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Biomedical subjects

H De Geest

Publications and source records attributed to H De Geest.

At least 91 records · Page 5Linked to original sources

Laser apexcardiogram in healthy young men: a comparative study with the conventional method.

Laser displacement technique is a new method to registrate the low frequency precordial movements. In 16 young healthy men the apexcardiograms were obtained subsequently by conventional way and by laser displacement technique. The basic differences in time intervals and amplitude relations were analyzed with paired t-test. On the laser apexcardiogram the peak of the positive deflection generated by ventricular systole came later (p less than 0.001), the proportion of the positive deflection to the total deflection was smaller (p less than 0.01) and the positive deflection elicited by atrial contraction was proportionally larger (p less than 0.05) than on the conventional apexcardiogram. The timing of the onset of systolic positive deflection and of the nadir of diastolic negative deflection were similar in both apexcardiograms. The observed differences are the consequences of the different physical basis of the two methods. The laser apexcardiogram seems to be more sensitive on the diastolic events and permits a better analysis of diastolic phenomena of the curve, including the atrial contraction.

Adult↗

Effect of intravenous diltiazem on myocardial ischemia occurring during percutaneous transluminal coronary angioplasty.

To investigate the antiischemic efficacy of intravenously administered diltiazem, 42 patients were randomly allocated to receive placebo or active treatment before 1-vessel percutaneous transluminal coronary angioplasty (PTCA). The development of myocardial ischemia was studied using subjective (pain) and objective (electrocardiography) parameters. Pretreatment with intravenous diltiazem resulted in a significantly delayed onset of ischemic pain and ST-segment elevation; these variables also returned to baseline earlier after balloon deflation. Thus, intravenous diltiazem prevents or delays the onset of myocardial ischemia during repetitive transient coronary occlusions; improvement of the myocardial blood flow distal to the coronary occlusion or impedance of calcium entry into the ischemic cell are considered as possible mechanisms. Because PTCA is increasingly used in patients with poor left ventricular function and more extensive disease, and because recent evidence suggests that better PTCA results could be obtained by the use of longer inflation times, the addition of diltiazem to the classic armamentarium could be beneficial.

Angina Pectoris↗

Fatal aortic rupture: an unusual complication of percutaneous balloon valvuloplasty for acquired valvular aortic stenosis.

A case report complicated by a perforation of the ascending aorta during percutaneous balloon valvuloplasty for acquired aortic stenosis in a bicuspid aortic valve is presented. The clinical and pathological findings are discussed. It is suggested that in patients with hard calcified valve cusps and calcifications of the aortic annulus balloon sizes exceeding the aortic diameter should be avoided.

Aged↗

Coronary reperfusion by thrombolysis and early beta-adrenergic blockade in acute experimental myocardial infarction.

The effects of beta-adrenergic blockade, thrombolysis and their combination on infarct size and left ventricular function were investigated in a canine model of thrombotic occlusion of the left anterior descending coronary artery. Metoprolol was administered intravenously (0.5 mg/kg) over 10 min, starting 15 min after occlusion. Recombinant human tissue-type plasminogen activator (rt-PA) was given intravenously 1 h after occlusion for clot lysis. Anatomic infarct size was measured as a percent of perfusion area and ventricular mass. Left ventricular function was assessed by ejection fraction and the centerline method. Groups 1, 3, 5 and 7 were evaluated after 24 h and received, respectively, metoprolol plus rt-PA, rt-PA, metoprolol and no treatment; groups 2, 4, 6 and 8 were studied after 1 week and treated, respectively, as groups 1, 3, 5 and 7. Metoprolol did not influence infarct size and global or regional ventricular function after 24 h and 1 week. Thrombolysis reduced infarct size from 69.5 +/- 3.4% (24 h) and 76.6 +/- 1.8% (1 week) in the control group to, respectively, 44.1 +/- 11.6% and 39.5 +/- 10.5% (p greater than 0.05), did not influence left ventricular function after 24 h and was accompanied after 1 week by a definite recovery of global and regional left ventricular function when compared with findings in control dogs. Metoprolol plus rt-PA further reduced infarct size (percent perfusion area) to 20.4 +/- 3.7% and 19.9 +/- 8.1% after 24 h and 1 week, respectively (p = NS versus rt-PA).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Extracorporeal shock wave lithotripsy and cardiac arrhythmias.

