PubMed Health⌕ Search

Biomedical subjects

P Samet

Publications and source records attributed to P Samet.

At least 19 recordsLinked to original sources
PubMed1979

Cardiac-pulmonary edema and low pulmonary capillary wedge pressure.

We describe a patient who presented with acute massive pulmonary edema, clinically and on chest roentgenogram. Two hours later the patient became hypotensive and was found to have a low pulmonary capillary wedge pressure (PCWP). The blood pressure returned to normal after administration of fluids. Acute pulmonary edema develops if PCWP rises higher than 25 to 30 mm Hg. In our patient, the elevated PCWP fell to low normal within two hours, when chest roentgenogram and clinical examination still suggested severe pulmonary edema. A phase lag existed between lowering of the pulmonary capillary wedge pressure and clearing of fluid from the alveolar and interstitial spaces in the lungs. At least three different pathogenetic mechanisms in patients with coronary artery disease can produce this phase lag. Transient global ischemia of the left ventricle was thought to be the responsible mechanism in our patient.

Blood Pressure↗
PubMed1979

Electrophysiologic evaluation of elderly patients with sinus bradycardia: a long-term follow-up study.

One hundred three patients with persistent sinus bradycardia were evaluated electrophysiologically and followed prospectively for a mean of 4.6 years. The 5-year survival rate was 74.8%, not significantly different from the 72% rate in the general population with similar age and sex distribution. Forty-one patients had abnormal corrected sinus-node recovery time. Overall accuracy of abnormal corrected sinus-node recovery time in predicting serious sinus node disease in symptomatic and asymptomatic patients was 90% (37 of 41 patients) and 100% in patients with syncope (18 of 18 patients). The sensitivity of the test was 66%. Abnormal corrected sinus-node recovery time in patients with sinus bradycardia appears to be a valuable specific, predictive index of serious sinus node disease and therefore a useful test in selecting patients for pacemaker therapy, especially if symptoms such as dizziness or syncope are present.

Aged↗
PubMed1979

Syncope and aortic stenosis: significance of conduction abnormalities.

22 patients with syncope and significant aortic stenosis underwent electrophysiological evaluation in addition to the hemodynamic study. Abnormalities of impulse formation or conduction were present in 12 patients. 6 patients demonstrated HV times greater than or equal to 55 msec. There was no correlation between the aortic valve gradient and the HV interval, between the enddiastolic volume of the ventricle and the HV time and between aortic valve calcification and the HV time. Syncopal attacks were corrected with aortic valve replacement even in patients with prolonged HV times.

Adult↗
PubMed1978

Optimal enzyme test combination for diagnosis of acute myocardial infarction.

One hundred consecutive patients admitted to our cardiology service with the suspected diagnosis of acute myocardial infarction were evaluated with serical enzyme and isoenzyme determinations in an attempt to develop the medically and financially optimal combination of enzyme tests. In patients with onset of chest pain less than 24 hours before admission, creatine phosphokinase MB determination on admission and after 12 hours was sufficient to diagnose of exclude myocardial infarction. One serum LDH isoenzyme determination 24 hours after admission confirmed the diagnosis in 74% of patients.

Acute Disease↗
PubMed1977

Conduction disturbances in patients with mitral valve prolapse.

The electrocardiograms (ECGs) of 55 patients with mitral valve prolapse were analyzed. Twelve of these demonstrated conduction abnormalities. Five patients had first degree heart block. Three had the classic ECG changes of the Wolff-Parkinson-White syndrome. Two patients had left anterior hemiblock, one of whom also had incomplete right bundle branch block. One patient had episodes of advanced atrioventricular block and periods of sinus arrest, which resulted in recurrent syncopal attacks. One patient had incomplete left bundle branch block. The presence of conduction disturbances points to the diffuse nature of the myocardial abnormality in mitral valve prolapse.

Adolescent↗
PubMed1977

Echocardiographic assessment of left ventricular function in coronary arterial disease.

