bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of exercise capacity after nifedipine in patients with eisenmenger syndrome complicating ventricular septal defect
Authors: Wong Cheuk‐Kit , Yeung David W. C. , Lau Chu‐Pak , Cheng Chun‐Ho , Leung Wing‐Hung
Published: February 2009

We investigated the potential benefit of a preferential pulmonary vasodilatory effect of nifedipine in 4 patients with Eisenmenger syndrome complicating ventricular septal defect. First‐pass radionuclide scan was performed at rest to measure intracardiac shunting before and after nifedipine. Two hours after 20 mg sublingual nifedipine, right‐to‐left shunt increased from 16.3 ± 1.4 to 20.4 ± 1.5% (p<0.05), but systemic arterial oxygen saturation (SAO2) remained steady. With 4 weeks of maintenance nifedipine therapy, resting intracardiac shunting and SAO2 were unchanged from baseline. Symptom‐limited cycle ergometry was performed before and after maintenance nifedipine with placebo control. Exercise duration was prolonged (8.7±0.6 vs. 6.8±0.9 min; p<0.02) and SAO2 at each stage of exercise was consistently increased in all patients after nifedipine. Cardiac output and the SAO2 at peak exercise were similar. Thus, chronic nifedipine therapy increases SAO2 on exercise and improves maximal exercise capacity in patients with Eisenmenger syndrome, which is not predicted by study of resting intracardiac shunting after acute therapy.
Prospective community evaluation of the signal‐averaged electrocardiogram in predicting malignant ventricular arrhythmias: Beneficial outcome with electrophysiology guided therapy
Authors: Nalos Peter C. , Pappas Jina M. , Nyitray William , Ishimori Tetsuo , DonMichael T. Anthony
Published: February 2009

The role of the signal‐averaged ECG was prospectively assessed in 517 patients in whom there was a suspicion for malignant ventricular arrhythmias. Patients were divided into Group I with a normal surface QRS width < 120 ms (426 patients) and Group II with a prolonged QRS duration > 120 ms (91 patients). Late potentials were present in 42 (10%) Group I patients and in 24 (26%) Group II patients. Programmed ventricular stimulation was performed for standard indications in 55 patients without late potentials and in 42 patients with late potentials, combining both groups. The sudden death or recurrent sustained ventricular tachycardia rate in follow‐up was evaluated based on the presence or absence of late potentials and whether programmed ventricular stimulation was performed. In the patients without late potentials, these rates were 4 patients (1.0%) in the no EP group and 3 patients (5.5%) in the EP group (p<.05), respectively (overall 1.6%). In the patients with late potentials, these rates were 7 patients (29%) in the no EP group and 7 patients (17%) in the EP group (p = .19), respectively (overall 21%). In addition, appropriate automatic defibrillator shocks were present in 1 patient without late potentials and in 8 patients with late potentials which were not included in the recurrent sudden death or sustained ventricular tachycardia statistics. The signal‐averaged ECG accurately defines patients at a higher risk for malignant ventricular arrhythmias regardless of unfiltered QRS duration. There is a trend toward improved survival with electrophysiology guided therapy in the late potential positive group with added incremental benefit from patients undergoing automatic defibrillator implantation.
Long‐term prognostic value of a normal dipyridamole thallium‐201 perfusion scan
Authors: Gal Rami A. , Gunasekera Joseph , Massardo Teresa , Shalev Yoseph , Port Steven C.
Published: February 2009

In a 4‐year period, 84 patients who were referred for a dipyridamole thallium‐201 stress test to rule out significant coronary artery disease had normal scans. A dipyridamole study was recommended instead of exercise because of arthritis, severe obesity, peripheral vascular disease, pulmonary disease, other chronic illnesses, or combinations of these problems. All patients had three‐view (i.e., anterior, shallow left anterior oblique, and steep left anterior oblique) planar thallium‐201 imaging 10 minutes and 3.5 hours after administration of 0.6 mg/kg of intravenous dipyridamole. The patients were followed for 42±13 (range 1–58) months to document the cardiac event rate. Of the 84 patients with normal results, 14 died during the follow‐up period from noncardiac causes. Three other patients died 29–51 months after the test due to an acute myocardial infarction, a probable acute myocardial infarction, and sudden cardiac death, respectively. Of the survivors, 5 suffered an acute myocardial infarction 28–50 months after the dipyridamole thallium scan and 1 had coronary artery bypass grafting due to increasing angina pectoris 58 months after the scan (overall cardiac event rate of 0.4% per year). Of the remaining 61 patients, 39 (64%) were asymptomatic, 20 (33%) had the same symptoms they had at the time of testing without significant deterioration, while 2 patients (3%) had deterioration of their chest pains but no cardiac complication. Thus, in this group of patients, a normal dipyridamole thallium‐201 perfusion scan predicted a good cardiovascular outcome for at least 24 months following the test.
Development and progression of aortic valve stenosis: Atherosclerosis risk factors—a causal relationship? a clinical morphologic study
Authors: Mohler Emile R. , Nichols R. , Harvey W. P. , Sheridan M. J. , Waller B. F. , Waller Bruce F.
Published: February 2009

