La diagnosi dello Scompenso Cardiaco Acuto

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La diagnosi dello scompenso

cardiaco acuto

.

Fabio Guarracino

U.O.C. Anestesia e T.I. Cardiotoracica

Azienda Ospedaliero Universitaria Pisana

Pisa, Italy

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ANMCO 2004

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Assessment of heart function

¾

PAC - Thermodilution

¾

contrast ventriculography

¾

radionuclide ventriculography

¾

echocardiography

¾

CT scan

¾

magnetic resonance

INDICE

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Systolic dysfunction

Diastolic

dysfunction

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(

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• Cardiac size and shape

• Pulmonary congestion

• Major pulmonary embolism

• Aortic dissection

• Differential diagnosis (inflamm./infectious)

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Troponin in myocardial ischemia

Cx

LDA

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• Regional and global LV and RV function

• Valvular structure and function

• Pericardial pathology

• Mechanical complications of AMI

• Aortic pathology

• CO

• PAP (from tricuspid regurgitant jet)

• Preload

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1. EF EDV ESV

2. FAC EDA ESA

LV

SYSTOLIC

FUNCTION

4. MPI

3. STROKE VOLUME

INDICE

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Cx

LDA

RCA

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Cx

LDA

RCA

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LDA Cx RCA LDA Cx LDA Cx LDA RCA INDICE

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DIMENTION: edd > 3.5 cm

KINESIS: hypokinesia

TAPSE: <1.4 cm: moderate

_{<1.0 cm: severe}

RV dysfunction

ITR: 3-4

TDI: Sa < 8 cm/s

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IMPAIRED

RELAXATION

IMPAIRED

_FILLING

Dependence

of filling on

atrial systole

Higher P needed

to fill the LV

↓ subendocardial flow

INDICE

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¾ Transmitral pulsed Doppler:

high E wave, E/A ratio > 1, DT 150- 220

msec

¾Pulmonary venous pulsed Doppler:

S/D ratio < 1, A wave > 30 cm/sec

¾Color M-mode:

V

_p

< 45 cm/sec.

E

_m

¾Tissue Doppler Echo:

E

_m

< 8 cm/sec.

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Tissue Doppler Echocardiography

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Color M-mode

E

A

V

_p

> 55 cm/sec.

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Diastolic dysfunction by integrating PAC & ECHO

Small EDA High

WP

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Fast response PAC

¾

right side pressures

¾

RV output

¾

RVEF and RV vol.

¾

SVO2

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Major pitfalls of PAC

¾

diastolic dysfunction

¾

LVOT dynamic obstruction

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Diagnosis of myocardial ischemia

Cx

LDA

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Echocardiography and PAC data

&

BNP – Troponin

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La diagnosi dello scompenso cardiaco acuto

.

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