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J Puel

Publications and source records attributed to J Puel.

At least 181 records · Page 10Linked to original sources
PubMed1984

[Myocardial revascularization in the developing phase of myocardial infarction using intracoronary thrombolytic therapy].

The author's experience on intracoronary thrombolysis on 71 patients that underwent coronary angiography in the first six hours of myocardial infarction is presented. The coronary artery responsible for the infarction was totally occluded in 66 cases and presented a subtotal occlusion in the remaining 5 cases. The protocol included the intracoronary injection of 2 mg isosorbide dinitrate and 78.000-385.000 U of streptokinase. An early reperfusion occurred in 66% of the patients, without mortality in the acute phase. ST-segment returned to normal in 41 of the 47 reperfused cases, but a Q wave developed in 42 cases. Hospital mortality was 6,4%, and the reocclusion rate was 17%.

Adult↗
PubMed1983

[Myocardial infarction before the age of 35. Clinical and coronarographic aspects].

Myocardial infarction under the age of 35 is no longer a rarity. A series of 22 patients exhibited all the usual epidemiological, clinical and angiographic features of the disease: risk factors, predominantly excessive smoking associated with dyslipoproteinaemia in 50% of the cases; onset during exercise in one quarter of the cases, more frequently than in elderly people; and absence of significant lesions at angiography in one third of the cases. Angiography of the coronary arteries, performed in the early stages of infarction in 5 patients, demonstrated the presence of several factors in the pathogenesis of arterial occlusion in young people, i.e. thrombosis in almost every case, arterial spasm in 10% of the patients and atheromatous plaques with little or no stenosis in one half.

Adult↗
PubMed1983

[Are calcium inhibitors useful in the treatment of effort angina pectoris].

Effort angina is the result of acute myocardial ischemia on exercise due to an imbalance between myocardial oxygen demand and supply. During exercise, ischemia is provoked by an increase in myocardial oxygen needs (tachycardia, increased blood pressure, etc.) which cannot be met by increased coronary blood flow. The commonest cause of insufficient flow is coronary atherosclerosis. Coronary spasm does, however, play a role, whether it occurs during exercise on normal or atheromatous coronary vessels. Classical anti-anginal therapy is directed towards a reduction in the intense adrenergic activity associated with exercise, and to the limitation of myocardial oxygen consumption. Calcium inhibitors which cause peripheral vasodilation, decrease ventricular wall tension and coronary resistance, are usually reserved for unstable or resistant angina. We studied 10 patients with stable effort angina for over 2 years with significant (greater than 70 per cent) atheromatous lesions on coronary angiography unsuitable for surgical treatment. The patients underwent a randomised double blind trial to compare the effects of propranolol, diltiazem and placebo. Exercise ECG was performed after a treatment period of one week, 3 hours after drug administration. The results showed a significant improvement of work capacity with propranolol and diltiazem as compared to placebo. Propranolol (160 mg/day) was more effective than diltiazem (180 mg/day) in 6 patients. In 4 cases, the improvement with diltiazem and propranolol was the same. The association of the two drugs in one open study in 5 patients was even more effective in 3 patients. The small number of patients studied makes it impossible to draw any firm conclusions. Although calcium inhibitors are the treatment of choice in coronary spasm and betablockers in effort angina, diltiazem exerts an anti-anginal effect by reduction of myocardial oxygen consumption without depression of myocardial contractility, as other workers have shown.

Angina Pectoris↗
PubMed1982

[Isosorbide dinitrate in the treatment of threatening myocardial infarction (author's transl)].

Thirty patients with threatening myocardial infarction were treated with intravenous isosorbide trinitrate. Eight patients had increasingly severe angina, 6 had de novo crescendo angina, 3 had Prinzmetal angina and 13 had signs of impending extension of a previous infarct. In all cases the anginal attacks occurred spontaneously. The drug was administered in association with a beta-blocker or a calcium antagonist. The initial dosage was 33 mcg/min and dosage adjustments ranged from 16 to 130 mcg/min. the main duration of treatment was 3.6 days. Pain was controlled in all patients. Anginal attacks ceased completely and permanently in 24, but the remaining 6 became isosorbide dinitrate-dependent and could only be weaned by aortocoronary bypass. The effects on the drug on heart rate and blood pressure remained moderate and never interfered with dosage adjustments. Coronary artery angiography was performed without any trouble in 25 patients, 21 of whom underwent myocardial revascularization by venous grafts.

