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Biomedical subjects

M Cholewa

Publications and source records attributed to M Cholewa.

At least 37 records · Page 2Linked to original sources
PubMed1991

Electrophysiologic effects of blocking and stimulating the opioid system in patients with unexplained heart palpitations.

The opioid system plays a role in the regulation of the cardiovascular system. Endogenic as well as egzogenic administration of opioids influences the heart rhythm. This work was undertaken in order to assess the influence of crossover activity of the heart opioid system on the heart conduction system in patients with various disturbances of rhythm having an efficient circulatory system and a normal 12-lead stationary ECG. Subjects were 20 patients (9 men and 11 women of mean age of 38.7 years) reporting sudden heart palpitations. They were subjected to invasive programmable electrophysiological studies (PES). Naloxone was administered intravenously to 10 patients. Pentazocine was administered in the same way. In the remaining 10 patients the order of drug administration was reversed. PES was done in the basic state and after the administration of each drug. Study results were subjected to statistical analysis with no-parameter Wilcoxon test assuming differences to be significant at p less than 0.05. Blocking of the opioid system resulted in significant lengthening of the sinoatrial (SACT), intra-atrial (PA), and atrioventricular node (AH) conduction times, while no changes were induced in conduction in the His-Purkinje system (HV) and automation of the sinus node. Naloxone lengthened the atrial (ERPA) and atrioventricular node (ERPA AVN) effective refractory periods. Stimulation of the opioid system resulted in decreases of the following values: SACT, PA, AH, ERPA, ERPA AVN, while no effect was exerted on the SNRT, HV, ERPV. Neither drug influenced the QRS time, although naloxone lengthened QTc period significantly. Opioids did not influence the time of conduction in concealed extranodal atrioventricular pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1990

[Effect of nitrates on left ventricular function and exercise tolerance in patients with mild circulatory failure caused by ischemic heart disease].

In 26 patients with ischaemic heart disease with symptoms of mild chronic circulatory failure (NYHA grade II) aged 56.2 +/- 14.4 years the left ventricular function was tested by two-dimensional echocardiography, the exercise tolerance was determined on cycle ergometer at submaximal workloads, the cardiothoracic index (CTI) and cardiac volume index (CVI) were calculated from chest radiograms. The tests were done before and after 2 and 6 weeks of treatment with isosorbide dinitrate in doses of 49.6 +/- 15.2 mg/day. Isosorbide was found to increase somewhat the ejection fraction (EF), and to raise statistically significantly (p less than 0.05) the velocity of shortening of the circumferential fibres in left ventricular myocardium (mVCF), and to reduce the internal dimensions of the left ventricle (LVIDd and LVIDs), without changing the values of the ejection index (SVI) and cardiac index (CI). Decreased transverse dimensions of the left ventricle was correlated with a significant decrease of the CVI index. No statistically significant effect of isosorbide was noted on the parameters characterizing exercise tolerance but the quotient of the exercise-induced heart rate by the workload (HR/Wat) and the index of myocardial oxygen requirement (HRx Ps) were decreased in a demonstrable way.

Adult↗
PubMed1990

[Effect of vasodilator agents on the character and incidence of cardiac arrhythmia in chronic heart failure].

