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H Douard

Publications and source records attributed to H Douard.

At least 73 records · Page 4Linked to original sources
PubMed1988

Validation of a digitized Holter monitoring system by comparison with the Marquette case system.

Detection of silent myocardial ischaemia must be accurate and reliable. With the new digitized Holter monitoring systems these qualities are feasible. We tested one of these devices (Monitor One, Q Med) by comparison with a digitized and averaged ECG signal provided by the Marquette Case system during exercise tests in 30 patients with angiographically documented coronary artery disease. Detection and quantitation of ST segment depression episodes by the Holter system were excellent. Furthermore, indirect ECG criteria of ischaemia as R-wave amplitude variations were easily recognized. Thus digital monitors may be used to detect ischaemic events in prospective and multicentre studies for the diagnosis and prognosis of silent myocardial ischaemia.

Coronary Disease↗
PubMed1988

[Respective diagnostic value of CM5 and V5 leads in exercise tests. Comparative study of 100 cases].

The respective diagnostic values of CM5 and V5 leads in exercise tests were studied in 100 patients, 89 of whom had coronary disease. Mean maximum ST depression and mean R wave amplitude at rest and at peak exertion were very much greater with CM5 than with V5 (p less than 0.0001). These two parameters seemed to vary concurrently. The contribution of both leads to the diagnosis in terms of sensitivity is probably the same; the more severe the coronary disease, the more pronounced the ST depression on CM5 tracings as compared to V5 tracings. A significant ST depression (1 mm) also appears more rapidly on the bipolar MC5 lead.

Coronary Disease↗
PubMed1987

Mono- or combination therapy for stable angina pectoris.

Symptom-limited exercise testing (SLET) makes it possible to appraise in a reproducible manner both the extent of ischemia and the circulatory profile. Therefore, repeated SLET with either one or another drug, or a combination of both allows a proper comparison and avoids the quite impractical trials lasting several weeks, far too complicated in the case of combination of drugs. From the knowledge of the components of myocardial oxygen demand and of the pharmacological properties of different drugs, it is easy to predict what combinations will be complementary, harmful, or redundant. The application of these principles to the individual patient is made easier by the determination of the circulatory profile and of the severity of ischemia. From that, the logical proposal for whichever combination is obvious. The more effective and less costly combination appears to be the association of beta 1-selective blockers and preventive sublingual nitroglycerin. beta-Blockers and nifedipine and diltiazem and molsidomine are also effective and well tolerated.

Angina Pectoris↗
PubMed1987

[Exercise test and ventricular tachycardia: the French experience].

The incidence of severe ventricular arrhythmia requiring electric shock or prompt intravenous therapy was evaluated during or immediately after 458,000 exercise tests performed in 46 french centres between 1975 and 1985; 177,000 tests were performed exclusively in cardiac patients during supervised exercise training sessions. Sixty cases of severe arrhythmia (ventricular fibrillation 23, ventricular tachycardia 35, asystole 2) occurred (1/7600 tests). One or several electric shocks were necessary in 35 cases. Six patients died (1/76,333 tests), 2 of them during training sessions; 5 had phase II or III myocardial infarction, and the 6th patient had moderately tight valvular aortic stenosis. The five coronary patients were taking various anti-arrhythmic drugs. Among the 54 survivors, 14 were lost sight of and 4 died, 2 of these suddenly including one who passed away during a bicycle ride. All others are alive after a 3.25 +/- 2.9 years follow-up. The association of a multiple-vessel disease with an extensive fibrous plaque is a syndrome that is highly sensitive but fortunately little specific in predicting severe arrhythmia during exercise tests.

Adult↗
PubMed1987

[Obstruction of the left coronary branch. Ergometric, hemodynamic and angiographic findings].

The authors present 6 personal cases of complete obstruction of the left main stem coronary artery and review the main epidemiological, clinical, ergometric, haemodynamic, angiographic and therapeutic data concerning this condition which is uncommon (0.66% of patients who underwent coronary angiography for angina in this series). This series had a number of special features. Clinical symptoms were moderate, consisting of exercise-induced aggravated angina, except in one patient with a history of anterior infarction complicated by regressive initial heart failure with residual angina. For this reason, all patients were able to perform a standard exercise-test on an ergometric bicycle without any problem. As the exercise test revealed major abnormalities, extreme precautions were observed when coronary angiography was performed, but no incident occurred in any of the 6 patients. Haemodynamic data were normal in 4 cases and altered in 2 cases. The important role played by collateral circulation must be stressed; it is probably under evaluated at arteriography. The absence of lesion of the right coronary artery is thought to facilitate the development of a collateral vascular network. Five patients were operated upon, made an uneventful recovery and were followed up for 19, 42, 17, 5 and 2 months respectively: all were symptom-free under medical treatment. In 3 out of these 5 patients who underwent a post-operative exercise-test all parameters showed excellent results; however, the 4th patient proved unadaptable to exercise, and ECG showed persistent ischaemia due to a very poor distal coronary bed; in the 5th patient, under diltiazem, the results on ischaemia and on the circulatory signs of heart failure were very good.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Ultrasonic study of gallbladder motility during exclusive continuous enteral feeding].

Total parenteral nutrition may be responsible for gallbladder sludge and lithiasis which might possibly be related to gallbladder bile stasis. Gallbladder motility has not yet been studied during constant-rate enteral nutrition. We performed serial ultrasonographic studies of gallbladder volume and contents in ten patients receiving constant-rate enteral nutrition during 35 +/- 17 days. Each patient had two weekly examinations at 9 AM and 2 PM on the same day. None of the patients developed gallbladder sludge or lithiasis. The gallbladder was frequently seen to be contracted. Mean gallbladder volume during constant-rate enteral nutrition was not significantly different from mean gallbladder volume after Bladex. Individual gallbladder volume changed significantly from one measurement to another. This study showed that gallbladder motility is preserved during constant-rate enteral nutrition. The persistence of gallbladder contractions may prevent the development of biliary sludge ad lithiasis.

