Simulation training Curriculum

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Slide 1 : Simulation training Curriculum Pericardial Disease
Slide 2 : Constrictive Pericarditis Etiology Idiopathic Irradiation Post-surgical Infectious Neoplastic Connective tissue disorder Uremia Trauma Sarcoid Methysergide therapy Epicardial implantable defibrillator patches CATHSAP6: Coronary Angiography and Intervention
Slide 3 : CATHSAP6: Coronary Angiography and Intervention
Slide 4 : CATHSAP6: Coronary Angiography and Intervention
Slide 5 : CATHSAP6: Coronary Angiography and Intervention
Slide 6 : CATHSAP6: Coronary Angiography and Intervention
Slide 7 : Kussmaul’s Sign CATHSAP6: Coronary Angiography and Intervention
Slide 8 : CATHSAP6: Coronary Angiography and Intervention
Slide 9 : CATHSAP6: Coronary Angiography and Intervention
Slide 10 : Cardiac Tamponade 20 0 40 CATHSAP6: Coronary Angiography and Intervention
Slide 11 : Balloon Pericardiotomy
Slide 12 : Case 1: Constrictive Pericarditis 64 year old female 1 Year s/p 3-vessel CABG Presents with 6 months of progressive dyspnea and atypical chest pain At angiography, all grafts are patent Hemodynamics
Slide 13 : Right atrium 0 20 40
Slide 14 : LV vs. RV 20 0 40
Slide 15 : LV vs. RV with Valsalva 20 40 0
Slide 16 : Constrictive Pericarditis Right Atrial Tracing
Slide 17 : Constrictive Pericarditis – LV vs. RV. Tachycardia Obscures Evaluation PVB
Slide 18 : Kussmaul sign
Slide 19 : Case 2: Restrictive Cardiomyopathy 43 year old female presented with predominant right heart failure (peripheral edema, ascites) Hemodynamic tracings suggest constrictive-restrictive physiology Exploratory thoracotomy excluded the presence of constrictive pericarditis
Slide 20 : CATHSAP6: Coronary Angiography and Intervention
Slide 21 : CATHSAP6: Coronary Angiography and Intervention
Slide 22 : CATHSAP6: Coronary Angiography and Intervention
Slide 23 : Restrictive Cardiomyopathy
Slide 24 : Ventricular Interdependence During Respirations Differentiates Constrictive Pericarditis from Restrictive Cardiomyopathy Constrictive Pericarditis (LV and RV discordant) Restrictive Cardiomyopathy (LV and RV concordant) Hurrell et al, Circulation 1996; 93:2007
Slide 25 : Sensitivities, Specificities, Positive Predictive Values, and Negative Predictive Values as a Function of Criteria Hurrell et al, Circulation 1996; 93:2007
Slide 26 : Constrictive Pericarditis vs. Restrictive Cardiomyopathy Greater ventricular interdependence in constrictive pericarditis Greater separation of diastolic pressure in restrictive cardiomyopathy LV and RV diastolic filling more rapid in constrictive pericarditis Pulmonary pressures higher in restrictive cardiomyopathy Adjunctive tests: evidence of pericardial thickening (normal 1-2 mm; thickening = 3 mm); pericardial calcification, RV biopsy, exploratory thoracotomy
Slide 27 : Case 3: Pericardial Tamponade 37 year old female 2 day history of dyspnea, fatigue and dizziness Mastectomy for breast cancer 3 years ago Echocardiogram suggests pericardial tamponade Hemodynamics
Slide 28 : inspiration expiration Femoral artery 0 100 200 Cardiac Tamponade Pulsus Paradoxus
Slide 29 : Right atrium 20 0 40
Slide 30 : Right ventricle 20 0 40
Slide 31 : Pulmonary artery 20 0 40
Slide 32 : Pulmonary capillary wedge 20 0 40
Slide 33 : Before Pericardiocentesis; Pericardium vs. RA 20 0 40
Slide 34 : After Pericardiocentesis 20 0 40 Right atrium Pericardium
Slide 35 : After Pericardiocentesis Right ventricle 20 0 40
Slide 36 : After Pericardiocentesis Pulmonary capillary wedge 20 0 40
Slide 37 : Long-Term Effectiveness of Pericardiocentesis 2/3 of patients with malignant pericardial effusions redevelop tamponade after a median of 7 days More than 80% of patients with non-malignant pericardial effusion require no further intervention Laham et al, Heart 1996; 75:67
Slide 38 : Variants on Constrictive-Restrictive Physiology Acute enlargement of the heart with constriction by normal pericardium right ventricular infarct, tricuspid regurgitation, mitral regurgitation Low pressure tamponade Effusive-constrictive pericarditis Single chamber tamponade Localized constriction Occult constrictive pericarditis
Slide 39 : Severe, Acute Tricuspid Regurgitation Associated With Constrictive-Restrictive Physiology
Slide 40 : Severe, Acute Mitral Regurgitation Associated With Constrictive-Restrictive Physiology
Slide 41 : Variants on Constrictive-Restrictive Physiology Acute enlargement of the heart with constriction by normal pericardium right ventricular infarct, tricuspid regurgitation, mitral regurgitation Low pressure tamponade Effusive-constrictive pericarditis Single chamber tamponade Localized constriction Occult constrictive pericarditis

 


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