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Biomedical subjects

W Piwowarska

Publications and source records attributed to W Piwowarska.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Current views on the clinical significance of coronary artery spasm].

Current views about etiology, pathogenesis, diagnostics and treatment of coronary artery spasm have been presented. A lot of researches show complexity of factors, which are responsible for coronary artery spasm. The most important are: a local hypersensitivity of vessels wall, neurogenic factors and humoral factors. The lack of magnesium plays also important role. Clinical manifestations of coronary artery spasm are: Printzmetal's angina, arrhythmia, acute myocardial infarction, atypical chest pain and cardiac sudden death. Among diagnostic examination the main importance have provocative tests with ergonovine and acetylcholine, rarely hyperventilation and cold are used. Calcium channel blockers, nitrate, molsidomine are employed in treatment patients with coronary artery spasm. There are taken modern examinations of new drugs like beta-1 adrenergic agonists and derived molsidomine agents. Beta-adrenergic blocking agents are contraindicated. It has been emphasized, that early diagnostics and pharmacologic treatment improve long-term prognosis in this group of patients.

Coronary Vasospasm↗
PubMed1995

[Hypertension in patients after heart transplantation].

Arterial hypertension is a serious and common complication of cyclosporine administration in humans. The prevalence of arterial hypertension in patients following orthotopic heart transplantation ranges from 38% to 92%. There are several characteristic features of this form of hypertension, including very early onset--usually within 4 to 6 weeks after transplantation and persistence with little alteration overtime. Diurnal profile shows the lack of normal nocturnal decline in blood pressure (BP) and appearance of the highest values of BP early in the morning. This phenomenon is caused by altered regulation of BP due to cardiac denervation. There was shown no correlation between the dose of cyclosporine and development of posttransplant arterial hypertension. It develops also independently of many investigated pretransplant and posttransplant cardiovascular risk factors. A great deal of attention has been focused on explantation of cyclosporine influence leading to hypertension occurrence. suggested mechanisms of this action are: elevation of systemic vascular resistance, prostaglandines and tromboxance production imbalance, hypomagnesemia, increased intravascular volume, modulation of sympathetic activity, nephrotoxicity. Reninangiotensin system seems to be not significantly associated with posttransplant hypertension, whereas the role of corticosteroides is still controversal. Hypertension remains the most common complication associated with cyclosporine administration in heart transplant recipients. Mechanisms of cyclosporine action leading to development of hypertension are still unknown. Further investigation is also needed into clinical significance of posttransplant hypertension and its influence on long-term survival after heart transplantation as they remain undefined.

Circadian Rhythm↗
PubMed1994

Analysis of circadian distribution of premature ventricular contractions in patients after heart transplantation.

UNLABELLED: The aim of our study was to analyze circadian distribution of premature ventricular contractions (PVC) and its coupling interval (CI) in patients after orthotopic heart transplantation (HTx). Forty-two patients (5 females, 37 males) were monitored from 2 weeks to 5 years after HTx; 180 24-hour Holter ECG studies were performed. All recordings were divided into two groups: group I, within 1 month after HTX; and group II, after 1 month. Patients with more than 250 PVC/24 hours were selected for distribution of PVC and CI evaluation. CONCLUSIONS: Ventricular arrhythmias occur frequently in patients after heart transplantation. In patients with high Lown scale arrhythmias low occurrence (< 250/24 hours) of PVC was frequently observed (IVa: 81.8%; IVb: 84.7%). Similar patterns of circadian distribution (CD) of PVC and CD of HR in denervated heart after HTx suggest the influence of circulating catecholamines on their occurrence.

Adolescent↗
PubMed1994

[Arrhythmias in patients with mitral valve prolapse].

The aim of the study was to analyse rhythm disturbances in 92 patients with mitral valve prolapse syndrome (52 women and 40 men). The patients were examined by resting electrocardiograms monitoring, exercise electrocardiogram (submaximal exercise test), phonocardiograms and echocardiograms. We found tachycardia sinusalis in 72 patients (78%), supraventricular premature beats in 23 (25%) and ventricular premature beats in 54 patients (59%). There was no correlation between dizziness and syncope and ventricular rhythm disturbances in those patients.

