American heart journal
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American heart journal · May 1998
Effects of intraaortic balloon counterpulsation on carotid artery blood flow.
The intraaortic balloon pump has been shown to improve cardiac output and diastolic coronary flow. Animal studies with balloon counterpulsation have shown variable effects on carotid and cerebral blood flow. We investigated the effects of counterpulsation with the intraaortic balloon pump on blood flow in the common carotid artery in human beings. ⋯ Despite a significant augmentation in diastolic blood flow with balloon counterpulsation, no increase occurred in total carotid artery blood flow. This appeared to be caused by improper timing of balloon deflation. This could result in no improvement in cerebral blood flow with intraaortic balloon pump counterpulsation in critically ill patients.
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American heart journal · May 1998
Randomized Controlled Trial Comparative Study Clinical TrialA randomized, double-blind comparison of intravenous diltiazem and digoxin for atrial fibrillation after coronary artery bypass surgery.
Atrial fibrillation (AF) after coronary bypass graft surgery may result in hypotension, heart failure symptoms, embolic complications, and prolongation in length of hospital stay (LOHS). The purpose of this study was to determine whether intravenous diltiazem is more effective than digoxin for ventricular rate control in AF after coronary artery bypass graft surgery. A secondary end point was to determine whether ventricular rate control with diltiazem reduces postoperative LOHS compared with digoxin. ⋯ Ventricular rate control occurs more rapidly with intravenous diltiazem than digoxin in AF after coronary artery bypass graft surgery. However, 12- and 24-hour response rates and duration of postoperative hospital stay associated with the two drugs are similar.
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American heart journal · May 1998
Randomized Controlled Trial Clinical TrialEffective arterial elastance and the hemodynamic effects of intraaortic balloon counterpulsation in patients with coronary heart disease.
The goal of the present study was to analyze the effects of different intraaortic balloon counterpulsation (IABC) inflation volumes on effective arterial elastance (Ea) in patients with complicated coronary heart disease and to determine whether Ea can predict the hemodynamic response to IABC. ⋯ A higher control Ea was associated with a lower control LV stroke work and a larger IABC-related hemodynamic improvement (that was maximal with the 40 ml inflation volume). The increase in LV stroke work was closely related to the decrease in Ea. Accordingly, hemodynamic benefits from IABC were less evident in patients with lower control Ea. In conclusion, effects of IABC were related to both balloon inflation volume and control hemodynamics, reflecting the afterload dependence of a depressed LV function.
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American heart journal · May 1998
Comparative StudyCardiac troponin T, creatine kinase, and its isoform release after successful percutaneous transluminal coronary angioplasty with or without stenting.
Cardiac troponin T is a sensitive and specific marker for the detection of minor myocardial injury. However, it has been rarely used to monitor myocardial injury after coronary stenting. The purpose of the study was to measure troponin T after apparently successful percutaneous transluminal coronary angioplasty (PTCA) with or without coronary stenting and to compare its result with serum creatine kinase and its isoform, CKMB. ⋯ Cardiac troponin T is more sensitive than creatine kinase and CKMB in detecting minor myocardial injury after coronary interventions. The incidence of troponin T release is higher in the patients undergoing stent implantation than in patients treated with angioplasty alone.
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American heart journal · May 1998
Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myocardial Infarction (NRMI-2) Participants.
Therapeutic decision making in critically ill patients requires both prompt and comprehensive analysis of available information. Data derived from randomized clinical trials provide a powerful tool for risk assessment in the setting of acute myocardial infarction (MI); however, timely and appropriate use of existing therapies and resources are the key determinants of outcome among high-risk patients. ⋯ This large registry experience included more than 150,000 nonselected patients with MI and suggests that high-risk patients can be identified on initial hospital presentation. The current use of reperfusion and adjunctive therapies among high-risk patients is suboptimal and may directly influence outcome. Randomized trials designed to test the impact of specific management strategies on outcome according to initial risk classification are warranted.