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Biomedical subjects

J Z Przybojewski

Publications and source records attributed to J Z Przybojewski.

At least 37 records · Page 2Linked to original sources
PubMed1986

Effects of nifedipine on the peri-operative ECG, as determined by continuous Holter monitoring. A double-blind study.

A double-blind study was performed on 50 elderly patients undergoing hip-replacement surgery under general anaesthesia; 26 were given nifedipine and the remaining 24 placebo to determine effects on the continuously monitored (Holter) ECG during the 4 peri-operative days. Drugs were only administered during the latter 3 days of the observation period. Surgery was performed on the morning of the 3rd day. A striking feature was the high incidence of arrhythmias in both groups of patients, a finding previously documented in both 'normal' and elderly people. A decrease in ST-segment changes was expected in the nifedipine-treated patients. An unexpected finding, therefore, was the lack of protection against cardiac ischaemic changes in the nifedipine-treated patients compared with the placebo patients. Interpretation of the ST segment as seen in the Holter-monitored ECG remains controversial. We have no clear explanation for the lack of protection against ischaemic changes. The effects of profound vasodilatation produced by nifedipine in elderly patients subjected to major surgery, general anaesthesia including administration of enflurane, and a variable amount of blood loss in the postoperative period may be important factors. In conclusion, one should perhaps be cautious of nifedipine administration under these circumstances.

Aged↗
PubMed1986

Myocardial infarction complicating dilated (congestive) cardiomyopathy in an industrial nitroglycerin worker. A case report.

A 46-year-old black man employed in an explosives factory and in direct contact with industrial nitroglycerin complained of angina pectoris both at rest and with effort. Special investigations established the presence of dilated (congestive) cardiomyopathy (COCM), transmural anteroseptal and anterolateral myocardial infarction (MI), and total proximal occlusion of the left anterior descending branch of the left coronary artery. Apart from this total occlusion, the coronary arteries appeared free of disease on angiography. It is postulated that some of the episodes of angina pectoris at rest were related to industrial nitroglycerin withdrawal, and that the pathophysiological mechanism involved was coronary vasospasm leading to thrombus formation which culminated in MI, aggravating the congestive cardiac failure due to the COCM. It is less likely that this MI was caused by a coronary embolism originating from the mural thrombus in the left ventricle associated with COCM.

Cardiac Catheterization↗
PubMed1986

Late symptomatic exercise-induced coronary vasospasm after percutaneous transluminal coronary angioplasty. A case report and review.

A patient who underwent a successful double-vessel percutaneous transluminal coronary angioplasty (PTCA) had suffered from exercise-induced ST-segment elevation associated with angina pectoris (AP). This ECG pattern was present both before and 12 months after PTCA while nifedipine (Adalat; Bayer-Miles) therapy was electively discontinued. Reintroduction of calcium blockade with this drug eliminated the chest pain and resulted in normalization of the stress ECG. Cardiac catheterization at 6 and 12 months after PTCA demonstrated continuing angiographic improvement of the coronary stenoses of the left anterior descending and left circumflex (LCx) coronary arteries previously subjected to PTCA. It is believed that coronary artery spasm at the PTCA site on the LCx coronary artery was responsible for the AP and exercise-induced ST-segment elevation. Likely pathogenetic mechanisms of coronary vasospasm during and after the performance of PTCA, as well as the interrelationship with re-stenosis and the clinical implications of drug therapy, are discussed.

Angina Pectoris↗
PubMed1986

Severe isolated left mainstem coronary artery stenosis. A case report.

A 33-year-old white man had exertional angina pectoris, followed by angina pectoris at rest, and then episodes of ischaemic acute pulmonary oedema associated with angina pectoris. Selective coronary angiography delineated an isolated long-segment stenosis of the left mainstem coronary artery with no other lesions. We believe that the mainstem obstruction was due to coronary artery fibromuscular hyperplasia, a condition rarely affecting the coronary artery circulation. At operation three coronary artery bypass grafts were inserted, one to the left anterior descending artery and two to the left circumflex coronary artery, with a most successful result. The patient's recurrent acute pulmonary oedema was due to severe myocardial ischaemia; the possibility of superadded coronary vasospasm aggravating the obstruction cannot be entirely discounted.

Adult↗
PubMed1986

Angina pectoris and acute myocardial infarction due to "slow-flow phenomenon" in nonatherosclerotic coronary arteries: a case report.

