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Biomedical subjects

B C Vasavada

Publications and source records attributed to B C Vasavada.

27 records · Page 2Linked to original sources
PubMed1995

Doppler echocardiographic methods to estimate severity of aortic stenosis.

The continuity equation should be regarded as the Doppler echocardiographic gold standard for estimation of valve area in patients with aortic stenosis, but a quick, easy, and inexpensive screening test may be desirable in an era of medical cost containment. Aortic valve leaflet separation could be used as such a test. In fact, it could prove especially useful in cases where calculations using the continuity equation or the fractional shortening-velocity ratio are problematic.

Aged↗
PubMed1993

Demonstration of a relation between urinary digoxin-like immunoreactive substance and cardiac performance.

OBJECTIVE: To determine the relation between urinary digoxin-like immunoreactive substance (DLIS) and cardiac performance. DESIGN: Cohort study. SETTING: Echocardiography laboratory of a university-affiliated teaching hospital. SUBJECTS: Thirty-four individuals referred for echocardiographic studies who had never received cardiac glycosides or other substances known to cross-react with a digoxin radioimmunoassay and had no condition that has been associated with increased DLIS. MEASUREMENTS: Cardiac dimensions and indices of cardiac performance derived from echocardiograms and cardiac Doppler flow studies and concentrations of urinary DLIS, creatinine, and electrolytes. RESULTS: Urinary DLIS ranged from < 0.125 ng (digoxin equivalents) per milliliter (below the sensitivity of the assay) to 0.99 ng/ml, averaging 0.22 +/- 0.24 ng/ml. On bivariate analyses, UDLIS was found to correlate significantly with body weight, left ventricular (LV) end-diastolic dimension, LV fractional shortening, mitral transvalvular flow velocity following atrial systole, and urinary calcium. On multivariate analyses, the association between urinary DLIS (alone or adjusted for urinary creatinine) and LV fractional shortening emerged as the paramount independent relation. CONCLUSION: Urinary DLIS can be related to cardiac performance under steady-state conditions. This suggests that DLIS may be a ligand for a cardiac glycoside receptor.

Adult↗
PubMed1986

Cardiac function in alcohol-associated systemic hypertension.

The pathogenesis of alcohol cardiomyopathy is obscure. Because systemic hypertension is observed in one-third of alcoholics, the relation of this finding to left ventricular (LV) function was analyzed in 66 alcoholics (26 with a blood pressure of 160/95 mm Hg or higher) 4 to 5 days after alcohol withdrawal. Hypertensive alcoholics had a more abnormal ratio of preejection period/LV ejection time (PEP/ET) (0.398 +/- 0.01 vs 0.35 +/- 0.01, p less than 0.02) than normotensive alcoholics (matched normal 0.290 +/- 0.01). Hypertensive alcoholics (transitory hypertension) with blood pressures of 120/80 mm Hg or less at time of study also had more abnormal PEP/LVET than matched normotensive alcoholics (0.415 +/- 0.03 vs 0.331 +/- 0.01, p less than 0.05). In both hypertensive (77 +/- 6 dynes/cm2 X 10(3)) and normotensive alcoholics (67 +/- 4 dynes/cm2 X 10(3) LV stress was elevated (normal 46 +/- 3 dynes/cm2 X 10(3), both p less than 0.02). However, LV mass was not increased (hypertensive 96 +/- 4 g/m2; vs normotensive 100 +/- 4 g/m2; (normal 92 +/- 5 g/m2), resulting in a markedly increased stress to mass ratio (hypertensive 0.8 +/- 0.06; Normal 0.05 +/- 0.05, p less than 0.02). Hypertensive alcoholics also had LV "hyperfunction," with an increased stress/LV end-systolic volume ratio (1.7 +/- 0.1 vs 1.3 +/- 0.1 dynes/cm2 X 10(3)/ml, p less than 0.02). Thus, hypertensive alcoholics, even those with transitory hypertension, have more abnormal cardiac function than normotensive alcoholics. Presence of hypertension with hyperdynamic LV features may be a prelude to heart failure.

Adult↗
PubMed1984

Abnormalities of the cardiovascular response to cold pressor test in type 1 diabetes. Correlation with blood glucose control.

