Heart : official journal of the British Cardiac Society
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Randomized Controlled Trial Clinical Trial
Different responses to dobutamine in the presence of carvedilol or metoprolol in patients with chronic heart failure.
To determine whether patients with congestive heart failure on different beta adrenoreceptor blocking drugs have similar haemodynamic responses to dobutamine. ⋯ Patients with congestive heart failure on a non-selective beta adrenoreceptor blocker or beta1 selective blocker responded differently to the inotropic drug dobutamine: the beta1 blockade caused by metoprolol could be counteracted by dobutamine, whereas with carvedilol a low dose of dobutamine increased cardiac output, and a higher dose of dobutamine caused a pressor effect. These findings may be clinically relevant when choosing an inotropic drug.
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Review
Where are we today? Early results from MINAP, the National Audit of Myocardial Infarction Project.
The Myocardial Infarction National Audit Project (MINAP) was developed primarily as a response by the profession to the audit requirements of the National Service Framework for coronary heart disease. MINAP began to collect data in October 2000 and by October 2002, 223 hospitals in England and Wales had returned data on patients with acute myocardial infarction. ⋯ At the same time only 37% of patients received treatment within 60 minutes of calling for help, and only about 20% reached hospital within 30 minutes of calling for help. In order to improve speed of access to thrombolytic treatment there is a need for increased use of pre-hospital treatment.
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Cardiac contusion is usually caused by blunt chest trauma and therefore is frequently suspected in patients involved in car or motorcycle accidents. The diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac contusion can cause life threatening arrhythmias and cardiac failure. ⋯ Nevertheless, diagnosis of a cardiac contusion and identification of patients at risk remain a challenge. In this review the current diagnostic tests will be discussed. Also, based on these diagnostic tests, a screening strategy containing data from the latest studies is presented, with the intention of detecting patients at risk.
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Randomized Controlled Trial Clinical Trial
Simvastatin attenuates leucocyte-endothelial interactions after coronary revascularisation with cardiopulmonary bypass.
To investigate the effects of preoperative simvastatin treatment on leucocyte-endothelial interactions following coronary artery bypass surgery with cardiopulmonary bypass. ⋯ Pretreatment with simvastatin reduces neutrophil adhesion to the venous endothelium in patients undergoing coronary surgery, irrespective of its efficacy at lowering cholesterol concentration.