Adolescent↗
PubMed1993

[Diagnostic difficulties in a 32-year old patient with cardiac tamponade].

At present the most frequent cause of cardiac tamponade is neoplasma. A case of a 32-year-old male with recurrent cardiac tamponade caused by pericardium mesothelioma is described. Despite advanced neoplastic process in the pericardium, pleura and mediastinum, neither radiologic examinations of the chest, echocardiography, nor repeated cytologic examination of the pericardial exudate, could establish the etiology of the tamponade. Only after a pericardial window had been performed was it possible to: 1) establish the diagnosis and introduce causal treatment; 2) prevent recurrence of the tamponade; 3) perform cytoreduction of the tumor. It seems that in cases of chronic exudative pericarditis of unknown cause it is proper to perform an early pericardial window as a diagnostic and therapeutic procedure.

Adult↗
PubMed1992

Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse.

The aim of this study was to evaluate a possible relation between the autonomic tone determined by daily urine catecholamine excretion and the incidence of ventricular arrhythmias (VA) in patients with mitral valve prolapse (MVP). The study included 53 patients (31 women and 22 men) aged 19-52 years (mean age 32.7). The diagnosis of MVP was based on medical history, physical examination, and echocardiography. Cardiac arrhythmias were detected by Holter monitoring and classified according to Lown grades. Daily heart rate and duration of corrected QT interval using Basett's formula were also analyzed. Daily urine adrenaline and noradrenaline levels were determined fluorometrically by Von Euler and Lishajko's method. The patients with Lown's grade III-V VA were evaluated with particular consideration. Student's t-test was used for statistical analysis. On Holter monitoring 26 patients showed VA, including 6 with grade I, 11 with grade II, 2 with grade III, 4 with grade IV, and 3 with grade V according to Lown's classification. The remaining 27 patients were free of cardiac arrhythmias. Mean daily heart rate ranged from 54-93 beats/min (73 +/- 8.44, mean +/- SD) and corrected QT from 336-494 ms (411 +/- 37.17). Daily adrenaline and noradrenaline excretion for the whole group of patients were 0.01-16.2 micrograms (2.1 +/- 2.38) and 1.6-31.0 micrograms (13.1 +/- 7.27), respectively, which was within normal range. However, the patients with serious ventricular arrhythmias showed significantly higher daily adrenaline excretion. Individual analysis of two-thirds of patients with ventricular arrhythmias grade III-V showed daily urine noradrenaline levels exceeding mean values for the whole group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Effect of beta adrenergic blocking drugs on the prognostic value of ST-segment depression during exercise electrocardiogram testing].

Exercise testing has been shown to be predictive for future cardiac events in patients with established diagnosis of coronary heart disease. Exercise test parameters associated with poor prognosis may be unreliable if patient is receiving beta adrenergic agents. The purpose of this study was: 1) to compare the results of exercise testing performed before and during beta blocking therapy, and 2) to determine the role of beta blockers in the prognostic significance of the ST-segment response recorded during exercise testing. The study population consisted of 518 patients (mean age 52 +/- 7 years) with coronary heart disease. The diagnosis was based on the presence of one of the following three criteria: 1) typical history and significant ST-segment depression on resting or exercise electrocardiogram, 2) history of myocardial infarction, 3) significant coronary angiographic abnormalities. In all patients symptom-limited exercise test was performed before and two weeks after the onset of beta blocker therapy. The data from the first and second tests were estimated for significance of differences between the mean values with following results: maximal heart rate--135 +/- 21 and 123 +/- 19 bpm (p less than 0.001), maximal work load achieved--98 +/- 43 and 109 +/- 44 W (p less than 0.001), maximal systolic blood pressure--171 +/- 28 and 163 +/- 26 mmHg (p less than 0.001). Occurrence of characteristic ST-segment depression was more frequent during the first than during the second test (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1992

[Does the appearance of pro-arrhythmic response to anti-arrhythmic drugs have prognostic significance?].

