ABSTRACT
Angiotensin-converting-enzyme inhibitors are frequently used in conjunction with diuretics in the treatment of congestive cardiac failure. We report two cases in which use of a proprietary combination diuretic containing a loop diuretic and potassium sparing agent with an angiotensin converting enzyme inhibitor was associated with hyperkalaemic cardiac arrest. Successful resuscitation from the arrest permitted elucidation of its mechanism. We believe that this outcome has not previously been reported, and emphasise the importance of electrolyte monitoring in patients receiving angiotensin converting enzyme inhibitors particularly if prescribed in addition to fixed combination proprietary diuretics.
Subject(s)
Angiotensin-Converting Enzyme Inhibitors/adverse effects , Diuretics/adverse effects , Enalapril/adverse effects , Heart Arrest/etiology , Hyperkalemia/chemically induced , Aged , Amiloride/adverse effects , Drug Therapy, Combination , Female , Furosemide/adverse effects , Humans , Hyperkalemia/complicationsABSTRACT
The hydrodynamic and haemodynamic function of 29 mm mitral and 23 mm aortic St Jude Medical (SJM) and CarboMedics (CM) heart valves have been compared in a pulsatile flow simulator in the laboratory and by doppler ultrasound in vivo. The laboratory studies showed that there was no significant difference in the pressure drop across the valves. The valves also had similar regurgitant volumes. Doppler ultrasound confirmed these results with a mean pressure drop of 12.9 +/- 5.5 mmHg across the CM aortic valves and 12.6 +/- 5.5 mmHg for the SJM aortic valves. The mean mitral diastolic pressure drops were 3.8 +/- 1.8 and 4.6 +/- 1.4 mmHg for the CM and SJM valves, respectively. Mild aortic regurgitation was detected in 5 of 14 patients in the CM group and 1 out of 6 patients in the SJM group, though none of the cases were clinically significant. Both the in vitro and in vivo results show these valves to have acceptable and comparable function.
Subject(s)
Heart Valve Prosthesis , Hemodynamics/physiology , Models, Cardiovascular , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Blood Flow Velocity/physiology , Cardiac Output/physiology , Echocardiography, Doppler , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/surgery , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Prosthesis DesignABSTRACT
Glossopharyngeal neuralgia associated with cardiac syncope developed in a 53 year old man. Symptoms were controlled with temporary and permanent transvenous pacing and carbamazepine.
