[Anticoagulation in pregnancy].
Explore the source record for details and available documents.
Abnormalities, Drug-Induced↗
Biomedical subjects
I Coma-Canella
Publications and source records attributed to I Coma-Canella.
Detection of restenosis with dobutamine stress test after coronary angioplasty.
Dobutamine ECG tests were serially performed before, at 15 days, and at 2 and 6 months after successful coronary angioplasty in 58 patients. The dose of dobutamine was progressively increased from 5 micrograms/kg/min to a maximum of 40 micrograms/kg/min every 5 minutes, with ECG and blood pressure control. Coronary angiography was performed at the end of the study. At 15 days after coronary angioplasty, the dobutamine test was of little value for the diagnosis or prediction of restenosis. At the end of the study, both the presence of angina and the results of the dobutamine test were related to coronary angiography, and their accuracy was calculated for the detection of mild (> or = 50%) and severe (> or = 70%) restenosis or new coronary lesions. The accuracy of angina was 68% for the detection of mild lesions and 70% for that of severe lesions, whereas the accuracy of the dobutamine test was 78% for mild lesions and 80% for severe lesions. It is concluded that the dobutamine stress test is a simple and useful method for the detection of restenosis when it is performed at 2 and 6 months after coronary angioplasty. However, it cannot distinguish between restenosis or new coronary lesions.
Adult↗
Stress-induced ST segment shift in leads V3R and V4R after acute myocardial infarction.
A total of 107 patients with acute myocardial infarction underwent a dobutamine stress test and received increasing doses of the drug (5, 10, 15, 20, and up to 40 micrograms/kg/min). Coronary angiography was performed within the first month. The 12 conventional ECG leads plus the right chest leads V3R and V4R were recorded under basal conditions and after each dose of dobutamine. In 51 patients (group A) there was an ST shift greater than or equal to 0.5 mm in the right chest leads, with two different patterns: rightward (V2 less than V1 less than V3R V less than V4R) (n = 26) and leftward (V2 less than V1 less than V3R greater than V4R) (n = 25). In 56 patients (group B) no ST shift in the right chest leads was induced. An ST segment elevation greater than or equal to 0.5 mm in V4R was 43% sensitive and 86% specific for the detection of proximal right coronary artery disease. Four subgroups were established in group A: A1R, rightward ST elevation (n = 23); A1L, leftward ST elevation (n = 12); A2R, rightward ST depression (n = 3); and A2L, leftward ST depression (n = 13). Group A1R had predominantly inferior infarcts and right coronary artery stenoses, group A1L had predominantly anterior infarcts and left anterior descending coronary stenoses, and group A2L had posteroinferior infarcts and right or left circumflex stenoses, all of them with low sensitivity (less than 50%) and high specificity (greater than 87%) for a such diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Coronary Angiography↗
Diagnosis of subacute ventricular wall rupture after acute myocardial infarction: sensitivity and specificity of clinical, hemodynamic and echocardiographic criteria.
When ventricular free wall rupture after acute myocardial infarction is not followed by sudden death, it is referred to as subacute ventricular rupture. The sensitivity and specificity of clinical, hemodynamic and echocardiographic diagnostic variables obtained at bedside are unknown and were therefore prospectively studied in 1,247 consecutive patients with acute myocardial infarction including 33 patients with subacute ventricular rupture diagnosed at operation (group A) and 1,214 patients without ventricular rupture (at operation, postmortem study or at discharge) (group B). The incidence of syncope, recurrent chest pain, hypotension, electromechanical dissociation, cardiac tamponade, pericardial effusion, high acoustic intrapericardial echoes, right atrial and right ventricular wall compression identified in two-dimensional echocardiograms and hemopericardium demonstrated during pericardiocentesis was higher in group A than in group B (p less than 0.00001). The presence of cardiac tamponade, pericardial effusion greater than 5 mm, high density intrapericardial echoes or right atrial or right ventricular wall compression had a high diagnostic sensitivity (greater than or equal to 70%) and specificity (greater than 90%). The number of false positive diagnoses was always high for each diagnostic variable alone (greater than 20%), but the combination of clinical (hypotension), hemodynamic (cardiac tamponade) and echocardiographic variables allowed a sensitivity of greater than or equal to 65% with a small number of false positive diagnoses (less than 10%) and provided useful information for therapeutic decisions. The diagnosis of subacute ventricular rupture requires a surgical decision. Twenty-five (76%) of the 33 patients with subacute ventricular rupture survived the surgical procedure and 16 (48.5%) are long-term survivors. Thus, subacute ventricular wall rupture is a relatively frequent complication after acute myocardial infarction that can be accurately diagnosed and successfully treated.
