Search PubMed⌕ Search

Biomedical subjects

J C Farcot

Publications and source records attributed to J C Farcot.

At least 37 records · Page 2Linked to original sources
PubMed1984

Two-dimensional echocardiographic demonstration of acute myocardial depression in septic shock.

A 50-yr-old woman exhibiting streptococcal neck cellulitis developed severe septic shock with low cardiac output, which was reversed by infusion of dopamine plus dobutamine. Two-dimensional echocardiography performed at the bedside demonstrated severe myocardial failure. The patient's condition remained dependent on inotropic drug support for 2 days and ultimately improved. Two-dimensional echocardiography repeated on the fourth day corroborated the disappearance of transient myocardial failure.

Cardiac Output, Low↗
PubMed1984

Echocardiographic evaluation of ventricles during continuous positive airway pressure breathing.

Using M-mode and two-dimensional echocardiography, we have compared left and right ventricular dimensions at expiration and inspiration in a group of 12 healthy young volunteers during the following two distinct periods: 1) a control period with atmospheric pressure breathing, and 2) a continuous positive airway pressure (CPAP) period with 15 cmH2O end-expiratory pressure breathing. In 6 of the 12 subjects we also evaluated inferior vena caval size, using the same technique. Inspiratory decrease in left ventricular short-axis area (A), length (L), calculated volumes (V = 5/6 AL), and inspiratory increase in right ventricular short-axis diameter and long-axis area were evident at both control and CPAP periods. CPAP also produced a marked decrease in left and an increase in right ventricular dimensions during both expiration and inspiration and a significant decrease in calculated stroke output. An increase in vena caval size during CPAP breathing indirectly suggested a decrease in venous return, but the finding of an unchanged percent of inspiratory change of this vessel during CPAP indicated that the inspiratory augmentation of venous return was still present. On the other hand, the finding of an increased right ventricular size indicated that the right ventricle was afterloaded by CPAP; this probably could explain the observed reduction in calculated stroke output.

Adult↗
PubMed1984

Two-dimensional echocardiographic assessment of left ventricular function in chronic obstructive pulmonary disease.

In 10 patients undergoing therapy for a mild exacerbation of their chronic obstructive pulmonary disease (COPD), a quantitative two-dimensional echocardiographic (2DE) study was performed together with hemodynamics to assess left ventricular (LV) function. From the 2DE examination, which was made up of parasternal, subcostal, and apical views, measurements of LV short axis end-diastolic and end-systolic areas (A) at the high papillary muscle level and long axis end-diastolic and end-systolic length (L) permitted us to calculate LV end-systolic and end-diastolic volumes (V) using the formula V = 5/6 AL. Compared with the same measurements obtained in a group of 12 normal volunteers, patients with COPD exhibited a markedly reduced LV cavity (LVES, 28.9 +/- 14.6 ml/m2 versus 51.5 +/- 11.0 ml/m2; LVEDV, 67.7 +/- 24.6 ml/m2 versus 103.2 +/- 19.9 ml/m2). An increased thickness of both left ventricular free wall and interventricular septum was also evidenced in patients with COPD. Left ventricular systolic function, assessed using both peak systolic blood pressure/end-systolic volume ratio and calculated left ventricular ejection fraction, was found to be clearly enhanced in patients with COPD. The influence of right ventricular enlargement on left ventricular diastolic function was also investigated in patients with COPD using progressive volume loading and 2DE right ventricular measurements. After a given threshold of volume loading, reduction in stroke index, opposite variations in right and left ventricular size and septal flattening, suggested the occurrence of ventricular interaction.

Adult↗
PubMed1983

[Pericarditis with recurrent cardiac compression in rheumatoid polyarthritis].

The authors report the case of seventy-two-year-old man with severe rheumatoid arthritis in whom onset of right ventricular failure led to the discovery of pericarditis. After fluid withdrawal, the anterior part of the pericardium was resected. Analysis of the fluid and histological findings suggested a rheumatoid origin. Pericarditis recurred two and a half years later causing subacute compression of the heart leading to repeated centeses in spite of corticosteroid therapy. In the terminal stage, M. tuberculosis was discovered but this finding was not confirmed subsequently. The main features of rheumatoid pericarditis are reviewed. Tuberculous pericarditis should be considered in patients under corticosteroids or immunosuppressive agents.

Aged↗
PubMed1983

[Patency of the foramen ovale in paradoxical embolism. Detection by contrast echocardiography and the cough provocation test].

Five patients with suspected paradoxical embolism were investigated for patent foramen ovale by contrast echocardiography. Right-to-left shunting was demonstrated in 3 patients: during a Valsalva manoeuvre in one and during coughing fits in all three. Patency of the foramen ovale was confirmed by cardiac catheterization in these 3 patients. In 2 patients the foramen was not patent and the diagnosis of paradoxical embolism was not confirmed. In two other patients, the right and left atrial pressures were measured simultaneously during a Valsalva manoeuvre and during coughing. The normal pressure gradient between the two atria was suppressed during the relaxation stage, resulting in decreased curvature of the interatrial septum which facilitated the flow of blood from the inferior vena cava into the left atrium. Coughing appears to be a simpler and more sensitive test than the Valsalva manoeuvre to induce transient right-to-left atrial shunting.

