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Biomedical subjects

T Pop

Publications and source records attributed to T Pop.

At least 55 records · Page 3Linked to original sources
PubMed1987

What is the need for further intracoronary treatment?

Intracoronary treatment in acute myocardial infarction seems to be useful in order (1) to reach the maximum rate of reperfusion, (2) to reduce rate of reocclusion and reinfarction, and (3) to improve coronary blood flow necessary to maximize salvage of myocardium. Particularly in patients with cardiogenic shock and right ventricular infarction, PTCA in addition to thrombolytic therapy seems to be a major improvement of therapy. Whether intracoronary therapy including PTCA is superior to intravenous thrombolytic therapy with elective PTCA will hopefully be answered in cooperative studies.

Angioplasty, Balloon↗
PubMed1987

[Incidence and kind of reperfusion arrhythmias in thrombolytic therapy of acute myocardial infarct].

UNLABELLED: In 200 consecutive patients with acute myocardial infarction combined medical-mechanical recanalization was attempted. Coronary angiography revealed an occluded vessel in 150 patients. This vessel could be opened in 127 patients. There were 112 men and 15 women, aged 32 to 72 years (mean age 61.2 years); 60 patients had an anterior and 67 patients presented with an inferior myocardial infarction. 103 from 127 patients presented with arrhythmias during the ischemic phase and 112 from 127 patients during the reperfusion phase. The following arrhythmias had a significantly higher incidence in the reperfusion phase compared to the ischemic phase: sinus bradycardia (29 pts. - 22.8% - vs. 15 pts. - 11.8%; p less than 0.05), ventricular bigeminy (28 pts. - 29.9% - vs. 5 pts. - 3.9%; p less than 0.01), ventricular couplets (34 pts. - 26.8% - vs. 20 pts. - 15.7%; p less than 0.05) and accelerated idioventricular rhythm (32 pts. - 25.2% - vs. 5 pts. - 3.9%; p less than 0.01). Ventricular fibrillation occurred during the ischemic phase in 9 patients and during the reperfusion phase in 7 patients (n.s.). None of the patients presented with sustained ventricular tachycardia, neither in the ischemic, nor in the reperfusion phase. CONCLUSIONS: The following rhythm disturbances can be called reperfusion arrhythmias: sinus bradycardia, ventricular bigeminy, ventricular couplets and accelerated idioventricular rhythm. The observed reperfusion arrhythmias were short-living and did not need special therapeutic measures.

Adult↗
PubMed1987

[Relation between spontaneous and electrically inducible ventricular arrhythmias in patients with coronary heart disease].

In a prospective study, 267 patients with invasively diagnosed coronary artery disease were studied by programmed electrical stimulation (PES) and induced ventricular arrhythmias were compared to spontaneous arrhythmias occurring during 24 h Holter registration. In 89 patients (33%) no evidence of myocardial infarction was present, 61 patients (23%) were studied for 6 weeks to 3 months, 36 patients (13%) for 3-6 months and 81 patients (31%) for more than 6 months after myocardial infarction. PES was performed in the right ventricular apex with 1 and 2 extrastimuli during pacing with 100, 120 and 140 beats/min. Endpoint of the study was defined by the induction of 4 repetitive ventricular responses (RVR). Within 72 hours after PES a 24 h Holter registration was performed in all patients. During PES, 15 patients (6%) were not inducible for any RVR. Single RVR (1-2) were induced in 146 patients (55%) and 3-5 RVR in 68 patients (25%). Ventricular tachycardia and ventricular fibrillation were induced in 38 patients (14%); 6 patients showed a sustained, monomorphic tachycardia. Altogether, the incidence of RVR was higher when a history of myocardial infarction was present. With increasing time after infarction the incidence of inducible 3-5 RVR remained stable; however, the number of greater than 6 RVR decreased. During Holter registration, 54/255 patients (21%) showed no spontaneous ventricular arrhythmias, 70 patients (28%) had arrhythmias of Lown-class I/II, 84 patients (33%) of Lown-class III. Complex arrhythmias were observed in 47 patients (18%) (Lown-class IVA: 33 patients, IVB: 14 patients).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

[Ischemia tolerance of the heart in percutaneous transluminal coronary angioplasty. Controlled study of the effect of isosorbide dinitrate and nifedipine].

