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Chhabra L, Spodick DH. Pyopericarditis in diabetes mellitus: some worthy considerations. Diabet Med 2015; 32:569. [PMID: 25640692 DOI: 10.1111/dme.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/26/2022]
Affiliation(s)
- L Chhabra
- Department of Cardiovascular Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT, USA
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Spodick DH. Noninvasive access to cardiovascular dynamics: Experimental and applied (bibliotheca cardiologica no. 37): Edited by G. Južnič, S. C. J. E. Južnič, A. A. Knoop, A. Noordergraaf, N. J. Winer S. Karger, Basel (1979) XVI + 224 pages, approx. US $84.50 ISBN 3. Clin Cardiol 2015. [DOI: 10.1002/clc.4960040608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chhabra L, Devadoss R, Gnanapandithan K, Spodick DH. Pleuropericardial effusion: an unusual presentation of polymyalgia rheumatica. Case Reports 2014; 2014:bcr-2014-203881. [DOI: 10.1136/bcr-2014-203881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Imazio M, Brucato A, Cemin R, Ferrua S, Maggiolini S, Belli R, Trinchero R, Spodick DH, Adler Y. Colchicine for acute pericarditis. Results from the Investigation on Colchicine in Acute Pericarditis (ICAP). A prospective, randomized, double-blind, placebo-controlled, multicenter trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AIMS To review the current major diagnostic issues on the diagnosis of acute and recurrent pericarditis. METHODS To review the current available evidence, we performed a through search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive Medline search with the MeSH terms 'pericarditis', 'etiology' and 'diagnosis'. RESULTS The diagnosis of pericarditis is based on clinical criteria including symptoms, presence of specific physical findings (rubs), electrocardiographical changes and pericardial effusion. Although the aetiology may be varied, most cases are idiopathic or viral, even after an extensive diagnostic evaluation. In such cases, the course is often benign following anti-inflammatory treatment, and management would be not affected by a more precise diagnostic evaluation. A triage of pericarditis can be safely performed on the basis of the clinical and echocardiographical presentation. Specific diagnostic tests are not warranted if no specific aetiologies are suspected on the basis of the epidemiological background, history and presentation. High-risk features associated with specific aetiologies or complications include: fever > 38 degrees C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to aspirin or a NSAID. CONCLUSIONS A targeted diagnostic evaluation is warranted in acute and recurrent pericarditis, with a specific aetiological search to rule out tuberculous, purulent or neoplastic pericarditis, as well as pericarditis related to a systemic disease, in selected patients according to the epidemiological background, presentation and clinical suspicion.
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Affiliation(s)
- M Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy.
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Spodick DH. P: the neglected deflection. Heart 2010; 96:389; author reply 389. [PMID: 20197367 DOI: 10.1136/hrt.2009.185918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Spodick DH. ECG: An introductory course a practical introduction to clinical electrocardiography M. J. Halhuber, R. Giinther, and M. Ciresa (English translation by H. J. Hirsch) Springer-Verlag, Berlin-Heidelberg-New York (1979) 155 pages with 98 figures and 7 tables. Clin Cardiol 2009. [DOI: 10.1002/clc.4960030414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Spodick DH, Moran JJ. Acute traumatic pericarditis: failed suicide with classic electrocardiogram. Clin Cardiol 2009; 22:544. [PMID: 10492845 PMCID: PMC6655316 DOI: 10.1002/clc.4960220811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- D H Spodick
- Cardiology Division, Saint Vincent Hospital, Worcester, MA 01604, USA
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Abstract
This report describes a patient admitted with shortness of breath due to cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed only after right heart pressures failed to decrease after successful pericardiocentesis. The patient was found to have widely metastatic adenocarcinoma of colon (with metastases to pericardium) and a paraneoplastic syndrome of deep vein thrombosis.
