Egil Sivertssen

Electrocardiographic atrial complex and acute atrial myocardial infarction

Abstract The atrial complex was examined by use of standard and right atrial leads in 59 patients with acute myocardial infarction. Abnormal atrial complexes were found in standard leads in 17 patients, and in the right atrial lead in 29 patients. Abnormal atrial complexes were found more frequently in patients who had arrhythmias in the acute phase than in patients without arrhythmias. Ten patients died during the acute phase. Infarcts in the right atrium were found in all 7 patients whose right atrium was examined microscopically. Abnormal atrial complexes in the right atrial lead were found in patients with atrial infarcts, especially when the lateral atrial wall was involved.

The Influence of Venous Collecting Pressure On Measurements of Calf Blood Flow By Venous Occlusion Plethysmography

mended that an appropriate venous collecting pressure (VCP) should be found by trial in each subjects This is possible during measurements of blood flow at rest. Whenever the state of the peripheral circulation is substantially changed, the pressure in the arteries may be altered, and it is necessary to select a VCP appropriate for the new conditions. Under certain circumstances, for instance during measurements of reactive hyperemia flow, it is impossible in practice to determine the individual optimal VCP. In many studies the same VCP which has been recommended for normal subjects, has been employed in measurements of flow in patients with pathological circulation. This may give correct values in some cases, but not always. The postischemic reactive hyperemia in patients with arterial insufficiency often lasts for a much longer time than it does in normal subjects, and a prolonged intraarterial pressure fall distal to the arterial obliteration may be seen,6 similar to the long-lasting pressure fall during post-exercise reactive hyperemia.~’ ~ 8 such a pressure fall may be of importance for the selection of an appropriate VCP. The aim of the present study was 1. to observe whether or not commonly used VCP may interfere with arterial inflow in patients with arterial obliterations. 2. to determine the optimal VCP for flow measurements during reactive hyperemia in the calf of normal subjects and patients with atherosclerosis obliterans in different locations.

Surgical Treatment of Left Ventricular Aneurysm: Analysis of Risk Factors, Morbidity and Mortality in 205 Cases

Left ventricular aneurysm was surgically treated in 205 patients during the decade 1975-1984. The patients had had one to five myocardial infarctions, the latest days to years (mean 32 months) preoperatively and 92% were in NYHA functional class III or IV. The main indications for surgery were angina (47%), congestive heart failure (38%) and arrhythmia (15%). The 176 anterior, 23 posterior and six combined aneurysms were treated with resection (130 cases) or plication (75). The early mortality was 5%. Univariate analysis identified arrhythmia, concomitant valve replacement and need for intra-aortic balloon pumping (IABP) as significant risk factors, and multivariate analysis revealed the indication for surgery and need for IABP as the only independent predictors of total mortality. The survival rates 5 and 10 years postoperatively were respectively, 74% and 60%. At follow-up after 1/2-10 years, almost 90% of the surviving patients had improved functional status. Left ventricular aneurysm thus can be surgically treated with low mortality rate and good functional result.

Risk factors for morbidity and mortality in mitral valve replacement

Risk factors of operative mortality and long term survival were identified in 219 patients who underwent mitral valve replacement (MVR) using Bjørk-Shiley mechanical prostheses. Early mortality was 7.3%. The accumulated follow-up time was 1134 patient-years, and the 5-year survival for the total cohort was 78 +/- 3%. Independent prognostic factors of early mortality were poor NYHA class, which carried a relative risk (RR) of 3.2, and ischaemic aetiology, with a RR of 2.2. Ischaemic aetiology was the sole predictor of heart pump failure requiring intra-aortic balloon pump support (RR = 2.7). Independent risk factors of total mortality (early and late) were male sex (RR = 2.3), NYHA class III-IV (RR = 2.4), presence of mitral regurgitation (RR = 3.2) and relative heart volume (RR = 1.6 for a 800 ml/m2 size compared to a heart of 550 ml/m2). Our results underline the importance of patient-related factors in MVR, and indicate that care is needed in comparing the quality of MVR from different institutions with respect to mortality and morbidity. The results of MVR are palliative rather than curative except in female patients with NYHA class II function and mitral stenosis, in whom cure was attained.

Myocardial Infarction after Aortocoronary Bypass Surgery. The Incidence in 187 Consecutive Patients and the Late Postoperative Significance

The incidence of postoperative acute myocardial infarction (AMI) was studied by serial postoperative ECG recordings in 187 patients, who underwent aortocoronary bypass surgery at Ulleval Hospital during the years 1971 to 1975. The occurrence of postoperative AMI was related to serial serum enzyme analyses and to short-and long-term prognoses.ECG signs of postoperative AMI were found in 10 patients (5.3%) and of possible AMI in 12 patients (6.4%). The location of the infarcts was inferior in 7 of the 10 patients with AMI. Only 1 of the patients died postoperatively. In the others the recovery was uneventful.S-GOT/ASAT and S-LDH/LD values were significantly higher in patients with ECG changes compatible with postoperative AMI than in patients with uncertain or no ECG findings. Maximal S-GOT/ASAT value more than 100 U/l was found in 8 out of 9 patients with postoperative AMI, in whom serum enzyme levels were measured, and in 6 out of 12 patients with possible AMI. The combination of postoperative ECG signs o...

