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Biomedical subjects

M Bory

Publications and source records attributed to M Bory.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Esophageal spasm: a common cause of spontaneous precordial pain].

Fifty-eight consecutive patients were investigated for spontaneous chest pain without symptoms of effort angina, previous myocardial infarction or other signs of cardiac disease, to determine the incidence of oesophageal spasm. The character of the chest pain, its context and the results of resting ECGs were analysed. An ECG recorded during chest pain was available in 23 cases and exercise stress testing was performed in 43 cases. Coronary angiography was carried out in all patients. The coronary arteries were normal or showed little change in 44 patients. Further investigations were ordered: oesophageal manometry (42 cases), echocardiography 44 cases) and ergometrine provocation tests (44 cases). The patients were then divided into 4 groups: 23 patients (40 p. 100) with coronary artery disease; either atheroma (14 cases) or spasm (9 cases); 8 patients (13,5 p. 100) with non-coronary cardiac pathology (myocardial hypertrophy or mitral valve prolapse); 15 patients (26 p. 100) with oesophageal spasm alone; 12 patients (20,5 p. 100) with no obvious organic disease. Often simulating spontaneous angina, clinically and electrocardiographically, oesophageal spasm may sometimes be distinguished (6 out of 15 cases) by the finding of painful dysphagia on swallowing ice-cold liquid. The condition is confirmed by oesophageal manometry which shows abnormalities of oesophageal contraction. In addition, 13 out of 15 patients in our series had hypotonia of the gastro-oesophageal sphincter. Dyskinetic phenomena and this hypotonia should be taken into consideration in the treatment of this condition.

Adult↗
PubMed1984

[Prognostic value of coronary spasm threshold determined by the ergometrine test].

The prognosis of spastic angina is difficult to determine. The object of this study was to try to evaluate the prognosis of coronary spasm on the results of provocative, ergometrine testing. Out of 708 patients with angiographically normal or near-normal coronary arteries undergoing the ergometrine test for assessment of chest pain, 78 patients with positive results were retained for study. The threshold of spasm was established in every case: this was defined as the quantity of ergometrine per kilogramme body weight required to provoke spasm. The values ranged from 1 to 12.5 micrograms/kg (average 7.58 micrograms/kg +/- 3.84). The reproducibility of the ergometrine test appeared to be very satisfactory. In the short term, only 4 out of 32 tests became negative. The test remained positive in 28 cases and the mean value of the threshold of spasm did not change significantly (5.64 +/- 3.27 to 5.52 +/- 3.18 micrograms/kg). In the long term only 2 out of 18 tests became negative. The test remained positive in 16 cases and the mean value of the threshold of spasm did not change significantly (5.68 +/- 2.96 to 6.58 +/- 3.11 micrograms/kg). The ergometrine test with a reference threshold of positivity of 5 micrograms/kg is doubly useful: this threshold value helps predict a good response to calcium inhibitor drugs: the threshold of spasm was less than this value in 6 of the 41 patients whose tests became negative after diltiazem therapy, and in 12 of 14 patients in whom the test remained positive (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Vasospasm↗
PubMed1984

[Uni- and bidimensional echocardiography in the etiologic diagnosis of precordial pain].

The distinction between precordial pain of cardiac origin and pain of extra-cardiac origin is a daily problem. We wanted to study the value of echocardiography in this difficult diagnostic problem. In a series of 148 patients admitted to the unit in 1982 for chest pain. 104 were investigated by echocardiography and coronary angiography. In 36 per cent of patients, the echocardiogram was normal and was unable to predict the presence or absence of coronary artery disease. Further investigations seem to be justified in these cases. In 57 per cent of cases, the echocardiogram was abnormal, suggestive of a cardiac cause for the pain. The demonstration of a disorder of segmental kinetics in the left ventricle is suggestive of coronary artery disease, which is detected 82 per cent of cases and is a good indication for coronary angiography. The other abnormalities detected, mitral valve prolapse, hypertrophic cardiomyopathy and dilated cardiomyopathy are rarely associated with coronary artery disease, which was found in 0, 13 and 14 per cent of cases, respectively. Initially, these abnormalities may be sufficient to explain the symptomatology. Pericardial detachments are associated with coronary artery lesions in 50 per cent of cases and should be very carefully monitored.

