Pneumopericardium vs. Pneumomediastinum

STAT Categories: Procedure-specific Mortality Risk Categories

Based on JTCVS 2009;138:1139

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Radial Artery Access - Vasodilator Cocktail

Vasodilator Cocktail for radial artery access:

Nicardipine 200 mcg in 2 ml
1% Lidocaine 1 ml
3-5K of Heparin
+ patient's blood

Infuse slowly as soon as access is obtained.

(Do some folks add Nitroglycerin to this cocktail?)

Terumo sheath - hydrophilic coating helps.
Propafol can be used as a lubricant.
Sterile mineral oil - if the pharmacy has it - can also be used as lubricant.

Radial Artery Access - Vasodilator Cocktail

Vasodilator Cocktail for radial artery access:

Nicardipine 200 mcg in 2 ml
1% Lidocaine 1 ml
3-5K of Heparin
+ patient's blood

Infuse slowly as soon as access is obtained.

(Do some folks add Nitroglycerin to this cocktail?)

Terumo sheath - hydrophilic coating helps.
Propafol can be used as a lubricant.
Sterile mineral oil - if the pharmacy has it - can also be used as lubricant.

Blalock-Hanlon Atrial Septectomy (d-Transposition of Great Arteries)

This is performed without cardiopulmonary bypass.

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From Clinical Aspects of Operable Heart Surgery 1968. Donald Kahn, Ruth Strang and William Wilson. Appleton-Century-Crofts (Meredith Corporation), New York. 1968.

Mustard Operation for d-Transposition of Great Arteries

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From Clinical Aspects of Operable Heart Surgery 1968. Donald Kahn, Ruth Strang and William Wilson. Appleton-Century-Crofts (Meredith Corporation), New York. 1968.

Pericardiocentesis - Using EKG via needle as guide

From Page 7.8 in Atlas of the Heart. Ed. J Willis Hurst, Robert H Anderson, Anton E Becker and Benson R Wilcox. Grower Medical Publishing, New York. 1988.

Early Repolarization Patterns

From Abdi Ali, et al. World Journal of Cardiology 2015;7:466-75.

Other related references:

Perez MV, Friday K, Froelicher V. Semantic confusion: the case of early repolarization and the J point. Am J Med. 2012;125:843-844.

aïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, Pasquié JL, Nogami A, Babuty D, Yli-Mayry S. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358:2016-2023.

New Food Label Design (to be implemented before July 2018)

Most important change: "Added Sugar" information.

Removal of "Calories from fat"

Inclusion of Vitamin D and Pottasium.

Few revisions to daily requirements calculation (Sodium chloride requirement was reduced from 2400 mg/day to 2300 mg/day)

How to identify pacemaker?

From Heart Rhythm 2011;8:915-922.

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Telephone numbers for manufacturers to identify the pacemaker:

Medtronic: 1-800-Medtronic (1-800-633-8766)

St Jude Medical: 1-800-PaceICD (1-800-722-3774)

Boston Scientific: 1-800-Cardiac (1-800-227-3422)

Sorin Gp (ELA): 1-800-352-6466

Biotronik: 1-800-547-0394

Note: The telephone numbers are different, to call the representative to come and interrogate the pacemakers.

Intropes - Mechanism of Action

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Anomalous origin of Vertebral Artery

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                          (Netter)                                                        (Am J Neuroradiol 1998;20:1318-1321)

Netter diagram: Top - Normal, Middle - "Bovine" arch (common origin for innominate and LCC arteries) and Botton - Right vertebral artery from innominate artery & Left vertebral artery from aortic arch.

AJNR cartoon: Possible anomalous vertebral artery origins

Carotid Intima Media Thickness Measurement & Normal Values

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Prevalence of late hypertension after coarctation repair - Age at operation

n=176 consecutive patients
Median f-up = 7.5 yrs.
Mortality - 0% for isolated coarctation (n=116), 7.4% for coarctation associated with other anomalies.
Seirafi et al.Ann Thoracic Surg 1998;66:1378-82.

Age at repair was not significant risk factor in another study: Hager et al. JTCVS 2007;134:738-45. n=405, Surgical era 1974-2000.