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Biomedical subjects

L R Erhardt

Publications and source records attributed to L R Erhardt.

At least 19 recordsLinked to original sources
PubMed1981

Relation between arrhythmic sensations, cardiac arrhythmias and psychological profile.

The relation between arrhythmic sensations and objective findings of ectopic arrhythmic activity was studied in 150 middle-aged men. Objective arrhythmias were studied by 24-hour Holter monitoring and subjective symptoms assessed by a questionnaire and a dairy protocol during the ECG recording. Psychological characteristics were described by means of a personality inventory, the Emotions Profile Index. No direct relationship was found between subjective symptoms and objective findings of cardiac arrhythmias. Those men, however, who complained of arrhythmic sensations but had no clinically important arrhythmias exhibited a few specific characteristics. They had no signs of organic heart disease and appeared less trustful and more aggressive than those with arrhythmias.

Adult↗
PubMed1979

Emergency room resuscitation of patients with cardiac arrest outside hospital. Outcome and immediate prognosis in 319 patients.

Resuscitation was attempted in 319 patients brought to hospital with cardiac arrest during a 5-year period. Primary successful results were achieved in 50 patients (15.7%). Twelve patients were long-term survivors (3.4%), 10 of whom had normal brain function, whereas 2 had mild cerebral dysfunction. To improve prognostication in patients with initially successful resuscitation, Bayes' theorem was applied using 4 clinical findings after 24 hours' treatment: reactions to painful stimuli, pupillary size, light reactions and BP, Bayes' theorem as well as coma depth after 24 hours gave valuable information regarding individual prognosis.

Aged↗
PubMed1979

Prediction of survival in patients with acute myocardial infarction. A clinical study on 100 consecutive patients.

Expected survival after acute myocardial infarction (AMI) in 100 consecutive patients was predicted by three doctors and two nurses at the time of discharge from a CCU. Predictions were compared with various coronary prognostic indices (CPI) and were found to be too optimistic for the first 9 months. Experienced physicians made more reliable predictions than junior physicians and nurses. All patients with a predicted survival of more than 10 years were alive after 1 year and all with predicted death within one month died during the first year. Intermediate predictions were unreliable with reference to the one-year survival. Regardless of which CPI was used, a low index score carried a very low one-year mortality and high index a high mortality. Intermediate index scores were unreliable. A comparison between the predictions and index scores showed that there was no difference in sensitivity and specificity between the methods. Our study thus shows that patients with either a very good or a very poor prognosis will be identified regardless of the method used. The problem of identifying the individual with an intermediate risk remains to be solved.

Acute Disease↗
PubMed1979

Early mobilization and discharge of patients with acute myocardial infarction. A prospective study using risk indicators and early exercise tests.

Consecutive patients (n=184) surviving 48 hours in a coronary care unit were divided into one rapidly (RM) (n=55, 30%) and one conventionally mobilized (CM) group (n=129, 70%). The selection of RM patients was based on the absence of five early risk indicators (RI), reflecting electrical and mechanical heart dysfunction. During after-care, five late RIs were evaluated, including a submaximal bicycle exercise test to 50 W, which excluded nine (16%) additional patients from the RM group. After excluding four patients for non-cardiac reasons, the remaining 42 RM patients were rapidly mobilized and discharged after a mean of nine days, in contrast to a mean of 19 days in the CM group, comprising 121 patients. No RM patient dies in hospital and only one patient died during a six-month follow-up, compared to 17 (p less than 0.01) and 28 (p less than 0.01) patients respectively, in the CM group. Both reinfarction and mortality increased with the number of positive RIs. The early exercise test excluded four patients from the RM group. Altogether 22 of 45 patients showed some abnormality during exercise. Half of these 22 patients were readmitted due to cardiac complications during the follow-up period. These findings indicate that it is possible to identify a group of patients with AMI suitable for early discharge, and that an early exercise test in selected good risk patients is safe and identifies a group prone to complications during the early follow-up period.

Aged↗
PubMed1979

Circumstances around the onset of a myocardial infarction. A study of factors relevant to the perception of symptoms and to the delay in arriving at a coronary care unit.

Psychosocial factors, experienced pain and anxiety in relation to patient delay were studied in 100 patients admitted for suspected acute myocardial infarction (AMI). More severe pain was reported by women, by those who had recently consulted a physician, who experienced severe anxiety, who fell ill away from their place of work, or who possessed little medical knowledge. These patients tried to get relief from pain by resting. Patients experiencing more severe anxiety were younger, had not consulted a physician recently, had poor medical knowledge, belonged to lower socio-economic groups or were impatient. These patients also sought relief from pain by resting. Pain, but not anxiety, was related to delay. Long delay was seen more often in patients who did not believe they had suffered an AMI and who were psychologically inactive prior to the onset of pain. Recent physician consultation, failure to call for help and belonging to lower socio-economic groups were also related to long delay. Medical knowledge was unrelated to patient delay. Patients with a low degree of pain rarely reported considerable anxiety, whereas several patients with severe pain had little or no anxiety.

Acute Disease↗
PubMed1978

Electrocardiographic changes in right ventricular infarction. A case report.

