PubMed Health⌕ Search

Biomedical subjects

M T Rothman

Publications and source records attributed to M T Rothman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Coronary lesion morphology in acute myocardial infarction: demonstration of early remodeling after streptokinase treatment.

Coronary lesion morphology was analyzed in 72 patients 1 to 8 days after streptokinase treatment for acute myocardial infarction and compared with lesion morphology in a control group of 24 patients with stable angina. In the streptokinase group the infarct-related artery was patent in 55 patients (76%). Compared with stenoses in the stable angina group, there were no differences in the stenosis length, severity, calcification or in the proportion located at an acute bend or at a branch point. However, lesions in the streptokinase group were more often irregular (p less than 0.005) and eccentric (p less than 0.01), had a shoulder (p less than 0.0001), globular filling defects (p less than 0.01), linear filling defects (p less than 0.00005) and contrast staining (p less than 0.05). Plaque ulceration index was higher in the streptokinase than in the stable angina group (6.2 +/- 7.9 versus 3.5 +/- 3.4, p less than 0.001). Of the 72 streptokinase-treated patients, 35 were maintained on heparin infusion until angioplasty 2 to 10 days later. At repeat angiography before angioplasty, globular lesion filling defects seen in eight patients had disappeared, whereas linear filling defects persisted in 7 of 14 cases. Fewer lesions were irregular (p less than 0.0001) and the ulceration index decreased from 7.4 +/- 10.4 to 3.0 +/- 1.6 (p less than 0.001). These data show that the lesion in the infarct-related artery after streptokinase treatment is irregular and often associated with filling defects, perhaps corresponding to plaque fissuring and intraluminal thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

Intravascular ultrasound imaging and three-dimensional modeling of arteries.

In this article, we describe the reconstruction of arterial structures using solid modeling. The alternative approaches to three-dimensional modeling are discussed and the voxel space system we use for intra-arterial imaging, based on ultrasonic data, is described. The complete three-dimensional ultrasonic imaging system comprising a purpose-built, catheter-mounted ultrasound probe, ultrasonic transceiver, and computer system is presented. This system has been used to recreate three-dimensional computer models of arterial sections in vitro and in vivo. Examples to illustrate the power and flexibility of voxel space modeling in terms of postprocessing and software manipulation are given. Preliminary work on tissue differentiation, using arterial models and color coding of the image, and three-dimensional presentation of flow data is included.

Arteries↗
PubMed1989

Day case cardiac catheterisation using the Sones technique.

Cardiac catheterisation using the Sones technique was planned as a day case procedure in 855 of 1662 consecutive patients admitted for cardiac catheterisation. Of these, 810 (95%) were discharged the same day. Forty-five (5%) needed overnight hospitalization, 34 for reasons connected with the procedure and 11 for other reasons. No serious complications occurred and there were no deaths. The cost of day stay was approximately half that incurred using overnight stay. Thus, cardiac catheterisation using the Sones technique on a day case basis is safe and may produce significant cost efficiency.

Ambulatory Care↗
PubMed1989

Survival after rupture of the oesophagus and subsequent candidal endocarditis: use of new serological methods in management.

The prognosis following both spontaneous rupture of the oesophagus (Boerhaave's syndrome) and candidal endocarditis is poor. Antifungal treatment for the latter has, in the past, been empirical. A patient who survived both these conditions is described, his case demonstrating some of the major risk factors for candidal endocarditis. Management of his antifungal treatment was guided by newly developed serological methods. Close liaison between microbiologist and clinician is essential for the management of this serious condition.

Adult↗
PubMed1988

Assessment of left ventricular performance during percutaneous transluminal coronary angioplasty: a study by intravenous digital subtraction ventriculography.

Left ventricular performance during percutaneous transluminal coronary angioplasty was assessed in 52 patients by intravenous digital subtraction ventriculography. After injection of contrast into the right atrium ventriculograms were obtained before and during balloon inflation. In 37 patients they were also obtained after the procedure. A 12 lead electrocardiogram was monitored throughout. During balloon inflation the left ventricular ejection fraction fell (from 73% to 57%) in all but one patient; the decreases in patients with single vessel or multivessel disease were similar. The fall in left ventricular ejection fraction during percutaneous transluminal coronary angioplasty of the left anterior descending artery (19%) was significantly greater than that during balloon inflation in the right coronary (10%) or circumflex (8%) coronary arteries. It also reduced anterobasal, anterior, and apical segmental shortening while right coronary percutaneous transluminal coronary angioplasty affected inferior and apical segments. In 33 (63%) patients the ST segment was altered during balloon inflation. The fall in left ventricular ejection fraction correlated significantly with the magnitude of both ST segment elevation (r = 0.637) and ST depression (r = 0.396). Left ventricular ejection fraction and regional wall motion returned to baseline values after the procedure. Balloon inflation during percutaneous transluminal coronary angioplasty produces considerable abnormalities of global and regional left ventricular performance and this indicates the presence of myocardial ischaemia, which may not be apparent on electrocardiographic monitoring. Intravenous digital subtraction ventriculography is useful for monitoring left ventricular performance during controlled episodes of coronary occlusion produced by balloon inflation.

