Biomedical subjects
Publications and source records attributed to J Cinca.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two patients with isolated T wave alternans are reported, with their vectocardiograms, their response to carotid sinus stimulation, and the response to calcium infusion in one of them with documented severe hypocalcemia. Eleven cases of the literature are briefly reviewed. The alternans of the T wave appears with severe QT prolongation, QT alternans, and an increased tendency to ventricular fibrillation. The findings are consistent with the hypothesis that T wave alternans may be the electrocardiographic manifestation of the transmembrane action potential alternans and could be related in some cases to hypocalcemia.
Isolated T wave alternans (TWA) could be consistently induced in 13 dogs by infusion of an acid dextrose solution (ACD) and in nine with a 2% EDTA disodium solution. To study the factors concerned in evoking TWA, serial determinations of total and ionized serum calcium (ICa), Mg, K, pH, pCO2 and pO2 were performed. Arterial or LV pressures and LV dp/dt as well as a standard electrocardiographic lead were monitored. TWA appeared after the QT interval was significantly prolonged and was associated with a fall in LV pressure and with mechanical alternans. QT alternans could also be detected in 50% of the cases. ICa levels were significantly reduced at the moment of appearance of the TWA. Data obtained support the conclusion that TWA was the result of a reduction in the level of the ICa, probably interfering with the calcium transport mechanisms of the myocardial cell, although the possibility that the alternans may be due to other effects of the two agents employed unrelated to calcium lowering cannot be excluded.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The existence of a cardiac phase of supernormal excitability is not fully proved at the cellular level. As far as the whole heart is concerned, the phenomenon of supernormal conduction is still under discussion. Intracardiac conduction has been studied both in the right atrium (13 dogs) and in the right ventricle (14 dogs) by programmed stimulation (extrastimulus technique), while monophasic action potential (MAP) was recorded. The phenomenon of supernormal conduction was noted in 67.7% of cases, starting at 59.0% and ending at 78.0% of the basic cycle, hence occuring shortly after phase 3 of the MAP. In the ventricle, a phase of supernormal conduction was present in 52.4% of cases, starting at 66.1% and ending at 77.9% of the basic cycle. After ajmaline, the supernormal conduction was moved towards the end of the cycle. The mechanism of supernormal conduction, and its implications in the study of arrhythmias are discussed.
The dependence of T-wave alternans on diastolic resting period duration as well as on regional differences in monophasic action potential duration was studied in the in situ dog heart. T-wave alternans was elicited when diastolic resting period shortened to values less than 41 +/- 6% of the cardiac cycle. This could be attained either by increasing the driving rate, or lengthening action potential duration by inducing hypocalcemia. During T-wave alternans, monophasic action potentials recorded from anterior and posterior left ventricular surface showed an alternation in duration; the degree in alternation in both regions differed and related to T-wave polarity.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.