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Diastolic Pressure (diastolic + pressure)

Distribution by Scientific Domains

Medical Sciences	84%
Life Sciences	15%

Distribution within Medical Sciences

Cardiovascular Disease	30%
Pediatrics	11%

Selected Abstracts

Losartan decreases vasopressin-mediated cAMP accumulation in the thick ascending limb of the loop of Henle in rats with congestive heart failure

ACTA PHYSIOLOGICA, Issue 4 2007
M. Torp
Abstract Introduction:, Vasopressin (AVP) stimulates sodium reabsorption and Na,K,2Cl-cotransporter (NKCC2) protein level in the thick ascending limb (TAL) of Henle's loop in rats. Rats with congestive heart failure (CHF) have increased protein level of NKCC2, which can be normalized by angiotensin II receptor type-1 (AT1) blockade with losartan. Aim:, In this study, we investigated whether CHF rats displayed changes in AVP stimulated cAMP formation in the TAL and examined the role of AT1 receptor blockade on this system. Method:, CHF was induced by ligation of the left anterior descending coronary artery (LAD). SHAM-operated rats were used as controls. Half of the rats were treated with losartan (10 mg kg day,1 i.p.). Results:, CHF rats were characterized by increased left ventricular end diastolic pressure. Measurement of cAMP in isolated outer medullary TAL showed that both basal and AVP (10,6 m) stimulated cAMP levels were significantly increased in CHF rats (25.52 ± 4.49 pmol cAMP ,g,1 protein, P < 0.05) compared to Sham rats (8.13 ± 1.14 pmol cAMP ,g,1 protein), P < 0.05). Losartan significantly reduced the basal level of cAMP in CHF rats (CHF: 12.56 ± 1.93 fmol ,g,1 protein vs. Los-CHF: 7.49 ± 1.08, P < 0.05), but not in Sham rats (SHAM: 4.66 ± 0.59 vs. Los-SHAM: 4.75 ± 0.71). AVP-mediated cAMP accumulation was absent in both groups treated with losartan (Los-SHAM: 4.75 ± 0.71 and Los-CHF: 7.49 ± 1.08). Conclusion:, The results indicate that the increased NKCC2 protein level in the mTAL from CHF rats is associated with increased cAMP accumulation in this segment. Furthermore, the finding that AT1 receptor blockade prevents AVP-mediated cAMP accumulation in both SHAM and CHF rats suggests an interaction between angiotensin II and AVP in regulation of mTAL Na reabsorption. [source]

Validity of Revised Doppler Echocardiographic Algorithms and Composite Clinical and Angiographic Data in Diagnosis of Diastolic Dysfunction

ECHOCARDIOGRAPHY, Issue 10 2006
Kofo O. Ogunyankin M.D.
Background: Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization. Method: Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications. Result: The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg. Conclusion: Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods. [source]

Arterial structural and functional alterations in uraemia

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2005
A. P. Guérin
Abstract Epidemiological and clinical studies have shown that cardiovascular disease in patients with end-stage renal disease (ESRD) is frequently related to damage of large conduit arteries. Arterial disease is responsible for the high incidence of ischaemic heart disease, peripheral artery diseases, left ventricular hypertrophy and congestive heart failure. The vascular complications in ESRD are ascribed to two different but associated mechanisms, namely atherosclerosis and arteriosclerosis. Whereas the former principally affects the conduit function with ischaemic lesions being the most characteristic consequence, the latter primarily disturbs the dampening function of large arteries. Arteriosclerosis in ESRD patients is characterized by diffuse dilation and wall hypertrophy of large conduit arteries and stiffening of arterial walls. These changes represent a clinical form of an accelerated ageing process. The main clinical characteristics due to arterial stiffening are isolated increase in systolic blood pressure with normal or lower diastolic pressure resulting in an increased pulse pressure. The consequences of these alterations are: (i) an increased left ventricular afterload with development of left ventricular hypertrophy and increased myocardial oxygen demand; and (ii) altered coronary perfusion and subendocardial blood flow distribution. Epidemiological studies have identified arterial remodelling and stiffening as independent predictors of overall and cardiac mortality in ESRD patients. [source]

Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: VI.

