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Biomedical subjects

M S Gotsman

Publications and source records attributed to M S Gotsman.

At least 163 records · Page 9Linked to original sources
PubMed1984

Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis.

The preoperative clinical, echocardiographic, hemodynamic and surgical data were studied from 40 consecutive patients with pure mitral stenosis and chronic atrial fibrillation who underwent surgical correction of mitral stenosis. After surgery, the patients had cardioversion of atrial fibrillation. The data of 24 patients who maintained sinus rhythm (SR) for more than 3 months (success group) were compared with the data of the 16 patients who failed to maintain SR for more than 3 months (failure group). The patients in the success group were younger (mean age 38 +/- 12 vs 47 +/- 13 years, p less than 0.05), had symptoms for a shorter time (3.0 +/- 4.3 vs 6.4 +/- 5.0 years, p less than 0.02) and had a smaller preoperative echocardiographic left atrial (LA) size (4.9 +/- 0.9 vs 5.5 +/- 1.0 cm, p less than 0.03). The correlation between duration of SR after cardioversion (range 0 to 12 months) and the preoperative data were examined with the use of the "all-possible-subsets-regression" software. The best subset of predictors of successful cardioversion included echocardiographic LA size, functional capacity, duration of symptoms and echocardiographic left ventricular fractional shortening. Patients with symptoms for more than 3 years and echocardiographic LA size of more than 5.2 cm had low rate of successful cardioversion; in this subset of patients, postoperative cardioversion should be avoided.

Adult↗
PubMed1984

Left ventricular volumes and function during atrial pacing in coronary artery disease: a radionuclide angiographic study.

This study set out to determine the pathophysiologic changes in the left ventricle during atrial pacing in 22 patients with coronary artery disease. Graduated right atrial pacing to a rate of 160 beats/min, or the induction of angina pectoris or significant ST depression was undertaken. Ventricular volumes were measured at rest and at rates of 100, 120, 140 and 160 beats/min using radionuclide angiography. The volumes at a pacing rate of 100 beats/min were used as a reference standard (100%). In the 22 patients with coronary artery disease, left ventricular end-diastolic volume decreased from 118 +/- 3% at rest to 80 +/- 5% at a rate of 160 beats/min; stroke volume from 121 +/- 3% to 54 +/- 5%; and ejection fraction (EF) from 49 +/- 3% to 37 +/- 5%. End-systolic volume decreased from 118 +/- 4% at rest, reached its minimal value of 94 +/- 5% at a rate of 120 beats/min and then increased slightly to 106 +/- 9% at 160 beats/min. Cardiac output and blood pressure did not change significantly. Compared to the control group of 10 normal subjects, the patients had a significantly smaller decrease in end-diastolic volume and end-systolic volume than in normal control subjects. EF in the normal subjects did not change. Blood pressure, cardiac output and stroke volume were similar in both groups. Atrial pacing tachycardia induced reversible ventricular dysfunction with a decrease in EF. Stroke volume was maintained because of relative ventricular dilatation.

Adult↗
PubMed1984

Two-channel ECG monitoring in the coronary care unit.

We describe the installation and clinical application of a two-channel monitoring system in the intensive coronary care unit using a single patient cable and two exchangeable ECG modules. Routine use of this system during a period of three years has shown that it has many advantages in the precise documentation and diagnosis of transient cardiac arrhythmias and for the recognition and localization of ischemic episodes.

Arrhythmias, Cardiac↗
PubMed1984

Left ventricular function during atrial pacing: a radionuclide angiographic study.

Multigated radionuclide angiography was performed at rest and during atrial pacing in 10 normal subjects. Left ventricular volumes in diastole and systole were measured by total counts in the region of interest of the left ventricle. Stroke volume, cardiac output, ejection fraction, and rates of ejection for each heart rate were calculated. As heart rate increased, there was a gradual decrease in end-diastolic, end-systolic, and stroke volumes without a significant change in cardiac output and ejection fraction. Ejection fraction rate increased and the uncorrected ejection rate decreased with the increase in heart rate. The normal response to tachycardia induced by atrial pacing was a decrease in ventricular volumes without a change in ejection fraction or cardiac output.

Adult↗
PubMed1984

Regional and global left ventricular function during intra-aortic balloon counterpulsation in patients with acute myocardial infarction shock.

