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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Haemodynamic measurements were made in 80 patients who underwent acute haemodilution (up to 40 ml/kg blood withdrawal) before cardiopulmonary bypass. Measurements of cardiac output, pulmonary arterial pressures including wedge pressure were made. Cardiac index, stroke volume and total peripheral resistance were calculated. Oxygen studies included: arterial and central venous partial pressures and saturations. Haemoglobin content, haematocrit and blood gas determinations were made during haemodilution and bypass. There was a direct relationship between haemodilution and stroke volume (stroke volume increase of 8,5% with 9,4 ml/kg and 25% increase with 40 ml/kg blood withdrawal). No change was found in mean pulmonary artery or wedge pressures. Central venous oxygen saturation remained constant during haemodilution which indicates that oxygen supply was adequate. Haemodilution should be avoided in patients with less than 35% haematocrit, with more than two vessel coronary artery disease and Class IV N.Y.H.A. because of the risk of possible impaired cardiac output compensation. During bypass, a haematocrit of 20% and 6 g% provides greater perfusion and optimal microcirculation. The problems of large volume homologous blood transfusion, hepatitis risk and loss of clotting factors can be lessened with haemodilution.
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PMID:[Haemodynamic effects of acute intra-operative haemodilution in open heart surgery (author's transl)]. 69 82

Mean electromechanical deltaP/deltat and systolic time intervals were measured in 30 patients with coronary artery disease. Total electromechanical systole (QS2), left ventricular ejection time (LVET) and preejection period (PEP) were measured and PEP/LVET calculated. Systolic time intervals were obtained noninvasively. Mean electromechanical deltaP/deltat was calculated by means of systemic diastolic blood pressure, pulmonary wedge pressure and PEP. Left ventricular ejection fraction (EF), pulmonary wedge pressure and stroke index were determined by catheterization and left ventriculography. PEP (r = -0.69) and PEP/LVET (r = -0.68) were better correlated to EF than mean electromechanical delatP/deltat (r = 0.63). Patients with previous myocardial infarction were found to have significantly longer PEP (P less than 0.02) and higher PEP/LVET (P less than 0.01) than patients without infarction. Neither of the methods showed significant differences between the groups of patients with 1-, 2- and 3-vessel disease. Although systolic time intervals cannot be used in predicting invasive measurements such as EF, the findings indicate that PEP and PEP/LVET may be useful supplement to clinical examination in evaluating left ventricular function in coronary artery disease.
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PMID:Mean electromechanical delta P/ delta t and systolic time intervals in coronary artery disease. 69 36

P wave terminal force (Ptf) and systolic time intervals (STI) were determined non-invasively from electrocardiogram, phonocardiogram and carotid pulse wave in fifteen men with coronary artery disease, before and during exercise. Left ventricular end diastolic pressure (LVEDP) and stroke volume (SV) were determined at catheterization simultaneously with the non-invasive recordings. Pre-ejection period (PEP) shortened in eleven patients, left ventricular ejection time (LVET) shortened in eight and Ptf and PEP/LVET decreased in ten patients during exercise. Ptf was significantly correlated to LVEDP both at rest (r = -0.66) and during exercise (r = -0.79). The change in Ptf and LVEDP was less correlated (r = -0.52). The change in LVET (r = -0.50), the change in PEP (r = 0.62) and in the index PEP/LVET (r = 0.65) was correlated to the change in SV. The use of both Ptf and STI may be of value in estimating left ventricular function during exercise in patients with coronary artery disease.
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PMID:Change in P wave terminal force and systolic time intervals during exercise in patients with coronary artery disease. 70 43

