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Sample records for cardiac patient monitoring

  1. Ambulatory Cardiac Monitoring for Discharged Emergency Department Patients with Possible Cardiac Arrhythmias

    Directory of Open Access Journals (Sweden)

    Donald Scheiber

    2014-03-01

    Full Text Available Introduction: Many emergency department (ED patients have symptoms that may be attributed to arrhythmias, necessitating outpatient ambulatory cardiac monitoring. Consensus is lacking on the optimal duration of monitoring. We describe the use of a novel device applied at ED discharge that provides continuous prolonged cardiac monitoring. Methods: We enrolled discharged adult ED patients with symptoms of possible cardiac arrhythmia. A novel, single use continuous recording patch (Zio®Patch was applied at ED discharge. Patients wore the device for up to 14 days or until they had symptoms to trigger an event. They then returned the device by mail for interpretation. Significant arrhythmias are defined as: ventricular tachycardia (VT ≥4 beats, supraventricular tachycardia (SVT ≥4 beats, atrial fibrillation, ≥3 second pause, 2nd degree Mobitz II, 3rd degree AV Block, or symptomatic bradycardia. Results: There were 174 patients were enrolled and all mailed back their devices. The average age was 52.2 (± 21.0 years, and 55% were female. The most common indications for device placement were palpitations 44.8%, syncope 24.1% and dizziness 6.3%. Eighty-three patients (47.7% had ≥1 arrhythmias and 17 (9.8% were symptomatic at the time of their arrhythmia. Median time to first arrhythmia was 1.0 days (IQR 0.2-2.8 and median time to first symptomatic arrhythmia was 1.5 days (IQR 0.4-6.7. 93 (53.4% of symptomatic patients did not have any arrhythmia during their triggered events. The overall diagnostic yield was 63.2% Conclusion: The Zio®Patch cardiac monitoring device can efficiently characterize symptomatic patients without significant arrhythmia and has a higher diagnostic yield for arrhythmias than traditional 24-48 hour Holter monitoring. It allows for longer term monitoring up to 14 days. [West J Emerg Med. 2014;15(2:194–198.

  2. Treating cardiac arrhythmias detected with an implantable cardiac monitor in patients after an acute myocardial infarction

    DEFF Research Database (Denmark)

    Jøns, Christian; Thomsen, Poul Erik Bloch

    2012-01-01

    OPINION STATEMENT: Using an implantable cardiac monitor (ICM) in patients with acute myocardial infarction (MI) allows continuous electrocardiogram monitoring and provides a much more detailed picture of the incidence of brady- and tachyarrhythmias than conventional follow-up. The CARISMA study...... was the first to use the ICM in post-MI patients with moderate to severe left ventricular systolic dysfunction. Atrial fibrillation (AF) events lasting longer than 30 s were associated with an almost threefold increase in the risk of major cardiac events. This confirms the current definition of clinically...... causes of AF such as progressive left ventricular dysfunction or myocardial ischemia. Asymptomatic, especially nightly, bradycardia episodes including high-degree 2°-3° atrioventricular (AV) block, sinus bradycardia, and sinus arrest were frequently documented by ICM in the CARISMA study. Ten percent...

  3. Estimating changes in cardiac output using an implanted hemodynamic monitor in heart failure patients

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Ersgård, David;

    2010-01-01

    OBJECTIVES: The aim of this study was to evaluate an algorithm that estimates changes in cardiac output (CO) from right ventricular (RV) pressure waveforms derived from an implantable hemodynamic monitor (IHM) in heart failure patients. DESIGN: Twelve heart failure patients (NYHA II-III, EF 32......%) with an implantable hemodynamic monitor (Chronicle) were included in this study. Changes in cardiac output were provoked by body position change at rest (left lateral supine, horizontal supine, sitting, and standing) and a steady state bicycle exercise at 20 watts. Estimated CO derived from the IHM (CO...

  4. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

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    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.

  5. ICD function and dysfunction in patients with arrhythmogenic cardiac diseases: the role of home monitoring

    NARCIS (Netherlands)

    Asmundis, C. de; Ricciardi, D.; Namdar, M.; Pappaert, G.; Rodriguez-Manero, M.; Wauters, K.; Casado-Arroyo, R.; Rao, J.J.; Bayrak, F.; Chierchia, G.B.; Sarkozy, A.; Brugada, P.

    2013-01-01

    BACKGROUND: Since their implementation in clinical practice, remote home monitoring systems (HM) have undoubtedly become an added value in patients with implantable devices for cardiac rhythm management. The aim of this study was to investigate the impact of HM on clinical management and outcome in

  6. Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA

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    Christie E Tung

    2015-01-01

    Full Text Available Background: It is important to evaluate patients with TIA or stroke for atrial fibrillation (AF because the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to oral anticoagulation. This study describes the diagnostic yield of a patch-based, single-use, and water-resistant 14-day continuous cardiac rhythm monitor (ZIO Patch in patients with stroke or TIA.Methods: We obtained data from the manufacturer and servicer of the ZIO Patch (iRhythm Technologies. Patients who were monitored between January 2012 and June 2013 and whose indication for monitoring was TIA or stroke were included. The duration of monitoring, the number and type of arrhythmias, and the time to first arrhythmia were documented. Results: 1,171 monitoring reports were analyzed. The mean monitor wear time was 10.9 days and the median wear time was 13.0 days (interquartile range 7.2-14.0. The median analyzable time relative to the total wear time was 98.7% (IQR 96.0-99.5%. AF was present in 5.0% of all reports. The mean duration before the first episode of paroxysmal AF (PAF was 1.5 days and the median duration was 0.4 days. 14.3% of first PAF episodes occurred after 48 hours. The mean PAF burden was 12.7% of the total monitoring duration. Conclusion: Excellent quality of the recordings and very good patient compliance coupled with a substantial proportion of AF detection beyond the first 48 hours of monitoring suggest that the cardiac patch is superior to conventional 48-hour Holter monitors for AF detection in patients with stroke or TIA.

  7. Cardiac Care Assistance using Self Configured Sensor Network—a Remote Patient Monitoring System

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    Sarma Dhulipala, V. R.; Kanagachidambaresan, G. R.

    2014-04-01

    Pervasive health care systems are used to monitor patients remotely without disturbing the normal day-to-day activities in real-time. Wearable physiological sensors required to monitor various significant ecological parameters of the patients are connected to Body Central Unit (BCU). Body Sensor Network (BSN) updates data in real-time and are designed to transmit alerts against abnormalities which enables quick response by medical units in case of an emergency. BSN helps monitoring patient without any need for attention to the subject. BSN helps in reducing the stress and strain caused by hospital environment. In this paper, mathematical models for heartbeat signal, electro cardio graph (ECG) signal and pulse rate are introduced. These signals are compared and their RMS difference-fast Fourier transforms (PRD-FFT) are processed. In the context of cardiac arrest, alert messages of these parameters and first aid for post-surgical operations has been suggested.

  8. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

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    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  9. A cost/benefit analysis of randomized invasive monitoring for patients undergoing cardiac surgery.

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    Pearson, K S; Gomez, M N; Moyers, J R; Carter, J G; Tinker, J H

    1989-09-01

    The aim of this study was to determine the effect of choice of invasive monitoring on cost, morbidity, and mortality in cardiac surgery. Two hundred and twenty-six adults undergoing elective cardiac surgery were initially assigned at random to receive either a central venous pressure monitoring catheter (group I), a conventional pulmonary artery (PA) catheter (group II), or a mixed venous oxygen saturation (SvO2) measuring PA catheter (group III). If the attending anesthesiologist believed that the patient initially randomized to group I should have a PA catheter, that patient was then reassigned to receive either a conventional PA catheter (group IV) or SvO2 measuring PA catheter (group V). The total costs were defined as the total amount billed to the patient for the catheter used; the professional cost of its insertion; and the determinations of cardiac output, arterial blood gas tensions, hemoglobin level, and hematocrit. Mean total monitoring and laboratory costs in Group I ($591 +/- 67) were statistically significantly (P less than 0.05) less than costs in Group II ($856 +/- 231). Further, mean monitoring and laboratory costs in Group II were statistically significantly (P less than 0.05) less than those in Group III ($1128 +/- 759). Patients in group IV incurred mean total costs of $986 +/- 578, while those in group V had mean total costs of $1126 +/- 382 (NS). There were no significant differences between any of the groups with respect to length of stay in the intensive care unit, morbidity, or mortality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2505641

  10. Remote Monitoring for Follow-up of Patients with Cardiac Implantable Electronic Devices

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    Morichelli, Loredana; Varma, Niraj

    2014-01-01

    Follow-up of patients with cardiac implantable electronic devices is challenging due to the increasing number and technical complexity of devices coupled to increasing clinical complexity of patients. Remote monitoring (RM) offers the opportunity to optimise clinic workflow and to improve device monitoring and patient management. Several randomised clinical trials and registries have demonstrated that RM may reduce number of hospital visits, time required for patient follow-up, physician and nurse time, hospital and social costs. Furthermore, patient retention and adherence to follow-up schedule are significantly improved by RM. Continuous wireless monitoring of data stored in the device memory with automatic alerts allows early detection of device malfunctions and of events requiring clinical reaction, such as atrial fibrillation, ventricular arrhythmias and heart failure. Early reaction may improve patient outcome. RM is easy to use and patients showed a high level of acceptance and satisfaction. Implementing RM in daily practice may require changes in clinic workflow. To this purpose, new organisational models have been introduced. In spite of a favourable cost:benefit ratio, RM reimbursement still represents an issue in several European countries. PMID:26835079

  11. [Anesthesia management of geriatric patients with arterial pressure-based cardiac output monitoring FloTrac sensor for emergency surgery].

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    Yamamoto, Shunsuke; Goto, Koji; Yasuda, Norihisa; Kusaka, Junya; Hidaka, Seigo; Miyakawa, Hiroshi; Noguchi, Takayuki

    2009-06-01

    In cases of emergency surgery for geriatric patients, immediate anesthesia induction and careful intraoperative management is necessary without sufficient preoperative information. We report anesthesia management of a 96-year and a 90-year old patients with FloTrac sensor which is an arterial pressure-based cardiac output monitoring device and is able to manage critical patients effectively and safely during anesthesia.

  12. Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Jons, Christian; Raatikainen, M J Pekka;

    2010-01-01

    Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction...... (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction....

  13. A Real-Time Health Monitoring System for Remote Cardiac Patients Using Smartphone and Wearable Sensors

    Directory of Open Access Journals (Sweden)

    Priyanka Kakria

    2015-01-01

    Full Text Available Online telemedicine systems are useful due to the possibility of timely and efficient healthcare services. These systems are based on advanced wireless and wearable sensor technologies. The rapid growth in technology has remarkably enhanced the scope of remote health monitoring systems. In this paper, a real-time heart monitoring system is developed considering the cost, ease of application, accuracy, and data security. The system is conceptualized to provide an interface between the doctor and the patients for two-way communication. The main purpose of this study is to facilitate the remote cardiac patients in getting latest healthcare services which might not be possible otherwise due to low doctor-to-patient ratio. The developed monitoring system is then evaluated for 40 individuals (aged between 18 and 66 years using wearable sensors while holding an Android device (i.e., smartphone under supervision of the experts. The performance analysis shows that the proposed system is reliable and helpful due to high speed. The analyses showed that the proposed system is convenient and reliable and ensures data security at low cost. In addition, the developed system is equipped to generate warning messages to the doctor and patient under critical circumstances.

  14. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics

    NARCIS (Netherlands)

    Leclercq, C.; Padeletti, L.; Cihak, R.; Ritter, P.; Milasinovic, G.; Gras, D.; Paul, V.; Van Gelder, I. C.; Stellbrink, C.; Rieger, G.; Corbucci, G.; Albers, B.; Daubert, J. C.

    2010-01-01

    Little is known about the incidence of paroxysmal atrial tachycardias (PAT) in patients with heart failure (HF). The availability of cardiac resynchronization therapy (CRT) devices with extended diagnostics for AT enables continuous monitoring of PAT episodes. The aim of the study was to assess the

  15. Pulmonary Carbon Dioxide Elimination for Cardiac Output Monitoring in Peri-operative and Critical Care Patients: History and Current Status

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    Philip J. Peyton

    2013-01-01

    Full Text Available Minimally invasive measurement of cardiac output as a central component of advanced haemodynamic monitoring has been increasingly recognised as a potential means of improving perioperative outcomes in patients undergoing major surgery. Methods based upon pulmonary carbon dioxide elimination are among the oldest techniques in this field, with comparable accuracy and precision to other techniques. Modern adaptations of these techniques suitable for use in the perioperative and critical are environment are based on the differential Fick approach, and include the partial carbon dioxide rebreathing method. The accuracy and precision of this approach to cardiac output measurement has been shown to be similar to other minimally invasive techniques. This paper reviews the underlying principles and evolution of the method, and future directions including recent adaptations designed to deliver continuous breath-by-breath monitoring of cardiac output.

  16. Cardiac output monitoring

    NARCIS (Netherlands)

    de Waal, Eric. E. C.; Wappler, Frank; Buhre, Wolfgang F.

    2009-01-01

    Purpose of review The primary goal of hemodynamic therapy is the prevention of inadequate tissue perfusion and inadequate oxygenation. Advanced cardiovascular monitoring is a prerequisite to optimize hemodynamic treatment in critically ill patients prone to cardiocirculatory failure. The most ideal

  17. Network representation of cardiac interbeat intervals for monitoring restitution of autonomic control for heart transplant patients

    CERN Document Server

    Makowiec, Danuta; Graff, Beata; Makowiec, Joanna Danuta; Kryszewski, Stanislaw; Graff, Beata; Wdowczyk-Szulc, Joanna; Buchnowiecka, Marta Zarczynska-; Gruchala, Marcin; Rynkiewicz, Andrzej

    2013-01-01

    The aim is to present the ability of a network of transitions as a nonlinear tool providing a graphical representation of a time series. This representation is used for cardiac RR-intervals in follow-up observation of changes in heart rhythm of patients recovering after heart transplant.

  18. Monitoring cardiac output during hyperbaric oxygen treatment of haemodynamically unstable patients

    DEFF Research Database (Denmark)

    Hansen, Marco Bo; Treschow, Frederik; Skielboe, Martin;

    2013-01-01

    Patients suffering from necrotizing fasciitis (NF) are often haemodynamically unstable and require extended monitoring of cardiovascular parameters; yet this is limited during hyperbaric oxygen treatment (HBOT). We aimed to evaluate the use and safety of transoesophageal Doppler (TED) monitoring...

  19. A prospective study to evaluate the accuracy of pulse power analysis to monitor cardiac output in critically ill patients

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    Grounds R Michael

    2008-02-01

    Full Text Available Abstract Background Intermittent measurement of cardiac output may be performed using a lithium dilution technique (LiDCO. This can then be used to calibrate a pulse power algorithm of the arterial waveform which provides a continuous estimate of this variable. The purpose of this study was to examine the duration of accuracy of the pulse power algorithm in critically ill patients with respect to time when compared to measurements of cardiac output by an independent technique. Methods Pulse power analysis was performed on critically ill patients using a proprietary commercial monitor (PulseCO. All measurements were made using an in-dwelling radial artery line and according to manufacturers instructions. Intermittent measurements of cardiac output were made with LiDCO in order to validate the pulse power measurements. These were made at baseline and then following 1, 2, 4 and 8 hours. The LiDCO measurement was considered the reference for comparison in this study. The two methods of measuring cardiac output were then compared by linear regression and a Bland Altman analysis. An error rate for the limits of agreement (LOA between the two techniques of less than 30% was defined as being acceptable for this study. Results 14 critically ill medical and surgical patients were enrolled over a three month period. At baseline patients showed a wide range of cardiac output (median 7.5 L/min, IQR 5.1 -9.0 L/min. The bias and limits of agreement between the two techniques was deemed acceptable for the first four hours of the study with percentage errors being 29%, 22%, and 285 respectively. The percentage error at eight hours following calibration increased to 36%. The ability of the PulseCo to detect changes in cardiac output was assessed with a similar analysis. The PulseCO tracked the changes in cardiac output with adequate accuracy for the first four hours with percentage errors being 20%, 24% and 25%. However at eight hours the error had increased to

  20. Longitudinal monitoring of cardiac siderosis using cardiovascular magnetic resonance T2* in patients with thalassemia major on various chelation regimens: a 6-year study.

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    Ambati, Srikanth R; Randolph, Rachel E; Mennitt, Kevin; Kleinert, Dorothy A; Weinsaft, Jonathan W; Giardina, Patricia J

    2013-08-01

    Cardiovascular magnetic resonance (CMR) and hepatic magnetic resonance imaging (MRI) have become reliable noninvasive tools to monitor iron excess in thalassemia major (TM) patients. However, long-term studies are lacking. We reviewed CMR and hepatic MRI T2* imaging on 54 TM patients who had three or more annual measurements. They were managed on various chelation regimens. Patients were grouped according to their degree of cardiac siderosis: severe (T2*, cardiac siderosis (T2*, >20 msec). We looked at the change in cardiac T2*, liver iron concentration (LIC) and left ventricular ejection fraction (LVEF) at years 3 and 5. In patients with severe cardiac siderosis, cardiac T2* (mean ± SD) improved from 6.9 ± 1.6 at baseline to 13.6 ± 10.0 by year 5, mean ΔT2* = 6.7 (P = 0.04). Change in cardiac T2* at year 3 was not significant in the severe group. Patients with mild to moderate cardiac siderosis had mean cardiac T2* of 14.6 ± 2.9 at baseline which improved to 26.3 ± 9.5 by year 3, mean ΔT2* =  1.7 (P = 0.01). At baseline, median LICs (mg/g dry weight) in patients with severe, mild-moderate, and no cardiac siderosis were 3.6, 2.8, and 3.3, whereas LVEFs (mean ± SD) (%) were 56.3 ± 10.1, 60 ± 5, and 66 ± 7.6, respectively. No significant correlation was noted between Δ cardiac T2* and Δ LIC, Δ cardiac T2*, and Δ LVEF at years 3 and 5. Throughout the observation period, patients with no cardiac siderosis maintained their cardiac T2* above 20 msec. The majority of patients with cardiac siderosis improve cardiac T2* over time with optimal chelation.

  1. Cardiac Output Monitoring Managing Intravenous Therapy (COMMIT) to Treat Emergency Department Patients with Sepsis

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    Hou, Peter C.; Filbin, Michael R.; Napoli, Anthony; Feldman, Joseph; Pang, Peter S.; Sankoff, Jeffrey; Lo, Bruce M.; Dickey-White, Howard; Birkhahn, Robert H.; Shapiro, Nathan I.

    2016-01-01

    ABSTRACT Objective: Fluid responsiveness is proposed as a physiology-based method to titrate fluid therapy based on preload dependence. The objectives of this study were to determine if a fluid responsiveness protocol would decrease progression of organ dysfunction, and a fluid responsiveness protocol would facilitate a more aggressive resuscitation. Methods: Prospective, 10-center, randomized interventional trial. Inclusion criteria: suspected sepsis and lactate 2.0 to 4.0 mmol/L. Exclusion criteria (abbreviated): systolic blood pressure more than 90 mmHg, and contraindication to aggressive fluid resuscitation. Intervention: fluid responsiveness protocol using Non-Invasive Cardiac Output Monitor (NICOM) to assess for fluid responsiveness (>10% increase in stroke volume in response to 5 mL/kg fluid bolus) with balance of a liter given in responsive patients. Control: standard clinical care. Outcomes: primary—change in Sepsis-related Organ Failure Assessment (SOFA) score at least 1 over 72 h; secondary—fluids administered. Trial was initially powered at 600 patients, but stopped early due to a change in sponsor's funding priorities. Results: Sixty-four patients were enrolled with 32 in the treatment arm. There were no significant differences between arms in age, comorbidities, baseline vital signs, or SOFA scores (P > 0.05 for all). Comparing treatment versus Standard of Care—there was no difference in proportion of increase in SOFA score of at least 1 point (30% vs. 33%) (note bene underpowered, P = 1.0) or mean preprotocol fluids 1,050 mL (95% confidence interval [CI]: 786–1,314) vs. 1,031 mL (95% CI: 741–1,325) (P = 0.93); however, treatment patients received more fluids during the protocol (2,633 mL [95% CI: 2,264–3,001] vs. 1,002 mL [95% CI: 707–1,298]) (P < 0.001). Conclusions: In this study of a “preshock” population, there was no change in progression of organ dysfunction with a fluid responsiveness protocol

  2. Telehome monitoring in patients with cardiac disease who are at high risk of readmission.

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    Woodend, A Kirsten; Sherrard, Heather; Fraser, Margaret; Stuewe, Lynne; Cheung, Tim; Struthers, Christine

    2008-01-01

    Patients with chronic conditions are heavy users of the health care system. There are opportunities for significant savings and improvements to patient care if patients can be maintained in their homes. A randomized control trial tested the impact of 3 months of telehome monitoring on hospital readmission, quality of life, and functional status in patients with heart failure or angina. The intervention consisted of video conferencing and phone line transmission of weight, blood pressure, and electrocardiograms. Telehome monitoring significantly reduced the number of hospital readmissions and days spent in the hospital for patients with angina and improved quality of life and functional status in patients with heart failure or angina. Patients found the technology easy to use and expressed high levels of satisfaction. Telehealth technologies are a viable means of providing home monitoring to patients with heart disease at high risk of hospital readmission to improve their self-care abilities. PMID:18206525

  3. 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.

  4. 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...

  5. [Cardiac output monitoring by impedance cardiography in cardiac surgery].

    Science.gov (United States)

    Shimizu, H; Seki, S; Mizuguchi, A; Tsuchida, H; Watanabe, H; Namiki, A

    1990-04-01

    The cardiac output monitoring by impedance cardiography, NCCOM3, was evaluated in adult patients (n = 12) who were subjected to coronary artery bypass grafting. Values of cardiac output measured by impedance cardiography were compared to those by the thermodilution method. Changes of base impedance level used as an index of thoracic fluid volume were also investigated before and after cardiopulmonary bypass (CPB). Correlation coefficient (r) of the values obtained by thermodilution with impedance cardiography was 0.79 and the mean difference was 1.29 +/- 16.9 (SD)% during induction of anesthesia. During the operation, r was 0.83 and the mean difference was -14.6 +/- 18.7%. The measurement by impedance cardiography could be carried out through the operation except when electro-cautery was used. Base impedance level before CPB was significantly lower as compared with that after CPB. There was a negative correlation between the base impedance level and central venous pressure (CVP). No patients showed any signs suggesting lung edema and all the values of CVP, pulmonary artery pressure and blood gas analysis were within normal ranges. From the result of this study, it was concluded that cardiac output monitoring by impedance cardiography was useful in cardiac surgery, but further detailed examinations will be necessary on the relationship between the numerical values of base impedance and the clinical state of the patients. PMID:2362347

  6. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

    OpenAIRE

    Layton, Aimee M.; James Whitworth; James Peacock; Bartels, Matthew N.; Jellen, Patricia A.; Thomashow, Byron M.

    2014-01-01

    The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients’ medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five parti...

  7. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

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    Schmitt, D. V.

    2010-01-01

    Full Text Available Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF. The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the

  8. Development of a patch type embedded cardiac function monitoring system using dual microprocessor for arrhythmia detection in heart disease patient.

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    Jang, Yongwon; Noh, Hyung Wook; Lee, I B; Jung, Ji-Wook; Song, Yoonseon; Lee, Sooyeul; Kim, Seunghwan

    2012-01-01

    A patch type embedded cardiac function monitoring system was developed to detect arrhythmias such as PVC (Premature Ventricular Contraction), pause, ventricular fibrillation, and tachy/bradycardia. The overall system is composed of a main module including a dual processor and a Bluetooth telecommunication module. The dual microprocessor strategy minimizes power consumption and size, and guarantees the resources of embedded software programs. The developed software was verified with standard DB, and showed good performance.

  9. Perioperative hemodynamic measurements with an implantable monitoring system (Chronicle) in a patient with severe heart failure undergoing non-cardiac surgery.

    Science.gov (United States)

    Cremers, B; Kjellström, B; Südkamp, M; Böhm, M

    2004-11-01

    A 53-year-old male patient with severe chronic heart failure due to ischemic cardiomyopathy (LVEF 25%) awaiting heart transplantation was admitted for resection of a bladder tumor. The patient underwent implantation of a Chronicle implantable hemodynamic monitor (IHM) two years before. Thus, perioperative monitoring of heart rate, right ventricular systolic, diastolic and pulse pressure, dP/dt and estimated pulmonary artery diastolic pressure through a lead implanted in the right ventricle was performed. In the postoperative period the patient developed low-output syndrome requiring catecholamine treatment. The patient was weaned from mechanical ventilation uneventfully the same day. However, he developed symptomatic and hemodynamic worsening of heart failure shortly after reduction of inotropes and required prolonged medical treatment with catecholamines. Patients with cardiac disease are known to be at increased risk for cardiovascular complications after noncardiac surgery. Therefore, it has been suggested that such patients could potentially benefit from perioperative invasive hemodynamic monitoring. For the first time, we report a case of perioperative continuous hemodynamic monitoring with a long term-implanted device in a potential heart transplant patient. PMID:15568151

  10. Cardiopulmonary stress testing using ambulatory radionuclide monitoring system: The relationship between vascular endothelial function and cardiac response in patients with ischemic heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Akima, Takashi; Tabata, Hirotsugu [Self-Defense Forces Central Hospital, Tokyo (Japan); Takase, Bonpei [National Defense Medical Coll., Tokorozawa, Saitama (Japan)] [and others

    2002-02-01

    The relationship in the title was studied with a new type ambulatory radionuclide monitoring system. Subjects were 12 male patients with ischemic heart diseases. After cardiac scintigraphy at rest of {sup 99m}Tc-human serum albumin (740 MBq) with GE Mirenium, patients wore the C-VEST jacket (Capintec medset cardiolight), which consisted from 2 radioactivity detectors and Holter ECG recorder, and underwent the cardiopulmonary stress testing with Treadmill Ramp exercise to evaluate the anaerobic threshold (AT), VO{sub 2}, left ventricular ejection flow (EF) and stroke volume (SV). Vascular endothelial function was recorded by ultrasonography of brachial artery by monitoring the flow-mediated dilation (FD). Mean EF at rest was 56% and there was no relationship between VO{sub 2} at rest or exercise and FD. However, the relationship between FD and change of SV or EF from rest to AT was recognized and thus FD was suggested to participate in cardiac function change at exercise of those patients. (K.H.)

  11. Coagulopathy and hemostatic monitoring in cardiac surgery

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sølbeck, Sacha; Genet, Gustav;

    2012-01-01

    Cardiac surgery with cardiopulmonary bypass (CPB) causes severe derangements in the hemostatic system, which in turn puts the patient at risks of microvascular bleeding. Excessive transfusion and surgical re-exploration after cardiac surgery are potentially associated with a number of adverse...

  12. Cardiac output measurement : evaluation of methods in ICU patients

    NARCIS (Netherlands)

    Wilde, Robert Bernard Pieter de

    2009-01-01

    Accurate clinical assessment of the circulatory status is particular desirable in critically ill patients in the intensive care unit (ICU) and patients undergoing cardiac, thoracic, or vascular interventions. As the patient’s haemodynamic status may change rapidly, continuous monitoring of cardiac o

  13. Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Desanka Dragosavac

    1999-08-01

    Full Text Available OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP. METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI, systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP, pulmonary capillary wedge pressure (PCWP, oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI, and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2 and consumption (VO2, p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS. Therefore, invasive hemodynamic monitoring is useful in handling blood volume, choice of vasoactive drugs, and indication for circulatory support.

  14. Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

    Directory of Open Access Journals (Sweden)

    Aimee M. Layton

    2014-01-01

    Full Text Available The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients’ medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group and 53% (>31-day group of the time, education material was read 44% (1–30 and 53% (>31 of the time, and physical activity was reported 25% (1–30 and 42% (>31 of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients.

  15. ECG Monitoring in Cardiac Rehabilitation: Is It Needed?

    Science.gov (United States)

    Greenland, Philip; Pomilla, Paul V.

    1989-01-01

    Discusses the controversial use of continuous electrocardiogram (ECG) monitoring as a safety measure in cardiac rehabilitation exercise programs. Little evidence substantiates its value for all patients during exercise. In the absence of empirical evidence documenting the worth of this expensive procedure, it is recommended for use with high-risk…

  16. Remote monitoring of cardiac implantable electronic devices

    OpenAIRE

    Lappegård, Knut Tore

    2015-01-01

    Seminario desarrollado en la Segunda Conferencia Internacional de Comunicación en Salud, celebrada el 23 de octubre de 2015 en la Universidad Carlos III de Madrid Cardiac implantable electronic devices (CIEDs) are used with increasing frequency for the diagnosis and treatment of cardiac arrhythmias. In Europe, a total number of 550,000 pacemakers and 180,000 defibrillators were implanted in 2014. Follow-up of these patients is a large challenge to the health system and requires a substanti...

  17. Results of plasma N-terminal pro B-type natriuretic peptide and cardiac troponin monitoring in GIST patients do not support the existence of imatinib-induced cardiotoxicity

    NARCIS (Netherlands)

    Perik, P. J.; Rikhof, B.; de Jong, F. A.; Verweij, J.; Gietema, J. A.; van der Graaf, W. T. A.

    2008-01-01

    Background: Recently, case reports of patients treated with imatinib (imatinib mesylate; Gleevec (R); Glvec (R)) indicated that this tyrosine kinase inhibitor may induce cardiomyopathy. Consequently, careful cardiac monitoring was advocated for clinical studies. The purpose of this study was to pros

  18. Results of plasma N-terminal pro B-type natriuretic peptide and cardiac troponin monitoring in GIST patients do not support the existence of imatinib-induced cardiotoxicity

    NARCIS (Netherlands)

    P.J. Perik; B. Rikhof; M.J.A. de Jonge (Maja); J. Verweij (Jaap); J.A. Gietema (Jourik); W.T.A. van der Graaf (Winette)

    2008-01-01

    textabstractBackground: Recently, case reports of patients treated with imatinib (imatinib mesylate; Gleevec®; Glivec®) indicated that this tyrosine kinase inhibitor may induce cardiomyopathy. Consequently, careful cardiac monitoring was advocated for clinical studies. The purpose of this study was

  19. ECLS in Pediatric Cardiac Patients

    Science.gov (United States)

    Di Nardo, Matteo; MacLaren, Graeme; Marano, Marco; Cecchetti, Corrado; Bernaschi, Paola; Amodeo, Antonio

    2016-01-01

    Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children. In this review, we will present the “state of art” of ECMO in neonate and children with heart failure. ECMO is commonly used in a variety of settings to provide support to critically ill patients with cardiac disease. However, a strict selection of patients and timing of intervention should be performed to avoid the increase in mortality and morbidity of these patients. Therefore, every attempt should be done to start ECLS “urgently” rather than “emergently,” before the presence of dysfunction of end organs or circulatory collapse. Even though exciting progress is being made in the development of VADs for long-term mechanical support in children, ECMO remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. With the increase in familiarity with ECMO, new indications have been added, such as extracorporeal cardiopulmonary resuscitation (ECPR). The literature supporting ECPR is increasing in children. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS have reduced in the last 5 years and many centers support patients with functionally univentricular circulations. Improved results have been recently achieved in this complex subset of patients. PMID

  20. Electrocardiographic Patch Devices and Contemporary Wireless Cardiac Monitoring

    Directory of Open Access Journals (Sweden)

    Erik eFung

    2015-05-01

    Full Text Available Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG, Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable ‘on-body’ ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery.

  1. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs...

  2. Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol

    Science.gov (United States)

    Yost, Jennifer; Turner, Andrew; Bender, Duane; Scott, Ted; Carroll, Sandra; Ritvo, Paul; Peter, Elizabeth; Lamy, Andre; Furze, Gill; Krull, Kirsten; Dunlop, Valerie; Good, Amber; Dvirnik, Nazari; Bedini, Debbie; Naus, Frank; Pettit, Shirley; Henry, Shaunattonie; Probst, Christine; Mills, Joseph; Gossage, Elaine; Travale, Irene; Duquette, Janine; Taberner, Christy; Bhavnani, Sanjeev; Khan, James S; Cowan, David; Romeril, Eric; Lee, John; Colella, Tracey; Choinière, Manon; Busse, Jason; Katz, Joel; Victor, J Charles; Hoch, Jeffrey; Isaranuwatchai, Wanrudee; Kaasalainen, Sharon; Ladak, Salima; O'Keefe-McCarthy, Sheila; Parry, Monica; Sessler, Daniel I; Stacey, Michael; Stevens, Bonnie; Stremler, Robyn; Thabane, Lehana; Watt-Watson, Judy; Whitlock, Richard; MacDermid, Joy C; Leegaard, Marit; McKelvie, Robert; Hillmer, Michael; Cooper, Lynn; Arthur, Gavin; Sider, Krista; Oliver, Susan; Boyajian, Karen; Farrow, Mark; Lawton, Chris; Gamble, Darryl; Walsh, Jake; Field, Mark; LeFort, Sandra; Clyne, Wendy; Ricupero, Maria; Poole, Laurie; Russell-Wood, Karsten; Weber, Michael; McNeil, Jolene; Alpert, Robyn; Sharpe, Sarah; Bhella, Sue; Mohajer, David; Ponnambalam, Sem; Lakhani, Naeem; Khan, Rabia; Liu, Peter

    2016-01-01

    Background Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT—VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom. Objective Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT). Methods CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a

  3. Data acquisition in a wireless diabetic and cardiac monitoring system.

    Science.gov (United States)

    Harvey, Paul; Woodward, Bryan; Datta, Sekharjit; Mulvaney, David

    2011-01-01

    A telemedicine system is described for monitoring the vital signs and general health indicators of patients with cardiac and diabetic conditions. Telemetry from wireless sensors and readings from other instruments are combined into a comprehensive patient health dataset. The data can be stored, accessed and displayed using mobile Internet communications with a server. The paper concentrates on the data acquisition process, using an alternative sensor network protocol to Bluetooth and manual data entry into a smartphone application and HTML5 web browser. PMID:22255009

  4. Newer methods of cardiac output monitoring

    Institute of Scientific and Technical Information of China (English)

    Yatin; Mehta; Dheeraj; Arora

    2014-01-01

    Cardiac output(CO) is the volume of blood ejected by each ventricle per minute and is the product of stroke volume and heart rate. CO can thus be manipulated by alteration in heart rate or rhythm, preload, contractility and afterload. Moreover it gives important information about tissue perfusion and oxygen delivery. CO can be measured by various methods and thermodilution method using pulmonary artery catheter(PAC) is till date considered as gold standard method. Complications associated with PAC led to development of newer methods which are minimally or non-invasive. Newer methods fulfil other properties like continuous and reproducible reading, cost effective, reliable during various physiological states and have fast response time. These methods are validated against the gold standard with good level agreement. In this review we have discussed various newer methods of CO monitoring and their effectiveness in clinical use.

  5. Application of pulse contour cardiac output monitoring technique in hemodynamic monitoring in critical patients%脉搏轮廓心排血量监测技术在危重病患者血流动力学监测中的应用

    Institute of Scientific and Technical Information of China (English)

    房贺; 郑兴锋; 夏照帆

    2014-01-01

    Pulse contour cardiac output (PiCCO) monitoring is a new type of invasive hemodynamic monitoring technology,which is more and more often applied in perioperative period and the patients suffering from multiple injuries,septic shock,and extensive burn.With PiCCO one is able to monitor patients' hemodynamic indexes safely,timely,accurately,and continuously to provide reference for judgment of patients' condition and proper quality and quantity of fluid administration.This technique has a good prospect in clinical application.

  6. Autonomic Dysfunction Predicts Early Cardiac Affection in Patients with Systemic Sclerosis

    OpenAIRE

    Othman, Khaled M.; Naglaa Youssef Assaf; Hanan Mohamed Farouk; Iman M. Aly Hassan

    2010-01-01

    Objective: To detect the early preclinical alterations in cardiac autonomic control as well as altered cardiac function in systemic sclerosis (SSc) patients and their relevance to the clinical features of the disease using noninvasive methods. Methods: 30 SSc patients and 15 healthy controls matched for age and sex underwent clinical examination, serological analysis, and echocardiographic assessment including Doppler flow imaging to evaluate cardiac function, and 24-hour Holter monitoring an...

  7. Application and Nursing of Pulse Index Continuous Cardiac Output Monitoring in Patients with Post-cardiac Arrest Syndrome%脉波指示剂连续心排血量监测在心搏骤停后综合征患者中的应用与护理

    Institute of Scientific and Technical Information of China (English)

    陈淑兰; 刘刚; 张秋真; 陈秋恋

    2011-01-01

    Objective To investigate the application effect and nursing of the pulse index continuous cardiac output (PICCO) monitoring technique in patients with post-cardiac arrest syndrome (PCAS). Methods The precautions and nursing points were developed for the flowsheet of operation, cooperation for the vein catheterization and measurements. Results Of the 15 patients using the PICCO monitoring technique in early stage,no complication occurred ,except one patient died of multiple organ failure and 3 abandoned the treatment,and the rest 11 patients survived. Conclusion PCAS patients undergoing PICCO monitoring device in the early stage can efficiently assist the fluid management,maintain the vital signs of the patients,and save their lives.%目的 探讨脉波指示剂连续心排血量监测( pulse index continuous cardiac output,PICCO)在心搏骤停后综合征(postcardiac arrest syndrome,PCAS)患者中的应用效果及护理.方法 制定操作流程、置管配合、测量的注意事项和护理要点.结果 15例患者通过早期采用了PICCO监测,并采取了相应的护理措施,均未出现并发症,除了1例患者因多器官功能衰竭死亡外,3例患者放弃治疗,其余11例患者均存活.结论 对PCAS患者早期进行PICCO监测,能对患者进行更准确的血流动力学监测,可以有效协助液体管理,维持患者生命体征的稳定,挽救患者生命.

  8. Remote monitoring of cardiac implantable electronic devices (CIED).

    Science.gov (United States)

    Zeitler, Emily P; Piccini, Jonathan P

    2016-08-01

    With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In parallel, the technology available for managing these devices has advanced considerably. In this setting, remote monitoring (RM) has emerged as a complement to routine in-office care. Rigorous studies, randomized and otherwise, have demonstrated advantages to patient with CIED management systems, which incorporates RM resulting in authoritative guidelines from relevant professional societies recommending RM for all eligible patients. In addition to clinical benefits, CIED management programs that include RM have been shown to be cost effective and associated with high patient satisfaction. Finally, RM programs hold promise for the future of CIED research in light of the massive data collected through RM databases converging with unprecedented computational capability. This review outlines the available data associated with clinical outcomes in patients managed with RM with an emphasis on randomized trials; the impact of RM on patient satisfaction, cost-effectiveness, and healthcare utilization; and possible future directions for the use of RM in clinical practice and research. PMID:27134007

  9. Learning rules from multisource data for cardiac monitoring

    CERN Document Server

    Cordier, Marie-Odile; Quiniou, René

    2009-01-01

    This paper formalises the concept of learning symbolic rules from multisource data in a cardiac monitoring context. Our sources, electrocardiograms and arterial blood pressure measures, describe cardiac behaviours from different viewpoints. To learn interpretable rules, we use an Inductive Logic Programming (ILP) method. We develop an original strategy to cope with the dimensionality issues caused by using this ILP technique on a rich multisource language. The results show that our method greatly improves the feasibility and the efficiency of the process while staying accurate. They also confirm the benefits of using multiple sources to improve the diagnosis of cardiac arrhythmias.

  10. Kredsløbsmonitorering af kritisk syge patienter med "pulse contour cardiac output"-systemet

    DEFF Research Database (Denmark)

    Afshari, Arash; Perner, Anders; Bonde, Jan

    2006-01-01

    The Pulse Contour Cardiac Output (PiCCO) monitoring system measures cardiac output with high precision and accuracy. The system may replace the pulmonary artery catheter in most critically ill patients because the rate of serious complications may be lower. Whether the use of dynamic or static...

  11. Cardiac Rehabilitation in Patients with Heart Failure

    OpenAIRE

    Fu, Tieh-Cheng; Huang, Shu-Chun; Hsu, Chih-Chin; Wang, Chao-Hung; Wang, Jong-Shyan

    2014-01-01

    Reduced exercise capacity negatively affects the ability of patients with heart failure (HF) to perform activities required for daily life, further decreasing their independence and quality of life (QoL). Cardiac rehabilitation (CR) can effectively improve aerobic fitness and overall health status in patients with HF. Low referral rate is an important limitation that may impede successful CR, whereas the automatic referral and liaison strategies performed by some healthcare providers manifest...

  12. 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; Diederichsen, Axel Cosmus Pyndt;

    2015-01-01

    , cardiac troponin-I (TnI), electrocardiogram (standard 12-lead and 48-h Holter monitoring), echocardiography with tissue Doppler measures, cardiac magnetic resonance (CMR) imaging with T2 mapping and semi-quantitative (99m)technetium pyrophosphate ((99m)Tc-PYP) scintigraphy. RESULTS: Dyspnoea was present....... The myocardial (99m)Tc-PYP uptake and CMR results differed between patients and controls, albeit not with statistical significance. Overall, cardiac abnormalities were demonstrated in 9 (64%) of the patients versus 2 (14%) of the controls (p=0.02). CONCLUSIONS: Cardiac abnormalities assessed by TnI, ECG...

  13. STUDY AND APPLICATION ABOUT COMPUTED SYSTEM FOR EXTERNAL CARDIAC MASSAGE,MONITOR OF HEART AND BODY TEMPERATURE

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To make and study computed system for external cardiac massage, monitor of heart and body temperature and observe its clinical effect. Method: The system was made and applied. Result: The effect of system was obvious. Conclusion: The system was an effective clinical equipment in treatment of patient with cardiac arrest.

  14. System for the diagnosis and monitoring of coronary artery disease, acute coronary syndromes, cardiomyopathy and other cardiac conditions

    Science.gov (United States)

    Schlegel, Todd T. (Inventor); Arenare, Brian (Inventor)

    2008-01-01

    Cardiac electrical data are received from a patient, manipulated to determine various useful aspects of the ECG signal, and displayed and stored in a useful form using a computer. The computer monitor displays various useful information, and in particular graphically displays various permutations of reduced amplitude zones and kurtosis that increase the rapidity and accuracy of cardiac diagnoses. New criteria for reduced amplitude zones are defined that enhance the sensitivity and specificity for detecting cardiac abnormalities.

  15. Cardiac imaging in patients with chronic liver disease

    DEFF Research Database (Denmark)

    Wiese, Signe; Hove, Jens D; Møller, Søren

    2016-01-01

    dysfunction at rest by application of new myocardial strain techniques. Experience with other modalities such as cardiac magnetic resonance imaging and cardiac computed tomography is limited. Future studies exploring these imaging modalities are necessary to characterize and monitor the cardiac changes...

  16. Patient selection for cardiac transplant in 2012.

    Science.gov (United States)

    Kinkhabwala, Mona Parikh; Mancini, Donna

    2013-02-01

    Heart transplantation is the treatment of choice for many patients with advanced heart failure who remain symptomatic despite optimal medical therapy. Although heart transplantation results have improved over the past 10 years, careful patient selection and risk stratification of patients with advanced heart failure is paramount given limited allograft resources. Moreover, as alternative therapies to heart transplant, such as mechanical circulatory support, continue to improve in terms of patient outcomes, the selection strategy for those patients who would benefit from device support as destination therapy or bridge-to-transplant versus those patients who should proceed directly to transplant will continue to evolve. This review focuses on the optimal timing for heart transplant, risk stratification models for patient selection, as well as examining factors that continue to provoke controversy during the candidate selection process and factors that have changed from absolute to relative contraindications as the authors experience with cardiac transplantation continues to increase. PMID:23405839

  17. Holter monitoring for the screening of cardiac disease in diabetes mellitus: The non-invasive Holter monitoring observation of new cardiac events in diabetics study.

    Science.gov (United States)

    Nakao, Yoko M; Ueshima, Kenji; Nohara, Ryuji; Mizunuma, Yoshimi; Segawa, Ikuo; Tanaka-Mizuno, Sachiko; Yasuno, Shinji; Nakao, Kazuwa; Hiramori, Katsuhiko; Kihara, Yasuki

    2015-11-01

    We investigated the usefulness of Holter monitoring to detect cardiac disease and predict future cardiovascular risk in asymptomatic diabetic patients. This is a multi-centre, prospective study in 406 asymptomatic diabetic patients. They were categorized into three groups based on findings of Holter monitoring. A total of 377 met inclusion criteria and were classified as low (n = 172), moderate (n = 136) and high risk (n = 69). In total, 86 in moderate and 53 in high risk receive further evaluation. In total, 29 in moderate and 25 in high risk were diagnosed as cardiac disease and 12 required additional treatment, including coronary intervention. Over 1.8 years of mean follow-up, 11 (16.5 per 1000 person-years) experienced cardiovascular events. The cumulative incidence in moderate and high risk was higher than that in low risk (p = 0.029 and p = 0.014, respectively). Our study suggests that Holter monitoring may be a useful screening tool to detect cardiac disease and predict future cardiovascular risk in asymptomatic diabetic patients.

  18. Cardiac abnormalities in adult patients with polymyositis or dermatomyositis as assessed by non-invasive modatities

    DEFF Research Database (Denmark)

    Christensen, Anne Friesgaard

    2016-01-01

    Objectives Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies (IIM). The study objective was in a controlled setting to describe cardiac abnormalities by non-invasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM......) and to identify predictors for cardiac dysfunction. Methods In a cross-sectional study, 76 patients with PM/DM and 48 matched healthy controls (HC) were assessed by serum levels of cardiac troponin-I (TnI), electrocardiography, Holter monitoring, echocardiography with tissue Doppler imaging (TDI) and quantitative...... cardiac (99m) technetium pyrophosphate ((99m) Tc-PYP) scintigraphy. Results Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% vs. 0%, P = 0.02) and longer QRS and QTc intervals (P = 0.007 and P 

  19. Electro-resistive bands for non-invasive cardiac and respiration monitoring, a feasibility study

    International Nuclear Information System (INIS)

    Continuous unobtrusive monitoring of tidal volume, particularly for critical care patients (i.e. neonates and patients in intensive care) during sleep studies and during daily activities, is still an unresolved monitoring need. Also a successful monitoring solution is yet to be proposed for continuous non-invasive cardiac stroke volume monitoring that is a novel clinical need. In this paper we present the feasibility study for a wearable, non-invasive, non-contact and unobtrusive sensor (embedded in a standard T-shirt) based on four electro-resistive bands that simultaneously monitors tidal volume and cardiac stroke volume changes. This low power sensor system (requires only 100 mW and accepts a wide power supply range up to ±18 V); thus the sensor can be easily embedded in existing wearable solutions (i.e. Holter monitors). Moreover, being contactless, it can be worn over bandages or electrodes, and as it does not rely over the integrity of the garment to work, it allows practitioners to perform procedures during monitoring. For this preliminary evaluation, one subject has worn the sensor over the period of 24 h (removing it only to shower); the accuracy of the tidal volume tested against a portable spirometer reported a precision of ±10% also during physical activity; accuracy tests for cardiac output (as it may require invasive procedure) have not been carried out in this preliminary trial. (note)

  20. Remote patient monitoring in chronic heart failure.

    Science.gov (United States)

    Palaniswamy, Chandrasekar; Mishkin, Aaron; Aronow, Wilbert S; Kalra, Ankur; Frishman, William H

    2013-01-01

    Heart failure (HF) poses a significant economic burden on our health-care resources with very high readmission rates. Remote monitoring has a substantial potential to improve the management and outcome of patients with HF. Readmission for decompensated HF is often preceded by a stage of subclinical hemodynamic decompensation, where therapeutic interventions would prevent subsequent clinical decompensation and hospitalization. Various methods of remote patient monitoring include structured telephone support, advanced telemonitoring technologies, remote monitoring of patients with implanted cardiac devices such as pacemakers and defibrillators, and implantable hemodynamic monitors. Current data examining the efficacy of remote monitoring technologies in improving outcomes have shown inconsistent results. Various medicolegal and financial issues need to be addressed before widespread implementation of this exciting technology can take place. PMID:23018667

  1. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

    Full Text Available In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course.

  2. The Effect of a Self Exercise Program in Cardiac Rehabilitation for Patients with Coronary Artery Disease

    OpenAIRE

    Kim, Chul; Youn, Jo Eun; Choi, Hee Eun

    2011-01-01

    Objective To investigate the effect of self exercise in cardiac rehabilitation on cardiopulmonary exercise capacity for selected patients with coronary artery disease. Method The subjects of this study were patients who received percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery and who participated in a cardiac rehabilitation program. The supervised exercise group participated in 6-8 weeks of aerobic exercise training with telemetry ECG monitoring in hosp...

  3. Monitoring of antibiotics application of patients undergoing cardiac catheterization interventional surgery%心导管介入手术患者应用抗菌药物监测分析

    Institute of Scientific and Technical Information of China (English)

    王鲜平; 高敏; 吕岩; 刘敏; 张娜

    2012-01-01

    目的 了解心导管介入诊断和治疗的手术患者预防性应用抗菌药物现状,为临床合理用药提供依据.方法 目标性监测心导管介入中心2011年9月-2012年4月住院手术病例,剔除原有感染已经使用抗菌药物的病例,由医院感染专职人员通过医院感染监测信息系统采集登记相关信息,进行统计分析;同时实施干预管理:开展合理用药技术培训,加强无菌技术操作管理,严格医疗环境管控等,每月将监测结果反馈给临床科室.结果 监测患者451例,平均年龄56岁;预防应用抗菌药物403例次,使用率89.14%,平均用药天数2.79 d;应用青霉素245例,左氧氟沙星129例,两者占用药总数的93.03%;有49例未用抗菌药物.结论 心导管介入诊疗手术预防应用抗菌药物,应在循证医学基础上,严格掌握用药指征,降低预防用药率,控制用药次数,避免过度应用抗菌药物.%OBJECTIVE To understand the current situation of the prophylactic use of antibiotics by the patients who underwent the cardiac catheterization interventional therapy so as to provide basis for the reasonable use of antibiotics. METHODS All cases in the cardiac interventional therapy center from Sep. 2011 to Apr, 2012 were monitored. The related information was collected and registered by using of the hospital infection monitoring systems, then the statistical analysis was carried out. At the same time the supervisal work was practiced, the training for rational use of drugs was carried out, the aseptic operation technique was strengthened, medical environment control was made strict. In addition, the monitoring results were fed back to the clinical departments monthly. RESULTS A total of 451 patients were monitored, and their average age was 56 years old. 7 types of antibiotics were used for prevention. There were 403 patients with the prophylactic use of antibiotics with the utilization rate of 89. 14% , the average medication duration was 2

  4. Music Therapy for Post Operative Cardiac Patients

    DEFF Research Database (Denmark)

    Schou, Karin

    Background This study is the first controlled research study undertaken in the early phase of rehabilitation after cardiac surgery investigating the effect of a receptive music therapy method. Various forms of music therapy interventions including both active and receptive methods were reported...... to be significantly more effective than music treatment with music medicine. Music listening and receptive music therapy (such as Guided Imagery and Music) have been proposed to help patients both before heart surgery and during the recovery phase. This study therefore intended to explore both a music therapy...

  5. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    Directory of Open Access Journals (Sweden)

    Ersin Kasım Ulusoy

    2015-08-01

    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  6. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars;

    2013-01-01

    AIM: We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory...... markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using...... the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...

  7. False Alarm Reduction in BSN-Based Cardiac Monitoring Using Signal Quality and Activity Type Information

    Directory of Open Access Journals (Sweden)

    Tanatorn Tanantong

    2015-02-01

    Full Text Available False alarms in cardiac monitoring affect the quality of medical care, impacting on both patients and healthcare providers. In continuous cardiac monitoring using wireless Body Sensor Networks (BSNs, the quality of ECG signals can be deteriorated owing to several factors, e.g., noises, low battery power, and network transmission problems, often resulting in high false alarm rates. In addition, body movements occurring from activities of daily living (ADLs can also create false alarms. This paper presents a two-phase framework for false arrhythmia alarm reduction in continuous cardiac monitoring, using signals from an ECG sensor and a 3D accelerometer. In the first phase, classification models constructed using machine learning algorithms are used for labeling input signals. ECG signals are labeled with heartbeat types and signal quality levels, while 3D acceleration signals are labeled with ADL types. In the second phase, a rule-based expert system is used for combining classification results in order to determine whether arrhythmia alarms should be accepted or suppressed. The proposed framework was validated on datasets acquired using BSNs and the MIT-BIH arrhythmia database. For the BSN dataset, acceleration and ECG signals were collected from 10 young and 10 elderly subjects while they were performing ADLs. The framework reduced the false alarm rate from 9.58% to 1.43% in our experimental study, showing that it can potentially assist physicians in diagnosing a vast amount of data acquired from wireless sensors and enhance the performance of continuous cardiac monitoring.

  8. Cardiac Bypass Pump Flow Management via NIRS Monitoring

    OpenAIRE

    Macnab, Andrew J.; Gagnon, Roy E.; Gagnon, Faith A.; Blackstock, Derek; LeBlanc, Jacques G.

    2003-01-01

    During cardiac surgery, bypass pumps rely on pressure monitors to evaluate flow. We studied whether it would be possible to optimize pump flow by monitoring changes in cerebral cytochrome a,a3 using NIRS to maintain cyt redox status at its pre-bypass level. Method: 18 healthy 7–45 kg swine were placed on bypass for repeated cycles of cooling and re-warming from 36 to 15 to 36°C in 3°C steps. Between each cycle, the swine's bypass pump blood flow rate was adjusted to restore cytochrome redox s...

  9. Assessment of pulmonary function tests in cardiac patients

    OpenAIRE

    El-Sobkey, Salwa B.; Gomaa, Magdi

    2011-01-01

    This study was aimed to assess the pulmonary function tests (PFTs) in cardiac patients; with ischemic or rheumatic heart diseases as well as in patients who underwent coronary artery bypass graft (CABG) or valvular procedures. For the forty eligible participants, the pulmonary function was measured using the spirometry test before and after the cardiac surgery. Data collection sheet was used for the patient’s demographic and intra-operative information. Cardiac diseases and surgeries had rest...

  10. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    OpenAIRE

    Ersin Kasım Ulusoy; Tolga Kunak; Şule Bilen; Fikri Ak

    2015-01-01

    Emery-Dreifuss muscular dystrophy (EDMD) is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t...

  11. Cardiac resynchronization therapy in a patient with amyloid cardiomyopathy.

    Science.gov (United States)

    Zizek, David; Cvijić, Marta; Zupan, Igor

    2013-06-01

    Cardiac involvement in systemic light chain amyloidosis carries poor prognosis. Amyloid deposition in the myocardium can alter regional left ventricular contraction and cause dyssynchrony. Cardiac resynchronization therapy (CRT) is an effective treatment strategy for patients with advanced heart failure and echocardiographic dyssynchrony. We report a clinical and echocardiographic response of a patient with amyloid cardiomyopathy, treated with a combination of chemotherapy and CRT.

  12. Optimized cardiac resynchronization therapy in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    NIU Hong-xia; HUA Wei; ZHANG Shu; SUN Xin; CHEN Ke-ping; WANG Fang-zheng; CHEN Xin

    2007-01-01

    @@ Heart failure was a major and increasing public health problem, with an almost "epidemic increase in the number of patients.1 Despite recent advances in pharmacotherapy, the prognosis remains poor. Cardiac resynchronization therapy (CRT), by pacing right and left ventricles, has been proved to improve symptoms and reduce mortality for heart failure patients with cardiac dyssynchrony.

  13. Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies.

    Science.gov (United States)

    Barutcu, A; Aksu, F; Ozcelik, F; Barutcu, C A E; Umit, G E; Pamuk, O N; Altun, A

    2015-09-01

    The aim of this study was to use transthoracic Doppler echocardiographic (TTE) imaging methods to identify cardiac dysfunction, an indicator of subclinical atherosclerosis in asymptomatic systemic lupus erythematosus (SLE) patients in terms of cardiac effects. This study involved 80 patients: a study group (n = 50) and control group (n = 30). They were categorized into four subgroups: anticardiolipin antibodies (aCL) (+) (n = 14) and aCL (-) (n = 36); systemic lupus erythematosus disease activity index (SLEDAI) ≥ 6 (n = 15) and SLEDAI 5 years group compared with the disease period <5 years group (p < 0.01, p < 0.05, respectively). Carrying out regular scans with TTE image of SLE patients is important in order to identify early cardiac involvement during monitoring and treatment. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates.

  14. A comparison of genetic findings in sudden cardiac death victims and cardiac patients

    DEFF Research Database (Denmark)

    Hertz, Christin L; Ferrero-Miliani, Laura; Frank-Hansen, Rune;

    2015-01-01

    systematically identified and reviewed. The frequencies of disease-causing mutation were on average between 16 and 48% in the cardiac patient studies, compared with ∼10% in the post-mortem studies. The frequency of pathogenic mutations in heart genes in cardiac patients is up to four-fold higher than that in SCD......Sudden cardiac death (SCD) is responsible for a large proportion of non-traumatic, sudden and unexpected deaths in young individuals. Sudden cardiac death is a known manifestation of several inherited cardiac diseases. In post-mortem examinations, about two-thirds of the SCD cases show structural...... previously characterized as unexplained. Additionally, a genetic diagnose in a SCD victim with a structural disease may not only add to the differential diagnosis, but also be of importance for pre-symptomatic family screening. In the case of SCD, the optimal establishment of the cause of death...

