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Biomedical subjects

J Stepińska

Publications and source records attributed to J Stepińska.

At least 19 recordsLinked to original sources
PubMed1998

[A case of dilated cardiomyopathy caused by myocardial microinfarcts in the course of polycythemia vera].

This article presents a case of 45-year-old man with polycythemia vera non diagnosed before. The first symptom of polycythemia vera was acute congestive heart failure which suggested diagnosis of myocarditis. Polycythemia vera was confirmed by raised hematocrit, significantly increased platelet count, normal oxygen saturation, score for leukocyte alkaline phosphatase (LAP)-130 and splemomegaly. Echocardiography revealed left ventricular histological. Coronary arteriography showed normal coronary arteries. Finding of histological examination of the endomyocardial biopsy were described as necrosis of myocytes and abnormal blood flow in very small coronary vessels. It was the main reason of dilated cardiomyopathy caused by microinfarcts in polycythemia vera. Hematological parameters were reduced to normal levels after hydroxyurea treatment. Digitalis and ACE-inhibitor therapy quickly improved cardiovascular status from III to II NYHA class.

Biopsy↗
PubMed1993

[Electrical ablation with high frequency (radiofrequency) in patients with recurrent atrioventricular nodal reentrant tachycardia--introductory information].

In 10 patients (pts) with atrioventricular nodal reentrant tachycardia type slow/fast (AVNRT) refractory to the antiarrhythmic treatment, radiofrequency current catheter ablation was performed. Adult pts (mean age 31 years) suffered from paroxysms of AVNRT for 2 to 18 years (mean 8 years). Episodes of arrhythmia recurred from 2-3 times a week to 1 for several months during antiarrhythmic therapy. The mean rate of the tachycardia was 243/min. 3 pts had syncope and 5 fainted during the tachycardia. In 2 females mitral valve prolapse was diagnosed. Programmed stimulation of the right atrium on the basic rate 130/min revealed ERP of the slow pathway mean 238 ms and ERP of the fast one mean 346 ms. The tachycardia has been induced with right atrium stimulation--most often programmed or burst stimulation--200 and 220/min, sometimes with incremental pacing. Successful radiofrequency energy ablation was performed in all 10 pts. Average number of the impulses for one pt was 7.7 (from 1 to 18 impulses). The total average time of the ablation was 216 s. The temperature of effective ablation was average 65 centigrade. The effect of the ablation was evaluated during repeated electrophysiological study before and after intravenous injection of atropine. Ablation was considered successful when no tachycardia was induced. P-R interval did not change and no episodes of AVNRT was observed in the 1-3 months follow-up. No complications were observed during the ablation and after the procedure, especially no thromboembolism was noticed. The echocardiographic evaluation revealed no damage to the heart structure. The pts receive no antiarrhythmic treatment and they are systematically controlled.

Adult↗
PubMed1993

[Difficulties with pharmacologic treatment of a patient with atrioventricular nodal reentrant tachycardia].

A case history of a 38 year old teacher with AVNRT is described. She had been treated for 11 years with 11 antiarrhythmic drugs in various combinations. No treatment prevented recurrence of arrhythmia. During long term treatment with class IA, IC, II, III and IV antiarrhythmic drugs, various side effects occurred. There was also suspicion of proarrhythmic effect, especially of prajmaline. Some of the drugs terminated tachycardia while administered intravenously. But often deep hypotonia, heart automatism disturbances and even asystole occurred, MAS syndrome occurred 5 times. The patient was referred to our laboratory to perform percutaneous radiofrequency ablation of the slow pathway. The procedure was performed without any complications. Efficacy of the ablation was proved by electrophysiologic study before and after intravenous atropine administration. During the 11 months follow-up the patient had no tachycardia. She is on no antiarrhythmic medication and continues her normal activity.

Adult↗
PubMed1993

[Selective catheter ablation of the slow pathway in a patient with recurrent atrioventricular nodal reentrant tachycardia].

The case of a 35 year-old patient with recurrent, sustained atrioventricular nodal reentry tachycardia (AVNRT)--type slow/fast--refractory to group IA, IC, II, IV antiarrhythmic agents is presented. The maximum rate of the tachycardia was 280/min. During the antiarrhythmic treatment with group IA, IC and IV agents the tachycardia rate was 230/min. The effective refractory period (ERP) of the slow pathway was 200 ms in antegrade direction. ERP of the fast pathway was 260 ms in antegrade and 210 ms in retrograde direction. Ablation of the slow pathway was performed with radiofrequency energy (device HAT 200 S manufactured by Osypka GMBH, catheter Cereblate No 6). The total ablation time was 96 s, maximal temperature of the effective ablation time was 51 centrigrades. Total energy delivered was 2316 J. The ablation caused neither atrioventricular conduction block nor any damage to the heart structure other than the slow conduction pathway. After the ablation there are no evidence of conduction through the slow pathway. Conduction in anterograde and retrograde direction occurs through the fast pathway. No AVNRT were observed. After ablation the patient has no antiarrhythmic treatment.

