[HSF] [Fwd: Re: ccml Quiz for Christmas]

[prasannasimha]

Agreed Claudia though with restriction - constriction there would be a 
prominent y descent too or at times even a venous square root sign 
though that is better seen in a ventricular trace.
Prasanna
claudia miranda wrote:
> Interesting case, Prasanna.
> We usually think of a prominent X descent if the patient has cardiac
> tamponade or constrictive pericarditis...but  an enlarged RV could 
> produce
> the same phenomenon, due to relative constriction by the pericardium. A
> prominent X descent can also be a clue to regional tamponade causing RV
> dysfunction.
>
> Claudia
>
>
> 2006/12/29, Ani Anyanwu <anianyanwu at hotmail.com>:
>>
>> All?
>> ----- Original Message -----
>> From: Tea Acuff<mailto:tacuff at swbell.net>
>> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>> Sent: Friday, December 29, 2006 12:15 AM
>> Subject: Re: [HSF] [Fwd: Re: ccml Quiz for Christmas]
>>
>>
>> All ventricular dysfunction is worsened by the cross clamp. Hopefully 
>> one
>> has otherwise improved its function and that it is only temporary.
>> Tea
>>
>>
>> ----- Original Message ----
>> From: prasannasimha <prasannasimha at gmail.com<mailto:
>> prasannasimha at gmail.com>>
>> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>> Sent: Thursday, December 28, 2006 9:49:31 AM
>> Subject: Re: [HSF] [Fwd: Re: ccml Quiz for Christmas]
>>
>>
>> Basically a case with severe TR and RV dysfunction worsened temporarily
>> by CPB.
>> Prasanna
>>
>> Tea Acuff wrote:
>> > Etiology?
>> > Tea
>> >
>> >
>> > ----- Original Message ----
>> > From: prasannasimha <prasannasimha at gmail.com<mailto:
>> prasannasimha at gmail.com>>
>> > To: 
>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
>> > Sent: Wednesday, December 27, 2006 9:38:35 AM
>> > Subject: Re: [HSF] [Fwd: Re: ccml Quiz for Christmas]
>> >
>> >
>> > No.
>> > The curve was  showing a CVP trace with a prominent X descent 
>> suggestive
>> > of either early tamponade or a dilated RV "restricted by the chest 
>> wall
>> > / pericardium. There was simultaneous increased delta dip showing a
>> > decrease in LV preload despite a CVP of 11 (volume loading was 
>> initially
>> > tried) as the RV was not "sending" volume to the left side adequately.
>> > Echo showed do diastolic collapse and RV dysfunction and was 
>> managed by
>> > increasing support for the next 6 hours and was weaned off after the X
>> > descent disappeared. Incidentally the chest tubes were removed as hey
>> > were not draining and removal gave a little more "space " for the RV.
>> > V. Aldrete, M.D. wrote:
>> >
>> >> Hi Prasanna,
>> >>
>> >> Did you have a drainage catether across the PA obstructing pulmonary
>> >> flow?
>> >>
>> >> Victor
>> >> On Dec 25, 2006, at 4:56 AM, prasannasimha wrote:
>> >>
>> >>
>> >>> Part2 of the same quiz
>> >>>
>> >>>
>> >>>
>> >>> Same case next day morning. Stable and off inotropes prior to 
>> removal
>> >>> of lines.
>> >>> Prasanna
>> >>>
>> >>>
>> >>>
>> >>>
>> >>> <quiz26answerfollowup.jpg>
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