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Biomedical subjects

R J Hall

Publications and source records attributed to R J Hall.

At least 127 records · Page 7Linked to original sources
PubMed1985

Athletic dysrhythmias. A case report and review of the phenomenon of the 'athlete's heart'.

A 36-year-old athlete was anaesthetised for a minor surgical procedure. His heart rate fell to 30 beats/minute during the operation, the electrocardiogram showed A-V junctional rhythm. Sinus rhythm of 58 beats/minute was restored by atropine 1.2 mg. His resting 12-lead electrocardiogram showed sinus bradycardia and features consistent with a diagnosis of 'athlete's heart'. A review is presented of the physiological and electrocardiographical features of this phenomenon. The current popularity of running as a leisure pursuit makes it important that anaesthetists recognise the peculiarities of the trained athletic heart.

Adult↗
PubMed1985

Cardiac sarcoidosis: two cases with ventricular tachycardia and review of cardiac involvement in sarcoid.

Patients with significant cardiac sarcoidosis are at increased risk of sudden death from ventricular dysrhythmias or conduction disturbances. We report two patients whose initial manifestation of cardiac sarcoidosis was nonsustained ventricular tachycardia unresponsive to standard antiarrhythmic measures. Endomyocardial biopsy aided the diagnosis in each patient. This technique is helpful in establishing the diagnosis of cardiac sarcoidosis, which causes life-threatening ventricular dysrhythmias.

Journal Article↗
PubMed1985

Myocardial infarction associated with cocaine abuse.

We report a patient who sustained a myocardial infarction after inhaling cocaine. He developed a persistent wall motion defect that was present 18 months after the acute event despite resolution of electrocardiographic evidence of infarction.

Journal Article↗
PubMed1985

Sinus node reentry: case report and review of electrocardiographic and electrophysiologic features.

We report a case of sinus node reentry, an uncommon form of supraventricular tachycardia in a patient with no organic heart disease. This tachycardia appeared at times with wide QRS complexes, which made the differentiation between supraventricular and ventricular tachycardia somewhat difficult. The purpose of this report is to discuss features of sinoatrial node reentry tachycardia, both on surface electrocardiography and intracardiac electrography. Electrophysiologic studies are usually required to confirm the diagnosis.

Journal Article↗
PubMed1985

Cyanosis after surgical correction of pulmonary valve stenosis: an old problem revisited.

The presence of cyanosis following repair of congenital cardiac defects may result from several different mechanisms. We report two patients in whom early postoperative arterial hypoxemia manifested by cyanosis was caused by right-to-left interatrial shunting. Two-dimensional contrast echocardiography correctly identified the site and direction of shunting, leading to surgical correction of the complication.

Journal Article↗
PubMed1985

An analysis of plasma levels and 24-hour ECG recordings in tricyclic antidepressant poisoning: implications for management.

Twenty-seven patients with confirmed tricyclic antidepressant (TCA) self-poisoning were studied for 24 h following admission to hospital. Ten patients were judged to be severely poisoned on clinical grounds, whilst 14 patients had initial plasma levels above 1 mg l-1, indicating severe poisoning. Plasma levels were generally maximal on admission to hospital and fell quickly thereafter. Clinical and ECG data showed patients to be most at risk in the casualty department and three patients sustained cardiac arrest. Initial management must be speedy as these patients present with acute toxicity.

Adolescent↗
PubMed1984

Cardiac abnormalities and exercise tolerance in patients receiving renal replacement therapy.

