ABSTRACT
Utilizing the apexcardiogram, the ratio of total amplitude to the height of the total diastolic wave was determined. Compared with a mean (+/- 1 SD) value of 21 +/- 4% for normal subjects there were statistically significant differences in those patients with isolated aortic regurgitation (30 +/- 10%, P = 0.01), aortic stenosis (12 +/- 11%, P less than 0.025) and mitral insufficiency (14 +/- 8%, P less than 0.025). There were no significant changes of this ratio in subjects with combined aortic stenosis and insufficiency (24 +/- 9%, P less than 0.25), triple vessel coronary artery disease (19 +/- 7%, P less than 0.25) and mitral valve prolapse (23 +/- 10%, P less than 0.35). There was a trend for higher ratio values in patients with greater angiographic evidence of aortic insufficiency, but no correlation between the ratio and left ventricular end-diastolic pressure. These alterations of the apexcardiogram accord with hemodynamic findings in the presence of each respective lesion. It is concluded that this ratio is useful for the noninvasive assessment of isolated aortic regurgitation, aortic stenosis and mitral insufficiency.
Subject(s)
Aortic Valve Insufficiency/physiopathology , Coronary Disease/physiopathology , Kinetocardiography , Adolescent , Adult , Aged , Diastole , Humans , Male , Middle AgedABSTRACT
Prazosin was administered orally at a maximal dose of 2 mg every 6 hours to 4 patients with congestive heart failure (CHF) who had not received either digitalis or diuretics for 72 hours before therapy. Three of the 4 patients had hypertensive and arteriosclerotic heart disease. Hemodynamic monitoring indicated a significant reduction of preload and afterload with a concomitant rise in the cardiac index. We concluded that isolated low-dose oral prazosin has salutary effects on indices of hemodynamic function in selected patients.
Subject(s)
Heart Failure/drug therapy , Hemodynamics , Prazosin/administration & dosage , Quinazolines/administration & dosage , Administration, Oral , Adult , Female , Hemodynamics/drug effects , Humans , Male , Middle Aged , Prazosin/pharmacologyABSTRACT
Non-directional blood velocity of left internal mammary bypass grafts was non-invasively studied with the Doppler ultrasonic probe. Thirteen of 14 subjects had angiographic evidence of bypass graft patency and their Doppler signals demonstrated high amplitude phasic blood velocities. A single patient with proximal left internal mammary arterial graft occlusion manifested marked attenuation of Doppler blood velocity signals. It is concluded that this technic offers a potential for ambulatory and in-office screening of internal mammary artery bypass graft function.
Subject(s)
Coronary Circulation , Myocardial Revascularization , Rheology , Blood Flow Velocity , Cardiac Catheterization , Carotid Arteries , Electrocardiography , Evaluation Studies as Topic , Humans , Male , Middle Aged , Myocardial Revascularization/adverse effects , Phonocardiography , PulseSubject(s)
Mitral Valve , Echocardiography , Female , Heart Valve Diseases/diagnosis , Humans , Phonocardiography , ProlapseABSTRACT
The incidence of ventricular arrhythmias after myocardial infarction was compared in a double blind study of disopyramide (33 patients), aprindine (34 patients) and placebo (31 patients). Total ventricular arrhythmias were less frequent in the aprindine group than in the disopyramide group (P less than 0.05) or than in the combined disopyramide and placebo groups (P less than 0.05). The incidence of life-threatening arrhythmias and of ventricular arrhythmias in high risk patients was also reduced by aprindine compared to disopyramide (P less than 0.001) or placebo (P less than 0.001). It is concluded that aprindine is effective in reducing ventricular arrhythmias and that further investigations on its preventive use after the onset of myocardial infarction are justified.
Subject(s)
Aprindine/therapeutic use , Arrhythmias, Cardiac/prevention & control , Disopyramide/therapeutic use , Indenes/therapeutic use , Myocardial Infarction/complications , Pyridines/therapeutic use , Acute Disease , Adult , Aged , Aprindine/adverse effects , Arrhythmias, Cardiac/etiology , Clinical Trials as Topic , Disopyramide/adverse effects , Double-Blind Method , Female , Humans , Male , Middle AgedABSTRACT
The independence of indices of contractility to Starling effects was tested in 6 closed-chest dogs. After vagal and beta-receptors blockade, indices calculated with total left ventricular isometric pressure (TP), were shown to be strongly dependent of rises in end-diastolic pressure (LVEDP) induced by dextran infusion. At LVEDP of 14.6 +/- 1.5, 22.2 +/- 1.1 and 32.8 +/- 1.5 mm Hg (+/- SEM), the peak value of velocity of the contractile elements calculated with total pressure (peak VCE, TP) diminished by 21, 40 and 50%, and the extrapolated value of VCE, TP at zero total pressure (Vmax, TP) diminished by 15, 30 and 44%. In contrast, indices calculated with developed pressure (DP = TP-LVEDP) at the same LVEDP were much less influenced, particularly the extrapolated value of VCE, DP at zero DP (V max, DP5) and (peak dP/dt)/DP did not significantly change. During angiotensin infusion, expected decreases in TP indices secondary to LVEDP rises were partially masked by simultaneous increases in contractility, and DP indices tended to rise. On the other hand, with minimal changes in LVEDP, as during calcium injection and paired stimulation, increases in TP and DP indices demonstrate inotropic effects equally well. Our study also shows that, besides Vmax calculated with DP, the instantaneous ratio of peak dP/dt and DP can also be proposed as a simpler and thus more convenient index of contractility independent of volume changes.
