Biomedical subjects

D Arriagada

Publications and source records attributed to D Arriagada.

At least 19 recordsLinked to original sources

PubMed1997

[Clinical epidemiologic study of patients admitted to the intensive care unit, according to age].

BACKGROUND: Lately, we have observed an increase in the admission to intensive care units of patients over 65 years old, probably due to the increase in life expectancy that is occurring in Chile. AIM: To compare the frequency of admissions to intensive care units in patients over 65 years old, their diagnoses, their severity and hospital course, with those of younger patients. PATIENTS AND METHODS: The charts of all patients admitted to an intensive care unit of a University Hospital, during one year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assessed using the Apache score. RESULTS: A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57%) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14.8% of patients over 65 years old and 18.7% in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. CONCLUSIONS: Patients older than 65 years old admitted to intensive care units are very similar to their younger counterparts in their prognosis and causes of admission.

Adolescent↗

PubMed1996

[Patients with acute adult respiratory distress syndrome: effects of inhaled nitric oxide on gas exchange and hemodynamics].

BACKGROUND: Adult respiratory distress syndrome is highly prevalent in intensive care units and has a high mortality. Lately, nitric oxide has been used as adjuvant therapy. AIM: To study the effects of nitric oxide inhalation in patients with adult respiratory distress syndrome. PATIENTS AND METHODS: Twelve patients with adult respiratory distress syndrome, were subjected to nitric oxide inhalation at a concentration of 10 parts per million, during 30 minutes. RESULTS: At the end of the nitric oxide inhalation period, there was an improvement of PaO2/FIO2 ratio from 89 +/- 32 to 111 +/- 43 mm Hg and a 16% reduction of lung shunting (Qs/Qt). CONCLUSIONS: Nitric oxide inhalation at a concentration of 10 parts per million improved arterial oxygenation and reduced pulmonary shunting in patients with adult respiratory distress syndrome.

Administration, Inhalation↗

PubMed1996

[Pulmonary thromboendarterectomy: a case of surgical treatment of chronic pulmonary thromboembolism under circulatory arrest with deep hypothermia].

Pulmonary thromboendarterectomy under circulatory arrest and deep hypothermia is presently a curative treatment for pulmonary hypertension secondary to chronic pulmonary artery thromboembolic occlusion, but is still not frequently performed around the world. We report here the first successful pulmonary thromboendarterectomy under circulatory arrest performed in Chile. The patient was a 37 year old white man, high school teacher, with a 5 months history of effort dyspnea and cough. Pulmonary hypertension secondary to chronic pulmonary thromboembolism was confirmed by angiography and echocardiography. The patient was operated on April 27, 1995. After the operation the patient had an immediate and maintained normalization of his pulmonary hemodynamics. He presented periods of delirium that postponed mechanical ventilation disconnection until the 7th postoperative day, after which he had an uneventful neurological recovery. Before hospital discharge a control angiography showed complete patency of the pulmonary artery system with no evidence of residual thrombi. Presently he is enjoying a normal life and back to his teaching activities.

Adult↗

PubMed1995

[Vital prognosis in severe acute hepatic failure. Value of the quantitative indexes of evaluation].

The aim of this study was to assess the predictive value for mortality of admission and daily APACHE II score, mortality due to multiple organ failure and the Organ Failure Score in patients with acute hepatic failure. We retrospectively studied 15 such patients admitted to an intensive care unit. Thirteen patients died (87%) and their admission APACHE II score was 22 +/- 7.5 compared to 21 +/- 8.5 in survivors. Daily APACHE II score, mortality due to multiple organ failure and multiple organ failure score had a 100% sensitivity to predict mortality and a 69.2, 76.9 and 76.9% specificity respectively. The predictive accuracies of multiple organ failure and multiple organ failure score were 80% and significantly better than the accuracy of admission APACHE II score (53%). We conclude that these prognostic scores can be useful in the assessment of patients with acute hepatic failure.

APACHE↗

PubMed1994

[Multidisciplinary study of cerebrovascular disorders. II. Cardiovascular profile of occlusive vascular disorders].

Ischemic stroke constitute a mayor cause of morbidity and mortality in the adult population, particularly in the elderly. Heart disease may predispose to ischemic stroke, especially in the presence of transient or permanent precipitating factors such as atrial fibrillation. To elucidate the role of heart disease in predisposing to ischemic stroke we studied the clinical and non invasive cardiac profile (EKG, 2D-Echo, Holter) of 186 consecutive patients, 91 of them embolic (GI) and 96 non embolic (lacunar, atherothrombotic, others) (GII), as determined by brain CT scan and thorough clinical evaluation. Age and male/female ratio were significantly different (71 + 13 vs 65 + 12 years, 40/60 vs 65/35, p < 0.003). Hypertension was equally common in both groups (38 and 40%). Patients in GI had higher prevalence of valvular heart disease (23 vs 1%), atrial fibrillation (67 vs 10%), 2D Echo left atrial enlargement (45 vs 16%) and supraventricular ectopy in Holter (59 vs 32%) p < 0,001. By contrast absence of heart disease (45 vs 19%), ST-T changes in EKG (28 vs 14%), left ventricular hypertrophy in 2D Echo (28 vs 9%) and ventricular ectopy in Holter (54 vs 23%) were more prevalent in GII patients, p < 0.001. Multiple stepwise logistic regression analysis showed age > 70 years (relative risk (RR) 1.67), valvular heart disease (RR 2.25), chronic AF (RR 2.44) and paroxysmal AF (RR 1.89) were significant independent predictors of embolic stroke, whereas the presence of left ventricular hypertrophy in 2D-Echo (RR 0.76) and frequent ventricular premature beats in Holter (RR 0.47) were predictors of occlusive non embolic stroke. Thus, the clinical and non invasive cardiac profile of embolic and non embolic ischemic stroke is significantly different, which is relevant to preventive strategies.

