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Protti I, van den Enden A, Van Mieghem NM, Meuwese CL, Meani P. Looking Back, Going Forward: Understanding Cardiac Pathophysiology from Pressure-Volume Loops. BIOLOGY 2024; 13:55. [PMID: 38275731 PMCID: PMC10813445 DOI: 10.3390/biology13010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
Knowing cardiac physiology is essential for health care professionals working in the cardiovascular field. Pressure-volume loops (PVLs) offer a unique understanding of the myocardial working and have become pivotal in complex pathophysiological scenarios, such as profound cardiogenic shock or when mechanical circulatory supports are implemented. This review provides a comprehensive summary of the left and right ventricle physiology, based on the PVL interpretation.
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Affiliation(s)
- Ilaria Protti
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Antoon van den Enden
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
| | - Nicolas M. Van Mieghem
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
| | - Christiaan L. Meuwese
- Department of Intensive Care and Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, 3012 Rotterdam, The Netherlands; (I.P.)
| | - Paolo Meani
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 Maastricht, The Netherlands
- Thoracic Research Center, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland
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Catheter-Based Management of Heart Failure: Pathophysiology and Contemporary Data. Interv Cardiol Clin 2022; 11:267-277. [PMID: 35710282 PMCID: PMC9797841 DOI: 10.1016/j.iccl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Device therapy for severe heart failure (HF) has shown efficacy both in acute and chronic settings. Recent percutaneous device innovations have pioneered a field known as interventional HF, providing clinicians with a variety of options for acute decompensated HF that are centered on nonsurgical mechanical circulatory support. Other structural-based therapies are aimed at the pathophysiology of chronic HF and target the underlying etiologies such as functional mitral regurgitation, ischemic cardiomyopathy, and increased neurohumoral activity. Remote hemodynamic monitoring devices have also been shown to be efficacious for the ambulatory management of HF. We review the current data on devices and investigational therapies for HF management whereby pharmacotherapy falls short.
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Gottula AL, Shaw CR, Milligan J, Chuko J, Lauria M, Swiencki A, Bonomo J, Ahmad S, Hinckley WR, Gorder KL. Impella in Transport: Physiology, Mechanics, Complications, and Transport Considerations. Air Med J 2022; 41:114-127. [PMID: 35248330 DOI: 10.1016/j.amj.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/10/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
Cardiogenic shock (CS) represents a spectrum of hemodynamic deficits in which the cardiac output is insufficient to provide adequate tissue perfusion. The Impella (Abiomed Inc, Danvers, MA) device, a contemporary percutaneous ventricular support, is most often indicated for classic, deteriorating, and extremis Society for Coronary Angiography and Intervention stages of CS, which describe CS that is not responsive to optimal medical management and conventional treatment measures. Impella devices are an evolving field of mechanical support that is used with increasing frequency. Critical care transport medicine crews are required to transport patient support by the Impella device with increasing frequency. It is important that critical care transport medicine crews are familiar with the Impella device and are able to troubleshoot complications that may arise in the transport environment. This article reviews many aspects of the Impella device critical to the transport of this complex patient population.
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Affiliation(s)
- Adam L Gottula
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
| | - Christopher R Shaw
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Justine Milligan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; Air Care & Mobile Care, University of Cincinnati Health, Cincinnati, OH
| | - Jonathan Chuko
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; Air Care & Mobile Care, University of Cincinnati Health, Cincinnati, OH
| | - Michael Lauria
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM
| | - Amy Swiencki
- Air Care & Mobile Care, University of Cincinnati Health, Cincinnati, OH
| | - Jordan Bonomo
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
| | - Saad Ahmad
- Department of Internal Medicine, Division of Cardiology, University of Cincinnati, Cincinnati, OH
| | - William R Hinckley
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; Air Care & Mobile Care, University of Cincinnati Health, Cincinnati, OH
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