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Biomedical subjects

O Edhag

Publications and source records attributed to O Edhag.

At least 73 records · Page 4Linked to original sources
PubMed1986

In vivo production of prostacyclin and thromboxane in patients with acute myocardial infarction.

The in vivo production of prostacyclin and thromboxane was monitored by measuring their major urinary metabolites 2,3-dinor-thromboxane B2 and 2,3-dinor-6-keto-prostaglandin F1 alpha in ten patients with acute myocardial infarction, five on standard treatment and five receiving prostacyclin infusion. During acute myocardial infarction excretion of 2,3-dinor-thromboxane B2 and 2,3-dinor-6-keto-prostaglandin F1 alpha, measured by a gas chromatography-mass spectrometry method with deuterated internal standards, was significantly increased. This indicates that thromboxane and prostacyclin synthesis are increased during the development of acute myocardial infarction. The excretion data for 2,3-dinor-thromboxane B2 showed that after administration of aspirin there was less pronounced and more variable inhibition than expected. Prostacyclin infusion did not markedly affect the excretion of the thromboxane metabolite.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Emergency care. Identification of psychosocial problems.

Psychosocial problems are common among emergency department visitors, and can remain undetected if not focused upon. In the present study the magnitude of these problems was analysed by a social worker through telephone interviews 3-5 days after patients emergency department visit. This survey revealed not only those patients recognized by the regular staff as in need of help because of social problems (5%) but also an additional 33% of patients whose problems went undetected. Fifteen percent of the visitors found contact with a social worker to be helpful and six percent requested such help. A follow-up investigation five months after the visit revealed that assistance had been given to 83% of those patients.

Emergency Service, Hospital↗
PubMed1986

Emergency room triage by a medical specialist.

This is an investigation of the impact of an emergency room triage by a medical specialist. The study encompassed patients who came to the medical section of the emergency room of a large university hospital during a two-week study period and a control period of the same length. The result showed that 36% of the patients could be sent home after the triage, thereby reducing the number of chemical tests and ECG examinations significantly (p less than 0.001). In addition, the patient's average treatment period was shortened by a mean of 63 min. No effect of the triage on hospital use of out-patient visits to the hospital during a one year follow-up period was noted. The triage procedure was safe for, and accepted by the patients, as was demonstrated by follow-ups involving investigation of the death register and personal interviews. The study shows that triage by a specialist is an effective method for reducing hospital service utilization and shortening patient treatment time.

Emergency Medical Services↗
PubMed1985

In vivo production of thromboxane in acute human myocardial infarction: a preliminary study.

Using a specific quantitative method based on gas chromatography-mass spectrometry the urinary excretion of 2,3-dinor-TxB2 was measured in five patients with acute myocardial infarction shortly after the onset of symptoms. The urinary excretion of 2,3-dinor-TxB2 was markedly higher than seen in normals in three of the five patients. This increased excretion of 2,3-dinor-TxB2 during and after the development of myocardial necrosis indicates an involvement of thromboxane A2 in the pathogenesis of at least some cases of acute myocardial infarction.

Aged↗
PubMed1985

Clinical and electrophysiologic course of sinus node disease: five-year follow-up study.

Thirty patients with symptomatic sinus node disease (SND) who 5 years previously had undergone a clinical investigation including intracardiac electrophysiologic studies with pharmacologic inhibition of autonomic tone were followed up with respect to development of arrhythmias and cardiac conduction abnormalities. In 17 of these patients a reinvestigation, including a second intracardiac study, was performed. Stable atrial fibrillation developed in five patients, paroxysmal supraventricular tachycardia occurred in one patient, and complete heart block appeared in another patient. Paroxysmal atrial arrhythmias and radiographic atrial enlargement were more common at the initial investigation in patients who during follow-up developed either stable atrial fibrillation or paroxysmal supraventricular tachycardia. Development of complete heart block was associated with signs of severe conduction defects at the initial study. General progression of conduction dysfunction as evaluated by intracardiac techniques was not a finding in this study. Conduction abnormalities limited to the atrioventricular (AV) node did not in this context predict a clinically important progression. The results indicate that those patients with SND who are predisposed to develop high-grade AV block and atrial arrhythmias can be identified by Holter monitoring, chest x-ray examination, and an intracardiac electrophysiologic study. These possibilities improve the selection of patients suitable for pacing modes preserving atrial transport.

