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Biomedical subjects

S Saltissi

Publications and source records attributed to S Saltissi.

At least 19 recordsLinked to original sources
PubMed2001

Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test.

OBJECTIVE: To examine the utility of the six-minute walk test (6'WT), in assessing the effectiveness of a six-week cardiac rehabilitation programme, of which exercise training was an integral part. SETTING: Royal Liverpool and Broad Green Hospitals Rehabilitation Unit. DESIGN: Two hundred and thirty-nine consecutive patients referred for cardiac rehabilitation were allocated to one of two groups. In group A 209 entered and 159 completed the usual rehabilitation programme whilst group B patients (n = 30) acted as a control by deferring entry to the programme for six weeks, continuing only activities of daily living. OUTCOME MEASURES: Both groups were assessed using the 6'WT, peak expiratory flow rate (PEFR) and isometric grip strength at enrolment and six weeks. RESULTS: At baseline, groups A and B were demographically identical without significant differences in terms of 6'WT, PEFR or grip strength. Following the study period, group A showed a significant increase in 6'WT from 314.7 +/- 76.2 to 377.3 +/- 78.6 m, in PEFR from 406.9 +/- 115.9 to 437.8 +/- 118.6 litres per minute and in grip strength from 28.8 +/- 9.31 to 30.3 +/- 8.93 kg, all p < 0.001. There were no significant changes in group B. CONCLUSIONS: The 6'WT proved to be a simple and effective measurement of functional capacity in patients performing cardiac rehabilitation. The clinical programme investigated successfully increased patients' functional capacity as assessed by the 6'WT. Significant improvement in PEFR and grip strength was also demonstrated, compared with a control population.

Aged↗
PubMed2001

Troponin T as a first-line test: the Royal Liverpool and Broadgreen University Hospital experience.

Many hospital laboratories are unable to offer a cardiac troponin service because of the cost of providing this assay in addition to existing cardiac enzyme profiles: we circumvented this problem by withdrawing the conventional cardiac enzyme service and substituting cardiac troponin T. By ensuring that only one specimen for cTnT is analysed per episode of chest pain. substantial financial savings have been achieved.

Chemistry, Clinical↗
PubMed1995

The management of acute myocardial infarction.

Greater understanding of the underlying pathophysiology of acute myocardial infarction (AMI) has led to more aggressive management and lower mortality, both in-hospital and long term. AMI results mainly from thrombotic occlusion of the infarct-related coronary artery. The ensuing necrosis evolves over a 6-12 h period providing a time window for interventions designed to reduce eventual infarct size. The most appropriate interventions are those which restore coronary artery patency and hence myocardial blood flow as soon as possible. Occasionally, disruption of the occluding thrombus and compression of the underlying atheromatous lesion is best achieved by direct percutaneous transluminal coronary angioplasty. For the vast majority however, revascularisation by drug therapy is more appropriate. As soon as possible, all patients without contraindications should be offered oral aspirin and intravenous thrombolysis, usually with streptokinase but occasionally with tissue plasminogen activator. Patients in whom these agents are contraindicated should be considered for intravenous beta-blockade using atenolol or metoprolol to reduce myocardial demand and hence infarct size. Patients with large infarcts, impaired ventricular function, left ventricular failure or hypertension should be considered for early angiotensin-converting enzyme inhibitor therapy. Other agents may be valuable symptomatically, but have no proven role in reducing infarct size or mortality. After the first 24 h, the main aims of management are to assess the likelihood of later ischaemic events or death (risk stratification) and hence to choose appropriate long term secondary prophylaxis.

Adrenergic beta-Antagonists↗
PubMed1994

Prognostic value of ambulatory ST segment monitoring compared with exercise testing at 1-3 months after acute myocardial infarction.

