Journal of cardiology
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Journal of cardiology · Jan 1993
[Serial changes in hemostatic and fibrinolytic states induced by coronary thrombolytic therapy].
The effects of coronary thrombolytic therapy with urokinase on the intrinsic hemostatic and fibrinolytic states were investigated by determining several markers for hemostatic and fibrinolytic activities in 6 patients with acute myocardial infarction who underwent coronary thrombolysis with urokinase. The markers for hemostasis and fibrinolysis were: markers for plasmin generation [alpha 2-plasmin inhibitor (alpha 2-PI), plasminogen, plasmin alpha 2-PI complex (PIC)]; markers for fibrinolysis [fibrin/fibrinogen degradation products-E fragment (FDP-E), FDP D-D dimer (D dimer), fibrinogen]; markers for hemostatic activity (prothrombin time (PT), antithrombin III (AT-III), protein C); markers for thrombin generation [thrombin antithrombin III complex (TAT)]; markers for intrinsic fibrinolytic activity [tissue plasminogen activator plasminogen activator inhibitor complex (TPA PAI complex)]. These markers were measured before, at 1 to 2 hours intervals during first 6 hours, daily during the next 3 days, and subsequently on the 7th and the 14th day after urokinase therapy. ⋯ TAT increased from 13.1 +/- 15.4 to 70.8 +/- 65.8 ng/ml soon after fibrinolysis occurred, indicating that thrombin generation occurred at the same time as fibrinolysis. The TPA PAI complex level before urokinase administration (26.4 +/- 6.4 ng/ml) was greater than the normal upper limit, indicating increased intrinsic fibrinolytic activity, then decreased after urokinase administration. These findings suggested that urokinase administration might affect the intrinsic fibrinolytic activity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Journal of cardiology · Jan 1992
Case Reports[Surgical decisions for active infective endocarditis in patients with acute neurological complications].
The surgical management of 7 patients with active infective endocarditis and recent (within 16 days) neurological injury was presented. All patients had preoperative computed tomographic scans which revealed no evidence of intracranial hemorrhage and underwent successful corrective cardiac surgery. ⋯ In the remaining surviving patient, intracerebral mycotic aneurysms were resolved spontaneously after postoperative antibiotic therapy, although new cerebral hemorrhage, a complication of emboli, occurred after open heart surgery. The results of this study indicated that 1) cerebrovascular complications were the causes of the 4 deaths in this series, and 2) although heparinization during open heart surgery may result in intracerebral hemorrhage from mycotic aneurysm or infarction, early surgical intervention after recent cardiogenic embolic strokes may save patients with minor cerebral infarcts.
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Journal of cardiology · Jan 1991
Clinical Trial[Efficacy of reperfusion therapy in acute myocardial infarction complicated by cardiogenic shock].
Efficacy of reperfusion therapy was studied in 40 patients with acute myocardial infarction complicated with cardiogenic shock. Among them, 27 were treated with intracoronary thrombolysis (ICT) and/or coronary angioplasty (Group I), and 13 were untreated by reperfusion therapy (Group II). In Group I, reperfusion was successful in 17 (Group Ia). ⋯ Among the surviving patients, 3 (23%) of Group Ia and all (100%) of Group Ib suffered from congestive heart failure. These findings suggested that reperfusion therapy improves the in-hospital survival rate in patients with cardiogenic shock. Therefore, reperfusion therapy may be recommended for cardiogenic shock secondary to acute myocardial infarction.
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Journal of cardiology · Jan 1990
[Left ventricular asynergy and myocardial necrosis accompanied by subarachnoid hemorrhage: contribution of neurogenic pulmonary edema].
One hundred-thirty patients with acute subarachnoid hemorrhages were investigated to examine the relationship of neurogenic pulmonary edema to cardiac lesions. Abnormal electrocardiograms were observed in 99 of these patients. Left ventricular asynergy was detected in nine of the 99 patients by two-dimensional (2D) echocardiography. ⋯ Biopsy findings were available in three and demonstrated severe fragmentation at the sites of left ventricular asynergy. Pulmonary edema, electrocardiographic abnormalities and left ventricular asynergy improved markedly during the courses of hospitalization. We concluded that left ventricular asynergy and myocardial necrosis may occur during the acute stage of subarachnoid hemorrhage and could produce neurogenic pulmonary edema rather than or in addition to permeability edema.
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Journal of cardiology · Jan 1990
Case Reports[Advantages of transesophageal color Doppler echocardiography in the diagnosis and surgical treatment of cardiac masses].
To determine the clinical advantages of transesophageal color Doppler echocardiography (TEE) for imaging cardiac tumors and left atrial thrombi, 24 cases with intra- or extracardiac masses were examined by transthoracic color Doppler echocardiography (TTE) and TEE before and after cardiac surgery. Five with left atrial myxomas, two with lung tumors, five with mediastinal tumors and 12 with mitral stenosis coexisting left atrial thrombi were included in this study. The echocardiographic findings of the cardiac masses were compared with the surgical findings in all cases. ⋯ Thrombi, when attached to the left atrial posterior or inferior walls, were easily detected in four of five cases, but were not identified in four of six and in eight of nine cases at the lateral wall or in the left atrial appendage by TTE. However, TEE detected all thrombi in every site in the left atrium and left atrial appendage in 11 of 12 cases. TEE was thus superior to TTE in detecting cardiac masses, recognizing abnormal flow and estimating anatomical relationship between tumors or thrombi and cardiac structures.(ABSTRACT TRUNCATED AT 400 WORDS)