In 50 patients with chronic congestive heart failure (CCHF, III or IV class), aged 62.8 +/- 9.1 years, who were treated with digoxin (Dx) and furosemide (F) (investigation A), continuous 24-hour ecg registration was performed according to Holter. Next, this treatment was extended by two-week administration of nifedipine (N) or isosorbide dinitrate (S) (investigation B), followed by one-month addition of captopril (Cp) (investigation C). During the last two weeks Dx, F, N or Dx, F, S were administered with Cp being withdrawn (investigation D). At the end of each stage of the treatment ecg registration was repeated according to Holter. At the same time, during the investigation A there were performed determinations of blood serum sodium, potassium and digoxin concentrations, two-dimensional echocardiography and evaluation of submaximal exercise tolerance. In 96 per cent of patients with CCHF, treated with Dx and F, cardiac rhythm disturbances were found. In 53.3 per cent life-threatening ventricular arrhythmias occurred, including unstable ventricular tachycardia in 11.1 per cent of patients. Addition of N or S to the classical treatment did not decrease either patient number or amounts of cardiac rhythm disturbances in individual classes according to Lown. Also Cp did not affect numbers of patients with cardiac rhythm disturbances, but it decreased numbers of patients with life-threatening ventricular arrhythmias from 53.3 per cent to 28.9 per cent (from 24/45 to 13/45). At the same time, Cp significantly decreased numbers of ventricular arrhythmias in class 3 and 4a (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Significance of 2-dimensional echocardiography for the diagnosis of dipyridamole-induced myocardial ischemia in patients with coronary heart disease].

In 24 patients with coronary heart disease (group 1) and in 16 control patients (group 2) dipyridamole test was performed in combination with two-dimensional echocardiography. The studies were aimed at the comparison of sensitivity, specificity and predictive values calculated during analysis of segmental contractility of the left ventricular wall and LVEDVI, LVESVI, SVI, CI and EF in relation to ecg examination. During analysis of changes in ST segment, dipyridamole test sensitivity was 0.37, specificity--0.94, predictive confirmatory value--0.90, and predictive excluding value--0.50. During analysis of LVEDVI, SVI and CI diagnostic value of the dipyridamole test did not change (p greater than 0.05). During analysis of LVESVI and EF dipyridamole test sensitivity increased to 0.75 and 0.83, respectively (p less than 0.05). Also during analysis of segmental contractility of the left ventricular wall sensitivity of the test increased to 0.75 (p less than 0.01), while its specificity and predictive value did not change (p greater than 0.05). Two-dimensional echocardiography augments diagnostic value of the dipyridamole test.

Adult↗
PubMed1990

[Changes in left-ventricular function in chronic congestive heart failure treated with digoxin, furosemide and vasodilators].

48 patients (62.8 +/- 9.1 yrs) with III or IV NYHa class congestive heart failure after 2-week therapy with digoxin (D) and furosemide (F) underwent two-dimensional echocardiographic examination to assess left ventricular function. Then in 25 patients (group I) DF and nifedipine (N) were given within 2 weeks, D, F, N and captopril (C) within 4 weeks and again D, F, N within 2 weeks. In 23 patients (group II) isosorbide dinitrate (S) was administered instead of nifedipine. 2-DE examination had been performed at the end of the each study stage. Optimal daily drug dose were: D-0.34 +/- 0.07 mg, F-40.7 +/- 12.5 mg, S-44.3 +/- 10.4 mg and 75.8 +/- 26.4 mg. Nifedipine and isosorbide dinitrate administrated with digoxin and furosemide did not improve left ventricular function in comparison with a standard therapy (DF). The best positive changes were observed in both groups during treatment with captopril. Ejection fraction by Teichholz increased from 42.9 +/- 15.0% during DF stage to 45.2 +/- 11.5% (DFNK stage) in group I (p less than 0.001) and from 35.3 +/- 10.5% to 36.4 +/- 10.4% in group II respectively (p greater than 0.01). Left ventricular systolic and diastolic internal diameters significantly decreased (p less than 0.05) whereas stroke volume and cardiac indices nonsignificantly increased (p greater than 0.05). Captopril with digoxine, furosemide and nifedipine caused significant hemodynamic improvement. Effect of captopril with nifedipine was greater that of captopril with isosorbide dinitrate.

Adult↗
PubMed1990

[Results of treatment for severe congestive heart failure with digoxin, furosemide and vasodilating agents].

In 61 patients with class IV (NYHA) of chronic congestive cardiac failure treated for 2 weeks with digoxin (0.290 +/- 0.108 mg/d) and furosemide (13.0 +/- 4.1 mg/d), for 2 weeks with digoxin, furosemide and isosorbide dinitrate (44.5 +/- 9.8 mg/d) or nifedipine (42.0 +/- 12.2 mg/d), for 4 weeks with digoxin, furosemide, isosorbide or nifedipine and captopril (angiotensin converting enzyme inhibitor) (75.1 +/- 24.4 mg/d), and for the last 2 weeks with digoxin, furosemide, isosorbide or nifedipine without captopril, after each stage the clinical state, exercise tolerance and haemodynamic parameters determined echocardiographically were assessed. Ten weeks of treatment by this method caused regression of pulmonary congestion in 80%, oedema in 63.3% and hepatomegaly in 33.3% of the patients. Moreover, 60.7% of the patients returned to class III, 13.1% to class II, and 26.2% remained in class IV (NYHA). In the group treated with digoxin, furosemide, nifedipine with captopril (n = 30) a significant rise was observed of the value of the ejection fraction and cardiac index in relation to the treatment with digoxin and furosemide and the treatment with digoxin, furosemide, nifedipine (p less than 0.05). No drug improved significantly the tolerance of submaximal exercise. During the treatment with captopril no clinical improvement was achieved in 4 cases, and worsening occurred in 3 cases of severe cardiac failure (7 of 61 patients, 11.5%). The obtained results showed that vasodilating drugs are safe in congestive cardiac failure and in many cases of severe failure captopril contributed to rapid clinical and haemodynamic improvement.

Adult↗
PubMed1989

[The importance of two-dimensional echocardiography in conjunction with trans-esophageal stimulation of the left atrium for the diagnosis of myocardial ischemia].

In 27 patients with coronary heart disease (group 1) and in 15 persons of ontrol group (group 2) transoesophageal left atrial pacing was performed. 12-lead ECG and two-dimensional echocardiography were done before and on the peak of the pacing. Changes of ST-segment (ST) and R-wave amplitude of V5 in the ECG (RV5) were analyzed. Left ventricular wall motion in the 11 segments and left ventricular enddiastolic volume index (LVEDVI), left ventrivular endsystolic volume index (LVESVI), stroke volume index (SVI), cardiac index (CI) and ejection fraction were studied by echocardiography. Sensitivity, specifity and predictive value confirming and excluding of coronary heart disease of the analyzed parameters were determined. During the analysis of ST-segment these values were 0.81, 0.67, 0.81 and 0.67 respectively. Diagnostic values of the analysis of the left ventricular wall motion and the ejection fraction were not statistically different (p greater than 0.05) from the analysis of ST-segment. During the analysis of LVEDVI, LVESVI, CI sensitivity of the transoesophageal atrial pacing was decreased and specifity was increased (p less than 0.05). The greatest value in the diagnosis of myocardial ischaemia during the two-dimensional echocardiography combined with transoesophageal left atrial pacing has the finding of the segmental asynergy of systole, diminution of EF and augmentation of LVESVI.

Adult↗
PubMed1989

Electrophysiologic effects of intravenous dipyridamole.

We evaluated the electrophysiologic effects of dipyridamole given intravenously to 24 patients during intracardiac electrophysiologic study. Electrophysiologic parameters were measured before and 5 minutes following infusion of 0.5 mg/kg of dipyridamole. The drug significantly shortened the sinus cycle length by 26 per cent (P less than 0.001), sinuatrial conduction time by 15 per cent (P less than 0.01), maximal sinus node recovery time by 21 per cent (P less than 0.001), atrial and atrioventricular nodal effective refractory period by 8 and by 11 per cent, respectively (both P less than 0.01), ventricular effective refractory period by 4 per cent (P less than 0.001), paced cycle length to atrioventricular nodal Mobitz type II block by 5 per cent (P = 0.046), and QT interval during sinus rhythm by 10 per cent (P less than 0.01). After dipyridamole, the PA interval increased by 16 per cent (P less than 0.001), the AH interval by 11 per cent (P less than 0.01), and the corrected QT interval by 5 per cent (P less than 0.01). During retrograde conduction we observed a shortening of the ventriculoatrial interval by 6 per cent (P = 0.036), retrograde atrioventricular nodal effective refractory period by 5 per cent (P less than 0.001), paced cycle length to atrioventricular nodal Wenckebach and atrioventricular nodal Mobitz type II block both by 8 per cent (P less than 0.01). We conclude that intravenous dipyridamole increases sinus node automaticity and reduces atrial, atrioventricular nodal and ventricular refractory periods, prolongs intra-atrial and atrioventricular nodal conduction, but does not produce any changes in His-Purkinje system conduction times.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Value of the analysis of left-ventricular systolic time intervals in the diagnosis of ischemic heart disease provoked by intravenous infusion of isoproterenol].

The aim of the study was to evaluate the value of analysis of left ventricular systolic intervals during Isuprel test in diagnosis of ischemic heart disease. 30 patients with ischemic heart disease without myocardial infarction in the past (group I) and after myocardial infarction (group II) as well as 15 healthy persons (group III) underwent the study. Electrocardiograms and polycardiograms were analyzed by means of Weissler's method. In patients with CAD during Isuprel test decrease of QS2I, LVETI, LVETI/S1S2 and increase of Q-1, ICT, PEPI, PEP/LVET were stated in comparison with healthy persons. Sensitivity of Isuprel test estimated by ST segment analysis was 80%, specificity 100%, predictive value for CAD confirmation 100% and for its exclusion 71.4%. Diagnostic value of Q-1, QS2I and LVETI intervals and PEP/LVET index did not statistically significantly differ from ST segment diagnostic value. Sensitivity of Isuprel test estimated by means of these intervals analysis was 63.3%, specificity 93.3-100%, predictive value for CAD confirmation 95-100%, and for its exclusion 56-57.7%. Analysis of left ventricular systolic intervals during Isuprel test is a valuable complement of an ECG examination.

Adult↗
PubMed1989

[Effect of a single dose of captopril on left-ventricular function in patients with chronic congestive cardiomyopathy].

In 15 patients with mild, chronic congestive heart failure the effect of a single dose of captopril (25 mg/m2 b.s.) on heart rate, systolic and diastolic blood pressure as well as on left ventricular function was studied at rest and after a submaximal physical effort. Preejection period (PEP), left ventricular ejection time (LVET) and the contractility index PEP/LVET were polycardiographically determined++. Left ventricular end diastolic volume (DVol), and systolic volume (SVol), ejection fraction (EF), stroke volume index (SVI) and cardiac index (CI) were estimated using two-dimensional echocardiography. Obtained data indicate, that in patients with chronic, congestive heart failure, a single dose of captopril lowers blood pressure at rest without significant changes of hemodynamic parameters, but improves left ventricular function during physical effort.

Adult↗
PubMed1989

[Evaluation of the effect of nifedipine in patients with chronic congestive heart failure].

18 patients with II NYHA class chronic congestive heart failure (CCHF) had been given nifedipine (Cordipin) 54.4 +/- 12.0 mg (day) for 6 weeks (group I). In 25 patients with III--IV NYHA class CCHF after 2-week optimal improvement of a clinical state with digoxine (D) and furosemide (F), nifedipine (N) had been added for 2 weeks/mean daily dose -- 40.8 +/- 12.8 mg (group II). Estimation of a left ventricular function using 2-DE and a submaximal effort tolerance as well as clinical examinations were carried out initially, after 2 and 6 weeks in group I, whereas in group II post D, F 2-week therapy and after next 2 weeks of combined D, F, N treatment. Nifedipine significantly increased ejection fraction from 44.2 +/- 13.0% to 49.0 +/- +/- 12.6% and decreased myocardial oxygen demand factor from 23.36 +/- 9.81 to 21.08 +/- 7.55 X 10(3) (p less than 0.05). Nonsignificant but marked increase of diuresis, cardiac and stroke indices as well as body weight loss were observed. Nifedipine addition to D and F neither improved nor deteriorated examined parameters in patients with III-IV NYHA class CCHF. Nifedipine did not also improve the submaximal exercise tolerance in both groups.

Adult↗
PubMed1988

[Effect of ergonovine and the cold stress test on time intervals of left ventricular systole and their significance for the diagnosis of coronary heart disease].

In 20 healthy test persons and 44 patients with a coronary heart disease without stenocardia at rest the ergonovine and the cold pressure test were performed. During the tests the ECG in 12 standard leads and the mechanocardiogrammes were registered, from which the time intervals of the left-ventricular systole were calculated. From the analysis of the pectanginous complaints and/or from the changes of the ST segment for the diagnosis of the coronary heart disease a sensitiveness of the ergonovine test of 40% was obtained, whereas the sensitiveness of the cold tolerance test was only 10%. In healthy test persons during the ergonovine test a shortening of Q-1, a decrease of the quotient PEP/LVET and a prolongation of LVETI were established. Apart from this, in patients with coronary heart disease also shortenings of ICT and PEP and an increase of the quotient LVET/S1S2 were made evident. During the cold tolerance test in healthy test persons, besides the prolongation of LVETI, no other changes were stated. On the other hand, in the patients a decrease of the quotient PEP/LVET and a shortening of PEP were existing. The diagnostic value of the analysis of the left-ventricular time intervals was insignificantly higher during the ergonovine test than at rest. However, during the cold pressure tests no differences were stated. The application of the analysis of the left-ventricular time intervals does not essentially enlarge the sensitiveness of the two tests in comparison to the analysis of the changes of the ST segment in the ECG.

Angina Pectoris, Variant↗
PubMed1988

[The significance of systolic time intervals in the dipyridamole test for the diagnosis of coronary disease].

The investigations concerning the significance of the systolic time intervals in the dipyridamole test for the diagnosis of the coronary heart disease were carried out in 15 healthy test persons and 40 patients with coronary heart disease. Apart from the systolic time intervals calculated according to Weissler and co-workers also the behaviour of the ST segment, the R wave in lead V5 (RV5) and the sum of the amplitudes of the R waves (sigma R) were estimated concerning sensitivity, specifity and predictive value. At a sensitivity of 65% for the behaviour of the ST segment under influence of the dipyridamole test this was smaller for RV 5, sigma R, ICT and LVET/S1S2, on the other hand greater for PEPI and OS2I (p less than 0.05). The other time intervals did not differ in their sensitivity to the ST segment. The specifity and the predictive confirming value were 100% for the changes of the ST segment. In the analysis of the other parameters no differences were stated (p greater than 0.05). The predictive value, excluding a coronary heart disease, was 51.7% for the ST segment and still higher for PEPI and OS2I (p less than 0.05). By the analysis of the systolic time intervals the diagnosis value of the dipyridamole test continues to increase.

Adult↗
PubMed1987

Effect of exercise on left-ventricular systolic time intervals in patients with coronary heart disease.

Left-ventricular systolic time intervals measured at rest and after submaximal exercise were analysed in 156 patients with positive exercise test results and in 219 healthy volunteers with negative exercise test results. The patients were suffering with high probability, from coronary heart disease. The healthy subjects as well as the patients were divided into five groups on the basis of the submaximal exercise loads tolerated by them. Load of 30 W was taken as starting point. At rest, the patients had shorter ejection times (LVET) and total electromechanical systolic times (QS2), and longer preejection periods (PEP) and isovolumetric contraction times (ICT), than the healthy subjects. The PEP/LVET ratio for the patients was higher than that for the healthy subjects. In groups of the same tolerance to work, exercise induced less pronounced decreases in PEP and PEP/LVET values and more pronounced decreases in QS2 and LVET values in the patients than in the healthy subjects.

Adult↗