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Sample records for cardiac catheterisations performed

  1. Cardiac arrhythmias associated with umbilical venous catheterisation in neonates

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    Verheij, Gerdina; Smits-Wintjens, Vivianne; Rozendaal, Lieke; Blom, Nico; Walther, Frans; Lopriore, Enrico

    2009-01-01

    Umbilical venous catheters (UVCs) are commonly used in the management of severely ill neonates. Several life-threatening complications have been described, including catheter-related infections, myocardial perforation, pericardial effusion and cardiac arrhythmias. This report describe two neonates with cardiac arrhythmias due to umbilical venous catheterisation. One neonate had a supraventricular tachycardia requiring treatment with intravenous adenosine administration. Another neonate had an atrial flutter and was managed successfully with synchronised cardioversion. The primary cause of cardiac arrhythmias after umbilical venous catheterisation is inappropriate position of the UVC within the heart and the first step to treat them should be to pull back or even remove the catheter. Cardiac arrhythmia is a rare but potentially severe complication of umbilical venous catheterisation in neonates. PMID:21691401

  2. Estimation of children's radiation dose from cardiac catheterisations, performed for the diagnosis or the treatment of a congenital heart disease using TLD dosimetry and Monte Carlo simulation

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    Yakoumakis, E N; Gialousis, G I; Papadopoulou, Despina; Makri, Triantafillia; Pappouli, Zografia; Yakoumakis, Nikolaos; Papagiannis, Panayotis; Georgiou, Evangelos [Medical Physics Department, University of Athens, 75 Mikras Asias Street, Athens 11527 (Greece)], E-mail: gialousis@med.uoa.gr

    2009-06-15

    Entrance surface radiation doses were measured with thermoluminescent dosimeters for 98 children who were referred to a cardiology department for the diagnosis or the treatment of a congenital heart disease. Additionally, all the radiographic parameters were recorded and Monte Carlo simulations were performed for the estimation of entrance surface dose to effective dose conversion factors, in order to further calculate the effective dose for each child. For diagnostic catheterisations the values ranged from 0.16 to 14.44 mSv, with average 3.71 mSv, and for therapeutic catheterisations the values ranged from 0.38 to 25.01 mSv, with average value 5 mSv. Effective doses were estimated for diagnostic procedures and interventional procedures performed for the treatment of five different heart diseases: (a) atrial septal defect (ASD), (b) ventricular septal defect (VSD), (c) patent ductus arteriosus (PDA), (d) aorta coarctation and (e) pulmonary stenosis. The high levels of radiation exposure are, however, balanced with the advantages of cardiac catheterisations such as the avoidance of surgical closure and the necessity of shorter or even no hospitalisation.

  3. Vascular complications following therapeutic and diagnostic cardiac catheterisation by the femoral artery

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    Bitsch, M; Liisberg-Larsen, Ole Christian; Schroeder, T V

    1994-01-01

    Twenty-one of 6327 (0.33%) patients undergoing cardiac catheterisation via the femoral artery had an acute vascular complication requiring surgical intervention. The complication rate was 0.1% after coronary angiography, 2% after PTCA and 6% after aortic ballon dilatation. The size of the catheter...... and evaluation of vascular injuries following diagnostic and therapeutic invasive interventions could have a self limitating effect on the complication rate....

  4. A technique for respiratory motion correction in image guided cardiac catheterisation procedures

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    King, A. P.; Boubertakh, R.; Ng, K. L.; Ma, Y. L.; Chinchapatnam, P.; Gao, G.; Schaeffter, T.; Hawkes, D. J.; Razavi, R.; Rhode, K. S.

    2008-03-01

    This paper presents a technique for compensating for respiratory motion and deformation in an augmented reality system for cardiac catheterisation procedures. The technique uses a subject-specific affine model of cardiac motion which is quickly constructed from a pre-procedure magnetic resonance imaging (MRI) scan. Respiratory phase information is acquired during the procedure by tracking the motion of the diaphragm in real-time X-ray images. This information is used as input to the model which uses it to predict the position of structures of interest during respiration. 3-D validation is performed on 4 volunteers and 4 patients using a leave-one-out test on manually identified anatomical landmarks in the MRI scan, and 2-D validation is performed by using the model to predict the respiratory motion of structures of the heart which contain catheters that are visible in X-ray images. The technique is shown to reduce 3-D registration errors due to respiratory motion from up to 15mm down to less than 5mm, which is within clinical requirements for many procedures. 2-D validation showed that accuracy improved from 14mm to 2mm. In addition, we use the model to analyse the effects of different types of breathing on the motion and deformation of the heart, specifically increasing the breathing rate and depth of breathing. Our findings suggest that the accuracy of the model is reduced if the subject breathes in a different way during model construction and application. However, models formed during deep breathing may be accurate enough to be applied to other types of breathing.

  5. Characteristics and safety of interventions and procedures performed during catheterisation of patients with congenital heart disease: early report from the national cardiovascular data registry.

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    Holzer, Ralf; Beekman, Robert; Benson, Lee; Bergersen, Lisa; Jayaram, Natalie; Jenkins, Kathy; Kennedy, Kevin; Moore, John; Ringel, Richard; Rome, Jonathan; Vincent, Robert; Martin, Gerard R

    2016-08-01

    The objective of this study was to report procedural characteristics and adverse events on the data collected in the IMproving Paediatric and Adult Congenital Treatment registry. The IMproving Paediatric and Adult Congenital Treatment- registry is a catheterisation registry focussed on paediatric and adult patients with congenital heart disease who are undergoing diagnostic catheterisations and catheter-based interventions. This study reports procedural characteristics and adverse events of patients who have undergone selected catheterisation procedures from January, 2011 to June, 2013. Demographic, clinical, procedural, and institutional data elements were collected at participating centres and entered via either a web-based platform or software provided by the American College of Cardiology-certified vendors, and were collected in a secure, centralised database. For the purpose of this study, procedures that were not classified as one of the 'core' IMproving Paediatric and Adult Congenital Treatment procedures originally chosen for additional data collection were identified and selected for further data analysis. During the time frame of data collection, a total of 8021 cases were classified as other procedures and/or multiple procedures. The most commonly performed case types - isolated or in combination with other procedures - were right ventricular biopsy in 3433 (42.8%), conduit/MPA interventions in 979 (12.3%), and systemic pulmonary artery collateral occlusion in 601 (7.5%). For the whole cohort, adverse events of any severity occurred in 957 (12.0%) cases, whereas major adverse events occurred in 113 (1.4%) cases; six patients (0.1%) died in the catheterisation laboratory. The IMproving Paediatric and Adult Congenital Treatment registry has provided important data on the frequency and spectrum of cardiac catheterisation procedures performed in the present era. For many procedures, more data and work are needed to identify more subtle differences between

  6. [Cardiac catheterisation and angiocardiography in evaluation of congenital heart anomalies (author's transl)].

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    Szelagowicz, B; Orkiszewski, M; Flejsierowicz, Z; Rachocka, J

    1975-01-01

    The material presented here was collected during 18 months since the Pediatric Institute in Poznań was opened. 252 children with congenital heart diseases were admitted to this institution. 152 children were over 12 months, and 100 were under 12 months old; 34 of them were less than 6 months old. 82 children were admitted for cardiac catheterization, angiocardiography or cine-angiocardiography. Below the age of 6 months the condition of the infants, endangering their life, was an indication for cardiac catheterization. In this age group catheterization and especially angiocardiography was not well tolerated by the small patients, but it was necessary to perform ballon septostomy in the transposition of the great arteries, or to establish definite indications for surgery. 5 children of this group died 48 hours after cardiac catheterization. The authors suggest that, in order to obtain better results, infants with cardiac malformations and in a condition endangering their life should be admitted as early as possible to hospitals where diagnostic and surgical services are working on continuous duty. This is not always possible because of technical and personnel difficulties.

  7. Protocol for the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) retrospective study of coronary catheterisation and percutaneous coronary intervention.

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    Li, Jing; Dharmarajan, Kumar; Li, Xi; Lin, Zhenqiu; Normand, Sharon-Lise T; Krumholz, Harlan M; Jiang, Lixin

    2014-03-07

    During the past decade, the volume of percutaneous coronary intervention (PCI) in China has risen by more than 20-fold. Yet little is known about patterns of care and outcomes across hospitals, regions and time during this period of rising cardiovascular disease and dynamic change in the Chinese healthcare system. Using the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) research network, the Retrospective Study of Coronary Catheterisation and Percutaneous Coronary Intervention (China PEACE-Retrospective CathPCI Study) will examine a nationally representative sample of 11 900 patients who underwent coronary catheterisation or PCI at 55 Chinese hospitals during 2001, 2006 and 2011. We selected patients and study sites using a two-stage cluster sampling design with simple random sampling stratified within economical-geographical strata. A central coordinating centre will monitor data quality at the stages of case ascertainment, medical record abstraction and data management. We will examine patient characteristics, diagnostic testing patterns, procedural treatments and in-hospital outcomes, including death, complications of treatment and costs of hospitalisation. We will additionally characterise variation in treatments and outcomes by patient characteristics, hospital, region and study year. The China PEACE collaboration is designed to translate research into improved care for patients. The study protocol was approved by the central ethics committee at the China National Center for Cardiovascular Diseases (NCCD) and collaborating hospitals. Findings will be shared with participating hospitals, policymakers and the academic community to promote quality monitoring, quality improvement and the efficient allocation and use of coronary catheterisation and PCI in China. http://www.clinicaltrials.gov (NCT01624896).

  8. Trends in nurse-administered procedural sedation and analgesia across cardiac catheterisation laboratories in Australia and New Zealand: results of an electronic survey.

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    Conway, Aaron; Rolley, John; Page, Karen; Fulbrook, Paul

    2014-02-01

    Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice. To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs. A quantitative, cross-sectional, descriptive survey design was used. Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data. A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n=58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n=58). One respondent indicated that propofol was also used. 20% (n=12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n=18) indicated that comprehensive education about PSA is provided. 45% (n=26) indicated that nurses who administer PSA should undergo competency assessment. By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand. Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Barriers to Implementing Intermittent Catheterisation in Spinal Cord Injury Patients in Northwest Regional Spinal Injuries Centre, Southport, U.K.

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    Subramanian Vaidyanathan

    2011-01-01

    Full Text Available Intermittent catheterisation is the preferred method of managing the neurogenic bladder in patients with spinal cord injury. However, spinal cord physicians experienced problems when trying to implement an intermittent catheterisation regime in some spinal cord injury patients in the northwest of England. We present illustrative cases to describe practical difficulties encountered by patients while trying to adopt an intermittent catheterisation regime. Barriers to intermittent catheterisation are (1 caregivers or nurses are not available to carry out five or six catheterisations a day; (2 lack of time to perform intermittent catheterisations; (3 unavailability of suitable toilet facilities in public places, including restaurants and offices; (4 redundant prepuce in a male patient, which prevents ready access to urethral meatus; (5 urethral false passage; (6 urethral sphincter spasm requiring the use of flexible-tip catheters and α-drenoceptor–blocking drugs; (7 reluctance to perform intermittent catheterisation in patients >60 years by some health professionals; and (8 difficulty in accessing the urethral meatus for catheterisation while the patient is sitting up, especially in female patients. These cases demonstrate the urgent need for provision of trained caregivers who can perform intermittent catheterisation, and improvement in public facilities that are suitable for performing catheterisation in spinal cord injury patients. Further, vigilance should be exercised during each catheterisation in order to prevent complications, such as urethral trauma and consequent false passages. Health professionals should make additional efforts to implement intermittent catheterisation in female spinal cord injury patients and in those >60 years.

  10. Emergency percutaneous implantation of veno-arterial extracorporeal membrane oxygenation in the catheterisation laboratory.

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    Goslar, Tomaz; Knafelj, Rihard; Radsel, Peter; Fister, Misa; Golicnik, Alenka; Steblovnik, Klemen; Gorjup, Vojka; Noc, Marko

    2016-12-20

    Our aim was to describe our protocol for emergency percutaneous implantation of femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO) in the catheterisation laboratory and to compare its effectiveness and safety with implantation in the intensive care unit and the operating room. Our retrospective observational study enrolled 56 consecutive patients undergoing VA ECMO implantation in the catheterisation laboratory (n=23), the intensive care unit (n=8) and the operating room (n=25). Among patients undergoing catheterisation laboratory implantation, 11 patients had profound cardiogenic shock but preserved arterial pulsations, and 12 patients had refractory cardiac arrest undergoing automated mechanical chest compression. Using our fluoroscopy-guided protocol, arterial and venous cannulas were successfully implanted and the desired ECMO flow obtained in each patient. There was no vessel perforation/dissection. Moderate/severe GUSTO or BARC 3 and 5 bleeding occurred in 13%. Ipsilateral limb ischaemia occurred in one of eight patients (13%) with upfront perfusion sheath implantation, and in two of three patients (75%) in whom this strategy was not used (p=0.15). There was no infection at the site of cannula implantation. Complications related to implantation in the catheterisation laboratory were comparable to surgical implantation in the operating room and percutaneous implantation in the intensive care unit using ultrasound guidance. Fluoroscopy-guided emergency implantation of femoral VA ECMO by an interventional cardiologist in the catheterisation laboratory is effective and safe for both patients in cardiogenic shock and those in refractory cardiac arrest.

  11. Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis.

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    Avouac, Jérôme; Huscher, Dörte; Furst, Daniel E; Opitz, Christian F; Distler, Oliver; Allanore, Yannick

    2014-01-01

    To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected. A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis. A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical (progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.

  12. Antiobiotic Resistance in Catheterised Patients

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    Subramanian Pramodhini

    2012-07-01

    Full Text Available Background Microbial biofilms pose a public health problem for persons requiring indwelling medical devices, as micro-organisms in biofilms are difficult to treat with antimicrobial agents. Thus the present study includes biofilm formation and antibiotic resistance pattern of uropathogens in hospitalised patients with catheter associated urinary tract infections (UTI. Method This prospective analysis included 100 urine samples from catheterised patients with symptoms of UTI over a period of six months. Following identification, all isolates were subjected to antibiotic sensitivity using modified Kirby-Bauer disc diffusion method. Detection of biofilms was done by tube adherence method and Congo red agar method. Results E.coli was found to be the most frequently isolated uropathogen 70%, followed by Klebsiella pneumoniae 16%, Pseudomonas aeruginosa 4%, Acinetobacter spp 2%, coagulase negative Staphylococci 6% and Enterococci spp 2%. In the current study 60% of strains were in vitro positive for biofilm production. Biofilm positive isolates showed 93.3%, 83.3%, 73.3% and 80% resistance to nalidixic acid, ampicillin, cephotaxime and cotrimoxazole, respectively, compared to 70%, 60%, 35%, 60% resistance showed by biofilm non-producers for the respective antibiotics. Approximately 80% of the biofilm producing strains showed multidrug resistant phenotype ConclusionE.coli was the most frequent isolate, of which 63% were biofilm producers. The antibiotic susceptibility pattern in the present study showed quinolones were the least active drug against uropathogens. The uropathogens showed the highest sensitivity to carbapenems. The next best alternatives were aminoglycosides. Significant correlation between biofilm production and multi-drug resistance was observed in our study.

  13. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults.

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    Kidd, Emily A; Stewart, Fiona; Kassis, Nadine C; Hom, Emily; Omar, Muhammad Imran

    2015-12-10

    Indwelling urethral catheters are often used for bladder drainage in hospital. Urinary tract infection is the most common hospital-acquired infection, and a common complication of urinary catheterisation. Pain, ease of use and quality of life are important to consider, as well as formal economic analysis. Suprapubic catheterisation can also result in bowel perforation and death. To determine the advantages and disadvantages of alternative routes of short-term bladder catheterisation in adults in terms of infection, adverse events, replacement, duration of use, participant satisfaction and cost effectiveness. For the purpose of this review, we define 'short-term' as intended duration of catheterisation for 14 days or less. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 26 February 2015), CINAHL (searched 27 January 2015) and the reference lists of relevant articles. We included all randomised and quasi-randomised trials comparing different routes of catheterisation for short-term use in hospitalised adults. At least two review authors extracted data and performed 'Risk of bias' assessment of the included trials. We sought clarification from the trialists if further information was required. In this systematic review, we included 42 trials.Twenty-five trials compared indwelling urethral and suprapubic catheterisation. There was insufficient evidence for symptomatic urinary tract infection (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.61 to 1.69; 5 trials, 575 participants; very low-quality evidence). Participants with indwelling catheters had more cases of asymptomatic bacteriuria (RR 2.25, 95% CI 1.63 to 3.10; 19 trials, 1894 participants; very low quality evidence) and more participants reported pain (RR 5.62, 95% CI

  14. Improving cardiac myocytes performance by CNTs platforms

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    Valentina eMartinelli

    2013-09-01

    Full Text Available The application of nanotechnology to the cardiovascular system has increasingly caught scientists’ attention as a potentially powerful tool for the development of new generation devices able to interface, repair or boost the performance of cardiac tissue. Carbon nanotubes (CNTs are considered as promising materials for nanomedicine applications in general and have been recently tested towards excitable cell growth. CNTs are cylindrically shaped structures made up of rolled-up graphene sheets, with unique electrical, thermal and mechanical properties, able to effectively conducting electrical current in electrochemical interfaces. CNTs-based scaffolds have been recently found to support the in vitro growth of cardiac cells: in particular, their ability to improve cardiomyocytes proliferation, maturation and electrical behavior are making CNTs extremely attractive for the development and exploitation of interfaces able to impact on cardiac cells physiology and function.

  15. The Steerable Microcatheter: A New Device for Selective Catheterisation

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    Soyama, Takeshi [Hokkaido University Hospital, Department of Diagnostic and Interventional Radiology (Japan); Yoshida, Daisuke [Sapporo Yamanoue Hospital, Department of Radiology (Japan); Sakuhara, Yusuke, E-mail: yusaku@med.hokudai.ac.jp; Morita, Ryo; Abo, Daisuke; Kudo, Kohsuke [Hokkaido University Hospital, Department of Diagnostic and Interventional Radiology (Japan)

    2017-06-15

    The steerable microcatheter (SwiftNINJA, Sumitomo Bakelite, Tokyo, Japan), which has a remote-controlled flexible tip manipulated using a dial in the handgrip, was recently developed and delivered to the market. This device enables the user to change the angle of the microcatheter tip manually, and potentially makes selective catheterisation easier. We evaluated its unique characteristics and utility in selective catheterisation and coil embolization. This article describes: (1) the advantages of this device in catheterisations involving acute angle branches, and (2) a new technique of compact coil packing with the use of intentional folding by the bendable tip of the catheter.

  16. Intermittent urethral catheterisation: the reality of the lubricants and catheters in the clinical practice of a Brazilian service.

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    Mazzo, Alessandra; Pecci, Gabriel Luiz; Fumincelli, Laís; Neves, Roberta Corsini; Dos Santos, Rachel Cristina Rodrigues; Cassini, Marcelo Ferreira; Tucci, Silvio

    2016-11-01

    To identify how catheters and lubricants have been used among patients using intermittent urinary catheterisation in rehabilitation. The clean intermittent urinary catheterisation technique is an invasive procedure can cause discomfort, pain and urethral traumas. The use of lubricants and lubricated urinary catheters reduces the friction between the catheter and the urethral mucosa, minimising the risks. A descriptive exploratory design was used. Quantitative and descriptive study developed at a rehabilitation centre of a University Hospital in the interior of the state of São Paulo, Brazil, at the Intermittent Urinary Catheterisation Outpatient Clinic, between June 2012-December 2014. After ethical approval, the data were collected through an interview with the support of a semistructured questionnaire, held during the nursing consultation. Among the users, patients using intermittent urinary catheterisation were interviewed, over 18 years of age and minors younger than eight years accompanied. Descriptive statistical analysis was applied. Most of 214 (100·0%) patients were interviewed were male, single, young adults and with a primary medical diagnosis of bone marrow injury and myelomeningocele. Most patients perform the urinary catheterisation between four and six times per day. For the procedure, the majority uses polyethylene (polyvinyl chloride) catheter and, as a lubricant, 2·0% lidocaine hydrochloride on the catheter itself. Many mention lack of sensitivity when passing the catheter. In the study sample, a risk of urethral traumas was evidenced, related to the inappropriate use of catheters and lubricants. For the patients' safety, the professionals need to acknowledge the importance of the appropriate use of lubricants and lubricated catheters to implement evidence-based practices that mobilise public policies. The use of evidences demonstrates that the appropriate use of lubricants for intermittent urinary catheterisation is fundamental for patient

  17. Influence of gravity on cardiac performance

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    Pantalos, G. M.; Sharp, M. K.; Woodruff, S. J.; O'Leary, D. S.; Lorange, R.; Everett, S. D.; Bennett, T. E.; Shurfranz, T.

    1998-01-01

    Results obtained by the investigators in ground-based experiments and in two parabolic flight series of tests aboard the NASA KC-135 aircraft with a hydraulic simulator of the human systemic circulation have confirmed that a simple lack of hydrostatic pressure within an artificial ventricle causes a decrease in stroke volume of 20%-50%. A corresponding drop in stroke volume (SV) and cardiac output (CO) was observed over a range of atrial pressures (AP), representing a rightward shift of the classic CO versus AP cardiac function curve. These results are in agreement with echocardiographic experiments performed on space shuttle flights, where an average decrease in SV of 15% was measured following a three-day period of adaptation to weightlessness. The similarity of behavior of the hydraulic model to the human system suggests that the simple physical effects of the lack of hydrostatic pressure may be an important mechanism for the observed changes in cardiac performance in astronauts during the weightlessness of space flight.

  18. Laparoscopic Mitrofanoff continent catheterisable stoma in children with spina bifida

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    Mallikarjun N Reddy

    2015-01-01

    Full Text Available Background: In 1980, Mitrofanoff described the creation of an appendicovesicostomy for continent urinary diversion. This procedure greatly facilitates clean intermittent catheterisation in patients with neurogenic bladder. The purpose of our study was to determine the clinical efficacy of the laparoscopic Mitrofanoff catheterisable stoma for children and adolescents with spina bifida. Materials and Methods: Review of hospital records revealed that 11 children with spina bifida underwent a laparoscopic Mitrofanoff procedure with at least 1-year of follow-up. A four-port transperitoneal laparoscopic approach was used to create a Mitrofanoff appendicovesicostomy. The child was followed-up in the urology clinic at 6 weeks, 3 months, 6 months, 1-year, and then semiannually after that. Questionnaires were administered to determine, from the children′s perspective, the level of satisfaction with catheterisation and the psychosocial implications of catheterisation before and after the creation of the Mitrofanoff continent catheterisable stoma. Results: Of the 11 children, six were female, and five were male. The mean age at presentation to Paediatric urological services was 11 × 3.22 years. Overall the mean operative time was 144.09 × 17.00 min. Mean estimated blood loss was 37.36 × 11.44 cc. None of the cases needed conversion to open. Patient satisfaction with their catheterisation was measured at 2.18 × 0.98 preoperatively, Post-operatively, this improved to 4.27 × 0.46. Statistical analysis using paired t-test showed significance with P < 001. Conclusions: Laparoscopic Mitrofanoff catheterisable stoma is feasible in children with spina bifida and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.

  19. Usefulness of an injectable anaesthetic protocol for semen collection through urethral catheterisation in domestic cats.

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    Pisu, Maria Carmela; Ponzio, Patrizia; Rovella, Chiara; Baravalle, Michela; Veronesi, Maria Cristina

    2017-10-01

    Objectives Although less often requested in comparison with dogs, the collection of semen in cats can be necessary for artificial insemination, for semen evaluation in tom cats used for breeding and for semen storage. Urethral catheterisation after pharmacological induction with medetomidine has proved to be useful for the collection of semen in domestic cats. However, most of the previously used protocols require the administration of high doses of medetomidine that can increase the risk of side effects, especially on the cardiovascular system. In routine clinical practice, one safe and useful injectable anaesthetic protocol for short-term clinical investigations or surgery in cats involves premedication with low intramuscular doses of dexmedetomidine with methadone, followed by intravenous propofol bolus injection. We aimed to assess the usefulness of this injectable anaesthetic protocol for semen collection, via urethral catheterisation, in domestic cats. Methods The study was performed on 38 purebred, adult cats, during the breeding season, and semen was collected via urethral catheterisation using an injectable anaesthesia protocol with methadone (0.2 mg/kg) and dexmedetomidine (5 µg/kg) premedication, followed by induction with propofol. Results The anaesthetic protocol used in the present study allowed the collection of large-volume semen samples, characterised by good parameters and without side effects. Conclusions and relevance The results from the present study suggest that the injectable anaesthetic protocol using methadone and dexmedetomidine premedication, followed by induction with propofol, could be suitable and safe for the collection of a good-quality semen sample, via urethral catheterisation, in domestic cats. It can therefore be used as an alternative to previous medetomidine-based sedation protocols.

  20. Right heart catheterisation: best practice and pitfalls in pulmonary hypertension

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    Stephan Rosenkranz

    2015-12-01

    Full Text Available Right heart catheterisation (RHC plays a central role in identifying pulmonary hypertension (PH disorders, and is required to definitively diagnose pulmonary arterial hypertension (PAH. Despite widespread acceptance, there is a lack of guidance regarding the best practice for performing RHC in clinical practice. In order to ensure the correct evaluation of haemodynamic parameters directly measured or calculated from RHC, attention should be drawn to standardising procedures such as the position of the pressure transducer and catheter balloon inflation volume. Measurement of pulmonary arterial wedge pressure, in particular, is vulnerable to over- or under-wedging, which can give rise to false readings. In turn, errors in RHC measurement and data interpretation can complicate the differentiation of PAH from other PH disorders and lead to misdiagnosis. In addition to diagnosis, the role of RHC in conjunction with noninvasive tests is widening rapidly to encompass monitoring of treatment response and establishing prognosis of patients diagnosed with PAH. However, further standardisation of RHC is warranted to ensure optimal use in routine clinical practice.

  1. Influence of menstrual cycle on cardiac performance.

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    Zengin, Kadriye; Tokac, Mehmet; Duzenli, Mehmet Akif; Soylu, Ahmet; Aygul, Nazif; Ozdemir, Kurtulus

    2007-09-20

    The purpose of this study was to investigate the relationship between endogen sex hormone levels and myocardial performance in two different phases of menstrual cycle. The relationships between cardiac performance and sex hormone levels in menstrual cycle have not yet been clearly identified. Twenty-seven women at the age of 19-42 years (mean 24.11+/-6.02) with regular menstrual cycles (28-31 days) were enrolled in this study. Cardiac performance was evaluated by tissue Doppler imaging (TDI) derived myocardial performance index (MPI) in the menstrual and the luteal phases of the menstrual cycle. Left ventricular MPI were statistically significant between the menstrual phase and luteal phase of the menstrual cycle (Inferior 0.53+/-0.10 versus 0.44+/-0.09, P<0.001; Anterior 0.54+/-0.13 versus 0.45+/-0.10, P<0.008; Lateral 0.50+/-0.09 versus 0.44+/-0.12, P<0.03; Septum 0.54+/-0.07 versus 0.46+/-0.10, P<0.005; Global 0.52+/-0.06 versus 0.44+/-0.09, P<0.001). Right ventricle MPI between the two periods was also significantly different (0.49+/-0.10 versus 0.42+/-0.10, P<0.01). There was a moderate correlation between estrogen levels and global MPI (r=0.46, P=0.001), but no correlation was found between progesterone levels and global MPI (r=0.22, P=NS). We firstly demonstrated that endogen estrogen or progesterone improved the combined systolic and diastolic function in both left and right ventricle during luteal phases of menstrual cycle. Considering the previous studies and our results, estrogen may be responsible for this improvement.

  2. Intermittent catheterisation for long-term bladder management.

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    Prieto, Jacqui; Murphy, Catherine L; Moore, Katherine N; Fader, Mandy

    2014-09-10

    Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective. To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies. Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables

  3. WITHDRAWN: Intermittent catheterisation for long-term bladder management.

    Science.gov (United States)

    Prieto, Jacqui; Murphy, Catherine L; Moore, Katherine N; Fader, Mandy

    2017-08-08

    Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective. To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying. We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies. Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables

  4. clean intermitent catheterisation in the management of urethral ...

    African Journals Online (AJOL)

    2007-11-11

    Nov 11, 2007 ... use of clean intermittent self-catheterisation in the management of recurrent urethral strictures. Setting: Kenyatta National ..... money. Fifteen untreated fistula patients had visited health institutions for the fistula problem while the rest 24 had not visited health facilities for this problem. Of those who visited ...

  5. Cardiac tissue structure, properties, and performance: a materials science perspective.

    Science.gov (United States)

    Golob, Mark; Moss, Richard L; Chesler, Naomi C

    2014-10-01

    From an engineering perspective, many forms of heart disease can be thought of as a reduction in biomaterial performance, in which the biomaterial is the tissue comprising the ventricular wall. In materials science, the structure and properties of a material are recognized to be interconnected with performance. In addition, for most measurements of structure, properties, and performance, some processing is required. Here, we review the current state of knowledge regarding cardiac tissue structure, properties, and performance as well as the processing steps taken to acquire those measurements. Understanding the impact of these factors and their interactions may enhance our understanding of heart function and heart failure. We also review design considerations for cardiac tissue property and performance measurements because, to date, most data on cardiac tissue has been obtained under non-physiological loading conditions. Novel measurement systems that account for these design considerations may improve future experiments and lead to greater insight into cardiac tissue structure, properties, and ultimately performance.

  6. Efficacy of Cardiac Resynchronization Therapy Performed Concomitantly with Primary Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Keisuke Morimoto, MD

    2005-01-01

    CONCLUSION: In patients with poor left ventricular function and impaired cardiac conduction, CRT performed concomitantly with primary surgery may improve the postoperative course. Further study on indications for implantation of a CRT device during primary surgery is needed.

  7. Evaluating the cost of iatrogenic urethral catheterisation injuries.

    Science.gov (United States)

    Bhatt, N R; Davis, N F; Addie, D; Flynn, R; McDermott, T E D; Manecksha, R P; Thornhill, J A

    2017-11-01

    Technique is vital to prevent urethral trauma during urethral catheterisation (UC). Education programmes are helpful but are not compulsory and safe UC remains operator dependent. Traumatic UC is associated with increased morbidity, length of stay, resource utilisation and surgical intervention. To determine the cost of iatrogenic urethral injuries managed in a tertiary referral centre over a 6-month period. A 6-month prospective study monitored iatrogenic urethral injuries secondary to traumatic UC. Included were referrals from district hospitals and inpatient consultations relating to urethral injury caused by traumatic UC. The added cost of management was estimated. Thirteen iatrogenic urethral injuries were recorded in 6 months. Management included open surgery for a ruptured bladder (n = 1), flexible cystourethroscopy (n = 10), suprapubic catherisation (n = 4), 3-way catheterisation (n = 4) and catheter re-insertion under direct vision (n = 6). The cost of acute management of these injuries was approximately €50,000 including theatre costs, ambulance transfer, hospital stay, procedural and equipment costs and short-term follow-up care. Iatrogenic injuries during UC represent a significant cost burden to the healthcare system. Training programmes should be compulsory for all healthcare professionals routinely involved in catheterisation procedures.

  8. Correlation between athlete training intensity and cardiac performance

    African Journals Online (AJOL)

    2016-09-03

    Sep 3, 2016 ... different schools for study, randomly divided the students ... 2013-December 2015, 3600 students from different sports schools were selected for the test. ... Key words: Athlete, cardiac performance, correlation, training intensity.

  9. Method for chronic catheterisation of the amniotic sac in cattle.

    Science.gov (United States)

    Mohamed, A R; Noakes, D E

    1983-07-01

    The chronic catheterisation of the amniotic sac of eight pregnant cows of 180 to 200 days gestational age is described using an indwelling catheter of polyvinyl tubing. Although strict asepsis was followed, the main problem encountered was preventing contaminant bacteria from overwhelming the fetus, causing its death. This was successfully achieved in four animals, three of which received a mixture of ampicillin and cloxacillin sodium intra-amniotically and parenterally in the dam. Daily sequential samples of amniotic fluid were readily obtained until just before fetal death.

  10. Making a choice of catheterisation gel and the role of chlorhexidine.

    Science.gov (United States)

    Williams, Cath

    2017-07-02

    It is estimated that over 90 000 people in the UK community live with an indwelling catheter ( Wilson, 2016 ). It is essential that a lubricating gel is used during catheterisation, as this helps to reduce the risk of pain, trauma and infection ( Loveday et al, 2014 ; National Institute for Health and Care Excellence, 2012 ). Chlorhexidine is an antiseptic contained in many catheterisation gels. Evidence demonstrates that increasing numbers of patients are experiencing hypersensitivity reactions to this ingredient ( Australian and New Zealand College of Anaesthetists, 2014 ). This article considers the range of catheterisation gel choices available to clinicians and the importance of selecting the correct gel for each patient. It addresses the benefits of using OptiLube Active CHG Free (with lidocaine 2%) - the only catheterisation gel currently available in the UK that contains the benefits of local anaesthetic without chlorhexidine - and recommends that this should be the gel of choice for non-specialist staff conducting catheterisations without individual patient assessments.

  11. Correlation between athlete training intensity and cardiac performance

    African Journals Online (AJOL)

    Objective: An effective analysis of correlation between training intensity of athletes and cardiac performance is done to develop scientific and reasonable exercise program and to promote health of athletes. Methods: During December 2013-December 2015, 3600 students from different sports schools were selected for the ...

  12. [Cardiac performance during insulin clamp: its evaluation by bioimpedance measurement].

    Science.gov (United States)

    Ferraro, S; Bellarosa, I; Genovese, S; Desiderio, A; D'Alto, M; Trimigliozzi, P; Chiariello, M

    1997-02-01

    Ten patients with dilated cardiomyopathy, 7 ischemic heart disease and 3 idiopathic (7 males and 3 females, mean age 54.8 +/- 11 years), were studied. An insulin euglycemic clamp was performed to evaluate the influence of insulin infusion on cardiac performance. All the subjects were in NYHA functional class II-III and had an ejection fraction < 60% at a previous echocardiographic examination. They were submitted to a noninvasive continuous cardiac output monitoring by variations of thoracic impedance at three stops: a basal evaluation (T0); 1.2 mU/kg/min insulin infusion (T1); 5 mU/kg/min insulin infusion (T2). Moreover at the same times Na+, K+, hematocrit (Hct) and catecholamines were measured in the plasma. The total time required for the study was about 4 hours. Cardiac performance improved as shown by a significant increase in T1 and T2 with respect to the basal condition (T0), of ejection fraction: 57.87 +/- 11.3% (T1) vs 52.25 +/- 14.1% (T0; p < 0.01); 59.5 +/- 10.7% (T2) vs 52.25 +/- 14.1% (T0; p < 0.005); stroke volume: 2.61 +/- 0.5 l/min/m2 (T1) vs 2.01 +/- 0.75 l/min/m2 (T0; p < 0.001); 3.35 +/- 0.66 l/min/m2 (T2) vs 2.01 +/- 0.75 l/min/m2 (T0; p < 0.001) and cardiac output: 41.14 +/- 9.1 ml/m2 (T1) vs 38.83 +/- 7.1 ml/m2 (T0; p < 0.01); 46.45 +/- 8.56 ml/m2 (T2) vs 38.83 +/- 7.1 ml/m2 (T0; p < 0.001). This improvement in cardiac function was not due to an increase in preload because end diastolic volume, Hct, Na+ did not differ through the study. Similarly, afterload measured as mean blood pressure did not decrease. Cardiac function improvement was obtained in the presence of increased catecholamines. In conclusion, exogenous insulin infusion was able, in the presence of euglycemic condition, to improve cardiac performance. This improvement could be due to a direct inotropic effect of insulin perhaps mediated by its metabolic properties on cardiac muscular cells and/or by increasing the cellular intake of Ca+2.

  13. Mycoplasma in urine and blood following catheterisation of patients undergoing vascular surgery

    DEFF Research Database (Denmark)

    Levi, N; Eiberg, J; Skov Jensen, J

    1997-01-01

    The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment.......The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment....

  14. Comparison of in vivo cardiac function with ex vivo cardiac performance of the rat heart after thoracic irradiation

    NARCIS (Netherlands)

    Franken, N. A.; Camps, J. A.; van Ravels, F. J.; van der Laarse, A.; Pauwels, E. K.; Wondergem, J.

    1997-01-01

    The aim of the study was to compare in vivo cardiac function with ex vivo cardiac performance after local heart irradiation in the same rat. Left ventricular ejection fraction (LVEF) was measured in vivo by radionuclide ventriculography in Sprague-Dawley rats up to 16 months after a single dose of

  15. Percutaneous transhepatic portal vein catheterisation in the diagnosis of hormone-producing tumors in the splanchnic area

    Energy Technology Data Exchange (ETDEWEB)

    Luska, G.; Zick, R.; Otten, G.; Mitzkat, H.J.

    1981-11-01

    During 1980, percutaneous transhepatic portal vein catheterisation was carried out in eight patients with suspected hormone-producing tumours in an attempt to localise these. Seven patients with hyperinsulinism were suspected of having an insulinoma and one a gastrinoma. There were no complications following the catheterisation, and difficulties were reduced by the use of a special catheter. The blood samples were examined by radio-immunological methods for insulin or gastrin. On the basis of localised rise in hormone level, it was possible to diagnose three insulinomas and one gastrinoma in the pancreas. The betacell tumours were removed by enucleation or segmental resection, the gastrinoma by a Whipple's operation. Three patients showed an insulin gradient and sub-total pancreatectomies were performed. In one patient there was no definite abnormality in the insulin level and an operation has so far not been performed. Our experience indicates that this technique is difficult, but is nevertheless a reliable method for localising hormone-producing tumours and surgery should not be carried out without it.

  16. Performance Evaluation of a Bedside Cardiac SPECT System

    Science.gov (United States)

    Studenski, Matthew T.; Gilland, David R.; Parker, Jason G.; Hammond, B.; Majewski, Stan; Weisenberger, Andrew G.; Popov, Vladimir

    2009-06-01

    This paper reports on the initial performance evaluation of a bedside cardiac PET/SPECT system. The system was designed to move within a hospital to image critically-ill patients, for example, those in intensive care unit (ICU) or emergency room settings, who cannot easily be transported to a conventional SPECT or PET facility. The system uses two compact (25 cm times 25 cm) detectors with pixilated NaI crystals and position sensitive PMTs. The performance is evaluated for both 140 keV (Tc-99m) and 511 keV (F-18) emitters with the system operating in single photon counting (SPECT) mode. The imaging performance metrics for both 140 keV and 511 keV included intrinsic energy resolution, spatial resolution (intrinsic, system, and reconstructed SPECT), detection sensitivity, count rate capability, and uniformity. Results demonstrated an intrinsic energy resolution of 31% at 140 keV and 23% at 511 keV, a planar intrinsic spatial resolution of 5.6 mm full width half-maximum (FWHM) at 140 keV and 6.3 mm FWHM at 511 keV, and a sensitivity of 4.15 countsmiddotmuCi-1 ldr s-1 at 140 keV and 0.67 counts ldr muCi-1 ldr s-1 at 511 keV. To further the study, a SPECT acquisition using a dynamic cardiac phantom was performed, and the resulting reconstructed images are presented.

  17. Effect of Gravitational Gradients on Cardiac Filling and Performance.

    Science.gov (United States)

    Negishi, Kazuaki; Borowski, Allen G; Popović, Zoran B; Greenberg, Neil L; Martin, David S; Bungo, Michael W; Levine, Benjamin D; Thomas, James D

    2017-12-01

    Gravity affects every aspect of cardiac performance. When gravitational gradients are at their greatest on Earth (i.e., during upright posture), orthostatic intolerance may ensue and is a common clinical problem that appears to be exacerbated by the adaptation to spaceflight. We sought to elucidate the alterations in cardiac performance during preload reduction with progressive upright tilt that are relevant both for space exploration and the upright posture, particularly the preload dependence of various parameters of cardiovascular performance. This was a prospective observational study with tilt-induced hydrostatic stress. Echocardiographic images were recorded at four different tilt angles in 13 astronauts, to mimic varying degrees of gravitational stress: 0° (supine, simulating microgravity of space), 22° head-up tilt (0.38 G, simulating Martian gravity), 41° (0.66 G, simulating approximate G load of a planetary lander), and 80° (1 G, effectively full Earth gravity). These images were then analyzed offline to assess the effects of preload reduction on anatomical and functional parameters. Although three-dimensional end-diastolic, end-systolic, and stroke volumes were significantly reduced during tilting, ejection fractions showed no significant change. Mitral annular e' and a' velocities were reduced with increasing gravitational load (P < .001 and P = .001), although s' was not altered. Global longitudinal strain (GLS; from -19.8% ± 2.2% to -14.7% ± 1.5%) and global circumferential strain (GCS; from -29.2% ± 2.5% to -26.0% ± 1.8%) were reduced significantly with increasing gravitational stress (both P < .001), while the change in strain rates were less certain: GLSR (P = .049); GCSR (P = .55). End-systolic elastance was not consistently changed (P = .53), while markers of cardiac afterload rose significantly (effective arterial elastance, P < .001; systemic vascular resistance, P < .001). Preload modification with

  18. Correlation between athlete training intensity and cardiac performance

    African Journals Online (AJOL)

    2016-09-03

    Sep 3, 2016 ... After the three groups of athletes received training of different intensities, there is a significant improvement in their cardiac function to a certain extent, especially Group. C athletes receiving 90-minute running. After training, athletes' cardiac muscle is effectively enhanced, and their myocardial strength is ...

  19. Intravesical gentamicin for recurrent urinary tract infection in patients with intermittent bladder catheterisation.

    Science.gov (United States)

    van Nieuwkoop, C; den Exter, P L; Elzevier, H W; den Hartigh, J; van Dissel, J T

    2010-12-01

    Clean intermittent catheterisation (CIC) of the bladder is used to imitate normal bladder emptying in patients with bladder dysfunction. CIC is associated with urinary tract infection (UTI) that may be difficult to treat in the case of antimicrobial resistance. The aim of this study was to establish the effect and safety of intravesical gentamicin treatment in such settings. In 2009, intravesical gentamicin treatment was started in selected patients. Here we describe our experience with two patients treated until March 2010. Two patients using CIC suffering recurrent UTI with multiresistant Escherichia coli were treated with daily administration of 80 mg intravesical gentamicin. On treatment they appeared asymptomatic. During 8- and 9-month follow-up they were free of UTI, urine cultures were negative and there were no side effects. A systematic review was conducted through searches of PubMed and other databases. Clinical trials that met the eligibility criteria and displayed the efficacy or safety of intravesical aminoglycoside treatment in patients using CIC were studied. Study selection was performed by two independent reviewers. Eight studies were included for review. Owing to study heterogeneity, a meta-analysis could not be performed. Of four controlled studies using neomycin or kanamycin, two demonstrated a significant reduction in bacteriuria, whilst two other trials did not. One case series on neomycin/polymyxin showed that the majority of patients still developed bacteriuria. Three case series using gentamicin all pointed towards a significant reduction in bacteriuria and UTIs. There were no clinically relevant side effects reported but follow-up in all studies was limited. Although data are limited, intravesical treatment with gentamicin might be a reasonable treatment option in selected patients practicing CIC who suffer recurrent UTIs with highly resistant microorganisms. Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy

  20. High-performance web viewer for cardiac images

    Science.gov (United States)

    dos Santos, Marcelo; Furuie, Sergio S.

    2004-04-01

    With the advent of the digital devices for medical diagnosis the use of the regular films in radiology has decreased. Thus, the management and handling of medical images in digital format has become an important and critical task. In Cardiology, for example, the main difficulty is to display dynamic images with the appropriated color palette and frame rate used on acquisition process by Cath, Angio and Echo systems. In addition, other difficulty is handling large images in memory by any existing personal computer, including thin clients. In this work we present a web-based application that carries out these tasks with robustness and excellent performance, without burdening the server and network. This application provides near-diagnostic quality display of cardiac images stored as DICOM 3.0 files via a web browser and provides a set of resources that allows the viewing of still and dynamic images. It can access image files from the local disks, or network connection. Its features include: allows real-time playback, dynamic thumbnails image viewing during loading, access to patient database information, image processing tools, linear and angular measurements, on-screen annotations, image printing and exporting DICOM images to other image formats, and many others, all characterized by a pleasant user-friendly interface, inside a Web browser by means of a Java application. This approach offers some advantages over the most of medical images viewers, such as: facility of installation, integration with other systems by means of public and standardized interfaces, platform independence, efficient manipulation and display of medical images, all with high performance.

  1. A within-subjects comparison of learning and memory performance before and after cardiac catheterization.

    NARCIS (Netherlands)

    Verwey, B.; Derikx, R.L.; Waarde, J.A. van; Essink, G.; Rooij, I.A.L.M. van; Zitman, F.G.

    2007-01-01

    OBJECTIVE: To investigate the influence of stress on the recall of neutral information in a clinical setting, a prospective study was performed on patients who were admitted to the hospital for cardiac catheterization. METHODS: During their hospital stay, 39 cardiac patients were tested for verbal

  2. Association between Hypotension, Low Ejection Fraction and Cognitive Performance in Cardiac Patients

    Directory of Open Access Journals (Sweden)

    Rebecca F. Gottesman

    2010-01-01

    Full Text Available Background and Purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF is associated with cognitive performance, and whether this is modified by low blood pressure.

  3. Relationship of thresholds of physical performance to nutritional status in older hospitalized male cardiac patients.

    Science.gov (United States)

    Izawa, Kazuhiro P; Watanabe, Satoshi; Oka, Koichiro

    2015-02-01

    Nutrition is the focus of a new treatment target in older hospitalized cardiac patients. However, little is known about the differences in nutritional status in relation to physical performance in these inpatients. We determined the differences in physical performance based on the Geriatric Nutritional Risk Index (GNRI) and physical performance cut-off values according to the GNRI in older male cardiac inpatients. We enrolled 251 Japanese male inpatients aged ≥65 years (mean age 74.7 years) with cardiac disease in the present cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (≥92 points; n=178) and low-GNRI group (nutrition, as shown by a low GNRI, could be a useful predictor of physical performance. The cut-off values determined in the present study might be expected minimum target values that can be attained by Japanese older male cardiac inpatients. © 2014 Japan Geriatrics Society.

  4. Cardiac power integral: a new method for monitoring cardiovascular performance

    OpenAIRE

    Rimehaug, Audun Eskeland; Lyng, Oddveig; Nordhaug, Dag Ole; Løvstakken, Lasse; Aadahl, Petter; Kirkeby-Garstad, Idar

    2013-01-01

    Cardiac power (PWR) is the continuous product of flow and pressure in the proximal aorta. Our aim was to validate the PWR integral as a marker of left ventricular energy transfer to the aorta, by comparing it to stroke work (SW) under multiple different loading and contractility conditions in subjects without obstructions in the left ventricular outflow tract. Six pigs were under general anesthesia equipped with transit time flow probes on their proximal aortas and Millar mi...

  5. Dispersant use as a response to oil spills: toxicological effects on fish cardiac performance.

    Science.gov (United States)

    Milinkovitch, Thomas; Thomas-Guyon, Hélène; Lefrançois, Christel; Imbert, Nathalie

    2013-04-01

    Dispersant use is a controversial technique used to respond to oil spills in nearshore areas. In order to assess the toxicity of this technique, this study evaluated the cardiac toxicological effects on juvenile golden grey mullets Liza aurata exposed for 48 h to either dispersant alone, chemically dispersed oil, mechanically dispersed oil, the water-soluble fraction of oil or a control condition. Following exposure, the positive inotropic effects of adrenaline were assessed in order to evaluate a potential impairment on the cardiac performance. The results revealed an impairment of the positive inotropic effects of adrenaline for all the contaminants (single dispersant, dispersed and undispersed oil, water-soluble fraction of oil). This suggests that: (1) cardiac performance is a valuable parameter to study the physiopathological effects of dispersed oil; (2) dispersant application is likely to impair cardiac performance.

  6. Increasing fill volume reduces cardiac performance in peritoneal dialysis

    DEFF Research Database (Denmark)

    Ivarsen, Per; Povlsen, Johan V; Jensen, Jens Dam

    2007-01-01

    the demand on the heart even during normal daily activities. METHODS: Fifteen stable PD patients were included in this randomized, controlled, open-label crossover study. After drainage, we measured blood pressure, pulse rate and cardiac output (CO) after 30 min in the supine position. The measurements were...... arterial blood pressure remained unchanged. In the upright position, SV and CO decreased and total peripheral systemic resistance increased. Pulse rate and mean arterial blood pressure were unchanged independent of fill volume when compared with the drained situation. During postural change, no significant...... repeated 5 min later in an upright position. Subsequently, following fill, the measurements were repeated after 30 min in the supine and 5 min later in the upright position. The two procedures were repeated twice. The fill was either 2 l or 3 l of dialysate. CO was measured with a non-invasive device based...

  7. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    Directory of Open Access Journals (Sweden)

    Nesreen Yaghmour

    2015-03-01

    Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

  8. Developing performance indicators for cardiac surgery: a demonstration project in Victoria.

    Science.gov (United States)

    Reid, C M; Solterbeck, A; Buxton, B F; Skillington, P D; Shardey, G C; Smith, J A; Rosenfeldt, F L

    2001-01-01

    Six Victorian cardiac surgical units pooled data in order to undertake a demonstration project aimed at developing performance indicators to assess outcomes following cardiac surgery. The outcome of the project was an indicative report for the purpose of monitoring surgical performance indicators in a format suitable for: (i) the general public; (ii) the Victorian State Government; and (iii) the participating units and surgeons. Each participating cardiac surgical unit had an existing database used for recording information from each procedure. A request was made to each unit to extract a subset of data from all cases entered over the past 5 years. The proposed list of performance indicators included surgical mortality (within the period of admission for surgery), complication rates (including sternal infection, postoperative myocardial infarction, postoperative stroke, haemorrhage requiring return to theatre), and length of hospital stay. A model was developed from the data and used to provide risk-adjusted measures of hospital performance. Cases from five cardiac surgical units (n = 10 715) were included in the final analysis. A risk-adjusted model (including age, sex, diabetes, hypertension, smoking, procedure type, urgency of procedure) was developed for surgical mortality. Performance indicators for coronary artery bypass graft surgery, including mortality, sternal infection rate and length of hospital stay are presented. From the available data, performance indicators for cardiac surgery in Victorian hospitals compared favourably with international benchmarks. This project has demonstrated that prospective data collection using a standardised system could readily produce local risk-adjustment models for cardiac surgery to aid in developing appropriate performance indicators.

  9. Cardiac performance correlates of relative heart ventricle mass in amphibians.

    Science.gov (United States)

    Kluthe, Gregory J; Hillman, Stanley S

    2013-08-01

    This study used an in situ heart preparation to analyze the power output and stroke work of spontaneously beating hearts of four anurans (Rhinella marina, Lithobates catesbeianus, Xenopus laevis, Pyxicephalus edulis) and three urodeles (Necturus maculosus, Ambystoma tigrinum, Amphiuma tridactylum) that span a representative range of relative ventricle mass (RVM) found in amphibians. Previous research has documented that RVM correlates with dehydration tolerance and maximal aerobic capacity in amphibians. The power output (mW g(-1) ventricle mass) and stroke work (mJ g(-1) ventricle muscle mass) were independent of RVM and were indistinguishable from previously published results for fish and reptiles. RVM was significantly correlated with maximum power output (P max, mW kg(-1) body mass), stroke volume, cardiac output, afterload pressure (P O) at P max, and preload pressure (P I) at P max. P I at P max and P O at P max also correlated very closely with each other. The increases in both P I and P O at maximal power outputs in large hearts suggest that concomitant increases in blood volume and/or increased modulation of vascular compliance either anatomically or via sympathetic tone on the venous vasculature would be necessary to achieve P max in vivo. Hypotheses for variation in RVM and its concomitant increased P max in amphibians are developed.

  10. Switching to an antimicrobial solution for skin cleansing before urinary catheterisation.

    Science.gov (United States)

    Levers, Helen

    2014-02-01

    Catheter-associated urinary tract infections (CAUTIs) are a cause of considerable concern and any measures which can be taken to potentially reduce the rate of CAUTIs should be given careful consideration. In 2012, the Infection Prevention and Control team at Rotherham Foundation Trust switched from saline solution to an antimicrobial solution (Octenilin® cleaning solution sachets) for skin cleansing prior to urinary catheterisation to try to reduce CAUTIs. Initially, Octenilin cleaning solution sachets were intended for use solely for patients with a current or historical confirmed result of MRSA in the urine and/or other sites. However, use has been extended to other patients, including those with a history of E. coli or Klebsiella, Gram-negative organisms frequently identified as a source of UTIs. Early feedback from using Octenilin cleaning solution sachets in place of saline solution has indicated a high level of satisfaction from both patients and health-care professionals. Reports of catheterisation-associated trauma have reduced significantly and no CAUTIs have been identified to date.

  11. Cardiac Output and Performance during a Marathon Race in Middle-Aged Recreational Runners

    Directory of Open Access Journals (Sweden)

    Véronique L. Billat

    2012-01-01

    Full Text Available Purpose. Despite the increasing popularity of marathon running, there are no data on the responses of stroke volume (SV and cardiac output (CO to exercise in this context. We sought to establish whether marathon performance is associated with the ability to sustain high fractional use of maximal SV and CO (i.e, cardiac endurance and/or CO, per meter (i.e., cardiac cost. Methods. We measured the SV, heart rate (HR, CO, and running speed of 14 recreational runners in an incremental, maximal laboratory test and then during a real marathon race (mean performance: 3 hr 30 min ± 45 min. Results. Our data revealed that HR, SV and CO were all in a high but submaximal steady state during the marathon (87.0 ± 1.6%, 77.2 ± 2.6%, and 68.7 ± 2.8% of maximal values, respectively. Marathon performance was inversely correlated with an upward drift in the CO/speed ratio (mL of CO×m−1 (r=−0.65, P<0.01 and positively correlated with the runner’s ability to complete the race at a high percentage of the speed at maximal SV (r=0.83, P<0.0002. Conclusion. Our results showed that marathon performance is inversely correlated with cardiac cost and positively correlated with cardiac endurance. The CO response could be a benchmark for race performance in recreational marathon runners.

  12. Performance monitoring in cardiac surgery: application of statistical process control to a single-site database.

    Science.gov (United States)

    Smith, Ian R; Gardner, Michael A; Garlick, Bruce; Brighouse, Russell D; Cameron, James; Lavercombe, Peter S; Mengersen, Kerrie; Foster, Kelley A; Rivers, John T

    2013-08-01

    Graphical Statistical Process Control (SPC) tools have been shown to promptly identify significant variations in clinical outcomes in a range of health care settings. We explored the application of these techniques to quantitatively inform the routine cardiac surgical (CAS) morbidity and mortality (M&M) review processes at a single site. Baseline clinical and procedural data relating to 5265 consecutive cardiac surgical procedures, performed at St Andrew's War Memorial Hospital (SAWMH) between the 1st January 2003 and the 30th April 2012, were retrospectively evaluated. A range of appropriate clinical outcome indicators (COIs) were developed and evaluated using a combination of Cumulative Sum charts, Exponentially Weighted Moving Average charts and Funnel Plots. Charts were updated regularly and discussed at the cardiac surgery unit's bi-monthly M&M meetings. Risk adjustment (RA) for the COIs was developed and validated for incorporation into the charts to improve monitoring performance. Discrete and aggregated measures, including blood product/reoperation, major acute post-procedural complications, cardiopulmonary bypass duration and Length of Stay/Readmission charts were examined thoroughly and could be related to changes in clinical practice (e.g. antifibrinolytic use) as well as differences in individual operator performance (in some instances, driven by case mix). SPC tools can promptly detect meaningful changes in clinical outcome thereby allowing early intervention to address altered performance. Careful interpretation of charts for group and individual operators has proven helpful in detecting and differentiating systemic versus individual variation. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  13. Molecular dynamics simulations of the cardiac troponin complex performed with FRET distances as restraints.

    Science.gov (United States)

    Jayasundar, Jayant James; Xing, Jun; Robinson, John M; Cheung, Herbert C; Dong, Wen-Ji

    2014-01-01

    Cardiac troponin (cTn) is the Ca(2+)-sensitive molecular switch that controls cardiac muscle activation and relaxation. However, the molecular detail of the switching mechanism and how the Ca(2+) signal received at cardiac troponin C (cTnC) is communicated to cardiac troponin I (cTnI) are still elusive. To unravel the structural details of troponin switching, we performed ensemble Förster resonance energy transfer (FRET) measurements and molecular dynamic (MD) simulations of the cardiac troponin core domain complex. The distance distributions of forty five inter-residue pairs were obtained under Ca(2+)-free and saturating Ca(2+) conditions from time-resolved FRET measurements. These distances were incorporated as restraints during the MD simulations of the cardiac troponin core domain. Compared to the Ca(2+)-saturated structure, the absence of regulatory Ca(2+) perturbed the cTnC N-domain hydrophobic pocket which assumed a closed conformation. This event partially unfolded the cTnI regulatory region/switch. The absence of Ca(2+), induced flexibility to the D/E linker and the cTnI inhibitory region, and rotated the cTnC N-domain with respect to rest of the troponin core domain. In the presence of saturating Ca(2+) the above said phenomenon were absent. We postulate that the secondary structure perturbations experienced by the cTnI regulatory region held within the cTnC N-domain hydrophobic pocket, coupled with the rotation of the cTnC N-domain would control the cTnI mobile domain interaction with actin. Concomitantly the rotation of the cTnC N-domain and perturbation of the D/E linker rigidity would control the cTnI inhibitory region interaction with actin to effect muscle relaxation.

  14. Molecular dynamics simulations of the cardiac troponin complex performed with FRET distances as restraints.

    Directory of Open Access Journals (Sweden)

    Jayant James Jayasundar

    Full Text Available Cardiac troponin (cTn is the Ca(2+-sensitive molecular switch that controls cardiac muscle activation and relaxation. However, the molecular detail of the switching mechanism and how the Ca(2+ signal received at cardiac troponin C (cTnC is communicated to cardiac troponin I (cTnI are still elusive. To unravel the structural details of troponin switching, we performed ensemble Förster resonance energy transfer (FRET measurements and molecular dynamic (MD simulations of the cardiac troponin core domain complex. The distance distributions of forty five inter-residue pairs were obtained under Ca(2+-free and saturating Ca(2+ conditions from time-resolved FRET measurements. These distances were incorporated as restraints during the MD simulations of the cardiac troponin core domain. Compared to the Ca(2+-saturated structure, the absence of regulatory Ca(2+ perturbed the cTnC N-domain hydrophobic pocket which assumed a closed conformation. This event partially unfolded the cTnI regulatory region/switch. The absence of Ca(2+, induced flexibility to the D/E linker and the cTnI inhibitory region, and rotated the cTnC N-domain with respect to rest of the troponin core domain. In the presence of saturating Ca(2+ the above said phenomenon were absent. We postulate that the secondary structure perturbations experienced by the cTnI regulatory region held within the cTnC N-domain hydrophobic pocket, coupled with the rotation of the cTnC N-domain would control the cTnI mobile domain interaction with actin. Concomitantly the rotation of the cTnC N-domain and perturbation of the D/E linker rigidity would control the cTnI inhibitory region interaction with actin to effect muscle relaxation.

  15. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.

    Science.gov (United States)

    van Rappard, Juliaan R M; Tolenaar, Jip L; Smits, Anke B; Go, Peter M N Y H

    2015-08-20

    We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery. 2015 BMJ Publishing Group Ltd.

  16. [Nurses' cardiopulmonary resuscitation performance during the first 5 minutes in in-situ simulated cardiac arrest].

    Science.gov (United States)

    Kim, Eun Jung; Lee, Kyeong Ryong; Lee, Myung Hyun; Kim, Jiyoung

    2012-06-01

    The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital. A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members. Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108±75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty-seven percent of the teams defibrillated at 224±67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively. The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.

  17. The left ventricular eccentricity as a predictor of postoperative cardiac performance in valvular heart diseases.

    Science.gov (United States)

    Teramoto, S; Sano, S; Aokage, K; Shigenobu, M; Murakami, T; Kawakami, S; Nawa, S; Senoo, Y

    1982-04-01

    A clear correlation expressed by the following equation was observed between the preoperative left ventricular end-systolic eccentricity (epsilon s) and the percentage change of the left ventricular dimension (% delta D) in chronic valvular heart diseases: % delta D = 88.37 epsilon s - 48.16 (r = 0.66, p less than 0.001). Therefore, epsilon s may function as an index for predicting the postoperative cardiac performance independent of the affected valvular locations and the morphology of the lesions.

  18. Cardiac output and performance during a marathon race in middle-aged recreational runners.

    Science.gov (United States)

    Billat, Véronique L; Petot, Hélène; Landrain, Morgan; Meilland, Renaud; Koralsztein, Jean Pierre; Mille-Hamard, Laurence

    2012-01-01

    Despite the increasing popularity of marathon running, there are no data on the responses of stroke volume (SV) and cardiac output (CO) to exercise in this context. We sought to establish whether marathon performance is associated with the ability to sustain high fractional use of maximal SV and CO (i.e, cardiac endurance) and/or CO, per meter (i.e., cardiac cost). We measured the SV, heart rate (HR), CO, and running speed of 14 recreational runners in an incremental, maximal laboratory test and then during a real marathon race (mean performance: 3 hr 30 min ± 45 min). Our data revealed that HR, SV and CO were all in a high but submaximal steady state during the marathon (87.0 ± 1.6%, 77.2 ± 2.6%, and 68.7 ± 2.8% of maximal values, respectively). Marathon performance was inversely correlated with an upward drift in the CO/speed ratio (mL of CO × m(-1)) (r = -0.65, P runner's ability to complete the race at a high percentage of the speed at maximal SV (r = 0.83, P recreational marathon runners.

  19. Pharmacy students' performance and perceptions in a flipped teaching pilot on cardiac arrhythmias.

    Science.gov (United States)

    Wong, Terri H; Ip, Eric J; Lopes, Ingrid; Rajagopalan, Vanishree

    2014-12-15

    To implement the flipped teaching method in a 3-class pilot on cardiac arrhythmias and to assess the impact of the intervention on academic performance and student perceptions. An intervention group of 101 first-year pharmacy students, who took the class with the flipped teaching method, were supplied with prerecorded lectures prior to their 3 classes (1 class in each of the following subjects: basic sciences, pharmacology, and therapeutics) on cardiac arrhythmias. Class time was focused on active-learning and case-based exercises. Students then took a final examination that included questions on cardiac arrhythmias. The examination scores of the intervention group were compared to scores of the Spring 2011 control group of 105 first-year students who took the class with traditional teaching methods. An online survey was conducted to assess student feedback from the intervention group. The mean examination scores of the intervention group were significantly higher than the mean examination scores of the control group for the cardiac arrhythmia classes in pharmacology (with 89.6 ± 2.0% vs 56.8 ± 2.2%, respectively) and therapeutics (89.2 ± 1.4% vs 73.7 ± 2.1%, respectively). The survey indicated higher student satisfaction for flipped classes with highly rated learning objectives, recordings, and in-class activities. Use of the flipped teaching method in a 3-class pilot on cardiac arrhythmias improved examination scores for 2 of the 3 classes (pharmacology and therapeutics). Student satisfaction was influenced by the quality of the learning objectives, prerecorded lectures, and inclass active-learning activities.

