ABSTRACT
This blinded cross-sectional study was to determine whether chronic cocaine exposure in utero produces abnormalities in left ventricular function (shortening fraction), heart rate, rhythm, and conduction in term neonates. Three groups of neonates were evaluated by two-dimensional echo Doppler and 24 hour Holter monitor, with studies initiated in the first 24 hours of life. Group A (n = 32) neonates had a positive history of chronic maternal cocaine use in pregnancy (MCU+) and a positive neonatal urine cocaine test (NUC+). Group B (n = 23) neonates were MCU+ but NUC-. Group C (n = 32) neonates were MCU- and NUC-. Measured parameters were compared statistically by analysis of variance. p < 0.05 was regarded as significant. Echocardiography showed no significant difference between groups A, B, and C for left ventricular shortening fraction. Holter monitor likewise revealed no significant difference between groups in minimal, maximal, and average heart rate, or in the incidence of supraventricular and ventricular arrhythmias greater than 20 beats/h in the 24-hour period. None of the patients had atrioventricular or bundle branch block. It is possible that the developmental state of the newborn heart makes it less responsive to the adverse effects of cocaine.
Subject(s)
Cocaine/adverse effects , Heart/drug effects , Infant, Newborn , Prenatal Exposure Delayed Effects , Analysis of Variance , Arrhythmias, Cardiac/etiology , Cocaine/urine , Cross-Sectional Studies , Echocardiography , Echocardiography, Doppler , Electrocardiography, Ambulatory/drug effects , Female , Heart Conduction System/drug effects , Heart Rate/drug effects , Humans , Infant, Newborn/urine , Myocardial Contraction/drug effects , Pregnancy , Pregnancy Complications , Single-Blind Method , Substance-Related Disorders , Tachycardia, Supraventricular/etiology , Ventricular Function, Left/drug effectsSubject(s)
Birth Weight , Mental Recall , Adolescent , Adult , Data Collection/methods , Female , Health Status , Humans , Infant, Low Birth Weight , Infant, Newborn , Mothers/psychology , Retrospective StudiesABSTRACT
Although surgery may correct the hemodynamic abnormalities of tetralogy of Fallot (TOF), the long-term effects on exercise tolerance are uncertain. Twenty-eight patients, aged 7 to 30 years, had cardiac catheterization and maximal graded exercise testing to evaluate the adequacy of the ehmodynamic repair and its relation to exercise performance. Patients were tested 2 to 9 years after operation, and 13 previously had had palliative shunt procedures. At catheterization, 23 of the 28 patients had good surgical results. Despite the satisfactory hemodynamics, maximal working capcity (MWC), maximum heart rate, and exercise blood pressure were diminished when compared to normal values. In 10 patients who had exercise studies at catheterization, right ventricular systolic pressure (RVSP) and residual gradients were magnified by exercise. Abnormalities were independent of age at time of correction, time elapsed since surgery, use of patch in the outflow tract, or any antecedent procedures.