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Affiliation(s)
- U C Jairath
- Saint Vincent Hospital, Worcester, Massachusetts 01604, USA
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Abstract
BACKGROUND Because the most characteristic and sensitive electrocardiographic (ECG) correlate of pulmonary emphysema in adults is verticalization of the frontal plane P-wave vector (P axis), we investigated its strength as a lone criterion to screen for obstructive pulmonary disease (OPD) in an adult hospital population. METHODS In all, 954 consecutive unselected ECGs were required to yield 100 with P axis > or = +70 degrees (unequivocally negative P in a VL during sinus rhythm) and pulmonary function tests. and 100 with P axis < or = +50 degrees (unequivocally positive P-aVL). RESULTS Obstructive pulmonary disease by both pulmonary function test and clinical criteria was present in 89 of 100 patients with vertical P axes and 4 of 100 patients without OPD. CONCLUSION The high sensitivity (89% for this series) and high specificity (96%) makes vertical P axis a useful screening criterion. Its at-a-glance simplicity makes it "user-friendly."
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Affiliation(s)
- R Baljepally
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01604, USA
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Abstract
BACKGROUND Interatrial block (IAB: P wave > or = 110 ms) is a strong correlate of left atrial (LA) enlargement and an important predictor of supraventricular tachyarrhythmias, notably atrial fibrillation and flutter. It is surprising that, despite its association with arrhythmias and its effects on the electromechanical properties of the left atrium, there is widespread neglect of this common abnormality. HYPOTHESIS The study was undertaken to investigate the prevalence of IAB in a general hospital population. METHODS We prospectively evaluated the electrocardiograms of 1,000 consecutive adult patients. analyzed for P-wave duration. RESULTS Our results showed a very high prevalence of IAB (41.1% of patients in sinus rhythm and 32.8% of all patients). As expected, it was more common in patients aged > 60 years. CONCLUSIONS Given this unusually high prevalence of IAB in hospital patients and its ominous portents (LA enlargement. thrombosis and embolism, arrhythmias), physicians should be aware of its frequency and computer software should be programmed to recognize it.
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Affiliation(s)
- U C Jairath
- Division of Cardiovascular Disease, Saint Vincent Hospital at Worcester Medical Center, Massachusetts 01608, USA
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Desai SA, Mehrok S, Spodick DH. Global T-wave inversion: limited QT dispersion despite QTc prolongation--a correlate of benignity in patients with strikingly abnormal electrocardiograms. Clin Cardiol 2009; 22:655-7. [PMID: 10526690 PMCID: PMC6656029 DOI: 10.1002/clc.4960221012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The global T-inversion (GTI) electrocardiogram (ECG) is strikingly abnormal with major QTc prolongation, but with a surprisingly good prognosis by Kaplan-Meier curve. This contrasts with most significant QTc prolongations. HYPOTHESIS This study was undertaken to ascertain QT interval dispersion (QTd) in global T wave inversion, a clinically benign long QTc ECG. METHODS Longest and shortest QT intervals in all 12 leads in 35 consecutive patients with GTI were determined by two mutually blinded observers. QTd was determined by subtraction (maximum-minimum) and QTc was calculated using the Bazett formula. RESULTS There was a 2:1 female preponderance QTc was prolonged and equal for men (0.471) and women (0.469). Observer variability of under 2% permitted averaging of QT measurements. Composite mean QTd was 55 ms. The literature revealed a range of QTd in normal subjects of 39 to 59 ms (mostly 49 to 59 ms). Patient series with abnormal QTd were well above this level. CONCLUSION Despite a strikingly abnormal ECG with marked QTc prolongation, QT dispersion was limited in global T inversion, consistent with its previously demonstrated benignity.
