Biomedical subjects
M B Sabom
Publications and source records attributed to M B Sabom.
Commentary on "The reality of death experiences" by Ernst Rodin.
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Similarities of ergonovine-induced and spontaneous attacks of variant angina.
Ergonovine has been shown to provoke attacks of variant angina, but a question remains whether spontaneous and ergonovine-induced attacks of variant angina are similar. Seven patients with variant angina undergoing cardiac catheterization were studied during transient episodes of spontaneous and ergonovine-induced rest angina with ST-segment elevation. Clinical, electrocardiographic, left ventricular hemodynamic and coronary angiographic observations were made before and repeated after ergonovine (0.05-0.2 mg I.V.). The character and duration of chest pain were similar during both spontaneous and ergonovine-induced episodes. ST-segment elevation (greater than 1 mm) was present inferiorly in three patients, anteriorly in three patients, and both inferiorly and anteriorly in one patient during both episodes. Mean heart rate and systolic arterial pressure changed little, while left ventricular end-diastolic pressure increased significantly during spontaneous or ergonovine-induced attacks. We observed subtotal or total dynamic obstruction in the left anterior descending (three patients), right coronary arteries (three patients) and both arteries in one patient during both attacks. Thus, in selected patients ergonovine-induced attacks of variant angina were remarkably similar to spontaneous episodes.
Ergonovine testing for coronary artery spasm in patients with angiographic mitral valve prolapse.
Coronary artery spasm (CAS) has been postulated to be a pathophysiologic mechanism in the production of ischemic-like chest pain and ECG changes in patients with idiopathic mitral valve prolapse syndrome. To evaluate the possible role of symptomatic CAS evoked by ergonovine maleate, this agent was administered (0.05 to 0.4 mg IV) to 24 patients with chest pain and mitral valve prolapse who had no significant (less than 50%) coronary artery obstruction. Symptoms, ECG and blood pressure changes were monitored in all patients following ergonovine administration. No significant changes were observed in heart rate, systolic blood pressure, or double product. Six patients developed their typical chest pain. In two of these six with chest pain, ST segment shift greater than 1 mm were seen. Post-ergonovine left ventricular end-diastolic pressure (LVEDP) and coronary angiographic changes were also studied in subgroup of 12 of these patients, including five of the six chest pain responders. In the five chest pain responders, pain was associated with a significant rise in LVEDP, whereas no significant change occurred in those patients not experiencing chest pain (p less than 0.01). Chest pain was also associated with significant CAS (greater than 50% lumen reduction) in two patients, each with ST segment shifts greater than 1 mm. In summary, ergonovine stimulation failed to evoke symptoms, ECG or blood pressure changes in three quarters of mitral valve prolapse patients studied. Six patients developed chest pain. Chest pain was assoicated with ECG changes characteristic of CAS in two of these patients, each with angiographic CAS. Thus, symptomatic CAS induced by ergonovine was absent in the majority of these 24 patients with idiopathic mitral valve prolapse syndrome.
Propranolol therapy during pregnancy in a patient with idiopathic hypertrophic subaortic stenosis: is it safe?
A case is presented of a low birth weight infant born prematurely with depressed respiration, sinus bradycardia, and hypoglycemia associated with maternal propranolol therapy during pregnancy and up until labor and delivery. The need for caution in the casual use of propranolol during pregnancy in an asymptomatic patient with IHSS and the potential fetal complications are emphasized.
Hemodynamic and myocardial metabolic effects of ergonovine in patients with chest pain.
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Effects of ergonovine in patients with and without coronary artery disease.
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Detection of a temporary cardiac pacing catheter in the left ventricle by chest X-ray.
This is the first reported case of detection by chest radiograph of a temporary cardiac pacing catheter inadvertently placed in the left ventricle. The unusual catheter position seen in the first chest radiograph was confirmed by a second film following reinsertion of the catheter into the right ventricle. The importance of roentgenographic confirmation of temporary cardiac pacing catheters, especially those inserted without fluoroscopy, is reemphasized.