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Biomedical subjects

M S Gotsman

Publications and source records attributed to M S Gotsman.

At least 91 records · Page 5Linked to original sources
PubMed1993

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva as a cause of ischemia at old age.

The case of a patient with an anomalous origin of the circumflex coronary artery causing myocardial ischemia and infarction is presented. Even though the anomalous artery was not located between aorta and pulmonary artery, this anomaly, which is usually considered benign, was responsible for the ischemic symptoms. Transesophageal echocardiographic study demonstrated an acute angulation at the proximal portion of this abnormal vessel, very close to its origin from the right coronary sinus, which we believe caused the abnormality in coronary flow in this patient.

Aged↗
PubMed1993

Arterial remodelling after percutaneous transluminal balloon angioplasty.

Atheromatous coronary artery disease progresses by atheroma accretion, plaque rupture and thrombus formation, with or without spontaneous fibrinolysis. The natural history may be altered by modifying risk factors in an attempt to induce regression, or treated by mechanical means such as balloon angioplasty, directional coronary atherectomy or drills, or flow modulated by the insertion of an aorto coronary bypass graft with or without endarterectomy. Here we discuss the natural history of the atheromatous disease in a series of 355 patients who underwent at least one PTCA procedure and then underwent a second angiographic study to determine the changes in the dilated and nondilated arteries.

Angioplasty, Balloon, Coronary↗
PubMed1993

Early heart rate variability alterations after acute myocardial infarction.

In order to assess early changes in heart rate variability, we studied 81 patients with acute myocardial infarction during the initial 24 hours after thrombolytic therapy. The standard deviation of the mean heart rate and the low (0 to 0.05 Hz), mid (0.05 to 0.20 Hz), and high (0.20 to 0.35 Hz) frequency band power were evaluated with 24-hour ECG Holter recordings. We found diminished variance in the time domain and reduced power spectrum in the frequency domain compared with a group of 41 normal subjects (p < 0.01). Patients with anterior infarction had significantly (p < 0.01) higher heart rates and lower heart rate variability values than patients with inferior infarction. Reduction in heart rate variability occurred within the first 8 hours in patients with anterior infarction; a significant fall (p < 0.03) was especially noted in the high-frequency band after a decline in ST-segment elevation. Heart rate variability alterations in patients with inferior infarction were most evident in the final 8-hour interval. These findings may be viewed in terms of sympathovagal imbalance and may be related to clinical signs of intense autonomic nervous system activity that are observed early in the course of acute anterior and inferior myocardial infarction.

Aspirin↗
PubMed1993

Comparison of different methodologies of heart rate variability analysis.

Two methodological aspects of heart rate variability (HRV) are tested. Heart rate variability and RR interval variability (RRV) are compared in 109 healthy subjects using 24-h Holter recordings. Autoregressive power spectrum analysis was performed, and the power in three frequency bands was evaluated by two different methods: the peak power and the mean power within the band. The power in the low frequency (LF) and high frequency (HF) ranges showed greater changes between day and night values when RRV was analysed compared with HRV. The mid frequency (MF) range power showed no significant change at night with RRV analysis compared with a significant decrease with HRV analysis. The different pattern of changes between day and night values when using RRV or HRV analysis is explained by the non-linear nature of the relationship between RR interval and heart rate and the lower heart rate at night. Therefore, depending on the heart rate, there may be amplification or attenuation of fluctuations when transforming from one heart rate variability method to another. When comparing peak power and mean power measurements within the frequency bands, the changes in LF and MF powers were similar. However, HF mean power with RRV analysis showed less change at night than the peak power and no change with HRV analysis. The explanation lies in the fact that respiratory fluctuations at night are much more regular, resulting in a sharp high peak in the power spectrum. The peak power is therefore higher at night, whereas the total power changes much less or remains unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Bias↗
PubMed1993

Intra-aortic balloon counterpulsation improves survival in cardiogenic shock complicating acute myocardial infarction.

