Category Archives: cardiac

Pulmonary hypertension

mean PAP > 25 mm Hg

Classification:

  1. Pulmonary arterial e.g. IPAH, systemic sclerosis, congenital heart disease
  2. Secondary to left heart disease
  3. Secondary to chronic lung disease
  4. Chronic thromobo-embolic
  5. Multifactorial/unknown

ECHO features:

  • Estimation of sPAP in Apical 4-Chamber view. PH likely if estimated sPAP>50 mm Hg
  • Other features of PH: dilated right side chambers, reduced RV function, RVH, enlarged PA, abnormal inter-ventricular septum motion

Management:

  • Ca-channel blockade
  • Prostacyclin
  • Endothelin receptor antagonists
  • NO
  • PDE-5 inhibitor
  • TREAT PRIMARY CAUSE
  • consider (CTPA) +/- treat VTE
  • diuretics

http://www.escardio.org/guidelines-surveys/esc-guidelines/guidelinesdocuments/guidelines-ph-ft.pdf

 

Cardiac recipe

For a ‘well patient’ of 70kg

Pre-med temazepam 10mg notce and mane

Standby:
Phenylepherine 100mcg/ml 20ml
Atropine 600mcg/ml
Phenylepherine 1mg/ml 10ml for perfusionist
CaCl 10% 10ml
MgSO4 50% 10ml

16G IVI
Awake arterial line

Antibiotics

Pre-O2
+/-Diazepam 10mg
Fentanyl 1mg (20ml of 50mcg/ml)
Etomidate 10-20mg (5-10ml of 2mg/ml) or propofol 50-100mg
Rocuronium 100mg (10ml of 5mg/ml)

ISO 0.5%
Tranexamic acid 1g
Propofol 1% at 10ml/hr

KTS:
MgSO4 5-10ml of 50% (500mg/ml or 2mmol/ml)
+/- Increase ISO up to 1%

Baseline ACT, ABG
Baseline ACT is 120-140sec

Have heparin ready. 400units/kg
OR, if using 1000units/ml then 0.4ml/kg or 2.5kg per ml or 50kg man = 20ml

ACT must be > 480 sec prior to bypass

Protamine for off-bypass
1mg per 100 units of heparin
4mg/kg
1ml heparin (1000iu/ml) = 1ml protamine (10mg/ml)

10mg morphine

On rewarming:
Noradrenaline 80mcg/ml @ 2ml/hr

Also need 50mg protamine per 500ml ‘pump blood’ transfused back.

CABG
+/- dobutamine

AVR
+/- GTN 1mg/ml

AA