Cough↗
PubMed1983

[Two-dimensional contrast echocardiography during the drainage of hemopericardium with tamponade].

In patients with cardiac tamponade, withdrawing blood during pericardiocentesis raises questions as to its origin: pericardium or cardiac cavities? These questions can be answered by bidimensional contrast echocardiography after reinjection of a few millilitres of the blood-stained fluid removed. Microcavitations surrounding the heart and vanishing within a few minutes indicate that blood comes from the pericardium. Microcavitations obscuring the right atrium or ventricle and washed away by the blood flow in a matter of seconds indicate that these cavities have been punctured.

Adult↗
PubMed1983

Diastolic synchronized retroperfusion versus reperfusion: effects on regional left ventricular function and myocardial blood flow during acute coronary occlusion in dogs.

The effects of 170 minutes of diastolic synchronized retroperfusion of the coronary sinus with arterial blood during 180 minutes of coronary artery occlusion on regional myocardial contractility (ultrasonic crystals) and blood flow (microspheres) were investigated in open-chest dogs. These effects were compared with those of 180 minutes of coronary occlusion and those of 170 minutes of anterograde reperfusion after 10 minutes of coronary occlusion in separate groups of dogs. Retroperfusion was able to almost restore transmural blood flow in the moderately ischemic zones and to increase it back to 47% of its preocclusion value in the severely ischemic zones with, in both zones, a favorable redistribution of flow toward the endocardium. Simultaneously, retroperfusion significantly improved segment length shortening in the moderately ischemic zones and significantly reduced the extent of paradoxical bulging in the severely ischemic zones. These partial recoveries in regional contractility and blood flow during retroperfusion were intermediate between those induced by 170 minutes of anterograde reperfusion and those of 180 minutes of coronary artery occlusion. Thus, in the presence of coronary artery occlusion, retroperfusion appears to exert a beneficial effect by improving both regional perfusion and function in the ischemic zones and may be proposed as a medical circulatory support to the jeopardized myocardium.

Acute Disease↗
PubMed1983

[8-hour hemodynamic study of 2 sustained-release nitrate derivatives. Comparative double-blind study against placebo].

The aim of this study was to evaluate the duration of the hemodynamic effects of a new slow release preparation of isosorbide dinitrate and to compare its action with placebo and a slow release nitroglycerin preparation whose hemodynamic efficacity has already been demonstrated. The study was undertaken in 30 patients admitted to the intensive care unit during the acute phase of myocardial infarction complicated by left ventricular failure less than 12 hours after the onset of the chest pain. The patient population was uniform: 24 males, 6 females, mean age 61 years. Fifteen patients had anterior infarcts and 15 posterior infarcts. The drugs were administered double blind in a randomised fashion to 3 groups of 10 patients, the initial clinical and hemodynamic characteristics of which were comparable: 10 patients received placebo (placebo group); 10 patients received slow release nitroglycerin in a 7,5 mg gelule (NTG group) and 10 patients received 40 mg slow release isosorbide dinitrate (ISDN group). The following parameters were compared: heart rate, right atrial pressure, pulmonary artery and capillary pressures, systemic arterial pressure, cardiac index and systemic and pulmonary arterial resistances. These parameters were measured before therapy, half an hour, one hour and every two hours up to the 8th hour after drug administration. All patients were in moderate left ventricular failure with an initial mean capillary pressure of 18 mmHg +/- 1,3 mmHg. In the placebo group, none of the parameters studied changed significantly during the study. Pulmonary artery pressure fell significantly by 11 p. cent in the NTG group and 7,5 p. cent in the ISDN group. Mean pulmonary capillary pressure fell progressively in both treatment groups; the change was significant compared to the placebo group from the first hour for the ISDN group, and from the second hour for the NTG group. The fall remained significant at the 8th hour for the ISDN group but not in the NTG group. Cardiac index, systemic blood pressure, systemic and pulmonary arterial resistances did not change significantly. The cardiac index remained stable in the 30 patients, but with a number of individual variations depending on initial mean pulmonary capillary pressure and the importance of its fall after nitrate administration. The authors conclude that the hemodynamic effects of slow release NTG and ISDN in the acute phase of myocardial infarction complicated by moderate left ventricular failure are comparable. Pulmonary capillary pressure was the hemodynamic parameter which underwent the greatest variation in the two treatment groups. Its fall was more prolonged in the ISDN than in the NTG group.

Administration, Oral↗
PubMed1982

[Influence of positive end-expiratory pressure ventilation on left ventricular function (author's transl)].

