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Biomedical subjects

D V Cokkinos

Publications and source records attributed to D V Cokkinos.

At least 19 recordsLinked to original sources
PubMed1992

Electrophysiological and electropharmacological studies in pre-excitation syndromes: results with propafenone therapy and isoproterenol infusion testing.

To study the electrophysiological effects of oral propafenone on accessory pathways and determine the potential for catecholamine-mediated reversal of these effects, comprehensive electrophysiology studies (EPS) were conducted in 11 patients with manifest (n = 9) or concealed (n = 2) pre-excitation syndrome. EPS were performed at baseline (in the drug-free state), after oral propafenone loading, and with isoproterenol infusion during propafenone therapy. The study group included 10 men and 1 woman with a mean age of 39 +/- 13 years, who presented with symptoms of palpitations (n = 6), presyncope (n = 3) and syncope (n = 2). The clinical arrhythmia was atrioventricular reciprocating tachycardia (n = 6), atrial flutter/fibrillation (n = 3), or both (n = 2). During the baseline EPS the accessory pathway location was identified as left (n = 6) or septal (n = 5). The mean anterograde effective refractory period was 265 +/- 42 ms, the shortest pre-excited RR interval 259 +/- 20 ms and the retrograde refractory period 258 +/- 39 ms. Orthodromic atrioventricular reciprocating tachycardia was induced in 10 patients (mean cycle length = 324 +/- 31 ms). Antidromic reciprocating tachycardia was induced in one patient (cycle length = 340 ms). In all the 11 patients EPS were repeated after 4 days of oral propafenone loading (668 +/- 226 mg daily) when drug steady state was expected to have been achieved. One additional patient had baseline EPS but developed clinical arrhythmia recurrences after propafenone loading and thus he was excluded from the study; follow-up EPS were conducted on procainamide.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1992

Effect of successful coronary angioplasty on the signal-averaged electrocardiogram.

The effect of successful coronary artery angioplasty on the signal-averaged electrocardiogram (SAECG) was examined in 50 patients (41 men, 9 women, aged 55 +/- 8 years) with stable (26 patients) or unstable angina (24 patients) and good overall left ventricular function (ejection fraction = 55% +/- 8%). The SAECG was recorded before and within 24-48 hours after the angioplasty and was filtered at 40-250 Hz, with 250 beats averaged. The noise level averaged 0.57 +/- 0.15 microV before and 0.56 +/- 0.17 microV after the procedure. There was no overall significant difference between pre- and postangioplasty SAECGs. Subgroup analysis showed that 14 patients had a significant increase of the root mean square voltage of the last 40 msec of the filtered QRS that was independent of noise level changes, previous myocardial infarction, stable or unstable angina status, positive or negative baseline SAECG, or vessel being dilated. Eleven patients (22%) had late potentials at baseline, of whom four (36%) lost them after angioplasty, while one patient developed them after the procedure, all due to root mean square voltage changes. Thus, successful angioplasty exerted no significant overall effect on the SAECG, suggesting that the substrate of late potentials was not grossly altered by the procedure in our patients. However, there appear to be some patients, constituting approximately one third of this study population, who derive a favorable influence on the SAECG from angioplasty, a subgroup that needs to be further defined in future studies.

Angina Pectoris↗
PubMed1990

The ST segment axis as a differential diagnostic feature between acute pericarditis and acute inferior myocardial infarction.

The ST segment electrical axis in the frontal plane was calculated in 20 patients with an acute inferior myocardial infarction (AIMI) and another 20 patients with the acute phase of pericarditis (AP). The ST segment axis of patients with AIMI ranged from 100 degrees-120 degrees (mean 114 degrees). The ST segment axis of patients with AP ranged from 30 degrees-60 degrees (mean 45 degrees). Thus, the ST segment axis can be used for the differential diagnosis in the early acute phase, especially when there are no other important distinguishing factors between these two conditions.

Acute Disease↗
PubMed1990

Exercise testing after acute myocardial infarction. How much? How soon?

