ABSTRACT
In patients with myocardial infarction (MI), anginal attacks, reinfarctions or sudden deaths occur occasionally during or after bathing. Therefore it is important to know well about influence of bathing on cardiac function. In this study we examined hemodynamic indices by means of Swan-Ganz catheter and blood flow pattern with Doppler echocardiographic method in comparison with cardiac events (CE) during and after admission.<br>Forty-nine patients with MI (mean age 58.9 years) were examined, including 14 patients with extensive anterior MI, 12 with anterior, 17 with inferior and 6 with anterior and inferior MI. Bathing was carried out at supine position in a tap water at 42°C during 5 minutes in the Hubbard tank. The patients was classified into two groups, one with CE (Group A), and the other without CE (Group B). Hemodynamic indices by means of Swan-Ganz catheter, peak velocities of blood flow (PV) at left ventricular outflow tract (LVOT) and blood flow pattern at left ventricular inflow tract (LVIT) with Doppler echocardiographic method were studied in comparisons.<br>Seven of 49 patients had CE (2 cases with sudden death, 2 cases with reattack of MI and 3 cases with heart failure), and 2 of theses 7 cases had CE during bathing (one with sudden death and the other with reattack of MI). Pulmonary capillary wedge pressure (PCWP) increased from 4.0±2.7mmHg to 12.5±4.6mmHg in Group B, while in Group A marked increases in PCWP on bathing were noted from 3.9±1.2mmHg to 18.1±4.8mmHg (p<0.001) and significant high level was maintained during bathing. Mean pulmonary arterial pressure (mPAP) in Group A also increased during bathing significantly compared with Group B. Six of 13 patients (46.2%) with decreased PV at LVOT and 3 of 8 patients (37.5%) with markedly increased A/R at LVIT on bathing had CE, which was noted at the higher rate compared with those with increased PV and without markedly increased A/R (each, p<0.001, p<0.05). In Group A, severe heart failure on admission into coronary care unit was significantly noted much (p<0.001), physical work capacity was lower in exercise tolerance test by bycyle ergometer and left ventricular ejection fraction was lower (26.9±6.1% vs 56.1±16.6%, p<0.001) with significance in cardiac catheterization, suggesting cardiac dysfunction.<br>In conclusion, bathing should be carried out carefully in patients with markedly increased PCWP or mPAP, with decreased PV at LVOT and with markedly increased A/R at LVIT.
ABSTRACT
Little is known about how isosorbide dinitrate (ISDN) contribute to bathing effects on patients with myocardial infarction. A study using an invasive method was made on 29 patients with myocardial infarction to clarify the hemodynamic changes occurring during bathing with and without sublingual ISDN, and to evaluate the overall effects of the ISDN. In bathing after discontinuing dosing of vasodilators (PRE-ISDN), patients were divided into the following two groups depending on the difference between the peak pulmonary capillary wedge pressure (PCWP) during bathing and PCWP before bathing: Increased PCWP group [(Group A): Δ PCWP≥10mmHg] and Unincreased PCWP group [(Group B): Δ PCWP <10mmHg].<br>Bathing was taken for 5 minutes at 42°C in a Hubbard tank, hemodynamics were observed during bathing and for 10 minutes after bathing, and after 30 minutes of sublingual administration of 5mg ISDN, bathing was taken in a similar manner. Group A patients showed a greater increase in heart rate, blood pressure, pulmonary arterial pressure (PAP), and right artial pressure than of Group B patients during bathing before being dosed with ISDN, and it seemed to be a considerable load on the heart. Although the remarkable increase of PAP and PCWP observed during the early stage of bathing before dosing with ISDN significantly decreased after sublingual dosing of ISDN (POST-ISDN) among Group A patients, these effects were not found in Group B patients. Group A showed more frequent reinfarction from a clinical viewpoint and triple vessel disease upon coronary arteriography, a lower ejection fraction upon left ventriculography, a higher left ventricular end-diastolic pressure, and lower left ventricular performance in most cases as compared to Group B. Although ISDN was found to be effective for severe cases in which the marked pre-load was observed by bathing, no beneficial effect on mild cases with well-maintained left ventricular performance was obtained.
ABSTRACT
The changes of hemodynamics during bathing in patients with heart diseases were studied by invasive methods using a Swan-Ganz catheter and UCG. As a population, we have used 37 peatients with heart disease, ages 20 to 76 (average age 52.9). There were 26 cases of myocardial infarction, 5 cases of valvular disease, 5 cases of cardiomyo pathy, and 1 case of VSD. Bathing was done with tap water in a Hubbard tank, for 10 minutes at 40°C and for 5 minutes at 43°C in a supine position. Arterial pressure, heart rate, pulmonary arterial pressure, pulmonary wedge pressure, right atrial pressure, cardiac output, stroke volume and stroke work index were increased during bathing and decreased after bathing. Systemic vascular resistance and pulmonary arteriolar resistance were decreased during bathing. Their changes were marked with a bath of 40 to 43°C. These findings suggest that preload may be increased during bathing, and preload and afterload reduced after bathing. Hydrostatic pressure, autonomic nervous reflexes or endocrine system were thought of as possible reasons for the increase in pulmonary arterial pressure. Because pulmonary arterial pressure, pulmonary wedge pressure and right atrial pressure increased during bathing even though systemic vascular resistance and pulmonary arteriolar resistance decreased, increase in venous return was thought of as the biggest possibility. And because the patients with low cardiac function could not control the extent of increase in venous return, pulmonary arterial pressure increased markedly in patients with low cardiac function. The patients with myocardial infarction were classifed into a group showing elevation of pulmonary arterial pressure (PAP) and a group showing no elevation of PAP. The group showing elevation of PAP, compared with that without PAP elevation, included many cases of severe myocardial infarction deter-mined by Forrester's classification, Killip's classification and Peel's prognostic index at admission to hospital. Among these patients showing PAP elevation, there were more cases having low physical work capacity and low ejection fraction at discharge from hospital than among the patients without PAP elevation.