The relative value of ambulatory ST segment monitoring for assessing prognosis following acute myocardial infarction is currently uncertain. Ambulatory monitoring was performed in 177 patients at a mean of 38 days (range 22-93) post-myocardial infarction and its prognostic value was compared with exercise treadmill testing (n = 170). Cardiac events (myocardial infarction, cardiac death or coronary revascularisation) were noted during at least 1 year of follow-up. The presence or absence of ST depression on ambulatory monitoring did not predict increased fatal or non-fatal cardiac events although more severe ST depression had some predictive power: after adjusting for clinical variables and coronary prognostic indices, the duration/24 h (P = 0.03) and magnitude (P = 0.007) of ST depression had independent value. ST deviation on exercise testing was associated (P < 0.05) with increased events (19/90; 21% vs 7/80; 9%) and in patients with a positive exercise test ST depression on ambulatory monitoring did not identify any additional events (8/41; 20% vs 11/49; 22%). No factor available from ambulatory monitoring was predictive of outcome once variables from exercise testing were taken into account. Ambulatory ST segment monitoring performed in the late recovery phase (1-3 months) after acute myocardial infarction is inferior to exercise testing for predicting prognosis and does not increase the predictive power of an exercise test. Ambulatory monitoring may only be indicated in patients unable to perform an exercise test.

Electrocardiography, Ambulatory↗
PubMed1993

Prognostic significance of transient myocardial ischemia on ambulatory monitoring after acute myocardial infarction.

The prognostic value of ambulatory ST-segment monitoring after myocardial infarction was prospectively assessed in 203 patients both early (mean 6 days, n = 201) and late (38 days, n = 177). During at least 1 year of follow-up there were 21 cardiac deaths and 44 cardiac events (death, reinfarction or coronary revascularization). ST depression was seen less often during early than late monitoring (29 of 201 [14%] vs 56 of 177 [32%]). Early ST depression was significantly associated with increased mortality (7 of 29 [24%] vs 14 of 172 [8%]) (< 0.05) and increased cardiac events (13 of 29 [45%] vs 30 of 172 [17%]) (p < 0.001) and had independent value after allowing for clinical factors and coronary prognostic indexes (adjusted relative risks 3.40 and 2.70, respectively). ST depression on late monitoring was only associated with increased cardiac events when it was: (1) frequent (e.g., > or = 3 episodes/day [10 of 31 patients, 32% vs 18 of 146, 12%]) (p < 0.01); (2) prolonged (e.g., > or = 20 minutes/day [8 of 25, 32% vs 20 of 152, 13%]) (p < 0.05); or (3) severe (e.g., maximum of > or = 1.5 mm [8 of 28, 29% vs 20 of 149, 13%]) (p < 0.05). Thus, ST depression occurs less frequently during ambulatory monitoring before discharge than during late monitoring, but is a more specific prognostic indicator; however, it is more benign during late monitoring. Ambulatory ST-segment monitoring can be used to predict prognosis in the first year after myocardial infarction, although its relative value as a screening test compared with exercise testing remains to be established.

Electrocardiography, Ambulatory↗
PubMed1993

Significance of ST-segment elevation during ambulatory monitoring after acute myocardial infarction.

The significance of ST segment elevation during ambulatory monitoring after acute myocardial infarction was examined in 203 patients. Ambulatory monitoring was performed both early (mean 6.4 days [range 3 to 15]; N = 201) and late (38 days [range 22 to 93]; N = 177), and 174 patients underwent exercise treadmill testing (38 days [range 22 to 93]). Cardiac events (death, reinfarction, and coronary revascularization) were documented during a 1-year follow-up period. ST elevation (all silent) occurred in 25 of 201 patients (12%) on early monitoring but in only 4 of 177 (2%) on late monitoring (p < 0.001). Compared with patients (N = 148) without any ST deviation, those with early ST elevation had more pericarditis (8/25 [32%] vs 23/148 [16%]; p = 0.089) but no more angina or exercise ischemia. The mortality rate tended to be higher in patients with early ST elevation (4/25 [16%] vs 10/148 [7%]; p = 0.24), but ST elevation was too infrequent to be a valuable prognostic indicator. ST elevation is not uncommon during ambulatory monitoring early after myocardial infarction but is rare during later monitoring. Such ST elevation is almost always silent, does not usually reflect myocardial ischemia, and is not a useful prognostic indicator.

Adult↗
PubMed1993

Transient myocardial ischaemia after acute myocardial infarction does not induce ventricular arrhythmias.

