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Biomedical subjects

B Semrád

Publications and source records attributed to B Semrád.

At least 19 recordsLinked to original sources
PubMed1999

[Electric programmed ventricular stimulation using a permanent cardiac pacing system--a noninvasive method in arrhythmia].

BACKGROUND: Complex forms of ventricular arrhythmias often occur in patients with an implanted permanent cardiac pacing system. Some of the pacemakers are provided with software which allows electrophysiological testing of the cardiac conduction system by coupling with an external diagnostic pacemaker via their programmer. This method is non-invasive. METHODS AND RESULTS: In a group of 26 patients (19 males, 7 females) with an implanted pacemaker (Paragon III, Synchrony III, Sensorithm--all Pacesetter) complex ventricular arrhythmias were observed (class Lown IVa and higher). In these patients the electrical stability of the myocardium was tested by the described method (protocol: incremental pacing 90-220 bpm, pacing drives 110 bpm and 140 bpm with 1-3 extrastimuli). Complex ventricular arrhythmias were induced in 42% patients (n = 11), in this subgroup 55% (n = 6) was non-sustained ventricular tachycardia, 36% (n = 4) sustained ventricular flutter, 9% (n = 1) sustained ventricular tachycardia. Patients with non-sustained ventricular tachycardia were treated with beta-blockers, in the others the effective therapy was selected according to electrophysiological testing (amiodarone in 4 patients, ICD in 1 patient). During a 24-month follow-up the overall mortality was 7.7% (n = 2), sudden death mortality was 3.8% (n = 1). CONCLUSIONS: Programmed ventricular stimulation performed by a permanent cardiac pacing system is a simple and above all non-invasive method with no need for fluoroscopy. It can be repeated several times. It is not possible to pace from the right ventricle outflow tract. This is the main disadvantage. Nevertheless, by using non-invasive risk stratification methods (echocardiography, signal averaged ECG, heart rate variability, baroreflex sensitivity, dispersion of QT interval) the patients in need of an invasive study can be identified. This method can be considered an alternative screening method and a standard part of the investigation of the algorithm in patients with a previously implanted pacemaker.

Arrhythmias, Cardiac↗
PubMed1997

[Selection and long-term effect of treatment in vasovagal neurocardiogenic syncope].

BACKGROUND: Syncope state performed by transient loss of consciousness connected with a postural tone decrease present still an important therapeutical problem. The authors use HUT testing for discovering of vasovagal etiology of a syncope. The aim of the study was to find out the optimal medication in treatment and prevention of VVS by repeated HUT drug testing in a group of positive patients. METHODS AND RESULTS: We examined a group of 300 patients (172 female and 128 male) age 35.26 +/- 13.47 years with an anamnesis of recurrent syncopes by HUT test. In 83 patients (27%) we set up a diagnosis of VVS. Thirteen patients (15.66%) were only followed without medication. The rest of the group (70 patients, 84.34%) started with a therapy. Testing was performed by repeated HUT according to the "Westminster protocol". HF and BP were measured by FINAPRESS 2,300 made by Ohmeda. The effective therapy was found in 64 patients (91.43%) of the group. For various reasons the therapy was changed and retested in 9 patients (14.06%). Beta1 selective beta-blockers were used in 51 patients (80.96%) theophyllin in 5 patients (7.94%), etilephrin in 6 patients (9.52%) and clonidine in 1 patient (1.59%). CONCLUSIONS: The therapy of VVS should be set-on according to the effective drug selection by serial drug testing in repeated HUT tests. The article shows a high predictive value of negative HUT test for a long term effect of tested therapy.

Adult↗
PubMed1997

[Significance of vegetative nerve tone in patients with vasovagal neurocardiogenic syncope].

The timely provided and precise diagnostic of the syncopal states as well as their causal therapy is a main subject of many medical branches interest within last time. Our work was concentrated on a vasovagal neurocardiogenic syncope. The definition of the vegetative nervous tonus participation on its development by a method of evaluation of the heart rate variability as well as the review of a possibility to the application of quantification these results to a prediction of vasovagal reaction, respective of its malignant variant, was the main aim of our effort. Our results enable a conclusion, that the observation of aquiet autonomic nervous tonus does not represent a contribution to a differential diagnostics of syncope of uncleared etiology with a suspicion on vasovagalous neurocardiogenous syncope, because the basal vagal tonus does not allow the forecast of head upright tilt table testing results as well as determination of the type of respectively provocated vasovagal neurocardiogenic syncope. However, a correlation between an actual reactive vageous tonus surveyed by the SD index for patients with vasovagal neurocardiogenic syncope of the type I and IIa in comparison with healthy persons, was found out. It allows to draw a conclusion, that the vasovagal neurocardiogenic syncope is not homogeneous nosological unit, what results in efforts to it's more detailed classification.

