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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This case report describes the anaesthetic management of a patient with bilateral phaeochromocytoma and cardiomyopathy. The hypertension and supraventricular tachycardia commonly seen during manipulation of this tumour was controlled by administration of sodium nitroprusside and verapamil. Verapamil allowed effective management of supraventricular rhythm disturbances and arterial blood pressure, and cardiac index remained unchanged during and after phaeochromocytoma removal. As the haemodynamic side-effects of the calcium blocking agent are readily reversed by intravenous calcium chloride, it may have a useful part to play in such cases.
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PMID:Cardiomyopathy in phaeochromocytoma: a case report. 256 35

At present nitrates remain the initial treatment for relief or prevention of angina in patients with coronary artery disease. In cases where nitrates and beta blockers have been used and are ineffective for managing effort angina, calcium antagonists may be substituted or added to the beta-blocking treatment. When the predominant symptom is rest angina, and there is evidence suggesting coronary artery spasm, nitrates and a calcium antagonist can be effective therapy. In patients with heart block, bradyarrhythmias, heart failure, or hypertension nifedipine may be the drug of choice. In contrast verapamil merits choice when supraventricular tachycardia is present. Diltiazem appears intermediate between nifedipine and verapamil and may be particularly useful when hypotension or other side effects must be avoided.
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PMID:Calcium antagonists. 286 40

Esmolol is a new intravenous beta-adrenergic blocker with an ultrashort (nine-minute) elimination half-life, which has been studied predominantly for control of supraventricular tachycardia and management of certain types of hypertension. Clinical studies indicate that the efficacy of esmolol is equivalent to that of propranolol and verapamil for control of supraventricular tachycardia and to sodium nitroferricyanide (sodium nitroprusside) for control of postoperative hypertension. Esmolol also has been shown to control heart rate and blood pressure during episodes of acute myocardial ischemia. Cardioselectivity is similar to that of metoprolol, and the ability to titrate the effect of esmolol may provide additional assurance that beta-adrenergic blockade will remain within the cardioselective range. The most commonly observed adverse effect seen in clinical trials was asymptomatic hypotension. Hypotension may be minimized by titrating to the minimum effective dose and is readily reversed within 10 to 30 minutes of discontinuing the infusion of esmolol. These unique features represent advantages of great potential merit in critical care medicine.
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PMID:Managing critically ill patients with esmolol. An ultra short-acting beta-adrenergic blocker. 289 47

Verapamil has been established as the drug of choice in the treatment of supraventricular dysrhythmias and is recognized as useful in the treatment of ischemic heart disease and hypertension. However, verapamil has not generally been considered helpful in the treatment of ventricular dysrhythmias. Five cases are reported in which verapamil was used to terminate a cycle of supraventricular tachycardia-mediated recurrent ventricular fibrillation that could not be suppressed by conventional antidysrhythmics such as lidocaine, procainamide, and bretylium, Proposed mechanisms of verapamil's beneficial effect in this usually fatal situation include (1) a reduction in oxygen consumption related to the reduction in heart rate, thereby raising the ventricular fibrillation threshold; (2) direct anti-ischemic effect; and (3) a direct antidysrhythmic effect. These proposed mechanisms are substantiated by clinical studies. On the basis of this observation, it is recommended that in a situation of supraventricular tachycardia-mediated recurrent ventricular fibrillation that cannot be terminated by conventional antidysrhythmics, the administration of verapamil should be considered.
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PMID:Terminating SVT-mediated recurrent ventricular fibrillation with verapamil. 317 Nov 18

In order to clarify the role of age and hypertension in determining arrhythmias, we evaluated the average heart rate, and the number of supraventricular and ventricular premature beats and their severity (Lown grade) by 24-h Holter electrocardiography of 336 patients. We excluded 54 patients with prolonged runs of atrial fibrillation or supraventricular tachycardia because these arrhythmias reduce the possibility of determining the number of premature beats. Analysis of variance, carried out after dividing the patients into four different groups according to age and blood pressure (excluding patients aged 60-65 years with diastolic blood pressure of 91-94 mmHg) showed that the hypertensives had a higher average heart rate (P less than 0.01) and more supraventricular (P less than 0.05) and premature ventricular (P less than 0.01) beats than the normotensives; no difference was found among groups of different ages. The severity of premature ventricular beats was higher in hypertensives than in normotensives, and also higher in elderly than in 'young' patients (P less than 0.01). In the evaluation of all 336 patients we found correlations between age and severity of premature ventricular beats in both normotensives (P less than 0.05) and hypertensives (P less than 0.001). Multilinear regression showed that mean blood pressure was independently related to the average heart rate, and supraventricular and premature ventricular beats and their severity, while age was correlated independently only with the severity of premature ventricular beats (P less than 0.001). We conclude that hypertension induces arrhythmias, and that age increases their severity.
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PMID:Arrhythmias, hypertension and the elderly: Holter evaluation. 321 39

The cardiovascular and respiratory complications and their treatment during the immediate postoperative period in the intensive care unit (ICU) are analyzed in 145 consecutive cases of supratentorial craniotomy. In this series, 87.5% of the patients remained in the unit less than 48 hours. In all, 67 cardiovascular disorders were observed in 49 subjects (33.7%). Supraventricular tachycardia, arterial hypotension and hypertension were, in order of frequency, the most common hemodynamic alterations. Fifty percent of the arterial hypertensions were treated with vasodilators. The etiological cause of hypotension was hypovolemia in 66.6% of the cases. Extubation was not performed in the operating room in 17.93% of the subjects, and seven patients in which it was had to be reintubated. The stay in the ICU was longer for those intubated (3.03 +/- 0.77 days). Mortality was 2.06%.
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PMID:Cardiovascular and respiratory complications after elective supratentorial craniotomy. 324 34

