P.G.F. Nixon

LEFT VENTRICULAR DIASTOLIC PRESSURE IN CARDIOGENIC SHOCK TREATED BY DEXTROSE INFUSION AND ADRENALINE

Abstract Within a few hours of the onset of cardiac infarction an active 73-year-old man had a cardiac arrest, and was resuscitated. Profound shock followed upon this and responded to treatment with 5% dextrose infusion, supplemented for a period with adrenaline. Left heart catheterisation during the shock revealed normal left ventricular diastolic pressure, rising to 15 mm. Hg under treatment.

A SLEEP REGIMEN FOR ACUTE MYOCARDIAL INFARCTION

Abstract Pain and fear may predispose to cardiac arrest in myocardial infarction, perhaps by increasing the risk of ventricular fibrillation by promoting the secretion of catecholamines. A regimen designed to reduce pain and fear was tried in fifty-nine patients in an intensive-care unit. The regimen consisted of maintaining the patient in a light sleep, by means of pethidine and promethazine, for 1-7 days, waking the patient thrice daily for feeding, washing, and physiotherapy. The patient was transferred to general wards 3-5 days after the end of the sleep regimen. The only death in the intensive-care unit was from gastrointestinal haemorrhage; arrhythmias did develop but in no case were they refractory. Eight patients (14%) died in hospital after they had left the unit.

CORONARY ARTERY BYPASS SURGERY

There are several newer, less invasive techniques for bypass surgery that can be used instead of open-chest surgery in some cases. In some procedures, the heart is slowed with medicine but is still beating during the procedure. For these types of surgery, a heart-lung bypass machine is not needed. (For open-chest surgery, a heart-lung machine may be used to circulate the blood and to add oxygen to it.) Other techniques use keyhole procedures or minimally invasive procedures instead of open-chest surgery. Keyhole procedures use several smaller openings in the chest and may or may not require a heart-lung machine. These techniques are still being studied and may not be available in all medical centers.