Eye Care: Prenatal to Postmortem

An analysis of clinical and hemodynamic findings in 20 patients with septic shock showed good correlation between survival and initial cardiac index. Clinical signs did not correlate with measured hemodynamics and were not helpful in predicting outcome. Although underlying disease had a significant hemodynamic effect, the sepsis itself accounted for many of the unusual features.     

Effects of closed-chest cardiac massage on intracranial pressure.

Closed-chest cardiac massage results in a marked increase in intrathoracic pressure and unusual patterns of blood flow. Among the physiological consequences of these changes appears to be a marked increase in intracranial pressure associated with chest compression as documented by the following patient case studies. While temporary, the marked nature of this rise in intracranial pressure suggests that the technique of closed-chest massage may, in itself, be responsible for clinically significant alterations in cerebral hemodynamics.     

An unusual mediastinal lipoma simulating cardiomegaly.

A patient with vague, nonspecific symptoms was initially thought to have an enlarged cardiac silhouette on chest roentgenogram, and a primary intracardiac disorder was suspected. At surgery, a mediastinal lipoma was diagnosed and excised. The roentgenographic appearance represents an unusual presentation of a mediastinal tumor.     

Pericarditis associated with ulcerative colitis and Crohn's disease.

Extracolonic manifestations of inflammatory bowel disease are common and diverse. However, cardiac complications are unusual and we therefore wish to report two cases in which pericarditis occurred. The first was a patient with Crohn's disease of the colon, in whom the pericarditis developed postoperatively. In the second case an acute pericarditis came on simultaneously with the initial presentation of ulcerative colitis.     

Multisystem organ failure secondary to Haemophilus parainfluenzae infective endocarditis on an ICD lead: A case report

Infection of implanted cardiac devices (ICD) is an unusual but life threatening event, rarely caused by Haemophilus parainfluenzae. While clinical presentation varies widely, infective endocarditis (IE) involving an ICD lead requires aggressive resuscitation and a multidisciplinary approach. We present a case of a 33-year-old intravenous drug user who presented in multisystem organ failure secondary to infective endocarditis on an ICD lead. This patient had a complicated hospital course requiring removal of her ICD, highlighting the dramatic presentation of this clinical state.     

The clinical features of immunoglobulin light-chain (AL) amyloidosis with heart involvement

We reviewed clinical presentation, investigations, therapy, prognosis and outcome of 232 patients with primary (AL) cardiac amyloidosis. There were 142 men and 90 women. Median age at presentation was 59 years (range 29-85). AL heart disease was unusual both in patients under the age of 40 (3.0%) and in non-Caucasians (6.5%). Fatigue and weakness were the commonest presenting symptoms. Hallmark features of periorbital ecchymoses and macroglossia were present in 12.5% and 27.2%, respectively. AL cardiac amyloidosis was unusual in isolation (3.9%), and most frequently patients had features of multiorgan dysfunction; heavy proteinuria and features of malabsorption predominating in this respect. Heart involvement represents the worst prognostic indicator, with a median survival from diagnosis of 1.08 years, falling to 0.75 years with the onset of heart failure. Current therapeutic procedures appear to prolong survival, with left ventricular wall thickness, mass and ejection fraction on echocardiography and late potentials on signal averaged electrocardiography of use in prognostic stratification. Cardiac involvement from AL amyloidosis is rapidly fatal. It should be suspected in all patients with heart failure who have wall thickening on echo, normal chamber sizes, low EKG voltages and evidence suggesting a multisystem disease.      

Thyroid storm and ventricular tachycardia

A 34-year-old woman was brought to our emergency department because of sudden loss of consciousness. Ventricular tachycardia and fibrillation were noted on electrocardiographic monitoring and reverted to sinus rhythm after repeated defibrillation. She was treated as a case of thyroid storm. Although tachycardia and fever normalized after 2 days, she remained comatose and died. This is an unusual case because the patient's initial presentation was cardiac arrest without previous history of cardiac disease. To our knowledge, this is the first reported case where ventricular tachyarrhythmia was the initial presenting sign of thyroid storm.     

Multiple organ failure and coma as initial presentation of pheochromocytoma in a patient with multiple endocrine neoplasia (MEN) type II A

The unusual case of a 65-year-old woman with intermittent hypotension, fever, pulmonary edema and coma as initial presentation of pheochromocytoma is reported. The patient developed respiratory, cardiac and renal failure, disseminated intravascular coagulation and liver dysfunction. She, had to be defibrillated on multiple occasions, occurring in periods of severe hypertension. After successful surgical removal of a pheochromocytoma a thyroid medullary carcinoma was detected. Several members of the patients family had presented with multiple endocrine neoplasia (MEN II).     

