RESUMO
Phenytoin was given intravenously in 37 patients with cardiac arrhythmias-21 had acute myocardial infarction and 16 had other conditions. There was a favourable response in 18 of the 21 cases with acute myocardial infarction, with a return to sinus rhythm in six of the nine cases with supraventricular arrhythmias, and a return to sinus rhythm in 10 of the 12 cases of ventricular arrhythmias, the remaining two showing a significant reduction in the number of ventricular extra-systoles.In the second group of 16 cases which had various causes there was a satisfactory response in only six. Digitalis played no part in producing any of the arrhythmias. Phenytoin was used orally for suppressing and preventing abnormal rhythm in five patients, and three of these responded favourably. The number of patients treated orally is too small to draw any definite conclusion.
Assuntos
Arritmias Cardíacas/tratamento farmacológico , Fenitoína/administração & dosagem , Doença Aguda , Adolescente , Adulto , Idoso , Arritmia Sinusal/tratamento farmacológico , Pressão Sanguínea/efeitos dos fármacos , Criança , Pré-Escolar , Eletrocardiografia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Fenitoína/farmacologia , Fibrilação Ventricular/tratamento farmacológicoRESUMO
In all, 611 patients were admitted to the coronary care unit during the first 16 months. The diagnosis of acute myocardial infarction was confirmed in 461 (73.4%) of these patients and the results of treatment are shown. The hospital mortality was 19.1 per cent. Eighteen patients, who would have died without resuscitation, survived and left hospital. Ventricular fibrillation occurred in 41 (8.9%) patients, early resuscitation was successful in 23, and 14 left hospital. Asystole was the cause of cardiac arrest in 31 (6.7%) patients, most of whom had extensive heart muscle damage and failure. Resuscitation was unusual in these patients. Complete heart block occurred in 31 (6.7%) patients and all were electrically paced. Sixteen returned to sinus rhythm and 14 left hospital. No patients required long-term pacing after acute myocardial infarction. Ventricular tachycardia occurred in 45 (9.7%) patients and this arrhythmia carried a high mortality (46.6%). Our results appear to be comparable with those of most other units, many of which are considerably more elaborate in design and more heavily staffed. There are disadvantages to siting a coronary care unit in a general ward and, though good results can be achieved in a unit of this type, we think it desirable that separate accommodation should be found whenever possible. This has now been done at Dudley Road Hospital.
Assuntos
Institutos de Cardiologia , Hospitais Especializados , Adulto , Idoso , Inglaterra , Feminino , Hospitais com menos de 100 Leitos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapiaRESUMO
The rate of removal of a standard dose of 25 mg indocyanine green was studied in 67 patients at the bedside using dichromatic ear densitometry. The determination of the percentage disappearance rate per minute and the half life of the dye permitted separation of patients into three groups: those with normal liver function, those with liver damage, and a group taking opiates (9), anticonvulsants (8), phenylbutazone (2), haloperidol (1), and nitrofurantoin (1). The last group showed enhanced clearance of indocyanine green from the circulation.
Assuntos
Tratamento Farmacológico , Verde de Indocianina/metabolismo , Fígado/metabolismo , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Densitometria , Orelha Externa , Feminino , Meia-Vida , Haloperidol/uso terapêutico , Hepatite/metabolismo , Heroína , Humanos , Cirrose Hepática/metabolismo , Masculino , Meperidina , Pessoa de Meia-Idade , Morfina , Nitrofurantoína/uso terapêutico , Fenilbutazona/uso terapêutico , Estimulação QuímicaRESUMO
Glucagon was administered to six patients with acute myocardial infarction. Three of them had cardiogenic shock syndrome. Glucagon produced a positive inotropic response in all cases, which resulted in a significant rise in blood pressure, with only slight chronotropic effect. No arrhythmias were induced, and all patients with cardiogenic shock improved temporarily. Further evaluation of glucagon in shock syndrome to determine the dose and method of administration is required.