Hospital records of 120 patients undergoing aortic valve replacement were retrospectively reviewed for risk factors associated with early aortic valve replacement. Patients were separated into four groups (rheumatic, congenital bicuspid, degenerative, and miscellaneous) based upon the morphologic etiology of aortic stenosis. Multiple regression analysis was performed using age at surgery as the dependent variable. Independent variables for the study were race, gender, systemic hypertension, total triglyceride level, total serum cholesterol level, tobacco smoking history, diabetes mellitus, and angiographic coronary artery disease. In the rheumatic valve group only race showed a statistically significant risk effect whereas in the congenital bicuspid valve group race, gender, and triglycerides were statistically correlated with age at surgery. In the degenerative valve group gender and smoking were found to be statistically significant risk factors. The establishment of aortic stenosis risk factors might be an indication for clinical trials of risk factor modification in patients with aortic stenosis.
Electromechanical concordance in alternans during sustained tachycardias
Authors: Tai Yau‐Ting , Lau Chu‐Pak , Chow Wing‐Hing , Leung Wing‐Hung
Published: February 2009

Electrical alternans and mechanical alternans are intriguing phenomena that have been reported to occur during tachycardias. Their precise pathophysiologic mechanism and in particular their interrelation have not been well defined. This report documents an unusual electromechanical concordance in alternans during sustained supraventricular tachycardia and ventricular tachycardia in two patients, raising interesting possibilities on the underlying mechanism of the concordant phenomena. The findings highlight the principle of excitation‐contraction coupling of the heart.
Limited clinical utility of endomyocardial biopsy in patients presenting with ventricular tachycardia without apparent structural heart disease
Authors: Oakes David F. , Manolis Antonis S. , Mark III N. A. Estes
Published: February 2009

To determine the cardiac pathology underlying ventricular tachyarrhythmias, endomyocardial biopsy was performed in 14 patients, 10 men and 4 women, with a mean age of 40 years (range 17–63) and no apparent structural heart disease, presenting with high‐density symptomatic nonsustained ventricular tachycardia (VT) (n = 4), sustained VT (n = 6), and ventricular fibrillation (n=4). The absence of coronary or valvular heart disease was documented by cardiac catheterization. The mean left ventricular ejection fraction was 56±10%. Noninvasive assessment of the ventricular arrhythmia was made in all patients with Holter monitoring and/or exercise testing, while invasive evaluation with programmed electrical stimulation was performed in 13 patients. Biopsy findings included subendocardial and interstitial fibrosis in 7 patients, and monocytes containing periodic acid Schiff (PAS) positive vacuoles in 1 patient; biopsy was normal in 6 patients. There was no relationship between the presence or absence of pathologic abnormalities on biopsy and left ventricular ejection fraction, presenting or induced arrhythmias, or prognosis. Pathologic evidence supporting a specific treatable diagnosis was not present in any biopsy. Drugs to suppress spontaneous (3 patients) or induced (8 patients) VT were instituted, while 2 patients were not treated. In 1 patient who was resuscitated from out‐of‐hospital cardiac arrest an automatic defibrillator was implanted. In 24.6 months of mean follow‐up there was 1 nonfatal arrhythmia recurrence, 1 noncardiac death, and 1 sudden death in a patient with fibrosis on biopsy, an ejection fraction of 45%, and both inducible and spontaneous sustained VT suppressed with an antiarrhythmic agent. We conclude that endomyocardial biopsy in patients presenting with VT and no coronary or valvular heart disease can be normal, rarely demonstrates a specific treatable diagnosis, and thus has limited clinical utility.
An evaluation of the safety of the β‐modulator cicloprolol in chronic heart failure
Authors: Cocco G. , Alfiero R. , Pouleur H.
Published: February 2009

The new β‐adrenoceptor partial agonist cicloprolol acts as a β‐agonist at normal levels and as a β‐antagonist at high levels of adrenergic discharge. Treatment with cicloprolol should protect the heart against excessive stimulation, while providing a baseline level of sympathetic drive. The clinical interest of such a profile is, however, not yet established in heart failure. Accordingly this study examined the safety of oral cicloprolol, a step necessary before undertaking efficacy comparison with other compounds recently proposed to treat heart failure. Twenty‐five patients were studied. Cicloprolol was given once a day for 2 weeks in a crossover double‐blind placebo‐controlled design. Follow‐ups were obtained at baseline and at the end of each period. At baseline all patients had clear evidence of heart failure. Cicloprolol did not affect resting heart rate and blood pressure, but it reduced significantly peak exercise heart rate and peak rate‐pressure product. The effect was especially significant in patients with sinus rhythm. The drug did not induce bradycardia or arrhythmias. Resting and exercise ejection rate were not affected. Cicloprolol improved the quality of life and the work capacity of 5 of 12 patients with congestive failure due to ischemic etiology. Side effects were few and similar with placebo and cicloprolol. Thus, short‐term administration of cicloprolol is safe in moderate heart failure.
Paradoxical effect of long‐term treatment of nifedipine on total ischemic load in patients with stable angina pectoris
Authors: Radice Maria , Giudici Vittorio , Albertini Alberto , Mannarini Alberto
Published: February 2009

