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Biomedical subjects

P Gregor

Publications and source records attributed to P Gregor.

At least 109 records · Page 6Linked to original sources
PubMed1986

Use of verapamil in the treatment of hypertrophic cardiomyopathy.

Thirty-seven patients with hypertrophic cardiomyopathy were treated with verapamil in a dose of 240-360 mg/day and followed for 40 months. Marked symptomatic improvement (by at least one class according to the NYHA classification) occurred in 21 (57%) of the patients improved. An increase of left ventricular end-diastolic dimension and volume was recorded. A significant reduction of isovolumic relaxation period (peak velocity of filling and peak velocity of circumferential fibre changes in diastole) occurred. These favourable effects were, however, no longer unequivocal from the fourth month of treatment onwards. Verapamil treatment in hypertrophic cardiomyopathy is a valuable approach by which symptomatic improvement and a favourable effect on some left ventricular functions can be achieved. Its value is, however, to some degree reduced by the lack of long-term effect.

Adolescent↗
PubMed1986

The possibility of non-invasive identification of occluded coronary artery in acute myocardial infarction. A comparison of ECG and echocardiography with coronary arteriography or autopsy.

In 73 patients with acute occlusion of single coronary artery, the authors assessed the possibilities of ECG and echocardiography in determining non-invasively which of the 3 main arteries had been occluded. The sensitivity of ECG for the individual arteries and particular ECG signs ranged between 30-98%, the specificity was between 86-100%. While it was always possible to determine occlusion of the left anterior descending coronary artery (LAD), in several cases it was difficult to distinguish between occlusion of the left circumflex (LCX) and the right coronary artery (RCA). The LCX occlusion is a frequent source of error in interpreting electrocardiograms of patients with fresh myocardial infarction. The sensitivity of echocardiography in identifying the occluded coronary artery ranged between 77-100%, specificity 97-100%. The following ECG and echocardiographic signs of coronary occlusion were determined. The LAD occlusion is indicated by ECG changes in V1-4, and anteroseptal and apica asynergy on echocardiography. LCX occlusion: increased R wave amplitude in V1, and lateral and posterior wall asynergy. The RCA occlusion: ECG changes in II, III, aVF, asynergy of the posterior wall and part of the septum and right ventricle. These combined signs make possible the identification the occluded coronary artery in 95% of patients with myocardial infarction.

Adult↗
PubMed1985

First month course of left ventricular asynergy after intracoronary thrombolysis in acute myocardial infarction. A longitudinal echocardiographic study.

Can intracoronary thrombolytic therapy (ITT) reduce the infarct size and improve regional and global left ventricular function and if so how long after recanalization does this improvement develop? 42 patients were treated with ITT, of whom 25 showed successful recanalization (group A) and 17 had persistent occlusion or reocclusion (group B). Both groups were examined five times during the first month after infarction with two-dimensional echocardiography. The 'asynergy index' improved in group A by 45% of initial pretreatment values, compared with no significant change in group B (P less than 0.005). The 'asynergy extent' improved in group A by 35%, while in group B again no change was observed (P less than 0.01). This improvement occurred slowly, significant differences being achieved by the 10th day. Entire normalization of left ventricular wall motion was observed in 5 patients (20%) from group A and in no patient from group B. We conclude that successful recanalization of the occluded coronary artery by ITT improves left ventricular wall motion in 80% of patients, with entire normalization of local function in 20% of cases. The improvement occurs slowly during the first 10 days.

Adult↗
PubMed1985

Coagulopathy related to dilution and hypotension during massive transfusion.

A retrospective review of 64 patients receiving more than 10 units of red cell concentrate plus crystalloid within 12 h revealed two consecutive patterns of elevation of the partial thromboplastin time (PTT). The PTT at 3 to 4 h (PTT3-4) correlated with the number of liters of crystalloid (LC) infused over the first 3 h (PTT3-4 = 37 + 7 LC, r = .7643, p less than .001); the PTT thereafter (PTT4+) correlated with the number of hours of closely antecedent hypotension (AH) (PTT4+ = 37 + 21AH, r = .8680, p less than .001). These data indicate a transient dilutional coagulopathy, followed by coagulopathy related to the duration of closely AH. Whether this latter is due to impaired production, disseminated intravascular coagulation, or dilution due to internal shifts of fluids and/or proteins, remains to be clarified. Therapeutic implications of these data are discussed.

