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Biomedical subjects

J V Nixon

Publications and source records attributed to J V Nixon.

At least 19 recordsLinked to original sources
PubMed1992

Transesophageal echocardiography to assess mitral valve function and flow during cardiopulmonary resuscitation.

This study further defines the mechanism of blood flow during closed-chest compression using transesophageal Doppler echocardiography. Although the echocardiographic demonstration of mitral valve closure during closed-chest compression has been used as evidence of direct cardiac compression, mitral valve closure has also been documented to occur during resuscitation by selectively increasing intrathoracic pressure. Transesophageal Doppler echocardiography was used to assess mitral valve position and flow in 17 adult patients undergoing cardiopulmonary resuscitation with a mechanical piston compression device. Left and right ventricular fractional shortening, mitral valve position with chest compression, timing and magnitude of transmitral flow, and anteroposterior chest diameter were recorded. In 12 patients (group I), the mitral valve closed during the down-stroke of chest compression; in the remaining 5 (group II), it opened further. Peak transmitral flow occurred during the release phase and was significantly higher (p < 0.05) in group I (39.5 +/- 9.3 cm/s) than the peak flow in group II (21.3 +/- 5.9 cm/s), which occurred during the downstroke of chest compression. Left ventricular fractional shortening inversely correlated (r = -0.68; p = 0.02) with the anteroposterior chest diameter, but did not correlate with peak transmitral flow (r = 0.34; p = not significant). It is concluded that the mitral valve closes during the downstroke of chest compression in most adult patients during resuscitation. The absence of a relation between mitral valve flow and left ventricular fractional shortening supports the hypothesis that other factors such as nonuniform increases in intrathoracic pressure cause the mitral valve to open or close during chest compression.

Blood Flow Velocity↗
PubMed1991

Effects of exercise on left ventricular diastolic performance in trained athletes.

Dynamically trained athletes develop increased left ventricular (LV) wall mass. To determine whether this increased wall mass impaired characteristics of LV diastolic filling, serial Doppler echocardiograms were obtained from 10 trained athletes (mean age 21 years) at rest, during supine graded bicycle exercise and during recovery at heart rates of 80, 120 and 140 beats/min, respectively. Similar studies were obtained in 10 age-matched control subjects. Studies at rest showed significant increases in athletes in LV end-diastolic dimension and indexed LV wall mass. Differences in peak filling rates and in normalized peak lengthening rates between athletes and control subjects were seen at heart rates of 140 beats/min during exercise and recovery. Differences in Doppler-derived variables between athletes and control subjects were seen in total time-velocity integral, early peak filling velocity and E/A ratio. In athletes, time-velocity integral was increased during recovery at heart rates of 120 beats/min and 80 beats/min, early peak filling velocity was increased during exercise at 120 beats/min and during recovery at 120 beats/min and 80 beats/min, and E/A ratio was higher at all heart rates during both exercise and recovery. Although no significant differences were found in LV diastolic filling indexes at rest, a significant enhancement was found in these parameters in dynamically trained athletes during exercise, particularly at higher levels of dynamic exercise.

Adult↗
PubMed1991

Noninvasive estimation of left atrial pressure in patients with congestive heart failure and mitral regurgitation by Doppler echocardiography.

A completely noninvasive method for estimating left atrial pressure in patients with congestive heart failure and mitral regurgitation has been devised with the use of continuous-wave Doppler echocardiography and brachial sphygmomanometry. Of 46 patients studied with mitral regurgitation, 35 (76%) had jets with distinct Doppler spectral envelopes recorded. The peak ventriculoatrial gradient was obtained by measuring peak mitral regurgitant velocity in systole and using the modified Bernoulli equation. This gradient was then subtracted from peak brachial systolic blood pressure, an estimate of left ventricular systolic pressure, to yield left atrial pressure (left atrial pressure = systolic blood pressure - mitral regurgitant pressure gradient). Noninvasive estimates of left atrial pressure from 35 patients were plotted against simultaneous recordings of mean pulmonary capillary wedge pressure resulting in the correlation y = 0.88x + 3.3, r = 0.88, standard error of estimate = +/- 4 mm Hg (p less than 0.001). Therefore, continuous-wave Doppler echocardiography and sphygmomanometry may be used in selected patients with congestive heart failure and mitral regurgitation for noninvasive estimation of left atrial pressure.

Atrial Function, Left↗
PubMed1990

Doppler echocardiographic evaluation of left ventricular diastolic function after percutaneous transluminal coronary angioplasty for unstable angina pectoris or acute myocardial infarction.

