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Biomedical subjects

H E Kulbertus

Publications and source records attributed to H E Kulbertus.

At least 55 records · Page 3Linked to original sources
PubMed1987

Cytomegalovirus hemopericarditis. Report of 1 case with histologic confirmation.

An otherwise healthy woman presented cytomegalovirus (CMV) infection with an haemorrhagic pericardial effusion. This disease was successfully treated by a pericardial window and corticoid administration. CMV antibody titers and observation of CMV inclusions in the pericardial biopsy (fig. 1) confirmed the infection by CMV.

Aged↗
PubMed1986

Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion.

The feasibility, safety and usefulness of 2-dimensional echocardiography (2-D echo) during dobutamine infusion for identifying patients with multivessel coronary artery disease (CAD) after acute myocardial infarction (AMI) were evaluated in 30 patients 5 to 10 days after AMI. Patients underwent 2-D echo under basal conditions and during dobutamine infusion at each dose from 5 to a maximum of 40 micrograms/kg/min, limited multilead submaximal bicycle exercise testing and coronary and left ventricular angiography. Echocardiograms were analyzed independently by 2 observers. The test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during dobutamine infusion in vascular distributions other than the area of infarction identified during basal conditions. Exercise testing was considered positive when more than 1 mm of ST depression occurred 80 ms after the J point. Dobutamine stress testing was well tolerated; no complications and no significant arrhythmia were observed. Echocardiographic recordings were adequate in all patients during the entire test; the concordance in interpretation between the 2 observers was perfect for the prediction and location of ischemic segments during dobutamine infusion. In 15 of 17 patients without multivessel CAD, no asynergy was observed outside the infarct zone during dobutamine infusion (specificity 88%). In 11 of 13 patients with multivessel CAD, new wall motion abnormalities were identified in the segments corresponding to the arterial lesions diagnosed by angiography (sensitivity 85%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Serum creatine kinase isoenzyme MB concentration after endomyocardial biopsy.

Serum total creatine kinase (CK), CK-MB and myoglobin (Mb) were serially determined in 17 patients who underwent endomyocardial biopsy. Mean total CK levels increased from 36 +/- 27 U/l 30 min before biopsy to a maximum of 112 +/- 77 U/l 8 h following the procedure (p less than 0.05). Similarly, Mb concentrations rose from 57 +/- 55 micrograms/l to 119 +/- 57 micrograms/l 30 min after biopsy (p less than 0.05). Normalization of total CK and Mb levels occurred within 16 and 8 h, respectively. A new immunoenzymetric assay (IEMA) was used to measure the mass concentration of the CK-MB molecule. The initial CK-MB levels were 0.2 +/- 0.4 microgram/l; a small but significant elevation was recorded as early as 2 h after biopsy (1.6 +/- 1.5 micrograms/l, p less than 0.05). CK-MB returned to initial concentration 16 h after the beginning of the procedure. Comparison with the maximum CK-MB levels recorded in 16 myocardial infarction patients (258 +/- 172 micrograms/l, range 90-680 micrograms/l) indicated that the modest increase of CK-MB level detected after biopsy probably reflects a limited endomyocardium lesion at the sampling site, excluding any significant myocardial damage. Total CK and Mb, which showed more pronounced elevations than CK-MB, are likely to originate from other sources than the myocardium.

Adult↗
PubMed1986

Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography.

To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 66 consecutive patients. Pericardial effusion was observed in 17 (26%); the effusion was small in 13 patients, moderate in 3 and large with signs of cardiac tamponade in 1. In this patient, two-dimensional echocardiography strongly suggested myocardial rupture. The observation of pericardial effusion was not associated with age, sex, previous myocardial infarction, atrial fibrillation or treatment with heparin. It was more often a complication of anterior than of inferior acute infarction. Patients with pericardial effusion had higher peak levels of creatine kinase and lactic dehydrogenase and a higher wall motion score index. More patients with pericardial effusion had congestive heart failure or ventricular arrhythmias, developed a ventricular aneurysm or died within 1 year after their infarction. In conclusion, pericardial effusion is frequently visualized by two-dimensional echocardiography after acute myocardial infarction and its presence is associated with an increased occurrence of complications and cardiac death.

Aged↗
PubMed1986

Incidence, clinical significance and prognosis of ventricular fibrillation in the early phase of myocardial infarction.

Of 1265 patients admitted to the CCU with the diagnosis of acute MI, 96 (7.6%) developed ventricular fibrillation within 72 hours following admission. Of these 96, 35 (36.5%) had secondary VF associated with left ventricular failure; they had a high in-hospital mortality of 57.1%. The remaining 61 (63.5%) had primary VF, i.e. VF occurring in the absence of significant LV failure. Fourteen of these (23%) died in hospital: 9 due to PVF (3 during the first episode, 6 during a recurrence). This mortality figure was significantly higher (P less than 0.001) than the mortality of 10% seen among patients who did not experience VF. Primary VF showed a recurrence rate of 20%. Compared with the 1061 patients who left the hospital without primary VF, the 61 subjects with this rhythm disorder were older, had larger infarcts and more frequent complications, such as pericarditis, conduction abnormalities, frequent ventricular premature contractions and signs of right ventricular failure. These findings, in contrast with a widely held view, suggest that primary VF may carry a guarded prognosis.