  15. Colorectal patients and cardiac arrhythmias detected on the surgical high dependency unit.

    OpenAIRE

    Batra, G. S.; Molyneux, J.; N. A. Scott

    2001-01-01

    INTRODUCTION: Surgical high dependency unit (SHDU) care is becoming an integral feature of colorectal surgical practice. Routine ECG monitoring is a feature of surgical care in this setting. The aim of this study was to determine the incidence and outcome of cardiac arrhythmias detected in an SHDU population of colorectal patients. PATIENTS AND METHODS: 226 patients over a 12 month period were admitted to a 6-bedded SHDU under the care of 3 colorectal surgeons. A total of 29 patients (13%) ha...

  16. Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

    Institute of Scientific and Technical Information of China (English)

    Yuxi Liu; Weicheng Hao; Xiaoming Yang; Yimin Wang; Yu Su

    2012-01-01

    The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical video-electroencephalogram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds (mean 8 seconds) prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds (average 16 seconds). The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure. Intracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

  17. High prevalence of cardiac involvement in patients with myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Witting, Nanna; Ersbøll, Mads Kristian;

    2014-01-01

    , Holter-monitoring and muscle strength testing. RESULTS: Cardiac involvement was found in 71 patients (55%) and included: 1) Conduction abnormalities: atrio-ventricular block grade I (AVB grade I) (23.6%), AVB grade II (5.6%), right/left bundle branch block (5.5/3.2%) and prolonged QTc (7.2%); 2...... associated with normal findings on Holter-monitoring or echocardiography. Patients with abnormal cardiac findings had weaker muscle strength than those with normal cardiac findings: ankle dorsal flexion (median (range) 4.5 (0-5) vs. 5.0 (2.5-5), p=0.004) and handgrip (median 4.0 (0-5) vs. 4.50 (2-5), p=0.......02). CONCLUSION: The cardiac phenotype of DM1 includes a high prevalence of conduction disorders, arrhythmias and risk factors of SCD. Systematic cardiac screening with ECG, Holter-monitoring and echocardiography is needed in order to make a proper characterization of cardiac involvement in DM1....

  18. STEM promotion through museum exhibits on cardiac monitoring & cardiac rhythm management.

    Science.gov (United States)

    Countryman, Jordan D; Dow, Douglas E

    2014-01-01

    Formal education in science, technology, engineering and math (STEM) does not successfully engage all of the students who have potential to become skilled in STEM activities and careers. Museum exhibits may be able to reach and engage a broader range of the public. STEM Exhibits that are both understandable and capture the imagination of viewers may contribute toward increased interest in STEM activities. One such topic for such an exhibit could be cardiac pacemakers and cardioverter defibrillators that sustain life. Although museums have existed for centuries, the available types of exhibit designs has dramatically increased in recent decades due to innovations in technology. Science and technology museums have especially taken advantage of the progression of exhibit design to developed new ways to communicate to their viewers. These novel presentation tools allow museums to more effectively convey to and engage viewers. This paper examines the techniques employed by museums in exhibits and considers the practices of several museums with exhibits related to cardiac monitoring (CM) and cardiac rhythm management (CRM).

  19. CARDIAC REHABILITATION PROGRAM (AEROBIC) AND QUALITY OF LIFE IN CARDIAC PATIENTS

    OpenAIRE

    Majid Gorgeh; Morad Jorgeh; Farzad Nazem; Ali Yelfani

    2011-01-01

    Cardiac rehabilitation is the effective method to improve quality of life; especially in heartdisease.The purpose of this study was to determine the effect of cardiac rehabilitation programson the quality of life of patients who had undergone coronary artery bypass grafting in Iran.Six weeks after CABG 60 patients ( 46 male and 14 female) participated in an 12-week cardiacrehabilitation program that consisted of formal supervised exercise training and educationalsessions in shahid beheshti re...

  20. Health status in patients treated with cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Denollet, Johan; Pedersen, Susanne S.;

    2008-01-01

    Cardiac resynchronization therapy (CRT) is a promising treatment in chronic heart failure (CHF). However, a subgroup of patients still report impaired health status, cardiac symptoms, and feelings of disability following CRT. The aims of this study were to examine (1) whether CHF patients treated...... with CRT improved in patient-centered outcomes and functional capacity, and (2) whether personality traits exert a stable effect on these outcomes over two months....

  1. Cardiac pacing in left bundle branch/ bifascicular block patients

    Directory of Open Access Journals (Sweden)

    Maddali Madan

    2010-01-01

    Full Text Available The primary concern in patients with bifascicular block is the increased risk of progression to complete heart block. Further, an additional first-degree A-V block in patients with bifascicular block or LBBB might increase the risk of block progression. Anesthesia, monitoring and surgical techniques can induce conduction defects and bradyarrhythmias in patients with pre-existing bundle branch block. In the setting of an acute MI, several different types of conduction disturbance may become manifest and complete heart block occurs usually in patients with acute myocardial infarction more commonly if there is pre-existing or new bundle branch block. The question that arises is whether it is necessary to insert a temporary pacing catheter in patients with bifascicular block undergoing anesthesia. It is important that an anesthesiologist should be aware of the indications for temporary cardiac pacing as well as the current recommendations for permanent pacing in patients with chronic bifascicular and trifascicular block. This article also highlights the recent guidelines for temporary transvenous pacing in the setting of acute MI and the different pacing modalities that are available for an anesthesiologist.

  2. Non invasive monitoring in mechanically ventilated pediatric patients.

    Science.gov (United States)

    Al-Subu, Awni M; Rehder, Kyle J; Cheifetz, Ira M; Turner, David A

    2014-12-01

    Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy. PMID:25119483

  3. Assessing Depression in Cardiac Patients: What Measures Should Be Considered?

    Directory of Open Access Journals (Sweden)

    M. Ceccarini

    2014-01-01

    Full Text Available It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients’ wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS, the Cognitive Behavioural Assessment Hospital Form (CBA-H, the Beck Depression Inventory (BDI, the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9, the Depression Interview and Structured Hamilton (DISH, the Hamilton Rating Scale for Depression (HAM-D/HRSD, and the Composite International Diagnostic Interview (CIDI. Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

  4. Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

    Directory of Open Access Journals (Sweden)

    Grace Sherry L

    2012-08-01

    Full Text Available Abstract Background In 2006, the Canadian Cardiovascular Society (CCS Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR. The objectives of the current study were to: (1 describe cardiac patient perceptions of actual and ideal CR wait times, (2 describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3 investigate actual wait times and factors that CR programs perceive to affect these wait times. Methods Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. Results Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate, and 92 CR programs (61.7% response rate. Patients reported that their wait time from hospital discharge to CR initiation was 65.6 ± 88.4 days (median, 42 days, while their ideal median wait time was 28 days. Most patients (91.5% considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p  Conclusions Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time

  5. Anxious attachment and psychological distress in cardiac rehabilitation patients.

    Science.gov (United States)

    West, M; Sarah Rose, M; Brewis, C S

    1995-06-01

    This study investigated the relevance of anxious attachment to the differentiation of psychologically distressed and non-psychologically distressed cardiac patients. Attachment is a biologically based behavioral system in which proximity to a special other is sought or maintained to achieve a sense of safety and security. Anxious attachment, as the name denotes, fails to achieve the function of attachment in the sense of individuals having little or no confidence in the availability of their attachment figures. Empirically, three scales (feared loss of the attachment figure, proximity seeking and separation protest) capture the features of anxious attachment as elaborated by Bowlby. These scales were administered to 178 cardiac rehabilitation patients drawn from the cardiac rehabilitation program of the Calgary General Hospital. The results indicate that feared loss and proximity seeking differentiated psychologically distressed from non-psychologically distressed patients. The implications of this finding for the understanding of psychologically distressed cardiac patients are discussed.

  6. The Role of Imaging with Cardiac Computed Tomography in Cardio-Oncology Patients.

    Science.gov (United States)

    Pitekova, Barbora; Ravi, Sriram; Shah, Shimoli V; Mladosievicova, Beata; Heitner, Stephen; Ferencik, Maros

    2016-09-01

    Cardiovascular diseases and cancer represent the two most common causes of morbidity and mortality in industrialized countries. With the increase in long-term survival of cancer patients, cardiovascular diseases are the leading cause of mortality for many cancer survivors. In this article, we will review the most common cardiovascular toxicities of cancer therapies and will describe the role of cardiac CT in the detection and monitoring of cardiovascular disease. While there is limited evidence for the use of CT imaging in cancer patients, we will discuss the utility of cardiac CT in the detection and management of coronary artery disease, pericardial and valvular heart disease. PMID:27443383

  7. Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution

    DEFF Research Database (Denmark)

    Møller-Sørensen, H; Hansen, K L; Ostergaard, M;

    2012-01-01

    BACKGROUND: Minimally invasive monitoring systems of central haemodynamics are gaining increasing popularity. The present study investigated the precision of the endotracheal cardiac output monitor (ECOM) system and its agreement with pulmonary artery catheter thermodilution (PAC TD) for measuring...

  8. Combined Application of Circulatory Assist Devices Following Cardiac Arrest in Patients after Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    Huang Huanlei; Xiao Xuejun; Wu Ruobin; Ruixin; Cheng Anheng; Zhang Xiaohua; Luo Zhengxiang

    2006-01-01

    Objectives To evaluateretrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation (CPCR). Methods Assisted circulation devices,including emergency cardiopulmonary bypass (ECPB), intra-aortic balloon pump (IABP), and left ventricular assist device (LVAD), were applied to 16 adult patients who had cardiac arrest 82 min~56 h after open heart surgery and did not respond to 20 min or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB.Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3~49 months (mean =22 months). Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% (6/16) long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis,and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.

  9. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

    Directory of Open Access Journals (Sweden)

    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  10. Clinical significance of lactate in acute cardiac patients

    Institute of Scientific and Technical Information of China (English)

    Chiara; Lazzeri; Serafina; Valente; Marco; Chiostri; Gian; Franco; Gensini

    2015-01-01

    Lactate, as a metabolite of easy and quick assessment, has been studied over time in critically ill patients in order to evaluate its prognostic ability. The present review is focused on the prognostic role of lactate levels in acute cardiac patients(that is with acute coronary syndrome, cardiogenic shock, cardiac arrest, non including post cardiac surgery patients). In patients with STelevation myocardial infarction treated with mechanical revascularization, hyperlactatemia identified a subset of patients at higher risk for early death and in-hospital complications, being strictly related mainly to hemodynamic derangement. The prognostic impact of hyperlactatemia on mortality has been documented in patients with cardiogenic shock and in those with cardiac arrest even if there is no cut-off value of lactate to be associated with worse outcome or to guide resuscitation or hemodynamic management. Therapeutic hypothermia seems to affect per se lactate values which have been shown to progressively decrease during hypothermia. The mechanism(s) accounting for lactate levels during hypothemia seem to be multiple ranging from the metabolic effects of reduced temperatures to the hemodynamic effects of hypothermia(i.e., reduced need of vasopressor agents). Serial lactate measurements over time, or lactate clearance, have been reported to be clinically more reliable than lactate absolute value also in acute cardiac patients. Despite differences in study design, timing of lactate measurements and type of acute cardiac conditions(i.e., cardiogenic shock, cardiac arrest, refractory cardiac arrest), available evidence strongly suggests that higher lactate levels can be observed on admission in non-survivors and that higher lactate clearance is associated with better outcome.

  11. Remote Patient Monitoring System

    Directory of Open Access Journals (Sweden)

    Sherin Sebastian

    2012-10-01

    Full Text Available The Telemedicine system comprises of both hardware and software components at both the patient and doctor ends. A leading field for application of telemedicine is in the field of cardiology where ECG is the major tool for diagnosis. The proposed project in this paper provides an image based techniques to acquire and analyse a constant streaming of ECG signal through digital camera for image capturing, information extraction and analysis performed using MATLAB tools as well as data sending system based on internet network. The method captures the vital signs and parameters from the ICU monitoring machine using a webcam and transmits the image through the internet. This original image is then availed to the consulting doctor via an ANDROID cell phone. In case of anomaly a notification is send to the doctor’s phone. The paper proposes a method to capture, compare and generate alert regarding the patient’s condition using the heart rate and make the captured image be available to the physician.

  12. Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database

    DEFF Research Database (Denmark)

    Andersen, Peter Oluf; Maaløe, Rikke; Andersen, Henning Boje

    2010-01-01

    Background Critical incident reports can identify areas for improvement in resuscitation practice. The Danish Patient Safety Database is a mandatory reporting system and receives critical incident reports submitted by hospital personnel. The aim of this study is to identify, analyse and categorize...... critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Methods The search terms “cardiac arrest” and “resuscitation” were used to identify reports in the Danish Patient Safety Database. Identified critical incidents were then classified into categories. Results One...... (n = 14; 11%), insufficient monitoring (n = 14; 11%), and medication error (n = 8; 7%). Conclusion Critical incidents related to cardiac arrest occur due to logistical, technical, teamworking and knowledge problems. These findings should be considered when planning education and implementing...

  13. Prediction of cardiac risk in patients undergoing vascular surgery

    Energy Technology Data Exchange (ETDEWEB)

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  14. Characterization of Cardiac Patients Based on the Synergy Model

    Directory of Open Access Journals (Sweden)

    Tavangar

    2014-10-01

    Full Text Available Background Cardiac patients need comprehensive support due to the adverse effects of this disease on different aspects of their lives. Synergy intervention is a model that focuses on patients' requirements. Objectives This study aimed to determine the eightfold characteristic of cardiac patients based on the synergy model that represent their clinical requirements. Materials and Methods In this descriptive cross-sectional study, 40 cardiac patients hospitalized at the cardiac care unit (CCU of Yazd Afshar Hospital were randomly selected. The data were collected by using a two-part check-list including demographic characteristics and also by studying eight characteristics of patients through interviewing and reviewing their records. The results were analyzed using descriptive statistics such as frequency (percentage and analytical statistics such as Spearman and Mann-Whitney test with the SPSS software, version 18. Results The results showed that among patients' internal characteristics, reversibility (70.6%, vulnerability (68.6%, and predictability (80.4% at level 1 (the minimum score had the highest frequency and stability (49% and complexity (54.9% were at level 3 (average score. Among external characteristics participation in decision-making (80.4% at level 1 had the highest frequency while care (62.7% and recourses (98% were at level 3. Conclusions Ignoring any of the eightfold characteristics based on the synergy model interferes with comprehensive support of cardiac patients. Therefore, it is necessary for professional health practitioners, especially nurses, to consider patients' eightfold characteristics in order to provide quality care.

  15. Engineered hybrid cardiac patches with multifunctional electronics for online monitoring and regulation of tissue function

    Science.gov (United States)

    Feiner, Ron; Engel, Leeya; Fleischer, Sharon; Malki, Maayan; Gal, Idan; Shapira, Assaf; Shacham-Diamand, Yosi; Dvir, Tal

    2016-06-01

    In cardiac tissue engineering approaches to treat myocardial infarction, cardiac cells are seeded within three-dimensional porous scaffolds to create functional cardiac patches. However, current cardiac patches do not allow for online monitoring and reporting of engineered-tissue performance, and do not interfere to deliver signals for patch activation or to enable its integration with the host. Here, we report an engineered cardiac patch that integrates cardiac cells with flexible, freestanding electronics and a 3D nanocomposite scaffold. The patch exhibited robust electronic properties, enabling the recording of cellular electrical activities and the on-demand provision of electrical stimulation for synchronizing cell contraction. We also show that electroactive polymers containing biological factors can be deposited on designated electrodes to release drugs in the patch microenvironment on demand. We expect that the integration of complex electronics within cardiac patches will eventually provide therapeutic control and regulation of cardiac function.

  16. Cardiac Function in Patients with Early Cirrhosis during Maximal Beta-Adrenergic Drive

    DEFF Research Database (Denmark)

    Krag, Aleksander; Bendtsen, Flemming; Dahl, Emilie Kristine;

    2014-01-01

    BACKGROUND AND AIM: Cardiac dysfunction in patients with early cirrhosis is debated. We investigated potential cardiac dysfunction by assessing left ventricular systolic performance during a dobutamine stress test in patients with early cirrhosis. PATIENTS AND METHODS: Nineteen patients with Chil...

  17. Continuous versus bolus cardiac output monitoring during or thotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Fang-Ping Bao; Jian Wu

    2008-01-01

    BACKGROUND: Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac output (BCO) thermodilution agree sufifciently to be used interchangeably, and whether CCO monitoring is reliable for patients undergoing liver transplantation. METHODS:Thirteen patients undergoing liver transplan-tation without veno-venous bypass were studied (37-66 years old, weight 46-75 kg). Continuous and bolus thermodilution measurements were performed at predeifned time points using an "Opti-Q" SvO2/CCO monitor (Abbott Laboratories, North Chicago, IL, USA). Bias and 95% limits of agreement were calculated according to Bland and Altman analysis. The limits of agreement by which two methods are judged to be interchangeable were deifned in advance as ±(13%× BCOmean) L/min. The repeatability and relative error of CCO, and the differences between CCO and the mean of the two measurements were calculated. RESULTS:Cardiac output measurements yielded 196 data pairs with ranges of 1.9 to 17.9 L/min for CCO and 2.1 to 18.3 L/min for BCO. The response time of CCO was delayed in the early phases after caval clamping and after reperfusion. At most of the measurement points, bias and 95%limits of agreement were-0.18±1.91 L/min. 95%limits of agreement did not fall within the predetermined limits of agreement of ±1.14 L/min. The repeatability coefifcient of CCO was 0.36 L/min and the relative error was 4.6±4.7%. The mean difference between CCO and the average of the two methods was-0.09 L/min (0.49 L/min). CONCLUSIONS:In patients undergoing liver transplan-tation, the delayed response of CCO limits its application during the early phases after caval clamping and after reperfusion of the graft. The two methods are not interchangeable even in hemodynamic stability. Continuous thermodilution monitoring, however, is reliable or acceptable for clinical purposes.

  18. Autonomic Dysfunction Predicts Early Cardiac Affection in Patients with Systemic Sclerosis

    Directory of Open Access Journals (Sweden)

    Khaled M. Othman

    2010-05-01

    Full Text Available Objective: To detect the early preclinical alterations in cardiac autonomic control as well as altered cardiac function in systemic sclerosis (SSc patients and their relevance to the clinical features of the disease using noninvasive methods. Methods: 30 SSc patients and 15 healthy controls matched for age and sex underwent clinical examination, serological analysis, and echocardiographic assessment including Doppler flow imaging to evaluate cardiac function, and 24-hour Holter monitoring analyzed for arrhythmia and heart rate variability (HRV in the time and frequency domains. Results: The trans-mitral Doppler of early to atrial wave (E/A ratio was reversed in five patients (16.6% and the tricuspid E/A ratio was reversed in 10 patients (33.3%. Holter analysis for SSc patients revealed an increased prevalence of premature ventricular contractions (PVC $ 10/h (P = 0.02, supra-ventricular tachycardias (SVTs (P = 0.2, and total PVC count (P = 0.0000. Highly significant (P = 0.000 impairment in all HRV parameters was demonstrated in the SSc patients. Total skin thickness score (TSS, Raynaud’s phenomenon and anti-scleroderma 70 (anti-SCL70 showed significant positive correlations with all arrhythmia parameters, while showing a significant negative correlation with the impaired ventricular diastolic function and various HRV parameters. No correlation was found between arrhythmia and HRV parameters and disease duration, disease type, or presence of anti-centromere antibodies. Conclusion: Low heart rate variability, increased TSS and the presence of anti-SCL70 are correlated with preclinical cardiac involvement in SSc patients and may predict the likelihood of malignant arrhythmia and sudden cardiac death. Therefore, noninvasive HRV evaluation before clinical cardiac involvement in these patients might be beneficial when added to the clinical and laboratory assessments in detecting high-risk patients, and may allow for implementation of preventive

  19. Comparison of an advanced minimally invasive cardiac output monitoring with a continuous invasive cardiac output monitoring during lung transplantation.

    Science.gov (United States)

    Tomasi, Roland; Prueckner, Stephan; Czerner, Stephan; Schramm, Renè; Preissler, Gerhard; Zwißler, Bernhard; von Dossow-Hanfstingl, Vera

    2016-08-01

    The aim of this study was to compare a continuous non-calibrated left heart cardiac index (CI) measurement by arterial waveform analysis (FloTrac(®)/Vigileo(®)) with a continuous calibrated right heart CI measurement by pulmonary artery thermodilution (CCOmbo-PAC(®)/Vigilance II(®)) for hemodynamic monitoring during lung transplantation. CI was measured simultaneously by both techniques in 13 consecutive lung transplants (n = 4 single-lung transplants, n = 9 sequential double-lung transplants) at distinct time points perioperatively. Linear regression analysis and Bland-Altman analysis with percentage error calculation were used for statistical comparison of CI measurements by both techniques. In this study the FloTrac(®) system underestimated the CI in comparison with the continuous pulmonary arterial thermodilution (p waveform and continuous pulmonary artery thermodilution are, therefore, not interchangeable during these complex operations.

  20. Effect of Cardiac Rehabilitation in Patients with ICD

    DEFF Research Database (Denmark)

    Christensen, Anne Vinggaard; Zwisler, Ann-Dorthe; Svendsen, Jesper Hastrup;

    2015-01-01

    in physical component scale, mental component scale, social functioning, physical functioning, bodily pain, vitality, mental health, and QoL with men having higher scores. Among men only, significant differences were found in VO2 (rehabilitation: 20.9 mL/min/kg [standard deviation (SD) 8.1] vs 23.4 m......BACKGROUND: The COPE-ICD (Copenhagen Outpatient ProgrammE-implantable cardioverter defibrillator) trial studied comprehensive cardiac rehabilitation for patients with ICDs. The purpose of this paper was to explore: (1) gender differences in self-rated health and quality of life (QoL) at hospital...... discharge after ICD implantation, (2) gender differences in effect of cardiac rehabilitation, and (3) predictors of effect of cardiac rehabilitation. METHODS: Patients with first-time ICD implantation were randomized to comprehensive cardiac rehabilitation versus usual care. Gender differences in self...

  1. Effects of sedation with low-dosage dexmedetomidine on cardiac function in elderly surgical patients

    Directory of Open Access Journals (Sweden)

    Yu LANG

    2011-09-01

    Full Text Available Objective To investigate the influence of continuous infusion of low-dose dexmedetomidine(DEX for sedation on cardiac function index in elderly surgical patients,and assess the impacts on circulation.Methods Sixty elderly surgical patients were randomized into DEX group and control group(30 each.The sex ratio of the patients was 24/36(male/female,and age from 65 to 89 years.After the cannulation of left radial artery,the arterial pressure continuous cardiac output(APCO monitor(Edwards,USA was connected,and the cardiac function index was continuously monitored,including cardiac output index(CI,stroke volume index(SVI,heart rate(HR and mean arterial pressure(MAP.The patients in DEX group were infused with DEX at 0.4μg(kg·h for 10min following intrathecal anesthesia,then the infusion rate was adjusted from 0.2 to 0.4μg(kg·h to keep the bispectral index values(BIS maintained between 75 and 85.Normal saline was administered with an equal volume in control group.The MAP,HR,respiration rate(RR,pulse oxygen saturation(SpO2,the partial pressure of end-tidal carbon dioxide(PETCO2 and BIS were recorded immediately at the DEX infusion(T0,and 10min(T1,20min(T2,30min(T3,60min(T4 after DEX infusion,and the end of surgery(T5.All cardiac function data were statistically analyzed,and P 0.05.Conclusion The sedation with continuous infusion of small-dosage DEX during intrathecal anesthesia in elderly surgical patients may have little impact on cardiac function index,but the conclusion remains to be verified with large sample and multicenter research.

  2. Cardiac troponin T mutations in Chinese patients with hypertrophic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    吴恒芳; 杨笛; 万文辉; 卞智萍; 徐晋丹; 马文珠; 张寄南

    2004-01-01

    @@ Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by unexplained ventricular hypertrophy and myofibrillar disarray, with a prevalence of about 0.2% in general population. HCM is associated with gene abnormalities. Nearly 200 mutations have been described in ten genes in patients with HCM.1 Cardiac troponin T (cTnT) is an essential component of the troponin complex and plays a central role in the calcium regulation of contractions in cardiac myocytes

  3. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt-Johansen, Ida Maria; Norsted, Kristine; Schmidt, Henrik;

    2015-01-01

    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors...

  4. Collaborative Cardiac Care Service: A Multidisciplinary Approach to Caring for Patients with Coronary Artery Disease

    Science.gov (United States)

    Sandhoff, Brian G; Kuca, Susan; Rasmussen, Jon; Merenich, John A

    2008-01-01

    Background: Coronary artery disease (CAD) remains the leading cause of death in the US. In 1996, Kaiser Permanente of Colorado (KPCO) developed the Collaborative Cardiac Care Service (CCCS) with the goal of improving the health of patients with CAD. Description: CCCS consists of a nursing team (the KP Cardiac Rehabilitation program) and a pharmacy team (the Clinical Pharmacy Cardiac Risk Service). CCCS works collaboratively with patients, primary care physicians, cardiologists, and other health care professionals to coordinate proven cardiac risk reduction strategies for patients with CAD. Activities such as lifestyle modification, medication initiation and adjustment, patient education, laboratory monitoring, and management of adverse events are all coordinated through CCCS. The CCCS uses an electronic medical record and patient-tracking software to document all interactions with patients, track patient appointments, and collect data for evaluation of both short- and long-term outcomes. Outcomes: The CCCS currently follows over 12,000 patients with CAD. The CCCS has demonstrated improvement in surrogate outcomes including: cholesterol screening (55% to 96.3%), the proportion of patients with a goal of low-density lipoprotein cholesterol (LDL-c) <100 mg/dL (22% to 76.9%), and has reduced the average LDL-c to 78.3 mg/dL for the CAD population it follows. The CCCS has shown a reduction in all-cause mortality associated with CAD by 76% in the patients followed by the service. Patient and physician satisfaction have been high with CCCS. Conclusion: The CCCS coordinates many aspects of cardiac risk reduction care resulting in excellent continuity of care. The CCCS has continued to grow and expand the number of patients enrolled by using innovative strategies and technology and has resulted in excellent care and improved outcomes of the CAD population at KPCO. PMID:21331203

  5. Milrinone for cardiac dysfunction in critically ill adult patients

    DEFF Research Database (Denmark)

    Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn;

    2016-01-01

    review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias...... analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. DISCUSSION: The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks...

  6. Subclinical atrial fibrillation and stroke: insights from continuous monitoring by implanted cardiac electronic devices.

    Science.gov (United States)

    Lau, Chu-Pak; Siu, Chung-Wah; Yiu, Kai-Hang; Lee, Kathy Lai-Fun; Chan, Yap-Hang; Tse, Hung-Fat

    2015-10-01

    Nearly one out of five strokes is associated with atrial fibrillation (AF). Atrial fibrillation is often intermittent and asymptomatic. Detection of AF after cryptogenic stroke will likely change therapy from antiplatelet to oral anticoagulation agents for secondary stroke prevention. A critical step is to convert 'covert' AF into electrocardiogram documented AF. External rhythm recording devices have registered a high incidence of AF to occur after a cryptogenic stroke, but are limited by short duration of continuous recordings. Invasive cardiac monitoring using insertable leadless cardiac monitors are sensitive means to identify subclinical AF (SCAF) after cryptogenic stroke, and AF has been reported to occur in 8.9% of these patients by 6 months in one study. It will be more attractive to identify SCAF before a stroke occurs. Recent series in pacemaker and implantable cardioverter-defibrillator (ICD) recipients showed that short episodes of SCAF increased stroke risk, with odds ratio ∼2.2-3.1 compared with those without SCAF recorded. However, temporal sequence of recorded SCAF and stroke occurrence was uncertain, and the overall stroke risk was lower compared with patients with clinical AF at similar risk scores. This article reviews the incidence and clinical role of using implanted devices to detect SCAF and discusses the implication of SCAF so detected in primary and secondary stroke prevention. PMID:26842114

  7. Medical applications of shortwave FM radar: Remote monitoring of cardiac and respiratory motion

    Science.gov (United States)

    Mostov, K.; Liptsen, E.; Boutchko, R.

    2010-01-01

    Purpose: This article introduces the use of low power continuous wave frequency modulated radar for medical applications, specifically for remote monitoring of vital signs in patients. Methods: Gigahertz frequency radar measures the electromagnetic wave signal reflected from the surface of a human body and from tissue boundaries. Time series analysis of the measured signal provides simultaneous information on range, size, and reflective properties of multiple targets in the field of view of the radar. This information is used to extract the respiratory and cardiac rates of the patient in real time. Results: The results from several preliminary human subject experiments are provided. The heart and respiration rate frequencies extracted from the radar signal match those measured independently for all the experiments, including a case when additional targets are simultaneously resolved in the field of view and a case when only the patient’s extremity is visible to the radar antennas. Conclusions: Micropower continuous wave FM radar is a reliable, robust, inexpensive, and harmless tool for real-time monitoring of the cardiac and respiratory rates. Additionally, it opens a range of new and exciting opportunities in diagnostic and critical care medicine. Differences between the presented approach and other types of radars used for biomedical applications are discussed. PMID:20384270

  8. Implanted near-infrared spectroscopy for cardiac monitoring

    Science.gov (United States)

    Bhunia, Sourav K.; Cinbis, Can

    2011-02-01

    Implanted Cardioverter Defibrillator (ICD) provides one of the most effective therapies for the prevention of sudden cardiac death, but also delivers some high voltage shocks inappropriately, causing morbidity and mortality. Implanted near-infrared spectroscopy (NIRS) may augment ICD arrhythmia detection by monitoring skeletal muscle perfusion. A two-wavelength, single-distance, continuous-wave implanted NIRS has been evaluated in-vivo. A weighted difference of the changes in attenuation at two wavelengths, across the isobestic point of the hemoglobin spectra, was taken to be the microvascular oxygenation trend indicator (O2 Index). Although the exact weight depends on the local vascular distribution and their oxygen levels, the hypothesis that a constant weight may be adequate for hemodynamic trending during short arrhythmic episodes, was tested. The sensor was implanted subcutaneously both on fresh tissue and inside scar tissue that formed around a pre-existing implant, in 3 animals each. Attenuations were recorded at 660 and 890 nm during normal sinus rhythm (NSR) and induced ventricular fibrillation (VF). The slope of the O2 Index over 10 seconds was computed for 7 NSR and 8 VF episodes in fresh and 13 NSR and 15 VF episodes in scar tissue pockets. The mean O2 Index slope was significantly different (pdetection of VF during electromagnetic interference, double counting of ECG T-wave as an R-wave, ICD lead failure, electrocardiographic aberrancy etc.

  9. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography.

    LENUS (Irish Health Repository)

    Weisz, Dany E

    2012-01-01

    Non-invasive cardiac output monitoring is a potentially useful clinical tool in the neonatal setting. Our aim was to evaluate a new method of non-invasive continuous cardiac output (CO) measurement (NICOM™) based on the principle of bioreactance in neonates.

  10. [Perioperative management of patients equipped with cardiac implanted electronic devices].

    Science.gov (United States)

    Booke, Michael; Casu, Sebastian

    2016-04-01

    Anaesthetists are in increasing frequency confronted with patients equipped with cardiac implantable electrical devices. A consensus conference standardized the handling of such patients for elective cases. However, this multidisciplinary approach is characterized by a complexity, which is hard to handle in emergency cases and even in nowadays clinical routine. However, risks associated with electrocautery or electromagnetic interference can be easily handled applying a significantly easier approach. Telemetric reprogramming and/or postoperative interrogation of the cardiac implanted eletronical device can be avoided in most cases. PMID:27070514

  11. The cardiac phenotype in patients with a CHD7 mutation

    DEFF Research Database (Denmark)

    Corsten-Janssen, Nicole; Kerstjens-Frederikse, Wilhelmina S; du Marchie Sarvaas, Gideon J;

    2013-01-01

    Loss-of-function mutations in CHD7 cause Coloboma, Heart Disease, Atresia of Choanae, Retardation of Growth and/or Development, Genital Hypoplasia, and Ear Abnormalities With or Without Deafness (CHARGE) syndrome, a variable combination of multiple congenital malformations including heart defects....... Heart defects are reported in 70% to 92% of patients with a CHD7 mutation, but most studies are small and do not provide a detailed classification of the defects. We present the first, detailed, descriptive study on the cardiac phenotype of 299 patients with a CHD7 mutation and discuss the role of CHD7...... in cardiac development....

  12. Non-cardiac issues in patients with heterotaxy syndrome

    Directory of Open Access Journals (Sweden)

    Shyam S Kothari

    2014-01-01

    Full Text Available Management of complex congenital heart disease in patients with Heterotaxy syndrome (HS has steadily improved. However, there is an insufficient appreciation of various non-cardiac issues that might impact the overall status of these patients. This article briefly reviews the implications of gastrointestinal, immunologic, genitourinary, respiratory, and central nervous system involvement in HS patients with a view to aid in their comprehensive clinical management.

  13. Management of Infection in the Post-Cardiac-Transplant Patient

    OpenAIRE

    Zeluff, Barry; Gentry, Layne O.

    1987-01-01

    In reviewing our post-transplant experience with infection in 192 cardiac transplant patients, * we have noticed a pattern. During the first month following transplantation, the patient seldom has an opportunistic infection, but is in danger of nosocomial infection (84 episodes in 57 patients). These include wound infection, and infections of the lungs, blood, and urinary tract. After the first month, and for the duration of the first year following transplantation, nosocomial infections beco...

  14. Medanta insulin protocols in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2014-01-01

    Full Text Available Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient′s estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification.

  15. Sudden chest pain and cardiac emergencies in the obstetric patient.

    Science.gov (United States)

    Mabie, W C; Freire, C M

    1995-03-01

    The differential diagnosis and work-up of a patient with chest pain during pregnancy is presented in this article. This is followed by discussions of cardiac emergencies including hypertensive crisis, pulmonary edema, arrhythmias, cardiopulmonary resuscitation, myocardial infarction, and aortic dissection. PMID:7784039

  16. Uncalibrated pulse power analysis fails to reliably measure cardiac output in patients undergoing coronary artery bypass surgery

    OpenAIRE

    Broch, Ole; Renner, Jochen; Höcker, Jan; Gruenewald, Matthias; Meybohm, Patrick; Schöttler, Jan; Steinfath, Markus; Bein, Berthold

    2011-01-01

    Introduction Uncalibrated arterial pulse power analysis has been recently introduced for continuous monitoring of cardiac index (CI). The aim of the present study was to compare the accuracy of arterial pulse power analysis with intermittent transpulmonary thermodilution (TPTD) before and after cardiopulmonary bypass (CPB). Methods Forty-two patients scheduled for elective coronary surgery were studied after induction of anaesthesia, before and after CPB respectively. Each patient was monitor...

  17. Perioperative management of pediatric patients on mechanical cardiac support.

    Science.gov (United States)

    Mossad, Emad B; Motta, Pablo; Rossano, Joseph; Hale, Brittani; Morales, David L

    2011-05-01

    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support. PMID:21332879

  18. Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

    Science.gov (United States)

    Osaka, Shunji; Yaoita, Hiroko; Ishii, Yusuke; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi

    2016-01-01

    Purpose: Recently, performance of cardiac surgery in hemodialysis patients has increased, but the mortality rate is high. Methods: We retrospectively examined the early and long-term outcomes in 128 dialysis patients who underwent cardiac surgery with or without carperitide infusion and were followed for 2 years. Sixty-three patients received carperitide infusion during surgery and 65 patients did not. Results: The hospital mortality rate was 1.6% in the carperitide group and 12.3% in the non-carperitide group, being significantly lower in the carperitide group. The 2-year actuarial survival rate was 90.5% ± 3.7% in the carperitide group, and 76.9% ± 5.2% in the non-carperitide group, while the major adverse cardiovascular and cerebrovascular events (MACCE)-free rate at 2 years postoperatively was 90.5% ± 3.7% in the carperitide group and 67.7% ± 5.8% in the non-carperitide group. Conclusions: These findings suggest that carperitide improves the early postoperative outcome in dialysis patients undergoing cardiac surgery, as has already been demonstrated in non-dialysis patients. An early postoperative cardioprotective effect of carperitide and improvement of renal function in oliguric patients might have contributed to this outcome. However, this was a retrospective study, so a prospective investigation is required to demonstrate the mechanisms involved. In addition, further evaluation of the long-term results would be desirable. PMID:27025780

  19. Serum Biomarkers for the Detection of Cardiac Toxicity after Chemotherapy and Radiation Therapy in Breast Cancer Patients

    Directory of Open Access Journals (Sweden)

    Sibo eTian

    2014-10-01

    Full Text Available Multi-modality cancer treatments that include chemotherapy, radiation therapy, and targeted agents are highly effective therapies. Their use, especially in combination, is limited by the risk of significant cardiac toxicity. The current paradigm for minimizing cardiac morbidity, based on serial cardiac function monitoring, is suboptimal. An alternative approach based on biomarker testing, has emerged as a promising adjunct and a potential substitute to routine echocardiography. Biomarkers, most prominently cardiac troponins and natriuretic peptides, have been evaluated for their ability to describe the risk of potential cardiac dysfunction in clinically asymptomatic patients. Early rises in cardiac troponin concentrations have consistently predicted the risk and severity of significant cardiac events in patients treated with anthracycline-based chemotherapy. Biomarkers represent a novel, efficient, and robust clinical decision tool for the management of cancer therapy-induced cardiotoxicity. This article aims to review the clinical evidence that supports the use of established biomarkers such as cardiac troponins and natriuretic peptides, as well as emerging data on proposed biomarkers.

  20. Monitoring the microcirculation in critically ill patients.

    Science.gov (United States)

    De Backer, Daniel; Durand, Arthur

    2014-12-01

    Alterations in microvascular perfusion have been identified in critically ill patients, especially in sepsis but also in cardiogenic shock, after cardiac arrest, and in high-risk surgery patients. These alterations seem to be implicated in the development of organ dysfunction and are associated with outcome. Even though microvascular perfusion can sometimes be homogenously decreased as in acute hemorrhage or in non-resuscitated cardiogenic shock, heterogeneity of perfusion is observed in sepsis and in resuscitated hemorrhagic/cardiogenic shock. Heterogeneity of perfusion has major implications for monitoring, as many techniques cannot detect microcirculatory alterations when heterogeneity of flow is present in significant amount. Indeed, devices such as laser Doppler or O2 electrodes and near-infrared spectroscopy have a relatively large sampling volume and measurements are affected by the highest values in the field. Using these techniques during a vascular occlusion test may help to characterize microvascular reactivity; however, microvascular reactivity sometimes fails to represent actual microvascular perfusion. Videomicroscopic techniques can nowadays be applied at bedside but are still restricted to some selected patients (quiet or sedated patients). Tissue PCO2 is an elegant alternative but is not yet broadly used. In this manuscript, we discuss the main advantages and limitations of the techniques available for bedside evaluation of the microcirculation in critically ill patients. PMID:25480773

  1. Management of Pregnancy in the Post-Cardiac Transplant Patient

    OpenAIRE

    Abdalla, Marwah; Mancini, Donna M.

    2014-01-01

    Over the past 10 years, heart transplantation survival has increased among transplant recipients. Because of improved outcomes in both congenital and adult transplant recipients, the number of male and female patients of childbearing age who desire pregnancy has also increased within this population. While there have been many successful pregnancies in post-cardiac transplant patients reported in the literature, long-term outcome data is limited. Decisions regarding the optimal timing and man...

  2. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    OpenAIRE

    Laura Crăciun; Claudiu Avram; Adina Avram; Stela Iurciuc; Dan Gaiţă

    2009-01-01

    Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG). Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-). Result:The p...

  3. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    OpenAIRE

    Hann Christopher E; Chase J; Sundaresan Ashwath; Shaw Geoffrey M

    2010-01-01

    Abstract The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines...

  4. Data analysis on patient exposures in cardiac angiography

    Energy Technology Data Exchange (ETDEWEB)

    Huyskens, C.J.; Hummel, W.A. [Eindhoven University of Technology (Netherlands). Radiation Protection Dept.

    1995-12-31

    In cardiac interventional radiology the fluoroscopy time and the film length are dominating factors for the resulting exposure of patients. From experiments in laboratory conditions and from measurements in actual practice an empirical formula has been derived to calculate the kerma-exposure product as a function of fluoroscopy time and film length. to simulate actual medical practice as closely as possible during the experiments, reference procedures were composed for fluoroscopy and cine-angiography. Over a period of two years, data on fluoroscopy time and cine film length were collected in the clinical practice of a large cardiology department in a major hospital in the Netherlands. The data refer to nearly 3000 cardiac intervention procedures, 50/50 divided between cardio-angiography (CAG) and percutaneous transluminal coronary angiography (PTCA). The mean value for the kerma-area product over all cardiac procedures is approx. 40 Gy cm{sup 2}. The relative standard deviation is 60%. From the distribution measured, it follows that about 20 % of all cardiac procedures account for approximately half the collective dose for patients. The empirically derived fit-function to calculate the kerma-area product provides a useful method to analyse patient exposures in interventional radiology as an aid in the context of quality assurance of medical practice and ALARA programmes in radiological protection. (Author).

  5. Radiofrequency and microwave tumor ablation in patients with implanted cardiac devices: Is it safe?

    Energy Technology Data Exchange (ETDEWEB)

    Skonieczki, Brendan D., E-mail: bskonieczki@lifespan.org [Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (United States); Wells, Catherine, E-mail: cwells1@bidmc.harvard.edu [Department of Radiology, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 (United States); Wasser, Elliot J., E-mail: ewasser@lifespan.org [Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (United States); Dupuy, Damian E., E-mail: ddupuy@lifespan.org [Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (United States)

    2011-09-15

    Purpose: To identify malfunction of implanted cardiac devices during or after thermal ablation of tumors in lung, kidney, liver or bone, using radiofrequency (RF) or microwave (MW) energy. Materials and methods: After providing written consent, 19 patients (15 men and 4 women; mean age 78 years) with pacemakers or pacemaker/defibrillators underwent 22 CT image-guided percutaneous RF or MW ablation of a variety of tumors. Before and after each procedure, cardiac devices were interrogated and reprogrammed by a trained cardiac electrophysiology fellow. Possible pacer malfunctions included abnormalities on electrocardiographic (EKG) monitoring and alterations in device settings. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. Informed consent for participation in this retrospective study was deemed unnecessary by our review board. Results: During 20 of 22 sessions, no abnormalities were identified in continuous, EKG tracings or pacemaker functions. However, in two sessions significant changes, occurred in pacemaker parameters: inhibition of pacing during RF application in one, session and resetting of mode by RF energy in another session. These changes did not, result in hemodynamic instability of either patient. MW ablation was not associated with, any malfunction. In all 22 sessions, pacemakers were undamaged and successfully reset to original parameters. Conclusion: RF or MW ablation of tumors in liver, kidney, bone and lung can be performed safely in patients with permanent intra-cardiac devices, but careful planning between radiology and cardiology is essential to avoid adverse outcomes.

  6. Cardiac evaluation in pediatric patients waiting for liver transplantation

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  7. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine.

    Science.gov (United States)

    Saugel, B; Cecconi, M; Wagner, J Y; Reuter, D A

    2015-04-01

    The determination of blood flow, i.e. cardiac output, is an integral part of haemodynamic monitoring. This is a review on noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. We present the underlying principles and validation data of the following technologies: thoracic electrical bioimpedance, thoracic bioreactance, vascular unloading technique, pulse wave transit time, and radial artery applanation tonometry. According to clinical studies, these technologies are capable of providing cardiac output readings noninvasively and continuously. They, therefore, might prove to be innovative tools for the assessment of advanced haemodynamic variables at the bedside. However, for most technologies there are conflicting data regarding the measurement performance in comparison with reference methods for cardiac output assessment. In addition, each of the reviewed technology has its own limitations regarding applicability in the clinical setting. In validation studies comparing cardiac output measurements using these noninvasive technologies in comparison with a criterion standard method, it is crucial to correctly apply statistical methods for the assessment of a technology's accuracy, precision, and trending capability. Uniform definitions for 'clinically acceptable agreement' between innovative noninvasive cardiac output monitoring systems and criterion standard methods are currently missing. Further research must aim to further develop the different technologies for noninvasive continuous cardiac output determination with regard to signal recording, signal processing, and clinical applicability. PMID:25596280

  8. Cardiac arrhythmias in adult patients with asthma

    DEFF Research Database (Denmark)

    Warnier, Miriam J; Rutten, Frans H; Kors, Jan A;

    2012-01-01

    and electrocardiographic characteristics of arrhythmogenicity (ECG) and to explore the role of β2-mimetics. METHODS: A cross-sectional study was conducted among 158 adult patients with a diagnosis of asthma and 6303 participants without asthma from the cohort of the Utrecht Health Project-an ongoing, longitudinal, primary...... more common (OR: 12.4 [95% CI: 4.7-32.8] and 3.7 [95% CI: 1.3-10.5], respectively). CONCLUSIONS: The adult patients with asthma more commonly show tachycardia and PVCs on the ECG than those without asthma. The patients with asthma received β2-mimetics; the risk of tachycardia and PVCs is even more...

  9. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    Directory of Open Access Journals (Sweden)

    Laura Crăciun

    2009-06-01

    Full Text Available Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG. Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-. Result:The prevelence of cardiovascular risk factors was about 76%, with an increased significance in CRP- group (p0.05, OR>1. Conclusion: At 16 months after revascularisation, the patientsstill present a high risk. The level of cardio-metabolic and hemodynamic risk are maintained the same by unreaching thetargeted values recomended by ESC prevention guideline. The patients in CPR+ group had a significant improvement ofcardiovascular risk factors. Indication but also compliance to structured cardiac rehabilitation programme after myocardialrevascularisation remains at a suboptimal level.

  10. Detection of ROSC in Patients with Cardiac Arrest During Chest Compression Using NIRS: A Pilot Study.

    Science.gov (United States)

    Yagi, Tsukasa; Nagao, Ken; Kawamorita, Tsuyoshi; Soga, Taketomo; Ishii, Mitsuru; Chiba, Nobutaka; Watanabe, Kazuhiro; Tani, Shigemasa; Yoshino, Atsuo; Hirayama, Atsushi; Sakatani, Kaoru

    2016-01-01

    Return of spontaneous circulation (ROSC) during chest compression is generally detected by arterial pulse palpation and end-tidal CO2 monitoring; however, it is necessary to stop chest compression during pulse palpation, and to perform endotracheal intubation for monitoring end-tidal CO2. In the present study, we evaluated whether near-infrared spectroscopy (NIRS) allows the detection of ROSC during chest compression without interruption. We monitored cerebral blood oxygenation in 19 patients with cardiac arrest using NIRS (NIRO-200NX, Hamamatsu Photonics, Japan). On arrival at the emergency room, the attending physicians immediately assessed whether a patient was eligible for this study after conventional advanced life support (ALS) and employed NIRS to measure cerebral blood oxygenation (CBO) in the bilateral frontal lobe in patients. We found cerebral blood flow waveforms in synchrony with chest compressions in all patients. In addition, we observed abrupt increases of oxy-hemoglobin concentration and tissue oxygen index (TOI), which were associated with ROSC detected by pulse palpation. The present findings indicate that NIRS can be used to assess the quality of chest compression in patients with cardiac arrest as demonstrated by the detection of synchronous waveforms during cardiopulmonary resuscitation (CPR). NIRS appears to be applicable for detection of ROSC without interruption of chest compression and without endotracheal intubation. PMID:26782207

  11. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  12. Microbial air monitoring in the operating theatres of Salam Center for Cardiac Surgery in Khartoum (Sudan

    Directory of Open Access Journals (Sweden)

    Margherita Scapaticci

    2012-06-01

    Full Text Available The seriousness of postoperative infections and the increased susceptibility of patients undergoing cardiac surgery increase the demand for the operating theatre (OT asepsis to prevent bacterial infections. In fact, the organisms carried by the air reach the wound after having sedimented onto sterile field. The air represents a critical point for quality control of air filtration systems, for sanitization procedures and for the evolution of hygienic features of the OT environment.Aim of the study is to evaluate the prevalence of microorganisms found in the operating rooms (OR air monitoring in the Salam Center for Cardiac Surgery of Khartoum (Sudan between July 2008 and March 2009.The specimens were collected every month in two different times: “OR at rest” (after sanitization and “OR operational”, using sedimentation method (Fisher 1972. Results showed that each sample collected at rest had IMA (index of microbial air contamination < 5CFU/plt, whereas the bacterial growth was between 25 and 50 CFU/plt when the samples had been collected in the same places during operating activities.This indicate the effectiveness of sanitization procedures and confirm that people working in OT are an important source of bacteria causing postoperative infections. Coagulase negative Staphylococci, Gram negative bacillus and Staphylococcus aureus spp. were the predominant organisms isolated.

  13. Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

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    Youming Long

    2014-01-01

    Full Text Available Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9% patients were women. Fifteen (55.6% patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2, moyamoya disease (n = 1, and neuromyelitis optica (n = 1. We found positive associations between mRS (>3 and female gender (r = 0.873, P10 × 109/L (r = 0.722, P = 0.002, tumour size (r = 0.866, P0.05. Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis.

  14. Cardiac changes in hospitalized patients of trauma.

    Science.gov (United States)

    Gawande, Ninad B; Tumram, Nilesh Keshav; Dongre, Anand Paikuji

    2014-09-01

    Modern clinical management of the patients sustaining traumatic injuries and thermal burns has resulted in their longer survival, but the clinical and pathological effects of these traumatic injuries over the myocardium have been largely neglected. It is speculated that certain factors such as the inflammatory and degenerative lesions of the heart, prolonged clinical course, and the subsequent stress and strain may play role in hastening the death. In the present study, 125 hospitalized cases of traumatic injuries and thermal burns brought for medicolegal autopsy were examined, with the purpose to find out the incidence, its significance, and the extent of the myocardial lesions due to stress and strain following trauma. About 20% patients had myocardial lesions recognized at gross and histological examination at autopsy. A myocardial lesion does develop in the cases of traumatic injuries and thermal burns. No significant sex difference is seen in the cases showing positive myocardial lesions. However, a relationship exists between these myocardial lesions and the after-effects developing in the cases of trauma. These myocardial lesions seen in the cases of traumatic injuries can be termed as early ischemic or anoxic lesions in the absence of any specific coronary pathology. The intensity of myocardial lesions increases with increase in the survival period of the patient. The findings in the study support the concept of human stress cardiomyopathy and demonstrate the potential significance of stress in precipitating death.

  15. Detection of atrial fibrillation with concurrent holter monitoring and continuous cardiac telemetry following ischemic stroke and transient ischemic attack.

    Science.gov (United States)

    Lazzaro, Marc A; Krishnan, Kousik; Prabhakaran, Shyam

    2012-02-01

    Atrial fibrillation (AF) is a major risk factor for recurrent ischemic stroke. We aimed to compare the detection rate of AF using continuous cardiac telemetry (CCT) versus Holter monitoring in hospitalized patients with ischemic stroke or transient ischemic attack (TIA). Between June 2007 and December 2008, 133 patients were admitted to an academic institution for ischemic stroke or TIA and underwent concurrent inpatient CCT and Holter monitoring. Rates of AF detection by CCT and Holter monitoring were compared using the McNemar paired proportion test. Among the 133 patients, 8 (6.0%) were diagnosed with new-onset AF. On average, Holter monitoring was performed for 29.8 hours, and CCT was performed for 73.6 hours. The overall rate of AF detection was higher for Holter monitoring compared with CCT (6.0%; 95% confidence interval [CI], 2.9-11.6 vs 0; 95% CI, 0-3.4; P = .008). Holter detection of AF was even higher in specific subgroups (those with an embolic infarct pattern, those age >65 years, and those with coronary artery disease). Holter monitoring detected AF in 6% of hospitalized ischemic stroke and TIA patients, with higher proportions in high-risk subgroups. Compared with CCT, Holter monitoring is significantly more likely to detect arrhythmias.

  16. Endothelial Function as a Possible Significant Determinant of Cardiac Function during Exercise in Patients with Structural Heart Disease

    Directory of Open Access Journals (Sweden)

    Bonpei Takase

    2009-01-01

    Full Text Available This study was investigated the role that endothelial function and systemic vascular resistance (SVR play in determining cardiac function reserve during exercise by a new ambulatory radionuclide monitoring system (VEST in patients with heart disease. The study population consisted of 32 patients. The patients had cardiopulmonary stress testing using the treadmill Ramp protocol and the VEST. The anaerobic threshold (AT was autodetermined using the V-slope method. The SVR was calculated by determining the mean blood pressure/cardiac output. Flow-mediated vasodilation (FMD was measured in the brachial artery to evaluate endotheilial function. FMD and the percent change f'rom rest to AT in SVR correlated with those from rest to AT in ejection fraction and peak ejection ratio by VEST, respectively. Our findings suggest that FMD in the brachial artery and the SVR determined by VEST in patients with heart disease can possibly reflect cardiac function reserve during aerobic exercise.

  17. Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus.

    Science.gov (United States)

    Zhang, Junlong; Tu, Weifeng; Dai, Jianqiang; Lv, Qing; Yang, Xiaoqi

    2011-01-01

    The pre- and post-operative cardiac autonomic nervous functions were compared in elderly, non-cardiac surgery patients with diabetes mellitus (DM) and without diabetes mellitus (NDM). A group of 30 unpremedicated elderly patients scheduled to undergo elective non-cardiac surgery were studied, including 15 DM patients and 15 NDM patients. Each component of heart rate variability (HRV) analysis in the frequency domain was monitored with Holter during the nights of the day before and on 1st and 2nd day after operation. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) significantly decreased as compared to the baseline values before operation in both groups (p<0.05). The LF/HF ratio was significantly changed in DM group but did not change in NDM group. On the 2nd postoperative day, TP, HF, LF and VLF in DM group were further decreased as compared to those on the 1st postoperative day and were significantly lower than those in NDM group (p<0.01 or 0.05), but these indices in NDM group did not show significant decreases. Surgery induced the cardiac autonomic nervous dysfunction in elderly patients not only with DM but also without diabetes. On the 2nd postoperative day, the disturbances of cardiac autonomic nervous activity were more sever in DM patients, compared to the 1st postoperative day, but was not significantly more sever than in the NDM patients.

  18. Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?

    Science.gov (United States)

    Oei, Elizabeth; Paudel, Klara; Visser, Annemarie; Finney, Hazel; Fan, Stanley L

    2016-01-01

    AIM To study the relationship between overhydration (OH) in peritoneal dialysis (PD) patients and cardiac mortality. METHODS OH, as measured by body composition monitor (BCM), is associated with increased mortality in dialysis patients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mortality, and if there was a correlation between OH and cardiac troponin-T (cTnT) levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH (> +2L). The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0. RESULTS There were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage (10.3 mo vs 37.0 mo, P < 0.0001) and were significantly more overhydrated by BCM measurement (2.95 L vs 1.35 L, P < 0.05). The mean (standard error of the means) hydration status of the 336 patients was +1.15 (0.12) L and the median [interquartile range (IQR)] cTnT level was 43.5 (20-90) ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log (cTnT) with the OH value (Spearman r value 0.425, P < 0.0001). We identified a sub-group of patients that were severely overhydrated

  19. Overhydration, cardiac function and survival in hemodialysis patients

    OpenAIRE

    Mihai Onofriescu; Dimitrie Siriopol; Luminita Voroneanu; Simona Hogas; Ionut Nistor; Mugurel Apetrii; Laura Florea; Gabriel Veisa; Irina Mititiuc; Mehmet Kanbay; Radu Sascau; Adrian Covic

    2015-01-01

    RESEARCH ARTICLE Overhydration, Cardiac Function and Survival in Hemodialysis Patients Mihai Onofriescu1☯, Dimitrie Siriopol1☯, Luminita Voroneanu1, Simona Hogas1, Ionut Nistor1, Mugurel Apetrii1, Laura Florea1, Gabriel Veisa1, Irina Mititiuc1, Mehmet Kanbay3, Radu Sascau2, Adrian Covic1* 1 Department of Nephrology, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania, 2 Department of Cardiology, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania...

  20. Anxiety, Depression and Psychosocial Stress in Patients with Cardiac Events

    OpenAIRE

    Michael, Anne John; Krishnaswamy, Saroja; Muthusamy, Tamil Selvan; Yusuf, Khalid; Mohamed, Jamaludin

    2005-01-01

    Stress tends to worsen the prognosis of patients with coronary heart disease. The aim of the study is to determine the relationship between stress related psychosocial factors like anxiety, depression and life events and temporally cardiac events specified as acute myocardial infarction and unstable angina 65 subjects with confirmed myocardial infarction or unstable angina were interviewed using 2 sets of questionnaire, the Hospital Anxiety and Depression Scale (HADS) and Life Changes Stress ...

