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Biomedical subjects

P Collignon

Publications and source records attributed to P Collignon.

At least 73 records · Page 4Linked to original sources
PubMed1984

Hemodynamic effects of intravenous diltiazem with impaired left ventricular function.

The acute hemodynamic effects of intravenous diltiazem were studied in 8 patients with coronary artery disease, left ventricular (LV) failure (New York Heart Association functional class III), a rest ejection fraction (EF) less than 40% or a cardiac index less than 2.4 liters/min/m2. Hemodynamic measurements and LV angiograms were performed at rest before and after the administration of diltiazem, 0.5 mg/kg, administered at a speed of 5 mg/min. Diltiazem treatment induced a decrease in heart rate from 68 +/- 12 to 55 +/- 9 beats/min (p less than 0.001). Mean aortic pressure decreased from 94 +/- 14 to 81 +/- 15 mmHg (p less than 0.05). Thus, the pressure-rate product significantly decreased under the influence of the drug, from 8,791 +/- 2,465 to 6,342 +/- 1,808 beats mm Hg/min, (p less than 0.001). Diltiazem induced no significant change of LV end-diastolic pressure, pulmonary wedge pressure, cardiac index and LV stroke work index. Systemic vascular resistance decreased (p less than 0.01), whereas pulmonary vascular resistance showed no change. End-systolic volume diminished (p less than 0.02), which accounts for the increase of stroke volume and ejection fraction (p less than 0.001). Disorders of regional contractility were not aggravated by diltiazem, and even improved in individual cases. Thus, intravenous diltiazem may be used safely in patients with heart failure. However, in view of the marked bradycardic effects seen in some cases, heart rate should be carefully monitored.

Adult↗
PubMed1984

Haemodynamic effects of intravenous diltiazem at rest and exercise in patients with coronary artery disease.

The acute effects of intravenous diltiazem on exercise performance were studied in 10 patients with coronary artery disease. Haemodynamic measurements were made at rest and during exercise before and after 0.5 mg kg-1 of diltiazem. Diltiazem prolonged the duration of exercise (+2.85 min, P less than 0.001) and delayed the onset of ischaemic ST depression or angina in all patients. The highest tolerated heart rate and pressure rate product were increased in all but one patient after diltiazem. At rest diltiazem decreased mean arterial pressure (-10.8%, P less than 0.005), systemic vascular resistance (SVR) (-11.8%, P less than 0.05) and left ventricular stroke work index (SWI) (-14.1%, P less than 0.005). During exercise under diltiazem therapy, at the level achieved before the drug, the pulmonary capillary wedge pressure (-30%, P less than 0.005) and the SVR (-13.6%, P less than 0.02) were lowered, the SWI (+13%, P less than 0.01) was increased; at the end of exercise only the SVR (-14%, P less than 0.05) was reduced. Two patients experienced angina on lying down and one had orthostatic hypotension after exercise with diltiazem. This study indicates that intravenous diltiazem is a potentially useful agent for the treatment of angina by reducing myocardial oxygen demand at rest and by improving left ventricular performances on exercise.

Adult↗
PubMed1983

Hemodynamic effects of a new antiarrhythmic agent, flecainide (R-818), in coronary heart disease.

The hemodynamic effects of flecainide acetate, a new class I antiarrhythmic agent, were studied in 10 patients with coronary heart disease. The drug was injected intravenously at a dose of 2 mg/kg over 30 minutes. The mean drug plasma level achieved was 394 ng/ml (range 329 to 470). The heart rate did not change, but a significant increase (p less than 0.001) in P-R (+17%), QRS (+15%), and Q-T (+7%) duration occurred after drug administration. Negative inotropic effects also were observed and consisted of an increase (p less than 0.01) in pulmonary wedge pressure (+27%) and a decrease (p less than 0.01) in stroke index (-10%), left ventricular stroke work index (-12%), and left ventricular ejection rate (-11%). No significant change in mean aortic pressure or systemic and pulmonary vascular resistance occurred. Left ventriculography performed after drug infusion revealed a significant increase (p less than 0.01) in systolic volume (+9%) and a decrease in ejection fraction (-9%) and mean velocity of circumferential fiber shortening (Vcf) (-13%). A progressive and significant decrease of dP/dt was observed during drug infusion, but 15 minutes after the injection, dP/dt had returned to near basal values. Thus, flecainide acetate has slight, but significant negative inotropic effects, particularly conspicuous during drug infusion. The drug should be administered with caution in patients with poorly compensated heart.

Adult↗
PubMed1983

Right ventricular myocardial infarction diagnosed by 99 m technetium pyrophosphate scintigraphy: clinical course and follow-up.