The exercise tolerance of the survivors of a consecutive group of 100 patients in a renal dialysis and transplant programme was compared with the prevalence of cardiac abnormalities detected by exercise testing, echocardiography, and radionuclide angiography. Fifty four patients attended for investigation 27 (SD 7) months after starting renal replacement therapy. Forty three of them (80%) were receiving antihypertensive treatment. Their performance on a bicycle ergometer exercise test was compared with that of 62 normal subjects and the patients divided into five groups of decreasing ability. The exercise tolerance of the patients was very poor, only 17 performing within the normal range. Impairment in exercise capacity was not explained by the type or quality of renal replacement therapy. Fourteen patients developed ischaemic electrocardiographic changes on exercise. Left ventricular ejection fraction was assessed by gated blood pool scanning in 37 patients; all nine of the patients with an abnormally low radionuclide ejection fraction also had abnormal exercise tolerance. Satisfactory M mode echocardiograms were obtained from 45 of the patients, and only two were normal. Left ventricular hypertrophy was detected in 25 (56%) of the echocardiograms, and abnormalities indicating impaired left ventricular function were common and widespread. Grouping all the abnormal cardiac features together for the patients in each exercise group showed a striking linear trend of increasing proportion of cardiac abnormalities with worsening exercise tolerance among the five exercise groups (p less than 0.001). The proportion of patients becoming unemployed within one year of starting renal replacement therapy similarly increased, from nil to 60% from the best exercise group to the most incapacitated. Twenty nine of the original cohort of 100 patients subsequently died, cardiovascular disease accounting for 12 (41%) of these deaths. Diminished exercise tolerance in patients receiving renal replacement therapy is strongly associated with cardiac abnormalities and reduced employment prospects.

Adolescent↗
PubMed1984

Coronary revascularization in the elderly patient.

A total of 1,275 elderly patients (70 years and older) underwent coronary artery bypass alone from 1970 to 1981. The percent of elderly patients who underwent coronary bypass surgery alone increased from 2.04% in 1971 to 8.2% in 1981. Most of the patients had severe, disabling or unstable angina pectoris. The overall early mortality rate was 5.8%. The early mortality rate was 13.9% in the first group (1970 to 1975) of 158 patients compared with 4.7% in the second group (1976 to 1981) of 1,117 patients. An average of 3.1 bypass grafts per patient were implanted. On follow-up examination, angina was relieved or decreased in 89% of the patients. The 5 year survival rate was 80.6% and the 10 year survival rate was 44.1%, with an average attrition of 3.9 and 5.6%/year, respectively. It is concluded that elderly patients are high risk surgical candidates, yet the risk has decreased progressively because of improved techniques of medical and surgical management and myocardial preservation. This decreasing operative mortality rate provides evidence that when medical management of the elderly patient with severe angina fails, coronary artery bypass becomes a successful alternative.

Age Factors↗
PubMed1984

Aortic valve disease.

AORTIC STENOSIS Clinical suspicion of significant aortic stenosis even in the presence of a normal chest X-ray and electrocardiogram should lead to careful 2-D echocardiographic examination. The lesion can be adjudged mild and the subject probably certificated if the recording shows normal septal and posterior wall thickness, normal left ventricular dimensions and fractional shortening and a valve opening greater than 15 mm. In cases of doubt or where technically satisfactory echocardiograms are unobtainable, cardiac catheterization is likely to be mandatory. For unrestricted certification the peak systolic gradient across the valve should be less than 20 mmHg and the LV end-diastolic pressure less than 12 mmHg at rest, and both must remain within these limits on exercise to three times resting oxygen consumption. AORTIC REGURGITATION Any abnormality of electrocardiogram at rest or on exercise, or of the chest X-ray, any increase in left ventricular dimensions on echocardiography, a diastolic pressure below 65 mmHg and/or pulse pressure greater than 55 mmHg is likely to lead to cardiac catheterization. For full certification any angiographic regurgitation should be trivial.

Adult↗
PubMed1984

Precision of digitized M-mode echocardiograms for clinical practice.

Computer digitization of M-Mode echocardiograms has proved a valuable research tool in the study of left ventricular function. It can be applied in clinical practice if the reproducibility of the technique is known so that imprecision can be minimised. Five normal echocardiograms of average clinical quality were selected and four cycles from each echocardiogram were digitized on two occasions by four different digitizers using an 'Apple II' computer. The study design allowed the sources of imprecision to be identified by analysis of variance. Assessment of the clinically most useful digitized measurement, peak rate of change of diastolic left ventricular dimension (dD/dt), was imprecise with a large within-subject variance and a 95% confidence interval of +/- 6.5 cm s-1; too wide for clinical use. The replication component accounted for 90% of this variance, with cycle to cycle and between-digitizer variance components being much less important. This large replication component will be reduced simply by repeating digitization; for dD/dt repeating digitization four times would theoretically reduce the confidence interval to a useful value of +/- 3.6 cm s-1. The 95% confidence interval for a single digitised measurement of diastolic left ventricular minor dimension was +/- 0.32 cm, for diastolic posterior wall thickness +/- 0.23 cm, and for the isovolumic relaxation time (A2-MVO) +/- 27 ms. Replication was again the largest component of variance so that the biggest improvement in precision will come from simply repeating digitization. Digitization on a cheap microcomputer system can provide clinically useful information provided reproducibility and sources of imprecision are known with clinical, as opposed to research, echocardiograms and conditions.

