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Biomedical subjects

K Forfang

Publications and source records attributed to K Forfang.

At least 37 records · Page 2Linked to original sources

An evaluation of ultrafiltration as treatment of therapy-resistant cardiac edema.

In six patients with therapy-resistant cardiac edema, ultrafiltration on two consecutive days removed on an average 7750 ml fluid and reduced body weight by 7.3 kg. A difference between the mean ultrafiltration rate (17.4 ml/min) and the calculated plasma refilling rate (12.7 ml/min) led to a reduction in plasma volume during treatment together with an increase in plasma colloid osmotic pressure. Systemic blood pressure, heart rate and cardiac output were unchanged during ultrafiltration while systemic vascular resistance increased and pulmonary capillary wedge pressure and right atrial pressure decreased significantly. No complications were recorded during or after treatment. Ultrafiltration is a safe method of fluid removal in patients with therapy-resistant cardiac edema and can be used as preparation for cardiac catheterization or surgery.

Adult

Optimal atrioventricular delay in physiological pacing determined by Doppler echocardiography.

Our study included eight patients with physiological pacemakers programmed to the VDD mode. The blood velocity in the aortic root was determined by Doppler echocardiography. Changes in the integral of maximum velocity reflect stroke volume changes. The Doppler probe was placed and held in the suprasternal position while programming the pacemakers from the VVI to all available AV delays in the VDD mode; the heart rates were nearly constant. Stroke volumes were highly dependent on changes of the AV delay; the optimum AV delay varied considerably from patient to patient. These changes were more pronounced in the patients with left ventricular strain due to aortic valve disease than in the patients with isolated conduction defects.

Adult

Congenital swallowing-induced symptomatic heart block: a case report of a probably hereditary disorder.

A 15-year-old girl had had syncope induced by swallowing since infancy. An ECG recorded during food intake revealed SA block with very slow junctional and ventricular escape rhythms. No symptoms or signs of other cardiac disorders or gastrointestinal diseases were present. Activation of a strong vagal reflex, able to inhibit impulse formation and propagation in an otherwise normal heart, is the most likely explanation of the disorder in this patient. Furthermore, ECGs of her close relatives which were recorded during food intake as compared with the findings in a reference group (n = 20), indicated that a genetic factor could be involved.

Adolescent

Changes in left ventricular stroke volume measured by Doppler echocardiography.

Cardiac stroke volume was measured simultaneously by Doppler echocardiography and thermodilution in 20 patients with coronary artery disease. Stroke volume as determined by ultrasound was calculated from the area of the aortic orifice and the flow velocity just distal to the aortic cusps. The recordings were made twice at rest. Ten patients were given dobutamine (2.5 and 5.0 micrograms/kg/min) by infusion to induce rapid changes in stroke volume from the resting state. The individual Doppler data before, during, and after dobutamine infusion correlated closely with the thermodilution data (r = 0.92). These results suggest that Doppler echocardiography reliably detects changes in stroke volume.

Adult

Heart transplantation in Norway. One-year experience.

Eight patients underwent orthotopic heart transplantation in Norway during 1984, with retransplantation in one case. The age range of the 5 men and 3 women was 19-53 years. The preoperative diagnosis was cardiomyopathy in 6 patients, ischaemic heart disease in one, and a combination of the two disorders in one patient. The immunosuppressive regimen, with cyclosporin A and low-dose prednisolone, and the treatment of graft rejection, followed the Stanford University protocol. There was no operative mortality. Three patients died shortly after the transplantation, 2 of them after about a week from acute rejection; in one of these 2 cases a second transplant was made, but was followed by pulmonary and renal complications. The third death occurred about 10 weeks postoperatively, from donor heart failure due to Toxoplasma myocarditis. The 5 survivors are clinically in good condition.

Adult

Determination of cardiac output by Doppler echocardiography.

Cardiac output determined by Doppler echocardiography was compared with that determined by thermodilution at rest and during dobutamine infusion in 10 patients (group A) and by the Fick method at rest in 11 patients (group B). All patients had angina pectoris without valvular heart disease. Maximum spatial blood velocity and cross sectional aortic area were estimated by the Doppler technique and echocardiography. Cardiac output was calculated by multiplying blood velocity by aortic area at various levels in the ascending aorta. The best correlation of cardiac output between the invasive and non-invasive methods was obtained when maximum velocity in the aortic root and the aortic orifice area were used in the calculations. Cardiac output was considerably overestimated when area measurements in the aortic root were used.

Adult

Effects of red rest and prazosin in congestive heart failure.

Twelve patients with congestive heart failure were monitored with invasive and noninvasive techniques to evaluate the effect of vasodilator treatment. During the 18 hours of strict bed rest before administration of prazosin, the hemodynamics improved substantially while only small and transient heModynamic changes were observed after introduction of prazosin. At 6 weeks' control the effect of vasodilator treatment with prazosin, 3 mg x 4, was lost. The beneficial results often credited to vasodilators in studies on congestive heart failure might in part be due to the concomitant bed rest introduced during the monitoring of the patients.

Adult

Posterior left ventricular aneurysm due to occlusion of the circumflex coronary artery with recurrent ventricular tachycardia. Case report.

A 62-year-old male developed a large posterior left ventricular aneurysm diagnosed 6 months after a sustained myocardial infarction. Coronary angiography revealed a proximal occlusion of the circumflex artery, two 75% stenoses of the right coronary artery and a normal left anterior descending artery. The main clinical indication for surgery was residual bouts of ventricular tachycardia. A successful "mechanical conversion" of this arrhythmia by means of light precordial knocks in the apex region is reported. In this way the patient could be prepared for surgery without using myocardial depressant drugs. The aneurysm was resected, encircling endocardial ventriculotomy was performed and the right coronary artery was grafted. Nine months after the operation the patient is well without the need for antiarrhythmic drugs. The rarity of this condition is stressed and the possible mechanisms of ventricular tachycardia and its treatment in this particular case are discussed.

Coronary Disease

Coarctation of the aorta. Follow-up of 218 patients operated on after 13 years of age.

Twohundred and eighteen patients aged 13 years or more at operation for coarctation of the aorta were selected for a long-term postoperative follow-up study. The mean age of operation was 25,3 years, range 13 to 62 years, and the mean follow-up period was 13 years, range 2 to 28 years. The surgical mortality rate was 1.4%, all 3 patients being in their fourth decade. There were 35 late deaths (16,3%), 26 having cardiovascular disease as the causation; 3 patients developed a dissecting aneurysm of the ascending aorta, and 11 died suddenly of unknown cause. Persisting hypertension was found in approximately one third of the patients. A highly significant correlation was demonstrated between the systolic blood pressures before and after surgery. Aortic valve disease occurred in 31 patients (14,2%). Coarctation of the aorta should be operated on in childhood, and a close postoperative long-term follow-up in all patients is recommended.

Adolescent

Coronary risk factors and physical fitness in healthy middle-aged men.

In 1832 healthy men aged 40-59 years subjected to a near maximal bicycle exercise test, physical fitness decline with age. Higher levels of physical fitness were in all age groups associated with lower cigarette consumption, blood pressure, serum triglycerides, hemoglobin and with better pulmonary function. Serum cholesterol, however, was independent of changes in physical fitness. In view of the beneficial effect of high physical activity on the well-known coronary risk factors, it is surprising that it has proved so difficult to show a protective effect of increased physical fitness and activity in coronary heart disease and its manifestations.

Adult