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Right Heart Catheterization and Swan-Ganz Hemodynamic Assessment
A clinician-focused review of right heart catheterization and Swan-Ganz catheterization, including indications, catheter positioning, pressure waveforms, cardiac-output measurement, pulmonary hypertension classification, shock profiles, complications, and common interpretation errors. Right heart catheterization, or RHC, provides direct measurement of right-sided and pulmonary hemodynamics. It remains the reference standard for confirming pulmonary hypertension, differentiating pre- from post-capillary physiology,…
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Amyloidosis: Recognition, Diagnosis, and Treatment Clinical Cheat Sheet
Amyloidosis comprises a heterogeneous group of disorders characterized by extracellular deposition of misfolded proteins as amyloid fibrils. The clinical phenotype depends on the precursor protein, the organs involved, and the extent of tissue deposition. The most important systemic forms encountered in clinical practice are immunoglobulin light-chain amyloidosis, or AL amyloidosis; transthyretin amyloidosis, or ATTR amyloidosis;…
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Hemodialysis: Indications, Prescription, Vascular Access, and Clinical Monitoring
Hemodialysis is an extracorporeal kidney replacement therapy that removes accumulated solutes and excess extracellular fluid while correcting selected electrolyte and acid-base abnormalities. Blood is circulated through a dialyzer containing a semipermeable membrane, across which solutes are cleared primarily by diffusion and fluid is removed by ultrafiltration. Although conventional maintenance hemodialysis is often delivered three times…
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Membranous Nephropathy: Symptoms, Diagnosis, Treatment Cheat Sheet
Membranous nephropathy is an immune-mediated disease of the glomeruli—the microscopic filtering units of the kidneys. It develops when antibodies and other immune components accumulate along the outer surface of the glomerular basement membrane, damaging the filtration barrier and allowing large amounts of protein to escape into the urine. The disease is an important cause of…
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Hyperthyroidism: Symptoms, Diagnosis, Treatment, and Complications
Hyperthyroidism is a condition in which the thyroid gland produces and releases excessive amounts of thyroid hormone. Because thyroid hormones influence energy use, body temperature, heart rate, digestion, muscle function, and many other processes, excess hormone creates a widespread hypermetabolic state in which many body systems speed up. The condition is usually treatable, but untreated…
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Kawasaki Disease: Clinical Features, Diagnosis, Treatment Cheat Sheet
Kawasaki disease is an acute inflammatory illness that primarily affects infants and young children. It causes inflammation of medium-sized blood vessels throughout the body, with the coronary arteries being the most clinically important vessels involved. Most cases occur in children younger than five years. Kawasaki disease is a leading cause of acquired heart disease in…
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IgA Nephropathy: Clinical Features, Diagnosis, and Treatment
IgA nephropathy, also called Berger disease, is an immune-mediated glomerular disease caused by the accumulation of immunoglobulin A–containing immune complexes within the kidney’s filtering units. It is among the most common primary glomerular diseases worldwide and can range from an incidental urinary abnormality to progressive chronic kidney disease and kidney failure. Although many patients remain…
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Cushing Syndrome: Clinical Cheat Sheet for Hypercortisolism
What is Cushing syndrome? Cushing syndrome is the clinical state caused by chronic exposure to excess glucocorticoids, most commonly cortisol. It can be caused by exogenous steroid use or by endogenous overproduction of cortisol from the pituitary, adrenal glands, or ectopic ACTH-secreting tumors. The most common cause overall is prolonged glucocorticoid therapy. (NIDDK) The key…
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How to Determine EKG Axis: A Simple Clinical Approach
What is EKG axis? The EKG axis describes the overall direction of ventricular depolarization in the frontal plane. In practical terms, when clinicians talk about “axis,” they are usually referring to the mean QRS axis. A normal QRS axis generally points downward and to the left, because the left ventricle contributes most of the ventricular…