Relationship of Weight, Venous Pressure and Radiosodium (Na22) Excretion in Chronic Congestive Heart Failure.

The effects of splenectomy in 18 children with thalassemia (Mediterranean anemia) are evaluated. The subjects varied in age at the time of splenectomy from 1½ to 18½ years and have been followed for 5 months to 28 years since operation. One death occurred at the time of splenectomy, during induction of anesthesia. All patients, even those who later died, benefited initially from splenectomy. They required fewer transfusions and maintained higher hemoglobin levels subsequently for varying periods of time. Of the 18 patients, 7 have died; all but 2 of these developed chronic congestive heart failure late in the course of the disease. Pericarditis was suspected in life and proven at necropsy in three subjects. No definite proof of the relationship of splenectomy to the incidence of penicarditis has been shown. In this small series of patients no significantly increased incidence of severe infection was observed postoperatively.

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Internal jugular vein ultrasound in patients with chronic congestive heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0858 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

P Thacker ◽

D Amaratunga ◽

K Shah ◽

R Watson ◽

A Singh ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Internal Jugular Vein ◽

Predictive Value ◽

Jugular Vein ◽

Venous Pressure ◽

Right Atrial ◽

Chronic Congestive Heart Failure ◽

Obese Patients ◽

Bedside Test

Abstract Background Bedside assessment of intravascular volume in patients with chronic congestive heart failure (CHF) is often difficult. Under- and over-diuresis are common causes of morbidity and readmissions in these patients. Purpose We hypothesized that ultrasound assessment of the internal jugular vein would be easier and more reproducible than clinically assessing jugular venous pressure (JVP). Our goal was to create a bedside test that would be simpler to learn than inferior vena cava (IVC) assessment and easier to perform in obese patients. Methods Adults with HF (n=53, 52% men, mean age 65 years, mean BMI 29.6 kg/m2, mean LVEF 44%) scheduled for right heart catheterization (RHC) had an ultrasound of their right internal jugular (RIJ) vein performed immediately prior. Cross-sectional area of RIJ was measured during normal breathing with patients at 90 and 45 degrees recumbency and was indexed by height (RIJI). JVP was also assessed clinically. Results were compared to right atrial pressure (RAP) measured by RHC. Operators were blinded to RHC results and vice versa. Results JVP was correctly assessed clinically in only 43%. RIJI at 90 and 45 degrees were significantly larger in patients with elevated RAP compared to euvolemic patients (Table). At 90 degrees, RIJI of >15 predicted a RAP of >10 mmHg with 68% sensitivity and 72% specificity. At 45 degrees, RIJI of >10 predicted a RAP of >10 mmHg with 94% sensitivity and a negative predictive value of 80% (Table). Simply being able to see the RIJ at 90 degrees (n=34) had an 82.4% positive predictive value for elevated RAP. IVC data could not be obtained on 23% of patients due to body habitus or inability to lay flat. Conclusion Ultrasonographic RIJI is more accurate than clinical assessment in patients with CHF and can be accurately performed even in obese patients. It requires only a basic linear ultrasound probe and was easily performed by clinicians at various stages of training with reproducible results. With the increased availability of bedside ultrasound in clinical practice, it is a feasible method of evaluating chronic CHF patients. FUNDunding Acknowledgement Type of funding sources: None.

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