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2005
Maubin in Myanmar
Background: The objective of the present study is to compare the findings of comprehensive geriatric assessments of community-dwelling elderly in Maubin township, Myanmar with those in Japan. Methods: A cross-sectional, study was undertaken of community-dwelling people aged 60 years and over who were living in downtown Maubin and two rural villages near Maubin city, and 411 people aged 65 years and over who were living in Sonobe, Kyoto, Japan. They were examined using a common comprehensive geriatric assessment tool, which included interviews regarding activities of daily living (ADL), medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale. Anthropometric, neurobehavioral and blood chemical examinations were also conducted. Using anova and Post Hoc Scheffe's F -test, findings from the three groups were compared. Results: Scores of basic ADL, instrumental self-maintenance, intellectual activities, social roles, QOL, Tokyo Metropolitan Institute of Gerontology Index of Competence, body mass index, total cholesterol levels, blood hemoglobin levels and HDL levels were lower in Myanmar's elderly subjects than in Japanese ones. There was no significant difference in prevalence of depression. Mean blood pressure measurements and rates of subjects with systolic pressure > 140 mmHg or diastolic pressure > 90 mmHg and prevalence of stroke were higher in downtown Maubin than in Japan. The atherogenic index was higher in Myanmar's elderly than in Japanese. Conclusion: In Myanmar subjects had lower ADL and QOL scores than Japanese elderly. Of particular note is the higher prevalence of anemia and subjects with history of stroke in Myanmar than in Japan. Further study is needed to detect the cause of high prevalence of stroke in Myanmar. [source]

Your Drug, My Drug, or Our Drugs: How Aggressive Should We Be With Antihypertensive Therapy?

JOURNAL OF CLINICAL HYPERTENSION, Issue 2005
Joseph L. Izzo Jr. MD
In the prevention of hypertensive complications, especially stroke and kidney disease, "lower is better" because for each decrease of 20 mm Hg systolic or 10 mm Hg diastolic pressure in the population, cardiovascular risk is halved. Ideally, the goal for each patient should be to reach the lowest blood pressure that is well tolerated, a value that may be well below the arbitrary threshold value of 140/90 mm Hg. For the majority of "uncomplicated hypertensives," the question of single-drug therapy is essentially moot, because more than one agent is almost always required to optimally control blood pressure. In individuals who already have heart or kidney disease, there are compelling indications for the use of drugs that block the renin-angiotensin system, but the large outcome studies that spawned these recommendations are themselves combination trials. Thus, in virtually all patients, more than one drug is indicated. The best combinations take advantage of long durations of action and complementary mechanisms of action of the component and are not only able to effectively lower blood pressure, but also to favorably affect the natural history of hypertensive complications. Regimens,including fixed-dose combination products,that combine a thiazide diuretic or calcium antagonist with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are most efficient. In summary, why would an astute clinician (or informed patient) be satisfied with the relatively limited effects of any single class of antihypertensive agents when better overall protection is possible? [source]

Utilization of excimer laser debulking for critical lesions unsuitable for standard renal angioplasty,

LASERS IN SURGERY AND MEDICINE, Issue 9 2009
On Topaz MD
Abstract Background The energy emitted by ultraviolet laser is avidly absorbed in atherosclerotic plaques. Conceptually, it could be applied for debulking of selected atherosclerotic renal artery stenoses. We describe early experience with revascularization of critical renal artery lesions deemed unsuitable for standard renal angioplasty. Institutional Review Board permission to conduct the data analysis was obtained. Methods Among 130 percutaneous renal artery interventions with balloon angioplasty and adjunct stenting, there were 12 (9%) patients who underwent laser debulking prior to stenting. These patients presented with critical (95±3.5% stenoses) lesions (11 de novo, 1 stent restenosis) deemed unsuitable for standard renal angioplasty because of marked eccentricity and presence of thrombus. Indications for intervention included preservation of kidney function, treatment of uncontrolled hypertension, management of congestive heart failure, and treatment of unstable angina. Blood pressure and estimated glomerular filtration rate (eGFR) were measured pre- and 3 weeks post-intervention. Results A baseline angiographic stenosis of 95±3.5% was reduced to 50±13% with laser debulking. There were no laser-induced complications. Post-stenting the angiographic residual stenosis was 0%. The mean gradient across the lesions was reduced from baseline 85±40 to 0,mmHg. A normal post-intervention antegrade renal flow was observed in all patients. Baseline mean systolic BP of 178±20,mmHg decreased to 132±12,mmHg (P<0.0001) and mean diastolic pressure of 85±16,mmHg reduced to 71±9,mmHg (P,=,0.01). A pre-intervention mean eGFR of 47.7±19,ml/min/1.73,m2 increased to 56±20.4,ml/min/1.73,m2 (P,=,0.05) post-procedure. The interventions were not associated with major renal or cardiac adverse events. During follow-up one patient developed transient contrast-induced nephropathy. Conclusions Debulking of select renal artery stenoses with laser angioplasty followed by adjunct stenting is feasible. Further prospective, randomized studies will be required to explore the role of debulking and laser angioplasty in renal artery revascularization. Lasers Surg. Med. 41:622,627, 2009. © 2009 Wiley-Liss, Inc. [source]

