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Biomedical subjects

T Pop

Publications and source records attributed to T Pop.

At least 109 records · Page 6Linked to original sources

[Importance of echocardiography for the assessment of left-ventricular function and cardiac complications in dilative cardiomyopathy].

One- and two-dimensional echocardiographic findings in 17 patients with dilated cardiomyopathy were compared with haemodynamic and angiographic results of cardiac catheterization. In a further 52 unselected patients with dilated cardiomyopathy, who had been seen as out- or in-patients over a period of two years, the frequency of intracardiac thrombi was investigated echocardiographically. A significant correlation (r = 0.66 and r = 0.68) was found between echocardiographically determined left-ventricular end-diastolic and end-systolic volumes on the one hand and volumes determined angiographically on the other. However, ventricular volumes were clearly underestimated by echocardiography. In contrast, both methods showed good agreement for the magnitude of the ejection fraction (r = 0.79). The aortic valve opening surface estimated with one-dimensional echocardiography correlated with left-ventricular ejection volume (r = 0.93). Thrombi were demonstrated in 7 out of 52 patients: 5 were located in the left, one in the right and a further one in the central pulmonary vascular system. Considering the aforementioned limitations, echocardiography is a useful method for evaluation of left-ventricular function and for demonstration of intracardiac thrombi in dilated cardiomyopathy.

Adolescent↗

[Ventricular septal defect in acute myocardial infarction].

Ventricular septal rupture is the fourth-common cause of death after cardiac arrhythmia, acute congestive failure and rupture of the cardiac wall in acute myocardial infarction. Generally it can be easily diagnosed by a systolic jet sound in the 4th and 5th intercostal space parasternally on the left side. Differential diagnostic difficulties occur in the acute phase of infarction regarding papillary muscle rupture. Myocardial rupture does not occur immediately after the onset of the pectanginous state and not within the first day of illness, but generally within the first week. Vasodilatory treatment permits only short-term stabilisation of vascular problems, however, time is made available for diagnostic measures, usually catheterisation of both sides of the heart and coronary angiography. Immediate operation and occlusion of the defect, if necessary accompanied by a saphenous vein bypass, is presently considered treatment of choice. Out of the three patients with this complication the ruptured site could be occluded surgically in two, one of whom had severe cardiogenic shock. Shock symptoms regressed immediately and the postoperative course was unremarkable. In the third patient no operation was performed due to his age of 77 years and general vascular sclerosis. He died of cardiogenic shock 11 hours after admission to hospital.

Aged↗

[Transient sinus node arrest-a dysregulation of the autonomic nervous system (author's transl)].

Electrophysiologic studies had been performed before and after pharmacologic autonomic blockade (propranolol 0.2 mg/kg and atropine 0.04 mg/kg body weight) in a 23-year-old female patient with documented sinus arrest of 27 sec duration. Normal electrophysiologic findings before and after autonomic blockade excluded intrinsic sinus node dysfunction. Sinus arrest is therefore though to be due to an intermittent dysregulation of the autonomic nervous system.

Adult↗

Separation of left atrium from right pulmonary artery: a new echocardiographic sign of pericardial effusion.

We report a new echocardiographic sign of pericardial effusion in patients with pericardial effusion examined by the suprasternal approach. In normal individuals the right pulmonary artery is closely connected with the superior wall of the left atrium. A separation of these structures is only to be noticed during atrial contraction. In 12 of 17 patients with a pericardial effusion observed a separation of the left atrium from the right pulmonary artery ranging from 3 to 20 mm throughout the cardial cycle. We suggest that this echo-free zone represents fluid in the transverse pericardial sinus which is located between the two structures. In five patients with a small pericardial effusion (less than 400 ml) this observation could not be made.

Diagnosis, Differential↗

[Hyperactive carotid sinus reflex (author's transl)].

Following carotid sinus stimulation a hyperactive reflex with ventricular asystole of more than 3 seconds was found in 9 out of 40 asymptomatic patients aged more than 60 years. Results varied considerably between different investigators and different investigation days. Over a period of two years patients with hyperactive reflex did not have a worse prognosis than patients with normal reflex response. Symptoms indicating hypersensitive carotid sinus syndrome had not been observed in a single case. The frequent occurrence of hyperactive carotid sinus reflex and its favourable prognosis and the similarly frequent occurrence of vertiginous attacks due to numerous reasons, in the older age group, do not readily allow for a diagnosis of the hypersensitive carotis sinus syndrome, even when both symptoms occur at the same time. Pacemaker implantation should only be considered when repeated syncope has occurred which cannot be attributed to other causes despite extensive investigations.

Age Factors↗

Incidence and diagnostic aspects of the bladder disorders in diabetics.

Bladder disorders are important among the various complications of diabetes, both because of their frequency and the severe involvements they can cause to the urinary tract and ultimately to the renal function. Because they are often mild, especially in the first stage, bladder disorders call for early detection and for a judicious assessment as possible by careful investigation. The incidence of bladder disorders was studied in 50 diabetics by performing cystoscopy, micturition cystourethrography and cystometry. The results emphasize the importance of these investigations, particularly the cystometric one, in recognizing such bladder troubles before severe complications occur.

