Biomedical subjects
Publications and source records attributed to C Streian.
A 33-year-old man presented a complete antrio-ventricular block due to two hydatid cysts localized in the interventricular septum and interrupting both bundle branches. Intracardiac rupture within the right ventricle led to extensive pulmonary hydatidosis and death.
The paper presents a report on the clinical and electrographic spectrum of nine patients with the sick sinus syndrome with severe symptoms of clinical disturbances and serious disorders of impulse formation and conduction. Seven patients had syncope associated with sinus bradycardia, sinoatrial block or atrial fibrillation with slow ventricular rate. Prolonged episodes of atrial and ventricular asystole occurred and were interrupted by junctional escape beats. Paroxysmal atrial fibrillation and flutter were foun in three patients and infrahisian block in four. Atropine induced a slight acceleration of the heart rate in all the patients studied while the post-suppression S-A node recovery time was prolonged in four.
In 12 patients with manifest hypothyroidism right atrial monophasic action potentials showed a significant prolongation in comparison with data from normal or euthyroid patients. Atrial effective refractory periods were also significantly prolonged. After thyroid treatment the monophasic action potential duration and the effective refractory period of the right atrium were within normal ranges. In 6 hypothyroid patients studies of AV conduction with the aid of His bundle electrography and atrial pacing showed a supraHisian conduction delay which was manifest in one case and latent in another two. InfraHisian conduction delay was encountered in 2 cases.
A case of juvenile reno-vascular hypertension is presented. Extensive involvement of aorta and its branches was found. The possible inflammatory or congenital origin of the arterial lesion is discussed.
In 28 patients with established atrial fibrillation [AF], right atrial monophasic action potentials [MAP] were recorded before DC shock. A close correlation was found between the atrial rate and MAP duration of the fibrillatory waves [FW]. The duration of MAPs ranged between 1 and 6 mV. The atrial rate ranged between 311 and 578 per minute, the highest rates were found during lone AF. In two patients in whom cardioversion failed, a prolongation of right atrial MAP duration of the FW was noted. The efficacy of DC shock and the maintenance of sinus rhythm after cardioversion was greater in patients with AF having a slower rate and a longer MAP.
Five patients with bidirectional tachycardia due to digitalis toxicity associated with severe organic heart disease were studied. The origin of the abnormal rhythm was established with the aid of His bundle recordings in three cases and by indirect clues in the others two. In three cases the origin of bidirectional tachycardia was suprahisian while in two patients it was infrahisian. In one patient the transition from junctional to ventricular tachycardia could be observed. Bidirectional tachycardia appears to be a complex arrhythmia in which similar electrocardiographic configuration can be due to different mechanism. Digitalis toxicity was often a causal factor.
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In a group of five patients with asymmetric septal hypertrophy, the presence of the mitral regurgitation and the left ventricular outflow tract gradient were studied by the Doppler echocardiographic technique. By means of Bernoulli's formula 4V2 = P1-P2, left ventricular maximal systolic pressure was assessed using mitral regurgitant and left ventricular outflow tract jets. Aortic systolic and diastolic blood pressures were measured by cuff sphygmomanometry, and simultaneous carotid pulse tracings were recorded. All patients had outflow tract pressure gradients (peak 84 +/- 11.7 mmHg) and mild mitral regurgitation. Continuous wave Doppler study recorded peak flow velocities in the outflow tract (4.6 +/- 0.26 m/sec) and mitral regurgitant (6.5 +/- 0.51 m/sec) jets. The values for ventricular systolic pressures by both methods were similar (180 +/- 24.2 vs 186 +/- 13.5 mmHg). This study confirms the presence of mitral regurgitation and actual obstruction in hypertrophic cardiomyopathy with asymmetric septal hypertrophy.
To identify the patients with hypertrophic cardiomyopathy at high risk of morbid events we investigated 25 patients with echocardiographic evidence of hypertrophic cardiomyopathy. All the patients were subjected to submaximal exercise test under electrocardiographic monitoring. More than 50% of the patients developed ventricular arrhythmias, about half of them presenting multiform or repetitive premature ventricular depolarizations; two patients presented ventricular tachycardia. Our results suggest the value of exercise test in identifying the patients at high risk of developing severe arrhythmias.
