Biomedical subjects
Publications and source records attributed to P Block.
A patient with group B streptococcal endocarditis and large vegetations resembling mitral valve myxoma is described. Group B streptococcal endocarditis and the differential diagnosis of vegetations and cardiac tumors are briefly reviewed.
In view of the increasing interest in quantifying and modifying the size of myocardial infarction (MI), it is important to look for clinically practical subsets of electrocardiographic leads that allow the earliest and most accurate diagnosis of the presence and electrocardiographic type of MI. A practical approach is described, taking advantage of the increased information content of body surface potential maps over standard electrocardiographic techniques for facilitating clinical use of body surface potential maps for such a purpose. Multivariate analysis was performed on 120-lead electrocardiographic data, simultaneously recorded in 236 normal subjects, 114 patients with anterior MI and 144 patients with inferior MI, using as features instantaneous voltages on time-normalized QRS and ST-T waveforms. Leads and features for optimal separation of normal subjects from, respectively, anterior MI and inferior MI patients were selected. Features measured on leads originating from the upper left precordial area, lower midthoracic region and the back correctly identified 97% of anterior MI patients, with a specificity of 95%; in patients with inferior MI, features obtained from leads located in the lower left back, left leg, right subclavicular area, upper dorsal region and lower right chest correctly classified 94% of the group, with specificity kept at 95%. Most features were measured in early and mid-QRS, although very potent discriminators were found in the late portion of the T wave.(ABSTRACT TRUNCATED AT 250 WORDS)
Beta-endorphin (beta-End) and adrenocorticotrophic hormone (ACTH) were determined in the peripheral blood of 14 human volunteers exercising on a bicycle ergometer. After 1 h of submaximal work below anaerobic threshold (AT), defined as the 4 mmol X l-1 lactic acid level in arteriolar blood (Kindermann 1979; Mader 1980), beta-End and ACTH levels did not change from control conditions. Eleven of the same 14 subjects performed an uninterrupted graded exercise test on the same bicycle ergometer until exhaustion. This time beta-End and ACTH levels increased concomitantly with exercise of high intensity: at each moment, during and after this maximal test, a highly significant correlation (P less than 0.0001) was noted between the levels of beta-End and ACTH. The peak values of these hormones were reached within 10 min after stopping maximal exercise, and coincided with lactic acid peak levels. A rise in lactic acid levels above the anaerobic threshold always preceded the exercise-induced rise in beta-End and ACTH. Within the population tested, two subgroups could be distinguished: one comprising individuals whose hormonal response nearly coincided with the rise in lactic acid (rapid responders) and a second group composed of subjects whose normal response appeared delayed with respect to the lactic acid rise (slow responders). These results support the view that beta-End and ACTH are secreted in equimolar quantities into the blood circulation in response to exercise, and suggest that metabolic changes of anaerobiosis play a key role in the regulation of stress-hormone release.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The clinical value of an index of left ventricular synergic pumping efficiency (EFF) was evaluated in 50 patients with uncomplicated myocardial infarction in which radionuclide ventriculography was performed within 72 h of the onset of the infarction and between 7 and 13 days post infarction. EFF was defined as the ratio of global left ventricular stroke volume to the magnitude of all intraventricular blood pool variations measured on a pixel by pixel basis. EFF correlated better with a subjectively evaluated wall motion index (r = 0.84) than did the ejection fraction (EF) measurements (r = 0.69). In all patients, but most significantly in patients with inferoposterior infarctions, EFF measurements in the acute phase were a better predictor of the predischarge ventricular performance than the EF measurements. The left ventricular EFF is a reliable parameter to quantitate the effect of regional wall motion disturbances on global ventricular function in a standardized manner.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two-dimensional echocardiography has proved to be reliable in the diagnosis of mitral, aortic and pulmonary stenosis. Its role in the diagnosis of rheumatic tricuspid stenosis is still being defined; therefore, the tricuspid valve echograms of 147 patients with rheumatic heart disease were examined. Thirty-eight of these patients also underwent hemodynamic evaluation. Tricuspid stenosis was defined echocardiographically as diastolic anterior leaflet doming, thickening and restricted excursion of the other two tricuspid leaflets and decreased separation of the leaflet tips. Using these criteria, the sensitivity and specificity of the echocardiogram in detecting tricuspid stenosis were 69 and 96%, respectively, in the group of 38 patients who had both echocardiographic and hemodynamic evaluations. However, when the smaller group of 17 patients who had simultaneous right atrial and right ventricular pressure recordings were considered separately, there was complete agreement between the echocardiographic and hemodynamic data. Thus, the two-dimensional echocardiogram is a sensitive and specific test for diagnosing rheumatic tricuspid stenosis. In addition, these data provided an opportunity to determine the prevalence of tricuspid stenosis in this group of patients with chronic rheumatic valvular disease. Tricuspid stenosis was present in 14 (9.5%) of the total group of 147 patients who had two-dimensional echocardiograms, and in 10 (26.3%) of the 38 who had both echocardiographic and hemodynamic studies. In patients with rheumatic heart disease about to undergo cardiac catheterization, an echocardiographic study should prove useful in making the diagnosis of tricuspid stenosis.
The history of a 67-year-old woman presenting a sudden nontraumatic pneumopericardium is reported. Investigation revealed that this patient had developed a bronchopericardial fistula secondary to a bronchogenic carcinoma. The clinical diagnosis was confirmed at autopsy. Although it is fairly evident that in this case the pneumopericardium could be related to the bronchogenic carcinoma, only a few reports of such an association have been published in the literature.
Explore the source record for details and available documents.
To define the optimal lead system for exercise electrocardiography, data of the whole body surface potential distribution were analyzed in 25 normal subjects and in 25 patients with coronary artery disease at rest and during exercise. All patients had a normal electrocardiogram at rest. The sensitivity of the standard chest leads was 60 percent; it improved to 84 percent with the body surface map whereas both methods had a 100 percent specificity. On the basis of these data, and reports from other centers, it is concluded that a single bipolar lead from the right subclavian area to lead V5 is adequate in those laboratories that are restricted to testing subjects with a normal electrocardiogram at rest. In patients with a previous infarction or other abnormalities in the electrocardiogram at rest three (pseudo) orthogonal leads or several standard leads are necessary. Recommendations for optimal measurements from the exercise electrocardiogram are based on quantitative computer analysis of the selected leads in larger groups of patients. Best results were obtained with a combination of S-T amplitude, S-T slope and heart rate. The improvement in sensitivity from 50 percent with visual analysis to 85 percent with computer was similar to that obtained with body surface mapping. Changes of the P wave and QRS complex during exercise appeared to be of little diagnostic value. The pathophysiologic mechanisms that contribute to the changes of the electrocardiogram during exercise are discussed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.