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PubMed1975

[Effect of aprotinin in acute myocardial infarction (clinical double-bind study (author's transl)].

In a double-bind study 164 patients with acute myocardial infarction, admitted to an intensive-care unit within 72 hours of infarction, were randomly treated for three days either with aprotinin (Trasylol-82 persons) or placebo (82 persons). Retrospective analysis proved both patient groups to have been comparable in all other respects. There was no definite influence on the course of the infarction, haemodynamic changes, arrythmias or mortality rate. Trasylol thus has no therapeutic importance in the treatment of acute myocardial infarction.

Acute Disease↗

PubMed2002

Studies on the cardiotoxicity of noradrenaline in isolated rabbit hearts.

UNLABELLED: The concentration-dependent toxic effects of exogenous noradrenaline (NA, CAS 51-41-2) on acute regional myocardial ischemia (MI) was investigated with and without alpha- and beta-adrenoceptor blockade. Electrically-driven rabbit Langendorff-hearts with depleted catecholamine stores were used (reserpin 7.0 mg/kg i.p. 16-24 h before preparation, constant pressure: 70 cm H2O, Tyrode solution, Ca2+ 1.8 mmol/l). Repetitive MI, separated by a reperfusion period of 50 min, was induced by coronary artery branch ligature, and quantitated from epicardial NADH-fluorescence photography. Starting after a reperfusion period of 20 min, hearts were treated with exogenous NA (10(-7), 10(-6) or 10(-5) mol/l). Adrenoceptors were blocked by propranolol (10(-6) mol/l) and phentolamine (10(-6) mol/l). Without adrenoceptor blockers, NA 10(-6) mol/l induced an increase in left ventricular pressure and a reduction in the relative coronary flow. Concomitantly, MI was enhanced. After adrenoceptor blockade, NA 10(-7) or 10(-6) mol/l had no influence on functional parameters. MI was not affected by NA 10(-7) mol/l, but MI was significantly enhanced by NA 10(-6) mol/l. MI enhancement by NA 10(-6) mol/l was completely prevented by superoxide dismutase (30 U/ml). Functional effects of NA 10(-5) mol/l were not completely inhibited by adrenoceptor blockers at the concentrations used, and arrythmias were observed. MI was also enhanced by NA 10(-5) mol/l. CONCLUSION: Deleterious effects on MI, that are independent on functional effects, are induced by NA in a micromolar concentration. These direct toxic effects are mediated by superoxide anion radicals. In lower concentrations (10(-7) mol/l), there is no evidence for direct toxic actions of NA independent of functional effects. MI enhancement by NA 10(-5), or 10(-6) mol/l without adrenoceptor blockers may have been caused in part by functional and arrythmogenic effects and/or through the generation of oxygen free radicals.

Adrenergic alpha-Agonists↗

PubMed2002

[Risk factors for pneumonia in patients with cardiovascular diseases].

A case-control-study was performed to identify patients at particularly high risk of community-acquired pneumonia and nosocomial pneumonia with a special focus on cardiovascular diseases as potential risk factors. Thirty-six consecutive hospitalized patients with cardiovascular diseases and pneumonia were matched with 36 controls also suffering from cardiovascular diseases but without pneumonia. From all cardiovascular diseases only heart failure proved to be an independent risk factor for pneumonia (OR 5.69, 95 % KI 1.69 - 19.04, p = 0.0048). Both chronic (p = 0.009) and acute heart failure (p = 0.028) were associated with an increased risk of pneumonia. The risk of pneumonia was closely related to the degree of ventricular function impairment. Coronary heart disease, valvular disease, arrythmia, myocarditis, endocarditis and cardiomyopathy did not increase the risk for pneumonia unless accompanied by heart failure. Pulmonary (OR 9.24, 95 % KI 1.48 - 57.74, p = 0.00174) and renal diseases (OR 7.49, 95 % KI 1.38 - 40.76, p = 0.0197) were validated as additional independent risk factors. A history of smoking was also associated with an increased risk of pneumonia (p = 0,023). This study supports the hypothesis that heart failure resulting from cardiovascular disease and not cardiovascular disease itself mounts the risk for pneumonia.

