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Biomedical subjects

A Ingram

Publications and source records attributed to A Ingram.

27 records · Page 2Linked to original sources
PubMed1991

The incidence of malignant vasovagal syndrome in patients with recurrent syncope.

We reviewed 322 patients with recurrent syncope between 1984 and 1988. Investigation included limited intracardiac electrophysiological study in all cases with programmed extra-stimulus studies in 48 cases. In 93 patients (29%), all investigations were normal, (including negative extrastimulus in 30). In the other 229 cases syncope was explained by AV-block (n = 111, 34%), sinus node disease (n = 68, 21%), carotid sinus syndrome (n = 32, 10%) and inducible sustained tachyarrhythmia (n = 18, 6%). Prolonged 60 degrees head-up tilt was performed in 71 out of 93 patients with unexplained syncope, and reproduced vasovagal syncope and presenting symptoms in 53 (75%), or 16% of the whole population reported. These patients were diagnosed as having malignant vasovagal syndrome. Positive tilts were significantly less common in a group of 27 subjects of similar age without a history of syncope (7%), and a random sample of 37 patients with atrioventricular block (n = 16), sick sinus syndrome (n = 18) and inducible tachyarrhythmia (n = 3), (19%, 11% and 0% respectively, P less than 0.01). From this retrospective review it appears, therefore, that tilt testing is a valuable provocative tool for vasovagal syncope and may reduce the number of syncopal patients that remain undiagnosed, although these early observations do not allow an exact appraisal of the sensitivity and specificity of the tilt test.

Arrhythmias, Cardiac↗
PubMed1991

Natural history of sinus node chronotropy in paced patients.

The natural history of chronotropic incompetence is not clear. To assess this, we evaluated corrected sinus node recovery time (cSNRT) and sinus node chronotropy at rest and during exercise in two groups of syncopal patients with sinus node disease. Group A comprised patients with resting bradycardia but normal cSNRT and group B had resting bradycardia and prolonged cSNRT (greater than 1000 ms). An additional two groups (C and D) were studied. Group C comprised patients with complete AV (CAVB) and no evidence of sinus node disease and group D were asymptomatic controls of similar age. At diagnosis, patients with symptomatic bradycardia but normal cSNRT and no evidence of carotid sinus syndrome (group A) had resting bradycardia and impaired peak heart rate (PHR-I) on exercise compared to controls (P less than 0.001 and P less than 0.05, respectively), but no reduction in exercise duration. At follow-up group A patients demonstrated an increase in resting rate that was significantly slower than the controls (P less than 0.01). Peak heart rate (PHR-II) also remained significantly slower (P less than 0.05). There was no difference in exercise duration between groups A and D at follow-up. Group B was further subdivided according to follow-up findings of preservation of atrial activity in seven patients (group B-1) and junctional rhythm without any atrial activity in four patients (group B-2). Retrospective analysis showed no significant difference in resting heart rate at initial examination but group B-2 showed a significantly lower peak heart rate on exercise compared with B-1 (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Recurrent symptoms after ventricular pacing in unexplained syncope.

We report clinical and hemodynamic data in two cases of recurrent syncope. Both patients received permanent demand ventricular pacing (VVI) for unexplained syncope. Both patients experienced recurrent syncope after pacemaker implantation. They later underwent 60 degrees head-up tilt testing, initially noninvasively and then with hemodynamic profile. A vasovagal response to tilt occurred with bradycardia and was complicated by the onset of ventricular pacing and retrograde atrioventricular conduction (RAVC) with hemodynamic deterioration and rapid reproduction of syncope. Limited intracardiac electrophysiological study (EPS) excluded atrioventricular (AV) conduction disease, sinus node disease, and carotid sinus syndrome, and confirmed RAVC. Both patients were upgraded to dual chamber pacing, DDI mode, with 50/80 rate hysteresis. One patient was asymptomatic at repeat tilt testing; the other experienced continued symptoms due to the vasodepressor component of vasovagal syncope. Cardiac pacing alone is ineffective treatment for this phenomenon, and no proven therapy is presently available. Ventricular pacing applied to patients with unexplained syncope may lead to an increase in or continuation of symptoms rather than an amelioration. There is a need for full investigation of such patients, which must include tilt testing, to allow for the most accurate diagnosis possible and guide the most appropriate therapy.

