Assuntos
Ansiedade/complicações , Ansiedade/terapia , Doença das Coronárias/psicologia , Doença das Coronárias/terapia , Depressão/complicações , Depressão/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Eletroconvulsoterapia , Humanos , Terapia de Relaxamento , Fatores de Risco , Resultado do TratamentoRESUMO
Arrhythmias are common after cardiac surgery and are associated with hemodynamic compromise, stroke, and prolonged hospitalization. Beta blockers prevent atrial fibrillation postoperatively, but there are few data regarding the prophylactic use of type 1 antiarrhythmic agents or the prevention of ventricular arrhythmias. Accordingly, we performed a randomized, double-blind, placebo-controlled study of the effects of oral procainamide on 100 patients undergoing elective coronary artery bypass surgery. Procainamide was received for 4 days; the dosage was adjusted for body weight. Patients receiving procainamide had a significant reduction in atrial fibrillation (16 vs 29 patient-days, p < 0.05) and ventricular tachycardia (2% vs 20%, p < 0.01). However, the incidence of atrial fibrillation was not significantly reduced (38% vas 26%). In the group achieving therapeutic serum procainamide levels, there was reduction in all measured postoperative arrhythmias. No serious cardiac or noncardiac adverse events were noted during procainamide therapy, although there was a significant increase in the incidence of nausea. We conclude that procainamide reduces arrhythmias in the early postoperative period after coronary artery bypass surgery, most prominently in patients who achieve therapeutic serum levels. This was associated with no serious cardiac adverse reactions.
Assuntos
Antiarrítmicos/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Procainamida/uso terapêutico , Taquicardia Ventricular/prevenção & controle , Administração Oral , Idoso , Antiarrítmicos/efeitos adversos , Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Preparações de Ação Retardada , Método Duplo-Cego , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Procainamida/efeitos adversos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Resultado do TratamentoAssuntos
Tamponamento Cardíaco/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Idoso , Tamponamento Cardíaco/diagnóstico , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnósticoRESUMO
Cerebral hemorrhage occurs in 0.2% of patients under the age of 60 years treated with thrombolytic therapy for acute myocardial infarction. A case of fatal cerebral hemorrhage following TPA therapy for myocardial infarction due to probable coronary artery embolism during unsuspected native valve infective endocarditis is reported.
Assuntos
Hemorragia Cerebral/etiologia , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Cateterismo/efeitos adversos , Trombose Coronária/complicações , Endocardite Bacteriana/complicações , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/etiologia , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
Left ventricular wall motion abnormalities, aneurysm formation, and progression to global hypokinesis have been described in patients with myocarditis and in patients with hypertrophic cardiomyopathy. We document a case of reversible aneurysm formation, cardiogenic shock, and complete recovery in a patient with myocarditis and hypertrophic cardiomyopathy. Pathophysiologic mechanisms of myocardial injury and recovery are discussed.
Assuntos
Cardiomiopatia Hipertrófica/complicações , Aneurisma Cardíaco/etiologia , Miocardite/complicações , Idoso , Feminino , HumanosAssuntos
Aneurisma Aórtico/diagnóstico , Dissecção Aórtica/diagnóstico , Diagnóstico por Imagem/normas , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Aortografia , Ecocardiografia , Reações Falso-Positivas , Humanos , Imageamento por Ressonância Magnética , Avaliação de Processos em Cuidados de Saúde , Sensibilidade e Especificidade , Avaliação da Tecnologia Biomédica , Tomografia Computadorizada por Raios XAssuntos
Cardiomiopatia Hipertrófica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Assistência Ambulatorial/métodos , Eletrocardiografia/métodos , Assistência Ambulatorial/instrumentação , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Estimulação Cardíaca Artificial/normas , Doença das Coronárias/diagnóstico , Diagnóstico , Frequência Cardíaca , Humanos , Fatores de RiscoRESUMO
The causes of stroke following coronary-artery bypass surgery are largely unknown. To determine whether carotid bruits increase the risk of these events, we compared 54 patients with postoperative stroke or transient ischemic attacks with 54 randomly selected control patients. Both groups were drawn from 5915 consecutive patients who had coronary bypass surgery at our hospital from 1970 to 1984. Carotid bruits were noted preoperatively in 13 patients with postoperative stroke and in 4 control patients. Case-control analysis showed that the presence of carotid bruits increased the risk of stroke or transient ischemic attacks by 3.9-fold (95 percent confidence interval, 1.2 to 12.8; P less than 0.05). This increased risk remained essentially unchanged after adjustment for potentially confounding variables in a multiple logistic regression analysis. Other factors associated with a significantly increased risk (P less than 0.05) of these neurologic deficits were a history of stroke or transient ischemic attack (odds ratio, 6.0; 95 percent confidence interval, 1.6 to 22.1), a history of congestive heart failure (odds ratio, 5.3; confidence interval, 1.6 to 17.0), mitral regurgitation (odds ratio, 4.3; confidence interval, 1.4 to 12.9), postoperative atrial fibrillation (odds ratio, 3.0; confidence interval, 1.4 to 6.7), a cardiopulmonary-bypass pump time of more than two hours (odds ratio, 2.7; confidence interval, 1.1 to 6.7), and a previous myocardial infarction (odds ratio, 2.3; confidence interval, 1.1 to 5.1). We conclude that the presence of carotid bruits increases the risk of stroke after coronary-artery bypass surgery. However, the absolute magnitude of this risk, 2.9 percent, is small and comparable to the reported risk of stroke from carotid endarterectomy.
