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Biomedical subjects

L Tavazzi

Publications and source records attributed to L Tavazzi.

At least 181 records · Page 10Linked to original sources
PubMed1987

Acute pulmonary edema provoked by psychologic stress. Report of two cases.

Emotional stress has been considered responsible for life-threatening ventricular arrhythmias but acute stress-induced heart failure has not been reported in man. Two patients with recent uncomplicated myocardial infarction presenting acute pulmonary edema immediately after psychologic stress testing are the object of this report. Four stressors, mental arithmetic, 30 emotionally involving questions (Sacks' test modified), an image quiz (Raven's matrices) and white noise were administered during hemodynamic monitoring (Swan-Ganz catheter) in a 3-min stress-5-min recovery sequence. Response to the stressors was not unusual; greatest cardiovascular response occurred during mental arithmetic, least during noise and intermediate patterns were induced by the other stressors. Heart rate and systemic blood pressure, markers of autonomic activation, increased moderately. Neither ventricular arrhythmias nor ischemic electrocardiographic changes were observed during or after stress testing. Complete recovery followed each stress-induced cardiovascular response. About 10 min after completing stress testing, acute pulmonary edema occurred in both patients neither of whom had presented other episodes of acute pulmonary edema, suggesting that psychologic stress may induce pump dysfunction in patients with latent heart failure.

Acute Disease↗
PubMed1986

Is post-infarction angina related to poor residual left ventricular function?

To investigate the relationship between left ventricular function and presence and type of myocardial ischaemia in the post-acute phase of myocardial infarction (MI) 313 patients admitted consecutively to our Center of Rehabilitation were studied. In all subjects a good quality two-dimensional echocardiogram, 24-h ambulatory electrocardiogram and in 308 of them a symptom-limited exercise test were performed. Clinical observation was for 3 months since MI occurrence. Transient episodes of post-MI ischaemia were observed in 164 patients (52%). No differences in left ventricular asynergy or ejection fraction were noted among patients with and without post-MI ischaemia as a whole, nor in subsets identified on the basis of occurrence of pain or ischaemia characteristics (at rest or exercise-induced). Episodes of left ventricular failure occurred more frequently in patients with silent, myocardial ischaemia at rest. Sublingual isosorbide dinitrate (5 mg), administered to 20 patients, did not differently change asynergy and ejection fraction in patients with and without documented post-MI ischaemia. In conclusion, extent of asynergy and degree of left ventricular dysfunction at rest seem to be: unrelated to the risk of post-MI ischaemia occurrence; related to the infarct size and not to the presence of stunned myocardium.

Aged↗
PubMed1986

The role of psychologic stress in the genesis of lethal arrhythmias in patients with coronary artery disease.

To investigate the influence of psychologic stress on the electrophysiology of the heart and the genesis of cardiac arrhythmias, programmed ventricular stimulation was performed in 19 patients with recent uncomplicated myocardial infarction (37 +/- 10 days after the acute episode) during control conditions and during mental arithmetic. Psychological assessment showed a normal profile in all subjects. During mental stress, blood pressure increased (from 147 +/- 16/96 +/- 9 to 171 +/- 16/106 +/- 8 mmHg, P less than 0.001), and the mean ventricular refractory period decreased by 8 ms (1-3 extrastimuli P less than 0.05-0.001). Unsustained ventricular tachycardia (greater than or equal to 6 beats) was induced in 2 and 7 patients during control and during stress stimulation respectively (P less than 0.05). Ventricular fibrillation was provoked by double (1 patient) and triple (1 patient) extrastimuli during stress. In conclusion mental stress can induce measurable cardiac electrophysiological modifications in uncomplicated postinfarct patients and such modifications may favour the appearance of life-threatening arrhythmias.

Adult↗
PubMed1986

Can body surface mapping improve the diagnostic power of standard electrocardiography in effort myocardial ischemia?

