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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...... significant AF episodes, as patients with episodes of shorter duration were not at increased risk. The association of AF to progressive heart failure, reinfarction, and cardiovascular death underlines the need for an intensive follow-up of post-MI patients with new-onset AF in order to reveal underlying...

  3. Cardiac monitoring in patients with syncope: making that elusive diagnosis.

    Science.gov (United States)

    Subbiah, Rajesh; Chia, Pow-Li; Gula, Lorne J; Klein, George J; Skanes, Allan C; Yee, Raymond; Krahn, Andrew D

    2013-11-01

    Elucidating the cause of syncope is often a diagnostic challenge. At present, there is a myriad of ambulatory cardiac monitoring modalities available for recording cardiac rhythm during spontaneous symptoms. We provide a comprehensive review of these devices and discuss strategies on how to reach the elusive diagnosis based on current evidencebased recommendations.

  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. 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...... was -0.39 L/min (11%). Limits of agreement were +/-1.56 L/min and relative error was 21%. CONCLUSIONS: A simple algorithm based on RV pressure wave form characteristics derived from an IHM can be used to estimate changes in CO in heart failure patients. These findings encourage further research aiming...

  7. 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.

  8. 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.

  9. 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.

  10. [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.

  11. 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

  12. 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

  13. 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...

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

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    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.

  15. 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.

  16. 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.

  17. Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    LU Jia-kai; ZHU Chen; JING He; WANG Yi-jun; QING En-ming

    2012-01-01

    Background For patients undergoing off-pump coronary artery bypass grafting (OPCABG),it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment.This study aimed to observe the clinical feasibility of artedal pressure-based cardiac output (APCO) for cardiac output (CO) monitoring and to evaluate the correlation between APCO and pulmonary artery catheter (PAC) for CO measurement for patients undergoing OPCABG intraoperatively.Methods Fifty patients of Amedcan Society of Anaesthesiologists (ASA) classification Ⅱ-Ⅲ,undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study.All patients were assigned to CO monitoring by PAC and APCO simultaneously.Patients with pacemaker,severe valvular heart disease,left ventdcular ejection fraction (EF) <40%,cardiac arrhythmias,peripheral vascular disease,application of intra-aortic balloon pump (IABP) and emergent diversion to cardiac pulmonary bypass were excluded.The radial artery wavaform was analyzed to estimate the stroke volume (SV) and heart rate (HR) continuously.CO was calculated as SV x HR; other derived parameters were cardiac index (CI),stroke volume index (SVI),systemic vascular resistance (SVR),and systemic vascular resistance index (SVRI).PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms.Continuous cardiac output (CCO),CI and other hemodynamic parameters were monitored at following 5 time points:immediate after anesthesia induction (baseline value),anastomosis of left intemal mammary artery to left anterior descending artery (LAD),anastomosis of left circumflex (LCX),anastomosis of posterior descending artery (PDA) and immediate after sternal closure.Results In the 50 patients,preoperative echocardiography measured left ventricular EF was (52.8±11.5)%,and 35 patients (70%) showed regional wall motion abnormalities.The correlation coefficient of CO

  18. 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...

  19. A remote monitor of bed patient cardiac vibration, respiration and movement.

    Science.gov (United States)

    Mukai, Koji; Yonezawa, Yoshiharu; Ogawa, Hidekuni; Maki, Hiromichi; Caldwell, W Morton

    2009-01-01

    We have developed a remote system for monitoring heart rate, respiration rate and movement behavior of at-home elderly people who are living alone. The system consists of a 40 kHz ultrasonic transmitter and receiver, linear integrated circuits, a low-power 8-bit single chip microcomputer and an Internet server computer. The 40 kHz ultrasonic transmitter and receiver are installed into a bed mattress. The transmitted signal diffuses into the bed mattress, and the amplitude of the received ultrasonic wave is modulated by the shape of the mattress and parameters such as respiration, cardiac vibration and movement. The modulated ultrasonic signal is received and demodulated by an envelope detection circuit. Low, high and band pass filters separate the respiration, cardiac vibration and movement signals, which are fed into the microcontroller and digitized at a sampling rate of 50 Hz by 8-bit A/D converters. The digitized data are sent to the server computer as a serial signal. This computer stores the data and also creates a graphic chart of the latest hour. The person's family or caregiver can download this chart via the Internet at any time.

  20. Clinical skills: cardiac rhythm recognition and monitoring.

    Science.gov (United States)

    Sharman, Joanna

    With technological advances, changes in provision of healthcare services and increasing pressure on critical care services, ward patients' severity of illness is ever increasing. As such, nurses need to develop their skills and knowledge to care for their client group. Competency in cardiac rhythm monitoring is beneficial to identify changes in cardiac status, assess response to treatment, diagnosis and post-surgical monitoring. This paper describes the basic anatomy and physiology of the heart and its conduction system, and explains a simple and easy to remember process of analysing cardiac rhythms (Resuscitation Council UK, 2000) that can be used in first-line assessment to assist healthcare practitioners in providing care to their patients.

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

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Goepfert, M; Gogarten, W; Grosse, J; Heller, A R; Heringlake, M; Kastrup, M; Kroener, A; Loer, S A; Marggraf, G; Markewitz, A; Reuter, D; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2010-06-15

    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 Scientific Medical

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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.

  4. Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery : a prospective observational study

    NARCIS (Netherlands)

    Schierenbeck, Fanny; Nijsten, Maarten W. N.; Franco-Cereceda, Anders; Liska, Jan

    2014-01-01

    Introduction: Lactate is a marker of hypoperfusion and may be used for risk assessment in critically ill patients. Although evidence suggests that repeated lactate measurements are of clinical interest, how and when lactate should be analyzed is controversial. Intravascular microdialysis provides a

  5. Aminoterminal Pro B-Type Natriuretic Peptide (NT-proBNP Levels for Monitoring Interventions in Paediatric Cardiac Patients with Stenotic Lesions

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    Eva Welisch

    2009-01-01

    Full Text Available Background. Serum concentration of NT-proBNP correlates well with the severity of cardiac disease in adults. Few studies have been performed on the applicability of NT-proBNP for monitoring children with congenital heart disease. Objective. To assess the potential of NT-proBNP for monitoring the success of interventions in children with stenotic cardiac lesions. Methods. NT-proBNP was measured in 42 children aged 1 day to 17 years (y before and 6 to 12 weeks after surgical or interventional correction of obstructive lesions of the heart. Comparison is made with the clinical status and echocardiographic data of the child. Results. NT-proBNP levels (median 280, range 10–263,000 pg/mL were above the reference value in all but 6 patients (pts prior to the intervention. Higher levels were found in more compromised patients. The 35 children with clinical improvement after the procedure showed a decline of their NT-proBNP level in all but 4 patients, whose levels remained unchanged. Five patients with unchanged gradients despite a therapeutic intervention also demonstrated unchanged NT-proBNP levels after the intervention. Thus, the success rate of the procedure correlated well to clinical and echocardiographic findings. Conclusion. NT-proBNP can be used to assess the efficiency of an intervention.

  6. Mini invasive hemodynamic monitoring: from arterial pressure to cardiac output

    OpenAIRE

    Della Rocca, Giorgio; Cecconi, Maurizio; Costa, Maria Gabriella

    2008-01-01

    To evaluate the Cardiac Output (CO) the standard invasive pulmonary artery catheter (PAC) is considered today the gold standard. The major criticism to the PAC is that its level of invasiveness is not supported by an improvement in patient's outcome. The interest to lesser and lesser invasive techniques is high. Therefore, the alternative techniques have been recently developed.Cardiac Output can be monitored continuously by different devices that analyze the arterial waveform to track change...

  7. 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...

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

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    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.)

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

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    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.

  10. Prevalence, Diagnosis, Perioperative Monitoring and Treatment of Right Ventricular Dysfunction and/or Pulmonary Arterial Hypertension in Cardiac Surgical Patients in Germany-A Postal Survey.

    Science.gov (United States)

    Heringlake, Matthias; Schön, Julika; Pliet, Teresa; Haake, Nils; Reinecke, Alexander; Habicher, Marit; Sander, Michael; Markewitz, Andreas; Reuter, Daniel A; Groesdonk, Heinrich Volker; Trummer, Georg; Pilarzyk, Kevin; von der Brelie, Michael; Bein, Berthold; Schirmer, Uwe

    2016-02-24

    Background Sparse data are available on the prevalence of right ventricular dysfunction and/or pulmonary arterial hypertension in patients scheduled for cardiac surgery in Germany as well as on the intensity and modalities used for diagnosis, perioperative monitoring, and treatment of these comorbidities. Methods A postal survey including questions on the prevalence of preoperative right ventricular dysfunction and/or pulmonary arterial hypertension in patients undergoing cardiac surgery in 2009 was sent to 81 German heart centers. Total 47 of 81 (58%) heart centers returned the questionnaires. The centers reported data on 51,095 patients, and 49.8% of the procedures were isolated coronary artery bypass grafting. Results Data on the prevalence of preoperative pulmonary hypertension and/or right ventricular dysfunction were not available in 54% and 64.6% of centers. In the remaining hospitals, 19.5% of patients presented right heart dysfunction and 10% pulmonary arterial hypertension. Preoperative echocardiography was performed in only 45.3% of the coronary artery bypass grafting cases. Preoperative pharmacologic treatment of pulmonary hypertension or right ventricular dysfunction with oral sildenafil, inhaled prostanoids, or nitric oxide was initiated in 71% and 95.7% of the centers, respectively. Intra- and postoperative treatment was most frequently accomplished with phosphodiesterase-III inhibitors. Conclusion The prevalence of preoperative right heart dysfunction and pulmonary arterial hypertension in cardiac surgical patients in Germany seems to be substantial. However, in more than 50% of the patients, no preoperative data on right ventricular function and pulmonary arterial pressure are available. This may lead to underestimation of perioperative risk and inappropriate management of this high-risk population.

  11. 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.

  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. 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…

  14. 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

    cardiac output (CO) during steady state and with induced haemodynamic changes in patients scheduled for elective cardiac surgery. METHODS: Twenty-five patients were enrolled. After induction of anaesthesia, endotracheal intubation using a dedicated ECOM tube, and insertion of the pulmonary artery catheter......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...

  15. The cardiac patient in Ramadan.

    Science.gov (United States)

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan

    2016-01-01

    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting.

  16. 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.

  17. Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest.

    Science.gov (United States)

    Jung, Julianna

    2016-10-01

    Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed.

  18. 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

  19. Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock: an observational study

    NARCIS (Netherlands)

    Slagt, C.; Helmi, M.; Malagon, I.; Groeneveld, A.B.

    2015-01-01

    BACKGROUND: Cardiac output (CO) measurement is often required in critically ill patients. The performances of newer, less invasive techniques require evaluation in patients with severe sepsis and septic shock. OBJECTIVES: To compare calibrated arterial pressure waveform analysis-derived CO (COap, Vo

  20. 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

  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. Cardiac abnormalities discovered during long-term monitoring for epilepsy.

    Science.gov (United States)

    Herder, Lisa A

    2008-09-01

    During routine EEGs, ambulatory EEGs, prolonged EEGs in the intensive care unit, and long-term monitoring for epilepsy (LTME), trained technologists record cerebral activity as well as a basic electrocardiogram (ECG). The traditional use of this ECG tracing is to differentiate ECG artifact from abnormal brain activity. The past few years of LTME have given rise to a greater appreciation of the importance of ECG recording in patients undergoing continuous video EEG monitoring. The ECG must be reviewed for abnormalities, both ictal and non-ictal related. Although EEG technologists are not formally trained in ECG, abnormalities on ECG may be observed that could warrant further investigation through cardiology services. In addition to treating the patient's neurological issues, it may be possible to bring attention to previously undiagnosed cardiac problems that could seriously threaten the patient's health.

  3. 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.

  4. Cardiac troponin elevations among critically ill patients.

    NARCIS (Netherlands)

    Klein Gunnewiek, J.M.T.; Hoeven, J.G. van der

    2004-01-01

    PURPOSE OF THE REVIEW: Elevated levels of cardiac troponins, indicative of the presence of cardiac injury, have been reported in critically ill patients. In this review, the incidence, significance, and clinical relevance of elevated troponin levels among this group of patients will be discussed. RE

  5. 连续多普勒无创血液动力学监测仪(USCOM)在危重患者中的运用%The Application of Ultrasonic Cardiac Output Monitor In the Critically Ill Patients

    Institute of Scientific and Technical Information of China (English)

    杨勤; 向明芳

    2012-01-01

    Objective: To compare the cardiac output detected by ultrasonic cardiac output monitor(USCOM) and Thoracic Electrical Bioimpedance(TEB). Methods: The cardiac outputs of 40 critically ill patients were detected by USCOM and TEB simultaneously. Results: There was no significant difference of the cardiac output detected by USCOM and TEB(P>0.10), the correlation analysis showed a positive correlation between cardiac output measured with USCOM and TEB(correlation coefficient of CO: r=0.8427, correlation coefficient of SV: r=0.8392, P0.10);且两种监测方法测得的结果具有正相关性(CO相关系数 r=0.8427,SV相关系数 r=0.8392,P均<0.01).结论采用USCOM技术监测危重患者的心输出量具有无创、连续、简便、准确的特点.

  6. Methemoglobinaemia in Cardiac Patients on Nitrate Therapy

    Directory of Open Access Journals (Sweden)

    Abdel Aziz A. Ghanem

    2010-06-01

    Full Text Available Background: Methaemoglobinaemia refers to the oxidation of ferrous iron to ferric iron within the haemoglobin molecule, which occurs following oxidative stresses. The subsequent impairment in oxygen transport may lead to progressive hypoxia that is highly dangerous condition especially in borderline patients like the cardiac patient.Objectives: In the present work, authors explore the extent of methaemoglobinaemia in cardiac patients receiving nitrate therapy.Methodology: The study included 970 cardiac patients presented in cardiology department, Mansoura Specialised Medical Hospital, Egypt, in the period from February to July 2009. Patients were taking oral, sublingual, dermal preparation or a combination of two preparations.Results: cases of the study had methemoglobin level 1.1782 ± 0.3476 g/dL with insignificant difference between males and females. Methemoglobin showed positive correlation with carboxyhemogloin and negative correlation with O2 content and O2 saturation. It was significantly higher in cardiac patient with chest infection, anaemia and diabetic patients but didn't differ in hepatic or non hepatic cardiac patients. 3.2% of cardiac patients who receive more than one nitrate preparation (either oral and dermal or oral and sublingual therapy have methemoglobin level significantly higher than those who receive single preparation. There is significant difference in methemoglobin level in cardiac patients complaining of myocardial infarction “MI”, unstable Angina, atrial fibrillation “AF” and hypertensive heart disease “HTN”.Conclusions: It is concluded that commonly used dosages of nitrates are capable of causing elevations of methemoglobin ranged from 0.9 – 5.3 g/dl. Although the elevation in methaemoglobin (MetHb levels was not of routine clinical significance, there was statistically significant increase in MetHb levels in cardiac patients with another pathologic condition as anaemia, diabetes mellitus or chest

  7. 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.

  8. The obesity paradox in cardiac arrest patients.

    Science.gov (United States)

    Chalkias, Athanasios; Xanthos, Theodoros

    2014-02-01

    Evidence from clinical cohorts indicates an obesity paradox in overweight and obese patients who seem to have a more favorable short-term and long-term prognosis than leaner patients. Although obese cardiac arrest victims are theoretically more difficult to be resuscitated due to difficulties in providing adequate chest compressions, ventilation, and oxygenation, research so far has shown that there is an obesity paradox in cardiac arrest.

  9. Thoracocentesis in cardiac surgery patients.

    Science.gov (United States)

    Wickbom, Anders; Cha, Soon Ok; Ahlsson, Anders

    2015-01-01

    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter.

  10. The cardiac patient during Ramadan and Hajj.

    Science.gov (United States)

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

    2014-10-01

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

  11. A usability study of patients setting up a cardiac event loop recorder and BlackBerry gateway for remote monitoring at home.

    Science.gov (United States)

    Sparkes, Jane; Valaitis, Ruta; McKibbon, Ann

    2012-01-01

    This article reports on a usability study of remote noninvasive cardiac testing in homes. We studied the Vitaphone 3100BT (Bluetooth®) event loop recorder (Vitaphone GmbH, Mannheim, Germany) and paired BlackBerry® Curve™ 8520 smartphone (Research In Motion, Ltd., Waterloo, ON, Canada). This application requires independent device set-up by patients in their own homes following receipt by mail out of the kit (instructions plus the event loop recorder and smartphone). The case studies of five participants, each with varying experience with technology, were documented as they interacted with the devices. Participants were videotaped following written instructions as they performed a "think aloud" procedure while completing 20 device set-up tasks. Interviews provided insight into how the independent device set-up and processes could be improved. This study concluded that gender, age, and familiarity with technology seemed to influence the participants' abilities to successfully set up these devices and that sending the kit by mail appeared to be an acceptable strategy to provide remote noninvasive cardiac diagnostic services. This study provides a foundation for future research assessing usability of mobile healthcare technology.

  12. 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.

  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. 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...

  16. Cardiac arrhythmias in adult patients with asthma

    DEFF Research Database (Denmark)

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

    2012-01-01

    OBJECTIVE: The pathogenesis of cardiac arrhythmias in asthma patients has not been fully elucidated. Adverse drug effects, particularly those of β2-mimetics, may play a role. The aim of this study was to determine whether asthma is associated with the risk of cardiac arrhythmias and electrocardio......OBJECTIVE: The pathogenesis of cardiac arrhythmias in asthma patients has not been fully elucidated. Adverse drug effects, particularly those of β2-mimetics, may play a role. The aim of this study was to determine whether asthma is associated with the risk of cardiac arrhythmias...... 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...... or flutter). Secondary outcomes were tachycardia, bradycardia, PVC, atrial fibrillation or flutter, mean heart rate, mean corrected QT (QTc) interval length, and prolonged QTc interval. RESULTS: Tachycardia and PVCs were more prevalent in patients with asthma (3% and 4%, respectively) than those without...

  17. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel; 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...

  18. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO

    2016-10-01

    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  19. Peripartum cardiomyopathy: postpartum decompensation and use of non-invasive cardiac output monitoring.

    Science.gov (United States)

    Lorello, G; Cubillos, J; McDonald, M; Balki, M

    2014-02-01

    The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported. A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction peripartum cardiomyopathy. We suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients.

  20. 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.

  1. [Multiplane transesophageal echocardiography for the monitoring of cardiac surgery].

    Science.gov (United States)

    Pepi, M; Barbier, P; Doria, E; Tamborini, G; Berti, M; Muratori, M; Guazzi, M; Maltagliati, A; Alimento, M; Celeste, F

    1994-08-01

    Multiplane transesophageal echocardiography (TEE) allows visualization of the heart and great vessels through an infinite number of imaging planes and improves the diagnostic capabilities of mono and biplane TEE. This study was undertaken to test whether MTEE is a useful intraoperative monitoring method during cardiac surgery. Intraoperative multiplane TEE was performed in 200 patients (mean age 56 +/- 19 years) as a part of the routine clinical care. We systematically acquired cardiac images from the gastric fundus (short and long axes of the ventricles), lower esophagus (four-chamber, two-chamber, and long axis), upper esophagus (13 views concerning the aorta, pulmonary artery, left and right atrium, systemic and pulmonary veins, coronary arteries, right ventricular outflow tract), and searched for complete views of the thoracic descending aorta. All views analyzed in the preoperative (immediately before cardiopulmonary bypass), intraoperative and postoperative phases evaluating: the angle between current and 0 degree at which each view was obtained; the success rate of each view; the usefulness of the different views in providing essential additional clinical information compared to 0 degrees and 90 degrees of the traditional biplane TEE. Most views of the heart and great vessels were visualized in oblique planes, and other views were significantly improved thanks to slight angle corrections. Multiplane TEE was particularly useful in the preoperative and postoperative phases of aortic dissection (11 cases), mitral valve repair (13 cases), left ventricular aneurysmectomy (9 cases), right atrial thrombosis (1 case), positioning of left ventricular hemopump (2 cases), mitral-aortic endocarditis (3 cases), bleeding from proximal suture of an aortic heterograft (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. 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...

  3. 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...... and a music medicine intervention. Guided Relaxation with Music was considered potentially helpful for post operative cardiac patients in order to induce relaxation and facilitate recovery involving listening to relaxing music as a background while systematically guiding patients through a process of bodily...... 'melody' and 'tempo' as important elements in choosing their preferred style of music. Voice quality was of high priority for participants to benefit from the GRM intervention. Attrition in the study was caused partly by difficulties participants experienced postoperatively in supplying data before...

  4. 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

    .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....... of controls. Thus, the optimal strategy for assessing cardiac involvement in DM1 is unclear. METHOD: In this large single-centre study, we evaluated 129 unselected DM1 patients (49.6% men), mean (SD) age 44 (14.7) years with family history, physical examination, electrocardiogram (ECG), echocardiography......, 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...

  5. [Severe hyperkalemia in cardiac patients].

    Science.gov (United States)

    Barrillon, A; Bousser, J P; Labrousse, J; Cousteau, J P; Lhoste, F; Gerbaux, A

    1976-10-02

    Hyperkalaemia with severe myocardial consequence may complicate the treatment of heart failure. In five patients who developed kalaemia ranging from 6.5. to 8.6. mEq/l, the ECG showed altered auriculogram and/or widened QRS, the latter change being associated with ST segment elevation and very large T wave in one case. Such hyperkalaemia cannot be termed iatrogenic, although it is promoted by diuretic-induced hyponatraemia and dehydration. The essential part is played by an aggravation of the haemodynamic status, responsible for acute renal insufficiency with oligoanuria, and by the attendant metabolic acidosis. The correction of this metabolic acidosis promotes diuresis, causing potassium depletion and the rapid regression of electrocardiographic abnormalities. Parenteral alkalinization with sodium bicarbonate, associated with furosemid to prevent sodium overload, instituted in emergency, is the only way to prevent asystole or ventricular fibrillation when kalaemia exceeds 8 mEq/l.

  6. 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.

  7. Laparoscopic Cholecystectomy of Patients with Cardiac Disease in Our Clinic; Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ömer Faruk Şavluk

    2013-03-01

    Full Text Available Introduction: The application of laparoscopic cholecystectomy is investigated to effected on patients with cardiac surgery or examination of patients that were identified with cardiac problem.Patients and Methods: Between 2008-2010 total of 233 patients with laporoscopiccholecystectomy were retrospectively analyzed follow up papers. Systolic blood pressure, diastolic blood pressure, heart rate, X-rays and ECGs were evaluated in preoperative examination in all patients. ECG, SpO2 monitoring was performed to all patients in the operating room. In all patients systolic blood pressure, diastolic blood pressure, heart rate and SpO2 values before the operation and during the operation were recorded. End-tidal CO2 was monitored during the operation. Additional disease duration of surgery, duration of intubation, preoperative, perioperative and postoperative need to inotropic support were recorded. Results: One hundred and one (43% patients were men and 132 (57% female. Forty five of 233 patients with cardiac problems are sick. Twenty five patients of these patients had coronary bypass surgery and eight patients underwent prosthetic valve surgery. As a result of preoperative transthoracic echocardiography in 12 patients were diagnosed with valve insufficiency. Demographic characteristics were similar than between the two groups. The mean operation time, insuflation time, extubation time, staying hospital time and hemodynamic data were similar than between the two groups. Conclusion: Laparoscopic cholecystectomy safely and easily can apply for application of the balanced anesthesia, low-pressure pneumoperitoneum after being stable cardiac status in patients with cardiac problem.

  8. [Cardiac rehabilitation in patients with atrial fibrillation].

    Science.gov (United States)

    Schlitt, Axel; Kamke, Wolfram; Guha, Manju; Haberecht, Olaf; Völler, Heinz

    2015-06-01

    The course of cardiac rehabilitation is often altered due to episodes of paroxysmal, predominantly postoperative atrial fibrillation. In symptomatic patients, a TEE-guided cardioversion - preferential DC shock - is indicated. In patients with persistent / permanent atrial fibrillation, a heart rate up to 110 / min and 170 / min at rest and during physical activity should, respectively, be tolerated. Therefore, training should not be quitted by heart rate but rather by load. The antithrombotic management is in addition a great task in treating patients with atrial fibrillation. With the exception of patients with a CHA2DS2-VASc-Score < 1, oral anticoagulation is indicated. Atrial fibrillation has little impact on social aspects, whereas the underlying heart disease and drug treatment (oral anticoagulation) has an important impact.

  9. 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.

  10. 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...... determined the 90-day mortality and neurological outcome at discharge for CA patients treated with therapeutic hypothermia (TH), in regard to determine the importance of the predictors for mortality and neurological outcome, with emphasize on combining initial rhythm and time to return of spontaneous...

  11. 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...

  12. Permanent cardiac pacing in pediatric patients.

    Science.gov (United States)

    Lotfy, Wael; Hegazy, Ranya; AbdElAziz, Osama; Sobhy, Rodina; Hasanein, Hossam; Shaltout, Fawzan

    2013-02-01

    Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow

  13. Frontal Cardiac area in patent ductus arteriosus patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Choo, Dong Woon [Seoul Natinal University College of Medicine, Seoul (Korea, Republic of)

    1972-03-15

    Cardiac mensuration by radiographic frontal cardiac area method was carried out on 21 patent ductus arteriosus patients, 15 females and 6 males. Formula used in this study is as follows. Frontal cardiac area = {pi}/4 X long diameter X broad diameter. Increase of frontal cardiac area in patent ductus arteriosus patients seems to be evident but the degree of the cardiomegaly is variable. Comparing to normal data by Choo and Kim, frontal cardiac area in patent ductus arteriosus patients in this series is increased in 15.9% to 98.1%. After surgical ligation of the ductus arteriosus, significant decrease of the frontal cardiac area is observed and the average is 12.5%.

  14. 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).

  15. Automated external cardioversion defibrillation monitoring in cardiac arrest: a randomized trial

    Directory of Open Access Journals (Sweden)

    Norvel Robert

    2008-06-01

    Full Text Available Abstract Background In-hospital cardiac arrest has a poor prognosis despite active electrocardiography monitoring. The initial rhythm of approximately 25% of in-hospital cardiopulmonary resuscitation (CPR events is pulseless ventricular tachycardia/ventricular fibrillation (VT/VF. Early defibrillation is an independent predictor of survival in CPR events caused by VT/VF. The automated external cardioverter defibrillator (AECD is a device attached by pads to the chest wall that monitors, detects, and within seconds, automatically delivers electric countershock to an appropriate tachyarrhythmia. Study Objectives • To evaluate safety of AECD monitoring in hospitalized patients. • To evaluate whether AECDs provide earlier defibrillation than hospital code teams. Methods The study is a prospective trial randomizing patients admitted to the telemetry ward to standard CPR (code team or standard CPR plus AECD monitoring (PowerHeart CRM. The AECD is programmed to deliver one 150 J biphasic shock to patients in sustained VT/VF. Data is collected using the Utstein criteria for cardiac arrest. The primary endpoint is time-to-defibrillation; secondary outcomes include neurological status and survival to discharge, with 3-year follow-up. Results To date, 192 patients have been recruited in the time period between 10/10/2006 to 7/20/2007. A total of 3,655 hours of telemetry data have been analyzed in the AECD arm. The AECD has monitored ambulatory telemetry patients in sinus rhythm, sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, with premature ventricular complexes and non-sustained VT without delivery of inappropriate shocks. One patient experienced sustained VT during AECD monitoring, who was successfully defibrillated (17 seconds after meeting programmed criteria. There are no events to report in the control arm. The patient survived the event without neurological complications. During the same time period, mean time to

  16. 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.