In 50 patients with stable effort angina the effect of three drugs, metoprolol, nifedipine, and diltiazem was assessed by analyzing exercise stress test response and ambulatory ECG recordings. Both metoprolol and diltiazem caused a significant increase in time to ischemic threshold during exercise and a significant decrease of maximum ST‐segment depression (during exercise and ambulatory ECG monitoring) and in the average number of daily ischemic episodes. Only metoprolol significantly reduced heart rate and rate–pressure product at the ischemic threshold during exercise. In the group of patients treated with nifedipine no significant improvement was observed in exercise tolerance or in number of ischemic episodes/24 h. Moreover, the subset of nonresponders in the two methods was larger than in the other two groups. In some of these patients a clearcut worsening of total ischemic load was observed, despite the control of symptoms. This adverse effect might be attributed to the different consequences of the vasodilatory effect of nifedipine on blood flow through stenosed vessels.
Is hypomagnesemia arrhythmogenic?
Authors: Millane Teri A. , Ward David E. , Camm A. John
Published: February 2009

An understanding of the role of magnesium in cardiac conduction is complicated by the multiplicity of intracellular events coordinated by the magnesium ion. Several reports have cited magnesium deficiency as the cause of a variety of ventricular and supraventricular arrhythmias. On further inspection, the circumstances of each report strongly suggest the coexistence of significant potassium depletion; isolated hypomagnesemia as a cause of arrhythmia is not reported. This discussion brings together new data from basic science with that of clinical research to refute the suggestion that isolated hypomagnesemia is arrhythmogenic. However, there is sufficient evidence to indicate that hypomagnesemia will significantly exacerbate the proarrhythmic effect of hypokalemia, particularly if occurring in the presence of digoxin toxicity. Potassium and magnesium depletion are commonly concomitant, and simultaneous repletion of both ions in the presence of hypokalemia‐induced arrhythmia would be both logical and effective. The beneficial effects of intravenous magnesium in the acute control of ventricular tachyarrhythmia are concluded to occur as a result of a separate antiarrhythmic action, quite independent of underlying magnesium balance.
Very early acute myocardial infarct treated with streptokinase and balloon angioplasty
Authors: Hackel Donald B. , Wagner Galen
Published: February 2009

A 57‐year‐old man developed anginalike chest pain for the first time but there was no objective evidence of an infarct (i.e., EKG and serum enzymes were normal). After 12 days the pain increased, but EKG and serum enzymes remained normal (“preinfarct,” crescendo, unstable, or accelerated angina). At this time a cardiac catheterization showed 90% occlusion of the left anterior descending (LAD) coronary artery. On the 17th day after the onset of pain, severe pain recurred together with an abnormal EKG and the patient was taken immediately to the laboratory where a total occlusion of the LAD was now found and he was treated with intracoronary streptokinase. The artery remained open for only a short time, and balloon angioplasty was performed. However, the patient died 12 hours after onset of the last episode of severe pain. A very early acute myocardial infarct was diagnosed at autopsy together with severe coronary atherosclerosis especially of the LAD which had disruption of atherosclerotic plaques and microscopic evidence of embolization.
Adenosine's effectiveness in long RP' re‐entrant tachycardia: Additional evidence of the decremental qualities of the retrograde limb
Authors: Wienecke Matthew M. , Case Christopher L. , Gillette Paul C.
Published: February 2009

Adenosine's ability to terminate atrioventricular (AV) re‐entrant supraventricular tachycardia is well documented. Typically, termination occurs as a consequence of transient conduction block in the atrioventricular node, a tissue with decremental qualities. However, the atrioventricular node is not always the site of action when adenosine is used on the re‐entrant types of long RP′ tachycardias. These tachycardias are, in part, characterized by the decremental qualities of the retrograde limb of the tachycardia circuit, which, in turn, are typically exemplified by retrograde Wenckebach during ventricular (VVI) pacing during intracardiac electrophysiology studies. This case report involves adenosine's ability to block conduction in the retrograde limb of the permanent form of junctional reciprocating tachycardia to provide further evidence as to the AV “nodelike” decremental qualities of this limb.
Efficacy and safety of calcium channel blockers in hypertensive patients with concomitant left ventricular dysfunction
Authors: Parmley William W.
Published: February 2009

The use of calcium channel blockers (CCBs) in the treatment of hypertension and concomitant left ventricular dysfunction is reviewed. Some CCBs, particularly second‐generation dihydropyridine agents such as felodipine, isradipine, nicardipine, nimodipine, and nitrendipine, have properties that enhance their usefulness in these patients. All CCBs have a similar mechanism of action. Differences in their selective action at various tissue sites determine which are most appropriate for patients with concomitant hypertension and left ventricular dysfunction. Most CCBs do not produce reflex stimulation of the heart or induce intravascular expansion. While all CCBs produce arteriolar dilation, all local beds and regional circulations in target organs are not affected equally. Most CCBs can decrease cardiac mass, and second‐generation CCBs tend to have little or no negative inotropic effects at therapeutic dosages. In addition, they increase blood flow and reduce myocardial oxygen requirements. Because of differences in functional and electrophsyiologic effects, specific CCBs may not be appropriate for all patients. Since second‐generation dihydropyridine CCBs lack clinically relevant negative inotropic effects, and have been shown to improve exercise tolerance and coronary artery perfusion, they are appropriate for hypertensive patients with left ventricular dysfunction, angina, and coronary heart disease. Second‐generation CCBs tend to lack cardiodepressant side effects and are less likely to react with digoxin than are first‐generation CCBs.
Cardiac free wall rupture in acute myocardial infarction: Ameliorative effect of coronary reperfusion
Authors: Nakamura Fumiaki , Nagano Masahiro , Higaki Jitsuo , Ogihara Toshio , Minamino Takazo , Higashino Yorihiko , Ito Hiroshi , Fujii Kenshi , Fujita Teruo
Published: February 2009