Cardiac Catheterization↗
Comparison of diastolic blood pressure changes with dobutamine and exercise test.
UNLABELLED: A total of 80 patients (44 with stable angina and 36 during coronary angioplasty follow-up) underwent both exercise and dobutamine stress testing within one week. Dobutamine was infused in doses of 5 micrograms.kg-1.min-1, up to 70 every 5 min with blood pressure and electrocardiographic control. Treadmill exercise testing was performed with a maximal, symptom-limited Bruce protocol. Both systolic blood pressure and heart rate increased significantly with dobutamine and exercise, but the increase was higher with exercise (P = 0.00001). Mean blood pressure increased only with exercise, while diastolic blood pressure increased with exercise and decreased with dobutamine (P = 0.00001). A test was positive when either typical angina or an ST segment shift greater than or equal to 1 mm 80 ms after the J point was present. There were 28 positive tests with exercise and 38 with dobutamine, 22 of them coinciding. In 36 patients both tests were negative. The concordance between both tests was 73%. When each test was related to coronary angiography, dobutamine showed greater sensitivity and efficacy than exercise. CONCLUSIONS: a dobutamine stress test induces a positive response in more patients than does an exercise stress test, although the increase in systolic blood pressure and heart rate is greater with exercise. The decrease in diastolic blood pressure with dobutamine probably plays a role in the positive response.
Angioplasty, Balloon, Coronary↗
Changes in plasma potassium during the dobutamine stress test.
We performed serial determinations of levels of potassium in 198 patients with suspected or proven coronary arterial disease who underwent a dobutamine stress test, so as to investigate if the depression in the ST segment induced by the test may be due to hypokalemia. The test consisted of an intravenous infusion of dobutamine, starting with a dose of 5 micrograms/kg/min for 5 minutes and continuing with 10, 15, 20 and up to 40 micrograms/kg/min every 5 minutes (mean peak dose = 20 micrograms/kg/min). Serial 12-lead electrocardiograms were taken to detect changes in the ST segment. The double product changed with dobutamine from 8844 +/- 6000 to 15201 +/- 3030. The peak dose of dobutamine induced a small but significant decrease in levels of serum potassium, with a further decrease 10 minutes later. In the 198 patients, the plasma potassium changes from 4.22 +/- 4.8 to 3.86 +/- 0.35 mmol/l (P less than 0.00001). The maximum decrease in potassium (0.56 +/- 0.49) occurred in the patients who received the highest dose of dobutamine (30 to 40 micrograms/kg/min). Only 17 patients reached levels lower than 3.5 mmol/l, and 4 of them achieved levels lower than 3.1 mmol/l. No correlation was found between depression of the ST segment equal to or greater than 1 mm on the electrocardiogram and the level of potassium after the test. No correlation was found between ventricular arrhythmias and levels of potassium. High doses of dobutamine, therefore, produce a small but significant decrease in potassium.(ABSTRACT TRUNCATED AT 250 WORDS)
Coronary Disease↗
Dobutamine stress test to diagnose the presence and severity of coronary artery lesions in angina.
