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H F Mizgala

Publications and source records attributed to H F Mizgala.

At least 19 recordsLinked to original sources
PubMed1991

British Columbia sends patients to Seattle for coronary artery surgery. Bypassing the queue in Canada.

Concern about waiting lists for elective procedures has become a highly visible challenge to the universal health insurance program in Canada. In response to lengthening queues for patients waiting for cardiac surgery, British Columbia made contracts with four Seattle hospitals to send a total of 200 patients for coronary artery bypass surgery. This article examines the cause of the queue for cardiac surgery in British Columbia and the events that led to outside contracting. Global hospital budgets and restrictions on capital expansion have limited hospital capacity for cardiac surgery. This constrained supply, combined with periodic shortages in critical care nurses and cardiac perfusion technologists, has resulted in a rapid increase in the waiting list. Reducing wide variations in the lengths of queues for individual surgeons may afford an opportunity to reduce long waits. While the patient queue for cardiac surgery has sparked a public debate about budget limits and health care needs, its clinical impact remains uncertain.

British Columbia↗
PubMed1979

Prognostic value of exercise testing soon after myocardial infarction.

The prognostic value of a limited treadmill exercises test performed one day before hospital discharge after acute myocardial infarction was studied in 210 consecutive patients who had no over heart failure and had been free of chest pain for at least four days. No complications occurred. During a one-year follow-up period 28 of 43 patients (65 per cent) who had chest pain during the test reported angina, as compared with 60 of 167 (36 per cent) who had no chest pain during test (P less than 0.001). The one-year mortality rates were 2.1 per cent (three of 146) in patients without changes in the S-T segment during exercise and 27 per cent (17 of 64) in those with depression of the S-T segment (P less than 0.001). Sudden death occurred in one of 146 (0.7 per cent) patients who showed no change in the S-T segment and in 10 of 64 (16 per cent) with depression of the segment (P less than 0.001). Thus, a limited treadmill exercise test performed before hospital discharge after acute myocardial infarction is safe and can predict mortality in the subsequent year.

Adult↗
PubMed1979

Recurrence of Prinzmetal angina seven years following aortocoronary bypass surgery: a clinical and angiographic follow-up.

A patient with Prinzmetal angina and ST segment elevation in the anterior ECG leads became asymptomatic after a 50% left anterior descending coronary artery stenosis was bypassed. However, seven years later Prinzmetal angina recurred but with ST segment elevation in the inferior ECG leads. Although the coronary bypass graft had remained patent, the proximal and distal left anterior descending coronary artery was occluded. No significant stenosis was present in the right coronary artery. Perhexiline maleate controlled his symptoms but when the drug was stopped because of side effects an acute inferior myocardial infarction occurred.

Adult↗
PubMed1979

Chronic oral vasodilator therapy to control heart failure in postinfarction ventricular septal defect.

This report describes a 70-year-old woman with biventricular failure following an anteroseptal infarction complicated by interventricular septal rupture. Treatment with nitroprusside followed by oral hydralazine eliminated the failure and reduced the shunt from 2.75 to 1 to 1.7 to 1. She is asymptomatic post-discharge. Chronic medical therapy including oral vasodilators may be an acceptable alternative to surgery in a small minority of patients with this complication of myocardial infarction.

Administration, Oral↗
PubMed1979

Coronary artery spasm during exercise in patients with variant angina.

Seven patients with typical variant angina without coronary stenoses greater than 50% developed angina and ST-segment elevation during treadmill exercise testing. In all cases the ST-segment elevation occurred in the same leads during exercise testing as during spontaneous attacks at rest. Five of the patients had developed spontaneous coronary spasm during coronary arteriography, in each case in the artery corresponding to the site of ST-segment elevation. In five patients, thallium was injected during the exercise test during which angina and ST-segment elevation occurred. In each case, a large perfusion defect not present at rest was found in the zone corresponding to the site of ST-segment elevation. These findings suggest that coronary artery spasm may occur during exercise in patients with variant angina.

Adult↗
PubMed1979

Left main coronary artery stenosis in young patients.

