Elderly Coronary Patients Research Articles

Elderly coronary artery bypass graft patients with left ventricular dysfunction are hemodynamically stable after two different doses of rocuronium

Objective: To clarify the detailed hemodynamic responses to bolus administration of 2× 95% effective dose (ED 95) and 3× ED 95 of rocuronium in elderly patients with left ventricular dysfunction undergoing elective coronary artery bypass grafting (CABG). Design: Prospective, randomized, clinical study. Setting: University hospital. Participants: Twenty patients aged older than 65 who had coronary artery disease with left ventricular ejection fractions equal to or less than 40%. Interventions: Using invasive cardiac monitoring, the detailed hemodynamic profile was obtained before and at 2, 4, 6, 8, and 10 minutes after the injection of rocuronium. Measurements and Main Results: Minor changes in all the measured or derived hemodynamic variables within the two groups did not attain statistical significance. Except for a higher baseline and the subsequent mean arterial pressures in one group, there were neither statistically nor clinically significant differences between two different doses of rocuronium in any of the variables at any time. Conclusion: The results demonstrate that bolus administration of rocuronium (2× to 3× ED 95) in combination with high-dose fentanyl provides sufficient cardiovascular stability among elderly CABG patients with left ventricular dysfunction. The cardiovascular profile of the two different bolus doses was similar. Rocuronium, in both doses, appears to be a suitable agent for muscle relaxation, especially for patients who require a high degree of cardiovascular stability.

Prevalence and Effects of Cardiac Rehabilitation on Depression in the Elderly With Coronary Heart Disease

Depression is a prevalent condition in coronary patients and is associated with increased morbidity and mortality following major coronary events. We measured the prevalence of depressive symptoms in 268 elderly coronary patients 4 to 6 weeks following a major coronary event and assessed its modulation by outpatient cardiac rehabilitation and found that cardiac rehabilitation resulted in a significant reduction in the prevalence and severity of this disorder.

EXERCISE TRAINING RESPONSES IN ELDERLY WOMEN AND MEN ENROLLED IN CARDIAC REHABILITATION 1579

Referral of the elderly coronary patient (> 70 years) for exercise rehabilitation is disproportionately low, often due to the perception that meaningful physiological gains are unlikely. The changes in cardiorespiratory status and body dimensions were measured in 32 elderly women ([horizontal bar over]x age = 75.0±3.9 yrs) and 167 men ([horizontal bar over]x age = 74.9±2.9 yrs) who completed an 18-month walk/jog exercise rehabilitation programme after acute myocardial infarction or coronary bypass surgery. RESULTS (absolute and percentage, initial and final testing):Table We conclude that older men and women can safely complete a cardiac exercise training programme and can obtain significant training benefits.

Predictive accuracy of midazolam in adult patients scheduled for coronary surgery

Study Objective: To evaluate the predictive accuracy of midazolam during cardiac anesthesia so as to orient the selection of the most appropriate pharmacokinetic model for use in a computer-assisted continuous-infusion system. Design: Retrospective analysis. Setting: Operating room at a university hospital. Patients: 66 consecutive middle-aged and elderly coronary patients scheduled for coronary artery bypass graft (CABG) surgery. Interventions: Patients were anesthetized using a variable-rate infusion of alfentanial combined with midazolam in an attempt to achieve and maintain target concentrations of 100 ng/ml or 500 ng/ml. Measurements and Main Results: A total of 323 arterial blood samples were taken, and serum midazolam concentrations were measured by high-performance liquid chromatography. Predicted midazolam concentrations were calculated using 3 selected data sets. Their bias, inaccuracy, and dispersion were assessed by determining the median performance error, the median absolute performance error (MDAPE), and the 10th and 90th percentiles. Two of the selected data sets of midazolam, with a clearance lower than 5 ml/ kg/min, were very accurate (MDAPE less than 20 %) in predicting low or high prebypass concentrations of midazolam in adult patients with good left ventricular function. Conclusions: Two of the 3 pharmacokinetic data sets of midazolam studied may be selected when using a computer-assisted infusion system in adult coronary patients.

Short Communication

Determination of Perceived Health Among Elderly Coronary Patients

Supporting elderly coronary patients in self‐help groups with a guidebook; a nurse intervention for public health

Summary Elderly people arc more often subject to coronary diseases than young people, and the rapid growth of the number of elderly people in society has implications for care. An interesting alternative or complement to traditional rehabilitative care is self‐help groups where ‘natural’ care can bring a new perspective to practice. The aim of this paper is to describe a nurse intervention in connection with self‐help groups for elderly persons post‐coronary. This intervention embraces health advice for the group members in the form of a guidebook, comprising physical, psychological and social health aspects to be used in group meetings. From a public health perspective such an intervention is one way to show how nurses can work in rehabilitative care, as well as in promotive and preventive care, outside the health care and medical services.

