ABSTRACT
The paper describes the case of a patients suffering from a pre-excitation syndrome who underwent numerous episodes of reciprocal tachycardia during pregnancy. The clinical implications and various methods of therapy used are discussed.
Subject(s)
Pregnancy Complications, Cardiovascular/diagnosis , Tachycardia, Paroxysmal/diagnosis , Wolff-Parkinson-White Syndrome/diagnosis , Acute Disease , Adult , Combined Modality Therapy , Electrocardiography , Female , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/therapy , Tachycardia, Paroxysmal/therapy , Wolff-Parkinson-White Syndrome/therapyABSTRACT
The acute effects of 20 mg of sublingual nifedipine in 12 patients with chronic severe aortic regurgitation were evaluated with M-mode echocardiography, continuous wave and colour Doppler. After nifedipine, heart rate increased from 68 +/- 8 to 82 +/- 11 beats/m' (p less than 0.001); arterial systolic and diastolic pressures decreased from 143 +/- 16 to 129 +/- 9 mmHg (p less than 0.01) and from 61 +/- 11 to 53 +/- 17 mmHg (p less than 0.01) respectively. Left ventricular systolic and diastolic diameters also decreased from 50 +/- 4 to 46 +/- 4 mm (p less than 0.01) and 76 +/- 6 to 72 +/- 6 mm (p less than 0.01) respectively; the slightly increase in fractional shortening which occurred was not significant. The aortic systolic and diastolic velocity integrals decreased from 38 +/- 9 to 34.7 +/- 8 cm (p less than 0.01) and from 203 +/- 41 to 163 +/- 29 cm (p less than 0.001); the diastolic slope of the velocity curve increased a little but significantly: from 334 +/- 70 to 394 +/- 70 cm/sec2 (p less than 0.01). With colour Doppler, protodiastolic jet areas decreased by 19% in the long parasternal view (p less than 0.01), by 28% in the apical view (p less than 0.001), by 26% in the short-axis view (p less than 0.01); the length of the jets in the long parasternal view decreased by 14% (p less than 0.001), but the height did not change significantly. Positive changes from acute nifedipine administration are present in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Aortic Valve Insufficiency/physiopathology , Echocardiography, Doppler , Nifedipine/pharmacology , Aortic Valve Insufficiency/diagnostic imaging , Blood Pressure/drug effects , Chronic Disease , Female , Heart Rate/drug effects , Humans , MaleABSTRACT
In 2001, 22% of the Italian population will be over 60 and the morbidity/mortality rate due to cardiovascular disease is extremely high in this age group. However reports in the literature disagree on the incidence of arrhythmias. The present study assesses the incidence of hyper and hypokinetic arrhythmias in a group of "over-sixties" with no clinical signs of cardiovascular and/or systemic disease. Twenty-four hour Holter monitoring was performed on 103 patients (49 male, 54 female) after clinical examination anamnesis, ECG and chest X-rays had shown a normal picture. There was a wide variation in total heart beats and maximum-minimum cardiac frequency but none of these variables appeared related to age. Total heart beat and minimum cardiac frequency figures were significantly higher among the bedridden (p less than 0.01 and p less than 0.05 respectively). There were no supraventricular arrhythmias in 63% of the patients and only simple forms were encountered in the 38 patients presenting such arrhythmias. Ventricular arrhythmias were absent in 60% of the group, while among the 41 patients presenting these phenomena, as many as 32 presented simple forms, while only 5 were in Lown's class IV and 2 of these due to a single pairing, 1 a single triplet. No significant difference was found in the incidence of supraventricular and ventricular arrhythmias among the 60-69 and 70-79 age groups. There were 3 cases of transitory nocturnal grade I atrioventricular block, but no advanced hypokinetic arrhythmias. The ST-T interval revealed no alterations definitely indicative of ischaemia, despite the presence of alterations in the basal morphology. To sum up, the study revealed a low incidence of supraventricular and ventricular arrhythmias in the elderly population examined and most importantly, the vast majority of those encountered were simple forms.
Subject(s)
Arrhythmias, Cardiac/physiopathology , Electrocardiography , Heart Rate , Aged , Aged, 80 and over , Cardiovascular Diseases/physiopathology , Female , Humans , Male , Middle Aged , Monitoring, PhysiologicSubject(s)
Aortic Valve/surgery , Bioprosthesis , Echocardiography , Heart Valve Prosthesis , Aged , Female , Hemodynamics , Humans , Male , Middle AgedSubject(s)
Arrhythmias, Cardiac/diagnosis , Electrocardiography/methods , Aged , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , Probability , Radiography, ThoracicABSTRACT
An investigation was performed to compare the effectiveness of oral penicillin V given twice daily with penicillin V given three times daily in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis. Patients were randomly assigned to receive 250 mg of penicillin V either two or three times daily for ten days. Overall, 23 (23%) of 99 patients had the same strain of GABHS isolated from their follow-up as from their initial throat culture and were considered to have bacteriologic-treatment failures. Of the 50 patients in the three-times-daily group, nine (18%) had bacteriologic-treatment failures, while 14 (28.5%) of 49 patients in the twice-daily group had bacteriologic-treatment failures. The results of this and earlier investigations suggest that penicillin V given twice daily is as effective as penicillin V given three times daily for the treatment of GABHS pharyngitis.
Subject(s)
Penicillin V/administration & dosage , Pharyngitis/drug therapy , Streptococcal Infections/drug therapy , Administration, Oral , Adolescent , Antibodies, Bacterial/analysis , Antistreptolysin/analysis , Child , Child, Preschool , Deoxyribonucleases/immunology , Drug Administration Schedule , Female , Humans , Male , Patient Compliance , Penicillin V/therapeutic use , Pharyngitis/etiology , Pharynx/microbiology , Prospective Studies , Random Allocation , Streptococcus pyogenesABSTRACT
A comparison of the accuracy and practicality of two new latex agglutination tests for the rapid identification of group A beta-hemolytic streptococci directly from throat swabs was performed in a busy pediatric office. The Directigen Group A Strep Test kit had a sensitivity of 84%, specificity 99%, positive predictive value 99%, and negative predictive value 93% when compared with blood agar cultures. The Culturette Brand 10-Minute Group A Strep ID Kit had a sensitivity of 83%, a specificity 99%, positive predictive value 97%, and negative predictive value 93% when compared with blood agar cultures. When cultures with less than 10 colonies of group A beta-hemolytic streptococci per plate were not considered positive, both rapid tests had a sensitivity of 95%. The Culturette Brand test required considerably less time, equipment, supplies, and skill than the Directigen test. Only the Culturette Brand test appeared to be practical for routine use in a pediatrician's office. Further investigations of the accuracy of both of these rapid tests need to be performed before either is accepted as a substitute for the throat culture.
