Asunto(s)
Arritmias Cardíacas/tratamiento farmacológico , Hemodinámica/efectos de los fármacos , Lidocaína/farmacología , Infarto del Miocardio/fisiopatología , Procainamida/farmacología , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Electrocardiografía , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Lidocaína/uso terapéutico , Masculino , Persona de Mediana Edad , Procainamida/administración & dosificación , Procainamida/uso terapéutico , Arteria Pulmonar , Factores de Tiempo , Resistencia Vascular/efectos de los fármacosAsunto(s)
Enfermedad Coronaria/prevención & control , Educación y Entrenamiento Físico , Adaptación Fisiológica , Adulto , Presión Sanguínea , Colesterol/sangre , Ensayos Clínicos como Asunto , Pruebas de Función Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Obesidad , Consumo de Oxígeno , Esfuerzo Físico , Aptitud Física , Pruebas Psicológicas , Respiración , Pruebas de Función Respiratoria , Fumar , Triglicéridos/sangreRESUMEN
Controversy attends the extent and temporal sequence of improvements in hemodynamic function resulting from the return of atrial contraction following cardioversion of supraventricular arrhythmias. Thus, mitral, left atrial (LA) and left ventricular (LV) echograms were obtained before and one hour after conversion of supraventricular arrhythmias to normal sinus rhythm by direct current countershock in patients with chronic coronary disease or cardiomyopathies without valvular dysfunction. The duration of the rhythm disturbance varied from one day to five years in 22 patients and was indeterminate in 13. Atrial systole immediately produced prominent mitral "A" waves with anterior valve excursion of 7.5 mm (range 3 to 12) in 33 of the 35 patients (94%). The two patients with atrial electromechanical dissociation reverted to atrial fibrillation within one week. Cardioversion caused a decline in LA diameter (3.5 to 3.2 cm, P less than .001) and a rise in LV end-diastolic dimension (5.2 to 5.5 cm, P less than .001) while LV end-systolic dimension was unchanged (4.2 cm). Thereby stroke volume rose. Heart rate fell an average of 16 beats/min. Depressed cardiac output was improved + 0.84 L/min/m-2. Thus, in the majority of patients with acute or chronic supraventricular arrhythmias without mitral valve disease, cardioversion promptly restores effective atrial contraction, decreases LA size, and results in substantial hemodynamic benefit.
Asunto(s)
Arritmias Cardíacas/terapia , Cardioversión Eléctrica , Atrios Cardíacos/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Ventrículos Cardíacos/fisiopatología , Hemodinámica , Válvula Mitral/fisiopatología , Adulto , Anciano , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Aleteo Atrial/fisiopatología , Aleteo Atrial/terapia , Gasto Cardíaco , Volumen Cardíaco , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Taquicardia Paroxística/fisiopatologíaRESUMEN
To determine the effects of early ambulation on peripheral venous thrombosis in the coronary care unit, 29 patients with acute myocardial infarction had daily 125I-fibrinogen point counting of both legs using a standard portable technique in the first 3 to 7 days after admission. Twenty-one patients underwent early ambulation during the initial 3 days, while 8 remained at complete bed rest for 5 days. Only 2 of 21 early ambulated patients had positive fibrinogen point counts, in contrast to 5 of 8 nonambulated patients (P less than 0.01). With heart failure, only 2 of 9 ambulated patients had positive point counts, compared with 4 of 5 nonambulated patients (P less than 0.05). In 16 patients undergoing venography, point counts were confirmed in 6 positive and 10 negative findings. These results show that the high frequency of peripheral venous thrombosis in immobilized acute myocardial infarction patients, particularly those with heart failure, can be effectively reduced by early ambulation.