Degree of coronary artery disease predicted by exercise testing

Abstract. The ability of exercise testing to predict the extent of coronary artery disease was examined in 268 male patients undergoing both coronary angiography and bicycle testing with electrocardiography before coronary artery bypass surgery. When maximal ST‐depressions limited by symptoms increased from 0 to 4 mm or more, the percentage of patients with ‘serious’ coronary disease, defined as either triple vessel disease or left main stem stenosis, increased from 50% to 80% (P = 0.0001). The patients in the lowest third of physical work capacity showed only a slightly increased risk of serious disease. This tendency was abolished in patients who were using β‐blockers, whereas the relationship between ST‐depression and disease was not affected by this medication. The probability of finding left main stem stenosis in a patient increased from 5 to 30% with increasing ST‐depression; β‐blockers did not affect this relationship, but there was no additional predictive effect of implicating the level of physical work capacity. It is concluded that traditional electrocardiography during exercise is of value when selecting patients for angiography, but that the physical work level obtained during the test does not predict the degree of coronary pathology.

Functional evaluation of aortocoronary bypass surgery by exercise testing.

Exercise stress test was performed prior to and after aortocoronary bypass surgery in 91 male patients in an attempt to quantitate the change of physical capacity after operation and to correlate this to clinical improvement and late shunt angiography. The mean maximal work load was significantly higher after than prior to surgery in all groups. In average the maximal work load increased 65%. No difference was found between patients who were operated on for stable angina pectoris and those with unstable angina or impending myocardial infarction. Patients, who subjectively were without symptoms or much better after surgery, had a higher maximal work load after operation than those who were subjectively less improved or worse. In a sub-group of patients the maximal oxygen consumption was calculated in per cent of normal values for the age. The mean maximal oxygen consumption increased from 59% prior to surgery to 76% of normal values after surgery.

Left Ventricular Function after Aortocoronary Bypass Surgery

Aortocoronary bypass operations without additional myocardial surgery or valve replacement were performed at Ullevål Hospital in 190 patients during the period May 1971 to Dec. 1975. Postoperatively re-examination was made by left-heart catheterization in 124 patients at a mean interval of 18.2 months and right-heart catheterization in 108 patients at a mean interval of 16.0 months after surgery. The mean postoperative values for PCVP at rest, PCVP during exercise, LVEDP before contrast and LVEDP after contrast were significantly lower than the mean pre-operative values. The difference between pre- and postoperative values were largest in patients with elevated PCVP or LVEDP values before surgery, whereas in patients with low pre-operative values the mean values after surgery were unchanged or increased. The results indicate that marked improvement of left ventricular function may occur after aortocoronary bypass operations, even in patients with signs of ventricular failure at rest. A stress test is, however, of importance in evaluating the haemodynamic consequences of coronary surgery. No difference was found in patients with single versus patients with double or triple shunts. Post-operative shunt occlusion was found in 44 of 258 grafts at re-examination. No difference was found between patients with all shunts patent and patients with one or more shunts occluded as regard to mean postoperative PCVP and LVEDP values.

Right Atrial Electrocardiography (Ra Ecg) in the Diagnosis of Right and Left Atrial Abnormalities

The current criteria for electrocardiographic diagnosis of atrial abnormalities are based on the electrical axis of the P wave, the amplitude, duration and morphology in standard limb and precordial leads. None of these criteria has been found to be satisfactory, and they correlate poorly to anatomic and angiographic findings. 1-4 Few data are available concerning direct and semi-direct electrocardiography in atrial abnormalities. In right atrial hypertrophy increased voltage has been found in intracavitary leads from the right atrium and a negative deflection even in the lower part of the atrium In left atrial hypertrophy, recordings from the lower and middle part of the right atrium have shown a broad negative deflection following the positive deflection. In recordings from the left atrial cavity a delayed intrinsicoid deflection has been described.6 Recordings from the outer surface of the right and left atria during thoractomy were performed by Reynolds7 in cases of mitral stenosis and congenital heart disease and in control cases with carcinoma of the bronchus. Compared with the controls, the voltage of the P waves was increased in mitral stenosis, especially in left atrial tracings, and in congenital heart disease mainly in right atrial tracings. Asynchronism of the P waves in right and left atrial tracings was believed

The Atrial Complex in Right Atrial Electrocardiography (Ra Ecg)

From Department of Medicine VIII, Ullevaal Hospital, University of Oslo, Oslo, Norway. The atrial complex is a subject which to some extent seems to have been neglected in the extensive field of electrocardiography. Of recent years however, this trend has reversed, due in no small measure to the interest in the pathogenesis and mechanisms of cardiac arrhythmias. In addition to conventional ECG leads, esophageal leads, special lead systems and vectorcardiography have been used to visualize the atrial complex. Studies of intracardiac electrocardiograms obtained by cardiac catheterization were first reported by Lenegre and Maurice.’ The normal intracardiac electrocardiogram has been further described by many, including Hecht,2 Battro and Bidoggia,3 Sodi-Pallares et a1.,4 Levine et al.5 and Kossman et al.s 6