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Biomedical subjects

D H Spodick

Publications and source records attributed to D H Spodick.

At least 325 records · Page 18Linked to original sources
PubMed1982

Effective management of congestive cardiomyopathy. Relation to ventricular structure and function.

Until recently, congestive cardiomyopathy has had a poor prognosis on standard treatment because of severe congestive failure, arrhythmias, and embolism from endocardial thrombi in both ventricles. This pluricausal disorder differs from other heart disease because of disproportionately small hypertrophy in relation to ventricular dilation, with ultimate severe impairment of systolic function. Absence of hypertrophy adequate to compensate dilation exaggerates ventricular wall stress beyond that seen in other disorders. Newer treatments seeming to promise unprecedented improvement include unloading therapy with vasodilators, nonglycoside inotropic therapy, beta-adrenoceptor blockade (experimental only), combinations of these agents with or without digitalis and diuretics, and intra-aortic balloon pumping for critical failure. New surgical approaches include mitral annuloplasty, coronary bypass (for ischemic cardiomyopathy), and, for appropriate recipients, cardiac transplantation.

Adrenergic beta-Antagonists↗
PubMed1981

Elucidation of physiologic lengthening of left ventricular ejection time during early upright exercise.

To elucidate the relationship between heart rate (HR) and left ventricular ejection time (LVET) during early exercise, 30 patients with chest pain were studied at 1 (1') and 4 minutes (4'). Mean results for control leads to 1' exercise: HR 79 to 105 beats per minute, LVET 247 to 260 msec. Thus instead of shortening as predicted by the HR change at 1' of exercise, LVET rose significantly (p less than 0.001). Subsequently LVET fell as HR continued rising, and by 4' had fallen toward control level. This phenomenon is comparable to the paradoxical decline in LVET as HR decreases early post-exercise and is comparably explained by transiently disproportionate change in determinants of LVET, stroke volume, and ejection rate. Absence of difference in response of exercise-positive (ST depression greater than or equal to 1 mm) and exercise-negative patients, also supports this initial paradoxical lengthening in LVET as a physiologic response.

Adult↗
PubMed1981

Noninvasive assessment of left ventricular performance in patients with ischemic heart disease: ear densitographic study during uninterrupted treadmill exercise.

Among 738 consecutive patients with chest pain referred for exercise testing, only 17 men fulfilled strict criteria for this pilot study: (1) achievement of at least 90 percent of age-predicted maximal heart rate or electrocardiographic criteria for a positive test; (2) subsequent coronary angiography; (3) exclusion of prior heart disease; and (4) absence of medication. Measurements of systolic time intervals obtained with ear densitography during early exercise differentiated 10 patients with coronary artery disease (Group 1) from 17 men (7 patients plus 10 normal volunteers) with normal coronary arteries (Group 2). Despite nearly identical heart rate and blood pressure responses in both groups, men in Group 1 had a significantly greater reduction of preejection period (PEP) at 1 minute and 4 minutes as well as a greater decrease in PEP/LVET (left ventricular ejection time) ratio. Differences were most significant when expressed as percent change of PEP/LVET ratio from control value (p less than 0.001 at both 1 minute and 4 minutes). After 4 minutes, men in Group 1 had no further decrease in PEP/LVET ratio and in 8 of the 10 men PEP/LVET ratio then increased to peak exercise. By contrast, PEP/LVET ratio continued to decrease to peak exercise in men in Group 2. The early floor in PEP/LVET ratio in Group 1 represents limited functional reserve and the subsequent increase suggests functional deterioration. Thus, densitographic systolic time interval measurements during uninterrupted exercise in unmedicated subjects appear to improve the sensitivity and specificity of the conventional treadmill test.

Adult↗
PubMed1981

Midsystolic closure of the aortic valve in primary pulmonary hypertension.

Echocardiographic examination in a patient with primary pulmonary hypertension demonstrated midsystolic closure of the aortic valve, which has often been described in hypertrophic cardiomyopathy with or without obstruction, in discrete subaortic stenosis, and in ruptured aneurysm of the right coronary sinus of Valsalva. A possible mechanism for this finding in primary pulmonary hypertension and differential diagnosis from other diseases are discussed.

Aortic Valve↗
PubMed1981

Motion of pulmonic valve and constrictive pericarditis.

Extreme respiratory variation in the depth of the "a" wave of the pulmonic valve echo was demonstrated in a patient with constrictive pericarditis; a mechanism for this finding is offered. Disparity in systolic and diastolic ventricular function in constriction is also useful in ruling out restrictive cardiomyopathy.

Aged↗