To investigate the pathophysiology of cardiac free wall rupture (cardiac rupture) following acute myocardial infarction (AMI), and to clarify whether reperfusion therapy prevents cardiac rupture, 1,329 cases of AMI (conventional therapy group: 807 cases and reperfusion therapy group: 533 cases) were studied retrospectively. The overall incidence of cardiac rupture was 2.3% (2.7% in the conventional therapy group vs. 1.7% in the reperfusion therapy group). Patients with cardiac rupture were divided into two subgroups according to the time interval from the onset of AMI to cardiac rupture (early rupture ≤72 h and late rupture ≥4 days). The indices of initial evolution of AMI was a significant risk of early cardiac rupture. The reperfusion therapy group showed significantly lower incidence of late rupture (0.4 vs. 1.5% in conventional therapy group; p<0.05). The incidence of cardiac rupture in the unsuccessful reperfusion therapy group was higher than that of the successful group (5.9% of 118 cases vs. 0.5% of 404 cases; p<0.05). It is concluded that the etiology of cardiac rupture following AMI cannot be explained by any single factor. Early rupture depends on the initial evolution of AMI, and early reperfusion and collateral flow prevent the late onset cardiac rapture.
Does cocaine cause coronary vasospasm in chronic cocaine abusers? a study of coronary and systemic hemodynamics
Authors: Majid Pirzada A. , Cheirif Jorge B. , Rokey Roxann , Sanders William E. , Patel Bharat , Zimmerman Janice L. , Philip Dellinger R.
Published: February 2009

The pathogenesis of acute myocardial ischemia or infarction following cocaine abuse is not known. Cocaine causes an increase in circulating catecholamines. Therefore alpha‐adrenergic mediated focal or generalized coronary artery spasm has been presumed to be the likely mechanism to induce ischemia. However, coronary vasospasm in chronic cocaine abusers has not been demonstrated angiographically. Moreover, it has been observed that patients commonly manifest ischemic changes hours up to a week after abusing cocaine. In order to evaluate direct effects of cocaine on coronary vasculature, 6 chronic cocaine abusers admitted with prolonged chest pain and electrocardiographic ST‐ and T‐wave changes were studied. Cocaine administered intravenously (maximum 32mg) produced subjective sensation of central nervous stimulation (the “high”) in all patients. However there was no significant change in coronary artery diameter (assessed by computer‐assisted quantitative technique), myocardial perfusion (assessed by contrast echocardiography) or left ventricular wall motion (assessed by two‐dimensional echocardiography) as compared with the baseline values. Coronary sinus flow (fhermodilution) showed an upward trend, a probable reflection of a significant increase in cardiac output (average 62%, p<0.007). Despite a significant elevation in heart rate (average 56%, p<0.007), mean systemic arterial pressure (average 12%, p<0.05) and rate‐pressure product (average 69%, p < 0.005), no symptomatic or acute electrocardiographic changes were observed. It is concluded that recreational doses of cocaine do not cause focal or generalized coronary vasospasm or reduced myocardial perfusion in patients who present with chest pain temporally related to cocaine. The results of this study are consistent with the hypothesis that cocaine‐induced activation of platelets may have an important role to play in producing myocardial ischemia by occlusion and spasm of diseased small coronary vessels; this was proven previously on biopsy and also in the initiation of acute coronary occlusion.
The effect of exercise‐induced myocardial ischemia on postischemic left ventricular diastolic filling
Authors: Stoddard Marcus F. , Johnstone John , Dillon Susan , Kupersmith Joel
Published: February 2009

To determine whether exercise‐induced ischemia impairs left ventricular diastolic filling in the postischemic period in humans, 101 men (mean age 57±10 years) were studied before and 2 h after a symptom‐limited thallium‐201 tomographic treadmill with pulsed Doppler echocardiography of mitral valve inflow. In the postischemic period 2 h after exercise, diastolic filling was significantly impaired in the ischemia group (reversible thallium defect; n = 24) as reflected by a decrease in the peak early filling velocity (44.5±10.1 to 39.9±9.9 cm/s, p<0.01), peak early to atrial filling velocity ratio (0.91 ± 0.27 to 0.76 ± 0.25, p<0.001), and deceleration rate of early filling (281 ± 104 to 245±86 cm/s2, p<0.01). Similar alterations in the postischemic period occurred in the myocardial infarction‐ischemia group (partially reversible defect; n = 28) as seen by a decrease in the peak early filling velocity (47.6±11.6 to 41.8±12.0 cm/s, p<0.001), peak early to atrial filling velocity ratio (0.84±0.21 to 0.68±0.18, p<0.001), and early time–velocity integral (7.06±1.78 to 5.64±2.07 cm, p<0.001). In the control group (no defects; n=33) and myocardial infarction group (fixed defect; n = 16), diastolic filling was unchanged in the postexercise period. Heart rate and blood pressure were unchanged post‐exercise in all groups. Exercise‐induced ischemia impairs diastolic filling in the postischemic period in humans. This most likely reflects impairment of diastolic function, but alterations of loading conditions cannot be completely excluded. It is possible mat recurrent episodes may chronically depress diastolic function and contribute to morbidity in subjects with coronary artery disease. The mechanism of how exercise‐induced ischemia “stuns” or impairs diastolic filling remains unclear but requires further study.
Morphologic aspects of pericardial heart disease: Part II
Authors: Waller Bruce F. , Taliercio Charles P. , Howard Jane , Green Frank , Orr Charles M. , Slack John D.
Published: February 2009

