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Biomedical subjects

C Gómez Pajuelo

Publications and source records attributed to C Gómez Pajuelo.

15 recordsLinked to original sources
PubMed2004

Systolic left atrial failure in elderly women with severe aortic stenosis: mitral and pulmonary vein Doppler analysis by transesophageal echocardiography.

We studied prospectively 35 elder women aged 65-82 years, with isolated severe symptomatic aortic stenosis, referred for aortic valve surgery. We assessed diastolic function by TEE before and after cardiac surgery, although follow-up data were collected in 26 patients. The examination was performed prior to surgery and 6 months after. The control group consisted of 32 patients referred for TEE. In the preoperative study, the velocities and integrals of the waves in the pulmonary vein flow were similar to the people of their same age, except the A-wave of atrial contraction and the integral of the systolic wave, which were significantly smaller (Control A-wave 26.1 +/- 5.1 vs preoperative A-wave 22.6 +/- 5.6, P = 0.009 and control double product A vel xA dur 2,748 +/- 835 vs preoperative 2,273 +/- 968, P = 0.03; systolic integral 14.6 +/- 3.8 vs 11.3 +/- 4, P = 0.0009). Six months after surgery, the PV flow was similar to the control group except for the wave of atrial contraction, which was significantly smaller but tended to normalization (postoperative A-wave 23.3 +/- 5, P = 0.04 vs control, and postoperative double product A vel x A dur 2460 +/- 893, P = 0.21 vs control). Mitral flow parameters did not change in the preoperative and postoperative period. Left ventricular mass index changed from 166 +/- 54 g/m(2) to 105 +/- 39 g/m(2) (P< 0.0001). The results of this study show that in elderly women with symptomatic severe AS, diastolic function does not change, left ventricular mass reduces, with improvement in symptoms, and the left atrium function, considered by pulmonary vein flow, is preoperative depressed and tends to mild recovery in the postoperative period, suggesting systolic LA failure.

Aged↗
PubMed1999

[An anomalous origin of the left coronary artery associated with a right coronary spasm as the cause of angina and presyncope].

We describe the rare association of angina at effort and presyncope in a young patient with an anomalous origin of left coronary artery and associated coronary spasm in the normal right coronary artery. The patient did well under calcium channel blocker therapy after seven years of follow-up, which is in contrast with the usual recommended management of these patients.

Adult↗
PubMed1999

[Quality of life and social support in patients with non-complicated acute myocardial infarct].

INTRODUCTION: There is a relationship between social support and health. However, there is no very much available research in the area of ischemic heart disease related to the influence of social support on the quality of life. OBJECTIVES: To study the social aspects of patients. To measure emotional and instrumental social support and quality of life, after a first acute myocardial infarction. PATIENTS AND METHODS: 155 patients were studied under two pieces of assessment: at admission's time and six months later. A protocol was selected with clinical, socio-economic, social support and quality of life variables. RESULTS: 90.9% could read and write, however 42.3% have any study or completed their primary studies. Moreover, 45.1% of patients were working, at six months only 14% of them had returned to their jobs. They were blue and white collar patients. Availability of instrumental and emotional social support was referred by 78.7% and 69.9% respectively of patient's. At the beginning, the mean quality of life was 108.1 +/- 19.3. Six months later was 101.1 +/- 19.1 SD. Statistics revealed that the availability of instrumental and emotional social support impacts favourably on human being's health. CONCLUSIONS: The quality of life is related to the patient's perceived social support. The perceived social support depends directly on the size of their network. Moreover, there is a relationship between quality of life and educational achievement, so that, the lower that patient's quality of life, the lower the educational achievement. After the first not complicated myocardial infarction the return to their jobs is really low.

Acute Disease↗
PubMed1996

[Cardiomyopathies (VII). Natural history of hypertrophic cardiomyopathy].

