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1.
Diabet Med ; 31(7): e25-8, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24698085

ABSTRACT

BACKGROUND: Purulent pericarditis is an acute and fulminant disease characterized by pus accumulation in the pericardial space. Its incidence has declined substantially and the common pathogen has changed since the beginning of the antibiotic era; however, it is still found in some patients with immunocompromised conditions. CASE REPORT: We report a rare case in which the onset of diabetes mellitus presented as extremely high HbA1c concentration, ketoacidosis, multi-site abscesses and purulent pericarditis. After antibiotic therapy and pericardiocentesis, the purulent pericarditis still did not resolve and further intrapericardial thrombolytic therapy also failed. Finally, this patient was treated successfully by surgical debridement and pericardiectomy. CONCLUSION: In the immunocompromised state of severe hyperglycaemia, purulent pericarditis is a possible complication of uncontrolled infection. If purulent pericarditis cannot be cured using non-surgical treatments, such as antibiotic therapy, pericardiocentesis and intrapericardial thrombolytic therapy, a surgical pericardiectomy should be considered to avoid morbidity and mortality.


Subject(s)
Abscess/diagnosis , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Debridement , Diabetes Mellitus, Type 2/complications , Ketosis/etiology , Pericardiectomy , Pericarditis/diagnosis , Pericarditis/therapy , Abscess/pathology , Diabetes Mellitus, Type 2/diagnosis , Echocardiography , Fibrinolytic Agents/therapeutic use , Humans , Ketosis/therapy , Male , Middle Aged , Pericardiocentesis , Suppuration , Thrombolytic Therapy , Treatment Outcome
2.
Clin Nephrol ; 72(6): 457-67, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19954723

ABSTRACT

AIM: The angiotensin II Type 1 receptor (AT1R) A1166C (rs5186) genez polymorphism is equivocally associated with the patients' susceptibility to chronic kidney disease or end-stage renal disease. We conducted a prospective study to investigate the influence of AT1R A1166C gene polymorphism on the quantitative changes of renal function. METHOD: Of 1500 people screened, 112 non-diabetic normotensive elderly Chinese were recruited and received biochemistry examination at the baseline, at the second and fourth year follow-up. Serum creatinine and calculated renal parameters, using Cockroft-Gault (CG) formula, Modification of Diet in Renal Disease (MDRD) Study and abbreviated MDRD (abMDRD) equation, were used to evaluate renal function and their progression. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULT: Age was 71.9 +/- 3.7 years (range 60 - 81). Serum creatinine, CG creatinine clearance (CrCl), MDRD and abMDRD glomerular filtration rate (GFR) were significantly decreased at the 2 and 4-year follow-up (all p < 0.001). The magnitude of 4-year decline of above four renal parameters was significantly higher in subjects carrying the AT1R AA genotype than C-allele carriers (p = 0.014, 0.033, 0.008 and 0.014 for creatinine, CG CrCl, MDRD and abMDRD GFR, respectively). This association was still significant in multivariate analyses (p = 0.019, 0.045, 0.035 and 0.018, respectively). CONCLUSION: This longitudinal study showed that the aging process was associated with decline of renal function in the healthy elderly. The AT1R A1166C gene polymorphism might modulate these changes in the Chinese. This provides further knowledge essential in the assessment of renal disease and determination of renal function in the older subjects.


Subject(s)
Aging/physiology , DNA/genetics , Genetic Predisposition to Disease , Kidney Failure, Chronic/genetics , Polymorphism, Genetic , Receptor, Angiotensin, Type 1/genetics , Aged , Aged, 80 and over , Alleles , Female , Follow-Up Studies , Genotype , Humans , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Polymerase Chain Reaction , Prevalence , Prognosis , Receptor, Angiotensin, Type 1/blood , Reference Values , Retrospective Studies , Taiwan/epidemiology , Time Factors
3.
Int J Obes (Lond) ; 32(2): 268-74, 2008 Feb.
Article in English | MEDLINE | ID: mdl-17878891