Exercise testing and training of the elderly coronary patient

Exercise testing and training of the elderly coronary patient

Exercise Testing and Training of the Elderly Coronary Patient

The majority of US patients with clinical evidence of coronary heart disease are elderly. Appropriately prescribed and designed exercise training can improve physical and psychologic functional status and encourage maintenance of an independent life-style. Exercise testing, in addition to helping identify elderly coronary patients at high risk of recurrent events who warrant added therapies, can guide the recommendations for their exercise regimen.

A utilização da artéria torácica interna aumenta a mortalidade hospitalar do paciente coronariano idoso revascularizado?

No InCor, foi elaborado um protocolo para avaliar se o emprego da artéria torácica interna alterava a mortalidade hospitalar nos pacientes coronarianos idosos (idade > 70 anos), submetidos a revascularizaçáo isolada, eletiva do miocárdio. No protocolo foram incluídos parâmetros clínicos, hemodinâmicos, radiológicos, operatórios e de pós-operatório. Foram analisados 100 pacientes consecutivos, com observações completas, em estudo prospectivo. A análise estatística foi realizada pelo teste de X² de Pearson. Concluímos que houve diferença estatística entre os grupos comparados e que a mortalidade hospitalar foi maior no grupo de pacientes nos quais se utilizou o enxerto de veia safena autógena. Atribuiu-se ao cirurgião, como triador, a obtenção de tais resultados, utilizando a artéria torácica interna naqueles pacientes em melhor estado geral.

Rehabilitation of the patient with coronary heart disease. New information for improved care.

The benefits of early ambulation and predischarge exercise testing for stable patients after acute myocardial infarction have been well documented. Early exercise testing can help stratify patients into risk categories; these can guide recommendations for further diagnostic testing for medical or surgical interventions, as well as suggest appropriate activity levels after hospital discharge. The scope of cardiac patients currently considered eligible for exercise rehabilitation is far greater than in the past. Exercise training can improve functional capacity, predominantly mediated by peripheral adaptations; guidelines must be developed for the exercise training and surveillance of severely ill and elderly coronary patients. Education in coronary risk reduction and counseling to limit psychosocial complications of coronary disease and encourage return to work when appropriate can improve the coronary patient's functional status and clinical outcome. Further research is needed to determine the rehabilitative needs of more severely impaired, medically complex patient subgroups and the most cost-effective means of delivering rehabilitative services.

Rehabilitation of elderly coronary patients.

Rehabilitation of elderly coronary patients.

C-REACTIVE PROTEIN SERUM CONCENTRATIONS IN WELL-TRAINED ATHLETES

Previously it had been shown that there is a sharp increase in C-reactive protein (CRP) serum concentration during the first few days after severe exercise. To evaluate the effect of physical training on the CRP levels, a sensitive enzyme immunoassay was developed and used to assess the basal CRP concentrations in 356 male and 103 female athletes, who trained at least 4 times per week in various disciplines, in 45 male and 40 female untrained controls, and in 35 elderly coronary patients. In male athletes the lowest CRP values were found in swimmers (median: 102 ng/ml, n = 59), which were significantly lower (P less than 0.001) than those of male controls (median: 502 ng/ml, n = 45). The CRP concentrations in rowers (median: 260 ng/ml, n = 108) were also significantly lower (P less than 0.01) than in the control group. CRP levels in middle- and long-distance runners (median: 315 ng/ml, n = 53), racing cyclists (median: 620 ng/ml, n = 111), and soccer players (median: 660 ng/ml, n = 25) did not differ significantly from those of the controls. In female athletes the lowest CRP concentrations were also found in swimmers (median: 110 ng/ml, n = 49), which were significantly lower (P less than 0.001) than those of the female controls (median: 396 ng/ml, n = 40). Female middle- and long-distance runners (n = 36) and female rowers (n = 18) had median CRP values of 250 and 285 ng/ml, respectively. This results suggest that training induces a suppressive effect upon CRP, responsible for the low serum levels in athletes (particularly swimmers) when compared to controls.(ABSTRACT TRUNCATED AT 250 WORDS)