The effect of percutaneous transluminal coronary angioplasty (PTCA) on left ventricular (LV) diastolic function has not been systematically investigated in patients treated for unstable angina or ischemia after acute myocardial infarction (AMI). To assess the relation between reduction of stenosis severity and improvement in diastolic function in this setting, 42 patients with either unstable angina (n = 22) or post-AMI ischemia (n = 20) were serially monitored by Doppler echocardiography 8 +/- 5 hours before and 2 +/- 1 days after PTCA. Doppler LV filling indexes included isovolumic relaxation time, mitral deceleration time, E/A peak velocity ratio and atrial filling fraction. Eighteen aged-matched control subjects served to establish normal values for comparison. Before PTCA, both groups exhibited abnormal diastolic function demonstrated by prolonged isovolumic relaxation time and mitral deceleration time, decreased E/A ratio and increased atrial filling fraction. After PTCA isovolumic relaxation time and deceleration time decreased 18 +/- 28 (p less than 0.005) and 33 +/- 43 ms (p less than 0.002) in the unstable angina group and 18 +/- 23 (p less than 0.003) and 14 +/- 34 ms (difference not significant), respectively, in the post-AMI ischemia group. An increase in E/A ratio and a decrease in atrial filling fraction occurred in both groups; however, these changes were significant only in patients with post-AMI ischemia (+21%, p less than 0.03 and -11.4%, p less than 0.005, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Reversible segmental left ventricular dysfunction after coronary angioplasty.

Patients with chronic segmental myocardial dysfunction may demonstrate improvement after coronary revascularization. To evaluate the early effects of percutaneous transluminal coronary angioplasty (PTCA) on resting left ventricular segmental function, we obtained serial two-dimensional echocardiograms 1.1 +/- 0.9 days before and 3.1 +/- 2 days after elective PTCA in 40 patients. Echocardiograms were reviewed in a blind fashion; left ventricular segmental wall motion was analyzed in four short-axis views, and a score was assigned to each region (0, normal; 1, hypokinetic; and 2, akinetic). Abnormal regional wall motion was present in 20 of the patients before PTCA. Summed segment scores in these 20 patients showed an improvement in regional wall motion from 4.5 +/- 2.5 to 1.6 +/- 2.1 (p less than 0.01) after successful PTCA. Similar results were obtained when the patients were divided into those with or without a previous myocardial infarction. Improvement occurred in the seven patients without a previous myocardial infarction; the summed segment score decreased from 4.2 +/- 3.4 to 0.86 +/- 1.6 (p less than 0.05) after PTCA. Ten of the 13 patients with a prior myocardial infarction demonstrated improvement in wall motion after PTCA; the summed segment scores decreased 54% (p less than 0.001). Of the 260 segments analyzed in the study, 180 were normal before and after PTCA. Forty-nine of the 69 hypokinetic segments were normal, and 10 of 12 akinetic segments were hypokinetic after successful coronary revascularization. There was no deterioration in wall motion after PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Perfluorochemical perfusion during coronary angioplasty in unstable and high-risk patients.

Perfluorochemical perfusion during coronary angioplasty was performed in 38 patients with unstable ischemic syndromes or with high-risk lesions in a single-blind crossover study. Patients received alternate 90-second balloon inflations with and without distal perfusion of oxygenated perfluorochemical (Fluosol, Alpha Therapeutic Corp., Los Angeles, California) at 60 ml/min. Efficacy was assessed by anginal intensity, hemodynamic and electrocardiographic parameters, and left ventricular function determined by two-dimensional echocardiography during balloon inflations. There was a trend toward lower anginal intensity with Fluosol perfusion at 30, 60, and 90 seconds of occlusion. Pulmonary wedge pressure increased significantly with and without Fluosol perfusion, and the magnitude of change was not different. Cardiac output decreased significantly less with Fluosol perfusion than with routine inflation for the total group (-0.8 vs. -1.2 l/min, p less than 0.01) and in the subgroup with left anterior descending coronary artery (LAD) angioplasty (-0.7 vs. -1.5 l/min, p less than 0.001). Left ventricular ejection fraction (EF) by echocardiography declined significantly less with Fluosol perfusion (-4.0 vs. -7.9 EF units, p less than 0.004) than with routine inflation for the total population and declined significantly less with Fluosol in the subgroup with LAD angioplasty (-5.5 vs. -9.7 EF units, p less than 0.008). Regional wall-motion abnormality score increased significantly with routine inflation (from 0.7 +/- 1.4 to 3.5 +/- 3.2, p less than 0.001) and did not change with Fluosol perfusion (from 0.8 +/- 1.3 to 1.3 +/- 1.1, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Effects of acute alcohol ingestion on the left ventricular performance of normal subjects before and after incomplete autonomic blockade.

