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

Of the patients treated in the CCU of Nippon Medical School for acute myocardial infarction in the past 5 years and 8 months, 44 with cardiogenic shock, 11 with severe heart failure, 7 with ventricular septal perforation and 2 with mitral regurgitation were treated by IABP. The peak effect of IABP on the hemodynamics of patients with cardiogenic shock was noted 24 hours after starting on IABP. When hemodynamics were compared between surviving and dead groups, there was a significant difference in stroke volume index between the two groups. When left ventricular function was compared between them, it was suggested that patients whose left ventricular function does not respond to IABP for 48 hours or longer are more likely to die than responders. Twenty-four of 44 patients became independent of IABP, but no more than 13 patients (30%) survived for 6 months or longer. Isosorbide dinitrate (ISDN) was combined with IABP in 7 patients who had a persistence of heart failure in spite of IABP. Combination therapy with IABP and ISDN elicited a significant increase in cardiac index, a significant decrease in pulmonary capillary wedge pressure, mean pulmonary arterial pressure and total peripheral resistance and a pronounced improvement in left ventricular function, and all 7 patients became independent of IABP. In the patients with acute myocardial infarction complicated with ventricular septal perforation, the mean systolic arterial pressure was 87.7 +/- 8.3 mmHg, mean pulmonary capillary wedge pressure, 20.3 +/- 7.4 mmHg and pulmonary-to-systemic flow ratio, 3.12 +/- 0.95 before starting on IABP. When the hemodynamics at 3 hours of IABP were compared to the pre-IABP values, the right atrial pressure, pulmonary capillary wedge pressure and pulmonary-to-systemic flow ratio had a tendency to decline, but the changes were not statistically significant, except for the peak arterial pressure which showed a significant elevation at 3 hours of IABP. Three of the 7 patients became dependent on IABP, and 2 of the 3 patients were saved by emergency operation.
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PMID:Effects of intraaortic balloon pumping on acute myocardial infarction in 64 cases of cardiogenic shock, severe heart failure and mechanical heart failure. 670 97

The hemodynamic effects of standard dose of Nitroglycerin (NTG) ointment (23 +/- 4 mg) and oral Isosorbide Dinitrate (ISDN) 10 mg were compared in the treatment of left ventricular failure. Ten patients, 8 males and 2 females (mean age 59 +/- 9 years), affected by acute myocardial infarction (7 cases). Ischemic cardiomyopathy (2 cases) and hypertensive cardiomyopathy (1 case) were submitted to right heart catheterization by triple lumen Swan-Ganz catheter. Heart Rate (HR), mean Arterial Pressure (AP), Right Atrial Pressure (RAP), mean Pulmonary Artery Pressure (PAP), Pulmonary Wedge Pressure (PWP), Stroke volume (SV), Cardiac Index (CI), Stroke Work Index (SWI), Systemic Vascular Resistances (SVR), Pulmonary Total Resistances (PTR) were controlled every 30 minutes until the disappearance of the hemodynamic effects. ISDN did not produce any statistically significant changes; on the contrary NTG ointment caused significant changes in: (formula: see text). Decrease of RAP, PAP, PWP, PTR and increase of SV, CI, SWI were statistically significant from 30 until 180 minutes after NTG ointment administration. These changes were statistically different from those produced by ISDN (p less than 0,05). Thus NTG ointment, at this dose, improved cardiac performance, while oral ISDN 10 mg did not. It is concluded that the hemodynamic effects of NTG ointment are prompt and sustained.
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PMID:[Comparison between the hemodynamic effects of nitroglycerine ointment and oral isosorbide dinitrate in the treatment of left ventricular failure (author's transl)]. 680 18

Thirteen patients with left ventricular aneurysms complicating myocardial infarction were studied by contrast angiography and by first pass radionuclide ventriculography. The ejection fraction of the contractile segment (EFCS) was measured from both studies using a double hemishperoid model, and the values correlated closely. There was a monotonic relation between EFCS and stroke volume index measured from thermodilution cardiac outputs carried out simultaneously with the radionuclide study. When radionuclide ventriculography was performed at submaximal supine exercise, changes in EFCS paralleled changes in the total left ventricular ejection fraction in 10 of the 13 cases. In nine patients, changes in EFCS paralleled changes in stroke volume index and the relation between EFCS and stroke volume index was maintained at exercise. After administration of the vasodilator isosorbide dinitrate to 12 patients, repeat exercise radionuclide ventriculography showed an improvement in left ventricular ejection fraction and in eight patients EFCS improved. First pass radionuclide ventriculography can accurately estimate EFCS, which may be an important factor in predicting the likely response to aneurysmectomy. Changes in EFCS on exercise are reflected in changes in total left ventricular ejection fraction and stroke volume index. Isosorbide dinitrate may improve contractile segment function on exercise.
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PMID:Assessment of function of contractile segments in patients with left ventricular aneurysms by quantitative first pass radionuclide ventriculography. Haemodynamic correlation at rest and exercise. 736 6