  17. 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.

  18. 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...

  19. 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.

  20. Cardiac magnetic resonance imaging: patient safety considerations.

    Science.gov (United States)

    Giroletti, Elio; Corbucci, Giorgio

    Magnetic Resonance Imaging (MRI) is widely used in medicine. In cardiology, it is used to assess congenital or acquired diseases of the heat: and large vessels. Unless proper precautions are taken, it is generally advisable to avoid using this technique in patients with implanted electronic stimulators, such as pacemakers and defibrillators, on account of the potential risk of inducing electrical currents on the endocardial catheters, since these currents might stimulate the heart at a high frequency, thereby triggering dangerous arrhythmias. In addition to providing some basic information on pacemakers, defibrillators and MRI, and on the possible physical phenomena that may produce harmful effects, the present review examines the indications given in the literature, with particular reference to coronary stents, artificial heart valves and implantable cardiac stimulators.

  1. 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.

  2. 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

    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...... 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...

  3. Assessment of cardiac stroke volume in patients with implanted cardiac pacemaker using parametric electrical impedance tomography: a theoretical 2D study.

    Science.gov (United States)

    Mhajna, Muhammad; Abboud, Shimon

    2013-05-01

    The present theoretical study examines the ability to estimate cardiac stroke volume (CSV) in patients with implanted cardiac pacemaker using parametric electrical impedance tomography (pEIT) in a 2D computerized model of the thorax. CSV is a direct indicator of the cardiac pumping efficiency. The commonly used methods for measuring CSV require the invasive procedure of right heart catheterization or use expensive imaging techniques (i.e., MRI). Hence, experience with these techniques for diagnosis and monitoring has been limited to hospitalized patients. In the present study, pEIT scheme was applied in a computerized 2D model of the human thorax with implanted cardiac device to determine the left ventricular (LV) volume at different cardiac cycle phases. The LV was simulated as a prolate ellipse with its axes' lengths as the reconstruction parameters while all other geometries and conductivity values remained constant. An optimization was carried out in order to ensure that the ellipse is the appropriate model for the LV at each cardiac cycle phase. LV volumes calculated by both the pEIT algorithm and the ellipsoid model are consistent. A high correlation (ρ = 0.99) between the true and reconstructed volumes was found. The SV calculation error was ∼1%. The results suggest that the LV volume can be estimated using the pEIT method in a 2D computerized model, and that the method has the potential to be used for monitoring patients with implanted cardiac pacemaker.

  4. 81. Upper body arterio-central venous PCO2 gap (UBCO2G in monitoring sick children with cardiac disease

    Directory of Open Access Journals (Sweden)

    Omar Mohammad Hijazi

    2015-10-01

    Conclusion: Upper is higher than lower body PCO2gap. UBPCO2G ⩾9.65 was associated with higher LA, BUN, creatinine, serum glucose and PRISM and lower urine output. Patients with UBPCO2G ⩾9.65 were sicker. UBPCO2G can be used as a biomarker in monitoring children with cardiac disease.

  5. Role of Troponins I and T and N-Terminal Prohormone of Brain Natriuretic Peptide in Monitoring Cardiac Safety of Patients With Early-Stage Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Receiving Trastuzumab: A Herceptin Adjuvant Study Cardiac Marker Substudy.

    Science.gov (United States)

    Zardavas, Dimitrios; Suter, Thomas M; Van Veldhuisen, Dirk J; Steinseifer, Jutta; Noe, Johannes; Lauer, Sabine; Al-Sakaff, Nedal; Piccart-Gebhart, Martine J; de Azambuja, Evandro

    2017-03-10

    Purpose Women receiving trastuzumab with chemotherapy are at risk for trastuzumab-related cardiac dysfunction (TRCD). We explored the prognostic value of cardiac markers (troponins I and T, N-terminal prohormone of brain natriuretic peptide [NT-proBNP]) to predict baseline susceptibility to develop TRCD. We examined whether development of cardiac end points or significant left ventricular ejection fraction (LVEF) drop was associated with markers' increases. Patients and Methods Cardiac marker assessments were coupled with LVEF measurements at different time points for 533 patients from the Herceptin Adjuvant (HERA) study who agreed to participate in this study. Patients with missing marker assessments were excluded, resulting in 452 evaluable patients. A primary cardiac end point was defined as symptomatic congestive heart failure of New York Heart Association class III or IV, confirmed by a cardiologist, and a significant LVEF drop, or death of definite or probable cardiac causes. A secondary cardiac end point was defined as a confirmed significant asymptomatic or mildly symptomatic LVEF drop. Results Elevated baseline troponin I (> 40 ng/L) and T (> 14 ng/L), occurring in 56 of 412 (13.6%) and 101 of 407 (24.8%) patients, respectively, were associated with an increased significant LVEF drop risk (univariate analysis: hazard ratio, 4.52; P < .001 and hazard ratio, 3.57; P < .001, respectively). Few patients had their first elevated troponin value recorded during the study (six patients for troponin I and 25 patients for troponin T). Two patients developed a primary and 31 patients a secondary cardiac end point (recovery rate of 74%, 23 of 31). For NT-proBNP, higher increases from baseline were seen in patients with significant LVEF drop. Conclusion Elevated troponin I or T before trastuzumab is associated with increased risk for TRCD. A similar conclusion for NT-proBNP could not be drawn because of the lack of a well-established elevation threshold; however

  6. [Design and application of user managing system of cardiac remote monitoring network].

    Science.gov (United States)

    Chen, Shouqiang; Zhang, Jianmin; Yuan, Feng; Gao, Haiqing

    2007-12-01

    According to inpatient records, data managing demand of cardiac remote monitoring network and computer, this software was designed with relative database ACCESS. Its interface, operational button and menu were designed in VBA language assistantly. Its design included collective design, amity, practicability and compatibility. Its function consisted of registering, inquiring, statisticing and printing, et al. It could be used to manage users effectively and could be helpful to exerting important action of cardiac remote monitoring network in preventing cardiac-vascular emergency ulteriorly.

  7. 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.

  8. Perioperative management of patients with cardiac implantable electronic devices.

    Science.gov (United States)

    Poveda-Jaramillo, R; Castro-Arias, H D; Vallejo-Zarate, C; Ramos-Hurtado, L F

    2017-05-01

    The use of implantable cardiac devices in people of all ages is increasing, especially in the elderly population: patients with pacemakers, cardioverter-defibrillators or cardiac resynchronization therapy devices regularly present for surgery for non-cardiac causes. This review was made in order to collect and analyze the latest evidence for the proper management of implantable cardiac devices in the perioperative period. Through a detailed exploration of PubMed, Academic Search Complete (EBSCO), ClinicalKey, Cochrane (Ovid), the search software UpToDate, textbooks and patents freely available to the public on Google, we selected 33 monographs, which matched the objectives of this publication.

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

    Science.gov (United States)

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

    2013-11-01

    Cardiac power (PWR) is the continuous product of flow and pressure in the proximal aorta. Our aim was to validate the PWR integral as a marker of left ventricular energy transfer to the aorta, by comparing it to stroke work (SW) under multiple different loading and contractility conditions in subjects without obstructions in the left ventricular outflow tract. Six pigs were under general anesthesia equipped with transit time flow probes on their proximal aortas and Millar micromanometer catheters in their descending aortas to measure PWR, and Leycom conductance catheters in their left ventricles to measure SW. The PWR integral was calculated as the time integral of PWR per cardiac cycle. SW was calculated as the area encompassed by the pressure-volume loop (PV loop). The relationship between the PWR integral and SW was tested during extensive mechanical and pharmacological interventions that affected the loading conditions and myocardial contractility. The PWR integral displayed a strong correlation with SW in all pigs (R (2) > 0.95, P integral relationship was similar among all six animals, whereas loading and contractility conditions tended to affect the slope. The PWR integral followed SW and appeared to be a promising parameter for monitoring the energy transferred from the left ventricle to the aorta. This conclusion motivates further studies to determine whether the PWR integral can be evaluated using less invasive methods, such as echocardiography combined with a radial artery catheter.

  10. 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 evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....

  11. 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.

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

    Science.gov (United States)

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

    2014-01-01

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

  13. 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

  14. [Management of aortic stenosis in patients undergoing non-cardiac surgery].

    Science.gov (United States)

    Labbé, Vincent; Ederhy, Stéphane; Szymkiewicz, Olga; Cohen, Ariel

    2015-01-01

    There is a significant risk of cardiovascular morbidity and mortality in patients with severe aortic stenosis (valve area angina, syncope, or heart failure). Before any surgery, clinical assessment should search for signs of aortic stenosis which justifies echocardiographic examination, particularly in the elderly. A systematic rest echocardiography with searching aortic stenosis should be considered in patients undergoing high risk surgery. The key points of pre-operative cardiac risk assessment are: assessment of the severity of aortic stenosis, measurement of the functional capacity, evaluation of the left ventricular systolic function, search of associated coronary artery disease, estimate of the surgical risk of cardiac events, and achievement of risk indices. In symptomatic patients with severe aortic stenosis, only urgent non-cardiac surgery should be performed under careful haemodynamic monitoring. Aortic valve replacement should be considered before elective non-cardiac surgery. In asymptomatic patients with severe aortic stenosis, aortic valve replacement should be considered before non-cardiac high risk surgery. Non-cardiac surgery at low/intermediate risk can be performed provided an adapted anaesthetic technique.

  15. 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.

  16. Milrinone for cardiac dysfunction in critically ill adult patients

    DEFF Research Database (Denmark)

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

    2016-01-01

    INTRODUCTION: Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. METHODS: This systematic...... 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...

  17. 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.

  18. Echocardiographic approach to cardiac tamponade in critically ill patients.

    Science.gov (United States)

    McCanny, Peter; Colreavy, Frances

    2016-12-24

    Cardiac tamponade should be considered in a critically ill patient in whom the cause of haemodynamic shock is unclear. When considering tamponade, transthoracic echocardiography plays an essential role and is the initial investigation of choice. Diagnostic sensitivity of transthoracic echocardiography is dependent on image quality, and in some cases a transoesophageal approach may be required to confirm the diagnosis. Knowledge of the pathophysiology and echocardiographic features of cardiac tamponade are essential for the practicing Intensivist. This review presents an approach to the recognition, diagnosis, and treatment of cardiac tamponade in critically ill patients.

  19. 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.

  20. 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.

  1. 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.

  2. 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 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; median (IQR) hydration at baseline was +2.7 (2.3 to 3

  3. 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.

  4. Cerebral oximetry and cerebral blood flow monitoring in 2 pediatric survivors with out-of-hospital cardiac arrest.

    Science.gov (United States)

    Abramo, Thomas; Aggarwal, Nitin; Kane, Ian; Crossman, Kristen; Meredith, Mark

    2014-04-01

    In pediatric out-of-hospital cardiac arrest (POHCA), cardiovascular monitoring tools have improved resuscitative endeavors and cardiovascular outcomes but with still poor neurologic outcomes. Regarding cardiac arrest in patients with congenital heart disease during surgery, the application of cerebral oximetry with blood volume index (BVI) during the resuscitation has shown significant results and prognostic significance. We present 2 POHCA patients who had cerebral oximetry with BVI monitoring during their arrest and postarrest phase in the emergency department and its potential prognostic aspect.Basic procedures include left and right cerebral oximetry with BVI monitoring at every 5-second interval during cardiac arrest, resuscitation, and postarrest in 2 POHCA patients in the pediatric emergency department.Regional cerebral tissue oxygen saturation (rSo2) with BVI readings in these 2 POHCA survivors demonstrated interesting cerebral physiology, blood flow, and potential prognostic outcome. In 1 patient, the reference range of cerebral rSo2 with positive blood flow during arrest and postarrest phases consistently occurred. This neurologic monitoring had its significance when the resuscitation effectiveness was used and end-tidal CO2 changes were lost. The other patient's cerebral rSo2 with simultaneous BVI readings and trending showed the effectiveness of the emergency medical services (EMS) resuscitation.Cerebral oximetry with cerebral blood flow index monitoring in these POHCA survivors demonstrates compelling periarrest and postarrest cerebral physiology information and prognostication. Cerebral oximetry with cerebral BVI monitoring during these arrest phases has potential as a neurologic monitor for the resuscitative intervention's effectiveness and its possible neurologic prognostic application in the pediatric OCHA patients.

  5. 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

  6. 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 Child...

  7. Airway Management of the Cardiac Surgical Patients: Current Perspective

    Science.gov (United States)

    Choudhury, Arindam; Gupta, Nishkarsh; Magoon, Rohan; Kapoor, Poonam Malhotra

    2017-01-01

    The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts. PMID:28074820

  8. Aprotinin and hemostasis monitoring concerns during cardiac surgery.

    Science.gov (United States)

    Swartz, Michael F; Fink, Gregory W; Searles, Bruce

    2004-12-01

    Aprotinin (Trasylol) is a serine protease inhibitor, isolated from bovine lung that initially was marketed for the treatment of pancreatitis. In the mid 1980s, reports of its ability to decrease hemorrhaging after cardiopulmonary bypass surgery introduced the drug to the realm of cardiac surgery. Unfortunately, its introduction into this arena was followed by the publication of multiple studies and case reports that blamed aprotinin for poor outcomes in the form of early graft closure. More than 17 years have passed since the initial article describing the use of aprotinin during cardiopulmonary bypass, and with time there has been a significant increase in scientific knowledge and clinical experience. Interestingly, modern literature does not support the dogma that aprotinin is a procoagulant. Aprotinin increases the activated partial thromboplastin time (aPTT), as well as the kaolin- and celite-activated clotting time (ACT), regardless of heparin. Aprotinin, because of its ability to inhibit kallikrein, has been found to decrease thrombin antithrombin III complexes, fibrin-split products, fibrinopeptide 1+2, prothrombin fragments, and all markers of thrombin formation. Some authors have suggested that it may have a synergistic effect with heparin to ensure graft patency. Anticoagulation monitoring during the use of aprotinin also has been developed based on early studies. Aprotinin administration does influence the results of various ACT tests, and consequently different methods of testing anticoagulation have been developed. Researchers have demonstrated that the celite ACT is not "artificially" prolonged in the presence of heparin and aprotinin, rather the kaolin ACT is "artificially" shortened. This article will review the scientific literature with regard to aprotinin's anticoagulatory effects and review the current recommendations for hemostasis monitoring during the use of aprotinin.

  9. Monitoring of the cardiac and vascular response to LBNP during the 14 day spaceflight "Cassiopee".

    Science.gov (United States)

    Arbeille, P h; Fomina, G; Sigaudo, D; Alferova, I; Porcher, M; Boulay, J; Gharib, C

    1997-07-01

    The objective of the present experiment was to monitor in real time the cardiac and the peripheral response to inflight LBNP. The second objective was to detect and quantify hemodynamic signs of orthostatic tolerance inflight by measuring the heart rate, blood pressure, cardiac and regional hemodynamics during LBNP.

  10. 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.

  11. 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

  12. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    Reliable methods for cardiac output determination are essential for studying the pathophysiology of intradialytic hypotension. Use of the current gold standard, the Transonic monitor, requires an arteriovenous fistula. We wished to verify the accuracy of a method based on finger pulse contour...

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

    NARCIS (Netherlands)

    Roos, A; Zoet-Nugteren, SK; Berghout, A

    2005-01-01

    Background: 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 signs/symptoms of cardiac isc

  14. Anxiety in Patients with Cardiac Disease

    Science.gov (United States)

    2005-01-01

    1997;96:1835- 1842. 43. Tavazzi L, Zotti AM, Mazzuero G. Acute pulmonary edema provoked by psychologic stress: report of two cases. Cardiology. 1987;74...Circulation. 1997;96:1835- 1842. 43. Tavazzi L, Zotti AM, Mazzuero G. Acute pulmonary edema provoked by psychologic stress: report of two cases. Cardiology...De Jong MJ. Cardiogenic shock. Am JNurs. 1997;97(6):40-41. 1997 De Jong M.J, Morton PG. Control of vascular complications after cardiac catheterization

  15. Monitoring of stable glaucoma patients

    NARCIS (Netherlands)

    K.M. Holtzer-Goor (Kim); N.S. Klazinga (Niek); M.A. Koopmanschap (Marc); H.G. Lemij (Hans); T. Plochg; E. van Sprundel (Esther)

    2010-01-01

    textabstractA high workload for ophthalmologists and long waiting lists for patients challenge the organization of ophthalmic care. Tasks that require less specialized skills, like the monitoring of stable (well controlled) glaucoma patients could be substituted from ophthalmologists to other profes

  16. Cardiac transplantation for pediatric patients. With inoperable congenital heart disease.

    OpenAIRE

    Shaffer, K M; Denfield, S W; Schowengerdt, K O; Towbin, J A; Radovancević, B; Frazier, O. H.; Price, J K; Gajarski, R J

    1998-01-01

    Recent studies have reported the expanding use of transplantation as the definitive option for pediatric patients with inoperable congenital heart disease. This study compares perioperative risk factors and outcomes in pediatric patients who received heart transplants for congenital heart disease with those in pediatric patients who received heart transplants for cardiomyopathy. Retrospective data collected on 40 consecutive pediatric patients undergoing cardiac transplantation from 1 January...

  17. 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.

  18. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    Directory of Open Access Journals (Sweden)

    Liana Maria Torres de Araújo Azi

    2016-01-01

    Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

  19. A system for monitoring cardiac vibration, respiration, and body movement in bed.

    Science.gov (United States)

    Mukai, Kouji; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Ninomiya, Ishio; Sada, Kouji; Hamada, Shingo; Hahn, Allen W

    2008-01-01

    We have developed a non-invasive system for monitoring cardiac vibrations, respiration and body movement of in-bed hospitalized patients and elderly people who need constant care. These physiological parameters are recorded by 40 kHz ultrasonic transmitter and receiver, which are installed into the bed mattress. The ultrasonic transmitter diffuses an ultrasonic wave into the mattress. The diffusion of the ultrasonic energy is changed by mattress shape variations, which modulate the amplitude of the received ultrasonic signal. The amplitude is also modulated by physiological parameters such as heart pulse, respiration and body movement. The received ultrasonic signal is demodulated by an envelope detection circuit, and the physiological parameters are detected by low, high and band pass filters.

  20. A system for monitoring cardiac vibration, respiration, and body movement in bed using an infrared.

    Science.gov (United States)

    Maki, Hiromichi; Ogawa, Hidekuni; Tsukamoto, Sosuke; Yonezawa, Yoshiharu; Caldwell, W Morton

    2010-01-01

    We have developed a non-invasive system for monitoring cardiac vibrations, respiration and body movement of in-bed hospitalized patients and elderly people who need constant care. These physiological parameters are recorded by an infrared emitting diode and a photo transistor, which are attached between spring coils in bed mattress. The infrared emitting diode diffuses infrared light into the mattress. The diffusion of this energy is changed by mattress shape variations and spring coil vibrations, which modulate the intensity of the received infrared signal. The intensity is also modulated by physiological parameters such as heart pulse, respiration and body movement. The physiological parameters are detected from the received infrared intensity signal by low, high and band pass filters.

  1. Development and feasibility of a smartphone, ECG and GPS based system for remotely monitoring exercise in cardiac rehabilitation.

    Directory of Open Access Journals (Sweden)

    Charles Worringham

    Full Text Available BACKGROUND: Despite its efficacy and cost-effectiveness, exercise-based cardiac rehabilitation is undertaken by less than one-third of clinically eligible cardiac patients in every country for which data is available. Reasons for non-participation include the unavailability of hospital-based rehabilitation programs, or excessive travel time and distance. For this reason, there have been calls for the development of more flexible alternatives. METHODOLOGY AND PRINCIPAL FINDINGS: We developed a system to enable walking-based cardiac rehabilitation in which the patient's single-lead ECG, heart rate, GPS-based speed and location are transmitted by a programmed smartphone to a secure server for real-time monitoring by a qualified exercise scientist. The feasibility of this approach was evaluated in 134 remotely-monitored exercise assessment and exercise sessions in cardiac patients unable to undertake hospital-based rehabilitation. Completion rates, rates of technical problems, detection of ECG changes, pre- and post-intervention six minute walk test (6 MWT, cardiac depression and Quality of Life (QOL were key measures. The system was rated as easy and quick to use. It allowed participants to complete six weeks of exercise-based rehabilitation near their homes, worksites, or when travelling. The majority of sessions were completed without any technical problems, although periodic signal loss in areas of poor coverage was an occasional limitation. Several exercise and post-exercise ECG changes were detected. Participants showed improvements comparable to those reported for hospital-based programs, walking significantly further on the post-intervention 6 MWT, 637 m (95% CI: 565-726, than on the pre-test, 524 m (95% CI: 420-655, and reporting significantly reduced levels of cardiac depression and significantly improved physical health-related QOL. CONCLUSIONS AND SIGNIFICANCE: The system provided a feasible and very flexible alternative form of

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

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    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.

  3. Prevalence of renal artery stenosis in patients undergoing cardiac catheterization.

    Science.gov (United States)

    Marcantoni, Carmelita; Carmelita, Marcantoni; Rastelli, Stefania; Stefania, Rastelli; Zanoli, Luca; Luca, Zanoli; Tripepi, Giovanni; Giovanni, Tripepi; Di Salvo, Marilena; Marilena, Di Salvo; Monaco, Sergio; Sergio, Monaco; Sgroi, Carmelo; Carmelo, Sgroi; Capodanno, Davide; Davide, Capodanno; Tamburino, Corrado; Corrado, Tamburino; Castellino, Pietro; Pietro, Castellino

    2013-08-01

    To investigate the prevalence of significant renal artery stenosis (RAS ≥50%), and to identify clinical predictors for significant RAS in patients with an elevated cardiovascular risk, such as those affected by ischemic heart disease. In patients with an elevated cardio-vascular risk, both atherosclerotic renovascular disease and coronary artery disease (CAD) are likely to occur. Prospectively from April 2007 to March 2008, all consecutive patients with ischemic heart disease undergoing non-emergent cardiac catheterization were also evaluated for atherosclerotic RAS by renal arteriography. A RAS ≥50% was considered as significant. A total of 1,298 patients underwent cardiac and renal angiography. Significant RAS was found in 70 out of 1,298 patients (5.4%). The presence of peripheral vascular disease, eGFR 66 years, dyslipidemia, CAD severity and pulse pressure >52 mmHg were independent clinical predictors of significant RAS, and jointly produced a ROC AUC of 0.79 (95% CI 0.73-0.85, P < 0.001). Based on these data, a prediction rule for significant RAS was developed, and it showed an adequate predictive performance with 64% sensitivity and 82% specificity. In a large cohort of patients undergoing coronary angiography, significant RAS is a relatively rare comorbidity (5.4%). A model based on simple clinical variables may be useful for the clinical identification of high CV risk patients who may be suitable for renal arteriography at the time of cardiac catheterization.

  4. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

    Science.gov (United States)

    Armenian, Saro H; Lacchetti, Christina; Barac, Ana; Carver, Joseph; Constine, Louis S; Denduluri, Neelima; Dent, Susan; Douglas, Pamela S; Durand, Jean-Bernard; Ewer, Michael; Fabian, Carol; Hudson, Melissa; Jessup, Mariell; Jones, Lee W; Ky, Bonnie; Mayer, Erica L; Moslehi, Javid; Oeffinger, Kevin; Ray, Katharine; Ruddy, Kathryn; Lenihan, Daniel

    2016-12-05

    Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

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

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    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.

  6. Clinical characteristics of 42 patients with cardiac amyloidosis

    Institute of Scientific and Technical Information of China (English)

    黄雨晴

    2014-01-01

    Objective To characterize the clinical features of patients with cardiac amyloidosis(CA).Methods Totally42 patients with CA admitted to Guangdong General Hospital since 2008 were included and retrospectively analyzed in the present study.CA was confirmed by abdomen and endocardium biopsy examination.Clinical manifestations,electrocardiogram and echocardiography were collected for the evaluation.Results Several clinic features are common in CA.In the present study,37 cases

  7. 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.

  8. Outcomes following cardiac surgery in patients with preoperative renal dialysis.

    Science.gov (United States)

    Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W

    2014-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.

  9. 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.

  10. Concordance of Brain and Core Temperature in Comatose Patients After Cardiac Arrest.

    Science.gov (United States)

    Coppler, Patrick J; Marill, Keith A; Okonkwo, David O; Shutter, Lori A; Dezfulian, Cameron; Rittenberger, Jon C; Callaway, Clifton W; Elmer, Jonathan

    2016-12-01

    Comatose patients after cardiac arrest should receive active targeted temperature management (TTM), with a goal core temperature of 32-36°C for at least 24 hours. Small variations in brain temperature may confer or mitigate a substantial degree of neuroprotection, which may be lost at temperatures near 37°C. The purpose of this study was to define the relationship between brain and core temperature after cardiac arrest through direct, simultaneous measurement of both. We placed intracranial monitors in a series of consecutive patients hospitalized for cardiac arrest at a single tertiary care facility within 12 hours of return of spontaneous circulation to guide postcardiac arrest care. We compared the absolute difference between brain and core (esophageal or rectal) temperature measurements every hour for the duration of intracranial monitoring and tested for a lag between brain and core temperature using the average square difference method. Overall, 11 patients underwent simultaneous brain and core temperature monitoring for a total of 906 hours of data (Median 95; IQR: 15-118 hours per subject). On average, brain temperature was 0.34C° (95% confidence interval [CI] 0.31-0.37) higher than core temperature. In 7% of observations, brain temperature exceeded the measured core temperature ≥1°C. Brain temperature lagged behind core temperature by 0.45 hours (95% CI = -0.27-1.27 hours). Brain temperature averages 0.34°C higher than core temperature after cardiac arrest, and is more than 1°C higher than core temperature 7% of the time. This phenomenon must be considered when carrying out TTM to a goal core temperature of <36°C.

  11. [Heart to heart: rehabilitation of sexuality in cardiac patients].

    Science.gov (United States)

    Ben-Zion, Itzhak; Shiber, Asher

    2006-05-01

    Heart disease in general and acute myocardial infarction involve sexual dysfunction caused by anxiety and by the same physiological problems that caused the heart problem, namely endothelial dysfunction. Unfortunately, many patients and their spouses hesitate to approach their doctor on issues related to their sexual concerns. Furthermore, the medical team in general and doctors in particular are irresolute in bringing up sexual issues when dealing with overall cardiac rehabilitation. Although patients can safely resume sexual activity at some point, only one in four actually return to their previous level of sexual activity. If we really want to assist in the rehabilitation of patients we have to advise them about resuming their sex life. Solving sexual problems can serve as a tool in primary, secondary and tertiary prevention of cardiac problems, as it can be used as an "arm swinger" for changing one's life habits. We urge increased research and treatment of sexual problems, in cardiac patients in general and in female patients in particular.

