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This guide originally accompanied the CD edition of the MGH/MF Waveform
Database. Special thanks to Ken Pierce for scanning a rare printed copy of
this guide, and for converting it with great care and attention to detail into
computer-readable form in order to make its contents available and searchable.
<p>
Follow the links below to jump directly to descriptions of each record in the
database:
<center><table>
<tr>
<td><a href="#mgh001">mgh001</a></td>
<td><a href="#mgh002">mgh002</a></td>
<td><a href="#mgh003">mgh003</a></td>
<td><a href="#mgh004">mgh004</a></td>
<td><a href="#mgh005">mgh005</a></td>
<td><a href="#mgh006">mgh006</a></td>
<td><a href="#mgh007">mgh007</a></td>
<td><a href="#mgh008">mgh008</a></td>
<td><a href="#mgh009">mgh009</a></td>
<td><a href="#mgh010">mgh010</a></td>
</tr>
<tr>
<td><a href="#mgh011">mgh011</a></td>
<td><a href="#mgh012">mgh012</a></td>
<td><a href="#mgh013">mgh013</a></td>
<td><a href="#mgh014">mgh014</a></td>
<td><a href="#mgh015">mgh015</a></td>
<td><a href="#mgh016">mgh016</a></td>
<td><a href="#mgh017">mgh017</a></td>
<td><a href="#mgh018">mgh018</a></td>
<td><a href="#mgh019">mgh019</a></td>
<td><a href="#mgh020">mgh020</a></td>
</tr>
<tr>
<td><a href="#mgh021">mgh021</a></td>
<td><a href="#mgh022">mgh022</a></td>
<td><a href="#mgh023">mgh023</a></td>
<td><a href="#mgh024">mgh024</a></td>
<td><a href="#mgh025">mgh025</a></td>
<td><a href="#mgh026">mgh026</a></td>
<td><a href="#mgh027">mgh027</a></td>
<td><a href="#mgh028">mgh028</a></td>
<td><a href="#mgh029">mgh029</a></td>
<td><a href="#mgh030">mgh030</a></td>
</tr>
<tr>
<td><a href="#mgh031">mgh031</a></td>
<td><a href="#mgh032">mgh032</a></td>
<td><a href="#mgh033">mgh033</a></td>
<td><a href="#mgh034">mgh034</a></td>
<td><a href="#mgh035">mgh035</a></td>
<td><a href="#mgh036">mgh036</a></td>
<td><a href="#mgh037">mgh037</a></td>
<td><a href="#mgh038">mgh038</a></td>
<td><a href="#mgh039">mgh039</a></td>
<td><a href="#mgh040">mgh040</a></td>
</tr>
<tr>
<td><a href="#mgh041">mgh041</a></td>
<td><a href="#mgh042">mgh042</a></td>
<td><a href="#mgh043">mgh043</a></td>
<td><a href="#mgh044">mgh044</a></td>
<td><a href="#mgh045">mgh045</a></td>
<td><a href="#mgh046">mgh046</a></td>
<td><a href="#mgh047">mgh047</a></td>
<td><a href="#mgh048">mgh048</a></td>
<td><a href="#mgh049">mgh049</a></td>
<td><a href="#mgh050">mgh050</a></td>
</tr>
<tr>
<td><a href="#mgh051">mgh051</a></td>
<td><a href="#mgh052">mgh052</a></td>
<td><a href="#mgh053">mgh053</a></td>
<td><a href="#mgh054">mgh054</a></td>
<td><a href="#mgh055">mgh055</a></td>
<td><a href="#mgh056">mgh056</a></td>
<td><a href="#mgh057">mgh057</a></td>
<td><a href="#mgh058">mgh058</a></td>
<td><a href="#mgh059">mgh059</a></td>
<td><a href="#mgh060">mgh060</a></td>
</tr>
<tr>
<td><a href="#mgh061">mgh061</a></td>
<td><a href="#mgh062">mgh062</a></td>
<td><a href="#mgh063">mgh063</a></td>
<td><a href="#mgh064">mgh064</a></td>
<td><a href="#mgh065">mgh065</a></td>
<td><a href="#mgh066">mgh066</a></td>
<td><a href="#mgh067">mgh067</a></td>
<td><a href="#mgh068">mgh068</a></td>
<td><a href="#mgh069">mgh069</a></td>
<td><a href="#mgh070">mgh070</a></td>
</tr>
<tr>
<td><a href="#mgh071">mgh071</a></td>
<td><a href="#mgh072">mgh072</a></td>
<td><a href="#mgh073">mgh073</a></td>
<td><a href="#mgh074">mgh074</a></td>
<td><a href="#mgh075">mgh075</a></td>
<td><a href="#mgh076">mgh076</a></td>
<td><a href="#mgh077">mgh077</a></td>
<td><a href="#mgh078">mgh078</a></td>
<td><a href="#mgh079">mgh079</a></td>
<td><a href="#mgh080">mgh080</a></td>
</tr>
<tr>
<td><a href="#mgh081">mgh081</a></td>
<td><a href="#mgh082">mgh082</a></td>
<td><a href="#mgh083">mgh083</a></td>
<td><a href="#mgh084">mgh084</a></td>
<td><a href="#mgh085">mgh085</a></td>
<td><a href="#mgh086">mgh086</a></td>
<td><a href="#mgh087">mgh087</a></td>
<td><a href="#mgh088">mgh088</a></td>
<td><a href="#mgh089">mgh089</a></td>
<td><a href="#mgh090">mgh090</a></td>
</tr>
<tr>
<td><a href="#mgh091">mgh091</a></td>
<td><a href="#mgh092">mgh092</a></td>
<td><a href="#mgh093">mgh093</a></td>
<td><a href="#mgh094">mgh094</a></td>
<td><a href="#mgh095">mgh095</a></td>
<td><a href="#mgh096">mgh096</a></td>
<td><a href="#mgh097">mgh097</a></td>
<td><a href="#mgh098">mgh098</a></td>
<td><a href="#mgh099">mgh099</a></td>
<td><a href="#mgh100">mgh100</a></td>
</tr>
<tr>
<td><a href="#mgh101">mgh101</a></td>
<td><a href="#mgh102">mgh102</a></td>
<td><a href="#mgh103">mgh103</a></td>
<td><a href="#mgh104">mgh104</a></td>
<td><a href="#mgh105">mgh105</a></td>
<td><a href="#mgh106">mgh106</a></td>
<td><a href="#mgh107">mgh107</a></td>
<td><a href="#mgh108">mgh108</a></td>
<td><a href="#mgh109">mgh109</a></td>
<td><a href="#mgh110">mgh110</a></td>
</tr>
<tr>
<td><a href="#mgh111">mgh111</a></td>
<td><a href="#mgh112">mgh112</a></td>
<td><a href="#mgh113">mgh113</a></td>
<td><a href="#mgh114">mgh114</a></td>
<td><a href="#mgh115">mgh115</a></td>
<td><a href="#mgh116">mgh116</a></td>
<td><a href="#mgh117">mgh117</a></td>
<td><a href="#mgh118">mgh118</a></td>
<td><a href="#mgh119">mgh119</a></td>
<td><a href="#mgh120">mgh120</a></td>
</tr>
<tr>
<td><a href="#mgh121">mgh121</a></td>
<td><a href="#mgh122">mgh122</a></td>
<td><a href="#mgh123">mgh123</a></td>
<td><a href="#mgh124">mgh124</a></td>
<td><a href="#mgh125">mgh125</a></td>
<td><a href="#mgh126">mgh126</a></td>
<td><a href="#mgh127">mgh127</a></td>
<td><a href="#mgh128">mgh128</a></td>
<td><a href="#mgh129">mgh129</a></td>
<td><a href="#mgh130">mgh130</a></td>
</tr>
<tr>
<td><a href="#mgh131">mgh131</a></td>
<td><a href="#mgh132">mgh132</a></td>
<td><a href="#mgh133">mgh133</a></td>
<td><a href="#mgh134">mgh134</a></td>
<td><a href="#mgh135">mgh135</a></td>
<td><a href="#mgh136">mgh136</a></td>
<td><a href="#mgh137">mgh137</a></td>
<td><a href="#mgh138">mgh138</a></td>
<td><a href="#mgh139">mgh139</a></td>
<td><a href="#mgh140">mgh140</a></td>
</tr>
<tr>
<td><a href="#mgh141">mgh141</a></td>
<td><a href="#mgh142">mgh142</a></td>
<td><a href="#mgh143">mgh143</a></td>
<td><a href="#mgh144">mgh144</a></td>
<td><a href="#mgh145">mgh145</a></td>
<td><a href="#mgh146">mgh146</a></td>
<td><a href="#mgh147">mgh147</a></td>
<td><a href="#mgh148">mgh148</a></td>
<td><a href="#mgh149">mgh149</a></td>
<td><a href="#mgh150">mgh150</a></td>
</tr>
<tr>
<td><a href="#mgh151">mgh151</a></td>
<td><a href="#mgh152">mgh152</a></td>
<td><a href="#mgh153">mgh153</a></td>
<td><a href="#mgh154">mgh154</a></td>
<td><a href="#mgh155">mgh155</a></td>
<td><a href="#mgh156">mgh156</a></td>
<td><a href="#mgh157">mgh157</a></td>
<td><a href="#mgh158">mgh158</a></td>
<td><a href="#mgh159">mgh159</a></td>
<td><a href="#mgh160">mgh160</a></td>
</tr>
<tr>
<td><a href="#mgh161">mgh161</a></td>
<td><a href="#mgh162">mgh162</a></td>
<td><a href="#mgh163">mgh163</a></td>
<td><a href="#mgh164">mgh164</a></td>
<td><a href="#mgh165">mgh165</a></td>
<td><a href="#mgh166">mgh166</a></td>
<td><a href="#mgh167">mgh167</a></td>
<td><a href="#mgh168">mgh168</a></td>
<td><a href="#mgh169">mgh169</a></td>
<td><a href="#mgh170">mgh170</a></td>
</tr>
<tr>
<td><a href="#mgh171">mgh171</a></td>
<td><a href="#mgh172">mgh172</a></td>
<td><a href="#mgh173">mgh173</a></td>
<td><a href="#mgh174">mgh174</a></td>
<td><a href="#mgh175">mgh175</a></td>
<td><a href="#mgh176">mgh176</a></td>
<td><a href="#mgh177">mgh177</a></td>
<td><a href="#mgh178">mgh178</a></td>
<td><a href="#mgh179">mgh179</a></td>
<td><a href="#mgh180">mgh180</a></td>
</tr>
<tr>
<td><a href="#mgh181">mgh181</a></td>
<td><a href="#mgh182">mgh182</a></td>
<td><a href="#mgh183">mgh183</a></td>
<td><a href="#mgh184">mgh184</a></td>
<td><a href="#mgh185">mgh185</a></td>
<td><a href="#mgh186">mgh186</a></td>
<td><a href="#mgh187">mgh187</a></td>
<td><a href="#mgh188">mgh188</a></td>
<td><a href="#mgh189">mgh189</a></td>
<td><a href="#mgh190">mgh190</a></td>
</tr>
<tr>
<td><a href="#mgh191">mgh191</a></td>
<td><a href="#mgh192">mgh192</a></td>
<td><a href="#mgh193">mgh193</a></td>
<td><a href="#mgh194">mgh194</a></td>
<td><a href="#mgh195">mgh195</a></td>
<td><a href="#mgh196">mgh196</a></td>
<td><a href="#mgh197">mgh197</a></td>
<td><a href="#mgh198">mgh198</a></td>
<td><a href="#mgh199">mgh199</a></td>
<td><a href="#mgh200">mgh200</a></td>
</tr>
<tr>
<td><a href="#mgh201">mgh201</a></td>
<td><a href="#mgh202">mgh202</a></td>
<td><a href="#mgh203">mgh203</a></td>
<td><a href="#mgh204">mgh204</a></td>
<td><a href="#mgh205">mgh205</a></td>
<td><a href="#mgh206">mgh206</a></td>
<td><a href="#mgh207">mgh207</a></td>
<td><a href="#mgh208">mgh208</a></td>
<td><a href="#mgh209">mgh209</a></td>
<td><a href="#mgh210">mgh210</a></td>
</tr>
<tr>
<td><a href="#mgh211">mgh211</a></td>
<td><a href="#mgh212">mgh212</a></td>
<td><a href="#mgh213">mgh213</a></td>
<td><a href="#mgh214">mgh214</a></td>
<td><a href="#mgh215">mgh215</a></td>
<td><a href="#mgh216">mgh216</a></td>
<td><a href="#mgh217">mgh217</a></td>
<td><a href="#mgh218">mgh218</a></td>
<td><a href="#mgh219">mgh219</a></td>
<td><a href="#mgh220">mgh220</a></td>
</tr>
<tr>
<td><a href="#mgh221">mgh221</a></td>
<td><a href="#mgh222">mgh222</a></td>
<td><a href="#mgh223">mgh223</a></td>
<td><a href="#mgh224">mgh224</a></td>
<td><a href="#mgh225">mgh225</a></td>
<td><a href="#mgh226">mgh226</a></td>
<td><a href="#mgh227">mgh227</a></td>
<td><a href="#mgh228">mgh228</a></td>
<td><a href="#mgh229">mgh229</a></td>
<td><a href="#mgh230">mgh230</a></td>
</tr>
<tr>
<td><a href="#mgh231">mgh231</a></td>
<td><a href="#mgh232">mgh232</a></td>
<td><a href="#mgh233">mgh233</a></td>
<td><a href="#mgh234">mgh234</a></td>
<td><a href="#mgh235">mgh235</a></td>
<td><a href="#mgh236">mgh236</a></td>
<td><a href="#mgh237">mgh237</a></td>
<td><a href="#mgh238">mgh238</a></td>
<td><a href="#mgh239">mgh239</a></td>
<td><a href="#mgh240">mgh240</a></td>
</tr>
<tr>
<td><a href="#mgh241">mgh241</a></td>
<td><a href="#mgh242">mgh242</a></td>
<td><a href="#mgh243">mgh243</a></td>
<td><a href="#mgh244">mgh244</a></td>
<td><a href="#mgh245">mgh245</a></td>
<td><a href="#mgh246">mgh246</a></td>
<td><a href="#mgh247">mgh247</a></td>
<td><a href="#mgh248">mgh248</a></td>
<td><a href="#mgh249">mgh249</a></td>
<td><a href="#mgh250">mgh250</a></td>
</tr>
</table></center>
<a href="#top">[top]</a>
<a name="mgh001"> </a>
<h3>Record: mgh001</h3>
<pre>
PATIENT DATA:
AGE/SEX:
80 year old female
DIAGNOSIS/SURGERY:
Carotid endartarectomy
PERTINENT HISTORY:
Congenital complete heart block
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Third degree heart block with junctional escape rhythm and intra-ventricular conduction defect @ 40 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
ECG INTERPRETATION:
Left atrial hypertrophy
Left ventricular hypertrophy
Intraventricular conduction defect
Possible old lateral myocardial infarction
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 140/50
PAP: 56/16
RAP: 10
WAVEFORM PATTERNS:
"Cannon waves" in CVP due to A-V asynchrony with CHB
Retrograde cannon wave effect in pulmonary arterial trace.
Pulmonary hypertension.
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh002"> </a>
<h3>Record: mgh002</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
Aorto-bifemoral graft
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 80 bpm
RHYTHM DISTURBANCES:
Junctional ectopy, occasional aberrant conduction
Onset of junctional rhythm @ 1 min
Conversion to NSR @ 24 min (carotid sinus massage and verapamil)
Unifocal ventricular ectopy
ECG INTERPRETATION:
Left atrial enlargement
Left anterior hemiblock
Old inferior infarct
TECHNICAL COMMENTS:
Chest lead = V2
HEMODYNAMIC DATA:
ART: 130/60 MEAN: 85
PAP: 32/8 PCW: 6 (@ 68 min)
RAP: 4
WAVEFORM PATTERNS:
Cannon waves in CVP with junctional rhythm due to A-V asynchrony
Ventricular ectopy produces "V waves" in the CVP trace
TECHNICAL COMMENTS:
Zero, cal and pop-tests @ 24 min - 377 min
RESPIRATORY DATA:
RATE: 14 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh003"> </a>
<h3>Record: mgh003</h3>
<pre>
PATIENT DATA:
AGE/SEX:
47 year old female
DIAGNOSIS/SURGERY:
Exploratory laporatomy for small bowel obstruction
PERTINENT HISTORY:
Terminal condition
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 140 bpm
ECG INTERPRETATION:
Low voltage ECG
Poor R wave progression consistent with counterclockwise rotation
Old antero-septal infarction less likely
Non-specific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 120/80 (pre-recording: hypotensive during recording)
PAP: 48/28 PCW: 19 (@ 21 min, 24 min)
RAP: 9
WAVEFORM PATTERNS:
Hypotension
Pulsus paradox
Marked respiratory variation
RESPIRATORY DATA:
RATE: 36 bpm
MODE OF VENTILATION:
Spontaneous
COMMENTS:
Respiratory pattern is rapid and labored
</pre>
<a href="#top">[top]</a>
<a name="mgh004"> </a>
<h3>Record: mgh004</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old female
DIAGNOSIS/SURGERY:
Acute cholecystitis
Cholecystectomy
GENERAL COMMENTS:
Short recording due to unexpected patient transfer
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 68 bpm
RHYTHM DISTURBANCES:
A trial ectopy
Premature junctional beats
Unifocal junctional ectopy
ECG INTERPRETATION:
Low ECG voltage
Left atrial enlargement
Poor R wave progression; ? old antero-septal infarct
Non-specific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 140/50
PAP: 32/16 PCW: 12 (@ 13 min)
RAP: 5
WAVEFORM PATTERNS:
Pulsus paradox
Respiratory variation
"Catheter whip" in PA trace with spiking in the PCW
Enlarged "a wave" in RA trace
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh005"> </a>
<h3>Record: mgh005</h3>
<pre>
PATIENT DATA:
AGE/SEX:
56 year old male
DIAGNOSIS/SURGERY:
Aortobifemoral graft
GI bleed
Exploratory laporotomy
Sepsis
PHARMACOLOGIC SUPPORT:
Dopamine @ 213 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 100 bpm
ECG INTERPRETATION:
Old antero-lateral infarct
Anterior ST segment elevation consistent with aneurysm
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 90
PAP: 28/20 PCW: 14 (@ 26 min, 31 min, 42 min, 58 min)
RAP: 12 CO: 9.2
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
ART pop-test unusual; tracing damped during recording
Transducer dome noted to be defective at end of case
RESPIRATORY DATA:
RATE: 12 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
Sidestream sensor with Datex unit on @ 55 min
</pre>
<a href="#top">[top]</a>
<a name="mgh006"> </a>
<h3>Record: mgh006</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old male
DIAGNOSIS/SURGERY:
Endocarditis
Sepsis
PHARMACOLOGIC SUPPORT:
Dopamine @ 950 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Ventricular pacing @ 100 bpm for sinus rhythm with A-V dissociation
PACEMAKER INFORMATION:
Temporary ventricular fixed rate pacing (VOO)
Transvenous wires (USCI bipolar #4)
Medtronic generator (output 5 mv)
Non-functional permanent coplin lithium pacer
TECHNICAL COMMENTS:
Pacer mode (CH2) activated @ 22 min
Persistent ECG interference
HEMODYNAMIC DATA:
ART: 120/50 MEAN: 72
PAP: 47/20 PCW: 17(@ 20 min, 32 min, 39 min)
RAP: 11
WAVEFORM PATTERNS:
Intermittent cannon waves in CVP and PCW due to A-V asynchrony
TECHNICAL COMMENTS:
CVP transduced with medications infusing simultaneously via pump
CVP on without medications @ 9 min - 11 min
Simultaneous CVP and PCW recording @ 20 min
RESPIRATORY DATA:
RATE: 8/22 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
Datex sidestream sensor
CO2 monitor malfunction @ 36 min, turned off
</pre>
<a href="#top">[top]</a>
<a name="mgh007"> </a>
<h3>Record: mgh007</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old female
DIAGNOSIS/SURGERY:
Multiple trauma
Aortic graft
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with first degree heart block @ 85 bpm
ECG INTERPRETATION:
Counterclockwise rotation
HEMODYNAMIC DATA:
ART: 120/80 MEAN: 92
PAP: 32/18 PCW: 12(@ 22 min, 31 min, 40 min)
RAP: 12
WAVEFORM PATTERNS:
Classic hemodynamic traces
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh008"> </a>
<h3>Record: mgh008</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old female
DIAGNOSIS/SURGERY:
Colon resection
Prosthetic valve
Endocarditis
PERTINENT HISTORY:
Aortic stenosis and regurgitation
Slight tricuspid regurgitation
s/p mitral valve replacement
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation with ventricular demand pacing @ 80 bpm
PACEMAKER DATA:
Permanent ventricular demand pacing (VVI)
Unipolar wire
Specifics unavailable
ECG INTERPRETATION:
minor nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 100/60 MEAN: 70
PAP: 34/16 PCW: 14 (@ 9 min, 16 min, 21 min, 30 min, 33 min)
RAP: 10
WAVEFORM PATTERNS:
"V waves" in PCW due to reduced atrial compliance with atrial hypertropy
"V waves" in CVP due to tricuspid regurgitation
Retrograde V wave spikes in the PA trace
Intermittent "overwedge" configuration is noted in PCW @ 30 min
Respiratory variation
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh009"> </a>
<h3>Record: mgh009</h3>
<pre>
PATIENT DATA:
AGE/SEX:
56 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of thoraco-abdominal aneurysm
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 105 bpm
ECG INTERPRETATION:
Left axis deviation
Minor nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
6O-cycle interference in Lead I
Movement artifact in V lead
HEMODYNAMIC DATA:
ART: 150/80 MEAN: 103
PAP: 26/16 PCW: 12 (@ 12 min, 27 min, 59 min)
RAP: 12
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
CVP re-zeroed @ 11 min
RESPIRATORY DATA:
RATE: 6/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh010"> </a>
<h3>Record: mgh010</h3>
<pre>
PATIENT DATA:
AGE/SEX:
56 year old female
DIAGNOSIS/SURGERY:
Mitral regurgitation
Prosthetic mitral valve endocarditis
Pneumonia
PERTINENT HISTORY:
sip mitral valve replacement (porcine)
PHARMACOLOGIC SUPPORT:
Initial rates: Nipride @ 125 mcg/mln; Dobutamine @ 686 mcg/min
Adjusted rates: Nipride to 50 mcg/min; Dopamine @ 150 mcg/min;
Dobutamine unchanged
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with first degree heart block @ 120 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy
Occasional couplets
Short runs of ventricular tachycardia
Changing P-R ? Wenckebach pattern
ECG INTERPRETATION:
Non-specific STT wave changes
Probable right ventricular hypertrophy
HEMODYNAMIC DATA:
ART: 98/60
PAP: 80/35 PCW: 36 (V wave = 42) (@ 30 min, 42 min, 47 min, 61 min, 61 min)
RAP: 16
WAVEFORM PATTERNS:
Intermittent "V waves" in pulmonary capillary wedge tracing
Unusual CVP trace due to heart block
Intermittent cannon waves
Pulmonary hypertension
Respiratory variation
TECHNICAL COMMENTS:
CVP off @ 57 min
RESPIRATORY DATA:
RATE: 17 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh011"> </a>
<h3>Record: mgh011</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old female
DIAGNOSIS/SURGERY:
Nephrectomy
Renal artery bypass graft
PERTINENT HISTORY:
Mitral regurgitation
PHARMACOLOGIC SUPPORT:
TNG paste
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intraventricular conduction defect @ 70 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy occasionally in a quadrageminal pattern
ECG INTERPRETATION:
Left atrial enlargement
Probable left ventricular hypertrophy
Old inferior infarct of indeterminate age with persistent ST segment elevation
Apicolateral ST segment and T wave abnormalities consistent with subendocardial ischemia
HEMODYNAMIC DATA:
ART: 150/60 MEAN: 102
PAP: 32/16 PCW: 10 (@ 9 min, 19 min, 36 min, 36 min)
RAP: 6 CO: 4.3
WAVEFORM PATTERNS:
V waves in right atrial tracing due to ventricular ectopy
Pulsus paradox
Respiratory variation
TECHNICAL COMMENTS:
Bolus of 200 ml volume (Ringers Lactate) @ 23 min
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh012"> </a>
<h3>Record: mgh012</h3>
<pre>
PATIENT DATA:
AGE/SEX:
77 year old female
DIAGNOSIS/SURGERY:
Burn trauma
PHARMACOLOGIC SUPPORT:
Aminophylline @ 20 mgm/hr
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Multifocal atrial tachycardia @ 120 bpm
RHYTHM CHANGES:
Occasional aberrant conduction
Acceleration of rate particularly during IMV breaths
ECG INTERPRETATION:
Low voltage
Diffuse nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 123/54
PAP: 42/20 PCW: 14 (@ 17 min, 26 min, 44 min)
RAP: 16 (not recorded)
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
Marked respiratory variation
RESPIRATORY DATA:
RATE: 11/21 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh013"> </a>
<h3>Record: mgh013</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old male
DIAGNOSIS/SURGERY:
Angioplasty of right external iliac artery
PATIENT HISTORY:
Coronary disease (unstable angina)
Cerebral vascular disease
Smoking
PHARMACOLOGIC SUPPORT:
TNG @ 30 mcg/min
GENERAL COMMENTS:
Recording in vascular angiography suite
Movement artifact due to patient re-positioning and agitation
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation with incomplete left bundle branch block @ 78 bpm
RHYTHM CHANGES:
Ventricular ectopy
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities consistent with digitalis effect
TECHNICAL COMMENTS:
Chest lead = V6 (re-positioned for angiography)
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 87
PAP: 56/32
RAP: 10 CO:5
WAVEFORM PATTERNS:
Pulmonary artery catheter migrates into right ventricle @ 66 min
Catheter re-positioned until end of trace
Pulmonary hypertension
TECHNICAL COMMENTS:
No initial cal and pop-tests
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh014"> </a>
<h3>Record: mgh014</h3>
<pre>
PATIENT DATA:
AGE/SEX:
58 year Old male
DIAGNOSIS/SURGERY:
Coronary artery bypass graft
PHARMACOLOGIC SUPPORT:
Dopamine @ 150 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 70 min - 71 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial pacing @ 95 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
PACEMAKER DATA:
Temporary atrial fixed rate pacing (AOO)
Epicardial wires
Medtronic 5330 pulse generator
MA 15
ECG INTERPRETATION:
Anterior infarct
? subendocardial apico-lateral infarct
Nonspecific ST segment and T wave abnormalities consistent with digitalis effect or ischemia
TECHNICAL COMMENTS:
Chest lead = V3
HEMODYNAMIC DATA:
ART: 114/58 MEAN: 84
PAP: 41/13
RAP: 13
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Aries console
1:8 balloon ratio (1: 1.1 :2.1:4 during timing sequence)
WAVEFORM INTERPRETATION:
Radial and aortic lumen IABP traces are recorded.
Timing sequences @ 14 min- 18 min and 29 min-33 min
Late deflation and early inflation during timing sequence
TECHNICAL COMMENTS:
Zero to RAD lumen @ 11 min
Zero to AO lumen @ 12 min
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh015"> </a>
<h3>Record: mgh015</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year Old male
DIAGNOSIS/SURGERY:
Femoral-popliteal bypass graft
PERTINENT HISTORY:
Coronary disease (unstable angina)
Cerebral vascular disease
Smoking
PHARMACOLOGIC SUPPORT:
TNG @ 50 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with first degree A-V block and incomplete left bundle branch block @ 75 bpm
RHYTHM DISTURBANCES:
Atrial tachycardia with 2: 1 block
? Mobitz II 2: 1 to 4: 1 block
Unifocal ventricular ectopy (rare)
ECG INTERPRETATION:
Diffuse ST segment and T wave abnormalities consistent with digitalis effect.
subendocardial ischemia
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 71
PAP: 36/16 PCW: 16 (@ 13 min, 39 min, 44 min)
RAP: 11 CO: 3.6
WAVEFORM PATTERNS:
"Catheter Whip" in PA trace
RESPIRATORY DATA:
RATE: 6/24 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh016"> </a>
<h3>Record: mgh016</h3>
<pre>
PATIENT DATA:
AGE/SEX:
82 year old male
DIAGNOSIS/SURGERY:
Abdominal aortic aneurysm resection and grafting
PERTINENT HISTORY:
Coronary disease (MI, angina)
Carotid disease
Smoking
PHARMACOLOGIC SUPPORT:
TNG @ 60 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
1: 1 ventricular pacing @ 50 bpm for tachy-brady syndrome
PACEMAKER DATA:
Permanent ventricular demand pacer
Specifics unavailable
ECG INTERPRETATION:
Non-specific STT wave changes
? Old infarct
HEMODYNAMIC DATA:
ART: 150/70 MEAN: 83
PAP: 20/8 PCW: 6 (@ 11 min, 15 min, 41 min, 44 min)
RAP: 3 CO: 3.5
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 2/18 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh017"> </a>
<h3>Record: mgh017</h3>
<pre>
PATIENT DATA:
AGE/SEX:
74 year old male
DIAGNOSIS/SURGERY:
Mitral valve replacement and coronary artery bypass graft
PERTINENT HISTORY:
Systemic and pulmonary hypertension
COPD
Peripheral vascular disease
PHARMACOLOGIC SUPPORT:
Dopamine @ 208 mcg/min
Regitine @ 28 mcg/min
Inocor
GENERAL COMMENTS:
Suctioned and ambued @ 48 min - 63 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 100 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
Inferior infarct
Right ventricular hypertrophy
Right axis deviation
Non-specific sn wave changes
Counterclockwise rotation
HEMODYNAMIC DATA:
ART: 123/56 MEAN: 95
PAP: 66/28
RAP: 13 Cl:2.5
INTRA-AORTIC BALLOON DATA:
40 cc balloon (transthoracic insertion)
Aries console
1: 1 balloon ratio
WAVEFORM PATTERNS:
Radial and femoral arterial IABP traces
Pulmonary hypertension
Respiratory variation; variation disappears during transient disconnection of ventilator
V wave in LA trace
TECHNICAL COMMENTS:
LA/CVP/PAP on same transducer
LA recordings: 13 min, 30 min - 36 min, 66 min - 67 min
CVP recordings: 14 min, 69 min - 70 min
PAP recordings: (wedge non-functional) 14 min, 38 min - 42 min, 67 min - 68 min
Art pop-test: 16 min
CVP zero: 15 min
RESPIRATORY DATA:
RATE: 6 bpm
MODE OF VENTILATION:
Controlled with rare spontaneous breaths
COMMENTS:
Impedance on @ 41 min
</pre>
<a href="#top">[top]</a>
<a name="mgh018"> </a>
<h3>Record: mgh018</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old male
DIAGNOSIS/SURGERY:
Repair of duodenal ulcer
PERTINENT HISTORY:
COPD
GENERAL COMMENTS:
Bedmaking
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 98 bpm
RHYTHM DISTURBANCES:
Multifocal atrial ectopy
Junctional escape beats
Multifocal ventricular ectopy
Ventricular bigeminy/couplets
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities
Anteroseptal infarct of indeterminate age
COMMENTS:
This tracing illustrates the electrocardiographic changes commonly observed during insertion of a pulmonary arterial catheter.
As the catheter moves through the right ventricle, multifocal ventricular ectopy appears, occasionally in a bigeminal pattern or in pairs.