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Affiliation(s)
- S A Desai
- Cardiology Division, St. Vincent Hospital, Worcester, MA 01604, USA
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Seferovic PM, Ristic AD, Maksimovic R, Petrovic P, Ostojic M, Simeunovic S, Zamaklar D, Simeunovic D, Spodick DH. Initial clinical experience with PerDUCER device: promising new tool in the diagnosis and treatment of pericardial disease. Clin Cardiol 2009; 22:I30-5. [PMID: 9929765 PMCID: PMC6655979 DOI: 10.1002/clc.4960221309] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The idea to enter the normal pericardial sac safely was unrealistic until recently. The development of a novel instrument (PerDUCER pericardial access device) for percutaneous access to the pericardium could potentially have a significant impact, not only on patients with pericardial diseases but even more, or primarily, on diagnosis and treatment of myocardial and coronary disease and arrhythmias. HYPOTHESIS The overall objective of the present study was to evaluate the feasibility and safety of the percutaneous pericardial access with PerDUCER in patients with pericardial disease, and to analyze our initial experience with this new technique, with particular emphasis on sequential procedural steps. METHODS The device was studied in five patients with pericardial disease (two men, mean age 50.4 years, range 30-68, four with normal body mass index). The procedure consists of two distinct techniques: (1) access to the mediastinal space, and (2) pericardial capture, puncture, and insertion of the guidewire. Access to the mediastinal space includes the introduction of a blunt cannula, a 0.038 guidewire, a dilator-introducer sheath set, and insertion of the PerDUCER device. Key points of the PerDUCER procedure are as follows: introduction of the blunt cannula without resistance, placement of the dilator-introducer sheath at the upper third of the heart, systolic movements of the PerDUCER device, successful vacuum and capture of pericardium, puncture and introduction of the intrapericardial guidewire. RESULTS Access to the mediastinal space was accomplished in four of five patients, as were pericardial capture and probably puncture. However, despite numerous successful captures and probably punctures of pericardium, we were not able to confirm introduction of the intrapericardial guidewire into the pericardial cavity in any of our patients (0/5). The procedure was very well tolerated in all patients (5/5). No major complications developed during the procedure, bearing in mind that the intrapericardial placement of the guidewire was not achieved. Minor complications included pain at the dilator-introducer sheath entry site (5/5) and mild transient fever (2/5). CONCLUSIONS According to the present experience, we believe that, with minor modifications, the PerDUCER device could be successfully implemented for pericardial entry in patients with pericardial disease. Further studies are needed to evaluate the feasibility and safety of this new instrument in patients with a normal pericardium. This could open a most exciting spectrum of possible implementations of the device in the future.
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Affiliation(s)
- P M Seferovic
- Institute for Cardiovascular Diseases of the University Medical Center of Serbia, Belgrade, Yugoslavia
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Affiliation(s)
- D H Spodick
- Cardiology Division, Saint Vincent Hospital, University of Massachusetts Medical School, Worcester 01604, USA
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Abstract
Intrapericardial delivery of therapeutic agents for pericardial diseases has long been available in the presence of excess pericardial fluid. Most patients with myocardial and coronary disease have no such excess so that their direct treatment requires pericardial access, for which a new instrument has succeeded in animals with induced infarctions, coronary lesions and arrhythmias. Nitric oxide (NO) donors, calcium-avid drugs, antibodies, angiogenic agents (pharmacologic coronary bypass), and hypothermic solutions have been instilled intrapericardially, and even iontophoresis has been used; gene therapy is also promising. Intrinsic pericardiogenic substances may potentially be stimulated for comparable purposes.
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Affiliation(s)
- D H Spodick
- University of Massachusetts Medical School, Cardiology Division, St. Vincent Hospital, Worcester, USA
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Abstract
Reports on the aetiologic distribution of acute pericarditis vary significantly from study to study. We attempted to summarise reports on incidence of different aetiologies of pericarditis and explain the variable range of reported frequencies of different aetiologies. The literature between 1978 and 2005 was reviewed for comparative incidence of acute pericarditis. Reports of more than 50 subjects were included. The most common cause of pericarditis was 'idiopathic' pericarditis (mean: 26.1%), followed by neoplastic diseases (mean: 25.6%) and iatrogenic pericarditis (mean: 16.3%). Each mean had a wide range of 95% confidence interval. In summary, the clinician is confronted by a huge dispersion of reported frequencies of pericarditis aetiologies as a consequence of multiple factors. Recognising specific rare causes of pericarditis, often essential for early diagnosis and successful treatment, means coping with that aetiologic dispersion and its implied probabilities.