Adult↗
PubMed1982

[Ventricular extrasystoles in the convalescence phase of myocardial infarction. Relation to angiographic data].

A series of 80 patients hospitalised for recent myocardial infarction underwent: --three continuous ambulatory 24 hour recordings (Holter method) on the 15th, 22nd days, and 6 months after infarction; --selective coronary angiography with left ventriculography, with a study of left ventricular performance and analysis of segmental contractility (Leighton's method). Five patients died over a mean follow-up period of 16 months. At the third week when physical activities were reintroduced 72,3 p. 100 of patients had frequent ventricular extrasystoles (Lown's Class II) or repeated ventricular extrasystoles (Classes III, IV, V). Holter monitoring gave reproducible results with a tendency to aggravation between the Ist and the 6th month (repetitive ventricular activity increasing from 35 to 45 p. 100). 55 p. 100 of posterior infarcts had few extrasystoles whilst 47 p. 100 of anterior infarcts had severe arrhythmias (Classes III, IV and V). There was a significant correlation between the presence of multivessel disease and severe ventricular extrasystoles 60 p. 100 of patients with multiple vessel lesions had repetitive ventricular activity (p less than 0,02). Positive correlations were established between: severe ventricular arrhythmias and a reduction in ventricular ejection fraction (p less than 0,01), dyskinesia in the infarcted zone (p less than 0,01) and reduction in wall motion of the non infarcted zones. The presence of incomplete occlusion of early revascularisation by collateral circulation in the infarcted zone seemed to favour severe ventricular arrhythmias. Five patients died (arrhythmias or cardiac failure): the association of severe hypokinesia and reduced left ventricular performance with repetitive ventricular activity was demonstrated. It is concluded from the correlations obtained between ventriculography and continuous electrocardiographic monitoring that repetitive ventricular activity is associated with severe reduction in left ventricular performance. The immediate gravity and poor prognosis of the ventricular arrhythmias are the result of the extent of the myocardial damage.

Cardiac Complexes, Premature↗
PubMed1982

[Cutaneous cholesterol in the young and aged coronary patient].

Serum cholesterol (ch), its lipoprotein fractions and triglycerides were measured in three populations of proven coronary patients (less than 50 years, n = 56; between 50 and 65 years, n = 56; greater than 65 years, n = 23); the risk factor total ch/HDL ch was calculated. The level of skin cholesterol was also estimated by skin biopsy in each patient and compared to that of three control populations of the same age. The results indicated that 1) there was no significant difference in skin cholesterol of patients with myocardial infarction whatever their age, 2) there was a significant difference (p less than 0,001) with control subjects of the same age except in the over 65 population, 3) the total cholesterol was normal in all three groups, 4) the HDL cholesterol of coronary patients over 50 year old was normal and slightly reduced in younger coronary patients, 5) the ratio total ch/HDL ch was increased in coronary patients under 50, but normal after this age, 6) the triglyceride level was higher in the young coronary patients than in those over 50 years old. Four conclusions are drawn: 1) the total Ch/HDL ch ratio is a good indicator of coronary risk in patients under 50 years old but shows less sensitive variations than the level of skin cholesterol, 2) the ch/HDL ch in coronary patients between 50 and 65 years old is normal; the only laboratory finding which correlates with the coronary event is skin cholesterol; after 65 years of age the skin cholesterol stabilises to the same levels as found in control subjects; 3) from the outset, at whatever age infarction occurs, skin cholesterol is increased (about 0,45 mumol/100 ngr of fresh skin), whilst the risk factor is higher in the younger population; 4) skin cholesterol shows less variation in the three coronary groups than the other blood parameters measured. It would therefore appear to be a very discriminating index of coronary atherosclerosis.

