Giornale italiano di cardiologia
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From December 1979 to April 1984, 266 victims of cardiac arrest outside the hospital in the metropolitan area of Florence received advanced cardiopulmonary resuscitation by a system for medical emergencies. 69 patients (25.9%) were successfully resuscitated and 42 (15.7%) were discharged alive from hospital without any neurological damage. The time delay between the onset of the cardiac arrest and the cardio-pulmonary resuscitation, the cardiac rhythm present on arrival of rescue squad, the degree of congestive heart failure immediately before the cardiac arrest and the neurological deficit after resuscitation significatively influenced immediate and late outcome.
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In patients with intermittent left bundle branch block (LBBB) it is common to observe T wave abnormalities in the right precordial leads during normally conducted beats. These changes have usually been interpreted as a result of anteroseptal ischemia. More recently it has been suggested that they may be the consequence of an electric phenomena secondary to the abnormal ventricular activation. ⋯ Within this period of observation, no patient developed symptoms or signs of cardiac involvement while all but three developed a stable LBBB (these three patients have been followed only for a limited period of time). Exercise thallium 201 scintigraphy showed in 4 patients a reversible septal perfusion defect during LBBB. We conclude that T wave abnormalities observed in the normally conducted beats in patients affected by intermittent LBBB have a favourable prognostic significance.(ABSTRACT TRUNCATED AT 250 WORDS)
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New antiarrhythmic drugs are chiefly assigned to Class 1C and 1B: "procainamide analogues" (acecainide, lorcainide, flecainide, encainide) and propafenone for the former, and mexiletine, tocainide and aprindine for the latter. Pharmacokinetics vary widely among the different antiarrhythmic agents. These and other problems which regulate therapeutic interventions, such as patient compliance, drug interactions, efficacy/toxicity ratio, drug combinations, and drug monitoring with plasma concentrations of antiarrhythmic agents are briefly considered.
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Vasodilator drugs are generally classified according to their prevalent site of action: arteriolar vasodilators (e.g. phentolamine, hydralazine, nifedipine) which reduce peripheral resistance and, therefore, increase stroke volume and cardiac output; venodilators (e.g. nitrates), which decrease filling pressure, redistributing intravascular blood volume from the central to the peripheral reservoirs and therefore relieve signs and symptoms of congestion; "balanced" vasodilators (e.g. nitroprusside, prazosin, captopril) which present both effects. Vasodilator therapy is indicated in heart failure caused by impaired contractility (congestive cardiomyopathy, ischemic heart disease) and volume overload (mitral and aortic regurgitation, ventricular septal defect). ⋯ Non-invasive studies (in particular echocardiography) don't seem actually adequate for vasodilator therapy evaluation. Finally it is not known if vasodilator treatment influence prognosis of chronic heart failure (especially survival), but there is evidence that it can lessen symptoms and increase effort tolerance.