Adult↗
PubMed1988

Coronary angioplasty in pregnancy.

Myocardial infarction is rare in pregnancy. A 30 year old white primigravida had an anterior infarct at 20 weeks' gestation, which was followed by troublesome angina. Coronary angiography showed a tight stenosis of the left anterior descending coronary artery. This was treated successfully by percutaneous transluminal coronary angioplasty.

Adult↗
PubMed1987

Pericardial effusion following conditioning for bone marrow transplantation in acute leukaemia.

We report the details of a young woman in whom pericardial tamponade developed acutely following preparation for allogeneic bone marrow transplantation for acute lymphoblastic leukaemia. The aetiology of the effusion, though uncertain, probably relates to the cumulative cardiotoxicity of cyclophosphamide and irradiation upon a myocardium previously sensitised by anthracycline therapy. As the number of transplant procedures increases, this complication may become more common, and might be avoided by a more critical assessment of cardiac function prior to transplantation, with radionuclide angiography.

Adult↗
PubMed1986

Diltiazem and propranolol in combination: hemodynamic effects following acute intravenous administration.

Diltiazem and propranolol are independently useful antianginal agents with common negative chronotropic, dromotropic, and inotropic properties. Concern over the safety of the concurrent use of these two drugs led to an investigation of their intravenous combination in 19 patients with suspected coronary artery disease. Hemodynamics were recorded in both a sinus and atrial paced rhythms at baseline and again following administration of a loading dose of diltiazem (0.25 mg/kg) followed by continuous infusion (0.002 mg/kg/min). Propranolol was then added by intravenous bolus (0.07 mg/kg) and continuous infusion (0.0012 mg/kg/min), with reassessment of hemodynamics once steady state was achieved. Patients were stratified by left ventricular ejection fraction (LVEF): group 1 (LVEF = 62% to 69%), group 2 (LVEF = 49% to 59%), and group 3 (LVEF = 20% to 47%). The combination of drugs resulted in a 15% drop in heart rate (p less than 0.01) and a 15% prolongation in the PR interval (p less than 0.01) for the group of 19 patients. Left ventricular end-diastolic pressure (LVEDP) was not significantly changed by diltiazem or its combination except in group 3. Cardiac output was lowered in all groups following diltiazem and propranolol (p less than 0.05). Untoward reactions included marked vasovagal reactions at the conclusion of the procedure in six patients. The combination of drugs resulted in profound sinus bradycardia with attendant 2:1 atrioventricular (AV) block in one patient. Diltiazem and propranolol were hemodynamically well tolerated in patients with preserved left ventricular function. Because of the additive negative dromotropic activities of these two drugs, ECG monitoring is warranted when they are acutely combined.

Adult↗
PubMed1984

Clinical results with Omni-Orthocor, an implantable antitachycardia pacing system.

Omni-Orthocor 234A and 239A are implantable pacers capable of synchronization with an external overdriver. Synchronous or asynchronous burst pacing, synchronized extrastimuli, or a combination of both can be obtained. Upon recognition of a tachycardia, the patient or physician can initiate pace-termination. Omni-Orthocor was implanted in 69 patients (53 for ventricular tachycardia, 11 for supraventricular tachycardia, 2 each with AV nodal reentry and WPW, and 1 patient with concealed accessory pathway). Thirty-five patients performed out of hospital termination. More resistant tachycardias were terminated in the hospital with 76.3% success in VT and only 50% success for SVT. Burst pacing was used in 75% of patients. Noninvasive electrophysiologic study was performed on all patients, and was the sole use of Omni-Orthocor in 20 patients. The device was not implicated in the six sudden death patients in this series.

Adult↗
PubMed1983

The pathophysiology of angina pectoris with normal coronary arteriograms. Histopathological and metabolic correlations with coronary vasospasm.