Pericardial heart disease is a common entity at necropsy. Frequently, focal areas of fibrin deposits or parietal‐visceral pericardial adhesion are observed at necropsy without previous clinical evidence of pericardial dysfunction. Some of these instances are related to clinically silent acute or healed myocardial infarction but the vast majority of cases are incidental (idiopathic) findings. The purpose of this review is to summarize various morphologic responses of the pericardium and to provide an etiologic framework for these responses. Part II will review specific morphologic responses of pericardial layers to selected diseases.
The effect of treatment on survival in congestive heart failure
Authors: Pitt Bertram , Cohn Jay N. , Francis Gary S. , Kostis John B. , Packer Milton , Pfeffer Marc A. , Swedberg Karl , Yusuf Salim
Published: February 2009

Congestive heart failure (CHF) is a disorder characterized by a variety of clinical, biochemical, electrophysiological, and hemodynamic abnormalities. During the past two decades, numerous drugs have been employed in the treatment of this complex syndrome, and many agents have been shown to improve symptoms and ventricular function in patients with CHF. Because CHF is associated with a high risk of death, treatment should be directed not only toward the relief of symptoms, but also toward a reduction in mortality. Many variables have been shown to be related to survival; taken individually, however, each is limited in its utility in predicting prognosis. In recent years, large‐scale studies with large sample sizes have directly assessed the effects of treatment on mortality in CHF. Results from these trials indicate that vasodilators and angiotensin‐converting enzyme (ACE) inhibitors may improve mortality in patients with symptoms of heart failure. Additional trials are now in progress to evaluate the effect of treatment on patients with asymptomatic left ventricular dysfunction.
Two‐year follow‐up after laser thermal balloon angioplasty (LTBA) in lower extremities: Initial experience
Authors: Masotti M. , Riambau V. , Crexells C. , Oriol A.
Published: February 2009

We describe the results obtained with the use of laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans of the lower limbs in 37 patients (34 males, 3 females, mean age 58 ±9 years) with occlusive arterial disease (Fontaine stages II‐IV) presenting 39 significant lesions. Immediate results and two years of clinical follow‐up are analyzed. Initial ankle/brachial Doppler index was 0.51 ±0.17. Eighteen lesions were located in the iliac area (13 stenoses 2.3 ± 1 cm and 5 occlusions 4.2 ±3 cm) and 21 lesions in the femoropopliteal area (5 stenoses 2.6±2 cm and 16 occlusions 5.7±3 cm). A percutaneous procedure was used in 38 cases. In only one case was femoral dissection needed. The laser source was argon in 26 cases and Nd‐YAG in 13. Initial success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p <0.01) and/or calcium (p <0.05) negatively influenced the immediate results. No major complications were observed; seven (17%) minor complications occurred. Ankle/brachial Doppler index after treatment was 0.82±0.21. Cumulative clinical patency for successfully treated patients after two‐year follow‐up was 91%. LTBA thus represents an effective and less aggressive way of treating peripheral atherosclerosis obliterans. In spite of some limitations, it is useful in selected patients. The results of this study are very much like those in the literature for similar series and early experience.
Atrial natriuretic factor in essential hypertension: Echocardiographic and humoral correlates
Authors: Lucarini Alessandra R. , Favilla Stefania , Marini Cecilia , Lattanzi Fabio , Urbani Michelangelo P. , Salvetti Antonio
Published: February 2009

Aim of this study was to assess the relationship between plasma concentration of atrial natriuretic factor (ANF) and its two‐dimensional echocardiographic (left ventricular mass, left atrium diameter) and humoral (plasma renin and aldosterone) variables in essential hypertension (EH). We evaluated 32 patients with uncomplicated mild to moderate EH and 10 controls. They were studied in the supine position after 7 days of constant dietary sodium intake and were off therapy since at least 3 weeks. ANF values overlapped between EH patients and controls (27.8 ±11.5 vs. 19.5 ±7.4 pg/ml, p=NS). In EH, no significant correlation was found between ANF values and left ventricular mass (r=0.29), left atrial diameter (r=0.04), mean arterial blood pressure (r=0.26), plasma renin activity (r=0.00), and aldosterone (r=0.26). In EH, ANF values overlapped between the 15 patients with hypertrophy and the 17 patients with normal ventricular mass: 30.3 ± 17 vs. 25.6± 10.6 pg/ms (p = NS). We conclude that there is a substantial overlap in plasma ANF values between mild to moderate uncomplicated EH and controls, and left ventricular hypertrophy is not a major independent stimulus to ANF release in EH.
Blood coagulability and fibrinolytic activity before and after physical training during the recovery phase of acute myocardial infarction
Authors: Suzuki Toshikazu , Yamauchi Kazunobu , Yamada Yoshiji , Furumichi Takeo , Furui Hirohiko , Tsuzuki Jitsuki , Hayashi Hiroshi , Sotobata Iwao , Saito Hidehiko
Published: February 2009