Premature atrial contractions and a junctional escape beat are evident as the catheter traverses the pulmonary artery.
HEMODYNAMIC DATA:
ART: 160/64
PAP: 41/24 PCW: 15 (@ 38 min, 42 min, 43 min, 51 min)
RAP: 16
WAVEFORM PATTERNS:
This tracing illustrates the hemodynamic patterns observed during insertion of a pulmonary arterial catheter.
As the catheter is advanced through the right atrium, right ventricle and pulmonary artery into the pulmonary capillary wedge position, distinctive hemodynamic patterns are evident.
TECHNICAL COMMENTS:
Insertion of pulmonary arterial catheter @ 0-10 min
CVP damped @ 52 min - 55 min
RESPIRATORY DATA:
RATE: 13/22 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
On @ 11 min
</pre>
<a href="#top">[top]</a>
<a name="mgh019"> </a>
<h3>Record: mgh019</h3>
<pre>
PATIENT DATA:
AGE/SEX:
79 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Smoking
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 90 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy
ECG INTERPRETATION:
Non-specific sn wave changes
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 88
PAP: 28/12 PCW: 8 (@ 23 min, 44 min, 52 min)
RAP: 6 CO: 3.4
RESPIRATORY DATA:
RATE: 2/11 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh020"> </a>
<h3>Record: mgh020</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old female
DIAGNOSIS/SURGERY:
Axillo-popliteal bypass graft
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
Dopamine @ 150 mcg/min
COMMENTS:
Arrhythmias on mgh137 with potassium therapy on mgh020
Stop/FFW @ 23 min
Bed changed @ 43 min - 53 min
Suctioning @ 54 min - 56 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Junctional rhythm with right bundle branch block @ 96 bpm
RHYTHM DISTURBANCES:
Runs of junctional tachycardia
Atrial ectopy
ECG INTERPRETATION:
Low voltage
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Wandering baseline
HEMODYNAMIC DATA:
ART: 110/70 MEAN: 75
PAP: 36/20 PCW: 14 (@ 5 min, 6 min, 66 min)
RAP: 11 CO: 2.2
WAVEFORM PATTERNS:
The abrupt conversion of junctional rhythm to junctional tachycardia creates ringing in the pulmonary arterial tracing and elevation of arterial diastolic pressure.
These changes subside with resumption of a slower rhythm. Central vascular pressures exhibit the pattern of respiratory variation of controlled ventilation.
TECHNICAL COMMENTS:
PA zero @ 9 min
RESPIRATORY DATA:
RATE: 7 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh021"> </a>
<h3>Record: mgh021</h3>
<pre>
PATIENT DATA:
AGE/SEX:
75 year old male
DIAGNOSIS/SURGERY:
Upper GI bleeding
PERTINENT HISTORY:
Coronary disease
Peripheral vascular disease
PHARMACOLOGIC SUPPORT:
Pitressin @ 12 mcg/min
TNG @ 30 mcg/min, then 100 mcg/min
Dopamine @ 320 mcg/min (then OFF @ 31 min)
GENERAL COMMENTS:
Recording ends @ 44 min with final annotation sequence
Re-started @ 44 min - 51 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 92 bpm
RHYTHM DISTURBANCES:
Atrial ectopy with bigeminal pattern
Supraventricular tachycardia
Multifocal ventricular ectopy, occasional fusion beats
ECG INTERPRETATION:
Question acute anterior subendocardial injury and possibly evolving infarction
TECHNICAL COMMENTS:
Wandering baseline
Carotid sinus massage @ 31 min
HEMODYNAMIC DATA:
ART: 100/75 MEAN: 85
(femoral)
PAP: 34/24
RAP: 16 CO: 3.2
WAVEFORM PATTERNS:
Fluctuations in arterial pressure
Respiratory variation
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh022"> </a>
<h3>Record: mgh022</h3>
<pre>
PATIENT DATA:
AGE/SEX:
74 year old male
DIAGNOSIS/SURGERY:
Upper GI bleed
PERTINENT HISTORY:
Coronary disease
Peripheral vascular disease
GENERAL COMMENTS:
Stop/FFW @ 62 min - 63 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 85 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasional blocked conduction
Multifocal ventricular ectopy with ventricular bigeminy, couplets and idioventricular rhythm (@ 0-13 min)
ECG INTERPRETATION:
Acute anterior subendocardial injury, question evolving infarction
HEMODYNAMIC DATA:
ART: 120/70 MEAN: 93
(femoral)
PAP: 36/20 PCW: 16 (@ 35 min, 49 min, 65 min)
RAP: 8 CO: 5.3
WAVEFORM PATTERNS:
"Catheter whip"
Respiratory variation
Arrhythmias produce A-V asynchrony in the right atrial pressure trace
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
CO2 RECORDING:
An impedance signal on @ 51 min
</pre>
<a href="#top">[top]</a>
<a name="mgh023"> </a>
<h3>Record: mgh023</h3>
<pre>
PATIENT DATA:
AGE/SEX:
78 year old male
DIAGNOSIS/SURGERY:
Cerebral hemorrhage
PERTINENT HISTORY:
Coronary disease
GENERAL COMMENTS:
Stop/FFW @ 35 min - 68 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial flutter with variable block @ 60 bpm, occasional aberrant conduction
RHYTHM DISTURBANCES:
Conversion to atrial fibrillation, occasional aberrant conduction
Ventricular ectopy, occasional bigeminy
ECG INTERPRETATION:
Antero-septal infarct
Antero-apical ischemia
Nonspecific T wave abnormalities
TECHNICAL COMMENTS:
Wandering baseline in Leads I and II near end of trace
HEMODYNAMIC DATA:
ART: 150/50
PAP: 49/26 PCW: 21 (not recorded)
RAP: 14
WAVEFORM PATTERNS:
Pulmonary hypertension
"Catheter whip" in pulmonary arterial trace
RESPIRATORY DATA:
RATE: 12/12 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh024"> </a>
<h3>Record: mgh024</h3>
<pre>
PATIENT DATA:
AGE/SEX:
55 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
Renal bypass graft
PERTINENT HISTORY:
Coronary disease
Renovascular hypertension
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Junctional tachycardia with intraventricular conduction defect @ 103 bpm
ECG INTERPRETATION:
Poor R wave progression, possibly secondary to intraventricular conduction defect
Possible old inferior infarct
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 168/102 NIBP MEAN: 113
PAP: 24/12 PCW: 12 (@ 13 min, 24 min, 45 min, 63 min)
RAP: 6 CO: 9
WAVEFORM PATTERNS:
Cannon waves with junctional tachycardia
TECHNICAL COMMENTS:
Arterial tracing not recorded; non-invasive blood pressure device in operation
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh025"> </a>
<h3>Record: mgh025</h3>
<pre>
PATIENT DATA:
AGE/SEX:
69 year old male
DIAGNOSIS/SURGERY:
Resection of bilateral iliac aneurysms
PERTINENT HISTORY:
Coronary disease
PHARMACOLOGIC SUPPORT:
TNG @ 100 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 26 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial flutter with intra-ventricular conduction defect @ 54 bpm
RHYTHM DISTURBANCES:
ECG INTERPRETATION:
Left atrial hypertrophy
Non-specific sn wave changes
Poor precordial R wave progression
? Old anteroseptal infarct
Possible old inferior infarct
TECHNICAL COMMENTS:
Muscle tremor, agitated, out of bed
?Change in lead configuration
LL and V electrode changed @ 26 min
HEMODYNAMIC DATA:
ART: 180/40 MEAN: 82
PAP: 40/11 to 56/24 PCW: 11 (@ 13 min, 38 min, 43 min, 57 min)
RAP: 8
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
Respiratory variation
RESPIRATORY DATA:
RATE: 7/16 changed to 5/16 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
On @ 26 min
</pre>
<a href="#top">[top]</a>
<a name="mgh026"> </a>
<h3>Record: mgh026</h3>
<pre>
PATIENT DATA:
AGE/SEX:
74 year old female
DIAGNOSIS/SURGERY:
Aorto-bifemoral bypass graft
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 50 mcg/min, then 100 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with right bundle branch block @ 100 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy with occasional bigeminy, couplets, and fusion beats (0-256)
? Supraventricular tachycardia @ 24 min
ECG INTERPRETATION:
Non-specific sn wave changes
Possible old anterolateral scar
TECHNICAL COMMENTS:
RA electrode disconnected/re-positioned @ 18 min
HEMODYNAMIC DATA:
ART: 160/60 MEAN: 88
PAP: 40/16 PCW: 16 (@ 27 min, 28 min, 65 min)
RAP: 8 CO: 5.6
WAVEFORM PATTERNS:
PA line repositioned @ 17 min, 29 min
TECHNICAL COMMENTS:
Zero/col/pop-test sequence @ 41 min - 50 min
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh027"> </a>
<h3>Record: mgh027</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old male
DIAGNOSIS/SURGERY:
Carotid endartarectomy
PERTINENT HISTORY:
Diffuse coronary disease
Cardiomyopathy
COPD
GENERAL COMMENTS:
Movement artifact throughout
Extreme artifact @ 10 min - 12 min
Asleep @ 25 min - 37 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 88 bpm
ECG INTERPRETATION:
Diffuse transmural infarct
Inferior wall ischemia
Non-specific sn wave changes
Left ventricular hypertrophy
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 72
PAP: 46/20
RAP: 14
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh028"> </a>
<h3>Record: mgh028</h3>
<pre>
PATIENT DATA:
AGE/SEX:
49 year old female
DIAGNOSIS/SURGERY:
Unstable post-infarction angina
PERTINENT HISTORY:
Mitral regurgitation
GENERAL COMMENTS:
Recording of PA and PCW during V pacing @ 0-4 min
Stop/FFW @ 4 min - 5 min
Record @ 5 min - 6 min
Stop/FFW @ 6 min - 7 min
Chest pain resolving @ 0 - 7 min
Set-up sequence @ 45 min - 52 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Ventricular pacing @ 70 bpm
RHYTHM DISTURBANCES:
First degree heart block
Transient acceleration of underlying sinus rhythm with RBBB near end of recording
PACEMAKER DATA:
Permanent ventricular demand pacemaker (WI)
Medtronic 8423 pulse generator
Pulse width .496 msec
Sensitivity 2.5 mv
Refractory period 324 msec
ECG INTERPRETATION:
Antero-septal infarct
Inferior infarct
Left anterior hemiblock
Left axis deviation
TECHNICAL COMMENTS:
Pace channel on @ 23 min
ECG cal after 52 min
Frequent movement artifact
HEMODYNAMIC DATA:
ART: 92/60
PAP: 44/22 PCW: 20 (@ 359 min)
WAVEFORM PATTERNS:
The pulmonary arterial channel illustrates the following configurations in sequence @ 0-4 min:
1) PCW cannon waves due to A-V asynchrony,
2) slight normalization of cannon waves (when P preceds QRS), with evidence of V waves in PCW due to mitral regurgitation,
3) cannon waves,
4) V waves during NSR, and
5) pulmonary arterial configuration.
The arterial trace exhibits minor changes in configuration during normal sinus rhythm when atrio-ventricular synchrony is restored.
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh029"> </a>
<h3>Record: mgh029</h3>
<pre>
PATIENT DATA:
AGE/SEX:
84 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
COPD
PHARMACOLOGIC SUPPORT:
Dopamine @ 800 mcg/min,then 200 mcg/min, then 800 mcg/min
Levophed @ 2 mcg/min, then 3 mcg/min, then 2 mcg/min, then 10 mcg/min
Accidental Levophed bolus near end of tape
GENERAL COMMENTS:
Suctioning @ 35 min - 40 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 100 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Unifocal ventricular ectopy
Run of supraventricular tachycardia @ 61 min
ECG INTERPRETATION:
Evolving anterior infarct
TECHNICAL COMMENTS:
LL electrode off @ 41 min - 43 min
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 85
PAP: 44/24 PCW: 20 (@ 8 min, 56 min, 57 min, 60 min)
RAP: 18
WAVEFORM PATTERNS:
Arterial hypotension near end of tape is followed by acute hypertension culminating in pulsus alternans.
The course of pulmonary hypertension parallels that of systemic arterial hypertension.
"Catheter whip" is pronounced in the pulmonary arterial tracing.
TECHNICAL COMMENTS:
Poor frequency response CVP (12.5 Hz)
Borderline frequency response PAP (16.5 H2z
RESPIRATORY DATA:
RATE: 10 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
On @ 11 min, off @ 50 min
</pre>
<a href="#top">[top]</a>
<a name="mgh030"> </a>
<h3>Record: mgh030</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old male
DIAGNOSIS/SURGERY:
Esophagogastrectomy
Sepsis
PERTINENT HISTORY:
Smoker
Aspiration
PHARMACOLOGIC SUPPORT:
Dopamine @ 240 mcg/min
Levophed @ 4.8 mcg/min
GENERAL COMMENTS:
Bedmaking @ 49 min
Stop/FFW @ 37 min and 64 min - 65 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 84 bpm
RHYTHM DISTURBANCES:
Atrial ectopy with occasional aberrant conduction
Atrial fibrillation
Atrial flutter with 2: 1 conduction @ 33 min
Unifocal ventricular ectopy
ECG INTERPRETATION:
Left anterior hemiblock
Left axis deviation
Non-specific sn wave changes
HEMODYNAMIC DATA:
ART: 124/58 (pedal)
PAP: 50/25 PCW: 15 (@ 12 min, 47 min, 69 min)
RAP: 14
WAVEFORM PATTERNS:
Pulmonary hypertension
TECHNICAL COMMENTS:
Zero @ 11 min
PAP/CVP on same transducer
RESPIRATORY DATA:
RATE: 18/18 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh031"> </a>
<h3>Record: mgh031</h3>
<pre>
PATIENT DATA:
AGE/SEX:
81 year old male
DIAGNOSIS/SURGERY:
Total hip replacement
Pneumonia
PERTINENT HISTORY:
Coronary disease
Aortic stenosis and mitral regurgitation
PHARMACOLOGIC SUPPORT:
TNG @ 60 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 2 min - 3 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 114 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy, occasional quadrageminy, fusion beats
ECG INTERPRETATION:
Inferior infarct
Left atrial enlargement
Anteroseptal scar
TECHNICAL COMMENTS:
Movement artifact
HEMODYNAMIC DATA:
ART: 100/60 MEAN: 69
PAP: 40/20
RAP: 16
RESPIRATORY DATA:
RATE: 30 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh032"> </a>
<h3>Record: mgh032</h3>
<pre>
PATIENT DATA:
AGE/SEX:
78 year old female
DIAGNOSIS/SURGERY:
Superior mesenteric embolectomy
Small bowel resection
PERTINENT HISTORY:
Mitral stenosis
GENERAL COMMENTS:
Suctioning @ 52 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 91 bpm
ECG INTERPRETATION:
Anteroseptal infarct
Left atrial enlargement
Left ventricular hypertrophy
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 100/40 MEAN: 55
(axillary)
PAP: 36/16
RAP: 6
TECHNICAL COMMENTS:
Cardiac output measurement @ 22 min; line movement
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh033"> </a>
<h3>Record: mgh033</h3>
<pre>
PATIENT DATA:
AGE/SEX:
77 year old male
DIAGNOSIS/SURGERY:
Colectomy
PERTINENT HISTORY:
Coronary disease
PHARMACOLOGIC SUPPORT:
TNG @ 20 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 69 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with first degree A-V block and left bundle branch block @ 93 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave changes
TECHNICAL COMMENTS:
Wandering baseline in Leads I, II, and V
HEMODYNAMIC DATA:
ART: 100/60 MEAN: 68
PAP: 44/24 PCW: 24 (@ 13 min, 14 min, 44 min, 47 min)
RAP: 7 CO: 4.8
WAVEFORM INTERPRETATION:
Volume change @ 44 min
PA configuration change (? damped, against wall)
Repositioning of PA catheter @ 50 min
Normal traces restored @ 53 min
V wave
RESPIRATORY DATA:
RATE: 16 born
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh034"> </a>
<h3>Record: mgh034</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old male
DIAGNOSIS/SURGERY:
Transurethral prostrate resection
PERTINENT HISTORY:
Coronary disease
Mitral regurgitation
Ventricular septal defect
Ventricular aneurysm
Smoker
GENERAL COMMENTS:
Bed change @ 47 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus bradycardia @ 58 bpm
ECG INTERPRETATION:
Non-specific sn wave changes
Old inferior infarct
Left atrial enlargement
TECHNICAL COMMENTS:
Muscle tremor
HEMODYNAMIC DATA:
ART: 140/70 MEAN: 88
PAP: 48/20 PCW: 18 (@ 52 min, 54 min, 64 min)
RAP: 6 CO: 7.8
WAVEFORM PATTERNS:
V wave
Overwedge @ 54 min
"Catheter whip" in PA trace
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh035"> </a>
<h3>Record: mgh035</h3>
<pre>
PATIENT DATA:
AGE/SEX:
68 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 100 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus bradycardia @ 42 bpm
ECG INTERPRETATION:
Left atrial enlargement
Left ventricular hypertrophy
HEMODYNAMIC DATA:
ART: 200/100 MEAN: 125
PAP: 32/16 PCW: 14 (@ 10 min, 14 min, 67 min)
RAP: 8 CO: 3.7
WAVEFORM PATTERNS:
Hypertension
RESPIRATORY DATA:
RATE: 5/8 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh036"> </a>
<h3>Record: mgh036</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old female
DIAGNOSIS/SURGERY:
Renal artery bypass graft
PERTINENT HISTORY:
Mild mitral regurgitation
Aortic regurgitation and stenosis
Coronary disease
Hypertension
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 76 bpm
ECG INTERPRETATION:
Inferior infarct
Anterior infarct
R waves consistent with left ventricular hypertrophy and strain
TECHNICAL COMMENTS:
Muscle tremor, wandering baseline and movement artifact
HEMODYNAMIC DATA:
ART: 160/59 MEAN: 83
PAP: 48/20 PCW: 18 (@ 14 min, 15 min, 22 min, 23 min, 37 min)
CO: 6.3
WAVEFORM PATTERNS:
V waves due to mitral regurgitation in the pulmonary capillary wedge tracing
Corresponding spikes in the pulmonary arterial tracing.
RESPIRATORY DATA:
RATE: 2/6 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh037"> </a>
<h3>Record: mgh037</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old female
DIAGNOSIS/SURGERY:
Renal artery bypass graft
PERTINENT HISTORY:
Mild mitral regurgitation
Coronary disease
PHARMACOLOGIC SUPPORT:
TNG @ 60 mcg/min
Labetolol @ .06 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 73 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasionally with aberrant or blocked conduction
Junctional escape beats
ECG INTERPRETATION:
Left ventricular hypertrophy
Old anterior infarct
Left axis deviation
Nonspecific ST segment and T wave abnormalities
Slurred upstroke, resembles Wolff-Parkinson-White pattern syndrome
HEMODYNAMIC DATA:
ART: 150/60
PAP: 36/16 PCW: 16 (@ 20 min, 21 min, 58 min)
RAP: 7 CO: 5.9
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh038"> </a>
<h3>Record: mgh038</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old female
DIAGNOSIS/SURGERY:
Renal artery bypass graft
PERTINENT HISTORY:
Mild mitral regurgitation
Aortic regurgitation and stenosis
Coronary disease
Hypertension
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 76 bpm
RHYTHM DISTURBANCES:
3-beat run of supra-ventricular tachycardia @ 25 min
Supraventricular ectopy, occasional aberrant conduction
Multifocal ventricular ectopy
ECG INTERPRETATION:
Inferior infarct
Anterior infarct
R waves consistent with left ventricular hypertrophy and strain
HEMODYNAMIC DATA:
ART: 140/40 MEAN: 76
PAP: 42/20 PCW: 16 (@ 13 min, 26 min, 52 min, 53 min)
CVP: 8 CO: 6.3
WAVEFORM PATTERNS:
V waves due to mitral regurgitation in the pulmonary capillary wedge tracing
Corresponding spikes in the pulmonary arterial tracing.
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh039"> </a>
<h3>Record: mgh039</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old female
DIAGNOSIS/SURGERY:
Renal artery bypass graft
PERTINENT HISTORY:
Mild mitral regurgitation
Aortic regurgitation and stenosis
Coronary disease
Hypertension
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 76 bpm
RHYTHM DISTURBANCES:
Supraventricular ectopy, occasional aberrant conduction
Multifocal ventricular ectopy
ECG INTERPRETATION:
Inferior infarct
Anterior infarct
R waves consistent with left ventricular hypertrophy and strain
HEMODYNAMIC DATA:
ART: 140/40 MEAN: 76
PAP: 42/20 PCW: 16
CVP: 8 CO: 6.3
WAVEFORM PATTERNS:
V waves due to mitral regurgitation in the pulmonary capillary wedge tracing
Corresponding spikes in the pulmonary arterial tracing.
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh040"> </a>
<h3>Record: mgh040</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
BYPASS
OFF BYPASS
</pre>
<a href="#top">[top]</a>
<a name="mgh041"> </a>
<h3>Record: mgh041</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
1 min ZERP/CA; CH8/9/11
3 min VENOUS CANNULALTION
6 min BYPASS
11 min VENTRICULAR FIBRILLATION
</pre>
<a href="#top">[top]</a>
<a name="mgh042"> </a>
<h3>Record: mgh042</h3>
<pre>
PATIENT DATA:
AGE/SEX:
1 year old female
DIAGNOSIS:
Ventricular septal defect
Coarctation of the aorta
PROCEDURE:
Pediatric Cath/RHC/LHC
ECG DATA:
LEADS:
I (telemetry), II, V4 (on ch5)
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Multifocal ventricular ectopy with fusion beats, couplets, and runs of tachycardia
Episodes of atrial tachycardia
ECG INTERPRETATION:
Biventricular hypertrophy
ST depression in V4 due to RV conduction defect
TECHNICAL COMMENTS:
ECG on Channel 5 initially set-up for Lead III, lead selection changed to V4 for recording
HEMODYNAMIC DATA:
ART: 100/?
PA: 35/14 (20)
CVP: 2
LAP: 8
VENTRICULAR SHUNT: 3: 1
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-10 sec CAL TO ECG
10-14 sec ZERO CH 10/CAL OF 200 CH 10
1 min ZERO CH9/CAL OF 200 CH9
1 min STOP TAPE
1 min ZERO CH8/CAL OF 200 CH8
2 min EKG ON
3 min CAL TO ECG TELEMETRY
5 min CAL TO ECG LEAD I, II, V4
8 min STOP/FFW
8 min TAPE ON
CATHETER IN IVC
TRACE OFF
11 min CATHETER IN RV RV
11 min CHANGE ATTENUATION
RUNS OF VT
12 min CATHETER IN PA PA
SCALE 0-100
12 min SCALE 0-40
13 min PULLBACK RV
13 min BLOCK AND IRRITABILITY
14 min RV BODY
SCALE 0-40
14 min SCALE 0-100
14 min PULLBACK TO RA RA
18 min ACROSS FORAMEN TO LA LA
18 min LV LV
25 min ECG TELEMETERY OFF
PRESSURE SCALE TO 200
29 min LV GRAM
</pre>
<a href="#top">[top]</a>
<a name="mgh043"> </a>
<h3>Record: mgh043</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old male
DIAGNOSIS:
Coronary artery disease
PROCEDURE:
Angioplasty
COMMENTS:
Intra-aortic balloon in place
ECG DATA:
LEADS:
I (telemetry), A VF, V3
RHYTHM:
Sinus Bradycardia with first degree heart block
RHYTHM CHANGES:
Sinus tachycardia
Atrial ectopy and runs of tachycardia
Episode of A-V dissociation
Ventricular ectopy with couplet
PACEMAKER INFORMATION:
Temporary WI pacer
ECG INTERPRETATION:
Acute ST wave changes
Inferior wall infarct
TECHNICAL COMMENTS:
AVF on Channel 4, V3 on Channel 5
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0 TAPE ON
16 min AO/RADIAL ARTERY
22 min IABP OFF
23 min IABPON
56 min GUIDE WIRE THRU LESION
66 min VPACE BRADYCARDIA/HYPOTENSION
BALLOON ON/levophed ON-OFF
TACHYCARDIC
</pre>
<a href="#top">[top]</a>
<a name="mgh044"> </a>
<h3>Record: mgh044</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old male
DIAGNOSIS:
Paroxysmal ventricular tachycardia
PROCEDURE:
Pace map
ECG DATA:
LEADS:
I (telemetry) II, III
RHYTHM:
Normal sinus rhythm with left bundle branch block
RHYTHM CHANGES:
Ventricular ectopy with runs of tachycardia requiring defibrillation
ECG INTERPRETATION:
Possible old anterior wall infarct
HEMODYNAMIC DATA:
ART: 98/68
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-16 sec CAL TO ECG (s)
18-27 sec STOP/FFW
INSERT PACING CATHETER
1 min ?PACE ON-OFF PACE
3 min ?PACE
4 min ON-OFF
4 min STIMULATE VT VT
5 min INTERRUPT VT WITH PACING
12 min ART
12 min ZERO/CAL
23 min CATHETER RE-POSITIONING RUNS OF VENTRICULAR
IRRITABILITY (BIGEMINY /COUPLETS/MULTIFOCAL)
29 min PACE PACE
PACE OFF
30 min REPEAT
32 min REPEAT
40 min ?PACE 3 BEAT RUN
40 min STIMULATE VT VT
41 min INTERRUPT VT
47 min STIMULATE VT VT
50 min DEFIBILLATE @ 100 joules
</pre>
<a href="#top">[top]</a>
<a name="mgh045"> </a>
<h3>Record: mgh045</h3>
<pre>
PATIENT DATA:
AGE/SEX:
9 month old female
DIAGNOSIS:
Ventricular septal defect repair
PA band and coarctation repair
PROCEDURE:
Pediatric Cath
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm with right bundle branch block
RHYTHM CHANGES:
Atrial ectopy and run of atrial tachycardia
Multifocal ventricular ectopy with couplets and runs of ventricular tachycardia
Mobitz II with 2: 1 and 3: 1 conduction
ECG INTERPRETATION:
Marked right axis deviation
Non-specific ST segment changes
HEMODYNAMIC DATA:(pre-cath)
ART: (72)
CVP: 6
GRADIENT: 50 mm gradient across aortic valve
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
2 sec ZERO
4-11 sec CAL OF 200 CH9
11-20 sec ZERO
20-22 sec TAPE OFF
1 min ECG CALS
1 min TAPE OFF
1 min TAPE ON
2 min SUBCLAVIAN INJECTION
5 min RA
6 min RV OUTFLOW 0-40 SCALE RV
7 min 0-100 SCALE
7 min 0-200 SCALE
8 min ARRHYTHMIAS
9 min LEFT PA 0-40 SCALE PA
9 min LEFT PA TO MAIN PA
9 min 0-100 SCALE MEAN PA
10 min PULLBACK
13 min 0-200 SCALE
13 min RV BODY RV
19 min DESCENDING AORTA 0-200 AO
19 min ZERO/CAL
19 min DESCENDING AORTA 0-100 MEAN ART = 72
20 min LV PRESSURE 0-100 LV
21 min LVEDP 0-40
21 min 0-200 SCALE
21 min PULLBACK TO AORTA AO
21 min LV LV
0-200 SCALE
PATIENT RE-POSITIONED
32 min LV GRAM
34 min 2: 1 BLOCK (Atropine)
35 min 3:1 BLOCK
36 min CATHETER OUT RATE UP
42 min LV LV
43 min LV INJECTION
LV PRESSURE
44 min ZERO/CAL
44 min LV PULLBACK 0-200 SCALE
44 min MEAN ACROSS COARCTATION
DESCENDING AORTA AO
RIGHT HEART CATHETER INSERTED RA
48 min RV RV
RE-POSITION PT
55 min RV
RA PRESSURE RA
64 min STOP
</pre>
<a href="#top">[top]</a>
<a name="mgh046"> </a>
<h3>Record: mgh046</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
0-14 sec ECG CAL
8 min PACING (CHECK THRESHOLD) PACE
11 min INSERT WIRE
MF-VENT
ECTOPY /COUPLETS/VT
12 min PACE PACE:PVCS/NO CAPTURE
13 min PACE OFF
14 min PACE
14 min VENTRICULAR TACHYCARDIA
15 min SINUS
15 min ARTERIAL
16 min ZERO
22 min ARTERIAL ON ART = 200/80
35 min PACE STIMULATION
36 min REPEAT
38 min REPEAT
39 min INSERT WIRE LV
43 min PACE STIMULATION
44 min REPEAT
REPEAT
47 min INDUCE VT VT
47 min ATTEMPT TO TERMINATE
47 min REPEAT
REPEAT
LV PACEMAP
53 min STIMULATE
54 min INDUCE VT VT
55 min STIMULATE
INDUCE VT VT
56 min STIMULATE
57 min INDUCE VT VT
59 min INDUCE VT VT
59 min PACE PACE
61 min PACE PACE
61 min INDUCE VT VT
66 min ZERO
66 min CAL
</pre>
<a href="#top">[top]</a>
<a name="mgh047"> </a>
<h3>Record: mgh047</h3>
<pre>
PATIENT DATA:
AGE/SEX:
1 year old male
DIAGNOSIS:
Tetralogy of Fallot
PROCEDURE:
Right /Left heart cath
ECG DATA:
LEADS:
I (telemetry), II, V?
RHYTHM:
Sinus tachycardia @ 120 bpm
RHYTHM CHANGES:
Atrial ectopy with occasional aberrant conduction
Run of atrial tachycardia
Ventricular ectopy with bigeminy, couplet, run of tachycardia
TECHNICAL COMMENTS:
Clipping of V lead; V lead on CH5
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-4 sec ECG CALS
10-15 sec REPEAT ECG CAL
28-29 sec REPEAT TELEMETRY CAL
2 min ZERO/CAL OF 20
2 min STOP /FFW ION
3 min ZERO
INSERT RIGHT HEART CATHETER
5 min LEFT ATRIUM LA
CHG CH5 LEVEL
7 min LEFT VENTRICLE LV
PULLBACK TO LEFT ATRIUM LA
9 min SCALE 40
9 min LEFT ATRIUM TO RIGHT ATRIUM LA/RA
9 min RIGHT ATRIUM
38 min PT RE-POSITIONED X2
40 min RV GRAM RV
42 min VENTRICULAR IRRITABILITY
45 min CHANGE IN CONDUCTION
55 min INCREASED BUNDLE BRANCH BLOCK
IRRITABILITY; BLOCK
57 min ASCENDING AO AO
59 min AO PRESSURE
60 min AO OFF
RE-ZERO
60 min AO ON
70 min AORTOGRAM
72 min PULLBACK
72 min RIGHT ATRIUM RA
73 min ECG CAL
83 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh048"> </a>
<h3>Record: mgh048</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-18 sec RUN VENTRICULAR
TACHYCARDIA
1 min LV /FEMORAL ARTERY LV/ART
RE-POSITION PT VENTRICULAR IRRITABILITY
10 min RUNS OF VT
10 min LV GRAM LV/VENTRICULAR BIGEMINY
23 min MOVE TO STRETCHER
26 min ECG OFF
32 min CAL OF 200
32 min ZERO
33 min STOP
</pre>
<a href="#top">[top]</a>
<a name="mgh049"> </a>
<h3>Record: mgh049</h3>
<pre>
PATIENT DATA:
AGE/SEX:
8 year old male
DIAGNOSIS:
Transposed right ventricle
Left Ventricle with Ebsteins tricuspid valve (?tricuspid regurgitation)
Ventricular septal defect
Infundibular and valvular stenosis
PROCEDURE:
Right heart cath/Left heart cath
ECG DATA:
LEADS:
I (telemetry), II, V?
