RESUMEN
According to the literature, electrocardiographic signs of right ventricular hypertrophy have low sensitivity. The cause of this low sensitivity may be attributed to the original studies that were performed mostly in children with hypoplastic left ventricles or congenital heart abnormalities. In adulthood cases of normal or hypertrophic left ventricles, electrocardiographic right ventricular hypertrophy can only be detected during the late phase of ventricular depolarization. Two hundred four adult cardiac patients with complete noninvasive and invasive records were systematically studied by conventional and vectocardiographic methods. The terminal QRS (S wave) of the standard lead I has proved to be informative for detecting electrocardiographic signs in the presence of elevated right ventricular pressure. In cases of chronic right ventricular pressure overload (right ventricular hypertrophy) the terminal depolarization QRS vectors pointed posteriorly and to the right; therefore, a characteristic terminal S wave was represented in the standard lead I. If right and left ventricular hypertrophy were simultaneously present, the same resultant vectors pointed posteriorly and slightly to the left. In these cases, notching of the declining phase of the R wave was frequent, and a flatness of the terminal R wave portion was characteristic. The latter electrocardiographic sign has been called "simultaneous overloading of both ventricles" by the authors. The clinical utility of the new signs have also been proved by statistical methods.
Asunto(s)
Electrocardiografía , Hipertrofia Ventricular Derecha/diagnóstico , Procesamiento de Señales Asistido por Computador , Función Ventricular Derecha/fisiología , Adulto , Femenino , Humanos , Hipertrofia Ventricular Derecha/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Sístole/fisiología , VectorcardiografíaRESUMEN
In authors' opinion the majority of the physicians speak about an incomplete right bundle branch block in cases of a terminal r'wave in lead V1 of the ECG, when the QRS complex is not wider than 0.12 sec. These ECG anomalies are not properly separated in the literature, either. Authors define 4 groups whose separation is possible by the analysis of leads V1 and V2. 1. Right ventricular conduction defect--the ECG width is 0.09-0.13 sec. This picture generally signs normal or only slight higher right ventricular pressure. 2. Real incomplete right bundle branch block--the terminal vector directs forward only in this group and it causes also an r' in V2 next to the high R' in lead V1. This group can be harmless, only a conduction defect, but it can mean an advanced stadium of serious right ventricular systolic or diastolic overloading, too. 3. Right ventricular diastolic overloading--the QRS width is normal. We saw this picture in slight forms of atrial septal defect. One of our conclusions was that in case of normal V1 a haemodynamic significant ASD I or ASD II can be excluded. 4. Normal variant: normal QRS width and only a very low r' in lead V1. It was seen in young patients or in patients with flat chest. Authors remark that this pattern can possibly be seen in childhood or in case of inexact ECG (V1) registration.
Asunto(s)
Bloqueo de Rama/diagnóstico , Bloqueo de Rama/fisiopatología , Electrocardiografía , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Función Ventricular Derecha/fisiologíaRESUMEN
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.
Asunto(s)
Electrocardiografía , Corazón/fisiología , Bloqueo de Rama/fisiopatología , Electrofisiología , Corazón/fisiopatología , Bloqueo Cardíaco/fisiopatología , HumanosAsunto(s)
Cardiomiopatía Dilatada/fisiopatología , Ejercicio Físico , Función Ventricular Izquierda/fisiología , Adolescente , Adulto , Factores de Edad , Anciano , Peso Corporal , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión Esfenoidal Pulmonar/fisiología , Volumen Sistólico/fisiologíaAsunto(s)
Función del Atrio Izquierdo/fisiología , Enfermedad Coronaria/fisiopatología , Cinetocardiografía , Adulto , Anciano , Presión Sanguínea , Enfermedad Coronaria/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión Esfenoidal Pulmonar/fisiología , Análisis de Regresión , Sensibilidad y EspecificidadRESUMEN
The anti-anginal effect of Tenormin (atenolol) has been examined besides placebo control by single blind method in 20 patients with ischaemic heart disease, suffering from stable effort angina proved by coronarography. It has been observed that atenolol significantly decreases the weekly number of anginal attacks, and the amount of sublingual nitroglycerin consumption. It has been proved that atenolol successfully prevents the exercise-induced elevation of blood pressure and heart rate, increases exercise tolerance, decreases myocardial O2 consumption. The place among beta-blockers of the cardioselective, low lipophilic atenolol, which lacks membrane stabilizing and partial agonist activity, has been discussed. The administration of a single daily dose (one 100-mg tablet), selective cardiac effect, lack of unwanted side-effects (cold extremity, nightmare, insomnia, etc.) are the advantages of the drug.