The impact of intra-aortic balloon counterpulsation (IABC) on survival of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) has been evaluated in this study of 85 patients. IABC was available for the 24 group A patients (and used in 20 patients). IABC was not available for the 21 group B patients who presented simultaneously with similar clinical characteristics and received identical pharmacological treatment. In-hospital and one year survival was significantly higher in group A (46% and 38% vs 19% and 10%, P < 0.001). Sixteen out of the 20 (group A1) IABC patients received early coronary revascularization. During 1980-1984, 35 patients with AMI and CS received IABC (group C) but none underwent early revascularization. There was no difference in in-hospital or one-year survival between group A1 (50% and 40%) and group C (45% and 40%). We conclude that early IABC improves survival of patients with AMI complicated by CS.

Combined Modality Therapy↗
PubMed1993

Cardiac rupture during coronary angioplasty.

Cardiac rupture is a catastrophic complication of acute myocardial infarction. We describe a patient with acute myocardial infarction who received thrombolytic therapy and then developed cardiac rupture and tamponade during rescue angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1993

Single physician approach to radiofrequency catheter ablation in patients with supraventricular tachycardia.

The minimal requirements for safe and effective performance of catheter ablation using radiofrequency current are still unclear. To determine the feasibility and safety of single physician approach to catheter ablation of supraventricular tachycardia substrate using radiofrequency energy, the results of the ablation procedure in 52 consecutive patients were evaluated. The procedures were performed during 1 year by the same physician and nurse. Twenty-one patients had selective atrioventricular (AV) nodal pathway ablation and 31 patients had accessory AV pathway ablation. Forty-eight patients (89%) had the diagnostic and the ablative procedure during the same electrophysiological test. In the 21 patients with AV nodal reentrant tachycardia, all had successful selective ablation of the fast (13) or the slow (8) pathways. Eight patients had recurrence of the clinical tachycardia and had a successful reablation. No patient developed complete AV block or other significant complications. The mean fluoroscopy time during the procedure was 16.0 +/- 8.6 minutes. In the eight patients with Wolff-Parkinson-White syndrome, all concealed accessory pathways were successfully ablated with a mean fluoroscopy time of 30.0 +/- 27.9 minutes. Two patients had recurrence of the conduction through the accessory pathway and had a successful reablation. Eighteen of 19 patients with a single overt accessory pathway had successful ablation, with a fluoroscopy time of 22.7 +/- 20.6 minutes. Three patients had an early recurrence of the conduction through the accessory pathway, reablation was successful in two of them. Ten accessory pathways were ablated in four patients with multiple pathways during nine procedures. Only two patients developed minor peripheral vascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Comparison between patients with and without reliable ventricular escape rhythm in the presence of long standing complete atrioventricular block.

The underlying heart rhythm was evaluated in 74 patients with complete atrioventricular block and had a permanent pacemaker implantation. The pacing was inhibited for 10 seconds or until the patient developed symptoms of presyncope or syncope. Fifty-six patients (74%) had a reliable escape with a mean cycle length of 2010 +/- 596 msec and a mean escape interval of 2335 +/- 971 msec. In 93% of these patients the escape interval was < 4 seconds. The patients without reliable escape (24%), developed symptoms only after a mean of 7153 +/- 1875 msec. The duration of the conduction disorder was longer in the patients without escape and the intraventricular conduction was slower. More patients without escape were treated and antiarrhythmic agents. Forty-eight patients were followed for 1 year and underwent at least two different studies and 13% had different results at different tests. In conclusion, patients without reliable escape have a longer history of conduction disorder, a slower intraventricular conduction, and are frequently treated with antiarrhythmic agents. Even patients with reliable escape occasionally may show a greater pacemaker dependence; therefore, they should also be considered as pacemaker dependent.

Aged↗
PubMed1992

Day vs night ECG and heart rate variability patterns in patients without obvious heart disease.

