A randomized double-blind trial was carried out to determine the relationship of the changes in blood pressure and heart rate with changes in echocardiographic left ventricular indices in moderate to severe hypertensive patients with established left ventricular hypertrophy who were being treated chronically with enalapril or hydrochlorothiazide plus propranolol for 26 weeks. After a 2-week period on placebo, drug dosages in the two groups were adjusted to individual needs until blood pressure was normalized (diastolic less than 90 mmHg). Patients in Group I received 10 to 40 mg enalapril/day; those in Group II received 50 mg hydrochlorothiazide plus 80 to 240 mg propranolol/day. Echocardiographic measurements were made at the end of the placebo and 26-week active treatment periods. Significant correlations were observed between the changes in four pairs of variables in each group. In the 8 patients receiving enalapril, there were negative correlations between interventricular septal thickness and supine systolic blood pressure, erect and supine heart rates, and a positive correlation between relative wall thickness and erect diastolic blood pressure. In the 7 patients on hydrochlorothiazide plus propranolol, there were negative correlations between relative wall thickness and erect and supine heart rate, and positive correlations between left ventricular mass and erect diastolic blood pressure, and the percentage change in internal diameter of the left ventricle and supine systolic blood pressure. Possible explanations for and implications of these regional changes are discussed.

Adult↗

PubMed1984

The correlation of changes in systolic blood pressure with regional anatomical regression of hypertensive left ventricular hypertrophy in patients on chronic antihypertensive therapy (greater than 1 year): alpha-methyldopa compared to propranolol.

Twenty patients with mild to moderate hypertension and evidence of left ventricular hypertrophy (relative wall thickness greater than or equal to 0.45), who previously had not received either alpha-methyldopa or propranolol, were allocated at random to treatment with one or other of these drugs as monotherapy after a 2-week baseline period on no medication. Dosage was titrated until normotension was attained and patients were then maintained on this treatment for a year. Analysis of blood pressure measurements and echocardiograms taken before and during maintenance therapy showed that there were significantly correlated changes in systolic blood pressure and heart rate with left ventricular cavity and regional wall changes during chronic drug administration. In the alpha-methyldopa group there were significant correlations between changes in erect and supine systolic blood pressure and the posterior wall index, and in erect systolic blood pressure and left ventricular mass. In the propranolol group, there were significant correlations between changes in supine systolic blood pressure and interventricular septal thickness, and in erect heart rate and supine systolic blood pressure with the percentage change in internal diameter of the left ventricle. It is suggested that these observations may have important therapeutic implications for hypertensive patients with documented left ventricular hypertrophy.

Adult↗

PubMed1983

Ventricular fibrillation following verapamil in the Wolff-Parkinson-White syndrome.

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Adolescent↗

PubMed1982

Acceleration of the ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome after verapamil.

We examined the electrophysiologic effects of verapamil in eight patients with the Wolff-Parkinson-White syndrome. Verapamil shortened the antegrade effective refractory period of the accessory pathway in three patients and abbreviated the shortest cycle length with 1:1 conduction over the accessory pathway in two patients. More significantly, verapamil decreased the shortest RR interval between preexcited ventricular complexes during atrial fibrillation (279 +/- 20 msec vs 236 +/- 18 msec, mean +/- SEM; p less than 0.01). After verapamil, two patients required cardioversion for hemodynamic deterioration after acceleration of the ventricular response during atrial fibrillation. In the four patients with predominantly preexcited ventricular complexes during atrial fibrillation the ventricular rate accelerated after verapamil, whereas in patients with predominantly normal ventricular complexes, the average ventricular rate decreased or did not change after verapamil. Verapamil may result in significant acceleration of ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome. The safety of verapamil in individual patients with the Wolff-Parkinson-White syndrome should be established by electrophysiologic testing before its use.

Adult↗

PubMed1982

A simple echocardiographic method to detect atrioventricular dissociation. A useful aid in the differential diagnosis of regular tachycardia with wide QRS complexes.

Regular tachycardia with wide QRS complexes may be difficult to classify as supraventricular (SVT) or ventricular (VT) without electrophysiologic studies. We felt that hemodynamic differences between VT and SVT should allow their distinction by echocardiography. In this study, we utilized high speed M-mode echocardiography in the usual projections in eight patients during tachycardia. Two patients had spontaneous VT and three had spontaneous SVT with aberrant conduction. The remaining three were patients in sinus rhythm undergoing electrophysiologic studies in whom right ventricular (RV) pacing (induced VT), right atrial (RA) pacing (induced SVT) and sequential RV-RA pacing (induced VT with 1:1 retrograde conduction) were carried out. The echocardiographic parameters studied included: left ventricular internal dimensions, time during which the mitral valve remained open (MVOT), left ventricular ejection time (LVET) and pre-ejection period. We measured 20 consecutive beats and for each parameter defined its variability. During A-V dissociation (VT, RV pacing) there was always a striking beat-to-beat variability in the values of MVOT (68 percent to 129 percent) and in LVET (41 percent to 175 percent). In contrast, during A-V association (SVT, sequential RV-RA pacing, sinus rhythm) the maximal variability of MVOT and LVET was 22 percent and 12 percent, respectively. Variability during A-V dissociation could be explained by asynchronous timing of atrial systole. We conclude that echocardiography can readily identify atrioventricular dissociation, a feature heavily in favor of a diagnosis of VT.

Adult↗

PubMed1981

Permanent junctional reciprocating tachycardia in an asymptomatic adult: further evidence for an accessory ventriculoatrial nodal structure.

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Atrioventricular Node↗

PubMed1981

Rapid estimation of echocardiographic peak velocity of circumferential fibre shortening (peak Vcf).

