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Biomedical subjects

D Durrer

Publications and source records attributed to D Durrer.

At least 37 records · Page 2Linked to original sources
PubMed1983

Left ventricular thrombus following acute myocardial infarction: a prospective serial echocardiographic study of 96 patients.

In a prospective serial study of 96 patients with acute myocardial infarction, two dimensional echocardiography identified left ventricular thrombus in 18 patients. The majority of thrombi (15) developed within the first 4 days after admission. In three patients thrombi were identified for the first time 4 months after the acute episode. All 18 patients had received therapeutic anticoagulants on admission and had large anterior wall infarctions complicated by severe pump failure and motion abnormalities echocardiographically. None of the patients had systemic embolisation during the study period. Thus, left ventricular thrombus is a not uncommon though silent complication of acute anterior wall infarction even when patients receive therapeutic anticoagulants.

Adult↗
PubMed1983

Two dimensional echocardiography in the diagnosis of left ventricular thrombus. A prospective study of 67 patients with anatomic validation.

Seventy-two patients, in whom a high prevalence of left ventricular thrombus (LVT) was anticipated, were studied prospectively by two-dimensional echocardiography (2DE). Adequate echocardiograms were obtained in 67 patients (93 percent). Presence or absence of LVT was verified at surgery in 51 patients undergoing aneurysmectomy, and at autopsy in 16 patients dying from acute myocardial infarction. Twenty-six patients had LVT and 41 did not. The LVT was defined echocardiographically as an echo-dense mass adjacent to asynergic left ventricular wall and distinct from the endocardial surface. Twenty-four of 26 LVT were correctly predicted by 2DE (sensitivity 92 percent). Absence of LVT was correctly predicted in 36 of 41 patients (specificity 88 percent). In five patients, LVT by 2DE was not anatomically confirmed (17 percent false positives). Thus, 2DE can detect or exclude the presence of LVT with a good sensitivity and specificity.

Adult↗
PubMed1982

Effect of sodium nitroprusside on mortality in acute myocardial infarction.

We gave sodium nitroprusside by intravenous infusion to 163 randomly selected patients during the first 24 hours after hospitalization for typical acute myocardial infarction, and we studied its effects on mortality at one week, on the incidence of cardiogenic shock, on clinical signs of left ventricular failure, and on peak levels of creatine kinase isoenzyme MB. A control group of 165 patients received standard medical treatment and infusion of 5 per cent glucose. The end point of the study was a significant reduction in mortality in the nitroprusside group; this was reached when five deaths had occurred in this group, as compared with 18 among the controls (P less than 0.05). The incidence of cardiogenic shock, clinical signs of left-heart failure, and mean peak levels of creatine kinase isoenzyme MB were all reduced (P less than 0.05). The results indicate that infusion of nitroprusside in the early phase of acute infarction limits complications, possibly by reducing infarct size. The drug was particularly effective in anterior-wall infarction.

Aged↗
PubMed1982

Echocardiographic-cineangiographic correlation in detecting left ventricular aneurysm: a prospective study of 422 patients.

Four hundred twenty-two consecutive patients with a documented myocardial infarction underwent cardiac catheterization and echocardiographic examination. Adequate two dimensional echocardiograms were obtained in 386 patients (91 percent). Left ventricular aneurysm was defined echocardiographically and cineangiographically as a well demarcated bulge in the contour of the left ventricular wall during both diastole and systole, demonstrating dyskinesia or akinesia. Cineangiography was considered as the standard for the diagnosis of left ventricular aneurysm. The site of aneurysm was mainly anteroapical. An aneurysm was judged present on cineangiography in 111 patients and on echocardiography in 118 patients. The presence and absence of an aneurysm echocardiographically correlated in 103 and 260 patients, respectively, with cineangiography. In 8 patients a cineangiographically identified aneurysm was not manifested echocardiographically, whereas in 15 patients an aneurysm identified on echocardiography was not evident on cineangiography. Thus two dimensional echocardiography can detect or exclude a left ventricular aneurysm with a high level of sensitivity (93 percent) and specificity (94 percent).

Adult↗
PubMed1982

Long-term prognosis in patients with bundle branch block complicating acute anteroseptal infarction.