The effects of physical training on hemostatic parameters were evaluated in 56 postmyocardial infarction (MI) patients before and after one month of systematic physical training and in 30 control post‐MI patients, who did not undergo such training. There were no significant changes in prothrombin time (PT) and alpha1‐ antitrypsin (α1AT) at the beginning and end of the study in either group. Levels of fibrinogen, Factor VIII: C (VIILC) and von Wildebrand antigen (vWf:Ag), and activities of ATIII and plasminogen (Plg) were significantly decreased in the group with physical training (p<0.05), while values were unchanged in the control group. Hematocrit, platelet counts, and alpha2‐plasmin inhibitor (α2PI) activities also decreased in the physical training group (p< 0.05). In contrast, these variables increased in the control group (p <0.05). Activated partial thromboplastin time (aPTT) tended to be prolonged in the group with physical training, while it was shortened in the control group. In a subset of 20 patients with physical training, resting levels of plasmin‐α2PI complex (PIC), thrombin‐antithrombin III complex (TAT), protein‐C (P‐C:Ag), plasminogen activator inhibitor‐1 (PAI‐1), VII:C, and P‐C activities had significantly decreased after one month of physical training (p<0.05), although tissue plasminogen activator activities remained unchanged. Physical training appeared to suppress coagulability as indicated by the decrease in fibrinogen, VIII:C, vWf:Ag, VII:C, and TAT, and prolongation of aPTT. The decrease in plasminogen, t‐PA:Ag, α2PI, PAI‐1, and PIC after physical training may result from the decreased coagulability. In conclusion, physical training appears to induce a suppression of the coagulation system in patients in the recovery phase of MI.
Acute circumferential subendocardial infarction
Authors: Hackel Donald B. , Wagner Galen S.
Published: February 2009

A 48‐year‐old black man had his first attack of chest pain on exertion, radiating to both arms, in December 1982 (angina pectoris). It was undoubtedly preceded by a period of asymptomatic coronary atherosclerosis of unknown duration. The first anginal attack was followed by three to four similar episodes over the next four months. The attacks became more prolonged, frequent, and severe thereafter (so‐called “pre‐infarct” angina), and six days later the patient showed signs of having developed actual myocardial necrosis. The patient underwent saphenous vein coronary artery bypass surgery but could not be weaned from the pump. He died late on the day of surgery. He was found at autopsy to have severe old three‐vessel coronary artery disease with the myocardial changes that would be expected from the severe global ischemia to which this heart was undoubtedly subjected. Several basic and important differences between this sort of a circumferential subendocardial infarct and a transmural infarct are discussed, as is the basis for the striking subendocardial hemorrhage.
Black scorpion envenomation: Two cases and review of the literature
Authors: Blum Arnon , Lubezki Aharon , Sclarovsky Samuel
Published: February 2009

Scorpion envenomation is quite common in India, southeast Asia, the U.S. southwest, and Israel (in the Negev and around Jerusalem). Yellow scorpion is considered the most dangerous scorpion that causes cardiac toxicity. Two patients are described, who lived in a nonendemic area of yellow scorpions and were envenomated by the black scorpion. Both suffered temporary cardiac involvement (manifested by electrocardiographic changes) which reverted to a normal pattern within 24 h. These are the first two cases that have been reported (from black scorpion envenomation) and indicate that the toxin of the black scorpion is also cardiotoxic, but much less than the “yellow scorpion” toxin.
Intermittent coronary spasm during graded exercise
Authors: Caralis Dennis G. , Kern Morton J. , Dotson Sybil , Castello Ramon
Published: February 2009

We report a patient with Prinzmetal's angina with nearly normal coronary angiogram who not only developed severe myocardial ischemia during exercise, documented both electrocardiographically (ST elevation) and scintigraphically (with thallium‐201), but also did so intermittently as the graded exercise progressed. Diagnostic coronary angiography showed spontaneous focal spasm of the proximal left anterior descending coronary artery. This unique response to exercise in a patient with variant angina suggests that factors other than catecholamine stimulation alone are active and rapidly attenuated in some patients. This phenomenon could be overlooked without appropriate electrocardiographic monitoring.
Spontaneous and induced vasodepressor/vasovagal syncope in hypertrophic cardiomyopathy
Authors: Buja Gianfranco , Melacini Paola , Folino Antonio , Miorelli Manuela , Nava Andrea
Published: February 2009

We describe a 47‐year‐old man affected with hypertrophic cardiomyopathy and frequent episodes of syncope. During ambulatory Holter monitoring and head‐up tilt test, a syncopal attack was associated with sinus arrest and hypotension. This case suggests an additional mechanism of syncope in hypertrophic cardiomyopathy.
Predischarge exercise echocardiography in patients with unstable angina who respond to medical treatment
Authors: Amanullah Aman M. , Lindvall Kaj
Published: February 2009

