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Biomedical subjects

J G Sloman

Publications and source records attributed to J G Sloman.

At least 19 recordsLinked to original sources
PubMed1982

Subendocardial myocardial infarction.

Sixty-one consecutive patients with acute subendocardial myocardial infarction (SEAMI) and 223 consecutive patients with transmural infarction (TMI) seen in a coronary care unit were followed for one year. All patients were less than 70 years of age. The patients with SEAMI had a higher frequency of previous infarction (34% vs 21%, p less than 0.025), less cardiac failure (44% vs 65%, p less than 0.005), and were more often free from arrhythmias (61% vs 31%, p less than 0.001) than patients with TMI. Hospital mortality was less in patients with SEAMI (0% vs 8%, p less than 0.05) but total mortality to one year was similar (15% vs 17%). Amongst patients with SEAMI, two died within two weeks of infarction but all other deaths occurred at least six weeks after infarction. Patients with SEAMI and a history of previous infarction had a higher one year mortality than patients without such a history (29% vs 7%, p less than 0.05). Coronary angiography with a view to coronary artery surgery should be considered in the former group.

Aged↗
PubMed1982

The antiarrhythmic effect of intravenous disopyramide in an open study.

The antiarrhythmic effect of intravenous disopyramide phosphate was assessed in a multicentre open study of 141 patients admitted to coronary care units. Disopyramide was administered in a bolus dose of 2 mg/kg over 10 min with an optional second bolus of 1 mg/kg and infusion of 0.4 mg/kg hour. Atrial fibrillation was terminated in 57% of 56 patients, supraventricular tachycardia in 82% of 11 patients, ventricular tachycardia in 88% of 17 patients and premature ventricular contractions were controlled in 85% of 55 patients. Atrial flutter was terminated in only 2 of 17 patients (12%). Side effects occurred in 38% of the patients, the most frequent being those relating to anticholinergic properties of the drug (15%) or systemic hypotension (13%). Occasionally worsening of the arrhythmia (4%), QRS widening (3) or apparent hypertension (2%) were noted. It was concluded that intravenous disopyramide is an effective antiarrhythmic agent in the coronary care unit setting, but that side effects require close monitoring of dosage.

Adolescent↗
PubMed1982

Recent concepts in the management of ischaemic cardiac syndromes.

Ischaemic heart disease is the most important cause of death in our society. Knowledge of the natural history of the various ischaemic syndromes leads to better management, with emphasis on prevention of cardiac necrosis rather than management of its sequelae. This article is from the Department of Cardiology, Royal Melbourne Hospital.

Adrenergic beta-Antagonists↗
PubMed1981

Coronary artery graft surgery.

The last decade has seen significant technical advances in equipment for the procedure of, and the surgeon's operating skill in coronary artery by pass surgery. Such surgery is indicated when, despite medical treatment, angina is disabling; although evidence is increasing that patients whose pain is controlled should be considered for surgery. Late operations are more complex and expensive, and patients are exposed to a higher risk of sudden death in the intervening period. Delay may also allow the disease to progress to an inoperable state. Patients unlikely to benefit from medical treatment should be offered surgery as soon as their disease is identified by angiography. Intensive medical treatment, with its poorer control of symptoms, leads to an increasing dependence on the State of medicine, hospital facilities and sickness benefits. The reputedly expensive coronary artery bypass operation is cheaper both to the State and to the patient tha unoperated invalidism.

Angina Pectoris↗
PubMed1981

The malfunctioning pacemaker system. Part I.

The success of an implanted cardiac pacemaker is dependent upon the establishment of a harmonious relationship between the artificial pacemaker and the human receiver. Failure of a pacemaker system may arise from an electronic or mechanical defect within the pacemaker, a physiologic problem, or from a poor relationship between the normal function of both. Such malfunctions may necessitate the repair, replacement, or repositioning of a pacemaker component or removal of a source of external interference. True pacemaker malfunctions must be clearly distinguished from pseudo-malfunctions, where there is no pacemaker system defect. These situations may, variously, require the repair of faulty testing equipment, reassessment of falsely interpreted test data, or treatment of the patient for an unrelated disorder. This paper outlines a system for investigating patients with suspected pacemaker malfunction. For simplicity, only malfunctions associated with the ventricular inhibited pacing system will be discussed.

Cardiac Pacing, Artificial↗
PubMed1980

The effect of long-term diphenylhydantoin therapy on glucose tolerance and insulin secretion: a controlled trial.

The influence of long-term administration of diphenylhydantoin (DPH) on glucose tolerance and insulin secretion was studied in a random controlled trial in non-epileptic patients receiving the drug for 2 years following recovery from myocardial infarction. While receiving DPH, insulin response to glucose was less than that in the control group, both in absolute terms and when related to the blood glucose level. Despite this, glucose tolerance did not differ from the control group. One month after cessation of DPH, the plasma insulin response had returned to the levels found in the control group, and glucose tolerance had improved to be significantly better than that found in the control group. Thus, the tendency of DPH to impair the insulin response to glucose has been confirmed in this controlled study. However, this does not result in significantly impaired glucose tolerance; it is suggested that the decreased insulin secretion is accompanied by improved insulin sensitivity.

Blood Glucose↗
PubMed1980

An assessment of the clinical use of glyceryl trinitrate in a hospital outpatient population.