  12. 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.

  13. 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

  14. Usefulness of Hemodynamic Sensors for Physiologic Cardiac Pacing in Heart Failure Patients

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    Eraldo Occhetta

    2011-01-01

    Full Text Available The rate adaptive sensors applied to cardiac pacing should respond as promptly as the normal sinus node with an highly specific and sensitive detection of the need of increasing heart rate. Sensors operating alone may not provide optimal heart responsiveness: central venous pH sensing, variations in the oxygen content of mixed venous blood, QT interval, breathing rate and pulmonary minute ventilation monitored by thoracic impedance variations, activity sensors. Using sensors that have different attributes but that work in a complementary manners offers distinct advantages. However, complicated sensors interactions may occur. Hemodynamic sensors detect changes in the hemodynamic performances of the heart, which partially depends on the autonomic nervous system-induced inotropic regulation of myocardial fibers. Specific hemodynamic sensors have been designed to measure different expression of the cardiac contraction strength: Peak Endocardial Acceleration (PEA, Closed Loop Stimulation (CLS and TransValvular Impedance (TVI, guided by intraventricular impedance variations. Rate-responsive pacing is just one of the potential applications of hemodynamic sensors in implantable pacemakers. Other issues discussed in the paper include: hemodynamic monitoring for the optimal programmation and follow up of patients with cardiac resynchronization therapy; hemodynamic deterioration impact of tachyarrhythmias; hemodynamic upper rate limit control; monitoring and prevention of vasovagal malignant syncopes.

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

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    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.

  16. 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.

  17. 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.

  18. 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.

  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. Cardiac sarcoid: a chameleon masquerading as hypertrophic cardiomyopathy and dilated cardiomyopathy in the same patient.

    Science.gov (United States)

    Agarwal, Anushree; Sulemanjee, Nasir Z; Cheema, Omar; Downey, Francis X; Tajik, A Jamil

    2014-05-01

    Sarcoidosis is a multisystem, granulomatous disease of unknown etiology often seen in young adults, with cardiac involvement in more than one-quarter of sarcoid patients. The clinical presentation of cardiac sarcoid depends upon the location and extent of myocardium involved. Although cardiac sarcoid may produce asymmetrical septal hypertrophy, it is most commonly considered in the differential diagnosis of dilated cardiomyopathy. The hypertrophic stage of cardiac sarcoid is rarely seen. We describe a case of cardiac sarcoid in a young patient wherein a distinctive appearance of the cardiac sarcoid spectrum from "hypertrophic" stage to thinned/scarred stage, masquerading as hypertrophic cardiomyopathy followed by dilated cardiomyopathy, is demonstrated.

  1. Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk.

    Science.gov (United States)

    Chow, Elaine; Bernjak, Alan; Williams, Scott; Fawdry, Robert A; Hibbert, Steve; Freeman, Jenny; Sheridan, Paul J; Heller, Simon R

    2014-05-01

    Recent trials of intensive glycemic control suggest a possible link between hypoglycemia and excess cardiovascular mortality in patients with type 2 diabetes. Hypoglycemia might cause arrhythmias through effects on cardiac repolarization and changes in cardiac autonomic activity. Our aim was to study the risk of arrhythmias during spontaneous hypoglycemia in type 2 diabetic patients with cardiovascular risk. Twenty-five insulin-treated patients with type 2 diabetes and a history of cardiovascular disease or two or more risk factors underwent simultaneous continuous interstitial glucose and ambulatory electrocardiogram monitoring. Frequency of arrhythmias, heart rate variability, and markers of cardiac repolarization were compared between hypoglycemia and euglycemia and between hyperglycemia and euglycemia matched for time of day. There were 134 h of recording at hypoglycemia, 65 h at hyperglycemia, and 1,258 h at euglycemia. Bradycardia and atrial and ventricular ectopic counts were significantly higher during nocturnal hypoglycemia compared with euglycemia. Arrhythmias were more frequent during nocturnal versus daytime hypoglycemia. Excessive compensatory vagal activation after the counterregulatory phase may account for bradycardia and associated arrhythmias. QT intervals, corrected for heart rate, >500 ms and abnormal T-wave morphology were observed during hypoglycemia in some participants. Hypoglycemia, frequently asymptomatic and prolonged, may increase the risk of arrhythmias in patients with type 2 diabetes and high cardiovascular risk. This is a plausible mechanism that could contribute to increased cardiovascular mortality during intensive glycemic therapy.

  2. Wireless miniature implantable devices and ASICs for monitoring, treatment, and study of glaucoma and cardiac disease

    Science.gov (United States)

    Chow, Eric Y.

    Glaucoma affects about 65 million people and is the second leading cause of blindness in the world. Although the condition is irreversible and incurable, early detection is vital to slowing and even stopping the progression of the disease. Our work focuses on the design, fabrication, and assembly of a continuous active glaucoma intraocular pressure (IOP) monitor that provides clinicians with the necessary data to more accurately diagnose and treat patients. Major benefits of an active monitoring device include the potential to develop a closed-loop treatment system and to operate independently for extended periods of time. The fully wireless operation uses gigahertzfrequency electromagnetic wave propagation, which allows for an orientation independent transfer of power and data over reasonable distances. Our system is comprised of a MEMS capacitive sensor, capacitive power storage array, ASIC, and monopole antenna assembled into a biocompatible liquid crystal polymer (LCP) package. We have performed in vivo trials on rabbits, both chronic and acute, to validate system functionality, fully wireless feasibility, and biocompatibility. Heart failure (HF) affects approximately 2% of the adult population in developed countries and 6-10% of people over the age of 65. Continuous monitoring of blood pressure, flow, and chemistry from a minimally invasive device can serve as a diagnostic and early-warning system for cardiac health. We developed a miniaturized system attached to the outer surface of an FDA approved stent, used as both the antenna for wireless telemetry/powering and structural support. The system comprises of a MEMS pressure sensor, ASIC for the sensor interface and wireless capabilities, LCP substrate, and FDA approved stent. In vivo studies on pigs validated functionality and fully wireless operation and demonstrate the feasibility of a stent-based wireless implant for continuous monitoring of blood pressure as well as other parameters including oxygen, flow

  3. NASA's contributions to patient monitoring, appendix

    Science.gov (United States)

    Murray, D. M.; Siemens, W. D.

    1971-01-01

    Health care problems, and markets for patient monitoring equipment are discussed along with contributions to all phases of patient monitoring, and technology transfer to nonaerospace problems. Health care medical requirements, and NASA achievements in patient monitoring are described, and a summary of the technology transfer is included.

  4. Individualized real-time clinical decision support to monitor cardiac loading during venoarterial ECMO

    NARCIS (Netherlands)

    Broomé, Michael; Donker, DW

    2016-01-01

    Veno-arterial extracoporeal membrane oxygenation (VA ECMO) is increasingly used for acute and refractory cardiogenic shock. Yet, in clinical practice, monitoring of cardiac loading conditions during VA ECMO can be cumbersome. To this end, we illustrate the validity and clinical applicability of a re

  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. [Guidelines for intensive care in cardiac surgery patients: haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine].

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Göpfert, M; Gogarten, W; Grosse, J; Heller, A; Heringlake, M; Kastrup, M; Kröner, A; Loer, S; Marggraf, G; Markewitz, A; Reuter, M; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2007-03-01

    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 and the German Society for Anaesthesiology and Intensive Care Medicine 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 available monitoring methods and their risks as well as the differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium-sensitizers and the use of intra-aortic balloon pumps. The guideline has been developed according to 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 Scientific Medical Societies in Germany (AWMF).

  7. 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 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...

  8. Prevalence of cardiac dysfunction and abnormalities in patients with adolescent idiopathic scoliosis requiring surgery.

    Science.gov (United States)

    Liu, Limin; Xiu, Peng; Li, Qian; Song, Yueming; Chen, Rigao; Zhou, Chunguang

    2010-12-01

    The prevalence of cardiac abnormalities in patients with adolescent idiopathic scoliosis in an Asian population has not been reported. A retrospective study was conducted to evaluate the incidence of cardiac abnormalities in these patients. From January 2007 to April 2009, echocardiography and pulmonary function tests were performed in 80 adolescent idiopathic scoliosis patients who required surgical intervention. A thorough analysis of cardiopulmonary functions and cardiac structures was performed. The risk factors, types of cardiac abnormalities, and associations between severity of scoliosis or pulmonary function and cardiac abnormalities were assessed. Cardiac abnormalities were detected by echocardiogram in 25 patients, including 14 with structural abnormalities and 11 with functional abnormalities. The most common functional abnormality was tricuspid regurgitation (9 of 80; 11.3%), whereas atrial septal defect was the most common structural abnormality (7 of 80). Altered hemodynamics occurred in 5 patients, including 3 with ventricular septal defect and 2 with mitral valve dysplasia. Abnormal electrocardiographic findings presented in only 9 of the 25 patients with cardiac abnormalities. No significant associations were found between severity of scoliosis or pulmonary function and cardiac abnormalities. A high incidence of cardiac abnormality exists in patients with adolescent idiopathic scoliosis in this region. Although most patients tolerated surgery, some patients were at risk of decompensation postoperatively. Electrocardiography is of limited value for detecting cardiac problems in patients with adolescent idiopathic scoliosis, we recommend echocardiography as a routine modality in the preoperative evaluation of patients with adolescent idiopathic scoliosis.

  9. 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

  10. Sudden cardiac death in hemodialysis patients: a comprehensive care approach to reduce risk.

    Science.gov (United States)

    Pun, Patrick H; Middleton, John P

    2012-01-01

    Sudden cardiac death is a major problem in hemodialysis patients, and our understanding of this disease is underdeveloped. The lack of a precise definition tailored for use in the hemodialysis population limits the reliability of epidemiologic reports. Efforts should be directed toward an accurate classification of all deaths that occur in this vulnerable population. The traditional paradigm of disease pathophysiology based on known cardiac risk factors appears to be inadequate to explain the magnitude of sudden cardiac death risk in chronic kidney disease, and numerous unique cofactors and exposures appear to determine risk in this population. Well-designed cohort studies will be needed for a basic understanding of disease pathophysiology and risk factors, and randomized intervention trials will be needed before best management practices can be implemented. This review examines available data to describe the characteristics of the high-risk patient and suggests a comprehensive common sense approach to prevention using existing cardiovascular medications and reducing and monitoring potential dialysis-related arrhythmic triggers. Other unproven cardiovascular therapies such as implantable cardioverter defibrillators should be used on a case-by-case basis, with recognition of the associated hazards that these devices carry among hemodialysis patients.

  11. [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.

  12. Serum cardiac troponin T in unstable angina pectoris patients.

    Science.gov (United States)

    Leowattana, W; Mahanonda, N; Bhuripanyo, K; Pokum, S; Kiartivich, S

    2000-11-01

    Cardiac troponin T (cTnT) is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. In this study, we used a second-generation enzyme immunoassay for cTnT to determine whether its presence in the serum of patients with unstable angina was a prognostic indicator. Thirty patients with unstable angina pectoris (UAP) and 30 patients with Q-wave acute myocardial infarction (AMI) were screened for serum CK-MB activity and cTnT at 6, 12, 24 and 48 hours after the onset of chest pain, All of the mean concentrations of CK-MB activity determined in UAP patients were less than the upper limit of normal (25 U/L). Meanwhile, the mean concentration of cTnT at 6, 12, 24 and 48 hours after onset of chest pain were higher than the cutoff values (0.1 microg/L), We found that one third of UAP patients had serum cTnT at the time of admission more than 0.1 microg/L and that these groups of patients were associated with a high risk for cardiac events. Our results suggested that patients with elevated serum cTnT could be considered as high-risk patients for developing myocardial infarction, Patients with normal cTnT levels and a low or intermediate clinical risk could be stabilized and further stratified noninvasively.

  13. The experiences of patients undertaking a 'virtual' cardiac rehabilitation program.

    Science.gov (United States)

    Banner, Davina; Lear, Scott; Kandola, Daman; Singer, Joel; Horvat, Dan; Bates, Joanna; Ignaszewski, Andrew

    2015-01-01

    Cardiac rehabilitation programs (CRP) are medically supervised, multidisciplinary programs that provide secondary prevention aimed at addressing risk factors and improving lifestyle behaviours for patients following an acute cardiac event. CRPs have been demonstrated to be a cost-effective and evidence-based mechanism to improve patient outcomes, but despite the known benefits of these programs, uptake remains poor. Poor attendance has been linked to many factors, but geographical accessibility is a key concern, since many CRPs are limited to hospitals in urban areas. The widespread availability of the Internet has made it possible to provide virtual health services to populations that may have previously been hard to access. This paper examines the qualitative findings from a 16-month mixed methods randomized controlled trial examining the impact of a virtual CRP (vCRP). The vCRP was revealed to be an accessible, appropriate, convenient and effective way to deliver cardiac rehabilitation services, with patients experiencing both clinical improvements and a high level of satisfaction. To understand the experience of patients undertaking the vCRP, semi-structured interviews were undertaken with a purposive sample of 22 participants. An analysis of the qualitative interviews revealed that the vCRP improved participants' access to healthcare professionals, supported them to make healthy choices, and enhanced feelings of accountability due to greater surveillance. Barriers to participation, such as computer literacy, and general perceptions of a vCRP were also examined. Further investigation into the use and long-term effectiveness of virtual programs across a broader range of healthcare settings is warranted, particularly in those with multiple chronic diseases and those located in rural and remote communities.

  14. [Glucose-lowering therapy in patients with cardiac comorbidities].

    Science.gov (United States)

    Meier, Juris J

    2015-04-01

    The risk for cardiovascular events, congestive heart failure and cardiac arrhythmia is significantly increased in patients with diabetes. Although poor glycaemic control has been associated with an increased cardiovascular event rate, aggressive glucose-lowering strategies have failed to improve cardiovascular endpoints or mortality. Therefore, treatment-associated adverse effects, especially hypoglycaemia and weight gain, must be carefully outbalanced against the potential benefits of better glycaemic control. Furthermore, certain drug-specific aspects must be considered: Pioglitazone is contraindicated in patients with heart failure, and DPP-4 inhibitors have recently been associated with an increased heart failure rate. Heart rate may increase during treatment with GLP-1 analogues. Only with metformin a reduction in cardiovascular endpoint has been demonstrated in patients with diabetes. Insulin and sulphonylureas have yielded neutral results in the available endpoint trials. Endpoint studies with GLP-1 analogues or SGLT-2 inhibitors have not yet been completed. These various drug-specific actions in the cardiovascular system need to be born in mind for the choice of the optimal glucose-lowering strategy in patients with cardiac comorbidities.

  15. Heart-Kidney Biomarkers in Patients Undergoing Cardiac Stress Testing

    Directory of Open Access Journals (Sweden)

    Mikko Haapio

    2011-01-01

    Full Text Available We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL. Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n=16, the patients in the high ischemia group (n=18 demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P=.06 in the detectable NGAL group, and 0.9 vs. 3.8 (P=.03 at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL, P=.03. LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P=.03 and 55.1 vs. 63.8 (P=.04, respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.

  16. 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.

  17. 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...

  18. Clinical evaluation of the accuracy of the USCOM ultrasonic cardiac output monitor in the septic shock patients%无创超声心输出量测定对急诊感染性休克患者血流动力学状态评价的临床研究

    Institute of Scientific and Technical Information of China (English)

    刘继海; 于学忠; 王仲; 朱华栋; 徐胜勇

    2011-01-01

    目的 对急诊感染性休克患者同时进行脉搏波形指示的连续心输出量(pulse indicated continuous cardiac output, PiCCO)监测技术和无创超声心输出量测定,以有创血流动力学监测的数值作为标准,对无创超声心输出量测定方法的可靠性进行评价.方法 本试验为前瞻性研究,2008-06~2009-06北京协和医院急诊科抢救室和EICU收治32例明确诊断为感染性休克的患者,对这些患者同时进行无创超声心输出量测定和PiCCO监测,对比两者在心脏指数(cardiac index, CI)这一血流动力学核心指标上的差异,以评价无创超声心输出量测定在急诊应用中的可靠性.结果 共有30例患者同时获得了满意的血流超声多普勒影像,其中男性20例,女性10例,最小年龄26岁,最大年龄89岁,另2例患者因无法获得满意的超声结果而放弃.对比结果显示,在获得满意超声多普勒影像的前提下,无创超声心输出量和PiCCO测定的CI分别为(3.89±1.61)L/(min·m2)和(4.35±1.72)L/(min·m2)(Pearson相关系数=0.97165,P<0.0001).结论 无创超声心输出量测定是一项准确、快速、安全、无创的血流动力学监测技术,比较适合急诊患者的应用.%Objective The USCOM ultrasonic cardiac output monitor ( USCOM Pty Ltd, Coffs Harbour, NSW, Australia) is a non - invasive device that determines cardiac output by continuouswave Doppler ultrasound. The aim of this study was to evaluate the accuracy of the USCOM device compared with the PiCCO ( pulse indicated continuous cardiac output) technique on the septic shock patients in Emergency Room and Emergency Intensive Care Unit in Peking Union Medical College Hospital. Methods We conducted a prospective study in Emergency Room and Emergency Intensive Care Unit in Peking Union Medical College Hospital from June lst, 2008 to May 3lst, 2009. Thirty -two patients who were diagnosed as septic shock were recruited in this study. We evaluated the USCOM monitor by

  19. Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots

    Science.gov (United States)

    Al-Nimer, Marwan S.; Al-Mahdawi, Sura A.; Abdullah, Namir M.; Al-Mahdawi, Akram

    2017-01-01

    Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias. PMID:28149075

  20. Epileptic patients are at risk of cardiac arrhythmias: A novel approach using QT-nomogram, tachogram, and cardiac restitution plots

    Directory of Open Access Journals (Sweden)

    Marwan S Al-Nimer

    2017-01-01

    Full Text Available Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz, and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I and 64 newly diagnosed epileptic patients (Group II were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

  1. 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

  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. Patient Outcomes of an International Telepediatric Cardiac Critical Care Program

    Science.gov (United States)

    Otero, Andrea Victoria; Welchering, Nils; Bermon, Anderson; Castillo, Victor; Duran, Álvaro; Castro, Javier; Muñoz, Ricardo

    2015-01-01

    Abstract Background: An optimal model for telemedicine use in the international care setting has not been established. Our objective was to describe variables associated with patient outcome during the implementation of an international pediatric cardiac critical care (PCCC) telemedicine program. Materials and Methods: A retrospective review was performed of clinical records and a telemedicine database of patients admitted to the cardiac intensive care unit (CICU) at the Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia, during the initial 10 months of our program, compared with patients admitted during a previous period. Information collected included demographic data, cardiac diagnosis and associated factors, Risk Adjustment for Congenital Heart Surgery (RACHS)-1 classification, and perioperative events. Primary outcome was composed of CICU and hospital mortality. Secondary outcomes were CICU and hospital length of stay (LOS). Results: Of the 553 patients who were included, teleconsultation was done for 71 (12.4%), with a total of 156 encounters, including 19 for patients on extracorporeal membrane oxygenation. Three hundred twenty-one recommendations were given, and 42 real-time interventions were documented. RACHS-1 distribution was similar between study periods (p=0.427). Teleconsulted patients were significantly younger (44 versus 24 months; p=0.03) and had higher surgical complexity than nonteleconsulted patients (p=0.01). RACHS-1 adjusted hospital survival was similar between study periods. CICU and hospital LOS intervals were significantly shorter in the telemedicine period (10 versus 17 days [p=0.02] and 22 versus 28 days [p<0.001]). In surgical cases, preoperative CICU LOS was significantly shorter (3 versus 6 days; p<0.001). Variables associated with hospital mortality were higher RACHS-1 categories, lower weight, bypass time longer than 150 min, and use of circulatory arrest, as well as the presence of sepsis or necrotizing enterocolitis

  4. Percutaneous treatment in patients presenting with malignant cardiac tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Marcy, P.Y. [Antoine Lacassagne Center, Interventional Radiology Department, Nice (France); Bondiau, P.Y. [Antoine Lacassagne Center, Radiation Therapy Department, Nice (France); Brunner, P. [Centre Hospitalier Princesse, Grace (Monaco). Interventional Radiology Department

    2005-09-01

    The percutaneous treatment of pericardial effusion resulting in cardiac tamponade has undergone an evolution in recent years with the use of less invasive drainage techniques in selected cases. To determine optimal therapy modalities for oncology patients with malignant pericardial tamponade (MPT), the authors review their institutional experience with percutaneous needle puncture routes, means of imaging-guided drainage and percutaneous management of the pericardial fluid effusion (pericardial sclerosis and balloon pericardiotomy). Advantages and limits of the percutaneous techniques will be compared to the surgical treatment. (orig.)

  5. Cardiac arrests in patients undergoing gastrointestinal endoscopy: A retrospective analysis of 73,029 procedures

    Directory of Open Access Journals (Sweden)

    Basavana Goudra

    2015-01-01

    Full Text Available Background/Aims: Airway difficulties leading to cardiac arrest are frequently encountered during propofol sedation in patients undergoing gastrointestinal (GI endoscopy. With a noticeable increase in the use of propofol for endoscopic sedation, we decided to examine the incidence and outcome of cardiac arrests in patients undergoing gastrointestinal (GI endoscopy with sedation. Patients and Methods: In this retrospective study, cardiac arrest data obtained from the clinical quality improvement and local registry over 5 years was analyzed. The information of patients who sustained cardiac arrest attributable to sedation was studied in detail. Analysis included comparison of cardiac arrests due to all causes until discharge (or death versus the cardiac arrests and death occurring during the procedure and in the recovery area. Results: The incidence of cardiac arrest and death (all causes, until discharge was 6.07 and 4.28 per 10,000 in patients sedated with propofol, compared with non–propofol-based sedation (0.67 and 0.44. The incidence of cardiac arrest during and immediately after the procedure (recovery area for all endoscopies was 3.92 per 10,000; of which, 72% were airway management related. About 90.0% of all peri-procedural cardiac arrests occurred in patients who received propofol. Conclusions: The incidence of cardiac arrest and death is about 10 times higher in patients receiving propofol-based sedation compared with those receiving midazolam–fentanyl sedation. More than two thirds of these events occur during EGD and ERCP.

  6. 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.

  7. 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。

  8. Depressed cardiac autonomic modulation in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Oliveira

    2014-04-01

    Full Text Available Introduction: A dysfunctional autonomic nervous system (ANS has also been recognized as an important mechanism contributing to the poor outcome in CKD patients, with several studies reporting a reduction in heart rate variability (HRV. Objective: Evaluate the sympathovagal balance in patients with chronic kidney disease on conservative treatment. Methods: In a cross-sectional study, patients with CKD stages 3, 4 and 5 not yet on dialysis (CKD group and age-matched healthy subjects (CON group underwent continuous heart rate recording during two twenty-minute periods in the supine position (pre-inclined, followed by passive postural inclination at 70° (inclined period. Power spectral analysis of the heart rate variability was used to assess the normalized low frequency (LFnu, indicative of sympathetic activity, and the normalized high frequency (HFnu, indicative of parasympathetic activity. The LFnu/HFnu ratio represented sympathovagal balance. Results: After tilting, CKD patients had lower sympathetic activity, higher parasympathetic activity, and lower sympathovagal balance than patients in the CON group. Compared to patients in stage 3, patients in stage 5 had a lower LFnu/HFnu ratio, suggesting a more pronounced impairment of sympathovagal balance as the disease progresses. Conclusion: CKD patients not yet on dialysis have reduced HRV, indicating cardiac autonomic dysfunction early in the course of CKD.

  9. Cardiac autonomic neuropathy in patients with diabetes mellitus.

    Science.gov (United States)

    Dimitropoulos, Gerasimos; Tahrani, Abd A; Stevens, Martin J

    2014-02-15

    Cardiac autonomic neuropathy (CAN) is an often overlooked and common complication of diabetes mellitus. CAN is associated with increased cardiovascular morbidity and mortality. The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death. In addition, autoimmune and genetic factors are involved in the development of CAN. CAN might be subclinical for several years until the patient develops resting tachycardia, exercise intolerance, postural hypotension, cardiac dysfunction and diabetic cardiomyopathy. During its sub-clinical phase, heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic. Newer imaging techniques (such as scintigraphy) have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system. One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN; however, the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN, and also proposed screening for CAN in patients with diabetes mellitus. A major challenge, however, is the lack of specific treatment to slow the progression or prevent the development of CAN. Lifestyle changes, improved metabolic control might prevent or slow the progression of CAN. Reversal will require combination of these treatments with new targeted therapeutic approaches. The aim of this article is to review the latest evidence regarding the epidemiology, pathogenesis, manifestations, diagnosis and treatment for CAN.

  10. Cardiac Arrest in a Pregnant Patient Diagnosed with Bochdalek Hernia

    Directory of Open Access Journals (Sweden)

    Pinar Karabacak

    2016-09-01

    Full Text Available Bochdalek hernia is thought to be the result of a defect of the pleuroperitoneal fold and the septum transversum fusion in the 8th week of gestation. The majority of these patients present with respiratory distress after delivery; asymptomatic progress until adulthood is an extremely rare clinical occurrence. The adult form of a Bochdalek hernia accompanying pregnancy is a rare entity. A 39-year-old, 24-week pregnant patient applied to Emergency service with epigastric pain and vomiting. Abdominal ultrasonography was planned due to the abdominal pain; sudden cardiopulmonary arrest occurred during the procedure. In this case report, congenital diaphragmatic hernia in a young pregnant woman who underwent cardiac arrest is presented.

  11. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites

    DEFF Research Database (Denmark)

    Krag, A; Bendtsen, F; Henriksen, J H;

    2010-01-01

    OBJECTIVES: Recent studies suggest that cardiac dysfunction precedes development of the hepatorenal syndrome. In this follow-up study, we aimed to investigate the relation between cardiac and renal function in patients with cirrhosis and ascites and the impact of cardiac systolic function...... on survival. Patients and DESIGN: Twenty-four patients with cirrhosis and ascites were included. Cardiac function was investigated by gated myocardial perfusion imaging (MPI) for assessment of cardiac index (CI) and cardiac volumes. The renal function was assessed by determination of glomerular filtration...... (130 (SD 46) vs 78 (SD 29) mumol/l, pdeveloped hepatorenal syndrome type 1 within 3 months was higher in the group with low CI than in the high CI group (43% vs 5%, p = 0.04). Patients with the lowest CI (N = 8) had significantly poorer survival at 3, 9, and 12 months...

  12. Predictors of Occult Paroxysmal Atrial Fibrillation in Cryptogenic Strokes Detected by Long-Term Noninvasive Cardiac Monitoring

    Directory of Open Access Journals (Sweden)

    Archit Bhatt

    2011-01-01

    Full Text Available Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring. Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14 years were analyzed. PAF was detected in 15 (24% patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97% of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92; P=.042 and strokes (high signal on Diffusion Weighted Imaging (OR 4.3, 95% CI, 5–36.3; P=.041 predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5, P<.01. Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI.

  13. 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.

  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.