  20. Pharmacy Students’ Performance and Perceptions in a Flipped Teaching Pilot on Cardiac Arrhythmias

    Science.gov (United States)

    Ip, Eric J.; Lopes, Ingrid; Rajagopalan, Vanishree

    2014-01-01

    Objective. To implement the flipped teaching method in a 3-class pilot on cardiac arrhythmias and to assess the impact of the intervention on academic performance and student perceptions. Design. An intervention group of 101 first-year pharmacy students, who took the class with the flipped teaching method, were supplied with prerecorded lectures prior to their 3 classes (1 class in each of the following subjects: basic sciences, pharmacology, and therapeutics) on cardiac arrhythmias. Class time was focused on active-learning and case-based exercises. Students then took a final examination that included questions on cardiac arrhythmias. The examination scores of the intervention group were compared to scores of the Spring 2011 control group of 105 first-year students who took the class with traditional teaching methods. An online survey was conducted to assess student feedback from the intervention group. Assessment. The mean examination scores of the intervention group were significantly higher than the mean examination scores of the control group for the cardiac arrhythmia classes in pharmacology (with 89.6 ± 2.0% vs 56.8 ± 2.2%, respectively) and therapeutics (89.2 ± 1.4% vs 73.7 ± 2.1%, respectively). The survey indicated higher student satisfaction for flipped classes with highly rated learning objectives, recordings, and in-class activities. Conclusion. Use of the flipped teaching method in a 3-class pilot on cardiac arrhythmias improved examination scores for 2 of the 3 classes (pharmacology and therapeutics). Student satisfaction was influenced by the quality of the learning objectives, prerecorded lectures, and inclass active-learning activities. PMID:25657372

  1. Influence of the coronary circulation on thermal tolerance and cardiac performance during warming in rainbow trout.

    Science.gov (United States)

    Ekström, Andreas; Axelsson, Michael; Gräns, Albin; Brijs, Jeroen; Sandblom, Erik

    2017-04-01

    Thermal tolerance in fish may be related to an oxygen limitation of cardiac function. While the hearts of some fish species receive oxygenated blood via a coronary circulation, the influence of this oxygen supply on thermal tolerance and cardiac performance during warming remain unexplored. Here, we analyzed the effect in vivo of acute warming on coronary blood flow in adult sexually mature rainbow trout (Onchorhynchus mykiss) and the consequences of chronic coronary ligation on cardiac function and thermal tolerance in juvenile trout. Coronary blood flow at 10°C was higher in females than males (0.56 ± 0.08 vs. 0.30 ± 0.08 ml·min-1·g ventricle-1), and averaged 0.47 ± 0.07 ml·min-1·g ventricle-1 across sexes. Warming increased coronary flow in both sexes until 14°C, at which it peaked and plateaued at 0.78 ± 0.1 and 0.61 ± 0.1 ml·min-1·g ventricle-1 in females and males, respectively. Thus, the scope for increasing coronary flow was 101% in males, but only 39% in females. Coronary-ligated juvenile trout exhibited elevated heart rate across temperatures, reduced Arrhenius breakpoint temperature for heart rate (23.0 vs. 24.6°C), and reduced upper critical thermal maximum (25.3 vs. 26.3°C). To further analyze the effects of coronary flow restriction on cardiac rhythmicity, electrocardiogram characteristics were determined before and after coronary occlusion in anesthetized trout. Occlusion resulted in reduced R-wave amplitude and an elevated S-T segment, indicating myocardial ischemia, while heart rate was unaffected. This suggests that the tachycardia in ligated trout across temperatures in vivo was mainly to compensate for reduced cardiac contractility to maintain cardiac output. Moreover, our findings show that coronary flow increases with warming in a sex-specific manner. This may improve whole animal thermal tolerance, presumably by sustaining cardiac oxygenation and contractility at high temperatures. Copyright © 2017 the American Physiological

  2. Cardiac catheterization

    Science.gov (United States)

    Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization; CAD - cardiac catheterization; Coronary artery disease - cardiac catheterization; Heart valve - cardiac catheterization; ...

  3. Peculiarities of cardiac performance in children with bronchial asthma against chronic tonsillitis

    Directory of Open Access Journals (Sweden)

    Kondratiev V.А.

    2015-11-01

    Full Text Available A comparative assessment of cardiac performance by the data of clinical-instrumental examination of 50 patients aged 5-15 years with persisting form of partially-controlled atopic bronchial asthma in the period between the attacks of the disease was made. Children were divided into two groups depending on presence of concomitant chronic tonsillitis (18 patients or absence of the latter (32 patients. In all cases by the data of spirography in children against chronic tonsillitis in the period between the attacks of the disease there were revealed ventillation disorders in the lungs by obstruction type, this promoted elevation of pressure in the pulmonary artery. Only in this group of patients in 27,8% of cases pulmonary arterial hypertension of moderate severity was revealed. By echocardiography data in children with asthma against chronic tonsillitis reliably more often (р<0,01 there was revealed decrease of contractile function of myocardium of the left cardiac ventricle; this was caused by the presence of metabolic disturbances in the myocardium in the majority of cases (83,3%. These changes were registered on the electrocardiogram in the form of repolarisation changes of the ventricular complex. Presence of concomitant chronic tonsillitis in children with bronchial asthma favored formation of pulmonary hypertension on the one side and worsening of contractile ability of myocardium of the left cardiac ventricle on the other side; this required performing therapeutic-preventive measures for sanation of chronic infectious focus in the nasopharynx to prevent formation of chronic cardiac insufficiency during asthma course.

  4. Effects of alpha-adrenoceptor and of combined sympathetic and parasympathetic blockade on cardiac performance and vascular resistance

    DEFF Research Database (Denmark)

    Kelbaek, H; Frandsen, Henrik Lund; Hilsted, J

    1992-01-01

    1. Cardiac performance and vascular resistance was studied in seven healthy men by radionuclide cardiography and venous plethysmography before and after alpha-adrenoceptor blockade with phentolamine and after combined alpha-adrenoceptor, beta-adrenoceptor (propranolol) and parasympathetic (atropine...

  5. Psychological coping with intermittent self-catheterisation (ISC) in people with spinal injury: a qualitative study.

    Science.gov (United States)

    Shaw, Chris; Logan, Karen

    2013-10-01

    Management of bladder function is important in rehabilitation of spinal injury. Failure to comply with bladder management techniques, such as intermittent catheterisation, can have long-term consequences leading to renal failure. It is important, therefore, that spinal injured people adapt to the therapy at an early stage, but there is little research aimed at exploring patient experiences of ISC. This study explores the experiences of patients who have a spinal cord injury and who carry out ISC in order to identify psychological coping factors that might affect therapy adherence. A qualitative study using a Grounded Theory framework involving individual interviews. There were 15 participants (11 men and 4 women), median age 52 years (range 24-68) who were discharged from spinal rehabilitation, living in the community and using ISC. The sample was recruited from the patient lists of a tertiary spinal injury unit and a Specialist Continence Service. In-depth interviews were carried out in participants' own homes by a trained interviewer. Interviews were audio-recorded, transcribed and analysis carried out using NUD*IST6 software. A core category of 'normalisation' was identified and the causes and consequences related to this category are reported. Categories of 'independence' and 'control' were closely related to, and were interdependent with, 'normalisation'. Participants were relieved of worry when they could exert control over their bladder function, and a feeling of normalisation helped them to maintain the integrity of their self-image. The ultimate outcome was either adaptation or maladaptation. Adaptation was dependent on positive acceptance of intermittent catheterisation and the need for good bladder management at the outset, whereas maladaptation was a result of avoidance and denial. Adherence to ISC is related to early psychological coping strategies of active acceptance rather than denial and avoidance in relation to bladder management. It is important

  6. 5-Fr sheathless transradial cardiac catheterization using conventional catheters and balloon assisted tracking; a new approach to downsizing.

    Science.gov (United States)

    Mamas, Mamas A; George, Sudhakar; Ratib, Karim; Kwok, Chun Shing; Elkhazin, Abdelnasir; Sandhu, Kully; Stubbs, Julie; Luxford, Pamela; Nolan, James

    While the uptake of transradial access site is growing, there are concerns about associated radial injury. We report a feasibility study of a technique that enables both 5Fr diagnostic and PCI cases to be undertaken without an arterial sheath using conventional diagnostic and guide catheters with a modified balloon assisted tracking (BAT) technique. We performed a prospective single center pilot study to assess the feasibility and effectiveness of sheathless radial artery access and BAT to perform coronary angiography and angioplasty using conventional 5 Fr diagnostic and guide catheters. We assessed for successful acquisition of good quality angiogram, completion of the angioplasty and access site complications. 5 Fr sheathless cardiac catheterization was undertaken in diagnostic (55%) and PCI cases (45%, all indications) in 60 consecutive patients (mean age 62.8±11.4years) using conventional catheters. The procedure was successfully performed via the radial artery using a sheathless technique with BAT in 93.3% of patients. All patients had a patent radial artery following removal of the Helix device and there were no recorded access site complications. Trans-radial cardiac catheterisation for diagnostic and PCI cases using 5F Sheathless catheters (whose outer diameter is smaller than a 3Fr introducer sheath) with BAT appears feasible and allows both cardiac catheterization for diagnostic and PCI indications to be undertaken safely using conventional catheters through the radial route, with high success rates. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Selective fallopian tube catheterisation in female infertility: clinical results and absorbed radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, K. [Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466 (Japan); Ishiguchi, T. [Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466 (Japan); Maekoshi, H. [Department of Radiological Technology, Nagoya University College of Medical Technology, Nagoya (Japan); Ando, Y. [Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466 (Japan); Tsuzaka, M. [Department of Radiological Technology, Nagoya University College of Medical Technology, Nagoya (Japan); Tamiya, T. [Department of Radiological Technology, Nagoya University College of Medical Technology, Nagoya (Japan); Suganuma, N. [Department of Obstetrics and Gynecology, Branch Hospital, Nagoya University School of Medicine, Nagoya (Japan); Ishigaki, T. [Department of Radiology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466 (Japan)

    1996-08-01

    Clinical results of fluoroscopic fallopian tube catheterisation and absorbed radiation doses during the procedure were evaluated in 30 infertility patients with unilateral or bilateral tubal obstruction documented on hysterosalpingography. The staged technique consisted of contrast injection through an intrauterine catheter with a vacuum cup device, ostial salpingography with the wedged catheter, and selective salpingography with a coaxial microcatheter. Of 45 fallopian tubes examined, 35 (78 %) were demonstrated by the procedure, and at least one tube was newly demonstrated in 26 patients (87 %). Six of these patients conceived spontaneously in the follow-up period of 1-11 months. Four pregnancies were intrauterine and 2 were ectopic. This technique provided accurate and detailed information in the diagnosis and treatment of tubal obstruction in infertility patients. The absorbed radiation dose to the ovary in the average standardised procedure was estimated to be 0.9 cGy. Further improvement in the X-ray equipment and technique is required to reduce the radiation dose. (orig.). With 3 figs., 3 tabs.

  8. Association between a Hospital’s Quality Performance for In-Hospital Cardiac Arrest and Common Medical Conditions

    Science.gov (United States)

    Chen, Lena M.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Spertus, John A.; Tang, Fengming; Chan, Paul S.

    2015-01-01

    Background Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown if this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions. Methods and Results Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia from Hospital Compare for the same period. The relationship between a hospital’s performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26,270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an inter-quartile range (IQR) of 19.7% to 24.2%. There were no significant correlations between a hospital’s outcomes for its cardiac arrest patients and its patients admitted for AMI (correlation of −0.12; P=0.16), HF (correlation of −0.05; P=0.57), or pneumonia (correlation of −0.15, P=0.10). Conclusions Hospitals that performed better on publicly reported outcomes for three common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality. PMID:24221831

  9. Swimming performance, venous oxygen tension and cardiac performance of coronary-ligated rainbow trout, Oncorhynchus mykiss, exposed to progressive hypoxia

    DEFF Research Database (Denmark)

    Steffensen, J F; Farrell, A P

    1998-01-01

    We performed in vivo studies to examine the idea that cardiac work is impaired in rainbow trout (Oncorhynchus mykiss) below a certain venous PO2 threshold. We hypothesized that coronary-ligated fish, swimming continuously at a reasonably high water velocity (1.5 body lengths x s(-1)) and exposed...... to progressive hypoxia, would fatigue at higher venous PO2 and ambient water PO2 compared with sham-operated fish. However, we found that both the lowest venous PO2 that supported hypoxic swimming (9.9 torr for coronary-ligated fish and 11.1 torr for sham-operated fish) and the venous PO2 at fatigue (7.8 torr...... and 8.6 torr, respectively) were the same for coronary-ligated and sham-operated fish. Also, both groups quit swimming at the same water PO2 heart rate and hematocrit. Nevertheless, significant differences in cardiac performance did exist between the two groups. Whereas ventral aortic blood pressure...

  10. Human placenta-derived adherent cells improve cardiac performance in mice with chronic heart failure.

    Science.gov (United States)

    Chen, Hong-Jung; Chen, Chien-Hsi; Chang, Ming-Yao; Tsai, Da-Ching; Baum, Ellen Z; Hariri, Robert; Herzberg, Uri; Hsieh, Patrick C H

    2015-03-01

    Human placenta-derived adherent cells (PDACs) are a culture-expanded, undifferentiated mesenchymal-like population derived from full-term placental tissue, with immunomodulatory, anti-inflammatory, angiogenic, and neuroprotective properties. PDA-001 (cenplacel-L), an intravenous formulation of PDAC cells, is in clinical development for the treatment of autoimmune and inflammatory diseases. We tested the therapeutic effects of PDA-001 in mice with chronic heart failure (CHF). Three weeks after transaortic constriction surgery to induce CHF, the mice underwent direct intramyocardial (IM) or i.v. injection of PDA-001 at a high (0.5 × 10(6) cells per mouse), medium (0.5 × 10(5) cells per mouse), or low (0.5 × 10(4) cells per mouse) dose. The mice were sacrificed 4 weeks after treatment. Echocardiography and ventricular catheterization showed that IM injection of PDA-001 significantly improved left ventricular systolic and diastolic function compared with injection of vehicle or i.v. injection of PDA-001. IM injection of PDA-001 also decreased cardiac fibrosis, shown by trichrome staining in the vicinity of the injection sites. Low-dose treatment showed the best improvement in cardiac performance compared with the medium- and high-dose groups. In another independent study to determine the mechanism of action with bromodeoxyuridine labeling, the proliferation rates of endothelial cells and cardiomyocytes were significantly increased by low or medium IM dose PDA-001. However, no surviving PDA-001 cells were detected in the heart 1 month after injection. In vivo real-time imaging consistently revealed that the PDA-001 cells were detectable only within 2 days after IM injection of luciferase-expressing PDA-001. Together, these results have demonstrated the cardiac therapeutic potential of PDA-001, likely through a paracrine effect. ©AlphaMed Press.

  11. Effects of combined mesenchymal stem cells and heme oxygenase-1 therapy on cardiac performance.

    Science.gov (United States)

    Zeng, Bin; Chen, Honglei; Zhu, Chengang; Ren, Xiaofeng; Lin, Guosheng; Cao, Feng

    2008-10-01

    Bone marrow mesenchymal stem cells (MSCs) have the potential to repair the infarcted myocardium and improve cardiac function. However, this approach is limited by its poor viability after transplantation, and controversy still exists over the mechanism by which MSCs contribute to the tissue repair. The human heme oxygenase-1 (hHO-1) was transfected into cultured MSCs using an adenoviral vector. 1 x 10(6) Ad-hHO-1-transfected MSCs (HO-1-MSCs) or Ad-Null-transfected MSCs (Null-MSCs) or PBS only (PBS group) were injected intramyocardially into rat hearts 1h after myocardial infarction. HO-1-MSCs survived in the infarcted myocardium, and expressed hHO-1 mRNA. The expression of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) was significantly enhanced in HO-1-MSCs-treated hearts. At the same time, there were significant reduction of TNF-alpha, IL-1-beta and IL-6 mRNA, and marked increase of IL-10 mRNA in HO-1-MSCs-treated hearts. Moreover, a further downregulation of proapoptotic protein, Bax, and a marked increase in microvessel density were observed in HO-1-MSCs-treated hearts. The infarct size and cardiac performance were also significantly improved in HO-1-MSCs-treated hearts. The combined approach improves MSCs survival and is superior to MSCs injection alone.

  12. Analytical performance and clinical decision limit of a new release for cardiac troponin I assay.

    Science.gov (United States)

    Moretti, M; Pieretti, B; Sisti, D; Rocchi, Mb; Gasperoni, S

    2015-01-01

    Cardiac troponins (cTns) are the 'gold standard' biomarker for the diagnosis and prognosis of acute coronary syndrome. Analytical performance is critical at low concentrations of cTn, and many of the current assays do not meet the guideline requirement of a 10% coefficient of variation (CV) at the 99th percentile concentrations. The aim of the study was to establish if the newly released Access® AccuTnI®+3 (AccuTnI+3) cardiac troponin I assay (Beckman Coulter Inc., Brea, CA, USA) reached this objective. All AccuTnI+3 assays were performed on UniCel® DxI800 analyzer (Beckman Coulter Inc). Limit of Blank (LoB), Limit of Detection (LoD) and Limit of Quantitation (LoQ) were determined according to Clinical Laboratory Standard Institute EP17-A and EP5-A2 protocols. The 99th percentile upper reference limit (URL) was determined by analysing serum samples from 330 apparently healthy blood donors (260 men, 70 women, age range 18-70 years, median age 36 years). LoB and LoD values were 2.6 and 12 ng/L, respectively. The 10% CV was at 18 ng/L (95% confidence interval [CI] 8-25). The 99th percentile URL was 22 ng/L (95% CI 11-34). The newly released assay has improved low-end analytical performance and reaches the goal of having a total imprecision ≤ 10% at 99th percentile of a healthy reference population (guideline acceptable). With this assay, it is now possible to utilize the 99th percentile as decision level for myocardial injury detection. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Evaluating an undergraduate interprofessional simulation-based educational module: communication, teamwork, and confidence performing cardiac resuscitation skills

    Directory of Open Access Journals (Sweden)

    Marian Luctkar-Flude

    2010-11-01

    Full Text Available Marian Luctkar-Flude1, Cynthia Baker1, Cheryl Pulling1, Robert McGraw2, Damon Dagnone2, Jennifer Medves1, Carly Turner-Kelly11School of Nursing, Queen’s University, Kingston, Ontario, Canada; 2School of Medicine, Queen’s University, Kingston, Ontario, CanadaPurpose: Interprofessional (IP collaboration during cardiac resuscitation is essential and contributes to patient wellbeing. The purpose of this study is to evaluate an innovative simulation-based IP educational module for undergraduate nursing and medical students on cardiac resuscitation skills.Methods: Nursing and medical trainees participated in a new cardiac resuscitation curriculum involving a 2-hour IP foundational cardiac resuscitation skills lab, followed by three 2-hour IP simulation sessions. Control group participants attended the existing two 2-hour IP simulation sessions. Study respondents (N = 71 completed a survey regarding their confidence performing cardiac resuscitation skills and their perceptions of IP collaboration.Results: Despite a consistent positive trend, only one out of 17 quantitative survey items were significantly improved for learners in the new curriculum. They were more likely to report feeling confident managing the airway during cardiac resuscitation (P = 0.001. Overall, quantitative results suggest that senior nursing and medical students were comfortable with IP communication and teamwork and confident with cardiac resuscitation skills. There were no significant differences between nursing students’ and medical students’ results. Through qualitative feedback, participants reported feeling comfortable learning with students from other professions and found value in the IP simulation sessions.Conclusion: Results from this study will inform ongoing restructuring of the IP cardiac resuscitation skills simulation module as defined by the action research process. Specific improvements that are suggested by these findings include strengthening the team

  14. Ontogeny of hypoxic modulation of cardiac performance and its allometry in the African clawed frog Xenopus laevis.

    Science.gov (United States)

    Pan, T-C Francis; Burggren, Warren W

    2013-01-01

    The ontogeny of cardiac hypoxic responses, and how such responses may be modified by rearing environment, are poorly understood in amphibians. In this study, cardiac performance was investigated in Xenopus laevis from 2 to 25 days post-fertilization (dpf). Larvae were reared under either normoxia or moderate hypoxia (PO₂ = 110 mmHg), and each population was assessed in both normoxia and acute hypoxia. Heart rate (f(H)) of normoxic-reared larvae exhibited an early increase from 77 ± 1 beats min⁻¹ at 2 dpf to 153 ± 1 beats min⁻¹ at 4 dpf, followed by gradual decreases to 123 ± 3 beats min⁻¹ at 25 dpf. Stroke volume (SV), 6 ± 1 nl, and cardiac output (CO), 0.8 ± 0.1 μl min⁻¹, at 5 dpf both increased by more than 40-fold to 25 dpf with rapid larval growth (~30-fold increase in body mass). When exposed to acute hypoxia, normoxic-reared larvae increased f(H) and CO between 5 and 25 dpf. Increased SV in acute hypoxia, produced by increased end-diastolic volume (EDV), only occurred before 10 dpf. Hypoxic-reared larvae showed decreased acute hypoxic responses of EDV, SV and CO at 7 and 10 dpf. Over the period of 2-25 dpf, cardiac scaling with mass showed scaling coefficients of -0.04 (f(H)), 1.23 (SV) and 1.19 (CO), contrary to the cardiac scaling relationships described in birds and mammals. In addition, f(H) scaling in hypoxic-reared larvae was altered to a shallower slope of -0.01. Collectively, these results indicate that acute cardiac hypoxic responses develop before 5 dpf. Chronic hypoxia at a moderate level can not only modulate this cardiac reflex, but also changes cardiac scaling relationship with mass.

  15. Evaluating an undergraduate interprofessional simulation-based educational module: communication, teamwork, and confidence performing cardiac resuscitation skills.

    Science.gov (United States)

    Luctkar-Flude, Marian; Baker, Cynthia; Pulling, Cheryl; McGraw, Robert; Dagnone, Damon; Medves, Jennifer; Turner-Kelly, Carly

    2010-01-01

    Interprofessional (IP) collaboration during cardiac resuscitation is essential and contributes to patient wellbeing. The purpose of this study is to evaluate an innovative simulation-based IP educational module for undergraduate nursing and medical students on cardiac resuscitation skills. Nursing and medical trainees participated in a new cardiac resuscitation curriculum involving a 2-hour IP foundational cardiac resuscitation skills lab, followed by three 2-hour IP simulation sessions. Control group participants attended the existing two 2-hour IP simulation sessions. Study respondents (N = 71) completed a survey regarding their confidence performing cardiac resuscitation skills and their perceptions of IP collaboration. Despite a consistent positive trend, only one out of 17 quantitative survey items were significantly improved for learners in the new curriculum. They were more likely to report feeling confident managing the airway during cardiac resuscitation (P = 0.001). Overall, quantitative results suggest that senior nursing and medical students were comfortable with IP communication and teamwork and confident with cardiac resuscitation skills. There were no significant differences between nursing students' and medical students' results. Through qualitative feedback, participants reported feeling comfortable learning with students from other professions and found value in the IP simulation sessions. Results from this study will inform ongoing restructuring of the IP cardiac resuscitation skills simulation module as defined by the action research process. Specific improvements that are suggested by these findings include strengthening the team leader component of the resuscitation skills lab and identifying learners who may benefit from additional practice in the role of team leader and with other skills where they lack confidence.

  16. The influence of genetic polymorphisms on performance and cardiac and hemodynamic parameters among Brazilian soccer players.

    Science.gov (United States)

    Dionísio, Thiago José; Thiengo, Carlos Rogério; Brozoski, Daniel Thomas; Dionísio, Evandro José; Talamoni, Guilherme Augusto; Silva, Roberto Braga; Garlet, Gustavo Pompermaier; Santos, Carlos Ferreira; Amaral, Sandra Lia

    2017-06-01

    This study investigated whether ACTN3 R577X, AMPD1 C34T, I/D ACE, and M235T AGT polymorphisms can affect performance tests such as jumping, sprinting, and endurance in 220 young male athletes from professional minor league soccer team from São Paulo Futebol Clube, Brazil. I/D ACE and M235T AGT polymorphisms were also analyzed according to cardiac and hemodynamic parameters. Athletes were grouped or not by age. DNA from saliva and Taqman assays were used for genotyping 220 athletes and the results were associated with performance tests. Ventricle mass, ventricle end-diastolic diameter, end-diastolic volume, and ejection fraction were assessed by echocardiogram. Arterial pressure, heart rate, and oximetry were assessed by a cardioscope. The main results of this study were that athletes who carried RR/RX (ACTN3) and DD (ACE) genotypes presented better performance during jump and sprint tests. On the other hand, athletes with ID/II genotype presented better results during endurance test, while AGT genotypes did not seem to favor the athletes during the evaluated physical tests. CC genotype (AMPD1) only favored the athletes during 10-m sprint test. Although there are environmental interactions influencing performance, the present results suggest that RR/RX ACTN3 and ACE DD genotypes may benefit athletes in activities that require strength and speed, while II ACE genotype may benefit athletes in endurance activities. This information could help coaches to plan the training session to improve the athletes' performance.

  17. Performance of automated software in the assessment of segmental left ventricular function in cardiac CT: Comparison with cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Rui [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); Meinel, Felix G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Munich (Germany); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Canstein, Christian [Siemens Medical Solutions USA, Malvern, PA (United States); Spearman, James V. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); De Cecco, Carlo N. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Departments of Radiological Sciences, Oncology and Pathology, Latina (Italy)

    2015-12-15

    To evaluate the accuracy, reliability and time saving potential of a novel cardiac CT (CCT)-based, automated software for the assessment of segmental left ventricular function compared to visual and manual quantitative assessment of CCT and cardiac magnetic resonance (CMR). Forty-seven patients with suspected or known coronary artery disease (CAD) were enrolled in the study. Wall thickening was calculated. Segmental LV wall motion was automatically calculated and shown as a colour-coded polar map. Processing time for each method was recorded. Mean wall thickness in both systolic and diastolic phases on polar map, CCT, and CMR was 9.2 ± 0.1 mm and 14.9 ± 0.2 mm, 8.9 ± 0.1 mm and 14.5 ± 0.1 mm, 8.3 ± 0.1 mm and 13.6 ± 0.1 mm, respectively. Mean wall thickening was 68.4 ± 1.5 %, 64.8 ± 1.4 % and 67.1 ± 1.4 %, respectively. Agreement for the assessment of LV wall motion between CCT, CMR and polar maps was good. Bland-Altman plots and ICC indicated good agreement between CCT, CMR and automated polar maps of the diastolic and systolic segmental wall thickness and thickening. The processing time using polar map was significantly decreased compared with CCT and CMR. Automated evaluation of segmental LV function with polar maps provides similar measurements to manual CCT and CMR evaluation, albeit with substantially reduced analysis time. (orig.)

  18. Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest.

    Science.gov (United States)

    Rittenberger, Jon C; Raina, Ketki; Holm, Margo B; Kim, Young Joo; Callaway, Clifton W

    2011-08-01

    Cerebral Performance Category (CPC), Modified Rankin Scale (mRS) and discharge disposition are commonly used to determine outcomes following cardiac arrest. This study tested the association between these outcome measures. Retrospective chart review of subjects who survived to hospital discharge between 1/1/2006 and 12/31/2009 was conducted. Charts were reviewed for outcomes (CPC, mRS, and discharge disposition). Discharge disposition was classified in 6 categories: home with no services, home with home healthcare, acute rehabilitation facility, skilled nursing facility, long term acute care facility, and hospice. Intra-and inter-rater reliabilities were calculated for outcome measures. Rates of "good outcome" (defined as a CPC of 1-2, mRS of 0-3, or discharge disposition to home or acute rehabilitation facility) were also determined. Kendall's tau correlation coefficients explored relationships among measures. A total of 211 charts were reviewed. Mean age was 60 years (SD 16), the majority (75%) were white males, in- and out-of hospital cardiac arrests were equally prevalent, and ventricular dysrhythmia was most common (N=109, 52%). Half of the subjects were comatose following resuscitation and 75 (35%) received therapeutic hypothermia. Inter-rater percentage agreement for CPC and mRS abstraction was 95.24% (kappa 0.89, pdefinition, 47 subjects (22%) using the mRS definition, and 129 subjects (61%) subjects using discharge disposition definition. There was fair relationship between the CPC and mRS (tau 0.43) and poor relationships between CPC and discharge disposition (tau 0.23) and between mRS and discharge disposition (tau 0.25). Determination of the CPC, mRS and discharge disposition at hospital discharge is reliable from chart review. These instruments provide widely differing estimates of "good outcome". Agreement between these measures ranges from poor to fair. A more nuanced outcome measure designed for the post-cardiac arrest population is needed

  19. Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil

    2015-01-01

    BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship.......37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59...

  20. Training Program for Cardiology Residents to Perform Focused Cardiac Ultrasound Examination with Portable Device.

    Science.gov (United States)

    Siqueira, Vicente N; Mancuso, Frederico J N; Campos, Orlando; De Paola, Angelo A; Carvalho, Antonio C; Moises, Valdir A

    2015-10-01

    Training requirements for general cardiologists without echocardiographic expertise to perform focused cardiac ultrasound (FCU) with portable devices have not yet been defined. The objective of this study was to evaluate a training program to instruct cardiology residents to perform FCU with a hand-carried device (HCD) in different clinical settings. Twelve cardiology residents were subjected to a 50-question test, 4 lectures on basic echocardiography and imaging interpretation, the supervised interpretation of 50 echocardiograms and performance of 30 exams using HCD. After this period, they repeated the written test and were administered a practical test comprising 30 exams each (360 patients) in different clinical settings. They reported on 15 parameters and a final diagnosis; their findings were compared to the HCD exam of a specialist in echocardiography. The proportion of correct answers on the theoretical test was higher after training (86%) than before (51%; P = 0.001). The agreement was substantial among the 15 parameters analyzed (kappa ranging from 0.615 to 0.891; P < 0.001). The percentage of correct interpretation was lower for abnormal (75%) than normal (95%) items, for valve abnormalities (85%) compared to other items (92%) and for graded scale (87%) than for dichotomous (95%) items (P < 0.0001, for all). For the final diagnoses, the kappa value was higher than 0.941 (P < 0.001; 95% CI [0.914, 0.955]). The training proposed enabled residents to perform FCU with HCD, and their findings were in good agreement with those of a cardiologist specialized in echocardiography. © 2015, Wiley Periodicals, Inc.

  1. Cardiac resynchronization therapy improves psycho-cognitive performance in patients with heart failure.

    Science.gov (United States)

    Duncker, David; Friedel, Katrin; König, Thorben; Schreyer, Hendrik; Lüsebrink, Ulrich; Duncker, Mareke; Oswald, Hanno; Klein, Gunnar; Gardiwal, Ajmal

    2015-09-01

    Reduced cognitive performance and high prevalence of depression have been reported in patients with congestive heart failure (CHF) and severe left ventricular dysfunction. However, effects of contemporary device therapy on cognitive performance and depression symptoms have not been studied thoroughly. Seventy-four consecutive CHF patients-45 receiving a biventricular defibrillator (CRT-D) and 29 receiving an implantable single or dual-chamber defibrillator (ICD) as a control group-were enrolled in this investigator-initiated, prospective, controlled, and investigator-blinded study. A set of neuropsychological tests (mini-mental state examination, DemTect, age-concentration test, and Beck depression inventory) was performed before, at 3 and at 6 months after device implantation. DemTect-score improved significantly (F = 7.8; P = 0.007) after CRT-D-implantation compared with ICD. Age-concentration test revealed better concentration ability after CRT-D-implantation (F = 8.3; P = 0.005) compared with ICD. Under CRT-D mini-mental state examination showed a significant improvement (F = 4.2; P = 0.043). CRT with defibrillator therapy also improved depression revealed by beck depression inventory (F = 14.7; P< 0.001) compared with ICD. This prospective study is the first to demonstrate psycho-cognitive improvement by resynchronization therapy in CHF patients with severe left ventricular dysfunction. In contrast to ICD therapy, the beneficial effect of CRT-D on psycho-cognitive performance might be attributed to improved cardiac function and haemodynamics. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  2. Haemodynamic characterisation and heart catheterisation complications in children with pulmonary hypertension : Insights from the Global TOPP Registry (tracking outcomes and practice in paediatric pulmonary hypertension)

    NARCIS (Netherlands)

    Beghetti, M.; Schulze-Neick, I.; Berger, R. M. F.; Ivy, D. D.; Bonnet, D.; Weintraub, R. G.; Saji, T.; Yung, D.; Mallory, G. B.; Geiger, R.; Berger, J. T.; Barst, R. J.; Humpl, T.; Mattos, S.; Jing, Z. C.; Han, Z. Y.; Sondergaard, L.; Jensen, T.; Levy, M.; Mebus, S.; Apitz, Ch.; Szatmari, A.; Ablonczy, L.; Milanesi, O.; Favero, V.; Pulido, T.; De La Garza, P.; Douwes, J. M.; Brun, H.; Moll, L.; Michalak, K.; Kawalec, W.; Zuk, M.; Boillat, M. Fasnacht; Olgunturk, R.; Kula, S. Serdar; Alehan, D.; Day, R. W.; Austin, E.; Moore, D. J.; Atz, A. M.; Feinstein, J. A.

    2016-01-01

    Background: The TOPP Registry has been designed to provide epidemiologic, diagnostic, clinical, and outcome data on children with pulmonary hypertension (PH) confirmed by heart catheterisation (HC). This study aims to identify important characteristics of the haemodynamic profile at diagnosis and HC

  3. Developing a clinical performance logbook for nursing students receiving cardiac care field training.

    Science.gov (United States)

    Yousefy, Alireza; Shayan, Shahram; Mosavi, Assadolah

    2012-01-01

    Assessment is one of the teachers' most important activities in teaching process which bears many purposes. With the rapid change of different sciences,old methods and tools are not meeting the present needs. Since in medical sciences, half of the educational course, including nursing courses,occurs at patients' bedside, the assessment of clinical competency is of great importance. In this study the goals , skills and expected level of competency for each skill and procedural skills needed for training nursing studentsreceivingcardiac care field training compiled. This research was a descriptive measurement study conducted in Esfahan in 2010-2011. Research community was nursing trainers who are responsible for training students takingcardiac care field training coursesin state medical science universities all over the country. Sampling was performed first in the form of the multi-stage cluster and then after selecting the colleges, their trainers entered the study in the form of census. To gather the information, after literature review and performing a focusing group, an initial questionnaire was compiled and survey was conducted using Delphi three-stage method. After literature review and focus group, 23 modules and 142 skills in the first section and 14 general procedural skills and 15 special procedural skills in the second stage were compiled. Finally after passing the Delphi stages, 150 skills in the form of 23 modules in the first section and 14 general procedural skill and 13 special procedural skills were obtainedin the second section. The expectancy levels of all the skills were also determined. This study has introduced an assessment pattern in the form of clinical performance logbook which can be a valuable tool for assessing the clinical competency of nursing students receiving field training in cardiac care units(CCU).

  4. The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    To investigate the value of the Doppler-derived myocardial performance index to predict early left-ventricular (LV) dilation and cardiac death after a first acute myocardial infarction (AMI), Doppler echocardiography was performed within 24 h of hospital admission, on day 5, 1 and 3 months after...... AMI in 125 consecutive patients. The index measured on day 1 correlated well with the change in end-diastolic volume index observed from day 1 to 3 months following AMI (r = 0.66, p 0.0001). One-year survival in patients with Doppler index patients with index > or = 0......, we conclude that the Doppler echocardiographic myocardial performance index is a predictor of LV dilation and cardiac death after a first AMI....

  5. Safety, efficacy, and performance of implanted recycled cardiac rhythm management (CRM) devices in underprivileged patients.

    Science.gov (United States)

    Hasan, Reema; Ghanbari, Hamid; Feldman, Dustin; Menesses, Daniel; Rivas, Daniel; Zakhem, Nicole C; Duarte, Carlos; Machado, Christian

    2011-06-01

    Patients in underdeveloped nations have limited access to life-saving medical technology including cardiac rhythm management (CRM) devices. We evaluated alternative means to provide such technology to this patient population while assessing the safety and efficacy of such a practice. Patients in the United States with clinical indications for extraction of CRM devices were consented. Antemortem CRM devices were cleaned and sterilized following a protocol established at our institution. Surveillance in vitro cultures were performed for quality assurance. The functional status of pulse generators was tested with a pacing system analyzer to confirm at least 70% battery life. Most generators were transported, in person, to an implanting institution in Nicaragua. Recipients with a Class I indication for CRM implantation, and meeting economical criteria set forth, were consented for implantation of a recycled device. Between 2003 and 2009, implantation was performed in 17 patients with an average age of 42.1 ± 20.3 years. Of the 17 patients, nine were male and eight were female. Mean follow-up was 68 ± 38 months. Device evaluation occurred prior to discharge, 4 weeks post implantation, and every 6 months thereafter. There were three deaths during the follow-up period secondary to myocardial infarction, stroke, and heart failure. Hematoma formation occurred in one patient. No infections, early battery depletion, or device malfunction were identified during follow-up. Our case series is the longest follow-up of recipients of recycled antemortem CRM devices. Our findings support the feasibility and safety of this alternative acquisition of life-saving technology. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.

  6. Diagnostic performance of combined cardiac MRI for detection of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Andrade Fernandes de Mello, Ricardo, E-mail: ricardoafmello@gmail.com [Hospital de Clinicas de Niteroi - HCN, Niteroi, RJ (Brazil); Radiology Department, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Universidade Federal do Espirito Santo - UFES, Vitroria, ES (Brazil); Nacif, Marcelo Souto, E-mail: msnacif@gmail.com [Hospital de Clinicas de Niteroi - HCN, Niteroi, RJ (Brazil); Radiology Department, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (United States); Radiology Department, Universidade Federal Fluminense - UFF, Niteroi, RJ (Brazil); Sarmet dos Santos, Alair Augusto Sarmet, E-mail: alairsarmet@globo.com [Hospital de Clinicas de Niteroi - HCN, Niteroi, RJ (Brazil); Radiology Department, Universidade Federal Fluminense - UFF, Niteroi, RJ (Brazil); Cury, Ricardo Caldeira, E-mail: RCury@baptisthealth.net [Baptist Cardiac and Vascular Institute, Miami, FL (United States); Rochitte, Carlos Eduardo, E-mail: rochitte@incor.usp.br [Department of Cardiovascular MRI and CT InCor - HCFMUSP, SP (Brazil); Marchiori, Edson, E-mail: edmarchiori@gmail.com [Radiology Department, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Radiology Department, Universidade Federal Fluminense - UFF, Niteroi, RJ (Brazil)

    2012-08-15

    Highlights: Black-Right-Pointing-Pointer In this study, we evaluated the accuracy of a Combined CMR protocol in the detection of significant CAD. Black-Right-Pointing-Pointer The invasive coronary angiography was the reference standard. Black-Right-Pointing-Pointer Results obtained in our study indicate that combination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis. Black-Right-Pointing-Pointer The Combined CMR protocol may therefore be helpful for risk stratification and defining treatment strategies. -- Abstract: Objective: To evaluate the diagnostic performance of stress perfusion cardiac MR (CMR) for detecting significant CAD ({>=}70% narrowing) in comparison with invasive coronary angiography (ICA) as a reference standard. Methods: Examinations of 54 patients who underwent both stress perfusion CMR and ICA for investigation of CAD between 2007 and 2009 were evaluated. The CMR protocol included dipyridamole stress and rest perfusion, stress and rest cine MRI for assessment of ventricular function and delayed gadolinium enhancement for assessment of myocardial viability and detection of infarction. CMR interpretation was performed by 2 observers blinded to the results of ICA and the clinical history. Results: From a total of 54 patients, 37 (68.5%) showed significant CAD in 71 coronary territories. A perfusion defect was detected in 35 patients and in 69 coronary territories. Individual stress perfusion CMR evaluation showed the highest accuracy (83%) of the CMR techniques. The combined analysis using all sequences increased the overall accuracy of CMR to 87%. Conclusion: Combination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis, and may therefore be helpful for

  7. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters.

    Science.gov (United States)

    Marterer, Robert; Hongchun, Zeng; Tschauner, Sebastian; Koestenberger, Martin; Sorantin, Erich

    2015-12-01

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, branch bundle block leads to an asynchronous ventricular contraction • In CMR, a delayed right ventricular contraction due to RBBB can be detected • Ignoring RV physiology in RBBB patients leads to underscoring of RV performance.

  8. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters

    Energy Technology Data Exchange (ETDEWEB)

    Marterer, Robert; Tschauner, Sebastian; Sorantin, Erich [Medical University of Graz, Division of Pediatric Radiology, Department of Radiology, Graz (Austria); Zeng, Hongchun [First Affiliated Hospital of Xinjiang Medical University, Department of Ultrasonography, Urumqi (China); Koestenberger, Martin [Medical University of Graz, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Graz (Austria)

    2015-12-15

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. (orig.)

  9. A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

    Directory of Open Access Journals (Sweden)

    Eikeland Husebø Sissel I

    2012-04-01

    Full Text Available Abstract Background Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. Methods We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14 performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14 performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Results Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio. We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. Conclusion We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team

  10. Upper-body progressive resistance training improves strength and household physical activity performance in women attending cardiac rehabilitation.

    Science.gov (United States)

    Coke, Lola A; Staffileno, Beth A; Braun, Lynne T; Gulanick, Meg

    2008-01-01

    The purpose of this study was to examine the impact of moderate-intensity, progressive, upper-body resistance training (RT) on muscle strength and perceived performance of household physical activities (HPA) among women in cardiac rehabilitation. The 10-week, pretest-posttest, experiment randomized women to either usual care (UC) aerobic exercise or RT. Muscle strength for 5 upper-body RT exercises (chest press, shoulder press, biceps curl, lateral row, and triceps extension) was measured using the 1-Repetition Maximum Assessment. The RT group progressively increased weight lifted using 40%, 50%, and 60% of obtained 1-Repetition Maximum Assessment at 3-week intervals. Perceived performance of HPA was measured with the Kimble Household Activities Scale. The RT group (n = 16, mean age 64 +/- 11) significantly increased muscle strength in all 5 exercises in comparison with the UC group (n = 14, mean age 65 +/- 10) (chest press, 18% vs 11%; shoulder press, 24% vs 14%; biceps curl, 21% vs 12%; lateral row, 32% vs 9%; and triceps extension, 28% vs 20%, respectively). By study end, Household Activities Scale scores significantly increased (F = 13.878, P = .001) in the RT group (8.75 +/- 3.19 vs 11.25 +/- 2.14), whereas scores in the UC group decreased (8.60 +/- 3.11 vs 6.86 +/- 4.13). Progressive upper-body RT in women shows promise as an effective tool to increase muscle strength and improve the ability to perform HPA after a cardiac event. Beginning RT early after a cardiac event in a monitored cardiac rehabilitation environment can maximize the strengthening benefit.

  11. Performance of a radiation protection cabin during extraction of cardiac devices.

    Science.gov (United States)

    Ploux, Sylvain; Jesel, Laurence; Eschalier, Romain; Amraoui, Sana; Ritter, Philippe; Haïssaguerre, Michel; Bordachar, Pierre

    2014-12-01

    Operators who extract cardiac devices are exposed to considerable irradiation and excess risk of radiation-induced disorders. A dedicated radioprotection cabin was developed to offer complete protection against radiation. This randomized study was designed to ascertain the protection against radiation conferred by a radioprotection cabin and the safety during extraction of cardiac devices. Thirty-seven consecutive patients who presented with an indication for extraction of a cardiac device were randomly assigned to a standard extraction technique (n = 19), vs extraction with the use of a radiation protection cabin (n = 18). Fluoroscopic exposure was compared using electronic dosimeters placed on the thorax, back, foot, and head of the operator. The procedural times and total fluoroscopic exposure times and the complication rates were not significantly different between the 2 groups. The mean dose of radiation delivered to the thorax and back was similar in both groups (P = 0.3 and P = 0.8, respectively). In contrast, the mean doses of radiation delivered to the head and to the feet were respectively 68 and 390 times less in the cabin group than in the control group (P lead apron, without increasing procedural time or complication rate during cardiac device extraction. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  12. Effects of changes in water salinity upon exercise and cardiac performance in the European seabass ( Dicentrarchus labrax )

    DEFF Research Database (Denmark)

    Chatelier, A.; McKenzie, David; Claireaux, G.

    2005-01-01

    The European seabass is an active euryhaline teleost that migrates and forages in waters of widely differing salinities. Oxygen uptake (M-O2) was measured in seabass (average mass and forklength 510 g and 34 cm, respectively) during exercise at incremental swimming speeds in a tunnel respirometer...... in seawater (SW) at a salinity of 30 parts per thousand and temperature of 14 degrees C, and their maximal sustainable (critical) swimming speed (U-crit) determined. Cardiac output (Q) was measured via an ultrasound flow probe on their ventral aorta. The fish were then exposed to acute reductions in water...... performance. This was linked to an exceptional capacity to maintain plasma osmolality and tissue water content unchanged following all salinity challenges. This extraordinary adaptation would allow the seabass to maintain skeletal and cardiac muscle function while migrating through waters of widely differing...

  13. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2016-01-01

    complex >150 ms, QRS complex narrowing under CRT, and sinus rhythm were included ≥3 months after CRT implantation. Echocardiographic assessment of left ventricular ejection fraction (LVEF), global peak systolic longitudinal strain (GLS), and contraction pattern by 2D strain was performed during intrinsic......PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...

  14. Definition of performance metrics and methods for screening for sudden cardiac arrest risk at a tertiary care medical center.

    Science.gov (United States)

    Rea, Robert F; Beinborn, Douglas; Webster, Tracy; Acker, Nancy; Kester, Tammy; Hayes, David L; McConnell, Mark

    2011-09-01

    The purpose of this study is to describe the results of manual and automatic electronic medical record-based screening of patients at risk of sudden cardiac arrest (SCA) based on measurements of left ventricular ejection fraction (LVEF). Counseling regarding SCA risk and implantable cardioverter defibrillator (ICD) therapy is underutilized in patients with reduced LVEF. We developed and implemented an electronic medical record (EMR)-based system for screening of such patients to improve care. In phase one, manual screening of electronic records and LVEF databases was initially performed by trained cardiac device nurses. In phase two, records were screened automatically by a customized program, and candidate patient records were sent to cardiac device nurses for final review and disposition. In phase one, 2,531 patients with LVEF ≤35% were identified over 398 days. Manual EMR review showed that 1,918 patients (76%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. In phase two, 1,081 patients with LVEF ≤35% were identified after automatic screening of 44,672 echocardiograms and EMR over 251 days. Of these, 513 patients (58%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. These data detail the utilization of consultation regarding SCA risk and ICDs in patients with reduced LVEF at a tertiary care center with ready access to arrhythmia specialists. Notification of primary providers of reduced LVEF with recommendation for consultation was not effective in improving patient care.

  15. Public reporting of cardiac surgery performance: Part 1--history, rationale, consequences.

    Science.gov (United States)

    Shahian, David M; Edwards, Fred H; Jacobs, Jeffrey P; Prager, Richard L; Normand, Sharon-Lise T; Shewan, Cynthia M; O'Brien, Sean M; Peterson, Eric D; Grover, Frederick L

    2011-09-01

    Cardiac surgical report cards have historically been mandatory. This paradigm changed when The Society of Thoracic Surgeons recently implemented a voluntary public reporting program based on benchmark analyses from its National Cardiac Database. The primary rationale is to provide transparency and accountability, thus affirming the fundamental ethical right of patient autonomy. Previous studies suggest that public reporting facilitates quality improvement, although other approaches such as confidential feedback of results and regional quality improvement initiatives are also effective. Public reporting has not substantially impacted patient referral patterns or market share. However, this may change with implementation of healthcare reform and with refinement of public reporting formats to enhance consumer interpretability. Finally, the potential unintended adverse consequences of public reporting must be monitored, particularly to assure that hospitals and surgeons remain willing to care for high-risk patients. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease.

    Science.gov (United States)

    Tavil, Yusuf; Ozturk, Mehmet Akif; Sen, Nihat; Kaya, Mehmet Gungor; Hizal, Fatma; Poyraz, Fatih; Turfan, Murat; Onder, Meltem; Gurer, Mehmet Ali; Cengel, Atiye

    2008-03-01

    Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.

  17. Effect of Steroid Elution on Electrical Performance and Tissue Responses in Quadripolar Left Ventricular Cardiac Vein Leads.

    Science.gov (United States)

    Yang, Zhongping; Kirchhof, Nicole; Li, Shelby; Hine, Douglas; McVenes, Rick

    2015-08-01

    The use of steroid elution (SE) electrode in a cardiac pacing lead is known to suppress myocardial inflammation to lower pacing thresholds (PTs). SE has been widely utilized on the distal electrode of left ventricular cardiac vein (LVCV) leads used in cardiac resynchronization therapy (CRT). However, no paired comparison in effect of SE has been studied in proximal electrodes of quadripolar LVCV leads. We evaluated electrical performance and tissue responses of quadripolar LVCV lead electrodes with and without SE in two canine studies with a total of 14 canines. Extended bipolar PT and pacing impedance of the LVCV electrodes to right ventricle coil were collected via an implantable CRT device/programmer or a percutaneous threshold analyzer/pacing analyzer at weeks 0, 1, 2, 4, 6, 8, and 12. Gross and histopathological examinations of the canines were performed at the end of the studies. Our preclinical studies showed that SE had significant effects on the long-term pacing performance of quadripolar LVCV leads. The SE tip and ring electrodes reduced postimplant PT peak and chronic PT, P = 0.038. Histological examination of the perilead tissue capsules at 12 weeks showed a reduced thickness for the location of SE electrodes. SE electrodes in quadripolar LVCV leads lower the PTs, and therefore may potentially reduce long-term current drain of CRT systems, thus improving the device longevity. These preclinical data serve as rationale to include SE on proximal electrodes for the Attain Performa LVCV leads and future quadripolar LVCV leads development. ©2015 Medtronic PLC. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

  18. Prolonged weightlessness (300 plus days) and cardiac performance in primates. 1: Neuro-humoral mechanisms in the control of cardiac and vascular performance in conscious animals

    Science.gov (United States)

    Hawthorne, E. W.

    1972-01-01

    Research during the period 1 Oct. 1971 to 1 Oct. 1972 is reported. Studies discussed include: development of techniques for instrumentation of dogs and other animals, effects of temporary application of lower body negative pressure, and effect of infusing selected drugs on ventricular performance.

  19. Selective Blockade of Periostin Exon 17 Preserves Cardiac Performance in Acute Myocardial Infarction.

    Science.gov (United States)

    Taniyama, Yoshiaki; Katsuragi, Naruto; Sanada, Fumihiro; Azuma, Junya; Iekushi, Kazuma; Koibuchi, Nobutaka; Okayama, Keita; Ikeda-Iwabu, Yuka; Muratsu, Jun; Otsu, Rei; Rakugi, Hiromi; Morishita, Ryuichi

    2016-02-01

    We previously reported that overexpression of full-length periostin, Pn-1, resulted in ventricular dilation with enhanced interstitial collagen deposition in a rat model. However, other reports have documented that the short-form splice variants Pn-2 (lacking exon 17) and Pn-4 (lacking exons 17 and 21) promoted cardiac repair by angiogenesis and prevented cardiac rupture after acute myocardial infarction. The apparently differing findings from those reports prompted us to use a neutralizing antibody to selectively inhibit Pn-1 by blockade of exon 17 in a rat acute myocardial infarction model. Administration of Pn neutralizing antibody resulted in a significant decrease in the infarcted and fibrotic areas of the myocardium, which prevented ventricular wall thinning and dilatation. The inhibition of fibrosis by Pn neutralizing antibody was associated with a significant decrease in gene expression of fibrotic markers, including collagen I, collagen III, and transforming growth factor-β1. Importantly, the number of α-smooth muscle actin-positive myofibroblasts was significantly reduced in the hearts of animals treated with Pn neutralizing antibody, whereas cardiomyocyte proliferation and angiogenesis were comparable in the IgG and neutralizing antibody groups. Moreover, the level of Pn-1 expression was significantly correlated with the severity of myocardial infarction. In addition, Pn-1, but not Pn-2 or Pn-4, inhibited fibroblast and myocyte attachment, which might account for the cell slippage observed during cardiac remodeling. Collectively, these results indicate that therapeutics that specifically inhibit Pn exon-17, via a neutralizing antibody or drug, without suppressing other periostin variants might offer a new class of medication for the treatment of acute myocardial infarction patients. © 2015 American Heart Association, Inc.

  20. Hardiness and Outcome of Self-catheterisation Training (HOST): protocol for an observational study exploring the effects of personality traits in women on ability to learn clean intermittent self-catheterisation.

    Science.gov (United States)

    Perkins, Kalbinder; Randall, Duncan; Toozs-Hobson, Philip; Sitch, Alice; Ismail, Khaled M K

    2014-01-08

    Clean intermittent self-catheterisation (CISC) is the recommended first-line management of voiding dysfunction; however, psychological factors involved in acceptance and take up are often neglected. There is a tendency to discuss the success of CISC in relation to factors that affect teaching and learning, with subsequent success or failure being attributed to these. There is limited research investigating what extent, personality traits impact on a woman's willingness to learn CISC and subsequent mastery of the technique. All women attending a tertiary urogynaecology department as eligible for CISC will be invited to participate in the study. Over the 14-month recruitment period, an estimated 130 women will be involved. The participants will complete a series of self-reported questionnaires. Personality types will be assessed using The Hardiness Scale and State-Trait Anxiety Inventory. The impact of urinary symptoms and CISC on quality of life (QoL) will be measured using an electronic pelvic-floor assessment questionnaire (ePAQ). Success and mastery will be measured by recording the number of hospital appointments and the length of time taken to learn. Confidence will be measured using the Likert scale. A sample of 20 women will be invited to participate in semi-structured in-depth interviews to explore women's views and experiences of CISC. Regulatory approvals will be in place prior to the start of the study. Good clinical practice guidelines will be followed throughout. Eligibility and training for CISC will be undertaken in accordance to individualised care plans in line with unit protocol and will not be influenced by the study. Trial data will be anonymised and participant confidentiality will be maintained. The Study findings will be disseminated through publications in relevant journals and will be presented at multiprofessional conferences and scientific meetings.

  1. Evaluation of the Early Results of the Initial 500 Cardiac Operations Performed in a New Center

    Directory of Open Access Journals (Sweden)

    Turan Erdoğan

    2011-12-01

    Full Text Available Background: The initial 500 cases of a new center which is established in a province having no history of open heart surgery are evaluated with respect to mortality especially.Methods: A total of 500 patients underwent operations at our clinic between March 2008 and November 2009. Of these patients 373 (74.6% were male, 127 (25.4% were female and the mean age was 64.15±11.54. Four hundred eleven patients had coronary artery disease (19 had left ventricular aneurysm, 46 patients had coronary artery disease together with heart valve disease (of these 2 had ascending aortic aneurysm, 1 had left ventricular aneurysm, 1 had rupture of sinus valsalva aneurysm, 30 patients had valvular disease ( 1 had also patent ductus arteriosus, 4 patients had type 1 aortic dissection, 4 patients had ascending aortic aneurysm (3 had aortic valve disease, 4 patients had coarctation of the aorta, and 1 of the patients underwent surgery with the diagnosis of secundum atrial septal defect. Results: In-hospital mortality rate was 2% with 10 patients. The reasons of deaths were; low cardiac output in 3, renal insufficiency in 2, peroperative myocardial infarction in 2, bleeding in 1, lung complications in 1 and cardiac tamponade in 1. Fifteen patients (3% due to bleeding caused for surgical re-exploration. Postoperative atrial fibrillation developed in 97 patients (19.4%. Four patients (0.8% suffered wound infections on saphenous vein region, one patient (0.2% developed mediastinitis. Three patients (0.6% had neurological complications (two patients developed hemiplegia, one suffered from persistent tonic-clonic convultion. Prolonged entubation, prolonged intensive care unit stay and readmission to intensive care were other complications with rates of 20 (4%, 31(6.2% and 13(2.6% respectively. Conclusion: Our study showed that there is a strong relationship between peroperative myocard infarction and mortality, and patients who had diminished renal functions

  2. Outcome of noncardiac surgery in children with congenital heart disease performed outside a cardiac center.

    Science.gov (United States)

    Ng, Shermayne M; Jin, Xi; Yates, Robert; Kelsall, Anthony W R

    2016-02-01

    The objective of this study was to review the outcome of children with congenital heart disease (CHD) undergoing noncardiac surgery requiring general anesthesia (GA) in a tertiary pediatric center between January 2010 and December 2012. A retrospective case note review of children surgery [Critical Care and Pain 2012;12:17-22]. 117 children with CHD were identified with a total of 240 procedures conducted. 36 procedures were conducted in the high-risk group, 135 in the intermediate-risk group, and 69 in the low-risk group. 40% of these were major operations such as small bowel and colonic procedures. Overall mortality rate at 7days and 30days was 0% and 0.4%, respectively, with a 1% mortality rate in minor procedures and 0% mortality rate in major procedures. There were no unexpected deaths. 17% of procedures resulted in complications. A higher rate of complications was recorded in emergency procedures. 17% of these procedures required admission to the intensive care unit, with the highest admissions rate in the high-risk group. The median duration of hospital stay for the whole cohort was 1day (range of 0-71days). Our study shows that procedures requiring GA can be safely conducted on children from any of the three risk groups in a nonspecialist cardiac center provided that there is close liaison and careful planning between the different specialties. Copyright © 2016. Published by Elsevier Inc.

  3. Modular minimally invasive extracorporeal circulation systems; can they become the standard practice for performing cardiac surgery?

    Science.gov (United States)

    Anastasiadis, K; Antonitsis, P; Argiriadou, H; Deliopoulos, A; Grosomanidis, V; Tossios, P

    2015-04-01

    Minimally invasive extracorporeal circulation (MiECC) has been developed in an attempt to integrate all advances in cardiopulmonary bypass technology in one closed circuit that shows improved biocompatibility and minimizes the systemic detrimental effects of CPB. Despite well-evidenced clinical advantages, penetration of MiECC technology into clinical practice is hampered by concerns raised by perfusionists and surgeons regarding air handling together with blood and volume management during CPB. We designed a modular MiECC circuit, bearing an accessory circuit for immediate transition to an open system that can be used in every adult cardiac surgical procedure, offering enhanced safety features. We challenged this modular circuit in a series of 50 consecutive patients. Our results showed that the modular AHEPA circuit design offers 100% technical success rate in a cohort of random, high-risk patients who underwent complex procedures, including reoperation and valve and aortic surgery, together with emergency cases. This pilot study applies to the real world and prompts for further evaluation of modular MiECC systems through multicentre trials. © The Author(s) 2015.

  4. Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

    Directory of Open Access Journals (Sweden)

    Dr. Nagla Hamdi Kamal Khalil El- Meanawi

    2015-08-01

    Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

  5. Half-molar sodium lactate infusion improves cardiac performance in acute heart failure: a pilot randomised controlled clinical trial.

    Science.gov (United States)

    Nalos, Marek; Leverve, Xavier; Huang, Stephen; Weisbrodt, Leonie; Parkin, Ray; Seppelt, Ian; Ting, Iris; Mclean, Anthony

    2014-03-25

    Acute heart failure (AHF) is characterized by inadequate cardiac output (CO), congestive symptoms, poor peripheral perfusion and end-organ dysfunction. Treatment often includes a combination of diuretics, oxygen, positive pressure ventilation, inotropes and vasodilators or vasopressors. Lactate is a marker of illness severity but is also an important metabolic substrate for the myocardium at rest and during stress. We tested the effects of half-molar sodium lactate infusion on cardiac performance in AHF. We conducted a prospective, randomised, controlled, open-label, pilot clinical trial in 40 patients fulfilling two of the following three criteria for AHF: (1) left ventricular ejection fraction Hartmann's solution without continuous infusion. The primary outcome was CO assessed by transthoracic echocardiography 24 hours after randomisation. Secondary outcomes included a measure of right ventricular systolic function (tricuspid annular plane systolic excursion (TAPSE)), acid-base balance, electrolyte and organ function parameters, along with length of stay and mortality. The infusion of half-molar sodium lactate increased (mean ± SD) CO from 4.05 ± 1.37 L/min to 5.49 ± 1.9 L/min (P < 0.01) and TAPSE from 14.7 ± 5.5 mm to 18.3 ± 7 mm (P = 0.02). Plasma sodium and pH increased (136 ± 4 to 146 ± 6 and 7.40 ± 0.06 to 7.53 ± 0.03, respectively; both P < 0.01), but potassium, chloride and phosphate levels decreased. There were no significant differences in the need for vasoactive therapy, respiratory support, renal or liver function tests, duration of ICU and hospital stay or 28- and 90-day mortality. Infusion of half-molar sodium lactate improved cardiac performance and led to metabolic alkalosis in AHF patients without any detrimental effects on organ function. Clinicaltrials.gov NCT01981655. Registered 13 August 2013.

  6. Performance of TCI Propofol Using the Schnider Model for Cardiac Surgery on Cardiopulmonary Bypass-A Pilot Study.

    Science.gov (United States)

    Lee, Aaron Kwang Yang; Kong, Aaron Yik Hang; Kong, Chee Fai

    2017-10-04

    This pilot study aimed to evaluate the performance of target-controlled infusion (TCI) of propofol using the Schnider pharmacokinetic model in patients undergoing cardiac surgery requiring cardiopulmonary bypass. This was a prospective pharmacokinetic study. A tertiary care hospital. This study is comprised of 10 patients, aged between 46 and 81, who underwent elective cardiac surgery requiring the use of cardiopulmonary bypass. Anesthetic technique was standardized. Hypnosis was maintained using TCI of propofol, titrated to achieve a bispectral index of 30 to 60. Calculated plasma propofol concentrations were recorded at 5 time points in total, before, during, and after cardiopulmonary bypass. Blood propofol concentration was measured at each of these time points. The prediction errors and absolute prediction errors were calculated for each sample. From these, the median prediction error (MDPE) and its absolute value (MDAPE) were derived. Agreement between predicted and measured propofol concentrations was assessed using a Bland-Altman plot. Mean prediction errors were also compared pre-, on, and post-bypass using the generalized linear latent and mixed model. The MDPE and MDAPE were both found to be 45%, indicating significant bias toward under-prediction in the Schnider pharmacokinetic model. This bias was increased at an average propofol concentration of 4.5 μg/mL and above. A significant decrease in mean prediction error was noted while on bypass (45.6%, 95% confidence intervals 9.2-82.1). The performance of the Schnider pharmacokinetic model for TCI propofol was poor, with a tendency toward under-prediction of blood propofol concentration, especially at higher average concentrations of propofol. While mitigating the risk of awareness, the risk of other adverse effects like hypotension and cardiorespiratory depression is increased. Patients should therefore be adequately monitored, and predicted plasma propofol concentrations taken in context with other

  7. Simulation of cardiac electrophysiology on next-generation high-performance computers.

    Science.gov (United States)

    Bordas, Rafel; Carpentieri, Bruno; Fotia, Giorgio; Maggio, Fabio; Nobes, Ross; Pitt-Francis, Joe; Southern, James

    2009-05-28

    Models of cardiac electrophysiology consist of a system of partial differential equations (PDEs) coupled with a system of ordinary differential equations representing cell membrane dynamics. Current software to solve such models does not provide the required computational speed for practical applications. One reason for this is that little use is made of recent developments in adaptive numerical algorithms for solving systems of PDEs. Studies have suggested that a speedup of up to two orders of magnitude is possible by using adaptive methods. The challenge lies in the efficient implementation of adaptive algorithms on massively parallel computers. The finite-element (FE) method is often used in heart simulators as it can encapsulate the complex geometry and small-scale details of the human heart. An alternative is the spectral element (SE) method, a high-order technique that provides the flexibility and accuracy of FE, but with a reduced number of degrees of freedom. The feasibility of implementing a parallel SE algorithm based on fully unstructured all-hexahedra meshes is discussed. A major computational task is solution of the large algebraic system resulting from FE or SE discretization. Choice of linear solver and preconditioner has a substantial effect on efficiency. A fully parallel implementation based on dynamic partitioning that accounts for load balance, communication and data movement costs is required. Each of these methods must be implemented on next-generation supercomputers in order to realize the necessary speedup. The problems that this may cause, and some of the techniques that are beginning to be developed to overcome these issues, are described.

