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Biomedical subjects

A Brusca

Publications and source records attributed to A Brusca.

At least 19 recordsLinked to original sources
PubMed1992

Wolff-Parkinson-White syndrome. Identification and management.

Patients with Wolff-Parkinson-White (WPW) pattern of ventricular pre-excitation may develop paroxysmal re-entrant tachyarrhythmias through the Kent bundle and, less commonly, atrial fibrillation. WPW patients are at risk of sudden death when a rapid ventricular response occurs during atrial fibrillation due to conduction through the accessory pathway. Conduction properties of the accessory pathway and atrial vulnerability, which is the propensity to develop atrial fibrillation, are important parameters for evaluation in these patients. The former can be assessed by means of noninvasive tests, such as stress and pharmacological tests, and with electrophysiological study; the latter only by electrophysiological study. There is no indication for treatment of asymptomatic patients. Antiarrhythmic prophylaxis is required in patients with previous episodes of atrial fibrillation with rapid ventricular response, in patients with paroxysmal re-entrant tachycardias and rapid conduction through the accessory pathway, and in patients with frequent episodes of re-entrant tachycardias of long duration. Vaughan-Williams class IC anti-arrhythmic drugs (propafenone, flecainide) are the first choice for drugs in patients with rapid anterograde conduction through the accessory pathway due to their high efficacy and low incidence of adverse effects, while beta-blockers (atenolol, nadolol) are indicated for patients with re-entrant tachycardias and low conduction capacity through the bypass tract. When pharmacological therapy is ineffective, surgical or catheter ablation of the accessory pathway may be considered.

Arrhythmias, Cardiac↗
PubMed1992

[The use of ergonovine in the hemodynamics laboratory].

In our department we have reviewed the use of ergonovine maleate as a provocative agent for inducing coronary spasm during coronary arteriography. From January 1978 to December 1991 the test has been performed in 116 patients. According to their symptoms, the patients were divided into 4 groups: (A) patients with exertional angina: 16 patients (13.8%), (B) patients with angina at rest: 64 patients (55.2%), (C) patients with atypical chest pain: 29 patients (25%), and (D) patients with previous myocardial infarct: 7 patients (6%). We have subdivided the patients with angina at rest, according to the electrocardiogram recorded during pain, into: (1) 16 patients with ST-segment elevation; (2) 14 patients with ST-segment depression or T wave inversion; (3) 5 patients with electrocardiogram unchanged during angina; (4) 29 patients with no electrocardiogram recorded during angina. In 67 patients (57.7%) the coronaries were normal, 17 patients (14.6%) had mild irregularities, 26 patients (22.4%) had non critical fixed obstructions (< or = 70%), and in 6 patients (3.5%) there were fixed coronary narrowings > or = 70%. The left ventricle was normal in 85 subjects (73.2%), hypo or akinetic in 31 (26.8%). After routine coronary angiography and ventriculography, ergonovine maleate, 0.05 up to 0.4 mg, was given intravenously. The ergonovine test was considered positive when a focal spasm narrowed a normal coronary artery, or one with a mild fixed obstruction (< or = 50%) to more than 70%, or when a 70% stenosis became occluded. The development of angina and/or electrocardiographic changes were not taken as a criteria of positivity. Thirteen tests (11.2%) were considered positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Propafenone versus hydroquinidine in long-term pharmacological prophylaxis of atrial fibrillation].

New antiarrhythmic class 1C agents have been proposed in the last few years in an attempt to suppress paroxysmal atrial fibrillation at long-term, as the most commonly used class 1A agents such as quinidine gave highly variable results as regards both side-effects and efficacy. The aim of this randomized prospective study is to evaluate the efficacy and safety of oral propafenone at long term in preventing paroxysmal atrial fibrillation and to compare the results with those obtained using agents such as quinidine. Two hundred patients with recurrent episodes of symptomatic atrial fibrillation were enrolled for this study with entry criteria based upon a history of more than 3 crises in the previous 6 months, with electrocardiographic (standard electrocardiogram or dynamic registration) documentation. According to a randomized selection either propafenone at 300 mg twice daily or hydroquinidine retard 250 mg twice daily were administered to the patients; clinical check-up was carried out every 3 months or if clinical course worsened. The dosages were increased if proved to be inadequate at check-up (i.e. recurrence of atrial fibrillation) up to 300 mg 3 times daily for propafenone and 500 mg twice daily for hydroquinidine. The efficacy at the 3rd month was 71% for propafenone and 60% for hydroquinidine, at the 6th month 60% for propafenone and 56% for hydroquinidine; this trend lowered progressively as the follow-up continued, to 48% for propafenone and 42% for hydroquinidine (NS). More than 70% of the responder patients assumed 600 mg twice for propafenone or 250 twice for hydroquinidine. Propafenone had a percentage of 10% side-effects and hydroquinidine 24% (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[The Study Group of Quinapril in Arterial Hypertension. The Steering Committee].