After a short historic review of conceptual developments in hypertrophic cardiomyopathy, the natural history of the disease is analyzed according to each of its morphologic and functional abnormalities. The lack of association between hypertrophic morphology and sudden death is considered. Diastolic dysfunction and LV obstruction, although a frequent cause of dyspnea and heart failure, is not a risk factor for sudden death. Something similar occurs with the infrequent appearance in this disease of contractile failure. Myocardial ischemia is frequent in hypertrophic cardiomyopathy and general prognostic information about it is still lacking. Nevertheless, in young patients with family history of sudden death, a positive Thallium effort test may be a marker of sudden death (without an arrhythmogenic substrate), and may respond to verapamil. Finally, the new knowledge about genetic mutations in hypertrophic cardiomyopathy are analized. We conclude with some futuristic comments about hypertrophic cardiomyopathy.

Adolescent↗
PubMed1996

[Pulmonary hypertension: current aspects].

Primary pulmonary hypertension, although less frequent than secondary forms, represents the true paradigm of this disease. The recent investigations on pulmonary vascular response mechanisms to different stimuli has increased our knowledge about the mechanism of high pulmonary pressure. Molecular biology of the endothelial cell has provided evidence that endothelial injury plus a genetic individual predisposition may be the pathogenic mainstream of this disease. The histologic findings of pulmonary hypertension are still a matter of controversy, although the clinical, epidemiological and prognostic features are better defined. Therapeutically, there has been important advances, specially with various vasodilators, like calciumantagonists, prostacyclin, adenosine and nitric oxide, as well as new routes of administration. In more advance stages of the disease, atrial septostomy (only paliative) and pulmonary or cardio-pulmonary transplantation, are other therapeutic options to consider, after an adequate selection of patients.

Algorithms↗
PubMed1995

[Effect of 3 hypertensive++ agents on ventricular geometry and function].

BACKGROUND: To assess the prevalence of left ventricular hypertrophy in hypertensive patients referred to an outpatient cardiology unit, and to assess its evolution under antihypertensive treatment. METHODS: One hundred and seven mild to moderate hypertensive patients were randomized to receive either xipamide, verapamil or atenolol. Cross-sectional echocardiography was performed in order to assess left ventricular mass and function. RESULTS: Mean age was 56 years, with a 4:1 female/male ratio. Mean follow-up was 120 days. Left ventricular hypertrophy was very common (65%) and decreased to 54% under antihypertensive treatment. Left ventricular mass decreased from 134.3 g/m2 to 118.1 g/m2 (p < 0.001). Concentric hypertrophy was the most common geometric pattern (42%), decreasing to 30% with treatment. Xipamide decreased ventricular mass by decreasing left ventricular diameters, while verapamil and atenolol decreased left ventricular thickness, mainly in septal wall. Systolic function was not modified during the treatment period. Diastolic function was not modified by xipamide and verapamil, and improved with atenolol. CONCLUSIONS: Left ventricular hypertrophy is very frequent when determined by echocardiography and all three drugs produced regression of left ventricular hypertrophy in a different way with respect to left ventricle geometry, an effect which could have potential therapeutic implications.

Atenolol↗
PubMed1992

Treatment of transient myocardial ischemia in patients with stable angina: a comparative study of verapamil slow-release and nifedipine plus propranolol.

We compared the effect of verapamil slow-release (VSR) and the combination of nifedipine plus propranolol on transient myocardial ischemia in a double-blind study comprising 20 patients with proven coronary artery disease and chronic stable angina. According to the results of 24-h Holter-monitoring recording, patients were divided into two groups: 10 patients with fixed coronary reserve and 10 patients with variable coronary reserve. The number of ischemic events was reduced with both therapies: from 12 +/- 10 at baseline to 3.4 +/- 4.0 (p less than 0.05) with verapamil and to 3.9 +/- 7.0 (p less than 0.05) with nifedipine plus propranolol (N + P). When total ischemic burden was measured, findings were similar: It was reduced from 104 +/- 196 min to 27 +/- 57 (p less than 0.05) with N + P and to 17 +/- 18 min with verapamil in patients with fixed coronary reserve and from 36 +/- 44 to 5 +/- 9 min (p less than 0.05) with verapamil and to 5 +/- 10 min with N + P in patients with a variable coronary reserve. VSR shows antiischemic efficacy similar to that of the combination of N + P in treatment of transient myocardial ischemia in patients with stable angina.

