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Biomedical subjects

J Vohra

Publications and source records attributed to J Vohra.

At least 19 recordsLinked to original sources
PubMed1992

Clinical experience with surgery for paroxysmal supraventricular tachycardia: a report of 103 cases.

One-hundred-and-three patients underwent surgery for paroxysmal supraventricular tachycardia (PSVT). In eighty-three patients (81%), PSVT was due to an accessory atrioventricular pathway (Group I) and in 20 (19%) to Atrioventricular Junctional (AV nodal) Reentrant Tachycardia (AVJRT:Group II). Initial surgery successfully divided 77 of 83 accessory pathways, including 58 of 60 left free wall pathways, 12 of 15 posteroseptal pathways, six of seven right free wall pathways and one anteroseptal pathway. Twenty patients had successful surgery for AVJRT. Surgery was performed with low morbidity and no early or late mortality in either group. One patient in each group required permanent pacemaker implantation. Immediate (within one week) postoperative electrophysiological study using epicardial wires was performed in 96% of patients and repeat electrophysiological study six months later was possible in 65/103 (63%) patients. Patients with surgery for accessory pathways were followed-up for a mean 34 +/- 23 months, while those with surgery for AVJRT for a mean of 13 +/- seven months. No patient with successful surgery has had a clinical recurrence of PSVT. Thus the results indicate that surgery is a safe and curative therapy for patients with PSVT.

Adolescent↗
PubMed1992

Late development of conduction block over the Mahaim fibers after electrical atrioventricular junction ablation for Mahaim fiber tachycardia.

A patient suffering from so called "Mahaim fiber" tachycardia is presented who developed complete heart block over Mahaim fibers after 18 months of AV junction ablation. Antegrade conduction along the Mahaim fiber was intact immediately after the procedure. This finding has not been previously described and suggests that permanent pacemaker implantation is mandatory in such patients.

Adult↗
PubMed1992

Coronary-pulmonary artery fistula arising distal to obstructive coronary lesions.

We report 2 cases of coronary-pulmonary artery fistulae (CPF) arising distal to obstructive coronary artery disease. The fistula in the first patient was in the form of a tortuous dilatation of the distal portion of the right coronary artery and opened into the right pulmonary artery. In the second case, the fistula, a plexus of vessels, arose from the left anterior descending artery and entered the left pulmonary artery. Both the fistulae were successfully ligated at the time of concurrent coronary artery bypass graft surgery.

Aged↗
PubMed1991

Tricyclic antidepressant poisoning.

OBJECTIVE: To review poisoning with tricyclic antidepressants. DATA SOURCE: English language literature search using Australian Medlars Service (1977-1989), manual search of journals and review of bibliographies in identified articles. STUDY SELECTION: Approximately 250 articles, abstracts and book chapters were selected for analysis. DATA EXTRACTION: The literature was reviewed and 93 articles were selected as representative of important advances. DATA SYNTHESIS: The major features of overdose are neurological, cardiac, respiratory and anticholinergic. Life-threatening complications develop within six hours of overdose or not at all. All patients seen within six hours of overdose should have their stomachs emptied. All patients should receive activated charcoal. Coma, convulsions, respiratory depression and hypotension are treated with standard resuscitation techniques and drugs. Treat patients with significant cardiotoxicity or cardiac arrest with alkalinisation by sodium bicarbonate or hyperventilation, aiming for an arterial pH of 7.45-7.55. Lignocaine is used for ventricular arrhythmias. Other antiarrhythmic drugs are contraindicated (Class 1A, Class 1C), potentially lethal (Class II), of no benefit (phenytoin) or of unproven efficacy (Class III and Class IV). Physostigmine has no role at all. Haemodialysis and haemoperfusion are of no benefit. CONCLUSION: The death rate of those who reach hospital is 2%-3%. Most of these deaths are cardiac in origin, and are caused by direct depression of myocardial function rather than cardiac arrhythmias.

Antidepressive Agents, Tricyclic↗
PubMed1990

Electrical ablation of posteroseptal accessory pathways.

Electrical ablation of a posteroseptal accessory pathway by delivery of direct current electrical energy at the coronary sinus ostium was attempted in six patients. As a result of 12 procedures in these six patients, the posteroseptal accessory pathway was successfully ablated in one patient. Retrograde conduction only was affected in a further three patients, abolishing paroxysmal supraventricular tachycardia in two and reducing the tachycardia rate in one. One of the six patients developed coronary sinus perforation requiring prompt pericardial aspiration. The procedure is complicated, time consuming, of limited efficacy and coronary sinus perforation is a significant risk. Surgery remains the preferred option as a curative procedure for arrhythmias due to posteroseptal accessory pathway.

Adult↗
PubMed1989

An appraisal of cardiovascular standards for Australian civilian flying licences.

This paper summarises recommendations drawn up at a meeting of a group of Cardiologists and Aviation Medical personnel to review cardiovascular standards for Australian Civil Flying Licences. Major recommendations were in the field of ischemic heart disease which remains the commonest cause of disqualification. The panel recommended consideration of coronary risk factors and increased attention to the high risk group as a preventive measure for loss of licence. Licensing, with appropriate safeguards and continued supervision, was considered permissible in carefully selected subjects with ischemic heart disease. Guidelines were also drawn up for various licence categories for subjects with valvular heart disease, cardiac arrhythmias, implanted pacemakers, cardiomyopathy and hypertension.