Between 1969 and 1976, 174 patients were treated surgically for simultaneous carotid and coronary atherosclerosis. In 59 patients, staged carotid endarterectomy was performed a few days to 6 months prior to myocardial revascularization. Severe (more than 60% stenosis) coronary atherosclerosis affected a single vessel in 11 patients (19%), two vessels in 20 patients (34%), and three vessels in 28 patients (47%). Left ventricular contraction was impaired in 30 patients (51%). Nine patients (15%) had previous neurological symptoms, and 50 patients (85%) had asymptomatic carotid stenosis. One patient (1.5%) had a permanent stroke after carotid endarterectomy. There were no permanent strokes after staged myocardial revascularization, and the early mortality rate was 1.7%. Combined carotid endarterectomy and myocardial revascularization were performed in 115 patients with severe cardiac disease. Coronary atherosclerosis affected a single vessel in 10 patients (9%), two vessels in 39 patients (34%), and three vessels in 66 patients (57%). Left ventricular impairment was present in 72 patients (63%). Thirty-five patients (30%) had previous neurological symptoms, and 80 patients (70%) had asymptomatic carotid stenosis. Five patients (4.3%) had permanent strokes after combined revascularization, and four of these patients had occlusion or severe stenosis of the contralateral internal carotid artery. The early mortality rate was 4.3%, but no deaths could be attributed to carotid repair. The results suggest that significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible. In the presence of severe cardiac disease, a combined precedure may be performed in face of higher risk of intraoperative stroke.
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PMID:Staged and combined surgical approach to simultaneous carotid and coronary vascular disease. 71

From 2,874 school children participating in the 1971 and 1973 Muscatine Coronary Risk Factor Survey, we selected three groups of index cases for detailed family study: the HIGH group (n = 56), with cholesterol levels greater than the 95th percentile twice; the MIDDLE group (n = 46), cholesterol levels between the 5th and 95th percentile; and the LOW group (n = 46), cholesterol levels less than the 5th percentile twice. Coronary mortality determined from death certificates was increased in the young relatives (ages 30-59) of the HIGH group index cases, as follows: twofold excess in HIGH male relatives compared with the MIDDLE or LOW group (p less than 0.05); tenfold excess in the HIGH female relatives compared with the MIDDLE and LOW group combined (p less than 0.01). After correction for years at risk, there was an approximately twofold significantly-increased coronary mortality. Stroke mortality was higher, although not significantly, in the older relatives (ages greater than or equal to 60) of the HIGH index cases. Cancer mortality was not significantly different among the relatives of the three groups of index cases. This study indicates that school children's cholesterol levels cluster with those of their family members and that persistent hypercholesterolemia in children identifies families at risk for coronary artery disease.
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PMID:Increased coronary mortality in relatives of hypercholesterolemic school children: the Muscatine study. 75 99

The haemodynamic effects of nitroglycerin (0.6 mg sublingual) have been studied in eleven patients with coronary artery disease, by means of the thermodilution method which enables cardiac output to be repeatedly measured at short time intervals (1-2 minutes). The following data have been studied: blood pressure (BP), pulmonary arterial pressure (PA), left ventricular filling pressure (LVFP), cardiac output (CO), stroke volume (SV), heart rate (HR), total systemic resistance (TSR), total pulmonary resistance (TPR), tension-time index (TTI) and left ventricular stroke work index (LVSWI). Within 1 minute following nitroglycerin (NG) administration the patients showed a decrease in TSR, TPR, and an increase in CO, SV, HR and LVCWI. TTI was reduced at the 5th minute. LVFP, PA and BP decreased after 3-5 minutes. CO increase at the 1st minute often compensated the fall in TSR, and blood pressure remained unchanged. The LVSWI/LVFP curve showed a transitory shift to the left at the 1st minute. In eleven normal subjects NG induced a minor increase in CO and SV, and a minor decrease in TSR at the 1st minute. The mechanism of action of NG in angina pectoris is briefly discussed.
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PMID:[Haemodynamic effects of nitroglycerin (author's transl)]. 81 Mar 83

The effects of nitroglycerin ointment (15 mg nitroglycerin) on hemodynamics at rest and during exercise were studied in 12 patients with coronary artery disease and exertional angina (angina group) and in 8 patients with normal coronary arteriograms or with nonsignificant arteriographic abnormalities who did not have exertional chest pain (nonangina group). In both groups at rest nitroglycerin ointment induced within 15 minutes a significant decrease in left ventricular end-diastolic pressure that was sustained for at least 60 minutes; systemic arterial pressure also decreased within 15 minutes and continued to decrease during the 60 minutes of observation. By 30 to 60 minutes there were significant decreases in cardiac index, stroke index, left ventricular stroke work index and tension-time index. During exercise performed 60 minutes after receiving nitroglycerin ointment, 10 of the 12 patients in the angina group had no pain, whereas 2 had delayed and less severe symptoms. Hemodynamic observations during this exercise period revealed significant decreases in left ventricular end-diastolic pressure, systemic pressure and tension-time index from values in the initial exercise period; heart rate remained unchanged. These data document the protective effect of nitroglycerin ointment for a period of at least 60 minutes and also suggest that the beneficial effects are related to a reduction in myocardial oxygen requirements.
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PMID:Effect of nitroglycerin ointment on the clinical and hemodynamic response to exercise. 82 28

