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Biomedical subjects

A Smalcelj

Publications and source records attributed to A Smalcelj.

16 recordsLinked to original sources
PubMed2000

Left ventricular hypertrophy in obese hypertensives: is it really eccentric? (An echocardiographic study).

In order to study left ventricular hypertrophy patterns in obese hypertensives, we examined 132 patients with essential hypertension by 2D, M-mode and Doppler echocardiography. The patients were classified in four comparable groups, corresponding to the values of Quetelet's body mass index (BMI) and grades of obesity. More obese hypertensives had on average larger left ventricles with thicker walls and larger left atria than less obese, or lean ones. Left ventricular mass increased significantly and progressively with advancing grades of obesity, but relative wall thickness (wall thickness/cavity size ratio) did not diminish. Doppler echocardiography revealed significantly higher prevalence of left ventricular diastolic dysfunction among obese than among lean hypertensives. In the second part of our study, we analyzed the subgroups defined by the severity of hypertension and the age of the patients. The correlation of the indices of left ventricular and left atrial hypertrophy with the BMI values was considerably better in the group of moderate than in the group of mild hypertension. The r values were 0.62 vs. 0.22 for left ventricular mass and 0.64 vs. 0.26 for left atrial dimension. The group of patients with severe hypertension was characterized by left ventricular cavity enlargement in correlation with increasing BMI values, but without corresponding left ventricular wall thickening. So called left ventricular "eccentricity index", as the reverse value of relative wall thickness, correlated well (r = 0.76) with the BMI values. The indices of left ventricular hypertrophy correlated with the BMI values slightly better in middle age groups than in the groups of the youngest (< or = 30 years) or the eldest (> or = 61 years) hypertensives. In conclusion, eccentric left ventricular hypertrophy does not seem to be a distinctive feature of hypertensive heart disease in obesity. There is only some tendency toward the "eccentricity" of left ventricular geometry which becomes more apparent in more severe forms of hypertension, especially in very obese persons.

Adolescent↗
PubMed1998

Effects of postmyocardial infarction scar size, cardiac function, and severity of coronary artery disease on QT interval dispersion as a risk factor for complex ventricular arrhythmia.

The aim of the study was to determine the relation between QT dispersion and ventricular arrhythmia after myocardial infarction, as well as the effects of postinfarction scar size, cardiac function, and severity of coronary artery disease on QT dispersion. Three hundred three patients, 3 months after myocardial infarction, and a group of 21 healthy subjects were evaluated. QT dispersion was the difference between maximal and minimal QT interval in 12-ECG leads. Postinfarction scar size was determined by Selvester's QRS scoring system. Cardiac function was evaluated by echocardiography and exercise stress test, and the severity of coronary artery disease by the number and degree of coronary artery stenoses. QT dispersion increased significantly in relation to the severity of arrhythmia (< 50 premature ventricular complexes vs ventricular tachycardia; 61.6 [+/- 12.3] vs 84.8 [+/- 16.4] ms, P < 0.001). QT dispersion > 80 ms was associated with ventricular tachycardia with the sensitivity of 68% and specificity of 88%. QT dispersion also increased significantly, dependent on the postinfarction scar size (0% vs > or = 33% of left ventricular myocardium; 61.8 [+/- 16.4] vs 74.7 [+/- 16] ms, P < 0.001), as well as in the case of significantly impaired cardiac function. Although QT dispersion increased with the number of diseased vessels and the degree of stenoses, the differences were not significant (P > 0.05). In conclusion, QT dispersion is a risk marker of complex ventricular arrhythmia in the chronic stage of myocardial infarction. Multiple regression analysis indicates that only the postinfarction scar size has an independent effect on QT dispersion (R2 = 0.39, P < 0.05).

Coronary Disease↗
PubMed1997

QT dispersion, daily variations, QT interval adaptation and late potentials as risk markers for ventricular tachycardia.

