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What does the dicrotic notch signify in intra-aortic balloon pump?
The dicrotic notch in the pressure waveform of an intra-aortic balloon pump (IABP) represents the closure of the aortic valve and the subsequent rebound of blood against the closed valve. It indicates the end of systole and the beginning of diastole in the cardiac cycle. This feature is crucial for assessing the timing and effectiveness of the IABP's inflation and deflation cycles, which aim to enhance coronary perfusion and reduce cardiac workload. Proper identification of the dicrotic notch helps optimize IABP therapy and ensure adequate hemodynamic support.
When will the intra aortic balloon pump be timed to deflate?
The intra-aortic balloon pump (IABP) is timed to deflate just before systole, specifically at the onset of the R-wave on the ECG. This timing allows for optimal coronary perfusion by promoting diastolic blood flow during the heart's relaxation phase. The balloon inflates during diastole to increase blood flow to the coronary arteries and deflates before the heart contracts to reduce afterload. Proper timing is crucial for maximizing hemodynamic support.
Why are IABP's often used?
Ease of insertion for placement in the aorta makes the intra-aorta balloon pump (IABP) the most often used ventricular assist device
What does the medical abbreviation IABP mean?
Intra-Aortic Balloon Pump
What is the cpt code for intra aortic balloon pump insertion?
The CPT code for intra-aortic balloon pump (IABP) insertion is 92987. This code specifically refers to the insertion of an intra-aortic balloon for temporary support of the heart in patients with certain cardiac conditions. It's important to ensure that the code is applied correctly based on the specific clinical scenario and documentation.
Which IABP timing error is most fatal?
Late deflation is an extremely dangerous timing error because the LV must eject against the resistance imposed by the inflated balloon.
When are medium or long term mechanical circulation supports necessary?
When short-term support devices such as ECMO, IABP, and the centrifugal pump are ineffective to sustain the patient to recovery or organ transplantation, a medium- or long-term device is required.
Intra-aortic balloon pump and Physical therapy?
An intraaortic balloon pump (IABP) is a machine that is used to increase the flow of oxygen-rich blood out of the heart. It lessens the workload of the actual heart muscles, sometimes producing up to 20% of its labor. When it comes to physical therapy, an IABP is often used after major heart failures or surgeries in order to help with several different things, such as improving blood circulation from the heart, lowering one's heart rate, decreasing the heart's workload, improving the heart's efficiency, and relieving pressure from the aorta (part of heart that sends blood to rest of body).
Heart failure - surgeries and devices?
DescriptionAlthough most of treating heart failure is changing your lifestyle and taking your medicines correctly, procedures and surgeries still play a role.Pacemakers and DefibrillatorsA heart pacemaker is a small, battery-operated device that sends a signal to your heart. The signal makes your heart beat at the correct pace. Pacemakers may be used:For people who have heart problems that cause their heart to beat too slowly, too fast, or in an irregular mannerFor people with heart failure, to match up the beating of both sides of the heart. These are called biventricular pacemakers.When your heart is weakened, gets too large, and does not pump blood very well, you are at high risk for life-threatening heartbeats.An implantable cardioverter-defibrillator (ICD) is a device that detects any life-threatening heartbeats. It then quickly sends an electrical shock to the heart to change the rhythm back to normal.Most of today's biventricular pacemakers can also work as implantable cardio-defibrillators (ICD).Surgery to Improve Blood Supply to the HeartThe most common cause of heart failure when the heart does not beat strongly enough is coronary artery disease (CAD), a narrowing of the small blood vessels that supply blood and oxygen to the heart. CAD may become worse and make it harder to manage your symptoms.After performing certain tests, your doctor may feel that opening a narrowed or blocked blood vessel will improve your heart failure symptoms. Suggested procedures may include:Angioplasty and stent placementHeart bypass surgeryHeart Valve SurgeryBlood that flows between different chambers of your heart or out of your heart into the aorta must pass through a heart valve. These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.When these valves do not work well, blood does not flow correctly through the heart to the body. This problem may cause heart failure or make heart failure worse.As a result, the patient may need surgery to repair one of the heart valves.Surgery for End-stage Heart FailureSevere heart failure may need the following treatments when other therapies no longer work. They are often used when a person is waiting for a heart transplant.You may need a left ventricular assist device (LVAD) if you have severe heart failure that cannot be controlled with medicine or a special pacemaker.Ventricular assist devices (VAD) help your heart pump blood from the main pumping chamber of your heart to the rest of your body. These pumps may be implanted in your body or connected to a pump outside your body.You may be on a waiting list for a heart transplant. Some patients who get a VAD are very ill and may already be on a heart-lung bypass machine.Intra-aortic balloon pumps (IABP) help maintain heart function in patients who are waiting for transplants. They can also help those who develop a sudden and severe decline in heart function. The IABP is an implanted thin balloon that is usually inserted temporarily into the artery in the leg and threaded up to the aorta leading from the heart.ReferencesMann DL. Management of heart failure patients with reduced ejection fraction. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 28.Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 66.Reviewed ByReview Date: 07/29/2011Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Cardiogenic shock?