Adult↗
PubMed1992

Right coronary artery-right atrium fistula in primary angiosarcoma of the heart.

We report a case of angiosarcoma of the heart, manifested as a continuous murmur. Right coronary arteriography disclosed a paracardiac mass with fistulas from the coronary vessel to the right atrium. Histologic study revealed this to be an angiosarcoma with sinusoidal pattern. To our knowledge, this is the first case of this kind of cardiac tumor presenting as a fistula from a coronary artery to the right atrium.

Coronary Disease↗
PubMed1991

Spontaneous left atrial haematoma.

We present a woman with paroxysmal atrial fibrillation and a mass in the left atrium. Cross-sectional echocardiography defined the lesion as cystic, while magnetic resonance imaging depicted it as a solid mass with areas of focal bleeding. Surgical resection showed a partially organized haematoma within the left atrial wall. The patient did well after surgery, although atrial fibrillation recurred. The presence of an atrial haematoma is rare, specially when spontaneous, and we stress the usefulness of magnetic resonance in reaching an aetiologic diagnosis.

Atrial Fibrillation↗
PubMed1991

[Severe poisoning with digitalis treated by the administration of anti-digoxin antibodies].

A case report of severe digitalis poisoning in a patient with prosthetic heart valve is presented. He complained of nausea, vomiting, drowsiness, temporal disorientation and lethargy. The electrocardiogram showed idioventricular rhythm, and plasma levels of digoxin were 6.78 ng/ml. Predisposing factors por digitalis poisoning were prerenal failure and concomitant quinidine therapy. Treatment with digoxin-immune antibody fragments (FAB) promptly lead to abolition of the ventricular arrhythmia and disappearance of every clinical symptoms in hours. Plasma digoxin levels showed a steep decrease until normal values at the fifth day. The favourable course of either clinical and electrocardiographic response to IV administration of FAB are discussed, stressing the fact of the high morbidity of digitalis poisoning in opposition to the relative safety of Fabs use in its therapy.

Digitalis Glycosides↗
PubMed1991

[Relationship between echocardiographic measurement of left atrial size and the incidence of systemic embolism in mitral stenosis].

In order to correlate left atrial diameter (LAD) with the prevalence of systemic embolism (SE) in mitral stenosis (MS), we assessed LAD by M mode tracings in 51 patients with SE and in 50 patients with MS without ES as control group (C). Mean age was similar in both groups (SE 47.3 +/- 12 vs C 46.8 +/- 14 years; p NS) (mean +/- SD). Functional class, cardiothoracic ratio and association of other valvular lesions were similar in both groups. Atrial fibrillation (AF) was more frequent in SE group (n = 39) than in C group (n = 20) (p less than 0.01). LAD in SE patients ranged from 2.9 to 9 cm (5.2 +/- 1) whereas in C patients range was from 2.8 to 7.5 (4.6 +/- 1) (p less than 0.01). Nevertheless, LAD in patients with AF was rather similar in both groups (SE 5.3 +/- 1.1 vs C 5.3 +/- 1; p NS). Our results suggest that LAD is not a good predictive parameter for SE in MS. The main risk factor for SE was the existence of AF. Echocardiographic LAD is not a useful parameter to prescribe chronic oral anticoagulation as prophylaxis for SE in patients with MS.

Adult↗
PubMed1989

Treatment of mild to moderate hypertension with verapamil slow-release in outpatients. Collaborative Group of the Spanish League for the Fight Against Hypertension.