Adult↗
PubMed1986

Complementary role of thallium-201 scintigraphy to predischarge exercise electrocardiography for patients stratification after a first myocardial infarction.

The value of a predischarge exercise test combined with thallium-201 myocardial scintigraphy in detecting patients with severe multivessel disease (MVD) was studied in 58 consecutive patients discharged after a first acute myocardial infarction. Twelve electrocardiographic, clinical and scintigraphic variables were analysed. Angiography at one month revealed MVD (greater than 70% narrowing in vessels unrelated to infarction) in 26 patients (45%). ST segment depression of 1mm or greater, thallium defects in multiple vascular distributions (MVTL), and reversible thallium defects in a vascular distribution different from the infarct related vessel predicted patients at risk for MVD (predictive value respectively of 68%, 65% and 75%). The other variables were not significantly associated with the presence of MVD. Only ST segment depression and thallium defects in multiple vascular distributions emerged as independent predictors of MVD. Their combination yielded a 77% sensitivity and a 59% specificity for MVD. Combination of thallium imaging with the predischarge exercise ECG significantly improved the stratification provided by the exercise test alone (P less than 0.05). A positive thallium scan (MVTl defects) associated with a positive ECG (ST depression) carried a risk for MVD of 80% in the population studied. When both tests were negative, MVD was infrequent (risk 22%). Because improvement in the stratification of patients is not as clear as expected from studies performed at a later stage, it appears that exercise thallium scintigraphy at a submaximal level one or two weeks after infarction does not provide optimal information. Predischarge exercise thallium-201 scintigraphy, however, is superior to an exercise tolerance test alone in separating patients into those with high and low risk of MVD.

Electrocardiography↗
PubMed1986

Ventricular arrhythmias, left ventricular function and mortality after acute myocardial infarction.

Ventricular arrhythmias constitute an independent risk in the year following a myocardial infarction. The risk is moderate, but certainly not negligible. We still do not know whether ablation of the arrhythmias can improve survival. Further controlled drug trials are still needed to assess the possible benefit and hazards of treating frequent and repetitive ventricular premature beats in the first few months after an acute myocardial infarction.

Anti-Arrhythmia Agents↗
PubMed1985

Effects of intravenous diltiazem administration in patients with inducible tachycardia.

The efficacy of diltiazem was studied with programmed electrical stimulation of the heart in 13 patients with inducible tachycardia (atrioventricular nodal tachycardia: 8 cases; orthodromic circus movement tachycardia involving an accessory pathway: 4 cases; ventricular tachycardia: one case). Diltiazem was administered intravenously at a dose of 0.25 mg kg-1 over 2 min. It lengthened the transnodal conduction time, and the effective and the functional refractory periods of the AV node. The shortest pacing cycle length with 1:1 conduction through the node lengthened both in the anterograde and retrograde directions. Diltiazem did not alter anterograde or retrograde refractoriness of accessory pathways. Infused intravenously during episodes of tachycardia, diltiazem interrupted the arrhythmia in all patients. Tachycardia could still be initiated in 2 patients after drug, but the arrhythmia was not sustained in one case. One patient with preexcitation and atrial fibrillation exhibited an increase in ventricular rate after diltiazem. The shortest RR intervals before and after diltiazem were 240 ms and 180 ms, respectively. Thus, iv diltiazem is an effective antiarrhythmic drug for patients with reciprocal supraventricular tachycardia and for selected patients with ventricular tachycardia.

Adolescent↗
PubMed1985

Comparative haemodynamic effects of intravenous flecainide in patients with and without heart failure and with and without beta-blocker therapy.

The haemodynamic effects of flecainide were compared in three different subsets of patients with documented coronary disease. Ten patients (A) had no heart failure, 5 patients were on beta blockers (B) and 5 patients had overt heart failure (C). Flecainide was associated with negative inotropic effects that were relatively more pronounced in patients with left ventricular dysfunction: pulmonary wedge pressure increased by 27% in A, by 31% in B and by 42% in C; left ventricular stroke volume and stroke work decreased respectively by 10 and 12% in A, 21 and 19% in B, 26 and 28% in C. Ejection fraction decreased by 9% in A, 13% in B and 20% in C, in relation with an increase in end systolic volume (+9% in A, +10% in B and +5% in C). Absolute changes, however, were not significantly different from one group to another except for the increase of systemic vascular resistance which was more pronounced in C as compared with the other groups. The myocardial depression was also confirmed by the fall in dP/dt that was maximal at the end of injection; dP/dt remained depressed 15 min later despite some improvement. Flecainide thus exerts negative inotropic effects that are maximal at the end of infusion and may be of importance in patients with established left ventricular dysfunction.

Adult↗
PubMed1985

Frequency and clinical significance of pericardial friction rubs in the acute phase of myocardial infarction.