In a randomized controlled study, influence of sublingual isosorbide dinitrate (ISDN) and nifedipine on ischemic tolerance of the heart during percutaneous transluminal coronary angioplasty (PTCA) was examined. After dilations without premedication except heparin ten patients received 10 mg ISDN sublingually and dilations after one, five, and ten minutes were repeated, then 20 mg nifedipine sublingually was administered followed by dilations at one, five, ten, and 15 minutes intervals (group A). First 20 mg nifedipine and then 10 mg ISDN were given sublingually with the same repeated dilations in ten patients forming group B. Mean arterial pressure decreased from 111 +/- 11 to 97 +/- 14 mmHg after ISDN (p less than 0.001) in group A and to 86 +/- 12 mmHg after nifedipine (p less than 0.001). In group B arterial pressure remained constant after nifedipine and decreased to 84 +/- 15 mmHg after ISDN (p less than 0.05). Coronary perfusion pressure in group A remained constant at about 27 +/- 11 mmHg and increased in group B from 27 +/- 14 to 31 +/- 20 mmHg after nifedipine and decreased to 20 +/- 16 mmHg after ISDN (n.s.). Dilation period increased in group A from 33 +/- 15 s to 69 +/- 25 s after ISDN (p less than 0.001) and remained constant after nifedipine 67 +/- 23 s. Dilation time in group B increased from 31 +/- 8 s to 49 +/- 17 s after nifedipine (p less than 0.001) and to 81 +/- 46 s after ISDN (p less than 0.001). Time until ST segment depression of greater than 0.1 mV increased from 14 +/- 5 s to 37 +/- 19 s by ISDN in group A and to 33 +/- 16 s after nifedipine (p less than 0.001). Times in group B measured 16 +/- 5 s and 24 +/- 8 s after nifedipine and 39 +/- 24 s after ISDN (p less than 0.05). In groups A and B arrhythmias could be suppressed despite prolonged dilation times only by application of both drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Sublingual↗
PubMed1987

[Differential diagnosis: right heart infarct or anteroseptal infarct?].

We report on the case of a patient with typical clinical symptoms and ST-segment elevation in V1-V4 who was diagnosed as having acute anteroseptal myocardial infarction. Coronary angiography revealed a proximal occlusion of the right coronary artery and a patent dominant left coronary artery. After successful thrombolysis with pro-urokinase a transluminal coronary angioplasty of the right coronary artery was performed. The exact analysis of the first electrocardiogram demonstrated that the decrease of ST-segment elevation in V1-V4 should have suggested the diagnosis of right ventricular infarction. This case report demonstrates the potential hazards in distinguishing right ventricular infarction from anteroseptal infarction by electrocardiogram only.

Adult↗
PubMed1987

[The electrocardiography image of atrial arrest].

11 patients, aged 36 to 85 years, 5 men and 6 women, with atrial standstill are described. Except for one patient they had organic heart disease (coronary heart disease, 4 patients; valvular heart disease, 6 patients). The extent of standstill was assessed by intra-atrial recording and stimulation. A permanent form was seen in 6 patients: 3 patients presented with a total, the other 3 with a partial atrial standstill. In 5 patients a transient atrial standstill was diagnosed, 2 with a total and 3 with a partial form of standstill. One of the latter patients presented with a hitherto undescribed feature: a partial atrial standstill induced by isolated hyperkalemia.

Adult↗
PubMed1986

[Thrombolytic therapy and balloon dilatation. The effect on infarct time, reperfusion and reocclusion].