Esmolol is the first intravenous, short-acting, titratable beta-blocker available for use in critical care and surgical settings. The predominant pharmacodynamic actions of the drug include a reduction in HR, BP, rate-pressure product, LVEF, and cardiac index. A desirable pharmacokinetic feature of esmolol is its esterase-induced rapid metabolic inactivation, which results in a return of all hemodynamic parameters to pretreatment levels within 30 minutes after discontinuation of the infusion. Control over the magnitude and duration of beta-blockade and the relative cardioselectivity of esmolol make it an ideal agent for use in critically ill patients, including those who, because of other conditions, are at risk if treated with beta-blockers. The clinical indications for esmolol therapy include SVT and perioperative tachycardia and hypertension. In patients with myocardial ischemic conditions (acute myocardial infarction and unstable angina), esmolol was safe and produced clinically significant reductions in HR and rate-pressure product. In general, untoward reactions to esmolol have been minimal, mild, and transient. Although attention must be given to the possibility of systolic hypotension during esmolol administration, this complication often occurs at doses beyond those which provide optimal therapeutic response and may be avoided by titrating to the minimal effective dose. If systolic hypotension occurs, it is reversible by either reducing the dose or discontinuing the esmolol infusion. A nursing plan of care should be developed for patients receiving esmolol therapy. Dosage and administration must be individualized. Careful titration of the esmolol infusion and monitoring of therapeutic and safety parameters by nursing professionals will promote the achievement of maximum beta-blocker effect while avoiding persistent and unnecessary adverse reactions.
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PMID:Esmolol, the first ultra-short-acting intravenous beta blocker for use in critically ill patients. 327 51

One hundred patients with focal cerebral ischaemic attacks of suspected embolic origin were investigated by Holter monitoring to determine whether paroxysmal arrhythmia may have been responsible for the episodes. There were 57 men and 43 women aged from 16 to 79 years (mean 50 years). Ninety-seven had residual focal neurological deficits and 3 had transient ischaemic attacks. The neurological lesions were verified by cerebral angiography in 68. Twenty-one had arterial hypertension and 9 had old myocardial infarction or angina. Nine had a history of palpitations. None had cardiac valve disease. All patients were in sinus rhythm, 4 had ventricular extrasystoles on routine ECG, and 4 had supraventricular extrasystoles. None of the patients were receiving anti-arrythmic drugs at the time of investigation. Holter monitoring was performed for 18 hours in 91 cases and for 24-54 hours in the remaining ones. The interval between the cerebral ischaemic attack and the monitoring was less than one month (mean 20 days) for 50 patients and longer for the others. Cardiac arrythmias were found in 36 patients. Sixteen had more than 10 supraventricular extrasystoles per hour, 13 had runs of 3 to 8 beats of supraventricular tachycardia, 1 had an episode of atrial fibrillation. Eighteen subjects had more than 5 ventricular extrasystoles per hour, 1 had accelerated ventricular rhythm, 2 had runs of 4 to 7 beats of ventricular tachycardia. Two patients had second degree A.V. block. None had palpitations during monitoring. Arrythmias were increasingly frequent with age. Our findings are similar to those obtained with monitoring in ambulatory asympatomatic subjects of the same age without apparent heart diseases reported by other authors. On the other hand, the frequency of arrythmia was unrelated to the time elapsed between the ischaemic attack and Holter monitoring. In conclusion, Holter monitoring performed several weeks after suspected cerebral embolism failed to reveal arrythmias likely to be responsible for a focal cerebral ischaemic attack.
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PMID:[Holter monitoring in patients with focal cerebral ischaemic attacks (author's transl)]. 616 34

Electrophysiologic studies were performed in 47 children aged 3 to 18 years, 15 of whom had cardiac arrhythmias 1 to 15 years after repair of tetralogy of Fallot. Six exhibited sinus or atrioventricular nodal dysfunction, 8 had ventricular extrasystoles, and 1 had supraventricular tachycardia. Hemodynamic and electrophysiologic data were obtained at postoperative catheterization. Although electrophysiologic responses were abnormal in a proportion of both the children with and those without arrhythmia, hemodynamic values were similar. Three of 6 children with impaired sinus impulse generation or atrioventricular nodal conduction had a prolonged A-H interval, and in 3 Wenckebach heart block developed at low pacing rates. Ventricular ectopic rhythm was not associated with any particular abnormality of basic intracardiac conduction intervals. Thus, arrhythmias and conduction abnormalities are not consistently related to residual right ventricular hypertension. Abnormalities in electrophysiologic function are common after repair of tetralogy of Fallot in patients with sinus rhythm and may have prognostic implications for these patients.
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PMID:Hemodynamics and intracardiac conduction after operative repair of tetralogy of Fallot. 618 35

A case of severe alcohol withdrawal complicated by seizures, hallucinosis, hypertension, and supraventricular tachycardia is presented. When the patient showed no response to intravenous diazepam (total, 70 mg over 30 minutes) three 0.5-mg increments of propranolol were administered intravenously, resulting in immediate conversion to sinus rhythm and reduction of blood pressure from 210/130 mm Hg to 130/80 mm Hg. The use of intravenous propranolol as an adjunct to standard therapy in the alcohol withdrawal syndrome is discussed.
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PMID:Acute alcohol withdrawal complicated by supraventricular tachycardia: treatment with intravenous propranolol. 668 57


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