Holter monitoring was performed in 400 patients undergoing extracorporeal shock wave lithotripsy (ESWL). The highest heart rate occurred before and after ESWL. During respiratory-triggered ESWL, 30% of the patients had one or more ventricular premature beats (VES), and 7% had couplets of VES. The number of ventricular and supraventricular premature contractions was significantly lower during ECG-triggered ESWL. Ventricular tachycardia occurred in seven patients during respiratory-triggered ESWL, and in one patient during nontriggered ESWL. All ventricular tachycardias were nonsustained, asymptomatic, and slow. Supraventricular tachycardia was seen in nine patients. The preference of the urologist for respiratory-triggered ESWL, conflicts with its higher incidence of ventricular arrhythmias.

Adult↗

Filter characteristics of the atrial sensing circuit of a rate responsive pacemaker. To see or not to see.

The intra-atrial electrograms (P waves) from floating orthogonal atrial electrodes of acutely implanted pacemaker leads (SRT lead) were recorded and the frequency characteristics were determined. The atrial sensing properties of the rate responsive pacemaker (RS4) used in conjunction with these leads, were studied in relation to the frequency spectra of atrial electrograms. Whereas the P waves showed a bandwidth to 65 Hz, the filter had an upper cutoff frequency of 35 Hz. We conclude that unreliable atrial sensing with the RS4-SRT pacing system is primarily due to an inappropriate filter match and therefore no satisfactory rate responsiveness is achieved.

Cardiac Pacing, Artificial↗

Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis.

A consecutive series of 192 patients (121 men and 71 women, mean age 59 years, range 28 to 82) with isolated, severe valvular aortic stenosis was with isolated, severe valvular aortic stenosis was analyzed retrospectively to determine the relation of angina pectoris and coronary risk factors to angiographically significant coronary artery disease (CAD). Significant CAD (diameter reduction greater than or equal to 50%) was found in 47 patients (24%). Angina was present in 83% of them, but it was also found in 61% of the non-CAD patients. This symptom had as a result a low positive predictive value (31%). Of the patients without angina (n = 65) 12% had significant CAD. The negative predictive value of angina alone was thus 88%. By using multivariate logistic regression, a risk score could be calculated based on angina, age and sex, which increased the negative predictive value to 95%. It was concluded that coronary arteriography can only be omitted in severe aortic valvular stenosis, when patients have no angina and when they are less than 40 years of age for men and less than 50 years for women. For all other cases, coronary arteriography should be recommended.

Adult↗

Angina pectoris and coronary artery disease in severe aortic regurgitation.

A consecutive series of 198 patients (148 men and 50 women, mean age 51 years, range 18 to 76) with pure, isolated, severe aortic regurgitation was retrospectively studied to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris and coronary risk factors. Significant CAD (coronary diameter stenoses greater than 50%) was found in 28 patients (14%). Typical angina was present in 18% and atypical chest pain in 16%. Angina alone had a sensitivity of 57% to detect significant CAD. The predictive accuracy of a positive history of angina was 46% and that of a negative test 93%. By using multivariate logistic regression, a risk score could be calculated that increased the sensitivity to 74% at equal specificity. Almost 40% of the total population had a risk score of less than -2.9 (only 1 patient in this group had CAD). It is concluded that coronary arteriography can safely be omitted in many patients with severe aortic regurgitation if they have no symptoms of myocardial ischemia or risk factors known to increase its incidence.

Angina Pectoris↗

An unusual case of guide wire fracture during percutaneous transluminal coronary angioplasty.

We report a case of guide wire fracture during percutaneous transluminal coronary angioplasty, using one of the newer catheter systems. The broken free end of the guide wire remained within the coronary tree, and surgical removal was necessary. Entrapment and overcoiling of the guide wire can cause fracture; in our case excessive bending in a tortuous coronary tree resulted in this unusual complication. An excessive tensile load to the guide wire may result from anatomical peculiarities and can cause wire fracture.

Angioplasty, Balloon↗

New high-frequency catheter technique for His bundle ablation in dogs.