127 patients, admitted within six hours of onset of symptoms of acute transmural myocardial infarction, received at first 250 000 U streptokinase intravenously over 20 min, followed by an intracoronary infusion of 250 000 U after coronary angiographic demonstration of the infarct vessel. Those in whom the infarct vessel was closed were randomized into two groups. An attempt at recanalization was made either by thrombolysis alone, through a specially developed 3F catheter (group I, 64 patients), or by thrombolysis and dilatation with 4F Grüntzig balloon catheter (group II, 63 patients). There was no significant difference between the two groups with regard to sex, age, infarct site, creatine-kinase level and interval between onset of symptoms and treatment. Re-perfusion rate for group I was 92% (59 patients), for group II 89% (56 patients). Re-occlusion during the hospital stay occurred in 10 of 59 patients in group I, in 9 of 55 in group II. Re-occlusion occurred in only 8% (3 patients) after successful dilatation, but in 35% (6 patients) after failed dilatation. In the subsequent six months further occlusions were observed in seven group I and two group II patients. Combined drug-mechanical recanalization thus increased the re-perfusion rate, shortened the infarction time and made possible full revascularization by subsequent dilatation which led to a reduction in the re-occlusion rate.

Aged↗
PubMed1986

Electrophysiological effects of intravenous MDL 17.043.

MDL 17.043, a nonglycoside, noncatecholamine imidazolone derivative with phosphodiesterase inhibiting activity, has been shown to possess both positive inotropic and vasodilator properties. In the present study, the electrophysiological effects of intravenous MDL 17.043 were assessed in 10 patients undergoing programmed right atrial stimulation for diagnostic purposes. MDL 17.043 was administered as a single intravenous bolus injection of 1.5 mg/kg body weight over 4 min followed by an intravenous infusion of 0.75 mg/kg body weight over 20 min. With the dosage schedule used, the MDL 17.043 plasma levels achieved were similar to those previously reported to be associated with significant hemodynamic improvement of congestive heart failure. Electrophysiological measurements were performed before and during MDL 17.043 administration. MDL 17.043 consistently shortened basic sinus cycle length, sinus node recovery time and sinuatrial conduction time and decreased Wenckebach cycle length, atrioventricular and atrial refractoriness leading to positive chronotropic and dromotropic effects.

Adult↗
PubMed1986

Percutaneous transluminal coronary angioplasty after thrombolytic therapy: a prospective controlled randomized trial.

In 162 patients with acute transmural myocardial infarction, combined intravenous and intracoronary thrombolytic therapy with streptokinase was initiated. In vessels that remained occluded, mechanical recanalization was performed with a 3F recanalization catheter (group I, n = 79) or a 4F Grüntzig balloon catheter (group II, n = 83). After reperfusion, intracoronary streptokinase was administered superselectively. After termination of streptokinase infusion, angioplasty was performed only in patients in group II. There was no difference between the groups in relation to sex, age, infarct location, creatine kinase levels and time between onset of symptoms and start of treatment. Initial coronary angiography showed an open vessel in 27 (34%) of 79 patients in group I and 21 (25%) of 83 patients in group II. The final reperfusion rate was 90% (71 of 79) in group I and 86% (71 of 83) in group II. Angioplasty was attempted in 69 of the 71 patients in group II with a success rate of 65% and an occlusion rate of 3%. During the hospital stay, reocclusion occurred in 14 (20%) of 71 patients in group I. After thrombolytic therapy, coronary luminal narrowing in group I was 75 +/- 17% in patients without and 87 +/- 6% in patients with reocclusion (p less than 0.05). In group II, reocclusion was found in 10 (14%) of 71 patients. After angioplasty, the degree of coronary stenosis in group II was reduced from 82 +/- 12 to 51 +/- 30% (p less than 0.001). Reocclusion was found in 3 (7%) of the 45 patients with successful angioplasty and in 7 (32%) of the 22 patients with unsuccessful angioplasty (p less than 0.01). Improvement in regional left ventricular function was observed only in patients from group II with anterior myocardial infarction. In conclusion, by combined medical and mechanical recanalization, the rate of coronary reperfusion can be increased and infarct time shortened, providing the possibility of full revascularization by angioplasty, with improvement of regional wall motion and reduction of the rate of reocclusion.

Adult↗
PubMed1986

Stimulus-induced vulnerability in the early and late postinfarction phase.

In 45 survivors of myocardial infarction, cardiac catheterization was performed one and six months after the acute event. After completion of the angiographic investigation, ventricular vulnerability was assessed, using programmed right ventricular stimulation (rates 120 and 140 min-1, single and double premature impulses). In 27/45 patients the results of programmed electrical stimulation were comparable at one and six months. The overall incidence of repetitive ventricular response did not change. There was no correlation between the change of repetitive ventricular response and the change of effective right ventricular refractory period and the change of angiographic parameters (Gensini score, left ventricular ejection fraction and volume indices). It is concluded that between the first and the sixth month after infarction there is no relevant alteration in the propensity to repetitive ventricular response.