The effects of intravenous isosorbide dinitrate (ISDN: 3, 6, 9, and 12 mg/h) on systemic and pulmonary vasculature, gas exchange, and dynamic lung compliance were investigated in 7 controlled ventilated patients suffering from ARDS after trauma or in sepsis. Parameters were recorded before and after 20 min. ISDN infusion with 30 min interruption between the different dosage steps. Systemic circulation, heart rate, cardiac index, and stroke index remained grossly unchanged. MPAP was significantly decreased at 6, 9, and 12 mg/h ISDN to 61,7%, 61%, and 69,3% of initial value, as well as PCWP to 49,6% 45,5% and 41,5% of initial value. The drop of RVSWI at 6 and 9 mg/h ISDN to 59,1% and 63,2% also was statistically significant. There was an increase in Qs/Qt, AaDO2, and dynClung, though the increases were not statistically significant. O2availability remained unchanged. Administration of ISDN in ARDS causes an improvement in right ventricular function due to a reduction of pre- and afterload as well as intrapulmonary blood volume. In a similar manner increasing lung compliance may be explained by volume shif. The slight alterations of ventilation-perfusion-ratio as seen by increases in Qs/Qt and AaDO2 can be tolerated because of the unchanged O2availability.
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PMID:[Influence of isosorbide dinitrate on haemodynamics and gas exchange in acute respiratory distress syndrome (author's transl)]. 745 99

We compared the acute hemodynamic effects of captopril and nitrates in 11 patients with severe congestive heart failure and grade IV cardiac disability. Pressures were measured using a Swan-Ganz catheter system; cardiac output and stroke index were measured by thermodilution, and left-ventricular (LV) volumes and ejection fraction were calculated simultaneously with the hemodynamic measurements from radionuclide ventriculography. Measurements were made in each of 4 treatment states: control, sublingual isosorbide dinitrate (ISDN; 5 and 15 mg), oral captopril (50-200 mg daily) and during combined therapy with captopril and ISDN. Captopril produced a fall in mean arterial pressure (p < 0.01) from 81 +/- 14 to 72 +/- 13 mm Hg and a rise in stroke index from 30 +/- 5 to 35 +/- 91/min/m2 (p < 0.05), while LV ejection fraction increased from 18 +/- 5 to 21 +/- 7% (p < 0.05). ISDN reduced mean arterial, pulmonary arterial, right-atrial and wedge pressure. The combination of captopril and ISDN produced a greater fall in mean arterial pressure, a further rise in ejection fraction to 22 +/- 8% (p < 0.05), a fall in systemic (p < 0.05) and pulmonary vascular resistance (p < 0.01) and a rise in cardiac (p < 0.01) and stroke work index (p < 0.01), while the beneficial effects of ISDN on right-atrial, pulmonary arterial and wedge pressure were again achieved. LV contractility, assessed from end-systolic stress-shortening relations, was essentially unaltered or decreased very slightly. The study showed that combined therapy with captopril and nitrates produced acute hemodynamic benefits superior to those achieved by treatment with captopril or nitrates alone.
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PMID:[The benefit of combined therapy with captopril and nitrates in severe congestive heart failure]. 808 24

