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PubMed2003

[Structural and electrical characteristics of myocardial remodeling in pulmonary diseases with obstructive and restrictive ventilation disorders].

Myocardial changes were studied in 239 patients with different diseases of the lungs associated with obstructive (84 patients) and restrictive (155 patients) ventilation disorders and in 109 healthy subjects (control group). Structural and electrical indices of the myocardium taken at echo- and vectorcardiography in patients with chronic pulmonary diseases differed from those of healthy subjects, depended on the type and severity of the ventilation disorders. Remodeling of the myocardium in obstructive ventilation disorders is accompanied by a moderate staged enlargement of atrial cavities, right ventricle, thickening of the walls of both ventricles in enhanced electric activity of all the heart compartment. The restrictive ventilation disorders are characterized by an early significant enlargement of both atria's cavities, and of both ventricles with maximal thickening of ventricular walls. Electric activity of the heart rose maximally at the initial stage, later it lowered. Variants of myocardial remodeling in abnormal external respiration were determined by differences in compensatory heart reactions. In the obstructive type, heart remodeling had better compensatory opportunities which manifested itself at all the stages of the ventilatory disorders. In the restrictive type, effective compensatory hyperfunction of the heart was seen only at the first stage of ventilatory disorders, at later stages it weakened.

Adolescent↗

PubMedDate not supplied

[Multipolar image of the heart in patients after myocardial infarction].

This paper regards 136 cases of cardiac ischaemia including 93 post-infarction cases and 43 with post-effort angina pectoris. The patients with history of infarction were divided according to its electrocardiographic++ location. The groups of subjects were submitted to multipolar electrocardiographic recording from chest surface by means of a multi-electrode network (diamentoid) introduced to vectorcardiography by the Kowarzyk method. The QRS complex divided into 8 equal sectors served as the basis for calculating, among other things of the non-ipolarity index (km) and its graphical representation. The ++non-dipolarity index tends to be especially high in patients with recurrent and large infarction, it was increased in angina pectoris.

Action Potentials↗

PubMed1991

[The hemodynamic changes in the course of the development from chronic obstructive pulmonary disease to cor pulmonale].

Swan-Ganz catheterization was done in 36 cases of COPD (19 cases) and chronic cor pulmonale (17 cases) patients diagnosed clinically. The results showed that exercise might greatly increase the rate of early diagnosis of chronic cor pulmonale in 47.4%, which is significant in clinical practice, together with gamma-camera, echocardiography and vectorcardiography, it can further increase the early diagnostic rate of cor pulmonale. In these 36 cases, 13 cases had no pulmonary hypertension and in 7 cases of them pulmonary arterial mean pressure were still in normal range even after exercise. If only right heart catheterization was used to diagnose cor-pulmonale without above three noninvasive examinations mentioned above, a high rate of misdiagnosis cor pulmonale would be possible.

Adult↗

PubMed1990

[The clinical application and limitation of electrocardiography].

Electrocardiography (EGG) is one of the most useful methods for diagnosis of the heart diseases, including ischemic heart disease, cardiomegaly and arrhythmias. However, image methods such as echocardiography, CT-scan and MRI for diagnosis of heart diseases developed in the recent several years gave rise to some conflictions between the findings obtained by ECG and the imaging methods. Therefore, the diagnostic criteria of ECG had to be re-examined. The body Surface Map (MAP) with 87 leads on the body surface revealed more circumstantial electric phenomena of the heart than the standard 12-lead ECG and vectorcardiography. However, the MAP needs a lot of time for recording and diagnosis because of its many electrodes. Computer diagnosis adequately developed, and simplification and abbreviation of recording are required. Morphologic disorders of the heart can be diagnosed more adequately by imaging methods such as echocardiography and CT-scan than ECGs. However for the study of arrhythmias, ECGs including standard 12-lead, vector and Holter electrocardiographies, and MAP are almost the only methods now available. Each method of ECG has different characteristics and is widely accepted not only for clinical diagnosis but also research of arrhythmias. In the near future, noninvasive examination from the body surface to reveal a minute electric change of the heart will be expected instead of invasive examinations as His-bundle ECGs.

Arrhythmias, Cardiac↗

PubMed1990

[The development of cardiology in the last 40 years].

In order to correctly appreciate the way cardiology developed in the last 40 years, the "state-of-the-art" balance when the first World Congress took place, September-1950, in Paris, is made. The most current diagnostic methods were relatively scarce at the time-ECG, chest X ray, phonocardiography, pulse wave tracings, coupled with vectorcardiography and ballistocardiography, but in the well equipped hospitals right ventricular catheterization was already performed. The therapeutics of the important morbid situations-like congestive heart failure, arterial hypertension, myocardial infarction and ischemia was disappointing, but closed heart surgery was already taking place. Since then, things had changed suddenly. Over the last 40 years a marked scientific and technology explosion has emerged, that had benefited cardiology science, encompassing several broad areas, namely, patient approaching, pathophysiology understanding, the emergence of new drugs and clinical use, interventional cardiology and remarkable progress in open heart surgery. Imaging techniques development and other technology lead to a simple and accurate cardiac diagnosis. 24 hours ECG and blood pressure recording, and cardiac output measurement, greatly improves our medical knowledge. Computers development, representing the most significant technology advances, has given to cardiology non-predicted advances.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiology↗

PubMed1989

[Evaluation of the Q wave in leads II, III and aVF. II. Impulse conduction disorders , hypertrophy of the cardiac muscle, pre-excitation, focal and diffuse changes in the cardiac muscle and other causes].