Age Factors↗

PubMed1992

Risk factors for systemic embolism in patients with paroxysmal atrial fibrillation.

The purpose of this study was to define the risk factors for systemic embolism in patients with recently diagnosed paroxysmal atrial fibrillation. We therefore studied 63 consecutive patients with symptomatic nonvalvular paroxysmal atrial fibrillation and performed a clinical and noninvasive cardiac, peripheral vascular, and neurologic evaluation that included two-dimensional echocardiography, 24-hour Holter monitoring, and computed tomographic brain scan. Patients with predisposing clinical conditions for systemic embolism (valvular heart or coronary artery disease) or paroxysmal atrial fibrillation (sick sinus disease, preexcitation, or thyroid dysfunction) were excluded. At entry 34 patients had idiopathic paroxysmal atrial fibrillation and 29 had hypertension. Fourteen patients had a recent systemic embolic complication: nine had a recent occlusive nonlacunar cerebrovascular accident, two had transient ischemic attacks, and three had peripheral systemic emboli that required surgery. In addition, five patients had evidence of old cerebrovascular accident on the computed tomographic scan (group 1). Forty-four patients had no systemic embolism (group 2). Results of univariate analysis showed that patients in group 1 were older (72 +/- 9 vs 63 +/- 13 years, p less than 0.05), had a higher incidence of hypertension (70% vs 35%, p less than 0.01), and had an increased left atrial diameter (4.1 +/- 0.7 vs 3.6 +/- 0.5 cm, p less than 0.05). Multiple stepwise logistic regression analysis showed that a history of hypertension and left atrial enlargement on two-dimensional echocardiography were significant independent risk factors for systemic embolism in patients with symptomatic nonvalvular paroxysmal atrial fibrillation.

Aged↗

PubMed1992

[Multidisciplinary study of cerebrovascular accidents: I. Definition, design, and general results].

Cerebrovascular accidents (CVA) constitute a major cause of adult cardiac cardiovascular mortality in Chile. From July 87 to August 89 we prospectively studied 300 patients with CVA utilizing a multidisciplinary approach. Besides clinical evaluation this included brain CT scan (48 hrs), glucidic and lipid profile. Occlusive CVA were additionally studied with 2D-Echocardiogram, 24 hr Holter, Cerebral Angiography and/or carotid Duplex Echotomograph, and a second brain CT scan was performed within the first week. We found a 62.3% incidence of cerebral infarcts, 28.3% of cerebral hemorrhages and 9.3% of transient ischemic attacks. Cerebral infarcts were found to be cardiac related in 33.5% of cases, whereas 13.2% were lacunar, 4.4% were atherothrombotic and 14% had no precise etiology. Hypertension was associated to cerebral hemorrhages in 76% of cases, 26% of which were intracranial. At 2 months of follow-up 16.3% of patients were severely handicapped and mortality was 19.3%. We have confirmed that cerebral infarcts constitute the most common cause of CVA and most of them are cardiac related. Hypertension appears to be the most important cause of cerebral hemorrhage. A multidisciplinary approach to cerebrovascular accidents allowed a more precise diagnosis and contributed to implement appropriate therapeutic and preventive strategies. Proper identification of high risk patients could contribute to decrease the high incidence and mortality of CVA in our community.

Aged↗

PubMed1989

[Severity evaluation system: APACHE II, SAPS. National experience in a unit of medical intensive therapy].

We evaluated 2 new prognostic indices, APACHE II and SAPS, in 533 consecutive patients admitted to a general hospital clinical care unit. Mortality was 19.5% (13.1% in the ICU). Among non-survivors 80% had a greater than = 20 APACHE II score and 77% a greater than = 13 SAPS score. Only 2% of patients with APACHE score less than 10 or SAPS less than 7 died. A good correlation with previously used indices (APACHE I and TISS) was 0.6. Utilization of these prognostic indices allows comparison of reports from different centers, evaluation of early and long term prognosis and a help in making cost-benefit decisions.

Chile↗

PubMed1989

[Intraventricular conduction disorders in acute myocardial infarction: early and late clinical significance].