Adult↗
PubMed1996

[Head-upright tilt table test: a new method for diagnosis of vasovagal neurocardiogenic syncope].

The head upright tilt table test (HUT) has been unambiguously included into the screening algorithm of syncopes. The HUT is based on exposing patients to orthostatic stress. This easy, cheap and safe test makes it possible to diagnose neurally-mediated vasovagal syncope (NMS). The pathophysiology of the NMS is based on the hypercontractility of the myocardium, when with the body being orthostatic, the venous return to the heart is lower and then followed by protecting mechanism--vasodilatation and bradycardia--both controlled by the CNS. Nowadays there is a tendency to integrate examination schedules of the HUT and all possible types of responses have been defined.

Humans↗
PubMed1995

[Use of creatine phosphate in treatment of cardiocerebral syndrome associated with acute myocardial infarct in the aged].

BACKGROUND: The objective of the investigation was to compare possibilities how to influence the general neuropsychic symptomatology described as cardiocerebral syndrome during the first three days of an acute myocardial infarction (AIM) in old age by means of creatine phosphate (CP). METHODS AND RESULTS: The investigation which extended over 8 months comprised 50 subjects admitted to the coronary unit (CU) because of AIM symptomatology, age 65-93 years (75.1 +/- 5.6 years). Twenty-five subjects were given, using a uniform protocol, during the first three days at the CU, 18 g CP (Neoton, Schiapparelli) by the i.v. rut. The control group of 25 subjects (randomized) with AIM of comparable parameters (age, sex, location and course of IM) were not given CP. Evaluation of the dynamics of mental deterioration by means of a test of cognitive functions (MMS) during the first three days after IM by means of simple regression analysis, comparing the two groups, revealed a favourable effect of CP on mental functions as compared with the control group (p = 0.05). In the CP treated group there was, as compared with the control group, on the 1st and 2nd day a lower incidence of stenocardias (statistically not significant; p = NS), ventricular dysrhythmias (p = NS) and cardiac failure (p = NS). CONCLUSIONS: Administration of creatine phosphate did not produce any undesirable side effects. Objective evidence was provided of the favourable effect of CP on mental deterioration in cardiocerebral syndrome in AIM in old age.

Aged↗
PubMed1995

[Neural syncope--a current therapeutic problem].

Syncope, a state performed by transient loss of consciousness connected with postural tone decrease present still an important therapeutical problem. It can vary from a benign physiological body reaction to a life-limiting situation. The authors of the article present HUT-testing to be a simple, useful and safe method for discovering vasovagal mechanism of the syncope. They notice the experiences with treatment according to the HUT results. The most frequent types of therapy are the pharmacological and the pacing ones, when the former is appropriate for I and III class of VVS the latter then for the II. class. There are some big studies in progress now which should bring more information about this clinical problem.

Humans↗
PubMed1994

[The effect of diuretics on the magnitude of the effect of isosorbide dinitrate given as a single dose and after long-term administration. Ergometric study in patients with stable angina pectoris].

The authors assessed in 24 men with stable angina pectoris, using means of ergometry, the antiischaemic and antianginose effects of a combination of the nitrate Iso-Mack retard and the diuretic Moduretic. The effects were compared with the effects of Iso-Mack retard administered alone and with the effects of placebo. The examination was made after a single dose of the drugs and after three-week administration. The authors revealed that a single dose of the diuretic significantly enhanced the effects of nitrate. During long-term administration the diuretic did not prevent a significant diminution of the nitrate effects. Finally the authors discuss possible mechanisms of development of tolerance for nitrates and possibilities how to influence this tolerance by a diuretic.

Adult↗
PubMed1994

[The role of the HUT test (head upright tilt table test) in patients with syncope of uncertain etiology].

