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Biomedical subjects

S Sclarovsky

Publications and source records attributed to S Sclarovsky.

At least 145 records · Page 8Linked to original sources
PubMed1986

Transient right axis deviation during acute anterior wall infarction or ischemia: electrocardiographic and angiographic correlation.

Eleven patients, three with acute anterior myocardial infarction and eight with anterior ischemia, who developed transient right axis deviation with a left posterior hemiblock pattern during the acute phase of myocardial infarction or ischemia are described (study group). A correlation between their electrocardiographic pattern and the angiographic findings was made. The arteriographic findings were compared with those of a group of 24 patients with acute anterior myocardial infarction or ischemia without transient right axis deviation (control group). The main electrocardiographic characteristics of the right axis deviation pattern were: an average shift of the mean frontal axis to the right of 42 degrees (10 degrees to 94 degrees); increased voltage of R waves in leads II, III and a VF and appearance of small Q waves or decreased voltage of Q waves if previously present in the same leads; decreased voltage of R waves and appearance of deep S waves in lead aVL; and inverted T waves and isoelectric ST segments in leads II, III and aVF. Coronary angiography revealed that the study group had a higher incidence of significant right coronary artery obstruction and collateral circulation between the left coronary system and the posterior descending artery than did the control group (100 versus 25% and 73 versus 0%, respectively; p less than 0.01). There were no differences between the groups regarding left anterior descending and circumflex artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Predominant right ventricular infarction. Clinical and electrocardiographic features.

Based on two-dimensional echocardiographic wall motion abnormalities, 82 patients with acute inferior wall myocardial infarction were divided into 3 groups: group 1. predominant right ventricular infarction-20 patients; group 2. combined right and left ventricular infarction-33 patients; and group 3. predominant left ventricular infarction-29 patients. There were no significant statistical differences between the three groups regarding age, sex, Killip class on admission and jugular venous engorgement. Group 2 patients had higher peak creatine kinase levels and a lower rate of life threatening ventricular arrhythmia than the other groups. On M-mode echo, patients in group 1 had higher RV/LV ratios and lower left ventricular systolic and diastolic dimensions than group 3 patients. On 2-D echo and radionuclear studies, group 1 patients had more right ventricular wall motion abnormalities and minimal left ventricular wall motion disturbances. The left ventricular ejection fraction was higher and the right ventricular ejection fraction lower in group 1 patients than in those groups 2 and 3. The electrocardiogram showed small Q and relatively tall R waves in II, III, AVF in group 1 patients, and deep Q with loss of R waves in patients with combined or exclusive left ventricular infarction (groups 2 and 3). We conclude that predominant right ventricular infarction, which occurs in 24% of inferior wall infarction patients cannot be characterized clinically; however, an electrocardiographic pattern was found to detect this form of infarction with a sensitivity of 80% and a specificity of 70%. Combined left and right ventricular infarction and exclusive left ventricular infarction could be detected electrocardiographically with a sensitivity of 70% and a specificity of only 30%.

Aged↗
PubMed1986

Alternating Wenckebach periods in acute inferior myocardial infarction: clinical, electrocardiographic, and therapeutic characterization.

We report on twelve patients with alternating Wenckebach periods (AWP) occurring during an acute inferior myocardial infarction (AIMI). There were nine males and three females, with a mean age of 61 years (range, 43 to 75). AWP appeared during the first 48 hours of the AIMI in 10 patients and on the fourth day of hospitalization in two patients. AWP occurred spontaneously in nine patients and following the administration of atropine in the remaining three patients. Mean systolic blood pressure significantly decreased during AWP as compared to the period preceding or following the bradyarrhythmia (93 +/- 42 mmHg vs 123 +/- 37 mmHg, p less than 0.02). Killip functional class was significantly higher during AWP as compared to the period preceding or following the bradyarrhythmia (2.1 +/- 1.2 vs 1.5 +/- 0.8, p less than 0.02). Pacemaker therapy was initiated prophylactically in two patients, because of syncope in six, because of hemodynamic deterioration in two, and for syncope and hemodynamic deterioration in two. Three patients died in cardiogenic shock despite pacemaker therapy. No evidence of right ventricular infarction was seen in the patients. Atropine administration during AWP significantly increased the sinus rate and significantly decreased the ventricular rates and the systolic blood pressure. In addition, three patients developed long bouts of paroxysmal AV block. Isoproterenol administration improved AV conduction in one patient, caused no change in two patients and induced non-sustained ventricular tachycardia in three patients. In conclusion, AWP occurring during AIMI is a symptomatic bradyarrhythmia associated with hemodynamic deterioration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Polymorphous ventricular tachycardia and atrioventricular block.

