Showing papers in "Acta Cardiologica in 1976"

Reversal of acute myocardial ischemia in closed chest animals by retrograde perfusion of the coronary sinus with arterial blood.

Abstract: The fundamental objective of this study was to develop a technique for salvaging aco the ischemic muscle segment is the coronary venous system. We have been able to ration) in closed chest dogs by placing a double lumen balloon catheter in the coronary sinus, and perfusing it with blood derived from a peripheral artery. We have been able to partially reverse these same manifestations in similar dogs with an ischemic period of 30-60 minutes.

Electrocardiographic findings in 24 patients with myasthenia gravis.

Abstract: Twenty four myasthenia gravis patients, 14 females and 10 males, aged between 5 and 65 years (average 29) were studied electrocardiographically. The abnormalities found in the ECG were: prolonged "Q-T" intervals (10 cases, 44.1%), sinus tachycardias (5 cases, 20.8%), sinus arrhythmias (5 cases, 20.8%), right bundle branch block (4 cases, 16.6%), and non-specific "T" wave changes (2 cases, 8.3%). Among our 24 patients with myasthenia gravis, in contrast to previous reports, only two had non-specific "T" wave abnormalities. But prolonged "Q-T" intervals, right bundle branch block, sinus tachycardias and sinus arrhythmias, when compared to normal population incidence, were found to be quite significant. In pathogenesis, primary myocardial histo-pathological abnormalities, and the role of extracardiac factors in producing the changes were discussed.

Relative value of beta blockers and thiazides for initiating antihypertensive therapy. Beta blockers or thiazides in hypertension.

Abstract: Fifty-five patients with mild to moderate, renal or essential hypertension were admitted to a double blind cross-over trial of 18 weeks, involving treatment periods with placebo, the thiazide bendrofluazide (15 mg daily) and the beta blocker atenolol (600 mg daily). Compared to the placebo period (190/117 mm Hg) the hypotensive effect of atenolol (-24/16 mm Hg) was more pronounced than the hypotensive effect of bendrofluazide (-17/6 mm Hg). Arguments in favor of initiating antihypertensive drug therapy with beta blocker were its more powerful hypotensive effect, the quicker onset of its action, less metabolic disturbance, decreased frequency of complaints and patient's preference. On thiazides body weight and the frequency of swollen ankles decreased. Plasma renin concentration was not found to have a strong predicting power for the hypotensive effect of atenolol or bendrofluazide but low renin patients showed a more pronounced blood pressure decrease on bendrofluazide and high renin patients, especially essential hypertensives, on atenolol. While these points can be a guide to therapy today, the preference of one drug over the other must eventually be based on their relative efficacy in decreasing morbidity and mortality from the hypertensive disease.

Pathology of chronic A-V Block.

Abstract: Study of 177 cases of permanent A-V block shows idiopathic bilateral bundle branch fibrosis to be the commonest single cause (33%). This entity covers a spectrum of localised loss of conduction fibres in the proximal left bundle branch and bifurcating main bundle (Lev's disease) to moore periphery loss of conduction fibres in the bundle branches alone (Lenegre's disease). The aetiological factors in idiopathic bundle branch fibrosis are still obscure. Ischaemic damage is responsible for 17% of cases and are usually patients who have survived destruction of the bundle branches in septal infarction. Calcific A-V block is the term applied to destruction of the main bundle by large masses of calcification in the mitral or aortic valve rings and is responsible for 10% of cases of chronic A-V block. The mass of calcium is visible to the naked eye at autopsy or by X ray in life. Cardiomyopathies of all types (except hypertrophic obstructive cardiomyopathy) involve the conduction system and produce 14% of cases of A-V block. The remaining numerous causes of chronic A-V block are individually very rare ranging through tumour involvement, congenital defects, collagen diseases and surgical or traumatic damage.

Serum magnesium concentrations in atrial fibrillation.