  8. Short-term effects of exercise and music on cognitive performance among participants in a cardiac rehabilitation program.

    Science.gov (United States)

    Emery, Charles F; Hsiao, Evana T; Hill, Scott M; Frid, David J

    2003-01-01

    Exercise has been associated with improved cognitive performance among patients with coronary artery disease. Music listening has been associated with enhanced cognitive functioning among healthy adults. This study evaluated the combined influence of exercise and music listening on cognitive performance among patients in cardiac rehabilitation (CR). Using a within-subjects repeated measures design, this study was conducted in an outpatient University-based CR facility. Thirty-three men and women (mean age = 62.6 +/- 10.5 years) participated in this study. Participants completed 1 exercise session accompanied by music and a second exercise session without music. Order of conditions was assigned randomly. Before and after each exercise session, participants completed a brief assessment of depression and anxiety, and a cognitive test of verbal fluency. The music condition was associated with significant improvements in verbal fluency, but the no-music control condition was not associated with cognitive change. The study provides preliminary evidence of the combined benefit of exercise and music listening for cognitive performance among patients in CR.

  9. External Cardioversion of Atrial Fibrillation Causes an Early Improvement of Cardiac Performance: A Longitudinal Strain Analysis Study

    Science.gov (United States)

    Fumagalli, Stefano; Gabbai, Debbie; Francini, Sara; Rinaldi, Marta Casalone; Pedri, Stefano; Baldasseroni, Samuele; Tarantini, Francesca; Serio, Claudia Di; Lonetto, Giuseppe; Bari, Mauro Di; Padeletti, Luigi; Crijns, Harry J.; Marchionni, Niccolò

    2014-01-01

    Introduction: Atrial fibrillation (AF) is often associated with heart failure. Several studies have demonstrated that resumption of sinus rhythm (SR) improves cardiac output in the long-term. Aims of this study were to evaluate the acute variations of left ventricular (LV) performance, following successful external cardioversion (ECV) of persistent AF using longitudinal strain (LSt) analysis, and the influence of inflammation. Materials and Methods: We enrolled 48 patients with AF (age: 73 ± 12 years, men: 83.3%). A standard transthoracic echocardiographic evaluation was performed before the procedure and 6 h later; this included the analysis of LV endocardial peak LSt, a measure of myocardial deformation. In the last 32 patients, plasma concentration of interleukin-6 (IL-6) was also determined. Results: Restoration of SR led to the decrease of heart rate (HR) (74 ± 21 vs 64 ± 10 bpm, P ECV of AF determines a significant and fast improvement of LV performance, which is readily captured by LSt analysis. Inflammatory status may impact the response to SR restoration. PMID:28465898

  10. Antibiotic treatment for intermittent bladder catheterisation with once daily prophylaxis (the AnTIC study): Study protocol for a randomised controlled trial.

    Science.gov (United States)

    Brennand, Catherine; von Wilamowitz-Moellendorff, Alexander; Dunn, Sarah; Wilkinson, Jennifer; Chadwick, Thomas; Ternent, Laura; Oluboyede, Yemi; Wood, Ruth; Walton, Katherine; Fader, Mandy; N'Dow, James; Abdel-Fattah, Mohamed; McClurg, Doreen; Little, Paul; Hilton, Paul; Timoney, Anthony; Morris, Nicola; Thiruchelvam, Nikesh; Larcombe, James; Harrison, Simon; Armstrong, Heather; McColl, Elaine; Pickard, Robert

    2016-06-04

    Clean intermittent self-catheterisation is an important management option for people who cannot empty their bladder effectively. Recurrent urinary tract infections are common in these patients. Data from recent studies suggest that antibiotic prophylaxis may be beneficial in reducing infection risk, but the effectiveness of this intervention remains uncertain. This is a 52-site, patient randomised superiority trial set in routine care comparing an experimental strategy of once daily antibiotic prophylaxis for 12 months against a control strategy of no prophylaxis in people who carry out self-catheterisation and suffer recurrent urinary tract infections. The primary outcome is number of urinary tract infections during a 12-month treatment period. Both groups will otherwise receive usual care including on demand treatment courses of antibiotics for urinary tract infection. Participants and their clinicians will not be blinded to the allocated intervention, but central trial staff managing and analysing trial data will, as far as possible, be unaware of participant allocation. The analysis will follow intention-to-treat principles. This trial was commissioned and funded by the United Kingdom National Health Service following prioritisation of the research question by the National Institute for Health and Care Excellence. ISRCTN67145101 EUDRACT2013-002556-32. Registered on 25 October 2013.

  11. Cardiac catheterization - discharge

    Science.gov (United States)

    Catheterization - cardiac - discharge; Heart catheterization - discharge: Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization discharge; CAD - cardiac catheterization discharge; Coronary ...

  12. The effect of acute and 7-days dietary nitrate on mechanical efficiency, exercise performance and cardiac biomarkers in patients with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Beijers, R.J.H.C.G.; Huysmans, S.M.D.; Bool, C. van de; Kingma, B.R.M.; Verdijk, A.B.; Loon, L.J.C.; Meex, S.J.R.; Gosker, H.R.; Schols, A.M.W.J.

    2017-01-01

    Background & aims : Many COPD patients have a reduced exercise capacity and mechanical efficiency and are at increased cardiometabolic risk. This study aimed to assess acute and 7-days effects of dietary nitrate on mechanical efficiency, exercise performance and cardiac biomarkers in patients with

  13. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery.

    Science.gov (United States)

    Sarkılar, Gamze; Sargın, Mehmet; Sarıtaş, Tuba Berra; Borazan, Hale; Gök, Funda; Kılıçaslan, Alper; Otelcioğlu, Şeref

    2015-01-01

    This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance Cormack-Lehane grade 3-4) were recorded. Hemodynamic parameters were similar between the groups at all time points of measurement. Airway characteristics and mask ventilation were no significant between the groups. The C-MAC video laryngoscope group had better laryngoscopic view as assessed by Cormack-Lehane and percentage of glottic view, and a longer intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses.

  14. When Listening Is Better Than Reading: Performance Gains on Cardiac Auscultation Test Questions.

    Science.gov (United States)

    Short, Kathleen; Bucak, S Deniz; Rosenthal, Francine; Raymond, Mark R

    2017-09-14

    In 2007, the United States Medical Licensing Examination embedded multimedia simulations of heart sounds into multiple-choice questions. This study investigated changes in item difficulty as determined by examinee performance over time. The data reflect outcomes obtained following initial use of multimedia items from 2007 through 2012, after which an interface change occurred. A total of 233,157 examinees responded to 1,306 cardiology test items over the six-year period; 138 items included multimedia simulations of heart sounds, while 1,168 text-based items without multimedia served as controls. The authors compared changes in difficulty of multimedia items over time with changes in difficulty of text-based cardiology items over time. Further, they compared changes in item difficulty for both groups of items between graduates of Liaison Committee on Medical Education (LCME)-accredited and non-LCME-accredited (i.e., international) medical schools. Examinee performance on cardiology test items with multimedia heart sounds improved by 12.4% over the six-year period, while performance on text-based cardiology items improved by approximately 1.4%. These results were similar for graduates of LCME-accredited and non-LCME-accredited medical schools. Examinees' ability to interpret auscultation findings in test items that include multimedia presentations increased from 2007 to 2012.

  15. The role of adrenaline as a modulator of cardiac performance in two Antarctic fishes

    DEFF Research Database (Denmark)

    Skov, Peter Vilhelm; Bushnell, Peter G.; Tirsgaard, Bjørn

    2009-01-01

    Abstract: The present work was performed to test the hypothesis that Antarctic teleosts rely mostly on cholinergic inhibition for autonomic modulation of the heart. The effects of adrenaline on the inotropic properties on paced, isometrically contracting muscle strips were examined in two distinct...... Antarctic teleosts, the haemoglobinless icefish Chaenocephalus aceratus and the red-blooded Notothenia coriiceps. All tissues examined revealed a negative force-frequency relationship. Under baseline conditions C. aceratus contracted with a force twice as great as that of N. coriiceps. While the degree...

  16. Battery longevity from cardiac resynchronization therapy defibrillators: differences between manufacturers and discrepancies with published product performance reports.

    Science.gov (United States)

    Alam, Mian Bilal; Munir, Muhammad Bilal; Rattan, Rohit; Adelstein, Evan; Jain, Sandeep; Saba, Samir

    2017-03-01

    Cardiac resynchronization therapy (CRT) is an important treatment for heart failure that requires constant ventricular pacing, placing a high energy burden on CRT defibrillators (CRT-D). Longer battery life reduces the need for device changes and associated complications, thereby affecting patient outcomes and cost of care. We therefore investigated the time to battery depletion of CRT-D from different manufacturers and compared these results with manufacturers' published product performance reports (PPRs). All CRT-D recipients at our institution between January 2008 and December 2010 were included in this study cohort. The patients were followed up to the endpoint of battery depletion and were otherwise censored at the time of death, last follow-up, or device removal for any reason other than battery depletion. A total of 621 patients [173 Boston Scientific (BSC), 391 Medtronic (MDT), and 57 St. Jude Medical (SJM)] were followed up for a median of 3.7 (IQR 1.6-5.0) years, during which time 253 (41%) devices were replaced for battery depletion. Compared with MDT devices, battery depletion was 85 and 54% less likely to happen with BSC and SJM devices, respectively (P battery longevity by more than 20% 6 years after device implantation. Large differences in CRT-D battery longevity exist between manufacturers. Industry-published PPRs significantly overestimate device longevity. These data have important implications to patients, healthcare professionals, hospitals, and third-party payers.

  17. Exercise-training in young Drosophila melanogaster reduces age-related decline in mobility and cardiac performance.

    Directory of Open Access Journals (Sweden)

    Nicole Piazza

    2009-06-01

    Full Text Available Declining mobility is a major concern, as well as a major source of health care costs, among the elderly population. Lack of mobility is a primary cause of entry into managed care facilities, and a contributing factor to the frequency of damaging falls. Exercise-based therapies have shown great promise in sustaining mobility in elderly patients, as well as in rodent models. However, the genetic basis of the changing physiological responses to exercise during aging is not well understood. Here, we describe the first exercise-training paradigm in an invertebrate genetic model system. Flies are exercised by a mechanized platform, known as the Power Tower, that rapidly, repeatedly, induces their innate instinct for negative geotaxis. When young flies are subjected to a carefully controlled, ramped paradigm of exercise-training, they display significant reduction in age-related decline in mobility and cardiac performance. Fly lines with improved mitochondrial efficiency display some of the phenotypes observed in wild-type exercised flies. The exercise response in flies is influenced by the amount of protein and lipid, but not carbohydrate, in the diet. The development of an exercise-training model in Drosophila melanogaster opens the way to direct testing of single-gene based genetic therapies for improved mobility in aged animals, as well as unbiased genetic screens for loci involved in the changing response to exercise during aging.

  18. Performance of a single crystal digital gamma camera for first pass cardiac studies.

    Science.gov (United States)

    Dobbeleir, A; Franken, P R; Ham, H R; Brihaye, C; Guillaume, M; Knapp, F F; Vandevivere, J

    1991-01-01

    First pass radionuclide angiocardiography (FPRNA) has gained increasing interest because of the development of new 99Tcm-labelled perfusion agents and of new 191Os/191Irm generator systems. The aim of the study was to evaluate the performance capacities of a small field of view single crystal digital gamma camera for 99Tcm and 191Irm at high count rates. The camera dead time for 99Tcm (window 30%) was well corrected up to 300 kcps in fast acquisition mode using the relative decrease of a small shielded reference source. Using the decaying activity method for 191Irm the non-linearity response of the gamma camera was corrected by an 191Os reference soruce up to 210 kcps at 70 keV, 75 kcps at 129 keV and 320 kcps including both peaks. Saturation count rates were respectively 270 kcps, 150 kcps and 420 kcps and high count rate resolution (FWHM) 9.0, 7.3 and 10.3 mm. Since the accuracy of first pass measurements is more sensitive to count rate than to spatial resolution the 50-150 keV window was chosen for clinical studies. In data obtained from 32 ECG gated FPRNA patient studies, the whole field of view count rate during the left ventricular phase ranged from 100 to 250 kcps with 80 to 120 mCi (2960-4400 MBq) of 191Irm and 100 to 180 kcps with 20 to 25 mCi (750-925 MBq) of 99Tcm red blood cells permitting for both tracers accurate non-linearity correction.

  19. Delay and performance of cardiopulmonary resuscitation in surf lifeguards after simulated cardiac arrest due to drowning.

    Science.gov (United States)

    Claesson, Andreas; Karlsson, Tomas; Thorén, Ann-Britt; Herlitz, Johan

    2011-11-01

    To describe time delay during surf rescue and compare the quality of cardiopulmonary resuscitation (CPR) before and after exertion in surf lifeguards. A total of 40 surf lifeguards at the Tylösand Surf Lifesaving Club in Sweden (65% men; age, 19-43 years) performed single-rescuer CPR for 10 minutes on a Laerdal SkillmeteÔ Resusci Anne manikin. The test was repeated with an initial simulated surf rescue on an unconscious 80-kg victim 100 m from the shore. The time to victim, to first ventilation, and to the start of CPR was documented. The mean time in seconds to the start of ventilations in the water was 155 ± 31 (mean ± SD) and to the start of CPR, 258 ± 44. Men were significantly faster during rescue (mean difference, 43 seconds) than women (P = .002). The mean compression depth (millimeters) at rest decreased significantly from 0-2 minutes (42.6 ± 7.8) to 8-10 minutes (40.8 ± 9.3; P = .02). The mean compression depth after exertion decreased significantly (44.2 ± 8.7 at 0-2 minutes to 41.5 ± 9.1 at 8-10 minutes; P = .0008). The compression rate per minute decreased after rescue from 117.2 ±14.3 at 0 to 2 minutes to 114.1 ± 16.1 after 8 to 10 minutes (P = .002). The percentage of correct compressions at 8 to 10 minutes was identical before and after rescue (62%). In a simulated drowning, 100 m from shore, it took twice as long to bring the patient back to shore as to reach him; and men were significantly faster. Half the participants delivered continuous chest compressions of more than 38 mm during 10 minutes of single-rescuer CPR. The quality was identical before and after surf rescue. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. The number of in-out catheterisations is reduced by mobilising the postoperative patient with bladder needs to the toilet in the recovery room

    DEFF Research Database (Denmark)

    Hansen, Anette Maria; Olsen, Karsten S

    2015-01-01

    BACKGROUND: Many patients are diagnosed with postoperative urine retention in the recovery room and treated with in-out catheterisation (IOC). OBJECTIVES: We hypothesised that the use of IOC could be reduced by mobilising patients to the toilet to pass urine instead of offering a bedpan or urinal....... DESIGN: A randomised, controlled, nonblinded study with two groups. SETTING: University Hospital, October 2009 to June 2012. PATIENTS: One hundred and fifty-two patients scheduled for surgery for cervical or lumbar disc herniation. Inclusion criteria were a bladder volume more than 350 ml and/or the need...... to pass urine in the recovery room. INTERVENTIONS: Participants were randomised in the recovery room for mobilisation to the toilet (Group I) or use of a bedpan or urinal in the bed (Group C). MAIN OUTCOME MEASURES: The number of IOC cases in the recovery room (primary outcome) and the duration of stay...

  1. Performance of a remote interrogation system for the in-hospital evaluation of cardiac implantable electronic devices.

    Science.gov (United States)

    Mittal, Suneet; Younge, Kevin; King-Ellison, Kelly; Hammill, Eric; Stein, Kenneth

    2016-08-01

    Patients with a cardiac implantable electronic device (CIED) often need device interrogation in an in-hospital environment. A diagnosis-only, remote interrogation device and process for CIED interrogation was developed to address this situation. Here, we describe our initial clinical experience with this system. The LATITUDE Consult Communicator is a stand-alone interrogation-only device used to read the patient's implanted CIED. Once retrieved, the data are securely transmitted via an analog phone line to a central server. The clinician can request a review of the transmitted data at any time. Following FDA approval, we determined the usage and performance of the system. Communicators (n = 53) were installed in 42 hospital facilities. The most common location was in the emergency department (n = 32, 60 %). There were 509 discreet transmissions, which were categorized as follows: no arrhythmia episodes in the past 72 h and no out of range measurements (n = 174, 34 %); arrhythmia episodes in past 72 h but no out of range measurements (n = 170, 33 %); and further review recommended (n = 130, 26 %). (In 35 [7 %] instances, interrogation without analysis was requested.) The further review interrogations were then sub-divided into those of a non-urgent and urgent nature. Overall, only 53 (10 %) of the 509 transmissions were classified as urgent. Clinicians had access to full technical consultation in ≤15 min in 89 % of instances. Our data demonstrate the feasibility of a new diagnosis-only, remote interrogation device and remote evaluation process for the interrogation of CIEDs in an in-hospital environment.

  2. The effect of acute and 7-days dietary nitrate on mechanical efficiency, exercise performance and cardiac biomarkers in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Beijers, Rosanne J H C G; Huysmans, Stephanie M D; van de Bool, Coby; Kingma, Boris R M; Verdijk, Lex B; van Loon, Luc J C; Meex, Steven J R; Gosker, Harry R; Schols, Annemie M W J

    2017-10-31

    Many COPD patients have a reduced exercise capacity and mechanical efficiency and are at increased cardiometabolic risk. This study aimed to assess acute and 7-days effects of dietary nitrate on mechanical efficiency, exercise performance and cardiac biomarkers in patients with COPD. This double-blind, randomized cross-over placebo controlled trial included 20 mild-to-moderate COPD patients (66.6 ± 7.5 years) with moderate exercise impairments and decreased mechanical efficiency, normal BMI (26 ± 3 kg/m 2 ) but high prevalence of abdominal obesity (83.3%). Subjects were randomly allocated to the treatment order of 7 days sodium nitrate ingestion (∼8 mmol/day) and 7 days placebo (NaCl solution) or vice versa, separated by a washout period. Before (Day-1) and after (Day-7) both intervention periods resting metabolic rate and the metabolic response during submaximal cycle ergometry, cycling endurance time, plasma nitrate and nitrite levels, cardiac plasma biomarkers (e.g. cardiac troponin T, Nt-proBNP and creatinine kinase) and blood pressure were measured. Subsequently, gross, net and delta mechanical efficiency were calculated. Plasma nitrate and nitrite concentrations increased at Day-1 and Day-7 after sodium nitrate but not after placebo ingestion. Systolic and diastolic blood pressure did not change following nitrate ingestion. Furthermore, no differences were observed in gross, net, and delta mechanical efficiency during submaximal exercise, cycling endurance time and cardiac biomarkers between nitrate and placebo on Day-1 and Day-7. Meta-analysis of all available studies in COPD also showed no beneficial effect of beetroot juice on systolic and diastolic blood pressure. Acute as well as 7-days sodium nitrate supplementation does not modulate mechanical efficiency, blood pressure or cardiac biomarkers in mild-to-moderate COPD patients. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  3. Summary of recommendations for the haemodynamic and angiographic assessment of the pulmonary circulation. Joint statement of the Polish Cardiac Society's Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions.

    Science.gov (United States)

    Kurzyna, Marcin; Araszkiewicz, Aleksander; Błaszczak, Piotr; Grabka, Marek; Hawranek, Michał; Kopeć, Grzegorz; Mroczek, Ewa; Zembala, Marian; Torbicki, Adam; Ochała, Andrzej

    2015-01-01

    Right heart catheterisation (RHC) is the 'gold standard' for haemodynamic assessment of the pulmonary circulation. For the diagnosis of pulmonary hypertension (PH), the guidelines of the European Society of Cardiology require a mean pulmonary arterial pressure ≥ 25 mm Hg to be confirmed by direct haemodynamic measurement. Additionally, RHC provides a lot of valuable information about the differential diagnosis and severity of PH, and also helps determine the patient's prognosis. Acute vasoreactivity testing performed in patients with pulmonary arterial hypertension is intended to identify the group of patients who should be treated with calcium channel blockers. Patients referred for heart transplantation require advanced pulmonary vascular disease to be ruled out either on resting examination or during vasoreactivity testing. RHC is a component of such interventional procedures as balloon atrial septostomy, closure of intracardiac shunts in congenital heart and great vessel defects, valvuloplasty for pulmonary valve stenosis, and pulmonary angioplasty. Pulmonary angiography is an examination recommended when selecting patients for pulmonary endarterectomy or balloon pulmonary angioplasty in thromboembolic PH. Due to the dynamic growth in the number of patients diagnosed with and treated for PH in Poland, the Boards of the Polish Cardiac Society's Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions have undertaken a joint project to develop recommendations to standardise guidelines for RHC procedure, acute vasoreactivity testing and pulmonary angiography at cardiac wards and haemodynamic laboratories in Poland. This document has been prepared by experts delegated by the Working Group on Pulmonary Circulation and the Association of Cardiovascular Interventions, and subsequently approved by the Boards of both organs of the Polish Cardiac Society.

  4. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance.

    Science.gov (United States)

    Focardi, Marta; Cameli, Matteo; Carbone, Salvatore Francesco; Massoni, Alberto; De Vito, Raffaella; Lisi, Matteo; Mondillo, Sergio

    2015-01-01

    Right ventricle fractional area change (RVFAC), tissue Doppler and M-mode measurements of tricuspid systolic motion [tricuspid Sm and tricuspid annular plane systolic excursion (TAPSE)], and 3D echocardiography are the current non-invasive methods for the quantification of RV systolic function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of RV performance. Using cardiac magnetic resonance (CMR) as the reference standard, this study aimed at exploring the correlation between the traditional (fractional shortening, s'RV, TAPSE) and innovative (strain) echocardiographic parameters and RV ejection fraction (RVEF) measured by CMR. CMR and transthoracic echo-Doppler were performed in 63 patients referred for clinical assessment. Twenty-one presented the suspicion of myocarditis, 8 presented idiopathic dilated cardiomyopathy, 10 hypertrophic cardiomyopathy, 10 arrhythmogenic right ventricular dysplasia (ARVD), 5 infiltrative cardiomyopathy, and 9 other reasons. RVEF was measured by magnetic resonance imaging (MRI). RVFAC, tricuspid S', and TAPSE were calculated in all patients. RV longitudinal strain (RVLS) by STE was assessed by averaging RV free-wall segments (free-wall RVLS) and by averaging all segments (global RVLS). The ROC analysis was applied for the assessment of diagnostic accuracy. Good correlations were found for TAPSE, tricuspid S', and global RVLS with RVEF (r = 0.45, r = 0.52, and r = -0.71, respectively; P = 0.01 for all). Close correlations between free-wall RVLS and RVFAC with RVEF were found (r = -0.86 and r = 0.77, respectively; P < 0.0001 for both). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy [area under curve (AUC) 0.92] and good sensitivity and specificity of 96 and 93%, respectively, to predict reduced RVEF <45%, using a cut-off value of less than -17.0%. In a heterogeneous group of patients referred to CMR evaluation, conventional (TAPSE, FAC, and tricuspid S

  5. Acrolein inhalation causes myocardial strain delay and decreased cardiac performance as detected by high-frequency echocardiography in mice

    Science.gov (United States)

    Acrolein, an unsaturated aldehyde found in air pollution, impairs Ca2+ flux and contraction in cardiomyocytes in vitro. To better define direct and delayed functional cardiac effects, we hypothesized that a single exposure to acrolein would modify myocardial strain and performanc...

  6. The temperature challenges on cardiac performance in winter-quiescent and migration-stage eels Anguilla anguilla

    DEFF Research Database (Denmark)

    Methling, C.; Steffensen, J. F.; Skov, Peter Vilhelm

    2012-01-01

    The present study was undertaken to examine cardiac responses to some of the temperature challenges that eels encounter in their natural environment. The contractile properties of ventricular muscle was studied on electrically paced tissue strips after long term acclimation at 0 °C, 10 °C, or 20 °C......, temperature-dependent response, but did not influence twitch duration. This suggests that adrenaline acts as an agent in maintaining an adequate contractile force following temperature challenges. A significant increased relative ventricular mass was observed in 0 °C and 10 °C-acclimated eels compared to 20...... °C-acclimated, which suggests that at low temperatures, eels secure cardiac output by heart enlargement. Inhibition of specific sarcolemmal Ca 2 + channels by selective drug treatment revealed that, depending on temperature, L-type channels is the major entry site, but also that reverse-mode Na +/Ca...

  7. Cardiac tumors: echo assessment

    Directory of Open Access Journals (Sweden)

    Rekha Mankad MD

    2016-12-01

    Full Text Available Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series. They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1 thrombus or vegetations are the most likely etiology, (2 cardiac tumors are mostly secondary and (3 primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

  8. [A statement the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for CTEPH patients after acute pulmonary embolism].

    Science.gov (United States)

    Ciurzyński, Michał; Kurzyna, Marcin; Kopeć, Grzegorz; Błaszczak, Piotr; Chrzanowski, Łukasz; Kamiński, Karol; Mizia-Stec, Katarzyna; Mularek-Kubzdela, Tatiana; Mroczek, Ewa; Biederman, Andrzej; Pruszczyk, Piotr; Torbicki, Adam

    2017-01-01

    Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present. Echocardiography is a main screening tool. The authors suggest that a diagnostic process of patients with significant clinical suspicion of CTEPH and right ventricle overload in echocardiography should be performed in reference centres. The document contains a list of Polish centres diagnosing patients with suspected CTEPH. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Multi-detector computed tomography with precise detection of thromboembolic residues in pulmonary circulation is important for planning of pulmonary endarterectomy. Right heart catheterisation definitely confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for identification of lesions suitable for thromboendarterectomy or pulmonary balloon angioplasty. In this document a diagnostic algorithm in patients with suspected CTEPH is also proposed. With individualised sequential diagnostic strategy each patient can be finally qualified for a particular mode of therapy by dedicated CTEPH Heart Team. Moreover the document contains short information for the primary care physician about the management of patients after APE.

  9. When is a Cardiac Arrest Non-Cardiac?

    Science.gov (United States)

    Carter, Ryan M; Cone, David C

    2017-10-01

    Introduction While the overall survival rate for out-of-hospital cardiac arrest (OHCA) is low, ranging from 5%-10%, several characteristics have been shown to decrease mortality, such as presence of bystander cardiopulmonary resuscitation (CPR), witnessed vs unwitnessed events, and favorable initial rhythm (VF/VT). More recently, studies have shown that modified CPR algorithms, such as chest-compression only or cardio-cerebral resuscitation, can further increase survival rates in OHCA. Most of these studies have included only OHCA patients with "presumed cardiac etiology," on the assumption that airway management is of lesser impact than chest compressions in these patients. However, prehospital personnel often lack objective and consistent criteria to assess whether an OHCA is of cardiac or non-cardiac etiology. Hypothesis/Problem The relative proportions of cardiac vs non-cardiac etiology in published data sets of OHCA in the peer-reviewed literature were examined in order to assess the variability of prehospital clinical etiology assessment. A Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA) search was performed using the subject headings "OHCA" and "Emergency Medical Services" (EMS). Studies were included if they reported prevalence of cardiac etiology among OHCA in the entire patient sample, or in all arms of a comparison study. Studies that either did not report etiology of OHCA, or that excluded all cardiac or non-cardiac etiologies prior to reporting clinical data, were excluded. Twenty-four studies were identified, containing 27 datasets of OHCA which reported the prevalence of presumed cardiac vs non-cardiac etiology. These 27 datasets were drawn from 15 different countries. The prevalence of cardiac etiology among OHCA ranged from 50% to 91%. No obvious patterns were found regarding database size, year of publication, or global region (continent) of origin. There exists significant variation in published

  10. Cardiac Malpositions

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Shi Joon; Im, Chung Gie; Yeon, Kyung Mo; Hasn, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    Cardiac Malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies may not afford an accurate information. Although the terms and classifications used to describe the internal cardiac anatomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases of cardiac malpositions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analyzed the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The results are as follows: 1. Among 18 cases with cardiac malpositions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malpositions were variable and complex with a tendency of high association of transposition and double outlet varieties with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesions can be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.

  11. The number of in-out catheterisations is reduced by mobilising the postoperative patient with bladder needs to the toilet in the recovery room: A randomised clinical trial.

    Science.gov (United States)

    Hansen, Anette B; Olsen, Karsten S

    2015-07-01

    Many patients are diagnosed with postoperative urine retention in the recovery room and treated with in-out catheterisation (IOC). We hypothesised that the use of IOC could be reduced by mobilising patients to the toilet to pass urine instead of offering a bedpan or urinal. A randomised, controlled, nonblinded study with two groups. University Hospital, October 2009 to June 2012. One hundred and fifty-two patients scheduled for surgery for cervical or lumbar disc herniation. Inclusion criteria were a bladder volume more than 350 ml and/or the need to pass urine in the recovery room. Participants were randomised in the recovery room for mobilisation to the toilet (Group I) or use of a bedpan or urinal in the bed (Group C). The number of IOC cases in the recovery room (primary outcome) and the duration of stay in the recovery room. Thirteen of 67 patients (19%) in Group I and 38 of 71 patients in Group C (54%) required IOC (P toilet visits in the recovery room. This strategy decreased the number of IOCs, duration of stay in the recovery room and time from arrival to first mobilisation in the general ward.

  12. Cardiac sarcoidosis

    Directory of Open Access Journals (Sweden)

    Costello BT

    2016-04-01

    Full Text Available Benedict T Costello,1,2 James Nadel,3 Andrew J Taylor,1,21Department of Cardiovascular Medicine, The Alfred Hospital, 2Baker IDI Heart and Diabetes Research Institute, Melbourne, VIC, 3School of Medicine, University of Notre Dame, Sydney, NSW, Australia Abstract: Cardiac sarcoidosis is a rare but life-threatening condition, requiring a high degree of clinical suspicion and low threshold for investigation to make the diagnosis. The cardiac manifestations include heart failure, conducting system disease, and arrhythmias predisposing to sudden cardiac death. A number of investigations are available to assist in making the diagnosis. The diagnosis may be made from the clinical history and evidence of inflammation on imaging modalities in the active phase and evidence of myocardial scarring in the chronic phase. Keywords: cardiac magnetic resonance, positron emission tomography, sarcoidosis, sudden cardiac death

  13. Cardiac ablation procedures

    Science.gov (United States)

    Catheter ablation; Radiofrequency catheter ablation; Cryoablation - cardiac ablation; AV nodal reentrant tachycardia - cardiac ablation; AVNRT - cardiac ablation; Wolff-Parkinson-White Syndrome - cardiac ablation; Atrial fibrillation - cardiac ablation; Atrial flutter - ...

  14. Abstract 20854: A Tale of Self-Fulfilling Prophecies in Out-of-Hospital Cardiac Arrest: Emergency Medical Technicians Deliberately Perform Substandard CPR When Anticipating Poor Prognosis

    DEFF Research Database (Denmark)

    Bødtker, Henrik; Klausen, Troels M; Lauridsen, Kasper G

    2017-01-01

    Background: Emergency medical technicians (EMTs) play a crucial role in resuscitating patients with out-of-hospital cardiac arrest. Perception of prognosis may affect level and quality of treatment. The aim of this study was to investigate if EMTs delay start of cardiopulmonary resuscitation (CPR......) if they believe resuscitation to be futile. Furthermore, to investigate if different patient and resuscitation attempt characteristics result in EMTs deliberately performing substandard CPR.Methods: This was a cross-sectional questionnaire survey study conducted in 2016 through 2017 including EMTs from a Danish...... and compressions). Overall, 22% and 51% would perform substandard CPR if the patient were 80 or 90 years old respectively, 46% if the patient was living in a nursing home and up to 31% due to comorbidity such as cancer. EMTs (51%) would deliberately perform substandard CPR in case of on-going bystander CPR >20...

  15. An update on insertable cardiac monitors

    DEFF Research Database (Denmark)

    Olsen, Flemming J; Biering-Sørensen, Tor; Krieger, Derk W

    2015-01-01

    Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring...

  16. [The performance of coronary angioplasties at centers without cardiac surgery. The recommendations of the Sociedad Española de Cardiología].

    Science.gov (United States)

    Esplugas Oliveras, E; Hernández Antolín, R A; López Bescós, L; Moreu Burgos, J; Pomar Moya-Prats, J L

    1999-01-01

    During the early years of coronary interventions a rigorous on-site surgical stand-by was mandatory. The increased experience in coronary angioplasty both on total number of procedures and the experience gained by each operator, together with the technical improvements, namely since the introduction of stents has induced an evolution in the stand-by strategy, with new concepts such as "next available operating room" or coronary interventions "without on site" surgical facilities, are gaining widespread acceptance. With the aim of defining the requirements to perform coronary interventions at hospitals without coronary surgery, the following aspects are reviewed: a) complications following coronary angioplasty that require coronary surgery; b) the current status of coronary angioplasty without surgical stand-by in different countries. All this information allows us to advance some recommendations concerning the performance of coronary interventions at hospitals without on-site cardiac surgery. Different issues including hospital characteristics, operator and cardiac catheterization laboratory requirements, as well as lesion characteristics and the type of informed consent, should be taken into account.

  17. An Autonomic Link Between Inhaled Diesel Exhaust and Impaired Cardiac Performance: Insight From Treadmill and Doubutamine Challenges in Heart Failure-Prone Rats

    Science.gov (United States)

    Background: Short-term exposure to vehicular emissions is associated with adverse cardiac events. Diesel exhaust (DE) is an ubiquitous air pollutant believed to provoke cardiac events partly through imbalance of the sympathetic and parasympathetic branches of the autonomic nervo...

  18. [Early invasive strategy no better than a selective invasive strategy for patients with non-ST-segment elevation acute coronary syndromes and elevated cardiac troponin T levels: long-term follow-up results of the ICTUS trial].

    Science.gov (United States)

    Windhausen, F; Hirsch, A; Tijssen, J G P; Verheugt, F W A; Cornel, J H; de Winter, R J

    2008-02-23

    To determine whether routine coronary angiography followed by revascularisation where appropriate is better than initial drug treatment in patients with non-ST-segment elevation acute coronary syndromes (nSTE-ACS) and elevated troponin T concentrations. Multicentre randomised clinical trial (www.controlled-trials. com, number: SRCTN82153174). Patients with nSTE-ACS and elevated cardiac troponin were randomly assigned to an early invasive strategy or a selective invasive strategy. The early invasive strategy consisted of coronary angiography and revascularisation as indicated within 48 hours. The selective invasive strategy consisted of initial drug therapy; catheterisation was performed if the patient developed refractory angina or recurrent ischaemia. The main endpoints were a composite of death, recurrent myocardial infarction and rehospitalisation for anginal symptoms within 3 years, and all-cause mortality within 4 years. A total of 1200 patients were enrolled from 42 hospitals in the Netherlands. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the composite endpoint was 30.0% in the early invasive group and 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI: 0.97-1.50; p = 0.09). The 4-year all-cause mortality rate was similar in both treatment groups (7.9% vs 7.7%; p = 0.62). Long-term follow-up of this trial suggests that an early invasive strategy is not better than a selective invasive strategy in patients with nSTE-ACS and elevated cardiac troponin. Therefore, implementation of either strategy is acceptable in these patients.

  19. Disease Stage-Dependent Changes in Cardiac Contractile Performance and Oxygen Utilization Underlie Reduced Myocardial Efficiency in Human Inherited Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Güçlü, Ahmet; Knaapen, Paul; Harms, Hendrik J; Parbhudayal, Rahana Y; Michels, Michelle; Lammertsma, Adriaan A; van Rossum, Albert C; Germans, Tjeerd; van der Velden, Jolanda

    2017-05-01

    Reduced myocardial efficiency represents a target for therapy in hypertrophic cardiomyopathy although therapeutic benefit may depend on disease stage. Here, we determined disease stage-dependent changes in myocardial efficiency and effects of myectomy surgery. Myocardial external efficiency (MEE) was determined in 27 asymptomatic mutation carriers (genotype positive/phenotype negative), 10 patients with hypertrophic obstructive cardiomyopathy (HOCM), 10 patients with aortic valve stenosis, and 14 healthy individuals using [ 11 C]-acetate positron emission tomography and cardiovascular magnetic resonance imaging. Follow-up measurements were performed in HOCM and aortic valve stenosis patients 4 months after surgery. External work did not differ in HOCM compared with controls, whereas myocardial oxygen consumption was lower in HOCM. Because of a higher cardiac mass, total cardiac oxygen consumption was significantly higher in HOCM than in controls and genotype positive/phenotype negative. MEE was significantly lower in genotype positive/phenotype negative than in controls (28±6% versus 42±6%) and was further decreased in HOCM (22±5%). In contrast to patients with aortic valve stenosis, MEE was not improved in patients with HOCM after surgery, which was explained by opposite changes in the septum (decrease) and lateral (increase) wall. Different mechanisms underlie reduced MEE at the early and advanced stage of hypertrophic cardiomyopathy. The initial increase and subsequent reduction in myocardial oxygen consumption during disease progression indicates that energy deficiency is a primary mutation-related event, whereas mechanisms secondary to disease remodeling underlie low MEE in HOCM. Our data highlight that the benefit of therapies to improve energetic status of the heart may vary depending on the disease stage and that treatment should be initiated before cardiac remodeling. © 2017 American Heart Association, Inc.

  20. Performance evaluation of GPU parallelization, space-time adaptive algorithms, and their combination for simulating cardiac electrophysiology.

    Science.gov (United States)

    Sachetto Oliveira, Rafael; Martins Rocha, Bernardo; Burgarelli, Denise; Meira, Wagner; Constantinides, Christakis; Weber Dos Santos, Rodrigo

    2018-02-01

    The use of computer models as a tool for the study and understanding of the complex phenomena of cardiac electrophysiology has attained increased importance nowadays. At the same time, the increased complexity of the biophysical processes translates into complex computational and mathematical models. To speed up cardiac simulations and to allow more precise and realistic uses, 2 different techniques have been traditionally exploited: parallel computing and sophisticated numerical methods. In this work, we combine a modern parallel computing technique based on multicore and graphics processing units (GPUs) and a sophisticated numerical method based on a new space-time adaptive algorithm. We evaluate each technique alone and in different combinations: multicore and GPU, multicore and GPU and space adaptivity, multicore and GPU and space adaptivity and time adaptivity. All the techniques and combinations were evaluated under different scenarios: 3D simulations on slabs, 3D simulations on a ventricular mouse mesh, ie, complex geometry, sinus-rhythm, and arrhythmic conditions. Our results suggest that multicore and GPU accelerate the simulations by an approximate factor of 33×, whereas the speedups attained by the space-time adaptive algorithms were approximately 48. Nevertheless, by combining all the techniques, we obtained speedups that ranged between 165 and 498. The tested methods were able to reduce the execution time of a simulation by more than 498× for a complex cellular model in a slab geometry and by 165× in a realistic heart geometry simulating spiral waves. The proposed methods will allow faster and more realistic simulations in a feasible time with no significant loss of accuracy. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Cardiac Rehabilitation

    Science.gov (United States)

    Cardiac rehabilitation (rehab) is a medically supervised program to help people who have A heart attack Angioplasty or coronary artery bypass grafting for coronary heart disease A heart valve repair or replacement A ...

  2. Cardiac rehabilitation

    Science.gov (United States)

    ... ncbi.nlm.nih.gov/pubmed/25503364 . Balady GJ, Williams MA, Ades PA, et al. Core components of ... ncbi.nlm.nih.gov/pubmed/22070836 . Thompson PD. Exercise-based, comprehensive cardiac rehabilitation. In: Mann DL, Zipes ...

  3. Cardiac arrest

    Science.gov (United States)

    ... also run other tests, depending on your health history and the results of these tests. Treatment Cardiac arrest needs emergency treatment right away to get the heart started again. Cardiopulmonary resuscitation (CPR) . This is often the first type of ...

  4. Cardiac Angiosarcoma

    Directory of Open Access Journals (Sweden)

    Monique Esteves Cardoso

    2011-01-01

    Full Text Available Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.

  5. Cardiac Angiosarcoma

    OpenAIRE

    Cardoso, Monique Esteves; Canale, Leonardo Secchin; Ramos, Rosana Grandelle; Salvador Junior, Edson da Silva; Lachtermacher, Stephan

    2011-01-01

    Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.

  6. Cardiac Angiosarcoma

    Science.gov (United States)

    Cardoso, Monique Esteves; Canale, Leonardo Secchin; Ramos, Rosana Grandelle; Salvador Junior, Edson da Silva; Lachtermacher, Stephan

    2011-01-01

    Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis. PMID:24826214

  7. Subtle alterations of cardiac performance in children with growth hormone deficiency: results of a two-year prospective, case-control study.

    Science.gov (United States)

    Capalbo, Donatella; Lo Vecchio, Andrea; Farina, Vincenzo; Spinelli, Letizia; Palladino, Angela; Tiano, Claudia; Lettiero, Teresa; Lombardi, Gaetano; Colao, Annamaria; Salerno, Mariacarolina

    2009-09-01

    GH-deficient (GHD) children have reduced left ventricular (LV) mass, but impairment of cardiac function has never been documented. The aim of the study was to evaluate effects of GHD and GH therapy on cardiac function using load-dependent and load-independent indices of myocardial contractility. Echocardiography was performed in 24 GHD children at baseline and 1 and 2 yr after GH therapy and in 24 controls. Compared with controls, GHD children at baseline had lower LV mass (LV mass/BSA 50.6 +/- 1.8 vs. 60.5 +/- 2.4 g/m(2); P Global systolic function was normal, with only a trend toward slight impairment of the fractional shortening (34.9 +/- 1.5 vs. 37.6 +/- 1.1%). However, subtle LV dysfunction was revealed by load-dependent and load-independent indices of myocardial contractility. In fact, GHD patients compared with controls showed lower rate-corrected mean velocity of circumferential fiber shortening (1.0 +/- 0.03 vs. 1.18 +/- 0.03 circ/sec; P = 0.0001) and stress shortening index (0.10 +/- 0.02 vs. 0.18 +/- 0.02; P children and further supports the beneficial effect of GH on the heart.

  8. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Tranberg, Tinne; Lippert, Freddy K; Christensen, Erika Frischknecht

    2017-01-01

    (OHCA) patients. Methods and results: Nationwide historical follow-up study of 41 186 unselected OHCA patients, in whom resuscitation was attempted between 2001 and 2013, identified through the Danish Cardiac Arrest Registry. We observed an increase in the proportion of patients receiving bystander CPR...... patients achieving ROSC, a larger proportion underwent acute CAG/PCI (5% in 2001, 27% in 2013, P defined as the CAG/PCI index. The following variables were associated with lower mortality in multivariable analyses...... to the nearest invasive centre was not associated with survival. Conclusion: Admission to an invasive heart centre and regional performance of acute CAG/PCI were associated with improved survival in OHCA patients, whereas distance to the invasive centre was not. These results support a centralized strategy...

  9. Superior early diagnostic performance of a sensitive cardiac troponin assay as compared to a standard troponin test in the diagnosis of acute myocardial infarction.

    Science.gov (United States)

    Pracoń, Radosław; Kruk, Mariusz; Jakubczak, Barbara; Demkow, Marcin; Bilińska, Zofia T

    2012-01-01

    New generation cardiac troponin assays have sufficient precision to detect and quantify plasma troponin concentrations below the lower threshold of detection of the currently employed troponin tests. However, diagnostic performance of the newer generation assays in daily clinical practice is not well established. To evaluate the diagnostic performance of a sensitive assay as compared to a standard assay in a single reading at admission in the diagnosis of acute myocardial infarction (AMI) in patients presenting to the Emergency Department with chest pain. The study comprised 187 consecutive patients admitted to the Institute of Cardiology in Warsaw in June and July 2010 with chest pain in whom the attending physician ordered troponin assay to rule AMI in or out. In all of these patients, in addition to the standard Dimension Flex Troponin I (Siemens Healthcare Diagnostics, Inc.) the sensitive Architect Stat Troponin I (Abbott Diagnostics) test was assayed. The triage of patients as well as all diagnostic and treatment decisions were left to the discretion of the attending physician who was blinded to the sensitive troponin test readings. The final diagnosis was adjudicated by a team of two cardiologists on the basis of all the available medical records except for sensitive troponin test results. Mean age of the study cohort (n = 187) was 64.3 ± 13.9 years and 119 (63.6%) were males. The final diagnosis of AMI was adjudicated in 84 (44.9%) patients (mean age 67.5 ± 12.9 years; 119 [63.6%] males). Receiver operating characteristic (ROC) analysis showed greater area under the curve (AUC) for the sensitive cardiac troponin assay compared to the standard assay (AUC = 0.916, 95% CI = 0.866-0.951 vs AUC = 0.863, 95% CI = 0.806-0.909, respectively; p = 0.02) in a single reading at admission. Sensitive assay was characterised by higher sensitivity (87%), specificity (88%), positive (86%) and negative (89%) predictive values in the detection of AMI compared to the standard

  10. Measuring the impact of emergency medical services (EMS) on out-of-hospital cardiac arrest survival in a developing country: A key metric for EMS systems' performance.

    Science.gov (United States)

    El Sayed, Mazen; Al Assad, Reem; Abi Aad, Yasmin; Gharios, Nour; Refaat, Marwan M; Tamim, Hani

    2017-07-01

    Out-of-hospital cardiac arrest (OHCA) can be used to evaluate the overall performance of the emergency medical services' (EMS) system. This study assessed the impact of EMS on OHCA survival rates in a setting where the prehospital system is underdeveloped.A retrospective chart review was carried out over a 5-year period of all adult OHCA patients admitted to the emergency department (ED) of a tertiary care center in Lebanon.A total of 271 patients with OHCA (179 [66.1%] men, mean age of 69.9 [standard deviation = 15.0 years] were enrolled. The most common OHCA location was residence/home (58.7%). The majority of arrests were witnessed (51.7%) with 6.1% witnessed by EMS; 211 patients (75.6%) were transported to the ED by EMS. Prehospital cardiopulmonary resuscitation (CPR) was done by EMS for 43.2% of the patients, whereas only 4.4% received CPR from a family member/bystander. Prehospital automated external defibrillator use was documented in 1.5% of cases in the prehospital setting. Only 2 patients had return of spontaneous circulation prior to ED arrival. Most patients (96.7%) were resuscitated in the ED. Patients presented to the ED mostly in asystole (79.3%). Forty-three patients (15.9%) survived to hospital admission and 13 (4.8%) were discharged alive with over half of them (53.8%) had a good neurological outcome upon discharge (cerebral performance category 1 or 2).Survival of EMS-treated OHCA victims in Lebanon is not as expected. Medical oversight of EMS activities is needed to link EMS activities to clinical outcomes and improve survival from cardiac arrest in Lebanon.

  11. Parametric modelling of cardiac system multiple measurement signals: an open-source computer framework for performance evaluation of ECG, PCG and ABP event detectors.

    Science.gov (United States)

    Homaeinezhad, M R; Sabetian, P; Feizollahi, A; Ghaffari, A; Rahmani, R

    2012-02-01

    The major focus of this study is to present a performance accuracy assessment framework based on mathematical modelling of cardiac system multiple measurement signals. Three mathematical algebraic subroutines with simple structural functions for synthetic generation of the synchronously triggered electrocardiogram (ECG), phonocardiogram (PCG) and arterial blood pressure (ABP) signals are described. In the case of ECG signals, normal and abnormal PQRST cycles in complicated conditions such as fascicular ventricular tachycardia, rate dependent conduction block and acute Q-wave infarctions of inferior and anterolateral walls can be simulated. Also, continuous ABP waveform with corresponding individual events such as systolic, diastolic and dicrotic pressures with normal or abnormal morphologies can be generated by another part of the model. In addition, the mathematical synthetic PCG framework is able to generate the S4-S1-S2-S3 cycles in normal and in cardiac disorder conditions such as stenosis, insufficiency, regurgitation and gallop. In the PCG model, the amplitude and frequency content (5-700 Hz) of each sound and variation patterns can be specified. The three proposed models were implemented to generate artificial signals with varies abnormality types and signal-to-noise ratios (SNR), for quantitative detection-delineation performance assessment of several ECG, PCG and ABP individual event detectors designed based on the Hilbert transform, discrete wavelet transform, geometric features such as area curve length (ACLM), the multiple higher order moments (MHOM) metric, and the principal components analysed geometric index (PCAGI). For each method the detection-delineation operating characteristics were obtained automatically in terms of sensitivity, positive predictivity and delineation (segmentation) error rms and checked by the cardiologist. The Matlab m-file script of the synthetic ECG, ABP and PCG signal generators are available in the Appendix.

  12. Sudden cardiac death

    DEFF Research Database (Denmark)

    Hougen, H P; Valenzuela, Antonio Jesus Sanchez; Lachica, E

    1992-01-01

    The study deals with the comparison of morphological, histochemical and biochemical methods applied to the detection of myocardial infarction in 150 medico-legal autopsies performed at the Institute of Forensic Pathology in Copenhagen. The study also included an NBT (formazan) test of cardiac cross...

  13. Pneumothorax in cardiac pacing

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard

    2012-01-01

    AIM: To identify risk factors for pneumothorax treated with a chest tube after cardiac pacing device implantation in a population-based cohort.METHODS AND RESULTS: A nationwide cohort study was performed based on data on 28 860 patients from the Danish Pacemaker Register, which included all Danish...... patients who received their first pacemaker (PM) or cardiac resynchronization device from 1997 to 2008. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for the association between risk factors and pneumothorax treated with a chest tube. The median...

  14. The Effect of Haemodialysis Access Types on Cardiac Performance and Morbidities in Patients with Symptomatic Heart Disease.

    Science.gov (United States)

    Chuang, Min-Kai; Chang, Chin-Hao; Chan, Chih-Yang

    2016-01-01

    Little is known about whether the arteriovenous type haemodialysis access affects cardiac function and whether it is still advantageous to the uremic patient with symptomatic heart disease. We conducted a retrospective comparative study. Patients with heart disease and end-stage renal disease that had a new chronic access created between January 2007 and December 2008 and met the inclusion criteria were assessed. The endpoint was major adverse event (MAE)-free survivals of arteriovenous access (AVA) and tunneled cuffed double-lumen central venous catheter (CVC) groups. Whether accesses worsened heart failure was also evaluated. There were 43 CVC patients and 60 AVA patients. The median follow-up time from access creation was 27.6 months (IQR 34.7, 10.9~45.6). Although CVC patients were older than AVA patients (median age 78.0, IQR 14.0 vs. 67.5, IQR 16.0, respectively, p = .009), they manifested non-inferior MAE-free survival (mean 17.1, 95% CI 10.3~24.0 vs. 12.9, 95% CI 8.5~17.4 months in CVC and AVA patients, respectively, p = .290). During follow-up, more patients in the AVA group than in the CVC group deteriorated in heart failure status (35 of 57 vs. 10 of 42, respectively, odds ratio 5.1, p heart disease and end stage renal disease (ESRD), CVC patients showed non-inferior MAE-free survival in comparison to those in the AVA group. AV type access could deteriorate heart failure. Accordingly, uremic patients with symptomatic heart disease are not ideal candidates for AV type access creation.

  15. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.

    2002-01-01

    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  16. Ability to work in anaerobic condition is associated with physical performance on the six-minute walk test in older patients receiving cardiac rehabilitation.

    Science.gov (United States)

    Pasquini, Guido; Vannetti, Federica; Molino-Lova, Raffaele

    2015-05-01

    During maximal incremental exercise, the ability to work in the anaerobic condition, expressed by the respiratory exchange ratio, is associated with physical performance. Further, peak respiratory exchange ratio is regarded as the best non-invasive measure of a patient's actual exercise effort. This study examined whether ability to work in the anaerobic condition is also associated with physical performance in submaximal constant work rate exercise. A total of 75 older patients (51 men, 24 women), mean age 71.1 years (standard deviation 6.7 years), who had recently undergone cardiac surgery, performed cardiopulmonary exercise testing in a 6-min walk test before and after rehabilitation. The distance walked, steady-state oxygen uptake, carbon dioxide output and respiratory exchange ratio increased significantly after rehabilitation (p anaerobic condition is associated with physical performance in submaximal constant work rate exercises. Thus the steady-state respiratory exchange ratio might be regarded as a measure of the patient's actual exercise effort. This information may prove useful in customizing exercise prescription and assessing the effects of rehabilitation.

  17. [Cardiac amyloidosis].

    Science.gov (United States)

    Boussabah, Elhem; Zakhama, Lilia; Ksontini, Iméne; Ibn Elhadj, Zied; Boukhris, Besma; Naffeti, Sana; Thameur, Moez; Ben Youssef, Soraya

    2008-09-01

    PREREQUIS: Amyloidosis is a rare infiltrative disease characterized by multiple clinical features. Various organs are involved and the cardiovascular system is a common target of amyloidosis. Cardiac involvement may occur with or without clinical manifestations and is considered as a major prognostic factor. To analyze the clinical features of cardiac involvement, to review actual knowledgement concerning echocardiographic diagnostic and to evaluate recent advances in treatment of the disease. An electronic search of the relevant literature was carried out using Medline and Pubmed. Keys words used for the final search were amyloidosis, cardiopathy and echocardiography. We considered for analysis reviews, studies and articles between 1990 and 2007. Amyloidosis represents 5 to 10% of non ischemic cardiomyoparhies. Cardiac involvement is the first cause of restrictive cardiomyopathy witch must be evoked in front of every inexplained cardiopathy after the age of forty. The amyloid nature of cardiopathy is suggered if some manifestations were associated as a peripheric neuropathy, a carpal tunnel sydrome and proteinuria > 3g/day. Echocardiography shows dilated atria, a granular sparkling appearance of myocardium, diastolic dysfunction and thickened left ventricle contrasting with a low electric voltage. The proof of amyloidosis is brought by an extra-cardiac biopsy, the indications of endomyocardial biopsy are very limited. The identification of the amyloid nature of cardiopathy has an direct therapeutic implication: it indicates the use of digitalis, calcium channel blockers and beta-blockers. Today the treatment of amyloidosis remains very unsatisfactory especially in the cardiac involvement. An early diagnosis before the cardiac damage may facilitate therapy and improve prognosis.

  18. No cardiac effects of therapeutic and supratherapeutic doses of rupatadine: results from a 'thorough QT/QTc study' performed according to ICH guidelines.

    Science.gov (United States)

    Donado, Ester; Izquierdo, Iñaki; Pérez, Iñaki; García, Olga; Antonijoan, Rosa M; Gich, Ignaci; Solans, Anna; Peña, Juana; Morganroth, Joel; Barbanoj, Manuel J

    2010-04-01

    To evaluate the effects of therapeutic and supratherapeutic doses of rupatadine on cardiac repolarization in line with a 'thorough QT/QTc study' protocol performed according to International Conference on Harmonization guidelines. This was a randomized (gender-balanced), parallel-group study involving 160 healthy volunteers. Rupatadine, 10 and 100 mg day(-1), and placebo were administered single-blind for 5 days, whilst moxifloxacin 400 mg day(-1) was given on days 1 and 5 in open-label fashion. ECGs were recorded over a 23-h period by continuous Holter monitoring at baseline and on treatment days 1 and 5. Three 10-s ECG samples were downloaded at regular intervals and were analysed independently. The primary analysis of QTc was based on individually corrected QT (QTcI). Treatment effects on QTcI were assessed using the largest time-matched mean difference between the drug and placebo (baseline-subtracted) for the QTcI interval. A negative 'thorough QT/QTc study' is one where the main variable is around 10 ms. The validity of the trial was confirmed by the fact that the moxifloxacin-positive control group produced the expected change in QTcI duration (around 5 ms). The ECG data for rupatadine at both 10 and 100 mg showed no signal effects on the ECG, after neither single nor repeated administration. Furthermore, no pharmacokinetic/pharmacodynamic relationship, gender effects or clinically relevant changes in ECG waveform outliers were observed. No deaths or serious or unexpected adverse events were reported. This 'thorough QT/QTc study' confirmed previous experience with rupatadine and demonstrated that it had no proarrhythmic potential and raised no concerns regarding its cardiac safety.

  19. No cardiac effects of therapeutic and supratherapeutic doses of rupatadine: results from a ‘thorough QT/QTc study’ performed according to ICH guidelines

    Science.gov (United States)

    Donado, Ester; Izquierdo, Iñaki; Pérez, Iñaki; García, Olga; Antonijoan, Rosa Ma; Gich, Ignaci; Solans, Anna; Peña, Juana; Morganroth, Joel; Barbanoj, Manuel J

    2010-01-01

    AIMS To evaluate the effects of therapeutic and supratherapeutic doses of rupatadine on cardiac repolarization in line with a ‘thorough QT/QTc study’ protocol performed according to International Conference on Harmonization guidelines. METHODS This was a randomized (gender-balanced), parallel-group study involving 160 healthy volunteers. Rupatadine, 10 and 100 mg day−1, and placebo were administered single-blind for 5 days, whilst moxifloxacin 400 mg day−1 was given on days 1 and 5 in open-label fashion. ECGs were recorded over a 23-h period by continuous Holter monitoring at baseline and on treatment days 1 and 5. Three 10-s ECG samples were downloaded at regular intervals and were analysed independently. The primary analysis of QTc was based on individually corrected QT (QTcI). Treatment effects on QTcI were assessed using the largest time-matched mean difference between the drug and placebo (baseline-subtracted) for the QTcI interval. A negative ‘thorough QT/QTc study’ is one where the main variable is around ≤5 ms, with a one-sided 95% confidence interval that excludes an effect >10 ms. RESULTS The validity of the trial was confirmed by the fact that the moxifloxacin-positive control group produced the expected change in QTcI duration (around 5 ms). The ECG data for rupatadine at both 10 and 100 mg showed no signal effects on the ECG, after neither single nor repeated administration. Furthermore, no pharmacokinetic/pharmacodynamic relationship, gender effects or clinically relevant changes in ECG waveform outliers were observed. No deaths or serious or unexpected adverse events were reported. CONCLUSIONS This ‘thorough QT/QTc study’ confirmed previous experience with rupatadine and demonstrated that it had no proarrhythmic potential and raised no concerns regarding its cardiac safety. PMID:20406224

  20. Exendin-4 pretreated adipose derived stem cells are resistant to oxidative stress and improve cardiac performance via enhanced adhesion in the infarcted heart.

    Directory of Open Access Journals (Sweden)

    Jianfeng Liu

    Full Text Available Reactive oxygen species (ROS, which were largely generated after myocardial ischemia, severely impaired the adhesion and survival of transplanted stem cells. In this study, we aimed to determine whether Exendin-4 pretreatment could improve the adhesion and therapeutic efficacy of transplanted adipose derived stem cells (ADSCs in ischemic myocardium. In vitro, H2O2 was used to provide ROS environments, in which ADSCs pretreated with Exendin-4 were incubated. ADSCs without pretreatment were used as control. Then, cell adhesion and viability were analyzed with time. Compared with control ADSCs, Exendin-4 treatment significantly increased the adhesion of ADSCs in ROS environment, while reduced intracellular ROS and cell injury as determined by dihydroethidium (DHE staining live/Dead staining, lactate dehydrogenase-release assay and MTT assay. Western Blotting demonstrated that ROS significantly decreased the expression of adhesion-related integrins and integrin-related focal adhesion proteins, which were significantly reversed by Exendin-4 pretreatment and followed by decreases in caspase-3, indicating that Exendin-4 may facilitate cell survival through enhanced adhesion. In vivo, myocardial infarction (MI was induced by the left anterior descending artery ligation in SD rats. Autologous ADSCs with or without Exendin-4 pretreatment were injected into the border area of infarcted hearts, respectively. Multi-techniques were used to assess the beneficial effects after transplantation. Longitudinal bioluminescence imaging and histological staining revealed that Exendin-4 pretreatment enhanced the survival and differentiation of engrafted ADSCs in ischemic myocardium, accompanied with significant benefits in cardiac function, matrix remodeling, and angiogenesis compared with non-pretreated ADSCs 4 weeks post-transplantation. In conclusion, transplantation of Exendin-4 pretreated ADSCs significantly improved cardiac performance and can be an innovative

  1. Feasibility of Remote Real-Time Guidance of a Cardiac Examination Performed by Novices Using a Pocket-Sized Ultrasound Device

    Directory of Open Access Journals (Sweden)

    Tuan V. Mai

    2013-01-01

    Full Text Available Background. The potential of pocket-sized ultrasound devices (PUDs to improve global healthcare delivery is limited by the lack of a suitable imaging protocol and trained users. Therefore, we investigated the feasibility of performing a brief, evidence-based cardiac limited ultrasound exam (CLUE through wireless guidance of novice users. Methods. Three trainees applied PUDs on 27 subjects while directed by an off-site cardiologist to obtain a CLUE to screen for LV systolic dysfunction (LVSD, LA enlargement (LAE, ultrasound lung comets (ULC+, and elevated CVP (eCVP. Real-time remote audiovisual guidance and interpretation by the cardiologist were performed using the iPhone 4/iPod (FaceTime, Apple, Inc. attached to the PUD and transmitted data wirelessly. Accuracy and technical quality of transmitted images were compared to on-site, gold-standard echo thresholds. Results. Novice versus sonographer imaging yielded technically adequate views in 122/135 (90% versus 130/135 (96% (. CLUE’s combined SN, SP, and ACC were 0.67, 0.96, and 0.90. Technical adequacy (% and accuracy for each abnormality ( were LVSD (85%, 0.93, , LAE (89%, 0.74, , ULC+ (100%, 0.94, , and eCVP (78%, 0.91, . Conclusion. A novice can perform the CLUE using PUD when wirelessly guided by an expert. This method could facilitate PUD use for off-site bedside medical decision making and triaging of patients.

  2. Assessment of dedicated low-dose cardiac micro-CT reconstruction algorithms using the left ventricular volume of small rodents as a performance measure.