Pilocarpine treatment in a mixed cohort of xerostomic patients

ORAL DISEASES, Issue 1 2007
DJ Aframian
Objective:, To compare the effect of a single 5-mg dose of pilocarpine hydrochloride on the salivary flow rate in three groups of xerostomic patients. Subjects and methods:, Forty-five patients were divided into three groups according to the etiology of their xerostomia: (i) radiotherapy; (ii) Sjögren's syndrome; and (iii) sialosis and xerogenic medications. Following the oral administration of a 5-mg pilocarpine hydrochloride tablet blood pressure, heart rate, body temperature and saliva secretion rates were monitored hourly for 3 h and adverse events were reported. Results:, The most significant and persistent elevation of salivary flow rate was observed in the sialosis/drug-induced group followed by the Sjögren's syndrome group. The radiotherapy group presented a significant elevation of salivary secretion rate after 1 and 2 h, but returned to baseline at 3 h. No significant changes in vital signs were reported, except for low diastolic pressure measured at 1 h in the radiotherapy group. Several adverse events were recorded throughout the trial; however, only one patient withdrew from the study. Conclusion:, Treatment with pilocarpine hydrochloride tablets may improve saliva secretion in patients taking xerogenic medications and/or suffering from metabolic sialosis expanding the beneficial potential of this sialogogue. [source]

Changes in pulmonary arterial pressure in term-infants with hypoxic,ischemic encephalopathy

PEDIATRICS INTERNATIONAL, Issue 6 2009
Jing Liu
Abstract Background:, Hypoxic,ischemic encephalopathy (HIE) is an important complication that results from birth asphyxia or some other adverse conditions and has a high risk of neonatal morbidity and mortality. It is unclear, however, whether the elevated pulmonary arterial pressure (PAP) can aggravate the condition and prognosis of HIE. The purpose of the present study was to investigate the relationship between the changes of PAP and HIE in term infants after birth asphyxia. Methods:, The left/right ventricle pre-ejection phase (LPEP/RPEP), left/right ventricle ejection time (LVET/RVET) and the ratios of LPEP/LVET and RPET/RVET were evaluated in 40 term infants with HIE and 40 healthy controls on days 1, 3, 7, and 12,14 after birth using echocardiogram. PAP such as pulmonary arterial diastolic pressure (PADP, mmHg), pulmonary arterial resistance (PAR, mmHg), and pulmonary arterial resistance/systemic resistance ratio (PAR/RS) was calculated using these indexes. Patient mortality was also evaluated. Results:, PADP, PAR, and PAR/RS were significantly higher in HIE patients than in healthy controls during the first week after birth, particularly in severe-degree HIE patients. And until the end of the first week of life, these indexes may return to the levels of healthy controls. Persistent fetal circulation (PFC) was found in nine patients (7/16 severe, 2/12 moderate HIE patients), and non-PFC was found in mild HIE patients. Two patients with PFC died. No patients without PFC died. The course of HIE was longer in patients with pulmonary hypertension than in those without. Conclusion:, Increased PAP is an important pathophysiological process that may influence the course and prognoses of HIE in infants after birth asphyxia, particular in severe HIE patients who often have PFC. Thus it is important to assess changes in PAP using echocardiography. [source]

Blood pressure, seasonal body fat, heart rate, and ecological differences in Caboclo populations of the Brazilian Amazon

AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2006
H.P. Silva
This study compares blood pressure (BP) and related cardiovascular risk factors among three Caboclo communities from the Brazilian Amazon. Its purpose is to investigate possible risk differentials related to variable ecological settings and Western influences. Caxiuanã is characterized as a more "traditional" group, while Aracampina and Santana are viewed as more "transitional" in lifestyle. A total of 348 subjects from the three communities were evaluated in the wet or the dry season or in both. Measurements across the communities were compared by season and sex. Results suggest little seasonal variation in average BP, BP change, body fat, or body fat change among men. Conversely, there is substantial seasonal and intercommunity variation among women. Additional analyses reveal (1) an inconsistent association between age and BP across the communities; (2) that BMI is not associated with BP transitional communities in either season but is associated with both systolic and diastolic pressure in the most traditional community; and (3) little to no sex effect on BP. These results suggest increased Western influence affects body composition particularly of women. However, increased BMI and fat among transitional Caboclo women does not directly translate into higher BP; rather, their BP appears to be more affected by seasonal stresses. Finally, conditions during the wet season diminish age-related variation in BP, suggesting that during the wet season these Caboclo may be less active. Am. J. Hum. Biol. 18:10,22, 2006. © 2005 Wiley-Liss, Inc. [source]

Vasomotor sympathetic neural control is maintained during sustained upright posture in humans

THE JOURNAL OF PHYSIOLOGY, Issue 2 2006
Qi Fu
Vasomotor sympathetic activity plays an important role in arterial pressure maintenance via the baroreflex during acute orthostasis in humans. If orthostasis is prolonged, blood pressure may be supported additionally by humoral factors with a possible reduction in sympathetic baroreflex sensitivity. We tested the hypothesis that baroreflex control of muscle sympathetic nerve activity (MSNA) decreases during prolonged upright posture. MSNA and haemodynamics were measured supine and during 45 min 60 deg upright tilt in 13 healthy individuals. Sympathetic baroreflex sensitivity was quantified using the slope of the linear correlation between MSNA and diastolic pressure during spontaneous breathing. It was further assessed as the relationship between MSNA and stroke volume, with stroke volume derived from cardiac output (C2H2 rebreathing) and heart rate. Total peripheral resistance was calculated from mean arterial pressure and cardiac output. We found that MSNA increased from supine to upright (17 ± 8 (s.d.) versus 38 ± 12 bursts min,1; P < 0.01), and continued to increase to a smaller degree during sustained tilt (39 ± 11, 41 ± 12, 43 ± 13 and 46 ± 15 bursts min,1 after 10, 20, 30 and 45 min of tilt; between treatments P < 0.01). Sympathetic baroreflex sensitivity increased from supine to upright (,292 ± 180 versus,718 ± 362 units beat,1 mmHg,1; P < 0.01), but remained unchanged as tilting continued (,611 ± 342 and ,521 ± 221 units beat,1 mmHg,1 after 20 and 45 min of tilt; P= 0.49). For each subject, changes in MSNA were associated with changes in stroke volume (r= 0.88 ± 0.13, P < 0.05), while total peripheral resistance was related to MSNA during 45 min upright tilt (r= 0.82 ± 0.15, P < 0.05). These results suggest that the vasoconstriction initiated by sympathetic adrenergic nerves is maintained by ongoing sympathetic activation during sustained (i.e. 45 min) orthostasis without obvious changes in vasomotor sympathetic neural control. [source]

Association Between Pulse Pressure and Cardiovascular Disease in Renal Transplant Patients

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2005
Gema Fernández-Fresnedo
Elevated pulse pressure in general population has been shown to be associated with cardiovascular disease, which is the main cause of death in renal transplant patients. We investigated the effect that a wider pulse pressure range may have on cardiovascular disease after renal transplantation in 532 transplant patients with functioning graft for more than 1 year. Patients were classified into two groups depending on 1-year pulse pressure (< or ,65 mmHg) and we analyzed patient and graft survival, post-transplant cardiovascular disease and main causes of death. Higher pulse pressure was associated with older recipient age (40.8 ± 10.8 vs. 50 ± 11.3), higher systolic blood pressure (132.7 ± 16.1 vs. 164.5 ± 16), lower blood diastolic pressure (84.5 ± 11.6 vs. 84.4 ± 11.2), higher prevalence of diabetes (12% vs. 23%) and total cardiovascular disease (20.9% vs. 33.6%). Five- and 10-year patient survivals were lower in the group with higher pulse pressure, being vascular disease the main cause of death in both groups. In a Cox regression model increased pulse pressure was associated with higher cardiovascular disease (RR = 1.73, 95% CI: 1.13,2.32 p < 0.01). In conclusion, pulse pressure was an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant patients. [source]

Autonomic dysfunction in presymptomatic and early symptomatic Huntington's disease