A 51 year-old White woman with angina pectoris and nonatheromatous coronary artery disease is presented. Cardiac catheterization demonstrated a "slow-flow phenomenon" in the left coronary artery accompanied by severe angina pectoris and anterolateral ST-segment elevation and culminating in an acute nontransmural myocardial infarction. At repeat coronary arteriography, ergonovine maleate provocation proved negative. This patient is unique, since the previously documented 6 cases with this coronary cineangiographic response did not exhibit angina pectoris or ECG evidence of myocardial ischemia during the "slow-flow phenomenon," and none was complicated by an acute myocardial infarction. Various aspects of the pathophysiology of angina pectoris in this patient, including the recently described "reduced vasodilator reserve" concept, are briefly outlined.

Angina Pectoris↗
PubMed1985

Cardiac involvement in mixed connective tissue disease. A fatal case of scleroderma combined with systemic lupus erythematosus.

A 27-year-old black woman with cardiac failure, angina pectoris and Raynaud's syndrome is presented. Skin biopsy and barium studies established the diagnosis of scleroderma (progressive systemic sclerosis (PSS)). Systemic lupus erythematosus (SLE) was strongly suggested by the results of immunological studies and increasing severity of renal failure. Because of the possibility of a cardiomyopathy, cardiac catheterization, selective coronary angiography and right ventricular endomyocardial biopsy were carried out but failed to show any histological features of either SLE or PSS. The patient went into progressive renal failure despite immunosuppressive therapy and plasmapheresis and died; consent for autopsy was refused. A final diagnosis of mixed connective tissue disease (MCTD) was made. The salient features of cardiac involvement in SLE, PSS and MCTD are outlined.

Adult↗
PubMed1985

Exercise-induced ST-segment elevation possibly caused by coronary artery spasm. A case presentation and review.

A 36-year-old man with classic angina pectoris had marked ST-segment elevation (STE) in the inferior leads on stress-testing in the absence of chest pain. There was no evidence of previous myocardial infarction (MI). Selective coronary arteriography delineated severe obstructions in the right coronary artery (RCA) with additional left circumflex coronary artery (LCx) obstruction. Left ventricular cine-angiography established that there was normal contractility and confirmed the absence of past MI. Coronary artery bypass graft surgery to the RCA and LCx was unfortunately complicated by an acute transmural inferoposterolateral MI. Treadmill stress testing 6 weeks after surgery failed to demonstrate the preoperative ST-segment change. The patient may have developed exercise-induced coronary artery spasm superimposed on the severe proximal RCA stenosis; this in turn may have caused the inferior STE. Exercise-induced STE is reviewed.

Adult↗
PubMed1985

Clinical characteristics of and prognosis in acute transmural anterior, transmural inferior and non-transmural myocardial infarction. A comparative retrospective study.

This retrospective study was undertaken to determine whether there was any difference in the clinical characteristics of and prognosis in white patients admitted to the Intensive Coronary Care Unit (ICCU) at Tygerberg Hospital with acute non-transmural, transmural anterior and transmural inferior myocardial infarction (MI). The three groups were carefully matched, taking into consideration the possible influence of previous MI and congestive cardiac failure (CCF). There were 187 patients with non-transmural MI, and 176 with transmural anterior and 209 with transmural inferior MI. Patients with acute transmural anterior MI had the worst prognosis while at the ICCU, at 3 months' follow-up and at long-term follow-up (mean 22,2 months). This group had the greatest frequency of CCF, cardiogenic shock, acute pericarditis, ventricular premature beats, ventricular tachycardia, left anterior hemiblock and complete left bundle-branch block and the highest mortality. Acute transmural inferior MI was responsible for the highest frequency of ventricular fibrillation in the ICCU and had a worse prognosis than non-transmural MI. Acute non-transmural MI resulted in the highest incidence of early and late myocardial reinfarction; although death in the ICCU was least frequent, mortality among this group had increased dramatically by 3 months' follow-up. Hence, acute non-transmural MI is not benign and an unstable period exists for 3 months thereafter. Because of this, more aggressive diagnostic measures should be instituted during this period in order possibly to improve prognosis in this group. It would appear that this is the first such study undertaken in South Africa.

Angina Pectoris↗
PubMed1985

Acute coronary thrombus formation after stress testing following percutaneous transluminal coronary angioplasty. A case report.