    Science.gov (United States)

    Maier, Joscha; Sawall, Stefan; Kachelrieß, Marc

    2014-05-01

    Phase-correlated microcomputed tomography (micro-CT) imaging plays an important role in the assessment of mouse models of cardiovascular diseases and the determination of functional parameters as the left ventricular volume. As the current gold standard, the phase-correlated Feldkamp reconstruction (PCF), shows poor performance in case of low dose scans, more sophisticated reconstruction algorithms have been proposed to enable low-dose imaging. In this study, the authors focus on the McKinnon-Bates (MKB) algorithm, the low dose phase-correlated (LDPC) reconstruction, and the high-dimensional total variation minimization reconstruction (HDTV) and investigate their potential to accurately determine the left ventricular volume at different dose levels from 50 to 500 mGy. The results were verified in phantom studies of a five-dimensional (5D) mathematical mouse phantom. Micro-CT data of eight mice, each administered with an x-ray dose of 500 mGy, were acquired, retrospectively gated for cardiac and respiratory motion and reconstructed using PCF, MKB, LDPC, and HDTV. Dose levels down to 50 mGy were simulated by using only a fraction of the projections. Contrast-to-noise ratio (CNR) was evaluated as a measure of image quality. Left ventricular volume was determined using different segmentation algorithms (Otsu, level sets, region growing). Forward projections of the 5D mouse phantom were performed to simulate a micro-CT scan. The simulated data were processed the same way as the real mouse data sets. Compared to the conventional PCF reconstruction, the MKB, LDPC, and HDTV algorithm yield images of increased quality in terms of CNR. While the MKB reconstruction only provides small improvements, a significant increase of the CNR is observed in LDPC and HDTV reconstructions. The phantom studies demonstrate that left ventricular volumes can be determined accurately at 500 mGy. For lower dose levels which were simulated for real mouse data sets, the HDTV algorithm shows the

  3. Assessment of dedicated low-dose cardiac micro-CT reconstruction algorithms using the left ventricular volume of small rodents as a performance measure

    Energy Technology Data Exchange (ETDEWEB)

    Maier, Joscha, E-mail: joscha.maier@dkfz.de [Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Sawall, Stefan; Kachelrieß, Marc [Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany and Institute of Medical Physics, University of Erlangen–Nürnberg, 91052 Erlangen (Germany)

    2014-05-15

    Purpose: Phase-correlated microcomputed tomography (micro-CT) imaging plays an important role in the assessment of mouse models of cardiovascular diseases and the determination of functional parameters as the left ventricular volume. As the current gold standard, the phase-correlated Feldkamp reconstruction (PCF), shows poor performance in case of low dose scans, more sophisticated reconstruction algorithms have been proposed to enable low-dose imaging. In this study, the authors focus on the McKinnon-Bates (MKB) algorithm, the low dose phase-correlated (LDPC) reconstruction, and the high-dimensional total variation minimization reconstruction (HDTV) and investigate their potential to accurately determine the left ventricular volume at different dose levels from 50 to 500 mGy. The results were verified in phantom studies of a five-dimensional (5D) mathematical mouse phantom. Methods: Micro-CT data of eight mice, each administered with an x-ray dose of 500 mGy, were acquired, retrospectively gated for cardiac and respiratory motion and reconstructed using PCF, MKB, LDPC, and HDTV. Dose levels down to 50 mGy were simulated by using only a fraction of the projections. Contrast-to-noise ratio (CNR) was evaluated as a measure of image quality. Left ventricular volume was determined using different segmentation algorithms (Otsu, level sets, region growing). Forward projections of the 5D mouse phantom were performed to simulate a micro-CT scan. The simulated data were processed the same way as the real mouse data sets. Results: Compared to the conventional PCF reconstruction, the MKB, LDPC, and HDTV algorithm yield images of increased quality in terms of CNR. While the MKB reconstruction only provides small improvements, a significant increase of the CNR is observed in LDPC and HDTV reconstructions. The phantom studies demonstrate that left ventricular volumes can be determined accurately at 500 mGy. For lower dose levels which were simulated for real mouse data sets, the

  4. Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities.

    Science.gov (United States)

    Arnoldo, Luca; Migliavacca, Roberta; Regattin, Laura; Raglio, Annibale; Pagani, Laura; Nucleo, Elisabetta; Spalla, Melissa; Vailati, Francesca; Agodi, Antonella; Mosca, Adriana; Zotti, Carla; Tardivo, Stefano; Bianco, Ines; Rulli, Adele; Gualdi, Paola; Panetta, Pietro; Pasini, Carlo; Pedroni, Mino; Brusaferro, Silvio

    2013-03-06

    Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections. A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay. 211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk

  5. Combining Amplitude Spectrum Area with Previous Shock Information Using Neural Networks Improves Prediction Performance of Defibrillation Outcome for Subsequent Shocks in Out-Of-Hospital Cardiac Arrest Patients.

    Science.gov (United States)

    He, Mi; Lu, Yubao; Zhang, Lei; Zhang, Hehua; Gong, Yushun; Li, Yongqin

    2016-01-01

    Quantitative ventricular fibrillation (VF) waveform analysis is a potentially powerful tool to optimize defibrillation. However, whether combining VF features with additional attributes that related to the previous shock could enhance the prediction performance for subsequent shocks is still uncertain. A total of 528 defibrillation shocks from 199 patients experienced out-of-hospital cardiac arrest were analyzed in this study. VF waveform was quantified using amplitude spectrum area (AMSA) from defibrillator's ECG recordings prior to each shock. Combinations of AMSA with previous shock index (PSI) or/and change of AMSA (ΔAMSA) between successive shocks were exercised through a training dataset including 255shocks from 99patientswith neural networks. Performance of the combination methods were compared with AMSA based single feature prediction by area under receiver operating characteristic curve(AUC), sensitivity, positive predictive value (PPV), negative predictive value (NPV) and prediction accuracy (PA) through a validation dataset that was consisted of 273 shocks from 100patients. A total of61 (61.0%) patients required subsequent shocks (N = 173) in the validation dataset. Combining AMSA with PSI and ΔAMSA obtained highest AUC (0.904 vs. 0.819, pdefibrillation outcome for subsequent shocks.

  6. Effect of indacaterol on lung deflation improves cardiac performance in hyperinflated COPD patients: an interventional, randomized, double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    Santus P

    2015-09-01

    residual capacity on right heart systolic and diastolic function indexes evaluated by TTE in patients treated with indacaterol, as compared to placebo.Results: Vital capacity, inspiratory capacity, and forced expiratory volume in 1 second were significantly increased by indacaterol, when compared with placebo, while residual volume, intrathoracic gas volume, and specific airway resistance were significantly reduced in patients treated with indacaterol. Tricuspid annular plane systolic excursion was significantly increased versus placebo, paralleled by an increase of tricuspid E-wave deceleration time. The cardiac frequency was also significantly reduced in indacaterol-treated patients.Conclusion: Indacaterol significantly reduces lung hyperinflation in acute conditions, with a clinically relevant improvement of dyspnea. These modifications are associated with a significant increase of the right ventricular compliance indexes and may have a role in improving left ventricular preload leading to a reduction in cardiac frequency.Keywords: lung deflation, bronchodilator, cardiac performance, right ventricular function, echocardiography

  7. Effect of patient's age on the profitability of inpatient cardiac catheterization: a contribution margin analysis of frequently performed procedures over a 5-year period.

    Science.gov (United States)

    Plehn, Gunnar; Butz, Thomas; Maagh, Petra; Meissner, Axel

    2017-01-18

    Due to a continuing age shift in the German society hospital providers are concerned about the additional costs associated with the treatment of elderly patients. It is not clear if cardiac catheterization in aged patients leads to higher resource utilization and if DRG-revenues do compensate for this factor. Procedure-related and administrative data of all patients who underwent cardiac catheterization at a tertiary heart center between 2007 and 2011 were collected and analyzed. Then a profitability analysis was performed by comparing the case related variable costs with the Diagnosis-related group (DRG) per case revenues. A particular emphasis was placed on a comparative analysis of identical clusters of procedures. The most frequently performed catheterization procedure (n = 1800) was associated with significantly higher material expenditure in very old patients (178 ± 48 €) than in old (171 ± 28; p = 0.001) and young patients (172 ± 39; p = 0.046). Furthermore, radiation time and the length of hospital stay were increased in very old patients (3.5 ± 3.8 min and 6.2 ± 4.8 days) compared to old (2.7 ± 2.8 min and 4.6 ± 3.8 days; p < 0.001) and young patients (2.5 ± 2.5 min and 4.5 ± 3.9 days; p < 0.001). Due to higher DRG revenues very old patients achieved higher absolute contribution margins (2065 ± 1033 €) than old (1804 ± 1902 €; p < 0.001) and young patients (1771 ± 902 €; p < 0.001). However, the contribution margins per day were significantly smaller (440 ± 226 €) than those in old (488 ± 234 €; p = 0.001) and young patients (484 ± 206 €; p = 0.001). Catheterization of very old patients is related to lower contribution margins per day despite higher material and time expenditures. Since efforts to reduce the length of hospital stay of these patients are limited, this may result in a competitive disadvantage of hospitals which

  8. Cardiac MRI in pulmonary artery hypertension: correlations between morphological and functional parameters and invasive measurements

    Energy Technology Data Exchange (ETDEWEB)

    Alunni, Jean-Philippe; Otal, Philippe; Rousseau, Herve; Chabbert, Valerie [CHU Rangueil, Department of Radiology, Toulouse (France); Degano, Bruno; Tetu, Laurent; Didier, Alain [CHU Larrey, Department of Pneumology, Toulouse (France); Arnaud, Catherine [CHU Rangueil, Department of Methods in Clinical Research, Toulouse (France); Blot-Souletie, Nathalie [CHU Rangueil, Department of Cardiology, Toulouse (France)

    2010-05-15

    To compare cardiac MRI with right heart catheterisation in patients with pulmonary hypertension (PH) and to evaluate its ability to assess PH severity. Forty patients were included. MRI included cine and phase-contrast sequences, study of ventricular function, cardiac cavity areas and ratios, position of the interventricular septum (IVS) in systole and diastole, and flow measurements. We defined four groups according to the severity of PH and three groups according to IVS position: A, normal position; B, abnormal in diastole; C, abnormal in diastole and systole. IVS position was correlated with pulmonary artery pressures and PVR (pulmonary vascular resistance). Median pulmonary artery pressures and resistance were significantly higher in patients with an abnormal septal position compared with those with a normal position. Correlations were good between the right ventricular ejection fraction and PVR, right ventricular end-systolic volume and PAP, percentage of right ventricular area change and PVR, and diastolic and systolic ventricular area ratio and PVR. These parameters were significantly associated with PH severity. Cardiac MRI can help to assess the severity of PH. (orig.)

  9. Role of bispectral index monitoring and burst suppression in prognostication following out-of-hospital cardiac arrest: a systematic review protocol.

    Science.gov (United States)

    Eveson, Leanne; Vizcaychipi, Marcela; Patil, Shashank

    2017-09-25

    Out-of-hospital cardiac arrest (OHCA) is associated with significant mortality or may have a poor neurological outcome. Various community-training programmes have improved practices like bystander cardiopulmonary resuscitation (CPR) and early defibrillation using automated external defibrillator (AED). Post-resuscitation care has also changed significantly in the millennium. Interventions like targeted temperature management (TTM), avoidance of hyperoxia and emergency cardiac catheterisation have given patients a chance of a better neurological outcome. Despite these timely interventions, it is still very difficult to predict neurological outcome. The European Resuscitation Council and European Society of Intensive Care Medicine (ERC-ESICM) published guidance in 2015 with a strong recommendation to delay prognostication for at least 72 h and with an emphasis to adapt a multimodal approach, which includes neurological examination, biomarkers, electroencephalogram (EEG) and radiological tests. These interventions not only have cost attached to them, but the unpredictability has a significant emotional impact on family members. Bispectral index (BIS) monitoring device acts on the principle of EEG and converts the waveform into an absolute number and also measures the burst suppression. We hypothesize that patients who have a low BIS value and high burst suppression within 24 h of presentation will have a poor neurological outcome. The primary objective of this review is to look at BIS monitor as a tool, which could help bring forward the timing of prognostication. Electronic databases will be systematically searched for randomised controlled trials and prospective or retrospective cohort studies with no language restrictions. The search will be supplemented with grey literature searches of thesis, dissertations and hand searching of relevant journals. Two independent reviewers will screen, select and perform analysis according to the Preferred Reporting Items for

  10. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson

    2008-11-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  11. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson MD

    2004-06-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  12. Barriers and Facilitators to Learning and Performing Cardiopulmonary Resuscitation (CPR) in Neighborhoods with Low Bystander CPR Prevalence and High Rates of Cardiac Arrest in Columbus, Ohio

    Science.gov (United States)

    Sasson, Comilla; Haukoos, Jason S.; Bond, Cindy; Rabe, Marilyn; Colbert, Susan H.; King, Renee; Sayre, Michael; Heisler, Michele

    2013-01-01

    Background Residents who live in neighborhoods that are primarily African-American, Latino, or poor are more likely to have an out-of-hospital cardiac arrest (OHCA), less likely to receive cardiopulmonary resuscitation (CPR), and less likely to survive. No prior studies have been conducted to understand the contributing factors that may decrease the likelihood of residents learning and performing CPR in these neighborhoods. The goal of this study was to identify barriers and facilitators to learning and performing CPR in three low-income, “high-risk” predominantly African American, neighborhoods in Columbus, Ohio. Methods and Results Community-Based Participatory Research (CBPR) approaches were used to develop and conduct six focus groups in conjunction with community partners in three target high-risk neighborhoods in Columbus, Ohio in January-February 2011. Snowball and purposeful sampling, done by community liaisons, was used to recruit participants. Three reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Three major barriers to learning CPR were identified and included financial, informational, and motivational factors. Four major barriers were identified for performing CPR and included fear of legal consequences, emotional issues, knowledge, and situational concerns. Participants suggested that family/self-preservation, emotional, and economic factors may serve as potential facilitators in increasing the provision of bystander CPR. Conclusion The financial cost of CPR training, lack of information, and the fear of risking one's own life must be addressed when designing a community-based CPR educational program. Using data from the community can facilitate improved design and implementation of CPR programs. PMID:24021699

  13. Combining Amplitude Spectrum Area with Previous Shock Information Using Neural Networks Improves Prediction Performance of Defibrillation Outcome for Subsequent Shocks in Out-Of-Hospital Cardiac Arrest Patients.

    Directory of Open Access Journals (Sweden)

    Mi He

    Full Text Available Quantitative ventricular fibrillation (VF waveform analysis is a potentially powerful tool to optimize defibrillation. However, whether combining VF features with additional attributes that related to the previous shock could enhance the prediction performance for subsequent shocks is still uncertain.A total of 528 defibrillation shocks from 199 patients experienced out-of-hospital cardiac arrest were analyzed in this study. VF waveform was quantified using amplitude spectrum area (AMSA from defibrillator's ECG recordings prior to each shock. Combinations of AMSA with previous shock index (PSI or/and change of AMSA (ΔAMSA between successive shocks were exercised through a training dataset including 255shocks from 99patientswith neural networks. Performance of the combination methods were compared with AMSA based single feature prediction by area under receiver operating characteristic curve(AUC, sensitivity, positive predictive value (PPV, negative predictive value (NPV and prediction accuracy (PA through a validation dataset that was consisted of 273 shocks from 100patients.A total of61 (61.0% patients required subsequent shocks (N = 173 in the validation dataset. Combining AMSA with PSI and ΔAMSA obtained highest AUC (0.904 vs. 0.819, p<0.001 among different combination approaches for subsequent shocks. Sensitivity (76.5% vs. 35.3%, p<0.001, NPV (90.2% vs. 76.9%, p = 0.007 and PA (86.1% vs. 74.0%, p = 0.005were greatly improved compared with AMSA based single feature prediction with a threshold of 90% specificity.In this retrospective study, combining AMSA with previous shock information using neural networks greatly improves prediction performance of defibrillation outcome for subsequent shocks.

  14. [The effects of enalapril on basal arterial pressure at rest and during exercise and on cardiac performance in hypertensive athletes].

    Science.gov (United States)

    D'Este, D; Giada, F; Sartori, F; Noventa, D; Cinquemani, S; Mantovan, R; Pascotto, P

    1990-10-01

    A dose of 10 mg of enalapril was administered once a day to regularly trained hypertensive athletes (mean age 39 +/- 8.9 range 29-51) in order to evaluate the effect of the drug on ambulatory blood pressure and on blood pressure and physical performance during stress testing. STUDY DESIGN. This investigation was a randomized, double blind, cross-over versus placebo trial. At first, subjects whose blood pressure met the entry criteria (casual diastolic blood pressure greater than or equal to 95 mmHg), were subjected to 24-hour ambulatory blood pressure monitoring and maximal upright bicycle stress testing including measurement of O2 uptake. Then they were randomly assigned to treatment with placebo or enalapril. After one month they repeated stress testing and then they were crossed over. Stress testing was repeated in all subjects after two months. The 24-hour ambulatory blood pressure monitoring was repeated in all subjects during enalapril treatment only, by a non-blind investigator. RESULTS. Ambulatory blood pressure decreased significantly during enalapril and no changes in heart rate were observed during the monitoring. The results of bicycle stress testing, both in basal and during the placebo test were comparable as regards blood pressure response, maximal workload, effort duration, maximal heart rate and VO2 max. With enalapril systolic and diastolic blood pressure decreased significantly during stress testing both versus basal test and placebo test at each workload considered including maximal workload. No changes were observed during enalapril as regards maximal workload, effort duration, maximal heart rate and VO2 max. CONCLUSION. Our results suggest that enalapril could be effective in treating hypertensive athletes because it reduces blood pressure during physical effort without affecting physical performance. We conclude that enalapril could be considered a first-choice drug in hypertensive athletes doing aerobic sports.

  15. Robotic Applications in Cardiac Surgery

    OpenAIRE

    Kypson, Alan P.; W. Randolph Chitwood Jr.

    2004-01-01

    Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were use...

  16. Evaluation of the diagnostic performance of current and next-generation assays for cardiac troponin I in the BWH-TIMI ED Chest Pain Study

    Science.gov (United States)

    Ruff, Christian T; Kosowsky, Joshua; Conrad, Michael J; Murphy, Sabina A; Sabatine, Marc S; Jarolim, Petr; Morrow, David A

    2013-01-01

    Background: Rapid diagnosis of acute coronary syndrome is a clinical and operational priority in busy emergency departments (ED). We examined the performance of an investigational troponin I (TnI) assay with 10–100-times greater sensitivity than current commercial assays. Methods: Among patients with non-traumatic chest pain enrolled in the BWH-TIMI ED Chest Pain Study, we measured TnI (n=381) at baseline, 4–6 h, and 12–24 h with an investigational assay (S-TnI; Singulex, detection-limit 0.0002 µg/l, 99th percentile 0.009 µg/l) and a contemporary sensitive assay (TnI-Ultra; Siemens, detection-limit 0.006 µg/l, 99th percentile 0.04 µg/l). Final diagnosis was adjudicated using all diagnostic data and local hospital-based cardiac TnI (Siemens), blinded to investigational cardiac Tn. Results: The adjudicated diagnosis was myocardial infarction (MI) in 96 patients, unstable angina in 41, and acute non-coronary cardiovascular conditions in 50 patients. Baseline S-TnI was highly sensitive for MI (97%, 95% CI 91–99%) with specificity 81% (95% CI 76–86%) and positive predictive value 63% (95% CI 55–71%). The negative predictive value with S-TnI was 99% (95% CI 96–100%). S-TnI had better diagnostic accuracy than the local assay (area under the curve 0.976 vs. 0.916, p=0.003). Among 20 patients with negative baseline TnI and diagnosis of MI, 19 had elevated baseline S-TnI. Compared to TnI-Ultra, S-TnI trended toward higher sensitivity (97 vs. 94%, p=NS) but did not differ significantly in negative predictive value (99 vs. 98%) or area under the curve (p=0.29). Conclusion: Current and investigational Tn assays substantially increased clinical sensitivity and improved diagnostic accuracy for MI, despite a decline in specificity. A contemporary sensitive assay delivered similar overall accuracy to the investigational test, suggesting that we have reached a point of maximum diagnostic return with increasing analytical sensitivity. PMID:24222830

  17. No cardiac effects of therapeutic and supratherapeutic doses of rupatadine: results from a thorough QT/QTc study performed according to ICH guidelines

    National Research Council Canada - National Science Library

    Donado, Ester; Izquierdo, Inaki; Perez, Inaki; Garcia, Olga; Antonijoan, Rosa Ma; Gich, Ignaci; Solans, Anna; Pena, Juana; Morganroth, Joel; Barbanoj, Manuel J

    2010-01-01

    ... • To our knowledge, this is one of the first published trials to evaluate multiple doses of antihistamine therapy using the new criteria and it confirms the cardiac safety of rupatadine, an anti-H1...

  18. Hospital Variation in Mortality From Cardiac Arrest After Cardiac Surgery: An Opportunity for Improvement?

    Science.gov (United States)

    LaPar, Damien J.; Ghanta, Ravi K.; Kern, John A.; Crosby, Ivan K.; Rich, Jeffrey B.; Speir, Alan M.; Kron, Irving L.; Ailawadi, Gorav

    2016-01-01

    Background Among all postoperative complications, cardiac arrest after cardiac surgical operations has the greatest association with mortality. However, hospital variation in the ability to rescue after cardiac arrest is unknown. The purpose of this study was to characterize the impact of cardiac arrest on mortality and determine the relative impact of patient, operative, and hospital factors on failure to rescue (FTR) rates and surgical mortality after cardiac arrest. Methods A total of 79,582 patients underwent operations at 17 different hospitals (2001 through 2011), including 5.2% (n = 4,138) with postoperative cardiac arrest. Failure to rescue was defined as mortality after cardiac arrest. Patient risk, operative features, and outcomes were compared among hospitals. Results Overall FTR rate was 60% with significant variation among hospitals (range, 50% to 83%; p cardiac arrest, and FTR rates varied across hospitals and did not correlate. High-performing hospitals with lowest FTR rates accrued longer postoperative and intensive care unit stays after the index operation (2 to 3 days; p cardiac surgical mortality and FTR rates after cardiac arrest. Institutional factors appear to confer the strongest influence on the likelihood for mortality after cardiac arrest compared with patient and operative factors. Identifying best practice patterns at the highest performing centers may serve to improve surgical outcomes after cardiac arrest and improve patient quality. PMID:24820394

  19. Clinical performance of cardiac Troponin I: A comparison between the POCT AQT90 FLEX and the Dimension Vista analyzer in an emergency setting.

    Science.gov (United States)

    Mion, Monica Maria; Bragato, Giada; Casarotti, Alessandra; Cosma, Chiara; Vigolo, Stefania; Vettore, Gianna; Tosato, Franco; Zaninotto, Martina; Plebani, Mario

    2017-09-01

    Cardiac troponin [cTn (I or T)] is the preferred biomarker for the diagnosis of myocardial infarction (MI). We studied the analytical performance of the POCT AQT90 FLEX cTnI assay and its diagnostic accuracy, in comparison to the Dimension Vista cTnI method, in patients presenting to the Emergency Department (ED) with suspect of acute coronary syndrome (ACS). 786 consecutive patients were enrolled. cTnI was measured at admission to the ED and about 3 and 6 hours later. The imprecision study was carried out using different lots of quality controls (QCs). ROC curve analysis was conducted using discharge diagnoses in order to verify the global diagnostic accuracy. The concentrations measured in the QCs ranging from 0.033 to 1.26μg/L show CVs% ranging from 2.81 to 7.56%, comparable to those declared by the manufacturer. Passing-Bablok and linear regression analysis show a high significant correlation (R2=0.90, pDimension Vista and AQT90 FLEX cTnI assays displayed similar clinical performance being not statistically significant the difference of the corresponding AUC. Comparing sensitivity and specificity of cTnI concentrations obtained from the ROC curve analysis using AQT90 FLEX, we found a "best cut-off" (0.014μg/L) lower than that declared from the manufacturer (0.023μg/L). The comparison of two different assays of cTnI against a diagnosis of acute MI (AMI) shows that both assays behave equally well with a high degree of sensitivity and specificity. The resulting "best cut-off" suggests that this AQT90 FLEX cTnI concentration could be evaluated as the potentially new "clinically usable" cut-off for AMI/myocardial necrosis diagnoses. Copyright © 2017. Published by Elsevier Inc.

  20. Cardiac conduction system

    Science.gov (United States)

    The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of the heart that send signals to the ... contract. The main components of the cardiac conduction system are the SA node, AV node, bundle of ...

  1. Sudden Cardiac Arrest (SCA)

    Science.gov (United States)

    ... Arrest (SCA) Back to Heart Diseases & Disorders Sudden Cardiac Arrest (SCA) Sudden Cardiac Arrest ( SCA ) occurs when the heart stops beating, abruptly ... to saving someone who is having a sudden cardiac arrest , it is important to understand the difference. The ...

  2. Accelerated real-time cardiac MRI using iterative sparse SENSE reconstruction: comparing performance in patients with sinus rhythm and atrial fibrillation.

    Science.gov (United States)

    Allen, Bradley D; Carr, Maria L; Markl, Michael; Zenge, Michael O; Schmidt, Michaela; Nadar, Mariappan S; Spottiswoode, Bruce; Collins, Jeremy D; Carr, James C

    2018-01-30

    To compare accelerated real-time cardiac MRI (CMR) using sparse spatial and temporal undersampling and non-linear iterative SENSE reconstruction (RT IS SENSE) with real-time CMR (RT) and segmented CMR (SEG) in a cohort that included atrial fibrillation (AF) patients. We evaluated 27 subjects, including 11 AF patients, by acquiring steady-state free precession cine images covering the left ventricle (LV) at 1.5 T with SEG (acceleration factor 2, TR 42 ms, 1.8 × 1.8 × 6 mm 3 ), RT (acceleration factor 3, TR 62 ms, 3.0 × 3.0 × 7 mm 3 ), and RT IS SENSE (acceleration factor 9.9-12, TR 42 ms, 2.0 × 2.0 × 7 mm 3 ). We performed quantitative LV functional analysis in sinus rhythm (SR) patients and qualitatively scored image quality, noise and artefact using a 5-point Likert scale in the complete cohort and AF and SR subgroups. There was no difference between LV functional parameters between acquisitions in SR patients. RT IS SENSE short-axis image quality was superior to SEG (4.5 ± 0.6 vs. 3.9 ± 1.1, p = 0.007) and RT (3.8 ± 0.4, p = 0.003). There was reduced artefact in RT IS SENSE compared to SEG (4.4 ± 0.6 vs. 3.8 ± 1.2, p = 0.04), driven by arrhythmia performance. RT IS SENSE short-axis image quality was superior to SEG (4.6 ± 0.5 vs. 3.1 ± 1.0, p SENSE provides excellent clinical performance, especially in patients with AF. • Iterative sparse SENSE significantly accelerates real-time cardiovascular MRI acquisitions. • It provides excellent qualitative and quantitative performance in sinus rhythm patients. • It outperforms standard segmented acquisitions in patients with atrial fibrillation. • It improves the trade-off between temporal and spatial resolution in real-time imaging.

  3. What Causes Sudden Cardiac Arrest?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  4. What Is Sudden Cardiac Arrest?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  5. Therapeutic Cardiac Catheterizations for Children with Congenital Heart Disease

    Science.gov (United States)

    Therapeutic Cardiac Catheterizations for Children with Congenital Heart Disease Introduction A therapeutic cardiac catheterization is a procedure performed to treat your child’s heart defect. A doctor will use special techniques and ...

  6. Addition of copeptin improves diagnostic performance of point-of-care testing (POCT) for cardiac troponin T in early rule-out of myocardial infarction - A pilot study.

    Science.gov (United States)

    Vafaie, Mehrshad; Biener, Moritz; Mueller, Matthias; Abu Sharar, Haitham; Hartmann, Oliver; Hertel, Sabine; Katus, Hugo A; Giannitsis, Evangelos

    2015-11-01

    Point of care testing (POCT) assays for cardiac troponin (cTn) are hampered by lower analytical sensitivity and thus suboptimal rule-out of myocardial infarction (MI). We investigated, whether additional measurement of copeptin using an ultrasensitive assay improves diagnostic performance of POCT for cTn T compared to a high sensitivity troponin T (hsTnT) assay. 131 patients with suspected acute coronary syndrome were prospectively enrolled in our center 08/2010 to 11/2011. In blood samples obtained at presentation, ultrasensitive copeptin (Kryptor, BRAHMS) and two commercially available POCT assays, AQT90 Flex Radiometer (Radiometer) and Cobas h232 POC-System (Cobas), were tested. HsTnT (Cobas E411, Roche) at baseline and after 3 and 6h in the central laboratory served as reference. Copeptin improved rule-out of non-STEMI combined with all tested troponin assays. Addition of copeptin increased sensitivity of Cobas from 67.9% (95% CI: 0.506; 0.852) to 89.3% (95% CI: 0.778; 1.007) and Radiometer from 71.4% (95% CI: 0.547; 0.882) to 85.7% (95% CI: 0.728; 0.987), achieving the sensitivity of hsTnT alone at admission of 85.7% (95% CI: 0.728; 0.987). The area under the curve (AUC) of Radiometer (0.822) was numerically but insignificantly (p=0.17) higher than AUC of Cobas (0.725). Addition of copeptin increased AUC of Radiometer to 0.826 (p=0.96) and AUC of Cobas to 0.814 (p=0.20). Additional use of ultrasensitive copeptin improves diagnostic performance of conventional sensitive POCT assays overcoming lower sensitivities at the cost of a drop of clinical specificity. When hsTn is temporarily unavailable, copeptin and POCT for cTn may allow initial evaluation at a comparable performance as hsTnT at admission. Copyright © 2015. Published by Elsevier Ireland Ltd.

  7. Imaging in cardiac mass lesions

    Energy Technology Data Exchange (ETDEWEB)

    Mundinger, A.; Gruber, H.P.; Dinkel, E.; Geibel, A.; Beck, A.; Wimmer, B.; Schlosser, V. (Freiburg Univ. (Germany))

    In 26 patients with cardiac mass lesions confirmed by surgery, diagnostic imaging was performed preoperatively by means of two-dimensional echocardiography (26 patients), angiography (12 patients), correlative computed tomography (CT, 8 patients), and magnetic resonance imaging (MRI, 3 patients). Two-dimensional echocardiography correctly identified the cardiac masses in all patients. Angiography missed two of 12 cardiac masses; CT missed one of eight. MRI identified three of three cardiac masses. Although the sensitivity of two-dimensional echocardiography was high (100%), all methods lacked specificity. None of the methods allowed differentiation between myxoma (n=13) and thrombus (n=7). Malignancy of the lesions was successfully predicted by noninvasive imaging methods in all six patients. However, CT and MRI provided additional information concerning cardiac mural infiltration, pericardial involvement, and extracardiac tumor extension, and should be integrated within a preoperative imaging strategy. Thus two-dimensional echocardiography is the method of choice for primary assessment of patients with suspected cardiac masses. Further preoperative imaging by CT or MRI can be limited to patients with malignancies suspected on the grounds of pericardial effusion or other clinical results. (author).

  8. About Cardiac Arrest

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More About Cardiac Arrest Updated:Mar 10,2017 What is cardiac arrest? ... and procedures related to heart disease and stroke. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  9. Cardiac MRI in Athletes

    NARCIS (Netherlands)

    Luijkx, T.

    2012-01-01

    Cardiac magnetic resonance imaging (CMR) is often used in athletes to image cardiac anatomy and function and is increasingly requested in the context of screening for pathology that can cause sudden cardiac death (SCD). In this thesis, patterns of cardiac adaptation to sports are investigated with

  10. Performance of highly sensitive cardiac troponin T assay to detect ischaemia at PET-CT in low-risk patients with acute coronary syndrome: a prospective observational study.

    Science.gov (United States)

    Morawiec, Beata; Fournier, Stephane; Tapponnier, Maxime; Prior, John O; Monney, Pierre; Dunet, Vincent; Lauriers, Nathalie; Recordon, Frederique; Trana, Catalina; Iglesias, Juan-Fernando; Kawecki, Damian; Boulat, Olivier; Bardy, Daniel; Lamsidri, Sabine; Eeckhout, Eric; Hugli, Olivier; Muller, Olivier

    2017-07-10

    Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented. To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain. Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled. Their hs-TnT samples were at T0, T2 and T6. Physicians were blinded to hs-TnT results. All patients underwent a PET-CT at rest and during adenosine-induced stress. All patients with a positive PET-CT result underwent a coronary angiography. Forty-eight patients were included. Six had ischaemia at PET-CT. All of them had ≥1 significant stenosis at coronary angiography. Areas under the curve (95% CI) for predicting significant ischaemia at PET-CT using hs-TnT were 0.764 (0.515 to 1.000) at T0, 0.812(0.616 to 1.000) at T2 and 0.813(0.638 to 0.989) at T6. The receiver operating characteristicbased optimal cut-off value for hs-TnT at T0, T2 and T6 needed to exclude significant ischaemia at PET-CT was <4 ng/L. Using this value, sensitivity, specificity, positive and negative predictive values of hs-TnT to predict significant ischaemia were 83%/38%/16%/94% at T0, 100%/40%/19%/100% at T2 and 100%/43%/20%/100% at T6, respectively. Our findings suggest that in low-risk patients, using the hs-TnT assay with a cut-off value of 4 ng/L demonstrates excellent negative predictive value to exclude myocardial ischaemia detection at PET-CT, at the expense of weak specificity and positive predictive value. ClinicalTrials.gov Identifier: NCT01374607. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  11. Glucagon and a glucagon-GLP-1 dual-agonist increases cardiac performance with different metabolic effects in insulin-resistant hearts

    DEFF Research Database (Denmark)

    Axelsen, Lene Nygaard; Keung, Wendy; Pedersen, Henrik D

    2012-01-01

    BACKGROUND AND PURPOSE The prevalence of heart disease continues to rise, particularly in subjects with insulin resistance (IR), and improved therapies for these patients is an important challenge. In this study we evaluated cardiac function and energy metabolism in IR JCR:LA-cp rat hearts before...

  12. The role of cardiac CT angiography in the pre- and postoperative evaluation of tetralogy of Fallot

    Directory of Open Access Journals (Sweden)

    Ebrahim Banderker

    2015-10-01

    Full Text Available Tetralogy of Fallot (TOF is the first described and most common cyanotic congenital heart anomaly that generated the first successful surgical palliation procedure and definitive intracardiac repair. Classical TOF comprises the four typical features of right ventricular outflow tract obstruction (RVOTO, right ventricular hypertrophy (RVH, ventricular septal defect (VSD and aortic dextroposition. Complex forms of the condition include TOF associated with absent pulmonary valve and TOF with pulmonary atresia (TOF-PA with or without major aortopulmonary collateral arteries (MAPCAs. The pathophysiological understanding that the tetrad is basically the sequel of a singular abnormality of infundibular malformation, with anterior deviation of the infundibular septum, had major surgical consequences that improved survival. Diagnostic and functional imaging play a key role in the clinical and surgical management of patients with TOF. We revisit the role of traditionally employed imaging modalities (echocardiography and cardiac catheterisation only briefly as these remain within the domain of cardiology practice. The emphasis of the present review is to outline the role of cardiac computed tomographic angiography (CTA in the evaluation of TOF, with special reference to the technical considerations and best practice recommendations. Cardiovascular magnetic resonance imaging (CMR is addressed only in passing, as this service is not currently available at our institution.

  13. [Cardiac sarcoidosis - clinical manifestation and diagnosis].

    Science.gov (United States)

    Błaut-Jurkowska, Justyna; Podolec, Piotr; Olszowska, Maria

    2016-08-01

    Sarcoidosis is a multisystem inflammatory disease defined histologically by the formation of noncaseating granulomas. The etiology of sarcoidosis remains unknown. Heart involvement in the course of sarcoidosis concerns about 5% of patients. The most common manifestation of cardiac sarcoidosis are conduction abnormalities, arrhythmias and heart failure. The diagnostic algorithm includes performing a clinical history, a 12-lead electrocardiogram (ECG) and an echocardiogram. If any of the initial screening investigations yields an abnormality, diagnostics should be continue using advanced imaging techniques: cardiovascular magnetic resonance (CMR) or fluorodeoxyglucose positron emission tomography (FDG-PET). Nowadays endomyocardial biopsy is not performed routinely.The clinical picture of cardiac sarcoidosis is highly variable. Screening for cardiac sarcoidosis should be performed in all patients diagnosed with extracardiac sarcoidosis. Cardiac sarcoidosis should also be suspected in young patients without a diagnosis of sarcoidosis who present with conduction abnormalities of unknown etiology, because cardiac sarcoidosis may be the first or the only manifestation of the disease. © 2016 MEDPRESS.

  14. Cardiac sarcoidosis. A case with unusual manifestation.

    Science.gov (United States)

    Cepin, D; McDonough, M; James, F

    1983-01-01

    A 26-year-old woman was hospitalized with new-onset congestive heart failure. M-mode and two-dimensional echocardiography revealed abnormal motion involving the apex and posterolateral wall of the left ventricle. Cardiac catheterization was performed. The left ventriculogram demonstrated apical akinesis and an apical filling defect. The diagnosis of cardiac sarcoidosis was made from an open myocardial biopsy.

  15. Single-unit muscle sympathetic nervous activity and its relation to cardiac noradrenaline spillover.

    Science.gov (United States)

    Lambert, Elisabeth A; Schlaich, Markus P; Dawood, Tye; Sari, Carolina; Chopra, Reena; Barton, David A; Kaye, David M; Elam, Mikael; Esler, Murray D; Lambert, Gavin W

    2011-05-15

    Recent work using single-unit sympathetic nerve recording techniques has demonstrated aberrations in the firing pattern of sympathetic nerves in a variety of patient groups. We sought to examine whether nerve firing pattern is associated with increased noradrenaline release. Using single-unit muscle sympathetic nerve recording techniques coupled with direct cardiac catheterisation and noradrenaline isotope dilution methodology we examined the relationship between single-unit firing patterns and cardiac and whole body noradrenaline spillover to plasma. Participants comprised patients with hypertension (n=6), depression (n=7) and panic disorder (n =9) who were drawn from our ongoing studies. The patient groups examined did not differ in their single-unit muscle sympathetic nerve firing characteristics nor in the rate of spillover of noradrenaline to plasma from the heart. The median incidence of multiple spikes per beat was 9%. Patients were stratified according to the firing pattern: low level of incidence (less than 9% incidence of multiple spikes per beat) and high level of incidence (greater than 9% incidence of multiple spikes per beat). High incidence of multiple spikes within a cardiac cycle was associated with higher firing rates (P noradrenaline spillover to plasma and (multi-unit) muscle sympathetic nerve activity in subjects with low incidence of multiple spikes was not different to that of those with high incidence of multiple spikes. In those with high incidence of multiple spikes there occurred a parallel activation of the sympathetic outflow to the heart, with cardiac noradrenaline spillover to plasma being two times that of subjects with low nerve firing rates (11.0 ± 1.5 vs. 22.0 ± 4.5 ng min⁻¹, P noradrenaline spillover.

  16. Joint Commission now offering Comprehensive Cardiac Center Certification.

    Science.gov (United States)

    Pellegrini, Carlos A

    2017-02-01

    Comprehensive Cardiac Center Certification is designed for hospitals with robust cardiac care facilities, with the aim of helping institutions to establish the structures, processes, and culture necessary to achieve sustained levels of effective clinical performance and patient outcomes across cardiac specialties and the continuum of care.

  17. Cardiac anxiety after sudden cardiac arrest: Severity, predictors and clinical implications.

    Science.gov (United States)

    Rosman, Lindsey; Whited, Amanda; Lampert, Rachel; Mosesso, Vincent N; Lawless, Christine; Sears, Samuel F

    2015-02-15

    Survival from cardiac arrest is a medical success but simultaneously produces psychological challenges related to perception of safety and threat. The current study evaluated symptoms of cardiac-specific anxiety in sudden cardiac arrest (SCA) survivors and examined predictors of cardiac anxiety secondary to cardiac arrest. A retrospective, cross-sectional study of 188 SCA survivors from the Sudden Cardiac Arrest Association patient registry completed an online questionnaire that included a measure of cardiac anxiety (CAQ) and sociodemographic, cardiac history, and psychosocial adjustment data. CAQ scores were compared to published means from implantable cardioverter defibrillator (ICD), inherited long QT syndrome (LQTS), and hypertrophic cardiomyopathy (HCM) samples and a hierarchical regression was performed. Clinically relevant cardiac anxiety and cardioprotective behaviors were frequently endorsed and 18% of survivors reported persistent worry about their heart even when presented with normal test results. Compared to all other samples, SCA survivors reported significantly higher levels of heart-focused attention (d=0.3-1.1) and greater cardiac fear and avoidance behaviors than LQTS patients. SCA patients endorsed less severe fear and avoidance symptoms than the HCM sample. Hierarchical regression analyses revealed that younger age (p=0.02), heart murmur (p=0.02), history of ICD shock≥1 (p=0.01), and generalized anxiety (p=0.008) significantly predicted cardiac anxiety. The overall model explained 29.2% of the total variance. SCA survivors endorse high levels of cardiac-specific fear, avoidance and preoccupation with cardiac symptoms. Successful management of SCA patients requires attention to anxiety about cardiac functioning and security. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Pediatric Cardiac Surgery In Eritrea.

    African Journals Online (AJOL)

    age, gender, demography, type of heart defects and treatment offered with surgical outcomes was retrieved. Diagnosis was primarily made clinically based on ... 300. Most open cardiac operations were performed for patients with ventricular septal defects 74(25%) while the majority of closed heart operations were for patent.

  19. Mechanical Regulation of Cardiac Development

    Directory of Open Access Journals (Sweden)

    Stephanie E Lindsey

    2014-08-01

    Full Text Available Mechanical forces are an essential contributor to and unavoidable component of cardiac formation, both inducing and orchestrating local and global molecular and cellular changes. Experimental animal studies have contributed substantially to understanding the mechanobiology of heart development. More recent integration of high-resolution imaging modalities with computational modeling has greatly improved our quantitative understanding of hemodynamic flow in heart development. Merging these latest experimental technologies with molecular and genetic signaling analysis will accelerate our understanding of the relationships integrating mechanical and biological signaling for proper cardiac formation. These advances will likely be essential for clinically translatable guidance for targeted interventions to rescue malforming hearts and/or reconfigure malformed circulations for optimal performance. This review summarizes our current understanding on the levels of mechanical signaling in the heart and their roles in orchestrating cardiac development.

  20. Calcium response of KCl-excited populations of ventricular myocytes from the European sea bass (Dicentrarchus labrax): a promising approach to integrate cell-to-cell heterogeneity in studying the cellular basis of fish cardiac performance.

    Science.gov (United States)

    Ollivier, Hélène; Marchant, James; Le Bayon, Nicolas; Servili, Arianna; Claireaux, Guy

    2015-10-01

    Climate change challenges the capacity of fishes to thrive in their habitat. However, through phenotypic diversity, they demonstrate remarkable resilience to deteriorating conditions. In fish populations, inter-individual variation in a number of fitness-determining physiological traits, including cardiac performance, is classically observed. Information about the cellular bases of inter-individual variability in cardiac performance is scarce including the possible contribution of excitation-contraction (EC) coupling. This study aimed at providing insight into EC coupling-related Ca(2+) response and thermal plasticity in the European sea bass (Dicentrarchus labrax). A cell population approach was used to lay the methodological basis for identifying the cellular determinants of cardiac performance. Fish were acclimated at 12 and 22 °C and changes in intracellular calcium concentration ([Ca(2+)]i) following KCl stimulation were measured using Fura-2, at 12 or 22 °C-test. The increase in [Ca(2+)]i resulted primarily from extracellular Ca(2+) entry but sarcoplasmic reticulum stores were also shown to be involved. As previously reported in sea bass, a modest effect of adrenaline was observed. Moreover, although the response appeared relatively insensitive to an acute temperature change, a difference in Ca(2+) response was observed between 12- and 22 °C-acclimated fish. In particular, a greater increase in [Ca(2+)]i at a high level of adrenaline was observed in 22 °C-acclimated fish that may be related to an improved efficiency of adrenaline under these conditions. In conclusion, this method allows a rapid screening of cellular characteristics. It represents a promising tool to identify the cellular determinants of inter-individual variability in fishes' capacity for environmental adaptation.

  1. A cardiac catheterisation laboratory core curriculum for the continuing professional development of nurses and allied health professions: developed by the Education working group of the Nurses and Allied Professions Committee for the European Association of Percutaneous Cardiovascular Interventions (EAPCI) 2016.

    Science.gov (United States)

    Hinterbuchner, Lynne; Coelho, Salomé; Esteves, Ricardo; Carson, Sarah; Kløvgaard, Lene; Gonçalves, Lino; Windecker, Stephan; Zughaft, David

    2017-03-20

    The aim of this report is to provide a standard educational structure for nurses and allied professionals (NAP) specialising in interventional cardiology. The curriculum can also be used as a basis for training on a certificate-based level in interventional cardiology. The curriculum was developed by a panel of experts from various allied health professions. The syllabus focuses on nine core areas of themes essential for NAP working in interventional cardiology. The highly technical knowledge required for working in interventional cardiology as well as the various roles of the different professional groups have been taken into consideration. This core curriculum will ensure that essential content is covered during education and a basic level of quality is achieved across specialty cardiovascular educational programmes throughout Europe.

  2. Reassessing the cardiac box: A comprehensive evaluation of the relationship between thoracic gunshot wounds and cardiac injury.

    Science.gov (United States)

    Jhunjhunwala, Rashi; Mina, Michael J; Roger, Elizabeth I; Dente, Christopher J; Heninger, Michael; Carr, Jacquelyn S; Dougherty, Stacy D; Gelbard, Rondi B; Nicholas, Jeffrey M; Wyrzykowski, Amy D; Feliciano, David V; Morse, Bryan C

    2017-09-01

    High-energy missiles can cause cardiac injury regardless of entrance site. This study assesses the adequacy of the anatomic borders of the current "cardiac box" to predict cardiac injury. Retrospective autopsy review was performed to identify patients with penetrating torso gunshot wounds (GSWs) 2011 to 2013. Using a circumferential grid system around the thorax, logistic regression analysis was performed to detect differences in rates of cardiac injury from entrance/exit wounds in the "cardiac box" versus the same for entrance/exit wounds outside the box. Analysis was repeated to identify regions to compare risk of cardiac injury between the current cardiac box and other regions of the thorax. Over the study period, 263 patients (89% men; mean age, 34 years; median injuries/person, 2) sustained 735 wounds (80% GSWs), and 239 patients with 620 GSWs were identified for study. Of these, 95 (34%) injured the heart. Of the 257 GSWs entering the cardiac box, 31% caused cardiac injury, whereas 21% GSWs outside the cardiac box (n = 67) penetrated the heart, suggesting that the current "cardiac box" is a poor predictor of cardiac injury relative to the thoracic non-"cardiac box" regions (relative risk [RR], 0.96; p = 0.82). The regions from the anterior to posterior midline of the left thorax provided the highest positive predictive value (41%) with high sensitivity (90%) while minimizing false-positives, making this region the most statistically significant discriminator of cardiac injury (RR, 2.9; p = 0.01). For GSWs, the current cardiac box is inadequate to discriminate whether a GSW will cause a cardiac injury. As expected, entrance wounds nearest to the heart are the most likely to result in cardiac injury, but, from a clinical standpoint, it is best to think outside the "box" for GSWs to the thorax. Therapeutic/care management, level IV.

  3. What Is Cardiac Rehabilitation?

    Science.gov (United States)

    ANSWERS by heart Treatments + Tests What Is Cardiac Rehabilitation? A cardiac rehabilitation (rehab) program takes place in a hospital or ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ...

  4. Cardiac Syndrome X

    Science.gov (United States)

    ... Stroke Sudden Cardiac Arrest Valve Disease Vulnerable Plaque Coronary Microvascular Disease (CMD) Related terms: angina, cardiac syndrome X, CMD, MVD, microvascular angina Coronary Microvascular Disease (CMD or MVD) is a type of heart ...

  5. Negative predictive value of cardiac troponin for predicting adverse cardiac events following blunt chest trauma.

    Science.gov (United States)

    Guild, Cameron S; deShazo, Matthew; Geraci, Stephen A

    2014-01-01

    Cardiac-specific troponins (Tns) are sensitive and specific markers of myocardial injury that have been shown to be predictive of outcomes in many cardiac and noncardiac conditions. We sought to determine whether normal cardiac Tn concentrations obtained during the first 24 hours following blunt chest trauma would predict good cardiac outcomes. A PubMed/MEDLINE search was performed to identify prospective studies in patients with blunt chest trauma in which serial cardiac TnT or TnI values were measured within 24 hours of admission and clinical outcomes assessed. Ten studies qualified for review. Studies that used the lower reference limit of Tn as the cutoff for cardiac injury showed 100% negative predictive value (NPV) for developing cardiac complications, whereas studies using higher Tn cutoffs showed wider variation in NPV (50%-98%). Cardiac Tn measured within 24 hours using the lower reference limit (LRL) as the cutoff appears to have excellent NPV for clinically significant adverse cardiac events. This could allow for early discharge after a 24-hour observation period in otherwise uncomplicated blunt chest trauma patients and avoid the need for more expensive cardiac imaging and additional resource utilization.

  6. Antifibrinolytics in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Achal Dhir

    2013-01-01

    Full Text Available Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA or epsilon amino caproic acid (EACA. While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

  7. Cardiac sodium channelopathies

    NARCIS (Netherlands)

    Amin, Ahmad S.; Asghari-Roodsari, Alaleh; Tan, Hanno L.

    2010-01-01

    Cardiac sodium channel are protein complexes that are expressed in the sarcolemma of cardiomyocytes to carry a large inward depolarizing current (I-Na) during phase 0 of the cardiac action potential. The importance of I-Na for normal cardiac electrical activity is reflected by the high incidence of

  8. Survival after major cardiac surgery: performance and comparison of predictive ability of EuroSCORE II and logistic EuroSCORE in a sample of Mediterranean population.

    Science.gov (United States)

    Arnáiz-García, María Elena; González-Santos, Jose María; López-Rodríguez, Javier; Dalmau-Sorlí, María José; Bueno-Codoñer, María; Arévalo-Abascal, Adolfo

    2014-06-01

    The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II has been recently introduced to improve mortality prediction in cardiac surgery. We compare the predictive ability of the new EuroSCORE II with that of the original logistic EuroSCORE and we made an evaluation of a sample of our population submitted to major cardiac surgery in the context of a Mediterranean country. Predicted and observed mortality were recorded in 1,200 consecutive patients undergoing major cardiac surgery at our institution with both logistic EuroSCORE and EuroSCORE II. Patients were grouped according to type of surgery: isolated valvular (n = 538), isolated coronary (n = 322), combined (n = 192), and miscellaneous (n = 148). Predictive capacity of both scales was compared for overall population and for each group in terms of calibration and discrimination using the observed by expected mortality rate, Hosmer-Lemeshow test, and C-statistic. Overall mortality was 6.8%, whereas that predicted by logistic EuroSCORE and EuroSCORE II was 9.7 and 3.7%, respectively. Mortality in our population was higher than mortality expected according to the original EuroSCORE II database. For all groups included in our population, logistic EuroSCORE overestimated mortality and EuroSCORE II underestimated the outcome even more. However, EuroSCORE II showed better calibration than logistic EuroSCORE for overall, valvular, and combined surgery. In contrast, logistic EuroSCORE demonstrated better calibration for coronary surgery. Discrimination capacity was good for both risk scores, but it was superior for logistic EuroSCORE than for EuroSCORE II in all considered subgroups unless combined surgery. Mortality in our population was higher than the mortality that would have been expected by the new EuroSCORE II analysis. Although EuroSCORE II has good calibration and discrimination capacity, both are worse than those demonstrated by logistic EuroSCORE. Forthcoming evaluations are

  9. Mediastinitis after cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Noedir A. G. Stolf

    2000-05-01

    Full Text Available OBJECTIVE: Assessment of incidence and behavior of mediastinitis after cardiac transplantation. METHODS: From 1985 to 1999, 214 cardiac transplantations were performed, 12 (5.6% of the transplanted patients developed confirmed mediastinitis. Patient's ages ranged from 42 to 66 years (mean of 52.3±10.0 years and 10 (83.3% patients were males. Seven (58.3% patients showed sternal stability on palpation, 4 (33.3% patients had pleural empyema, and 2 (16.7% patients did not show purulent secretion draining through the wound. RESULTS: Staphylococcus aureus was the infectious agent identified in the wound secretion or in the mediastinum, or both, in 8 (66.7% patients. Staphylococcus epidermidis was identified in 2 (16.7% patients, Enterococcus faecalis in 1 (8.3% patient, and the cause of mediastinitis could not be determined in 1 (8.3% patient. Surgical treatment was performed on an emergency basis, and the extension of the débridement varied with local conditions. In 2 (16.7% patients, we chose to leave the surgical wound open and performed daily dressings with granulated sugar. Total sternal resection was performed in only 1 (8.3% patient. Out of this series, 5 (41.7% patients died, and the causes of death were related to the infection. Autopsy revealed persistence of mediastinitis in 1 (8.3% patient. CONCLUSION: Promptness in diagnosing mediastinitis and precocious surgical drainage have changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis.

  10. Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI.

    Science.gov (United States)

    Kim, S M; Choi, J-H; Chang, S-A; Choe, Y H

    2013-12-01

    We assessed the diagnostic performance of adenosine-stress dynamic CT perfusion (ASDCTP) imaging and coronary CT angiography (CCTA) for the detection of ischaemic myocardial lesions using 128-slice dual-source CT compared with that of 1.5 T cardiac MRI. This prospective study included 33 patients (61±8 years, 82% male) with suspected coronary artery diseases who underwent ASDCTP imaging and adenosine-stress cardiac MRI. Two investigators independently evaluated ASDCTP images in correlation with significant coronary stenosis on CCTA using two different thresholds of 50% and 70% diameter stenosis. Hypoattenuated myocardial lesions on ASDCTP associated with significant coronary stenoses on CCTA were regarded as true perfusion defects. All estimates of diagnostic performance were calculated and compared with those of cardiac MRI. With use of a threshold of 50% diameter stenosis on CCTA, the diagnostic estimates per-myocardial segment were as follows: sensitivity, 81% [95% confidence interval (CI): 70-92%]; specificity, 94% (95% CI: 92-96%); and accuracy 93% (95% CI: 91-95%). With use of a threshold of 70%, the diagnostic estimates were as follows: sensitivity, 48% (95% CI: 34-62%); specificity, 99% (95% CI: 98-100%); and accuracy, 94% (95% CI: 92-96%). Dynamic CTP using 128-slice dual-source CT enables the assessment of the physiological significance of coronary artery lesions with high diagnostic accuracy in patients with clinically suspected coronary artery disease. Combined CCTA and ASDCTP yielded high accuracy in the detection of perfusion defects regardless of the threshold of significant coronary stenosis.

  11. Non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death

    NARCIS (Netherlands)

    Straus, SMJM; Sturkenboom, MCJM; Bleumink, GS; van der Lei, J; de Graeff, PA; Kingma, JH; Stricker, BHC

    2005-01-01

    Aims To assess the association between the use of non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death. Methods and results A population-based case-control study was performed in the Integrated Primary Care Information (IPCI) project, a longitudinal observational database with

  12. Fetal Primary Cardiac Tumors During Perinatal Period

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2017-06-01

    Full Text Available Fetal primary cardiac tumors are rare, but they may cause complications, which are sometimes life threatening, including arrhythmias, hydrops fetalis, ventricular outflow/inflow obstruction, cardiac failure, and even sudden death. Among fetal primary cardiac tumors, rhabdomyomas are most common, followed by teratomas, fibromas, hemangiomas, and myxomas. Everolimus, a mammalian target of rapamycin inhibitor, has been reported to be an effective drug to cause tumor remission in three neonates with multiple cardiac rhabdomyomas. Neonatal cardiac surgery for the resection of primary cardiac tumors found by fetal echocardiography has been reported sporadically. However, open fetal surgery for pericardial teratoma resection, which was performed successfully via a fetal median sternotomy in one case report, could be a promising intervention to rescue these patients with large pericardial effusions. These recent achievements undoubtedly encourage further development in early management of fetal cardiac tumors. Owing to the rarity of fetal primary cardiac tumors, relevant information in terms of prenatal diagnosis, treatment, and prognosis remains to be clarified.

  13. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    LENUS (Irish Health Repository)

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient\\'s cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  14. Stimulating endogenous cardiac regeneration

    Directory of Open Access Journals (Sweden)

    Amanda eFinan

    2015-09-01

    Full Text Available The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration,a combination of these approaches couldameliorate the overall repair process to incorporate the participation ofmultiple cell players.

  15. Cardiac Innervation and Sudden Cardiac Death

    Science.gov (United States)

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L.; Shivkumar, Kalyanam

    2015-01-01

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  16. Development of Models for Regional Cardiac Surgery Centers

    Directory of Open Access Journals (Sweden)

    Choon Seon Park

    2016-12-01

    Full Text Available Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness, three models were developed: the ‘independent regional cardiac surgery center’ model, the ‘satellite cardiac surgery center within hospitals’ model, and the ‘extended cardiac surgery department within hospitals’ model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

  17. Cardiac myxoma in pregnancy: a comprehensive review

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2015-09-01

    Full Text Available AbstractObjective:Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses.Methods:A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review.Results:Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49; while no surgical resection was performed in 4.1% (2/49 patients (P=0.000. More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47 vs. 12.8% (6/47, P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7% cases. In the remaining 31 (60.8% pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%, 14 (38.9% and 17 (47.2% patients, respectively. No patients died. In the delivery group, 20 (76.9% neonates were event-free survivals, 4 (15.4% were complicated and 2 (7.7% died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery.Conclusion:The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in

  18. Cardiac myxoma in pregnancy: a comprehensive review.

    Science.gov (United States)

    Yuan, Shi-Min

    2015-01-01

    Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses. A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review. Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery. The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals.

  19. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons

    National Research Council Canada - National Science Library

    Thomas, Randal J; King, Marjorie; Lui, Karen; Oldridge, Neil; Piña, Ileana L; Spertus, John; Bonow, Robert O; Estes, 3rd, N A Mark; Goff, David C; Grady, Kathleen L; Hiniker, Ann R; Masoudi, Frederick A; Radford, Martha J; Rumsfeld, John S; Whitman, Gayle R

    2007-01-01

      Endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association...

  20. Echocardiography and cardiac arrhythmias.

    Science.gov (United States)

    Papadopoulos, Constantinos H; Oikonomidis, Dimitrios; Lazaris, Efstathios; Nihoyannopoulos, Petros

    2017-12-05

    Cardiac arrhythmias refer to any abnormality or disturbance in the normal activation sequence of the myocardium and may be indicative of structural heart disease and the cause of significant cardiovascular complications and sudden cardiac death. The following review summarizes the current state-of-the-art knowledge on the role of echocardiography in the management of cardiac arrhythmias and focuses on atrial fibrillation and ventricular arrhythmias where echocardiography presents a particular diagnostic and prognostic interest. Moreover, a brief reference is made to the effect of cardiac arrhythmias and conduction abnormalities on echocardiographic examination. Copyright © 2017 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  1. Sudden Cardiac Death.

    Science.gov (United States)

    Goldberger

    1999-08-01

    Great strides have been made in the approach to the management of sudden cardiac death. Patients who have been successfully resuscitated from an episode of sudden cardiac death are at high risk of recurrence. Much larger groups of patients who have not had episodes of sudden cardiac death are also at substantial risk for this event, however. Because the survival rates associated with out-of-hospital cardiac arrest are dismal, these high-risk populations must be targeted for prophylaxis. Beta-blockers have been shown to be an effective pharmacologic therapy in patients who have had myocardial infarction and, most recently, in patients with congestive heart failure. When possible, these agents should be used in these populations. No class I or class III antiarrhythmic drugs, with the possible exception of amiodarone, have been shown to have efficacy as prophylactic agents for the reduction of mortality in these populations. In patients who have hemodynamically significant sustained ventricular tachyarrhythmias or an aborted episode of sudden cardiac death, the current therapy of choice is an implantable cardioverter-defibrillator (ICD). For prophylaxis of sudden cardiac death in patients who have not had a previous event, several approaches may be considered. Currently, the best therapeutic approach for prophylaxis of sudden cardiac death seems to be the ICD; however, use of this device can be justified only in patients at substantial risk of sudden cardiac death. Defining the high-risk populations that will benefit from ICDs is critical in managing the problem of sudden cardiac death.

  2. Cardiac magnetic resonance imaging

    African Journals Online (AJOL)

    2011-03-06

    right ventricular fibrosis); (d) idiopathic dilated cardiomyopathy. (midwall fibrosis); (e) infiltrative cardiomyopathies (cardiac sarcoidosis); and (f) systemic vasculitides (Churg Strauss Syndrome). LV = left ventricle;. RV = right ...

  3. Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United States

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2016-02-01

    Full Text Available Purpose: It aimed to find if written test results improved for advanced cardiac life support (ACLS taught in flipped classroom/team-based Learning (FC/TBL vs. lecture-based (LB control in University of California-Irvine School of Medicine, USA. Methods: Medical students took 2010 ACLS with FC/TBL (2015, compared to 3 classes in LB (2012-14 format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours, and 20 (12 lecture, simulation 8 hours in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14 or podcast (2015 as was testing: 50 multiple-choice questions (MCQ, 20 rhythm matchings, and 7 fill-in clinical cases. Results: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015. Two of 3 tests (MCQ and fill-in improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4 to 95.1% (92.8, 96.7, P=0.0001. For the fill-in test: 94.1% for LB (89.6, 97.2 to 96.6% for FC/TBL (92.4, 99.20 P=0.0001. For MC: 88% for LB (84, 92 to 90% for FC/TBL (86, 94, P=0.0002. For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%, and 2 or 3 components (8.1% vs. 3.2%, P=0.006. Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%. Conclusion: A FC/TBL format for ACLS marginally improved written test results.

  4. Role of Cardiac PET in Clinical Practice.

    Science.gov (United States)

    Salata, Brian M; Singh, Parmanand

    2017-11-09

    Early identification of atherosclerosis and at-risk lesions plays a critical role in reducing the burden of cardiovascular disease. While invasive coronary angiography serves as the gold standard for diagnosing coronary artery disease, non-invasive imaging techniques provide visualization of both anatomical and functional atherosclerotic processes prior to clinical presentation. The development of cardiac positron emission tomography (PET) has greatly enhanced our capability to diagnose and treat patients with early stages of atherosclerosis. Cardiac PET is a powerful, versatile non-invasive diagnostic tool with utility in the identification of high-risk plaques, myocardial perfusion defects, and viable myocardial tissue. Cardiac PET allows for comparisons of myocardial function both at time of rest and stress, providing accurate assessments of both myocardial perfusion and viability. Furthermore, novel PET techniques with unique radiotracers yield clinically relevant data on high-risk plaques in active progressive atherosclerosis. While PET exercise stress tests were previously difficult to perform given short radiotracer half-life, the development of the novel radiotracer Flurpiridaz F-18 provides a promising future for PET exercise stress imaging. In addition, hybrid imaging with computed tomography angiography (CTA) and cardiac magnetic resonance (CMR) provides integration of cardiac function and structure. In this review article, we discuss the principles of cardiac PET, the clinical applications of PET in diagnosing and prognosticating patients at risk for future cardiovascular events, compare PET with other non-invasive cardiac imaging modalities, and discuss future applications of PET in CVD evaluation and management.

