Alfred P. Spivack

Effect of Lidocaine on Ventricular Arrhythmias in Patients with Coronary Heart Disease

LIDOCAINE (Xylocaine) has become one of the most frequently used drugs in the treatment of ventricular arrhythmias, particularly those associated with acute myocardial infarction. It has been shown...

The Use of Central Venous Oxygen Saturation Measurements in a Coronary Care Unit

Abstract A technique for detecting changes in myocardial function in patients with myocardial infarction by serial measurements of central venous oxygen saturation is described. The results obtaine...

Blood Lidocaine Levels and Kinetics following High-Dose Intramuscular Administration

In order to evaluate further the potential benefit of prophylactic intramuscular lidocaine administration in coronary artery disease, 24 patients with suspected acute myocardial infarction were given an intramuscular injection of lidocaine (10% solution) in the deltoid and gluteal muscles on consecutive days. Twelve patients received an intermediate dose (4 mg/kg), and 12 received a high dose (6 mg/kg) of lidocaine, and blood lidocaine levels were measured over a 4-hour study period.Intradeltoid injection produced higher blood lidocaine levels and more rapid development of peak blood levels than did intragluteal injection. Administration of high-dose lidocaine (average dose 450 mg) into the deltoid muscle produced the ideal combination of rapid peak blood levels (6.5 &mgr;g/ml ± 2.1 SEM at 5 min) and persistence of therapeutic levels (>1.5 &mgr;g/ml) for over 2 hours. Although drowsiness, paresthesias, slurred speech, and tinnitus occurred in seven of the 12 patients in the high-dose group, no major neurotoxicity, such as grand mal seizures, were observed, nor was there evidence of hypotension or increase in atrioventricular block. Prophylactic administration of high-dose 10% lidocaine into the deltoid muscle appears to have potential for reducing the early mortality following acute myocardial infarction.

The periodic abnormalities of the temperospatial QRS vector in isolated right ventricular overwork

Abstract The scalar vector leads X, Y, and Z of 43 patients who had heart conditions which caused isolated overwork of the right ventricle were recorded, using the orthogonal lead system of Helm-Frank. With the aid of an electronic computer, polar coordinates of the temperospatial heart vector representing the time-varying resultant potential of ventricular activation were calculated and plotted automatically on a linear time base by the computer output. These data were compared with those in 154 healthy adults reported on previously. The resulting differences, which could be ascribed to chronic overwork and hypertrophy of the right ventricle, were of three characteristic types: (1) abnormal rightward deviation of the heart vector during the period from 40 to 50 msec. after the onset of ventricular activation; (2) abnormal anterior tilting of the heart vector during the period from 35 to 75 msec.; and (3) an abnormal momentary reduction in the spatial magnitude of the heart vector during the period from 40 to 55 msec. The results were compared with a recently reported study of left ventricular overwork, and the pattern of deviation of right and left ventricular overwork is presented graphically against the background of the region of normal scatter to demonstrate the importance of the time function display for the discernment of the characteristic abnormalities.

The calculated tempero-spatial heart vector in proved isolated left ventricular overwork☆

Abstract From the records of the orthogonal 3-lead system of Helm, the polar coordinates of the time-varying spatial heart vector of ventricular activation were calculated. Forty-six patients with clinical conditions which caused isolated left ventricular over-work were compared with 154 normal control subjects. Variation from normal in the group of patients with left ventricular overwork could be divided into two categories: less than normal anterior tilting of the heart vector during the first 40 msec. of ventricular activation, and an increase in the spatial magnitude of the heart vector from 35 msec. to the end of ventricular activation. The results of the study represent the changes in the vector forces derived from the body surface during ventricular activation which occur in isolated overwork of the left ventricle. The difference in result between the orthogonal 3-lead system and the serial 12-lead electrocardiogram appeared to be dependent mostly on the detection of abnormal direction of the heart vector along an anteroposterior body axis for short periods during the initial half of ventricular activation.

The coronary care unit activities program: its role in post-infarction rehabilitation.

Abstract In order to prevent deconditioning during convalescence from myocardial infarction, 10 patients without major complications participated in a rehabilitation program which combined mild, graded exercise, early sitting posture, and early ambulation. Exercises were begun at 3 days post-infarction and continued to discharge 16 days later; determinations of oxygen consumption at these times revealed only a modest increase in energy cost with exercise. Hemodynamic changes were insignificant, and there were no complications in these 10 patients, in an earlier pilot group of 10 patients, or in a subsequent group of 50 patients. Patient acceptance and cooperation were excellent, and patient morale appeared to improve through participation in the program. In selected patients, this program is safe, simple, does not prolong hospitalization, and may contribute to earlier and more complete rehabilitation.

Atrial flutter with 1:1 A-V conduction associated with pulmonary embolism in the aged

Abstract Atrial flutter with 1:1 A-V conduction occurring in 2 patients over 60 years of age is reported. The etiological significance of pulmonary embolism is discussed.