Abstract: Serum magnesium and digoxin levels were obtained in 13 nontoxic patients with atrial fibrillation due to chronic rheumatic heart disease receiving digoxin for the control of ventricular rate and heart failure. Fairly good correlations were made between serum digoxin levels and ventricular rates. Hypomagnesemia was quite common (7 out of 13) and mean magnesium serum levels were significantly lowered in total as well in 7 hypomagnesemic patients, as compared to in healthy controls. Magnesium sulphate was successfully used in patients with magnesium deficiency to control the ventricular rates.

Protein synthesis in heart mitochondria: mechanism and metabolic aspects.

Abstract: A short review is given with respect to the status quo of the knowledge of mitochondrial protein synthesis in mammalian tissues. The inhibitory effects of antibiotic such as chloramphenicol and thiamphenicol are discussed from the point of possible complications for cardiac metabolism. It is shown that a decrease of the activity of cytochrome c oxidase, the terminal enzyme of the respiratory chain, caused an increase in the production of lactate, if beating heart cells are cultured in the presence of chloramphenicol. In vivo treatment of rabbits with the chloramphenicol analogue thiamphenicol causes a strong fall in the cytochrome aa3 content of the hearts. The results are discussed in the light of the possible implications for cardiac function and metabolism in man.

Magnesium and the heart.

Abstract: Magnesium is a most important cation in the body mostly distributed in the skeleton, muscles and liver. The most important causes of magnesium deficiency in the body include wide range of gastrointestinal disorders, diuretic therapy, endocrine disorders, renal diseases, alcoholism, etc. The demonstration of hypomagnesemia in patients of digitalis toxicity is of great clinical significance since magnesium can be replaced among these patients and toxicity and mortality due to this drug can be minimised. In patients with low serum magnesium, the cellular content of this ion may be normal. Therefore, it is of great interest to study the myocardial level of this ion in cardiovascular diseases. The clinical features of magnesium deficit are related to neuromuscular disorders. However, ST and T waves changes are quite commonly seen in the electrocardiogram and cardiac arrhythmias rarely have also been described. Magnesium administration on the other hand causes hypotention, bradycardia, and conduction defects. Magnesium depresses central nervous system, neuromuscular transmission and conductivity of the heart. Magnesium therapy is indicated when clinical features of magnesium deficiency are present in association with low serum or tissue levels.

Prognostic value of intraventricular conduction blocks in acute myocardial infarction.

Abstract: An intraventricular conduction defect complicated 61 out of 765 cases of acute myocardial infarctions. The defect, with the exception of two cases, always developed in infarctions affecting the anterior wall of the heart. Compared with the other acute anterior myocardial infarctions in which the mortality in the Coronary Care Unit was 15%, infarctions complicated by intraventricular conduction defects have on the whole, presented a worse clinical course and a higher mortality rate (54%). It must be stressed that clinical course and mortality rate have been very different in the various conduction defects. The most innocuous conduction defects were the anterior fascicular block, and, with some reserve, the right bundle branch block too, defects in which the clinical course and the mortality rate were not significantly different from those of the other anterior myocardial infarctions not complicated by intraventricular conduction troubles. On the contrary clinical course was more serious and mortality rate higher (52%) in the cases in which the two defects were associated. Myocardial infarctions complicated by left bundle branch block, right bundle branch block with posterior fascicular block, alternating bundle branch block presented an extremely serious clinical course and a very high mortality rate (over 85%). These differences in the clinical course and in the mortality rate of the various intraventricular conduction defects are explained by the fact that they are associated with myocardial damage of different degree, which is clarified by knowledge of the blood supply of the intraventricular conduction system.

Arthritis and heart lesions. A study of 25 cases with pericarditis or valvular lesions associated to inflammatory joint disease.