Assuntos
Artérias Carótidas/fisiopatologia , Transtornos Cerebrovasculares/etiologia , Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Fibrilação Atrial/complicações , Auscultação , Insuficiência Cardíaca/complicações , Humanos , Ataque Isquêmico Transitório/complicações , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Análise de Regressão , Fatores de Risco , Fatores de TempoRESUMO
Between 1963 and 1983, 55 patients presented to our hospital with a clinical picture that suggested aortic dissection but with aortograms that were interpreted as negative for that entity. In 4 patients, the aortographic findings subsequently proved to be false negative. The remaining 51 patients had the following diagnoses: myocardial infarction in 9 patients; aortic regurgitation in 5; thoracic nondissecting aneurysm in 4; musculoskeletal pain in 4; mediastinal tumor in 4; pericarditis in 3; acute coronary insufficiency in 3; cholecystitis in 2; miscellaneous in 3; and unknown in 14. The clinical features in these patients were compared with those of 125 patients with true aortic dissection. Three features were significantly more prevalent in patients with than without dissection: prior systemic hypertension, pain for 24 hours or less, and migratory pain. Patients without dissection were younger than those with distal dissection and had significantly less systemic hypertension, posterior thoracic pain and migratory pain. Patients without dissection had significantly less frequent congestive heart failure, pulse deficits and aortic regurgitation, and more frequent hypertension and pain for more than 24 hours than patients with proximal dissection. This study defines the actual differential diagnosis of aortic dissection at our hospital, the frequency of false-negative aortographic findings and contrasts the clinical features of patients with and without dissection.
Assuntos
Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Fatores Etários , Idoso , Aorta Torácica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Aortografia , Doença das Coronárias/diagnóstico , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Dor/diagnóstico , Pericardite/diagnóstico , Estudos RetrospectivosRESUMO
Retrospective data on the treatment of aortic dissection at the Massachusetts General Hospital from 1963 to 1978 are reported. During this period, 160 patients with spontaneous aortic dissection were treated by definitive medical or definitive surgical therapy. Patients were classified according to type (proximal versus distal) and duration (acute versus chronic) of dissection. Long-term follow-up (mean 48 months, range 1 to 147) was available in 156 cases. Hospital and late survival in each of the categories of dissection were evaluated in relation to those features of the dissection itself and of the subsequent therapy that correlated with ultimate survival. Results show that: 1) chronic presentation was the most significant determinant of both hospital and late survival; 2) in acute dissection, prognosis was determined largely by the presence or absence of major complications, regardless of ultimate therapy; the only complication without adverse effect on survival was aortic insufficiency; 3) late survival after discharge from the hospital was similar for patients with all types of dissection and modes of therapy; and 4) the incidence of late complications from aortic dissection was lower than previously reported. Thus, the success of early definitive medical and surgical treatment was sustained on long-term follow-up.
Assuntos
Aneurisma Aórtico/mortalidade , Dissecção Aórtica/mortalidade , Doença Aguda , Dissecção Aórtica/tratamento farmacológico , Dissecção Aórtica/cirurgia , Aneurisma Aórtico/tratamento farmacológico , Aneurisma Aórtico/cirurgia , Doença Crônica , Feminino , Humanos , Masculino , Transtornos Mentais/induzido quimicamente , Pessoa de Meia-Idade , Dor/etiologia , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Long-term follow-up was obtained on 138 patients who participated in a prospective, randomized study comparing two weeks with three weeks of hospitalization following uncomplicated acute myocardial infarction. Follow-up information was available on 123 (89%) of all randomized patients. The mean follow-up period was 35 months for those patients who died and 99 months for those who survived. No differences were found between the two groups with respect to survival, cardiac-related deaths, frequency or severity of angina pectoris, subsequent myocardial infarction, incidence of congestive heart failure, number of ventricular aneurysms, or subsequent medical therapy. A significantly greater number of survivors in both groups stopped smoking and had a normal initial heart size than those who died. This long-term follow-up study further supports the conclusions of earlier short-term studies that two weeks of hospitalization is safe in patients with uncomplicated acute myocardial infarction.