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Biomedical subjects

L Rudas

Publications and source records attributed to L Rudas.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Management of severe orthostatic hypotension by head-up-tilt posture and administration of fludrocortisone].

A case of a 66-year-old man with recurrent episodes of syncope is reported. The syncopal attacks started five years ago in sitting and standing positions. At the time of admission the fainting attacks occurred 2-3 times per day. The diagnostic tests revealed severe orthostatic hypotension. The medical treatment was started with salt enriched diet and fludrocortisone. The efficacy of the therapy was tested by using the tilt table test with a self developed computer system consisting of a non-invasive finger blood pressure monitor and ECG. The orthostatic tolerance improved with the medical therapy, however remained unsatisfactory for the patient's daily activity. Though the patient had less frequent symptoms, he had still sustained episodes of recurrent syncopes. The medical therapy was than combined with sleeping in the 15 degrees head-up-tilt position. The repeat tilt table test was performed two weeks after initiation of the 15 degrees head-up-tilt sleeping. The orthostatic tolerance was markedly improved. The patient became free of symptoms and during a four-week follow-up his condition remained stable. At the control the patient reported about deterioration of his symptoms as a result of the discontinuation of sleeping in "head-up-tilt" position for two weeks. The objective signs leading to aggravate his symptoms was documented by the tilt table test. We reinstituted the "head-up-tilt" sleeping in his therapeutic management.

Aged↗
PubMed1996

[Association of AV reciprocating tachycardia, using a concealed bundle of Kent, and paroxysmal atrial fibrillation in neurocardiogenic syncope].

A case of neurocardiogenic syncope is reported in which both AV-reciprocating tachycardia due to a concealed retrogradely conducting posteroseptal bypass tract and paroxysmal atrial fibrillation were observed. In connection with this case, attention is paid to the difficulties of differential diagnosis and to the pathophysiological correlations concerning the occurrence of neurocardiogenic/vasovagal reflex syncope and cardiac arrhythmias. A prolonged period of freedom from syncope and tachycardia was achieved by means of drug treatment, through the combined administration of disopyramide, bisoprolol and theophylline.

Aged↗
PubMed1996

[Correlations between clinical picture and coronary angiography in unstable angina].

In a one year period (from 01.07. 1993 to 30. 06. 1994) 103 patients were admitted to the Central Intensive Care Unit of the Albert Szent-Györgyi Medical University with the diagnosis of unstable angina. In this cohort of patients the authors assessed the correlation of clinical and angiographic data. Significant coronary artery disease was found in 84% (85 patients), single-vessel disease in 23% (24 patients), double-vessel disease in 38% (29 patients), triple-vessel disease in 20% (21 patients), left main stenosis in 8% (8 patients). The culprit lesion was determined in 73 cases. The distribution of the culprit lesion severity was the following: 50-70% in 17% (12 cases), 70-90% in 27% (20 cases), greater than 90% in 44% (32 cases), 100% in 12% (9 cases). Simplex lesions were seen in 43 cases, complex lesions in 9 cases, diffuse irregularities in 5 cases and total occlusions in 9 cases. Abnormalities indicating intracoronary thrombin-us were seen on 5 coronarograms. No correlation could be demonstrated between the clinical classes according to Braunwald and the angiographic morphology.

Adult↗
PubMed1996

Changes in blood pressure and heart period variability in patients with recent acute myocardial infarction.