  5. Effects of exercise training and coronary ablation on swimming performance, heart size, and cardiac enzymes in rainbow trout, Oncorhynchus mykiss

    DEFF Research Database (Denmark)

    FARRELL, AP; JOHANSEN, JA; STEFFENSEN, JF

    1990-01-01

    Rainbow trout, Oncorhynchus mykiss, were exercise trained for 28-52 days. Trained fish were 13% larger and swam 12% faster in an aerobic swimming test. Training induced cardiac growth that was isometric with body growth, since ventricle mass relative to body mass was constant. The proportions of ...... if the coronary artery was ligated and an increase in metabolic enzymes associated with ATP generation, namely, citrate synthase, ß-hydroxyacyl CoA dehydrogenase, and hexokinase....... of compact and spongy myocardia in the ventricle were also unchanged by training. Trained fish had significantly higher levels of citrate synthase, ß-hydroxyacyl CoA dehydrogenase, and hexokinase in both compact and spongy myocardium. Ligation of a 0.5- to 1.0-cm section of the coronary artery produced only...... of citrate synthase, ß-hydroxyacyl CoA dehydrogenase, and hexokinase. Exercise-induced increases in the levels of these enzymes in the compact myocardium were prevented by coronary ligation. The decrease of enzymes in the compact myocardium as a result of coronary ligation was compensated for by a 30...

  6. Cardiac function and cognition in older community-dwelling cardiac patients.

    Science.gov (United States)

    Eggermont, Laura H P; Aly, Mohamed F A; Vuijk, Pieter J; de Boer, Karin; Kamp, Otto; van Rossum, Albert C; Scherder, Erik J A

    2017-11-01

    Cognitive deficits have been reported in older cardiac patients. An underlying mechanism for these findings may be reduced cardiac function. The relationship between cardiac function as represented by different echocardiographic measures and different cognitive function domains in older cardiac patients remains unknown. An older (≥70 years) heterogeneous group of 117 community-dwelling cardiac patients under medical supervision by a cardiologist underwent thorough echocardiographic assessment including left ventricular ejection fraction, cardiac index, left atrial volume index, left ventricular mass index, left ventricular diastolic function, and valvular calcification. During a home visit, a neuropsychological assessment was performed within 7.1 ± 3.8 months after echocardiographic assessment; the neuropsychological assessment included three subtests of a word-learning test (encoding, recall, recognition) to examine one memory function domain and three executive function tests, including digit span backwards, Trail Making Test B minus A, and the Stroop colour-word test. Regression analyses showed no significant linear or quadratic associations between any of the echocardiographic functions and the cognitive function measures. None of the echocardiographic measures as representative of cardiac function was correlated with memory or executive function in this group of community-dwelling older cardiac patients. These findings contrast with those of previous studies. © 2017 Japanese Psychogeriatric Society.

  7. [Advances in cardiac pacing].

    Science.gov (United States)

    de Carranza, María-José Sancho-Tello; Fidalgo-Andrés, María Luisa; Ferrer, José Martínez; Mateas, Francisco Ruiz

    2012-01-01

    This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  8. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  9. Pregnancy and cardiac disease

    African Journals Online (AJOL)

    Diagnosing cardiac disease. History and examination. Many disorders can be identified by a clinical examination and a patient's history, but in the majority, if not all cases, an echocardiogram is required to confirm clinical suspicions. ARTICLE. Pregnancy and cardiac disease. C Elliott,1 MB ChB, FCOG (SA), MMed; K Sliwa ...

  10. Cardiac sympathetic neuronal imaging using PET

    Energy Technology Data Exchange (ETDEWEB)

    Lautamaeki, Riikka; Tipre, Dnyanesh [Johns Hopkins University, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Bengel, Frank M. [Johns Hopkins University, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Cardiovascular Nuclear Medicine, Baltimore, MD (United States)

    2007-06-15

    Balance of the autonomic nervous system is essential for adequate cardiac performance, and alterations seem to play a key role in the development and progression of various cardiac diseases. PET imaging of the cardiac autonomic nervous system has advanced extensively in recent years, and multiple pre- and postsynaptic tracers have been introduced. The high spatial and temporal resolution of PET enables noninvasive quantification of neurophysiologic processes at the tissue level. Ligands for catecholamine receptors, along with radiolabeled catecholamines and catecholamine analogs, have been applied to determine involvement of sympathetic dysinnervation at different stages of heart diseases such as ischemia, heart failure, and arrhythmia. This review summarizes the recent findings in neurocardiological PET imaging. Experimental studies with several radioligands and clinical findings in cardiac dysautonomias are discussed. (orig.)

  11. Daily Oxygen/O3 Treatment Reduces Muscular Fatigue and Improves Cardiac Performance in Rats Subjected to Prolonged High Intensity Physical Exercise

    Directory of Open Access Journals (Sweden)

    C. Di Filippo

    2015-01-01

    Full Text Available Rats receiving daily intraperitoneal administration of O2 and running on a treadmill covered an average distance of 482.8 ± 21.8 m/week as calculated during 5-week observation. This distance was increased in rats receiving daily intraperitoneal administration of an oxygen/O3 mixture at a dose of 100; 150; and 300 μg/kg with the maximum increase being +34.5% at 300 μg/kg and still present after stopping the administration of oxygen/O3. Oxygen/O3 decreased the mean arterial blood pressure (−13%, the heart rate (−6%, the gastrocnemius and cardiac hypertrophy, and fibrosis and reduced by 49% the left ventricular mass and relative wall thickness measurements. Systolic and diastolic functions were improved in exercised oxygen/O3 rats compared to O2 rats. Oxygen/O3 treatment led to higher MPI index starting from the dose of 150 μg/kg (p<0.05 and more effective (+14% at a dose of 300 μg/kg oxygen/O3. Oxygen/O3 dose-dependently increased the expression of the antioxidant enzymes Mn-SOD and GPx1 and of eNOS compared to the exercised O2 rats. The same doses resulted in decrease of LDH levels, CPK, TnI, and nitrotyrosine concentration in the heart and gastrocnemius tissues, arguing a beneficial effect of the ozone molecule against the fatigue induced by a prolonged high intensity exercise.

  12. Sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Neeraj Parakh

    2015-01-01

    Full Text Available Sudden cardiac death is one of the most common cause of mortality worldwide. Despite significant advances in the medical science, there is little improvement in the sudden cardiac death related mortality. Coronary artery disease is the most common etiology behind sudden cardiac death, in the above 40 years population. Even in the apparently healthy population, there is a small percentage of patients dying from sudden cardiac death. Given the large denominator, this small percentage contributes to the largest burden of sudden cardiac death. Identification of this at risk group among the apparently healthy individual is a great challenge for the medical fraternity. This article looks into the causes and methods of preventing SCD and at some of the Indian data. Details of Brugada syndrome, Long QT syndrome, Genetics of SCD are discussed. Recent guidelines on many of these causes are summarised.

  13. Biomaterials for cardiac regeneration

    CERN Document Server

    Ruel, Marc

    2015-01-01

    This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

  14. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone

    2014-01-01

    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  15. How Is Sudden Cardiac Arrest Treated?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  16. How Is Sudden Cardiac Arrest Diagnosed?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  17. Performance of a high-sensitivity dedicated cardiac SPECT scanner for striatal uptake quantification in the brain based on analysis of projection data

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi-Ae; Moore, Stephen C.; McQuaid, Sarah J.; Kijewski, Marie Foley [Department of Radiology, Brigham and Women' s Hospital and Harvard Medical School, Boston, Massachusetts 02115 (United States); Mueller, Stefan P. [Abteilung Nuklearmedizin, Universitaetsklinikum Essen, 45147 Essen (Germany)

    2013-04-15

    Purpose: The authors have previously reported the advantages of high-sensitivity single-photon emission computed tomography (SPECT) systems for imaging structures located deep inside the brain. DaTscan (Isoflupane I-123) is a dopamine transporter (DaT) imaging agent that has shown potential for early detection of Parkinson disease (PD), as well as for monitoring progression of the disease. Realizing the full potential of DaTscan requires efficient estimation of striatal uptake from SPECT images. They have evaluated two SPECT systems, a conventional dual-head gamma camera with low-energy high-resolution collimators (conventional) and a dedicated high-sensitivity multidetector cardiac imaging system (dedicated) for imaging tasks related to PD. Methods: Cramer-Rao bounds (CRB) on precision of estimates of striatal and background activity concentrations were calculated from high-count, separate acquisitions of the compartments (right striata, left striata, background) of a striatal phantom. CRB on striatal and background activity concentration were calculated from essentially noise-free projection datasets, synthesized by scaling and summing the compartment projection datasets, for a range of total detected counts. They also calculated variances of estimates of specific-to-nonspecific binding ratios (BR) and asymmetry indices from these values using propagation of error analysis, as well as the precision of measuring changes in BR on the order of the average annual decline in early PD. Results: Under typical clinical conditions, the conventional camera detected 2 M counts while the dedicated camera detected 12 M counts. Assuming a normal BR of 5, the standard deviation of BR estimates was 0.042 and 0.021 for the conventional and dedicated system, respectively. For an 8% decrease to BR = 4.6, the signal-to-noise ratio were 6.8 (conventional) and 13.3 (dedicated); for a 5% decrease, they were 4.2 (conventional) and 8.3 (dedicated). Conclusions: This implies that PD can

  18. Cardiac sympathetic afferent denervation attenuates cardiac remodeling and improves cardiovascular dysfunction in rats with heart failure.

    Science.gov (United States)

    Wang, Han-Jun; Wang, Wei; Cornish, Kurtis G; Rozanski, George J; Zucker, Irving H

    2014-10-01

    The enhanced cardiac sympathetic afferent reflex (CSAR) contributes to the exaggerated sympathoexcitation in chronic heart failure (CHF). Increased sympathoexcitation is positively related to mortality in patients with CHF. However, the potential beneficial effects of chronic CSAR deletion on cardiac and autonomic function in CHF have not been previously explored. Here, we determined the effects of chronic CSAR deletion on cardiac remodeling and autonomic dysfunction in CHF. To delete the transient receptor potential vanilloid 1 receptor-expressing CSAR afferents selectively, epicardial application of resiniferatoxin (50 μg/mL), an ultrapotent analog of capsaicin, was performed during myocardium infarction surgery in rats. This procedure largely abolished the enhanced CSAR, prevented the exaggerated renal and cardiac sympathetic nerve activity and improved baroreflex sensitivity in CHF rats. Most importantly, we found that epicardial application of resiniferatoxin largely prevented the elevated left ventricle end-diastolic pressure, lung edema, and cardiac hypertrophy, partially reduced left ventricular dimensions in the failing heart, and increased cardiac contractile reserve in response to β-adrenergic receptor stimulation with isoproterenol in CHF rats. Molecular evidence showed that resiniferatoxin attenuated cardiac fibrosis and apoptosis and reduced expression of fibrotic markers and transforming growth factor-β receptor I in CHF rats. Pressure-volume loop analysis showed that resiniferatoxin reduced the end-diastolic pressure volume relationships in CHF rats, indicating improved cardiac compliance. In summary, cardiac sympathetic afferent deletion exhibits protective effects against deleterious cardiac remodeling and autonomic dysfunction in CHF. These data suggest a potential new paradigm and therapeutic potential in the management of CHF. © 2014 American Heart Association, Inc.

  19. Cardiac Mapping: Utility or Futility?

    Directory of Open Access Journals (Sweden)

    Gupta Anoop Kumar

    2002-01-01

    Full Text Available Cardiac mapping is a broad term that covers several modes of mapping such as body surface,1 endocardial,2 and epicardial3 mapping. The recording and analysis of extracellular electrograms, reported as early as 1915, forms the basis for cardiac mapping.4 More commonly, cardiac mapping is performed with catheters that are introduced percutaneously into the heart chambers and sequentially record the endocardial electrograms with the purpose of correlating local electrogram to cardiac anatomy. These electrophysiological catheters are navigated and localized with the use of fluoroscopy. Nevertheless, the use of fluoroscopy for these purposes may be problematic for a number of reasons, including: 1 the inability to accurately associate intracardiac electrograms with their precise location within the heart; 2 the endocardial surface is invisible using fluoroscopy and the target sites can only be approximated by their relationship with nearby structures such as ribs, blood vessels, and the position of other catheters; 3 due to the limitations of two-dimensional fluoroscopy, navigation is not exact, time consuming, and requires multiple views to estimate the three-dimensional location of the catheter; 4 inability to accurately return the catheter precisely to a previously mapped site; and 5 exposure of the patient and medical team to radiation. Newer mapping systems have revolutionized the clinical electrophysiology laboratory in recent years and have offered new insights into arrhythmia mechanisms. They are aimed at improving the resolution, three-dimensional spatial localization, and/or rapidity of acquisition of cardiac activation maps. These systems use novel approaches to accurately determine the three-dimensional location of the mapping catheter and local electrograms are acquired using conventional, well-established methods. Recorded data of the catheter location and intracardiac electrogram at that location are used to reconstruct in real-time a

  20. Naturally occurring cardiac glycosides.

    Science.gov (United States)

    Radford, D J; Gillies, A D; Hinds, J A; Duffy, P

    1986-05-12

    Cardiac glycoside poisoning from the ingestion of plants, particularly of oleanders, occurs with reasonable frequency in tropical and subtropical areas. We have assessed a variety of plant specimens for their cardiac glycoside content by means of radioimmunoassays with antibodies that differ in their specificity for cardiac glycosides. Significant amounts of immunoreactive cardiac glycoside were found to be present in the ornamental shrubs: yellow oleander (Thevetia peruviana); oleander (Nerium oleander); wintersweet (Carissa spectabilis); bushman's poison (Carissa acokanthera); sea-mango (Cerbera manghas); and frangipani (Plumeria rubra); and in the milkweeds: redheaded cotton-bush (Asclepias curassavica); balloon cotton (Asclepias fruiticosa); king's crown (Calotropis procera); and rubber vine (Cryptostegia grandifolia). The venom gland of the cane toad (Bufo marinus) also contained large quantities of cardiac glycosides. The competitive immunoassay method permits the rapid screening of specimens that are suspected to contain cardiac glycosides. Awareness of the existence of these plant and animal toxins and their dangers allows them to be avoided and poisoning prevented. The method is also useful for the confirmation of the presence of cardiac glycosides in serum in cases of poisoning.

  1. Imaging for cardiac electrophysiology

    Directory of Open Access Journals (Sweden)

    Benoit Desjardins

    2016-11-01

    Full Text Available Clinical cardiac electrophysiology is the study of the origin and treatment of arrhythmia. There has been considerable recent development in this field, where imaging has had a transformational impact. In this invited review, we offer a global overview of the most important developments in the use of imaging in cardiac electrophysiology. We first describe the radiological imaging modalities involved in cardiac electrophysiology, to assess cardiac anatomy, function and scar. We then introduce an imaging modality with which readers are probably unfamiliar (electroanatomical mapping [EAM], but which is routinely used by electrophysiologists to plan and guide cardiac mapping and cardiac ablation therapy by catheter, a therapy which can reduce or even cure arrhythmia. We identify the limitations of EAM and describe how radiological imaging modalities can complement this technique. We then describe and illustrate how imaging has helped the diagnosis of arrhythmogenic conditions, and how imaging is used to plan and guide clinical cardiac electrophysiologic procedures and assess their results and complications. We focus on the two most common arrhythmias for which imaging has the greatest impact: atrial fibrillation and ventricular tachycardia.

  2. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery.

    Science.gov (United States)

    Noordzij, P G; van Geffen, O; Dijkstra, I M; Boerma, D; Meinders, A J; Rettig, T C D; Eefting, F D; van Loon, D; van de Garde, E M W; van Dongen, E P A

    2015-06-01

    Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the relationship between postoperative high-sensitive cardiac troponin T elevations and non-cardiac complications in patients after major abdominal surgery. This prospective observational single-centre cohort study included patients at risk for coronary artery disease undergoing elective major abdominal surgery. Cardiac troponin was measured before surgery and at day 1, 3, and 7. Multivariable logistic regression analysis was performed to examine the adjusted association for different cut-off concentrations of postoperative myocardial injury and non-cardiac outcome. In 203 patients, 690 high-sensitive cardiac troponin T measurements were performed. Fifty-three patients (26%) had a non-cardiac complication within 30 days after surgery. Hospital mortality was 4% (8/203). An increase in cardiac troponin T concentration ≥100% compared with baseline was a superior independent predictor of non-cardiac postoperative clinical complications (adjusted odds ratio 4.3, 95% confidence interval 1.8-10.1, Phigh-sensitive cardiac troponin T increase ≥100% is a strong predictor of non-cardiac 30 day complications, increased hospital stay and hospital mortality in patients undergoing major abdominal surgery. NCT02150486. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Expression patterns of cardiac aging in Drosophila.

    Science.gov (United States)

    Cannon, Leah; Zambon, Alexander C; Cammarato, Anthony; Zhang, Zhi; Vogler, Georg; Munoz, Matthew; Taylor, Erika; Cartry, Jérôme; Bernstein, Sanford I; Melov, Simon; Bodmer, Rolf

    2017-02-01

    Aging causes cardiac dysfunction, often leading to heart failure and death. The molecular basis of age-associated changes in cardiac structure and function is largely unknown. The fruit fly, Drosophila melanogaster, is well-suited to investigate the genetics of cardiac aging. Flies age rapidly over the course of weeks, benefit from many tools to easily manipulate their genome, and their heart has significant genetic and phenotypic similarities to the human heart. Here, we performed a cardiac-specific gene expression study on aging Drosophila and carried out a comparative meta-analysis with published rodent data. Pathway level transcriptome comparisons suggest that age-related, extra-cellular matrix remodeling and alterations in mitochondrial metabolism, protein handling, and contractile functions are conserved between Drosophila and rodent hearts. However, expression of only a few individual genes similarly changed over time between and even within species. We also examined gene expression in single fly hearts and found significant variability as has been reported in rodents. We propose that individuals may arrive at similar cardiac aging phenotypes via dissimilar transcriptional changes, including those in transcription factors and micro-RNAs. Finally, our data suggest the transcription factor Odd-skipped, which is essential for normal heart development, is also a crucial regulator of cardiac aging. © 2017 The Authors. Aging Cell published by the Anatomical Society and John Wiley & Sons Ltd.

  4. Genetics of sudden cardiac death

    NARCIS (Netherlands)

    Bezzina, Connie R.; Lahrouchi, Najim; Priori, Silvia G.

    2015-01-01

    Sudden cardiac death occurs in a broad spectrum of cardiac pathologies and is an important cause of mortality in the general population. Genetic studies conducted during the past 20 years have markedly illuminated the genetic basis of the inherited cardiac disorders associated with sudden cardiac

  5. Extracting cardiac myofiber orientations from high frequency ultrasound images

    Science.gov (United States)

    Qin, Xulei; Cong, Zhibin; Jiang, Rong; Shen, Ming; Wagner, Mary B.; Kirshbom, Paul; Fei, Baowei

    2013-03-01

    Cardiac myofiber plays an important role in stress mechanism during heart beating periods. The orientation of myofibers decides the effects of the stress distribution and the whole heart deformation. It is important to image and quantitatively extract these orientations for understanding the cardiac physiological and pathological mechanism and for diagnosis of chronic diseases. Ultrasound has been wildly used in cardiac diagnosis because of its ability of performing dynamic and noninvasive imaging and because of its low cost. An extraction method is proposed to automatically detect the cardiac myofiber orientations from high frequency ultrasound images. First, heart walls containing myofibers are imaged by B-mode high frequency (pig hearts.

  6. Korean guidelines for the appropriate use of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Jin [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul(Korea, Republic of); Yong, Hwan Seok [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul(Korea, Republic of); Kim, Sung Mok [Dept. of Radiology, amsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jung A [Dept. of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of); Hong, Yoo Jin [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-04-15

    The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.

  7. Fetal cardiac axis and congenital heart defects in early gestation.

    Science.gov (United States)

    Sinkovskaya, Elena S; Chaoui, Rabih; Karl, Katrin; Andreeva, Elena; Zhuchenko, Ludmila; Abuhamad, Alfred Z

    2015-02-01

    To investigate the association between cardiac axis and fetal congenital heart defects to demonstrate the potential clinical applicability of cardiac axis measurement for detection of congenital heart defect in early gestation. This case-control study was undertaken in three tertiary centers with expertise in fetal imaging in early gestation. Fetal cardiac axis was evaluated between 11 0/7 and 14 6/7 weeks of gestation in 197 fetuses with confirmed congenital heart defects. A control group was selected by matching each fetus with a congenital heart defect with two fetuses in the control group with similar crown-rump length (± 5 mm) and date of study (± 2 months). Cardiac axis was measured on the four-chamber view as the angle between the line that traces the long axis of the heart and the line that bisects the thorax in an anteroposterior direction. In the control group, mean cardiac axis was 44.5 ± 7.4°. The cardiac axis did not significantly change in early pregnancy. In the congenital heart defect group, 25.9% of fetuses had cardiac axis measurements within normal limits. In 74.1%, the cardiac axis was abnormal including 110 fetuses in the case group with left deviation (cardiac axis > 97.5th percentile), 19 fetuses in the case group with right deviation (cardiac axis axis. The performance of cardiac axis measurement in detection of major congenital heart defect was significantly better than enlarged nuchal translucency, tricuspid regurgitation, or reversed A-wave in ductus venosus used alone or in combination. Abnormal cardiac axis is present in two-thirds of fetuses with congenital heart defect in early gestation. Adding cardiac axis assessment to the nuchal translucency measurement is helpful in defining a population at risk for fetal congenital heart defect.

  8. Socially differentiated cardiac rehabilitation

    DEFF Research Database (Denmark)

    Meillier, Lucette Kirsten; Nielsen, Kirsten Melgaard; Larsen, Finn Breinholt

    2012-01-01

    Aim: The comprehensive cardiac rehabilitation (CR) programme after myocardial infarction (MI) improves quality of life and results in reduced cardiac mortality and recurrence of MI. Hospitals worldwide face problems with low participation rates in rehabilitation programmes. Inequality...... cardiac rehabilitation programme. Methods: From 1 September 2002 to 31 December 2005, 388 first-incidence MI patients ≤75 years were hospitalised. Register check for newly hospitalised MI patients, screening interview, and systematic referral were conducted by a project nurse. Patients were referred...... to a standard rehabilitation programme (SRP). If patients were identified as socially vulnerable, they were offered an extended version of the rehabilitation programme (ERP). Excluded patients were offered home visits by a cardiac nurse. Concordance principles were used in the individualised programme elements...

  9. Quantitative cardiac ultrasound

    NARCIS (Netherlands)

    H. Rijsterborgh (Hans)

    1990-01-01

    textabstractThis thesis is about the various aspects of quantitative cardiac ultrasound. The first four chapters are mainly devoted to the reproducibility of echocardiographic measurements. These . are focussed on the variation of echocardiographic measurements within patients. An important

  10. Cardiac Tumors; Tumeurs cardiaques

    Energy Technology Data Exchange (ETDEWEB)

    Laissy, J.P.; Fernandez, P. [Centre Hospitalier Universitaire Bichat Claude Bernard, Service d' Imagerie, 76 - Rouen (France); Mousseaux, E. [Hopital Europeen Georges Pompidou (HEGP), Service de Radiologie Cardio Vasculaire et Interventionnelle, 75 - Paris (France); Dacher, J.N. [Centre Hospitalier Universitaire Charles Nicolle, 75 - Rouen (France); Crochet, D. [Centre Hospitalier Universitaire, Hopital Laennec, Centre Hemodynamique, Radiologie Thoracique et Vasculaire, 44 - Nantes (France)

    2004-04-01

    Metastases are the most frequent tumors of the heart even though they seldom are recognized. Most primary cardiac tumors are benign. The main role of imaging is to differentiate a cardiac tumor from thrombus and rare pseudo-tumors: tuberculoma, hydatid cyst. Echocardiography is the fist line imaging technique to detect cardiac tumors, but CT and MRl arc useful for further characterization and differential diagnosis. Myxoma of the left atrium is the most frequent benign cardiac tumor. It usually is pedunculated and sometimes calcified. Sarcoma is the most frequent primary malignant tumor and usually presents as a sessile infiltrative tumor. Lymphoma and metastases are usually recognized by the presence of known tumor elsewhere of by characteristic direct contiguous involvement. Diagnosing primary and secondary pericardial tumors often is difficult. Imaging is valuable for diagnosis, characterization, pre-surgical evaluation and follow-up. (author)

  11. Cardiac Catheterization (For Teens)

    Science.gov (United States)

    ... Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & ... will do the cardiac catheterization in a catheterization lab . The lab contains X-ray and imaging machines ...

  12. Autonomic cardiac innervation

    Science.gov (United States)

    Hasan, Wohaib

    2013-01-01

    Autonomic cardiac neurons have a common origin in the neural crest but undergo distinct developmental differentiation as they mature toward their adult phenotype. Progenitor cells respond to repulsive cues during migration, followed by differentiation cues from paracrine sources that promote neurochemistry and differentiation. When autonomic axons start to innervate cardiac tissue, neurotrophic factors from vascular tissue are essential for maintenance of neurons before they reach their targets, upon which target-derived trophic factors take over final maturation, synaptic strength and postnatal survival. Although target-derived neurotrophins have a central role to play in development, alternative sources of neurotrophins may also modulate innervation. Both developing and adult sympathetic neurons express proNGF, and adult parasympathetic cardiac ganglion neurons also synthesize and release NGF. The physiological function of these “non-classical” cardiac sources of neurotrophins remains to be determined, especially in relation to autocrine/paracrine sustenance during development.   Cardiac autonomic nerves are closely spatially associated in cardiac plexuses, ganglia and pacemaker regions and so are sensitive to release of neurotransmitter, neuropeptides and trophic factors from adjacent nerves. As such, in many cardiac pathologies, it is an imbalance within the two arms of the autonomic system that is critical for disease progression. Although this crosstalk between sympathetic and parasympathetic nerves has been well established for adult nerves, it is unclear whether a degree of paracrine regulation occurs across the autonomic limbs during development. Aberrant nerve remodeling is a common occurrence in many adult cardiovascular pathologies, and the mechanisms regulating outgrowth or denervation are disparate. However, autonomic neurons display considerable plasticity in this regard with neurotrophins and inflammatory cytokines having a central regulatory

  13. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  14. Cardiac imaging in adults

    Energy Technology Data Exchange (ETDEWEB)

    Jaffe, C.C.

    1987-01-01

    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

  15. [Cardiac CT: new applications].

    Science.gov (United States)

    Pesenti-Rossi, D; Baron, N; Allouch, P; Convers, R; Gibault-Genty, G; Aubert, S

    2014-11-01

    Since the introduction of the 64-generation scanners, the accuracy and robustness of the diagnosis of coronary artery disease has progressed. The main advantage of cardiac CT is the exclusion of coronary artery disease by its excellent negative predictive value. Currently, cardiac CT applications extend thanks to innovations both in terms of technological development systems scanner or stents implanted, that the evolution of surgical procedures such as TAVI. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Cardiac T1 Imaging

    OpenAIRE

    Jerosch-Herold, Michael; Kwong, Raymond Y.

    2014-01-01

    T1 mapping of the heart has evolved into a valuable tool to evaluate myocardial tissue properties, with or without contrast injection, including assessment of myocardial edema and free water content, extra-cellular volume (expansion), and most recently cardiomyocyte hypertrophy. The MRI pulse sequence techniques developed for these applications have had to address at least two important considerations for cardiac applications: measure magnetization inversion recoveries during cardiac motion w...

  17. Adherence to Surgical Site Infection Guidelines in Cardiac Surgery ...

    African Journals Online (AJOL)

    Purpose: To assess the appropriateness and compliance of antibiotic prophylaxis practices in cardiac surgery in a tertiary hospital in United Arab Emirates (UAE) using three international guidelines. Methods: A retrospective study was performed by reviewing patients' files admitted for cardiac surgery between January 2008 ...

  18. Occurrence of cardiac arrhythmias in Standardbred racehorses.

    Science.gov (United States)

    Slack, J; Boston, R C; Soma, L R; Reef, V B

    2015-07-01

    Cardiac arrhythmias are a recognised but poorly characterised problem in the Standardbred racehorse. Frequency data could aid the development of cardiac arrhythmia screening programmes. To characterise the occurrence of cardiac arrhythmias in Standardbreds prior to racing and in the late post race period using a handheld, noncontinuous recording device. Prospective, observational study, convenience sampling. Noncontinuous electrocardiographic recordings were obtained over a 12 week period from Standardbred horses competing at a single racetrack. Electrocardiograms were obtained before racing and between 6 and 29 min after the race using a handheld recording device. Prevalence of arrhythmias was calculated for all horses and overall frequency of arrhythmias was calculated for race starts and poor performers. Univariate logistic regression analysis was used to identify risk factors for cardiac arrhythmias. A total of 8657 electrocardiogram recordings were obtained from 1816 horses. Six horses had atrial fibrillation after racing (prevalence = 0.11%, frequency = 0.14%), one horse had supraventricular tachycardia before racing (prevalence = 0.06%, frequency = 0.02%), and 2 horses had ventricular tachyarrhythmias after racing (prevalence = 0.06%, frequency = 0.05%). The frequency of atrial fibrillation among race starts with poor performance was 1.3-2.0%. Increasing age was a significant risk factor for the presence of atrial premature contractions before racing and atrial fibrillation and ventricular ectopy after racing. Both physiological and pathological cardiac arrhythmias can be detected in apparently healthy Standardbred horses in the prerace and late post race period using noncontinuous recording methods. Future studies should examine cumulative training or racing hours as a risk factor for cardiac arrhythmia. The prevalence and frequency information may be useful for track veterinarians and regulatory personnel following trends in cardiac arrhythmias. © 2014

  19. Association between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival

    Science.gov (United States)

    Chen, Lena M.; Nallamothu, Brahmajee K.; Spertus, John A.; Li, Yan; Chan, Paul S.

    2014-01-01

    Context National efforts to measure hospital performance for cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place. Objective To describe the association between inpatient cardiac arrest incidence and survival rates. Design, Setting, and Patients Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000 and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital’s cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics. Main Outcome Measure The correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest. Results Of 102,153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (IQR: 2.95 to 5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (IQR: 14.5% to 22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (correlation of -0.16; P=0.003). This relationship persisted after adjusting for patient characteristics (correlation of -0.15; P=0.004). After adjusting for potential mediators of this relationship (i.e., hospital characteristics), the relationship between incidence and case-survival was attenuated (correlation of -0.07; P=0.18). The one modifiable hospital factor that most attenuated this relationship was a hospital’s nurse-to-bed ratio (correlation of -0.12; P=0.03). Conclusions Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case-mix. This relationship is partially mediated by measured hospital attributes

  20. Preoperative Feeding Neonates With Cardiac Disease.

    Science.gov (United States)

    Scahill, Carly J; Graham, Eric M; Atz, Andrew M; Bradley, Scott M; Kavarana, Minoo N; Zyblewski, Sinai C

    2017-01-01

    The potential for necrotizing enterocolitis (NEC) in neonates requiring cardiac surgery has contributed largely to wide feeding practice variations and a hesitation to initiate enteral feeding during the preoperative period, specifically those patients with hypoplastic left heart syndrome. A retrospective chart review of neonates undergoing cardiac surgery at a single institution between July 2011 and July 2013 was performed. The primary objective of this study was to determine if preoperative feeding was associated with NEC in neonates requiring cardiac surgery. Univariable and multivariable analyses were performed to evaluate the relationship between preoperative feeding and NEC. Secondary outcomes including growth failure, total ventilator days, total length of stay, and tube-assisted feeds at discharge were analyzed. One hundred thirty consecutive neonates who required cardiac surgery were included in the analysis. Preoperative feeding occurred in 61% (n = 79). The overall prevalence of NEC was 9% (12/130), including three neonates with surgical NEC. There was no difference in the prevalence of NEC between the preoperative feeding and nil per os (NPO) groups. Preoperative NPO status was associated with longer ventilator-dependent days ( P = .01) but was not associated with worsened growth failure, longer length of stay, or increased prevalence of tube-assisted feeds at discharge. In this study cohort, preoperative feeding was associated with a low prevalence of NEC. Larger prospective studies evaluating the safety and benefits of preoperative feeding in cardiac neonates are warranted.

  1. Sudden cardiac death in athletes

    OpenAIRE

    Bockeria O.L.; Ispir’yan A.Yu.

    2013-01-01

    Cases of sudden cardiac death (SCD) in young athletes during physical exercises are rare. According to the data of prospective population study performed in Veneto (Italy), incidence of SCD is 2.3 cases per year (2.6 among men and 1.1 among women) per 100,000 athletes aged 12 to 35 years for all reasons. Out of them 2.1 cases of SCD were caused by cardiovascular diseases. Coronary artery disease is the most frequent cause of SCD in athletes aged over 35 years. Also there are a number of other...

  2. [Psychosomatic aspects of cardiac arrhythmias].

    Science.gov (United States)

    Siepmann, Martin; Kirch, Wilhelm

    2010-07-01

    Emotional stress facilitates the occurrence of cardiac arrhythmias including sudden cardiac death. The prevalence of anxiety and depression is increased in cardiac patients as compared to the normal population. The risk of cardiovascular mortality is enhanced in patients suffering from depression. Comorbid anxiety disorders worsen the course of cardiac arrhythmias. Disturbance of neurocardiac regulation with predominance of the sympathetic tone is hypothesized to be causative for this. The emotional reaction to cardiac arrhythmias is differing to a large extent between individuals. Emotional stress may result from coping with treatment of cardiac arrhythmias. Emotional stress and cardiac arrhythmias may influence each other in the sense of a vicious circle. Somatoform cardiac arrhythmias are predominantly of psychogenic origin. Instrumental measures and frequent contacts between physicians and patients may facilitate disease chronification. The present review is dealing with the multifaceted relationships between cardiac arrhythmias and emotional stress. The underlying mechanisms and corresponding treatment modalities are discussed.

  3. Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study.

    Science.gov (United States)

    Fernandez Castelao, Ezequiel; Boos, Margarete; Ringer, Christiane; Eich, Christoph; Russo, Sebastian G

    2015-07-24

    Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.

  4. Comparative study of radiopharmaceuticals as radiodiagnostic agent of cardiac damage in rats

    Energy Technology Data Exchange (ETDEWEB)

    Gil V, M.C.; Mena T, P. (Comision Chilena de Energia Nuclear, Santiago. Dept. de Aplicaciones de los Isotopos y Radiaciones); Gallego H, R.; Mendoza A, J. (Chile Univ., Santiago. Facultad de Ciencias Agrarias, Veterinarias y Forestales)

    1984-04-01

    Cardiac uptake studies with six radiopharmaceuticals have been performed at different time intervals, after to induce cardiac damage in rats as biological model. Phosphorous radiopharmaceuticals sup((99m) Tc-MDP and sup(113m) In-EDTMP) and /sup 197/Hg-MPG possessed the higher cardiac uptake compared with sup(99m) Tc-GH and sup(99m) Tc-DMSA.

  5. Critical pathway for the management of acute heart failure at the Veterans Affairs San Diego Healthcare System: transforming performance measures into cardiac care.

    Science.gov (United States)

    Gardetto, Nancy J; Greaney, Karen; Arai, Lisa; Brenner, April; Carroll, Karen C; Howerton, Nancy M; Lee, Melinda; Pada, Laureen; Tseng, Marilynne; Maisel, Alan S

    2008-09-01

    Acute decompensated heart failure (ADHF) is a major public health problem and leading cause for hospitalization in people 65 years and older. Admission rates for ADHF, accounted for more than 1 million heart failure (HF) hospitalizations in 2004, and more than 6.5 million inpatient hospital days. Despite significant advances in HF management, including pharmacotherapy and devices; and extensive collaborative efforts of the American College of Cardiology, and American Heart Association to disseminate evidence-based practice guidelines for management of chronic HF in adults; 3 patients continue to present to the emergency departments in ADHF. The hospital treatment of HF frequently does not follow published guidelines, potentially contributing to the high morbidity, mortality, and economic cost of this disorder. This highlights an ongoing need for development of quality improvement programs that focus on delivering reliable, evidence-based care for patients with ADHF. Consequently, the development of clinical pathways has the potential to reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. The Veterans Affairs San Diego Healthcare System (VASDHCS) formed a multidisciplinary HF performance improvement team. The team set forth on the task of developing standard order sets for patients with ADHF. After analyzing local care processes, reviewing evidence of best care practices, and defining appropriate goals to satisfy the multidimensional needs of HF patient; the team developed a computerized pathway in a user-friendly format that is simple, yet comprehensive; and focuses on early stages of HF evaluation and treatment for patients presenting to the emergency department. Successful strategies to improve care for HF patients need to assist health care providers with rapid recognition and early aggressive treatment, while creating a reliable process that ensures continuity of care. This critical pathway for management of

  6. Right Heart Catheterisation in Patients with Echocardiographic ...

    African Journals Online (AJOL)

    Echo was accurate in only 31.1% of instances in patients with congenital heart disease and inaccurate in all patients with rheumatic heart disease. Conclusion: Differences exist between pressures measured by Echo and RHC. Clinically, these differences may to lead to inappropriate management of patients. RHC is ...

  7. Robust temporal alignment of multimodal cardiac sequences

    Science.gov (United States)

    Perissinotto, Andrea; Queirós, Sandro; Morais, Pedro; Baptista, Maria J.; Monaghan, Mark; Rodrigues, Nuno F.; D'hooge, Jan; Vilaça, João. L.; Barbosa, Daniel

    2015-03-01

    Given the dynamic nature of cardiac function, correct temporal alignment of pre-operative models and intraoperative images is crucial for augmented reality in cardiac image-guided interventions. As such, the current study focuses on the development of an image-based strategy for temporal alignment of multimodal cardiac imaging sequences, such as cine Magnetic Resonance Imaging (MRI) or 3D Ultrasound (US). First, we derive a robust, modality-independent signal from the image sequences, estimated by computing the normalized cross-correlation between each frame in the temporal sequence and the end-diastolic frame. This signal is a resembler for the left-ventricle (LV) volume curve over time, whose variation indicates different temporal landmarks of the cardiac cycle. We then perform the temporal alignment of these surrogate signals derived from MRI and US sequences of the same patient through Dynamic Time Warping (DTW), allowing to synchronize both sequences. The proposed framework was evaluated in 98 patients, which have undergone both 3D+t MRI and US scans. The end-systolic frame could be accurately estimated as the minimum of the image-derived surrogate signal, presenting a relative error of 1.6 +/- 1.9% and 4.0 +/- 4.2% for the MRI and US sequences, respectively, thus supporting its association with key temporal instants of the cardiac cycle. The use of DTW reduces the desynchronization of the cardiac events in MRI and US sequences, allowing to temporally align multimodal cardiac imaging sequences. Overall, a generic, fast and accurate method for temporal synchronization of MRI and US sequences of the same patient was introduced. This approach could be straightforwardly used for the correct temporal alignment of pre-operative MRI information and intra-operative US images.

  8. Preconception Counseling for Women With Cardiac Disease.

    Science.gov (United States)

    Clapp, Mark A; Bernstein, Sarah N

    2017-09-01

    All providers who care for reproductive-aged women with cardiac disease should assess these patients' desires and plans for pregnancy at every encounter. For those considering pregnancy, preconception counseling, often performed by a maternal-fetal medicine specialist, can help patients understand the potential implications of pregnancy on their health and estimate the risks of an adverse cardiac event prior to conceiving. There are cardiac conditions, such as pulmonary hypertension and aortic stenosis, in which pregnancy may be contraindicated given the high morbidity and mortality; there are tools available to help quantify a patient's risk. Furthermore, some cardiac lesions may be inherited, which may warrant parental testing or a discussion of strategies to reduce the risk of an affected child, such as the use of assisted reproductive technologies. Preconception counseling is also important to identify other maternal risk factors, such as obesity, hypertension, and tobacco use, which are associated with adverse pregnancy outcomes and develop a strategy to mitigate their potential risks, ideally before pregnancy. For women on medications for their heart disease or other comorbidities, a thorough review of these medications can potentially avoid an exposure to a teratogen during conception and pregnancy. Once pregnant, a patient's obstetrical provider and cardiologist should work together to outline a plan to monitor a patient's cardiac status as the normal physiologic changes of pregnancy, such as increased blood volume and cardiac output, may challenge a patient's functional status and increase the risk for an adverse outcome. Labor and delivery planning are essential to ensure patients with cardiac disease deliver at the appropriate hospital, equipped with the staff and resources to care for women with complex conditions. In summary, preconception counseling aims to stratify a patient's risk in pregnancy, inform patients of possible complications, and discuss

  9. Cardiac radiology: centenary review.

    Science.gov (United States)

    de Roos, Albert; Higgins, Charles B

    2014-11-01

    During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

  10. Fast Registration of Cardiac Perfusion MRI

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille; Larsson, Henrik B. W.

    2003-01-01

    This abstract presents a novel method for registration of cardiac perfusion MRI sequences. By performing complex analyses of variance and clustering in an annotated training set off-line, our method provides real-time segmentation in an on-line setting. This renders the method feasible for live...

  11. in Cardiac Muscles of Hemorrhagic Shocked Rats

    African Journals Online (AJOL)

    Purpose: To investigate the protective effects of various resuscitating fluids on severe hemorrhagic shocked (HS) rats by comparing the expression changes of hsp90α in cardiac muscles and survival of rats. Methods: Western-blot and immunohistochemistry methods were performed to determine hsp90á expressions in ...

  12. Patch in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alireza Alizadeh Ghavidel

    2014-06-01

    Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

  13. Femoral arterial cannulation performed by residents: a comparison between ultrasound-guided and palpation technique in infants and children undergoing cardiac surgery.

    Science.gov (United States)

    Siddik-Sayyid, Sahar M; Aouad, Marie T; Ibrahim, Muhammad H; Taha, Samar K; Nawfal, Maud F; Tfaili, Youssef J; Kaddoum, Roland N

    2016-08-01

    Percutaneous cannulation of the femoral artery in the pediatric age group can be technically challenging, especially when performed by residents in training. We examined whether the use of real-time ultrasound guidance is superior to a palpation landmark technique for femoral artery catheterization in children undergoing heart surgery. Patients were prospectively randomized into two groups. In the palpation group, the femoral artery was cannulated using the traditional landmark method of palpation of arterial pulse. In the ultrasound group, cannulation was guided by real-time scanning with an ultrasound probe. Ten minutes were set as time limit for the resident's trials during which the time taken for attempted cannulation (primary outcome), number of attempts, number of successful cannulations on first attempt, and success rate were compared between the two groups. Adverse events were monitored on postoperative days 1 and 3. A total of 106 patients were included in the study. The time taken for attempted femoral artery cannulation was shorter (301 ± 234 vs 420 ± 248 s; difference in mean: 119; 95% confidence interval (CI) of difference: 26-212; P = 0.012) and the number of attempts was lower [1 (1-10) vs 2 (1-5); difference in median: 1, 95% CI of difference: 0.28-1.72; P = 0.003] in the ultrasound group compared with the palpation group. The number of successful cannulations on first attempt was higher in the ultrasound group compared with palpation group [24/53 (45%) vs 13/53 (25%); odds ratio (OR): 2.54, 95% CI: 1.11-5.82; P = 0.025]. The number of patients who had successful cannulation was 31 of 55 (58%) in the palpation group and 40 of 53 (75%) in the ultrasound group (OR: 2.18, 95% CI: 0.95-5.01; P = 0.06). None of the patients had adverse events at days 1 and 3. Ultrasound-guided femoral arterial cannulation in children when performed by anesthesia residents is superior to the palpation technique based on the reduction of the time taken for attempted

  14. Cardiac Manifestation of Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Werner, Rudolf A; Rudelius, Martina; Thurner, Annette; Higuchi, Takahiro; Lapa, Constantin

    2016-07-01

    Here, we report on a 38-year-old man with unclear right heart failure. Imaging with cardiac MRI and combined PET/CT with F-FDG revealed a hypermetabolic mass extending from the right ventricle to the atrium. In addition, intense glucose utilization throughout the bone marrow was noted. Biopsies of both bone marrow and cardiac mass were performed and revealed precursor B-cell acute lymphoblastic leukemia with gross leukemic infiltration of the myopericardium, a rare manifestation of acute lymphoblastic leukemia at initial diagnosis.

  15. Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM)

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, Denis [CHU Caen and Normandy University, Department of Nuclear Medicine, Caen (France); Normandy University, Caen (France); Marie, Pierre-Yves [University of Lorraine, Faculty of Medicine, Nancyclotep Experimental Imaging Platform, Nancy (France); University of Lorraine, Faculty of Medicine, CHU Nancy, Department of Nuclear Medicine, Nancy (France); University of Lorraine, Faculty of Medicine, Nancy (France); Ben-Haim, Simona [University College London, University College Hospital, Institute of Nuclear Medicine, London (United Kingdom); Chaim Sheba Medical Center, Department of Nuclear Medicine, Ramat Gan (Israel); Rouzet, Francois [University Hospital of Paris-Bichat, UMR 1148, Inserm et Paris Diderot-Paris 7 University Paris, Department of Nuclear Medicine, Paris (France); UMR 1148, Inserm and Paris Diderot-Paris 7 University Paris, Paris (France); Songy, Bernard [Centre Cardiologique du Nord, Saint-Denis (France); Giordano, Alessandro [Institute of Nuclear Medicine, Catholic University of Sacred Heart, Largo A. Gemelli, Department of Bioimages and Radiological Sciences, Rome (Italy); Gimelli, Alessia [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); Hyafil, Fabien [Bichat University Hospital, Assistance Publique - Hopitaux de Paris, UMR 1148, Inserm and Paris Diderot-Paris 7 University, Department of Nuclear Medicine, Paris (France); Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, Florence (Italy); Bucerius, Jan [Maastricht University Medical Center, Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht (Netherlands); Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht (Netherlands); University Hospital RWTH Aachen, Department of Nuclear Medicine, Aachen (Germany); Verberne, Hein J. [Academic Medical Center, Department of Nuclear Medicine, Amsterdam (Netherlands); Slart, Riemer H.J.A. [University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen (Netherlands); University of Twente, Faculty of Science and Technology, Department of Biomedical Photonic Imaging, Enschede (Netherlands); Lindner, Oliver [Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeynhausen (Germany); Collaboration: Cardiovascular Committee of the European Association of Nuclear Medicine (EANM)

    2016-12-15

    The trade-off between resolution and count sensitivity dominates the performance of standard gamma cameras and dictates the need for relatively high doses of radioactivity of the used radiopharmaceuticals in order to limit image acquisition duration. The introduction of cadmium-zinc-telluride (CZT)-based cameras may overcome some of the limitations against conventional gamma cameras. CZT cameras used for the evaluation of myocardial perfusion have been shown to have a higher count sensitivity compared to conventional single photon emission computed tomography (SPECT) techniques. CZT image quality is further improved by the development of a dedicated three-dimensional iterative reconstruction algorithm, based on maximum likelihood expectation maximization (MLEM), which corrects for the loss in spatial resolution due to line response function of the collimator. All these innovations significantly reduce imaging time and result in a lower patient's radiation exposure compared with standard SPECT. To guide current and possible future users of the CZT technique for myocardial perfusion imaging, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, has decided to examine the current literature regarding procedures and clinical data on CZT cameras. The committee hereby aims (1) to identify the main acquisitions protocols; (2) to evaluate the diagnostic and prognostic value of CZT derived myocardial perfusion, and finally (3) to determine the impact of CZT on radiation exposure. (orig.)

  16. Autoantibodies and Cardiac Arrhythmias

    Science.gov (United States)

    Lee, Hon-Chi; Huang, Kristin T. L.; Wang, Xiao-Li; Shen, Win-Kuang

    2013-01-01

    Autoimmune diseases are associated with significant morbidity and mortality, afflicting about 5% of the population of the United States. They encompass a wide range of disorders that affect all organs of the human body and have a predilection for women. In the past, autoimmune pathogenesis was not thought to be a major mechanism for cardiovascular disorders, and potential relationships remain understudied. However, accumulating evidence suggests that a number of vascular and cardiac conditions are autoimmune-mediated. Recent studies indicate that autoantibodies play an important role in the development of cardiac arrhythmias, including atrial fibrillation, modulation of autonomic influences on heart rate and rhythm, conduction system abnormalities, and ventricular arrhythmias. This manuscript will review the current evidence for the role of autoantibodies in the development of cardiac arrhythmias. PMID:21740882

  17. Assessing Cardiac Metabolism

    Science.gov (United States)

    Taegtmeyer, Heinrich; Young, Martin E.; Lopaschuk, Gary D.; Abel, E. Dale; Brunengraber, Henri; Darley-Usmar, Victor; Des Rosiers, Christine; Gerszten, Robert; Glatz, Jan F.; Griffin, Julian L.; Gropler, Robert J.; Holzhuetter, Hermann-Georg; Kizer, Jorge R.; Lewandowski, E. Douglas; Malloy, Craig R.; Neubauer, Stefan; Peterson, Linda R.; Portman, Michael A.; Recchia, Fabio A.; Van Eyk, Jennifer E.; Wang, Thomas J.

    2016-01-01

    In a complex system of interrelated reactions, the heart converts chemical energy to mechanical energy. Energy transfer is achieved through coordinated activation of enzymes, ion channels, and contractile elements, as well as structural and membrane proteins. The heart’s needs for energy are difficult to overestimate. At a time when the cardiovascular research community is discovering a plethora of new molecular methods to assess cardiac metabolism, the methods remain scattered in the literature. The present statement on “Assessing Cardiac Metabolism” seeks to provide a collective and curated resource on methods and models used to investigate established and emerging aspects of cardiac metabolism. Some of those methods are refinements of classic biochemical tools, whereas most others are recent additions from the powerful tools of molecular biology. The aim of this statement is to be useful to many and to do justice to a dynamic field of great complexity. PMID:27012580

  18. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa

    2002-01-01

    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  19. Fetal Cardiac Interventions

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2015-04-01

    Full Text Available The present article aims to highlight fetal cardiac interventions (FCIs in terms of indications, strategies, and fetal prognoses. FCIs of the early years were predominantly pharmacological therapies for fetal arrhythmia or heart block. A transplacental transmission of therapeutic agents has now become the main route of pharmacological FCIs. There have been various FCI strategies, which can be categorized into three types: pharmacological, open FCIs, and closed FCIs. Rather than as a routine management for materno-fetal cardiac disorders, however, FCIs are only applied in those fetal cardiac disorders that are at an increased risk of mortality and morbidity and warrant an interventional therapy. Pharmacological FCIs have been well applied in fetal arrhythmias but require further investigations for novel therapeutic agents. The development of open FCI in humans is an issue for the long run. Closed FCIs may largely rely on advanced imaging techniques. Hybrid FCIs might be the future goal in the treatment of fetal heart diseases.

  20. Comprehensive cardiac rehabilitation

    DEFF Research Database (Denmark)

    Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O

    2006-01-01

    OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

  1. Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

    Science.gov (United States)

    Jarvis, Stuart; Kovacs, Caroline; Briggs, Jim; Meredith, Paul; Schmidt, Paul E; Featherstone, Peter I; Prytherch, David R; Smith, Gary B

    2015-08-01

    Although the weightings to be summed in an early warning score (EWS) calculation are small, calculation and other errors occur frequently, potentially impacting on hospital efficiency and patient care. Use of a simpler EWS has the potential to reduce errors. We truncated 36 published 'standard' EWSs so that, for each component, only two scores were possible: 0 when the standard EWS scored 0 and 1 when the standard EWS scored greater than 0. Using 1564,153 vital signs observation sets from 68,576 patient care episodes, we compared the discrimination (measured using the area under the receiver operator characteristic curve--AUROC) of each standard EWS and its truncated 'binary' equivalent. The binary EWSs had lower AUROCs than the standard EWSs in most cases, although for some the difference was not significant. One system, the binary form of the National Early Warning System (NEWS), had significantly better discrimination than all standard EWSs, except for NEWS. Overall, Binary NEWS at a trigger value of 3 would detect as many adverse outcomes as are detected by NEWS using a trigger of 5, but would require a 15% higher triggering rate. The performance of Binary NEWS is only exceeded by that of standard NEWS. It may be that Binary NEWS, as a simplified system, can be used with fewer errors. However, its introduction could lead to significant increases in workload for ward and rapid response team staff. The balance between fewer errors and a potentially greater workload needs further investigation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Robotic cardiac surgery: an anaesthetic challenge.

    Science.gov (United States)

    Wang, Gang; Gao, Changqing

    2014-08-01

    Robotic cardiac surgery with the da Vinci robotic surgical system offers the benefits of a minimally invasive procedure, including a smaller incision and scar, reduced risk of infection, less pain and trauma, less bleeding and blood transfusion requirements, shorter hospital stay and decreased recovery time. Robotic cardiac surgery includes extracardiac and intracardiac procedures. Extracardiac procedures are often performed on a beating heart. Intracardiac procedures require the aid of peripheral cardiopulmonary bypass via a minithoracotomy. Robotic cardiac surgery, however, poses challenges to the anaesthetist, as the obligatory one-lung ventilation (OLV) and CO2 insufflation may reduce cardiac output and increase pulmonary vascular resistance, potentially resulting in hypoxaemia and haemodynamic compromise. In addition, surgery requires appropriate positioning of specialised cannulae such as an endopulmonary vent, endocoronary sinus catheter, and endoaortic clamp catheter under the guidance of transoesophageal echocardiography. Therefore, cardiac anaesthetists should have a working knowledge of these systems, OLV and haemodynamic support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Almanac 2013: cardiac arrhythmias and pacing.

    Science.gov (United States)

    Liew, Reginald

    2013-10-01

    Important advances have been made in the past few years in the fields of clinical cardiac electrophysiology and pacing. Researchers and clinicians have a greater understanding of the pathophysiological mechanisms underlying atrial fibrillation (AF), which has transpired into improved methods of detection, risk stratification, and treatments. The introduction of novel oral anticoagulants has provided clinicians with alternative options in managing patients with AF at moderate to high thromboembolic risk and further data has been emerging on the use of catheter ablation for the treatment of symptomatic AF. Another area of intense research in the field of cardiac arrhythmias and pacing is in the use of cardiac resynchronisation therapy (CRT) for the treatment of patients with heart failure. Following the publication of major landmark randomised controlled trials reporting that CRT confers a survival advantage in patients with severe heart failure and improves symptoms, many subsequent studies have been performed to further refine the selection of patients for CRT and determine the clinical characteristics associated with a favourable response. The field of sudden cardiac death and implantable cardioverter defibrillators also continues to be actively researched, with important new epidemiological and clinical data emerging on improved methods for patient selection, risk stratification, and management. This review covers the major recent advances in these areas related to cardiac arrhythmias and pacing.

  4. ACUTE RENAL FAILURE AFTER CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    N Safai

    2008-08-01

    Full Text Available "nAcute renal failure (ARF following cardiac surgery occurs in 1 to 10% of patients. Patients who develop ARF have higher rates of mortality. This study was undertaken to estimate the role of perioperative variables in predicting of post cardiac surgery ARF. We studied a cohort of 398 adult patients who underwent cardiac surgery at our institution from February 2004 to February 2006. Adult patients who were scheduled for cardiac valvular surgery, coronary artery bypass grafting (CABG or both, with or without cardiopulmonary bypass (CPB were included. Exclusion criteria were death within two days of operation (n= 8, incomplete patient data, and preexisting renal dysfunction and dialysis requirement or a baseline serum creatinine > 4 mg/dl. Age, sex, left ventricular ejection fraction, diabetes, preoperative, presence of proteinuria (on dipstick, type of surgery, use of CPB and duration of surgery were recorded. A logistic regression analysis was performed to assess independent contribution of variables in the risk of ARF. A binary logistic regression revealed age was an independent predictor of ARF (P < 0.05. When both all variables were included in a multinominal logistic regression model, preoperative proteinuria independently predicted ARF (Odds ratio= 3.91, 95% CI: 1.55-9.91, P = 0.004. Our results revealed that special considerations should be given to elderly and patients with proteinuria when managing post cardiac surgery ARF.

  5. Cardiac Physiology of Aging: Extracellular Considerations.

    Science.gov (United States)

    Horn, Margaux A

    2015-07-01

    Aging is a major risk factor for the development of cardiovascular disease, with the majority of affected patients being elderly. Progressive changes to myocardial structure and function occur with aging, often in concert with underlying pathologies. However, whether chronological aging results in a remodeled "aged substrate" has yet to be established. In addition to myocyte contractility, myocardial performance relies heavily on the cardiac extracellular matrix (ECM), the roles of which are as dynamic as they are significant; including providing structural integrity, assisting in force transmission throughout the cardiac cycle and acting as a signaling medium for communication between cells and the extracellular environment. In the healthy heart, ECM homeostasis must be maintained, and matrix deposition is in balance with degradation. Consequently, alterations to, or misregulation of the cardiac ECM has been shown to occur in both aging and in pathological remodeling with disease. Mounting evidence suggests that age-induced matrix remodeling may occur at the level of ECM control; including collagen synthesis, deposition, maturation, and degradation. Furthermore, experimental studies using aged animal models not only suggest that the aged heart may respond differently to insult than the young, but the identification of key players specific to remodeling with age may hold future therapeutic potential for the treatment of cardiac dysfunction in the elderly. This review will focus on the role of the cardiac interstitium in the physiology of the aging myocardium, with particular emphasis on the implications to age-related remodeling in disease. © 2015 American Physiological Society.

  6. Unusual manifestations of penetrating cardiac injuries.

    Science.gov (United States)

    Fallah-Nejad, M; Wallace, H W; Su, C C; Kutty, A C; Blakemore, W S

    1975-11-01

    Penetrating cardiac injuries frequently first appear in an unusual and insidious manner, and their diagnosis may not be immediately obvious. In a series of 20 cases of cardiac injury, ten cases were indicative of such subtle symptoms, several of which were life-threatening. These unusual manifestations can be categorized as early, intermediate, or late. Early problems of four patients included the following: (1) sudden onset of shock during laparotomy, performed due to apparent abdominal trauma; (2) cardiac arrest on arrival in the emergency room; and (3) cerebral air embolus and mimicked symptoms of possible irreversible anoxic brain damage. The intermediate manifestations of cardiac injury are usually discovered in the early recovery period, and include myocardial infarction with cardiogenic shock and bullet embolus to a peripheral artery. Intermediate manifestations were observed in two patients. Four patients had late complications that included pseudoaneurysm, ventricular septal defect, valvular damage, and recurrent pericarditis. These late complications were observed between one month and 21 years after cardiac injury. This indicates the necessity of long-term follow-up of these patients.

  7. Cardiac Arrest: MedlinePlus Health Topic

    Science.gov (United States)

    ... and Blood Institute Start Here About Cardiac Arrest (American Heart Association) Sudden Cardiac Arrest (Texas Heart Institute) Also in ... Blood Institute) Understand Your Risk for Cardiac Arrest (American Heart Association) Warning Signs of Heart Attack, Stroke and Cardiac ...

  8. Cardiac optogenetics : using light to monitor cardiac physiology

    NARCIS (Netherlands)

    Koopman, Charlotte D.|info:eu-repo/dai/nl/41375491X; Zimmermann, Wolfram-Hubertus; Knöpfel, Thomas; de Boer, Teun P.|info:eu-repo/dai/nl/30481878X

    2017-01-01

    Our current understanding of cardiac excitation and its coupling to contraction is largely based on ex vivo studies utilising fluorescent organic dyes to assess cardiac action potentials and signal transduction. Recent advances in optogenetic sensors open exciting new possibilities for cardiac

  9. Exercise-related cardiac arrest in cardiac rehabilitation - The ...

    African Journals Online (AJOL)

    ... to establish the safety of cardiac rehabilitation as a medical intervention at the Johannesburg Cardiac Rehabilitation Centre from its inception in September 1982 to July 1988, and analyses the medical status of patients who suffered a cardiac arrest (CA) in order to determine possible factors predictive of sudden death.

  10. THE CARDIAC ANXIETY QUESTIONNAIRE : CROSS-VALIDATION AMONG CARDIAC INPATIENTS

    NARCIS (Netherlands)

    van Beek, M. H. C. T.; Voshaar, R. C. Oude; van Deelen, F. M.; van Balkom, A. J. L. M.; Pop, G.; Speckens, A. E. M.

    2012-01-01

    Objective: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the

  11. The cardiac anxiety questionnaire: cross-validation among cardiac inpatients

    NARCIS (Netherlands)

    Beek, M.H. van; Oude Voshaar, R.C.; van Deelen, F.M.; Balkom, A.J. van; Pop, G.A.; Speckens, A.E.

    2012-01-01

    OBJECTIVE: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the

  12. The Cardiac Anxiety Questionnaire: cross-validation among cardiac inpatients

    NARCIS (Netherlands)

    van Beek, M.H.C.T.; Voshaar, R.C.O.; van Deelen, F.M.; van Balkom, A.J.L.M.; Pop, G.; Speckens, A.E.M.

    2012-01-01

    Objective: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the

  13. Exercise-related cardiac cardiac rehabilitation arrest In

    African Journals Online (AJOL)

    most important being myocardial infarction and cardiac arrest. (CA).1,2. 'Normal' ... myocardial infarction and CA in cardiac rehabilitation pro- ..... The acute risk of. Strenuous exercise.JAMA 1980; 244: 1799-1801. 5. Siscovick DS, Weiss NS, Fletcber RH et al. The incidence of primary cardiac arrest during vigorous exercise.

  14. Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study.

    Science.gov (United States)

    Arcopinto, Michele; Salzano, Andrea; Giallauria, Francesco; Bossone, Eduardo; Isgaard, Jörgen; Marra, Alberto M; Bobbio, Emanuele; Vriz, Olga; Åberg, David N; Masarone, Daniele; De Paulis, Amato; Saldamarco, Lavinia; Vigorito, Carlo; Formisano, Pietro; Niola, Massimo; Perticone, Francesco; Bonaduce, Domenico; Saccà, Luigi; Colao, Annamaria; Cittadini, Antonio

    2017-01-01

    Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD in mild-to-moderate CHF and to explore clinical and functional correlates of GHD. One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay. GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF. GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also

  15. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease

    Directory of Open Access Journals (Sweden)

    James Yates

    2016-08-01

    Full Text Available Background: Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease. This has not been reported in a general practice setting. Aim: To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. Design and setting: A prospective observational study of 80 patients aged over 50 years and who had not received echocardiography or chest CT within 12 months presenting to a general practice. Method: Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. Results and conclusion: Echocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20% patients, including aortic stenosis in 9 (11% and cardiac failure in 7 (9%, which were missed by clinical examination in 10 (62.5% of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease including referral for diagnostic echocardiography in 8 (10%, commencement of heart failure treatment in 3 (4% and referral to a cardiologist in 1 patient (1%. Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50 years presenting to a general practice.

  16. Cardiac output measurement

    Directory of Open Access Journals (Sweden)

    Andreja Möller Petrun

    2014-02-01

    Full Text Available In recent years, developments in the measuring of cardiac output and other haemodynamic variables are focused on the so-called minimally invasive methods. The aim of these methods is to simplify the management of high-risk and haemodynamically unstable patients. Due to the need of invasive approach and the possibility of serious complications the use of pulmonary artery catheter has decreased. This article describes the methods for measuring cardiac output, which are based on volume measurement (Fick method, indicator dilution method, pulse wave analysis, Doppler effect, and electrical bioimpedance.

  17. Performative

    DEFF Research Database (Denmark)

    Sack-Nielsen, Torsten

    2015-01-01

    The article describes the potential of building skins being climate-adaptive. The principle of folding, and the relation between form and performance of facades are discussed here.......The article describes the potential of building skins being climate-adaptive. The principle of folding, and the relation between form and performance of facades are discussed here....

