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Biomedical subjects

H N Hultgren

Publications and source records attributed to H N Hultgren.

At least 73 records · Page 4Linked to original sources
PubMed1976

Acute coronary embolism complicating bacterial endocarditis: operative treatment.

A patient with bacterial endocarditis and no previous history of angina substained an acute anterolateral myocardial infarction while awaiting surgery. Selective coronary arteriography revealed a filling defect in the left anterior descending coronary artery with limited flow beyond the area of occlusion. A calcific embolus from the infected aortic valve was removed at the time of valve replacement, and the patient had an uneventful immediate postoperative course. Late postoperatively paravalvular aortic regurgitation recurred before and after a second repair.

Acute Disease↗
PubMed1976

Medical versus surgical treatment of unstable angina.

Unstable angina is an important symptom of coronary artery disease. Two general clinical presentations may occur: (1) stable angina with a recent increase in severity or angina of recent onset, or (2) acute coronary insufficiency or angina at rest with chest pain resembling that of acute infarction. The risk of death or infarction is greater in patients who have recurrent chest pain and ST-T wave abnormalities despite hospital treatment. In patients without electrocardiographic or serum enzyme evidence of a completed infarct, coronary arteriography and bypass graft surgery can be performed with an acceptably low mortality rate. Surgical treatment provides better symptomatic relief than medical management in many patients, but the significant incidence of perioperative infarction makes it difficult to determine if surgery prevents infarction. Some studies indicate that surgery improves survival in subgroups, but data from large scale randomized studies will be needed to answer this question securely. Patients with disease of the left main coronary artery should probably have surgical treatment. Medical treatment will relieve symptoms in most patients with unstable angina and on a long-term basis may obviate the need for surgery. A preliminary period of intensive medical treatment before surgery may be advantageous since there is little evidence that survival rates are improved by treating unstable angina as an acute surgical emergency.

Acute Disease↗
PubMed1976

The cardiovascular effects of lithium in man. A review of the literature.

The medical literature since 1900 has been reviewed to determine the nature of lithium's cardiovascular effects. In therapeutic doses, lithium produces reversible T wave flattening and inversion in the electrocardiogram: rarely, it may cause sinus node dysfunction or ventricular arrhythmias. Patients with lithium toxicity almost always present with neurologic signs and symptoms. "Hypotension and cardiovascular collapse," alleged cardiotoxic manifestations of lithium, invariably follow days of coma. Given the possible cardiotoxic effect other psychopharmacologic agents and the hazards of withholding effective therapy in mania, it is concluded that lithium may be used safely in patients with cardiac disease if the dose is adjusted to the rate of lithium excretion and if serum levels of lithium are followed carefully. When used in patients with cardiac arrhythmias, frequent electrocardiographic monitoring is advised.

Adult↗
PubMed1976

The effect of coronary bypass surgery on exercise-induced ventricular arrhythmias.

Ninety-one patients with angiographically proved coronary artery disease and stable angina were randomly assigned into surgical and medical therapy. Graded exercise tests were performed on entry into the study and repeated in 1 year. Ventricular arrhythmias during exercise and 8 minutes of recovery were studied. Arrhythmias were graded on a scale of 0 to 7 by their presumed severity. On entry, both groups were similar in the severity of coronary disease, exercise capacity, and frequency and severity of exercise-induced ventricular arrhythmias. At 1 year, the frequency and severity of arrhythmias remained unchanged in both groups, whereas the surgically treated patients showed a marked improvement in their exercise capacity (p less than 0.005). The medically treated patients had a slight deterioration in their work capacity which, however, did not achieve statistical significance (p = 0.08). Twelve patients died suddenly. In seven medically treated patients who died suddenly, the frequency and severity of ventricular arrythmias on exercise were not different from those of the rest of the medical patients. In the five surgically treated patients who died suddenly, one had multiform premature ventricular beats, a second developed ventricular fibrillation (2 years before dying suddenly), and a third had no arrhythmias during exercise. Two died before the 1 year evaluation. Successful coronary surgery improves exercise capacity without decreasing associated ventricular arrhythmias. Exercise-induced ventricular arrhythmias, with the exception of ventricular fibrillation, may not be closely associated with the risk of sudden death.