1. A decreased heart period variability and baroreflex sensitivity in patients with acute myocardial infarction have already been documented. Since one of the major determinants of heart period variability is blood pressure variability, it would be important to know the characteristics of blood pressure regulation in this setting. The changes in blood pressure variability during the acute phase of myocardial infarction have not yet been studied. 2. We investigated the blood pressure variability and the heart period variability in 11 patients with acute myocardial infarction 3 to 5 days after their admission. Thirteen age matched patients with no evidence signs of ischaemic heart disease or previous myocardial infarction served as controls. We used the frequency domain indexes of short term measurements of finger blood pressure variability and heart period variability. The spectral powers for both heart period variability and blood pressure variability were divided into three major components: total frequency (0.01-0.4 Hz), low frequency (0.04-0.15 Hz) and high frequency (0.15-0.4 Hz). 3. All of the frequency-domain components of the heart period variability were significantly decreased in patients with recent acute myocardial infarction compared to the controls: Ln(total power): 5.68 +/- 0.24 vs. 7.21 +/- 0.29, Ln(low-frequency power): 4.31 +/- 0.28 vs. 7.05 +/- 0.53, Ln(high-frequency power): 3.50 +/- 0.33 vs. 5.48 +/- 0.32. Acute myocardial infarction patients showed a significantly reduced blood pressure variability in all frequency components compared to the controls: Ln(total power): 4.21 +/- 0.18 vs. 6.79 +/- 0.48, Ln(low-frequency power): 2.40 +/- 0.24 vs. 4.36 +/- 0.21, Ln(high-frequency power): 3.31 +/- 0.25 vs. 5.66 +/- 0.38. 4. We hypothesize that the reduced blood pressure variability in the acute phase of myocardial infarction could be related to a relative invariance of stroke volume. The underlying mechanism is the reduced left ventricular compliance.

Blood Pressure↗
PubMed1996

Regulation of immediate blood pressure response to orthostasis in patients with fixed ventricular pacemaker rhythm.

1. The immediate heart rate and blood pressure changes upon standing have been well documented. It has been recognized, that blood pressure transients elicit baroreflex responses contributing to the complex mechanism of post standing heart rate fluctuations. On the other hand the influence of heart rate changes on orthostatic blood pressure control is not well understood. Therefore we have studied the blood pressure regulation of 28 pacemaker dependent subjects with fixed ventricular pacemaker rhythm during active orthostasis, and their responses were compared to that of 10 elderly (66 +/- 11 year), and 12 young (35 +/- 5 year) volunteers. 2. The young volunteers exhibited the characteristic biphasic heart rate response on standing, with a maximum acceleration of 29 +/- 12 beats. The heart rate response of the elderly volunteers was very limited, and no response was seen among pacemaker subjects. A significantly greater (-37 +/- 15 mmHg) systolic blood pressure drop was seen in the pacemaker group than in the group of young volunteers (-22 +/- 13 mmHg). The systolic blood pressure overshoot of the young volunteers (36 +/- 17 mmHg) was significantly greater than that of the pacemaker patients' (11 +/- 22 mmHg). The blood pressure transients of the elderly volunteers and pacemaker subjects were very similar. Significant correlation was detected between the extent of maximum heart rate acceleration and the magnitude of the subsequent blood pressure overshoot (R = 0.68, p < 0.0005) among healthy volunteers. 3. Our results indicate that certain post standing blood pressure transients are heart rate dependent. The chronotrop incompetency of healthy elderly volunteers and pacemaker subjects result in similar alteration of the orthostatic blood pressure regulation, however this modified response does not interfere with a satisfactory hemodynamic stabilization.

Adult↗
PubMed1995

[Unstable angina pectoris associated with surgically treated coronary artery atresia].

A case report of a rare, presumably congenital form of "single coronary artery", is presented. The authors review the classification and clinical significance of the entity with special emphasis with regard to anginal symptoms and the so called sudden unexpected death syndrome. Details and result of surgical intervention (conventional aorto-coronary saphenous bypass) are discussed.

Angina, Unstable↗
PubMed1995

[Experience with a minute ventilation sensing rate frequency adapted pacemaker].

In the last two years 27 patients (mean age: 63.2 +/- 6.9 years) received Telectronics META MV pacemaker generators at the SZOTE. In 6 cases the generators were connected to atrial pacemaker electrodes, and in 21 cases to ventricular electrodes. To assess the characteristics of the rate responsive function exercise stress test was performed by 17 of these subjects. The authors give an account on the rate adaptive functions of these type pacemakers. The generator is an SSIR one. The rate responsive factor--i.e. the numerical characteristics of the pulse rate acceleration suggested by the pacemaker itself--was similar for atrial and ventricular electrodes.

