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Biomedical subjects

J Boschat

Publications and source records attributed to J Boschat.

At least 109 records · Page 6Linked to original sources
PubMed1978

[Posterior mycardial infarction with or without the initial complication of atroventricular block. Short and long term comparative clinical study (author's transl)].

Comparison of the short term clinical course of 2 groups of patients who had suffered a first posterior myocardial infarction complicated during the acute phase (group A) by 2nd or 3rd degree atrioventricular block, or free of such a complication (group B), confirmed two classical concepts: the onset of this complication in one case out of five and a two-fold increase in mortality when it occurs. In the mid- and long term, however, the course is relatively similar in both groups, which do not differ initially in terms of average age, sex distribution nor the usual risk factors of coronary artery disease. In addition, the absence of sudden deaths in group A would suggest that AV block is a definitively regressive complication.

Acute Disease↗
PubMed1978

[Anterior and posterior myocardial infarct: clinical comparative study on its outcome].

A comparison of the short and long term outcome in two groups of patients admitted to hospital during the acute phase of their first myocardial infarction, an anterior group (123 cases) and a posterior group (147 cases) has produced the following results:--an immediate mortality which was significantly higher (identical cause of death) in the anterior infarct group (22.8%) than in the posterior infarct group (11.6%): p less than 0.02;--a very similar long term mortality (5 to 6% per year) in the two groups (the main causes for which cannot be equated) despite the fact that the initial destruction of muscle was usually greater when the infarct had been anterior. These results seem to lead to the following conclusion: a better overall prognosis seems to be related to efforts to limit the extent of an infarct, especially when it is anteriorly situated; sometime after the infarct, it is also linked to the improvement in vascularity of the regions which are not involved, especially in cases of posterior necrosis.

Acute Disease↗
PubMed1978

[Effort electrocardiography and coronary arteriography following a 1st myocardial infarction. Critical study of the effort test].

Sixty-five patients, convalescent from a first myocardial infarction (anterior in 24 cases; inferior in 41 cases), underwent an effort electrocardiogram on a treadmill and coronary arteriography. In the anterior infarcts, coronary arteriography showed single vessel disease (anterior descending artery) in 54% of cases and double or triple vessel disease in the others. The effort test was positive in only 25% of patients with an anterior infarct. The presence of stenotic lesions of the circumflex artery and/or right coronary artery was unsuspected in 63% of patients. In the inferior infarcts, there was a significant stenosis of the anterior descending artery in 51% of the cases. The effort test was positive in 54% of patients and in 77% of those the anterior descending artery showed a significant stenosis. The appearance (or increase) of ST elevation greater than or equal to 1 mm in the leads facing the infarcted zone was an indication of more severe deterioration in left ventricular function as shown by a more marked reduction in ejection fraction and a more extensive akinetic region. The co-existence of ST elevation in the leads facing the infarcted zone and of ST depression greater than or equal to 1 mm in the reciprocal leads always indicated that another major vessel was involved, but this was only found in 25% of cases in this series.

Angiography↗
PubMed1978

[Complete bundle-branch block and myocardial infarct. Natural history. Comparative study].

Myocardial infarction (MI), (and especially anteriorly situated necrosis) was complicated by complete branch block (CBB) in 9.7% of cases (45 patients out of 462). A comparison of the short- and long-term outcome in two groups of patients (group A: 45 cases of MI complicated by CBB; group B: 45 cases of MI with no atrio-ventricular or intra-ventricular conduction defects) showed that there was a much bigger immediate mortality in group A, which was not changed by temporary cardiac pacemaking, and depended on the extent of myocardial destruction. A study of the long-term outcome showed that there were more deaths in group A (recurrence of MI, intractable cardiac failure). However, the incidence of sudden death was equal in the two groups (group A 15%, group B 13%), and there was no obvious explanation in the absence of electrocardiographic tracings. Therefore this study lends no support to the argument which favours prophylactic implantation of a cardiac pacemaker during the course of MI complicated by CBB.

Adult↗
PubMed1977

Menopause and myocardial infarction.

