The Canadian journal of cardiology
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To assess the causes and outcomes of patients with postcardiac surgery renal dysfunction. ⋯ Patients who develop postoperative renal dysfunction have a high mortality rate. Postoperative low cardiac output is the most important cause of postoperative renal dysfunction and, therefore, should be avoided. Patients with creatinine concentrations of less than 200 mmol/L at postoperative day 4 or 5 will probably resume normal renal function. Patients with creatinine concentrations of more than 200 mmol/L at days 4 and 5 have a 30% chance of needing long term dialysis.
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According to previous reports, plasma atrial natriuretic peptide levels increase in atrial fibrillation (AF) and decrease after successful direct current (DC) cardioversion, but there have been no reports on plasma brain natriuretic peptide (BNP). ⋯ Lone AF raises plasma BNP levels, which is more marked if there is underlying structural heart disease present, and cardioversion reduces plasma BNP levels. Therefore, high plasma BNP levels in patients with chronic AF are likely to be caused by AF and reflect cardiac overloading associated with, although contributed to in part by, underlying heart diseases.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of midazolam with or without fentanyl for conscious sedation and hemodynamics in coronary angiography.
To compare the hemodynamic and sedative effects of midazolam - with or without fentanyl combination - with placebo in coronary angiography. ⋯ Both techniques of conscious sedation - midazolam and midazolam with fentanyl - are satisfactory for coronary angiography where hemodynamic stability and patient cooperation are required. In such procedures, local anesthesia without sedation may lead to hypertension and increase overall morbidity.
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Comparative Study
The management of patients who have suffered an acute myocardial infarction in a tertiary care centre.
The standard of management after acute myocardial infarction (MI) includes beta-blockers and acetylsalicylic acid (ASA). Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents are indicated for some patients, and calcium channel blockers should generally be avoided. It is suspected that many patients with MI are not discharged from hospital with optimal medical management. ⋯ The study centre showed much better use of appropriate medications than has been previously described, showing that optimal medical therapy can be achieved for the vast majority of patients with acute MI.