ACTA NEUROLOGICA SCANDINAVICA, Issue 6 2010
J. Kobal
Kobal J, Melik Z, Cankar K, Bajrovic FF, Meglic B, Peterlin B, Zaletel M. Autonomic dysfunction in presymptomatic and early symptomatic Huntington's disease. Acta Neurol Scand: 2010: 121: 392,399. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives,,, Although autonomic dysfunction was found in advanced Huntington's disease (HD) patients it is not clear whether there is autonomic dysfunction in presymptomatic and early symptomatic HD. Material & methods,,, Different cardiovascular autonomic tests were performed in 14 presymptomatic HD mutation carriers (PHD), 11 early symptomatic HD patients (EHD) and in 25 sex and age matched controls. Results,,, We found attenuated response to simple mental arithmetic test (relative heart rate in PHD and EHD was 10% lower than in controls; diastolic pressure was 10.6% lower in EHD than in controls; P < 0.05) and exaggerated response to the late phase of cold pressor test (relative heart rate was 10% higher in PHD and 7% higher in EHD than in controls; P < 0.05). The rest of the cardiovascular autonomic tests did not reveal significant differences between patients and controls. Conclusions,,, Our results suggest that subtle autonomic dysfunction occurs even in PHD and EHD. [source]

Carbon Monoxide Has Direct Toxicity on the Myocardium Distinct from Effects of Hypoxia in an Ex Vivo Rat Heart Model

ACADEMIC EMERGENCY MEDICINE, Issue 1 2008
Selim Suner MD
Abstract Objectives:, Carbon monoxide (CO) toxicity causes significant central nervous system and cardiac injury. Although the neurological damage caused by CO toxicity is extensively described, the mechanisms underlying myocardial insult are unclear. The authors used an externally perfused isolated rat heart model to examine the effects of a physiological saline solution (Krebs Henseleit HEPES, KHH) aerated with CO on cardiac function. Methods:, Fifteen rats were equally divided into three groups: the control group (KHH + 100% O2), the nitrogen control group (KHH + 70% O2, 30% N2), and the CO group (KHH + 70% oxygen, 30% CO). Left ventricular peak systolic pressure (LVPsP), end diastolic pressure (LVEdP), and coronary perfusion pressure were measured while the isolated heart was paced and perfused on a modified Langendorf apparatus. Results:, Left ventricular generated pressure (LVGP = LVPsP , LVEdP) decreased in the nitrogen control and CO groups compared to the control group. There was higher LVGP in the recovery phase between the nitrogen control group compared to the CO group. Both groups had increased lactic acid levels in the experimental phase. Conclusions:, Carbon monoxide with hypoxia and hypoxemic hypoxia both result in similar depression of cardiac function. Hearts poisoned with CO with hypoxia do not recover function to the extent that hearts rendered hypoxic with nitrogen do when perfused with 100% oxygen after the insult. This suggests that CO causes direct myocardial toxicity distinct from the effects of hypoxia. [source]

Risk factors for dyslipidemia in Chinese children

ACTA PAEDIATRICA, Issue 10 2008
Ying Liao
Abstract Aim: Since the mortality rate due to cardiovascular disease continues to increase, research into dyslipidemia has been emphasized in not only adults but also paediatric populations. We aimed to study the risk factors of dyslipidemia in Chinese children. Methods: Nine hundred and sixty-two children, aged 6,18 years, in Beijing were enrolled. For each child, data were collected on body height (cm), body weight (kg), sitting height (cm), waist circumference, upper arm circumference, serum lipid levels, as well as familial history of dyslipidemia and early onset cardiovascular disease. Subgroups were determined on the basis of age and sex. Results: The prevalence rate of dyslipidemia was 11.1% (107/962). Children with dyslipidemia differed significantly from those without, in sitting height, upper arm circumference, body mass index (BMI), waist-to-height ratio (WHR) and diastolic and systolic blood pressure (p < 0.05). Logistic regression analysis suggested that WHR, diastolic blood pressure and positive familial history were risk factors for dyslipidemia in children. Conclusion: Sitting height, upper arm circumference, BMI, WHR, diastolic pressure and systolic pressure were significantly higher in dyslipidemic children than in normal subjects in China. BMI, WHR, diastolic pressure and familial history of dyslipidemia and early-onset cardiovascular disease were risk factors for dyslipidemia in Chinese children. [source]

