[Use of serial measurements of myoglobin level in the serum for evaluation of the extent of early myocardial infarction].
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Biomedical subjects
Publications and source records attributed to R J Zochowski.
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We studied the effects of intravenous clonidine treatment in a group of 24 patients with acute myocardial transmural anterior and/or lateral wall infarction. Clonidine, known as an antihypertonic agent, was administered as a bolus of 1-2 micrograms/kg body weight and repeated every 2-3 hr. However, maximal range of the time interval was 20 min to 4 hr, maximal range of doses 37 to 150 micrograms, depending on the hemodynamic status. The effects were measured by precordial electrocardiographic mapping as well as serial creatine phosphokinase determinations. A big decrease in ST-segment elevation was observed: sigma ST reduction after 24 hr was 37% of initial value (140% in control group), after 48 hr - 30% (120% - control); NST fall after 24 hr - 45% (145% - control), after 48 hr - 41% (142% - control). NQ increased after 24 hr to 135% of initial value (156% - control), after 72 hr to 137% (167% - control). Detailed analysis revealed undoubted correlation between the dosage and favourable dynamics of precordial mapping parameters. Hemodynamic, antiarrhythmic and above all adrenolytic activity were noted. The treatment caused a distinct deterioration in daily adrenalinuria mean values to 5.99 micrograms in the first day (14.20 - control) and lower in the following days. No side effects were observed but sudden discontinuation of the therapy caused an unfavorable reaction. A temporal association between diminished adrenalinuria and both clinical improvement and limitation of infarct size was observed. Therapy with intravenous clonidine requires meticulous individualization of clonidine dosage depending on the patient's initial hemodynamic status.
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A mobile instrumentation and noninvasive method developed recently for external His bundle recording and employing the signal averaging technique was applied for intra-atrial recording of the pre-P (sino-atrial node region) activity. Recordings were obtained in ten anesthetized dogs and five patients at the time of right heart catheterization. A bipolar intra-atrial lead was used for triggering of the averaging process and a unipolar intra-atrial lead was used for signal recording. Direct bipolar epicardial recordings were obtained for comparison from the sino-atrial (S-A) node area in experimental animals. In animals studies, the averaged intra-atrial recording showed 30 muV amplitude deflections beginning 40-45 ms prior to the onset of P wave and were preceded by a slow rise and lower frequency and amplitude deflections arising 60-70 ms earlier. There was good correlation between the pre-P activity recorded intra-atrially and from the epicardium. Deflections of similar configuration but smaller amplitude (1 muV) were recorded in human studies. They preceded the onset of large atrial activity deflections (P wave) in the reference electrocardiogram by 40-80 ms. The exact source of these pre-P activity potentials has not been definitely established, but they appear to originate from the S-A node region, based on their similarity to the direct epicardial recordings and time relationship to the preceding T and following P wave.
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Mobile instrumentation and a clinically applicable method have been developed for external His bundle recording. High gain signal amplification (10)(5) filtering (30--300 HZ) and averaging (128 or 256 consecutive cycles) are used. Acquisition of signals arising in the P-R interval is triggered by the patient's QRS signal at the end of that interval. The precordial bipolar electrodiogram is digitized at 5k HZ with 8 bit resolution and transferred to a 1,024 word, 18 bit signal averager. The averaged signal is then displayed on an oscilloscope and photographed. Good correlations were obtained between direct intracardiac and precordial recordings in experimental animals and in humans. Noise level after averaging was below 0.3 microV, and there was good elimination of asynchronous atrial and ectopic ventricular activity. With averaging of 128 or 256 consecutive cycles, the signal attenuation after propagation to the chest wall was in the range 1:2000 to 1:4000 in comparison with the directly recorded His bundle activity deflections. The noninvasive method may be of value in follow-up of acute and chronic disturbances of atrioventricular conduction, as well as in studies of effects of pharmacologic interventions.
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