Exercise testing shortly after acute myocardial infarction is considered safe and valuable for the determination of long-term prognosis. One point of discussion is whether a submaximal pre-discharge test or a maximal test at 6-8 weeks, which has a higher sensitivity for diagnosing multivessel disease should be preferred. The former is the authors' choice, since the submaximal predischarge test has excellent prognostic value for adverse effects, and because approximately 1.5% of patients who have a positive test have been noted to present with early ischemic deaths which ideally could have been prevented. In patients unable to exercise, mortality is about 19%. In these, the ejection fraction should be determined, and "stress" tests should be carried out administering dipyridamole or dobutamine intravenously and probably augmenting the diagnostic sensitivity of the test by radionuclide or echocardiographic evaluation.

Echocardiography↗
PubMed1989

The effective treatment of multifocal atrial tachycardia with amiodarone.

Multifocal atrial tachycardia (MAT) was observed in 9 patients aged 60-85 (mean 72.1 +/- 8.6) years during exacerbation of their chronic lung and/or cardiac disease. Four, in whom the rapid heart rate caused symptoms of pulmonary congestion, were treated with intravenous amiodarone (450-900 mg over 2 hours) with restoration of sinus rhythm soon after the termination of the drug infusion. In 1, with recurrence of MAT, the same intravenous dosage was repeated for 2 consecutive days, with final achievement of stable sinus rhythm. Five patients, apart from the conventional management of their underlying disease (digitalis, diuretics, aminophylline) were treated with oral amiodarone (600 mg/day). Sinus rhythm was restored in all and remained stable during their hospitalization, under alpha maintenance dosage of 200-400 mg daily. Amiodarone may be the drug of choice for the treatment of MAT, for which up to now no effective therapy has been established.

Administration, Oral↗
PubMed1989

Atrial septal defect and constrictive pericarditis. An unusual combination.

We describe a case of atrial septal defect associated with constrictive pericarditis. This combination is extremely rare and clinically misleading, since it may simulate other more common conditions. A variety of techniques, such as computerized tomography, echocardiography and cardiac catheterization were necessary for establishing the right diagnosis. Although there are suggestions of a possible association of atrial septal defect with pericardial disease, it is difficult to prove that this combination is other than coincidence.

Aged↗
PubMed1988

Arrhythmogenic right ventricular dysplasia: case report presentation and review of the literature.

A man complaining of palpitations was found to have ventricular tachycardia (VT) with LBBB configuration. From the investigations which followed, he was diagnosed as having arrhythmogenic right ventricular dysplasia (ARVD). The patient has been treated with amiodarone and propafenon for 7 months without VT recurrence. ARVD and Uhl's anomaly, which is its most extreme form, may be familial and represent an important cause of sudden death among young people: Prophylactic antiarrhythmic therapy and sometimes surgical treatment are required in case of refractory VT.

Bundle-Branch Block↗
PubMed1979

Effect of digitalis on diminished baroreceptor sensitivity in diabetics.

The baroreceptor sensitivity was estimated in 50 normal controls (Group A) and in 50 diabetics of comparable age (Group B). The technique used was infusion of angiotensin (0.5 microgram/min) and measurement of the bradycardic response resulting from the increase of blood pressure. The slope was used as an index of baroreceptor sensitivity. Diabetics had significantly lower baroreceptor sensitivity and a higher resting heart rate. Sensitivity decreased with age in both groups. The reproducibility of the method was excellent. Deslanoside-C (0.8 mg) significantly increased the baroreceptor sensitivity in 11 normal controls and 9 diabetics. Very low sensitivity was found in 26 diabetics who had no evidence of orthostatic hypotension, neuropathy, or retinopathy. However all 17 patients with the above findings had very low sensitivity.

Adolescent↗
PubMed1979

Increased mortality rate from coronary artery disease following operation for coarctation of the aorta at a late age.

