Follow the links below to jump directly to descriptions of each record in the database:
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES: BYPASS OFF BYPASS[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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 @ ?[top]
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[top]
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[top]
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[top]
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[top]
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
[top]
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[top]
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[top]
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
[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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
[top]
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[top]
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[top]
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
[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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
[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
PATIENT DATA: AGE/SEX: 5 month old female DIAGNOSIS: TGA/PS/ASD PROCEDURE: Right heart cath/left heart cath TECHNICAL COMMENTS: Data erased accidentally[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES: BYPASS OFF BYPASS[top]
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)[top]
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[top]
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES SET-UP 0-20 sec ZERO CH8/9/11 57 min ZERI/CAL CH9/ll 71 min STOP[top]
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[top]
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES: SET-UP 1-2 min ZEROS[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
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[top]
PROCEDURAL EVENTS: RHYTHM/PRESSURE CHANGES: SET-UP HYPERTENSION; TNG ADMINISTERED 31 min END[top]