Arrhythmias, Cardiac↗
PubMed1976

Left anterior descending coronary artery obstruction. Clinical, electrocardiographic, and angiographic correlates.

Seventy-six patients with severe (greater than 80%) occlusive left anterior descending coronary artery disease by coronary angiography were examined for the electrocardiographic characteristics of this disease in the presence (group A 59 patients) or the absence (group B 17 patients) of anterior wall asynergy (akinesis or dyskinesis). The incidence of clinically documented anterior myocardial infarction in these two groups of patients was examined. The collateral circulation to the left anterior descending coronary artery was also examined in the groups of patients with and without anterior wall asynergy. Thirty-eight of 59 (64%) patients with anterior wall asynergy (group A) showed electrocardiographic signs of anterior myocardial infarction, 17 per cent showed probable electrocardiographic signs of anterior myocardial infarction and 19 per cent showed no electrocardiographic signs. None of the 17 patients without anterior wall asynergy (group B) showed electrocardiographic signs of anterior myocardial infarction. In group A 74.6 per cent had documented clinical evidence of previous anterior myocardial infarction. Collateral filling of the distal left anterior descending coronary artery was seen in 71 per cent of group A and 100 per cent of group B patients. There was a significantly higher incidence (P = 0.02) of collateral filling in the patients without electrocardiographic evidence of definite anterior myocardial infarction (93% of 28 patients), than in those who showed definite electrocardiographic evidence of anterior myocardial infarction (66% of 38 patients).it is concluded that severe occlusive left anterior descending coronary artery disease with anterior wall myocardial asynergy is usually associated with electrocardiographic signs of anterior myocardial infarction, whereas equally severe left anterior descending coronary artery disease without anterior wall asynergy is rarely associated with electrocardiographic abnormalities of anterior myocardial infarction. Severe left anterior descending coronary artery obstruction without electrocardiographic and angiographic evidence of anterior myocardial infarction is usually associated with collateral circulation to the left anterior descending coronary artery and collateral circulation to the left anterior descending coronary artery is present less frequently when obstruction is associated with anterior myocardial infarction.

Adult↗
PubMed1976

Medical versus surgical treatment of stable angina pectoris: progress report of a large scale study.

A large scale, prospective, randomized study of surgical v. medical management of disabling angina pectoris is being conducted as a cooperative study among thirteen Veterans Administration hospitals in the U.S.A. A total of 1015 patients have been entered into the study and follow-up data are currently being evaluated. Patient entry into the study was concluded in December 1974. Patient compliance has been acceptable with only 7% of patients not adhering to their randomization category. Thirty-day operative mortality (1972-1974) in 309 patients was 5-3%. The patient population exhibited a severe degree of coronary disease. There was ECG evidence of prior myocardial infarction in 40%. There were significant obstructive lesions in three major coronary arteries in 51% and significant lesions of the left main coronary artery in 11%. Medical and surgical treatment groups demonstrated no significant differences in objective descriptive characteristics. Mortality in the medical group at 1 year was 8%. Mortality was influenced by several factors including the number of vessels involved, left ventricular function and the presence of left main coronary artery disease. The lowest mortality occurred in patients with single vessel disease and normal LV function who had a 1-year mortality of 3%. Patients with 3-vessel disease and abnormal LV function exhibited a 14% 1-year mortality. Patients with disease of the left main coronary artery and poor LV function had a 1-year mortality of 37%. Analyses of the results of treatment modalities in sub-groups is currently being performed and will be reported in future publications.

Adult↗
PubMed1976

The VA cooperative randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions.

