[Proceedings: Sick sinus syndrome. (II). Automatic heart function test].
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The clinical evaluation of cardiac function by non-invasive means with the help of radioactive isotopes registering minimal cardiac transit times (MTTs) is increasingly employed in routine diagnosis. In order to economise on work load and time expenditure and for the purpose of an objective and complete evaluation of data, automatic data processing is desirable. This paper describes a program that consists of 4 sections: 1. examination 2. generation of data 3. processing of data 4. evaluation of data. The program permits a nearly total automated data generation, analysis, calculation, classification, final clinical evaluation and the automated production of a medical report. This greatly reduces the time spent per examination to approximately 5 minutes. The automated evaluation of the data is based on clinical experience with approximately 3.500 measurements in patients with the most frequent cardiac diseases. The result is an objective statement of causes of MTT changes and is highly useful for medical routine application. The control and the final inclusion of the findings into the spectrum of other clinical results remains the subject of the physician's judgement. The advantage of the method is the evaluation of all cardiac segments. This pertains to the evaluation of both atria and both ventricles, as well as of the entire central circulation with and without participation of the lung.
The authors submitted to electrophysiological examination a total of 100 patients (66 men and 34 women) with brief disorders of consciousness where they ruled out extracardiac causes of unconsciousness, impaired blood flow through the heart and the syndrome of s-a node dysfunction. Forty-three subjects had severe arrhythmias during ECG monitoring in bed or by Holter's system (20 subjects paroxysms of ventricular tachycardia, 14 subjects ventricular extrasystoles according to Lown class 3-5, six subjects had transient high-grade a-v blocks, three subjects had symptomatic paroxysms of supraventricular tachycardia). In 57 patients ECG monitoring did not reveal ectopic arrhythmias and high-grade a-v blocks. Invasive examination confirmed or diagnosed arrhythmic syncopes in 49% of the entire group of 100 patients. It assessed the arrhythmic cause of syncopes in 33% of 57 subjects without severe arrhythmias and in 70% of 43 subjects with severe arrhythmias detected during ECG monitoring.
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In 81 patients with an ischaemic heart disease and myocardial infarction the evidence of the presphygmic index PI (non-invasive index) was tested concerning a beginning myocardial functional disturbance and a latent heart insufficiency, respectively, with the help of an invasive cardiopulmonary functional diagnostics which was performed under dosed bicycle ergometer load in the steady state. The presphygmic index PI correlates in significantly positive way with the end-diastolic pressure of the heart and the quotient from minute volume of the heart and the end-diastolic pressure of the pulmonary arteries (VM/PAEDP). The presphygmic index is on the basis of this correlation of the left-ventricular function suitable to establish disturbances of the myocardial functions and to give the possibility of a separation of the patients in cardially sufficient and cardially insufficient ones. Here the evidence of the presphygmic index might be larger concerning the recognition of a latent heart insufficiency than concerning the recognition of beginning myocardial functional disturbances. The presphygmic index apparantly possesses a high degree of sensibility then, when the myocardial functional disturbances coincide with a beginning reduction of the pumping action of the heart.
Twenty normal subjects and 25 patients with coronary artery disease underwent systolic time interval analysis before and after rapidly smoking two cigarettes. A slight increase in heart rate and arterial pressure was seen in both groups. In patients with coronary artery disease, preejection period/left ventricular ejection time ratio increased; in normal subjects it decreased. Left ventricular performance is diminished after cigarette smoking among subjects who have preexisting significant coronary artery disease.
1. An exercise test has been developed which is suitable for elderly or frail subjects. It is based on free walking at three different speeds on a level indoor course of 256m. The subject sets his own pace in accord with simple instructions. 2. Twenty-four elderly men and ten young men took part in the study. 3. The time and number of paces taken to cover two sections of 100m within the course were used to establish that the subjects walked steadily. Walking speed, pace frequency and stride length were then calculated. 4. Heart rate was obtained with body-borne tape recorders and related to the walking speed. The heart rate at a standard walking speed could then be obtained by interpolation. This is an assessment of the cardiovascular response to exercise (physical condition). The variation on repeating the test was +/-5 per cent and there was no significant difference between the two age groups. 5. The assessment was found to correlate moderately well with a conventional assessment of physical condition based on oxygen uptake from tests on a bicycle ergometer. 6. The test could also be used as a performance index since walking speed was characteristic for the subject. The younger group walked significantly faster than the older group. As a performance index the test is therefor sensitive to age differences.
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The hemodynamic effects of nifedipine and propranolol administered intravenously were studied in 17 patients with angina pectoris. Nine patients received nifedipine and eight received propranolol. The hemodynamic parameters were compared at rest and during supine bicycle exercise at work loads known to produce angina. Exercise-induced angina improved in four out of nine patients following nifedipine and in one out of eight patients following propranolol. Nifedipine significantly reduced the increment of left ventricular end-diastolic pressure and Vmax during exercise. Intravenous propranolol significantly suppressed the increment of heart rate, max dp/dt, tension time index, and Vmax during exercise. Although the exact mode of action of nifedipine remains uncertain, it is suggested that it decreases myocardial oxygen requirements primarily through a reduction of left ventricular volume, whereas propranolol suppresses the positive chronotropic and inotropic responses of the heart muscle to exercise.
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Advanced or second-degree atrioventricular (AV) heart block pre-existing or developing during atrial pacing (AP) at low heart rates of smaller than 130 per minute, limits the value of AP to stress the left ventricle. When Wenkebach type AV block is present, the heart rate can be increased by administration of atropine before atrial pacing or by right ventricular pacing. Atropine, however, occasionally may cause serious supraventricular or ventricular arrhythmias, and high rate right ventricular pacing is not tolerated by many patients with left ventricular dysfunction because of the absence of the atrial contribution. Twenty-eight out of 101 patients with angina pectoris (27.7 percent) developed second degree AV heart block during atrial pacing studies performed for evaluation of left ventricular function. In 8 of the 28 patients, sequential AV pacing (SP) was performed successfully, with the heart rate being increased to 150-167 per minute. In 4 of the 8 patients, left ventricular dysnfunction was demonstrated during and immediately after SP. Typical angina pectoris developed in two of the four patients during SP, one of whom proved to have normal coronary arteriogram. Sequential AV pacing is an alternative method to increase the heart rate for the purpose of stressing the left ventricle when advanced degree or second-degree AV heart block pre-exists or develops during right atrial pacing. In some patients the method of SP might be preferable to administration of atropine or to ventricular pacing.
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