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Biomedical subjects

L J Szatmáry

Publications and source records attributed to L J Szatmáry.

10 recordsLinked to original sources
PubMed1997

[Use of coronary vessel prosthesis. Complex coronary angioplasty under general anesthesia].

In 1995 we attempted to treat with PTCA 437 ischemic patients. We stended 29 patients (6.6%) with 34 stents. Emergency stenting was done in 5, semi-elective stenting in 6, and elective stents were applied in 18 patients with restenosis. We have achieved good angiological results without occurrence of myocardial infarction, with no emergency open heart surgery or death. No intracoronary thrombosis was observed during one-month follow-up with combined aspirin and ticlopidin treatment. Hemodynamical and angiological high-risk patients were treated under general anesthesia with assisted respiration. No complications were observed during the procedures. In cases of in-stent restenosis (17%) we redilated the coronary artery. This technique proved to be promising and is routinely applied world-wide to optimise immediate and long-term results of PTCA. The realisation of such interventional cardiological centers with appropriate financial background is an absolute requirement for spreading this technique in Hungary.

Aged↗
PubMed1994

[Emergency and elective percutaneous recanalization in ischemic heart disease].

The success and complication rates of programmed angioplasty performed after diagnostic coronarography and of ad hoc angioplasty performed at the time of the diagnostic catheterization are analysed in the study. We have attempted percutaneous recanalisation of 1071 lesions on 440 patients and dilated an average 2.4 stenoses or occlusions by patient. Immediate intervention was performed on 59.5% of patients with overall 91.7% success rate. The need for emergency surgery was 0.7%, periprocedural myocardial infarction was observed in 1.5%, and the mortality rate was 1.5%. The success and complication rates were similar for both studied groups. In the ad hoc angioplasty group there were relatively more easily solvable cases concerning the techniques, however the incidence of unstable angina and acute, emergency settings were more frequent. Ad hoc angioplasty does not diminish the success rate and resulted a faster, and more spectacular recovery in the above severe cases. Extensive experience with ad hoc angioplasty has proven it to be reasonable approach, efficient and safe variation not only in rescue, but also in complex angiological settings, if the considerable logistics are possible in an individual cardiovascular center. The provision of ischaemic heart disease patients is subject to the planning and creating such anti-ischaemic interventional cardiological centers in Hungary.

Age Factors↗
PubMed1990

Life-threatening arrhythmias stopped by cough.

In the course of 131 coronary angiographies, a non-ionic hyperosmolar contrast medium (Uromiro 75%, Bracco, Milano) provoked transient arrhythmias in 92 cases: 50 marked sinus bradycardias, 11 asystoles, 21 low-rate idiojunctional rhythms, 1 first-degree AV block, 7 third-degree AV blocks and 2 ventricular fibrillations. In 90 cases the rhythm disturbance was stopped by mere repeated cough. In the 2 cases of ventricular fibrillation direct current shock was used. If instructed coughing started within 8 seconds after the onset of arrhythmia, the patient maintained consciousness and the cough, as an internal cardiac massage, proved to be an adequate resuscitation method. In case prodromal signs of artificial bradycardiac arrhythmias were present, immediate cough could usually prevent the loss of consciousness and could also stop the arrhythmia. Therefore it seems logical to apply this method in patients at risk of Adams-Stokes attacks. A certain number of sudden deaths could be avoided.

Adams-Stokes Syndrome↗
PubMed1989

Intrinsic and extrinsic sinus node dysfunction: diagnostic problems.

Based on clinical and experimental experience, pacemaker dysfunction in sick sinus syndrome can be differentiated into intrinsic and extrinsic. Sinus node activity is characterized electrophysiologically by automaticity, recovery and sinoatrial conduction. The automaticity of the sinus pacemaker cell groups and sinus recovery can be differentiated properly under experimental conditions. Studies of the electrophysiological characteristics have shown the basic functional parameters to be normal in extrinsic-autonomic sinus dysfunction. Diagnosis is either based on clinical observation or on the data of Holter monitoring, the electrophysiological methods being inadequate for diagnosing this neurovegetative form of sick sinus syndrome. On the other hand, intrinsic sinus dysfunction can be diagnosed by electrophysiological tests. If completed by complex pharmacological studies, in this organic form of sick sinus syndrome, even the severity of the intrinsic injuries can be assessed quantitatively. The above division provides a basis for selection and evaluation of the differential diagnostic procedures, while information on the aetiopathology of sinus dysfunction and on the degree of the functional injuries of the electrophysiological structure of the heart provides an adequate basis for therapy.

Adult↗
PubMed1988

Actuality in the treatment of unstable angina pectoris.

In an attempt to relieve ischaemic symptoms and to prevent progression to myocardial infarction, coronary angioplasty was attempted in 236 multivessel coronary heart disease patients with unstable angina, refractory to medical treatment including oral Ca2+ antagonists, beta blockers and nitroglycerin drugs. Unstable angina was defined as ischaemic chest pain at rest lasting for at least 20 min, accompanied by reversible ST-T changes. The initial angioplasty success rate was 87% (205/236 cases). Vessel occlusion necessitating urgent bypass surgery occurred in five patients (2.1%). There was evidence of myocardial infarction in eight patients (3.4%). There were seven deaths (2.9%) related to the procedure. 191 of the 205 successfully dilated patients were followed up for 14 months on the average. Late mortality occurred in 4.2% (8/191), late nonfatal infarction in 2.6%, 127 patients remained asymptomatic and 11 were considered to be disabling angina (New York Heart Association classification III or IV). Recurrent angina rate with progression in ischaemic disease (restenosis and native vessel stenosis) occurred in 30%. For this reason, repeated angioplasty and elective bypass surgery were performed in 48 and 14 cases, respectively. These results support the growing evidence that angioplasty as an emergency procedure in multivessel disease patients with unstable angina pectoris refractory to intensive medical treatment can restore coronary blood flow with an acceptable risk and a good initial and short-term success rate.

