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

In 20 patients with chronic hypoxemia due to chronic obstructive pulmonary disease, we measured responses to CO2 and hypoxia in terms of ventilation and P0.1, the pressure generated by the respiratory muscles during the first 0.1 s of inspiratory effort against a closed airway at functional residual capacity. These responses were compared to those of a control group of 17 patients with similar ventilatory abnormality but without hypoxemia. Hypoxemic patients demonstrated significantly less response to hypoxia than did control subjects in terms of both ventilation and P0.1 The decreased hypoxic response might be analogous to that reported in high altitude dwellers and patients with cyanotic congenital heart disease. Ventilatory responses to CO2 were depressed in hypoxemic patients, but P0.1 responses were not significantly decreased. While breathing at rest with arterial O2 saturation of 95 per cent, hypoxemic patients demonstrated the same minute ventilation as control subjects, but tidal volume was smaller, inspiratory duration was shorter, and breathing frequency was slightly higher. This breathing pattern appeared to be independent of whether or not these patients retained CO2.
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PMID:Ventilatory control in patients with hypoxemia due to obstructive lung disease. 3 89

The indices of P a-A CO2, P A-a O2 and VD/VT were evaluated in a group of children treated with controlled ventilation (IPPV) for: pneumonia, congenital heart disease, respiratory distress syndrome or central nervous system diseases. The P A-a O2 index is regarded as the most useful one, since it enables the possibility to select a F IO2 value for obtaining an optimal P aO2. For calculation of VD/VT according to Bohr's formula during connection of the child to respirator P ECO2 was determined planimetrically from the capnographic curve. P a-A CO2 was recognized as a less useful index and difficult to interpret.
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PMID:Evaluation of P a-A CO2, P A-a O2 and VD/VT measurements during controlled respiration in children. Preliminary communication. 79 76

Seven young to middle-aged patients with Haemophilus parainfluenzae endocarditis are reported. Three patients had underlying heart disease and three patients had recent events predisposing for endocarditis. The clinical presentation was subacute or acute and new pathologic murmurs were uncommon. Diagnosis was prolonged because of difficulties in isolating the organism. Routine subculturing of blood cultures to chocolate agar with incubation in CO2 is recommended. A prominent complication, occurring in six patients, was major arterial occlusion secondary to emboli. Antibiotic control of infection was difficult and best achieved by the concomitant administration of ampicillin and gentamicin. Killing curves proved useful in assessing antibiotic efficacy. There were two medical failures and one death in the series. It appears H. parainfluenzae endocarditis is characterized by distinctive clinical features, difficult in vitro isolation of the organism, and the necessity for combination antibiotic therapy.
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PMID:Haemophilus parainfluenzae infective endocarditis. 84 91

Brain abscess is a serious complication of congenital cyanotic heart disease. We retrospectively evaluated the risk factors for brain abscess in 21 such patients treated between 1975 and 1990 in comparison with a control group. The mean arterial oxygen saturation, arterial partial pressure of O2, arterial blood oxygen content, and base excess in patients with brain abscess were significantly lower than in the control patients. The mean arterial partial pressure of CO2, pH, hematocrit, hemoglobin, and red blood cell content in patients with brain abscess were not significantly different. Patients with congenital cyanotic heart disease may develop minute encephalomalacia due to severe hypoxemia and increased blood viscosity resulting from compensatory polycythemia. The increased blood viscosity and reduced blood flow in the microcirculation may induce cerebral thrombosis or exaggerate minute encephalomalacia during dehydration or cardiac dysfunction, and shunted blood containing infectious organisms at such sites may be followed by focal cerebritis.
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PMID:Risk factors for brain abscess in patients with congenital cyanotic heart disease. 138 54

