PubMed Health⌕ Search

Biomedical subjects

H E Kulbertus

Publications and source records attributed to H E Kulbertus.

At least 73 records · Page 4Linked to original sources
PubMed1984

Clinical experience with implantable devices for control of tachyarrhythmias.

Pacing is becoming an accepted form of treatment for reentry tachycardias. The different pacing modalities available and experience with a patient-activated antitachycardia pacemaker are presented in this paper. This system has bidirectional communication between pacemaker and pacemaker-activator and between pacemaker and prescription formulator (which is a sophisticated portable stimulator used for non-invasive electrophysiological evaluation of the system). This pacemaker was implanted in 18 patients with drug-resistant tachycardias. Six patients had ventricular tachycardia, 3 had A-V nodal reentrant tachycardia, 4 had the concealed accessory pathway, and 5 had the WPW syndrome. In the 3 months before implantation the mean number of admissions for termination of tachycardia was 2.1 per patient-month. During a follow-up period of 3-26 months only 6 patients were admitted once for termination of tachycardia (0.02 admissions per patient-month). The reasons for admission of these 6 patients were: defective pacemaker activator in 2 patients, inadequate control of tachycardia in 2 patients, inappropriate use of the device in 1, and inadequate intake of medication in 1. All these problems were solved easily. Eight pacemaker activators required reprogramming, which was done in 5 patients on an out-patient basis. The interval scanning mode was used in 9 patients. Nine patients required more than 2 stimuli for reproducible termination. A step-wise increase in number of stimuli was used in 5 patients. This system has proven to be a safe and effective form of treatment of drug-resistant supraventricular and ventricular tachycardias and has resulted in marked improvement of the quality of life of these patients.

Adult↗
PubMed1984

On the interpretation of serial laboratory measurements in acute myocardial infarction.

Serial laboratory determinations are now routinely performed on patients admitted to intensive-care units. Adequate interpretation of such cumulative information for clinical decision-making purposes is a challenging problem. We describe a statistical method for predicting--sequentially as the data become available--the patient's outcome, death or survival. Thus, the method goes beyond previously reported techniques that base such prediction on only a single multivariate observation. The method has been applied to daily measurements of serum urea and lactate dehydrogenase, performed during one week on patients hospitalized in the coronary-care unit with acute myocardial infarction. Two baseline variables were also included in the dynamic risk index so derived: the age of the patient and the number of previous myocardial infarctions recorded on admission. We also discuss the problems of selecting the most-predictive laboratory tests and of determining for each test the amount of past data needed to achieve satisfactory prediction. We distinguish between global evaluation of the dynamic risk index obtained (in terms of specificity and sensitivity) and individual interpretation (in terms of posterior/prior probability ratio) of a given risk score for a particular patient. The approach described may contribute to more effective use of results of repeated laboratory tests on critically ill patients.

Acute Disease↗
PubMed1983

Hemodynamic effects of a new antiarrhythmic agent, flecainide (R-818), in coronary heart disease.

The hemodynamic effects of flecainide acetate, a new class I antiarrhythmic agent, were studied in 10 patients with coronary heart disease. The drug was injected intravenously at a dose of 2 mg/kg over 30 minutes. The mean drug plasma level achieved was 394 ng/ml (range 329 to 470). The heart rate did not change, but a significant increase (p less than 0.001) in P-R (+17%), QRS (+15%), and Q-T (+7%) duration occurred after drug administration. Negative inotropic effects also were observed and consisted of an increase (p less than 0.01) in pulmonary wedge pressure (+27%) and a decrease (p less than 0.01) in stroke index (-10%), left ventricular stroke work index (-12%), and left ventricular ejection rate (-11%). No significant change in mean aortic pressure or systemic and pulmonary vascular resistance occurred. Left ventriculography performed after drug infusion revealed a significant increase (p less than 0.01) in systolic volume (+9%) and a decrease in ejection fraction (-9%) and mean velocity of circumferential fiber shortening (Vcf) (-13%). A progressive and significant decrease of dP/dt was observed during drug infusion, but 15 minutes after the injection, dP/dt had returned to near basal values. Thus, flecainide acetate has slight, but significant negative inotropic effects, particularly conspicuous during drug infusion. The drug should be administered with caution in patients with poorly compensated heart.

Adult↗
PubMed1983

Right ventricular myocardial infarction diagnosed by 99 m technetium pyrophosphate scintigraphy: clinical course and follow-up.