During the last decade several attempts have been made to elucidate the mechanism of the fall in cardiac output observed during positive end-expiratory pressure ventilation (PEEP). some of these studies have given conflicting results, but the weight of experimental and clinical evidence available today points to a coherent physiopathology. PEEP does not alter left ventricular contractility, but it impedes left ventricular filling by reducing pulmonary venous return and left ventricular compliance. In patients under high PEEP, reduction in left ventricular distensibility results from septal shift and flattening of the left ventricle due to right ventricular overload.

Diastole↗
PubMed1982

Mechanism of paradoxic pulse in bronchial asthma.

To elucidate the mechanism of paradoxic pulse in severe bronchial asthma, we performed hemodynamic studies and measured esophageal pressure in nine patients who had status asthmaticus and clinical paradoxic pulse. Two-dimensional echocardiography allowed simultaneous assessment of cyclic changes in right- and left-heart size throughout the respiratory cycle. Esophageal pressure varied from a markedly negative level during inspiration (-24.4 +/- 6.5 cm H2O) to a positive level during expiration (7.6 +/- 6.0 cm H2O). Competition between right- and left-heart chambers for pericardial space during inspiration was suggested by the reduced left ventricular cross-sectional area at end-systole (-24%, p less than 0.01) and end-diastole (-32%, p less than 0.01), the leftward septal shift, and the increased right ventricular internal diameter at end-systole (42%, p less than 0.01) and end-diastole (40%, p less than 0.001). Competition for filling, however, could not entirely account for the paradoxic pulse, for systemic and pulmonary pulse pressures were almost (within one cardiac cycle) in phase: both were minimal at inspiration and maximal at expiration. The increase in impedance to right ventricular ejection is another major factor reducing left ventricular preload at inspiration. This reduction in preload was shown to be the predominant mechanism for the decrease in left ventricular stroke output at inspiration.

Adult↗
PubMed1982

[Update on the study of true and false left ventricular aneurysms by 2-dimensional echocardiography].

2D echocardiography is a great advance in the study of left ventricular aneurysms. The wide field of visualisation and the numerous planes of examination obtained from different transducer positions allow precise spatial orientation and reliable analysis of regional wall movement. An aneurysm appears as a clear and constant bulge of a segment of left ventricular wall in both diastole and systole. Antero apical aneurysms are the commonest variety. The sensitivity and specificity of 2D echo in the detection of ventricular aneurysms are high. Thrombosis within the aneurysmal bulge may also be detected (33-38%). Pseudo-left ventricular aneurysms are easily identified as a chamber communicating with the ventricle by means of a narrow neck; the width of this neck is the main echocardiographic feature differentiating pseudo and true ventricular aneurysms. 2D echocardiography gives valuable information on the state of the remaining contractile area, an important prognostic factor when surgical resection of the aneurysm is being considered.

Diagnosis, Differential↗
PubMed1981

Influence of positive end-expiratory pressure on left ventricular performance.

Although left ventricular dysfunction is common during ventilatory support with positive end-expiratory pressure (PEEP), the mechanism of this disorder remains unclear. In 10 patients with the adult respiratory-distress syndrome we studied the effects of a stepwise increase in PEEP from 0.to 30 cm H2O on left ventricular output, intracardiac transmural pressures, and two-dimensional echocardiographic measurements of left ventricular cross-sectional area at end-systole and at end-diastole. Increasing PEEP was associated with progressive declines in cardiac output, mean blood pressure, and left ventricular dimensions and with equalization of right and left ventricular filling pressures. The radius of septal curvature decreased at both end-diastole and end-systole, implying a leftward shift of the interventricular septum. At the highest PEEP, blood-volume expansion did not restore cardiac output, although left ventricular transmural filling pressures had returned to base-line values. We conclude that decreased cardiac output during PEEP is mediated by a leftward displacement of the interventricular septum, which restricts left ventricular filling.

Blood Pressure↗
PubMed1980

[Peripheral effects of nitrate compounds (author's transl)].

Nitroglycerin primarily acts on smooth muscle fibers, and this effect is dose-dependent. High doses seem to affect mainly coronary blood flow; moderate doses act on both systemic arterial blood flow (resistance vascular bed) and return venous blood flow (capacitance vascular bed), while low doses influence only the latter. These various modes of action account for the discrepancies observed between the results of experimental studies, the final effect being the algebraical resultant of combined individual actions. In coronary insufficiency, where treatment aims at reducing myocardial oxygen consumption without lowering coronary perfusion pressure, nitroglycerin should be given in low doses. In congestive heart failure, where the primary target is reduction in preload and, consequently, heart work without excessive reduction in afterload that would result in decreased stroke index through Frank-Starling's mechanism, a detailed knowledge of the physiological mechanisms involved is required to guide nitroglycerin treatment.

Angina Pectoris↗