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Biomedical subjects

P Graux

Publications and source records attributed to P Graux.

At least 19 recordsLinked to original sources
PubMed1992

[Measurement of pacemaker effect: incidences on the choice of pacing mode? A prospective and statistical study of 396 patients].

Single ventricular stimulation induces haemodynamic disturbances, the best known of which is the pacemaker syndrome. In order to assess the prevalence and severity of these abnormalities, invasive blood pressure monitoring was performed in 396 consecutive patients undergoing endocavitary electrophysiological investigations: a decrease in systolic blood pressure at a rate near to that of the spontaneous rhythm defines the pacemaker syndrome. It is maximal after 3 to 5 beats of equivalent intensity with or without retrograde conduction. The pacemaker syndrome is greater in hypertensive and coronary patients than in subjects with healthy hearts (-44.2 mmHg and -37.2 mmHg versus -33 mmHg, p < 0.001 and p < 0.04). It is less pronounced in cases of cardiac failure (-31.8 mmHg). The pacemaker syndrome increases in intensity with age (-44.3 mmHg after 80 years of age versus -23.1 mmHg in subjects under 50 years of age; p < 0.001). Two electrophysiological abnormalities are associated with an increased pacemaker syndrome even in apparently normal hearts: sustained induced supraventricular tachycardia (-34.2 mmHg versus -26 mmHg, p < 0.002), mixed carotid sinus syndromes (-38 mmHg) and pure vasodepressive syndromes (-48.5 mmHg, p < 0.001). The study of the pacemaker syndrome is useful for three reasons: the detection of another cardiac abnormality in cases of sustained induced supraventricular tachycardia, even in an apparently healthy heart; to assess the presence of a second haemodynamic abnormality independent of the vagal effect in cases of carotid sinus syndrome with vasodepression; finally, to identify the patients at high risk of a pacemaker syndrome.

Adult↗
PubMed1992

[Value of intravenous flecainide in electro-induced supraventricular arrhythmia. Apropos of 37 cases].

Thirty-seven patients presenting with electro-induced supraventricular arrhythmia sustained for more than 10 min or symptomatic received an intravenous injection of flecainide acetate (1.5 mg/kg; 10 mg/min). There were 24 cases of atrial fibrillation, 13 of atrial tachysystole with more than 180 beats per minute. Electrophysiological exploration was carried out for syncope (13 cases), lipothymia with palpitations (11 cases) or without palpitations (8 cases), or for a stroke of unknown origin. The induced arrhythmia was the only electrophysiological abnormality in 57% of cases. A return of sinus rhythm was obtained in 70% of cases during the injection (12 cases) or shortly after the end of the injection (14 patients). Safety was good, with the exception of the onset of two junctional rhythms and one case of non-syncopal monomorphic ventricular tachycardia. After an initial reduction, the PR, QRS, PA and HV intervals were significantly longer than baseline, whereas the AH space and the systolic blood pressure remained virtually unchanged. Thus the provision of IV flecainide acetate can only be beneficial in carrying out study protocols of abnormalities of the atrial substrate.

Adult↗
PubMed1991

[Effects on the bone metabolism of long-term treatment with antivitamins K1].

Oral anticoagulants (OC) prevent the activation by carboxylation of coagulation proteins. However this action also affects osteocalcin, or bone Gla-protein, a parameter of bone remodelling. Phosphorus and calcium metabolism, osteocalcin levels and bone mineral content were studied in twelve men aged under 60, and who had been taking OC for more than a year, in comparison with a paired group of nine controls with the same cardiovascular pathology but not taking anticoagulants. Osteocalcin levels were lower in the OC group (3.44 ng/ml) than in the control group (5.88 ng/ml) (p = 0.01). There was no significant difference in other phosphorus/calcium balance parameters nor in bone density between the two groups. No evidence was found of any osteopathy in the OC group, but the decrease in serum osteocalcin could result either from inhibition of its secretion or of its carboxylation, or from an action on the osteoblast.

Anticoagulants↗
PubMed1990

[Myocardial infarction in patients aged 70 years and over].

109 subjects aged 70 years (58 women, 51 men; average age 77 years) were hospitalized in the CICU (Cardiology Intensive Care Unit) over the period stretching from 1984 to 1986. The average length of stay in the CICU was 1 week, completed by an average stay of 5 days in the cardiology department. 100 per cent of the patients were followed up. Of the clinical parameters made evident by this study, the authors note that hypertension was the predominant risk factor (52.2 per cent); a history of coronary disease was noted in 60.5 per cent; 26.6 per cent of the patients were hospitalized before the 6th hour, chest pain being typical in 78 per cent versus painless in 11 per cent of patients; topographically, the infarction was anterior in 55 per cent, posterior in 40.4 per cent, and around the circumference in 4.6 per cent of cases; 80.8 per cent of the infarctions were transmural versus 19.2 per cent of infarctions without the Q wave--the latter accounted for a higher hospital mortality rate (38 per cent versus 27.3 per cent). The main complications were disturbances in rhythm (60.6 per cent) and LVI (56.9 per cent). Complications on the form of infections were noted in 15.6 per cent. Apart from the usual indicators of severity (cardiogenic shock, VF, LVI), infarction of the RV and AF had a serious effect on the prognosis. latrogenic disease accounted for 18.9 per cent. From the point of view of prognosis, hospital mortality was 30 per cent; mortality after one year was 44 per cent and 47.7 per cent after 2 years (in a group of 76 subjects).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Carotid sinus syndrome. Contribution of arterial pressure monitoring to intracavitary electrophysiological exploration].