An early pericardial friction rub was noted in 23.4% of a population of 1264 consecutive patients admitted with acute myocardial infarction. The incidence of the rub did not vary with age, sex or past cardiac history. The pericardial rub, however, was more often a complication of Q- than non-Q-wave infarcts (25.5% vs 10.5%, P greater than 0.001) and of anterior than inferior infarcts (35.3% vs 20.8%, P greater than 0.001). In comparing the 297 patients with a pericardial rub to the 967 others, we noted that the former group had a higher CK peak (1706 +/- 1110 UI l-1 vs 1189 +/- 1038 UI l-1, P greater than 0.001) and a higher incidence of Killip class greater than 1 (47.5% vs 33.2%, P greater than 0.001), atrial flutter or fibrillation (22.2% vs 9.3%, P greater than 0.001), second or third degree atrioventricular blocks (16.8% vs 9.4%, P greater than 0.001) and complete bundle branch block (14.5% vs 7.1%, P greater than 0.001). In spite of this, the development of a pericardial rub did not increase the in-hospital mortality (10.8% in patients with pericardial rub; 11.3% in those without).

Aged↗
PubMed1985

Artificial circus movement tachycardias: incidence, mechanisms, and prevention.

In a group of 45 patients treated with Medtronic 7000 and 7100 pulse generators for sick sinus syndrome or second or third degree atrioventricular block, an atrial synchronous mode of pacing was programmed in 34 cases and spontaneously occurring artificial circus movement tachycardias (ACMTs) were observed in nine. An analysis of conditions of occurrence, triggering mechanisms and patterns of ACMT, is presented. Various modalities of prevention are discussed. They resulted in suppression of ACMT in five patients and decrease of incidence in a sixth; the three remaining subjects were managed by definitive reprogramming in the DVI mode. Our conclusion is that correct prevention of ACMT requires the use of dual chamber pulse generators with programmable atrial refractory periods. For patients in whom a unit has already been implanted, careful observation of the triggering mechanism and pattern of ACMT may help in determining the most suitable way to prevent and suppress the arrhythmia.

Adult↗
PubMed1984

Hemodynamic effects of intravenous diltiazem with impaired left ventricular function.

The acute hemodynamic effects of intravenous diltiazem were studied in 8 patients with coronary artery disease, left ventricular (LV) failure (New York Heart Association functional class III), a rest ejection fraction (EF) less than 40% or a cardiac index less than 2.4 liters/min/m2. Hemodynamic measurements and LV angiograms were performed at rest before and after the administration of diltiazem, 0.5 mg/kg, administered at a speed of 5 mg/min. Diltiazem treatment induced a decrease in heart rate from 68 +/- 12 to 55 +/- 9 beats/min (p less than 0.001). Mean aortic pressure decreased from 94 +/- 14 to 81 +/- 15 mmHg (p less than 0.05). Thus, the pressure-rate product significantly decreased under the influence of the drug, from 8,791 +/- 2,465 to 6,342 +/- 1,808 beats mm Hg/min, (p less than 0.001). Diltiazem induced no significant change of LV end-diastolic pressure, pulmonary wedge pressure, cardiac index and LV stroke work index. Systemic vascular resistance decreased (p less than 0.01), whereas pulmonary vascular resistance showed no change. End-systolic volume diminished (p less than 0.02), which accounts for the increase of stroke volume and ejection fraction (p less than 0.001). Disorders of regional contractility were not aggravated by diltiazem, and even improved in individual cases. Thus, intravenous diltiazem may be used safely in patients with heart failure. However, in view of the marked bradycardic effects seen in some cases, heart rate should be carefully monitored.

Adult↗
PubMed1984

Haemodynamic effects of intravenous diltiazem at rest and exercise in patients with coronary artery disease.

The acute effects of intravenous diltiazem on exercise performance were studied in 10 patients with coronary artery disease. Haemodynamic measurements were made at rest and during exercise before and after 0.5 mg kg-1 of diltiazem. Diltiazem prolonged the duration of exercise (+2.85 min, P less than 0.001) and delayed the onset of ischaemic ST depression or angina in all patients. The highest tolerated heart rate and pressure rate product were increased in all but one patient after diltiazem. At rest diltiazem decreased mean arterial pressure (-10.8%, P less than 0.005), systemic vascular resistance (SVR) (-11.8%, P less than 0.05) and left ventricular stroke work index (SWI) (-14.1%, P less than 0.005). During exercise under diltiazem therapy, at the level achieved before the drug, the pulmonary capillary wedge pressure (-30%, P less than 0.005) and the SVR (-13.6%, P less than 0.02) were lowered, the SWI (+13%, P less than 0.01) was increased; at the end of exercise only the SVR (-14%, P less than 0.05) was reduced. Two patients experienced angina on lying down and one had orthostatic hypotension after exercise with diltiazem. This study indicates that intravenous diltiazem is a potentially useful agent for the treatment of angina by reducing myocardial oxygen demand at rest and by improving left ventricular performances on exercise.

Adult↗