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PubMed2006

Symptomatic intracerebral hematomas in posterior circulation stroke patients anticoagulated with heparin.

BACKGROUND: A lot of clinicians use heparin in patients with posterior circulation stroke. Frequency and risk factors of symptomatic intracerebral hematoma (ICH) in posterior circulation infarct patients anticoagulated with unfractionated heparin are not known. METHODS: To determine the incidence and the risk factors of the heparin-related ICH in posterior circulation infarct patients, we retrospectively reviewed the clinical features of 37 patients who had acute posterior circulation infarct and received intravenous heparin after they underwent brain computed tomographic scans and diffusion-weighted imaging (DWI). Follow-up brain scans were obtained at any time if clinical symptoms worsened. Volumes of acute posterior circulation infarction were calculated on DWI. RESULTS: Of 37 patients, four (10.8%) developed symptomatic ICH during heparin infusion. The location of ICH was cerebellum in all the hemorrhagic worsening patients. We found that the size of an acute infarction calculated on DWI is the risk factor of symptomatic ICH during intravenous heparin therapy in patients with posterior circulation infarct. CONCLUSIONS: Until a large prospective study is performed, it may be prudent to avoid heparin infusion in patients with large posterior circulation infarct documented on DWI.

Aged↗
PubMed1999

Symptomatic Ventricular Tachycardia.

The approach to patients with symptomatic ventricular tachycardia (VT) depends on the presence and type of structural heart disease. In patients with underlying heart disease and ventricular fibrillation or sustained symptomatic VT with hemodynamic compromise, the implantable cardioverter-defibrillator (ICD) is superior to antiarrhythmic drugs for the improvement of overall survival. These patients should receive an ICD unless contraindications are present. For patients with sustained VT and a structurally normal heart (idiopathic VT), radiofrequency catheter ablation is a reasonable option. If patients are symptomatic, nonsustained VT should be treated with beta-adrenergic blocking agents or antiarrhythmic drugs, which should be selected on the basis of the underlying cardiovascular substrate. In patients with coronary artery disease, depressed left ventricular function, and nonsustained VT, we recommend the use of programmed electrical stimulation for additional risk stratification. If a sustained ventricular arrhythmia is induced, an ICD should be implanted.

Journal Article↗
PubMed1982

High prevalence of symptomatic bradyarrhythmias due to atrioventricular node-fascicular and sinus node-atrial disease in patients with mitral anular calcification.

Mitral anular calcification (MAC) is associated with high frequency of conduction defects. To delineate this association in patients with symptomatic bradyarrhythmias, 68 consecutive patients requiring pacemakers (group I) and 56 matched controls (group II) were studied. The patients comprised 41 men and 27 women, whose ages ranged from 24 to 92 years (mean 68). The control group consisted of 56 subjects without bradyarrhythmias, whose ages ranged from 30 to 86 years (mean 70); there were 36 men and 20 women. MAC was detected in 59 patients (87%) with symptomatic bradyarrhythmias compared with 8 subjects (14%) in the control group. In group I, 15 patients (22%) had complete atrioventricular block, 23 patients (34%) had atrial fibrillation with slow ventricular response, and 30 patients (44%) had intermittent sinus arrest. The incidence of MAC was similar among these subgroups (93%, 83%, and 87%, respectively). Thus the present study confirms the strong association of MAC with symptomatic bradyarrhythmias.

Adult↗
PubMed1976

Value of Holter monitoring in assessing cardiac arrhythmias in symptomatic patients.

Holter electrocardiographic monitoring in 55 symptomatic patients with syncope, palpitations or dizziness uncovered significant arrhythmias in 30 patients (55 percent). By providing an observation period of at least 24 hours including a period of sleep, the procedure aided detection and diagnosis in both symptomatic and asymptomatic patients of transient arrhythmias or conduction abnormalities not documented by routine electrocardiograms. Bradyarrhythmias accounted for the majority of arrhythmias recorded in 21 or 30 symptomatic patients (70 percent); 15 had sinus bradycardia (35 to 55 beats/min) alone and 6 also had long episodes of sinus arrest of up to 5 seconds. Two had sinus bradycardia with periods of atrioventricular block with Wenckebach phenomenon. Five patients had a tachycardia-bradycardia syndrome; three had other episodic arrhythmias and one had pacemaker failure. In 15 (60 percent) of the 25 patients without arrhythmias, monitoring did not document the cause of symptoms. Holter monitoring is of considerable value in assessing the efficacy and adequacy of drug treatment, especially in patients with known heart disease, and in detecting pacemaker malfunction. However, very long periods of monitoring may be needed to make a diagnosis in those with only sporadic symptoms.

