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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Cardiac imaging studies encompass a wide range of noninvasive and minimally invasive techniques designed to visualize the heart's structure and function in detail. One such technique is echocardiography, which uses high-frequency ultrasound waves to produce detailed images of the heart, known as echocardiograms.
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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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[Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide].

R F Trauzeddel1, M Nordine1, H V Groesdonk2

  • 1Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.

Der Anaesthesist
|March 4, 2021
PubMed
Summary

Perioperative echocardiography provides a rapid bedside assessment of cardiac function and hemodynamics. This approach aids anesthesiologists in optimizing care for high-risk surgical patients by identifying causes of instability.

Keywords:
Hemodynamic instabilityHemodynamic monitoringHemodynamic optimizationTransesophageal echocardiographyTransthoracic echocardiography

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Area of Science:

  • Anesthesiology
  • Cardiovascular Physiology
  • Critical Care Medicine

Background:

  • Increasing number of high-risk patients undergoing surgery.
  • Need for timely assessment of perioperative hemodynamics and organ oxygen supply (DO2).
  • Limitations of current hemodynamic monitoring in identifying causes of cardiovascular impairment.

Purpose of the Study:

  • Present a stepwise algorithm for perioperative echocardiography-based hemodynamic optimization.
  • Guide anesthesiologists in managing high-risk noncardiac surgery patients.
  • Utilize echocardiography on demand or as a planned intraoperative procedure.

Main Methods:

  • Employing echocardiography as a bedside method for hemodynamic assessment.
  • Focusing on echocardiography on demand during hemodynamic instability or nonresponse to treatment.
  • Utilizing transesophageal echocardiography for planned intraoperative procedures.

Main Results:

  • Echocardiography enables timely diagnosis of cardiac filling obstructions and volume status.
  • Assessment of right and left heart function and heart valve function is facilitated.
  • Bedside echocardiography provides rapid evaluation of hemodynamic parameters.

Conclusions:

  • Integrating echocardiographic findings allows for differentiated cardiovascular assessment.
  • Enables a pathophysiologically oriented and individualized hemodynamic treatment.
  • Echocardiography is crucial for optimizing perioperative hemodynamic management in high-risk patients.