Health Care Blog (Page 6)

Figure 1. Effect of intravenous amiodarone (amio) on heart rate (HR). There is a significant slowing, from 109 ± 14 to 94 ± 15 beats/ min (p

The Effect of Intravenous Amiodarone on Heart Rate in Patients with Acute Myocardial Infarction or Ischemia and Sinus Tachycardia: Results

Patients’ Characteristics There were 22 patients (Table 1), 11 men and 11 women, with a mean age of 63.5 years (range 48 to 83 years). Eighteen patients presented with acute myocardial infarction, which was of anterior location in 15 patients and of inferior location in three. Four patients presented with acute myocardial ischemia which was anterior in three and inferior in the remaining patient. Efficacy of Intravenous Amiodarone Prior to amiodarone administration the sinus heart rates ranged from 95 to 136 beats/min (mean 109 ± 14 beats/min). Following the administration of amiodarone, the sinus rates slowed in all but two patients to 72 to 125 beats/min (mean 94 ± 15; p<0.0005) (Fig 1).

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The Effect of Intravenous Amiodarone on Heart Rate in Patients with Acute Myocardial Infarction or Ischemia and Sinus Tachycardia: Material and Methods

Intravenous Amiodarone Administration Protocol Amiodarone was administered IV in a dose of 300 mg dissolved in 50 to 100 ml of glucose solution over a 15-minute period. Sinus rates (recorded by cardiac monitoring) were registered before and 15 minutes after the end of infusion. Cuff blood pressure was measured every 5 minutes until 15 minutes after drug administration. Each patient served as his own control. Excluding three patients, all were observed for at least 30 minutes before amiodarone was given to rule out spontaneous variations in sinus rates. At the end of the 30-minute observation period, sinus rates had to persist in the ±5 beats/min range of the originally recorded heart rate. In addition, care was taken not to administer any drug that could alter the baseline sinus tachycardia; eg, (3-blockers, sedatives, diuretics, analgesics. Three patients received IV amiodarone within ten minutes of arrival to the coronary care unit. This…

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The Effect of Intravenous Amiodarone on Heart Rate in Patients with Acute Myocardial Infarction or Ischemia and Sinus Tachycardia

The Effect of Intravenous Amiodarone on Heart Rate in Patients with Acute Myocardial Infarction or Ischemia and Sinus Tachycardia

Sinus tachycardia in the setting of acute myocardial infarction or ischemia may worsen the ischemic injury. Intravenous (IV) amiodarone is an effective antiarrhythmic agent for a variety of supraventricular and ventricular arrhythmias. In addition, a beneficial anti-ischemic effect has also been demonstrated in experimental and human studies. The effect of IV amiodarone on heart rate is controversial and difficult to interpret because of possible increased sympathetic tone caused by vasodilation. Studies have shown either no significant change or a reduction in heart rate following its administration. However, most of the patients studied have had heart rates within the normal range. We investigated the efficacy of IV amiodarone in slowing the heart rate in a group of patients with acute myocardial infarction or ischemia and sinus tachycardia.

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Granulomatous Pneumocystis carinii Pneumonia in Three Patients with the Acquired Immune Deficiency Syndrome: Conclusion

Granulomatous Pneumocystis carinii Pneumonia in Three Patients with the Acquired Immune Deficiency Syndrome: Conclusion

The entire subject of typical and atypical appearances of P carinii pneumonia was reviewed by Weber et al in 1975, with the addition of other occasionally occurring atypical features such as interstitial fibrosis, a dense interstitial infiltrate, severe infiltration of alveolar macrophages, and calcification. These authors found atypical histologic features present in 69 percent of the 36 cases they studied. Nearly all of these patients had either a primary immunodeficiency or had been immunosuppressed secondary to chemotherapy for malignancy or transplantation. so We believe that our cases are the first descriptions of this histologic variant in the setting of the AIDS. In two of the three cases, the only organism implicated by all available studies was P carinii. Although cultures of one of the cases eventually grew Mycobacterium avium-intracellulare, we believe that the granulomas we observed in this case were in large part due to the presence of Pneumocystis, since…

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Granulomatous Pneumocystis carinii Pneumonia in Three Patients with the Acquired Immune Deficiency Syndrome: Discussion

Pneumocystis carinii has now become a particularly prevalent pathogen in the increasing population of patients with AIDS. It thus becomes increasingly relevant to discuss all of the organisms manifestations with special attention to its unusual presentations. While the classic radiographic appearance of hazy, bilateral alveolar infiltrates beginning in perihilar areas and progressing to diffuse involvement is certainly most common, it has become evident in recent years that other appearances are possible. These include segmental or lobular consolidation, nodular densities, and even cavitating lesions. These appearances may mimic those of tuberculosis and have led to initial clinical suspicion of mycobacterial infections, as was true in our cases 1 and 2.

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Figure 4. Chest x-ray film (case 2) showing ill-defined stellate density in right upper lobe and increased interstitial markings bilaterally.

Granulomatous Pneumocystis carinii Pneumonia in Three Patients with the Acquired Immune Deficiency Syndrome: Case 2

Case 2 A 28-year-old woman with no known risk factors for AIDS was admitted to the Mount Sinai Hospital with a 9-kg weight loss, fever, shortness of breath, nonproductive cough, and oral thrush. Chest x-ray film showed slightly increased interstitial markings and a stellate nodular density in the right upper lobe (Fig 4). She underwent fiberoptic bronchoscopy, and transbronchial biopsies were obtained under fluoroscopic guidance. Routine histologic sections were prepared and stained with hematoxylin-eosin, Grocott methenamine silver, Ziehl Nielsen acid-fast, and Giemsa stains. An intra-alveolar and interstitial infiltrate of pale staining histiocytic-appearing cells and lymphocytes was seen. No multinucleated giant cells were present. There was also focal intra-alveolar foamy acellular eosinophilic exudate. Cysts of P carinii were readily found both within the areas of exudate as well as in the granulomatous areas. No other organisms were identified. The patient was treated with IV trimethoprim-sulfamethoxazole for three weeks and had clinical…

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Figure 1. Computerized tomography of chest (case 1) showing pulmonary nodule.

Granulomatous Pneumocystis carinii Pneumonia in Three Patients with the Acquired Immune Deficiency Syndrome: Case Reports

A transcutaneous needle biopsy of the nodule showed nonspecific fibrosis. Special stains for organisms were negative. A 5-TU tuberculin test was nonreactive. Several weeks later she was admitted to Mount Sinai Hospital. Her past medical history was remarkable for an upper GI bleed secondary to peptic ulcer disease several months earlier, a herpes zoster infection one year earlier, and a cigarette smoking history of one pack per day Physical examination revealed a temperature of 38.3°C, oral thrush, and clear lungs on auscultation. Her admission blood gas analysis values were pH, 7.44; PaC02, 38.7 mm Hg; and Pa02, 92 mm Hg on room air. A chest x-ray film again revealed a nodule, and a chest CT scan confirmed a 2 X 3-cm left suprahilar parenchymal mass and a smaller, ill-defined left lingular mass (Fig 1). other

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