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Biomedical subjects

R K Mautner

Publications and source records attributed to R K Mautner.

At least 19 recordsLinked to original sources
PubMed1983

Catheter-induced coronary artery spasm: an angiographic manifestation of vasospastic angina?

During a 4-year period, 33 patients with angiographic coronary artery spasm in the absence of significant fixed occlusive disease were reviewed. Sixteen patients had typical variant angina and 17 had catheter-induced spasm. All patients had one or more episodes of rest angina. Left ventriculography demonstrated mitral valve prolapse in 14 patients (42%) and end-systolic cavity obliteration in six (18%). Spasm was demonstrated to occur in the right coronary artery in 26 patients and in the left coronary artery in seven. Two patients had multivessel spasm. Comparing patients with variant angina and catheter-induced spasm demonstrated no significant difference in clinical, ECG, or angiographic parameters. Two patients with catheter-induced spasm had healed myocardial infarctions and both developed spontaneous non catheter-induced spasm in the infarct vessel. The majority of patients responded to long-acting nitrate therapy, though those with catheter-induced spasm tended to have more recurrent chest pain. Six patients were placed on calcium antagonist drugs with marked symptomatic improvement in five. This study suggests that patients with catheter-induced spasm are similar to those with variant angina and its angiographic documentation may be a marker for the identification of patients with vasospastic angina.

Adult↗
PubMed1982

Limitations of ergonovine testing in patients with variant angina.

Fourteen patients with variant angina underwent ergonovine testing during diagnostic coronary angiography. The clinical electrocardiographic or angiographic manifestations of coronary artery spasm could not be reproduced in six of these patients. Five patients had chest pain and transient ST-segment elevation within 4 days of the ergonovine study, including three who developed coronary spasm in the catheterization laboratory. It appears that the sensitivity of ergonovine testing in the diagnosis of coronary spasm is lower than previously emphasized.

Adult↗
PubMed1982

Myocardial ischemia in patients with fixed occlusive coronary artery disease secondary to vasospasm in the "normal" vessel.

Seven patients with significant fixed occlusive coronary artery disease had coronary artery spasm in a "normal" vessel. All patients had one or more episodes of rest angina and six had exertional angina as well. Four sustained previous myocardial infarction. During spontaneous angina, five patients had ST-segment elevation in the inferior electrocardiographic leads. One patient had ST-segment elevation in anterior leads. During angiography, spasm was demonstrated in the right coronary artery in three patients and in the left anterior descending coronary artery in one patient. This study emphasizes the interaction of fixed and vasospastic disease and has strong implications concerning the management of patients with ischemic heart disease.

Adult↗
PubMed1982

Electrocardiographic changes in acute pancreatitis.

Electrograms recorded during 50 episodes of acute pancreatitis were analyzed and compared to those recorded during an asymptomatic period. Ten episodes of acute pancreatitis occurred in eight patients with normal ECGs during an asymptomatic period. Nonspecific ST-T changes were recorded in only two of them (one with mild hypokalemia). ECGs recorded during 40 episodes of acute pancreatitis in 24 patients who had ECG abnormalities during an asymptomatic period revealed no significant changes during 33 of the episodes. The seven episodes associated with significant ECG changes occurred in patients with previous ECG abnormalities. Review of the literature and of our cases strongly suggests that significant ECG alterations during acute pancreatitis usually occur in patients with previous cardiac abnormalities.

Acute Disease↗
PubMed1981

Coronary angiography post first myocardial infarction in the asymptomatic or mildly symptomatic patient: clinical, angiographic, and prospective observations.

The role of coronary arteriography in the asymptomatic or mildly symptomatic post first myocardial infarction patient is controversial. Thirty-one class 0-1 patients (Canadian Heart Association Grading System) underwent coronary arteriography within six months (mean 67 days) of their first myocardial infarction. Coronary arteriography revealed three-vessel disease in nine (29%), two-vessel disease in ten (32%), single-vessel disease in ten (32%), and normal coronary arteries in two (6%). No patient had left main disease, and two (6%) had left main equivalent disease. In 12 patients with single-vessel disease or normal coronary arteries there were no morbid events over a mean follow-up period of 26 months. In the 19 with multivessel disease, eight (40)% developed a cardiac event during a mean follow-up period of 11.4 months. These included one who elected to undergo immediate aortocoronary bypass surgery, two with unstable angina, three acute myocardial infarctions, and two deaths. Based on these data and review of the literature, a scheme is proposed for the subsequent evaluation and treatment of this patient group.

Adult↗
PubMed1981

Short-term effects of intravenous clonidine in congestive heart failure.

After intravenous bolus injections of clonidine HCl (150 micrograms) to 12 patients with congestive heart failure, peak effects appeared in 5 to 20 min. Clonidine reduced heart rate from 94 +/- 14 to 82 +/- 14 bpm (mean +/- SD, P less than 0.05), left ventricular filling pressure from 31 +/- 5 to 23 +/- 5 mm Hg (P less than 0.001), mean systemic arterial pressure from 98 +/- 13 to 82 +/- 13 mm Hg (P less than 0.001), mean pulmonary artery pressure from 46 +/- 6 to 38 +/- 6 mm Hg (P less than 0.001), and right atrial pressure from 14 +/- 5 to 11 +/- 5 mm Hg (P less than 0.05). Cardiac index increased from 1.6 +/- 0.4 to 1.8 +/- 0.6 l/min/m2 (P less than 0.05) and stroke volume from 32 +/- 10 to 43+/- 12 ml/beat (P less than 0.05). Systemic vascular resistance decreased from 2,342 +/- 800 to 1,795 +/- 345 dynes sec cm-5 (P less than 0.05) and pulmonary vascular resistance from 365 +/- 158 to 263 +/- 114 dynes sec cm-5 (P less than 0.05). We conclude that clonidine decreases heart rate and left ventricular preload and afterload in congestive heart failure.

