bluuebunny/crossref_metadata_2025 huggingface dataset:
Superiority of supine bicycle over isometric handgrip exercise in the assessment of ischemic heart disease: An evaluation of left ventricular ejection fraction response using radionuclide angiography
Authors: Kaul S. , Hecht H. S. , Hopkins J. , Siedman R. I. , Singh B. N.
Published: February 2009

Left ventricular ejection fraction (LVEF) response to supine bicycle and isometric handgrip exercise was evaluated in 15 patients with documented coronary artery disease (CAD) and stress‐induced ischemia using radionuclide angiography. For purposes of analysis, the patients were divided into two groups: group I (n=7) with single‐vessel disease and group II (n = 8) with multiple‐vessel disease including 3 with left main artery disease. The studies were repeated 18 days later at similar external workloads to assess reproducibility of both tests. LVEF response to bicycle exercise was different for the two groups. The change in LVEF from rest to peak exercise was +0.04±0.02 for group I and ‐0.07±0.04 for group II (p <.001). LVEP response to isometric handgrip exercise was not different between the two groups. The change from rest to end of handgrip exercise was ‐0.02+0.02 for group I and ‐0.05 ±0.02 for group II. The reproducibility of LVEF response to bicycle exercise at similar workloads on day 1 and day 19 was good (r=0.85) while it was poor for isometric handgrip testing (r=0.67). Our data demonstrate that radionuclide angio‐graphic measurement of LVEF response to supine bicycle exercise testing is superior to LVEF response to isometric handgrip testing in the evaluation of patients with CAD.
Prolonged survival in tricuspid atresia with eisenmenger's physiology
Authors: Hart A. S. , Vacek J. L.
Published: February 2009

Survival to adulthood is very rare in tricuspid atresia, particularly in certain subtypes and in the presence of Eisenmenger's physiology. We report a 32‐year‐old woman who has the type IC variant of tricuspid atresia and who has had documented Eisenmenger's physiology for over 10 years.
Left ventriculography induced coronary artery spasm
Authors: Fleming G. , Shanes J. G.
Published: February 2009

Angiographic contrast material is generally considered a vasodilator, although in vitro experiments have documented a spasmogenic effect. In this report we describe a patient with exercise and rest angina who developed spasm of the right coronary artery immediately following left ventricular angiography. The patient was treated successfully with calcium channel blockers. This is the first reported case of left ventricular angiography‐induced coronary artery spasm.
Clinical and echocardiographic features of isolated severe pure mitral regurgitation
Authors: Pizzarello R. A. , Turnier J. , Dworkin P. , Goldman M. A. , Oka M. , Tortolani A. J. , Padmanabhan V. T.
Published: February 2009

Recent studies have shown that rheumatic heart disease is no longer the main cause of isolated severe pure mitral regurgitation. In this study, we evaluated various clinical and echocardiographic features found in the syndrome of mitral regurgitation. Our data is consistent with recent reports that mitral valve prolapse and coronary artery disease are now the predominant causes of mitral regurgitation and that rheumatic heart disease is a much less common etiology. In addition, our data suggest that clinical evaluation alone is usually very accurate in identifying the correct etiology. Various clinical and echocardiographic features found in the subsets of acute and chronic mitral regurgitation are described. Specifically, patients with acute mitral regurgitation were more likely to have echocardiographic evidence of segmental left ventricular dysfunction and flail mitral valve leaflet. In chronic mitral regurgitation, atrial fibrillation and left atrial dilatation were more commonly present. Echocardiography was found to be more useful in the detection of the complications of coronary artery disease rather than in identifying its presence. Patients with a New York Heart Association classification of IV and those with echocardiographic evidence of an increased left ventricular end‐systolic dimension or left ventricular hypertrophy had a worse prognosis.
Global left ventricular function and regional wall motion in pure mitral stenosis‐Left ventricular function in pure mitral stenosis
Authors: Colle J. P. , Rahal S. , Ohayon J. , Bonnet J. , Le Goff G. , Besse P. , Bricaud H.
Published: February 2009

