RESUMO
Amrinone, a new inotropic agent, was used to treat 24 patients with chronic congestive heart failure who were classified as clinically stable and who were in New York Heart Association's classes II and III. Patients were treated for up to 30 months (mean, 12.5 months). Exercise tolerance improved in 20 patients, but only eight experienced significant improvement in symptoms of fatigue, dyspnea, and orthopnea and only nine tolerated the drug without apparent side effects. Eight were unable to continue amrinone therapy because of limiting side effects. The most significant adverse effects were cardiac arrhythmias, thrombocytopenia, abnormal results of liver function tests, diarrhea, fever, and nausea. Amrinone has a narrow therapeutic-toxic ratio, but a significant proportion (42%) of patients tolerate and benefit from amrinone therapy.
Assuntos
Aminopiridinas/uso terapêutico , Cardiotônicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Adulto , Idoso , Aminopiridinas/efeitos adversos , Amrinona , Arritmias Cardíacas/induzido quimicamente , Cardiotônicos/efeitos adversos , Doença Crônica , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Volume SistólicoAssuntos
Doença das Coronárias/diagnóstico , Dor/etiologia , Tórax , Teste de Esforço , Humanos , NitroglicerinaRESUMO
To evaluate the relationship of results of maximal treadmill testing and results of saphenous vein bypass surgery (SVG), 30 patients underwent a maximal treadmill test before and after SVG; an additional 39 had results of postoperative exercise testing available. These patients were part of a group of 91 patients (95% of 96 survivors) who had complete right- and left-heart catheterizations and coronary angiography before and after operation. Twenty-one per cent had improved ejection fractions postoperatively; in 32% ejection fractions were worse. Duration of maximal treadmill exercise correlated poorly with ejection fraction changes or graft patency. Rate-pressure product (RPP) was usually lower postoperatively in patients with worse ejection fractions, primarily because of a low systolic blood pressure at maximum exercise. RPP postoperatively of less than 25,000 almost always meant poor surgical results, either graft occlusion or poor left ventricular function, while RPP of more than 30,000 meant that left ventricular function was preserved and all grafts or the graft to the anterior descending were patent. Thus, success or failure of SVG in these groups may be predicted without postoperative catheterization. An open graft to the anterior descending coronary generally insured a high RPP with exercise, even if other grafts were closed, as long as ventricular function remained good.
Assuntos
Ponte de Artéria Coronária , Teste de Esforço , Coração/fisiopatologia , Hemodinâmica , Angina Pectoris , Pressão Sanguínea , Doença das Coronárias/fisiopatologia , Estudos de Avaliação como Assunto , Frequência Cardíaca , HumanosRESUMO
Six patients with aortic regurgitation secondary to flail aortic valve leaflet syndrome were studied echocardiographically, angiographically, surgically, and pathologically. The etiology of flail aortic leaflet was myxomatous degeneration in four patients and bacterial endocarditis in two. The echocardiographic manifestations of flail aortic valve leaflet are diastolic fluttering of the aortic cusp echoes, abnormal systolic aortic leaflet movement, and abnormal diastolic fluttering echoes in the left ventricular outflow tract. Diastolic fluttering of the aortic valve leaflets is specific echocardiographic evidence of aortic regurgitation due to flail aortic leaflets, and demonstration of diastolic fluttering of the aortic leaflets and diastolic fluttering echoes in the left ventricular outflow tracts is direct evidence of flail and prolapsed aortic leaflets.