Search PubMed⌕ Search

Biomedical subjects

G Sloman

Publications and source records attributed to G Sloman.

At least 19 recordsLinked to original sources
PubMed1992

Angiotensin-converting enzyme inhibition, the sympathetic nervous system, and congestive heart failure. The Australian Zestril (Lisinopril) Study Group.

Catecholamines have been found to be powerful indicators of prognosis in patients with congestive heart failure. However, it is uncertain whether catecholamines are a marker for decreased cardiac performance or part of the pathologic process. Catecholamines, exogenously derived beta-adrenergic stimulants, and drugs that amplify sympathetic responsiveness produce early hemodynamic benefits, but do not appear to provide long-term improvement in terms of symptoms or exercise tolerance, whereas blockade of the beta-adrenoceptor appears to have little early benefit but may improve long-term prognosis. This suggests that in the long term, increased catecholamine levels may be deleterious. Angiotensin-converting enzyme (ACE) inhibitors can modulate circulating catecholamines, and the persistence and degree of ACE inhibition may be important not only in reducing catecholamines, but possibly also in reducing mortality in heart failure. It appears that ACE inhibitors definitely reduce mortality in congestive heart failure. It remains to be documented whether the persistence and degree of ACE inhibition is a factor in this effect, and, thus, comparison of short- with long-acting ACE inhibitors and study of the dosage of ACE inhibitors are of importance. The extent to which modulation of the sympathetic nervous system by ACE inhibitors is an important mechanism in their effect in reducing mortality remains to be established.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Blood pressure changes with age in two ethnic groups in Fiji.

Blood pressure was studied in urban and rural samples of the Melanesian and Indian populations of Fiji during a National Cardiovascular Disease and Diabetes Survey in 1980. Mean blood pressures rose with age and tended to be higher in urban than in rural populations, particularly in the middle age range. There was no clear or significant difference between the ethnic groups. When the prevalence of hypertension was studied (using WHO criteria) similar age, geographic and ethnic differences were found. Comparisons with data from 1960 revealed no significant change in mean blood pressures during the 20-year interval. Rural populations were leaner and appeared to consume less salt than did urban groups. There were positive and significant correlations between blood pressure and triceps skinfold thickness in most subgroups.

Age Factors↗
PubMed1986

Cardiac surgery in a private hospital. With special reference to coronary artery surgery.

In a four-year period in a private hospital there were 1396 open heart operations of which 1275 were for isolated coronary artery disease. The various techniques that were used for coronary artery reconstruction were saphenous vein grafts and internal mammary artery grafts, both singly and sequentially, and endarterectomy. The operative mortality for isolated coronary artery surgery was 1.1% and the perioperative infarction rate was 2.1%. When combined with an endarterectomy of the right coronary artery, the mortality was 3% and the infarction rate was 4% (not significant); when combined with endarterectomy of the left anterior descending coronary artery, the mortality was 11.7% (not significant), and the infarction rate was 11.7% (not significant). The operative risk was no higher in patients with poor ventricular function.

Adult↗
PubMed1986

Pacemaker update.

Explore the source record for details and available documents.

Arrhythmias, Cardiac↗
PubMed1979

Predictors of reinfarction and sudden death in a high-risk group of acute myocardial infarction survivors.

75 patients aged under 70 years who had survived acute myocardial infarction complicated by both significant arrhythmias and cardiac failure were followed-up for 1 year in an attempt to identify features which suggest the likelihood of late death or reinfarction. Patients were carefully instructed in the identification and importance of possible prodromal symptoms and the availability of a mobile intensivecare ambulance service and a 24 h hospital control centre. Horizontal ST-segment depression or anginal pain on an exercise test done within 6 weeks of infarction was a useful predictor of late death. Routine twice weekly E.C.G. recordings taken by telephone transmitter at rest and after mild exertion resulted in the identification of significant arrhythmias in only 7 patients. 13 patients (17%) died, 5 of them instantaneously. 4 of the 13 patients and 22 of the 62 survivors reported "prodromal symptoms". Unreported prodromal symptoms were elicited retrospectively in 14 of the 62 survivors and from the relatives of 4 of the 13 patients who died. Thus, 35% of prodromal symptoms were not reported despite intensive patient education and counselling. The incidence of "prodromal symptoms" was no higher in patients who died than in those who did not die.

Acute Disease↗
PubMed1979

Mitral valve prolapse.

Mitral valve prolapse is a relatively common condition in the general population. The syndrome appears more common in females, and is often associated with a family history. Patients may be asymptomatic or may present with a variety of symptoms ranging from mild chest aches and anxiety to severe angina-like chest pain, palpitations and dizziness. The common auscultatory features include mid-systolic clicks and a late systolic murmur, either alone or in combination. The wide spectrum of symptoms and signs may be explained by ventriculovalvular disproportion, where either the ventricle is too small for the valve, or the valve is too large for the ventricle. The long-term prognosis is very good; severe mitral regurgitation can occasionally develop, but both sudden death and bacterial endocarditis are rare. No treatment is required for asymptomatic patients, beyond antibiotic cover for dental procedures and surgery.

