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Simulation training Curriculum

. Constrictive Pericarditis Etiology. IdiopathicIrradiationPost-surgicalInfectiousNeoplasticConnective tissue disorder. UremiaTraumaSarcoidMethysergide therapyEpicardial implantable defibrillator patches. CATHSAP6: Coronary Angiography and Intervention. . . CATHSAP6: Coronary Angiography

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Simulation training Curriculum

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    1. Simulation training Curriculum Pericardial Disease

    2. Constrictive Pericarditis Etiology Idiopathic Irradiation Post-surgical Infectious Neoplastic Connective tissue disorder Uremia Trauma Sarcoid Methysergide therapy Epicardial implantable defibrillator patches

    12. Case 1: Constrictive Pericarditis 64 year old female 1 Year s/p 3-vessel CABG Presents with 6 months of progressive dyspnea and atypical chest pain At angiography, all grafts are patent Hemodynamics

    16. Constrictive Pericarditis Right Atrial Tracing

    17. Constrictive Pericarditis – LV vs. RV. Tachycardia Obscures Evaluation

    18. Kussmaul sign

    19. Case 2: Restrictive Cardiomyopathy 43 year old female presented with predominant right heart failure (peripheral edema, ascites) Hemodynamic tracings suggest constrictive-restrictive physiology Exploratory thoracotomy excluded the presence of constrictive pericarditis

    23. Restrictive Cardiomyopathy

    24. Ventricular Interdependence During Respirations Differentiates Constrictive Pericarditis from Restrictive Cardiomyopathy

    25. Sensitivities, Specificities, Positive Predictive Values, and Negative Predictive Values as a Function of Criteria

    26. Constrictive Pericarditis vs. Restrictive Cardiomyopathy Greater ventricular interdependence in constrictive pericarditis Greater separation of diastolic pressure in restrictive cardiomyopathy LV and RV diastolic filling more rapid in constrictive pericarditis Pulmonary pressures higher in restrictive cardiomyopathy Adjunctive tests: evidence of pericardial thickening (normal 1-2 mm; thickening = 3 mm); pericardial calcification, RV biopsy, exploratory thoracotomy

    27. Case 3: Pericardial Tamponade 37 year old female 2 day history of dyspnea, fatigue and dizziness Mastectomy for breast cancer 3 years ago Echocardiogram suggests pericardial tamponade Hemodynamics

    28. Cardiac Tamponade Pulsus Paradoxus

    37. Long-Term Effectiveness of Pericardiocentesis 2/3 of patients with malignant pericardial effusions redevelop tamponade after a median of 7 days More than 80% of patients with non-malignant pericardial effusion require no further intervention

    38. Variants on Constrictive-Restrictive Physiology Acute enlargement of the heart with constriction by normal pericardium right ventricular infarct, tricuspid regurgitation, mitral regurgitation Low pressure tamponade Effusive-constrictive pericarditis Single chamber tamponade Localized constriction Occult constrictive pericarditis

    39. Severe, Acute Tricuspid Regurgitation Associated With Constrictive-Restrictive Physiology

    40. Severe, Acute Mitral Regurgitation Associated With Constrictive-Restrictive Physiology

    41. Variants on Constrictive-Restrictive Physiology Acute enlargement of the heart with constriction by normal pericardium right ventricular infarct, tricuspid regurgitation, mitral regurgitation Low pressure tamponade Effusive-constrictive pericarditis Single chamber tamponade Localized constriction Occult constrictive pericarditis

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