New treatments for old hearts.
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Age Factors↗
Biomedical subjects
N D Berman
Publications and source records attributed to N D Berman.
Detection of entrapped intracardiac air with intraoperative echocardiography.
Embolization of entrapped intracardiac air represents a significant risk to the patient undergoing open heart surgery. To date, there have been no menas available to ensure that the heart is free of air prior to restoration of the circulation. To assess whether M mode echocardiography can accurately detect intracardiac air, we studied 10 dogs during cardiopulmonary bypass. Randomly, air was or was not injected into the left ventricular cavity of the fibrillating heart. Intracardiac air could be recognized by the presence of a stippled granular pattern, or a loss of the discrete linear echoes or decreased far field echoes, or any combination of these three. In all, 131 random observations were made. When 1.0 cc of air was injected, sensitivity and specificity were both 100 percent, but when 0.2 cc was injected, sensitivity and specificity decreased to 86 and 58 percent, respectively. thus, M mode echocardiography appears to provide a sensitive and specific tool for detecting intracardiac air.
Animals↗
Surgical procedures involving cardiopulmonary bypass in patients aged 70 or older.
Cardiac surgery was performed in 27 patients whose ages ranged from 70 to 78 years (mean, 72). In 17 of these patients, the operation was coronary artery bypass grafting without other procedures. There were 3 operative deaths (17.6 percent) but no late deaths during a mean follow-up period of 14 months, and all the 14 surviving patients were improved symptomatically. In the other 10 of the 27 patients, the operation was valve replacement. There was no operative mortality among the 6 aortic valve patients and 1 operative death among the 4 mitral valve patients; the corresponding late deaths were 2 and 1, respectively, during a mean follow-up period of 41.3 months. Improvements in operative management and improved criteria for the selection of patients should afford benefits and risks for elderly cardiac patients similar to those for younger cardiac patients.
Aged↗
Ventricular tachycardia initiated by both normally and aberrantly conducted atrial premature beats.
Electrophysiologic studies were performed in a 72-year-old female with recurrent ventricular tachycardia in whom all documented spontaneous episodes were initiated by atrial premature beats. These studies confirmed the diagnosis of ventricular tachycardia and its initiation by atrial premature beats. Both normally and aberrantly conducted atrial premature beats were capable of initiating the tachycardia. With aberrant prematures the onset of the tachycardia was delayed in proportion to the delay in the right bundle branch. Triggered automaticity and re-entry were equally plausible as underlying mechanisms for this arrhythmia.
Aged↗
T wave sensing with a programmable pacemaker.
A patient with a recently implanted programmable pacemaker presented with slowing of the pacemaker discharge rate. At all programmed rates the cycle length of pacing was equal to the programmed cycle length plus the interval from pacing artifact to the midpoint of the T wave. Recordings from the implanted electrode documented that the amplitude of the T wave. Recordings from the implanted electrode documented that the amplitude of the T wave beyound the refractory period of the pacemaker was still sufficient to recycle the pacemaker.
Adult↗
Patient-initiated transtelephone transmission of electrocardiographic signals in the diagnosis of arrhythmias.
Thirty-one patients who had complained of recurrent palpitations were given transtelephone transmitters of electrocardiographic signals and instructed to use the transmitters while they were having symptoms. From the transcribed electrocardiograms sinus tachycardia was documented in 12 patients, paroxysmal atrial tachycardia in 7, atrial fibrillation in 4, atrial flutter in 3, frequent ventricular premature beats in 4 and ventricular tachycardia in 1. Patient-initiated transtelephone transmission of electrocardiographic signals was found to be an effective means of documenting the nature of symptomatic paroxysmal tachycardia.
Adolescent↗
The elderly patient in the coronary care unit. II. Incidence and treatment of arrhythmias.
In 1976, 130 patients aged 70 or older were admitted to the Coronary Care Unit (CCU) at Toronto Western Hospital. Arrhythmias were noted in all but 24 percent. Digoxin was given to 53 patients, lidocaine to 24, propranolol to 28, and quinidine to 11. In 2 patients, cardioversion by direct current was required for supraventricular arrhythmias. In 26 patients, temporary pacemakers were used. Of 13 patients who experienced at least one cardiac arrest in the CCU, 10 survived to be discharged to the ward. In total, only 12 of the 130 elderly patients died in the hospital, and in only 3 of these was arrhythmia the primary cause of death. The treatment of arrhythmias in the elderly is as successful and rewarding as in younger patients. Indications for the various antiarrhythmic drugs are similar. Except for digoxin, the dosages of such drugs for the elderly are the same as those for younger patients. Adverse effects apparently are not more common in the elderly.
Aged↗
The elderly patient in the coronary care unit. I. Acute myocardial infarction.
In a Coronary Care Unit (CCU) with no age barrier for admission, 21 percent of the patients admitted in 1976 were aged 70 or older. Myocardial infarction was documented in 55 of 130 elderly patients. The overall incidence of arrhythmias was similar to that for younger patients. The mean duration of stay in the unit and the CCU mortality (9.1 percent) were similar in both elderly and younger patients, as was the in-hospital mortality rate. Of the patients who survived hospitalization, 75.6 percent were still living 18.1 months after the myocardial infarction. The elderly patient is as likely as the younger one to benefit from admission to a CCU.
Acute Disease↗
Pneumopericardium following laparoscopy.
