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Biomedical subjects

J C Demoulin

Publications and source records attributed to J C Demoulin.

At least 91 records · Page 5Linked to original sources
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↗
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↗
PubMed1981

[Corrected transposition of the great vessels in the aged. Presentation of a case, review of the literature on the development and an anatomical and histological study of the conduction system].

A previously healthy 46 year old man was found to have a murmur suggestive of mitral incompetence, when examined after an accident. Investigations revealed corrected transposition of the great arteries and severe regurgitation of the left atrioventricular valve. A complementary bibliographic study of 19 other cases, aged over 40 years old was undertaken to assess the natural history of the condition, apparently fatal before the fifth decade in cases with associated lesions, shunt or valvular disease, but of better prognosis in the rare cases of isolated corrected transposition. The anatomical study suggested a congenital malformation of the regurgitant valve (cleft and abnormal chordal pattern) but a traumatic origin could not be excluded. Examination of the conduction system showed the presence of degenerative lesions. The atrioventricular node was located in the classical "posterior position", which is unusual in this type of congenital malformation.

Aged↗
PubMed1981

[Involvement of the common trunk of the left coronary artery].

This work describes the observations made in a group of 32 patients suffering from left main coronary stenosis (narrowing of 70% or more). 28 patients underwent surgical treatment: they represent 14% of 200 consecutive surgical cases. The diagnosis of left main narrowing is not possible on clinical ground only. However, several common features can be noted. Patients without myocardial infarction commemoratives all experienced unstable angina pectoris. When a bicycle ergometric test could be realized, it was positive for a low work load. It showed a mean 3 mm ST depression for a mean charge of 75 watts. The repolarisation disturbance lasted long after interruption of effort (more than 7 minutes). Coronarography very often showed multiple vessel disease. the anterior descending artery was stenosed in 25 patients, the circumflex artery artery in 23 and the right coronary artery in 27 patients out of the 32. In the majority of the patients, an anastomotic circulation was evidenced. The direction of the vicarious flow was determined by the relative degree of stenosis on the arteries implied in this collaterality. The mortality of coronarography was 1/32. Among the 28 operated patients, 1 died shortly after operation, giving an operative mortality of 3.6%. During a mean follow-up of 15 months, 1 death during the first postoperative year, 2 failures, 2 partial successes and 22 clinical recoveries were noted. Out of 18 patients socially susceptible to work again, 12 are effectively working, 3 are retired and 3 are still totally unable to work at the present time.

Angina Pectoris↗
PubMed1980

Combined mexiletine and amiodarone treatment of refractory recurrent ventricular tachycardia.

A combined mexiletine and amiodarone treatment was applied in nine cases with recurrent refractory ventricular tachycardia. During the first two days of treatment, mexiletine and amiodarone were perfused intravenously at a dose of 1,000 mg. and 1,500 mg. per 24 hours, respectively. Simultaneously amiodarone was also given orally at a dose of 600 mg. per 24 hours. From the third day onwards, the intravenous administration was interrupted and both drugs were continued orally at a dose of 600 mg. daily. The first three patients were very critically ill and had had at least five episodes of ventricular tachycardia per 24 hours during the last 10 days in the intensive care unit. The treatment resulted in total suppression of the tachycardic episodes within three days after initiation of therapy. In the remaining six cases, ventricular tachycardia was easily initiated by programmed electrical stimulation of the heart. No arrhythmia could be elicited by repeated testing on the seventh day of treatment. The mean follow-up period was 6 months. Two patients with poor left ventricular function died in intractable heart failure. Another one died suddenly 4-1/2 months after his release from the hospital. He had a large aneurysm and whether he continued his treatment is unknown. A fourth patient had an aneurysmectomy; he suffered a recurrence, and died at his second operation. All the others presently remain asymptomatic. The association of a class I (mexiletine) with a class III (amiodarone) agent is theoretically attractive for the treatment of refractory ventricular arrhythmias. The present findings corroborate this hypothesis, but show that this association is not able to protect individuals with severe underlying myocardial damage.

Adult↗
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

Five years' experience with intraaortic balloon pumping. The changing of indications and the emergence of prognostic indices.

The authors report their experience with IABP during 5 years. 40 patients have been submitted to this procedure, 31 for spontaneous non-complicated myocardial infarction. Overall survival rate was poor in those non-surgical conditions (8/31); better outcome was obtained if IABP was applied earlier in the course of the infarction and if left ventricular filling was continuously assessed. Therefore, use of prognostic index (such as SWI/PWP) and monitoring of pulmonary wedge pressure is stressed. Incidence of sudden death is high among short term survivors 4 out 5 deaths in 8 short term survivors. Usefulness of IABP in preparation for surgery or/and as postsurgical support is evident in this series (5/7 successes) with the exception of patients who did not come off pump (2 cases) and for whom IABP was ineffective.

Assisted Circulation↗
PubMed1980

[Complete obstruction of the common trunk of the left coronary vessel. Observation of a case].

A case of complete left main coronary artery obstruction is described. After an anterolateral and inferior subendocardial myocardial infarction, the patient remained symptomatic and underwent an angiographic investigation. Complete left main artery obstruction was disclosed and an important coronary collateral circulation was evidenced. This collaterality explains the absence of extensive transmural myocardial infarction of some patients with left main coronary artery thrombosis.

Collateral Circulation↗