Despite the availability of information on the use of glyceryl trinitrate (GTN) in standard texts, in practice many patients fail to obtain maximum benefit from GTN. This study of an Outpatient population, documents the patients' knowledge of the use and precautions which should apply to GTN and records the ways in which these patients took the drug. Fifty patients who regularly took GTN (greater than 5 tablets per week) were asked a series of questions by the same interviewer. Forty-nine of the 50 patients took GTN for the relief of chest pain, but only 34 patients knew that the drug could be used to prevent chest pain. Although 48 patients kept their bulk supply of GTN in the original container, over 40% transferred some or all of the tablets to other containers and locations. Seventy per cent of patients knew that GTN tablets deteriorate with time. However, knowledge of the factors which influence the rate of deterioration was lacking. Less than half the patients knew that the prompt relief of pain or the local effects on the buccal mucosa could be used as simple tests of the activity of tablets. It is recommended that all physicians should take more time to explain to their patients how to use glyceryl trinitrate correctly.

Aged↗
PubMed1980

Multiform ventricular tachycardia.

Electrophysiological studies were performed in three patients with chronic recurrent ventricular tachycardia (VT) associated with coronary artery disease. In each case the ventricular origin of the tachycardia was confirmed and induction of tachycardia by programmed stimulation suggested a re-entry mechanism. Multiple types of ventricular tachycardia were observed which differed in cycle length, QRS morphology, timing of local epicardial and endocardial ventricular electrograms and the use of the specialized conduction system for propagation. There was evidence of one or more re-entry circuits arising in or near previously infarcted areas, with features of cycle length alternation, change in exit points and variations in subsequent conduction through the myocardium and specialized conduction tissues. These findings suggest multiform VT can be due to a number of factors. A modified surgical approach is recommended for management of medically refractory VT when there is evidence of multiple types.

Adult↗
PubMed1979

Chronic diphenylhydantoin therapy does not reduce plasma 25-hydroxy-vitamin D.

A randomized controlled study was performed to investigate the effect of 2 years' monitored diphenylhydantoin (DPH) therapy on plasma 25-hydroxyvitamin D (25-OHD) in non-epileptic, non-institutionalized subjects. Mean +/- SEM plasma 25-OHD of 18 DPH-treated subjects at the end of 2 years' drug treatment was 59 +/- 8 nmol/l (23.6 +/- 3.2 ng/ml), which was not decreased compared to that of eighteen control subjects (54 +/- 8 nmol/l, 21.6 +/- 3.2 ng/ml). In addition, mean plasma 25-OHD had not changed 1 month after ceasing DPH. The treated group had a higher mean serum alkaline phosphatase (SAP) during DPH treatment, attributable to hepatic enzyme induction. It is concluded that therapeutic doses of DPH without other anticonvulsants do not have a clinically significant effect on plasma 25-OHD.

Adult↗
PubMed1979

Chronic recurrent ventricular tachycardia--an electrophysiological study.

Electrophysiological techniques were used to study 17 patients with chronic recurrent ventricular tachycardia. Twelve of the patients had coronary disease, while eight had pre-existing intraventricular conduction defects. The site of origin of the tachycardia as deduced by analysis of the QRS morphology correlated well with the electrocardiographic evidence of the site of the old infarction. Ventricular tachycardia was induced by pacing techniques in eight patients while it occurred spontaneously during the study in two others. In only four of the eight patients in whom tachycardia was induced, could the arrhythmia be reinduced; the arrhythmia could not be reproduced in one, while reproducibility was not assessed in the remaining three. Tachycardia was terminated by pacing techniques in six patients and by DC cardioversion in four. Ventricular tachycardia was initiated with a run of "torsade de pointes" in four patients. Ventricular tachycardias with varying morphology were observed in three patients. Electrophysiological study was of significant benefit in patient management in 14 of the 17 patients, particularly those with pre-existing intraventricular conduction defects, undocumented tachycardia or undocumented syncope.

Adult↗
PubMed1979

The use of balloon-tipped electrodes for permanent cardiac pacing.

A new balloon-tipped ventricular endocardial electrode for permanent artificial cardiac pacing is described. Following transvenous insertion of the electrode to the right ventricular apex, the distal balloon is inflated with contrast material in order to wedge the electrode tip between or beneath trabeculae and prevent displacement. fifty-nine electrodes were implanted, including a second generation type incorporating a wedge tip as well as the balloon. The incidence of displacement was 17% with 10% of cases being early, and 7% late. Early in the series, 50% Urografin was used to inflate the balloon and this resulted in premature deflation and early electrode displacement in two of the nine patients. When the concentration of Urografin was reduced, the balloon remained inflated for a longer period and the incidence of early displacement was reduced to 8%. However, there was still a late displacement of 8%. Only one wedge-tipped balloon electrode displaced. This electrode had a faulty sealing mechanism and the balloon could not be adequately inflated. There was a 3% incidence of early and a 3% incidence of late threshold problems with the electrode. However, name of the wedge-tipped balloon electrodes exhibited this problem. It was concluded that this new electrode did not fulfill its objectives. The total electrode failure rate, including displacements and episodes of high threshold was approximately 24%.

Aged↗
PubMed1979

Similar QRS morphology in sinus rhythm and ventricular tachycardia.

A 74-year-old man with coronary artery disease and bifascicular block suffered recurrent tachycardia. Although the similarity of QRS morphology in tachycardia and sinus rhythm suggested a supraventricular origin, His bundle electrocardiography and programmed stimulation showed a ventricular origin. Digitalis toxicity was not an etiological factor and there was no evidence to suggest a His bundle tachycardia. The case illustrates that in occasional circumstances the onset of ventricular tachycardia may produce no change in QRS morphology thus making the diagnosis by conventional electrocardiographic criteria difficult.

Aged↗