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Affiliation(s)
- M Lorbar
- Division of Cardiology, Department of Medicine, St. Vincent Hospital, Worcester, MA, USA
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Brucato A, Brambilla G, Adler Y, Spodick DH, Canesi B. Therapy for recurrent acute pericarditis: a rheumatological solution? Clin Exp Rheumatol 2006; 24:45-50. [PMID: 16539818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To assess the efficacy of a multidrug protocol in recurrent acute pericarditis. We tried also to assess the specific role of colchicine. METHODS We studied 58 patients (34 males) in the largest monocentric observational study. All patients received prolonged courses of non-steroidal anti-inflammatory drugs; generally we do not start a corticosteroid in recurrent acute pericarditis, but if a steroid had already been started, we planned a very slow tapering; if necessary azathioprine, hydroxychloroquine, and other immunosuppressive drugs were used; 44 patients (27 males, 61.4%) were treated also with colchicine and 14 patients (7 males, 50%) were not given this drug. RESULTS After starting our protocol recurrences dropped from 0.48 to 0.03 attacks/patient/month (p < 0.00001) within 12 months and remained at the same level till the end of the follow-up (mean 8.1 years) in the whole cohort. In the 44 patients treated with colchicine recurrences dropped from 0.54 to 0.03 attacks/patient/month (p < 0.00001) within 12 months, and in 14 patients not given colchicine recurrences decreased from 0.31 to 0.06 attacks/patient/month (p = 0.002). In patients treated with colchicine the decrease was significantly higher (0.51) than in patients not taking this drug (0.25) (p = 0.006). Colchicine was discontinued by 16.3% of patients because of side effects. CONCLUSION A multidrug protocol including non-steroidal anti-inflammatory drugs at high dosage, slow tapering of corticosteroid, colchicine, reassurance and close clinical monitoring is very effective in recurrent pericarditis; this improvement is more dramatic in colchicine treated patients, but also patients who do not tolerate it can achieve good control of the disease.
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Affiliation(s)
- A Brucato
- Department of Rheumatology, Internal Medicine and Emergency Medicine, Ospedale Niguarda, Milan, Italy
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Spodick DH. Benefits and burdens of surgery. Br J Surg 2005. [DOI: 10.1002/bjs.1800730933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D H Spodick
- St. Vincent Hospital Inc., Worcester, Massachusetts 01604, USA
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Abstract
Interatrial block (IAB; P wave>or=110 ms) indicates conduction delay between the right and left atria. IAB can present as partial or advanced and is denoted on the electrocardiogram (ECG) by bifid or biphasic P waves, respectively, the latter in inferior leads. The importance of IAB cannot be overemphasized due to high prevalence, especially at ages 60 and over, and due to grave associations with atrial flutter and fibrillation as well as congestive heart failure. Thus, we present a classic ECG of the much less common form of IAB, namely advanced IAB, as it serves as an excellent yardstick and teaching tool to help clinicians understand this medical entity thoroughly and to easily recognize this often missed type of block.
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Affiliation(s)
- V Ariyarajah
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Spodick DH. Three Kinds of Block. The American Journal of Geriatric Cardiology 2004; 13:48. [PMID: 14724403 DOI: 10.1111/j.1076-7460.2004.03299.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D H Spodick
- Cardiology Division, St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA 01608, USA
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Affiliation(s)
- A Tandar
- Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester Medical Center, Worcester, Massachusetts 01608, USA
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Spodick DH. Does right heart catheterization prevent perioperative complications? JAMA 2001; 286:2940; author reply 2941. [PMID: 11743821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- D H Spodick
- Cardiology Division, St Vincent Hospital, Worcester, Mass., USA
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Affiliation(s)
- B Maisch
- Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany.
