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Biomedical subjects

R A Warner

Publications and source records attributed to R A Warner.

At least 19 recordsLinked to original sources
PubMed1992

An analysis of symptoms in patients with permanent ventricular pacemakers.

The prevalence and severity of symptoms of the "pacemaker syndrome" were investigated in 64 patients with VVI pacemakers and compared, in the same patients, to a series of control symptoms, unrelated to pacemaker function. Symptoms were also compared in patient groups unlikely to have the "pacemaker syndrome" (atrial fibrillation), most likely to have such symptoms (retrograde atrial activation) and in an intermediate group (competitive paced and sinus rhythms). There was a linear relationship between the frequency and severity of "pacemaker" symptoms and control questions in all groups and no preponderance of "pacemaker" symptoms in any group. The study provides an estimate of the number and severity of symptoms in patients with VVI pacemakers, demonstrates the non-specificity of the "pacemaker syndrome" and shows no evidence of a sub-clinical "pacemaker syndrome" in the patients observed.

Aged↗
PubMed1991

Mitral valve prolapse and neuroticism in chest pain patients with normal and diseased coronary arteries.

Patients with chest pain and normal coronary arteries (NCA) score higher on measures of neuroticism than patients with coronary artery disease (CAD). This relationship, coupled with findings linking mitral valve prolapse (MVP) and anxiety disorders, led us to examine prospectively the possibility that a greater incidence of MVP among NCA patients accounts for their elevated neuroticism scores. One-hundred-forty-four patients completed psychological tests and a structured interview prior to cardiac catheterization. Forty-one of the 144 patients (28%) had normal coronary arteries. Within the NCA group 29 percent had MVP; within the CAD group only 13 percent had MVP. Despite the significant difference between NCA and CAD groups on measures of neuroticism, there were no differences as a function of MVP status, nor was there an interaction of MVP and coronary arterial status. These findings support the case for an association between NCA and neuroticism independent of the presence or absence of MVP.

Angina Pectoris↗
PubMed1990

Use of hepatic vein catheterization in the evaluation of patients with anasarca.

In patients with anasarca, the relative importance of cardiac, pulmonary and/or hepatic dysfunction is often difficult to determine. Conventional use of the Swan-Ganz catheter helps to separate the contributions of right and left heart disease, but it is seldom used to evaluate liver dysfunction. This report describes passage of a Swan-Ganz catheter into the hepatic vein prior to pulmonary artery placement in 11 patients. Hepatic vein catheterization permitted wedged hepatic venography using contrast media and measurement of the wedged and free hepatic venous pressures. All 11 patients had pulmonary hypertension; three had cor pulmonale only, and the others had combinations of left and right heart failure. In addition, six patients had either a cirrhotic pattern on venography, or portal hypertension. Only three of these six patients had previous clinical evidence of liver disease. This study does not prove that identification of hepatic dysfunction by this method improves the outcome in such patients. However, this low risk modification of standard pulmonary artery catheterization provides additional information which is clinically useful in searching for and avoiding complications of cirrhosis, as well as offering a clearer understanding of pathophysiology in acute multisystem disease.

Ascites↗
PubMed1988

One-year psychosocial follow-up of patients with chest pain and angiographically normal coronary arteries.

As many as 30% of patients with chest pain symptoms who are referred for arteriography are found to have normal coronary arteries. Research has shown that patients with anginal symptoms and normal coronary arteries score higher on neuroticism measurements (anxiety, depression and somatic concerns) at the time of catheterization than patients with anginal symptoms who have coronary artery disease. Research examining the cardiac course of chest pain patients with normal coronary arteries indicates that this is a nonprogressive disorder. Although follow-up studies of these patients report continued chest pain and diminished physical activity, these studies have ignored the psychologic status of the patients. Thus, it is not known whether their higher neuroticism scores at the time of catheterization persist following angiography or whether such elevated indexes of neuroticism are transient phenomena associated with precatheterization anticipatory stress. The present study examined 48 Veterans Administration Medical Center patients: 24 with anginal symptoms and normal coronary arteries and 24 with documented coronary artery disease. The patients completed a structured clinical interview and a set of psychologic inventories on the day before catheterization and 1 year later. The findings established continued high neuroticism scores among patients with anginal symptoms only and supported the findings of other investigators regarding continuing chest pain and restricted physical activity. The knowledge alone of benign coronary artery status resulted in virtually no change in the psychosocial status of these patients. Alternative treatment methods are discussed.

