[Hemodynamic repercussions of heart rhythm disorders].
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Biomedical subjects
Publications and source records attributed to J Carlier.
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Belgians have been gradually shifting from a low ratio of polyunsaturated/saturated fat in their food to a higher one with lower total fat and cholesterol. This has occurred predominantly in the north, where the most obvious change is a decrease in butter consumption and an increase in margarine consumption. The northerners have a four to five times smaller intake of butter than the southerners and nearly double the intake of margarine. Evidence gathered over the past ten years reveals in the north a decreasing serum-cholesterol and in the south a significantly higher serum-cholesterol, associated with higher coronary morbidity and mortality. Life expectancy of males in the north is 2-4 years higher at birth and 2-2 years higher at the age of 30. It is concluded that the food habits of a population can be changed, with great benefit.
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A single dosis of disopyramide (100 mg), given intravenously in 10 min to 30 patients admitted in the coronary or respiratory care unit, induces a reduction of cardiac output of 13.4%, which is highly statistically significant, without altering the systemic and pulmonary pressures. The heart rate is also slightly diminished.
After having reviewed the indications and the main modes of electrostimulation, the author introduces the problem of choice and especially of replacement of the pacemaker. In an overwhelming majority of cases, effective stimulation stops because the batteries are exhausted: this is announced in various ways, one of them being a reduced rate of discharge. The author's opinion is that a pacemaker should not be replaced preventively. On the contrary, appropriate follow-up during the last theoretical period of life, as mentioned by the manufacturers, will avoid losing many months of adequate stimulation. This problem will be developed in detail in the next papers.
The incidence, the evolution and the prognosis of conduction disturbances associated with myocardial infarction are described in a serie of 450 consecutive unselected patients hospitalized in a coronary care unit. Pacemaking does not seem to influence largely the natural history of myocardial infarction with conduction disturbances, which is essentially determined by myocardial power failure. Indications of insertion of a pacing catheter are presented.
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The intravenous injection of disopyramide (1.5 mg/kg) induces the return to sinus rhythm in about 60% of arrhythmias. When there exist perturbations of the cardiac rhythm, secondary to recent myocardial infarction, the percentage of success reaches 70%. The drug induces the disappearance of the extrasystoles in 80% of the cases, whatever the nature of the underlying cardiopathy. Although the secondary effects of the drug are slight, it is advisable to administer the substance in a slow intravenous injection (5 minutes), while controlling the arterial pressure and the E.C.G.
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