Abstract: Clinical and laboratory data of 25 patients with inflammatory joint disease and pericarditis or valvular heart disease are reviewed. The patients were divided in two groups: 11 presented pericarditis and 14 valvular heart disease. The patients studied presented a spectrum of diseases ranging from classical sero-positive rheumatoid arthritis to ankylosing spondylitis. Acute rheumatic fever was in no case the actual joint disease. In contrast to the patients with valvular heart disease nearly all patients with pericarditis were rheumatoid arthritis factor positive and signs of a generalized systemic disease with vasculitis were also more frequent. In the pericarditis group there was no sex difference in contrast to the valvular group where females were more often affected. The heart lesions were usually detected late in the course of the chronic joint disease. Valvular heart disease occurs not only in ankylosing spondylitis but also in rheumatoid arthritis, usually the sero-negative type. In the light of a survey of the literature, the pertinent findings are discussed.

Polysplenia with left ventricular hypoplasia and partial anomalous pulmonary venous connection.

Abstract: A case is reported of left ventricular hypoplasia associated with anisosplenia. Even though congenital heart malformations are frequently found in cases of splenic anomalies, the association of polysplenia with hypoplastic left heart syndrome is extremely rare. The existence in addition of partial anomalous pulmonary venous connection of the right pulmonary veins to the right atrium, gave us the possibility of study the different changes in pulmonary arteries wall thickness in both lungs.

Left bundle branch block: a rare manifestation of digitalis intoxication.

Abstract: A case of LBBB due to digoxin intoxication is presented. The diagnosis was made by repeated electrocardiograms and demonstration of high serum digoxin level at the time of toxic manifestation. Differential diagnosis of LBBB may also include drugs like digoxin.

Surface maps and myocardial scanning at rest and during exercise: comparison with coronary angiography.

Abstract: The observations of surface electromaps recorded at rest and during exercise in two examplative cases are reported: the first one deals with a normal man while the second refers to a patient suffering from an old inferior myocardial infarction with bouts of angina pectoris; these surface maps are compared with myocardial scanning also performed at rest and during exercise. Special attention is devoted to the possible relation of the above described, non invasive, techniques to the anatomical description of coronary lesions as demonstrated by coronary angiography. A close relationship is found between the surface potential distribution pattern and the area of hypofixation observed on the scan as far as the presumed location of ischemic myocardial tissue is concerned. These two techniques might offer the following advantages, when used together: they are non invasive, which should result in diminishing risks and allow repeated investigations; therefore they perhaps could be better suited for population screening and follow up studies than invasive techniques such as coronary angiography; they may provide interesting clues as to the site, the extent and the evolution of damaged myocardial areas; they could also provide a more objective criterion for the selection of patients who should undergo coronarography. However, we have to take into account that these techniques are rather expensive. This is the reason why, although the first results look promising, further studies are needed.

Multiple coronary arteriovenous fistulae.

Abstract: A case with multiple congenital coronary arteriovenous fistulae is reported. The right coronary artery was communicating with the right ventricle. The left coronary artery was entering directly into the pulmonary trunk and two terminal branches of the anterior descending into the left ventricle. The direct communication of the left coronary artery without interposition of an accessory artery or a circoid plexus is met for the first time.

The angiocardiographic appearance of the endocardial cushion defect in selected transposition and malposition complexes.

Abstract: Although the angiocardiographic features of the endocardial cushion defect (ECD) have been well described in the patient with two normally related ventricles (D-ventricular loop in situs solitus) and normally related great arteries, little attention has been focused on the angiocardiographic appearance of the ECD in patients with complex cardiovascular disease. Because of recent surgical advances in the treatment of single ventricle and double outlet right ventricle complexes, it has become increasingly important to document the status of the atrioventricular valves in these patients. The angiocardiographic features of the ECD are therefore described in two patients, one with D-loop, single left ventricle and outlet chamber, D-transposition of the great arteries, bilateral conus and pulmonary stenosis and the other with dextrocardia, situs inversus, double outlet right ventricle, common atrioventricular canal and pulmonary stenosis. In both patients, the left ventricular outflow tract, despite aortic-mitral discontinuity, is characterized by elongation, scalloping and serration, and the classic appearance of the "gooseneck" deformity is observed on left ventricular angiography. It thus appears that aortic-mitral continuity and two well-formed, normally related ventricles and great arteries are not invariable necessary to the manifestation of the "gooseneck" deformity in the patient with complex cardiovascular disease and associated endocardial cushion defect.