Adult↗
PubMed1981

Early treadmill testing and coronary arteriography after myocardial infarction.

Thirteen male patients underwent early symptom-limited treadmill testing and coronary arteriography after their first myocardial infarction. All were functional class I at the time of evaluation, and none sustained any complications. Of five patients with a negative treadmill test, two had single-vessel disease, one had double-vessel disease, and two had triple-vessel disease. Two had elective aortocoronary bypass surgery, and three remained asymptomatic during a one-year follow-up. Eight patients had a positive test. From this group, one had single-vessel disease, one had double-vessel disease, and six had triple-vessel disease, including two with stenosis of the left main coronary artery. Four had aortocoronary bypass surgery, two died suddenly, progressive angina developed in one, and one remained asymptomatic. Early treadmill testing and coronary angiography in asymptomatic survivors of their first myocardial infarction is safe and extremely valuable in identifying patients with critical multivessel coronary artery disease.

Adult↗
PubMed1981

Coronary artery spasm: a mechanism of chest pain in selected patients with the mitral valve prolapse syndrome.

A group of 14 patients with mitral valve prolapse syndrome was referred for coronary angiographic study. The group was selected on the basis that all members had recurrent chest pain as their chief complaint and all had interpreted their chest pain as serious enough to warrant at lest two previous emergency visits to medical facilities in the six months preceding the study. All were found to have normal left ventricular function, and only one had a significant fixed obstructive coronary lesion. Seven of 14 patients (50 percent) showed evidence of coronary artery spasm during the catheterization study, five of whom had histories highly suggestive of coronary vasospasm. During the catheterization, spasm occurred spontaneously in three patients, ws ergonovine-induced in two, and was catheter-tip-induced in two. Ergonovine was administered to nine of the 14 patients. The drug induced vasospasm in two patients but failed in seven (two of whom had previously demonstrated catheter tip spasm). Of those seven patients who showed evidence of spasm, four had typical chest pain in association with reversible ST segment elevation and manifested a variant anginal syndrome.

Adult↗
PubMed1981

The prolonged effect of pentaerythritol tetranitrate on exercise capacity in stable effort angina pectoris.

We studied the effect of a single oral dose of 40 mg of pentaerythritol tetranitrate (PETN) on the exercise capacity of ten patients with angina pectoris. The study design was a randomized double-blind crossover comparing the effects of 40 mg of oral PETN with placebo on exercise tolerance. Patients were exercised to moderate angina pectoris before and 2 1/2 and 4 1/2 hours after receiving the placebo or PETN at seven-day intervals during the double-blind crossover period. Exercise tolerance time was measured using a multistage, progressive treadmill test. Exercise times were greater 2 1/2 hours and 4 1/2 hours following PETN compared with placebo (P less than 0.05). Heart rate, systolic and diastolic blood pressure, and double product at rest (supine and standing) and at point of angina pectoris did not change significantly.

Administration, Oral↗
PubMed1980

Coronary artery pain. A possible cause of graft occlusion in a patient with fixed obstructive coronary artery disease.

We describe a 50-year-old man with rest angina and ECG anterior wall subendocardial ischemia. During coronary angiography, a high-grade proximal left anterior descending stenosis was present. Spontaneous total spasm distal to the lesion occurred without chest pain or ST segment shifts. The patient underwent aortocoronary bypass surgery and continued to have the same pain as preoperatively. Repeated catheterization demonstrated total occlusion of the bypass graft with unchanged native coronary vessels. This suggests prolonged coronary artery spasm as the mechanism for graft occlusion.

Angina Pectoris, Variant↗
PubMed1980

Atrioventricular and intraventricular conduction disturbances in aortic valvular disease.

Electrophysiologic studies of His' bundle were done on 32 consecutive patients with symptomatic aortic valvular disease. Nineteen had pure aortic regurgitation and 13 had aortic stenosis, four with significant regurgitation. Fifteen of the former had atrioventricular (AV) and/or intraventricular (IV) conduction abnormalities. In those with aortic stenosis, eight had conduction abnormalities, all intraventricular but one. Twelve of the 13 with aortic stenosis had radiographically indentifiable valve calcification; all four with a peak systolic gradient greater than 80 mm Hg had IV conduction defects. Of the 32 patients, six had A-H prolongation and in all the predominant lesion was aortic regurgitation (one with moderate stenosis). There was no difference in age, clinical congestive heart failure, coronary artery disease, or prolonged H-V interval. However, PR prolongation (P = .01) and decreased ejection fraction (P = .02) was significantly increased in the former group. Patients with aortic regurgitation had longer A-H and H-V intervals (NS), induced A-V block at lower heart rates (P = .01), and higher A-V node effective (P = .001) and functional (P = .01) refractory periods. In summary, patients with aortic valvular disease have a high incidence of atrioventricular and intraventricular conduction disease.

Adult↗