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

Twenty-five normotensive men without any cardiac or arterial pathology, aged 22 to 68 years, 12 less than 45 year old, 13 over 45 years, underwent cardiac catheterisation and angiography. The following parameters were calculated: 1) a global index of arterial function (Ea) and its determining factors (Ea = LVESP/SV where LEVSP = left ventricular end systolic pressure and SV = left ventricular stroke volume); Ea = (HR x SVR) + Ea' where HR = heart rate, SVR = total systemic vascular resistance and Ea' = (LVESP - MAP/SV) (MAP = mean arterial pressure); 2) an index of global left ventricular pump function: ELV (ELV = LVESP/LVESV, where LVEDV = left ventricular end systolic volume; 3) an index of LV-arterial coupling: the Ea/ELV ratio. With aging, both Ea (by increase in SVR) and Ea' and ELV increased significantly. Ea/ELV (inverse of the ejection fraction-1) increased with age but ELV less than Ea. Ea/ELV was significantly higher in patients over 45 years of age but the correlation between ejection fraction and age was not statistically significant (p = 0.10). These results suggest that with aging, the improvement in LV pump function approximately corresponds to the degradation in arterial transport function: the left ventricular-arterial coupling as assessed by the Ea/ELV ratio (and therefore the ejection fraction) is maintained in the majority of cases.
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PMID:[Effects of aging on left ventricle-arterial coupling in man]. 812 7

Interactive effects between exogenous dopamine (DA) and isoflurane (I) combined with thoracic epidural blockade (TEA) were studied in dogs during chloralose anesthesia. The I-TEA intervention per se decreased heart rate (HR; 28%), mean arterial pressure (MAP; 63%), cardiac output (CO; 54%), left ventricular dP/dt (LVdP/dt; 75%) and LVdP/dt/systolic arterial pressure (SAP; 42%). Prior to the I-TEA intervention, dopamine increased MAP, CO, LVdP/dt, LVdP/dt/SAP and stroke volume (SV) already at the dose 10 micrograms.kg-1.min-1 and, additionally, increased mean pulmonary artery pressure (MPAP) at the dose 20 micrograms.kg-1.min-1. During the I-TEA intervention, the DA-induced increases in MAP and systemic vascular resistance (SVR) were significantly higher than prior to I-TEA, as indicated by significant ANOVA interactive effects. At the dose 10 micrograms.kg-1.min-1, DA restored MAP, CO, LVdP/dt, LVdP/dt/SAP and SV to levels found before the I-TEA intervention, while HR was restored first at the dose 20 micrograms.kg-1.min-1. At the dose 20 micrograms.kg-1.min-1, DA also increased MAP (39%), LVdP/dt (119%), LVdP/dt/SAP (73%), SVR (28%) and MPAP (70%) above levels prior to I-TEA. To conclude, exogenous dopamine effectively and dose-dependently counters cardiovascular depression induced by the anesthetic technique of combining I and TEA. The pressor and systemic vasoconstrictor actions of dopamine are potentiated by conjoint administration of I and TEA.
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PMID:Cardiovascular depression by isoflurane and concomitant thoracic epidural anesthesia is reversed by dopamine. 817 48

The hemodynamic effects of argon pneumoperitoneum were studied to define its possible role as an alternative gas for intraperitoneal insufflation during minimally invasive surgery. Adult pigs were anesthetized and placed on mechanical ventilation. Parameters measured or determined included mean arterial (MAP), pulmonary arterial (PAP), pulmonary arterial wedge (PAWP), right atrial (CVP), and inferior vena cava venous (IVC) pressures, total excretion of CO2 (VCO2), oxygen consumption (VO2), minute ventilation, and arterial blood gases. Also determined were cardiac output, stroke volume, and systemic vascular resistance all indexed to weight (CI, SVI, SVRI). Data were recorded during a 1-h baseline, 2 h of insufflation with argon gas at a constant pressure of 15 mmHg, and 1 h recovery after desufflation. There was no significant change from baseline in VCO2, VO2, MAP, PAP, PAWP, CVP, PaCO2, or arterial pH. Argon pneumoperitoneum significantly increased systemic vascular resistance index and exerted a depressant effect on stroke volume index and cardiac index by 25% and 30% from baseline values, respectively (P < 0.05). Inferior vena cava pressure increased as a reflection of the intraabdominal pressure. Argon insufflation had no effect on respiratory function. Argon gas may not be physiologically inert, and in patients with cardiovascular disease its effects may be clinically important.
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PMID:Hemodynamic effects of argon pneumoperitoneum. 820 3

