Cardiovascular Module 3

Question 1

What drugs are safest to use with heart disease

Answer 1

Alfaxalone, BZPs, Opioids Iso/Sevo

Question 2

What are causes of pericardial effusion?

Answer 2

1. Idiopathic
2. Neoplastic
3. SIRs
4. Septic peritonitis
5. RHF
6. Coagulopathy
7. Atrial rupture (MVD)

Question 3

What is cardiac tamponade?

Answer 3

Encompasses the clinical signs associated with pericardial effusion

CS of right heart disease
- ascites +/- pleural fluid
- hepatic venous distention

Heart only fills at expiration properly

Amount of fluid can give an idea of chronicity - larger volume (chronic), small volume with CS sudden

Question 4

How to stabilise a pericardial effusion

Answer 4

1. Echo first - check for RA masses
2. Left lateral recumbency: drain
   from the right side, avoids the
   left coronary arteries (will die if
   bleed)
3. Sedate - buptorphanol (0.2-
   0.4mg/kg)/midazolam
   (0.25mg.kg) top up with propofol
4. Aseptic prep, place ECG - VPC if
   you hit heart
5. Ultrasound guidance: 12-15f chest tube kit (3 way tap, mila chest kit and scalpel blade)
   - If no chest tube, 12g catheter + 8f urinary cath
6. LA lidocaine (skin and intercostal
   space - orange needle into
   intercostal space and instill as
   withdrawing
7. 11 scalpel blade to nick skin for
   the tube
8. Echo and mark rib space to go
   over
9. Insert cannula and thumb over
   end and go perpendicular to skin
10. remove stylet and place thumb
    over catheter
11. Pass guidewire through to the
    20cm and then pull catheter
    over wire and insert mila chest
    drain

Question 5

Fluids v. diuretics with pericardial effusion

Answer 5

Give neither!

Fluid will increase the pressure within the right atrium of the heart and will worsen failure
(with Peri. E enough fluid is present but not being pushed through due to shit CO so more fluid will just increase pressure and worsen failure)

Diuretics will reduce fluid volume but also further decrease CO leading to more hypovolaemia

Question 6

what are complications and contraindications to pericardial draining?

Answer 6

Complications
- Hit the heart
- Incomplete drainage - only go in once
- AF post pericardiocentesis
- Cardiac puncture
- Infection (rare)
- Death (rare)

Contraindications
- Left atrium enlargement - atrial rupture

Question 7

What are the main differentials for pericardial effusion

Answer 7

1. Idiopathic - 48%
2. Small right atrial mass - 50% mesothelioma
3. Septic
4. Other - coags