The efficacy and safety of the treatment of arterial hypertension with the ACE-inhibitor quinapril, were evaluated in a multicentre study conducted in Italy. The study, lasting 14 weeks, after a preliminary wash-out period, allowed response-based titration of quinapril dose from 10 mg to 40 mg once a day, with provision to combine additional hydrochlorothiazide (12.5 to 25 mg), in case of persistently high diastolic pressure levels. The efficacy sample included 1267 patients: at therapy week 14, 78.6% of patients were treated with quinapril alone. Global response rate (intent-to-treat) was 83.3%, with a mean reduction of diastolic pressure of 15.8 mmHg (95% confidence interval from 15.5 to 16.2 mmHg). 91 patients reported 126 associated adverse events (7.0%); the most frequently reported event was cough (2.7%). First-dose hypotension was rarely reported (1.3%), even in elderly and diabetic patients.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

[ Bacterial endocarditis of the pulmonary valve damaged by thoracic radiotherapy (in Hodgkin's disease)].

It is well known that radiation therapy to the anterior mediastinum may induce lesions of all cardiac structures. The pericardium is most frequently involved, but atrioventricular conduction disorders, cardiomyopathy, coronary stenosis may also be produced. Aortic, mitral and tricuspid lesions have been described. However, clinical evidence of pulmonic valve involvement has not been reported. Only at necropsy has fibrotic thickening of the pulmonic cusps occasionally been found. We report a case of infective endocarditis of the pulmonic valve in a 53-year-old patient who had undergone thoracic radiation therapy for Hodgkin's disease 31 years previously. Four years prior to the endocarditis he had also been submitted to myocardial revascularisation for critical lesions of the left main and right coronary ostia, and to aortic valve replacement because of stenosis and insufficiency. At that time, the pulmonic valve was fibrotic on echo examination. It is noteworthy that, of all the cardiac valves, the infective process involved only the pulmonic one, which is seldom the target of an infection. To our knowledge this is the first case of bacterial endocarditis of a heart valve that had been previously damaged by radiation therapy.

Aortic Valve↗
PubMed1991

Intracoronary streptokinase in unstable angina: a prospective randomised study.

Results of our prospective, randomised pilot trial to evaluate the clinical effects and the angiographic correlates of early thrombolysis in patients with unstable angina are reported. Sixty-seven patients had coronary angiography 10 +/- 8 (median 7) hours after an episode of transient chest pain at rest with reversible ischaemic changes on the electrocardiogram. Patients with left main disease (4), or diffuse coronary disease and unidentified ischemia-producing lesions (13) were excluded, as were those without severe (greater than or equal to 70%) stenosis (10). Intracoronary thrombus was identified at angiography in 7 patients (17%) and complex coronary lesions in 5 (12%) of the remaining 40 patients who were randomised to either intracoronary streptokinase 250,000 IU followed by intravenous heparin along with conventional treatment (20 patients), or to conventional treatment alone (20 patients). All patients received Aspirin. No differences between the streptokinase and the conventional treatment groups were observed with respect to demographic and clinical characteristics at admission to the study. During observation in the intensive care unit for 3 +/- 1 days, 8 patients (40%) with streptokinase and 10 (50%) with conventional treatment were free from angina and infarction (p = 0.75; 95% confidence interval for the difference in response rates = -20 to 40%). There were no bleeding complications and no patient died. Patients enrolled in our study had fewer coronary thrombi at angiography than currently reported. Our data did not show that adjunct treatment with streptokinase and heparin is superior to conventional treatment alone in these patients.

Aged↗
PubMed1991

[Rapid onset aortic stenosis and clinical course in adults. Clinico-hemodynamic correlations].

In 8 patients aged 41-66 years, a second left heart catheterisation done 27-98 months after the first study, demonstrated a pressure gradient across the aortic valve, that had not previously existed, or had been trivial. No significant change of the cardiac output had occurred. All but 1 patient were hypertensive. The etiology was rheumatic in 4, degenerative in 4. Electrocardiographic, radiographic, and echocardiographic evolution could not separate the patients with a gradient greater than or equal to 70 mmHg from those whose gradient was less than or equal to 40 mmHg. The intensity of the aortic component of the second heart sound, however, decreased in all former patients, and in only 1 of the latter. Aortic valvular stenosis can arise and rapidly develop in adult patients. Concomitant rheumatic mitral valve disease, coronary artery disease and hypertension can mask and/or modify symptoms, signs and laboratory findings. Changes of the aortic component of the second sound may suggest its occurrence.