Adult↗
PubMed1984

Comparison of two-dimensional echocardiography, radionuclide ventriculography and cineangiography in detecting surgically documented left ventricular thrombi.

To assess the diagnostic value of various imaging techniques for identifying left ventricular thrombi, we studied 35 patients who underwent left ventricular aneurysm repair and inspection of the ventricular cavity for the presence of a thrombus. All patients underwent preoperative two-dimensional echocardiography and left ventricular cineangiography; radionuclide ventriculography was also performed in 19 of these patients. Data from these procedures were analyzed as in a blind study, and were interpreted as either positive or negative for thrombus. A left ventricular thrombus was present in 22 of the 35 patients at surgery (63%). Two-dimensional echocardiography showed a sensitivity of 95%, specificity of 92% and overall predictive accuracy of 94% for the detection or exclusion of thrombi. In comparison, cineangiography yielded a sensitivity of 73%, specificity of 92% and predictive accuracy of 80%. The sensitivity of radionuclide ventriculography was 60%, specificity was 100%, and predictive accuracy was 79%. Our data, based on a surgical-pathological standard, shows that two-dimensional echocardiography is a highly accurate technique for the diagnosis of left ventricular thrombi, and may be the procedure of choice for this purpose.

Journal Article↗
PubMed1984

Left ventricular functional assessment by radionuclide ventriculography during isometric handgrip and bicycle exercise in patients with aortic insufficiency.

Twelve patients with chronic aortic insufficiency underwent radionuclide ventriculography performed in conjunction with dynamic bicycle and isometric handgrip exercise. Changes in left ventricular ejection fraction (LVEF) during exercise were measured. In all patients, the degree of regurgitation was determined by catheterization, and in eight patients, left ventricular end-diastolic pressure (LVEDP) was measured. The change in LVEF during either form of exercise was inversely related to the LVEDP. This correlation was somewhat better and more linear for bicycle exercise (R=0.84, p <.005) than for handgrip (R = 0.71, p<.025). By either exercise technique, a decrease in LVEF by >4 points occurred only in patients with 3 to 4 + regurgitation. We conclude that although radionuclide ventriculography with either bicycle or handgrip exercise is useful in determining the effect of aortic insufficiency on left ventricular functional reserve, bicycle exercise correlates better with other criteria of ventricular dysfunction.

Journal Article↗
PubMed1983

Effects of stress management training and dietary changes in treating ischemic heart disease.

To evaluate the short-term effects of an intervention that consists of stress management training and dietary changes in patients with ischemic heart disease (IHD), we compared the cardiovascular status of 23 patients who received this intervention with a randomized control group of 23 patient who did not. After 24 days, patients in the experimental group demonstrated a 44% mean increase in duration of exercise, a 55% mean increase in total work performed, somewhat improved left ventricular regional wall motion during peak exercise, and a net change in the left ventricular ejection fraction from rest to maximum exercise of +6.4%. Also, we measured a 20.5% mean decrease in plasma cholesterol levels and a 91.0% mean reduction in frequency of anginal episodes. In this selected sample, short-term improvements in cardiovascular status seem to result from these adjuncts to conventional treatments of IHD.

Aged↗
PubMed1983

Aneurysm of the interatrial septum occurring as an isolated anomaly.

We report a case of aneurysm of the atrial septum occurring as an isolated abnormality in a patient with atypical chest pain. Apical two-dimensional echocardiography demonstrated phasic bulging of the fossa ovalis region of the atrial septum into the right atrium. Biplane cineangiography confirmed the presence of a large septal aneurysm in an otherwise normal heart. The incidence, pathogenesis, and complications of this unusual anomaly are briefly discussed.

Adult↗