ECG warning system is established for real time monitoring of a patient's electrocardiogram (ECG) and automatic detection of certainement cardiac diseases, namely myocardial infarction, hyperkalemia and atrioventricular block. A distinctive research work related on the assimilation of modern technologies: software, computer and information technologies. ECG early warning system's algorithm is developed in accordance to measuring the average of the ECG signatures and Interprets the data with simulated healthy curve. The prototype system INITIALLY classifies the data and Evaluated it with natural healthy simulated curve. Meanwhile the system discards f healthy curve exists otherwise the system stores the distinguished abnormalities in the curve then transfers Warning to the doctor and patient. Cardiac patients can be assisted by this warning system by detecting abnormalities at the very early stage. Consequently, doctors Provide better tools to identify cardiac diseases resulting things more accurate medical advice

Introduction — Hyperkalemia, defined as serum potassium >6.0mmol/L, affects ±6% of people with kidney disease and is a contraindication to surgery due to the perioperative risk of potentially fatal cardiac dysrhythmia (1,2,3). When emergency surgery cannot be avoided, hyperkalemia must be managed perioperatively using a variety of traditional practice patterns which vary in efficacy (3,4,5). We present a case report of successful rapid correction of hyperkalemia in a 67-year- old man with a history of chronic kidney disease who presented to the emergency department for acute compartment syndrome in need of emergent fasciotomy to prevent loss of limb. Methods — Since emergent treatment of hyperkalemia is often managed through a combination of medications with multiple mechanisms of action, we reviewed available related literature in PubMed in order to present this educational case report. Patient Presentation — At the time of presentation, our patient’s serum potassium was 7.7mmol/L, creatinine kinase was 33,160U/L, and an ECG revealed a first-degree AV node block with slight ST depression. Following intubation, as a team of surgeons started extensive fasciotomy of his arm, our anesthesia team gave several medications in tandem—calcium gluconate to stabilize cardiac myocytes and prevent ventricular arrythmia, coadministration of dextrose and insulin to induce an intracellular shift of potassium, sodium bicarbonate to induce cellular hydrogen/potassium exchange, and albuterol to increase cellular uptake of potassium via β2 adrenergic receptors (1,6). The patient’s hyperkalemia improved from 7.7 to 3.7 (normal 3.5 – 5.1mmol/L) over 4 hours. Discussion and Conclusion — Our review of available literature identified several methods of treatment of hyperkalemia, some with limitations to use which we believe support our team’s approach to treatment in this case report (6). Calcium salts are integral to the treatment of hyperkalemia by stabilizing cardiac myocytes, however they do not directly influence serum or total body potassium levels. Our report adds to a growing pool of existing case reports and small studies documenting safe, efficacious emergent treatment of hyperkalemia. It also describes the utility of the anesthesiologist in providing safe, effective perioperative medical care.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Han, Jianguo. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 66-76). / Abstracts in English and Chinese. / Declaration --- p.i / Acknowledgement --- p.□ / Publication --- p.□ / Abstract (English) --- p.□xi / Abstract (Chinese) --- p.