  1. Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Norsk, Peter;

    2009-01-01

    and prolonged by 40 ms in 27 CRT patients and 9 controls without heart failure. Cardiac output (CO) was measured by inert gas rebreathing (Innocor) as the average over different body positions (left-lateral, supine, sitting, standing, and exercise). In eight CRT patients with an implantable haemodynamic monitor......, the estimated pulmonary artery diastolic pressure (ePAD) was analysed. RESULTS: The magnitude of CO response to AVD changes was greater in CRT patients than in controls (0.25 vs. 0.20 L/min, P

  2. Nursing care to patients with PiCCO monitoring

    Directory of Open Access Journals (Sweden)

    Ramona Rodríguez Flores

    2009-03-01

    Full Text Available The monitoring of physiological parameters turns out to be indispensable to obtain a treatment directed therapeutic in critical patients.In the Units of Intensive care it is in the habit of being frequent to meet complex systems of monitoring homodynamic, since they are the Catheter of Pulmonary Artery (CAP or of Swan-Ganz and the system of monitoring PiCCO (In English, Pulse-Induced Contour Cardiac Output, to measure the Cardiac Output for analysis of the curve of the arterial pulse.These systems are of necessary in patients with great instability homodynamic, septic shock, injury or pulmonary hurt and organic hurt.The lens of this work, it is to announce the system of monitoring PiCCO since it is a relatively new system and allows measuring parameters that do not decide with the catheter Swan-Ganz, besides other advantages. Also we have elaborated a plan of taken care of standard Nursing to patients with monitoring PiCCO.For his production we have based on a wide bibliographical review and expert consults professionals, as well as a deep navigation for Internet.

  3. Semantic remote patient monitoring system.

    Science.gov (United States)

    Shojanoori, Reza; Juric, Radmila

    2013-02-01

    We propose an automated and personalized remote patient monitoring (RPM) system, which is applied to care homes and is dependent on the manipulation of semantics describing situations during patient monitoring in ontological models. Decision making in RPM is based on reasoning performed upon ontologies, which secures the delivery of appropriate e-health services in care homes. Our working experiment shows an example of preventive e-healthcare, but it can be extended to any situation that requires either urgent action from healthcare professionals or a simple recommendation during RPM. We use Semantic Web technology and OWL/SWRL-enabled ontologies to illustrate the proposal and feasibility of implementing this RPM system as a software solution in pervasive healthcare. It will be of interest to healthcare professionals, who can directly shape and populate the proposed ontological model, and software engineers, who would consider using OWL/SWRL when creating e-health services in general. PMID:23363406

  4. Heart Rate Variability as an Alternative Indicator for Identifying Cardiac Iron Status in Non-Transfusion Dependent Thalassemia Patients.

    Directory of Open Access Journals (Sweden)

    Karn Wijarnpreecha

    Full Text Available Iron-overload cardiomyopathy is a major cause of death in thalassemia patients due to the lack of an early detection strategy. Although cardiac magnetic resonance (CMR T2* is used for early detection of cardiac iron accumulation, its availability is limited. Heart rate variability (HRV has been used to evaluate cardiac autonomic function and found to be depressed in thalassemia. However, its direct correlation with cardiac iron accumulation has never been investigated. We investigated whether HRV can be used as an alternative indicator for early identification of cardiac iron deposition in thalassemia patients.Ninety-nine non-transfusion dependent thalassemia patients (23.00 (17.00, 32.75 years, 35 male were enrolled. The correlation between HRV recorded using 24-hour Holter monitoring and non-transferrin bound iron (NTBI, hemoglobin (Hb, serum ferritin, LV ejection fraction (LVEF, and CMR-T2* were determined.The median NTBI value was 3.15 (1.11, 6.59 μM. Both time and frequency domains of HRV showed a significant correlation with the NTBI level, supporting HRV as a marker of iron overload. Moreover, the LF/HF ratio showed a significant correlation with CMR-T2* with the receiver operating characteristic (ROC curve of 0.684±0.063, suggesting that it could represent the cardiac iron deposit in thalassemia patients. HRV was also significantly correlated with serum ferritin and Hb.This novel finding regarding the correlation between HRV and CMR-T2* indicates that HRV could be a potential marker in identifying early cardiac iron deposition prior to the development of LV dysfunction, and may be used as an alternative to CMR-T2* for screening cardiac iron status in thalassemia patients.

  5. Management of radiation therapy patients with cardiac defibrillator or pacemaker.

    Science.gov (United States)

    Salerno, Francesca; Gomellini, Sara; Caruso, Cristina; Barbara, Raffaele; Musio, Daniela; Coppi, Tamara; Cardinale, Mario; Tombolini, Vincenzo; de Paula, Ugo

    2016-06-01

    The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary.

  6. An unusual cause of cardiac arrest in a hospitalized patient

    Directory of Open Access Journals (Sweden)

    K Ranjan Shetty

    2013-01-01

    Full Text Available We present an unusual case of 24 year old male who was hospitalized for dental procedure and developed cardiac arrest 2 days after the procedure. The patient presented with swelling of buccal cavity for which a biopsy was taken. Two days after the procedure, apparently normal patient suddenly presented at mid night with VT and VF, which were intractable requiring multiple DC shocks. During this period arterial blood gas analysis revealed severe acidosis. The circumstances led us to suspect poisoning as one of the cause for his medical condition. We looked for commonly available toxins. One of the commonly available toxins is hand sanitizer which contains Isopropyl alcohol, glycerin and perfume. Due to prolonged cardiac arrest and intractable arrhythmia patient had sustained hypoxic brain injury. Patient remained hemodynamically stable for next 9 days although his CNS status did not improve. Patient succumbed to sepsis on 9 th day. Healthcare professionals should be aware of such possibilities and treat the patients at the earliest and put a check on the easy availability of IPA based hand sanitizers.

  7. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

    Science.gov (United States)

    Wang, Chu

    Patients undergoing cardiac catheterization are potentially at risk of radiation-induced health effects from the interventional fluoroscopic X-ray imaging used throughout the clinical procedure. The amount of radiation exposure is highly dependent on the complexity of the procedure and the level of optimization in imaging parameters applied by the clinician. For cardiac catheterization, patient radiation dosimetry, for key organs as well as whole-body effective, is challenging due to the lack of fixed imaging protocols, unlike other common X-ray based imaging modalities. Pediatric patients are at a greater risk compared to adults due to their greater cellular radio-sensitivities as well as longer remaining life-expectancy following the radiation exposure. In terms of radiation dosimetry, they are often more challenging due to greater variation in body size, which often triggers a wider range of imaging parameters in modern imaging systems with automatic dose rate modulation. The overall objective of this dissertation was to develop a comprehensive method of radiation dose estimation for pediatric patients undergoing cardiac catheterization. In this dissertation, the research is divided into two main parts: the Physics Component and the Clinical Component. A proof-of-principle study focused on two patient age groups (Newborn and Five-year-old), one popular biplane imaging system, and the clinical practice of two pediatric cardiologists at one large academic medical center. The Physics Component includes experiments relevant to the physical measurement of patient organ dose using high-sensitivity MOSFET dosimeters placed in anthropomorphic pediatric phantoms. First, the three-dimensional angular dependence of MOSFET detectors in scatter medium under fluoroscopic irradiation was characterized. A custom-made spherical scatter phantom was used to measure response variations in three-dimensional angular orientations. The results were to be used as angular dependence

  8. Radiation Therapy, Cardiac Risk Factors, and Cardiac Toxicity in Early-Stage Breast Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: The benefits of adjuvant radiation therapy (RT) for breast cancer may be counterbalanced by the risk of cardiac toxicity. We studied the cardiac effects of RT and the impact of pre-existing cardiac risk factors (CRFs) in a population-based sample of older patients with breast cancer. Methods and Materials: In the Surveillance, Epidemiology and End-Results (SEER)-Medicare database of women ≥65 years diagnosed with Stages I to III breast cancer from January 1, 1992 to December 31, 2000, we used multivariable logistic regression to model the associations of demographic and clinical variables with postmastectomy and postlumpectomy RT. Using Cox proportional hazards regression, we then modeled the association between treatment and myocardial infarction (MI) and ischemia in the 10 or more years after diagnosis, taking the predictors of treatment into account. Results: Among 48,353 women with breast cancer; 19,897 (42%) were treated with lumpectomy and 26,534 (55%) with mastectomy; the remainder had unknown surgery type (3%). Receipt of RT was associated with later year of diagnosis, younger age, fewer comorbidities, nonrural residence, and chemotherapy. Postlumpectomy RT was also associated with white ethnicity and no prior history of heart disease (HD). The RT did not increase the risk of MI. Presence of MI was associated with age, African American ethnicity, advanced stage, nonrural residence, more than one comorbid condition, a hormone receptor-negative tumor, CRFs and HD. Among patients who received RT, tumor laterality was not associated with MI outcome. The effect of RT on the heart was not influenced by HD or CRFs. Conclusion: It appears unlikely that RT would increase the risk of MI in elderly women with breast cancer, regardless of type of surgery, tumor laterality, or history of CRFs or HD, for at least 10 years

  9. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2003-01-01

    OBJECTIVE: To study prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest. DESIGN: Structured interview of 250 consecutive patients with acute coronary syndrome and relatives of 48 patients with witnessed cardiac arrest. The following courses of action......-four per cent of the patients admitted with cardiac arrest expressed no prior symptoms. Two-thirds of patients with typical symptoms interpreted it as cardiac-still only half took action within 20 min. Fifty per cent of patients who called a physician were delayed by wrong advice or misinterpretation. One...

  10. [Intraoperative myocardial protection with extracellular cardioplegic solutions in patients with cardiac valve diseases].

    Science.gov (United States)

    Zhidkov, I L; Ivanov, V A; Kozhevnikov, V A; Charnaia, M A; Mukhamedzianova, A R; Trekova, N A

    2007-01-01

    A hundred patients operated on under extracorporeal circulation (EC) with bicaval cannulation in the moderate general hypothermia mode were intraoperatively examined. According to the used cardioplegic solution, all the patients were divided into three groups: 1) Konsol; 2) Konsol MF; 3) St. Thomas (a control group). All the groups were matched by age, gender, the duration of myocardial ischemia (MI) (37-128 min), that of EC (52-186 min), and the nature of surgical interventions, of which mitral valve replacement amounted to 72-78%. To prepare a modified solution, 20 ml of 40% glucose, 20 units of insulin, and 200 mg of creatine phosphate (Neoton) were added to a flask containing 400 ml of Konsol. The efficiency of myocardial protection was evaluated by the data characterizing cardiac arrest and cardiac performance resumption, as well as by heart rate and the use of inotropic support in the reperfusion period. The parameters of central hemodynamics and systemic coronary blood flow, the concentrations of glucose and lactate, the blood gas and electrolyte composition of the coronary sinus (CS), myocardial oxygen consumption and the oxygen-utilizing coefficient were monitored. The cardioplegic solutions Consol and Consol MF were found to have a more effective cardioprotective activity in patients with cardiac valvular disease, operated on under EC and moderate hypothermia that St. Thomas'solution. Modification of the Consol solution by adding glucose, creatine phosphate, and insulin improves the protective effect of the solution, promoting a rapider transition of the myocardium from anaerobic to aerobic metabolism.

  11. A novel continuous cardiac output monitor based on pulse wave transit time.

    Science.gov (United States)

    Sugo, Yoshihiro; Ukawa, Teiji; Takeda, Sunao; Ishihara, Hironori; Kazama, Tomiei; Takeda, Junzo

    2010-01-01

    Monitoring cardiac output (CO) is important for the management of patient circulation in an operation room (OR) or intensive care unit (ICU). We assumed that the change in pulse wave transit time (PWTT) obtained from an electrocardiogram (ECG) and a pulse oximeter wave is correlated with the change in stroke volume (SV), from which CO is derived. The present study reports the verification of this hypothesis using a hemodynamic analysis theory and animal study. PWTT consists of a pre-ejection period (PEP), the pulse transit time through an elasticity artery (T(1)), and the pulse transit time through peripheral resistance arteries (T(2)). We assumed a consistent negative correlation between PWTT and SV under all conditions of varying circulatory dynamics. The equation for calculating SV from PWTT was derived based on the following procedures. 1. Approximating SV using a linear equation of PWTT. 2. The slope and y-intercept of the above equation were determined under consideration of vessel compliance (SV was divided by Pulse Pressure (PP)), animal type, and the inherent relationship between PP and PWTT. Animal study was performed to verify the above-mentioned assumption. The correlation coefficient of PWTT and SV became r = -0.710 (p 〈 0.001), and a good correlation was admitted. It has been confirmed that accurate continuous CO and SV measurement is only possible by monitoring regular clinical parameters (ECG, SpO2, and NIBP). PMID:21095971

  12. Hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Mahdi; Najafi; David; Faraoni

    2015-01-01

    Although red blood cells(RBCs) transfusion is sometimes associated with adverse reactions,anemia could also lead to increased morbidity and mortality in highrisk patients. For these reasons,the definition of perioperative strategies that aims to detect and treat preoperative anemia,prevent excessive blood loss,and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions,several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications,dosage,and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects,some high-risk patients(e.g.,symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade,a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.

  13. Exercise-based cardiac rehabilitation in patients with heart failure

    DEFF Research Database (Denmark)

    Lewinter, Christian; Doherty, Patrick; Gale, Christopher P;

    2015-01-01

    BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF. METHODS: This was ......BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF. METHODS......: This was a systematic review including a meta-analysis of EBCR on all-cause mortality, hospital admission, and standardised exercise capacity using four separate exercise tests in patients with heart failure over a minimum follow-up of six months from January 1999-January 2013. Electronic searches were performed...... in their funnel plots. CONCLUSIONS: EBCR in patients with HF is associated with significant improvements in exercise capacity and hospital admission over a minimum of six months follow-up, but not in all-cause mortality....

  14. An ECG Monitoring System For Prediction Of Cardiac Anomalies Using WBAN

    OpenAIRE

    Hadjem, Medina; Salem, Osman; Naït-Abdesselam, Farid

    2014-01-01

    International audience Cardiovascular diseases (CVD) are known to be the most widespread causes to death. Therefore, detecting earlier signs of cardiac anomalies is of prominent importance to ease the treatment of any cardiac complication or take appropriate actions. Electrocardiogram (ECG) is used by doctors as an important diagnosis tool and in most cases, it's recorded and analyzed at hospital after the appearance of first symptoms or recorded by patients using a device named holter ECG...

  15. Effects of alcohol ingestion on cardiac rhythm in patients with ischaemic heart disease.

    Science.gov (United States)

    Kentala, E; Luurila, O; Salaspuro, M P

    1976-12-01

    The effect of alcohol on cardiac rhythm was examined in ten male volunteers with a history of acute myocardial infarction. ECG monitoring with a portable ECG recorder was carried out for a period of 48 hours. After a control period of 15-18 hours an exercise test was performed and repeated after a standard dose (0.5 g/kg b.wt.) of alcohol. Then the patients were allowed to drink alcohol freely for two and half hours. The third exercise test was performed on the second morning. Heart rate at rest and sitting on a bicycle was highest in the third test, during the "hangover" period (p less than 0.05). With a submaximal work load heart rate, and also the heart rate-blood pressure pressure product, were highest after a standard dose of alcohol in the second test (p less than 0.05 and less than 0.01 respectively). The number of ectopic beats showed no significant difference in repeated exercise tests. On tape recordings, however, five of the ten patients experienced changes in cardiac rhythm after alcohol. In two patients the number of ectopic beats increased, the third patient had three successive ventricular ectopic beats after alcohol ingestion and in the fourth patient multiple sinus arrests occurred. In one patient a higher heart rate after alcohol ingestion abolished the ventricular ectopic focus seen during the control period. PMID:1008479

  16. Clinical utility and cost effectiveness of a personal ultrasound imager for cardiac evaluation during consultation rounds in patients with suspected cardiac disease

    NARCIS (Netherlands)

    E.C. Vourvouri (Eleni); L.Y. Koroleva; F.J. ten Cate (Folkert); D. Poldermans (Don); A.F.L. Schinkel (Arend); W.B. Vletter (Wim); J.R.T.C. Roelandt (Jos); R.T. van Domburg (Ron)

    2003-01-01

    textabstractOBJECTIVE: To assess the clinical utility and cost effectiveness of a personal ultrasound imager (PUI) during consultation rounds for cardiac evaluation of patients with suspected cardiac disease. METHODS: 107 unselected patients from non-cardiac departments (55% men) w

  17. Cardiac involvement in patients with limb-girdle muscular dystrophy type 2 and Becker muscular dystrophy

    DEFF Research Database (Denmark)

    Sveen, Marie-Louise; Thune, Jens Jakob; Køber, Lars;

    2008-01-01

    OBJECTIVE: To investigate the extent of cardiac involvement in patients with 1 of the 12 groups of recessively inherited limb-girdle muscular dystrophy type 2 (LGMD2A-L) and Becker muscular dystrophy (BMD). DESIGN: Prospective screening. SETTING: Neuromuscular Clinic and Department of Cardiology......-I and in 14 of 30 patients (47%) with BMD. Only a few patients with LGMD2A and unclassified LGMD2 had mild cardiac involvement, whereas 29% and 67% of patients with LGMD2I and LGMD2E, respectively, had cardiac involvement. Cardiac involvement was not correlated with age, muscle strength, or the level...... of dystrophic changes on muscle biopsy. CONCLUSIONS: This study demonstrates a high prevalence of cardiac involvement in patients with LGMD2I, LGMD2E, and BMD. Patients with LGMD2A, LGMD2D, and unclassified LGMD2 have a much lower and milder prevalence of cardiac involvement....

  18. Evolving concepts of hemodynamic monitoring for critically ill patients

    Directory of Open Access Journals (Sweden)

    Olfa Hamzaoui

    2015-01-01

    Full Text Available The last decades have been characterized by a continuous evolution of hemodynamic monitoring techniques from intermittent toward continuous and real-time measurements and from an invasive towards a less invasive approach. The latter approach uses ultrasounds and pulse contour analysis techniques that have been developed over the last 15 years. During the same period, the concept of prediction of fluid responsiveness has also been developed and dynamic indices such as pulse pressure variation, stroke volume variation, and the real-time response of cardiac output to passive leg raising or to end-expiration occlusion, can be easily obtained and displayed with the minimally invasive techniques. In this article, we review the main hemodynamic monitoring devices currently available with their respective advantages and drawbacks. We also present the current viewpoint on how to choose a hemodynamic monitoring device in the most severely ill patients and especially in patients with circulatory shock.

  19. Cardiac Biomarkers and Left Ventricular Hypertrophy in Asymptomatic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Reneta Yovcheva Koycheva

    2015-12-01

    Full Text Available BACKGROUND: Cardiac biomarkers are often elevated in dialysis patients showing the presence of left ventricular dysfunction. The aim of the study is to establish the plasma levels of high-sensitivity cardiac troponin T (hs TnT, precursor of B-natriuretic peptide (NT-proBNP and high sensitivity C-reactive protein (hs CRP and their relation to the presence of left ventricular hypertrophy (LVH in patients undergoing hemodialysis without signs of acute coronary syndrome or heart failure. MATERIAL AND METHODS: Were studied 48 patients - 26 men and 22 women. Pre and postdialysis levels of hs cTnT, NT-proBNP and hs CRP were measured at week interim procedure. Patients were divided in two groups according to the presence of echocardiographic evidence of LVH - gr A - 40 patients (with LVH, and gr B - 8 patients (without LVH. RESULTS: In the whole group of patients was found elevated predialysis levels of all three biomarkers with significant increase (p < 0.05 after dialysis with low-flux dialyzers. Predialysis values of NT-proBNP show moderate positive correlation with hs cTnT (r = 0.47 and weaker with hs CRP (r = 0.163. Such dependence is observed in postdialysis values of these biomarkers. There is a strong positive correlation between the pre and postdialysis levels: for hs cTnT (r = 0.966, for NT-proBNP (r = 0.918 and for hs CRP (r = 0.859. It was found a significant difference in the mean values of hs cTnT in gr. A and gr. B (0.07 ± 0.01 versus 0.03 ± 0.01 ng /mL, p < 0.05 and NT-proBNP (15,605.8 ± 2,072.5 versus 2,745.5 ± 533.55 pg /mL, p < 0.05. Not find a significant difference in hs CRP in both groups. CONCLUSIONS: The results indicate the relationship of the studied cardiac biomarkers with LVH in asymptomatic patients undergoing hemodialysis treatment.

  20. Engineered hybrid cardiac patches with multifunctional electronics for online monitoring and regulation of tissue function.

    Science.gov (United States)

    Feiner, Ron; Engel, Leeya; Fleischer, Sharon; Malki, Maayan; Gal, Idan; Shapira, Assaf; Shacham-Diamand, Yosi; Dvir, Tal

    2016-06-01

    In cardiac tissue engineering approaches to treat myocardial infarction, cardiac cells are seeded within three-dimensional porous scaffolds to create functional cardiac patches. However, current cardiac patches do not allow for online monitoring and reporting of engineered-tissue performance, and do not interfere to deliver signals for patch activation or to enable its integration with the host. Here, we report an engineered cardiac patch that integrates cardiac cells with flexible, freestanding electronics and a 3D nanocomposite scaffold. The patch exhibited robust electronic properties, enabling the recording of cellular electrical activities and the on-demand provision of electrical stimulation for synchronizing cell contraction. We also show that electroactive polymers containing biological factors can be deposited on designated electrodes to release drugs in the patch microenvironment on demand. We expect that the integration of complex electronics within cardiac patches will eventually provide therapeutic control and regulation of cardiac function.

  1. Recommendations of the Brazilian Society of Cardiac Arrhythmias for Holter Monitoring Services

    OpenAIRE

    Lorga Filho, Adalberto; Cintra, Fatima Dumas; Lorga, Adalberto; Grupi, Cesar José; Pinho, Claudio; Moreira, Dalmo Antonio Ribeiro; Dario C. Sobral Filho; de Brito, Fabio Sandoli; Kruse, José Claudio Lupi; Neto, José Sobral

    2013-01-01

    Background There are innumerous indicators to assure the quality of a service. However, medical competence and the proper performance of a procedure determine its final quality. The Brazilian Society of Cardiac Arrhythmias recommends minimum parameters necessary to guarantee the excellence of ambulatory electrocardiographic monitoring services. Objective To recommend minimum medical competences and the information required to issue a Holter monitoring report. Methods This study was grounded i...

  2. Prevalence of sleep-disordered breathing in elderly patients with cardiac pacemaker: a case-control study

    Institute of Scientific and Technical Information of China (English)

    Haiyun WU; Shiwen WANG; Jianping JIA; Wenli ZHANG; Qiang XU

    2005-01-01

    Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients' sleep apnea-hypopnea index.Methods Forty-four elderly patients (>60 years) with cardiac pacemaker and their 44 controls matched for gender, age, body mass index and cardiovascular morbidity were studied using polysomnography or portable sleep monitoring device. Results Prevalence of sleep-disordered breathing (apnea-hypopnea index ≥5/h) was 44.7% and the mean apnea-hypopnea index was 8.2 ±4.1/h in the cardiac pacemaker group, which were significantly higher than those in control subjects (25% and 4.6±2.4/h, respectively, P<0.01 and P<0.05). The mean apnea-hypopnea index of patients with DDD or AAI pacemaker was significantly lower than that of patients with VVI pacemaker. Conclusions Sleep-disordered breathing was more common in patients who had their cardiac pacemaker implanted due to bradyarrhythmias than in their matched controls. Compared with VVI pacing, DDD or AAI pacing may be more beneficial to patients with bradyarrhythmias and sleep-disordered breathing.

  3. Cardiac sarcoidosis: Recurrent disease in a heart transplant patient following pulmonary tuberculosis infection

    OpenAIRE

    Luk, Adriana; Lee, Andrew; Ahn, Eric; Soor, Gursharan S.; Ross, Heather J.; Butany, Jagdish

    2010-01-01

    Cardiac transplantation is indicated for patients with end-stage cardiomyopathy secondary to cardiac sarcoidosis. Although rare, recurrent disease has been reported in two cases. The current report presents a case of recurrent cardiac sarcoidosis in a patient 45 months postorthotopic heart transplantation and 40 months following reactivation of latent Mycobacterium tuberculosis infection. The patient was the first to have recurrent disease following an infection that has been proposed to be i...

  4. Early goal-directed therapy in moderate to high-risk cardiac surgery patients

    OpenAIRE

    Kapoor Poonam; Kakani Madhava; Chowdhury Ujjwal; Choudhury Minati; Lakshmy R; Kiran Usha

    2008-01-01

    Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE ≥3 undergoing coro...

  5. Radiation Dose to the Thyroid and Gonads in Patients Undergoing Cardiac CT Angiography

    OpenAIRE

    Behroozi, Hamid; Davoodi, Mohammad; Aghasi, Shahriar

    2015-01-01

    Background: The present data show a global increase in the rate of cardiovascular disease. Cardiac CT angiography has developed as a fast and non-invasive cardiac imaging modality following the introduction of multi-slice computed tomogaraphy. Objectives: The aim of this study was to measure the radiation dose to the thyroid and pelvis regions in patients undergoing cardiac CT angiography using the Care Dose 4D method of 64-slice scanner. Patients and Methods: Eighty-one patients (41 males an...

  6. Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy

    NARCIS (Netherlands)

    Hofhuizen, C.M.; Lansdorp, B.; Hoeven, J.G. van der; Scheffer, G.J.; Lemson, J.

    2014-01-01

    INTRODUCTION: Nexfin (Edwards Lifesciences, Irvine, CA) allows for noninvasive continuous monitoring of blood pressure (ABPNI) and cardiac output (CONI) by measuring finger arterial pressure (FAP). To evaluate the accuracy of FAP in measuring ABPNI and CONI as well as the adequacy of detecting chang

  7. Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy

    NARCIS (Netherlands)

    Hofhuizen, Charlotte; Lansdorp, Benno; Hoeven, van der Johannes G.; Scheffer, Gert-Jan; Lemson, Joris

    2014-01-01

    Introduction Nexfin (Edwards Lifesciences, Irvine, CA) allows for noninvasive continuous monitoring of blood pressure (ABPNI) and cardiac output (CONI) by measuring finger arterial pressure (FAP). To evaluate the accuracy of FAP in measuring ABPNI and CONI as well as the adequacy of detecting change

  8. Prevention of sudden cardiac death in hemodialysis patients.

    Science.gov (United States)

    O'Shaughnessy, Michelle M; O'Regan, John A; Lavin, Peter J

    2014-01-01

    One quarter of all hemodialysis patients will succumb to sudden cardiac death (SCD), a rate far exceeding that observed in the general population. A high prevalence of atherosclerotic coronary artery disease amongst patients with end-stage kidney disease (ESKD) partly explains this exaggerated risk. However, uremia and dialysis related factors are also of critical importance. Interventions aimed at preventing SCD have been inadequately studied in patients with ESKD. Data extrapolated from non-renal populations cannot necessarily be applied to hemodialysis patients, who possess relatively unique risk factors for SCD including "uremic cardiomyopathy", electrolyte shifts, fluctuations in intravascular volume and derangements of mineral and bone metabolism. Pending data derived from proposed randomized controlled clinical trials, critical appraisal of existing evidence and the selective application of guidelines developed for the general population to dialysis patients are required if therapeutic nihilism, or excessive intervention, are to be avoided. We discuss the evidence supporting a role for medical therapies, dialysis prescription refinements, revascularization procedures and electrical therapies as potential interventions to prevent SCD amongst hemodialysis patients. Based on current best available evidence, we present suggested strategies for the prevention of arrhythmia-mediated death in this highly vulnerable patient population. PMID:24720456

  9. Detection of atrial high-rate events by continuous Home Monitoring: clinical significance in the heart failure–cardiac resynchronization therapy population

    OpenAIRE

    Shanmugam, Nesan; Boerdlein, Annegret; Proff, Jochen; Ong, Peter; Valencia, Oswaldo; Maier, Sebastian K. G.; Bauer, Wolfgang R; Paul, Vince; Sack, Stefan

    2011-01-01

    Aims Uncertainty exists over the importance of device-detected short-duration atrial arrhythmias. Continuous atrial diagnostics, through home monitoring (HM) technology (BIOTRONIK, Berlin, Germany), provides a unique opportunity to assess frequency and quantity of atrial fibrillation (AF) episodes defined as atrial high-rate events (AHRE). Methods and results Prospective data from 560 heart failure (HF) patients (age 67 ± 10 years, median ejection fraction 27%) patients with a cardiac resynch...

  10. A portable cadmium telluride multidetector probe for cardiac function monitoring

    CERN Document Server

    Arntz, Y; Dumitresco, B; Eclancher, B; Prat, V

    1999-01-01

    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) wh...

  11. Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Rathachai Kaewlai

    2011-01-01

    Full Text Available Trauma patients with thoracic aortic injury (TAI suffer blunt cardiac injury (BCI at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG and serum creatine kinase-MB (CK-MB from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4 in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7, eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P<0.001.

  12. Combined Therapeutic and Monitoring Ultrasonic Catheter for Cardiac Ablation Therapies.

    Science.gov (United States)

    Carias, Mathew; Hynynen, Kullervo

    2016-01-01

    This study evaluated the feasibility of a combined therapeutic and diagnostic ultrasonic catheter for cardiac ablation therapies. Ultrasound can be used to determine when diseased cardiac tissues have become fully coagulated through a method known as local harmonic motion imaging (LHMI). LHMI is an imaging modality for treatment monitoring that uses acoustic radiation force, displacement tracking and the different mechanical properties of viable and ablated tissues. In this study, we developed catheters that are capable of LHMI measurements. Experiments were conducted in phantoms, ex vivo cardiac samples and the in vivo beating hearts of healthy porcine subjects. In vivo experiments revealed that four of four epicardial sonications revealed a decrease in measured displacements from LHMI experiments and that when lower power was used, no lesions formed and there was no corresponding decrease in measured displacement amplitudes. In addition, two of three endocardial lesions were confirmed and corresponded to a decrease in the measured displacement amplitude. PMID:26431798

  13. Pulse Indicator Continuous Cardiac Output for Hemodynamics Monitoring in Patients with Septic Shock%脉搏指示连续心排血量监测(PiCCO)在脓毒症休克患者血流动力学监测中的临床价值

    Institute of Scientific and Technical Information of China (English)

    陈涛

    2015-01-01

    Objective To observe and analyze patients with septic shock pulse wave indicates continuous cardiac output monitoring (Picco) clinical value, to provide a reference for future clinical use. Methods January 2013—2014 in March during outpatient sep-sis patients admitted to 40 cases for the study, depending on the admission of hemodynamic monitoring methods divided into two groups, the study group and the control group 20 cases. Two were used for routine monitoring (control group), Picco monitoring (study group) to guide clinical treatment (fluid resuscitation, inotropic drugs, vasoconstrictor drugs, etc.). Results The mean arterial pressure in the two groups of patients after treatment of the initial value and compare, P 0.05). Conclusion Picco be monitored in patients with septic shock hemodynamic parameters with good results, it is worth further study in late.%目的:观察脓毒症休克患者采用脉波指示连续心排血量监测(PiCCO)的效果,并分析其临床应用价值。方法将医院2012年1月—2014年3月期间门诊收入的脓毒症50例患者选为研究对象,按照患者就诊时血动力指标的监测方式不同分成两组:研究组25例,对照组25例。两组分别采用常规监测(对照组)、PiCCO监测(研究组)指导临床治疗(液体复苏、正性肌力药物、血管收缩药物等)。结果两组患者的平均动脉压在初始值比较(P<0.01);研究组患者入院3 d内不同时点GEDI、PPV、SVV检测值比较,组间差异有统计学意义(P<0.05)。组间在去甲肾上腺素和就诊1周输液量比较,差异无统计学意义(P>0.05)。结论脓毒症休克患者予以PiCCO监测血流动力学指标具有良好效果,值得在后期进一步研究。

  14. A NOVEL BCG SENSOR-ARRAY FOR UNOBTRUSIVE CARDIAC MONITORING

    OpenAIRE

    Anna Böhm; Christoph Brüser; Steffen Leonhardt Leonhardt

    2013-01-01

    Unobtrusive heart rate monitoring is a popular research topic in biomedical engineering. The reason is that convential methods, e.g. the clinical gold standard electrocardiography, require conductive contact to the human body. Other methods such as ballistocardiography try to record these vital signs without electrodes that are attached to the body. So far, these systems cannot replace routine procedures. Most systems have some drawbacks that cannot be compensated, such as aging of the sensor...

  15. Early goal-directed therapy in moderate to high-risk cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    Kapoor Poonam

    2008-01-01

    Full Text Available Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE ≥3 undergoing coronary artery bypass surgery under cardiopulmonary bypass. The patients were randomly divided into two groups, namely, control and early goal-directed therapy (EGDT groups. All the subjects received standardized care; arterial pressure was monitored through radial artery, central venous pressure through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour and frequent arterial blood gas analysis. In addition, cardiac index monitoring using FloTrac™ and continuous central venous oxygen saturation using PreSep™ was used in patients in the EGTD group. Our aim was to maintain the cardiac index at 2.5-4.2 l/min/m 2 , stroke volume index 30-65 ml/beat/m 2 , systemic vascular resistance index 1500-2500 dynes/s/cm 5 /m 2 , oxygen delivery index 450-600 ml/min/m 2 , continuous central venous oximetry more than 70%, stroke volume variation less than 10%; in addition to the control group parameters such as central venous pressure 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal arterial blood gas analysis values, pulse oximetry, hematocrit value above 30% and urine output more than 1 ml/kg/h. The aims were achieved by altering the administration of intravenous fluids and doses of inotropic or vasodilator agents. Three patients were excluded from the study and the data of 27 patients analyzed. The extra volume used (330 ± 160 v/s 80 ± 80 ml, P = 0.043 number of adjustments of inotropic agents (3

  16. Recurrent cardiac events in patients with idiopathic ventricular fibrillation, excluding patients with the Brugada syndrome

    Directory of Open Access Journals (Sweden)

    Philippon François

    2005-01-01

    Full Text Available Abstract Background The recurrence of cardiac events in patients with idiopathic ventricular fibrillation (VF excluding patients with the Brugada syndrome is unclear since this entity remains present in previous studies. Methods Since 1992, 18 patients (72% male with idiopathic VF out of 455 ICD implants were treated with an implantable cardioverter defibrillator (ICD. The mean age at first ICD implantation was 42 ± 14 years. Brugada syndrome, as well as other primary electrical diseases (e.g. long QT, were systematically excluded in all patients by the absence of the typical electrocardiogram (ST elevation in the right precordial leads at rest and/or after pharmacological tests (ajmaline, flecainide, or procainamide. Recurrence of cardiac events was prospectively assessed. Results During a mean follow-up period of 41 ± 27 months, VF recurrence with appropriate shock occurred in 7 patients (39% covering a total of 27 shocks. The median time to first appropriate shock was 12 ± 9 months. There were no deaths. In the electrophysiological study, 39% of patients were inducible, but inducibility failed to predict subsequent arrhythmic events. Forty-four percent of patients suffered 21 inappropriate shocks, which were caused by sinus tachycardia, atrial arrhythmias or lead malfunction. Conclusion Idiopathic ventricular fibrillation patients have a high recurrence rate of potentially fatal ventricular arrhythmias, excluding patients with the Brugada syndrome or other known causes. ICD prevents sudden cardiac death but inappropriate shocks remained a major issue in this young and active population.

  17. Preoperative physical therapy for elective cardiac surgery patients

    NARCIS (Netherlands)

    Hulzebos, E.H.J.; Smit, Y.; Helders, P.P.J.M.; Meeteren, N.L.U. van

    2012-01-01

    BACKGROUND: After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES: To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac sur

  18. A Wearable Contactless Sensor Suitable for Continuous Simultaneous Monitoring of Respiration and Cardiac Activity

    Directory of Open Access Journals (Sweden)

    Gaetano D. Gargiulo

    2015-01-01

    Full Text Available A reliable system that can simultaneously and accurately monitor respiration and cardiac output would have great utility in healthcare applications. In this paper we present a novel approach to creating such a system. This noninvasive, low power, low cost, contactless sensor is suitable for continuous monitoring of respiration (tidal volume and cardiac stroke volume. Furthermore, it is capable of delivering this data in true volume (i.e., mL. The current embodiment, specifically designed for sleep monitoring applications, requires only 100 mW when powered by a 4.8 V battery pack and is based on the use of a single electroresistive band embedded in a T-shirt. Here, we describe the implementation of the device, explaining the rational and design choices for the electronic circuit and the physical garment together with the preliminary tests performed using one volunteer subject. Comparison of the device with a commercially available spirometer demonstrates that tidal volume can be monitored over extended periods with a precision of ±10%. We further demonstrate the utility of the device to measure cardiac output and respiration effort.

  19. Cardiac Output Measurements in Septic Patients: Comparing the Accuracy of USCOM to PiCCO

    Directory of Open Access Journals (Sweden)

    Sophia Horster

    2012-01-01

    Full Text Available USCOM is an ultrasound-based method which has been accepted for noninvasive hemodynamic monitoring in various clinical conditions (USCOM, Ultrasonic cardiac output monitoring. The present study aimed at comparing the accuracy of the USCOM device with that of the thermodilution technique in patients with septicemia. We conducted a prospective observational study in a medical but noncardiological ICU of a university hospital. Septic adult patients (median age 55 years, median SAPS-II-Score 43 points on mechanical ventilation and catecholamine support were monitored with USCOM and PiCCO (=70. Seventy paired left-sided CO measurements (transaortic access = COUS-A were obtained. The mean COUS-A were 6.55 l/min (±2.19 versus COPiCCO 6.5 l/min (±2.18. The correlation coefficient was =0.89. Comparison by Bland-Altman analysis revealed a bias of −0.36 l/min (±0.99 l/min leading to a mean percentage error of 29%. USCOM is a feasible and rapid method to evaluate CO in septic patients. USCOM does reliably represent CO values as compared to the reference technique based on thermodilution (PiCCO. It seems to be appropriate in situations where CO measurements are most pertinent to patient management.

  20. Sexual counselling of cardiac patients : Nurses' perception of practice, responsibility and confidence

    NARCIS (Netherlands)

    Jaarsma, T.; Stromberg, A.; Fridlund, B.; De Geest, S.; Martensson, J.; Moons, P.; Norekval, T. M.; Smith, K.; Steinke, E.; Thompson, D. R.

    2010-01-01

    Background: Cardiac patients may experience problems with sexual activity as a result of their disease, medications or anxiety and nurses play an important role in sexual counselling. We studied the practice, responsibility and confidence of cardiac nurses in the sexual counselling of these patients

  1. THE EFFICACY OF MELDONIUM IN REDUCTION OF CARDIAC ELECTRICAL INSTABILITY IN PATIENTS WITH ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    A. A. Abdullaev

    2015-09-01

    Full Text Available Aim. To study meldonium effect in the combination therapy for ventricular repolarization disorders and cardiac electrical instability in patients with ischemic stroke.Material and methods. Patients (n=46 with acute phase of ischemic stroke were included in a randomized, open-label, uncontrolled study. Patients were randomized into two groups. Group 1 patients (n=25 had been receiving meldonium (Mildronate;Grindex,Latvia;Pharmstandard,Russia, 1.0 g/day intravenously once daily, as a part of standard therapy for 10 days since admission to the hospital. Group 2 patients (n=21 had standard therapy alone. A standart 12-lead ECG, ventricular late potentials (VLP, 24-hour Holter monitoring, troponin test were performed at the baseline and after 10 days.Results. Patients of the group 1 as compared to the group 2 demonstrated more significant positive effect on the clinical condition of patients with ischemic stroke, ventricular repolarization, reduction of frequency (from 3.7±0.5 to 2.1±0.4; p<0.05 and duration (from 6.6±1, 3 to 4.0±1.1 min; p<0.05 of painless myocardial ischemia episodes and VLP (from 48 to 32%.Conclusion. Adding meldonium to standard therapy in patients with acute phase of ischemic stroke can have a positive effect on the clinical condition, repolarization disorders on ECG, frequency of VLP and episodes of painless myocardial ischemia detection. This may have a positive effect on the electrical stability and prevention of cardiac arrhythmias. 

  2. THE EFFICACY OF MELDONIUM IN REDUCTION OF CARDIAC ELECTRICAL INSTABILITY IN PATIENTS WITH ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    A. A. Abdullaev

    2014-01-01

    Full Text Available Aim. To study meldonium effect in the combination therapy for ventricular repolarization disorders and cardiac electrical instability in patients with ischemic stroke.Material and methods. Patients (n=46 with acute phase of ischemic stroke were included in a randomized, open-label, uncontrolled study. Patients were randomized into two groups. Group 1 patients (n=25 had been receiving meldonium (Mildronate;Grindex,Latvia;Pharmstandard,Russia, 1.0 g/day intravenously once daily, as a part of standard therapy for 10 days since admission to the hospital. Group 2 patients (n=21 had standard therapy alone. A standart 12-lead ECG, ventricular late potentials (VLP, 24-hour Holter monitoring, troponin test were performed at the baseline and after 10 days.Results. Patients of the group 1 as compared to the group 2 demonstrated more significant positive effect on the clinical condition of patients with ischemic stroke, ventricular repolarization, reduction of frequency (from 3.7±0.5 to 2.1±0.4; p<0.05 and duration (from 6.6±1, 3 to 4.0±1.1 min; p<0.05 of painless myocardial ischemia episodes and VLP (from 48 to 32%.Conclusion. Adding meldonium to standard therapy in patients with acute phase of ischemic stroke can have a positive effect on the clinical condition, repolarization disorders on ECG, frequency of VLP and episodes of painless myocardial ischemia detection. This may have a positive effect on the electrical stability and prevention of cardiac arrhythmias. 

  3. Intelligent Cardiac Monitoring System using Virtual Instrumentation Techniques

    Directory of Open Access Journals (Sweden)

    Sharva Kant

    2011-07-01

    Full Text Available This paper describes the design of a portable, cheap and easy to handle microcontroller-based heart monitoring system using a Atmega32 model-based microcontroller and GLCD. The project is capable of detecting and distinguishing the normal heart signal from an abnormal one. A circuit was designed to convert the sound signals from the heart into electrical signals. The signal so obtained was then processed and conditioned to get a Phonocardiogram (PCG. The design considerations of this project are influenced by its target users. Its major application lies with medical practitioners in remote areas and army units in warzones where technical help is usually difficult. This project will facilitate a PCG read in such areas resulting in preventive timely measures being taken. This paper also gives solution to display the graphs and results on a GLCD which would further enhance the portability of this system.

  4. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Hann Christopher E

    2010-11-01

    Full Text Available Abstract The application of positive end expiratory pressure (PEEP in mechanically ventilated (MV patients with acute respiratory distress syndrome (ARDS decreases cardiac output (CO. Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.

  5. Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients

    DEFF Research Database (Denmark)

    Pelle, Aline J; Erdman, Ruud A M; van Domburg, Ron T;

    2008-01-01

    Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients.......Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients....

  6. A NOVEL BCG SENSOR-ARRAY FOR UNOBTRUSIVE CARDIAC MONITORING

    Directory of Open Access Journals (Sweden)

    Anna Böhm

    2013-12-01

    Full Text Available Unobtrusive heart rate monitoring is a popular research topic in biomedical engineering. The reason is that convential methods, e.g. the clinical gold standard electrocardiography, require conductive contact to the human body. Other methods such as ballistocardiography try to record these vital signs without electrodes that are attached to the body. So far, these systems cannot replace routine procedures. Most systems have some drawbacks that cannot be compensated, such as aging of the sensor materials or movement artifacts. In addition, the signal form differs greatly from an ECG, which is an electrical signal. The ballistocardiogram has a mechanical source, which makes it harder to evaluate. We have developed a new sensor array made of near-IR-LEDs to record BCGs. IR-sensors do not age in relevant time scales. Analog filtering was neccesary, because the signal amplitude was very small. The digitized data was then processed by various algorithms to extract beat-to-beat or breath-to-breath intervals. The redundancy of multiple BCG channels was used to provide a robust estimation of beat-to-beat intervals and heart rate. We installed the system beneath a mattress topper of a hospital bed, but any other bed would have been sufficient. The validation of this measurement system shows that it is well suited for BCG recordings. The use of multiple channels has proven to be superior to relying on a single BCG channel.

  7. DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices

    Energy Technology Data Exchange (ETDEWEB)

    Gauter-Fleckenstein, Benjamin; Steil, Volker; Wenz, Frederik [Ruprecht-Karls-Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Universitaetsmedizin Mannheim, Mannheim (Germany); Israel, Carsten W. [Klinik fuer Innere Medizin - Kardiologie, Diabetologie und Nephrologie, Ev. Krankenhaus Bielefeld, Bielefeld (Germany); Dorenkamp, Marc [Charite - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Berlin (Germany); Dunst, Juergen [Universitaetsklinik Schleswig-Holstein, Campus Luebeck, Klinik fuer Strahlentherapie, Luebeck (Germany); Roser, Mattias [Charite - Universitaetsmedizin Berlin, Campus Benjamin Franklin, Medizinische Klinik fuer Kardiologie und Pulmologie, Berlin (Germany); Schimpf, Rainer [Ruprecht-Karls-Universitaet Heidelberg, I. Medizinische Klinik - Kardiologie, Universitaetsmedizin Mannheim, Heidelberg (Germany); Schaefer, Joerg [Strahlentherapie Speyer, Speyer (Germany); Hoeller, Ulrike [Charite Universitaetsmedizin Berlin, Campus Charite Mitte, Klinik fuer Radioonkologie und Strahlentherapie, Berlin (Germany)

    2015-05-01

    An increasing number of patients undergoing radiotherapy (RT) have cardiac implantable electronic devices [CIEDs, cardiac pacemakers (PMs) and implanted cardioverters/defibrillators (ICDs)]. Ionizing radiation can cause latent and permanent damage to CIEDs, which may result in loss of function in patients with asystole or ventricular fibrillation. Reviewing the current literature, the interdisciplinary German guideline (DEGRO/DGK) was developed reflecting patient risk according to type of CIED, cardiac condition, and estimated radiation dose to the CIED. Planning for RT should consider the CIED specifications as well as patient-related characteristics (pacing-dependent, previous ventricular tachycardia/fibrillation). Antitachyarrhythmia therapy should be suspended in patients with ICDs, who should be under electrocardiographic monitoring with an external defibrillator on stand-by. The beam energy should be limited to 6 (to 10) MV CIEDs should never be located in the beam, and the cumulative scatter radiation dose should be limited to 2 Gy. Personnel must be able to respond adequately in the case of a cardiac emergency and initiate basic life support, while an emergency team capable of advanced life support should be available within 5 min. CIEDs need to be interrogated 1, 3, and 6 months after the last RT due to the risk of latent damage. (orig.) [German] Strahlentherapie (RT) ist zunehmend haeufig bei Patienten mit kardialen implantierten elektronischen Geraeten (CIED; Herzschrittmacher [SM] und Kardioverter-Defibrillatoren [ICD]) indiziert. Durch ionisierende Strahlen koennen Schaeden und Fehlfunktionen des CIED auftreten, die einen permanenten Funktionsverlust beim Geraet und eine Asystolie oder Kammerflimmern beim Patienten ausloesen. Deshalb wurde vor dem Hintergrund der bisher verfuegbaren Daten eine interdisziplinaere Leitlinie (DEGRO/DGK) erarbeitet, die sich an der zu erwartenden Strahlendosis am CIED sowie dem kardialen Risiko des Patienten orientiert. In

  8. Cardiac amyloidosis in a heart transplant patient - A case report and retrospective analysis of amyloidosis evolution

    OpenAIRE

    Kintsler, Svetlana; Jäkel, Jörg; Brandenburg, Vincent; Kersten, Katrin; Knuechel, Ruth; Röcken, Christoph

    2015-01-01

    Cardiac amyloidosis is a very rare cause of heart failure in heart transplant recipients but an important differential diagnosis in cases of progressive cardiac failure. We report a 72-year-old male patient with the diagnosis of senile systemic amyloidosis (SSA) in a transplanted heart 15 years after transplantation by the initial diagnosis of the dilated cardiomyopathy. Additionally performed immunohistochemical analysis with anti-transthyretin antibody of the cardiac biopsies of the last 15...

  9. Are hospitals also for relatives? A survey of hospitals' activities regarding relatives of cardiac patients

    DEFF Research Database (Denmark)

    Nissen, Nina Konstantin; Madsen, Mette; Kjøller, Mette;

    2008-01-01

    AIM: Patients and their close relatives both feel the burden of cardiovascular disease. Relatives of heart patients experience lower quality of life and increased mortality than the general population and relatives of patients with other diseases. Nevertheless, knowledge on health services aimed...... at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. METHODS: We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey...... and 50 of 55 invited hospital departments participated. RESULTS: Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments...

  10. Pulse Indicator Continuous Cardiac Output for Hemodynamics Monitoring in Patients with Septic Shock%脉搏指示连续心排血量监测(PiCCO)在脓毒症休克患者血流动力学监测中的临床价值

    Institute of Scientific and Technical Information of China (English)

    伊敏; 么改琦; 朱曦; 郭向阳

    2013-01-01

    目的 探讨脉搏指示连续心排血量监测技术(pulse indicator continuous cardiac output,PiCCO)在脓毒症休克患者血流动力学监测中的临床价值. 方法 2012年1~8月,前瞻性队列研究比较常规监测(n=12)与PiCCO监测(n=19)脓毒症休克患者的血流动力学,应用PiCCO监测指导脓毒症休克患者的液体复苏、血管收缩药和正性肌力药物的使用. 结果 2组脓毒症休克患者性别、年龄、原发病、既往病史、多器官功能不全综合征(MODS)的发生和发生MODS器官数、急性生理学及慢性健康状况评分系统(APACHE)Ⅱ、脓毒症相关器官衰竭评分(SOFA)、应用去甲肾上腺素剂量和入ICU后7天总的输液量差异均无显著性,PiCCO组初始平均动脉压(MAP)明显低于常规组[(52.00±5.00)mm Hg vs.(59.58±3.42)mm Hg,t=4.603,P=0.000],而对于PiCCO组存在心功能损害的患者应用正性肌力药治疗后达到与常规组相同的MAP达标值[(68.00±2.43)mm Hg vs.(68.58±2.88)mm Hg,t=0.607,P=0.549],2组MAP达标值差异无显著性. 结论 在PiCCO监测指导下,可以对于存在心功能损害的患者应用正性肌力药物,而不是仅应用血管收缩药升高血压.%Objective To investigate the clinical value of pulse indicator continuous cardiac output ( PiCCO) in hemodynamics monitoring for patients with septic shock. Methods A prospective cohort study comparing routine hemodynamics monitoring (n = 12) and PiCCO (n = 19) for patients with septic shock were carried out from January to August 2012. The PiCCO monitor provided a continuous assessment of fluid resuscitation, vasopressors and inotropes infusion in septic shock patients. Results There were no significant difference between the two groups in sex, age, etiology of critical illness, medical history, incidence of MODS, number of MODS involved organ, APACHE Ⅱ and SOFA scores, usage of noradrenaline, and total volume of fluid infusion in a week. In the PiCCO group, the original MAP

  11. Apathy and Cognitive Test Performance in Patients Undergoing Cardiac Testing

    Directory of Open Access Journals (Sweden)

    Lynn Reese Kakos

    2013-01-01

    Full Text Available Background. Psychiatric comorbidity is common in patients with cardiovascular disease, with the literature indicating that this population may be at risk for apathy. The current study examined the prevalence of apathy in patients with cardiovascular disease and its relation to aspects of cognitive function. Methods. 123 participants from an outpatient cardiology clinic completed a brief neuropsychological battery, a cardiac stress test, and demographic information, medical history, and depression symptomatology self-report measures. Participants also completed the Apathy Evaluation Scale to quantify apathy. Results. These subjects reported limited levels of apathy and depression. Increased depressive symptomatology, history of heart attack, and metabolic equivalents were significantly correlated with apathy (P<0.05. Partial correlations adjusting for these factors revealed significant correlations between behavioral apathy and a measure of executive function and the other apathy subscale with a measure of attention. Conclusion. Findings revealed that apathy was not prevalent in this sample though associated with medical variables. Apathy was largely unrelated to cognitive function. This pattern may be a result of the mild levels of cardiovascular disease and cognitive dysfunction in the current sample. Future studies in samples with severe cardiovascular disease or neuropsychological impairment may provide insight into these associations.

  12. Effects of a brief intervention on retention of patients in a cardiac rehabilitation program.

    Science.gov (United States)

    McGrady, Angele; Burkes, Robert; Badenhop, Dalynn; McGinnis, Ron

    2014-12-01

    This intervention assessed the effects of a brief intervention on dropout rate in a cardiac rehabilitation program. One hundred thirty five patients were recruited from a cardiac rehabilitation program and randomized to either a control or intervention group. The intervention group participated in four sessions of motivational interviewing and stress management-relaxation in addition to standard cardiac rehabilitation. The control group underwent cardiac rehabilitation alone. Patients who completed the intervention completed an average of 30 sessions while those who dropped out of the intervention completed about six (p Anxiety and depression measured at baseline were the primary predictors of dropout. Patients in both the intervention and controls groups who completed cardiac rehabilitation improved the distance walked, quality of life and decreased anxiety. PMID:25150038

  13. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

    DEFF Research Database (Denmark)

    Dankiewicz, J; Nielsen, N; Annborn, M;

    2015-01-01

    PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) trial...... early CAG was not significantly associated with survival. CONCLUSIONS: In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved...... showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within...

  14. Cardiac transplant in young female patient diagnosed with diffuse systemic sclerosis.

    Science.gov (United States)

    Bennasar, Guillermo; Carlevaris, Leandro; Secco, Anastasia; Romanini, Felix; Mamani, Marta

    2016-01-01

    Systemic sclerosis (SS) in a multifactorial and systemic, chronic, autoimmune disease that affects the connective tissue. We present this clinical case given the low prevalence of diffuse SS with early and progressive cardiac compromise in a young patient, and treatment with cardiac transplantation.

  15. Complement activation and its prognostic role in post-cardiac arrest patients

    DEFF Research Database (Denmark)

    Jenei, Z M; Zima, E; Csuka, D;

    2014-01-01

    of therapeutic hypothermia predicted 30-day mortality regardless of age, sex and the APACHE II score. Complement activation occurs in post-cardiac arrest patients, and its extent correlates with 30-day survival. The C3a/C3 ratio might prove useful for estimating the prognosis of comatose post-cardiac arrest...

  16. Cost and effectiveness assessment of cardiac rehabilitation for dialysis patients following coronary bypass

    OpenAIRE

    Huang, Yijian; Zhang, Rebecca; Culler, Steven; Kutner, Nancy

    2008-01-01

    Dialysis patients have a high risk of cardiovascular disease. In the general population, cardiac rehabilitation is recommended as a standard component of care and is covered by Medicare for patients who have undergone coronary artery bypass grafting (CABG). Previous investigation demonstrated survival benefit of cardiac rehabilitation in dialysis patients. This study investigated its impact on Medicare expenditure and its cost effectiveness. A cohort of 4,324 end-stage renal disease (ESRD) pa...

  17. Blood glucose management in the patient undergoing cardiac surgery: A review

    Institute of Scientific and Technical Information of China (English)

    Pingle; Reddy; Brian; Duggar; John; Butterworth

    2014-01-01

    Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns.

  18. Quantitative 1H MR spectroscopy of the brain in patients with congestive heart failure before and after cardiac transplantation

    International Nuclear Information System (INIS)

    To evaluate the effects of cardiac transplantation on the brain in patients with congestive heart failure (CHF), using quantitative 1H MR spectroscopy (1H-MRS). Ten patients with CHF underwent MRI and quantitative 1H-MRS before and 1-2 and 4-9 months after cardiac transplantation. MR spectra were obtained from parietal white matter (PWM) and occipital gray matter (OGM) using PROBE (PROton Brain Exam). Changes in MR signal intensity were evaluated, and the cerebral metabolic concentrations in PWM and OGM were compared. For comparative purposes, 20 normal volunteers were included. No abnormal MR signal intensity was seen in the brain before or after cardiac transplantation. Changes in cerebral metabolic concentrations were observed on 1H-MRS; concentrations of creatine (Cr) in PWM, and of N-acetylacepartate (NAA), Cr and myo-Inositol(mI) in OGM were significantly lower before transplantation. After successful transplantation, Cr levels returned to their normal range in PWM and OGM, while a slightly increase choline (Cho) level was observed in PWM. Cerebral hypoperfusion in CHF can be evaluated using 1H-MRS. MRS may play a substantial role in monitoring the effect of cardiac transplantation

  19. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Poenisch, Falk [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pinnix, Chelsea C. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sheu, Tommy [Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Memon, Nada [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rozner, Marc A. [Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dougherty, Anne H. [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving

  20. Biatrial Cardiac Metastases in a Patient with Uterine Cervix Malignant Melanoma

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    Caglayan Geredeli

    2015-01-01

    Full Text Available Primary malignant melanomas of uterine cervix are quite rarely seen neoplasms, and long-life prognosis of patients with this disease is poor. Immunohistochemical methods and exclusion of other primary melanoma sites are used to confirm the diagnosis. As with other melanomas, cervix malignant melanomas may also cause cardiac metastases. Cardiac metastases are among rarely seen but more commonly encountered cases, compared to primary cardiac tumors. Here, we present a case of biatrial cardiac metastases in a 73-year-old patient with uterine cervix malignant melanomas. The patient underwent echocardiography, cardiac magnetic resonance imaging, and computed tomography. Our report shows the importance of advanced diagnostic techniques, such as cardiac magnetic resonance, not only for the detection of cardiac masses, but for a better anatomic definition and tissue characterization. Although the cases of malignant melanomas leading to multiple cardiac metastasis were reported in literature, the metastatic concurrence of malignant melanomas in both right and left atriums is quite rarely encountered as metastatic malignant melanomas. Also, another intriguing point in our case is that the primary lesion of our case was stemmed from uterine cervix, but not skin.