DefinitionCardiogenic shock is a state in which the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.Alternative NamesShock - cardiogenicCauses, incidence, and risk factorsShock occurs whenever the heart is unable to pump as much blood as the body needs.The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction). These complications include:A large section of heart muscle that no longer moves well or does not move at allDangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardiaRupture of the heart muscle due to damage from the heart attackTear or rupture of the muscles or tendons that support the heart valves, especially the mitral valveTear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)Very slow heart rhythm (bradycardia) or heart conduction blockSymptomsChest pain or pressureProfuse sweating, moist skinRapid breathingRapid pulseRestlessness, agitation, confusionShortness of breathSkin that feels cool to the touchPale skin coloror blotchy (mottled) skinWeak (thready) pulseDecreased mental status Loss of ability to concentrateLoss of alertnessComa (loss of consciousness)Signs and testsAn examination will reveal:Low blood pressure (less than 90 systolic)Blood pressure drop of more than 10 points when you stand up after lying down (orthostatic hypotension)Weak (thready) pulseTo diagnose cardiogenic shock, a catheter (tube) may be placed in the pulmonary artery (right heart catheterization). Measurements often indicate that blood is backing up into the lungs and the heart is not pumping properly.Tests include:Cardiac catheterizationChest x-rayCoronary angiographyEchocardiogramElectrocardiogramNuclear scansOther studies may be recommended to determine why the heart is not functioning properly.Laboratory tests include:Arterial blood gasBlood chemistry(chem-7, chem-20, electrolytes)Cardiac enzymes (troponin, CKMB)Complete blood count (CBC)TreatmentCardiogenic shock is a medical emergency. Treatment requires hospitalization, usually in the Intensive Care Unit. The goal of treatment is to identify and treat the cause of shock in order to save your life.Medications may be needed to increase blood pressure and improve heart function, including:DobutamineDopamineEpinephrineNorepinephrineWhen a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:Electrical "shock" therapy (defibrillation or cardioversion)Implanting a temporary pacemakerMedications given through a vein (intravenous)You may receive pain medicine if necessary. Bed rest is recommended to reduce demands on the heart.Receiving oxygen, either by a nasal tube or mask over the mouth, lowers the workload of the heart by reducing tissue demands for blood flow.You may receive intravenous fluids, including blood and blood products, if needed.Other treatments for shock may include:Cardiac catheterization with coronary angioplasty and stentingHeart monitoring, including hemodynamic monitoring, to guide treatmentHeart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)Intra-aortic balloon counterpulsation (IABP) to improve heart and blood vessel functionPacemakerExpectations (prognosis)In the past, the death rate from cardiogenic shock ranged 80 - 90%. In more recent studies, this rate has decreased to 50 - 75%.When cardiogenic shock is not treated, the outlook is poor.ComplicationsBrain damageKidney damageLiver damageCalling your health care providerGo to the emergency room or call the local emergency number (such as 911) if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.PreventionYou may reduce the risk of developing cardiogenic shock by:Quickly and aggressively treating its cause (such as heart attack or heart valve dysfunction)Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco useReferencesJones AE, Kline JA. Shock. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 4.Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e57.Antman EM. ST-elevation myocardial infarction: management. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders; 2007:chap 51.
Mitral regurgitation - acute?