Adult↗
PubMed1981

[Clinical, haemodynamic and biochemical effects of angiotensin-converting enzyme inhibition in chronic refractory cardiac failure (author's transl)].

Twenty patients with chronic congestive heart failure resistant to conventional treatment with digitalis, diuretics and vasodilators received captopril, an oral inhibitor of the angiotensin-converting enzyme, in daily doses of 200 mg and were followed up for 2 months or more. At 2 months, there was a significant reduction in functional symptoms (NYHA classification), bodyweight and left ventricular filling pressure, with an equally significant rise in cardiac output and sodium urinary excretion. There was no fall in systemic blood pressure, nor tachycardia. These effects were sustained in 8 patients followed up for 6 months. They seem to indicate that captopril is both effective and well tolerated in chronic congestive heart failure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1981

[Surgical revascularization of infarcted myocardial areas. Its effects on left ventricular function].

The results of twelve patients undergoing revascularisation procedures of infarcted myocardial territory alone were analysed quantitatively by planimetry in the right anterior oblique projection. Patients operated in the acute phase of myocardial infarction (2 cases) were distinguished from those with preinfarction syndromes (8 patients) and those with postinfarction angina (2 patients). Two posterior wall and ten anterior wall revascularisations were carried out by single bypass grafts (8) and double bypass grafts (2) with no operative deaths. The results were assessed 2 months to two years after operation (average: 6 months). Twelve of the fourteen bypass grafts were patent. Only one of the twelve operated patients, an anterior wall revascularisation, was considered a complete surgical failure: global left ventricular function and segmental wall movement progressively deteriorated with reduced contractility and velocity of fibre shortening. Improved contraction of both anterior and posterior walls was observed in the other 11 patients. The ejection fraction of the 9 patients with anterior wall revascularisation rose significantly from 47,1 +/- 10,5% to 56,3 +/- 3,5% and a similar rise was observed in systolic index (29,0 +/- 12,0 to 36,8 +/- 11,0 ml/syst./m2); the average akinetic end diastolic perimeter fell by 17%; segmental wall analysis of mean radial shortening and mean amplitude of excursion on the hemiaxes was improved, especially in the antero apical region: the corrected rates of mean excursion and average systolic work indices (33,2 +/- 15 to 41 +/- 13 gm/syst./m2) also increased. Surgical revascularisation of infarcted zones, made possible by new methods of cardioplagia and reliable circulatory assistance, may lead to improvement in global and segmental left ventricular function with minimal risk to the patient: this is thought to be due to an active mechanism and not to the passive process of scarring. Although a reserved attitude should be adopted in the acute phase of myocardial infarction, preinfarction syndromes and unstable postinfarction angina could well benefit from surgical management.

Adult↗
PubMed1981

["Slowing" right bundle-branch block in reciprocating tachycardia from a latent right lateral Kent bundle].

The authors report the case of a 56 year old man with paroxysmal reciprocating tachycardia. The participation of a right lateral Kent bundle, latent in sinus rhythm and with retrograde atrioventricular conduction during tachycardia was proved by : 1) the slowing of the tachycardia rhythm and lengthening of the ventriculo-atrial conduction time by 50 ms during right bundle branch block ; 2) atrial mapping during tachycardia showing right lateral atrial pre excitation ; 3) the spontaneous termination of some attacks after a blocked Hisian depolarisation. Analysis of the mechanisms of spontaneous termination of tachycardia showed a block in the accessory pathway in 80% of cases, leading to the successful use of Amiodarone. The particular electrophysiological mechanism of functional bundle branch block makes it the most reliable positive diagnostic criterion in reciprocating tachycardia. A review of previously reported series shows participation of right lateral and septal accessory pathways to be uncommon during reciprocating tachycardia. Functional bundle branch block does not necessarily lengthen the ventriculo-atrial interval with septal accessory pathways. Left lateral Kent bundles are much more common. These points are analysed together with the mechanism of functional bundle branch block in the discussion.

Bundle-Branch Block↗