Cardiovascular Diseases↗

PubMed1983

[Echocardiography diagnosis of infarct complications].

Congestive heart failure, shock or severe arrythmias after myocardial infarction can be caused by mechanical complications suitable for surgical correction. These complications - such as aneurysms, rupture of the ventricular wall, septum or papillary muscle, pericardial tamponade - are reliably detected or excluded by echocardiography. Additional aspects related to the surgical techniques can be evaluated, moinly the resectability of left ventricular aneurysms. From these, pseudoaneurysms bearing a high risk of rupture can be differentiated. The causes of systolic murmurs after myocardial infarction - septal rupture, papillary muscle rupture or dysfunction - can be classified definitely. The diagnosis of Dressler's syndrome is facilitated by echocardiographic demonstration of pericardial effusion.

Diagnosis, Differential↗

PubMed2002

Abdominal aortic aneurysm repair with the Zenith stent graft: short to midterm results.

PURPOSE: The purpose of this study was to assess the short-term and mid-term results of endovascular aneurysm repair with the Zenith stent graft in a single-center prospective study. METHOD: Between October 1998 and July 2001, we used the Zenith stent graft for elective endovascular aneurysm repair in 116 patients, six of whom were women. The mean age was 75 years, and the mean aneurysm diameter was 60.3 +/- 8.8 mm. Stent grafts were oversized 10% to 20% relative to computed tomographic (CT) scan-based diameter measurements. All repairs were performed in the operating room through surgically exposed femoral arteries. The results were assessed before discharge with three-phase, contrast-enhanced CT scan and plain abdominal radiograph. These studies were repeated at 1, 6, 12, and 24 months after operation. Follow-up periods ranged from 1 to 34 months. RESULTS: No failed insertions and no conversions to open surgery occurred. The diameter of the main body of the stent graft was 28 mm or more in 73 patients (63%). Additional stents were inserted during surgery to treat kinking in eight patients (6.9%) and renal artery encroachment in two patients (1.7%). Mean fluoroscopy time was 35.1 +/- 18.3 minutes, contrast load was 146 +/- 53 mL (350 mg/mL), and estimated blood loss was 249 +/- 407 mL. The major complication rate was 9.5%, and the minor complication rate was 10.3%. The perioperative complications were myocardial infarction in four patients, arrythmia in four patients, and pulmonary embolism, renal failure, stroke, small bowel obstruction, femoral stenosis, digital embolism, and graft limb thrombosis in one patient each. All 116 patients went home from the hospital, but one patient died 2 weeks later of a combination of pulmonary embolism and myocardial infarction. Endoleak was seen on the first CT scan in 16 patients (15%); 15 were type II, and one was type III. No endoleaks of type I or IV were seen. Additional interventions were performed for each of the following conditions: type II endoleak (n = 4), type III endoleak (n = 1), femoral clamp injury (n = 1), renal artery stenosis (n = 1), and graft limb occlusion (n = 1). One patient had acute aneurysm dilatation and rupture caused by a type II endoleak through the inferior mesenteric artery 6 months after stent graft implantation. No cases were seen of late graft occlusion, stent graft migration, stent fracture, barb fracture, or secondary endoleak. CONCLUSION: The Zenith device is safe, versatile, and effective in the short to medium term. Most patients need wide stent grafts (>or=28 mm proximally and >or=16 mm distally) to achieve 10% to 20% oversizing to prevent type I endoleak.

Aged↗

PubMed2002

Modulation of the cardiac sodium channel Nav1.5 by fibroblast growth factor homologous factor 1B.

We have previously shown that fibroblast growth factor homologous factor 1B (FHF1B), a cytosolic member of the fibroblast growth factor family, associates with the sensory neuron-specific channel Na(v)1.9 but not with the other sodium channels present in adult rat dorsal root ganglia neurons. We show in this study that FHF1B binds to the C terminus of the cardiac voltage-gated sodium channel Na(v)1.5 and modulates the properties of the channel. The N-terminal 41 amino acid residues of FHF1B are essential for binding to Na(v)1.5, and the conserved acidic rich domain (amino acids 1773-1832) in the C terminus of Na(v)1.5 is sufficient for association with this factor. Binding of the growth factor to recombinant wild type human Na(v)1.5 in human embryonic kidney 293 cells produces a significant hyperpolarizing shift in the voltage dependence of channel inactivation. An aspartic acid to glycine substitution at position 1790 of the channel, which underlies one of the LQT-3 phenotypes of cardiac arrythmias, abolishes the interaction of the Na(v)1.5 channel with FHF1B. This is the first report showing that interaction with a growth factor can modulate properties of a voltage-gated sodium channel.