Mechanical alterations of the left ventricle during right atrial pacing.

Abstract: The effect of increasing heart rate by right atrial pacing on the peak value of the first derivative of left ventricular (LV) pressure(dp/dt) and the maximal velocity of the contractile element (KVmax) was studied in 12 cases. Peak dp/dt was poor as regards its sensitivity in reflecting the changes of contractility, due to its strong dependence on LV end-diastolic (EDP) and systolic pressure. KVmax increased constantly in the 4 normals and in 2 cases of ischaemic heart disease which did not develop angina; the increase exceeded 90 ml sec-1 in the former and one of the latter cases in which resting LV function was normal. In contrast, it decreased during the development of ischaemia in two of the three cases which developed angina; in the third case, in which also resting LV function was seriously impaired, the course of KVmax was almost flat. A similar flat course was observed in the three cases of congestive myocardiopathy. the above alterations of KV max were independent of the EDP and proportional to the basic contractility and its anticipated changes during pacing.

Epidemiology of cardiovascular disease in the urban population of the town of Pahlavi (North Iran)

Abstract: A survey of cardiovascular diseases was carried out in June-August 1973 in the city of Pahlavi, a port in the Caspian area in Iran. A representative sample was taken from persons aged 35 years and older from both sexes. The prevalence of high blood pressure (WHO definition) is 29,7% in men and 31,0% in women of this age group. ECG tracings were prepared and the prevalence of various abnormalities are presented. A considerable proportion of the population have ST segment and T wave abnormalities. Correlation between ECG abnormalities and blood pressure figures has been studied. This study shows that there is a relationship between ECG abnormalities of group 3, 4 and 5 (Minnesota Coding) and the levels of blood pressure.

Orientation of the fascicles of the ventricular myocardium.

Abstract: A new technique was developed to examine the arrangement of the fascicles of the myocardium. Liquid plastic was injected intramurally into the free walls and the septum of more than 300 hearts of mammals and birds. After the plastic hardened, the tissues were digested in alkali, thereby releasing a plastic cast which had been formed in the myocardium. The plastic plates formed in the heart were consistently perpendicular to the surfaces of the epicardium and the endocardium. Related studies have shown that each cluster or clone of muscle fibers is contained in a fibrous connective tissue capsule. The injected plastic is therefore confined to the trabecular (extracapsular) clefts which define the borders of the capsules. The casts show that the capsules containing the muscle fibers are arranged in the planes of great circles of the myocardial spheroid. These capsules are shaped as wedges with acute angles at the endocardium, and with dihedral angles less than 1 degree. Interventricular sulci interrupt and separate the capsules of the right free wall from the left free wall. Septal capsules are separated from but aligned with the long directions of the capsules of the adjacent free walls. These data challenge the currently accepted concept of the bandage-like arrangement of the myocardial fascicles. The significance of our findings with respect to myocardial function is discussed.

Postventriculotomy aneurysm and left ventricular dysfunction following closed mitral commissurotomy.

Abstract: A ventricular aneurysm at the site of a previous transventricular commissurotomy for mitral stenosis was diagnosed in a 39 year old female. Catheterization data showed abnormal left ventricular response to exercise and to increased afterload. Death occurred following mitral valve replacement. At autopsy no cause other than left ventricular aneurysm could be established to explain left ventricular dysfunction.

Calcific constrictive pericarditis of anginal form complicated by hemopericardium and tamponade during anticoagulant treatment

Abstract: The case-history of a patient with calcified constrictive epicardopericarditis with rapidely progressive aggravation after digestive hemorrage due to excessive dose or oral anticoagulant therapy is reported. The occurrence of a cardiac tamponade has necessitated pericardectomy which has permitted to detect a partitionned hemopericardium. The surgical act was followed by gross improvement of both constrictive phenomenon and angina pectoris which have grounded the prescription of anticoagulant therapy. Anticoagulant therapy is likely responsible of the hemopericardium. Such facts are exceptionals in the course of constrictive pericarditis; diagnostic and therapeutic problems related to this complication are studied. The question of angina pectoris in the course of acute and chronic pericarditis is briefly studied by the way of this observation. Attention is drawed on the danger of the prescription of anticoagulant therapy in the course of some constrictive pericarditides.