Adult↗
PubMed1985

The significance of ST and T changes for the development of coronary events in patients with acute coronary chest pain, treated in a coronary care unit without verified acute myocardial infarction.

The one-year prognosis for patients with a confirmed diagnosis of acute myocardial infarction (AMI) was compared with that of non-AMI patients treated in the coronary care unit (CCU). The one-year incidence of coronary events (CE) after discharge from CCU was 37% in the 51 AMI patients and 20% in the 81 non-AMI patients. The one-year mortality rates were 27 and 4%, respectively. Among the non-AMI patients, well known risk factors such as hypertension, previous AMI, congestive heart failure, smoking, diabetes and hyperlipaemia were not more common in those who developed a CE. ST segment depression and T wave inversion, each of at least 0.1 mV, in three or more ECG leads were selective criteria for a high-risk group with respect to CE. Preventive measures should be considered in this group of patients without verified AMI.

Acute Disease↗
PubMed1985

Valsalva-induced variations in the intracardiac signal.

Variations in the intracardiac signal may substantially affect the sensing function of cardiac pacemakers. As the Valsalva maneuver causes a change in heart volume, its effect on the intracardiac signal was studied in seven patients with an adequate escape rhythm who had permanent ventricular pacemakers. During generator replacement, they were asked to perform a standardized Valsalva maneuver. An increase from the baseline amplitude ranging from 5% to 70% was noted during forced expiration against the closed glottis. There was a decrease from the baseline ranging from 15% to 50% after termination of this maneuver. Similar changes were noted for the rate of voltage change (slew rate). The magnitude of these alterations was most pronounced in patients with comparatively low intracardiac amplitudes. Because marked changes in the intracardiac signal can result from the Valsalva maneuver, it might be an important source of undersensing among patients with permanent pacemakers.

Aged↗
PubMed1985

Prostacyclin infusion in patients with acute myocardial infarction.

To investigate whether prostacyclin protects ischaemic myocardium in humans the effect of prostacyclin or placebo was studied in two groups of patients with acute myocardial infarction who presented within six and 16 hours of the onset of symptoms. Intravenous infusion of prostacyclin or placebo was started immediately after admission at a rate corresponding to 4-5 ng/kg/minute. The infusion was maintained for 72 hours. Clinical status, electrocardiograms, plasma enzyme activity, infarct extension during the infusion, and reinfarction after the infusion were studied. Prostacyclin was well tolerated by most patients: neither systemic blood pressure nor heart rate differed between the two groups. In the 11 patients who received treatment within six hours of the onset of symptoms prostacyclin significantly lowered the maximum plasma activities of creatine kinase MB and lactate dehydrogenase. In the 19 patients who received treatment 6-16 hours after the onset of symptoms prostacyclin had no such effect. None of the patients receiving prostacyclin had an extension of the infarction during the infusion, whereas four patients receiving placebo did; this difference was significant. These data are the first to provide evidence that prostacyclin might limit myocardial injury in patients with acute myocardial infarction.

Adolescent↗
PubMed1985

Disopyramide induced second and third degree atrioventricular block in patients with bifascicular block. An acute stress test to predict atrioventricular block progression.

Syncopal attacks in patients with bifascicular block may be due to both ventricular tachyarrhythmias and intermittent atrioventricular block in addition to non-cardiac causes and lead to antiarrhythmic treatment with drugs or pacemaker or both. The acute electrophysiological effect of intravenous disopyramide 2 mg/kg body weight given over five minutes on the His-Purkinje system was assessed in 27 patients with chronic bifascicular block undergoing evaluation for permanent pacemaker treatment. The predictive value of this pharmacological stress test as regards the development of atrioventricular block during follow up was analysed. The HV interval increased (mean 43%) and the QRS duration was prolonged (mean 24%). Intrahisian or infrahisian second or third degree atrioventricular block occurred in 14 patients after disopyramide administration, requiring temporary pacing in four of them. Before the electrophysiological study 15 of the 27 patients had had at least two syncopal attacks of suspected cardiac origin but no evidence of second or third degree atrioventricular block. Second or third degree atrioventricular block was subsequently recorded in five of these 15 patients during a mean of two years follow up. The sensitivity, specificity, and predictive value of second or third degree atrioventricular block produced by disopyramide administration including subsequent atrial pacing--a positive disopyramide test--as regards later development of atrioventricular block were 80%, 90%, and 80% respectively. Intravenous administration of disopyramide to patients with bifascicular block and syncopal attacks of suspected cardiac origin may provoke atrioventricular block and asystole requiring immediate temporary pacing. Furthermore, a positive disopyramide test seems to have a significant value in predicting the later development of atrioventricular block.