ABSTRACT

OBJECTIVE: Epicardial and abdominal adipose tissues have recently been demonstrated to play inflammatory roles in coronary atherosclerosis. We sought to compare tissue adipocytokine levels of these two anatomically distinct adipose stores in patients with and without coronary artery diseases (CAD). DESIGN: Samples of abdominal and epicardial fat tissues were harvested to detect the levels of adipocytokines and proinflammatory mediators. SUBJECTS: Forty-six patients with CAD who underwent coronary artery bypass surgery and 12 non-CAD control subjects who underwent other types of open-heart surgery. MEASUREMENTS: Tissue levels of adipocytokines (adiponectin, leptin and visfatin) and proinflammatory mediators (tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6)) were determined by enzyme-linked immunosorbent assay. RESULTS: Tissue levels of TNF-alpha, IL-6, leptin and visfatin were significantly higher in CAD patients relative to control subjects. In addition, significantly higher tissue levels of these four cytokines from abdominal fat depots were found compared to those from epicardial fat in CAD patients. Conversely, in comparison with control subjects, tissue levels of adiponectin were significantly reduced in CAD patients with a significantly lower tissue levels of abdominal than epicardial fat depots demonstrated. CONCLUSION: Abdominal adiposity may play more significant role than epicardial fat in the pathogenesis of coronary atherosclerosis.


Subject(s)
Adipokines/metabolism , Adipose Tissue/metabolism , Coronary Artery Disease/metabolism , Inflammation Mediators/metabolism , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Coronary Artery Disease/etiology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , Obesity/complications , Obesity/metabolism
4.
J Electrocardiol ; 34(4): 285-8, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11590554

ABSTRACT

We studied the seasonal variability of QT dispersion in 25 healthy subjects, aged 36 +/- 5 (25 to 46) years. Four seasonal 12-lead rest electrocardiograms (ECGs) recorded at a double amplitude were performed at 25 mm/s at intervals of roughly 3 months. To avoid possible confusion from the circadian rhythm of QT dispersion, subsequent ECGs were recorded within 30 minutes of the reference summer one. The QT dispersion was calculated as the difference between the longest and the shortest mean QT intervals. There was a seasonal variability in the QT dispersion (P =.001), with the largest QT dispersion occurring in winter (66 +/- 21 ms) and the smallest one in spring (48 +/- 18 ms). In conclusion, there exists a seasonal variability of QT dispersion in healthy subjects and such variability should be taken into consideration in comparison of the QT dispersion.


Subject(s)
Heart Conduction System/physiology , Seasons , Adult , Electrocardiography , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Reference Values , Reproducibility of Results
5.
Kaohsiung J Med Sci ; 17(6): 336-9, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11559973

ABSTRACT

The Kearns-Sayre (K-S) syndrome which includes the triad of progressive external ophthalmoplegia, pigment retinopathy, and disorder of cardiac conduction was first described in 1958. The mitochondria disorder is believed to be the cause of this syndrome. Involvement of the cardiac conduction system is the most importent prognostic factor in K-S syndrome. A 34-year-old male K-S syndrome patient, manifesting as ptosis and weakness of limbs since the age of 15 years, suffered from dizziness and weakness. Twelve-lead eletrocardiography (ECG) showed a 2:1 atrioventricular (AV) block with slow ventricular rate. Intermittent complete AV block, complete left bundle branch block and torsades de pointes were noted in Holter ECG. The electrophysiology study demonstrated prolonged HV interval (85 ms) on conduction beat and infra-His block on non-conduction beat. A VVIR mode of permanent pacemaker was implanted and the patient's condition was stable during this period of follow-up.