□ / Abbreviations --- p.ix / List of figures / tables --- p.x / Chapter Chapter 1. --- General Introduction / Chapter 1.1 --- Role of vascular smooth muscle cells in the control of coronary circulation --- p.1 / Chapter 1.1.1 --- Potassium channels in the coronary smooth muscle cells --- p.2 / Chapter 1.1.1.1 --- Voltage -dependent potassium (Kv) channels --- p.3 / Chapter 1.1.1.2 --- Inward rectifier K+ (Kir) channels --- p.4 / Chapter 1.1.1.3 --- ATP-sensitive potassium (Katp) channels --- p.4 / Chapter 1.1.2 --- BKCa channels in the regulation of vascular function --- p.6 / Chapter 1.1.2.1 --- The structure of BKCa channels --- p.6 / Chapter 1.1.2.2 --- Role of BKCa channels in the regulation of vascular function --- p.6 / Chapter 1.2 --- Functional alteration of the coronary SMCs during cardiac surgery --- p.7 / Chapter 1.2.1 --- Effect of ischemia on the function of SMCs in the coronary circulation --- p.8 / Chapter 1.2.2 --- Effect of cardioplegic/organ preservation solutions on the function of SMCs in the coronary circulation --- p.11 / Chapter Chapter 2. --- Materials and Methods --- p.14 / Chapter 2.1 --- Isometric force study in small coronary arteries --- p.14 / Chapter 2.1.1 --- Preparation of porcine small coronary arteries --- p.14 / Chapter 2.1.2 --- Experiment procedure --- p.15 / Chapter 2.1.2.1 --- Mounting of small coronary arteries --- p.15 / Chapter 2.1.2.2 --- Normalization procedure for small coronary arteries --- p.16 / Chapter 2.1.2.3 --- Precontraction and relaxation --- p.17 / Chapter 2.1.3 --- Data acquisition and analysis --- p.17 / Chapter 2.2 --- Patch-clamp electrophysiology --- p.18 / Chapter 2.2.1 --- Preparation of porcine coronary arteries --- p.18 / Chapter 2.2.2 --- Enzymatic dissociation of coronary arterial SMCs --- p.18 / Chapter 2.2.3 --- Primary cell culture --- p.19 / Chapter 2.2.4 --- Recording of BKca channel currents --- p.19 / Chapter 2.3 --- Statistical analysis --- p.21 / Chapter 2.4 --- Chemicals --- p.21 / Chapter Chapter 3. --- The Effect of Ischemia on BKCa channels in the Isolated SMCs of Coronary Arteries --- p.22 / Chapter 3.1 --- Abstract --- p.22 / Chapter 3.2 --- Introduction --- p.23 / Chapter 3.3 --- Experimental design and analysis --- p.25 / Chapter 3.3.1 --- Isometric force study in small coronary arteries --- p.25 / Chapter 3.3.2 --- Effect of ischemia on NS1619-induced relaxation in small coronary arteries --- p.26 / Chapter 3.3.3 --- Effect of ischemia on smooth muscle BKca channel currents --- p.27 / Chapter 3.3.3.1 --- Preparation of porcine coronary artery --- p.27 / Chapter 3.3.3.2 --- Enzymatic dissociation of coronary arterial SMCs --- p.27 / Chapter 3.3.3.3 --- Recording of BKCa channel currents --- p.27 / Chapter 3.3.4 --- Data acquisition and analysis --- p.28 / Chapter 3.4 --- Results --- p.28 / Chapter 3.4.1 --- Electrophysiological studies --- p.28 / Chapter 3.4.1.1 --- Effect of IBTX on the whole cell outward currents --- p.29 / Chapter 3.4.1.2 --- Effect of ischemia on the IBTX-sensitive BKca currents --- p.30 / Chapter 3.4.2 --- Relaxation studies --- p.30 / Chapter 3.4.2.1 --- Resting force --- p.30 / Chapter 3.4.2.2 --- U46619-induced contraction force --- p.31 / Chapter 3.4.2.3 --- Effect of IBTX on the NS1619-induced relaxation --- p.31 / Chapter 3.4.2.4 --- Effect of ischemia on the NS1619-induced relaxation --- p.31 / Chapter 3.5 --- Discussion --- p.32 / Chapter 3.5.1 --- Functional changes of the coronary smooth muscle BKca channels after ischemic exposure --- p.33 / Chapter 3.5.2 --- Role of BKca channels in SMCs during ischemia --- p.33 / Chapter 3.5.3 --- Clinical implications --- p.35 / Chapter Chapter 4. --- The Effect of Hyperkalemia on BKCa channels in the Isolated SMCs of Coronary Arteries --- p.41 / Chapter 4.1 --- Abstract --- p.41 / Chapter 4.2 --- Introduction --- p.42 / Chapter 4.3 --- Experimental design and analysis --- p.44 / Chapter 4.3.1 --- Isometric force study in small coronary arteries --- p.44 / Chapter 4.3.1.1 --- Effect of hyperkalemia on NS1619-mediated relaxation in small coronary arteries --- p.44 / Chapter 4.3.2. --- Effect of hyperkalemia on BKCa currents of SMCs --- p.45 / Chapter 4.3.2.1 --- Preparation of porcine coronary arteries --- p.45 / Chapter 4.3.2.2 --- Enzymatic dissociation of coronary arterial SMCs --- p.45 / Chapter 4.3.2.3 --- Recording of BKca channel currents --- p.46 / Chapter 4.3.3. --- Data acquisition and analysis --- p.46 / Chapter 4.4 --- Results --- p.47 / Chapter 4.4.1 --- Effect of hyperkalemia on the iberiotoxin-sensitive BKCa channel currents --- p.47 / Chapter 4.4.2 --- Relaxation studies --- p.48 / Chapter 4.4.2.1 --- Resting force --- p.48 / Chapter 4.4.2.2 --- U46619- and high K+-induced contraction force --- p.48 / Chapter 4.4.2.3 --- Effect of high K+ on the NS1619-induced relaxation --- p.48 / Chapter 4.4.2.4 --- Effect of IBTX on the NS1619-induced relaxation --- p.49 / Chapter 4.5 --- Discussion --- p.49 / Chapter 4.5.1 --- Role of BKCa channels in the isolated SMCs in hyperkalemic solution --- p.50 / Chapter 4.5.2 --- Functional changes of BKCa channels in coronary SMCs in hyperkalemia exposure --- p.51 / Chapter 4.5.3 --- Clinical implications --- p.52 / Chapter Chapter 5. --- General Discussion --- p.58 / Chapter 5.1 --- BKCa channels in porcine coronary SMCs --- p.59 / Chapter 5.2 --- Alteration of BKCa function related to ischemia in porcine coronary SMCs --- p.60 / Chapter 5.3 --- Alteration of BKCa function related to hyperkalemia in porcine coronary SMCs --- p.61 / Chapter 5.4 --- Limitation of the study --- p.62 / Chapter 5.5 --- Future investigations --- p.63 / Chapter 5.6 --- Conclusions --- p.63 / References --- p.66

A obstrução uretral é uma condição clínica comum em gatos, caracterizada por alterações metabólicas e do equilíbrio hidroeletrolítico e ácido-básico que são potencialmente fatais. Dentre as causas de obstrução uretral, a cistite idiopática é a mais frequentemente observada em diversos estudos. Outras causas incluem urolitíase, tampões uretrais e infecção do trato urinário. Em muitos casos, os gatos encontram-se em estado crítico e a morte pode ocorrer em decorrência de alterações metabólicas, como estado urêmico avançado e hipercalemia. As principais alterações eletrolíticas e do equilíbrio ácido-básico relatadas são hipercalemia, acidose metabólica, hiponatremia e hipocalcemia ionizada. Embora a obstrução uretral seja muito frequente na rotina clínica, estudos para caracterizar a população de gatos acometida ainda são escassos no Brasil. Características relacionadas ao manejo, dieta e perfil dos tutores podem influenciar na manifestação da doença. Os objetivos do presente estudo foram avaliar os parâmetros clínicos e as alterações hematológicas, bioquímicas, urinárias, eletrolíticas e ácido-básicas presentes em gatos com obstrução uretral e a associação entre estas variáveis. Além disso, objetivou-se conhecer as principais causas de obstrução uretral nos gatos atendidos no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul. Para isso, foram incluídos no estudo 28 gatos com diagnóstico de obstrução uretral no período de dezembro de 2015 a dezembro de 2016. Foram obtidos dados referentes ao histórico, exame físico, coletados sangue e urina, além da realização de exames de imagem (radiografia e ultrassonografia abdominal). Em todos os gatos foram realizados hemograma, bioquímica sérica, análise de pH, gases e eletrólitos sanguíneos, urinálise e urocultura. Após, todos os pacientes foram tratados de acordo com um protocolo pré-estabelecido. A causa mais comum de obstrução uretral neste estudo foi a cistite idiopática, que ocorreu em mais de 60% dos casos, seguida de tampões uretrais e infecção do trato urinário. Nenhum caso de urolitíase foi diagnosticado, o que pode ser explicado por fatores como idade, ambiente e estilo de vida dos animais. A maioria dos gatos obstruídos apresentou múltiplos sinais sistêmicos, assim como alterações metabólicas, eletrolíticas e do equilíbrio ácido-básico, principalmente azotemia, hiperlactatemia, acidose metabólica, hipercalemia e hipocalcemia ionizada. Hipotermia, depressão do estado mental, bradicardia e desidratação foram os parâmetros clínicos que tiveram maior quantidade de associação com as alterações metabólicas e podem ser considerados bons preditores clínicos destas desordens. Por outro lado, o lactato não foi considerado um bom preditor de alterações clínicas e laboratoriais neste