We evaluated the improvement in hemodynamic and left ventricular (LV) function in 15 patients with acute myocardial infarction and cardiogenic shock, who were treated with intraaortic balloon counterpulsation (IABP). They were studied by flow-directed right heart catheterization and nuclear angiography. IABP decreased LV end-diastolic volume from 134 to 114 ml and LV end-systolic volume from 100 to 72 ml. LV stroke volume increased from 34 to 42 ml and cardiac output from 3.0 to 3.6 L/min. Global LV ejection fraction increased from 27.6% to 36.1%, and this was due to improvement in regional ejection fraction in ischemic areas. Pulmonary capillary wedge pressure and pulmonary blood volume decreased. Right ventricular ejection fraction also increased significantly. IABP improved LV function in acute myocardial infarction.

Adult↗
PubMed1984

Improvement in regional ventricular function after percutaneous transluminal coronary angioplasty.

We performed atrial pacing and radionuclide ventriculography in 12 patients before and after percutaneous transluminal coronary angioplasty (PTCA). Successful dilatation was achieved in 9 patients while in 3 the procedure was unsuccessful. Atrial pacing before PTCA showed ischemic dysfunction of the region supplied by the narrowed coronary artery. Regional ejection fraction decreased by 36 +/- 12% during rapid atrial pacing, while global left ventricular ejection fraction fell by 11 +/- 7% with a secondary increase in end-diastolic and end-systolic ventricular volume with the onset of ischemia. After successful PTCA, ischemic dysfunction was ameliorated or abolished. Measurements made at identical heart rates showed that both global and in particular regional left ventricular ejection fraction were significantly higher after successful angioplasty and did not fall during the stress of atrial pacing. There was no improvement in regional or global LV function in patients in whom angioplasty was not successful. The study showed that nuclear ventriculography with the stress of graded atrial pacing was a useful method for analysing the immediate results of coronary angioplasty and for studying its effects on regional myocardial function.

Adult↗
PubMed1984

Two potentially arrhythmogenic mechanisms of adrenaline action in cardiac muscle.

The effects of rate changes and 'premature' stimulation on the slow inward current of cardiac muscle were studied in the frog atrium. The effects of adrenaline under these conditions was investigated. It was found that adrenaline markedly accelerates the repriming kinetics of the slow inward channel. Adrenaline at low concentrations, sufficient to augment this current, also increases the effect of rate changes. Thus there is a larger second inward current 'staircase' in the presence of adrenaline. It is proposed that the combination of these effects is a possible mechanism by which adrenaline can induce cardiac disorders of rhythm.

Animals↗
PubMed1984

The effect of nifedipine on normal and ischemic left ventricular function during atrial pacing stress.

We studied 44 patients (group I: 9 with insignificant disease and group II: 35 with significant coronary artery disease) by nuclear angiography during the controlled increase in heart rate by atrial pacing to evaluate the effect of 20 mg of sublingual nifedipine on left ventricular function. Left ventricular volumes were calculated using count-derived changes: end-diastolic (EDE), end-systolic (ESE), stroke volume (SVE) and cardiac output equivalents (COE) and ejection fraction (EF) and ejection rate (ER) were calculated during basal sinus rhythm (C) and at the maximal atrial pacing (AP) rate with and without nifedipine. In normal subjects, AP decreased ventricular volumes. The administration of nifedipine decreased blood pressure but had no further effect on left ventricular volume. In the ischemic ventricle, AP produced reversible ventricular wall paresis with a smaller decrease in EDE, an increase in ESE and a significant fall in EF. Nifedipine induced a striking improvement in EF and ER. This was probably a consequence of afterload reduction and increased coronary blood flow.

Adult↗
PubMed1984

Verapamil in ventricular tachycardia.

We compared the effects of verapamil to high dose procainamide on the rate of inducible and spontaneously occurring ventricular tachycardia (VT) in 10 patients. Verapamil induced a significant increase in the rate of tachycardia (R-R interval decreased from 278 +/- 54 to 233 +/- 32 ms, mean +/- SD; p less than 0.025 by paired t test) while procainamide slowed the tachycardia (mean R-R interval was 328 +/- 72 ms, p less than 0.02). Verapamil prevented the induction of sustained VT and was effective as chronic oral antiarrhythmic therapy in 2 patients. The accelerated VT culminated in ventricular fibrillation in 1 patient. It is assumed that verapamil may have either increased conduction velocity or shortened the reentrant cycle. This may be related either to a primary effect of the drug or secondary to increased catecholamine stimulation due to a vasodilatory effect.

Adolescent↗
PubMed1984

Left ventricular function during asynchronous ventricular pacing: a radionuclide study.

