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Biomedical subjects

David H Spodick

Publications and source records attributed to David H Spodick.

At least 73 records · Page 4Linked to original sources
PubMed2003

Pulsus paradoxus in cardiac tamponade: a pathophysiologic continuum.

Pulsus paradoxus has interested physicians for more than a century. Since McGregor's comprehensive New England Journal of Medicine article in 1979, there have been no updated reviews; accordingly, we review pulsus paradoxus based on the clinical and physiologic literature and personal experience.

Blood Pressure↗
PubMed2003

Acute right atrial strain: regression in normal as well as abnormal P-wave amplitudes with treatment of obstructive pulmonary disease.

OBJECTIVE: To evaluate right atrial (RA) "strain" as reflected by changes in P-wave amplitude and vector in patients with COPD immediately before and immediately after beginning treatment of exacerbations. BACKGROUND: P-pulmonale (frequently temporary, reflecting acute RA strain) occurs under a variety of circumstances, including COPD. Emergency room (ED) ECGs in patients with acute exacerbations of COPD have suggested that P-pulmonale (P waves > or = 2.5 in leads II, III, and aVF) tends to resolve subsequent to acute treatment. RA strain is defined as a response to RA stress (probably transient pressure rise and/or acute RA enlargement) in patients with COPD. Since P-pulmonale occurs in a small minority of patients with COPD, we investigated dynamic changes in size and mean vector (axis) of all frontal plane P waves in the ED vs the immediate subsequent ward ECG in patients with acute exacerbations of COPD. METHODS: We prospectively compared P-wave amplitude in the ED with the first in-patient ECG in 50 consecutive patients with acute exacerbations of COPD and in 20 consecutive nonpulmonary control patients, analyzing only ECGs showing sinus rhythm and in which P waves were clearly recorded. Despite using a calibrated magnifying graticule, it was difficult to interpret a dynamic change if the initial ED ECG had P-wave amplitude < 1.5 mm in leads II and aVF. We selected lead II because it usually has the largest frontal plane P waves and also aVF to reflect the relative verticality of the mean P vector (axis). We performed a matched-pair analysis to compare the equality of means. RESULTS: Of the patients with COPD, only seven patients (14%) had classical P-pulmonale on the ED ECG. Forty-eight of 50 consecutive patients (96%) demonstrated a decrease in P-wave amplitude between ED and subsequent ward ECGs. Two patients showed no change. The mean differences of P-wave amplitude between ED and ward ECGs in lead II was 0.78 mm, and that in lead aVF was 0.8 mm. The difference of the mean P-axis between ED and ward ECGs was - 5.24 degrees (p < 0.0001 for all three measurements). There was no P-wave amplitude change in the control group between ED and ward ECGs. CONCLUSIONS: P-wave amplitude in patients with COPD decreases once an acute exacerbation subsides. Thus, P-wave amplitude and vector are dynamic and could reflect reduced RA strain. We question the traditional (1935) absolute cutoff of 2.5 mm for P-pulmonale as of limited value due to insensitivity, hence inappropriate for what this investigation demonstrates to be a continuous variable.

Confidence Intervals↗
PubMed2002

Intrapericardial therapy and diagnosis.

Diagnosis and treatment for the heart and virtually all its structures is becoming available via the pericardium. With or without pericardial effusion (formerly necessary for safe access), instruments that can enter the noneffusive pericardium are available and thoroughly tested experimentally, with human trials currently under way. Successful therapy includes antiarrhythmic, vasodilatory, angiogenic, and other gene-related modalities and agents that stimulate the pericardial mesothelium to exceed the normal production of many active substances.

Animals↗
PubMedDate not supplied

Nonsteroidal anti-inflammatory drugs in the treatment of pericarditis.

Nonsteroidal antiinflammatory drugs (NSAIDs) represent the mainstay of treatment of acute pericarditis. We systematically reviewed efficacy and safety of NSAIDs, management of NSAID-induced side effects and potential superiority of specific agents in the treatment of pericarditis. We also reviewed the role of NSAIDs in specific pericardial disease entities that may represent therapeutic challenge.

Acute Disease↗
PubMedDate not supplied

The Bachmann Bundle and interatrial conduction.

The cardiac conduction system (CCS) is responsible for generation and systematic conduction of cardiac impulses. The Bachmann Bundle (BB), considered one of its several accessory impulse-conducting pathways, plays a fundamental role in interatrial conduction. Delay in this pathway leads to prolongation of the P wave on the electrocardiogram (interatrial delay or block), which in turn is a precursor for atrial tachyarrhythmias, mainly atrial fibrillation and significant left atrial electromechanical dysfunction. As such, the magnitude of its sequelae has necessitated a flurry of investigations that have been targeted toward its prevention and management. Although current studies on the use of angiotensin-converting enzyme inhibitors and atrial pacing have indeed shown some promise, it would be shortsighted to overlook and circumvent the actual underlying lesion-BB abnormality. Thus, a thorough understanding of the CCS and interatrial conduction is essential. We review current literature on the BB and discuss potential mechanisms that affect its conduction.

Arrhythmias, Cardiac↗