The authors present a brief account of contemporary findings in the literature on the evaluation of the Q wave in the electrocardiogram in leads II, III and aVF in disorders of the conduction of impulses (also combination with focal lesions of the heart muscle), in preexcitation of various extent, in hypertrophy and different focal and diffuse changes of the heart muscle. They mention briefly also other cardiac and extracardiac causes of the development and persistence of the Q wave in leads, II, III, aVF. They reached the main conclusion that isolated evaluation of this phenomenon only from the electrocardiogram can lead to erroneous conclusions, therefore they advocate comprehensive evaluation of the clinical condition of these patients (in indicated cases with extension of the range of ECG examinations by vectorcardiography and mapping of electric potentials of the heart on the body surface; echocardiography and scintigraphy may prove valuable).

Arrhythmias, Cardiac↗

PubMed1986

Noninvasive diagnosis of pulmonary hypertension: a World Health Organization study.

In the detection of pulmonary hypertension, especially that of only moderate extent usually associated with chronic obstructive lung disease, noninvasive methods, applied individually, are usually of insufficient accuracy. Accordingly, the World Health Organization undertook a prospective study in which several noninvasive methods were employed together in order to improve the diagnostic accuracy. The examinations analyzed encompassed chest roentgenography, electrocardiography, vectorcardiography, mechanocardiography, echocardiography, myocardial scintigraphy and ventriculography and pulmonary scintigraphy. From the chest X-ray, the size of the main pulmonary artery, the transpulmonary artery distance and the size of the right descending pulmonary artery were analyzed; correct identification of patients with or without pulmonary hypertension was achieved in only 40%. With respect to the electrocardiogram, the number of false negative and false positive findings renders this method of negligible usefulness. Mechanocardiography proved technically difficult and incurred inconsistencies in interpretation such that this method was only rarely useful in the diagnosis of pulmonary hypertension. The same held true for the use of echocardiography since it is technically difficult to obtain adequate imaging in patients with overinflated lungs and the pulmonic valve can only be visualized in about 50% of the patients. Right ventricular systolic time intervals would be interest but their measurement can only be accomplished in a small number of patients. Myocardial scintigraphy with thallium-201 may render indirect evidence of pulmonary hypertension if the right ventricular wall can be visualized; this is the case in 80% of patients in whom mean pulmonary artery pressure exceeds 30 mm Hg but only in 56% of those with mean pulmonary artery pressures between 21 and 30 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗

PubMed1984

[Heart involvement in lung sarcoidosis. Results of a retrospective analysis of clinical courses collected over a 10-year period].

Both the roentgenographic assessment of heart size (CTR) and the evaluation of serial ECG are simple methods in diagnosing possible heart involvement in patients with pulmonary sarcoidosis. Heart rhythm disturbances (ventricular ectopic beats, atrial and ventricular tachycardia, bundle branch block, high degree av-block) are of particular diagnostic value especially in view of intermittent occurrence or therapeutic disappearance. Other noninvasive methods as vectorcardiography, echocardiography and nuclear myocardial imaging are of worth in confirming the diagnosis. There are some difficulties in differential diagnosis of other cardiomyopathies and ischaemic heart disease.

Arrhythmias, Cardiac↗

PubMed1983

[Treatment of pain in patients with ischemic heart disease and osteochondrosis of the cervicothoracic vertebrae].

A total of 124 patients with coronary disease (CD) and vertebral osteochondrosis (76 males and 48 females) were examined. Extended vertebral osteochondrosis was diagnosed in 68 patients, cervical osteochondrosis in 29, cervicothoracal osteochondrosis in 27. The patients were investigated by means of spinal X-ray, electro- and vectorcardiography, tetrapolar rheography. Bicycle ergometry was used in 72 patients, and tele-electrocardiography in 52, to uncover latent coronary insufficiency. Anginal manifestations, cardiac as well as extracardiac in origin, were shown to be numerous and varied, with CD signs being combined with symptoms typical for vertebral osteochondrosis with the visceral syndrome. The treatment with antianginal drugs in combination with orthopedic procedures was effective in 92.6% of the patients.

Aged↗

PubMed1993

[Recent progress in analysis of arrhythmias using electrocardiography].

