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Biomedical subjects

A Pichard

Publications and source records attributed to A Pichard.

At least 37 records · Page 2Linked to original sources
PubMed1983

Determinants of ventricular tachycardia in patients with coronary artery disease and ventricular aneurysm. Clinical, hemodynamic, and angiographic factors.

Many patients with coronary artery disease (CAD) in whom ventricular tachycardia (VT) develops have transmural scars or frank aneurysms. However, only a minority of patients with ventricular aneurysms go on to develop VT. To determine which factors are associated with the development of VT in patients with aneurysms, we retrospectively reviewed the records of 154 patients with CAD and segments of akinesia or dyskinesia, or both, on left ventriculography. Of the 154 patients, 85 had 24-hour Holter monitoring or 48 consecutive hours of continuous electrocardiographic monitoring in an intensive care unit within 6 months of catheterization. VT occurring at least 10 days after myocardial infarction (MI) or in the chronic phase was recorded in 19 patients (Group I); the remaining 66 patients did not have VT (Group II). The clinical, hemodynamic, and angiographic characteristics of these 2 groups showed no significant difference with respect to age, time from first transmural MI to catheterization, congestive heart failure (CHF), ejection fraction, or presence of dyskinesia. Patients with VT had significantly larger aneurysms and a higher prevalence of septal akinesia or dyskinesia. However, stepwise discriminant analysis revealed septal akinesia or dyskinesia to be the only independently significant variable distinguishing the 2 groups. Thus, septal involvement appears to be a major determinant of VT in patients with CAD and ventricular aneurysm.

Adult↗
PubMed1983

Association of coronary artery disease and valvular heart disease in Chile.

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.

Aged↗
PubMed1982

Angina pectoris before and after myocardial infarction. Angiographic correlations.

Clinical, hemodynamic, and angiographic data were examined in 97 consecutive patients who underwent catheterization within two years of documented acute transmural myocardial infarction. The patients were divided according to the absence or presence of angina pectoris prior to myocardial infarction (groups 1 and 2). Group 1 had more females, was younger, and had a greater prevalence of one-vessel coronary artery disease. Of the patients surviving the myocardial infarction until hospital discharge, group 1 had fewer cases of postinfarction angina pectoris. The following were not statistically different for the two groups: mean time from infarction to catheterization, location of infarction, heart failure, coronary risk factors, mean left ventricular end-diastolic pressure, and mean ejection fraction. The angiographic significance of angina following infarction was analyzed in the 94 survivors. Patients with angina after infarction had a greater prevalence of two- and three-vessel coronary artery disease compared with patients without angina following infarction. Group 1 patients who had developed angina after infarction also had a greater prevalence of two- and three-vessel disease than patients who had no postinfarction angina. One-vessel disease was found in 82 percent of patients who had no angina before and after infarction. Infarction as the first manifestation of coronary artery disease (group 1) is often associated with one-vessel disease, especially if angina does not appear after infraction. Angina before or after infarction suggests two- and three-vessel disease.

Adult↗
PubMed1981

Preliminary experience with reversal of venoatrial flow in the diagnosis of tricuspid regurgitation.

Present methods of assessing tricuspid regurgitation are often unreliable. We present preliminary data concerning a new angiographic method for identification of tricuspid regurgitation which evaluates direction of flow of contrast media during right ventricular (RV) systole in the inferior vena cava (IVC) and hepatic veins following right atrial or IVC angiography. Group I consisted of 15 patients who had tricuspid regurgitation by conventional criteria. All 15 patients exhibited reversal of venoatrial flow by right atrial or inferior vena cava angiography. In a control group (group III) of 20 patients who do not have clinical tricuspid regurgitation, one patient demonstrated retrograde flow. Group II consisted of 11 patients with mitral valve disease and mild to moderate pulmonary hypertension. All 11 had no conventional evidence of tricuspid regurgitation; however, all 11 had the pathophysiologic potential for tricuspid regurgitation. Five of 11 had reversal of venoatrial flow during RV systole, suggesting the presence of clinically inapparent tricuspid. In conclusion, preliminary data suggest that angiographic reversal of venoatrial flow may be both sensitive and specific for the presence of tricuspid regurgitation. Further investigation with comparison to RV angiography and real-time echocardiography should be performed.

Adult↗
PubMed1980

Use of the ambulatory ECG to diagnose coronary artery disease.

Forty-nine patients undergoing cardiac catheterization for suspected coronary artery disease (CAD) were monitored with a two-channel ambulatory ECG and were given maximal treadmill exercise tests when these were not contraindicated. The ambulatory ECG recordings were evaluated for the number of ST segment deviations after correction for positional changes, and the results were then compared with those of the exercise test and coronary angiography. Sensitivity and specificity of ambulatory ECG monitoring for ST segment deviations to detect CAD were 76% and 75% respectively while those of exercise testing were 78% and 63% respectively. Sixteen patients (33% of this series) had equivocal or contraindicated exercise tests and twelve of these patients were correctly classified as to the presence or absence of CAD by ambulatory ECG. ST segment deviations on ambulatory ECG were found in 93% of patients with three vessel, two vessel, or one vessel LAD disease, while exercise testing detected 74% of these patients. Ambulatory ECG is an effective non-invasive method to diagnose CAD and is complementary to excercise testing. It is of special value when the exercise test is equivocal or contraindicated.

Adult↗
PubMed1975

Results of graft surgery for coronary artery disease: a progress report.

Coronary artery surgery is here to stay, but it will continue to be influenced by accumulating experience and evolving techniques. Direct internal mammary-to-coronary artery anastomoses offer the hope for improved results in certain patients. Tissue-compatible prosthetic grafts could be developed and offer an alternative in selected patients. Improved microsurgical techniques may permit broader applications with multiple grafts to smaller branches in patients with more diffuse disease. We are continually reminded, however, that surgical treatment is palliative, and that most of these patients will ultimately die of their disease. Thus the search for a better understanding of the arteriosclerotic process and improved methods for altering the course of the disease becomes more important than ever.

Coronary Angiography↗
PubMed1975

Selection of the candidate for myocardial revascularization; a profile of high risk based on multivariate analysis.

A survey of 60 patients who died from cardiac related causes after vein or artery bypass operations alone (1967 to 1973) was made with respect to 26 clinical, angiographic, and operative variables. These factors were compared with identical characteristics of 1,188 survivors operated upon in 1973. Through discriminant analysis, the various characteristics, isolated or multiple in any combination, have been converted into risk related to operative death. The distinctive features of the mortality group were vastly different from those in the surviving group. Ten patients (16.67 per cent) of the mortality group were in the ninety-ninth percentile of risk, whereas these factors or variables of similar weight produced an equivalent risk of only 0.34 per cent of the survivors; thus, operative death in these circumstances could be predicted with an estimated 98.0 per cent assurance. Each of 6 patients with mortality risks above 0.99999 had (1) marked cardimegaly, (2) uncompensated congestive heart failure (CHF), (3) triple vessel coronary artery disease and/or obstruction of the left main coronary artery, (4) generalized impairment of left ventricular contraction or segmental left ventricular scar, and (5) evelated left ventricular end-diastolic pressure. As a single factor, congestive heart failure (CHF) exerted the most influence on the probability of dying. A new and more desctiptive statistical interpretation of the factors presumed to affect risk is presented.

Age Factors↗