Activation Of ,1 -Adrenoceptors Is Not Essential For The Mediation Of Ischaemic Preconditioning In Rat Heart

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 1-2 2002
E Vasara
SUMMARY 1. The aim of the present study was to clarify the role of ,1 -adrenoceptors in the mechanism of ischaemic preconditioning (IP). 2. Rat isolated perfused hearts were either non- preconditioned, preconditioned with 5 min ischaemia or treated for 5 min with ,1 -adrenoceptor agonists (50 ,mol/L phenylephrine; 0.1, 0.5 and 1 ,mol/L methoxamine) before being subjected to 45 min of sustained ischaemia followed by 60 min reperfusion. 3. Within each of the above protocols, hearts were divided into groups to which ,1 -adrenoceptor antagonists (prazosin, 5,-methyl urapidil and chloroethylclonidine (CEC)) were administered. Functional recovery and infarct size were used as indices of the effects of ischaemia. Ischaemic contracture characteristics and maximal diastolic pressure during reflow were also assessed. 4. Blockade of ,1 -adrenoceptors with prazosin or the subtype-selective antagonists 5,-methyl urapidil and CEC did not abolish the protective effect of IP with respect to both functional recovery and infarct size reduction. 5. Protection afforded by phenylephrine was attenuated in hearts treated with prazosin or the ,1B -adrenoceptor- selective antagonist CEC, but not in those treated with the ,1A -adrenoceptor-selective antagonist 5,-methyl urapidil. 6. Treatment with low concentrations of methoxamine, considered to be ,1A -adrenoceptor selective, did not confer any protection to the ischaemic myocardium. 7. A close relationship between accelerated ischaemic contracture and enhanced cardioprotection was observed. 8. The results suggest that ,1 -adrenoceptor stimulation mimics IP, but it is not an essential component in the mechanism behind the protective effect of IP in rat heart. In addition, the present study demonstrates that stimulation of the ,1B - but not the ,1A -adrenoceptor subtype is responsible for the catecholamine-induced protection of ischaemic myocardium in rat. [source]

Validity of Revised Doppler Echocardiographic Algorithms and Composite Clinical and Angiographic Data in Diagnosis of Diastolic Dysfunction

Accuracy of Tissue Doppler Echocardiography in the Diagnosis of New-Onset Congestive Heart Failure in Patients with Levels of B-Type Natriuretic Peptide in the Midrange and Normal Left Ventricular Ejection Fraction

ECHOCARDIOGRAPHY, Issue 8 2006
Stephane Arques M.D.
Background: Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of tissue Doppler echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. Methods: 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100,400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler echocardiography was performed within 3 hours after admission. Results: unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). Conclusion: by better reflecting LV filling pressures, bedside tissue Doppler echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction. [source]

Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patients

PEDIATRIC ANESTHESIA, Issue 9 2006
MARIO JOSE DA CONCEIÇÃO MSC MD TSA
Summary Background:, Tonsillectomy has a high incidence of postoperative pain. The aim of the present study was to determine whether the use of low-dose IV ketamine, before the start of surgery or after the end of the operation, would lead to significantly improved pain control after tonsillectomy in pediatric patients. Methods:, Ninety children, 5,7 years old, scheduled for elective tonsillectomy were randomly assigned to one of three groups of 30 patients each; groups I, II and III. Patients in group I received no ketamine. Patients in group II received 0.5 mg·kg,1 of ketamine before the surgical start and for group III the same dose was given after the operation ended. Postoperative pain was scored by the Oucher scale. Systolic and diastolic pressures and heart rate were recorded perioperatively. Unwanted side effects were recorded by the ward staff personnel on a 24-h study-specific questionnaire. Statistical tests consisted of Student's t -test, chi-square and anova as appropriated. Results:, The number of patients complaining of pain was greater in group I compared with patients in groups II and III with a significative statistical difference (P < 0.05). The degree of postoperative pain was significantly higher in patients of group I compared with groups II and III (P < 0.05). Eight patients in group I needed rescue doses of morphine, three for group II and none for group III. In group I, three of eight patients required two doses of morphine during the first 249h postoperatively. No unwanted side effects were noted. Conclusions:, The use of a single small dose of ketamine in a pediatric population undergoing tonsillectomy could reduce the frequency or even avoid the use of rescue analgesia in the postoperative period independent of whether used before or after the surgical procedure. [source]