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R Kala

Publications and source records attributed to R Kala.

At least 19 recordsLinked to original sources
PubMed1999

[An odd ECG].

Explore the source record for details and available documents.

Arrhythmias, Cardiac↗
PubMed1998

Beta-blockers and antithrombotic treatment for secondary prevention after acute myocardial infarction. Towards an understanding of factors influencing clinical practice. The European Secondary Prevention Study Group.

AIMS: Long-term beta-blockade reduced mortality after acute myocardial infarction by about a quarter in a series of published trials. Representative data on beta-blocker use for secondary prevention are scanty but indicate wide variations. We have analysed European practice, and sources of variation, by regional sampling of acute myocardial infarction patients admitted to hospital in 11 countries during the period January 1993-June 1994. METHODS AND RESULTS: Treatment data for 4035 representative patients were collected for the hospital phase and 6 months after discharge. A logistic regression model was developed to describe the predictors of beta-blocker use. In the 11 regional samples, 6-38% (20% overall) of patients had no recorded contraindications but were discharged without a beta-blocker. In the absence of perceived contraindications, there was a strong, independent negative association between age and odds of treatment (P < 0.001), and women were less likely to be treated than men (adjusted odds ratio 0.76, 95% CI 0.58-0.99). Discontinuation of beta-blocker treatment by 6 months was significantly less likely in regions where the proportion given such treatment at discharge was high. In contrast, use of antithrombotic agents in the samples was consistently high. CONCLUSIONS: There is persisting low use of beta-blocker secondary prophylaxis, particularly in the elderly and in women, not attributable to perceived contraindications or intolerance. Considerable regional variations persist despite shared trials evidence. Discharge treatment strongly influences long-term medication.

Adrenergic beta-Antagonists↗
PubMed1998

Use of coronary angiography and revascularization procedures following acute myocardial infarction. A European perspective.

AIMS: There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions concerning the impact of the high rate of these cardiac procedures. METHODS AND RESULTS: A population-based patient sampling approach was utilized to identify routine practice in representative samples from 11 European countries. Data were collected retrospectively on treatment in the 6 months following acute myocardial infarction (n=2807). There was wide variation in utilization of coronary angiography and revascularization procedures. Even after restricting the analysis to patients <65 years (n=1262), there remained a 6 13 fold variation in the use of these procedures. A decreased likelihood of undergoing these procedures was associated with older age. In addition, there was an independent and negative association between female sex and utilization of coronary angiography and coronary artery bypass grafting (CABG). CONCLUSION: The effect on patient outcome of the observed variation in use of these procedures is not known but has important cost and resource implications for the health services. Outcome research is needed to define patient selection criteria and to measure the cost-utility of different angiography and revascularization rates.

Adult↗
PubMed1991

Sleep and cardiac rhythm in healthy men.

Cardiac rhythm during sleep was analysed in 168 healthy men aged 19 to 30 (mean 21.8) years using continuous nocturnal ECG recordings. Thirty five of the subjects were endurance athletes; 99 were recorded at home and 69 at a garrison during military service. The number of short term (less than one min) accelerations of heart rate of more than ten beats per minute ranged from 1.3 to 14.3 per hour; the number or accelerations (greater than one min) of more than 25 beats per minute typical of nocturnal restlessness ranged from zero to 6.1 per hour. The accelerations indicating nocturnal restlessness were more common during recordings done at the garrison than at home (2.2 per hour vs 1.3 per hour, P less than 0.01), whereas the short term accelerations were not (5.8 per hour vs 5.1 per hour, NS). Sinus pauses exceeding 2.00 sec occurred in 17 men (13 in athletes), occasional second degree atrioventricular block in 19 (eight in athletes) and ventricular premature beats in 37. Eighty-two per cent of sinus pauses, 83% of second degree atrioventricular blocks, and 81% of ventricular premature beats (when less than ten in the same subject) were associated with short term changes in heart rate. In conclusion, rapid changes in heart rate, presumably as a results of autonomic activation, are closely associated with most arrhythmias in healthy men during sleep, whereas changes in heart rate typical of nocturnal restlessness have little arrhythmogenic effect.