    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......-patient cardiac rehabilitation during 1-2 months is offered after the acute treatment. Knowledge of the patients’ experiences of cardiac problems when receiving the current standards of treatment is needed in order to develop sufficient care. Hence the aim was to investigate how patients with new onset unstable...

  15. 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.

  16. 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

  17. 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...

  18. Evaluation of cardiac functions in patients with thalassemia major

    Energy Technology Data Exchange (ETDEWEB)

    Kucuk, N.O.; Aras, G.; Sipahi, T.; Ibis, E.; Akar, N.; Soylu, A.; Erbay, G. [Ankara Univ. (Turkey). Medical School

    1999-06-01

    It is known that a blood transfusion is necessary for survival in patients with thalassemia, but it may cause myocardial dysfunction due to myocardial siderosis as in other organs. The aim of this study was to evaluate myocardial perfusion by means of stress thallium scanning (MPS) and left ventricular functions by rest radionuclide ventriculography (RNV). Twenty-one patients at ages 9-16 (mean 12.1{+-}3.2) who have been diagnosed with thalassemia for 4-15 years mean 12.7{+-}4.8) were included in the study. They had blood transfusion 78-318 times (mean 162.1{+-}71). MPS and RNV was performed within two days after the any transfusion. MPS showed ischemia in 3 patients and normal perfusion in 18 patients. RNV revealed normal systolic parameters (wall motion, EF, PER, TPE) but diminished diastolic parameters (TPF, PFR) compared with normal values (p<0.05). We conclude that ischemia or fixed defects may be seen in stress MPS as results of cardiac involvement in patients with thalassemia. But, RNV is an important and preferable test for the early detection of subclinic cardiomyopathy. RNV may therefore show diastolic abnormalities before the systolic abnormalities show up. (author)

  19. 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. 

  20. 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. 

  1. Functional and Hemodynamic Cardiac Determinants of Exercise Capacity in Patients With Systolic Heart Failure

    NARCIS (Netherlands)

    Hummel, Yoran M.; Bugatti, Silvia; Damman, Kevin; Willemsen, Suzan; Hartog, Jasper W. L.; Metra, Marco; Sipkens, Johannes S.; van Veldhuisen, Dirk J.; Voors, Adriaan A.

    2012-01-01

    Decreased exercise capacity is the main symptom in patients with heart failure (HF). We assessed the association among noninvasively determined maximal cardiac output at exercise, systolic and diastolic cardiac functions at rest, and peak oxygen uptake (pVO(2)) exercise capacity in patients with con

  2. 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

  3. Pneumopericardium Leading to Cardiac Tamponade in a Patient with Lung Cancer.

    Science.gov (United States)

    Al-Taweel, Ahmad; Ayub, Adil; Huang, Chyun-Yin; Rehmani, Sadiq; Al-Ayoubi, Adnan; Bhora, Faiz Y

    2016-12-01

    Pneumopericardium resulting in cardiac tamponade in patients with lung cancer is not documented. We report a case of squamous cell carcinoma of the lung complicated by pneumopericardium and subsequent cardiac tamponade. The patient underwent an urgent pericardial window with rapid improvement in symptoms. We discuss the possible pathogenesis and treatment options for this rare condition.

  4. Pneumopericardium Leading to Cardiac Tamponade in a Patient with Lung Cancer

    OpenAIRE

    Al-Taweel, Ahmad; Ayub, Adil; Huang, Chyun-yin; Rehmani, Sadiq; Al-Ayoubi, Adnan; Bhora, Faiz Y.

    2016-01-01

    Pneumopericardium resulting in cardiac tamponade in patients with lung cancer is not documented. We report a case of squamous cell carcinoma of the lung complicated by pneumopericardium and subsequent cardiac tamponade. The patient underwent an urgent pericardial window with rapid improvement in symptoms. We discuss the possible pathogenesis and treatment options for this rare condition.

  5. Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities

    DEFF Research Database (Denmark)

    Diederichsen, L P; Simonsen, J A; Diederichsen, A C

    2016-01-01

    OBJECTIVE: Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies. The study objective was in a controlled setting to describe cardiac abnormalities by noninvasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM) and to identify...

  6. [Cardiac transplantation. Selection of patients and long-term results].

    Science.gov (United States)

    Cabrol, C; Gandjbakhch, I; Pavie, A; Bors, V; Cabrol, A; Léger, P; Vaissier, E; Simmoneau, F; Chomette, G; Aupetit, B

    1987-12-01

    Performed for the first time in the world, in December 1967, by Barnard in Capetown, and for the first time in Europe by our team in April 1968, cardiac transplantation has now 20 years of clinical applications. A best selection of the recipients, a more precise selection of donors, refinements in surgical technique, a better and earlier diagnosis of post-operative complications, more effective therapeutic means especially cyclosporin, have brought us, from 1981, such major improvements that many teams were prompted to resume the procedure. In our experience of more than 400 transplants at La Pitié Hospital, a five-year follow-up shows that 70 p. cent of the patients are alive, having resumed a normal familial, social, professional and often sporting life. Much progress remains to be achieved, but this procedure now seems to be quite common if not routine, only limited by the insufficient number of donors.

  7. 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.

    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......Purpose. Patients face demanding and challenging processes when they experience cardiac problems. Exercise-based cardiac rehabilitation is established to enable these patients to move forward to lead a satisfying life. It is recognised that patients fail to join all sessions of the rehabilitation......, and it seems to be crucial to further emphasise the individuals lived experiences when exercise-based cardiac rehabilitation is followed. Hence this study aims to investigate how patients experience exercise-based cardiac rehabilitation in a hospital setting. Methods. This study, which included nine men...

  8. 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.

  9. Remote monitoring in patients with spondylitis

    Directory of Open Access Journals (Sweden)

    Akulova A.l.

    2014-06-01

    Full Text Available Objective: to evaluate the adherence to therapy and treatment outcomes in patients with spondylitis (SpA in which activity of the disease managed remotely. Material and Methods. 193 patients with axial SpA were randomized into 3 groups with the different ways of the disease activity monitoring: 96 patients were managed in free way, 26 patients visited rheumatologist every 12 weeks, 69 patients managed remotely — we called them every 4 weeks. After the first year of follow up we made 3-month break in the telephone monitoring. The data on the treatment and SpA activity (indexes BASDAI, PASS, ESR, CRP were collected. Results. In patients managed in a free way SpA activity was severe after a year. In groups managed remotely and once in 3 month the significant reduction in the disease activity was achieved with maximal decrease in remote monitoring group. Positive PASS group 3 was found in 15 patients (57.69%, n=26, in group 2 — in 4 patients (20%, n=20, in group 1 — no patients (0%. NSAIDs intake was arbitrarily changed by 5 (19.23%, n=26, 15(75%, n=20, and 93(96.87%, n=96 patients of groups 3, 2 and 1, respectively. After a 3- month break in remote monitoring in 13 patients with initial BASDAI>4 disease activity significantly increased, in 33 patients with BASDAK4 disease activity decreased. 17 (51.5% patients independently changed the drug intake regimen after the break in monitoring. Conclusion. Remote monitoring is associated with better adherence to therapy and the best results of treatment of patients with SpA than the other modes of observation. Remote monitoring frequency must be determined individually.

  10. The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections: a retrospective study

    NARCIS (Netherlands)

    Vranken, N.P.; Weerwind, P.W.; Barenbrug, P.J.; Teerenstra, S.; Ganushchak, Y.M.; Maessen, J.G.

    2014-01-01

    OBJECTIVES: We aimed to investigate the association of patient characteristics and allogeneic blood transfusion products in development of post-cardiac surgery nosocomial infections. METHODS: This retrospective study was conducted in 7888 patients undergoing cardiac surgery with median sternotomy an

  11. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit

    NARCIS (Netherlands)

    J.A. Lipton (Jonathan); R. Barendse (Rj); R.T. van Domburg (Ron); A.F.L. Schinkel (Arend); H. Boersma (Eric); M.L. Simoons (Maarten); K.M. Akkerhuis (Martijn)

    2013-01-01

    textabstractAims: Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described. Methods: Observational study of patients admitted t

  12. 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

  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)

    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

  14. Cardiac Arrhythmias in Patients with Chronic Kidney Disease: Implications of Renal Failure for Antiarrhythmic Drug Therapy.

    Science.gov (United States)

    Potpara, Tatjana S; Jokic, Vera; Dagres, Nikolaos; Marin, Francisco; Prostran, Milica S; Blomstrom-Lundqvist, Carina; Lip, Gregory Y H

    2016-01-01

    The kidney has numerous complex interactions with the heart, including shared risk factors (e.g., hypertension, dyslipidemia, etc.) and mutual amplification of morbidity and mortality. Both cardiovascular diseases and chronic kidney disease (CKD) may cause various alterations in cardiovascular system, metabolic homeostasis and autonomic nervous system that may facilitate the occurrence of cardiac arrhythmias. Also, pre-existent or incident cardiac arrhythmias such as atrial fibrillation (AF) may accelerate the progression of CKD. Patients with CKD may experience various cardiac rhythm disturbances including sudden cardiac death. Contemporary management of cardiac arrhythmias includes the use of antiarrhythmic drugs (AADs), catheter ablation and cardiac implantable electronic devices (CIEDs). Importantly, AADs are not used only as the principal treatment strategy, but also as an adjunct therapy in combination with CIEDs, to facilitate their effects or to minimize inappropriate device activation in selected patients. Along with their principal antiarrhythmic effect, AADs may also induce cardiac arrhythmias and the risk for such proarrhythmic effect(s) is particularly increased in patients with reduced left ventricular systolic function or in the setting of electrolyte imbalance. Moreover, CKD itself can induce profound alterations in the pharmacokinetics and pharmacodynamics of many drugs including AADs, thus facilitating the drug accumulation and increased exposure. Hence, the use of AADs in patients with CKD may be challenging. In this review article, we provide an overview of the characteristics of arrhythmogenesis in patients with CKD with special emphasis on the complexity of pharmacokinetics and risk for proarrhythmias when using AADs in patients with cardiac arrhythmias and CKD.

  15. 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......BACKGROUND: Heart transplantation remains the last treatment option for patients with end-stage cardiac disease. Such diseases include ischemic cardiomyopathy, nonischemic cardiomyopathy and other conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and cardiac...... 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...

  16. Is the cardiac monitoring function related to the self in both the default network and right anterior insula?

    Science.gov (United States)

    Wolpert, Nicolai; Adam, Claude; Hasboun, Dominique

    2016-01-01

    The self has been proposed to be rooted in the neural monitoring of internal bodily signals and might thus involve interoceptive areas, notably the right anterior insula (rAI). However, studies on the self consistently showed the involvement of midline default network (DN) nodes, without referring to visceral monitoring. Here, we investigate this apparent discrepancy. We previously showed that neural responses to heartbeats in the DN encode two different self-dimensions, the agentive ‘I’ and the introspective ‘Me’, in a whole-brain analysis of magnetoencephalography (MEG) data. Here, we confirm and anatomically refine this result with intracranial recordings (intracranial electroencephalography, iEEG). In two patients, we show a parametric modulation of neural responses to heartbeats by the self-relatedness of thoughts, at the single trial level. A region-of-interest analysis of the insula reveals that MEG responses to heartbeats in the rAI encode the ‘I’ self-dimension. The effect in rAI was weaker than in the DN and was replicated in iEEG data in one patient out of two. We propose that a common mechanism, the neural monitoring of cardiac signals, underlies the self in both the DN and rAI. This might reconcile studies on the self highlighting the DN, with studies on interoception focusing on the insula. This article is part of the themed issue ‘Interoception beyond homeostasis: affect, cognition and mental health’. PMID:28080963

  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

    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.......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...... at Rigshospitalet. Patients One hundred one patients with LGMD2A-I and BMD and 29 patients with LGMD2 and no molecular diagnosis. MAIN OUTCOME MEASURES: Clinical investigation, echocardiography, and electrocardiographic findings. RESULTS: Cardiac involvement was present in 24 of 100 patients (24%) with LGMD2A...

  18. 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.

  19. 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.

  20. Hybrid ECMO for a patient in respiratory failure developing cardiac insufficiency.

    Science.gov (United States)

    Youdle, Jemma; Penn, Sarah; Maunz, Olaf; Simon, Andre

    2016-04-01

    A 45-year-old patient in lung failure treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) developed subsequent right heart failure and required cardiac support.We present a method of upgrading a VV ECMO to a hybrid system for simultaneous support for respiratory and cardiac failure.

  1. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    OpenAIRE

    André Luiz Lisboa Cordeiro; Thiago Araújo de Melo; Daniela Neves; Julianne Luna; Mateus Souza Esquivel; André Raimundo França Guimarães; Daniel Lago Borges; Jefferson Petto

    2016-01-01

    Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled tri...

  2. 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.

  3. Prediction of oxygen consumption in cardiac rehabilitation patients performing leg ergometry

    Science.gov (United States)

    Alvarez, John Gershwin

    The purpose of this study was two-fold. First, to determine the validity of the ACSM leg ergometry equation in the prediction of steady-state oxygen consumption (VO2) in a heterogeneous population of cardiac patients. Second, to determine whether a more accurate prediction equation could be developed for use in the cardiac population. Thirty-one cardiac rehabilitation patients participated in the study of which 24 were men and 7 were women. Biometric variables (mean +/- sd) of the participants were as follows: age = 61.9 +/- 9.5 years; height = 172.6 +/- 1.6 cm; and body mass = 82.3 +/- 10.6 kg. Subjects exercised on a MonarchTM cycle ergometer at 0, 180, 360, 540 and 720 kgm ˙ min-1. The length of each stage was five minutes. Heart rate, ECG, and VO2 were continuously monitored. Blood pressure and heart rate were collected at the end of each stage. Steady state VO 2 was calculated for each stage using the average of the last two minutes. Correlation coefficients, standard error of estimate, coefficient of determination, total error, and mean bias were used to determine the accuracy of the ACSM equation (1995). The analysis found the ACSM equation to be a valid means of estimating VO2 in cardiac patients. Simple linear regression was used to develop a new equation. Regression analysis found workload to be a significant predictor of VO2. The following equation is the result: VO2 = (1.6 x kgm ˙ min-1) + 444 ml ˙ min-1. The r of the equation was .78 (p equation. The analysis found the ACSM and new equation to significantly (p equation was found to significantly (p equations were compared based on correlation coefficients, coefficients of determinations, SEEs, total error, and mean bias the new equation was found to have equal or better accuracy at all workloads. The final form of the new equation is: VO2 (ml ˙ min-1) = (kgm ˙ min-1 x 1.6 ml ˙ kgm-1) + (3.5 ml ˙ kg-1 ˙ min-1 x body mass in kg) + 156 ml ˙ min-1.

  4. Preventing Long-Term Cardiac Damage in Pediatric Patients With Kawasaki Disease.

    Science.gov (United States)

    Williams, Kelly

    Kawasaki disease is currently the leading cause of long-term cardiac damage in pediatric patients in the United States. Kawasaki disease is diagnosed based on symptomatology and by ruling out other etiology. There is a significant need for an improved, standardized treatment protocol for patients diagnosed with Kawasaki disease and a more rapid initiation of treatment for these patients. Decreasing the cardiac damage caused by Kawasaki disease with timely diagnosis and treatment needs be a principal goal.

  5. 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.

  6. Impairment of diastolic function in adult patients affected by osteogenesis imperfecta clinically asymptomatic for cardiac disease: casuality or causality?

    Science.gov (United States)

    Migliaccio, Silvia; Barbaro, Giuseppe; Fornari, Rachele; Di Lorenzo, Gabriella; Celli, Mauro; Lubrano, Carla; Falcone, Stefania; Fabbrini, Elisa; Greco, Emanuela; Zambrano, Anna; Brama, Marina; Prossomariti, Giancarlo; Marzano, Sara; Marini, Mario; Conti, Francesco; D'Eufemia, Patrizia; Spera, Giovanni

    2009-01-09

    Osteogenesis imperfecta (OI) is a rare inherited connective disorder causing increased bone fragility and low bone mass. OI includes severe bone fragility, impaired dentinogenesis, with less common alterations in the joints, blood vessels, heart valves, skin. Interestingly, description of left ventricular rupture, aortic dissection and heart valves incompetence has been previously described. Death may occur in OI patients for cardiac disease in asyntomatic subjects. Aim of our study has been to evaluate the presence of potential subclinical cardiac disorders and to characterize cardiac functional parameters by echocardiography in adults with OI in absence of cardiac symptoms. Forty patients (21 females and 19 males) affected by type I, III, IV OI and 40 control subjects (20 females and 20 males) were evaluated in the study. Patients and controls underwent clinical examination, screening for endocrine and metabolic disorders, 12-lead electrocardiogram and echocardiogram. In particular, all subjects were evaluated by two-dimensional echocardiography with continuous- and pulse-wave Doppler. Patients and controls belonged to NYHA class I and no significant electrocardiographic alteration was documented in both groups. Thirty-eight patients (95%) showed valvular regurgitation compared to one control subject (2.5%; Prelaxation time (IRT) was increased by 47% (95% CI: 26% to 53%; Pmetabolic alterations. These diastolic echocardiographic parameters might worsen over time, especially if other cardiovascular risk factors (e.g., smoking, hypertension, metabolic and endocrine alterations) are not carefully checked, monitored and treated. In the context of a multidisciplinary evaluation of OI patients, our data suggest that a careful cardiological evaluation of these patients is indicated beside skeletal evaluation and therapeutical skeletal options.

  7. Cardiac sarcoidosis and heart transplantation: a report of four consecutive patients

    DEFF Research Database (Denmark)

    Milman, N.; Andersen, Claus Bøgelund; Mortensen, Sven Aage;

    2008-01-01

    Heart transplantation (HTx) is a well-established treatment for severe cardiac failure. However, HTx for cardiac sarcoidosis is rare; less than 80 patients have been reported worldwide. In many patients, the diagnosis was not made prior to HTx. The aim of this study was to describe the use of HTx...... to HTx. In three patients, all with dilated cardiomyopathy due to myocardial sarcoidosis, the final diagnosis was obtained by examination of the explanted heart. Arrythmias (supraventricular and ventricular), heart block, mitral valve insufficiency and dilated cardiomyopathy were prominent clinical...... features. None of the patients had recurrence of sarcoid disease in the allograft. Two patients are long-term survivors and two are deceased, one of primary graft failure, the other from Cytomegalovirus myocarditis. In conclusion, HTx is a viable treatment for cardiac sarcoidosis with end stage cardiac...

  8. 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

  9. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine B

    2016-01-01

    fibrillation and sex to cardiac rehabilitation consisting of 12 weeks physical exercise and four psycho-educational consultations plus usual care (cardiac rehabilitation group) versus usual care. The primary outcome was Vo2 peak. The secondary outcome was self-rated mental health measured by the Short Form-36......BACKGROUND: To assess the effects of comprehensive cardiac rehabilitation compared with usual care on physical activity and mental health for patients treated with catheter ablation for atrial fibrillation. METHODS: The patients were randomized 1:1 stratified by paroxysmal or persistent atrial...... cardiac rehabilitation had a positive effect on physical capacity compared with usual care, but not on mental health. Cardiac rehabilitation caused more non-serious adverse events....

  10. Overhydration, Cardiac Function and Survival in Hemodialysis Patients.

    Directory of Open Access Journals (Sweden)

    Mihai Onofriescu

    Full Text Available Chronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered.A prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE, by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup. Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO: 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort.In the entire study population, patients considered overhydrated (using both cut-offs had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30-3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72-4.78 for RFO>17.4%, respectively and multivariate (HR = 1.87, 95%CI = 1.12-3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60-4.63 for RFO>17.4%, respectively Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated patients in both univariate (HR = 2.46, 95%CI = 1.56-3.87 for RFO >15% and HR = 3

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

    Directory of Open Access Journals (Sweden)

    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

  12. 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.

  13. Increased neutrophil priming and sensitization before commencing cardiopulmonary bypass in cardiac surgical patients

    NARCIS (Netherlands)

    Gu, YJ; Schoen, P; Tigchelaar, [No Value; Loef, BG; Ebels, T; Rankin, AJ; van Oeveren, W

    2002-01-01

    Background. Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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...... the first 6 h after arrest. Primary outcome was mortality at the end of trial. A Cox proportional hazard model was created to estimate hazard of death, adjusting for covariates. In addition, a propensity score matched analysis was performed. RESULTS: A total of 252 patients (46 %) received early CAG...

  16. Therapeutic application of inhaled nitric oxide in adult cardiac surgical patients.

    Science.gov (United States)

    Makker, Robina; Mehta, Yatin; Trehan, Naresh; Bapna, Rk

    2006-01-01

    Increased pulmonary vascular resistance can be detrimental to the cardiac output in post-operative cardiac surgical patients. Pulmonary vasodilator therapy by systemic pharmacologic agents is non-selective. Inhaled nitric oxide is a selective pulmonary vasodilator and does not cause systemic hypotension. In this prospective study, 14 adult post-operative cardiac surgical patients with pulmonary hypertension underwent inhaled nitric oxide therapy and their hemodynamic changes were evaluated. Inhaled nitric oxide was administered in doses of 5 ppm-25 ppm. The result was a decrease in pulmonary vascular resistance from 456.57 +/- 137.13 to 357.64 +/- 119.80 dynes-sec- Continued. - See Free Full Text.

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

    Directory of Open Access Journals (Sweden)

    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. Application of pulse indicator continuous cardiac output monitor in the fluid resuscitation therapy in elderly patients with septic shock%脉搏指示连续心排血量监护仪在老年感染性休克液体复苏治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    林华; 郑瑞强; 吴晓燕; 於江泉; 卢年芳; 邵俊; 王海霞

    2012-01-01

    Objective To investigate the guiding significance of pulse indicator continuous cardiac output(PICCO) for the fluid resuscitation in elderly patients with septic shock. Methods Twenty-four elderly patients with septic shock were divided into observation group and control group,twelve cases in each group. The patients in observation group were treated with fluid resuscitation under the guidance of PICCO monitor, while the patients in control group were treated with fluid resuscitation under the guidance of monitoring central venous pressure, then the curative effect was compared between the two groups. Results On the first day of treatment, there was no statistical difference in the blood cell and neutrophil counts, mixed venous oxygen saturation ( SvO2) ,the levels of procalcitonin ( PCT) and lactic acid (LA) between the two groups (P >0. 05). On the second and third days of treatment, the white blood cell, neutrophil counts and the levels of LA and PCT in observation group were significantly lower than those in control group(P <0. 05) ,but SvO2 was significantly higher( P < 0. 05). Compared with control group,the mechanical ventilation time was significantly shorter(P <0. 05) , and the case fatality within 28 days was lower in observation group( P < 0.05 ). Conclusion PICCO monitor has important guiding significance in the treatment of fluid resuscitation in elderly patients with septic shock,which can significantly improve blood gas analysis index,shorten the mechanical ventilation time and reduce mortality.%目的 探讨脉搏指示连续心排血量(PICCO)监测技术对老年感染性休克液体复苏治疗的指导意义.方法 24例老年感染性休克患者分为观察组和对照组,每组12例.观察组患者在PICCO监护仪监测指导下补液治疗,对照组患者在监测中心静脉压指导下补液治疗;观察比较2组治疗效果.结果 治疗第1天,2组患者白细胞、中性粒细胞计数、混合静脉血氧饱和度(SvO2)、血降

  20. 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

  1. Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure.

    Science.gov (United States)

    Jakovljevic, Djordje G; Seferovic, Petar M; Nunan, David; Donovan, Gay; Trenell, Michael I; Grocott-Mason, Richard; Brodie, David A

    2012-02-01

    Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

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

    Directory of Open Access Journals (Sweden)

    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

  3. Wearable impedance monitoring system for dialysis patients.

    Science.gov (United States)

    Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P

    2016-08-01

    This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

  4. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    Science.gov (United States)

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all ptamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, ptamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  5. Extramedullary hematopoiesis is associated with lower cardiac iron loading in chronically transfused thalassemia patients.

    Science.gov (United States)

    Ricchi, Paolo; Meloni, Antonella; Spasiano, Anna; Neri, Maria Giovanna; Gamberini, Maria Rita; Cuccia, Liana; Caruso, Vincenzo; Gerardi, Calogera; D'Ascola, Domenico Giuseppe; Rosso, Rosamaria; Campisi, Saveria; Rizzo, Michele; Terrazzino, Fabrizia; Vangosa, Alessandra Briatico; Chiodi, Elisabetta; Missere, Massimiliano; Mangione, Maurizio; Positano, Vincenzo; Pepe, Alessia

    2015-11-01

    The aim of this study was to evaluate, in a large cohort of chronically transfused patients, whether the presence of extramedullary hematopoiesis (EMH) accounts for the typical patterns of cardiac iron distribution and/or cardiac function parameters. We retrospectively selected 1,266 thalassemia major patients who had undergone regular transfusions (611 men and 655 women; mean age: 31.3 ± 8.9 years, range: 4.2-66.6 years) and were consecutively enrolled within the Myocardial Iron Overload in Thalassemia network. The presence of EMH was evaluated based on steady-state free precession sequences; cardiac and liver iron overloads were quantified using a multiecho T2* approach; cardiac function parameters and pulmonary diameter were quantified using the steady-state free precession sequences; and myocardial fibrosis was evaluated using the late gadolinium enhancement technique. EMH was detected in 167 (13.2%) patients. The EMH+ patients had significantly lower cardiac iron overload than that of the EMH- patients (P = 0.003). The patterns of cardiac iron distribution were significantly different in the EMH+ and EMH- patients (P < 0.0001), with a higher prevalence of patients with no myocardial iron overload and heterogeneous myocardial iron overload and no significant global heart iron in the EMH+ group EMH+ patients had a significantly higher left ventricle mass index (P = 0.001) and a significantly higher pulmonary artery diameter (P = 0.002). In conclusion, in regularly transfused thalassemia patients, EMH was common and was associated with a thalassemia intermedia-like pattern of cardiac iron deposition despite regular transfusion therapy.

  6. 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.

  7. A study of potential drug-drug interactions among hospitalized cardiac patients in a teaching hospital in Western Nepal

    Directory of Open Access Journals (Sweden)

    Sushmita Sharma

    2014-01-01

    Full Text Available Aim: Drug-drug interaction (DDI is of major concern in patients with complex therapeutic regimens. The involvement of cardiovascular medicines in drug interaction is even higher. However, reports of DDI between these groups of drugs are few. The study aims to identify the potential DDI among hospitalized cardiac patients. Furthermore, we assessed the possible risk factors associated with these interactions. Subjects and Methods: The prospective observational study was conducted from May 2012 to August 2012 among hospitalized cardiac patients. Cardiac patients who were taking at least two drugs and who had a hospital stay of at least 24 h were enrolled. The medications of the patients were analyzed for possible interactions using the standard drug interaction database - Micromedex -2 (Thomson Reuters × 2.0. Results: From a total of 150 enrolled patients, at least one interacting drug combination was identified among 32 patients. The incidence of potential DDI was 21.3%. A total of 48 potentially hazardous drug interactions were identified. Atorvastatin/azithromycin (10.4%, enalapril/metformin (10.4%, enalapril/potassium chloride (10.4%, atorvastatin/clarithromycin (8.3% and furosemide/gentamicin (6.3% were the most common interacting pairs. Drugs most commonly involved were atorvastatin, enalapril, digoxin, furosemide, clopidogrel and warfarin. Majority of interactions were of moderate severity (62.5% and pharmacokinetic (58.3% in nature. Increased number of medicines, prolonged hospital stays and comorbid conditions were the risk factors found associated with the potential DDI. Conclusions: This study highlighted the need of intense monitoring of patients who have identified risk factors to help detect and prevent them from serious health hazards associated with drug interactions.

