A comparison of cardiac rate-pressure product and pressure-rate quotient with Holter monitoring in patients with hypertension and cardiovascular disease: a follow-up report.

OBJECTIVES: The purpose of this study was to evaluate patients with hypertension or cardiovascular disease, or both, for myocardial ischemia and cardiac arrhythmias while undergoing minor oral surgery. STUDY DESIGN: Sixteen patients were studied with noninvasive monitoring including heart rate, systolic, diastolic, and mean arterial blood pressure to calculate rate-pressure product (systolic blood pressure multiplied by heart rate) and pressure-rate quotient (mean arterial pressure divided by heart rate). These calculated measures were compared with the incidence of cardiac arrhythmias and ST segment depression recorded on a continuous Holter monitoring system. RESULTS: Nine of 16 (56%) developed supraventricular or ventricular ectopy during dental extractions or minor preprosthetic surgery performed with local anesthesia 2% xylocaine with 1/100,000 epinephrine dilution. Three of the nine patients who experienced these arrhythmias had coincident abnormal rate pressure product and pressure-rate quotient values. None of these patients exhibited ST-T wave changes suggestive of myocardial ischemia. Atrial or ventricular ectopy suggests that myocardial irritability was more likely to occur than ischemia as measured by Holter monitoring and compared with abnormal rate pressure product and pressure-rate quotient values recorded.

A comparison of cardiac rate-pressure product and pressure-rate quotient in healthy and medically compromised patients.

Healthy and medically compromised patients were studied to compare blood pressure and heart rate changes in response to stress of routine dental extractions performed while they were under local anesthesia. Thirty-nine patients divided into American Society of Anesthesiologists (ASA) I and II groups were noninvasively monitored every 5 minutes. Systolic, diastolic, and mean arterial pressures and heart rate were recorded. Rate pressure products (RPP) and pressure rate (PRQ) quotients were calculated and compared in each group. Significant results were measures of RPP greater than 12,000 and PRQ less than one. Of the 24 patients in the ASA I category, 50% demonstrated elevated RPP values, but only two of 24 had coincidental PRQ abnormalities. Of the 15 patients in the ASA II category, 80% demonstrated elevated RPP values, but two of 15 had coincidental PRQ abnormalities. Patients in the ASA II category had a higher incidence of RPP and PRQ abnormalities, as was expected. However, it is not known which of these two measures is a more sensitive indicator of increased risk associated with stimulation of the sympathetic-adrenergic axis during oral surgery performed with patients under local anesthesia. Correlation studies with continuous Holter monitoring for ST-T wave changes on electrocardiography are forthcoming.

Surgical resection of lung cancer.

Surgery remains the treatment of choice for patients with lung cancer who demonstrate resectable tumors. The type of surgical procedure performed depends on the degree of metastasis and the functional lung capacity of the patient. In addition to problems common to all surgical patients, complications such as cardiac arrhythmias, pulmonary embolus, respiratory failure, bronchopleural fistula, and empyema may occur. Although survival statistics for patients with lung cancer remain poor, the common denominator in patients that have survived 5 years is surgical resection.