This study compares the effects and duration of the effects of 5 mg. of sublingual (SL) isosorbide dinitrate (ISD), 20 mg. of oral ISD, and 0.4 mg. of SL nitroglycerin (TNG) on central circulatory dynamics. Twenty-seven patients with coronary artery disease were evaluated with radioisotope techniques and determinations made of heart rate (HR), blood pressure (BP), cardiac index (CI), stroke volume index (SVI), left ventricular enddiastolic volume index (LVEDVI), and left ventricular ejection fraction (LVEF). There were significant and equivalent reductions in BP, SVI, LVEDVI, and CI 15 minutes after TNG, 1 hour after SL ISD, and 4 hours after oral ISD in addition to comparative increases in HR and EF by all drugs at these same time intervals. The effects of TNG were gone at 30 minutes while changes in LVEDVI, LVEF, and CI were present 4 hours after SL ISD and persistent changes in LVEDVI and SVI present 6 hours after oral ISD. We conclude that nitrates have significant effects on both preload and afterload and that the duration of effects of sublingual and oral ISD are truly long acting as compared to TNG.
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PMID:Effects of isosorbide dinitrate and nitroglycerin on central circulatory dynamics in coronary artery disease. 82 3

The effect of nitroglycerin administration on left venticular performance relative to its ability to improve contraction of asynergic zones was examined in 66 patients with coronary artery disease, divided into those whose asynergic zones responded following nitroglycerin administration and those in whom no response was observed. In the responsive group with asynergy of more than one segment, the ejection fraction improved (P less than 0.001), while in the unresponsive group, it decreased (P less than 0.05). Similarly, in patients with one-segment asynergy, the responsive group exhibited a significant increase in ejection fraction P less than 0.001), while the unresponsive group showed no change. The stroke volume index remained unchanged in the responsive group with asynergy of more than one segment, while it decreased significantly (P less than 0.05) in the unresponsive patients. Left ventricular pressures and volumes changed to a similar degree after nitroglycerin administration in all of the patients, regardless of the responsiveness of asynergic zones. It is concluded that nitroglycerin administration results in a differential effect on total left ventricular performance depending on the responsiveness of asynergic zones.
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PMID:Nitroglycerin and ventricular performance. Differential effect in the presence of reversible and irreversible asynergy. 82 1

In 8 patients with coronary artery disease and symmetrical left ventricular contraction, an echocardiographic study of left ventricular function was performed before and 3 minutes after the administration of 0-6 mg nitroglycerin sublingually. The left ventricular end-diastolic diameter decreased from 5-2 +/- 0-2 to 4-9 +/- 0-2 cm (P less than 0-05) and the end-systolic diameter from 4-2 +/- 0-2 to 3-7 +/- 0-2 cm (P less than 0-001). The estimated stroke volume did not change significantly, while the cardiac output increased, 5-8 +/- 0-6 to 7-7 +/- 0-6 l min-1 (P less than 0-001) and the heart rate increased from 72 +/- 5 to 90 +/- 6 (P less than 0-001). The mean arterial blood pressure decreased from 105 +/- 4 to 88 +/- 3 mmHg (P less than 0-001). The ejection fraction increased from 53 +/- 3 per cent to 65 +/- 6 per cent (P less than 0-001) and the mean velocity of circumferential fibre shortening (VCF) from 0-81 +/- 0-05 to 1-15 +/- 0-10 circumferences per second (P less than 0-001). The estimated midsystolic midwall stress decreased from 155 +/- 14 g cm-2 to 102 +/- 12 g cm-2 after mitroglycerin (P less than 0-001). The administration of nitroglycerin was associated with a significant decrease in left ventricular preload and afterload. A vasodilating effect is suggested by the fall in peripheral resistance. The overall improvement in ejection fraction and VCF may not reflect a true increase contractility, because of the concomitant fall in wall stress.
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PMID:Effect of sublingual nitroglycerin on cardiac performance in patients with coronary artery disease and non-dyskinetic left ventricular contraction. 82 2


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