This investigation was designed to determine the role of echocardiography in the assessment of left ventricular function in patients with significant coronary arterial disease. Satisfactory echocardiograms were obtained in 43 patients with coronary arterial disease. The ventriculographic ejection fraction was determined by the area length method. The echocardiographic left ventricular end-diastolic dimension was increased to more than 5-4 cm in 17 patients. Fifteen of these patients had an ejection fraction of 0-45 or less. Three patients had a normal left ventricular end-diastolic dimension but an ejection fraction of less than 0-45. Twenty-three patients had an ejection fraction of more than 0-45 and a normal left ventricular end-diastolic dimension. The left ventricular end-diastolic dimension index was increased (greater than 3 cm/m2) in 15 patients, all of whom had ejection fraction of less than 0-45. Three patients had a normal left ventricular end-diastolic dimension index and an ejection fraction of less than 0-45. Twenty-five patients had a left ventricular end-diastolic dimension index of less than 3 cm/m2 or less and an ejection fraction of more than 0-45. The percentage fractional shortening of the echocardiographic left ventricular dimension was reduced in 25 patients. In 18 of these the ejection fraction was 0-45 or less. The percentage fractional shortening of the left ventricle was normal in 18 patients. In 2 of them the ejection fraction was less than 0-45. In summary, increase of the left ventricular end-diastolic dimension or left ventricular end-diastolic dimension index is usually associated with a critical reduction of the ejection fraction as determined by ventriculography. Since the ejection fraction is an important determinant of mortality related to bypass graft surgery, echocardiography should be useful in the detection of patients with a poor prognosis.

Adult↗
PubMed1977

Coronary artery bypass surgery in patients seventy years of age and older.

Fifty patients 70 years of age and older underwent coronary artery bypass surgery for disabling angina pectoris or congestive heart failure or both (two quadruple, 11 triple, 25 double grafts, 12 single). Twenty additional procedures were done (11 mitral valve replacements for papillary muscle dysfunction, six ventricular aneurysmectomies, four aortic valve replacements, and one repair of ventricular septal defect). Surgical mortality rate was 8 per cent (four patients). Total mortality rate was 14 per cent, after a mean follow-up of 17 months. Of 30 patients undergoing coronary artery bypass surgery alone, two died during surgery and none of follow-up. Age alone should not be a contraindication for coronary artery bypass surgery. Surgical risk is acceptable in older patients, and improvement can be expected in the majority of patients.

Age Factors↗
PubMed1977

Mitral valve replacement in medically unresponsive congestive heart failure due to papillary muscle dysfunction.

Forty patients with a mean age of 65 years (range 44-76 years) were operated on; 30 of 40 patients (75%) had prior myocardial infarction. All had severe therapy-resistant congestive heart failure, 75% (30 of 40 patients) were symptomatic at rest, and 25% (10 of 40 patients) were symptomatic on minimal exertion. Cardiac index ranged from 1.24-2.84 L/min/m2 (mean 1.99). Left ventricular end-diastolic pressure ranged from 3-36 mm Hg (mean 18). All patients had significant mitral insufficiency and contractility was reduced markedly to moderately in 63% (25 of 40 patients). Significant coronary artery disease (obstruction greater than or equal to 75%) was present in all patients. All had mitral valve replacement, 30 had bypass surgery, and 7 left ventricular aneurysmectomy. Five died during surgery or before discharge (early mortality 12.5%). After a mean follow-up period of 16 months, another eight patients died, two with causes not related to the cardiovascular system (total mortality 32.5%). Of 20 patients with a cardiac index greater than or equal to 1.5 L/min/m2 and an ejection fraction greater than or equal to 0.40, 17 survived surgery and improved postoperatively. Mitral valve replacement for this group of patients is recommended.

Adult↗
PubMed1976

Diagnosis of Björk-Shiley aortic valve dysfunction by echocardiography.

Echocardiography was performed on 26 patients with prosthetic Björk-Shiley aortic valves (BSAV). Technically satisfactory records were obtained in 22 patients. The systolic displacement of the valve disc varied from 1 to 1.8 cm. (mean, 1.4 cm.). Six patients developed valve dysfunction. Two patients had complete absence of Björk disc motion and dense echoes in the aortic root were noted on the echocardiogram. Extensive clot formation in and around the valve was seen at operation. After clot removal, these two echocardiograms showed excellent disc motion (1.5 and 1.8 cm.). In a third patient with a clotted valve, marked reduction of the velocity of opening and closing of the valve was noted. Three patients had aortic incompetence without evidence of clot formation. Normal disc motion (DM) was observed in all three. A seventh patient presented with a low output state and markedly reduced valve clicks. Echocardiography revealed normal DM with marked dilatation of the left ventricle. These features were confirmed by angiography. We conclude that: (1) satisfactory echocardiograms can be obtained in most patients with BSAV; (2) echocardiography may be a useful method of detecting Björk valve dysfunction.