Age and circumstances of menopause (natural or artificial) are detailed in 104 cases of recent myocardial infarction (MI). The results of this study with statistical analysis show no correlation between the age at menopause and the age at onset of MI; so for this study, an early menopause, cannot be considered, whatever circumstances, as a risk factor for coronary heart disease.

Age Factors↗
PubMed1977

Comparative haemodynamic effects of dobutamine and isoproterenol in man.

Dobutamine was infused at a rate of 8 mcg/kg/min in 17 patients with or without congestive heart failure. Cardiac output increased from an average 2.92 to 4.45 1/min/m2(p less than 0.001) with no change in mean aortic pressure (93.4 to 97.8 mmHg) and only a slight increase in heart rate (78 to 87 beats/min). Left ventricular end-diastolic pressure decreased from an average 19 to 13.7 mmHg (p less than 0.01). Peak left ventricular dp/dt was doubled (1147 to 2370 mmHg/sec, p less than 0.001) and Vmax increased from 1.08 to 2.18 circ/sec (p less than 0.001). In 10 patients given equi-inotropic doses (100 per cent increase in peak dp/dt) Isoproterenol produced a greater increase in cardiac output (71 percent) than Dobutamine /51 percent). Isoproterenol caused mean aortic pressure to fall significantly (8 percent) while no change was noted with Dobutamine. Accordingly, peripheral vascular resistances were reduced to a greater extent with Isoproterenol than with Dobutamine (p less than 0.05). Mean pulmonary arterial pressure decreased significantly (25 +/- 5.9 to 22 +/- 5.7 mmHg, p less than 0.05) with Isoproterenol infusion and remained unchanged with Dobutamine infusion. Dobutamine increased both stroke work (57 percent) and minute work (83 percent). With Isoproterenol however, only minute work was significantly increased (90 percent). Dobutamine therefore is a potent inotropic drug, with mild chronotropic and peripheral vascular effect and may be valuable in the management of severe heart failure not associated with hypotension.

Adult↗
PubMed1977

The length of the left main coronary artery: pathological features.

The mean length of the LCA found by pathological (or angiographic) methods is fairly constant. This exclusively anatomical study shows no significant relationship between the length of the LCA and stenotic atherosclerosis in the LCA or the heart weight or a dominant left circumflex coronary artery or a complete His left bundle-branch block.

Aged↗
PubMed1977

[Short-term outcome of a 1st myocardial infarct preceeded or not by a premonitory sign. Comparative study].

A comparative study of two groups of patients after their first myocardial infarction, distingusihed by the presence (group A, 149 cases) or absence (group B, 184 cases) of premonitory signs has shown no difference between the two groups in the short-term (5 weeks). The only differences were in the age (younger patients and in the larger number of anteriorly situated infarcts in the 45% of patients in this series who had premonitory signs.

Angina Pectoris↗
PubMed1977

[Complete auriculo-ventricular block. A study of supplemental pacemakers].

The following conclusions have been drawn from a study of 20 cases of total atrio-ventricular block, which were supra-His in 7 cases, intra-His in 4 cases, infra-His in 9 cases, and were with (11 cases) or without (8 cases) recent Stockes-Adams (1 case was excluded): resumption of the basal rhythm after the post-stimulatory pause is slower in cases of infra-His A-V block; automatic discharge from the focus is easily upset by rapid stimulation, whatever the site of the focus (ventricular or junctional); subsidiary foci of stimulation would behave from the electro-physiological standpoint like a sinus focus with reduced autonomy, and deprived of its peripheral zone of physiologically slow conduction; unfortunately electro-physiological investigation of this group does not allow us to separate with confidence those patients who have had Stockes-Adams attacks from those who have not.

Adams-Stokes Syndrome↗
PubMed1977

[Intramural anterior interventricular artery. Anatomical study].