A transparent grid for estimating peak Vcf directly from the echocardiograph recording is described. Estimates so obtained were compared with peak Vcf measurements made by an echocardiographic digitising technique and with the angiographic ejection fraction in 13 patients with normal left ventricular function and 17 patients with impaired left ventricular function. No patient had angiographic segmental wall motion abnormalities. Significant linear correlations were found between peak Vcf derived by the simple manual technique and peak Vcf determined by the digitising technique and also between peak Vcf derived by the simple manual technique and the angiographic ejection fraction. Peak Vcf derived by the simple manual technique was found to be a reliable predictor of ventricular function, being more than 1.4 circumferences/s in 11 of 13 patients with angiographic ejection fractions greater than or equal to 55% and less than 1.4 in 14 of 17 patients with angiographic ejection fractions less than 55% (sensitivity 82%, specificity 85%). Thus, peak Vcf is an echocardiographic index that can be estimated rapidly and accurately without the need for digitising equipment and is well suited to general clinical use.

Adolescent↗

PubMed1981

Left ventricular function in marathon runners: echocardiographic assessment.

Cardiac alterations induced by chronic isotonic exercise were assessed echocardiographically in 8 active male marathon runners aged 29 +/- 7 yr (mean +/- SD) compared with 10 sedentary controls aged 27 +/- 5 yr. The runners had a significantly higher aerobic capacity than the controls (72.8 +/- 6 vs. 41.4 +/- 6 ml . kg-1 . min-1; P less than 0.001). Compared with the controls, the runners had a significantly lower heart rate at rest (49 +/- 3 vs. 73 +/- 9 beats/min; P less than 0.01) and during submaximal supine exercise at a similar absolute work load (115 +/- 11 vs. 124 +/- 12 beats/min; P less than 0.01). Similarly, the runners had a lower pressure-rate product both at rest (5.52 +/- 1.0 x 10(3) vs. 9.43 +/- 1.4 x 10(-3)) and during submaximal exercise (19.7 +/- 3.2 x 10(3) vs. 25.0 +/- 4.2 x 10(3); P less than 0.01). The left ventricular peak velocity of circumferential fiber shortening of the runners relative to that of the controls was significantly reduced both at rest (1.40 +/- 0.08 vs. 1.64 +/- 0.08 circ/s) and during submaximal supine exercise at a similar absolute work load (2.36 +/- 0.15 vs. 2.71 +/- 0.10 circ/s). However, this reduction in V cf was found to be directly related to the lower pressure-rate product of the runners and therefore did not reflect a decreased intrinsic myocardial contractility in the runners relative to the controls.

Adult↗

PubMed1980

Congenital tracheoesophageal fistula without esophageal atresia. A 22 year experience.

Experience in managing the patients with congenital tracheoesophageal fistula without esophageal atresia led to the following conclusions: (1) The pulmonary and gastrointestinal manifestations of this lesion may be subtle and similar to those of other disorders. A high index of suspicion is required to recognize the fistula. (2) Skillful and persistent efforts should be made to establish the diagnosis and localize the fistula before any surgical attempt at correction. (3) Adequate preoperative preparation, cannulation of the fistula and careful surgical dissection will minimize surgical complications.

Child, Preschool↗

PubMed1977

Technetium pyrophosphate scanning in the detection of acute myocardial infarction: clinical experience.

Technetium-99m-stannous pyrophosphate (99mTc-PYP) accumulates in acutely infarcted myocardium and can be detected by scintiscanning. The clinical value of 99mTc-PYP scintiscanning was studied in 83 patients 6 hours to 21 days after the onset of acute chest pain. In 12 patients with normal electrocardiograms and serum enzyme values no uptake of 99mTc-PYP was detected on the scintigrams. Of 44 patients with electrocardiographic or enzyme evidence, or both, of acute myocardial infarction the scintigrams were positive in 31, "questionable" in 2 and negative in 11; no positive scan was obtained within 12 hours of the onset of pain, and the scans generally remained positive for up to 5 days. In 24 patients with evidence of prolonged myocardial ischemia the scans were positive in 2, questionable in 4 and negative in 18. The scans were negative in each of three patients with acute or constrictive pericarditis. Localization by electrocardiography and scintiscanning correlated nearly perfectly for transmural infarcts but subendocardial infarcts could not always be localized precisely by scintiscanning. The infarct area (total area of 99mTc-PYP uptake) correlated well with the peak serum value of creatine phosphokinase.

Angina Pectoris↗

PubMedDate not supplied

Lack of effect of particle size on the identification of the sentinel node in cutaneous malignancies.

BACKGROUND: Radiotracers have become a routine technical component of the new procedure of intraoperative lymphatic mapping and selective lymphadenectomy. Because different colloids have differing physicochemical properties, their distribution and uptake may be different. For this reason, the optimal colloid to identify and localize the sentinel node remains controversial. METHODS: Nineteen consecutive patients with cutaneous malignancies underwent diagnostic lymphoscintigraphy with 99mTc-labeled human serum albumin (99mTc-HSA) and preoperative lymphoscintigraphy with 99mTc-labeled sulfur colloid (99mTc-SC). The results of intraoperative lymphatic mapping and selective lymphadenectomy were reviewed. RESULTS: Intraoperative lymphatic mapping and selective node dissection were successful in 21 of 22 lymphatic basins (18 of 19 patients). There was excellent correlation between the "hot" marker placed on the skin surface when 99mTc-HSA was used compared with the use of 99mTc-SC. In 20 of 21 lymphatic basins the sentinel node both was "hot" and was stained with isosulfan blue. CONCLUSIONS: No discernible difference between the ability to localize in the sentinel node with these two radiocolloids was identified. For logistical reasons, 99mTC-SC appears to be the colloid of choice in intraoperative lymphatic mapping.

Carcinoma, Squamous Cell↗