Global left ventricular function (LVF) and scgmental wall motion of the left ventricle are registered in 113 patients presenting a pure mitral stenosis (MS) and in a control group of 50 individuals. The segmental wall motion is measured on the end‐diastolic‐end‐systolic frames of the left ventricle, obtained from right anterior oblique (RAO) monoplane cineangiography. Measurement of the segmental wall shortening is performed using the Stanford method. Group 1 includes 68 patients (60% of the total number of patients studied). These patients show no pathological contraction abnormality. In this group, the global LVF is not different from the control group. Group 2 includes 45 patients (40% of the total) for whom contraction abnormalities are present: anterior hypokinesis in 20% of the cases (anterior area mean shortening (AAS) = 18±8%; p<0.001 vs. group 1 and control group), and posterior hypokinesis in 20% of the cases (posterior area mean shortening (PAS) = 9.8 ±5.8%, p<0.001 vs. group 1 and control group). In this group, global LVF is impaired; ejection fraction (EF) = 0.57±0.1% (p<0.001 vs. group 1); velocity of circumferential fiber shortening (Vcf) = l±0.3 circ/s (p<0.001 vs. group 1); end‐diastolic pressure (EDP) = 11±5 mmHg (p<0.01 vs. group 1). Segmental contraction abnormalities appear to be the main factor involved in the global LVF impairment. Segmental wall motion abnormalities could be related to subvalvular fibrosis, or LV filling difficulties, or principally, to a possible interplay between the right and the left ventricles.
Intracoronary streptokinase therapy in the coronary care unit for acute myocardial infarction
Authors: Natarajan N. , Karlekar K. , Turkevich D. , Herschman A. , Weisfogel G. , Stahl T. , Jennings P. B. , Pessolano J. , Larson V. , Burke P.
Published: February 2009

Intracoronary streptokinase was offered and preliminary coronary angiography performed in 14 patients who were seen with the clinical diagnosis of acute myocardial infarction within 4 h of onset of symptoms. The procedure was performed in the Coronary Care Unit (CCU) of St. Peter's Medical Center with the use of a portable C‐arm fluoroscope. Angiography was recorded on video tape. Service was provided by an “on‐call” team consisting of two physicians, a CCU nurse, and a radiology technician, on a 24‐h service basis. Adequate visualization of coronary anatomy was obtained in all patients. Patency of occluded vessels was achieved in 10 of 11 patients who received intracoronary streptokinase. The initial streptokinase bolus was administered at a mean interval of 4.1 h from onset of symptoms. It is concluded that speedy and effective coronary thrombolytic therapy can be provided in the CCU on a 24‐h service basis by an on‐call team. The use of CCU for this purpose will make this therapy widely available across the country, without the need for Cardiac Catheterization Laboratory.
Systolic and diastolic time intervals during spontaneous angina
Authors: Ferro G. , Piscione F. , Carella G. , Betocchi S. , Spinelli L. , Chiariellom M.
Published: February 2009

In 5 patients who suffered spontaneous angina during cardiac catheterization, aortic pressure and electrocardiographic lead (V5) were recorded at rest, at the onset of anginal pain, 5 and 10 min after 0.6 mg sublingual nitroglycerin (NTG). Heart rate, systemic arterial pressure, systolic, and diastolic time intervals were measured. Heart rate and systemic arterial pressure rose significantly immediately after the onset of angina and declined progressively within 10 min from NTG administration. Pre‐ejection period did not change during angina, while left ventricular ejection time and electromechanical systole lengthened. As a consequence, diastolic time, expressed as percent of cardiac cycle, shortened sharply. All parameters considered went back to basal values within 10 min from NTG administration, and were preceded by relief or reduction of anginal pain. We concluded that a fall in diastolic time, secondary to a prolongation of electromechanical systole occurring during angina, may further increase the degree of ischemia resulting in a vicious cycle that can be interrupted by NTG administration.
Echocardiographic evaluation of cardiovascular effects of amrinone
Authors: Modena M. G. , Benassi A. , Mattoli G.
Published: February 2009

Amrinone, a new inotropic drug, was infused at a dosage of 2.5 mg/kg body weight in 14 patients affected by dilatative cardiomyopathy in New York Heart Association (NYHA) functional class III and IV. Cardiac index, mean arterial pressure, and some echocardiographic parameters were evaluated. Cardiac index (CI) increased from 2.03±0.24 to 2.82±0.43 1/min/m2 (p<0.001). Fractional shortening (FS) increased from 16.4 ± 5.2 to 21.5±5.3% (p<0.05). End‐diastolic and end‐systolic diameters showed a significant reduction. Mean arterial pressure decreased from 90.7±8.8 to 87.3±8.4 mmHg (p<0.001), the end‐systolic stress (ESS) decreased from 5.8±1 to 5.2±1 g/cm (p<0.001). Analyzing the relationship between FS and ESS, it was possible in some cases to suppose the presence of an important vasodilator effect of the drug. The afterload in 7 patients was therefore modified before and after infusion of the drug to analyze FS at the same levels of afterload. This was done to evaluate the vasodilator effect of amrinone. Examining the regression line of FS/ESS ratio it was possible to observe a predominant vasodilator effect in some patients, but in most, a sinergic action was noted. This may be useful for chronic treatment of congestive heart failure, reducing amrinone doses, and using it in association with other vasodilator drugs.
Asymmetric septal hypertrophy in kearns‐sayre syndrome
Authors: Kupari M.
Published: February 2009