  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. [A hardware-software system for monitoring the characteristics of the cardiac conduction system].

    Science.gov (United States)

    Fedotov, N M; Oferkin, A I; Zharyĭ, S V

    2008-01-01

    A new hardware-software system for monitoring and treatment of the cardiac conduction system abnormalities is described. The system can also be used to test non-X-ray devices for detection and imaging of endocardial electrodes. The system uses a reliable position measurement method based on biplane fluoroscopy. The system consists of standard units for electrophysiological examination of the heart. The system can operate using a preset model stored in the system database or a model constructed from X-ray imaging data. The preset mathematical model provides fast detection of the abnormal excitation site and effective electrode navigation based on the iteration procedure. On the other hand, the constructed model is more specific: it provides an opportunity to reconstruct the excitation front and store the electrode and site positions.

  10. 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.

  11. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment?

    Science.gov (United States)

    Napp, Andreas; Stunder, Dominik; Maytin, Melanie; Kraus, Thomas; Marx, Nikolaus; Driessen, Sarah

    2015-07-21

    Utilization of cardiac implants such as pacemakers and implantable cardioverter defibrillators is now commonplace among heart disease patients. The ever-increasing technological complexity of these devices is matched by the near omnipresent exposure to electric, magnetic, and electromagnetic fields (EMFs), both in everyday life and the occupational environment. Given that electromagnetic interferences (EMIs) are associated with potential risk in device patients, physicians are increasingly confronted with managing device patients with intermittent EMI and chronic occupational exposure. The current review aims to provide a contemporary overview of cardiovascular implantable electronic devices, their function and susceptibility of non-medical EMFs and provide recommendations for physicians caring for cardiac device patients presenting with EMI.

  12. Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence.

    Science.gov (United States)

    Shi, William Y; Li, Sheila; Collins, Nicholas; Cottee, David B; Bastian, Bruce C; James, Allen N; Mejia, Ross

    2015-07-01

    Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. Current evidence suggests that levosimendan enhances cardiac function after cardiopulmonary bypass in patients with both normal and reduced left ventricular function. In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent.

  13. 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 Cardiac rehabilitation decreased oscillation amplitude (P cardiac 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.

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. The experience of family members of ICU patients who require extensive monitoring: a qualitative study.

    Science.gov (United States)

    Smith, Claudia DiSabatino; Custard, Kristi

    2014-09-01

    A mixed methods study using family research with a phenomenological approach (n = 5 families) was conducted to explore family members' perceptions about the extensive monitoring technology used on their critically ill family member after cardiac surgery, as experienced when family members initially visited the patient in the cardiovascular intensive care unit. Five relevant themes emerged: overwhelmed by all of the machines; feelings of uncertainty; methods of coping; meaning of the numbers on the machines; and need for education.

  20. 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 ...... of resources, lack of interest and knowledge among staff, and practical and psychological barriers among patients and relatives. More research is needed on health services concerning relatives of cardiac patients, regarding both the prevalence of activities and barriers to these....

  1. A model to calculate cardiac output in hemodialysis patients by thermodilution

    Directory of Open Access Journals (Sweden)

    Alayoud Ahmed

    2012-06-01

    Full Text Available Abstract The Blood Temperature Monitor module (BTM is used to measure recirculation by thermodilution in dialysis. Numerous studies have confirmed its interest in the measuring of the vascular access flow. In this letter we describe a model to calculate cardiac output in dialysis by the BTM.

  2. 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.

  3. Capsule endoscopy in patients with cardiac pacemakers, implantable cardioverter defibrillators and left heart assist devices.

    Science.gov (United States)

    Bandorski, Dirk; Höltgen, Reinhard; Stunder, Dominik; Keuchel, Martin

    2014-01-01

    According to the recommendations of the US Food and Drug Administration and manufacturers, capsule endoscopy should not be used in patients carrying implanted cardiac devices. For this review we considered studies indexed (until 30.06.2013) in Medline [keywords: capsule endoscopy, small bowel endoscopy, cardiac pacemaker, implantable cardioverter defibrillator, interference, left heart assist device], technical information from Given Imaging and one own publication (not listed in Medline). Several in vitro and in vivo studies included patients with implanted cardiac devices who underwent capsule endoscopy. No clinically relevant interference was noticed. Initial reports on interference with a simulating device were not reproduced. Furthermore technical data of PillCam (Given Imaging) demonstrate that the maximum transmission power is below the permitted limits for cardiac devices. Hence, impairment of cardiac pacemaker, defibrillator or left ventricular heart assist device function by capsule endoscopy is not expected. However, wireless telemetry can cause dysfunction of capsule endoscopy recording. Application of capsule endoscopy is feasible and safe in patients with implanted cardiac devices such as pacemakers, cardioverter defibrillators, and left heart assist devices. Development of new technologies warrants future re-evaluation.

  4. Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

    Directory of Open Access Journals (Sweden)

    Malik Madhur

    2010-01-01

    Full Text Available Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery were prospectively collected as per the EuroSCORE model. The model′s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73 and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6% was double that of predicted mortality (7.5%. The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

  5. 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, Marcus T. R.; 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

  6. [Does echocardiography have any role in selecting patients for cardiac resynchronization therapy?].

    Science.gov (United States)

    Gazzaniga, Pietrocarlo; Tovena, Daniela Maria; Nanetti, Massimiliano; Rizzini, Angelo Lodi; Foffa, Antonio; Inama, Giuseppe

    2010-10-01

    Cardiac resynchronization therapy (CRT) has an established role in the treatment of end-stage, drug-refractory heart failure patients. Large randomized controlled trials have demonstrated that CRT improves morbidity and mortality and, in current practice, there is a substantial number of patients treated with CRT for off-label indications. Nevertheless, a significant proportion of patients lack clinical and echocardiographic improvement or even deteriorate. Novel, sophisticated echocardiographic techniques seem promising in predicting response to CRT but need adequate training and refinements. In the meantime, a comprehensive, multiparametric echocardiographic approach is probably required for a better evaluation of mechanical dyssynchrony. Other non-invasive cardiac imaging modalities, including magnetic resonance and multislice computed tomography, are providing further insight into the pathophysiological mechanisms underlying CRT response. An integrated approach based on multimodality cardiac imaging may aid to optimize the selection of heart failure patients who are candidate to CRT.

  7. Management of Gingival Overgrowth in a Cardiac Transplant Patient Using Laser-Assisted Gingivectomy/Gingivoplasty.

    Science.gov (United States)

    Maddi, Abhiram; Alluri, Leela Subhashini; Ciancio, Sebastian G

    2015-07-01

    Drug-induced gingival overgrowth (DIGO) is an oral clinical manifestation associated with certain medications such as immunosuppressants that are administered to organ transplant patients to prevent graft rejection. In patients with cardiac transplants, management of DIGO is critical. In such patients, plaque biofilm accumulation at the gingival interface might be detrimental as it may lead to transient bacteremia as well as systemic inflammation resulting in thromboembolic events. This case report describes the management of DIGO in a cardiac transplant recipient by change of immunosuppressant medication, non-surgical periodontal therapy and laser-assisted gingivectomy.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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...

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

    OpenAIRE

    Patel, Rajan K.; Oliver, Scott; Mark, Patrick B.; Powell, Joanna R.; Emily P. McQuarrie; 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. Effect of cardiac resynchronization therapy in patients with diabetes randomized in EchoCRT

    DEFF Research Database (Denmark)

    Nägele, Matthias P; Steffel, Jan; Robertson, Michele;

    2017-01-01

    AIMS: As patients with heart failure (HF) and concomitant diabetes carry a poor prognosis, this post-hoc subgroup analysis aimed to compare the outcomes of patients with and without diabetes randomized in the Echocardiography Guided Cardiac Resynchronization Therapy (EchoCRT) study. METHODS AND R...

  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. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

    NARCIS (Netherlands)

    Mastenbroek, MH; Pedersen, S.S.; Meine, M; Versteeg, H

    2016-01-01

    PURPOSE:It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.METHODS:A cohort of 139

  18. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

    NARCIS (Netherlands)

    T.J. Mastenbroek (Tom); S.S. Pedersen (Susanne S.); M. Meine (Mathias); H. Versteeg (Henneke)

    2016-01-01

    textabstractPurpose: It is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. Methods:

  19. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

    NARCIS (Netherlands)

    Mastenbroek, M.H.; Pedersen, S.S.; Meine, M.M.; Versteeg, H.

    2016-01-01

    Purpose It is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. Methods A cohort of 13

  20. 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...

  1. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    NARCIS (Netherlands)

    Mastenbroek, Mirjam H; van t Sant, Jetske; Versteeg, Henneke; Cramer, MJ; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias

    2016-01-01

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT-defibrilla

  2. 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...

  3. Autoantibodies against α1 adrenergic receptor related with cardiac remodeling in hypertensive patients by clinical observation

    Institute of Scientific and Technical Information of China (English)

    李正在

    2006-01-01

    Objective To investigate the effects of autoantibodies against a adrenergic receptor on cardiac remodeling in patients with hypertension. Methods Five hundred and fifty three patients with hypertension in our hospital were selected. The autoantibodies againstα1 adrenergic receptor in sera of donor were detected by ELISA, and the Results of echocardiography were recorded. By

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

    OpenAIRE

    Maura Gabriela FELEA; Mitu, Florin; 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 ...

  5. Cardiac Sarcoidosis.

    Science.gov (United States)

    Birnie, David; Ha, Andrew C T; Gula, Lorne J; Chakrabarti, Santabhanu; Beanlands, Rob S B; Nery, Pablo

    2015-12-01

    Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.

  6. Feasibility of Rapid-Sequence {sup 31}P Magnetic Resonance Spectroscopy in Cardiac Patients

    Energy Technology Data Exchange (ETDEWEB)

    Chida, K.; Otani, H.; Saito, H.; Nagasaka, T.; Kagaya, Y.; Kohzuki, M.; Zuguchi, M.; Shirato, K. [Tohoku Univ., School of Health Sciences, Sendai (Japan). Dept. of Radiological Technology

    2005-07-01

    Purpose: To determine the clinical feasibility of rapid-sequence phosphorus-31 magnetic resonance spectroscopy ({sup 31}P -MRS) of the heart with cardiac patients using a 5T clinical MR system. Material and Methods: Twenty cardiac patients, i.e. dilated cardiomyopathy (DCM)3 cases, hypertrophic cardiomyopathy (HCM) 3 cases, hypertensive heart diseases (HHD) 3 cases, and aortic regurgitation (AR) case were examined using rapid cardiac {sup 31}P-MRS. Complete three-dimensional localization was performed using a two-dimensional phosphorus chemical-shift imaging sequence in combination with 30-mm axial slice-selective excitation. The rapid-sequence {sup 31}P-MRS procedure was phase encoded in arrays of 8x8 steps with an average of 4 acquisitions. The total examination time, including proton imaging and shimming, for the rapid cardiac {sup 31}P-MRS procedure, ranged from 0 to 5 min, depending on the heart rate. Student's t test was used to compare creatine phosphate (PCr)/adenosine triphosphate (ATP) ratios from the cardiac patients with those of the control subjects (n{approx_equal}13). Results: The myocardial PCr/ATP ratio obtained by rapid {sup 31}P-MRS was significantly lower (P <0.001) in DCM patients (1.82{+-}0.33, mean{+-}SD), and in patients with global myocardial dysfunction (combined data for 20 patients:.89{+-}0.32) than in normal volunteers (2.96{+-}0.59). These results are similar to previous studies. Conclusion: Rapid-sequence {sup 31}P-MRS may be a valid diagnostic tool for patients with cardiac disease.

  7. Prevalence of hospital malnutrition among cardiac patients: results from six nutrition screening tools

    OpenAIRE

    2014-01-01

    Malnutrition is highly prevalent among hospitalized patients, ranging from 30% to 50% depending on the patient population and the criteria used for diagnosis. Identifying early those who are malnourished and at risk of malnutrition and intervening at an early stage will improve patients overall prognosis and will reduce the costs to the state. Even though cardiac patients are at risk of malnutrition, data on the prevalence of malnutrition among cardiology inpatients is limited. The aim of the...

  8. 全自动远程家庭监测系统在植入心律转复除颤器患者中的应用%Home monitoring in patients with implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator

    Institute of Scientific and Technical Information of China (English)

    王凤梅; 李述峰; 王帆; 张烁

    2014-01-01

    目的 评价全自动远程家庭监测(HM)在植入心律转复除颤器(ICD)/心脏再同步治疗除颤器(CRT-D)患者中的应用.方法 随访23例植入了带有HM功能的ICD及CRT-D患者,分析HM所获得的日常信息和报警数据,观察其对系统相关事件、心律失常和心力衰竭(心衰)监测在内的临床相关事件的早期监测及临床干预的疗效.结果 对23例患者随访122~937(452.1±262.2)d,共接收报警信息1 991次,发现异常事件1 481次,其中96.4%是临床相关事件,1.5%为系统相关事件,无信息传输事件占2.1%.系统相关事件多为感知异常,其中发现左心室导线脱位1例.临床相关事件中心律失常报警事件占84.7%[室上性心律失常和心房颤动(房颤)事件较多],心衰报警事件占15.3%,以静息时心率升高及心脏再同步治疗心室起搏百分比降低为主.根据HM系统报警信息,电话联络患者65例次,优化参数11例次,指导调整药物治疗方案18例次,4例患者入院治疗.结论 对于植入ICD/CRT-D的患者,HM系统是一项必要的、安全可靠的远程监测方法,可以及时识别起搏系统相关异常、发现临床相关事件,可指导对患者进行早期临床干预,优化随访管理,提高患者生活质量.%Objective To evaluate the benefit of Home monitoring (HM) system in patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator(CRT-D).Methods Twentythree patients undergoing implantation of ICD or CRT-D with HM were enrolled,data automatically collected on a daily basis and alerts by HM were analyzed.Early detection and intervention effect of HM included arrhythmias or heart failure to clinical events and system related events.Results The mean follow-up duration was 122-937 (452.1±262.2) d,a total of 1 991 remote transmissions were received.Among these transmissions,1 481 abnormal events were reported,96.4% of events were clinical-related,and 1.5

  9. Myocardial Ischemia Induces SDF-1α Release in Cardiac Surgery Patients.

    Science.gov (United States)

    Kim, Bong-Sung; Jacobs, Denise; Emontzpohl, Christoph; Goetzenich, Andreas; Soppert, Josefin; Jarchow, Mareike; Schindler, Lisa; Averdunk, Luisa; Kraemer, Sandra; Marx, Gernot; Bernhagen, Jürgen; Pallua, Norbert; Schlemmer, Heinz-Peter; Simons, David; Stoppe, Christian

    2016-06-01

    In the present observational study, we measured serum levels of the chemokine stromal cell-derived factor-1α (SDF-1α) in 100 patients undergoing cardiac surgery with cardiopulmonary bypass at seven distinct time points including preoperative values, myocardial ischemia, reperfusion, and the postoperative course. Myocardial ischemia triggered a marked increase of SDF-1α serum levels whereas cardiac reperfusion had no significant influence. Perioperative SDF-1α serum levels were influenced by patients' characteristics (e.g., age, gender, aspirin intake). In an explorative analysis, we observed an inverse association between SDF-1α serum levels and the incidence of organ dysfunction. In conclusion, time of myocardial ischemia was identified as the key stimulus for a significant upregulation of SDF-1α, indicating its role as a marker of myocardial injury. The inverse association between SDF-1α levels and organ dysfunction association encourages further studies to evaluate its organoprotective properties in cardiac surgery patients.

  10. Divine Love and Deep Connections: A Long-Term Followup of Patients Surviving Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Amy L. Ai

    2011-01-01

    Full Text Available We examined experiencing divine love as an indicator of affective spiritual growth in a prospective cohort of 200 patients surviving cardiac surgery. These patients previously completed two-wave preoperative interviews when standardized cardiac surgery data were also collected. The information included left ventricular ejection fraction, New York Heart Association Classification, baseline health (physical and mental, optimism, hope, religiousness, prayer coping, religious/spiritual coping, and demographics. We then measured divine love at 900 days postoperatively. Hierarchical linear regression indicated the direct effect of positive religious coping on experiences of divine love, controlling for other key variables. Postoperatively perceived spiritual support was entered at the final step as an explanatory factor, which appeared to mediate the coping effect. None of the other faith factors predicted divine love. Further research regarding divine love and spiritual support may eventually guide clinical attempts to support patients' spiritual growth as an independently relevant outcome of cardiac surgery.

  11. 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.

  12. 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.

  13. Patient experience with a novel patch-like external loop recorder for cardiac arrhythmia detection in India.

    Science.gov (United States)

    Shrivastav, Maneesh; Padte, Sanjay; Sinha, Nakul

    2014-05-01

    Cardiovascular disease (CVD) is reaching pandemic proportions in India. The effects of CVD are disastrous for the Indian economy as the disease strikes in the prime working ages of the labor force. The great need for therapeutic and diagnostic options combined with pressure on cost containment place emphasis on the development of low cost, credible, point of care diagnostic tools to pinpoint issues in cardiac health for the Indian consumer. A previous study of 125 patients in India examined a novel external loop recorder (ELR) for ambulatory ECG monitoring with high yield and compliance. The current study probes the patient experience, inclusive of patient comfort, ease of use, clarity of the diagnostic report, and value of the ELR. The analysis shows that 85% found this ELR comfortable to wear and deploy, 77% responded with no challenges with the use of this ELR, 60% mentioned they were inclined to seek treatment after this ELR was deployed, and 60% found good value in the device. The results indicate that this particular ELR is a high performing device with excellent patient satisfaction, indicating that the device is a suitable tool for diagnosis of cardiac arrhythmia in India.

  14. 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.

  15. Elevated Levels of Asymmetric Dimethylarginine (ADMA in the Pericardial Fluid of Cardiac Patients Correlate with Cardiac Hypertrophy.

    Directory of Open Access Journals (Sweden)

    Zoltan Nemeth

    Full Text Available Pericardial fluid (PF contains several biologically active substances, which may provide information regarding the cardiac conditions. Nitric oxide (NO has been implicated in cardiac remodeling. We hypothesized that L-arginine (L-Arg precursor of NO-synthase (NOS and asymmetric dimethylarginine (ADMA, an inhibitor of NOS, are present in PF of cardiac patients and their altered levels may contribute to altered cardiac morphology.L-Arg and ADMA concentrations in plasma and PF, and echocardiographic parameters of patients undergoing coronary artery bypass graft (CABG, n = 28 or valve replacement (VR, n = 25 were determined.We have found LV hypertrophy in 35.7% of CABG, and 80% of VR patients. In all groups, plasma and PF L-Arg levels were higher than that of ADMA. Plasma L-Arg level was higher in CABG than VR (75.7 ± 4.6 μmol/L vs. 58.1 ± 4.9 μmol/L, p = 0.011, whereas PF ADMA level was higher in VR than CABG (0.9 ± 0.0 μmol/L vs. 0.7 ± 0.0 μmol/L, p = 0.009. L-Arg/ADMA ratio was lower in the VR than CABG (VRplasma: 76.1 ± 6.6 vs. CABGplasma: 125.4 ± 10.7, p = 0.004; VRPF: 81.7 ± 4.8 vs. CABGPF: 110.4 ± 7.2, p = 0.009. There was a positive correlation between plasma L-Arg and ADMA in CABG (r = 0.539, p = 0.015; and plasma and PF L-Arg in CABG (r = 0.357, p = 0.031; and plasma and PF ADMA in VR (r = 0.529, p = 0.003; and PF L-Arg and ADMA in both CABG and VR (CABG: r = 0.468, p = 0.006; VR: r = 0.371, p = 0.034. The following echocardiographic parameters were higher in VR compared to CABG: interventricular septum (14.7 ± 0.5 mm vs. 11.9 ± 0.4 mm, p = 0.000; posterior wall thickness (12.6 ± 0.3 mm vs. 11.5 ± 0.2 mm, p = 0.000; left ventricular (LV mass (318.6 ± 23.5 g vs. 234.6 ± 12.3 g, p = 0.007; right ventricular (RV (33.9 ± 0.9 cm2 vs. 29.7 ± 0.7 cm2, p = 0.004; right atrial (18.6 ± 1.0 cm2 vs. 15.4 ± 0.6 cm2, p = 0.020; left atrial (19.8 ± 1.0 cm2 vs. 16.9 ± 0.6 cm2, p = 0.033 areas. There was a positive correlation

  16. Perfectionism, Type D personality, and illness-related coping styles in cardiac rehabilitation patients.

    Science.gov (United States)

    Shanmugasegaram, Shamila; Flett, Gordon L; Madan, Mina; Oh, Paul; Marzolini, Susan; Reitav, Jaan; Hewitt, Paul L; Sturman, Edward D

    2014-03-01

    This study investigated the associations among trait perfectionism, perfectionistic self-presentation, Type D personality, and illness-specific coping styles in 100 cardiac rehabilitation patients. Participants completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Type D Scale-14, and the Coping with Health Injuries and Problems Scale. Correlational analyses established that emotional preoccupation coping was associated with trait perfectionism, perfectionistic self-presentation, and Type D personality. Perfectionism was linked with both facets of the Type D construct (negative emotionality and social inhibition). Our results suggest that perfectionistic Type D patients have maladaptive coping with potential negative implications for their cardiac rehabilitation outcomes.

  17. [Rosuvastatin in prevention of cardiac complications following surgical treatment of patients with vascular pathology].

    Science.gov (United States)

    Pokrovskiĭ, A V; Kuntsevich, G I; Zotikov, A E; Goloviuk, A L; Burtseva, E A; Ivanov, L O; Suntsov, D S

    2009-01-01

    The article deals with the findings of studying the use of rosuvastatin in patients after endured reconstructive operations on the brachiocephalic arteries and aortofemoral segment in order to prevent cardiac atherothrombotic complications. A total of thirty patients were given "Crestors" at a daily dose of 10 mg for two weeks prior to surgery and for two weeks postoperatively and were found to have a significant decrease in the average levels of total cholesterol and low-density lipoproteins, which was accompanied and followed by certain improvement in the functional state of the vascular wall, with no cardiac complications being observed in either case.

  18. 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.

  19. 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

    A maximal exercise test was performed in 54 patients with acute myocardial infarction (AMI) before discharge and in 49 age-matched control subjects. The long-term prognosis was assessed after an average follow-up of 7.6 years in AMI patients and 5.8 years in control subjects. The maximal work...... 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...

  20. 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 error (23.6 %). Significant 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. 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 ...

  4. 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.

  5. Mutations in the Kv1.5 channel gene KCNA5 in cardiac arrest patients

    DEFF Research Database (Denmark)

    Nielsen, Nathalie H; Winkel, Bo G; Kanters, Jørgen K

    2007-01-01

    identified the point mutations P91L and E33V in the KCNA5 gene encoding the Kv1.5 potassium channel that has not previously been associated with arrhythmia. We functionally characterized the mutations in HEK293 cells. The mutated channels behaved similarly to the wild-type with respect to biophysical......Mutations in one of the ion channels shaping the cardiac action potential can lead to action potential prolongation. However, only in a minority of cardiac arrest cases mutations in the known arrhythmia-related genes can be identified. In two patients with arrhythmia and cardiac arrest, we...... characteristics and drug sensitivity. Both patients also carried a D85N polymorphism in KCNE1, which was neither found to influence the Kv1.5 nor the Kv7.1 channel activity. We conclude that although the two N-terminal Kv1.5 mutations did not show any apparent electrophysiological phenotype, it is possible...

  6. Observation of right descending pulmonary arterial size and frontal cardiac area in patent ductus arteriosus patients

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Kyung Soo; Seol, Hae Yung; Suh, Won Huk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

    1979-12-15

    Frontal cardiac area, right descending pulmonary arterial size and size of the ductus arteriosus were measured on 29 patients with patent ductus arteriosus,21 females and 8 males. The results are as follows: 1. Frontal cardiac area in PDA patient in this series is increased in 0.63% to 100.11 % and the average is 38.91-23.54%. 2. Central branch of the right descending pulmonary artery is dilated in 28 cases (96.55%) on pre-operative stage, and combination with dilation of central branch and constriction of peripheral branch is in 18 cases (62.1%). 3. Degree of dilation of central branch is correlated with increase of age, but it is not related with size of ductus arteriosus. 4. Increase rate of frontal cardiac area is not related with size of ductus arteriosus.

  7. 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.

  8. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    André Luiz Lisboa Cordeiro

    Full Text Available Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results: 50 patients, 27 (54% males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073 and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031. Conclusion: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

  9. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery.

    Science.gov (United States)

    Boyce, J M; Potter-Bynoe, G; Opal, S M; Dziobek, L; Medeiros, A A

    1990-03-01

    A single strain of Staphylococcus epidermidis caused an outbreak of postoperative wound infections and endocarditis during a 6-month period. Infections caused by the epidemic strain developed more frequently in valve surgery patients than in those undergoing coronary artery bypass graft surgery (P = .03) and occurred only in patients operated on by surgeon A. None of 17 members of the cardiac surgery team carried the epidemic strain in their anterior nares, axillae, or inguinal folds. Hand cultures were performed on 8 surgical personnel, and only surgeon A carried the epidemic strain on his hands. Isolates from cardiac surgery patients, bypass pump blood cultures, and the hands of the implicated surgeon all had identical antimicrobial susceptibility patterns, plasmid profiles, and EcoRI restriction endonuclease digest patterns. In the 24 months after control measures were implemented, no infections caused by the epidemic strain occurred among open heart surgery patients. The findings suggest that the common-source outbreak of infections among cardiac surgery patients was due to carriage of a strain S. epidermidis on the hands of a cardiac surgeon.

  10. The effect of marine n-3 polyunsaturated fatty acids on cardiac autonomic and hemodynamic function in patients with psoriatic arthritis

    DEFF Research Database (Denmark)

    Kristensen, Salome; Schmidt, Erik Berg; Schlemmer, Annette;

    2016-01-01

    The aim of this study was to investigate the effect of marine n-3 polyunsaturated fatty acids (PUFA) on cardiac autonomic function and vascular function in patients with psoriatic arthritis.......The aim of this study was to investigate the effect of marine n-3 polyunsaturated fatty acids (PUFA) on cardiac autonomic function and vascular function in patients with psoriatic arthritis....

  11. 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.

  12. 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

  13. 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

  14. 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.)