Irreversible poor pulmonary venous compliance (PV comp) could worsened natural course of patients (pts) with high pulmonary capillary wedge pressure especially pts with mitral stenosis. Nitrates (isosorbide dinitrate-ISDN) possessing venous dilating action could increase PV comp in most of pts. The main aim of that study was to assess hemodynamic effects of ISDN, in pts with MS, with special emphasis on PV com changes. PV comp was estimated according to Hirakawa equation (dV/dp = 0.4*k2*SV/(v-d) in 35 pts with MS, during preoperative right heart catheterisation with VYGON 5155-180 thermodilution catheters during rest and effort in supine position (25W). The same protocol was performed after Iso-Mack sprawy 3.75 mg. According to the PV comp response to ISDN, pts were divided in two groups: good responders (I)-15% and higher increase in PV comp and poor responders (II). ISDN increased PV comp in the whole group according to the response to ISDN, there were significant differences in stroke volume index (SVI) and heart rate (HR). In the group of good responders mean right atrial pressure (RA), mean pulmonary artery pressure (PAP), mean pulmonary wedge pressure (PWP) decreased significantly with simultaneous slight not significant decrease in SVI and not significant increase of HR. In the group of poor responders SVI decreased significantly by about 20% with significant increase of HR. In conclusion significant decrease in pulmonary pressures (PAP, PWP) in pts with good response to ISDN are secondary to the increase of PV comp, while among poor responders the same effects are due to diminished flow secondary to the decrease of the systemic venous return.
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PMID:[Effect of isosorbide dinitrate on pulmonary venous compliance]. 814 53

Irreversible poor pulmonary venous compliance can worsen the natural course of patients with high pulmonary capillary wedge pressure, especially those with mitral stenosis, but nitrates (isosorbide dinitrate--ISDN), which have venodilatory properties, could increase this compliance in most patients. The aim of this study was to assess the hemodynamic effects of ISDN in patients with mitral stenosis, with special emphasis on the pulmonary venous compliance. Pulmonary venous compliance was estimated according to the Hirakawa equation (dV/dp = 0.4 x k2 x sV/(v-d)) in 39 patients with mitral stenosis during preoperative right heart catheterization with Vygon 5155-180 thermodilution catheters at rest and during exercise (25 W) in the supine position. This procedure was repeated after the application of 3.75 mg of Iso-Mack spray. Overall, ISDN increased pulmonary venous compliance significantly both at rest and during exercise (6.0 to 7.5 ml/mmHg and 6.0 to 7.6 ml/mmHg, respectively). The patients were divided into two groups according to their level of ISDN response; those with a good response of an increase of 15% or more in pulmonary venous compliance (Group I), and those with an increase of less than 15% (Group II). There were significant differences between these two groups in stroke volume index and heart rate. In Group I, while the mean right atrial pressure, mean pulmonary artery pressure and mean pulmonary wedge pressure all decreased significantly, there was a simultaneous insignificant decrease in the stroke volume index and an also insignificant increase in the heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Influence of isosorbide dinitrate (ISDN) on compliance of the pulmonary venous system. 826 Nov 58

We studied knowledge transfer for the determination of the suitability of stroke patients for a specialist surgical procedure (split anterior tibial tendon transfer). Gait analysis data from patients at a general hospital were discussed with an expert in another country using personal computers, an ISDN connection (128 kbit/s) and TCP/IP-based communication tools. The key issue was whether the staff in the general hospital became better able to determine suitability for surgery. Twelve patients were studied. In three of the first four cases the advice of the remote expert changed the plan for surgery. After that the treatment plans did not change after consultation. After eight cases the local clinicians did not need to ask for further advice. There was a rapid increase in skill in determining suitability for surgery. The experience and skills of the local clinicians were thought to increase more rapidly than would have been the case without the consultations with a remote expert.
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PMID:A feasibility study of remote consultation to determine suitability for surgery in stroke rehabilitation. 1506 48

We conducted a pilot telerehabilitation study with post-stroke patients with arm motor impairment. We compared the degree of satisfaction of patients undergoing a virtual reality (VR) therapy programme at home (Tele-VR group) to satisfaction experienced by those undergoing the same VR therapy in a hospital setting (VR-group). The rehabilitation equipment used a 3D motion tracking system to create a virtual environment in which the patient's movement was represented. In tele-therapy, the patient equipment was installed in their homes, connected to the hospital by four ISDN lines at a total bandwidth of 512 kbit/s. Rehabilitation data were transmitted via one line and videoconferencing via the other three. Ten patients with mild to intermediate arm motor impairment due to an ischaemic stroke, were randomized into VR or Tele-VR groups. A questionnaire was used at the end of treatment to measure each patient's degree of satisfaction. Tele-VR treated patients showed median values equal to or higher than the VR group patients in all 12 items investigated, except one. In motor performance, the Tele-VR group improved significantly (P < or = 0.05), while the VR group showed no significant change. Patients assigned to the Tele-VR group were able to engage in therapy at home and the videoconferencing system ensured a good relationship between the patient and the physical therapist whose physical proximity was not required.
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PMID:Satisfaction with care in post-stroke patients undergoing a telerehabilitation programme at home. 1863 1


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