Adult↗
PubMed1984

HLA-B27-associated heart disease. Clinicopathologic study of three cases.

The histologic features of the cardiac lesions in HLA-B27-associated heart disease were examined in three cases that illustrate different nuances of the clinical spectrum of this disorder. One of these cases constitutes an important link between the previously established concept of cardiac manifestations in ankylosing spondylitis and Reiter's disease and the recently introduced, wider concept of HLA-B27-associated cardiac manifestations. A correlation between the invasive electrophysiologic results and the autopsy findings is demonstrated in another case.

Aged↗
PubMed1984

Paroxysmal complete heart block due to bradycardia-dependent "phase 4" fascicular block in a patient with sinus node dysfunction and bifascicular block.

A 34-year-old man with ankylosing spondylitis was admitted to the hospital because of syncopal attacks and heart block. Standard ECG, telemetry and an invasive electrophysiologic examination demonstrated right bundle branch block with left anterior fascicular block, sinus node dysfunction with spontaneous slowing of the sinus rate and, as a result, complete infrahisian atrioventricular block in the remaining fascicle at sinus rates below 57 beats per minute. Infrequent supraventricular extrasystoles and abruptly terminated atrial pacing led to the same result. Atrioventricular conduction resumed after three-to-four blocked atrial impulses with successively increasing rate. Pacemaker treatment provided complete symptomatic relief.

Adams-Stokes Syndrome↗
PubMed1984

Complete heart block in HLA B27 associated disease. Electrophysiological and clinical characteristics.

A genetic predisposition associated with HLA B27 for developing complete heart block with or without clinical or radiological signs of associated rheumatic disease has recently been found. In this electrophysiological study of 12 patients with spontaneous complete heart block and HLA B27 associated disease, of whom eight had ankylosing spondylitis, 10 had suprahisian second or third degree atrioventricular block (eight spontaneously and two during atrial pacing at rates below 90 impulses per minute) and one infrahisian block. One patient with narrow QRS complexes during complete heart block three months earlier had normal findings. Three patients also had sinus node malfunction and six had fascicular or bundle branch block. In HLA B27 associated disease the atrioventricular block seems to be preferentially located in the atrioventricular node, although the conduction system may be widely affected. The findings in this study indicate a further cause of high degree atrioventricular block with a predominantly suprahisian location in addition to acute inferior myocardial infarction, digitalis intoxication, and "congenital" heart block.

Adult↗
PubMed1984

Pacemaker dependence in patients with bifascicular block during acute anterior myocardial infarction.

Eleven patients with bifascicular block complicating anteroseptal acute myocardial infarction were studied to determine the effect of prophylactic permanent pacing; eight of them also had transient high grade atrioventricular block during the acute phase of the infarction. One month after the infarction an electrophysiological study was performed and a bradycardia indicating pacemaker implanted. All the patients were followed for two years. Six had bradycardia detected, two of whom did not have high grade atrioventricular block during the index infarction. Seven patients died, four of them suddenly. There was no correlation between the electrophysiological findings and subsequent development of bradycardia. Thus pacemaker dependence seems to be common in patients with bifascicular block complicating acute myocardial infarction. Mortality is, however, also high in patients treated with pacemakers. Prospective studies to determine the predictive factors in those patients with an anterior acute myocardial infarction and who benefit from a combination of permanent pacemaker treatment and antiarrhythmic treatment are needed.

Aged↗