Nine patients are presented who had polymorphous ventricular tachycardia (PMVT) occurring during atrioventricular (AV) block. There were five men and four women with a mean age of 80 +/- 9 years. Five patients had organic heart disease and the remaining four had primary conduction disease (bundle branch block). AV block was complete in four patients (2:1 in three, and paroxysmal in two). The mean ventricular cycle length (of the AV block rhythm) was 1567 +/- 203 ms. The mean QT interval was 0.64 +/- 0.09 s and the mean QTc was 0.51 +/- 0.06 s. When compared to a similar control group with AV block but without PMVT, the ventricular cycle length was similar but the QT and QTc were significantly longer. PMVT was usually of short duration (eight beats to 12 s) and in seven of these nine patients, frequent premature ventricular beats (PVBs) were recorded at various times from the occurrence of PMVT. This is in contrast to the control patients in whom PVBs were detected in one patient only. In conclusion, patients with AV block who develop PMVT usually have longer QT intervals and have detectable PVBs on routine ECGs, unlike similar patients with AV block but without PMVT. In a patient with AV block, a QT interval above 0.60 s and PVBs on the ECG seem to indicate an increased risk for the development of PMVT.

Aged↗
PubMed1985

Efficacy of intravenous amiodarone in the management of paroxysmal or new atrial fibrillation with fast ventricular response.

We tested the efficacy of intravenous amiodarone (5 mg/kg) in slowing ventricular response and/or restoring sinus rhythm in 26 patients with paroxysmal or new atrial fibrillation with fast ventricular response. There were 16 men and 10 women with ages ranging from 35 to 84 years, mean 63 years. Intravenous amiodarone initially slowed the ventricular response in all patients from 143 +/- 27 to 96 +/- 10 beats/min (P less than 0.001). Twelve patients (46%) reverted to sinus rhythm within the first 30 min (range 5 to 30 min, mean 14 +/- 9 min). One patient reverted to atrial flutter after 10 min and 40 min later to sinus rhythm. Six patients (23%) converted to sinus rhythm after 2 to 8 hr and in these 6 cases, the initial slowing in ventricular response obtained with amiodarone persisted until conversion. Seven patients (27%) did not convert to sinus rhythm following amiodarone administration and they required further medical therapy to slow the ventricular response and/or to convert to sinus rhythm. No serious side effects from drug administration were noted. Intravenous amiodarone appears as a highly effective medication in the conversion or control of new onset atrial fibrillation with fast ventricular response.

Adult↗
PubMed1985

Right ventricular dysfunction in acute inferoposterior myocardial infarction. An echocardiographic and isotopic study.

We analyzed right ventricular (RV) regional wall motion by two-dimensional echocardiographic (2D echo) and multigated acquisition radionuclear (MUGA) studies in 104 patients with acute inferoposterior myocardial infarction (AIPMI). Sixty-eight patients (65 percent) had 2D echo RV regional wall motion abnormalities (RV dysfunction(RVD) group) while 36 patients showed no 2-D echo RV regional wall motion abnormalities (no-RVD group). The RVD group had a higher incidence of jugular venous engorgement (p less than 0.05), Kusmaul's sign, (p less than 0.05) complete atrio-ventricular block (p less than 0.05), and in-hospital death (p less than 0.02). The RVD group had significantly higher 2-D echo RV end-systolic dimensions (p less than 0.005) and lower values of percentage of fractional shortening (%FS) (p less than 0.005) in the long and short axis of the RV four-chamber view than patients in the no-RVD group and a control group of 20 patients with normal hearts. There was no statistical significant difference in the 2-D echo RV end-diastolic dimensions among the three groups. Patients in the RVD group had a lower MUGA derived RV ejection fraction (EF) than patients in the no-RVD and control groups (26.5 +/- 13.2 vs. 46.3 +/- 7 and vs. 50.6 +/- 4, respectively; p less than 0.05). RVD was diagnosed by both 2-D echo and MUGA in 60 of 104 patients (57.7 percent) with a sensitivity for 2-D echo of 92 percent and 79 percent specificity (when compared to the MUGA study). The predictive value for a positive test was 88 percent and for a negative test 86 percent. The accuracy was 87.5 percent. Recognition of regional wall motion abnormalities by 2-D echo permits a prompt and accurate bedside identification of right ventricular dysfunction (RVD) within the first 72 hours of clinical onset. An enlarged RV 2D echo end-diastolic dimension was not a sensitive parameter for the diagnosis of this pathology, whereas an increased end-systolic RV diameter and decreased RV %FS were better indicators of RV dysfunction in patients with acute inferoposterior wall myocardial infarction.

