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731 records · Page 41Linked to original sources
PubMed1995

[Acute myocardial ischemia: ECG or echocardiography? Considerations on a clinical case].

We present a clinical case and a review of the literature on the usefulness of two-dimensional echocardiography for the diagnosis of acute myocardial ischemia in patients presenting with chest pain but without diagnostic electrocardiographic changes. The case refers to a patient admitted a few hours after an episode of prolonged chest pain without diagnostic electrocardiographic changes, but with a severe wall motion abnormality assessed by two-dimensional echocardiogram. The electrocardiogram obtained 24 hours after admission showed giant negative T waves in the anterior chest leads when the patient was asymptomatic and the echocardiogram showed disappearance of wall motion abnormalities. Coronary angiography demonstrated a thrombotic occlusion of the left anterior descending coronary artery, that was treated by transluminal angioplasty. The considerations refer to the following points: 1) a substantial portion of patients with chest pain examined in the emergency room has initially a normal or non-diagnostic electrocardiogram; 2) in these patients two-dimensional echocardiography provides a highly sensitive and specific noninvasive tool for the establishment of the correct diagnosis of acute myocardial ischemia when a severe wall motion abnormality is shown; 3) if successive amelioration of regional myocardial dysfunction is assessed, this was probably due to stunned myocardium; 4) it is probably not correct to consider T wave inversion as the electrocardiographic equivalent of myocardial stunning, as the two phenomena are not chronologically correlated.

Acute Disease↗
PubMedDate not supplied

[Significance of the site of uterine contraction for labor progress and duration of pregnancy].

A four-channel topographic technique was developed in order to improve information about spatial uterine motility. 54 women were monitored during delivery. Four pressure transducers were attached in a square around the umbilicus. Most frequently the origin of labour could be determined in the upper right segment of the uterus. The rate of operative deliveries was decreased in case of predominant upper right origin of labour. The majority of contractions with clear propagation patterns originated at the upper right site, continued to the left and then to the lower right part of the uterus. The highest relative intensity was also measured at the upper right site. Predominant upper right origin of labour may be important for undisturbed delivery. The probability of a preterm delivery is increased in case of an upper right origin of labour.

Adult↗
PubMed1977

[Idiopathic cardiomyopathies in children: a description of two rare cases (author's transl)].

Two cases of idiopathic cardiomyopathy in children are described. Although classifiable respectively as of the non-obstructive or dilating type (in case 1) and of the restrictive type (in case 2), some peculiar clinical and angiocardiographic aspects could be found which differentiated them from the typical forms. In case 1 multiple semilunar dilatations were present at the posterobasal level of the left ventricle. In case 2 the restriction of the ventricular chamber with markedly reduced compliance affected only the left ventricle, with marked dilatation of the left atrium and right side cavities. As occurs in the field of idiopathic cardiomyopathies, intermediate forms of anatomical variations can be found with clinical and angiographic atypical features.

Adolescent↗
PubMed1995

Digital stress-echocardiography using a public domain program for the Macintosh personal computer.

Left ventricular wall motion abnormalities secondary to stress-induced myocardial ischemia can be detected with difficulty by mentally comparing echocardiographic images sequentially recorded on videotape. Digital stress-echocardiography, a combination of ultrasound imaging and digital archiving technologies, at least partially can overcome this problem: the technique is based on reviewing images at rest and after stress (exercise or pharmacological) side by side in dual- or quad-screen digital format, in a synchronized cine-loop, as if obtained simultaneously. This technique however is presently not widely used, due to the high cost of most commercially available systems. We have developed a digital stress-echo system, which is easy to use and relatively inexpensive, running on a Macintosh II personal computer with 8-bit graphics. The 2-D echocardiographic images recorded on videotape are digitized offline using a video digitizing board. The image can be displayed and analyzed using the public domain NIH image software developed by Wayne Rasband, without loss in image quality and resolution, particularly if using Super-VHS videotape. We have made a macro procedure for the montage in a quad-screen format of four digital recorded echocardiographic cardiac cycles of six frames that takes only a little more time than commercially available systems. In conclusion, the use of a personal computer and low-cost software may help to make digital stress-echo techniques more widely feasible in the clinical setting and increase the diagnostic power of the ultrasound technique in the evaluation of patients with known or suspected coronary artery disease.

Coronary Disease↗
PubMed1997

[The exercise test with atropine].

BACKGROUND: Exercise testing remains the most accessible and widely used technique for the detection of coronary artery disease (CAD) and for the assessment of its severity. Clinical usefulness of the simple exercise test is limited by poor sensitivity and imperfect specificity. Many patients referred for diagnostic stress testing cannot achieve an adequate increase in heart rate due to lack of motivation, poor physical condition, or medications. Atropine increases the heart rate and therefore myocardial oxygen consumption, and might improve the diagnostic accuracy of exercise testing, either reducing the number of non-diagnostic examinations, or increasing the positivity of the test in patients with non severe coronary disease. METHODS: One-hundred-seventy-two consecutive patients (144 males and 28 females, age 58 +/- 8 years) with suspected coronary artery disease underwent exercise testing and coronary angiography. Exercise testing was considered positive in the presence of ST segment depression > or = 0.10 mV horizontal or downsloping, > or = 0.15 mV upsloping, or in the presence of ST elevation without Q waves. The test was considered negative in the absence of significant ST depression or elevation if the exercise heart rate was > 85% of age-predicted maximum, non-diagnostic if the heart rate was < 85%. In 148 patients (86%) coronary angiography showed CAD (> 70% luminal reduction in at least one major vessel), in 24 patients (14%) non significant CAD or angiographically normal coronary arteries (NoCAD). Exercise testing was positive in 134 patients (78%: 85% in CAD, 33% in NoCAD), negative in 13 patients (8%: 3% in CAD, 38% in NoCAD), non-diagnostic in 25 patients (14%; 12% in CAD, 29% in NoCAD). The sensitivity was 85%, specificity was 38%, and diagnostic accuracy 78%. In the 25 patients with non-diagnostic test (18 CAD, 7 NoCAD) the exercise was repeated 30-90 minutes later, immediately after i.v. injection of 1-2 mg of atropine, and was stopped at the same workload of the index test. RESULTS: The atropine-exercise test was well tolerated and accomplished in all cases. The maximal heart rate (139 +/- 11 vs 121 +/- 11) and the double product (25,308 +/- 4082 vs 22,166 +/- 3569) were significantly greater after atropine. The increase of the maximal heart rate improved the detection of the electrocardiographic signs of exercise-induced myocardial ischemia only in CAD patients. In the 18 CAD patients the atropine-exercise test was positive in 8, negative in 5, non-diagnostic in 5. In the 7 NoCAD patients the atropine-exercise test was positive in 1, negative in 6. The test remained non-diagnostic only in 3% of patients. The sensitivity of the test with atropine was 91%, specificity was 63%, and diagnostic accuracy 87%. CONCLUSIONS: The addition of atropine to exercise testing, which causes further chronotropic stress to the myocardium, is well tolerated and safe, and improves the diagnostic accuracy of the test for the detection of coronary artery disease in patients who cannot achieve an adequate exercise heart rate. The combination with atropine increases the utility and the cost-effectiveness of exercise testing.

Atropine↗