Search PubMed⌕ Search

Biomedical subjects

J Toman

Publications and source records attributed to J Toman.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Are central hemodynamics the decisive factor in the manifestation of chronic heart failure?].

In the past some authors revealed that data assembled during examinations of the central haemodynamics, echocardiography, subjective complaints, physical findings and load tolerance in patients with chronic heart failure are not mutually consistent. The authors examined therefore comprehensively 40 patients with different grades of cardiac failure. They revealed very loose relations between the grade of functional classification, echocardiographic and invasive haemodynamic parameters at rest on the one hand and spiroergometric indicators on the other hand. Closer relations with spiroergometric findings were obtained with values of invasive haemodynamic parameters after a load, in particular values of the cardiac index, and systemic vascular resistance. The authors conclude that for clinical manifestations of chronic cardiac failure the peripheral circulation and tissue metabolism is at least equally important as changes of central haemodynamics. Moreover, the importance of the right ventricular function and diastolic cardiac function is not sufficiently appreciated.

Adult↗
PubMed1992

Amlodipine in patients with stable angina pectoris treated with nitrates and beta-blockers. The influence on exercise tolerance, systolic and diastolic functions of the left ventricle.

The effects of 5 and 10 mg of amlodipine and of placebo were compared in 21 patients with stable angina pectoris and multivessel coronary artery disease. The blind comparison was performed by means of bicycle ergometry and stress echocardiography using esophageal stimulation of the left heart atrium. All patients subsequently received placebo, amlodipine 5 mg and 10 mg for 2 weeks. In bicycle ergometry both doses of amlodipine in comparison with placebo significantly lowered the ST segment depression in lead V5 and prolonged the time to onset of angina. The exercise duration was significantly prolonged only after 10 mg of amlodipine. In stress echocardiography 10 mg of amlodipine significantly improved ejection fraction and reduced wall motion score during stimulation and increased peak velocity of relaxation of left ventricular posterior wall at rest and immediately after stimulation. In the patients with left ventricular end-diastolic pressure < or = 20 mmHg, amlodipine reduced the ratio of peak transmitral flow velocity in atrial contraction to that in early diastole (A/E) at rest and shortened deceleration time at rest and immediately after stimulation. Amlodipine in patients with stable angina pectoris significantly improved the exercise tolerance and the function of the left ventricle in a dose-dependent way. Amlodipine was well tolerated.

Amlodipine↗
PubMed1992

Cardiac arrhythmias in chronic heart failure.

It has been proven that treatment of chronic heart failure (CHF) with some modern drugs is able to reduce mortality in groups of patients with the severest grades of this disease. The risk of sudden death has been unchanged, however. Out of 49 patients on long-term follow-up, 28 patients are surviving (group A) and 21 died (group B). 52.3% of the dead patients died suddenly. Eight patients in NYHA classes I-II died, all of them suddenly. Contrary to this, sudden death was the cause of death only in three of 13 patients in NYHA classes III-IV (p < 0.001). More severe heart failure was present in group B (NYHA class 2.95 +/- 0.96 vs. 2.18 +/- 0.48 in group A--p < 0.1). Antiarrhythmic drugs were given more frequently in group B (in 47.6% of pts vs. 17.9% in group A--p < 0.05). It is concluded that the occurrence of sudden death is higher in patients with less severe forms of CHF and has not been reduced by the means employed. Use of antiarrhythmic drugs may be dangerous and their indication should be based on results of a comprehensive examination. Use of the implantable cardioverter-defibrillator seems to be the most promising approach in indicated cases.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Radiologic changes in chronic heart failure.

The relationship between chest X-ray findings and NYHA classification or haemodynamic parameters (ejection fraction, end-diastolic and end-systolic volumes by echocardiography, right atrial pressure--RAP, pulmonary artery pressure--PAP and pulmonary wedge pressure--PAWP by right heart catheterization) was evaluated in 44 and 22 patients with chronic congestive heart failure, respectively. In chest X-ray, the cardiothoracic index (CTI) and authors' own classification of pulmonary congestion (PCG) of classes 0, 1 and 2 were used. A significant correlation was found between CTI and NYHA classification or haemodynamic parameters, and between PCG (classes 0 and 2) and echocardiographic parameters or right heart pressures (EDV, ESV, RAP, PAP, PAWP), but there was no significant relationship between X-ray and left ventricular ejection fraction. For a PAWP higher than 18 mmHg and PCG class 2, the sensitivity of X-ray was 86% and specificity 80%. The authors conclude that chest X-ray provides reliable information about the haemodynamic parametres, comparable to echocardiographic and catheterization data.