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Atrial tachycardia
Multi-focal ventricular ectopy, bigeminy, couplets, with runs of tachycardia
ECG INTERPRETATION:
Intraventricular conduction defect
STT wave abnormalities consistent with LV strain
TECHNICAL COMMENTS:
V lead on CHS
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-7 sec ECG STD
7-11 sec TELEMETRY STD
11-20 sec FFW/ON
12 min ZERO CH9
12 min CAL OF 200 CH9
CATHETER INSERTION
12 min DESCENDING AORTA AO
13 min LEFT VENTRICLE LV
SCALE 200
13 min SCALE 40
14 min PULLBACK TO AORTA AO
MEAN/PHASIC
14 min LEFT VENTRICLE LV
16 min PULMONARY VEINS PV
SCALE 40
22 min ANGIO TEST
23 min LEFT VENTRICLE LV
RIGHT VENTRICLE RV
24 min SCALE 40
24 min SCALE 100
24 min SCALE 200
26 min PULMONARY ARTERY PA
SCALE 40
27 min PULLBACK PA TO LV PA/LV
SCALE 40
27 min SCALE 100
28 min INFUNDIBULUM
28 min BODY
30 min ZERO CH9
31 min CAL CH9
31 min PULLBACK
SCALE 100
37 min VENTRICULAR IRRITABILITY
RE-POSITION PT
46 min ANGIOGRAM
TACHYCARDIA
PULLBACK ATRIUM ATRIUM
52 min ANGIO
59 min CORONARY CATHETER IN
65 min CORONARY ANGIOGRAM
69 min REPEAT
69 min REPEAT
PRESSURE ON (DAMPED) DAMPING
70 min REPEAT COR
VENTRICULAR IRRITABILITY
70 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh050"> </a>
<h3>Record: mgh050</h3>
<pre>
PATIENT DATA:
AGE/SEX:
10 month old male
DIAGNOSIS:
ASD/PDA/pulmonary disease
PROCEDURE:
Right heart cath/Left heart cath
ECG DATA:
LEADS:
I (telemetry), III, V4
RHYTHM:
Atrial tachycardia
RHYTHM CHANGES:
Atrial tachycardia, occasional aberrant conduction
Multifocal ventricular ectopy with bigeminy, couplets, and runs of tachycardia
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-18 sec ECG STD
18-22 sec FFW/STOP/ON
4 min SUPRA VENTRICULAR
TACHYCARDIA
6 min ZERO/CAL
CATHETER INSERTION
7 min RIGHT ATRIUM RA
SCALE 40
7 min MEAN RIGHT ATRIUM
8 min RIGHT VENTRICLE RV
SCALE 40
8 min PULMONARY ARTERY PA
SCALE 100
8 min MEAN PA
12 min RIGHT VENTRICLE RV
SCALE 100
13 min RIGHT ATRIUM RA
SCALE 100
14 min SCALE 40
16 min LEFT ATRIUM LA
17 min PULMONARY VEIN PV
18 min LEFT UPPER PULMONARY VEIN
19 min SUPRA VENTRICULAR
TACHYCARDIA
20 min LEFT VENTRICLE LV
SCALE 100
20 min SCALE 40
COUPLETS/RUN OF VT
LEFT ATRIUM LA
22 min LEFT ATRIUM MEAN
22 min RIGHT ATRIUM RA
25 min RIGHT ATRIUM
27 min RIGHT VENTRICLE RV
29 min PULMONARY ARTERY PA
30 min SUPERIOR VENA CAVA
MULTI FOCAL VPCS/RUNS OF VT
33 min LEFT VENTRICLE LV
34 min VT vs. SVT with ABERRANCY
35 min LEFT VENTRICLE TO LEFT ATRIUM LV/LA
LEFT ATRIUM TO RIGHT ATRIUM LA/RA/RV
35 min TO RIGHT VENTRICLE
49 min PA GRAM PA
61 min RV GRAM
RUN OFVT
RIGHT VENTRICLE RV
62 min RIGHT ATRIUM
</pre>
<a href="#top">[top]</a>
<a name="mgh051"> </a>
<h3>Record: mgh051</h3>
<pre>
PATIENT DATA:
AGE/SEX: 75 year old male
DIAGNOSIS/SURGERY:
Aortic and mitral valve replacements for valvular stenosis
Coronary artery bypass graft
PHARMACOLOGIC SUPPORT:
Dopamine @ 250 mcg/min
TNG @ 83 mcg/min
Levophed @ .75 mcg/min
GENERAL COMMENTS:
Stop/FFW 14 min - 15 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation with 1: 1 intraventricular conduction defect and ventricular demand pacing
PACEMAKER DATA:
Temporary ventricular demand pacing (WI)
Epicardial wires
Medtronic A-V sequential pacer
MA 13
ECG INTERPRETATION:
Low voltage
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 106/36
PAP: 36/18
RAP: 11 Cl: 2.4
TECHNICAL COMMENTS:
PAP/CVP/LAP on same transducer
PAP recordings @ 16 min - 19 min and 26 min
CVP recordings @ 19 min - 22 min and 33 min
LAP recordings @ 24 min - 25 min and 33 min
No pop-test on combined pressure channel
RESPIRATORY DATA:
RATE: B/B changed to 6 bpm @ 23 min
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh052"> </a>
<h3>Record: mgh052</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old male
DIAGNOSIS/SURGERY:
Coronary artery bypass grafts
PERTINENT HISTORY:
Apical aneurysm
PHARMACOLOGIC SUPPORT: .
Dopamine @ 180 mcg/min
Levophed @ 5 mcg/min
TNG @ 41 mcg/min
GENERAL COMMENTS:
Motion artifact with suctioning @ 42 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with left bundle branch block @ 108 bpm
RHYTHM DISTURBANCES:
Premature atrial contractions
Unifocal ventricular ectopy
ECG INTERPRETATION:
Non-specific sn wave changes
Old antero-septal infarct
Old inferior infarct
TECHNICAL COMMENTS:
Chest lead = V4
HEMODYNAMIC DATA:
ART: 100/43 MEAN: 80
PAP: 31/15
RAP: 13 CO: 6.1
INTRA-AORTIC BALLOON DATA:
Aries console
1: 1 balloon ratio
WAVEFORM INTERPRETATION:
Aortic lumen and radial IABP traces
Equivalent systolic and augmented diastolic peaks
Example of late inflation
RESPIRATORY DATA:
RATE: 5/5 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh053"> </a>
<h3>Record: mgh053</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old male
DIAGNOSIS/SURGERY:
Acute antero-lateral infarct
PHARMACOLOGIC SUPPORT:
TNG @ 100 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 84 bpm
ECG INTERPRETATION:
Poor R wave progression consistent with anterior infarct of indeterminate age
ST segment and T wave abnormalities consistent with evolving anterolateral infarct
HEMODYNAMIC DATA:
ART: 135/58 MEAN: 89
INTRA-AORTIC BALLOON DATA:
40 cc
Aries console
1: 1 ratio
WAVEFORM INTERPRETATION:
Radial and aortic lumen IABP traces
Timing adjustment @ 13 min - 18 min
Systolic peak greater than augmented diastolic
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh054"> </a>
<h3>Record: mgh054</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of thoracoabdominal aneurysm
Bifurcation graft to common iliac artery
Bleeding diathesis
PERTINENT HISTORY:
G-suit (MASD applied with pressure of 40 mm Hg
Hypothermic @ 3 min
Massive transfusions and pressor support
PHARMACOLOGIC SUPPORT:
Levophed @ 17.5 mcg/min, then 20 mcg/min
Pitressin @ 0.1 mcg/min
Amicar @ 1 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 76 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities with U waves consistent with electrolyte imbalance
(? low potassium)
HEMODYNAMIC DATA:
ART: 100/75 MEAN: 93
(femoral)
PAP: 70/48
RAP: 36 CO: 4.64
WAVEFORM PATTERNS:
Hypotension
Pulmonary hypertension
Respiratory variation
TECHNICAL COMMENTS:
No final zero/cal for PA/CVP lines
ECG cal still not working
RESPIRATORY DATA:
RATE: 16/16 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh055"> </a>
<h3>Record: mgh055</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old female
DIAGNOSIS/SURGERY:
Coronary artery bypass graft
PERTINENT HISTORY:
VF arrest s/p MI
Hypertension
PHARMACOLOGIC SUPPORT:
Nipride @ 41 mcg/min
TNG @ 41 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 105 bpm
ECG INTERPRETATION:
Anterior infarct
HEMODYNAMIC DATA:
ART: 101/42 MEAN: 80
PAP: 37/10 PCW: 20
RAP: 10 LAP: 19 CO: 2.5
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Aries console
1 : 1 balloon ratiO
WAVEFORM PATTERNS:
Radial and aortic lumen IABP traces
V wave in LA trace
TECHNICAL COMMENTS:
PA/CVP/LA on same transducer
PA and RAP traces not recorded
LA zero @ 10 min
Sequence of traces @ 12 min - 21 min
IABP off @ 17 min
No poptests to PA/CVP/LA
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh056"> </a>
<h3>Record: mgh056</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old male
DIAGNOSIS/SURGERY:
Ventricular septal defect post MI
Sepsis
PERTINENT HISTORY:
Coronary Disease
Smoking
PHARMACOLOGIC SUPPORT:
Dopamine @ 300 mcg/min
Inocor @ 583 mcg/min
GENERAL COMMENTS:
Suctioning/ambu @ 16 min - 31 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 86 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
Non-specific sn wave changes
Prolonged QT interval
Old inferior infarct
HEMODYNAMIC DATA:
ART: 84/66 MEAN: 66
RAP: 13
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Kontron console
1: 1 balloon ratio
WAVEFORM PATTERNS:
Aortic lumen and radial arterial IABP traces
TECHNICAL COMMENTS:
PA/CVP on same transducer
Poor quality PA/CVP tracings (air trapping in system)
RESPIRATORY DATA:
RATE: 7/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
Ambu thru sensor @ 18 min
CO2 off @ 45 min
</pre>
<a href="#top">[top]</a>
<a name="mgh057"> </a>
<h3>Record: mgh057</h3>
<pre>
PATIENT DATA:
AGE/SEX:
57 year old male
DIAGNOSIS/SURGERY:
Coronary artery bypass graft
PHARMACOLOGIC SUPPORT:
TNG @ 36 mcg/min, then off
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial pacing @ 96 bpm (AOO)
PACEMAKER INFO:
Temporary atrial fixed rate pacing
Epicardial wires
Medtronic S837 pulse generator
MA 14.96
ECG INTERPRETATION:
Inferior and anterior infarcts
Low voltage
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Intermittent 6O-cycle interference
HEMODYNAMIC DATA:
ART: 114/56 MEAN: 88
PAP: 38/16
RAP: 14 LAP: 16 CO: 3.4
INTRA-AORTIC BALLOON DATA:
40 cc ballon
Kontron console
1:1 balloon ratio
WAVEFORM PATTERNS:
Aortic lumen and radial arterial IABP trace
TECHNICAL COMMENTS:
Aortic lumen damping, flushed
PA recording @ 19 min - 23 min
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh058"> </a>
<h3>Record: mgh058</h3>
<pre>
PATIENT DATA:
AGE/SEX:
78 year old male
DIAGNOSIS/SURGERY:
Coronary artery bypass grafts
PHARMACOLOGIC SUPPORT:
Dopamine @ 208 mcg/min
TNG @ 41 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 3 min
RHYTHM DISTURBANCES:
Sinus tachycardia
Atrial ectopy
ECG INTERPRETATION:
Minor nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 100/47 MEAN: 80
PAP: 49/15 PCW: 13
RAP: 14 LAP: 13 Cl: 2.3
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Kontron console
1: 1 balloon ratio
WAVEFORM PATTERNS:
Respiratory variation
Radial and aortic lumen IABP traces
TECHNICAL COMMENTS:
LAP recording @ 28 min
Zero @ 35 min
No final zero-cal-pop-test sequence
RESPIRATORY DATA:
RATE: 3/12 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh059"> </a>
<h3>Record: mgh059</h3>
<pre>
PATIENT DATA:
AGE/SEX:
25 year old male
DIAGNOSIS/SURGERY:
Spinal fusion
PERTINENT HISTORY:
Quadriplegic
Scoliosis
GENERAL COMMENTS:
Suctioning @ SO min - 60 min
Phrenic nerve stimulation for nighttime breathing
PPV blower for day ventilation
Movement artifact due to patient re-positioning
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 84 bpm
HEMODYNAMIC DATA:
ART: 100/50
RAP: 10
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
CVP dressing changed @ 62 min
RESPIRATORY DATA:
RATE: 5/5 bpm
MODE OF VENTILATION:
Diaphragmatic pacer
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh060"> </a>
<h3>Record: mgh060</h3>
<pre>
PATIENT DATA:
AGE/SEX:
25 year old male
DIAGNOSIS/SURGERY:
Spinal fusion
PERTINENT HISTORY:
Quadriplegic
Scoliosis
GENERAL COMMENTS:
Application of iron lung @ 5 min
Out of lung @ 1 min
Phrenic nerve stimulation for nighttime breathing
PPV blower for day ventilation
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 84 bpm
HEMODYNAMIC DATA:
ART: 100/50
RAP: 10
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 5/5 bpm
MODE OF VENTILATION:
Iron Lung
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh061"> </a>
<h3>Record: mgh061</h3>
<pre>
PATIENT DATA:
AGE/SEX:
58 year old male
DIAGNOSIS/SURGERY:
Coronary artery bypass grafting
PERTINENT HISTORY:
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ mcg/min
COMMENT:
Chest physical therapy @ 94 bpm
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 94 bpm
ECG INTERPRETATION:
Left atrial enlargement
Old anteroseptal infarct
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 120/50 MEAN: 85
PAP: 30/9
RAP: 14 LAP: 14 CO: 5.4
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Kontron console
1: 1 balloon ratio
WAVEFORM PATTERNS:
Radial artery and aortic lumen IABP tracings
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh062"> </a>
<h3>Record: mgh062</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Aortic valve replacement
PERTINENT HISTORY:
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Ventricular demand pacing @ 85 born for atrial fibrillation with complete heart block
PACEMAKER DATA:
Permanent pacer
Medtronic 4011-58 leads
Medtronic 5985 generator
MAS
RHYTHM DISTURBANCES:
Rare ventricular ectopy
ECG INTERPRETATION:
Anterior infarct
Left ventricular hypertrophy
HEMODYNAMIC DATA:
ART: 126/70
RESPIRATORY DATA:
RATE: 36 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh063"> </a>
<h3>Record: mgh063</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old female
DIAGNOSIS/SURGERY:
Mitral valve replacement
Coronary disease
PERTINENT HISTORY:
COPD
PHARMACOLOGIC SUPPORT:
Dopamine @ 150 mcg/min
Dobutamine @ 466 mcg/min
TNG @ 60mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrioventricular pacing @ 89 bpm
PACEMAKER DATA:
Temporary artioventricular fixed rate pacing (000)
Epicardial wires
Medtronic 5837 (MA 14.9 for atria and ventricles)
RHYTHM DISTURBANCES:
Loss of atrial capture
ECG INTERPRETATION:
Inferior infarct
Non-specific sn wave changes
Left atrial enlargement
TECHNICAL COMMENTS:
Muscle tremor
Electrical interference
HEMODYNAMIC DATA:
ART: 134/31 MEAN: 84
PAP: 35/13
RAP: 16 LAP: 16 CI: l.9
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Kontron console
1 : 1 balloon ratio
WAVEFORM PATTERNS:
IABP waveform
Respiratory variation
TECHNICAL COMMENTS:
Poor frequency response on CVP (13 Hz)
CVP on @ 16 min and off @ 34 min; Zero @ 18 min
PA and LA on same transducer; LAP on @ 22 min - 24 min
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh064"> </a>
<h3>Record: mgh064</h3>
<pre>
PATIENT DATA:
AGE/SEX:
50 year old female
DIAGNOSIS/SURGERY:
Coronary bypass graft
PERTINENT HISTORY:
Mitral valve prolapse
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 117 bpm
ECG INTERPRETATION:
Posterior subendocardial infarct
Minor nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 124/56 MEAN: 84
PAP: 29/11
RAP: 2 CI:4.2
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Kontron console
1 :4 balloon ratio
WAVEFORM PATTERNS:
Radial artery and aortic lumen IABP traces
TECHNICAL COMMENTS:
PA frequency response low (16.7 Hz)
RESPIRATORY DATA:
RATE: 12 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh065"> </a>
<h3>Record: mgh065</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old female
DIAGNOSIS/SURGERY:
Redo mitral valve replacement
PERTINENT HISTORY:
Coronary disease (post CAB6)
Hypertension
Smoker
PHARMACOLOGIC SUPPORT:
Dopamine @ 250 mcg/mln
TNG @ 60 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 53 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 98 bpm
RHYTHM DISTURBANCES:
Sinus pause @ 47 min
Burst of atrial pacing @ 59 min
ECG INTERPRETATION:
Non-specific ST segment and T wave changes
TECHNICAL COMMENTS:
No pace channel activation
HEMODYNAMIC DATA:
ART: 114/68
PAP: 40/15
RAP: 9 LAP: 15 CO: 5.3
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
TECHNICAL COMMENTS:
PA/CVP/LAP on same transducer
LA @ 15 min - 19 min
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh066"> </a>
<h3>Record: mgh066</h3>
<pre>
PATIENT DATA:
AGE/SEX:
49 year old female
DIAGNOSIS/SURGERY:
Unstable post-infarction angina
PERTINENT HISTORY:
Mitral regurgitation
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Ventricular pacing @ 70 born. re-programmed to 60 (@ 0 min - 20 min)
RHYTHM DISTURBANCES:
First degree heart block
Transient acceleration of underlying sinus rhythm with RBBB near end of recording
PACEMAKER DATA:
Implanted WI pacemaker
Medtronic 8423
Pulse width .496 msec; sensitivity 2.5 mv
Refractory period 324 msec
ECG INTERPRETATION:
Antero-septal infarct
Inferior infarct
Left anterior hemiblock
Left axis deviation
GENERAL COMMENTS:
Carotid sinus massage x2 @ 20 min and 22 min
Re-programming pacemaker from rate of 70 to 60 @ 0 min - 20 min
HEMODYNAMIC DATA:
ART: 92/60
PAP: 44/22 PCW: 20 (@ .6 min,S min, 7 min)
WAVEFORM PATTERNS:
V wave in PCW
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh067"> </a>
<h3>Record: mgh067</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old female
DIAGNOSIS/SURGERY:
Redo coronary artery bypass graft
GENERAL COMMENTS:
Stop/FFW @ 12 min and 51 min - 52 min
Coughing @ 61 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial pacing with incomplete right bundle branch block @ 87 bpm
RHYTHM DISTURBANCES:
Competition
PACEMAKER DATA:
Temporary atrial fixed rate pacing (AOO)
Epicardial wires
Medtronic 5330 pulse generator
MA 15
ECG INTERPRETATION:
Left atrial hypertrophy
Old inferior infarct
ST segment and T wave abnormalities consistent with lateral ischemia digitalis effect
TECHNICAL COMMENTS:
Wandering baseline
Electrodes changed @ 44 min
HEMODYNAMIC DATA:
ART: 170/44 MEAN: 84
PAP: 52/23 PCW: 19 (not recorded)
RAP: 15 LAP: 17 CI: 3.2
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Aries console
1 :4 balloon ratio
WAVEFORM PATTERNS:
Radial and aortic lumen traces
Balloon console intermittently sensing atrial pacing spike as R wave from 0 min to 12 min interfering with timing.
Good timing restored from 12 min
Timing adjusted from 58 min - 60 min
Timing poor from 60 min to 61 min
TECHNICAL COMMENTS:
PA/CVP/LAP on same transducer.
No final pop-tests
ECG and BP curve output from console recorded on CH8 and CH12, respectively, from 36 min - 51 min
BP curve is substituted for aortic lumen tracing on AUX channel 10 due to saturation of CH8 @ 55 min
(Signal is still clipped on CH8)
RESPIRATORY DATA:
RATE: 5/27 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh068"> </a>
<h3>Record: mgh068</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Cholecystectomy
PERTINENT HISTORY:
Chronic CHF
COPD
GENERAL COMMENTS:
Chest physical therapy @ 11 min and 21 min - 25 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial flutter @ 61 bpm with ventricular demand pacing for sick sinus syndrome
RHYTHM DISTURBANCES:
Mobitz II
PACEMAKER INFO:
Specifics unavailable
Permanent ventricular demand pacemaker (WI)
ECG INTERPRETATION:
Poor R wave progression consistent with old anteroseptal infarct
Chronic obstructive pulmonary disease
Nonspecific ST segment and T wave changes
TECHNICAL COMMENTS:
Monitor pace channel off and on x2 @ 14 min - 15 min
Muscle tremor
HEMODYNAMIC DATA:
ART: 140/50 MEAN: 71
TECHNICAL COMMENTS:
Best tracings @ 33 min - 43 min
Arterial line tracing of 2nd patient recorded @ 51 min - 54 min
Arterial line damped @ 62 min
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh069"> </a>
<h3>Record: mgh069</h3>
<pre>
PATIENT DATA:
AGE/SEX:
81 year old male
DIAGNOSIS/SURGERY:
Resection of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Aortic stenosis
Cardiomyopathy
PHARMACOLOGIC SUPPORT:
Dopamine @ 250 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 100 bpm with ventricular demand pacemaker
RHYTHM DISTURBANCES:
Ventricular pacing overdrive for ventricular ectopy
PACEMAKER INFO:
Specifics unavailable
HEMODYNAMIC DATA:
ART: 90/40 MEAN: 48
PAP: 36/20 PCW: 14 (@ 13 min, 26 min, 30 min, 43 min)
RAP: 8 CO: 5.9
TECHNICAL COMMENTS:
Zero @ 14 min
CVP on @ 17 min - 33 min
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh070"> </a>
<h3>Record: mgh070</h3>
<pre>
PATIENT DATA:
AGE/SEX:
81 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Aortic stenosis
Cardiomyopathy
PHARMACOLOGIC SUPPORT:
Digoxin @ 32 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
A trial fibrillation @ 120 bpm
RHYTHM DISTURBANCES:
Ventricular pacing overdrive for ventricular ectopy
PACEMAKER INFO:
Specifics unavailable
TECHNICAL COMMENTS:
RA electrode off @ 54 min
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 68
PAP: 54/24 PCW: 22 (@ 10 min, 13 min, 27 min)
RAP: 12
WAVEFORM PATTERNS:
Atrial contours changing? V waves
Pulmonary hypertension
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh071"> </a>
<h3>Record: mgh071</h3>
<pre>
PATIENT DATA:
AGE/SEX:
79 year old female
DIAGNOSIS/SURGERY:
Fixation hip fracture
GI bleed
PERTINENT HISTORY:
Post mitral valve replacement
Aortic regurgitation
PHARMACOLOGIC SUPPORT:
Dopamine @ 80 mcg/min started @ 53 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Ventricular pacing @ 70 bpm for sick sinus syndrome with AV block
PACEMAKER INFO:
Permanent ventricular demand pacemaker (WI)
Medtronic Spectrax 5985
TECHNICAL COMMENTS:
Agitated
HEMODYNAMIC DATA:
ART: 118/45
PAP: 90/28 PCW: 20 (@ 3 min, 8 min, 22 min)
RAP: 20 CO: 3.2
WAVEFORM INTERPRETATION:
Respiratory variation
TECHNICAL COMMENTS:
PA/CVP on same transducer
CVP on @ 14 min and 37 min - 41 min
Zero/cal/pop-test sequence @ 27 min
RESPIRATORY DATA:
RATE: 22 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh072"> </a>
<h3>Record: mgh072</h3>
<pre>
PATIENT DATA:
AGE/SEX:
78 year old female
DIAGNOSIS/SURGERY:
Coronary artery bypass graft
PHARMACOLOGIC SUPPORT:
Dopamine @ 200 mcg/min
TNG @ 64 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial pacing @ 75 bpm for cardiac output support
RHYTHM DISTURBANCES:
Left bundle branch block
Atrial ectopy
Multifocal ventricular ectopy
First degree heart block
Loss of atrial capture @ 36 min
Pacing discontinued @ 37 min
PACEMAKER INFO:
Temporary atrial fixed rate pacing (AOO)
Epicardial wires
Medtronic 5330 pulse generator (MA 20)
ECG INTERPRETATION:
Inferior infarct
Left atrial enlargement
HEMODYNAMIC DATA:
ART: 176/28 MEAN: 85
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Aries console
1: 1 balloon ratio
PAP: 27/10 PCW: 11 (@ 20 min, 65 min)
RAP: 11 CI: 1.6
WAVEFORM PATTERNS:
Radial and aortic lumen IABP traces
Timing adjusted @ 64 min
TECHNICAL COMMENTS:
PAP/CVP/LAP on same transducer
Left atrial tracing @ 69 min - 70 min
CVP tracing @ 71 min
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh073"> </a>
<h3>Record: mgh073</h3>
<pre>
PATIENT DATA:
AGE/SEX:
. 61 year old male
DIAGNOSIS/SURGERY:
Infarctectomy
Repair of ventricular septal defect
PERTINENT HISTORY:
Peripheral vascular disease
PHARMACOLOGIC SUPPORT:
Dopamine @ 416 mcg/min
Epinephrine @ 3 mcg/min
Levophed @ 4 mcg/min
Inocor @ 816 mcg/min
GENERAL COMMENTS:
Chest physical therapy @ 61 min - 75 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 136 bpm
ECG INTERPRETATION:
Possible inferior myocardial infarction
ST segment elevation suggesting injury or pericarditis
HEMODYNAMIC DATA:
ART: 96/46 MEAN: 76
PAP: 41/28
RAP: 24 LAP: 28
INTRA-AORTIC BALLOON DATA:
40 cc balloon
Aries console 1: 1 balloon ratio
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
Radial and aortic lumen IABP traces
TECHNICAL COMMENTS:
PA/CVP/LA on same transducer
No final zero/cal/pop-test sequence
CVP /LA traces recorded @ 22 min - 23 min
Arterial blood gas/flush @ 30 min
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh074"> </a>
<h3>Record: mgh074</h3>
<pre>
PATIENT DATA:
AGE/SEX:
75 year old male
DIAGNOSIS:
Coronary artery bypass graft
PROCEDURE:
Insertion of temporary pacemaker
ECG DATA:
LEADS: II
RHYTHM:
Atrial pacing @ 95 bpm with right bundle branch block
PACER INFO:
Epicardial wires
Medtronic hi-output external pacemaker
RHYTHM CHANGES:
Rare ventricular ectopy
Brief episode of aystole off pacer
ECG INTERPRETATION:
Possible old inferior infarct
HEMODYNAMIC DATA:
ART: 200/95
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-20 sec ZERO
1 min CAL OF 100
1 min TAPE OFF/ON
15 min PACER OFF
CRE-ADJUST NIPRIDE TO 6)
34 min STOP/FFW
CHANGE LEVEL FOR ECG CHANNEL
39 min POWER OFF
ABG drawn
INSERTION OF V PACE WIRE PVC/Couplet
47 min Atrial pacer rate to 60 atrial pacing
50 min A trial pacer rate to 85
CHANGED to 60
51 min V pace capture @ 10 MA
PACER turned off
Atrial pace on
53 min Repeat pace sequence
56 min Decrease A pace rate 95 to 60
V pacing; increase V pace MA ventricular pacing
65 min STOP/FFW
68 min STOP/FFW
Atrial capture near end
</pre>
<a href="#top">[top]</a>
<a name="mgh075"> </a>
<h3>Record: mgh075</h3>
<pre>
PATIENT DATA:
AGE/SEX:
52 year old male
DIAGNOSIS:
Cardiomyopathy
ECG DATA:
LEADS:
I, II, III, VI
RHYTHM:
Dual chamber pacing (DDD)
COMMENTS:
ECG recording only
</pre>
<a href="#top">[top]</a>
<a name="mgh076"> </a>
<h3>Record: mgh076</h3>
<pre>
PATIENT DATA:
AGE/SEX:
52 year old male
DIAGNOSIS/SURGERY:
Pancreatic abscess
Exploratory laparotomy
Adult respiratory distress syndrome
Sepsis
GENERAL COMMENTS:
Chest physical therapy @ 63 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 117 bpm
RHYTHM DISTURBANCES:
Rare unifocal ventricular ectopy
ECG INTERPRETATION:
Probable old infero-posterior myocardial infarction
Short PR intervol consistent with tachycardia, or pre-excitation
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Persistent interference in ECG signals; extreme patient agitation
Clearest tracing @ 23 min - 24 min, 38 min - 43 min
HEMODYNAMIC DATA:
ART: 150/70 MEAN: 96
RAP: 12
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Repeat zero @ 9 min - 10 min
Damping of traces
RESPIRATORY DATA:
RATE: 6/28 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation.