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Abstract
OBJECTIVES Our purpose was to determine the effect of interatrial block (IAB, P-wave duration >/=120 ms) on left atrial (LA) dynamics. IAB is associated with LA enlargement (LAE). LA dysfunction is associated with decreased left ventricular filling, a propensity for LA appendage thrombus formation, and reduced atrial natriuretic peptide levels. We evaluated LA function in patients with and without IAB matched for LA size. METHODS Echocardiograms with LA enlargement were analyzed. Twenty-four patients had IAB, and 16 patients without IAB formed the control group. LA volumes, A-wave acceleration times (At), LA stroke volume (LASV), ejection fraction (LAEF), and kinetic energy (LAKE) were calculated. RESULTS The control group and patients with IAB had comparable maximal LA volume and diameter (P >.05). Patients with IAB had significantly longer At (115 +/- 39 ms vs 83 +/- 24 ms, P <.01) and smaller LASV (7 +/- 5 mL vs 17 +/- 6 mL, P <.01), LAEF (9% +/- 6% vs 25% +/- 8%, P <.01), and LAKE (20 +/- 14 vs 65 +/- 44 Kdyne/cm/s, P <.01). LAKE varied inversely with P-wave duration (r = -0.51, P <.01). P-wave duration and minimal LA volume were independent determinants of LAEF. CONCLUSIONS Patients with IAB have a sluggish, poorly contractile LA, and the extent of dysfunction is related to the degree of electrical delay from IAB. IAB should be considered a marker of an electromechanically dysfunctional LA and hence a risk factor for atrial fibrillation and congestive heart failure.
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Affiliation(s)
- S B Goyal
- Cardiovascular Division, Department of Medicine, University of Massachusetts Medical School-St Vincent Hospital, Worcester, MA 01608, USA
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Spodick DH. Atrial tachycardia with block (second-degree: wenckebach). Am J Geriatr Cardiol 2001; 10:371. [PMID: 11684924 DOI: 10.1111/j.1076-7460.2001.00049.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D H Spodick
- Cardiology Division, St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA
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Jacob MA, Goyal SB, Pacifico L, Spodick DH. Multiple coronary artery-left ventricular fistulas associated with hereditary hemorrhagic telangiectasia. Chest 2001; 120:1415-7. [PMID: 11591593 DOI: 10.1378/chest.120.4.1415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Coronary artery-left ventricular (LV) fistulas are extremely rare and can cause myocardial ischemia from coronary steal. We describe an elderly woman who presented with unstable angina from multiple and extensive coronary artery-LV fistulas. She also had clinical features suggestive of hereditary hemorrhagic telangiectasia (HHT). Association of coronary artery-LV fistulas with HHT has not been reported and can pose a management dilemma in view of the risks of extensive cardiopulmonary surgery and potential complications of myocardial ischemia, stroke, and brain abscess.
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Affiliation(s)
- M A Jacob
- Department of Cardiology, University of Massachusetts-Saint Vincent Hospital, Worcester, MA 01608, USA
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Spodick DH. Atrial premature complexes with and without aberrant ventricular conduction. Am J Geriatr Cardiol 2001; 10:286. [PMID: 11528290 DOI: 10.1111/j.1076-7460.2001.00039.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D H Spodick
- Cardiology Division, St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA
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Spodick DH. Effect of interatrial block on left atrial function. J Cardiol 2001; 38:169-71. [PMID: 11577614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Interatrial block produces prolonged P-waves due to conduction delay mainly in the Bachmann bundle, the most direct route from right to left atrium. It is prevalent in patients over age 60 with its main clinical significance its association with eventual atrial fibrillation and/or flutter. Having demonstrated a mean delay in the onset of active left ventricular filling of 37 msec, we defined the electromechanical abnormality further by measuring left atrial volume at key points in the atrial cycle to produce 10 measurements of left atrial function. Compared to the normal left atrium, interatrial block is correlated with a large, poorly contractile left atrium with a delayed and markedly reduced contribution to left ventricular filling and the kinetic energy with which atrial systole propels blood.