Subject(s)
Heart Block/etiology , Kearns-Sayre Syndrome/complications , Adult , Humans , Male
6.
Cardiology ; 95(3): 151-5, 2001.
Article in English | MEDLINE | ID: mdl-11474161

ABSTRACT

The intraventricular to mitral E velocity ratio (IvE/MvE) and the color M-mode Doppler inflow propagation velocity (LVIPV) were evaluated in 36 healthy controls and 33 patients with hypertension and/or ischemic heart disease. The intraventricular E velocity was significantly lower than the mitral E velocity in the control group (52 vs. 68 cm/s, p < 0.001), but they are similar in the disease group (59 vs. 63 cm/s, p = nonsignificant). Compared with the control group, the disease group had a higher IvE/MvE (0.95 +/- 0.28 vs. 0.78 +/- 0.23, p < 0.01). Nevertheless, the LVIPV was not significantly different between the disease and control groups (53 +/- 14 vs. 56 +/- 13 cm/s, p = nonsignificant). The LVIPV did not correlate with the IvE/MvE (r = 0.202, p = nonsignificant). Therefore, an intraventricular dispersion of early diastolic filling does not seem to indicate impaired left ventricular relaxation.


Subject(s)
Blood Flow Velocity/physiology , Diastole/physiology , Echocardiography, Doppler, Color , Ventricular Dysfunction, Left/diagnostic imaging , Adolescent , Adult , Aged , Coronary Disease/diagnostic imaging , Coronary Disease/physiopathology , Female , Humans , Hypertension/diagnostic imaging , Hypertension/physiopathology , Male , Middle Aged , Myocardial Contraction/physiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/physiology
8.
Kaohsiung J Med Sci ; 17(10): 530-3, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11831117

ABSTRACT

Very few investigators have studied the effect of contrast media on fibrinolysis. The results of those previous studies are contradictory and inconclusive. The purpose of this study was to evaluate the effect of ionic and nonionic contrast media on fibrinolysis in patients undergoing angiocardiography. Sixty-two patients randomly received either ionic contrast medium Hypaque-76 (n = 31) or nonionic contrast medium Ultravist-370 (n = 31). Plasma tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, and D-dimer were measured before and 20 minutes after the procedures. A significant increase of PAI-1 levels was seen in the Ultravist group but not in the Hypaque group. The t-PA and fibrinogen levels remained virtually unchanged in both groups. A significant increase of D-dimer concentrations was observed in the Hypaque group but not in the Ultravist group. The results of this study may in part explain the reason that the ionic contrast media produce fewer thromboembolic complications than the nonionic contrast media during the cardiac catheterization.


Subject(s)
Contrast Media/adverse effects , Coronary Angiography , Fibrinolysis/drug effects , Adult , Aged , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Male , Middle Aged , Plasminogen Activator Inhibitor 1/blood , Tissue Plasminogen Activator/blood
9.
Kaohsiung J Med Sci ; 17(11): 579-81, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11852466

ABSTRACT

Myxoma is the most common primary tumor of heart. The typical picture of myxoma under echocardiography is a solid, dense echo mass and left atrium is the most common site to find it. The cystic form of myxoma is vary rare. We report a patient who received echocardiographic examination under impression of mitral valve stenosis. A multilobulated cystic mass which was like a hydatid cyst was found in the left atrium and atrioventricular flow was affected by this mass. After tumor resection, myxoma with internal hemorrhage was proved by pathology. No further recurrent myxoma was found during follow-up echocardiographic examination.


Subject(s)
Heart Neoplasms/diagnostic imaging , Myxoma/diagnostic imaging , Aged , Echocardiography , Female , Heart Atria , Heart Neoplasms/surgery , Humans , Magnetic Resonance Imaging , Myxoma/surgery
10.
Am J Cardiol ; 85(7): 882-5, A9, 2000 Apr 01.
Article in English | MEDLINE | ID: mdl-10758933

ABSTRACT

In patients with left Kent bundle, the initial phase of isovolumic relaxation flow was directed basally at pre-excited beats, but apically at nonpreexcited beats or after successful ablation of the Kent bundle. This suggests an important role of the left ventricular activation sequence in the direction of isovolumic relaxation flow.


