ABSTRACT
UNLABELLED: To test if a low Q wave voltage and its faulty increase after exercise is an additional sign of myocardial ischemia, 64 pts with no previous myocardial infarction, bundle branch block or left ventricular hypertrophy were studied by a treadmill test and coronary angiography. Nineteen had single vessel disease (SVD), 21 double vessel disease (DVD), 4 triple vessel disease (TVD) and 20 normal coronary arteries. Sensitivity (SENS), specificity (SPEC) and predictive value (P) of Q wave changes have resulted as follows: 84%, 55%, 80.4%, respectively, compared to 79.5%, 75%, 87.5% of ST modifications associated or not with angina. The SENS of Q wave changes was 72% in SVD and 92% in multivessel disease (p less than 0.05). In 68% of our pts ST and Q wave changes gave concordant results and their combination increased SENS, SPEC, PV to 90.1%, 80%, 90.3%. IN CONCLUSION: Q wave analysis can provide further evidence of myocardial ischemia and can increase SENS, SPEC of stress test. In our experience Q wave is a more sensitive finding than ST depression in multivessel disease.
Subject(s)
Coronary Disease/diagnosis , Electrocardiography , Exercise Test , Coronary Disease/physiopathology , Female , Humans , Male , Middle AgedABSTRACT
The Authors refer on the antiarrhythmic efficacy of quinidine polygalacturonate and prajmalium bitartrate combination for the treatment of refractory recurrent paroxysmal atrial fibrillation, in one patient.
Subject(s)
Ajmaline/analogs & derivatives , Atrial Fibrillation/drug therapy , Pectins/therapeutic use , Prajmaline/therapeutic use , Quinidine/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Drug Combinations/therapeutic use , Drug Therapy, Combination , Humans , Male , Middle Aged , Prajmaline/administration & dosage , RecurrenceABSTRACT
BACKGROUND AND OBJECTIVES: The law demands that the work-load (WL) in the Public Health Service be defined, and also dictates audit criteria referring to: a) the total activities performed during the previous three years; b) the standard times (STD) required to perform the different activities; c) the degree of demand fulfillment (DDF). Aim of this study is to establish the WL of 19 cardiologists (C) operating in a referral Hospital. METHODS: We examined the years 1993-1995. We calculated all medical procedures (P) carried out by our Institute ("procedure" method), and we determined the theoretical time needed to perform them based on STD. The activities of the Coronary Unit (CCU) and of the Ward (W) have been evaluated based on the duty-time table ("presence" method). The sum of the hours calculated with the two methods is the theoretical duty-time per week (TDT = sigma P x STD Time + CCU hours + W hours). We then measured the actual duty-time (ADT). By comparing TDT and ADT we obtained an efficiency index EI = [(TDT - ADT)/TDT]%. The DDF has been estimated based on the waiting-lists. RESULTS: We noticed an increase in invasive P and related activities, and a stable trend or a small decrease in non-invasive P, except for echography. TDT was always found to be superior to ADT (1993: 731.3 vs 670; 1994: 742.7 vs 670.9; 1995: 734 vs 652.1) with an increasing IE (8.3; 9.6; 11.1 respectively). We found rather high figures for extra hours per week (mean 31.6), C time (mean 34.9) and hours lost for vacation, illness, etc. (mean 137.5/week, equal to duty-time of more than three C). When GCS was considered, the total WL was 770 hours per week, equal to a duty-time of 19.25 C. CONCLUSIONS: WL evaluation allows a better understanding of operating conditions ina ward, it is essential when C are committed to pursue specific objectives, and it represents a basis to monitor efficiency. The reliability of WL largely depends upon STD; this underscores the fundamental role of Scientific Societies to prevent a tool intended for a better utilisation of human resources from becoming a pure instrument of cost-containment.
Subject(s)
Cardiology/legislation & jurisprudence , Work Schedule Tolerance , Cardiology/standards , Coronary Care Units , Echocardiography , Heart Diseases/diagnosis , Heart Diseases/surgery , Humans , Italy , Referral and ConsultationABSTRACT
The present study was designed to assess the antiarrhythmic Prajmalium Bitartrate (PB) efficacy in the long term treatment of 22 patients with recent myocardial infarction and persistent, frequent, polimorphous, repetitive (two or more in a row) ventricular premature complexes (VPCs). VPCs were exposed by means of 24-hours ambulatory monitoring. The acute drug testing with a single dose of PB (30 mg) was followed by multiple maintenance therapy with a dose decreasing from 60 to 40 mg every day. Than, the long term antiarrhythmic action was evaluated by both monitoring and exercise stress testing (EST), symptom self-limited, in a 7 months and 28 days follow-up. A favorable therapeutic effect, with a reduction of VPCs frequency greater than 85% and the suppression of their greater Lown degrees, was obtained in 13 cases (59.2%) using PB alone and in 6 cases (27.2%) using PB associated with Amiodarone in 5 patients and with Metoprololo in one. No VPCs were present or they were less than 2 every 3 minutes during EST. Fourteen patients reported a recurrence of VPCs when the drug was stopped for 24-28 hours, after 3-5 months of the treatment. In 3 patients (13.6%) the PB was uneffective. In a case there was, during the acute drug testing, a paradox increasing of the arrhythmias, and in the other two an abnormal lengthening of QTc interval, while arrhythmia was unchanged. PB, alone or associated with other antiarrhythmic drugs, appears a well tolerated, handy and effective agent and it can be proposed as a drug of first choice for controlling VPCs.