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Affiliation(s)
- D H Spodick
- Worcester Medical Center/Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA
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Spodick DH. Misleading lead II "rhythm strip". Am J Geriatr Cardiol 2001; 10:228. [PMID: 11455244 DOI: 10.1111/j.1076-7460.2001.00025.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D H Spodick
- Cardiology Division, St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA
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Spodick DH. Predictors of atrial fibrillation after conventional and beating heart coronary surgery. Circulation 2001; 103:E130. [PMID: 11425789 DOI: 10.1161/01.cir.103.25.e130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Spodick DH. Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction. J Am Soc Echocardiogr 2001; 14:413. [PMID: 11394369 DOI: 10.1067/mje.2001.113649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Spodick DH. Pulmonary artery catheterization in the ICU/critical care unit : indications and contraindications remain objectively undefined. Chest 2001; 119:999-1000. [PMID: 11296160 DOI: 10.1378/chest.119.4.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Affiliation(s)
- D H Spodick
- Cardiology Division, St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA
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Abstract
Pericardial disease is common in patients with renal disease. Approximately 20% of uremic patients requiring chronic dialysis develop uremic pericarditis or dialysis pericarditis. In all forms of uremic pericarditis, cardiac tamponade is the main danger. Pericardial contents are sterile unless secondarily infected. Differential diagnosis may be difficult, especially in mentally confused patients and because nonuremic intercurrent pericarditis of any cause is always possible. In uremic patients, frequent autonomic impairment and decreased cardiac adenylate cyclase limit heart rate increases during pericarditis, even during tamponade, so that the heart rate may be deceptively slow even with fever and hypotension. Adequate renal dialysis effectively ends uremic pericarditis. Several factors are associated with precipitating dialysis pericarditis and effusion, above all inadequate dialysis. Pericarditis in hepatorenal failure occurs at relatively low blood urea nitrogen levels and does not respond to dialysis.
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Affiliation(s)
- S R Gunukula
- Saint Vincent Hospital, University of Massachusetts, Worcester 01608, USA
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Maisch B, Ristić AD, Seferovic PM, Spodick DH. Intrapericardial treatment of autoreactive myocarditis with triamcinolon. Successful administration in patients with minimal pericardial effusion. Herz 2000; 25:781-6. [PMID: 11200127 DOI: 10.1007/pl00001997] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A major clinical drawback in the treatment of autoreactive pericarditis is its inherent feature to relapse. Intrapericardial treatment with triamcinolone was reported to be efficient in patients with large, symptomatic autoreactive pericardial effusions, avoiding side effects of systemic treatment as well as compliance problems. Intrapericardial treatment with 300 mg/m2 triamcinolone was for the first time performed in patients with autoreactive myopericarditis and minimal pericardial effusions (75 to 110 ml). After 12 months of follow-up both patients are asymptomatic and there were no further recurrences of pericardial effusion. Pericardiocentesis in these patients was performed with the application of the PerDUCER device, guided by pericardioscopy. This device has a hemispherical cavity at the top of the instrument connected with a vacuum-producing syringe. In this cavity the pericardium is captured by vacuum and tangentially punctured by the introducer needle. Pericardium that can be captured, must be up to 2 mm thin to fit into the hemispherical cavity. Pericardioscopy performed from the anterior mediastinum significantly contributed to the success of the procedures enabling visualization of the portions of the pericardium free of adipose tissue or adhesions, suitable for puncture with the PerDUCER. In conclusion, intrapericardial treatment of symptomatic autoreactive myopericarditis with minimal pericardial effusion was safely and efficiently performed in 2 patients. Pericardiocentesis was enabled by means of the PerDUCER device, facilitated by pericardioscopy.
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Affiliation(s)
- B Maisch
- Department of Internal Medicine-Cardiology, Philipps University, Marburg, Germany.