CO2 RECORDING:
Datex sidestream sensor
</pre>
<a href="#top">[top]</a>
<a name="mgh077"> </a>
<h3>Record: mgh077</h3>
<pre>
PATIENT DATA:
AGE/SEX:
19 year old male
DIAGNOSIS/SURGERY:
Head trauma
Craniotomy
Laparotomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 106 bpm
ECG INTERPRETATION:
sn wave change
HEMODYNAMIC DATA:
ART: 140/90
ICP:
WAVEFORM INTERPRETATION:
Arterial tracing characteristic of neuro trauma
Respiratory variation
TECHNICAL COMMENTS:
Intra-cranial pressure on CVP CH 11
RESPIRATORY DATA:
RATE: 14/14 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh078"> </a>
<h3>Record: mgh078</h3>
<pre>
PATIENT DATA:
AGE/SEX:
75 year old female
DIAGNOSIS/SURGERY:
Exploratory laparotomy
Cholecystectomy
Common duct exploration
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 80 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
ECG INTERPRETATION:
Low voltage consistent with chronic obstructive pulmonary disease or pericardial effusion
Nonspecific ST segment and T wave abnormalities
?Old anterolateral infarct
HEMODYNAMIC DATA:
ART: 90/60
PAP: 27/17 PCW: 11 (@ 15 min,42 min, 58 min, 63 min)
RAP: 10 CI:2
TECHNICAL COMMENTS:
PA and CVP on same transducer
PA off @ 35 min
Movement @ 43 min - 51 min
CVP recording @ 65 min and 73 min - 76 min
RESPIRATORY DATA:
RATE: 10/12 changed to 10/16 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh079"> </a>
<h3>Record: mgh079</h3>
<pre>
PATIENT DATA:
AGE/SEX:
20 year old male
DIAGNOSIS/SURGERY:
Head trauma/bilateral ventriculostomy
Exploratory laparotomy
PHARMACOLOGIC SUPPORT:
Pitressin .05 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 72 bpm
HEMODYNAMIC DATA:
ART: 110/70 MEAN: 92
CVP: 6 CP:4
RAP: 6
TECHNICAL COMMENTS:
Zero to ICP @ 10 min
L-sided ICP @ 12 min
R-sided ICP @ 15 min
Change head dressing @ 24 min
CVP @ 36 min
ICP off @ 37 min
CVP on @ 43 min
ICP on aux CH 10
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh080"> </a>
<h3>Record: mgh080</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
Colectomy /colostomy
PERTINENT HISTORY:
Low systemic vascular resistance due to dysfunction from spinal cord lesion
PHARMACOLOGIC SUPPORT:
Neosynephrine @ 16 mcg/min
GENERAL COMMENTS:
Kinetic bed in use
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 76 bpm
ECG INTERPRETATION:
Left axis deviation
Possible lateral infarct, age undetermined
Non-specific sn wave changes
Left atrial hypertrophy
HEMODYNAMIC DATA:
ART: 120/70
RAP: 20
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh081"> </a>
<h3>Record: mgh081</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old male
DIAGNOSIS/SURGERY:
Esophageal carcinoma
Small bowel-esophageal bypass
PERTINENT HISTORY:
COPD
PHARMACOLOGIC SUPPORT:
Levophed @ 15 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 106 bpm
ECG INTERPRETATION:
Non-specific sn wave changes
Prolonged QT interval or TU fusion, consider myocardial disease, electrolyte imbalance, or drug effects
HEMODYNAMIC DATA:
ART: 112/80
PAP: 28/18 PCW: 14 (@ 9 min, 25 min, 30 min, 33 min)
RAP: 12 CO: 6.25
RESPIRATORY DATA:
RATE: 11/26 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh082"> </a>
<h3>Record: mgh082</h3>
<pre>
PATIENT DATA:
AGE/SEX:
43 year old female
DIAGNOSIS/SURGERY:
Crohns disease
Bacterial endocarditis
Cerebrovascular accident
Pneumonia? ARDS
PERTINENT HISTORY:
Mitral and tricusupid regurgitation secondary to staph endocarditis
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 118 bpm
ECG INTERPRETATION:
Low voltage
Left atrial enlargement
Nonspecific st segment and T wave abnormalities
Poor R wave progression consistent with clockwise rotation
HEMODYNAMIC DATA:
ART: 110/70 MEAN: 82
RAP: 12
WAVEFORM PATTERNS:
"Catheter Whip" in PA trace
TECHNICAL COMMENTS:
CVP zero @ 22 min
Changing CVP dressing @ 35 min - 41 min
RESPIRATORY DATA:
RATE: 4/38 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh083"> </a>
<h3>Record: mgh083</h3>
<pre>
PATIENT DATA:
AGE/SEX:
17 year old female
DIAGNOSIS/SURGERY:
Adult respiratory distress syndrome
PHARMACOLOGIC SUPPORT:
Dopamine 80 mcg/min, then 240 mcg/min
Epinephrine .6 mcg/min, then .5 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 98 bpm
ECG INTERPRETATION:
Low voltage
U waves consistent with lateral myocardial infarction of indeterminate age
Diffuse nonspecific segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 112/80
(femoral)
PAP: 44/26 PCW: 16 (@ 13 min, 23 min, 51 min)
RAP: 14 CO: 3.48
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
PA/CVP on single transducer
CVP recordings @ 13 min - 14 min and 20 min - 21 min
PA re-positioned @ 25 min
RESPIRATORY DATA:
RATE: 6/6 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh084"> </a>
<h3>Record: mgh084</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year Old male
DIAGNOSIS/SURGERY:
Upper GI bleed
Esophageal varices
Coagulopathy
Porto-caval shunt
PERTINENT HISTORY:
COPD
Hypertension
MI
PHARMACOLOGIC SUPPORT:
Dopamine @ 200 mcg/min
Levophed @ 11 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 96 bpm
ECG INTERPRETATION:
Anterior infarct
Infero-lateral ischemia
TECHNICAL COMMENTS:
Wandering baseline
ECG off @ 33 min
HEMODYNAMIC DATA:
ART: 110/50 MEAN: 67
(femoral)
PAP: 40/24 PCW: 18
RAP: 28 CO:S
TECHNICAL COMMENTS:
CVP non-functional
RESPIRATORY DATA:
RATE: 15/15 bpm
MODE OF VENTILATION:
Controlled with rare spontaneous attempts
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh085"> </a>
<h3>Record: mgh085</h3>
<pre>
PATIENT DATA:
AGE/SEX:
43 year old female
DIAGNOSIS/SURGERY:
LUL lobectomy for sarcoid bronchitis
LLL apical segmentectomy
PHARMACOLOGIC SUPPORT:
Aminophylline @ 6 mgm/hr
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 120 bpm
RHYTHM DISTURBANCES:
Rare atrial ectopy
Rare ventricular ectopy
ECG INTERPRETATION:
Peaked T waves suggest acidosis or high potassium effect
HEMODYNAMIC DATA:
ART: 200/90
RAP: 25 CO: 7.0
WAVEFORM PATTERNS:
Hypertension
TECHNICAL COMMENTS:
CVP recorded @ 46 min - 60 min
Tracing damped
RESPIRATORY DATA:
RATE: 33/33 bpm
MODE OF VENTILATION:
Controlled (spontaneous attempts initially, then sedated)
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh086"> </a>
<h3>Record: mgh086</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old female
DIAGNOSIS/SURGERY:
Sigmoid resection and colostomy
Sepsis
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
Dopamine @ 600 mcg/min
Neosynephrine @ 280 mcg/mln, then discontinued
Levophed @ 15 mcg/min, then 24 mcg/min, then 22 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 11 min - 12 min
Recording resumed @ 61 min - 81 min after final zero/col/pop-test sequence @ 55 min - 61 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 129 bpm
ECG INTERPRETATION:
Borderline low voltage
Diffuse nonspecific ST segment and T wave abnormalities
Poor R wave progression consistent with anterior myocardial infarction, poor lead placement, COPD
HEMODYNAMIC DATA:
ART: 80/50 MEAN: 65
(brachial)
PAP: 32/20 CW: 16(@ 16 min, 18 min,27 min, 43 min)
RAP: 18 CO: 5.4
WAVEFORM PATTERNS:
Episode of hypotension
Pulsus paradox
TECHNICAL COMMENTS:
Arterial pop-test repeated @ 12 min - 13 min
RESPIRATORY DATA:
RATE: 18/18 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh087"> </a>
<h3>Record: mgh087</h3>
<pre>
PATIENT DATA:
AGE/SEX:
43 year old male
DIAGNOSIS/SURGERY:
Aorto-bifemoral bypass graft
PERTINENT HISTORY:
Hypertension
PHARMACOLOGIC SUPPORT:
TNG @ 160 mcg/min
GENERAL COMMENTS:
Hypothermic @ 3 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 65 bpm
RHYTHM DISTURBANCES:
Rare ventricular ectopy
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Muscle tremor
HEMODYNAMIC DATA:
ART: 140/80 MEAN: 98
PAP: 16/8 PCW: 8 (@ 25 min, 29 min)
RAP: 5
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Zero CVP @ 9 min
RESPIRATORY DATA:
RATE: 5/12 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh088"> </a>
<h3>Record: mgh088</h3>
<pre>
PATIENT DATA:
AGE/SEX:
77 year old female
DIAGNOSIS/SURGERY:
Hepato-renal bypass graft
PERTINENT HISTORY:
Coronary disease
Hypertension
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 75 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Ventricular ectopy
HEMODYNAMIC DATA:
ART: 160/60 MEAN: 99
PAP: 32/16 PCW: 14 (@ 13 min, 15 min, 68 min)
RAP: 10 CO: 3.5
RESPIRATORY DATA:
RATE: 5/30 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh089"> </a>
<h3>Record: mgh089</h3>
<pre>
PATIENT DATA:
AGE/SEX:
32 year old female
DIAGNOSIS/SURGERY:
Malignant hyperthermia
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 124 bpm
TECHNICAL COMMENTS:
Muscle tremor and shivering
HEMODYNAMIC DATA:
ART: 100/50 MEAN: 64
(femoral)
RAP: 8
WAVEFORM PATTERNS:
Pulsus paradox
RESPIRATORY DATA:
RATE: 7/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh090"> </a>
<h3>Record: mgh090</h3>
<pre>
PATIENT DATA:
AGE/SEX:
24 year old female
DIAGNOSIS/SURGERY:
Multiple trauma
Depressed occipital skull fracture
Flail chest
Liver resection for laceration
Cardiac contusion
? ARDS
PHARMACOLOGIC SUPPORT:
Dopamine @ 100 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 69 bpm
ECG INTERPRETATION:
Low voltage
Counterclockwise rotation
QT interval prolonged for rate, consistent with drug effect metabolic abnormality, myocardial process
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 120/77
RAP: 13 ICP: 13
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh091"> </a>
<h3>Record: mgh091</h3>
<pre>
PATIENT DATA:
AGE/SEX:
54 year old male
DIAGNOSIS/SURGERY:
Multiple trauma
PERTINENT HISTORY:
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycadia @ 101 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
TECHNICAL COMMENTS:
Chest lead = V5
HEMODYNAMIC DATA:
ART: 140/70 MEAN: 94
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh092"> </a>
<h3>Record: mgh092</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aneurysm
PERTINENT HISTORY:
COPD
GENERAL COMMENTS:
Hypothermic @ 93F
Ambuing and suctioning @ 61 min - 65 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 64 bpm
RHYTHM DISTURBANCES:
Rare atrial ectopy
Rare ventricular ectopy
ECG INTERPRETATION:
Non-specific sn wave changes
TECHNICAL COMMENTS:
Shivering and movement artifact
"V lead" message on monitor
Chest lead = V2
HEMODYNAMIC DATA:
ART: 100/50 MEAN: 60
PAP: 32/16 PCW: 16 (@ 16 min, 29 min, 40 min)
RAP: 10 (not recorded)
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 15 bpm
MODE OF VENTILATION:
Spontaneous
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh093"> </a>
<h3>Record: mgh093</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of ruptured abdominal aneurysm
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 100 mcg/min
Dopamine @ 200 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 112 bpm
ECG INTERPRETATION:
Possible old inferior infarct
T wave changes consistent with anterior ischemia
HEMODYNAMIC DATA:
ART: 110/60 MEAN: 77
PAP: 36/20 PCW: 12 (@ 12 min, 46 min, 53 min)
RAP: 14
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 8/10 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh094"> </a>
<h3>Record: mgh094</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old male
DIAGNOSIS/SURGERY:
Pancreatectomy
Splenectomy
Gastrectomy
PHARMACOLOGIC SUPPORT:
Levophed @ 8 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 84 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
Low voltage
Poor R wave progression consistent with old anteroseptal infarct or chronic obstructive pulmonary disease
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 92/44
PAP: 30/18 PCW: 16 (@ 5 min, 42 min, 20 min, 57 min)
RAP: 13 CO: 9.5
WAVEFORM PATTERNS:
Unusual PA configuration
TECHNICAL COMMENTS:
PA/CVP on same transducer
CVP on @ 39 min - 41 min
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh095"> </a>
<h3>Record: mgh095</h3>
<pre>
PATIENT DATA:
AGE/SEX:
16 year old male
DIAGNOSIS/SURGERY:
Cerebral anoxia (drowning)
PERTINENT HISTORY:
ARDS
PHARMACOLOGIC SUPPORT:
Dopamine @ 266 mcg/min
GENERAL COMMENTS:
Hypothermic @ 96F
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 114 bpm
ECG INTERPRETATION:
Mild nonspecific ST segment and T wave changes
HEMODYNAMIC DATA:
ART: 110/60 (axillary)
PAP: 28/14 PCW: 10 (@ 7 min, 33 min, 50 min)
RAP: 7 ICP: 14 CO: 3.5
WAVEFORM PATTERNS:
Biphasic, notched, arterial trace
Arterial configuration positional
Pulsus paradox
Unusual PA configuration
TECHNICAL COMMENTS:
ICP on CVP CH11
CVP not recorded
RESPIRATORY DATA:
RATE: 12/12 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
Discontinued @ 45 min
COMMENTS:
Hiccupping
</pre>
<a href="#top">[top]</a>
<a name="mgh096"> </a>
<h3>Record: mgh096</h3>
<pre>
PATIENT DATA:
AGE/SEX:
80 year old female
DIAGNOSIS/SURGERY:
Aortobifemoral graft
PERTINENT HISTORY:
Coronary disease
?Mitral regurgitation
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 88 bpm
ECG INTERPRETATION:
Anterolateral ST and T wave abnormalities consistent with subendocardial ischemia/injury
HEMODYNAMIC DATA:
ART: 160/80 MEAN: 98
PAP: 36/20 PCW: 13 (@ 22 min, 63 min, 44 min)
RAP: 12 CO: 3.85
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Repeat de-bubbling and pop-test @ 9 min - 16 min
RESPIRATORY DATA:
RATE: 4/12 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
On @ 35 min
</pre>
<a href="#top">[top]</a>
<a name="mgh097"> </a>
<h3>Record: mgh097</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old male
DIAGNOSIS/SURGERY:
Resection and grafting abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intra-ventricular conduction defect @ 82 bpm
ECG INTERPRETATION:
Left atrial enlargement
Old anteroseptal infarct
Probable old anterolateral subendocardial myocardial infarction
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 87
PAP: 20/8 PCW: 8 (@ 35 min, 63 min, 68 min)
RAP: 8
RESPIRATORY DATA:
RATE: 7/19 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh098"> </a>
<h3>Record: mgh098</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old male
DIAGNOSIS/SURGERY:
Hemipelvectomy
PERTINENT HISTORY:
Hypertension
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 81 born
RHYTHM DISTURBANCES:
Wenckebach
ECG INTERPRETATION:
Non-specific sn wave changes
Markedly decreased voltage raising the possibility of pericardial fluid
TECHNICAL COMMENTS:
Electrical interference
HEMODYNAMIC DATA:
ART: 154/40
RAP: 8
RESPIRATORY DATA:
RATE: 5/22 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh099"> </a>
<h3>Record: mgh099</h3>
<pre>
PATIENT DATA:
AGE/SEX:
49 year old male
DIAGNOSIS/SURGERY:
Aorto-bifemoral bypass graft
PERTINENT HISTORY:
Coronary
PHARMACOLOGIC SUPPORT:
TNG @ 40 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 89 bpm
ECG INTERPRETATION:
Antero-septal infarct
Old inferior infarct
Nonspecific ST segment and T wave changes
HEMODYNAMIC DATA:
ART: 130/60 MEAN: 88
PAP: 32/16 PCW: 12 (@ 19 min, 36 min, 68 min)
RAP: 9 CO: 5.4
RESPIRATORY DATA:
RATE: 12 bpm
MODE OF VENTILATION:
Spontaneous
CO2 RECORDING:
On @ 18 min and discontinued @ 25 min with extubation
</pre>
<a href="#top">[top]</a>
<a name="mgh100"> </a>
<h3>Record: mgh100</h3>
<pre>
PATIENT DATA:
AGE/SEX:
20 year Old male
DIAGNOSIS/SURGERY:
Multiple trauma
Craniotomy
PHARMACOLOGIC SUPPORT:
Neosynephrine @ 25 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 102 bpm
HEMODYNAMIC DATA:
ART: 90/50 MEAN: 66
ICP: 11
TECHNICAL COMMENTS:
ICP on CVP @ CH 11
RESPIRATORY DATA:
RATE: 9/9 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh101"> </a>
<h3>Record: mgh101</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old male
DIAGNOSIS/SURGERY:
Cervical spondylolysis
Laminectomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 78 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Unifocal ventricular ectopy
ECG INTERPRETATION:
Left anterior hemiblock
Left axis deviation
Poor R wave progression, possibly due to left anterior hemiblock, clockwise rotation
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 130/50 MEAN: 75
PAP: 32/16 PCW: 18 (@ 7 min, 25 min, 33 min)
RAP: 7 CO: 5
WAVEFORM PATTERNS:
Large "a waves" in CVP
"Catheter whip" in pulmonary arterial trace
Respiratory variation
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh102"> </a>
<h3>Record: mgh102</h3>
<pre>
PATIENT DATA:
AGE/SEX:
59 year Old male
DIAGNOSIS/SURGERY:
Cerebral aneurysm
Middle cerebral artery clipping
GENERAL COMMENTS:
Multiple interruptions during recording
Stop/FFW @ 12 min - 13 min
Intermittent movement artifact
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 70 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
ECG INTERPRETATION
Old infero-posterior infarct
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 93
PAP: 24/12 PCW: 8(@ 29 min)
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Re-zero @ counter # 13 min
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh103"> </a>
<h3>Record: mgh103</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PHARMACOLOGIC SUPPORT:
TNG paste
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Chaotic atrial rhythm with left bundle branch block @ 80 bpm
RHYTHM DISTURBANCES:
Atrial ectopy with occasional aberrant or blocked conduction
Multifocal ventricular ectopy
ECG INTERPRETATION:
Left atrial enlargement
Left axis deviation
Old anterior wall infarct
Non-specific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
6O-cycle artifact Lead I & III
Electrodes replaced @ 28 min - 33 min
Chest lead = V2
HEMODYNAMIC DATA:
ART: 120/50 MEAN: 90
RAP: 12
WAVEFORM PATTERNS:
Right atrial tracing changes with Cheynes-Stokes due to effect on venous return
TECHNICAL COMMENTS:
CVP line used intermittently for medication infusion
Tracing recorded @ 18 min, 43 min, 51 min
Intermittent ART line damping
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
PATTERN:
Cheynes-Stokes
</pre>
<a href="#top">[top]</a>
<a name="mgh104"> </a>
<h3>Record: mgh104</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old female
DIAGNOSIS/SURGERY:
Exploratory laporotomy
Closure gastric perforation
Pyloroplasty and vagotomy
Cholecystectomy
PHARMACOLOGIC SUPPORT:
Aminophylline @ 25 mgm/hr
GENERAL COMMENTS:
Stop/FFW @ 2 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 87 bpm
RHYTHM DISTURBANCES:
Premature atrial contractions, occasional blocked conduction
Multifocal ventricular ectopy
ECG INTERPRETATION:
Old inferior infarct
Low voltage
Short PR interval
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 110/60 MEAN: 80 (axillary)
PAP: 52/26 PCW: 18 (@ 14 min, 15 min, 22 min, 54 min)
RAP: 12
WAVEFORM INTERPRETATION:
Slight pulsus paradox
Unusual wedge configurations
Pulmonary hypertension
TECHNICAL COMMENTS:
CVP on @ 21 min
PAP/PCW trace change? de 'ping @ 62 min
PAP/PCW traces normalize @ 42 min
PA flush @ 52 min
Best PCW recording @ 54 min
RESPIRATORY DATA:
RATE: 6/12 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh105"> </a>
<h3>Record: mgh105</h3>
<pre>
PATIENT DATA:
AGE/SEX:
86 year old male
DIAGNOSIS/SURGERY:
GI bleed
Choledochojejunostomy
PERTINENT HISTORY:
Terminal condition
PHARMACOLOGIC SUPPORT:
Dopamine @ 200 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation right bundle branch block @ 111 bpm
RHYTHM DISTURBANCES:
Occasional aberrant conduction
Multifocal ventricular ectopy with couplets
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities
Possible old antero-septal infarct
HEMODYNAMIC DATA:
ART: 60/40 MEAN: 44
RAP: 12
WAVEFORM INTERPRETATION:
Arterial hypotension
TECHNICAL COMMENTS:
CVP off @ 10 min
RESPIRATORY DATA:
RATE: 10/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh106"> </a>
<h3>Record: mgh106</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Perforated viscus
Colectomy
PERTINENT HISTORY:
COPD
Hypertension
GENERAL COMMENTS:
Muscle tremor when awake
Asleep @ 31 min - 40 min and 41 min - 47 min (least artifact)
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia
RHYTHM DISTURBANCES:
Atrial ectopy with bursts of atrial tachycardia
Occasional junctional escape beats
Multifocal ventricular ectopy with fusion and interpolated beats, rare couplet
ECG INTERPRETATION:
Old inferior infarct
Counterclockwise rotation versus old "true posterior" myocardial infarction
TECHNICAL COMMENTS:
Movement artifact due to muscle tremor, agitation
HEMODYNAMIC DATA:
ART: 150/60 MEAN: 91á
RAP: 9
RESPIRATORY DATA:
RATE: 4/24 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh107"> </a>
<h3>Record: mgh107</h3>
<pre>
PATIENT DATA:
AGE/SEX:
77 year old female
DIAGNOSIS/SURGERY:
Head trauma
Aspiration pneumonia
PERTINENT HISTORY:
COPD
Mitral regurgitation
PHARMACOLOGIC SUPPORT:
Neosynephrine @ 40 mcg/min
Dopamine @ 106 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 60 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Multifocal ventricular ectopy
Occasional bigeminy
ECG INTERPRETATION:
Evolving infero-lateral infarct
Left atrial enlargement
Minor nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
No ECG cal
Movement artifact from muscle tremor
HEMODYNAMIC DATA:
ART: 125/50
PAP: 50/22 PCW: 16 (@ 34 MIN, 41 MIN, 45 MIN)
RAP: 15 CO: 3.0
WAVEFORM PATTERNS:
Pulmonary hypertension
TECHNICAL COMMENTS:
PA pop-test poor (14.3 Hz)
RESPIRATORY DATA:
RATE: 12 to 18/38 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh108"> </a>
<h3>Record: mgh108</h3>
<pre>
PATIENT DATA:
AGE/SEX:
51 year old male
DIAGNOSIS/SURGERY:
Total repair of Tetralogy of Fallot
PERTINENT HISTORY:
1 day post-cardiac arrest
PHARMACOLOGIC SUPPORT:
Levophed 13 mcg/min, then 18
Inocor @ 186 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with right bundle branch block @ 106 bpm
RHYTHM DISTURBANCES:
Ventricular ectopy
ECG INTERPRETATION:
Left anterior hemiblock
Right ventricular hypertrophy
TECHNICAL COMMENTS:
Electrical interference during ECG cal
Poor electrode contact due to skin excoriation
HEMODYNAMIC DATA:
ART: 104/58
RAP: 18
WAVEFORM PATTERNS:
Pulsus paradox
Hypotension
Respiratory variation
TECHNICAL COMMENTS:
CVP zero @ 11 min and 12 min - 25 min
RESPIRATORY DATA:
RATE: 28/28 bpm
MODE OF VENTILATION:
Controlled
TECHNICAL COMMENTS:
Respiratory impedance signal poor
</pre>
<a href="#top">[top]</a>
<a name="mgh109"> </a>
<h3>Record: mgh109</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
Femoral popliteal gift
PERTINENT HISTORY:
Coronary disease
Hypertension
PHARMACOLOGIC SUPPORT:
Inocor @ 350 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 93 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy, occasional bigeminy
ECG INTERPRETATION:
Nonspecific ST segment abnormalities
Question old inferior infarct
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 80
PAP: 32/16
RAP: 12
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
CVP on @ 27 min
RESPIRATORY DATA:
RATE: 8/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
Off @ 58 min
</pre>
<a href="#top">[top]</a>
<a name="mgh110"> </a>
<h3>Record: mgh110</h3>
<pre>
PATIENT DATA:
AGE/SEX:
42 year old female
DIAGNOSIS/SURGERY:
Hepatitis
Upper GI bleedinq
Sepsis
PHARMACOLOGIC SUPPORT:
Dopamine @ 1000 mcg/min
Levophed @ 10 mgm/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 80 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy
ECG INTERPRETATION:
Low voltage
TECHNICAL COMMENTS:
Wandering baseline; poor electrode contact due to skin excoriation
HEMODYNAMIC DATA:
ART: 66/31 MEAN: 39
RAP: 14
WAVEFORM PATTERNS:
Hypotension
TECHNICAL COMMENTS:
Zero CVP @ 36 min
RESPIRATORY DATA:
RATE: 16/16 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh111"> </a>
<h3>Record: mgh111</h3>
<pre>
PATIENT DATA:
AGE/SEX:
49 year old male
DIAGNOSIS/SURGERY:
Colectomy
Sepsis
PERTINENT HISTORY:
Coronary disease
Peripheral vascular disease
COPD
PHARMACOLOGIC SUPPORT:
Dopamine @ 320 mcg/min
TNG @ 275 mcg/min
GENERAL COMMENTS:
PA insertion @ 0 min - 15 min, TNG off resulting in worsening hemodynamics and ECG pattern
Suctioning @ 32 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with incomplete right bundle branch block @ 84 bpm
RHYTHM DISTURBANCES:
Rare atrial ectopy
Supraventricular tachycardia
Multifocal ventricular ectopy, occasional fusion beats or bigeminy
ECG INTERPRETATION:
Left atrial enlargement
Diffuse ST segment and T wave changes consistent with subendocardial myocardial infarction/ischemia
HEMODYNAMIC DATA:
ART: 104/56 (pedal)
PAP: 40/25 PCW: (@ 10 min, 11 min, 17 min, 18 min, 56 min, 66 min)
RAP: 14 CO: 7.6
WAVEFORM PATTERNS:
Rise in PCW and fall in blood pressure with pulsus alternans due to discontinuation of TNG during PA insertion
TECHNICAL COMMENTS:
Zero @ 15 min - 16 min
Zero/cal/pop-test sequence @ 20 min - 26 min
PA pop-test repeated due to poor quality
RESPIRATORY DATA:
RATE: 14/14 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
COMMENTS:
Poor impedance signal
</pre>
<a href="#top">[top]</a>
<a name="mgh112"> </a>
<h3>Record: mgh112</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old male
DIAGNOSIS/SURGERY:
Removal of renal stones
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
Dopamine @ 266 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intraventricular conduction defect @ 79 bpm
RHYTHM DISTURBANCES:
Ventricular ectopy
ECG INTERPRETATION:
ST segment and T wave abnormalities consistent with anterolateral subendocardial ischemia/infarction
HEMODYNAMIC DATA:
ART: 155/75 MEAN: 103
PAP: 25/15 PCW: 12 (@ 14 min, 62 min, 65 min)
RAP: 10
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
RESPIRATORY DATA:
RATE: 5/16 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh113"> </a>
<h3>Record: mgh113</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old male
DIAGNOSIS/SURGERY:
Aorto-iliac bypass graft
PERTINENT HISTORY:
Coronary disease
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intra-ventricular conduction defect @ 89 bpm
RHYTHM DISTURBANCES:
Occasional multifocal ventricular ectopy
ECG INTERPRETATION:
Old inferior infarct
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 100/60 MEAN: 80
PAP: 28/12 PCW: 6 (@ 13 min, 24 min, 48 min, 60 min)
RAP: 5 CO: 3.6
TECHNICAL COMMENTS:
Poor frequency response CVP
RESPIRATORY DATA:
RATE: 6/6 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh114"> </a>
<h3>Record: mgh114</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old male
DIAGNOSIS/SURGERY:
Colectomy
PERTINENT HISTORY:
Coronary disease
Smoker
GENERAL COMMENTS:
Monitor "discharged" @ 30 min - 31 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 94 bpm
RHYTHM DISTURBANCES:
Multifocal ventricular ectopy, occasional fusion beats
ECG INTERPRETATION:
Antero-lateral infarct
Non-specific sn wave changes
HEMODYNAMIC DATA:
ART: 120/50 MEAN: 68
PAP: 68/24 PCW: 16 (@ 8 min, 26 min, 51 min)
RAP: 11
WAVEFORM PATTERNS:
Pulmonary hypertension
Overwedge @ 51 min
TECHNICAL COMMENTS:
Zero @ 31 min
RESPIRATORY DATA:
RATE: 24 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh115"> </a>
<h3>Record: mgh115</h3>
<pre>
PATIENT DATA:
AGE/SEX:
85 year old male
DIAGNOSIS/SURGERY:
Cholecystectomy
PERTINENT HISTORY:
ARDS
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 107 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
ECG INTERPRETATION:
Left axis deviation
Left anterior hemiblock
Low voltage
Poor R wave progression consistent with COPD, old ante rose pta I infarct, left anterior hemiblock
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Extremely diaphoretic, wandering baseline due to poor electrode contact
HEMODYNAMIC DATA:
ART: 145/60
PAP: 55/33 PCW: 20 (@ 45 min, 64 min)
RAP: 15
WAVEFORM PATTERNS:
Pulmonary hypertension
Respiratory variation
PA catheter in RV from 0-250 floated to wedge @ 7 min and 8 min
TECHNICAL COMMENTS:
PA/CVP on same transducer
CVP tracing @ 36 min - 38 min
RESPIRATORY DATA:
RATE: 14/28 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
On @ 21 min
</pre>
<a href="#top">[top]</a>
<a name="mgh116"> </a>
<h3>Record: mgh116</h3>
<pre>
PATIENT DATA:
AGE/SEX:
82 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Post-aortic valve replacement
GENERAL COMMENTS:
Hypothermic @ 95F
Coughing, movement artifact, suctioning @ 26 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 65 bpm
RHYTHM DISTURBANCES:
?Sinus block
Atrial ectopy
Multifocal ventricular ectopy, occasional bigeminy
ECG INTERPRETATION:
Left axis deviation
Left anterior hemiblock
Nonspecific ST segment and T wave changes
TECHNICAL COMMENTS:
Intermittent electrical interference
HEMODYNAMIC DATA:
ART: 110/60 MEAN: 73
PAP: 20/8 PCW: 4 (@ 20 min, 36 min)
RAP: 6 CO: 3.25
TECHNICAL COMMENTS:
CVP off @ 46 min - 47 min
RESPIRATORY DATA:
RATE: 8/14 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh117"> </a>
<h3>Record: mgh117</h3>
<pre>
PATIENT DATA:
AGE/SEX:
88 year old male
DIAGNOSIS/SURGERY:
Leukemia
Acute renal failure
Respiratory failure
PERTINENT HISTORY:
Hypertension
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with left bundle branch block @ 112 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasional aberrant conduction
Multifocal ventricular ectopy
TECHNICAL COMMENTS:
ECG only @ 0 min - 30 min
LL electrode fail @ 49 min - 57 min
Axis shift noted during electrode repositioning
Repeat loss of electrodes @ 67 min
HEMODYNAMIC DATA:
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
Respiratory variation
TECHNICAL COMMENTS:
Zero @ 30 min and 33 min
GENERAL COMMENTS:
Unable to obtain additional data
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh118"> </a>
<h3>Record: mgh118</h3>
<pre>
PATIENT DATA:
AGE/SEX:
88 year Old male
DIAGNOSIS/SURGERY:
Leukemia
Acute renal failure
Respiratory failure
PERTINENT HISTORY:
Hypertension
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with left bundle branch block @ 112 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasional aberrant conduction
Multifocal ventricular ectopy
HEMODYNAMIC DATA:
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
Respiratory variation
GENERAL COMMENTS:
Unable to obtain additional data
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh119"> </a>
<h3>Record: mgh119</h3>
<pre>
PATIENT DATA:
AGE/SEX:
88 year old male
DIAGNOSIS/SURGERY:
Leukemia
Acute renal failure
Respiratory failure
PERTINENT HISTORY:
Hypertension
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with left bundle branch block @ 112 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasional aberrant conduction
Multifocal ventricular ectopy
HEMODYNAMIC DATA:
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
Respiratory variation
GENERAL COMMENTS:
Unable to obtain additional data
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh120"> </a>
<h3>Record: mgh120</h3>
<pre>
PATIENT DATA:
AGE/SEX:
65 year old female
DIAGNOSIS/SURGERY:
Mitral and tricuspid valve replacements
PHARMACOLOGIC SUPPORT
Dopamine @ 90 mcg/min
GENERAL COMMENTS:
Bed change @ 41 min
Suctioning @ 57 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial flutter with incomplete right bundle branch block @ 82 bpm
RHYTHM DISTURBANCES:
Occasional aberrant conduction
Multifocal ventricular ectopy
ECG INTERPRETATION:
Left ventricular hypertrophy
ST segment and T wave changes
Possible anterior ischemia
HEMODYNAMIC DATA:
ART: 120/44
RAP: 18
TECHNICAL COMMENTS:
CVP on @ 32 min - 41 min
Pressure transducers disconnected @ 65 min
No zero/col/pop-test sequence
RESPIRATORY DATA:
RATE: Not documented
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh121"> </a>
<h3>Record: mgh121</h3>
<pre>
PATIENT DATA:
AGE/SEX:
75 year old male
DIAGNOSIS/SURGERY:
Multiple trauma
PERTINENT HISTORY:
Coronary disease
PHARMACOLOGIC SUPPORT:
Dopamine @ 200 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 70 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 104 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
ECG INTERPRETATION:
Probable old inferior infarct
Nonspecific ST segment and T wave changes
HEMODYNAMIC DATA:
ART: 120/40 MEAN: 73
PAP: 44/20 PCW: 16 (@ 21 min, 30 min, 35 min)
RAP: 16 CO: 8.6
WAVEFORM INTERPRETATION:
"Catheter whip" in PA trace
RESPIRATORY DATA:
RATE: 12/16 changed to 12/1.2 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
On @ 37 min
</pre>
<a href="#top">[top]</a>
<a name="mgh122"> </a>
<h3>Record: mgh122</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old female
DIAGNOSIS/SURGERY:
Cardiac arrest
Post-mitral valve replacement
GENERAL COMMENTS:
Recording begins with ECG recording only
Cardiac massage is initiated
ECG electrodes fall off
Arterial tracing is turned on
Electrodes are changed
ECG and arterial traces are recorded during massage @ 16 min
Massage is intermittently stopped, then resumed throughout tracing
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with intraventricular conduction delay
RHYTHM DISTURBANCES:
Idioventricular rhythm
ECG INTERPRETATION:
Nonspecific T wave abnormalities
RESPIRATORY DATA:
MODE OF VENTILATION:
Controlled and ambu ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh123"> </a>
<h3>Record: mgh123</h3>
<pre>
PATIENT DATA:
AGE/SEX:
80 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
COPD
PHARMACOLOGIC SUPPORT:
Levophed @ 13 mcg/min
TNG @ 40 mcg/min
Dopamine @ 267 mcg/min
GENERAL COMMENTS:
Dressings changed @ 46 min
Patient movement, bed changed; Stop/FFW @ 64 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 102 bpm
RHYTHM DISTURBANCES:
A trial ectopy
Unifocal ventricular ectopy
First degree heart block
ECG INTERPRETATION:
Anteroseptal infarction
Lateral extension
Bi-atrial hypertrophy
Intraventricular conduction delay @ 64 min
Nonspecific ST segment and T wave changes
TECHNICAL COMMENTS:
RA and V lead off @ 59 min
HEMODYNAMIC DATA:
ART: 120/40 MEAN: 69
PAP: 40/20 PCW: 14
RAP: 12 CO: 4.6
WAVEFORM PATTERNS:
Overwedge @ 49 min
Pulsus paradox
"Catheter whip" in PA trace
Respiratory variation
TECHNICAL COMMENTS:
Damping arterial trace @ 59 min
RESPIRATORY DATA:
RATE: 12/12 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
On @ 11 min
</pre>
<a href="#top">[top]</a>
<a name="mgh124"> </a>
<h3>Record: mgh124</h3>
<pre>
PATIENT DATA:
AGE/SEX:
80 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
COPD
PHARMACOLOGIC SUPPORT:
Levophed @ 13 mcg/min
TNG @ 40 mcg/min
Dopamine @ 267 mcg/min
GENERAL COMMENTS:
Chest physical therapy @ 57 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 102 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Unifocal ventricular ectopy
First degree heart block
ECG INTERPRETATION:
Anteroseptal infarction
Lateral extension
Bi-atrial hypertrophy
Nonspecific ST segment and T wave changes
HEMODYNAMIC DATA:
ART: 120/40 MEAN: 69
PAP: 40/20 PCW: 14
RAP: 12 CO: 4.6
WAVEFORM PATTERNS:
Pulsus paradox
"Catheter whip" in PA trace
Respiratory variation
RESPIRATORY DATA:
RATE: 12/12 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
Off @ ?
