Ten patients aged 22 to 80 years (median 57) with severe left ventricular (LV) dysfunction and atrial fibrillation (AF) with rapid ventricular response were evaluated after therapy. Because most patients were unaware of their arrhythmia, duration was usually unknown. All patients had heart failure symptoms; 9 presented with New York Heart Association class III or IV disability, and 1 with class II disability. Initial LV ejection fraction ranged from 12 to 30% (median 25). No patient had symptomatic coronary artery disease (4 underwent angiography). Myocarditis and infiltrative processes were excluded by biopsy in 5 patients. All patients were considered initially to have idiopathic dilated cardiomyopathy with secondary AF. Ventricular rate was controlled in all patients, with sinus rhythm restored in 5. At follow-up (median 30 months, range 3 to 56), all patients were asymptomatic. LV ejection fraction after treatment ranged from 40 to 64% (median 52). It is concluded that in some patients initially considered to have idiopathic dilated cardiomyopathy, AF with rapid ventricular response may be the primary cause rather than the consequence of severe LV dysfunction. LV dysfunction may be completely reversible with ventricular rate control.

Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy.

Disturbances of rate, rhythm and conduction in acute myocardial infarction: A prospective study of 100 consecutive unselected patients with the aid of electrocardiographic monitoring

Objectives: Encephalopathy is a common complication of sepsis. This review describes the different pathologic mechanisms that may be involved in its etiology. Data Sources: The studies described here were derived from the database PubMed (http:\\www.nlm.nih.gov) and from references identified in the bibliographies of pertinent articles and books. The citations are largely confined to English language articles between 1966 and 1998. Older publications were used if they were of historical significance. Study Selection: All investigations in which any aspect of septic encephalopathy was reported were included. This selection encompasses clinical, animal, and in vitro cell culture work. Data Extraction: The literature cited was published in peerreviewed clinical or basic science journals or in books. Data Synthesis: Contradictions between the results of published studies are discussed. Conclusions: The most immediate and serious complication of septic encephalopathy is impaired consciousness, for which the patient may require ventilation. The etiology of septic encephalopathy involves reduced cerebral blood flow and oxygen extraction by the brain, cerebral edema, and disruption of the bloodbrain barrier that may arise from the action of inflammatory mediators on the cerebrovascular endothelium, abnormal neurotransmitter composition of the reticular activating system, impaired astrocyte function, and neuronal degeneration. Currently, there is no treatment. (Crit Care Med 2000; 28:3019 ‐3024)

Pathophysiology of septic encephalopathy: a review.

THE striking degree of malnutrition that may accompany chronic congestive heart failure has been termed cardiac cachexia. Hippocrates was perhaps the first to record this association between dropsy...

The pathogenesis of cardiac cachexia

Bedside catheterization of the right heart with a percutaneously introduced flowdirected catheter was carried out in 24 critically ill patients; 71 determinations of mixed venous oxygen saturation (MVo2) were obtained. A second catheter was inserted either into a central intrathoracic vein or the right atrium for simultaneous sampling of central venous (CVo2) or right atrial (RAo2) oxygen saturation. For the group as a whole, mean CVo2 (57.9% ± 15.25) was significantly greater than mean MVo2 (53.3% ± 14.84) (P<0.001), but there was no significant difference and correlation was good between changes in central venous compared to changes in mixed venous oxygen saturation. On the other hand, there was no significant mean difference as well as an excellent correlation between individual values of RAo2 and MVo2 (r=+0.95). Patients with heart failure or shock showed poor correlation between CVo2 and simultaneously determined MVo2. Furthermore, subjects with shock showed a mean CVo2 (58.0%±13.05) that was signifi...

Critical Assessment of Use of Central Venous Oxygen Saturation as a Mirror of Mixed Venous Oxygen in Severely Ill Cardiac Patients

Excerpt This study will consider the hemodynamic disturbances of the coronary flow which occur during cardiac arrhythmias. It has been shown that fast cardiac arrhythmias can precipitate severe dis...

John H. Williams

Papers

Effect of the cardiac arrhythmias on the coronary circulations

Effect of shock and of vasopressor drugs on the regional circulation of the brain, heart, kidney and liver.

The rationale of vasopressor treatment of cerebrovascular insufficiency and coronary insufficiency.