Adult↗
PubMed1991

[Nonpharmacological therapy of supraventricular arrhythmia].

Between 1985 and 1990, 1242 patients with supraventricular arrhythmias were followed-up at our Institution. Six hundred and twenty patients had atrial fibrillation or flutter; 7 of them (1%) underwent modulation of atrioventricular conduction. Four hundred and twenty-eight patients had ventricular preexcitation; in 23 (5%) surgical or transcatheter ablation of an accessory pathway were performed. Atrioventricular node reentrant tachycardias were diagnosed in 111 patients; 8 patients (7%) underwent antitachycardia pacemaker implantation. Surgical and catheter ablative techniques eliminate the substrate of the tachycardia; death and complete A-V block (paraseptal pathways) are at this moment rarely reported. Antitachycardia pacemakers do not offer a definitive therapy. For their safeness and effectiveness they are still indicated in patients with A-V node reentrant tachycardias, until technological development will reduce the risks of ablative techniques.

Arrhythmias, Cardiac↗
PubMed1991

[Thromboembolic pulmonary hypertension].

Pulmonary hypertension due to recurrent thromboembolism is a rare disease but life-threatening. We evaluated 18 patients (11 female, 7 male) with this pathology between 1973 and 1991. We compared clinical features and evolution of our patients with the ones of the literature. The mean interval between beginning of symptoms and diagnosis was 5 years (range 1-10 years) and the most frequent symptom was increasing dyspnoea. In 2 of our patients there were well definite predisposing causes for thromboembolism (intracardiac catheters), 6 of the others had a previous episode of acute pulmonary embolism. Mean pulmonary arterial pressure was 50 mmHg and low output was present in 8 of these. Lung perfusion scintigraphy was diagnostic in 98% of cases showing segmental defects and pulmonary angiography confirms diagnosis revealing abrupt cut-off of cases showing segmental defects and pulmonary angiography confirms diagnosis revealing abrupt cut-off a major pulmonary artery. Angiographic evaluation of thrombus extent and location was difficult. In a small number of patients was found lupus anticoagulant, deficiency of protein C, of protein S and of antithrombin III. Mortality in medical treatment was 39% at a mean follow-up of 4-5 years. Progression of pulmonary hypertension was due to recurrent pulmonary embolism only in 30-40% of cases. The role of caval filter is not well established. Thromboendarterectomy shows immediate good results at short time but the long-term results are not known.

Adult↗
PubMed1991

[Heparin activity during percutaneous coronary angioplasty].

In the experimental model of porcine carotid artery angioplasty, whenever a deep lesion--involving the media--is produced, thrombus deposition invariably follows. It has been shown that the thrombus formation can be prevented by heparin administration, albeit at higher doses than usually employed in the clinical setting. In patients with unstable angina and acute myocardial infarction there appears to be a hitherto ill-defined thrombogenic state and, in fact, percutaneous transluminal coronary angioplasty is still plagued by a higher incidence of acute reocclusion in such conditions. It appears reasonable to infer that during percutaneous transluminal coronary angioplasty higher dose of heparin should be infused, under close monitoring, particularly in such patients. However, at the moment this remains an unproven hypothesis that needs careful clinical testing.

Angioplasty, Balloon, Coronary↗
PubMed1990

Relation between spontaneous atrial fibrillation and atrial vulnerability in patients with Wolff-Parkinson-White pattern.

An intracavitary electrophysiological study was carried out on 103 patients with Wolff-Parkinson-White (WPW), 23 symptomatic patients had documented episodes of atrial fibrillation, 54 symptomatic patients had atrioventricular reentrant tachycardias, and 26 asymptomatic. Patients were examined for the relation between spontaneous atrial fibrillation and atrial vulnerability, defined as the possibility to induce sustained (greater than 1 minute) episodes of atrial fibrillation with a stimulation protocol excluding atrial bursts. Atrail fibrillation induction was attempted by single and double atrial extrastimuli during pacing at two different cycle lengths and incremental atrial pacing. Sustained atrail fibrillation was induced in 65% of the patients with spontaneous atrial fibrillation, and in 13% of the symptomatic patients with documented episodes of atrioventricular reentrant tachycardias and in 15% of the asymptomatic patients (P less than 0.0005). Atrial vulnerability was higher in patients with spontaneous atrial fibrillation than in patients without this arrhythmia. No significant difference was observed between symptomatic without atrial fibrillation and asymptomatic patients.