</pre>
<a href="#top">[top]</a>
<a name="mgh125"> </a>
<h3>Record: mgh125</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Sub-total gastrectomy/duodenostomy
PERTINENT HISTORY:
Smoking
PHARMACOLOGIC SUPPORT:
Levophed @ 30 mcg/min
Dopamine @ 187 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 96 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasional blocked conduction, ? occasional aberrant conduction
Junctional escape beat
Supraventricular tachycardia
Ventricular escape beat
Idioventricular rhythm @ 66 min
ECG INTERPRETATION:
Non-specific sn wave changes
Low voltage
Poor R wave progression consistent with old anterior scar or pericardial effusion
HEMODYNAMIC DATA:
ART: 90/50 MEAN: 66
PAP: 34/16 PCW: 16(@ 11 min, 18 min, 51 min)
RAP: 12
WAVEFORM PATTERNS:
Pressure change @ 66 min
Hypotension
Pulsus paradox
Giant A wave in CVP trace
"Catheter whip" in PA trace
Respiratory variation
TECHNICAL COMMENTS:
Arterial line on @ 14 min
Zero @ 15 min, 17 min, 73 min
RESPIRATORY DATA:
RATE: 8/24 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh126"> </a>
<h3>Record: mgh126</h3>
<pre>
PATIENT DATA:
AGE/SEX:
46 year old female
DIAGNOSIS/SURGERY:
Pelvic mass
Abdominal hysterectomy with removal of ovaries
PERTINENT HISTORY:
Severe mitral stenosis
Mild aortic regurgitation
Moderate tricuspid regurgitation
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
A trial fibrillation @ 80 bpm
ECG INTERPRETATION:
ST segment and T wave abnormalities consistent with digitalis effect.
HEMODYNAMIC DATA:
ART: 100/60 MEAN: 57
PAP: 36/16 PCW: 12 (@ 31 min)
RAP: 8 CI: 2.8
WAVEFORM PATTERNS:
Unusual arterial notching (? secondary to aortic valve dysfunction)
Hemodynamic pattern of atrial fibrillation
TECHNICAL COMMENTS:
Borderline frequency response for CVP/PAP
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh127"> </a>
<h3>Record: mgh127</h3>
<pre>
PATIENT DATA:
AGE/SEX:
74 year old female
DIAGNOSIS/SURGERY:
Chronic visceral ischemia
Aorto-superior mesenteric artery/celiac bypass graft
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 73 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Unifocal ventricular ectopy
ECG INTERPRETATION:
Non-specific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 160/50 MEAN: 70
RAP: 8
WAVEFORM PATTERNS:
Exaggerated "a waves" in CVP trace
"V waves" in CVP trace with ventricular ectopy
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh128"> </a>
<h3>Record: mgh128</h3>
<pre>
PATIENT DATA:
AGE/SEX:
84 year old male
DIAGNOSIS/SURGERY:
Exploratory laparotomy
Colectomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with left bundle branch block @ 103 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Sick sinus syndrome
ECG INTERPRETATION:
sn wave changes due to digitalis effect
TECHNICAL COMMENTS:
Wandering ECG baseline
HEMODYNAMIC DATA:
ART: 100/40 MEAN: 52
PAP: 40/20 PCW: 10 (@ 17 min, 29 min, 46 min)
RAP: 10 CO: 3.6
WAVEFORM PATTERNS:
Pulmonary hypertension
"Catheter whip" in PA trace
Respiratory variation
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous with CPAP
Extubated @ 42 min
COMMENTS:
Respiratory mechanics @ 38 min
Suctioned and extubated @ 42 min
CO2 RECORDING:
Datex sidestream sensor
CO2 recording discontinued @ 42 min
</pre>
<a href="#top">[top]</a>
<a name="mgh129"> </a>
<h3>Record: mgh129</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old female
DIAGNOSIS/SURGERY:
Gas gangrene sepsis
PHARMACOLOGIC SUPPORT:
Dopamine @ 900 mcg/min
Levophed @ 2 mcg/min
GENERAL COMMENTS:
Chest physical therapy @ 8 min - 13 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 98 bpm
RHYTHM CHANGES:
Conversion to atrial fibrillation with right bundle branch block @ 150 bpm @ 21 min
Veropamil administered @ 66 min
ECG INTERPRETATION:
Left atrial enlargement
Old anteroseptal infarct
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
V lead off @ 26 min - 33 min
HEMODYNAMIC DATA:
ART: 110/50
PAP: 30/16 PCW: 10 (@ 17 min, 57 min, 63 min)
RAP: 5
WAVEFORM PATTERNS:
Hemodynamic pattern of atrial fibrillation
RESPIRATORY DATA:
RATE: 8 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh130"> </a>
<h3>Record: mgh130</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old male
DIAGNOSIS/SURGERY:
Angioplasty of right external iliac artery
PERTINENT HISTORY:
Coronary disease (unstable angina)
Cerebral vascular disease
Smoking
PHARMACOLOGIC SUPPORT:
TNG @ 37 mcg/min, reduced to 30 @ 22 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation with incomplete left bundle branch block @ 78 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities consistent with digitalis effect
TECHNICAL COMMENTS:
Chest lead = V1 (V6 on tape 37)
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 87
PAP: 56/32
RAP: 10 CO:5
WAVEFORM PATTERNS:
Pulmonary hypertension
TECHNICAL COMMENTS:
CVP off @ 13 min, on @ 45 min
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh131"> </a>
<h3>Record: mgh131</h3>
<pre>
PATIENT DATA:
AGE/SEX:
77 year old female
DIAGNOSIS/SURGERY:
Burns
Acute respiratory distress syndrome
PERTINENT HISTORY:
Trauma
PHARMACOLOGIC SUPPORT:
Dopamine 159 mcg to 212.8 during recording
Aminophylline @ 40 mgm/hr
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 81 bpm
RHYTHM DISTURBANCES:
Multifocal atrial ectopy, with occasional aberrant conduction
ECG INTERPRETATION:
Low voltage
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 101/41 MEAN: 57
PAP: 63/30 PCW: 20 (@ 13 min, 39 min, 40 min)
RAP: 25
WAVEFORM INTERPRETATION:
Pulmonary hypertension
TECHNICAL COMMENTS:
PA and CVP on same transducer
Zero PA channel @ 7 min and 53 min
CVP recording @ 54 min - 55 min and 56 min - 57 min
RESPIRATORY DATA:
RATE: 24/24 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
Discontinued @ 43 min
COMMENTS:
Respiratory impedance channel working poorly
</pre>
<a href="#top">[top]</a>
<a name="mgh132"> </a>
<h3>Record: mgh132</h3>
<pre>
PATIENT DATA:
AGE/SEX:
65 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of aortic aneurysm
Bypass graft to superior mesenteric artery
PERTINENT HISTORY:
Hypertension
PHARMACOLOGIC SUPPORT:
Neosynephrine @ 20 mcg/min
GENERAL COMMENTS:
On hemodialysis during recording
Insertion of catheters @ 10 min- 17 min
Unit on @ 17 min
Suctioning @ 13 min - 17 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
A trial fibrillation @ 103 bpm
RHYTHM DISTURBANCES:
Occasional ventricular ectopy or aberrancy
ECG INTERPRETATION:
ST segment and T wave abnormalities consistent with digitalis effect
HEMODYNAMIC DATA:
ART: 100/50 MEAN: 66
(axillary)
PAP: 32/12 PCW: 8 (@ 34 min, 36 min, 39 min, 44 min, 56 min)
RAP: 10
RESPIRATORY DATA:
RATE: 8/8 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh133"> </a>
<h3>Record: mgh133</h3>
<pre>
PATIENT DATA:
AGE/SEX:
69 year Old male
DIAGNOSIS/SURGERY:
RLL lobectomy for carcinoma
PERTINENT HISTORY:
COPD
PHARMACOLOGIC SUPPORT:
Dopamine @ 53 mcg/min,
GENERAL COMMENTS:
Hypothermic @ 3.2 min
Jet ventilation
Chest physical therapy @ 20 min, 36 min - 47 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus bradycardia @ 58 bpm
RHYTHM DISTURBANCES:
Junctional rhythm @ 20 min - 32 min
Rare ventricular ectopy
ECG INTERPRETATIONS:
Marked ST abnormality
Possible inferior subendocardial injury
HEMODYNAMIC DATA:
ART: 150/50
PAP: 48/18 PCW: 13 (@ 19 min, 34 min, 49 min)
RAP: 10
TECHNICAL COMMENTS:
PA/CVP on same transducer
RESPIRATORY DATA:
RATE: 2/100 bpm
MODE OF VENTILATION:
High frequency jet ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh134"> </a>
<h3>Record: mgh134</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
COPD
Asthma
PHARMACOLOGIC SUPPORT:
Aminophylline @ 30 mgm/hr
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 90 bpm
RHYTHM DISTURBANCES:
Ventricular ectopy
Changing P-R ? A-V Dissociation
Junctional rhythm
ECG INTERPRETATION:
Left anterior hemiblock
Left axis deviation
HEMODYNAMIC DATA:
ART: 140/80 MEAN: 101
PAP: 28/12 PCW: 8 (@ 10 min, 16 min, 21 min)
RAP: 6 CO: 3.74
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh135"> </a>
<h3>Record: mgh135</h3>
<pre>
PATIENT DATA:
AGE/SEX:
65 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of aortic aneurysm
Bypass graft to superior mesenteric artery
PERTINENT HISTORY:
Hypertension
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 104 bpm
ECG INTERPRETATION:
ST segment and T wave abnormalities consistent with digitalis effect
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 76 (brachial)
RAP: 10
WAVEFORM PATTERNS:
Arterial trace "spiking"
Respiratory variation
RESPIRATORY DATA:
RATE: 5/32 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh136"> </a>
<h3>Record: mgh136</h3>
<pre>
PATIENT DATA:
AGE/SEX:
55 year old male
DIAGNOSIS/SURGERY:
Sepsis
PERTINENT HISTORY:
Coronary disease
Acute respiratory distress syndrome
PHARMACOLOGIC SUPPORT:
Dopamine @ 213 mcg/min
Epinephrine @ 2.6 mcg/min
TNG @ 26 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 124 bpm
ECG INTERPRETATION:
Low voltage
Possible old anteroseptal infarct
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Intermittent 60-cycle interference
HEMODYNAMIC DATA:
ART: 100/80
PAP: 40/18 PCW: 18 (@ 25 min, 32 min, 41 min)
RAP: 16
TECHNICAL COMMENTS:
CVP and PAP on same transducer
CVP on @ 33 min - 39 min
RESPIRATORY DATA:
RATE: 8 bpm
MODE OF VENTILATION:
Controlled ventilation
CO2 RECORDING:
Off @ 36 min
TECHNICAL COMMENTS:
Poor respiratory impedance signal
</pre>
<a href="#top">[top]</a>
<a name="mgh137"> </a>
<h3>Record: mgh137</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old female
DIAGNOSIS/SURGERY:
Axillo-popliteal bypass graft
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
Dopamine @ 150 mcg/min
COMMENTS:
Severe hyperkalemia results in a variety of progressively worsening arrhythmias
Arrhythmias resolve with potassium therapy on mgh020
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Junctional rhythm with right bundle branch block @ 96 bpm
RHYTHM DISTURBANCES:
Runs of junctional tachycardia @ 63 min
Atrial ectopy
ECG INTERPRETATION:
Low voltage
Nonspecific St segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 110/70 MEAN: 75
PAP: 36/20 PCW: 14(@ 4 min,21 min,41 min)
RAP: 11 CO: 3.2
WAVEFORM PATTERNS:
Episodes of hypotension
Fluctuations in hemodynamic pattern due to arrhythmias
TECHNICAL COMMENTS:
Zero to CVP and PAP @ 38 min
Final zero/cal/pop-test sequence on mgh020
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh138"> </a>
<h3>Record: mgh138</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old male
DIAGNOSIS/SURGERY:
Aorto-bifemoral graft
PERTINENT HISTORY:
Coronary disease
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 84 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
First degree heart block
ECG INTERPRETATION:
Borderline voltage
Minor ST segment and T wave changes
HEMODYNAMIC DATA:
ART: 100/50 MEAN: 68
PAP: 24/12 PCW: 1O(@ 13 min, 30 min, 40 min)
RAP: 8 CO: 5.4
WAVEFORM PATTERNS:
Giant A wave in CVP trace
Respiratory variation
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh139"> </a>
<h3>Record: mgh139</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old female
DIAGNOSIS/SURGERY:
Renal calculus
Retroperitoneal hematoma
PERTINENT HISTORY:
5 years post aortic valve replacement, mitral and tricuspid valvuloplasty
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 97 bpm
RHYTHM DISTURBANCES:
Occasional abe 't conduction
Ventricular ecto.
ECG INTERPRETATION:
Anterolateral ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Movement artifact
Loss of electrodes
HEMODYNAMIC DATA:
ART: 123/60
PAP: 36/20 PCW: 30 (@ 16 min, 45 min, 56 min, 65 min)
RAP: 17
TECHNICAL COMMENTS:
PA and CVP on same transducer
CVP on @ 33 min - 43 min and 50 min - 52 min
RESPIRATORY DATA:
RATE: 32 changed to 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh140"> </a>
<h3>Record: mgh140</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of thoraco-abdominal aneurysm
PERTINENT HISTORY:
Coronary disease
Hypertension
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 100 bpm
RHYTHM DISTURBANCES:
A tria I ectopy
ECG INTERPRETATION:
Left ventricular hypertrophy
Probable old inferior infarct
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 200/80 MEAN: 105
RAP: 10
WAVEFORM PATTERNS:
Hypertension
Respiratory variation
RESPIRATORY DATA:
RATE: 6/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh141"> </a>
<h3>Record: mgh141</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old male
DIAGNOSIS/SURGERY:
Resection of abdominal aortic aneurysm
PERTINENT HISTORY:
Diffuse coronary disease
Cardiomyopathy
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 75 bpm
ECG INTERPRETATION:
Diffuse infarct
?Inferior ischemia
Left ventricular hypertrophy
Nonspecific T wave abnormalities
TECHNICAL COMMENTS:
V lead off @ 28 min
LL electrode off @ 31 min
HEMODYNAMIC DATA:
ART: 110/50 MEAN: 60
PAP: 44/16 PCW: 8 (@ 5 min, 6 min, 8 min, 10 min, 57 min, 63 min)
RAP: 10
TECHNICAL COMMENTS:
Zero PA @ 9 min
RESPIRATORY DATA:
RATE: 6/6 bpm to 10/10 @ 44 min
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
Changes @ 44 min
</pre>
<a href="#top">[top]</a>
<a name="mgh142"> </a>
<h3>Record: mgh142</h3>
<pre>
PATIENT DATA:
AGE/SEX:
82 year old male
DIAGNOSIS/SURGERY:
Abdominal aortic aneurysm
Peripheral vascular disease
PERTINENT HISTORY:
Coronary disease
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 124 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
?Junctional ectopy
Rare unifocal ventricular ectopy with fusion beat @ 34 min
ECG INTERPRETATION:
Prominent "R" wave in leads V1-V2 consistent with counterclockwise rotation
Cannot rule out old "true posterior" myocardial infarction
Possible old inferior infarct
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
"V lead fail message"
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 85
PAP: 20/8 PCW: 8
RAP: 3 CO: 5.2
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
TECHNICAL COMMENTS:
PAP/CVP traces damped due to catheter kinking @ 54 min - 55 min
RESPIRATORY DATA:
RATE: 24 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh143"> </a>
<h3>Record: mgh143</h3>
<pre>
PATIENT DATA:
AGE/SEX:
69 year old male
DIAGNOSIS/SURGERY:
Resection of bilateral iliac aneursysms
Respiratory distress
PERTINENT HISTORY:
Coronary artery disease
PHARMACOLOGIC SUPPORT:
Neosynephrine 30 mcg/min then discontinued
GENERAL COMMENTS:
Turning @ 55 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with first degree heart block and intra-ventricular conduction defect @ 81 bpm
RHYTHM DISTURBANCES:
Atrial ectopy, occasional blocked conduction
Junctional escape beat
Rare unifocal ventricular ectopy
ECG INTERPRETATION:
Left atrial enlargement
Poor R wave progression consistent with old anteroseptal infarct
Nonspecific ST segment and T wave abnormalities
Inferolateral infarct
Non-specific STT wave changes
TECHNICAL COMMENTS:
Occasional muscle tremor
HEMODYNAMIC DATA:
ART: 130/50 MEAN: 75
PAP: 52/24 PCW: 22 (@ 19 min, 42 min, 46 min)
RAP: 10 CO: 7.3
WAVEFORM PATTERNS:
Pulmonary hypertension
"Catheter whip" in PA trace
RESPIRATORY DATA:
RATE: 10/32 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh144"> </a>
<h3>Record: mgh144</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old female
DIAGNOSIS/SURGERY:
Innominate artery bypass
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 47 mcg/min
Dopamine @ 200 mcg/min, then off
Levophed
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 73 bpm
ECG INTERPRETATION:
Low voltage
Left axis deviation
Anterolateral ST segment and T wave abnormalities consistent with ischemia
TECHNICAL COMMENTS:
Wandering baseline, tremor, electrical interference
HEMODYNAMIC DATA:
ART: 160/70 MEAN: 92 (pedal)
PAP: 36/16
RAP: 15
TECHNICAL COMMENTS:
CVP on @ 31 min
RESPIRATORY DATA:
RATE: 4/8 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh145"> </a>
<h3>Record: mgh145</h3>
<pre>
PATIENT DATA:
AGE/SEX:
81 year old female
DIAGNOSIS/SURGERY:
Aortic valve replacement
PHARMACOLOGIC SUPPORT:
Dopamine @ 216 mcg/min
GENERAL COMMENTS:
Chest physical therapy @ 62 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 87 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities persists
HEMODYNAMIC DATA:
ART: 97/40
RAP: 15
RESPIRATORY DATA:
RATE: 12/12 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh146"> </a>
<h3>Record: mgh146</h3>
<pre>
PATIENT DATA:
AGE/SEX:
87 year old female
DIAGNOSIS/SURGERY:
Superior mesenteric
Embolectomy
Small bowel resection
PERTINENT HISTORY:
Coronary disease
PHARMACOLOGIC SUPPORT:
Dopamine @ 200 mcg/min
Inocor @ 350 mcg/min
GENERAL COMMENTS:
Stop/FFW @ 53 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation @ 100 born
ECG INTERPRETATION:
Left ventricular hypertrophy
Poor R wave progression consistent with chronic obstructive pulmonary disease, anteroseptal infarction ST segment and T wave abnormalities consistent with digitalis/ischemia
HEMODYNAMIC DATA:
ART: 140/50 MEAN: 70
PAP: 40/20 PCW: 18
RAP: 12
RESPIRATORY DATA:
RATE: 8/8 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING:
On @ 55 min
</pre>
<a href="#top">[top]</a>
<a name="mgh147"> </a>
<h3>Record: mgh147</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Post-mitral valve replacement
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 50 mcg/min, then off
Dopamine on @ 63 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation with intra-ventricular conduction defect @ 106 bpm
ECG INTERPRETATION:
Left atrial enlargement
Left ventricular hypertrophy
HEMODYNAMIC DATA:
ART: 150/60 MEAN: 82
PAP: 36/20 PCW: 18
RAP: 4 CO: 3.4
TECHNICAL COMMENTS:
Poor CVP frequency response (12.5 Hz)
RESPIRATORY DATA:
RATE: 8/8 bpm
MODE OF VENTILATION:
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh148"> </a>
<h3>Record: mgh148</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Sub-total gastrectomy/ duodenostomy
PERTINENT HISTORY:
Smoking
PHARMACOLOGIC SUPPORT:
Levophed @ 30 mcg/min
Dopamine @ 187 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 96 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Supraventricular tachycardia
ECG INTERPRETATION:
Non-specific STT wave changes
Low voltage and poor R wave progression consistent with old anterior scar or pericardial effusion
HEMODYNAMIC DATA:
ART: 90/50 MEAN: 66
PAP: 34/16 PCW: 16
RAP: 12
WAVEFORM PATTERNS:
Hypotension
Pulsus paradox
Giant A wave in CVP trace
Respiratory variation
TECHNICAL COMMENTS:
No final zero/cot/coo-test sequence
RESPIRATORY DATA:
RATE: 8/24 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh149"> </a>
<h3>Record: mgh149</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old female
DIAGNOSIS/SURGERY:
Mitral valve replacement
Tricuspid annuloplasty
Persistent tricuspid regurgitation
Coronary artery bypass graft
PHARMACOLOGIC SUPPORT:
Dopamine @ 150 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Atrial fibrillation with intraventricular conduction defect @ 81 bpm
RHYTHM DISTURBANCES:
Rare multifocal ventricular ectopy
ECG INTERPRETATION:
Nonspecific T wave abnormalities
HEMODYNAMIC DATA:
ART: 136/60
PAP: 96/28 PCW: 18 (@ 28 min, 36 min, 68 min)
RAP: 20 CI: 2.0
WAVEFORM PATTERNS:
Pulmonary hypertension
TECHNICAL COMMENTS:
PA on CVP CH11
CVP on PA CH8
Zero @ 17 min
Zero CVP only @ 19 min
RESPIRATORY DATA:
RATE: 8/8 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh150"> </a>
<h3>Record: mgh150</h3>
<pre>
PATIENT DATA:
AGE/SEX:
69 year old female
DIAGNOSIS:
Respiratory insufficiency sip re-do CABG
ECG DATA:
LEADS:
I,II,III,VI
RHYTHM:
Chaotic atrial rhythm with left bundle branch block and aberrant beats
ECG INTERPRETATION:
Non-specific STT wave changes
HEMODYNAMIC DATA:
ART: 132/62
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
STANDARD ICU RECORDING
1 min ANNOTATION
7 min STOP/FFW/START
ELECTRODES CHANGED/MOVED TO BED
59 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh151"> </a>
<h3>Record: mgh151</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old male
DIAGNOSIS/SURGERY:
Hepatic cancer
Hepatectomy
Exploratory laparotomy
PHARMACOLOGIC SUPPORT:
Aminophylline @ 30 mgm/hr,
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 130 bpm
ECG INTERPRETATION:
Old inferior infarct
Old antero-septal infarct
HEMODYNAMIC DATA:
ART: 130/60 MEAN: 88
PAP: 34/20 PCW: 14 (@ 38 min)
RAP: 9 CO: 8
WAVEFORM PATTERNS:
Respiratory variation
CVP damping
TECHNICAL COMMENTS:
Borderline frequency response for CVP,
CVP turned of @ 46 min
RESPIRATORY DATA:
RATE: 40 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh152"> </a>
<h3>Record: mgh152</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old female
DIAGNOSIS/SURGERY:
Gangrene of the foot
Amputation
Sepsis
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 91 bpm
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 73
CVP: 6
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh153"> </a>
<h3>Record: mgh153</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old male
DIAGNOSIS/SURGERY:
Intraventricular tumor
Frontal craniotomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 72 bpm
ECG INTERPRETATION:
Left atrial enlargement
Left axis deviation
Stable anterior infarct of indeterminate age
HEMODYNAMIC DATA:
ART: 120/50 MEAN: 68
PAP: 68/24 PCW: 22 (@ 18 min)
RAP: 4
WAVEFORM PATTERNS:
During PCW recording, tracing converts to PA trace momentarily at peak inspiration
RESPIRATORY DATA:
RATE: 10 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh154"> </a>
<h3>Record: mgh154</h3>
<pre>
PATIENT DATA:
AGE/SEX:
77 year old male
DIAGNOSIS/SURGERY:
Renal stones
Renal exploration
Ureteral stent
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 80 bpm
ECG INTERPRETATION:
?Old antero-septal scar
HEMODYNAMIC DATA:
ART: 100/40 MEAN: 64
PAP: 20/8 PCW: 4 (@ 17 min, 22 min, 48 min)
RAP: 6
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh155"> </a>
<h3>Record: mgh155</h3>
<pre>
PATIENT DATA:
AGE/SEX:
56 year old male
DIAGNOSIS/SURGERY:
Upper gastrointestinal bleed
Sepsis
Aorto-bifemoral bypass graft
Abdominal laporotomy
PERTINENT HISTORY:
Ongoing antero-septal ischemia
PHARMACOLOGIC SUPPORT:
Levophed @ 2.8 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 112 bpm
ECG INTERPRETATION:
Old anterolateral infarct
Persistent anterior ST segment elevation consistent with aneurysm
HEMODYNAMIC DATA:
ART: 110/60 MEAN: 77
PAP: 36/20 PCW: 16 (@ 13 min, 36 min, 52 min)
RAP: 20
WAVEFORM PATTERNS:
Arterial line intermittently damped
Pulsus paradox
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh156"> </a>
<h3>Record: mgh156</h3>
<pre>
PATIENT DATA:
AGE/SEX:
41 year old male
DIAGNOSIS/SURGERY:
Congestive heart failure
PERTINENT HISTORY:
Severe mitral stenosis
Moderate mitral regurgitation
Aortic stenosis
s/p AVR and MVR 10 years earlier
PHARMACOLOGIC SUPPORT:
Dopamine @ 213 mcg/min