肝外梗阻性黄疸的血液动力学研究

应用彩色多普勒血流声像仪对２１例肝外梗阻性黄疸患者的血液动力学进行定量测定，并与２３例正常人对比。结果发现，肝外梗阻性黄疸患者ＣＩ及ＣＯ下降，差异有显著性意义；ＥＦ有下降趋势。因此，对黄疸患者手术时应注意保护心功能，有条件时观察血液动力学变化     

Metastatic melanoma of the left ventricle: Cardiac imaging in the diagnosis and surgical approach

A mass lesion occupying the left ventricle was noted on a screening CT scan in a 42-year-old man with a history of malignant melanoma. Subsequent echocardiography and cardiac MR imaging provided further hemodynamic and anatomic characterization of the lesion. These studies were also essential in guiding the proper surgical approach to allow extensive resection of the large mass without disrupting cardiac structures and function. The unique clinical aspects of this case are the unusual location for a lone cardiac metastasis of melanoma and the asymptomatic presentation despite the large size of the tumor and its apparent obstruction of ventricular outflow. The clinical and imaging features of this patients threatening cardiac lesion are presented.     

Direct monitoring pressure overload predicts cardiac hypertrophy in mice

Pressure overload (POL) is a classical model for studying cardiac hypertrophy, but there has been no direct measure of hemodynamics in a conscious ambulatory mouse model of POL. We used abdominal aortic constriction to produce POL and radiotelemetry to measure the blood pressure and heart rate for three weeks. The cardiac size correlated with the systolic pressure in the last week is better than other hemodynamic parameters. Cardiac fibrosis was more correlated to the cardiac size than to the systolic pressure. The expression of the cardiac genes that are typically associated with cardiac hypertrophy was correlated with both cardiac size and systolic pressure. In conclusion, the systolic pressure is the major determinant of cardiac hypertrophy in the murine POL model. In contrast, cardiac fibrosis shows the influence of other factors besides systolic pressure. The combination of the POL model with continuous direct measurements of hemodynamics represents a significant technological advance and will lead to an extended usefulness of POL methodologically.     

心脏瓣膜置换术围手术期处理

目的　探讨心脏瓣膜置换术围手术期血流动力学变化及其手术处理方法。方法　选取 4 3例重症心脏瓣膜病患者 ,均为风湿性二尖瓣和 /或主动脉瓣病变 ,分别行单瓣或双瓣置换术。围手术期采用Swan Ganz四腔气囊漂浮导管监测中心静脉压、右房压、肺动脉压、肺毛细血管楔压 ,并计算心排血量、心脏指数和周围血管阻力。结果　 4 3例患者均安全度过围手术期 ,无早期死亡。结论　对重症心脏瓣膜病 ,维持血流动力学稳定和有效的心肌保护是围术期管理的关键。     

A case of thoracic aortic dissection presenting as lateral pleuritic chest pain

An unusual presentation of thoracic aortic dissection in a 73 year old man is described. He was admitted to hospital with severe left sided pleuritic chest pain. Examination on admission was normal apart from minor tenderness on palpation of the left lower chest wall. Chest x ray showed cardiomegaly with right lung shadowing, and ventilation/perfusion scan was negative. Spiral computed tomography done on the fourth day showed a false lumen on the ascending aorta. He underwent surgery but deteriorated postoperatively because of intrathoracic bleeding and developed cardiac tamponade from which resuscitation was not possible.     

二维彩色多普勒超声对心脏间隔膨胀瘤的诊断分析

目的：探讨各种原因所致心脏间隔膨胀瘤的超声特征。方法：应用二维彩色多普勒分析45例心脏间隔膨胀瘤形成病因、发生部位、膨胀瘤与心脏血流动力学之间的相互关系。结果：房间隔膨胀瘤及室间隔膜部膨胀瘤多为先天性间隔发育薄弱所致，室间隔肌部膨胀瘤多因心肌梗死导致。结论：膨胀瘤的大小与间隔发育情况、心肌梗死范围有关；膨胀瘤的破裂与瘤壁厚薄及心脏血流动力学有关。     