Aged↗
PubMed1985

A simplified QRS scoring system for the estimation of the severity of acute inferior wall myocardial infarction.

Electrocardiographic assessment of the R/Q wave ratio (lead 2) of patients with a first acute inferior wall myocardial infarction (IWMI) offers important indirect quantitative information regarding the severity and extent of the myocardial damage. Eighty-eight consecutive patients with IWMI were investigated by echocardiography and radionuclear angiography. After measuring the R/Q ratio in lead 2 during the ST-wave stabilized stage of myocardial infarction, patients were separated into three groups--group 1 with an R/Q ratio greater than 2; group 2 with an R/Q ratio between 1 to 2; and group 3 with an R/Q ratio less than 1. Utilizing the information thus gathered from the electrocardiogram (ECG) offers a simple and efficient method for early prognosis which merits further investigation.

Adult↗
PubMed1985

Carotid sinus syndrome: an overlooked cause of syncope.

Carotid sinus syncope was diagnosed during a 2-year period in 21 men and 5 women, aged 51 to 80 years, who had experienced 1 to 30 syncopal episodes during periods of time which varied from 1 day to 6 years. In 19 of these patients there was evidence of organic heart disease. Carotid sinus hypersensitivity of the cardioinhibitory type was present in 14 patients, the vasodepressor type in 1 patient, and a mixed type in 7 patients. In four patients with the cardioinhibitory response, the possibility of the vasodepressor response was not excluded. A pacemaker was placed in 17 patients, deferred in 4 patients and refused by 5 patients. Follow-up of patients with pacemakers over 9.5 +/- 7.0 (SD) months revealed recurrence of symptoms in two patients due to a previously unrecognized vasodepressor response. Follow-up of the patients without pacemakers was brief (4.6 +/- 3.7 months), and they remained asymptomatic, except for one patient with recurring vertigo.

Aged↗
PubMed1984

Left and right ventricular function in inferior acute myocardial infarction and significance of advanced atrioventricular block.

Of 139 consecutive patients with a first inferior acute myocardial infarction, 26 (19%) had advanced atrioventricular (AV) block and 113 (81%) did not. All were evaluated by 2-dimensional echocardiography (2-D echo) and radionuclide angiography. Patients with advanced AV block had lower radionuclide left ventricular (LV) ejection fraction (51 +/- 10 vs 58 +/- 11%, p less than 0.01), higher LV wall motion score on 2-D echo (5.6 +/- 2.6 vs 3.1 +/- 2.7, p less than 0.001), lower radionuclide right ventricular (RV) ejection fraction (32 +/- 15 vs 39 +/- 16%, p less than 0.001) and higher RV wall motion score on 2-D echo (3.4 +/- 1.7 vs 1.5 +/- 2, p less than 0.002) than did patients without AV block. The incidence rate of RV dysfunction was higher in patients with advanced AV block (78 vs 40%, p less than 0.02), and the mortality rate was also higher (although not significantly) in patients with advanced AV block (15 vs 6%). In conclusion, patients with inferior acute myocardial infarction and advanced AV block have larger infarct sizes (as seen on radionuclide angiography and 2-D echo) and lower RV and LV function than patients without AV block. This finding may explain the higher mortality rate observed in this group.

Adult↗
PubMed1984

Advanced early and late atrioventricular block in acute inferior wall myocardial infarction.

Seventy-six patients with acute inferior acute myocardial infarction (AMI) and advanced atrioventricular (AV) block are described. According to pre-established ECG criteria and time of appearance of the advanced AV block, patients were divided into two groups. The early block group consisted of 31 patients who developed advanced AV block during the hyperacute ECG stage of AMI. Advanced AV block in these patients was characterized by early appearance, short duration, third-degree type block, poor response to atropine, and increased need for pacemaker therapy. The late block group consisted of 45 patients who developed advanced AV block during subsequent ECG stages of AMI. Advanced AV block in these patients was characterized by late appearance, longer duration, second-degree type block, positive response to atropine, and diminished need for pacemaker therapy. Morbidity and mortality also differed between both groups. Patients with early block had more syncope (32% vs 2%, p less than 0.0001), more left heart failure (36 vs 7%, p less than 0.005), and more cardiogenic shock (39% vs 2%, p less than 0.001) than patients with late block. The mortality rate in the early block group was high (23%) and similar to that reported in the literature, whereas the mortality rate in the late block group was low (7%, p less than 0.05) and similar to the mortality rate reported for acute inferior AMI without advanced AV block. These data identify a subgroup of patients with acute inferior AMI and advanced AV block, which accounts for the high mortality rate reported in this group of patients.