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  20. Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes

    Science.gov (United States)

    Giakoumidakis, Konstantinos; Fotos, Nikolaos V; Patelarou, Athina; Theologou, Stavros; Argiriou, Mihalis; Chatziefstratiou, Anastasia A; Katzilieri, Christina; Brokalaki, Hero

    2017-01-01

    Purpose The purpose of the present study was to investigate the association between the perioperative neutrophil to lymphocyte ratio (NLR) and cardiac surgery patient outcomes. Patients and methods A retrospective cohort study of 145 patients who underwent cardiac surgery in a tertiary hospital of Athens, Greece, from January to March 2015, was conducted. By using a structured short questionnaire, this study reviewed the electronic hospital database and the medical and nursing patient records for data collection purposes. The statistical significance was two-tailed, and p-values care unit (ICU) (p=0.002), and in-hospital (p=0.018), and likewise with delayed tracheal extubation (p≤0.001). Furthermore, patients with elevated NLR during the second postoperative day had significantly higher in-hospital mortality (p=0.018), increased incidence of pneumonia (p=0.022), higher probability of readmission to the ICU (p=0.002), prolonged ICU LOS (p≤0.001), and delayed tracheal extubation (p≤0.001). Conclusion Increased perioperative NLR seems to be associated with significantly higher mortality and morbidity in cardiac surgery patients. At the same time, NLR is a significant and inexpensive biomarker for the early identification of patients at high risk for complications. In addition, NLR levels could lead clinicians to perform measures for the optimal therapeutic patient approach. PMID:28243161

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2014-07-01

    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.

  3. 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.

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

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    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.

  5. 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.

  6. 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

  7. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    Science.gov (United States)

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  8. 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...

  9. Exercise-based cardiac rehabilitation in patients with chronic heart failure : a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, A.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.A. (Tinus); Hendriks, E.J.M.

    2015-01-01

    Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate c

  10. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

    NARCIS (Netherlands)

    Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.

    2015-01-01

    RATIONALE: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. GUIDELINE DEVELOPMENT: A systematic literature search was performed to formulate

  11. 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

  12. Cardiac Rehabilitation Improves the QRS Fragmentation in Patients With ST Elevatıon Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mustafa Bulut

    2015-09-01

    Conclusion: The existence of the fQRS decreases after CR in patients with STEMI especially in hypertensive individuals, which may be related to improved electrical stability in the myocardium as a predictor of increase in survival and decrease in major cardiac events.

  13. 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

  14. [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.

  15. 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....

  16. 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...

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

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    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

  18. Evaluation of Red Blood Cell Distribution Width in Patients with Cardiac Syndrome X

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    Ping Qing

    2013-01-01

    Full Text Available BACKGROUND: Cardiac syndrome X (CSX is a condition characterized by chest pain with normal coronary arteries. However, its pathogenesis has not fully been understood yet. Red blood cell distribution width (RDW has recently been suggested as a marker of acute and chronic cardiovascular diseases, while no data is available in patients with CSX.

  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. 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

  1. Cardiac characterization of 16 patients with large NF1 gene deletions.

    Science.gov (United States)

    Nguyen, R; Mir, T S; Kluwe, L; Jett, K; Kentsch, M; Mueller, G; Kehrer-Sawatzki, H; Friedman, J M; Mautner, V-F

    2013-10-01

    The aim of this study was to characterize cardiac features of patients with neurofibromatosis 1 (NF1) and large deletions of the NF1 gene region. The study participants were 16 patients with large NF1 deletions and 16 age- and sex-matched NF1 patients without such deletions. All the patients were comprehensively characterized clinically and by echocardiography. Six of 16 NF1 deletion patients but none of 16 non-deletion NF1 patients have major cardiac abnormalities (p = 0.041). Congenital heart defects (CHDs) include mitral insufficiency in two patients and ventricular septal defect, aortic stenosis, and aortic insufficiency in one patient each. Three deletion patients have hypertrophic cardiomyopathy. Two patients have intracardiac tumors. NF1 patients without large deletions have increased left ventricular (LV) diastolic posterior wall thickness (p NF1, suggestive of eccentric LV hypertrophy. CHDs and other cardiovascular anomalies are more frequent among patients with large NF1 deletion and may cause serious clinical complications. Eccentric LV hypertrophy may occur in NF1 patients without whole gene deletions, but the clinical significance of this finding is uncertain. All patients with clinical suspicion for NF1 should be referred to a cardiologist for evaluation and surveillance.

  2. Factors related to monitoring during admission of acute patients

    DEFF Research Database (Denmark)

    Schmidt, Thomas; Bech, Camilla Louise Nørgaard; Brabrand, Mikkel

    2017-01-01

    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 nursing office had little influence on patients monitored ... the office reduced the level of monitoring. Higher levels of severity were related to higher degrees of monitoring, but being admitted to the surgical wing reduce how much patients were monitored, and periods with many concurrent patients lead to a small increase in monitoring. We found a significant...

  3. Association between frequency of atrial and ventricular ectopic beats and biventricular pacing percentage and outcomes in patients with cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Mittal, Suneet; Ruwald, Anne-Christine

    2014-01-01

    -defibrillator device with data available on biventricular pacing percentage and pre-implantation 24-h Holter recordings were included. Using logistic regression, we estimated the influence of ectopic beats on the percentage of biventricular pacing. Reverse remodeling was measured as reductions in atrial and left.......001) in patients with >1.5% ectopic beats compared with those with reverse remodeling (percent reduction in LVESV 31 ± 15%) than patients with ... biventricular pacing (reverse remodeling and higher risk of HF/death and VTA. This supports pre-implantation Holter monitoring of patients selected for CRT for optimal outcome. (MADIT-CRT: Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization...

  4. 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

  5. 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

  6. 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.

  7. Enteral nutrition. Potential complications and patient monitoring.

    Science.gov (United States)

    Kohn, C L; Keithley, J K

    1989-06-01

    Enteral feedings are safely tolerated by most patients. When complications occur, gastrointestinal disturbances are most frequently encountered, followed by mechanical and metabolic complications. Nurses can prevent many of the problems associated with enteral feeding through careful monitoring. Based on the current literature, the authors make the following recommendations: 1. All patients receiving tube feedings should be placed on a protocol that provides guidelines for (a) confirming correct tube placement; (b) preventing/managing tube obstruction; (c) handling and selecting formulas; (d) administering formulas; and (e) monitoring patients. 2. Fine-bore tubes are easily misplaced or dislodged; ensure correct positioning both before and during feeding. Food coloring should be added to all feedings to help detect aspiration/tube displacement. 3. Multiple factors can cause diarrhea in tube-fed patients and, therefore, require periodic assessment. These factors include concomitant drug therapy; malnutrition/hypoalbuminemia; formula-related factors (for example, lactose content, osmolality); and bacterial contamination. 4. Urine sugar and acetone levels should be checked every 6 hours (until stable). Vital signs and fluid intake and output should be determined every 8 hours, and weight should be measured on a daily basis. Serum electrolytes, blood urea nitrogen, and glucose levels should be determined daily, until serum levels stabilize. Weekly measurements of trace elements should be made to ensure adequate mineral replacement. 5. Use a controller pump to administer continuous feedings at a constant rate or to administer formulas that are viscous. Flush feeding tubes with water every 4 hours during continuous feedings, after giving intermittent feedings, after giving medications, and after checking for gastric residuals. If tube obstruction occurs, attempt to irrigate the tube with either water or cola. 6. Select feedings that contain appropriate nutrient sources

  8. 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.

  9. 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.

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

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    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.

  11. 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.

  12. Acute Mesenteric Ischemia after Cardiac Surgery: An Analysis of 52 Patients

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    Cuneyt Eris

    2013-01-01

    Full Text Available Objective. Acute mesenteric ischemia (AMI is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. Methods. From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. Results. The study included 6013 patients, of which 52 (0.86% patients suffered from AMI, 35 (67% of whom died. The control group (150 patients was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB. Preoperative parameters including age (, renal insufficiency (, peripheral vascular disease (, preoperative inotropic support (, poor left ventricular ejection fraction (, cardiogenic shock (, and preoperative intra-aortic balloon pump (IABP support ( revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (, dialysis (, inotropic support (, prolonged ventilator time (, and IABP support ( appeared significantly higher in the AMI group than the control group. Conclusions. Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.

  13. 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.

  14. 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.

  15. 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

    and prognosis after OHCA in NH. Methods Consecutive emergency medical service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. Results A total of 2......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......,541 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 return of spontaneous circulation (ROSC) compared to OHCA in non-nursing...

  16. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

    Science.gov (United States)

    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.

  17. 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

  18. 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

  19. 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.

  20. 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 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......, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality - being in a limbo and becoming a heart...

  1. Changes in quality of life associated with surgical risk in elderly patients undergoing cardiac surgery.

    Science.gov (United States)

    Romero, Paola Severo; de Souza, Emiliane Nogueira; Rodrigues, Juliane; Moraes, Maria Antonieta

    2015-10-01

    The study aims to verify quality of life of elderly patients submitted to cardiac surgery, and correlating surgical risk to health-related quality of life instrument domains. Prospective cohort study, performed at a cardiology hospital. It included elderly patients who had undergone elective cardiac surgery. Pre- and postoperative quality of life was evaluated by applying the World Health Organization Quality of Life-Old (WHOQOL-OLD) scale and the Short-Form Health Survey (SF-36) questionnaire. Surgical risk was stratified using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Fifty-four patients, mostly men (64.8%), were included, with a mean age of 69.3 ± 5.7 years. The eight domains of the SF-36 questionnaire, and the four facets presented for the WHOQOL-OLD scale showed improved quality of life 6 months after surgery (P quality of life instruments. The data showed improved quality of life of elderly people submitted to cardiac surgery, unrelated to surgical risk.

  2. 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.

  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. Echocardiographic Monitoring of Cardiac Parameters after Mitral Valve Replacement with the Preservation of Subvalvular Structures

    Institute of Scientific and Technical Information of China (English)

    Rasul Sadirhanovich Parpiyev; Mirdjamal Mirumarovich Zufarov; Khamidulla Amannullaevich Abdumadjivov; Sayora Abdullaeva; Khusan Gazihanovich Khalikulov

    2011-01-01

    @@ TO date many monitoring techniques have been used to determine the efficacy of surgical correction of mitral valve disease.The most common non-invasive method in use is echocardiography which can assess the myocardial and mitral valve function changes after mitral valve replacement procedures.In this study,we investigated the five-year follow-up echocardiographic results of 143 patients undergoing mitral valve replacement with preservation of subvalvuiar apparatus to analyze the recovery of myocardial and mitral valve functions.

  5. 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.

  6. Prevalence of Chest Pain, Depression, Somatization, Anxiety, Global Distress, and Substance Use among Cardiac and Pulmonary Rehabilitation Patients

    Directory of Open Access Journals (Sweden)

    Eva R. Serber

    2012-01-01

    Full Text Available Psychosocial factors of cardiovascular disease receive a preponderance of attention. Little attention is paid to psychosocial factors of pulmonary disease. This paper sought to describe psychosocial characteristics and to identify differences between cardiac and pulmonary patients entering a phase II rehabilitation program. Parametric and nonparametric analyses were conducted to examine scores on the Brief Symptom Inventory-18 (BSI-18 and the CAGE-D, administered at entry as standard clinical care. Participants were 163 cardiac and 63 pulmonary patients. Scores on the BSI-18 “chest pain” item indicated that more cardiac patients report chest pain than pulmonary patients. Among all subjects, chest pain ratings were positively related to anxiety, depression, and global distress. There were equivocal proportions of anxiety and somatization in patient groups. Pulmonary patients were more likely to endorse clinically significant levels of depression and global psychological distress than cardiac patients. Cardiac patients were significantly more likely to screen positively on the CAGE-D than pulmonary patients. Findings show a relationship between symptoms of chest pain and psychological distress. Despite equivalent proportions of anxiety and somatization between groups, a greater proportion of pulmonary patients reported symptoms of depression and global psychological distress, while more cardiac patients reported chest pain. Further research is needed to examine this paradigm.

  7. Cardiopulmonary response to exercise and cardiac assessment in patients with turner syndrome.

    Science.gov (United States)

    Tancredi, Giancarlo; Versacci, Paolo; Pasquino, Anna Maria; Vittucci, Anna Chiara; Pucarelli, Ida; Cappa, Marco; Di Mambro, Corrado; Marino, Bruno

    2011-04-01

    Turner syndrome (TS) is a chromosomal disorder; however, little is known about the exercise tolerance of patients with this syndrome. The aim of the present study was to measure the maximal aerobic capacity and cardiac function using cardiopulmonary exercise testing and lung function tests and to evaluate the cardiac parameters using echocardiography in patients with TS and control subjects. A total of 50 women with TS (mean age 21.3 ± 8.5 years) and 56 age-matched controls (mean age 21.1 ± 3.7 years) were enrolled from the Pediatric Department of "Sapienza" University of Rome and underwent cardiopulmonary exercise testing, lung function testing, and echocardiography. The maximal oxygen uptake was lower in the patients with TS than in the controls (28.4 ± 4.0 vs 35.6 ± 6.2 ml/min/kg; p <0.0001). Also, the forced expiratory volume in 1 second, expressed as a percentage of the predicted value, was greater in the patients with TS than in the controls (116.2 ± 15.2% vs 102.8 ± 4.8%, p <0.0001). The patients with TS had a smaller left ventricle than did the controls. Tissue Doppler imaging revealed subclinical systolic and diastolic dysfunction in the left ventricle in those with TS but not in the controls. The left ventricular mass index was greater in the patients with TS than in the controls (38.6 ± 9.3 vs 27.2 ± 4.5 g/m(2.7), p <0.0001). In conclusion, the patients with TS had a lower maximal aerobic capacity and exercise tolerance than did the controls. The anatomic and functional cardiac aspects were peculiar to those with TS and might represent a specific cardiac phenotype.

  8. 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

  9. Relationship between double product break point, lactate threshold, and ventilatory threshold in cardiac patients.

    Science.gov (United States)

    Omiya, Kazuto; Itoh, Haruki; Harada, Naomi; Maeda, Tomoko; Tajima, Akihiko; Oikawa, Keiko; Koike, Akira; Aizawa, Tadanori; Fu, Long-Tai; Osada, Naohiko

    2004-03-01

    A double product break point (DPBP) occurs simultaneously with both ventilatory threshold (VT) and lactate threshold (LT) in normal subjects. We sought to determine whether a DPBP also occurs in cardiac patients and to investigate correlations between DPBP, VT and LT (study 1). We also evaluated a non-invasive DPBP measurement system that determined blood pressure automatically by the cuff method (study 2). Study 1 comprised 15 patients [8 men and 7 women, mean (SD) age 47.7 (11.1) years] who performed cardiopulmonary exercise tests on a cycle ergometer. The double product was defined as the product of heart rate and direct systolic blood pressure. Arterial blood samples were obtained for measurement of lactate, pyruvate, pH, and norepinephrine levels. VT was determined by gas analysis, and LT was determined as the lactate/pyruvate ratio. DPBPs were detected in all 15 patients. Double product slopes above the DPBP were significantly greater than those below the DPBP (286.2 vs 98.5/W, P<0.001). The lactate/pyruvate ratio increased, arterial pH decreased, and plasma norepinephrine concentration increased above the DPBP. DPBP had strong positive correlations with VT ( r=0.93) and LT ( r=0.95). Study 2 comprised 65 cardiac patients. The DPBP was detected in 89.2% of patients and correlated closely with VT. We conclude that DPBP occurs near VT and LT in cardiac patients during incremental exercise, that the noninvasive DPBP measurement method is comparable to the invasive method, and that DPBP may be as useful an index of exercise intensity in patients with cardiac disease as VT or LT.

  10. Cardiac function and hypertension in patients with obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Bertolami A

    2014-08-01

    Full Text Available Adriana Bertolami, Carolina Gonzaga, Celso AmodeoSleep Laboratory of Dante Pazzanese Institute of Cardiology, Sao Paulo, BrazilAbstract: Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA is a common but still underestimated condition. OSA often coexists and interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflammation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea or complete interruption (apnea of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardiovascular disease should be better assessed.Keywords: obstructive sleep apnea, hypertension, cardiac function

  11. [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.

  12. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H.; Pedersen, Susanne S.; Meine, Mathias

    2016-01-01

    PURPOSE: It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. METHODS: A cohort...... levels after implantation. CONCLUSIONS: Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients' psychological profile and NYHA classification...

  13. Simulation of Daily Snapshot Rhythm Monitoring to Identify Atrial Fibrillation in Continuously Monitored Patients with Stroke Risk Factors.

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    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.

  14. 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.

  15. 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...

  16. [Successful mitral valve replacement in a patient with functional mitral regurgitation induced by cardiac sarcoidosis;report of a case].

    Science.gov (United States)

    Sato, Ken; Takazawa, Ippei; Aizawa, Kei; Misawa, Yoshio

    2015-03-01

    We report a case of cardiac sarcoidosis associated with mitral valve regurgitation. A 62-year-old woman with cardiac sarcoidosis was admitted for the treatment of an intractable mitral regurgitation. She had been treated for cardiac sarcoidosis with prednisolone, and she had undergone pacemaker implantation because of advanced complete A-V block 5 years before. However, her hemodynamics deteriorated, and echocardiography revealed severe functional mitral regurgitation, thinning of the ventricular septum, and left ventricular dysfunction. The patient underwent mitral valve replacement with a mechanical prosthetic valve, and her postoperative course was uneventful. She is currently well without exacerbation of heart failure at 2 years after operation. Functional mitral regurgitation is a relatively common complication in patients with cardiac sarcoidosis. Mitral valve replacement should be considered in patients with medically intractable mitral valve dysfunction due to cardiac sarcoidosis.

  17. Clinical Profile of Patients with Tetralogy of Fallot admitted for Surgery at a Cardiac surgical centre

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    B E Otaigbe

    2011-04-01

    Full Text Available INTRODUCTION: Tetralogy of Fallot (TOF, a conotruncal defect, has been documented to be associated with chromosome abnormalities, single gene syndrome (22q11 microdeletion, known teratogens, with the rest associations being multifactorial. This study was carried out to determine the clinical profile and associated risk factors in patients with TOF admitted for surgical repairs. METHODS: Case files of all patients admitted for Tetralogy of Fallot over a period of one year were retrieved from the Medical Records Department and reviewed. Data on the patients' and their family history and associated cardiac anomalies were noted. RESULTS: There were 54 patients, 37 males and 17 females, with a mean age of 6.8 years +/- 7.1. Sixty percent were born between July and December, 81.5% as full term and 44% as first born. Twenty-six percent were born into consanguineous marriages. Five patients had dysmorphic features. Associated cardiac anomalies included right aortic arch, pulmonary atresia, dextrocardia and left superior vena cavae. CONCLUSION: The associated risk factors noted in this study were male sex, birthdates between July and December, first born and increased paternal age. Other risk factors were consanguinity and specific patterns of cardiovascular diseases associated with 22q 11 deletions. This suggests a multifactorial etiology for TOF. Keywords: associated risk factors, cardiac anomalies, demographic factors, Tetralogy of Fallot

  18. Heart rate complexity and cardiac sympathetic dysinnervation in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Baumert, Mathias; Sacre, Julian W

    2013-01-01

    Cardiovascular autonomic neuropathy (CAN) is one of the most severe complications of type 2 diabetes mellitus (T2DM). The aim of this study was to investigate associations of cardiac sympathetic dysinnervation (CSD; by (123)I-MIBG scintigraphy) with short-term heart rate variability (HRV) measured by traditional vs. complexity markers. ECG was measured in 31 diabetic patients during rest over a period of 5 minutes and HRV quantified in different domains (time and frequency domain, scaling properties, symbolic dynamics). (123)I-MIBG scintigraphy identified 16 patients with CSD. Resting heart rate was increased and HRV reduced in these patients. In a subgroup of 16 patients ECG was also measured during standing. Changes in several HRV measures upon standing demonstrated cardiac responsiveness to orthostatic stress. Strong correlations between HRV, measured during standing, and CSD were observed with metrics based on symbolic dynamics. In conclusion, HRV assessment during standing may be useful for assessing cardiac sympathetic dysinnervation in patients with type 2 diabetes mellitus.

  19. What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

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    André La Gerche

    2010-01-01

    Full Text Available 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 dependent upon flow through the pulmonary circulation and this requires adequate RV performance. In the Fontan patient, the reasons for exercise intolerance are complex. In those patients with myocardial dysfunction or other pathologies of the circulatory components, it is likely that these abnormalities serve as a limitation to cardiac performance during exercise. However, in the healthy Fontan patient, it may be the absence of a sub-pulmonary pump which limits normal increases in pulmonary pressures, trans-pulmonary flow requirements and cardiac output. If so, performance will be exquisitely dependent on pulmonary vascular resistance. This provides a potential explanation as to why pulmonary vasodilators may improve exercise tolerance. As has recently been demonstrated, these agents may offer an important new treatment strategy which directly addresses the physiological limitations in the Fontan patient.

  20. Clinical benefits of a metabolic approach in the cardiac rehabilitation of patients with coronary artery disease.

    Science.gov (United States)

    Belardinelli, Romualdo; Lacalaprice, Francesca; Faccenda, Ernesto; Volpe, Loretta

    2006-09-04

    Patients referred for cardiac rehabilitation may benefit from combining trimetazidine with exercise training because both treatments produce synergic benefits on the cardiovascular system. There is evidence that trimetazidine improves left ventricular (LV) function in patients with ischemic and diabetic cardiomyopathy by shifting the cellular energy substrate reference from fatty acids to glucose oxidation, and that this effect is associated with a better outcome. Recently, results have demonstrated that trimetazidine improves radial artery endothelium-dependent relaxation related to its antioxidant properties. Similarly, exercise training has been demonstrated to improve diastolic filling and systolic function in patients with ischemic cardiomyopathy, in relation to enhanced perfusion and contractility of dysfunctional myocardium. Patients with viable myocardium, in theory, should have the greatest benefits because trimetazidine improves contractility of dysfunctional hibernating/stunned myocardium, whereas exercise has documented efficacy in improving endothelial vasomotor response of coronary arteries, stimulating coronary collateral circulation and small vessel growth, improving LV function, and increasing functional capacity. At present, there are no published reports about the efficacy of the combination of trimetazidine with exercise training. In this article, we discuss the rationale for using trimetazidine in cardiac rehabilitation, the identification of patients referred for cardiac rehabilitation who might benefit the most from the addition of trimetazidine to standard therapy, and the documented benefits.

  1. Safety of magnetic resonance imaging in patients with implanted cardiac prostheses and metallic cardiovascular electronic devices.

    Science.gov (United States)

    Baikoussis, Nikolaos G; Apostolakis, Efstratios; Papakonstantinou, Nikolaos A; Sarantitis, Ioannis; Dougenis, Dimitrios

    2011-06-01

    Magnetic resonance imaging (MRI) in patients with implanted cardiac prostheses and metallic cardiovascular electronic devices is sometimes a risky procedure. Thus MRI in these patients should be performed when it is the only examination able to help with the diagnosis. Moreover the diagnostic benefit must outweigh the risks. Coronary artery stents, prosthetic cardiac valves, metal sternal sutures, mediastinal vascular clips, and epicardial pacing wires are not contraindications for MRI, in contrast to pacemakers and implantable cardioverter-defibrillators. Appropriate patient selection and precautions ensure MRI safety. However it is commonly accepted that although hundreds of patients with pacemakers or implantable cardioverter-defibrillators have undergone safe MRI scanning, it is not a safe procedure. Currently, heating of the pacemaker lead is the major problem undermining MRI safety. According to the US Food and Drug Administration (FDA), there are currently neither "MRI-safe" nor "MRI-compatible" pacemakers and implantable cardioverter-defibrillators. In this article we review the international literature in regard to safety during MRI of patients with implanted cardiac prostheses and metallic cardiovascular electronic devices.

  2. ZigBee-based remote patient monitoring.

    Science.gov (United States)

    Fernandez-Lopez, Helena; Afonso, José Augusto; Correia, José Higino; Simões, Ricardo

    2012-01-01

    This paper describes a developed continuous patient monitoring system based on the ZigBee protocol. The system was tested in the hospital environment using six sensor devices in two different modes. For electrocardiogram transmission and in the absence of hidden-nodes, the system achieved a mean delivery ratio of 100% and 98.56%, respectively for star and 2-hop tree network topologies. When sensor devices were arranged in a way that three of them were unable to hear the transmissions made by the other three, the mean delivery ratio dropped to 83.96%. However, when sensor devices were reprogrammed to transmit only heart rate values, the mean delivery ratio increased to 99.90%, despite the presence of hidden-nodes.

  3. 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.

  4. Heart Rate Variability for Early Detection of Cardiac Iron Deposition in Patients with Transfusion-Dependent Thalassemia

    Science.gov (United States)

    Silvilairat, Suchaya; Charoenkwan, Pimlak; Saekho, Suwit; Tantiworawit, Adisak; Phrommintikul, Arintaya; Srichairatanakool, Somdet; Chattipakorn, Nipon

    2016-01-01

    Background Iron overload cardiomyopathy remains the major cause of death in patients with transfusion-dependent thalassemia. Cardiac T2* magnetic resonance imaging is costly yet effective in detecting cardiac iron accumulation in the heart. Heart rate variability (HRV) has been used to evaluate cardiac autonomic function and is depressed in cases of thalassemia. We evaluated whether HRV could be used as an indicator for early identification of cardiac iron deposition. Methods One hundred and one patients with transfusion-dependent thalassemia were enrolled in this study. The correlation between recorded HRV and hemoglobin, non-transferrin bound iron (NTBI), serum ferritin and cardiac T2* were evaluated. Results The median age was 18 years (range 8–59 years). The patient group with a 5-year mean serum ferritin >5,000 ng/mL included significantly more homozygous β-thalassemia and splenectomized patients, had lower hemoglobin levels, and had more cardiac iron deposit than all other groups. Anemia strongly influenced all domains of HRV. After adjusting for anemia, neither serum ferritin nor NTBI impacted the HRV. However cardiac T2* was an independent predictor of HRV, even after adjusting for anemia. For receiver operative characteristic (ROC) curve analysis of cardiac T2* ≤20 ms, only mean ferritin in the last 12 months and the average of the standard deviation of all R-R intervals for all five-minute segments in the 24-hour recording were predictors for cardiac T2* ≤20 ms, with area under the ROC curve of 0.961 (p<0.0001) and 0.701 (p = 0.05), respectively. Conclusions Hemoglobin and cardiac T2* as significant predictors for HRV indicate that anemia and cardiac iron deposition result in cardiac autonomic imbalance. The mean ferritin in the last 12 months could be useful as the best indicator for further evaluation of cardiac risk. The ability of serum ferritin to predict cardiac risk is stronger than observed in other thalassemia cohorts. HRV might be a

  5. Monitoring high-risk patients: minimally invasive and non-invasive possibilities.

    Science.gov (United States)

    Renner, Jochen; Grünewald, Matthias; Bein, Berthold

    2016-06-01

    Over the past decades, there has been considerable progress in the field of less invasive haemodynamic monitoring technologies. Substantial evidence has accumulated, which supports the continuous measurement and optimization of flow-based variables such as stroke volume, that is, cardiac output, in order to prevent occult hypoperfusion and consequently to improve patients' outcome in the perioperative setting. However, there is a striking gap between the developments in haemodynamic monitoring and the increasing evidence to implement defined treatment protocols based on the measured variables, and daily clinical routine. Recent trials have shown that perioperative morbidity and mortality is higher than anticipated. This emphasizes the need for the anaesthesia community to address this issue and promotes the implementation of proven concepts into clinical practice in order to improve patients' outcome, especially in high-risk patients. The advances in minimally invasive and non-invasive monitoring techniques can be seen as a driving force in this respect, as the degree of invasiveness of any monitoring tool determines the frequency of its application, especially in the operating room (OR). From this point of view, we are very confident that some of these minimally invasive and non-invasive haemodynamic monitoring technologies will become an inherent part of our monitoring armamentarium in the OR and in the intensive care unit (ICU).