Successful percutaneous transluminal coronary angioplasty (PTCA) was performed on a 37-year-old white man with an isolated 95% right coronary artery stenosis who initially presented with type II unstable angina. Submaximal treadmill stress testing was not carried out before PTCA, but testing 3 days after PTCA was strongly positive without accompanying symptoms of myocardial ischaemia. Some 30 minutes after this test the patient experienced severe precordial pain with features of a hyperacute transmural inferior myocardial infarction. Immediate coronary arteriography delineated fresh thrombus related to the previous PTCA site. Intracoronary thrombolysis with streptokinase was successful, revealing an underlying severe stenosis at the PTCA site. PTCA was not repeated, nor was emergency coronary artery bypass grafting (CABG) performed. This is the second such case documented in the literature; the first patient failed to respond to intracoronary thrombolysis with streptokinase and was submitted to emergency CABG. The possible underlying pathophysiological mechanisms are discussed. We believe that the late thrombus formation was directly related to submaximal stress testing after successful PTCA, and recommend that testing to assess the efficacy of PTCA be deferred until at least 1 month after the procedure to allow for completion of the healing process.

Acute Disease↗
PubMed1985

Endomyocardial biopsy: a review of the literature.

A review of the literature relating to endomyocardial biopsy (EMB) is presented. This is considered important at this time since EMB is being utilized with increasing frequency, particularly for the diagnosis of myocarditis. The development of the technique is briefly outlined. Emphasis is placed on the clinical application of EMB in the various primary cardiomyopathies (dilated, hypertrophic, restrictive, and obliterative), the infiltrative secondary cardiomyopathies (amyloidosis, sarcoidosis, hemochromatosis), myocarditis, as well as such conditions as adriamycin cardiotoxicity, cardiac transplant rejection, and Kawasaki disease. More controversial application of EMB in primary mitral valve prolapse (Barlow's syndrome), idiopathic ventricular arrhythmias, and the elucidation of the enigmatic finding of angina with angiographically normal coronary arteries is detailed. Experience with immunological and biochemical investigation of biopsy material, as well as with virus isolation and drug assays in the myocardium, is alluded to. Complications encountered with this procedure are also discussed, and its future role is contemplated.

Amyloidosis↗
PubMed1984

Hypertrophic cardiomyopathy complicated by complete heart block. Case report and review of the literature.

A 48-year-old man with symptoms of presyncope and congestive cardiac failure had hypertrophic cardiomyopathy (HCM) without obstruction. Complete heart block (CHB), a rare complication of this disease, was preceded by complete left bundle-branch block. Right ventricular (RV) heart failure was a dominant clinical feature but improved dramatically after temporary transvenous RV pacing prompting the insertion of a permanent RV inhibited pacemaker. Repeated ventricular fibrillation was successfully controlled by amiodarone. This is the seventh case of HCM complicated by CHB reported in the literature, and the first in which RV endomyocardial biopsies were undertaken. Two other patients reported in the literature had RV inhibited permanent pacemakers implanted, and a further 2 had atrioventricular sequential pacemakers.

Biopsy↗
PubMed1984

Acute transmural myocardial infarction--coronary vasospasm, thrombosis or coronary embolus? A case report.

A very fit 28-year-old Coloured athlete presented with an acute transmural anteroseptal and non-transmural anterolateral myocardial infarction (MI). He had no significant risk factors for coronary artery disease apart from moderate cigarette smoking. Cardiac catheterization 2 months later demonstrated a significant area of myocardial damage as well as a large mural thrombus, but the coronary arteries appeared normal apart from a large irregular filling defect in the proximal left anterior descending (LAD) branch, apparently due to a thrombus. Cardiac catheterization a further 4 months later documented no further filling defect in the LAD branch and the coronary arteries appeared free of disease. Ergometrine maleate provocation on this occasion failed to demonstrate any coronary vasospasm. Possible pathophysiological mechanisms for the unexpected MI are outlined.

Adult↗
PubMed1984

Ergometrine-provoked coronary vasospasm on angiography without angina or ischaemia on ECG. A case report.

A 32-year-old White man suffered a large transmural inferoposterior myocardial infarction (MI). Coronary vasospasm is strongly suspected of having caused this MI since the ergometrine maleate provocation test gave rise to severe coronary vasospasm resulting in total occlusion of the dominant right coronary artery, without angina or ECG or haemodynamic features of myocardial ischaemia. This is a most unusual response to ergometrine maleate. Possible explanations are suggested and the implications are briefly discussed.

Adult↗
PubMed1984

Hypertrophic non-obstructive apical cardiomyopathy. A case presentation and review of the literature.