Amino Acid Sequence↗

PubMed1989

Cardiac arrhythmia and suspect cardiomyopathy in a Boxer dog.

A 3 year old Boxer dog was presented with a history of syncope and an irregular heart heat. An arrhythmia characterised by ventricular premature contractions was detected and was thought to cause the syncopal episodes. On the basis of the age, breed and the characteristic electrocardiographic findings, a diagnosis of Boxer Cardiomyopathy was made. The dog was treated with procainamide 500 mg every 8 hours to control the arrythmia and there were no further syncopal episodes in the subsequent 13 months.

Journal Article↗

PubMed1999

Differences in quality of life in men and women with ischemic heart disease. A prospective controlled study.

A study was conducted in Sweden in 1989-1992 to evaluate differences in quality of life (QL) in consecutive male and female patients after acute myocardial infarction (AMI), coronary artery by-pass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). Somatic and psychological dimensions of QL were assessed by self-administered questionnaire in patients one month (n = 376) and one year (n = 349) after the cardiac event. Normal controls (n = 88) were used for comparison. Differences between gender groups, as well as between study patients and controls in somatic and psychological dimensions of QL were studied. Patients were shown to experience poorer QL when compared with demographically similar controls, especially at the one-month assessment. Female patients had poorer QL after one month (in general health, feeling of arrythmia, anxiety, depression, self-esteem, experience of sex life) and after one year (general health, anxiety, depression) compared with male patients. In all dimensions of QL a proportion of patients (19-45%) experienced a decrease in QL from the one-month to the one-year assessment occasion. Healthcare workers concerned with secondary prevention must be aware that QL differs between male and female patients in several dimensions after a cardiac event. These findings should be taken into account in the clinical management of patients, particularly for female patients who may need special attention.

Aged↗

PubMed2004

Circadian variation in cardiac autonomic activity: reactivity measurements to different types of stressors.

The role of endogenous circadian rhythmicity in autonomic cardiac reactivity to different stressors was investigated. A constant routine protocol was used with repeated exposure to a dual task and a cold pressor test. The 29 subjects were randomly divided into two groups in order to manipulate prior wakefulness. Group 1 started at 09:00 h immediately after a monitored sleep period, whereas group 2 started 12 h later. Measures of interbeat intervals (IBI), respiratory sinus arrythmia (RSA, a measure of parasympathetic activity), pre-ejection period (PEP, a measure of sympathetic activity), as well as core body temperature (CBT) were recorded continuously. Multilevel regression analyses (across-subjects) revealed significant (mainly 24 h) sinusoidal circadian variation in the response to both stressors for IBI and RSA, but not for PEP. Individual 24 + 12 h cosine fits demonstrated a relatively large interindividual variation of the phases of the IBI and RSA rhythms, as compared to that of the CBT rhythm. Sinusoidal by group interactions were found for IBI and PEP, but not for RSA. These findings were interpreted as an indication for endogenous circadian and exogenous parasympathetic (vagal) modulation of cardiac reactivity, while sympathetic reactivity is relatively unaffected by the endogenous circadian drive and mainly influenced by exogenous factors.

Adolescent↗

PubMed2002

Thyroid hormone and cardiac surgery.

Thyroid hormone has important effects on the heart and peripheral vascular system. The relationship between thyroid disease states and cardiovascular hemodynamics is well recognized. Diverse clinical situations are associated with low serum triiodothyronine (T3) levels including a number of cardiovascular illnesses. In particular, cardiopulmonary bypass and open heart operations result in a low T3 state and are often complicated by significant cardiovascular dysfunction similar to that observed in clinical hypothyroidism. Multiple lines of evidence have suggested that T3 can act acutely as a positive inotrope and vasodilator agent. This recognition has prompted a number of investigators to study the effects of T3 administration to patients in the perioperative period. This paper reviews the experimental background that supported such clinical trials as well as outlines the results that have been documented in both adult and pediatric patients undergoing cardiac surgery. Low serum T3 levels resulting from cardiopulmonary bypass can be safely reversed with pharmacologic T3 supplementation. Data have suggested that T3 repletion may improve postoperative hemodynamic performance and lower the incidence of arrythmias. However, beneficial effects on major clinical outcome variables have not yet been conclusively demonstrated, and require future large-scale clinical trials.

