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Biomedical subjects

R Cicogna

Publications and source records attributed to R Cicogna.

34 records · Page 2Linked to original sources
PubMed1987

[Study of myocardial perfusion by means of scintigraphy with thallium-210 in left bundle branch block induced by exertion].

Myocardial perfusion scintigraphy with 201-TL was performed in a group of subjects affected by exercise-induced, rate-dependent left bundle branch block (LBBB). The aim of the study was: to define the significance of the exercise-induced conduction abnormality: "primitive" or "ischemic". 14 patients, aging 28-58 years (x = 42), 8 with chest pain (4 typical angina, 4 atypical angina) and 6 without any symptoms were studied. None had history of prior myocardial infarction or clinical and echocardiographic signs of heart disease. LBBB appeared at a heart rate ranging from 70 to 160 beats/min. 6 patients showed repolarization abnormalities (ST changes, deep and negative T wave) suggestive for ischemia, during successive QRS normalization. 201-TL-uptake was normal in 5 subjects; in the remaining 9 ones reversible TL defects were demonstrated in the septum (6), in the septum and apex (2), in the septum and inferior-apical wall (1). No patients had irreversible impaired perfusion. All the patients had normal coronary angiography, with negative ergonovine test for coronary artery spasm. In conclusion, in the majority of our subjects (64%) with exercise-induced LBBB, a reversible TL-uptake defect, usually located in the septum without diagnostic value of obstructive CAD, has been observed. Further studies will establish if the TL-defect is only an "apparent phenomenon" due to contraction abnormality secondary to LBBB, or, on the contrary, an expression of myocardial ischemia with normal coronary vessels as a consequence of the LBBB.

Adult↗
PubMed1985

Hemodynamic advantage of combined administration of oral ibopamine and nitroprusside in patients with ischemic and idiopathic congestive cardiomyopathy.

The hemodynamic effects of combined administration of ibopamine (Ib) (150 mg orally) with nitroprusside (NP) (50-150 micrograms/min intravenously) were compared with those of NP alone in 17 patients with severe congestive heart failure due to coronary artery disease (7 patients) or idiopathic cardiomyopathy (10 patients). Hemodynamic measurements were obtained using a Swan-Ganz thermodilution catheter and a bedside thermodilution cardiac output computer. Nitroprusside alone produced a significant decrease (-12.4%) in mean arterial pressure, mean pulmonary arterial pressure (-28.3%), and systemic vascular resistance (-22.6%), and a significant increase in stroke volume index (23.1%). The administration of combined NP and Ib produced a further significant increase of stroke volume index (20.1%) with a concomitant and significant reduction of systemic vascular resistance (-19.4%); heart rate, mean systemic and pulmonary arterial pressures did not change significantly from the values observed with NP alone. Moreover, stroke work index, although not significantly modified with the vasodilator alone, was significantly increased over control values with NP + Ib association. Although NP alone induced similar effects in both the ischemic and idiopathic cardiomyopathies, the association of Ib gave a more favorable, though not significant, hemodynamic response in the subjects with primitive cardiomyopathy than in the ischemic ones. Thus, the association of Ib to NP therapy, in patients with congestive heart failure, further increases stroke volume index and stroke work index with a concomitant reduction of systemic vascular resistance, without any significant change in mean systemic and pulmonary arterial pressures, or heart rate. These results point out the possibility of associating Ib with other orally active vasodilators in the chronic treatment of congestive heart failure.

Adult↗
PubMed1985

Syncope and tumours in the neck: carotid sinus or glossopharyngeal syndrome?

Three patients with syncope, lateral cervical metastasis and/or carotid sinus hypersensitivity are described. The initial diagnosis in these patients was carotid sinus syndrome (CSS). Further investigations, including computerized tomography, showed in all the patients a malignant tumour localized in the epipharynx or nearby. We think that the symptomatology in our patients can be attributed to the epipharyngeal tumour. The mechanism of the attacks could be similar to that which operates in the glossopharyngeal neuralgia-asystole syndrome, but does not involve pain pathways. The clinical picture in our patients was quite different from the classic CSS; the vaso-vagal attacks were more prolonged, severe, and relapsing and were mainly vasodepressor. Symptoms were not improved by demand ventricular pacing, but A-V sequential pacing achieved a moderate improvement in two patients.

