Electrophysiologic noninvasives parameters in patients with sick sinus syndrome and syncopal attacks.

21 patients accusing previous syncopal attacks, without myocardial infarction, preexcitation syndrome or severe cardiac failure were submitted to a 24 hrs Holter monitoring with 10 min. of esophageal electrocardiogram. Nine patients were considered as cases of sinus bradycardia (mean HR = 49.5 +/- 4.4 b/min). Other 12 patients with normal basic sinus rhythm were admitted for ventricular premature beats (HR = 65.5 +/- 8.7 b/min.). Fourier transformation analysis (mean method, linear interpolation) was used for determination of the heart rate variability (HRV) and other two variables: variation range (VR)--(longest-shortest cycle/mean basic sinus cycle, %) and differences of sinus cycle length (DSCL = maximal difference of any two consecutive sinus cycle, ms). In all the 9 patients with low sinus rhythm and in 7 patients with normal basic sinus rhythm, at least one episode of critical bradycardia (under 45 b/m) was observed. In 3 of the 9 patients with sinus bradycardia at least two episodes of nonsustained ventricular tachycardia were observed. In all the 12 patients with ventricular premature beats, many episodes of nonsustained ventricular tachycardia were registered. In all the 21 studied patients low and very low frequency HRV was observed. The VR and DSCL presented a significant dependence on age, but this relationship was weaker than the established limits of normality. In the cases of sick sinus syndrome with sinus bradycardia and/or severe ventricular tachyarrhythmias, the noninvasive Holter analysis of HRV can determine the correct diagnosis and indications for permanent cardiac pacing and antiarrhythmic drug therapy.

[The treatment of hypertensive crisis with nifedipine as the basis]. / Tratamentul crizei hipertensive cu nifedipina în teren.

In 48 patients (p) with hypertensive crisis (HC) the effect of nifedipine (N) sublingual 10-20 mg alone (group I, n = 19, mean control AH +/- SD 232 +/- 15.3/132.5 +/- 4.9 mmHg) or associated with furosemide and clonidine (group II, n = 29, AT 249 +/- 21/131.8 +/- 13.6 mmHg). In both groups the AT fell significantly starting five minutes after the administration of N (except diastolic AT in group II); the values measured at 45 min. being 177 +/- 32/105.4 +/- 13 mmHg in group I and 164.6 +/- 44.4/100.1 +/- 16.3 mmHg in group II (the mean proportional difference at 45 min. for systolic AT was 24.6 +/- 11.4% in group I and 28.7 +/- 12.2% in group II; for diastolic AT 20.5 +/- 9.4% in group I, and 27 +/- 12.2% for group II). The good clinical results consisted of lowering of the AT values below critical levels and clinical improvement in 42 p (87.5%). Tolerance to N was good, in a single case was hypotension associated with fainting, both being promptly treated by simple means. CONCLUSIONS. 1. N administered sublingual, 10-20 mg, alone or associated with furosemide has in most patients a rapid hypotensive effect, lowering AT below critical limits within 45 min; 2. the drug is readily administered and without the risk of side effects and can be used in the field in the emergency treatment of hypertension.

The effects of captopril in severe congestive heart failure. An echocardiographic study.

In 12 patients with severe congestive heart failure (CHF), captopril in doses of 25 to 150 mg, every 8 hours, was given for a period of 2 months, in addition to cardiac glycoside and diuretic drugs. After this treatment left ventricular end-diastolic diameter (EDD) decreased from 6.4 +/- 0.5 to 6.2 +/- 0.6 cm (p less than 0.05), left-ventricular end-systolic diameter (ESD) decreased from 5.7 +/- 0.5 to 5.4 +/- 0.6 cm (p less than 0.001), the ejection fraction increased from 30.8 +/- 7.0 to 36.2 +/- 6.9% (p less than 0.005) and mean velocity of circumferential fiber shortening (Vcf) increased from 0.51 +/- 0.12 to 0.62 +/- 0.13 circ/sec (p less than 0.001). Captopril markedly relieved dyspnea and fatigue. Three patients improved from class IV to class III, 4 patients from class IV to class II and 3 patients from class III to class II. These data suggest that captopril may be effective in the treatment of severe chronic CHF.