Orthotopic heart transplantation (OHT) represents an effective alternative for individuals with end-stage heart disease. The current literature reports only the responses of OHT patients to greater than or equal to 4 mo of exercise training (ET) and frequently lacks adequate controls. Most programs currently treating OHT patients usually provide 6-12 wk of ET. This study describes the effects of a 10-wk supervised ET program in 12 male OHT patients and 5 other male OHT patients who served as a comparison group. Graded exercise tests were performed before and after ET. After ET, maximal O2 consumption was significantly greater for the ET group than the comparison group (P less than 0.05) and the mean increase in peak heart rate was 18 +/- 4 and 6 +/- 4 (SE) min-1 for ET and comparison groups, respectively (P less than 0.05). Maximal ventilation was also significantly greater for the ET group at after ET, while resting heart rate and blood pressure and peak blood pressure, O2 pulse, respiratory rate, and ventilatory equivalents for O2 and CO2 were not significantly changed. We conclude that after OHT a 10-wk ET program improves maximal O2 consumption and, by improving peak heart rate, improves O2 delivery.
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PMID:Cardiovascular responses of heart transplant patients to exercise training. 188 57

Respiratory failure accompanied by cardiac failure occurs mostly due to decreased PaO2. However, sometimes we encounter patients with cardiac failure having on increase of PaCO2, who develop CO2 narcosis in the ICU. In this study we evaluated hypoventilation respiratory failure in patients with cardiac failure. Seventy-six patients with both respiratory failure and cardiac failure caused by intrinsic heart disease, who required mechanical ventilation in the ICU were studied. The patients were divided into 2 groups; hypoxic respiratory failure group (n = 53) and hypoventilation respiratory failure group (n = 23). Blood gas analysis and cardiovascular hemodynamics including arterial blood pressure, heart rate and Swan-Ganz catheter findings were performed before, during and after mechanical ventilation in each patient. Mortality rate and its relation to hemodynamic variables were also evaluated in each group. In both groups even when it was possible to maintain oxygenation capacity by conducting mechanical ventilation against severe respiratory failure, what can be said about the prognosis is that it depended totally on the improvement of cardiac function. The mechanism by which hypoxemia is displayed due to cardiogenic pulmonary edema is already well known, but in regard to the mechanism of hypercapnia in cases with hypersensitivity of the airways it is thought that through induction of cardiogenic pulmonary edema bronchial spasms is induced, and this causes hypercapnia. However, it is also possible to consider cardiac asthma as the cause. Among respiratory failure cases due to cardiogenic pulmonary edema that occurs in association with heart failure, there is both hypoxic respiratory failure as well as hypoventilation respiratory failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Study on the respiratory failure with cardiac failure--focus on hypoventilation respiratory failure]. 221 87

The ability to assess changes in pulmonary blood flow, using a modified Qp/Qs ratio (Qp/Qsmod), was evaluated in 12 infants with congenital heart disease and complete intracardiac mixing who underwent modified Blalock-Taussig shunt procedures. At the various measuring stages there were no major changes in mean arterial pressure or heart rate. Arterial oxygen tensions and saturation increased (P less than 0.01) and the arterial to end-tidal carbon dioxide difference (PaCO2-PE'CO2) was significantly reduced (P less than 0.001) after completion of the shunt procedure. There was a significant increase in mean Qp/Qsmod after chest closure (P less than 0.001), which was seen to correlate well with early clinical outcome. Two patients who did not demonstrate any increase in Qp/Qsmod over the course of the procedure had failed shunts. The limitations of use of the Qp/Qsmod are discussed. A modified Qp/Qs ratio of less than unity after surgery is strongly indicative of inadequate palliation.
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PMID:Pulmonary blood flow during closed heart surgery. Use of a modified Qp/Qs ratio to assess adequacy of palliation of systemic-pulmonary artery shunts. 245 89