  1. Echocardiographic abnormalities in the assessment of cardiac organ damage in never-treated hypertensive patients.

    Science.gov (United States)

    Milan, Alberto; Avenatti, Eleonora; Puglisi, Elisabetta; Abram, Sara; Magnino, Corrado; Naso, Diego; Tosello, Francesco; Fabbri, Ambra; Vairo, Alessandro; Mulatero, Paolo; Rabbia, Franco; Veglio, Franco

    2012-01-01

    Hypertension-related cardiac organ damage, other than left ventricular (LV) hypertrophy (LVH), has been described: in particular, concentric remodeling, LV diastolic dysfunction (DD), and left atrial (LA) enlargement are significantly associated with cardiovascular morbility and mortality in different populations. This study evaluated the prevalence of these latter morphofunctional abnormalities, in never-treated essential hypertensive patients and the role of such a serial assessment of hypertensive cardiac damage in improving cardiovascular risk stratification in these patients. A total of 100 never-treated essential hypertensive subjects underwent a complete clinical and echocardiographic evaluation. Left ventricular morphology, systolic and diastolic function, and LA dimension (linear and volume) were evaluated by echocardiography. Left ventricular hypertrophy was present in 14% of the patients, whereas concentric remodeling was present in 25% of the subjects. Among patients free from LV morphology abnormalities, the most frequent abnormality was LA enlargement (global prevalence 57%); the percentage of patients with at least one parameter consistent with DD was 22% in the entire population, but DD was present as the only cardiac abnormality in 1% of our patient. Left atrial volume indexed for body surface area was the most sensitive parameter in identifying hypertension-related cardiac modification. The global prevalence of cardiac alteration reached 73% in never-treated hypertensive patients. Left ventricular remodeling and LA enlargement evaluation may grant a better assessment of cardiac organ damage and cardiovascular risk stratification of hypertensive patients without evidence of LVH after routine examination. PMID:22738434

  2. Evaluation of bluetooth low power for physiological monitoring in a home based cardiac rehabilitation program.

    Science.gov (United States)

    Martin, Timothy; Ding, Hang; D'Souza, Matthew; Karunanithi, Mohan

    2012-01-01

    Cardiovascular disease (CVD) is the leading cause of mortality in Australia, and places large burdens on the healthcare system. To assist patients with CVDs in recovering from cardiac events and mediating cardiac risk factors, a home based cardiac rehabilitation program, known as the Care Assessment Platform (CAP), was developed. In the CAP program, patients are required to manually enter health information into their mobile phones on a daily basis. The manual operation is often subject to human errors and is inconvenient for some elderly patients. To improve this, an automated wireless solution has been desired. The objectives of this paper are to investigate the feasibility of implementing the newly released Bluetooth 4.0 (BT4.0) for the CAP program, and practically evaluate BT4.0 communications between a developed mobile application and some emulated healthcare devices. The study demonstrated that BT4.0 addresses usability, interoperability and security for healthcare applications, reduces the power consumption in wireless communication, and improves the flexibility of interface for software development. This evaluation study provides an essential mobile BT4.0 framework to incorporate a large range of healthcare devices for clinical assessment and intervention in the CAP program, and hence it is useful for similar development and research work of other mobile healthcare solutions. PMID:22797030

  3. Cardiac rehabilitation patient's perspectives on the recovery following heart valve surgery: a narrative analysis

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe Olsen; Berg, Selina Kikkenborg;

    2016-01-01

    AIMS: To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation. BACKGROUND: Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging, but ...... benefit from more extensive medical follow-up immediately after discharge, individual psychological assessment and individualized, realistic information about the recovery trajectory.......AIMS: To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation. BACKGROUND: Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging......, but evidence on the long-term recovery process is very limited, especially following heart valve surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. DESIGN: A qualitative study with serial interviews analysed using narrative methods. METHODS: We...

  4. Severe reversible cardiac failure after bortezomib treatment combined with chemotherapy in a non-small cell lung cancer patient: a case report

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    Giaccone Giuseppe

    2006-05-01

    Full Text Available Abstract Background Bortezomib (Velcade®, a dipeptide boronate proteasome inhibitor, is a novel anti-cancer agent registered for multiple myeloma (MM. It has also shown promising clinical activity in non-small cell lung cancer (NSCLC. Clinical experience with bortezomib so far indicates that overall incidence of cardiac failure associated with bortezomib therapy remains incidental. Nevertheless, acute development or exacerbation of congestive cardiac failure has been associated with bortezomib treatment. Case presentation We present here a case of severe, but reversible, congestive cardiac failure in a lung cancer patient who had no prior cardiac history, after receiving an experimental treatment of bortezomib combined with chemotherapy. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP, as retrospectively measured in archived serum samples, were suggestive of pre-existent (sub-clinical left ventricular dysfunction. Conclusion Based on literature, we hypothesize that baseline presence of sub clinical cardiomyopathy, characterized by a dysregulation of the ubiquitin-proteasome system, could have predisposed this patient for a cardiac side effect induced by systemic proteasome inhibition. Patients with heart disease or risk factors for it should be closely monitored when being submitted to treatment with proteasome inhibition therapy such as bortezomib. Caution is therefore warranted in lung cancer patients who often present with cardiac comorbidities.

  5. DIAGNOSTIC EFFICACY OF CARDIAC TROPONIN-T IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN INTENSIVE CARDIAC CARE UNIT

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    Tapan

    2016-03-01

    Full Text Available INTRODUCTION Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD. Acute myocardial infarction (AMI is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death. AIM The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI. MATERIAL & METHOD One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study. Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study. The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991 as well as CK-MB (creatine kinase-MB isoenzymeassays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset. RESULTS The rapid cardiac Troponin-T test (CTn-T has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72

  6. Genomic Stability of Legionella pneumophila Isolates Recovered from Two Cardiac Transplant Patients with Nosocomial Legionnaires' Disease

    OpenAIRE

    Marrie, Thomas J; Johnson, Wendy M; Tyler, Shaun D.; Bezanson, Gregory S.; Burbridge, Susan

    1994-01-01

    Pulsed-field gel electrophoresis revealed that multiple consecutive isolates of Legionella pneumophila from two cardiac transplant patients remained genomically stable, despite exposure to host defenses and antimicrobial agents.

  7. Sudden cardiac death in patients with diabetes mellitus and chronic heart failure.

    Science.gov (United States)

    Walker, Andrew Mn; Cubbon, Richard M

    2015-07-01

    In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area.

  8. Collaborative Cardiac Care Service: A Multidisciplinary Approach to Caring for Patients with Coronary Artery Disease

    OpenAIRE

    Sandhoff, Brian G; Kuca, Susan; Rasmussen, Jon; Merenich, John A

    2008-01-01

    Background: Coronary artery disease (CAD) remains the leading cause of death in the US. In 1996, Kaiser Permanente of Colorado (KPCO) developed the Collaborative Cardiac Care Service (CCCS) with the goal of improving the health of patients with CAD.

  9. Pre-operative echocardiogram in hip fracture patients with cardiac murmur- an audit

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    Talkhani Imtiyaz

    2011-09-01

    Full Text Available Abstract Background All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients. Methods All hip fracture patients (N = 349 between 01/06/08 and 01/06/09 were included in the study. 29 patients had pre-operative echocardiogram (echo group. A computer generated randomised sample of 40 patients was generated from N, 'non-echo' group. Data was obtained from medical records and the Hospital Information Support System (HISS. The groups were compared using Student's t test. Approval was obtained locally from the clinical governance department for this project. Results Age and gender distribution were similar in both groups. Indication for echo was an acute cardiac abnormality in 4 cases. 25 patients had echo for no new cardiac problem (indication being cardiac murmur in 23 patients and extensive cardiac history in 2 cases. Cardiology opinion was sought in 5 cases. No patient required cardiac surgery or balloon angioplasty preoperatively. Patients having pre-operative echo had significant delay to surgery (average 2.7 days, range 0-6 days compared to 'non-echo' group (average 1.1 days, range 0-3 days, (p Conclusion We have developed departmental guidelines for expediting echo requests in hip fracture patients with cardiac murmur. A liaison has been established with our cardiology department to prioritise such patients on the Echocardiography waiting list, to prevent unnecessary avoidable delay. Careful patient selection for pre-operative echocardiography is important to avoid unnecessary delay to surgery.

  10. Robust cardiac event change detection method for long-term healthcare monitoring applications.

    Science.gov (United States)

    Satija, Udit; Ramkumar, Barathram; Manikandan, M Sabarimalai

    2016-06-01

    A long-term continuous cardiac health monitoring system highly demands more battery power for real-time transmission of electrocardiogram (ECG) signals and increases bandwidth, treatment costs and traffic load of the diagnostic server. In this Letter, the authors present an automated low-complexity robust cardiac event change detection (CECD) method that can continuously detect specific changes in PQRST morphological patterns and heart rhythms and then enable transmission/storing of the recorded ECG signals. The proposed CECD method consists of four stages: ECG signal quality assessment, R-peak detection and beat waveform extraction, temporal and RR interval feature extraction and cardiac event change decision. The proposed method is tested and validated using both normal and abnormal ECG signals including different types of arrhythmia beats, heart rates and signal quality. Results show that the method achieves an average sensitivity of 99.76%, positive predictivity of 94.58% and overall accuracy of 94.32% in determining the changes in heartbeat waveforms of the ECG signals. PMID:27382480

  11. Cardiac computed tomography in patients with acute coronary syndrome; Kardiale CT beim akuten Koronarsyndrom

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, C.L. [Universitaetsklinikum, Heidelberg (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Alkadhi, H. [Universitaetsspital, Zuerich (Switzerland); Bamberg, F. [Universitaetsklinikum, Tuebingen (Germany). Diagnostische und Interventionelle Radiologie

    2014-09-15

    Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

  12. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    OpenAIRE

    Jyotsna, Viveka P.; Smita Ambekar; Rajiv Singla; Ansumali Joshi; Anju Dhawan; Neeta Kumar; Deepak, K. K.; Sreenivas, V.

    2013-01-01

    Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam) had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and c...

  13. Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients

    OpenAIRE

    Heringlake, Matthias; Nowak, Yvonne; Schön, Julika; Trautmann, Jens; Berggreen, Astrid Ellen; Charitos, Efstratios I.; Paarmann, Hauke

    2014-01-01

    Introduction Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with a poor prognosis. Mechanical ventilation is an important risk factor for developing AKI in critically ill patients. Ventilation with high tidal volumes has been associated with postoperative organ dysfunction in cardiac surgical patients. No data are available about the effects of the duration of postoperative respiratory support in the immediate postoperative period on the incidence...

  14. Heart shaking transitions - A phenomenological-hermeneutic study of patients´ experiences in cardiac rehabilitation

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.;

    angina pectoris or non-St-elevation myocardial infarction experience their life situation. Methods. Within a phenomenological-hermeneutic frame a qualitative design was chosen. Introductory field observations were made. Focus group interviews and individual interviews were conducted with 11 patients...... enrolled in the cardiac rehabilitation programme. The data underwent interpretation consisting of three phases: naïve reading, structural analysis and comprehensive interpretation. Results. The preliminary findings are that the patients go through a Heart Shaking Journey in Cardiac Rehabilitation. Three...

  15. Cardiac rehabilitation for patients after coronary artery bypass graft surgery Nursing Interventions

    OpenAIRE

    Tsaloglidou A.; Lavdaniti M.; Ioannidis T.

    2010-01-01

    Purpose: To describe the way by which the rehabilitation of the patients that have undergone cardiac surgery is performed, to present the content of the cardiac rehabilitation programs and to determine the nursing role in the whole process. Methodology: Literature review of the relevant articles in the databases pubmed and scopus. Results: The patients with coronary heart disease usually face a lot of problems in their everyday life. Coronary artery bypass graft surgery (CABG) is commonly per...

  16. Increased anxiety and depression in Danish cardiac patients with a type D personality

    DEFF Research Database (Denmark)

    Spindler, Helle; Kruse, Charlotte; Zwisler, Ann-Dorthe;

    2009-01-01

    Type D personality is an emerging risk factor in cardiovascular disease. We examined the psychometric properties of the Danish version of the Type D Scale (DS14) and the impact of Type D on anxiety and depression in cardiac patients.......Type D personality is an emerging risk factor in cardiovascular disease. We examined the psychometric properties of the Danish version of the Type D Scale (DS14) and the impact of Type D on anxiety and depression in cardiac patients....

  17. Cardiac myxoma: A surgical experience of 38 patients over 9 years, at SSKM hospital Kolkata, India

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    Mohammad Shahbaaz Khan

    2013-01-01

    Full Text Available Background: Cardiac myxoma is the most common benign intracardiac tumor. We studied its clinical presentation, morbidity, mortality and recurrence following surgery over a period of 9 years. Materials and Methods: This study was performed at cardiothoracic and vascular surgery department of a tertiary level hospital of eastern India, Seth Sukhlal Karnani Memorial hospital, Institute of Post Graduate Medical Education and Research Kolkata. Near 6000 cardiac cases were operated at our center over this period. Preoperative diagnosis was made with clinical presentation and preoperative echocardiography. Complete tumor excision was done and all patients were followed up for recurrence and complications. Result: A total of 38 cases of cardiac myxoma were operated over a period from October 2002 to October 2011. Cardiac myxoma constituted about 0.6% of all cardiac cases operated at our institute. This most commonly presented at fifth decade of life. Of these, 35 cases were left atrial and 2 cases were right atrial, and 1 case was having both atrial involvements. The left atrial myxoma mostly presented as mitral stenosis and very few presented with embolic and constitutional symptoms. No death or recurrence was observed during the follow up period. Conclusion: Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity.

  18. Blunt cardiac rupture in patient with liver laceration

    Institute of Scientific and Technical Information of China (English)

    王文林; 曾伟生; 蒋仁超

    2003-01-01

    The early diagnosis of cardiac rupture is one of the key factors for a successful outcome. However, the accurate diagnosis is often difficult in the early stage of injury, especially when some obvious severe wounds are found in other regions of the body,1,2 for they are easy to disguise the symptom of the heart. We report a case with cardiac rupture and liver trauma caused by traffic accident.

  19. Effect of Tanshinone IIA on cardiac function and inflammatory cytokines in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Yan Li

    2016-01-01

    Objective:To explore the effect of Tanshinone IIA on the cardiac function and inflammatory cytokines in patients with acute myocardial infarction (AMI).Methods:A total of 70 patients with AMI who were admitted in our hospital from March, 2015 to March, 2016 were included in the study and randomized into the observation group and the control group. On the basis of routine treatments, the patients in the control group were given urokinase 1-1.5 million U + 0.5% NaCl 100 mL, iv drip, 30-45min, aspirin from the initial dosage of 300 mg/d to 100 mg/d on the second day, and low molecular weight heparin sodium, 7 500-1 000 IU/time, twice/d, subcutaneous injection. Seven-day treatment was regarded as one course. On the above basis, the patients in the observation group were given Tanshinone IIA 60 mg + 5% glucose 250 mL, iv drip, 1 time/d. Seven-day treatment was regarded as one course. The efficacy was evaluated after seven-day treatment. ELISA was used to detect hs-CRP, TNF-α, and IL-6 levels before and after treatment. The color Doppler ultrasound diagnostic apparatus was used to monitor LVEF, LVESD, LVEDD, and IVST. The occurrence of adverse cardiac events was observed. Results:After treatment, LVEF in the two groups was significantly elevated, LVESD, LVEDD, and IVST were significantly reduced when compared with before treatment (P<0.05), and those in the observation group were significantly superior to those in the control group (P<0.05). After treatment, the serum hs-CRP, TNF-α, and IL-6 levels in the two groups were significantly reduced when compared with before treatment (P<0.05), and the reduced degree in the observation group was significantly superior to that in the control group (P<0.05). The occurrence rate of arrhythmia, cardiogenic shock, and heart rate in the observation group was significantly lower than that in the control group (P<0.05).Conclusions:Tanshinone IIA in the treatment of AMI can effectively improve the cardiac function after thrombolysis

  20. Incidence and management of diaphragmatic palsy in patients after cardiac surgery

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    Mehta Yatin

    2008-01-01

    Full Text Available Background: Diaphragm is the most important part of the respiratory system. Diaphragmatic palsy following cardiac surgery is not uncommon and can cause deterioration of pulmonary functions and attendant pulmonary complications. Objectives: Aim of this study was to observe the incidence of diaphragmatic palsy after off pump coronary artery bypass grafting (OPCAB as compared to conventional CABG and to assess the efficacy of chest physiotherapy on diaphragmatic palsy in post cardiac surgical patients. Design and Setting: An observational prospective interventional study done at a tertiary care cardiac centre. Patients: 2280 consecutive adult patients who underwent cardiac surgery from February 2005 to august 2005. Results: 30 patients out of 2280 (1.31% developed diaphragmatic palsy. Patients were divided based on the presence or absence of symptoms viz. breathlessness at rest or exertion or with the change of posture along with hypoxemia and / or hypercapnia. Group I included 14 patients who were symptomatic (CABG n=13, post valve surgery n=1, While Group II included 16 asymptomatic patients (CABG n=12, post valve surgery n=4, 9 patients (64% from Group I (n=14 and 4 patients (25% from group II showed complete recovery from diaphragmatic palsy as demonstrated ultrasonographically. Conclusion: The incidence of diaphragmatic palsy was remarkably less in our adult cardiac surgical patients because most of the cardiac surgeries were performed off pump and intensive chest physiotherapy beginning shortly after extubation helped in complete or near complete recovery of diaphragmatic palsy. Chest Physiotherapy led to marked improvement in functional outcome following post cardiac surgery diaphragmatic palsy. We also conclude that ultrasonography is a simple valuable bed-side tool for rapid diagnosis of diaphragmatic palsy

  1. Monitoring treatment expectations in patients with an implantable cardioverter-defibrillator using the EXPECT-ICD scale

    DEFF Research Database (Denmark)

    Habibovic, Mirela; Pedersen, Susanne S.; van den Broek, Krista C;

    2014-01-01

    AIMS: Patient treatment expectations may affect cardiac outcomes; however, till date, no validated instruments have been developed to monitor treatment expectations in patients with an implantable cardioverter-defibrillator (ICD). This study evaluates the predictive value of the newly developed 10...

  2. Reentrant Supraventricular Tachycardia in a Pediatric Trauma Patient Masquerading as a Cardiac Contusion

    Directory of Open Access Journals (Sweden)

    Bradbum, Christopher

    2005-01-01

    Full Text Available Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the controversy over the definition of the disease, and the lack of a true gold standard confirmatory test. Atrioventricular nodal reentrant tachycardia (AVNRT is a common form of supraventricular tachycardia (SVT that can also present a diagnostic challenge to emergency physicians. While electrophysiologic studies are the gold standard for confirming the diagnosis, there are certain aspects of the history, electrocardiogram (ECG, and responses to cardiac maneuvers that strongly suggest the diagnosis. We present the case of a pediatric trauma patient that presented with new onset AVNRT masquerading as cardiac contusion.

  3. Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices

    Directory of Open Access Journals (Sweden)

    Manisha Mishra

    2014-01-01

    Full Text Available The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.

  4. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K.; Folke, Fredrik;

    2013-01-01

    resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n......IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine...... temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which...

  5. The relationship between cerebral oxygen saturation changes and post operative neurologic complications in patients undergoing cardiac surgery

    International Nuclear Information System (INIS)

    To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on -pump) Group II: without CPB (off- pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSo/sub 2/ in different hours of surgery was significant in group I and group II (P=0.0001 in both) but it was not significant in group III ( P=0.075) . Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications. (author)

  6. Evaluation of target and cardiac position during visually monitored deep inspiration breath-hold for breast radiotherapy.

    Science.gov (United States)

    Conroy, Leigh; Yeung, Rosanna; Watt, Elizabeth; Quirk, Sarah; Long, Karen; Hudson, Alana; Phan, Tien; Smith, Wendy L

    2016-01-01

    A low-resource visually monitored deep inspiration breath-hold (VM-DIBH) technique was successfully implemented in our clinic to reduce cardiac dose in left-sided breast radiotherapy. In this study, we retrospectively characterized the chest wall and heart positioning accuracy of VM-DIBH using cine portal images from 42 patients. Central chest wall position from field edge and in-field maximum heart distance (MHD) were manually measured on cine images and compared to the planned positions based on the digitally reconstructed radiographs (DRRs). An in-house program was designed to measure left anterior descending artery (LAD) and chest wall separation on the planning DIBH CT scan with respect to breath-hold level (BHL) during simulation to determine a minimum BHL for VM-DIBH eligibility. Systematic and random setup uncertainties of 3.0 mm and 2.6 mm, respectively, were found for VM-DIBH treatment from the chest wall measurements. Intrabeam breath-hold stability was found to be good, with over 96% of delivered fields within 3 mm. Average treatment MHD was significantly larger for those patients where some of the heart was planned in the field compared to patients whose heart was completely shielded in the plan (p < 0.001). No evidence for a minimum BHL was found, suggesting that all patients who can tolerate DIBH may yield a benefit from it. PMID:27455494

  7. Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Sandra Spronk

    Full Text Available OBJECTIVE: Peripheral arterial disease (PAD often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD undergoing cardiac rehabilitation. DATA SOURCES: Best-available evidence was retrieved from literature and combined with primary data from 231 patients. METHODS: We developed a markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs, life-time costs (US $, incremental cost-effectiveness ratios (ICER, and gain in net health benefits (NHB in QALY equivalents were calculated. A threshold willingness-to-pay of $75,000 was used. RESULTS: ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44,251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: -0.17, 0.29 at a threshold willingness-to-pay of $75,000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30,246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:-0.24, 0.46 compared to current practice. The results were robust for other different input parameters. CONCLUSION: ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.

  8. Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy

    DEFF Research Database (Denmark)

    Astrup, Anne Sofie; Tarnow, Lise; Rossing, Peter;

    2006-01-01

    Cardiac autonomic neuropathy (CAN) has been associated with a poor prognosis in patients with diabetes. Because CAN is common in patients with diabetic nephropathy, we evaluated the predictive value of CAN in type 1 diabetic patients with and without diabetic nephropathy....

  9. MULTIPLE FACETS OF REHABILITATION IN ELDERLY PATIENTS AFTER CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    Maura Gabriela FELEA

    2014-11-01

    Full Text Available The elderly rehabilitation program after coronary artery bypass graft (CABG encompasses endurance training performed on a cycloergometer and physical rehabilitation, the results being exceeded by adding strength and balance exercises. Early initiation of mobilization exercises can prevent problems of posture, as well as thoraco-pulmonary and scapular-humeral articulation conditions often encountered after cardiac surgery. The results of special functional training in elderly can be assessed by six minute walk perimeter and quality of life questionnaire. This article describes the extents of multiple dimensions facets of cardiac rehabilitation program, like effort capacity and psycho-social benefits, morbi-mortality and cost-effectiveness. Referral to cardiac rehabilitation for primary and secondary prevention programs remains low in developing countries. There is a need for a network intelligence schema in order to address patients’ needs and to improve health care professionals’ education.

  10. Predischarge maximal exercise test identifies risk for cardiac death in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, J R; Mickley, H; Damsgaard, E M;

    1990-01-01

    capacity and systolic blood pressure increase in AMI patients was 59% that of control subjects (p less than 0.001). Seventeen AMI patients had significant ST-segment shifts, 13 with ST depression and 4 with ST elevation. In AMI patients experiencing a cardiac death during follow-up the maximal work...... were of no significant value. In this study maximal work capacity turned out to be the best single exercise variable for identifying groups of AMI patients with very low and relative high risk of cardiac death. When all 3 exercise variables were combined, the predischarge maximal exercise test...... was of great value in identifying AMI patients at low risk for cardiac death (predictive value of a negative test: 95%)....

  11. Reducing cardiovascular risk in spouses of cardiac patients: a randomized controlled trial.

    Science.gov (United States)

    Yates, Bernice C; Rowland, Sheri; Mancuso, Kerry; Kupzyk, Kevin A; Norman, Joseph F; Shurmur, Scott; Tesina, Karen

    2015-01-01

    Few studies have examined risk-reducing interventions in spouses of coronary artery bypass patients. This study examined the effects of the Partners Together in Health (PaTH) intervention versus usual care on cardiovascular risk factors. Spouses in the experimental group (n = 17/group) attended cardiac rehabilitation with patients and made the same physical activity and healthy eating changes as patients. Spouses in the usual care group attended educational classes with patients. Spouses' 30-year cardiovascular risk was calculated using the Lifetime Risk Scale before and after cardiac rehabilitation (3 months), and at 6 months. Spouses in both groups significantly reduced 30-year risk scores at 3 and 6 months. Exercise was the key ingredient in lowering risk. There was a trend toward reduction in systolic blood pressure and an increase in high-density lipoprotein cholesterol in both groups. Although there were no group differences, having spouses participate in cardiac rehabilitation with the patient was effective for reducing spouses' cardiovascular risk.

  12. [Manifestations of polymorphism of β1-adrenoreceptors in patients with newly diagnosed cardiac rhythm disorders].

    Science.gov (United States)

    Afanas'ev, S A; Rebrova, T Iu; Batalov, R E; Muslimova, É F; Borisova, E V; Popov, S V

    2013-01-01

    Individual peculiarities of the receptor apparatus of cardiomyocytes may determine pathological features of heart activity and susceptibility to pharmaceuticals. The possible role of beta-adrenoreceptor polymorphism in the development of cardiac rhythm disturbances is assessed by PCR. Special attention is given to A145G polymorphism of the ADRB1 gene in 127 patients with primary cardiac rhythm disorders. It was shown that AJ45G polymorphism (Ser49Gly) at DNA sites encoding for the amino acid sequence of beta-1 adrenoreceptors can influence the development of sex-specific cardiac rhythm disorders. PMID:24437165

  13. An unusual case of mesenteric ischemia in a patient with cardiac myxoma.

    Science.gov (United States)

    Pérez Baztarrica, Gabriel; Bornancini, Norberto; Salvaggio, Flavio; Porcile, Rafael

    2013-01-01

    Symptoms related to peripheral embolism are experienced in 2%-15% of cases of cardiac myxoma. We present a rare case of a 54-year-old man admitted due to sudden abdominal pain. A computed tomography (CT) scan showed occlusion of the superior mesenteric artery (SMA). As the patient's response to support treatment was favorable, a non-invasive approach was adopted, with prescription of oral anticoagulation (OAC) therapy. Transesophageal echocardiography revealed a tumor in the left atrium. The cardiac mass was completely removed and diagnosed as myxoma by histopathological analysis. As periodic CT scans showed progressive improvement of blood flow through the SMA, OAC was continued. OAC may have been beneficial due to the nature of emboli originating from a cardiac myxoma: thrombi covering the surface of the tumor. At present, there is no explanation in the literature for the benefits of OAC in patients with embolism associated with cardiac myxoma. PMID:23890757

  14. Usefulness of Cardiac Sympathetic Nerve Imaging Using (123)Iodine-Metaiodobenzylguanidine Scintigraphy for Predicting Sudden Cardiac Death in Patients With Heart Failure.

    Science.gov (United States)

    Kasama, Shu; Toyama, Takuji; Kurabayashi, Masahiko

    2016-01-01

    The autonomic nervous system plays an important role in the human heart. Activation of the cardiac sympathetic nervous system is a cardinal pathophysiological abnormality associated with the failing human heart. Myocardial imaging using (123)I-metaiodobenzylguanidine (MIBG), an analog of norepinephrine, can be used to investigate the activity of norepinephrine, the predominant neurotransmitter of the sympathetic nervous system. Many clinical trials have demonstrated that (123)I-MIBG scintigraphic parameters predict cardiac adverse events, especially sudden cardiac death, in patients with heart failure. In this review, we summarize results from published studies that have focused on the use of cardiac sympathetic nerve imaging using (123)I-MIBG scintigraphy for risk stratification of sudden cardiac death in patients with heart failure.

  15. Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery

    OpenAIRE

    van der Merwe Juliana; Bailey Michael; Shepherd Judy; Bradley Scott; Spitzer Ondine; Braun Lesley; Rosenfeldt Franklin; Leong Jee; Esmore Donald

    2011-01-01

    Abstract Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in...

  16. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

    OpenAIRE

    Kelli Maria Souza Santos; Manoel Luiz de Cerqueira Neto; Vitor Oliveira Carvalho; Valter Joviniano Santana Filho; Walderi Monteiro da Silva Junior; Amaro Afrânio Araújo Filho; Telma Cristina Fontes Cerqueira; Lucas de Assis Pereira Cacau

    2014-01-01

    Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M...

  17. Anesthetic management for the patients with cardiac transplant

    Institute of Scientific and Technical Information of China (English)

    Xinchun Chen; John Faris; Mickle Michael; Chris Cokis

    2005-01-01

    With the advancement of medical technique and application of the new immunosuppressant agents, cardiac transplantation has become an effective treatment for end-stage heart disease caused by different reasons. The orthotopic procedure has been performed in many countries nowadays. Whether it is successful or not mainly depends on harvesting the denoted heart, operative technique and perioperative management.

  18. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi;

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidenc...

  19. Short-term effect of cardiac resynchronization therapy in patients with ischaemic or nonischaemic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    HUA Wei; NIU Hong-xia; WANG Fang-zheng; ZHANG Shu; CHEN Ke-ping; CHEN Xin

    2006-01-01

    Background Patients with heart failure were candidates for cardiac resynchronization therapy (CRT)regardless of underlying aetiology. This study observed the effect of CRT in patients with ischaemic or nonischaemic cardiomyopathy.Methods One hundred and forty-two patients with refractory chronic heart failure and left bundle branch block received cardiac resynchronization therapy, 91 men and 51 women, average age 60 years. Left ventricular ejection fraction (LVEF) was severely depressed (mean 29%), left ventricular end diastolic diameter (LVEDD)enlarged (mean 72 mm) and QRS width was lengthened (mean 147 ms). Ninety-eight had nonischaemic cardiomyopathy and 44 had ischaemic cardiomyopathy.Results After cardiac resynchronization therapy, the heart function was significantly improved. The mean LVEF increased from 29% to 36% after pacing. In patients with nonischaemic cardiomyopathy, the LVEF was improved from 28% to 37%, and in patients with ischaemic cardiomyopathy, the LVEF was improved from 30% to 36%. No significant difference of the improvement was found between the two groups (P>0.05).Conclusions Cardiac resynchronization therapy could significantly improve cardiac function in patients with chronic heart failure regardless of the underlying heart disease.

  20. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

    Directory of Open Access Journals (Sweden)

    Ana Carla Pereira de Araujo

    2014-11-01

    Full Text Available Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1 or positive (G2 for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%. During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016. The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022 and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively. Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

  1. The use of epinephrine-containing anesthetic solutions in cardiac patients: a survey

    Directory of Open Access Journals (Sweden)

    GERLACH Raquel Fernanda

    1998-01-01

    Full Text Available A questionnaire survey of 150 last term dental students from four dental schools was performed to delineate their current opinion with regard to the use of epinephrine-containing anesthetic solutions for dental procedures in cardiac patients. The students provided their opinion as "contraindicated" or "not contraindicated" regarding the use of these solutions in eight cardiac patients with either stable or unstable heart diseases including ischemic heart disease, arrhythmia, hypertension, and heart failure. We found an overall 77% rate of right answers among all students. Mistakes occurred more frequently when treating patients with ischemic heart disease (68% of right answers. Although vasoconstrictors may offer many advantages and are not contraindicated to the majority of cardiac patients, graduating dental students sometimes do not comply with current guidelines.

  2. Cardiac arrest after anesthetic management in a patient with hereditary sensory autonomic neuropathy type IV

    Directory of Open Access Journals (Sweden)

    Ergül Yakup

    2011-01-01

    Full Text Available Hereditary sensory autonomic neuropathy type IV is a rare disorder with an autosomal recessive transmission and characterized by self-mutilation due to a lack in pain and heat sensation. Recurrent hyperpyrexia and anhydrosis are seen in patients as a result of a lack of sweat gland innervation. Self-mutilation and insensitivity to pain result in orthopedic complications and patients undergone recurrent surgical interventions with anesthesia. However, these patients are prone to perioperative complications such as hyperthermia, hypothermia, and cardiac complications like bradycardia and hypotension. We report a 5-year-old boy with hereditary sensory autonomic neuropathy type IV, developing hyperpyrexia and cardiac arrest after anesthesia.

  3. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric;

    2009-01-01

    of 296 surgically excised hearts over a 20-year period (January 1987 to July 2006) at one institution were examined. Patients were separated into groups based on year of heart transplantation. The tissue was examined to determine the underlying cardiac pathology leading to congestive heart failure...... amyloidosis. OBJECTIVE: To review the changes that have occurred over time in the etiology of heart disease in patients requiring heart transplantation, and to compare the clinical and histological diagnoses of explanted hearts from patients with progressive cardiac disease. METHODS: The pathological findings...

  4. Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

    OpenAIRE

    Farin Erik; Meder Milena

    2010-01-01

    Abstract Background Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation. Methods N = 331 patients with c...

  5. Serial measurements of cardiac biomarkers in patients after allogeneic hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Roziakova Lubica

    2012-02-01

    Full Text Available Abstract Background Previous therapy with anthracyclines (ANT and conditioning regimen followed by hematopoietic stem cell transplantation (HSCT represents a high risk for development of cardiotoxicity. The aim of this study was to assess subclinical myocardial damage after HSCT using echocardiography and cardiac biomarkers - high sensitive cardiac troponin T (hs-cTnT and N-terminal pro-B-type natriuretic peptide (NT-proBNP and to identify patients at risk of developing clinical cardiotoxicity. Patients and methods Thirty-seven patients who were treated with allogeneic HSCT for hematologic diseases at median age of 28 years at time of HSCT were studied. Conditioning regimen included either chemotherapy without total body irradiation (TBI or combination of chemotherapy with TBI. Twenty-nine (78,3% patients were pretreated with ANT therapy. Cardiac biomarkers were serially measured before conditioning regimen and at days 1, 14 and 30 after HSCT. Cardiac systolic and diastolic functions were assessed before conditioning regimen and 1 month after HSCT by echocardiography. Results The changes in plasma NT-proBNP and hs-cTnT levels during the 30 days following the HSCT were statistically significant (P P Conclusions Elevations in both cardiac biomarkers were found before clinical signs of cardiotoxicity developed. Persistent elevations in NT-pro-BNP and hs-cTnT concentrations simultaneously for a period exceeding 14 days might be used for identification of patients at risk of developing cardiotoxicity and requiring further cardiological follow up.

  6. Functional Status, Anxiety, Cardiac Self-Efficacy, and Health Beliefs of Patients with Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Hamid Allahverdipour

    2013-12-01

    Full Text Available Background: Beliefs and emotions could effect on functional status, quality of life, and mortality amongst patients who are suffering coronary heart disease (CHD. Current study examined the role of anxiety: trait/ state, self-efficacy, health beliefs, and functional status among patient with history of CHD. Method: In this correlational study, 105 hospitalized and outpatients patients suffering CHD in Tehran Heart Center Hospital participated by using convenience sampling method in 2012. Cardiac self-efficacy, Seattle Angina, and research- designed health beliefs questionnaires were used to gather data. Results: The functional status in CHD patients showed significant relationships with gender, job, and type of medical insurance of the participants (All ps<0.05. In addition , perceived vulnerability to face again cardiac attack in the future, perceived severity of next cardiac attack, anxiety, state anxiety and trait anxiety (All ps<0.05 had significant and negative relationships with functional status. Conversely, the cardiac self-efficacy had a positive and significant relationship (P<0.001 with functional status. Conclusion: Psychological factors have important role in functional status and quality of life of patients who suffering CHD. Therefore, it is necessary to emphasize on supportive and complementary programs to promote Cardiac Rehabilitation Programs.

  7. Stressors in Patients Undergoing Cardiac Surgery and Attitudes of Nurses and Patients

    Directory of Open Access Journals (Sweden)

    Mousavi Shabestari Mitra

    2014-01-01

    Full Text Available Objective: Cardiac surgery is an important event an individual’s life and can cause the collapse of the economic, personal, and professional life of the person and impair their physical functioning. Fear, anxiety, depression, and other mental health problems may be experienced by the operated patient. Assessment of the causes of anxiety and stress requires the awareness of nurses and patients of these factors which differ from each other. The aim of this review study was to examine nurses' views regarding stressors of coronary artery bypass surgery. Materials and Methods: This research was a review study and was conducted by reviewing the literature related to this topic and also visiting the Cumulative Index to Nursing and Allied Health Literature (CINAHL, PubMed, and other authentic websites. Results: It is better that nurses and patients have an open relationship at any given time and nurses encourage the patients to speak about their anxiety. Evaluating patients’ perception of fear and anxiety may help identify patients at risk of substantial psychological stress. Conclusion: According to previous studies, in general, the assessment of individuals should be one of the goals of nursing care so that appropriate trainings can be provided according to the needs of patients and patients can be assisted in coping with stressors.

  8. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    WANG Yun; YUE Yun; SUN Yong-hai; WU An-shi; WU Qi-wei; ZHANG Yong-qian; FENG Chun-sheng

    2005-01-01

    Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.Methods Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P>0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P>0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the

  9. 脉波指示剂连续心排血量监测技术在早期目标导向治疗中的临床作用分析%Pulse Indicator Continuous Cardiac Output for Hemodynamics Monitoring in Patients with Septic Shock

    Institute of Scientific and Technical Information of China (English)

    陈刚; 王标; 郭小芙

    2014-01-01

    Objective To investigate the application of pulse index continuous cardiac output (PiCCO) in patients with septic shock.MethodsSixty patients with septic shock were randomly divided into two groups: routine monitoring group and PiCCO monitoring group, with 30 patients in each group. The rate of reaching standard of early goal directed therapy (EGDT) was observed after treatment for 6, 24 and 48 hours. In addition, blood lactic acid, central venous oxygen saturation (ScvO2), central venous pressure (CVP), mean arterial pressure (MAP) and urine volume were determined after treatment for 6, 24 and 48 hours, and positive fluid balance amount and dosages of dopamine and dobutamine were measured after treatment for 6, 24 and 48 hours. Mortality was observed in the patients of both groups.Results After treatment for 6, 24 and 48 hours, in PiCCO monitoring group, ScvO2 signifi cantly increased, blood lactic acid level, positivefl uid balance amount, dosages of dopamine and dobutamine signifi cantly decreased compared with routine monitoring group (P<0.05). The rate of reaching standard of EGDT in PiCCO monitoring group was signifi cantly higher than that in routine monitoring group after treatment for 6, 24 hours. There also was difference in mortality between the two groups (P<0.05).Conclusion PiCCO monitor has an important clinical guide signifi cance for the resuscitation of septic shock, which can help to reach the fast and effective treatment target, improve septic shock, avoid the damage of blindfl uid infusion, provide fast and right treatment evidence. So it is worth being spread in clinic treatment.%目的:探讨脉波指示剂连续心排血量监测(PiCCO)技术在脓毒性休克患者早期目标导向治疗(EGDT)中的临床指导价值。方法将60例脓毒性休克患者按随机数字表法分为常规监测组和PiCCO监测组各30例,PiCCO监测组在PiCCO技术指导下行EGDT,常规监测组患者放置中心静脉导管和桡动脉导

  10. Comparison of monitoring performance of bioreactance versus esophageal Doppler in pediatric patients

    Directory of Open Access Journals (Sweden)

    Clément Dubost

    2015-01-01

    Full Text Available Background and Aims: Cardiac output (CO monitoring and goal-directed therapy during major abdominal surgery is currently used to decrease postoperative complications. However, few monitors are currently available for pediatric patients. Nicom ® is a noninvasive CO monitoring technique based on the bioreactance principle (analysis of frequency variations of a delivered oscillating current traversing the thoracic cavity. Nicom ® may be a useful monitor for pediatric patients. Subjects and Methods: Pediatric patients undergoing major abdominal surgery under general anesthesia with cardiac monitoring by transesophageal Doppler (TED were included. Continuously recorded hemodynamic variables obtained from both bioreactance and TED were compared. Data were analyzed using the Bland-Altman method. Results: A total of 113 pairs of cardiac index (CI measurments from 16 patients were analyzed. Mean age was 59 months (95% CI: 42-75 and mean weight was 17 kg (95% CI: 15-20. In the overall population, Bland-Altman analysis revealed a bias of 0.4 L/min/m 2 , precision of 1.55 L/min/m 2 , limits of agreement of −1.1 to 1.9 L/min/m 2 and a percentage error of 47%. For children weighing >15 kg, results were: Bias 0.51 L/min/m 2 , precision 1.17 L/min/m 2 , limits of agreement −0.64 to 1.66 L/min/m 2 and percentage error 34%. Conclusion: Simultaneous CI estimations made by bioreactance and TED showed high percentage of errors that is not clinically acceptable. Bioreactance cannot be considered suitable for monitoring pediatric patients.

  11. Automated analysis of background EEG and reactivity during therapeutic hypothermia in comatose patients after cardiac arrest.

    Science.gov (United States)

    Noirhomme, Quentin; Lehembre, Rémy; Lugo, Zulay Del Rosario; Lesenfants, Damien; Luxen, André; Laureys, Steven; Oddo, Mauro; Rossetti, Andrea O

    2014-01-01

    Visual analysis of electroencephalography (EEG) background and reactivity during therapeutic hypothermia provides important outcome information, but is time-consuming and not always consistent between reviewers. Automated EEG analysis may help quantify the brain damage. Forty-six comatose patients in therapeutic hypothermia, after cardiac arrest, were included in the study. EEG background was quantified with burst-suppression ratio (BSR) and approximate entropy, both used to monitor anesthesia. Reactivity was detected through change in the power spectrum of signal before and after stimulation. Automatic results obtained almost perfect agreement (discontinuity) to substantial agreement (background reactivity) with a visual score from EEG-certified neurologists. Burst-suppression ratio was more suited to distinguish continuous EEG background from burst-suppression than approximate entropy in this specific population. Automatic EEG background and reactivity measures were significantly related to good and poor outcome. We conclude that quantitative EEG measurements can provide promising information regarding current state of the patient and clinical outcome, but further work is needed before routine application in a clinical setting.

  12. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    OpenAIRE

    Claudiu Avram; Adina Avram; L.aura Crăciun; Stela Iurciuc; Lucian Hoble; Alexandra Rusu; Bogdan Almăjan-Guţă; Silvia Mancaş

    2010-01-01

    The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Grou...

  13. Cardiac Repolarization Abnormalities and Potential Evidence for Loss of Cardiac Sodium Currents on ECGs of Patients with Chagas' Heart Disease

    Science.gov (United States)

    Schlegel, T. T.; Medina, R.; Jugo, D.; Nunez, T. J.; Borrego, A.; Arellano, E.; Arenare, B.; DePalma, J. L.; Greco, E. C.; Starc, V.

    2007-01-01

    Some individuals with Chagas disease develop right precordial lead ST segment elevation in response to an ajmaline challenge test, and the prevalence of right bundle branch block (RBBB) is also high in Chagas disease. Because these same electrocardiographic abnormalities occur in the Brugada syndrome, which involves genetically defective cardiac sodium channels, acquired damage to cardiac sodium channels may also occur in Chagas disease. We studied several conventional and advanced resting 12-lead/derived Frank-lead ECG parameters in 34 patients with Chagas -related heart disease (mean age 39 14 years) and in 34 age-/gender-matched healthy controls. All ECG recordings were of 5-10 min duration, obtained in the supine position using high fidelity hardware/software (CardioSoft, Houston, TX). Even after excluding those Chagas patients who had resting BBBs, tachycardia and/or pathologic arrhythmia (n=8), significant differences remained in multiple conventional and advanced ECG parameters between the Chagas and control groups (n=26/group), especially in their respective QT interval variability indices, maximal spatial QRS-T angles and low frequency HRV powers (p=0.0006, p=0.0015 and p=0.0314 respectively). In relation to the issue of potential damage to cardiac sodium channels, the Chagas patients had: 1) greater than or equal to twice the incidence of resting ST segment elevation in leads V1-V3 (n=10/26 vs. n=5/26) and of both leftward (n=5/26 versus n=0/26) and rightward (n=7/26 versus n=3/26) QRS axis deviation than controls; 2) significantly increased filtered (40-250 Hz) QRS interval durations (92.1 8.5 versus 85.3 plus or minus 9.0 ms, p=0.022) versus controls; and 3) significantly decreased QT and especially JT interval durations versus controls (QT interval: 387.5 plus or minus 26.4 versus 408.9 plus or minus 34.6 ms, p=0.013; JT interval: 290.5 plus or minus 26.3 versus 314.8 plus or minus 31.3 ms; p=0.0029). Heart rates and Bazett-corrected QTc/JTc intervals

  14. Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

    OpenAIRE

    Patel, Rajan K.; Oliver, Scott; Patrick B. Mark; Powell, Joanna R.; McQuarrie, Emily P.; Traynor, James P.; Dargie, Henry J; Jardine, Alan G

    2009-01-01

    Background and objectives: Left ventricular hypertrophy (LVH) is an independent risk factor for premature cardiovascular death in hemodialysis (HD) patients and one of the three forms of uremic cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a volume-independent technique to assess cardiac structure. We used CMR to assess the determinants of left ventricular mass (LVM) and LVH in HD patients.

  15. Extended cardiac rehabilitation for socially vulnerable patients improves attendance and outcome

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Meillier, Lucette Kirsten; Larsen, Mogens Lytken

    2013-01-01

    Patients living alone or having a low socioeconomic status are likely to quit cardiac rehabilitation. We aimed to compare patients being offered extended rehabilitation (ERP) with those being offered standard rehabilitation (SRP) as concerns 1) attendance rates and 2) achievement of treatment goals...

  16. Value of plasma ADMA in predicting cardiac structure and function of patients with chronic kidney diseases

    Institute of Scientific and Technical Information of China (English)

    叶建华

    2012-01-01

    Objective To explore the predicting value of plasma asymmetric dimethylarginine (ADMA) in cardiac structure and function of patients with chronic kidney diseases(CKD). Methods A total of 100 CKD patients were enrolled in this cross-sectional study. According to staging of the

  17. Progression of cardiac involvement in patients with limb-girdle type 2 and Becker muscular dystrophies

    DEFF Research Database (Denmark)

    Petri, Helle; Sveen, Marie-Louise; Thune, Jens Jakob;

    2015-01-01

    AIM: To assess the degree and progression of cardiac involvement in patients with limb-girdle type 2 (LGMD2) and Becker muscular dystrophies (BMD). METHODS: A follow-up study of 100 LGMD2 (types A-L) and 30 BMD patients assessed by electrocardiogram (ECG) and echocardiography, supplemented...

  18. Cardiac Responses during Picture Viewing in Young Male Patients with Schizophrenia

    Directory of Open Access Journals (Sweden)

    Roelie J. Hempel

    2012-01-01

    Full Text Available Previous research investigating the emotion recognition ability in patients with schizophrenia has mainly focused on the recognition of facial expressions. To broaden our understanding of emotional processes in patients with schizophrenia, this study aimed to investigate whether these patients experience and process other emotionally evocative stimuli differently from healthy participants. To investigate this, we measured the cardiac and subjective responses of 33 male patients (9 with and 24 without antipsychotic medication and 40 male control subjects to emotion-eliciting pictures. Cardiac responses were chosen as an outcome measure because previous research has indicated that these are linked with attentional and emotional processes and provide a more objective measure than self-report measures alone. The differences in cardiac responses between patients and controls were limited to medicated patients: only the medicated patients showed significantly decreased cardiac orienting responses compared with control subjects, regardless of picture contents. These results indicate that medicated patients directed less attention towards emotion-eliciting pictures than controls. Decreased attentional resources while processing emotional evocative stimuli could lead to incorrect appraisals of the environment and may have detrimental emotional and social consequences, contributing to chronic stress levels and an increased risk for cardiovascular disease.

  19. Predicting non-return to work in patients attending cardiac rehabilitation

    DEFF Research Database (Denmark)

    Samkange-Zeeb, Florence; Altenhöner, Thomas; Berg, Gabriele;

    2006-01-01

    Return to work (RTW) is the primary goal in the rehabilitation of patients suffering from coronary heart diseases. However, in spite of expensive rehabilitative efforts, many patients do not resume work following cardiac rehabilitation. To increase cost-effectiveness, predictive tests for non-RTW...

  20. Cardiac disease in patients with mucopolysaccharidosis: presentation, diagnosis and management

    OpenAIRE

    Braunlin, Elizabeth A.; Harmatz, Paul R.; Scarpa, Maurizio; Furlanetto, Beatriz; Kampmann, Christoph; Loehr, James P.; Ponder, Katherine P.; Roberts, William C.; Rosenfeld, Howard M.; Giugliani, Roberto

    2011-01-01

    The mucopolysaccharidoses (MPSs) are inherited lysosomal storage disorders caused by the absence of functional enzymes that contribute to the degradation of glycosaminoglycans (GAGs). The progressive systemic deposition of GAGs results in multi-organ system dysfunction that varies with the particular GAG deposited and the specific enzyme mutation(s) present. Cardiac involvement has been reported in all MPS syndromes and is a common and early feature, particularly for those with MPS I, II, and...

  1. MULTIPLE FACETS OF REHABILITATION IN ELDERLY PATIENTS AFTER CARDIAC SURGERY

    OpenAIRE

    Maura Gabriela FELEA; Florin MITU; Maria M. LEON

    2014-01-01

    The elderly rehabilitation program after coronary artery bypass graft (CABG) encompasses endurance training performed on a cycloergometer and physical rehabilitation, the results being exceeded by adding strength and balance exercises. Early initiation of mobilization exercises can prevent problems of posture, as well as thoraco-pulmonary and scapular-humeral articulation conditions often encountered after cardiac surgery. The results of special functional training in elderly can be assessed ...

  2. Cardiac Acceleration at the Onset of Exercise : A Potential Parameter for Monitoring Progress During Physical Training in Sports and Rehabilitation

    NARCIS (Netherlands)

    Hettinga, Florentina J.; Monden, Paul G.; van Meeteren, Nico L. U.; Daanen, Hein A. M.

    2014-01-01

    There is a need for easy-to-use methods to assess training progress in sports and rehabilitation research. The present review investigated whether cardiac acceleration at the onset of physical exercise (HRonset) can be used as a monitoring variable. The digital databases of Scopus and PubMed were se

  3. Invasive and non-invasive methods for cardiac output measurement

    OpenAIRE

    Lavdaniti M.

    2008-01-01

    The hemodynamic status monitoring of high-risk surgical patients and critically ill patients inIntensive Care Units is one of the main objectives of their therapeutic management. Cardiac output is one of the mostimportant parameters for cardiac function monitoring, providing an estimate of whole body perfusion oxygen deliveryand allowing for an understanding of the causes of high blood pressure. The purpose of the present review is thedescription of cardiac output measurement methods as prese...

  4. Effects of levosimendan for low cardiac output syndrome in critically ill patients

    DEFF Research Database (Denmark)

    Koster, Geert; Wetterslev, Jørn; Gluud, Christian;

    2015-01-01

    PURPOSE: To assess the benefits and harms of levosimendan for low cardiac output syndrome in critically ill patients. METHODS: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials comparing levosimendan with any type of control. Two...... populations was considered inappropriate. Pooled analysis of 30 trials including critically ill patients not having cardiac surgery showed an association between levosimendan and mortality (RR 0.83, TSA-adjusted 95 % CI 0.59-0.97), while trials with lower risk of bias showed no significant difference (RR 0.......83, TSA-adjusted 95 % CI 0.48-1.55). Conventional meta-analysis of all 14 trials including cardiac surgery patients showed an association, while lower risk of bias trials showed no association between levosimendan and mortality (RR 0.52, 95 % CI 0.37-0.73 versus RR 1.02, 95 % CI 0.48-2.16). CONCLUSIONS...

  5. Pseudoxanthoma elasticum: cardiac findings in patients and Abcc6-deficient mouse model.

    Directory of Open Access Journals (Sweden)

    Fabrice Prunier

    Full Text Available BACKGROUND: Pseudoxanthoma elasticum (PXE, caused by mutations in the ABCC6 gene, is a rare multiorgan disease characterized by the mineralization and fragmentation of elastic fibers in connective tissue. Cardiac complications reportedly associated with PXE are mainly based on case reports. METHODS: A cohort of 67 PXE patients was prospectively assessed. Patients underwent physical examination, electrocardiogram, transthoracic echocardiography, cardiac magnetic resonance imaging (CMR, treadmill testing, and perfusion myocardial scintigraphy (SPECT. Additionally, the hearts of a PXE mouse models (Abcc6(-/- and wild-type controls (WT were analyzed. RESULTS: Three patients had a history of proven coronary artery disease. In total, 40 patients underwent exercise treadmill tests, and 28 SPECT. The treadmill tests were all negative. SPECT showed mild perfusion abnormalities in two patients. Mean left ventricular (LV dimension and function values were within the normal range. LV hypertrophy was found in 7 (10.4% patients, though the hypertrophy etiology was unknown for 3 of those patients. Echocardiography revealed frequent but insignificant mitral and tricuspid valvulopathies. Mitral valve prolapse was present in 3 patients (4.5%. Two patients exhibited significant aortic stenosis (3.0%. While none of the functional and histological parameters diverged significantly between the Abcc6(-/- and WT mice groups at age of 6 and 12 months, the 24-month-old Abcc6(-/- mice developed cardiac hypertrophy without contractile dysfunction. CONCLUSIONS: Despite sporadic cases, PXE does not appear to be associated with frequent cardiac complications. However, the development of cardiac hypertrophy in the 24-month-old Abcc6(-/- mice suggests that old PXE patients might be prone to developing late cardiopathy.

  6. Multisite Tissue Oxygenation Monitoring Indicates Organ-Specific Flow Distribution and Oxygen Delivery Related to Low Cardiac Output in Preterm Infants With Clinical Sepsis

    NARCIS (Netherlands)

    van der Laan, Michelle E; Roofthooft, Marc; Fries, Marian W A; Schat, Trijntje E; Bos, Arend F; Berger, Rolf M F; Kooi, Elisabeth M W

    2016-01-01

    OBJECTIVES: Cardiac output may be compromised in preterm infants with sepsis. Whether low cardiac output is associated with low tissue oxygen supply in these patients is unclear. The aim of the current study was to assess the association between cardiac output, assessed by echocardiography, and tiss

  7. Cardiac Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy parameter predicts cardiac and cerebrovascular events in type 2 diabetic patients without structural heart disease

    International Nuclear Information System (INIS)

    Cardiac iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy is an established method of assessment of cardiovascular sympathetic function. The aim of the present study was to investigate the long-term cardiovascular predictive value of cardiac 123I-MIBG scintigraphy parameters in Japanese type 2 diabetic patients without structural heart disease. Cardiac 123I-MIBG scintigraphy in 108 patients with type 2 diabetes who did not have structural heart disease, was evaluated. The washout rate (WR) was considered enhanced if it was ≥40%. Accurate follow-up information for 4.6 years was obtained in 54 enhanced WR patients (27 male; mean age, 61±11 years) and in 54 sex- and age-matched preserved WR patients (27 male; mean age, 61±10 years). Major adverse cardiac and cerebrovascular events (MACCE) were investigated. During follow-up, 10 enhanced WR patients developed MACCE including cardiac death, coronary revascularization, stroke, and congestive heart failure, while MACCE occurred in only 3 male patients. The Kaplan-Meier curves indicated that enhanced WR patients had higher incidence of MACCE than those with preserved WR (P123I-MIBG scintigraphy at baseline has long-term cardiovascular predictive value in Japanese patients with type 2 diabetes without structural heart disease. (author)

  8. Cardiac arrest after sugammadex administration in a patient with variant angina: a case report

    Science.gov (United States)

    Kim, Yong Han; Kang, Eunsu; Lee, Byeong-Cheol; Lee, Sujung

    2016-01-01

    A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.

  9. Developing a visualized patient-centered, flow-based and objective-oriented care path of cardiac catheterization examination.