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Abstract
Recent capability to enter the normal effusion-free pericardium has expanded intrapericardial therapy which was formerly restricted to patients with effusive pericardial disease, to intrapericardial treatment of cardiac diseases of all kinds. It is now possible to deposit in the intact pericardium a variety of therapeutic agents targeting the myocardium, valves, conduction system and even the endocardium. In addition to such specific agents, the unique microphysiology of the pericardial mesothelium provides investigators with 2 entirely new applications of intrapericardial therapy: 1. supplementing substances like prostanoids and a variety of immune factors, and 2. stimulating pericardial production of such products of metabolism, e.g., superfusion of the normal pericardium by non-steroidal antiinflammatory agents to stimulate prostanoid production with a variety of effects including possible inhibition of coronary thrombosis. Continuing research and development should determine the precise roles of these new applications in human medicine.
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Affiliation(s)
- D H Spodick
- Worcester Medical Center/Saint Vincent Hospital, University of Massachusetts Medical School, 20 Worcester Center Blvd., Worcester, MA 01608, USA.
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Spodick DH. Gene therapy for atherosclerotic cardiovascular disease. Mayo Clin Proc 2000; 75:1223. [PMID: 11075757 DOI: 10.4065/75.11.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jairath UC, Spodick DH. The eyes see only what the mind knows. J Emerg Med 2000; 19:275-6. [PMID: 11033275 DOI: 10.1016/s0736-4679(00)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- U C Jairath
- Cardiology Division, Saint Vincent Hospital/University of Massachusetts Medical School, Worcester, Massachusetts 01604, USA
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Spodick DH. The ten most commonly asked questions about pericardial disease. Cardiol Rev 1999; 7:313-5. [PMID: 11208242 DOI: 10.1097/00045415-199911000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D H Spodick
- St. Vincent Hospital, Worcester, MA 01604, USA
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Arjomand H, Mascarenhas DA, Ye S, Spodick DH. Normal electrocardiogram with total occlusion of the left anterior descending coronary artery. J Invasive Cardiol 1999; 11:500-2. [PMID: 10745583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Total occlusion of the left anterior descending coronary artery is usually characterized by ST-segment elevation in the anterior leads of the surface electrocardiogram. We report a case of a patient who had a persistently normal electrocardiogram throughout his hospitalization despite the angiographic findings of total occlusion of the left anterior descending coronary artery and no collateral vessels. Percutaneous transluminal coronary angioplasty with stent placement was performed successfully.
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Affiliation(s)
- H Arjomand
- Department of Medicine, Easton Hospital/MCP-Hahnemann University, 123 South 22nd Street, Easton, PA 18042, USA
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Abstract
Constrictive pericarditis is an uncommon disorder with various causes. Although most often idiopathic, it may also occur after cardiovascular surgery, radiation therapy, and tuberculosis, especially in developing countries. The encasement of the heart by a rigid, nonpliable pericardium results in characteristic pathophysiologic effects, including impaired diastolic filling of the ventricles, exaggerated ventricular interdependence, and dissociation of intracardiac and intrathoracic pressures during respiration. Constrictive pericarditis typically presents with chronic insidious signs and symptoms of predominantly systemic venous congestion. Notoriously difficult to diagnose and distinguish from restrictive cardiomyopathy (RCM), the use of cardiac catheterization, echocardiography (transthoracic and transesophageal), central venous (hepatic and pulmonary) and transvalvular Doppler measurements, and magnetic resonance imaging should secure the diagnosis in most cases, eliminating the need for diagnostic thoracotomy. Although medical treatment may temporarily alleviate symptoms of heart failure, patients do poorly without pericardiectomy.
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Affiliation(s)
- R B Myers
- Sunnybrook Health Science Centre, Division of Cardiology, University of Toronto, Ontario, Canada.
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Spodick DH. Ventricular reduction therapy: controlled clinical trials overdue. J Am Coll Cardiol 1999; 34:610-1. [PMID: 10440182 DOI: 10.1016/s0735-1097(99)00248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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