The efficacy of verapamil, a calcium channel blocker in slow-release form, 240 mg once a day, was assessed in 1,412 ambulatory, mildly to moderately hypertensive patients. Blood pressure decreased from 171.82 +/- 17/103.55 +/- 6 mm Hg at week 0 to 157 +/- 15/93.6 +/- 8 mm Hg at 2 weeks (p less than 0.001) in 78% of patients. At week 12 there were 1,249 patients (88%) controlled with therapy, either with verapamil alone (950 patients, 67%) or plus additional diuretic (21%). Blood pressure showed a mean decrease of 24.6 mm Hg in systolic and 17.2 mm Hg in diastolic pressure at week 12. Heart rate decreased from 81.4 +/- 11 beats/min at week 0 to 75.69 +/- 8.5 beats/min at week 12 (p less than 0.05). There were no statistical differences in the effect on diastolic blood pressure between elderly (greater than 65 years) and nonelderly patients in the study, although the elderly showed higher baseline systolic pressure (178.27 +/- 17 mm Hg vs. 168.97 +/- 16 mm Hg, p less than 0.001) than did nonelderly patients. Verapamil therapy produced a similar effect on systolic pressure (p = NS) in younger patients (23.96 mm Hg decrement) and in the elderly (25.93 mm Hg decrement). The overall incidence of adverse reactions was 16.58%, accounting for 1.06% of patients' withdrawals. Constipation (5%) was the most common side effect. We conclude that slow-release verapamil, 240 mg once a day, is an effective therapeutic alternative in systemic hypertension, and must be included in the first step of antihypertensive therapy.

Aged↗
PubMedDate not supplied

[The effect of trandolapril, in monotherapy and associated with verapamil, on arterial pressure, albuminuria, and metabolic control in hypertensive patients with type 2 diabetes and albuminuria].

The aim of this study was to analyse the effect of the ACE-1, Trandolapril, alone or with Verapamil on blood pressure, albuminuria and metabolic profile in type 2 diabetic patients with hypertension and albuminuria. It was an open multicenter, consecutive and prospective study conducted in 281 patients. There was a four-week wash-out period of antihypertensive drugs, after which we carried out a measurement over a 24-h period of the urinary excretion of albumina (UEA). Blood pressure was recorded after at least 5 minutes of rest in the sitting position at 1 to 3 minute intervals with a mercury sphygmomanometer in good condition. Average BP was obtained from three consecutive readings. Within treatment changes were analysed using descriptive statistics and t-tests on the change from baseline. Analysis of variance, chi-square and Mc Nemar tests were also used. If after 8 weeks of treatment with Trandolapril 2 mg o.q.d. the patients were non-responders (mean blood pressure reduction of 5 mmHg or less) or their blood pressure remained uncontrolled (blood pressure > or = 140/90 mmHg), Verapamil 180 mg o.q.d. was added. Two hundred and thirty patients completed the 12 weeks study. Population included 157 (55.9%) males with an average of 61.7 +/- 9.2 years. Baseline measurements were systolic 165.4 +/- 14.6 and diastolic 94.8 +/- 8.5 mmHg blood pressures, fasting glucose 162.7 +/- 43.9 mg/dL, glycosylated hemoglobin (HbAlc) 6.8 +/- 1.2%, and albuminuria 520.9 +/- 602 mg/day. UEA fell significantly (p < 0.001) after treatment to 177.9 +/- 24.3 mg/day (CI 95%, 129.9 to 225.8). The percent reduction reached 29.6%. Albuminuria was lower than 30 mg/day in 47 patients. Blood pressure was completely controlled in 125 (54%) patients. Glucemia fell significantly (p < 0.001) to 153.2 +/- 42.7 mg/dL, and the HbAlc to 6.5 +/- 1.3% (p = 0.012). In summary, in those diabetic type 2 patients with arterial hypertension and proteinuria, Trandolapril alone or associated with Verapamil significant lowered albuminuria and blood pressure facilitated the control or their metabolic profile.

Albuminuria↗