Adult↗
PubMed1984

Conduction system abnormalities in symptomatic mitral valve prolapse: an electrophysiologic analysis of 60 patients.

This study examined the site of atrioventricular (AV) block in mitral valve prolapse (MVP). Sixty symptomatic patients with MVP underwent electrophysiologic study; 49 had documented arrhythmias and 28 had syncope. Eight patients had spontaneous second- or third-degree AV block and 10 had chronic bundle branch block. Electrophysiologic study revealed abnormal sinus node function in 8 patients, prolonged HV interval in 10, intra-Hisian delay in 9, and functional bundle branch block in 15. Dual AV nodal pathways were demonstrated in 24 patients. Comparison with 101 similarly symptomatic patients without MVP revealed a greater prevalence of dual AV nodal pathways in the MVP patients. Infranodal conduction abnormalities and dual AV nodal pathways are frequently revealed by electrophysiologic testing in symptomatic patients with MVP.

Adolescent↗
PubMed1986

Hemodynamic and electrocardiographic correlates of symptomatic and silent myocardial ischemia: pathophysiologic and therapeutic implications.

Numerous hemodynamic, electrocardiographic, metabolic and radionuclide measurements in various subsets of patients with coronary artery disease (CAD) reveal that ischemia does not always occur on the basis of increases in myocardial oxygen consumption. Continuous hemodynamic monitoring indicates that most episodes of myocardial ischemia are not preceded by increases in such major determinants of oxygen consumption as heart rate or blood pressure, but that these usually increase in response to the development of ischemia. The development of pain during ischemia is a late feature and most episodes are silent. There are no significant differences in the hemodynamic characteristics of symptomatic versus asymptomatic episodes of myocardial ischemia in patients with angina at rest or between those associated with ST-segment depression and those with ST-segment elevation. Continuous Holter recordings analyzed by compact analog technique in hospitalized and ambulatory patients with ischemic heart disease indicate that in both unstable and chronic stable angina, over two-thirds of myocardial ischemic episodes are clinically silent. Symptomatic and silent episodes do not differ significantly with respect to duration. Most symptomatic and asymptomatic episodes are not triggered by increases in the determinants of oxygen demand. Such episodes may arise on the basis of a critical reduction in the lumen of the diseased coronary artery leading to a primary reduction in blood flow. Intermittent obstruction due to changes in coronary vasomobility or possibly formation of thrombi may be a common mechanism for the pathogenesis of myocardial ischemia in patients with a varying spectrum of coronary artery lesions. At present, the precise clinical and prognostic significance of silent ischemia in CAD is not completely defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1986

Serum magnesium levels in symptomatic atrial fibrillation and their relation to rhythm control by intravenous digoxin.

To study the effect of hypomagnesemia on control of atrial fibrillation (AF), serum magnesium levels were determined in 45 consecutive patients with symptomatic AF; 20% were hypomagnesemic (serum magnesium less than 1.5 mEq/liter). In a blinded treatment protocol, hypomagnesemic patients required twice the amount of intravenous digoxin to effect control of AF (p less than 0.05). Underlying diagnoses, blood chemistries and the use of other medications that could affect digoxin therapy were similar for the 2 groups. Diuretic therapy before inclusion into the study was not significantly associated with hypomagnesemia. Thus, hypomagnesemia is common among patients with symptomatic AF. Moreover, it appears to interfere with the effect of intravenous digoxin on AF. These results suggest that monitoring of serum magnesium and, where necessary, replacement of magnesium deficiency may be beneficial in patients with symptomatic AF for whom digoxin therapy is being contemplated.

Adrenergic beta-Antagonists↗
PubMed1994

Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performance.

The natural history of patients with severe nonischemic mitral regurgitation (MR) from mitral valve prolapse, who are asymptomatic or minimally symptomatic and have normal right ventricular (RV) and left ventricular (LV) performance, has not been evaluated previously. To define natural history in this population and to determine if any objective variables could predict disease progression, 31 patients were followed annually with severe MR due to prolapse, who at entry were asymptomatic or minimally symptomatic and had normal RV and LV performance at rest by radionuclide cineangiography. Average follow-up in patients not reaching surgical end point was 4.7 years. The Kaplan-Meier product limit estimates were used to determine the rate of progression to either "operable" symptoms or to previously defined "high risk" ventricular performance descriptors, if the latter occurred first. Univariate comparisons of Kaplan-Meier curves and multivariate Cox proportional hazards analyses were used to define prognostically important variables measured at entry. Fourteen patients developed symptoms warranting referral for operation; none developed high-risk ventricular performance descriptors. The annual end point risk was 10.3%. Of all covariates, only change in RV ejection fraction from rest to exercise was significantly associated with disease progression. Annual risk of progression to surgical end point was 4.9% in the subgroup in which this parameter increased with exercise and 14.7% in the subgroup without an increase (p = 0.04). Patients with severe MR due to mitral valve prolapse, who are asymptomatic or minimally symptomatic with normal ventricular performance, can be expected to progress to surgical indications at an annual rate of 10.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort Studies↗
PubMed1982

Increased plasma catecholamine levels in patients with symptomatic mitral valve prolapse.