Epinephrine @ 2.1 mcg/min
Isuprel @ 2.5 mcg/min
GENERAL COMMENTS:
Hypothermic @ 91.9F
ELECTROCARDIOGRAPHIC DATA
UNDERLYING RHYTHM:
Normal sinus rhythm with incomplete right bundle branch block @ 90 bpm
ECG INTERPRETATION:
Rightward axis shift
Right ventricular strain
Left atrial enlargement
HEMODYNAMIC DATA:
ART: 100/50 (axillary)
PAP: 83/56 PCW: 30 (@ 17 min, 27 min, 41 min)
RAP: 15
WAVEFORM PATTERNS:
V waves due to mitral regurgitation in PCW trace
Pulmonary hypertension
Anacrotic notch on arterial trace due to aortic stenosis
Pulsus paradox
TECHNICAL COMMENTS:
CVP and PAP on single transducer
CVP data inaccurate? medications infused simultaneously
Zero @ 9 min
CVP recording @ 14 min - 15 min
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh157"> </a>
<h3>Record: mgh157</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old male
DIAGNOSIS/SURGERY:
Thoracic abdominal aortic aneurysm
Coagulopathy
Aortobifemoral bypass graft
Exploratory laporotomy
PHARMACOLOGIC SUPPORT:
Dopamine @ 400 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 124 bpm
ECG INTERPRETATION:
Low voltage consistent with pericardial effusion, obesity, pneumothorax
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Electrodes changed once during recording
HEMODYNAMIC DATA:
ART: 130/80 MEAN: 109
PAP: 60/36 PCW: 24 (@ 9 min, 11 min, 23 min, 46 min, 46 min)
RAP: 26
WAVEFORM PATTERNS:
Pulsus paradox
Pulmonary hypertension
Respiratory variation
TECHNICAL COMMENTS:
Electronic cals @ 61 min
Repeat mercury cals @ 71 min
RESPIRATORY DATA:
RATE: 12 bpm
MODE OF VENTILATION:
Controlled
COMMENTS:
Respiratory impedance channel on @ 20 min
</pre>
<a href="#top">[top]</a>
<a name="mgh158"> </a>
<h3>Record: mgh158</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Arterial insufficiency
Ileo-profunda graft
PHARMACOLOGIC SUPPORT:
TNG @ 60 mcg/min, then off
Neosynephrine @ 30 mcg/min, then off, then 40 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 109 bpm
ECG INTERPRETATION:
Infero-apical ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 74
PAP: 44/24
RAP: 7
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 24 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh159"> </a>
<h3>Record: mgh159</h3>
<pre>
PATIENT DATA:
AGE/SEX:
34 year old female
DIAGNOSIS/SURGERY:
Liver transplant
PHARMACOLOGIC SUPPORT:
Dopamine @ 100 mcg/min (discontinued temporarily during recording)
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 115 bpm
ECG INTERPRETATION:
Minor nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
ECG cable disconnected @ 60 min
HEMODYNAMIC DATA:
ART: 140/90
RAP: 14
TECHNICAL COMMENTS:
Change in arterial line configuration @ 26 min
CVP kinked @ 40 min
RESPIRATORY DATA:
RATE: 12/22 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh160"> </a>
<h3>Record: mgh160</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old female
DIAGNOSIS/SURGERY:
Exploratory laporotomy
Colectomy
Cholecystectomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 94 bpm
ECG INTERPRETATION:
Left axis deviation consistent with left anterior hemiblock
Poor R wave progression consistent with old anterolateral infarct or left anterior hemiblock
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
No ECG cal signal
HEMODYNAMIC DATA:
ART: 130/70 MEAN: 90
PAP: 36/20 PCW: 10 (@ 15 min, 26 min, 51 min, 54 min)
RAP: 5
WAVEFORM PATTERNS:
Giant A wave
"Catheter whip" in PA trace
RESPIRATORY DATA:
RATE: 5/12 born
MODE OF VENTILATION:
Intermittent mandatory ventilation
COMMENTS:
Impedance channel off
</pre>
<a href="#top">[top]</a>
<a name="mgh161"> </a>
<h3>Record: mgh161</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old female
DIAGNOSIS/SURGERY:
Multiple trauma
Cerebral injury
Fractures of ribs and pelvis
GENERAL COMMENTS:
Stop/FFW @ 54 min - 55 min
Record mgh162 was recorded from the same patient
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 69 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities consistent with digitalis effect or ischemia
Low voltage
HEMODYNAMIC DATA:
ART: 140/80 MEAN: 98 (femoral)
RAP: 10 CO:8
WAVEFORM PATTERNS:
Simultaneous femoral and radial traces
TECHNICAL COMMENTS:
Radial arterial trace on PA channel after 56 min
Zero/cal/pop-test to art lines 55 min - 61 min
Both art lines on @ 61 min
CVP off @ 19 min - 21 min and 27 min - 55 min
RESPIRATORY DATA:
RATE:
8/8 bpm
MODE OF VENTILATION:
Controlled
COMMENTS:
CO2 monitor off @ 68 min
</pre>
<a href="#top">[top]</a>
<a name="mgh162"> </a>
<h3>Record: mgh162</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old female
DIAGNOSIS/SURGERY:
Multiple trauma
Cerebral injury
Fractures of ribs and pelvis
GENERAL COMMENTS:
OFF 53 min
Record mgh161 was recorded from the same patient
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 69 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities consistent with digitalis effect or ischemia
Low voltage
TECHNICAL COMMENTS:
ECG module changed @ 45 min - 61 min
HEMODYNAMIC DATA:
ART: 140/80 MEAN: 98 (femoral)
RAP: 10 CO:8
WAVEFORM PATTERNS:
Simultaneous femoral and radial traces
TECHNICAL COMMENTS:
Femoral line damped @ 25 min
CVP off @ 43 min
Clipping of radial trace
RESPIRATORY DATA:
RATE:
Regains consciousness, initiating spontaneous breaths
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh163"> </a>
<h3>Record: mgh163</h3>
<pre>
PATIENT DATA:
AGE/SEX:
69 year old male
DIAGNOSIS/SURGERY:
Spleno-renal shunt
Splenectomy
PERTINENT HISTORY:
Coronary disease
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 95 bpm
RHYTHM DISTURBANCES:
Unifocal ventricular ectopy
ECG INTERPRETATION:
Posterolateral infarct
Left atrial enlargement
Probable right ventricular hypertrophy
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 120/40 MEAN: 65
PAP: 20/8 PCW: 4 (@ 12 min, 42 min, 44 min)
RAP: 5 CO: 6.5
TECHNICAL COMMENTS:
Arterial set-up first
RESPIRATORY DATA:
RATE: 10 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh164"> </a>
<h3>Record: mgh164</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old female
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
GENERAL COMMENTS:
Stop/FFW @ 1 min - 2 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 96 bpm
ECG INTERPRETATION:
Right axis deviation consistent with right ventricular hypertrophy or left posterior hemiblock
Probable old anterior infarct
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 160/60 MEAN: 93
PAP: 40/16
RAP: 10
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Poor CVP frequency response (12.5 Hz)
Repeat CVP pop-test @ 12 min
RESPIRATORY DATA:
RATE: 24 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh165"> </a>
<h3>Record: mgh165</h3>
<pre>
PATIENT DATA:
AGE/SEX:
75 year old male
DIAGNOSIS/SURGERY:
Multiple trauma
PERTINENT HISTORY:
Coronary disease
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 83 bpm
ECG INTERPRETATION:
Possible old inferior infarct
QT interval prolonged
Nonspecific ST segment and T wave abnormalities
Possible anterior subendocardial ischemia
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 73
PAP: 40/16 PCW: 14 (@ 10 min, 30 min)
RAP: 12
TECHNICAL COMMENTS:
Arterial blood gas withdrawn @ 16 min
RESPIRATORY DATA:
RATE: 10/10 born
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh166"> </a>
<h3>Record: mgh166</h3>
<pre>
PATIENT DATA:
AGE/SEX:
52 year old female
DIAGNOSIS/SURGERY:
Multiple trauma
Exploratory laporotomy
Sepsis
PHARMACOLOGIC SUPPORT:
Dopamine @ 213 mcg/min
Levophed @ 21 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 130 bpm
HEMODYNAMIC DATA:
ART: 120/60
PAP: 40/20 PCW: 17 (@ 20 min, 41 min, 63 min)
RAP: 17
WAVEFORM INTERPRETATION:
Pulsus paradox
TECHNICAL COMMENTS:
Zero @ 10 min
RESPIRATORY DATA:
RATE: 16/16 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh167"> </a>
<h3>Record: mgh167</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old male
DIAGNOSIS/SURGERY:
Pulmonary lobectomy
PERTINENT HISTORY:
Coronary disease
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus bradycardia @ 54 bpm
RHYTHM DISTURBANCES:
Rare unifocal ventricular ectopy
ECG INTERPRETATION:
Minor nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 170/80
PAP: 40/18
RAP: 13 CO: 3.2
TECHNICAL COMMENTS:
PA/CVP on same transducer
CVP on @ 7 min - 8 min
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh168"> </a>
<h3>Record: mgh168</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 40 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 69 bpm
RHYTHM DISTURBANCES:
First degree heart block
ECG INTERPRETATION:
Generalized T wave abnormalities
HEMODYNAMIC DATA:
ART: 140/50 MEAN: 78
PAP: 26/8 PCW: 6 (@ 46 min, 66 min)
RAP: 8
WAVEFORM PATTERNS:
Change in arterial line configuration @ 19 min
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh169"> </a>
<h3>Record: mgh169</h3>
<pre>
PATIENT DATA:
AGE/SEX:
58 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Smoker
GENERAL COMMENTS:
Stop/Start @ 68 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 89 bpm
ECG INTERPRETATION:
Left axis deviation
Left anterior hemiblock
Left atrial enlargement
HEMODYNAMIC DATA:
ART: 130/60 MEAN: 80
PAP: 36/14
RAP: 10
RESPIRATORY DATA:
RATE: 23 bpm
MODE OF VENTILATION:
Spontaneous
CO2 RECORDING:
Discontinued @ 67 min
</pre>
<a href="#top">[top]</a>
<a name="mgh170"> </a>
<h3>Record: mgh170</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old male
DIAGNOSIS/SURGERY:
Hepato-renal bypass graft
PERTINENT HISTORY:
Hypertension
Coronary disease
Peripheral vascular disease
PHARMACOLOGIC SUPPORT:
TNG @ 200 mcg/min
GENERAL COMMENTS:
Short recording to capture V waves
No set-up sequence
Inderal administered @ 10 sec, 2 min, 6 min
Hypothermic @ 96.9F
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 70 bpm
ECG INTERPRETATION:
Inferolateral subendocardial injury
TECHNICAL COMMENTS:
ECG recording started @ 2 min
HEMODYNAMIC DATA:
ART: 200/60 MEAN: 92
PAP: 48/22 PCW: 22 (@ 3 min, 12 min)
RAP: 12 CO: 8.2
WAVEFORM PATTERNS:
Hypertension
V wave
Respiratory variation
TECHNICAL COMMENTS:
No initial set-up sequence
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh171"> </a>
<h3>Record: mgh171</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old male
DIAGNOSIS/SURGERY:
Coronary artery bypass graft
PERTINENT HISTORY:
Peripheral vascular disease
PHARMACOLOGIC SUPPORT:
TNG @ 40 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with right bundle branch block @ 117 bpm
ECG INTERPRETATION:
Non-specific STT wave changes
Anteroseptal infarct
HEMODYNAMIC DATA:
ART: 158/60
PAP: 38/20 PCW: 13 (@ 11 min, 12 min, 19 min, 28 min, 49 min, 69 min)
RAP: 12
WAVEFORM PATTERNS:
Changing pulmonary arterial and pulmonary capillary wedge waveforms
TECHNICAL COMMENTS:
Zero to ART and PA @ 8 min
Zeros to PA @ 18 min
Arterial line re-positioned @ 56 min
RESPIRATORY DATA:
RATE: 9/9 changed to 8/8 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh172"> </a>
<h3>Record: mgh172</h3>
<pre>
PATIENT DATA:
AGE/SEX:
66 year old female
DIAGNOSIS/SURGERY:
Renal artery bypass graft
PERTINENT HISTORY:
Mild mitral regurgitation
Aortic regurgitation and stenosis
Coronary disease
Hypertension
Smoker
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 76 bpm
ECG INTERPRETATION:
Inferior infarct
Anterior infarct
R waves consistent with left ventricular hypertrophy and strain
HEMODYNAMIC DATA:
ART: 200/70 MEAN: 113
PAP: 44/16 PCW: 16 (@ 18 min, 29 min, 31 min, 52 min)
RAP: 8 CO: 3.5
WAVEFORM PATTERNS:
Hypertension
TECHNICAL COMMENTS:
Arterial blood gas @ 24 min
RESPIRATORY DATA:
RATE: 7/7 bpm
MODE OF VENTILATION:
Controlled/intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh173"> </a>
<h3>Record: mgh173</h3>
<pre>
PATIENT DATA:
AGE/SEX:
4 day old male
DIAGNOSIS/SURGERY:
RV hypoplasia
Pulmonary atresia/valvotomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 120 bpm
ECG INTERPRETATION:
Right atrial enlargement
Small right ventricle
Dominant left ventricle
HEMODYNAMIC DATA:
ART: 80/40 MEAN: 53
RESPIRATORY DATA:
RATE: 14/14 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh174"> </a>
<h3>Record: mgh174</h3>
<pre>
PATIENT DATA:
AGE/SEX:
27 year old male
DIAGNOSIS/SURGERY:
Aortic valve replacement
Patch closure of aorta
PHARMACOLOGIC SUPPORT:
Nipride @ 100 mcg/min, then off. then @ 500 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia with left bundle branch block @ 104 bpm
RHYTHM DISTURBANCES:
Rare unifocal ventricular ectopy
ECG INTERPRETATION:
Left ventricular hypertrophy
Left atrial enlargement
Left axis deviation
TECHNICAL COMMENTS:HEMODYNAMIC DATA:
Chest lead = V4
ART: 116/48
PAP: 28/11 PCW: 15
RAP: 8 CI: 2.7
WAVEFORM PATTERNS:
Unusual biphasic arterial trace
RESPIRATORY DATA:
RATE: 8/8 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh175"> </a>
<h3>Record: mgh175</h3>
<pre>
PATIENT DATA:
AGE/SEX:
30 year old male
DIAGNOSIS/SURGERY:
Reconstruction of popliteal artery and vein
GENERAL COMMENTS:
Bed changed
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 117 bpm
TECHNICAL COMMENTS:
ECG cal @ 20 min
HEMODYNAMIC DATA:
ART: 200/100 MEAN: 128
PAP: 12
WAVEFORM PATTERNS:
Hypertension
Respiratory variation
TECHNICAL COMMENTS:
Transducers re-levelled @ 34 min
RESPIRATORY DATA:
RATE: 4/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh176"> </a>
<h3>Record: mgh176</h3>
<pre>
PATIENT DATA:
AGE/SEX:
60 year old male
DIAGNOSIS/SURGERY:
Abdominal aortic aneurysm
Aneurysm resection/insertion bifurcation graft
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus rhythm @ 68 bpm
RHYTHM DISTURBANCES:
Rare atrial ectopy, with normal and aberrant conduction
Rare ventricular ectopy
ECG INTERPRETATION:
Left atrial enlargement
Poor R wave progression consistent with old anteroseptal infarct, COPD, clockwise rotation
Nonspecific St segment and T wave abnormalities
TECHNICAL COMMENTS:
Wandering baseline
HEMODYNAMIC DATA:
ART: 160/60 MEAN: 93
PAP: 38/14 PCW: (@ 13 min, 20 min, 36 min)
RAP: 4
WAVEFORM PATTERNS:
"Catheter whip" in PA trace
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh177"> </a>
<h3>Record: mgh177</h3>
<pre>
PATIENT DATA:
AGE/SEX:
67 year old female
DIAGNOSIS/SURGERY
Abdominal aortlc aneurysm
Aorto-bifemoral graft
Aorto-iliac occlusion
Bilateral lumbar sympathectomy
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 84 bpm
RHYTHM DISTURBANCES:
Rare multifocal ventricular ectopy
ECG INTERPRETATION:
Nonspecific T wave abnormalities
TECHNICAL COMMENTS:
Occasional artifact from muscle tremor
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 84
PAP: 28/14 PCW: 8 (@ 24 min, 39 min, 52 min)
RAP: 8
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh178"> </a>
<h3>Record: mgh178</h3>
<pre>
PATIENT DATA:
AGE/SEX:
52 year old male
DIAGNOSIS/SURGERY:
Left carotid artery endartarectomy
GENERAL COMMENTS:
Transferred from bed to chair @ 14 min
Returned to bed @ 24 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 100 bpm
ECG INTERPRETATION:
Non-specific STT wave changes
HEMODYNAMIC DATA:
ART: 160/60 MEAN: 99
PAP: 36/16 PCW: 12 (@ 1O min, 25 min, 39 min)
RAP: 4
WAVEFORM PATTERNS:
Overwedge configuration x2 @ 39 min
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh179"> </a>
<h3>Record: mgh179</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old female
DIAGNOSIS/SURGERY:
Chronic obstructive lung disease with pneumonia
PHARMACOLOGIC SUPPORT:
Neosynephrine @ 59 mcg/min
GENERAL COMMENTS:
Power to monitor off @ 27 min - 28 min
Data collection ends @ 45 min
Final zero/cal pop test sequence @ 45 min - 50 min
Stop/FFW @ 52 min - 53 min
ECG recorded during chest physical therapy @ 53 min-end
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 87 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Wandering baseline
Electrodes replaced @ 52 min
HEMODYNAMIC DATA:
ART: 110/60 (axillary)
PAP: 65/27 (39) PCW: 12 (@ 10 min, 18 min, 20 min, 52 min,= best)
RAP: 8 CO: 4.35
WAVEFORM PATTERNS:
Pulmonary hypertension
Respiratory variation
TECHNICAL COMMENTS:
PA and CVP on same transducer
CVP @ 16 min - 19 min
RESPIRATORY DATA:
RATE: 12/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh180"> </a>
<h3>Record: mgh180</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old female
DIAGNOSIS/SURGERY:
Abdominal aortic aneurysm resection and grafting
Aortobifemoral bypass graft
PERTINENT HISTORY:
Hypertension
Smoking
PHARMACOLOGIC SUPPORT:
Dopamine 300 mcg/min then 600 mcg/min, then discontinued
Neosynephrine @ 20 mcg/min, then 40 mcg /min
GENERAL COMMENTS:
Extremely agitated
Motion artifact
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 114 bpm
ECG INTERPRETATION:
Left atrial enlargement
? Left ventricular hypertrophy
TECHNICAL COMMENTS:
Wandering baseline
Electrode contact lost near end of recording
HEMODYNAMIC DATA:
ART: 100/50 MEAN: 67
PAP: 30/16 PCW: 14 (@ 41 min, 46 min, 62 min, 63 min)
RAP: 12 CO: 6.5
WAVEFORM PATTERNS:
Unusual contour changes in CVP
Off pressors, hypotensive @ 32 min
Normotensive @ 36 min
Pulsus paradox
TECHNICAL COMMENTS:
CVP off for CO @ 32 min
RESPIRATORY DATA:
RATE: 8/24 changed to 6/24 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
COMMENTS:
Dyscoordinate breathing
</pre>
<a href="#top">[top]</a>
<a name="mgh181"> </a>
<h3>Record: mgh181</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old male
DIAGNOSIS/SURGERY:
Femoropopliteal bypass graft
Respiratory arrest
PERTINENT HISTORY:
Coronary disease (CABG)
Hvpertenslon
Carotid disease
Smoking
Chronic obstructive pulmonary disease
GENERAL COMMENTS:
Agitated with muscle tremor
In chair @ 10 min - 16 min
Moving @ 33 min
Stop/FFW for chest pt @ 47 min - 48 min
Least artifact @ 58 min - 60 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with left bundle branch block @ 91 bpm
RHYTHM DISTURBANCES:
Junctional escape rhythm
Atrioventricular dissociation
Unifocal ventricular ectopy with couplet
TECHNICAL COMMENTS:
Poor quality due to artifact
HEMODYNAMIC DATA:
ART: 140/50 MEAN: 74
PAP: 60/24
RAP: 14 CO: 4.8
WAVEFORM PATTERNS:
Pulmonary hvpertenslon
Respiratory variation
TECHNICAL COMMENTS:
Zero @ 12 min - 14 min
RESPIRATORY DATA:
RATE: 6/24 bpm changed to 2/24 bpm changed to spontaneous @ 55 min
MODE OF VENTILATION:
Intermittent mandatory ventilation changed to spontaneous
CO2 RECORDING:
On @ 13 min
</pre>
<a href="#top">[top]</a>
<a name="mgh182"> </a>
<h3>Record: mgh182</h3>
<pre>
PATIENT DATA:
AGE/SEX:
43 year old female
DIAGNOSIS/SURGERY:
Crohns disease
Bacterial endocarditis
Cerebrovascular accident
Pneumonia? ARDS
PERTINENT HISTORY:
Mitral and tricuspid regurgitation secondary to staph endocarditis
PHARMACOLOGIC SUPPORT:
Dopamine 250 mcg/min, then 450 mcg/min
GENERAL COMMENTS:
Seizure @ 16 min
Bed-making @ 50 min - 54 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 101 bpm
ECG INTERPRETATION:
Minor nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 120/70 MEAN: 85
PAP: 30/24 PCW: 18 (@ 13 min, 39 min, 47 min)
RAP: 18
WAVEFORM PATTERNS:
Pulsus paradox
Respiratory variation
RESPIRATORY DATA:
RATE: 20/20 bpm
MODE OF VENTILATION:
Controlled
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh183"> </a>
<h3>Record: mgh183</h3>
<pre>
PATIENT DATA:
AGE/SEX:
42 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary artery bypass grafts
Hypertension
GENERAL COMMENTS:
Suctioning @ 49 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with first degree A-V block and right bundle branch block @ 65 bpm
ECG INTERPRETATION:
ST segment and T wave abnormalities secondary to right bundle branch block
HEMODYNAMIC DATA:
ART: 160/80 MEAN: 111
PAP: 22/8 PCW: 6 (@ 16 min, 26 min, 52 min)
RAP: 4
RESPIRATORY DATA:
RATE: 4/22 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh184"> </a>
<h3>Record: mgh184</h3>
<pre>
PATIENT DATA:
AGE/SEX:
72 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of thoracoabdominal aneurysm
PERTINENT HISTORY:
Hypertension
PHARMACOLOGIC SUPPORT:
Dopamine @ 250 mcg/min
Neosynephrine @ 120 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 85 bpm
RHYTHM DISTURBANCES:
First degree heart block
TECHNICAL COMMENTS:
Wandering baseline
HEMODYNAMIC DATA:
ART: 120/80 MEAN: 95
PAP: 36/20 PCW: 14 (@ 14 min, 28 min, 41 min)
RAP: 10 CO: 3.5
WAVEFORM PATTERNS:
Pulsus paradox
Respiratory variation
TECHNICAL COMMENTS:
No final arterial pop-test
RESPIRATORY DATA:
RATE: 6/6 changed to 5/16 bpm
MODE OF VENTILATION:
Controlled changed to intermittent mandatory ventilation
CO2 RECORDING
COMMENTS:
Paralyzed left hemidiaphragm
</pre>
<a href="#top">[top]</a>
<a name="mgh185"> </a>
<h3>Record: mgh185</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old male
DIAGNOSIS/SURGERY:
Amputation foot
Respiratory arrest
PERTINENT HISTORY:
Hypertension
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 30 mcg/min
GENERAL COMMENTS:
Suctioning @ 33 min - 41 min
Stop/FFW @ 49 min - 50 min and Stop @ 62 min
Changing bed @ 55 min - 61 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with right bundle branch block @ 78 born
ECG INTERPRETATION:
Anterior infarct
Left atrial enlargement
Left anterior hemiblock
Increased QT interval
TECHNICAL COMMENTS:
Movement artifact
HEMODYNAMIC DATA:
ART: 180/80 MEAN: 131
PAP: 52/32 PCW: 26
RAP: 13 CO: 3.6
WAVEFORM PATTERNS:
Overwedge of PCW @ 67 min
Pulmonary hvpertenslon
RESPIRATORY DATA:
RATE: 10/15 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh186"> </a>
<h3>Record: mgh186</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
COPD
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus arrhythmia @ 66 bpm
RHYTHM DISTURBANCES:
First degree heart block
Atrial ectopy
ECG INTERPRETATION:
Left anterior hemiblock
Old anteroseptal infarct
Left axis deviation
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
Intermittent electrical interference on ECG cal and Lead III
Wandering baseline
HEMODYNAMIC DATA:
ART: 160/80 MEAN: 108
PAP: 32/16 PCW: 16 (@ 41 min, 54 min, 66 min)
RAP: 10
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 7/20 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh187"> </a>
<h3>Record: mgh187</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old male
DIAGNOSIS/SURGERY:
Thoraco-abdominal SMA bypass graft
PERTINENT HISTORY:
COPD
GENERAL COMMENTS:
Patient movement @ 43 min, suctioning @ 59 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intra-ventricular conduction defect @ 96 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 140/50
RAP: 8
WAVEFORM PATTERNS:
Respiratory variation
RESPIRATORY DATA:
RATE: 6/28 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh188"> </a>
<h3>Record: mgh188</h3>
<pre>
PATIENT DATA:
AGE/SEX:
74 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of aortic aneurysm
Insertion of aorto-bifemoral graft
PERTINENT HISTORY:
Coronary disease
?COPD
PHARMACOLOGIC SUPPORT:
TNG @ 400 mcg/min
Neosynephrine @ 30 mcg/min
GENERAL COMMENTS:
Chest physical therapy @ 21 min - 36 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 88 bpm
RHYTHM DISTURBANCES:
Rare atrial ectopy
Rare junctional ectopy
Rare ventricular ectopy
ECG INTERPRETATION:
Left atrial enlargement
Non-specific STT wave changes
Left axis deviation
Probable old inferior infarct
HEMODYNAMIC DATA:
ART: 120/70 MEAN: 83
PAP: 28/8 PCW: 12 (@ 10 min, 39 min, 41 min, 62 min)
RAP: 10 CO: 6.1
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Poor CVP frequency response (12.5 - 14 Hz)
CVP off @ 50 min - 51 min and 53 min
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh189"> </a>
<h3>Record: mgh189</h3>
<pre>
PATIENT DATA:
AGE/SEX:
29 year old male
DIAGNOSIS/SURGERY:
Multiple trauma
Exploratory laparotomy
Splenectomy
Craniotomy
GENERAL COMMENTS:
Power off to data collection system @ 20 min
Stop/FFW tape @ 20 min - 21 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 140 bpm
TECHNICAL COMMENTS:
Shivering, movement artifact
HEMODYNAMIC DATA:
ART: 130/80 (pedal)
RAP: 6 ICP:3
WAVEFORM PATTERNS:
Pulsus paradox
Elevation of arterial pressure during shivering
TECHNICAL COMMENTS:
ICP on AUX CH10
CVP tracing not recorded
Arterial pop-test 18.2 Hz
RESPIRATORY DATA:
RATE: 12/25 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh190"> </a>
<h3>Record: mgh190</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old male
DIAGNOSIS/SURGERY:
Aorto-iliac bypass graft
PERTINENT HISTORY:
Coronary disease
Smoker
GENERAL COMMENTS:
Developed hiccoughs @ 46 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intra-ventricular conduction defect @ 95 bpm
RHYTHM DISTURBANCES:
Rare ventricular ectopy
ECG INTERPRETATION:
Old inferior infarct
Nonspecific ST segment and T wave abnormalities
TECHNICAL COMMENTS:
ECG discontinued @ 13 min - 14 min
HEMODYNAMIC DATA:
ART: 140/60 MEAN: 72
PAP: 24/8 PCW: 6 (@ 32 min, 40 min, 55 min)
RAP: 3 CO: 3.6
WAVEFORM PATTERNS:
Respiratory variation
TECHNICAL COMMENTS:
Poor frequency response CVP
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh191"> </a>
<h3>Record: mgh191</h3>
<pre>
PATIENT DATA:
AGE/SEX:
19 year old male
DIAGNOSIS/SURGERY:
Multiple trauma
Exploratory laparotomy
GENERAL COMMENTS:
Stop/FFW @ 59 min - 60 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 128 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
Unifocal ventricular ectopy
TECHNICAL COMMENTS:
Wandering baseline
"V fail" message, electrode changed without result
RA electrode off @ 50 min
HEMODYNAMIC DATA:
ART: 120/60 MEAN: 84
RAP: 4
WAVEFORM PATTERNS:
Unusual CVP trace
TECHNICAL COMMENTS:
Poor CVP frequency response (16.6 Hz)
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh192"> </a>
<h3>Record: mgh192</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old female
DIAGNOSIS/SURGERY:
Sclerotherapy of esophageal varices
PERTINENT HISTORY:
Smoker
PHARMACOLOGIC SUPPORT:
Dopamine @ 320 mcg/min
GENERAL COMMENTS:
Suctioning @ 16 min - 30 min
Morphine administered @ 38 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 94 bpm
ECG INTERPRETATION:
Counterclockwise rotation
Nonspecific ST segment and T wave changes
TECHNICAL COMMENTS:
ECG baseline displaced early in recording due to electrode movement
HEMODYNAMIC DATA:
ART: 120/75 to 180/96
PAP: 45/30 to 61/33 PCW: 20 (@ 10 min, 33 min, 34 min)
RAP: 18 CO: 6.7
WAVEFORM PATTERNS:
Overwedge tracings @ 10 min and 33 min
Pulmonary hypertension
TECHNICAL COMMENTS:
Arterial line set-up sequence precedes PA set-up
RESPIRATORY DATA:
RATE: 14/28 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh193"> </a>
<h3>Record: mgh193</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old female
DIAGNOSIS/SURGERY:
Aorto-subclavian/aorto-carotid bypass
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 26 mcg/min
Neosynephrine @ 36.7 mcg/min
GENERAL COMMENTS:
Suctioning and chest PT @ 7 min - 15 min
Stop/FFW @ 65 min - 66 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 109 bpm
ECG INTERPRETATION:
ST segment and T wave abnormalities consistent with subendocardial ischemia
Digitalis effect
TECHNICAL COMMENTS:
Wandering baseline
HEMODYNAMIC DATA:
ART: 90/48
PAP: 35/16 PCW: 11 (@ 6 min, 17 min, 37 min)
RAP: 10
TECHNICAL COMMENTS:
PAP/CVP on same transducer
Flush CVP @ 32 min
CVP on @ 33 min - 35 min
RESPIRATORY DATA:
RATE: 12/12 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh194"> </a>
<h3>Record: mgh194</h3>
<pre>
PATIENT DATA:
AGE/SEX:
59 year old female
DIAGNOSIS/SURGERY:
Craniotomy
Clipping of aneurysm
PERTINENT HISTORY:
COPD
GENERAL COMMENTS:
Bed bath and changing bed @ 24 min - 45 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 73 bpm
ECG INTERPRETATION:
Short PR interval
Low voltage antero-lateral T waves
TECHNICAL COMMENTS:
Change LL electrode @ 45 min
Movement artifact
HEMODYNAMIC DATA:
ART: 160/70 MEAN: 98
PAP: 40/8
RAP: 4
RESPIRATORY DATA:
RATE: 18 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh195"> </a>
<h3>Record: mgh195</h3>
<pre>
PATIENT DATA:
AGE/SEX:
29 year old male
DIAGNOSIS/SURGERY:
Radial retroperitoneal resection of pheochromocytoma
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 62 corn
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
Slight J point elevation
Consistent with normal early repolarization
HEMODYNAMIC DATA:
ART: 120/80 MEAN: 91
RAP: 9
TECHNICAL COMMENTS:
CVP motion artifact (dressing change) @ 58 min
Turning in bed @ 73 min
RESPIRATORY DATA:
RATE: 14 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh196"> </a>
<h3>Record: mgh196</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old male
DIAGNOSIS/SURGERY:
Hepato-renal bypass graft
PERTINENT HISTORY:
Hypertension
Coronary disease
Peripheral vascular disease
PHARMACOLOGIC SUPPORT:
Nipride @ 60 mcg/min
GENERAL COMMENTS:
Turning @ 41 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 83 bpm
RHYTHM DISTURBANCES:
Rare unifocal ventricular ectopy
ECG INTERPRETATION:
Inferolateral subendocardial injury
HEMODYNAMIC DATA:
ART: 180/60 MEAN: 89
PAP: 60/24 PCW: 24 (@ 12 min, 14 min, 28 min, 62 min)
RAP: 10
WAVEFORM PATTERNS:
Pulmonary hvpertenslon
V wave
Overwedge @ 28 min
TECHNICAL COMMENTS:
Zero @ 24 min - 26 min
RESPIRATORY DATA:
RATE: 16 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh197"> </a>
<h3>Record: mgh197</h3>
<pre>
PATIENT DATA:
AGE/SEX:
78 year old female
DIAGNOSIS/SURGERY:
Esophagogastrectomy
PERTINENT HISTORY:
Coronary disease
Mitral regurgitation
Peripheral vascular disease
GENERAL COMMENTS:
Suctioning @ 50 min
Out of bed in chair
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 94 bpm
RHYTHM DISTURBANCES:
Rare atrial ectopy
ECG INTERPRETATION:
Poor precordial R wave progression, possible old anteroseptanyopoI infarct
Question of an old inferior infarct
Minor nonspecific ST segment and T wave changes
TECHNICAL COMMENTS:
Wandering baseline @ 38 min
HEMODYNAMIC DATA:
ART: 200/70 MEAN: 114
PAP: 40/16 PCW: 12 (@ 21 min 40 min)
RAP: 20
WAVEFORM PATTERNS:
Arterial pulsus paradox
Changing arterial pressure
Unusual PCW tracing
RESPIRATORY DATA:
RATE: 8/16 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING:
On @ 15 min
</pre>
<a href="#top">[top]</a>
<a name="mgh198"> </a>
<h3>Record: mgh198</h3>
<pre>
PATIENT DATA:
AGE/SEX:
38 year old female
DIAGNOSIS/SURGERY:
Thoracotomy
Decortication
PERTINENT HISTORY:
Mitral regurgitation
Aortic regurgitation
Pulmonary hypertension
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 119 bpm
TECHNICAL COMMENTS:
Wandering baseline
HEMODYNAMIC DATA:
ART: 110/60
PAP: 35/15 PCW: 12 (@ 9 min, 27 min, 58 min)
RAP: 13 CO: 4.8
WAVEFORM PATTERNS:
Pulsus paradox
Respiratory variation
TECHNICAL COMMENTS:
PAP and CVP on same transducer
CVP on @ 59 min - 62 min
RESPIRATORY DATA:
RATE: 6/24 changed to 4 bpm @ 63 min
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh199"> </a>
<h3>Record: mgh199</h3>
<pre>
PATIENT DATA:
AGE/SEX:
68 year Old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
PERTINENT HISTORY:
Coronary disease
Smoker
PHARMACOLOGIC SUPPORT:
TNG @ 100 mcg/min
GENERAL COMMENTS:
Patient movement for chest X-ray @ 42 min
Bed change @ 51 min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus bradycardia @ 42 bpm
ECG INTERPRETATION:
Left atrial enlargement
Left ventricular hypertrophy
Nonspecific T wave abnormality
HEMODYNAMIC DATA:
ART: 200/100 MEAN: 125
PAP: 32/16 PCW: 14
RAP: 8 CO: 3.7
WAVEFORM PATTERNS:
Hypertension
TECHNICAL COMMENTS:
Arterial set-up precedes PA and CVP
Zero @ 19 min
RESPIRATORY DATA:
RATE: 8/8 changed to 5/8 bpm @ 15 min
MODE OF VENTILATION:
Controlled changed to intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh200"> </a>
<h3>Record: mgh200</h3>
<pre>
PATIENT DATA:
AGE/SEX:
64 year old male
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aneurysm
PERTINENT HISTORY:
Smoker
GENERAL COMMENTS:
Bed change @ 14 min
Stop/FFW @ 72 min - 73 min
Hypothermic @ 94.9F
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm with intraventricular conduction defect @ 71 bpm
RHYTHM DISTURBANCES:
Rare multifocal ventricular ectopy
HEMODYNAMIC DATA:
ART: 170/90 MEAN: 126
RAP: 8
TECHNICAL COMMENTS:
Pressures turned off @ 46 min
RESPIRATORY DATA:
RATE: 10/10 bpm
MODE OF VENTILATION:
Controlled
</pre>
<a href="#top">[top]</a>
<a name="mgh201"> </a>
<h3>Record: mgh201</h3>
<pre>
PATIENT DATA:
AGE/SEX:
70 year old male
DIAGNOSIS/SURGERY:
Abdominal aortic aneurysm resection and grafting
Aortobifemoral bypass graft
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 92 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
sn wave change
Prolonged QT interval
HEMODYNAMIC DATA:
ART: 140/78
PAP: 44/22 PCW: 15 (@ 5 min, 19 min, 27 min, 47 min)
RAP: 10
WAVEFORM PATTERNS:
Pulsus paradox
Respiratory variation
TECHNICAL COMMENTS:
PA and CVP on same transducer
PA turned off and CVP on @ 22 min
Zero @ 26 min
RESPIRATORY DATA:
RATE: 8/8 changed to 7/16 bpm
MODE OF VENTILATION:
Controlled changed to IMV
</pre>
<a href="#top">[top]</a>
<a name="mgh202"> </a>
<h3>Record: mgh202</h3>
<pre>
PATIENT DATA:
AGE/SEX:
78 year old female
DIAGNOSIS/SURGERY:
Resection and grafting of abdominal aortic aneurysm
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 74 bpm
ECG INTERPRETATION:
Small inferior Q waves
Nonspecific ST segment and T wave abnormalities
HEMODYNAMIC DATA:
ART: 100/50 MEAN: 69
RAP: 3
RESPIRATORY DATA:
RATE: 20 bpm
MODE OF VENTILATION:
Spontaneous
</pre>
<a href="#top">[top]</a>
<a name="mgh203"> </a>
<h3>Record: mgh203</h3>
<pre>
PATIENT DATA:
AGE/SEX:
41 year old female
DIAGNOSIS/SURGERY:
Aorto-bronchial fistula
PERTINENT HISTORY:
Marfans disease
Aspiration
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 100 bpm
ECG INTERPRETATION:
Nonspecific ST segment and T wave changes, probably postoperative
TECHNICAL COMMENTS:
"V lead fail" message
HEMODYNAMIC DATA:
ART: 130/62 (femoral)
RAP: 15
TECHNICAL COMMENTS:
Zero @ 17 min
RESPIRATORY DATA:
RATE: 38 bpm
MODE OF VENTILATION:
Spontaneous
GENERAL COMMENTS:
CPAP increased from 5 to 10 @ 35 min
</pre>
<a href="#top">[top]</a>
<a name="mgh204"> </a>
<h3>Record: mgh204</h3>
<pre>
PATIENT DATA:
AGE/SEX:
27 year old female
DIAGNOSIS:
Mitral stenosis
PROCEDURE:
Right heart cath/left heart cath
(Evaluation for mitral valvulotomy)
ECG DATA:
LEADS: II
RHYTHM:
Normal sinus rhythm
RHYTHM CHANGES:
Atrial ectopy and tachycardia
Multifocal ventricular ectopy with couplets and 3-beat run of tachycardia
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
4-21 sec ZERO
1 min CAL OF 40 TO CH11
1 min CAL OF 100 CH9
2 min CAL OF 40 TO CH8
2-3 min ZERO
3-4 min STOP/FFW/START
4 min INSERTION OF PA CATHETER RA/RV /PA/PCW
6 min INSERTION OF RADIAL LINE ART
17 min INSERTION OF TRANS-SEPTAL CATHETER
25 min STOP/FFW/START
25 min RADIAL ON/OFFART
POSITIONING TRANS-SEPTAL CATHETER
31 min STOP TAPE/START
34 min TRANSEPTAL CATHETER IN POSITION
LEFT A TRIAL TRACE
ON
35 min
PCW/LA
39 min RE-INSERTION OF CATHETER
44 min RA?LA
INSERTION RETROGRADE CATHETER
47 min PA TO PCW TO PA
PA/PCW/PA
50 min RADIAL TRACE
ON/OFF
53 min ZERO
54 min LV AND PCW: 10 mm
GRADIENT
57 min PA PULLBACK PA
59 min RADIAL
ON
59 min LV INJECTION LV
ZERO LV
60 min TRACE ON
61 min PULLBACK TRANSEPTAL
63 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh205"> </a>
<h3>Record: mgh205</h3>
<pre>
PATIENT DATA:
AGE/SEX:
61 year old male
DIAGNOSIS:
Coronary artery disease
PROCEDURE:
Right heart cath/coronary angiography/left heart cath
ECG DATA:
LEADS:
II, III, V3 (telemetry)
RHYTHM:
Normal sinus rhythm @ 64 bpm
RHYTHM CHANGES:
Occasional PVCs (rare episodes of bigeminy, couplets, and multifocal ectopy) Sinus pauses
ECG INTERPRETATION:
Old inferior wall infarct
Left ventricular
Hypertrophy
STT changes
TECHNICAL COMMENTS:
ECG changes with position
HEMODYNAMIC DATA:
ART: 150/40
PA: 19/7 PCW: 5
CVP: 1
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-11 sec ZERO
1 min CAL OF 200
1 min ZERO
1 min CAL 200
2 min CAL OF 20
2 min ZERO
2-3 min ANNOTATION
3 min START RECORDING
INSERT PA CATHETER RA/RV /PA/PCW
4 min PCW (PCW=5;CVP= 1)
8 min RIGHT CORONARY INJECTION
9 min REPEAT
10 min STOP/FFW
11 min LEFT CORONARY INJECTION
13 min REPEAT CENTRAL AORTIC TRACE
15 min REPEAT BRIEF ASYSTOLIC EPISODE
20 min REPEAT
22 min REPEAT
26 min REPEAT
29 min LV CATHETER INSERTION LVEDP = 22
34 min LV ANGIOGRAM
35 min CHANGE ATTENUATION LVEDP = 25
36 min PULL-BACK LV CATHETER
38 min STOP/FFW
38 min FINAL ANNOTATION
40 min STOP
</pre>
<a href="#top">[top]</a>
<a name="mgh206"> </a>
<h3>Record: mgh206</h3>
<pre>
PATIENT DATA:
AGE/SEX:
57 year old male
DIAGNOSIS:
RCA disease
PROCEDURE:
post-TPA
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm @ 60 bpm
ECG INTERPRETATION:
sn changes consistent with pericarditis
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0 RECORDING ON
3 min INTRA-AORTIC BALLOON INSERTED
17 min STOP/FFW
17-18 min CAL ?200
18 min ECG CAL
18-19 min ANNOTATE
</pre>
<a href="#top">[top]</a>
<a name="mgh207"> </a>
<h3>Record: mgh207</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old male
DIAGNOSIS:
Recurrent angina post-coronary artery bypass graft
PROCEDURE:
Right heart cath/coronary angiography/left heart cath
ECG DATA:
LEADS:
II, III, V3 (telemetry)
RHYTHM:
Normal sinus rhythm of 60 bpm
RHYTHM CHANGES:
Sinus bradycardia
Ventricular ectopy with couplets and 3-5 beat runs of tachycardia
ECG INTERPRETATION:
Left atrial enlargement
Left axis deviation
Non-specific sn changes
HEMODYNAMIC DATA:
ART: 118/76
PA: 26/7 PCW: 8
CVP: 6
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
13/16 sec ZERO/CAL200 PRESSURE CH9
1 min ZERO/CAL200 PRESSURE CH 11
3 min ECG CAL
6 min ECG CAL TELEMETRY
6 min TAPE ON
6-7 min STOP/FFW
8 min TAPE ON
12-14 min SWAN-GANZ INSERTION RA/RV /PA/PCW
RIGHT CORONARY ARTERY INJECTION
18 min REPEAT
18 min REPEAT
19 min REPEAT
21 min REPEAT
21 min REPEAT
22 min REPEAT
22 min REPEAT
23 min REPEAT
23 min REPEAT
LEFT CORONARY ARTERY INJECTION
26 min REPEAT
28 min REPEAT
29 min REPEAT
32 min BYPASS GRAFT INJECTION
33 min REPEAT
PULLBACK TO AORTA AO
REPEAT
37 min REPEAT
46 min CHANGE CATHETER
ATTENUATION CHANGES
47 min RUN OF PVCS
LV CATH ETER INSERTION
ATTENUATION CHANGES
49 min LV GRAM LV
50 min ATTENUATION CHANGES
50 min CATHETER PULL-BACK AO
51 min CATHETER TO LV LV
51 min CATHETER PULL-BACK AO
53 min CATHETER TO AO TO LV AO/LV
RCA GRAFT
55 min PT RE-POSITIONED ON PILLOW
57 min RCA INJECTION
CO MEASUREMENT
62 min ADJUST ZERO/CAL
ARRHYTHMIAS
</pre>
<a href="#top">[top]</a>
<a name="mgh208"> </a>
<h3>Record: mgh208</h3>
<pre>
PATIENT DATA:
AGE/SEX:
54 year old male
DIAGNOSIS:
Refractory ventricular fibrillation
PROCEDURE:
Coronary angiography/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm @ 70 bpm .
RHYTHM CHANGES:
Ventricular ectopy
Runs of VT/SVT
ECG INTERPRETATION:
T wave inversion in inferior and anterolateral leads
Left axis deviation
HEMODYNAMIC DATA:
ART: 130/70
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-21 sec ECG CAL
21 sec TAPE OFF/ON
9 min VENTRICULAR COUPLET
17 min ZERO/CAL OF 200
18 min RIGHT CORONARY INJECTION
19 min REPEAT
SIT CHANGES
COUGHING/VOMITING
22 min LEFT CORONARY INJECTION
23 min REPEAT
SIT CHANGES
29 min REPEAT
29 min REPEAT
30 min RE-ADJUST PILLOW
32 min REPEAT
37 min LV CATHETER IN LVEDP = 9
39 min LV GRAM
ATTENUATION CHANGE
40 min LV TO AO
</pre>
<a href="#top">[top]</a>
<a name="mgh209"> </a>
<h3>Record: mgh209</h3>
<pre>
PATIENT DATA:
AGE/SEX:
62 year old male
DIAGNOSIS:
Coronary artery disease
PROCEDURE:
Right heart cath/coronary angiography/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm @ 67 bpm
RHYTHM CHANGES:
Sinus bradycardia
Atrial ectopy, run of atrial tachycardia
Junctional ectopy
Episode of asystole followed by A pacing
ECG INTERPRETATION:
Poor R wave progression with inferior T wave inversion and peaking? posterior ischemia
TECHNICAL COMMENTS:
Terrible ECG quality
HEMODYNAMIC DATA:
ART: 118/49 (69)
PA: 29/12 PCW: 9
CVP: 4
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-14 sec ECG CAL
14-17 sec ECG CAL TELEMETRY
17-24 sec REPEAT CAL
24 sec TAPE OFF/ON
4 min INSERTION SWAN-GANZ (CH11) RA/RV /PA/PCW -ART
OFF(CH10)
6 min AO/RADIAL ARTERIAL
8 min TEST A PACE CAPTURE
9 min RIGHT CORONARY ARTERY INJECTION
AO TO RCA
10 min REPEAT
10 min REPEAT
11 min REPEAT ASYSTOLE TO A PACE
15 min REPEAT
17 min LEFT CORONARY ARTERY INFECTION
18 min REPEAT
19 min REPEAT
19 min REPEAT
20 min RE-ADJUST PILLOW
22 min REPEAT
22 min REPEAT
23 min INSERT LV CATHETER LV
CHANGE ATTENUATION
26 min LV GRAM
27 min PULL-BACK
</pre>
<a href="#top">[top]</a>
<a name="mgh210"> </a>
<h3>Record: mgh210</h3>
<pre>
PATIENT DATA:
AGE/SEX:
32 year old male
DIAGNOSIS:
Congenital heart disease (corrected Tetralogy of Fallot)
Coronary heart disease
PROCEDURE:
Right heart cath/left heart cath/coronary angiography
ECG DATA:
LEADS: I (telemetry), II, III
RHYTHM:
Ventricular pacing
PACEMAKER INFORMATION:
Permanent WI pacer
RHYTHM CHANGES:
Multifocal ventricular ectopy with couplets and runs of tachycardia
ECG INTERPRETATION:
Probable ventricular atrial conduction
HEMODYNAMIC DATA:
ART: 100/70
PA: 40/20 (30) PCW: 26
CVP: 30
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-18 sec CAL TO ECG AND TELEMETRY
18-27 sec
STOP/FFW
1 min ATTACH CATHETER CH8
1 min ATTACH CATHETER CH9
6 min CAL OF 200 CH9
6 min CAL OF 200 CH8
6 min ZERO
9 min PA INSERTION RA/RV /PA/PCW
12 min CATHETER IN PA OUTFLOW TRACT
17 min ZERO
RA TRACE
RV/PA TRACE
30 min PA CATHETER OUT
34 min RE-ZERO CH9
34 min CATHETER TO DESCENDING AORTA
AO(CH9)
35 min RE-ZERO CH8
35 min CATHETER TO FEMORAL ARTERY
ART(CH8)
36 min
LV/FEMORAL
43 min RE-ZERO CH8
44 min POSITION IN RV RV
INSERT RIGHT HEART CATHETER
RE-ZERO
44 min LV/RV
46 min PA
46 min LV
49 min PULLBACK PA TO RV PA/RV
49 min PULLBACK RV TO RA RV/RA
54 min PCW (CH 8)
55 min PCW
59 min RE-ZERO CH 8
59 min PULLBACK
77 min TEST DOSE
78 min RV GRAM RV
</pre>
<a href="#top">[top]</a>
<a name="mgh211"> </a>
<h3>Record: mgh211</h3>
<pre>
PATIENT DATA:
AGE/SEX:
3 year old female
DIAGNOSIS:
post VSD repair
PROCEDURE:
Pediatric right heart cath
ECG DATA:
LEADS:
I (telemetry), II, V5
RHYTHM:
Normal sinus rhythm
RHYTHM CHANGES:
Wenckebach
ECG INTERPRETATION:
Incomplete right bundle branch block with left
Anterior hemiblock
Biventricular hypertrophy
TECHNICAL COMMENTS:
V5 on CH 5
V lead gain shifting
HEMODYNAMIC DATA:
CVP: 8
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-6 sec ECG CAL
9/10 sec ZERO/CAL 200 CH8
1 min ZERO/CAL 200 CH9
2 min ZERO/CAL 200 CH 11
2 min TAPE OFF/ON
WENCKEBACH
(atropine.1 X2)
7 min ECG TELEMETRY CAL
14 min
CHANGE IN EKG
14 min ECG CAL
19 min ZERO/CAL
20 min RA RA
20 min RV RV
0-40 SCALE
20 min 0-100 SCALE
22 min
CHANGE IN EKG
22 min RIGHT PA PA
0-40 SCALE
22 min MEAN PA
23 min MAIN PA
0-40 SCALE MEAN
25 min PULLBACK PA/RV
0-40 SCALE
26 min RV RV
0-40 SCALE
33 min STOP
</pre>
<a href="#top">[top]</a>
<a name="mgh212"> </a>
<h3>Record: mgh212</h3>
<pre>
PATIENT DATA:
AGE/SEX:
6 month old male
DIAGNOSIS:
Evaluation for mitral stenosis
PROCEDURE:
Left heart cath/right heart cath
ECG DATA:
LEADS:
I (telemetry), II, V2
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Atrial ectopy and tachycardia, occasional aberrant conduction
Junctional rhythm
Multifocal ventricular ectopy, bigeminy, and run of ventricular tachycardia
Second degree heart block
HEMODYNAMIC DATA:
ART: 105/
LA: 20 LVEDP: 5-7
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-6 sec ECG CAL
6-11 sec ECG CAL TELEMETRY
1 min STOP /FFW ION
3 min LEFT ATRIUM LA
3 min ZERO
3 min CAL OF ?200
3 min LEFT ATRIUM 0-40 A WAVE TO 35
MEAN LA
LA/VENTRICULAR
IRRITABILITY
LEFT ATRIUM/LEFT VENTRICLE LA/LV
6 min ZERO
CAL
8 min LEFT VENTRICLE
100 SCALE
8 min 200 SCALE
8 min LEFT VENTRICLE/FEMORAL ARTERY LV/FA
200 SCALE
9 min AORTA SCALE 200 AO
MEAN AORTA
9 min ZERO
10 min LEFT ATRIUM LA
MEAN LA
PULL-BACK TO RIGHT ATRIUM RA
RA PHASIC
RIGHT VENTRICLE RV
SCALE 40
11 min SCALE 100
PULMONARY CAPILLARY WEDGE PCW
11 min SCALE 40
11 min MEAN PCW
PULMONARY ARTERY PA
12 min SCALE 100
12 min MEAN PA
12 min MEAN PA SCALE 40
12 min PHASIC PA
13 min PULMONARY ARTERY TO RIGHT VENTRICLE PA/RV
SCALE 100
14 min RIGHT VENTRICLE OUT
15 min LEFT ATRIUM LA
SCALE 40
29 min LEFT VENTRICULAR ANGIOGRAM LV
35 min VENTRICULAR ECTOPY
36 min PULMONARY ARTERY PA
SCALE 100
40 min PULMONARY ARTERY INJECTION
45 min HEART BLOCK
48 min LEFT ATRIUM LA
51 min LA GRAM
54 min HEART BLOCK
56 min LEFT SUPERIOR VENA CAVA
56 min LEFT ATRIUM LA
56 min HEART BLOCK
57 min LEFT VENTRICLE LV
SCALE 40
57 min JUNCTIONAL RHYTHM
58 min PULL-BACK
NORMAL SINUS
RHYTHM
</pre>
<a href="#top">[top]</a>
<a name="mgh213"> </a>
<h3>Record: mgh213</h3>
<pre>
PATIENT DATA:
AGE/SEX:
59 year old male
DIAGNOSIS:
Unstable angina
PROCEDURE:
Right heart cath/coronary angiography/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm
RHYTHM CHANGES:
Atrial ectopy with normal and blocked conduction
Atrial and ventricular Couplets
Atrial pacing
ECG INTERPRETATION:
Indeterminant axis
HEMODYNAMIC DATA: (pre-cath)
ART: (100)
PCW: 5
CVP: 2
CO: 7.58, 6.74
PROCEDURAL EVENTS:
RHYTHM/PRESSURE CHANGES:
SET-UP
0-14 sec ECG CAL
14 min ZERO
INSERTION OF PA CATHETER
14 min RIGHT ATRIUM RA
14 min RIGHT VENTRICLE RV
14 min PULMONARY ARTERY PA
14 min PULMONARY CAPILLARY WEDGE PCW
CHANGE SCALE
15 min ECG CAL
16 min AORTA A
21 min ATRIAL PACING A
PACE
23 min RIGHT CORONARY INJECTION
25 min REPEAT
28 min LEFT CORONARY INJECTION
28 min REPEAT
29 min REPEAT
30 min REPEAT
PT SITS UP
33 min REPEAT
34 min REPEAT
38 min ZERO
38 min CAL OF 200
38 min LV CATH ETER INSERTION LV/CHEST PAIN
CHANGE SCALE X2
43 min LV ANGIOGRAM
46 min REPEAT
47 min LV PRESSURE
48 min PULLBACK LV/AO
</pre>
<a href="#top">[top]</a>
<a name="mgh214"> </a>
<h3>Record: mgh214</h3>
<pre>
PATIENT DATA:
AGE/SEX:
17 year old female
DIAGNOSIS:
Mitral regurgitation
Atrial septal defect
Ventricular septal defect
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, V?
