The American journal of cardiology
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This study describe the values of pulmonary artery wedge pressure (PAWP) and the extravascular lung water (EVLW) index in patients with acute cardiogenic pulmonary edema who require mechanical ventilation. Ten consecutive patients with acute cardiogenic pulmonary edema who required mechanical ventilation were studied. Cardiac index was determined with thermodilution. ⋯ Thus, patients with acute cardiogenic pulmonary edema requiring mechanical ventilation may have a normal PAWP after mechanical ventilation has been initiated. In a hemodynamic unstable situation, these patients may require fluid challenges to improve cardiac output, despite the presence of pulmonary edema. The pulmonary edema, measured as EVLW index, resolves rapidly when cardiac performance improves, despite positive fluid balances and weight gain in the first 24 hours.
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Review Comparative Study
Pharmacologic versus direct-current electrical cardioversion of atrial flutter and fibrillation.
Conversion of atrial flutter and atrial fibrillation (AF) can be achieved by either pharmacologic or direct-current (DC) electrical cardioversion. DC electrical cardioversion is more effective and restores sinus rhythm instantaneously; however, general anesthesia is necessary, which can cause severe complications. On the other hand, pharmacologic cardioversion is less effective. ⋯ In a hybrid approach, antiarrhythmic drugs may be used to enhance DC conversion and prevent (sub)acute recurrences of AF. However, it may increase the defibrillation threshold, especially if class IC drugs are used. New treatment options such as automatic defibrillation (implantable atrioverter) are still investigational.
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Prompt cardiopulmonary resuscitation (CPR) and early defibrillation significantly improve the likelihood of successful resuscitation from cardiac arrest and are the key components in the American Heart Association's "chain of survival." Although representing current clinical practice in the United States, there is limited evidence supporting the benefit of acute administration of such antiarrhythmic medications as lidocaine, bretylium, magnesium, and procainamide to a victim of cardiac arrest. There has been only 1 published case-controlled clinical trial in which shock-refractory victims of out-of-hospital ventricular fibrillation were stratified into those who received lidocaine and those who did not. ⋯ With the possible exception of intravenous amiodarone, available evidence of definitive benefit from antiarrhythmic drugs in cardiac arrest is inconclusive. Due to regulatory issues, clinical trials in cardiac arrest are extremely difficult to design and perform.
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This is a study of the use of T3 infusion in the postoperative period in 6 pediatric patients who underwent complex cardiac surgical procedures under cardiopulmonary bypass. Normalization of serum T3 levels was reflected in a marked decrease in requirement of inotropic support, conversion to normal sinus rhythm, and progressively improving clinical course.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of oral loading dose of propafenone and amiodarone for converting recent-onset atrial fibrillation. PARSIFAL Study Group.
In patients with recent-onset atrial fibrillation (AF), restoration of sinus rhythm is considered to be the first-line therapeutic option. Although this conversion might be obtained by direct-current shock or intravenous antiarrhythmic drugs, administration of an oral loading dose of class I or III antiarrhythmic drugs is more simple and convenient. This prospective, randomized, multicenter study compares the time to conversion to sinus rhythm obtained with an oral loading dose of propafenone or amiodarone. ⋯ After 24 hours (56% in the propofenone and 47% in the amiodarone group) and 48 hours, the same proportion of patients in the 2 groups recovered sinus rhythm (no serious adverse events were noticed). Thus, oral loading dose of propafenone or amiodarone was safe with a similar conversion rate of recent-onset AF. Propafenone had a faster action.