Biomedical subjects

Steen Hvitfeldt Poulsen

Publications and source records attributed to Steen Hvitfeldt Poulsen.

9 recordsLinked to original sources

PubMed2006

[Myocardial necrosis with late occurrence of ventricular tachyarrythmia secondary to diabetic ketoacidosis].

We present a case of a 27-year-old woman with diabetic ketoacidosis, who developed myocardial necrosis with raised troponin T, CKMB, universal ST-segment elevations and ventricular tachyarrythmia 27 hours after admission. At that time the initial electrolyte disturbances and ketoacidosis had been resolved. Coronary angiography was normal, but echocardiography showed impaired left ventricle function, with an ejection fraction of 45%. At the three-month follow-up echocardiography was normal. The mechanism of myocardial necrosis secondary to metabolic derangements remains unknown.

Adult↗

PubMed2006

Aorto-mitral inflammation in rheumatological disease: transoesophageal echocardiographic presentation.

Thickening of the aortic root and anterior mitral leaflet has been described in patients with aortic valve insufficiency associated with ankylosing spondylitis. We report identical findings made by transthoracic and transoesophageal echocardiography in three patients with inflammatory, non-infective aorto-mitral pathology as manifestation of various rheumatological disorders. All three patients had significant aortic valve incompetence. All three had thickened walls of the sinuses of Valsalvae and a thickened anterior mitral leaflet, in one case with chordal rupture. These findings were confirmed at open heart surgery, and further characterized by histological examination.

Adult↗

PubMed2006

[Constrictive pericarditis caused by carbergoline].

A 72-year-old male with paralysis agitans presented with symptoms and findings of constrictive pericarditis (CP). One year prior, he had a minor lateral MI. The patient had been treated with cabergoline for four years. At pericardiectomy, a thickened pericardium of 1-1,5 cm encased the right side of the heart. The pericardium was normal in the infarction area. Dopamine agonists pergolide and cabergoline for treatment of Parkinson s disease have been associated with development of CP. The absence of pericardial thickening in the infarction area suggests cabergoline as a probable cause.

Aged↗

PubMed2006

[Radio frequency of atrial fibrillation: results from 102 consecutive patients--secondary publication].

Segmental pulmonary vein isolation (SPVI) and circumferential pulmonary vein isolation (CPVI) are the two main approaches to radiofrequency ablation in patients with atrial fibrillation (AF). The aim of this retrospective study was to investigate the safety level and patient outcome of both approaches. The overall freedom from symptoms was 73% and 25% after CPVI and SPVI, respectively. Our study concludes that CPVI is an effective treatment of highly symptomatic and drug-resistant AF and when used in laboratories by experienced electrophysiologists has a promising and reproducible outcome ratio and safety level.

Atrial Fibrillation↗

PubMed2005

Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study).

AIMS: In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. METHODS AND RESULTS: In 92 STEMI patients, continuous ST-monitoring was initiated in the pre-hospital phase and continued during and 90 min following PCI. Patients were divided into three groups: (A) patients achieving spontaneous ST-resolution before PCI; (B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and (C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A (n=22), B (n=43), and C (n=27) differed in peak level of troponin-T (1.4, 4.7, and 7.2 microg/L, P<0.001), creatinine kinase MB isoenzyme (35, 150, and 325 microg/L, P<0.001), and N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) (183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI (0.53, 0.48, and 0.45, P=0.047) and after 3 months (0.58, 0.54, and 0.45, P<0.001). Groups B and C also differed in time from first balloon inflation to > or =70% resolution of ST-elevation (14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. CONCLUSION: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.

Aged↗

PubMed2005

Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention.

AIMS: The majority of patients with ST-elevation myocardial infarction (STEMI) are admitted to local hospitals without primary percutaneous coronary intervention (primary PCI) facilities. Acute transferral to an interventional centre is necessary to treat these patients with primary PCI. The present study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to an interventional centre. METHODS AND RESULTS: Two local hospitals without primary PCI facilities were serving the study region. Pre-hospital diagnoses were established with the use of telemedicine, by ambulance physicians, or by general practitioners. Primary PCI was accepted as the preferred reperfusion therapy in patients with STEMI. From 31 October 2002 to 31 January 2004 all patients transported by ambulance and transferred for primary PCI were registered. Patients with STEMI were divided into three groups: (A) patients diagnosed at a local hospital (n = 55), (B) patients diagnosed pre-hospitally and admitted to a local hospital (n = 85), and (C) patients diagnosed pre-hospitally and referred directly to the interventional centre (n = 21). When comparing group A with group B and C, no difference was found in age, sex, infarct location, or distance from the scene of event to the interventional centre, whereas the median time from ambulance call to first balloon inflation was 41 min shorter in group B compared with group A (P<0.001) and 81 min shorter in group C compared with group A (P<0.001). CONCLUSION: In a cohort of patients scheduled for admission to a local hospital and subsequent transferral to an interventional centre for primary PCI, those diagnosed pre-hospitally had shorter treatment delay compared with those diagnosed in hospital, both in the setting of initial admission to a local hospital, and to an even larger extent in the setting of referral directly to the interventional centre.