Angina pectoris may occur in the presence of normal major coronary vessels (NCA) in 10-20 per cent of patients investigated by coronary arteriography. Whilst hypertrophic cardiomyopathy, mitral valve prolapse and hyperthyroidism are excluded by routine investigation, in the remainder coronary vasospasm may be demonstrated. An organic basis for angina may not always be found. In order to document the pathophysiological basis for angina pectoris with NCA we have investigated patients using atrial pacing stress with measurement of coronary sinus blood flow and lactate metabolism, together with myocardial biopsy to determine biochemical and histopathological abnormalities. These have been correlated with localised coronary vasospasm induced by ergometrine (E). Thallium scintigraphy has also been used to detect the myocardial changes. Fifteen patients were investigated: 5 of 15 patients developed abnormal lactate metabolism on atrial pacing (change greater than 0.8 mg per cent in A/V lactate difference) and all had greater than 50 per cent coronary luman reduction after E. In 10 of 15 patients no lactate change occurred and in 7 no significant response to E was seen. However, significantly lower myocardial enzyme activities were found in the first group (lactate dehydrogenase p less than 0.01, malate dehydrogenase p less than 0.05, alpha hydroxy-butyrate dehydrogenase p less than 0.02). The change in myocardial enzyme activities in angina with NCA may indicate a metabolic basis for angina in those patients who develop both abnormal lactate metabolism on pacing and coronary vasospasm after ergometrine. The enzyme activities and histological changes in angina with NCA are similar to these in dilated cardiomyopathy.

Adult↗
PubMed1982

Simultaneous measurement of coronary venous blood flow and oxygen saturation during transient alterations in myocardial oxygen supply and demand.

Continuous simultaneous measurements of coronary venous oxygen saturation and coronary venous blood flow were performed in 10 open chest dogs and 13 conscious human patients, using a combination of fiberoptic oximetry and thermodilution. Measurements were made during transient coronary arterial occlusion and during the intracoronary administration of nitroglycerin or isoproterenol. Two patterns of coronary vasodilation were distinguished: in primary (demand-independent) vasodilation, both coronary flow and coronary venous oxygen saturation increased, while myocardial oxygen consumption remained constant. In secondary (autoregulatory) vasodilation, coronary flow increased as coronary venous oxygen saturation decreased, corresponding to an increase in myocardial oxygen consumption. These observations could not have been made if either coronary venous blood flow or oxygen saturation had been measured alone; thus, this investigation demonstrates the utility of this combination of techniques in the study of the coronary circulation.

Animals↗
PubMed1982

Recurrent ventricular tachycardia induced by an atrial synchronous ventricular-inhibited pacemaker.

Atrial synchronous pacemakers have been known to cause a variety of cardiac arrhythmias. Of particular concern are those arrhythmias involving a pacemaker stimulus occurring on a T wave, because these may lead to ventricular tachycardia. The Medtronic 2409 ASVIP pacemaker is an atrial synchronous pacemaker with several features designed to decrease the likelihood of such arrhythmias. We report a patient in whom a normally functioning Medtronic 2409 ASVIP pacemaker, despite these features, induced recurrent ventricular tachycardia. Conditions which predisposed this patient to pacemaker-induced re-entrant arrhythmias are discussed.

Digoxin↗
PubMed1980

Improved catheter for regional coronary sinus flow and metabolic studies.

An improved coronary sinus catheter has been developed whose enhanced flexibility facilitates catheterization of the great cardiac vein. It allows simultaneous thermodilution measurement of blood flow in the great cardiac vein and proximal coronary sinus, easy withdrawal of blood from both sites and bipolar atrial pacing from the proximal coronary sinus. The accuracy of flow measurement with this catheter has been validated by in vitro testing, and the catheter has been used successfully in eight patients. The advantages of this improved catheter over the existing coronary sinus thermodilution catheter are discussed.

Cardiac Catheterization↗
PubMed1980

Haemodynamic effects of intravenous morphine in patients with acute myocardial infarction complicated by severe left ventricular failure.

The haemodynamic effects of intravenous morphine sulphate (0.2 mg/kg body weight) were measured in 10 patients with acute myocardial infarction complicated by severe left ventricular failure. Fifteen minutes after morphine injection there was a significant fall in mean heart rate (from 109 to 101 beats/min) and mean systemic arterial pressure (from 80 to 65 mm HG), and a small fall in mean cardiac index (from 2.4 to 2.21/min/m2). Haemodynamic changes at 45 minutes were similar. Neither stroke index nor indirect left ventricular filling pressure (measured as pulmonary artery end-diastolic pressure) were consistently improved 15 or 45 minutes after injection. The useful action of morphine in relieving distressing cardiac dyspnoea is not adequately explained by systemic venous blood pooling. These results suggest that the effects of morphine on the central nervous system are more important.

Aged↗