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Atenolol/uso terapéutico , Adulto , Anciano , Angina de Pecho/diagnóstico , Atenolol/administración & dosificación , Atenolol/farmacología , Presión Sanguínea/efectos de los fármacos , Angiografía Coronaria , Electrocardiografía/efectos de los fármacos , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A series of 137 patients suffered in clinically documented angina pectoris were analyzed by 12-lead exercise ECG, exercise body surface potential mapping and exercise thallium scintigraphic methods and the results were compared to that of selective coronary angiography and left ventriculography. If coronary artery stenosis were considered to be significant in the presence of more than 70% vessel narrowing, the sensitivity figures were 76, 93 and 88% for exercise 12-lead ECG, exercise body surface potential mapping and exercise thallium scintigraphy, respectively. In considering 50% coronary artery narrowing to be significant, the same figures were 78, 94 and 89%. Specificity figures at the same order were 59, 65 and 80% for more than 70%, and 64, 70 and 88% for more than 50% coronary obstructions. Exercise body surface potential mapping and exercise thallium scintigraphy applied parallelly gave a sensitivity of 100% and specificity of 53%. False-negative and false-positive exercise body surface potential mapping and thallium scintigraphic tests were analysed taking into consideration left ventricular function indices and respective patients. The authors suggest that the outstanding high sensitivity of the above mentioned two tests applied parallelly reveals that they highlights partially different aspects of coronary artery disease, and that is why the overlapping between the methods is relatively small. The majority of false-positive tests characterize a pathological state, and in these cases the exact diagnosis should be cleared up by other noninvasive/invasive methods.
Asunto(s)
Angina de Pecho/diagnóstico , Enfermedad Coronaria/diagnóstico , Pruebas de Función Cardíaca/métodos , Angiocardiografía , Superficie Corporal , Electrocardiografía , Prueba de Esfuerzo , Humanos , Cintigrafía , Radioisótopos de TalioAsunto(s)
Captopril/uso terapéutico , Dihidralazina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Cardiomiopatía Dilatada/complicaciones , Enfermedad Coronaria/complicaciones , Prueba de Esfuerzo , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Cintigrafía , UltrasonografíaRESUMEN
Precordial exercise electrocardiographic mapping and exercise 201-thallium scintigraphy were simultaneously used on sixteen patients before, shortly after and three months after percutaneous transluminal coronary angioplasty (PTCA) to evaluate the immediate and late results of the intervention. In spite of the limited number of observations, positive exercise precordial mapping and or a reversible 201-thallium perfusion defect after PTCA seem to be indicative of failure of balloon dilatation or of development of restenosis in a given coronary artery. "Reverse minimum", that is the minimum in the resting precordial map which disappears on exercise, may be a sign of segmental coronary artery occlusion and well functioning collateral supply.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Electrocardiografía , Prueba de Esfuerzo/métodos , Hemodinámica/fisiología , Radioisótopos de Talio , Adulto , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/fisiopatología , Angina de Pecho/terapia , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Electrocardiografía/instrumentación , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Microcomputadores , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Cintigrafía , Recurrencia , Procesamiento de Señales Asistido por Computador/instrumentación , TalioRESUMEN
A double blind, randomised crossover study with 20 patients was performed to compare the antianginal effects of atenolol 100 mg once daily and pindolol 5 mg thrice daily. After a placebo run-in period, 2 treatments were given for 2 wk each. The number of anginal attacks and the nitroglycerin (NTG) consumption were determined. During bicycle exercise testing, the systolic blood pressure (BP), heart rate (HR), double product and exercise tolerance were measured. Both drugs reduced the number of anginal attacks and NTG consumption relative to the placebo, with atenolol being more effective than pindolol. During exercise, both beta-blockers produced a slight increase in BP and HR compared to the placebo. HR attained with atenolol was lower than pindolol at the same workload. The total duration of exercise and the maximal tolerated workload were greater in atenolol than pindolol experiment. The special properties of beta-blockers, such as cardioselectivity or intrinsic sympathomimetic activity (ISA), may have clinical importance in the treatment of angina pectoris.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Atenolol/uso terapéutico , Pindolol/uso terapéutico , Adulto , Anciano , Angina de Pecho/fisiopatología , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Distribución AleatoriaRESUMEN
(SLE) One hundred patients suffering from systemic lupus erythematosus (SLE) were examined by clinical, non invasive cardiological, radiological and laboratory methods. Valve diseases were revealed by M-mode echocardiographic examination in 17 patients. 14 patients had various conduction disturbances. Out of the remaining 83 patients not having any valve disease, systolic dysfunction of the myocardium was detectable in 17 persons and pericardial effusion in 3 persons. Spirometric alterations have been found in 64 persons and cor pulmonale has been diagnosed in 8 persons.
