Aortic valve area was calculated noninvasively in 30 patients with aortic stenosis undergoing cardiac catheterization. Continuous wave Doppler ultrasound was employed to estimate the mean transvalvular pressure gradient. The mean left ventricular outflow tract flow velocity and cross-sectional area were determined from pulsed Doppler and two-dimensional ultrasound recordings. Electrical transthoracic bioimpedance cardiography performed simultaneously with the ultrasonic study and repeated at the time of catheterization measured heart rate, systolic ejection period and cardiac output. These noninvasive data permitted calculation of aortic valve area using the Gorlin equation (range 0.21 to 1.75 cm2) and the continuity equation (range 0.25 to 1.9 cm2). Subsequent cardiac catheterization showed valve area to range from 0.21 to 1.75 cm2. The mean Doppler pressure gradient estimate was highly predictive of the gradient measured at catheterization (r = +0.92, SEE = 10). Bioimpedance cardiac output measurements agreed with the average of Fick and indicator dye estimates (r = +0.90, SEE = 0.52). Valve area estimates utilizing continuous wave Doppler ultrasound and electrical bioimpedance were superior (r = +0.91, SEE = 0.12) to estimates obtained utilizing the continuity equation (r = +0.76, SEE = 0.29) and were more reliable in the detection of patients with severe aortic stenosis (9 of 11 versus 6 of 11). These data show that 1) electrical bioimpedance methods accurately estimate cardiac output in the presence of aortic stenosis; 2) the hybridized bioimpedance-Doppler ultrasound method yields accurate estimates of aortic stenosis area; and 3) the speed, accuracy and cost-effectiveness of aortic stenosis evaluation may be improved by this hybridized approach.

Adult↗

PubMed1986

Quantification of aortic regurgitation utilizing continuous wave Doppler ultrasound.

Aortic regurgitation and mitral stenosis are hemodynamically similar, insofar as both result in passive ventricular filling across a narrow orifice driven by a declining pressure gradient. Because mitral stenosis is successfully characterized by Doppler ultrasound determination of the velocity half-time, or time constant, aortic regurgitation might be quantified in an analogous fashion. Eighty-six patients with diverse causes of aortic regurgitation underwent continuous wave Doppler examination before cardiac catheterization or urgent aortic valve replacement. The Doppler velocity half-time was defined as the time required for the diastolic aortic regurgitation velocity profile to decay by 29%, whereas catheterization pressure half-time was calculated as the time required for transvalvular pressure to decay by 50%. Doppler velocity and catheterization pressure half-times were linearly related (r = 0.91). Doppler velocity half-times were inversely related to regurgitant fraction (r = -0.88). Angiographic severity (1+ = mild to 4+ = severe) was also inversely related to pressure and velocity half-time; a Doppler half-time threshold of 400 ms separated mild (1+, 2+) from significant (3+, 4+) aortic regurgitation with high specificity (0.92) and predictive value (0.90). The Doppler velocity half-time was independent of pulse pressure, mean arterial pressure, ejection fraction and left ventricular end-diastolic pressure. Estimation of transvalvular aortic pressure half-time utilizing continuous wave Doppler ultrasound is a reliable and accurate method for the noninvasive evaluation of the severity of aortic regurgitation.

Acute Disease↗

PubMed1984

Autoradiographic characterization of beta adrenergic receptors in coronary blood vessels and myocytes in normal and ischemic myocardium of the canine heart.

This light microscopic autoradiographic study was performed to test the hypotheses that (a) the density of beta adrenergic receptors (BAR) may differ in various components of the heart and (b) BAR in certain components of the heart may exhibit a selective response to pharmacologic and pathological stimuli. Blocks of canine left ventricle were frozen and tissue sections cut and incubated in (-)[3H]dihydroalprenolol (DHA) to label the BAR. For total and nonspecific binding, serial sections were incubated with and without 10(-5) M (+/-)propranolol. Scintillation spectrometry of sections demonstrated rapid binding, saturability, stereospecificity, a dissociation constant (KD) of 3.2 +/- 0.5 nM (SD) (n = 3), and a maximal binding of 31.3 +/- 3.1 fmol/mg of tissue protein. Isoproterenol was 12.5 times more effective than norepinephrine in displacing DHA. Sections incubated with 10(-5) - 10(-8) M metoprolol, a beta one selective antagonist, demonstrated a KD of 0.7 X 10(-6) M. For autoradiography, emulsion-coated coverslips were attached to the slides. After exposure, the slides were developed and stained, and grain density quantified. Specific BAR binding (n = 4 dogs) was 1,047 +/- 131 (SEM) grains/10(-2) mm2 for myocardial arterioles, 219 +/- 30 for myocardial arteries, 31 +/- 12 for the proximal left anterior descending coronary artery (LAD), and 231 +/- 34 for cardiac myocytes. Specific binding in the presence of 10(-5) M metoprolol was reduced approximately 75% for both arterioles and myocytes. However, at 10(-6) M metoprolol, the percent reduction in specific DHA binding was greater for myocytes (50%) than for arterioles (0%), and at 10(-7) M metoprolol, the percent reduction in specific DHA binding was 17% for myocytes with no reduction over arterioles. After 1 h of LAD occlusion, a selective increase (18%) in BAR density occurred over cardiac myocytes, but not over blood vessels in the ischemic myocardium. Thus, (a) specific BAR binding was five times greater in arterioles than in small arteries and myocardium and 34 times greater than in the proximal LAD; (b) BAR of myocytes were more sensitive than those of arterioles to displacement by the beta one selective antagonist, metoprolol; and (c) a selective increase in BAR occurs in cardiac myocytes but not in blood vessels after 1 h of ischemia in this experimental model.