Adolescent↗
PubMed1985

Ultrasound characteristics of myocardial hypertrophy in patients affected by hypertrophic cardiomyopathy.

A study of the extent and local distribution of the heart muscle hypertrophy affecting the left ventricle and the septum has been performed in 70 hypertrophic cardiomyopathy patients. According to these signs the patients have been distributed into 5 types. Type I, where the hypertrophy affected only the interventricular septum, appeared in 14.2% of the cases. In type IIa the anterior wall of the ventricle was simultaneously affected (37.1%), in type IIb it was also the lateral wall of the ventricle (30.0%). Type III manifested hypertrophy of the posterior wall (4.3%), type IV affected the apical portion of the left ventricle (8.5% of the patients). Under the heading of type V there figured patients who had a concentric hypertrophy of the whole left ventricle including the septum (5.7%). Among the obstructive forms we revealed especially the types Ia, IIa, IIb. Using the M-mode alone, detection of the hypertrophy was impossible in such patients who had isolated affection of the dorsal part of the septum, the anterolateral or the apical portion of the left ventricle (type Ib, IV and some of the type IIa and IIb patients--a total of 13%). Signs of asymmetrical septal hypertrophy were lacking in 23% of the patients.

Adolescent↗
PubMed1985

Electrocardiography in different types of hypertrophic cardiomyopathies.

Alterations in ECG in hypertrophic cardiomyopathies (HCMP) have been described already earlier when the knowledge of HCMP was not so profound. The aim of this work was to analyse ECG findings in hypertrophic myelopathy and to determine their relation to morphological observations. 76 patients examined echocardiographically with catheterization were performed ECG recordings. Normal ECG had 3 patients (3.9%). In the rest of them electrocardiography confirmed left ventricular hypertrophy (63.2%), large R wave in V1(-3) (14.5%), diminishing of R wave in V1(-3) (28.9%), pathologic Q wave (23.7%), absence of "q" wave in V5,6 (48.8%), ST-T abnormalities (86.7%). Pathologic Q wave was found more often in patients with right ventricular hypertrophy, deep T waves (greater than 10 mm) currently occurred in apical form. It follows that the presence and the range of myocardial hypertrophy cannot be electrocardiographically recorded. Therefore the ECG is applied in great majority of patients only as a screening method.

Adolescent↗
PubMed1985

Intracoronary thrombolytic treatment in myocardial infarction and unstable angina pectoris.

The authors report on 18 patients with fresh transmural myocardial infarction (MI) and 5 patients with an abrupt change of stable into unstable angina pectoris (AP), in whom superselective intracoronary thrombolysis (SIT) was performed. All patients with unstable AP showed an improvement of subjective complaints and increased tolerance of exercise, even though a demonstrable angiographic effect of SIT was found only in 1 patient. Coronary occlusion disappeared in 13 patients with MI (72%). A significant improvement of local kinetic disturbances and of the global left ventricular function occurred in 50%, in-hospital death occurred only in the group in which recanalization did not succeed. Emphasis is placed on the necessity of checking the effect of SIT not only by documenting correction, of the coronary occlusion but also by evaluating the size of MI and the extent of disturbances of local and total left ventricular kinetics. The most accurate and practical method for this purpose is two-dimensional echocardiography. The authors developed their own echocardiographic indicators of the infarction focus--asynergy extent and asynergy index.

Adult↗
PubMed1985

The role of echocardiography in a coronary care unit.

The purpose of the study was to assess the clinical value of echocardiography in a coronary care unit. 133 patients admitted for an acute cardiovascular disorder were examined by a mobile echocardiograph. 83 patients had an acute myocardial infarction, 8 extracardiac chest pain, 6 unstable angina pectoris, 6 acute pulmonary embolism and 16 other acute cardiovascular diseases. 14 patients were excluded from the study because of poor image quality. Echocardiography was found most advantageous in solving the following clinical problems: 1) early diagnosis of acute myocardial infarction (probably the earliest of all available methods); 2) immediate and precise diagnosis of complications in myocardial infarction; 3) differential diagnosis of chest pain; 4) detection of left ventricular thrombi (the most useful method for this purpose); 5) differential diagnosis of other acute cardiovascular diseases (pulmonary embolism, aortic root dissection etc.).

Acute Disease↗