Adult↗
PubMed1984

[Normal coronary arteries and spontaneous precordial pain].

In 100 successive patients with normal coronary arteriography performed for spontaneous precordial chest pain, a Methergine test was performed to induce coronary artery spasm, in addition to esophageal manometry, and an angiographic and echocardiographic study of the left ventricle. These tests were all normal in 39 patients, whereas the remaining 61 patients had pain due to coronary artery spasm (14 times), a non-coronary artery cardiopathy (16 times) (hypertrophic cardiomyopathy or mitral valve prolapse), or esophageal dyskinesia (35 times). The latter was an isolated finding 29 times, was associated 3 times with coronary artery spasm, and 3 times with non-coronary artery cardiopathy.

Coronary Angiography↗
PubMed1983

[Provocation tests for coronary spasm. Methods, value and indications].

Five methods are currently used to demonstrate coronary spasm: they use derivatives of ergotamine, alkalinisation, cold, adenosine triphosphate and exercise stress test. The criteria used to confirm spasm are either direct visualisation at coronary angiography or indirect electrocardiographic changes. The value of these test is beginning to be established: --their specificity is excellent with all methods (a positive test is diagnostic); --their sensitivity is mediocre (a negative test does not exclude the diagnosis). This depends on three factors: the choice of criteria of positivity: angiographic appearances is the most reliable; the timing of the test: it is more likely to be positive when the test is carried out close to episodes of chest pain; the method of provocation: the most sensitive tests use either the ergotamine derivatives or alkalinisation; --reproductibility is satisfactory at short and long term. These tests have diagnostic and therapeutic indications. It is preferable to perform diagnostic tests during coronary angiography in patients with normal coronary arteries and unexplained episodes of chest pain. However, in patients with fixed coronary lesions (except triple vessel and left main stem disease) when coronary bypass surgery is planned, the results of the test can help in the choice of associated therapy, such as plexectomy and calcium antagonist drugs. The repetition of the test is useful in the evaluation of antispastic therapy: when the test becomes negative the drug used is probably effective. In conclusion, with equal patient comfort and MSR, provocation tests using the ergotamine derivatives would seem to be the method of choice: alkalinisation is a good alternative.

Adenosine Triphosphate↗
PubMed1983

[Detection of left intraventricular thrombi in the acute phase of myocardial infarction by 2-dimensional echocardiography. Apropos of 103 cases].

Two-dimensional echocardiography (2D echo) was performed in 103 patients (94 men, 9 women, aged 35 to 76 years; mean 55,4 years) during the acute phase of primary myocardial infarction in order to detect left ventricular thrombi (LVT). This investigation was carried out between the 7th and 30th days with an 84 degrees phased array sector scanner. A total of 17 LVT were visualised, all at the apex of the left ventricle. There factors seemed to predispose to this condition: --the site of infarction: LVT were more common in anterior (16/56) than inferior infarcts (1/47) (p less than 0,001); --the extent of the necrosis: LVT occurred in 13/30 antérior infarcts when the akinesia involved at least two antero-apical segments, compared to only 3/26 when the necrosis was less extensive (p less than 0,05); --cardiac failure in anterior myocardial infarction: LVT were found in 11/21 cases with cardiac failure and in only 5/35 without cardiac failure (p less than 0,01). The outcome of 45 patients was assessed by 2D echo 3 to 12 months after the acute episode (mean 7,6 months). Control echo was unchanged in 35 patients (15 inferior, 20 anterior infarcts) without LVT. In 10 patients with LVT treated by oral VitK antagonists, the thrombus disappeared in 5 cases without embolism; it decreased in volume in 3 cases and persisted unchanged in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[Outcome of vasospastic angina with normal or near-normal coronary arteries (author's transl)].

