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Biomedical subjects

M H Hust

Publications and source records attributed to M H Hust.

34 records · Page 2Linked to original sources

Noninvasive evaluation of pulmonary hypertension by quantitative contrast M-mode echocardiography.

Although it has been shown that pulmonary flow velocity can be calculated from contrast M-mode echocardiographic tracings, the clinical value of this noninvasive method has not been established. We used contrast M-mode echocardiography to examine the flow velocity pattern at the pulmonary valve in 30 adults referred for diagnostic cardiac catheterization. In the 15 patients with normal pulmonary artery pressure (PAP) (mean pressure less than or equal to 20 mm Hg), midsystolic pulmonary flow velocity was significantly (p less than 0.001) higher (654 +/- 140 mm/sec) compared to the 15 patients with pulmonary hypertension (342 +/- 85 mm/sec, mean pressure greater than 20 mm Hg). Fourteen of the 15 patients with pulmonary hypertension exhibited an early systolic flow velocity peak, whereas all patients with normal PAP showed a dome-shaped systolic flow velocity profile with maximal flow velocity occurring in midsystole. A significant close correlation was found between the relative early to midsystolic flow velocity change and mean PAP (r = 0.96; p less than 0.001). Thus quantitative contrast M-mode echocardiography reliably differentiates patients with pulmonary hypertension from patients with normal mean PAP. In addition, this technique allows a noninvasive estimation of PAP.

Adolescent↗

Ventricular arrhythmias and Q-Tc interval during stress-ECG.

Q-T prolongation is well-known to be related to ventricular arrhythmias in a number of clinical circumstances. The purpose of this study was to determine whether heart rate corrected Q-T interval (QTc) may indicate susceptibility to ventricular arrhythmias during stress testing. QTc was determined at rest, during submaximal and maximal bicycle work load in normals and patients with remote myocardial infarction, documented coronary artery disease (CAD) and in a group of patients with different cardiac diseases and premature ventricular beats during exercise testing (PVC). Ventricular arrhythmias were graded according to Lown. Q-Tc interval significantly increased in all groups of those patients having complex ventricular arrhythmias (Lown greater than or equal to III). In patients with ischemic S-T segment depression during stress testing, QTc was only lengthened if complex ventricular arrhythmias were present. Q-Tc lengthening in stress testing is assumed to be associated with occurrence of ventricular premature beats rather than ischemia. There is evidence that abnormal repolarization due to imbalance of the autonomic nervous system induces ventricular arrhythmias. Monitoring of Q-Tc interval during stress testing is warranted and may be useful to predict future cardiac events such as sudden cardiac death.

Angina Pectoris↗

Q-T prolongation and torsades de pointes in a patient with subarachnoid hemorrhage.

An extreme Q-T prolongation in a patient with subarachnoid hemorrhage was observed. Multiple torsades de pointes occurred. Lidocaine, metoprolol, and atropine were not effective in controlling the arrhythmia, whereas shortening the Q-T interval by intravenous administration of orciprenaline or overdrive ventricular pacing was successful. The occurrence of T wave alternations was a sign of increased sympathetic activity.

Aged↗

Sudden cardiac death recorded during ambulatory electrocardiographic monitoring.

Two case reports of sudden cardiac death are detailed here. Holter monitoring plays an important role in documenting arrhythmias leading to sudden cardiac death. In addition, the importance of the Lown grading concept should not be underestimated. Our two case reports and a subsequent review of the literature demonstrate both points.

Aged↗

[The effect of various cutaneously administered nitroglycerin preparations on coronary heart disease].

Sublingually administered nitroglycerin provides marked benefit in the treatment of angina pectoris due to occlusive coronary disease. Because of its brief duration of action, its usefulness as a prophylactic agent is limited. One way to prolong the beneficial effects is cutaneous administration of a nitroglycerin ointment, and the effects and duration of action of three different preparations of topical nitroglycerin on exercise performance have therefore been studied in a double-blind randomized manner in 44 patients with well documented coronary artery disease and stable angina pectoris. 30 mg 2% nitroglycerin ointment((Plantorgan Co.) produced significant improvement in maximal exercise capacity one and six hours after application; concomitantly there was a decrease in the sum of exercise induced ST-segment depression especially one hour, but less markedly six hours, later. 10 mg 2% nitroglycerin ointment (Pohl Boskamp Co.) also produced an increase in maximal exercise tolerance and a reduction in the degree of myocardial ischemia estimated by the magnitude of exercise-induced ST-segment depression one hour after application, but no clear effect could be measured four hours later. 25 mg nitroglycerin in the "transdermal therapeutic system" (Ciba Geigy) produced a significant improvement in maximal exercise capacity and a significant decrease in the sum of exercise-induced ST-segment depression one and five hours after cutaneous application. Side effects were not observed during these studies, and the topical compatibility of the different ointments was good.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗

[Prognostic significance of the QT-interval following myocardial infarction].

