血流动力学监测–初步教程杜斌医学课件.ppt

PAC Q 6 from Jean Francois Dhainaut Which of the following is INCORRECT? The incremental increase in Ppw is due to malposition of the catheter Disconnection from mechanical ventilation may unmask mitral regurgitation Disconnection from mechanical ventilation may unmask hypervolemia Echocardiography is needed PAC A 6 from Jean Francois Dhainaut Correct answer is A. The catheter is clearly in the right place (A): zone 3 condition, because the ventilator-induced variations of Ppa are roughly equivalent to those of Ppw. Disconnection of the ventilator unmasks a giant V-wave, which may correspond to either hypervolemia (C) or mitral regurgitation (B). 2D-echocardiography with doppler is needed to analyze mitral valve function (D). It demonstrates moderate mitral regurgitation probably due to papillary muscle ischemia. PAC Q 7 from Jean Francois Dhainaut A 65 yr-old patient is admitted to ICU with cardiogenic shock, 12 hrs after the onset of abdominal pain. The ECG shows a recent inferior myocardial infarction. The pulmonary artery pressure (PAP) tracing, right ventricular (RVP) and right atrial (RAP) pressure tracings are presented below and cardiac output is 2.2 L/min/m2. These data suggest which of the following diagnoses: Decreased right ventricular compliance Cardiac tamponade Severe pulmonary embolism Right ventricular infarction Tricuspid regurgitation PAC A 7 from Jean Francois Dhainaut Correct answers are A and D. The RV pressure tracing shows a marked increase in end-diastolic pressure with a diastolic tracing close to a dip-and-plateau pattern, and a deep y descent, on the RAP waveform, suggesting a decrease in the apparent distensibility of both ventricles. This is due, in a large part, to the mechanical constraint exerted by the distended pericardium in the presence of RV dilatation (A). This morphology is different from that observed in cardiac tamponade (deep x descent and no y descent) (B), as well as tricuspid regurgitation (D). PAC A 7 from Jean Francois