There have been no published reports of pneumopericardium complicating laparoscopy. Following an apparently uncomplicated laparoscopy, a 35-year-old woman developed pneumopericardium associated with subcutaneous emphysema of the neck. This resolved without specific therapy and without sequelae.
Adult↗
Influence of aortocoronary bypass surgery on employment.
Aortocoronary bypass operations are expensive. Economic benefit might be derived if such operations influenced the ability of persons with symptomatic coronary artery disease to be employed. Follow-up data were obtained for 329 survivors of bypass operations 2 to 60 months (mean, 22.9 months) postoperatively; 178 had been working prior to the operation and 213 were working at the time of follow-up, for a net gain of 35 employed patients. Therefore, bypass surgery does lead to a small but significant increase in the proportion of angina patients who are employed.
Adult↗
The surface electrocardiogram in complete intra-his heart block.
In some cases, the surface ECG may be useful in predicting that the level of heart block is intra-His rather than supra-His. In five patients with third degree heart block the level of block was documented to be within the His bundle. In all five, the surface ECG showed an escape rhythm with QRS complexes of less than 0.10s. duration. The initial QRS forces were abnormal in that "septal" q waves were not present in leads 1 and V6. Two of the five patients had occasional conducted beats with normal "septal" q waves. Thus, heart block associated with an escape rhythm of narrow QRS morphology but abnormal septal depolarization may indicate that the level of the block is intra-His rather than supra-His.
Aged↗
Permanent pacing in the elderly.
A total of 89 patients, age 80 years or older at the time of initial permanent pacemaker implantation, were followed for 10 to 128 months [mean 32.7]. There were 54 males and 35 females. The mean age was 84.8 years. There were 51 patients age 80-84, 25 age 85-89, and 13 age 90-94. The actuarial 5-year survival was 45%. Complications occurred in 23 patients [40 episodes]. To date, 41 patients have already required at least one pulse generator replacement and 2 patients have already required 5 replacements. All but 3 patients were symptomatic prior to pacing and 56 were asymptomatic at last follow-up. Permanent pacing in the elderly is therapeutically rewarding and not associated with excess morbidity.
Actuarial Analysis↗
Myocardial infarction, hyperthyroidism and normal coronary arteries: report of two cases.
Myocardial infarction is uncommon in persons with hyperthyroidism and also uncommon in the absence of demonstrable coronary artery disease. Cardiac catheterization and selective coronary angiography were performed in two men following apparent myocardial infarctions. Both patients were 33 years of age, thyrotoxic and angiographically free of coronary artery abnormalities.
Adult↗
Early recognition of cardiac tamponade.
Nine patients with cardiac tamponade were seen in an 11-month period. Analysis of the clinical and laboratory data indicated that pulsus paradoxus was the most useful physical sign and echocardiography the most useful investigative technique. Three of nine patients died but in only one was the late recognition of tamponade a possible factor in the outcome. Pericardial fenestrations were required in four patients. Viral pericarditis accounted for the tamponade in three cases. There were two cases each of uremia and malignant disease and one case of tuberculous pericarditis. One other case followed pericardiectomy. In five patients tamponade was the initial manifestation of illness.
Adult↗
Long-term angiographic assessment of the influence of coronary risk factors on native coronary circulation and saphenous vein aortocoronary grafts.
The influence of smoking, hyperlipidemia, and glucose intolerance on graft patency and rate of progression of obstructive disease in the native circulation was assessed in 99 patients 1 1/2 years after aortocoronary bypass grafting. There were 24 patients in whom none of these risk factors was identified. There were 42 patients with one, 29 with two, and four with three risk factors. Overall graft patency rate was 74%. Graft patency was not significantly influenced by any of these factors either singly or in combination. Progression of obstructive disease in both proximal and distal segments of grafted vessels and in nongrafted vessels was not significantly increased by the presence of one, two, or three risk factors. Over all, there was progression in 56% of segments proximal to grafts, in 8% distal to grafts, and in 14% of nongrafted vessels. Longer term studies will be required to establish any adverse influence of these risk factors on saphenous vein bypass grafts and native circulation.
Adult↗
Prinzmetal's angina with coronary artery spasm. Angiographic, pharmacologic, metabolic and radionuclide perfusion studies.
We studied the effects of coronary artery spasm on perfusion of the microvasculature in a patient with Prinzmetal's angina. Intracoronary injections of 99mTc and 131I-labelled macroaggregated human serum albumin were performed (1) at rest, (2) during spontaneous angina, (3) after the administration of nitroglycerin and (4) during pacing-induced spasm and the resultant scans compared. The resting scan was normal. Pain and spasm were associated with a perfusion defect that was localized to the anterior and inferior walls of the left ventricle. The localization of the perfusion defect corresponded with angiographically demonstrated spasm involving left anterior descending and distal circumflex coronary arteries. A subsequent myocardial infarction was localized by 43K scanning to the same perfusion area. Metabolic and parasympathetic stimulation studies were performed but were inconclusive. The patient's recurrent pains were ultimately controlled with large oral doses of isosorbide dinitrate.
Angina Pectoris↗
A method for the on-line automatic beat-to-beat digital display of cardiac action potential duration.
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Action Potentials↗
Cannon waves with A-V association.
Under appropriate circumstances, cannon waves can occur in the presence of A-V associated rhythms. Presented here is a case of first degree A-V block with cannon waves. Recognition of these waves and their behavior aided in diagnosing the patient's rhythm. The cannon waves were documented by jugular venous pulse recordings.
Electrocardiography↗