We determined both the slope of the left ventricular end-systolic pressure-volume relation (Emax), which is a measure of contractility independent of loading conditions, and the slope of the arterial end-systolic pressure-stroke volume relation (Ea), which is a measure of arterial load independent of ventricular function, in 10 patients undergoing elective noncardiac surgery. Left ventricular end-systolic volume (Ves) was measured by transesophageal echocardiography and instantaneous left ventricular end-systolic pressure (Pes) was estimated from the dicrotic notch pressure in the radial artery. Emax was calculated during afterload reduction (nicardipine 30 micrograms.kg-1 iv), and the correlation of Emax to either Pes/Ves ratio or MAP (mean arterial blood pressure)/Ves ratio was accomplished in order to investigate whether these indices were clinically useful measurements of ventricular function or not. Ea was also calculated from the data obtained before and 2-3 min after nicardipine iv. The averaged Emax and x-axis intercept (Vo) were 3.11 mmHg.ml-1 and -3.8 ml, respectively. The correlation coefficient obtained between Emax and Pes/Ves was 0.96, and that obtained between Emax and MAP/Ves was 0.97. Ea decreased significantly (P < 0.05) following intravenous nicardipine, demonstrating a decreased arterial load. The direction of changes in Ea was similar to that reported previously in systemic vascular resistance. From these results, we conclude that measurement of Emax (or Pes/Ves, MAP/Ves) and Ea using transesophageal echocardiography and radial artery pressure tracing is feasible and these are a useful tool to estimate left ventricular performance and arterial load during surgery.
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PMID:[Assessment of left ventricular contractility (Emax) and arterial load (Ea) in humans by transesophageal echocardiography and radial artery pressure tracing]. 825 69

Seated recovery [at 5, 15, 20, 40, and 60 min (R5,15,20,40,60)] body temperature (T) and blood pressure were examined after 45 min of cycling exercise (54 +/- 5% maximal O2 uptake) in 12 normotensive males to study the relationship between postexercise thermal and hemodynamic responses. Data were analyzed with a repeated-measures analysis of variance. Systolic (SBP, R15,20,40; P < 0.01) and mean arterial (MAP, R15,20; P < 0.05) blood pressures were significantly lower, but diastolic blood pressure (DBP) was unchanged. Heart rate (R5,15,20, P < 0.001) was above that measured at rest. Decreases in mean skin T (Tsk, R15,20,60; P < 0.01) and increases in core T (Tc, R5,15,20; P < 0.01) were found. Significant negative correlations averaging -0.68 (R15,20,40) and -0.69 (R15,20,40) were demonstrated for Tsk and SBP and MAP, respectively. Increases in thigh Tsk (R5,15,20; P < 0.00001) and decreases in calf (R15,20,40,60; P < 0.00001) and chest (Tchest, R5,15,20,40; P < 0.00001) Tsk were found. Significant negative correlations averaging -0.67 (R5,15,20,40) and -0.71 (R20,40,60) were demonstrated for Tchest and SBP and MAP, respectively. Inverse relationships between various regional Ts and blood pressure and the increased R Tc suggest a vasodilatory response in the visceral organs and/or lower limbs leading to a pooling of blood and transient decreases in blood pressure by a reduced venous return, although not affecting stroke volume and cardiac output.
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PMID:Blood pressure, hemodynamic, and thermal responses after cycling exercise. 837 70

