Скачать или смотреть BAMC 3298 Part 1: Amyl Nitrite Inhalation and Ectopy (Right and Left Heart Pressures)

Amyl Nitrite Inhalation and Ectopy (Part 1: Right and Left Heart Pressures) (BAMC 3298)
PAO Approval: 03.15.2022

This video was produced for teaching purposes only. Hemodynamic waveforms were obtained from the digitization of an FM tape recording from the Cardiac Catheterization Laboratory at Brooke Army Medical Center that were originally recorded between 1973 and 1992. Digitized recordings were rescaled from the original calibration signals recorded on the FM tape.

It is anticipated that instructors may use one or more of the sequences presented in this video to complement their instruction. Videos may be paused to allow more time for content review. For students viewing this video without the benefit of an instructor, it is recommended to consult standard textbooks or PubMed reviews for additional information.

Case Information:
Patient was a 39-year-old Active-Duty male who reported his usual state of good health until he experienced a two-hour episode of chest discomfort awakening him from sleep. Subsequent evaluation included a normal baseline electrocardiogram (ECG) and normal echocardiogram. Initial exercise stress test (Bruce protocol) showed a mild hypertensive response with no reported symptoms but with findings of complex ventricular ectopy. A repeat treadmill stress with Thallium showed no occurrence of ventricular ectopy but a 1mm ST segment depression was suggestive of ischemia. He was referred for further evaluation of definitive diagnosis. Cardiac catheterization (circa 1980) revealed no evidence of underlying structural or coronary artery disease and the patient was discharged on antiarrhythmic therapy and follow-up with Holter monitoring.

Case Comments: Ventricular ectopy was demonstrated with the first deep breath of amyl nitrite and continued intermittently through the response. During the amyl nitrite response ventricular ectopy was noted with the presence of fully compensatory pauses and signs of AV dissociation as evidenced by capture and fusion beats. By comparison, ectopy was less frequent during five minutes of recorded rest and five minutes of recorded submaximal supine exercise hemodynamics. A link to additional published information about this case is provided below.

Video Sequence: Part I provides three different display formats for illustrating right and left heart pressure changes associated with amyl nitrite inhalation in a patient with ventricular ectopy.

Video Segment 1 (1:00): Real-time display of left and right heart hemodynamics with inhalation of amyl nitrite. High-fidelity right and left heart pressures are displayed with fluid right heart pulmonary capillary wedge pressure (PCWP) with a step-up to pulmonary artery pressure (PAP). The real-time clip includes comments by recording technician at the time of catheterization and derived heart sounds from post-processing pressure waveforms from the aortic sensor (L prox). Hemodynamics are displayed in a ten second window and the total duration of the video segment is 90 seconds.

Video segment 2 (2:58): Real-time display of high-fidelity PAP, RAP, AoP with fluid PCWP step-up to PAP in a 90 second display window. PAP and AoP means are displayed as solid white lines.

Video segment 3 (4:45): Real-time display of high-fidelity PAP, RVP, RAP, AoP, LVP and with fluid PCWP step-up to PAP in a 90 second display window. AoP mean is displayed as a solid white line.

Link to related published work for this case: https://pubmed.ncbi.nlm.nih.gov/8096167/

MLA citation for this video:
“BAMC 3298 Part 1: Amyl Nitrite Inhalation and Ectopy.” YouTube, uploaded by HemodynamicRounds, 25 Apr. 2022,    • BAMC 3298  Part 1:  Amyl Nitrite Inhalatio...  .