Moslem Doctor
Forum Senior
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in usmle world they say it lead to diastolic dysfunction and impaired diastolic filling (reduced compilance) which lead to reduces right ventricular oout put which lead to decrease left ventricular one also
and we treat with saline infusion first then inotrope next
and my Question
1- it wasnt known that infarction do systolic dysfunction rather than diastolic?
2- if it is really diastolic so why give inotropes??!
3- kaplan and other book mention we use diuretics and b blockers in diastolic disfuction , so in which cases we use ?in cases of pulmonary oedema and left ventricular affection only? or what
thanks for all
thanks
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Say ye: "We believe in Allah, and the revelation given to us, and to Abraham, Isma'il, Isaac, Jacob, and the Tribes, and that given to Moses and Jesus, and that given to (all) prophets from their Lord: We make no difference between one and another of them: And we bow to Allah (in Islam)." Holy Quran
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| doyoudig
Forum Guru
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1. They will have to give you clues that it is one or the other
2. For RV Infarction You give NS 1st b/c u are trying to push fluid forward to incr CO, if that failed then consider + ionotrophs
3. BB are given to incr filling time during distastolic in Pt w/ increased HR of Diastolic Dysf of the LV (less time to fill if the Pts heart is beating too fast)
Diuretics given in Pt has evidence of SEVERE Pulm Edema/Pedal Edema only
ps anyone add or correct
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| Moslem Doctor
Forum Senior
Topics: 41
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thank you dr doyoudig
in that case in uw where they gave NS , the pts had peda edema and JVD , but i think we will sacrify this in purpose to improve CO hence the man has no systolic function proplem and this edema is not in lung (not life threatining )
but still the Question , if the man have diastolic dysfunction why give ionotrops !!?
and the other Question why not use beta blocker in such patient to prolong filling time like we do in lef ventricular diastolic dysfunction ?
___________________
Say ye: "We believe in Allah, and the revelation given to us, and to Abraham, Isma'il, Isaac, Jacob, and the Tribes, and that given to Moses and Jesus, and that given to (all) prophets from their Lord: We make no difference between one and another of them: And we bow to Allah (in Islam)." Holy Quran
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| doyoudig
Forum Guru
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Posts: 613
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This is explanation from another forum and I agree
its more diastolic dysfunction RV filling affected
thus volume loading done to inc RV filling pressure
inotropes may be used after that
RV is mainly a conduit for blood..rather than a systolic force
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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by the way just to answer ur question on BB, they are considered negative inonotrophs, hence giving then in RV infraction would decrease preload, hence decrease CO
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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add
BB r doc in LV diastolic dysfunction...
in RV dysfun the RV compliance( ie distensibilty) is dec so inc the diastolic interval wont matter at all....and the dec preload wud actually be more bad....
more volume can expand the ventricle
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