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Biomedical subjects

H G Richman

Publications and source records attributed to H G Richman.

9 recordsLinked to original sources
PubMed1979

Clinical evaluation of automated processing of electrocardiograms by the Veterans Administration program (AVA 3.4).

Automated processing of electrocardiograms by the Veterans Administration program was evaluated for both agreement with physician interpretation and interpretative accuracy as assessed with nonelectrocardiographic criteria. One thousand unselected electrocardiograms were analyzed by two reviewer groups, one familiar and the other unfamiliar with the computer program. A significant number of measurement errors involving repolarization changes and left axis deviation occurred; however, interpretative disagreements related to statistical decision were largely language-related. Use of a printout with a more traditional format resulted in agreement with physician interpretation by both reviewer groups in more than 80 percent of cases. Overall sensitivity based on agreement with nonelectrocardiographic criteria was significantly greater with use of the computer program than with use of the conventional criteria utilized by the reviewers. This difference was particularly evident in the subgroup analysis of myocardial infarction and left ventricular hypertrophy. The degree of overdiagnosis of left ventricular hypertrophy and posteroinferior infarction was initially unacceptable, but this difficulty was corrected by adjustment of probabilities. Clinical acceptability of the Veterans Administration program appears to require greater physician education than that needed for other computer programs of electrocardiographic analysis; the flexibility of interpretation by statistical decision offers the potential for better diagnostic accuracy.

Cardiomegaly↗
PubMed1977

The significance and prognosis of chronic bifascicular block.

The clinical course of 303 patients with bifascicular block was reviewed. Initially, 62% of the total group had evidence of heart disease. The highest frequency of heart disease was in patients with left bundle-branch block and first-degree atrioventricular block (78% or 22/28), while the lowest was in those with right bundle-branch block and left axis deviation (56% or 55/98). During the subsequent clinical course the occurrence of cardiovascular morbidity was greatest in patients who had left bundle-branch block and heart disease (55% or 49/89). Complete heart block occurred in only 11 patients. The highest incidence of complete heart block occurred in right bundle-branch block and left axis deviation when associated with heart disease, but the annual rate was only 4%/yr. Mortality was highest in those with left bundle-branch block, first-degree atrioventricular block, and left axis deviation (43%/yr). A one-year mortality of 65% (11/17) was noted for patients who had bifascicular block prior to the time of acute myocardial infarction.

Bundle-Branch Block↗
PubMed1977

Exercising pulmonary blood flow in mitral stenosis with anomalous pulmonary venous connection.

Exercising pulmonary blood flow was estimated from indicator-dilution curves in a patient with the infrequent combination of rheumatic mitral stenosis and anomalous pulmonary venous connection from the left lung. During supine exercise against progressively increasing external workloads, the proportion of flow to each lung remained nearly constant. The pulmonary vascular resistance was highest in the left lung, which emptied into the low-pressure systemic vein. Although right and left atrial pressures differed markedly during supine exercise, the proportion of pulmonary blood flow shunted to the systemic venous sytem remained essentially unchanged.

Adult↗
PubMed1977

Multifocal atrial tachycardia.

Multifocal atrial tachycardia (MAT) was observed in 41 patients, 35 of whom were in acute respiratory distress. A hospital mortality of 37% reflected the seriousness of their underlying conditions. In no patient was the arrhythmia the primary cause of death. The MAT preceded and/or followed atrial fibrillation (AF) or atrial flutter (Af) in 19 patients (46%). The MAT simulated AF in several cases in which P-waves were inconspicuous. Our cases suggest that MAT is not a manifestation of digitalis intoxication. Quinidine sulfate, procainamide hydrochloride, lidocaine, and phenytoin (diphenythydantoin) did not affect the rhythm. Digitalis was usually not effective in slowing the ventricular response in patients with MAT. Propranolol hydrochloride was given to seven patients and was effective in slowing the atrial rate in all cases. An attempt at electrocardioversion was unsuccessful in one patient.

Aged↗
PubMed1976

Chest pain as a predictor of coronary artery disease in patients with obstructive aortic valve disease.

To clarify the association between chest pain and significant coronary artery disease in patients who have aortic valve disease, 76 consecutive candidates for aortic valve replacement were evaluated prospectively with use of a historical questionnaire and coronary arteriography. Of the 76 patients, 19 (25 percent) had no chest pain, 21 (28 percent) had chest pain that was not typical of angina pectoris and 36 (47 percent) had chest pain typical of anigina pectoris. In 18 of 19 patients the absence of chest pain correlated with the absence of coronary artery disease. The single patient without chest pain who had coronary artery disease had evidence of an inferior myocardial infarction in the electrocardiogram. Thus, absence of chest pain and the absence of electrocardiographic evidence of infarction predicted the absence of coronary disease in all cases. The presence of chest pain did not predict the presence of coronary artery disease, but the more typical the pain of angina pectoris the more likely were patients to have significant coronary artery disease. Of the 21 patients with atypical chest pain, 6 (29 percent) had coronary artery disease, but of the 36 patients with typical angina pectoris 23 (64 percent) had significant coronary artery disease. In addition, when patients with chest pain not typical of angina pectoris also had coronary artery disease, the diseased vessels usually supplied smaller areas of the left ventricle than when the pain was typical of angina pectoris. In 21 of 23 patients (91 percent) with typical angina pectoris and significant coronary artery disease, lesions were present in the left coronary artery. There was no systolic pressure gradient across the aortic valve that excluded the presence of coronary artery disease, although all patients with a calculated aortic valve area of less than 0.4 cm2 were free of coronary artery disease. Patients with severe left ventricular dysfunction were more likely to have normal coronary arteries.

Adult↗
PubMed1976

Effect of calcium on RNA and protein synthesis in the hypertrophied myocardium.

Myocardial protein synthesis was elevated 7 days after rats were subjected to experimental aortic outflow obstruction. Although RNA synthesis was not increased at this time, RNA concentration was elevated and may have provided for the observed increase in protein synthesis. A possible basis for the persistence of the high RNA levels was a decrease in the degradation of RNA. The increase in intracellular calcium observed in hypertrophied tissue may be involved in the maintenance of RNA concentration and in the increased rate of protein synthesis.

Animals↗
PubMedDate not supplied

[Auricular fibrillation and flutter with slow ventricular frequency. Clinical and electrophysiological study].

We have studied atrio-ventricular conduction in 9 patients with atrial fibrillation and flutter and ventricular response below 90 per minute, by means of His bundle electrograms. Despite the finding of intraventricular conduction defects in 6 cases, the block of the atrial impulses occurred at the high atrio-ventricular junction in every case. In four patients the arrhythmia was an incidental finding and there were no other signs of cardiac disease. Several patients tolerated low ventricular rates for years without symptoms, but in two cases it was necessary to insert a pacemaker to treat cerebral ischemic symptoms. The problems of interpretation of the His bundle electrogram, in the presence of atrial fibrillation, are discussed in detail.

Aged↗