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Biomedical subjects

L Toivonen

Publications and source records attributed to L Toivonen.

113 records · Page 7Linked to original sources
PubMed1982

Ambulatory ECG recording in patients referred because of syncope or dizziness.

Data are presented on patients referred for ambulatory ECG recording because of syncope or dizziness during a 2-year period. Of the 272 consecutive patients subjected to the recording, 107 (39.3%) had syncope or dizziness as the main indication for referral. Sixteen of these patients (14.9%) experienced the presenting symptom during the recording, and in 8 (50%) of these the simultaneous ECG finding was interpreted as causative. In patients who were symptom-free during the recording, sinus arrests exceeding 2.5 seconds seemed to be a valuable finding to support the cardiac aetiology of the syncopal symptoms, whereas the diagnostic value of second degree AV block with either Wenckebach or Mobitz II like patterns, as such, and of ventricular tachycardia remained mostly unsettled.

Ambulatory Care↗
PubMedDate not supplied

Later potentials on signal-averaged electrocardiograms in children after right ventriculotomy.

After corrective surgery for congenital heart defects, scars may create fractionation and delay of the electrical signals in the heart muscle, providing a substrate for arrhythmias. Signal-averaged electrocardiograms (SAECGs) were obtained from 33 children after right ventriculotomy, on average 6 years after surgery, and from 38 healthy controls of the same age. The duration of the filtered QRS complex (fQRS), the duration of the low amplitude signal (< 40 microV) in the terminal QRS complex (LAS40), and the root mean square amplitude of the terminal 40 ms of the QRS complex (RMS40) were determined. The values of fQRS > or = 117 ms, RMS40 < or = 25 microV, and LAS40 > or = 35 ms, which were beyond the mean +/- 2 SD of the healthy controls, were considered abnormal. Most patients had right bundle branch block and therefore a prolonged fQRS. Late potentials were defined as present if both the RMS40 and LAS40 were abnormal. Altogether nine patients (27%) had late potentials. In the patients with late potentials the incidence of serious ventricular arrhythmias was 44% (4 of 9) and in the patients without late potentials 0% (0 of 24). In seven patients with enlargement of the right ventricle, the incidence of arrhythmias was 57% (4 of 7) when late potentials were present and 0% (0 of 7) when they were absent. In the present study late potentials were associated with a history of arrhythmias, especially when the right ventricle was enlarged. Therefore the SAECG may be useful for determining the risk of serious arrhythmia events in children operated for congenital heart defects.

Adolescent↗
PubMedDate not supplied

Magnetocardiographic localization of ventricular pre-excitation in a child with a congenital heart defect.

Magnetocardiographic mapping was performed on a 2-year-old boy who suffered from the Wolff-Parkinson-White syndrome in association with a complex congenital heart defect. The pre-excitation site was determined noninvasively from the measured cardiac magnetic fields. The location was in the same anatomic region as found by intraoperative epicardial mapping. This result shows that magnetocardiography can be helpful for determining an accessory pathway also in patients with grossly abnormal cardiac anatomy.

Child, Preschool↗
PubMedDate not supplied

Changes in heart rate variability in elderly patients undergoing major noncardiac surgery under spinal or general anesthesia.

BACKGROUND AND OBJECTIVES: Heart rate variability (HRV), widely used as an indicator of activity of the autonomic nervous system, has been reported to decrease during and after both spinal and general anesthesia in patients without cardiovascular disease. We evaluated the changes in HRV bands in 40 patients with a high risk of ischemic heart disease. METHODS: The patients were randomly assigned to receive either spinal (SA) or general anesthesia (GA) for elective total hip arthroplasty or peripheral vascular surgery. Anesthetic techniques and perioperative fluid administration were standardized. Holter monitoring was started preoperatively and continued until the third postoperative day. Three HRV frequency bands were analyzed. RESULTS: A significant decrease was seen in very low frequency (VLF) and low frequency (LF) bands during GA but not during SA. Also the LF/high frequency (HF) ratio decreased during GA but not during SA. A decrease in all HRV frequency bands was seen after both types of anesthesia. None of the frequency bands returned back to the preoperative level during the 3-day trial. Postoperatively circadian variation was found only in the VLF band after SA. CONCLUSIONS: The sympathovagal balance (LF/HF) is more stable during SA than during GA in patients with a high risk of ischemic heart disease. The postoperative decrease in HRV bands, however, is independent of the anesthetic technique.

Aged↗