This study was undertaken to assess ventricular volumes and function by radionuclide angiography during asynchronous ventricular pacing in a group of 22 patients who needed an artificial pacemaker. 14 had ischaemic heart disease and 8 had primary disturbances of conduction of the impulse-forming system. The transition from sinus to a paced rhythm or increasing the pacing rate had little effect on patients with primary conduction disturbances. In contrast, in patients with ischaemic heart disease, the transition to a paced rhythm decreased significantly left ventricular end-diastolic (15.3 +/- 4.7%) and stroke (26.3 +/- 4%) volumes, ejection fraction (9.0 +/- 4.4%), and cardiac output (21.0 +/- 3.9%). Pacing at a progressively increasing heart rate showed that each patient had an optimal rate of pacing.

Aged↗
PubMed1983

Localization of lesions in the coronary circulation.

The location of coronary artery narrowings in coronary disease (CAD) is of considerable importance in assessing the mass of myocardium at risk as well as patient prognosis. The detailed distribution of coronary lesions was mapped in 302 patients with CAD who had coronary angiography for chest pain. All identifiable coronary lesions were measured manually and the site and degree of narrowing were stored in a computer-based multisegmental model of the coronary tree. A high prevalence of CAD was found in proximal vessels and especially at, or adjacent to, proximal points of branching. In the left anterior descending coronary artery, the lesions were most prevalent immediately after the first diagonal branch and at the origin of this branch. In the right coronary artery, there was a high prevalence of narrowing between the infundibular and acute marginal branches and specifically around the origin of the right ventricular branch. In the left circumflex coronary artery, there was a predilection for narrowing in and around the origin of the first marginal branch. When a ramus intermedius was present, its origin was frequently the site of narrowing.

Adult↗
PubMed1983

Survival after sudden obstruction of the left main coronary artery.

Left main coronary artery (LMCA) stenosis occurs in 10% of patients undergoing coronary arteriography, but total occlusion is rare. Goldberg et al reported 6 cases of complete obstruction of the LMCA among 2,200 patients studied arteriographically. Sudden obstruction of the LMCA should be lethal, and we found no report describing survival with sudden obstruction of the LMCA. The present report describes such a patient.

Coronary Angiography↗
PubMed1983

Prediction of in-hospital ventricular fibrillation from admission data in acute myocardial infarction.

We studied retrospectively 26 readily obtainable clinical and electrocardiographic variables in 22 consecutive patients who experienced primary ventricular fibrillation in association with an episode of acute myocardial infarction. Twenty-eight consecutive patients who had an uncomplicated course after acute myocardial infarction served as controls. The clinical profile of the two groups was similar except that patients who had primary ventricular fibrillation smoked more and had a higher peak creatinine phosphokinase level at the time of infarction. The data was evaluated using univariate and stepwise logistic regression analysis. This analysis demonstrated that patients who developed primary ventricular fibrillation had, on admission (1) more evidence of congestive heart failure (Killip classification), (2) a lower diastolic blood pressure, (3) greater ST-segment elevation, (4) a longer QTc interval, and (5) a less distinguishable J point on the electrocardiogram. This method of logistic analysis that utilizes easily obtainable hospital admission data serves as a preliminary model for prediction of the relative risk of primary ventricular fibrillation in a patient with acute myocardial infarction. The ability to identify patients at risk has important therapeutic implications.

Aged↗
PubMed1983

Intravenous verapamil therapy in imminent myocardial infarction.

We studied 16 patients with small myocardial infarction who had further episodes of chest pain with ST-segment elevation, a sign of transmural myocardial ischemia and imminent infarction extension. Coronary angiography in 14 showed a critical lesion in 13. Intravenous verapamil abolished chest pain and ST-segment elevation. It caused a fall in right atrial and left ventricular end-diastolic pressures (LVEDP) and cardiac output, reflex systemic vasoconstriction, and a rise in systemic vascular resistance. There was no reflex tachycardia. Volume expansion raised LVEDP and restored a normal cardiac output. Accelerated junctional rhythm with isorhythmic A-V dissociation occurred in 5 patients. Two patients sustained a transmural infarction, 10 underwent coronary artery bypass grafting, and 4 are symptom-free with oral treatment. Intravenous treatment was an effective method of treating acute episodes of transmural myocardial ischemia and preventing their recurrence in patients with critical coronary artery narrowing. Continuous verapamil infusion stabilized the patients' condition and enabled smooth coronary angiography and induction of anesthesia for surgery.

Aged↗
PubMed1983

A graphic computerized system for reporting and analysis of coronary angiograms.

A graphic computer based system for coronary angiographic reporting and data storage has been developed. It uses a multisegmental model of the coronary tree so that precise localization of coronary lesions can be made in relation to major branches. The percentage narrowing of the vessel, the length of the lesion, and diameter of the distal coronary vessel can be measured. Collateral vessels, coronary artery bypass grafts, and coronary artery spasm are recorded. The system is simple to use and useful for routine clinical reporting and for detailed analysis of coronary lesions.

Angiography↗