Adult↗
PubMed1984

Right axis deviation in acute myocardial infarction. Clinical significance, hospital evolution, and long-term follow-up.

The incidence, in-hospital evolution, and long-term follow-up were studied in patients who developed acute deviation of the mean (frontal) QRS axis to the right during an acute myocardial infarction (AMI). Among 3,160 patients evaluated, 13 (0.41 percent) developed left posterior hemiblock (LPHB) and 57 (1.8 percent) developed an incomplete form of LPHB, the right axis deviation group (RAD). Patients in the LPHB group had a statistically significant higher incidence of in-hospital morbidity (69 percent incidence of congestive heart failure) and mortality (38.5 percent). Follow-up revealed a statistically significant higher incidence of cardiac symptomatology (angina pectoris and congestive heart failure) in the RAD group than in the control group, mainly in patients in whom RAD persisted for more than 24 hours. Patients developing LPHB during AMI constitute a high risk population with a high incidence of morbidity and mortality. Patients developing RAD constitute an intermediate group (between the LPHB and the control group) characterized by a high incidence of cardiac symptoms at the time of follow-up.

Angina Pectoris↗
PubMed1984

Life-threatening ventricular arrhythmias in septicemia.

Sixteen episodes of ventricular tachycardia and/or fibrillation, 12 of which occurred during shaking chills, were recorded in six patients with septicemia. All patients were greater than 60 years of age and had suffered a previous myocardial infarction. Patients who survived the condition sustained no further arrhythmias during a follow-up period of 1 to 4 years, despite the fact that no antiarrhythmic medication was administered. It is suggested that patients greater than 60 years of age who had suffered a previous myocardial infarction should be carefully monitored during septic episodes and especially during shaking chills, since these may represent vulnerable periods facilitating the precipitation of potentially lethal arrhythmias.

Aged↗
PubMed1983

Amiodarone-induced polymorphous ventricular tachycardia.

Five cases of amiodarone-induced polymorphous ventricular tachycardia (torsade de pointes) are presented. All patients had recurrent syncope or dizziness due to polymorphous ventricular tachycardia and in all cases the QT interval was prolonged. In two cases hypokalemia was present at the time the arrhythmia was first recorded, but in both cases polymorphous ventricular tachycardia persisted despite correction of the electrolyte imbalance. Standard treatment for polymorphous ventricular tachycardia (isoproterenol, ventricular pacing, or both) was successful in all patients, however, therapy had to be continued for 5 to 10 days, most probably because of the long elimination half-life of amiodarone.

Aged↗
PubMed1983

Multiform accelerated idioventricular rhythm in acute myocardial infarction: electrocardiographic characteristics and response to verapamil.

Thirteen patients with acute myocardial infarction with multiform accelerated idioventricular rhythm (AIVR) occurring during the first 12 hours of monitoring in the coronary care unit are described. This arrhythmia, similar to the more common uniform AIVR, was intermittent, did not cause hemodynamic compromise, and was not related to more serious ventricular arrhythmias. There was no correlation between the bundle branch block pattern of the multiform AIVR and the electrocardiographic location of the myocardial infarction, but there was a perfect correlation between the frontal plane electrical axis of the multiform AIVR and the electrocardiographic location of the myocardial infarction. The presence of fusion beats between the different forms of AIVR suggests multifocality rather than multiformity. Intravenous verapamil (3 to 5 mg bolus) was administered to 6 patients with multiform AIVR in whom the arrhythmias were persistent enough to allow the evaluation of the effect of verapamil on the arrhythmia. Verapamil caused no change in the rate of AIVR in 1 patient, but in a second patient it decreased the rate by 20 beats/min. In 4 patients, verapamil abolished the arrhythmia: in 2 patients carotid sinus pressure (induced sinus slowing) allowed the emergence of the AIVR at a lower rate, and in the remaining 2 patients the arrhythmia was not observed.

Adult↗