Animals↗

PubMed1986

Monitoring of ionized calcium during human hepatic transplantation. Critical values and their relevance to cardiac and hemodynamic management.

During human hepatic transplantation, ionized calcium (ICa) measured in whole blood with an ion-selective electrode varied greatly from ICa predicted from total calcium (TCa), protein, albumin, and pH, by means of recently published nomograms. Measurement of ICa was necessary because the interaction of citrate in transfused blood and calcium chloride (administered to offset citrate binding) caused large variations in TCa. During hepatic transplantation, ICa and electrolyte measurements were obtained at approximately 15-minute intervals or more frequently if indicated by changing cardiac status. In one patient, hemodynamic instability was accompanied by a large decrease in ICa, which then was followed by cardiac arrest aggravated by myocardial depression from inadequate ICa. Cardiovascular phenomena associated with ionized hypocalcemia suggest that the critical value for ICa should be no more than 0.4 mmol/L (1.6 mg/dL) below the reference range mean. The authors propose critical limits for ICa and discuss their significance in clinical management of tetany, hypotension, arrythmias, and cardiac arrest.

Adolescent↗

PubMedDate not supplied

Viral myocarditis.

Although most cases of viral myocarditis are subclinical, some patients develop overt symptomatic disease. These patients may present with findings that range from benign myopericarditis to frank heart failure. Furthermore, a growing body of evidence links viral myocarditis with idiopathic dilated cardiomyopathy, sudden death, and chronic arrythmias. The pathogenesis of the disease is currently incompletely understood in humans but is being investigated in animal models. A multifactorial process involving direct viral damage, autoimmunity, and possibly vascular damage is emerging. Breakthroughs in rapid diagnosis, such as the use of DNA probes, are occurring and may soon provide the opportunity for early intervention. Although there is currently no widely accepted standard of treatment, promising new therapeutic modalities are under investigation. These include the use of general immunosuppressive agents, T cell monoclonal antibody, interferon, specific immunization, and synthetic antiviral agents.

Humans↗

PubMed2005

Diagnostic yield of patient-activated loop recorders for detecting heart rhythm abnormalities in general practice: a randomised clinical trial.

BACKGROUND: Because palpitations and light headedness often occur paroxysmally these complaints are difficult to diagnose. The hazards for a GP are too many diagnostic interventions for worried well and too few diagnostics for potentially life threatening complaints. OBJECTIVES: Patient-activated memo event recorders have proved to be successful in diagnosing episodes of cardiac arrythmias in secondary care. We tested the diagnostic yield of these devices in general practice. METHODS: A randomized clinical trial in general practice. Consecutive patients with complaints of palpitations or light-headedness were randomized to either usual care or usual care plus event-recorder. The main outcome was the difference in explained episodes. Secondary outcomes were the differences in the number and character of cardiac diagnoses and the feasibility of the event-recorder. RESULTS: There were fewer patients without a diagnosis in the intervention group (17% vs 38%; RR = 0.5, 95% CI 0.3 to 0.7) and more patients with a cardiac diagnosis (67% vs. 27%: RR 2.5, CI 1.8 to 3,5). More relevant cardiac arrhythmias were detected (22% vs 7%) with event recording than with usual care (RR 3.2, 95% CI 1.5 to 6.8). CONCLUSION: Patient-activated loop recorders are feasible and effective diagnostic tools in patients with palpitations or light-headedness in primary care. More research into patient characteristics and selection criteria is needed to fine-tune the use of these devices in primary care.

Arrhythmias, Cardiac↗

PubMed1997

Complications following butane inhalation and flash fire.