  18. Assessing quality in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Samer A.M. Nashef

    2005-07-01

    Full Text Available There is a the strong temporal, if not causal, link between the intervention and the outcome in cardiac surgery and therefore a link becomes established between operative mortality and the measurement of surgical performance. In Britain the law stipulates that data collected by any public body or using public funds must be made freely available. Tools and mechanisms we devise and develop are likely to form the models on which the quality of care is assessed in other surgical and perhaps medical specialties. Measuring professional performance should be done by the profession. To measure risk there are a number of scores as crude mortality is not enough. A very important benefit of assessing the risk of death is to use this knowledge in the determination of the indication to operate. The second benefit is in the assessment of the quality of care as risk prediction gives a standard against performance of hospitals and surgeons. Peer review and “naming and shaming” are two mechanisms to monitor quality. There are two potentially damaging outcomes from the publication of results in a league-table form: the first is the damage to the hospital; the second is to refuse to operate on high-risk patients. There is a real need for quality monitoring in medicine in general and in cardiac surgery in particular. Good quality surgical work requires robust knowledge of three crucial variables: activity, risk prediction and performance. In Europe, the three major specialist societies have agreed to establish the European Cardiovascular and Thoracic Surgery Institute of Accreditation (ECTSIA. Performance monitoring is soon to become imperative. If we surgeons are not on board, we shall have no control on its final destination, and the consequences may be equally damaging to us and to our patients.

  19. Data analysis in cardiac arrhythmias.

    Science.gov (United States)

    Rodrigo, Miguel; Pedrón-Torecilla, Jorge; Hernández, Ismael; Liberos, Alejandro; Climent, Andreu M; Guillem, María S

    2015-01-01

    Cardiac arrhythmias are an increasingly present in developed countries and represent a major health and economic burden. The occurrence of cardiac arrhythmias is closely linked to the electrical function of the heart. Consequently, the analysis of the electrical signal generated by the heart tissue, either recorded invasively or noninvasively, provides valuable information for the study of cardiac arrhythmias. In this chapter, novel cardiac signal analysis techniques that allow the study and diagnosis of cardiac arrhythmias are described, with emphasis on cardiac mapping which allows for spatiotemporal analysis of cardiac signals.Cardiac mapping can serve as a diagnostic tool by recording cardiac signals either in close contact to the heart tissue or noninvasively from the body surface, and allows the identification of cardiac sites responsible of the development or maintenance of arrhythmias. Cardiac mapping can also be used for research in cardiac arrhythmias in order to understand their mechanisms. For this purpose, both synthetic signals generated by computer simulations and animal experimental models allow for more controlled physiological conditions and complete access to the organ.

  20. Cardiac transplantation and mechanical assistance.

    Science.gov (United States)

    Jeevanandam, V

    1994-01-01

    The era of human heart transplantation began in 1967 by Dr. Christian Barnard in South Africa. Unfortunately, most patients died within the first year after transplantation from rejection or opportunistic infection, and the procedure was abandoned in all but a few centers. With the dedicated work of Dr. Norman Shumway from Stanford University, advances in immunosuppression and improved detection and management of rejection allowed heart transplantation to evolve from a laboratory curiosity into a clinical reality. Finally, with the introduction of the immunosuppressant, Cyclosporin A (CyA), in the 1980s the number of cardiac transplants being performed increased exponentially. Heart transplantation has entered the mainstream of surgical management of congestive heart failure and approximately 2000 procedures are performed annually in the United States and 3000 worldwide.

  1. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery.

    Science.gov (United States)

    Li, Ji-ke; Wang, Jun; Li, Tian-fa

    2014-12-01

    The management of cardiac arrest after cardiac surgery differs from the management of cardiac arrest under other circumstances. In other studies, interposed abdominal compression-cardiopulmonary resuscitation (IAC-CPR) resulted in a better outcome compared with conventional CPR. The aim of the present study was to determine the feasibility, safety and efficacy of IAC-CPR compared with conventional CPR in patients with cardiac arrest after cardiac surgery. Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 h after surgery were collected prospectively. Cardiac arrest was defined as the cessation of cardiac mechanical activity with the absence of a palpable central pulse, apnoea and unresponsiveness, including ventricular fibrillation, asystole and pulseless electrical activity. Forty patients were randomized to either conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially performed by compressing the abdomen midway between the xiphoid and the umbilicus during the relaxation phase of chest compression. If spontaneous circulation was not restored after 10-15 min, the surgical team would immediately proceed to resternotomy. The endpoints of the study were safety, return of spontaneous circulation (ROSC) >5 min, survival to hospital discharge and survival for 6 months. With IAC-CPR, there were more patients in terms of ROSC, survival to hospital discharge, survival for 6 months and fewer CPR-related injuries compared with patients who underwent conventional CPR. IAC-CPR is feasible and safe and may be advantageous in cases of cardiac arrest after cardiac surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

    Directory of Open Access Journals (Sweden)

    Satoshi Kurokawa

    2014-04-01

    Conclusion: Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery.

  3. Cardiac magnetic resonance imaging

    African Journals Online (AJOL)

    2011-03-06

    Mar 6, 2011 ... Bruce Spottiswoode has a BSc in Electrical Engineering from the University of the Witwatersrand and a PhD in Biomedical Engineering on cardiac MRI from the. University of Cape Town. He has worked on developing electronics for the CSIR, on MRI image reconstruction for Siemens, and on X-ray imaging ...

  4. Integrative Cardiac Health Project

    Science.gov (United States)

    2014-10-01

    weight loss in obese adolescents . Int J Obes (Lond). 2009;33:758–767. 27. Saarikangas J, Zhao H, Lappalainen P. Regulation of the actin cytoskeleton...primary cardiac arrest. Circulation. 1998;97(2):155Y160. 8. Sesso HD, Lee IM, Gaziano JM, Rexrode KM, Glynn RJ, Buring JE. Maternal and paternal

  5. Post cardiac injury syndrome

    DEFF Research Database (Denmark)

    Nielsen, S L; Nielsen, F E

    1991-01-01

    The post-pericardiotomy syndrome is a symptom complex which is similar in many respects to the post-myocardial infarction syndrome and these are summarized under the diagnosis of the Post Cardiac Injury Syndrome (PCIS). This condition, which is observed most frequently after open heart surgery...

  6. Statins in cardiac surgery

    African Journals Online (AJOL)

    Abstract. Background: Recent studies on the utility of statins in cardiac surgery appear to show conflicting results. Most studies are either retrospective or prospective observational, with small sample sizes. In order to address these limitations, we systematically reviewed studies from 2008 to the present, in order to determine ...

  7. Neonatal cardiac emergencies

    African Journals Online (AJOL)

    spending two wet years at the Royal Brompton Hospital as a Fellow in Paediatric Cardiac Intensive Care, during which he became tired of not being able to talk properly to his ..... on students. Nothing, apparently, can come between US students and sugary drinks. In states where schools banned sugary soft drinks to reduce.

  8. Cardiac CT angiography in children with congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Siripornpitak, Suvipaporn, E-mail: ssiripornpitak@yahoo.com [Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Pornkul, Ratanaporn [Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Khowsathit, Pongsak [Pediatric Cardiac Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand); Layangool, Thanarat; Promphan, Worakan [Pediatric Cardiology Unit, Queen Sirikit National Institute of Child Health, Bangkok (Thailand); Pongpanich, Boonchob [Pediatric Cardiac Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (Thailand)

    2013-07-15

    Cardiac imaging plays an important role in both congenital and acquired heart diseases. Cardiac computed tomography (angiography) cCT(A) is a non-invasive, increasingly popular, complementary modality to echocardiography in evaluation of congenital heart diseases (CHD) in children. Despite radiation exposure, cCT(A) is now commonly used for evaluation of the complex CHD, giving information of both intra-cardiac and extra-cardiac anatomy, coronary arteries, and vascular structures. This review article will focus on the fundamentals and essentials for performing cCT(A) in children, including radiation dose awareness, basic techniques, and strengths and weaknesses of cCT(A) compared with cardiac magnetic resonance imaging (cMRI), and applications. The limitations of this modality will also be discussed, including the CHD for which cMRI may be substituted.

  9. Serum tau and neurological outcome in cardiac arrest

    DEFF Research Database (Denmark)

    Mattsson, Niklas; Zetterberg, Henrik; Nielsen, Niklas

    2017-01-01

    OBJECTIVE: To test serum tau as a predictor of neurological outcome after cardiac arrest. METHODS: We measured the neuronal protein tau in serum at 24, 48, and 72 h after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome was poor...... neurological outcome, defined as Cerebral Performance Category 3-5 at 6 months. RESULTS: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median 38.5 [IQR 5.7-245] ng/L in poor versus 1.5 [0.7-2.4] ng/L in good outcome, for tau at 72 h, p... and 36°C targeted temperature after cardiac arrest. INTERPRETATION: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better than serum NSE, which is recommended in guidelines and currently used in clinical practice...

  10. Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries.

    Science.gov (United States)

    Hammer, Mark M; Raptis, Demetrios A; Cummings, Kristopher W; Mellnick, Vincent M; Bhalla, Sanjeev; Schuerer, Douglas J; Raptis, Constantine A

    2016-05-01

    Blunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described. To evaluate CT findings and associated injuries in patients with clinically diagnosed BCI. We identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries. CT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT. CT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. A methodology to split the total cumulative Hp(10) dose into the Hp(10) i doses received during various procedures performed by interventional cardiologist.

    Science.gov (United States)

    Domienik, Joanna

    2017-03-01

    The methodology describing how to split the cumulative Hp(10) dose of interventional cardiologists into Hp(10) i doses received during procedures of various types based on procedure-specific ELDO coefficients and Hp(3) doses per procedure is presented. The appropriate equations for Hp(10) i (Hp(10) for procedure type i), depending on the number of various procedure types (i  =  1 … 4) performed by a particular physician, are derived. The methodology can be applied to whole-body doses measured on the lead apron and therefore can be used for optimisation of work practices in those catheterisation labs where routine dosimeter is worn above the apron.

  12. Cardiac angiosarcoma: an unexpected diagnosis

    Directory of Open Access Journals (Sweden)

    Milton Roberto Furst Crenitte

    2014-09-01

    Full Text Available Cardiac angiosarcoma is a rare entity. The incidence through autopsy findings ranges between 0.001% and 0.03%. The disease usually presents with non-specific symptoms, although asymptomatic cases are frequent; therefore, diagnosis is unexpected and consequently delayed. The authors report the case of a middle-aged man with a recent onset cough and dyspnea. He sought medical care several times without receiving a definite diagnosis until a plain chest radiography was taken showing a mediastinal enlargement, which was the reason why he was hospitalized for clinical investigation. During the diagnostic workup, an echodopplercardiogram and a thoracic computed tomography were performed, showing a heterogeneous soft-tissue mass infiltrating the pericardium and the anterior atrial wall. Multiple and scattered pulmonary nodules were also present. A pulmonary nodule was biopsied, which revealed an angiosarcoma. The clinical features added to the radiological and histological findings permitted the diagnosis of right atrial angiosarcoma. The authors highlight the unexpected pattern in the presentation of cardiac tumors.

  13. Maternal cardiac metabolism in pregnancy

    Science.gov (United States)

    Liu, Laura X.; Arany, Zolt

    2014-01-01

    Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal ‘invasion’ profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology. PMID:24448314

  14. Diagnostic performance of coronary CT angiography, stress dual-energy CT perfusion, and stress perfusion single-photon emission computed tomography for coronary artery disease: Comparison with combined invasive coronary angiography and stress perfusion cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Hyun Woo; Ko, Sung Min; Hwang, Hweung Kon; So, Young; Yi, Jeong Geun [Konkuk University Medical Center, Research Institute of Biomedical Science, Konkuk University School of Medicine, Seoul (Korea, Republic of); Lee, Eun Jeong [Dept. of Nuclear Medicine, Seoul Medical Center, Seoul (Korea, Republic of)

    2017-06-15

    To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.

  15. Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Bistra Iordanova

    2017-08-01

    Full Text Available Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest.

  16. Self-gated cardiac cine imaging using phase information.

    Science.gov (United States)

    Seo, Hyunseok; Kim, Dongchan; Oh, Changheun; Park, HyunWook

    2017-03-01

    To obtain multiphase cardiac cine images with high resolution, a novel self-gating method for both cardiac and respiratory motions is proposed. The proposed method uses the phase of projection data obtained from a separate axial slice to measure cardiac and respiratory motion, after the acquisition of every k-space line in the image plane. Cardiac motion is estimated from the phase of the projection data passing through the aorta, which is amplified by superior-inferior directional bipolar gradients, whereas respiratory motion is estimated from the phase of the left-right directional projection data of the abdomen. To verify the proposed self-gating method, a simulation and in vivo steady state free precession cardiac imaging were performed. The proposed method provides high resolution multiphase cardiac cine images. Using the proposed self-gating method, the phase variation of the projection data offers information about cardiac and respiratory motions that is equivalent to external gating devices. The proposed method can capture time-resolved cardiac and respiratory motion from the phase information of the projection data. Because the projection data is obtained from a separate gating slice, the self-gating signals are not affected by imaging planes. Magn Reson Med 77:1216-1222, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  17. Evaluation of respiratory and cardiac motion correction schemes in dual gated PET/CT cardiac imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lamare, F., E-mail: frederic.lamare@chu-bordeaux.fr; Fernandez, P. [Univ. Bordeaux, INCIA, UMR 5287, F-33400 Talence (France); CNRS, INCIA, UMR 5287, F-33400 Talence (France); Service de Médecine Nucléaire, Hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux (France); Le Maitre, A.; Visvikis, D. [INSERM, UMR1101, LaTIM, Université de Bretagne Occidentale, 29609 Brest (France); Dawood, M.; Schäfers, K. P. [European Institute for Molecular Imaging, University of Münster, Mendelstr. 11, 48149 Münster (Germany); Rimoldi, O. E. [Vita-Salute University and Scientific Institute San Raffaele, Milan, Italy and CNR Istituto di Bioimmagini e Fisiologia Molecolare, Milan (Italy)

    2014-07-15

    Purpose: Cardiac imaging suffers from both respiratory and cardiac motion. One of the proposed solutions involves double gated acquisitions. Although such an approach may lead to both respiratory and cardiac motion compensation there are issues associated with (a) the combination of data from cardiac and respiratory motion bins, and (b) poor statistical quality images as a result of using only part of the acquired data. The main objective of this work was to evaluate different schemes of combining binned data in order to identify the best strategy to reconstruct motion free cardiac images from dual gated positron emission tomography (PET) acquisitions. Methods: A digital phantom study as well as seven human studies were used in this evaluation. PET data were acquired in list mode (LM). A real-time position management system and an electrocardiogram device were used to provide the respiratory and cardiac motion triggers registered within the LM file. Acquired data were subsequently binned considering four and six cardiac gates, or the diastole only in combination with eight respiratory amplitude gates. PET images were corrected for attenuation, but no randoms nor scatter corrections were included. Reconstructed images from each of the bins considered above were subsequently used in combination with an affine or an elastic registration algorithm to derive transformation parameters allowing the combination of all acquired data in a particular position in the cardiac and respiratory cycles. Images were assessed in terms of signal-to-noise ratio (SNR), contrast, image profile, coefficient-of-variation (COV), and relative difference of the recovered activity concentration. Results: Regardless of the considered motion compensation strategy, the nonrigid motion model performed better than the affine model, leading to higher SNR and contrast combined with a lower COV. Nevertheless, when compensating for respiration only, no statistically significant differences were

  18. The cardiac patient during Ramadan and Hajj.

    Science.gov (United States)

    Chamsi-Pasha, Hassan; Ahmed, Waqar H; Al-Shaibi, Khaled F

    2014-10-01

    The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of fasting on stable patients with cardiac disease are minimal and the majority of patients with stable cardiac illness can endure Ramadan fasting with no clinical deterioration. Fasting during Ramadan does not seem to increase hospitalizations for congestive heart failure. However, patients with decompensated heart failure or those requiring large doses of diuretics are strongly advised not to fast, particularly when Ramadan falls in summer. Patients with controlled hypertension can safely fast. However, patients with resistant hypertension should be advised not to fast until their blood pressure is reasonably controlled. Patients with recent myocardial infarction, unstable angina, recent cardiac intervention or cardiac surgery should avoid fasting. Physician advice should be individualized and patients are encouraged to seek medical advice before fasting in order to adjust their medications, if required. The performance of the Hajj pilgrimage is another pillar of Islam and is obligatory once in the lifetime for all adult Muslims who are in good health and can afford to undertake the journey. Hajj is a physically, mentally, emotionally, and spiritually demanding experience. Medical checkups one or two months before leaving for Hajj is warranted, especially for those with chronic illnesses such as cardiovascular disease. Patients with heart failure, uncontrolled hypertension, serious arrhythmias, unstable angina, recent myocardial infarction, or cardiac surgery should be

  19. Acute myocarditis: multiparametric cardiac MR imaging.

    Science.gov (United States)

    Luetkens, Julian A; Doerner, Jonas; Thomas, Daniel K; Dabir, Darius; Gieseke, Juergen; Sprinkart, Alois M; Fimmers, Rolf; Stehning, Christian; Homsi, Rami; Schwab, Joerg O; Schild, Hans; Naehle, Claas P

    2014-11-01

    To evaluate the diagnostic value of cardiac magnetic resonance (MR) imaging at 3 T in patients suspected of having acute myocarditis by using a multiparametric cardiac MR imaging approach including T1 relaxation time as an additional tool for tissue characterization. Ethics commission approval was obtained for this prospective study, and written informed consent was obtained from all subjects. Twenty four patients with acute myocarditis (mean age ± standard deviation, 34.7 years ± 15.1; 75% men) and 42 control subjects (mean age, 38.7 years ± 10.2; 64% men) were included. Cardiac MR imaging approaches included relative T2 short tau inversion-recovery signal intensity ratio (T2 ratio), early gadolinium enhancement ratio, late gadolinium enhancement, native T1 relaxation times, and extracellular volume fraction. Receiver operating characteristic analysis was performed to compare diagnostic performance. The reference standard was the clinical evidence for acute myocarditis. Native T1 relaxation times were significantly longer in patients with acute myocarditis than in control subjects (1185.3 msec ± 49.3 vs 1089.1 msec ± 44.9, respectively; P T1 relaxation times (0.94) were higher compared with those of other cardiac MR parameters (late gadolinium enhancement, 0.90; T2 ratio, 0.79; extracellular volume fraction, 0.71; early gadolinium enhancement ratio, 0.63; P = .390, .018, .002, and T1 relaxation times (cutoff, 1140 msec) were equivalent compared with those of the established combined Lake Louise criteria (sensitivity, 92%; specificity, 80%; diagnostic accuracy, 85%). Diagnostic performance with native T1 mapping was superior to that with T2 ratio and early gadolinium enhancement ratio, and specificity was higher with native T1 mapping than that with Lake Louise criteria. This study underlines the potential of native T1 relaxation times to complement current cardiac MR approaches in patients suspected of having acute myocarditis.

  20. Transcriptional profile of isoproterenol-induced cardiomyopathy and comparison to exercise-induced cardiac hypertrophy and human cardiac failure

    Directory of Open Access Journals (Sweden)

    McIver Lauren J

    2009-12-01

    Full Text Available Abstract Background Isoproterenol-induced cardiac hypertrophy in mice has been used in a number of studies to model human cardiac disease. In this study, we compared the transcriptional response of the heart in this model to other animal models of heart failure, as well as to the transcriptional response of human hearts suffering heart failure. Results We performed microarray analyses on RNA from mice with isoproterenol-induced cardiac hypertrophy and mice with exercise-induced physiological hypertrophy and identified 865 and 2,534 genes that were significantly altered in pathological and physiological cardiac hypertrophy models, respectively. We compared our results to 18 different microarray data sets (318 individual arrays representing various other animal models and four human cardiac diseases and identified a canonical set of 64 genes that are generally altered in failing hearts. We also produced a pairwise similarity matrix to illustrate relatedness of animal models with human heart disease and identified ischemia as the human condition that most resembles isoproterenol treatment. Conclusion The overall patterns of gene expression are consistent with observed structural and molecular differences between normal and maladaptive cardiac hypertrophy and support a role for the immune system (or immune cell infiltration in the pathology of stress-induced hypertrophy. Cross-study comparisons such as the results presented here provide targets for further research of cardiac disease that might generally apply to maladaptive cardiac stresses and are also a means of identifying which animal models best recapitulate human disease at the transcriptional level.

  1. Comparison of plasma cardiac troponin I concentrations among dogs with cardiac hemangiosarcoma, noncardiac hemangiosarcoma, other neoplasms, and pericardial effusion of nonhemangiosarcoma origin.

    Science.gov (United States)

    Chun, Ruthanne; Kellihan, Heidi B; Henik, Rosemary A; Stepien, Rebecca L

    2010-10-01

    To determine whether plasma cardiac troponin I (cTnl) concentrations can be used to identify cardiac involvement in dogs with hemangiosarcoma, exclude cardiac hemangiosarcoma in dogs with noncardiac hemangiosarcoma, and identify cardiac hemangiosarcoma in dogs with pericardial effusion. Cohort study. 57 dogs (18 with confirmed [5 dogs] or suspected [13] cardiac hemangiosarcoma, 14 with confirmed hemangiosarcoma involving sites other than the heart [noncardiac hemangiosarcoma], 10 with pericardial effusion not caused by hemangiosarcoma, and 15 with noncardiac nonhemangiosarcoma neoplasms). Plasma cTnl concentration was measured, and thoracic radiography, abdominal ultrasonography, and echocardiography were performed in each dog. The cTnl concentration was compared among groups. Median plasma cTnl concentration in dogs with cardiac hemangiosarcoma was significantly higher than the concentration in each of the other groups. A plasma cTnl concentration > 0.25 ng/mL could be used to identify cardiac involvement in dogs with hemangiosarcoma at any site (sensitivity, 78%; specificity, 71 %). A plasma cTnl concentration > 0.25 ng/mL could be used to identify cardiac hemangiosarcoma in dogs with pericardia effusion (sensitivity, 81%; specificity, 100%). The median plasma cTnl concentration was higher in dogs with cardiac hemangiosarcoma, compared with the median concentration in dogs with hemangiosarcoma at other sites, dogs with other neoplasms, and dogs with pericardial effusion not caused by hemangiosarcoma. The plasma cTnl concentration may be used to identify cardiac involvement in dogs with hemangiosarcoma and to identify cardiac hemangiosarcoma in dogs with pericardial effusion.

  2. Toward microendoscopy-inspired cardiac optogenetics in vivo: technical overview and perspective

    Science.gov (United States)

    Klimas, Aleksandra; Entcheva, Emilia

    2014-08-01

    The ability to perform precise, spatially localized actuation and measurements of electrical activity in the heart is crucial in understanding cardiac electrophysiology and devising new therapeutic solutions for control of cardiac arrhythmias. Current cardiac imaging techniques (i.e. optical mapping) employ voltage- or calcium-sensitive fluorescent dyes to visualize the electrical signal propagation through cardiac syncytium in vitro or in situ with very high-spatiotemporal resolution. The extension of optogenetics into the cardiac field, where cardiac tissue is genetically altered to express light-sensitive ion channels allowing electrical activity to be elicited or suppressed in a precise cell-specific way, has opened the possibility for all-optical interrogation of cardiac electrophysiology. In vivo application of cardiac optogenetics faces multiple challenges and necessitates suitable optical systems employing fiber optics to actuate and sense electrical signals. In this technical perspective, we present a compendium of clinically relevant access routes to different parts of the cardiac electrical conduction system based on currently employed catheter imaging systems and determine the quantitative size constraints for endoscopic cardiac optogenetics. We discuss the relevant technical advancements in microendoscopy, cardiac imaging, and optogenetics and outline the strategies for combining them to create a portable, miniaturized fiber-based system for all-optical interrogation of cardiac electrophysiology in vivo.

  3. Cardiac nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Gerson, M.C.

    1987-01-01

    The book begins with a review of the radionuclide methods available for evaluating cardiac perfusion and function. The authors discuss planar and tomographic thallium myocardial imaging, first-pass and equilibrium radionuclide angiography, and imaging with infarct-avid tracers. Several common but more specialized procedures are then reviewed: nonogemetric measurement of left ventricular volume, phase (Fourier) analysis, stroke volume ratio, right ventricular function, and diastolic function. A separate chapter is devoted to drug interventions and in particular the use of radionuclide ventriculography to monitor doxorubicin toxicity and therapy of congestive heart failure. The subsequent chapters provide a comprehensive guide to test selection, accuracy, and results in acute myocardial infarction, in postmyocardial infarction, in chronic coronary artery disease, before and after medical or surgical revascularization, in valvular heart disease, in cardiomyopathies, and in cardiac trauma.

  4. Cardiac Screening for Athletes

    OpenAIRE

    Senem Ozgur; Selmin Karademir

    2013-01-01

    As obesity and cardiovascular mortality has recently increased, sporting activities are recommended to people of all age groups more than past decades. Sudden cardiac death during sporting events resonate in a wide range of media and cause serious concern to the families. In order to reduce mortality, athlete screening has been raised. There is a disagreement about how to do the most effective and the least costly screening, also the necessity of screening. The American Heart Academy recommen...

  5. Frequency of Cardiac Arrhythmias in Patients with Aluminum Phosphide Poisoning

    Directory of Open Access Journals (Sweden)

    Umair Aziz

    2015-12-01

    Full Text Available Background: Cardiac failure is the major lethal consequence of aluminum phosphide (AlP poisoning. This study was designed to determine the frequency of cardiac arrhythmias in patients with AlP poisoning. Methods: In this prospective cross-sectional study, patients with definitive history of AlP poisoning treated at emergency department of Allied Hospital Faisalabad, Faisalabad, Pakistan, from July 2013 to November 2014 were included. On admission, twelve-lead electrocardiogram (ECG was performed for all patients. During admission, all patients underwent continuous cardiac monitoring using a cardiac monitor. If an arrhythmia was suspected on the cardiac monitor, another ECG was obtained immediately.  Results: During the study period, 100 patients with AlP poisoning (63% men were treated at Allied Hospital Faisalabad. Mean age of the patients was 26.7 ± 7.9 years ranging from 16 to 54 years. Tachycardia was detected in 68 patients and bradycardia in 12 patients. Hypotension was observed in 75 patients. Eighty patients developed cardiac arrhythmia. The most frequent arrhythmia was atrial fibrillation (31% of patients followed by ventricular fibrillation (20%, ventricular tachycardia (17%, 3rd degree AV block (7% and 2nd degree AV block (5%. In total, 78 patients died, depicting a 78% mortality rate following wheat pill poisoning. Among those who died, seventy-one patients had cardiac arrhythmia. Comparison of death rate between patients with and without cardiac arrhythmia showed a significant difference (71/80 (88.8% vs. 7/20 (35%; P < 0.001.  Conclusion: Wheat pill poisoning causes a very high mortality, and circulatory collapse is the major cause of death among these patients. Most of the patients with AlP poisoning develop cardiac arrhythmias which are invariably life threatening. Early detection of cardiac disorders and proper management of arrhythmias may reduce mortalities.

  6. Blunt cardiac trauma: lessons learned from the medical examiner.

    Science.gov (United States)

    Teixeira, Pedro G R; Georgiou, Chrysanthos; Inaba, Kenji; Dubose, Joseph; Plurad, David; Chan, Linda S; Toms, Carla; Noguchi, Thomas T; Demetriades, Demetrios

    2009-12-01

    The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries. All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis. The study population was divided into two groups according to the presence or absence of a cardiac injury and compared for differences in baseline characteristics and types of associated injuries. Of the 881 fatal victims of blunt trauma received by the Los Angeles County Forensic Medicine Division, 304 (35%) underwent a full autopsy with internal examination and were included in the analysis. The mean age was 43 years +/- 21 years, patients were more often men (71%) and were intoxicated in 39% of the cases. The most common mechanism was motor vehicle collision (50%), followed by pedestrian struck by auto (37%), and 32% had a cardiac injury. Death at the scene was significantly more common in patients with a cardiac injury (78% vs. 65%, p = 0.02). The right chambers were the most frequently injured (30%, right atrium; 27%, right ventricle). Among the 96 patients with cardiac injuries, 64% had transmural rupture. Multiple chambers were ruptured in 26%, the right atrium in 25%, and the right ventricle in 20% of these patients. Patients with cardiac injuries were significantly more likely to have other associated injuries: thoracic aorta (47% vs. 27%, p = 0.001), hemothorax (81% vs. 59%, p injury (77% vs. 48%, p cardiac injury. Of the 96 patients with a cardiac injury, 78% died at the scene of the crash and 22% died en route or at the hospital. Cardiac injury is a common autopsy finding after blunt traumatic fatalities, with the majority of deaths occurring at the scene. Patients with cardiac injuries are at significantly increased risk for

  7. Innovations in cardiac transplantation.

    Science.gov (United States)

    Hasan, Reema; Ela, Ashraf Abou El; Goldstein, Daniel

    2017-03-16

    As the number of people living with heart failure continues to grow, future treatments will focus on efficient donor organ donation and ensuring safe and durable outcomes. This review will focus on organ procurement, graft surveillance and emerging therapies. Preliminary studies into donation after cardiac death have indicated that this may be an effective means to increase the donor pool. Novel preservation techniques that include ex-vivo perfusion to improve donor metabolic stabilization prior to implantation may also expand the donor pool. Biomarkers, including circulating-free DNA, are emerging that could replace the endomyocardial biopsy for acute graft rejection, but we lack a risk predictive biomarker in heart transplantation. Novel immune suppressants are being investigated. Emerging therapeutics to reduce the development of chronic allograft vasculopathy are yet to be found. This review highlights the most recent studies and future possible therapies that will improve outcomes in cardiac transplantation. Larger clinical trials are currently taking place and will be needed in the future to develop and sustain current trends toward better survival rates with cardiac transplantation.

  8. Cardiac arrhythmogenesis and temperature.

    Science.gov (United States)

    Shah, Ujas; Bien, Harold; Entcheva, Emilia

    2006-01-01

    Fast processes in cardiac electrophysiology are often studied at temperatures lower than physiological. Extrapolation of values is based on widely accepted Q10 (Arrhenius) model of temperature dependence (ratio of kinetic properties for a 10 degrees C change in temperature). In this study, we set out to quantify the temperature dependence of essential parameters that define spatiotemporal behavior of cardiac excitation. Additionally, we examined temperature's effects on restitution dynamics. We employed fast fluorescence imaging with voltage-and calcium-sensitive dyes in neonatal rat cardiomyocyte sheets. Conduction velocity (CV), calcium transient duration (CTD), action potential duration (APD) and wavelength (W=CV*duration) change as functions of temperature were quantified. Using 24 degrees C as a reference point, we found a strong temperature-driven increase of CV (Q10=2.3) with smaller CTD and APD changes (Q10=1.33, 1.24, respectively). The spatial equivalents of voltage and calcium duration, wavelength, were slightly less sensitive to temperature with Q10=2.05 and 1.78, respectively, due to the opposing influences of decreasing duration with increased velocity. More importantly, we found that Q10 varies as a function of diastolic interval. Our results indicate the importance of examining temperature sensitivity across several frequencies. Armed with our results, experimentalists and modelers alike have a tool for reconciling different environmental conditions. In a broader sense, these data help better understand thermal influences on arrhythmia development or suppression such as during hibernation or cardiac surgery.

  9. Dental screening of pediatric cardiac surgical patients.

    Science.gov (United States)

    Hayes, P A; Fasules, J

    2001-01-01

    Dental screenings were completed on 209 pediatric patients six months and older that were scheduled for cardiac surgery from two different geographical locations. The screening involved an educational session on bacterial endocarditis and preventive dentistry followed by a dental examination. We found that sixty-two (30 percent) patients had seen a dentist regularly, ninety-three (44 percent) practiced daily oral hygiene and thirty-seven (18 percent) knew about bacterial endocarditis. Local dentists performed invasive procedures on seventy-one (34 percent) patients and thirty-four (48 percent) received antibiotic prophylaxis. Only twenty-three (68 percent) of the thirty-four patients received the then current American Heart Association antibiotic regimen. Dental disease was diagnosed in 175 (84 percent) of the 209 patients: 164 (78 percent) gingivitis; sixty (29 percent) caries; six (7 percent) dental abscess; three (1 percent) periodontal abscess; five (2 percent) periocornitis. Cardiac surgery was postponed in twenty-four (12 percent) patients. We conclude that parents lacked knowledge about bacterial endocarditis even after being informed during their routine cardiology visit, there appears to be a deficiency of knowledge among dentists regarding the indications and antibiotic regimen required to prevent bacterial endocarditis, and all cardiac surgical patients should have a dental exam and preventive dental program implemented prior to six months of age and dental screening prior to their cardiac surgery.

  10. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad

    2017-01-01

    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  11. Neurohumoral indicators of efficacy radiofrequency cardiac denervation

    Energy Technology Data Exchange (ETDEWEB)

    Evtushenko, A. V., E-mail: ave@cardio-tomsk.ru; Evtushenko, V. V. [National Research Tomsk State University, Tomsk (Russian Federation); Federal State Budgetary Scientific Institution “Research Institute for Cardiology”, Tomsk (Russian Federation); Saushkina, Yu. V.; Gusakova, A. M.; Suslova, T. E.; Dymbrylova, O. N.; Smyshlyaev, K. A.; Kurlov, I. O. [Federal State Budgetary Scientific Institution “Research Institute for Cardiology”, Tomsk (Russian Federation); Lishmanov, Yu. B.; Anfinogenova, Ya. D. [National Research Tomsk Polytechnic University, Tomsk (Russian Federation); Federal State Budgetary Scientific Institution “Research Institute for Cardiology”, Tomsk (Russian Federation); Sergeevichev, D. S. [Academician E.N. Meshalkin State Research Institute of Circulation Pathology, Novosibirsk (Russian Federation); Bykov, A. N.; Syryamkin, V. I.; Kistenev, Yu. V. [National Research Tomsk State University, Tomsk (Russian Federation); Lotkov, A. I. [Institute of Strength Physics and Materials Science of the Siberian Branch of the RAS, Tomsk (Russian Federation); Pokushalov, E. A.

    2015-11-17

    In this study, we compared pre- and postoperative parameters of the cardiac sympathetic innervation. The aim of the study was to examine the approaches to evaluating the quality of radiofrequency (RF)-induced cardiac denervation by using non-invasive and laboratory methods. The study included 32 people with long-lasting persistent atrial fibrillation (AF). The patients were divided into 2 groups according to the objectives of the study: group 1 (main) - 21 patients with mitral valve diseases, which simultaneously with radiofrequency ablation (RFA) AF carried out on the effects of the paraganglionic nervous plexuses by C. Pappone (2004) and N. Doll (2008) schemes. The second group (control) contained 11 patients with heart diseases in sinus rhythm (the RF denervation not been performed). All patients, who underwent surgical treatment, were received examination of cardiac sympathetic tone by using {sup 123}I-MIBG. All of them made blood analysis from ascending aorta and coronary sinus to determine the level of norepinephrine and its metabolites before and after cardiac denervation. Data of radionuclide examination are correlating with laboratory data.

  12. Cardiac dysfunction in a porcine model of pediatric malnutrition

    DEFF Research Database (Denmark)

    Fabiansen, Christian; Lykke, Mikkel; Nielsen, Anne-Louise Hother

    2015-01-01

    BACKGROUND: Half a million children die annually of severe acute malnutrition and cardiac dysfunction may contribute to the mortality. However, cardiac function remains poorly examined in cases of severe acute malnutrition. OBJECTIVE: To determine malnutrition-induced echocardiographic disturbances...... and longitudinal changes in plasma pro-atrial natriuretic peptide and cardiac troponin-T in a pediatric porcine model. METHODS AND RESULTS: Five-week old piglets (Duroc-x-Danish Landrace-x-Yorkshire) were fed a nutritionally inadequate maize-flour diet to induce malnutrition (MAIZE, n = 12) or a reference diet...... groups. The myocardial performance index was 86% higher in MAIZE vs AGE-REF (pMalnutrition associates with cardiac dysfunction in a pediatric porcine model by increased myocardial performance index and pro-atrial natriuretic peptide...

  13. Obesity-associated cardiac pathogenesis in broiler breeder hens: Pathological adaption of cardiac hypertrophy.

    Science.gov (United States)

    Chen, C Y; Lin, H Y; Chen, Y W; Ko, Y J; Liu, Y J; Chen, Y H; Walzem, R L; Chen, S E

    2017-07-01

    Broiler hens consuming feed to appetite (ad libitum; AL) show increased mortality. Feed restriction (R) typically improves reproductive performance and livability of hens. Rapidly growing broilers can exhibit increased mortality due to cardiac insufficiency but it is unknown whether the increased mortality of non-R broiler hens is also due to cardiac compromise. To assess cardiac growth and physiology in fully mature birds, 45-week-old hens were either continued on R rations or assigned to AL feeding for 7 or 21 days. AL hens exhibited increased bodyweight, adiposity, absolute and relative heart weight, ventricular hypertrophy, and cardiac protein/DNA ratio by d 21 (P growth was attributed to enhanced IGF-1-Akt-FoxO1 signaling and its downstream target, translation initiation factor 4E-BP1 in conjunction with down-regulation of ubiquitin ligase atrogin-1/MAFbx (P growth were further supported by uregulation of heart failure markers, BNP and MHC-β (P broiler hens results in maladaptive cardiac hypertrophy that progresses to overt pathogenesis in contractility and thereby increases mortality. Feed restriction provides clear physiological benefit to heart function of adult broiler hens. © 2017 Poultry Science Association Inc.

  14. Continuous cardiac output measurement: arterial pressure analysis versus thermodilution technique during cardiac surgery with cardiopulmonary bypass

    NARCIS (Netherlands)

    Lorsomradee, S.; Lorsomradee, S. R.; Cromheecke, S.; de Hert, S. G.

    2007-01-01

    This study compared cardiac output measured with an arterial pressure-based cardiac output measurement system and a thermodilution cardiac output measurement system. We studied 36 patients undergoing cardiac surgery with cardiopulmonary bypass. Simultaneous arterial pressure-based and thermodilution

  15. Biosynthesis of cardiac natriuretic peptides

    DEFF Research Database (Denmark)

    Goetze, Jens Peter

    2010-01-01

    Cardiac-derived peptide hormones were identified more than 25 years ago. An astonishing amount of clinical studies have established cardiac natriuretic peptides and their molecular precursors as useful markers of heart disease. In contrast to the clinical applications, the biogenesis of cardiac....... An inefficient post-translational prohormone maturation will also affect the biology of the cardiac natriuretic peptide system. This review aims at summarizing the myocardial synthesis of natriuretic peptides focusing on B-type natriuretic peptide, where new data has disclosed cardiac myocytes as highly...... competent endocrine cells. The structurally related atrial natriuretic peptide will be mentioned where appropriate, whereas C-type natriuretic peptide will not be considered as a cardiac peptide of relevance in mammalian physiology....

  16. Autonomic cardiac nerves: literature review.

    Science.gov (United States)

    Kuder, T; Nowak, E

    2015-01-01

    The aim of this paper was to summarise the knowledge about the autonomic cardiac innervation. It is generally known, that the cardiac nervous system consists of nerve plexoganglionic structures located mostly around the strategic regions of the heart. They consist of two main types of components: parasympathetic neurons, which exert an inhibitory effect, and sympathetic postganglionic nerve fibres, which stimulate the cardiac conduction system, and myocardial cells. However, many authors describe that cardiac ganglia contain various populations of neurons. The largest group are classical cholinergic neurons. The second group of cardiac neurons are cells of dual, cholinergic-adrenergic character. There is also subpopulation of small intensely fluoroscent cells of typically adrenergic phenotype. Moreover, many authors indicated the presence of various neurotransmitters in various combinations. In this way, the neurons in cardiac ganglia are a neurochemical complex beyond the classical vision of parasympathetic ganglia.

  17. Magnetic resonance imaging for cardiac tumors

    Energy Technology Data Exchange (ETDEWEB)

    Niwa, Koichiro; Tashima, Kazuyuki; Okajima, Yoshitomo; Nakajima, Hiromichi; Terai, Masaru; Nakajima, Hironori; Harada, Tsutomu; Ishida, Yoshikazu.

    1988-09-01

    We performed magnetic resonance imaging (MRI) in 4 patients with cardiac tumor (1 with rhabdomyoma, 1 with left atrial myxoma, and 2 with tumor of the left ventricular wall) for morphological evaluation of the tumor. ECG-gated MRI was performed by the spin echo imaging technique using a superconducting MRI system operating at 0.5 tesla. Spatial extension of the tumor was clearly demonstrated in all the patients. Gadolinium-DTPA (Gd-DTPA), was used in the 2 patients with tumor of the left ventricular myocardium to enhance the contrast, and allowed clear visualization of the tumor. These findings show the usefulness of MRI and MRI with Gd-DTPA for morphological evaluation of cardiac tumor.

  18. Medical robots in cardiac surgery ? application and perspectives

    OpenAIRE

    Kroczek, Karolina; Kroczek, Piotr; Nawrat, Zbigniew

    2017-01-01

    Medical robots offer new standards and opportunities for treatment. This paper presents a review of the literature and market information on the current situation and future perspectives for the applications of robots in cardiac surgery. Currently in the United States, only 10% of thoracic surgical procedures are conducted using robots, while globally this value remains below 1%. Cardiac and thoracic surgeons use robotic surgical systems increasingly often. The goal is to perform more than on...

  19. Computational Modelling of Cardiac Electrophysiology: from Cell to Bedside

    OpenAIRE

    Passini, Elisa

    2015-01-01

    Heart diseases are the leading cause of death worldwide, both for men and women. However, the ionic mechanisms underlying many cardiac arrhythmias and genetic disorders are not completely understood, thus leading to a limited efficacy of the current available therapies and leaving many open questions for cardiac electrophysiologists. On the other hand, experimental data availability is still a great issue in this field: most of the experiments are performed in vitro and/or using animal mod...

  20. Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: simple cardiac ECMO score.

    Science.gov (United States)

    Peigh, Graham; Cavarocchi, Nicholas; Keith, Scott W; Hirose, Hitoshi

    2015-10-01

    Although the use of cardiac extracorporeal membrane oxygenation (ECMO) is increasing in adult patients, the field lacks understanding of associated risk factors. While standard intensive care unit risk scores such as SAPS II (simplified acute physiology score II), SOFA (sequential organ failure assessment), and APACHE II (acute physiology and chronic health evaluation II), or disease-specific scores such as MELD (model for end-stage liver disease) and RIFLE (kidney risk, injury, failure, loss of function, ESRD) exist, they may not apply to adult cardiac ECMO patients as their risk factors differ from variables used in these scores. Between 2010 and 2014, 73 ECMOs were performed for cardiac support at our institution. Patient demographics and survival were retrospectively analyzed. A new easily calculated score for predicting ECMO mortality was created using identified risk factors from univariate and multivariate analyses, and model discrimination was compared with other scoring systems. Cardiac ECMO was performed on 73 patients (47 males and 26 females) with a mean age of 48 ± 14 y. Sixty-four percent of patients (47/73) survived ECMO support. Pre-ECMO SAPS II, SOFA, APACHE II, MELD, RIFLE, PRESERVE, and ECMOnet scores, were not correlated with survival. Univariate analysis of pre-ECMO risk factors demonstrated that increased lactate, renal dysfunction, and postcardiotomy cardiogenic shock were risk factors for death. Applying these data into a new simplified cardiac ECMO score (minimal risk = 0, maximal = 5) predicted patient survival. Survivors had a lower risk score (1.8 ± 1.2) versus the nonsurvivors (3.0 ± 0.99), P ECMO patients did not correlate with ECMO survival, whereas a new simplified cardiac ECMO score provides survival predictability. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Cardiac Autonomic Function Is Associated With the Coronary Microcirculatory Function in Patients With Type 2 Diabetes

    DEFF Research Database (Denmark)

    von Scholten, Bernt Johan; Hansen, Christian Stevns; Hasbak, Philip

    2016-01-01

    ). In a cross-sectional design, coronary flow reserve (CFR) assessed by cardiac (82)Rb-positron emission tomography/computed tomography, cardiac autonomic reflex tests, and heart rate variability indices were performed in 55 patients with T2DM, without cardiovascular disease, and in 28 control subjects. Cardiac......Cardiac autonomic dysfunction and cardiac microvascular dysfunction are diabetic complications associated with increased mortality, but the association between these has been difficult to assess. We applied new and sensitive methods to assess this in patients with type 2 diabetes mellitus (T2DM....... The late heart-to- mediastinum ratio remained correlated with CFR after further adjustment. In patients with T2DM without cardiovascular disease, we demonstrate an independent association between cardiac autonomic function and CFR. We suggest that a reduced cardiac autonomic function and damage...

  2. Ubiquitous health monitoring and real-time cardiac arrhythmias detection: a case study.

    Science.gov (United States)

    Li, Jian; Zhou, Haiying; Zuo, Decheng; Hou, Kun-Mean; De Vaulx, Christophe

    2014-01-01

    As the symptoms and signs of heart diseases that cause sudden cardiac death, cardiac arrhythmia has attracted great attention. Due to limitations in time and space, traditional approaches to cardiac arrhythmias detection fail to provide a real-time continuous monitoring and testing service applicable in different environmental conditions. Integrated with the latest technologies in ECG (electrocardiograph) analysis and medical care, the pervasive computing technology makes possible the ubiquitous cardiac care services, and thus brings about new technical challenges, especially in the formation of cardiac care architecture and realization of the real-time automatic ECG detection algorithm dedicated to care devices. In this paper, a ubiquitous cardiac care prototype system is presented with its architecture framework well elaborated. This prototype system has been tested and evaluated in all the clinical-/home-/outdoor-care modes with a satisfactory performance in providing real-time continuous cardiac arrhythmias monitoring service unlimitedly adaptable in time and space.

  3. [Development and importance of outpatient cardiac rehabilitation in German-speaking countries].

    Science.gov (United States)

    Benzer, W

    2014-07-01

    Cardiac rehabilitation is a coordinated treatment approach. The interdisciplinary team aims to provide the best possible physical and psychological outcomes for patients with cardiac diseases. Patients should be enable to independently resume work and and social life. Furthermore cardiac rehabilitation wants to limit or reverse the progress of cardiac disease through sustained health-related life habits. Cardiac rehabilitation significantly contributes to long-term success based on comprehensive care of cardiac patients. Outpatient cardiac rehabilitation has shown to be effective after myocardial infarction, coronary artery bypass grafting and chronic heart failure. However randomized controlled trials were performed only in Anglo-American countries. In these trials effects were observed mainly for exercise-based cardiac rehabilitation programs. Because the results have been derived from different program settings they cannot simply be translated to German-speaking countries. However, several cohort studies predominantly performed in Germany also revealed effects of inpatient and outpatient cardiac rehabilitation programs for German-speaking countries. The most recent results demonstrated a significant reduction of recurrent events in patients after inpatient cardiac rehabilitation. Following the current evidence concerning the effect of inpatient and outpatient cardiac rehabilitation programs particularly after myocardial infarction international guidelines provide Class I (USA) and IIa (Europe) recommendation for this treatment intervention.In contrast to Anglo-American countries cardiac rehabilitation in Austria, Germany and Switzerland was established at its beginning exclusively for inpatient programs. In addition more and more outpatient programs were introduced in the last decades. Nevertheless inpatient cardiac rehabilitation is still the most common program in German-speaking countries.Future challenges of cardiac rehabilitation should not address the

  4. Multicenter Study of Planar Technetium 99m Pyrophosphate Cardiac Imaging: Predicting Survival for Patients With ATTR Cardiac Amyloidosis.

    Science.gov (United States)

    Castano, Adam; Haq, Muhammad; Narotsky, David L; Goldsmith, Jeff; Weinberg, Richard L; Morgenstern, Rachelle; Pozniakoff, Ted; Ruberg, Frederick L; Miller, Edward J; Berk, John L; Dispenzieri, Angela; Grogan, Martha; Johnson, Geoffrey; Bokhari, Sabahat; Maurer, Mathew S

    2016-11-01

    Transthyretin cardiac amyloidosis (also known as ATTR cardiac amyloidosis) is an increasingly recognized cause of heart failure with preserved ejection fraction. In single-center studies, technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging noninvasively detects ATTR cardiac amyloidosis, but the accuracy of this technique in a multicenter study and the association of Tc 99m PYP myocardial uptake with survival are unknown. To assess Tc 99m PYP cardiac imaging as a diagnostic tool for ATTR cardiac amyloidosis and its association with survival in a multicenter study. Retrospective cohort study performed at 3 academic specialty centers for cardiac amyloidosis in the United States in which 229 participants were evaluated for cardiac amyloidosis and also underwent Tc 99m PYP cardiac imaging. The date of analysis and final confirmation from the statistician was May 4, 2016. Tc 99m PYP cardiac imaging for detection of ATTR cardiac amyloidosis. Retention of Tc 99m PYP in the heart was assessed using both a semiquantitative visual score (range, 0 [no uptake] to 3 [uptake greater than bone]) and a quantitative heart to contralateral (H/CL) ratio. The H/CL ratio was calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc 99m PYP imaging. Tc 99m PYP imaging of 171 participants (121 with ATTR cardiac amyloidosis and 50 with non-ATTR cardiac amyloidosis [34 with AL amyloidosis and 16 with nonamyloid heart failure with preserved ejection fraction]; 86% male; median [IQR] age, 73 years [65-79 years]) demonstrated 91% sensitivity and 92% specificity for detecting ATTR cardiac amyloidosis with an area under the curve of 0.960 (95% CI, 0.930-0.981). Univariable and multivariable Cox proportional hazards regression analyses among participants with ATTR cardiac amyloidosis showed that an H/CL ratio of 1.6 or greater predicted

  5. Registry of Unexplained Cardiac Arrest

    Science.gov (United States)

    2016-05-16

    Cardiac Arrest; Long QT Syndrome; Brugada Syndrome; Catecholaminergi Polymorphic Ventricular Tachycardia; Idiopathic VentricularFibrillation; Early Repolarization Syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy

  6. Cardiac Dysautonomia in Huntington's Disease.

    Science.gov (United States)

    Abildtrup, Mads; Shattock, Michael

    2013-01-01

    Huntington's disease is a fatal, hereditary, neurodegenerative disorder best known for its clinical triad of progressive motor impairment, cognitive deficits and psychiatric disturbances. Although a disease of the central nervous system, mortality surveys indicate that heart disease is a leading cause of death. The nature of such cardiac abnormalities remains unknown. Clinical findings indicate a high prevalence of autonomic nervous system dysfunction - dysautonomia - which may be a result of pathology of the central autonomic network. Dysautonomia can have profound effects on cardiac health, and pronounced autonomic dysfunction can be associated with neurogenic arrhythmias and sudden cardiac death. Significant advances in the knowledge of neural mechanisms in cardiac disease have recently been made which further aid our understanding of cardiac mortality in Huntington's disease. Even so, despite the evidence of aberrant autonomic activity the potential cardiac consequences of autonomic dysfunction have been somewhat ignored. In fact, underlying cardiac abnormalities such as arrhythmias have been part of the exclusion criteria in clinical autonomic Huntington's disease research. A comprehensive analysis of cardiac function in Huntington's disease patients is warranted. Further experimental and clinical studies are needed to clarify how the autonomic nervous system is controlled and regulated in higher, central areas of the brain - and how these regions may be altered in neurological pathology, such as Huntington's disease. Ultimately, research will hopefully result in an improvement of management with the aim of preventing early death in Huntington's disease from cardiac causes.

  7. Blunt and Penetrating Cardiac Trauma.

    Science.gov (United States)

    Bellister, Seth A; Dennis, Bradley M; Guillamondegui, Oscar D

    2017-10-01

    Patients with traumatic cardiac injuries can present with wide variability in their severity of illness. The most severe will present in cardiac arrest, whereas the most benign may be altogether asymptomatic; most will fall somewhere in between. Management of cardiac injuries largely depends on mechanism of injury and patient physiology. Understanding the spectrum of injuries and their associated manifestations can help providers react more quickly and initiate potentially life-saving therapies more efficiently when time is critical. This article discusses the workup and management of both blunt and penetrating cardiac injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Autoimmune channelopathies as a novel mechanism in cardiac arrhythmias.

    Science.gov (United States)

    Lazzerini, Pietro Enea; Capecchi, Pier Leopoldo; Laghi-Pasini, Franco; Boutjdir, Mohamed

    2017-09-01

    Cardiac arrhythmias confer a considerable burden of morbidity and mortality in industrialized countries. Although coronary artery disease and heart failure are the prevalent causes of cardiac arrest, in 5-15% of patients, structural abnormalities at autopsy are absent. In a proportion of these patients, mutations in genes encoding cardiac ion channels are documented (inherited channelopathies), but, to date, the molecular autopsy is negative in nearly 70% of patients. Emerging evidence indicates that autoimmunity is involved in the pathogenesis of cardiac arrhythmias. In particular, several arrhythmogenic autoantibodies targeting specific calcium, potassium, or sodium channels in the heart have been identified. Experimental and clinical studies demonstrate that these autoantibodies can promote conduction disturbances and life-threatening tachyarrhythmias by inducing substantial electrophysiological changes. In this Review, we propose the term 'autoimmune cardiac channelopathies' to define this novel pathogenic mechanism of cardiac arrhythmias, which could be more frequent and clinically relevant than previously appreciated. Indeed, pathogenic autoantibodies against ion channels are detectable not only in patients with manifest autoimmune disease, but also in apparently healthy individuals, which suggests a causal role in some cases of unexplained arrhythmias and cardiac arrest. Considering this possibility and performing specific testing in patients with 'idiopathic' rhythm disturbances could create novel treatment opportunities.

  9. PERFORMANCE

    Directory of Open Access Journals (Sweden)

    M Cilli

    2014-10-01

    Full Text Available This study aimed to investigate the kinematic and kinetic changes when resistance is applied in horizontal and vertical directions, produced by using different percentages of body weight, caused by jumping movements during a dynamic warm-up. The group of subjects consisted of 35 voluntary male athletes (19 basketball and 16 volleyball players; age: 23.4 ± 1.4 years, training experience: 9.6 ± 2.7 years; height: 177.2 ± 5.7 cm, body weight: 69.9 ± 6.9 kg studying Physical Education, who had a jump training background and who were training for 2 hours, on 4 days in a week. A dynamic warm-up protocol containing seven specific resistance movements with specific resistance corresponding to different percentages of body weight (2%, 4%, 6%, 8%, 10% was applied randomly on non consecutive days. Effects of different warm-up protocols were assessed by pre-/post- exercise changes in jump height in the countermovement jump (CMJ and the squat jump (SJ measured using a force platform and changes in hip and knee joint angles at the end of the eccentric phase measured using a video camera. A significant increase in jump height was observed in the dynamic resistance warm-up conducted with different percentages of body weight (p 0.05. In jump movements before and after the warm-up, while no significant difference between the vertical ground reaction forces applied by athletes was observed (p>0.05, in some cases of resistance, a significant reduction was observed in hip and knee joint angles (p<0.05. The dynamic resistance warm-up method was found to cause changes in the kinematics of jumping movements, as well as an increase in jump height values. As a result, dynamic warm-up exercises could be applicable in cases of resistance corresponding to 6-10% of body weight applied in horizontal and vertical directions in order to increase the jump performance acutely.

  10. Cardiac arrest leadership: in need of resuscitation?

    Science.gov (United States)

    Robinson, Philip S; Shall, Emma; Rakhit, Roby

    2016-12-01

    Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions. Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training. Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. The Danish Cardiac Rehabilitation Database

    Science.gov (United States)

    Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne; Foghmar, Sussie; Eichhorst, Regina; Prescott, Eva; Cerqueira, Charlotte; Soja, Anne Merete Boas; Gislason, Gunnar H; Larsen, Mogens Lytken; Andersen, Ulla Overgaard; Gustafsson, Ida; Thomsen, Kristian K; Boye Hansen, Lene; Hammer, Signe; Viggers, Lone; Christensen, Bo; Kvist, Birgitte; Lindström Egholm, Cecilie; May, Ole

    2016-01-01

    Aim of database The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Study population Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Main variables Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Descriptive data Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. Conclusion The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients. PMID:27822083

  12. The Danish Cardiac Rehabilitation Database.

    Science.gov (United States)

    Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne; Foghmar, Sussie; Eichhorst, Regina; Prescott, Eva; Cerqueira, Charlotte; Soja, Anne Merete Boas; Gislason, Gunnar H; Larsen, Mogens Lytken; Andersen, Ulla Overgaard; Gustafsson, Ida; Thomsen, Kristian K; Boye Hansen, Lene; Hammer, Signe; Viggers, Lone; Christensen, Bo; Kvist, Birgitte; Lindström Egholm, Cecilie; May, Ole

    2016-01-01

    The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients.

  13. Cardiac Screening for Athletes

    Directory of Open Access Journals (Sweden)

    Senem Ozgur

    2013-08-01

    Full Text Available As obesity and cardiovascular mortality has recently increased, sporting activities are recommended to people of all age groups more than past decades. Sudden cardiac death during sporting events resonate in a wide range of media and cause serious concern to the families. In order to reduce mortality, athlete screening has been raised. There is a disagreement about how to do the most effective and the least costly screening, also the necessity of screening. The American Heart Academy recommends screening with only history and physical examination, while European Society of Cardiology considers the inclusion of the electrocardiography. During sports activities, in response to the growing needs for the heart, a number of structural and electrical changes in the heart of athlete occur. This situation is briefly defined as the athlete heart. Although it is considered to be due to physiological changes in the athlete's heart, these changes are reflected in electrocardiography and they increase the number of false-positive cases. In 2010, European Society of Cardiology divided findings into two groups as physiological and pathological findings in order to prevent this confusion. With these criteria, it was aimed to increase the sensitivity of electrocardiography while reducing the false-positive rates. Despite all the precautions sudden cardiac death could not be completely precluded. Because of this, as well as the protective measures; cautions after the incident are also important. In the emergency plan, knowledgeable and experienced team of resuscitation and external cardiac defibrillator dissemination campaigns are the first things coming to mind. [Archives Medical Review Journal 2013; 22(4.000: 575-590

  14. [Cardiac rehabilitation in women].

    Science.gov (United States)

    Ghannem, M; Ghannem, L; Lamouchi, S; Justin, K D; Meimoun, P; Ghannem, L

    2016-12-01

    Coronary artery disease (CAD) occurs later in life in women when compared to men (10 years later). The FAST-MI study has shown that the profile of women with CAD has changed in the past 15 years, they are younger, more obese, and usually smokers. Whatever the age at which CAD occurs in women, the prognosis tends to be worse than in men, despite a higher frequency of acute coronary syndrome (ACS) with angiographically normal coronary arteries in women. In women without significant lesion at coronary angiography, the WISE study has shown abnormalities of the coronary vasomotricy. Despite its beneficial effect on morbidity and mortality, cardiac rehabilitation is underused particularly in women. Indeed, several factors do not encourage a woman to follow a cardiac rehabilitation program, even after an ACS. These factors may be cultural, domestic, familial, orthopedic, or even the fear of exercising. Therefore, physicians have to be particularly convincing in women, in order to have them participating in rehabilitation programs. Physical capacity is lower in women when compared to men. However, the weaker the physical capacity, the better the benefit of cardiac rehabilitation. Physical endurance training continuously or in interval, associated to muscle strengthening can improve the physical capacity in women. Vascular risk factors correction is also an important step for the management of women with CAD. Therapeutic education and several available workshops help women to better understand their disease and to improve their self-management when they return home. Anxiety, depression, and sexual dysfunction frequently deteriorate the quality of life of our patients. Therefore, psychological management is also essential in our departments. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Relations between haemoglobin mass, cardiac dimensions and aerobic capacity in endurance trained cyclists.

    Science.gov (United States)

    Ahlgrim, C; Pottgiesser, T; Kron, J; Duerr, H; Baumstark, M; Schumacher, Y O

    2009-12-01

    Chronic endurance exercise triggers increased cardiac dimensions, blood volumes and haemoglobin mass (Hb mass). Cardiac output and Hb mass are considered as independent contributors to aerobic performance. Therefore, increased Hb mass could counterbalance for a relative deficiency in cardiac adaptation. The purpose of the present study is to investigate relations between Hb mass and cardiac dimensions in a group of endurance athletes with respect to aerobic capacity. Two groups of highly trained cyclists featuring high (HHB group, N.=13) and low (LHB group, N.=13) Hb mass (measured by a CO-rebreathing method) were compared for measures of aerobic performance, cardiac wall thickness, cavity size and left ventricular mass (determined by 2-D-echocardiography). Lean body mass (LBM) was chosen as anthropometrical reference for Hb mass. HHB featured higher cardiac wall thickness than LHB, but no difference appeared in cardiac cavity size, left ventricular mass and the performance parameters. Normalising Hb mass for body weight instead of LBM improved correlations between Hb mass and performance parameters. Our data provides new evidence for a connection between cardiac wall thickness and Hb mass in endurance athletes but no further evidence for a counterbalance between Hb mass and cardiac adaptation was found. Moreover, we postulate that Hb mass loses predictive value for aerobic performance when normalised for LBM.

  16. CSI cardiac prevent 2015

    Directory of Open Access Journals (Sweden)

    S Ramakrishnan

    2015-01-01

    Full Text Available The CSI Cardiac Prevent 2015 was held at Hotel Taj Palace, New Delhi, on September 25-27, 2015. The major challenge was to create interest among cardiologists and physicians on preventive cardiology, a neglected area. The theme of the conference was "Innovations in Heart Disease Prevention.′′ This conference included "CSI at WHF Roadmap Workshop, Inauguration Ceremony, scientific program, plenary sessions, Nursing/Dietician track, Industry Exhibition, Social Events," Great India blood pressure Survey, and CSI Smart Heart App. A total of 848 delegates/faculties attended this conference against a total of 1140 people registered for the meeting.

  17. Four Dimensional Cardiac Imaging

    Science.gov (United States)

    Smith, L. D. R.; Quarendon, P.

    1986-05-01

    A system for the production of a four dimensional (moving three dimensional) human epicardial left ventriculogram, modelled and highlighted to show regional wall motion changes, is described. The moving image is derived by fitting a surface to the three dimensional coordinates of coronary artery bifurcations. These are determined by analysis of digitised biplane coronary cineangiograms. This image system not only provides a unique 3-D view of left ventricular activity but might also provide measures of cardiac dynamics such as, stroke volume and velocity of wall movement. The system is not fully automated although operator interaction may be minimised. Further work on vessel tracking systems is required before full automation is possible.

  18. Impact of donor cardiac arrest on heart transplantation.

    Science.gov (United States)

    Southerland, Kevin W; Castleberry, Anthony W; Williams, Judson B; Daneshmand, Mani A; Ali, Ayyaz A; Milano, Carmelo A

    2013-08-01

    Cardiac transplantation is an effective therapy for patients with end-stage heart failure, but it is still hindered by the lack of donor organs. A history of donor cardiac arrest raises trepidation regarding the possibility of poor post-transplant outcomes. The impact of donor cardiac arrest following successful cardiopulmonary resuscitation on heart transplant outcomes is unknown. Therefore, we sought to evaluate the impact of donor cardiac arrest on orthotropic heart transplantation using the United Network for Organ Sharing database. We performed a secondary longitudinal analysis of all cardiac transplants performed between April 1994 and December 2011 through the United Network for Organ Sharing registry. Multiorgan transplants, repeat transplants, and pediatric recipients were excluded. Survival analyses were performed using Kaplan-Meier methods as well as multivariate adjusted logistic regression and Cox proportional hazard models. A total of 19,980 patients were analyzed. In 856 cases, the donors had histories of cardiac arrest, and in the remaining 19,124 cases, there was no history of donor cardiac arrest. The unadjusted 1-, 5-, and 10-year actuarial survival rates between the arrest and the nonarrest groups were not significantly different. Multivariate logistic regression demonstrated no difference in survival in the donor arrest group at 30 days, 1 year, or 3 years. Furthermore, the adjusted Cox proportional hazard model for cumulative survival also showed no survival difference between the 2 groups. If standard recipient and donor transplantation criteria are met, a history of donor cardiac arrest should not prohibit the potential consideration of an organ for transplantation. Copyright © 2013 Mosby, Inc. All rights reserved.

