[Value of classical and new criteria of electrocardiography in diagnosis of hypoxic cor pulmonale evaluated by hemodynamics tests]. / Wartosc klasycznych i nowych kryteriów elektrokardiograficznych rozpoznawania hipoksyjnego serca plucnego oceniana badaniami hemodynamicznymi.

Electrocardiogram is commonly used in the diagnosis of cor pulmonale in patients with chronic obstructive pulmonary disease (COPD). Pulmonary hemodynamics being the definite method for diagnosis the disease can be used to vary the ecg criteria for diagnosis cor pulmonale. After excluding patients with old myocardial infarction and with pulmonary wedge pressure > 12 mm Hg in 66 patients aged 65.2 with advanced COPD (FEV1 0.78 +/- 0.3 litre) pulmonary hemodynamics and ecg were performed at the same time. The signs of right ventricular hypertrophy were sought for using 3 sets of criteria: the World Health Organisation criteria, new compiled Lehtonen et al. Criteria and right ventricular precordial leads. WHO criteria had a specificity and sensitivity of 50% and 57.6%, the modified right precordial leads-53% and 64.5% and compiled Lehtonen's criteria -57% and 59% respectively. In 32 patients with mild pulmonary hypertension (20-29 mm Hg) sensitivity of WHO criteria was 46.8%, right precordial leads -51.6%, and Lethonen and co. Criteria -50%, in 10 patients with moderate pulmonary hypertension (30-39 mm Hg) 59%-62.5%-50%, in 9 patients with severe hypertension (> or = 40 mm Hg) 100%-100%-100% respectively. Our studies confirm the poor sensitivity and of ecg criteria for diagnosis of cor pulmonale (pulmonary hypertension) in COPD. However, in mild and moderate pulmonary hypertension, sensitivity of ecg diagnosis of cor pulmonale is improved if right modifieds precordial leads are used. New, compiled Lehtonen's criteria failed to improved diagnosis of diagnosis of cor pulmonale. All studied sets of criteria are highly sensitive in COPD patients with severe pulmonary hypertension.

[Clinical, electrocardiographic and electrophysiologic evaluation of intravenous and oral ipratropium bromide in patients with symptomatic bradycardia]. / Kliniczna, elektrokardiograficzna i elektrofizjologiczna ocena bromku ipratropium postaci dozylnej i doustnej u chorych na objawowa bradykardie.

Both oral and intravenous ipratropium bromide were assessed clinically, electrocardiographically and electrophysiologically in 15 patients with symptomatic bradycardia, aged between 32 and 79 years. Ipratropium bromide administered intravenously accelerated heart rate by more than 30% in the majority of patients. Electrophysiologically it normalized conduction time and sinus node response. Electrophysiological studies did not enable to foreseen the efficiency of oral form which may be useful in the treatment of symptomatic bradycardia in increased parasympathetic tone and both mild, and moderate sinus node insufficiency.

Long-term prazosin therapy for COPD pulmonary hypertension.

A 51-year-old patient with COPD, obesity, and pulmonary hypertension underwent long-term prazosin therapy after a successful hemodynamic response to 1 mg of oral prazosin. The 18-month administration of prazosin, in a dose of 3 mg a day, resulted in continued hemodynamic and echocardiographic benefits.

[Enalapril improves hemodynamics and exercise tolerance in pulmonary heart disease caused by obstructive lung disease]. / Enalapril poprawia hemodynamike i tolerancje wysilku w zespole plucno-sercowym spowodowanym przewlekla obturacyjna choroba pluc.

Chronic enalapril therapy was assessed in 11 patients with cor pulmonale due to chronic obstructive pulmonary disease. Enalapril was added to the maintenance dose of diuretics and digitalis and when clinical stabilisation was achieved haemodynamics, spirometry, blood gases and maximal treadmill exercise test accompanied by +pulse oximetry were performed before and after 30 days, 10-20 mg a day, enalapril therapy. Haemodynamic study showed moderate but significant decrease in mean pulmonary artery pressure, from 24 +/- 3 to 21 +/- 5 mmHg (p = 0.05). There were no substantial differences in cardiac output as well as in blood gases and spirometry after enalapril therapy. Slight decrease in oxygen delivery, on an average from 9157 +/- 3808 to 8074 +/- 3574 (p = NS), was accompanied by a concomitant fall in haemoglobin. We noted significant improvement of maximal exercise test results after enalapril therapy. Maximal workload achieved and the time of exercise increased. It was accompanied by subjective improvement as assessed by Borg scale. We observed no adverse effects of enalapril during one month therapy in patients with cor pulmonale and COPD.

[Clinical and hemodynamic evaluation of 6-week treatment of pulmonary hypertension in chronic obstructive lung diseases (COLD) with low dose of prazosin]. / Kliniczna i hemodynamiczna ocena 6 tygodniowego leczenia nadcisnienia plucnego wystepujacego w przebiegu przewleklej obturacyjnej choroby pluc (p.o.ch.p.) niewielka dawka prazosyny.

The value of vasodilatatory treatment of pulmonary hypertension due to chronic obturative pulmonary disease (c.o.p.d.) is still controversial. However in patients with c.o.p.d. causal treatment as well as chronic domestic oxygen therapy have a wide range of limitations. Among vasodilator alpha-1 blockers show less vasodilator-related adverse effects, and as known from acute trials they exert a potent effect on pulmonary circulation in patients with pulmonary hypertension and c.o.p.d. Prazosin was studied in 11 patients (10 men, 1 women) aged 63 +/- 7 years with advanced c.o.p.d. (FVC 1.8 +/- 0.41, FEV1 0.99 +/- 0.55 l) (s) after their clinical stabilisation. In 4 of them prazosin was added to the maintenance dose of diuretics and digitalis. Subjective status, NYHA functional class, spirometric (FVC, FEV1) and gaseous (PaO2, PCO2) parameters, weight, systemic blood pressure, and heart rate were noted. During Swan-Ganz catheterization mean pulmonary artery pressure (MPAP), right ventricular end-diastolic pressure (RVEDP), pulmonary wedge pressure (PCWP), cardiac output (CO), systemic (SVR) and pulmonary (PVR) vascular resistance were measured. The acute trial with 1 mg prazosin taken orally was followed by 2- and 6-week of 3 mg prazosin treatment assessment. After a single dose of 1 mg prazosin there was a significant decrease in MPAP from 36 +/- 9 to 28 +/- 10 (p = 0.001) and 44% decrease in RVEDP (p = 0.05). CO increased by 16% (p = 0.01). The fall in PVR (30%, p = 0.01) exceeded that in SVR (17%, NS). No adverse effects were observed. During 2-week 3 mg a day prazosin therapy 2 patients were excluded following dyspnea and systemic hypotonia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Giant thrombus of mitral valve prosthesis diagnosed by two-dimensional and Doppler echocardiography and confirmed by autopsy]. / Rozpoznany echokardigrafia dwuwymiarowa i dopplerowska, potwierdzony sekcyjnie ogromny zakrzep sztucznej zastawki mitralnej.

Authors presented intravitally diagnosed and well echocardiographically supplied documentary evidence for a huge thrombus positioned in the left atrioventricular ostium in a 52 years old woman within two months of Björk-Shiley mitral valve replacement because of a mitral valve disease.