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Biomedical subjects

C Belli

Publications and source records attributed to C Belli.

At least 37 records · Page 2Linked to original sources
PubMed1980

[Electrocardiographical changes and rhythm disorders in Barlow's syndrome].

Mitral valve prolapse ( MVP ) , responsible for most of the symptoms which had previously been interpreted as being due to neurocirculatory disorders or cardiac neurosis , is being recognised more often and has an incidence of about 6-8 % in an unselected population . Although this condition was considered for a long time to be a benign auscultatory abnormality , it may be the cause of serious cardiac complication . Arrhythmias predominate with an incidence of 60 to 80 % on continuous electrocardiography . In a series of 245 patients with mitral valve prolapse confirmed on echocardiography , 52 patients chosen at random were studied to determine the incidence pf ST changes , disturbances of heart rate , QT interval , changes of QRS , arrhythmias with resting , exercise and continuous ECG over 24 hours ( HMS = Holter Monitoring System ) . Abnormalities of ventricular repolarisation , especially flattening of the T wave and , less commonly , St depression were observed in about one third of the patients . These changes were more common in the inferior but were also found in the left precordial leads . 73 % of the 52 patients had a heart rate of 75/mn and their QT intervals showed the following changes : 30.7 % Had a duration greater than the 120 th percentile ; 19.2 % had a duration greater than the upper limit of normal . The other 50 % had a QT interval of around the 100 th percentile . None had a duration of less than the 90 th percentile . In 22.5 % patients , QRS changes due to conduction defects were recorded ( 15 % right bundle branch block - RBBB - , 7.5 % incomplete RBBB ) . HMS is the method of choice for detection of arrhythmias . Resting ECG only showed premature ventricular contractions ( PVCs ) in 12.5 % , compared to 32.5 % on exercise ECG and 62.5 % on HMS . 50 % PVCs were monomorphic , 5 % polymorphic , 7.5 % in salvos and 7.4 % supraventricular in origin . The circadian variation of PVC was striking with a high incidence during periods of activity . There was no statistical correlation between the incidence of PVCs , age , sex , type of MVP and the symptoms and auscultatory findings . The theories on the pathogenesis of the arrhythmias are divided between that based on an underlying cardiomyopathy ( confirmed by the presence of degenerated myocytes on electron microscopy ) and the mechanical hypothesis ( chordae tendinae irritating the endocardium or traction on the papillary muscle with resulting ischaemia ) which provide a better explanation of the clear predominance of monomorphic PVCs . The treatment of Barlow's syndrome is discussed . In our opininon , therapy is only required for ventricular arrhythmias detected by a sufficiently sensitive method such as HMS . Most authors use beta blockers , eventually in association with quinidine Therapeutic successes have also been observed with mexiletine , amiodarone , aprindine and less commonly with disopyramide .

Adolescent↗
PubMed1980

[Specificity and sensitivity of pulmonary valve motion in echocardiographic examination as an index of pulmonary hypertension].

Many investigation have been made to establish the role of echocardiography in the diagnosis of pulmonary hypertension based on some parameters derived from the pulmonic valve leaflet echo motion. By observing 160 echo tracings of pulmonary valve motion, the authors calculated the specificity, sensibility and predictive value of these parameters as predictor of pulmonary hypertension, comparing echo data with corresponding haemodynamic determination of pulmonary artery systolic, diastolic and mean pressure and the degree of pulmonary vascular resistances. By means of the statistical analysis of variance correlation between "a" wave depth and severity of pulmonary hypertension was made. "A" wave depth and RPEP/RVET ratio resulted quite sensitive and highly specific indices of pulmonary hypertension, in particular "a" wave depth proved to correlate very well with the level of pulmonary artery systolic, diastolic and mean pressure and with the degree of pulmonary vascular resistances. Highly specific, but not always detectable, was the presence of a midsystolic notch. In conclusion, pulmonary valve echo motion detected by M-mode technique provides useful index of pulmonary hypertension, chiefly by the measurement of "a" wave depth which can also predict its severity.

Echocardiography↗
PubMed1980

[Role of M-mode and 2-dimensional (sector-scan) echocardiography in studying postinfarct ventricular kinetic changes].

20 patients with previous myocardial infarction clinically suspected to have large impairment of ventricular wall kinesis were studied to evaluate the contribution of M-mode and two-dimensional echocardiography compared with the cineangiographic study in detecting left ventricular asynergy. Two-dimensional cross-sectional echocardiography yielded a satisfactory overlapping of results with ventriculography as far as left ventricular internal dimension and apical and posterior wall kinesis were concerned. The two-dimensional study proved to be an useful technique to observe the interventricular septum, in all its extension and the lateral wall as well. The M-mode technique, on the other hand, provided a reliable method, by means of the mitral valve echo, to determine the presence of elevated left-ventricular end-diastolic pressure; this was indicated by the occurrence of a B point, on the AC slope. A late opening of the mitral valve compared with the onset of left ventricular posterior wall relaxation phase, and other anomalies observed on the CD slope (SAM or pseudo-SAM), indicated pathological left ventricular kinesis. The failure of the left ventricular posterior wall to reach the septum moving the transducer from the aorta to the cardiac apex was considered indicative of apical dilatation, even if limited by a great number of false negatives. M-mode echocardiography provided also a quantitative evaluation of septal and postero-basal wall movement (particularly important from a prognostic point of view) and left ventricular end-diastolic dimension which, if corrected by body surface, resulted similar to those obtained by the two-dimensional technique. M-mode and Two-dimensional cross sectional echocardiography appeared to be complementary techniques which allow an adequate evaluation and diagnosis of left ventricular asynergy. They seem to be particularly useful to follow prospectively patients affected by myocardial infarction.

