Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Jun 1985
Esmolol: a new ultrashort-acting beta-adrenergic blocking agent for rapid control of heart rate in postoperative supraventricular tachyarrhythmias.
Prompt control of heart rate is important for successful treatment of supraventricular tachyarrhythmias early after open heart surgery when sympathetic tone is high and ventricular response rates may be rapid. Esmolol, a new ultrashort-acting (9 minute half-life) beta-receptor blocking agent, was given by continuous intravenous infusion for up to 24 hours in 24 patients (21 with isolated coronary bypass surgery and 3 with valve replacement) 1 to 7 days after surgery. Atrial fibrillation was present in 9 patients, atrial flutter in 2 and sinus tachycardia in 13. ⋯ Within 5 to 18 minutes after initiation of therapy, all patients had achieved a 15% reduction in heart rate at a maintenance dose of 150 micrograms/kg per min or less. A 20% reduction in heart rate was attained in 19 of the 24 patients, and conversion to sinus rhythm occurred during esmolol infusion in 5 of the 11 patients with atrial flutter or fibrillation. Transient asymptomatic hypotension (less than 90/50 mm Hg) was seen in 13 patients, requiring cessation of esmolol therapy in 2.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Am. Coll. Cardiol. · Feb 1985
Case ReportsPersistent left superior vena cava and right superior vena cava drainage into the left atrium without arterial hypoxemia.
A 46 year old patient who presented with an acute myocardial infarction was discovered to have a systemic venous communication with the left heart during attempted insertion of a pulmonary flotation catheter. There was no evidence of cyanosis or systemic arterial desaturation. A right superior vena cava that emptied into the right superior pulmonary vein and a persistent left superior vena cava draining into the coronary sinus were confirmed pathologically after death related to a brain abscess. The embryology, physiology and noninvasive diagnostic approach to this unique venous anomaly are discussed.
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J. Am. Coll. Cardiol. · Feb 1985
Randomized Controlled Trial Comparative Study Clinical TrialComparison of intravenous lorcainide with lidocaine for acute therapy of complex ventricular arrhythmias: results of a randomized study with crossover option.
There is a need for effective, well tolerated, intravenous antiarrhythmic agents. The effects of lorcainide, a new class I antiarrhythmic agent, were compared with those of lidocaine in a randomized parallel study with cross-over option in 30 hospitalized patients with frequent (greater than 1/min) complex ventricular arrhythmias. Lorcainide loading dose was 2 mg/kg (at 2 mg/min) supplemented, if needed, with 100 mg in 1 hour; maintenance dose was 8 mg/h. ⋯ Couplets decreased by a median of 100% after lorcainide and by 89% after lidocaine. Couplets were eliminated in 62% of the patients after lorcainide and in 27% after lidocaine (p = 0.06). There was 100% suppression of runs of premature beats in 11 patients after lorcainide and 99% suppression in 10 patients after lidocaine.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Am. Coll. Cardiol. · Feb 1985
Acute hemodynamic effects of increasing hemoglobin concentration in children with a right to left ventricular shunt and relative anemia.
The short-term effects of increasing hemoglobin concentration were evaluated at cardiac catheterization in seven children (aged 0.3 to 7.5 years) with a right to left ventricular shunt and relative anemia. Diagnoses were tetralogy of Fallot in six and L-transposition of the great vessels with ventricular septal defect and pulmonary stenosis in one. Before and 20 minutes after isovolumic partial exchange transfusion with 20 ml/kg packed red cells, the following variables were measured: hemoglobin, partial pressure of oxygen (PO2), oxygen consumption, oxygen saturation and pressure in the aorta, superior vena cava and right and left atria. ⋯ Effective pulmonary blood flow increased by 17% from 2.72 +/- 0.10 to 3.17 +/- 0.10 liters/min per m2 (p less than 0.01), and right to left shunt decreased by 59% from 1.44 +/- 0.29 to 0.59 +/- 0.10 liters/min per m2 (p less than 0.01). Systemic oxygen transport increased from 658 +/- 48 to 738 +/- 46 ml/min per m2 (p less than 0.002). After partial exchange transfusion, systemic vascular resistance increased from 15.9 +/- 1.1 to 20.0 +/- 1.4 units (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Am. Coll. Cardiol. · Jan 1985
Case ReportsSevere hypoxemia due to shunting through a patent foramen ovale: a correctable complication of right ventricular infarction.
A patient with recent inferior myocardial infarction with right ventricular involvement developed severe hypoxemia unresponsive to 100% oxygen. Contrast two-dimensional echocardiography revealed right to left shunting through an aneurysmal fossa ovalis with a patent foramen ovale. ⋯ Surgical closure of the defect was probably life-saving. This case report illustrates that right to left shunting through a foramen ovale should be considered in the differential diagnosis of hypoxemia in patients presenting with inferior myocardial infarction.