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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In addition to the standard monitoring of heart rate and blood pressure, the Systolic Time Intervals were used to evaluate cardiac performance, and the Pressure Time Indices (tension time index = TTI; diastolic pressure time index = DPTI) were used to estimate myocardial oxygen balance. Twelve patients with known heart disease were studied during induction with thiopental, intubation, and early anesthesia with methoxyflurane. Cardiac performance diminished after thiopental; and during methoxyflurane it was reflected in increases in pre-ejection period (PEP) and the ratio PEP/LVET. Intubation resulted in a hyperactive state of the heart, as shown by maximal decreases in PEP and PEP/LVET. Myocardial oxygen balance--estimated from the supply/demand ratio (DPTI/TTI)--was impaired after thiopental. After intubation, DPTI/TTI decreased to its lowest value due to an excess of myocardial oxygen demand (TTI) over myocardial oxygen supply (DPTI), signifying a transitory underperfusion of the subendocardium. During methoxyflurane the oxygen balance was gradually restored towards control value. The Systolic Time Intervals and the Pressure Time Indices provided valuable information on cardiac function not available from standard monitoring alone.
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PMID:Cardiac function during induction and early anesthesia with methoxyflurane. An evaluation using systolic time intervals and pressure time indices. 72 67

In 44 patients with congenital or acquired heart disease, functional class II--IV NYHAC, the effects of calcium gluconate (10 ml 10%) and calcium chloride (10 ml 5.5%) on hemodynamics, inotropy and myocardial oxygen consumption were investigated during and immediately after cardiosurgical procedures. There was a significant increase in blood pressure, left ventricular pressure, total systemic resistance, cardiac index, stroke index, peak dp/dt and myocardial oxygen consumption as well as in arterial perfusion pressure during extracorporeal circulation due to i.v.-injection of either one of the drugs. The positive inotropic effects were more pronounced after application of calcium chloride. In emergency situations during anaesthesia or resuscitation, therefore, calcium chloride seems to be of more advantage than calcium gluconate.
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PMID:[Effects of calcium gluconate and calcium chloride on cardiocirculatory parameters in man (author's transl)]. 72 23

1. A study was made of 34 cases (33%) of myocardial infarction trans and immediately postoperative which occurred in 11,210 surgical interventions with and without extracorporeal circulation. 2. This presents a statistical relation of the frequency of myocardial infarction in realtion to the heart disease acquired with or without extracorporeal circulation with the mitral, aortic, and double prosthesis of the mitral and aortic valves. A correlation was also made with the ischemic heart disease subjected to revascularization. The same analysis was carried out in the congenital heart disease with or without extracorporeal circulation. 3. In all cases the antecedents, precipitating factors, and the clinical picture were studied and in 12 cases the necropsy was analized. The principal finding was transmural myocardial infarction with electrocardiographic proof and serial enzymes. 4. The group was divided into two sub-groups; Group "A" with acute myocardial infarction transoperative, and Group "B" with acute myocardial infarction in the first eight postoperative days. The electrical and mechanical complications were analized. 5. A correlation was made of the causes of mortality related to the type of congenital or acquired heart disease with or without extracorporeal circulation. 6. The frequency of this entity was studied with the total time of aortic clamping, and the complications such as the low cardiac output syndrome, rupture of the wall, aneurysms, acute pulmonary edema, and with the disturbances of rhythm and conduction. 7. The presence of 33.3% of normal coronaries in these of necropsy was emphasized. 8. The importance of the coronary profile of this group in relation to the consequences of a stress from anesthesia, surgery, extracorporeal circulation, and aortic clamping is mentioned. 9. The diagnostic parameters such as arterial hypotension with or without the low cardiac output syndrome, enzyme levels, and the action of the potassium ion are mentioned. 10. An analysis is made of the possible etiological factors of the precipitation of the myocardial necrosis in the cases with normal coronaries and those in which there was no important obstruction of the coronary macrocirculation. 11. In the subgroup "A" it was found that the frequency of myocardial infarction was less than in the subgroup "B", but there was greater mortality in group "A". The possible causal factors are analized.
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PMID:[Trans and postoperative myocardial infarct in heart surgery]. 93 52