  6. Evaluation of cardiac function tests in Sudanese adult patients with sickle cell trait

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    Kamal E.A. Abdelsalam

    2016-10-01

    Full Text Available Background: Cardiac dysfunctions have been recognized as a common complication of sickle cell anaemia (SCA, and together with pulmonary disorder accounts for many deaths in these patients. However, sickle cell traits appear clinically normal, although they have genetic abnormality. The aim of this study was to assess the effect of sickle cell trait on cardiac prognostic markers by measuring high density lipoprotein (HDL-C, low density lipoprotein (LDL-C, cardiac creatine kinase (CK-MB, ultra-sensitive C reactive protein (us-CRP, total homocysteine (Hyc, and N-terminal pro-brain natriuretic peptide (NT-pro BNP tests in adult Sudanese patients with sickle cell trait.Methods: A cross-sectional study was performed in 200 healthy volunteers as a control group and 200 diagnosed patients with sickle cell trait. It was carried out in Khartoum Specialized Hospital, Al-Bayan Hospital, Obayed Clinical Center and Dr. Nadir Specialized Hospital, Sudan between January 2015 and January 2016. All participants were between 20-32 years old. LDL-C, HDL-C, CK-MB, NT-proBNP and hs-CRP concentrations were measured by Hitachi 912 full-automated Chemistry Analyzer (Roche Diagnostics, Germany as manufacturer procedure, while homocysteine level was measured by ELISA technique using special kit.Results: When compared to control group, the levels of LDL-C, hs-CRP and NT-proBNP revealed significant increase in patients’ sera (p<0.001, while Hyc and CK-MB levels were increased insignificantly in patients with SCT (p=0.069, p=0.054 respectively. On the other hand, comparison to control group, HDL-C showed insignificant reduction in patients (p=0.099.Conclusion: The results suggest that sickle cell trait increased the risk of patient-related complication secondary to cardiac dysfunction.

  7. CORRELATION OF MEAN PLATELET VOLUME IN PATIENTS WITH CARDIAC SYNDROME X IN INDIAN POPULATION

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    Ram Anil Raj

    2016-08-01

    Full Text Available Platelets play a pivotal role in the development of atherosclerotic lesions, plaque destabilization and atherothrombosis. The methods of testing platelet activity can be time-consuming, expensive and technically difficult. Unlike more expensive or timeconsuming methods of assessing platelet function, the determination of platelet size by quantification of Mean Platelet Volume (MPV, using automated haemograms, is simple and inexpensive. “Cardiac syndrome X” characterized with 1. Angina or angina-like chest pain, 2. ST segment depression that can be induced by treadmill exercise testing, 3. Normal coronary arteriography. As cardiac syndrome X and angina pectoris caused by typical obstructive coronary heart disease should be distinguished from each other for effective treatment. Although there has not been a clear explanation of the exact pathophysiological mechanism underlying cardiac Syndrome X, studies are suggestive that coronary micro-circular abnormalities and endothelial dysfunction play a role in the aetiology of the disease. Atherosclerosis and endothelial vasomotor dysfunction have been suggested as possible contributing factors. There are limited datas in literature to compare the MPV in cardiac syndrome X. This study was designed to compare MPVs of patients with Cardiac syndrome X, patient with CAD and of normal controls. METHODS Nine hundred and forty four patients who had undergone coronary angiography between May 2014 and April 2016 in Rajarajeshwari Medical College and Hospital, Bangalore, were retrospectively examined. Of these, 118 patients were enrolled in the study and were divided into three groups. The Cardiac Syndrome X group consisted of 40 subjects (18 men and 22 women with mean age group 45+4.2 years. The CAD group consisted of 33 subjects (18 men and 15 women with mean age of 46+4.8 years with CAD, which was defined as >50% stenosis in a minimum of one coronary artery. The control group consisted of 45 age and sex

  8. Patient position alters attenuation effects in multipinhole cardiac SPECT

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    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

  9. Progression of isolated aortic stenosis: analysis of 29 patients having more than 1 cardiac catheterization.

    Science.gov (United States)

    Nestico, P F; DePace, N L; Kimbiris, D; Hakki, A H; Khanderia, B; Iskandrian, A S; Segal, B

    1983-11-01

    Factors related to progression of nonrheumatic aortic stenosis (AS) were analyzed in 29 adult patients who underwent serial hemodynamic studies over a mean of 71 months. AS was congenital in 8 patients and degenerative in 21. The patients were divided into 2 groups on the basis of the change in aortic valve area between the 2 studies. Twelve patients had a greater than or equal to 25% reduction in aortic valve area (Group I) and 17 patients had less than 25% decrease in aortic valve area (Group II). There were no significant differences between the 2 groups in age, interval between studies, cardiac output, left ventricular end-diastolic pressure, left ventricular peak systolic pressure and origin of AS (congenital or degenerative). Group I patients had significantly larger initial aortic valve areas than did Group II patients (1.3 +/- 0.9 cm2 versus 0.8 +/- 0.4 cm2, p = 0.02). Also, the initial peak transaortic pressure gradients were lower in Group I than in Group II (27 +/- 19 versus 58 +/- 38 mm Hg, p = 0.01). Group I patients had a significantly greater increase in pressure gradient and a greater reduction in cardiac output than did Group II patients (24 +/- 21 mm Hg in Group I versus -0.1 +/- 24.5 mm Hg in Group II, p = 0.01, and -1.0 +/- 1.3 liters/min in Group I versus 0.10 +/- 1.4 liters/min in Group II, p = 0.03). Thus, AS progressed in 41% of a selected group of patients who underwent repeated cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation (AF): insights from more than 200 continuously monitored patients.

    Science.gov (United States)

    Pecha, Simon; Aydin, Muhammet Ali; Ahmadzade, Teymour; Hartel, Friederike; Hoffmann, Boris; Steven, Daniel; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian Mathias

    2016-08-01

    Different follow-up methods have been used to report success rates after AF ablation. Recent studies have shown that intermittent rhythm monitoring underestimates the actual AF recurrence rate. We therefore report our experience with continuous rhythm monitoring by implantable loop recorder (ILR) in a large patient cohort. Between 09/2008 and 12/2012, 343 cardiac surgical patients underwent concomitant surgical AF ablation. ILR implantation was performed in 206 patients. ILR interrogation was accomplished at 3, 6 and 12 months postoperatively. Successful ablation was defined as AF Burden <0.5 %. Primary outcome of the study was freedom from AF at 12-month follow-up. Mean patient's age was 70.5 ± 7.4 years. No major ablation- or ILR-related complications occurred. In 4 patients (1.9 %) ILR had to be explanted due to ILR-related wound infection (n = 2) or chronic pain (n = 2). Survival rate at 1-year follow-up was 96.6 %. Freedom from AF rate after 1-year follow-up was 68.5 and 63.6 % off antiarrhythmic drugs, respectively. Statistically significant predictors for successful ablation at 1-year follow-up were smaller LA diameter, shorter duration of AF and preoperative paroxysmal AF. Demographic data, indication for surgery, lesion set and used energy source had no impact on freedom from AF after 1 year. Continuous ILR monitoring after concomitant surgical AF ablation was safe and feasible, with registered freedom from AF rate of 68.5 % at 1-year follow-up. Thus continuous rhythm monitoring provides reliable outcome data and helps to guide antiarrhythmic therapy.

  11. Deficient knowledge nursing diagnosis: identifying the learning needs of patients with cardiac disease.

    Science.gov (United States)

    Galdeano, Luzia Elaine; Rossi, Lídia Aparecida; Spadoti Dantas, Rosana Aparecida

    2010-01-01

    OBJECTIVES. To identify the learning needs of patients with cardiac disease and the aspects of the disease and anesthetic and surgical procedures about which Brazilian patients have the greatest gaps in knowledge. METHODS. Eighty preoperative patients answered a General Evaluation Questionnaire, a Questionnaire to Evaluate Patient Knowledge, and the Mini-Mental State Exam. FINDINGS. Fifty-nine patients had learning needs. More than 50% of the patients were mistaken or unable to answer questions about the disease, and the goals of and type of surgery to be performed and anesthesia to be used. CONCLUSIONS. Most patients had poor performance on the questionnaire that assessed their knowledge about coronary artery disease and its treatment. PRACTICE IMPLICATIONS. This study can contribute to health professionals' assessment of patients' knowledge.

  12. 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...

  13. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

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    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

  14. Cardiac iron overload in chronically transfused patients with thalassemia, sickle cell anemia, or myelodysplastic syndrome

    Science.gov (United States)

    de Montalembert, Mariane; Ribeil, Jean-Antoine; Brousse, Valentine; Guerci-Bresler, Agnes; Stamatoullas, Aspasia; Vannier, Jean-Pierre; Dumesnil, Cécile; Lahary, Agnès; Touati, Mohamed; Bouabdallah, Krimo; Cavazzana, Marina; Chauzit, Emmanuelle; Baptiste, Amandine; Lefebvre, Thibaud; Puy, Hervé; Elie, Caroline

    2017-01-01

    The risk and clinical significance of cardiac iron overload due to chronic transfusion varies with the underlying disease. Cardiac iron overload shortens the life expectancy of patients with thalassemia, whereas its effect is unclear in those with myelodysplastic syndromes (MDS). In patients with sickle cell anemia (SCA), iron does not seem to deposit quickly in the heart. Our primary objective was to assess through a multicentric study the prevalence of cardiac iron overload, defined as a cardiovascular magnetic resonance T2*8 ECs in the past year, and age older than 6 years. We included from 9 centers 20 patients with thalassemia, 41 with SCA, and 25 with MDS in 2012-2014. Erythrocytapharesis did not consistently prevent iron overload in patients with SCA. Cardiac iron overload was found in 3 (15%) patients with thalassemia, none with SCA, and 4 (16%) with MDS. The liver iron content (LIC) ranged from 10.4 to 15.2 mg/g dry weight, with no significant differences across groups (P = 0.29). Abnormal T2* was not significantly associated with any of the measures of transfusion or chelation. Ferritin levels showed a strong association with LIC. Non-transferrin-bound iron was high in the thalassemia and MDS groups but low in the SCA group (P<0.001). Hepcidin was low in thalassemia, normal in SCA, and markedly elevated in MDS (P<0.001). Two mechanisms may explain that iron deposition largely spares the heart in SCA: the high level of erythropoiesis recycles the iron and the chronic inflammation retains iron within the macrophages. Thalassemia, in contrast, is characterized by inefficient erythropoiesis, unable to handle free iron. Iron accumulation varies widely in MDS syndromes due to the competing influences of abnormal erythropoiesis, excess iron supply, and inflammation. PMID:28257476

  15. Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support

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    Peek Giles J

    2007-01-01

    Full Text Available Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD and identified the risk factors associated with hospital mortality. Methods From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031. Conclusion ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.

  16. Validity of Type D personality in Iceland: association with disease severity and risk markers in cardiac patients.

    Science.gov (United States)

    Svansdottir, Erla; Karlsson, Hrobjartur D; Gudnason, Thorarinn; Olason, Daniel T; Thorgilsson, Hordur; Sigtryggsdottir, Unnur; Sijbrands, Eric J; Pedersen, Susanne S; Denollet, Johan

    2012-04-01

    Type D personality has been associated with poor prognosis in cardiac patients. This study investigated the validity of the Type D construct in Iceland and its association with disease severity and health-related risk markers in cardiac patients. A sample of 1,452 cardiac patients completed the Type D scale (DS14), and a subgroup of 161 patients completed measurements for the five-factor model of personality, emotional control, anxiety, depression, stress and lifestyle factors. The Icelandic DS14 had good psychometric properties and its construct validity was confirmed. Prevalence of Type D was 26-29%, and assessment of Type D personality was not confounded by severity of underlying coronary artery disease. Regarding risk markers, Type D patients reported more psychopharmacological medication use and smoking, but frequency of previous mental problems was similar across groups. Type D is a valid personality construct in Iceland, and is associated with health-related risk markers, but not cardiac disease severity.

  17. 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.

  18. 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)

  19. 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.

  20. 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...

  1. Phenylephrine Administration Increases Cardiac Output in Parasympathically Blocked Patients

    NARCIS (Netherlands)

    Kalmar, A.F.; Poterman, Marieke; Scheeren, Thomas

    2013-01-01

    Introduction:  Phenylephrine (PHE), a pure α1-agonist, is widely used to treat hypotension in anesthetized patients although controversy on its beneficial versus deleterious effects on blood flow and tissue perfusion is still vivid. Conventionally, PHE is considered to increase the arterial blood pr

  2. Stress Echocardiography and Major Cardiac Events in Patients with Normal Exercise Test

    Science.gov (United States)

    Calasans, Flávia Ricci; Santos, Bruno Fernandes de Oliveira; Silveira, Débora Consuelo Rocha; de Araújo, Ana Carla Pereira; Melo, Luiza Dantas; Barreto-Filho, José Augusto; Sousa, Antônio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2013-01-01

    Background Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. Objective To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. Methods 397 patients with intermediate CAD pretest probability, estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). Results G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). Conclusion Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET. PMID:23765384

  3. 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.

  4. Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation

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    Mabel Chung

    2014-01-01

    Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO provides mechanical support to the patient with cardiac or cardiopulmonary failure. This paper reviews the physiology of VA ECMO including the determinants of ECMO flow and gas exchange. The efficacy of this therapy may be determined by assessing patient hemodynamics and device flow, overall gas exchange support, markers of adequate oxygen delivery, and pulsatility of the arterial blood pressure waveform.

  5. Predictors of Acute Renal Failure During Extracorporeal Membrane Oxygenation in Pediatric Patients After Cardiac Surgery.

    Science.gov (United States)

    Lv, Lin; Long, Cun; Liu, Jinping; Hei, Feilong; Ji, Bingyang; Yu, Kun; Hu, Qiang; Hu, Jinxiao; Yuan, Yuan; Gao, Guodong

    2016-05-01

    Acute renal failure (ARF) is associated with increased mortality in pediatric extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of ARF during ECMO in pediatric patients after cardiac surgery. A retrospective study analyzed 42 children (≤15 years) after cardiac surgery requiring venous-arterial ECMO between December 2008 and December 2014 at Fuwai Hospital. ARF was defined as ≥300% rise in serum creatinine (SCr) concentration from baseline or application of dialysis. Multivariate logistic regression was performed to identify the predictors of ARF during ECMO. A total of 42 children (age, interquartile range [IQR], 13.0 [7.2-29.8] months; weight, IQR, 8.5 [6.7-11.0] kg) after cardiac surgery requiring ECMO were included in this study. The total survival rate was 52.4%, and the incidence of ARF was 40.5%. As the result of univariate analysis, ECMO duration, cardiopulmonary resuscitation, maximum free hemoglobin (FHB) during ECMO, lactate level, and mean blood pressure before initiation of ECMO were entered in multiple logistic regression analysis. In multiple logistic regression analysis, FHB during ECMO (OR 1.136, 95% CI 1.023-1.261) and lactate level before initiation of ECMO (OR 1.602, 95% CI 1.025-2.502) were risk factors for ARF during ECMO after pediatric cardiac surgery. There was a linear correlation between maximum SCr and maximum FHB (Pearson's r = 0.535, P = 0.001). Maximum SCr during ECMO has also a linear correlation with lactate level before initiation of ECMO (Pearson's r = 0.342, P = 0.044). Increased FHB during ECMO and high lactate level before initiation of ECMO were risk factors for ARF during ECMO in pediatric patients after cardiac surgery.

  6. Intraoperative cardiac arrest and mortality in trauma patients. A 14-yr survey from a Brazilian tertiary teaching hospital.

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    Marcelo T O Carlucci

    Full Text Available BACKGROUND: Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009. METHODS: Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related. FINDINGS: Fifty-one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (P<0.001 and young adults (18-35 years (P=0.04 with ASA physical status IV or V (P<0.001 undergoing gastroenterological or multiclinical surgeries (P<0.001. Motor vehicle crashes and violence were the main causes of trauma (P<0.001. Uncontrolled hemorrhage or head injury were the most significant associated factors of intraoperative cardiac arrest and mortality (P<0.001. All cardiac arrests and deaths reported were totally related to trauma patient condition. CONCLUSIONS: Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence.

  7. Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients.

    Science.gov (United States)

    Kramer, Philip A; Chacko, Balu K; George, David J; Zhi, Degui; Wei, Chih-Cheng; Dell'Italia, Louis J; Melby, Spencer J; George, James F; Darley-Usmar, Victor M

    2015-07-01

    Monitoring the bioenergetics of leucocytes is now emerging as an important approach in translational research to detect mitochondrial dysfunction in blood or other patient samples. Using the mitochondrial stress test, which involves the sequential addition of mitochondrial inhibitors to adherent leucocytes, we have calculated a single value, the Bioenergetic Health Index (BHI), which represents the mitochondrial function in cells isolated from patients. In the present report, we assess the BHI of monocytes isolated from the post-operative blood and post-operative pericardial fluid (PO-PCF) from patients undergoing cardiac surgery. Analysis of the bioenergetics of monocytes isolated from patients' PO-PCF revealed a profound decrease in mitochondrial function compared with monocytes isolated from their blood or from healthy controls. Further, patient blood monocytes showed no significant difference in the individual energetic parameters from the mitochondrial stress test but, when integrated into the BHI evaluation, there was a significant decrease in BHI compared with healthy control monocytes. These data support the utility of BHI measurements in integrating the individual parameters from the mitochondrial stress test into a single value. Supporting our previous finding that the PO-PCF is pro-oxidant, we found that exposure of rat cardiomyocytes to PO-PCF caused a significant loss of mitochondrial membrane potential and increased reactive oxygen species (ROS). These findings support the hypothesis that integrated measures of bioenergetic health could have prognostic and diagnostic value in translational bioenergetics.

  8. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy

    OpenAIRE

    Mastenbroek, M.H.; Pedersen, S S; Meine, M.M.; Versteeg, H.

    2016-01-01

    PURPOSE: It is well known that a significant proportion of heart failure patients (10-44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation.METHODS: A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12-14 months p...

  9. 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.

  10. Dental treatment in patients with cardiac pacemakers: Is it a risky affair?

    Directory of Open Access Journals (Sweden)

    Reet Kamal

    2016-01-01

    Full Text Available Cardiac pacemakers are the implanted devices used to treat patients with damaged heart muscles. These electronic devices are sensitive to strong electromagnetic signals. The dental literature also included articles regarding electromagnetic interferences to pacemakers, due to dental devices such as ultrasonic scalers, electrosurgical unit, ultrasonic bath cleaners, and battery driven light cure composite unit. Although pacemakers of new generation have more protective features than those of past, but still precautionary measures should be taken in dental clinics for the safety of cardiac patients with pacemaker. The aim of this paper is to identify the possible sources from dental clinics which can adversely interfere with the pacemaker activity and to provide some guidelines for safe dental practice in this high-risk group.

  11. Cardiac valve degeneration in a patient with Sneddon syndrome.

    Science.gov (United States)

    Diosteanu, Raluca; Schuler, Gerhard; Müller, Ulrike

    2015-06-01

    Sneddon syndrome--a rare cause of aortic and mitral valve stenosis. Sneddon syndrome is a rare disorder that leads to repeated occurrence of cerebrovascular disease and skin manifestation, defined as livedo racemosa generalisata. The authors report the occurrence of multiple valve degenerations in a 49-year-old patient with Sneddon syndrome, which seemed to have been asymptomatic through a long period of time and was diagnosed as it needed a complex surgical intervention.

  12. Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

    Science.gov (United States)

    Bein, Berthold; Gruenewald, Matthias; Masing, Sarah; Huenges, Katharina; Haneya, Assad; Steinfath, Markus; Renner, Jochen

    2016-01-01

    Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1–9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).

  13. 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.

  14. Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

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    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.

  15. 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.

  16. Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction

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    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. The curious case of a cardiac tamponade in the hypertensive patient presenting as abdominal fullness.

    Science.gov (United States)

    Li, William; Subedi, Rogin; Madhira, Bhaskara

    2017-01-19

    Cardiac tamponade is a medical emergency consisting of an accumulation of fluid in the pericardial space which is rapidly progressing and fatal. Because cardiac tamponade is ultimately a clinical diagnosis, mindful consideration for atypical presentations is essential for the reduction of mortality in the acute setting. Our patient was a 77year-old female admitted after presenting with general malaise, weakness, somnolence, altered mental status and urinary incontinence found to have CML (chronic myeloid leukemia) on confirmatory bone marrow biopsy after suspicions arose from a leukocytosis of 34,000 cells per mcL with 85% neutrophils and elevated blasts (8%). Initial vital signs revealed mild tachycardia, mild tachypnea and blood pressure elevated to 162/84mm Hg along with a temperature of 38.7°C and oxygen saturation of 96% on 2l by nasal cannula. She received the standard of care for a community acquired pneumonia and was started on treatment with decitabine as further work-up was unremarkable. An abdominal CT performed for abdominal fullness later displayed a large pericardial effusion. Repeat echocardiography exhibited right atrial diastolic collapse, inferior vena cava dilatation (IVC) without inspiratory collapse >50% and the large pericardial effusion consistent with tamponade. The blood pressure remained hypertensive until she suddenly went into cardiac arrest after being intubated for a pericardial window and expired. Our case highlights the need to keep cardiac tamponade as a differential in the hypertensive individual with abdominal complaints as atypical presentations can obscure diagnosis, delay treatment and increase mortality.

  19. Cardiac resynchronization therapy in a young patient with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Kono T

    2015-08-01

    Full Text Available Tamami Kono,1 Akiyoshi Ogimoto,1 Kazuhisa Nishimura,1 Toshihiro Yorozuya,2 Takafumi Okura,1 Jitsuo Higaki1 1Department of Cardiology, Pulmonology, Hypertension and Nephrology, 2Department of Anesthesiology and Resuscitology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan Abstract: A 32-year-old man with Duchenne muscular dystrophy (DMD was admitted to the hospital because of worsening dyspnea and general fatigue. He had received medication therapy for cardiomyopathy with heart failure and home mechanical ventilation for respiratory failure. An electrocardiogram on admission showed intermittent third-degree atrioventricular block. Echocardiography showed global mild left ventricular systolic dysfunction with dyssynchrony (ejection fraction: 45%. He underwent implantation of a cardiac resynchronization therapy–defibrillator. His B-type natriuretic peptide level was improved after cardiac resynchronization therapy–defibrillator implantation, and he remains asymptomatic. The incidence of cardiomyopathy increases with age. By adulthood, 100% of patients have cardiac involvement. Keywords: cardiac resynchronization therapy, Duchenne muscular dystrophy, progression of cardiomyopathy, heart failure, arrhythmia

  20. 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

  1. Cardiac Migration of Endogenous Mesenchymal Stromal Cells in Patients with Inflammatory Cardiomyopathy

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    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.

  2. 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; 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 < 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. PMID:25814787

  3. A Rare Cardiac Malformation in a Patient Presenting with Transient Ischemic Attack: Isolated Left Ventricular Diverticulum

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    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.

  4. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

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    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.

  5. Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion.

    Science.gov (United States)

    Greenberg, Steven B; Deshur, Mark; Khavkin, Yevgeniy; Karaikovic, Elden; Vender, Jeffery

    2008-06-01

    A patient with a history of T12 burst fracture caused by a fall, and with progressive weakness and sensory loss in the left leg, survived a cardiac arrest after pulsed saline bacitracin lavage irrigation during a posterior spinal fusion.

  6. 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

    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...

  7. 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.

  8. Can prophylactic breast irradiation contribute to cardiac toxicity in patients with prostate cancer receiving androgen suppressing drugs?

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    Molls Michael

    2008-01-01

    Full Text Available Abstract Background Androgen suppression treatment (AST might increase the risk of cardiac morbidity in prostate cancer patients. Possible explanations were provided, however, they disregard the potential contribution of prophylactic radiotherapy to the mamillary regions (PMRT, prescribed to avoid gynecomastia. Methods We studied the exposure of the heart in a typical electron beam PMRT setting by evaluating computed tomography (CT scans in 40 non-cancer patients (age 65 and 75 years in 50% each and 17 prostate cancer patients. Five of the younger, 7 of the older and 4 of the cancer patients had significant cardiac disease. Results The median distance between skin and outer heart contour decreased with age. In all three groups, patients with cardiac morbidity had smaller distances. When using the CT-determined PMRT beam energy, 10% of the younger, 15% of the older and none of the prostate cancer patients would receive approximately 50% of the prescription dose to a part of the heart (2 had no history of cardiac disease. When using the clinically rather than CT-determined beam energy, as often done in daily practice, an additional 12.5% of the non-cancer and 12% of the prostate cancer patients would be exposed to comparably high doses. Conclusion The present data provide preliminary evidence that PMRT might be a factor that contributes to cardiac side effects. Previous studies that established a relationship between AST and cardiac morbidity did not include information on delivery of PMRT.

  9. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

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    Falaknazi Kianoosh

    2009-01-01

    Full Text Available 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 chemiluminescence′s 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.

  10. 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.

  11. Genetic Polymorphisms in Endothelin-1 as Predictors for Long-Term Survival and the Cardiac Index in Patients Undergoing On-Pump Cardiac Surgery.

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    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.

  12. Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients - a randomized controlled trial

    OpenAIRE

    Paulus, Frederique; Veelo, Denise P; Selma B. de Nijs; Beenen, Ludo FM; Bresser, Paul; de Mol, Bas AJM; Binnekade, Jan M; Schultz, Marcus J

    2011-01-01

    Introduction Cardiac surgery is associated with post-operative reductions of functional residual capacity (FRC). Manual hyperinflation (MH) aims to prevent airway plugging, and as such could prevent the reduction of FRC after surgery. The main purpose of this study was to determine the effect of MH on post-operative FRC of cardiac surgical patients. Methods This was a randomized controlled trial of patients after elective coronary artery bypass graft and/or valve surgery admitted to the inten...