Adolescent↗
PubMed1987

[Simultaneous occurrence of left heart block and chest pain during exertion].

Two principal theories have been formulated to explain the simultaneous occurrence of a left bundle branch system block (LBBsB) and a stress-induced chest pain: initial stage of the permanent LBBsB of a primary myocardiopathy, or original clinical expression of coronary insufficiency. In the case presented here, the similarity of symptoms, the improvement observed in ergometric exercise tests under nitroglycerin and the increase of lactate concentrations in the coronary sinus were in favour of the second theory. However, the results of a radionuclide myocardial perfusion study and a radionuclide ventriculography were not sufficiently specific to support this assumption. The lack of free interval between the LBBsB and the angina-like chest pain (neurosensorial reflex) stands against an ischaemic mechanism. The initial intermittent LBBsB phase found in our patient during the exercise test might correspond to this free interval. The favourable prognosis and the uncertain effectiveness of treatment are suggestive of a very early stage in either primary cardiomyopathy or coronary disease.

Bundle-Branch Block↗
PubMed1987

[Comparative effect of atenolol and verapamil in exertion angina. A single-blind crossed study with computerized exercise test].

The anti-ischemic activity of Verapamil (360 mg/24 h) is compared with a cardioselective betablocker, Atenolol (100 mg/24 h), in a single blind study with computerized stress tests. Although acting through different mechanisms, and are evaluated indirectly by measurements with equal cardiac work and frequency, the improvement of the performance, the decrease of the sub-denivellation at the end of the stress and the frequency of interruption because of pain, seem approximately similar for both medications.

Angina Pectoris↗
PubMed1986

[TM and bidimensional echocardiography of subvalvular aortic stenoses].

28 children (age: 7.5 +/- 4.6 years) and five adults with a subvalvular aortic stenosis were evaluated by TM and bidimensional echography. Long axis parasternal and apical two cavities-aorta views seem the most reliable to determine the anatomical varieties (type I in diaphragm: 25 cases; type II fibromuscular: 5 cases; tunnel: 1 case; isolated mitral abnormalities: 2 cases). 24 patients were catheterized. Among the various echocardiographic parameters that were measured, the ratio parietal thickness/left ventricular diameter in telesystole appears best correlated to the hemodynamic gradient (r = 0.65).

Adolescent↗
PubMed1986

[Medium term outcome of 191 cases of coronary insufficiency technically operable and treated medically].

After evaluation by clinical examination, stress testing and coronary angiography, coronary patients may be classified into several subgroups according to the therapeutic orientation: 1) surgical and operable, 2) surgical but inoperable, 3) operable, but not immediately, 4) inoperable and not referred for operation. Groups 1 and 2 have severe ischaemia at rest or on exercise and an incomplete response to medical therapy: surgical revascularisation may be possible (Group 1) or not (Group 2). The surgical indication in Group 4 is not formal, but would be this so the operation would not be possible technically: this is the case for example in isolated thrombosis of the right coronary or left anterior descending arteries after infarction in their territories. This study concerns cases in Group 3; a total of 196 patients were deliberately treated medically after exercise stress testing had indicated a probable good prognosis despite patent coronary lesions (1.76 vessels with over 70% stenosis or thrombosis). Of the 1,181 patients who underwent exercise stress testing without therapy before coronary angiography between January 1979 and March 1983, 700 were operated (Group 1), 200 were inoperable (Group 2), 50 were inoperable and not referred for surgery (Group 4) and 196 were deliberate abstentions (Group 3); 35 patients underwent angioplasty; the average age of these 196 patients (168 men and 27 women) was 57.6 +/- 9 years (range 29 to 76 years). The incidence of single, double and triple vessel disease in this subgroup was 42%, 38% and 20%, respectively; 37% had previous infarction; 16% had atypical chest pain; 40% had stable angina, recent in 44% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Diagnostic value of amplitude variations of the Q wave during computerized stress electrocardiogram].

Variations in the amplitude of the Q wave in lead CM5 during computerised exercise stress testing were studied in 220 patients and compared with the results of coronary angiography. The average amplitude of the Q wave increases during exercise in athletes (n = 30) from 3 +/- 2.75 mm to 4.72 +/- 2.35 mm (p less than 0.01), and in subjects without coronary artery disease (n = 49) from 0.92 +/- 1.05 mm to 1.75 +/- 1.62 mm (p less than 0.01). The Q wave did not vary significantly during exercise in patients with coronary disease but without previous infarction (n = 88) (0.70 +/- 0.91 mm to 0.62 +/- 0.85 mm). The amplitude of the Q wave did tend to decrease in patients with previous myocardial infarction (n = 83) from 1.96 +/- 2.05 mm to 1.35 +/- 1.26 mm (p less than 0.05). It is therefore possible to define a new diagnostic criterion of coronary disease: "the exercise stress test is said to be positive (delta q+) when the Q wave tends to decrease or remains stable during exercise, and negative (delta q-) when the Q wave amplitude increases during exercise". This criterion was tested in 49 normal and 83 coronary patients without infarction. The sensitivity (Se) was 79 p. 100 and the specificity (Sp) 65 p. 100, so correctly classifying 74 p. 100 of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