Transient elevation of pulmonary arterial pressure induced by sublingual angiotensin converting enzyme inhibitors

Twelve patients with ischemic heart disease had complete left and right catheterization before and after sublingual captopril. Hemodynamic measurements were ten (10) minutes apart and were monitored for thirty (30) minutes. The heart rate increased from 70 +/- 13 to 76 +/- 11 beats/minute (P = .04). There was no change in the arterial blood pressure, although the systemic vascular resistance decreased from 1500 +/- 400 to 1026 +/- 480 dynes-sec-cm-5 (P < .0001). The pulmonary artery pressure was increased 15 +/- 6 to 25 +/- 5mmHg (P = .005) and the pulmonary vascular resistance increased from 288 + 160 to 376 + 160 dynes-sec-cm-5 (P < .0001). The wedge pressure increased from 7 +/- 2 to 14 +/- 3 mmHg (P = .05). The cardiac output (CO) increased from 5.06 +/- 1.06 to 578 +/- 1.58 Lt/min. (P.05 =. The left ventricular end diastolic volume (LVEDV) increased from 128 +/- 40 to 145 +/- 37cc)P = .002), without change in the end systolic volume (ESV). The ejection fraction (EF) increased from 56 +/- 3 to 61 +/- 4 per cent (P = .02). These pressure changes appeared at two (2) minutes and disappeared after thirty (30) minutes. The study shows that, sublingual captopril produces a transient elevation of the pulmonary artery pressure and resistance

The use of biosensors in pacemaker technology: experience with a ventricular rate responsive pacemaker

Ten elderly patientes each had a ventricular rate responsive pulse generator (Activitrax) placed in then to help correct severe conduction abnormalities; none had suspected ischemic heart disease. The pulse generator was programmed to a maximal pacing rate of 125 ppm, a medium activity threshold, and a rate response of 6. Six weeks after implantation of the pulse generator, the patients were evaluated before exercing and again when the pacing rate reached 125ppm. The evaluation protocol included an M-mode echocardiogram from which the following measurements were taken; the left ventricular end-diastolic volume (EDV), the end-systolic volume (ESV), the ejection fraction (EF), and the peak systolic pressure/end-systolic volume (PSP/ESV). The numerical values were recorded, clculated, and compared statically with the following results: the EDV increased from 91 ñ 10 to 125 ñ 20 cc (p < .05); the ESV decreased from 64 ñ 10 to 24 ñ 6cc (p < ..005); the EF increased from 41 ñ 5 to 61 ñ 10% (p < .05); and the PSP/ESV ratio increased from 1.70 ñ 1 to 4.10 ñ 2mm Hg/cc (p = 10). Also, during the maximal pacing rate, the septum of all patients showed paradoxical septal motion. All patients in our study have been asymptomatic and have shown an increase in their exercise capacity. We conclude that during exercise the left ventricular function ins influenced more by heart rate than by AV synchrony, as indicated by an elevated EDV in most patients

Left, ventricular function in adults with atrial septal defect

Dieciseis pacientes con un defecto interatrial fueron cateterizados enfatizando el análisis cuantitativo del ventrículo al final de sístole y a mitad de expulsión. La fracción de expulsión promedio estuvo reducida 57 + 8% cuando fue comparada con un grupo control (71 + 10%) P < .005. Ocho pacientes tuvieron volumenes diastólicos elevados (156 + 10cc) al compararles con el grupo control (95 + 100cc) P <.005. Un total de 32 áreas hipoquinéticas y 35 tardoquinéticas se encontraron. Ocho pacietnes fueron reestudiados después de nitroglicerina sublingual (4mg). Se encontró un aumento en la fracción de expulsión de 54% a 70% (P <.005). La mayoria de las áreas hipoquinéticas fueron normalizadas. No se encontró una correlación entre la fracción de expulsión o movimiento sistólico total y el tamaño del corto circuito. Probablemente estas anormalidades son primarias y no debidas al cortocircuito intracardíaco

Sinus node dysfunction: the role of hypervagotomia and its treatment

Dos pacientes con historial de mareos y síncope fueron evaluados en nuestra institución. Estudios electrofisiológicos demostraron valores normales para la función de los nódulos sinusal y atrio ventricular. Grabaciones del Holter de 24 horas, electroencefalograma, tolerancia de glucosa fueron normales. El diagnóstico de disfunción sinusal por hypervagotonia fue hecho y tratado con marcapasos fisiológicos. Ambos han permanecido sin síntomas