BACKGROUND: Cardiac arrhythmias and other cardiac dysfunctions occur in relation with acute cerebral ischemia. This study was undertaken to evaluate the sequential changes of electrocardiogram and cardiac enzymes after acute ischemic stroke, and to evaluate the incidence of cardiac arrhythmias. METHODS: Forty-three patients with acute ischemic stroke were recruited for this study. Electrocardiogram and cardiac enzymes were checked at 1, 3, 5, 7, 15, and 30 days after onset. RESULTS: Heart rates were decreased acutely after ischemic stroke and showed maximal decrease at day 3 (p<0.05). Heart rates were more significantly decreased in the right-sided lesions than the left (p<0.05) and in the supratentorial lesions than the infratentorial (p<0.05). PR intervals and durations of QRS complex were prolonged at day 3 and 5 but were not significant. The prolongation of the QTc interval was found in 21 patients (48.8%) and sustained QTc prolongation at day 30 were seen in 16 patients. Compared with controls, patients showed significantly higher incidence of arrhythmias (p<0.01). Creatine phosphokinase-MB (CK-MB) was significantly increased at day 5 (p<0.01) and lactic dehydrogenase (LDH) was increased at day 7 (p<0.01). CONCLUSIONS: In our study, the incidence of neurogenic cardiac abnormalities in acute ischemic stroke was higher than that of previous studies. Abnormalities peaked at days 3 and 5 were nearly similar to control levels at day 30. These periods of peak abnormalities coincided with those of increasing brain edema. Therefore, we postulate that cardiac autonomic controls are also influenced by acute brain edema. (J Korean Neurol Assoc 19(3):207~212, 2001)
Arrhythmias, Cardiac ; Brain Edema ; Brain Ischemia ; Cerebral Infarction ; Creatine ; Electrocardiography* ; Heart Rate ; Humans ; Incidence ; Oxidoreductases ; Stroke*

Carbon monoxide (CO) is a well-known chemical asphyxiant, which causes tissue hypoxia with prominent neurological and cardiovascular injury. After exposure to CO, several cardiac manifestations have been reported, including arrhythmias, acute myocardial infarction, and pulmonary edema. However, an ST elevation myocardial infarction (STEMI) due to CO poisoning is a very rare presentation, and the treatment for STEMI due to CO poisoning is not well established. Here, we report a rare case of STEMI complicated by increased thrombogenicity secondary to acute CO poisoning and complete revascularization after antithrombotic treatment.
Anoxia ; Arrhythmias, Cardiac ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Myocardial Infarction ; Pulmonary Edema

The infiltration of dilute epinephrine solution has been used for many years to provide hemostasis. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced epinephrine-induced cardiovascular crisis, with severe hypertension, tachycardia, and cardiac arrest after subcutaneous infiltration of a 2% lidocaine and 1 : 200,000 epinephrine solution in a patient with an asymptomatic subarachnoid hemorrhage. We provided successfully advanced cardiac life support in the operating room and cardioverted the patient back into a sinus rhythm with no untoward effects. The patient recovered without any apparent sequelae after intensive care.
Advanced Cardiac Life Support ; Arrhythmias, Cardiac ; Epinephrine ; Heart Arrest ; Hemostasis ; Humans ; Hypertension ; Critical Care ; Lidocaine ; Operating Rooms ; Pulmonary Edema ; Subarachnoid Hemorrhage ; Tachycardia

Sick sinus syndrome (SSS) is an abnormality of sinus nodal impulse formation by intrinsic or extrinsic causes. Patients with SSS often are asymptomatic, or have mild or nonspecific symptoms, including dizziness, palpitations, fatigue, and confusion related to the decreased cardiac output. SSS can rarely cause conditions like syncope, congestive heart failure, thromboembolism, pulmonary edema, cardiac arrest, or sudden death. We report here on a severe bradycardia during general anesthesia for aneurysmal clipping and tachycardia-bradycardia syndrome followed by cardiac arrest postoperatively in the ICU, which was subsequently diagnosed as SSS with 24-hour Holter monitoring.
Anesthesia, General ; Aneurysm ; Bradycardia ; Cardiac Output ; Death, Sudden ; Dizziness ; Edema, Cardiac ; Electrocardiography, Ambulatory ; Fatigue ; Heart Arrest ; Heart Failure ; Humans ; Pulmonary Embolism ; Sick Sinus Syndrome ; Syncope

Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension in which the primary abnormality is obliterative obstruction of pulmonary veins, especially venules. Clinicaly, we should suspect this disease in the case of congestive cardiac failure with pulmonary hypertension, chronic interstitial pulmonary edema, and normal or elevated wedge pressure on cardiac catheterization. We experience a case of pulmonary hypertension due to pulmonary veno-occlusive disease. A 55-years -old woman developed progressive dry cough and dyspnea for 3 months. Physical examination showed normal heart sounds, diffuse crackles in the whole lung fields. The liver was not palpable and pitting edema was absent. The diagnosis was made by chest HRCT, 2-D echocardiography, normal pulmonary capillary wedge pressure on cardiac catheterization, and confirmed by thoracoscopic lung biopsy. This patient was treated with vasodilator(calcium antagonist) and with mild symptomatic improvement. We reported a case of pulmonary veno-occlusive disease with review of literatures.
Biopsy ; Cardiac Catheterization ; Cardiac Catheters ; Cough ; Diagnosis ; Dyspnea ; Echocardiography ; Edema ; Estrogens, Conjugated (USP) ; Female ; Heart Failure ; Heart Sounds ; Humans ; Hypertension, Pulmonary ; Liver ; Lung ; Physical Examination ; Pulmonary Edema ; Pulmonary Veins ; Pulmonary Veno-Occlusive Disease* ; Pulmonary Wedge Pressure ; Respiratory Sounds ; Thorax ; Venules

BACKGROUND: Refractory edema in some patients with advanced heart failure or renal failure will not respond to diuretic therapy. In this setting, the ex- cess fluid can be removed by continuous hemofiltration either by continuous arteriovenous hemofiltration (CAVH) or continuous venovenous hemofiltration (CVVH). Careful monitoring is required to prevent life-threatening hypotension due to continued production of large ultrafiltrate. To overcome these disadvantages of CVVH, we attempted to perform daytime 1VVH as an alternative therapeutic modality to CVVH. METHODS: We performed venovenous hemofiltration for eight hours in the daytime in dialysis unit and repeated intermittently at 1 or 2 days interval if further treatment is required. We called this intermittent venovenous hemofiltration(IVVH). From October 1992 through November 1997, we prospectively studied the efficacy and usefulness of IVVH in 42 patients with refractory edema. RESULTS: Underlying disorders which required IVVH were renal insufficiency in 28 patients and nephrotic syndrome in 14 patients. The mean duration of treatment was 17.0+/-8.4 hours. Total UFR was 26.1+/-153L and mean UFR/hr was 1.5+/-2.2L. Edema was successfully controled with only one time treatment of IVVH in 12(28.6%), two in 17(40.5%), three in 7(16.6%), four in 4(9.5%), and five in 2(4.8%), Mean number of IVVH treatments per patient was 2.2+/-0.4 to complete the treatment of refractory edema. Changes in blood chemistry and hemodynamics before and after IVVH were not significantly different. Body weight and abdominal girth decreased significantly after IVVH(p<0.001). No major complications occurred during these trials. There were only two episodes(5.1%) of transient hypotension, and each one episode(2.6%) of bleeding at access site and arrhythmia, respectively. CONCLUSION: These results stongly suggest that IVVH is a simple, safe and effective method in the treatment of refractory edema not responding to diuretic therapy.
Arrhythmias, Cardiac ; Body Weight ; Chemistry ; Dialysis ; Edema* ; Heart Failure ; Hemodynamics ; Hemofiltration ; Hemorrhage ; Humans ; Hypotension ; Nephrotic Syndrome ; Prospective Studies ; Renal Insufficiency

OBJECTIVETo explore the role of central venous pressure (CVP), global end diastolic volume index (GEDI) and extravascular lung water index (ELWI) monitoring in patients with septic shock during fluid resuscitation by pulse induced continuous cardiac output (PiCCO) test.