UNLABELLED: The authors have examined 73 patients at the mean age of 36.8 +/- 15.3 (M:34, F:39). All the pts have suffered from recurrent presyncopes or syncopes the etiology of which has not been diagnosed by previous internal, neurological or psychiatric examination. Before the HUT the patients have undergone a complete cardiological examination. The HUT has been carried out according to the modificated Westminster protocol, the blood pressure and the heart rate have been monitored continuously. The end-point of the HUT has been a presyncope or a syncope, viewed as positive. The positive pts have been divided into 4 groups according to the changes of their blood pressure and heart rate during a presyncope or a syncope-mixed, cardioinhibitory A, cardioinhibitory B and vasodepressor responses. Out of 73 pts there have been 27 pts (37%) with positive responses and 46 (63%) with negative responses. The mixed type has been achieved in 12 pts, cardioinhibitory A-in 5 pts, cardioinhibitory B-in 2 pts, vasodepressoric in 8 pts. The mean time needed for positive response during the native HUT has been 17.7 +/- 11 min, after activating with isoproterenol for 2.6 +/- 1 min. The achieved results correlate with data in medical literature. The test activated with isoproterenol increases its sensitivity. There have not been any complications marked within the examined group. CONCLUSION: The HUT has been unambiguously included into screening algorithms of syncopes as an easy, cheap, safe examination with good sensitivity and specificity.

Adult↗
PubMed1993

[Comparison of the effects of molsidomine retard and isosorbide dinitrate retard in patients with stable angina pectoris using an ergometry test].

In 24 men with angina after exertion the authors assessed, using ergometry, the action of molsidomine retard and isosorbide dinitrate retard after a single dose and after tree-week administration of the drug. The authors found that 8 mg of molsidomine retard in a single dose had a somewhat more potent effect than 40 mg isosorbide dinitrate retard. After prolonged administration the effect of both drugs on haemodynamics diminished and in molsidomine a significant decline of action was observed before development of a reduced S-T segment on the ECG. After three weeks' administration the effects of both drugs were comparable. After neither drug clinically significant tolerance developed when the drug was administered every 8 hours. In the conclusion the authors discuss possible mechanisms involved in development of tolerance.

Adult↗
PubMed1993

[24-hour monitoring of blood pressure in patients with essential hypertension].

The aim of the study was to determine the efficiency of enalapril therapy during 24-hours blood pressure monitoring. A group of healthy subjects (C, n = 11), a group of patients with essential hypertension without therapy (EH, n = 9) and a group of patients with essential hypertension II (WHO) treated with enalapril (Acepril Lachema) in once a day doses (13.0 +/- 2.1 mg per kg) during at least 10 months (EH A, n = 8). In all groups of patients and healthy subjects 24-hours blood pressure measurement was provided using Accutracker II equipment. The mean values of systolic (SBP) and diastolic blood pressure (DBP) from 24-hours measurement (+/- SD) were in the group of healthy subjects C 121.38 +/- 10.49/74.79 +/- 7.88 mmHg, in the group EH 146.58 +/- 12.20/88.0 +/- 8.97 mmHg, in the group EH A 127.38 +/- 8.36/74.71 +/- 6.08 mmHg. The differences between the maximum and minimum mean blood pressure values during 24 hours (SBP/DBP) were in the group C 33/27 mmHg, EH 37/29 mmHg, EH A 29/21 mmHg. The smaller difference in SBP and DBP in EH A patients was significant in comparison to C and EH (t-test, p < 0.05). Cosinor analysis proved the results. From our results we can conclude that the Acepril therapy decreases blood pressure more during the day-hours then during night and it is preferable in connection to the risk of night hypotension with hypoxia.

Blood Pressure↗
PubMed1992

Pressure wave cardiography; cardiac diagnosis by means of noninvasive continuous blood pressure record.

