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

No consensus has been reached regarding the need for a routine 12-lead electrocardiogram (ECG) preoperatively or on general admission in adult patients. Critical review of relevant studies reveals important weaknesses and gaps in the data needed to formulate definitive recommendations. Available data, however, do not support the necessity for obtaining a baseline or screening ECG in all adult patients before surgery involving general or regional anesthesia or on hospital admission for other indications. To reduce costs related to unnecessary tests and false-positive results, routine use of the ECG is warranted only in selected subsets of hospitalized patients, including those with cardiac signs or symptoms and those at risk for occult heart disease, particularly older patients.
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PMID:Utility of the routine electrocardiogram before surgery and on general hospital admission. Critical review and new guidelines. 375 62

A review of factors altering the safety margin between a therapeutic and a toxic dose of digitalis includes the consideration of: clinical conditions to which digitalis action may be undesirable, allergy and hypersensitivity to digitalis, physiologic factors modifying tolerance to digitalis, factors that change the amount of digitalis in the body, nervous and metabolic factors modifying tolerance to digitalis, modifications of digitalis tolerance produced by the status of the myocardium, and modifications of digitalis tolerance produced by diseases of other organs. The problems related to digitalis toxicity are more common than those of resistance to treatment. The most important factors contributing to decreased tolerance and risk of toxicity are: heart disease, poor renal function, hypokalemia and hypothyroidism. The roles of impaired liver function, chronic lung disease, acid-base disturbances, anesthesia, autonomic imbalance, calcium and magnesium are less important and less well established.
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PMID:Factors affecting tolerance to digitalis. 388 54

The anesthetic management of the first stage palliative surgical repair of hypoplastic left heart syndrome with a high-dose fentanyl (50 micrograms/kg)-pancuronium (0.14 mg/kg) anesthetic technique is described in 30 neonates. Previously this severe form of congenital heart disease carried a 100% rate of mortality. The pathophysiology that leads to this mortality is explained and related to the surgical procedure utilized for palliation. The major problem encountered intraoperatively was control of pulmonary blood flow. Management of the effect of anesthesia and intraoperative events on pulmonary blood flow was important because the rapid flux in pulmonary vascular resistance during the postnatal and perioperative period is the major destabilizing factor in these neonates. Ventricular fibrillation with surgical manipulation was a minor problem in the present series but was a major problem in an earlier series where a low dose narcotic-nitrous oxide technique was used. Ventricular fibrillation probably occurred due to the relative coronary insufficiency resulting from the anatomy present in this syndrome.
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PMID:Anesthesia for hypoplastic left heart syndrome: use of high-dose fentanyl in 30 neonates. 394 99

We describe a seven-compartment physiologic model of inhalational anesthetic induction with circulatory shunts that was used to simulate inhalational anesthetic induction in children with congenital heart disease. Our conclusions based on this model are that left-to-right (L-R) shunting has little effect on speed of induction; right-to-left (R-L) shunting significantly slows induction of N2O and halothane anesthesia; and adding an L-R shunt to a preexisting R-L shunt will attenuate the slowing of induction caused by the R-L shunt.
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PMID:Effect of left-to-right, mixed left-to-right, and right-to-left shunts on inhalational anesthetic induction in children: a computer model. 397 Mar 55

Chronic cigarette use is common in persons who habitually use other cardioactive agents that have been causally associated with heart disease. This study was undertaken to determine if cigarette use intensifies the abnormalities of myocardial function and composition observed in experimental alcoholism over an 18-month period. Young adult male beagles with tracheostomy were divided into four groups. There were 10 controls (group 1); 9 smoked seven cigarettes per day (group 2); 7 were fed ethanol as 20% of calories (group 3), and 6 received both ethanol and cigarettes (group 4). After a period of 18 months, left ventricular function was assessed under anesthesia. Heart rate, left ventricular end-diastolic pressures, and volumes (indicator dilution) did not differ in the four groups. An index of contractility derived by normalizing peak dP/dt for pre- and afterload was reduced significantly below the level of 2.41 +/- 0.7 cm/s in controls to 1.41 +/- 0.35 in group 2, 1.19 +/- 0.38 in group 3, and 1.28 +/- 0.17 in the ethanol cigarette group (each p less than 0.002). Arterial pressures were moderately elevated above group 1 in all three experimental groups without evidence of left ventricular hypertrophy. In contrast to smoking, which elicited no abnormalities of myocardial cation composition, ethanol reduced myocardial potassium and sodium in group 3 without a gain of water content. In group 4, no further decline of tissue cations was observed. Thus, cigarette use when combined with ethanol over a relatively long period produced no greater myocardial abnormalities than ethanol alone and may not be essential to the genesis of cardiomyopathy in alcoholics.
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PMID:Interaction of chronic cigarette and ethanol use on myocardium. 397 84

One hundred and forty-one randomly selected surgical patients, aged 35 years or over, were studied preoperatively, followed through their operative procedures, and reassessed during the first post-operative week for evidence of myocardial ischaemia associated with surgical operations under general anaesthesia. Of these patients 38% were found to have preoperative clinical evidence of heart disease, hypertension, or diabetes; 45% had abnormal preoperative E.C.G. patterns.Three patients experienced myocardial infarction during or within 36 hours of operation, all of the occult type; all were in the preoperative abnormal groups. Non-specific postoperative E.C.G. changes were equally common in the groups of patients with normal or abnormal preoperative electrocardiograms.A relationship existed between a rise in serum lactic dehydrogenase (L.D.H.) concentration and the field of the operation, but the diagnosis of infarction was not confused provided serum L.D.H. isoenzyme patterns and a rise in serum aspartate aminotransferase (S.G.O.T.) levels were consistent with the diagnosis.
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PMID:Myocardial infarction following surgical operations. 572 23