OBJECTIVE: To see whether transient myocardial ischaemia on ambulatory monitoring after myocardial infarction is associated with ventricular arrhythmias. DESIGN: A prospective study. SETTING: The coronary care unit, general medical wards, and cardiorespiratory department of a major teaching hospital. PATIENTS: 203 consecutive patients without specific exclusion criteria admitted with acute myocardial infarction. INTERVENTIONS: 24 hour ambulatory electrocardiographic monitoring for ventricular arrhythmias and ST depression both early (mean 6.3 days after infarction, n = 201) and late (mean 38 days, n = 177). MAIN OUTCOME MEASURES: Episodes of myocardial ischaemia were identified during ambulatory monitoring by transient ST depression of > or = 1.0 mm lasting for > or = 30 s. Ventricular arrhythmias were single extrasystoles, couplets, or ventricular tachycardia. RESULTS: All ventricular arrhythmias were significantly more frequent in late than early monitoring. The arrhythmias included couplets (in 83/174 (48%) v 49/200 (25%) of patients, p = 0.0000028) and ventricular tachycardia (29/174 (17%) v 15/199 (8%), p = 0.0064). Patients with ST depression (29 early; 56 late), compared with those without ischaemia, did not experience a significant increase in single extrasystoles, couplets (31% v 23% early; 47% v 48% late), or ventricular tachycardia (3% v 8% early; 18% v 16% late). Even patients with frequent (> or = 3 episodes), and deep (> or = 1.5 mm) or prolonged (> or = 20 min) ST depression had no increase in arrhythmias. CONCLUSIONS: Ventricular arrhythmias after myocardial infarction are not associated with transient myocardial ischaemia during daily activities. This study does not support the belief that to abolish silent ischaemia would reduce the incidence of sudden death due to uncontrollable ventricular arrhythmias after myocardial infarction.

Adult↗
PubMed1993

Electrocardiogram interpretation in general practice: relevance to prehospital thrombolysis.

OBJECTIVE: To assess, in the context of their possible role in prehospital thrombolysis, the ability of general practitioners to recognise acute transmural myocardial ischaemia/infarction on an electrocardiogram. DESIGN: 150 doctors (every fifth name) were selected from the alphabetical list of 750 on Merseyside general practitioner register and without prior warning were asked to interpret a series of six 12 lead electrocardiograms. Three of these showed acute transmural ischaemia/infarction, one was normal, and two showed non-acute abnormalities. Details of doctors' ages, postgraduate training, and clinical practice were sought. SETTING: General practitioners' surgeries and postgraduate centres within the Merseyside area. PARTICIPANTS: 106 general practitioners (mean age 45 years) agreed to participate. MAIN OUTCOME MEASURE: Accuracy of general practitioners' interpretations of the six electrocardiograms. RESULTS: 82% of general practitioners correctly recognised a normal electrocardiogram. Recognition of acute abnormalities was less reliable. Between 33% and 61% correctly identified acute transmural ischaemia/infarction depending on the specific trace presented. Accurate localisation of the site of the infarct was achieved only by between 8% and 30% of participants, while between 22% and 25% correctly interpreted non-acute abnormalities. Neither routine use of electrocardiography nor postgraduate hospital experience in general medicine was associated with significantly greater expertise. CONCLUSION: The current level of proficiency of a sample of general practitioners in the Merseyside area in recognising acute transmural ischaemia/infarction on an electrocardiogram suggests that refresher training is needed if general practitioners are to give prehospital thrombolysis.

Adult↗
PubMed1991

Isradipine therapy in chronic stable angina pectoris--comparison with nifedipine.

Current available calcium antagonists, although useful in angina pectoris, are often poorly tolerated. We therefore compared isradipine, a new calcium antagonist, with nifedipine in 18 patients with angina. Patients sequentially received incremental doses of either isradipine (IS) 2.5-7.5 mg three times daily or nifedipine (NF) 10-30 mg three times daily for 6 weeks each, in a randomized double-blind crossover study. Both agents produced similar (P = 0.43) increases in maximum exercise duration (IS + 30%; NF + 34%) and an equivalent (P = 0.38) increase in time to onset of angina on exercise (IS + 53%; NF + 62%). Both IS and NF significantly reduced exercise-induced ST depression (-40% and -45%) to a similar degree (P = 0.48). NF significantly (P = 0.019) reduced angina attacks (-3.0 attacks.week-1; 26%) compared to IS (-0.4; 4%) whilst a similar but non-significant trend in favour of NF was also apparent in the consumption of sublingual glyceryl trinitrate (-0.1 tablets.week-1; 2% vs +1.3.week-1; 23%; P = 0.28). However, significantly (P less than 0.03) more patients experienced adverse events whilst taking NF than with IS (36 events in 16/18 (89%) v 18 in 9/18 (50%). Thus, IS and NF increased exercise tolerance and reduced exercise angina and ST depression equally well although NF use was associated with fewer anginal episodes and IS with fewer side effects.

