Cardiology

ST changes and location of infarction

 
A suspiciously low dicrotic notch could mean very poor vascular resistance, eg. in a situation like severe septic shock.
 



Milrinone: 
  • Can use as alternative to dobutamine in pts with cardiogenic shock and on b-blockers

Intraaortic balloon pump


Quick reference: Volume status and Echo

IVC assessment and Volume responsiveness vs volume tolerance: The IVC Assessment by bedside ultrasound: Let’s apply some common sense! 

-CVP is a poor predictor of fluid responsiveness. 

-IVC distensibility index = (IVCmax - IVCmin )/ IVCmin if >18% = fluid responsiveness Sen 90%, Spec 100%

Is V4 better than V5 during anesthesia?  V5 vs V4 for ischemia - Barash

"The V4 lead data was more clinically relevant to outcome because this lead was the most sensitive for detecting prolonged ischemia (>10 minutes) associated with myocardial infarction (83%). In contrast, the V5 lead detected only 75% of episodes of prolonged ischemia. The combinations of V4+V5 and V 3+V5 were 100% sensitive in detecting patients who went on to have a myocardial infarction. Importantly, Landesberg et al also showed that V4 was less likely than V5 to exhibit a baseline abnormality that would interfere with the determination of ST-segment depression" 



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