Asunto(s)
Cardiopatías/etiología , Lupus Eritematoso Sistémico/complicaciones , Enfermedad Cardiopulmonar/etiología , Ecocardiografía , Cardiopatías/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Enfermedad Cardiopulmonar/diagnóstico , EspirometríaRESUMEN
Of 100 cases of acute myocardial infarction as shown on autopsy, 55 cases were transmural infarcts and 45 were subendocardial. Pathologic Q waves appeared in 67% of the cases of transmural infarct and in 30% of subendocardial infarct. In transmural infarcts, Q wave infarcts occurred twice as frequently as non-Q wave infarcts. In the cases of subendocardial infarcts just the opposite was observed: non-Q wave infarcts had double the frequency of Q wave infarcts. In spite of this, when a myocardial infarct is characterized strictly by electrocardiology, it should be described by only the accurate terminology of Q wave infarct or non-Q wave infarct. To distinguish with certitude between subendocardial infarct and transmural myocardial infarct on the basis of the ECG does not seem possible. Q wave infarct as "transmural" and non-Q wave infarct as "subendocardial" does not correspond to the pathologic evidence.
Asunto(s)
Electrocardiografía , Infarto del Miocardio/patología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors have compared the short-term effect of two captopril (ACE inhibitor) preparations namely the Lopirin (SQUIBB) and Tensiomin (EGIS) and dihydralazine as well as placebo in 15 patients with severe heart failure (NYHA III-IV, class). In case of 8 patients with NYHA IV, functional class the short-term effect of the combined therapy of dihydralazine and Lopirin and dihydralazine and Tensiomin as well dihydralazine and placebo have been compared. The underlying disease was dilated cardiomyopathy (DCM) and ischaemic heart disease (IHD). At the end of the treatment with different drugs and placebo the clinical signs of heart failure (complaints and physical status) and the echo and mechanocardiographic parameters of left ventricular function were assessed. The parameters, apart from the clinical signs, have been evaluated in double blind fashion. Compared to placebo all the three drugs i.e. dihydralazine, Lopirin as well as Tensiomin have decreased significantly the NYHA classes, influenced favorably the non-invasive parameters of left ventricular function and decreased blood pressure. As to the dihydralazine, it improved the left ventricular ejection function and the clinical state of the patients with DCM in a higher degree than the two ACE inhibitors did. The effect of Tensiomin and Lopirin was the same in every respect. Both have influenced more favourable the complaints and physical state of patients with IHD than dihydralazine has. The left ventricular filling pressure, the double product (heart rate x wall tension) indicating the myocardial oxygen demand were more reduced in their effect than in that of dihydralazine. Unlike dihydralazine both decreased the heart rate. Administering one of the two ACE inhibitors to the dihydralazine beneficial additive effects have been experienced; the NYHA classes, the heart rate, the left ventricular wall tension and the double product diminished. The authors, on the bases of the results, consider Tensiomin and Lopirin as equivalent in their effect. In their opinion the administration of these drugs mean a new, efficient way of therapy, first of all in cases of heart failure caused by IHD. In the most severe cases they suggest a trial with the combined dihydralazine-ACE inhibitor therapy.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Captopril/uso terapéutico , Gasto Cardíaco Bajo/tratamiento farmacológico , Dihidralazina/uso terapéutico , Hidralazina/análogos & derivados , Adulto , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Presión Sanguínea/efectos de los fármacos , Captopril/efectos adversos , Gasto Cardíaco Bajo/sangre , Gasto Cardíaco Bajo/fisiopatología , Enfermedad Crónica , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico/efectos de los fármacos , Factores de TiempoRESUMEN
One hundred patients suffering from ankylosing spondylitis (AS) and one hundred patients suffering from rheumatoid arthritis (RA) were examined by clinical, non-invasive cardiological, radiological and laboratory methods to determine the prevalence of their cardiac and cardiopulmonary disorders. Fourteen patients with AS and 24 patients with RA had several valvular abnormalities. Among the patients not having any valvular abnormality, systolic dysfunction of the myocardium was detectable in 15 and 11 cases respectively, and cor pulmonale was diagnosed in 16 and 7 cases respectively. Conduction disturbances were demonstrated in 17 patients suffering from AS and in 14 patients suffering from RA.