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Biomedical subjects

J P Broustet

Publications and source records attributed to J P Broustet.

At least 19 recordsLinked to original sources
PubMed1992

[Role of physical effort in the monitoring of coronary disease: under medical treatment, after bypass, after angioplasty].

Exercise tests must be performed only in hospitals and private clinics equipped for intensive care. Electrocardiographs must be fitted with a computer-assisted system for averaging and smoothing. In all but special cases it would be preferable to interrupt or delay the anti-angina treatment, so that the degree of ischaemia can be quantified. In this way, the severity of coronary lesions, the risk of arrhythmia and the prognosis for life can be predicted with good statistical certainty. In addition, the patient's fitness for work can easily be evaluated. As years go by, the ischaemia may be found to have become worse, and it might be decided to revascularize the myocardium in due course. Following revascularisation exercise tests are used to evaluate its benefits and follow their persistence. In addition, exercise tests are a very useful means of adjusting the antianginal treatment. Finally, exercise tests create a special link between patients and their medical team since they participate, both physically and psychologically, in their own diagnosis and evaluation of treatment.

Angioplasty, Balloon, Coronary↗
PubMed1992

The benefit of graded physical exercise in chronic heart failure.

A new program of rehabilitation is less demanding on cardiac output than standard programs. Twenty-five patients with chronic heart failure (ejection fraction [EF]: 0.26 +/- 0.10) were randomized into 2 groups: a control group with 13 patients and a rehabilitation group of 12 patients. In the control group, 2 did not complete the study (cancer, cardiac transplantation). For the 11 others, the different parameters studied were comparable at day 0 with group R and did not significantly change over 3 months outside of a spontaneous improvement in endurance performance by 22%. In the rehabilitation group (40 sessions over 90 days; specialized equipment) there were no incidents. Tolerance was excellent (heart rate during sessions less than 115 bpm) and all functional parameters improved. Training did not modify the isotopic ejection fraction. The quality of life score increased respectively by 52% (p less than 0.0001 in comparison with the control group) and by 63% (p less than 0.0001); 80% of the patients requested that training be prolonged. The functional improvement obtained by purely peripheral effect had no adverse effect on the heart.

Chronic Disease↗
PubMed1992

[Return to work after myocardial infarction: evaluation and decision].

Working capacity after myocardial infarction depends on the physical and cardiovascular status, psychological repercussions and conditions of work. The latter two are much more important than the first two factors. Cardiovascular functional status is readily assessed by the large number of available investigations which leave little unknown. Exercise stress testing during the second week is the most cost-efficient investigation, providing reliable and sufficiently quantifiable data about the possible sequellae of cardiac failure on effort, ischemia and arrhythmias: an idea of the patient's functional capacity and circulatory responses (athletic, hyperkinetic) may also be obtained allowing adjustment of treatment to improve exercise capacity which goes much further than the statistical hope of prolonging survival. However, it would be naive to think that a satisfactory exercise stress test guarantees the patients' capacity to return to work. Psychological and sociological factors are more important by far. The dominant trait of the post-infarction psychological syndrome must be identified (anxiety, depression, negation): the positive and negative influences of the family, social and professional environment must be evaluated. A good knowledge of the patient's working conditions is essential to go against a number of taboos hindering the return to work (stress, stairs, restaurant meals, etc...). Finally, the medico-legal relationship between the infarct and work should not be neglected: the management of myocardial infarction when an occupational disease must respect the legislative and judicial texts which do not always correspond with everyday clinical practice. There is a lack of structures for cardiac function testing for assessing physical aptitude: we suggest that in the context of the proposed hospital reforms, departmental heads should consider setting up such units which would have a specific task respecting the spirit of these reforms. Nevertheless, cardiologists should pay more attention to the convalescent phase of infarction. This is the time when many social catastrophes can be avoided.

Arrhythmias, Cardiac↗
PubMed1991

[Which coronary investigation should be performed in patients with peripheral arterial diseases?].

In the context of peripheral vascular disease, the clinical history provides a means of evaluating coronary risk. The key features are: age, previous myocardial infarction especially when recent (under 6 months), anginal pain, smoking, diabetes and ventricular arrhythmias. Treadmill testing, often limited by symptoms of claudication, may reveal severe coronary ischemia and thereby the patients at very high risk. Upper limb exercise stress testing gives results similar to standard protocols of non-atherosclerotic patients when correctly performed and a reliable detection and evaluation of coronary lesions. Thallium dipyridamol myocardial scintigraphy is a very useful diagnostic method but requires special radionuclide facilities. This technique demonstrates the site of ischemia. Coronary angiography should be reserved for special cases because the risks of the procedure are always greater in patients with peripheral vascular disease.

Coronary Angiography↗
PubMed1991

[Computerized analysis of ST segment during exercise. Interpretation of "saw tooth" appearance].

The authors report original appearances (sinusoid or "saw tooth" aspect) of computerised analysis of the ST segment in 3 cases, corresponding to ST changes during exercise stress testing. This is due to alternating ST elevation and depression probably related to abnormal vasomotor tone given the fact that the recording was normalised by coronary vasodilator therapy.

Angina Pectoris, Variant↗
PubMed1991

[Severe ischemic ventricular arrhythmia during dipyridamole scintigraphy].

