Continuous Positive Airways Pressure (CPAP) In Left Ventricular Dysfunction Acute Pulmonary Oedema

CPAP General Facts:

• Continuous positive airways pressure (CPAP).
• May be useful in the management of acute pulmonary oedema related to left ventricular failure.
• CPAP has both cardiac and pulmonary benefits.

CPAP Cardiac Benefits:

• Reduction in left ventricular (LV) preload.
• Reduction in mitral regurgitation.
• Improved ejection fraction.

CPAP Pulmonary Benefits:

• Increases functional residual capacity.
• Leading to an effective increase in alveolar surface area.
• Leading to improved oxygenation.
• Leading to reduced work of breathing.

CPAP Cautions:

• Hyperinflated chest
• Restrictive chest wall disease

Image: Acute Pulmonary Oedema by Jmh649 [CC-BY-SA-3.0)

Tags: Cardiac - CPAP - LV Dysfunction - Oxygenation - Pulmonary - Pulmonary Oedema
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Transient Constrictive Pericarditis

Transient Constrictive Pericarditis Clinical Features:

• Transient form of constrictive pericarditis lasting around 3 months.
• Approximately 2/rds of cases will have either a pericardial effusion or pericardial thinkening on echocardiography.
  

Epidemiology:

• Occurs in 10-20% of cases during the resolution of pericardial inflammation.

Investigation:

• Serial echocardiography.
• Inflammatory markers - ESR, CRP, WCC.
• ECG.
  

Pathophysiology & Aetiology:

• Occurring during or following acute pericarditis.
• May occur spontaneously.
• Commonly seen after empiric use of anti-inflammatory therapies.

Prognosis:

• Research evidence suggests that if constrictive findings are going to resolve, they will generally do so at an average time of three months.

Treatment & Management:

• Ensure there is absence of features suggesting chronicity - i.e. cachexia, atrial fibrillation (AF), liver dysfunction, or pericardial calcification).
• Assess for possible haemodynamic instability.
• If the patient is haemodynamically stable with no evidence of chronicity then a trial period (2-3 months) of conservative management with empiric anti-inflammatory therapy, or watchful waiting is recommended.
• Use NSAIDs for chest pain.
• Appropriate antibiotics for infection.
• Treat fluid retention with diuretics.
• Patients with worsening symptoms or clinical deterioration which is not responsive to medical treatment should be considered for early surgery (pericardiectomy).

References:
Haley, J. H. et al. Transient constrictive pericarditis: causes and natural history. J. Am. Coll. Cardiol. 43, 271-275 (2004).

Image: from Mystery To Medicine
Tags: Constrictive Pericarditis - Echocardiography - NSAID - Pericardiectomy - Pericarditis
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Open Heart Surgery Graphic

Open Heart Surgery Graphic:

Image: from TinyPic.com
Tags: Graphic - Heart - Open Heart Surgery - Pericardium - Retractor
Posted by Medicalchemy
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