Subject(s)
Heart Ventricles/physiopathology , Ventricular Function, Left/physiology , Wolff-Parkinson-White Syndrome/physiopathology , Adult , Blood Flow Velocity , Echocardiography, Doppler, Pulsed , Electrocardiography , Female , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Myocardial Contraction , Stroke Volume , Wolff-Parkinson-White Syndrome/diagnostic imaging
11.
Kaohsiung J Med Sci ; 16(9): 490-5, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11271735

ABSTRACT

Anomalous pulmonary venous connection is a relatively common associated anomaly in patients with atrial septal defect (ASD), particularly among those with the sinus venosus type. The incidence of partial anomalous pulmonary venous connection (PAPVC) is higher than 0.7% in the general population and 10% in patients with ASD. In this study, we present two cases with initial impression of ASD, the sinus venosus type in one and the secundum type in the other. The one with the sinus venosus type was found to have a PAPVC that drained into SVC, and the other was suspected of having the same problem because an abnormal shunt was found during cardiac catheterization. This speculation could not be proved, however, due to transesophageal echocardiogram failure. Because we feared the possibility of cardiac defects other than ASD, we performed a minimally invasive operation using a small midline incision instead of the submammary incision and did a full median sternotomy on the patient to look for other complicating coexistent cardiac defects. This patient and the former one were both proven intraoperatively to have a PAPVC that drained into SVC with sinus venosus ASD. The operation to correct an ASD is a rudimentary procedure, and it often becomes a common type of minimally invasive operation among young cardiac surgeons with limited experience. A submammary incision under the impression of simple ASD may meet with certain complications. Therefore, after our experience with the latter case, we do the minimally invasive operation using a small midline incision, which can be easily extended if need be.


Subject(s)
Heart Septal Defects, Atrial/diagnostic imaging , Pulmonary Veins/abnormalities , Adult , Echocardiography , Female , Heart Septal Defects, Atrial/surgery , Humans , Male , Middle Aged , Vena Cava, Superior
12.
Kaohsiung J Med Sci ; 16(12): 600-6, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11392099

ABSTRACT

Several studies have shown cardiovascular benefit in treating hypercholesterolemia with HMG-CoA reductase inhibitor. However, in addition to the lowering of cholesterol, the beneficial effects of this inhibitor reflect other pharmacological activities. Whether these beneficial effects are partly mediated by changes in fibrinolytic factors remains to be proven, since clinical studies on the effects of HMG-CoA reductase inhibitors on fibrinolytic factors have not yielded consistent results. The purpose of this study was to evaluate the effects of fluvastatin on fibrinolytic factors in hypercholesterolemic patients. After 6 weeks on a low-fat, low-cholesterol diet, 23 outpatients known to have primary hypercholesterolemia with low density lipoprotein cholesterol (LDL-C) > or = 130 mg/dl with at least 2 risk factors or fasting LDL-C > or = 160 mg/dl were selected for the study. Venous blood samples were collected at baseline and at 8 weeks after fluvastatin therapy (40 mg/day) to measure of tissue plasminogen activator (t-PA), plasminogen activators inhibitor-1 (PAI-1), fibrinogen, D-dimer and lipid profile. After 8 weeks of therapy, fluvastatin reduced serum cholesterol by 11% (261.9 mg/dl vs 233.2 mg/dl, P < 0.01) and LDL-C by 22% (191.9 mg/dl vs 149.3 mg/dl, P < 0.01). D-dimer was significantly decreased (0.38 ng/L vs 0.28 ng/L, P = 0.02) and tPA, PAI-1 and fibrinogen tended to decrease after therapy. Fluvastatin therapy improved fibrinolytic profile; the result of this study may in part explain the benefit of HMG-CoA reductase inhibitor on cardiovascular system other than lipid lowering.