DefinitionAcute mitral regurgitation is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to flow backward (leak) into the upper heart chamber when the left lower heart chamber contracts.See also: Chronic mitral regurgitationAlternative NamesMitral insufficiency; Acute mitral regurgitationCauses, incidence, and risk factorsRegurgitation means leaking from a valve that doesn't close all the way. Diseases that weaken or damage the valve or its supporting structures cause mitral regurgitation.When the mitral valve doesn't close all the way, blood flows backward into the left upper heart chamber (atrium). This leads to a decrease in blood flow to the rest of the body. As a result, the heart may try to pump harder.Acute mitral regurgitation may be caused by dysfunction or injury to the valve following a heart attack or infection of the heart valve (infective endocarditis). These conditions may rupture the valve or surrounding structures, leaving an opening for blood to move backwards.SymptomsChest pain -- unrelated to coronary artery disease or a heart attackCoughRapid breathingShortness of breath that increases when lying flat (orthopnea)Sensation of feeling the heart beat (palpitations)Note: Symptoms may start suddenly.Signs and testsThe doctor may detect a thrill (vibration) over the heart when feeling (palpating) the chest area. An extra heart sound (S4 gallop) and a distinctive heart murmur may be heard when listening to the chest with a stethoscope. However, some patients may not have this murmur. If fluid backs up into the lungs, there may be crackles heard in the lungs.Blood pressureis usually normal.The following tests may be performed:Cardiac catheterizationChest MRI scanChest x-ray - may also show fluid in the lungs or prominent lung veinsColor flow Doppler examCT scan of the chestEchocardiogramECG - usually shows a normal sinus rhythm but may show abnormal heart rhythmsRadionuclide scansRight heart catheterization - may show high left atrial pressure.Transesophageal echocardiogram (TEE)TreatmentPatients with severe symptoms may need to be admitted to a hospital for diagnosis and treatment.Emergency surgery may be necessary for severe leakages, usually resulting from infection, heart attack, or rupture of a valve structure.Medications may include:Antibiotics to fight any bacterial infectionsAntiarrhythmics to control heart rhythmsBlood thinners to prevent clot formation if atrial fibrillation is present (mainly used for patients with chronic mitral regurgitation)Digitalis to strengthen the heartbeatDiuretics (water pills) to remove excess fluid in the lungsVasodilators to dilate blood vessels and reduce the workload of the heartIf blood pressure cannot be controlled, an intra-aortic balloon pump (IABP) may be used to help move blood forward into the aorta, the main artery from the heart.Expectations (prognosis)How well a patient does depends on the cause and severity of the valve leakage. Milder forms may become a chronic condition.Acute mitral regurgitation can rarely be controlled with medications. Surgery is usually needed to repair or replace the mitral valve. See: Valve replacement.Abnormal heart rhythms associated with acute mitral regurgitation can sometimes be deadly.ComplicationsAbnormal heart rhythms, including atrial fibrillationBlood clots in other parts of the bodyChronic mitral regurgitationHeart failurePulmonary edema(fluid in the lungs)StrokeValve infectionCalling your health care providerCall your health care provider if you have symptoms of mitral valve regurgitation, or if symptoms worsen or do not improve with treatment.Call your health care provider if you are being treated for this condition and develop signs of infection, which include:ChillsFeverGeneral ill feelingHeadacheMuscle achesPreventionPrompt treatment of disorders that can cause mitral regurgitation reduces your risk.Any invasiveprocedure, including dental work and cleaning, can introduce bacteria into your bloodstream. The bacteria can infect a damaged mitral valve, causing endocarditis. Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Taking antibiotics before dental or other invasive procedures may decrease your risk of endocarditis.ReferencesKarchmer AW. Infectious endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap 63.Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:676-685.Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 28th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 62.
Heart failure?
DefinitionHeart failure, also called congestive heart failure, is a condition in which the heart can no longer pump enough blood to the rest of the body.Alternative NamesCHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failureCauses, incidence, and risk factorsHeart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.The condition may affect the right side, the left side, or both sides of the heart.Right-sided heart failure means the right ventricle of the heart loses its pumping function.Left-sided heart failure means the heart's ability to pump blood forward from the left side of the heart is decreased. The left side of the heart normally receives blood rich in oxygen from the lungs and pumps it to the remainder of the body.Heart failure is often classified as either systolic or diastolic.Systolic heart failure means that your heart muscle cannot pump, or eject, the blood out of the heart very well.Diastolic heart failure means that your heart's pumping chamber does not fill up with blood.Both of these problems mean the heart is no longer able to pump enough blood out to the rest of your body, especially when you exercise or are active.As the heart's pumping action is lost, blood may back up in other areas of the body, producing congestion in the lungs, the liver, the gastrointestinal tract, and the arms and legs. As a result, there is a lack of oxygen and nutrition to organs, which damages them and reduces their ability to work properly.Perhaps the most common cause of heart failure is coronary artery disease, a narrowing of the small blood vessels that supply