Study was undertaken to assess whether proarrhythmic response to antiarrhythmic drug is a risk factor for cardiac death in patients (pts) with ischaemic heart disease (IHD). In 782 pts with IHD and frequent and/or complex ventricular ectopic beats (VEB) 1041 drug tests guided by 24 hour Holter monitoring were conducted. The following drugs were assessed: propranolol, disopyramide, mexiletine, amiodarone. Pro-arrhythmia was defined according to Velebit: 1/greater than or equal to 4-fold increase in VEBs, 2/greater than or equal to 10-fold increase in repetitive forms of 3/new occurrence of ventricular tachycardia or ventricular fibrillation (VT/VF). Proarrhythmic effect was observed in 8.4% of pts and in 7.9% of drug tests. The frequency with individual drugs ranged from 5.7% to 9%. No drug was completely free of this type of reaction. Antiarrhythmic drugs inducing arrhythmogenic response were eliminated. Pts were followed-up for a mean of 22 months (range 1-49). Chronic antiarrhythmic treatment was conducted. Pts were discharged taking the agent deemed most effective for suppression of arrhythmia. Follow-up visits were made every 6-12 months. All cases of death were verified. In long-term observation cardiac death and sudden death occurred in 53 and 32 pts. With actuarial analysis (Kaplan-Meler method, log rank test) there was significant difference in cardiac death (p less than 0.05) of pro-arrhythmia (+) compared with ++pro-arrhythmia (-) pts at yr (11% v 4%, 7% v 3%) and 3 yr (24% x 11%, 16% v 7%). The relative importance of baseline clinical variables in predicting survival was assessed with a stepwise Cox regression.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Arrhythmia Agents↗
PubMed1991

Proarrhythmic response to antiarrhythmic drug as a risk factor for sudden cardiac death in patients with ischemic heart disease.

The prognostic significance of arrhythmogenic response to an antiarrhythmic drug was studied. In 782 patients with ischemic heart disease (IHD) and frequent and/or complex ventricular premature beats (VPBs), 1,041 drug tests guided by 24-hour Holter monitoring were conducted. The following drugs were assessed: beta blockers, disopyramide, mexiletine, amiodarone. Proarrhythmia was defined as: (1) greater than 4-fold increase in VPBs, (2) greater than 10-fold increase in repetitive forms, or (3) new occurrence of ventricular tachycardia or ventricular fibrillation (VT/VF). During a follow-up of 1-49 months (mean 22) patients were treated with antiarrhythmic drugs found to be safe in control Holter monitoring. Proarrhythmic effects were observed in 8.4% of patients. No drug was completely free of this type of reaction. In long-term observation, cardiac death and sudden death occurred in 53 and 32 patients, respectively. With actuarial analysis (Kaplan-Meier method, log-rank test) there was a significant difference in cardiac death (P less than 0.01) and sudden death rate (P less than 0.05) of proarrhythmia (+) compared with proarrhythmia (-) patients at 1 year (11% vs 4%, 7% vs 3%) and 3 years (24% vs 11%, 16% vs 7%). Proarrhythmic response was an independent risk factor apart from myocardial infarction, VT/VF, ejection fraction less than 40% and QTc greater than 440 msec. Arrhythmogenic response to antiarrhythmic drugs seems to be an additional predictor of sudden death in IHD.

Anti-Arrhythmia Agents↗
PubMed1991

[Differences and similarities in ischemic heart disease in men and women].

Ischemic heart disease (IHD) with its most developed manifestation in the form of myocardial infarction (MI) shows certain differences in the clinical picture between men and women. Pathogenetic differences in the development of IHD between both sexes, protective effects of estrogens, genetic factors and physiology of the sex cycle in women were analyzed. Clinical significance of the selected coronary risk factors including the role of oral contraceptive agents, nicotine, arterial hypertension and professional work were discussed. We made an attempt at specifying reasons for the observed differences and determinants of an increase in morbidity due to IHD in women. The validity of present recommendations for women with the risk for the development of IHD and MI was evaluated.

