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Biomedical subjects

L Gould

Publications and source records attributed to L Gould.

At least 91 records · Page 5Linked to original sources
PubMed1981

Pacemaker failure following external defibrillation.

An 81-year-old female with the sick sinus syndrome had a permanent pacemaker implanted. She subsequently developed ventricular fibrillation and was successfully defibrillated. However, the defibrillation paddle was placed on the pulse generator which led to a complete loss of function of the pulse generator. External defibrillation can produce varying degrees of damage to the implanted pulse generator. The resultant abnormalities are discussed and recommended defibrillation procedures are also outlined in this report.

Aged↗
PubMed1981

Successful removal of a severed transvenous pacemaker electrode.

The ease and simplicity of the transvenous approach to permanent pacing continue to be among its greatest advantages. However in a small proportion of transvenously paced patients complications can occur. A rare complication is an incompletely removed pacing catheter with subsequent embolization to more central parts of the cardiovascular system. This communication reports the migration of a severed transvenous pacemaker electrode and its removal from the left iliac vein with a femoral-ventricular pigtail catheter.

Aged↗
PubMed1981

Multiple conduction delays with the His bundle.

His Bundle recordings in a 75-year-old male with complete heart block exhibited split His Bundle potentials with three components thus demonstrating multiple conduction delays within the bundle of His.

Aged↗
PubMed1981

Noninvasive assessment of load reduction in chronic congestive heart failure patients.

Therapy with phentolamine can improve the condition of patients with congestive heart failure due to the inotropic effect of this drug as well as its vasodilating action. Therefore, 8 patients with volume-overloaded left ventricles due to aortic insufficiency and mitral insufficiency received 50 mg of phentolamine 4 times a day for 2 weeks. Peak and end systolic wall stress were estimated using a noninvasive echocardiographic technique. The peak systolic wall stress in this group was 133 X 10(3) dynes/sq cm, which is similar to the reported normal value. However, the end systolic wall stress was 89 X 19(3) dynes/sq cm, which is much higher than the reported normal values. After PO administration of phentolamine, the end systolic stress was normalized while the peak systolic stress was reduced below normal. As a result of therapy with phentolamine, the ejection fraction, the percentage of change in the minor axis, and the velocity of circumferential fiber shortening significantly increased. Thus, PO administration of phentolamine can improve left ventricular function in patients with mitral insufficiency and aortic insufficiency.

Adult↗
PubMed1981

Enhancement of phentolamine by nitrates in patients with congestive heart failure.

Phentolamine dilates the resistance bed and to a lesser degree the capacitance bed, while the nitrates have the opposite action. Therefore, in 7 patients with congestive heart failure due to congestive cardiomyopathy, hemodynamic measurements were made using a Swan Ganz thermodilution catheter and cardiac output computer. The patients received 5 mg of an IV infusion of phentolamine administered at 0.3 mg/minute. At the end of the infusion, the pressures and cardiac output were obtained. Then, 2 1/2 inches of nitroglycerin ointment was applied to the chest, and the hemodynamic parameters were obtained 30 minutes later. Phentolamine produced a significant reduction in the right and left ventricular filling pressures and a significant increase in the cardiac output. The hemodynamic effects of phentolamine are known to persist for an hour or longer. The addition of nitroglycerin ointment led to a further reduction in the right and left ventricular filling pressures. Thus, the combination of phentolamine and nitrates can be effectively used in the treatment of congestive heart failure.

Blood Pressure↗
PubMed1980

Three hundred and fifty-three consecutive patients with permanent transvenous pacemakers.

The safety and convenience of the transvenous approach to long-term endocardial pacing are well established, but its principal drawback is electrode displacement. The reported incidence of this complication varies between 3.0% to 36.7%, and is highest in the early post-implantation period before endocardial fixation of the electrode tip. Recently Brewster and Evans determined that the electrode displacement rate in 21 published series averaged 14.3%. However, the Inter Society Committee on Heart Diseases (ICHD) report on pacemakers states that a rate of early displacement greater than 5% calls for a critical review of results. The training and expertise of the persons inserting the pacemaker electrodes undoubtedly are major factors which determine the proper transvenous placement of permanent cardiac electrodes. This paper deals with our clinical experience of 353 patients who received permanent transvenous pacemakers during the period September 1, 1974 through March 1, 1979, with emphasis on problems and complications encountered and overall results.

Adolescent↗
PubMed1980

Electrophysiologic properties of hydralazine in man.