A new method is presented for the production of complete atrioventricular heart block. It consists of a special catheter, which is inserted into the right atrium via a femoral vein and positioned in the region of the His bundle for His bundle potential recording. Production of heart block is achieved by a high frequency current pulse from an electrocautery unit.

Animals↗

Long term spontaneous evolution of left ventricular function after experimental acute coronary occlusion.

In a canine model of acute occlusion of the left anterior descending artery (LAD), left ventriculography was performed before and immediately after occlusion and also one and three weeks later. Regional left ventricular function was evaluated by the centreline method. Global and regional left ventricular function were significantly depressed immediately after occlusion and showed no significant recovery after one and three weeks, except for a decrease in the paradoxical motion of the LAD territory, which was probably due to stiffening of the infarct area.

Angiocardiography↗

Thrombo-embolic complication after streptokinase therapy of pulmonary emboli.

A 58-year old patient is reported who developed an ischaemic cerebrovascular accident 22 hours after successful thrombolysis with streptokinase for life-threatening pulmonary emboli. Despite effective thrombolysis, the plasma fibrinogen level rose during streptokinase administration and reached extremely high values 72 hours later. The mechanism of this unusual early and extreme rise of fibrinogen levels is unclear but it probably played a role in the pathogenesis of the cerebrovascular accident.

Coronary Artery Bypass↗

Surgical treatment of biventricular endomyocardial fibrosis. A case report.

The clinical, fono-mechano-echocardiographic, hemodynamic and angiographic findings before and after surgery of a patient who developed bilateral extensive endomyocardial fibrosis probably secondary to filariasis, are described. The patient was surgically treated by endocardial decortication and insertion of a mitral and tricuspid Ionescu Shiley low profile valve, which was followed by a marked subjective and objective improvement during a follow-up period of 42 months.

Angiography↗

Intravenous streptokinase during acute myocardial infarction. A prospective open study.

To evaluate the efficacy of intravenous streptokinase in acute myocardial infarction (AMI) 108 patients received a high-dose (1.5 million units), short-term infusion (60 minutes) within 6 hours after onset of symptoms, followed by anticoagulation. Before discharge a submaximal exercise test and a coronary arteriography were performed in 100 surviving patients. Sixty-seven patients had a patent infarct-related vessel. Clinical reocclusion occurred in 21 patients. Left ventricular function was slightly, but not significantly, better in patients with patent infarct-related vessels: ejection fraction 59.5 +/- 13% versus 57.4 +/- 13%. Additional procedures were performed in 20 patients: percutaneous transluminal coronary angioplasty (PTCA) in 8 and coronary artery bypass surgery (CABG) in 12. The results indicate that streptokinase applicated during a 6 hour-time window is a potent thrombolytic agent in acute myocardial infarction with limited effect on global left ventricular function. Pre-discharge evaluation is necessary to screen patients for residual ischemia.

Adult↗

Simultaneous right atrial appendage sensing with a target tip, a solid tip and J orthogonal electrodes.

To compare the sensing characteristics of a solid tip, target tip (Medtronic) and orthogonal electrodes within the right atrial appendage, atrial electrograms were simultaneously recorded from 2 pacing leads in 11 patients. No significant differences were noted between atrial electrograms derived from target tip or a solid tip electrode in contact with atrial myocardium. Mean values for P-wave amplitudes of 3.0 vs 3.1 mV and slew rates 0.4 V/s vs 0.6 V/s, and QRS amplitudes of 1.0 vs 1.2 mV and slew rates 0.4 vs 0.2 V/s were obtained. The frequency content was also similar, with spectral maxima at 8 vs 9 Hz (P wave) and 7 vs 6 Hz (QRS). In contrast, atrial electrocardiograms derived from the orthogonal electrodes were significantly different: P-wave amplitude of 6.1 mV (p less than 0.025) and slew rate of 1 V/s and QRS of 0.13 mV and slew rate of 0.04 V/s. Spectral analysis was also dissimilar with maxima at 34 Hz (P wave) and 3 Hz (QRS). Orthogonal noncontacting sensing electrodes positioned within the atrial appendage offer substantially better electrographic P-wave amplitude detection and QRS rejection than contacting tip electrodes. These leads yield a significant improvement when discriminate atrial sensing is required.

Atrial Function↗