The pulse pressure (PP) is proportional to the preceding interval (T) because of the restitution of contractility and the Starling mechanism, and is inversely proportional to the pre-preceding interval (T-1) because of potentiation of contractility. The aim of the present paper was to find if this relationship can be used for diagnostic purposes. Blood pressure was noninvasively and continuously recorded for 3 minutes (Penáz method), in 26 healthy subjects, in 13 patients with congestive heart failure (NYHA I,II) and sinusoidal rhythms and in 21 patients with atrial fibrillations. By means of multidimensional regression analysis the coefficient D[T] and D[T-1] were calculated in each subject. D[T] expresses the relative role of the preceding, D[T-1] of the pre-preceding interval. The correlation between PP and T was small in subjects with sinusoidal rhythms. Subjects with particular correlation coefficients between PP and T-1 higher than 0.5 were used for further analysis (18 controls, 7 patients). The difference between D[T-1] in controls (0.30 +/- 0.20) and in patients (0.48 +/- 0.19) was significant (Wilcoxon P less than 0.05). In subjects with atrial fibrillations both D[T] and D[T-1] were higher in decompensated patients (Wilcoxon P less than 0.05). The ratio D[T]/D[T-1] was higher in patients with mitral stenosis than in patients with ischaemic heart disease (t-test, P less than 0.05). The test can be usefully employed as a screening test in medical practice.

Atrial Fibrillation↗
PubMed1990

[Replacement of the aortic valve in patients over 60 years of age].

The authors evaluated a group of operated patients above 60 years of age where the main cardiosurgical operation was a aortic valve replacement. The early mortality in the group comprising 49 patients was 4.1%. (Of 33 patients where the replacement of the aortic valve was an isolated operation none of the patients died. From another 16 patients where also the mitral valve had to be replaced or IHD had to be resolved by revascularization of the heart muscle by aortocoronary bypasses, two patients died.) During a check-up examination one year after operation 92% of the checked patients where in functional group I or II according to NYHA classification (before operation all were in group III or IV). Prostheses of aortic valves do not only considerably prolong the life even in older patients but also improve its quality. Advanced age alone is no contraindication for operation and the surgical risk is not greater than in younger age groups. The authors recommend to implant in advanced age bioprostheses because of the markedly lower risk of serious haemorrhagic complications in the long-term postoperative course.

Aged↗
PubMed1989

[Replacement of the mitral valve with preservation of the posterior leaflet, papillary muscles and chordae tendineae].

The authors used in 11 patients with chronic mitral regurgitation Lillehei's method of replacement of the mitral valve by a mechanical valve preserving the posterior leaflet of the mitral valve, papillary muscles and chordae tendineae. None of the operated patients died. The authors proved marked functional improvement in the patients, reduction of the size of the left ventricle and left atrium, where by the ejection fraction did not change markedly. These results support the hypothesis that the continuity between the mitral anulus and the left ventricular wall through the valvular leaflet, chordae tendineae and papillary muscles assists the left ventricle on its systolic function.

Adult↗
PubMed1989

[Ebstein's anomaly of the tricuspid valve with the WPW syndrome].

Case-history of a four-year-old boy with Ebstein's anomaly of the tricuspid valve with WPW syndrome. Severe tricuspid insufficiency and repeatedly occurring tachydysrhythmias soon led to cardiac decompensation and death before the intended cardiac operation. Non-invasive clinical, ECG, X-ray and ECHO examinations correlated with catheterization, electrophysiological and pathological findings. In addition to the dislocated, malformed tricuspid valve the septal cusp of which was fused with the ventricular septum the authors found another additional atrioventricular muscular connection between the lower part of the septum of the right atrium and right ventricle.

Child, Preschool↗
PubMed1987

Occurrence, diagnosis and treatment of thromboses of heart valve prostheses.

In the period from 1978 to 1985, the authors implanted a total of 667 Björk-Shiley heart valve prostheses. In the same period, they performed 6 times reoperation for thrombosis of these valves. There was one reoperation for thrombosis per 271 years of life with a valve prosthesis, i.e. 0.36% per patient year. All 6 reoperations were successful and there was until now no recurrence of thrombosis in any of the reoperated patients. All cases involved were thrombosis of the flat disc Björk-Shiley valve. There was now no thrombosis of convexo-concave types, which the authors have been using since 1981. The most important preventive measure against the development of thrombosis is strict observance and control of anticoagulation regimen. Thrombosis of a disc valve prosthesis can in most cases be diagnosed on the basis of the clinical picture and X-ray evidence of restricted disc mobility. Diagnosis of thrombosis is an indication for urgent reoperation, which is preferred to an uncertain attempt at thrombolysis.

Aortic Valve↗