Aged↗
PubMed1995

The mechanism of blood pressure variability. Study in patients with fixed ventricular pacemaker rhythm.

BACKGROUND: Several studies have shown that heart rate variability plays an anti-oscillatory role in the regulation of blood pressure variability in humans. We tested whether systolic blood pressure variability in patients with a fixed ventricular pacemaker rhythm differs from that in patients with sinus rhythm. METHODS AND RESULTS: In 18 patients with a fixed ventricular pacemaker rhythm and in ten age-matched patients with sinus rhythm the systolic blood pressure oscillation and the low and high-frequency spectral components of systolic blood pressure were studied in the resting supine position during spontaneous breathing and during forced deep ventilation of 6 cycles.min-1. Patients with a pacemaker had a higher amplitude of systolic blood pressure oscillation than control subjects during spontaneous breathing (13.5 +/- 2.0 mmHg vs 6.4 +/- 1.6 mmHg, P = 0.035), and a slight but not significant difference also persisted during forced deep ventilation 19.0 +/- 2.3 mmHg vs 15.0 +/- 2.3 mmHg, P = 0.18). The increment in systolic blood pressure fluctuation from spontaneous breathing to forced deep ventilation was less marked in the pacemaker group than in the control subjects (40% vs 130%, P = 0.43). Although all the systolic blood pressure spectral components of the pacemaker patients were higher during both spontaneous breathing and forced deep ventilation, the differences between the two groups did not reach statistical significance. CONCLUSIONS: Our observations in patients with a fixed ventricular pacemaker rhythm suggest that the mechanical effects on the intrathoracic vessels and the consecutive stroke volume changes are responsible for respiration-related systolic blood pressure oscillation and reflex systolic blood pressure changes.

Aged↗
PubMed1994

[Persistent atrial flutter induced by propafenone (Rytmonorm)].

The case history of two patients with atrial fibrillation are presented. In order to prevent/terminate fibrillation propafenone (Rytmonorm, 450-600 mg/day) was started, however this therapy resulted in permanent atrial flutter of 230-270/min mainly with 2:1 antrioventricular conduction. Analyzing the cases the authors emphasize that although Class Ic antiarrhythmic drugs (flecainide, encainide, propafenone) are capable to prevent or terminate atrial fibrillation, they may also induce atrial flutter in approximately 3.5-5% of these patients. The mechanism and recognition of this atrial proarrhythmic action are discussed.

Aged↗
PubMed1994

[Continuous non-invasive blood pressure monitoring in the diagnosis of pacemaker syndrome].

The drop in blood pressure coinciding with the atrioventricular dyssynchrony plays an important role in the genesis of pacemaker syndrome. The diagnosis is often based on continuous blood pressure recording. Formerly the continuous blood pressure monitoring could only be performed by invasive methods. The authors demonstrate the feasibility of a new non invasive continuous blood pressure recorder, the Finapres 2300, by presenting illustrative case reports. The authors recommend more widespread use of non invasive haemodynamic monitoring for the diagnosis of pacemaker syndrome.

Aged↗
PubMed1993

[Comparison of invasive and non-invasive measuring of blood pressure in patients following open heart surgery].

Accuracy of blood pressure measurements with a new noninvasive ambulatory blood pressure monitor (Meditech KFT Budapest) was studied in 12 postoperative patients following open heart surgery. We compared 532 systolic and diastolic blood pressure recordings taken simultaneously both invasively and noninvasively. The values obtained noninvasively were subtracted from the corresponding values obtained invasively, and the differences were assessed according the British Hypertension Society recommendations. Values obtained with the two methods demonstrated good correlation (R: 0.85; p < 0.0001). 60 per cent of the differences in diastolic and 76 per cent of the differences in systolic blood pressure recordings fell into the range of +/- 5 mmHg. Thus the accuracy of diastolic blood pressure measurements was classified as "A" (characteristic fo the best equipment) and those of the systolic recordings was classified as "B" (characteristic of good equipment). Based on our findings the new blood pressure monitor provides accurate recordings and its use is highly recommended in the everyday practice.