The use of modified haemoglobin solutions as blood substitutes has been investigated extensively during the past decades. Ultrapurified, polymerised bovine haemoglobin (upbHb) is a promising new substance in this respect. It was the aim of the present investigation to study the cardiovascular and respiratory effects of massive blood replacement with upbHb in a new model of conscious rats with continuous haemodynamic monitoring. METHODS. The right femoral artery and vein of 13 male Sprague-Dawley rats were catheterised during halothane-N2O-O2 anaesthesia. A thermistor catheter was placed in the descending aorta via the left femoral artery for measuring cardiac output by the thermodilution method. After recovery from anaesthesia blood replacement was achieved by arterial blood withdrawal and simultaneous venous infusion of upbHb in equal amounts. The haematocrit was lowered to < 3% and the animals were then left undisturbed in a rat restrainer while breathing room air. RESULTS. The animals showed no signs of disturbed behaviour patterns, distress, or adverse reactions. There were no significant changes in cardiac index and oxygen delivery during the investigation period of 4 h. A marked increase in mean arterial pressure (MABP) and systemic vascular resistance (SVR) of 30% was observed while stroke volume remained unchanged. Blood gases, acid-base status, and plasma glucose showed no major changes. Plasma oncotic pressure increased during the investigation period. CONCLUSIONS. The results indicate that there is adequate oxygenation and sufficient systemic oxygen delivery in conscious and drug-free rats after isovolaemic haemodilution with upbHb to a final haematocrit of < 3%. In contrast to previous haemodilution studies, which have tested non-oxygen-carrying solutions, no changes in cardiac index were observed. The cause of the increase in MAP and SVR remains to be established.
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PMID:[Modified hemoglobin as a blood substitute in a rat model]. 847 Jul 90

Sympathetic beta-adrenergic influences on cardiovascular responses to 50 degrees head-up tilt were evaluated with metoprolol (beta 1-blockade; 0.29 mg kg-1) and propranolol (beta 1 and beta 2-blockade; 0.28 mg kg-1) in eight males. A normotensive-tachycardic phase was followed by a hypotensive-bradycardic episode associated with presyncopal symptoms after 23 +/- 3 min (control, mean +/- SE). Head-up tilt made thoracic electrical impedance (3.0 +/- 1.0 omega), mean arterial pressure (MAP, 86 +/- 4-93 +/- 4 mmHg), heart rate (HR, 63 +/- 3-99 +/- 10 beats min-1) and total peripheral resistance (TPR, 15 +/- 1-28 +/- 4 mmHg min L-1) increase, while central venous oxygen saturation (74 +/- 2-58 +/- 4%), cardiac output (5.7 +/- 0.1-3.1 +/- 0.3 L min-1), stroke volume (95 +/- 6-41 +/- 5 mL) and pulse pressure (55 +/- 4-49 +/- 4 mmHg) decreased (P < 0.05). Central venous pressure decreased during head-up tilt (7 +/- 2-0 +/- 1 mmHg), but it remained stable during the sustained tilt. At the appearance of presyncopal symptoms MAP (49 +/- 3 mmHg), HR (66 +/- 4 beats min-1) and TPR (15 +/- 3 mmHg min L-1) decreased (P < 0.05). Neither metoprolol or propranolol changed tilt tolerance or cardiovascular variables, except for HR that remained at 57 +/- 2 (metoprolol) and 55 +/- 3 beats min-1 (propranolol), and MAP that remained at 87 +/- 5 mmHg during the first phase with metoprolol. In conclusion, sympathetic activation was crucial for the heart rate elevation during normotensive head-up tilt, but not for tilt tolerance or for the associated hypotension and bradycardia.
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PMID:Sympathetic influence on cardiovascular responses to sustained head-up tilt in humans. 871 63