    Science.gov (United States)

    Kuo, Ming Chuan; Chang, Polun

    2009-01-01

    It has been known that visualization is a user-preferred and more meaningful interface of information systems. To reduce the anxiety and uncertainty of patients, we transformed the sophisticated process of cardiac catheterization into visualized information. The Microsoft Visio 2003 and Excel 2003 with the VBA automation tool were used to design a process flow of Cardiac Catheterization. The results show the technical feasibility and potentials helpful for patient to realize the nursing process of cardiac catheterization. PMID:19593031

  10. Daptomycin as supportive treatment option in patients developing mediastinitis after open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Weis Florian

    2012-09-01

    Full Text Available Abstract Background Mediastinitis is a severe complication after cardiac surgery. While improvement of prophylaxis and of medical and surgical therapy has reduced its incidence, the treatment of mediastinitis continues to be a challenging problem. Within this study, we report the successful use of daptomycin as supportive therapy in patients developing mediastinitis after open cardiac surgery. Methods The records of 21 consecutive patients who developed mediastinitis after cardiac surgery were retrospectively reviewed. After diagnosis, all patients received surgical debridement and antibiotic therapy with daptomycin. All patients were followed up to death or discharge. Results Clinical improvement after combined surgical and antibiotic therapy with daptomycin was found in 90.5% of the patients. The median time until clinical improvement occurred was 5 [4/6] days. Daptomycin was well-tolerated and no major adverse events during therapy were observed observed. Conclusions This study provides new and helpful information regarding the beneficial use of daptomycin as supportive treatment option in patients developing mediastinitis after cardiac surgery.

  11. Major depressive disorder predicts cardiac events in patients with coronary artery disease.

    Science.gov (United States)

    Carney, R M; Rich, M W; Freedland, K E; Saini, J; teVelde, A; Simeone, C; Clark, K

    1988-01-01

    Fifty-two patients undergoing cardiac catheterization and subsequently found to have significant coronary artery disease (CAD) were given structured psychiatric interviews before catheterization. Nine of these patients met criteria for major depressive disorder. All 52 patients were contacted 12 months after catheterization, and the occurrence of myocardial infarction, angioplasty, coronary bypass surgery and death was determined. Results of the study show that major depressive disorder was the best predictor of these major cardiac events during the 12 months following catheterization. The predictive effect was independent of the severity of CAD, left ventricular ejection fraction, and the presence of smoking. Furthermore, with the exception of smoking, there were no statistically significant differences between those patients with major depressive disorder and the remaining patients on any variable studied. The possible mechanisms relating major depressive disorder to subsequent cardiac events are discussed. It is concluded that major depressive disorder is an important independent risk factor for the occurrence of major cardiac events in patients with CAD. PMID:2976950

  12. Telemetry system for monitoring the ECG for patients with high cardiovascular risk. Main design requirements and technical solutions

    International Nuclear Information System (INIS)

    In this paper the main design requirements concerning the setting up of a telemetry ECG monitoring system are presented. The design's most important technical solutions as well as some details are also discussed. This system is intended to provide skilled medical assistance during the cardiac rehabilitation of both asymptomatic and high risk coronary patients

  13. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    Directory of Open Access Journals (Sweden)

    Viveka P Jyotsna

    2013-01-01

    Full Text Available Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04. The change in sympathetic functions in the standard therapy group was not significant (P 0.75.Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06. In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99. Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

  14. Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients.

    Science.gov (United States)

    Sebern, Margaret; Brown, Roger; Flatley-Brennan, Patricia

    2016-07-01

    Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study's purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes. PMID:26864996

  15. Bortezomib-Induced Complete Heart Block and Myocardial Scar: The Potential Role of Cardiac Biomarkers in Monitoring Cardiotoxicity

    Directory of Open Access Journals (Sweden)

    Sachin Diwadkar

    2016-01-01

    Full Text Available Bortezomib is a proteasome inhibitor used to treat multiple myeloma and mantle cell lymphoma. Traditionally, bortezomib was thought to have little cardiovascular toxicity; however, there is increasing evidence that bortezomib can lead to cardiac complications including left ventricular dysfunction and atrioventricular block. We present the case of a 66-year-old man with multiple myeloma and persistent asymptomatic elevations of cardiac biomarkers who developed complete heart block and evidence of myocardial scar after his eighth cycle of bortezomib, requiring permanent pacemaker placement. In addition to discussing the cardiovascular complications of bortezomib therapy, we propose a potential role for biomarkers in the prediction and monitoring of bortezomib cardiotoxicity.

  16. Cardiac involvement in myotonic muscular dystrophy (Steinert's disease): a prospective study of 25 patients

    International Nuclear Information System (INIS)

    The presence, degree and frequency of disorders of cardiac conduction and rhythm and of regional or global myocardial dystrophy or myotonia have not previously been studied prospectively and systematically in the same population of patients with myotonic dystrophy. Accordingly, 25 adults with classic Steinert's disease underwent electrocardiography, 24-hour ambulatory electrocardiography, vectorcardiography, chest x-rays, echocardiography, electrophysiologic studies, and technetium-99m angiography. Clinically important cardiac manifestations of myotonic dystrophy reside in specialized tissues rather than in myocardium. Involvement is relatively specific, primarily assigned to the His-Purkinje system. The cardiac muscle disorder takes the form of dystrophy rather than myotonia, and is not selective, appearing with approximately equal distribution in all 4 chambers. Myocardial dystrophy seldom results in clinically overt ventricular failure, but may be responsible for atrial and ventricular arrhythmias. Since myotonic dystrophy is genetically transmitted, a primary biochemical defect has been proposed with complete expression of the gene toward striated muscle tissue, whether skeletal or cardiac. Specialized cardiac tissue and myocardium have close, if not identical, embryologic origins, so it is not surprising that the genetic marker affects both. Cardiac involvement is therefore an integral part of myotonic dystrophy, targeting particularly the infranodal conduction system, to a lesser extent the sinus node, and still less specifically, the myocardium

  17. Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2013-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

  18. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction

    OpenAIRE

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-01-01

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion (“ACS” lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and ...

  19. Single center experience with intrathoracic impedance monitoring in chronic heart failure patients

    Institute of Scientific and Technical Information of China (English)

    QIAO Qing; HUA Wei; DING Li-gang; CHEN Ke-ping; WANG Jing; WANG Fang-zheng; ZHANG Shu

    2011-01-01

    Background The Medtronic InSync Sentry is the first available cardiac resynchronization therapy defibrillator (CRT-D)which can monitor fluid status by measuring intrathoracic impedance. This study was designed to observe the effectiveness of intrathoracic impedance monitoring on detecting aggravation of heart failure.Methods We retrospectively analyzed the clinical data of 14 consecutive patients. Patients were regularly followed up every 3-6 months after the implantation. At each visit, interrogation of the device was done. Patients were instructed to inform the researcher on hearing the device alert, and to take extra 40 milligrams of furosemidum if they had aggravated symptoms later. If the symptoms could not be relieved, they were asked to see a doctor. Data about heart failure hospitalization were collected from the medical record.Results During 18-48 months follow-up, a total of 7 patients encountered 28 alert events. On one hand, alert events appeared before all deteriorated symptoms and heart failure hospitalizations. On the other hand, there were 23 alerts followed by deterioration of heart failure symptoms, and 2 alerts related to 2 hospitalizations caused by pulmonary infection in one patient. Only 5 patients were hospitalized 10 times for deterioration of cardiac function.Conclusion The function of intrathoracic impedance monitoring is reliable in predicting deterioration of heart failure.

  20. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Pedersen, Preben Ulrich; Zwisler, Ann-Dorthe;

    2015-01-01

    Aims:The aim of this randomised clinical trial was to assess a comprehensive cardiac rehabilitation intervention including exercise training and psycho-education vs 'treatment as usual' in patients treated with an implantable cardioverter defibrillator (ICD).Methods:In this study 196 patients...... with first time ICD implantation (mean age 57.2 (standard deviation (SD)=13.2); 79% men) were randomised (1:1) to comprehensive cardiac rehabilitation vs 'treatment as usual'. Altogether 144 participants completed the 12 month follow-up. The intervention consisted of twelve weeks of exercise training and one...... rehabilitation significantly increased VO2 uptake after exercise training to 23.0 (95% confidence interval (CI) 20.9-22.7) vs 20.8 (95% CI 18.9-22.7) ml/min/kg in the control group (p=0.004 (multiplicity p=0.015)). Comprehensive cardiac rehabilitation significantly increased general health; at three months (mean...

  1. The cardiac safety of aripiprazole treatment in patients at high risk for torsade

    DEFF Research Database (Denmark)

    Polcwiartek, Christoffer; Sneider, Benjamin; Graff, Claus;

    2015-01-01

    reviewed and cardiac safety data were extracted. Continuous and dichotomous QTc data were used in the meta-analysis. RESULTS: Preclinical studies suggested that aripiprazole has limited affinity for the delayed rectifier potassium current. TdP was reported in two case reports and SCD was reported in one...... case report and one case series. No clinical studies assessing aripiprazole's cardiac safety in patients at high risk for torsade were found. No thorough QT (TQT) study with aripiprazole was found. The meta-analysis revealed that the mean ΔQTc interval was decreased with aripiprazole and QTc...... factors. OBJECTIVES: Aripiprazole's cardiac safety has not been assessed in patients at high risk for torsade, where QTc prolongation risk is highly increased. METHODS: MEDLINE, Embase, and The Cochrane Library were searched for preclinical, clinical, and epidemiological studies. Eligible studies were...

  2. Effect of weight support exercise therapy on the cardiac function in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    Dong-Dong Jiao; Wen-Yu Zhang; Jing Xu; Guang-Jian Zhu; Jia Chen

    2016-01-01

    Objective:To explore the effect of weight support exercise therapy on the cardiac function and living quality in patients with chronic heart failure.Methods: A total of 75 patients with CHF were included in the study and randomized into the observation group (n=38) and the control group (n=37). the patients in the control group were given routine drug therapy. on the above basis, the patients in the observation group were given weight support exercise therapy for rehabilitation. six-month treatment was regarded as one course. the plasma BNP and aldosterone levels before and after treatment in the two groups were detected. the related cardiac function indicators in the two groups were compared. 6mwt and MHL were used to evaluate the exercise tolerance and living quality, respectively.Results:The comparison of plasma BNP and aldosterone levels, various cardiac function indicators, 6 min walking distance, and MHL score before treatment between the two groups was not statistically significant. BNP and aldosterone levels after treatment in the two groups were significantly reduced, and the reduced degree in the observation group was significantly greater than that in the control group. after treatment, HR, LVEDD, and MHL score were significantly reduced, LVEF, FS, and 6 min walking distance were significantly increased, and the comparison between the two groups was statistically significant.Conclusions:Weight support exercise therapy can significantly reduce the plasma BNP and aldosterone levels in CHF patients, improve the cardiac function, and enhance the exercise tolerance and living quality.

  3. Evaluation of cardiac ischaemia in cardiac asymptomatic newly diagnosed untreated patients with primary hypothyroidism

    NARCIS (Netherlands)

    A. Roos; S.K. Zoet-Nugteren; A. Berghout (Arie)

    2005-01-01

    textabstractBACKGROUND: Hypothyroidism is regarded as a risk factor for coronary artery disease. Possible factors involved in this association are hyperlipidaemia and hypertension, both occurring with increased frequency in hypothyroid patients. The aim of our study was to evaluate

  4. POST-OPERATIVE VENTRICULAR TACHYCARDIA LEADING TO CARDIAC ARREST IN AN ASAG- I PATIENT OF CHOLECYSTECTOMY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Pradip

    2014-03-01

    Full Text Available We here present our experience with ventricular tachycardia (VT leading to cardiac arrest in a patient with American Society of Anesthesiologists grade-I (ASA-I 11 hours after cholecystectomy. Excessive fluid overload and hypoxemia due to lung congestion may lead to cardiac arrest in this case. Immediate diagnosis and appropriate intervention saved the life of the patient.

  5. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

  6. Impaired cardiac sympathetic innervation in symptomatic patients with long QT syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kies, Peter; Stegger, Lars; Schober, Otmar [University Hospital Muenster, Department of Nuclear Medicine, Muenster (Germany); Paul, Matthias; Moennig, Gerold [University Hospital Muenster, Department for Cardiology and Angiology, Muenster (Germany); Gerss, Joachim [University of Muenster, Institute of Biostatistics and Clinical Research, Muenster (Germany); Wichter, Thomas [Marienhospital Osnabrueck, Department of Cardiology, Niels-Stensen-Kliniken, Osnabrueck (Germany); Schaefers, Michael [University of Muenster, European Institute of Molecular Imaging - EIMI, Muenster (Germany); Schulze-Bahr, Eric [University Hospital Muenster, Department for Cardiology and Angiology, Muenster (Germany); University Hospital Muenster, Institute for Genetics of Heart Diseases, Muenster (Germany)

    2011-10-15

    Increased sympathetic activation is a key modifier for arrhythmogenesis in patients with long QT syndrome (LQTS), a congenital channelopathy. Therefore, we investigated cardiac sympathetic function using {sup 123}I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) in a cohort of symptomatic LQTS patients and correlated these findings with the underlying genotype. [{sup 123}I]MIBG SPECT was performed in 28 LQTS patients. Among these, 18 patients (64%) had a previous syncope and 10 patients (36%) survived sudden cardiac arrest. Patients were characterized in terms of genetic subtypes and QTc interval on surface ECGs. SPECT images were analysed for regional [{sup 123}I]MIBG uptake in a 33-segment bullseye scheme and compared to those obtained from 10 age-matched healthy control subjects (43 {+-} 12 years). An abnormal {sup 123}I-MIBG scan was found in 17 of 28 LQTS patients (61%) with a tracer reduction mainly located in the anteroseptal segments of the left ventricle. This finding was independent of the genetic LQTS subtype. In addition, no differences were found between LQTS patients with a QTc >500 ms vs <500 ms or those suffering from syncope vs VF (p > 0.05). A distinct regional pattern of impaired cardiac sympathetic function was identified in the majority of symptomatic LQTS patients. This innervation defect was independent of the underlying genotype and clinical disease expression. (orig.)

  7. Impaired cardiac sympathetic innervation in symptomatic patients with long QT syndrome

    International Nuclear Information System (INIS)

    Increased sympathetic activation is a key modifier for arrhythmogenesis in patients with long QT syndrome (LQTS), a congenital channelopathy. Therefore, we investigated cardiac sympathetic function using 123I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) in a cohort of symptomatic LQTS patients and correlated these findings with the underlying genotype. [123I]MIBG SPECT was performed in 28 LQTS patients. Among these, 18 patients (64%) had a previous syncope and 10 patients (36%) survived sudden cardiac arrest. Patients were characterized in terms of genetic subtypes and QTc interval on surface ECGs. SPECT images were analysed for regional [123I]MIBG uptake in a 33-segment bullseye scheme and compared to those obtained from 10 age-matched healthy control subjects (43 ± 12 years). An abnormal 123I-MIBG scan was found in 17 of 28 LQTS patients (61%) with a tracer reduction mainly located in the anteroseptal segments of the left ventricle. This finding was independent of the genetic LQTS subtype. In addition, no differences were found between LQTS patients with a QTc >500 ms vs 0.05). A distinct regional pattern of impaired cardiac sympathetic function was identified in the majority of symptomatic LQTS patients. This innervation defect was independent of the underlying genotype and clinical disease expression. (orig.)

  8. Clinical Use of Ultrasensitive Cardiac Troponin I Assay in Intermediate- and High-Risk Surgery Patients

    Directory of Open Access Journals (Sweden)

    Flávia Kessler Borges

    2013-01-01

    Full Text Available Background. Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI assay could provide more accurate prognostic information. Methods. This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated. Results. cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI. After 30 days, 16 patients had major adverse cardiac events (MACE. Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperative major bleeding, and elevated levels of pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP. Maximal cTnI values showed the highest sensitivity (94%, specificity (75%, and overall accuracy (AUC 0.89; 95% CI 0.80–0.98 for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3–39.2 and a preoperative NT-proBNP level ≥917 pg/mL (OR 3.47; 95% CI 1.05–11.6 were independent risk factors for MACE. Conclusions. cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment.

  9. The Role of Levosimendan in Patients with Decreased Left Ventricular Function Undergoing Cardiac Surgery

    Science.gov (United States)

    Bozhinovska, Marija; Taleska, Gordana; Fabian, Andrej; Šoštarič, Maja

    2016-01-01

    The postoperative low cardiac output is one of the most important complications following cardiac surgery and is associated with increased morbidity and mortality. The condition requires inotropic support to achieve adequate hemodynamic status and tissue perfusion. While catecholamines are utilised as a standard therapy in cardiac surgery, their use is limited due to increased oxygen consumption. Levosimendan is calcium sensitising inodilatator expressing positive inotropic effect by binding with cardiac troponin C without increasing oxygen demand. Furthermore, the drug opens potassium ATP (KATP) channels in cardiac mitochondria and in the vascular muscle cells, showing cardioprotective and vasodilator properties, respectively. In the past decade, levosimendan demonstrated promising results in treating patients with reduced left ventricular function when administered in peri- or post- operative settings. In addition, pre-operative use of levosimendan in patients with severely reduced left ventricular ejection fraction may reduce the requirements for postoperative inotropic support, mechanical support, duration of intensive care unit stay as well as hospital stay and a decrease in post-operative mortality. However, larger studies are needed to clarify clinical advantages of levosimendan versus conventional inotropes.

  10. Cardiac anesthesia and surgery in geriatric patients: epidemiology, current surgical outcomes, and future directions.

    Science.gov (United States)

    Castillo, J G; Silvay, G; Chikwe, J

    2009-01-01

    The mean life expectancy of the population of the United States is projected to increase from 78.3 years at present to over 81 years in 2025, with a concomitant increase in the percentage of the population over the age of 75 years. Elderly patients are more likely to present with valvular and coronary artery disease than younger patients, and as better perioperative management contributes to improving post-operative outcomes and lower referral thresholds, very elderly patients form an increasingly large proportion of the cardiac surgical population. This article summarizes the impact of age-related pathophysiologic changes on patients' response to cardiac surgery and anesthesia, outlines useful perioperative strategies in this age group, and reviews the literature on outcomes after valvular and coronary in elderly patients.

  11. Improvement of cardiac function after kidney transplantation with dilated cardiomyopathy and long dialysis vintage.

    Science.gov (United States)

    Mimura, Imari; Kawarazaki, Hiroo; Momose, Toshimitsu; Shibagaki, Yugo; Fujita, Toshiro

    2009-12-01

    Patients with long dialysis vintage have low cardiac output for various reasons. Although kidney transplantation is known to improve cardiac mortality, patients are sometimes evaluated as contraindicated for transplantation because of cardiac risk. We successfully performed kidney transplantation for a patient with a long dialysis vintage and dilated cardiomyopathy. Sequential (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy suggested that amelioration of uraemia improved cardiac function. Kidney transplantation for patients with severely impaired cardiac function is safe and effective under careful perioperative monitoring irrespective of dialysis vintage. Sequential (123)I-MIBG scintigraphy can be used as an evaluation tool for the improvement in cardiac function.

  12. Smoking cessation in cardiac patients: the influence of action plans, coping plans and self-efficacy on quitting smoking.

    Science.gov (United States)

    de Hoog, Natascha; Bolman, Catherine; Berndt, Nadine; Kers, Esther; Mudde, Aart; de Vries, Hein; Lechner, Lilian

    2016-06-01

    Smoking cessation is the most effective action for cardiac patients who smoke to improve their prognosis, yet more than one-half of cardiac patients continue to smoke after hospital admission. This study examined the influence of action plans, coping plans and self-efficacy on intention to quit and smoking cessation in cardiac patients. Cardiac patients completed a baseline questionnaire (N = 245) assessing demographic characteristics, smoking behavior, intention, self-efficacy, relapse self-efficacy and action and coping plans. Six months later (N = 184) continued abstinence from smoking was assessed. Self-efficacy predicted intention to quit smoking and was an indirect predictor of continued abstinence, through intention. Intention to quit smoking and making action plans both directly influenced continued abstinence. Future interventions to facilitate smoking cessation in cardiac patients should put strong emphasis on enhancing self-efficacy and on making specific action plans to increase the likelihood of smoking cessation.

  13. Remote monitoring of heart failure patients.

    Science.gov (United States)

    Bhimaraj, Arvind

    2013-01-01

    "The Teledactyl (Tele, far; Dactyl, finger--from the Greek) is a future instrument by which it will be possible for us to 'feel at a distance.' This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance...The doctor manipulates his controls, which are then manipulated at the patient's room in exactly the same manner. The doctor sees what is going on in the patient's room by means of a television screen." -Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor.

  14. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  15. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Yih-Giun Cherng

    Full Text Available BACKGROUND: End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS: Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS: Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33 when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31 and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47 than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION: Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.

  16. Physical therapy intervention in patients with non-cardiac chest pain following a recent cardiac event: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Astrid T Berg

    2015-04-01

    Full Text Available Objectives: To assess the effect of two different physical therapy interventions in patients with stable coronary heart disease and non-cardiac chest pain. Methods: A randomized controlled trial was carried out at a university hospital in Norway. A total of 30 patients with known and stable coronary heart disease and self-reported persistent chest pain reproduced by palpation of intercostal trigger points were participating in the study. The intervention was deep friction massage and heat pack versus heat pack only. The primary outcome was pain intensity after the intervention period and 3 months after the last treatment session, measured by Visual Analogue Scale, 0 to 100. Secondary outcome was health-related quality of life. Results: Treatment with deep friction massage and heat pack gave significant pain reduction compared to heat pack only (–17.6, 95% confidence interval: –30.5, –4.7; p < 0.01, and the reduction was persistent at 3 months’ follow-up (–15.2, 95% confidence interval: –28.5, –1.8; p = 0.03. Health-related quality of life improved in all three domains in patients with no significant difference between groups. Conclusion: Deep friction massage combined with heat pack is an efficient treatment of musculoskeletal chest pain in patients with stable coronary heart disease.

  17. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Farhad Heidari; Helaleh Rabiee; Mahdi Sharif-Alhoseini; Hamid Shokoohi; Vafa Rahimi-Movaghar

    2012-01-01

    Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14%) had pericardial effusion,11 (22%) had hypovolemia,and 39 (78%) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR.

  18. Type D personality and cardiac mortality in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Smith, Otto R F; Pedersen, Susanne S.;

    2010-01-01

    Clinical predictors of cardiac mortality in chronic heart failure (CHF) are established, but less is known about chronic psychological predictors. Therefore, we examined the prognostic value of Type D personality (tendency to experience negative feelings and inhibit self-expression) in CHF patients....

  19. Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease

    NARCIS (Netherlands)

    S. Spronk (Sandra); J.L.H.R. Bosch (Ruud); C. Ryjewski (Connie); J. Rosenblum (Judy); G.C. Kaandorp (Guido); J.V. White (John); M.G.M. Hunink (Myriam)

    2008-01-01

    textabstractObjective: Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (

  20. Effect of a cardiac rehabilitation program on exercise oscillatory ventilation in Japanese patients with heart failure.

    Science.gov (United States)

    Yamauchi, Fumitake; Adachi, Hitoshi; Tomono, Jun-Ichi; Toyoda, Shigeru; Iwamatsu, Koichi; Sakuma, Masashi; Nakajima, Toshiaki; Oshima, Shigeru; Inoue, Teruo

    2016-10-01

    Although exercise oscillatory ventilation has emerged as a potent independent risk factor for adverse prognosis in heart failure, it is not well known whether cardiac rehabilitation can improve oscillatory ventilation. In this study, we investigated the magnitude of oscillations in ventilation before and after cardiac rehabilitation in chronic heart failure patients with exercise oscillatory ventilation. Cardiac rehabilitation (5-month program) was performed in 26 patients with chronic heart failure who showed an oscillatory ventilation pattern during cardiopulmonary exercise testing (CPX). After the 5-month rehabilitation program was completed, the patients again underwent CPX. To determine the magnitude of oscillations in ventilation, the amplitude and cycle length of the oscillations were calculated and compared with several other parameters, including biomarkers that have established prognostic value in heart failure. At baseline before cardiac rehabilitation, both oscillation amplitude (R = 0.625, P rehabilitation decreased oscillation amplitude (P rehabilitation program improves exercise oscillatory ventilation in chronic heart failure patients by reducing the oscillation amplitude. This effect is associated with a reduction of plasma BNP levels, potentially contributing to an improvement of heart failure.

  1. Predictors of arrhythmic sudden cardiac death in heart failure patients in the CARE-HF study

    DEFF Research Database (Denmark)

    Uretsky, B.; Cleland, J.G.F.; Freemantle, N.;

    2006-01-01

    Topic(s):Rsynchronisation therapy   Cardiac resynchronization therapy (CRT) has become an important modality to improve symptoms, exercise performance, and survival in patients with severe heart failure and left ventricular dyssynchrony. The CARE-HF study showed that CRT reduced mortality in syst...

  2. Non-potassium sparing diuretics and sudden cardiac death in hypertensive patients : a pharmacoepidemiologic approach

    NARCIS (Netherlands)

    A.W. Hoes (Arno)

    1992-01-01

    textabstractThe studies described in this thesis focus on the possible relationship between the use of non-potassium sparing diuretics and the occurrence of sudden cardiac death in hypertensive patients. To study this potential adverse drug reaction several methods were applied, including estimates

  3. First reported case of Aspergillus granulosus infection in a cardiac transplant patient.

    OpenAIRE

    Fakih, M G; Barden, G E; Oakes, C A; Berenson, C. S.

    1995-01-01

    We report a case of disseminated infection with Aspergillus granulosus in a cardiac transplant recipient on immunosuppressive therapy. This is the first reported case in which this organism has been described as a pathogen. This organism bears morphological features different from those of more common Aspergillus species and should be considered a potential pathogen in immunocompromised patients.

  4. Correlation between antiplatelet resistance and recurrent cardiac ischemic events of patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李蕾

    2012-01-01

    Objective To evaluate the predictive value of anti-platelet resistance assessed by whole blood electronic impedance aggregometry(EIA) for the risk of recurrent cardiac ischemic events in patients with acute myocardial infarction(AMI) who underwent coronary stenting. Methods We enrolled

  5. Cardiac rehabilitation for patients after coronary artery bypass graft surgery Nursing Interventions

    Directory of Open Access Journals (Sweden)

    Tsaloglidou A.

    2010-07-01

    Full Text Available Purpose: To describe the way by which the rehabilitation of the patients that have undergone cardiac surgery is performed, to present the content of the cardiac rehabilitation programs and to determine the nursing role in the whole process. Methodology: Literature review of the relevant articles in the databases pubmed and scopus. Results: The patients with coronary heart disease usually face a lot of problems in their everyday life. Coronary artery bypass graft surgery (CABG is commonly performed to improve the quality of patients’ life and to extend their survival. Ιn order for the positive results of the surgery to be maintained and the quality of patients’ life to be improved, it is essential that the patients participate after the surgery in programs of cardiac rehabilitation. The cardiac rehabilitation programs are usually consisted of four phases and they involve a variety of interventions including exercise training, suitable drug therapy, psychological input, risk factor education, as well as teaching for the rules of a healthy diet. Conclusions: Nurses and other health care professionals have to inform the patients of the existing rehabilitation programs and instruct to participate in them as well as to return in the daily life activities.

  6. [Permanent cardiac stimulation in a patient with isolated dextrocardia and ventricular septal defect].

    Science.gov (United States)

    Słowiński, S; Derlaga, B; Kapusta, J

    A case of pacemaker implantation because of acquired atrioventricular block third degree in woman aged 39 years with rare isolated dextrocardia with inversion of cardiac ventricles, compensatory transposition of both aorta and pulmonary artery, and ventricular septal defect. The end of electrode has wedged in the apex of the arterial ventricle. Following pacemaker implantation, patients clinical course of gynaecological operation was uneventful.

  7. Heart rate variability characterized by refined multiscale entropy applied to cardiac death in ischemic cardiomyopathy patients

    OpenAIRE

    Caminal Magrans, Pere; Valencia Murillo, José Fernando; Vallverdú Ferrer, Montserrat; Schroeder, Rico; Cygankiewicz, I.; Vázquez, Rafael; Bayes de Luna, Antonio; Porta, Alberto; Voss, Andreas

    2010-01-01

    In this work, Refined Multiscale Entropy (RMSE) was applied to characterize risk of cardiac death in ischemic cardiomyopathy patients, analyzing heart rate variability (HRV) by means of RR series during daytime and nighttime. RMSE approach measures an entropy rate in different time scales of a series, giving a multiscale characterization of complexity of that series. RMSE showed statistically significant differences (p

  8. 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; Diederichsen, Axel Cosmus Pyndt;

    2015-01-01

    inflammatory myopathies (IIM) by means of non-invasive techniques. METHODS: Fourteen patients with IIM (8 polymyositis, 4 dermatomyositis, 2 cancer-associated dermatomyositis) and 14 gender- and age- matched healthy control subjects were investigated. Participant assessments included a cardiac questionnaire...

  9. Participation in sports groups for patients with cardiac problems : An experimental study

    NARCIS (Netherlands)

    Schaperclaus, G; deGreef, M; Rispens, P; deCalonne, D; Landsman, M; Lie, KI; Oudhof, J

    1997-01-01

    An experimental study was carried out to determine the influence of participation in Sports Groups for Patients with Cardiac Problems (SPCP) on physical and mental fitness and on risk factor level after myocardial infarction. SPCP members (n = 74; 67 men and 7 women) were compared with Nonsporting P

  10. Incidence of cardiac conduction disorders in patients with rheumatic disease receiving hydroxychloroquine

    Directory of Open Access Journals (Sweden)

    Vijaya Prasanna Parimi

    2015-06-01

    Conclusion: This study highlights need for periodic cardiac evaluation of patients receiving long-term antimalarials. Reversibility of antimalarial toxicity is also highlighted in this study. Conduction disorders observed were similar to that expected in general population thus adding further evidence on safety of HCQ. [Int J Basic Clin Pharmacol 2015; 4(3.000: 565-567

  11. Sexual Problems in Cardiac Patients How to Assess, When to Refer

    NARCIS (Netherlands)

    Jaarsma, Tiny; Steinke, Elaine E.; Gianotten, Woet L.

    2010-01-01

    It is increasingly realized that discussing sexuality is an important issue in the holistic care for cardiac patients. In this review article, the conditions of a good assessment of sexual problems are identified such as creating an appropriate environment, ensuring confidentiality, and using approp

  12. Cardiac assessment of patients with late stage Duchenne muscular dystrophy

    NARCIS (Netherlands)

    van Bockel, E. A. P.; Lind, J. S.; Zijlstra, J. G.; Wijkstra, P. J.; Meijer, P. M.; van den Berg, M. P.; Slart, R. H. J. A.; Aarts, L. P. H. J.; Tulleken, J. E.

    2009-01-01

    Background. Duchenne muscular dystrophy (DMD) patients used to die mainly from pulmonary problems. However, as advances in respiratory care increase life expectancy, mortality due to cardiomyopathy rises. Echocardiography remains the standard diagnostic modality for cardiomyopathy in DMD patients, b

  13. Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

    Science.gov (United States)

    Lee, Sang Hyun; Lee, Dae Sung; Lee, Soo Yong; Hwang, Jongmin; Chon, Min Ku; Hwang, Ki Won; Kim, Jeong Su; Park, Yong Huyn; Kim, June Hong

    2016-01-01

    Background and Objectives Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients. Subjects and Methods The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications). Results We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group. Conclusion Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients. PMID:27014351

  14. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2012-01-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  15. Predicted risks of radiogenic cardiac toxicity in two pediatric patients undergoing photon or proton radiotherapy

    International Nuclear Information System (INIS)

    Hodgkin disease (HD) and medulloblastoma (MB) are common malignancies found in children and young adults, and radiotherapy is part of the standard treatment. It was reported that these patients who received radiation therapy have an increased risk of cardiovascular late effects. We compared the predicted risk of developing radiogenic cardiac toxicity after photon versus proton radiotherapies for a pediatric patient with HD and a pediatric patient with MB. In the treatment plans, each patient’s heart was contoured in fine detail, including substructures of the pericardium and myocardium. Risk calculations took into account both therapeutic and stray radiation doses. We calculated the relative risk (RR) of cardiac toxicity using a linear risk model and the normal tissue complication probability (NTCP) values using relative seriality and Lyman models. Uncertainty analyses were also performed. The RR values of cardiac toxicity for the HD patient were 7.27 (proton) and 8.37 (photon), respectively; the RR values for the MB patient were 1.28 (proton) and 8.39 (photon), respectively. The predicted NTCP values for the HD patient were 2.17% (proton) and 2.67% (photon) for the myocardium, and were 2.11% (proton) and 1.92% (photon) for the whole heart. The predicted ratios of NTCP values (proton/photon) for the MB patient were much less than unity. Uncertainty analyses revealed that the predicted ratio of risk between proton and photon therapies was sensitive to uncertainties in the NTCP model parameters and the mean radiation weighting factor for neutrons, but was not sensitive to heart structure contours. The qualitative findings of the study were not sensitive to uncertainties in these factors. We conclude that proton and photon radiotherapies confer similar predicted risks of cardiac toxicity for the HD patient in this study, and that proton therapy reduced the predicted risk for the MB patient in this study

  16. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-12-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  17. Prognostic value of high-sensitivity cardiac troponin T in patients with en-domyocardial-biopsy proven cardiac amyloidosis

    Institute of Scientific and Technical Information of China (English)

    Geng QIAN; Chen WU; Yang ZHANG; Yun-Dai CHEN; Wei DONG; Yi-Hong REN

    2014-01-01

    Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age (56 ±12 years vs. 50 ±15 years, P=0.022), higher incidences of heart failure (36.92%vs. 16.22%, P=0.041), pericardial effusion (60.00%vs. 35.14%, P=0.023), greater thickness of interventricular septum (IVS) (15 ±4 mm vs. 13 ±4 mm, P=0.034), higher level of hs-cTnT (0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001) and higher NT-proBNP (N-terminal pro-B-type natriuretic pep-tide) levels (11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006). At multivariate Cox regression analysis, heart failure (HR:1.78, 95%CI:1.09-2.92, P=0.021), greater wall thickness of IVS (HR:1.44, 95%CI:1.04-3.01, P=0.0375) and higher hs-cTnT level (HR:6.16, 95%CI:2.20-17.24, P=0.001) at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.

  18. Effect of Cardiac Resynchronization Therapy in Patients With Insulin-Treated Diabetes Mellitus

    DEFF Research Database (Denmark)

    Szepietowska, Barbara; Kutyifa, Valentina; Ruwald, Martin H;

    2015-01-01

    branch block in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy trial. Treatment with CRT-D versus implantable cardioverter defibrillator was associated with 76% risk reduction in all-cause mortality (hazard ratio 0.24; 95% confidence interval 0.08 to 0...... by the presence of insulin treatment. We determined whether cardiac resynchronization therapy with defibrillator (CRT-D) versus implantable cardioverter defibrillator improves clinical outcomes in these 3 subgroups. Cox proportional hazards regression models were used to analyze 1,278 patients with left bundle...

  19. Use of nitric oxide in thoracic surgery for a high risk cardiac patient

    Directory of Open Access Journals (Sweden)

    Vishal Garg

    2014-01-01

    Full Text Available Nitric oxide (NO is a selective pulmonary vasodilator especially in the presence of pulmonary artery hypertension. With right ventricle (RV dysfunction, inhaled NO may increase RV ejection fraction and cardiac output. The main advantage of NO over intravenous therapy is its inability to decrease systemic pressure thereby maintaining the coronary perfusion pressure and the myocardial perfusion. In this case report, we discuss the use of NO in a routine thoracic surgery patient suffering with severe left ventricular dysfunction and a potential candidate for a very high cardiac risk.

  20. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure

    Science.gov (United States)

    Schmid, Jean‐Paul; Noveanu, Markus; Morger, Cyrill; Gaillet, Raymond; Capoferri, Mauro; Anderegg, Matthias; Saner, Hugo

    2007-01-01

    Background Whole‐body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation. Aim To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF). Methods 10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (V̇o2) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak V̇o2 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak V̇o2 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32°C) water immersion and exercise was measured using a non‐invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming. Results Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). V̇o2 during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls. Conclusions Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak V̇o2 of at least 15 ml/kg/min during a symptom‐limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and V̇o2 are lower than in patients

  1. A STUDY ON ASYMPTOMATIC CARDIAC CHANGES IN TYPE 2 DIABETES PATIENTS

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    Ramchandra Rao

    2015-06-01

    Full Text Available INTRODUCTION: Majority of the time the patient of Diabetes presents with complications like Myocardial infarction, heart failure, being end stages of cardiovascular 2 disease associated with other macro and microvascular complications. If patients are screened at an early stage of Diabetes before the onset of symptoms the cardiovascular complications can be delayed and mortality can be reduced . There are only few studies in India done to screen asymptomatic diabetic individuals for cardiovascular compli cations. This study is done in view of screening the asymptomatic individuals in our area to prevent complications. With the available infrastructure, ECG, 2D ECHO were done in 50 patients who met inclusion, exclusion criterias, the changes were noted and the cardiac status was evaluated. AIM AND OBJECTIVES : “To study the asymptomatic cardiac changes in type2 Diabetes patients”. To observe the ECG changes in patients of type2 Diabetes without any symptoms of cardiac disease. To evaluate the ECG changes along with 2DECHO findings in asymptomatic cardiac patients of type 2 Diabetes. To study the correlation between these two investigations and evaluate the cardiac status of the individual. CONCLUSIONS : M ost of the patients in study group belong to 5 th decade , Males with Diabetes were almost double that of females , Most of the patients had duration of Diabetes as 5yrs , Less than half of patients had family history of Diabetes , Half of the group had alcohol, smoking habits , More than half of patients were overweight , Only 20% had good control of Diabetes , Total cholesterol is above normal in almost all of the patients, LDL is elevated in half of the patients, triglycerides in most of them, there is significant dyslipidemia in patients of Diabetes , Only 6 had normal ECG. Rest of them have LVH, ischemia , 18 patients had changes in echo including LVD, regional and global hypokinesias , t hus the present study shows patients with type 2

  2. Effects of Obstructive Sleep Apnea on Cardiac Function and Clinical Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

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    Baoxin Liu

    2014-01-01

    Full Text Available Aim. The objective of this study was to investigate the influence of OSA on cardiac function in Chinese patients with ST-elevation myocardial infarction (STEMI and determine the prognostic impact of OSA among these patients. Methods. In this retrospective study, 198 STEMI patients were enrolled. Doppler echocardiography was performed to detect the effect of OSA on cardiac function. Major adverse cardiac events (MACE and cardiac mortality were analyzed to determine whether OSA was a clinical prognostic factor; its prognostic impact was then assessed adjusting for other covariates. Results. The echocardiographic results showed that the myocardium of STEMI patients with OSA appeared to be more hypertrophic and with a poorer cardiac function compared with non-OSA STEMI patients. A Kaplan-Meier survival analysis revealed significantly higher cumulative incidence of MACE and cardiac mortality in the OSA group compared with that in the non-OSA group during a mean follow-up of 24 months. Multivariate Cox regression analysis revealed that OSA was an independent risk factor for MACE and cardiac mortality. Conclusion. These results indicate that the OSA is a powerful predictor of decreased survival and exerts negative prognostic impact on cardiac function in STEMI patients.

  3. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

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    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.

  4. Metoclopramide-induced cardiac arrest

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    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

  5. Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation.

    Science.gov (United States)

    Kim, Sang; DeMaria, Samuel; Cohen, Edmond; Silvay, George; Zerillo, Jeron

    2016-09-01

    We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation. Cardiothoracic surgery was consulted for potential use of extracorporeal membrane oxygenation, however, the myocardial function improved and the surgery was completed without further intervention. On postoperative day 6, the patient was extubated without neurologic or cardiac impairment. The patient continues to do well 2 years posttransplant, able to perform independent daily activities of living and his previous job. This case underscores the potential for positive outcomes with profoundly prolonged, effective advanced cardiovascular life support in patients who experience postreperfusion syndrome. PMID:27233818

  6. Electrocardiographic Presentation, Cardiac Arrhythmias, and Their Management in β-Thalassemia Major Patients.

    Science.gov (United States)

    Russo, Vincenzo; Rago, Anna; Papa, Andrea Antonio; Nigro, Gerardo

    2016-07-01

    Beta-thalassemia major (β-TM) is a genetic hemoglobin disorder characterized by an absent synthesis of globin chains that are essential for hemoglobin formation, causing chronic hemolytic anemia. Clinical management of thalassemia major consists in regular long-life red blood cell transfusions and iron chelation therapy to remove iron introduced in excess with transfusions. Iron deposition in combination with inflammatory and immunogenic factors is involved in the pathophysiology of cardiac dysfunction in these patients. Heart failure and arrhythmias, caused by myocardial siderosis, are the most important life-limiting complications of iron overload in beta-thalassemia patients. Cardiac complications are responsible for 71% of global death in the beta-thalassemia major patients. The aim of this review was to describe the most frequent electrocardiographic abnormalities and arrhythmias observed in β-TM patients, analyzing their prognostic impact and current treatment strategies. PMID:27324981

  7. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: A cohort study of cardiac function

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    Reza Karbasi Afshar

    2015-01-01

    Full Text Available Introduction: Cardiac resynchronization therapy (CRT is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG, with and without CRT-defibrillator (CRT-D inserting and then measured its effects on these two groups. Patients and Methods: Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG and Group 2 ( n = 52 without receiving CRT-D. Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF, echocardiographic assessment, and New York Heart Association (NYHA class level. Results: The mean age of participants in Group 1 (48 male and in Group 2 (52 male was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF changes and NYHA class level was significant ( P > 0.05. Hospitalization ( P = 0.008, mortality rate ( P = 0.007, and AF were significantly different between these two groups. Conclusions: The results showed that the increase in LVEF and patient′s improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.

  8. Myocardial Scintigraphy in the Evaluation of Cardiac Events in Patients without Typical Symptoms

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    Smanio, Paola Emanuela Poggio, E-mail: pgmsmanio@gmail.com; Silva, Juliana Horie; Holtz, João Vitor; Ueda, Leandro; Abreu, Marilia; Marques, Carlindo; Machado, Leonardo [Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil Mailing (Brazil)

    2015-08-15

    Cardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined. To verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea) that underwent myocardial scintigraphy (MS), over a period of 8 years. Secondary objectives were to identify cardiac risk factors associated with myocardial scintigraphy abnormalities and possible predictors for major cardiac events in this group. This was a retrospective, observational study using the medical records of 892 patients that underwent myocardial scintigraphy between 2005 and 2011 and who were followed until 2013 for assessment of major cardiac events and risk factors associated with myocardial scintigraphy abnormalities. Statistical analysis was performed by Fisher’s exact test, logistic regression and Kaplan-Meyer survival curves, with statistical significance being set at p ≤ 0.05. Of the total sample, 52.1% were men, 86.9% were hypertensive, 72.4% had hyperlipidemia, 33.6% were diabetic, and 12.2% were smokers; 44.5% had known coronary artery disease; and 70% had high Framingham score, 21.8% had moderate and 8% had low risk. Of the myocardial scintigraphies, 58.6% were normal, 26.1% suggestive of fibrosis and 15.3% suggestive of ischemia. At evolution, 13 patients (1.5%) had non-fatal myocardial infarction and six individuals (0.7%) died. The group with normal myocardial scintigraphy showed longer period of time free of major cardiac events, non-fatal myocardial infarction (p = 0.036) and death. Fibrosis in the myocardial scintigraphy determined a 2.4-fold increased risk of non-fatal myocardial infarction and five-fold higher risk of death (odds ratio: 2.4 and 5.7, respectively; p = 0.043). The occurrence of major cardiac events in 8 years

  9. Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion.

    Science.gov (United States)

    Wolf, R; Habel, F; Heiermann, M; Jäkel, R; Sinn, R

    2005-04-01

    The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing

  10. Accuracy and precision of minimally-invasive cardiac output monitoring in children: a systematic review and meta-analysis.

    Science.gov (United States)

    Suehiro, Koichi; Joosten, Alexandre; Murphy, Linda Suk-Ling; Desebbe, Olivier; Alexander, Brenton; Kim, Sang-Hyun; Cannesson, Maxime

    2016-10-01

    Several minimally-invasive technologies are available for cardiac output (CO) measurement in children, but the accuracy and precision of these devices have not yet been evaluated in a systematic review and meta-analysis. We conducted a comprehensive search of the medical literature in PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science from its inception to June 2014 assessing the accuracy and precision of all minimally-invasive CO monitoring systems used in children when compared with CO monitoring reference methods. Pooled mean bias, standard deviation, and mean percentage error of included studies were calculated using a random-effects model. The inter-study heterogeneity was also assessed using an I(2) statistic. A total of 20 studies (624 patients) were included. The overall random-effects pooled bias, and mean percentage error were 0.13 ± 0.44 l min(-1) and 29.1 %, respectively. Significant inter-study heterogeneity was detected (P residual heterogeneity remained after conducting sensitivity and subgroup analyses based on the various study characteristics. By meta-regression analysis, we found no independent effects of study characteristics on weighted mean difference between reference and tested methods. Although the pooled bias was small, the mean pooled percentage error was in the gray zone of clinical applicability. In the sub-group analysis, electrical cardiometry was the device that provided the most accurate measurement. However, a high heterogeneity between studies was found, likely due to a wide range of study characteristics. PMID:26315477

  11. A Soft Processor MicroBlaze-Based Embedded System for Cardiac Monitoring

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    El Hassan El Mimouni

    2013-10-01

    Full Text Available this paper aims to contribute to the efforts of design community to demonstrate the effectiveness of the state of the art Field Programmable Gate Array (FPGA, in the embedded systems development, taking a case study in the biomedical field. With this design approach, we have developed a System on Chip (SoC for cardiac monitoring based on the soft processor MicroBlaze and the Xilkernel Real Time Operating System (RTOS, both from Xilinx. The system permits the acquisition and the digitizing of the Electrocardiogram (ECG analog signal, displaying heart rate on seven segments module and ECG on Video Graphics Adapter (VGA screen, tracing the heart rate variability (HRV tachogram, and communication with a Personal Computer (PC via the serial port. We have used the MIT_BIH Database records to test and evaluate our implementation performance. In terms of the resources utilization, the implementation occupies around 70% of the used FPGA, namely the Xilinx Spartan 6 XC6SLX16. The accuracy of the QRS detection exceeds 96%.

  12. Are patients undergoing treatment of hyperlipidaemia with statins the best candidates for early cardiac rehabilitation?

    OpenAIRE

    Celiński, Rafał; Grzywa-Celińska, Anna; Myśliński, Wojciech; Dybała, Andrzej; Mosiewicz, Jerzy

    2011-01-01

    The role of statins in the primary and secondary prevention of cardiovascular events is well known. An important adverse event associated with statin treatment is myopathy; intensive physical effort in patients treated with statins increases the risk of muscle injury/myopathy. In this article we discuss the benefits and risks associated with statin treatment in patients undergoing cardiac rehabilitation after acute coronary syndromes and/or coronary revascularization procedures. In our opinio...

  13. Usefulness of Danaparoid sodium in patients with Heparin-induced thrombocytopenia after cardiac surgery

    OpenAIRE

    Foroughinia, Farzaneh; Farsad, Fariborz; Gholami, Kheirollah; Ahmadi, Somayeh

    2015-01-01

    Objective: Thrombocytopenia is a common problem in cardiovascular surgery patients. However, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication of prophylaxis or treatment with heparin. Prompt management of HIT with an alternative anticoagulant is necessary due to the extreme risk of thrombotic complications. Therefore, we evaluated the effects of danaparoid in the treatment of HIT in patients with cardiac surgery who are at moderate to high risk of HIT. Method...

  14. Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients.

    Science.gov (United States)

    Beaty, Rachel S; Moffett, Brady S; Hall, Stuart; Kim, Jeffrey

    2015-10-01

    Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating

  15. Effect of Cardiac Rehabilitation on Strength and Balance in Patients after Coronary Artery Bypass Graft

    OpenAIRE

    Nahid Nazari; Ali Akbar Hashemi-Javaheri; Amir Rashid-Lamir; Emad Alaviniya

    2014-01-01

    Background: The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. Materials and Methods: This study is based on clinical trial before and after rehabilitation. t...

  16. Can abnormalities of ventricular repolarisation identify insulin dependent diabetic patients at risk of sudden cardiac death?

    OpenAIRE

    Weston, P. J.; Glancy, J. M.; McNally, P G; Thurston, H; de Bono, D P

    1997-01-01

    OBJECTIVE: To study the possible association or QT dispersion and mean QTc intervals, as measured from standard 12 lead electrocardiograms, with baroreceptor-cardiac reflex sensitivity (BRS) in insulin dependent diabetic patients. DESIGN: Comparative study of non-invasive assessment of BRS, QT interval, and QT dispersion. SETTING: Large teaching hospital. SUBJECTS: 31 young asymptomatic, normotensive, insulin dependent diabetic patients, aged 20-55 years with normal clinical autonomic functio...

  17. Monitoring of immune activation using biochemical changes in a porcine model of cardiac arrest

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    Anton Amann

    2001-01-01

    Full Text Available In animal models, immune activation is often difficult to assess because of the limited availability of specific assays to detect cytokine activities. In human monocytes/macrophages, interferon-γ induces increased production of neopterin and an enhanced activity of indoleamine 2,3-dioxygenase, which degrades tryptophan via the kynurenine pathway. Therefore, monitoring of neopterin concentrations and of tryptophan degradation can serve to detect the extent of T helper cell 1-type immune activation during cellular immune response in humans. In a porcine model of cardiac arrest, we examined the potential use of neopterin measurements and determination of the tryptophan degradation rate as a means of estimating the extent of immune activation. Urinary neopterin concentrations were measured with high-performance liquid chromatography (HPLC and radioimmunoassay (RIA (BRAHMS Diagnostica, Berlin, Germany. Serum and plasma tryptophan and kynurenine concentrations were also determined using HPLC. Serum and urine neopterin concentrations were not detectable with HPLC in these specimens, whereas RIA gave weakly (presumably false positive results. The mean serum tryptophan concentration was 39.0 Ī 6.2 μmol/l, and the mean kynurenine concentration was 0.85 Ī 0.33 μmol/l. The average kynurenine-per-tryptophan quotient in serum was 21.7Ī 8.4 nmol/μmol, and that in plasma was 20.7Ī 9.5 nmol/μmol (n = 7, which corresponds well to normal values in humans. This study provides preliminary data to support the monitoring of tryptophan degradation but not neopterin concentrations as a potential means of detecting immune activation in a porcine model. The kynurenine-per-tryptophan quotient may serve as a short-term measurement of immune activation and hence permit an estimate of the extent of immune activation.

  18. Cerebral oxygenation monitoring during cardiac bypass surgery in infants with broad band spatially resolved spectroscopy

    Science.gov (United States)

    Soschinski, Jan; Ben Mine, Lofti; Geraskin, Dmitri; Bennink, Gerardus; Kohl-Bareis, Matthias

    2007-07-01

    Neurological impairments following cardio-pulmonary bypass (CPB) during open heart surgery can result from microembolism and ischaemia. Here we present results from monitoring cerebral haemodynamics during CPB with near infrared spatially resolved broadband spectroscopy. In particular, the study has the objective (a) to monitor oxy- and deoxy-hemoglobin concentrations (oxy-Hb, deoxy-Hb) and their changes as well as oxygen saturation during CPB surgery and (b) to develop and test algorithms for the calculation of these parameters from broad band spectroscopy. For this purpose a detection system was developed based on an especially designed lens imaging spectrograph with optimised sensitivity of recorded reflectance spectra for wavelengths between 600 and 1000 nm. The high f/#-number of 1:1.2 of the system results in about a factor of 10 higher light throughput combined with a lower astigmatism and crosstalk between channels when compared with a commercial mirror spectrometers (f/# = 1:4). For both hemispheres two independent channels each with three source-detector distances (ρ = 25 . 35 mm) were used resulting in six spectra. The broad band approach allows to investigate the influence of the wavelength range on the calculated haemoglobin concentrations and their changes and oxygen saturation when the attenuation A(λ) and its slope ΔA(λ)/Δρ are evaluated. Furthermore, the different depth sensitivities of these measurement parameters are estimated from Monte Carlo simulations and exploited for an optimization of the cerebral signals. It is demonstrated that the system does record cerebral oxygenation parameters during CPB in infants. In particular, the correlation of haemoglobin concentrations with blood supply (flow, pressure) by the heart-lung machine and the significant decreases in oxygen saturation during cardiac arrest is discussed.

  19. Clinical usefulness of cardiac cine magnetic resonance imaging in patients with atrial fibrillation

    International Nuclear Information System (INIS)

    We studied the clinical usefulness of cine mode magnetic resonance (MR) imaging in patients with atrial fibrillation (AF) from aspects of image quality and cardiac function. The signal-to-noise (S/N) ratio in the myocardium was significantly (p<0.05) lower in patients with AF than those with normal sinus rhythm. Two radiologists who did not know any patient's information evaluated the image quality visually by marking method on a scale of 12 points. There was no difference of image quality between the two groups. The standard deviation of R-R interval was significantly (r=-0.92, p<0.001) correlated with the S/N ratio in myocardium. Consequently, it was not favorable to estimate visually cardiac cine MR image in patients with AF, when standard deviation of R-R interval was large. The left ventricular (LV) end diastolic, end systolic and stroke volumes and ejection fraction were closely (r=0.82∼0.95, p<0.05∼0.001) correlated between MR imaging and M-mode echocardiography, respectively. The ability to detect left side valvular regurgitation was almost equal in both MR imaging and color Doppler echocardiography. This result was coincided to previous papers in patients with normal sinus rhythm. In conclusion, cine mode MR imaging was also useful to analyze cardiac function and detect valvular regurgitation in patients with AF. (author)

  20. Cardiac autonomic dysfunction in patients with schizophrenia and their healthy relatives – a small review

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    Karl Juergen Bär

    2015-06-01

    Full Text Available The majority of excess mortality among people with schizophrenia seems to be caused by cardiovascular complications, and in particular, coronary heart disease. In addition, the prevalence of heart failure and arrhythmias is increased in this population. Reduced efferent vagal activity, which has been consistently described in these patients and their healthy first-degree relatives, might be one important mechanism contributing to their increased cardiac mortality. A decrease in heart rate variability (HRV and complexity was often shown in unmedicated patients when compared to healthy controls. In addition, faster breathing rates, accompanied by shallow breathing, seem to influence autonomic cardiac functioning in acute unmedicated patients substantially. Moreover, low physical fitness is a further and independent cardiac risk factor present in this patient population. Interestingly, new studies describe chronotropic incompetence during physical exercise as an important additional risk factor in patients with schizophrenia. Some studies report a correlation of the autonomic imbalance with the degree of positive symptoms (i.e. delusions and some with the duration of disease. The main body of psychiatric research is focused on mental aspects of the disease, thereby neglecting obvious physical health needs of these patients. Here, a joint effort is needed to design interventional strategies in everyday clinical settings to improve physical health and quality of life.

  1. Outcomes of Cardiac Surgery in Patients With Previous Solid Organ Transplantation (Kidney, Liver, and Pancreas).

    Science.gov (United States)

    Vargo, Patrick R; Schiltz, Nicholas K; Johnston, Douglas R; Smedira, Nicholas G; Moazami, Nader; Blackstone, Eugene H; Soltesz, Edward G

    2015-12-15

    A growing number of solid organ transplant survivors require surgery for cardiac disease. We examined the effect of having a previous transplant on outcomes after cardiac surgery in these patients from a population-based perspective. Of 1,709,735 patients who underwent coronary artery bypass grafting, valve, or thoracic aorta surgery from 2004 to 2008 in the Nationwide Inpatient Sample, 3,535 patients (0.21%) had a previous organ transplant (2,712 kidney, 738 liver, 300 pancreas). Multivariate logistic regression analysis and propensity score matching were used to determine the effect of a previous solid organ transplant on outcomes. In-hospital mortality rate was 7% for patients who underwent transplantation versus 4% for patients who did not undergo transplantation (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.16 to 2.38). Patients who underwent transplantation were at an increased risk for acute renal failure (OR 1.62, CI 1.36 to 1.94) and blood transfusions (OR 1.63, CI 1.36 to 1.95). Median length of stay was longer (10 vs 9 days), with greater median total charges ($111,362 vs $102,221; both p mortality after cardiac surgery. Renal protective strategies and bleeding control should be stressed to mitigate complications.

  2. Cardiac acceleration at the onset of exercise: a potential parameter for monitoring progress during physical training in sports and rehabilitation.