The diagnostic and prognostic value of predischarge exercise echocardiography (echo) was assessed prospectively in 36 patients with unstable angina soon after stabilization on medical treatment. Two‐dimensional echo was performed at rest and immediately after a symptom‐limited exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle‐branch block and dilated cardiomyopathy were excluded. Left ventricular regional wall motion was analyzed visually and a wall motion score index (WMSI) was derived. Patients were followed prospectively for an average period of 26 months (range 16–34 months). The study end points were a new cardiac event defined as acute myocardial infarction or a need for coronary revascularization because of a recurrence of severe medically refractory angina. Sixteen patients (44%) had positive exercise electrocardiography (ECG), while exercise echo was positive in 22 patients (61%). Of 28 patients undergoing coronary angiography, 23 had significant coronary artery disease (CAD). The sensitivity of exercise ECG in detecting CAD was 61% while the corresponding result was 83% for exercise echo. Cardiac events occurred in 21 patients (58%). Exercise ECG was positive in 12 of these patients (57%), while a positive exercise echo was found in 17 patients (81%). There were significantly more patients with positive exercise echo among patients experiencing cardiac events than among those without cardiac events (p<0.01). In patients with CAD, WMSI decreased significantly after exercise (p<0.05). Exercise WMSI was also significantly lower in patients with CAD than in those without CAD (p<0.02). Exercise WMSI also discriminated patients with cardiac events from those without such events (p < 0.01). Thus predischarge exercise echo is highly sensitive in detecting significant CAD and in identifying subsequent cardiac events in patients with unstable angina stabilized on medical treatment.
Myocardial systolic function in systemic lupus erythematosus: A study based on radionuclide ventriculography
Authors: Bahl V. K. , Aradhye S. , Vasan R. S. , Malhotra A. , Reddy K. S. , Malaviya A. N.
Published: February 2009

We assessed left ventricular systolic function by means of radionuclide ventriculography in 20 consecutive unselected patients with systemic lupus erythematosus. All patients had normal left ventricular systolic function (defined as ejection fraction > 45%) in a resting state. Regional wall motion abnormalities were, however, seen in 4 patients (20%). Of these 20 patients, 8 were able to exercise on a bicycle ergometer. These patients were subjected to exercise radionuclide ventriculography. Of these 8 patients, 3 (37.5%) had an abnormal ventriculographic response to exercise (as evidenced by a subnormal rise in ejection fraction or a fall, appearance of a new regional wall motion abnormality or worsening of a pre‐existing one). This probably reflects subclinical left ventricular dysfunction unmasked by the stress of exercise. The clinical significance of these abnormalities on long‐term myocardial function and their possible reversibility with remission of the disease needs to be assessed in future studies.
Cardiac risk of speed traps
Authors: Cocco Giuseppe , Iselin Hans Ulrich
Published: February 2009

Twenty‐two patients with stable cardiac disease drove into a radar trap while having an ambulatory electrocardiogram. All patients reported cardiac symptoms, heart rate increases, and appearance of repetitive ventricular arrhythmias. Myocardial ischemia was observed in some patients. Being caught while car speeding under the stresses of daily life may induce potentially dangerous cardiac effects. The data confirm the effects of stress and adrenergic tone on ventricular arrhythmias.
Direct current cardioversion of established atrial fibrillation
Authors: Lévy Samuel
Published: February 2009

Restoration and maintenance of sinus rhythm is a desirable end point in patients with chronic atrial fibrillation. If clinically indicated, external cardioversion using direct current is the method of choice in most centers. The results range from 20 to 90% and are highly influenced by the underlying etiology. A number of determinants including age, duration of atrial fibrillation, and size of left atrium are usually taken into account in the indications but have been recently questioned. The use of prophylactic antiarrhythmic therapy has been shown to reduce the recurrence of atrial fibrillation significantly, but concerns remain regarding the safety of this treatment. In patients who failed external cardioversion, shocks delivered within the right atrium according to a recently described technique may be attempted. The initial results are promising, as 83% of patients are successfully cardioverted and 46% of patients are in sinus rhythm at 12 months. This new technique offers an additional alternative in patients with chronic atrial fibrillation and may therefore reduce the incidence of frightening embolic complications.
Pulsed doppler echocardiographic indices of left ventricular diastolic function in normal subjects
Authors: Bahl V. K. , Dave T. H. , Sundaram K. R. , Shrivastava S.
Published: February 2009

To establish the normal limits for various pulsed Doppler echocardiographic indices of left ventricular diastolic function, 92 healthy volunteers aged from 5 to 75 years were prospectively studied. The influence of various variables including age, gender, body surface area, fractional shortening, and left ventricular mass on these parameters was also assessed. Mean (2SD) values for 15 direct and 11 derived parameters were analyzed from transmittal inflow velocity waveform. No statistically significant differences were observed between males and females for any of these parameters. On stepwise multivariate linear regression analysis, age was found to be an independent strong determinant (p < 0.001) of peak velocity of early diastolic filling wave, area of atrial filling period, deceleration slope, normalized peak filling rate, and early filling fraction. There was a significant correlation between heart rate and time to peak early diastolic velocity, total diastolic time period, early diastolic period, atrial filling period, and atrial filling fraction. It was further observed that a significant correlation (p < 0.001) persisted between both age and heart rate with area of early filling period, one‐third filling area, one‐half filling area, ratio of early to atrial peak velocity and area, atrial filling fraction, and one‐third filling fraction. None of the parameters were found to correlate with fractional shortening or left ventricular mass. Thus an effort was made to establish normal limits for various Doppler‐derived parameters in healthy volunteers for future comparison in diseased states. Age and heart rate were found to have a significant influence on pattern of diastolic filling and should be taken into account while studying transmittal flow pattern in diseased states.
QT interval shortening and ST elevation in intracoronary ECG during PTCA
Authors: Maeda Toshihiro , Saikawa Tetsunori , Niwa Hiroko , Shimoyama Nobuo , Hara Masahide , Maruyama Tohru , Takaki Ryosaburo , Ito Morio , Kohmatsu Kohsei
Published: February 2009

