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Biomedical subjects

S Chaithiraphan

Publications and source records attributed to S Chaithiraphan.

At least 55 records · Page 3Linked to original sources
PubMed1995

Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results.

The objective of this investigation was the assessment of the response rate of oral atenolol in patients with vasovagal syncope after 1 month of treatment. We randomized into two groups all patients referred to our unit who had had at least one episode of syncope or two episodes of presyncope 1 month before presentation and had a positive isuprel Tilt Table Test (TTT). Group 1 (Gr 1) received oral atenolol, and group 2 (Gr 2) received placebo medication. After a 1-month period patients were reassessed for degree of their symptoms and underwent repeated TTT. Forty-two patients were enrolled in the study. Gr 1 and Gr 2 were comparable in age (38 +/- 13 years vs 43 +/- 14 years, p = 0.216 and sex (male/female = 6:15 vs 10:11, p = 0.204). The severity of attack was similar in both groups. Eight patients in Gr 1 and six patients in Gr 2 had mitral valve prolapse (p = 0.5). No significant differences were seen in systolic blood pressure (122 +/- 17 vs 117 +/- 16 mmHg, p = 0.334), diastolic blood pressure (70 +/- 11 vs 72 +/- 11 mm Hg, p = 0.677), and heart rate (79 +/- 12 vs 79 +/- 13, p = 0.98) between the two groups. The response rates (negative TTT) after 1 month of treatment were 62% versus 5% (p = 0.0004) in the atenolol and control group, respectively. Moreover, patients who received atenolol reported feeling better compared with those who received placebo (71% vs 29%, p = 0.02). In conclusion, atenolol significantly improved symptoms of patients with vasovagal syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1995

Prevalence of coronary artery disease in patient with valvular heart disease.

The prevalence of coronary artery disease in valvular disease was 10.9 per cent. The prevalence of coronary artery disease was more common in males, increasing age, aortic valvular disease and mitral regurgitation with chest pain, other types of valvular lesions did not correlate with the presence of coronary artery disease. The prevalence of significant coronary artery disease especially three vessel disease was relatively rare in those aged < 50 years. We recommend performing coronary arteriography only in patients aged > 50 years regardless of symptoms of chest pain, especially in aortic valvular disease and mitral regurgitation.

Adult↗
PubMed1995

Radiofrequency catheter ablation in idiopathic ventricular tachycardia with structurally normal heart.

In conclusion, we reported two cases of idiopathic right and left VT who presented with syncope and palpitation. The surface QRS during VT and electrophysiologic studies showed the site of origin at RVOT in the first case and inferoapical area of left ventricle in the other. RF ablation was an effective treatment in both patients without any serious complication. Both of them are free of symptoms without any medication.

Adult↗
PubMed1994

A comparative study of coumadin and aspirin for primary cardioembolic stroke and thromboembolic preventions of chronic rheumatic mitral stenosis with atrial fibrillation.

The comparative study of the efficacy of coumadin and aspirin in primary cardioembolic stroke prevention of chronic rheumatic heart disease (mitral stenosis) with atrial fibrillation was conducted at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Seventy-nine patients were enrolled in the trial. Allocation of patients into coumadin or aspirin groups depended upon the patients' choice. Nineteen patients were given coumadin at the adjusted dosage to maintain the therapeutic range of International Normalised Ratio between 1.5-3. Sixty patients were given aspirin at the fixed dosage of 75 mg per day. Six patients were lost to follow-up over the 3 yr period; four in the aspirin group and 2 in the coumadin group. There were three patients with nonfatal cardioembolic stroke in the aspirin group but none in the coumadin group after three years of follow-up. Six patients had mitral valve replacement during the study (i.e. three patients in each group). There were complications in 12 patients, 10 in the aspirin (16.6 per cent) and 2 in the coumadin (10.5 per cent) group. The complications in coumadin group were minor bleeding over the thigh in one patient and generalised ecchymosis over the whole body in one other. In the aspirin group, the complication was gastrointestional symptoms, mainly epigastric pain, but no frank bleeding was observed. Primary prevention of cardioembolic stroke in chronic rheumatic heart disease was found to be more effective with coumadin than aspirin. Our study does not support the use of aspirin in primary prevention of cardiac embolism in chronic rheumatic heart disease.