    Science.gov (United States)

    Hettinga, Florentina J; Monden, Paul G; van Meeteren, Nico L U; Daanen, Hein A M

    2014-05-01

    There is a need for easy-to-use methods to assess training progress in sports and rehabilitation research. The present review investigated whether cardiac acceleration at the onset of physical exercise (HRonset) can be used as a monitoring variable. The digital databases of Scopus and PubMed were searched to retrieve studies investigating HRonset. In total 652 studies were retrieved. These articles were then classified as having emphasis on HRonset in a sports or rehabilitation setting, which resulted in 8 of 112 studies with a sports application and 6 of 68 studies with a rehabilitation application that met inclusion criteria. Two co-existing mechanisms underlie HRonset: feedforward (central command) and feedback (mechanoreflex, metaboreflex, baroreflex) control. A number of studies investigated HRonset during the first few seconds of exercise (HRonsetshort), in which central command and the mechanoreflex determine vagal withdrawal, the major mechanism by which heart rate (HR) increases. In subsequent sports and rehabilitation studies, interest focused on HRonset during dynamic exercise over a longer period of time (HRonsetlong). Central command, mechanoreflexes, baroreflexes, and possibly metaboreflexes contribute to HRonset during the first seconds and minutes of exercise, which in turn leads to further vagal withdrawal and an increase in sympathetic activity. HRonset has been described as the increase in HR compared with resting state (delta HR) or by exponential modeling, with measurement intervals ranging from 0-4 s up to 2 min. Delta HR was used to evaluate HRonsetshort over the first 4 s of exercise, as well as for analyzing HRonsetlong. In exponential modeling, the HR response to dynamic exercise is biphasic, consisting of fast (parasympathetic, 0-10 s) and slow (sympathetic, 1-4 min) components. Although available studies differed largely in measurement protocols, cross-sectional and longitudinal training studies showed that studies analyzing HRonset

  3. Cardiac magnetic field map topology quantified by Kullback-Leibler entropy identifies patients with hypertrophic cardiomyopathy

    Science.gov (United States)

    Schirdewan, A.; Gapelyuk, A.; Fischer, R.; Koch, L.; Schütt, H.; Zacharzowsky, U.; Dietz, R.; Thierfelder, L.; Wessel, N.

    2007-03-01

    Hypertrophic cardiomyopathy (HCM) is a common primary inherited cardiac muscle disorder, defined clinically by the presence of unexplained left ventricular hypertrophy. The detection of affected patients remains challenging. Genetic testing is limited because only in 50%-60% of all HCM diagnoses an underlying mutation can be found. Furthermore, the disease has a varied clinical course and outcome, with many patients having little or no discernible cardiovascular symptoms, whereas others develop profound exercise limitation and recurrent arrhythmias or sudden cardiac death. Therefore prospective screening of HCM family members is strongly recommended. According to the current guidelines this includes serial echocardiographic and electrocardiographic examinations. In this study we investigated the capability of cardiac magnetic field mapping (CMFM) to detect patients suffering from HCM. We introduce for the first time a combined diagnostic approach based on map topology quantification using Kullback-Leibler (KL) entropy and regional magnetic field strength parameters. The cardiac magnetic field was recorded over the anterior chest wall using a multichannel-LT-SQUID system. CMFM was calculated based on a regular 36 point grid. We analyzed CMFM in patients with confirmed diagnosis of HCM (HCM, n =33, 43.8±13 years, 13 women, 20 men), a control group of healthy subjects (NORMAL, n =57, 39.6±8.9 years; 22 women and 35 men), and patients with confirmed cardiac hypertrophy due to arterial hypertension (HYP, n =42, 49.7±7.9 years, 15 women and 27 men). A subgroup analysis was performed between HCM patients suffering from the obstructive (HOCM, n =19) and nonobstructive (HNCM, n =14) form of the disease. KL entropy based map topology quantification alone identified HCM patients with a sensitivity of 78.8% and specificity of 86.9% (overall classification rate 84.8%). The combination of the KL parameters with a regional field strength parameter improved the overall

  4. Remote Monitoring of Heart Failure Patients

    Science.gov (United States)

    Bhimaraj, Arvind

    2013-01-01

    “The Teledactyl (Tele, far; Dactyl, finger — from the Greek) is a future instrument by which it will be possible for us to ‘feel at a distance.’ This idea is not at all impossible, for the instrument can be built today with means available right now. It is simply the well known telautograph, translated into radio terms, with additional refinements. The doctor of the future, by means of this instrument, will be able to feel his patient, as it were, at a distance…The doctor manipulates his controls, which are then manipulated at the patient’s room in exactly the same manner. The doctor sees what is going on in the patient’s room by means of a television screen.” —Hugo Gernsback, Science and Invention Magazine, February 1925 Heart failure continues to be a major burden on our health care system. As the number of patients with heart failure increases, the cost of hospitalization alone is contributing significantly to the overall cost of this disease. Readmission rate and hospital length of stay are emerging as quality markers of heart failure care along with reimbursement policies that force hospitals to optimize these outcomes. Apart from maintaining quality assurance, the disease process of heart failure per-se requires demanding and close attention to vitals, diet, and medication compliance to prevent acute decompensation episodes. Remote patient monitoring is morphing into a key disease management strategy to optimize care for heart failure. Innovative implantable technologies to monitor intracardiac hemodynamics also are evolving, which potentially could offer better and substantial parameters to monitor. PMID:23519115

  5. Miniaturized Human Insertable Cardiac Monitoring System with Wireless Power Transmission Technique

    Directory of Open Access Journals (Sweden)

    Jong-Ha Lee

    2016-01-01

    Full Text Available Prolonged monitoring is more likely to diagnose atrial fibrillation accurately than intermittent or short-term monitoring. In this study, an implantable electrocardiograph (ECG sensor to monitor atrial fibrillation patients in real time was developed. The implantable sensor is composed of a micro controller unit, an analog-to-digital converter, a signal transmitter, an antenna, and two electrodes. The sensor detects ECG signals from the two electrodes and transmits these to an external receiver carried by the patient. Because the sensor continuously transmits signals, its battery consumption rate is extremely high; therefore, the sensor includes a wireless power transmission module that allows it to charge wirelessly from an external power source. The integrated sensor has the approximate dimensions 3 mm × 4 mm × 14 mm, which is small enough to be inserted into a patient without the need for major surgery. The signal and power transmission data sampling rate and frequency of the unit are 300 samples/s and 430 Hz, respectively. To validate the developed sensor, experiments were conducted on small animals.

  6. Successful treatment of 54 patients with acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

    Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13

  7. Use of transesophageal Doppler as a sole cardiac output monitor for reperfusion hemodynamic changes during living donor liver transplantation: An observational study

    Directory of Open Access Journals (Sweden)

    M Hussien

    2011-01-01

    Full Text Available Aims: To report the use of transesophageal Doppler (TED, a minimally invasive cardiac output (COP monitor, before, during and after reperfusion and study its effect on anesthetic management during living donor liver transplantation (LDLT. Setting and Design: A prospective observational study. Methods: A total of 25 consecutive recipients with a MELD score between 15 and 20 were enrolled. Data were recorded at baseline (TB; anhepatic phase (TA; and post-reperfusion - 1, 5, 10 and 30 minutes. Fluid therapy was guided by corrected flow time (FTc of the TED. Packed red blood cells (RBCs were only given when hematocrit was less than 25%. Rotational thromboelastometry (ROTEM and standard laboratory tests were used to guide component blood products requirements. Results: Post-reperfusion, the COP, Cardiac Index (CI and stroke volume (SV increased significantly at all points of measurements; this was associated with a significant decrease in systemic vascular resistance (SVR ( P <.05. Immediately post-reperfusion, for 5 minutes, mean arterial blood pressure (ABP dropped significantly (P<.05, and 14 out of the 25 patients required boluses of epinephrine (10 μg to restore the mean ABP; 3 of the 14 patients required norepinephrine infusion till the end of surgery. Central venous pressure (CVP and urine output (UOP at all measures were maintained adequately with FTc-guided fluid replacement. Eight out of the 25 patients required no blood transfusion, and 4 of the 8 patients required no catecholamine support. Conclusion: TED as a sole monitor for COP was able to present significant and reliable changes in the cardiovascular status of the recipients during reperfusion, which could help to guide fluid- and drug-supportive therapy in this population of patients. This preliminary study needs to be applied on a larger scale.

  8. Detection of Left Ventricular Regional Dysfunction and Myocardial Abnormalities Using Complementary Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis without Cardiac Symptoms: A Pilot Study.

    Science.gov (United States)

    Kobayashi, Yasuyuki; Kobayashi, Hitomi; T Giles, Jon; Yokoe, Isamu; Hirano, Masaharu; Nakajima, Yasuo; Takei, Masami

    2016-01-01

    Objective We sought to detect the presence of left ventricular regional dysfunction and myocardial abnormalities in systemic sclerosis (SSc) patients without cardiac symptoms using a complementary cardiac magnetic resonance (CMR) imaging approach. Methods Consecutive patients with SSc without cardiac symptoms and healthy controls underwent CMR on a 1.5 T scanner. The peak systolic regional function in the circumferential and radial strain (Ecc, % and Err, %) were calculated using a feature tracking analysis on the mid-left ventricular slices obtained with cine MRI. In addition, we investigated the myocardial characteristics by contrast MRI. Pharmacological stress and rest perfusion scans were performed to assess perfusion defect (PD) due to micro- or macrovascular impairment, and late gadolinium enhancement (LGE) images were obtained for the assessment of myocarditis and/or fibrosis. Results We compared 15 SSc patients with 10 healthy controls. No statistically significant differences were observed in the baseline characteristics between the patients and healthy controls. The mean peak Err and Ecc of all segments was significantly lower in the patients than the controls (p=0.011 and p=0.003, respectively). Four patients with LGE (28.6%) and seven patients with PD (50.0%) were observed. PD was significantly associated with digital ulcers (p=0.005). Utilizing a linear regression model, the presence of myocardial LGE was significantly associated with the peak Ecc (p=0.024). After adjusting for age, the association between myocardial LGE and the peak Ecc was strengthened. Conclusion A subclinical myocardial involvement, as detected by CMR, was prevalent in the SSc patients without cardiac symptoms. Regional dysfunction might predict the myocardial abnormalities observed in SSc patients without cardiac symptoms.

  9. The role of the immuno-inflammatory response in patients after cardiac arrest

    OpenAIRE

    Samborska-Sablik, Anna; Sablik, Zbigniew; Gaszynski, Wojciech

    2011-01-01

    Introduction The aim of the research was to assess whether concentrations of inflammatory markers in blood of patients after cardiac arrest (CA) are related to their clinical state and survival. Material and methods Forty-six patients, aged 63 ±12 years, 21 of them after out-of-hospital CA and 25 after in-hospital CA, were enrolled in the study. Twenty-five patients survived and were discharged from hospital (CA-S); 21 died during hospitalization (CA-D). The clinical state of the patients was...

  10. [The state of sympathetic-adrenal system in patients with chronic cardiac insufficiency].

    Science.gov (United States)

    Nigmatullin, R R; Kirillova, V V; Dzhordzhikiia, R K; Kudrin, V S; Klodt, P M

    2009-01-01

    Activation of sympato-adrenal system plays an important role in the development of chronic cardiac failure (CCF). However, its relation to morpho-functional state of myocardium in CCF patients is virtually unknown. HPLC with electrochemical detection was used to determine plasma noradrenalin, adrenalin, and their precursors, 3,4-dioxyphenylalanine (DOPA) and dopamine, in patients with different morpho-functional changes in myocardium. The study demonstrated enhanced activity of sympato-adrenal system in patients with CCF. It showed for the first time that activity of sympato-adrenal system in CCF patients depends on the morpho-functional status of myocardium.

  11. Burnout versus work engagement in their effects on 24-hour ambulatory monitored cardiac autonomic function

    NARCIS (Netherlands)

    L.J.P. van Doornen (Lorenz); J.H. Houtveen (Jan); S. Langelaan (Saar); A.B. Bakker (Arnold); W. van Rhenen (Willem); W.B. Schaufeli (Wilmar)

    2009-01-01

    textabstractBurnout has been associated with increased risk of cardiovascular disease. This relationship may be mediated by a stress-related disruption in cardiac autonomic activity. The aim of the present study was to assess cardiac autonomic activity (sympathetic and parasympathetic) during a work

  12. Frozen Elephant Trunk Technique in a Patient with Multiple Previous Cardiac Procedures: A Case Report.

    Science.gov (United States)

    Christ, Torsten; Lembcke, Alexander; Laule, Michael; Dohmen, Pascal

    2016-01-01

    BACKGROUND We present the case of a 69-year-old female patient with giant aortic aneurysm who underwent previously multiple cardiac surgeries or interventions. CASE REPORT Ross procedure was performed in 2006 due to aortic valve regurgitation and aneurysm of the ascending aorta. In 2010 the patient was re-admitted for pulmonary valve insufficiency and a transcatheter pulmonary valve was implanted. Recently, the patient presented with an aortic arch aneurysm, maximum diameter 78 mm, which was treated by a hybrid approach, implanting a frozen elephant trunk and a covered stent graft. CONCLUSIONS The current case report demonstrates a suitable hybrid option for an extremely demanding procedure by multiple previous cardiac procedures. PMID:27357920

  13. Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

    DEFF Research Database (Denmark)

    Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K;

    2014-01-01

    BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years, and new data are therefore needed to avoid unsubstantiated statements when debating futility of resuscitation attempts following OHCA in nursing home (NH)-residents. We aimed to investigate the outcome...... of 2541 consecutive OHCA-patients were recorded, 245 (10%) of who were current NH-residents. NH-patients were older, more frequently female, had more witnessed arrests, fewer shockable primary rhythm and assumed cardiac aetiology, but shorter time to the return of spontaneous circulation (ROSC) compared...... to OHCA in non-nursing homes (non-NH). Overall 30-day survival rate was 9% in NH and 18% in non-NH, parrests 79 (32%) patients were admitted to hospital compared to 937 (41%) from non-NH (p

  14. [Assessment of risk of sudden cardiac death in patients with hypertrophic cardiomyopathy].

    Science.gov (United States)

    Attanasio, Philipp; Blaschke, Florian; Pieske, Burkert; Tschöpe, Carsten; Haverkamp, Wilhelm

    2016-07-01

    Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterized by left ventricular hypertrophy with or without concomitant outflow tract obstruction. Identification of patients with HCM who are at high risk of sudden cardiac death (SCD) is crucial as those patients are likely to benefit from an implantable cardioverter defibrillator (ICD). Based on the HCM Risk-SCD study published in 2013, that included 3675 HCM patients with 24 313 years of follow up, a new clinical risk prediction model for sudden cardiac death was developed. This model was included in the recently released 2014 ESC guidelines. This review summarizes the changes in the prediction model and the resulting recommendations and discusses potential risks and limitations of the new score. PMID:27404936

  15. Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure.

    Science.gov (United States)

    Qin, Chuan; Zhang, Li; Zhang, Zi-Ming; Wang, Bin; Ye, Zhou; Wang, Yong; Nanda, Navin C; Xie, Ming-Xing

    2016-06-01

    The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (Pcardiac dyssynchrony in patients with CHF.

  16. Tissue Doppler echocardiography reveals impaired cardiac function in patients with reversible ischaemia

    DEFF Research Database (Denmark)

    Hoffmann, Søren; Mogelvang, Rasmus; Sogaard, Peter;

    2011-01-01

    = 30) or without (false-positive SPECT, n= 12) significant coronary stenoses assessed by CAG. Regional longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured by colour TDI at six mitral annular sites and averaged to provide global estimates...... of the cardiac function was even more evident in patients with a true-positive SPECT with reduced average s' (5.5 ± 0.8 vs. 6.1 ± 1.1 cm/s; P... velocities could be demonstrated in patients with a false-positive SPECT compared with controls. CONCLUSION: In patients with stable angina pectoris, preserved ejection fraction, and reversible ischaemia assessed by SPECT, echocardiographic colour TDI performed at rest reveals impaired cardiac function...

  17. Evaluation of exercise tolerance patients in cardiac rehabilitation D model based on 6 Minute Walk Test

    Directory of Open Access Journals (Sweden)

    Bielawa Lukasz.

    2012-12-01

    Full Text Available Evaluation of the results of 6-minute walk test depending on gender, age, left ventricular ejection fraction, the primary disease and BMI. Patients underwent assessment of Cardiac Rehabilitation Department in Szymbark in 2012 (80 people. Duration of rehabilitation for all patients was 21 days. The test was performed at the beginning and end of the cycle. Following the 3-week cardiac rehabilitation in the model D in a group of 80 patients with a mean age of 72 years achieved a statistically significant improvement in exercise capacity, expressed in the increase in test 6MWT distance by an average of 52 meters. In the study, men received final results statistically superior to women. The largest increase in the distance gained to patients after aortic valve prosthesis. People who are obese with a body mass index BMI over 30 have an average trip distance underperform both at baseline, final, and in the resulting increase of the distance than those with a BMI under 30. Prevention of obesity, one of the modifiable risk factors for cardiovascular disease should be the goal of training during cardiac rehabilitation patient education.

  18. Approach to postoperative fever in pediatric cardiac patients

    International Nuclear Information System (INIS)

    Fever in the postoperative period in children undergoing surgery for congenital heart disease is fairly common and tends to cause anxiety to both the surgeon and the patient. Such fever is associated with the metabolic response to trauma, systemic response to the cardiopulmonary bypass, hypothermia, presence of drainage tubes, drugs, blood transfusion as well as infections. Establishing the diagnosis requires proper assessment of the patient with focused history, targeted physical examination and judicious use of investigations with the knowledge of the common causes

  19. Cardiac events in patients with positive exercise ECG and normal myocardial perfusion scan - a retrospective study

    International Nuclear Information System (INIS)

    Full text: The low risk of future cardiac events following a normal myocardial perfusion study with normal stress ECG has been well documented. However, there is little literature regarding the prognosis in patients with a positive stress ECG (PosETT) and normal myocardial perfusion scan (MPS). A search of our database over an eighteen month period identified 21 patients who fitted study criteria. A PosETT was defined as stress induced horizontal or downsloping ST depression > 1mm in one or more leads with a normal baseline 12 lead ECG. Patients were divided into two subgroups depending on the severity of ST depression. A mildly PosETT was defined as ST depression of 1-1.5mm (n=10) and strongly PosETT was defined as ST depression of >2mm in at least one lead with depression in other leads (n=l 1). A normal MPS was defined as absence of reversible perfusion defects on SPECT imaging. Technetium 99m Tetrofosmin was the imaging agent used in 18/21 patients. All 21 patients exercised using the Bruce protocol for 3-12 minutes, and 9 experienced chest pain 12 months after the MPS, referring physicians were contacted. Cardiac events were defined as cardiac death, myocardial infarction, unstable angina, cardiac failure, revascularisation or a coronary angiogram demonstrating >70% stenosis. To date, follow up is complete in 11 patients with one confirmed case of single vessel revascularisation 3 months post MPS. Full follow up data will be presented. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  20. Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

    Institute of Scientific and Technical Information of China (English)

    Hung Ming-Yow; Li Ju-Chi; Hao Wen-Rui; Wu Cheng-Hsueh; Hung Ming-Jui

    2011-01-01

    Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

  1. Symptom monitoring in treatment of cancer patients

    Institute of Scientific and Technical Information of China (English)

    Yao Wanxia; Lin Miao; Lü Ye; Yang Biao; Yao Cong; Liu Juan; Wang Wenru

    2008-01-01

    Objective To examine self-reported symptoms by the patients receiving cancer therapy, and find out the symptoms that should be coped with and managed during the treatment. Methods A pilot study was conducted on self-reported symptoms on 185 patients receiving chemotherapy and/or radiotherapy for different cancers. The Therapy-Related Symptoms Checklist (TRSC) was used. Results Severe symptoms on the TRSC subscales: loss of appetite,feeling sluggish, weight loss, nausea and hair loss, were reported by the patients. The frequently reported symptoms by those on chemotherapy were nausea, feeling sluggish, weight loss, vomiting, and taste change. The frequently reported symptoms by those on radiotherapy were feeling sluggish, weight loss, loss of appetite, difficult sleeping, and changing taste. The symptoms of loss of appetite, feeling sluggish, weight loss, hair loss, and nausea were both frequently reported by those on radiotherapy and those on chemotherapy. Conclusion Symptom monitoring may be facilitated by TRSC, based on the severity and frequency of reported symptoms, more patients and caregivers could know which symptoms should be preferential interventions.

  2. Patient position alters attenuation effects in multipinhole cardiac SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Timmins, Rachel; Ruddy, Terrence D.; Wells, R. Glenn, E-mail: gwells@ottawaheart.ca [Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7 (Canada)

    2015-03-15

    Purpose: Dedicated cardiac cameras offer improved sensitivity over conventional SPECT cameras. Sensitivity gains are obtained by large numbers of detectors and novel collimator arrangements such as an array of multiple pinholes that focus on the heart. Pinholes lead to variable amounts of attenuation as a source is moved within the camera field of view. This study evaluated the effects of this variable attenuation on myocardial SPECT images. Methods: Computer simulations were performed for a set of nine point sources distributed in the left ventricular wall (LV). Sources were placed at the location of the heart in both an anthropomorphic and a water-cylinder computer phantom. Sources were translated in x, y, and z by up to 5 cm from the center. Projections were simulated with and without attenuation and the changes in attenuation were compared. A LV with an inferior wall defect was also simulated in both phantoms over the same range of positions. Real camera data were acquired on a Discovery NM530c camera (GE Healthcare, Haifa, Israel) for five min in list-mode using an anthropomorphic phantom (DataSpectrum, Durham, NC) with 100 MBq of Tc-99m in the LV. Images were taken over the same range of positions as the simulations and were compared based on the summed perfusion score (SPS), defect width, and apparent defect uptake for each position. Results: Point sources in the water phantom showed absolute changes in attenuation of ≤8% over the range of positions and relative changes of ≤5% compared to the apex. In the anthropomorphic computer simulations, absolute change increased to 20%. The changes in relative attenuation caused a change in SPS of <1.5 for the water phantom but up to 4.2 in the anthropomorphic phantom. Changes were larger for axial than for transverse translations. These results were supported by SPS changes of up to six seen in the physical anthropomorphic phantom for axial translations. Defect width was also seen to significantly increase. The

  3. Approach to postoperative fever in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Ajay K Gupta

    2012-01-01

    Full Text Available Fever in the postoperative period in children undergoing surgery for congenital heart disease is fairly common and tends to cause anxiety to both the surgeon and the patient. Such fever is associated with the metabolic response to trauma, systemic response to the cardiopulmonary bypass, hypothermia, presence of drainage tubes, drugs, blood transfusion as well as infections. Establishing the diagnosis requires proper assessment of the patient with focused history, targeted physical examination and judicious use of investigations with the knowledge of the common causes.

  4. Drug–drug Interactions in Hospitalized Cardiac Patients

    OpenAIRE

    Mateti, UV; Rajakannan, T; Nekkanti, H; V. Rajesh; Mallaysamy, SR; Ramachandran, P.

    2011-01-01

    Drug–drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. DDI in patients receiving multidrug therapy is a major concern. The aim of the present study was to assess the incidence and risk factors of DDIs in patients admitted in cardiology unit of a teaching hospital. A prospective, observational study was carried out for a period of 3 months (April–July 2009). During the study period, a total...

  5. Factors related to monitoring during admission of acute patients

    DEFF Research Database (Denmark)

    Schmidt, Thomas; Bech, Camilla Louise Nørgaard; Brabrand, Mikkel;

    2016-01-01

    Understanding the use of patient monitoring systems in emergency and acute facilities may help to identify reasons for failure to identify risk patients in these settings. Hence, we investigate factors related to the utilization of automated monitoring for patients admitted to an acute admission...... one measurement were analyzed using quantile regression by looking at the impact of distance from nursing office, number of concurrent patients, wing type (medical/surgical), age, sex, comorbidities, and severity conditioned on how much patients were monitored during their admissions. We registered 11......,848 admissions, of which we were able to link patient monitor readings to 3149 (26.6 %) with 50 % being monitored <1.4 % of total admission time. Distance from nursing office had little influence on patients monitored <10 % of their admission time. But for other patients, being positioned further away from the...

  6. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study.

    Science.gov (United States)

    Virkkunen, Ilkka; Yli-Hankala, Arvi; Silfvast, Tom

    2004-09-01

    The cooling and haemodynamic effects of prehospital infusion of ice-cold Ringer's solution were studied in 13 adult patients after successful resuscitation from non-traumatic cardiac arrest. After haemodynamics stabilisation, 30 ml/kg of Ringer's solution was infused at a rate of 100ml/min into the antecubital vein. Arterial blood pressure and blood gases, pulse rate, end-tidal CO(2) and oesophageal temperature were monitored closely. The mean core temperature decreased from 35.8 +/- 0.9 degrees C at the start of infusion to 34.0 +/- 1.2 degrees C on arrival at hospital (P < 0.0001). No serious adverse haemodynamic effects occurred. It is concluded that the induction of therapeutic hypothermia using this technique in the prehospital setting is feasible. PMID:15325449

  7. Association of cardiac troponin I with disease severity and outcomes in patients with pulmonary hypertension.

    Science.gov (United States)

    Vélez-Martínez, Mariella; Ayers, Colby; Mishkin, Joseph D; Bartolome, Sonja B; García, Christine K; Torres, Fernando; Drazner, Mark H; de Lemos, James A; Turer, Aslan T; Chin, Kelly M

    2013-06-15

    Previous studies have identified cardiac troponin I (cTnI) as an important marker in pulmonary hypertension (PH) prognosis. However, traditional assays are limited by poor sensitivity, even among patients at high risk. cTnI was measured in 255 PH patients using a new highly sensitive (hs) assay. Other measures included demographics, creatinine, 6-minute walk distance, hemodynamics, cardiac magnetic resonance imaging, and B-type natriuretic peptide level. The association between cTnI and survival was assessed using Kaplan-Meier analysis and Cox regression. cTnI was detectable with the hs assay in 95% of the patients with a median level of 6.9 pg/ml (IQR 2.7-12.6 pg/ml). Higher cTnI levels associated with higher levels of B-type natriuretic peptide, shorter 6-minute walk distance, and more severe hemodynamic and cardiac magnetic resonance imaging abnormalities. During a median follow-up of 3.5 years, 60 individuals died. Unadjusted event rates increased across higher cTnI quartiles (3, 5, 13, 17 events/100 person-years, respectively, p trend = 0.002). cTnI in the fourth (vs first) quartile remained associated with death in a final stepwise multivariable model that included clinical variables and hemodynamics (adjusted hazard ratio 5.3, 95% confidence interval 1.8-15.6). In conclusion, cTnI levels, detectable with a novel hs assay, identify patients with PH who have more severe hemodynamic and cardiac structural abnormalities and provide novel and independent prognostic information. This hs assay has the potential to detect more at-risk patients and improve current risk-stratification algorithms. PMID:23540547

  8. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    .36; nonshockable electrocardiography (EKG rhythm (OR =5.67, 95% CI =1.93–16.62; cardiac arrest occurring in postoperative period (OR =7.35, 95% CI =2.89–18.74; and duration of CPR more than 30 minutes (OR =4.32, 95% CI =1.39–13.45. The prognostic factors associated with survival with complications were being greater than or equal to 65 years of age (OR =4.30, 95% CI =1.13–16.42, upper abdominal site of surgery (OR =10.86, 95% CI =1.99–59.13, shock prior to cardiac arrest (OR =3.62, 95% CI =1.30–10.12, arrhythmia prior to cardiac arrest (OR =4.61, 95% CI =1.01–21.13, and cardiac arrest occurring in the postoperative period (OR =3.63, 95% CI =1.31–10.02. Conclusion: The mortality and morbidity in patients who received anesthesia for emergency surgery within 24 hours of their first CPR were high, and were associated with identifiable patient comorbidity, age, shock, anatomic site of operation, the timing of cardiac arrest, EKG rhythm, and the duration of CPR. EKG monitoring helps to identify cardiac arrest quickly and diagnose the EKG rhythm as a shockable or nonshockable rhythm, with CPR being performed as per the American Heart Association (AHA CPR Guidelines 2010. The use of the fast track system in combination with an interdisciplinary team for surgery, CPR, and postoperative care helps to rescue patients in a short time. Keywords: CPR, cardiac arrest, emergency surgery, prognostic factors, death, survival, survival with complications, mortality, morbidity

  9. Tai Chi Chuan for Cardiac Rehabilitation in Patients with Coronary Arterial Disease

    Directory of Open Access Journals (Sweden)

    Rosane Maria Nery

    2014-07-01

    Full Text Available Background: Several studies have shown that Tai Chi Chuan can improve cardiac function in patients with heart disease. Objective: To conduct a systematic review of the literature to assess the effects of Tai Chi Chuan on cardiac rehabilitation for patients with coronary artery disease. Methods: We performed a search for studies published in English, Portuguese and Spanish in the following databases: MEDLINE, EMBASE, LILACS and Cochrane Register of Controlled Trials. Data were extracted in a standardized manner by three independent investigators, who were responsible for assessing the methodological quality of the manuscripts. Results: The initial search found 201 studies that, after review of titles and abstracts, resulted in a selection of 12 manuscripts. They were fully analyzed and of these, nine were excluded. As a final result, three randomized controlled trials remained. The studies analyzed in this systematic review included patients with a confirmed diagnosis of coronary artery disease, all were clinically stable and able to exercise. The three experiments had a control group that practiced structured exercise training or received counseling for exercise. Follow-up ranged from 2 to 12 months. Conclusion: Preliminary evidence suggests that Tai Chi Chuan can be an unconventional form of cardiac rehabilitation, being an adjunctive therapy in the treatment of patients with stable coronary artery disease. However, the methodological quality of the included articles and the small sample sizes clearly indicate that new randomized controlled trials are needed in this regard.

  10. Sympathoadrenal and hypophyseal-adrenal systems in preoperative irradiation of patients with esophageal and cardiac cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tarutinov, V.I.; Starosel' skij, I.V.; Gol' dshmidt, B.Ya.; Shmal' ko, Yu.P.; Levchenko, A.M. (Nauchno-Issledovatel' skij Rentgeno-Radiologicheskij i Onkologicheskij Inst., Kiev (Ukrainian SSR))

    1983-11-01

    A study was made of 74 patients with esophageal and cardiac cancer, Stages 3 and 4. The excretion of catecholamines, corticosteroids and their precursors was studied, tests with adrenalin before and after preoperative irradiation at a summary dose of 30 Gy were done. It has been shown that before the start of radiation therapy the excretion of catecholamines and corticosteroids is lowered, the reaction to adrenalin administration is negative in most patients, the phase syndrome of cardiac hypodynamics associated with disturbed function of the sympathoadrenal system was revealed. Preoperative irradiation in patients with esophageal and cardiac cancer results in an increased excretion of 17-ketosteroids (17-KS) and 17-ketogenic steroids, however 17-KS excretion does not reach the normal level. For better tolerance of irradiation and for a radiosensitization effect testenate is administered to patients before and during radiation therapy. The administration of testenate 7-10 days before the start and during radiotherapy proved to be effective which was confirmed by noticeable necrobiotic and necrotic changes of cancer cells.

  11. Usefulness of true FISP cine MR imaging in patients with poor cardiac function

    Energy Technology Data Exchange (ETDEWEB)

    Sakuma, Toshiharu; Yamada, Naoaki; Motooka, Makoto; Enomoto, Naoyuki; Maeshima, Isamu; Matsuda, Kazuhide; Urayama, Shinichi; Ikeo, Miki [National Cardiovascular Center, Suita, Osaka (Japan)

    2002-01-01

    This study was done to assess the value of True FISP cine in patients with poor cardiac function. True FISP cine and FLASH cine imaging were performed on a 1.5 T machine. Both short axis and horizontal long axis imaging sections were used. The imaging sections used a Matrix (120 x 128), FOV (24 x 32 cm), and had a slice thickness of 8 mm. The imaging time for True FISP cine was 8 heart beats and 17 heart beats for FLASH cine. The contrast-to-noise ratio between the blood and myocardium (CNR) was measured at enddiastole and endsystole. The subjects in the study were 10 healty volunteers (average age 26.5{+-}3.2 years) and 12 patients with hypofunction (average age 53.9{+-}13.2 years). In the volunteers, the CNR of the short axis imaging was similar in both True FISP (24.6{+-}3.7) and FLASH (23.4{+-}5.9). In the patients with poor cardiac function however, the CNR of True FISP was larger than FLASH in both the short and long axis. In the short axis (22.7{+-}6.1 vs. 17.9{+-}5.3, P<0.01) and in the long axis (17.4{+-}4.3 vs. 9.3{+-}4.0, P<0.01). We conclude that True FISP cine has a higher contrast in a shorter imaging time than FLASH cine. True FISP cine is especially useful in patients with poor cardiac function. (author)

  12. Poor health status and distress in cardiac patients

    DEFF Research Database (Denmark)

    Habibović, Mirela; Versteeg, Henneke; Pelle, Aline J M;

    2013-01-01

    Implantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influence...

  13. Beta-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Shilane, David; Go, Alan S;

    2014-01-01

    BACKGROUND: The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). OBJECTIVES: The purpose of this study was to assess the association of beta-blockers with outcomes among...... patients with new-onset CHD. METHODS: We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time...

  14. Risk factors for the occurrence of cardiac arrhythmias in patients on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Canziani, M E; Saragoça, M A; Draibe, S A; Barbieri, A; Ajzen, H

    1993-01-01

    In order to evaluate the risk factors for the occurrence of ventricular arrhythmias (VA) in continuous ambulatory peritoneal dialysis (CAPD), we studied 47 patients by echocardiography, dipyridamole-thallium tests, and biochemical profile. We observed that the group with VA had a greater cardiac mass index dependent only on an increased left ventricular internal diameter. Septum and posterior wall thickness, as well as biochemical variables, were not associated with the presence of VA in CAPD patients. In addition, altered myocardial perfusion was not associated with VA in these patients. PMID:8399625

  15. Medical attention proposal for patients under the iodo therapy in cardiac arrest cases

    International Nuclear Information System (INIS)

    This research has like aim to present a proposition about how to attend the patients which are under the iodo therapy, and the possibility they can show a cardiac arrest during their hospitalization. The physical medical department with the nurse group and the team of ICU (Intensive Care Unit) looked for to establish basic norms of radiological protection in order to avoid the radiation and contamination of all workers involved with one patient, without changing the routine of attendance service. We analyzed all rules of service including the attendance the hospital room and mainly if it is necessary to lead the patient to the ICU. (authors). 4 refs

  16. Invasive aspergillosis in an immunocompetent patient with fever and a cardiac mass

    Directory of Open Access Journals (Sweden)

    Matthew LaBarbera

    2011-10-01

    Full Text Available Invasive aspergillosis is an often fatal disease that usually occurs in immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Invasive aspergillosis should be considered in the differential diagnosis of an otherwise undiagnosed febrile respiratory illness, even in immunocompetent patients. Echocardiography should be peformed to evaluate for endocarditis in such cases. Prompt initiation of appropriate antifungal therapy is warranted, even before the diagnosis of invasive aspergillosis is confirmed.

  17. Cardiac comorbidity is an independent risk factor for radiation-induced lung toxicity in lung cancer patients

    International Nuclear Information System (INIS)

    Purpose: To test the hypothesis that cardiac comorbidity before the start of radiotherapy (RT) is associated with an increased risk of radiation-induced lung toxicity (RILT) in lung cancer patients. Material and methods: A retrospective analysis was performed of a prospective cohort of 259 patients with locoregional lung cancer treated with definitive radio(chemo)therapy between 2007 and 2011 (ClinicalTrials.gov Identifiers: NCT00572325 and NCT00573040). We defined RILT as dyspnea CTCv.3.0 grade ⩾2 within 6 months after RT, and cardiac comorbidity as a recorded treatment of a cardiac pathology at a cardiology department. Univariate and multivariate analyses, as well as external validation, were performed. The model-performance measure was the area under the receiver operating characteristic curve (AUC). Results: Prior to RT, 75/259 (28.9%) patients had cardiac comorbidity, 44% of whom (33/75) developed RILT. The odds ratio of developing RILT for patients with cardiac comorbidity was 2.58 (p < 0.01). The cross-validated AUC of a model with cardiac comorbidity, tumor location, forced expiratory volume in 1 s, sequential chemotherapy and pretreatment dyspnea score was 0.72 (p < 0.001) on the training set, and 0.67 (p < 0.001) on the validation set. Conclusion: Cardiac comorbidity is an important risk factor for developing RILT after definite radio(chemo)therapy of lung cancer patients

  18. Predictors associated with an efficient health information management in patients with cardiac surgery.

    Science.gov (United States)

    Lee, Seong-Ran

    2014-01-01

    Because of the increasing number of cardiac patients all over the world, the importance of cardiac disease prevention is increasing. This study was attempted to identify the predictors associated with an efficient health information patients in two general hospitals located in Seoul from May 13 to June 13, 2012. The results were as follows: First, analysis of the percentage of nutrient intake in terms of meal pattern showed that the response rate of 47.9% in the case group at vegetable intake of 2 or 3 times per week was significantly higher than the response rate of 47.1% in the control group (X^{2}=9.08, pefficiency of a health information management was significantly associated with female (OR=3.24, 95% Cl: 1.93-6.84), the subjects having abdominal obesity (OR=2.29, 95% Cl: 1.15-3.60). Therefore, the proposed framework will be helpful for health information system developers.

  19. PATIENTS OVERCOME ANXIETY AND ARE ENCOURAGED TO BE PHYSICAL ACTIVE THROUGH EXERCISE-BASED CARDIAC REHABILITATION

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.;

    other to begin exercising; and growing confidence in the heart, whereby the patients overcome anxiety and dare to be physically active. Conclusions. Exercise-based cardiac rehabilitation provides a comfort-giving setting that offers peer support and a positive physical perception leading to confidence...... interviews were performed 1-2 months later. A phenomenological hermeneutic interpretation was conducted, comprising three methodological steps: naïve reading, structural analysis and comprehensive interpretation. Results. The preliminary findings are that although physically and especially mentally...... into that the heart endures physical activity. In addition to serving as physical guidance, exercise-based cardiac rehabilitation offers valuable mental support. The patients find help to overcome an initial anxiety and move forward towards a physically active life featuring a feeling of improved health and new...

  20. PULMONARY PHYSIOTHERAPY EFFECT ON PATIENTS UNDERGOING OPEN CARDIAC SURGERY

    OpenAIRE

    Seyed Kazem Shakuri; Yaghoub Salekzamani; Ali Taghizadieh; Hamed Sabbagh-Jadid; Jamal Soleymani; Leyla Sahebi

    2014-01-01

    Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery...

  1. Imunocitomonitorização em pacientes transplantados cardíacos Immunocytomonitorization in patients submitted to cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Ricardo Manrique

    1990-04-01

    we state in terms of a set of active lymphocytes. The technique was applied to follow-up and control of activity of cellular immunology in nine patients submitted to cardiac transplantation, twenty normal volunteers, and five patients candidates to cardiac transplantation. We also submitted to the CIM test, in order to obtain the normal range of lymphocytic activity in the brazilian population. Both groups had not antecedents, either infectious or immunological, chronic or acute pictures. Ten patients with acute bacteriological or viral infection had been tested as a positive control. In normal individuals, we found 1,8% (+/- 1.088 of active lymphocytes and 3,2% (+/0,49 in candidates for cardiac transplantation. In our experience, values above are indicators of an immunological reactivity related to infection or rejection. Out of the 63 tests performed to the cardiac transplanted patients, four of them were positive, three cases related to infectious complications and one was confirmed as a process of acute graft rejection in progress. The mean time for the CIM execution was about two hours. The method was successful for the immunological diagnosis in transplanted cardiacs, due to its sensibility, low costs and promptness of results.

  2. Assessment of Patient and Relatives Satisfaction in a Cardiac Surgery ICU Model

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2015-10-01

    Full Text Available Introduction: Evaluation of patients’ and their families’ satisfaction regarding the quality of care in the ICU is an important concern that can identify deficiencies of this field and help to improve satisfaction of both patients and their families. Considering the fact that problems related to cardiac surgery ICUs differ from other ICUs, recognition of these problems and the factors that lead to patient or family dissatisfaction can not only improve the quality and quantity of services provided in this section but also lead to increased satisfaction in these groups and promote scientific and practical knowledge related to sectors at regional levels. The aim of this study was to evaluate the satisfaction of patients and their families from the quantity and quality of services provided in the cardiac surgical ICU of Madani hospital, Tabriz, Iran. Materials and Methods: In this descriptive study, satisfaction of patients and their relatives from cardiac surgery ICU of Shahid Madani Hospital was evaluated using Modified MISS questionnaire for patients and CCMFNA questionnaires for their relatives during one year (1391-1390. The obtained data were statistically analyzed using descriptive statistics (frequency, percentage, mean ± SD and SPSS ver. 15. Results: Majority of patients expressed moderate to high satisfaction. The overall satisfaction of doctors was higher than nurses (27% vs. 22%. The lowest level of satisfaction related to the possibility of meeting relatives (14.3%. Most relatives were spouses of patients who contributed to the highest rate of satisfaction; however, the location and meets expectations were less satisfactory. Conclusion: Improving waiting room quality, increasing duration of family meetings and increasing nursing attention are the factors that could be associated with further satisfaction. Keywords: ICU; Patient satisfaction; Family satisfaction

  3. Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

    Directory of Open Access Journals (Sweden)

    Mauro Felippe Felix Mediano

    2016-06-01

    Full Text Available Abstract: INTRODUCTION: The benefit of a cardiac rehabilitation (CR program for patients with Chagas heart failure (CHF remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. METHODS: A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session. Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test, muscle respiratory strength (manovacuometry, and body composition (anthropometry and skinfolds were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography, biomarkers (lipid profile, glucose, and glycated hemoglobin and quality of life (Minnesota Living with Heart Failure Questionnaire were assessed at baseline and at the end of the intervention. RESULTS: Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF and respiratory strength improved after 8 months. Patients with right ventricular (RV dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CONCLUSIONS: CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

  4. Effects of oral premedication on cognitive status of elderly patients undergoing cardiac catheterization

    Institute of Scientific and Technical Information of China (English)

    Javed M Ashraf; Marc Schweiger; Neelima Vallurupalli; Sandra Bellantonio; James R Cook

    2015-01-01

    Background Sedatives and analgesics are often administered to achieve conscious sedation for diagnostic and therapeutic procedures. Appropriate concerns have been raised regarding post procedure delirium related to peri-procedural medication in the elderly. The objective of this study was to investigate the effect of premedication on new onset delirium and procedural care in elderly patients. Methods Patients≥70 years old and scheduled for elective cardiac catheterization were randomly assigned to receive either oral diphenhydramine and diaze-pam (25 mg/5 mg) or no premedication. All patients underwent a mini mental state exam and delirium assessment using confusion assess-ment method prior to the procedure and repeated at 4 h after the procedure and prior to discharge. Patients’ cooperation during the procedure and ease of post-procedure were measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, and twice hourly afterwards using Observer’s Assessment of Alertness/Sedation Scale (OAA/S). Results A total of 93 patients were enrolled. The mean age was 77 years, and 47 patients received premedication prior to the procedure. None of the patients in either group developed delirium. Patients’ cooperation and the ease of procedure was greater and pain medication requirement less both during and after the procedure in the pre-medicated group (P < 0.05 for both). Nurses reported an improvement with patient management in the pre-medicated group (P=0.08). Conclusions In conclusion, premedication did not cause delirium in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients undergoing cardiac catheterization.

  5. Effect of Desmopressin in Reducing Bleeding after Cardiac Surgery in Patients Receiving Anti-Platelet Agents

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2016-07-01

    Full Text Available Background: Severe bleeding is an important cause of morbidity and mortality in cardiac surgery using the cardiopulmonary bypass (CPB pump. Desmopressin, a synthetic analogue of vasopressin, is used to prevent postoperative bleeding in patients with renal insufficiency. The aim of the present study was to evaluate the effect of desmopressin in reducing blood loss after cardiac surgery in patients receiving antiplatelet drugs. Methods: In this prospective clinical trial, 40 patients undergoing coronary artery bypass grafting (CABG surgery with CPB, aged over 18 years, and on antiplatelet therapy for a week before surgery were divided in two groups. Case and control groups received nasal desmopressin spray and nasal normal saline spray, respectively. Patient vital signs, blood loss, administration of blood products, prescription drugs to improve the coagulation status, serum and whole intake and output of patients, need for a second surgery to control the bleeding, remaining sternum open, mortality due to bleeding, duration of intensive care unit (ICU stay and mechanical ventilation were recorded. Results: In the case and control groups there were no differences in duration of operation, mechanical ventilation and length of ICU stay. There was no significant difference in terms of postoperative bleeding and intake of blood products between two groups (P>0.05. Reoperation due to bleeding in the case and control groups was observed in 3 (15%, and 1 (5% patient(s, respectively (P=0.3. Conclusion: Desmopressin has no significant effect on reducing the amount of bleeding after cardiac surgery in patients receiving anti-platelet agents. Keywords: CABG; cardio pulmonary bypass pump; hemorrhage; desmopressin 

  6. Anaesthetic management of patients with congenital heart disease presenting for non-cardiac surgery.

    OpenAIRE

    Mohindra R; Beebe David; Belani Kumar

    2002-01-01

    The incidence of congenital heart disease is about one percent of all live births in the United States. Treatment is being performed at a younger age and these children are showing improved survival. It is not unusual for children with congenital heart disease to present for non-cardiac surgery. Their management depends on their age, type of lesion, extent of corrective procedure, the presence of complications and other congenital anomalies. Each patient needs a detailed pre-operative evaluat...

  7. Cardiac Migration of Endogenous Mesenchymal Stromal Cells in Patients with Inflammatory Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Caroline Schmidt-Lucke

    2015-01-01

    Full Text Available Introduction. Mesenchymal stromal cells (MSC have immunomodulatory features. The aim of this study was to investigate the migration and homing potential of endogenous circulating MSC in virus negative inflammatory cardiomyopathy (CMi. Methods. In 29 patients with n=23 or without n=6 CMi undergoing endomyocardial biopsies (EMB, transcardiac gradients (TCGs of circulating MSC were measured by flow cytometry from blood simultaneously sampled from aorta and coronary sinus. The presence of MSC in EMB, cardiac inflammation, and SDF-1α mRNA expression were detected via immunohistochemistry and real-time PCR. Results. MSC defined as CD45−CD34−CD11b−CD73+CD90+ cells accounted for 0.010 [0.0025–0.048]%/peripheral mononuclear cell (PMNC and as CD45−CD34−CD11b−CD73+CD105+ cells for 0.019 [0.0026–0.067]%/PMNC, both with similar counts in patients with or without cardiac inflammation. There was a 29.9% P<0.01 transcardiac reduction of circulating MSC in patients with CMi, correlating with the extent of cardiac inflammation (P<0.05, multivariate analysis. A strong correlation was found between the TCG of circulating MSC and numbers of MSC (CD45−CD34−CD90+CD105+ in EMB (r=-0.73, P<0.005. SDF-1α was the strongest predictor for increased MSC in EMB (P<0.005, multivariate analysis. Conclusions. Endogenous MSC continuously migrate to the heart in patients with CMi triggered by cardiac inflammation.

  8. Anaesthesia Application for Cardiac Denervation in a Patient with Long QT Syndrome and Cardiomyopathy

    Science.gov (United States)

    Karadeniz, Ümit; Demir, Aslı; Koçulu, Rabia

    2016-01-01

    Long QT syndrome is a congenital disorder that is characterized by a prolongation of the QT interval on electrocardiograms and a propensity to ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest or sudden death. Cardiomyopathy and pulmonary hypertension diseases have additional risks in anaesthesia management. In this study, we emphasize on one lung ventilation, pacemaker-implantable cardioverter–defibrillator and the anaesthesia management process in a patient with long QT syndrome, cardiomyopathy and pulmonary hypertension who underwent thoracic sympathectomy. PMID:27366557

  9. Effect of Cardiac Resynchronization Therapy on Pulmonary Function in Patients With Heart Failure

    OpenAIRE

    Cundrle, Ivan; Johnson, Bruce D.; Somers, Virend K.; Scott, Christopher G; REA, ROBERT F.; Olson, Lyle J.

    2013-01-01

    Pulmonary congestion due to heart failure causes abnormal lung function. Cardiac resynchronization therapy (CRT) is a proven effective treatment for heart failure. The aim of this study was to test the hypothesis that CRT promotes increased lung volumes, bronchial conductance, and gas diffusion. Forty-four consecutive patients with heart failure were prospectively investigated before and after CRT. Spirometry, gas diffusion (diffusing capacity for carbon monoxide), cardiopulmonary exercise te...

  10. Comparison of two ventilation modes in post-cardiac surgical patients

    OpenAIRE

    Aloka Samantaray; Nathan Hemanth

    2011-01-01

    Background: The cardiopulmonary bypass (CPB)-associated atelectasis accounted for most of the marked post-CPB increase in shunt and hypoxemia. We hypothesized that pressure-regulated volume-control (PRVC) modes having a distinct theoretical advantage over pressure-controlled ventilation (PCV) by providing the target tidal volume at the minimum available pressure may prove advantageous while ventilating these atelactic lungs. Methods: In this prospective study, 36 post-cardiac surgical patient...

  11. RETROSPECTIVE ANALYSIS: TO ENHANCE PATIENT SAFETY BY MINIMIZING MEDICATION ERRORS IN TERTIARY CARE CARDIAC HOSPITAL

    OpenAIRE

    Lal Sukhbir; Saini Vikas; Choudhary Balram; Saini Reetu

    2012-01-01

    To identify and measure the frequency of medication errors, to understand the causes for errors and best strategies to decrease medication errors rate in a cardiac hospital New Delhi. The Retrospective study of 137 case files, was undertaken to find out the medication errors in new drugs to be included in hospital formulary and to study policy compliances,for the period of a month, February 2010.We studied 137 patient files and Medication error related were reported most often at the stages ...

  12. Reduction of cardiovascular event rate: different effects of cardiac rehabilitation in CABG and PCI patients

    OpenAIRE

    Hansen, D.; DENDALE, PAUL; Leenders, M; Berger, J.; Raskin, A.; Vaes, J.; Meeusen, R.

    2009-01-01

    Objective - In coronary artery disease, the implementation of a cardiac rehabilitation (CR) programme favourably affects cardiovascular prognosis. However, it remains uncertain whether patients benefit to a similar extent from CR after coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). In this study, we have assessed whether CR is equally effective for suppressing the two-year cardiovascular event incidence after CABG or PCI. Methods and results - 194 PCI...

  13. A Rare Cardiac Malformation in a Patient Presenting with Transient Ischemic Attack: Isolated Left Ventricular Diverticulum

    Directory of Open Access Journals (Sweden)

    Haldun Müderrisoğlu1

    2012-12-01

    Full Text Available Left ventricular diverticulum is a rare congenital malformation consisting of a localized protrusion of the endocardium and myocardium from the free wall of the left ventricle (LV. The prevalence of the disease is 0.26% in nonselected patients who underwent cardiac catheterization. It is believed that the etiology is an intrinsic abnormality developing during embryogenesis. It often does not cause any symptoms. We report a case of isolated left ventricular diverticulum with complaints of transient ischemic attack.

  14. Transoesophageal echocardiography improves the diagnostic value of cardiac ultrasound in patients with carcinoid heart disease.

    OpenAIRE

    Lundin, L.; Landelius, J; Andrén, B; Oberg, K.

    1990-01-01

    Transthoracic and transoesophageal cardiac echocardiography and Doppler investigations were performed in 31 consecutive patients with malignant midgut carcinoid tumours. The transoesophageal images allowed measurement of the thickness of the atrioventricular valve leaflets and the superficial wall layers on the cavity side of both atria. The mean thickness of the anterior tricuspid leaflet was significantly greater than that of the mitral valve--a difference not seen in a control group of age...

  15. What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

    OpenAIRE

    André La Gerche; Marc Gewillig

    2010-01-01

    Exercise is an important determinant of health but is significantly reduced in the patient with a univentricular circulation. Normal exercise physiology mandates an increase in pulmonary artery pressures which places an increased work demand on the right ventricle (RV). In a biventricular circulation with pathological increases in pulmonary vascular resistance and/or reductions in RV function, exercise-induced augmentation of cardiac output is limited. Left ventricular preload reserve is depe...

  16. Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction

    Directory of Open Access Journals (Sweden)

    Leiner Tim

    2011-05-01

    Full Text Available Abstract Background Increased cardiac lipid content has been associated with diabetic cardiomyopathy. We recently showed that cardiac lipid content is reduced after 12 weeks of physical activity training in healthy overweight subjects. The beneficial effect of exercise training on cardiovascular risk is well established and the decrease in cardiac lipid content with exercise training in healthy overweight subjects was accompanied by improved ejection fraction. It is yet unclear whether diabetic patients respond similarly to physical activity training and whether a lowered lipid content in the heart is necessary for improvements in cardiac function. Here, we investigated whether exercise training is able to lower cardiac lipid content and improve cardiac function in type 2 diabetic patients. Methods Eleven overweight-to-obese male patients with type 2 diabetes mellitus (age: 58.4 ± 0.9 years, BMI: 29.9 ± 0.01 kg/m2 followed a 12-week training program (combination endurance/strength training, three sessions/week. Before and after training, maximal whole body oxygen uptake (VO2max and insulin sensitivity (by hyperinsulinemic, euglycemic clamp was determined. Systolic function was determined under resting conditions by CINE-MRI and cardiac lipid content in the septum of the heart by Proton Magnetic Resonance Spectroscopy. Results VO2max increased (from 27.1 ± 1.5 to 30.1 ± 1.6 ml/min/kg, p = 0.001 and insulin sensitivity improved upon training (insulin stimulated glucose disposal (delta Rd of glucose improved from 5.8 ± 1.9 to 10.3 ± 2.0 μmol/kg/min, p = 0.02. Left-ventricular ejection fraction improved after training (from 50.5 ± 2.0 to 55.6 ± 1.5%, p = 0.01 as well as cardiac index and cardiac output. Unexpectedly, cardiac lipid content in the septum remained unchanged (from 0.80 ± 0.22% to 0.95 ± 0.21%, p = 0.15. Conclusions Twelve weeks of progressive endurance/strength training was effective in improving VO2max, insulin sensitivity

  17. Docetaxel does not impair cardiac autonomic function in breast cancer patients previously treated with anthracyclines.

    Science.gov (United States)

    Ekholm, Eeva; Rantanen, Virpi; Syvänen, Kari; Jalonen, Jarmo; Antila, Kari; Salminen, Eeva

    2002-04-01

    The effects of docetaxel treatment on autonomic cardiac function was studied with 24-h ECG recordings in breast cancer patients pretreated with anthracyclines. Twenty-four women were evaluated before docetaxel treatment and after 3-4 courses of docetaxel 100 mg/m(2). The heart rate, cardiac extrasystoles and heart rate variability (HRV) in both the time and frequency domain were assessed from 24-h ECG recordings. The acute effects of docetaxel were calculated from 1-h recordings immediately prior to, during and after infusion. Long-term effects were evaluated from 24-h recordings performed before treatment and after 3-4 courses of docetaxel. There was no increase in the number of cardiac extrasystoles during docetaxel infusion. The number of ventricular extrasystoles decreased from 14 (23) to 7 (14) during and 5 (10) after the first infusion (p=0.02). The heart rate, HRV and extrasystoles were similar before and after 3-4 courses of docetaxel. The treatment did not abolish circadian variability of the heart rate. Docetaxel did not deteriorate autonomic cardiac function. In conclusion, our findings suggest that docetaxel does not have harmful cumulative effects on autonomic control of the heart and is therefore unlikely to be cardiotoxic.

  18. Monitoring multiple myeloma patients treated with daratumumab

    DEFF Research Database (Denmark)

    McCudden, Christopher; Axel, Amy E; Slaets, Dominique;

    2016-01-01

    and IFE can confound the use of these tests for response assessment in clinical trials and disease monitoring. METHODS: To discriminate between endogenous myeloma protein and daratumumab, a daratumumab-specific immunofixation electrophoresis reflex assay (DIRA) was developed using a mouse anti......-daratumumab antibody. To evaluate whether anti-daratumumab bound to and shifted the migration pattern of daratumumab, it was spiked into daratumumab-containing serum and resolved by IFE/SPE. The presence (DIRA positive) or absence (DIRA negative) of residual M-protein in daratumumab-treated patient samples...... was evaluated using predetermined assessment criteria. DIRA was evaluated for specificity, limit of sensitivity, and reproducibility. RESULTS: In all of the tested samples, DIRA distinguished between daratumumab and residual M-protein in commercial serum samples spiked with daratumumab and in daratumumab...

  19. Simulation of Daily Snapshot Rhythm Monitoring to Identify Atrial Fibrillation in Continuously Monitored Patients with Stroke Risk Factors.

    Directory of Open Access Journals (Sweden)

    Yuichiro Yano

    Full Text Available New technologies are diffusing into medical practice swiftly. Hand-held devices such as smartphones can record short-duration (e.g., 1-minute ECGs, but their effectiveness in identifying patients with paroxysmal atrial fibrillation (AF is unknown.We used data from the TRENDS study, which included 370 patients (mean age 71 years, 71% men, CHADS2 score≥1 point: mean 2.3 points who had no documentation of atrial tachycardia (AT/AF or antiarrhythmic or anticoagulant drug use at baseline. All were subsequently newly diagnosed with AT/AF by a cardiac implantable electronic device (CIED over one year of follow-up. Using a computer simulation approach (5,000 repetitions, we estimated the detection rate for paroxysmal AT/AF via daily snapshot ECG monitoring over various periods, with the probability of detection equal to the percent AT/AF burden on each day.The estimated AT/AF detection rates with snapshot monitoring periods of 14, 28, 56, 112, and 365 days were 10%, 15%, 21%, 28%, and 50% respectively. The detection rate over 365 days of monitoring was higher in those with CHADS2 scores ≥2 than in those with CHADS2 scores of 1 (53% vs. 38%, and was higher in those with AT/AF burden ≥0.044 hours/day compared to those with AT/AF burden <0.044 hours/day (91% vs. 14%; both P<0.05.Daily snapshot ECG monitoring over 365 days detects half of patients who developed AT/AF as detected by CIED, and shorter intervals of monitoring detected fewer AT/AF patients. The detection rate was associated with individual CHADS2 score and AT/AF burden.ClinicalTrials.gov NCT00279981.