There is considerable interest in selecting the proper drug to preserve the ischemic myocardium, or twilight zone, in a patient with a recent myocardial infarction. Vasodilator therapy with an infusion of nitroprusside or phentolamine has been shown to improve left ventricular function by reducing both preload and afterload. Sublingual nitroglycerin as well as an infusion of nitroglycerin can also alleviate left ventricular failure in patients with an acute myocardial infarction. Similarly, chronic congestive heart failure patients, irrespective of the etiology, improve hemodynamically after an infusion of phentolamine, nitroprusside or hydralazine. Oral nitrates, phentolamine, and hydralazine have also been demonstrated to produce improvement in chronic heart failure patients. Recently data has become available on the effects of phentolamine, nitroglycerin and nitroprusside on cardiac conduction in man. However there is no information on the electrophysiological properties of hydralazine in man. The present study involving 12 human subjects was undertaken to determine what effect intravenously administered hydralazine has on the human conduction system.

Aged↗
PubMed1980

Evaluation of cardiac conduction in anorexia nervosa.

Anorexia nervosa is a disorder characterized by excessive dieting, a morbid fear of becoming obese, a distorted body image and amenorrhea in women. The condition is seen chiefly in girls and young women but also occurs in men. Death in anorexia nervosa may be sudden, and the mortality rate is the highest of any psychiatric disease. Despite investigations of its endocrine and psychiatric manifestations, little has been written about cardiac conduction in this entity. We report a patient with anorexia nervosa who presented with syncope due to a sinus bradycardia. His bundle electrograms were performed during the course of her hospitalization, and revealed that the abnormalities were reversible with food intake.

Adult↗
PubMed1980

T-wave changes with intermittent left bundle branch block.

A 70-year-old woman was found to have an intermittent left bundle branch block. When her electrocardiogram showed normal conduction, T-wave inversions in leads V1-V3 appeared. These alterations suggested an anteroseptal infarction. However, the patient was asymptomatic, and the serum enzymes, technetium 99m pyrophosphate scan, and the thalium 201 scan were all negative. Thus the LBBB itself can produce T-wave in versions in the right precordial leads during the normal conduction phase which may simulate an acute myocardial infarction.

Aged↗
PubMed1980

Effects of intravenous phentolamine on hemodynamics and resting pulmonary gas exchange in man.

The influence of intravenous phentolamine on hemodynamics, ventilation, and blood gases were studied in 22 patients with cardiac disease. Phentolamine produced a significant increase in the heart rate and cardiac index and a significant decrease in the mean arterial pressure, mean pulmonary artery pressure, left ventricular end diastolic pressure, peripheral vascular resistance, and pulmonary vascular resistance. There was no significant change in the arterial pH, PO2, PCO2, alveolar-arterial PO2, and the dead space-tidal volume ratio. The favorable hemodynamic responses are attributable to the fact that the vasodilator effect of phentolamine is predominately on the arteriolar resistance bed and much less on the venous capacitance bed. In addition, phentolamine has a positive inotropic action which is indirect and dependent on the release of norepinephrine.

Adolescent↗
PubMed1980

Effect of potassium infusion on the human conduction system.

His bundle electrograms were recorded in 12 patients before and after the intravenous administration of 5 mEq of potassium. Antegrade and retrograde refractory periods were determined with the extrastimulus technique. The AH interval was 84 +/- 7 msec before and 89 +/- 7 msec after potassium (P < 0.05). The AH interval at an atrial pacing rate of 140/minute was 129 +/- 13 msec before and 143 +/- 16 msec after potassium (P < 0.02). The effective refractory period of the atrium was 264 +/- 9 msec before and 280 +/- 9 msec after potassium (P < 0.001). Thus small amounts of potassium delay conduction at the atrial and AV nodal level.

Aged↗
PubMed1980

Effect of nitroglycerin ointment on hemodynamics in patients with mitral insufficiency.

A reduction in impedance or afterload produces beneficial hemodynamic effects in patients with mitral regurgitation. This mechanism has been studied via intravenous infusion of nitroprusside, phentolamine, and hydralazine. But there is little information on the effect of nitroglycerin ointment in patients with mitral insufficiency. Thus 6 patients with mitral insufficiency underwent right and left heart catheterization. After the control hemodynamic measurements were recorded, a 2 1/2-inch strip of 2% nitroglycerin ointment was applied to the chest for half an hour. Pressure recordings and cardiac output were then repeated. The control cardiac index fell from 2.79 to a treatment value of 2.05 L/min/m2 (P < 0.01), while the stroke index also decreased from 29 to 22 ml/beat/m2 (P < 0.05). There was a nonsignificant increase in peripheral resistance. Thus nitroglycerin ointment can be detrimental when given to patients with mitral insufficiency.

Adult↗