  13. 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

  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. Features of remodeling of right heart chambers according to tissue Doppler and its correlation with cardiac rhythm disturbance in patients with COPD 2-3 severity

    Directory of Open Access Journals (Sweden)

    O. A. Zhuk

    2014-01-01

    Full Text Available The article presents the study of early sings of dysfunction of right and left chambers of heart in patients with COPD 2 - 3 severity, correlation between structural and electrical remodeling of heart according to the stages of pulmonary hypertension. Standard tissue Doppler echocardiographic parameters and modes were used for the diagnosing. We examined 35 patients with COPD 2 - 3 severity; the control group consisted of 15 patients. The ECG Holter monitoring was made for all patients to identify cardiac rhythm disturbance and correlation with the COPD severity. Standard method of the ECG with modes of tissue Doppler (pulsed wave Tissue Doppler Imaging - PW TDI, color tissue Doppler imaging -TDI, tissue myocardial Doppler - TMD, tissue Tracking - TT, Doppler for evaluation of myocardial strain and myocardial strain rate were made to identify the stage of dysfunction. The results of the study concluded that according to the TDI the dysfunction of right ventricle was more apparent in patients with COPD 3 severity. Pathological arrhythmias were significantly detected in group of patients with COPD 3 severity. In compliance with our observations, the reduce of rapid myocardial strain rates and its inverse proportion with the severity in accordance to the evaluation of longitudinal strain and rate of movement of fibrous ring in tricuspid valve were observed in patients with COPD. Thus the application of the TDI modes for evaluating of early signs of cardiac remodeling in patients with COPD and potential adequate jugulation for preventing chronic cor pulmonale is expedient.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

    Directory of Open Access Journals (Sweden)

    Faheem W. Guirgis

    2014-03-01

    Full Text Available Introduction: In 2007 there were 64,000 visits to the emergency department (ED for possible myocardial infarction (MI related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB, and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103 and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%. Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain. [West J Emerg Med. 2014;15(2:180–183.

  1. Dynamic changes in sRAGE levels and relationship with cardiac function in STEMI patients

    DEFF Research Database (Denmark)

    Jensen, Louise J N; Lindberg, Søren; Hoffmann, Søren;

    2015-01-01

    the dynamic changes in sRAGE levels during AMI and relationship with cardiac dysfunction. DESIGN AND METHODS: We prospectively included 80 patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). sRAGE concentrations were measured before p......OBJECTIVES: Soluble receptor of advanced glycation end-products (sRAGE) may be a predictive biomarker in coronary artery disease (CAD). Patients with acute myocardial infarction (AMI) have higher sRAGE levels compared to healthy subjects. Accordingly, the aim of this study was to investigate...

  2. Neurohormonal activation and diagnostic value of cardiac peptides in patients with suspected mild heart failure

    DEFF Research Database (Denmark)

    Mikkelsen, Kirsten V.; Bie, Peter; Møller, Jacob E.;

    2006-01-01

    BACKGROUND: Data describing activation of brain natriuretic peptide (BNP) system relative to the renin-angiotensin-aldosterone system (RAAS) are sparse in the early phase of heart failure (HF). AIMS: To compare activation of BNP system relative to RAAS hyperactivity and to assess diagnostic...... accuracy of cardiac peptides to detect any left ventricular dysfunction (LVD) in patients referred from primary care with suspected HF before institution of medical therapy. METHODS: Of 166 referred patients 150 were consecutively included (14 were excluded and two refused consent). Echocardiography...

  3. 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.

  4. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest.

    Science.gov (United States)

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis.

  5. 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.

  6. 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.

  7. Comparison of Benefits from Cardiac Resynchronization Therapy between Patients with Ischemic Cardiomyopathy and Patients with Idiopathic Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Talia Alenabi

    2009-06-01

    Full Text Available Background: Cardiac resynchronization therapy (CRT is an effective treatment for patients with moderate to severe heart failure. However, 20-30% of patients remain non-responders to CRT. We sought to identify which patients benefit the most from CRT in regard to the etiology of heart failure. Methods: Eighty-three consecutive patients (62 men who had a biventricular pacemaker inserted at Tehran Heart Center between May 2004 and March 2007 were evaluated retrospectively. The inclusion criteria were comprised of New York Heart Association (NYHA class III or IV, left ventricular ejection fraction120ms. After 6 months, response was defined as being alive, no hospitalization for cardiac decompensation, and an improvement in NYHA class>1 grade. Results: After 6 months, 60 patients out of the 83 patients were responders. Amongst the 83 patients, 48 had ischemic cardiomyopathy and 35 had non-ischemic cardiomyopathy. A cross-tabulation of response versus etiology showed no significant difference between ischemic versus non-ischemic cardiomyopathy with regard to response to CRT (P=0.322. Conclusion: According to our study, there was no difference in response to CRT between ischemic versus non-ischemic cardiomyopathy at six months’ follow-up.

  8. 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.)

  9. 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

  10. 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...

  11. 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 < .001. Patients who experienced an entrance interview were most likely to enroll, χ(2)(1) = 86.80, p < .001. Direct logistic regression determined that the full model was statistically significant for all predictors, χ(2)(5), 105.56, p < .001, with the strongest predictor, the entrance interview, having an odds ratio of 1.73.

  12. 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......-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (pint) to determine whether the association differed for patients with or without a recent MI. RESULTS: A total of 26,793 patients were included, 19...

  13. 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.

  14. Detection of intramyocardial fatty components in patients with cardiac disease by ultrafast X-ray CT

    Energy Technology Data Exchange (ETDEWEB)

    Kaminaga, T. [Div. of Tracer Kinetics, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Naito, H. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Takamiya, M. [Dept. of Radiology, National Cardiovascular Center, Suita, Osaka (Japan)

    1994-10-01

    To investigate intramyocardial fatty components as regards their distribution, frequency by disorder and cause, 331 patients with cardiac disease were examined with ultrafast X-ray CT (UFCT). The patient group consisted of 139 cases of myocardial infarction and angina, 27 cases of Kawasaki disease, 28 cases of hypertrophic cardiomyopathy (HCM), 22 cases of dilated cardiomyopathy (DCM), 3 cases of arrhythmogenic right ventricular dysplasia (ARVD), 40 cases of valvular disease, 33 cases of left ventricular hypertrophy due to hypertension, 17 cases of arrhythmia, 10 cases of cardiac sarcoidosis, 6 cases of myocarditis and 6 cases of congenital anomaly. Intramyocardial fatty components were detected in 15 patients (5 myocardial infarction, 2 Kawasaki disease, 3 HCM, 4 DCM, 1 ARVD). In patients with myocardial infarction, Kawasaki disease or DCM, the segments with fatty components agreed well with the segments with asynergy in left ventriculography and/or the segments with perfusion defects in thallium myocardial scintigraphy. The frequency of intramyocardial fatty components in each disease was initially determined as follows: 6% in myocardial infarction, 7% in Kawasaki disease, 11% in HCM and 18% in DCM. Ischaemic myocardial damage can induce intramyocardial fatty components in patients with myocardial infarction, Kawasaki disease or DCM. (orig.)

  15. Cardiac Rehabilitation Improves the QRS Fragmentation in Patients With ST Elevatıon Myocardial Infarction

    Science.gov (United States)

    Bulut, Mustafa; Deniz Acar, Rezzan; Ergün, Sunay; Geçmen, Çetin; Akçakoyun, Mustafa

    2015-01-01

    Introduction: We aimed to evaluate the effect of exercise-based cardiac rehabilitation (CR) on the fragmented QRS (fQRS) in patients with ST elevation myocardial infarction (STEMI). Methods: Ninety-seven patients with STEMI participated CR and 81 patients as a control group were included to the study. The trained patients were grouped according to the presence and persistence of QRS fragmentation on the electrocardiogram (ECG) before and after CR. If the fragmentation was present on the ECG at the beginning of the CR but not on the ECG at the end of CR; the transient group, if the fQRS persists after CR; the persistent fQRS group. ECGs obtained from the control group were grouped according to the presence of a fQRS on ECG. Results: Among the trained patients, 45 (46%) did not have a fQRS before CR, whereas 52 (54%) presented a fQRS before CR, which was persistent in 35 patients (the persistent fQRS group) and transient in 17 patients (the transient fQRS group). Among 81 patients included in the control group, fQRS was persistent in 41 patients. Presence of fQRS on the ECG was significantly decreased with CR and it is better in trained group than the control group (P = .034). There were not significant correlations with other characteristics, except hypertension. Conclusion: The existence of the fQRS decreases after CR in patients with STEMI especially in hypertensive individuals, which may be related to improved electrical stability in the myocardium as a predictor of increase in survival and decrease in major cardiac events. PMID:26430496

  16. 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.

  17. Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration.

    Science.gov (United States)

    Yoshihisa, Akiomi; Shimizu, Takeshi; Owada, Takashi; Nakamura, Yuichi; Iwaya, Shoji; Yamauchi, Hiroyuki; Miyata, Makiko; Hoshino, Yasuto; Sato, Takamasa; Suzuki, Satoshi; Sugimoto, Koichi; Yamaki, Takayoshi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2011-01-01

    Cheyne-Stokes respiration (CSR) is often observed in patients with chronic heart failure (CHF). Although adaptive servo ventilation (ASV) is effective for CSR, it remains unclear whether ASV improves the cardiac function and prognosis of patients with CHF and CSR.Sixty patients with CHF and CSR (mean left ventricular ejection fraction 38.7%, mean apnea hypopnea index 36.8 times/hour, mean central apnea index 19.1 times/hour) were enrolled in this study. Patients were divided into two groups: 23 patients treated with ASV (ASV group) and 37 patients treated without ASV (Non-ASV group). Measurement of plasma B-type natriuretic peptide (BNP) levels and echocardiography were performed before, 3 and 6 months after treatments in each group. Patients were followed-up for cardiac events (cardiac death and re-hospitalization) after discharge. In the ASV group, NYHA functional class, BNP levels, cardiac systolic and diastolic function were significantly improved with ASV treatment for 6 months. In contrast, none of these parameters changed in the Non-ASV group. Importantly, Kaplan-Meier analysis clearly demonstrated that the event-free rate was significantly higher in the ASV group than in the Non-ASV group.Adaptive servo ventilation improves cardiac function and prognosis in patients with chronic heart failure and Cheyne-Stokes respiration.

  18. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.

  19. Risk factor paradox in the occurrence of cardiac arrest in acute coronary syndrome patients

    Science.gov (United States)

    Rosa, Silvia Aguiar; Timóteo, Ana Teresa; Nogueira, Marta Afonso; Belo, Adriana; Ferreira, Rui Cruz

    2016-01-01

    Objective To compare patients without previously diagnosed cardiovascular risk factors) and patients with one or more risk factors admitted with acute coronary syndrome. Methods This was a retrospective analysis of patients admitted with first episode of acute coronary syndrome without previous heart disease, who were included in a national acute coronary syndrome registry. The patients were divided according to the number of risk factors, as follows: 0 risk factor (G0), 1 or 2 risk factors (G1 - 2) and 3 or more risk factors (G ≥ 3). Comparative analysis was performed between the three groups, and independent predictors of cardiac arrest and death were studied. Results A total of 5,518 patients were studied, of which 72.2% were male and the mean age was 64 ± 14 years. G0 had a greater incidence of ST-segment elevation myocardial infarction, with the left anterior descending artery being the most frequently involved vessel, and a lower prevalence of multivessel disease. Even though G0 had a lower Killip class (96% in Killip I; p < 0.001) and higher ejection fraction (G0 56 ± 10% versus G1 - 2 and G ≥ 3 53 ± 12%; p = 0.024) on admission, there was a significant higher incidence of cardiac arrest. Multivariate analysis identified the absence of risk factors as an independent predictor of cardiac arrest (OR 2.78; p = 0.019). Hospital mortality was slightly higher in G0, although this difference was not significant. By Cox regression analysis, the number of risk factors was found not to be associated with mortality. Predictors of death at 1 year follow up included age (OR 1.05; p < 0.001), ST-segment elevation myocardial infarction (OR 1.94; p = 0.003) and ejection fraction < 50% (OR 2.34; p < 0.001). Conclusion Even though the group without risk factors was composed of younger patients with fewer comorbidities, better left ventricular function and less extensive coronary disease, the absence of risk factors was an independent predictor of cardiac arrest. PMID

  20. 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

  1. 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.

  2. 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.

  3. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Sevuk U

    2015-08-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Nurettin Ay,3 Yakup Altas,2 Rojhat Altindag,2 Baris Yaylak,2 Vahhac Alp,3 Ertan Demirtas4 1Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 2Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 4Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12 deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG surgery.Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98.Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017 and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034 than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004. Delirium severity score showed a moderate correlation with cobalamin levels (Ρ=-0.27; P=0.024. Logistic regression analysis demonstrated that

  4. 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

  5. Prognostic significance of elevated troponin in non-cardiac hospitalized patients: a systematic review and meta-analysis.

    Science.gov (United States)

    Ahmed, Amna N; Blonde, Ken; Hackam, Daniel; Iansavichene, Alla; Mrkobrada, Marko

    2014-12-01

    Cardiac biomarker troponin can be elevated in patients without a primary cardiac diagnosis and may have prognostic value. We conducted a systematic review to estimate the prevalence and prognostic significance of elevated troponin levels in patients admitted to hospital without a primary cardiac diagnosis. Literature search was done using MEDLINE (1946 to November 2012), EMBASE (1974 to Week 45, 2012), and Cochrane Central Register of Controlled Trials (November 2012). Two independent investigators reviewed full-text studies for final inclusion. We included studies of patients admitted without a primary cardiac diagnosis. Eligible studies compared adverse outcomes in patients with normal versus elevated troponin levels. Twenty-seven studies were included in the meta-analysis. Elevated troponin was associated with increased in-hospital and 30-day mortality (25 studies, 7255 patients, OR 3.88, 95% CI 2.90-5.19, P troponin was also associated with increased risk of long-term mortality at 6 months (9 studies, 5368 patients, OR 4.21, 95% CI 1.84-9.64, P Troponin is an independent predictor of short-term mortality with a pooled adjusted OR of 2.36, 95% CI 1.47-3.76, P troponin in non-cardiac patients is independently associated with increased mortality.

  6. Effectiveness of massage therapy on post-operative outcomes among patients undergoing cardiac surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    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

  7. [CERTAIN PROBLEMS OF DIAGNOSTICS OF CHRONIC CARDIAC INSUFFICIENCY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE].

    Science.gov (United States)

    Karoli, N A; Borodkin, A V; Rebrov, A P

    2015-01-01

    Apnea is a commonest complaint in aged patients. It may be due to chronic cardiac insufficiency (CCI) and chronic obstructive pulmonary disease (COPD). The prevalence of CCI in the general populations and among 65 year old subjects is 1.8 and 6-10% respectively, decompensation being the most frequent cause of hospitalization of elderly patients. Different authors report CCI in 30-62% of the elderly patients with COPD. Combination of CCI and COPD create difficulties for diagnostics and treatment due to late detection of CCI, common risk factors and pathogenetic features of the two conditions their similar clinical picture. This paper is designed to consider methods of CCI diagnostics in patients with COPD. Special emphasis is laid on the thorough analysis of medical histories, specific laboratory tests (BNP NT-proBNP), and instrumental methods (echocardiogram, MRI, spirography, X-ray studies).

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. Cardiac sympathetic activity in chronic heart failure: cardiac (123)I-mIBG scintigraphy to improve patient selection for ICD implantation.

    Science.gov (United States)

    Verschure, D O; van Eck-Smit, B L F; Somsen, G A; Knol, R J J; Verberne, H J

    2016-12-01

    Heart failure is a life-threatening disease with a growing incidence in the Netherlands. This growing incidence is related to increased life expectancy, improvement of survival after myocardial infarction and better treatment options for heart failure. As a consequence, the costs related to heart failure care will increase. Despite huge improvements in treatment, the prognosis remains unfavourable with high one-year mortality rates. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) has improved the overall survival of patients with chronic heart failure. However, after ICD implantation for primary prevention in heart failure a high percentage of patients never have appropriate ICD discharges. In addition 25-50 % of CRT patients have no therapeutic effect. Moreover, both ICDs and CRTs are associated with malfunction and complications (e. g. inappropriate shocks, infection). Last but not least is the relatively high cost of these devices. Therefore, it is essential, not only from a clinical but also from a socioeconomic point of view, to optimise the current selection criteria for ICD and CRT. This review focusses on the role of cardiac sympathetic hyperactivity in optimising ICD selection criteria. Cardiac sympathetic hyperactivity is related to fatal arrhythmias and can be non-invasively assessed with (123)I-meta-iodobenzylguanide ((123)I-mIBG) scintigraphy. We conclude that cardiac sympathetic activity assessed with (123)I-mIBG scintigraphy is a promising tool to better identify patients who will benefit from ICD implantation.

  16. Psychiatric disorders and cardiac anxiety in exercising and sedentary coronary artery disease patients: a case-control study

    Directory of Open Access Journals (Sweden)

    A. Sardinha

    2012-12-01

    Full Text Available Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD. The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60, there was a lower prevalence (45 vs 81%; P < 0.001 of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59. Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001. In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.

  17. 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.

  18. Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients

    Science.gov (United States)

    Oh, Joo Hyun; Kim, Chae Min; Song, Seung Yong; Uhm, Jae Sun; Lew, Dae Hyun

    2017-01-01

    Background The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach. Methods From July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of 20.1 kg/m2. In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously. Results One case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others. Conclusions With superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients. PMID:28194345

  19. Dimensionality of the hospital anxiety and depression scale (HADS) in cardiac patients

    DEFF Research Database (Denmark)

    Emons, Wilco H M; Sijtsma, Klaas; Pedersen, Susanne S.

    2012-01-01

    The hospital anxiety and depression scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined...... items each were found to be structurally sound and reliable. These scales covered the two key attributes of anxiety and (anhedonic) depression. The findings suggest that the HADS may be reduced to a 10-item questionnaire comprising two 5-item scales measuring anxiety and depressive symptoms....

  20. 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.

  1. Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Ming Yen [University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, ON (Canada); The University of Hong Kong, Queen Mary Hospital, Department of Diagnostic Radiology, Hong Kong (China); Karimzad, Yasser; Menezes, Ravi J.; Wintersperger, Bernd J.; Li, Qin; Forero, Julian; Paul, Narinder S.; Nguyen, Elsie T. [University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, ON (Canada)

    2016-10-15

    To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography (CCTA), pulmonary vein CT (PVCT) and coronary calcium score CT (CCS). Patients were randomised to a control group (i.e. standard of care protocol) or to a relaxation music group (ie. standard of care protocol with music). The groups were compared for heart rate, radiation dose, image quality and dose of IV metoprolol. Both groups completed State-Trait Anxiety Inventory anxiety questionnaires to assess patient experience. One hundred and ninety-seven patients were recruited (61.9 % males); mean age 56y (19-86 y); 127 CCTA, 17 PVCT, 53 CCS. No significant difference in heart rate, radiation dose, image quality, metoprolol dose and anxiety scores. 86 % of patients enjoyed the music. 90 % of patients in the music group expressed a strong preference to have music for future examinations. The patient cohort demonstrated low anxiety levels prior to CT. Relaxation music in CCTA, PVCT and CCS does not reduce heart rate or IV metoprolol use. Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate. Music can be used in cardiac CT to improve patient experience. (orig.)

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Management of patients with prosthetic heart valves during non-cardiac surgery.

    Science.gov (United States)

    Prendergast, Bernard D

    2004-01-01

    Non-cardiac surgery in patients with prosthetic heart valves poses the particular hazards of infective endocarditis, increased bleeding risk and the possibility of acute/subacute valve thrombosis or systemic thromboembolism associated with interrupted anticoagulation. Management is complicated by the absence of randomised trials examining peri-operative anticoagulation management. Thromboembolic risk increases substantially when oral anticoagulation is discontinued and valve thrombosis may be inapparent for 1-2 months. This delayed diagnosis makes it difficult to identify the inciting event, either clinically or in experimental trials. Furthermore, the absence of early post-operative events may falsely suggest that peri-operative anticoagulation was safe and adequate. The approach to management therefore remains controversial. Seamless oral anticoagulation is preferred whenever possible and this is safe for a range of minor procedures, including cardiac catheterisation, dental and ophthalmic surgery. Major surgical procedures require withdrawal of oral anticoagulation before surgery to lower the international normalised ratio (INR) to anticoagulation with unfractionated heparin which should be started when the INR is patients and anticoagulation is then resumed post-operatively, though therapeutic levels are not achieved for several days. The determination of which patients require prolonged overlap of heparin and oral anticoagulants is difficult. Clinical judgement is required but these regimes are strongly recommended for those at highest risk of thromboembolism. With strict adherence to these guidelines, the incidence of major complications is low.

  8. 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.

  9. 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...

  10. Cardiac autonomic neuropathy in patients with uraemia is not related to pre-diabetes

    DEFF Research Database (Denmark)

    Eming, Marie Bayer; Hornum, Mads; Feldt-Rasmussen, Bo Friis

    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 (ECG) 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

  11. Association between absolute blood eosinophil count and CKD stages among cardiac patients.

    Science.gov (United States)

    Ishii, Rui; Fujita, Shu-Ichi; Kizawa, Shun; Sakane, Kazushi; Morita, Hideaki; Ozeki, Michishige; Sohmiya, Koichi; Hoshiga, Masaaki; Ishizaka, Nobukazu

    2016-02-01

    Elevated eosinophil count was shown to be associated with the development of cholesterol embolization syndrome, a potentially life-threatening condition, after catheter-based procedures. We investigated the association between stages of chronic kidney disease (CKD) and the absolute eosinophil count (AEC) among cardiac patients. CKD stages were determined solely on the estimated glomerular filtration rate or requirement for hemodialysis. Eosinophilia is defined as an eosinophil count exceeding 500/μL. A total of 1022 patients were enrolled in the current study, and eosinophil counts (/μL) in the first through fourth eosinophil count quartiles were blood pressure, and total white blood cell count. Similarly, after adjustment for the same variables, eosinophilia was associated with severe renal dysfunction with an odds ratio of 2.60 (95 % confidence interval, 1.08-6.26, P count was positively associated with higher CKD stages among cardiology patients, some fraction of which might be related to subclinical cholesterol embolization.

  12. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H; Sant, Jetske Van't; Versteeg, Henneke

    2016-01-01

    -defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic......BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT...... response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only...

  13. 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.

  14. SCAI/CCAS/SPA expert consensus statement for anesthesia and sedation practice: Recommendations for patients undergoing diagnostic and therapeutic procedures in the pediatric and congenital cardiac catheterization laboratory.

    Science.gov (United States)

    Odegard, Kirsten C; Vincent, Robert; Baijal, Rahul; Daves, SuAnne; Gray, Robert; Javois, Alex; Love, Barry; Moore, Phil; Nykanen, David; Riegger, Lori; Walker, Scott G; Wilson, Elizabeth C

    2016-11-15

    Current practice of sedation and anesthesia for patients undergoing pediatric congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institutions, a multi-society expert panel with representatives from the Congenital Heart Disease Council of the Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA) and the Congenital Cardiac Anesthesia Society (CCAS) was convened to evaluate the types of sedation and personnel necessary for procedures performed in the PCCCL. The goal of this panel was to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs. Recommendations can neither encompass all clinical circumstances nor replace the judgment of individual clinicians in the management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring sedation and anesthesia. What follows are recommendations for patient monitoring in the PCCCL regardless of whether minimal or no sedation is being used or general anesthesia is being provided by an anesthesiologist. © 2016 Wiley Periodicals Inc.

  15. Neurohormones as markers of right- and left-sided cardiac dimensions and function in patients with untreated chronic heart failure

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Hildebrandt, Per; Appel, Jon;

    2005-01-01

    BACKGROUND: It is now well accepted that neuroendocrine activation is of pathophysiological and prognostic importance in patients with chronic heart failure (CHF). We hypothesized that the different neuroendocrine factors reflect different aspects of the cardiac dysfunction in CHF patients...... and that neuroendocrine profiling could be of value. In order to study this, we investigated the relationship between hormones and cardiac dimensions and function of both the right and left ventricle. METHODS: Twenty-three patients with newly diagnosed, untreated CHF were included. Right (RVEF) and left ventricular...

  16. Cardiac Murmur Prompting Diagnosis of Metastatic Nonseminomatous Germ Cell Testicular Neoplasia in an 18-Year-Old Patient

    Directory of Open Access Journals (Sweden)

    Steve Y. Chung

    2005-01-01

    Full Text Available Most retroperitoneal tumors such as renal cell carcinoma have been associated with tumor thrombus extending into the renal vein, inferior vena cava (IVC, and heart. The retroperitoneal metastatic potential of testicular tumors is well known. We report here the first instance of a cardiac murmur prompting diagnosis of metastatic testicular neoplasia in an 18-year-old patient. Chemotherapy was delayed and after successful surgical resection of the ventricular mass, the patient recovered uneventfully. This case underscores the need to pursue abnormal cardiac exams in newly diagnosed testicular cancer patients.

  17. Diclofenac plasma protein binding: PK-PD modelling in cardiac patients submitted to cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Auler Jr. J.O.

    1997-01-01

    Full Text Available Twenty-four surgical patients of both sexes without cardiac, hepatic, renal or endocrine dysfunctions were divided into two groups: 10 cardiac surgical patients submitted to myocardial revascularization and cardiopulmonary bypass (CPB, 3 females and 7 males aged 65 ± 11 years, 74 ± 16 kg body weight, 166 ± 9 cm height and 1.80 ± 0.21 m2 body surface area (BSA, and control, 14 surgical patients not submitted to CPB, 11 female and 3 males aged 41 ± 14 years, 66 ± 14 kg body weight, 159 ± 9 cm height and 1.65 ± 0.16 m2 BSA (mean ± SD. Sodium diclofenac (1 mg/kg, im Voltaren 75® twice a day was administered to patients in the Recovery Unit 48 h after surgery. Venous blood samples were collected during a period of 0-12 h and analgesia was measured by the visual analogue scale (VAS during the same period. Plasma diclofenac levels were measured by high performance liquid chromatography. A two-compartment open model was applied to obtain the plasma decay curve and to estimate kinetic parameters. Plasma diclofenac protein binding decreased whereas free plasma diclofenac levels were increased five-fold in CPB patients. Data obtained for analgesia reported as the maximum effect (EMAX were: 25% VAS (CPB vs 10% VAS (control, P<0.05, median measured by the visual analogue scale where 100% is equivalent to the highest level of pain. To correlate the effect versus plasma diclofenac levels, the EMAX sigmoid model was applied. A prolongation of the mean residence time for maximum effect (MRTEMAX was observed without any change in lag-time in CPB in spite of the reduced analgesia reported for these patients, during the time-dose interval. In conclusion, the extent of plasma diclofenac protein binding was influenced by CPB with clinically relevant kinetic-dynamic consequences

  18. 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.

  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.

  20. Determinants of eligibility and use of ehealth for cardiac rehabilitation patients: preliminary results.

    Science.gov (United States)

    Wiggers, Anne-Marieke; Peek, Niels; Kraaijenhagen, Roderik; Jaspers, Monique

    2014-01-01

    To foster implementation of eHealth in care practice, it is important to gain insight into the factors that influence acceptance. The aim of this study was to identify determinants of eligibility and use for completing an electronic needs assessment for cardiac rehabilitation. We analysed the influence of age, gender, diagnosis, health literacy, quality of life scores, and depression and anxiety scores. Among 240 patients entering CR in two clinics, 101 patients were deemed eligible to use the system by their CR professional, of which 75 (74.2%) actually used it. Only 50% of the patients who had an acute coronary syndrome and 20% of the patients with chronic heart failure were deemed eligible. Furthermore, there was a decreasing trend towards usage in female patients, patients with symptoms of anxiety, and patients with a better quality of life. In the future we will continue to explore barriers and success factors as experienced by the patients and the participating clinics to optimize the system.

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

    Directory of Open Access Journals (Sweden)

    Claudiu Avram

    2010-12-01

    Full Text Available 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:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardia