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Biomedical subjects

N Goldschlager

Publications and source records attributed to N Goldschlager.

At least 55 records · Page 3Linked to original sources
PubMed1982

Hemodynamic benefit of atrial pacing in right ventricular myocardial infarction.

Right ventricular and inferior-posterior myocardial infarctions in four patients were complicated by low-output syndrome unresponsive to increasing intravascular volume. Ventricular pacing was started because of bradyarrhythmias, but failed to increase cardiac output; atrial pacing at identical rates resulted in dramatic increases in cardiac output. The importance of atrial contribution to ventricular function, as well as the role of the pericardium in this clinical setting, are discussed. In treating right ventricular myocardial infarction, atrial or atrioventricular sequential cardiac pacing may be preferable to ventricular pacing.

Aged↗
PubMed1982

Use of the treadmill test in the diagnosis of coronary artery disease in patients with chest pain.

For the best clinical use of the treadmill exercise test, and to have rational expectations of it as a reliable diagnostic tool, sound understanding of the information provided by the test is needed. The electrocardiographic response to cardiopulmonary stress; blood pressure response; and workload, heart rate, and blood pressure achieved at peak exercise all are important indicators of exercise performance and must be considered when interpreting test results. Test results indicating the presence or absence and extent of coronary artery disease must be interpreted in the light of particular clinical factors, as diagnostic accuracy differs with patient populations. Diagnostic use of the treadmill test in patients with chest pain syndromes is reviewed, and issues that must be considered by the clinician in doing the test and evaluating its results are emphasized.

Coronary Disease↗
PubMed1981

ECG diagnostic pearls and pitfalls. 1. Acute myocardial infarction and pseudoinfarction.

An accumulation of valuable empirical data supports the clinical usefulness of the ECG in diagnosis of cardiac disorders and electrolyte disturbances. Although the patterns in some conditions are sufficiently characteristic to be diagnostic, many ECG abnormalities fit several conditions and many mimic the findings in myocardial infarction. Thus, interpretation presents many pitfalls, and each ECG must be carefully scrutinized in light of the complete clinical picture and laboratory data. ECGs may be used to diagnose, date, and locate the site of myocardial ischemia or infarction and many afford clues to pseudoinfarction patterns as described here. The ECG is also valuable in assessment of fascicle block and ventricular hypertrophy (part 2, page 136) and in diagnosis of drug-induced and electrolyte disturbances (part 3, page 145).

Adult↗
PubMed1981

Pacer rhythms.

Explore the source record for details and available documents.

Aged↗
PubMed1981

Inadvertent atrial location of a sutureless epicardial pacemaker electrode.

A 70-year-old woman had an epicardial pacing system implanted after transvenous right ventricular endocardial pacing resulted in cardiac perforation. At the time of revision of the epicardial system for pacing failure, it was noted that one of the bipolar epicardial electrodes was pacing atrial tissue. The differential diagnosis of this unusual finding is discussed and recommendation urged for systematic analysis of pacing system function at the time of implant, in order to avoid inadvertent electrode placement.

Aged↗
PubMed1979

Use of treadmill score to quantify ischemic response and predict extent of coronary disease.

In this study we assessed whether various responses to exercise testing could be quantified in order to derive the probabilities of presence of coronary disease, and if present, to assess its severity. A treadmill score based on the exercise response was determined in 405 patients who had both treadmill tests and coronary angiograms. The score was derived using discriminant function analysis, by weighting and combining depth and configuration of ST depression (downsloping, horizontal or slowly upsloping), timing onset and duration of ischemia, grading ventricular arrhythmias, heart rate and blood pressure change, coexistence of exercise-induced chest pain and sex. The treadmill score was effective in detecting coronary disease (lesions with an greater than or equal to 50% narrowing), with a predictive accuracy (PA) (probability that a subject manifesting a positive test has disease) of 87%, a true negative rate (TNR) (probability of a subject with a negative test having no disease) of 80%, and sensitivity of 94%. The treadmill score also detected severe disease (triple-vessel, main left and/or greater than 90% proximal occlusion of the left anterior descending artery), with a PA of 73%, TNR of 79% and sensitivity of 82%. We conclude that the exercise response, expressed numerically as a treadmill score, permits analysis of most of the relevant data from exercise testing, increases test accuracy by 10-15% compared with standard criteria for treatmill test interpretation, and enables the derivation of probability statements for presence and severity of coronary disease. The validity of any prediction on the basis of exercise performance may thus be quantitatively judged.

Analysis of Variance↗
PubMed1977

Determination of shunt flow in a case of multiple arteriosystemic connections.

A 64-year-old woman presented with acute congestive heart failure and atrial fibrillation, with good response to medical management. Selective coronary and left ventricular cineangiography demonstrated multiple arteriosystemic connections arising from both left and right coronary arteries, but normal (although tortuous) coronary vessels and ventricular contraction pattern. Determination of the magnitude of the shunt flow and concommitant measurement of myocardial lactate extraction suggested that this type of coronary vascular abnormality was an angiographic curiosity without discernible clinical import; however, the etiology of the patient's heart disease remains an enigma.

Coronary Circulation↗
PubMed1976

Sensitivity and specificity of electrocardiographic diagnosis of ventricular motion disorders. Studies in patients recovered from myocardial infarction.

Angiographic-electrocardiographic correlations were studied in 253 patients with coronary arterial disease. Left ventriculograms were examined for various motion disorders (local hypokinesia, akinesia, dyskinesia or aneurysm, and generalized hypokinesia). Electrocardiograms were reviewed for the presence of Q waves indicative of transmural myocardial infarction and for the presence of upward convex ST-segment elevation of at least 2 mm. Of 27 consecutively studied subjects with normal coronary arteries and normal ventriculograms, none had Q waves, giving a specificity of 100% for the Q wave. Pathologic Q waves (greater than or equal to 0.04 second) were found in 20% (19) of 96 patients with coronary arterial disease having normal ventricular motion, reducing the specificity for the Q wave to 80% in patients with documented coronary disease. Of 157 patients with coronary disease and ventricular dyssynergy, 118 had pathologic Q waves, yielding a sensitivity of 75%. Concomitant Q waves plus 2 mm ST-segment elevation were present in 45 of the 118 postinfarction patients with ventricular dyssynergy, giving a sensitivity of 38%. The specificity of this combination in coronary patients was 84%.

Angiocardiography↗
PubMed1976

Treadmill stress tests as indicators of presence and severity of coronary artery disease.

The configuration, time of onset, and duration of depressed ST segments during and after treadmill exercise testing were evaluated in 269 patients with angiographically proven coronary artery disease and 141 normal subjects. The test specificity was 93% and sensitivity 64%, the latter being influenced by the type of ST response; false-positive responses were rare with depressed, downsloping STs (1 of 123, 1%), occurred more frequently with horizontal ST depression (9 of 60, 15%), and occurred commonly with slowly upsloping STs (15 of 47, 32%). Depressed downsloping STs, ischemic changes appearing in the first 3 minutes of exercise, and those persisting past 8 minutes in recovery were associated with 91%, 86%, and 90% prevalences of two- to three-vessel or main left coronary disease, respectively. It is concluded that attention to configuration, time of onset, and duration of ischemic ST depression aids both in assessing the validity of exercise responses in diagnosing coronary artery disease and in delineating patients with advanced coronary obstruction.

Adult↗
PubMed1975

Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease.

Eight patients with chronic congestive heart failure (four with cardiomyopathy and four with ischemic heart disease) underwent hemodynamic studies during acute administration of digoxin, given intravenously in two 0-5 mg doses 2 hours apart. Observations were made before administration of digitalis (control period) and serially therafter for 4 hours after the first dose. Resting mean cardiac index and pulmonary arterial wedge pressure were as follows: 2.0 liters/min per m2 and 23 mm Hg (control period); 2.1 and 24 (at 1 hour); 2.0 and 23 (at 2 hours); 2.7 and 19 (at 3 hours); and 2.3 and 20 (at 4 hours). Exercise responses of mean cardiac index and pulmonary arterial wedge pressure in five patients were: 3.1 liters/min per m2 and 36 mm Hg (control period); 3.2 and 33 (at 1 hour); 3.2 and 28 (at 2 hours); 3.1 and 27 (at.3 hours); and 3.4 and 31 (at 4 hours). The pulmonary arterial wedge pressure remained elevated during exercise in all cases. Arrhythmias were seen in five patients after administration of 0.5 mg of digoxin. Hemodynamic improvement at 4 hours involving both reduced filling pressure and increased blood flow was observed in only two patients at rest and in one additional patient during exercise. Acute deterioration of cardiac function (elevated pulmonary arterial wedge pressure of decreased cardiac index) occurred 30 minutes after administration of digoxin in four patients, concomitantly with increased systemic resistance. In six patients, a peak hemodynamic effect appeared 1 to 1 1/2 hours after administration of digoxin, with partial or total loss of initial benefit by 2 and 4 hours. In previously performed studies observations have seldom exceeded 1 hour; the results of this 4 hour study suggest that, in patients with cardiomyopathy or coronary artery disease and chronic congestive heart failure, acute digitalization does not necessarily lead to consistent, marked or lasting hemodynamic improvement. Thus, current concepts of the use of digitalis is such patients may require revision.

Adult↗