The Utility of Maternal Point of Care Ultrasound on Labor and Delivery Wards.

Point-of-care ultrasonography (POCUS) refers to limited bedside ultrasound used to evaluate patients for conditions specific to the scope of their practice. Given the benefits of its application, interest in its use is increasing. We aimed to review the literature and assess the potential feasibility of using POCUS of the heart and lungs in the field of obstetrics. We aim to describe its relevance and value as an adjunctive tool for critically ill obstetric patients on labor and delivery wards.

Evaluation and Diagnostic Testing.

The evaluation of cardiovascular disease in pregnancy is challenging due to overlaps between cardiac and normal pregnancy symptomatology, as well as concerns about the potential impact, if any, of imaging studies on fetal development. We discuss here an approach to the evaluation of the pregnant cardiac patient and review the safety and utility of available diagnostic tests, including labs, electrocardiogram, echocardiography, stress testing, computed tomography, magnetic resonance imaging, and cardiac catheterization. Importantly, the majority of standard imaging studies can be safely performed in pregnancy, and a high index of suspicion must be maintained when evaluating pregnant patients, especially those with preexisting cardiovascular disease.

An Overlap Presentation of Pericardial Decompression Syndrome and Stress Cardiomyopathy Following Therapeutic Pericardiocentesis.

Pericardial decompression syndrome, defined as paradoxical hypotension and pulmonary edema after pericardiocentesis, is a rare complication of pericardiocentesis. Stress cardiomyopathy, caused by excess catecholamine response resulting in left ventricular dysfunction and elevated cardiac enzymes, can overlap with pericardial decompression syndrome, and both might belong to the same spectrum of disease. (Level of Difficulty: Intermediate.).

Association of Nasal Mucosal Vascular Alterations, Gastrointestinal Arteriovenous Malformations, and Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices.

OBJECTIVES: This study sought to determine whether the nasal mucosa can serve as a surrogate for evaluating arteriovenous malformations (AVMs) related gastrointestinal (GI) bleeding in patients supported by continuous-flow left ventricular assist devices (CF LVADs). BACKGROUND: Bleeding from the mucosal surfaces of GI tract, particularly AVMs, is the most common complication of CF LVAD support. The pathophysiology of AVM formation during CF LVAD support is of critical interest yet poorly understood; in large part because of the length and accessibility of the GI tract. Nasal endoscopy is a minimally invasive, bedside test giving access to a mucosal surface possibly representative of the GI tract. METHODS: Eighty subjects (35 with CF LVAD, 30 with heart failure reduced ejection fraction [HFrEF], and 15 controls without heart failure) underwent nasal endoscopy for systematic evaluation of the intranasal mucosa for the presence of hypervascularity (HV). Patient records were reviewed for episodes and etiology of GI bleeding. RESULTS: Nasal HV was present in 63%, 57%, and 20% of the LVAD, HFrEF, and control groups, respectively (p = 0.018). Although the prevalence was similar, the severity of nasal HV was significantly higher in the CF LVAD group compared with the HFrEF group. Of the baseline characteristics in the entire cohort, only a history of heart failure was associated with HV (odds ratio: 4.8; 95% confidence interval: 1.02 to 22.31; p = 0.040) in adjusted logistic regression modeling. HV was strongly associated with GI bleeding in the CF LVAD cohort: the incidence was 32% in subjects with HV compared with 0% in subjects with normal mucosa (p = 0.023). CONCLUSIONS: In this pilot study, HV of the nasal mucosa was associated with GI bleeding in subjects with CF LVADs. Nasal endoscopy has significant potential to further investigation into mechanisms of bleeding and risk stratification during CF LVAD support.

Development of a scoring system to estimate mortality in abdominal aortic aneurysms management.

INTRODUCTION: This study aimed to define risk factors associated with inpatient mortality in patients undergoing elective repair for unruptured abdominal aortic aneurysm and utilize these factors to create a scoring system to estimate risk of mortality. METHODS: A retrospective analysis was completed using the Nationwide Inpatient Sample from 1998 to 2011. Patients who underwent elective abdominal aortic aneurysm repair were identified using ICD-9 codes. Demographics, comorbidities, length of stay, insurance status, and mortality were recorded. Statistically significant variables were identified using a multivariate analysis, and a discriminant analysis was used to identify factors predictive of inpatient mortality. RESULTS: Over a 14-year period, 28,448 patients underwent elective repair of an unruptured abdominal aortic aneurysm. Independent variables associated with inpatient mortality included: age >60, female gender, congestive heart failure, peripheral artery disease, renal failure, malnutrition, and hypercoagulability. Endovascular aneurysm repair was protective against inpatient mortality. The area under the curve for the discriminant function was 0.83 (95% CI, 0.81-0.85) and successfully classified 87.9% of patients within the Nationwide Inpatient Sample (25,006/28,448 patients). CONCLUSION: Seven factors that predict an increased risk of mortality and one factor that decreased the risk of mortality were identified. Preoperative risk factor mitigation may improve mortality following elective abdominal aortic aneurysm repair.