AIMS: The aim of the study was to determine the value and correlation between QT dispersion, daily variations in the QT interval and late potentials as risk markers for ventricular tachycardia. METHODS AND RESULTS: QT dispersion was defined as the difference between the longest and the shortest QT interval in 12 electrocardiographic leads, QTc variability as the difference between the maximal and minimal QTc interval during 24-h Holter monitoring and QT interval adaptation as the regression line between heart rate and the uncorrected QT interval. One hundred and forty-five patients, 3 months after myocardial infarction were included in the study. QT dispersion significantly increased with the severity of arrhythmia (modified Lown's classification; P< 0.001). The level of 80 ms was associated with ventricular tachycardia with a sensitivity of 72.7% and a specificity of 86.4%. The greater daily variability of the QTc interval in patients with ventricular tachycardia was insignificant (P > 0.05). QT interval adaptation did not discriminate between patients with ventricular tachycardia from those in other groups. Late potentials were associated with ventricular tachycardia with a sensitivity of 50% and a specificity of 90.3%. CONCLUSION: Large QT dispersion and late potentials were risk markers for ventricular tachycardia, but there was no correlation between QT dispersion, daily variations in the QT interval and late potentials in patients 3 months after myocardial infarction.

Action Potentials↗
PubMed1997

The influence of atenolol and propafenone on QT interval dispersion in patients 3 months after myocardial infarction.

UNLABELLED: The aim of the study was to determine changes in QTc dispersion and QTc interval during the administration of atenolol and propafenone. METHODS: Eighty-five patients, 3 months after myocardial infarction, were randomized in 2 groups. The first group (n = 46) received atenolol 50 mg daily during 7 days and the second group (n = 39) propafenone 300 mg per os twice a day. QT interval was measured in 12 ECG leads before and after the treatment after 100% strip enlargement on a photocopy machine. For correction we used Bazett's formula. QTc dispersion was defined as the difference between the longest and the shortest QTc interval in 12 ECG leads. RESULTS: QTc dispersion increased significantly with the severity of arrhythmia (< 50 premature ventricular complexes vs. ventricular tachycardia, 82.3 (18.1) vs. 110.0 (9.0) ms (p < 0.001)). QTc dispersion significantly decreases with the administration of atenolol (72.7 (14.8) vs. 63.6 (15.3)) (p < 0.001) as well as with propafenone (75.0 (17.7) vs. 63.2 (16.4)) (p < 0.001). QTc interval also decreases with atenolol (451 (28) vs. 431 (32)) (p < 0.01) while it does not change with propafenone administration (441 (26) vs. 444 (26)). CONCLUSION: QTc dispersion is associated with ventricular tachycardia. Both atenolol and propafenone significantly decrease QTc dispersion. Atenolol also decreases QTc interval, while with propafenone it does not change.

Adrenergic beta-Antagonists↗
PubMed1991

[Relation between helper and suppressive/cytotoxic T lymphocytes in the peripheral blood in patients with dilated cardiomyopathy].

In 32 patients with dilated cardiomyopathy the percentages of helper (CD4+) and suppressor (CD8+) T lymphocytes, as well as their ratio, have been analyzed. The percentage of CD8+ lymphocytes in the group with dilated cardiomyopathy was 20.62 +/- 8.27% (X +/- SD), vs. 26.38 +/- 6.19% in control group; the difference was not statistically significant. The percentages of CD4+ lymphocytes were similar in both groups, 39.55 +/- 12.86% vs. 40.52 +/- 6.59%. The CD4+/CD8+ ratio was markedly higher in the group with dilated cardiomyopathy, 2.49 +/- 2.10 vs. 1.65 +/- 0.49, but the difference was not statistically significant, probably because of great variability in the group. In the subgroup of 12 patients with possible alcoholic etiology of dilated cardiomyopathy, the values were almost identical to those of the remaining 20 patients. No correlation between echocardiographic fractional shortening of the left ventricle and any of the aforementioned values of T lymphocytes in the group of patients with dilated cardiomyopathy was found. The tendency toward decline in number of suppressor T lymphocytes is in accordance with the hypothesis that the "overreacting" inflammatory response to (viral) myocarditis might be the cause of dilated cardiomyopathy. However, the specificity of the decline of suppressor activity in respect to the other causes of heart failure is questionable and the analysis of its significance is complex. This is due to dynamic character of immune disorders, and a considerable number of other theories considering the etiology and pathogenesis of the disease also exist. The need to perform complex studies is anticipated, including continual observation of clinical, immunologic and bioptic parameters of the disease.

