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

In 30 patients with congenital or acquired heart disease the haemodynamic effects of diazepam (Valium) 0.3 mg/kg were investigated during surgical procedures under neuroleptanalgesia. The following parameters were measured or calculated: Heart rate (HR), arterial pressure (-Part, Psyst, Pdiast), pulmonary artery pressure (-PAP), right (-PRA) and left atrial pressure (-PLA), left ventricular pressure (PLV), left ventricular enddiastolic pressure (PLVED), left ventricular peak dp/dt (dp/dtmax), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), total systemic resistance (TSR), total pulmonary resistance (TPR), work index of the right (RVWI) and left ventricle (LVWI). In comparison with a control group (n = 36) diazepam caused a decrease in arterial pressure cardiac index, stroke index, right and left atrial pressure and dp/dtmax. This, however, was mainly attributable to vasodilatation and not to a negative inotropic effect, which is of only minor importance with diazepam. These haemodynamic changes resulted in a reduction in myocardial oxygen consumption. Diazepam is a valuable drug in neuroleptanalgesia, when an increase in blood pressure can not be controlled by fentanyl or droperidol.
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PMID:[Diazepam (valium). Changes in haemodynamics, myocardial oxygen consumption and vascular tone (author's transl)]. 69 81

In 12 patients with heart disease, hypercarbia was induced for carotid endarterectomy. Anesthesia was maintained with nitrous oxide in oxygen and methoxyflurane. In addition to intra-arterial measurements of blood pressure, cardiac output, systolic time intervals (STI), and pressure time indices (PTI) were determined in order to assess cardiovascular responses in these patients. Internal carotid stump blood pressure was measured in five patients before and after induction of hypercarbia. Mild elevation of the Paco2 level affected systolic time intervals but not heart rate and blood pressure. When Paco2 levels reached 56 to 65 torr, systolic but not diastolic blood pressure rose significantly, heart rate and cardiac output increased, while the shortening in the preejection period (PEP), left ventricular ejection time (LVET), and the decrease in the PEP/LVET ratio signified increased mechanical cardiac activity. Hypercarbia caused intense sympathetic stimulation as demonstrated by twofold to threefold increases in plasma catecholamine levels. Stump blood pressure was elevated. Cardiac oxygen demand was significantly increased, while coronary filling time was shortened, as indicated by the increase in the tension time index and shortening in the diastolic time. This signified a relative myocardial underperfusion. Thus, while hypercarbia to levels of 66 to 70 torr increased internal carotid artery stump pressure, it also caused increased cardiac mechanical activity and concomitant unfavorable balance between myocardial oxygen consumption and supply. The measurement of STI and the computation of PTI provided early detection of alterations in cardiac function.
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PMID:Cardiac function and hypercarbia. 70 41

Exercise testing has a definite role in pediatrics today. Different methods are presented, and the value of maximal exercise with determination of oxygen uptake and blood lactate is stressed. In children with heart disease, exercise testing with precordial electrocardiogram can be of both diagnostic and prognostic value. The cardiovascular function at different intensities of exercise is evaluated, serious dysrhythmias may be revealed, hypertension judged and the effect of drug therapy can be checked by exercise testing. It is an important way in assessing the child's functional capacity after heart surgery in the decision whether she or he should take part in physical education and sports activities and in the choice of profession. It is also of great psychological value to the parents and the patient himself. In children with other chronic diseases, e.g., diabetes, obesity, asthma, neurocirculatory dysfunctions--physical training together with exercise testing is of importance for therapy and rehabilitation.
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PMID:Exercise testing in children. 72 65

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

The effects of dopamine (DOPA) on haemodynamics, coronary blood flow and myocardial oxygen requirements were compared with those of L-noradrenaline and isoprenaline (isoproterenol) in patients after open-heart surgery, performed because of mitral valvular and congenital heart disease. The patients were in low cardiac output state but not in shock. DOPA increased heart rate less than isoprenaline, averaging 22 and 31 beats/min, and was less arrhythmogenic. DOPA increased mean arterial pressure by an average of 7 mmHg, whereas isoprenaline had little effect; noradrenaline uniformly increased all measurements of arterial pressure. DOPA and isoprenaline increased cardiac index by an average of 1.01 and 0.94 1 min--1 m--2; noradrenaline did not significantly improve peripheral perfusion. DOPA and isoprenaline decreased systemic vascular resistance by an average of 465 and 549 dynes s cm--5; noradrenaline increased resistance in all patients. For similar cardiac outputs average urine flow increased more with DOPA (75 ml/h) than with isoprenaline (28 ml/h). DOPA increased coronary blood flow and myocardial O2 consumption by an average of 28 and 3.60 ml min--1 100 g--1, noradrenaline by 16 and 1.93 and isoprenaline by 62 and 4.25 ml min--1 100 g--1 respectively. Arterial--coronary sinus O2 differences remained unchanged (normal) with DOPA and noradrenaline and decreased with isoprenaline on average by 1.10 ml/100 ml. Myocardial lactate utilization was normal before and during catecholamine administration. It is concluded that, in its haemodynamic effects, DOPA is intermediate between noradrenaline and isoprenaline. The effects of DOPA on coronary blood flow and myocardial O2 consumption are closer to those of noradrenaline than of isoprenaline. DOPA increase coronary blood flow according to myocardial metabolic demand; it is not a potent primary coronary vasodilator. DOPA, although increasing myocardial O2 consumption more than noradrenaline, is by far less O2-demanding than isoprenaline. DOPA appears to be the superior vasoactive agent among the three catecholamines for the treatment of low cardiac output state in patients with preserved coronary reserve.
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PMID:Effects of dopamine on haemodynamics and myocardial energetics in man: comparison with effects of isoprenaline and L-noradrenaline. 74 Oct 96