The Doppler method (pulsatile and continuous) was used for finding out and semiquantitatively evaluating the mitral insufficiency of various etiologies: inflammatory (rheumatic); prolapse of mitral valve; obstructive hypertrophic cardiomyopathy; dilatative cardiomyopathy; calcification of valvular ring. The Doppler parameters obtained after automatic processing of the image (speed transvalvular pressure gradient, flow period and acceleration) offer data on the diastolic performance of the left ventricle. Registration of the aortic flow makes possible the calculation of the cardiac flow (the diameter of the aorta is measured in echo-B), and of the aortic flow permits the noninvasive evaluation of the lung arterial pressure. The method offers a large vista in the noninvasive evaluation of the patients suffering from mitral insufficiency.
The present study investigates 16 patients with aortic regurgitation (AR), and 10 patients with mitral regurgitation (MR). Before operation, all the 26 patients had increased telediastolic and telesystolic diameters. The patients were divided into two groups, as a function of the postoperative values of the telediastolic diameter: group A--with the telediastolic diameter within normal limits; group B--with the persistence of the increased values of the telediastolic diameter. In the case of the patients with AR, the following postoperative situation was noticed: in group A: the peak systolic stress (PSS) was increased, the shortening fraction (SF) in the telesystolic stress (TSS) within normal limits; in group B: PSS and TSS were increased, and ST depressed. 8 months after the valvular correction, in group A: PSS, TSS and SF were normal; in group B: the changes in PSS and TSS continued and was lowered. In the case of the patients with MR, before operation, in group A: PSS was slightly increased while TSS and SF were normal; in group B: PSS was slightly increased, TSS, increased and SF depressed. 8 months after the surgical correction: in group A: PSS and SF decreased; in group B: echocardiographic changes continued. Therefore, in the group B patients with MR and AR, the persistence of the increased values of PSS, TSS leads to the postoperative decrease of SF (post-charge in excess).
The hypertensive cardiopathy is a controversial entity as regards the physiopathological mechanisms and clinical aspects. Defined as the hypertrophy of the left ventricle, secondary to the permanent tension increases, it accompanies not only the severe forms of arterial hypertension but also the medium and mild ones. In the authors' opinion, based on numerous experimental and clinical studies, the main factor that initiates the myocardial hypertrophy is the increased parietal tension (hemodynamic hypertrophy). The natural evolution is progressive, the myocardial hypertrophy initially adaptive becomes pathological and the cardiac performance is affected gradually, first in its diastolic and then in its systolic component, up to the final stage of congestive cardiac insufficiency. The structural changes of the myocardial fibre also document the adaptive and pathological hypertrophy, the alteration of the myocardial contractility consisting in the difficulty of transforming the chemical energy into mechanical work. The clinical aspects show an incipient myocardial hypertrophy, considered adaptive, since the cardiac performance is normal; an important hypertrophy affecting the diastolic component and the hypertrophy with dilatation that affects the overall performance. Of the evaluation methods, the echocardiography is the most accurate one in quantifying hypertrophy, evaluation of the cardiac performance and possibility of detecting several characteristic aspects of the hypertensive cardiopathy. The transition moment from the adaptive hypertrophy to the pathological hypertrophy cannot be exactly established but it is documented that the hemodynamic and nonhemodynamic hypertrophy is a supplementary cardiovascular risk factor.
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In 12 patients with severe congestive heart failure (CHF), captopril in doses of 25 to 150 mg, every 8 hours, was given for a period of 2 months, in addition to cardiac glycoside and diuretic drugs. After this treatment left ventricular end-diastolic diameter (EDD) decreased from 6.4 +/- 0.5 to 6.2 +/- 0.6 cm (p less than 0.05), left-ventricular end-systolic diameter (ESD) decreased from 5.7 +/- 0.5 to 5.4 +/- 0.6 cm (p less than 0.001), the ejection fraction increased from 30.8 +/- 7.0 to 36.2 +/- 6.9% (p less than 0.005) and mean velocity of circumferential fiber shortening (Vcf) increased from 0.51 +/- 0.12 to 0.62 +/- 0.13 circ/sec (p less than 0.001). Captopril markedly relieved dyspnea and fatigue. Three patients improved from class IV to class III, 4 patients from class IV to class II and 3 patients from class III to class II. These data suggest that captopril may be effective in the treatment of severe chronic CHF.