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Biomedical subjects

A Tadei

Publications and source records attributed to A Tadei.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Diagnosis of chronic coronary failure by clinical aspects, ECG and myocardial scintigraphy after infusion of isoprenaline. Comparison with coronarography].

The purpose of this study was to assess the ability of isoproterenol (IPNA) to provoke chest pain, electrocardiographic (ECG) changes and transient defects on thallium 201 myocardial scintigraphy for coronary artery disease (CAD) diagnosis. Thirty patients without prior myocardial infarction who underwent coronary angiography were included. Significant stenosis was found in 15 and absent in the other 15. The most relevant clinical and ECG data were observed in the few minutes that followed IPNA perfusion: 1) angina pectoris occurred in ten patients of whom eight had CAD (sensitivity: 53 p. cent + 13 p. cent; specificity: 87 p. cent + 9 p. cent); 2) ST segment depression was observed in 11 CAD and 3 non-CAD patients (sensitivity: 73 p. cent + 11 p. cent; specificity: 30 p. cent + 10 p. cent); 3) reversible perfusion defects on planar myocardial thallium 201 scintigrams occurred in 16 patients of whom 13 had CAD. Thallium scintigraphy sensitivity was 87 p. cent + 9 p. cent and specificity was 80 p. cent + 10 p. cent. The combined interpretation and stochastic sequential analysis of two or three presumed independent criteria increased significantly the diagnostic value of the test. We conclude that the isoproterenol test is a safe and reliable method to provoke myocardial ischemia with clinical, ECG and myocardial scintigraphic expression. It has an information content nearly identical to exercise stress test for CAD detection. Because it allows a three step sequential probability analysis, the diagnosis is more reliable than with other pharmacological tests which apply only to scintigraphy.

Adult↗
PubMed1987

[Reciprocal changes in the ST segment in acute inferior myocardial infarction. Value of delay in appearance].

The significance of a "reciprocal" ST depression (ST(-)) in the acute phase of myocardial infarction remains controverted. This may be due to ST(-) not having the same determinants when studied at an early stage (less than 6 hours) or later (greater than 6 hours). The purpose of this study was to find out whether "reciprocal" ST(-) correlates with the same parameters when measured on very early ECG's (before 6 hours) or at a distance from the onset of infarction. The parameters concerned are coronary lesions, extent of the infarction and left ventricular function. ECG was performed in 46 patients with inferior infarct aged from 26 to 70 years (mean 50.8 +/- 9.2 years) between 2-6 h, 6-12 h, 12-24 h and 24-48 h from the beginning of pain. The sum of ST(-) on V1V2V2V4 (V1-4), D1aV1V1 to V6 and L1aV1V5V6, and the sum of ST elevation on L2L3aVf were measured at each period of time. The extent of global and anterior territory hypokinesia, the ejection fraction and the left coronary impairment were evaluated between the 2nd and 4th weeks. At 2-6 hours (a) the sum of ST(-) was greater (though not significantly), and the sum of ST elevation on L2L3aVf was significantly greater (p less than 0.001) when the left anterior descending artery (LAD) was not involved than when it was involved; (b) there was no difference between patients with and without ST depression (on all lead groups) in the degree of left ventricular hypokinesia and ejection fraction value.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Influence of the autonomic nervous system on the normal and pathological atrioventricular node].

The finding of a first-degree atrioventricular block suggests various mechanisms of atrioventricular (AV) node alteration: organic lesion, or functional disorder related to the autonomic nervous system, or a combination of both. The influence of the autonomic nervous system was evaluated by administration of Jose's regimen, i.e. intravenous injection of propranolol 0.2 mg/kg bodyweight and atropine 0.04 mg/kg bodyweight. This regimen was tested in 101 patients divided into two groups: 38 subjects with normal sinus node and AV node acting as controls, and 63 patients with abnormal AV node. In the control group the autonomic nervous system had no influence on atrio-hisian (AH) conduction time or on the effective refractory period of the AV node under an imposed cycle of 600 ms. Wenckebach's period significantly (p less than 0.01) increased from 352 +/- 40 ms to 376 +/- 47 ms. Parasympathetic activity was found to predominate in the sinus node. In the group with pathological AV node three types of response were observed after pharmacological inhibition of the autonomic nervous system: (a) improvement or even complete normalization (40%) of AV node conduction ability (AH, Wenckebach's period) suggesting vagal hyperactivity, as also found in the sinus node; (b) changes similar to those observed in the control group and reflecting the same behaviour of the autonomic nervous system, and (c) increase in AH conduction abnormalities reflecting the presence of a sympathetic overdrive tending to minimize the consequences of an atrioventricular organic lesion. This sympathetic overdrive was also found to be present in the sinus node.