From a large cooperative prospective randomized study, data relating to a subgroup of 113 patients with angina pectoris and a significant lesion of the left main coronary artery were analyzed. Of these patients, 53 had been randomly allocated to a medical treatment group and 60 to a surgical treatment group. The former group received conventional medical treatment, while the surgical treatment group received one or more aortocoronary saphenous vein bypass grafts. Important risk factors were approximately uniformly distributed between the two groups. Both are being followed up to 60 months (average follow-up, 30 months). To date, 12 of 60 surgical patients (20%) and 19 of 53 medical patients (36%) died (P less than 0.06). The operative (30-day) mortality declined from a rate of 25% for the first 2 years of the study to 7% for the last 3 years. Of patients randomized in the latter 3 years of the study, 12 of 41 medical patients (29%) and three of 42 surgical patients (7%) died (P less than 0.01). The average follow-up period in this group was 24 months. The proportion surviving 24 months was clearly larger in the surgically treated group (P less than 0.02). The difference in the proportion of patients surviving after surgery as compared with medical treatment was greatest in patients with additional significant disease involving the right coronary artery, with or without left ventricular dysfunction. Relief of angina as assessed by an "anginal score" was also better in surgical patients to a significant degree. Graft-patency rates correlated well with relief of angina, but objective studies including treadmill testing are not yet available.

Angina Pectoris↗
PubMed1975

Cardiac arrest due to oral potassium administration.

Cardiac arrest developed in two patients after the administration of oral potassium. Neither patient had renal insufficiency, but both had underlying heart disease. In one patient fatal ventricular fibrillation developed 4 days after he received an aortic valve replacement for aortic stenosis and while he was receiving oral potassium supplements. The serum potassium level before cardiac arrest was 8.1 meq. The second patient had angina and was given 40 meq of potassium orally 15 minutes after an exercise test which produced chest pain and S-T segment depression. One hour later, ventricular fibrillation developed. Resuscitation was successful. Both patients had electrocardiographic evidence of hyperkalemia. Oral administration of potassium may produce severe cardiac toxicity in patients with heart disease even when renal function is clinically normal.

Administration, Oral↗
PubMed1975

Aneurysms of the coronary arteries in the adult. Clincial and angiographic features.

One thousand coronary arteriograms were reviewed to determine the incidence, clinical presentation and angiographic features of aneurysms of the coronary artery (ACA) in adults with angina. Criteria for the angiographic diagnosis are described and the angiographic aspects are emphasized. The incidence of ACA was 1.1%. Saccular and fusiform aneurysms were seen. Single aneurysms were present in 7 patients. One patient had an abdominal aneurysm. Five patients underwent surgery; two had postoperative selective coronary angiography one year later and all five underwent follow-up left ventricular angiography. The most likely etiology of the aneurysms in this series is atherosclerosis.

Adult↗
PubMed1975

Occult atrial septal defect in adults.

Two patients are described who presented with congestive heart failure and were found to have an atrial septal defect with a pulmonary blood flow approximately twice the systemic blood flow. Most of the usual clinical signs of atrial septal defect were absent, and the diagnosis was established by right heart catheterization and radioisotopic angiography. Both patients had hypertension and coronary artery disease. Atrial septal defect in the adult patient may not be recognized because of associated cardiac disease, including coronary artery disease and hypertension, or pulmonary disease which may obscure the usual clinical signs of a septal defect. Radioisotopic angiography and right heart catheterization should be considered in any patients with heart disease or congestive failure of obscure cause even if the usual diagnostic signs of atrial septal defect are absent.

Cardiac Catheterization↗
PubMed1975

Myocardial damage in combined valvular and coronary bypass surgery.

The incidence of perioperative myocardial infarction (MI) and acute ischemic injury was determined in 44 patients having aortic valve replacement plus aortocoronary vein grafts (AVR + CABG) and in 22 patients having mitral valve repair or replacement plus aortocoronary vein grafts (MVR + CABG). These data were correlated with aortic cross-clamp time, fibrillation time, presence of left ventricular hypertrophy, and, in selected cases, left ventricular biopsy. Perioperative MI occurred in 21% (9/44) of the AVR + CABG patients and 5% (1/22) of MVR + CABG patients. In contrast, the MI rate for isolated valve replacement was 7% (15/213), and for isolated CABG 14% (16/112). In the AVR + CABG group, 100% (5/5) of patients with combined cross-clamp and fibrillation times greater than 120 minutes suffered MI. These results indicate that patients with combined AVR + CABG are subject to substantially greater risk of perioperative myocardial damage than the other groups. Excessive aortic cross-clamp times and fibrillation plus aortic cross-clamp times should be avoided in AVR + CABG patients.

Aortic Valve↗