Out of 178 consecutive patients with acute inferior wall myocardial infarction submitted to technetium-99 m pyrophosphate scintigraphy, 49 (27.5%) were found to have concomitant right ventricular infarction. Gated blood pool scans showed right ventricular abnormalities in 21 out of 26 patients who were submitted to this investigation (right ventricular asynergy: 16 cases; right ventricular dilatation: eight cases; decreased right ventricular ejection fraction: 16 cases). Complications were common in the acute stage. Shock was noted in 19 cases (eight related to bradycardia, three related to relative hypovolaemia and eight instances of true cardiogenic shock). Atrial fibrillation (seven patients), ventricular fibrillation (eight patients) and severe atrioventricular conduction disorders (13 patients) were also frequent. In spite of this, the in-hospital mortality was low: three deaths occurred (6.1%), one from heart failure, two others from posterior septal rupture. All patients were followed up for one year or more. Six additional deaths were noted (three from left cardiac failure, two from recurrent anterior wall infarction and one from massive pulmonary embolism). Clinical assessment, haemodynamic measurements and gated blood pool scans showed significant improvement of right ventricular function with return to normal in those cases with small right ventricular infarcts as judged from technetium-99 m pyrophosphate scintigraphy. In spite of the complications seen in the initial period, patients with a right ventricular infarction have a good overall prognosis and the long-term outcome, primarily determined by the left-sided lesions, is often favourable.

Adult↗
PubMed1983

The value of amiodarone for the treatment of unstable angina.

Amiodarone is a potent coronary vasodilator; it has alpha and beta receptor-antagonist activity and is well-known for its marked antiarrhythmic efficacy. This report describes the results of a randomized study of amiodarone in unstable angina. 40 patients (33 male, 7 female; mean age: 55) with unstable angina entered the study. They were randomized into two treatment groups. In group I (20 cases), amiodarone was the first drug applied (during the first 3 days; 1500 mg/24 hours IV + 200 mg orally every 8th hour; from day 4 onwards: 200 mg orally 3 times daily). If, after 8 hours following initiation of treatment, the symptoms were still present or recurred, nifedipine was added at a dose of 10 mg 4 times daily. In case of failure of the combined medical treatment, coronary angiography and, if needed, surgery was performed after 16 hours. In group II (20 cases), nifedipine was given as the first drug and at a dose of 10 mg every 6th hour. If, after 8 hours, this therapy failed, amiodarone was added according to the scheme previously described. In case of failure of the combined therapy, coronary angiography and surgery were performed. In group I, amiodarone was successful within 8 hours in 12 cases. None of the non-responders was improved by the addition of nifedipine. In group II, nifedipine was successful within 8 hours in 6 cases (p = 0.086). Among the 14 non-responders, amiodarone controlled the anginal episodes in 11 instances (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Does lactate dehydrogenase isoenzyme-5 contribute to the predictive power of total lactate dehydrogenase in myocardial infarction?

In 385 patients with acute myocardial infarction, lactate dehydrogenase (LD; EC 1.1.1.27) isoenzymes were determined electrophoretically 24, 48, and 72 h after admission. At those times, LD-1/LD-2 ratios exceeding 1 were recorded in 78.9, 88.8, and 92.2% of the cases, respectively. LD-1 ranged from 181 to 2674 U/L, or 21.9 to 66.1% of the total activity. On the first day of hospitalization, 27.3% of the patients demonstrated abnormal LD-5 (greater than 6% of total LD); this finding dropped to 20.5% and 17.4% in the two following days. Early increases in LD-5 were most frequently observed in patients associating inferior infarcts with posterior or lateral extension and having a previous history of myocardial infarction. On day 1, LD-5 was significantly increased in early deceased patients as compared to long-term survivors (9.7% vs 4.9% of total LD, p less than 0.01). LD-5 definitely contributes to the prognostic efficiency of total LD in acute myocardial infarction, but does not replace it as a risk predictor. This study confirms the superiority of total LD over the isoenzyme measurements to achieve short-term prognostication.

Aged↗
PubMed1982

The left hemiblocks: significance, prognosis and treatment.

