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M Dancy

Publications and source records attributed to M Dancy.

28 records · Page 2Linked to original sources
PubMed1985

Misdiagnosis of chronic recurrent ventricular tachycardia.

24 patients with recurrent ventricular tachycardia were repeatedly misdiagnosed as having supraventricular tachycardia. Supraventricular tachycardia was recorded as the diagnosis 163 times in these patients. 72 12-lead electrocardiograms (ECGs) were available and they were reviewed together with the notes made at the time of the ECGs to discover the reasons for misdiagnosis. 7 consultant cardiologists, 22 consultant physicians, 13 senior registrars, and 57 registrars were involved in the misdiagnosis. Retrospective application of the established criteria used to distinguish ventricular tachycardia from supraventricular tachycardia with aberrancy enabled the diagnosis of ventricular tachycardia to be made in 22/24 patients (92%). In all but 2/72 episodes the only differentiating criterion noted by the attending physicians was dissociated atrial activity, and there seemed to be considerable bias in favour of the diagnosis of supraventricular tachycardia. 20/24 patients were given inappropriate treatment, which had dangerous consequences in 5.

Adolescent↗
PubMed1985

Preclinical left ventricular abnormalities in alcoholics are independent of nutritional status, cirrhosis, and cigarette smoking.

M mode echo recordings of the left ventricle (LV) were performed in 33 patients with alcoholic liver disease, 26 patients with various non-alcoholic liver diseases, and in 18 non-alcoholic controls. Groups were well matched for age and overall nutritional status (as assessed by anthropometry) and none of the subjects studied had cardiorespiratory symptoms. Alcoholics had significantly increased LV free wall thickness and LV cavity dimension at end diastole (EDD). Multiple regression analysis of the data identified alcohol abuse as the most important variable affecting EDD, and this relation could not be explained by differences in age, sex, overall nutrition, cigarette smoking, thiamine status (total blood thiamine and thiamine pyrophosphate concentration), presence of liver disease, or severity of liver disease (cirrhotic vs non-cirrhotic). The increase in LV free wall thickness was not significantly related to alcohol abuse. These results suggest that chronic alcohol abuse is an important independent risk factor for cardiac dilatation, and that increase in EDD may be an early marker of alcoholic cardiomyopathy.

Adult↗
PubMed1984

Blood thiamine and thiamine phosphate ester concentrations in alcoholic and non-alcoholic liver diseases.

Thiamine state was investigated in patients with alcoholic liver disease, patients with various non-alcoholic liver diseases, and controls using a direct technique (thiochrome assay) to measure thiamine, thiamine monophospate, and the active coenzyme thiamine pyrophosphate in whole blood after isolating the fractions by ion exchange chromatography. Overall nutrition was similar in all groups as assessed by anthropometry, and no patient had clinical evidence of thiamine deficiency. There was no significant difference among the groups in mean concentration of any form of thiamine. The scatter was much greater in patients with alcoholic liver disease but only 8.7% had biochemical thiamine deficiency (defined as a blood concentration of the active coenzyme greater than 2 SD below the mean control value). An unexpected finding was of abnormally high total thiamine concentrations (greater than 2 SD above the mean control value) in 17.4% of patients with alcoholic liver disease, the highest concentrations being found in two patients with severe alcoholic hepatitis and cirrhosis. The ratio of phosphorylated to unphosphorylated thiamine was calculated as an index of phosphorylation and, although the mean did not differ significantly among the groups, the range was greatest in alcoholic liver disease. The lowest ratios occurred in the two patients with severe alcoholic hepatitis, but neither had evidence of thiamine pyrophosphate deficiency. Contrary to studies using indirect assay techniques, these results suggest that thiamine deficiency is unusual in well nourished patients with alcoholic liver disease. The new finding of unexpectedly high thiamine concentrations in some patients may be due to abnormalities of hepatic storage or release in liver disease, particularly in severe alcoholic hepatitis. There was no convincing evidence of impaired thiamine phosphorylation in any patients with liver disease. Conclusions from studies using indirect assays on the prevalence and mechanisms of thiamine deficiency in liver diseases may not be valid.

Adult↗
PubMed1984

Comparison of cinefluoroscopy and M mode echocardiography for detecting aortic valve calcification. Correlation with severity of stenosis of non-rheumatic aetiology.