Adult↗
PubMed1990

[The midterm clinical results of myocardial revascularization with the internal mammary artery].

After a 3-year (1985-1988) experience of myocardial revascularization using internal mammary artery (AMI) grafts and after having excluded (1986) an higher operative mortality and morbidity, clinical medium-term results have been analysed. The first 144 patients discharged alive after AMI bypass surgery in 1985 were clinically evaluated, with a mean interval of 21 months from surgery (range: 5-29 months). Exercise electrocardiographic test was performed by 100 patients, and angiography repeated in 15. Actuarial survival function was estimated by Cutler-Ederer method: 2-year actuarial survival was 99.3 +/- 0.7% (94 +/- 1.8%, when operative deaths were included). Non fatal myocardial infarction occurred in 3 patients and, at follow-up, 26 were symptomatic for angina: 2 patients underwent re-operation and 2 angioplasty. Two years after AMI bypass surgery, actuarial estimate of ischemic event-free patients was 70.9 +/- 4.5% (67.7 +/- 4.5%, when operative deaths were included): 73 out of 100 exercise tests were negative for both angina and ischemia, although only 43 patients, reached maximal work load; 9 were positive for both angina and ischemia and 18 for ischemia only. All patients who underwent angiographic evaluation (15 patients, 11 of whom because of angina relapse) had AMI grafts open, while in only 4 patients all the implanted grafts were open.

Aged↗
PubMed1990

[Spectral analysis and color-coded Doppler study of the changes in aortic regurgitation induced by vasodilators in asymptomatic patients with severe aortic insufficiency].

The acute effects of 20 mg of sublingual nifedipine in 12 patients with chronic severe aortic regurgitation were evaluated with M-mode echocardiography, continuous wave and colour Doppler. After nifedipine, heart rate increased from 68 +/- 8 to 82 +/- 11 beats/m' (p less than 0.001); arterial systolic and diastolic pressures decreased from 143 +/- 16 to 129 +/- 9 mmHg (p less than 0.01) and from 61 +/- 11 to 53 +/- 17 mmHg (p less than 0.01) respectively. Left ventricular systolic and diastolic diameters also decreased from 50 +/- 4 to 46 +/- 4 mm (p less than 0.01) and 76 +/- 6 to 72 +/- 6 mm (p less than 0.01) respectively; the slightly increase in fractional shortening which occurred was not significant. The aortic systolic and diastolic velocity integrals decreased from 38 +/- 9 to 34.7 +/- 8 cm (p less than 0.01) and from 203 +/- 41 to 163 +/- 29 cm (p less than 0.001); the diastolic slope of the velocity curve increased a little but significantly: from 334 +/- 70 to 394 +/- 70 cm/sec2 (p less than 0.01). With colour Doppler, protodiastolic jet areas decreased by 19% in the long parasternal view (p less than 0.01), by 28% in the apical view (p less than 0.001), by 26% in the short-axis view (p less than 0.01); the length of the jets in the long parasternal view decreased by 14% (p less than 0.001), but the height did not change significantly. Positive changes from acute nifedipine administration are present in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1990

[Induction of atrial tachyarrhythmia in patients with Wolff-Parkinson-White syndrome with and without spontaneous atrial fibrillation].

The purpose of this study was to examine the relation between spontaneous atrial fibrillation and the induction of atrial tachyarrhythmias during electrophysiologic study in patients with Wolff-Parkinson-White, with and without atrial fibrillation. Intracavitary electrophysiologic study was performed on 115 patients, 27 with spontaneous atrial fibrillation (group 1), 57 symptomatic due to AV re-entrant tachycardias, without spontaneous atrial fibrillation (group 2) and 31 asymptomatic (group 3). Induction of atrial fibrillation was attempted by using single and double atrial extrastimuli during atrial pacing at 2 different cycle lengths and by incremental atrial pacing (protocol A). When atrial fibrillation was not obtained, atrial bursts were added (protocol B). Atrial fibrillation or flutter were induced in 81% of group 1.54% of group 2 and 55% of group 3 patients (p less than 0.05), using protocol A. They were induced in 100, 75 and 71%, respectively (p = 0.01), with protocol B. Considering only sustained (greater than 1 minute) episodes, atrial fibrillation or flutter were induced in the three groups with protocol A in 74, 33 and 32% of the patients, respectively (p less than 0.001). The difference in the three groups was even greater when atrial fibrillation was considered separately from atrial flutter. The reason for this was that atrial fibrillation was induced in two thirds of group 1 patients, while only about 15% of patients without spontaneous atrial fibrillation had this arrhythmia induced. Our results suggest that the induction of sustained atrial fibrillation is a useful parameter to separate Wolff-Parkinson-White patients with from those without spontaneous atrial fibrillation. Due to the low specificity of the analysis of the shortest R-R interval during induced atrial fibrillation for the identification of the patients at risk of sudden death, the induction of sustained atrial fibrillation could be proposed as an additional parameter. This would improve the specificity of electrophysiologic study.

