Subject(s)
Disease/classification , Diagnosis , Humans , Nursing Care , Severity of Illness Index , TherapeuticsABSTRACT
Among 4178 patients who between 1980 and 1986 had undergone left-heart catheterization with left-heart injections and coronary angiography there were 76 (1.8%) with previous reactions to contrast media. These latter patients were given, three days before the planned investigation, 6 alpha-methylprednisolone, 24 mg daily by mouth, and phenhydramine hydrogenmaleinate, 150 mg daily, and two hours before the investigation 80 mg 6 alpha-methylprednisolone hemisuccinate intravenously. The effect of this prophylactic regimen was tested prospectively. Diatrizoate 76% was the contrast medium used. Of 4102 patients without known contrast-medium intolerance 137 (3.34%) had a reaction, 27 of them (0.66%) severe enough to require treatment. Among the 76 patients with known previous reactions, nine (11.8%) had reactions, one very severe requiring treatment, the others mild. The described pre-injection regimen thus allows indicated left-heart contrast-medium injection to be undertaken at a justifiable risk.
Subject(s)
Contrast Media/immunology , Coronary Angiography , Diatrizoate , Drug Hypersensitivity/prevention & control , Glucocorticoids/administration & dosage , Histamine H1 Antagonists/administration & dosage , Cardiac Catheterization , Diatrizoate/immunology , Humans , Premedication , RiskABSTRACT
In 190 patients, 208 "screw-in" type pacemaker leads were implanted; 147 in the right ventricle and 61 in the right atrium. There was no significant difference in the time required for atrial (54.7 +/- 19 min) or ventricular fixation (56.0 +/- 25 min). Similarly, fluoroscopy times for both atrial (6.3 +/- 4 min) and ventricular positioning (8.1 +/- 6 min) were equivalent. In the subsequent follow-up period ranging from one to 23 months, only one dislocation of a "screw-in" type atrial lead was seen, and that in a patient with "twiddler syndrome". Otherwise, in patients in whom the lead was securely implanted, no evidence of dislocation has been observed. In one patient "under-sensing" developed subsequent to repositioning for exit-block. In this patient population, the use of "screw-in" type electrodes, in particular through facilitation of atrial positioning, has substantially lessened the rate of pacemaker complications.
Subject(s)
Electrodes, Implanted , Pacemaker, Artificial , Electrocardiography , Heart Atria , Heart Ventricles , Humans , PrognosisABSTRACT
The possible relationship between the cardiac volume, as determined radiologically in the supine position in 119 patients with angiographically proven coronary artery disease, and the results of ergometry and balloon catheterization was investigated. There was no relationship between the heart size on the one side and the maximum exercise tolerance and the maximum cardiac output on the other, except for the fact, that these parameters tended to decrease with increasing heart size. This was especially true in patients with angina. The maximum cardiac output of patients with angina was always below the value of patients without angina but comparable heart size. Reduced cardiac output under exercise (exertional cardiac insufficiency) was present in 50% of patients with enlarged hearts but already in 22% of patients with heart volumes in the lower range of normal. The diastolic pulmonary artery pressure, determined under exercise, was the only parameter with a significant relationship to the heart size: The larger the heart size, the higher the diastolic pulmonary artery pressure. On the other hand: the diastolic pulmonary artery pressure at rest was abnormal with significant frequency only, when the heart was enlarged. Our data suggest, that the hemodynamics are determined by 2 factors: Myocardial scarring secondary to infarction and coronary insufficiency (ischemia). Of these two factors only the former influences cardiac size. Therefore, determination of the heart volume helps evaluating the respective role of these two factors in individual cases.
Subject(s)
Coronary Disease/diagnosis , Adult , Aged , Angina Pectoris/diagnosis , Blood Pressure , Cardiac Catheterization , Cardiac Output , Cardiac Volume , Female , Heart Failure/complications , Humans , Male , Methods , Middle Aged , Physical Exertion , Pulmonary ArteryABSTRACT
We have investigated the possible relationship between the radiogically determined cardiac volume and the coronary angiogram and laevocardiogram. There was no relationship between cardiac size and coronary angiogram. Independently from the number of coronary vessels involved, we found normal sized hearts in patients without ECG-evidence of myocardial infarction, and enlarged hearts in patients with ECG-evidence of myocardial infarction. There was a significant, though loose relationship between the cardiac volume and the endsystolic and enddiastolic volumes (r=0.73 and 0.55 respectively) and the ejection fraction (r=0.69) as determined by laevocardiography. The critical value of the cardiac size, about which one encounters an increased number of abnormal volume parameters, was the upper boundary of 1-SD. Using this value we found a specifity of 81% and a sensitivity of 74% for the heart volume as a predictor of a pathological ejection fraction. On the other hand, using the upper boundary of 2-SD as a critical value, there was a sensitivity of only 58%, but a specificity of 92%. Only 11% of the patients with a cardiac size in the lower range of normal or below had an ejection fraction below 50%. Therefore the radiologically determined heart size is a simple, in daily practive acceptable method to assess and follow up left ventricular function in coronary patients.
