RESUMO
Excess mortality and morbidity associated with right bundle branch and left anterior fascicular block were evaluated in 108 patients with block (age 74 +/- 10 years, 69% male) and 108 age- and sex-matched control patients with normal conduction. Clinical characteristics were similar initially except for more congestive heart failure in patients with block. Life table analysis revealed a higher 12 year mortality with block, even after omitting patients with moderate or severe congestive heart failure (risk ratio 1.47, p less than 0.05). Compared with control subjects, the group of patients with block had more sudden death and deaths of unknown cause, but a similar number of noncardiac and diagnosed cardiac deaths. More patients with block developed new second and third degree atrioventricular block or new overt coronary artery disease, but this finding did not support prophylactic pacing in asymptomatic patients. The importance of internal controls in assessing the natural history of clinical and electrocardiographic abnormalities is emphasized.
Assuntos
Bloqueio de Ramo/mortalidade , Adulto , Fatores Etários , Idoso , Arritmias Cardíacas/etiologia , Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/complicações , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores SexuaisRESUMO
A patient with cyanosis in an uncomplicated ostium secundum atrial septal defect without pulmonary hypertension is described. There were no anatomic abnormalities in right-sided cardiac valves or venous return and no evidence of right ventricular hypoplasia or hypertrophy; however, the diastolic pressure curve suggested a decreased compliance. We suggest that this unusual finding may be a result of intrinsically abnormal right ventricular compliance.
Assuntos
Pressão Sanguínea , Cianose/etiologia , Comunicação Interatrial/fisiopatologia , Artéria Pulmonar/fisiopatologia , Adulto , Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Humanos , MasculinoAssuntos
Insuficiência Cardíaca/tratamento farmacológico , Vasodilatadores/uso terapêutico , Captopril/uso terapêutico , Humanos , Hidralazina/uso terapêutico , Dinitrato de Isossorbida/uso terapêutico , Minoxidil/uso terapêutico , Nitroglicerina/uso terapêutico , Nitroprussiato/uso terapêutico , Prazosina/uso terapêuticoAssuntos
Injúria Renal Aguda/induzido quimicamente , Genfibrozila/efeitos adversos , Hiperlipidemias/tratamento farmacológico , Lovastatina/efeitos adversos , Rabdomiólise/induzido quimicamente , Quimioterapia Combinada , Genfibrozila/administração & dosagem , Humanos , Lovastatina/administração & dosagem , Masculino , Pessoa de Meia-IdadeRESUMO
The recently devised therapy for psoriasis and related skin diseases, consisting of long-wave ultraviolet light and oral 8-methoxypsoralen (PUVA), was investigated for its cardiovascular effects. In seventeen patients, long-wave ultraviolet light therapy in a treatment enclosure (mean duration, 19.3 minutes) resulted in ambient temperatures of 39.2 degrees C +/- 2.1 degrees C (SD) and skin temperatures of 38.2 degrees C +/- 1.4 degrees C. In upright subjects, heart rate rose 30.8% to 114.4 +/- 25.2 beats per minute (bpm). Intensive room air conditioning, outside of the treatment enclosure, although significantly lowering skin and ambient temperatures, did not affect the heart rates significantly. PUVA therapy is associated with a definite cardiovascular stress when the box type of therapeutic unit is used. Possible modifications are discussed.