The density of aortic valve calcification was estimated using cinefluoroscopy and M mode echocardiography in 86 patients with pure aortic stenosis. The results were compared with the degree of outflow obstruction measured haemodynamically. Cinefluoroscopic estimates of aortic valve calcification correlated well with the measured aortic valve gradient whereas echocardiographic results were less accurate. Echocardiography gave accurate information about the distribution of calcium within the cusps, but this was not of value in predicting the degree of obstruction. The amount of calcium in the aortic valve as assessed by simple cinefluoroscopy is a useful guide to the severity of aortic stenosis in patients in the middle and older age groups.

Adult↗
PubMed1984

Changes in echocardiographic left ventricular minor axis dimensions during exercise in patients with aortic stenosis.

Twelve patients with aortic stenosis (gradient 62 (25) mm Hg), and six normal subjects were examined using M mode echocardiography before and during submaximal bicycle exercise. Normal subjects showed a progressive fall in the end systolic minor axis dimension of the left ventricle and a rise in end diastolic dimension, giving an increase in stroke dimension and shortening fraction of 45% and 37% respectively at peak exercise. Patients with aortic stenosis showed no consistent alteration in either end systolic or end diastolic dimension, and consequently stroke dimension was unchanged during exercise. None of the patients with an abnormal exercise response had evidence of left ventricular failure at rest, and all but one completed the exercise protocol without undue dyspnoea. Non-invasive exercise testing in patients with aortic stenosis may detect abnormalities of left heart function which are not apparent at rest. These abnormalities may provide early evidence either of severe aortic stenosis or of incipient left ventricular failure.

Adolescent↗
PubMed1982

Significance of complete right bundle-branch block when an isolated finding. An echocardiographic study.

Twenty-seven patients with complete right bundle-branch block as the only abnormal finding were studied using high speed M-mode echocardiography to determine the effect of the electrical delay on the mechanical events of right ventricular systole. Pulmonary valve opening (PVOm) was delayed in all cases. In some the delay was mainly between mitral valve closure (MVC) and tricuspid valve closure (TVC), and this was designated proximal block. In the others the main delay was between tricuspid valve closure and pulmonary valve opening and this was designated distal block. The patients were divided into those with proximal and those with distal block by calculating the ratio TVC-PVOm/MVC-TVC. Twelve out of 13 of those with distal delay but only one out of 14 of those with proximal delay had episodes of syncope or near syncope. These results are consistent with previous theories about the pathophysiology of right bundle-branch block. Echocardiography may offer a non-invasive method to estimate the prognosis in isolated right bundle-branch block.

Adult↗
PubMedDate not supplied

Absent right precordial R waves are associated with reduced left ventricular function and poor prognosis in patients with aortic stenosis.

Right precordial Q waves can be present in patients with aortic stenosis as well as in those with anterior myocardial infarction. In order to evaluate the relationship of right precordial Q waves to left ventricular function and prognosis in patients with aortic stenosis, we studied 49 such patients with no history of myocardial infarction, by means of ECG, clinical history and echocardiography. 15 (31%) patients had Q waves in both V1 and V2 and 34 (69%) did not. There were no differences in age (77+/-9.0 years vs. 78+/-9.7), follow-up time (15+/-9.0 months vs. 18+/-10), gender (female:male 8:7 vs. 15:19), aortic valve gradient on Doppler (70.0+/-20 mmHg vs. 71+/-20) and left ventricular mass (360+/-118 g vs. 320+/-80) between the two groups (all P=NS). Left ventricular shortening fraction (22+/-9.0% vs. 28+/-8.5, P<0.05), ejection fraction (51+/-15% vs. 62+/-12, P<0.01) and circumferential fibre shortening (0.8+/-0.3 circ/s vs. 1.0+/-0.3, P<0.0s) were all significantly reduced in patients with right precordial Q waves compared to those without. During a mean follow-up of 1.5 years, 9 out of 15 (60%) patients with right precordial Q waves died compared with only 5 out of 34 (15%) patients with a normal QRS pattern died (P<0.01). In summary, a right precordial QS ECG pattern is present in nearly 1/3 patients with aortic stenosis and is associated with impaired left ventricular systolic function and adverse prognosis.

Aged↗