Adult↗
PubMed1990

[Echocardiographic analysis of changes in the heart in patients with systemic lupus erythematosus].

Fifty-six patients, 49 females and 7 males, with the confirmed diagnosis of systemic lupus erythematosus were examined by M-mode, 2--D and Doppler echocardiography. Pericardial effusion was found in 15 patients (27%), while pericardial thickening was suspected in 6 additional patients (37.5% altogether). Two patients had the signs of a pericardial tamponade, but both of them were uraemic. Libman-Sacks endocarditis was suspected in 4 patients (7.5%) because of verrucous changes in the aortic or mitral valve and regurgitant jet. Slight to moderate left ventricular hypocontractility was present in 3 patients (5%), while 3 additional patients had borderline values of the left ventricular contractility parameters. Left ventricular hypertrophy, usually mild, was found in 21 patients (37.5%). Echocardiographic signs of pulmonary hypertension were present in 2 patients (3.6%). It has been concluded that pericardial affection is frequent during the course of systemic lupus erystematosus, while a diffuse myocardial involvement is rare, except the consequences of arterial hypertension and accelerated coronary atherosclerosis. Libman-Sacks endocarditis still represents a diagnostic problem. For a more precise definition of cardiac involvement in systemic lupus erythematosus, a comparative analysis of the disease activity and immunosuppressive therapy is needed.

Adolescent↗
PubMed1990

[Quantification of mitral regurgitation using Doppler echocardiography].

Examining 18 patients without regurgitation (control group) and 20 patients with mitral regurgitation the method of Doppler echokardiography, the pulsating and continual wave, was applied. Both groups consisted of patients with heart diseases in whom a heart catheterization was indicated for the evaluation of the actual state. Thus, the competence of the mitral orifice was also evaluated. The aim of the investigation was to quantify or more accurately estimate the degree of mitral regurgitation. The accuracy of the Doppler method was tested by means of the measured cardiac stroke volumes of the right heart side in both groups with the probability higher than 80% but lower than 90% (0.80 less than p 0.23 less than 0.90), and by testing the cardiac stroke volumes of the right heart and the diastolic volumes of the left heart (control group: mitral and pulmonal orifice) with the probability higher than 70% and lower than 80% with the error of 6% of the measured volume. The regurgitation mitral fraction (RF) was presented as the difference between the total forwards volume (TFV) in the mitral orifice and the net forwards volume (NFV) in the pulmonal orifice and calculated in cm3, and as the regurgitation fraction index (RFI) in percentages (RFI = 1--NFV/TFV). It was also expressed as the regurgitation volume index (RVI) whose values were divided into degrees, according to the literature data. Numerical values of the regurgitation fraction and the regurgitation fraction index were classified in the mitral insufficiency degrees from 1 to 4. A fast regurgitation screening was possible due to the regurgitation fraction index, which is lower than the 45% of the diastolic volume in the cases of mild mitral insufficiency, while the values over 45% denote severe mitral insufficiency. The obtained values of the regurgitation fraction and index divided into degrees showed a close correlation with the angioventriculographic degrees obtained by heart catheterization. Cardiac output measured by the Doppler and Fick methods in the group with regurgitation showed a high correlation coefficient (r = 0.85) (0.60 less than p 0.47 less than 0.70).

Echocardiography, Doppler↗
PubMed1990

[Evaluation of the effectiveness of streptokinase in acute myocardial infarct with respect to the pump function of the heart].

