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Biomedical subjects

P Messner-Pellenc

Publications and source records attributed to P Messner-Pellenc.

14 recordsLinked to original sources
PubMed1995

Exercise intolerance in patients with chronic heart failure: role of pulmonary diffusing limitation.

In order to test the hypothesis of pulmonary diffusing capacity involvement in exercise limitation in subjects with chronic heart failure (CHF), lung transfer factor (TLCO), oxygen saturation (SaO2), cardiac output (CO) and gas exchange were studied over the course of an incremental exercise test in 10 patients and 10 controls. The TLCO and transfer coefficient for carbon monoxide (TLCO/VA) were measured at rest and during recovery by the single breath method. The SaO2 was followed non-invasively with a finger oximeter and CO was determined according to the carbon dioxide rebreathing method. Analysis of respiratory variables at maximal effort showed significantly lower values in patients with CHF as regards peak oxygen uptake (VO2), minute ventilation (VE), heart rate (HR), oxygen pulse (O2 pulse), and CO with higher ventilatory reserve (VR) than controls. At a comparable workload (30 W), patients with CHF demonstrated higher values for VE and lower values for CO than controls. The TLCO, expressed as percent of predicted values, was significantly lower in CHF patients than controls, respectively, at rest (90.5 +/- 3.75% vs 106.8 +/- 3.8%) and within 5 min after maximal exercise (87 +/- 4.4% vs 117.4 +/- 3.81%). The TLCO/VA showed comparable data between the two groups at rest (81.7 +/- 3.28 vs 90.3 +/- 2.86%). However, significantly lower values of TLCO/VA were obtained for CHF after maximal exercise in comparison to control subjects (77.5 +/- 3.85% vs 96.3 +/- 3.95%). These results confirm the alteration of the main variables in relation to cardiopulmonary exercise limitation in-tHF, and indicate a significant decrease in TLCO and TLCO/VA after maximal exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise↗
PubMed1995

[Clinico-pathological polymorphism of hypertrophic cardiomyopathy in echocardiography].

An echocardiographic Study of 322 adults (age: 40 +/- 16 years), belonging to 20 families with hypertrophic cardiomyopathy (HCM), was undertaken. Affected subjects had a LV diastolic wall thickness > 13 mm. The patients were classified according to the distribution of left ventricular hypertrophy (LVH) and by Maron's classification: 189 subjects were normal, 127 were affected and 6 could not been classified. By Maron's classification: 3% were type I, 33% were type II, 58% were type III and 6% were type IV. LVH was asymmetrical in 95% of cases (septum/posterior wall ratio > 1.3). The familial distribution of LVH of the 4 families in which HCM was genetically related to different loci (chromosome 11, 14 exon 13, 14 exon 8, fifth locus); the LVH was analysed from two short axis LV parasternal views and each plane was divided into 5 segments. The distribution of LVH was said to be identical between two first degree relations when all the same segments were affected, similar when they differed by only 1 or 2 segments and different when they differed by 3 or more segments. In the 26 pairs studied, LVH was identical in 2/26 (8%), similar in 11/26 (42%) and different in 13/26 (50%). Familial HCM usually gives rise to asymmetrical LVH affecting the septum and free wall. An identical distribution in 50% of affected first degree relatives.

Adolescent↗
PubMed1995

[Ventricular fibrillation and defibrillation; electrophysiological bases and clinical applications].

During sinus rhythm, the successive responses to the application of electrical stimuli of increasing intensity during the vulnerable period are cardiac stimulations followed by repetitive ventricular responses and then ventricular fibrillation. An impulse of even greater intensity is not followed by ventricular fibrillation (shock at the upper limit of vulnerability) suggesting that defibrillatory shock is effective only when it does not reinduce fibrillation. Two other hypotheses are also proposed in fibrillation, that of critical mass and that of extension of the refractory periods, in particular after biphasic shocks. Clinically, the measurement of the threshold of defibrillation is difficult as it is a random process which does not obey the all or nothing principle. Ideally, a graph of efficacy versus energy should be constructed but this is only possible under experimental conditions. The effects of different antiarrhythmic drugs have been studied in this manner; in general, the sodium channel blockers improve the energies of defibrillation.

Animals↗
PubMed1994

Cardiopulmonary exercise testing. Determinants of dyspnea due to cardiac or pulmonary limitation.

