RESUMO
BACKGROUND: Circadian patterns of onset favoring the morning hours have been demonstrated for many cardiovascular disorders. Although much is known about cardiogenic acute pulmonary edema (CAPE), the relationship between time of day and CAPE episode onset has not been previously studied. METHODS: We examined 154 consecutive episodes of CAPE treated at an urban community hospital to determine whether circadian patterns existed in the time these episodes began. RESULTS: For all episodes, a significant circadian pattern existed, with peak onset between 6:00 and 11:59 A.M. (p < 0.01). When CAPE episodes were analyzed by the most probable precipitant of pulmonary edema, only the pattern for patients with progressive symptoms, showing a peak in the 6:00 and 11:59 A.M. interval, was statistically significant (p < 0.01). Although a similar trend existed for CAPE occurring in association with acute myocardial infarction, the pattern fell short of statistical significance (p = 0.09). CONCLUSIONS: These data suggest that circadian patterns favoring the morning hours exist for episodes of CAPE, and that patterns may vary depending on the precipitant of the episode.
Assuntos
Ritmo Circadiano , Cardiopatias/complicações , Edema Pulmonar/etiologia , Doença Aguda , Idoso , Feminino , Humanos , MasculinoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Bacteriemia/diagnóstico , Endocardite Bacteriana/diagnóstico , Infecções por Salmonella/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Cocaína , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella/classificação , Salmonella/isolamento & purificação , Infecções por Salmonella/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/complicações , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
Thrombolytic therapy was administered to a 49-year-old woman with an acute anterior wall myocardial infarction after having prolonged cardiopulmonary resuscitation for 13 minutes. On admission, there was no clinical or radiographic evidence of gross trauma. There was no significant morbidity and the patient recovered to a completely functional status. The literature of thrombolytic therapy after cardiopulmonary resuscitation is reviewed. In the absence of gross trauma from cardiopulmonary resuscitation, thrombolytic therapy in acute myocardial infarction should not necessarily be excluded because of the duration of resuscitation. Further experience with such patients will shed additional light on efficacy and safety.
