Cardiac Consultation In Patients With Neuropsychiatry Problems

The Clinical Value of the ECG in Noncardiac Conditions

The ECG is an indispensable tool in the ICU for the detection and diagnosis of heart disease. ECG abnormalities however can be present in a wide variety of noncardiac conditions, complicating the differential diagnosis with primary cardiac pathology. This overview discusses the ECG abnormalities and their pathophysiologic basis in the most frequently encountered noncardiac conditions, such as electrolyte abnormalities, pulmonary embolism, CNS diseases, esophageal disorders, hypothermia, and drug-related and other conditions. Knowledge of the characteristic ECG changes may provide early clues to the presence of these disorders, the prompt recognition of which can be life saving.

Late neurocognitive changes from neurological damage following coronary bypass surgery

A detailed case study with neuropsychological data over a 26-year period was used to explore the relationship between neurocognitive vulnerability preoperatively and subsequent neurocognitive decline identified several years postoperatively. Guidelines regarding the importance of neuropsychological assessment of intelligence, attention, memory, language, and visual-spatial planning and organizational skills are provided. Such evaluations clarify postoperative treatment planning because rehabilitation of cardiac patients with premorbid neurocognitive deficits poses special rehabilitation problems. With a detailed neurologic history as part of the preoperative evaluation, healthcare providers can identify acute and subtle risk factors for postoperative neurologic syndromes. This may lead to interventions designed to provide increased patient and family support.

Cardiac surgery in special populations, Part 1: Octogenarians, patients with neuropsychiatric disorders, and blacks

This is the first of a series of articles that discusses the pertinent issues involved in caring for patients undergoing surgery who belong to special populations. Octogenarians have higher mortality, more comorbidities, and special needs regarding convalescence. Patients with neuropsychiatric disorders may have exacerbations of their mental illness after surgery and require special care and patience by the nurse. Survival after cardiac surgery is similar in black and white patients, but the number of blacks having cardiac surgery is significantly and proportionately lower than whites, suggesting either a referral bias or a problem with access to care. Subsequent articles discuss cardiac surgery in women, during pregnancy, in Jehovah's Witnesses, and in patients with Down's Syndrome.