Adult↗
PubMed1993

Enhanced detection of cardiac allograft arterial disease with intracoronary ultrasonographic imaging.

Intracoronary ultrasonographic imaging was performed in 60 patients 0.3 to 9 years (mean 2.9 +/- 1.9) after heart transplantation. By using a 1.8 mm intravascular ultrasonographic catheter, 192 (80%) of 240 angiographically visualized major epicardial coronary arteries (right, left main, anterior descending, and circumflex) were imaged by ultrasonography. Coronary luminal irregularities were detected in 15% of arteries by angiography compared with 34% by ultrasonography (p < 0.0001). The typical abnormality detected by ultrasonography consisted of crescentic and/or concentric intimal and medial thickening. Calcification in vascular lesions was rare (< 1% of arteries studied). Although the prevalence of angiographic abnormalities tended to be time dependent, ultrasonographic abnormalities were more strongly associated with donor age (normal, 22 +/- 8 years, vs abnormal, 33 +/- 10 years; p < 0.0001). Cardiac allograft coronary arterial disease is significantly underestimated by contrast angiography. Intravascular ultrasonography may provide a useful adjunct for identification and serial follow-up of this significant problem.

Adult↗
PubMed1993

Immediate cardiovascular responses to orthostasis in the early and late months after cardiac transplantation.

Immediate post-standing (< 30 s) heart rate and blood pressure regulation was studied in patients in the early (2 +/- 2 months, n = 10) and late months (49 +/- 18 months, n = 30) after orthotopic heart or heart and lung transplantation with continuous non-invasive blood pressure (Finapress) and ECG recordings, and was compared to 15 healthy subjects. Heart rate acceleration on standing was standing was absent in the early post-transplantation period. Modest, delayed heart rate acceleration (maximum 12 +/- 8 beats/min) was seen late post-transplantation. Subgroup analysis showed that 15 patients late post-transplantation had limited (maximum 6 +/- 3 beats/min) heart rate acceleration, 11 patients showed maximum heart rate acceleration between 11 and 19 beats/min and 4 patients showed heart rate acceleration comparable in magnitude with that of normal subjects (maximum 28 +/- 5 beats/min). The blood pressure transients were comparable in the 3 groups, with a tendency for greater drop and smaller overshoot in systolic blood pressure in transplant subjects. The findings of normal blood pressure transients in the setting of extensive afferent cardiac denervation questions the role of intracardiac (intraventricular) receptors in reflex blood pressure regulation. The development of heart rate responsiveness is compatible with sympathetic reinnervation in many patients in the late post-transplantation period; however, an intrinsic cardiac mechanism may also be possible.

Adult↗
PubMed1992

Normalization of upright exercise hemodynamics and improved exercise capacity one year after orthotopic cardiac transplantation.

The mechanisms of improved functional capacity over the first year after cardiac transplantation are not well studied. To assess the contribution of cardiac changes to this improvement, the serial evolution of upright rest and exercise hemodynamics during graded upright bicycle exercise was studied in 17 patients at 3 and 12 months after heart transplantation. Heart rate responsiveness, reflected by rapid heart rate acceleration on sitting and rapid deceleration after exercise, developed in the first year. Pulmonary capillary wedge pressure was lower at 1 year, both at rest and at peak exercise (10 +/- 3 vs 13 +/- 5 mm Hg at rest supine and 14 +/- 6 vs 18 +/- 8 mm Hg at peak exercise, p less than 0.05). Similarly, right atrial pressures were also significantly lower at 1 year (4 +/- 2 vs 6 +/- 3 mm Hg at rest supine and 6 +/- 5 vs 11 +/- 5 mm Hg at peak exercise, p less than 0.05). Cardiac index at peak exercise was greater at 12 months (6.4 +/- 1.3 vs 5.8 +/- 0.8 liters/min/m2, p less than 0.05), mediated primarily by higher exercise heart rate (135 +/- 16 vs 125 +/- 12 beats/min, p less than 0.05). In the first year after heart transplantation, improved rest and exercise hemodynamics and heart rate responsiveness contribute significantly to the improved functional capacity observed in these patients.

Adult↗