estudo. / Urethral obstruction is a common and potentially life-threatening condition, characterized by severe metabolic, electrolyte and acid-base disturbances. Among the causes of urethral obstruction, idiopathic cystitis is the most frequent in several studies. Other causes include urolithiasis, urethral plugs and urinary tract infection. In many cases, cats are critically ill and death may occur due to metabolic alterations, such as advanced uremic status and hyperkalemia. The main electrolyte and acid-base balance disorders reported are hyperkalemia, metabolic acidosis, hyponatremia and ionized hypocalcemia. Although urethral obstruction is a very common condition, there are few studies characterizing the population affected by the disease in Brazil. Characteristics related to management, diet and owner’s profile can influence the manifestation of the disease. The aim of the present study was to evaluate the association of clinical, haematological, biochemical, urinary, hydroelectrolyte and acid-base parameters in male cats with urethral obstruction. In addition, the objective was to determine the causes of urethral obstruction in male cats admitted to the Veterinary Teaching Hospital of Federal University of Rio Grande do Sul. Twenty-eight cats diagnosed with urethral obstruction were included in the study between December 2015 and December 2016. Data regarding medical history and physical examination were obtained. Blood and urine were collected, and imaging tests were performed (abdominal radiography and ultrasonography). Complete blood count, serum chemistry, blood pH, gas and electrolyte, urinalysis and urine culture were performed. All patients were treated accordingly to a previous established protocol. The most common cause of urethral obstruction in this study was idiopathic cystitis, which occurred in more than 60% of cases, followed by urethral plugs and urinary tract infection. No diagnosis of urolithiasis was achieved which could be explained by factors like age, environment and life style of cats. Most of obstructed cats presented with multiple systemic clinical signs, as well as, metabolic, electrolyte and acid-base alterations. The main disorders found were azotemia, hyperlactatemia, metabolic acidosis, hyperkalemia and ionized hypocalcemia. Hypothermia, depressed mental status, bradycardia and dehydration were the clinical parameters with the greatest amount of associations with the metabolic alterations and can be considered as good predictors of metabolic disorders. On the other hand, lactate was not considered a good predictor of clinical and laboratory abnormalities in this study.

A obstrução uretral é uma condição clínica comum em gatos, caracterizada por alterações metabólicas e do equilíbrio hidroeletrolítico e ácido-básico que são potencialmente fatais. Dentre as causas de obstrução uretral, a cistite idiopática é a mais frequentemente observada em diversos estudos. Outras causas incluem urolitíase, tampões uretrais e infecção do trato urinário. Em muitos casos, os gatos encontram-se em estado crítico e a morte pode ocorrer em decorrência de alterações metabólicas, como estado urêmico avançado e hipercalemia. As principais alterações eletrolíticas e do equilíbrio ácido-básico relatadas são hipercalemia, acidose metabólica, hiponatremia e hipocalcemia ionizada. Embora a obstrução uretral seja muito frequente na rotina clínica, estudos para caracterizar a população de gatos acometida ainda são escassos no Brasil. Características relacionadas ao manejo, dieta e perfil dos tutores podem influenciar na manifestação da doença. Os objetivos do presente estudo foram avaliar os parâmetros clínicos e as alterações hematológicas, bioquímicas, urinárias, eletrolíticas e ácido-básicas presentes em gatos com obstrução uretral e a associação entre estas variáveis. Além disso, objetivou-se conhecer as principais causas de obstrução uretral nos gatos atendidos no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul. Para isso, foram incluídos no estudo 28 