End-tidal CO2 (PETCO2), arterial CO2 (PaCO2), mixed expired CO2 (PECO2), arterial and mixed venous oxygen contents were measured and the PaCO2 to PETCO2 difference (delta PCO2), physiologic dead space to tidal volume ratios (VD/VT) and venous admixture (Qs/Qt) were calculated in 41 anesthetized infants and children undergoing repair of congenital cardiac lesions. Eighteen children were acyanotic; 9 with normal pulmonary blood flow (PBF) and normal intracardiac anatomy (normal group); and 9 with increased PBF (acyanotic group). Twenty-three children were cyanotic; 14 with right to left intracardiac shunts and decreased PBF (cyanotic (D) group); and 9 with mixing lesions with normal or increased PBF (cyanotic (I) group). Correlations between PaCO2 and PETCO2 in the four groups of children were carried out and the relationship of delta PCO2 to VD/VT and Qs/Qt was determined. PETCO2 correlated closely with the PaCO2 in the normal and acyanotic groups (r2 = 0.97 and 0.91, respectively) and the lines of regression for the relationship between PaCO2 and PETCO2 for both groups did not differ from the line of identity (P less than or equal to 0.05). Mean +/- SD VD/VT for the normal and acyanotic groups were 0.35 +/- 0.17 and 0.39 +/- 0.19, respectively (NS). Corresponding values for the cyanotic (D) group and cyanotic (I) group were 0.38 +/- 0.16 and 0.55 +/- 0.16, respectively (NS), and were significantly greater than those from the normal and acyanotic groups (P less than 0.05). The relationship of delta PCO2 to VD/VT and Qs/Qt demonstrated that VD/VT was the most important determinant of delta PCO2, but in instances where Qs/Qt were large (e.g., cyanotic congenital heart disease) the percentage contribution of Qs/Qt to the delta PCO2 can be considerable.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Physiologic dead space, venous admixture, and the arterial to end-tidal carbon dioxide difference in infants and children undergoing cardiac surgery. 249 9

Oxygen consumption (VO2, ml min-1) and carbon dioxide elimination (VCO2, ml min-1), minute ventilation (VE), tidal volume (VT), rate of ventilation (f) and end-tidal carbon dioxide concentration (E'CO2%) were measured in 38 infants and children (body weights 3.6-25 kg). Four children (body weight less than 5 kg) had congenital heart malformations and were studied during controlled mechanical ventilation, whereas the remainder (n = 34) who were healthy, breathed spontaneously. Anaesthesia was maintained with oxygen in air (FIO2 0.45) and halothane through a non-rebreathing circuit. Minute ventilation was measured by pneumotachography, E'CO2 with an in-line infra-red carbon dioxide meter and gas concentrations with a mass spectrometer. There were no differences in VO2 and VCO2 between children with and without heart disease. VO2 was related to body weight by the equation: VO2 = 5.0 x kg + 19.8 (r = 0.94) and VCO2 to body weight by the equation: VCO2 = 4.8 x kg + 6.4 (r = 0.94). There were no differences between VO2 or VCO2 before and after the start of surgery. In 11 of 21 patients weighing less than 10 kg, a reduced VCO2 was noted, giving respiratory quotients of less than 0.7. It is speculated that this age-dependent variation of VCO2 may result from partial inhibition of lipolysis in brown adipose tissue produced by halothane.
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PMID:Oxygen consumption and carbon dioxide elimination in infants and children during anaesthesia and surgery. 249 15

The single breath test for carbon dioxide (SBT-CO2) is the plot of expired FCO2 or CO2% against expired volume. It can be monitored during anaesthesia and in the intensive care unit with modest additions to generally available equipment. This paper describes some aspects of a computer program for presenting SBT-CO2 during controlled ventilation, in particular, the corrections to the primary data necessary for scientific accuracy. Examples are given of how the use of SBT-CO2 has increased our understanding of factors which influence the arterial-end-tidal PCO2 difference (PaCO2-PE,CO2). PaCO2-PE, CO2 is, in a given individual, usually dependent on tidal volume and frequency. Changes in lung volume and manoeuvres such as opening the pleura also affect gas exchange. Monitoring CO2 elimination gives a measure of metabolic rate if ventilation and pulmonary perfusion are maintained. This facilitates ventilatory therapy in situations where CO2 production is greatly increased, e.g. sepsis and tetanus. On the other hand, if metabolism and ventilation are unchanged, a reduction in CO2 elimination implies reduced pulmonary perfusion. This can be seen during increased right-left shunting, such as in surgery in patients with congenital heart disease.
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PMID:On-line expiratory CO2 monitoring. 309 79


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