[Long-term treatment of hypertension with the combination of hydrochlorothiazine and amiloride. Results of a multi-center study of 277 patients].
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Biomedical subjects
B De Piccoli
Publications and source records attributed to B De Piccoli.
[Evolutive study of the vectorcardiogram from the 14th day to the 6th month of life on the normal infant].
With the purpose of a better evaluation of the changes of cardiac potentials during the early hemodynamic arrangement of the normal heart, the authors analyze the VCG of 10 normal children periodically recorded from the 14th day to the 6th month from birth. Rotation of QRS, T and P loops in the three planes, direction and voltage of principal planar and spatial vectors were analyzed. The QRS loop showed a balanced distribution between right and left ventricular forces in the second week and developed a leftward orientation from the 4th week to the 3rd month, as demonstrated both by the loss of clockwise rotation of horizontal QRS loop and by the progressive leftward and backward direction of intermediate vectors. The initial vectors were sketched or absent in the 14th day and increased successively until the typical Q loop. The voltage of terminal vectors did not change in the course of time, but the S loop in the horizontal plane lost its original clockwise rotation and shifted to middle posterior line. The T loop progressively shifted backward so that it was always posterior after the 30th day. The P loop in the frontal plane was similar to the adult's one while in the horizontal plane it often presented a figure-of-eight. The semeiological aspects and the electrogenic considerations of these changes were discussed.
Age Factors↗
[The vectorcardiogram of the normal child, 2-12 years of age (author's transl)].
Morphological aspects and the most important vectorial parameters of the VCG (Frank method) of normal children, aged 2 to 12 years, were analyzed. The total group consisted of 110 subjects (10 for each )ear) subdivided into three subgroups of progressive age. Semeiologic evaluation of the QRS in the frontal and sagittal planes was not significant because of the stereotypes of the figures. In the horizontal plane the majority of cases showed typical triphasic development of the vectorial groups, while biphasic morphology was found in the minority. The triphasic loop presented 1) a balance between anterior and posterior forces which was more frequent in the youngest children, 2) a posterior orientation which was more frequent in the oldest children or 3) an anterior orientation which was infrequent. Since the anterior orientation of triphasic QRS was not related to the age -- it may also be seen in normal adults -- it was attributed to a variation of ventricular activation. The biphasic loop was attributed to immaturity of ventricular conduction. The evaluation of quantitative parameters was in agreement with the results of other studies. The changes of initial and intermediate vectors were probably due to the more important development of the left ventricle. The QRS duration increased with age. The T loop was posterior in the majority of the youngest children and progressively advanced with age, although it remained posterior in an important number of cases of children aged twelve.
Age Factors↗
Transesophageal echocardiographic evaluation of the morphologic and hemodynamic cardiac changes during ventricular fibrillation.
To analyze cardiac motion during ventricular fibrillation (VF), we used transesophageal echocardiography to study nine male subjects, aged 44 +/- 7 years, affected by heart disease who have poor left ventricular function, during implantation of an Implantable Cardioverter Defibrillator, when VF is induced several times to determine the defibrillation threshold. Wall and valvular motion, transmitral and transaortic blood flow, and blood echoreflectivity were evaluated in all patients. Moreover, in basal conditions, during VF, 1 and 5 minutes after restoration of basal rhythm, we calculated the left ventricular end-diastolic volume (EDLVV) and area (EDLVA), the left ventricular end-systolic volume and area, the ejection fraction, and the fractional area change with a four-chamber echocardiographic view. At the onset of VF, the myocardium and valves exhibited a chaotic motion. About 10 seconds later the oscillatory movement of the heart walls became more ample and regular; the mitral valve showed a cyclic closure and opening with a forward flow, and the aortic valve exhibited similar behavior, although at a lower intensity. A spontaneous echo contrast appeared inside the atrial and ventricular cavities, gradually becoming an incrt homogeneous mass that was completely flushed away with the restoration of the basal rhythm. When VF started, EDLVV (286 +/- 98 ml) and EDLVA (50 +/- 16.5 cm2) decreased abruptly (EDLVV = 182 +/- 65 ml, p < 0.02; EDLVA = 38 +/- 9.2 cm2,p < 0.05); so did ejection fraction (31.8% +/- 15% versus 11% +/- 5%; p < 0.003) and fractional area change (25.8% +/- 6.5% versus 7% +/- 3.4%; p < 0.001). When the basal rhythm was restored, the heart extended again and EDLVV, EDLVA, ejection fraction, and fractional area change after 1 and 5 minutes were similar to those calculated before induction of VF. This behavior was observed during both the first and last induced VF. Thus during VF, great variations of heart morphology and dynamics, as well as blood echoreflectivity, occur; the heart seems to make attempts to organize its dynamics during the arrhythmia. Repeated episodes of VF and defibrillation with low energies do not seem to worsen left ventricular dynamics even in impaired hearts.
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