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At least 19 recordsLinked to original sources
PubMed1977

[Cardiac effects of antikaliuretic diuretics-clinical and biochemical investigation (author's transl)].

Recently direct myocardial effects of antikaliuretic diuretics with respect to contractility parameters and prevention of digitalis-induced arrhythmias were published. In order to test the value of these reports we measured the effect of potassium-canrenoate and triamterene on cardiac output and on digitalis-induced arrhythmias in patients during diagnostic and the therapeutic flow directed right heart catheterization (Swan-Ganz) in our intensive care unit. In addition the influence of these drugs on (Na+ + K+)-ATPase and on (3H)g-strophanthin binding to human cardiac cell membranes was investigated to gain information on the mechanism of their action. Triamterene (100-200 mg p.o.) was without any effect on cardiac output, the same was found true for potassium-canrenoate given in a single dose (200-1000 mg intravenously). However, when applied in two doses (200 mg i.v. and 60 min later 400 mg i.v.), potassium-canrenoate increased cardiac output by 11 percent (p less than 0.05). Only in 2 out of 14 patients potassium-canrenoate (200-400 mg i.v.) suppressed digitalis-induced ventricular ectopic beats. Canrenone, the active metabolite of potassium-canrenoate displaces [(3H)]g-strophanthin from its binding sites in human cardiac cell membranes and inhibits (Na+ + K+)-ATPase activity. These in vitro effects were measured at the same concentrations as found in vivo after "therapeutical" doses. The effects of triamterene in this respect were found only in extremely high concentrations. Our results imply that canrenone has cardiac glycoside-like effects in human cardiac cell membranes.

Adenosine Triphosphatases↗
PubMed1979

Glucose-insulin-potassium infusion in acute myocardial infarction. Review of clinical experience.

A solution of 300 gm of glucose, 50 units of regular insulin, and 80 mEq of potassium chloride in 1,000 ml of sterile water infused at a rate of 1.5 ml/kg of body weight per hour can alter the availability of glucose and free fatty acids to the myocardium. Clinical studies of patients receiving this infusion less than 15 hours after the onset of symptoms of acute myocardial infarction suggest a reduction in mortality, an improvement in left ventricular mechanical performance, and a reduction in cardiac irritability as beneficial effects. Swan-Ganz catheterization for hemodynamic, electrophysiologic, and metabolic monitoring is recommended. Diabetics who require insulin and patients with impaired renal function are not candidates for the infusion. Further clinical studies are required before conclusions can be reached regarding the efficacy of glucose-insulin-potassium infusion in attempts to salvage damaged myocardium.

Acute Disease↗
PubMed1978

Incremental intravenous nitroglycerin for control of afterload during anesthesia in patients undergoing myocardial revascularization.

In 25 patients undergoing coronary artery bypass grafting hemodynamic measurements (including values obtained with Swan-Ganz catheterization in 21 of the patients) were made before and after administering a bolus injection of 64 or 96 mcg of nitroglycerin to relieve intraoperative hypertension. This pharmacological agent reduced afterload and preload without raising heart rate. The effect was apparent within 1-3 min and lasted 5-10 min. Untoward hypotension was not encountered in any instance. This intervention appears to be a safe approach to the treatment of intraoperative hypertension in patients with coronary artery disease.

Adult↗
PubMed2026

Pulmonary artery catheters or central venous catheters for cardiac surgery: the PUMA Pilot randomised clinical trial.

INTRODUCTION: Pulmonary artery catheters are used widely in cardiac surgery despite observed associations with worse outcomes and guidelines that recommend against their routine use. No adequately powered randomised trials are available. METHODS: The PUMA Pilot was a multicentre, randomised, parallel assignment, open-label, pilot and feasibility trial conducted at three tertiary cardiac surgery centres. Eligible patients were adults undergoing coronary artery bypass grafting, aortic valve replacement or surgery on the aortic root or ascending aorta with or without aortic valve replacement, with a predicted surgical mortality of <&#x2009;2%. Patients were allocated randomly to receive a pulmonary artery catheter or a central venous catheter inserted immediately before surgery. The primary feasibility outcome was protocol compliance, defined as receiving the assigned intervention without crossover. Secondary feasibility outcomes were eligibility rate; recruitment proportion and rate; data completeness; and rate of clinician refusal. RESULTS: We screened 480 patients and 206 (43%) were eligible; 150/203 (74%) approached provided informed consent. Three of 206 (1%) eligible patients were not included due to clinician refusal. Of 149 patients who were randomised, 76 were assigned to the pulmonary artery catheter group and 73 to the central venous catheter group. For the primary feasibility outcome, 147 patients (99%) received the allocated intervention. Data were complete for 144 (97%) patients. Median (IQR [range]) days alive and at home at 30&#x2009;days was 23.7 (21.9-24.7 [7.0-26.0]) in the pulmonary artery catheter group and 22.9 (20.8-23.9 [8.6-25.8]) in the central venous catheter group. Acute kidney injury occurred in 26/76 (34%) patients in the pulmonary artery catheter group and 14/73 (19%) in the central venous catheter group. DISCUSSION: A randomised trial of pulmonary artery catheters compared with central venous catheters in low-risk cardiac surgery is feasible. Such a trial would address significant practice variability and inform international guidelines.

Humans↗
PubMed1978

The Swan-Ganz catheter: a review.