Adolescent↗
PubMed1986

[Corrected transposition of the great vessels in aged adults. Apropos of 2 patients aged 72 and 80].

The authors report two unusual new cases of corrected transposition of the great arteries diagnosed in patients 72 and 80 years of age respectively, presenting with symptoms of cardiac failure of recent onset. Both patients had mild or moderate regurgitation of the systemic atrio-ventricular valve, associated in one case with aortic regurgitation. This association would appear to be fortuitous although already reported in six occasions. The diagnosis was made by echocardiography and confirmed by catheterisation in one case, and by digitised intravenous angiography in the other. These cases are of interest for three reasons: They are very rare: there have been only 20 comparable cases reported in patients over 40 years of age, the eldest being 73. This is probably explained by the high frequency of associated malformations. They illustrate the decisive role of echocardiography in the diagnosis of congenital heart disease, even in the adult. They constitute a "natural experimental model" of a right ventricle submitted to systemic pressures and tend to show that, in the absence of other abnormalities giving rise to an additional pressure or volume overload, the right ventricle is capable of long term adaptation to this situation. These observations indicate a favourable long-term prognosis for children who have undergone "corrective" surgery at atrial level for simple transposition and in whom the right ventricle is required to assume the function of the systemic ventricle for the rest of their life.

Aged↗
PubMed1985

[Determination of left ventricular volume by cardiac angio-scintigraphy at equilibrium. Comparison with a radiologic method].

Cardiac angioscintigraphy at equilibrium was performed after in vitro red cell labelling in the left anterior oblique and anterior views. A syringe of 10 ml labelled blood was placed on the patient's chest over the left ventricle and in contact with the camera's collimator in the LAO incidence. This syringe plays a dual part: as a direct reference for left ventricular radio-activity and as a marker for measuring the distance between the centre of gravity of the LV and the collimator by Links' method. The correction factor for absorption varies with each individual. An algorithm integrating this data automatically calculates the EDV in millilitres (ml) and the end diastolic and systolic volumes from the ejection fraction (EF) determined by an independent method. The study group was 100 patients (91 men, 9 women; 81 coronary, 11 valvular heart and 8 other diseases) with radiological EDV ranging from 107 to 1 283 ml and radiological EF ranging from 14 to 75 p. 100. A very significant correlation was observed between the radiological and scintigraphic EDV with a regression line close to that of identity: EDVs = 1.05 . EDVR-5 ml (or -3 ml/m2); SD = 48 ml; r = 0.953; p less than or equal to 0.001. The mean deviation between the methods was 35.7 ml (median 24 ml) or 13.7 p. 100 (median 9.4 p. 100) of EDVR. A large discrepancy (over 90 ml or 30 p. 100) was observed in only 7 patients, 4 of whom had severe mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1985

[Cardiac angioscintigraphy at equilibrium coupled with isoproterenol perfusion. Method of diagnosing chronic coronary insufficiency].

