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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In conducting 381 stimulations in 330 patients with brady- and tachysystolic disorders of cardiac rhythm of various etiology 122 complications were revealed. Dislocation of the electrode was noted in 71 cases (18.6%), perforation of the myocardium by the endocardial electrode in 9 (2.1%), ventricular fibrillation in 11 (2.3%), and sepsis in 5 (1.3%) of the cases. A special device may be used for the immediate detection of dislocation. Characteristic changes are noted on the intracardiac ECG in penetration of the electrode into the myocardium (precursor of perforation).
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PMID:[Hazards and complications of temporary endocardial stimulation]. 35 53

An experience with penetrating cardiac injuries between 1974 and 1977 has permitted designation of particular findings as indications for emergent operations and appropriate therapeutic approaches. Of the 46 patients with cardiac trauma, 28 suffered gunshot wounds. Seventeen patients died, and 14 of the deaths occurred as a result of asystole, ventricular fibrillation or exsanguination during operation. Two patients died of neurologic sequelae following successful cardiac repair, and one died secondary to injury not disclosed by physical examination or roentgenogram. The surviving 29 patients had five major complications. Sepsis, organ system failure and cardiac defects rarely occurred despite rapidly performed thoracotomy and severe shock. Since delayed operation has been uniformly associated with adverse outcome and because postoperative complications of emergent pericardial exploration are mild, the following conclusions have been reached: 1) Mediastinal entrance wounds, severe hypotension and signs of cardiac tamponade are demonstrative of cardiac trauma. Therefore, virtually any combination of these physical signs mandates pericardial exploration. 2) Subxiphoid or transdiaphragmatic exploration (during laparotomy) of the pericardium has been valuable in diagnosis of suspected heart wounds. 3) Emergent cardiorrhaphy is the treatment of choice. Pericardiocentesis is at best only temporarily effective. Thoracotomies performed in the emergency room were uniformly unsuccessful. If possible, cardiorrhaphy should be done in the operating room. 4) Median sternotomy is the approach of choice. 5) The basic principles of management of cardiac injury are rapid diagnosis, relief of tamponade, control of hemorrhage, repair of cardiac defects and restoration of blood volume.
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PMID:Principles for the management of penetrating cardiac wounds. 45 48

Out of 124 patients who had taken massive doses of digitoxin in attempted suicide, emergency endocardial pacing was performed in the 68 with the worst prognosis. The mortality (13%) in the 124 patients compared favorably with the mortality (20%) in a previous series of 70 similar patients none of whom were paced. Sixteen (23%) of the 68 paced patients died. The causes of death were: asystole (two); cardiogenic shock (two); septicemia (one); and ventricular fibrillation (eleven). Ventricular fibrillation occurred during introduction of the pacing catheter in two patients, as a result of electrode displacement in these patients, because of premature withdrawal of the catheter in one patient, and for no detectable reason, during normally proceeding pacing, in five patients. Endocardial pacing has a place in the emergency treatment of massive digitoxin poisoning. Its chief hazards are mechanical, and one of the commonest is electrode displacement.
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PMID:Acute digitoxin intoxication treated by intracardiac pacemaker: experience in sixty-eight patients. 86 79

4 patients (P) with recurrent, sustained ventricular tachycardia (VT) resistant to medical treatment, underwent surgery for cure of this arrhythmia. Each P had episodes of VT lasting 30 or more seconds, 3 of them had episodes of ventricular fibrillation. In all cases rhythm disturbances were secondary to post myocardial infarction aneurysm. Coronary angiography showed in all P total occlusion of LAD, in 2 cases significant lesion in RCA were found. 1 P had lung cancer. All P underwent aneurysmectomy and an excision of the altered endocardium by Harken's method. The endocardial excision was performed without endocardial mapping. 2 P had concomitant CABG to RCA. In the P with lung cancer lobectomy was performed. There were 2 ++non-arrhythmic death. The P with lung cancer died because of sepsis due to lung abscess. One P died because of heart failure (preoperative EF 10%), 6 months after the surgery. The 2 survivors remained free of VT during a follow-up period 8 months. In conclusion, endocardial excision by Harken's method is efficient in treating recurrent sustained VT, resistant to medical treatment, in patients with post myocardial infarction aneurysm. The surgical procedure can be performed without intraoperative endocardial mapping.
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PMID:[Surgical treatment of ventricular tachycardia in patients with post-infarction aneurysms]. 147 71

The Vienna heart uses a vacuum formed, pellethane pulsatile ventricle and is available in left ventricular assist (LVAD) and total artificial heart (TAH) configurations. This device was used as mechanical support of the failing heart in nine patients intended for heart transplantation. In two patients with cardiomyopathy an orthotopic TAH was implanted; one survived despite severe preoperative ischemic liver damage, and the other died of sepsis. In seven patients an atrio-aortic LVAD was implanted; six had suffered an acute myocardial infarction with cardiogenic shock, and one could not be weaned off bypass. Three patients survived. These included one 65-year-old with incipient ARDS at operation, and a 40-year-old with preoperative liver and kidney insufficiency who was transplanted in septicemia. In this patient the septic focus, natural and artificial heart, were removed at transplantation. Four patients died. In one we were unable to establish satisfactory circulation, one died after failure of the transplanted heart, one suffered a lethal cerebral embolism and one developed multi-organ failure after repeated attacks of ventricular fibrillation. With the Vienna heart sufficient circulatory support could be established with cardiac outputs between 6 and 8 l/min for the TAH and 3.5 to 4.5 l/min for the LVAD. With this type of support an overall survival rate of 44% could be achieved. Mechanical hemolysis was not a clinical problem and no device failure occurred.
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PMID:Mechanical bridge to transplantation with the Vienna heart in TAH and LVAD configuration. 152 99