Adult↗
PubMed1988

Mechanical circulatory assistance in the management of patients in coronary care unit.

Mechanical circulatory assistance was attempted in 73 patients at our coronary care unit from January 1, 1983, to January 1, 1987. Of these, 62 were men and 11 were women. The intra-aortic balloon pump (IABP) was successfully inserted by percutaneous femoral puncture in all cases. Indications for an IABP included: acute infarction and haemodynamic deterioration (23 cases), refractory congestive heart failure (2 cases), hypotension, ST-T changes and chest pain complicating coronarography or coronary angioplasty procedures (16 cases), unstable angina pectoris resistent to medical therapy, treated by coronary angioplasty (16 cases) and preoperative haemodynamic coverage (16 cases). The overall major complication rate of IABP was 1.5%. Our experience supports aggressive management of cardiogenic shock, i.e. early angioplasty or cardiac surgery, which considerably influences the functional status and the long-term survival rate (7/9 cases) over medical therapy combined with IABP (2 of the 14 patients are alive). The IABP was also effective in managing other high-risk patients when it was combined with some form of definitive cardioprotective mechanical correction, i.e. aneurysmectomy, valve replacement, coronary recanalization procedure. When the counterpulsation was used prophylactically, no interventional myocardial infarctions or deaths occurred; the survival rate was 27/32 patients for a 22 month average follow-up. It is suggested that the clinical results and late survival were improved by use of IABP in selected patients undergoing coronary angioplasty or open-heart surgery.

Adult↗
PubMed1987

Haemodynamic and antiischaemic protective effects of intra-aortic balloon counterpulsation in high risk coronary heart patients undergoing percutaneous transluminal coronary angioplasty.

Sixteen critically ill atherosclerotic cardiac patients required intra-aortic balloon counterpulsation (IABP) for uncontrollable chest pain, hypotension or shock in connection with percutaneous transluminal coronary angioplasty (PTCA). 1.75 coronary artery angioplasty/patient were attempted. An angiographic and an immediate clinical success was achieved in 27 out of 28 attempts (96% primary success rate). All patients received heparin and antiplatelet agents. After PTCA, haemodynamic stabilization was achieved and IABP support was stopped in 14 to 96 hours. The percutaneous therapeutic procedures were well tolerated. Three patients died: one of cerebrovascular accident not related to cardiovascular problems, two other patients died suddenly 1 and 3 months later. Two patients required coronary bypass surgery, one a repeated angioplasty on a reoccluded left anterior descending saphenous vein bypass. 12 of the 13 survivors are asymptomatic after a 15-months follow-up period. IABP is a useful adjunct to PTCA in patients with severely damaged coronary circulation and compromised haemodynamics.

Adult↗
PubMed1984

Autonomic blockade and sick sinus syndrome. New concept in the interpretation of electrophysiological and Holter data.

Autonomic blockade is commonly employed as a test of sinus node dysfunction. We compared primary and secondary atrial postpacing pauses and postextrasystolic sino-atrial responses before and after autonomic blockade in 56 patients with the clinical diagnosis of sick sinus syndrome. Pharmacological autonomic blockade was achieved by atropine 0.04 mg kg-1 and propranolol 0.2 mg kg-1, i.v. In a group of patients with a normal intrinsic heart rate the number of positive electrophysiologic variables associated with sinus node dysfunction declined after autonomic blockade. In 91% of these patients, sinus node function was characterized by a normal intrinsic recovery time, gradual exponential return to the constant sinus cycle length, and biphasic postextrasystolic return responses. Three patients in this group had intrinsic SA-block revealed by atrial pacing and verified by Holter monitoring. Besides normal intrinsic pacemaker properties in 53% of patients, rhythm monitoring revealed severe sinus node dysfunction as manifested by bradycardia and the tachycardia-bradycardia syndrome. SA-block and sinus arrest up to 29120 ms. In the abnormal intrinsic heart rate group, disturbed intrinsic rhythmicity was characterized in all by a prolonged corrected intrinsic recovery time (2320 +/- 2740 ms [+/- SD]), arrhythmia and/or bradycardia in the secondary postpacing cycles, chaotic postextrasystolic patterns, or prolonged sinoatrial conduction times. Significantly slow minimal heart rates during sleep significantly prolonged average sinus cycle lengths and positive ECGs for sinoatrial disorders in the waking period were present on the 24-h rhythm recording. It is concluded that intrinsic heart rate obtained by autonomic blockade is the best and most simple method for the diagnosis of intrinsic sinus node dysfunction. Combined autonomic blockade and electrophysiological tests can be of great value in unmasking the severity and degree of intrinsic dysfunction and analyzing the abnormality of secondary pacemaker function. These investigations, however, are rather insensitive and therefore ineffective in detecting autonomic sinus node dysfunction. To assess the role and significance of the autonomous neurovegetative tone in the genesis of sinoatrial disorders, rhythm monitoring is required.

Adolescent↗