This review article is concerned with the concept of left hemiblocks and analyses their significance, prognosis and treatment. It first stresses that the left bundle branch is not sensu stricto a bifascicular structure since it generally is either fanlike, or trifascicular. The anatomical situation, however, remains compatible with the physiological concept of the hemiblocks. The electrocardiographic features of left anterior and posterior hemiblocks are described. A histopathological investigation clearly demonstrates that both are signs of left bundle branch disease, often degenerative in nature and more widely spread than expected from the electrocardiographic terminology. The association of a left hemiblock with right bundle branch block is frequently considered as sign of poor prognosis. This is true in the setting of acute myocardial infarction where it accompanies large infarcts. In chronic cases, the prognosis is primarily influenced by the underlying pathology. Patients with partial bilateral bundle branch block should be investigated and, if needed, paced when they have symptoms, a PR interval which lengthens with the course of time, or signs of cardiomyopathy, or large anterior infarction. Asymptomatic individuals with apparent primary disease of the conducting system are neither studied, nor considered for prophylactic pacing.

Adolescent↗
PubMed1982

Effect of the haptoglobin phenotype on the size of a myocardial infarct.

We investigated the relation between haptoglobin (Hp) phenotypes and serum levels of various biochemical markers after myocardial infarction in 496 patients. In 122 subjects selected on the basis of short delays until hospitalization, patients with Hp 2-2 had higher cumulated creatine kinase activity than patients with Hp 1-1, or Hp 2-1 (P less than 0.05), as well as higher myoglobin concentrations (P less than 0.02) 12 to 28 hours after admission. Comparison of serum enzyme activities in the remaining 374 patients confirmed that Hp 2-2 patients had significantly higher total creatine kinase, creatine kinase isoenzyme MB fraction, aspartate aminotransferase, and lactate dehydrogenase peak levels. Complications of left ventricular failure were more frequent in these patients (P = 0.05). Our results suggest that Hp 2-2 patients have more severe myocardial infarctions than Hp 1-1 and Hp 2-1 patients, However, no difference in the distribution of haptoglobin phenotype was found between patients who had a myocardial infarction and healthy subjects, indicating that Hp 2-2 does not predispose to the occurrence of infarction.

Adult↗
PubMed1982

Critical evaluation of serum uric acid levels in acute myocardial infarction.

Serial measurements of serum uric acid were performed on patients suffering from acute myocardial infarction. Nearly 80 percent of the cases demonstrated a fall in uric acid concentrations during the first two days of hospitalization and a subsequent return to initial levels within six to eight days. There was a relationship between the decrease in uric acid levels and the serum lactate dehydrogenase activity. No evidence could be found that male patients were hyperuricemic as compared to control subjects. However, female patients between 40 and 60 years of age demonstrated significantly higher uric acid levels than healthy women of corresponding ages, even after adjustment for diuretic use.

Aged↗
PubMed1981

The prognostic significance of serum alpha 1-acid glycoprotein changes in acute myocardial infarction.

Serum alpha 1-acid glycoprotein and haptoglobin concentrations were evaluated in 151 patients with acute myocardial infarction (MI) during the first ten days of hospitalization. Maximum glycoprotein concentrations were found to be related to myoglobin and enzyme peak levels. Glycoprotein levels recorded upon patients' admission did not vary for acute phase survivors and early deaths (15 patients), but the latter demonstrated significantly higher alpha 1-acid glycoprotein levels (p less than 0.05) on day 1. The maximum glycoprotein concentrations were, however, reached too long after the onset of acute MI to be of interest for short-term prognosis. Comparison of the evolution of the two glycoproteins investigated in late deaths (10 patients) and in 6-month survivors indicated increased alpha 1-acid glycoprotein levels in non-survivors, with a maximum discrimination occurring on day 8 (p less than 0.001). Haptoglobin was not significantly different in the two groups and even demonstrated lower concentrations from day 4 to day 10 in non-survivors. The decrease of haptoglobin levels in patients with hepatic dysfunction could explain the divergent results given by the serum concentrations of the two glycoproteins to predict mortality. We show in this study that alpha 1-acid glycoprotein measured at the end of hospitalization can give relevant prognostic information for the 6-month period following acute MI.

Aging↗
PubMed1981

5-HT2-receptor blockade in the treatment of heart failure. A preliminary study.

Ketanserin (R 41 468), a quinazoline derivative, has been shown to be a selective blocker of 5-HT2 receptors. The drug was administered intravenously (10 mg given over a 3 min period) to 8 patients with severe cardiac failure already treated with digitalis, diuretics, and, in 4 cases, vasodilators. R 41 468 produced a significant fall in right-atrial, pulmonary-artery, pulmonary-wedge, and systemic arterial pressures. Systemic dynamic and total pulmonary vascular resistances were also reduced. Cardiac and stroke-work indices both increased, Heart rate remained unchanged. The platelet aggregation index, assessed in 2 patients, was initially low and was nearly normal 15 min after administration of a single dose of R 41 468.

Adult↗