1
|
Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART II: ADULT PATIENTS AFTER HEART SURGERY. J Cardiopulm Rehabil Prev 2017; 37:397-403. [PMID: 28787352 DOI: 10.1097/hcr.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This clinical skills review describes the most common cardiac auscultatory findings in adults after heart surgery and correlates them with prognostic indicators. It was written for noncardiologist health care providers who work in outpatient cardiac rehabilitation programs.Mechanical prosthetic valves produce typical closing and opening clicks. Listening to their timing and features, as well as to presence and quality of murmurs, contributes to the awareness of potential prosthesis malfunction before other dramatic clinical signs or symptoms become evident. In patients with biological prostheses, murmurs should be carefully evaluated to rule out both valve malfunction and degeneration. Rubs of post-pericardiotomy pericarditis should prompt further investigation for early signs of cardiac tamponade. Third and fourth heart sounds and systolic murmurs in anemic patients should be differentiated from pathological conditions. Relatively new groups of heart surgery patients are those with chronic heart failure treated with continuous-flow left ventricle assist devices. These devices produce characteristic continuous noise that may suddenly disappear or vary in quality and intensity with device malfunction. After heart transplantation, a carefully performed and regularly repeated cardiac auscultation may contribute to suspicion of impending acute rejection. During cardiac rehabilitation, periodic cardiac auscultation may provide useful information regarding clinical-hemodynamic status and allow detection of heralding signs of possible complications in an efficient and low-cost manner.
Collapse
|
2
|
Olivencia-Yurvati AH, Cherry BH, Gurji HA, White DW, Newton JT, Scott GF, Hoxha B, Gourlay T, Mallet RT. Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage. JOURNAL OF CLINICAL & EXPERIMENTAL CARDIOLOGY 2014; 5. [PMID: 25478289 PMCID: PMC4251778 DOI: 10.4172/2155-9880.1000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at −20 cm H2O for 30 min. Results When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, P<0.001). By 30 min, the split drain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications.
Collapse
Affiliation(s)
- Albert H Olivencia-Yurvati
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Brandon H Cherry
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Hunaid A Gurji
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Daniel W White
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - J Tyler Newton
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Gary F Scott
- Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Besim Hoxha
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Terence Gourlay
- Bioengineering Unit, Wolfson Centre, University of Strathclyde, Glasgow, UK
| | - Robert T Mallet
- Departments of Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA ; Departments of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, TX, USA ; Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
4
|
Chen-Scarabelli C. Beating-Heart Coronary Artery Bypass Graft Surgery: Indications, Advantages, and Limitations. Crit Care Nurse 2002. [DOI: 10.4037/ccn2002.22.5.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Carol Chen-Scarabelli
- Carol Chen-Scarabelli is a nurse practitioner in the Division of Cardiothoracic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Fla
| |
Collapse
|