During 2 years and 3 months 230 patients suffering from acute myocardial infarction were treated at an Intensive Care Unit and a Department of Cardiology. Streptokinase was given intravenously to 54 of them. Out of 54 patients, in 52% the localisation of the myocardial infarction was in the anterior and in 48% in the posterior wall. The patients were divided in the three categories according to the onset of symptoms: up to 2 hours, 2-4 hours and 4-6 hours. The dose of streptokinase was 1,500,000 i.u. during 1.5 hours. The CPK and MBCPK level reached the maximum values up to 12 hours and was to lowest in the first group. In 74% of the patients the serum enzyme level showed successful reperfusion of a coronary artery. Electrocardiographic findings of a successful myocardial reperfusion amounted to 36% in the first, 40% in the second, and 17% in the third group. Malignant ventricular arrhythmias appeared in the first group in 3.6%, in the second in 12.5% and in the third group in 14.2%. The criteria for successful myocardial reperfusion by echocardiography (analysed regional wall motion) were present in 52% in the first, in 50% in the second, and in 17% in the third group. Coronarography and ventriculography were performed in 17 patients after 21 days of treatment, with successful results in 88% (15 out of 17 patients). In a group of 176 patients unable to be treated with streptokinase because of the onset of symptoms of myocardial infarction (more than 6 hours) or because of contraindications for that treatment, the lethality rate reached 17.6%. The lethality rate in the group of 54 patients treated with streptokinase was 5.5%. Local complication (hemorrhage) during the treatment was observed in one patient (2%).

Heart↗
PubMed1985

Relation between mitral valve closure and early systolic function of the left ventricle.

In order to investigate relations between mitral valve closure and mechanical events at the onset of left ventricular systole, simultaneous M mode echocardiograms and phonocardiograms were recorded with the apexcardiogram and its first differential (dA/dt) in 25 normal subjects and 88 patients with heart disease. The timing of mitral and aortic valve closure and the onset and peak rate of rise of the apexcardiogram with respect to the Q wave of the electrocardiogram were measured. There was considerable variation in the intervals from Q to mitral valve closure (Q-MVC) and from Q to peak dA/dt and in the isovolumic contraction time between normal subjects. There was no consistent abnormality of these intervals in patients with coronary artery or valvar disease, and no relation between the interval from Q to mitral valve closure and end diastolic pressure. When the timing of the first heart sound and peak dA/dt were considered together, however, clear abnormalities became apparent. In normal subjects, the intervals Q-MVC and Q to peak dA/dt were significantly correlated. In coronary artery disease, the expected relation between Q-MVC and Q to peak dA/dt was found only when end diastolic pressure was normal and was lost when end diastolic pressure was raised. Mitral stenosis was associated with delayed mitral closure in a few cases only, but in chronic aortic regurgitation closure was consistently early with respect to the apexcardiogram. In patients with atrial fibrillation and a normal mitral valve the timing of mitral valve closure with respect to the apexcardiogram was normal, which is inconsistent with an atrial contribution to the timing of mitral valve closure. Thus when considered in isolation the timing of mitral valve closure and the duration of isovolumic contraction time gave little information about cardiac function. Nevertheless, a predictable relation exists between mitral valve closure and the onset of left ventricular mechanical systole in normal subjects, which can be used to identify characteristic alterations in patients with heart disease.

Adult↗
PubMedDate not supplied

[A Möbitz II atrioventricular block in a healthy male].

The case of a young, asymptomatic and otherwise healthy male with atrioventricular block Möbitz type II is presented. Contrary to the expectations, considering the type of the block, electrophysiologic study revealed only a vagotonic conduction delay in the atrioventricular node. The electrophysiological aspects and clinical significance of such a rare finding are discussed, especially in respect to Möbitz type II atrioventricular block.

Adult↗
PubMedDate not supplied

[Blue color vision as a sign of digitalis poisoning].

The paper deals with the course of the illness in a 66 years old male, who had taken an amount of 0.2 mg of medigoxin for an unknown period of time, because of chronic heart failure due to atherosclerotic heart disease and chronic atrial fibrillation. He have had a cholelithiasis also and reduced renal reserve. He was admitted by an emergency admittance because of nausea, vomiting, color vision disturbances: blue colored vision, and with other signs of digitalis toxicity: diffuse abdominal pain, an absolute arrhythmia with a slow ventricular rate, and with a short corrected Q-T interval in an electrocardiogram of 0.315 seconds and with high serum digoxin level reacted 3.8 nmol/L. After stopping of a digitalis treatment, in a period of time of four days, all signs of digitalis toxicity including blue color vision disturbances disappeared. In the paper that rare sign of digitalis toxicity is discussed.