Subject(s)
Ajmaline/analogs & derivatives , Arrhythmias, Cardiac/drug therapy , Myocardial Infarction/complications , Prajmaline/therapeutic use , Adult , Aged , Ambulatory Care , Amiodarone/administration & dosage , Arrhythmias, Cardiac/etiology , Drug Therapy, Combination , Electrocardiography , Female , Humans , Male , Metoprolol/administration & dosage , Middle Aged , Monitoring, Physiologic , Myocardial Infarction/rehabilitation , Prajmaline/administration & dosageABSTRACT
The stroke volume of the left ventricle (SV) was assessed in nine young men (mean age 22.2, ranging from 20 to 25 years) during cycle ergometer upright exercise at exercise intensities from 60 to 150 W (about 20% to 80% of individual maximal aerobic power). The SV was calculated from noninvasive tracings of the arterial blood pressure, determined from photoplethysmograph records and compared to the SV determined simultaneously by pulsed Doppler echocardiography (PDE). Given the relationship SV = As.Z-1 in which A(s) is the area underneath the systolic pressure profile (in millimetres of mercury and second), and Z (in millimetres of mercury and second per millilitre) is the apparent hydraulic impedance of the circulatory system, a prerequisite for the assessment of SV from the photoplethysmograph tracings is a knowledge of Z. The experimental value of Z (hereafter defined Z*) was calculated by dividing A(s) (from the finger photoplethysmograph) by SV as obtained by PDE. When the whole group of subjects was considered, Z* was not greatly affected by the exercise intensity: it amounted to 0.089 (SD 0.028; n = 36). The Z was also estimated independently of any parameter other than heart rate (HR), mean (MAP) and pulse (PP) arterial blood pressure obtained from the photoplethysmograph. A computerized statistical method allowed us to interpolate the experimental values of Z*, HR, PP and MAP by the equation Zm = a.(b + c.HR + d.PP + e.MAP)-1, thus obtaining the coefficients a to e. The mean percentage error between Zm (calculated from the coefficients obtained and Z* was 21.8 (SD 14.3)%. However, it was observed that, in a given subject, Z* was significantly affected by the exercise intensity. Therefore, to improve the estimate of Z a second algorithm was developed to update the experimental value of Z determined initially at rest (Zin). This updated value (Zcor) of Z was calculated as Zcor = Zin. [(f/(i + g.(HR/HRin) + h.(PP/PPin) + 1.(MAP/MAPin)], where HRin, PPin, MAPin, HR, PP, MAP are the above parameters at rest and during exercise, respectively. Also in this case, the coefficients f to 1 were determined by a computerized statistical method using Z* as the experimental reference. The values of Zcor so obtained allowed us to calculate SV from arterial pulse contour analysis as SVF = As.Z-1cor. The mean percentage error between the SVF obtained and the values simultaneously determined by PDE, was 10.0 (SD 8.7)%. It is concluded that the SV of the left ventricle, and hence cardiac output, can be determined during exercise from photoplethysmograph tracings with reasonable accuracy, provided that an initial estimate of SV at rest is made by means an independent high quality reference method.
Subject(s)
Blood Pressure , Cardiac Output , Exercise/physiology , Adult , Algorithms , Echocardiography, Doppler, Pulsed , Heart Rate , Humans , Male , Mathematics , Stroke VolumeABSTRACT
The stroke volume of the left ventricle (SV) was calculated from noninvasive recordings of the arterial pressure using a finger photoplethysmograph and compared to the values obtained by pulsed Doppler echocardiography (PDE). A group of 19 healthy men and 12 women [mean ages: 20.8 (SD 1.6) and 22.2 (SD 1.6) years respectively] were studied at rest in the supine position. The ratio of the area below the ejection phase of the arterial pressure wave (A(s)) to SV, as obtained by PDE, yielded a "calibration factor" dimensionally equal to the hydraulic impedance of the system (Zao = A(s).SV-1). The Zao amounted on average to 0.062 (SD 0.018) mmHg.s.cm-3 for the men and to 0.104 (SD 0.024) mmHg.s.cm-3 for the women. The Zao was also estimated from the equation: Zao = a.(d + b.HR + c.PP + e.MAP)-1, where HR was the heart rate, PP the pulse pressure, MAP the mean arterial pressure and the coefficients of the equation were obtained by an iterating statistical package. The value of Zao thus obtained allowed the calculation of SV from measurements derived from the photoplethysmograph only. The mean percentage error between the SV thus obtained and those experimentally determined by PDE amounted to 14.8 and 15.6 for the men and the women, respectively. The error of the estimate was reduced to 12.3 and to 11.1, respectively, if the factor Zao, experimentally obtained from a given heart beat, was subsequently applied to other beats to obtain SV from the A(s) measurement in the same subject.