American heart journal
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American heart journal · Jan 1999
ReviewCardiopulmonary resuscitation: historical perspective to recent investigations.
There are at least 300,000 cardiac arrests annually in the United States. Cardiopulmonary resuscitation (CPR) effectively restores hemodynamic stability, return of spontaneous circulation (ROSC), in 40% to 60% of arrests. Prolonged survival is significantly lower because of underlying illness and the postresuscitation syndrome, specifically central nervous system injury and left ventricular stunning after resuscitation. ⋯ Active compression-decompression and interposed abdominal compressions improved ROSC in prospective randomized trials; abdominal compressions have also been shown to increase survival to hospital discharge. Despite 30 years of research, CPR is now performed much as it was initially. Further research into the mechanisms of cardiac arrest, development of predictive models, and improved means to improve cardiac output and survival are needed.
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American heart journal · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical TrialA randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. Antithrombotic Therapy Consortium Investigators.
Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians. ⋯ Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-of-care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.
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American heart journal · Jan 1999
Comparative StudyParaplane analysis from precordial three-dimensional echocardiographic data sets for rapid and accurate quantification of left ventricular volume and function: a comparison with magnetic resonance imaging.
Three-dimensional echocardiography (3DE) calculates left ventricular volumes (LVV) and ejection fraction (EF) without geometric assumptions, but prolonged analysis time limits its routine use. This study was designed to validate a modified 3DE method for rapid and accurate LVV and EF calculation compared with magnetic resonance imaging (MRI). ⋯ The 3DE-A and 3DE-B methods have excellent correlation and close limits of agreement with MRI for calculating LVV and EF in both normal subjects and cardiac patients. The 3DE-B method by paraplane analysis with 8 equidistant short-axis slices has observer variability similar to MRI and reduces the 3DE analysis time to 10 minutes, therefore offering a rapid, reproducible, and accurate method for LVV and EF calculation.
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American heart journal · Dec 1998
Randomized Controlled Trial Clinical TrialSpinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study.
Spinal cord stimulation is known to be a successful treatment for chronic intractable angina pectoris. Its effect may be anti-ischemic. It is uncertain if the clinical effect is partly caused by a placebo effect of surgery for implantation of a stimulator. In this study, clinical efficacy is investigated, together with a possible placebo effect. ⋯ Spinal cord stimulation is effective in chronic intractable angina pectoris, and its effect is exerted through anti-ischemic action. Efficacy is unlikely to be explained as a placebo effect from surgery.
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American heart journal · Dec 1998
Clinical TrialDobutamine stress Doppler hemodynamics in patients with aortic stenosis: feasibility, safety, and surgical correlations.
This study was designed to describe the experience of our center with the safety and feasibility of dobutamine stress echocardiography (DSE) in aortic stenosis (AS), to characterize the hemodynamic response to dobutamine infusion, and to examine the hemodynamic response in relation to the anatomic evaluation of the valve among patients who underwent valve replacement. ⋯ Although more data are needed to fully establish the safety of the test in this indication, this study suggests that patients with AS can safely undergo DSE. Dobutamine results in an increase not only in the mean gradient, but also in the valve area. An increase in valve area with dobutamine was observed in some patients with anatomically confirmed severe AS and thus does not exclude fixed valve disease.