In a previous study patients with bundle branch block complications acute anteroseptal infarction found to have a high incidence rate of sudden death and late ventricular fibrillation in the first 6 weeks after infarction. Forty-two such consecutive patients were therefore kept within the monitoring area during those 6 weeks. Eighteen (43 percent) of these 42 patients survived and were then followed up for an average of 13 months to assess long-term prognosis and to evaluate whether the in-hospital monitoring period should be extended over 6 weeks. In most of these 18 patients a bifascicular block developed in the acute stage of infarction and in 3 it progressed to transient high degree atrioventricular (A-V) block. Seven of the 18 survivors had potentially lethal complications during the first 6 weeks. Four of these seven underwent aneurysmectomy between 10 and 20 weeks after infarction, and one of them died of a surgical complication. Major cardiac events occurred in 3 of the 17 survivors. None of these patients died during the follow-up period. In one patient complete A-V block developed after aneurysm resection; this was the only patient treated with permanent pacing. Fifteen of the 17 patients were in functional class I or II. These results indicate that (1) patients with bundle branch block complicating acute anteroseptal infarction who survive the first 6 weeks after infarction have a good prognosis during the 1st year, and (2) extension of the in-hospital monitoring period is not necessary. The results further suggest that prophylactic permanent pacing does not affect prognosis in these patients.

Bundle-Branch Block↗
PubMed1982

Apex two dimensional echocardiography. Alternative approach to quantification of acute myocardial infarction.

Apex echocardiography has been chosen as an approach to detect and quantify acute myocardial infarction because the usual parasternal acoustic windows are often occluded. Fifty-three patients were studied, all within 12 hours after the onset of symptoms of their first myocardial infarction. Three apical long axis views were obtained, that is the two and four chamber views, and the right anterior oblique equivalent or three chamber view. Satisfactory echocardiograms were obtained in 48 patients (91%). The individual apical views were divided into equal segments and the area of asynergy was estimated in each view. Left ventricular asynergy was present in all 48 patients. In 46 patients a positive correlation between the electrocardiogram and the echocardiogram was obtained, as far as infarct localisation was concerned. The estimated asynergic area correlated well with the peak value of the isoenzyme of creatine kinase (CK MB). Apex echocardiography is a reliable alternative method of detecting and quantifying myocardial infarction soon after the onset of symptoms.

Adult↗
PubMed1981

Detection and quantification of acute, isolated myocardial infarction by two dimensional echocardiography.

Ninety consecutive patients with acute, isolated myocardial infarction were evaluated with two dimensional echocardiography. Satisfactory echocardiograms were obtained in 66 patients (73 percent). All patients were studied 2 to 12 hours after the onset of symptoms. Sixty patients had additional studies at 48 and 72 hours. Long axis views were obtained at the base, body and apex of the left ventricle. Five short axis views of the left ventricle were obtained at different levels from the cardiac base to the apex. The individual short axis views, corrected for the end-diastolic internal diameter of the left ventricle, were divided into equal segments and the area of asynergy in each view was estimated. Infarct localization was similar on electrocardiography and echocardiography in 62 of 66 patients. In two dimensional echocardiography in one patient. The results of an echocardiographic study in one patient were false negative. During the study period the individual asynergic area remained stable. The initial asynergic area correlated well (r = 0.87, p less than 0.01) with the peak value of the isoenzyme of creatine kinase (CK-MB), which occurred hours later. Thus, two dimensional echocardiography is a reliable method to localize and quantify, early after the onset of symptoms, the eventual extent of myocardial involvement in patients with acute, isolated infarction.

Adult↗
PubMed1980

Effects of tocainide on ectopic impulse formation in isolated cardiac tissue.

The effect of tocainide on enhanced automaticity if Purkinje fibers was studied under the influence of epinephrine (0.2 microgram/ml) by means of intracellular recordings with microglass electrodes. In the presence of tocainide 5 microgram/ml and 10 microgram/ml cycle length of enhanced automaticity was increased in the range of 10.6% and 34.9% and in the range of 26.3% and 108.7% respectively. Repetitive impulse formation in ventricular myocardium was generated by creating a potential difference in a papillary muscle mounted in a partition chamber. One chamber was connected to ground, the potential of the other chamber could be changed in the range of 0 to 500 mV. By progressively increasing the voltage difference across the papillary muscle repetitive rhythmic impulse formation was induced. The threshold voltage gradient increased in the presence of tocainide (100 microgram/ml) from--285 to--335 mV. The results suggest that tocainide is suitable to suppress arrhythmias due to enhanced automaticity of Purkinje fibers.

Action Potentials↗
PubMed1980

Clinical setting and prognostic significance of high degree atrioventricular block in acute inferior myocardial infarction: a study of 144 patients.

High degree AV block occurred in 144 of 843 patients consecutively admitted because of acute inferior myocardial infarction and was associated with more extensive myocardial damage and a higher mortality rate, as compared to those without AV block. Patients with power failure at the time of appearance of high degree AV block and a ventricular rate of less than 50 per minute, seemed to profit from pacemaker therapy. By contrast in patients with power failure and a ventricular rate of more than 50 per minute, pacemaker insertion did not affect immediate prognosis.

Acute Disease↗