Total plasma catecholamine levels, plasma norepinephrine levels, heart rate, and systolic and diastolic pressures were measured in 15 symptomatic patients with mitral valve prolapse and in 19 normal subjects in supine baseline conditions and in a standing position. In the 15 symptomatic patients, total plasma catecholamine levels and plasma norepinephrine levels were significantly elevated in both positions, and heart rate was lower than in normal subjects in the supine position but returned to normal in the upright position. Thus, symptomatic patients with mitral valve prolapse demonstrate increased resting sympathetic tone. In addition, the associated supine bradycardia suggested that increased vagal tone might also be present at rest. These observations support the hypothesis of a dual autonomic dysfunction in these patients and could account for some of the clinical manifestations of the mitral valve prolapse syndrome.

Agoraphobia↗
PubMed1990

Management of patients with symptomatic gallstones: a quantitative analysis.

Should persons with symptomatic gallstones (i.e., those that have caused biliary pain) be treated immediately? Or may they be managed expectantly until pain recurs or a biliary complication (i.e., acute cholecystitis or pancreatitis) occurs? To assess the mortality risk of different strategies, we performed a quantitative analysis. For the expectant management strategy that requires surgery only if a biliary complication occurs, the cumulative lifetime probability of gallstone disease death in a 30-year-old man is about 2%, and most deaths occur after age 65. In comparison, elective cholecystectomy has only a 0.1% rate of gallstone disease death, but all deaths occur at age 30. The average amount of life expectancy gained by immediate cholecystectomy compared with expectant management is 52 days, which is reduced to 23 days using 5% discounting. This gain could be increased only slightly by a 100% effective and risk-free therapy such as perfected lithotripsy or medical dissolution. Results are similar for women. The results suggest that, for persons with symptomatic gallstones, the life expectancy gain of immediate cholecystectomy is relatively small and that the potential incremental gain of nonsurgical therapy is also small. For patients and physicians who believe that life expectancy is of primary consideration, the decision about therapy may be made primarily on non-mortality considerations. Some patients and physicians may decide that the risk of symptomatic gallstones is low enough that a policy of expectant management may be acceptable.

Adult↗
PubMed1991

Ultrasonographic diagnosis of symptomatic deep venous thrombosis in pregnancy.

Color flow imaging combined with compression ultrasonography were used to prospectively evaluate symptomatic patients first seen with suspected deep vein thrombosis during pregnancy. The incidence of symptomatic deep vein thrombosis (7 of 10,000 deliveries) shown prospectively by ultrasonography was similar to that of historic controls who had a diagnosis confirmed by venography (11 of 26,191 deliveries). A preferential pattern of proximal left-sided iliac or femoral vein involvement was common to both cohorts, being seen in five of the seven cases diagnosed by ultrasonography and eight of the eleven cases diagnosed by venography. We conclude that ultrasonography, consisting of compression ultrasonography and color flow imaging, can replace venography in the diagnosis and evaluation of the extent of symptomatic deep vein thrombosis during pregnancy.

Adolescent↗
PubMed1984

Complications of acute symptomatic posterior vitreous detachment.

During a ten-year period, 172 eyes of 155 patients developed acute symptomatic posterior vitreous detachments. The study included only patients examined within three months of the onset of symptoms. The patients ranged in age from 22 to 82 years, with an average age of 60 years. Of the 172 eyes, 118 (69%) developed no retinal or vitreous complications. Retinal tears occurred in 14 eyes (8%) and vitreous or retinal hemorrhages occurred in 36 eyes (21%). Seventeen patients (11%) who had acute symptomatic posterior vitreous detachment in one eye later developed acute symptomatic posterior vitreous detachment in the fellow eye. The second posterior vitreous detachment developed within two years of the first one in 15 eyes (88%). In 13 patients (76%), the second eye responded in the same manner to the posterior vitreous detachment as had the first, that is, ten pairs of eyes had no further complications, two pairs had retinal or vitreous hemorrhages, and one pair had retinal breaks.