  19. Cardiac manifestations of myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Vissing, John; Witting, Nanna

    2012-01-01

    To estimate the degree of cardiac involvement regarding left ventricular ejection fraction, conduction abnormalities, arrhythmia, risk of sudden cardiac death (SCD) and the associations between cardiac involvement and cytosine-thymine-guanine (CTG)-repeat, neuromuscular involvement, age and gender...

  20. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study.

    Science.gov (United States)

    Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; Verheugt, Freek W A; Cornel, Jan Hein; de Winter, Robbert J

    2007-03-10

    The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or rehospitalisation after 1 year. We did a follow-up study to assess the effects of these treatment strategies after 4 years. 1200 patients with nSTE-ACS and an elevated cardiac troponin were enrolled from 42 hospitals in the Netherlands. Patients were randomly assigned either to an early invasive strategy, including early routine catheterisation and revascularisation where appropriate, or to a more selective invasive strategy, where catheterisation was done if the patient had refractory angina or recurrent ischaemia. The main endpoints for the current follow-up study were death, recurrent myocardial infarction, or rehospitalisation for anginal symptoms within 3 years after randomisation, and cardiovascular mortality and all-cause mortality within 4 years. Analysis was by intention-to-treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN82153174. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the combined endpoint was 30.0% in the early invasive group compared with 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI 0.97-1.50; p=0.09). Myocardial infarction was more frequent in the early invasive strategy group (106 [18.3%] vs 69 [12.3%]; HR 1.61; 1.19-2.18; p=0.002). Rates of death or spontaneous myocardial infarction were not different (76 [14.3%] patients in the early invasive and 63 [11.2%] patients in the selective invasive strategy [HR 1.19; 0.86-1.67; p=0.30]). No difference in all-cause mortality (7.9%vs 7.7%; p=0.62) or cardiovascular mortality (4.5%vs 5.0%; p=0.97) was seen within 4 years. Long-term follow-up of

  1. Prevalence of myocardial fibrosis patterns in patients with systolic dysfunction: prognostic significance for the prediction of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy.

    Science.gov (United States)

    Almehmadi, Fahad; Joncas, Sebastien Xavier; Nevis, Immaculate; Zahrani, Mohammad; Bokhari, Mahmoud; Stirrat, John; Fine, Nowell M; Yee, Raymond; White, James A

    2014-07-01

    Late gadolinium enhancement-cardiac magnetic resonance is increasingly performed in patients with systolic dysfunction. Numerous patterns of fibrosis are commonly reported among this population. However, the relative prevalence and prognostic significance of these findings remains uncertain. Three hundred eighteen consecutive patients referred for late gadolinium enhancement-cardiac magnetic resonance and a left ventricular ejection fraction 35% (40% versus 6%; P=0.005). Patients with systolic dysfunction frequently demonstrate multiple patterns of myocardial fibrosis. Of these, a midwall striae pattern of fibrosis is the strongest independent predictor of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy. © 2014 American Heart Association, Inc.

  2. Characterization of mitochondrial injury after cardiac arrest (COMICA).

    Science.gov (United States)

    Donnino, Michael W; Liu, Xiaowen; Andersen, Lars W; Rittenberger, Jon C; Abella, Benjamin S; Gaieski, David F; Ornato, Joseph P; Gazmuri, Raúl J; Grossestreuer, Anne V; Cocchi, Michael N; Abbate, Antonio; Uber, Amy; Clore, John; Peberdy, Mary Anne; Callaway, Clifton W

    2017-04-01

    Mitochondrial injury post-cardiac arrest has been described in pre-clinical settings but the extent to which this injury occurs in humans remains largely unknown. We hypothesized that increased levels of mitochondrial biomarkers would be associated with mortality and neurological morbidity in post-cardiac arrest subjects. We performed a prospective multicenter study of post-cardiac arrest subjects. Inclusion criteria were comatose adults who suffered an out-of-hospital cardiac arrest. Mitochondrial biomarkers were measured at 0, 12, 24, 36 and 48h after return of spontaneous circulation as well as in healthy controls. Out of 111 subjects enrolled, 102 had evaluable samples at 0h. Cardiac arrest subjects had higher baseline cytochrome c levels compared to controls (2.18ng/mL [0.74, 7.74] vs. 0.16ng/mL [0.03, 0.91], pcardiac arrest subjects at baseline compared to the control subjects. There were no differences between survivors and non-survivors for mitochondrial DNA, nuclear DNA, or cell free DNA. Cytochrome c was increased in post- cardiac arrest subjects compared to controls, and in post-cardiac arrest non-survivors compared to survivors. Nuclear DNA and cell free DNA was increased in plasma of post-cardiac arrest subjects. There were no differences in mitochondrial DNA, nuclear DNA, or cell free DNA between survivors and non-survivors. Mitochondrial injury markers showed mixed results in the post-cardiac arrest period. Future research needs to investigate these differences. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Cardiac Variables as Main Predictors of Endotracheal Reintubation Rate after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Forouzan Yazdanian

    2015-10-01

    Full Text Available Background: Reintubation in patients after cardiac surgery is associated with undesirable consequences. The purpose of the present study was to identify variables that could predict reintubation necessity in this group of patients.Methods: We performed a prospective study in 1000 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass. The patients who required reintubation after extubation were compared with patients not requiring reintubation regarding demographic and preoperative clinical variables, including postoperative complications and in- hospital mortality.Results: Postoperatively, 26 (2.6% of the 1000 patients studied required reintubation due to respiratory, cardiac, or neurological reasons. Advanced age and mainly cardiac variables were determined as univariate intra- and postoperative predictors of reintubation (all p values < 0.05. Multiple logistic regression analysis revealed lower preoperative (p = 0.014; OR = 3.00, 95%CI: 1.25 - 7.21, and postoperative ejection fraction (p = 0.001; OR = 11.10, 95%CI: 3.88 - 31.79, valvular disease (p = 0.043; OR = 1.84, 95%CI: 1.05 - 3.96, arrhythmia (p = 0.006; OR = 3.84, 95%CI: 1.47 - 10.03, and postoperative intra-aortic balloon pump requirement (p = 0.019; OR = 4.20, 95%CI: 1.26 - 14.00 as the independent predictors of reintubation.Conclusion: These findings reveal that cardiac variables are more common and significant predictors of reintubation after cardiac surgery in adult patients than are respiratory variables. The incidence of this complication, reintubation, is low, although it could result in significant postoperative morbidity and mortality.

  4. Cardiac arrhythmias in pregnancy.

    Science.gov (United States)

    Knotts, Robert J; Garan, Hasan

    2014-08-01

    As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Leadership in cardiac surgery.

    Science.gov (United States)

    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos

    2011-06-01

    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  6. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

  7. Lentiginosis, Deafness and Cardiac Abnormalities*

    African Journals Online (AJOL)

    1973-01-06

    Jan 6, 1973 ... The familia:l form is milder. The cardiac lesion commonly consists of hypertrophic obstructive cardiomyopathy of either ventricle or abnor- malities of the ECG.' The obstructive lesion may be pro- gressive and cause cardiac failure. The ECG features include conduction abnormalities, such as left hemiblock,.

  8. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  9. Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography.

    Science.gov (United States)

    Karlsberg, Daniel W; Elad, Yaron; Kass, Robert M; Karlsberg, Ronald P

    2012-01-01

    A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role.

  10. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2015-01-01

    Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

  11. Who Is at Risk for Sudden Cardiac Arrest?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  12. How Can Death Due to Sudden Cardiac Arrest Be Prevented?

    Science.gov (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  13. Cardiac Auscultation Using Smartphones: Pilot Study.

    Science.gov (United States)

    Kang, Si-Hyuck; Joe, Byunggill; Yoon, Yeonyee; Cho, Goo-Yeong; Shin, Insik; Suh, Jung-Won

    2018-02-28

    Cardiac auscultation is a cost-effective, noninvasive screening tool that can provide information about cardiovascular hemodynamics and disease. However, with advances in imaging and laboratory tests, the importance of cardiac auscultation is less appreciated in clinical practice. The widespread use of smartphones provides opportunities for nonmedical expert users to perform self-examination before hospital visits. The objective of our study was to assess the feasibility of cardiac auscultation using smartphones with no add-on devices for use at the prehospital stage. We performed a pilot study of patients with normal and pathologic heart sounds. Heart sounds were recorded on the skin of the chest wall using 3 smartphones: the Samsung Galaxy S5 and Galaxy S6, and the LG G3. Recorded heart sounds were processed and classified by a diagnostic algorithm using convolutional neural networks. We assessed diagnostic accuracy, as well as sensitivity, specificity, and predictive values. A total of 46 participants underwent heart sound recording. After audio file processing, 30 of 46 (65%) heart sounds were proven interpretable. Atrial fibrillation and diastolic murmur were significantly associated with failure to acquire interpretable heart sounds. The diagnostic algorithm classified the heart sounds into the correct category with high accuracy: Galaxy S5, 90% (95% CI 73%-98%); Galaxy S6, 87% (95% CI 69%-96%); and LG G3, 90% (95% CI 73%-98%). Sensitivity, specificity, positive predictive value, and negative predictive value were also acceptable for the 3 devices. Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge. ClinicalTrials.gov NCT03273803; https://clinicaltrials.gov/ct2/show/NCT03273803 (Archived by WebCite at http://www.webcitation.org/6x6g1fHIu).

  14. Cardiac Interventions in Pregnant Patients without Fluoroscopy.

    Science.gov (United States)

    Tuzcu, Volkan; Gul, Enes Elvin; Erdem, Abdullah; Kamali, Hacer; Saritas, Turkay; Karadeniz, Cem; Akdeniz, Celal

    2015-08-01

    Cardiac interventions with fluoroscopy during pregnancy carry significant risks for the fetus. This report reviews three pregnant patients: two of them requiring pacemaker implantation and one underwent diagnostic cardiac catheterization without fluoroscopy. The cases were performed using EnSite system (St. Jude Medical Inc., MN, USA) guidance. The necessary cardiac structure geometries were reconstructed with a deflectable quadripolar electrophysiology catheter without fluoroscopy. In two cases, pacemaker leads were connected to the EnSite system for navigation and fixation of leads. In the third case, long sheaths and electrophysiology catheters were used to access the right ventricle and pulmonary artery. Transthoracic echocardiography was also used in all three cases. A 31-year-old woman at 8-week pregnancy was admitted with ventricular septal defect and significant pulmonary hypertension. The patient underwent catheterization to assess for the risk of continuation of pregnancy. There was partial reactivity, it was decided not to terminate the pregnancy, and an uneventful delivery was succeeded at 35 weeks of gestation without complications. The rest of the two pregnant patients were a 28-year-old pregnant woman at 14 weeks of gestation and a 40-year-old woman at 12-week gestation. Both of them presented with symptomatic complete AV block. A single-chamber pacemaker was implanted in the first one, and a dual-chamber pacemaker was implanted in the latter. Pregnancy continued in both without complications. Successful cardiac catheterization and pacemaker implantation can be performed safely in selected pregnant patients using an electroanatomic mapping system guidance without fluoroscopy.

  15. Exercise training reduces sympathetic modulation on cardiovascular system and cardiac oxidative stress in spontaneously hypertensive rats.

    Science.gov (United States)

    Bertagnolli, Mariane; Schenkel, Paulo C; Campos, Cristina; Mostarda, Cristiano T; Casarini, Dulce E; Belló-Klein, Adriane; Irigoyen, Maria C; Rigatto, Katya

    2008-11-01

    Spontaneously hypertensive rats (SHRs) show increased cardiac sympathetic activity, which could stimulate cardiomyocyte hypertrophy, cardiac damage, and apoptosis. Norepinephrine (NE)-induced cardiac oxidative stress seems to be involved in SHR cardiac hypertrophy development. Because exercise training (ET) decreases sympathetic activation and oxidative stress, it may alter cardiac hypertrophy in SHR. The aim of this study was to determine, in vivo, whether ET alters cardiac sympathetic modulation on cardiovascular system and whether a correlation exists between cardiac oxidative stress and hypertrophy. Male SHRs (15-weeks old) were divided into sedentary hypertensive (SHR, n = 7) and exercise-trained hypertensive rats (SHR-T, n = 7). Moderate ET was performed on a treadmill (5 days/week, 60 min, 10 weeks). After ET, cardiopulmonary reflex responses were assessed by bolus injections of 5-HT. Autoregressive spectral estimation was performed for systolic arterial pressure (SAP) with oscillatory components quantified as low (LF: 0.2-0.75 Hz) and high (HF: 0.75-4.0 Hz) frequency ranges. Cardiac NE concentration, lipid peroxidation, antioxidant enzymes activities, and total nitrates/nitrites were determined. ET reduced mean arterial pressure, SAP variability (SAP var), LF of SAP, and cardiac hypertrophy and increased cardiopulmonary reflex responses. Cardiac lipid peroxidation was decreased in trained SHRs and positively correlated with NE concentrations (r = 0.89, P < 0.01) and heart weight/body weight ratio (r = 0.72, P < 0.01), and inversely correlated with total nitrates/nitrites (r = -0.79, P < 0.01). Moreover, in trained SHR, cardiac total nitrates/nitrites were inversely correlated with NE concentrations (r = -0.82, P < 0.01). ET attenuates cardiac sympathetic modulation and cardiac hypertrophy, which were associated with reduced oxidative stress and increased nitric oxide (NO) bioavailability.

  16. Cardiac potassium channel subtypes

    DEFF Research Database (Denmark)

    Schmitt, Nicole; Grunnet, Morten; Olesen, Søren-Peter

    2014-01-01

    About 10 distinct potassium channels in the heart are involved in shaping the action potential. Some of the K(+) channels are primarily responsible for early repolarization, whereas others drive late repolarization and still others are open throughout the cardiac cycle. Three main K(+) channels...... drive the late repolarization of the ventricle with some redundancy, and in atria this repolarization reserve is supplemented by the fairly atrial-specific KV1.5, Kir3, KCa, and K2P channels. The role of the latter two subtypes in atria is currently being clarified, and several findings indicate...... that they could constitute targets for new pharmacological treatment of atrial fibrillation. The interplay between the different K(+) channel subtypes in both atria and ventricle is dynamic, and a significant up- and downregulation occurs in disease states such as atrial fibrillation or heart failure...

  17. Sudden Cardiac Death

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza

    2017-01-01

    Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how...... pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through...... review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men...

  18. Hypertension and Cardiac Arrhythmias

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Coca, Antonio; Kahan, Thomas

    2017-01-01

    Hypertension (HTN) is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease (CAD), stroke, peripheral artery disease and chronic renal failure. Hypertensive heart disease can manifest as many types of cardiac arrhythmias, most commonly being atrial fibrillation......, hypomagnesaemia), contributing further to arrhythmias, while effective Blood pressure control may prevent the development of the arrhythmias such as AF.In recognizing this close relationship between HTN and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society of Cardiology (ESC......) Council on Hypertension convened a Task Force, with representation from the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit of comprehensively reviewing the available evidence...

  19. Hypertension and cardiac arrhythmias

    DEFF Research Database (Denmark)

    Lip, Gregory Y.H.; Coca, Antonio; Kahan, Thomas

    2017-01-01

    Hypertension is a common cardiovascular risk factor leading to heart failure (HF), coronary artery disease, stroke, peripheral artery disease and chronic renal insufficiency. Hypertensive heart disease can manifest as many cardiac arrhythmias, most commonly being atrial fibrillation (AF). Both......, hypomagnesemia), further contributing to arrhythmias, whereas effective control of blood pressure may prevent the development of the arrhythmias such as AF. In recognizing this close relationship between hypertension and arrhythmias, the European Heart Rhythm Association (EHRA) and the European Society...... supraventricular and ventricular arrhythmias may occur in hypertensive patients, especially in those with left ventricular hypertrophy (LVH) or HF. Also, some of the antihypertensive drugs commonly used to reduce blood pressure, such as thiazide diuretics, may result in electrolyte abnormalities (e.g. hypokalaemia...

  20. Physics of Cardiac Arrhythmogenesis

    Science.gov (United States)

    Karma, Alain

    2013-04-01

    A normal heartbeat is orchestrated by the stable propagation of an excitation wave that produces an orderly contraction. In contrast, wave turbulence in the ventricles, clinically known as ventricular fibrillation (VF), stops the heart from pumping and is lethal without prompt defibrillation. I review experimental, computational, and theoretical studies that have shed light on complex dynamical phenomena linked to the initiation, maintenance, and control of wave turbulence. I first discuss advances made to understand the precursor state to a reentrant arrhythmia where the refractory period of cardiac tissue becomes spatiotemporally disordered; this is known as an arrhythmogenic tissue substrate. I describe observed patterns of transmembrane voltage and intracellular calcium signaling that can contribute to this substrate, and symmetry breaking instabilities to explain their formation. I then survey mechanisms of wave turbulence and discuss novel methods that exploit electrical pacing stimuli to control precursor patterns and low-energy pulsed electric fields to control turbulence.

  1. Radionuclide cardiac ventriculogram

    Energy Technology Data Exchange (ETDEWEB)

    Nolan, N.G.; Lindsay, J. Jr.

    1980-10-01

    Coronary artery disease represents one of the most prevalent and serious diseases in the western world. In consequence, there is considerable need for a reliable method for its diagnosis. Until now the best available laboratory methods were the EKG treadmill test and arteriography. The former suffers from the disadvantages of suboptimal sensitivity and specificity, while the latter is both expensive and invasive. The recent introduction of the nuclear cardiac ventriculogram offers new hope for the non-invasive diagnosis of this condition. Based on an experience of more than two thousand patient studies, we consider that this procedure represents a significant advance in the ability to distinguish between the normal and abnormal left ventricle.

  2. Inflammatory mediators in diet-induced cardiac dysfunction

    NARCIS (Netherlands)

    Louwe, Maria Cornelia (Mieke)

    2013-01-01

    The studies in this thesis are performed to provide additional and improved insight into the effects and interplay of dietary lipids and metabolic inflammation on cardiac performance in the presence or absence of atherosclerosis and myocardial infarctions (MI). We show that high-fat diet feeding has

  3. [Cardiac screening of young athletes].

    Science.gov (United States)

    Stokstad, Magnus Thue; Berge, Hilde Moseby; Gjesdal, Knut

    2013-09-03

    Young athletes are at an increased risk of sudden cardiac death compared to others. Cardiac screening has been proposed to prevent deaths. We wished to review the evidence for cardiac screening of young athletes. We have conducted a literature search in PubMed on sudden cardiac death in young athletes, using a combination of search terms related to screening, incidence, cost efficiency and recommendations, supplemented by secondary references and articles from our own archive. Published studies utilise a variety of definitions of athlete and sudden death, and some studies also include cardiac arrest with subsequent successful resuscitation. Retrospective studies, often based on media searches, remain the most common form. The cause of death is not invariably determined by an autopsy. Recommendations in favour of screening are based on studies of limited quality and on the personal, often regional, experiences of experts. The differences in study methods result in uncertain incidence figures. The estimates of cost efficiency are therefore questionable. To improve the quality of knowledge, standardised methods need to be devised, ideally also including a register of cardiac arrest in children and young people. To date, we have insufficient knowledge to recommend mandatory cardiac screening with ECG in Norway. Should this be introduced, it should be differentiated according to gender, type of sport and competition level. Cost efficiency could probably be improved with the aid of standardised questionnaires and a standardised interpretation of ECG among athletes.

  4. Trends in Cardiac Pacemaker Batteries

    Directory of Open Access Journals (Sweden)

    Venkateswara Sarma Mallela

    2004-10-01

    Full Text Available Batteries used in Implantable cardiac pacemakers-present unique challenges to their developers and manufacturers in terms of high levels of safety and reliability. In addition, the batteries must have longevity to avoid frequent replacements. Technological advances in leads/electrodes have reduced energy requirements by two orders of magnitude. Micro-electronics advances sharply reduce internal current drain concurrently decreasing size and increasing functionality, reliability, and longevity. It is reported that about 600,000 pacemakers are implanted each year worldwide and the total number of people with various types of implanted pacemaker has already crossed 3 million. A cardiac pacemaker uses half of its battery power for cardiac stimulation and the other half for housekeeping tasks such as monitoring and data logging. The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers. This paper briefly reviews various developments of battery technologies since the inception of cardiac pacemaker and presents the alternative to lithium iodine battery for the near future.

  5. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  6. Selectivity verification of cardiac troponin monoclonal antibodies for cardiac troponin detection by using conventional ELISA

    Science.gov (United States)

    Fathil, M. F. M.; Arshad, M. K. Md; Gopinath, Subash C. B.; Adzhri, R.; Ruslinda, A. R.; Hashim, U.

    2017-03-01

    This paper presents preparation and characterization of conventional enzyme-linked immunosorbent assay (ELISA) for cardiac troponin detection to determine the selectivity of the cardiac troponin monoclonal antibodies. Monoclonal antibodies, used to capture and bind the targets in this experiment, are cTnI monoclonal antibody (MAb-cTnI) and cTnT monoclonal antibody (MAb-cTnT), while both cardiac troponin I (cTnI) and T (cTnT) are used as targets. ELISA is performed inside two microtiter plates for MAb-cTnI and MAb-cTnT. For each plate, monoclonal antibodies are tested by various concentrations of cTnI and cTnT ranging from 0-6400 µg/l. The binding selectivity and level of detection between monoclonal antibodies and antigen are determined through visual observation based on the color change inside each well on the plate. ELISA reader is further used to quantitatively measured the optical density of the color changes, thus produced more accurate reading. The results from this experiment are utilized to justify the use of these monoclonal antibodies as bio-receptors for cardiac troponin detection by using field-effect transistor (FET)-based biosensors coupled with substrate-gate in the future.

  7. The Total Joint Arthroplasty Cardiac Risk Index for Predicting Perioperative Myocardial Infarction and Cardiac Arrest After Primary Total Knee and Hip Arthroplasty.

    Science.gov (United States)

    Waterman, Brian R; Belmont, Philip J; Bader, Julia O; Schoenfeld, Andrew J

    2016-06-01

    Current indices fail to consistently predict risk for major adverse cardiac events after major total joint arthroplasty. All primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified from the National Surgical Quality Improvement Program data set. Based on prior analyses, age ≥80 years, history of hypertension, and history of cardiac disease were evaluated as predictors of myocardial infarction and cardiac arrest using stepwise multivariate logistic regression. A series of predictive scores were constructed and weighted to identify the influence of each variable on 30-day postoperative cardiac events, while comparing with the Revised Cardiac Risk Index (RCRI). Among 85,129 patients, age ≥80 years, hypertension, and a history of cardiac disease were all statistically significant predictors of postoperative cardiac events (0.32%; n = 275) after TKA and THA (P ≤ .02). Equal weighting of all variables maintained the highest discriminative capacity in both THA and TKA cohorts. Adjusted models explained 75% and 71% of the variation in postoperative cardiac events for those with THA and TKA, respectively, without statistically significant lack of fit (P = .52; P = .23, respectively). Conversely, the RCRI was not a significant predictor of postoperative cardiac events after TKA (odds ratio, 3.36; 95% CI, 0.19, 58.04; P = .40), although it maintained a similar discriminative capacity after THA (76%). The current total joint arthroplasty Cardiac Risk Index score was the most economical in predicting postoperative cardiac complication after primary unilateral TKA and THA. The RCRI was not a significant predictor of perioperative cardiac events for TKA patients but performed similarly to the current model for THA. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Acupuncture therapy related cardiac injury.

    Science.gov (United States)

    Li, Xue-feng; Wang, Xian

    2013-12-01

    Cardiac injury is the most serious adverse event in acupuncture therapy. The causes include needling chest points near the heart, the cardiac enlargement and pericardial effusion that will enlarge the projected area on the body surface and make the proper depth of needling shorter, and the incorrect needling method of the points. Therefore, acupuncture practitioners must be familiar with the points of the heart projected area on the chest and the correct needling methods in order to reduce the risk of acupuncture therapy related cardiac injury.

  9. Genetic and physiologic dissection of the vertebrate cardiac conduction system.

    Directory of Open Access Journals (Sweden)

    Neil C Chi

    2008-05-01

    Full Text Available Vertebrate hearts depend on highly specialized cardiomyocytes that form the cardiac conduction system (CCS to coordinate chamber contraction and drive blood efficiently and unidirectionally throughout the organism. Defects in this specialized wiring system can lead to syncope and sudden cardiac death. Thus, a greater understanding of cardiac conduction development may help to prevent these devastating clinical outcomes. Utilizing a cardiac-specific fluorescent calcium indicator zebrafish transgenic line, Tg(cmlc2:gCaMP(s878, that allows for in vivo optical mapping analysis in intact animals, we identified and analyzed four distinct stages of cardiac conduction development that correspond to cellular and anatomical changes of the developing heart. Additionally, we observed that epigenetic factors, such as hemodynamic flow and contraction, regulate the fast conduction network of this specialized electrical system. To identify novel regulators of the CCS, we designed and performed a new, physiology-based, forward genetic screen and identified for the first time, to our knowledge, 17 conduction-specific mutations. Positional cloning of hobgoblin(s634 revealed that tcf2, a homeobox transcription factor gene involved in mature onset diabetes of the young and familial glomerulocystic kidney disease, also regulates conduction between the atrium and the ventricle. The combination of the Tg(cmlc2:gCaMP(s878 line/in vivo optical mapping technique and characterization of cardiac conduction mutants provides a novel multidisciplinary approach to further understand the molecular determinants of the vertebrate CCS.

  10. Cardiac Sarcoidosis: Is it More Common in Men?

    Science.gov (United States)

    Martusewicz-Boros, Magdalena M; Boros, Piotr W; Wiatr, Elżbieta; Kempisty, Anna; Piotrowska-Kownacka, Dorota; Roszkowski-Śliż, Kazimierz

    2016-02-01

    Sarcoidosis is a systemic granulomatous disease which predominantly affects the lungs, although granulomas can also involve all other organs, including the heart. Cardiac sarcoidosis (CS) may occur at any stage of the disease and may be the cause of sudden cardiac death, even in a previously asymptomatic patient. The aim of this study was to evaluate the incidence of CS in a large group of patients diagnosed or followed up due to sarcoidosis. We performed a retrospective analysis of patients at our institution discharged with the final diagnosis "sarcoidosis" (ICD-10: D86) from January 2008 to October 2012. Only those with biopsy (from respiratory tract or lymph nodes) confirmed diagnosis of sarcoidosis were included. We then selected the subset of patients with cardiac involvement due to sarcoidosis confirmed by positive magnetic resonance imaging. The study covered 1375 consecutive sarcoidosis patients (51 % men), who were hospitalized during 5 years. Multiorgan disease was detected in 160 cases (11.7 %), and cardiac involvement was found in 64 patients (4.7 % of all), 70.3 % of whom were men. Twelve of those with CS were in stage I, 48 in stage II, and four in stage III. The odds ratio for having cardiac involvement in men compared to women was 2.3 (95 % CI 1.36-4.0, p = 0.002). Cardiac involvement in sarcoidosis was diagnosed in the similar percentage as in previously published data but was significantly more frequently in men.

  11. Cardiac Myxoma With Unusual Obstructive and Embolic Presentations

    Science.gov (United States)

    Chen, Robert Jeen-Chen; Chou, Hsin-Hua; Tsai, Kuei-Ton; Shen, Ta-Chung; Hu, Chin-Yuan

    2015-01-01

    Abstract We present a case of cardiac myxoma with atypical presentations of concurrent stroke and angiography-negative myocardial infarction. The case emphasizes the importance of basic echocardiography and timely surgery in the management of cardiac myxoma. An elderly woman presented to the emergency department in an unconscious state. Electrocardiogram and elevated cardiac enzymes suggested acute myocardial infarction; however, immediate coronary angiography proved patency. Basic echocardiography revealed an oscillating left atrial myxoma obstructing inflow through the mitral valve. After regaining consciousness while in the intensive care unit, the patient developed respiratory distress and shock, and emergent en bloc resection was performed. Ataxia was noted in her postoperative course and multiple small cerebellar infarcts were found on magnetic resonance imaging. After a 1-month period of rehabilitation, the patient recovered well and continues to be followed as an outpatient. Cardiac myxoma requires timely management and may be missed if not included in the differential diagnoses. Basic echocardiography, also called focused cardiac ultrasound, may aid in the diagnosing of perplexing cardiac cases. PMID:26402823

  12. Thiamine as a neuroprotective agent after cardiac arrest.

    Science.gov (United States)

    Ikeda, Kohei; Liu, Xiaowen; Kida, Kotaro; Marutani, Eizo; Hirai, Shuichi; Sakaguchi, Masahiro; Andersen, Lars W; Bagchi, Aranya; Cocchi, Michael N; Berg, Katherine M; Ichinose, Fumito; Donnino, Michael W

    2016-08-01

    Reduction of pyruvate dehydrogenase (PDH) activity in the brain is associated with neurological deficits in animals resuscitated from cardiac arrest. Thiamine is an essential co-factor of PDH. The objective of this study was to examine whether administration of thiamine improves outcomes after cardiac arrest in mice. Secondarily, we aimed to characterize the impact of cardiac arrest on PDH activity in mice and humans. Animal study: Adult mice were subjected to cardiac arrest whereupon cardiopulmonary resuscitation was performed. Thiamine or vehicle was administered 2min before resuscitation and daily thereafter. Mortality, neurological outcome, and metabolic markers were evaluated. Human study: In a convenience sample of post-cardiac arrest patients, we measured serial PDH activity from peripheral blood mononuclear cells and compared them to healthy controls. Animal study: Mice treated with thiamine had increased 10-day survival (48% versus 17%, Pcardiac arrest patients had lower PDH activity in mononuclear cells than did healthy volunteers (estimated difference: -5.8O.D./min/mg protein, Pcardiac arrest improved neurological outcome and 10-day survival in mice. PDH activity was markedly depressed in post-cardiac arrest patients suggesting that this pathway may represent a therapeutic target. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Pentoxifylline Attenuates Cardiac Remodeling Induced by Tobacco Smoke Exposure

    Energy Technology Data Exchange (ETDEWEB)

    Minicucci, Marcos; Oliveira, Fernando; Santos, Priscila; Polegato, Bertha; Roscani, Meliza; Fernandes, Ana Angelica; Lustosa, Beatriz; Paiva, Sergio; Zornoff, Leonardo; Azevedo, Paula, E-mail: paulasa@fmb.unesp.br [Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP (Brazil)

    2016-05-15

    Tobacco smoke exposure is an important risk factor for cardiac remodeling. Under this condition, inflammation, oxidative stress, energy metabolism abnormalities, apoptosis, and hypertrophy are present. Pentoxifylline has anti‑inflammatory, anti-apoptotic, anti-thrombotic and anti-proliferative properties. The present study tested the hypothesis that pentoxifylline would attenuate cardiac remodeling induced by smoking. Wistar rats were distributed in four groups: Control (C), Pentoxifylline (PX), Tobacco Smoke (TS), and PX-TS. After two months, echocardiography, invasive blood pressure measurement, biochemical, and histological studies were performed. The groups were compared by two-way ANOVA with a significance level of 5%. TS increased left atrium diameter and area, which was attenuated by PX. In the isolated heart study, TS lowered the positive derivate (+dp/dt), and this was attenuated by PX. The antioxidants enzyme superoxide dismutase and glutathione peroxidase were decreased in the TS group; PX recovered these activities. TS increased lactate dehydrogenase (LDH) and decreased 3-hydroxyacyl Coenzyme A dehydrogenases (OH-DHA) and citrate synthase (CS). PX attenuated LDH, 3-OH-DHA and CS alterations in TS-PX group. TS increased IL-10, ICAM-1, and caspase-3. PX did not influence these variables. TS induced cardiac remodeling, associated with increased inflammation, oxidative stress, apoptosis, and changed energy metabolism. PX attenuated cardiac remodeling by reducing oxidative stress and improving cardiac bioenergetics, but did not act upon cardiac cytokines and apoptosis.

  14. Understand Your Risk for Cardiac Arrest

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More Understand Your Risk for Cardiac Arrest Updated:Mar 10,2017 Cardiac arrest may be ... arrest. This content was last reviewed March 2017. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  15. Normal cardiac function in mice with supraphysiological cardiac creatine levels

    Science.gov (United States)

    Hernandez, Alejandro; Nienaber, Jeffrey; Mishra, Rajashree; Pinilla, Miguel; Burchette, James; Mao, Lan; Rockman, Howard A.; Jacobs, Danny O.

    2013-01-01

    Creatine and phosphocreatine levels are decreased in heart failure, and reductions in myocellular phosphocreatine levels predict the severity of the disease and portend adverse outcomes. Previous studies of transgenic mouse models with increased creatine content higher than two times baseline showed the development of heart failure and shortened lifespan. Given phosphocreatine's role in buffering ATP content, we tested the hypothesis whether elevated cardiac creatine content would alter cardiac function under normal physiological conditions. Here, we report the creation of transgenic mice that overexpress the human creatine transporter (CrT) in cardiac muscle under the control of the α-myosin heavy chain promoter. Cardiac transgene expression was quantified by qRT-PCR, and human CrT protein expression was documented on Western blots and immunohistochemistry using a specific anti-CrT antibody. High-energy phosphate metabolites and cardiac function were measured in transgenic animals and compared with age-matched, wild-type controls. Adult transgenic animals showed increases of 5.7- and 4.7-fold in the content of creatine and free ADP, respectively. Phosphocreatine and ATP levels were two times as high in young transgenic animals but declined to control levels by the time the animals reached 8 wk of age. Transgenic mice appeared to be healthy and had normal life spans. Cardiac morphometry, conscious echocardiography, and pressure-volume loop studies demonstrated mild hypertrophy but normal function. Based on our characterization of the human CrT protein expression, creatine and phosphocreatine content, and cardiac morphometry and function, these transgenic mice provide an in vivo model for examining the therapeutic value of elevated creatine content for cardiac pathologies. PMID:24271489

  16. Cardiac arrhythmia classification using autoregressive modeling

    Directory of Open Access Journals (Sweden)

    Srinivasan Narayanan

    2002-11-01

    Full Text Available Abstract Background Computer-assisted arrhythmia recognition is critical for the management of cardiac disorders. Various techniques have been utilized to classify arrhythmias. Generally, these techniques classify two or three arrhythmias or have significantly large processing times. A simpler autoregressive modeling (AR technique is proposed to classify normal sinus rhythm (NSR and various cardiac arrhythmias including atrial premature contraction (APC, premature ventricular contraction (PVC, superventricular tachycardia (SVT, ventricular tachycardia (VT and ventricular fibrillation (VF. Methods AR Modeling was performed on ECG data from normal sinus rhythm as well as various arrhythmias. The AR coefficients were computed using Burg's algorithm. The AR coefficients were classified using a generalized linear model (GLM based algorithm in various stages. Results AR modeling results showed that an order of four was sufficient for modeling the ECG signals. The accuracy of detecting NSR, APC, PVC, SVT, VT and VF were 93.2% to 100% using the GLM based classification algorithm. Conclusion The results show that AR modeling is useful for the classification of cardiac arrhythmias, with reasonably high accuracies. Further validation of the proposed technique will yield acceptable results for clinical implementation.

  17. Engineering design of a cardiac myocyte

    Science.gov (United States)

    Adams, W. J.; Pong, T.; Geisse, N. A.; Sheehy, S. P.; Diop-Frimpong, B.; Parker, K. K.

    2007-04-01

    We describe a design algorithm to build a cardiac myocyte with specific spatial dimensions and physiological function. Using a computational model of a cardiac muscle cell, we modeled calcium (Ca2+) wave dynamics in a cardiac myocyte with controlled spatial dimensions. The modeled myocyte was replicated in vitro when primary neonate rat ventricular myocytes were cultured on micropatterned substrates. The myocytes remodel to conform to the two dimensional boundary conditions and assume the shape of the printed extracellular matrix island. Mechanical perturbation of the myocyte with an atomic force microscope results in calcium-induced calcium release from intracellular stores and the propagation of a Ca2+ wave, as indicated by high speed video microscopy using fluorescent indicators of intracellular Ca2+. Analysis and comparison of the measured wavefront dynamics with those simulated in the computer model reveal that the engineered myocyte behaves as predicted by the model. These results are important because they represent the use of computer modeling, computer-aided design, and physiological experiments to design and validate the performance of engineered cells. The ability to successfully engineer biological cells and tissues for assays or therapeutic implants will require design algorithms and tools for quality and regulatory assurance.

  18. The history and development of cardiac transplantation.

    Science.gov (United States)

    DiBardino, D J

    1999-01-01

    The history of heart surgery, spanning only 100 years to date, has seen some of the most daring and persistent men and women in all of medical history. Many aspects of heart surgery, including such innovations as the heart-lung machine, aortic aneurysm surgery, and the correction of congenital heart defects, have provided future surgeons with an important lesson: diligent research can solve complex problems. The history and development of cardiac transplantation is particularly full of challenges that have been overcome, with the research phase alone spanning more than 90 years. During that time, essential contributions came from all over the world, including the United States, Russia, England, and South Africa. As is typical of medical advancement, individual contributions did not stand alone but added to the experience of those who had come before. Even so, the work of a few particular groups deserves special recognition. Most notable is the Stanford team, led by Dr. Norman Shumway, who continued to transplant human hearts when other institutions had abandoned hopes for the operation. Largely because of the commitment of that team, cardiac transplantation has become a standard option in the treatment of end-stage heart disease. Currently, only the availability of donor hearts limits the number of cardiac transplantations performed worldwide.

  19. Improvement of cardiac screening in amateur athletes.

    Science.gov (United States)

    Schmied, Christian M

    2015-01-01

    Although not performing on a professional level, amateur athletes, nevertheless, are participating in competitive sports and thus underlie a relevant risk for exercise-related SCD which implicates the need for an adequate pre-competition cardiac screening. As many amateur athletes belong to the category of "older" individuals, particularly CAD among male athletes with risk factors has to be targeted by the screening. However, the detection of clinically silent underlying coronary heart disease is challenging and cannot be accurately achieved by a standard screening provided to young athletes (history, clinical status, ECG). An extended work-up, at least, mandates the detection of cholesterol levels to estimate the individual cardiovascular risk. The fact that only less than 10% of Swiss amateur athletes have undergone cardiac screening led to various promising approaches to improve the awareness of the issue. Exemplarily, we successfully invented an "on-site" prevention campaign that positively influenced the attitude of the athletes towards cardiac screening. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Inverse Correlation Between Cardiac Injury and Cardiac Anxiety A Potential Role for Communication

    NARCIS (Netherlands)

    van Beek, Maria H. C. T.; Oude Voshaar, Richard; van Deelen, Femke M.; van Balkom, Anton J. L. M.; Pop, Gheorghe; Speckens, Anne E. M.

    2014-01-01

    Objective: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. Methods: We assessed cardiac anxiety in 237 patients

  1. Inverse correlation between cardiac injury and cardiac anxiety: a potential role for communication

    NARCIS (Netherlands)

    Beek, M.H.C.T. van; Oude Voshaar, R.C.; Deelen, F.M. van; Balkom, A.J.L.M. van; Pop, G.A.; Speckens, A.E.M.

    2014-01-01

    OBJECTIVE: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. METHODS: We assessed cardiac anxiety in 237 patients

  2. Inverse correlation between cardiac injury and cardiac anxiety: A potential role for communication

    NARCIS (Netherlands)

    van Beek, M.H.C.T.; Voshaar, R.C.O.; van Deelen, F.M.; van Balkom, A.J.L.M.; Pop, G.; Speckens, A.E.M.

    2014-01-01

    Objective: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. Methods: We assessed cardiac anxiety in 237 patients

  3. Cardiac amyloidosis detection with pyrophosphate-99mTc scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Souza, D.S.F.; Ichiki, W.A.; Coura Filho, G.B.; Izaki, M.; Giorgi, M.C.P.; Soares Junior, J; Meneghetti, J.C. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Fac. de Medicina. Instituto do Coracao. Servico de Medicina Nuclear e Imagem Molecular

    2008-07-01

    . Cardiac amyloidosis is often under diagnosed due to unspecific and varied signs and symptoms. The diagnosis is confirmed by endomyocardial biopsy, an invasive procedure with inherent risks to this technique. Pyrophosphate-{sup 99m}Tc scintigraphy is a simple, non-invasive, low cost, with good sensitivity method for detection of cardiac amyloidosis. The scintigraphy pattern observed in cardiac amyloidosis cases is abnormal diffuse tracer uptake in both heart ventricles. Planar and/or tomographic imaging may be performed. It is considered a highly sensitive test, with low rates of false-negative results despite the existing little literature. Therefore the scintigraphy can be useful to select patients for biopsy. Conclusion: Scintigraphy can be of great assistance in cardiac amyloidosis, despite its low specificity. Due to its high sensibility, it can be a useful test to early discriminate patients who should undergo biopsy, allowing treatment optimization. (author)

  4. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Seitaro [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Kumamoto University, Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto (Japan); Weissman, Gaby; Weigold, W. Guy [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Vembar, Mani [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States)

    2015-01-15

    The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality - graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality - was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. (orig.)

  5. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality.

    Science.gov (United States)

    Oda, Seitaro; Weissman, Gaby; Vembar, Mani; Weigold, Wm Guy

    2015-01-01

    The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality--graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality--was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. • Cardiac CT before redo surgery may mitigate increased risk • Iterative model reconstruction is the next generation in iterative reconstruction • Iterative model reconstruction improves the image quality in cardiac CT.

  6. Recent developments in cardiac pacing.

    Science.gov (United States)

    Rodak, D J

    1995-10-01

    Indications for cardiac pacing continue to expand. Pacing to improve functional capacity, which is now common, relies on careful patient selection and technical improvements, such as complex software algorithms and diagnostic capabilities.

  7. Cardiac retransplantation: an ethical dilemma.

    Science.gov (United States)

    Haddad, Haissam

    2006-03-01

    The evolution of scientific advancements that paved the way for clinical cardiac transplantation spans the era of the 20 century, heart transplantation has revolutionized therapy for end-stage heart failure. Demand far exceeds supply, resulting in a long waiting period, and an increasing number of deaths while on a waiting list. The shortage of donors poses dilemmas for allocation of organs and managing the waiting list. The disparity between the demand and supply for donor hearts makes cardiac retransplantation an ethical issue with some patients being allowed a second transplant while some patients are dying on the waiting list before receiving their first transplant, especially with overall sub-optimal outcomes compared with primary transplantation. The cardiac transplant community is mandated to closely monitor the results of cardiac retransplantation to identify the appropriate candidate who should receive a retransplantation.

  8. An airline cardiac arrest program

    National Research Council Canada - National Science Library

    O'Rourke, M F; Donaldson, E; Geddes, J S

    1997-01-01

    ...) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation...

  9. Haptoglobin Enhances Cardiac Transplant Rejection

    National Research Council Canada - National Science Library

    Shen, Hua; Heuzey, Elizabeth; Mori, Daniel N; Wong, Christine K; Colangelo, Christopher M; Chung, Lisa M; Bruce, Can; Slizovskiy, Ilya B; Booth, Carmen J; Kreisel, Daniel; Goldstein, Daniel R

    2015-01-01

    .... Unbiased mass spectrometric analysis of cardiac tissue before and ≤72 hours after transplantation revealed that 22 proteins including haptoglobin, a known antioxidant, are significantly upregulated in our grafts...

  10. Understanding traumatic blunt cardiac injury.

    Science.gov (United States)

    El-Menyar, Ayman; Al Thani, Hassan; Zarour, Ahmad; Latifi, Rifat

    2012-01-01

    Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  11. Understanding traumatic blunt cardiac injury

    Directory of Open Access Journals (Sweden)

    Ayman El-Menyar

    2012-01-01

    Full Text Available Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  12. Spectrum of paediatric cardiac diseases: a study of 15,066 children undergoing cardiac intervention at a tertiary care centre in India with special emphasis on gender.

    Science.gov (United States)

    Kiran, Viralam S; Nath, Parrimala P; Maheshwari, Sunita

    2011-02-01

    To analyse the relative frequency and gender ratios in the procedures (both surgical and catheter-based interventions) performed for cardiac diseases in Indian children. Not many studies are available in the developing countries with regard to the prevalence, relative frequency, or gender distribution of cardiac diseases in children. As universal newborn screening is not carried out for congenital cardiac diseases, the statistics are difficult to ascertain. Do female and male children with cardiac disease get equal parental preference in terms of surgical correction and catheter interventions in India? This question is also unanswered. Analysis of 15,066 consecutive Indian children aged ratios of cardiac lesions in these children were determined and compared with the studies in literature. Overall male/female ratio in the study was 1.4:1. Ventricular septal defect was the most common lesion (24.2%) with male/female ratio of 1.5:1, followed by tetralogy of Fallot (18.7%, 1.6:1), atrial septal defect (14.4%, 0.9:1) and so on. Male children dominated the total number of procedures performed. In most of the individual cardiac lesions, the relative frequency was different from that of international studies. The gender ratio for the majority of the individual type of cardiac problems was different from that of international references. These findings may suggest a preference for the male child in the treatment of cardiac diseases in India, which could possibly be related to social causes.

  13. [Norman Edward Shumway - pioneer of cardiac surgery (February 9, 1923 to February 10, 2006)].

    Science.gov (United States)

    Schmitto, Jan D; Grossmann, Marius; Kubbe, Eric; Liakopoulos, Oliver J; Popov, Aron F; Mirzaie, Masoud; Seipelt, Ralf; Schöndube, Friedrich A

    2008-07-01

    After a fulfilled life, Norman E. Shumway, the great pioneer of cardiac transplantation, died of lung cancer 1 day after his 83rd birthday in Palo Alto, California, USA. Already at the beginning of the 1960s, he and his colleague Richard R. Lower did revolutionary experimental work on developing and establishing the technique of orthotopic cardiac transplantation in dogs. Several studies on cardiac transplantation were carried out in his department and a few years later, Shumway and his team were on their way to perform the worldwide first human-to-human cardiac transplantation. On December 3, 1967, Christiaan Neethling Barnard, a cardiac surgeon from South Africa, forestalled Shumway and performed this operation in Cape Town, South Africa. This event initiated a global boom of cardiac transplantations in the following years." Many heart centers started their own cardiac transplant programs but high mortality rates led again to stagnancy of transplant activities. Shumway remained stable in believing in good results of cardiac transplantation and continued his program steadily. At the beginning of the 1970s, he and his group were responsible for most cardiac transplantations worldwide.

  14. A Prospective Study of Sudden Cardiac Death among Children and Young Adults.

    Science.gov (United States)

    Bagnall, Richard D; Weintraub, Robert G; Ingles, Jodie; Duflou, Johan; Yeates, Laura; Lam, Lien; Davis, Andrew M; Thompson, Tina; Connell, Vanessa; Wallace, Jennie; Naylor, Charles; Crawford, Jackie; Love, Donald R; Hallam, Lavinia; White, Jodi; Lawrence, Christopher; Lynch, Matthew; Morgan, Natalie; James, Paul; du Sart, Desirée; Puranik, Rajesh; Langlois, Neil; Vohra, Jitendra; Winship, Ingrid; Atherton, John; McGaughran, Julie; Skinner, Jonathan R; Semsarian, Christopher

    2016-06-23

    Sudden cardiac death among children and young adults is a devastating event. We performed a prospective, population-based, clinical and genetic study of sudden cardiac death among children and young adults. We prospectively collected clinical, demographic, and autopsy information on all cases of sudden cardiac death among children and young adults 1 to 35 years of age in Australia and New Zealand from 2010 through 2012. In cases that had no cause identified after a comprehensive autopsy that included toxicologic and histologic studies (unexplained sudden cardiac death), at least 59 cardiac genes were analyzed for a clinically relevant cardiac gene mutation. A total of 490 cases of sudden cardiac death were identified. The annual incidence was 1.3 cases per 100,000 persons 1 to 35 years of age; 72% of the cases involved boys or young men. Persons 31 to 35 years of age had the highest incidence of sudden cardiac death (3.2 cases per 100,000 persons per year), and persons 16 to 20 years of age had the highest incidence of unexplained sudden cardiac death (0.8 cases per 100,000 persons per year). The most common explained causes of sudden cardiac death were coronary artery disease (24% of cases) and inherited cardiomyopathies (16% of cases). Unexplained sudden cardiac death (40% of cases) was the predominant finding among persons in all age groups, except for those 31 to 35 years of age, for whom coronary artery disease was the most common finding. Younger age and death at night were independently associated with unexplained sudden cardiac death as compared with explained sudden cardiac death. A clinically relevant cardiac gene mutation was identified in 31 of 113 cases (27%) of unexplained sudden cardiac death in which genetic testing was performed. During follow-up, a clinical diagnosis of an inherited cardiovascular disease was identified in 13% of the families in which an unexplained sudden cardiac death occurred. The addition of genetic testing to autopsy

  15. Infrequent cardiac manifestations of sarcoidosis.

    Science.gov (United States)

    Ashraf, Said; Briasoulis, Alexandros; Afonso, Luis

    Cardiac sarcoidosis (CS) is found in 2-7% of patients with systemic sarcoidosis (SS). Its diagnosis and treatment is challenging, notwithstanding the poor prognosis and treatment. Hereby, we present a case of systemic sarcoidosis with rare cardiac manifestations of severe mitral incompetence and large coronary aneurysm in a previously healthy woman. She underwent successful mitral valve replacement and coronary artery bypass surgery and was maintained on low dose glucocorticoid therapy. Copyright © 2016. Published by Elsevier Inc.

  16. Cardiac PET imaging in mice with simultaneous cardiac and respiratory gating

    Science.gov (United States)

    Yang, Yongfeng; Rendig, Stephen; Siegel, Stefan; Newport, Danny F.; Cherry, Simon R.

    2005-07-01

    Gating firmware and software were developed for the microPET II small animal scanner. The measured cardiac and respiratory signals were collected and converted to TTL gating signals by a Biopac MP150 data acquisition system and sent to microPET II through two BNC connectors on the front panel. During acquisition, the coincidence monitor takes the average of the last eight gate input cycles and inserts this into the list mode data stream on the falling edge of the gating pulse. This value is then used to determine the current time interval of the next gate cycle when the list mode data are sorted into sinograms. The gating firmware and software were validated by an experiment using a rotating point source. Mouse heart (18F-FDG) and bone (18F-) imaging was performed with simultaneous cardiac and respiratory gating. It was clearly demonstrated that the contractile function of the mouse heart can be studied by cardiac-gated imaging with microPET II. The left ventricular volumes at different times of the cardiac cycle were measured and the ejection fraction was calculated. In the bone scan, no detectable movement caused by heart contraction was observed. Respiratory motion was more subtle with virtually no motion for more than 75% of the respiratory cycle. The motion of the mouse heart and bones in the thorax caused by respiration was less than 1 mm. It appears with the current resolution of PET, and the small fraction of the respiratory cycle in which motion occurs, that respiratory gating is probably not necessary for most mouse cardiac studies.

  17. Cardiac nuclear high mobility group box 1 prevents the development of cardiac hypertrophy and heart failure.

    Science.gov (United States)

    Funayama, Akira; Shishido, Tetsuro; Netsu, Shunsuke; Narumi, Taro; Kadowaki, Shinpei; Takahashi, Hiroki; Miyamoto, Takuya; Watanabe, Tetsu; Woo, Chang-Hoon; Abe, Jun-ichi; Kuwahara, Koichiro; Nakao, Kazuwa; Takeishi, Yasuchika; Kubota, Isao

    2013-09-01

    High mobility group box 1 (HMGB1) is an abundant and ubiquitous nuclear DNA-binding protein that has multiple functions dependent on its cellular location. HMGB1 binds to DNA, facilitating numerous nuclear functions including maintenance of genome stability, transcription, and repair. However, little is known about the effects of nuclear HMGB1 on cardiac hypertrophy and heart failure. The aim of this study was to examine whether nuclear HMGB1 plays a role in the development of cardiac hypertrophy induced by pressure overload. Analysis of human biopsy samples by immunohistochemistry showed decreased nuclear HMGB1 expression in failing hearts compared with normal hearts. Nuclear HMGB1 decreased in response to both endothelin-1 (ET-1) and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes, where nuclear HMGB1 was acetylated and translocated to the cytoplasm. Overexpression of nuclear HMGB1 attenuated ET-1 induced cardiomyocyte hypertrophy. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) and wild-type (WT) mice. Cardiac hypertrophy after TAC was attenuated in HMGB1-Tg mice and the survival rate after TAC was higher in HMGB1-Tg mice than in WT mice. Induction of foetal cardiac genes was decreased in HMGB1-Tg mice compared with WT mice. Nuclear HMGB1 expression was preserved in HMGB1-Tg mice compared with WT mice and significantly attenuated DNA damage after TAC was attenuated in HMGB1-TG mice. These results suggest that the maintenance of stable nuclear HMGB1 levels prevents hypertrophy and heart failure by inhibiting DNA damage.

  18. Dental extractions in patients with cardiac sarcoidosis.

    Science.gov (United States)

    Yoshimura, Yasuro; Nariai, Yoshiki; Yoshimura, Hitoshi

    2007-09-01

    To present data on hemodynamic changes during dental extractions in 5 patients with cardiac sarcoidosis, performed with electrocardiogram, heart rate, and blood pressure monitoring throughout the procedures, and to discuss the problems relating to the disease and dental extraction. The medical data for 5 patients, including medical records, physician correspondence, and laboratory data before the treatments, were assessed. Seven dental extractions were then performed while monitoring and recording the hemodynamic conditions. Heart rate, blood pressure, rate pressure products, and electrocardiographic findings were analyzed. Finally, posttreatment evaluations of the general and local conditions of the patients were conducted. All dental extractions were performed in nonactive stable periods, with no remarkable hemodynamic changes or complications, while maintaining a stable hemodynamic state throughout the extraction procedure. All patients received a pretreatment supplement of corticosteroid. Wound healing was similar to that in normal patients under antibiotic prophylaxis against infection originating from the dental extraction wound and the original dental lesion. Pretreatment general evaluation of patients with cardiac sarcoidosis should be performed through various examinations and physician consultation, and a stable hemodynamic change during the surgical procedure should be maintained under any hemodynamic monitors. Corticosteroid supplement and antibiotic coverage are also necessary for safe dental extraction and suitable healing.

  19. Cardiac Dysfunction in a Porcine Model of Pediatric Malnutrition.

    Directory of Open Access Journals (Sweden)

    Christian Fabiansen

    Full Text Available Half a million children die annually of severe acute malnutrition and cardiac dysfunction may contribute to the mortality. However, cardiac function remains poorly examined in cases of severe acute malnutrition.To determine malnutrition-induced echocardiographic disturbances and longitudinal changes in plasma pro-atrial natriuretic peptide and cardiac troponin-T in a pediatric porcine model.Five-week old piglets (Duroc-x-Danish Landrace-x-Yorkshire were fed a nutritionally inadequate maize-flour diet to induce malnutrition (MAIZE, n = 12 or a reference diet (AGE-REF, n = 12 for 7 weeks. Outcomes were compared to a weight-matched reference group (WEIGHT-REF, n = 8. Pro-atrial natriuretic peptide and cardiac troponin-T were measured weekly. Plasma pro-atrial natriuretic peptide decreased in both MAIZE and AGE-REF during the first 3 weeks but increased markedly in MAIZE relative to AGE-REF during week 5-7 (p ≤ 0.001. There was overall no difference in plasma cardiac troponin-T between groups. However, further analysis revealed that release of cardiac troponin-T in plasma was more frequent in AGE-REF compared with MAIZE (OR: 4.8; 95%CI: 1.2-19.7; p = 0.03. However, when release occurred, cardiac troponin-T concentration was 6.9-fold higher (95%CI: 3.0-15.9; p < 0.001 in MAIZE compared to AGE-REF. At week 7, the mean body weight in MAIZE was lower than AGE-REF (8.3 vs 32.4 kg, p < 0.001, whereas heart-weight relative to body-weight was similar across the three groups. The myocardial performance index was 86% higher in MAIZE vs AGE-REF (p < 0.001 and 27% higher in MAIZE vs WEIGHT-REF (p = 0.025.Malnutrition associates with cardiac dysfunction in a pediatric porcine model by increased myocardial performance index and pro-atrial natriuretic peptide and it associates with cardiac injury by elevated cardiac troponin-T. Clinical studies are needed to see if the same applies for children suffering from malnutrition.

  20. ASSUMED OXYGEN-CONSUMPTION BASED ON CALCULATION FROM DYE DILUTION CARDIAC-OUTPUT - AN IMPROVED FORMULA

    NARCIS (Netherlands)

    BERGSTRA, A; VANDIJK, RB; HILLEGE, HL; LIE, KI; MOOK, GA

    This study was performed because of observed differences between dye dilution cardiac output and the Fick cardiac output, calculated from estimated oxygen consumption according to LaFarge and Miettinen, and to find a better formula for assumed oxygen consumption. In 250 patients who underwent left

  1. Cardiac output monitoring by echocardiography: should we pass on Swan-Ganz catheters?

    OpenAIRE

    Perrino, A. C.

    1993-01-01

    Transesophageal echocardiography offers a noninvasive technique for the continuous monitoring of cardiac performance. The combination of 2-dimensional echocardiography and Doppler velocitometry provide assessment of cardiac anatomy, valve function and, ventricular loading conditions. Although transesophageal echocardiography has become accepted for perioperative monitoring, it is typically used in conjunction with Swan-Ganz catheterization. To supplant Swan-Ganz catheters, an echocardiographi...

  2. Experiences, considerations and emotions relating to cardiogenetic evaluation in relatives of young sudden cardiac death victims

    NARCIS (Netherlands)

    van der Werf, Christian; Onderwater, Astrid T.; van Langen, Irene M.; Smets, Ellen M. A.

    2014-01-01

    Relatives of young sudden cardiac death (SCD) victims are at increased risk of carrying a potentially fatal inherited cardiac disease. Hence, it is recommended to perform an autopsy on the victim and to refer his or her relatives to a cardiogenetics clinic for a full evaluation to identify those at

  3. Physiological and pathological cardiac hypertrophy.

    Science.gov (United States)

    Shimizu, Ippei; Minamino, Tohru

    2016-08-01

    The heart must continuously pump blood to supply the body with oxygen and nutrients. To maintain the high energy consumption required by this role, the heart is equipped with multiple complex biological systems that allow adaptation to changes of systemic demand. The processes of growth (hypertrophy), angiogenesis, and metabolic plasticity are critically involved in maintenance of cardiac homeostasis. Cardiac hypertrophy is classified as physiological when it is associated with normal cardiac function or as pathological when associated with cardiac dysfunction. Physiological hypertrophy of the heart occurs in response to normal growth of children or during pregnancy, as well as in athletes. In contrast, pathological hypertrophy is induced by factors such as prolonged and abnormal hemodynamic stress, due to hypertension, myocardial infarction etc. Pathological hypertrophy is associated with fibrosis, capillary rarefaction, increased production of pro-inflammatory cytokines, and cellular dysfunction (impairment of signaling, suppression of autophagy, and abnormal cardiomyocyte/non-cardiomyocyte interactions), as well as undesirable epigenetic changes, with these complex responses leading to maladaptive cardiac remodeling and heart failure. This review describes the key molecules and cellular responses involved in physiological/pathological cardiac hypertrophy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Cardiac misconceptions in healthcare workers.

    Science.gov (United States)

    Angus, Neil; Patience, Fiona; Maclean, Elizabeth; Corrigall, Helen; Bradbury, Ian; Thompson, David R; Atherton, Iain; Leslie, Stephen J

    2012-12-01

    Cardiac misconceptions are common and may have a detrimental effect on patients. Such misconceptions may be introduced or reinforced by vague and inconsistent advice from healthcare staff and can adversely affect health outcomes. To assess whether level of cardiac misconceptions significantly differs between groups of healthcare staff based on occupation. The 22-item York cardiac beliefs questionnaire (YCBQ) was administered to a convenience sample of healthcare staff (n = 263) in direct contact with cardiac patients. Data was also collected on the occupation of healthcare staff and years worked. Medical staff had the lowest mean score (17.5, CI 15.6-19.4), indicating fewest misconceptions, and unqualified healthcare workers had the highest mean score (32.1, CI 28.4-35.7). Analysis by ANOVA indicated differences between staff groups to be statistically significant (F = 17.66, p misconception score (Pearson's r = - 0.243, p misconceptions in different groups of healthcare staff. Education to correct cardiac misconceptions should be particularly targeted at unqualified healthcare staff. The importance of maintaining appropriate ratios of qualified to unqualified healthcare staff in the care of cardiac patients is supported by this study.

  5. Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction

    DEFF Research Database (Denmark)

    Hald, Kathrine; Nielsen, Kirsten Melgaard; Nielsen, Claus Vinther

    2018-01-01

    OBJECTIVE: Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine...... compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality......, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after. DESIGN: Prospective cohort study. SETTING: The cardiac ward at a university hospital in Denmark from 2000 to 2004. PARTICIPANTS: 379 patients aged

  6. Recurrent late cardiac tamponade following cardiac surgery : a deceiving and potentially lethal complication

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Meuzelaar, Jacobus J.

    2010-01-01

    Background - Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. Case report - We present a case of recurrent cardiac tamponade following valve surgery. At first presentation,

  7. Cardiac output during exercise

    DEFF Research Database (Denmark)

    Siebenmann, C; Rasmussen, P.; Sørensen, H.

    2015-01-01

    a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0......Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from...... the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2  = 12%). While all four methods reported...

  8. Imaging of Cardiac Valves by Computed Tomography

    OpenAIRE

    Gudrun Feuchtner

    2013-01-01

    This paper describes “how to” examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, “how to” perform and optimize a multislice CT scan and “how to” interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide “how to” use ...

  9. German cardiac CT registry: indications, procedural data and clinical consequences in 7061 patients undergoing cardiac computed tomography.

