Biomedical subjects

J P Stoltz

Publications and source records attributed to J P Stoltz.

At least 19 recordsLinked to original sources

PubMed1995

[Syncopal ventricular tachycardia complicating paroxysmal atrial fibrillation in severe myocardial ischemia].

The authors report two cases of spontaneous paroxysmal atrial fibrillation closely followed by syncopal ventricular tachycardia resulting in cardiac arrest requiring defibrillation. Both patients, men aged 62 and 64 years, had a past history of myocardial infarction without arrhythmias; atrial fibrillation occurred during severe myocardial ischaemia; coronary arteriography showed tight stenoses of the left main coronary artery with normal left ventricular function. Ventricular tachycardia (or fibrillation) during spontaneous paroxysmal atrial fibrillation is a rare occurrence. This sequence of events has been described in patients with accessory conduction pathways or in hypertrophic cardiomyopathy. It is an exceptionally rare complication of ischemic heart disease with only a very few previously reported cases. Myocardial ischaemia is probably the cause of the arrhythmia in together with irregularity of the ventricular contractions responsible for long cycle-short cycle sequences which are particularly arrhythmogenic and changes in sympathetic tone.

Atrial Fibrillation↗

PubMed1992

[False aneurysm of the left ventricle during the acute phase of myocardial infarction: diagnosis by transesophageal echocardiography].

The authors report a case of myocardial infarction complicated by a false aneurysm of the posterior wall of the left ventricle, the diagnosis of which was confirmed, for the first time, by transesophageal echocardiography (TEE) which provided better definition of the anatomical features of the lesion: visualisation of the particularly wide neck (5 cm) and the site of rupture of the myocardium; demonstration of the presence in the false aneurysm with a thin pericardial wall of a large thrombus of different acoustic density, itself overlain by swirling whorls. Colour Doppler combined with TEE clearly showed the acceleration of flow at the neck and its slowing in the newly formed cavity. Once the diagnosis was made, the patient rapidly underwent surgery with a successful outcome. The quality of the images obtained without risk by TEE suggests the important role which this investigation could play in the future in the diagnosis of certain mechanical complications of myocardial infarction.

Diagnosis, Differential↗

PubMed1991

[Unstable angina and infarction without Q wave treated with verapamil: value of the early exercise test].

Twenty patients aged 56.8 +/- 10 years, hospitalised for unstable angina (12 cases) or infarct without Q wave (8 cases) were treated with IV heparin, aspirin and oral verapamil. The clinical syndrome was controlled by verapamil in 16 cases out of 20 (80% of cases) at the dosage of 360 mg/d in 14 patients and of 480 mg/d in two. An exercise ECG, limited by symptoms, was obtained in 18 patients (90%) between the 8th and 12th day. Coronary arteriography was considered to be indicated in three sets of circumstances: recurrence of angina resistant to nitroglycerin, positive exercise ECG with verapamil, persisting despite triple therapy or strongly positive exercise ECG (total duration less than or equal to 6 minutes). An infarct complicated the early course in 4 patients (20%): twice following angioplasty, once following exercise ECG (spastic angina) and once during triple therapy (refractory angina). Hospital and mid-term (18 +/- 6 months) mortality was nil. With verapamil, the absence of recurrence of angina together with a negative exercise ECG enabled the identification of a large group of patients (40%) with a low risk of a subsequent major accident and in whom early and routine coronary arteriography is probably not indispensable.

Adult↗

PubMed1988

[Angina at rest without significant changes in the per-critical ECG in coronary insufficiency].

In coronary patients angina pectoris at rest is usually attended by clear changes in repolarization, and in the absence of such changes clinicians are justifiably reluctant to assert that the constrictive chest pain is due to ischaemia. However, a number of concordant data indicates that in some cases myocardial ischaemia--whether spontaneous or induced by the ergonovine test or by coronary angioplasty--may cause an anginal pain that proceeds without significant alterations in repolarization and indeed, without any changes in ECG tracings. Prior to making a firm diagnosis of this type of angina, several causes of error must be excluded, the main one being that repolarization disorders are labile and may have disappeared whilst the anginal pain persists. But above all, the ischaemic episode that accompanies angina must be documented by haemodynamic, angiographic, scintigraphic or echocardiographic data. The pathogenesis of angina at rest occurring in coronary patients and without changes in per-critical ECG is still imperfectly known and probably complex. The authors review several possible mechanisms: the pain perception threshold may be lowered, the collateral circulation may be highly developed, and the ischaemic episode may be so discreet and/or controlled by treatment, or so evenly distributed between two opposite territories that no electric gradient is generated.

Angina Pectoris↗

PubMed1988

[Anomalies of the T waves induced by flecainide].

Flecainide is a class I antiarrhythmic agent which depresses depolarization and conduction velocities in myocardial and Purkinje's fibres, thereby extending their refractory period. As the drug belongs to the IC group, it may increase--moderately as a rule--the duration of QRS, but it does not alter the action potential duration and therefore does not increase the JT interval. In 3 patients treated with flecainide we observed a peculiar alteration in the shape of T waves, the peak of which was flattened and notched, forming a double hump. This abnormality, most clearly visible on precordial leads, remained isolated with no changes in other electrocardiographic parameters. It appeared independently of any circumstance likely to modify repolarization. It remained stable throughout treatment with flecainide and vanished when the drug was discontinued. It was regularly observed with the recommended therapeutic doses (200-300 mg/day) and was unaccompanied by signs of toxicity. To our knowledge, these T wave abnormalities have not yet been reported. Yet they deserve to be known and correctly interpreted, since they reflect impregnation of the myocardium by the antiarrhythmic agent which should not be withdrawn on this account.