Adult↗
PubMed1976

Development of mitral insufficiency following closure of ostium secundum atrial-septal defect.

The development of severe mitral insufficiency after a successful closure of an ostium secundum ASD was encountered in four adult patients. This acquired postoperative lesion appeared nine years, three and a half years, two year, and two months following ASD repair. It was associated with deterioration of the excellent clinical improvement following closure of ASD, and was detected clinically by the appearance of a new apical holosystolic murmur. In one patient, pathologic examination of the mitral valve indicates insufficiency to be possibly due to rheumatic valvulitis. The cause of mitral insufficiency in the other patients is not clear. Multiple etiologies could be responsible for this unusual association.

Adult↗
PubMed1976

Selective versus non-selective His bundle pacing.

His bundle pacing was achieved in 10 anaesthetized open chest dogs by stimulation from bipolar electrode catheters positioned in the aortic root and right heart. Recordings were taken directly through plunge wires from the right atrium, high ventricular septum, and epicardial sites on the right and left ventricles. Six types of response were seen during A-V junctional stimulation: (1) low atrial pacing; (2) combined atrial and His bundle pacing; (3) His bundle pacing; (4) combined atrial, ventricular septal, and His bundle pacing; (5) combined septal and His bundle pacing; and (6) ventricular pacing. Pacing of the His bundle in combination with the atrium and/or ventricular septum is designated as non-selective, whereas stimulation of the His bundle alone is considered selective pacing. Non-selective His bundle pacing can be recognized from the surface leads by changes in onset and amplitude of the QRS with appreciable T-wave alterations. Although electrode position was an important determinant of the type of pacing achieved, a variety of patterns of stimulation resulted from variation in the modalities of the pacing stimulus, ie, polarity, intensity, and duration. Unless these factors are considered, selective His bundle pacing may not be achieved.

Animals↗
PubMed1975

Inotropic action of tolbutamide on human myocardium.

The inotropic action of tolbutamide previously demonstrated in vitro was evaluated in 15 nondiabetic subjects during diagnostic cardiac catheterization. Following bolus injection of 250 mg of tolbutamide intravenously, a rise of serum insulin and a slight fall of serum potassium were observed. Inotropic response was determined from significant fall in PEP/LVET ratio, significant fall of left ventricular end-diastolic pressure, shift to an augmented function curve in work-pressure relationships, and prominent rise of dP/dt values at comparable heart rates. The inotropic effect was greatest at 5-15 min with return to near control values at 30 min. An unusually marked inotropic response was observed in one subject. While the measurable net hemodynamic effect of tolbutamide in the human heart is small, its effect on ischemic and normal areas within the heart of a diabetic patient with atherosclerosis may be different. Thus, its ultimate effect on the diseased heart may be significant.

Blood Glucose↗
PubMed1975

Thromboembolism associated with pigtail catheters.

Three incidents of asymptomatic arterial thromboembolism associated with polyurethane pigtail catheters occurred during 1,417 cases of left ventricular angiocardiography. No similar incident occurred with polyethylene pigtail or (dacron) Eppendorf and Gensini (style) catheters. In vitro comparison of hydraulic characteristics of polyurethane (Cordis) and polyethylene (Cook) pigtail catheters showed higher flow-pressure transmission through the tip of the Cordis polyurethane catheter favoring dislodgment of any existing clot. The problem of thrombogencity of polyethylene compared with polyurethane remains unsettled. Our experience with polyurethane pigtail catheters has resulted in limitation of their use in our laboratory.

Adult↗
PubMed1975

Coronary arteriography: prevention of thromboembolic complications using a pressure-drip flushing technique.