ST segment elevations in leads CR4R or V4R indicating right ventricular (RV) involvement are sometimes seen in patients with acute inferior transmural infarction. Whether the RV lesion per se or the concomitant infarction of the posterior septum causes this ECG pattern is unknown. We describe a patient with anteroseptal transmural infarction who developed unusually marked ST segment elevations in lead V4R. At autopsy, extensive old fibrotic infarction was found, involving the anterior and lateral RV walls, as well as recent necrosis of the interventricular septum. These findings suggest that the ST segment elevation in V4R in patients with RV infarction may not be caused by the RV necrosis per se but rather by visualization of the posterior septum through the necrotic RV myocardium.

Acute Disease↗
PubMed1978

Complete heart block due to granulomatous giant cell myocarditis: report of 3 cases.

3 patients with chronic complete AV block were found at autopsy to have granulomatous giant cell myocarditis (GGCM). In 1 patient an unusual clinical course led to more extensive investigation including echocardiography which revealed ventricular septal abnormalities. A review of the literature is presented. Although GGCM is a rare disease echocardiography may be a useful screening procedure in patient with AV block especially in the presence of immunological disorders.

Adult↗
PubMed1976

Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction.

The ST segment in a single right-sided chest lead, CR4R, has been studied in 92 consecutive patients with acute inferior transmural left ventricular myocardial infarction. A transient ST- segment rise of more than 1 mm. was recorded in 35 patients, and strongly indicated a significant extension of the infarction to the posterior free right ventricular wall according to autopsy findings. This ECG pattern was furthermore associated with right-sided heart failure, hypotension and oliguria. Left heart failure was also common. The short-term prognosis of patients with ST-segment elevation in CR4R was poor.

Aged↗
PubMed1976

Formation of coronary arterial thrombi in relation to onset of necrosis in acute myocardial infarction in man. A clinical and autoradiographic study.

The presence of radioactivity in coronary arterial thrombi was studied at necropsy by autoradiography in 12 patients with acute myocardial infarction. Seven patients had been given 125I-and five patients 131I-labeled fibrinogen. With a short interval (less than 10 hours) between onset of symptoms and injection of fibrinogen the entire thrombus was radioactive in four of five patients, whereas with longer time intervals only parts or none of the thrombus contained detectable radioactivity. The findings give further evidence that thrombus formation in acute myocardial infarction probably is a slow process and that the major part of the thrombus may form after the onset of necrosis.

Aged↗
PubMed1976

Pattern of enzyme activity following acute myocardial infarction with special reference to gamma-glutamyl transpeptidase.

The present study on 55 consecutive patients with acute myocardial infarction (AMI) draws attention to the relationship between different enzyme maxima in AMI, with special reference to serum gamma-glutamyl transpeptidase (S-GT). In more than 60% of the patients the S-GT was increased during the hospital stay. The S-GT rise nearly always began during the first days, reached a maximum within 5--8 days and normalized with 2--3 weeks. We failed to find the late increase in S-GT reported by others. The rise of S-GT is particularly common in patients with inferior infarction, with or without right ventricular involvement. We conclude that S-GT activity is not a useful early or late indicator of AMI but a very sensitive test for hepatic dysfunction in patients with AMI.

Acute Disease↗
PubMed1976

Attempted diagnosis of ventricular mural thrombi in acute mycardial infarction using 125I-labelled fibrinogen.

In an attempt to diagnose ventricular mural thrombi complicating acute myocardial infarction (AMI), 80 patients have been given 100 muCi 125I-labelled fibrinogen after admission to a CCU. Precordial radioactivity was recorded for the following 6 days over four sites corresponding to chest leads CR1-CR4. A sustained rise in radioactivity of at least 15% of initial recordings was classed as type A pattern, a minor rise or flattened response as type B pattern and a rapid decrease as type C pattern; 28% showed a type A, 19% a type B and 54% a type C pattern. There was no significant difference between the groups in incidence of pericardial friction rub but when patients with suspected pericarditis (as evidenced by characteristic pains) were added, pericarditis was significantly overrepresented in the type A group. Smaller infarctions (SGOT less than 100 U/1) were significantly more common in patients with a type C decay pattern. No differences were noted between the groups as regards type and site of the infarction. A sustained rise in precordial radioactivity after an AMI may be an indication of mural thrombosis but the influence of other factors secondary to an infarction, e.g. pericarditis, cannot be determined at present.

Acute Disease↗
PubMed1976

Right ventricular involvement in acute myocardial infarction.

Involvement of the RV in AMI is not as rare as previously thought and may lead to a particular clinical and hemodynamic syndrome with raised RV filling pressures, hypotension and oliguria. Major extension to the RV from inferior LV infarctions can be recognized by ST segment elevations iead CR4R or V4R. The significance of anterior RV extension and of RV papillary muscle infarction is still largerly unknown. It has been suggested from autopsy studies that the prognosis of patients with RV involvement might be poor healed extensive RV infarction is rarely seen. Indeed, ST segment elevation in lead CR4R indicating RV involvement has been found to carry a poor short-term prognosis. An increased awareness of the possibility of impaired RV function and of the special therapeutic considerations in some of these patients may increase survival.

Animals↗
PubMed1975

Selected psychosocial variables in the delay of reaching the coronoary care unit.

Sixty-one first admissions to a coronary care unit have been analysed regarding "delay period" from onset of chest pain to admission to the CCU in relation to psychosocial information, collected from the closest relative. On the whole, psychosocial variables seemed to play a modest role in the determination of the delay period. However, one "type A behavior" variable, inability to relax during leisure time, was related to a shorter delay period. Young subjects tended to have a relatively short delay.

Age Factors↗