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Biomedical subjects

L Rudas

Publications and source records attributed to L Rudas.

At least 19 recordsLinked to original sources
PubMed1998

[Cardiovascular autonomic regulation following orthoptic heart transplantation].

Numerous recent observations have indicated autonomic reinnervation of transplanted human hearts. In order to assess autonomic regulation 5 patients were studied 1 to 5 years following cardiac transplantation. A series of tests were performed, including blood pressure and ECG recordings on rest, during 15/min patterned breathing, isometric handgrip exercise, and Valsalva manoeuvre. The time domain indices (SDRR, pNN50, rMSSD) and the frequency domain indices of heart rate variability were also studied. Among the five patients under study only one exhibited features compatible with both sympathetic and parasympathetic reinnervation. Traditional autonomic reflex tests and the analysis of time and frequency domain indices of HRV serve as simple tool in primary assessment of cardiac reinnervation.

Adult↗
PubMed1998

[Pacemaker syndrome without a pacemaker].

Circulatory consequences of cardiac arrhythmias are not always evident. Proper interpretation of the clinical symptoms in certain cases requires assessment of the patients' other hemodynamic characteristics. The authors present the case of a patient with left ventricular hypertrophy, who developed severe circulatory failure at the time of artrioventricular dyssynchrony in association with junctional rhythm. Analogy between the circulatory consequences of the junctional rhythm and ventricular pacing was documented by hemodynamic measurements. The patient was subsequently treated by implanting an atrioventricular pacemaker.

Aged↗
PubMed1998

[Carotid sinus syncope: the vasodepressor component].

Carotis sinus syncope is one of the leading indications for pacemaker implantation in Hungary. Although the role of the vasodepressor component is emphasized in our current guidelines, documentation of the vasodepression in technically difficult and therefore often abandoned. A case of a patient is presented who received a VVI pacemaker in spite of documented mixed carotid sinus syncope. Subsequent to the pacemaker implantation, patient's condition deteriorated, characterized by frequent syncopal episods. Replacing the VVI pacemaker by a DDD device resulted in prompt relief of symptoms. The importance of invasive or noninvasive hemodynamic monitoring in the diagnostic workup of these patients is emphasized.

Aged↗
PubMed1998

[Angina pectoris induced by pacemaker syndrome].

Pacemaker syndrome is caused primarily by the lack of atrial kick and by neurocardiogenic reflex mechanisms due to simultaneous atrial and ventricular contractions. The most common clinical symptoms are dyspnoe, hypotension, dizziness and syncopal attacks. A case report of a patient with pacemaker syndrome is presented, in which the main clinical manifestation was a recurrent chest pain. A VVI demand pacemaker was implanted because of sick sinus syndrome ten years ago and shortly afterwards anginal attacks of rest developed. Coronary angiography revealed a non-significant (25%) narrowing of the right coronary artery (RCA). Casual and long-term ambulatory blood pressure (ABPM) measurements elucidated that the patient occasionally has extremely low diastolic blood pressure. This later phenomenon was confirmed and refined by a "beat-to-beat" blood pressure measuring technique. The elimination of the pronounced "beat-to-beat" variability of arterial blood pressure and transient coronary hypoperfusion due to implantation of an AV sequential bifocal pacemaker resulted in a full disappearance of angina pectoris.

Angina Pectoris↗
PubMed1997

[Defecation syncope following pacemaker implantation].

A case of syncope is reported, where hemodynamic responses compatible with pacemaker syndrome occurred during defecation. A 73 year old female received a VVI pacemaker for complete heart block. Subsequently she sustained repeated episodes of defecation syncope. Hemodynamic investigations revealed an abnormal blood pressure drop occurring at the overshoot phase of the Valsalva maneuver in association with alternation of sinus and pacemaker rhythm. This modified Valsalva response in the presence of contributing factors, such as hypovolemia and nitroglycerin therapy manifested as defecation syncope. The abnormal condition was treated by eliminating the contributing factors, and by programming a low pacemaker frequency, thus precluding sinus-pacemaker alterations.

Aged↗
PubMed1997

Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population.

The anatomical patterns and frequency of occurrence of congenital coronary anomalies (CCA) in a Central European cohort has not yet been studied. The angiographic data of 7,694 consecutive patients undergoing coronary arteriography at the Albert Szent-Györgyi Medical University, Szeged, Hungary, from 1984 to 1994 were analyzed. CCA were found in 103 patients (1.34% incidence). Ninety-eight of them (95.2%) had anomalies of origin and distribution, and five (4.8%) had coronary artery fistulae. The incidence was the highest for the separate origin of left descending artery and left circumflex from the left sinus of Valsalva (52.42%). Anomalous origin of the left circumflex coronary artery from the right coronary was 8.7% while from the right sinus of Valsalva 18.4%. CCA, which may be associated with potentially serious events, such as ectopic coronary origin from the opposite aortic sinus (1.9%) and single coronary arteries (3.88%), were not frequent. The incidence of CCA in the Central European cohort under study was similar to that of the largest North American study. The anatomic classification presented can be useful from both clinical and surgical standpoints.

