Search PubMed⌕ Search

Biomedical subjects

H Mickley

Publications and source records attributed to H Mickley.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Complications of long-term treatment with vitamin K antagonists].

Long-term treatment with vitamin K antagonists (vKA) frequently involves complications. The commonest complication is haemorrhage and cases of serious haemorrhage are stated in the literature to occur with a frequency per 1,000 treatment years of 12-108, of which 2-17 are fatal. The majority of deaths associated with haemorrhage are due to intracranial haemorrhage. Notifications of complications of vKA treatment in Denmark are considerably fewer than might be anticipated from the literature. The stability of anticoagulation treatment decreases with the number of drugs administered simultaneously and numerous drugs and other factors interact with the effect of vKA. A series of examples are reviewed and some known drugs which do not interact are mentioned. Non-haemorrhagic side effects of coumarin derivatives are rare. Anticoagulation treatment during pregnancy is associated with very special problems and must be regarded as a specialist task.

Anticoagulants↗
PubMed1990

Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients.

The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage was 200 (100-400) mg. Follow-up period 3 mths (15 days-15 mths). Based on the history and ECG flecainide had been effective in 51 pts. The improvement was most pronounced in pts suffering from supraventricular tachycardia involving an accessory bypass tract (84-92%). Flecainide had been discontinued in 50 pts due to: insufficient effect in 28, side effects in 17 and for other reasons in 5. The side effects indicating flecainide withdrawal (pts) were: cerebral symptoms (4), gastrointestinal complaints (2), bradyarrhythmias (2), heart failure (3) and suspected pro-arrhythmia (4). (Ventricular tachycardia in 3, 1:1 AV-conducting during atrial flutter in 1).

Administration, Oral↗
PubMed1989

[Exercise-induced ST segment depression following acute myocardial infarction. Occurrence and prognostic significance].

On the basis of a review of 20 investigations (3,587 patients), the prevalence of significant ST-segment-depression (ST-depr) in patients performing an exercise test 9-30 days after acute myocardial infarction (AMI) was found to be 33% (3-70%). The reason for the considerable variation is due to a combination of several factors: 1) different and frequently incomplete definition of significant ST-depr; 2) heterogenically composed patient groups (first vs subsequent AMI, different prevalence of infarct types and localization, consecutive vs selected patients, +/- cardioactive drugs during the exercise test); 3) different procedures for the exercise tests (submaximal vs maximal; few vs several ECG leads). The great variation in the prevalence of ST-depr, is also reflected in the prognostic significance. In about half of the investigations ST-depr has been prognostic for future death and/or cardiac events while ECG changes as an isolated variable did not prove to be of prognostic significance in the remainder. In general, it may be stated that a maximal exercise test with several ECG leads is more sensitive while ST-depr at a submaximal work capacity appears to be more specific for subsequent cardiac events.

Aged↗
PubMed1989

[Leisure activities and sports in younger pacemaker patients].

Based on a semistructured questionnaire the consequences of pacemaker treatment on leisure activities in 81 patients aged 20 to 60 years were investigated. At follow up after an average of 33.8 months, 36 of the 72 survivors participated in the following out-of-the-home physical activities: Badminton (3), bicycle-riding (6), firefighting (1), fishing (3), golf (2), gymnastics (3), handball (1), hunting (4), riding (1), running/jogging (4), sailing (5), shooting (2), skiing (3), soccer (5), swimming (1), theatre (1), chorus (1), and tennis (2). No significant changes in the levels of activity before and after pacemaker implantation were observed. Twenty of the patients did not feel the pacemaker had affected their levels of physical activity while ten patients experienced improvement in their physical capacities. Six patients felt that the pleasure in performing their favourite sport was restricted mainly due to fear of damaging the battery. Fifteen patients (21%) were members of sport clubs. These results imply that several leisure activities are available for pacemaker patients. In case a particular sport is of interest, this should be taken into account when the sitting of the pacemaker battery is decided.

Adult↗
PubMed1989

Runaway pacemaker: a still existing complication and therapeutic guidelines.