The effects of isoproterenol (IPNA) on global and regional left ventricular wall motion were studied by cardiac angioscintigraphy at equilibrium performed under basal conditions, during IPNA administration (per IPNA) and 10 minutes after (post IPNA) in 50 patients classified by coronary angiography as coronary (C) (n = 37) and non-coronary (NC) patients (n = 13), 5 reference subjects (REF) and 8 non-coronary pathology. The effects were assessed from variations of global LV function and from indices of regional wall function (12 regional ejection fractions - REF). The IPNA perfusion was well tolerated, even in patients with severe coronary lesions. 1. Diagnosis of myocardial dysfunction due to coronary artery disease: it was possible to separate the patients into C and NC groups according to the variations in EF, end systolic (ESV) and REF, especially post IPNA: NC group: per IPNA: 12/13 NC patients showed an increase in EF (+10.7%), a decrease in ESV (-41%) and increased or stable REFs. Post IPNA: 10/13 had raised EF (+4.6%), 9/13 had a reduced ESV (-17.4%) and 10/13 had stable or increased REF. C group: per IPNA: 15/37 C patients showed decreased EF, 12/37 had increased ESV and 15/37 had a decrease in at least two ref greater than or equal to 5%. Post IPNA: 25/37 had decreased EF, 21/37 increased ESV, 34/37 had at least two reduced REFs. These results show that decreased ref post IPNA (sensitivity 91.9%, specificity 66.9%) was a better indicator of coronary artery disease than VEF (sensitivity 68%, specificity 54%), increased ESV (sensitivity 57%, specificity 77%) or ECG changes (sensitivity 54%, p 0.05; specificity 91%, p less than 0.1). 2. Diagnosis of the extent of coronary artery disease: the post IPNA abnormal ref were situated in zones compatible with the coronary lesions: 10/13 single vessel disease (2 false negatives, 1 false localisation); 8/11 double vessel disease (1 false negative, 2 single vessel disease); 5/10 triple vessel disease (2 single vessel and 3 double vessel disease); 2/3 left main stem disease (1 single vessel disease). The study of REF demonstrated at least 2 diseased zones in 15/24 patients with multiple diseased vessels. Independently, the diagnosis of multivessel disease may be suspected by the fall in EF per IPNA (4/13 single vessel cases compared to 11/24 multivessel disease) and, more generally, by the fact that the EF and ZSV per and post IPNA appear more pathological with respect to the reference group when the coronary lesions are most diffuse.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Fruste form of hyperthyroidism manifested by auricular arrhythmia. Importance of the assay of the free fraction of thyroxine (FT4) and the role of the TRH test].

The TRH test was used to detect hyperthyroidism in 87 patients aged from 38 to 85 years who presented with atrial arrhythmia with or without heart disease. The patients had no clinical evidence of thyrotoxicosis, and total thyroxine (T4), free thyroxine index (FTI) and triiodothyronine (T3) values were normal. Hyperthyroidism was diagnosed in the 18 patients (21%) with negative TRH test; 15 of them had high free thyroxine (FT4) levels. The most common causes of hyperthyroidism were "warm" nodules in 7 and iodine overload in 10. Adding an anti-thyroid treatment to the hitherto unsuccessful anti-arrhythmic treatment resulted in a return to sustained sinus rhythm in 50% of cases. FT4 levels became normal in all. This study indicates that all patients with atrial arrhythmia, with or without heart disease, should be investigated for occult hyperthyroidism. It also demonstrates the value of FT4 assays to detect the disease. The TRH test is only required as a second-line exploratory method in some patients, notably those with iodine overload.

Adult↗
PubMed1984

[Plasma catecholamine concentrations during exercise in the untrained subject and in the sportsman].

Plasma noradrenaline (NA) and adrenaline (A) concentrations were measured by high liquid pressure chromatography in five untrained subjects and in five well-trained rowers during an exercise test on bicycle ergometer. Blood samples were collected, via a venous catheter, at rest, after standing 5 minutes, at maximal work level and at 5, 10, 20 minutes of post-exercise. Plasma NA and A concentrations at rest and after 5 minutes of standing were similar in the two groups. At maximal work load (340 +/- 38 for rowers and 220 +/- 11 W for untrained subjects), for a same pulse rate (178.0 +/- 7.6 for rowers and 176.6 +/- 4.7 beats/minutes-1 for untrained subjects), NA and A concentrations were higher in athletes (NA: 5.57 +/- 1.32 microgram/l; A: 0.95 +/- 0.31 microgram/l) than in untrained subjects (NA: 2.13 +/- 0.80 microgram/l; A: 0.40 +/- 0,34 microgram/l). During recovery, no significant difference was observed between the two groups.