The aim of this study was to bring to light new and simple criteria, obtained during cardiopulmonary exercise testing, in order to demonstrate in patients the cardiac or the pulmonary origin of a comparable exertional dyspnea. Forty male subjects were compared, who exercised with a 30-W/3-min protocol and were divided into three groups: the cardiac heart failure (CHF) group (n = 15), the chronic obstructive lung disease (COLD) group (n = 15), and the control group (n = 10). The two groups of patients differed totally from the control group concerning their spirometric values at rest and a clear inability during effort which was confirmed by all the studied cardiopulmonary parameters at maximal exercise. The CHF and COLD groups differed slightly concerning their maximum symptom-limited oxygen uptake, only when related to body mass (13.26 +/- 0.69 ml/kg/min in CHF group, 17.05 +/- 1.59 ml/kg/min in COLD group; p < 0.05), and concerning their maximum ventilatory equivalent for oxygen which tended to be higher in the CHF group in comparison with the COLD group (p = 0.082). Furthermore, and as foreseen, the two groups of patients clearly differed at maximum exercise concerning the ventilatory reserve respiratory parameter (49.73 +/- 3.18 percent in CHF group, 8.38 +/- 5.85 percent in COLD group; p < 0.01). On the other hand, they did not differ concerning cardiac parameters or those considered as such (maximum heart rate [HR], HR reserve, HR response, maximum O2 pulse measurement). While their maximum ventilation was similar in the CHF and COLD groups, a difference in adaptation during exercise was found by observing their breathing pattern. In the CHF group, this was demonstrated by a significantly lower breathing frequency at maximum exercise (31.24 +/- 1.53 beats/min vs 37.75 +/- 2.24 beats/min; p < 0.05) and a tidal volume that tended to be higher at maximum exercise (p = 0.077) and significantly higher at 60-W work load (p < 0.05). This work shows that the study of ventilatory reserve and breathing pattern during exercise testing allows one to discriminate if dyspnea on exertion in patients is due to cardiac or respiratory disease.

Adult↗
PubMed1994

[Electrocardiographic aspects of sinoatrial block].

There are many electrocardiographic changes in sinoatrial block. Only 2nd and 3rd degree blocks can be analysed on surface recordings. However, they manifest themselves by pauses, the descriptions of which are rich and varied. They also vary according to the circumstances of apparition and the escape rhythms which accompany them. Related ECG changes such as chronotropic insufficiency or carotid sinus syndrome have been described. However, their significance is not univocal and only a precise analysis of the ECG recordings allows correct interpretation of the clinical and paraclinical signs and the institution of appropriate therapy.

Cardiac Complexes, Premature↗
PubMed1994

[Floating thrombus in the right atrium and severe pulmonary embolism. Value of intravenous thrombolysis].

Mobile right atrial thrombi carry a high risk of pulmonary embolism which may be massive and are a medical emergency. Although surgery is commonly indicated, treatment with intravenous thrombolytics is an alternative and was successful in 4 out of 6 cases reported by the authors. Six patients, admitted for severe pulmonary embolism confirmed by pulmonary scintigraphy (6 cases) and by angiography (2 cases), underwent echocardiography which demonstrated a mobile right atrial thrombus. One patient was operated as an emergency and died immediately afterwards. Another, treated with heparin because of contraindications to surgery and thrombolysis had a recurrent fatal pulmonary embolism. In the other four cases, intravenous thrombolytic therapy was started immediately after echocardiography with 250,000 IU of streptokinase in 30 minutes, followed by 100,000 IU per hour for 48 to 72 hours associated with heparin 300 to 500 IU/kg/day. The biological efficacy of the treatment was confirmed in all cases (fibrinogen < 1 milligram; TCA > 60 s). A clinical improvement with improved blood gases was rapidly obtained in all 4 cases. The thrombus had totally disappeared at control echocardiography 8 to 12 hours after the initial examination. There were no complications, in particular no haemorrhages. After 6 months' follow-up, the outcome was good with oral anticoagulants (4 cases) associated with implantation of a caval filter in 1 case. Thrombolysis seems to be an effective alternative to surgery as there four cases demonstrate.

Aged↗
PubMed1992

[Hemorrhage of the brain after therapeutic fibrinolysis. 11 cases].