The stroke volume of the left ventricle (SV) was assessed in nine young men (mean age 22.2, ranging from 20 to 25 years) during cycle ergometer upright exercise at exercise intensities from 60 to 150 W (about 20% to 80% of individual maximal aerobic power). The SV was calculated from noninvasive tracings of the arterial blood pressure, determined from photoplethysmograph records and compared to the SV determined simultaneously by pulsed Doppler echocardiography (PDE). Given the relationship SV = As.Z-1 in which A(s) is the area underneath the systolic pressure profile (in millimetres of mercury and second), and Z (in millimetres of mercury and second per millilitre) is the apparent hydraulic impedance of the circulatory system, a prerequisite for the assessment of SV from the photoplethysmograph tracings is a knowledge of Z. The experimental value of Z (hereafter defined Z*) was calculated by dividing A(s) (from the finger photoplethysmograph) by SV as obtained by PDE. When the whole group of subjects was considered, Z* was not greatly affected by the exercise intensity: it amounted to 0.089 (SD 0.028; n = 36). The Z was also estimated independently of any parameter other than heart rate (HR), mean (MAP) and pulse (PP) arterial blood pressure obtained from the photoplethysmograph. A computerized statistical method allowed us to interpolate the experimental values of Z*, HR, PP and MAP by the equation Zm = a.(b + c.HR + d.PP + e.MAP)-1, thus obtaining the coefficients a to e. The mean percentage error between Zm (calculated from the coefficients obtained and Z* was 21.8 (SD 14.3)%. However, it was observed that, in a given subject, Z* was significantly affected by the exercise intensity. Therefore, to improve the estimate of Z a second algorithm was developed to update the experimental value of Z determined initially at rest (Zin). This updated value (Zcor) of Z was calculated as Zcor = Zin. [(f/(i + g.(HR/HRin) + h.(PP/PPin) + 1.(MAP/MAPin)], where HRin, PPin, MAPin, HR, PP, MAP are the above parameters at rest and during exercise, respectively. Also in this case, the coefficients f to 1 were determined by a computerized statistical method using Z* as the experimental reference. The values of Zcor so obtained allowed us to calculate SV from arterial pulse contour analysis as SVF = As.Z-1cor. The mean percentage error between the SVF obtained and the values simultaneously determined by PDE, was 10.0 (SD 8.7)%. It is concluded that the SV of the left ventricle, and hence cardiac output, can be determined during exercise from photoplethysmograph tracings with reasonable accuracy, provided that an initial estimate of SV at rest is made by means an independent high quality reference method.
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PMID:Noninvasive assessment of cardiac output from arterial pressure profiles during exercise. 878 65

The cardiovascular effects of the K-ATP channel blocker U-37883A and 5 related morpholinoguanidines were determined in 6 experimental preparations. In anesthetized dogs, U-37883A (0.5-8.0 mg/kg i.v.) increased mean arterial pressure (MAP; +18%) and left ventricular (LV) effective refractory period (ERP; +35%), and decreased LV contractility (-41%). Higher doses of U-37883A (16-32 mg/kg) fatally reduced MAP (-84%), heart rate (HR; -57%) and LV contractility (-72%). In anesthetized rats, U-37883A (1.0-50 mg/kg i.v.) also maximally reduced MAP, HR and LV contractility by 68, 77 and 48%, respectively. U-37883A and its analogs were diuretic in conscious rats (1.5-15 mg/kg i.v.) and blocked pinacidil in rabbit mesenteric artery (EC50 = 0.5-50 microM). In rabbit papillary muscle, 50 microM U-37883A significantly reduced force of contraction (-33%) and prolonged conduction time (+244%). Milder papillary effects were seen with the N'-OH analog U-45194A, which did not depress LV contractility in intact rats. In conscious dogs, oral U-45194A (50 mg/kg) was diuretic but reduced LV stroke volume and increased peripheral vascular resistance. These studies characterize U-37883A's systemic cardiovascular and direct myocardial effects, and identify U-45194A as a less cardiac depressant analog having U-37883A-like diuretic and functional K-ATP channel blocking activities.
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PMID:Cardiovascular effects of the K-ATP channel blocker U-37883A and structurally related morpholinoguanidines. 880 57

Haemodynamic changes in children examined by reocardiography impedance method were compared for 15 sessions performed with new capillary cuprophan dialysers and 15 sessions performed with reused ones (fourth use). Subsequent parameters of cardiovascular system performance were assessed: CI-cardiac index, SI-stroke index, ACI-acceleration index, SVRI-systemic vascular resistance index, EF-ejection fraction, TFC-thoracic fluid conductivity, MAP-mean arterial pressure. Significant differences in MAP, EF, TFC, ACI values between the sessions with the first and the fourth use of cuprophan dialysers were noted. Marked increase of cardiac output during the acetate haemodialysis was observed as the result of afterload declining by lowering systemic vascular resistance during the session with new and reused cuprophan dialysers. Contractility of myocardium and ejection fraction significantly increased during the session performed on new dialysers. Ejection fraction remained unchanged and myocardial contractility slightly improved during the fourth use of cuprophan dialysers.
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PMID:[The influence of multiple use of cuprophan dialysers on hemodynamic changes in children with chronic kidney failure]. 883 33


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