Subject(s)
Anticholesteremic Agents/pharmacology , Fatty Acids, Monounsaturated/pharmacology , Fibrinolysis/drug effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Hypercholesterolemia/drug therapy , Indoles/pharmacology , Aged , Female , Fibrin Fibrinogen Degradation Products/analysis , Fibrinogen/analysis , Fluvastatin , Humans , Hypercholesterolemia/blood , Male , Middle Aged , Plasminogen Activator Inhibitor 1/blood , Tissue Plasminogen Activator/blood
13.
Kaohsiung J Med Sci ; 14(3): 177-80, 1998 Mar.
Article in English | MEDLINE | ID: mdl-9849045

ABSTRACT

We report on a 68-year-old male case of mitral regurgitation secondary to aortic regurgitation diagnosed using transthoracic echocardiography. A different mechanism of mitral regurgitation secondary to aortic regurgitation is demonstrated in this report. Two-dimensional color Doppler echocardiography may be a useful tool for anatomic evaluation to define its mechanism.


Subject(s)
Aortic Valve Insufficiency/complications , Mitral Valve Insufficiency/etiology , Aged , Aortic Valve Insufficiency/diagnostic imaging , Diastole , Echocardiography, Doppler, Color , Humans , Male , Mitral Valve Insufficiency/diagnostic imaging
14.
Kaohsiung J Med Sci ; 13(2): 117-22, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9099050

ABSTRACT

We report a 50-year-old female case of mitral stenosis with congenital coronary artery fistula communicating the left anterior descending artery to pulmonary artery. In reviewing the literature, mitral stenosis associated with coronary artery fistula is rare. The case was initially treated medically for congestive heart failure. The electrocardiogram revealed severe myocardial ischemia and no obvious etiology was found clinically. The coronary angiogram demonstrated the diagnosis of coronary artery fistula. Myocardial ischemia improved markedly after surgical correction of the valvular disease and the fistula. The patient continued to do well during 2 years and 10 months follow up. The concomitant mitral stenosis masked the symptoms of coronary artery fistula, and made us fall to diagnose the condition initially. Valvular heart disease associated with severe myocardial ischemia without obvious atherosclerotic stenosis of coronary artery reminded us of the possibility of coronary artery fistula, though it has rarely been reported.


Subject(s)
Arterio-Arterial Fistula/complications , Arterio-Arterial Fistula/physiopathology , Coronary Disease/complications , Coronary Disease/physiopathology , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/physiopathology , Myocardial Ischemia/physiopathology , Electrocardiography , Female , Humans , Middle Aged
15.
Gaoxiong Yi Xue Ke Xue Za Zhi ; 10(11): 649-53, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7837325

ABSTRACT

A 76-year-old woman was admitted due to recurrent syncope. Sinus bradycardia and intermittent sinus pauses (up to 2.24 sec) were documented by 24 hour Holter electrocardiogram. Although intravenous atropine can increase the sinus rate up to 100 bpm, electrophysiologic study showed marked prolongation of sinus node recovery time both at the control state and after autonomic blockades. Sick sinus syndrome was diagnosed, even with a normal atropine test, and a permanent pacemaker resulted in resolution of the syncope.


Subject(s)
Atropine/pharmacology , Heart Rate/drug effects , Sick Sinus Syndrome/physiopathology , Aged , Female , Humans
16.
Gaoxiong Yi Xue Ke Xue Za Zhi ; 10(2): 52-62, 1994 Feb.
Article in English | MEDLINE | ID: mdl-8176771