Limitations of the standard 12-lead electrocardiogram in sensitivity, specificity and information content on the effort induced ischemic process might be partly due to an inadequate sampling of cardiac electrical events. An extensive array of electrodes is an effective way to verify this hypothesis. Actually body surface mapping provides: a 10-15% increase in diagnostic yield mainly in patients with mild coronary artery disease and elusive signs of ischemia in standard leads a very approximate indication of the extent of coronary artery disease a substantial contribution to the identification of the site of ischemia. Regarding the last point, preliminary results of an ongoing study are reported. One hundred and three patients with recent myocardial infarction have been studied by exercise test with simultaneous recording of surface map and Thallium 201 scan. So far in the subset with inferior myocardial infarction (76 patients) three different map patterns corresponding to different ischemic regions (anterior, inferior and posterior) have been identified. In anterior myocardial infarction (27 patients) a characteristic map pattern for exercise-induced myocardial ischemia has been observed, apparently able to discriminate between ischemia and the changes of early repolarization induced by the dyskinesia of the infarcted ventricular wall. In conclusion, electrocardiographic mapping makes a practical contribution to the understanding of ischemia-induced cardiac electrical events.

Action Potentials↗
PubMed1986

[TM-mode echocardiography in the evaluation of ventricular function in convalescent patients after recent infarction. Correlations with hemodynamic parameters recorded at rest and after a cycloergometric test].

133 patients (50 +/- 11 years), under observation at 1 to 2 months after the acute episode (38 +/- 10 days) and in the absence of medical treatment in most cases (90%), underwent the same day a maximal cycloergometric test, limited to symptoms of clinostatism with hemodynamic monitoring (Swan-Ganz 7F for pressure and thermodilution), and a good quality echocardiogram in TM mode (semi-automatic reading) in order to identify every valvular lesion. The ECHO-TM parameters of the left ventricular function (LV) taken into consideration (circumferential velocity of shortening of LV : CVSLV, percentage of systolic shortening of LV, telediastolic dimension of LV,E-septum distance, PR-AC, relation between the intervals Q-mitral block and aortic block-mitral point E,QC/A2E, left auricular dimension and mitral point B) have shown a low correlation (0.31) with the telediastolic pulmonary arterial pressure (TDPAP) at rest and after effort. The ECHO-TM parameters have not demonstrated significant differences when the patients are grouped according to the locus of the infarction (76 inferior, 50 anterior and 7 antero-inferior) and age (36 younger than 45 years, 87 aged between 45 and 64 years and 10 older than 64 years), whereas significant differences were found on segregating the patients according to the value of the last level at a threshold of 75 watts (44 patients did not attain 75 watts and 89 exceeded it).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[The influence of age on left ventricular function in patients with recent myocardial infarct].

To assess the effects of age on the left ventricular function at rest and during exercise in patients with first recent myocardial infarction, a symptom-limited exercise test was performed in 470 patients within 2 months from the acute episode, in supine position during hemodynamic and electrocardiographic monitoring after drug interruption and wash-out period. According to the age, the patients were divided into 3 groups: group 1 (less than or equal to 40 years) 68 patients; group 2 (41-59 years) 319 patients and group 3 (greater than or equal to 60 years) 83 patients. Coronary angiography was performed within 6 months in 159 patients. The possible differences in the hemodynamic pattern of these groups were analyzed with ANOVA and chi 2 test. Pulmonary artery end-diastolic pressure and cardiac output of each patient were compared to the normal values obtained in different age groups. The normal limits adopted are reported. At rest cardiac output and stroke volume were significantly lower and the rate pressure product higher in patients of group 3. Maximal work load was significantly lower (62 +/- 26 watts p less than .05) and pulmonary artery end-diastolic pressure higher (27 +/- 7 mmHg, p less than .05) in group 3 as compared to groups 2 (78 +/- 29 watts, 23 +/- 8 mmHg) and 1 (94 +/- 28 watts, 19 +/- 9 mmHg). However using different normal limits according to age (less than or equal to 20 mmHg in patients less than or equal to 60 years and less than or equal to 25 mmHg in patients greater than 60 years) the number of patients with an abnormal increase of pulmonary artery end-diastolic pressure was similar in all groups: 39.7%, 60.6% and 50.6% (NS) in group 1, 2 and 3 respectively. On the contrary cardiac output was abnormally low during exercise in 16.8% of group 3 vs 5.6% and 5.8% of groups 2 and 1 (p less than .05). The greater hemodynamic impairment of group 3 was independent from the electrocardiographic size of necrosis, from ST-segment depression during exercise and from the number of involved coronary vessels. In conclusion, age seems to play a significant role in determining the hemodynamic pattern in patients with recent myocardial infarction.