Cardiomegaly↗
PubMed1991

Hemodynamic effects of transdermal nitroglycerin patches in patients with acute myocardial infarction.

Transdermal nitroglycerin patches are used mainly in the therapy of angina pectoris. However, the magnitude and duration of their effects are still controversial. In this study, transdermal discs with nitroglycerin were given to 14 patients with acute myocardial infarction (AMI) and mild hemodynamic impairment. Seven patients received Nitroderm TTS, and seven patients Deponit 5 (in this case 2 patches), the nitroglycerin dose being 10 mg. Hemodynamic measurements were made 19-24 h after application of the patch and 1 h after its removal. Comparing with the values obtained 1 h after removal of the patch, 19-24 h after the application of the patch heart rate was significantly higher (90.2 +/- 3.8 vs. 85.6 +/- 4.0 min-1; p less than 0.01), mean right atrial pressure was significantly lower (10.8 +/- 1.0 vs. 12.7 +/- 1.3 mm Hg; p less than 0.01), and so were the pulmonary artery pressure: systolic (36.9 +/- 3.0 vs. 43.0 +/- 3.1 mm Hg; p less than 0.001), mean (26.8 +/- 2.1 vs. 31.4 +/- 2.0 mm Hg; p less than 0.001) and the capillary wedge pressure (19.2 +/- 1.8 vs. 23.0 +/- 1.9 mm Hg; p less than 0.01). These findings revealed that in patients with AMI hemodynamic effects persist for at least 19 h after single application of a nitroglycerin patch of 10 mg. The therapy is safe and the risk of side effects is small.

Administration, Cutaneous↗
PubMed1990

[Echocardiographic aspects of developmental changes in ventricular function during acute myocardial infarct].

The development of ventricular function in the course of the first three weeks after acute myocardial infarction (AMI) was studied in the light of repeated examinations of 76 patients. Segmental derangement of mobility keeps increasing over the first postinfarction days in many patients, while the second and third week show a trend towards improvement. The derangements of segmental kinetics can be evaluated quantitatively by means of a computer or semi-quantitatively by subjective assessment. The former approach is suitable particularly in research work, the latter is fully satisfactory for routine practice. Concavity of the left ventricular wall was detected in 34.8% of the patients and in 56.5% of these the concavity appeared already on the first post AMI day. The organism responds in several ways to derangements of segmental mobility. First the sympathoadrenal activity is increased, which is echocardiographically reflected by hyperkinesia of the unaffected areas of the left ventricle. Further on segmental pliability decreases and the left ventricle becomes dilated by heterometric regulation. Reduced right ventricular function was recorded in 48.4% of patients with infarction of the lower wall and in 11.4% of patients with infarction of the anterior wall.

Adult↗
PubMed1990

[Long-term monitoring of changes in contractility of the left ventricular wall in patients with myocardial infarct].

Using two-dimensional echocardiography, the authors made a one-year investigation of left ventricular function in a group of patients after a first transmural myocardial infarction. They evaluated subjectively and quantitatively changes in the contractility and the development of the diastolic area of the left ventricle. They revealed a certain improvement of the contractility, probably as a result of the development of a collateral circulation and altered structure of the infarction focus associated with dilatation of the left ventricle by the Frank-Starling mechanism.

Adult↗
PubMed1989

[Computer tomography and its use in orofacial oncology].

The authors communicate their experience with the application of CT in the diagnosis of neoplasms in orofacial region. The examinations were done with the head CT apparatus of 2nd generation. Indications for this examination are defined in the following areas: 1) retromaxillary, 2) paranasal sinuses, 3) orbits, 4) parotid glands, 5) cranial base, 6) malformation diseases, 7) mandibular joint, 8) lower region of the face and neck, 9) cervical nodes, 10) tumours extensive in volume. The authors present an analysis of results of 63 examinations in 57 patients with tumorous diseases.

Head and Neck Neoplasms↗
PubMed1989

[Comparison of changes in the mobility of the left ventricular wall with coronarographic findings in patients after myocardial infarct].

The authors examined by echocardiography at rest and after exertion a group of 55 patients after a clinically confirmed first transmural infarction. They compared the echocardiographic findings with coronarographic ones. The finding at rest, as regards impaired mobility of the left ventricular wall, corresponded to the clinical finding and the coronarographic finding. By diagnosis of the extended asynergy of contraction during an isometric load it was not possible to differentiate the functional and organic cause of impaired mobility and thus to assess the extent of the coronary affection. The impaired mobility of the left ventricular wall is associated above all with the state of the blood supply rather than with the finding on the coronary artery.

Adult↗