Adult↗
PubMed1989

Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syndrome at risk of sudden death.

Noninvasive stress and pharmacologic tests with procainamide and propafenone were studied as methods to identify patients with Wolff-Parkinson-White syndrome (WPW) who would otherwise be judged at risk of sudden death on the basis of electrophysiologic criteria: the shortest RR interval during induced atrial fibrillation less than or equal to 250 ms or accessory pathway anterograde effective refractory period less than or equal to 250 ms. Sixty-five patients were studied. Twenty-four patients fulfilled the electrophysiologic risk criteria (group A) and 41 patients fulfilled none of these criteria (group B). Persistence of preexcitation during stress test showed a sensitivity of 96% and a specificity of 17% to identify group A patients; its positive predictive value was 40% and negative predictive value 88%. With both procainamide and propafenone tests persistence of preexcitation identified group A patients with a sensitivity of 96% and a specificity of 51%; their positive and negative predictive value were, respectively, 53 and 95%. Stress and pharmacologic tests have good sensitivity and negative predictive value, but low specificity and positive predictive value.

Adolescent↗
PubMed1989

Right ventricular dysplasia: radioisotopic angiography.

To evaluate if regional wall motion (RWM) abnormalities detected at rest in patients with high presumption of right ventricular dysplasia (RVD) are confirmed by stress test and could be considered of diagnostic value in the clinical setting of the disease, 12 patients underwent first-pass radionuclide angiography (RA) at rest and during exercise. The mean global right ventricular ejection fraction (EF) was 29.83 +/- 7.91 at rest; during exercise, we found a non-significant increase (32.16 +/- 9.8, P greater than 0.05). Six segments with systo-diastolic dyskinesis, three segments with diastolic dyskinesis, and 10 segments with akinesis at rest confirmed the same degrees of dysfunction during exercise. Eight of the 15 hypokinetic segments at rest showed normal function during exercise; the remaining seven confirmed the same degree of dysfunction during exercise. We conclude that various degrees of RWM abnormalities are found in all patients with RVD; hypokinetic dysfunction has to be confirmed by exercise. RWM abnormalities are not specific for RVD, and clinical and electrophysiological data should be combined to obtain as much evidence as possible for diagnosis.

Adolescent↗
PubMed1989

[Long-term variability in unsustained ventricular arrhythmias: pharmacologic and pro-arrhythmic effect].

A 72% reduction in the number of premature ventricular complexes, a 75 and 65% reduction in pairs and repetitive forms, respectively, are commonly accepted criteria for the evaluation of the efficacy of short-term antiarrhythmic treatment. On the other hand, a three-to-ten fold increase in the frequency of premature ventricular complexes is considered as a proarrhythmic effect. The aim of this paper is to verify if these criteria can still be applied on a long-term basis. Twenty-eight subjects without a demonstrable underlying organic heart disease and 21 patients with stable chronic ischaemic heart disease were studied. All patients showed more than 30 premature ventricular complexes per hour during ambulatory electrocardiogram monitoring. The spontaneous long term variability of ventricular arrhythmias was evaluated by comparing the first of three consecutive 24-hour ambulatory ECGs at the beginning of the study with a 24-hour ECG monitoring at the end of a 24-month follow-up period. According to the previous criteria about 50% of patients showed a spontaneous reduction in the number of premature ventricular complexes (greater than 72%) mimicking a therapeutic effect if any drug had been given. The increase in ventricular arrhythmias mimicked a proarrhythmic effect in almost 10% of patients. This trend is substantially the same both in subjects without organic heart disease and in patients with chronic coronary artery disease. The results of this study demonstrate that the initially established criteria used to judge the efficacy or the proarrhythmic effect of a given drug cannot be relied upon on a long-term basis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