Activities of Daily Living↗
PubMed1991

Transient ischaemia after acute myocardial infarction: relationship to exercise ischaemia.

To study the implications of transient myocardial ischaemia following acute myocardial infarction we compared ambulatory ST segment monitoring with exercise treadmill testing in 170 patients (mean age 58 years) at 4-8 weeks after admission. Ambulatory monitoring detected transient ischaemia (265 episodes; 249 (94%) silent) in 53/170 patients (31%) which was less frequent than ischaemia during exercise testing (90 patients; 53%) (P less than 0.0001). However, patients displaying transient ambulatory ischaemia (i) achieved less total exercise (248.7 +/- 17.2 vs 318.7 +/- 14.1 s; means +/- SEM) (P less than 0.006), (ii) developed exercise ST deviation earlier (172.4 +/- 14.3 vs 244.8 +/- 16.2 s) (P less than 0.0004) and (iii) had more widespread exercise ischaemia (3.8 +/- 0.3 vs 2.5 +/- 0.2 ECG leads) (P less than 0.005). Positive ambulatory ST segment monitoring was infrequently found (12/80 patients; 15%) in the presence of a negative exercise test but did identify the majority of patients (9/11 patients; 82%) with easily provoked exercise ischaemia and hence strongly positive exercise tests. These data suggest a limited role for routine 24 h ambulatory monitoring after myocardial infarction for the diagnosis of ongoing ischaemia but raise the possibility of an important place for this test in prognosis and risk stratification.

Adult↗
PubMed1991

Domiciliary investigation of sleep-related hypoxaemia in Duchenne muscular dystrophy.

In Duchenne muscular dystrophy (DMD) nocturnal oxygen desaturation occurs during rapid eye movement (REM) sleep. Polysomnography, which requires hospital admission, will detect sleep-related breathing abnormalities. In order to avoid the inconvenience of hospital admission for the disabled patient, we investigated overnight oxygenation in ten boys with DMD by domiciliary oximetry. In four boys the results of oximetry were compared with those of a polysomnographic recording. The "repeatability" of domiciliary oximetry was assessed in six boys by performing oximetry on two non-consecutive nights. Older boys with DMD may develop a cardiomyopathy. In order to assess cardiac rhythm and ST segment changes we performed simultaneous Holter monitoring and oximetry in seven boys with overnight hypoxaemia. Six of the initial ten boys studied demonstrated episodic nocturnal hypoxaemia and there was a strong correlation between minimum oxygen saturation overnight and daytime arterial oxygen and carbon dioxide tensions (PaO2 r = 0.89; PaCO2 r = -0.87). Despite adequate REM time during polysomnography, greater oxygen desaturation was found during domiciliary oximetry. No difference was found in the severity of desaturation recorded in the boys who were studied on two separate occasions. Five boys demonstrated marked heart rate variation during hypoxaemic episodes and more serious arrhythmias occurred overnight in the three most hypoxaemic boys. Domiciliary oximetry is a simple, repeatable method of assessing overnight oxygenation and compares well with polysomnography. In boys with advanced DMD and severe nocturnal hypoxaemia, 24 h electrocardiographic monitoring may detect potentially life-threatening arrhythmias.

Adolescent↗
PubMed1990

Transient myocardial ischaemia after acute myocardial infarction.

The prevalence and characteristics of transient myocardial ischaemia were studied in 203 patients with recent acute myocardial infarction by both early (6.4 days) and late (38 days) ambulatory monitoring of the ST segment. Transient ST segment depression was much commoner during late (32% patients) than early (14%) monitoring. Most transient ischaemia (greater than 85% episodes) was silent and 80% of patients had only silent episodes. During late monitoring painful ST depression was accompanied by greater ST depression and tended to occur at a higher heart rate. Late transient ischaemia showed a diurnal distribution, occurred at a higher initial heart rate, and was more often accompanied by a further increase in heart rate than early ischaemia. Thus in the first 2 months after myocardial infarction transient ischaemia became increasingly common and more closely associated with increased myocardial oxygen demand. Because transient ischaemic episodes during early and late ambulatory monitoring have dissimilar characteristics they may also have different pathophysiologies and prognostic implications.

Adult↗