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Pulmonary arterial hypertension is a hemodynamic condition defined as a pulmonary artery mean pressure higher than 25 mmHg. However, this may depend on the level of the systemic pressure. Another potential definition could be pulmonary pressure >60% systemic with signs of low cardiac output.
This chapter discusses the anatomical and physiological basis for chronic pulmonary arterial hypertension, its diagnosis and management. Pulmonary arterial hypertension (PAH) can lead to significant cardiac dysfunction and is associated with an increased risk of perioperative cardiovascular complications [1]. The selection of appropriate therapies is complex, requiring familiarity with the underlying...
The definition and classification of cardiomyopathies was recently revised by an expert panel of the American Heart Association [1] following the initial classification by the World Health Organization in 1995 [2]. Cardiomyopathies are considered “a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate...
Pericardial diseases are defined as structural or functional abnormalities of the visceral or parietal pericardium that may or may not have an impact on cardiac function. Diseases of the pericardium include a spectrum of acquired and congenital problems consisting of infectious and inflammatory processes, neoplastic lesions, as well as congenital structural defects.
Infective endocarditis (IE) is defined as a microbial infection of the endocardial surface of the heart. Native and prosthetic valves are the most frequently involved sites. Other sites can be involved, including septal defects, prosthetic materials such as intracardiac patches, surgically created shunts or a naturally occurring shunt such as an arteriovenous shunt. Central venous and pacing catheters...
Heart failure is defined as the inability of the heart’s output to meet the metabolic demands of the body; or the heart is able to meet these demands only in the setting of an abnormally elevated filling pressure. The clinical appearance of a patient with heart failure can vary from a well compensated state, which can be associated with minimal signs or symptoms, to fulminant cardiogenic shock. Heart...
Shock is a situation of circulatory failure characterized by a generalized and severe decrease of tissue oxygen and nutrient delivery. Shock, whatever the etiology, induces reversible and later irreversible cell lesions.
Extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is the implementation of the cardiopulmonary bypass machine for prolonged periods of time to sustain systemic perfusion and gas exchange. The support is preferred for patients with potentially treatable pulmonary or cardiac disease. Currently, it is the most common method of mechanical circulatory support for pediatric...
Cardiac transplantation offers the only hope for survival and improved quality of life for selected children with end-stage heart disease, whether due to cardiomyopathy or congenital defects. The first pediatric transplant was performed by Kantrowitz and associates in December, 1967, only a few days after Dr. Christian Barnard’s pioneering operation in an adult. Interest in transplantation of the...
Recognition and management of disorders of cardiac rate and rhythm are key aspects of the care that must be provided to pediatric patients in the intensive care setting. In this chapter we will discuss the use of the 12 lead ECG, rhythm strip, cardiac bedside monitor, and atrial electrograms in the general approach to the diagnosis of arrhythmias. Management of specific arrhythmias will then be reviewed.
Cardiac output is dependent on normal mechanical function of the heart, which in turn is dependent on normal functioning of the cardiac conduction system. When derangements of cardiac conduction occur, this can result in poor cardiac output acutely as well as poor cardiac reserve chronically. These derangements can occur as a result of bradycardia, tachycardia, or electrical dyssynchrony (atrioventricular...
This chapter addresses some ethically challenging situations that can occur especially in Pediatric Intensive care Units (PICUs) and Pediatric Cardiac Intensive Care Units (PCICUs). It begins with an overview of some principles of Medical Ethics. It continues with a discussion on decision making. Finally it broaches the difficult question of End-of-Life (EOL). This chapter aims at helping cardiac...
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