Acute embolic arterial occlusion is the most frequent emergency in vascular surgery; the patients usually have significant heart disease and additional risk factors due to high age. Since 1966 acute embolic occlusions of major vessels of the lower extremity have been operated in 1496 patients; 82% of patients were over 65 years of age--18% even over 80 years. Standardized embolectomy from a small groin incision in local anaesthesia after preoperative check of general conditions has the best prognosis concerned limb salvage. Postoperative long term anticoagulation is performed routinely to prevent recurrent embolization. Preoperative angiography is required only when there is a clinical suspect of preexisting occlusive vessel disease with acute arterial thrombosis. If possible, this group of patients should be subjected to elective reconstructive surgery (fem. pop. bypass, profundoplasty etc.) since embolectomy alone does not mean definitive help in this group. Also for acute iliofemoral venous thrombosis high age is a significant risk factor. Among 240 patients, operated since 1966, about 25% were over 70 years of age. In these patients operative thrombectomy is the only effective means since lysis is usually not performed. Thrombectomy provided a very good result (fully patent veins, normal venous pressure response curves) in 28%. In 64% pressure curves were grossly normal, though recurrent thrombosis had occurred in either femoral or lower leg veins. Only 8% revealed total iliofemoral reocclusion. Thus also in these high risk patients thrombectomy seems to be justified to accomplish early remobilization and prevent respiratory distress syndrome.
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PMID:[Vascular surgical emergency in advanced age: arterial embolism--iliofemoral venous thrombosis]. 613 56

Two hundred nine children with congenital heart defects characterized by excessive pulmonary blood flow underwent pulmonary artery banding at The Hospital for Sick Children from January, 1972, through December, 1982. The indications for banding, rather than complete repair, varied with the type of cardiac defect as well as with the year of presentation to our hospital. A simplified method of estimating required band circumference has been developed for infants with ventricular septal defect, with or without major intracardiac mixing disorders. Infants with simple defects without intracardiac bidirectional mixing disorders receive a band at a circumference of 20 mm + 1 mm for each kilogram of body weight, whereas infants with bidirectional mixing disorders receive a band at a circumference of 24 mm + 1 mm for each kilogram of body weight. The overall operative mortality varies with the underlying cardiac defect and with associated medical conditions but is relatively low in the less-complicated cases. The use of a formula to predict a starting band circumference, with loosening only as required by cyanosis or bradycardia, allows predictable control of congestive symptoms and pulmonary hypertension in the majority of infants. The cumbersome measurement of pulmonary artery pressure and the unpredictable changes in pressure during anesthesia are avoided. Pulmonary artery banding remains an effective means of achieving satisfactory palliation in infants with congenital heart disease and excessive pulmonary blood flow.
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PMID:Pulmonary artery banding. 620 31

Cutaneous infiltration of dilute solutions of epinephrine for hemostasis during halothane anesthesia can result in ventricular dysrhythmias. Our clinical experience, published reports, and a study comparing piglets with adult swine suggest that children may be less susceptible than adults to dysrhythmias under these conditions. We therefore undertook a prospective survey of heart rate and rhythm in halothane-anesthesized children who received subcutaneous epinephrine for hemostasis. Mass spectrometry was used to quantify end-tidal halothane and to avoid hypercarbia. In 83 children anesthesized with halothane, we continuously recorded ECG, heart rate (HR), end-tidal halothane (ETHalo), and carbon dioxide (ETCO2). The surgeons injected 0.4--15.7 micrograms/kg of epinephrine (in saline or 1% lidocaine) to provide hemostasis at a variety of sites. No child developed a ventricular dysrhythmia. One child had self-limited premature atrial contractions (PAC). Sixty-three children had some increase in heart rate after epinephrine injection, while seven increased their HR 15% or more above pre-injection levels. No relation between any increase in HR and epinephrine dosage, ETHalo, ETCO2, physical status, or age was found by multiple linear regression; however, HR was increased significantly in patients receiving epinephrine in head and neck sites other than the palate. The authors conclude that children tolerate higher doses of subcutaneous epinephrine than adults during halothane anesthesia. The arrhythmogenic dose of epinephrine in children receiving halothane has yet to be determined, but at least 10 micrograms/kg of epinephrine infiltration may be used safely in normocarbic and hypocarbic pediatric patients without congenital heart disease. The presence of PAC and tachycardia emphasize the need for continuous ECG monitoring and caution during halothane anesthesia with epinephrine injection.
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PMID:Epinephrine-halothane interactions in children. 633 28

Successful management of a patient with heart disease requires an understanding not only of the pharmacology of anesthesia but also of the pathophysiology of heart disease. Both of these factors as well as the choice and conduct of anesthesia by the anesthesiologist are thoroughly explored in this article.
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PMID:The anesthetic evaluation and management of the surgical patient with heart disease. 635 17


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