  20. Prototype Development of an Electrical Impedance Based Simultaneous Respiratory and Cardiac Monitoring System for Gated Radiotherapy

    OpenAIRE

    Kohli, Kirpal; Liu, Jeff; Schellenberg, Devin; Karvat, Anand; Parameswaran, Ash; Grewal, Parvind; Thomas, Steven

    2014-01-01

    Background In radiotherapy, temporary translocations of the internal organs and tumor induced by respiratory and cardiac activities can undesirably lead to significantly lower radiation dose on the targeted tumor but more harmful radiation on surrounding healthy tissues. Respiratory and cardiac gated radiotherapy offers a potential solution for the treatment of tumors located in the upper thorax. The present study focuses on the design and development of simultaneous acquisition of respira...

  1. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Shakuri

    2014-09-01

    Full Text Available Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery were divided into two groups randomly (groups A and B. In group A it was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and six-minute walk test. Results — Thirty nine of males (65% and 21 females (35% with a mean age of 8.10±9.56 was been analyzed. The mean difference in predicted forced vital capacity (CI95%: 1.3 to 8.7 and predicted peak flow indices (CI95%: 1.9 to 9.4 of spirometery indicator was significant, also evaluation of six-minute walk test showed, mean difference in walking distant (CI95%: 8.8 to 21.0 and mean oxyhemoglobin saturation (CI95%: 0.59 to 1.67 in group A was more than group B. Inverse correlation of heart rate with forced vital capacity showed that patients with more restriction had more heart rate during the walking test. Conclusion — Pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery. Further evaluations are necessary in relation to the sensitivity and specificity of six-minute walk test parameters alone in the evaluation of respiratory performance.

  2. Churg-Strauss syndrome cardiac involvement evaluated by cardiac magnetic resonance imaging and positron-emission tomography: a prospective study on 20 patients

    International Nuclear Information System (INIS)

    Churg-Strauss syndrome (CSS) cardiac involvement is associated with a poor prognosis. Recently cardiac MRI (CMRI) has emerged as a promising technique to detect early CSS cardiac involvement. However, CMRI-detected myocardial delayed enhancement (MDE) could correspond to fibrosis or inflammation. Fluoro-2-deoxyglucose PET (FDG-PET) was previously used in other systemic diseases to distinguish between them. To determine whether the CMRI-MDE detected in CSS patients reflected fibrosis or myocardial inflammation, patients in CSS remission underwent FDG-PET. Twenty consecutive CSS patients in remission (BVAS = 0) were recruited. Fourteen patients [eight men, six women; mean (S.D.) age 49 (9) years; mean disease duration 3.5 (2.9) years] with CMRI-detected MDE, and six patients [four men, two women; mean (S.D.) age 44 (15) years; mean disease duration 3.5 (5.3) years] with normal CMRI underwent FDG-PET. Segments with MDE on CMRI were analysed on FDG-PET images, with myocardial FDG hypo-fixation defining fibrosis and hyper-fixation corresponding inflammation. Among the 14 patients with MDE on CMRI, FDG-PET showed 10 had hypo-fixation, 2 had hyper-fixation and 2 had normal scans. CSS duration at the time of CMRI was shorter for patients with myocardial inflammation than in those with fibrosis. The six patients with normal CMRI had normal FDG-PET images. For CSS patients in remission, CMRI detected subclinical active myocardial lesions and could be recommended to assess cardiac involvement. However, because CMRI-detected MDE can reflect fibrosis or inflammation, FDG-PET might help to distinguish between the two. (authors)

  3. Lack of agreement between bioimpedance and continuous thermodilution measurement of cardiac output in intensive care unit patients

    OpenAIRE

    Barry, Ben N; Mallick, Abhiram; Bodenham, Andrew R; Vucevic, Michael

    1997-01-01

    Background: Bolus thermodilution is the standard bedside method of cardiac output measurement in the intensive care unit (ICU). The Baxter Vigilance monitor uses a modified thermodilution pulmonary artery catheter with a thermal filament to give a continuous read-out of cardiac output. This has been shown to correlate very well with both the 'gold standard' dye dilution method and the bolus thermodilution method. Bioimpedance cardiography using the Bomed NCCOM 3 offers a noninvasive means of ...

  4. Cardiac migration of endogenous mesenchymal stromal cells in patients with inflammatory cardiomyopathy.

    Science.gov (United States)

    Schmidt-Lucke, Caroline; Escher, Felicitas; Van Linthout, Sophie; Kühl, Uwe; Miteva, Kapka; Ringe, Jochen; Zobel, Thomas; Schultheiss, Heinz-Peter; Tschöpe, Carsten

    2015-01-01

    Introduction. Mesenchymal stromal cells (MSC) have immunomodulatory features. The aim of this study was to investigate the migration and homing potential of endogenous circulating MSC in virus negative inflammatory cardiomyopathy (CMi). Methods. In 29 patients with (n = 23) or without (n = 6) CMi undergoing endomyocardial biopsies (EMB), transcardiac gradients (TCGs) of circulating MSC were measured by flow cytometry from blood simultaneously sampled from aorta and coronary sinus. The presence of MSC in EMB, cardiac inflammation, and SDF-1α mRNA expression were detected via immunohistochemistry and real-time PCR. Results. MSC defined as CD45(-)CD34(-)CD11b(-)CD73(+)CD90(+) cells accounted for 0.010 [0.0025-0.048]%/peripheral mononuclear cell (PMNC) and as CD45(-)CD34(-)CD11b(-)CD73(+)CD105(+) cells for 0.019 [0.0026-0.067]%/PMNC, both with similar counts in patients with or without cardiac inflammation. There was a 29.9% (P TCG of circulating MSC and numbers of MSC (CD45(-)CD34(-)CD90(+)CD105(+)) in EMB (r = -0.73, P < 0.005). SDF-1α was the strongest predictor for increased MSC in EMB (P < 0.005, multivariate analysis). Conclusions. Endogenous MSC continuously migrate to the heart in patients with CMi triggered by cardiac inflammation. PMID:25814787

  5. Importance of re-calibration time on pulse contour analysis agreement with thermodilution measurements of cardiac output: a retrospective analysis of intensive care unit patients.

    Science.gov (United States)

    Scully, Christopher G; Gomatam, Shanti; Forrest, Shawn; Strauss, David G

    2016-10-01

    We assessed the effect of re-calibration time on cardiac output estimation and trending performance in a retrospective analysis of an intensive care unit patient population using error grid analyses. Paired thermodilution and arterial blood pressure waveform measurements (N = 2141) from 222 patient records were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. Pulse contour analysis was performed by implementing a previously reported algorithm at calibration times of 1, 2, 8 and 24 h. Cardiac output estimation agreement was assessed using Bland-Altman and error grid analyses. Trending was assessed by concordance and a 4-Quadrant error grid analysis. Error between pulse contour and thermodilution increased with longer calibration times. Limits of agreement were -1.85 to 1.66 L/min for 1 h maximum calibration time compared to -2.70 to 2.41 L/min for 24 h. Error grid analysis resulted in 74.2 % of points bounded by 20 % error limits of thermodilution measurements for 1 h calibration time compared to 65 % for 24 h. 4-Quadrant error grid analysis showed analysis method and thermodilution showed poor agreement to monitor changes in cardiac output.

  6. Successful use of levosimendan as a primary inotrope in pediatric cardiac surgery: An observational study in 110 patients

    Directory of Open Access Journals (Sweden)

    Reena Khantwal Joshi

    2016-01-01

    Conclusions: Levosimendan-based inotropic regime offers optimized cardiac output with a well-controlled heart rate and a low incidence of arrhythmias in patients undergoing all categories of congenital heart surgeries.

  7. Survival of male patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study

    Directory of Open Access Journals (Sweden)

    Deborah Caruso, MD

    2014-11-01

    Full Text Available Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate, both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.

  8. Effects of febuxostat and allopurinol on the inflammation and cardiac function in chronic heart failure patients with hyperuricemia

    Directory of Open Access Journals (Sweden)

    Akihiro Nakagomi

    2015-09-01

    Conclusions: These data indicate that febuxostat is more effective than allopurinol in reducing the UA level and inflammation and may improve the cardiac function in CHF patients with hyperuricemia due, at least in part, to reductions in inflammation.

  9. Changes in the Cardiopulmonary Response to Exercise after Cardiac Transplantation in Patients Enrolled in an Early Rehabilitation Program

    Directory of Open Access Journals (Sweden)

    Lizanne M Bussières

    1997-01-01

    Full Text Available OBJECTIVE: To evaluate the changes in the cardiopulmonary response to exercise in the first year after cardiac transplantation in patients enrolled in a rehabilitation program in the first three months post-transplantation.

  10. Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review

    OpenAIRE

    2012-01-01

    AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).

  11. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

    International Nuclear Information System (INIS)

    Hemodialysis (Hd) patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP) as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescences immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group) (p< 0.05). However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients. (author)

  12. Association of hypothyroidism with adverse events in patients with heart failure receiving cardiac resynchronization therapy.

    Science.gov (United States)

    Sharma, Ajay K; Vegh, Eszter; Orencole, Mary; Miller, Alexandra; Blendea, Dan; Moore, Stephanie; Lewis, Gregory D; Singh, Jagmeet P; Parks, Kimberly A; Heist, E Kevin

    2015-05-01

    Hypothyroidism is associated with an adverse prognosis in cardiac patients in general and in particular in patients with heart failure (HF). The aim of this study was to evaluate the impact of hypothyroidism on patients with HF receiving cardiac resynchronization therapy (CRT). Additionally, the impact of level of control of hypothyroidism on risk of adverse events after CRT implantation was also evaluated. We included consecutive patients in whom a CRT device was implanted from April 2004 to April 2010 at our institution with sufficient follow-up data available for analysis; 511 patients were included (age 68.5±12.4 years, women 20.4%); 84 patients with a clinical history of hypothyroidism, on treatment with thyroid hormone repletion or serum thyroid-stimulating hormone level≥5.00 μU/ml, were included in the hypothyroid group. The patients were followed for up to 3 years after implant for a composite end point of hospitalization for HF, left ventricular assist device placement, or heart transplant and cardiac death; 215 composite end point events were noted in this period. In a multivariate model, hypothyroidism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.027 to 2.085, p=0.035), female gender (HR 0.64, 95% CI 0.428 to 0.963, p=0.032), and creatinine (HR 1.26, 95% CI 1.145 to 1.382, phypothyroidism at baseline developed the composite end point compared with 39.8% of those with euthyroidism (p=0.02). In conclusion, hypothyroidism is associated with a worse prognosis after CRT implantation.

  13. Patient perspective on remote monitoring of cardiovascular implantable electronic devices

    DEFF Research Database (Denmark)

    Versteeg, H; Pedersen, Susanne S.; Mastenbroek, M H;

    2014-01-01

    BACKGROUND: Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the patient perspective on remote monitoring is scarce and inconsistent. OBJECTIVES: The primary...... objective of the REMOTE-CIED study is to evaluate the influence of remote patient monitoring versus in-clinic follow-up on patient-reported outcomes. Secondary objectives are to: 1) identify subgroups of patients who may not be satisfied with remote monitoring; and 2) investigate the cost-effectiveness...... of remote monitoring. METHODS: The REMOTE-CIED study is an international randomised controlled study that will include 900 consecutive heart failure patients implanted with an implantable cardioverter defibrillator (ICD) compatible with the Boston Scientific LATITUDE® Remote Patient Management system...

  14. Cardiac catheterization in patients with unstable angina. Recent onset vs crescendo pattern.

    Science.gov (United States)

    Plotnik, G D; Fisher, M L; Carliner, N H; Becker, L C

    1980-08-01

    Among patients with unstable angina pectoris, those with crescendo angina seem to be at high risk for death and myocardial infarction. We reviewed the clinical, arteriographic, and hemodynamic findings in 218 consecutive catheterized patients with unstable angina. Unstable angina was defined as ischemic cardiac pain at rest associated with transient ECG changes but no evidence for acute myocardial infarction. Patients were divided into two groups according to the duration of symptoms: 134 patients with crescendo angina (new, or increasing, rest pain with previous ischemic symptoms present for more than three months) and 84 with recent onset angina (symptoms present for less than three months). Compared with patients with recent onset symptoms, patients with crescendo angina had more extensive coronary disease and lower ejection fractions, which may explain their poor prognosis.

  15. The Occurrence of Acute Postoperative Confusion in Patients after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Jürgen Osterbrink

    2005-01-01

    Full Text Available This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22–91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged 80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication.

  16. Impact of Critical Limb Ischemia on Long-Term Cardiac Mortality in Diabetic Patients Undergoing Percutaneous Coronary Revascularization

    OpenAIRE

    Liistro, Francesco; Angioli, Paolo; Grotti, Simone; Brandini, Rossella; Porto, Italo; Ricci, Lucia; Tacconi, Danilo; Ducci, Kenneth; Falsini, Giovanni; Bellandi, Guido; Bolognese, Leonardo

    2013-01-01

    OBJECTIVE Development of critical limb ischemia (CLI) has been reported as an independent predictor of cardiac mortality in diabetic patients. We aimed to determine whether CLI, managed in a structured setting of close collaboration between different vascular specialists and treated with early endovascular intervention, has any impact on long-term cardiac mortality of diabetic patients initially presenting with symptomatic coronary artery disease (CAD). RESEARCH DESIGN AND METHODS We designed...

  17. Clinical features and outcome of eight patients with mediastinal and neck hematoma after transradial cardiac catheterization approach

    Institute of Scientific and Technical Information of China (English)

    杨伟宪

    2014-01-01

    Objective The clinical features of patients with mediastinal and/or neck hematoma after transradial cardiac catheterization were reviewed and analyzed to help the clinicians to recognize this complication,and try their best to avoid the complication and treat the complication properly.Methods A total of 8 patients with mediastinal and/or neck hematoma after right transradial cardiac catheterization in Fuwai hospital from January 1,2005 to the end of 2012 were included in this study.Among

  18. Prevalence of pre-transplant electrocardiographic abnormalities and post-transplant cardiac events in patients with liver cirrhosis

    OpenAIRE

    Josefsson, Axel; Fu, Michael; Björnsson, Einar; Kalaitzakis, Evangelos

    2014-01-01

    Background Although cardiovascular disease is thouht to be common in cirrhosis, there are no systematic investigations on the prevalence of electrocardiographic (ECG) abnormalities in these patients and data on the occurrence of post-transplant cardiac events in comparison with the general population are lacking. We aimed to study the prevalence and predictors of ECG abnormalities in patients with cirrhosis undergoing liver transplantation and to define the risk of cardiac events post-transpl...

  19. Prevalence of pre-transplant electrocardiographic abnormalities and post-transplant cardiac events in patients with liver cirrhosis

    OpenAIRE

    Josefsson, Axel; Fu, Michael; Bjoernsson, Einar; Kalaitzakis, Evangelos

    2014-01-01

    Background: Although cardiovascular disease is thouht to be common in cirrhosis, there are no systematic investigations on the prevalence of electrocardiographic (ECG) abnormalities in these patients and data on the occurrence of post-transplant cardiac events in comparison with the general population are lacking. We aimed to study the prevalence and predictors of ECG abnormalities in patients with cirrhosis undergoing liver transplantation and to define the risk of cardiac events post-transp...

  20. Genetic Polymorphisms in Endothelin-1 as Predictors for Long-Term Survival and the Cardiac Index in Patients Undergoing On-Pump Cardiac Surgery.

    Directory of Open Access Journals (Sweden)

    Ashham Mansur

    Full Text Available Genetic variants within the endothelin-1 gene (EDN1 have been associated with several cardiovascular diseases and may act as genetic prognostic markers. Here, we explored the overall relevance of EDN1 polymorphisms for long-term survival in patients undergoing on-pump cardiac surgery. A prospectively collected cohort of 455 Caucasian patients who underwent cardiac surgery with cardiopulmonary bypass was followed up for 5 years. The obtained genotypes and inferred haplotypes were analyzed for their associations with the five-year mortality rate (primary endpoint. The EDN1 T-1370G and K198N genotype distributions did not deviate from Hardy-Weinberg equilibrium and the major allele frequencies were 83% and 77%, respectively. The cardiovascular risk factors were equally distributed in terms of the different genotypes and haplotypes associated with the two polymorphisms. The five-year mortality rate did not differ among the different EDN1 T-1370G and K198N genotypes and haplotypes. Haplotype analysis revealed that carriers of the G-T (compound EDN1 T-1370G G/K198N T haplotype had a higher cardiac index than did non-carriers (p = 0.0008; however, this difference did not reach significance after adjusting for multiple testing. The results indicate that common variations in EDN1 do not act as prognostic markers for long-term survival in patients undergoing on-pump cardiac surgery.

  1. A framework for the comparison of mobile patient monitoring systems.

    Science.gov (United States)

    Pawar, Pravin; Jones, Val; van Beijnum, Bert-Jan F; Hermens, Hermie

    2012-06-01

    A mobile patient monitoring system makes use of mobile computing and wireless communication technologies for continuous or periodic measurement and analysis of biosignals of a mobile patient. In a number of trials these systems have demonstrated their user-friendliness, convenience and effectiveness for both patients and healthcare professionals. In this paper we propose a generic architecture, associated terminology and a classificatory framework for comparing mobile patient monitoring systems. We then apply this comparison framework to classify six mobile patient monitoring systems selected according to the following criteria: use of diverse mobile communication techniques, evidence of practical trials and availability of sufficient published scientific information. We also show how to use this framework to determine feature sets of prospective real-time mobile patient monitoring systems using the example of epilepsy monitoring. This paper is aimed at both healthcare professionals and computer professionals. For healthcare professionals, this paper provides a general understanding of technical aspects of the mobile patient monitoring systems and highlights a number of issues implied by the use of these systems. The proposed framework for comparing mobile patient monitoring systems can be used by healthcare professionals to determine feature sets of prospective mobile patient monitoring systems to address particular healthcare related needs. Computer professionals are expected to benefit by gaining an understanding of the latest developments in the important emerging application area of mobile patient monitoring systems. PMID:22406009

  2. Efficacy of Mild Hypothermia for the Treatment of Patients with Cardiac Arrest

    Institute of Scientific and Technical Information of China (English)

    Yu Gao; Kang-Li Hui; Yu-Jie Wang; Lin Wu; Man-Lin Duan; Jian-Guo Xu; De-Xin Li

    2015-01-01

    Background:Therapeutic hypothermia has been recommended for the treatment of cardiac arrest patients who remain comatose after the return of spontaneous circulation.The aim of this study was to evaluate the effectiveness and safety of mild hypothermia on patients with cardiac arrest by conducting a meta-analysis.Methods:The relevant trials were searched in Cochrane Library,PubMed,Web of Science,Embase,CNKI and Wan Fang Data from the date of their establishment to October 2014.Thereafter,the studies retrieved were screened based on predefined inclusion and exclusion criteria.Data were extracted,and the quality of the included studies was evaluated.A meta-analysis was conducted using the Cochrane Collaboration Review Manager 5.2 software.Results:Six randomized controlled trials involving 531 cases were included,among which 273 cases were assigned to the treatment group and the other 258 cases to the control group.The meta-analysis indicated that mild hypothermia therapy after cardiac arrest produced significant differences in survival rate (relative risk [RR] =1.23,95% confidence interval [CI]:1.02-1.48,P =0.03) and neurological function (RR =1.33,95% CI:1.08-1.65,P =0.007) after 6 months compared with normothermia therapy.However,no significant differences were observed in the survival to the hospital discharge (RR =1.35,95% CI:0.87-2.10,P =0.18),favorable neurological outcome at hospital discharge (RR =1.53,95% CI:0.95-2.45,P =0.08) and adverse events.Conclusions:The meta-analysis demonstrated that mild hypothermia can improve the survival rate and neurological function of patients with cardiac arrest after 6 months.On the other hand,regarding the survival to hospital discharge,favorable neurological outcome at hospital discharge,and adverse events,our meta-analysis produced nonsignificant results.

  3. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  4. Stress testing for risk stratification of patients with low to moderate probability of acute cardiac ischemia.

    Science.gov (United States)

    Chandra, A; Rudraiah, L; Zalenski, R J

    2001-02-01

    In summary, this article focused on the use of stress testing to risk-stratify patients at the conclusion of their emergency evaluation for ACI. As discussed, those patients in the probably not ACI category require additional risk stratification prior to discharge. It should be kept in mind that patients in this category are heterogeneous, containing subgroups at both higher and lower risk of ACI and cardiac events. The patients with lower pretest probability for ACI may only need exercise testing in the ED. Patients with higher pretest probability should undergo myocardial perfusion or echocardiographic stress testing to maximize diagnostic and prognostic information. Prognostic information is the key to provocative testing in the ED. Prognostic information is the component that will help emergency physicians identify the patients who may be discharged home safely without having to worry about a 6% annual cardiac death rate and a 10% overall death rate over the next 30 months. Stress testing provides this key prognostic data, and it can be obtained in short-stay chest pain observation units in a safe, timely, and cost-effective fashion. PMID:11214405

  5. Evaluation of cardiac sympathetic neuronal integrity in diabetic patients using iodine-123 metaiodobenzylguanidine

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sun Jung [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Lee, Jong Doo [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Ryu, Young Hoon [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Jeon, Pyoung [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Shim, Yong Woon [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Yoo, Hyung Sik [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Park, Chang Yun [Department of Diagnostic Radiology and Nuclear Medicine, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of); Lim, Seung Gil [Department of Endocrinology, Yonsei University, College of Medicine, 134 Shincheon-dong, Seodaemun-gu, Seoul, 120-752 (Korea, Republic of)

    1996-04-01

    Autonomic dysfunction is associated with increased mortality in diabetic patients. To evaluate the cardiac autonomic dysfunction in these patients, a prospective study was undertaken using iodine-123 metaiodobenzylguanidine (MIBG) single-photon emission tomography (SPET). The study groups consisted of ten diabetic patients with cardiac autonomic neuropathy (group I) and six without autonomic neuropathy (group II). Autonomic nervous function tests, thallium scan, radionuclide ventriculographic data including ejection fraction and wall motion study, and 24-h urine catecholamine levels were evaluated. {sup 123}I-MIBG SPET was performed at 30 min and 4 h following injection of 3 mCi of {sup 123}I-MIBG in groups I and II and in normal subjects (n=4). On planar images, the heart to mediastinum (H/M) ratio was measured. Defect pattern and severity of MIBG uptake were qualitatively analysed on SPET. Compared with control subjects, diabetic patients had a reduced H/M ratio regardless of the presence of clinical autonomic neuropathy. There was no difference in H/M ratio between groups I and II. On SPET images, focal or diffuse defects were demonstrated in all patients in group I, and in five of the six patients in group II. The extent of defects tended to be more pronounced in group I than in group II. In conclusion, {sup 123}I-MIBG scan was found to be a more sensitive method than clinical autonomic nervous function tests for the detection of autonomic neuropathy in diabetes. (orig.). With 3 figs., 1 tab.

  6. Analysis of prognostic value of clinical information and myocardial perfusion imaging in diabetic patients on cardiac events occurrence

    International Nuclear Information System (INIS)

    Objective: To explore the risk factors of cardiac event (CE) occurrence and evaluate the prognostic value of myocardial perfusion imaging (MPI) in diabetic patients. Methods: We conducted a study with 172(16.4%) consecutively registered patients with diabetes (132 males, 40 females; age range 16-90 years, mean age 55.94±12.46 years) and 875(83.6%) patients without diabetes with known or suspected coronary artery disease (CAD) undergoing SPECT MPI. Follow-up information was obtained through telephone interviews. Patients were followed up for at least 18 months. End points were defined as death due to primary cardiac cause, or nonfatal acute myocardial infarction and revascularization. The mean time of follow-up was 33.25±14.95 (1∼56) months. Results: Logistic stepwise regression analysis evaluated history of smoking and drinking, hypertension, hyperlipemia and the family history of CAD as predictors. A multiple regression formula was obtained: Y=-5.593+0.958X1+0.921 X2+0.428X3, (Y=cardiac events, X1=diabetes, X2=the family history of CAD, X3=hypertension). Diabetes, the family history of CAD and hypertension were dangerous factors for cardiac events, but hyperlipemia, history of smoking and drinking were protective factors for cardiac events. Over the follow-up period, there are 42 cardiac events in diabetic group, 86 in non-diabetic group. Patients with diabetes had significantly higher rates of cardiac events (24.4% versus 9.8%; chi-square 28.5, P<0.0001), compared with rates among patients without diabetes (table 1). Kaplan-Meier survival curves analyzing the no-CE rates in the diabetic and non-diabetic groups, diabetic patients were significantly lower than non-diabetic ones (Log-rank statistic, chi-square 28.75, P <0.0001). Of 172 diabetic patients, 32.2% of the patients with abnormal MPI occurred cardiac events, but only 7.4% of the patients with normal ones did(chi-square 12.34, P <0.001) (figure 1). Abnormal SPECT MPI was associated with the higher rate

  7. 脉搏轮廓心排血量监测技术在成批特大面积烧伤患者延迟复苏中的应用效果%Effect of application of pulse contour cardiac output monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty

    Institute of Scientific and Technical Information of China (English)

    杨雯娴; 郭光华; 沈国良; 林伟; 赵小瑜; 祁强; 钱汉根; 谢文忠; 王志学

    2016-01-01

    Objective To investigate the effect of the application of pulse contour cardiac output (PiCCO) monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty.Methods The clinical data of 41 patients injured in Kunshan dash explosion hospitalized in the First Affiliated Hospital of Soochow University,the 100th Hospital of the People's Liberation Army,and Suzhou Municipal Hospital were retrospectively analyzed.The patients were divided into traditional monitoring group (T,n =22) and PiCCO monitoring group (P,n =19) according to the monitoring technic during delayed resuscitation.The input volumes of electrolyte,colloids,and water of patients in the two groups within 2 hours after admission,the first,second,and third 8 hours post injury (HPI),and the first 24 HPI were recorded.The fluid infusion coefficients of patients in the two groups within 2 hours after admission,the first,second,and third 8 HPI,and the first,second,third,and fourth 24 HPI were calculated.The urine volume,mean arterial pressure (MAP),and central venous pressure (CVP) of patients in the two groups at post injury hour (PIH) 8,16,24,48,72,and 96 were recorded.The blood lactate,base excess,hematocrit (HCT),and platelet count of patients in the two groups at PIH 24,48,72,and 96 were recorded.Complications and death of patients in the two groups were recorded.Data were processed with analysis of variance for repeated measurement,Chi-square test,t test,and Wilcoxon test.The deviations between figure 2 and the fluid infusion coefficients of the first or second 24 HPI,and the deviations between figure 1 and the fluid infusion coefficients of the second,third or fourth 24 HPI were calculated,and the three groups deviations were analyzed by Pearson correlation analysis.Results (1) The input volumes of electrolyte of patients in group P were significantly more than those in group T within the first 8 and 24 HPI (with Z values respectively-3.506 and-2.654,P < 0.05 or P

  8. Application of cine cardiac MR imaging in normal subjects and patients with valvular, coronary artery, and aortic disease

    International Nuclear Information System (INIS)

    Cine MR imaging was performed on 15 normal subjects and 27 patients with cardiac disease. In normal subjects, high signal intensity of flowing blood contrasted with that of the myocardium. In 16 patients with valvular regurgitation, signal void jet due to turbulence was visualized across the diseased valves. In three IHSS patients, thickened LV myocardium, mitral regurgitant jets, and systolic LV outflow jets were noted. Five patients with myocardial infarction (MI) showed thinning and/or hypokinesis of MI regions. In three patients with Marfan syndrome, aortic dilatation, insufficiency, and flap (one pt) were identified. Cine MR imaging is potentially useful for evaluation of a variety of cardiac diseases

  9. Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

    Science.gov (United States)

    Murtaza, Ghulam; Khan, Muhammad Yasir Ghani; Azhar, Saira; Khan, Shujaat Ali; Khan, Tahir M

    2016-03-01

    Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs. PMID:27013915

  10. Combined arterial and venous whole-body MR angiography with cardiac MR imaging in patients with thromboembolic disease - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, Florian M.; Hunold, Peter; Barkhausen, Joerg [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Herborn, Christoph U. [University Hospital Hamburg-Eppendorf, Medical Prevention Center Hamburg (MPCH) at University Hospital Hamburg-Eppendorf, Hamburg (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Kroger, Knut [University Hospital Essen, Department of Angiology, Essen (Germany)

    2008-05-15

    The objective was to assess the feasibility of a combined arterial and venous whole-body three-dimensional magnetic resonance (MR) angiography, together with a cardiac MR examination, in patients with arterial thromboembolism. Ten patients with arterial thromboembolism underwent a contrast-enhanced whole-body MR examination of the arterial and venous vessels, followed by a cardiac MR examination on a separate occasion within 24 h. All examinations were performed on a 1.5-T MR scanner. For both arterial and venous MR angiography only one injection of contrast agent was necessary. The cardiac imaging protocol included dark-blood-prepared half-Fourier acquisition single-shot turbo-spin-echo sequences, fast steady-state free precession cine sequences, T2-weighted turbo-spin-echo sequences and inversion recovery gradient-echo fast low-angle-shot sequences after injection of contrast agent. MR imaging revealed additional clinically unknown arterial thromboembolisms in four patients. The thoracic aorta was depicted as embolic source in four patients, while deep vein thrombosis (DVT) was found in one patient as the underlying disease. Unsuspected infarction of parenchymal organs was detected by MRI in two patients. An unknown additional DVT was found in one patient. Four patients were considered to have arterial emboli of cardiac origin. In conclusion, acquisition of arterial and venous MR angiograms of the entire vascular system combined with cardiac MR imaging is a most comprehensive and valuable strategy in patients with arterial thromboembolism. (orig.)

  11. CARDIAC TOXICITY AFTER RADIATION THERAPY FOR 52 PATIENTS WITH MALIGNANT THYMIC TUMORS

    Institute of Scientific and Technical Information of China (English)

    孙艳; 韩树奎; 邓珊明

    2003-01-01

    Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radiotherapy for malignant thymic tumor (14 at Masaoka stage II, 23 at stage III and 15 at stage IV). Treatment included radical (in 20), postoperative (in 14), preoperative (in 2) and palliative (in 16) radiotherapy. The conventional two-dimension (2D) radiation therapy was performed in forty-seven patients and three-dimension (3D) conformal radiation therapy has been used in 5 patients since October 2000. The total tumor dose ranged from 10 Gy to 84.5 Gy (median of 55 Gy). Chemotherapy was given in twenty-five patients before or after radiotherapy. The results of following-up could be obtained from the database and updated where appropriated. The dose volume histogram (DVH) of heart in radiotherapy for all patients was analyzed for the effective volume dose of heart. Result: The median following-up was 14 months (ranged from 0.6 to 111.3 months) in the study. RIHD was observed in seven patients. Cardiac toxicity of these seven patients were evaluated as SOMA grade 1-3. The median two-third effective volume dose of heart was 47.2 Gy (ranged from 8.3 Gy to 70.1 Gy) for conventional 2D radiotherapy, which correlated with thymic tumor dose (P<0.0001). The median two-third effective volume dose of heart was 35.3 Gy (ranged from 13 Gy to 38.7 Gy) for 3D conformal radiotherapy. The effective volume doses of heart were decreased by using 3D conformal radiotherapy (P=0.048). A significant association between cardiac toxicity and effective volume dose of heart was found in this study (P<0.0001). Cardiac toxicity accounted for 10.4% and 4.1% of patients receiving and not receiving adjuvant chemotherapy, respectively, and occurred earlier in radiochemotherapy group (P=0.0528). Multivariate analysis suggested that cardiac toxicity was significantly influenced by the

  12. New insight into epirubicin cardiac toxicity: competing risks analysis of 1097 breast cancer patients

    DEFF Research Database (Denmark)

    Ryberg, Marianne; Cortese, Giuliana; Nielsen, Gitte;

    2008-01-01

    % confidence interval = 1.21 to 1.61), patient age, predisposition to cardiac disease, history of mediastinal irradiation, or antihormonal treatment for metastatic disease. Risk factors for death from all other causes (including breast cancer) included lesser dosages of epirubicin, increased tumor burden...... and death from all other causes as the competing event. All statistical tests were two-sided. RESULTS: A total of 11.4% of patients developed cardiotoxicity. Risk factors for cardiotoxicity included increased cumulative dose of epirubicin (hazard ratio per every 100 mg/m(2) administered = 1.40, 95...

  13. Cardiac findings in patients with Behçet's disease: Facts and controversies.

    Science.gov (United States)

    Farouk, Heba; Zayed, Hania Salah; El-Chilali, Karim

    2016-07-01

    Behçet's disease (BD) is a systemic vasculitis of unknown etiology. It is characterized by recurrent oral and genital ulcers, uveitis, and a number of systemic manifestations. Although the disease is recognized worldwide, its prevalence is highly variable. A detailed review and analysis of the worldwide published reports on BD showed that not only the prevalence of the disease but also its cardiac complications differ according to the geographic distribution of the studied population. With the exception of France, Greece, Spain, and Italy, very few reports and studies regarding BD have been published from the western countries. Cardiovascular complications are an important cause of poor outcome in patients with BD. Over the past few years, many case reports and studies have been published, providing more facts about these complications. For example, peculiar echocardiographic findings in patients with aortic valve regurgitation and intracardiac thrombi secondary to BD were recently described. The role of these findings in the initial diagnosis of the disease, however, remains to be evaluated. On the other hand, some reports present contradictory results, especially concerning the left ventricular diastolic function, pathogenesis of coronary artery disease, and proper management of the cardiac complications in BD. Importantly, management of these complications is based mainly on the discretion of the treating physician due to the absence of large controlled studies and clear guidelines. This approach sometimes creates inconsistent data and allows controversies to persist. The review presented here will discuss some of the facts and controversies related to cardiac complications in BD.

  14. Analyses of the redistribution of work following cardiac resynchronisation therapy in a patient specific model.

    Directory of Open Access Journals (Sweden)

    Steven Alexander Niederer

    Full Text Available Regulation of regional work is essential for efficient cardiac function. In patients with heart failure and electrical dysfunction such as left branch bundle block regional work is often depressed in the septum. Following cardiac resynchronisation therapy (CRT this heterogeneous distribution of work can be rebalanced by altering the pattern of electrical activation. To investigate the changes in regional work in these patients and the mechanisms underpinning the improved function following CRT we have developed a personalised computational model. Simulations of electromechanical cardiac function in the model estimate the regional stress, strain and work pre- and post-CRT. These simulations predict that the increase in observed work performed by the septum following CRT is not due to an increase in the volume of myocardial tissue recruited during contraction but rather that the volume of recruited myocardium remains the same and the average peak work rate per unit volume increases. These increases in the peak average rate of work is is attributed to slower and more effective contraction in the septum, as opposed to a change in active tension. Model results predict that this improved septal work rate following CRT is a result of resistance to septal contraction provided by the LV free wall. This resistance results in septal shortening over a longer period which, in turn, allows the septum to contract while generating higher levels of active tension to produce a higher work rate.

  15. Prediction of the potential clinical outcomes for post-resuscitated patients after cardiac arrest

    Science.gov (United States)

    Hong, Sungmin; Kwon, Bojun; Yun, Il Dong; Lee, Sang Uk; Kim, Kyuseok; Kim, Joonghee

    2013-02-01

    Cerebral injuries after cardiac arrest are serious causes for morbidity. Many previous researches in the medical society have been proposed to prognosticate the functional recoveries of post-resuscitated patients after cardiac arrest, but the validity of suggested features and the automation of prognostication have not been made yet. This paper presents the automatic classification method which predicts the potential clinical outcomes of post-resuscitated patients who suffered from cardiac arrest. The global features and the local features are adapted from the researches from the medical society. The global features, which are consisted of the percentage of the partial volume under the uniformly increasing thresholds, represent the global tendency of apparent diffusion coefficient value in a DWI. The local features are localized and measured on the refined local apparent diffusion coefficient minimal points. The local features represent the ischemic change of small areas in a brain. The features are trained and classified by the random forest method, which have been widely used in the machine learning society for classification. The validity of features is automatically evaluated during the classification process. The proposed method achieved the 0.129 false-positive rate while maintaining the perfect true-positive rate. The area-under-curve of the proposed method was 0.9516, which showed the feasibility and the robustness of the proposed method.

  16. The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Hassager, Christian;

    2014-01-01

    BACKGROUND: Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long-term outcome. Cardiac abnormalities dominated by left ventricular (LV) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists...... on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI. METHODS: We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment...... fraction or GLS attenuated its importance considerably. CONCLUSION: Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV...

  17. Comparison of temperature measurements in bladder, rectum and pulmonary artery in patients after cardiac surgery

    NARCIS (Netherlands)

    Wollerich, H.; Ismael, Farouq; Nijsten, Maarten; Dieperink, Willem

    2012-01-01

    In many patients in the intensive care unit (ICU) con-tinuous temperature monitoring is performed with rectal probes. Currently there are more options to measure temperature in critically ill patients. Since bladder catheters are routinely used in the majority of ICU patients, using bladder temperat

  18. Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation.

    Science.gov (United States)

    Pulignano, Giovanni; Tinti, Maria Denitza; Del Sindaco, Donatella; Tolone, Stefano; Minardi, Giovanni; Lax, Antonio; Uguccioni, Massimo

    2016-01-01

    In heart failure (HF), cardiac rehabilitation (CR) may reduce decompensations, hospitalization, and ultimately mortality in long term. Many studies over the past decade have demonstrated that aerobic exercise training is effective and safe in stable patients with HF. Exercise CR resulted in a clinically important improvement in the QOL. Several clinical and psychosocial factors are associated with decreased participation in CR programs of elderly HF patients, such as perception of exercise as tiring or painful, comorbidities, lack of physician encouragement, and opinion that CR will not improve their health status. Besides low functional capacity, and chronic deconditioning may also deter patients from participating in CR programs. Recent data suggest that current smoking, a BMI ≥30 kg/m2, diabetes mellitus, and cognitive dysfunction are associated with failure to enroll in outpatient CR in older age group. Moreover the lack of availability of CR facilities or the absence of financial refunds for enrolment of CHF patients in cardiac rehabilitation programs can play a crucial role. Many of this factors are modifiable through patient education and self care strategy instruction, health providers sensibilization, and implementing economic measures in order to make CR affordable.

  19. Personal and social factors regarding medical non-compliance in cardiac failure patients

    International Nuclear Information System (INIS)

    Objective: To determine the frequency and association of various personal and social factors with medical non-compliance in cardiac failure patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: National Institute of Cardiovascular Diseases (NICVD), Karachi from January to August 2010. Methodology: Patients admitted in the medical wards of NICVD, who were being treated for cardiac failure, were included. Information regarding basic demographics, education level, self engagement in therapy and status of compliance was obtained by questionnaire. Statistical analysis was carried out by using Fisher's exact test and chi-square. Level of significance was < 0.05. Data was analyzed using SPSS V-15. Out of 267 patients, 73 (27.3%) were compliant while 194 (72.7%) were non-compliant. Educated, self caring patient, and those who knew names of their medications were more compliant than the rest. Conclusion: Medical non-compliance is very common in heart failure patients. Illiteracy and no self engagement in therapy are associated with non-compliance. (author)

  20. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy

    Science.gov (United States)

    Egholm, Gro; Thim, Troels; Madsen, Morten; Sørensen, Henrik Toft; Pedersen, Jan Bech; Eggert Jensen, Svend; Jensen, Lisette Okkels; Kristensen, Steen Dalby; Bøtker, Hans Erik; Maeng, Michael

    2016-01-01

    Background and study aims: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. Patients and methods: Patients receiving gastroscopy within 12 months of PCI were identified and two nested case-control analyses were performed within the PCI cohort by linking Danish medical registries. Cases were patients with adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) or hemostatic intervention. In both studies, controls were patients with gastroscopy including biopsy without adverse cardiac events and hemostatic intervention, respectively. Medical records were reviewed to obtain information on exposure to DAPT. Results: We identified 22 654 PCI patients of whom 1497 patients (6.6 %) underwent gastroscopy. Twenty-two patients (1.5 %) suffered an adverse cardiac event, 93 patients (6.2 %) received hemostatic intervention during or within 30 days of the index gastroscopy. Interrupting DAPT was associated with a 3.46 times higher risk of adverse cardiac events (95 %CI 0.49 – 24.7). Discontinuation of one antiplatelet agent did not increase the risk (OR 0.65, 95 %CI 0.17 – 2.47). No hemostatic interventions were caused by endoscopic complications. Conclusion: Gastroscopy can be safely performed in PCI patients treated with DES and single antiplatelet therapy while interruption of DAPT may be associated with an increased risk of adverse cardiac events. PMID:27227109

  1. Improvement of cardiac function after transplantation of autologous bone marrow mesenchymal stem cells in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈绍良; 方五旺; 钱钧; 叶飞; 刘煜昊; 单守杰; 张俊杰; 林松; 廖联明; 赵春华

    2005-01-01

    Background The infarct size determines the long-term prognosis of patients with acute myocardial infarction (AMI). There is a growing interest in repairing scar area by transplanting bone marrow stem cells. However, effectiveness of intracoronary injection of bone marrow mesenchymal stem cells (BMSCs) in patients with AMI still remains unclear.Methods Sixty-nine patients with AMI ,after percutaneous coronary intervention (PCI) were randomly divided into intracoronary injection of BMSCs (n=34) and saline (control group, n=35) groups. Serial single positron emission computer tomography (SPECT) , cardiac echo and cardiac electromechanical mapping were done at the designed time intervals until six months after transplantation of BMSCs or injection of saline.Results The proportion with functional defect decreased significantly in the BMSCs patients after three months [(13±5)%] compared with that pre-transplantation [(32±11)%] and the control group [(28±10)%] at three month follow-up (P0.05]. Left ventricular ejection fraction (LVEF) three months after transplantation in BMSCs group increased significantly compared with that pre-implantation and with that of the control group at three months post'injection [(67±11)% vs (49±9)% and (53±8)%, P<0.05 respectively]. SPECT scan results showed that perfusion defect was improved significantly in BMSCs group at three-month follow-up compared with that in the control group [(134±66)cm2 vs (185±87)cm2, P<0.01]. At the same time, left ventricular end-diastolic volume [(136±31)ml vs (162±27)ml, P<0.05] and end-systolic volume [(63±20)ml vs (88±19)ml, P<0.05] decreased synchronously. The ratio of end-systolic pressure to end-systolic volume [Psyst/ESV, (2.84±1.30)mmHg/ml vs (1.72±1.23)mmHg/ml, P<0.05] increased significantly. Cardiac electromechnical mapping demonstrated significant improvement at three months after implantation of BMSCs compared with that preinjection in both cardiac mechanical capability as left line

  2. Improvement of cardiac function after transplantation of autologous bone marrow mesenchymal stem cells in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈绍良; 方五旺; 钱钧; 叶飞; 刘煜昊; 单守杰; 张俊杰; 林松; 廖联明; 赵春华

    2004-01-01

    Background The infarct size determines the long-term prognosis of patients with acute myocardial infarction (AMI). There is a growing interest in repairing scar area by transplanting bone marrow stem cells. However, effectiveness of intracoronary injection of bone marrow mesenchymal stem cells (BMSCs) in patients with AMI still remains unclear.Methods Sixty-nine patients with AMI after percutaneous coronary intervention (PCI) were randomly divided into intracoronary injection of BMSCs (n=34) and saline (control group, n=35) groups. Serial single positron emission computer tomography (SPECT), cardiac echo and cardiac electromechanical mapping were done at the designed time intervals until six months after transplantation of BMSCs or injection of saline. Results The proportion with functional defect decreased significantly in the BMSCs patients after three months [(13±5)%] compared with that pre-transplantation [(32±11)%] and the control group [(28±10)%] at three month follow-up (P0.05]. Left ventricular ejection fraction (LVEF) three months after transplantation in BMSCs group increased significantly compared with that pre-implantation and with that of the control group at three months post-injection [(67±11)% vs (49±9)% and (53±8)%, P<0.05 respectively]. SPECT scan results showed that perfusion defect was improved significantly in BMSCs group at three-month follow-up compared with that in the control group [(134±66)cm2 vs (185±87)cm2, P<0.01]. At the same time, left ventricular end-diastolic volume [(136±31) ml vs (162±27) ml, P<0.05] and end-systolic volume [(63±20) ml vs (88±19) ml, P<0.05] decreased synchronously. The ratio of end-systolic pressure to end-systolic volume [Psyst/ESV, (2.84±1.30) mmHg/ml vs (1.72±1.23) mmHg/ml, P<0.05] increased significantly. Cardiac electromechnical mapping demonstrated significant improvement at three months after implantation of BMSCs compared with that pre-injection in both cardiac mechanical capability as left

  3. Effect of fast-track cardiac anesthesia on myocardial oxidative damage, inflammation and nerve related peptides of patients undergoing cardiac operation

    Institute of Scientific and Technical Information of China (English)

    Xing-Tao Cai; Zhong-Jun Zhang; Wen-Bo Diao

    2016-01-01

    Objective:To study the effect of fast-track cardiac anesthesia on myocardial oxidative damage, inflammation and nerve related peptides of patients undergoing cardiac operation.Methods:Sixty patients with rheumatic heart disease undergoing heart valve surgery were randomly divided into the fast track group (n=30) and conventional group (n=30). Then myocardial injury indicators, mitochondrial oxidative stress indicators, inflammation indicators and nerve-related peptides of both groups were analyzed.Results: cTnI contents at T2-T4 points in time of both groups showed an increasing trend and the increasing trend of fast track group was weaker than that of conventional group; SOD contents as well as mitochondrial tristate respiratory function, respiratory control ratios and phosphorus oxygen ratios in myocardial tissue of fast track group were higher than those of conventional group, and MDA contents was lower than those of conventional group; plasma TNF-α, IL-6, IL-8, NSE, S100β and Aβcontents of fast track group were lower than those of conventional group.Conclusions:Fast-track cardiac anesthesia can protect myocardial cells, reduce mitochondrial oxidative stress, relieve inflammation and improve nerve function; it is an ideal anesthesia method for cardiac operation.

  4. Relationship between myocardial T2* values and cardiac volumetric and functional parameters in β-thalassemia patients evaluated by cardiac magnetic resonance in association with serum ferritin levels

    International Nuclear Information System (INIS)

    Purpose: Myocardial T2* cardiovascular magnetic resonance provides a rapid and reproducible assessment of cardiac iron load in thalassemia patients. Although cardiac involvement is mainly characterized by left ventricular dysfunction caused by iron overload, little is known about right ventricular function. The aim of this study was to assess the relationship between T2* value in myocardium and left–right ventricular volumetric and functional parameters and to evaluate the existing associations between left–right ventricles volumetric and functional parameter, myocardial T2* values and blood ferritin levels. Materials and methods: A retrospective analysis of 208 patients with β-thalassemia major and thalassemia intermedia was performed (109 males and 99 females; mean age 37.7 ± 13 years; 143 thalassemia major, 65 thalassemia intermedia). Myocardial iron load was assessed by T2* measurements, and volumetric functions were analyzed using the steady state free precession sequence. Results: A significant correlation was observed between EFLV and T2* (p = 0.0001), EFRV and T2* (p = 0.0279). An inverse correlation was present between DVLV and T2* (p = 0.0468), SVLV and T2* (p = 0.0003), SVRV and T2* (p = 0.0001). There was no significant correlation between cardiac T2* and LV–RV mass indices. A significant correlation was observed between T2* and serum ferritin levels (p < 0.001) and between EFLV and serum ferritin (p < 0.05). Conclusion: Myocardial iron load assessed by T2* cardiac magnetic resonance is associated with deterioration in left–right ventricular function; this is more evident when T2* values fall below 14 ms. CMR appears to be a promising approach for cardiac risk evaluation in TM patients

  5. Relationship between myocardial T2* values and cardiac volumetric and functional parameters in β-thalassemia patients evaluated by cardiac magnetic resonance in association with serum ferritin levels

    Energy Technology Data Exchange (ETDEWEB)

    Liguori, Carlo, E-mail: c.liguori@unicampus.it [Department of Diagnostic Imaging, Campus Bio Medico University, via Alvaro del Portillo 200, 00128 Rome (Italy); Pitocco, Francesca, E-mail: f.pitocco@unicampus.it [Department of Diagnostic Imaging, Campus Bio Medico University, via Alvaro del Portillo 200, 00128 Rome (Italy); Di Giampietro, Ilenia, E-mail: i.digiampietro@unicampus.it [Department of Diagnostic Imaging, Campus Bio Medico University, via Alvaro del Portillo 200, 00128 Rome (Italy); Vivo, Aldo Eros de, E-mail: devivoeros@gmail.com [Department of Diagnostic Imaging, Campus Bio Medico University, via Alvaro del Portillo 200, 00128 Rome (Italy); Schena, Emiliano, E-mail: e.schena@unicampus.it [Unit of Measurements and Biomedical Instrumentation, Campus Bio Medico University, via Alvaro del Portillo 200, 00128 Rome (Italy); Cianciulli, Paolo, E-mail: CIANCIULLI.PAOLO@aslrmc.it [Thalassemia Unit, Ospedale Sant Eugenio, Piazzale dell’Umanesimo 10, 00143 Rome (Italy); Zobel, Bruno Beomonte, E-mail: b.zobel@unicampus.it [Department of Diagnostic Imaging, Campus Bio Medico University, via Alvaro del Portillo 200, 00128 Rome (Italy)

    2013-09-15

    Purpose: Myocardial T2* cardiovascular magnetic resonance provides a rapid and reproducible assessment of cardiac iron load in thalassemia patients. Although cardiac involvement is mainly characterized by left ventricular dysfunction caused by iron overload, little is known about right ventricular function. The aim of this study was to assess the relationship between T2* value in myocardium and left–right ventricular volumetric and functional parameters and to evaluate the existing associations between left–right ventricles volumetric and functional parameter, myocardial T2* values and blood ferritin levels. Materials and methods: A retrospective analysis of 208 patients with β-thalassemia major and thalassemia intermedia was performed (109 males and 99 females; mean age 37.7 ± 13 years; 143 thalassemia major, 65 thalassemia intermedia). Myocardial iron load was assessed by T2* measurements, and volumetric functions were analyzed using the steady state free precession sequence. Results: A significant correlation was observed between EFLV and T2* (p = 0.0001), EFRV and T2* (p = 0.0279). An inverse correlation was present between DVLV and T2* (p = 0.0468), SVLV and T2* (p = 0.0003), SVRV and T2* (p = 0.0001). There was no significant correlation between cardiac T2* and LV–RV mass indices. A significant correlation was observed between T2* and serum ferritin levels (p < 0.001) and between EFLV and serum ferritin (p < 0.05). Conclusion: Myocardial iron load assessed by T2* cardiac magnetic resonance is associated with deterioration in left–right ventricular function; this is more evident when T2* values fall below 14 ms. CMR appears to be a promising approach for cardiac risk evaluation in TM patients.

  6. Reduction of atrial fibrillation in remotely monitored pacemaker patients: results from a Chinese multicentre registry

    Institute of Scientific and Technical Information of China (English)

    CHEN Ke-ping; DAI Yan; HUA Wei; YANG Jie-fu; LI Kang; LIANG Zhao-guang; SHEN Fa-rong

    2013-01-01

    Background Many recipients of implantable cardiac electronic devices have atrial fibrillation (AF) occurrences after device implantation,even if there is no previous history of AF,and some of the episodes are asymptomatic.The purpose of this study was to evaluate trends in AF burden following early AF detection in patients treated with pacemakers equipped with automatic,daily Home Monitoring function.Methods Between February 2009 and December 2010,the registry recruited 701 pacemaker patients (628 dual-chamber,73 biventricular devices) at 97 clinical centers in China.Daily Home Monitoring data transmissions were analyzed to screen for the AF burden.In-office follow-ups were scheduled for 3 and 6 months after implantation.Upon first AF (i.e.,mode-switch) detection in a patient,screening of AF burden by Home Monitoring was extended for the next 180 days.Results At least one episode of AF was observed in 22.9% of patients with dual-chamber pacemakers and in 28.8% of patients with biventricular pacemakers.The first AF detection in a patient occurred,on average,about 2 months before scheduled follow-up visits.In both pacemaker groups,mean AF burden decreased significantly (P<0.05) over 180 days following first AF detection:from 12.0% to 2.5% in dual-chamber and from 12.2% to 0.5% in biventricular pacemaker recipients.The number of patients with an AF burden >10% per month was significantly reduced over 6 months of implantation in both dual chamber (38 patients in the first month vs.21 patients in month 6,P<0.05) and biventricular (7 patients in the first month vs.0 patient in months 4-6,P<0.05) pacemaker recipients.Conclusions Automatic,daily Home Monitoring of patients treated with cardiac pacemakers allows early detection of AF,and there is a gradual and significant decrease in AF burden.

  7. Prevalence of cardiac autonomic neuropathy in Asian Indian patients with fibrocalculous pancreatic diabetes

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    Amrit Nanaiah

    2012-01-01

    Full Text Available Background: It was formerly believed that since fibrocalculous pancreatic diabetes (FCPD is a secondary form of diabetes, specific diabetic complications were uncommon. This is no longer considered to be true. Our objective was to study the prevalence and pattern of cardiac autonomic neuropathy (CAN in patients with FCPD. Materials and Methods: A cross-sectional study on consecutive male patients with FCPD was performed. Using an automated CAN System Analyzer, heart rate response to deep breathing, Valsalva maneuver, standing and blood pressure response to standing were measured. The standard Ewing′s criteria were used to define normal, borderline, and abnormal values. Prevalence rates were calculated and the patients were defined to have normal autonomic function, parasympathetic, sympathetic, and combined dysfunction. Results: The prevalence of CAN in this study population was 63.3%. Isolated parasympathetic dysfunction (42.3% was the most common abnormality. Combined sympathetic and parasympathetic dysfunction was noted in 13.3% of patients. Isolated borderline dysfunction was noted among 13.3% of patients. CAN was detected in six patients with a duration of diabetes of less than 1 year after diagnosis. Patients with autonomic dysfunction were found to have a lower body mass index (BMI and low density lipoprotein (LDL-cholesterol when compared to those with normal autonomic functions, which was not statistically significant. Conclusion: The prevalence of abnormal cardiac autonomic function is as high as 63.3% in the present study population which warrants regular screening of patients with FCPD for autonomic dysfunction. Patients with FCPD and autonomic dysfunction were found to have a lower BMI and lower LDL-cholesterol, which may be indicators of malnutrition in the group with autonomic dysfunction. Whether this malnutrition contributes to autonomic dysfunction needs further exploration.

  8. Update on pharmacological cardiac stress testing: efficacy, risk stratification and patient selection.

    Science.gov (United States)

    Blankstein, Ron; Cannon, Christopher; Udelson, James

    2014-11-01

    Despite greater control of risk factors and improved treatments, coronary heart disease (CHD) remains a significant cause of mortality with 1 in every 4 deaths in the United States due to this disorder.(1) Cardiac stress tests have long been one of the most often utilized testing modalities used to identify patients suspected of having CHD, specifically coronary artery disease (CAD). These tests allow for noninvasive assessment of the coronary circulation and its ability to augment flow in response to physiologic demand. As with any diagnostic testing however, potential health risks as well as the financial burden of cardiovascular stress testing, must be weighed against the benefits and utility of the data procured. Given the rapidly evolving field of cardiac stress testing with respect to new risk stratification guidelines, new agents, and new assessment methods, it is difficult for physicians to remain up to date on the latest research and the benefits and risks of different testing modalities. A recent survey of primary care physicians and cardiologists conducted by the Elsevier Office of Continuing Medical Education found that approximately one-quarter of the cardiologists and primary care physicians surveyed do not feel confident identifying the factors which should be considered before ordering a cardiac stress test as part of pre-operative screening for a patient. Additionally, this survey also reported that primary care physicians reported a high degree of confidence in ordering the appropriate cardiac screening tests for patients yet, cardiologists reported that they frequently/somewhat frequently felt the need to change the test ordered by the internist. This educational intervention focuses on patient selection, exercise vs. pharmacologic stress testing, pharmacologic agents, and the importance of patient and doctor communication in ensuring the right test is recommended for the right patient. This CME Multimedia Activity is also available through the

  9. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Liang Chen; Yuan Bai; Fei-Yu Wang; Zhi-Gang Zhang; Xing-Hua Shan; Tao Chen; Xian-Xian Zhao

    2015-01-01

    Background:Permanent atrial fibrillation (AF) is the most common form of dysrhythmia associated with atrial septal defects (ASDs) in patients older than 40 years.However,little is known about cardiac remodeling after transcatheter closure in patients with permanent AF.This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients.Methods:Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively.Of them,63 patients with permanent AF were assigned to the case group,and the other 226 patients without permanent AF were assigned to the control group.Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups.Results:Patients in the case group were significantly older than those in the control group.The right ventricular (RV) volume and right atrial (RA) volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001).The left atrial dimensions,left ventricular end-systolic dimensions,left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups.Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P =0.005 and P < 0.001).The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period.Conclusions:The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  10. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Liang Chen

    2015-01-01

    Full Text Available Background: Permanent atrial fibrillation (AF is the most common form of dysrhythmia associated with atrial septal defects (ASDs in patients older than 40 years. However, little is known about cardiac remodeling after transcatheter closure in patients with permanent AF. This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients. Methods: Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively. Of them, 63 patients with permanent AF were assigned to the case group, and the other 226 patients without permanent AF were assigned to the control group. Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups. Results: Patients in the case group were significantly older than those in the control group. The right ventricular (RV volume and right atrial (RA volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001. The left atrial dimensions, left ventricular end-systolic dimensions, left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups. Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P = 0.005 and P < 0.001. The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period. Conclusions: The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  11. Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation

    International Nuclear Information System (INIS)

    Purpose: Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. Materials and methods: Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7 ± 9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0 ± 9.9 years of age). Mann-Whitney tests served for statistical comparison. Results: CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1 ± 8.0 vs. 29.1 ± 11.9, p = 0.030), and a significant reduction of fluoroscopy time was found (41.8 ± 12.0 min vs. 51.2 ± 16.0 min, p = 0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9 ± 10.0 mSv vs. 20.0 ± 16.0 mSv, p = 0.203). The mean additive effective dose of the cardiac CT was 85 ± 0.3 mSv. (orig.)