Adult↗
PubMed1997

Effect of postural changes on arterial baroreflex sensitivity assessed by the spontaneous sequence method and Valsalva manoeuvre in healthy subjects.

The objective of this study was to compare the baroreflex sensitivity (BRS) assessed by the new, non-invasive, spontaneous sequence method (BRS-sequence) with the Valsalva manoeuvrebased BRS. Fourteen healthy volunteers were studied in the supine position, during 60 degrees head-up tilt (HUT) and during -30 degrees head-down tilt (HDT). Blood pressure and R-R intervals were continuously and non-invasively recorded using a Finapres device. The BRS-sequence was assessed by analysing the slopes of spontaneously occurring sequences of three or more consecutive beats in which systolic blood pressure and R-R interval of the following beat increased or decreased in the same direction in a linear fashion; it was compared with data obtained during the Valsalva manoeuvre in each position. The time and frequency domain indices of R-R interval variability were also evaluated. The mean difference of BRS between the two non-invasive methods was 3.86 ms/mmHg with a standard deviation of 9.14 ms/mmHg. BRS was decreased during HUT and increased during HDT as assessed by both techniques. The changes in BRS were associated with vagal withdrawal and sympathetic activation during HUT and enhancement in the cardiac vagal tone and reduction in the sympathetic activity during HDT. We conclude that the BRS-sequence technique provides a reliable method to study the neural control of the circulation, although the body position in consecutive measurements needs to be standardized.

Adolescent↗
PubMed1996

[Micturition syncope].

The micturition syncope is a special manifestation of the so called "situational syncopes". These reflex syncopes share efferent mechanisms with the neurocardiogenic, or vasovagal syncope. A case of a patient is reported, who presented with micturition syncope. The patient's tendency for vasovagal syncope was documented by a positive tilt table test. The uniform premonitory symptoms preceding the two fainting attacks indicated the relation between the episodes. The authors review the literature of the micturition syncope, and discuss the potential pathomechanisms.

Humans↗
PubMed1996

[Management of severe orthostatic hypotension by head-up-tilt posture and administration of fludrocortisone].

A case of a 66-year-old man with recurrent episodes of syncope is reported. The syncopal attacks started five years ago in sitting and standing positions. At the time of admission the fainting attacks occurred 2-3 times per day. The diagnostic tests revealed severe orthostatic hypotension. The medical treatment was started with salt enriched diet and fludrocortisone. The efficacy of the therapy was tested by using the tilt table test with a self developed computer system consisting of a non-invasive finger blood pressure monitor and ECG. The orthostatic tolerance improved with the medical therapy, however remained unsatisfactory for the patient's daily activity. Though the patient had less frequent symptoms, he had still sustained episodes of recurrent syncopes. The medical therapy was than combined with sleeping in the 15 degrees head-up-tilt position. The repeat tilt table test was performed two weeks after initiation of the 15 degrees head-up-tilt sleeping. The orthostatic tolerance was markedly improved. The patient became free of symptoms and during a four-week follow-up his condition remained stable. At the control the patient reported about deterioration of his symptoms as a result of the discontinuation of sleeping in "head-up-tilt" position for two weeks. The objective signs leading to aggravate his symptoms was documented by the tilt table test. We reinstituted the "head-up-tilt" sleeping in his therapeutic management.

Aged↗
PubMed1996

[Association of AV reciprocating tachycardia, using a concealed bundle of Kent, and paroxysmal atrial fibrillation in neurocardiogenic syncope].

A case of neurocardiogenic syncope is reported in which both AV-reciprocating tachycardia due to a concealed retrogradely conducting posteroseptal bypass tract and paroxysmal atrial fibrillation were observed. In connection with this case, attention is paid to the difficulties of differential diagnosis and to the pathophysiological correlations concerning the occurrence of neurocardiogenic/vasovagal reflex syncope and cardiac arrhythmias. A prolonged period of freedom from syncope and tachycardia was achieved by means of drug treatment, through the combined administration of disopyramide, bisoprolol and theophylline.

Aged↗
PubMed1996

[Correlations between clinical picture and coronary angiography in unstable angina].

In a one year period (from 01.07. 1993 to 30. 06. 1994) 103 patients were admitted to the Central Intensive Care Unit of the Albert Szent-Györgyi Medical University with the diagnosis of unstable angina. In this cohort of patients the authors assessed the correlation of clinical and angiographic data. Significant coronary artery disease was found in 84% (85 patients), single-vessel disease in 23% (24 patients), double-vessel disease in 38% (29 patients), triple-vessel disease in 20% (21 patients), left main stenosis in 8% (8 patients). The culprit lesion was determined in 73 cases. The distribution of the culprit lesion severity was the following: 50-70% in 17% (12 cases), 70-90% in 27% (20 cases), greater than 90% in 44% (32 cases), 100% in 12% (9 cases). Simplex lesions were seen in 43 cases, complex lesions in 9 cases, diffuse irregularities in 5 cases and total occlusions in 9 cases. Abnormalities indicating intracoronary thrombin-us were seen on 5 coronarograms. No correlation could be demonstrated between the clinical classes according to Braunwald and the angiographic morphology.