Recently, various novel techniques have been used in clinic to analyze arrhythmias. These include vectorcardiography, body surface ECG mapping, signal-averaged ECG, intracardiac electrogram and monophasic action potentials, and 24-hour ECG recordings. We examined 24-hour ECG recordings in patients with frequent ventricular premature contractions (VPCs), to identify VPCs possibly due to delayed afterdepolarizations (DADs). We evaluated :1) the relationship between VPC frequency and heart rate (HR); 2) the time course of changes in VPC frequency following an abrupt and sustained increase in HR; and 3) the effects of oral diltiazem on VPCs. Patients could be divided into 2 groups according to whether VPCs increased with an increase in HRs (positive correlation or P group) or not (non-positive correlation or NP group). In the P group, changes in VPCs after an abrupt and sustained increase showed 2 types: 1) delayed-ascent type, in which VPCs increased as the duration of HR increase was prolonged; and 2) non-delayed-ascent type. Diltiazem suppressed almost only the VPCs of delayed-ascent type. The VPCs of delayed-ascent type had several important feature characteristic of DADs, suggesting these VPCs may be due to DADs.

Arrhythmias, Cardiac↗

PubMed1994

Diagnosis of acute myocardial infarction.

A number of new techniques have been shown to be superior to creatine kinase and the 12-lead ECG for the diagnosis of acute myocardial infarction. Myoglobin and heart fatty acid-binding protein are more sensitive than creatine kinase for the diagnosis of acute myocardial infarction; myoglobin is also a superior marker for estimating infarct size. Cardiac troponin is a protein specific for the myocardium. It can be used to differentiate myocardial necrosis when creatine kinase levels are elevated from other clinical conditions. Body surface potential mapping and vectorcardiography are better for localizing the site of acute myocardial infarction than the standard 12-lead ECG. Although echocardiography is frequently used for evaluating infarct remodeling, in the future it could be replaced by ultrafast computed tomography or magnetic resonance imaging. Two excellent techniques for the determination of myocardial viability are late thallium redistribution imaging and positron-emission tomography with 18F-fluorodeoxyglucose.

Biomarkers↗

PubMed1993

A new method to assess the difficulty of a medical diagnosis: application to electrocardiographic interpretation.

A new method to assess the relative difficulty of a medical diagnosis and the efficacy of a diagnostic procedure is described. The cases within a population are classified by N independent interpreters, i.e., medical experts or computer programs. The percentages of correctly diagnosed cases by N (unanimity), N-1, N-2, ..., zero interpreters, respectively, are calculated. These N + 1 percentages are presented in a histogram. A cumulative plot is derived from the "unanimity" value. The ratio "unanimity value"/"zero value" is proposed as an index of diagnostic performance. An application to the CSE database is presented which is composed of 1,220 electrocardiographic tracings interpreted by 13 cardiologists and 15 computer programs. The cumulative plots, the performance index and Log (index) values, established for eight different diagnostic statements, clearly show the relative degree of diagnostic difficulty for each of them and the particular efficacy of each approach, i.e., electrocardiography versus vectorcardiography, and computerized versus human interpretation.

Diagnosis↗

PubMed1993

A new possibility in the study of heart activation: the nondipolar body surface map.

The main goal of the present paper is to study the temporal and spatial course of cardiac electrical activation noninvasively, and to acquire more information than can be obtained from conventional methods, such as electrocardiography or vectorcardiography. The single moving resultant heart dipole is determined from a set of measured body surface potential maps before dipolar and nondipolar theoretical body surface potential maps are calculated. These three kinds of maps are studied together in different electro-cardiological situations (normal, left and right bundle branch block, and necrosis) during the entire cardiac cycle. The set of nondipolar maps is suitable for localizing and following the changes of minor positivity and negativity to detect small extensions of infarcts.

Bundle-Branch Block↗

PubMedDate not supplied

[Pre-excitation syndrome in monozygotic twins].

A family group of seven members is presented, two of which have pre-excitation syndrome. These subjects are identical twin brothers. One of them has the W-P-W syndrome tipe B, and the other has L-G-L syndrome. The latter had an associated atrial-septal defect, and the other twin had no associated cardiovascular lesions. Both underwent electrocardiographic and vectorcardiographic studies, as well as His bundle electrograms. In the case with W-P-W, the diagnosis was made by electrocardiography, and was confirmed by vertocardiography. The His bundle electrogram showed the habitual findings in this type of pre-excitation. The His bundle potential was preceded by the beginning of the delta wave. The patient with W-P-W had episodes of supraventricular paroxysmal tachycardia, some of these with antegrade conduction through the normal pathway, and others with conduction through the anomalous pathway. The other had a L-G-L syndrome, demonstrated by electrocardiography and vectorcardiography. During the register of the His bundle electrogram, he did not present pre-excitation, the tracings in basal conditions as well as during atrial stimulation were normal. The conclusion is that many factors exist which back up the hypothesis that the pre-excitation syndromes occur because of anomalous pathways, and that this type of alteration might have a sex linked genetic basis. This presumption appears to be confirmed by the presence of pre-excitation in identical twin brothers. Other possibilities are also discussed.

Child↗

PubMed1964