American heart journal
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American heart journal · Feb 1992
Flecainide therapy in patients treated for supraventricular tachycardia with near normal left ventricular function.
Concerns about the safety and efficacy of class IC antiarrhythmic agents have arisen as a result of the recent CAST data. We reviewed records of 175 consecutive patients treated with flecainide between July 1, 1988 and July 5, 1989. One hundred ten patients with normal or mildly impaired left ventricular function and symptomatic supraventricular arrhythmias were identified. ⋯ Two patients developed proarrhythmic events (nonsustained ventricular tachycardia). There were no deaths during the follow-up period. In conclusion, flecainide provides safe and effective therapy for supraventricular tachyarrhythmias in patients with normal or mildly impaired left ventricular function.
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American heart journal · Jan 1992
Intraoperative determination of cardiac output by transesophageal continuous wave Doppler.
A new prototype transesophageal transducer with continuous-wave Doppler and pulsed Doppler capabilities was evaluated to calculate intraoperative cardiac output from the main pulmonary artery. Fifteen consecutive patients undergoing elective coronary artery bypass surgery were studied. The main pulmonary artery diameter above the pulmonic valve was measured with the single horizontal plane transesophageal transducer. ⋯ The closest correlation with thermodilution cardiac output was with the continuous-wave Doppler cardiac output method: R = 0.91, SEE = 0.2 L/min, and y = 1.1x . 0.2 (p less than 0.001). The correlation of thermodilution with pulsed Doppler cardiac output was R = 0.83, SEE = 0.5 L/min, and and y = 0.86 + 1.0 (p less than 0.001). Transesophageal continuous-wave Doppler is a new technique that may be used in selected patients for accurate determination of intraoperative cardiac output.
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American heart journal · Jan 1992
Increased oxygen free radical activity in patients on cardiopulmonary bypass undergoing aortocoronary bypass surgery.
Cardiac dysfunction after cardiopulmonary bypass (CPB) has been reported by various investigators. Oxygen free radicals have been shown to depress cardiac function and contractility. To evaluate the possible role of oxygen free radicals (OFR) in post-pump cardiac dysfunction, measurements of cardiac function, OFR producing activity of polymorphonuclear (PMN) leukocytes (PMN chemiluminescence) and malondialdehyde (MDA), a lipid peroxidation product, in blood were made at induction of anesthesia (T1), before cross clamping of the aorta (T2), after closure of the chest (T3), and 24 hours postoperatively (T4) in 21 patients undergoing aortocoronary bypass surgery. ⋯ There were decreases in the blood pressure and stroke volume, and increases in the central venous pressure, capillary wedge pressure, and heart rate during CPB and postoperatively. Cardiac output remained unchanged during this procedure. There was leukopenia during CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
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American heart journal · Jan 1992
Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow-up study.
To determine the prevalence and natural history of left ventricular thrombus in dilated cardiomyopathy, we prospectively performed two-dimensional echocardiograms in 25 patients with nonischemic dilated cardiomyopathy who were not receiving anticoagulation. Eighty-five echocardiograms were performed serially over a 9- to 30-month period (mean follow-up 21.5 months). A left ventricular thrombus was present on initial echocardiogram in 11 (44%) patients, became present during follow-up in an additional four, and disappeared in two. ⋯ Three of five thrombi that protruded into the left ventricular cavity subsequently embolized. We conclude that in nonanticoagulated patients with dilated cardiomyopathy left ventricular thrombus and thromboembolism are common. Echocardiography may be helpful in predicting which patients are at risk of thromboembolism.