Angiography↗
PubMed1988

Relationship between Doppler left ventricular diastolic filling indexes and the electrocardiographic criteria for left atrial enlargement.

Traditional electrocardiographic (ECG) criteria for left atrial enlargement (LAE) emphasize the increased amplitude and width of the corresponding component of the hypertrophied atrium. Although a correlation exists between LAE and ECG criteria, a cause-and-effect relationship has not been conclusively demonstrated. Because the diastolic properties of the left ventricle directly influence left atrial emptying, these properties might also influence the ECG diagnosis of LAE. Therefore, the authors hypothesized that the ECG criteria for LAE are influenced by diastolic properties of the left ventricle as defined by Doppler-derived parameters.

Atrial Fibrillation↗
PubMed1988

Usefulness of abnormalities of repolarization in the electrocardiographic diagnosis of healed myocardial infarction.

The authors evaluated the ability of criteria involving abnormalities of repolarization to diagnose healed myocardial infarction (MI). They studied the Q, R, S, and T waves and the ST-segments of the electrocardiograms (ECGs) of 60 angiographic-normal patients, 63 patients with angiographic evidence of healed inferior MI, and 33 patients with angiographic evidence of anterior MI. The best individual criteria involving repolarization were T wave amplitude less than or equal to 0.4 mm in lead II for inferior MI (specificity, 93%: sensitivity, 67%) and T wave amplitude greater than 2.4 mm for anterior MI (specificity, 100%: sensitivity, 27%). These T wave criteria enhanced the diagnostic performances of otherwise marginal QRS criteria for both inferior and anterior MI. The authors conclude that ECG criteria that involve abnormalities of the T waves are useful for diagnosing healed MI.

Electrocardiography↗
PubMed1987

Nonpenetrating traumatic rupture of the tricuspid valve. Formation of ventricular septal aneurysm and subsequent septal necrosis: recognition by two-dimensional Doppler echocardiography.

A 26-year old man was admitted with blunt trauma to the chest following a high-speed deceleration injury. A two-dimensional Doppler echocardiogram demonstrated traumatic rupture of the tricuspid valve and a hematoma in the basilar portion of the interventricular septum. Serial two-dimensional Doppler echocardiographic analyses demonstrated evolutionary formation of a septal aneurysm and subsequent rupture with formation of a ventricular septal defect. The usefulness of the two-dimensional Doppler echocardiogram as a screening tool for cardiac contusion is discussed.

Adult↗
PubMed1987

Reevaluation of the VCG and ECG criteria for left ventricular enlargement.

Traditional electrocardiographic (ECG) and vectorcardiographic (VCG) criteria for left ventricular enlargement (LVE) understandably emphasize the increased tendency of the maximal electrical forces of ventricular depolarization to be directed toward the left. This tendency is manifested on the ECG by increased amplitudes of the R waves in leads I, AVL, V5 and V6 and by deeper S waves in lead V1. However, because the left ventricle is a relatively posterior as well as leftward structure in the thorax, LVE should also cause these forces to be directed posteriorly. Such changes in the anteroposterior dimension should be reflected in the VCG loop in the transverse plane and in the scalar ECG leads which are placed anterior to the heart. Therefore, we hypothesized that both the ECG and VCG criteria for LVE might be optimized if a variety of parameters that reflect alterations in the anteroposterior as well as in the right to left dimension are investigated.

Cardiomegaly↗
PubMed1987

Recent advances in the diagnosis of myocardial infarction.

A method of interpreting ECGs based on vectorcardiographic principles is presented. Using this method, the author and his colleagues have developed improved diagnostic criteria for inferior, anterior, and apical myocardial infarction and challenged the validity of some traditional concepts of electrocardiography.

Electrocardiography↗
PubMed1986

Systemic systolic hypertension in the elderly: correlation of hemodynamics, plasma volume, renin, aldosterone, urinary metanephrines and response to thiazide therapy.