Seventy-seven patients with drug refractory ventricular tachycardia (57) and ventricular fibrillation (20) received the implantable defibrillator. There were 55 men and 22 women with a mean age of 63 +/- 10 years. The anatomical diagnoses were coronary artery disease in 61 patients, cardiomyopathy in 15 patients, and aortic stenosis in one patient. The mean ejection fraction was 32 +/- 12%. Concurrent surgery at defibrillator implantation was coronary bypass in eight patients and aortic valve replacement in one patient. There were no intraoperative mortalities. The mean ventricular fibrillation termination threshold was 13 +/- 6 joules. During a follow-up period of 16 +/- 10 months (range 2-40 months) four patients died: electrical mechanical dissociation (two patients), respiratory failure, and sepsis. Thirty-eight patients (51%) continued receiving antiarrhythmic drug therapy, with quinidine sulfate and procainamide being the most frequently utilized agents. Fifty-four patients (72%) have received a mean of 9 +/- 10 shocks (range 1-44). Implantable defibrillators are often needed in patients seen in large community hospitals. This technology can be administered successfully in this setting with complications and results comparable to those reported from university hospitals. Implantable defibrillators are effective in preventing arrhythmic death and can be used with low risk to the patients.
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PMID:Long-term community hospital experience with the internal defibrillator. 170 35

Surgical treatment of 201 dogs with patent ductus arteriosus at the College of Veterinary Medicine, The Ohio State University was evaluated retrospectively to determine risk factors for development of surgical complications. During surgery, 15 dogs (7%) died because of hemorrhage associated with ductus dissection (n = 8), pulmonary edema (n = 4), ventricular fibrillation (n = 1), hemorrhage not associated with ductus dissection (n = 1), and cardiac arrest immediately after ductus ligation (n = 1). An additional 8 dogs (4%) died less than 1 month after surgery (total mortality before, during, and immediately after surgery, 11%). Nineteen dogs (9.5%) developed hemorrhage during surgery. Sixteen dogs developed complications other than hemorrhage (pulmonary edema [n = 4], cardiac arrest [n = 4], iatrogenic lung trauma [n = 3], ventricular fibrillation [n = 2], septicemia [n = 2], and recanalized ductus [n = 2]). Correlation was not found between age, sex, body weight, surgical technique (Jackson method vs standard method of dissection), or surgeon level of training and development of hemorrhage during surgery, other complications, or survival less than 5 days. Positive correlation (P less than 0.05) was found between hemorrhage and death within 5 days after surgery. Positive correlation (P less than 0.05) was also found between other complications and death within 5 days after surgery. Nineteen dogs survived surgery, but later died of unrelated causes (mean life span, 57 months); 63 of the dogs were still alive and doing well as of January 1990 (mean life span, 47 months after surgery). Contrary to previous reports, age, body weight, and surgical technique did not affect results.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of ligation of patent ductus arteriosus in dogs: 201 cases (1969-1988). 236 30

A 29-year-old white male with a recent history of gastroenteritis sustained a cardiac arrest at home. He was found to be in ventricular fibrillation and could not be resuscitated. Pathologic findings included focal aggregates of histiocytes, lymphocytes and occasional neutrophils in the myocardium as well as inflammatory changes in the colon, liver, and spleen. Blood cultures were positive for Salmonella heidelberg. The patient was seen 3 times by emergency departments prior to his demise. Death from Salmonella is rare except when associated with septicemia. The severity of illness and prognosis are often related to the site of infection and underlying disease processes.
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PMID:Fatal myocarditis secondary to Salmonella septicemia in a young adult. 237 38

Complete data concerning long-term results of transcatheter electrical ablation of the atrioventricular junction is not available. At the request of the French Cardiac Arrhythmia Working group we undertook an inquiry in October 1983. All centers potentially able to perform such procedures were asked to report their experience. Eight centers have performed one case or more, over a period of 3 years, for a total of 91 patients. The mean follow-up completed in all patients in April 1986 was 12 +/- 10 months. The procedure was indicated for a supraventricular arrhythmia resistant to a mean of 3.9 +/- 1.3 classes of antiarrhythmic agents. Atrial flutter or fibrillation in 54 (59%) and atrioventricular nodal reentry in 17 (18%) were the most common arrhythmias. A mean of 2.6 +/- 2.3 electrical shocks (range 1-14 shocks) with a stored energy of 130-400 joules was delivered during 1-5 sessions. Complete heart block was obtained in 83 patients and persisted at the time of discharge from the hospital in 46 patients (50.5%). The immediate complication (within 24 hours after the procedure) included ventricular fibrillation successfully converted (one patient) and nonsustained ventricular tachycardia (three patients). Late complications included one death 3 days after the procedure, in a patient in whom sustained ventricular tachycardia was documented, nonsustained ventricular tachycardia in two patients, sepsis in three patients and pericardial effusion in one patient. At the time of the follow-up, there were three additional deaths related to sepsis due to pacemaker pocket infection in one patient and to preexisting congestive heart failure in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up of atrioventricular junctional transcatheter electrical ablation. 245 67

There were 347 cardiac arrests analysed over a 5 year period. 180 patients were successfully resuscitated and 61 eventually left hospital. Patients with thromboembolic disease, renal failure, stroke, neoplasia, head injury and septicemia did badly. No patient with liver failure who arrested left hospital. The need for intubation at the arrest was associated with an increased mortality. Patients who developed ventricular fibrillation or tachycardia were more likely to survive than patients who developed asystole. Our discharge outcome of 18% compares favourably with all previous studies.
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PMID:A 5 year audit of cardiac arrests at Riyadh Armed Forces Hospital. 263 51


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