Assuntos
Dispneia/etiologia , Insuficiência Cardíaca/complicações , Postura/fisiologia , Feminino , Humanos , MasculinoAssuntos
Benzimidazóis/administração & dosagem , Circulação Cerebrovascular/efeitos dos fármacos , Cognição/efeitos dos fármacos , Disfunção Cognitiva/tratamento farmacológico , Hipertensão/tratamento farmacológico , Fluxo Sanguíneo Regional/fisiologia , Tetrazóis/administração & dosagem , Feminino , Humanos , MasculinoRESUMO
Myocardial injury caused by blunt chest trauma has been recognized with increased frequency over the past 2 decades. Increased awareness by physicians and the increased use of various clinical and laboratory diagnostic modalities have contributed to this recognition. Injuries range from inconsequential to catastrophic and can affect any or all areas of the heart: pericardium, myocardium, coronary arteries and veins, chordae, papillary muscles, valves, and great vessels. In addition to the medical importance of the diagnosis, substantial forensic implications have been known to arise. It is important to assess and classify properly the extent of the trauma and its prognostication as to the possibility of residual sequelae. A proposed classification is presented that has both medical and legal application. The uses of stages 0 (suspect), I (mild), II (moderate), III (severe), and IV (catastrophic) are illustrated in detail.
Assuntos
Contusões/classificação , Medicina Legal/normas , Traumatismos Cardíacos/classificação , Miocárdio/patologia , Terminologia como Assunto , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Contusões/diagnóstico , Contusões/etiologia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Humanos , Prognóstico , Índice de Gravidade de Doença , Ferimentos não Penetrantes/patologiaRESUMO
A patient with a painless, extensive anterolateral myocardial infarct, which occurred during a prolonged bout of refractory asthma, is presented. Cardiac catheterization revealed a large akinetic area involving the septum and anterolateral walls and completely normal coronary arteries. The etiology of the infarct was believed to be intense coronary vasospasm occurring during the lengthy period of status asthmaticus.
Assuntos
Infarto do Miocárdio/etiologia , Estado Asmático/complicações , Idoso , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/etiologia , Eletrocardiografia , Feminino , Humanos , Infarto do Miocárdio/diagnósticoRESUMO
One hundred fifty-two consecutive patients with a known or suspected diagnosis of atherosclerotic coronary artery disease were administered 5 mg sublingual isosorbide dinitrate 2 hours and (1/2) hour preoperatively and every 4 hours postoperatively for 3 days, for the prevention of cardiovascular morbidity and mortality, which could result from various noncardiac surgical procedures; 125 patients received general anesthesia. Cardiovascular complications occurred in 3 patients (1.9%). Two patients did not enter the study, owing to side effects of the medication (1.3%). The complications were 1 each (0.6%) of the following: atrial fibrillation, hypotension, and cardiac arrest. Mortality was 0%. These results are exceptionally favorable when compared to the average cardiovascular morbidity rate of 2.8% to 49% in patients assigned to various risk stratifications in the medical literature.
Assuntos
Doença da Artéria Coronariana/cirurgia , Cardiopatias/prevenção & controle , Dinitrato de Isossorbida/administração & dosagem , Assistência Perioperatória , Complicações Pós-Operatórias , Vasodilatadores/administração & dosagem , Administração Sublingual , Adulto , Idoso , Doença da Artéria Coronariana/complicações , Feminino , Cardiopatias/etiologia , Cardiopatias/mortalidade , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Although aminophylline/theophylline has been relegated to third- and fourth-line status in the cardiopulmonary armamentarium, its use in specific pathophysiologic states, especially those of cardiac etiology, can be of significant benefit. The consulting clinician should maintain an awareness of its potential as adjunctive therapy in cases of atrioventricular block, cardiac arrest, heart failure, and bradyarrhythmias in particular. It should not yet be shelved as an archaic agent.