Adult↗
PubMed1986

Adverse reactions to fluorescein angiography.

Adverse reactions to ophthalmic patients during 9909 fluorescein angiographies during 9 years were registered. Nausea (4.6%) and vomiting (1.3%) were the most common untoward reactions. Allergic skin manifestations occurred in 48 patients, and 5 patients complained of shortness of breath. 56 patients (0.6%) felt dizzy during or immediately after the investigation. Nine patients complained of chest pain, three of whom developed myocardial infarction. Sixteen patients collapsed during the procedure. One healthy male, 42-year-old, collapsed after the injection of fluorescein during angiography, and electrocardiogram showed an asystole of 24 seconds. Otherwise, the electrocardiograms registered on 100 consecutive patients did not reveal any systematic changes in heart rate or rhythm during fluorescein angiography.

Adolescent↗
PubMed1986

Parent-child agreement on child psychiatric symptoms assessed via structured interview.

Correlations between scores derived from structured interviews with 299 disturbed children aged 6-18 and their parents indicated low-to-moderate levels of agreement regarding the presence and severity of child psychiatric symptoms. Agreement was higher on behavior and conduct problems than on anxiety, fears, obsessions-compulsions, psychotic symptoms and affective disturbances. Parents reported more child behavior and conduct problems than children, whereas children reported more affective and neurotic symptoms than parents. Parent-child agreement also increased sharply with age.

Adolescent↗
PubMed1984

Effect of beta-blocking drugs on beta-cell function and insulin sensitivity in hypertensive non-diabetic patients.

The effects of two beta-blocking drugs on endogenous insulin secretion and insulin sensitivity were investigated in a double-blind cross-over study in 13 hypertensive patients. The patients were randomly allocated to each of three 2-week treatment periods with propranolol 80 mg b.i.d., atenolol 50 mg b.i.d. and placebo b.i.d. Endogenous insulin secretion was assessed by measuring serum insulin and C-peptide before and 6 min after iv administration of glucagon; insulin sensitivity was determined by measuring insulin binding to erythrocytes, and as the glucose disappearance rate (KITT) after i.v. insulin. Fasting concentrations of serum free fatty acids (S-FFA) and plasma gastric inhibitory polypeptide (P-GIP) were also recorded during the three study periods. Both propranolol and atenolol reduced blood pressure, heart rate and S-FFA concentrations compared to placebo, and all patients showed measurable plasma concentrations of propranolol and atenolol. The results can be considered representative, therefore, of clinical beta-blockade. The two drugs did not significantly influence the fasting blood glucose level. There was an increase in fasting and glucagon-stimulated serum C-peptide concentration during propranolol therapy compared with placebo (p = 0.037 and p = 0.030, respectively), although this was not reflected by a significant change in serum insulin. Propranolol and atenolol did not significantly influence insulin binding to erythrocytes, but they clearly reduced the glucose disappearance rate KITT was compared to placebo (p = 0.0036 and p = 0.0003), respectively). The findings support the view that beta-blocking drugs can influence glucose metabolism by mechanisms other than inhibition of endogenous insulin secretion.

Adrenergic beta-Antagonists↗
PubMed1984

Influence of laryngoscope design on heart rate and rhythm changes during intubation.

One hundred and twenty adult patients about to undergo surgery were premedicated with either meperidine or meperidine and atropine. After anaesthesia was induced with thiopentone and succinylcholine given, tracheal intubation was performed with the use of either a Magill or a Macintosh laryngoscope. There were no statistical differences in changes of heart rate and rhythm between the groups, as regards the type of premedication given or the design of laryngoscope used.

Adult↗
PubMed1984

Ambulatory electrocardiographic findings in young athletes between 14 and 16 years of age.

