Key Points 1. The rapid development of molecular biologic and genetic techniques has greatly expanded the understanding of cardiac functioning, and these techniques are beginning to be applied clinically. 2. Cardiac ion channels form the machinery behind the cardiac rhythm;…
Key Points 1. To care for patients with coronary artery disease in the perioperative period safely, the clinician must understand how the coronary circulation functions in health and disease. 2. Coronary endothelium modulates myocardial blood flow by producing factors that…
Key Points 1. The cartilaginous skeleton, myocardial fiber orientation, valves, blood supply, and conduction system of the heart determine its mechanical capabilities and limitations. 2. The cardiac myocyte is engineered for contraction and relaxation, not protein synthesis. 3. The cardiac…
Key Points 1. Cardiac arrhythmias are common and result from an ectopic focus or a reentry circuit. 2. Surgical and catheter-based ablative therapies can abolish the origins of arrhythmias by interposition of scar tissue along the reentrant pathway or by…
Key Points 1. The cardiac catheterization laboratory has evolved from a purely diagnostic facility to a therapeutic one in which many facets of cardiovascular disease can be effectively modified or treated. 2. Guidelines for diagnostic cardiac catheterization have established indications,…
Key Points 1. Multivariate modeling has been used to develop risk indices that focus on preoperative variables, intraoperative variables, or both. 2. Key predictors of perioperative risk are dependent on the type of cardiac operation and the outcome of interest.…
Key Points 1. Cardiac surgical patients who require intensive care represent a particular population whose outcomes are dependent on decision-making throughout the perioperative period. 2. Cardiac surgery patients are susceptible to acute kidney injury (AKI) from a variety of mechanisms…
Key Points 1. The care of heart and lung transplant patients requires a multidisciplinary approach by a team dedicated to collaborating to provide the best care. 2. Inotropic therapy is often required for patients undergoing heart or lung transplantation with…
Key Points 1. Intra-aortic balloon pump counterpulsation increases coronary artery perfusion pressure, increases coronary artery blood flow (particularly in cardiogenic shock), and augments cardiac output by approximately 5% to 15%. 2. Catheter-mounted ventricular assist devices (VADs) are available for isolated…
Key Points 1. Maintaining oxygen transport and oxygen delivery appropriately to meet the tissue metabolic needs is the goal of postoperative circulatory control. 2. Cardiac function worsens after cardiac surgery. Therapeutic approaches to reversing this dysfunction, including pharmacologic and mechanical…