成人行心脏手术病人导尿时机的选择和探讨

目的观察优化导尿时机在成人心脏手术中对血流动力学的影响。方法选择23例成人择期心脏手术病人,随机分为2组。采用相同麻醉方式,A组(常规导尿组):麻醉诱导气管插管后行常规导尿。B组(选择时机导尿组):在麻醉诱导后病人意识丧失、睫毛反射消失,而此时尚不具备气管插管条件时导尿。监测心率、心律、桡动脉压(ASP)、中心静脉压(CVP),并连续记录诱导前(1时点)、意识丧失(2时点)、意识丧失后1 min(3时点;此时为B组导尿时刻)、气管插管即刻(4时点)、气管插管后1 min(5时点;此时为A组导尿时刻)5个时点血流动力学指标。结果所有病人无导尿相关不良反应。两组麻醉诱导后血压、心率下降,与A组相比,B组在3时点血压、心率恢复,在5时点无血压、心率过高。结论优化导尿时机选择麻醉诱导用药使病人意识丧失、睫毛反射消失时进行导尿,病人血流动力学更平稳,手术更安全。     

血液透析纠正慢性肾功能衰竭合并心力衰竭的血流动力学机制探讨

目的 探讨血液透析治疗对慢性肾功能衰竭合并心力衰竭患者血流动力学改变的影响。方法 应用血液循环动力学信息检到仪(CD)对慢性肾功能衰竭合并心力衰竭及无心力衰竭者于血液透析前、透析结束前进行CD检到。结果 血液透析明显降低左室舒张末期容量、每搏血量、左室舒张末期压力、心肌耗氟量、左室有效功率，升高射血分数，心力衰竭组较非心力衰竭组更显著(P均＜0．01)。结论 血液透析有效降低心脏前负荷，增加心肌收缩力，改善心功能，同时也增加心脏后负荷。     

Levosimendan for low cardiac output: a pediatric experience

This was a retrospective observational study in a pediatric intensive care unit, in which 19 patients received levosimendan. There were no adverse events attributable to levosimendan and no instances where the clinical condition worsened after administration. Arterial lactate levels decreased significantly following levosimendan administration during cardiopulmonary bypass for anticipated low cardiac output. In those with established low cardiac output, trends toward improved hemodynamics were seen, with heart rate reduction, an increase in mean blood pressure, a reduction in arterial lactate, and reduced conventional inotrope use. Levosimendan was safely used in a small number of pediatric patients with established low cardiac output state who demonstrated improved hemodynamics and tissue perfusion, with a tendency to reduced conventional inotrope usage, and this warrants its evaluation as an inotrope in the pediatric population.     

Hemodynamics of transcutaneous cardiac pacing

Transcutaneous cardiac pacing has recently been rediscovered as a rapid means of initiating emergency cardiac pacing. Potential myocardial injury from extended transcutaneous pacing could adversely affect cardiac hemodynamics during pacing. This canine study compares the hemodynamics of transcutaneous and transvenous cardiac pacing in animals with induced chronic heart block. One to two weeks following chemical ablation of the His bundle, hemodynamic measurements were made during 60 minutes of transcutaneous and 5-minute periods of conventional right ventricular endocardial pacing. Cardiac index and output were found to increase significantly (P less than 0.005), and systemic vascular resistance was found to decrease significantly (P less than 0.005) from baseline values with both pacing techniques. A hemodynamic difference between pacing techniques was evident only for mean arterial blood pressure; pressure measurements during transvenous pacing were slightly greater than those during transcutaneous cardiac pacing. The hemodynamic measurements were found to be stable during a 60-minute period of transcutaneous cardiac pacing. This study demonstrates that transcutaneous cardiac pacing is as effective hemodynamically as conventional transvenous pacing in animals with induced chronic heart block.     

Efficacy of captopril in the treatment of patients with severe forms of chronic heart failure

A study was made of the efficacy of captopril used alone and in combination with cardiac glycosides in 20 patients with stage IIB congestive heart failure. The patients' clinical status and changes in some indices of hemodynamics and external respiratory function were taken into account. A single use of the drug improved the clinical status and indices of hemodynamics and external respiratory function in the patients. The most noticeable clinical effect was achieved with the combined use of cardiac glycosides, diuretics and captopril.     

应用超声心动图评价妊娠对孕妇心脏功能及血液动力学的影响

本文应用超声心动图测定正常各期孕妇的心脏功能及血液动力学变化。结果表明:妊娠各期血液动力学及心脏功能变化结果与妊娠胎儿发育成长相一致,其特点是心排血量渐增,到妊娠晚期达到最高峰。其机理可能为:和血容量增加、外周阻力降低、心率快、心室扩大、心肌纤维增长变粗及心肌重量增加以及雌激素和孕激素的调节作用有关。