Cardiology clinics
-
Principles of cardiovascular physiology tell us that during cardiac arrest and CPR, forward flow of blood can be generated by external compression or decompression of either the chest or the abdomen. Standard CPR utilizes only one of these modes--chest compression--and generates roughly 1 L/min forward flow in an adult human, which is 20% of normal cardiac output. IAC-CPR uses two of these modes--chest compression and abdominal compression--and generates roughly twice the forward flow, or 2 L/min in an adult human. ⋯ Theoretically, full four-phase CPR, including active compression and decompression of both chest and abdomen, is capable of generating 4 L/min forward flow or greater, which is 80% of normal, and there is a reasonable prospect of achieving 100% of normal flow under conditions in which all four phases are optimized. Standard CPR is clearly not the ultimate form of external CPR. There is real, credible evidence that substantial improvements in resuscitation methods and results will be possible in the next decade.
-
Postresuscitation myocardial dysfunction is common after prolonged cardiac arrest and can have life-threatening consequences. Experimental data suggest that systolic and diastolic left ventricular function can be adversely effected following successful resuscitation. ⋯ Potential treatments include dobutamine, KATP channel activators, and 21-aminosteroids. In the author's efforts to improve long-term survival from cardiac arrest, more attention is needed to the postresuscitation period.
-
CPR represents the primary intervention used during cardiac arrest for maintaining perfusion and extending the potential resuscitation period. Effective CPR, however, requires careful attention to detail by the resuscitation team, including (1) effective control of the airway using manual maneuvers or airway adjuncts, (2) delivery of effective ventilation that assures adequate oxygenation, while reducing the chance for gastric inflation, and (3) chest compressions delivered at the appropriate depth and rate using a duty cycle of 50% compression and 50% release. During the resuscitation effort team leaders should closely monitor the performance of CPR, rotate rescuers frequently to avoid fatigue, and provide continuous feedback based upon direct (transmitted pulse, chest rise) and indirect (end-tidal CO2) measures of effectiveness. A careful and measured approach to CPR performance, combined with a strong chain of survival, provides victims of cardiac arrest the best chance for survival.
-
Obesity is a chronic metabolic disorder associated with CVD and increased morbidity and mortality. When the BMI is > or = 30 kg/m2, mortality rates from all causes, and especially CVD, are increased by 50% to 100%. There is strong evidence that weight loss in overweight and obese individuals improves risk factors for diabetes and CVD. ⋯ However, the use of physical activity as a method to lose weight seems inversely related to patients' age and BMI and directly related to the level of education. Thus, public health interventions helping these groups to become physically active remain a challenge and further emphasize the importance of the one-on-one interaction between the clinician/health care professional with the obese individual "at risk" of CVD. This notion is critical, as it has been shown that less than half of obese adults have reported being advised to lose weight under the guidance of health care professionals.
-
Aortic dissection is a life-threatening cardiovascular emergency requiring immediate diagnosis and treatment. It is mainly associated with hypertension and the Marfan syndrome. ⋯ Echocardiographic hallmarks of aortic dissection ar the presence of a dissection membrane separating a true from a false lumen, rupture sites in the membrane with to-and-from flow, aortic regurgitation, and pericardial effusion. Dissection of the ascending aorta, which has an extremely high mortality and necessitates emergency surgery, is diagnosed quickly and accurately by TEE.