Adult↗
PubMed1996

Changes in blood pressure and heart period variability in patients with recent acute myocardial infarction.

1. A decreased heart period variability and baroreflex sensitivity in patients with acute myocardial infarction have already been documented. Since one of the major determinants of heart period variability is blood pressure variability, it would be important to know the characteristics of blood pressure regulation in this setting. The changes in blood pressure variability during the acute phase of myocardial infarction have not yet been studied. 2. We investigated the blood pressure variability and the heart period variability in 11 patients with acute myocardial infarction 3 to 5 days after their admission. Thirteen age matched patients with no evidence signs of ischaemic heart disease or previous myocardial infarction served as controls. We used the frequency domain indexes of short term measurements of finger blood pressure variability and heart period variability. The spectral powers for both heart period variability and blood pressure variability were divided into three major components: total frequency (0.01-0.4 Hz), low frequency (0.04-0.15 Hz) and high frequency (0.15-0.4 Hz). 3. All of the frequency-domain components of the heart period variability were significantly decreased in patients with recent acute myocardial infarction compared to the controls: Ln(total power): 5.68 +/- 0.24 vs. 7.21 +/- 0.29, Ln(low-frequency power): 4.31 +/- 0.28 vs. 7.05 +/- 0.53, Ln(high-frequency power): 3.50 +/- 0.33 vs. 5.48 +/- 0.32. Acute myocardial infarction patients showed a significantly reduced blood pressure variability in all frequency components compared to the controls: Ln(total power): 4.21 +/- 0.18 vs. 6.79 +/- 0.48, Ln(low-frequency power): 2.40 +/- 0.24 vs. 4.36 +/- 0.21, Ln(high-frequency power): 3.31 +/- 0.25 vs. 5.66 +/- 0.38. 4. We hypothesize that the reduced blood pressure variability in the acute phase of myocardial infarction could be related to a relative invariance of stroke volume. The underlying mechanism is the reduced left ventricular compliance.

Blood Pressure↗
PubMed1996

Regulation of immediate blood pressure response to orthostasis in patients with fixed ventricular pacemaker rhythm.

1. The immediate heart rate and blood pressure changes upon standing have been well documented. It has been recognized, that blood pressure transients elicit baroreflex responses contributing to the complex mechanism of post standing heart rate fluctuations. On the other hand the influence of heart rate changes on orthostatic blood pressure control is not well understood. Therefore we have studied the blood pressure regulation of 28 pacemaker dependent subjects with fixed ventricular pacemaker rhythm during active orthostasis, and their responses were compared to that of 10 elderly (66 +/- 11 year), and 12 young (35 +/- 5 year) volunteers. 2. The young volunteers exhibited the characteristic biphasic heart rate response on standing, with a maximum acceleration of 29 +/- 12 beats. The heart rate response of the elderly volunteers was very limited, and no response was seen among pacemaker subjects. A significantly greater (-37 +/- 15 mmHg) systolic blood pressure drop was seen in the pacemaker group than in the group of young volunteers (-22 +/- 13 mmHg). The systolic blood pressure overshoot of the young volunteers (36 +/- 17 mmHg) was significantly greater than that of the pacemaker patients' (11 +/- 22 mmHg). The blood pressure transients of the elderly volunteers and pacemaker subjects were very similar. Significant correlation was detected between the extent of maximum heart rate acceleration and the magnitude of the subsequent blood pressure overshoot (R = 0.68, p < 0.0005) among healthy volunteers. 3. Our results indicate that certain post standing blood pressure transients are heart rate dependent. The chronotrop incompetency of healthy elderly volunteers and pacemaker subjects result in similar alteration of the orthostatic blood pressure regulation, however this modified response does not interfere with a satisfactory hemodynamic stabilization.

Adult↗
PubMed1995

[Unstable angina pectoris associated with surgically treated coronary artery atresia].

A case report of a rare, presumably congenital form of "single coronary artery", is presented. The authors review the classification and clinical significance of the entity with special emphasis with regard to anginal symptoms and the so called sudden unexpected death syndrome. Details and result of surgical intervention (conventional aorto-coronary saphenous bypass) are discussed.

Angina, Unstable↗
PubMed1995

[Experience with a minute ventilation sensing rate frequency adapted pacemaker].

In the last two years 27 patients (mean age: 63.2 +/- 6.9 years) received Telectronics META MV pacemaker generators at the SZOTE. In 6 cases the generators were connected to atrial pacemaker electrodes, and in 21 cases to ventricular electrodes. To assess the characteristics of the rate responsive function exercise stress test was performed by 17 of these subjects. The authors give an account on the rate adaptive functions of these type pacemakers. The generator is an SSIR one. The rate responsive factor--i.e. the numerical characteristics of the pulse rate acceleration suggested by the pacemaker itself--was similar for atrial and ventricular electrodes.

Aged↗