Results of follow-up study in cardiac pacing at St. Raphael University Hosital in Leuven.

Abstract: After this follow-up period some data seem important for the future: 1. Sudden failure never occurred for ventricular asynchronous units. Moreover battery survival time of fixed rate units is longer than that of ventricular-inhibited units. On the other hand, the use of fixed rate pacers avoids a number of demand function-related electrode difficulties. We must be aware of false signals generated by malfunctioning electrodes. 2. The reliability of a pacemaker clinic improves by replacing ventricular-inhibited units after 34 months. 3. Despite the additional work and cost we feel that photoanalysis is indispensable in today's pacemaker clinic.

The contribution of right ventricular angiocardiography to the diagnosis of tricuspid valvular stenosis (Observations made on 3 patients).

Abstract: The right ventricular angiocardiographic findings, in the anterioposterior projection, are described on three patients with tricuspid valvular stenosis. During diastole, the tricuspid valve was delineated as an arcline contour, placed between the non opacified right atrium and the opacified right ventricle, and it was displaced to the left of the spine. Its mobility was diminished. Right ventricular angiocardiography seems to be a useful method for the diagnosis of the tricuspid valvular stenosis and the estimation of the pathology and the functional condition of the tricuspid valve. The method is recommended for further evaluation.

Left ventricular aneurysmectomy for refractory tachyarrhythmias: report in 11 postinfarction patients.

Abstract: Between January 1970 and August 1974, eleven postinfarction patients underwent left ventricular aneurysmectomy for refractory tachyarrhythmias. Ten suffered from ventricular tachycardias and one from supraventricular tachycardia. All had localized aneurysms and normal contractions of the surrounding myocardium on angiocardiography. None suffered from significant angina, congestive heart failure or papillary muscle dysfunction. The diagnosis was first suspected at fluoroscopy, the latter being in our opinion a most reliable screening method for the recognition of these cases. There was one hospital death after surgery. The remaining ten patients are now free from further arrhythmic attacks for a follow-up period between fourteen months to five and a half years. These results confirm that in some carefully selected postinfarction patients, left ventricular aneurysmectomy without concomittant aortocoronary bypass may result in the elimination of medically intractable tachyarrhythmias.

Prinzmetal's variant angina.

Abstract: Two patients are described with a typical Prinzmetal's variant angina. Both patients were young, active males with angina of recent onset. They experienced angina only at rest and in one patient the angina had a cyclic character appearing only between 4 and 10 a.m. In both patients there was no correlation whatsoever between the angina pectoris and effort, emotion or change in temperature and the angina reacted promptly to nitroglycerine sublingually. The number of attacks and the intensity of the pain were increasing rapidly over a short period of time in both cases. The stenoses in both patients did not exceed 50% of the lumen of the coronary arteries, but coronary surgery has been performed on clinical grounds because both patients were completely disabled and one of them suffered from life-threatening dysrhythmias. For respectively 18 and 6 months after saphenous vein bypass surgery both patients have been symptom-free and able to resume their work. The problems concerning the diagnosis Prinzmetal's variant of angina pectoris are discussed.

Résultats immédiats et à long terme de la chirurgie de la valve tricuspide. a propos de 62 cas opères

Abstract: Operative and late results in a series of patients operated on at the tricuspid valve (replacement or annuloplasty) at the moment of surgery upon mitral and aortic valves are reported. Functional tricuspid insufficiency carries a greater risk than organic tricuspid disease. Considering the duration of the underlying mitral disease, four grades are set up for the mitro tricuspid patient allowing for prognosis and indication of the type of surgery to be done on the tricuspid valve.