gatos com diagnóstico de obstrução uretral no período de dezembro de 2015 a dezembro de 2016. Foram obtidos dados referentes ao histórico, exame físico, coletados sangue e urina, além da realização de exames de imagem (radiografia e ultrassonografia abdominal). Em todos os gatos foram realizados hemograma, bioquímica sérica, análise de pH, gases e eletrólitos sanguíneos, urinálise e urocultura. Após, todos os pacientes foram tratados de acordo com um protocolo pré-estabelecido. A causa mais comum de obstrução uretral neste estudo foi a cistite idiopática, que ocorreu em mais de 60% dos casos, seguida de tampões uretrais e infecção do trato urinário. Nenhum caso de urolitíase foi diagnosticado, o que pode ser explicado por fatores como idade, ambiente e estilo de vida dos animais. A maioria dos gatos obstruídos apresentou múltiplos sinais sistêmicos, assim como alterações metabólicas, eletrolíticas e do equilíbrio ácido-básico, principalmente azotemia, hiperlactatemia, acidose metabólica, hipercalemia e hipocalcemia ionizada. Hipotermia, depressão do estado mental, bradicardia e desidratação foram os parâmetros clínicos que tiveram maior quantidade de associação com as alterações metabólicas e podem ser considerados bons preditores clínicos destas desordens. Por outro lado, o lactato não foi considerado um bom preditor de alterações clínicas e laboratoriais neste estudo. / Urethral obstruction is a common and potentially life-threatening condition, characterized by severe metabolic, electrolyte and acid-base disturbances. Among the causes of urethral obstruction, idiopathic cystitis is the most frequent in several studies. Other causes include urolithiasis, urethral plugs and urinary tract infection. In many cases, cats are critically ill and death may occur due to metabolic alterations, such as advanced uremic status and hyperkalemia. The main electrolyte and acid-base balance disorders reported are hyperkalemia, metabolic acidosis, hyponatremia and ionized hypocalcemia. Although urethral obstruction is a very common condition, there are few studies characterizing the population affected by the disease in Brazil. Characteristics related to management, diet and owner’s profile can influence the manifestation of the disease. The aim of the present study was to evaluate the association of clinical, haematological, biochemical, urinary, hydroelectrolyte and acid-base parameters in male cats with urethral obstruction. In addition, the objective was to determine the causes of urethral obstruction in male cats admitted to the Veterinary Teaching Hospital of Federal University of Rio Grande do Sul. Twenty-eight cats diagnosed with urethral obstruction were included in the study between December 2015 and December 2016. Data regarding medical history and physical examination were obtained. Blood and urine were collected, and imaging tests were performed (abdominal radiography and ultrasonography). Complete blood count, serum chemistry, blood pH, gas and electrolyte, urinalysis and urine culture were performed. All patients were treated accordingly to a previous established protocol. The most common cause of urethral obstruction in this study was idiopathic cystitis, which occurred in more than 60% of cases, followed by urethral plugs and urinary tract infection. No diagnosis of urolithiasis was achieved which could be explained by factors like age, environment and life style of cats. Most of obstructed cats presented with multiple systemic clinical signs, as well as, metabolic, electrolyte and acid-base alterations. The main disorders found were azotemia, hyperlactatemia, metabolic acidosis, hyperkalemia and ionized hypocalcemia. Hypothermia, depressed mental status, bradycardia and dehydration were the clinical parameters with the greatest amount of associations with the metabolic alterations and can be considered as good predictors of metabolic disorders. On the other hand, lactate was not considered a good predictor of clinical and laboratory abnormalities in this study.