To calculate the accuracy of dobutamine infusion as a stress test to detect coronary lesions, 90 patients with angina and nine asymptomatic subjects with nonsignificant coronary lesions were submitted to a dobutamine test and coronary arteriography. Dobutamine was given in doses of 5, 10, 15 and 20 micrograms kg-1 min-1 every 5 min; a 12 lead ECG and blood pressure was monitored. Pressure x rate product increased from 8240 +/- 1667 to 14,898 +/- 3042. The test was negative (neither angina pain, nor ST segment shift) in 31 patients, and positive in 68. The ST segment was depressed in 33 cases and elevated in 20. Significant (greater than or equal to 50%) coronary lesions were seen in 63 patients and functional (coronary spasm or vasoconstriction) abnormalities in six. The sensitivity of the dobutamine test for the detection of coronary lesions was 95%, specificity 78%, predictive value of a positive test 88%, of a negative test 90% and diagnostic efficiency 89%. Strongly positive tests predicted severe lesions in 91% of the cases, and slightly positive tests ruled out severe lesions in 84%. ST segment elevation was induced in 20 cases and corresponded to a severe coronary lesion. In conclusion, the dobutamine stress test is a simple and accurate method of predicting coronary artery disease in patients with angina, distinguishing between severe and mild lesions. It can be a good alternative to an exercise test.
Adult↗
Significance of ST segment changes induced by dobutamine stress test after acute myocardial infarction. Which are reciprocal?
In order to determine the significance of predischarge stress-induced ST segment changes after a first non-complicated acute myocardial infarction, a dobutamine stress test was performed in 104 patients. Dobutamine was infused in doses of 5, 10, 15 and 20 micrograms.kg-1.min-1 every 5 min with ECG and blood pressure control. It induced a substantial increase in heart rate and systolic blood pressure. The patients were divided into 4 groups: (1) anterior (n = 28); (2) inferior (n = 32); (3) posteroinferior (n = 27) and (4) high lateral plus anterior or anterolateral (n = 17) infarction. They were followed for 2 to 18 months (mean 7.5 +/- 5). In basal conditions the ST segment was elevated in 49 patients and depressed in 20. Combined ST elevation and depression was seen in 11. After dobutamine there was ST elevation in 80 patients, depression in 71 and combined elevation and depression in 60. The magnitude of the maximal ST elevation was correlated with the magnitude of the maximal ST depression in each group of patients. There was a good inverse linear correlation between ST segment shifts in inferior vs high lateral leads, and ST depression was considered as a benign mirror image of opposite ST elevation in such leads. In patients with posterior infarction, anterior ST depression was considered as a mirror image of posterior ST elevation. In the remaining cases ST depression was a criterion of positivity.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Right ventricular infarction as a risk factor for ventricular fibrillation during pulmonary artery catheterization using Swan-Ganz catheters.
Explore the source record for details and available documents.
Adult↗
Sensitivity and specificity of dobutamine--electrocardiography test to detect multivessel disease after acute myocardial infarction.
The value of dobutamine-electrocardiography (ECG) as a stress test to detect multivessel coronary disease after non-complicated acute myocardial infarction (AMI) was assessed in 75 patients before hospital discharge. Dobutamine-ECG test (dose of 5, 10, 15 and 20 micrograms kg-1 min-1 every 5 min) was performed 5 to 12 days after the beginning of the symptoms of AMI, and coronary angiography within the first month. Heart rate increased from 71 +/- 12 to 106 +/- 17 beats min-1, and systolic blood pressure from 111 +/- 15 to 139 +/- 20 mmHg. Dobutamine test was negative (neither anginal pain, nor ST-segment depression) in 33 patients and positive in 42. The angiographic study showed the presence of non-significant (less than or equal to 50%) coronary lesions in 11 patients, one-vessel disease in 33, two-vessel disease in 18 and three-vessel disease in 13 patients. Sensitivity of dobutamine-ECG test to detect multivessel (two- or three-vessel) disease was 84%, specificity 64%, predictive value of a positive test: 62%, predictive value of a negative test: 85%, and diagnostic efficiency: 72%. In conclusion dobutamine-ECG is a highly sensitive test to diagnose multivessel disease in patients with non-complicated AMI. The specificity is lower, probably due to detection of peri-infarction ischaemia in cases of one-vessel disease.