All selective coronary arteriographic examinations (1,833) performed in the authors' laboratory during a five-year period (1/1/70 to 12/31/74) were analyzed for mortality and total morbidity according to method used. During the first two years, the control period, the classic brachial artery cutdown (Sones) and percutaneous femoral artery puncture (Judkins) techniques were utilized. Mortality rate for the total 589 patients was 1.01%. This included a mortality of 0.26% (1/386) for the brachial arteriotomy method, and 2.5% (5/203) for the percutaneous femoral puncture approach. After introduction of the pressure-drip flushing technique, the subsequent three-year mortality rate for a total of 1,244 patients was 0.16%. This included an incidence of 0.17% (1/585) for brachial arteriotomy and 0.15% (1/659) for modified percutaneous puncture techniques. The morbidity incidence during the initial two-year period was 3.0% (18/589). This included an incidence of 2.0% for brachial arteriotomy and 5.0% for percutaneous puncture techniques. After institution of the new pressure-drip flushing technique the total incidence fell to 1.2% equally divided between arteriotomy and percutaneous techniques. Modification of the classic percutaneous femoral artery puncture techniques has resulted in major reduction of mortality and morbidity complications which are chiefly thromboembolic in nature. It has not significantly influenced local thrombotic complications of arteriotomy.

Angiocardiography↗
PubMed1975

Calcific aortic insufficiency--a review of 26 patients.

Twenty-six patients, 8.3 per cent of all patients with aortic valve disease, and 10.7 per cent of all patients with any degree of aortic insufficiency detected in our catheterization laboratory, had pure calcific aortic insufficiency (no associated stenosis). Nineteen (73 per cent) males and seven (27 per cent) females ranged in age from 25 to 75 years of age (mean 51). Twenty-three per cent were younger than 40. Sixteen (62 per cent) had rheumatic heart disease, one had luetic aortic valve disease, one had congenital bicuspid valve, and eight (31 per cent) had aortic insufficiency of undetermined etiology. Twenty-three patients (89 per cent) had an aortic systolic ejection murmur, and seven (28 per cent) had an aortic ejection click. Aortic valve calcification was detected by plain chest films in only four patients (16 per cent), and by routine image intensification fluoroscopy (before catheterization) in fifteen patients (68 per cent). The reamining 32 per cent had the calcification of the aortic valve detected during catheterization. Aortic valve calcification was severe in nine patients (35 per cent), moderate in eleven patients (42 per cent), and minimal in six patients (22 per cent). Aortic insufficiency was severe in twenty patients (77 per cent), moderate in five patients (19 per cent), and minimal in one patient (4 per cent). Nineteen patients (77 per cent) had reduced left ventricular contractility. Sixteen patients (67 per cent) had low cardiac index. Eighteen patients had obstructive coronary artery disease. Aortic stenosis was misdiagnosed as the predominant lesion in fourteen patients (54 per cent)--prior to catheterization. This series demonstrates that all patients with calcified aortic valve disease and with ejection murmurs do not necessarily have aortic stenosis. Pure calcific aortic insufficiency is a distinct entity, more common than previously suspected.

Adult↗
PubMed1975

A His bundle electrocardiographic analysis of cardiac conduction in the pediatric and adolescent patient.

Bipolar electrode catheter recordings of His bundle electrograms with three simultaneously recorded surface electrocardiographic leads were obtained from 30 pediatric and adolescent patients (aged 3 to 18 years). In 14 patients, cardiac murmurs were proved to be innocent by cardiac catheterization. The control conduction intervals were compared to those of 13 patients with congenital heart disease, and three with acquired heart disease (myocardiopathy, rheumatic valvular disease, and Friedreich's ataxia). P-R, intra-atrial (P-A), A-V nodal (A-H), and intraventricular (H-V) conduction intervals were measured to the nearest 5 msec. Conduction delays were analyzed in each of the three components of the P-R interval. These delays occurred both in single components of the system as well as in combined conduction delays and were not always demonstrable by surface electrocardiograms. The Wenckebach phenomenon induced by atrial pacing was localized to the A-V node as well as the His-Purkinje system. This technique of intracardiac electrogram recordings is safe, does not significantly prolong cardiac atheterization time, and often yields unique and useful data concerning A-V conduction.

Adolescent↗