Ambulatory electrocardiographic recordings were obtained from 35 male athletes between 14 and 16 years old, and from 35 male non-athlete controls of the same ages, in order to determine the effects of regular physical training on cardiac electrical activity. In the young athletes, the heart rates were significantly (P less than 0.01) lower than in the nonathletes. Sinus intervals over 2.00 s were present in five athletes (14%) and one control (3%). First-degree atrioventricular block was detected in eight athletes (23%) and four controls (11%), and second-degree block was detected in seven athletes (20%) and one control (3%) (P less than 0.05). Ventricular premature beats were present in 60% of athletes and 57% of controls. The bradycardia in athletes did not predispose to ventricular ectopic activity, since heart rates at the times of occurrence of extrasystoles were higher in athletes than in controls. Even after two years of regular physical training there are significant differences in sinus nodal function and atrioventricular conduction as between young athletes and controls.

Adolescent↗
PubMed1984

24-Hour electrocardiographic recordings in mild acute infectious myocarditis.

Arrhythmias and even sudden death may be caused by acute infectious myocarditis. We therefore recorded 24-hour electrocardiograms in 26 myocarditis patients both one week and two to three months after the detection of myocarditis. Two of the patients were also monitored on the first day of their symptomatic myopericarditis . Twenty-eight control subjects had recordings one to two weeks after the onset of acute uncomplicated infections. One of the two patients monitored during the first day of myopericarditis had repetitive, asymptomatic bursts of ventricular tachycardia. In the 1-week recordings 27% of the myocarditis patients and 7% of the control subjects (p less than 0.06) had complex ventricular premature beats; these occurred in only 8% of the myocarditis patients during the late recording. However, the overall number of ventricular premature beats was low in both groups and recordings. A lengthening of the QT interval was related (p less than 0.05) to the occurrence of complex premature beats in repeated recordings in the same individuals. The heart rate was higher (p less than 0.02) in myocarditis patients, but no significant difference was noted in the frequency of conduction defects. We conclude that there seems to be no reason for a prolonged restriction of physical activity during clinically uncomplicated recovery from mild acute myocarditis. However, potentially dangerous arrhythmias may occur during the very first days of the disease.

Acute Disease↗
PubMed1983

Ambulatory electrocardiographic recording in mild or moderate myotonic dystrophy and myotonia congenita (Thomsen's disease).

Ambulatory electrocardiographic recording (AER) was performed on 27 adult patients with mild or moderate myotonic dystrophy (MD) and in 12 adult patients with mild myotonia congenita (MC) to determine whether characteristic arrhythmias and conduction disturbances occur in the early stages of these myotonic disorders. In MD and MC, AER showed at least one finding regarded as normal in 93% and 0% of cases, respectively. The most common abnormalities in MD were first degree atrioventricular (A-V) block (in 70% of cases) and QTc greater than or equal to 0.46 s (in 33%). Abnormal sinus intervals and frequent second degree A-V block were rare, each occurring in 4% of patients. Ventricular tachycardia did not occur. It is concluded that signs of involvement of cardiac conductive tissue in the MD disease process are very common, even in the early stages. Delayed A-V conduction in the most common single finding. Sinus nodal dysfunction, severe disturbances in A-V conduction, and ventricular arrhythmias are not common in mild disease. Repeated AER is indicated, to evaluate whether conduction disturbances in MD are progressing.

Adolescent↗
PubMed1983

Nitroglycerin ointment effective for seven hours in severe angina pectoris.

The efficacy and tolerability of nitroglycerin (NTG) ointment were studied in 80 male patients with severe angina pectoris. Two symptom-limited exercise tests were performed on successive days after application of an ointment containing 15 mg NTG or a placebo (P) ointment. The patients were assigned to 4 groups. The study was conducted in a double-blind, cross-over manner. The total amount of work performed was higher in all groups on NTG (46-70%) compared to P ointment. The difference was statistically significant (p less than 0.001) at all points of time from 0.5 to 7 hours. The ST segment depression in ECG at the end of the exercise test was slightly greater on P than on NTG, but the difference was statistically significant only in the 3-hour group (p less than 0.01). The frequencies of headache and dizziness were 35% and 16%, respectively, on NTG. Eight patients (10%) reported that headache was severe enough to prevent regular use of NTG ointment. NTG ointment is effective, has a long duration of action and is relatively well tolerated by patients with severe angina pectoris.

Angina Pectoris↗