In an anatomical study of 187 patients who had died from various heart disorders, the anterior descending artery (ADA) had an intra-mural course in 33 cases (17.65 p. 100). This abnormal course had had no correlation with the sex of the patients, the nature of the disease, length of the trunk of the left coronary artery, and to the relative sizes of the coronary vascular supply on the right and the left. It is associated, to a degree which may reach statistical significance, with certain abnormalities of distrubution of the ADA itself, of other pericardial arteries, and with a particularly short course which means that it does not reach the apex of the heart in more than a third of cases. The anatomical position of the intraparietal segment appears to be remarkably constant, and several anatomical landmarks (the origin of the second anterior septal artery and of the second diagonal artery, both collaterals of the anterior descending artery) may lead one to suspect the presence of an anomaly in the course of the artery when the coronary arteriogram is doubtful. The thickness of the muscular bridge is variable, but is not as a rule great. The most constant anatomical finding is that the anterior descending artery, in its intra-parietal segment, maintains a thin wall, and is never the seat of atheromatous deposits, whatever the age of the patient.

Arteries↗
PubMed1977

[Fatal cardiac insufficiency in the course of an initial acute myocardial infarct. Anatomical-clinical data].

In a series of 51 clinico-pathological examinations on patients who died during the first 15 days after the onset of clinical symptoms of their first and only transmural myocardial infarction (anterior: 29 cases; posterior: 22 cases) the causes of death were divided into: heart failure -- 26 cases (53 p. 100); rupture of the heart -- 22 cases (43 p. 100); disorders of ventricular rhythm -- 2 cases (4 p. 100). The anatomical basis of fatal cardiac failure is twofold: either a very extensive area of necrosed muscle, of poor quality of the mass of muscle not involved in the infarction. In the anterior infarctions (16 cases, representing 55 p. 100 of deaths in this group) the first factor was foremost, the mean extent of necrosed muscle constituting 42 p. 100 of the total left and septal ventricular mass; stenotic coronary lesions, which were commonly found on the anterior descending artery, were confined to this artery alone in 10 cases 62 (p. 100). In posterior infarctions (11 cases, representing 50 p. 100 of deaths in this group), the mass of muscle destroyed was less (mean 36 p. 100), but the stenotic coronary lesions were diffuse, involving the three main trunks in 9 cases, which also explains the poor quality of the muscle not involved by necrosis. Thus there is a clear difference between anterior and posterior infarctions followed by deaths from cardiac failure: in the first group, the remaining muscular mass is quantitatively insufficient to maintain the haemodynamics, while in the second it is qualitatively insufficient, because of poor blood supply, to maintain an adequate cardiac output.

Acute Disease↗
PubMed1977

[Coronary arterial thrombosis and transmural myocardial infarct. Cause or consequence?].

Macroscopical examination at postmortem of 64 patients who died of their first transmural myocardial infarction (32 with anterior infarctions, 28 with posterior and 4 with lateral), during the first 30 days after the onset of symptoms, has shown that in 59 cases (92.2 p. 100) there was a totally occlusive thrombosis in the coronary artery. In all cases these thromboses were sited on the major coronary arterial trunk to zone of muscle which was destroyed, and on top of an ulcerated atheromatous plaque. The age of the thrombosis and the infarction were identical. There was no relationship between the presence (59 cases) or the absence (5 cases) of coronary arterial thrombosis with the age, sex, survival time or extent of the infarction. These postmortem findings are strongly suggestive of a fairly constant cause and effect relationship between coronary arterial thrombosis and acute transmural myocardial infarction.

Age Factors↗
PubMed1976

[Myocardial and coronary lesions in anterior and posterior myocardial infarction. Comparative macroscopic anatomical study].

Comparative anatomical macroscopic study of two groups of 24 cases of recently fatal first myocardial infarction (anterior or inferior) confirmed certain classical notions: higher age in females (p less than 0.02), inferior necrosis less extensive (p less than 0.05), higher occurrence of rupture of the myocardium in the case or an anterior lesion, and less frequent rupture but more often involving the septum in the case of inferior infarction. Furthermore the study showed the virtually constant presence of an intracoronary thrombus responsible for the infarction, the wider extent of atherosclerotic lesions in the right coronary system, and, above all, a fairly direct opposition between stenotic lesions most often proximal, and affecting the single anterior trunk (75%), in the case of anterior infarction, whilst significant atherosclerotic occlusion of the anterior (87%) and left (67%) systems were seen in the case of inferior infarction due to complete occlusion of the right coronary artery. These anatomical findings indicate the need for routine coronary arteriography after inferior infarctions, the recurrence of chest pain being related not to changes "in sity" but rather to significant occlusion of another coronary system.

Aged↗