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Biomedical subjects

P K Mazeika

Publications and source records attributed to P K Mazeika.

14 recordsLinked to original sources
PubMed1994

Influence of haemodynamics and myocardial ischaemia on Doppler transmitral flow in patients undergoing dobutamine echocardiography.

To examine whether pulsed Doppler left ventricular filling indices can reliably detect myocardial ischaemia in patients with coronary artery disease undergoing dobutamine stress echocardiography we studied three groups matched for age and global indices of left ventricular function. Group I patients (n = 10) had normal coronary arteries whereas those in Groups 2 (n = 12) and 3 (n = 15) had significant coronary disease (> or = 70% diameter stenosis) at angiography. After stopping cardioactive treatment, patients underwent incremental dobutamine stress (5, 10, 15 and 20 micrograms.kg-1.min-1) during pulsed Doppler interrogation of diastolic filling with simultaneous heart rate and blood pressure measurements. Only Group 3 patients developed myocardial ischaemia using electrocardiographic and cross sectional echocardiographic criteria; subset 3A (n = 4) comprised those with inducible mitral regurgitation on colour Doppler. Electrocardiographic R-R interval decreased (-311 +/- 123 ms, P < 0.001) and mean blood pressure altered (5 +/- 17 mmHg, P = ns) uniformly across groups. The respective changes in peak early velocity, peak atrial velocity and their ratio for Groups 1 (0.08 +/- 0.09 m.s-1, 0.26 +/- 0.18 m.s-1 and -0.32 +/- 0.36), 2 (0.07 +/- 0.07 m.s-1, 0.18 +/- 0.15 m.s-1 and -0.13 +/- 0.21) and 3 (0.09 +/- 0.12 m.s-1, 0.20 +/- 0.13 m.s-1 and -0.17 +/- 0.21) were similar (all P = ns between groups). Corresponding data for subset 3A (0.23 +/- 0.04 m.s-1, 0.20 +/- 0.10 m.s-1 and 0.00 +/- 0.16) revealed a significantly greater increase in peak early velocity and normalized velocity ratio in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1994

Massive pulmonary embolism in pregnancy treated with streptokinase and percutaneous catheter fragmentation.

Despite heightened awareness, pulmonary embolism remains a major cause of maternal mortality in the antenatal period and one which has not decreased in incidence over the four triennia since 1976. We report a patient who suffered massive pulmonary embolism with circulatory collapse in the second trimester and who was treated with intravenous streptokinase followed by percutaneous mechanical dispersion of thrombus using a catheter and guide wire. She made an excellent recovery despite complicating antepartum haemorrhage. In life-threatening circumstances pharmacological thrombolysis is mandatory particularly for hospitals without a cardiac catheterization laboratory on site.

Adult↗
PubMed1993

Prognostic value of dobutamine echocardiography in patients with high pretest likelihood of coronary artery disease.

To examine the value of transient regional asynergy on dobutamine stress echocardiography as a noninvasive predictor of future cardiac events, 51 symptomatic patients (aged 54 +/- 9 years) with suspected coronary artery disease (CAD) were studied using an incremental regimen of 5, 10, 15 and 20 micrograms/kg/min. Pretest likelihood of CAD was (mean +/- standard error of the percentage) 79.7 +/- 5.6% before and 83.4 +/- 5.2% after exercise electrocardiography using probability analysis based on age, sex and symptoms. Two-dimensional images were analyzed with reference to an 11-segment model and gave good interrater agreement. During 24 +/- 4 months (range 19 to 32) of follow-up, 23 patients had events (1 myocardial infarction, 9 unstable angina, 10 coronary bypass surgery, 3 coronary angioplasty) and 28 were event free. Age, proportion with baseline asynergy and both pretest echocardiographic ejection fraction and its response to dobutamine were similar in these 2 groups (all p = not significant). Transient asynergy was seen in 17 of 23 patients (74%) with and 8 of 28 patients (29%) without events (p < 0.01); 5 of 6 patients (83%) with involvement of 3 segments had events. Myocardial infarction or unstable angina occurred in 8 of 25 (32%) with a positive and 2 of 26 (8%) with a negative stress echocardiogram (p < 0.05). Both exercise duration (389 +/- 195 vs 517 +/- 237 seconds, p < 0.05) and time to diagnostic ST-segment shift (291 +/- 192 vs 447 +/- 212 seconds, p = 0.05) were shorter in those with inducible asynergy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cardiocytolytic antimyolemmal antibodies in dilated cardiomyopathy following presentation: observations in 7 patients.

The prevalence of lytic activity of circulating antimyolemmal antibodies in dilated cardiomyopathy of recent onset is unclear. To obtain preliminary data we studied 7 consecutive patients with dilated cardiomyopathy (age 44 +/- 14 years) and symptoms for fewer than 6 months. The presence of antimyolemmal antibodies was determined in vitro using intact rat and human cardiocytes and indirect immunofluorescence. Serum cytolytic index for antimyolemmal antibodies was measured by microcytotoxicity assay and the data were compared with that from 70 controls (normal range 0.92 +/- 0.07, effective cytolysis < 0.75). Autoantibody screening was uniformly negative and only 1 patient had positive viral serology. Light microscopy of cardiac biopsies revealed non-specific histology in 2, focal myocarditis in 1 and healing or healed myocarditis in 4. Significant binding of IgG, IgM or polyvalent antibodies to antimyolemmal antibodies bound to rat or human cardiocytes was present in every patient and 5 of them were positive with all 3 markers. Cytolytic index for the group ranged from 0.47 to 0.60 indicating effective lysis in all patients (P < 0.01 versus controls). Cardiocytolytic antimyolemmal antibodies are commonly present in dilated cardiomyopathy following presentation. Their detection might reflect ongoing disease activity and help identify patients likely to benefit from immunomodulative therapy.

