American heart journal
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American heart journal · Feb 1996
Comparative StudyImproved detection of cardiac contusion with cardiac troponin I.
Detecting cardiac injury in patients with chest trauma is difficult because the level of the MB isoenzyme of creatine kinase (MBCK) can be elevated from skeletal muscle injury alone. However, the level of cardiac troponin I (cTnl) is not elevated by skeletal muscle injury. To determine whether its measurement would improve the ability to detect cardiac injury in patients with blunt chest trauma, 44 patients were studied. ⋯ Twenty-six of the 37 patients without contusion had elevations of MBCK; none had elevations of cTnl. The ratio of MBCK to total creatine kinase improved specificity at the expense of sensitivity. Measurement of cTnl accurately detects cardiac injury in patients with blunt chest trauma and should facilitate the diagnosis and management of such patients.
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American heart journal · Feb 1996
Comparative StudyLast-minute preoperative cardiology consultations: epidemiology and impact.
To identify clinical predictors of last-minute preoperative cardiology consultations and to evaluate the impact of these consultations on patient care, we performed a retrospective case-control study including all 166 patients who received unscheduled cardiology consultations at the preadmission testing center (PATC) of an urban teaching hospital. Control subjects were 166 patients matched by date and category of surgical procedure. ⋯ Thus among patients undergoing elective noncardiac surgery, last-minute preoperative consultations are common and are usually precipitated by an abnormal electrocardiogram or history of cardiovascular disease. Last-minute consultations may be preventable if those patients with risk factors for consultation are identified in advance of the preadmission evaluation and referred for elective consultation.
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American heart journal · Jan 1996
Influence of left atrial function on Doppler transmitral and pulmonary venous flow patterns in dilated and hypertrophic cardiomyopathy: evaluation of left atrial appendage function by transesophageal echocardiography.
Information regarding the relation of left atrial (LA) function to transmitral and pulmonary venous (PV) flow is limited. Using transesophageal echocardiography, we analyzed this relation in 23 patients with dilated cardiomyopathy (DCM) and 25 patients with hypertrophic cardiomyopathy (HCM). Left atrial appendage (LAA) function was assessed as a substitute for overall LA function. ⋯ In addition, the reverse flow velocity at atrial contraction in the PV was lower in the DCM group than in the HCM group (19 +/- 8 cm/sec vs 37 +/- 8 cm/sec; p < 0.01). These findings were associated with poorer LA systolic function in the DCM group (LAA-A, 35 +/- 13 cm/sec vs 60 +/- 11 cm/sec; LAA-EF, 37% +/- 12% vs 55% +/- 15%, p < 0.05, respectively). Our data suggest that a restrictive transmitral flow pattern develops more easily in DCM than in HCM because LA dysfunction is present in DCM, and that LA contractility plays an important role in determining the atrial contraction wave of transmitral and PV flows with elevated LA pressure.
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American heart journal · Jan 1996
Clinical spectrum, therapeutic management, and follow-up of ventricular tachycardia in infants and young children.
We reviewed 40 infants and young children with VT. Median maximum VT rate was 214 beats/min (range 152 to 375 beats/min). A cause was defined in 20 (50%), the most common being cardiomyopathy or myocarditis in 8 (20%). ⋯ At follow-up, 31 (91%) of 34 survivors did not have VT. The presence of symptoms was a predictor of death related to VT. The outlook for asymptomatic patients and those who survived more than 6 months after diagnosis and who do not have progressive myocardial disease appears good.