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Biomedical subjects

A Ghahramani

Publications and source records attributed to A Ghahramani.

17 recordsLinked to original sources
PubMed1977

His bundle electrocardiography in manifest and concealed right bundle branch extrasystoles.

His bundle electrocardiography was helpful in the diagnosis of impulse formation in the right bundle branch. Ten patients with narrow QRS complexes had ectopic beats with an "incomplete" left bundle branch pattern and almost simultaneous activation of His bundle and ventricles. Both QRS morphology and H- - V intervals depended on the more proximal or distal location of the ectopic focus. In four patients with "complete" right bundle branch block the morphology of ectopic ventricular complexes and H- - V intervals also depeneded on the presence or absence of retrograde block and differential degrees of forward and/or retrograde conduction delays. Nine patients with "complete" right bundle branch block and four with "complete" left bundle branch block had premature beats which could have originated in the proximal right bundle branch, proximal left bundle branch, or distal His bundle. In one patient with "complete" left bundle branch block, "concealed" His bundle depolarizations (probably originating in an ectopic focus located in the right bundle branch) produced pseudo Type II (Mobitz) A-V block. Although lidocaine appeared to have been more effective in patients with bundle branch block than in those with narrow QRS complexes, further studies are necessary to corroborate this impression.

Adult↗
PubMed1976

The retrograde His bundle deflection: its recognition and value in the analysis of tachyarrhythmias induced by stimulation on the T wave.

Interpretation of deflections presumably retrograde His bundle in origin has to be performed in context considering the coexisting changes in simultaneously recorded intracardiac and surface leads. His bundle electrocardiography thus conceived is helpful in the analysis of the runs of ectopic beats elicited by premature ventricular stimulation during the antecedent T wave in patients without coronary artery or primary myocardial disease. Identification of AV nodal echoes within the paroxysms as well as the subsequent runs of reciprocating tachycardias, was possible in patients with and without preexcitation, although a thorough study of these cases also requires recording of coronary sinus and low lateral right atrial electrograms. The behavior of the retrograde H deflection in respect to the first extra beat following the premature QRS complex helped in excluding bundle branch reentry. The latter is improbable in patients with 'complete' bundle branch block pattern, if extra beats show a contralateral bundle branch morphology. However, in absence of bundle branch block, retrograde H deflections were not helpful in elucidating the mechanisms of pacemaker-induced intraventricular (bundle branch, fasicular or vulnerability-related) reentry.

Atrioventricular Node↗
PubMed1975

Results of direct coronary artery surgery in women.

In the past 4 years, among 260 patients receiving coronary bypass grafts for coronary artery disease and stable angina pectoris, there were 34 women (13 per cent). The operative mortality rate for women was 8 per cent (3 of 34), and one late death due to myocardial infarction occurred in spite of a patent coronary bypass graft. The intraoperative infarction rate was 20 per cent (6 per cent in men). Although preoperative cardiac pump and muscle function parameters were better in women than in men (p less than 0.05), postoperatively only 30 per cent of women showed improvement in function as compared with 50 per cent of men. At 6 to 46 months' follow-up, 84 per cent of women were free of angina in contrast with 94 per cent of men. The early (4 month) graft patency rate was 50 per cent (14 of 27 grafts), as opposed to 80 per cent (20 of 25 grafts) in men. These results indicate that, although coronary artery disease shows anatomic similarity in women and men, the result of coronary revascularization in women is inferior to that in the male population.

Adult↗
PubMed1975

Role of coronary artery surgery in patients surviving unexpected cardiac arrest.

During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.

Adult↗
PubMed1975

Coronary revascularization in patients surviving unexpected ventricular fibrillation.

Coronary angiography and hemodynamic studies were performed in a group of 13 patients who had been successfully resuscitated from unexpected ventricular fibrillation, had had angina pectoris prior to the cardiac arrest, and who had not had an acute myocardial infarction in the periarrest period. Eleven of the 13 had one or more coronary artery lesions which were amenable to surgical intervention, and eight of the 11 accepted surgery. Left ventricular end-diastolic pressure was elevated in most patients, while cardiac index and ejection fraction were depressed. Bypassable lesions were found in the main left coronary artery in one patient, and the proximal left anterior descending artery in two. Both of these patients had disease elsewhere. The remaining five patients had diffuse three-vessel disease. The eight patients have survived for periods ranging from 8 to 32 months (average = 24 months). This contrasts to an overall 1-year mortality of approximately 30% in survivors of hospitalization after unexpected ventricular fibrillation.

Cardiac Catheterization↗