Adult↗
Repetitive myocardial infarction in a young woman with vasospastic coronary artery disease.
Explore the source record for details and available documents.
Adult↗
Anatomic findings in acute papillary muscle necrosis.
To investigate the consequences of acute papillary muscle necrosis of the left ventricle, 25 cases from a total of 133 autopsies of acute myocardial infarction were studied. Cardiac hypertrophy was found in 84%. The anterior papillary muscle was involved in four cases, the posterior in 13, and both muscles in eight. Left ventricular subendocardial infarction was found in 32% of cases. The size of left ventricular necrosis ranged from 11% to 75% of the left ventricular mass. Associated right ventricular infarction was observed in 68%. There were 19 cases of cardiogenic shock, four cases of pulmonary edema, and two cases of sudden death. We conclude that papillary muscle necrosis is usually associated with cardiac hypertrophy, posterior necrosis of both ventricles, and subendocardial infarction. Acute mitral regurgitation is probably an important contributing factor to clinical impairment and death, mostly in cases of small necrosis.
Aged↗
Acute right ventricular infarction secondary to massive pulmonary embolism.
Isolated right ventricular infarction has been found in cases of right ventricular hypertrophy, but there are no reports on right ventricular infarction secondary to massive pulmonary embolism. Six autopsied patients with massive pulmonary embolism and pure right ventricular infarction, suspected to be secondary to the embolism, were selected from a population of 216 autopsies. Pulmonary embolism was the suspected diagnosis in five cases due to typical clinical, electrocardiographic and haemodynamic data. Right ventricular infarction was a post-mortem finding, not previously diagnosed. In every case the thickness of the right ventricular myocardium was normal. The necrosis of the right ventricle was transmural in four cases and subendocardial in two and the entire right ventricular wall (anterolateral as well as posterior) was involved. No mural thrombi were present and in no case did the necrosis involve the left ventricle. In one case the coronary arteries were normal, in the other five significant lesions of the right or left coronary arteries were observed. These lesions may have been, in part, responsible for the necrosis of the right ventricle when the massive pulmonary embolism was added. We conclude that right ventricular infarction may be secondary to pulmonary hypertension in the setting of massive pulmonary embolism, even in the absence of right ventricular hypertrophy and with normal or stenotic coronary arteries.
Aged↗
Hemodynamic effect of dextran, dobutamine, and pericardiocentesis in cardiac tamponade secondary to subacute heart rupture.
Seventeen patients with acute myocardial infarction and tamponade after subacute ventricular free-wall rupture were treated with dextran, dobutamine, and pericardiocentesis before definitive surgical repair. In all of the patients the diagnosis was confirmed anatomically. Dextran (200 to 900 ml), administered to 10 patients, induced a significant increase in systolic blood pressure, cardiac index, stroke index, right atrial pressure, and pulmonary capillary pressure. Dobutamine (500 micrograms/min for 20 to 40 minutes), was infused in 16 patients and induced a significant increase in systolic blood pressure, cardiac index, stroke index, and heart rate. Pericardiocentesis, with extraction of 150 to 500 ml, was performed in five patients. It produced a significant increase in systolic blood pressure, cardiac index, and stroke index and a significant decrease in right atrial pressure and heart rate. The best results were obtained after pericardiocentesis. However, it must not be performed in every case because of its potential risk. Dextran and dobutamine may be sufficient in many cases to support these patients before surgery.
Adult↗
Electrocardiographic alterations in leads V1 to V3 in the diagnosis of right and left ventricular infarction.
