Is a pacemaker indicated for vasovagal patients with severe cardioinhibitory reflex as identified by the ATP test? A preliminary randomized trial.

Background: A previous observational study suggested that, in syncopal elderly patients with vasovagal syndrome, a test using adenosine-5'-triphosphate (intravenous ATP 20 mg. 2 ml-1) could identify a subgroup of patients at high risk of severe cardioinhibitory response and guide the therapeutic strategy. To test one aspect of these results prospectively, we designed a small study focusing only on vasovagal patients with abnormal response to ATP testing.

Can adenosine 5'-triphosphate be used to select treatment in severe vasovagal syndrome?

Background: Selection of treatment in vasovagal syndrome should be guided by the mechanism of symptoms. This study determined whether a simple drug test may assess one mechanism.

Methods And Results: To identify patients at risk of severe cardioinhibitory response of vagal origin, we infused 20 mg ATP into 316 patients hospitalized for recurrent syncope (n=195) or presyncope (n=121) of unknown origin and into normal subjects (n=51).

Acute and long-term efficacy of perindopril in severe chronic congestive heart failure.

To assess the short- and long-term hemodynamic efficacy of perindopril, 15 patients (12 men and 3 women) diagnosed with congestive heart failure were treated with oral perindopril (4 mg daily) for 3 months in association with digitalis and diuretic maintenance therapy. Patients were in New York Heart Association (NYHA) functional classes III and IV. Underlying cardiopathy was ischemic (6 patients), hypertensive (5 patients), valvular (2 patients), and dilated cardiomyopathy (2 patients).

[Intravenous enoximone versus conventional treatment in acute lung edema. Preliminary results of a randomized study].

The aim of this open study was to compare the efficacy of Enoximone and conventional treatment in 44 patients with acute pulmonary edema. At the time of this interim analysis, 22 patients had received Enoximone (1 mg/kg by rapid intravenous injection every 8 hours for 48 hours) and 22 were given conventional treatment (furosemide, nitrates, dopamine-dobutamine). The treatment schedules were randomised.

Acute pulmonary oedema: preliminary results of a randomized trial of the intravenous phosphodiesterase inhibitor, enoximone, vs conventional therapy.

The purpose of this open study was to compare the effects of enoximone and conventional therapy in 44 patients with acute pulmonary oedema. In this preliminary report, 22 patients were randomly assigned to the enoximone group (1 mg/kg bolus, every 8 hours for 48 hours) and 22 patients to conventional therapy (frusemide, nitrates, dopamine-dobutamine). Patients were assessed clinically at 0, 1, 2, 24 and 48 hours by the change in their Killip-Kimball score, dyspnoea, pulmonary rales, blood pressure, diuresis, requirement for additional therapy and/or death.

[Post-infarction anterior septal rupture. Aspects of the IVC flux on bidimensional Doppler with color coding].

In a case of anterior septal rupture complicating a transeptal myocardial infarction, the diagnosis of IVC is immediately confirmed by bidimensional Doppler with color coding. The abnormal flow and its three components are studied in multiple section planes. Incidences permitting the best visualization of the shunt are the longitudinal sections: left parasternal and apical-long axis.

[Acute thrombosis of mitral Starr prosthesis. Value of color coded two-dimensional doppler echocardiography].

In a case of acute thrombosis on mitral Starr valve two-dimensional doppler-echocardiography rapidly showed that parts of the transprosthetic jets had disappeared, while conventional continuous wave doppler ultrasound confirmed the presence of a severe haemodynamic obstacle. With colour-coded doppler ultrasound, there only remained a jet that was parallel to the posterior wall of the left ventricle. This jet was of unusual pattern, with the presence of turbulence and high velocities in aliasing colour.

Myocardial infarction: is bepridil, a new calcium antagonist, able to improve the course of the acute phase?

Several calcium antagonists are useful in the treatment of ischemic heart disease. This open randomized study was designed to determine the effects of bepridil, a new long-acting calcium antagonist with antiarrhythmic properties, on the course of acute myocardial infarction (AMI). Two hundred patients with AMI of less than 48 hours duration (average 10.

Electrophysiological profile of bepridil, a new anti-anginal drug with calcium blocking properties.

The electrophysiological effects of intravenously administered bepridil, a new anti-anginal drug with slow calcium current blocking properties, were studied in 20 patients undergoing an endocavitary cardiac exploration for various reasons. Classical techniques of programmed electrical stimulation were used. Bepridil markedly increased the refractory period of the atrium, atrioventricular node and the AH-interval.

[Isolated ventricular tachycardia without patent cardiopathy].

The authors have made a further study of the case notes of 49 patients who were followed up for several years with isolated ventricular tachycardia occurring in a heart which was otherwise healthy; such tachycardias are also called essential or idiopathic. First they define the criteria necessary for the diagnosis of essential ventricular tachycardia: -- an arbitrary age criterion (less than 45 years in men and 50 years in women) which seeks to exclude the so-called "arterial" ventricular tachycardias; -- a follow-up period of supervision of more than two years, which excludes certain primary cardiomyopathies whose presenting feature is a series of attacks of ventricular tachycardia. They then attempt to classify the ventricular tchycardias into four types, according to their clinical features and the electrocardiographic tracings at rest and on exercise, and to predict the prognosis.