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Biomedical subjects

H Kulbertus

Publications and source records attributed to H Kulbertus.

At least 163 records · Page 9Linked to original sources
PubMed1982

Patients with myocardial infarction and normal coronary arteriogram.

Eighteen patients who survived an acute myocardial infarction were found to have a normal coronary arteriogram. Seven patients were younger than 35 years and six were female. The myocardial infarction was nontransmural in 11 cases. The mean follow-up was 21.6 months. Eleven patients developed residual chest pain at rest early after myocardial infarction. One, treated by beta-blockers, suffered a recurrent myocardial infarction. Eight became asymptomatic, and two improved under antispastic therapy. Another patient developed a severe form of variant angina three months after myocardial infarction; she died following plexectomy. Finally, two patients experienced rare episodes of angina at rest. The stress ECG was negative in all cases. Provocative test for spasm was positive in three out of nine patients. Diffuse narrowing associated with chest pain was demostrated in two patients at angiography. Thus, myocardial infarction and subsequent normal coronary angiogram are mainly found in young female patients, and infarction is often nontransmural. Clinical evidence of vasospastic phenomena and increased vasomotor tone are found in most patients. Whenever residual chest pain is controlled by antispastic therapy, the follow-up course seems benign.

Adult↗
PubMed1981

Prognostic significance of electrocardiographic findings in angina at rest. Therapeutic implications.

Ninety-five patients with angina at rest were observed in the coronary care unit. Eighty-one per cent presented concomitantly or had previously presented some other manifestations of coronary artery disease. These patients were divided into two subgroups. In subgroup 1 (40 patients), episodes of non-exertional angina were associated with a pattern of hyperacute subepicardial injury and, frequently, with ventricular arrhythmias. In subgroup 2 (55 patients), the episodes of angina at rest were attended by horizontal ST depression, isolated T wave inversion, or trivial ST-T changes. Coronary angiographic findings were similar in both subgroups. Symptoms regressed in only 9% of patients in subgroup 1 while they were receiving beta-receptor antagonists, whereas amiodarone alone or amiodarone with nifedipine was successful in 58%. Of these patients, 25% developed a myocardial infarction shortly after admission. In subgroup 2 patients, beta-blockers were successful in 61%. Amiodarone isolated or associated with nifedipine was successful in 55% of the patients in whom it was tried. Only 5% of patients in this subgroup developed a myocardial infarction during their hospital stay. It is concluded that: (1) observation of the electrocardiogram during spontaneous angina in patients with known atherosclerotic coronary heart disease may be of prognostic significance and may influence therapeutic decision. (2) Amiodarone by virtue of its anginal and antiarrhythmic properties may be particularly useful in the treatment of non-exertional angina.

Adrenergic beta-Antagonists↗
PubMed1980

[Hemodynamic complication of ventricular stimulation in a patient with moderate aortic stenosis].

This report is concerned with a patient aged 76 with mild to moderate aortic stenosis and transient A-V block who was treated by stand-by intracardiac pacing. In spite of this, the patient continued to present syncopal attacks. It is demonstrated that these episodes were related to dramatic decreases of systolic blood pressure and cardiac output occurring whenever the right ventricle was paced. These hemodynamic alterations were secondary to the loss of atrial contribution to ventricular filling. They were suppressed by insertion of a sequential auriculoventricular pacemaker.

Aged↗
PubMed1980

The efficacy of intravenous moxaprindine on ventricular ectopic activity.

Moxaprindine, a new derivative of aprindine, has been showed to possess strong antiarrhythmic properties in the dog. It is significantly less toxic than aprindine on hematopoietic cells in culture. This drug was given intravenously (2 mg/kg given over a 30 min period), to 10 patients with severe, refractory and symptomatic ventricular arrhythmias. In 8 of them, all ventricular ectopic activity was suppressed for at least 90 min following the end of perfusion. In 7, no ventricular ectopic beats recurred before the end of the experimentation (150 min). There were two non-responders: one of them developed a torsade de pointes phenomenon under the influence of the drug. The mean drug concentration which was reached at the end of perfusion was 4.83 +/- 2.46 gamma/ml. It progressively fell to a value of 1.11 +/- 0.35 gamma/ml, 150 min later. The drug prolongs the PR interval, QRS duration and QT interval. Moxaprindine is a powerful antiarrhythmic agent which deserves further assessment in long term studies.

Adult↗
PubMed1978

[Spike torsade].

Explore the source record for details and available documents.

Aged↗
PubMed1976

[Long-term results in the isolated replacement of mitral and aortic valves].

This is a study of 85 valve replacements by mechanical prostheses, 41 of which were in the aortic position and 44 in the mitral position. The results were analysed from the standpoint of the immediate and late mortality, the morbidity, and thrombo-embolic complications. The influence of the severity factors (NYHA classification) on the operative risk and the late mortality has been evaluated. The maximum follow-up period was 8 years for the aortic replacements and 7 years for the mitral replacements. Actuarial graphs show that there is a 78.3% survival for aortic valve replacement and a 66% survival for mitral valve replacement. We feel that the shape of the survival curves is greatly influenced by the size of population studied. As soon as a plateau appears, the significance of the analysis is in doubt. It seems to us that calculation of the degree of confidence is essential if the good quality of the long-term results is not to be overestimated. The results of surgery must be assessed by comparing the survival curves of the operated patients with those of non-operated patients with the same risk factors. The conclusion emerges that prosthetic replacement of the mitral and aortic valves markedly improves the life expectancy of stage IV patients. We can see no indication for early surgery on the aortic valve. On the other hand, mitral valve replacement should be undertaken on stage III patients so that those with a poor life expectancy can be offered a better outlook. The way in which the mitral and aortic valve disorders carry a much greater mortality after the 6th decade should induce us to bring forward the indications for surgery in this age group in spite of the slightly greater immediate and late risk from operating on patients of this age.

Adolescent↗
PubMed1975

131Cs myocardial scintigraphy. Application to assessment of anterior myocardial infarction.

Earlier studies have indicated that caesium-131 is a good myocardial scanning agent for the demonstration of anterior infarcts. One hundred and ten patients with documented anterior myocardial infarction were studied by 131Cs myocardial scintigraphy. An anterior area of decreased uptake of caesium was noted in all but 3 subjects whose necrotic zone was likely to be of small dimensions. In 20 cases, the scintigram showed a definite, sometimes very large, cold area whereas the electrocardiogram failed to display any diagnostic feature of myocardial necrosis. In most of the latter instances, the electrocardiographic diagnosis was obscured by the presence of intraventricular conduction disturbances. In order to visualize the intracardiac cavities, the 131Cs investigation was usually completed by a 113mIn scintigram, which allowed recognition of a parietal aneurysm in 12 of the 18 patients with extensive anterior lesions. In each case, an index of necrosis was computed from planimetric measurements of the infarcted area as compared to the total left ventricular surfact in both the anteroposterior and left anterior oblique projections. This index was shown to correlate with the incidence of major complications developing after the acute episode of coronary occlusion. The sensitivity, specificity, and accuracy of the method are briefly discussed. It is felt that myocardial scintigraphy represents a sound approach to the semiquantitative assessment of anterior myocardial infarction; the clinical usefulness of the technique seems sufficiently demonstrated to prompt further research in this field.

Adult↗