The effects of acute alcohol ingestion on the left ventricular performance of nine normal subjects, mean age 25 years, were studied before and after incomplete autonomic blockade, produced by atropine, 0.04 mg/kg body weight, and propranolol, 0.2 mg/kg body weight. Left ventricular (LV) function curves (stroke volume vs. end-diastolic volume) were plotted from data generated before and after large variations in cardiac preload. Increase in preload was produced by five degrees of head-down tilt for 90 minutes; decrease in preload was produced by graduated lower body negative pressure to -40 mmHg. After incomplete autonomic blockade, the negative inotropic effects of acute alcohol ingestion were minimal but significant and manifest by the reduction in mean velocity of circumferential fiber shortening (p less than 0.05). Studies during wide variations in preload confirmed the importance of maintaining central blood volume after alcohol ingestion. Lower body negative pressure after both incomplete autonomic blockade and alcohol produced a further deterioration in mean velocity of circumferential fiber shortening (p less than 0.05).

Adult↗
PubMed1986

Non-Q-wave myocardial infarction.

The rationale for introducing the term "non-Q-wave myocardial infarction" is identified. The incidence, pathology, pathogenesis, and diagnostic criteria for this condition, previously identified as nontransmural or subendocardial infarction, are reviewed. In reviewing the diagnostic criteria, the various noninvasive techniques that may be applied are discussed. The clinical course, prognosis, and management are discussed under the headings of early postinfarction period, late clinical course, predischarge evaluation, and long-term care. The issues of the management of infarct extension and acute interventional therapy are raised and reviewed. Suggestions regarding specific aspects of therapy in non-Q-wave myocardial infarction are included in the summary.

Clinical Enzyme Tests↗
PubMed1979

Cor triatriatum with mitral regurgitation in a 52-year-old male.

The clinical, echocardiographic, and cineangiographic features of the oldest known living case of cor triatriatum are presented. Mitral regurgitation, also found in this patient, has been reported on only two previous occasions to coexist with other wise uncomplicated cor triatriatum. The value of two-dimensional echocardiography in the identification of this congenital anomaly is confirmed.

Adolescent↗
PubMed1979

A comparison of mathematical models for estimating right ventricular volumes in animals and man.

Volume of 19 right ventricular canine casts and 11 right ventricular human casts were obtained by water displacement and compared to three different mathematical models for estimating right ventricular volumes by biplane cineangiography. In the canine studies, significant linear correlation coefficients were obtained using the longest measured length method (r = 0.92), the triangular modification of Simpson's rule (r = 0.93), and the elliptical modification of Simpson's rule (r = 0.93). The human studies resulted in similar significant correlation coefficients of 0.96, 0.97, and 0.97, respectively. Although the highest correlation with the lowest standard error of estimate was obtained using the triangular model, all three mathematical models produced volume estimations that feel within acceptabe biological limits of accuracy.

Animals↗
PubMed1979

Exercise testing in men with significant left main coronary disease.

The exercise tests of 26 male patients with significant left main disease were compared with those of 51 patients with three-vessel disease and 38 patients with two-vessel disease. Exercise-induced ischaemia (chest pain and/or greater than 1 mm ST segment change) occurred in 100 per cent of left main, 69 per cent of three-vessel, and 45 per cent of two-vessel disease patients. Though the mean peak work load was significantly higher in the two-vessel disease group than in those with three-vessel of left main disease, there was a wide overlap between groups. No intergroup differences were found in mean peak heart rates. In patients taking propranolol, no differences in mean peak work loads and heart rates were seen. The study showed that the absence of an exercise-induced abnormal electrocardiographic response virtually excludes left main disease. As judged by exercise performance, the presence of left main disease did not correlate with the severity of the patient's symptomatology. Propranolol did not influence the frequency of an ischaemic response in patients with left main or three-vessel disease.

Coronary Disease↗
PubMed1979

Cardiovascular effects of positive-pressure ventilation in normal subjects.

In normal subjects during 15-min positive-pressure ventilation with 10 cmH2O end-expiratory pressure (PEEP), cardiac output fell 19% due to a fall in stroke volume. Transmural mean right atrial pressure rose 3.1 cmH2O and right ventricular end-diastolic diameter increased 15%. Simultaneously, left ventricular end-diastolic diameter decreased 21%, ejection time increased 11%, and velocity of circumferential fiber shortening fell 30%. Thus, right ventricular filling increased and left ventricular filling decreased. The function of the right ventricle was impaired and the function of the left ventricle may have been impaired. Cardiac output gradually increased due to a 7% increase in heart rate as PEEP was continued for 1 h and transmural mean right atrial pressure also increased further by 2.4 cmH2O. Compensation for the reduced stroke volume occurred as filling pressures and heart rate rose, but ventricular function remained impaired for the entire duration of PEEP. On resuming spontaneous breathing, cardiac output and ventricular function returned to base-line levels. We conclude that the reduced cardiac output during PEEP is not due to a direct mechanical reduction in right ventricular filling.

Adult↗