Acute Disease↗
PubMed1996

Symptomatic tachydysrhythmias after esophagectomy: incidence and outcome measures.

BACKGROUND: Supraventricular tachydysrhythmias (SVT) after esophageal operations for carcinoma occur frequently and may be associated with increased morbidity. Prospective data on the etiology, incidence, and importance of these dysrhythmias are sparse. METHODS: In 100 consecutive patients undergoing esophagectomy without prior history of atrial dysrhythmias or receiving antiarrhythmics, we prospectively examined the effects of predefined risk factors by history and pulmonary function on the 30-day incidence of symptomatic postoperative SVT, need for intensive care unit admission, and mortality rate. RESULTS: Symptomatic postoperative SVT occurred in 13 (13%) of the 100 patients studied at a median of 3 days after operation and was accompanied by hypotension in 9/13 (69%). Univariate correlates of SVT were older age (p = 0.03), perioperative use of theophylline (p = 0.044), and a low carbon monoxide diffusion capacity (measured in 56% of patients) on preoperative pulmonary function. Patients in whom SVT developed had a higher rate of intensive care unit admission (p = 0.0001) and a longer hospital stay (p = 0.036). Although patients in whom SVT developed had a higher (p = 0.013) 30-day mortality rate, SVT was not the direct cause of death. CONCLUSIONS: These prospective data show that the true incidence of symptomatic SVT within 30 days of esophagectomy is lower than previously reported. Occurrence of SVT was associated with significant morbidity. Older age was the strongest predictor of SVT after esophagectomy. In high-risk patients, continued monitoring (48 to 72 hours) and early interventions to decrease the incidence of postoperative SVT may improve overall surgical outcomes.

Age Factors↗
PubMed1991

Responses of striatal neurons to peripheral sensory stimulation in symptomatic MPTP-exposed cats.

Extracellular single unit activity was recorded in the dorsal lateral caudate nucleus of awake cats and the responses of these neurons to somatosensory, visual and auditory stimuli were assessed. Recordings were obtained when animals were normal and when they were symptomatic for a Parkinson-like syndrome as a result of exposure to the dopaminergic toxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). In normal animals, 22% of recorded neurons responded to tactile stimulation of the face, 7% had auditory responses, 6% had visual responses, and 6% were multimodal. The post-MPTP period was divided into an 'early' period, in which cats had received several MPTP injections but still remained asymptomatic, and a 'late' period, in which cats had severe motor and sensorimotor impairments. Unit responsiveness was essentially normal in the 'early' period but grossly abnormal in the 'late' period. When animals were symptomatic, only 6% of sampled neurons had responses to somatosensory stimulation, 0.8% had auditory responses and no cells were found with visual responses. Those cells that did respond to somatosensory stimulation did so in a non-specific fashion. Symptomatic animals had 93-96% depletion of dorsal striatal dopamine and extensive loss of substantia nigra pars compacta neurons. The results suggest that sensorimotor and motor abnormalities that accompany severe loss of striatal dopamine are at least in part due to a dopamine-dependent loss of sensory processing abilities of striatal neurons.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMed1995

Alterations in pallidal neuronal responses to peripheral sensory and striatal stimulation in symptomatic and recovered parkinsonian cats.

The spontaneous activity, responses to peripheral sensory and ipsilateral caudate nucleus stimulation of globus pallidus (GP) and entopeduncular nucleus (ENTO) neurons were studied in cats while normal, symptomatic for 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced parkinsonism, and when spontaneously recovered from gross parkinsonian motor deficits. Administration of MPTP resulted in parkinsonian motor symptoms that spontaneously recovered approximately 4-6 weeks after the MPTP administration. Post-mortem dopamine levels in recovered animals was approximately 95% below levels previously measured in normal animals. In symptomatic animals, the mean spontaneous firing rate for GP units was decreased by 50% and increased by 55% for ENTO units recorded. Spontaneous firing rates for GP and ENTO units in recovered cats were not significantly different from those observed in normal cats. In normal cats, 31.4% of GP and 29% of ENTO units tested responded to tactile stimulation of the face. Only 12.2% of GP and 13% of ENTO units responded to such stimulation in parkinsonian animals while the responses were generally less specific (larger receptive fields, more bilateral receptive fields, and more responses to multiple stimulation types) than normal. In recovered cats GP and ENTO responses resembled those observed in normal cats. There was no difference in the overall percentage of pallidal units responding to striatal stimulation across the 3 experimental conditions. There was, however, an increase in the percentage of units responding with complex response sequences (i.e. decrease in activity followed by an increase in activity) in symptomatic animals as compared to normal and recovered animals. The results suggest that loss of striatal dopamine in parkinsonian animals has profound effects on the sensory responsiveness of GP and ENTO neurons and that these effects coincide with the appearance of and recovery from parkinsonian motor deficits. These data further support the notion that sensory information processing by the basal ganglia may play an important role in influencing motor output.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗
PubMedDate not supplied

Giardia lamblia: isoenzyme analysis of 19 axenic strains isolated from symptomatic and asymptomatic patients in Mexico.