Aged↗
PubMed1985

[Hypotension during ventricular pacing. A study of the vagal reflex component].

It has been suggested that hypotension during ventricular pacing (V) could be caused by a parasympathetic vasodilating reflex. In order to evaluate this hypothesis, we studied 10 patients who had wide fluctuations of arterial pressure during V. Intra-arterial pressure, right atrial pressure, EKG and cardiac index (thermodilution) were determined in the following conditions: basal rhythm (B), V, atrioventricular pacing (A-V) and ventricular-atrial pacing (V-A). The same investigations have been carried out in the same conditions (B,V,A-V,V-A) after atropine 0.03 mg/Kg intravenously. The arterial blood pressure during V decreased markedly simultaneously with the appearance of cannon waves in the right atrial pressure tracing. During A-V the arterial pressure remained stable at the highest level observed during V. The start of V-A pacing induced a marked drop of arterial pressure, which, however, gradually increased to a level slightly lower than during A-V pacing. After atropine the arterial blood pressure during V decreased again in all patients concomitantly to the appearance of cannon waves in the atrium as before atropine. The values of arterial blood pressure during B, A-V and V-A were not different from those measured before atropine. Therefore, an increase of parasympathetic activity during V is not responsible for the wide fluctuation of arterial blood pressure. A possible role of sympathetic failure must be considered.

Adult↗
PubMed1985

[T-wave changes in intermittent left bundle branch block. Pathogenesis and clinical significance].

In patients with intermittent left bundle branch block (LBBB) it is common to observe T wave abnormalities in the right precordial leads during normally conducted beats. These changes have usually been interpreted as a result of anteroseptal ischemia. More recently it has been suggested that they may be the consequence of an electric phenomena secondary to the abnormal ventricular activation. However, the "benign" character of these abnormalities has never been confirmed by clinical studies. We have studied a group of 10 pts (3 males and 7 females), aging between 23 and 66 years (mean 41 +/- 8) with atypical precordial pain admitted to our institution, because of intermittent LBBB and T wave inversion in the right precordial leads during the normally conducted beats. All patients had normal left ventriculography and coronary angiograms. During the follow-up period (20 to 102 months, mean 4.7 years) they were subjected to serial clinical examinations, 24 hours ECG Holter monitoring echocardiogram and exercise thallium 201 scintigraphy. Within this period of observation, no patient developed symptoms or signs of cardiac involvement while all but three developed a stable LBBB (these three patients have been followed only for a limited period of time). Exercise thallium 201 scintigraphy showed in 4 patients a reversible septal perfusion defect during LBBB. We conclude that T wave abnormalities observed in the normally conducted beats in patients affected by intermittent LBBB have a favourable prognostic significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

[Syncope during potassium depletion (author's transl)].

The onset of serious arrhythmias during potassium depletion occurs rather frequently in female subjects who have undergone hypotensive-diuretic treatment, independently from the duration and doses of drugs. These arrhythmias which produce a cardiac arrest, can also occur in subjects not affected with heart disease. They are not necessarily preceeded by clinical prodrumus or other types of minor arrhythmias not accompanied by other important electrocardiographic or serum-logical alterations of hypokaliemia. The most commonly observed type is the "torsades de pointe", though cases of ventricular tachycardia or ventricular fibrillation are also documented. The ethiopathogenesis is discussed with regard to the alterations of the basic electrocardiogram as well as to the kind of major arrhythmia. In most cases , lidocaine has given the most satisfactory thmias, results in the treatment of these arrhythmias, probably because of the modality of the action which is substantially different from the other antiarrhythmic drugs.

Adult↗