As Q wave and ST segment elevation in leads V1 to V3 may be due either to right ventricular infarction (RVI) or to anterior left ventricular infarction (ALVI), 72 autopsy patients with acute myocardial infarction who had had conventional 12-lead ECG records were studied to determine the accuracy of these ECG criteria, both for the diagnosis of RVI (29 patients, group A) and of ALVI (43 patients, group B). The accuracy of three ECG criteria (Q wave, ST segment elevation greater than or equal to 0.05 mV, and ST segment elevation greater than or equal to 0.1 mV) in diagnosing group A and group B patients was determined in each precordial lead (V1, V2, and V3) and the three criteria were found to be significantly more accurate in diagnosing group B than group A patients. In conclusion, although Q wave and ST segment elevation in leads V1, V2, and V3 may be present in some cases of RVI, their accuracy is too low to be considered useful diagnostic criteria in these patients.
Adult↗
Haemodynamic findings in experimental right ventricular ischaemia after right coronary arterial ligation.
Acute ischaemia limited to the free wall of the right ventricle was produced by right coronary arterial ligation (RCAL) in 20 dogs. Contrast M-mode and cross-sectional echocardiography was performed in 7 cases to investigate the presence of tricuspid insufficiency. The haemodynamic findings obtained with an open pericardium at 15 to 30 min showed increases in right (1.2 +/- 0.5 to 2.7 +/- 0.7 mmHg, P less than 0.01) and left (5.0 +/- 0.8 to 6.6 +/- 0.9 mmHg, P less than 0.05) ventricular end-diastolic pressures, and decreases in heart rate (139 +/- 4.9 to 119 +/- 5.1 bpm, P less than 0.01), cardiac index (106 +/- 6.6 to 81 +/- 7.3 ml min-1 kg-1, P less than 0.01), stroke index (79 +/- 6 to 72 +/- 8 ml X 100 beat-1 kg-1, P less than 0.02), right (23.8 +/- 1.5 to 19.4 +/- 1.5 mmHg, P less than 0.01) and left (109 +/- 7.2 to 95 +/- 8.2 mmHg, P less than 0.05) ventricular systolic pressures and right ventricular stroke work index (18.3 +/- 2.4 to 11.4 +/- 1.8 g m kg-1, P less than 0.01). In 6 of 15 cases the 'y' descent became deeper than the 'x' descent in right atrial pressure (RAP). Tricuspid insufficiency grade I-II/IV was present in 3 of 7 cases, 2 of them with a 'y' greater than 'x' in RAP. Right ventricular mechanical alternans, probably secondary to a decrease in contractility, appeared in 10 of 20 cases after RCAL.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Echocardiographic detection of circulating blood in normal canine hearts.
Explore the source record for details and available documents.
Animals↗
Electrocardiographic findings in acute right ventricular infarction: sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, V1, V2, and V3.
To determine the sensitivity, specificity, predictive value and diagnostic efficiency of electrocardiographic alterations in the diagnosis of acute right ventricular infarction, 43 autopsy patients with acute myocardial infarction and an electrocardiogram including 12 leads plus leads V3R and V4R were studied. Group A included 21 patients with right ventricular infarction, of whom 14 (group AI) had posterior and 7 (group AII) had anterior right ventricular infarction. Group B included 22 patients without right ventricular infarction. Excluding group AII patients, the sensitivity of the presence of a Q wave reached 78.6% in lead V4R and decreased in leads V1 to V3; its specificity was low in all the leads. The sensitivity of ST segment elevation reached 100% in lead V4R and decreased in leads V1 to V3; its specificity was highest (68.2%) in leads V4R and V3R, its negative predictive value was 100% and its diagnostic efficiency was 80.6%. The criterion of ST segment elevation in lead V4R being higher than that in leads V1 to V3 was less sensitive (78.6%) than ST segment elevation in lead V4R alone, but its specificity reached 100%, its positive predictive value 100% and its diagnostic efficiency 91.7%. In conclusion, there are no electrocardiographic criteria to identify anterior right ventricular necrosis, but posterior right ventricular necrosis may be identified by the presence of a Q wave or ST segment elevation in the right precordial leads, reaching the highest sensitivity and specificity in lead V4R. The criterion of ST segment elevation in lead V4R being higher than that in leads V1 to V3 offers the highest specificity and efficiency in the diagnosis.
Acute Disease↗