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Biomedical subjects

J Beregovich

Publications and source records attributed to J Beregovich.

18 recordsLinked to original sources
PubMed1996

[Cardiology of yesterday, today and tomorrow].

The subject of this lecture has been chosen in relation to the contribution that Professor H Alessandri made in the first half of this century, as an outstanding clinician in the professional, humanistic and ethical development of generations of physicians in this country. This lecture is divided in three sections: the first reviews the practice of cardiology in the 50's, a period of initiation of the present advances in the specialty, still dominated at that time by a semiologic and clinical approach. The second part presents examples of the significant contributions made by newer technologies in the fields of echocardiography, nuclear medicine, electrophysiology and therapeutic procedures. Finally, an assessment is made of the needed balance between technology and clinical judgement, coupled with humanistic and ethical considerations in the management of patients.

Cardiology↗
PubMed1993

[Prospective study on post-acute myocardial infarction patients].

Long-term prognosis in acute myocardial infarction (AMI) can be related to a number of risk factors, including the electrocardiographic stress test (ECG Test). This study analyzes its contribution to the prognosis and management of such patients. 60 individuals discharged from a coronary care unit, without or with persisting complications underwent an ECG test 4-6 weeks following AMI, and were followed for a period of 12-39 months. 40 cases had a negative ECG test. During follow-up they continued to be generally asymptomatic and their survival was 100%. Coronary angiography in patients younger than 45 years revealed mainly single vessel disease. 20 cases (33%) had a positive ECG test. During follow-up 50% of these had anginal manifestations, and coronary angiograms revealed mainly 2-3 vessel disease. 6 patients underwent surgical revascularization. One patient died awaiting surgery. Overall survival in this group was 95%. It is concluded that stress testing performed during the convalescence period of patients with an AMI allows recognition of patients with a potentially poorer prognosis, which can be modified by appropriate study and revascularization in selected cases, bringing survival expectations to the same level of more benign cases.

Adult↗
PubMed1992

[Ventricular extrasystole and coronary disease: to treat or not to treat?].

The prognostic significance of ventricular premature beats (VPB) and their proper management are still a subject of controversy, particularly since during the last few years a number of publications have raised doubts as to the effectiveness and safety of antiarrhythmic drugs. An appropriate assessment of the VPB must consider: 1) electrocardiographic characteristics. 2) Associated symptoms. 3) Presence or absence of underlying disease, and 4) Ventricular function (VF). On this basis VPB may be classified as "Benign" (isolated; asymptomatic; mild or absent cardiopathy, and preserved VF); "Hazardous" (presence of complex VPB; with or without symptoms, and recognized organic heart disease), and "Malignant" (complex VPB and ventricular tachyarrhythmias; symptomatic cardiac disease, and compromised VF). Antiarrhythmic drugs are indicated for "Hazardous" and "Malignant" VPB. However, selection and efficacy must be documented by objective testing (Holter, stress, plasma levels). When utilized in well defined groups of patients, with reduction in the hourly number of VPB (more than 50-70%) and mainly of complex forms, there is clear benefit in terms of long-term survival, including coronary disease and congestive heart failure.

Anti-Arrhythmia Agents↗
PubMed1990

[Controversies on digitalis].

The introduction of newer drugs with effective cardiovascular action to clinical practice has reduced dependence on digitalis compounds. This tendency has been further justified by statements to the effect that consistently satisfactory results can be obtained with alternative drugs; that the inotropic action of digitalis is not evident in patients with normal sinus rhythm; that digitalis increases myocardial oxygen consumption, and finally that the high incidence of intoxication should limit its use. The present article reviews the use of alternative agents; the inotropic effects of digitalis in the presence of sinus rhythm; the implications of the use of drugs augmenting contractility upon total myocardial performance and oxygen consumption, and the factors pertinent in favoring digitalis toxicity. Digitalis continues to be a useful agent in the treatment of heart failure, either in patients with atrial fibrillation or in sinus rhythm. It may well be administered in addition to diuretics, vasodilators or fosfodiesterase inhibitors. Digitalis toxicity can be minimized by considering factors enhancing such complication or conditions where its use is ineffective.

Cardiac Output, Low↗
PubMed1989

[Silent myocardial ischemia].

During the last few years, the concept of "silent myocardial ischemia" has received special attention, particularly regarding its prognostic implications. Unfortunately a great variety of patients in different clinical settings have been included under the same definition. Thus, totally asymptomatic individuals are considered together with patients who have clinically evident stable or unstable angina pectoris, or patients in the post myocardial infarction phase. As a consequence, prognostic observations derived from clearly symptomatic cases are extrapolated to asymptomatic individuals in whom the only evidence of underlying coronary disease is an abnormal ECG stress test. The prognostic information available in this particular group shows that their clinical course is usually benign. Thus, invasive forms of investigation and management are not generally justified, in patients with properly define "silent myocardial ischemia".

Adult↗
PubMed1989

[Cardiogenic shock].

In spite of advances in our understanding of the pathophysiology of cardiogenic shock, and the introduction of potent vasoactive pharmacological agents in its management, prognosis continued to be dismal with hospital mortalities over 85%. It has been only through additional and aggressive interventions--including intraaortic balloon counterpulsation (IABC), percutaneous transluminal coronary angioplasty (PTCA) and surgical revascularization--that improved survival can be achieved. Today's management of cardiogenic shock requires an early and integrated approach including physiological monitoring, vasoactive drugs, IABC, coronary angiography and PTCA, with the expectation of improving prognosis.

Angioplasty, Balloon↗
PubMed1975

Effects of dobutamine on atrioventricular conduction.

Dobutamine, a new beta-stimulating catecholamine, has been investigated in terms of its effect upon atrioventricular conduction. Bundle of His recordings were obtained on six patients in basal conditions and with right atrial pacing at rates of 100, 120, and 140 per minute. Recordings were repeated following intravenous administration of Dobutamine in doses of 5, 10, and 15 mug per kilogram per minute. Dose-response curves were thus obtained for A-H and H-V intervals. Heart rate increased only moderately with progressive concentrations of the drug. Very significant facilitation of A-H conduction was demonstrated with doses of 10 and 15 mug per kilogram per minute, with no effect upon H-V times. Dobutamine may be a clinically useful inotropic agent in conditions associated with A-V conduction disturbances.

Adult↗
PubMed1975

Haemodynamic effects of a new inotropic agent (dobutamine) in chronic cardiac failure.

The haemodynamic effects of dobutamine were studied in 14 patients with chronic congestive cardiac failure. Heart rate, central venous, pulmonary arterial, pulmonary wedge, and aortic pressures, aortic dp/dt, cardiac output, cardiac index, stroke volume, and pulmonary and systemic vascular resistances were measured or derived. Dose-response curves were obtained by recording all measurements before and after intravenous infusion of dobutamine at rates of 2.5, 5, and 10 mug/kg per min for periods of 30 minutes each. Significant increases in mean values were observed for cardiac output from 3.7 to 6.4 l/min (82%), for stroke volume from 44 to 64 ml (39%), and aortic dp/dt from 692 to 1414 mmHg/s (92.0 to 188.1 kPa/s (76%). Heart rate increased only moderately from 86 to 101 per minute (31%). Significant reduction occurred in pulmonary wedge and central venous pressures. Mean aortic and pulmonary pressures did not change significantly, as a measure of decreased vascular resistances. The drug was uniformly well tolerated. The predominant inotropic effects of dobutamine without tachycardia or arrhythmias may be valuable in severe heart failure.

Adult↗