Aerospace Medicine↗
PubMed1979

Effect of mianserin on cardiac conduction.

A cardiovascular study of a new antidepressant, mianserin, given at 60 mg a day for a three-week period to 10 ambulant, moderately depressed patients is described. No effects on cardiac conduction were found by means of His bundle electrocardiography. Nine of 10 depressed patients improved while on the medication; mild sedation was the only side effect noted.

Adult↗
PubMed1978

Cardiological effects of nomifensine, a new antidepressant.

A cardiovascular study of a new antidepressant, nomifensine, revealed no significant cardiac effects in eight ambulant patients who received up to 200 mg of nomifensine per day for three weeks. In an electro-physiological study of cardiac conduction, nomifensine had significantly less effect on cardiac activity than amitriptyline and doxepin. Results of the clinical and the experimental studies suggest that nomifensine may be of value in treating the depressed patient with heart disease.

Action Potentials↗
PubMed1978

Electrophysiology of disopyramide in man.

The electrophysiological effects of an intravenous dose of disopyramide phosphate (2 mg per kg body weight) were studied in 17 patients. Studies were performed with the patients fasting, unpremedicated, and off all medication for three days. Blood samples for estimation of serum levels of disopyramide were collected in 15 of these patients. The effects of intravenous disopyramide were maximal at five minutes, less marked at 20 minutes, and largely gone by 30 minutes after administration of the drug. Sinus cycle length and corrected sinus node recovery time were shortened significantly. No index of atrioventricular nodal function was significantly changed. Both atrial and ventricular effective refractory periods were significantly prolonged. Further impairment of intraventricular conduction occurred in six patients with bundle branch block on electrocardiogram or prolonged HV interval. In one of two patients with Wolff-Parkinson-White syndrome, the bypass effective refractory period was prolonged. These electrophysiological changes are similar to quinidine and quinidine like drugs. It is recommended that disopyramide should be used cautiously in patients with evidence of His Purkinje system disease since it may lead to higher degrees of intraventricular block.

Adolescent↗
PubMed1976

The effect of tricyclic antidepressant drugs on the heart.

The effects on the heart rate and ECG of anaesthetised guines-pigs of amitriptyline, doxepin, imipramine and nortiptyline infused at 1.0 mg/kg/min until death were observed. In addition an in vitro study on guinea-pig atria was performed on the chronotropic and inotropic effects of these drugs and of desmethylimipramine and protriptyline at a concentration of 10(-5) M. The effect of sodium bicarbonate (3 mEq/kg i.v.) and propranolol (0.01--0.2 mg/kg i.v.) on amitriptyline and doxepin induced ECG changes was also assessed. A difference in the cardiac effects of the in vivo and in vitro model was observed. Guinea-pigs infused with doxepin survived significantly longer than those infused with amitriptyline, imipramine or nortriptyline. No statistically significant difference was found between the tricyclic drugs with respect to onset of widening of the QRS complex, increased PR and QT intervals. In the spontaneously beating atrial preparation doxepin was the most potent cardio-depressant. Sodium bicarbonate had no effect on arrhythmias induced by tricyclics, while propranolol, apart from the bradycardia induced, was without beneficial effect on the ECG. The guinea-pig provides a good model for studying the arrhythmogenic actions of tricyclic antidepressants.

Animals↗
PubMed1976

Cardiac effects of different tricyclic antidepressant drugs.

The effects of tricyclic antidepressants on the heart are reviewed. Statistically significant increases in heart rate and in atrioventricular conduction times were found following the administration of tricyclic drugs to 32 depressed patients. The method of His bundle electrocardiography was used to study atrioventricular conduction in ambulant patients and in patients admitted after an overdose of tricyclic antidepressant drugs. Distal conduction defects were frequently found in patients following tricyclic overdosage, but these were not seen with doxepin overdosage. Impaired distal conduction was also found in occasional patients on therapeutic doses of tricyclic drugs. Some animal experiments giving similar results to the above clinical findings are also described. The clinical implications of these findings are discussed.

Amitriptyline↗
PubMed1975

Clinical experience with verapamil.

Verapamil administered by the intravenous route restored sinus rhythm in 33 out of 40 episodes of supraventricular tachycardia. The drug was also effective in reducing ventricular rate in patients with atrial fibrillation. Intracardiac conduction studies using His bundle electrograms showed prolongation of atrioventricular nodal conduction in eight out of nine cases after 5 mg of verapamil were given. The distal conduction was unaffected. Bradycardia and hypotension occurred in two cases and responded promptly to intravenous administration of atropine. Verapamil is an effective antiarrhythmic agent which is, in general, free from significant side effects.

Arrhythmias, Cardiac↗
PubMed1975

Haemodynamic effect of intravenous verapamil in controlled atrial fibrillation.

The haemodynamic effect of intravenous verapamil was assessed in eight digitalised patients with atrial fibrillation, at rest and on exercise. The reported regularisation of the ventricular rate in atrial fibrillation with verapamil, was also examined. The only significant haemodynamic effect attributable to the drug was an increased stroke volume which was in accordance with significant heart rate slowing which occurred at rest and both during and after exercise. There was no significant change in cardiac output. Although the heart rate slowed in all studies, regularisation of the R-R interval did not occur.

Adult↗