blood and oxygen to the heart. For information on this condition and its risk factors, see: Coronary artery disease.Heart failure can also occur when an illness or toxin weakens the heart muscle or changes the heart muscle structure. Such events are called cardiomyopathies. There are many different types of cardiomyopathy. For information, see: CardiomyopathyOther heart problems that may cause heart failure are:Congenital heart diseaseHeart valve diseaseSome types of abnormal heart rhythms (arrhythmias)Diseases such as emphysema, severe anemia, hyperthyroidism, or hypothyroidism, may cause or contribute to heart failureSymptomsCommon symptoms are:Shortness of breath with activity, or after lying down for a whileCoughSwelling of feet and anklesSwelling of the abdomenWeight gainIrregular or rapid pulseSensation of feeling the heart beat (palpitations)Difficulty sleepingFatigue, weakness, faintnessLoss of appetite, indigestionOther symptoms may include:Decreased alertness or concentrationDecreased urine productionNausea and vomitingNeed to urinate at nightInfants may sweat during feeding (or other activity).Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:Abnormal heart rhythm (arrhythmias)AnemiaHyperthyroidismInfections with high feverKidney diseaseSigns and testsA physical examination may reveal the following:Fluid around the lungs (pleural effusion)Irregular heartbeatLeg swelling (edema)Neck veins that stick out (are distended)Swelling of the liverListening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds.The following tests may reveal heart swelling,decreased heart function, or lung congestion:Chest x-rayECGEchocardiogramCardiac stress testsHeart CT scanHeart catheterizationMRI of the heartNuclear heart scansThis disease may also alter the following test results:Blood chemistryBUNComplete blood countCreatinineCreatinine clearanceLiver function testsUric acid-blood testSodium - blood testUrinalysisSodium - urine testTreatmentIf you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that your heart failure is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.Other important measures include:Take your medications as directed. Carry a list of medications with you wherever you go.Limit salt intake.Don't smoke.Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.Lose weight if you are overweight.Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.Here are some tips to lower your salt and sodium intake:Look for foods that are labeled "low-sodium," "sodium-free," "no salt added," or "unsalted." Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.Don't cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.Use oil and vinegar, rather than bottled dressings, on salads.Eat fresh fruit or sorbet when having dessert.Your doctor may consider prescribing the following medications:ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heartDiuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium)Digitalis glycosides to increase the ability of the heart muscle to contract properly and help treat some heart rhythm disturbancesAngiotensin receptor blockers (ARBs) such as losartan and candesartan to reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitorsBeta-blockers such as such as carvedilol and metoprolol, which are particularly useful for those with a history of coronary artery diseaseCertain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms.Valve replacements or repair coronary bypass surgery (CABG), and angioplasty may help some people with heart failure.The following devices may be recommended for certain patients:A single or dual chamber pacemaker to help with slow heart rates or certain other heart signaling problemsA biventricular pacemaker to help the left and right side of your heart contract at the same time.An implantable cardioverter-defibrillator to correct or prevent severe arrhythmias (abnormal heart rhythms)Severe heart failure may require the following treatments:Intra-aortic balloon pump (IABP), a temporary device placed into the aortaLeft ventricular assist device (LVAD), which takes over the role of the heart by pumping blood from the heart into the aorta; it's most often used by those who are waiting for a heart transplant.Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.Heart failure symptoms may be improved with biventricular pacemaker or cardiac resynchronization therapy. Ask your provider if you are a candidate for this type of treatment.Expectations (prognosis)Heart failure is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress.Many forms of heart failure can be controlled with medication, lifestyle changes, and treatment of any underlying disorder.ComplicationsIrregular heart rhythms (can be deadly)Pulmonary edemaTotal heart failure (circulatory collapse)Possible side effects of medications include:CoughDigitalis toxicityGastrointestinal upset (such as nausea, heartburn, diarrhea)HeadacheLight-headedness and faintingLow blood pressureLupusreactionMuscle crampsCalling your health care providerCall your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.Go to the emergency room or call the local emergency number (such as 911) if you experience severe crushing chest pain, fainting, or rapid and irregular heartbeat(particularly if other symptoms accompany a rapid and irregular heartbeat).PreventionFollow your health care provider's treatment recommendations and take all medications as directed.Keep your blood pressure , heart rate, and cholesterol under control as recommended by your doctor. This may involve exercise, a special diet, and medications.Other important treatment measures:Do not smoke.Do not drink alcohol.Reduce salt intake.Exercise as recommended by your health care provider.ReferencesHunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. J Am Coll Cardiol. 2005;46:1-82.Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007: chap 25.Hess OM and Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007: chap 23.Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009 Apr 14;119(14):1977-2016. Epub 2009 Mar 26.