Adult↗
PubMed1991

[Indications for emergency surgical treatment of ectopic atrial tachycardia].

Recurrent automatic atrial tachycardia can induce dilated cardiomyopathy. We present clinical and therapeutic problems of 16 years old male with ectopic left atrial tachycardia refractory to pharmacological therapy. In this patient long periods of atrial tachycardia 200-240/min due to lack of effective medication caused cardiac failure. Uncontrolled taking of various antiarrhythmic drugs and persistent tachycardia led to cardiogenic shock. The electrophysiologic study revealed focus of the tachycardia localized in the area of left cardiac auricle. The rate of the tachycardia was changing from 84 to 240/min, with periods of Mobitz I block in the AV node. In periods of 1:1 AV conduction the tachycardia had sometimes LBBB QRS morphology. The atrial tachycardia provoked unsustained ventricular one. The patient was operated. Resection of left auricle and mitral valvuloplasty were performed. After the operation the patient regained undisturbed sinus rhythm and symptoms of heart failure disappeared.

Adolescent↗
PubMed1991

[Indications for emergency cardiovascular surgery at the Institute of Cardiology].

Between 1981 and 1989 73 patients (46 males, 27 females aged 15-69; mean 42) underwent emergency cardiac operation in the I Clinic of Cardiosurgery. There were 39 (53%) patients with valvular disease, 18 (25%) with prosthetic valve dysfunction and endocarditis, 9 (12%) with acute aortic dissection (2 of them had Marfan's syndrome), 5 (7%) with atrial myxoma and 2 (3%) with malignant pericardial mesothelioma. All of them were treated in C.C.U. before surgery. 27 urgent operations were performed within the first 24 hours after the admission to C.C.U. 30 of 73 patients died (41%). The IV NYHA functional class was stated as the most significant predictive factor for in-hospital mortality. The greatest mortality was observed in the group of patients with valvular disease (53%). In hospital survival rate reached 50% after reoperations as a procedure of choice in prosthetic valve dysfunction. Good early results were observed in patients with aortic dissection (survival rate--66%). The presence of Marfan's syndrome was associated with a poor surgical prognosis. There were no deaths after atrial myxoma removal, but all patients with malignant mesothelioma died. The most common cause of all deaths was congestive heart failure.

Adolescent↗
PubMed1990

[Dissection of the accessory conduction pathways with simultaneous mitral valve surgery].

The case of surgical treatment of a 44-years old female with a double atrio-ventricular accessory pathway and mitral stenosis was described. Fast ventricular rates due to conduction through the accessory pathways during atrial fibrillation in course of mitral stenosis caused severe heart failure, occasionally with deep hypotonia. Combined treatment with prajmaline and propafenone blocked conduction through accessory pathways. The ventricular rate slowed from approx. 200/min to 150/min. Addition of digoxin slowed the ventricular rate down to approx 80-100/min. There were no signs of preexcitation. Treatment with diuretics and vasodilators was continued. The state of patient improved. Echocardiographic and hemodynamic evaluation revealed: mitral stenosis (orifice - 75 mm2) with moderate regurgitation, small aortic and tricuspid regurgitation. The coronary arteries were normal. On the base of the ECG recordings during atrial fibrillation both accessory pathways were localized on lateral and posterior parts of the left free wall. The patient was operated on. Both atrio-ventricular by-pass tracts were dissected using Sealy's method in Cox modification and then mitral valve prosthesis Medtronic-Hall 27 mm was implanted. Prajmaline and propafenone were discontinued and preexcitation did not recovered. The sinus rhythm was restored by electroversion. The patient had no overt heart failure on discharge from the Institute.

Adult↗
PubMed1989

[Captopril-induced attacks of bronchial asthma].

There was presented the case of a bronchial asthma attack in 29 years old patient with congestive heart failure and a history of atopic bronchial asthma in 30th minute after 12.5 mg of captopril administration.

Adult↗
PubMed1989

[Comparison of the effect of Lasolvan and betamethasone on lung maturity of fetal rabbits].

8 rabbits received Lasolvan i.v. on day 25, 26 and 27 of pregnancy. 8 rabbits received betamethasone i.m. on 26th and 27th day of pregnancy. The control group received 0.9% NaCl. On day 28 of pregnancy the caesarean section was carried out, the newborn rabbits killed after 45 minutes. In their lungs the lecithin contents was significantly higher in the Lasolvan group than in the betamethasone group and control group, but in the betamethasone group not significantly higher than in the control group. Betamethasone caused in the fetuses the lowering of the body weight, of the wet weight of lungs, of the dry weight lungs and the increase of the pulmonary fluid contents. Lasolvan had no such undiserable effect.

Ambroxol↗