ABSTRACT
Patients and methods: Nine patients with dilated cardiomyopathy were studied. Hemodynamic and tissular perfusion values, echocardiographic and radioisotopic ventricular function parameters were measured before and after six hours of AV interval shortening with electrical stimulation of the heart. Results: After electrical stimulation, cardiac output increased from 3.38 ñ 0.8 to 32.87 ñ 0.79 l/min (p < 0.05). Pulmonary capillary pressure decreased from 23.8 ñ 8.9 to 19.8 ñ 9.2 mm Hg (p = NS). There were no significant changes in ventricular function parameters or in systemic and pulmonary pressures. Conclusions: Electrical shortening of AV interval in patients with dilated cardiomyopathy increases cardiac output but does not change ventricular function parameters
Subject(s)
Humans , Male , Adult , Middle Aged , Cardiomyopathy, Dilated/physiopathology , Hemodynamics/physiology , Creatine/urine , Creatine/blood , Lactic Acid/blood , Cardiac Pacing, Artificial/methods , Electric Stimulation/methods , Ventricular Function/physiology , Cardiac Output/physiology , Blood Pressure/physiology , Systole/physiologyABSTRACT
La insuficiencia cardiaca constituye unfactor de riesgo de mayormortalidad intrahospitalaria en pacientes con infarto agudo del miocardio (IAM). En el presente trabajo analizamos retrospectivamente las características clínicas y evolución alejada de pacientes que presentan congestión pulmonar durante la fase aguda del IAM y los comparamos con los que no presentaron esa complicación. Para ello utilizamos un abase de datos de 518 pacientes consecutivos con IAM, 309 de los cuales no presentaron congestión pulmonar (Grupo I, edad promedio 61 ñ 11 años) y 209 que deasrrollaron insuficiencia cardiaca Killip II oIII (Grupo II, edad promedio 63 ñ 11 años). Las siguientes características fueron significativamente diferentes entre ambos grupos (Grupo II vs Grupo I, p<0,01). Mortalidad a 30 días 17,4 vs 4,7 por ciento localización anterior del IAM 62 vs 52 por ciento , IAM transmural 83 vs 76 por ciento ; arritmias ventriculares 24,4 vs 12,5 por ciento . En la evolución alejada (promedio 44 meses) los pacienets del Grupo II tuvieron mayor mortalidad (25,9 vs 6,8 por ciento , p<0,01) al año post IAM y a los cinco años de seguimiento (34,9 vs 12,9 por ciento , p<0,01). Confirmamos así que los pacientes que presentan congestión pulmonar durante el curso de un IAM tienen una mayor morbimortalidad tanto precoz como tardía y ello se relaciona con mayor incidencia de IAM anterior y de tipo transmural
Subject(s)
Humans , Male , Female , Heart Failure/mortality , Myocardial Infarction/complications , Follow-Up Studies , Myocardial Infarction/physiopathology , PrognosisABSTRACT
Systemic thrombolysis is an effective therapy for acute myocardial infarction, since it restores coronary flow and contributes to preserve left ventricular function. We analyzeour experience with intravenous thrombolytic therapy in 45 cases with acute myocardialinfarction treated within 6 hours of onset of symptoms. 28 patients had anterior and 17 inferior myocardial infarction. We treated 38 patients with streptokinase 1 to 1,5 million units infused during a during a 30 to 60 minute period and 7 patients with tissue plasminogen activator factor, 100 mg infused during 2 hours. Regression of chest pain and ST segment elevation and early CPK peaking (< 4 hours) were utilized as criteria for reperfusion. Accordingly 20 patients (64%) met these criteria. Coronary angiogram ws performed within 7 days in 38 patients. It disclosed a patent coronary artery in the infarcted area in 28 cases (74%). Transient hypotension with thrombolytic therapy was observed in 17 patients (38%) and bleeding complications in 3 cases (7%). Two patients (4%) died early after therapeutic failure. In summary we have confirmed that intravenous thrombolytic therapy is safe and effective in the early period of myocardial infarction and that is associated with a high incidence of clinical and angiographic reperfusion