Twenty-four men, mean age 63 +/- 1.7 years, with systemic systolic hypertension were studied before and after 1 month of therapy with oral hydrochlorothiazide, 50 mg/day. The control mean plasma volume was 2,664 +/- 96 ml, cardiac index 3.9 +/- 0.2 liters/min/m2, stroke volume index 52 +/- 2 ml/beat/m2, systemic vascular resistance 1,351 +/- 80 dynes s cm-5, plasma aldosterone 8.6 +/- 1.0 ng/dl and 24-hour urinary excretion of metanephrines 0.371 +/- 0.044 mg. On renin-sodium profiling in 23 patients, 12 were classified into a normal group and 11 into a low-renin group; none had high renin values. Based on multiple regression analysis, the 24-hour urinary excretion of total metanephrines appeared to be the single most important factor explaining 28% of the variability in systolic blood pressure (BP). After therapy with oral hydrochlorothiazide, the elevated systolic BP decreased (p less than 0.0001) and diastolic BP decreased (p less than 0.005), with concomitant reduction in systemic vascular resistance (p less than 0.03). Patients in both the normal- and low-renin groups had normal plasma volume and responded similarly to thiazide diuretic therapy, without symptomatic side effects.

Aged↗
PubMed1986

Diagnostic significance for coronary artery disease of abnormal Q waves in the "lateral" electrocardiographic leads.

To determine the diagnostic significance for coronary artery disease of abnormally large Q waves in leads I, aVL, V5 and V6--the "lateral" electrocardiographic leads--the electrocardiograms of 240 patients who had undergone cardiac catheterization were studied. First, the electrocardiograms of 99 subjects proved normal by cardiac catheterization (group 1) were studied to determine the values of the durations of Q waves in leads I, aVL, V5 and V6 that should be exceeded to be considered abnormal. These values were 30, 30, 20 and 25 ms, respectively. Then, 67 patients were identified who had abnormal Q waves in at least 1 of these leads (group 2) and 74 patients with at least 1 angiographic abnormality but without abnormal Q waves in any of these leads (group 3). Group 2 had generally more extensive left ventricular disease and a higher prevalence of anterior, inferior and apical healed myocardial infarction (MI) than group 3. However, compared with group 3, group 2 had lower prevalences of significant narrowing of the coronary arteries that supply the left ventricular lateral wall. Within group 2, abnormal Q waves in leads I and aVL (traditionally designated high lateral MI) were associated with anterior as well as apical MI, and abnormal Q waves in leads V5 and V6 (traditionally designated anterolateral MI) were associated with inferior as well as apical MI. Thus, abnormal Q waves in leads I, aVL, V5 and V6 tend to reflect apical rather than lateral MI and the term anterolateral MI is especially misleading.

Adult↗
PubMed1986

Importance of the distance and velocity of electrical forces in the diagnosis of inferior wall healed myocardial infarction: a vectorcardiographic study.

The vectorcardiograms of 41 patients with angiographically proved inferior myocardial infarction (MI) and 51 normal subjects were analyzed to determine whether it is the time (in milliseconds) or the distance (in millivolts) of the initial superiority directed forces of ventricular depolarization that is increased more by inferior MI, and whether parameters derived from both the initial superior time and distance can be used to detect inferior MI. The 10 best individual and the 10 best paired criteria for inferior MI involve superior distance, either alone or used in the calculation of average velocity (in volts per second), and the product of initial superior time and distance (in millivolts per second). The 2 best individual criteria for inferior MI are: inferior velocity more than 0.0065 V/s (sensitivity 71%, specificity 100%) and superior distance more than 0.39 mV (sensitivity 68%, specificity 100%). These diagnostic performances are superior to those of the best criterion that involves only the duration of the initial superior forces, i.e., initial superior time longer than 28 ms (sensitivity 49%, specificity 98%) (chi 2 = 8.42, p less than 0.005 and chi 2 = 6.31, p less than 0.025, respectively). Initial superior distance and parameters calculated from both initial superior distance and time are better vectorcardiographic criteria for inferior MI than are criteria that involve only initial superior time.

Diagnosis, Differential↗
PubMed1986

The effect of nitroglycerin on forearm arterial distensibility.

Nitroglycerin acts, in part, to reduce arterial impedance, and thus left ventricular work. The reduction in arterial impedance is largely attributable to a fall in systemic vascular resistance, but may also be due to an increased distensibility of the arterial tree. In this study, volume distensibility of forearm arteries was calculated from measurements of pulse-wave velocity before and during intravenous nitroglycerin infusion. Since a fall in blood pressure itself increases arterial distensibility, the induced blood pressure change was controlled as a variable by repeating the measurements with the subject's forearm in a plastic cylinder and repeating the measurements at a variety of altered cylinder pressures. At every studied pressure, nitroglycerin infusion increased forearm arterial distensibility, demonstrating another way in which nitroglycerin reduces left ventricular afterload. Since the pulsatile portion of cardiac work is approximately 10% of total work, the magnitude of this nitroglycerin effect on cardiac function is probably small.

Adult↗