Aged↗
PubMedDate not supplied

[Syncope caused by iatrogenic hypercalcemia].

A course of the disease of a 68-year-old female who had been taking medigoxin, furosemide, verapamil and an unknown amount of spironolactone and potassium salt due to congestive heart failure is presented. She was admitted to emergency department of the University Hospital Rebro after an episode of syncopal attack because of arrhythmia due to hyperkalemia (8.9 nmol/L). She has had a fast idioventricular rhythm, followed by atrial tachycardia after that and with fast ventricular rhythm, S-T segment depression and a tall and peaked T-wave. In the following electrocardiograms left anterior hemiblock appeared, a tall R-wave of the anterolateral location, supraventricular and ventricular premature beats and atrioventricular block of the first degree. The patient had signs of non-oliguric form of acute renal failure at the admission which was a partly explanation for the development of hyperkalemia, together with the use of spironolactone and potassium salt. After the treatment she had normal serum creatinine values. She suffered from combined mitral valve disease: stenosis with a predominant regurgitation of the II/III degree. She was discharged from the hospital in a compensated state with normal serum potassium values.

Aged↗
PubMedDate not supplied

[Is there a correlation between changes in the electrocardiogram and high serum digoxin levels in the aged?].

In a group of 84 patients aged 65 to 89 years with the high serum digoxin levels, electrocardiograms, as well as serum creatinine and serum potassium levels were analysed. In an electrocardiogram, a rhythm and conduction disturbances, PR interval, PTQ index, corrected QT interval, both a corrected QT interval I using the second root from a heart frequency and a corrected QT interval II using the third root from a heart frequency were studied. A rhythm disturbances were seen in 37% and a conduction disturbances in 39% of the patients, but no changes were observed in 24% of the patients. There was no correlation between serum digoxin levels and the PR interval. There was a slight correlation between serum digoxin levels and the PTQ index, and no correlation could be demonstrated between serum digoxin levels and a corrected QT interval I as well as a corrected QT interval II. Also, no correlation was evident between serum digoxin levels and serum creatinine levels, although many of those patients suffered from chronic renal failure. In an analysis of the influence of digoxin on the heart, electrocardiographic changes together with serum digoxin levels and serum potassium levels have to be followed. Only one of these parameters is not enough for the analysis of the effect of digoxin on the heart. It is concluded that clinical examination is most important in the analysis of digoxin action.

Aged↗
PubMedDate not supplied

[Risk factors for the onset of ventricular tachycardia in patients with mitral valve prolapse].

Non-invasive diagnostic methods (history, ECG, phonocardiography, exercise testing, Holter monitoring and Doppler echocardiography) were done in 48 persons with mitral valve prolapse (MVP). The aim was to establish possible risk factors for occurrence of ventricular tachycardia (VT) in persons with MVP and to find a possible difference between these risk factors. The possible risk factors for VT are: syncope, negative T wave in the inferolateral ECG leads, longer duration of QT interval, ST devalvation and duration of the ST devalvation, reduction of oxygen consumption evaluated by exercise testing, left ventricular function impairment, polymorphic premature ventricular contractions (PVC's), paired PVC's, larger dimensions of left cardiac chambers, larger surface and thickness of anterior mitral leaflet, extent of mitral regurgitation and higher mitral valve prolapse score. In patients with sustained VT we found higher age, more frequent syncopal attacks, longer QTc interval, more frequent negative T wave in inferolateral ECG leads, deeper ST devalvations, lower oxygen consumption, more prominent left ventricular function impairment, more frequent polimorphic PVC's (more than 10/1000 ventricular complexes), paired PVC's and thicker anterior mitral leaflet than in patients with non-sustained VT. (For all these risk factors is p < 0.01). Non-invasive diagnostic methods could help to identify the patients with mitral valve prolapse at elevated risk for VT.

Adult↗