METHODSForty-six patients with severe sepsis and septic shock were enrolled in this study. Hemodynamic monitoring was performed during fluid resuscitation and the data including CVP, GEDI and ELWI were collected to analyze their relationship and the clinical values.

RESULTSIn patients with septic shock, CVP showed a weak linear correlation with GEDI during fluid resuscitation (r=0.137, P=0.009). In the subgroups stratified with CVP cut-off values of 8 mmHg and 12 mmHg, the correlation coefficient between CVP and GEDI was 0.149 (P=0.029) in CVP<8 mmHg group, 0.075 (P=0.462) in 8 mmHg ≤ CVP ≤ 12 mmHg group, and 0.049 (P=0.726) in CVP>12 mmHg group. In the total of 367 data groups obtained, CVP showed no linear correlation with ELWI (r=0.040, P=0.445). In the CVP subgroups, CVP and ELWI were weakly correlated in CVP<8 mmHg group (r=0.221, P=0.001), but they showed no correlations in 8 mmH g≤ CVP ≤ 12 mmHg and CVP>12 mmHg groups (r=-0.047, P=0.646; r=0.042, P=0.765).

CONCLUSIONThere is no significant linear correlation between CVP and GEDI or between CVP and ELWI in patients with septic shock. CVP can not reflect the circulatory blood volume or the degree of pulmonary edema.

Blood Volume ; Cardiac Output ; Central Venous Pressure ; Extravascular Lung Water ; Fluid Therapy ; Humans ; Pulmonary Edema ; Resuscitation ; Shock, Septic ; therapy

A mixture of local anesthetic and epinephrine provides hemostasis for ear microsurgery. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced catecholamine-induced cardiovascular crisis, with severe hypertension, tachycardia, and acute pulmonary edema, after subcutaneous infiltration with a 2% lidocaine and 1:200,000 epinephrine solution. The patient recovered without any apparent sequelae after intensive care, including diuretics, steroids, and nitroglycerin for the hypertension and pulmonary edema, and a vasopressor for the subsequent hypotension.
Arrhythmias, Cardiac ; Diuretics ; Ear ; Epinephrine ; Heart Arrest ; Hemostasis ; Humans ; Hypertension ; Hypotension ; Critical Care ; Lidocaine ; Microsurgery ; Nitroglycerin ; Pulmonary Edema ; Steroids ; Tachycardia

Vasopressin, an extremely potent vasoconstrictor, has been widely used for surgical hemostasis in gynecological practices. But, Intramyometrial infiltration of vasopressin is not free of side effects and may cause lethal complications including pulmonary edema, myocardial infarction, and cardiac arrest in spite of infrequency of reported cases. Sudden cardiac arrest was encountered just after intramyometrial injection of vasopressin in our patient undergoing dilation and curettage. We believe that this awful complication was due to baroreflex-mediated regulation of blood pressure, caused by unintentional penetration of vasopressin into the vessels. We herewith discuss the complications of the local injection of vasopressin and the safe dose of vasopressin for intramyometrial injection.
Anesthesia, General* ; Baroreflex ; Blood Pressure ; Curettage* ; Death, Sudden, Cardiac ; Heart Arrest* ; Hemostasis, Surgical ; Humans ; Myocardial Infarction ; Pulmonary Edema ; Vasopressins*

A 28-year-old male with hemophagocytic lymphohistiocytosis presented with left ventricular dysfunction and cardiac arrest. Percutaneous cardiopulmonary support (PCPS) was initiated, but left heart distension developed with associated aggravation of pulmonary edema. Percutaneous transseptal left atrial sheath (28-Fr) drainage was incorporated into the PCPS venous circuit under fluoroscopic guidance to enable left heart decompression 1 days after PCPS initiation. The patient's pulmonary edema improved markedly, and distention of his left heart diminished. He was successfully weaned from PCPS 5 days later. Percutaneous transseptal left atrial drainage with large venous cannulae is feasible and effective in decompressing the left heart in adult patients during PCPS.
Adult ; Assisted Circulation ; Cardiac Catheterization ; Catheters ; Decompression ; Drainage ; Heart ; Heart Arrest ; Humans ; Lymphohistiocytosis, Hemophagocytic ; Male ; Pulmonary Edema ; Ventricular Dysfunction, Left