Electrophysiologic properties of alcohol in man.
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Biomedical subjects
Publications and source records attributed to L Gould.
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A His bundle electrogram was obtained in a 70 year old male with syncopal episodes. A split bundle of His deflection was recorded. After the intravenous administration of phentolamine, a marked shortening of the H-H' interval was observed. This signifies an improvement in conduction at the bundle of His level.
The syndrome of severe mitral regurgitation with a normal-sized left atrium may or may not be associated with pulmonary hypertension and prominent left atrial V waves. To explain these pressure alterations by a single pressure-volume relationship is probably not adequate. It would appear that, whatever the clinical circumstances, normal pulmonary vascular pressures cannot exclude the diagnosis of mitral regurgitation.
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Hypertension, diabetes mellitus, hypercholesterolemia, and smoking are known coronary risk factors. It has been our impression that premature graying of the hair also predisposes individuals to myocardial infarctions. To test this hypothesis, we evaluated all of the patients under the age of 50 who were admitted to the coronary care unit between 1974 and 1976 with a proven diagnosis of a myocardial infarction. There were 50 patients. Thirty-eight did not have premature graying. Twelve of the male patients (24%) had virtual total graying of the hair which made them appear older than their stated age. The graying in these patients started on the average at 29 years. Five of these patients state that other family members had premature hair graying. The incidence of diabetes, hypertension, and smoking was similar in those with and without premature hair graying. This preliminary study suggests that premature graying of the hair is associated with premature cardiovascular disease. It should probably be regarded as a coronary risk factor and used to identify patients at increased risk.
Seven patients with mitral insufficiency and seven patients with aortic insufficiency were studied by right and left heart catheterization. Hemodynamic observations were made during a control period and during the infusion of phentolamine. Significant declines in the pulmonary artery mean pressure, left ventricular end diastolic pressure, peripheral resistance, and arteriovenous oxygen difference were seen in both groups. The cardiac index increased significantly in the two groups. Phentolamine therapy produced favorable hemodynamic effects because of its vasodilating action as well as its positive inotropic effects.
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Tachycardias may be associated with the pre-excitation syndrome, a short PR interval or a prolonged QT interval. This report describes seven patients whose electrocardiograms (ECGs) did not reveal any of the above-named conditions. All of the patients presented with syncopal episodes, and the history of palpitations was elicited in five of the patients. His bundle electrogram studies in all of the patients showed an essentially unchanged AH interval with atrial pacing rates up to 180 beats/min. This can only be explained by a total bypass of the AV node. Two of the patients were also paced from the ventricle, and an unchanged pacing stimulus to A wave interval was observed. This signifies in these patients a functioning bypass pathway in the retrograde direction as well. Thus it would appear that pre-excitation cannot by eliminated as a diagnostic possibility even if the ECG is normal.
Hypogonadotropic hypogonadism with anosmia was found in a 38 year old female. Cardiac abnormalities were manifested by a second degree heart block as well as a conduction delay below the AV node. Striking T wave inversions developed in the absence of any symptoms. These changes probably reflect a central nervous system defect.
The effects of phentolamine, 0-3 mg/min given intravenously for 15 minutes, on His bundle electrograms were studied in 11 patients with heart disease. Recordings were made at varied heart rates, using atrial pacing. Phentolamine significantly reduced the AH interval in every patient but it had no effect on the HV interval. Functional and effective refractory periods were measured with the use of the atrial extrastimulus technique. The effective refractory period of the atrium and atrioventricular node as well as the functional refractory period of the atrioventricular node all significantly decreased after phentolamine infusion. This improvement in conduction is probably mediated by a release of catecholamines.
A case of bilateral pulmonary artery aneurysms is presented. Serial cardiac catheterizations over an 8-year period showed remarkably little hemodynamic change. Thus there may be a long period of clinical and hemodynamic stability in this condition.
A 44-year-old woman with marked eosinophilia, leukocytosis, congestive heart failure, and the murmur of mitral stenosis had a restrictive type of pulse contour at cardiac catheterization. A right atrial angiogram revealed a huge right atrium, a small right ventricle, and a dilated contractile outflow tract consistent with the diagnosis of Loeffler's endocarditis. A marked conduction delay at the atrial level was demonstrated by His bundle electrogram studies.
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