International journal of cardiology
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The classification of myocardial disease proposed by the WHO/ISFC task force in 1980 distinguishes specific heart muscle diseases from myocardial diseases of unknown origin, termed cardiomyopathies, and differentiated into the dilated, hypertrophic and restrictive forms. This last group includes endomyocardiofibrosis and fibroblastic parietal endocarditis. In more recent years, two new forms of heart muscle disease have been recognized: so-called "primary" restrictive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. ⋯ In arrhythmogenic right ventricular cardiomyopathy, the myocardium of the right ventricular free wall is substituted by fibrous and/or adipose tissue, which results in regional dynamic alterations and ominous ventricular arrhythmias. The left ventricle is usually spared. Both forms should be classified as heart muscle diseases of unknown origin, and kept clearly distinct from the other cardiomyopathies listed in the WHO classification.
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Case Reports
Cardiac tamponade produced by a loculated pericardial hematoma simulating a right atrial mass.
We report a case of cardiac tamponade due to thrombosis of a loculated pericardial effusion which occurred after open heart surgery. The loculated hematoma was highly echogenic and mimicked a right atrial mass. Cross-sectional echocardiography, in association with color Doppler flow imaging, was extremely useful in identifying this rare complication of cardiac surgery and, therefore, in determining the subsequent surgical approach.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of dobutamine and enoximone for low output states following cardiac surgery.
Low output syndrome sometimes complicates early postoperative states following cardiac surgery. A comparative study of haemodynamic responses to enoximone and dobutamine was carried out in two groups of 20 patients each, during a 24-hour postoperative observation period. Parameters in addition to routine measurements were determined using a pulmonary artery catheter. ⋯ After dobutamine, cardiac index rose from 2.33 +/- 0.60 litres/minute/m2 to 2.90 +/- 0.81 (15 minutes), 3.52 +/- 0.74 (120 minutes) and 4.12 +/- 1.07 litres/minute/m2 (24 hours). The pulmonary wedge pressure values decreased in this group, from 15.20 +/- 3.14 mm Hg at the beginning to 13.74 +/- 3.02 (15 minutes), 12.17 +/- 5.25 (120 minutes) and 9.81 +/- 4.23 mm Hg (24 hours). The enoximone group showed a diminution of systolic arterial pressure of 14% in the first 120 minutes, with a return to initial values after 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Acute pulmonary oedema: preliminary results of a randomized trial of the intravenous phosphodiesterase inhibitor, enoximone, vs conventional therapy.
The purpose of this open study was to compare the effects of enoximone and conventional therapy in 44 patients with acute pulmonary oedema. In this preliminary report, 22 patients were randomly assigned to the enoximone group (1 mg/kg bolus, every 8 hours for 48 hours) and 22 patients to conventional therapy (frusemide, nitrates, dopamine-dobutamine). Patients were assessed clinically at 0, 1, 2, 24 and 48 hours by the change in their Killip-Kimball score, dyspnoea, pulmonary rales, blood pressure, diuresis, requirement for additional therapy and/or death. ⋯ On the other hand, in the conventional therapy group, it was necessary to institute enoximone therapy in 9 cases. With the dosage used, enoximone appeared to be at least as effective as conventional therapy in acute pulmonary oedema. Moreover, no side-effects or tachyphylaxis appeared during the hospital assessment.
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The addition of enoximone, a phosphodiesterase inhibitor, to adrenergic agents has been found useful in increasing cardiac output in severe heart failure. In one study of 13 patients in cardiogenic shock already receiving adrenergic support, enoximone was administered as a bolus of 0.5 mg/kg over 20 minutes. Pulmonary artery occlusion pressure decreased significantly from 21.7 +/- 5.8 mm Hg to 19.8 +/- 6.0 mm Hg (P less than 0.01) and cardiac index increased markedly. ⋯ Cardiac index increased markedly after enoximone, 0.25 mg/kg. These changes were significant after the initial dose of 0.125 mg/kg. Thus, the addition of even small doses of enoximone to adrenergic agents can markedly increase cardiac index without significant effect on arterial pressure in medical or surgical cardiac patients.