Out of 178 consecutive patients with acute inferior wall myocardial infarction submitted to technetium-99 m pyrophosphate scintigraphy, 49 (27.5%) were found to have concomitant right ventricular infarction. Gated blood pool scans showed right ventricular abnormalities in 21 out of 26 patients who were submitted to this investigation (right ventricular asynergy: 16 cases; right ventricular dilatation: eight cases; decreased right ventricular ejection fraction: 16 cases). Complications were common in the acute stage. Shock was noted in 19 cases (eight related to bradycardia, three related to relative hypovolaemia and eight instances of true cardiogenic shock). Atrial fibrillation (seven patients), ventricular fibrillation (eight patients) and severe atrioventricular conduction disorders (13 patients) were also frequent. In spite of this, the in-hospital mortality was low: three deaths occurred (6.1%), one from heart failure, two others from posterior septal rupture. All patients were followed up for one year or more. Six additional deaths were noted (three from left cardiac failure, two from recurrent anterior wall infarction and one from massive pulmonary embolism). Clinical assessment, haemodynamic measurements and gated blood pool scans showed significant improvement of right ventricular function with return to normal in those cases with small right ventricular infarcts as judged from technetium-99 m pyrophosphate scintigraphy. In spite of the complications seen in the initial period, patients with a right ventricular infarction have a good overall prognosis and the long-term outcome, primarily determined by the left-sided lesions, is often favourable.

Adult↗
PubMed1982

Hemodynamic response to glyceryl trinitrate in a spray at rest and during exercise in a sitting position.

Glyceryl trinitrate (GNT, 0.8 mg) was administered in a spray to 15 coronary patients of whom 7 had a pulmonary wedge pressure (PWP) greater than 16 mm Hg on exercise (subgroup I) and the others (subgroup II) had a normal PWP at rest and during exercise. At rest, GNT increased heart rate and decreased cardiac output, systolic index, stroke work index, right atrial pressure, pulmonary wedge and mean systemic pressures in all patients. Peripheral resistances did not change. During exercise, GNT lowered PWP, systemic arterial pressure and peripheral resistances in all cases. It increased cardiac output as well as systolic and stroke work indices only in patients of subgroup I. In subjects with coronary disease, no overt cardiac failure but elevated PWP on exercise, GNT in a spray can quickly improve exercise capacity and hemodynamic reserves and increase anginal threshold.

Administration, Oral↗
PubMed1981

Pharmacokinetics of piperacillin in renal failure.

Patients with chronic renal failure who received bolus doses of piperacillin maintained high serum levels for up to six hours. The percentage of the injected dose which was detectable in the urine in 24 hours was reduced proportionately to the severity of the renal failure.

Female↗
PubMed1981

[Pathophysiology and treatment of acute hypotension occurring during hemodialysis (author's transl)].

We have recorded, by invasive techniques, the hemodynamic and biological parameters during a conventional haemodialysis session (HD), in patients exhibiting acute (Gr. I, n : 8) or progressive arterial pressure decrease (gr II, n : 6). The HD conditions are similar in both series. The sequence of events are as follows: 1. Ultrafiltration induces hypovolemia which is not counterbalanced because there is a delay in fluid transfer from extravascular to vascular space and a shift of fluid from vascular to extravascular compartment since the vascular space is hypotonic. 2. These mechanisms produce a decrease of filling pressures in all patients (gr. I and II) but, in the patients of gr. I, a sudden drop of cardiac output, cardiac index, aggravated by an absence of increase or even a decrease of vascular resistances and of the heart rate. 3. The injection of hypertonic NaCl induces a rapid rise of plasma osmolality producing a fluid transfer from extravascular to vascular compartment with simultaneously a correction of filling pressures, cardiac index and arterial pressure. 4. A difference in preload between both groups could explain in part the difference of their hemodynamic comportment but not why some patients of group II exhibit a good left ventricular work index on contrary to gr. I patients.

Blood↗
PubMed1980

[Hemodynamic complication of ventricular stimulation in a patient with moderate aortic stenosis].

This report is concerned with a patient aged 76 with mild to moderate aortic stenosis and transient A-V block who was treated by stand-by intracardiac pacing. In spite of this, the patient continued to present syncopal attacks. It is demonstrated that these episodes were related to dramatic decreases of systolic blood pressure and cardiac output occurring whenever the right ventricle was paced. These hemodynamic alterations were secondary to the loss of atrial contribution to ventricular filling. They were suppressed by insertion of a sequential auriculoventricular pacemaker.

Aged↗