Sixty-six patients past 35 years of age at operation for coarctation of the aorta had significantly higher hospital (five of 66, 7.5 percent) and late cardiovascular (10 of 61, 16.4 percent) mortality rates than 137 patients aged 15 to 34 years (mean, 21.9 years). Three of the five hospital deaths, as well as four of the 10 late deaths, in the group greater than 35 years of age were due to myocardial infarction. Thus the total coronary mortality rate was 10.6 percent (seven of 66 patients), with all deaths occurring in men. It appears that coronary artery disease (CAD) is a significant complication in male patients who undergo operation for coarctation of the aorta at a late age.

Adolescent↗
PubMed1978

Electrocardiographic criteria of left ventricular hypertrophy in left bundle-branch block.

In order to determine whether the electrocardiographic criteria of left ventricular hypertrophy apply in the presence of left bundle-branch block we studied 79 cases of intermittent left bundle-branch block and compared the QRS voltage and axis before and after its onset. Cases of incomplete left bundle-branch block were excluded. There was a statistically significant correlation between pre- and post-left bundle-branch block values of R or S wave voltage in leads I, V1, V2, V5, and V6, the Sokolow index (R V5 or V6 + S V1), and the QRS axis. There was a statistically significant reduction in R wave voltage in leads I, V5, and V6, an increase in S wave voltage in V1 and V2, and leftward shift of QRS axis, but the Sokolow index remained unchanged, after the onset of left bundle-branch block. The Sokolow criteria for left ventricular hypertrophy apply satisfactorily even in the presence of left bundle-branch block, though specificity is low, but QRS axis is unhelpful.

Bundle-Branch Block↗
PubMed1978

"Torsades de pointe": a distinct entity of ventricular arrhythmia?

Seven cases of an unusual type of ventricular arrhythmia, already named "Torsades de pointe" by French authors, are presented. It is characterized by a changing pattern of the ventricular complexes, spontaneous onset and cessation, and refractoriness to defibrillation and antiarrhythmic drugs which decrease intraventricular conduction. Prior to its onset, Q-T prolongation is almost universally seen in the ECG. Hypokalemia, myocardial depressants and bradycardia are common causes. Isoproterenol and rapid cardiac pacing are recommended as the treatment of choice. This arrhythmia is a distinct entity, quite different from typical ventricular tachycardia or fibrillation.

Aged↗
PubMed1978

Influence of digitalis on cardiac function before and after autonomic blockade.

The influence of Deslanoside C (D), 1.2 mg intravenously on the systolic time intervals (STI) was assessed in 15 individuals with right ventricular pacemakers, who were studied on two occasions, ten days apart. In the first case D was given under basal conditions, and in the second after autonomic blockade (with practolol 20 mg intravenously and atropine 1.5 and 1.0 mg intravenously) at 1 hour's interval. There were similar changes of the STI with digitalis administration both before and after automic blockade. Autonomic blockade is not necessary for full expression of digitalis action on the human heart, as advocated by some authors to be the case in experimental animals.

Adult↗
PubMed1976

Association of ostium secundum atrial septal defects with mitral valve prolapse.

Severe prolapse of the mitral valve leaflets was seen at left ventricular angiography in 16 of 92 patients with a secundum type atrial septal defect studied prospectively from 1970 to 1974. The patients were aged 15 to 69 years; angioplasty or mitral valve replacement was carried out in nine. In 9 of 122 patients aged 15 to 55 years who were operated on for closure of a secundum type atrial septal defect between 1956 and 1969, mitral regurgitation due to prolapse but with intact chordae tendineae was seen at operation. In three of these patients chordal rupture was seen at a second operation 2 to 6 years later. The outlook in the syndrome of mitral valve prolapse may be less benign than is usually believed.

Adolescent↗
PubMed1976

Constancy of pressure-rate product in pacing-induced angina pectoris.

The pressure-rate product during anginal pain produced by right atrial pacing was studied in 12 patients before, during, and after an angiotensin infusion sufficient to produce a significant rise in blood pressure. During the infusion the pain occurred at a significantly lower heart rate (P less than 0.001). However, the pressure-rate product was similar during anginal pain before and during the angiotensin-induced hypertension and after it wore off. Our studies support the concept that in each individual there is a constant level of myocardial oxygen consumption, as expressed by the pressure-rate product, at which anginal pain occurs.

Angina Pectoris↗