Adolescent↗
PubMed1978

Electrophysiology of disopyramide in man.

The electrophysiological effects of an intravenous dose of disopyramide phosphate (2 mg per kg body weight) were studied in 17 patients. Studies were performed with the patients fasting, unpremedicated, and off all medication for three days. Blood samples for estimation of serum levels of disopyramide were collected in 15 of these patients. The effects of intravenous disopyramide were maximal at five minutes, less marked at 20 minutes, and largely gone by 30 minutes after administration of the drug. Sinus cycle length and corrected sinus node recovery time were shortened significantly. No index of atrioventricular nodal function was significantly changed. Both atrial and ventricular effective refractory periods were significantly prolonged. Further impairment of intraventricular conduction occurred in six patients with bundle branch block on electrocardiogram or prolonged HV interval. In one of two patients with Wolff-Parkinson-White syndrome, the bypass effective refractory period was prolonged. These electrophysiological changes are similar to quinidine and quinidine like drugs. It is recommended that disopyramide should be used cautiously in patients with evidence of His Purkinje system disease since it may lead to higher degrees of intraventricular block.

Adolescent↗
PubMed1978

The diagnosis of right ventricular perforation by an endocardial pacemaker electrode.

The diagnosis of right ventricular perforation by an endocardial pacemaker electrode should be suspected when failure of pacing occurs without electrode displacement. Although a number of changes occur on the standard electrocardiogram (ECG), none of these are diagnostic. The intracardiac electrogram performed during electrode withdrawal is not only diagnostic of perforation but can also aid in electrode positioning. Two case reports highlight these changes in the intracardiac electrogram. The first case also illustrates that, with electrode perforation, the ability to sense the intrinsic intracardiac electrical activity may be retained.

Aged↗
PubMed1978

Effect on survival after myocardial infarction of long-term treatment with phenytoin.

A prospective, randomised, open trial was performed in 150 patients to test for any beneficial effects on 2-year mortality of long-term antiarrhythmic therapy with phenytoin in patients with acute myocardial infarction. Patients were stratified according to age, sex, past history of myocardial infarction, and the presence of absence of electrical or mechanical complications in the course of acute infarction. They were then randomised to treatment or control groups (74 v. 76). The former received phenytoin in doses aimed at maintaining plasma phenytoin levels between 40 and 80 mumol/litre. All patients entered the study before discharge from the coronary care ward. Plasma phenytoin levels were in the therapeutic range in between 51 and 75 per cent of subjects at any follow up visit. There were 19 withdrawals from the treatment group, 10 of which were the result of side effects. There were 5 withdrawals from the control group. According to the original intention to treat, there were 18 deaths at 2 years in the treatment group and 14 deaths in the control group. There was no reduction in the incidence of instantaneous or sudden deaths. Deaths on treatment were not associated with a low phenytoin plasma level. Phenytoin treatment showed no beneficial effects on mortality and was associated with a high incidence of side effects.

Adult↗
PubMed1978

Effects of atrial fibrillation on prognosis of acute myocardial infarction.

Nine hundred and sixty-nine coronary care patients with acute myocardial infarction were followed for one year. Atrial fibrillation was documented in 107 patients. Compared with patients without atrial fibrillation, those with this arrhythmia were older, had clinically more severe infarction, and had a higher frequency of ventricular fibrillation or tachycardia, and right bundle-branch block. They had similar past histories of ischaemic heart disease and coronary risk factors. Patients with atrial fibrillation had a higher total mortality at 3 months and 12 months. The presence of atrial fibrillation was not associated with any significant increase in mortality within any decade of age or within any subgroup of clinical severity of infarction. The frequency of atrial fibrillation was similar in anterior and inferior infarction. Multiple episodes of atrial fibrillation occurred in 52 patients and episodes usually lasted for over 1 hour. In 50% of patients with single episode of atrial fibrillation the initial ventricular rate was greater than 120 beats per minute.

Acute Disease↗
PubMed1977

Changing patterns and mortality of acute myocardial infarction in a coronary care unit.

Three groups of patients who had been admitted to a coronary care unit with infarction at different periods since 1963 were reviewed to assess whether the outcome in such patients had improved over 12 years. There was a significant reduction in mortality among consecutive patients with mild or severe infarction between 1969-70 and 1974-5. Classifying the patients in all three groups according to their risk factors showed that for each risk factor mortality had decreased since 1963. The incidence of arrhythmias and conduction defects decreased between 1969-70 and 1974-5, and mortality among patients with each arrhythmia also fell. The reduction in mortality may reflect a changing pattern in the natural history of the disease as well as a benefit of improved treatment.

Adult↗
PubMed1977

Procaineamide blood levels after administration of a sustained-release preparation.

Procaineamide is now available as a sustained-release preparation. This preparation was administered in an eight-hourly regime to 26 patients, and therapeutic blood levels were obtained for the duration of the 56-hour study period in 20 patients. No side effects were observed. Inadequate blood levels may be predicted from a single blood level eight hours after the first dose, which could allow for dosage adjustment.

Arrhythmias, Cardiac↗