A 20-year-old Coloured man gave a history of atypical chest pain, palpitations after strenuous exercise and a single episode of post-exertional presyncope. The diagnosis of hypertrophic non-obstructive apical cardiomyopathy (HNOAC) was established by means of electrocardiography, echocardiography (both M-mode and two-dimensional) and left ventricular cineangiography. This variant of hypertrophic cardiomyopathy is most unusual and has been encountered most frequently in Japan, although a few cases have been diagnosed in the USA. The present case is the second reported from the Republic of South Africa. Important aspects of HNOAC are reviewed.

Adult↗
PubMed1984

Recurrent coronary artery spasm in the billowing mitral leaflet syndrome (primary mitral valve prolapse). A case report and review of the literature.

A 46-year-old White man had a 2-year history of frequent atypical chest pain associated with palpitations and presyncope. Clinical examination revealed an intermittent mid-systolic non-ejection click followed by a blowing mid-to-late systolic murmur indicative of the billowing mitral leaflet syndrome (BMLS) (primary mitral valve prolapse (MVP); Barlow's syndrome). This diagnosis was confirmed on cardiac catheterization, left ventricular cine angiography showing mild mitral insufficiency. M-mode and cross-sectional echocardiography documented the intermittent non-ejection click and mid-systolic apical murmur. Ambulatory Holter monitoring showed symptomatic inferolateral myocardial ischaemia, and maximal stress-testing elicited asymptomatic ischaemia in the same zone. Selective coronary angiography delineated a normal left coronary artery and an insignificant fixed obstructive lesion in the second part of the dominant right coronary artery (RCA). Provocation with ergometrine (ergonovine) maleate gave rise to severe coronary vasospasm superimposed on the insignificant lesion in the RCA. This spasm provoked myocardial ischaemia resulting in symptomatic ventricular fibrillation which was successfully reversed. The patient's symptoms have been fairly well controlled by nitrates and nifedipine. As far as I am aware this is the first documentation of coronary vasospasm in the BMLS. In this syndrome coronary artery spasm has often been postulated to be responsible for acute myocardial infarction with a normal appearance of the coronary arteries on angiography. This mechanism has also been incriminated in the genesis of ventricular arrhythmias in cases of primary MVP. These various contentious and important issues are reviewed.

Angina, Unstable↗
PubMed1984

Familial dilated (congestive) cardiomyopathy. Occurrence in two brothers and an overview of the literature.

Two young White brothers had dilated (congestive) cardiomyopathy. The elder came to autopsy after a chronic course of congestive cardiac failure, the younger underwent repeated cardiac catheterization and transvenous right ventricular endomyocardial biopsy specimens demonstrated histopathological features in keeping with a diagnosis of idiopathic dilated cardiomyopathy. These brothers may have the familial form of the disease, although post-viral myocarditis cardiomyopathy cannot be entirely excluded. The literature relating to familial dilated (congestive) cardiomyopathy is reviewed.

Adult↗
PubMed1984

Coronary artery bypass surgery in a patient with symptomatic ventricular arrhythmia. A case presentation and review of the literature.

A 42-year-old White man suffered from recurrent symptomatic ventricular tachycardia but no angina pectoris. Cardiac catheterization demonstrated a normally contracting left ventricle and coronary angiography delineated significant atherosclerotic obstructions in the left circumflex (LC) coronary artery and the first diagonal branch of the left anterior descending (LAD) coronary artery. Coronary artery bypass graft (CABG) surgery was carried out on the anterolateral and mid-lateral branches of the LC coronary artery as well as the first diagonal branch of the LAD coronary artery. Frequent postoperative Holter monitoring as well as maximum-exercise stress testing has failed to show any recurrence of the ventricular arrhythmia, and the patient has remained asymptomatic and medical therapy has been discontinued. Some 30 months after operation left ventricular cine angiography demonstrated normal contractility. Selective coronary arteriography indicated that the CABG to the anterolateral branch of the LC coronary artery was occluded at its proximal aortic anastomosis. However, the CABGs to the midlateral branch of the LC and LAD coronary arteries were still patent. Repeat serial resting ECGs failed to show any evidence of postoperative myocardial infarction. It is concluded that CABG surgery was responsible for eliminating the episodes of life-threatening ventricular tachycardia, presumably by correcting myocardial ischaemia. The role of CABG surgery in the control of medically unresponsive and dangerous ventricular arrhythmias is reviewed.

Adult↗