ABC | Volume 111, Nº1, July 2018

Special Article Ayub-Ferreira Guidelines for MCS of the BSC Arq Bras Cardiol. 2018; 111(1):4-12 Figure 2 – Optimization and management of right ventricular function. MgSO 4 : magnesium sulfate; HR: heart rate; DC PM: dual-chamber pacemaker with right atrial and ventricular stimulation and sensitivity; LVAD: Left ventricular assist device; CVP: central venous pressure; CI: cardiac index; TTE: transthoracic echocardiogram; TEE: transesophageal echocardiography; RV: right ventricular; PVR: pulmonary vascular resistance; LV: left ventricular; SVR: systemic vascular resistance; RVAD: right ventricular assist device; mAP: mean arterial pressure. Cardioversion MgSO 4 Digoxin Fast High High Slow Abnormal Low Low Low Leftward shift Sinus rhythm HR 80-100 bpm Normal sinus rhythm Preload CVP 10-15 mmHg Contractility CI > 2,0 – 4,0 Interventricular septal position RV preload PVR 40 – 100 dynas.s.cm –5 LV afterload PVR 800 – 1200 dynas.s.cm –5 mAP < 50 mmHg Low flow through RVAD Peripheral hypoperfusion Diuresis Dialysis ↓ Flow LVAD iNO Protective pulmonary ventilation DC PM Adrenaline Isoproterenol MgSO 4 Lidocaine Amiodarone Volume Milrinone Adrenaline Dobutamine Adrenaline Noradrenaline Vasopressin ↓ Flow LVAD Consider LVAD TTE/TEE Chart 7 – Contraindications for long-term mechanical circulatory support devices Absolute Coumarin intolerance Absence of trained caregivers Severe psychiatric disorders or nonadherence to the staff instructions Severe motor deficit or cognitive deficit related after stroke Neoplastic disease with unfavorable prognosis Vascular malformation of the small bowel that predisposes to bleeding Severe pulmonary obstructive disease Severe hepatic dysfunction Active infection Hematologic changes (platelets < 50,000 mm 3 and thrombophilia) Relative Moderate-to-severe right ventricular dysfunction Dialytic therapy for renal failure Difficult-to-control diabetes Partial motor deficit after stroke Severe malnutrition Significative peripheral artery disease 10