A obstrução uretral é uma condição clínica comum em gatos, caracterizada por alterações metabólicas e do equilíbrio hidroeletrolítico e ácido-básico que são potencialmente fatais. Dentre as causas de obstrução uretral, a cistite idiopática é a mais frequentemente observada em diversos estudos. Outras causas incluem urolitíase, tampões uretrais e infecção do trato urinário. Em muitos casos, os gatos encontram-se em estado crítico e a morte pode ocorrer em decorrência de alterações metabólicas, como estado urêmico avançado e hipercalemia. As principais alterações eletrolíticas e do equilíbrio ácido-básico relatadas são hipercalemia, acidose metabólica, hiponatremia e hipocalcemia ionizada. Embora a obstrução uretral seja muito frequente na rotina clínica, estudos para caracterizar a população de gatos acometida ainda são escassos no Brasil. Características relacionadas ao manejo, dieta e perfil dos tutores podem influenciar na manifestação da doença. Os objetivos do presente estudo foram avaliar os parâmetros clínicos e as alterações hematológicas, bioquímicas, urinárias, eletrolíticas e ácido-básicas presentes em gatos com obstrução uretral e a associação entre estas variáveis. Além disso, objetivou-se conhecer as principais causas de obstrução uretral nos gatos atendidos no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul. Para isso, foram incluídos no estudo 28 gatos com diagnóstico de obstrução uretral no período de dezembro de 2015 a dezembro de 2016. Foram obtidos dados referentes ao histórico, exame físico, coletados sangue e urina, além da realização de exames de imagem (radiografia e ultrassonografia abdominal). Em todos os gatos foram realizados hemograma, bioquímica sérica, análise de pH, gases e eletrólitos sanguíneos, urinálise e urocultura. Após, todos os pacientes foram tratados de acordo com um protocolo pré-estabelecido. A causa mais comum de obstrução uretral neste estudo foi a cistite idiopática, que ocorreu em mais de 60% dos casos, seguida de tampões uretrais e infecção do trato urinário. Nenhum caso de urolitíase foi diagnosticado, o que pode ser explicado por fatores como idade, ambiente e estilo de vida dos animais. A maioria dos gatos obstruídos apresentou múltiplos sinais sistêmicos, assim como alterações metabólicas, eletrolíticas e do equilíbrio ácido-básico, principalmente azotemia, hiperlactatemia, acidose metabólica, hipercalemia e hipocalcemia ionizada. Hipotermia, depressão do estado mental, bradicardia e desidratação foram os parâmetros clínicos que tiveram maior quantidade de associação com as alterações metabólicas e podem ser considerados bons preditores clínicos destas desordens. Por outro lado, o lactato não foi considerado um bom preditor de alterações clínicas e laboratoriais neste estudo. / Urethral obstruction is a common and potentially life-threatening condition, characterized by severe metabolic, electrolyte and acid-base disturbances. Among the causes of urethral obstruction, idiopathic cystitis is the most frequent in several studies. Other causes include urolithiasis, urethral plugs and urinary tract infection. In many cases, cats are critically ill and death may occur due to metabolic alterations, such as advanced uremic status and hyperkalemia. The main electrolyte and acid-base balance disorders reported are hyperkalemia, metabolic acidosis, hyponatremia and ionized hypocalcemia. Although urethral obstruction is a very common condition, there are few studies characterizing the population affected by the disease in Brazil. Characteristics related to management, diet and owner’s profile can influence the manifestation of the disease. The aim of the present study was to evaluate the association of clinical, haematological, biochemical, urinary, hydroelectrolyte and acid-base parameters in male cats with urethral obstruction. In addition, the objective was to determine the causes of urethral obstruction in male cats admitted to the Veterinary Teaching Hospital of Federal University of Rio Grande do Sul. Twenty-eight cats diagnosed with urethral obstruction were included in the study between December 2015 and December 2016. Data regarding medical history and physical examination were obtained. Blood and urine were collected, and imaging tests were performed (abdominal radiography and ultrasonography). Complete blood count, serum chemistry, blood pH, gas and electrolyte, urinalysis and urine culture were performed. All patients were treated accordingly to a previous established protocol. The most common cause of urethral obstruction in this study was idiopathic cystitis, which occurred in more than 60% of cases, followed by urethral plugs and urinary tract infection. No diagnosis of urolithiasis was achieved which could be explained by factors like age, environment and life style of cats. Most of obstructed cats presented with multiple systemic clinical signs, as well as, metabolic, electrolyte and acid-base alterations. The main disorders found were azotemia, hyperlactatemia, metabolic acidosis, hyperkalemia and ionized hypocalcemia. Hypothermia, depressed mental status, bradycardia and dehydration were the clinical parameters with the greatest amount of associations with the metabolic alterations and can be considered as good predictors of metabolic disorders. On the other hand, lactate was not considered a good predictor of clinical and laboratory abnormalities in this study.