Among 1,041 patients less than 45 years old who underwent coronary arteriography from 1972 to 1977, left main coronary stenosis greater than or equal to 50 percent was present in 31 men (3.4 percent) and in 10 women (7.2 percent, P less than 0.05). The degree of stenosis did not correlate with the duration of symptoms, the severity of angina, the presence of a previous myocardial infarction, nor with the number of risk factors. The clinical and angiographic features in young men did not seem to differ from those described in unselected populations; however, in young women, left main coronary stenosis was often an isolated lesion associated with a short duration of symptoms, a high prevalence of hypertension, no previous myocardial infarction, and a normal ventriculogram, suggesting the possibility that a different pathophysiologic mechanism might be involved. Two deaths occurred at angiography (4.9 percent). Thirty patients underwent coronary artery bypass surgery, with one operative death and one late death; good functional results were obtained, and 21 out of 28 survivors (75 percent) were asymptomatic after a mean follow-up of 29 months.

Adult↗
PubMed1979

[Unstable angina].

Explore the source record for details and available documents.

Angina Pectoris↗
PubMed1978

Coronary artery disease in young women: clinical and angiographic features and correlation with risk factors.

Coronary arteriography was performed because of suspected coronary disease in 239 women less than 45 years of age. Normal coronary arteries were found in 112 women, and a further 23 had insignificant stenosis (less than 50 percent narrowing of luminal diameter). Of the remaining 104 women, 56 had one vessel, 22 two vessel and 26 three vessel disease. Hyperlipidemia, hypertension, diabetes, smoking and a family history of coronary disease were significantly more frequent in women with significant stenosis than in women with normal arteries. Significant coronary disease was found in 55 percent (100 of 182) of women with more than two risk factors but in only 7 percent (4 of 57) of those with less than two risk factors (P less than 0.0001). Evaluation of symptoms and the resting electrocardiogram also discriminated between women with and without coronary disease, but exercise testing was of little value. Only 4 of the 46 women with previous myocardial infarction had normal or near-normal coronary arteries. Among women with segmental wall motion abnormalities on ventriculography, the site was anterior in 90 percent (19 of 21) of women who used oral contraceptive drugs but in only 60 percent (21 of 35) of nonusers (P less than 0.05). However, in most respects, coronary artery disease in young women does not appear to differ from coronary disease in other patients.

Adult↗
PubMed1977

Hemodynamic and therapeutic effects of intravenous dopamine.

The effects of intravenous dopamine were evaluated in 10 patients with severe but stable coronary artery disease, 17 consecutive patients with primary cardiogenic shock and 3 with severe congestive heart failure and oliguria. Dopamine infusion at 10 mug/kg.min in the 10 patients increased cardiac output by 35%, left ventricular peak dP/dt by 38%, left ventricular minute work index by 44% and mean systolic ejection rate by 7% (P < 0.01); heart rate, aortic pressure, left ventricular end-diastolic pressure and tension-time index were unchanged. For oxygen, potassium and lactate, arterial and coronary sinus values, coronary arteriovenous oxygen differences and myocardial extraction were unchanged. Hemodynamically 13 of the 17 patients in shock responded favourably to dopamine infusion (0.5 to 15 mug/kg.min), with decrease in heart rate, increase in systolic arterial pressure from 75 to 100 mm Hg (P <0.001), decrease in ventricular filling pressure from 20 to 16 mm Hg (P < 0.01) and increase in urine output from 10 to 100 ml/h (P < 0.01). Eleven of those patients survived the shock episode. A close relation was observed between the hemodynamic response to dopamine, survival from the shock episode and the time between onset of shock and initiation of therapy. Low rates of dopamine infusion induced diuresis in the three patients with severe cardiac failure.Dopamine thus seems to improve the mechanical efficiency of the heart in coronary artery disease. Cardiac output is selectively increased and myocardial ischemia does not appear to be induced; those beneficial effects as well as presumably specific action on renal flow and natriuresis, improve immediate survival from cardiogenic shock and severe heart failure.

Adult↗