The outcome of vasospastic angina with normal or near-normal coronary arteries was investigated in 48 patients followed up for periods of 3 to 55 months (mean : 19.1 months). The course of the disease was unfavorable in 13 patients, of whom 3 died, 5 developed myocardial infarction and 5 refractory angina. It was favourable in 16 patients who remained asymptomatic for at least 6 months, and intermediate in 16 patients whose anginal attacks became less frequent. Three patients were lost sight of. Calcium antagonists were administered to 32 patients; they proved superior to beta-blockers but imperfectly controlled the course of the disease : the anginal attacks completely ceased in 12 patients, became less frequent in 11 and persisted or became worse in 5. A close correlation was found between long-term outcome and the results of provocation tests performed at the beginning of treatment, and it is proposed that these tests should be used as therapeutic guide-lines.

Adrenergic beta-Antagonists↗
PubMed1982

[Disappearance of coronary collateral circulation during a crisis of spontaneous angina. The role of spasm].

Disappearance of the collateral coronary circulation was observed during an attack of spontaneous angina. During coronary angiography, the patient developed precordial pain, ST depression in Leads I, II, III, AVL, AVF, and V2 to V6. The two coronary arteries were opacified: there was no change in the left coronary tree but the collateral circulation arising from the right coronary artery and revascularising the obstructed left anterior descending artery the ECG reverted to its previous state and the collateral circulation reappeared. This case suggests that coronary artery spasm may lead to disappearance of the collateral circulation. It raises problems of methodology in the demonstration of spastic phenomena and emphasises the role of the collateral circulation in the genesis of ischaemia. It is another illustration of coronary artery spasm accompanied by ST depression.

Angina Pectoris, Variant↗
PubMed1982

[Block of the autonomic nervous system in the study of sinus function].

Blockade of the autonomic nervous system by injection of propranolol (0,2 mg/Kg) and atropine (0,04 mg/Kg) was carried out in a series of 48 patients classified in 3 groups:--Group I:sinus bradycardia (22 cases)--Group II:suspected tachycardia-bradycardia syndrome (14 cases)--Group III:suspected sinus node dysfunction (12 cases). Two parameters were studied after autonomic blockade: observed intrinsic sinus node frequency (OIF) and corrected "adjusted" sinus node recovery time (CASRT). The results were compared with those obtained during basal electrophysiological investigation. The OIF was abnormal in 26 cases (54%) and junctional rhythm was observed 9 times (19%). Prolongation of the post-stimulation pause occurred in 32 cases (67%), transformation from a normal to a pathological pause in 15 cases and normalisation of a pathological pause in 4 cases (8%). Sinus node recovery time did not change significantly in the other cases. There was a good correlation between OIF and CASRT when the OIF was abnormal and mediocre (48%), when the OIF was normal. The following conclusions were made:--CASRT improves diagnosis of organic sinus node dysfunction which may escape detection by basal electrophysiological investigation and excludes functional abnormalities.--OIF is of good diagnostic value when pathological. However, the integrity of sinus node function cannot be affirmed when this parameter is normal.

Aged↗
PubMed1982

[Treatment of a severe coronary artery spasm, refractory to complete denervation of the heart (autotransplantation)].

The case reported is that of a 49 year old man with very severe Prinzmetal angina due to spasm of the left circumflex artery. Despite intensive medical treatment he continued to suffer frequent attacks with atrioventricular block. As plexectomy was not possible in this case, complete cardiac denervation was performed. After surgery, he had no further attacks and continuous ECG monitoring showed no ischemic phenomena. Nevertheless, a stress test was still able to induce spasm of the same artery which was painless but associated with ECG changes. Eighteen months postoperatively, resting angina recurred with positive stress tests giving painful attacks. Four hypotheses are discussed: 1) the local factor was very important, with a zone of hyperactivity on the left circumflex artery, 2) one of the mechanisms of coronary artery spasm could be the nervous stimulation of this zone, 3) this zone was insensitive to nervous stimulation after autotransplantation but remained sensitive to methylergometrine, 4) the recurrence of resting angina and painful symptoms on stress testing suggests the possibility of reinnervation of the heart, as has been shown after cardiac transplantation, the autonomic nervous system does not play the role generally attributed to it in the genesis of spasm.