The day vs night values of variables that may be related to the autonomic nervous system were compared in 50 individuals without obvious heart disease. Using ambulatory electrocardiographic monitoring and heart rate variability analysis, it was found that in contrast to daytime, nocturnal heart rate and total heart rate variability were reduced and low (0-0.05 Hz) and high (0.2-0.35 Hz) frequency power of nocturnal heart rate variability were increased, whereas mid-frequency (0.05-0.2 Hz) power was reduced. In addition, nocturnal episodes of trapezoidal-shaped waveforms of heart rate increase were present primarily at night and ST was elevated to a greater extent at night. Many of these factors were related to age and tentatively, despite the small sample size, reflect an age-related diminished autonomic nervous system response. These results serve to establish a circadian basis for comparison when evaluating disease states such as ischemic heart disease and its prognosis.

Adult↗
PubMed1992

Autodecremental pacing for the interruption of ventricular tachycardia and atrial flutter.

The efficacy and safety of autodecremental pacing (ADP) to interrupt ventricular tachycardia (VT) and atrial flutter was examined. Once tachycardia was recognized, ADP was initiated using a short train of stimuli with gradual shortening (3%) of the interstimulus interval. ADP was applied to 13 consecutive patients during 75 episodes of VT (mostly following induction by ventricular stimulation). Successful interruption of VT occurred in 88% of the episodes. In 6 episodes (8%), ADP resulted in ventricular fibrillation and in 3 episodes VT was unaffected by ADP. The only significant discriminator between the failure or success of ADP was the rate of VT. ADP was also applied to 17 consecutive patients with an atrial flutter that was resistant to conventional antiarrhythmic agents. Successful conversion of atrial flutter to sinus was seen in only 8 patients (47%). A temporary acceleration to atrial fibrillation appeared in 3 patients (18%), and in 6 patients atrial flutter was unaffected by ADP. ADP was successful in 70% (7/10) of patients with type 1 (< 300 beats/min) atrial flutter. The authors conclude that ADP is beneficial in the interruption of VT and atrial flutter in a selected group of patients, especially with a slower rate of tachyarrhythmia (atrial rate during atrial flutter < 300 beats/min and ventricular tachycardia < 180 beats/min).

Adult↗
PubMed1991

Cardiovascular risk factor clustering and ratio of total cholesterol to high-density lipoprotein cholesterol in angiographically documented coronary artery disease.

High levels of cardiac risk factors tend to cluster together and act synergistically. To develop a suitable and practical marker for clustering, we evaluated 380 consecutive patients at the time of coronary angiography. Analyses of lipid, rheologic, clinical and arteriographic profiles indicated a variety of interwoven relations. Because the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (total/HDL cholesterol) was closely related to both the presence and extent of greater than or equal to 50% diameter reduction of greater than or equal to 1 coronary arteries, it was used to divide patients into quartiles. Clustering of high- and low-level risk factors was demonstrated in the highest and lowest quartiles of total/HDL cholesterol, respectively (p less than 0.001). The highest quartile may be characterized by an only moderately elevated total cholesterol level but patients in this quartile may have a very low HDL cholesterol level, high triglycerides, a tendency toward high hemoglobin and fibrinogen levels, a history of smoking, previous myocardial infarction and multivessel disease. These results suggest that total/HDL cholesterol serves as a marker not only for obstructive coronary disease but also for a cluster of potentially modifiable risk factors.

Angiography↗
PubMed1991

Cardiac tamponade following coronary arterial rupture during coronary angioplasty.

We describe a patient in whom percutaneous transluminal coronary angioplasty (PTCA) was complicated by rupture of the left anterior descending coronary artery (LAD) with pericardial tamponade. The outcome was favorable with drastic intervention which included: occlusion of the bleeding vessel with the PTCA balloon, pericardiocentesis, and ligation of the vessel without the need of aortocoronary bypass graft.

Angioplasty, Balloon, Coronary↗