Solvent inhalation is a well-documented form of drug abuse that can cause euphoria and hallucinations. Sudden death involving a volatile substance is most commonly caused by cardiac arrythmias, asphyxia, direct drug effects, and trauma. The victim in this paper suffered superficial partial thickness (12% total body surface area) burns from a flash fire that occurred when lighting a match after inhaling butane in an enclosed vehicle. The victim was admitted to the hospital for 2 days of observation but did not develop any respiratory symptoms under 2 days following her release. The victim died during her readmission, 9 days after the flash fire. Postmortem examination showed extensive epithelial injury from the upper airway and trachea to the terminal bronchioles, most likely due in part to both the initial inhalation injury and the resulting adult respiratory distress syndrome (ARDS) and staphylococcal infection. Many victims with superficial burn injuries may not seek medical attention owing to either embarrassment or fear of legal prosecution. Even those who do seek medical assistance may not reveal solvent abuse as the cause of their injuries. It is possible that delayed death may occur at home following volatile substance abuse but may remain unrecognized even with a thorough scene investigation.

Adolescent↗

PubMed1997

Vehicular accidents and cardiac concussion. A traumatic connection.

Concussion of the heart (commotio cordis) occurs in traffic accidents in which blunt force impact over the precordial area occurs, even in the absence of multiple blunt force injuries. The functional dynamics of the heart, with ventricular arrythmias and conduction disturbances, serve as the pathophysiological basis of this condition. As a cause of death in vehicular accidents, it is less common than other causes. However, it should be considered in the differential diagnosis, especially in cases with minor or no apparent injuries.

Accidents, Traffic↗

PubMed1977

Cardiac toxicity with thioridazine-tricyclic antidepressant combination.

Thioridazine-tricyclic antidepressant combination is frequently used in clinical practice. One reason for the choice of this combination may be its anticipated effectiveness in depressions which show both retarded and anxious features. Because both of these drugs have an adverse effect on cardiac repolarization, this may be a particularly hazardous combination. Two cases are presented illustrating life-threatening ventricular arrythmia in patients who have ingested both thioridazine and tricyclic antidepressants.

Adult↗

PubMed1975

"Pseudocardiogenic" pulmonary edema.

Fifteen postoperative surgical patients, in whom noncardiac pulmonary edema developed were studied. A presumptive diagnosis of left ventricle failure would have been based on historical evidence of heart disease (80%), electrocardiographic changes of ischemia or arrythmia (87%), or cardiogenic shock (20%). (see article) Fig. 6. PAEDP-PCW gradient. Note that arterial oxygen tension had an inverse relationship to this pressure differential. Roentgenographic findings included pulmonary edema (73%), pulmonary vascular congestion (60%), cardiomegaly or congestive heart failure (40%). Mean increase in A-aDO2 was 290 torr. Further cardiovascular investigation seemed to exclude left ventricular failure. Mean cardiac index was 4.1 plus or minus 1.3 L/min/m2; pulmonary capillary wedge pressure 4 plus or minus 2.7 torr, and stroke work was 87 plus or minus 8.7 gm-meters. Possible etiologic agents included elevated pulmonary artery pressure (67%), allergic reactions (27%), peritonitis or multiple system trauma (54%), or multiple transfusions (33%). Forty-seven per cent of the entire group survived. Therapy was directed toward the underlying noncardiogenic suspected etiology. Direct cardiovascular measurements were necessary to correct the erroneous though seemingly well founded suspected diagnosis of left ventricular failure in these patients.

Adult↗

PubMed1986

Electrocardiographic monitoring after electrical injury: necessity or luxury.

It has been common practice to perform routine electrocardiographic (EKG) monitoring of electrically burned patients for the first 24 hours following injury. Is this monitoring necessary, or is it a luxury based on remote probabilities? The records of 48 consecutive patients admitted with high-voltage (greater than 1,000 volts) electrical injuries were reviewed with respect to history of a cardiac event in the field, EKG abnormalities on admission, and the presence of cardiac arrhythmias during the first postinjury day. No serious arrhythmias occurred in any patients who had a normal EKG on admission. It was concluded that routine cardiac monitoring after a high-voltage injury should be individualized based on history of loss of consciousness, documentation of an arrythmia, or an abnormal EKG.

Adolescent↗