A prospective study based on intracavitary electrophysiological exploration coupled with invasive arterial pressure monitoring was conducted in 245 patients aged 70.2 +/- 13 years who had experienced syncopes and/or lipothymias of uncertain origin. The study showed that 63 patients (25.7 p. 100) had carotid sinus syndrome (CSS). The syndrome was of the vagal type (cardiac inhibition) in 27 p. 100 of the cases, of the depressor type (vasodepression) in 22 p. 100 of the cases and mixed in 51 p. 100 of the cases with the two types of pathological response: electrophysiological and haemodynamic. Compared with the remaining 182 patients, these 63 patients were more frequently male (63.5 p. 100, p less than 0.01), of the same age (71.7 years, NS) and more symptomatic, meaning that syncopes occurred in 80 p. 100 of the cases and that their number per patient was higher (2.92, p less than 0.01). A predisposing factor (usually a vagal predominance) was found in 26.9 p. 100 of the cases. In 30 p. 100 of the patients CSS was associated with a sinus node disease or with disorders of atrioventricular conduction. Another haemodynamic abnormality often associated with CSS was a more pronounced (-38.7 mmHg, p less than 0.01) and more frequent (68 p. 100, p less than 0.01) pacemaker effect. 62 p. 100 of patients with mixed CSS had an increase in systolic arterial pressure during vagogenic manoeuvres with DDD mode stimulation as compared with the VVI mode stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Spondylodiscitis disclosing bacterial endocarditis. Apropos of a case. Review of the literature].

The authors report a case of infectious spondylodiscitis revealing a staphylococcal endocarditis in a patient with a Carpentier aortic heterograft. This case, along with 60 descriptions from the literature, has enabled them to specify the characteristics of occurrence of endocarditis during a spondylodiscitis. The clinical factors in favor of this association are: a pre-existing cardiopathy, an oral port of entry, occurrence of other rheumatoid manifestations, even more the presence of complications of endocarditis. The laboratory factors in favor of an association are: discovery of an inflammatory anemia, of circulating immune complexes, of a cryoglobulinemia, of a rheumatoid factor, of hematuria. But it is mostly the demonstration of streptococcus in blood cultures and other samples that should be an indication to search for an endocarditis, the course of which dominates the prognosis.

Discitis↗
PubMed1987

[Primary liposarcoma of the left atrium surgically treated].

A case of myxoid liposarcoma of the left atrium in a 35-year old man is reported. The tumour, revealed by an atrial flutter, was excised. The patient died 13 months later, with multiple metastases. A review of the literature yielded only 7 cases of primary liposarcoma of the heart, including 4 which were surgically treated. This confirms the extreme rarity of a tumour which has a very poor prognosis due to recurrence in situ or metastatic spread.

Adult↗
PubMed1986

[Congestive cardiomyopathy in addiction to clobenzorex, an anorexigenic drug].

Cardiac failure caused by high doses of amphetamine-like drugs is rare. We report a case of decompensated congestive cardiomyopathy occurring in a 29 year old woman addicted to clobenzorex (Dinintel). This patient had been taking 5 to 7 capsules per day for 5 years. No other cause of cardiac failure was detected. A rapid improvement was obtained by digitalis and diuretic therapy; no further episodes of cardiac failure were observed after one year. However, the drug could not be completely withdrawn and echocardiography has shown increasing left ventricular dilatation. The possible mechanisms of amphetamine induced myocardial toxicity are discussed and the analogy with the group of adrenergic cardiomyopathies is underlined.

Adult↗
PubMed1986

[Iatrogenic pathology in coronary intensive care units. Results of a prospective survey on 802 patients].

Iatrogenic disease in the coronary care unit was detected and analysed using a grid over a 17.5 month period (16.09.82 to 25.02.84). The cases of 802 patients, mean age 65.8 years, predominantly male (56.6%) were examined. Minor or minimal pathology in which the causal relationship was conditional or doubtful according to Karch's criteria was excluded. Only those conditions, moderate, severe or even lethal, specific or not to this type of unit, requiring specialised hospital care and in which the causal relationship could be adequately established were retained. Iatrogenic pathology was common: 11.84% of admissions. This group of 95 patients did not differ significantly from a control group with respect to age [average 4 years older (NS)] or mortality. However, there was a clear cut female predominance (68%, p. less than 0.01) and a different distribution of the organic pathology (p less than 0.001). The iatrogenic disease developed before hospital admission in 40% of patients and during hospitalisation in 60% of patients. It increased the duration of the patient's stay by half (2.77 days). Nearly a quarter of these patients had two or more types of iatrogenic disease. The undesirable effects of drugs were mainly bradycardia (44 cases), tachycardia (11 cases), haemodynamic changes, vascular, renal, gastrointestinal, metabolic and endocrine complications. Twenty-one complications of medical procedures and 13 of surgical procedures were also noted. This study, the first to have been performed in a Coronary Care Unit to the author's knowledge, confirms the high incidence of iatrogenic pathology. This fact should be born in mind before taking any therapeutic decision or before performing invasive diagnostic investigations.

Adult↗