By Sara Thorne, Paul Clift
To the grownup heart specialist, the language of congenital center ailment might be complicated and the spectrum of illness bewildering. Many locate the possibility of assembly an grownup with complicated congenital center ailment within the emergency division tense, and rightly so. This ebook goals to dispel confusion and equip cardiology trainees, normal cardiologists, and acute medication physicians with a legitimate realizing of the foundations of the body structure and administration of grownup congenital middle ailment, for you to deal with emergencies and realize the necessity for referral to a consultant unit.
With easy-to-understand diagrams and key medical issues, this instruction manual offers either quick reference to be used while the scientific want arises and in addition an perception into the fundamental ideas of congenital middle illness, giving the reader an exceptional grounding within the care of the grownup with congenital center affliction.
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Extra resources for Adult Congenital Heart Disease
Rhythm. • BP. • At peak exercise or immediately post exercise. • O2 saturation (start and at peak/immediately after exercise). • Exercise ﬂow and metabolic gas exchange. • Maximum minute ventilation (VE max). METABOLIC EXERCISE TESTING • Maximum oxygen uptake (VO2 max). e. maximal exercise) has been reached. • Comparison with expected values and with previous tests. • Conclusion and consequences of the test. Data derived from the test is displayed in a Wassermann nine-panel display. b see Further reading.
Limited by inter-test variability—very important to standardize methods used. Bruce exercise test (or similar) • • • • • • Available in most hospitals. Incremental exercise, increase in speed and slope. Continuous ECG monitoring for ST segment changes. Very useful if ischaemic heart disease suspected. Unable to determine if anaerobic threshold reached. Prognostic information for risk of future coronary events only (low risk in congenital heart disease). Metabolic (cardiopulmonary) exercise testing (CPEX) • Objective assessment of performance based on incremental exercise and analysis of inspired and expired O2 and CO2.
Enables serial comparison. • Disadvantages: • Radiation dose. • Structures are projected in 2D and can be superimposed. Points to look for: • Extra cardiac—bones: cervical ribs, previous thoracotomy, kyphoscoliosis. • Prosthetic material—clips coils, prosthetic valves, devices, sternal wires (not always used post-sternotomy in children). ) • Cardiothoracic ratio (CTR). : • Pulmonary atresia—coeur en sabot (clog-shaped heart) (b see Fig. 3). • Ebstein—large globular heart (measure serial CTR) (b see Fig.