A case of severe myocardial ischaemia complicated by syncopal ventricular tachycardia during injection of Dipyridamole for stress Thallium myocardial scintigraphy in a coronary patient is reported. Myocardial ischaemia (chest pain, ECG changes) is classically rare (30% of cases) and usually benign during Dipyridamole injection, and either regress spontaneously or after administration of Theophylline. However, the possibility of serious complications such as this justifies the same criteria of strict surveillance as for classical exercise stress testing.

Aged↗
PubMed1979

[Prinzmetal's angina initiated by interruption of exercise. 5 cases with normal coronary radiograms].

Five male patients, aged between 31 and 58 years, presented with anginal chest pain with nausea and sweating after the interruption of exercise. Prinzmetal variant angina was observed during the recovery phase of exercise tolerance testing. Coronary arteriography and selective left ventricular angiography were normal in all cases. Ergonovine, used in one case, induced coronary artery spasm. The angina was eased by Nifedipine in three patients and passed off with time in the other two patients. In one case attack occurred with amiodarone therapy and in another with glyceril trinitrate, after normal exercise tolerance tests. Vagotonia, all the more pronounced when sympathetic tonus is increased, and hyperventilation seem to be the causative factors of what probably results from coronary artery spasm. Nifedipine, a calcium-blocking agent would appear to be the treatment of choice.

Adult↗
PubMed1979

[Wolff-Parkinson-White syndrome. Correlation between the results of electrophysiological investigation and exercise tolerance testing on the electrical aspect of preexcitation].

Fourteen patients with permanent electrocardiographical features of the Wolff-Parkison-White syndrome in sinus rhythm referred for electrophysiological investigation also underwent maximal exercise tolerance tests. The working hypothesis was that in patients with the Wolff-Parkinson-White syndrome with accessory pathways of longer effective refractory periods than the normal pathway (group I) the delta wave should disappear on exercise, whilst in patients with accessory pathways with shorter refractory periods than the normal pathway (group II) the delta wave should persist. Of the 9 patients in group I,the delta wave regressed in 8 and persisted in 1 patient; of the 5 patients in group II, the delta wave persisted in 4 of them. Three patients had attacks of tachycardia during or just after the exercise tolerance test. These results suggest that the exercise tolerance test may help in the identification of patients with accessory pathways with long refractory periods, less susceptible to rapid ventricular rhythms should atrial fibrillation occur, and therefore with better prognoses.

Adolescent↗
PubMed1978

[The fate of patients with stenosis of the trunk of the left coronary artery].

We have studied the fate of 49 patients with stenosis of the trunk of the left coronary artery of more than 50%. The follow-up period extends from 1,5 years to 5 years (with a mean of 33.83 +/- 13.55 months). The clinical picture was not characteristic. Unstable angina was found in 59% of cases. The exercice test (29 patients) was positive in 100%, with a mean depression of 3.3 mm. Stenosis of the trunk, which is rarely an isolated condition (8% of cases), is usually associated with disorders of the other main coronary vessels. Twenty six patients underwent surgery. Thirteen patients who were operable were treated medically. The performance of the left ventricle and the degree of involvement of the coronary arteries were comparable in these two groups. Seven inoperable patients were treated medically. Actuarial survival curves show a significant difference (p less than 0.01) in survival after two years between the operated cases (88%), the operable cases treated medically (60%), and the inoperable cases (57%). The decreased mortality of the operated cases corresponds also with a greater functional capacity in the survivors compared with that of the cases treated medically.

Adult↗
PubMed1978

[Hemolysis and platelet function in patients with prosthetic heart valves. Changes during exercise and with propranolol].

10 control subjects and 27 patients with prosthetic valves (15 with Björk aortic valves, 6 with mitral prostheses, 4 with aortic and mitral valves, 1 with a Björk mitral and a Starr aortic valve, and 1 with a Beall mitral valve) underwent, at intervals of 24 hours, two maximal exercise tests, initially without (day J) and subsequently with (day J + 2) propranolol in a dose of 80 mg/24 h, haemolysis and platelet function being assessed immediately before and immediately after each test. Exercise tolerance was not altered by propranolol in this dose, provided the heart size was not more than 1500 ml. Haemolysis, as assessed by the level of lactic dehydrogenase (LDH1) was increased by exercise, especially in the aortic prosthesis cases in which the LDH1 was increased by 21.6% (p less than 0.025). The increase was less marked under propranolol treatment, when it was 12.3% (p less than 0.05). Propranolol did not correct the platelet clumping caused by the prosthetic mitral valves, but did decrease platelet stickiness on exercise in the patients with prostheses (delta = -11.7%; p less than 0.05). Propranolol can not therefore be recommended for increased haemolysis if there is no demonstrable dysfunction of the prosthetic valve. Neither would we advise its use at present with the aim of reducing thrombotic accidents.

Adult↗
PubMed1976

[The exercise electrocardiogram after the acute phase of myocardial infection. Analysis of 100 cases].

A study was made of the effort electrocardiogram (ECG) of 100 patients who had had a myocardial infarction and correlated in 46 cases with findings at coronography. Angina occurred in 38 cases. The ECG remained stable in 17 cases and showed changes in 83. In 60 patients, in those leads with pathological Q waves, isolated T wave changes (15 cases), ST elevation (43 cases) or ST depression were seen. In 17 cases there was isolated ST depression in leads free of any signs of infarction. In 6 cases alterations in rhythm or conduction were seen.

Angina Pectoris↗