Adult↗
PubMed1983

[Relation between serum levels and inotropic effect of digoxin in advanced cardiac failure during long-term treatment].

The aim of this study was to determine the relationship of digoxin serum levels to their inotropic effects in advanced cardiac failure during long-term therapy with different dosages. The study was based on the analysis of left ventricular systolic time intervals (STI) measured at 97 follow-up appointments of 20 patients in advanced, stable cardiac failure over an average period of 37 days. The dosage of digoxin was varied at successive consultations so that the serum digoxin levels reached 0.50 ng/ml on at least one occasion. The serum digoxin levels (SD) varied between 0 and 4 ng/ml. Four levels of SD were individualised: A) "control" SD less than 0.25 ng/ml (22 consultations); B) SD: 0.25 to 1 ng/ml (n = 25); C) SD: 1.0 to 2.0 ng/ml (n = 29); D) SD greater than 2 ng/ml (n = 21) including 6 cases with clinical and/or ECG signs of digoxin toxicity. A progressive significant shortening of the electromechanical systolic index (Q-S2 I) was observed up to levels of 2 ng/ml (B and C, -18 ms and -28 ms respectively). The same phenomenon was observed with the ejection time index (ETi) and pre-ejection time index (PETi) (-7 ms and -14 ms; -11 ms and -15 ms respectively) compared to the basal values. At SD greater than 2 ng/ml the reduction remained stable and then started to decrease (positive difference between C and D). These changes were observed in the absence of significant variations of the heart rate. There was a significant linear relationship between the variations of the STI and SD in 15 out of 18 patients (in whom the regression could be calculated, these patients having attended at least 3 appointments). These linear relationships were observed for the Q-S2 i (11-18), the ETi (9-18) and/or PETi (10-18). An unexpected increase in the pre-ejection period was observed in 2 patients. In conclusion, a linear relationship has been shown between SD and inotropic effect which is particularly noticeable at SD levels less than 2 ng/ml. When SD is greater than 2 ng/ml, further increases in SD are associated with smaller variations of the STI. On the other hand, a significant inotropic effect is observed with small doses and SD levels less than 1 ng/ml. This inotropic effect persists unchanged at long-term.

Aged↗
PubMed1980

[Noninvasive methods in the diagnosis of post-infarction false aneurysm. Apropos of a case].

A case of post-aneurysm detected by chance in an asymptomatic 41 year old man, 3 months after acute infarction, and managed by surgery is reported. Although the aneurysm was too small to cause chest X-Ray changes, the parietal defect was clearly defined by isotopic angioscintigraphy, CAT scanning and M-mode echocardiography. The features of pseudo-aneurysms on CAT scanning are discussed. The value of M-mode echocardiography is confirmed, it alone giving the precise diagnosis through the demonstration of one dynamic sign: systolic expansion of the aneurysmal pocket on a tracing more suggestive of a localised pericardial effusion than of ventricular aneurysm. Early diagnosis by these non-invasive methods of investigation, requested as a result of some initial clinical abnormality, confirmed by angiography, may benefit some patients as the risk of secondary rupture may be avoided by surgical cure. The rarity of this condition is also under question due to the increasing number of reported cases.

Diagnosis, Differential↗
PubMed1975

[Phentolamine in treatment of acute left ventricular insufficiancies].

Phentolamine (Regitine) at the dose of 0.3 mg/mn behaves as an arterial and, above all venous, vasodilatator agent, resulting in a marked and early lowering of the pulmonary pressures in acute oedema of the lung and in cardiac asthma. It was used alone in 47 attacks of acute severe left ventricular failure with very favourable results in 43 cases, as proved by the rapid improvement of the haemodynamic status and of the aicd-base balance. Under strict observation, tolerance has been excellent. This therapeutic method seems of great interest in the cases of acute pulmonary oedema with a maintained blood pressure level, and in the forms with severe arterial hypertension which might tolerate larger doses.

Acid-Base Equilibrium↗