Adult↗
PubMed1985

[Recent myocardial infarction: role of digitalis therapy in patients with left ventricular dysfunction during exercise who participated in a short-term physical training program].

In order to verify the usefulness of long-term digitalis therapy during physical rehabilitation in patients with recent myocardial infarction (MI) and left ventricular disfunction during exercise, 24 consecutive pts with PAedP greater than or equal to 25 mmHg (Swan-Ganz cath.) at maximal work load were selected. Pts with angina, ST depression (greater than or equal to 2 mm), complex ventricular arrhythmias (Lown 4-5), symptoms of left ventricular failure were excluded. At random 12 pts were assigned to group A (digoxin therapy) and 12 to group B (no therapy). Serum digoxin level was on average 1.48 ng/ml (range 1-2.85 ng/ml). Both groups performed over 4 weeks the same controlled training program. Before and soon after the end of the training period all pts underwent to an exercise test, standard chest x-ray films, 24 hour ambulatory ECG and two-dimensional echocardiography. No complication was observed during exercise test and training period. Age, myocardial infarction location, cardiac volume and hemodynamic behaviour during the first exercise test were similar in both groups. After training, maximal work capacity was increased in group A by 14% and in group B by 16% without significant changes in PAedP and Cl; at the same work load PAedP was lower in group B (-12%, p less than .02) while LVSWI was increased in both groups (14% and 17% respectively, p less than .05). No significant changes in cardiac volume, left ventricular asynergy, EF, and ventricular premature beats were observed. QT interval at rest decreased significantly only in group A 408 +/- 31 msec vs 371 +/- 34 msec (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Digoxin↗
PubMed1985

[Limits of mental stress as an instrument for evaluative screening in recent myocardial infarction].

In order to investigate whether stressors could induce ventricular arrhythmias or myocardial ischemia in the postinfarction period, 130 patients with recent myocardial infarction (1-2 months after the acute episode), after drug washout, were exposed to two stressors in a random sequence. Mental arithmetic and Sacks test (30 incomplete sentences with high emotional content) were used for 3 min, followed by 5 min recovery. Ninety % of the patients underwent an exercise test and 73% a 24 hour ambulatory monitoring in the same conditions. Ventricular arrhythmias occurred respectively in 21%, 26% and 86% of the patients during mental stress, exercise test and ambulatory ECG monitoring. The arrhythmias score (Italian Lown modified classification) was greater than or equal to 40 in 2% of the patients during mental stress and in 39% in the ambulatory ECG. Only 3 patients (2.3%) showed ST-segment depression greater than or equal to 1mm during mental stress vs. 30.7% during exercise. The double product threshold for ST-segment shift was reached or exceeded during mental stress by 22% of the patients. The increments in heart rate and blood pressure were independent from each other, and similar in the two stress tests. Only the heart rate was slightly higher during mental arithmetic (p less than 0.01). In conclusion, the utilized short-lasting stressors were poorly effective in inducing myocardial ischemia and ventricular arrhythmias in patients with recent myocardial infarction. It is suggested to avoid the generalization of these results to patients with different pathophysiological conditions, taking on account the methodological limits of the study.

Female↗
PubMed1984

Exercise haemodynamics in patients over 65 years of age with recent myocardial infarction.

Five hundred patients underwent exercise testing during haemodynamic monitoring 36 +/- 17 days after an acute myocardial infarction: 136 were 45 or less years of age (group A), 323 aged 46-64 years of age (group B) and 41 were over 64 years of age (group C). Group C showed at rest a lower stroke volume and cardiac output (CO) and during exercise a more frequent ST depression, a higher pulmonary artery end-diastolic pressure at a lower work load and a higher incidence of patients with inappropriate increments of CO. The differences among groups were statistically significant (P less than 0.05) and independent of the extension of necrosis and the presence of myocardial ischaemia. It is concluded that these changes are at least partially age-related.

Aged↗