Runaway pacemaker is a rare, but still existing potential lethal complication in permanent pacemakers. Within 4 1/2 years, we saw two cases of runaway pacemaker in patients with multiprogrammable, VVI pacemakers (Siemens-Elema, Model 668). In both cases a pacemaker-induced ventricular tachycardia (rate 240-260 beats/min) was documented. One patient died. Runaway pacemakers must be exchanged as soon as possible. Until this can be accomplished, different emergency maneuvers should be tried. As documented in the cases presented, placing a magnet over the pacemaker may result in a lower, more physiological pacing rate. Reprogramming the pulse generator to a lower output or the use of external chest wall overdrive stimulation may also be successful, but these procedures require the presence of an adequate escape rhythm. If this is not the case or the former maneuvers have failed, an external pacemaker may be connected to the permanent pacing lead. Thereafter, the lead can be safely cut. As an alternative, a temporary transvenous pacing lead may be established prior to disconnecting the permanent pacing lead.

Aged↗
PubMed1989

The effect of carotid sinus massage is independent of posture in patients with heart disease.

The influence of posture on the effect of carotid sinus massage (CSM) in patients with heart disease has not been systematically evaluated. In the present study CSM was performed in 80 patients (mean age 55 +/- 10 (SD) years) suffering from various cardiovascular diseases. Each subject had unilateral right- and left-sided CSM performed in the supine and in the sitting position, while heart rate and systolic blood pressure were monitored. No statistically significant differences in the CSM-induced response in systolic blood pressure or heart rate were found between the two postures. In the supine position the drop in heart rate was significantly greater after right-sided than after left-sided CSM (P less than 0.05). In only one patient (1%) was a significant carotid sinus reflex evoked. The response was cardioinhibitory with asystole for 3700 ms during right-sided, supine CSM. These results imply that posture does not influence the effect of CSM in patients suffering from heart disease.

Aged↗
PubMed1989

Subjective consequences of permanent pacemaker therapy in patients under the age of retirement.

During a 5-year period, 81 patients ages 20 to 60 years old had implantation of a permanent cardiac pacemaker at the University Hospital, Odense. At follow-up, during 1985, the 73 survivors received a semi-structured questionnaire regarding subjective consequences of pacemaker therapy, and 72 people (98.6%) agreed to participate. The mean pacing period (range) was 33.8 (11-72) months. Surgical intervention was required in 14 patients (19.4%) during follow-up. Regarding all symptoms 67 patients (93.1%) perceived benefit from the pacemaker. The effectiveness of cardiac pacing was most pronounced in subjects suffering from syncope and/or dizziness. Eight patients (11.1%) perceived anxiety most frequently due to fear of pacing failure. Physical complaints were present in 17 patients (23.6%), and the discomfort was mainly due to the size of generator, pain/tenderness from the scar or a sensation of "impulses"/palpitations. To the majority (49 patients or 68.1%) pacemaker treatment did not influence quality of sexual activity. Six patients (8.3%) perceived an improvement, whereas a corresponding number felt deterioration in sexual activity following pacemaker implantation. Pacemaker therapy had not affected life quality in 30 (41.7%) of the patients. However 31 patients (43%) felt an improvement, and only a minority of ten patients (13.9%) perceived deterioration in quality of life owed to pacemaker therapy.

Adult↗
PubMed1987

Posture-dependent chronotropic effect of carotid sinus massage.

The hypertensive carotid sinus can be divided into cardioinhibitory (chronotropic) and vasodepressor components; the former can be evaluated by carotid sinus massage performed in the supine position. We present the case of a patient in whom the abnormal cardioinhibitory response could only be demonstrated while in the sitting position.

Carotid Sinus↗
PubMed1985

Petechiae and vasculitis in asymptomatic primary biliary cirrhosis.

Recurrent petechiae of the lower legs and signs of asymptomatic primary biliary cirrhosis have been found in three women. Large immune complexes were identified in the serum of three and cryoglobulin/cryofibrinogen in two. Histological examination of skin biopsies revealed a leukocytoclastic vasculitis in all three patients. Direct immunofluorescent studies showed deposits of IgM, C3 and fibrinogen in and around the walls of the small vessels of the skin of two and C3 as well as fibrinogen in one patient. It is suggested that leukocytoclastic vasculitis may be a microscopic feature of the systemic involvement in asymptomatic primary biliary cirrhosis, and petechiae the clinical manifestation.

Aged↗