[Preliminary evaluation of the use of nifedipine in peripheral circulatory disorders on a functional basis].
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Biomedical subjects
Publications and source records attributed to C M Finzi.
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An echo- and vectorcardiographic study had been performed in order to analyze the motion of the interventricular septum (IVS) in thirty-six patients with chronic pacing at the apex of the right ventricle. As this pattern has been reported as just like that of LBBB, five patients with LBBB have been studied as well, with transient pacing. As far as the first group, in 25 P. IVS moves, both during spontaneous activity and pacing, like in normal subjects; in 8 P. the records were questionable; in 3 P. IVS moves liek in LBBB. The group of 5 P. with LBBB shows paradoxical motion of IVS both before and during pacing. In vectorcardiograms, the initial ventricular vectors (from 0 to 30 msec) are upward, backward and rightward oriented, in 33 of the first group's 36 P. The second group of 5 LBBB failed to show a costant pattern. The possible electrophysiologic hypotheses, about genesis of these patterns, are discussed.
85 vectorcardiograms, characterized by anteriorly oriented horizontal ventricular loop, were analized in order to evaluate if this pattern can be considered diagnostic at all for strictly posterior myocardial infarction. Records were divided into two groups according to positivity or negativity of clinical history for myocardial infarction. Records consistent with right ventricular hypertrophy were ruled out. Nine parameters related to ventricular depolarization and repolarization were measured and the values were submitted to statistical analysis. The study showed that:--selection of the two groups was correct, because of first group's homogeneity and control group's unhomogeneity;--mean values of the nine parameters did not differ significantly in the two groups;--single parameter into each group was unrelated to others. As a consequence, criteria at the time in use for diagnosis of strictly posterior myocardial infarction seem not to be useful, as other conditions beside myocardial infarction or right ventricular hypertrophy are able to determine the same vectorcardiographic pattern.
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500 vectorcardiograms of variously located myocardial infarctions were analysed. Abnormalities of the afferent limb of QRS loop, consistent with intraventricular conduction disturbances, were detected in 42 cases. This pattern, according to Rosenbaum, was called "infarction block"; it was always associated with inferior and/or posterior infarction. This kind of block is shown by a large downward, righward and backward-directed vector, which always appears about 50 msec after the onset of ventricular activation. Total ventricular depolarization time was not significantly prolonged. The pattern was explained as a variant of "peri-infarction block" and its origin is hypothesized as the interruption of a peripheral ramification of LBB posterior fascicle.
The complex question of peri-infarction blocks is examined. Whereas this term was once used for conduction disturbances now interpreted as fascicular blocks, a distinction is drawn here between these and parietal, post-Hisian blocks and infarctual blocks. Their vectorcardiographic picture are described, along with the possible expression of segmentary blocks at the peripheral branches of the posterior fascicle of the left branch. These electrogenetic interpretations are discussed in the light of data obtained by phonomechanographic methods in cases of parietal block.
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