By means of the case of a patient resuscitated after cardiac arrest attention is brought to the occurring of Mendelson's syndrome in coronary care units. Aspiration pneumonitis following inhalation of acid gastric contents is little known outside of anesthesia, but is likely to occur more frequent than its diagnosis is made. A considerable black number is to be expected, mostly because of the danger that the aspiration itself has not been registered and the pulmonary edema setting in after a latency of several hours is regarded as sequela of the underlying heart disease. But this misunderstanding can have deleterious effects, because therapy has to consider a hypovolemia caused by the fluid loss into the lungs. Therefore pathogenesis and therapy of the lung edema in Mendelson's syndrome are carefully delineated. In patients surviving the acute stage of the disease, further prognosis is favorable: late sequelae have so far not been observed.
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PMID:[Mendelson's syndrome in coronary care units (author's transl)]. 95 Sep 48

Twelve arrhythmias that occurred in conjunction with surgery for congenital heart disease were studied in a group of 38 randomly selected patients. Halothane was used for anaesthesia and procaine-magnesium-aspartate solution for cardiac arrest. Registration and analysis of rhythm disturbances were carried out at 10 different time points, spaced narrowly in the intra- and early postoperative phases, then more widely up to the 96th hour of observation. Arrhythmic incidence per case and occurrence per case and phase are given, thereby also allowing an account of transient arrhythmias. The peak occurrence of intra-operative rhythm disturbances was found at about the time of aortic cross-clamping and release (ischaemia and halothane effect). A decline in arrhythmic incidence in the 1st-6th post-bypass hours was followed by a 2nd peak in the 6th-23rd postoperative hours (electrolyte and acid-base disturbances and/or a digitalis effect). All 12 arrhythmia types of the cardiopulmonary bypass group, as well as the separately considered ventricular arrhythmias of the first "arrhythmia peak", did not reveal any significant relation to: patients' age, total anaesthesia time, total surgery time and total bypass time. It is recognized that any comparative evaluation of operative arrhythmias, and especially a study of the causes and development of "surgically induced" A-V block, is problematic.
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PMID:Long-term observation of cardiac arrhythmias during and after cardiac surgery. II. Congenital heart disease. 95 87

185 cases of pregnancy in cardiac patients followed since 1965 included 48 therapeutic abortions, 20% premature deliveries, 36 Caesarean sections, and 101 vaginal deliveries. Abortions, done by dilatation and curettage or hysterotomy, usually with tubal ligation, were performed in class III or IV cardiopathies (inoperable or relapses) and in those with decompensation in first trimester or in previous pregnancies. 10 women were operated by closed heart technique during pregnancy, usually mitral valvotomy procedures. Treatments during pregnancy included bed rest, hospitalization 2 weeks before term, low salt diet, diuretics, digitalis, calcium heparin, sedatives, and antibiotics. Prognosis depends on severity and nature of the cardiopathy, age, parity, obstetric history, and the patient's ability to follow instructions. Deliveries were originally done by Caesarean section if sterilization was planned, but recently tubal ligation is done within 2 months postpartum. 55% of the vaginal deliveries were by forceps under local anesthesia; 40% by natural chiildbirth. 4 neonates died, and 36 were premature or dysmature. Lactation was suppressed by ethinyl estradiol in almost all patients.
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PMID:[Cardiac disease and pregnancy. 2. Pregnancy in the cardiac patient. 185 cases studied at the Boucicaut maternity hospital]. 100 Sep 14

The course of anesthesia for patients with cardiac disease includes assessment and management of complications during the entire perioperative period. A thorough understanding of the pharmacology of anesthetic drugs and their interactions with medications taken by patients with heart disease is of utmost importance. The rapid changes in intraoperative circulatory status may often necessitate second-to-second invasive monitoring techniques to maintain stability. Finally, knowledge of complications occurring commonly in such patients allows the anesthesiologist to prepare ahead of time for corrective measures which may be lifesaving.
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PMID:Anesthetic management of patients with cardiac disease. 110 13