The resaturation curve, a noninvasive indicator-dilution test using an ear oximeter to detect rates of change in arterial oxygen saturation during breathing of various concentrations of oxygen, was used to assess cardiac performance in normal subjects and in 108 patients with cardiac valvular disease. Measurements made during exercise included the time constant of resaturation (tau) and beat-to-beat changes in arterial oxygen saturation (the left heart clearance fraction). At maximum rates of voluntary work, patients had a significantly reduced clearance fraction and longer tau than normal subjects. Clearance fraction and tau improved in patients after aortic valve replacement; deterioration occurred in tau and clearance fraction over time in patients treated medically, as compared to normal subjects who showed little change during a ten-year period. Clearance fraction and tau correlated with hemodynamic data obtained during cardiac catheterization. The resaturation curve provides an objective measure of cardiac impairment that can be readily repeated during follow-up of patients with heart disease.
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PMID:Noninvasive measurement of cardiac function during exercise, using resaturation curves. 79 86

The effect of continuous positive airway pressure (CPAP) on lung mechanics was investigated in 12 babies after operation for severe congenital heart disease. At the time of study all babies were receiving or being weaned from ventilatory support and had abnormally low lung volume or compliance. During CPAP there was a fall in the pulmonary resistance which, with a slight decrease in minute ventilation, resulted in a significant decrease in the work of breathing. It is suggested that lowering the oxygen cost of breathing may contribute to the improvement in arterial oxygenation seen when CPAP is used.
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PMID:Effects of continuous positive airway pressure on lung mechanics of babies after operation for congenital heart disease. 80 62

Patients with congenital cyanotic heart disease have a blunted ventilatory response to hypoxia, but the permanence of the blunting is disputed. To determine how early the blunted ventilatory response develops and whether it is reversible, we studied three groups of children and young adults: five (seven to 13 years of age) with acyanotic heart disease, eight (seven to 16) with cyanotic congenital heart disease (arterial oxygen saturation, 55 to 83 per cent), and 13 (seven to 17) whose cardiac defects were repaired (arterial oxygen saturation, 93 to 98 per cent). The ventilatory response to acute hypoxia was subnormal in the hypoxemic children in that their ventilation showed little increase when arterial oxygen saturation fell by 10 to 20 per cent, compared to a 150 to 300 per cent increase in the control subjects. This characteristic even appeared in a seven-year-old patient, indicating that the disorder occurs in early life. The appearance of blunted ventilatory response is delayed when hypoxia from birth is less severe. After operation, with return of the arterial hypoxemia to normal, the response was in the normal range. We conclude that the blunted response is reversible.
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PMID:Normalization of the blunted ventilatory response to acute hypoxia in congenital cyanotic heart disease. 83 Nov 5

To study myocardial metabolism in chronic hypoxia due to cyanotic congenital heart disease, coronary arteriovenous differences of lactate (L), pyruvate (P), inorganic phosphate (Pi) and potassium (K) were measured in 14 cyanotic patients and seven controls, at rest and during atrial pacing. At rest, there was no difference in any parameter between cyanotic and noncyanotic patients. During atrial pacing (150-175/min) for 10 min, a moderate drop in L-extraction occurred in the control patients with some increase in L/P ratio in coronary venous blood. Cyanotic patients fell into two groups: in nine (group I), the arterial oxygen saturation (SaO2) dropped with pacing. Their L-extraction fell sharply, from 28.1 +/- 3.12 to --2.8 5.51 and L production occurred in five. There was a significance increase in coronary venous L/P ratio. Five cyanotic patients (group II) showed no drop in SaO2 with pacing, and L extraction as well as L/P ratio remained stable. Uptake of Pi was noted in all patients at rest, during pacing this disappeared in controls and group I cyanotics but not in group II. No K changes were seen in any patient. Thus, myocardial metabolism is normal at rest in patients with cyanotic CHD; during atrial pacing, a shift toward anaerobic metabolism occurs if SaO2 drops; cyanotic patients whose SaO2 remains stable appear to withstand pacing better than controls.
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PMID:Myocardial metabolism in cyanotic congenital heart disease studied by arteriovenous differences of lactate, phosphate, and potassium at rest and during atrial pacing. 83 11


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