Adult↗
PubMed1986

Balloon coronary angioplasty in patients with acute myocardial infarction.

After successful thrombolysis, approximately 75% of all patients will have significant coronary stenosis, which can be dilated by means of percutaneous transluminal balloon angioplasty (PTCA). In a randomized control study, 95 of our patients (Group I) had thrombolysis alone, whereas 95 others (Group II) had thrombolysis and PTCA. Both groups were comparable with respect to age, sex, infarct location, and maximal creatine kinase (CK) value. The clinical outcome during the hospital phase was better in Group II, which had a reocclusion rate of 13%, a reinfarction rate of 5%, a lethal reinfarction rate of 2%, and a cardiac death rate of 7%, compared with respective rates of 20%, 13%, 7%, and 13% in Group I. Furthermore, in Group I, residual coronary stenosis immediately after thrombolysis (75% +/- 20%) did not improve significantly until the end of the hospital phase, when it decreased to 69% +/- 21%. In Group II, stenosis (78% +/- 16%) was improved by PTCA to 33% +/- 21%, and this improvement remained constant during the hospital phase (30% +/- 26%). In Group-II patients who had an unsuccessful PTCA, stenosis was approximately the same before dilatation (83% +/- 12%), after dilatation (80% +/- 17%), and at the control study (83% +/- 17%). The end-diastolic, end-systolic, and stroke volume indices, as well as the ejection fraction, also remained unchanged. In Group I, the number of pathologic wall segments (12.2 +/- 5.0) did not improve during the hospital phase (12.2 +/- 7.9), but in Group II, the improvement was significant (14.0 +/- 5.7 vs. 10.9 +/- 8.2) (p < 0.05). PTCA seems to improve the clinical outcome, reduce the infarction and mortality rates, and enhance myocardial perfusion and performance.

Journal Article↗
PubMed1986

[Combined use of thrombolysis and PTCA in myocardial infarct. Effect on global and regional ventricular function].

The study was performed to evaluate the combined effect of thrombolysis therapy and percutaneous coronary transluminal angioplasty (PTCA) on global and regional left ventricular function. In 127 patients with acute transmural myocardial infarction combined intravenous (250 000 U) and intracoronary (50 000 U) streptokinase therapy was started. When the infarct related vessel was occluded mechanical recanalization was performed with recanalization by Gruentzig balloon catheters. Patients were randomized in two groups, group I, n = 64, thrombolysis without PTCA; group II, n = 63, thrombolysis with PTCA. Both groups demonstrated no difference in relation to sex, age, infarct location, as well as CPK levels and time between onset of symptoms and start of treatment. First coronary angiography showed an open vessel in 23/64 patients (36%) of group I and in 12/63 patients (19%) of group II (p less than 0.001). Mechanical recanalization with 3 F catheters could be achieved in 27/41 patients (66%) of group I and with 4 F catheters in 26/51 patients (51%) of group II. In 9/41 patients (22%) of group I and in 18/51 patients (35%) in group II reperfusion took place before mechanical recanalization could be performed or occurred during superselective thrombolysis therapy, when mechanical recanalization failed. Thus, reperfusion rate in group I was 59/64 patients (92%) and in group II 56/63 patients (89%). PTCA was attempted in 55/56 patients in group II with a success rate of 65% and reocclusion rate of 4%. During hospital stay, reocclusion occurred in 10/59 patients in group I (17%) and in group II in 9/55 patients (16%). The patients were divided in those with and without successful angioplasty. Reocclusion was found in 3/36 patients (8%) and 6/17 patients (35%), respectively. Improvement with PTCA of regional and global left ventricular function was observed in patients with anterior myocardial infarction. With combined medical-mechanical recanalization, reperfusion rate can be increased and infarct time shortened, thus, providing the possibility of full revascularization by PTCA, improving coronary blood flow as well as improving global and regional left ventricular function.

Angioplasty, Balloon↗