ABSTRACT

From January 1992 to June 1993, 100 consecutive patients with clinically documented paroxysmal supraventricular tachycardias underwent radiofrequency catheter ablation. Group 1 consisted of 46 patients (male:female = 9:37, age: 46 +/- 13 years) with slow-fast atrioventricular nodal reentrant tachycardia. Radiofrequency current was aimed at the slow pathway area which was identified by both anatomical and electrophysiological methods. A mean application of 8 +/- 9 was delivered at a mean power of 22 +/- 4 watts with a mean duration of 21 +/- 3 seconds. Selective ablation of slow pathway conduction was achieved in 28 patients and modification of slow pathway conduction in 12 patients. Antegrade fast pathway conduction was ablated in 3 patients, and retrograde fast pathway conduction in 1. Mean peak CPK was 156 +/- 117 IU/L after ablation. Neither AV block nor clinical recurrence was found during 9.7 +/- 5.1 months follow up. Group 2 consisted of 54 patients with accessory pathway (AP) mediated atrioventricular reciprocating tachycardia. For 35 patients (M:F = 21:14, age: 40 +/- 12 years) who had left-sided accessory pathway, catheter ablation was approached by the retrograde trans-aortic technique in 33 patients and by the transseptal left atrial approach through patent foramen ovale in 2 patients. The mean energy delivered was 28 +/- 5 watts for a duration of 27 +/- 12 sec and 9 +/- 8 applications. The accessory pathway conduction was successfully ablated in 30 patients (86%). Mean peak CPK was 392 +/- 534 IU/L. Cardiac tamponade occurred in 1 patient and transient cerebral ischemia in another, but without mortality. No clinical recurrence was found during 9 +/- 4 months follow-up. Nineteen patients (M:F = 7:12, age: 36 +/- 11 years) had right-sided AP. The mean energy required for successful ablation was 30 +/- 4 watts for a duration of 35 +/- 15 sec and 12 +/- 9 applications. Mean peak CPK was 147 +/- 70 IU/L. Clinical recurrence occurred in 3 patients (15.8%), 1 of them had subsequent successive ablation. The overall immediate procedure success rate for right-sided AP was 65%. In conclusion, radiofrequency catheter ablation is a safe and effective treatment modality for patients with paroxysmal supraventricular tachycardias.


Subject(s)
Catheter Ablation , Tachycardia, Paroxysmal/surgery , Tachycardia, Supraventricular/surgery , Adolescent , Adult , Aged , Catheter Ablation/adverse effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Tachycardia, Atrioventricular Nodal Reentry/surgery
17.
Gaoxiong Yi Xue Ke Xue Za Zhi ; 10(2): 84-8, 1994 Feb.
Article in English | MEDLINE | ID: mdl-8176775

ABSTRACT

It is well known that both normal subjects and hypertensives manifest a distinct nocturnal fall of arterial blood pressure and heart rate. But till now there has been no report about the diurnal change of blood pressure and heart rate in MVP patients. In this report we studied the circadian variations of blood pressure and heart rate in 18 symptomatic MVP patients (mean age 32 +/- 10 years) and compared them with those in 18 age- and sex-matched normal control subjects (mean age 35 +/- 9 years). The MVP group presented a statistically significant blunting of the nocturnal fall in systolic blood pressure (4.2 +/- 3.6% vs 9.7 +/- 3.7%, p = 0.0002). No obvious difference in the nocturnal fall in heart rate was noted between both groups (20.2 +/- 6.0% vs 18.8 +/- 5.6%, p = 0.4290). In conclusion, the circadian variation of blood pressure was blunted in patients with mitral valve prolapse. The mechanism is uncertain and further studies are necessary to clarify it.


Subject(s)
Blood Pressure , Circadian Rhythm , Heart Rate , Mitral Valve Prolapse/physiopathology , Adult , Female , Humans , Male
18.
Gaoxiong Yi Xue Ke Xue Za Zhi ; 9(11): 659-63, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8046786

ABSTRACT

A 52-year-old male patient presented with resistant congestive heart failure. Echocardiographic findings revealed increased right ventricular (RV) wall thickness in conjunction with concentric left ventricular (LV) hypertrophy, LV systolic dysfunction and a granular sparking myocardial appearance. Doppler assessment showed a restrictive LV and RV diastolic filling pattern. These echocardiographic features combined with low voltage of the electrocardiogram is highly suggestive of cardiac amyloidosis. The diagnosis was confirmed by cardiac catheterization and endomyocardial biopsy.


