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Biomedical subjects

S C Vlay

Publications and source records attributed to S C Vlay.

At least 55 records · Page 3Linked to original sources
PubMed1989

Anxiety and anger in patients with ventricular tachyarrhythmias. Responses after automatic internal cardioverter defibrillator implantation.

In order to assess the psychological profile of patients with malignant ventricular tachyarrhythmias, eight patients who underwent implantation of the automatic internal cardioverter defibrillator for refractory arrhythmias were evaluated. Six men and two women with a mean age of 53 years were examined with the Symptom Checklist-90, the State Trait Personality Inventory and a specifically designed questionnaire about the automatic internal cardioverter defibrillator. The group studied manifested high degrees of both anger and anxiety compared to normal controls or to other medically ill populations. The trait scores remained essentially unchanged before and after the AICD implantation. The state of anxiety was markedly reduced by 26 percentage points after implantation (P less than 0.01), while the state of anger remained unchanged. In evaluating the number of AICD discharges, it was observed that the number of discharges in the first 6 months was higher than that observed in the subsequent follow-up period (mean 30 months). The reduction in AICD discharges demonstrated a trend (P = 0.094). Patient acceptance of the automatic internal cardioverter defibrillator was high. They became accustomed to the pulse generator after a mean of 3.6 months. The defibrillator permitted resumption of normal activities. If the device became battery depleted, all patients would insist on replacement. The evaluation of this group of patients with malignant ventricular arrhythmias indicates a high degree of anxiety and anger, which potentially may influence outcome. The reduction in defibrillator discharges after the first 6 months in addition to a reduced state of anxiety is a relationship that merits further investigation.

Anger↗
PubMed1989

Acute and semiacute management of cardiac arrest.

Successful management of the survivor of sudden cardiac arrest includes proper performance of cardiopulmonary resuscitation and appropriate evaluation thereafter. If the event was not associated with acute myocardial infarction, there is a high probability of recurrence. Evaluation consists of cardiac catheterization and electrophysiologic testing, along with ambulatory electrocardiographic recording and exercise testing. Therapeutic options include pharmacologic intervention, surgery, and electronic devices such as the automatic internal cardioverter defibrillator, depending on the result of invasive and noninvasive studies.

Electrocardiography↗
PubMed1988

Improvement in NYHA functional class 4 congestive heart failure patients with nifedipine: a hemodynamic evaluation.

Twelve patients referred for evaluation of functional class 4 heart failure as classified by the New York Heart Association underwent treatment with nifedipine after other regimens proved unsatisfactory. Seven men and five women with a mean age of 63 years and a mean ejection fraction of 28% underwent hemodynamic evaluation after insertion of a pulmonary artery monitoring catheter. Nifedipine was administered as a 10 mg sublingual dose, followed by 10 mg orally every 8 hours for 24 hours. Seven patients experienced improvement of symptoms of dyspnea (group 1) and continued nifedipine as outpatients for one month. An improvement in function to class 3 (five subjects) and class 2 (two subjects) was observed. The remaining five patients experienced no improvement (group 2) and did not receive nifedipine after 24 hours. Statistical analysis of the hemodynamic variables revealed that the responders (group 1) had a significant decrease in the pulmonary vascular resistance from 250 dynes second cm-5 at baseline to 155 dynes second cm-5 at 15 minutes after sublingual nifedipine (p less than .05 and 135 dynes second cm-5 at 24 hours while on oral nifedipine. Although trends were seen with other variables, none was statistically significant. After one year of extended follow-up, six of seven group 1 subjects (responders) were alive, compared to only one of five group 2 subjects (p less than .05). All five deaths were related to progressive heart failure. Although ejection fraction did not correlate with final outcome, the duration of heart failure was significantly longer in the nonresponders (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1988

Sensing aberration by the automatic implantable cardioverter defibrillator during intraoperative testing.

A 50-year-old man underwent replacement of his automatic implantable cardioverter defibrillator (AICD) because a magnet test revealed severe battery depletion. He had had his unit implanted 18 months previously after an episode of sudden cardiac death. He had documented torsades de pointes and inducible ventricular tachycardia, confirmed by electrophysiologic study. Before a new unit was implanted thresholds were measured by an external cardioverter defibrillator. Ventricular fibrillation (VF) was induced by alternating current through a standard, line-operated battery charger with stimulation delivered to the epicardium via rate-sensing electrodes. VF was allowed to continue for 10 seconds before shock was delivered. Termination of VF required 15 joules, which was higher than that required at initial implantation 18 months earlier. The new pulse generator was activated for testing and VF was again induced. The AICD discharged after 12.3 seconds. Prior to wound closing, the AICD was deactivated by magnet. Instead of R-wave synchronous beeping tones during deactivation, double beeping tones were heard. Electrogram recordings revealed abnormalities of the T-wave and ST segment of the rate-sensing electrodes, which were the cause of the tone irregularities. Stabilization of the T-wave and ST segment occurred within 8 minutes and the tones became normal. The procedure was then completed.

Electric Countershock↗
PubMed1988

The safety of combined thrombolysis and beta-adrenergic blockade in patients with acute myocardial infarction. A randomized study.

