Fig 3 - uploaded by Thach Nguyen
Content may be subject to copyright.
The common femoral vein is measured at the level immediately proximal to the bifurcation of the superficial and deep femoral artery.
Source publication
In the diagnosis and management of patients with Coronary Artery Disease (CAD) and chronic Left Ventricular (LV) dysfunction or Heart Failure (HF), there are many uncertainties because of the non-specificity of the symptoms and signs of HF. Usually, severe CAD causes LV dysfunction. However, not rarely, LV dysfunction is the cause or aggravation of...
Citations
... questions of when and how these agents are used in patients with CAD and HF [20]. On the other hand, coronary microcirculation dysfunction or coronary vasospasm was considered as one of the causes of myocardial infarction with non-obstructive coronary arteries (MINOCA). ...
Heart Failure (HF) is on the end stage of the disease spectrum with many confounders and thus no specific symptoms and signs. There is a need for a test that can effectively confirm the diagnosis of volume overload in HF at its earliest to guide the initial approach and subsequent management. This study aimed to evaluate the effectiveness of a new test noted as the Size and Expansion of Femoral Vein (SEFV) in the diagnosis and management of patients with HF. This test was used specifically on asymptomatic patients or those who presented with severe comorbidities. The patients who arrived at the emergency room with a diagnosis of HF or suspected HF were enrolled. Ten patients without HF formed the control group. All patients received a standard physical examination (PE). The patients with the obvious diagnosis of HF by PE formed the HF control group. All patients with tentative diagnoses formed the HF study group. All patients underwent the ultrasound test to measure the size of the common femoral vein (CFV) and artery (CFA). The study enlisted 167 patients with HF or suspected HF. The results showed that the SEFV test was more accurate (98%) than the PE (54%). The SEFV test accurately differentiated between severely sick patients with intravascular overload and moderately sick patients with extravascular overflow. The test was accurate in patients with severe comorbidities (93%) or hypotension (100%). The SEFV test was more accurate in confirming the presence of fluid overload in patients with severe comorbidities or hypotension.
This chapter provides the clinical risk factors of mortality and morbidity following acute periprocedural closure in high‐risk patients. The most important mortality factor is severe left ventricular (LV) dysfunction. The chapter lists the strategies for percutaneous coronary intervention (PCI) of complex lesions in high‐risk patients. LV dysfunction is the most important predictor of immediate and long‐term survival in patients with coronary artery disease. In general, patients with acute coronary syndromes having continued, recurrent, or refractory angina should be referred for coronary angiography for subsequent PCI, if needed. The chapter presents strategies for guiding the performance of PCI in multivessel disease. In acute myocardial infarction with mild‐to‐moderate degrees of heart failure and reduced cardiac output, the Impella device seems superior because the hemodynamic support of this device would likely prove sufficient in normalizing the blood pressure while limiting the infarct size.
Acute ST‐segment elevation myocardial infarction (STEMI) is usually caused by acute occlusion of a major epicardial coronary artery in the absence of adequate collateral flow from other coronary territories. Prompt, complete, and sustained recanalization of the infarct‐related artery (IRA) with restoration of normal myocardial perfusion reduces the infarct size, preserves left ventricular function, and decreases mortality. After defining the coronary anatomy and clinical evaluation of the patient, primary percutaneous coronary interventions (PCI) should be attempted if the IRA has a significant stenosis or thrombus with inadequate epicardial flow. Patients presenting with cardiogenic shock should have multiple access points upfront: typically two arterial sites (one of which should be femoral at minimum), and at least one central venous line. PCI can be performed if the bleeding can be stopped by mechanical means (compressing or ligating the artery) and the patient can tolerate 4 h of anticoagulant without excessive further bleeding during PCI.