Ten cases of cerebral hemorrhage and one of intraspinal subdural hematoma after thrombolytic therapy are reported. Six patients were treated with streptokinase, four with rt-PA and one with a combination of both drugs. The incidence was 0.5 to 2% and was higher in case of rt-PA therapy (3.7%). In all cases, CT scan showed primary hemorrhage rather than hemorrhagic infarction. Four patients died of stroke. Among the survivors, residual disability was severe in one and mild in five. Only one patient recovered completely. In patients treated with streptokinase, the hemorrhage was probably due to a more than 80% decrease in plasma fibrinogen. In those receiving rt-PA, either excessive dosage (2 cases in our series) or lysis of cerebral microthrombi are thought to be responsible for the hemorrhagic complications. Treatment consists of infection of aprotinin (an anti-fibrinolytic drug), cryoprecipitates with factors V and VIII and protamine sulfate.

Aged↗
PubMed1991

[Late cardiac tamponade by localized compression of the left cavities after heart valve surgery. Apropos of 2 cases].

The authors report two cases of left cardiac failure occurring three and ten months after aortic valve replacement. Echocardiography established the diagnosis of localized compression of left heart chambers by hemopericardium. Surgical drainage dramatically improved patients with a follow-up of 4 years and 18 months. The authors emphasize the interest of left thoracotomy for drainage and discuss the etiology.

Aortic Valve↗
PubMed1990

[Cardiovascular disorders during sleep].

Holter recordings of subjects apparently free from cardiovascular disease have demonstrated a moderate sinusal and nodal depression during sleep. This depression does not seem to be sufficient to create overt cardiovascular disorders in apparently healthy subjects, but it may aggravate or even reveal an underlying disorder of rhythm or conduction in elderly people or in patients taking drugs that potentiate its effects. In sleep apnea syndrome prolonged episodes of apnea may produce a paroxysmal, then permanent increase in pulmonary arterial pressure, which may lead to right heart failure. These episodes also increase the pre- and after-load and decrease myocardial contractility, thus facilitating the occurrence of left ventricular failure, potentiated by systemic arterial hypertension, overweight or even coronary disease, all conditions that are often present in these subjects. Arterial hypertension is so frequent in sleep apnea syndrome that some authors advocate a systematic search for the syndrome by Holter recordings before the hypertension is pronounced "essential". All studies confirm the existence of rhythm and conduction disorders directly related to apneic episodes. These disorders decrease or regress after a well-conducted treatment of the sleep apnea syndrome. They are mainly of the "hypokinetic" type, created by depression of sinus activity and conduction pathways. Their frequency, their severity and, in particular, the risk of sudden death they carry seem to have been overestimated, especially since no evidence has ever been produced of a potentially lethal rhythm disorder occurring during sleep apnea. Nevertheless, there is no certainty that these patients are not at risk of sudden death related to their sleep apnea syndrome.

Arrhythmias, Cardiac↗
PubMed1988

[Doppler color echocardiography in the diagnosis of 4 septal perforations complicating anterior myocardial infarction].

The 4 cases reported here are meant to illustrate the value of colour doppler-echocardiography in the diagnosis of ventricular septal rupture consecutive to an anterior myocardial infarction. With this method, the examination begins with colour doppler ultrasound superimposed on two-dimensional echocardiographic images and is completed by pulsed and continuous wave doppler velocimetry. In all 4 patients an abnormal colour doppler flow was visualized from the outset; it started in the left ventricule and crossed the ventricular septum to enter the right ventricule, thus confirming the diagnosis and locating the septal defect. This abnormal flow was easy to recognize. On the apical "4 cavity" projection it followed a semi-circular anti-clockwise course which occurred at each cardiac cycle. The flow was red at first in presystole at the apex of the left ventricule; it became blue in pre- and middle-systole while traversing the septum, then mosaic-like in middle- or end-systole around the septal defect on the right ventricular side, and finally blue again in pre-diastole within the right ventricle. The blue trans-septal flow persisted at least up to pre-diastole. The diagnosis of septal rupture was confirmed at surgery in 3 cases and at right heart catheterization in 1 case. Colour doppler-echocardiography is a simple, efficient and rapid method, superior to contrast echocardiography or pulsed doppler alone, for direct real-time visualization of the shunt. It makes the septal defect easy to locate, and it avoids invasive exploratory manoeuvres in cases where surgery is contra-indicated and/or when coronary angiography is not mandatory.

Aged↗
PubMedDate not supplied

[Echocardiography].

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Echocardiography↗