To assess the safety of combined intervention in acute myocardial infarction, a pilot study of thrombolysis and beta-adrenergic blockade was performed. Twenty-five subjects were randomized to therapy with intravenous (IV) metoprolol and IV streptokinase (group 1) or to IV metoprolol (group 2) alone. Two-dimensional echocardiography was performed before intervention and five days later. The mean time from onset of symptoms to intervention was 1.92 hours. No major adverse reactions related to the intervention were observed in either group. Significant improvement from baseline was observed with combined therapy on both the biplane mean ejection fraction (p less than .02) and a calculated wall motion index of regional wall motion abnormalities (p less than .002). The presumed reperfusion rate was significantly higher in group 1 (p less than .03). Intravenous metoprolol and IV streptokinase in combination was found to be safe in the acute phase of acute myocardial infarction when administered to appropriate patients without contra-indications and deserves further study.

Adrenergic beta-Antagonists↗
PubMed1986

Intravenous and oral lorcainide: assessment of central nervous system toxicity and antiarrhythmic efficacy.

Twenty-eight subjects underwent evaluation of drug toxicity and antiarrhythmic efficacy with oral and intravenous lorcainide. Lorcainide, a new type 1C antiarrhythmic drug, has an active metabolite, norlorcainide, which accumulates after oral but not significantly after intravenous administration. Group 1 consisted of 14 subjects who received intravenous lorcainide with an initial bolus of 2 mg/kg at a rate of 2 mg/min followed by 0.14 mg/min or 200 mg/24 hours. The lorcainide level after bolus was 0.432 micrograms/ml and fell to 0.178 micrograms/ml at 4 to 6 hours despite constant drug infusion. Prior work has demonstrated no detectable norlorcainide levels after intravenous infusion. Group II consisted of 14 subjects who received oral lorcainide, 100 mg orally every 8 hours. Mean lorcainide levels were 0.287 micrograms/ml and mean norlorcainide levels were 0.377 micrograms/ml. Only 2 of 12 subjects in group I experienced headache, dizziness, or sleep disturbance, compared to 12 of 14 subjects in group II (p less than 0.01). Intravenous lorcainide has a lower incidence of central nervous system side effects than oral lorcainide. These effects may be attributable to the accumulation of the norlorcainide metabolite with oral therapy.

Administration, Oral↗
PubMed1986

Frequent episodes of silent myocardial ischemia after apparently uncomplicated myocardial infarction.

Frequent episodes of silent myocardial ischemia were documented in two patients, one with recognized and one with unrecognized prior myocardial infarction. Neither patient had symptoms after the infarction, but both demonstrated silent myocardial ischemia on exercise testing, which prompted further study with 48 hour ambulatory electrocardiographic (Holter) recordings. In each patient, heart rate recorded with the Holter monitor during the ischemic episodes was usually less than that observed during ischemia precipitated by exercise testing. This suggests that increased vasoconstrictive tone may play a role in silent ischemic episodes occurring during daily activities.

Coronary Disease↗
PubMed1986

Psychiatric aspects of patients with malignant ventricular arrhythmias.

The major cause of cardiac mortality in the United States is sudden cardiac death, most often the result of ventricular tachycardia-ventricular fibrillation. Transient risk factors for sudden cardiac death include psychiatric conditions mediated through the CNS. Major advances in the evaluation and treatment of patients who have survived malignant ventricular arrhythmias have been accompanied by challenging management and therapy issues for the psychiatrist involved in the care of such patients. The authors suggest ways to meet these challenges, especially in the care of patients with concomitant anxiety, depression, delirium, or psychosis.

Adult↗
PubMed1985

Psychosocial aspects of surviving sudden cardiac death.

The psychosocial problems faced by the survivor of "sudden cardiac death" are discussed from the point of view of the patient, the family, and the physician. The patient faces a battery of intensive diagnostic tests, as well as concern for future capability to resume function as "spouse, parent, and citizen." Emotions such as depression, anger, anxiety, frustration, and fear must be dealt with in a constructive manner. Management includes education, support, encouragement of adaptive denial, anxiolytic medication if necessary, and relaxation techniques when helpful. Our approach begins with education of the patient and family in regard to the medical aspects of the illness. Next, we provide support for the patient and allow the patient to express his or her concerns at an individual pace. Adaptive denial is encouraged and maladaptive denial addressed. Appropriate medication is prescribed when necessary, and finally, relaxation techniques may have a role in some patients. A strong physician-patient relationship is necessary for successful evaluation and therapy. The unique stresses of the cardiologist and the electrophysiology team are described.

Adaptation, Psychological↗
PubMed1985

How the university cardiologist treats ventricular premature beats: a nationwide survey of 65 University Medical Centers.

Sixty-five of 118 university cardiologists responded to a survey of indications for treatment of ventricular ectopy, particularly in the completely asymptomatic patient or those with palpitations as the only symptom. The percentage of cardiologists treating these patients increased as the complexity of ventricular ectopy increased, as the severity of underlying heart disease increased, as the symptoms increased from completely asymptomatic to palpitations or skipped beats, if the patient experienced dizziness or syncope, and if the patient had complex VPBs or asymptomatic VT after MI. Ninety-eight percent of respondents had patients who experienced exacerbation of arrhythmia with antiarrhythmic drugs. Of the conventional type 1 drugs, the drug of first choice was quinidine for 60%, procainamide for 37%, and disopyramide for 3%. The accepted indications for electrophysiologic testing included survivors of sudden cardiac arrest and patients with symptomatic VT.

Anti-Arrhythmia Agents↗