Adolescent↗
PubMed1992

Dobutamine stress echocardiography for detection and assessment of coronary artery disease.

Stress echocardiography with dobutamine infusion for detection of coronary artery disease is a potential alternative to exercise stress testing with some theoretic advantages. Fifty patients who were not receiving cardioactive medication were prospectively studied with two-dimensional echocardiography and 12-lead electrocardiography (ECG) during incremental dobutamine infusion (5, 10, 15 and 20 micrograms/kg body weight per min, each dose for 8 min). Images were analyzed by using an 11-segment left ventricular model. All patients underwent correlative exercise ECG and coronary angiography, which revealed normal coronary arteries in 14 and significant disease (greater than or equal to 70% diameter stenosis) in 36. Peak rate-pressure product during dobutamine infusion was 18,845 +/- 4,156 versus 23,740 +/- 6,158 mm Hg/min on exercise (p less than 0.01). Interobserver concordance for wall motion analysis was good (kappa coefficient = 0.77). The use of baseline (n = 14) or reversible (n = 24) regional asynergy to define an abnormal dobutamine echocardiogram resulted in a sensitivity for detecting coronary artery disease of 78% and a specificity of 93%. Corresponding data for the dobutamine ECG were 47% and 71% and for the exercise ECG were 72% and 71%, respectively. The development of new mitral regurgitation on Doppler color flow imaging (n = 4) improved sensitivity to 81% without loss of specificity. Inducible asynergy or new mitral regurgitation was observed in 6 (50%) of 12 patients with single-, 6 (60%) of 10 with double- and 12 (86%) of 14 with triple-vessel disease. The site of transient asynergy provided additional localizing information. Exercise duration and time to diagnostic ST segment shift were shorter in patients with coronary artery disease with versus those without echocardiographic evidence of ischemia (both p less than 0.05). Side effects during dobutamine infusion were mild and short-lived. Dobutamine stress echocardiography is well tolerated, is useful for detection and assessment of coronary artery disease and is applicable to patients unable to exercise.

Adult↗
PubMed1992

Stress Doppler echocardiography using dobutamine in coronary patients with and without ischaemia induction.

To examine the effects of dobutamine on pulsed-Doppler left ventricular ejection dynamics and its utility for evaluation of coronary disease (CAD) we studied 10 patients with normal coronaries (Group 1) and 24 patients with significant CAD (greater than or equal to 70% diameter stenosis) using a graded stress infusion (5 to 20 micrograms.kg-1.min-1). Two-dimensional echocardiography was performed to detect regional asynergy and analysed using an 11-segment model. Patients with CAD were divided into those with (Group 3, n = 14) and without (Group 2, n = 10) inducible ischaemia; six patients had reversible involvement of greater than or equal to three segments (subset 3A). Groups were well matched for baseline left ventricular function and all studies were carried out while the patients were not taking cardioactive therapy. Hyperkinetic wall motion was typical and exaggerated hyperkinesis of normal segments was commonly seen in those with baseline (n = 9) or reversible asynergy (n = 14). Normals and CAD patients showed comparable changes in heart rate and blood pressure (P = NS between groups).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Aspirin to prevent growth of vegetations and cerebral emboli in infective endocarditis.

The incidence of stroke on cranial computed tomography (CT) and change in echocardiographic vegetation area was prospectively compared in a preliminary observational study involving nine patients with infective endocarditis randomized to either low-dose aspirin (75 mg d-1, Group I, n = 4) or no aspirin (Group II, n = 5). Two symptomatic cerebral infarcts and one myocardial infarct occurred in the controls, compared to no events in patients on aspirin during a total observation period of 343 d (range 28-49 d). The mean vegetation area decreased in the aspirin group (mean change = -0.24 cm2), compared to an increase in controls (mean change = +0.35 cm2). The platelet half-life (normal range 5-6 d), which was measured using Indium-111 radiolabelling, tended to be lower in Group II (4.6 +/- 0.2 vs. 3.9 +/- 0.5 d). No side-effects or complications attributable to aspirin were observed. A possible role for adjunctive aspirin therapy in the prevention of embolic complications in infective endocarditis is suggested, and warrants further study.

Adult↗
PubMed1991

Pharmacological stress echocardiography in the evaluation of coronary artery disease.

This article deals with the application of pharmacological stress echocardiography, a relatively new and evolving technique, to the diagnosis and assessment of patients with coronary artery disease. The value of echocardiography in ischaemic heart disease is initially outlined, followed by a brief review of the exercise two-dimensional echocardiography and exercise echo-Doppler literature. Dipyridamole, adenosine and dobutamine stress echocardiography are then examined, and the rationale and potential advantages of this approach explained. The findings of our own work using dipyridamole and dobutamine stress, combined with both two-dimensional echocardiography and Doppler, are then described. A review of the various methods of echocardiographic image analysis is then presented and the article concludes by suggesting directions for future work.

Adenosine↗
PubMed1989

Chronic active hepatitis associated with diclofenac sodium therapy.

Diclofenac sodium (Voltarol, Geigy Pharmaceuticals) is a non-steroidal anti-inflammatory derivative of phenylacetic acid. Although generally well-tolerated, asymptomatic abnormalities of liver function have been recorded and, less commonly, severe hepatitis induced by diclofenac. The patient described developed chronic active hepatitis after six months therapy with diclofenac sodium which progressed despite the withdrawal of the drug, a finding not previously reported.

Adult↗