Adult↗
PubMed1990

[Complex ventricular arrhythmias in ischemic heart disease].

The purpose of the study was to describe the clinical picture in patients with ischemic heart disease (IHD) and verifying severity of ventricular arrhythmias. The study included 856 patients with IHD aged 23-88 years (mean = 55.3), including 659 men and 197 women. Holter monitoring was performed in all patients. Ventricular arrhythmias were graded according to Lown. The patients were divided into five groups: group 1-349 patients with Lown's grade 1 and 2; group 2-95 patients with grade 3; group 3-152 patients with grade 4a and 4b; group 4-11 patients with grade 5; group 5-507 patients (selected from groups 2, 3 and 4) with Lown's grade 3 and 4 or 5. Arterial hypertension was found in 17.1%, myocardial infraction in 66%, and syncope in 12.3% of the patients. The patients with complex ventricular arrhythmias versus Lown's grade 1 and 2 show significant differences especially in respect to: the frequency of previous anterior myocardial infraction, the incidence of pain at rest, loss consciousness, the frequency of ventricular tachycardia and fibrillation, anginal pain and exercise-related arrhythmias. The patients with Lown's ventricular arrhythmia grade 3-5 do not differ significantly in their clinical manifestations of IHD from the patients with ventricular arrhythmias grade from 3 to 5. The development of silent myocardial ischemia during exercise stress testing is typical also for the patients with complex ventricular arrhythmias. A decreased contractility index, ejection fraction and dyskinesis are significantly more frequent in the patients with complex ventricular arrhythmias.

Adult↗
PubMed1988

Diagnostic value pharmacological autonomic blockade in patients with suspected sick sinus syndrome.

The study comprised 67 subjects, mean age 43.7 years, with suspected sick sinus syndrome, in whom rapid atrial pacing before and after combined atropine and propranolol was performed by Narula's method. Three groups were formed: group I--with normal sinus node recovery time (SNRT) and corrected sinus node recovery time (CNRT) before and after the autonomic blockade; group II--with functional disorders of the sinus node and group III--with intrinsic sinus node dysfunction. After autonomic blockade in groups I and II mean SNRT, CNRT, post-stimulation cycle lengths (except No. 2 and Nos. 5, 6, 10, respectively) shortened, whereas HR rose. In contrast, in group III mean SNRT, CNRT, post-stimulation cycle lengths (Nos. 1, 2, 6, 10) and HR increased. Significant differences in post-stimulation cycle lengths were observed between groups I and III as well as groups II and III. In conclusion, rapid atrial pacing after combined atropine and propranolol helps us to diagnose latent sick sinus syndrome and extrinsic sinus node dysfunction more precisely, and significant differences in post-stimulation cycle lengths between the groups confirm diagnostic value.

Adolescent↗
PubMed1988

Follow-up of patients with mitral valve prolapse presenting with rhythm disturbances.

The aim of the study was to analyze rhythm disturbances and clinical course in 18 patients aged 20-52 years with mitral valve prolapse. The patients were followed up for a mean of three years (range: 1-11 years). We analyzed clinical signs, resting ECG 24 hour ECG, exercise ECG, echocardiograms and the effects of antiarrhythmic treatment. One patient developed marked mitral incompetence. Supraventricular arrhythmias occurred in three patients and ventricular extrasystoles in all 18 patients (class I in 2, II in 6, III in 4, IV in 3, V in 3, according to Lown). Five patients required combined antiarrhythmic treatment. Course of pregnancy and births in two patients with mitral valve prolapse syndrome and class IV arrhythmias were uncomplicated for both the mothers and their babies. Great clinical variability of mitral valve prolapse syndrome ranging from an asymptomatic form to ventricular fibrillation is emphasized.

Adult↗