Infection of the small intestine of humans with the parasitic protozoon Giardia lamblia may have an asymptomatic course, or it may produce acute or chronic diarrhoea. In order to establish if the different clinical outcome of giardiasis in children could be due, at least partially, to strain differences, 19 isolates from asymptomatic and symptomatic cases studied in Mexico City were cultured under axenic conditions and the isoenzyme electrophoretic patterns of 10 different enzymes were compared. Strains from carriers and from symptomatic cases of giardiasis were equally amenable to isolation and axenization. Isoenzyme electrophoresis demonstrated remarkable homogeneity in 7 enzyme patterns for all 19 isolates, except for phosphoglucomutase, for which 3 different zymodemes were found. Therefore, these isolates of G. lamblia, obtained from a single geographical location, tended to be genetically homogeneous. In addition, there were no consistent zymodeme differences between isolates from symptomatic and asymptomatic human infections.

Animals↗
PubMed1992

Effects of exercise test on plasma markers of an activation of coagulation and/or fibrinolysis in patients with symptomatic or silent myocardial ischemia.

It has been suggested that unstable angina at rest, like acute myocardial infarction, might be associated with a thrombotic process. In order to study the hypothesis that myocardial ischemia during exercise could also be associated with an activation of blood coagulation and/or fibrinolysis, we investigated the presence of plasma markers of a prethrombotic or thrombotic state (thrombin-antithrombin III complexes TAT, prothrombin fragment F1 + 2, and D-dimers DD) in 100 consecutive patients with confirmed or suspected coronary artery disease during ergometric test with myocardial thallium-201 scintigraphy. Symptoms and scintigrams allowed to define three groups of patients: those showing no ischemia (n = 79) and those with symptomatic (n = 8) or silent myocardial ischemia (n = 13). Before exercise, DD and TAT levels were not significantly different among the three groups. On the other hand, the F1 + 2 levels were slightly albeit significantly higher in the patients without ischemia than in the patients with symptomatic or silent ischemia. After exercise, no significant difference was found between the three groups. Exercise induced a significant and parallel increase in both the TAT and the F1 + 2 levels (but not of the DD levels) in the three groups. Thus, our study does not support the hypothesis that myocardial ischemia, silent or symptomatic, is associated with an activation of plasma coagulation and fibrinolysis that can be distinguished from the exercise-induced thrombin generation.

Adult↗
PubMed1992

Cytokines in symptomatic asthma airways.

To determine whether cytokines are generated in vivo in subjects with asthma, we have measured cytokine levels (tumor necrosis factor [TNF], granulocyte-macrophage-colony-stimulating factor [GM-CSF], interleukin [IL]-1 alpha, IL-1 beta, IL-2, IL-4, and IL-6) in the airways of subjects with symptomatic (N = 24) and asymptomatic (N = 9) asthma with immunoassays (GM-CSF, IL-1 alpha, IL-1 beta, IL-2, and IL-4) or bioassays (TNF and IL-6) and the polymerase chain reaction (IL-1 beta and TNF). Significant levels of TNF (578 +/- 917 pg/ml versus 24 +/- 29 pg/ml) (p = 0.01), GM-CSF (24 +/- 41 pg/ml versus less than 8 pg/ml) (p = 0.02), and IL-6 (225 +/- 327 pg/ml versus 7 +/- 12 pg/ml) (p = 0.01), but not IL-1 alpha or IL-4, were detected in the bronchoalveolar lavage fluid (BALF) of patients with symptomatic compared with BALF of patients with asymptomatic asthma. Levels of IL-1 beta (266 +/- 270 pg/ml versus less than 20 pg/ml) (p = 0.001) and IL-2 (1.4 +/- 2.8 ng/ml versus less than 0.3 ng/ml) (p = 0.05) in BALF in patients with symptomatic compared with that in BALF levels in patients with asymptomatic asthma suggested activation of alveolar macrophages and T cells. Thus, in episodes of asthma, several cytokines, including TNF, GM-CSF, IL-1 beta, IL-2, and IL-6 are detectable in BALF.

Asthma↗