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The aim of the study was to assess the duration of the haemodynamic effects of a new sustained-release oral formulation of isosorbide dinitrate (ISDN). Twenty patients (17 men and 3 women; mean age 60 years) with acute myocardial infarction (10 anterior, 10 inferior) complicated by moderate left ventricular failure took part in a randomized controlled trial. Ten patients were randomly assigned to the placebo group and 10 to the ISDN group, who received 40 mg sustained release isosorbide dinitrate. Haemodynamic variables were measured before treatment, after 0.5 and 1 h and then every 2 hours up to the 8th hour after treatment. There was no significant change in any haemodynamic parameter in the placebo group, during the study period. In the ISDN group there was a significant fall in pulmonary artery diastolic pressure at 4 and 8 h, from 19.0±1.0 mmHg to 16.5±1.2 mmHg and 15.5±0.8 mmHg, respectively. The mean pulmonary capillary wedge pressure fell progressively from 17.9±1.0 to 12.5±1.2 mmHg at 2 h (p<0.001 in comparison with the placebo group. The fall remained significant up to 8 h. There was no statistically significant change in heart rate, cardiac index, systemic blood pressure or systemic and pulmonary vascular resistances. On the whole the cardiac index remained unchanged. There were numerous individual variations of cardiac index in relation to the initial mean pulmonary capillary wedge pressure and the magnitude of its fall following administration of ISDN. The change in cardiac index was inversely correlated with the control cardiac index (r=-0.69, p<0.02).

Circulatory failure occurs in about 10% of patients with pulmonary embolism, resulting from a massive obstruction of the pulmonary arterial bed. Hemodynamic and respiratory features are well established; they involve precapillary pulmonary hypertension, low cardiac output state, elevated filling pressure for the right ventricle, and venous admixture. More recently, two-dimensional echocardiography permitted the visualization of pulmonary artery and right heart enlargement, reduced right ventricular ejection fraction, and tricuspid regurgitation. Evaluated by this latter means, left ventricular systolic function appeared unchanged, but diastolic function might be reduced by septal bulging.

We studied changes in the peripheral plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in seven patients with congestive heart failure (CHF) during four 1-h protocols [...]

For electroventilation, short duration pulse trains (0.1 ms) were applied between two axillary pads (transehest) and compared with transesophageal electroventilation where pulses passed between the same pads to an esophageal [...]

The purpose of this investigation was to determine right ventricular function during weaning from controlled ventilation comparing a biphasic positive airway pressure ventilatory support system (BiPAP [Respironics]) with pressure support [...]

Respiratory dysfunction, particularly atelectasis, is common after open heart surgery. Routine use of PEEP (5 to 10 cm [H.sub.2] O) in these patients has been advocated. We studied the effects [...]

Respiratory failure commonly complicates severe asthma and can lead to death if not treated rapidly and effectively. The goal of this summary is to review the management of respiratory failure, [...]

The Problems Recently there have been considerable advances in our understanding of the role of the 'hands that hold the heart' - the lungs which form the cardiac fossa in [...]