The prognostic impact of new bundle branch block (BBB) upon the intra hospital course and long-term prognosis of patients with acute myocardial infarction (MI) was studied in 517 consecutive patients with a recent MI: 449 patients did not have BBB (group I) and 69 developed a new BBB (group II). Age and sex were similar in both groups. Incidence of BBB among patients with anterior wall MI was 61% compared to 8% in patients with inferior wall MI (p less than 0.05). The distribution of RBBB, RBBB + left anterior hemiblock and LBBB was 32%, 30% and 38% among 46 patients with anterior wall MI, compared to 28%, 6% and 68% among 18 patients with inferior wall MI (p less than 0.05). The level of peak CK values (2345 vs 1437 IU/l), presence of Killip grade III or IV (56 vs 18%), complete A-V block (24 vs 6%) and mortality (34 vs 9%) were significantly higher in group II (p less than 0.05). Long-term mortality at 1 and 5 years of follow up was 29% and 51% in group II patients, a three fold increase over group I. We conclude that development of new BBB during myocardial infarction is associated with a poor immediate and long term prognosis. This may be related to larger infarcts rather than the conduction defect itself.

Bundle-Branch Block↗

PubMed1989

[Are there any differences between myocardial infarction with Q and non-Q in ECG].

Recent literature provides evidence that Non-Q wave myocardial infarction (Non-Q MI) has a different intrahospital course and prognosis than Q-wave myocardial infarction (Q-MI). We evaluated clinical and laboratory characteristics, complications and therapeutic requirements of 557 consecutive patients, 440 with Q-MI and 117 with Non-Q MI. Risk factors for coronary artery disease did not differ among groups. Non-Q MI patients had a significantly higher incidence of previous cardiac events such as myocardial infarction, angina pectoris and heart failure. Peak CPK enzyme values were significantly lower in Non Q MI patients (952 +/- 753 vs 1,743 +/- 1,425 VI/l p less than 0.05). Early complications were different for both groups: The incidence of heart failure, ventricular arrhythmias and conduction defects was lower in Non-Q MI patients while the incidence of unstable angina pectoris and need for aorto coronary by-pass surgery was higher (18 vs 12%, 17 vs 7% respectively, p less than 0.05). Mortality was not different (8.4% in Non-Q MI vs 12.3% in Q MI). Thus, Non Q MI appears to have a more benign clinical course than Q-MI in terms of less complications such as heart failure, ventricular arrhythmias and conduction defects. However, Non-Q MI is a potentially unstable clinical entity with a higher incidence of early post MI angina pectoris requiring a more aggressive medical and surgical therapy.

Aged↗

PubMed1989

[Syncope: general characteristics and its relation to age].

We retrospectively analyzed the clinical data of 146 patients admitted to a general hospital with the diagnosis of syncope. A definite or highly likely cause was identified in 91 patients (62%). These were of cardiovascular origin in 78%: conduction defects (31), sinus node disease (9), obstructive causes (8), ventricular arrhythmia (8), ischemia (5) and miscellaneous (14). A non cardiovascular origin was present in 22% of patients: intoxication (7), hysteria (5), hypoxemia (3), vasovagal (2), gastrointestinal bleeding (2) and 2 others. The final diagnosis in patients with a known cause was established by the history and physical examination in 16, the ECG in 42, Holter 9, ECG monitoring in ICU 8 and echocardiogram 6. No difference in the distribution of causes was present between patients below or above 65 years of age. In hospital mortality was 2%.

Adult↗

PubMed1988

Role of programmed electrical stimulation of the heart in risk stratification post-myocardial infarction.

Programmed electrical stimulation (PES) of the heart was evaluated as a method of identifying patients at risk of sudden death post-myocardial infarction (post-MI). Eighty-four patients (mean age, 56 +/- 10 years) underwent PES 6 to 8 weeks post-MI. PES was performed at the right ventricular apex at twice diastolic threshold. Prior to stimulation patients were studied with exercise stress testing, 24-hour Holter monitoring and radionuclide ejection fraction. The patients were placed into two groups, according to their responses to electrical stimulation. Group 1:65 patients in whom no arrhythmias were induced or who had repetitive responses that lasted less than six cycles; Group 2:19 patients in whom ventricular tachycardia was induced. At the end of follow-up (20 +/- 9 months) six patients from Group 1 had died. Complex ventricular ectopy and ventricular tachycardia were more frequently detected on Holter in Group 2 (9/19) than in Group 1 (14/65) (p less than 0.03). The results of exercise testing and radionuclide ejection fraction did not correlate with the response to PES. However all but one of the patients who died had a left ventricular ejection fraction (LVEF) under 40% and four out of six patients had ventricular tachycardia on Holter monitor. We draw the conclusion that PES did not contribute to the identification of high-risk patients post-MI, as none of the 19 patients in whom ventricular tachycardia was induced died during follow-up. In addition, high-risk patients were characterized by poor ventricular function and complex ventricular arrhythmias on Holter recording.

Electric Stimulation↗

PubMed1988