Adult↗
PubMed1980

[Uni- and cross-sectional bidimensional echocardiography in coronary care unit. Study on 117 patients (author's transl)].

The Authors present the results of an unidimensional and cross-sectional bidimensional echocardiographic study carried out on 117 patients taken into the Coronary Care Unit of the Divisione Rizzi in the Milano-Niguarda Hospital. The purpose of this work was to reconsider the usefulness of this diagnostic methodology in situations of cardiologic emergency, with particular reference to acute coronaropaties. The echocardiographic examination was recorded within 24-48 hours since the admission in CCU of patients taken in for acute myocardial infarction, cardiogenic shock, serious dysrhythmias and unstable angina. In particular, 17 cases of acute myocardial infarction have been followed with cross-sectional bidimensional echocardiography, holding the exams at the time of admission and in II, III, V and XV day of illness. Moreover, such examinations were held in emergency situations as occurred in CCU. All the patients were also investigated from the clinical, electrocardiograhic, radiological and laboratorial point of view. The obtained results were the following: 1) In contrast with unidimensional echocardiography, cross-sectional bidimensional echocardiography has turned out to be technically feasible in all cases; moreover, it has permitted a view of the zones of the left ventricul that couldn't be explored by unidimensional technique. 2) A good correlation has been demonstrated between electrocardiographical location of acute myocardial infarction and dyskinetic zones as seen on the echocadiogram; indeed, in some cases, echocardiography has been able to point out an impairment of wall motion greater than expected only on the basis of electrocardiographic evaluation. 3) Systematic use of the echocardiography in CCU has often been able to point out pathological findings whose diagnosis was not feasible only on the basis of the usual clinical or instrumental data. In conclusion, the Authors confirm the diagnostic and prognostic usefulness of unidimensional echocardiographic study in CCU and underline that the event of cross-sectional bidimensional echocadiography opens new opportunities for the employment of the ultrasonographic methodology, although it is not yet in the position to completely substitute unidimensional echocardiography.

Coronary Care Units↗
PubMed1976

Antidepressant treatment with maprotiline in the management of emotional disturbances in patients with acute myocardial infarction: a controlled study.

In coronary artery disease the patients usually manifest both anxiety and depression disturbances. A controlled clinical study was conducted to test the efficacy of a new antidepressant agent, maprotiline, in the early stages of acute myocardial infarction. The sample consisted of 126 patients, sixty-three receiving orally 25 mg of maprotiline twice daily and the remainder 5 mg of diazepam twice daily. Treatment lasted on an average two weeks (ten days to eight weeks). The depressive and/or anxiety conditions were rated on the basis of a questionnaire administered before and after treatment. Depression improved markedly in patients receiving maprotiline, while the two drugs developed a comparable anxiolytic action. Tolerability was good. No clinical or ECG evidence of cardiotoxic signs was detected. The importance of a drug with these characteristics in the management of emotional disturbances in the early stages of coronary artery disease is emphasized.

Acute Disease↗
PubMed1976

[A correlative study of the evolution of myocardial infarction using 131Cs scintigraphy and ecocardiography (author's transl)].

21 patients with acute myocardial infarction (A.M.I.) were studied by echocardiography (Echo) and 131CS myocardial scintigraphy (M.S.). Some months after discharge from Hospital (mean value = 10 months), the echocardiograms and myocardial scintigrams were taken again. M.S. resulted modified in 13 patients (62%); in 7 of these there was a reduction of the "cold" area due to M.I.; in 6 an extension with scintigraphic pattern of left ventricular aneurysm was shown. Echo showed in the first group of 7, with normal ventricular cavity (L.V.C.), dimension and good movement of the walls affected by A.M.I. In the second group of 6, L.V.C. dilatation (mean value = 5,6 cm) and reduction of L.V. walls movements gave noticeable results. In the patients (8 = 38%) with unchanged M.S., Echo showed an L.V.C. dimensions increase and L.V. wall movement reduction. The most important results of the present study is the sensitivity of the M.S. and Echo to picking up left ventricular aneurysm by means of non-invasive techniques. The Authors emphasize the availability of Echo and M.S. in the follow up of M.I.

Cesium Radioisotopes↗
PubMed1976

[Prognostic value of serial determination of CPK in acute myocardial infarction (author's transl)].

Serial determinations of CPK enzyme were performed every 4 hours during a 72 hour period in 40 patients with acute myocardial infarction (AMI) admitted to the Coronary Care Unit in the first 6 hours (average 2.6) from the appearance of symptoms. The peak ratio of activity of CPK was 708 mU/ml +/- 48 E.S. as medium value in the whole group was reached in a medium period of 21,1 +/- 0,74 E.S. hours from the attack. Half value of the peak ratio activity was reached after a medium time of 19,1 +/- 1,0 E.S. hours. A significant statistical correlation between the CPK peak ratio and the prognostic index of Selvini et al. was found. The peak ratio resulted in 571 +/- 41 E.S. in patients with uncomplicated AMI, whereas in those with complications such as arrhythmias and heart failure the average value was 901 +/- 136 E.S. No significant correlation between CPK values and ST wave evolution of the ECG peak ratio of 1638 mU/ml was found; however, one patient who died of cardiac rupture showed a low level of 395 mU/ml. The diagnostic and prognostic value of the serial determination of CPK during the first 48 hours of a coronary attack is emphasized.

Acute Disease↗