Animals↗

PubMed1983

Direct endocardial recording from an accessory atrioventricular pathway: localization of the site of block, effect of antiarrhythmic drugs, and attempt at nonsurgical ablation.

We recorded a discrete 0.95 mV potential consistent with accessory atrioventricular pathway (AP) activation during serial electrophysiologic studies in a patient with Ebstein's anomaly and Wolff-Parkinson-White syndrome. Bipolar pacing from the catheter electrode in which the AP potential was recorded resulted in a stimulus-ventricle interval identical to the AP-ventricle interval during antegrade conduction, and a stimulus-atrium interval identical to the AP-atrium interval during retrograde conduction. With the patient in the drug-free state, antegrade AP block during atrial pacing and retrograde AP block during ventricular pacing occurred distal to the AP potential (AP-ventricle junction and AP-atrium junction, respectively), supporting the "impedance mismatch" hypothesis. Procainamide and disopyramide each lengthened the antegrade AP effective refractory period by affecting the AP-ventricle junction (possibly by decreasing the current generated by the AP). Both drugs also lengthened the retrograde AP effective refractory period but produced a greater effect on the ventricle-AP junction than on the AP-atrium junction, suggesting marginal geometry of the former. R wave synchronous shocks of 160 and 320 W-sec delivered between the catheter electrode recording the largest unipolar AP potential and a skin electrode produced transient, complete, antegrade block over the AP, suggesting the feasibility of this new nonsurgical technique for AP ablation.

Adult↗

PubMed1982

Immunofluorescent findings and clinical overlap in two cases of follicular lichen planus.

Explore the source record for details and available documents.

Adult↗

PubMed1982

Multiple cutaneous granular cell tumors.

Explore the source record for details and available documents.

Adolescent↗

PubMed1977

Effects of orthostatic postural changes on myocardial oxygen demands.

The effects of orthostatic tilting were studied in 12 mongrel dogs anesthetized with sodium pentobarbital. Orthostasis produced significant decreases in cardiac output and left ventricular dimensions. Secondary decreases in coronary flow and myocardial oxygen consumption were also documented. These changes were attenuated when the animals were pretreated with propranolol. The upright posture may be of value in treatment of angina pectoris.

Animals↗

PubMed1977

Mucocutaneous lymph node syndrome.

In 1967, Kawasaki reported an acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes that afflicted infants and young children in Japan. He called the entity mucocutaneous lymph node syndrome. In 1974, the condition was reported in Hawaii, and several cases have been reported subsequently from the continental United States and other countries. One percent to two % of patients had died suddenly of cardiac failure. Rickettsia-like bodies have been demonstrated from skin and lymph node biopsy specimens, and the pathologic features suggest a relationship to infantile periarteritis nodosa.

Child↗

PubMed1976

N-dimethylisopropyl propranolol. Effects on myocardial oxygen demands.

N-Dimethylisopropyl propranolol (DMP) is a quaternary derivative which lacks significant beta-adrenergic blocking and local anesthetic effects. It has been reported, nonetheless, to be effective in treating experimental arrhythmias and in limiting the extent of ST-segment elevations following experimental coronary occlusion. The present study examined the effects of DMP on the hemodynamics and myocardial oxygen demands of anesthetized dogs. After a single dose of 3 mg/kg, heart rate fell from 146 +/- 8 to 124 +/- 6 beats/min (P less than 0.0025), and aortic systolic pressure fell from 151 +/- 11 to 141 +/- 9 mm Hg (0.05 less than P less than 0.10), resulting in a 16.8% reduction in the tension-time index. Stroke volume was reduced by 10% despite a 54% increase in left ventricular end-diastolic pressure, suggesting a negative inotropic effect. This was supported by a decrease in maximum extrapolated contractile element velocity from 9.10 +/- 1.05 to 6.61 +/- 65 units/sec (P less than 0.0025). Myocardial oxygen consumption was reduced from 12.0 +/- 1.4 to 9.9 +/- 1.5 ml/min/100 g tissue (P less than 0.05). Myocardial oxygen extraction was unchanged, indicating that the decrease in oxygen consumption resulted from a reduction in myocardial oxygen demand. When heart rate and systolic pressure were artificially restored to control levels, after the administration of DMP, myocardial oxygen consumption remained significantly below the control level. DMP, therefore, appeared to reduce myocardial oxygen demands primarily by its negative inotropic effect. This drug may have application in the treatment of ischemic heart disease.

Animals↗

PubMedDate not supplied

How in the world is WHO doing?

The World Health Organization has chalked up some impressive victories in its 43 years but is nowhere near reaching its ambitious goal of "Health for All by the Year 2000." Uphill battles against some intractable health conundrums and shrinking financial resources face the Geneva, Switzerland-based organization, threatening its stated goal of guaranteeing universal health care within the decade.

Budgets↗