Aged↗
PubMed1982

[Spasm, stenosis and thrombosis. Their role in the genesis of myocardial infarction].

A 42 year old patient underwent coronary angiography 3 hours after the onset of inferior myocardial infarction with the object of local thrombolysis therapy. Complete proximal obstruction of the right coronary artery was relieved mechanically by the catheter. This was associated with a return of the ST segment to the isoelectric line but Q waves persisted in Lead III and AVF. A second injection showed 70 p. 100 stenosis at the site of the obstruction and the radiolucent appearances of thrombus below it. This was followed by 4 successive periods of ST elevation as the right coronary artery reoccluded. These phenomena were relieved by injection of nitroglycerine suggesting a spastic mechanism. The radiolucent image of thrombus disappeared and was replaced by amputation of a distal branch of the right coronary artery. Further coronary opacification showed good run-off beyond the stenosis and reappearance of the distal branch. This case suggests that three factors played a role in the mechanism of infarction: stenosis accompanied by spasm and thrombosis.

Adult↗
PubMed1981

[An approach to the diagnosis of coronary artery spasm in spontaneous angina pectoris (author's transl)].

Spontaneously occurring spasms are more likely to be detected by performing coronary angiography during an acute ischaemic attack. This was achieved in 28 out of 41 cases. Spasm was found to be present in 23/25 attacks with elevated S-T segment but in only 5/16 attacks with other changes on ECG. The difference was statistically significant (p less than 0.01). When coronary angiography was performed outside anginal attacks, arterial spasm was detected in 16 out of 1071 cases (1.48%). The percentage increased in patients with spontaneous angina: 13/15 cases (8.6%). These spontaneous spasms are painless and can be differentiated from catheter-induced spasms and organic stenosis by the nitroglycerin test. Spasms which do not occur spontaneously can be provoked by methylergometrine maleate. This was done 175 time with 16 positive results. The criteria of positivity of the test, as well as its value, indications and dangers are discussed.

Angina Pectoris↗
PubMed1981

[Use of intramuscular lidocaine in the acute stage of myocardial infarction].

Methods of using intramuscular lignocaine and its relay with an intravenous infusion were studied in 34 patients with reference to serum levels. A first group of 9 patients with myocardial infarction received an intramuscular injection of 300 mg lignocaine into the deltoid or gluteral muscles at five day intervals. The deltoid appears to be the better site of injection in patients confined to bed because of its quick absorption, higher serum levels between the 15th and 90th minute (+47%), and longer duration of action (180 compared to 120 minutes). The difference is not observed in ambulatory patients and seems to be related to sluggish circulation in the gluteral muscles during bed rest. Its relay with intravenous infusion was studied in 14 patients. In the first 6 patients, intradeltoid injection was immediately followed by an infusion of 2.5 mg/mn, giving an average plasma lignocaine level between the 15th and 60th minute greater than 5 mu/ml. In the 8 other patients, a period of I hour was allowed to elapse before starting the infusion. The plasma levels were found to be within the therapeutic range in all patients and no side effects were observed. The administration of an intravenous infusion of 150 mg/hr of lignocaine for 48 hours led to excessively high plasma levels in 8 patients at the 24th hour, 3 of whom had side effects. Reducing the dosage to 100 mg/hr from the 12th hour onwards in II patients avoided this complication. A 300 mg intradeltoid injection of lignocaine is easy to give in the patient's home and therefore, is the best adapted method for the pre hospital treatment of myocardial infarction. When necessary, it may be relayed with an intravenous infusion one hour later, in the coronary care unit.

Aged↗