British heart journal
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British heart journal · Aug 1984
Comparative StudyCross sectional echocardiographic assessment of left ventricular volume and ejection fraction in patients with tetralogy of Fallot. Comparison with biplane angiographic measurements.
To evaluate the usefulness and accuracy of calculating left ventricular volume and ejection fraction from cross sectional echocardiograms in patients with tetralogy of Fallot, 28 patients were studied within 24 hours of cineangiography. Indexed end diastolic and end systolic volumes were calculated from three different paired echocardiographic projections: (a) the two and four chamber views from the apical impulse window, (b) the parasternal long axis view and the subxiphoid long axis view, and (c) the four chamber view and short axis precordial views at mitral and papillary muscle level. Volumes were calculated in five different ways using three different algorithms (area length, Simpson's rule, the Parisi formula). ⋯ The second best correlation was obtained with the area length method using the two and four chamber apical views; the other correlations were less satisfactory. Thus these results show that left ventricular volumes can be accurately assessed by cross sectional echocardiography in children with tetralogy of Fallot and that the ejection fraction can be satisfactorily estimated. The results depend on careful gain setting and precise demonstration of the left ventricular endocardium, which is best seen in the sub-xiphoid and long axis views.
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British heart journal · Jul 1984
Case ReportsSuccessful cardiopulmonary bypass in diabetics with anaphylactoid reactions to protamine.
Two insulin dependent diabetics with previous anaphylactic like (anaphylactoid) reactions to protamine underwent successful cardiopulmonary bypass for coronary artery surgery. Platelet concentrates instead of protamine were used to neutralise their systemic heparinisation. In both cases the anaphylactoid reactions first became apparent after administration of protamine sulphate at the end of cardiac catheterisation. These cases show that adverse reactions to protamine need not be a contraindication to cardiopulmonary bypass and cardiac surgery and emphasise that this condition should be considered in all patients with a history of previous protamine exposure or one which may be associated with anaphylactoid reactions to protamine.
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British heart journal · Jun 1984
Single lead atrial synchronised pacing in patients with cardiogenic shock after acute myocardial infarction.
A pacing system requiring only a single lead was used to establish atrial synchronised pacing in eight patients with complete atrioventricular block and cardiogenic shock following acute myocardial infarction. Spontaneous atrial activity was sensed through electrodes positioned on the pacing lead and used to trigger ventricular demand pacing. A normal atrioventricular relation could be established in each of these critically ill patients without the complexity of inserting and finding a stable position for an additional atrial sensing lead. ⋯ Atrial synchronised pacing abolished this effect and resulted in a stable blood pressure at or above the peak pressure achieved with conventional pacing. Atrial synchronised pacing with a single lead system can be established rapidly. This mode of pacing has appreciable and significant haemodynamic superiority over conventional ventricular pacing in patients with cardiogenic shock and atrioventricular block following acute myocardial infarction.
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A 30 year old man with a 15 year history of alcohol abuse presented with symptoms and signs of circulatory shock, severe disturbances of renal and liver functions, and metabolic acidosis. The cardiovascular and metabolic features were attributable to Shoshin beriberi. He recovered completely after treatment with thiamine.
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British heart journal · Apr 1984
Randomized Controlled Trial Clinical TrialEffect of metoprolol on chest pain in acute myocardial infarction.
A total of 1395 patients aged 40 to 74 years were included in a double blind trial with the beta 1 selective blocker metoprolol in suspected acute myocardial infarction. Metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital followed by 200 mg daily for three months. A placebo was given in the same manner. ⋯ The estimated duration of pain was shorter in the metoprolol group than in the placebo group. These effects were related to the initial heart rate, the initial systolic blood pressure, and the final site of the infarct as determined electrocardiographically. Thus metoprolol given in the acute phase of suspected or definite myocardial infarction appears to reduce the severity of chest pain.