Aged↗

PubMed2004

Influence of oxygen tension on myocardial performance. Evaluation by tissue Doppler imaging.

BACKGROUND: Low O2 tension dilates coronary arteries and high O2 tension is a coronary vasoconstrictor but reports on O2-dependent effects on ventricular performance diverge. Yet oxygen supplementation remains first line treatment in cardiovascular disease. We hypothesized that hypoxia improves and hyperoxia worsens myocardial performance. METHODS: Seven male volunteers (mean age 38 +/- 3 years) were examined with echocardiography at respiratory equilibrium during: 1) normoxia (approximately 21% O2, 79% N2), 2) while inhaling a hypoxic gas mixture (approximately 11% O2, 89% N2), and 3) while inhaling 100% O2. Tissue Doppler recordings were acquired in the apical 4-chamber, 2-chamber, and long-axis views. Strain rate and tissue tracking displacement analyses were carried out in each segment of the 16-segment left ventricular model and in the basal, middle and apical portions of the right ventricle. RESULTS: Heart rate increased with hypoxia (68 +/- 4 bpm at normoxia vs. 79 +/- 5 bpm, P < 0.001) and decreased with hyperoxia (59 +/- 5 bpm, P < 0.001 vs. normoxia). Hypoxia increased strain rate in four left ventricular segments and global systolic contraction amplitude was increased (normoxia: 9.76 +/- 0.41 vs hypoxia: 10.87 +/- 0.42, P < 0.001). Tissue tracking displacement was reduced in the right ventricular segments and tricuspid regurgitation increased with hypoxia (7.5 +/- 1.9 mmHg vs. 33.5 +/- 1.8 mmHg, P < 0.001). The TEI index and E/E' did not change with hypoxia. Hyperoxia reduced strain rate in 10 left ventricular segments, global systolic contraction amplitude was decreased (8.83 +/- 0.38, P < 0.001 vs. normoxia) while right ventricular function was unchanged. The spectral and tissue Doppler TEI indexes were significantly increased but E/E' did not change with hyperoxia. CONCLUSION: Hypoxia improves and hyperoxia worsens systolic myocardial performance in healthy male volunteers. Tissue Doppler measures of diastolic function are unaffected by hypoxia/hyperoxia which support that the changes in myocardial performance are secondary to changes in vascular tone. It remains to be settled whether oxygen therapy to patients with heart disease is a consistent rational treatment.

Adult↗

PubMed2003

Evaluation of the longitudinal contraction of the left ventricle in normal subjects by Doppler tissue tracking and strain rate.

BACKGROUND: Tissue tracking (TT) and strain rate (SR) are new echocardiographic modalities on the basis of Doppler tissue imaging, which allow assessment of the systolic longitudinal contraction of the myocardium. OBJECTIVE: The aim of this study was to describe the global and regional longitudinal function of the left ventricle by TT and SR analysis. METHODS: The study population consisted of 55 normal subjects. To assess longitudinal myocardial contraction, TT was performed in the standard apical views and expressed as a score index of the 16 myocardial segments. In addition, SR was performed in each segment. RESULTS: The mean longitudinal contraction was 7.8 +/- 1.8 mm. Longitudinal contraction was significantly decreasing with increasing age and systolic blood pressure (r = -0.46, P <.01 for both measures), but independent of heart rate, left ventricular diameters, ejection fraction, and fractional shortening. SR was found significantly larger in the basal segments than in the middle and apical segments (-1.8 +/- 0.6 s(-1) vs 1.4 +/- 0.3 s(-1) P <.001). CONCLUSION: TT and SR analysis are easily obtained and may complement conventional measures of left ventricular systolic function.

Echocardiography, Doppler↗

PubMedDate not supplied

Myocardial injury with biomarker elevation in diabetic ketoacidosis.

We report of two patients with severe ketoacidosis, minute elevations of myocardial biomarkers (troponin T and CK-MB) and initial ECG changes compatible with myocardial infarction (MI). All successive investigations, including coronary arteriography, were normal, and the patients recovered fully without further evidence of ischemic heart disease. We suggest that acidosis and very high levels of free fatty acids could cause membrane instability and biomarker leakage. Regardless of the pathogenesis, these two case stories suggest that nonspecific myocardial injury may occur in severe diabetic ketoacidosis and that the presence of minute biomarker elevation and ECG changes does not necessarily signify MI.

Adult↗