Prenylamine inhibition of isoproterenol induced myocardial lesions. Histochemical and ultrastructural findings.

Abstract: Eighty Wistar rats were divided into 4 groups. All of them received 10 mg/kg i.p. isoproterenol (ISP). The animals were sacrificed at 5 min. (groups A and B) and 24 hours (groups C and D). Groups A and C served as control of group B and D. Group B also received 9 mg/kg prenylamine (P), 30 min before ISP and group D 9 mg/kg P, 1 hour before and 1 hour after ISP. Transversal slices of each heart underwent the following procedures: hematoxilineosin, Barbeito-Lopez trichromic, "ischemia stain", acid phosphatase stain and standard electron microscopy. Group A and C showed positivity for ischemic techniques; necrotic and ischemic zones represented, in average 25.1 +/- 1.4% of the myocardial volume. Group B and D (ISP + prenylamine) showed no significant lesions. Group D (ISP + prenylamine, sacrificed at 24 hours) presented complete absence of "infarct-like" lesions in 17 out of the 20 studied animals. No evident changes in acid-phosphatase enzymes were detected. Animals treated with ISP alone presented "contraction bands" at electron microscopy as well as myofibrillar fragmentation. Those receiving also P showed only light alterations, in the electron microscopy specimens. A primary action of ISP on the calcium pump might explain the infarct-like lesions found in our study. The inhibition of these above mentioned lesions by prenylamine, a drug which acts by slowing down the ca transport, also supports this interpretation.

Bidirectional tachycardia a study of five cases.

Abstract: Five patients with bidirectional tachycardia due to digitalis toxicity associated with severe organic heart disease were studied. The origin of the abnormal rhythm was established with the aid of His bundle recordings in three cases and by indirect clues in the others two. In three cases the origin of bidirectional tachycardia was suprahisian while in two patients it was infrahisian. In one patient the transition from junctional to ventricular tachycardia could be observed. Bidirectional tachycardia appears to be a complex arrhythmia in which similar electrocardiographic configuration can be due to different mechanism. Digitalis toxicity was often a causal factor.

Double atrial parasystole. Case report.

Abstract: A 62 year-old man with hiatal hernia and complex atrial arrhythmia is reported. On the standard electrocardiogram a double atrial parasystole is found, with reversed coupling. During carotid sinus massage only one of the parasystolic foci is not influenced, and assumes the atrial activity, regularizing the cardiac rhythm.

Haemodynamic alterations of the left ventricle during right atrial pacing.

Abstract: The left ventricular haemodynamic alterations during right atrial pacing were studied in 12 cases. Cardiac index varied little: during maximal rate however, its mean value was slightly lower than the resting one. Stroke index decreased inversely to the heart rate. The course of these indices did not separate the normal from abnormal cases. Ventricular function curves (VFCs) were constructed by relating the changes of left ventricular (LV) end-diastolic pressure (EDP) to those of stroke index (SI). In 4 normal cases the curves were steep, showing a fall of EDP with relatively large decrease of SI; in 3 cases of congestive myocardiopathy they were flat, showing fall of EDP in two and increase in one, with relatively small decrease of SI; in 5 patients with effort angina LVEDP initially decreased. This initial fall of VFCs was steep in two with normal and flattened in three with impaired resting LV function. Increase of EDP, evidently due to development of ischaemia, followed in all; it exceeded resting EDP in two out of three cases developing angina and in one out of two not developing angina. Our findings support the view that the increase of LVEDP is due to decrease of both myocardial contractility and compliance.

[Hepatic lesions and coagulation disorders in pulmonary embolism: a clinico-pathological case].

Abstract: The authors described the case of a 49-patient suffering from obstructive broncho-pneumopathy and ischemic myocardiopathy complicated by multiple pulmonary embolism. The clinics were dominated by signs of major hepatic deficiency and of intravascular disseminated coagulation with fibrinolysis. The clinical and biological parameters evoking pulmonary embolism in that intricated chart were discussed.