    Science.gov (United States)

    Marwan, Mohamed; Achenbach, Stephan; Korosoglou, Grigorios; Schmermund, Axel; Schneider, Steffen; Bruder, Oliver; Hausleiter, Jörg; Schroeder, Stephen; Barth, Sebastian; Kerber, Sebastian; Leber, Alexander; Moshage, Werner; Senges, Jochen

    2017-12-01

    Cardiac computed tomography permits quantification of coronary calcification as well as detection of coronary artery stenoses after contrast enhancement. Moreover, cardiac CT offers high-resolution morphologic and functional imaging of cardiac structures which is valuable for various structural heart disease interventions and electrophysiology procedures. So far, only limited data exist regarding the spectrum of indications, image acquisition parameters as well as results and clinical consequences of cardiac CT examinations using state-of-the-art CT systems in experienced centers. Twelve cardiology centers with profound expertise in cardiovascular imaging participated in the German Cardiac CT Registry. Criteria for participation included adequate experience in cardiac CT as well of the availability of a 64-slice or newer CT system. Between 2009 and 2014, 7061 patients were prospectively enrolled. For all cardiac CT examinations, patient parameters, procedural data, indication and clinical consequences of the examination were documented. Mean patient age was 61 ± 12 years, 63% were males. The majority (63%) of all cardiac CT examinations were performed in an outpatient setting, 37% were performed during an inpatient stay. 91% were elective and 9% were scheduled in an acute setting. In most examinations (48%), reporting was performed by cardiologists, in 4% by radiologists and in 47% of the cases as a consensus reading. Cardiac CT was limited to native acquisitions for assessment of coronary artery calcification in 9% of patients, only contrast-enhanced coronary CT angiography was performed in 16.6% and combined native and contrast-enhanced coronary CT angiography was performed in 57.7% of patients. Non-coronary cardiac CT examinations constituted 16.6% of all cases. Coronary artery calcification assessment was performed using prospectively ECG-triggered acquisition in 76.9% of all cases. The median dose length product (DLP) was 42 mGy cm (estimated effective

  10. ECPR for Refractory Out-Of-Hospital Cardiac Arrest

    Science.gov (United States)

    2017-05-17

    Cardiac Arrest; Heart Arrest; Sudden Cardiac Arrest; Cardiopulmonary Arrest; Death, Sudden, Cardiac; Cardiopulmonary Resuscitation; CPR; Extracorporeal Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation

  11. Cardiac CT: A system architecture study.

    Science.gov (United States)

    FitzGerald, Paul; Bennett, James; Carr, Jeffrey; Edic, Peter M; Entrikin, Daniel; Gao, Hewei; Iatrou, Maria; Jin, Yannan; Liu, Baodong; Wang, Ge; Wang, Jiao; Yin, Zhye; Yu, Hengyong; Zeng, Kai; De Man, Bruno

    2016-01-01

    We are interested in exploring dedicated, high-performance cardiac CT systems optimized to provide the best tradeoff between system cost, image quality, and radiation dose. We sought to identify and evaluate a broad range of CT architectures that could provide an optimal, dedicated cardiac CT solution. We identified and evaluated thirty candidate architectures using consistent design choices. We defined specific evaluation metrics related to cost and performance. We then scored the candidates versus the defined metrics. Lastly, we applied a weighting system to combine scores for all metrics into a single overall score for each architecture. CT experts with backgrounds in cardiovascular radiology, x-ray physics, CT hardware and CT algorithms performed the scoring and weighting. We found nearly a twofold difference between the most and the least promising candidate architectures. Architectures employed by contemporary commercial diagnostic CT systems were among the highest-scoring candidates. We identified six architectures that show sufficient promise to merit further in-depth analysis and comparison. Our results suggest that contemporary diagnostic CT system architectures outperform most other candidates that we evaluated, but the results for a few alternatives were relatively close. We selected six representative high-scoring candidates for more detailed design and further comparative evaluation.

  12. Cardiac rehabilitation costs.

    Science.gov (United States)

    Moghei, Mahshid; Turk-Adawi, Karam; Isaranuwatchai, Wanrudee; Sarrafzadegan, Nizal; Oh, Paul; Chessex, Caroline; Grace, Sherry L

    2017-10-01

    Despite the clinical benefits of cardiac rehabilitation (CR) and its cost-effectiveness, it is not widely received. Arguably, capacity could be greatly increased if lower-cost models were implemented. The aims of this review were to describe: the costs associated with CR delivery, approaches to reduce these costs, and associated implications. Upon finalizing the PICO statement, information scientists were enlisted to develop the search strategy of MEDLINE, Embase, CDSR, Google Scholar and Scopus. Citations identified were considered for inclusion by the first author. Extracted cost data were summarized in tabular format and qualitatively synthesized. There is wide variability in the cost of CR delivery around the world, and patients pay out-of-pocket for some or all of services in 55% of countries. Supervised CR costs in high-income countries ranged from PPP$294 (Purchasing Power Parity; 2016 United States Dollars) in the United Kingdom to PPP$12,409 in Italy, and in middle-income countries ranged from PPP$146 in Venezuela to PPP$1095 in Brazil. Costs relate to facilities, personnel, and session dose. Delivering CR using information and communication technology (mean cost PPP$753/patient/program), lowering the dose and using lower-cost personnel and equipment are important strategies to consider in containing costs, however few explicitly low-cost models are available in the literature. More research is needed regarding the costs to deliver CR in community settings, the cost-effectiveness of CR in most countries, and the economic impact of return-to-work with CR participation. A low-cost model of CR should be standardized and tested for efficacy across multiple healthcare systems. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Cardiac output monitoring

    Directory of Open Access Journals (Sweden)

    Mathews Lailu

    2008-01-01

    Full Text Available Minimally invasive and non-invasive methods of estimation of cardiac output (CO were developed to overcome the limitations of invasive nature of pulmonary artery catheterization (PAC and direct Fick method used for the measurement of stroke volume (SV. The important minimally invasive techniques available are: oesophageal Doppler monitoring (ODM, the derivative Fick method (using partial carbon dioxide (CO 2 breathing, transpulmonary thermodilution, lithium indicator dilution, pulse contour and pulse power analysis. Impedance cardiography is probably the only non-invasive technique in true sense. It provides information about haemodynamic status without the risk, cost and skill associated with the other invasive or minimally invasive techniques. It is important to understand what is really being measured and what assumptions and calculations have been incorporated with respect to a monitoring device. Understanding the basic principles of the above techniques as well as their advantages and limitations may be useful. In addition, the clinical validation of new techniques is necessary to convince that these new tools provide reliable measurements. In this review the physics behind the working of ODM, partial CO 2 breathing, transpulmonary thermodilution and lithium dilution techniques are dealt with. The physical and the physiological aspects underlying the pulse contour and pulse power analyses, various pulse contour techniques, their development, advantages and limitations are also covered. The principle of thoracic bioimpedance along with computation of CO from changes in thoracic impedance is explained. The purpose of the review is to help us minimize the dogmatic nature of practice favouring one technique or the other.

  14. Is there a beneficial effect difference between age, gender, and different cardiac pathology groups of exercise training at ventilatory threshold in cardiac patients?

    Science.gov (United States)

    Temfemo, Abdou; Chlif, Mehdi; Mandengue, Samuel Honoré; Lelard, Thierry; Choquet, Dominique; Ahmaidi, Said

    2011-01-01

    Research on cardiac rehabilitation has raised interesting methods and effects without however establishing the share of the profits according to age, sex and cardiac pathology. Yet today, this disease with various pathologies strikes people of all ages and both sexes, and the recommended rehabilitation exercise intensity is often the ventilatory threshold. The aim of this study was to compare benefits of a training program at ventilatory threshold according to age, gender and cardiac pathology. One hundred and eighty eight cardiac patients, of whom 62 had coronary artery bypass surgery, 22 artery angioplasty, 54 myocardial infarction and 50 valve replacements, aged 31-82 years, performed spirometric and cardiopulmonary exercise tests before and after a training program. This program consisted of exercise on a cycloergometer for three sessions of 45 min per week for eight weeks at heart rates attenuated at ventilatory threshold (V(Th)) obtained during a cardiopulmonary exercise test conducted before the training period. Peak heart rate, peak aerobic power, and peak oxygen uptake determined at V(Th) increased during the training period in all groups of subjects. Men and adult groups had higher absolute values compared to women and elderly groups. No difference was observed in cardiac pathology groups. Similar improvements of aerobic capacities were observed in age, gender and cardiac pathology groups. A training program conducted at personalised V(Th) significantly improves the aerobic physical capacities of all cardiac patients, and inducessimilar benefits whatever the age, gender or cardiac pathology.

  15. Identification of genes regulated during mechanical load-induced cardiac hypertrophy

    Science.gov (United States)

    Johnatty, S. E.; Dyck, J. R.; Michael, L. H.; Olson, E. N.; Abdellatif, M.; Schneider, M. (Principal Investigator)

    2000-01-01

    Cardiac hypertrophy is associated with both adaptive and adverse changes in gene expression. To identify genes regulated by pressure overload, we performed suppressive subtractive hybridization between cDNA from the hearts of aortic-banded (7-day) and sham-operated mice. In parallel, we performed a subtraction between an adult and a neonatal heart, for the purpose of comparing different forms of cardiac hypertrophy. Sequencing more than 100 clones led to the identification of an array of functionally known (70%) and unknown genes (30%) that are upregulated during cardiac growth. At least nine of those genes were preferentially expressed in both the neonatal and pressure over-load hearts alike. Using Northern blot analysis to investigate whether some of the identified genes were upregulated in the load-independent calcineurin-induced cardiac hypertrophy mouse model, revealed its incomplete similarity with the former models of cardiac growth. Copyright 2000 Academic Press.

  16. Cardiac Rehabilitation Enhancing Programs in Patients with Myocardial Infarction: A literature Review

    Directory of Open Access Journals (Sweden)

    Ahyana Ahyana

    2013-01-01

    professionals should be involved in CR programs in order to enhance patients’ performance in CR behaviors; moreover, further study is also needed to examine the existing intervention studies to improve the CR program.Keywords: cardiac rehabilitation, attendance, behaviors, outcomes, secondary prevention and myocardial infarction (MI.

  17. Reduced incidence of cardiac arrhythmias in walkers and runners.

    Science.gov (United States)

    Williams, Paul T; Franklin, Barry A

    2013-01-01

    Walking is purported to reduce the risk of atrial fibrillation by 48%, whereas jogging is purported to increase its risk by 53%, suggesting a strong anti-arrhythmic benefit of walking over running. The purpose of these analyses is to compare incident self-reported physician-diagnosed cardiac arrhythmia to baseline energy expenditure (metabolic equivalent hours per day, METhr/d) from walking, running and other exercise. Proportional hazards analysis of 14,734 walkers and 32,073 runners. There were 1,060 incident cardiac arrhythmias (412 walkers, 648 runners) during 6.2 years of follow-up. The risk for incident cardiac arrhythmias declined 4.4% per baseline METhr/d walked by the walkers, or running in the runners (P = 0.0001). Specifically, the risk declined 14.2% (hazard ratio: 0.858) for 1.8 to 3.6 METhr/d, 26.5% for 3.6 to 5.4 METhr/d, and 31.7% for ≥5.4 METhr/d, relative to cardiac arrhythmias. Cardiac arrhythmias were unrelated to walking and running intensity, and unrelated to marathon participation and performance. The risk for cardiac arrhythmias was similar in walkers and runners who expended comparable METhr/d during structured exercise. We found no significant risk increase for self-reported cardiac arrhythmias associated with running distance, exercise intensity, or marathon participation. Rhythm abnormalities were based on self-report, precluding definitive categorization of the nature of the rhythm disturbance. However, even if the runners' arrhythmias include sinus bradycardia due to running itself, there was no increase in arrhythmias with greater running distance.

  18. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study

    Directory of Open Access Journals (Sweden)

    Fatima Dumas Cintra

    2014-11-01

    Full Text Available Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart® system. Results: A total of 767 participants (461 men with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001. After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.

  19. Animal models of cardiac cachexia.

    Science.gov (United States)

    Molinari, Francesca; Malara, Natalia; Mollace, Vincenzo; Rosano, Giuseppe; Ferraro, Elisabetta

    2016-09-15

    Cachexia is the loss of body weight associated with several chronic diseases including chronic heart failure (CHF). The cachectic condition is mainly due to loss of skeletal muscle mass and adipose tissue depletion. The majority of experimental in vivo studies on cachexia rely on animal models of cancer cachexia while a reliable and appropriate model for cardiac cachexia has not yet been established. A critical issue in generating a cardiac cachexia model is that genetic modifications or pharmacological treatments impairing the heart functionality and used to obtain the heart failure model might likely impair the skeletal muscle, this also being a striated muscle and sharing with the myocardium several molecular and physiological mechanisms. On the other hand, often, the induction of heart damage in the several existing models of heart failure does not necessarily lead to skeletal muscle loss and cachexia. Here we describe the main features of cardiac cachexia and illustrate some animal models proposed for cardiac cachexia studies; they include the genetic calsequestrin and Dahl salt-sensitive models, the monocrotaline model and the surgical models obtained by left anterior descending (LAD) ligation, transverse aortic constriction (TAC) and ascending aortic banding. The availability of a specific animal model for cardiac cachexia is a crucial issue since, besides the common aspects of cachexia in the different syndromes, each disease has some peculiarities in its etiology and pathophysiology leading to cachexia. Such peculiarities need to be unraveled in order to find new targets for effective therapies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. aging hypotension and intra-operative cardiac arres

    African Journals Online (AJOL)

    The development of a scoring tool for the measurement of performance in man- aging hypotension and intra-operative cardiac arrest during spinal anaesthesia ..... clinical evidence, likelihood of negative consequences, current standards of care or simply their own practice. No specific approach was prescribed and this may ...

  1. The Relationship Between QT Intervals and Cardiac Autonomic ...

    African Journals Online (AJOL)

    To study the pattern of QT intervals in Type 2 diabetic patients (T2DM) and investigate whether they have correlation with or predict development of Cardiac Autonomic Neuropathy (CAN). One hundred and eight (108) T2DM patients were compared with 88 normal controls. They all had resting ECG performed and QT ...

  2. Antipsychotics and the risk of sudden cardiac death

    NARCIS (Netherlands)

    Straus, S.M.J.M.; Bleumink, G.S.; Dieleman, J.P.; van der Lei, J.; 't Jong, G.W.; Kingma, J. Herre; Sturkenboom, M.C J M; Stricker, B.H C

    2004-01-01

    Background Antipsychotics have been associated with prolongation of the corrected QT interval and sudden cardiac death. Only a few epidemiological studies have investigated this association. We performed a case-control study to investigate the association between use of antipsychotics and sudden

  3. Cardiac Time Intervals by Tissue Doppler Imaging M-Mode

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Mogelvang, Rasmus; de Knegt, Martina Chantal

    2016-01-01

    PURPOSE: To define normal values of the cardiac time intervals obtained by tissue Doppler imaging (TDI) M-mode through the mitral valve (MV). Furthermore, to evaluate the association of the myocardial performance index (MPI) obtained by TDI M-mode (MPITDI) and the conventional method of obtaining...

  4. Importance of pre- and postoperative physiotherapy in pediatric cardiac surgery.

    Science.gov (United States)

    Cavenaghi, Simone; Moura, Silvia Cristina Garcia de; Silva, Thalis Henrique da; Venturinelli, Talita Daniela; Marino, Lais Helena Carvalho; Lamari, Neuseli Marino

    2009-01-01

    Lung complications during postoperative of pediatric heart surgery are frequently highlighting atelectasis and pneumonia. Physiotherapy has an important role in the treatment of these complications. We reviewed and update the physiotherapy performance in the preoperative and in the postoperative lung complication of pediatric cardiac surgery. We noted efficacy of physiotherapy treatment through different specific techniques and the need for development of new studies.

  5. Cardiac Time Intervals by Tissue Doppler Imaging M-Mode

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Mogelvang, Rasmus; de Knegt, Martina Chantal

    2016-01-01

    PURPOSE: To define normal values of the cardiac time intervals obtained by tissue Doppler imaging (TDI) M-mode through the mitral valve (MV). Furthermore, to evaluate the association of the myocardial performance index (MPI) obtained by TDI M-mode (MPITDI) and the conventional method of obtaining...... MPI (MPIConv), with established echocardiographic and invasive measures of systolic and diastolic function. METHODS: In a large community based population study (n = 974), where all are free of any cardiovascular disease and cardiovascular risk factors, cardiac time intervals, including isovolumic...... the MPITDI and MPIConv measured. RESULTS: IVRT, IVRT/ET and MPI all increased significantly with increasing age in both genders (pcardiac function. MPITDI...

  6. Eosinophilic cardiac disease: Molecular, clinical and imaging aspects.

    Science.gov (United States)

    Séguéla, Pierre-Emmanuel; Iriart, Xavier; Acar, Philippe; Montaudon, Michel; Roudaut, Raymond; Thambo, Jean-Benoit

    2015-04-01

    Eosinophilia may be responsible for cardiac injuries of widely varying severity, from acute myocarditis to endomyocardial fibrosis. In this review, we present both the molecular mechanisms that are responsible for these lesions and their clinical and paraclinical aspects. Numerous aetiologies can lead to severe eosinophilia, but these are mainly represented by hypersensitivity reactions, rheumatological diseases and hypereosinophilic syndrome. Because cardiac involvement may be extremely severe, echocardiography should be always performed in the context of eosinophilia and appropriate therapeutics should be started rapidly in order to limit the progression of the disease. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Increased risk of sudden cardiac arrest in obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Blom, Marieke Tabo; Bardai, Abdennasser

    2013-01-01

    BACKGROUND: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use....... METHODS: A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes...

  8. Cardiac involvement in myotonic dystrophy

    DEFF Research Database (Denmark)

    Lund, Marie; Diaz, Lars Jorge; Ranthe, Mattis Flyvholm

    2014-01-01

    genetic testing for DM1. Information on incident cardiac diseases was obtained from the NPR. We estimated standardized incidence ratios (SIRs) of cardiac disease compared with the background population, overall and according to selected diagnostic subgroups (cardiomyopathy, heart failure, conduction...... belonging to the selected subgroups, the risk was particularly high in the first year after DM diagnosis [SIR 15.4 (95% CI: 10.9-21.3)] but remained significantly elevated in subsequent years [SIR 6.07 (95% CI: 5.11-7.16]). The risk was higher in young cohort members [e.g. 20-39 years: SIR 18.1 (95% CI: 12...... is pronounced in the young and remains elevated throughout life, stressing the importance of lifelong cardiac follow-up from time of DM diagnosis....

  9. Alcohol effects on cardiac function.

    Science.gov (United States)

    Gardner, Jason D; Mouton, Alan J

    2015-04-01

    The consumption of ethanol can have both beneficial and detrimental effects on the function of the heart and cardiovascular system, depending on the amount consumed. Low-to-moderate amounts of ethanol intake are associated with improvements in cardiac function and vascular health. On the other hand, ethanol chronically consumed in large amounts acts as a toxin to the heart and vasculature. The cardiac injury produced by chronic alcohol abuse can progress to heart failure and eventual death. Furthermore, alcohol abuse may exacerbate preexisting heart conditions, such as hypertension and cardiomyopathy. This article focuses on the molecular mechanisms and pathophysiology of both the beneficial and detrimental cardiac effects of alcohol. © 2015 American Physiological Society.

  10. Cardiac dynamics: Alternans and arrhythmogenesis

    Directory of Open Access Journals (Sweden)

    Gary Tse, BA Hons MBBS MA PhD

    2016-10-01

    Full Text Available Pre-existing heterogeneities present in cardiac tissue are essential for maintaining the normal electrical and mechanical functions of the heart. Exacerbation of such heterogeneities or the emergence of dynamic factors can produce repolarization alternans, which are beat-to-beat alternations in the action potential time course. Traditionally, this was explained by restitution, but additional factors, such as cardiac memory, calcium handling dynamics, refractory period restitution, and mechano-electric feedback, are increasingly recognized as the underlying causes. The aim of this article is to review the mechanisms that generate cardiac repolarization alternans and convert spatially concordant alternans to the more arrhythmogenic spatially discordant alternans. This is followed by a discussion on how alternans generate arrhythmias in a number of clinical scenarios, and concluded by an outline of future therapeutic targets for anti-arrhythmic therapy.

  11. Serum tau and neurological outcome in cardiac arrest

    DEFF Research Database (Denmark)

    Mattsson, Niklas; Zetterberg, Henrik; Nielsen, Niklas

    2017-01-01

    OBJECTIVE: To test serum tau as a predictor of neurological outcome after cardiac arrest. METHODS: We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome...... was poor neurological outcome, defined as Cerebral Performance Categories 3-5 at 6 months. RESULTS: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7-245ng/l in poor vs median = 1.5, IQR = 0.7-2.4ng/l in good outcome, for tau....... The accuracy in predicting outcome by serum tau was equally high for patients randomized to 33 °C and 36 °C targeted temperature after cardiac arrest. INTERPRETATION: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better...

  12. Sildenafil after cardiac arrest and infarction; an experimental rat model.

    Science.gov (United States)

    Mennander, Ari A; Vuohelainen, Vilma; Aanismaa, Riikka S; Narkilahti, Susanna; Paavonen, Timo; Tarkka, Matti

    2013-02-01

    Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We evaluated whether sildenafil, a phosphodiesterase-5 inhibitor, has an impact on recovery after cardiac arrest in a rat cardiac transplantation model. Sixty-one Fischer344 rats underwent syngeneic heterotopic cardiac transplantation after ischemia and ligation of the left anterior coronary artery of the heart to yield myocardial infarction (IRI + MI). Of these, 22 rats received subcutaneously injected sildenafil (1 mg/kg/day) (IRI +MI + S). Twenty-three additional grafted animals with transplantation only served as controls with ischemia reperfusion injury (IRI). After 2 days, immunohistochemistry for eNOS, and RT-PCR for iNOS and Aquaporin-7 were performed after graft harvesting and histology. Two days after transplantation, remote intramyocardial arteries were more preserved in IRI + MI + S as compared with IRI +MI and IRI (0.74 ± 0.14, 0.56 ± 0.23 and 0.55 ± 0.22, PSU, p cardiac arrest and ischemia.

  13. Estrogens mediate cardiac hypertrophy in a stimulus-dependent manner.

    Science.gov (United States)

    Haines, Christopher D; Harvey, Pamela A; Leinwand, Leslie A

    2012-09-01

    The incidence of cardiac hypertrophy, an established risk factor for heart failure, is generally lower in women compared with men, but this advantage is lost after menopause. Although it is widely believed that estrogens are cardioprotective, there are contradictory reports, including increased cardiac events in postmenopausal women receiving estrogens and enhanced cardiac protection from ischemic injury in female mice without estrogens. We exposed aromatase knockout (ArKO) mice, which produce no estrogens, to both pathologic and physiologic stimuli. This model allows an investigation into the effects of a complete, chronic lack of estrogens in male and female hearts. At baseline, female ArKO mice had normal-sized hearts but decreased cardiac function and paradoxically increased phosphorylation of many progrowth kinases. When challenged with the pathological stimulus, isoproterenol, ArKO females developed 2-fold more hypertrophy than wild-type females. In contrast, exercise-induced physiological hypertrophy was unaffected by the absence of estrogens in either sex, although running performance was blunted in ArKO females. Thus, loss of estrogen signaling in females, but not males, impairs cardiac function and sensitizes the heart to pathological insults through up-regulation of multiple hypertrophic pathways. These findings provide insight into the apparent loss of cardioprotection after menopause and suggest that caution is warranted in the long-term use of aromatase inhibitors in the setting of breast cancer prevention.

  14. 3D cardiac wall thickening assessment for acute myocardial infarction

    Science.gov (United States)

    Khalid, A.; Chan, B. T.; Lim, E.; Liew, Y. M.

    2017-06-01

    Acute myocardial infarction (AMI) is the most severe form of coronary artery disease leading to localized myocardial injury and therefore irregularities in the cardiac wall contractility. Studies have found very limited differences in global indices (such as ejection fraction, myocardial mass and volume) between healthy subjects and AMI patients, and therefore suggested regional assessment. Regional index, specifically cardiac wall thickness (WT) and thickening is closely related to cardiac function and could reveal regional abnormality due to AMI. In this study, we developed a 3D wall thickening assessment method to identify regional wall contractility dysfunction due to localized myocardial injury from infarction. Wall thickness and thickening were assessed from 3D personalized cardiac models reconstructed from cine MRI images by fitting inscribed sphere between endocardial and epicardial wall. The thickening analysis was performed in 5 patients and 3 healthy subjects and the results were compared against the gold standard 2D late-gadolinium-enhanced (LGE) images for infarct localization. The notable finding of this study is the highly accurate estimation and visual representation of the infarct size and location in 3D. This study provides clinicians with an intuitive way to visually and qualitatively assess regional cardiac wall dysfunction due to infarction in AMI patients.

  15. Usefulness of electron microscopy in the diagnosis of cardiac sarcoidosis.

    Science.gov (United States)

    Takemura, G; Takatsu, Y; Ono, K; Miyatake, T; Ono, M; Izumi, T; Fujiwara, H

    1995-01-01

    A 49-year-old man with cardiac sarcoidosis is presented. He suffered from congestive heart failure, and left ventricular asynergy and reduced function was evident by echocardiogram and left ventriculogram. A light microscopic examination of the endomyocardial biopsy revealed nonspecific myocarditis without giant cells or noncaseating granulomas. Under an electron microscope, however, several epithelioid cells were found in the specimen. The serum level of lysozyme was elevated. The patient had a past history of sarcoidosis of the eyes and lungs 22 years previously. Cardiac diseases presenting epithelioid cells other than sarcoidosis were clinically ruled out. Thus, the diagnosis of cardiac sarcoidosis was made based on both clinical and ultrastructural findings, and corticosteroid therapy was initiated. In the second biopsy, performed 4 months later, a noncaseating granuloma was found. Generally, the incidence of histological diagnosis of cardiac sarcoidosis by light microscopy is relatively low in endomyocardial biopsy specimens. The present case suggests that the addition of an ultrastructural examination may improve the diagnostic usefulness of the endomyocardial biopsy in cardiac sarcoidosis, since electron microscopy can clearly identify the presence of even one epithelioid cell.

  16. Functional cardiac imaging by random access microscopy

    Directory of Open Access Journals (Sweden)

    Claudia eCrocini

    2014-10-01

    Full Text Available Advances in the development of voltage sensitive dyes and Ca2+ sensors in combination with innovative microscopy techniques allowed researchers to perform functional measurements with an unprecedented spatial and temporal resolution. At the moment, one of the shortcomings of available technologies is their incapability of imaging multiple fast phenomena while controlling the biological determinants involved. In the near future, ultrafast deflectors can be used to rapidly scan laser beams across the sample, performing optical measurements of action potential and Ca2+ release from multiple sites within cardiac cells and tissues. The same scanning modality could also be used to control local Ca2+ release and membrane electrical activity by activation of caged compounds and light-gated ion channels. With this approach, local Ca2+ or voltage perturbations could be induced, simulating arrhythmogenic events, and their impact on physiological cell activity could be explored. The development of this optical methodology will provide fundamental insights in cardiac disease, boosting new therapeutic strategies, and, more generally, it will represent a new approach for the investigation of the physiology of excitable cells.

  17. Community involvement in out of hospital cardiac arrest

    Science.gov (United States)

    Shams, Ali; Raad, Mohamad; Chams, Nour; Chams, Sana; Bachir, Rana; El Sayed, Mazen J.

    2016-01-01

    Abstract Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Developing countries including Lebanon report low survival rates and poor neurologic outcomes in affected victims. Community involvement through early recognition and bystander cardiopulmonary resuscitation (CPR) can improve OHCA survival. This study assesses knowledge and attitude of university students in Lebanon and identifies potential barriers and facilitators to learning and performing CPR. A cross-sectional survey was administered to university students. The questionnaire included questions regarding the following data elements: demographics, knowledge, and awareness about sudden cardiac arrest, CPR, automated external defibrillator (AED) use, prior CPR and AED training, ability to perform CPR or use AED, barriers to performing/learning CPR/AED, and preferred location for attending CPR/AED courses. Descriptive analysis followed by multivariate analysis was carried out to identify predictors and barriers to learning and performing CPR. A total of 948 students completed the survey. Participants’ mean age was 20.1 (±2.1) years with 53.1% women. Less than half of participants (42.9%) were able to identify all the presenting signs of cardiac arrest. Only 33.7% of participants felt able to perform CPR when witnessing a cardiac arrest. Fewer participants (20.3%) reported receiving previous CPR training. Several perceived barriers to learning and performing CPR were also reported. Significant predictors of willingness to perform CPR when faced with a cardiac arrest were: earning higher income, previous CPR training and feeling confident in one's ability to apply an AED, or perform CPR. Lacking enough expertise in performing CPR was a significant barrier to willingness to perform CPR. University students in Lebanon are familiar with the symptoms of cardiac arrest, however, they are not well trained in CPR and lack confidence to perform it. The attitude towards the importance of

  18. Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Archana Sinha

    2015-01-01

    Full Text Available Pericardial effusion is a common cardiac manifestation of hypothyroidism, but effusion resulting in cardiac tamponade is extremely rare. We present a case of a 56-year-old African American woman with slurred speech and altered mental status that was initially suspected to have stroke. Her chest X-ray revealed cardiomegaly and subsequent echocardiogram showed a large pericardial effusion with echocardiographic evidence of cardiac tamponade. Clinically, patient did not have pulsus paradoxus or hypotension. Further questioning revealed a history of total surgical thyroidectomy and noncompliance with thyroid replacement therapy. Pericardiocentesis was performed promptly and thyroxine replacement therapy was started. Thereafter, her mental status improved significantly. The management of pericardial effusion associated with hypothyroidism varies depending on size of effusion and hemodynamic stability of the patient. The management strategy ranges from conservative management with close monitoring and thyroxine replacement to pericardiocentesis or creation of a pericardial window.

  19. Automated external defibrillators and simulated in-hospital cardiac arrests.

    Science.gov (United States)

    Rossano, Joseph W; Jefferson, Larry S; Smith, E O'Brian; Ward, Mark A; Mott, Antonio R

    2009-05-01

    To test the hypothesis that pediatric residents would have shorter time to attempted defibrillation using automated external defibrillators (AEDs) compared with manual defibrillators (MDs). A prospective, randomized, controlled trial of AEDs versus MDs was performed. Pediatric residents responded to a simulated in-hospital ventricular fibrillation cardiac arrest and were randomized to using either an AED or MD. The primary end point was time to attempted defibrillation. Sixty residents, 21 (35%) interns, were randomized to 2 groups (AED = 30, MD = 30). Residents randomized to the AED group had a significantly shorter time to attempted defibrillation [median, 60 seconds (interquartile range, 53 to 71 seconds)] compared with those randomized to the MD group [median, 103 seconds (interquartile range, 68 to 288 seconds)] (P attempted defibrillation at attempted defibrillation by pediatric residents in simulated cardiac arrests. Further studies are needed to help determine the role of AEDs in pediatric in-hospital cardiac arrests.

  20. An airline cardiac arrest program.

    Science.gov (United States)

    O'Rourke, M F; Donaldson, E; Geddes, J S

    1997-11-04

    As many as 1000 lives are lost annually from cardiac arrest in commercial aircraft. Ventricular fibrillation (VF), the most common mechanism, can be treated effectively only with prompt defibrillation, whereas the current policy of most airlines is to continue cardiopulmonary resuscitation pending aircraft diversion. The objective of this study was to assess the impact of making semiautomatic external defibrillators (AEDs) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation. Supervision was provided by medical volunteers or (remotely) by airline physicians. During a 64-month period, AEDs were used on 109 occasions: 63 times for monitoring an acutely ill passenger and 46 times for cardiac arrest. Twenty-seven episodes of cardiac arrest occurred in aircraft, often (11 of 27 [41%]) unwitnessed, and they were usually (21 of 27 [78%]) associated with asystole or pulseless idioventricular rhythm. All 19 arrests in terminals were witnessed; VF was present in 17 (89%). Overall, defibrillation was initially successful in 21 of 23 cases (91%). Long-term survival from VF was achieved in 26% (2 of 6 in aircraft and 4 of 17 in terminals). The ability to monitor cardiac rhythm aided decisions on diversion, which was avoided in most passengers with asystole or idioventricular rhythm. AEDs in aircraft and terminals, with appropriate crew training, are helpful in the management of cardiac emergencies. Survival from VF is practicable and is comparable with the most effective prehospital ambulance emergency services. Costly aircraft diversions can be avoided in clearly futile situations, enhancing the cost-effectiveness of the program.

  1. Complications after cardiac implantable electronic device implantations

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard

    2013-01-01

    Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient...

  2. Sudden Cardiac Arrest (SCA) Risk Assessment

    Science.gov (United States)

    ... Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without warning, and two- ... and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool is supported in part ...

  3. Aortic valve replacement in octogenarians with prior cardiac surgery.

    Science.gov (United States)

    Timek, Tomasz A; Turfe, Zaahir; Hooker, Robert L; Davis, Alan T; Willekes, Charles L; Murphy, Edward T; Bove, Theodore J; Heiser, John C; Patzelt, Lawrence H

    2015-02-01

    Transcatheter aortic valve implantation (TAVI) has been advocated for very elderly patients with aortic stenosis, and prior cardiac surgery as a less invasive treatment option. Although surgical aortic valve replacement (AVR) is safe and effective in selected elderly patients, the perioperative and mid-term outcomes of AVR in very elderly with prior cardiac surgery are unknown. The Society of Thoracic Surgeons (STS) Database at our center enrolled 3,735 patients after AVR since 1997. In this time interval, we identified 61 patients 80 years and older who underwent AVR for severe AS or failed aortic bioprosthesis after having prior cardiac surgery. All clinical parameters were derived from the STS database. Follow-up mortality was assessed using the Social Security Death Index. The average age of the patients was 83 ± 2 years, 77% were male, and 75% underwent an isolated coronary artery bypass graft (CABG) as their first cardiac procedure. The mean ejection fraction was 0.53 ± 0.13. The CABG was performed concurrently in 49% of patients at the time of redo sternotomy and AVR. Stented bioprosthesis was implanted in 61% of patients and stentless in 39%. Perioperative mortality was 1.6% (1 of 61). One, 3, 5, and 7 year survival rates were 85%, 69%, 63%, and 43%, respectively. Patients with AVR only had similar survival to patients who underwent concomitant AVR and CABG. Type of aortic prosthesis did not influence postoperative survival. In selected patients over the age of 80 with history of prior cardiac surgery, AVR can be performed safely with very good mid-term outcomes. Age alone should not be exclusion criteria for surgical AVR in octogenarians with prior cardiac surgery. Copyright © 2015. Published by Elsevier Inc.

  4. Cardiac Surgery: One year experience of cardiac surgery at ...

    African Journals Online (AJOL)

    Mitral valve disease was the commonest cause of cardiac disease (58.1%). Prolonged duration of aortic cross-clamp and total operation time were associated with prolonged intensive care stay and poor patients' outcome respectively (p<0.05). While, ventricular dysfunction and total cardiopulmonary bypass time were not.

  5. Cardiac progenitor-cell derived exosomes as cell-free therapeutic for cardiac repair

    NARCIS (Netherlands)

    Mol, E. A.; Goumans, Marie-Jose; Sluijter, J. P.G.

    2017-01-01

    Cardiac progenitor cells (CPCs) have emerged as potential therapy to improve cardiac repair and prevent damage in cardiac diseases. CPCs are a promising cell source for cardiac therapy as they can generate all cardiovascular lineages in vitro and in vivo. Originating from the heart itself, CPCs may

  6. Scintigraphic assessment of cardiac sympathetic innervation with I-123-metaiodobenzylguanidine in cardiomyopathy. Special reference to cardiac arrhythmia

    Energy Technology Data Exchange (ETDEWEB)

    Asano, Takahisa; Otsuka, Nobuaki; Sone, Teruki; Mimura, Hiroaki; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao [Kawasaki Medical School, Kurashiki, Okayama (Japan); Morita, Koichi

    1999-07-01

    Cardiac sympathetic imagings with I-123-metaiodobenzylguanidine (MIBG) were carried out in 5 cases with dilated cardiomyopathy (DCM), 26 cases with hypertrophic cardiomyopathy (HCM), and 4 cases without cardiac disease as a control to assess cardiac sympathetic innervation qualitatively and quantitatively, and to clarify the relation of MIBG accumulation to arrhythmia. MIBG scintigraphy was performed at 15 min. (early image) and 4 hr. (delayed image) after intravenous injection of MIBG 111 MBq. The MIBG uptake ratio of mediastinum (H/M) and the cardiac washout rate (WR) from early to delayed images were calculated. On both early and delayed SPECTs, MIBG uptake was assessed by defect scores (DSs). Regarding the cases with HCM, the MIBG uptake ratio, WR, and DS were also compared in cases with and without arrhythmia. In DCM, the MIBG uptake on delayed SPECT was markedly low, the H/M ratio was significantly lower, and the DS was significantly higher than in the control (all p<0.05). As for the WR, there was no significant difference between HCM, DCM and the control. In HCM, significantly reduced MIBG uptake was observed in cases with ventricular techycardia (VT) and in cases with atrial fibrillation (Af), as compared with cases without arrhythmia (all p<0.05). There results suggest that MIBG scintigraphy might be a useful tool in the assessment of cardiac sympathetic abnormalities in cardiomyopathy, especially in cases with arrhythmia. (author)

  7. Effects of Caloric Restriction on Cardiac Oxidative Stress and Mitochondrial Bioenergetics: Potential Role of Cardiac Sirtuins

    Directory of Open Access Journals (Sweden)

    Ken Shinmura

    2013-01-01

    Full Text Available The biology of aging has not been fully clarified, but the free radical theory of aging is one of the strongest aging theories proposed to date. The free radical theory has been expanded to the oxidative stress theory, in which mitochondria play a central role in the development of the aging process because of their critical roles in bioenergetics, oxidant production, and regulation of cell death. A decline in cardiac mitochondrial function associated with the accumulation of oxidative damage might be responsible, at least in part, for the decline in cardiac performance with age. In contrast, lifelong caloric restriction can attenuate functional decline with age, delay the onset of morbidity, and extend lifespan in various species. The effect of caloric restriction appears to be related to a reduction in cellular damage induced by reactive oxygen species. There is increasing evidence that sirtuins play an essential role in the reduction of mitochondrial oxidative stress during caloric restriction. We speculate that cardiac sirtuins attenuate the accumulation of oxidative damage associated with age by modifying specific mitochondrial proteins posttranscriptionally. Therefore, the distinct role of each sirtuin in the heart subjected to caloric restriction should be clarified to translate sirtuin biology into clinical practice.

  8. Cardiac Catheterization (For Parents)

    Science.gov (United States)

    ... Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & ... performed by a pediatric cardiologist in a catheterization lab. The lab has special X-ray and imaging ...

  9. A portable cadmium telluride multidetector probe for cardiac function monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Arntz, Y.; Chambron, J.; Dumitresco, B.; Eclancher, B. E-mail: eclan@alsace.u-strasbg.fr; Prat, V

    1999-06-01

    A new nuclear stethoscope based on a matrix of small CdTe semiconductor detectors has been developed for studying the cardiac performance by gamma ventriculography at the equilibrium, in rest and stress conditions, in the early and recovery phases of the coronary disease and to follow the long-term therapy. The light-weight probe consists of an array of 64 detectors 5x5x2 mm grouped in 16 independent units in a lead shielded aluminum box including 16 preamplifiers. The probe is connected to an electronic box containing DC power supply, 16 channel amplifiers, discriminators and counters, two analog-triggering ECG channels, and interface to a PC. The left ventricle activity is, preferentially, detected by using a low-resolution matching convergent collimator. A physical evaluation of the probe has been performed, both with static tests and dynamically with a hydraulic home-built model of beating heart ventricle paced by a rhythm simulator. The sum of the 16 detectors activity provided a radiocardiogram (RCG) which well depicted the filling and ejection of the cardiac beats, allowing to compare the clinically relevant parameters of the cardiac performance, proportional variables of the stroke volume (SV), ejection fraction (EF) and ventricular flow-rate with the known absolute values programmed on the model. The portable system is now in operation for clinical assessment of cardiac patients.

  10. Cardiac fibrillation risk of Taser weapons.

    Science.gov (United States)

    Leitgeb, Norbert

    2014-06-01

    The debate on potential health hazards associated with delivering electric discharges to incapacitated subjects, in particular on whether electric discharge weapons are lethal, less lethal or non-lethal, is still controversial. The cardiac fibrillation risks of Taser weapons X26 and X3 have been investigated by measuring the delivered high-tension pulses in dependence on load impedance. Excitation thresholds and sinus-to-Taser conversion factors have been determined by numerical modeling of endocardial, myocardial, and epicardial cells. Detailed quantitative assessment of cardiac electric exposure has been performed by numerical simulation at the normal-weighted anatomical model NORMAN. The impact of anatomical variation has been quantified at an overweight model (Visible Man), both with a spatial resolution of 2 × 2 × 2 mm voxels. Spacing and location of dart electrodes were systematically varied and the worst-case position determined. Based on volume-weighted cardiac exposure assessment, the fibrillation probability of the worst-case hit was determined to 30% (Taser X26) and 9% (Taser X3). The overall risk assessment of Taser application accounting for realistic spatial hit distributions was derived from training sessions of police officers under realistic scenarios and by accounting for the influence of body (over-)weight as well as gender. The analysis of the results showed that the overall fibrillation risk of Taser use is not negligible. It is higher at Taser X26 than at Taser X3 and amounts to about 1% for Europeans with an about 20% higher risk for Asians. Results demonstrate that enhancement as well as further reduction of fibrillation risk depends on responsible use or abuse of Taser weapons.

  11. Cardiac Complications in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Christopher Lewandowski

    2011-05-01

    Full Text Available Introduction: To characterize cardiac complications in acute ischemic stroke (AIS patients admitted from an urban emergency department (ED. Methods: Retrospective cross-sectional study evaluating AIS patients admitted from the ED within 24 hours of symptom onset who also had an echocardiogram performed within 72 hours of admission. Results: Two hundred AIS patients were identified with an overall in-hospital mortality rate of 8% (n¼ 16. In our cohort, 57 (28.5% of 200 had an ejection fraction less than 50%, 35 (20.4% of 171 had ischemic changes on electrocardiogram (ECG, 18 (10.5% of 171 presented in active atrial fibrillation, 21 (13.0% of 161 had serum troponin elevation, and 2 (1.1% of 184 survivors had potentially lethal arrhythmias on telemetry monitoring. Subgroup analysis revealed higher in-hospital mortality rates among those with systolic dysfunction (15.8% versus 4.9%; P ¼ 0.0180, troponin elevation (38.1% versus 3.4%; P , 0.0001, atrial fibrillation on ECG (33.3% versus 3.8%; P ¼ 0.0003, and ischemic changes on ECG (17.1% versus 6.1%; P ¼ 0.0398 compared with those without. Conclusion: A proportion of AIS patients may have cardiac complications. Systolic dysfunction, troponin elevation, atrial fibrillation, or ischemic changes on ECG may be associated with higher inhospital mortality rates. These findings support the adjunctive role of cardiac-monitoring strategies in the acute presentation of AIS. [West J Emerg Med. 2011;12(4:414–420.

  12. Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest

    NARCIS (Netherlands)

    Monsieurs, Koenraad G.; De Regge, Melissa; Vansteelandt, Kristof; De Smet, Jeroen; Annaert, Emmanuel; Lemoyne, Sabine; Kalmar, Alain F.; Calle, Paul A.

    2012-01-01

    Background and goal of study: The relationship between chest compression rate and compression depth is unknown. In order to characterise this relationship, we performed an observational study in prehospital cardiac arrest patients. We hypothesised that faster compressions are associated with

  13. Possible protection by inhaled budesonide against ischaemic cardiac events in mild COPD

    NARCIS (Netherlands)

    Lofdahl, C-G.; Postma, D. S.; Pride, N. B.; Boe, J.; Thoren, A.

    Epidemiological studies have indicated that chronic obstructive pulmonary disease (COPD) may be associated with an increased incidence of ischaemic cardiac events. The current authors performed a post hoc analysis of the European Respiratory Society's study on Chronic Obstructive Pulmonary Disease

  14. Prediction for Major Adverse Outcomes in Cardiac Surgery: Comparison of Three Prediction Models

    Directory of Open Access Journals (Sweden)

    Cheng-Hung Hsieh

    2007-09-01

    Conclusion: The Parsonnet score performed as well as the logistic regression models in predicting major adverse outcomes. The Parsonnet score appears to be a very suitable model for clinicians to use in risk stratification of cardiac surgery.

  15. Cardiac axis shift within the cardiac cycle of normal fetuses and fetuses with congenital heart defect.

    Science.gov (United States)

    Zhao, Y; Abuhamad, S; Sinkovskaya, E; Mlynarczyk, M; Romary, L; Abuhamad, A

    2015-11-01

    To investigate changes in the cardiac axis (CAx) within the cardiac cycle of normal fetuses and fetuses with congenital heart defects (CHD). This was a retrospective case-control study in which stored videoclips of four-chamber views from 527 prenatal ultrasound examinations performed at 18 + 0 to 36 + 6 weeks of gestation were reviewed. Among the ultrasound scans included, 287 were of normal fetuses (controls) and 240 were of fetuses with CHD. In each case, the CAx was measured at end systole (just before the atrioventricular (AV) valve opened) and at end diastole (just before the AV valve closed). CAx measurements of fetuses with CHD were compared to those of controls. The mean CAx in the control group was 45.9 ± 8.5° at end systole and 38.3 ± 8.4° at end diastole (P left heart syndrome and L-transposition of the great arteries, the CAx was greater at end diastole than at end systole, with a difference of more than 5°. In 21.3% of control fetuses, there was a CAx shift within the cardiac cycle of ≥ 10°. Abnormal CAx measured at end systole was strongly associated with CHD. Measurement of the CAx at end systole provides values that differ from those when measured at end diastole, in both normal fetuses and those with CHD. We recommend that the CAx be measured at end systole as a greater proportion of fetuses with CHD and fewer normal fetuses have an abnormal CAx at this stage compared to at end diastole. The occurrence of an abnormal CAx and the CAx shift within the fetal cardiac cycle depend on the type of CHD. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  16. Mathematics and the Heart: Understanding Cardiac Output

    Science.gov (United States)

    Champanerkar, Jyoti

    2013-01-01

    This paper illustrates a biological application of the concepts of relative change and area under a curve, from mathematics. We study two biological measures "relative change in cardiac output" and "cardiac output", which are predictors of heart blockages and other related ailments. Cardiac output refers to the quantity of…

  17. Sudden cardiac arrest risk in young athletes

    African Journals Online (AJOL)

    Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during ...

  18. Optimal Technique in Cardiac Anesthesia Recovery

    NARCIS (Netherlands)

    Svircevic, V.

    2014-01-01

    The aim of this thesis is to evaluate fast-track cardiac anesthesia techniques and investigate their impact on postoperative mortality, morbidity and quality of life. The following topics will be discussed in the thesis. (1.) Is fast track cardiac anesthesia a safe technique for cardiac surgery?

  19. Regulation of Cardiac Hypertrophy: the nuclear option

    NARCIS (Netherlands)

    D.W.D. Kuster (Diederik)

    2011-01-01

    textabstractCardiac hypertrophy is the response of the heart to an increased workload. After myocardial infarction (MI) the surviving muscle tissue has to work harder to maintain cardiac output. This sustained increase in workload leads to cardiac hypertrophy. Despite its apparent appropriateness,

  20. Discovery and progress of direct cardiac reprogramming.

    Science.gov (United States)

    Kojima, Hidenori; Ieda, Masaki

    2017-06-01

    Cardiac disease remains a major cause of death worldwide. Direct cardiac reprogramming has emerged as a promising approach for cardiac regenerative therapy. After the discovery of MyoD, a master regulator for skeletal muscle, other single cardiac reprogramming factors (master regulators) have been sought. Discovery of cardiac reprogramming factors was inspired by the finding that multiple, but not single, transcription factors were needed to generate induced pluripotent stem cells (iPSCs) from fibroblasts. We first reported a combination of cardiac-specific transcription factors, Gata4, Mef2c, and Tbx5 (GMT), that could convert mouse fibroblasts into cardiomyocyte-like cells, which were designated as induced cardiomyocyte-like cells (iCMs). Following our first report of cardiac reprogramming, many researchers, including ourselves, demonstrated an improvement in cardiac reprogramming efficiency, in vivo direct cardiac reprogramming for heart regeneration, and cardiac reprogramming in human cells. However, cardiac reprogramming in human cells and adult fibroblasts remains inefficient, and further efforts are needed. We believe that future research elucidating epigenetic barriers and molecular mechanisms of direct cardiac reprogramming will improve the reprogramming efficiency, and that this new technology has great potential for clinical applications.

  1. Cardiac magnetic resonance imaging has limited additional yield in cryptogenic stroke evaluation after transesophageal echocardiography.

    Science.gov (United States)

    Liberman, Ava L; Kalani, Rizwan E; Aw-Zoretic, Jessie; Sondag, Matthew; Daruwalla, Vistasp J; Mitter, Sumeet S; Bernstein, Richard; Collins, Jeremy D; Prabhakaran, Shyam

    2017-12-01

    Background The use of cardiac magnetic resonance imaging is increasing, but its role in the diagnostic work-up following ischemic stroke has received limited study. We aimed to explore the added yield of cardiac magnetic resonance imaging to identify cardio-aortic sources not detected by transesophageal echocardiography among patients with cryptogenic stroke. Methods A retrospective single-center cohort study was performed from 01 January 2009 to 01 March 2013. Consecutive patients who had both a stroke protocol cardiac magnetic resonance imaging and a transesophageal echocardiography preformed during a single hospitalization were included. All cardiac magnetic resonance imaging studies underwent independent, blinded review by two investigators. We applied the causative classification system for ischemic stroke to all patients, first blinded to cardiac magnetic resonance imaging results; we then reapplied the causative classification system using cardiac magnetic resonance imaging. Standard statistical tests to evaluate stroke subtype reclassification rates were used. Results Ninety-three patients were included in the final analysis; 68.8% were classified as cryptogenic stroke after initial diagnostic evaluation. Among patients with cryptogenic stroke, five (7.8%) were reclassified due to cardiac magnetic resonance imaging findings: one was reclassified as "cardio-aortic embolism evident" due to the presence of a patent foramen ovale and focal cardiac infarct and four were reclassified as "cardio-aortic embolism possible" due to mitral valve thickening (n = 1) or hypertensive cardiomyopathy (n = 3). Overall, findings on cardiac magnetic resonance imaging reduced the percentage of patients with cryptogenic stroke by slightly more than 1%. Conclusion Our stroke subtype reclassification rate after the addition of cardiac magnetic resonance imaging results to a diagnostic work-up which includes transesophageal echocardiography was very low. Prospective studies

  2. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest.

    Science.gov (United States)

    Cureton, Elizabeth L; Yeung, Louise Y; Kwan, Rita O; Miraflor, Emily J; Sadjadi, Javid; Price, Daniel D; Victorino, Gregory P

    2012-07-01

    The clinical utility of determining cardiac motion on ultrasound has been reported for patients presenting in pulseless medical cardiac arrest. However, the relationship between ultrasound-documented cardiac activity and the probability of surviving pulseless electrical activity has not been examined in populations with trauma. We hypothesized that cardiac activity on ultrasound predicts survival for patients presenting in pulseless traumatic arrest. We conducted a retrospective analysis at our university-based urban trauma center of adult patients with trauma, who were pulseless on hospital arrival. Results of cardiac ultrasound performed during trauma resuscitations were compared with the electrocardiogram (EKG) rhythm and survival. Among 318 pulseless patients with trauma, 162 had both EKG tracings and a cardiac ultrasound, and 4.3% of these 162 patients survived to hospital admission. Survival was higher for those with cardiac motion than for those without it (23.5% vs. 1.9% for patients with EKG electrical activity, p = 0.002, and 66.7% vs. 0% for patients without EKG electrical activity, p cardiac motion to predict survival to hospital admission was 86% (specificity, 91%; positive predictive value, 30%; negative predictive value, 99%). When examined by mechanism, sensitivity was 100% for the 111 patients with penetrating trauma and 75% for the 50 patients with blunt trauma. Survival in pulseless traumatic arrest is very low, but survival for patients with no cardiac motion on ultrasound is also exceedingly rare. Cardiac ultrasound had a negative predictive value approaching 100% for survival to hospital admission. For patients with prolonged prehospital cardiopulmonary resuscitation, ultrasound evaluation of cardiac motion in pulseless patients with trauma may be a rapid way to help determine which patients have no chance of survival in the setting of lethal injuries, so that futile resuscitations can be stopped.

  3. Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

    LENUS (Irish Health Repository)

    O'Donnell, David H

    2012-02-01

    OBJECTIVE: This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION: Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

  4. History of cardiac trauma surgery

    African Journals Online (AJOL)

    This is but what might reasonably be expected. For, if the primary or dominant part be diseased, there is nothing from which the other parts which depend upon it can derive sucour'.[10,11] Celsus. (1st century AD) recognised the clinical features of shock associated with a cardiac injury when he wrote in De Medicina that,.

  5. Multiple immunophenotypes of cardiac telocytes.

    Science.gov (United States)

    Chang, Yuqiao; Li, Cixia; Lu, Zhaohui; Li, He; Guo, Zhikun

    2015-11-01

    Telocytes (TCs) form a 3-dimensional network in the myocardial interstitium, which most probably play important role(s) in heart development. However, the dynamics of their prolongations, continuous cell shape changes and adherence properties have not been well documented till recently. The aim of this study was to investigate dynamics of extension of prolongations (Telopods) and multiple phenotypes of cardiac TCs cultured in vitro. Cardiac TCs were isolated from neonatal rats by a combined enzyme digestion process and identified by light microscopy, immunofluorescence analysis and scanning using electron microscopy (SEM). Their continuous changes in shape were analyzed by a Live Cell Imaging System and multiple phenotypes were identified by immunofluorescence analysis using various markers, like vimentin, c-kit, CD34, nanog and sca-1. Cardiac TCs displayed piriform/spindle/triangular shapes with long and slender telopodes showing extremely long prolongations. The morphology of cell body was continuously changing while their prolongations were extending gradually. After adhering to the surface, TCs' movement and extension of their prolongations lasted for approximately 1.5h. Cardiac TCs expressed mesenchymal cell marker vimentin, hematopoietic stem cell marker CD34, embryonic stem cell-associated gene of Nanog, and myocardial stem cell markers sca-1 and c-kit. These findings indicate that cultured TCs in vitro have multiple phenotypes, which are most likely important for evaluating their functional roles in heart development. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Current Perspectives in Cardiac Laterality

    Directory of Open Access Journals (Sweden)

    Marina Campione

    2016-12-01

    Full Text Available The heart is the first organ to break symmetry in the developing embryo and onset of dextral looping is the first indication of this event. Looping is a complex process that progresses concomitantly to cardiac chamber differentiation and ultimately leads to the alignment of the cardiac regions in their final topology. Generation of cardiac asymmetry is crucial to ensuring proper form and consequent functionality of the heart, and therefore it is a highly regulated process. It has long been known that molecular left/right signals originate far before morphological asymmetry and therefore can direct it. The use of several animal models has led to the characterization of a complex regulatory network, which invariably converges on the Tgf-β signaling molecule Nodal and its downstream target, the homeobox transcription factor Pitx2. Here, we review current data on the cellular and molecular bases of cardiac looping and laterality, and discuss the contribution of Nodal and Pitx2 to these processes. A special emphasis will be given to the morphogenetic role of Pitx2 and to its modulation of transcriptional and functional properties, which have also linked laterality to atrial fibrillation.

  7. Cardiac leiomyosarcoma, a case report

    DEFF Research Database (Denmark)

    Andersen, Rikke; Kristensen, Bjarne W; Gill, Sabine

    2013-01-01

    In this case report we present the history of a patient admitted with recurrent pulmonary edema. Transesophageal chocardiography showed a tumour in the left atrium, occluding the ostium of the mitral valve and mimicking intermittent mitral stenosis. Cardiac surgery followed by pathological...

  8. Congenital cardiac disease in dogs.

    Science.gov (United States)

    Aronson, E; McCaw, D

    1984-09-01

    Aortic stenosis is a heritable cardiac anomaly most common in German Shepherds, Boxers and Newfoundlands, and less common in Pugs, English Bulldogs, Boston Terriers, Fox Terriers, Schnauzers and Bassets. Clinical signs are associated with secondary left-sided heart failure and include coughing, moist rales, exercise intolerance, arrhythmias and a weak femoral pulse. It causes an ejection-type crescendo-decrescendo, systolic murmur best heard on the left side near the elbow. The ECG may be normal or may show signs of left ventricular hypertrophy, including an axis of less than 40 degrees, a QRS complex of greater than 60 seconds in duration, R waves greater than 3 mv in amplitude, ST segment slurring or depression, or T waves of an amplitude greater than 25% of that of R waves. A LAT radiograph usually reveals an enlarged cardiac silhouette, loss of the cranial cardiac waist, and normal pulmonary vasculature, while DV projections show an elongated cardiac silhouette, rounding of the left ventricular border, and a normal descending aorta. Nonselective angiocardiography reveals poststenotic dilatation of the aorta. Treatment of severely affected dogs involves surgical correction.

  9. History of cardiac trauma surgery

    African Journals Online (AJOL)

    6. History of cardiac trauma surgery scene of battle. Previously, casualties were considered to be a nuisance. He introduced a system of triage to manage patients according to the severity of their wounds and also successfully decompressed the pericardial sac of a patient by catheter drainage. The pericardiotomy that was.

  10. Response to cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Schiffer, Angélique A; Widdershoven, Jos W

    2009-01-01

    Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders...

  11. The Johannesburg cardiac rehabilitation programme

    African Journals Online (AJOL)

    1991-02-16

    Feb 16, 1991 ... Cardiac rehabilitation, including supervised exercise therapy, has become a generally accepted mode of ... the effects of a combined health education and exercise training programme on these patients' ..... when exercise training was combined with body weight loss. It has also recently been suggested ...

  12. Practolol in Hyperthyroid Cardiac Failure*

    African Journals Online (AJOL)

    1971-07-24

    Jul 24, 1971 ... continuous bruit, hyperactivity, tremor, lid-lag, warm sweaty palms, and a proximal myopathy. In addition, signs of cardiac failure were found. notably ankle oedema, a raised jugular venous pressure. hepatomegaly and atrial fibrillation. Protein- bound iodine concentration was 12 .ug/100 ml and neck "'I.

  13. The cardiac patient in Ramadan.

    Science.gov (United States)

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan

    2016-01-01

    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting.

  14. Prospective surveillance for cardiac adverse events in healthy adults receiving modified vaccinia Ankara vaccines: a systematic review.

    Directory of Open Access Journals (Sweden)

    Marnie L Elizaga

    Full Text Available Vaccinia-associated myo/pericarditis was observed during the US smallpox vaccination (DryVax campaign initiated in 2002. A highly-attenuated vaccinia strain, modified vaccinia Ankara (MVA has been evaluated in clinical trials as a safer alternative to DryVax and as a vector for recombinant vaccines. Due to the lack of prospectively collected cardiac safety data, the US Food and Drug Administration required cardiac screening and surveillance in all clinical trials of MVA since 2004. Here, we report cardiac safety surveillance from 6 phase I trials of MVA vaccines.Four clinical research organizations contributed cardiac safety data using common surveillance methods in trials administering MVA or recombinant MVA vaccines to healthy participants. 'Routine cardiac investigations' (ECGs and cardiac enzymes obtained 2 weeks after injections of MVA or MVA-HIV recombinants, or placebo-controls, and 'Symptom-driven cardiac investigations' are reported. The outcome measure is the number of participants who met the CDC-case definition for vaccinia-related myo/pericarditis or who experienced cardiac adverse events from an MVA vaccine.Four hundred twenty-five study participants had post-vaccination safety data analyzed, 382 received at least one MVA-containing vaccine and 43 received placebo; 717 routine ECGs and 930 cardiac troponin assays were performed. Forty-five MVA recipients (12% had additional cardiac testing performed; 22 for cardiac symptoms, 19 for ECG/laboratory changes, and 4 for cardiac symptoms with an ECG/laboratory change. No participant had evidence of symptomatic or asymptomatic myo/pericarditis meeting the CDC-case definition and judged to be related to an MVA vaccine.Prospective surveillance of MVA recipients for myo/pericarditis did not detect cardiac adverse reactions in 382 study participants.ClinicalTrials.gov NCT00082446 NCT003766090 NCT00252148 NCT00083603 NCT00301184 NCT00428337.

  15. Prospective surveillance for cardiac adverse events in healthy adults receiving modified vaccinia Ankara vaccines: a systematic review.

    Science.gov (United States)

    Elizaga, Marnie L; Vasan, Sandhya; Marovich, Mary A; Sato, Alicia H; Lawrence, Dale N; Chaitman, Bernard R; Frey, Sharon E; Keefer, Michael C

    2013-01-01

    Vaccinia-associated myo/pericarditis was observed during the US smallpox vaccination (DryVax) campaign initiated in 2002. A highly-attenuated vaccinia strain, modified vaccinia Ankara (MVA) has been evaluated in clinical trials as a safer alternative to DryVax and as a vector for recombinant vaccines. Due to the lack of prospectively collected cardiac safety data, the US Food and Drug Administration required cardiac screening and surveillance in all clinical trials of MVA since 2004. Here, we report cardiac safety surveillance from 6 phase I trials of MVA vaccines. Four clinical research organizations contributed cardiac safety data using common surveillance methods in trials administering MVA or recombinant MVA vaccines to healthy participants. 'Routine cardiac investigations' (ECGs and cardiac enzymes obtained 2 weeks after injections of MVA or MVA-HIV recombinants, or placebo-controls), and 'Symptom-driven cardiac investigations' are reported. The outcome measure is the number of participants who met the CDC-case definition for vaccinia-related myo/pericarditis or who experienced cardiac adverse events from an MVA vaccine. Four hundred twenty-five study participants had post-vaccination safety data analyzed, 382 received at least one MVA-containing vaccine and 43 received placebo; 717 routine ECGs and 930 cardiac troponin assays were performed. Forty-five MVA recipients (12%) had additional cardiac testing performed; 22 for cardiac symptoms, 19 for ECG/laboratory changes, and 4 for cardiac symptoms with an ECG/laboratory change. No participant had evidence of symptomatic or asymptomatic myo/pericarditis meeting the CDC-case definition and judged to be related to an MVA vaccine. Prospective surveillance of MVA recipients for myo/pericarditis did not detect cardiac adverse reactions in 382 study participants. ClinicalTrials.gov NCT00082446 NCT003766090 NCT00252148 NCT00083603 NCT00301184 NCT00428337.

  16. The Effect of Previous Coronary Artery Revascularization on the Adverse Cardiac Events Ninety days After Total Joint Arthroplasty.

    Science.gov (United States)

    Feng, Bin; Lin, Jin; Jin, Jin; Qian, Wenwei; Cao, Shiliang; Weng, Xisheng

    2018-01-01

    Although coronary artery revascularization therapies are effective for treating coronary artery disease (CAD), these patients may be more susceptible to adverse cardiac events during later non-cardiac surgeries. The purpose of this study is to evaluate post-operative 90-day complications of total joint arthroplasty (TJA) in CAD patients with a history of CAD and to study the risk factors for cardiac complications. We performed a retrospective analysis of TJA patients between 2005 and 2015 at our institute by summarizing the history of CAD, cardiac revascularization, and cardiac complications within 90 days after the operation. Multivariate logistic regression was performed to identify the factors that predicted cardiac complications within 90 days after the operation. A total of 4414 patients were included; of these, 64 underwent cardiac revascularization and 201 CAD patients underwent medical therapy other than revascularization. All the revascularization had history of myocardial infarction (MI). The rate of cardiac complications within 90 days for the CAD with revascularization was 18.7%, 18.4% for the CAD without revascularization, and 2.0% for the non-CAD group. A history of CAD and revascularization, bilateral TJA, general anesthesia, body mass index ≥30 kg/m2, and history of MI were associated with a higher risk of cardiac complications. Patients who underwent TJA within 2 years after cardiac revascularization had a significantly higher cardiac complication rate, and the risk decreased with time. There is an increased risk of cardiac complications within 90 days after the operation among TJA patients with a history of CAD. Revascularization cannot significantly reduce the risk of cardiac complications after TJA for CAD patients. However, the risk decreased as the interval between revascularization and TJA increased. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel; Diede