining complete atelectasis of middle and upper right lung lobes and compression of superior vena cava, of some branches of pulmonary artery and ipsilateral pulmonary veins too; supra-aortic trunks and aorta were surrounded by the mass but open; the mass enveloped the right posterolateral area of the heart, displacing it to the left and compressing right atrium with apparent pericardial infiltration. Moreover there were approximately 16 mm of pericardial effusion and multiple mediastinal adenopathies. A chest and abdomen magnetic resonance confirmed the presence of the known voluminous heteroplastic formation occupying almost all right hemithorax, indissociable from the pericardium, with compression of right heart chambers and cavae veins. A thoracic biopsy of mediastinal mass was urgently performed under ultrasound guidance and followed by systemic steroid therapy. Histological examination showed off the diagnosis of primary large B cell lymphoma of the mediastinum (PMBCL, according to WHO classification 2016). A steroid therapy and chemotherapy cycles were started (Cyclophosphamide-Hydroxydaunorubicin-Oncovin-Prednisone—CHOP scheme). On the second day after chemotherapy, we saw a sudden worsening of clinical conditions: the patient had severe respiratory distress and signs of low cardiac output such as hypotension, elevated heart rate, increased blood lactates, low venous oxygen saturation (SVO2 45%), and elevation N-terminal prohormone of brain natriuretic peptide (NT-proBNP); she was therefore admitted to intensive care unit (ICU) where a gradual optimization of haemodynamic parameters. Then she underwent a second cycle of chemotherapy: dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R) and was then successfully discharged. In such cases a careful evaluation and balancing of both haematological and gynecological–obstetric aspects is needed and it requires a multidisciplinary team approach in order to identify the best diagnostic and therapeutic pathway and, most of all, the best timing for delivery depending on gestational age.

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