Adolescent↗
PubMed1993

Laboratory assessment of thrombolytic therapy in acute myocardial infarction.

Hemostatic profiles and cardiac enzymes were studied in 55 acute myocardial infarct (AMI) patients to assess SK and rt-PA therapy. Hypofibrinogenemia occurred 85% in SK group and 55% in rt-PA group with high FDP and D-Dimer, indicating systemic fibrinogenolysis and local crosslinked fibrin clot lysis. The incidence of bleeding in SK and rt-PA groups combined with anticoagulants were the same but lower in rt-PA with antiplatelet. The mean FDP was significantly higher in the bleeding group (p < 0.01). Cardiac enzymes: CK, CK-MB peak values indicated reperfusion were 26.6%, 60% and 90% in conventional, SK and rt-PA therapy, respectively. Early and late occlusion did not occur either in SK or rt-PA followed by anticoagulants. Late occlusion was found in patients treated with rt-PA and antiplatelet. Mortality rate was 20% in conventional therapy.

Blood Coagulation Disorders↗
PubMed1993

Hemodynamic effects of a beta adrenergic blocking agent-atenolol in patients with severe mitral stenosis.

The hemodynamic effects of atenolol, a cardioselective adrenergic blocking drug, were studied in 10 patients with clinically severe mitral stenosis during cardiac catheterization to evaluate the severity of disease before cardiac surgery. At 5 minutes after intravenous injection of 0.1 mg/kg of atenolol, there were significant reductions of heart rate, cardiac index, pulmonary pressure, pulmonary capillary wedge pressure and mitral valve gradient. The right and left ventricular filling pressures were increased slightly. The pulmonary and systemic vascular resistance did not change after atenolol. The PR interval although prolonged significantly was still within normal range. No serious side effects occurred during the post-catheterization 24 hour observation period except for one patient who developed slow ventricular rate (48/min) during the study. The hemodynamic effects of atenolol observed in this study appear to benefit the patients with mitral stenosis by reduction of pulmonary pressure, pulmonary capillary wedge pressure and mitral valve gradient. These hemodynamic changes may, therefore, lead to improvement of pulmonary congestive symptoms.

Adolescent↗
PubMed1992

Endomyocardial biopsy: its diagnostic usefulness.

In order to assess the diagnostic usefulness of EMB in patients with clinically suspected myocardial diseases, with and without heart failure or dysrhythmias, a prospective study was carried out in 84 consecutive patients. With EMB, the histological diagnosis was considered specific in 33 patients (39.3%), confirmative in 12 patients (14.3%) and negative in 39 patients (46.4%). It was found particularly useful in patients with unexplained heart failure and idiopathic dysrhythmias and in the differentiation between restrictive cardiomyopathy and constrictive pericarditis. The procedure can be safely performed with minimal morbidity and there was no mortality in the present study.

Adolescent↗
PubMed1992

Transthoracic and transesophageal echocardiographic diagnosis of cor triatriatum: operation without catheterization in an adult patient.

Cor triatriatum presenting in adulthood is extremely rare. An 18-year-old female patient presented with a clinical picture masquerading mitral valvular heart disease. Both transthoracic and transesophageal echocardiography demonstrated a membrane in the left atrium with no other cardiac anomaly. The patient was successfully operated on without the need for catheterization.

Adolescent↗
PubMed1990

Multivariate analysis in the prediction of death in hospital after acute myocardial infarction.

Prognostic factors in patients with acute myocardial infarction based on clinical and investigative data on admission were evaluated prospectively in 111 consecutive patients. Seventeen patients (15.3%) died during hospital stay. Age, a previous infarct, high Killip class, cardiomegaly, high serum concentrations of cardiac enzymes, a low ejection fraction, and a high wall motion score index correlated significantly with in-hospital mortality; whereas sex, risk factors, and pericardial effusion did not. Multivariate analysis showed that age and the wall motion score index were the best predictors of death in hospital. Wall motion detected by cross sectional echocardiography may reflect the extent of myocardial involvement. Age and wall motion score index predicted in-hospital mortality with a sensitivity of 76.5%, a specificity of 91.5%, and a predictive accuracy of 89.2%. Age and the wall motion score index can be determined on admission and are useful for identifying patients at high risk of cardiac death who might benefit from early intervention.