Adult↗

Undersensing of demand pacemakers in acute myocardial infarction.

Trasient asynchronous pacing due to abnormal sensing function is reported in two patients with inserted demand pacemakers during the early phase of acute myocardial infarction. The hazards of the pacemaker induced parasystole with R on T phenomenon in conditions of enhanced electrical instability could be successfully overcome applying overdrive suppression of the inserted pacing system by external chest wall stimulation.

Acute Disease↗

The vulnerability of the right atrium. III. Electrophysiologic correlates of atrial vulnerability.

70 patients were investigated by means of the atrial extrastimulus method at three different driving rates: 80, 100 and 120/min. At each rate the effective, the relative, the total and the functional refractory periods were measured. 30 patients who showed signs of atrial vulnerability at least one of the tested rates were included in the so called vulnerability group. The remaining 40 patients, who did not fulfill the criteria for atrial vulnerability, were included in the nonvulnerability group. When the two groups were compared to each other there were significant larger P waves (p less than 0.005), shorter effective refractory periods (p less than 0.001) and longer relative refractory periods (p less than 0.001) in the vulnerability group. With increasing driving rate there was an increased tendency to repletitive firing in the vulnerability group. The phenomenon of vulnerability correlated well with the rate-induced shortening of the effective and the lengthening of the relative refractory period. The above described phenomena are compatible with the concept of re-entry as the electrophysiologic mechanism of atrial vulnerability in man.

Atrial Fibrillation↗

[Electrocardiology basis of paroxysmal atrial fibrillation (author's transl)].

55 patients (15 subjects in whom a special cardiac disease could be ruled out and 40 patients with paroxysmal atrial fibrillation) were investigated by means of the extrastimulus method at a driving rate of 80 min-1. In 32 of the 40 patients with paroxysmal atrial fibrillation occurred signs of atrial vulnerability. When compared with the healthy subjects and the remaining 8 patients who did not fulfil the criteria for vulnerability, there were significant shorter effective and longer relative refractory periods of the right atrium in the vulnerability group. These findings suggest that the re-entry phenomenon may be the underlying mechanism of paroxysmal atrial fibrillation in the group with atrial vulnerability.

Adult↗

[Pharmacodynamic studies in suicidal digoxin poisoning (author's transl)].

In two patients with suicidal digoxin poisoning the correlations between serum digoxin concentration and changes in the duration of QTc and the flattening of the T-waves were studied. The digoxin serum half-life following suicidal digoxin poisoning was in the first patient (10 mg beta-acetyl derivative of digoxin) 77 h, prolonged cause of renal insufficiency, and in the second patient 39.6 h. (20 mg beta-acetyl derivative of digoxin). In both patients the digoxin induced flattening of the T-wave reached a plateau of maximum efficacy at a serum level of 2-3 ng/ml with no further change up to a serum level of 13.2 ng/ml and 9.6 ng/ml respectively. A linear correlation, however, was found between the digoxin serum concentration and the digoxin induced shortening of QTc, r = 0.88 and r = 0.92 respectively. A plateau maximum efficacy was not found. The regression equations were y = -12.0 chi + 430.8 and y = -8.0 chi + 391.9 respectively. The shortening of QTc is therefore an important parameter for the diagnosis of digoxin poisoning. It can be determined very quick with no methodical problems.

Digoxin↗

Assessment of refractoriness of the human Purkinje system.

In 35 unselected patients premature right ventricular stimulation during a constant right ventricular drive rhythm was performed at the rates of 80, 100, and 120 per min. Several surface ECG leads and intracardiac electrograms were simultaneously recorded. To assess the beginning of decreased conductivity of the His-Purkinje system for retrograde conduction the premature test pulse interval was measured when the retrograde intraventricular conduction to the bundle of His prolonged for the first time. This interval was defined as the beginning of relative refractoriness of the Purkinje system. Additionally, the effective refractory period of the right ventricular muscle was determined. A rate dependancy between the beginning of relative refractoriness of the Purkinje system and the effective refractory period of the right ventricular muscle, as it is known from animal experiments, could be established with significantly different (P less than 0.001) mean values at the three different heart rates. The method described may be the only means by which to obtain approximate information about normal and abnormal conductivity of the human Purkinje system. It is inferred that critical prolongation of refractoriness of the Purkinje system relative to the refractoriness of the myocardium may be relevant to the occurrence of ventricular arrhythmias.

Adult↗

[The vulnerability of the right atrium. II. Correlations between vulnerability and the atrial refractory periods (author's transl)].

The vulnerability of the right atrium to single electrical stimuli was investigated in 100 non-selected patients. According to the response pattern to extrasystolic stimulation of the right atrium during the relative refractory period, the patients could be divided in 3 groups: Group A: no signs of vulnerability. Group B: 1 to 5 additional atrial extrasystoles after the premature atrial stimulus. Group C: runs of atrial flutter or fibrillation for at least 8 s. The 3 groups were compared with respect to the duration of the effective and relative refractory period of the right atrium. From group A to group C the effective refractory period showed a tendency to shorten, while the relative refractory period showed a tendency to prolong. These results are interpreted as supporting a reentry as the underlying mechanism of the here described atrial vulnerability.

Arrhythmias, Cardiac↗