Within the last generation the application of major advances in drug therapy, intensive care, transfusion techniques, surgery, anaesthesia, and radiotherapy, together with a vast expansion of knowledge due to increased investigative facilities, have led to an unprecedented, dramatic and beneficial increase in the number of persons who would previously have died, or lived with severe handicaps, but can now be cured. Techniques have also been developed to prolong the lives of many people who are now able to enjoy several extra years of productive and meaningful existence, and to alleviate and improve the quality of life of many seriously handicapped persons, enabling them to become integrated as useful and contented members of the community. Choosing from numerous examples of paediatric experience, it is notable that many more extremely premature infants now survive without physical or intellectual damage; infection can almost always be cured, including neonatal and all other forms of pyogenic meningitis and the now rare cases of tuberculous meningitis and miliary tuberculosis. The few remaining new cases of Rh-haemolytic disease are also readily cured. There are outstanding successes in the treatment of childhood malignancy. Paediatric surgery has made great strides. The prognosis of congenital heart disease, of obstructions of the alimentary canal and many other conditions has improved beyond recognition. Unfortunately, the indiscriminate use of advanced techniques of all types has also kept alive those who would have died but now live with distressing physical or mental handicaps or both, often for many years, without hope of ever having an independent existence compatible with human dignity. There are many examples, including those who have sustained major brain or spinal cord injuries.
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PMID:Ethical problems in the management of myelomeningocele and hydrocephalus. The Milroy Lecture 1975. 110 20

During 76 extracorporeal circulations (CEC) carried out for open heart operations using an identical protocol, the authors carried out renal function tests from the time of administration of the anesthetic to the post-operative period. Various periods may be distinguished: pre-operative, anesthesia induction (CEC 1, CEC 2) post induction (CEC 1, post CEC 2) finally, the post-operative period (post-operative 1 to 4). As far as renal hemodynamics are concerned, the authors made the following observations: constant reduction in thiosulphate clearance and endogenous creatinine clearance, which reflect glomerular filtration. Reduction in PAH clearance, which reflects renal perfusion. Taking into consideration changes in the hematocrit, one may consider that there is a reduction in renal blood flow at all stages of anesthesia. Taking into consideration concomitant variations in blood pressure, one may calculate that intrarenal resistances are increased. The diuresis/minute increases in very great proportions during induction of anesthesia. Plasma osmolality also increases, urinary osmolality becomes reduced and osmolar clearance rises. The ratio between osmolar clearance and creatinine clearance rises. The clearance of free water rises from negative values. The serum sodium becomes slightly reduced, and sodium diuresis increases. Serum potassium becomes slightly reduced and urinary potassium rises. The interpretation of these phenomena is difficult and should take into consideration the experimental conditions. Comparison with published results shows that there are definite differences depending on whether pure or diluted blood is used. It is however, possible to seek the role of the anesthetic, the thoracotomy or the extracorporeal circulation itself and its load, quite independent of prior changes due to decompensation or not of the congenital heart disease, whether or not it has been treated. The study of these changes in renal function permits one to understand better the precariousness of renal perfusion during extracorporeal circulation, imperfectly corrected by osmotic diuresis and responsible for transient and reversible renal hypofunction, liable to lead however, in cases of complications and prolonged low blood flow, to organic renal failure.
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PMID:[Renal functions and extracorporeal circulation]. 110 26

One hundred seventeen patients undergoing cardiac operations over a two-year period were studied. Electroencephalograms were recorded preoperatively, in the recovery room (up to 12 hours following operation), 24 hours later, and further as required. Operative and anesthesia data were correlated with EEG findings. All patients had normal EEGs preoperatively. This unusual occurrence may largely reflect the absence of congenital heart disease and the small number of valvular lesions in our patients. Prognosis was not significantly influenced by age. Bypass time appeared directly related to outcome by group but not individually. Hypotension prior to pumping occurred most often and mean blood loss was greatest in the patients who had abnormal EEGs in the recovery room with progressively worsening patterns until death. In the recovery room many patients were awake, while others were either drowsy, lethargic, or asleep. Some were comatose. The level of consciousness was not as prognostic as was the EEG. The pattern of EEGs in the first few postoperative days is more important than any single record by itself. All those who showed progressive deterioration in the first two or three days died shortly thereafter.
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PMID:Prognostic value of electroencephalography in cardiac surgery. 111 50


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