Left-ventricular (LV) function in type 1 diabetics without clinical heart disease was compared with that found in matched normal subjects. Although diabetics had a normal LV ejection fraction (66% +/- 6%), they showed a trend toward smaller left ventricles. Their cardiovascular response to a cold pressor test was abnormal and cardiac function after the cold pressor test correlated with hemoglobin A1c levels: Average hemoglobin A1c was inversely related to ejection fraction and early filling volume and directly related to the ratio of pre-ejection period to ejection time (PEP/LVET) after a cold pressor test. Hemoglobin A1c at the time of study correlated more closely with PEP/LVET after cold pressor test than did the six-month average hemoglobin A1c level, suggesting that cardiac function fluctuates with recent changes in blood glucose control. Thus, even when diabetics have a normal LV ejection fraction, an abnormal cardiovascular response to stress may still be present, and such abnormalities correlate with blood glucose control.

Adult↗
PubMed1981

Impact of peer review in reduction of permanent pacemaker implantations.

Because of a sharp increase in the number of permanent pacemakers inserted at The Brooklyn Hospital between 1972 and 1976, a peer-review committee was established to monitor subsequent pacemaker implantation. Total initial implants declined from 48 to 22 per year in the two years that followed. The number of implantations for sinoatrial bradycardias declined from 50 to 27 and the number of implantations for intraventricular conduction defects declined from 32 to five in the two years after peer review, compared with the two years before. There was no change in the number of pacemakers implanted for complete or advanced heart block. Almost 10% of patients who received a pacemaker between 1972 and 1976 had other conditions that might have accounted for the events that precipitated the decision to implant a pacemaker. The symptoms for which the pacemaker was implanted persisted in 19% of patients, despite a normally functioning pacemaker system. Patients receiving a permanent pacemaker before peer review had a 17% one-year and a 43% three-year mortality. When a more critical patient selection process was instituted, a smaller percentage remained symptomatic (9% vs 19%) and three-year survival rate was improved (86% vs 57%). From 1977 through 1978, when permanent pacemaker implantations declined, the number of hospital, medical service, and coronary care unit admissions increased. It is concluded that peer review can have substantial impact on permanent pacemaker implantations.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Age-related differences in the use of cardiac medications in patients with coronary artery disease.

BACKGROUND: Benefits of aspirin and beta-blocker use in patients with coronary artery disease and angiotensin-converting enzyme (ACE) inhibitors in those with left ventricular systolic dysfunction are well documented in all age groups. OBJECTIVE: To investigate whether aspirin, beta-blockers, and ACE inhibitors are equally used in geriatric (> or =65 years) versus younger (<65 years) patients with coronary artery disease. SETTING: University-affiliated major academic hospital. METHODS: Records of 402 patients with coronary artery disease were analyzed for use of aspirin, beta-blockers, and ACE inhibitors. One hundred thirty patients with contraindications to use of these agents were excluded. RESULTS: Of 272 study patients, 85% were using aspirin and 71% beta-blockers. Among the patients with left ventricular systolic dysfunction, 79% were using ACE inhibitors. One hundred forty-seven patients were of geriatric age, whereas 125 were of younger age. No significant difference in the use of aspirin (82% versus 89%, P = 0.10), beta-blockers (71% versus 70%, P = 0.85), or ACE inhibitors (86% versus 69%, P = 0.13) was found between geriatric and younger patients. This lack of difference in use of cardiac medications between geriatric and younger patients persisted on gender-based subgroup analysis. On decade-of-age-based analysis, aspirin use was not equally distributed among all the decades of age (P < 0.005), but beta-blocker use was. CONCLUSION: Results of this study demonstrate equal use of aspirin, beta-blockers, and ACE inhibitors in geriatric versus younger patients with coronary artery disease. Aspirin use was not equally distributed among all the decades of age.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Atrial fibrillation associated with systemic lupus erythematosus and use of methylprednisolone.

Systemic lupus erythematosus is known to have cardiac manifestations consisting of pericarditis, myocarditis, endocarditis, and coronary vasculitis. Pericarditis is the most common cardiac manifestation of systemic lupus erythematosus. Myocarditis may be suspected in patients presenting with unexplained tachycardia, conduction disturbances, unexplained systolic dysfunction with or without heart failure, or arrhythmias. The development of arrhythmias in systemic lupus erythematosus could be secondary to pericarditis, myocarditis, or ischemia caused by coronary vasculitis. The development of atrial fibrillation in systemic lupus erythematosus is not commonly reported. There have been few reports on the patients developing atrial fibrillation after being started on methylprednisolone therapy. Described here is a case of the development of atrial fibrillation in a newly diagnosed 37-year-old patient with systemic lupus erythematosus who was started on intravenous methylprednisolone therapy.

Adult↗