Right heart catheterization, first reported in 1905, is now used for bedside assessment and management of the critically ill patient. A Swan-Ganz catheter and pulmonary artery pressure monitoring are the tools employed. In spite of the complications cited, the occurrence of hazard to the patient is infrequent. The catheter is particularly valuable in the hemodynamic evaluation of cardiac function. Right and left heart pump performance can be assessed by pressure measurements. The ability of the left heart to provide an adequate cardiac output can be numerically calculated, and its adequacy at a cellular level can be evaluated by determining arterial-venous oxygen saturation difference. One of the more important and newest uses of the Swan-Ganz catheter is the preventive function it plays in anesthesia administration. Implications of the Swan-Ganz catheter for nursing practice are: (1) explanation and support to patient and family; (2) technical understanding and knowledge of set-up; (3) care and maintenance of the catheter after insertion; (4) the understanding of physiologic principles underlying the use of the catheter; and, most important, (5) ability to correlate clinical observations and physiologic changes occurring in the patient with pressure measurements.

Cardiac Catheterization↗
PubMed1979

[Correlations between hemodynamic measures and respiratory functions in patients with chronic obstructive lung syndromes].

Fourteen patients with chronic obstructive pulmonary disease underwent right catheterization with a Swan-Ganz catheter to correlate lung function with hemodynamic features at rest and on exercise. There appears to be a good correlation between some pulmonary function tests (FEV1, RV/TLC, PaO2 at rest and on exercise) and mean pulmonary artery pressure at rest and on exercise in these patients.

Blood Pressure↗
PubMed1979

[Variants of hemodynamic changes in acute period of myocardial infarct and the importance of their detection for treatment].

Sixty-three patients suffering from acute myocardial infarction were examined within the first 24 hours of the disease (27 within the first 6 hours) by means of catheterization of the right parts of the heart with a Swan-Ganz balloon catheter and thermodilution. Comparison between the cardiac output and the pressure of left ventricular filling allowed the following hemodynamic variants of myocardial infarction to be distinguished: normo-, hypokinetic, with increased pressure of left ventricular filling and normal cardiac output, hypovolemic, and hyperdynamic. The results of the tests with acute rheopolyglucin load (9 patients) showed that some of the patients with normal values of hemodynamics had latent cardiac insufficiency. Hemodynamic study and recognition of the variant of hemodynamic changes in the acute period of myocardial infarction made it possible to determine properly the indications for the use of vasodilators, active inotropic agents, and infusion therapy.

Acute Disease↗
PubMed1976

Hazards of the intensive care unit.

Complications arise in the introduction, maintenance, and use of devices for life support and monitoring in an intensive care unit. Since recognition of such complications is frequently difficult in this clinical setting, the radiologist is often in a position to be the first to detect complications associated with the use of endotracheal and tracheostomy tubes, Swan-Ganz catheters, subclavian catheters, central venous pressure catheters, and intra-aortic balloons.

Cardiac Catheterization↗
PubMed1978

Treatment of massive hemoptysis by combined occlusion of pulmonary and bronchial arteries.

Massive, life-threatening hemoptysis occurred in a patient with left upper lobe bronchiectasis secondary to old tuberculosis. Selective left bronchial arteriography showed extravasation of contrast medium in the bronchiectatic area. A marked decrease in hemoptysis occurred after selective left bronchial arterial embolization. Complete cessation of bleeding followed the inflation of a Swan-Ganz balloon catheter that had been placed in the left main pulmonary artery.

Aged↗
PubMed1979

The Swan-Ganz catheter and management of patients undergoing pelvic exenteration.

A Swan-Ganz catheter has been used in 10 consecutive patients undergoing pelvic exenteration and has made the intraoperative and postoperative management of these patients a much easier task. Use of this catheter eliminates the guesswork involved in managing fluid and volume status by providing an accurate assessment of left ventricular end diastolic pressure. The complication rate is reported as 5% and consists mostly of ruptured balloons, infection, coiling of the catheter, and cardiac irritability. There have been no complications in the 10 patients in whom we have used the catheter. We believe that the use of the Swan-Ganz catheter in these difficult-to-manage patients is justified because of its low complication rate, easy use, and the accurate valuable information obtained.

Cardiac Catheterization↗
PubMed1979

Systolic click from a Swan-Ganz catheter: phonoechocardiographic depiction of the underlying mechanism.

Although echocardiographic manifestations of Swan-Ganz catheters have received increasing attention, auscultatory sequelae have not previously been described. In the patient described in this report, insertion of a Swan-Ganz catheter resulted in a loud mid systolic click; removal of the catheter eliminated the click. Simultaneous phonoechocardiograms suggest that the click resulted from crisp contact of the catheter against the ventricular septum. Catheter momentum was enhanced by wide excursion and systemic pressures in the right ventricle; paradoxical motion of the septum during systole may have accentuated the force of its contact with the catheter.

Cardiac Catheterization↗
PubMedDate not supplied

Left subclavian vein puncture for insertion of Swan-Ganz catheters.

A rapid, safe, and reliable method for insertion of Swan-Ganz flow-directed, balloon-tipped catheters using the left subclavian vein is described. Experience with this method in 24 consecutive patients indicates a distinct advantage over the antecubital fossa approach: A venous cutdown is not necessary, the pulmonary artery is readily entered, fluoroscopy is not required, the patient is free to move both arms, and thrombophlebitis and infection occur infrequently. With proper attention to landmarks such as the clavicular tubercle, the procedure may be performed with facility. The major complication, pneumothorax, is minimized if mechanical ventilators are briefly disconnected during the subclavian puncture.

Cardiac Catheterization↗