American heart journal
-
American heart journal · Feb 1994
Ventricular tachycardias of right ventricular origin: markers of subclinical right ventricular disease.
The diagnosis of subclinical myocardial disease in patients with ventricular tachycardias of right ventricular (RV) origin and no overt cardiac abnormalities is important, inasmuch as the presence of RV cardiomyopathy or arrhythmogenic dysplasia can be associated with a poor prognosis. To this end the relative value of symptoms, ECG features of ventricular tachycardia, signal-averaged ECGs, and RV echocardiograms as compared with endomyocardial biopsy findings was prospectively evaluated. Twenty-seven patients with chronic ventricular tachycardias with a left bundle branch block-like morphology, presumed to be of RV origin, were studied. ⋯ An abnormal RV echocardiogram was both a sensitive (73%) and a specific (94%) indicator of an abnormal RV biopsy. Sustained tachycardia although sensitive (90%) had a low specificity (56%). In comparison, a superior frontal plane axis of ventricular tachycardia and an abnormal signal-averaged ECG were indicative of high specificity and low sensitivity for abnormal myocardial histologic findings.(ABSTRACT TRUNCATED AT 250 WORDS)
-
American heart journal · Feb 1994
ReviewInterposed abdominal compression as an adjunct to cardiopulmonary resuscitation.
The addition of IAC to otherwise standard CPR provides for the application of external pressure over the abdomen in counterpoint to the rhythm of chest compression. Interposed abdominal compression is a simple manual technique that can supplement the use of adrenergic drugs to increase both coronary perfusion pressure and total blood flow during CPR. Mechanistically, manual abdominal compressions induce both central aortic and central venous pressure pulses. ⋯ The incidence of abdominal trauma, regurgitation, or other complications is not increased by IAC. Recently, randomized trials have shown that short-term and long-term survival of patients resuscitated in the hospital by IAC-CPR are about twice that of control patients resuscitated by standard CPR. The technique of IAC has thus evolved to become a highly promising adjunct to normal CPR, which is likely to be implemented in an increasing number of clinical protocols in the 1990s.