[Echocardiographic parameters in the follow-up of left ventricular performance before and after the surgical correction of mitral and aortic regurgitation]. / Parametrii ecocardiografici de urmarire a performantei ventriculare stîngi, înainte si dupa corectia chirurgicala a regurgitarii mitrale si aortice.

The present study investigates 16 patients with aortic regurgitation (AR), and 10 patients with mitral regurgitation (MR). Before operation, all the 26 patients had increased telediastolic and telesystolic diameters. The patients were divided into two groups, as a function of the postoperative values of the telediastolic diameter: group A--with the telediastolic diameter within normal limits; group B--with the persistence of the increased values of the telediastolic diameter. In the case of the patients with AR, the following postoperative situation was noticed: in group A: the peak systolic stress (PSS) was increased, the shortening fraction (SF) in the telesystolic stress (TSS) within normal limits; in group B: PSS and TSS were increased, and ST depressed. 8 months after the valvular correction, in group A: PSS, TSS and SF were normal; in group B: the changes in PSS and TSS continued and was lowered. In the case of the patients with MR, before operation, in group A: PSS was slightly increased while TSS and SF were normal; in group B: PSS was slightly increased, TSS, increased and SF depressed. 8 months after the surgical correction: in group A: PSS and SF decreased; in group B: echocardiographic changes continued. Therefore, in the group B patients with MR and AR, the persistence of the increased values of PSS, TSS leads to the postoperative decrease of SF (post-charge in excess).

Evaluation of pulmonary hypertension by echocardiographic right ventricular systolic time intervals.

Pulmonary valve echogram and right cardiac catheterization were simultaneously performed in 18 patients suffering from heart disease in whom pulmonary hypertension was suspected. Echocardiography was employed to measure right preejection period (RPEP), right ventricular ejection time (RVET) and RPEP/RVET ratio. Cardiac catheterization was used to determine pulmonary artery diastolic pressure (PADP), pulmonary artery systolic pressure (PASP), pulmonary artery mean pressure (PAMP) and right ventricular and diastolic pressure (RVDP). Each of these pressures was compared to each of the echo-date by means of regression analysis. The best correlation (r = 0.970; p less than 0.0005) was between PADP and RPEP/RVET ratio. We also found that RPEP/RVET ratio and RVET were each good predictors for the pulmonary artery pressures.

Exercise tests in labile hypertensive patients.

From a collectivity of 17,256 subjects below the age of 30 years, 80 subjects with labile hypertension (LH) were selected. The LH subjects were subjected to exercise test and the response of arterial blood pressure (BP) was followed up. The data obtained were compared with similar determinations carried out in a group of normotensive subjects. The mean value of systolic blood pressure (SBP) on exercise in the normal subjects was 171.0 +/- 2.9 mmHg and that of diastolic blood pressure (DBP) was 77.5 + 1.5 mmHg. The LH subjects presented, on exercise increases of both SBP and DBP in 35 cases (43.7%), increase of only SBP in 10 cases (12.5%) and "normal" type response in 35 cases (43.7%). In these subjects the mean value of SBP, on exercise, was 191.0 +/- 2.6 mmHg (p less than 0.001 as compared with the normal) and that of DBP was 90.0 +/- 1.9 mmHg (p less than 0.001 as compared with the normal). The above data proved that the LH subjects represented a group distinct from the normal subjects. The LH subjects presented a bimodal percent distribution of SBP and DBP on exercise, suggesting the existence of two subgroups one with "normal" type BP response the other with "hypertensive" type response. The BP response to exercise represents a simple test for the detection of abnormal BP increases. The authors consider as fully justified a longitudinal study of LH subjects. The exercise test might have a predictive value in detecting the early signs of essential hypertension.