  12. Effect of Cardiac Rehabilitation on Strength and Balance in Patients after Coronary Artery Bypass Graft

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    Nahid Nazari

    Full Text Available Background: The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. Materials and Methods: This study is based on clinical trial before and after rehabilitation. the exercise protocol lasted for one month, three times per week, each session lasting 1 hour, on 30 male patients in two groups in control (N=15 and experimental group (N=15 after CABG in the centre of rehabilitation in Javad-Alaeme Heart Hospital, Mashhad. The strength of lower limb by chair standing test, the static balance by standing on one leg and dynamic balance by time up and go (TUG test, was evaluated before and after 1 month rehabilitation in training group and detraining in control group. Data were analyzed with SPSS-16 and used t-test analysis (p≤0.05.Results: The strength of lower limb (p=0.001, static balance (p=0.023 and dynamic balance (p=0.037 increased significantly after one month of cardiac rehabilitation.Conclusion: The result of this study indicates that cardiac rehabilitation after coronary artery bypass surgery causes significant increase in strength of lower limb and balance in patients, the more muscle strength is associated with an increase in ability of performing daily activities and so it causes improved quality of life.

  13. Effect of Cardiac Rehabilitation on Strength and Balance in Patients after Coronary Artery Bypass Graft

    Directory of Open Access Journals (Sweden)

    Nahid Nazari

    2014-01-01

    Full Text Available Background: The most common method for improving the quality of life especially in chronic heart disease is rehabilitation. For increasing the level of knowledge about effect of rehabilitation and its' impression on improving the quality of life in patients. This study evaluates effect of one month cardiac rehabilitation on lower limb strength and the static and dynamic balance of CABG patients. Materials and Methods: This study is based on clinical trial before and after rehabilitation. the exercise protocol lasted for one month, three times per week, each session lasting 1 hour, on 30 male patients in two groups in control (N=15 and experimental group (N=15 after CABG in the centre of rehabilitation in Javad-Alaeme Heart Hospital, Mashhad. The strength of lower limb by chair standing test, the static balance by standing on one leg and dynamic balance by time up and go (TUG test, was evaluated before and after 1 month rehabilitation in training group and detraining in control group. Data were analyzed with SPSS-16 and used t-test analysis (p≤0.054T. Results: The strength of lower limb (p=0.001, static balance (p=0.023 and dynamic balance (p=0.037 increased significantly after one month of cardiac rehabilitation4T. Conclusion: The result of this study indicates that cardiac rehabilitation after coronary artery bypass surgery causes significant increase in strength of lower limb and balance in patients, the more muscle strength is associated with an increase in ability of performing daily activities and so it causes improved quality of life4T.

  14. CMR Imaging With Rapid Visual T1 Assessment Predicts Mortality in Patients Suspected of Cardiac Amyloidosis

    Science.gov (United States)

    White, James A.; Kim, Han W.; Shah, Dipan; Fine, Nowell; Kim, Ki-Young; Wendell, David C.; Al-Jaroudi, Wael; Parker, Michele; Patel, Manesh; Gwadry-Sridhar, Femida; Judd, Robert M.; Kim, Raymond J.

    2014-01-01

    OBJECTIVES This study tested the diagnostic and prognostic utility of a rapid, visual T1 assessment method for identification of cardiac amyloidosis (CA) in a “real-life” referral population undergoing cardiac magnetic resonance for suspected CA. BACKGROUND In patients with confirmed CA, delayed-enhancement cardiac magnetic resonance (DE-CMR) frequently shows a diffuse, global hyperenhancement (HE) pattern. However, imaging is often technically challenging, and the prognostic significance of diffuse HE is unclear. METHODS Ninety consecutive patients referred for suspected CA and 64 hypertensive patients with left ventricular hypertrophy (LVH) were prospectively enrolled and underwent a modified DE-CMR protocol. After gadolinium administration a method for rapid, visual T1 assessment was used to identify the presence of diffuse HE during the scan, allowing immediate optimization of settings for the conventional DE-CMR that followed. The primary endpoint was all-cause mortality. RESULTS Among patients with suspected CA, 66% (59 of 90) demonstrated HE, with 81% (48 of 59) of these meeting pre-specified visual T1 assessment criteria for diffuse HE. Among hypertensive LVH patients, 6% (4 of 64) had HE, with none having diffuse HE. During 29 months of follow-up (interquartile range: 12 to 44 months), there were 50 (56%) deaths in patients with suspected CA and 4 (6%) in patients with hypertensive LVH. Multivariable analysis demonstrated that the presence of diffuse HE was the most important predictor of death in the group with suspected CA (hazard ratio: 5.5, 95% confidence interval: 2.7 to 11.0; p < 0.0001) and in the population as a whole (hazard ratio: 6.0, 95% confidence interval 3.0 to 12.1; p < 0.0001). Among 25 patients with myocardial histology obtained during follow-up, the sensitivity, specificity, and accuracy of diffuse HE in the diagnosis of CA were 93%, 70%, and 84%, respectively. CONCLUSIONS Among patients suspected of CA, the presence of diffuse HE by

  15. Effectiveness of massage therapy on post-operative outcomes among patients undergoing cardiac surgery: A systematic review

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    C. Ramesh

    2015-09-01

    Full Text Available The incidence and prevalence of cardiovascular disease (CVD are increasing rapidly in developing countries. Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery. This highly stressful experience results in increased levels of anxiety for patients. The objective of this review was to evaluate the efficacy of massage therapy on postoperative outcomes among patients undergoing cardiac surgery. A comprehensive literature search was made on PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science and the Cochrane library databases for original research articles published between 2000 and 2015. Original articles that reported the efficacy of massage therapy in patients undergoing cardiac surgery were included. The Cochrane data extraction form was used to extract data. A total of 297 studies were identified in the literature search. However, only seven studies were eligible for analysis. Of the seven studies, six studies demonstrated the effects of massage therapy on improving post-operative outcomes of patients, while one study found no evidence of improvement. Although the methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that massage therapy can lead to positive postoperative outcomes. Evidence of the effectiveness of massage therapy in patients undergoing cardiac surgery remains inconclusive. Additional research is needed to provide a strong evidence base for the use of massage therapy to improve post-operative outcomes and recovery among cardiac surgery patients

  16. Prognostic Value of the Six-Minute Walk Test in Heart Failure Patients Undergoing Cardiac Surgery: A Literature Review

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    Dominika Zielińska

    2013-01-01

    Full Text Available Background. The prognostic value of cardiopulmonary exercise testing (CPET is known, but the predictive value of 6MWT in patients with heart failure (HF and patients undergoing coronary artery bypass grafting (CABG is not established yet. Objective. We conducted a systematic review exploring the prognostic value of 6MWT in HF patients undergoing cardiac surgery. The aim was to find out whether the change in the distance walked during follow-up visits was associated with prognosis. Data Source. We searched “PubMed” from January 1990 to December 2012 for any review articles or experimental studies investigating the prognostic value of 6MWT in HF patients and patients undergoing cardiac surgery. Results. 53 studies were included in the review, and they explored the role of 6MWT in cardiology, cardiac surgery, and rehabilitation. The results did not show the relation between the six-minute walk distance and adverse events after CABG. The predictive power of the distance walked for death in HF patients undergoing cardiac surgery was not found. It is not yet proved if the change in the six-minute walk distance is associated with prognosis. The predictive power of the six-minute walk distance for death in HF patients undergoing cardiac surgery remains unclear.

  17. Prognostic value of the six-minute walk test in heart failure patients undergoing cardiac surgery: a literature review.

    Science.gov (United States)

    Zielińska, Dominika; Bellwon, Jerzy; Rynkiewicz, Andrzej; Elkady, Mohamed Amr

    2013-01-01

    Background. The prognostic value of cardiopulmonary exercise testing (CPET) is known, but the predictive value of 6MWT in patients with heart failure (HF) and patients undergoing coronary artery bypass grafting (CABG) is not established yet. Objective. We conducted a systematic review exploring the prognostic value of 6MWT in HF patients undergoing cardiac surgery. The aim was to find out whether the change in the distance walked during follow-up visits was associated with prognosis. Data Source. We searched "PubMed" from January 1990 to December 2012 for any review articles or experimental studies investigating the prognostic value of 6MWT in HF patients and patients undergoing cardiac surgery. Results. 53 studies were included in the review, and they explored the role of 6MWT in cardiology, cardiac surgery, and rehabilitation. The results did not show the relation between the six-minute walk distance and adverse events after CABG. The predictive power of the distance walked for death in HF patients undergoing cardiac surgery was not found. It is not yet proved if the change in the six-minute walk distance is associated with prognosis. The predictive power of the six-minute walk distance for death in HF patients undergoing cardiac surgery remains unclear. PMID:23984074

  18. Cardiac rehabilitation programs improve metabolic parameters in patients with the metabolic syndrome and coronary heart disease.

    Science.gov (United States)

    Pérez, Ignacio P; Zapata, Maria A; Cervantes, Carlos E; Jarabo, Rosario M; Grande, Cristina; Plaza, Rose; Garcia, Sara; Rodriguez, Miriam L; Crespo, Silvia; Perea, Jesús

    2010-05-01

    This study was performed to determine the effectiveness of a cardiac rehabilitation and exercise training program on metabolic parameters and coronary risk factors in patients with the metabolic syndrome and coronary heart disease. The study involved 642 patients with coronary heart disease. Of them, 171 (26.7%) fulfilled criteria for the metabolic syndrome. Clinical data, laboratory tests, and exercise testing were performed before and after the program, which lasted 2 to 3 months. Except for waist circumference, there were no significant differences between groups; blood pressure, high-density lipoprotein cholesterol, triglycerides, and fasting glucose improvements during the follow-up were higher in patients with the metabolic syndrome (all Pmetabolic syndrome, functional capacity increased by 26.45% ( Pmetabolic equivalents, with a slight increase of 1.25% ( P=not significant) in the double product. Patients with the metabolic syndrome who took part in this secondary prevention program reported improvements in cardiovascular risk profile and functional capacity.

  19. Cardiac Rehabilitation Enrollment and the Impact of Systematic Nursing Interventions for Postmyocardial Infarction and Stent Patients.

    Science.gov (United States)

    Grossman, Joan A Cebrick

    2016-08-01

    A randomized experimental design was used to determine the most effective intervention for enhancing cardiac rehabilitation (CR) enrollment for postmyocardial infarction and stent patients. The 104 subjects (70 males and 34 females; 23-87 years old) were patients with a discharge diagnosis of a myocardial infarction followed by a percutaneous coronary intervention, which included a percutaneous transluminal coronary angioplasty and the placement of one or more coronary stents. Regardless of the intervention, patients who received face-to-face nursing interventions were more likely to enroll in CR than were patients who had indirect interventions, χ(2)(3) = 32.84, p interview were most likely to enroll, χ(2)(1) = 86.80, p interview, having an odds ratio of 1.73. PMID:26655562

  20. Automated segmentation and reconstruction of patient-specific cardiac anatomy and pathology from in vivo MRI

    International Nuclear Information System (INIS)

    This paper presents an automated method to segment left ventricle (LV) tissues from functional and delayed-enhancement (DE) cardiac magnetic resonance imaging (MRI) scans using a sequential multi-step approach. First, a region of interest (ROI) is computed to create a subvolume around the LV using morphological operations and image arithmetic. From the subvolume, the myocardial contours are automatically delineated using difference of Gaussians (DoG) filters and GSV snakes. These contours are used as a mask to identify pathological tissues, such as fibrosis or scar, within the DE-MRI. The presented automated technique is able to accurately delineate the myocardium and identify the pathological tissue in patient sets. The results were validated by two expert cardiologists, and in one set the automated results are quantitatively and qualitatively compared with expert manual delineation. Furthermore, the method is patient-specific, performed on an entire patient MRI series. Thus, in addition to providing a quick analysis of individual MRI scans, the fully automated segmentation method is used for effectively tagging regions in order to reconstruct computerized patient-specific 3D cardiac models. These models can then be used in electrophysiological studies and surgical strategy planning. (paper)

  1. Cardiac surgery in patients on hemodialysis: Eight years experience of the Tunisian military hospital

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    Gharsallah Hedi

    2010-01-01

    Full Text Available End-stage renal disease (ESRD is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG and 38.5% had replacement or reconstruction of one or two valves. The perioperative mortality rate was 26% with five deaths occurring in patients undergoing CABG procedure. We found CABG procedure, being female and left ventricular (LV function < 30% to be associated with a higher relative risk for perioperative death. In conclusion, our data suggest that both indi-cations and referral for surgical intervention for coronary artery disease may be delayed in pa-tients who have ESRD, contributing to the relatively high perioperative mortality.

  2. Exploring time series retrieved from cardiac implantable devices for optimizing patient follow-up

    Science.gov (United States)

    Guéguin, Marie; Roux, Emmanuel; Hernández, Alfredo I; Porée, Fabienne; Mabo, Philippe; Graindorge, Laurence; Carrault, Guy

    2008-01-01

    Current cardiac implantable devices (ID) are equipped with a set of sensors that can provide useful information to improve patient follow-up and to prevent health deterioration in the postoperative period. In this paper, data obtained from an ID with two such sensors (a transthoracic impedance sensor and an accelerometer) are analyzed in order to evaluate their potential application for the follow-up of patients treated with a cardiac resynchronization therapy (CRT). A methodology combining spatio-temporal fuzzy coding and multiple correspondence analysis (MCA) is applied in order to: i) reduce the dimensionality of the data and provide new synthetic indices based on the “factorial axes” obtained from MCA, ii) interpret these factorial axes in physiological terms and iii) analyze the evolution of the patient’s status by projecting the acquired data into the plane formed by the first two factorial axes named “factorial plane”. In order to classify the different evolution patterns, a new similarity measure is proposed and validated on simulated datasets, and then used to cluster observed data from 41 CRT patients. The obtained clusters are compared with the annotations on each patient’s medical record. Two areas on the factorial plane are identified, one being correlated with a health degradation of patients and the other with a stable clinical state. PMID:18838359

  3. Combined survival analysis of cardiac patients by a Cox PH model and a Markov chain.

    Science.gov (United States)

    Shauly, Michal; Rabinowitz, Gad; Gilutz, Harel; Parmet, Yisrael

    2011-10-01

    The control and treatment of dyslipidemia is a major public health challenge, particularly for patients with coronary heart diseases. In this paper we propose a framework for survival analysis of patients who had a major cardiac event, focusing on assessment of the effect of changing LDL-cholesterol level and statins consumption on survival. This framework includes a Cox PH model and a Markov chain, and combines their results into reinforced conclusions regarding the factors that affect survival time. We prospectively studied 2,277 cardiac patients, and the results show high congruence between the Markov model and the PH model; both evidence that diabetes, history of stroke, peripheral vascular disease and smoking significantly increase hazard rate and reduce survival time. On the other hand, statin consumption is correlated with a lower hazard rate and longer survival time in both models. The role of such a framework in understanding the therapeutic behavior of patients and implementing effective secondary and primary prevention of heart diseases is discussed here. PMID:21735134

  4. Cardiac magnetic resonance: Impact on diagnosis and management of patients with congenital cardiovascular disease

    Energy Technology Data Exchange (ETDEWEB)

    Secchi, F., E-mail: francescosecchimd@gmail.com [Scuola di Specializzazione in Radiodiagnostica, Universita degli Studi di Milano, Milan (Italy); Di Leo, G. [S.C. di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milan (Italy); Papini, G.D.E. [Scuola di Specializzazione in Radiodiagnostica, Universita degli Studi di Milano, Milan (Italy); Nardella, V.G. [Facolta di Medicina e Chirurgia, Universita degli Studi di Milano, Milan (Italy); Negura, D.; Carminati, M. [S.C. di Cardiologia Pediatrica, IRCCS Policlinico San Donato, San Donato Milanese, Milan (Italy); Sardanelli, F. [S.C. di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Milan (Italy); Dipartimento di Scienze Medico-Chirurgiche, Universita degli Studi di Milano, Milan (Italy)

    2011-08-15

    Aim: To estimate the clinical impact of cardiac magnetic resonance (CMR) in patients with congenital cardiovascular disease (CCD). Materials and methods: Since 2003, 1.5 T CMR was used at our university hospital to evaluate morphology, cardiac kinetics, aortic and pulmonary flow, and vascular anatomy in patients with CCD. The present study considered a consecutive series of these patients from 2003 to 2006. A paediatric cardiologist judged our reports as expected or unexpected and, secondarily, as not reliable (level 0), describing findings already known (level 1), not changing therapy/suggested lifestyle (level 2), changing therapy/suggested lifestyle (level 3) or changing diagnosis (level 4). Results: CMR reports were judged to be expected in 187/214 (87%) and unexpected in 27/214 (13%). Less than 2% of CMRs were judged as levels 0 or 1, 66% as level 2, and 5% as level 4. During 2005-2006 the clinical impact improved toward higher impact levels (p < 0.001, chi-square test). Conclusions: In patients with CCD, more than one in 10 CMR reports were unexpected to cardiologists and over seven in 10 prompted a change of diagnosis or therapy.

  5. Feasibility study of patient motion monitoring using tactile array sensor

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Ho; Kang, Seong Hee; Kim, Dong Su; Cho, Min Seok; Kim, Kyeong Hyeon; Suh, Tae Suk [Dept. of Biomedical Engineering, Research Institute of Biomedical Engineering, the Catholic University of Korea, Seoul (Korea, Republic of); Kim, Si Yong [Dept. of Radiation Oncology, Virginia Commonwealth University, Richmond (United States)

    2014-11-15

    The aim of this study is to evaluate patient pretreatment set-up error and intra-fraction motion using the tactile array sensors (Pressure Profile Systems Inc, Los Angeles, CA) which could measure distributed pressure profiles along the contacting surface and to check a feasibility of the sensor (tactile array sensor) in the patient motion monitoring. Laser alignment and optical camera based monitoring system are very useful for reduce patient set-up error but these systems could not monitor the blind area like patient's back position. Actually after patient alignment using laser or optical monitoring system, it was assumed that there is no error in the patient's back position (pressure profile distribution). But if an error occurs in the patient's back position, it will affect the radiation therapy accuracy. In spite of optical motion monitoring or using the immobilization tool, distributed pressure profiles of patient's back position was changed during inter and intra-fraction. For more accurate patient set-up, blind area (patient's back) monitoring was necessary. We expect that the proposed method will be very useful for make up for the weakness of optical monitoring method.

  6. Achieving better in-hospital and after-hospital care of patients with acute cardiac disease.

    Science.gov (United States)

    Scott, Ian A; Denaro, Charles P; Bennett, Cameron J; Hickey, Annabel C; Mudge, Alison M; Flores, Judy L; Sanders, Daniela C J; Thiele, Justine M; Wenck, Beres; Bennett, John W; Jones, Mark A

    2004-05-17

    In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after-hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF: Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P = 0.06) and from 13.4% to 10.1% (P = 0.06) for patients with ACS and from 22.8% to 15.2% (P improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes. PMID:15139843

  7. Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease).

    NARCIS (Netherlands)

    Hachamovitch, R.; Nutter, B.; Hlatky, M.A.; Shaw, L.J.; Ridner, M.L.; Dorbala, S.; Beanlands, R.S.; Chow, B.J.; Branscomb, E.; Chareonthaitawee, P.; Weigold, W.G.; Voros, S.; Abbara, S.; Yasuda, T.; Jacobs, J.E.; Lesser, J.; Berman, D.S.; Thomson, L.E.; Raman, S.; Heller, G.V.; Schussheim, A.; Brunken, R.; Williams, K.A.; Farkas, S.; Delbeke, D.; Schoepf, U.J.; Reichek, N.; Rabinowitz, S.; Sigman, S.R.; Patterson, R.; Corn, C.R.; White, R.; Kazerooni, E.; Corbett, J.; Bokhari, S.; Machac, J.; Guarneri, E.; Borges-Neto, S.; Millstine, J.W.; Caldwell, J.; Arrighi, J.; Hoffmann, U.; Budoff, M.; Lima, J.; Johnson, J.R.; Johnson, B.; Gaber, M.; Williams, J.A.; Foster, C.; Hainer, J.; Carli, M.F. Di

    2012-01-01

    OBJECTIVES: This study examined short-term cardiac catheterization rates and medication changes after cardiac imaging. BACKGROUND: Noninvasive cardiac imaging is widely used in coronary artery disease, but its effects on subsequent patient management are unclear. METHODS: We assessed the 90-day post

  8. A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL

    OpenAIRE

    Smith, H.; Taylor, R.; Mitchell, A.

    2000-01-01

    BACKGROUND—With the increasing use of quality of life measures in evaluations of cardiac interventions, criteria are needed for selecting appropriate quality of life measures. An important criterion is the sensitivity of a measure for detecting clinically important changes.
OBJECTIVES—To compare the sensitivity of four measures when used in a group of cardiac patients undergoing the same intervention.
METHODS—The short form 36 (SF-36), the quality of life index-cardiac version (QLI), the qual...

  9. Post-Traumatic Stress Disorder among Cardiac Patients: Prevalence, Risk Factors, and Considerations for Assessment and Treatment

    Directory of Open Access Journals (Sweden)

    Heather Tulloch

    2014-12-01

    Full Text Available There is increasing awareness of the impact of post-traumatic stress disorder (PTSD on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and risk for recurrence in cardiac patients. We explore possible mechanisms to explain these relationships, as well as appropriate assessment and treatment strategies for this population. Our main conclusion is that screening and referral for appropriate treatments are important given the high prevalence rates of PTSD in cardiac populations and the associated impact on morbidity and mortality.

  10. Web-based multimedia courseware for emergency cardiac patient management simulations.

    Science.gov (United States)

    Ambrosiadou, V; Compton, T; Panchal, T; Polovina, S

    2000-01-01

    This is a multidisciplinary inter-departmental/faculty project between the departments of computer science, electronic, communications and electrical engineering and nursing and paramedic sciences. The objective is to develop a web based multimedia front end to existing simulations of cardiac emergency scenaria. It will be used firstly in the teaching of nurses. The University of Hertfordshire is the only University in Britain using simulations of cardiac emergency scenaria for nurse and paramedic science education and therefore this project will add the multimedia dimension in distributed courses over the web and will assess the improvement in the educational process. The use of network and multimedia technologies, provide interactive learning, immediate feedback to students' responses, individually tailored instructions, objective testing and entertaining delivery. The end product of this project will serve as interactive material to enhance experiential learning for nursing students using the simulations of cardiac emergency scenaria. The emergency treatment simulations have been developed using VisSim and may be compiled as C code. The objective of the project is to provide a web based user friendly multimedia interface in order to demonstrate the way in which patients may be managed in critical situations by applying advanced technological equipment and drug administration. Then the user will be able to better appreciate the concepts involved by running the VisSim simulations. The evaluation group for the proposed software will be the Department of Nursing and Paramedic Sciences About 200 nurses use simulations every year for training purposes as part of their course requirements.

  11. Factors which influence the cardiac surgeon's decision not to operate on patients referred for consideration of surgery

    Directory of Open Access Journals (Sweden)

    Sivaprakasam Rajesh

    2008-02-01

    Full Text Available Abstract Background The aim of this study was to document what proportion of patients referred for consideration of cardiac surgery are turned down, the reasons given for not operating and also to evaluate what happens to those patients who do not undergo surgery. Methods 382 elective patients referred for consideration of cardiac surgery to one of six consultant cardiac surgeons at Wythenshawe Hospital during a one year period from were included in the study. Data for those patients who underwent an operation were collected prospectively in a cardiac surgery database. The case notes of those patients who did not undergo an operation were reviewed to establish reasons given by surgeons for not operating. Patients were followed up to determine vital status at the end of the study period. Results 333 (87.2% patients underwent an operation and 49 (12.8% did not. 68% of patients turned down were thought to be too high-risk. 14% of patients did not fulfill symptomatic or prognostic criteria for surgery and in 8% of patients coronary artery surgery was thought ineffective due to poor distal vessels. 6% of patients declined an operation and 4% were thought to be more suitable for coronary angioplasty. Patients turned down for surgery had more renal dysfunction (p = 0.017, respiratory disease (p Conclusion 12.8% of patients referred for consideration of cardiac surgery did not undergo an operation. Two thirds of patients not accepted for surgery were thought too high risk. Those patients who did not undergo an operation had a significantly worse mortality.

  12. Epidemiological and clinical use of GMHAT-PC (Global Mental Health assessment tool – primary care in cardiac patients

    Directory of Open Access Journals (Sweden)

    Krishna Murali

    2009-04-01

    Full Text Available Abstract Background A computer assisted interview, the GMHAT/PC has been developed to assist General Practitioners and other Health Professionals to make a quick, convenient and comprehensive standardised mental health assessment. It has proved to be a reliable and valid tool in our previous studies involving General Practitioners and Nurses. Little is known about its use in cardiac rehabilitation settings. Aim The study aims to assess the feasibility of using a computer assisted diagnostic interview by nurses for patients attending Cardiac Rehabilitation Clinics and to examine the level of agreement between the GMHAT/PC diagnosis and a Psychiatrist clinical diagnosis. Prevalence of mental illness was also measured. Design Cross sectional validation and feasibility study. Methods Nurses using GMHAT/PC examined consecutive patients presenting to a cardiac rehabilitation centre. A total of 118 patients were assessed by nurses and consultant psychiatrist in cardiac rehabilitation centres. The kappa coefficient (κ, sensitivity, and specificity of the GMHAT/PC diagnosis were analysed as measures of validity. The time taken for the interview as well as feedback from patients and interviewers were indicators of feasibility. Data on prevalence of mental disorders in an outpatient cardiac rehabilitation setting was collected. Results The mean duration of the interview was 14 minutes. Feedback from patients and interviewers indicated good practical feasibility. The agreement between GMHAT/PC interview-based diagnoses and consultant psychiatrists' ICD-10 criteria-based clinical diagnosis was good or excellent (κ = 0.76, sensitivity = 0.73, specificity = 0.90. The prevalence of mental disorders in this group was 22%, predominantly depression. Very few cases were on treatment. Conclusion GMHAT/PC can assist nurses in making accurate mental health assessments and diagnoses in a cardiac rehabilitation setting and is acceptable to cardiac patients. It can

  13. Value of cardiac 320-multidetector computed tomography and cardiac magnetic resonance imaging for assessment of myocardial perfusion defects in patients with known chronic ischemic heart disease

    DEFF Research Database (Denmark)

    Qayyum, Abbas Ali; Kühl, Jørgen T; Mathiasen, Anders B;

    2013-01-01

    The challenge for therapies targeting perfusion abnormalities is to identify and evaluate the region of interest. The aim of this study was to compare rest and stress myocardial perfusion measured by cardiac multi-detector computed tomography (MDCT) and cardiac magnetic resonance (CMR) imaging...... in patients with invasive coronary angiography demonstrated occluded vessels. Twenty-four patients with refractory angina due to occluded coronary arteries underwent perfusion imaging obtained by 320-MDCT scanner and 1.5 T MR scanner. Rest and adenosine stress images were obtained and interpreted using......) or 1 (abnormal). The summed rest and stress scores were calculated. MDCT and CMR had a high probability to identify perfusion defects. An excellent correlation between MDCT and CMR summed rest (r = 0.916) and stress scores (r = 0.915) was found. The interobserver reproducibility was high for MDCT...

  14. Cardiac oxygen supply is compromised during the night in hypertensive patients.

    Science.gov (United States)

    Westerhof, Berend E; van Lieshout, Johannes J; Parati, Gianfranco; van Montfrans, Gert A; Guelen, Ilja; Spaan, Jos A E; Westerhof, Nico; Karemaker, John M; Bos, Willem Jan W

    2011-09-01

    The enhanced heart rate and blood pressure soon after awaking increases cardiac oxygen demand, and has been associated with the high incidence of acute myocardial infarction in the morning. The behavior of cardiac oxygen supply is unknown. We hypothesized that oxygen supply decreases in the morning and to that purpose investigated cardiac oxygen demand and oxygen supply at night and after awaking. We compared hypertensive to normotensive subjects and furthermore assessed whether pressures measured non-invasively and intra-arterially give similar results. Aortic pressure was reconstructed from 24-h intra-brachial and simultaneously obtained non-invasive finger pressure in 14 hypertensives and 8 normotensives. Supply was assessed by Diastolic Time Fraction (DTF, ratio of diastolic and heart period), demand by Rate-Pressure Product (RPP, systolic pressure times heart rate, HR) and supply/demand ratio by A(dia)/A(sys), with A(dia) and A(sys) diastolic and systolic areas under the aortic pressure curve. Hypertensives had lower supply by DTF and higher demand by RPP than normotensives during the night. DTF decreased and RPP increased in both groups after awaking. The DTF of hypertensives decreased less becoming similar to the DTF of normotensives in the morning; the RPP remained higher. A(dia)/A(sys) followed the pattern of DTF. Findings from invasively and non-invasively determined pressure were similar. The cardiac oxygen supply/demand ratio in hypertensive patients is lower than in normotensives at night. With a smaller night-day differences, the hypertensives' risk for cardiovascular events may be more evenly spread over the 24 h. This information can be obtained noninvasively. PMID:21786015

  15. Are there meaningful longitudinal changes in health related quality of life--SF36, in cardiac rehabilitation patients?

    LENUS (Irish Health Repository)

    McKee, Gabrielle

    2012-02-01

    BACKGROUND: This study aimed to observe changes in quality of life and minimal clinical important differences of quality of life over time in cardiac rehabilitation patients and to compare these with published normal data. METHODS: In this non-randomised study, SF36 questionnaires were completed by 187 patients recruited to a Phase III cardiac rehabilitation multidisciplinary outpatient programme. Data was collected at beginning, end and six months after Phase III cardiac rehabilitation programme. RESULTS: There were significant improvements in physical functioning, role limitation due to physical function, pain and general health perception scales, over the above time frame, from both a statistically and a mean clinical important difference point of view. These improvements occurred mainly during the cardiac rehabilitation programme phase. CONCLUSIONS: These improvements meant that patients six months post-cardiac rehabilitation were only 5% below the quality of life for an aged matched normal group. However patients still had significant deficits in physical role and emotional role limitations. Suitable measurement of quality of life on an individual basis, supported by normal values is needed. This would facilitate the identification of shortfalls in patient quality of life and the subsequent tailoring of care to address these individualised patient needs.

  16. Using Lorenz plot and Cardiac Sympathetic Index of heart rate variability for detecting seizures for patients with epilepsy.

    Science.gov (United States)

    Jeppesen, Jesper; Beniczky, Sandor; Johansen, Peter; Sidenius, Per; Fuglsang-Frederiksen, Anders

    2014-01-01

    Tachycardia is often seen during epileptic seizures, but it also occurs during physical exercise. In order to assess whether focal epileptic seizures can be detected by short term moving window Heart Rate Variability (HRV) analysis, we modified the geometric HRV method, Lorenz plot, to consist of only 30, 50 or 100 R-R intervals per analyzed window. From each window we calculated the longitudinal (L) and transverse (T) variability of Lorenz plot to retrieve the Cardiac Sympathetic Index (CSI) as (L/T) and "Modified CSI" (described in methods), and compared the maximum during the patient's epileptic seizures with that during the patient's own exercise and non-seizure sessions as control. All five analyzed patients had complex partial seizures (CPS) originating in the temporal lobe (11 seizures) during their 1-5 days long term video-EEG monitoring. All CPS with electroencephalographic correlation were selected for the HRV analysis. The CSI and Modified CSI were correspondently calculated after each heart beat depicting the prior 30, 50 and 100 R-R intervals at the time. CSI (30, 50 and 100) and Modified CSI (100) showed a higher maximum peak during seizures than exercise/non-seizure (121-296%) for 4 of the 5 patients within 4 seconds before till 60 seconds after seizure onset time even though exercise maximum HR exceeded that of the seizures. The results indicate a detectable, sudden and inordinate shift towards sympathetic overdrive in the sympathovagal balance of the autonomic nervous system just around seizure-onset for certain patients. This new modified moving window Lorenz plot method seems promising way of constructing a portable ECG-based epilepsy alarm for certain patients with epilepsy who needs aid during seizure.

  17. Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

    Directory of Open Access Journals (Sweden)

    Farin Erik

    2010-09-01

    Full Text Available Abstract Background Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician on the health related quality of life (HRQOL of cardiac patients after rehabilitation. Methods N = 331 patients with chronic ischemic heart disease were surveyed using questionnaires at two time points (beginning and end of 3-weeks inpatient rehabilitation. In addition, characteristics of the disease and cardiac risk factors were provided by the physician. HRQOL was measured using a total of six scales and three instruments: SF-12, MacNew questionnaire, and SAQ. Hierarchical regression analyses were carried out to predict HRQOL after rehabilitation, in which the baseline values of HRQOL, sociodemographic variables, characteristics of the disease and risk factors, personality traits, and finally the aspects of the physician-patient relationship were included stepwise. As a number of variables were used for the regression models, multiple imputation was conducted. Results The baseline values explain most of the variance (42%-60%. After controlling the baseline values, the sociodemographic variables explain up to 5% incremental variance of HRQOL, with income being the most important predictor. The characteristics of the disease and cardiac risk factors explain between 0.4% and 3.8% incremental variance, however, variance increase is often not significant. The personality traits added in the fourth step explain up to 2% additional variance; trait anger is a significant predictor of HRQOL in three of the six scales. The features of the physician-patient relationship included in the last step lead to a significant increase in explained variance (between 1.3% and 3.9% for all six

  18. Feasibility of Home-Use Animal-Assisted Activities in Patients With Implanted Cardiac Electronic Devices

    Directory of Open Access Journals (Sweden)

    Peter Jirak

    2016-02-01

    Full Text Available Animal-assisted activities (AAAs are mainly carried out in institutions. The aim of this prospective pilot study was to assess the willingness of patients with cardiac implanted electronic devices (IEDs to participate in AAA. The sample included 75 ambulatory patients (18 females, M age = 69 years, who attended an outpatient clinic for control of antibradycardic pacemakers (n = 15 or implanted cardioverter defibrillators (n = 60. Twenty-three percent were current and 48% were previous pet-owners. Current pet-owners were younger than non-pet-owners (63.5 vs. 72.0 years, p = .0003. Twelve patients (16% showed interest in AAA visits. However, only two patients agreed to an AAA visit. Both patients were visited once, but declined further visits. Hence, AAA sessions at home were poorly accepted, mainly because the patients considered themselves too busy or healthy, or due to a general disinterest in AAA. Potential health benefits associated with AAA may not be feasible to investigate during home visits of AAA-teams in patients with IEDs who are healthy enough to leave their homes. For further studies concerning AAA in patients with cardiovascular diseases, we suggest focusing on institutions like rehabilitation centers or day care centers and on more severely sick, homebound patients.

  19. Complications of cardiac resynchronization therapy in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Previous clinical studies have suggested that patients with congestive heart failure and intraventricular conduction delay could benefit from cardiac resynchronization therapy (CRT). Implantation of left ventricular lead is a complex procedure with some potential for complications. This study was conducted to analyse the complications of CRT in patients with congestive heart failure.Methods Totally 117 patients, 86 males and 31 females, mean age of 53 years, with congestive heart failure and intraventricular conduction delaywere enrolled in this study. Venography was performed on all patients. Different types of coronary sinus leads were used to pace the left ventricle. Results Left ventricular lead was attempted to implant through coronary sinus for all the 117 patients and was successfully implanted in 111 patients. The success rate was 94.9%. Main complications rate was 6.8%, including coronary sinus dissection in 4 patients, phrenic nerve stimulation required lead repositioning in 2 patients and lead dislodgement in 2 patients. Conclusions It is feasible and safe to pace left ventricle through coronary sinus. However, there are some procedural complications.

  20. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death

    Science.gov (United States)

    Günther, Michael; Quick, Silvio; Pfluecke, Christian; Rottstädt, Fabian; Szymkiewicz, Steven J.; Ringquist, Steven; Strasser, Ruth H.; Speiser, Uwe

    2016-01-01

    Background: This study evaluated the wearable cardioverter-defibrillator (WCD) for use and effectiveness in preventing sudden death caused by ventricular tachyarrhythmia or fibrillation. Methods: From April 2010 through October 2013, 6043 German WCD patients (median age, 57 years; male, 78.5%) were recruited from 404 German centers. Deidentified German patient data were used for a retrospective, nonrandomized analysis. Results: Ninety-four patients (1.6%) were treated by the WCD in response to ventricular tachyarrhythmia/fibrillation. The incidence rate was 8.4 (95% confidence interval, 6.8–10.2) per 100 patient-years. Patients with implantable cardioverter-defibrillator explantation had an incidence rate of 19.3 (95% confidence interval, 12.2–29.0) per 100 patient-years. In contrast, an incidence rate of 8.2 (95% confidence interval, 6.4–10.3) was observed in the remaining cardiac diagnosis groups, including dilated cardiomyopathy, myocarditis, and ischemic and nonischemic cardiomyopathies. Among 120 shocked patients, 112 (93%) survived 24 hours after treatment, whereas asystole was observed in 2 patients (0.03%) with 1 resulting death. ConclusionS: This large cohort represents the first nationwide evaluation of WCD use in patients outside the US healthcare system and confirms the overall value of the WCD in German treatment pathways. PMID:27458236

  1. Cardiac output determined by echocardiography in patients with cirrhosis: comparison with the indicator dilution technique

    DEFF Research Database (Denmark)

    Andersen, Ulrik B; Møller, Søren; Bendtsen, Flemming;

    2003-01-01

    , the mean squared difference between CO(d) and CO(I) was 2.3 (l/min)2. A Bland-Altman plot revealed no trend with the level of cardiac output. The standard deviation (0.79 vs 0.30 l/min, P coefficient of variation (10.5 vs 4.2%, P ... technique (CO(I)). METHODS: Twelve patients with cirrhosis were studied. CO(d) was measured as the spatial mean velocity of the left ventricular outflow tract, multiplied by the cross-sectional area and the heart rate. CO(I) was determined by the standard indicator dilution technique after injection of 125I...

  2. Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine

    OpenAIRE

    Mehta, Sangeeta; Granton, John; Gordon, Anthony C; Cook, Deborah J.; Lapinsky, Stephen; Newton, Gary; Bandayrel, Kris; Little, Anjuli; Siau, Chuin; Ayers, Dieter; Singer, Joel; Lee, Terry CK; Keith R Walley; Storms, Michelle; Cooper, D James

    2013-01-01

    Introduction Cardiac troponins are sensitive and specific biomarkers of myocardial necrosis. We evaluated troponin, CK, and ECG abnormalities in patients with septic shock and compared the effect of vasopressin (VP) versus norepinephrine (NE) on troponin, CK, and ECGs. Methods This was a prospective substudy of a randomized trial. Adults with septic shock randomly received, blinded, a low-dose infusion of VP (0.01 to 0.03 U/min) or NE (5 to 15 μg/min) in addition to open-label vasopressors, t...

  3. Optimal Cardiac Resynchronization Therapy Pacing Rate in Non-Ischemic Heart Failure Patients

    DEFF Research Database (Denmark)

    Ghotbi, Adam Ali; Sander, Mikael; Køber, Lars;

    2015-01-01

    patients with non-ischemic heart failure (NYHA class II-III) were enrolled in a randomized, double-blind, crossover trial, in which the basal pacing rate was set at DDD-60 and DDD-80 for 3 months (DDD-R for 2 patients). At baseline, 3 months and 6 months, we assessed sympathetic nerve activity...... by microneurography (MSNA), peak oxygen consumption (pVO2), N-terminal pro-brain natriuretic peptide (p-NT-proBNP), echocardiography and QoL. RESULTS: DDD-80 pacing for 3 months increased the mean heart rate from 77.3 to 86.1 (p = 0.001) and reduced sympathetic activity compared to DDD-60 (51±14 bursts/100 cardiac...... cycles vs. 64±14 bursts/100 cardiac cycles, pDDD-60 to 16.7±6 mL/min/kg during DDD-80, and p-NT-proBNP remained unchanged. The QoL score indicated that DDD-60 was better tolerated. CONCLUSION: In CRT patients with non...

  4. Silent myocardial infarction secondary to cardiac autonomic neuropathy in a patient with rheumatoid arthritis.

    Science.gov (United States)

    Unnikrishnan, Dileep; Jacob, Aasems; Anthony Diaz, Mark; Lederman, Jeffrey

    2016-01-01

    An 83-year-old female patient with rheumatoid arthritis and hypertension presented to the emergency department with fever and chills of 1 day duration. On examination, temperature was 100.9 F, heart rate 111/min and she had orthostatic hypotension. Laboratory tests showed elevated blood urea nitrogen and white cell count. The patient underwent treatment for symptomatic urinary tract infection and while her fever and leucocytosis resolved, tachycardia persisted. An EKG done showed T inversions in leads II, III, arteriovenous fistula, V2 and V3. Troponin-I was elevated. Nuclear stress test revealed apical wall motion abnormality confirming myocardial infarction. Ewing's tests were carried out at bedside and these diagnosed severe autonomic neuropathy. Rheumatoid arthritis can cause cardiac autonomic neuropathy from chronic inflammation. This case entails the importance of assessing and detecting cardiac autonomic neuropathy in chronic inflammatory conditions, and the need to be cautious of acute coronary events in these patients, even for minimal or no symptoms. PMID:27489064

  5. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Kelli Maria Souza Santos

    2014-09-01

    Full Text Available Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors at three different times: preoperatively (M1, the day of discharge (M2 and hospital discharge (M3. Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results: Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1, with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion: The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

  6. Serial changes of the myocardium in patients with Duchenne's muscular dystrophy followed by cardiac nuclear imaging

    International Nuclear Information System (INIS)

    In order to evaluate the natural course of Duchenne's cardiomyopathy (DMD), 201Tl-SPECT and RI cardioangiography with 99mTc-albumin were performed in 14 patients. They were examined once a year for five years except for 6 patients. Hypo-perfusion was observed in both posterior-inferior and anterior wall at 12 years of age and extended to the lateral wall and septum with aging. The degree of cardiac involvement was different in each case. Systolic parameters (LVEF, 1/3EF, 1/3ER-mean) tended to decrease with aging from 15 years of age. Diastolic parameters (%EFV, 1/3FF, 1/3FR mean) decreased gradually after 16 years of age. Hypokinetic changes of regional wall motion were observed at 15 years of age and they became severely with aging. Although phase delay appeared visually at 16 years of age, standard deviation of phase angle increased from 15 years of age. Follow up studies by 201Tl myocardial SPECT and gated pool scintigraphy revealed well the progression of cardiac involvement in patients with DMD. (author) 84 refs

  7. Effect of Losartan on the Cardiac and Renal Function in Patients With Chronic Heart Failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    To explore the effect of losartan on cardiac and renal function in patients with chronic heart failure (CI-IF). Methods Sixty-five patients with CHF were divided into two groups using a randomized, control and single blind method: losartan group ( n = 30) and convention group ( n = 35 ), with a treatment course of 8 weeks for both groups. The concentrations of cystatin C (cys C) in serum, microamount albumin (MA) in urine were measured by immunoturbidimetry. The concentration of aquaporin-2 (AQP-2) was determined by enzyme-linked-immunosorbent assay (ELISA) and the heart contractile function was measured by echocardiography before and after treatment respectively. Results Comparing with routine treatment group, left ventricular end-diastolic dimension (LVEDd) decreased significantly, while left ventricular ejection fraction (LVEF) and left ventricular fractional shortening ( LVFS ) increased significantly in losartan group. The levels of cys C in serum and MA, AQP-2 in urine were significantly lower in losartan group than in routine treatment group. Conclusion Losartan can improve cardiac and renal function in patients with CHF.

  8. Performance comparison between static and dynamic cardiac CT on perfusion quantitation and patient classification tasks

    Science.gov (United States)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

    2015-03-01

    Cardiac CT acquisitions for perfusion assessment can be performed in a dynamic or static mode. In this simulation study, we evaluate the relative classification and quantification performance of these modes for assessing myocardial blood flow (MBF). In the dynamic method, a series of low dose cardiac CT acquisitions yields data on contrast bolus dynamics over time; these data are fit with a model to give a quantitative MBF estimate. In the static method, a single CT acquisition is obtained, and the relative CT numbers in the myocardium are used to infer perfusion states. The static method does not directly yield a quantitative estimate of MBF, but these estimates can be roughly approximated by introducing assumed linear relationships between CT number and MBF, consistent with the ways such images are typically visually interpreted. Data obtained by either method may be used for a variety of clinical tasks, including 1) stratifying patients into differing categories of ischemia and 2) using the quantitative MBF estimate directly to evaluate ischemic disease severity. Through simulations, we evaluate the performance on each of these tasks. The dynamic method has very low bias in MBF estimates, making it particularly suitable for quantitative estimation. At matched radiation dose levels, ROC analysis demonstrated that the static method, with its high bias but generally lower variance, has superior performance in stratifying patients, especially for larger patients.

  9. Relationship between Peripheral Artery Disease and Cardiac Function in Elderly Patients with Ischemic Heart Disease

    Directory of Open Access Journals (Sweden)

    Moatasem S Amer*, Heba M Tawfik*, Manar MA Maamoun*, Ayman M Abd Elmoteleb

    2013-04-01

    Full Text Available Background: There is high prevalence of combined peripheral and coronary artery disease (CAD related to atherosclerosis with associated increase in morbidity and mortality . Objectives:The aim of our study was to find an association between ankle brachial index (ABI and cardiac function in elderly patients with CAD using ejection fraction (EF.Method: A Case control study. The case group included 100 elderly patients who had peripheral artery disease ( PAD divided into 2 groups according to age ( 60- 70 and > 70 years. The control group included 100 elderly subjects who didn't have PAD which were divided also into 2 groups according to age . Both groups have CAD and underwent coronary angiography (CA showing significant CAD lesions. Echocardiography were done to all patients showing cardiac function. Results: EF was lowest in cases > 70 years (46.84 ± 9.82 and was highest in controls > 70 years (53.02 ± 5.53 which is statistically significant (P- Value 0.009. Also EF is correlated with ABI. Conclusion: There is a significant positive relationship between ABI and EF.

  10. Anaesthesia for non-cardiac surgery in a cardiac transplant recipient

    OpenAIRE

    Adarsh C Swami; Amit Kumar; Sunny Rupal; Sneh Lata

    2011-01-01

    Cardiac transplantation has become the standard therapy for idiopathic dilated cardiomyopathy and end-stage ischaemic heart disease. With the introduction of newer immunosuppressants, together with better patient selection, improved perioperative monitoring and care, the overall survival of recipients has improved. An increasing number of patients who received a transplant present for either elective or emergency non-cardiac surgery. We hereby discuss the perioperative management of such a pa...

  11. Self-Inflicted Intraoral Hematoma in a Cardiac Patient Receiving Oral Anticoagulant Therapy- A Case Report

    Directory of Open Access Journals (Sweden)

    Shantala Arunkumar

    2015-01-01

    Full Text Available Intraoral hematoma secondary to systemic anticoagulant therapy is rare, but it is a potentially fatal condition requiring immediate medical management. Case report: Here we report a case of self-inflicted hematoma in the anterior maxillary gingival region in a 65year old female cardiac patient who was on systemic anticoagulant therapy with a poor periodontal condition, manifesting as a periodontal swelling for a period of one week. Oral anticoagulant therapy is considerably imperative to prevent thromboembolic complications in various medical conditions, in such patients there are chances for spontaneous bleeding or hematoma by means of minor trauma due to sharp teeth or dental prosthesis in the mouth leading to life threatening complications such as partial or complete airway blockage. Therefore,directives about possible bleeding complications secondary to anticoagulant drugs in the oral cavity and the importance of maintaining oral health hygiene are necessary for the patient.

  12. Cardiac autonomic neuropathy in patients with uraemia is not related to pre-diabetes

    DEFF Research Database (Denmark)

    Elming, Marie Bayer; Hornum, Mads; Feldt-Rasmussen, Bo;

    2011-01-01

    INTRODUCTION: It has been proposed that pre-diabetes may cause neuropathy. The aim of this study was to investigate whether cardiac autonomic neuropathy (CAN) in uraemic patients was related to the presence of pre-diabetes. MATERIAL AND METHODS: The study included 66 non-diabetic uraemic patients...... enrolled. Beat-to-beat variability was determined from the echocardiographic recording during deep inspiration and expiration. CAN was defined as a beat-to-beat value below 10 beats/min. Pre-diabetes was defined as presence of impaired fasting glucose and/or impaired glucose tolerance measured by oral...... glucose tolerance test (WHO/American Diabetes Association criteria 2007). RESULTS: The prevalence of CAN was 38% in uraemic patients compared with 8% in the controls (p diabetic, while the remaining 39 had a normal glucose tolerance...

  13. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction.

    Science.gov (United States)

    Gorjup, Vojka; Noc, Marko; Radsel, Peter

    2014-06-26

    Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion ("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.

  14. Clinical Significance and Changes of ECG in the Patients with Cardiac Deficiency of the Qi and the Yin

    Institute of Scientific and Technical Information of China (English)

    LIN Qi-Shanxi

    2005-01-01

    In order to explore the changes and clinical significance of ECG in the patients with cardiac deficiency of the Qi and Yin, 124 patients with heart diseases were examined by means of ECG. The results showed that the prevalence of left ventricular hypertrophy in cardiac deficiency of the Qi (CDQ) was obviously higher than that of cardiac deficiency of the Yin (CDY). The higher prevalence of tachycardia occurred in the patients with CDY.The prevalence of the Q - T interval prolongation and abnormalities of ST - T segment in the patients with CDY was also higher than that of CDQ. The difference between two groups suggests that the diagnosis of two syndromes by ECG may be of important value.

  15. Gastroscopy-related adverse cardiac events and bleeding complications among patients treated with coronary stents and dual antiplatelet therapy

    DEFF Research Database (Denmark)

    Egholm, Gro; Thim, Troels; Madsen, Morten;

    2016-01-01

    of adverse cardiac events and gastroscopy-related bleeding complications within 30 days of gastroscopy, and (3) the association between antiplatelet therapy and these events. PATIENTS AND METHODS: Patients receiving gastroscopy within 12 months of PCI were identified and two nested case......BACKGROUND AND STUDY AIMS: Dual antiplatelet therapy (DAPT) is recommended following percutaneous coronary intervention (PCI) with drug-eluting stent (DES). DAPT is a risk factor for gastrointestinal bleeding. We aimed to quantify (1) the rate of gastroscopy within 12 months after PCI, (2) the rate......-control analyses were performed within the PCI cohort by linking Danish medical registries. Cases were patients with adverse cardiac events (cardiac death, myocardial infarction, or stent thrombosis) or hemostatic intervention. In both studies, controls were patients with gastroscopy including biopsy without...

  16. Pulmonary function, cholinergic bronchomotor tone, and cardiac autonomic abnormalities in type 2 diabetic patients

    Directory of Open Access Journals (Sweden)

    Melo E.

    2003-01-01

    Full Text Available This prospective study analyzed the involvement of the autonomic nervous system in pulmonary and cardiac function by evaluating cardiovascular reflex and its correlation with pulmonary function abnormalities of type 2 diabetic patients. Diabetic patients (N = 17 and healthy subjects (N = 17 were evaluated by 1 pulmonary function tests including spirometry, He-dilution method, N2 washout test, and specific airway conductance (SGaw determined by plethysmography before and after aerosol administration of atropine sulfate, and 2 autonomic cardiovascular activity by the passive tilting test and the magnitude of respiratory sinus arrhythmia (RSA. Basal heart rate was higher in the diabetic group (87.8 ± 11.2 bpm; mean ± SD than in the control group (72.9 ± 7.8 bpm, P<0.05. The increase of heart rate at 5 s of tilting was 11.8 ± 6.5 bpm in diabetic patients and 17.6 ± 6.2 bpm in the control group (P<0.05. Systemic arterial pressure and RSA analysis did not reveal significant differences between groups. Diabetes intragroup analysis revealed two behaviors: 10 patients with close to normal findings and 7 with significant abnormalities in terms of RSA, with the latter subgroup presenting one or more abnormalities in other tests and clear evidence of cardiovascular autonomic dysfunction. End-expiratory flows were significantly lower in diabetic patients than in the control group (P<0.05. Pulmonary function tests before and after atropine administration demonstrated comparable responses by both groups. Type 2 diabetic patients have cardiac autonomic dysfunction that is not associated with bronchomotor tone alterations, probably reflecting a less severe impairment than that of type 1 diabetes mellitus. Yet, a reduction of end-expiratory flow was detected.

  17. Automatic selection of optimal cardiac-phase in coronary CT angiography. Its clinical usefulness for patients with atrial fibrillation

    International Nuclear Information System (INIS)

    The optimal cardiac phases for coronary CT angiography (CTA) are end-systole and mid-diastole, in which cardiac movement is slow. In conventional methods, these cardiac phases are determined by visual selection. We have compared the images in the optimal cardiac phases that were selected by the conventional method and cardiac-phase search software (Phase Navi), and examined the clinical usefulness of Phase Navi in patients with atrial fibrillation. The subjects were 38 patients (regular rhythm: 20, atrial fibrillation: 18). The continuity scores of patients with regular rhythm (Phase Navi, conventional methods) were 2.4±0.3-2.5±0.3 in end-systole and 2.4±0.5-2.4±0.4 in mid-diastole. The scores of patients with atrial fibrillation (Phase Navi, conventional methods) were 2.3±0.4-2.3±0.4 in end-systole, and 2.2±0.5-2.1±0.6 in mid-diastole. Because the continuity scores of the optimal images from Phase Navi were similar to those from the conventional method, Phase Navi had clinical usefulness in patients with atrial fibrillation. (author)

  18. Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis.

    Science.gov (United States)

    Sano, Makoto; Satoh, Hiroshi; Suwa, Kenichiro; Nobuhara, Mamoru; Saitoh, Takeji; Saotome, Masao; Urushida, Tsuyoshi; Katoh, Hideki; Shimoyama, Kumiko; Suzuki, Daisuke; Ogawa, Noriyoshi; Takehara, Yasuo; Sakahara, Harumi; Hayashi, Hideharu

    2015-11-01

    Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p 125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction.

  19. Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis.

    Science.gov (United States)

    Sano, Makoto; Satoh, Hiroshi; Suwa, Kenichiro; Nobuhara, Mamoru; Saitoh, Takeji; Saotome, Masao; Urushida, Tsuyoshi; Katoh, Hideki; Shimoyama, Kumiko; Suzuki, Daisuke; Ogawa, Noriyoshi; Takehara, Yasuo; Sakahara, Harumi; Hayashi, Hideharu

    2015-11-01

    Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p 125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction. PMID:24996373

  20. Enhancing Cardiac Resynchronization Therapy for Patients with Atrial Fibrillation: The Role of AV Node Ablation

    Directory of Open Access Journals (Sweden)

    Jeff M. Berry, MD

    2012-04-01

    Full Text Available Cardiac resynchronization therapy (CRT has evolved as an effective therapy for patients with congestive heart failure (CHF and ventricular dyssynchrony, currently defined as a wide QRS on the electrocardiogram. While multiple randomized controlled trials have confirmed the favorable effects of CRT on mortality and heart failure symptoms for patients in sinus rhythm, only recently observational studies have begun to suggest a similar benefit for patients with atrial fibrillation (AF and dyssynchrony. Yet, implementing effective biventricular pacing in patients with AF can be problematic due to competing intrinsic AV conduction. For patients with depressed ejection fractions needing AV node (AVN ablation to control fast ventricular rates, biventricular pacing has been shown to be superior to right ventricular pacing alone. When consistent pacing (over 90% of the time cannot be achieved in AF patients due to a rapid ventricular response despite pharmacological therapy, AVN ablation should be considered. The additional benefit of performing AVN ablation to promote biventricular pacing in patients without rapid ventricular rates remains uncertain. A randomized controlled trial is needed to test the incremental benefit of AVN ablation to promote biventricular pacing in heart failure patients with AF and wide QRS.