Aged↗
PubMed1989

Symptomatology and quality of life in patients with rate-responsive pacemakers: a double-blind, randomized, crossover study.

Although the hemodynamic advantages of rate-responsive (RR) pacing are well established, the symptomatic benefits remain controversial and the effects on the quality of life have not been assessed. Sixteen patients with RR pacemakers and a mean age of 56 (range 22-77) years were involved in a double-blind crossover study to assess their exercise capacity (treadmill testing), symptomatology, and quality of life (structured questionnaires). Pacemakers were implanted because of symptomatic heart block or sick sinus syndrome. Ventricular demand pacemakers were randomly programmed into the constant rate (VVI) or RR pacing modes for four-week study periods. All patients exercised longer in the RR mode than in the VVI mode (570 +/- 29 vs. 437 +/- 17 s, p less than 0.001). Statistically significant improvements in "shortness of breath" and "energy during daily activities" as measured by a 10-point scale were reported in the RR pacing mode by the patients and were also observed by their close relatives. Symptoms such as "chest pain" and "palpitations" were not worsened during RR pacing. Nondisease-specific "quality of life" was studied in 11 patients using the Nottingham Health Profile which showed a trend for an improved quality of life in five of the six dimensions of perceived health, although none of the changes were statistically significant. This study suggests that RR pacing should be recommended in selected patients on symptomatic grounds.

Adult↗
PubMed1986

Head-up tilt: a useful test for investigating unexplained syncope.

Head-up tilt, a recognised stimulus to vasovagal syncope, was used to investigate syncope that remained unexplained despite full clinical and electrophysiological assessment in fifteen patients, mean age 65 +/- 10 years, who had had 15 +/- 19 episodes of unexplained syncope over periods of a week to 26 years. After overnight fast systolic blood pressure and heart rate were continuously monitored during 40 degrees head-up tilt for 60 min. Ten control subjects with no history of syncope were studied similarly. In ten patients (67%) and one control vasovagal syncope developed after 29 +/- 19 min (p less than 0.001). In symptomatic patients systolic blood pressure fell from 150 +/- 32 to 56 +/- 9 mm Hg (p less than 0.001) and heart rate from 62 +/- 9 to 38 +/- 12 beats per min (p less than 0.01). In each case symptoms during the test reproduced those previously experienced. No clinical findings predicted development of syncope during tilt. Baseline systolic blood pressure and heart rate did not differ significantly between patients and controls. Pacemakers were implanted in seven patients who have remained symptom-free since implant (follow-up 10 +/- 3 mo).

Aged↗
PubMed1986

Optimum pacing mode for patients with angina pectoris.

A within patient double blind prospective study of symptoms and exercise tolerance was designed to determine the preferred pacing mode in 10 patients with programmable dual chamber pacemakers who also had angina pectoris. Patients were randomly allocated to one month in each of the following modes: ventricular pacing at 70 beats/min (VVI) or atrioventricular synchronous upper rate 150 beats/min (DDD 150) or 100 beats/min (DDD 100). Medications were unchanged throughout the study; none was taking beta blockers. At the end of each month patients underwent an exercise test. During each month patients recorded symptoms and their preferred pacing mode. DDD 100 was the preferred mode (seven patients). There was significantly less chest pain with this mode than with either of the other modes. There were significantly more episodes of dizziness in VVI, and two patients who developed pacemaker syndrome were unable to complete the pacing period. Three patients developed angina during exercise testing in DDD 150. Atrial synchronous ventricular pacing is better than ventricular pacing for the control of symptoms in patients with angina pectoris provided that the upper atrial tracking rate is limited.

Aged↗
PubMedDate not supplied

IgA nephropathy and pulmonary hemorrhage in an adult.

IgA nephropathy is the most common glomerular disease worldwide, but is generally renal limited or associated with a rash. Pulmonary hemorrhage has been very uncommonly associated with IgA nephropathy, although it is frequently seen in other glomerulonephritides. We describe a well-proven case of IgA nephropathy associated with pulmonary hemorrhage, in which immunosuppressive medication was administered. We also review the literature to make a case for immunosuppression in these rare patients.

Adult↗