Adult↗
PubMed1990

Echocardiographic diagnosis of a ruptured aneurysm of the sinus of Valsalva: operation without catheterisation in seven patients.

A ruptured aneurysm of the sinus of Valsalva was diagnosed by Doppler, colour, and cross sectional echocardiography in a consecutive series of seven patients. The diagnoses were confirmed at operation without cardiac catheterisation. Examination by pulsed and continuous Doppler echocardiography showed continuous turbulence in six patients with aneurysms rupturing into the right ventricular outflow tract and in the patient with rupture of an aneurysm of the non-coronary sinus into the right atrium. Colour Doppler echocardiography showed turbulent flow across the defects in all seven patients. A ventricular septal defect with aortic regurgitation was detected in one patient and an associated ventricular septal defect in another. Doppler, colour, and cross sectional echocardiography were useful non-invasive techniques for diagnosing a ruptured aneurysm of the sinus of Valsalva without the need for cardiac catheterisation.

Adult↗
PubMed1990

Accuracy of two-dimensional echocardiography in diagnosis of aortic dissection.

The usefulness of transthoracic and transabdominal two-dimensional echocardiography (2-D echo) in patients who presented with dilated aorta with or without acute chest pain and/or abdominal pain was assessed for diagnosis of aortic dissection (AD) both acute and chronic forms. The criterion for diagnosis of AD was the constant appearance of undulating motion of abnormal linear echo in the aortic lumen in more than one scan plane. During a 4-year period (1984-1988), a prospective analysis of 16 patients was carried out and the result disclosed that 11 had AD (6 in acute AD, 5 in chronic AD) while the other 5 did not have AD. 2-D echo findings were diagnostic of De Bakey Type I in 7 patients, Type II in one, Type III in two, false negative Type I in one, and true negative in the remaining five. Therefore, the sensitivity was 91 per cent and the positive predictive value was 100 per cent. Thus, our data indicates that 2-D echo is a reliable non-invasive method for diagnosis of AD in either the acute or chronic form and proximal or distal AD.

Adult↗
PubMed1989

Two-dimensional echocardiographic detection of in-hospital complications in acute myocardial infarction.

The two-dimensional echocardiogram is an ideal noninvasive method for evaluation of the global and regional wall function of left ventricle particularly the apical part in the early phase of acute myocardial infarction. Apical dysfunction, right ventricular infarction, left ventricular thrombi can be detected by 2D-Echo. It is especially useful in the identification of a high risk group of patients with acute myocardial infarction, as a guideline for attempting different therapeutic modalities in these patients.

Adult↗
PubMed1989

Short and long term mortality after acute myocardial infarction as predicted by two-dimensional echocardiography.

We have non-invasively determined the extent of the acute myocardial insult shortly after admission in a large group of patients with acute myocardial infarction. There appeared a fairly sharp distinction between patients with low and high likelihood of in-hospital death and one year mortality on the basis of echocardiographic findings. The use of wall motion score index and ejection fraction in the prediction of short term mortality (in-hospital death) is good, but the prediction of long term mortality is not that good, since several patients survived up to one year even with high wall motion score index (greater than 2.2) or low ejection fraction (less than or equal to 35%) on admission. One-year survival is high up to 90 per cent in patients with low wall motion score index or high ejection fraction on admission.

Adult↗
PubMed1988

Diagnosis of a right coronary artery-left ventricular fistula by cross sectional and Doppler echocardiography.

A case of right coronary to left ventricular fistula was diagnosed by cross sectional and Doppler echocardiography. The origin and site of entry into the left ventricle of the enlarged right coronary artery were shown by cross sectional echocardiography. Diastolic flow was detected in the left ventricle by both pulsed and continuous Doppler echocardiography. The fistula was confirmed by cardiac catheterisation and was successfully closed at operation.

Adult↗