The prognostic value of QT prolongation was evaluated in 109 patients with myocardial infarction. Patients who suffered from reinfarction during the first month or developed ventricular fibrillation and sudden death did not have longer QT intervals than patients without these complications. On the other hand, QT prolongation was of prognostic value in the prediction of late reinfarction. The reasons for varying results from different investigators are discussed.

Adult↗

Flecainide-induced aggravation of ventricular tachycardia.

Flecainide acetate is a new class I antiarrhythmic agent which slows atrial, A-V nodal and ventricular conduction velocity, and prolongs refractoriness of these structures (Borchard et al., 1982; Hodess et al., 1979). Recent studies with oral flecainide therapy suggested its high potential for suppression of ventricular tachycardia in humans (Anderson et al., 1981; Duff et al., 1981; Hodges et al., 1982). Its favorable pharmacokinetics with an average plasma half-time of about 20 hours allows in most patients twice daily dosing (Duff et al., 1981). Usually, the drug seemed to be well tolerated and side-effects, such as blurred vision, could be resolved with smaller but still effective doses (Duff et al., 1981). Actually, the ideal antiarrhythmic agent which represents a high degree of effectiveness, a low level of toxicity, a wide therapeutic range, and a prolonged antiarrhythmic action does not exist (Dreifus and Ogawa, 1977). In this report we describe a patient with flecainide-induced aggravation of ventricular tachycardia necessitating resuscitation because of severe hemodynamic deterioration.

Anti-Arrhythmia Agents↗

[Cardiodepressive effect of alcohol in low doses in normal persons and patients with coronary disease].

To study the effect of small amounts of ethanol 1 ml whisky (43 vol. %) per kg body weight was given to normal subjects (n = 11) and patients with coronary heart disease (n = 11) and the systolic time intervals (STI) PEP (preejection period), LVET (left ventricular ejection time), QS2 (total electromechanical systole) and PEP/LVET were measured. A control group consisted of five patients with coronary heart disease. The following results were obtained: Already at rest PEP/LVET was significantly higher in patients with coronary heart disease. After the ingestion of alcohol, significant changes of the STI were observed; mainly an increase of PEP and PEP-LVET was found. In patients with coronary heart disease the effect began earlier, was significantly higher and lasted significantly longer than in normal subjects. According to invasive correlation-studies of different authors, these results indicate an impairment of left ventricular function, especially of ejection fraction and contractility. These alterations seem to be more pronounced in patients with coronary heart disease. The results of this study should be considered in advising patients with coronary heart disease.

Adult↗

Transesophageal echocardiographic artifact mimicking pseudoaneurysm of the aorta.

Transesophageal echocardiography (TEE) is a sensitive and specific procedure that gives detailed images of the thoracic aortic anatomy and blood flow; however, there are few reports on pitfalls with TEE. This case describes a patient with a typical history of a possible aortic rupture; artifacts in the TEE mimicked aortic rupture and development of a pseudoaneurysm. Echocardiographers should know this possible pitfall to make the correct diagnosis.

Aneurysm, False↗

Denver shunt causing abnormal right atrial mass: noninvasive determination of shunt patency by color-coded Doppler shuntography.

An unusual floating mass was detected in the right atrium of a 71-year-old man with liver cirrhosis and intractable ascites using two-dimensional echocardiography. The mass was caused by the venous tip of a Denver peritoneovenous shunt. Shunt patency could be assessed easily by compression of the pump body; this maneuver resulted in a laminar or turbulent flow that was recorded at the tip of the shunt in the right atrium by color-coded Doppler echocardiography. We are reporting the first case demonstrating the value of echocardiography in diagnosing a Denver shunt in the heart and shunt patency by color-coded Doppler shuntography.

Aged↗

Cerebrospinal fluid and metastasis of transitional cell carcinoma of the bladder.

Two cases are presented of cerebrospinal fluid with tumor cells metastatic from transitional cell carcinomas of the bladder. They demonstrate that in spite of the rarity of transitional cell carcinoma's metastasizing to the central nervous system (0.4% to 0.6%), it is necessary to consider the bladder as the primary site and to obtain urinary cytology in such cases when the primary tumor is still unknown.

Aged↗