RHYTHM:
Normal sinus rhythm with right bundle branch block
RHYTHM CHANGES:
Atrial and ventricular ectopy with couplet, run of ventricular tachycardia
ECG INTERPRETATION:
Left axis deviation
Probable left ventricular hypertrophy
TECHNICAL COMMENTS:
V lead on CH5
HEMODYNAMIC DATA:
PA: 40/20 PCW: 18
CVP: 12
CO: 5.9
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-8 sec ECG CAL
8 sec TELEMETRY CAL
12-16 sec ECG CAL
16-26 STOP /FFW ION
6 min-8 Z ZERO/CAL OF 200
7 min INSERT PA CATHETER
RA APPENDAGE RA
13 min RIGHT VENTRICLE RV
PULMONARY ARTERY PA
PULMONARY CAPILLARY WEDGE PCW
RE-ZERO
13 min CAL
14 min PULMONARY CAPILLARY WEDGE
SCALE 40
14 min MEAN PCW
14 min PULLBACK
PULMONARY ARTERY PA
14 min MEAN PA
15 min RIGHT VENTRICLE RV
VENTRICULAR ECTOPY
17 min ZERO/CAL
18 min RIGHT ATRIUM RA
SCALE 40
18 min MID RIGHT ATRIUM
19 min RIGHT ATRIUM
26 min LEFT VENTRICLE LV CD
SCALE 200
27 min SCALE 40
27 min SCALE 200
38 min ELECTRODE OFF
40 min LEFT VENTRICULOGRAM
40 min LEFT VENTRICLE LV
44 min RE-ZERO/CAL
44 min LEFT VENTRICLE TO AORTA LV/AO
44 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh215"> </a>
<h3>Record: mgh215</h3>
<pre>
PATIENT DATA:
AGE/SEX:
54 year old male
DIAGNOSIS:
Mitral stenosis
Mitral regurgitation
PROCEDURE:
Right heart cath/left heart cath/coronary angiography
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm
RHYTHM CHANGES:
Atrial ectopy with couplet, occasional aberrant conduction
Multifocal ventricular ectopy with bigeminy, couplet, run of ventricular tachycardia
ECG INTERPRETATION:
Left atrial enlargement
Intra-ventricular conduction defect
Non-specific SIT wave changes
TECHNICAL COMMENTS:
EKG off @ 26 min on mgh048
HEMODYNAMIC DATA:
PCW: 26
CVP: 0
CO: 5.61/4.15/5.69
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-7 sec ECG CAL
7-18 sec TELEMETRY CAL
20 sec TAPE OFF/ON
5 min LEAD III ON
18 min ZERO/CAL
19 min FEMORAL ARTERY ON ART
INSERT PA CATHETER
24 min RIGHT ATRIUM RA
25 min ZERO/CAL
RE-LEVEL
26 min ZERO
26 min RIGHT ATRIUM
RIGHT VENTRICLE RV
26 min SCALE 40
26 min SCALE 100
27 min PULMONARY ARTERY PA
PULMONARY CAPILLARY WEDGE PCW
27 min SCALE 40
27 min MEAN PCW
SCALE 100
29 min FEMORAL ARTERY/MEAN PA ART/PA
SCALE 200/100
34 min ZERO/CAL_S
35 min ZERO/CAL
36 min SIMULTANEOUS ART TRACES ART 1124-33 RE-CAL CH10
CATHETER TIP PRESSURE
40 min RE-ZERO/CAL
40 min SIMULTANEOUS TRACES
41 min VENTRICULAR IRRITABILITY
42 min CATHETER TO LV LV
VENTRICULAR IRRITABILITY
LV END-DIASTOLIC PRESSURE
43 min SCALE 40
43 min PULMONARY ARTERY/LV PA/LV
SCALE 40
SCALE 100 PCW: 40; LVEDP: 8
ZERO CH8 & 9
47 min CAL CH9
47 min ZERO CH10
48 min RE-ZERO
PCW/LV
PCW/LV
SCALE 40
MEAN
SCALE 100
MEAN
49 min PCW PCW
49 min PA TO MEAN PA TO PA PA
54 min LV/AO
SCALE 200
54 min PULLBACK
INSERT CORONARY CATHETERS
60 min MEAN PA
SCALE 100
SCALE 40
SCALE 100
60 min RE-ZERO/CAL
64 min LEFT VENTRICLE LV/VENTRICULAR ECTOPY
65 min RIGHT CORONARY
66 min LEFT CORONARY
67 min REPEAT X2
RE-POSITION PT
69 min REPEAT
73 min ZERO CAL
PC PCW
74 min SCALE 40
MEAN PCW
</pre>
<a href="#top">[top]</a>
<a name="mgh216"> </a>
<h3>Record: mgh216</h3>
<pre>
PATIENT DATA:
AGE/SEX:
14 year old male
DIAGNOSIS:
Mitral regurgitation secondary to endocarditis
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, III/V? (telemetry)
RHYTHM:
Normal sinus rhythm
RHYTHM CHANGES:
Atrial ectopy with occasional aberrant conduction
Multifocal ventricular ectopy with bigeminy, couplets, runs of ventricular tachycardia
TECHNICAL COMMENTS:
V lead on CH5
HEMODYNAMIC DATA:
CO: 9.2
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-10 sec ECG CAL
10-17 sec FFW /STOP ION
INSERT PA CATHETER
4 min CHANGE III TO VLEAD
5 min RIGHT ATRIUM RA
6 min RIGHT VENTRICLE RV
7 min PA MEAN PA
SCALE 40
7 min PCW PCW
SCALE 40
8 min PULLBACK PA PA
9 min LV ON LV
SCALE 200
9 min SCALE 40
9 min PCW/LV
PCW/LV
10 min MEAN PA/LV PA/LV
SCALE 100
18 min LV ANGIO
22 min AORTA AO
23 min MEAN AORTA
26 min AORTOGRAM
</pre>
<a href="#top">[top]</a>
<a name="mgh217"> </a>
<h3>Record: mgh217</h3>
<pre>
PATIENT DATA:
AGE/SEX:
1 year old male
DIAGNOSIS:
Congenital heart disease
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Atrial ectopy with normal and blocked conduction
Atrial tachycardia
Multifocal ventricular ectopy and tachycardia
ECG INTERPRETATION:
Right ventricular hypertrophy
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-15 sec ECG CAL
15-20 sec STOP /FFW ION
20-25 sec ZERO/CAL OF 200
1 min STOP /FFW ION
INSERT CATHETER
5 min RIGHT ATRIUM RA
ZERO/CAL
6 min RIGHT ATRIUM
9 min RIGHT VENTRICLE RV
10 min ZERO
10 min RIGHT VENTRICLE
SCALE 40
10 min SCALE 100
10 min RIGHT ATRIUM RA
10 min SCALE 40
11 min MEAN RIGHT ATRIUM
11 min RIGHT VENTRICLE RV
11 min SCALE 100
RIGHT PULMONARY ARTERY PA
11 min SCALE 40
11 min MEAN PA
12 min MAIN PULMONARY ARTERY
12 min LEFT PULMONARY ARTERY
13 min SCALE 100
PULLBACK:PA-RV-RA PA/RV/RA
VENTRICULAR IRRITABILITY
14 min PULMONARY VEIN PV
15 min LEFT ATRIUM LA
SCALE 100
15 min SCALE 40
15 min MEAN LA
LEFT VENTRICLE LV
16 min SCALE 40
16 min SCALE 100 VENTRICULAR IRRITABILITY
18 min VENTRICULAR IRRITABILITY
CONDUCTION CHANGES
19 min ASCENDING AORTA AO
SCALE 100
MEAN AO
27 min AORTOGRAM
31 min LV ANGIOGRAM
32 min LV DAMPED TRACING
32 min LV LV
33 min ZERO/CAL
LV
34 min SCALE 100
34 min SCALE 40
34 min LEFT ATRIUM LA
MEAN LA
34 min MEAN RA RA
34 min RA PHASIC
34 min RIGHT VENTRICLE RV
41 min LV ANGIOGRAM LV
43 min VENA CAVA ANGIOGRAM
44 min RIGHT ATRIUM RA
46 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh218"> </a>
<h3>Record: mgh218</h3>
<pre>
PATIENT DATA:
AGE/SEX:
5 year old male
DIAGNOSIS:
Tetralogy of Fallot
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), AVL, III
RHYTHM:
Normal sinus rhythm
ECG INTERPRETATION:
Right axis deviation
Right ventricular hypertrophy
TECHNICAL COMMENTS:
Artifact
No cal signal
Telemetry intermittent
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
1 min RECORDING
1 min ZERO/CAL
3 min SUPERIOR VENA CAVA ANGIOGRAM
6 min RIGHT VENTRICLE RV
SCALE 40
7 min SCALE 100
8 min AORTA AO
8 min RIGHT VENTRICLE TO AORTA RV/AO
8 min AORTA AO
MEAN AO
SCALE 100
8 min SCALE 200
10 min SCALE 200
10 min RIGHT VENTRICLE RV
RIGHT PULMONARY ARTERY PA
SCALE 100
10 min SCALE 40
11 min LEFT PULMONARY ARTERY
12 min SCALE 100
12 min PULLBACK TO INFUNDIBULUM RV
12 min SCALE 40
12 min RIGHT ATRIUM RA
50 cc BOLUS
19 min PULMONARY VEIN PV
v
19 min MEAN PV
LEFT ATRIUM LA
20 min MEAN LA
LEFT VENTRICLE LV
SCALE 40
20 min SCALE 100
20 min SCALE 200
AORTA AO
21 min SCALE 200
AORTA TO LV AND BACK
AO/LV/AO
21 min ASCENDING AORTA
22 min MEAN AO
27 min TELEMETRY ON
28 min AORTOGRAM
29 min LV ANGIOGRAM
31 min ZERO/CAL
32 min LV LV
SCALE 40
SCALE 100
32 min LV TO LA LV/LA
32 min LA TO RA (patent foramen) LA/RA
40 min RV ANGIOGRAM
41 min RV TO RA RV/RA
41 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh219"> </a>
<h3>Record: mgh219</h3>
<pre>
PATIENT DATA:
AGE/SEX:
1 year old male
DIAGNOSIS:
Congenital heart disease
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), V?, III
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Ventricular ectopy
Heart block
ECG INTERPRETATION:
Right axis deviation
Prominent R wave in leads VI-3 ,consistent with age
Normal early repolarization
TECHNICAL COMMENTS:
Artifact
V lead on CH4
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
1 min ECG CAL
1 min FFW/STOP
INSERTION OF CATHETER
6 min RIGHT ATRIUM RA
7 min MEAN RA
10 min LEFT VENTRICLE LV
SCALE 40
11 min SCALE 100
11 min PULMONARY ARTERY PA
SCALE 100
11 min MEAN PA
12 min RIGHT PULMONARY ARTERY
13 min LEFT PULMONARY ARTERY
13 min PULLBACK TO RV RV
13 min RIGHT VENTRICULAR BODY
13 min RIGHT ATRIUM RA
14 min LEFT ATRIUM LA
14 min SCALE 40
14 min LEFT VENTRICLE LV
SCALE 40
14 min SCALE 100
15 min SCALE 40
15 min SCALE 100
15 min SCALE 200
VENTRICULAR IRRITABILITY
17 min LEFT VENTRICLE LV
18 min SCALE 40
18 min SCALE 100
21 min IRRITABLE; OCCASIONAL
BLOCK
21 min AORTA AO
MEAN AO SCALE 100
26 min AORTOGRAM
31 min LV GRAM
33 min ZERO/CAL
PULLBACK
33 min LEFT ATRIUM LA
SCALE 40
34 min PULMONARY VEIN PV
34 min MEAN PV
37 min BLOCK
38 min LEFT ATRIUM LA
MEAN LA
38 min MEAN RA RA
40 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh220"> </a>
<h3>Record: mgh220</h3>
<pre>
PATIENT DATA:
AGE/SEX:
4 month old male
DIAGNOSIS:
Congenital heart disease
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), II, III/V4
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Atrial ectopy with occasional blocked conduction
Multifocal ventricular ectopy with couplets and runs of tachycardia
ECG INTERPRETATION:
Abnormal right axis deviation
RSR or QR pattern in V1 suggests right ventricular conduction delay
Marked ST Abnormality
Possible Inferior Subendocardial Injury
TECHNICAL COMMENTS:
CH5 changed from Lead III to V4 (225) to III
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-7 sec ECG CAL
7-19 sec TELEMETRY CAL
19 sec OFF/ON
1 min ZERO/CAL CH8
3 min RE-ZERO
3 min RIGHT ATRIUM RA MEAN = 8
SCALE 40
SLIGHT BLOCK
IRRITABILITY
RIGHT VENTRICLE RV
5 min SCALE 40
5 min SCALE 100
5 min SCALE 200
IRRITABILITY
7 min LEAD III TO V4
7 min LEAD V4 TO III
8 min PULMONARY ARTERY PA
SCALE 200
8 min SCALE 100
11 min PT CRYING
SCALE 200
18 min PA ANGIOGRAM
PULMONARY ARTERY
19 min RIGHT VENTRICLE RV
20 min LEFT ATRIUM LA
20 min SCALE 40
IRRITABILITY/BLOCK
21 min LEFT VENTRICLE LV
SCALE 40
SCALE 100
21 min SCALE 200
21 min SCALE 100
29 min LV ANGIOGRAM
30 min RE-ZERO
SCALE 100
SCALE 40
PULLBACK
30 min LEFT ATRIUM LA
31 min RIGHT ATRIAL MEAN RA
31 min RIGHT ATRIUM
</pre>
<a href="#top">[top]</a>
<a name="mgh221"> </a>
<h3>Record: mgh221</h3>
<pre>
PATIENT DATA:
AGE/SEX:
1 year old female
DIAGNOSIS:
Congenital heart disease
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), AVF, III
RHYTHM:
Sinus tachycardia
RHYTHM CHANGES:
Atrial ectopy
Multifocal ventricular ectopy with bigeminy, couplets with runs of
Tachycardia
TECHNICAL COMMENTS:
AVF on CH4
No ECG cal
HEMODYNAMIC DATA:
TECHNICAL COMMENTS:
No zero/cal data
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
INSERTION OF CATHETER
16 sec MID-RIGHT ATRIUM RA
1 min RIGHT VENTRICLE , RV
1 min PA: DISTAL TO PA BAND PA
SCALE 100
2 min SCALE 40
2 min SCALE 100
2 min SCALE 40
SCALE 100
4 min MAIN PA
PULLBACK TO OUTFLOW
MAIN PA TO LEFT PA
6 min LEFT PA PULLBACK
6 min MAIN
6 min OUTFLOW
7 min RV OUTFLOW RV
7 min RV APEX
8 min COUPLET
14 min RV GRAM
17 min LA LA
SCALE 40
18 min LA
19 min LV LV
SCALE 40
19 min SCALE 100
19 min SCALE 20
22 min LV TO LA TO LV LV/LA/LV
LV GRAM
27 min LV TO LA LV/LA
31 min LA TO RA LA/RA
33 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh222"> </a>
<h3>Record: mgh222</h3>
<pre>
PATIENT DATA:
AGE/SEX:
5 month old female
DIAGNOSIS:
TGA/PS/ASD
PROCEDURE:
Right heart cath/left heart cath
TECHNICAL COMMENTS:
Data erased accidentally
</pre>
<a href="#top">[top]</a>
<a name="mgh223"> </a>
<h3>Record: mgh223</h3>
<pre>
PATIENT DATA:
AGE/SEX:
49 year old male
DIAGNOSIS:
Post cardiac transplantation
PROCEDURE:
RV Bbopsy
ECG DATA:
LEADS:
I (telemetry), III, V2
RHYTHM:
Normal sinus rhythm
RHYTHM CHANGES:
Multifocal ventricular ectopy with couplets and runs of tachycardia
HEMODYNAMIC DATA:
CO: 7.1, 6.4
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
20 min ECG CAL
23 min RUN OF VENTRICULAR
ECTOPY
PVCS
RV BIOPSY
35 min ZERO/CAL
INSERTION OF PA CATHETER
36 min RIGHT ATRIUM RA
37 min RIGHT VENTRICLE RV
38 min PULMONARY CAPILLARY WEDGE PCW
++"CATHETER FLING"
43 min END
</pre>
<a href="#top">[top]</a>
<a name="mgh224"> </a>
<h3>Record: mgh224</h3>
<pre>
PATIENT DATA:
Documentation incomplete
DIAGNOSIS:
? Aortic regurgitation
PROCEDURE:
Cardiac catheterization
ECG DATA:
LEADS:
I (telemetry), A VF, II
RHYTHM CHANGES:
Normal sinus rhythm with first degree heart block and intraventricular conduction defect
Complete heart block
Ventricular pacing
DOCUMENTATION INCOMPLETE
</pre>
<a href="#top">[top]</a>
<a name="mgh225"> </a>
<h3>Record: mgh225</h3>
<pre>
PATIENT DATA:
AGE/SEX:
10 month male
DIAGNOSIS:
A-V Canal
?Hypoplastic left ventricle
PROCEDURE:
Right heart cath/left heart cath
ECG DATA:
LEADS:
I (telemetry), III, V4
DOCUMENTATION INCOMPLETE
</pre>
<a href="#top">[top]</a>
<a name="mgh226"> </a>
<h3>Record: mgh226</h3>
<pre>
PATIENT DATA:
AGE/SEX:
71 year old male
DIAGNOSIS/SURGERY:
Thoracic aneurysm
Pancreatic abscess
Sepsis
Respiratory insufficiency
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Normal sinus rhythm @ 92 bpm
RHYTHM DISTURBANCES:
Occasional unifocal ventricular ectopy
ECG INTERPRETATION:
Non-specific ST segment and T abnormalities
HEMODYNAMIC DATA:
ART: 105/50
PAP: 33/20 PCW: 13 (@ 13 min, 17 min, 42 min, 63 min, 66 min)
RAP: 13 CO: 11.2 (AM); 9.15 (PM)
WAVEFORM PATTERNS:
Unusual arterial tracing post-obliteration with cuff pressure
Pulsus paradox
TECHNICAL COMMENTS:
CVP and PAP on single transducer
Poor CVP tracing quality @ 25 min - 35 min
CVP tracing repeated @ 37 min - 40 min
RESPIRATORY DATA:
RATE: 8/28 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
</pre>
<a href="#top">[top]</a>
<a name="mgh227"> </a>
<h3>Record: mgh227</h3>
<pre>
PATIENT DATA:
AGE/SEX:
76 year old male
DIAGNOSIS/SURGERY:
Sub-total gastrectomy/duodenostomy
PERTINENT HISTORY:
Smoking
PHARMACOLOGIC SUPPORT:
Levophed @ 40 mcg/min
Dopamine @ 187 mcg/min
ELECTROCARDIOGRAPHIC DATA:
UNDERLYING RHYTHM:
Sinus tachycardia @ 119 bpm
RHYTHM DISTURBANCES:
Atrial ectopy
ECG INTERPRETATION:
Non-specific SIT wave changes
HEMODYNAMIC DATA:
ART: 80/40 MEAN: 55
PAP: 36/26 PCW: 12 (@ 9 min, 30 min, 62 min, 63 min)
RAP: 8
WAVEFORM PATTERNS:
Hypotension
Pulsus paradox
Giant A wave in CVP trace
Respiratory variation
RESPIRATORY DATA:
RATE: 8/28 bpm
MODE OF VENTILATION:
Intermittent mandatory ventilation
CO2 RECORDING
</pre>
<a href="#top">[top]</a>
<a name="mgh228"> </a>
<h3>Record: mgh228</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old male
DIAGNOSIS:
Coronary artery disease
PROCEDURE:
Coronary artery bypass graft
ECG DATA:
LEADS:
II, V5 or V6
RHYTHM:
Normal sinus rhythm with incomplete left bundle branch block
RHYTHM CHANGES: (mgh228 and mgh040)
Sinus bradycardia
Atrial ectopy, tachycardia, flutter, fibrillation
Junctional rhythm
Occasional aberrant conduction
Ventricular escape beats
Multifocal ventricular ectopy with couplets, runs of tachycardia
Ventricular fibrillation
Idioventricular rhythm
TECHNICAL COMMENTS:
Electrocautery interference
V lead off momentarily
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
1 min ZERO/CAL
INSERTION OF PA CATHETER RA/RV /PA/PCW
15 min INDUCTION OF ANESTHESIA HYPOTENSION
PRESSURE FLUCTUATION
NEOSYNEPHRINE ADMINISTERED
ARRHYTHMIAS
21 min INTUBATION
23 min DRAPE/PREP
46 min INCISIONS
ELECTROCAUTERY
51 min STERNOTOMY
</pre>
<a href="#top">[top]</a>
<a name="mgh229"> </a>
<h3>Record: mgh229</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
BYPASS
OFF BYPASS
</pre>
<a href="#top">[top]</a>
<a name="mgh230"> </a>
<h3>Record: mgh230</h3>
<pre>
PATIENT DATA:
AGE/SEX:
43 year old female
DIAGNOSIS:
Mitral stenosis
PROCEDURE:
Mitral valvulotomy
ECG DATA:
RHYTHM:
Sinus tachycardia
TECHNICAL COMMENTS:
ECG data on DR CH2 by mistake therefore data lost
HEMODYNAMIC DATA:
ART: 140/70
CO: 5.3, 4.4
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
2 min ZERO/CAL
CAL OF 200 CH8/CH10
CAL OF 20 CH9/CH11
2 min ZERO ALL CHANNELS
3 min ZERO
3-6 min INSERTION OF LA CATHETER
6-7 min STOP/FFW/START
7-8 min LEFT ATRIUM LA=45
8 min CAL OF 200 CH9
9 min CAL OF 20 CH8
10 min PULMONARY ARTERY PA
PHASIC
10 min LEFT ATRIUM LA
PHASIC
39 min ZERO CH10
40 min LEFT VENTRICLE LV
VENTRICULAR ECTOPY; RUNS OF VT
PASSING WIRE
50 min ILIAC
50 min STOP/FFW/START
53 min STOP/FFW/START
53 min INSERTING DILATING CATHETER (25mm)
56 min DILATE
57 min DILATE
PCW MEAN
PCW REDUCED
59 min DILATE
62 min DILATE
62-63 min STOP/FFW/START
WITHDRAW/EXCHANGE CATHETER (15mm)
63 min DILATIONS X2
63 min DILATE
63 min DILATE
64 min DILATE
64 min DILATE
65 min DILATE
66 min DILATE
66 min DILATE
66 min DILATE
67 min PCW
67 min STOP/FFW/START
WITHDRAW/EXCHANGE CATHETER
67 min DILATE
68 min DILATE
69 min DILATE
69 min DILATE
69 min DILATE
70 min DILATE
70 min DILATE
71 min DILATE
71 min STOP/FFW/START
WITHDRAW/EXCHANGE CATHETER
71 min DUAL BALLOON DILATION
72 min DILATE
73 min DILATE
73 min DILATE
74 min DILATE
74 min STOP/FFW/START
74 min CATHETER OUT PAP 2265 LEFT ATRIAL CATHETER IN
75 min LEFT ATRIUM LA 2312 LA/LV
78 min PA/PCW
79 min RIGHT ATRIUM RA
(CONTINUED ON mgh235)
</pre>
<a href="#top">[top]</a>
<a name="mgh231"> </a>
<h3>Record: mgh231</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old female
DIAGNOSIS:
Unstable angina
PROCEDURE:
Coronary artery bypass graft
ECG DATA:
LEADS:
II, V6
RHYTHM:
Sinus tachycardia
ECG INTERPRETATION:
STI abnormalities, ?anterolateral subendocardial ischemia/infarct, LV strain or post-cardiotomy
TECHNICAL COMMENTS:
V electrode off before 800, re-positioned @ 26 min
HEMODYNAMIC DATA:
ART: 110/50
PA: 25/10 PCW: 6
CVP: 6
CO: 4.2
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-1 min ZERO/CAL
5 min INDUCTION SLIGHT REDUCTION IN
PRESSURE
6 min CO INJECTION
DRAPING
26 min CHANGE V ELECTRODE
43 min INCISIONS/ELECTROCAUTERY
51 min STERNAL INCISION
73 min AORTIC CANNULATION
75 min STOP
</pre>
<a href="#top">[top]</a>
<a name="mgh232"> </a>
<h3>Record: mgh232</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES
SET-UP
0-20 sec ZERO CH8/9/11
57 min ZERI/CAL CH9/ll
71 min STOP
</pre>
<a href="#top">[top]</a>
<a name="mgh233"> </a>
<h3>Record: mgh233</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-1 sec ZERO ALL CHANNELS
23 min STOP/FFW/STOP
23-24 min ZERO CH8/9
COMING OFF BYPASS
PACING WIRES IN
47 min MANUAL VENTILATION
49 min ATRIAL PACING PACING:LACK OF
CAPTURE
49 min LA ON/PAP OFF
51 min CVPON
52 min PAP MEAN TO PCW
PHASIC PAP
54 min CO VIA CVP 3.7
54 min PACER OFF/ON PACE
55 min AORTIC ROOT X2
58 min PCW
63 min CHANGE PACERS PACE
</pre>
<a href="#top">[top]</a>
<a name="mgh234"> </a>
<h3>Record: mgh234</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
1-2 min ZEROS
</pre>
<a href="#top">[top]</a>
<a name="mgh235"> </a>
<h3>Record: mgh235</h3>
<pre>
PATIENT DATA:
AGE/SEX:
43 year old female
DIAGNOSIS:
Mitral stenosis
PROCEDURE:
Mitral valvulotomy
ECG DATA:
RHYTHM:
Sinus tachycardia
TECHNICAL COMMENTS:
ECG data on DR CH2 by mistake therefore data lost
(CONTINUATION OF mgh230)
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-20 sec ZERO
7 min ADMINISTER VOLUME
VAGAL EPIDODE (atropine/
dopamine/levophed)
15 min PCW
ART
20 min LV GRAM LV
37-38 min ZERO/CAL CH9
38 min ZERO/CAL CH 11
38 min CAL CH8
39 min CAL CH10
40 min ECG CAL
41 min END
</pre>
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<a name="mgh236"> </a>
<h3>Record: mgh236</h3>
<pre>
PATIENT DATA:
AGE/SEX:
56 year old male
DIAGNOSIS:
Paroxysmal ventricular tachycardia
PROCEDURE:
Ablation
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm with right bundle branch block
RHYTHM CHANGES:
Idioventricular rhythm
Ventricular ectopy with couplet and 3-beat run of tachycardia
ECG INTERPRETATION:
Old antero-septal infarct with apical aneurysm
Old infero-posterior infarct
Left atrial enlargement
T wave abnormalities
HEMODYNAMIC DATA:
LVEDP: 6-8
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
0-15 sec ANNOTATION
15-22 sec STOP/FFW
SET-UP
22-26 sec ZERO
1 min CAL OF 200
1 min STOP/FFW
1 min ART
8 min STOP/FFW
DAMPING ARTERIAL
LINE
VENTRICULAR ECTOPY
13 min STOP/FFW
13 min CATHETER IN LV LV PRESSURE FROM TIP
PACE MAP SEQUENCE
23 min PACE
33 min PACE
34 min PACE
39 min RE-POSITION CATHETER
ADJUST PACER DELAYS/OUTPUT
44 min STIMULATE V VT
45 min TERMINATE VT
47 min STOP/FFW
47 min REPEAT STIMULATION
48 min STOP/FFW
54 min INDUCTION OF ANESTHESIA
59 min ABLATION Idioventricular Rhythm
Sinus
60 min Flush LV catheter
61 min V Pace Pace: No capture @ 61 min
63 min ABLATION Idioventricular Rhythm
Sinus
65 min V Pace PACE: No capture
67 min STOP
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<a name="mgh237"> </a>
<h3>Record: mgh237</h3>
<pre>
PATIENT DATA:
AGE/SEX:
83 year old male
DIAGNOSIS:
Aortic stenosis
PROCEDURE:
Aortic valvulotomy
ECG DATA:
LEADS: II
RHYTHM:
Normal sinus rhythm @ 70 bpm
RHYTHM CHANGES:
Atrial ectopy with run of atrial tachycardia
Multifocal ventricular ectopy with bigeminy, couplet, runs of ventricular tachycardia
ECG INTERPRETATION:
Postero-basilar infarct
HEMODYNAMIC DATA:
ART: 95/60
PA: 20/? (14) PCW: 4
CVP: 0 RV: 20/0
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-20 sec ZERO
1 min CAL OF 100
2 min TAPE OFF/ON 2 PRESSURE
CHANNELS ON
INSERT TRANSEPTAL CATHETER
7 min ?RA TO LA
9-10 min STOP/FFW
10-11 min RA TO RV TO PA TO PCW
12 min LA
13 min ART
CHANGE LV ATTENUATION
16 min LV/ART
LV OFF
26 min LA/LV
27 min LV
28 min CATHETER TO LA LA
28 min CATHETER TO LV LV
29 min LV OFF
30 min AO
30 min AO/RAD
31 min RE-ZERO
31 min LV/AO
31 min AO OFF
RADIAL ART
39 min STOP/FFW
ATTEMPTS AT DILATION
39 min
39 min
40 min 8 MM BALLOON
40-41 min
45-46 min
46 min
47-48 min
48-49 min PRESSURE MAINTAINED 20 MM
55-56 min
56 min RUN OF PVCS @ 57 min
57 min
58 min FLUSH CA TH ETER
58 min RE-ZERO
60 min LV TO LA/AO
61 min LA TO LV
61 min LV/AO
62 min AO TO LV PULL-BACK
LV TO LA PULL-BACK
63 min LA/LV
64 min RAD ART/LV
65 min LA
65 min RADIAL
68'min ANNOTATE
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<a name="mgh238"> </a>
<h3>Record: mgh238</h3>
<pre>
PATIENT DATA:
AGE/SEX:
63 year old male
DIAGNOSIS:
Coronary artery disease
PROCEDURE:
Coronary artery bypass graft
ECG DATA:
LEADS:
II,V4
RHYTHM:
Normal Sinus Rhythm @ 80 bpm
RHYTHM CHANGES: (mgh239 and mgh240)
Atrial ectopy and tachycardia
Multifocal ventricular ectopy with bigeminy, couplets, runs of tachycardia
Ventricular fibrillation
Idioventricular rhythm
Atrial pacing with competition
ECG INTERPRETATION:
Anterior T wave changes
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
8-13 sec ZERO/CAL OF 40 CH8
16-23 sec ZERO/CAL OF 40 CH 11
1 min ZERO/CAL OF 200 CH9
1 min PRESSURES ON
5-6 min CHANGE LEVEL CH6
7-11 min CHANGE ZERO CH 11
13 min INDUCTION
17 min INTUBATION
40 min PREP/DRAPE
36 min ART LINE ON
INTERMITTENTLY
38 min EKG CAL
43 min INCISIONS
82 min END
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<a name="mgh239"> </a>
<h3>Record: mgh239</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
31 min CHANGE PAP/CVP SCALE
32-33 min ZERO/CAL OF 40 CH8
33 min ZERO/CAL OF 40 CH 11
33 min ZERO/CAL OF 200 CH8
36 min pew
36 min SCAN EKG CHANNELS
40 min PCW
48 min PCW
43 min CANNULATION
PROXIMAL ANASTOMOSES
66 min BYPASS
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<a name="mgh240"> </a>
<h3>Record: mgh240</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
1 min ZERO CH11
2 min . ZERO CH8
2 min ZERO CH9
WARMING
5 min ATRIAL PACING ATRIAL PACING: LOSS OF CAPTURE
7 min COMING OFF BYPASS ATRIAL PACING
9 min LEFT A TRIAL TRACE PHASIC/MEAN
11 min LV VENT /LA/PV
13 min MEAN LA
16 min PCW TO MEAN PA
43 min CHEST CLOSING SHIFT ECG AXIS
50 min CLOSED
70 min DRAPES OFF
MOVED TO BED
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<a name="mgh241"> </a>
<h3>Record: mgh241</h3>
<pre>
AGE/SEX:
61 year old male
DIAGNOSIS:
Coronary artery disease
Congestive heart failure
Mild mitral regurgitation
PROCEDURE:
LV aneurysmectomy
ECG DATA:
LEADS:
II,V4
RHYTHM:
Ventricular pacing @ 100 bpm
PACEMAKER DATA:
Permanent = Atomic ventricular pacer
Pre-bypass = Swan-Ganz temporary pacer
Post-bypass = temporary epicardial pacing
RHYTHM CHANGES: (Tapes 209, 210, and 211)
Ventricular ectopy
Asystolic episode
Single and dual chamber pacing (competition)
Ventricular fibrillation
Dual chamber pacing
ECG INTERPRETATION:
Antero-lateral infarct
STI wave change post-bypass
HEMODYNAMIC DATA:
ART: 132/60
PA: 50/ (37) PCW: 25
CVP: 15
CO: 2.6 (1st); 4.0 (30 min later)
NOTE: Cannon or V waves with V Pacing
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-11 sec ECG CAL
14/17 sec ZERO/CAL OF 200 CH9
1 min STOP/FFW/START
2 min CHANGE CH4 LEVEL
2 min ZERO/CAL OF 40 CH 11
2-3 min ZERO/CAL OF 40 CH8
14 min SWAN-GANZ INSERTION
23 min RIGHT VENTRICLE RV
23 min PULMONARY ARTERY PA
23 min PCW PCW
24 min ANNOTATION
25 min ZERO/CAL OF 40 CH 11
26 min ZERO/CAL OF 40 CH8
26 min ZERO/CAL OF 200 CH9
CHANGE IN ARTERIAL CONTOUR:
Nipride/Volume/increased cardiac output
28 min CHANGE IN ZERO CH 11
28 min CHANGE IN ZERO CH 11
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<a name="mgh242"> </a>
<h3>Record: mgh242</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
OPENING STERNUM
46 min PARTIAL BYPASS
48 min FULL BYPASS/COOLING ASYSTOLE
50 min ZERO/CAL OF 40 CH 11
50 min ZERO/CAL OF 40 CH8
51 min ZERO/CAL OF 200 CH9
51-52 min STOP/FFW/START
52 min OFF BYPASS A-V PACING
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<a name="mgh243"> </a>
<h3>Record: mgh243</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP LOSS OF CAPTURE WITH A-V
PACING
TO V PACE
21 min ? MITRAL REGURGITATION
47 min ART = 160/75; PAP = 38/18;
PCW = 13
LAP = 13
48 min PULLBACK CATHETER
49 min ZERO CH8
49 min ZERO CH11
49 min ZERO CH9
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<a name="mgh244"> </a>
<h3>Record: mgh244</h3>
<pre>
PATIENT DATA:
AGE/SEX:
7 year old male
DIAGNOSIS:
PA conduit stenosis post closure VSD
Insertion of aortic valve prosthetic (Bjork-Shiley) and PA conduit with valve (CE)
PROCEDURE:
Right heart cath/Left heart cath
ECG DATA:
LEADS:
I (telemetry), II, V?3 (telemetry)
RHYTHM:
Normal sinus rhythm with right bundle branch block
RHYTHM CHANGES:
Atrial ectopy
Ventricular ectopy with couplet
ECG INTERPRETATION:
Right axis deviation
Right ventricular hypertrophy
TECHNICAL COMMENTS:
V lead on channel 5
V lead clipped on cath lab monitor and consequently on tape
HEMODYNAMIC DATA:
CVP: 10
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-5 sec ECG CAL
5-10 sec CAL TO ECG TELEMETRY
10-20 sec STOP/FFW
1 min CAL OF 200 TO CH8
1 min ZERO CH8
1 min STOP/FFW
1 min TAPE ON
INSERT CATHETER FEMORAL VEIN
4 min RA RA
5 min RV RV
0-40 SCALE
0-100 SCALE
5 min 0-200 SCALE
0-100 SCALE
6 min PA
6 min 0-40 SCALE
6 min 0-100 SCALE
7 min PULLBACK FROM PA PA/RV
7 min TO RV
8 min PULLBACK CONDUIT TO RV BODY
10 min TO LA THRU FORAMEN LA
0-40 SCALE
ECTOPY
12 min RV RV
18 min LV GRAM
LV LV
22 min 0-100 SCALE
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<a name="mgh245"> </a>
<h3>Record: mgh245</h3>
<pre>
PROCEDURE:
Insertion of Swan-Ganz catheter (under fluoroscopic guidance)
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
PA INSERTION RA/RV /PA/PCW
27 min ZERO/CAL 200 CH9
27 min PA DAMPED
FLUSH PA
28 min RECORD PA PA
29 min ADVANCE TO PCW PCW
53 min ZERO /CAL 200
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<a name="mgh246"> </a>
<h3>Record: mgh246</h3>
<pre>
PATIENT DATA:
AGE/SEX:
21 year old male
DIAGNOSIS:
Cardiac transplantation
PROCEDURE:
RV biopsy
ECG DATA:
LEADS:
I (telemetry)
RHYTHM:
Normal sinus rhythm @ 90 bpm
RHYTHM CHANGES:
Ventricular ectopy with couplets
HEMODYNAMIC DATA: (pre-cath)
ART: 145/75
PA: 40/20 PCW: 10
CVP: 5
PHARMACOLOGIC SUPPORT:
Nipride/Dopamine/Isuprel
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-5 sec ECG CAL
5-7 sec TELEMETRY ECG CAL
18 sec STOP/FFW
19 sec TAPE ON
24-27 sec ZERO/CAL OF 200 CH8
1-3 min ART ON
3 min STOP/REWIND TO 100/RESTART
INSERT BIOPSY CATHETER
12 min ZERO CH 11
12 min PAON PA
13 min RA RA
13 min RV RV
13 min PA PA
PCW PCW
18 min STOP
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<a name="mgh247"> </a>
<h3>Record: mgh247</h3>
<pre>
PATIENT DATA:
AGE/SEX:
73 year old female
DIAGNOSIS:
Paroxysmal ventricular tachycardia
PROCEDURE:
Right heart cath/coronary angiography/left heart cath
Pace map
ECG DATA:
LEADS:
I (telemetry), II, III
RHYTHM:
Normal sinus rhythm with intraventricular conduction defect
RHYTHM CHANGES:
Multifocal ventricular ectopy with runs of tachycardia and couplets
(Ventricular pacing stimulation and interruption of VT on mgh046)
ECG INTERPRETATION:
Old inferior infarct
Non-specific SIT wave abnormalities
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-14 sec ECG CAL
2-3 min ADJUST ZERO/GAIN
7 min ZERO
8-9 min CALS OF 200
3-26 min INSERTION OF PA CATHETER
26 min RA RA
32 min ART ART
35-38 min ELECTRODES OFF
41 min LEFT CORONARY INJECTION
42 min REPEAT
42 min REPEAT
43 min REPEAT
47 min REPEAT
52 min LEFT VENTRICULAR CATHETER LV
VENTRICULAR IRRITABILITY
55 min LV ANGIOGRAM
VENTRICULAR IRRITABILITY
55 min PULLBACK
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<a name="mgh248"> </a>
<h3>Record: mgh248</h3>
<pre>
PATIENT DATA:
AGE/SEX:
83 year old male
DIAGNOSIS:
Abdominal aortic aneurysm
PROCEDURE:
Resection and grafting of aneurysm
ECG DATA:
LEADS:
I, II, III,V5
RHYTHM:
Normal sinus rhythm with right bundle branch block
ECG INTERPRETATION:
Left atrial enlargement
HEMODYNAMIC DATA:
ART: 150/60
PA: 28/6 PCW: 6
CVP: 6
CO: 3.38
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
0-10 sec ZERO
10-15 sec ECG CAL
2 min CHANGE LEVEL
INDUCTION
INCISION/ELECTROCAUTERY
31 min RE-POSITION ELECTRODES
43 min ECG CAL
48 min+50 ZERO/CAL OF 100 CH9/20 CH8/11 1564 CHG?
80 min CLAMP AORTA
</pre>
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<a name="mgh249"> </a>
<h3>Record: mgh249</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
7 min PCW
25 min MOVE CLAMP/PRE-CLOT GRAFT
36 min REMOVE CLOT
48 min FLOW TO LEFT LEG
49 min FLOW TO RIGHT LEG
79 min ZERO
</pre>
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<a name="mgh250"> </a>
<h3>Record: mgh250</h3>
<pre>
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES:
SET-UP
HYPERTENSION; TNG
ADMINISTERED
31 min END
</pre>
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