Subject(s)
Amyloidosis/diagnosis , Cardiomyopathies/diagnosis , Amyloidosis/therapy , Cardiomyopathies/therapy , Echocardiography , Electrocardiography , Humans , Male , Middle Aged
19.
Gaoxiong Yi Xue Ke Xue Za Zhi ; 9(9): 518-23, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8271325

ABSTRACT

To evaluate the effect of ionic contrast medium on plasma atrial natriuretic peptide (ANP) and its contributing factors, we measured plasma ANP, serum osmolality, pulmonary capillary wedge pressure (PCWP), femoral artery systolic pressure (FASP), and heart rate before and after left ventriculography with Rayvist in 13 patients suspected of coronary artery disease. The control values of plasma ANP, serum osmolality, and PCWP were 20.3 +/- 5.1 pg/ml, 293.5 +/- 1.5 mosm/kg, 6.6 +/- 0.8 mm Hg, respectively. Rayvist produced a significant increase in plasma ANP, serum osmolality, and PCWP at 1 minute (26.0 +/- 6.3 pg/ml, p < 0.05; 300.7 +/- 1.9 mosm/Kg, p < 0.001; 10.7 +/- 1.3 mm Hg, p < 0.001) and 5 minutes (27.3 +/- 6.3 pg/ml, p < 0.01; 296.8 +/- 1.9 mosm/Kg, p < 0.001; 10.4 +/- 1.7 mm Hg, p < 0.01) post left ventriculography. The FASP decreased significantly at 1 minute, followed by an insignificant increase at 5 minutes. The heart rate increased significantly at 1 minute but no significant change was noted at 5 minutes. We conclude that plasma ANP increases significantly after left ventriculography with Rayvist and its response may be related to left ventricular filling pressure and serum osmolality, but not to FASP or heart rate.


Subject(s)
Atrial Natriuretic Factor/blood , Contrast Media/pharmacology , Iothalamic Acid/analogs & derivatives , Adult , Aged , Female , Humans , Iothalamic Acid/pharmacology , Male , Middle Aged , Osmolar Concentration , Radionuclide Ventriculography
20.
Am J Cardiol ; 71(5): 405-8, 1993 Feb 15.
Article in English | MEDLINE | ID: mdl-8430627

ABSTRACT

The electrophysiologic effects of intravenous verapamil (0.15 mg/kg) and oral sustained-release verapamil (verapamil-SR) (240 mg once daily for 7 days) were studied in 17 patients with paroxysmal supraventricular tachycardia (SVT). Ten patients had atrioventricular (AV) nodal reentrant tachycardia and 7 had AV reciprocating tachycardia involving an accessory AV pathway. Both preparations significantly prolonged anterograde effective refractory period of the AV node and depressed the retrograde AV nodal conduction system. The sinus cycle length, and atrial and ventricular effective refractory periods were prolonged after oral verapamil-SR. Furthermore, oral verapamil-SR depressed retrograde accessory pathway conduction which was not interfered with by intravenous verapamil. Intravenous verapamil and oral verapamil-SR prevented induction of sustained SVT in 12 of 17 (71%) and 10 of 17 (59%) patients, respectively. Follow-up study with oral verapamil-SR 240 mg once daily in 15 patients for 19 +/- 6 months revealed that among the 8 patients without induction of sustained SVT, 7 have been free of symptomatic arrhythmia; only 1 patient had occasional SVT attacks. For the 7 patients with induction of sustained SVT, 3 patients failed to respond to oral verapamil-SR, 1 patient became symptom free, and the remaining 3 patients had less frequent SVT attacks. Thus, immediate intravenous verapamil testing predicts the electrophysiologic results of oral verapamil-SR therapy, and oral verapamil-SR once daily may be used for long-term prophylaxis of SVT with better patient compliance.


Subject(s)
Heart Conduction System/drug effects , Tachycardia, Paroxysmal/drug therapy , Tachycardia, Supraventricular/drug therapy , Verapamil/administration & dosage , Administration, Oral , Cardiac Pacing, Artificial , Delayed-Action Preparations , Electrocardiography , Female , Follow-Up Studies , Humans , Injections, Intravenous , Male , Middle Aged , Tachycardia, Paroxysmal/epidemiology , Tachycardia, Supraventricular/epidemiology , Verapamil/blood , Verapamil/therapeutic use
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