Percutaneous transluminal coronary angioplasty (PTCA) can provide a unique model of transient and reversible myocardial ischemia. The aim of this study was to assess the serial changes in QT interval during elective PTCA‐induced transient ischemia. The serial changes in QT interval before, during, and after PTCA of the left anterior descending artery (LAD) were measured in patients who showed ST elevation in intracoronary electrocardiogram. Twelve consecutive patients who showed ST‐segment elevation during PTCA‐induced ischemia in anterior precordial leads of the electrocardiogram (ECG) were enrolled in the present study. Target lesions for PTCA were all in the LAD. There were six patients with angina pectoris, two with non‐Q‐wave infarction, and four with Q‐wave myocardial infarction. During balloon inflation, QTc interval shortened in both intracoronary ECG (ic‐ECG) (0.472±0.013 vs 0.436±0.014) and surface ECG (0.462±0.012 vs 0.438±0.011). However, a significant shortening of the QT interval was more rapidly observed in the ic‐ECG (20 s) than in the surface ECG (40 s). We conclude that the QT interval in both ic‐ECG and surface ECG becomes shortened in PTCA‐induced myocardial ischemia, and that the ic‐ECG might be a good probe for detecting survived viable myocardium in the infarcted zone.
Massive main pulmonary artery embolism diagnosed with two‐dimensional doppler echocardiography
Authors: Gabrielsen Frede , Schmidt Arnold , Eggeling Thomas , Hoeher Martin , Kochs Matthias , Hombach Vinzenz
Published: February 2009

This report describes the usefulness of echocardiography in the differential diagnosis of acute cardiovascular events. In a 66‐year‐old patient with known aortic stenosis and mitral valve prothesis, who suddenly deteriorated with severe dyspnea, a thrombus within the pulmonary artery could be detected with 2‐D echo. Pulsedwave Doppler disclosed the resulting flow‐velocity disturbances.
Prognosis for patients with initially suspected acute myocardial infarction in relation to presence of chest pain
Authors: Herlitz Johan , Karlson Björn W. , Richter Arina , Strömbom Ulf , Hjalmarson Åke
Published: February 2009

In all 4,232 patients admitted to a single hospital during a 21‐month period due to initially suspected acute myocardial infarction (AMI), the prognosis and risk factor pattern were related to whether patients had chest pain or not. Symptoms other than chest pain that raised a suspicion of AMI were mainly acute heart failure, arrhythmia, and loss of consciousness. In 377 patients (9%) symptoms other than chest pain raised an initial suspicion of AMI. These patients developed a confirmed infarction during the first three days in hospital with a similar frequency (22%) as compared with patients having chest pain (22%). However, patients with “other symptoms” had a one‐year mortality of 28% versus 15% for chest pain patients (p < 0.001). Patients with “other symptoms” more often died in association with ventricular fibrillation and less often in association with cardiogenic shock as compared with chest pain patients. Among the 921 patients who developed early AMI, 64 (7%) had symptoms other than chest pain. They had a one‐year mortality of 48% versus 27% for chest pain patients (p<0.001). We conclude that in a nonselected group of patients hospitalized due to suspected AMI, those with symptoms other than chest pain have a one‐year mortality, which is nearly twice that of patients with chest pain.
Left ventricular diastolic dysfunction in coronary artery disease: Effects of coronary revascularization
Authors: Inoue Teruo , Morooka Shigenori , Hayashi Terumi , Takayanagi Kan , Sakai Yoshihiko , Takabatake Yutaka
Published: February 2009

Left ventricular diastolic dysfunction was studied globally and regionally in patients with coronary artery disease, and the effects of coronary revascularization were evaluated. A total of 25 patients with angina pectoris who had a stenotic lesion (≥90%) in only left anterior descending branch underwent coronary revascularization [percutaneous transluminal coronary angioplasty (PTCA) in 13 patients and coronary artery bypass graft (CABG) in 12]. Nine patients with normal coronary artery were studied as controls. Left ventricular volume and radial axes were measured on serial frames of one cardiac cycle by cine left ventriculography. The radial axes were drawn from the left ventricular gravity to left ventricular wall at every 20°. Left ventricular filling fraction and distension rate of radial axes were calculated at the times of 25%, 50%, 75%, and 100% of diastolic period, 100% being end‐diastole. Although there were no significant changes of the systolic function by revascularization, the filling fraction increased from 11.2±2.6 to 14.5±3.5% (p<0.001) at 25% time of diastole, from 29.9±4.9 to 32.5±5.0% (p<0.05) at 50% time in the PTCA group, and from 11.8±3.7 to 13.4±3.8% (p<0.01) at 25% time in the CABG group. The distension rate of radial axis to the anterior wall also increased significantly at 25% and 50% time of diastole after revascularization, and the change was marked in the PTCA group. However, these increases did not apply to the control patients. The results showed that the global and regional left ventricular early diastolic dysfunctions in patients with angina pectoris was partially reversible by coronary revascularization.