Adult↗

PubMed1988

[Aneurysm of the interauricular septum].

In reference to three personal cases of interatrial septum aneurysm discovered on ultrasonography performed for the diagnosis of a cerebral embolism, the authors describe the positive diagnosis criteria, in mono- and bi-dimensional mode, of this abnormality, as well as related data obtained from catheterization, angiocardiography, and phonocardiography. This malformation, the frequency and pathogenesis of which still remain, today, difficult to evaluate, may be at the origin of complications, especially embolic migrations, systemic and also pulmonary, supraventricular rhythm disorders, interatrial shunt, reduced ventricular filling. Once established, the diagnosis is the subject of many controversies: if plain monitoring appears logical in asymptomatic forms, the occurrence of a systemic embolism makes it difficult to choose between surgical treatment and long-term anticoagulant therapy.

Aged↗

PubMed1987

[Auricular fibrillation: a cause of reversible myocardiopathy].

A chronic supraventricular tachycardia may alone be responsible for a picture of severe congestive cardiac insufficiency, which is totally reversible after return to a sinus rhythm. The two cases reported here emphasize this particular fact, the physiopathology of which still remains unknown. There is also a prognostic advantage to such cases: in the presence of a congestive cardiopathy with atrial fibrillation, apparently idiopathic, it is important to try to obtain a sinus rhythm and to study from a distance the left ventricular performance indexes which may return to normal after regularization of the rhythm.

Atrial Fibrillation↗

PubMed1985

[Splenic abscess disclosing endocarditis].

A 54 year old man, hospitalised for thoraco-abdominal pain resulting from a septicemia which gives positive hemocultures for streptococcus D Bovis, is diagnosed to have a splenic abscess which will require splenectomy. At the same time, an endocarditis develops and gets worse, with auriculo-ventricular blockade and, especially, major aortic insufficiency, which is the cause of death by a brutal and massive pulmonary oedema. In the progression of an endocarditis, the occurrence of a splenic abscess, primary localisation of the initial septicemia or the secondary of an arterial septic embolism, is a rare contingency compared to the frequency of splenomegaly or splenic infarction: less than 2 percent of the cases in the literature. This very atypical and exceptional case serves as a reminder, on the one hand, of the diagnostic inadequacy of echocardiography which cannot visualise vegetation in the course of progressive endocarditis, and, on the other, of the prognostic importance of auriculoventricular blockade in septal and aortic endocardial lesions.

Abscess↗

PubMed1983

Angina pectoris without ST-T changes in patients with documented coronary heart disease.

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Angina Pectoris↗

PubMed1983

[Septal rupture in elderly patients. Apropos of 2 cases treated surgically in the acute phase of myocardial infarction].

Two cases of interventricular septal rupture (VSR) in elderly patients (71 and 74 years) occurring at the 5th and 12th day of primary postero-inferior myocardial infarction, were reported. The diagnosis was made at 2D echocardiography and confirmed at catheterisation with coronary angiography. Good surgical results were obtained after operation 72 and 12 hours after VSR (9th and 12th infarct days, respectively): the first patient had a good outcome with a 2 year follow-up, but the second patient died in the 55th postoperative day, of renal failure. The authors underline the value of 2D echo in the management of acute myocardial infarction and in the detection of VSR. In addition, the advances in intensive care and surgical techniques allow early and complete cure of cardiac lesions with a low hospital mortality and significant functional improvement, even in the elderly patient.

Aged↗

PubMed1982

[Left ventricular apical ectasia and rheumatic cardiopathy].

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Cardiomegaly↗

PubMed1982

[Rupture of a post-infarct ventricular aneurysm. Apropos of 3 cases cured surgically].

The authors report 3 cases of post-infarction left ventricular aneurysm with localised rupture into the pericardium. The patients (3 men aged 54, 58 and 67 years old) had left ventricular aneurysms (2 anterior, I posterior) which ruptured early, between the second and tenth week. All presented with cardiogenic shock. The diagnosis was made by 2D echocardiography (I case) or by pericardial aspiration and angiography (2 cases). Good results were obtained by surgical evacuation of the hemopericardium and resection of the ventricular aneurysm with a follow-up of 3 to 12 months. The rarity of these cases is underlined: only three other similar cases appear to have been previously reported.

Aged↗

PubMed1981

[Constrictive pericarditis secondary to myocardial infarction. Surgical care].

The authors report the case of anteroseptal myocardial infarction, complicated by a late pericardial reaction (5th - 10th week), the development of an aneurysm, and, above all, refractory ascites (12th week) found to be secondary to constrictive pericarditis. Pericardectomy and partial resection of the aneurysm were performed. Constrictive pericarditis is rare after myocardial infarction and its relationship to a forme fruste of Dressler's syndrome remains uncertain. The pathogenesis of the constriction is unknown. This complication (only reported once previously) should be recognised because of the surgical management it implies.

Adult↗

PubMed1981

[Pseudoventricular tachycardia linked to a reciprocal antidromic rhythm from Mahaim's fibers].

A 24 year old female presented with paroxysmal pseudo-ventricular tachycardia with wide QRS complexes and complete atrioventricular dissociation. Electrophysiological studies showed a junctional tachycardia with an antidromic reciprocating rhythm. The activation involved Mahaïm nodo-ventricular fibres in the anterograde direction, the nodo-hisian pathway being the retrograde limb of the reentry pathway. The main point of interest of this case was the presence of complete atrioventricular dissociation during tachycardia, the atria remaining in sinus rhythm with the possibility of sinus capture formally excluding the diagnosis of a paraseptal Kent bundle. This reentry mechanism has been previously described and constitutes a differential diagnosis of ventricular tachycardia.

Adult↗

PubMed1981