Kearns‐Sayre syndrome was diagnosed in a 40‐year‐old female patient admitted for evaluation of symptomatic bradycardia. In addition to the classic triad—external ophthalmoplegia, pigmentary retinopathy, and heart block—she also had secondary amenorrhea, hearing loss, diabetes, and increased concentrations of blood lactate and pyruvate as manifestations of this multisystem disease. The echocardiographic examination disclosed asymmetric septal hypertrophy with a septal diastolic thickness of 17 mm and a septum to free wall ratio of 1.5. The left ventricular size and function were normal. Thus, asymmetric' septal hypertrophy may represent subclinical heart muscle involvement in Kearns‐Sayre syndrome.
Secondary mania associated with diltiazem
Authors: Palat G. K. , Hooker E. A. , Movahed A.
Published: February 2009

Diltiazem, a calcium‐channel blocker, is an effective antianginal agent, particularly in treating the vasospastic type of angina pectoris. This drug has recently been released for use in the United States. Noncardiac untoward effects of diltiazem are few. We describe a case of mania with psychotic features that occurred while a patient was on diltiazem.
The use of calcium gluconate priorto verapamil in infants with paroxysmal supraventricular tachycardia
Authors: Roguin N. , Shapir Y. , Blazer S. , Zeltzer M. , Berant M.
Published: February 2009

Verapamil is a useful drug for treating supraventricular tachycardia; however, severe side effects occasionally have been reported in infants. We describe here our experience with the use of a 10 percent solution of intravenous calcium gluconate prior to the use of verapamil in infants with paroxysmal supraventricular tachycardia. In all the attacks verapamil converted the supraventricular tachycardia to sinus rhythm. We feel that calcium gluconate injected previous to verapamil can avoid the negative inotropic effects without interfering with the antiarrhythmic properties of verapamil.
Lithium causing a serious sinus‐node dysfunction at therapeutic doses
Authors: Montalescot G. , Levy Y. , Farge D. , Brochard L. , Fantin B. , Arnoux C. , Hatt P. Y.
Published: February 2009

The cardiovascular effects of lithium have been indexed in literature since 1900, most frequently in cases of intoxication. We recently studied the exceptional case of a patient showing a serious sinus node dysfunction during lithium treatment. The serum lithium levels were always within the therapeutic range. After two endocardial explorations and withdrawal of lithium, we found that the sinus node dysfunction was due to lithium and reversible after withdrawal of it. Some ignored dysfunctions could exist with a regularly controlled treatment.
Staphylococcal abscess complicating endocardial aneurysmectomy
Authors: Schneiderman H. , Bloom K. , Shima M. , Ezri M. , Goldin M.
Published: February 2009

Subendocardial left ventricular aneurysmectomy relieved previously intractable ventricular tachycardia in a 68‐year‐old man with severe coronary artery disease. Staphylococcal septicemia developed postopera‐tively; an infected venoclysis site may have provided the portal of entry. Autopsy confirmed staphylococcal abscess at the epicardial aspect of the ventriculotomy, constituting the first reported case, to our knowledge, of this complication following endocardial surgery.
The efficacy and safety of high‐dose verapamil and diltiazem in the long‐term treatment of stable exertional angina
Authors: Weiner D. A. , Mccabe C. H. , Cutler S. S. , Ryan T. J. , Klein M. D.
Published: February 2009

The efficacy and safety of high‐dose verapamil (480 mg/day) and diltiazem therapy (360 mg/day) were compared in separate cohorts of 26 and 20 patients, respectively. All patients had stable exertional angina and underwent an initial 6‐week double‐blind, placebo‐controlled, randomized phase followed by a 12‐month open‐label period. Angina attacks were reduced by verapamil (6.3±7.5 to 2.5±4.1 attacks per week, p<0.001) and by diltiazem (9.2±7.5 to 3.0±3.1 attacks per week, p<0.001), while treadmill time increased with both verapamil (372±132 to 444±108 s, p<0.001) and diltiazem (412± 175 to 536± 164 s, p<0.001) during the short‐term study. Both agents continued to show similar salu‐tory effects at the end of one year. The beneficial effects of both drugs appeared to be related in part to a reduction of the rate‐pressure product during submaximal exercise (12% by verapamil, 7% by diltiazem, both p<0.05). Adverse effects were few and consisted primarily of mild constipation in six patients taking verapamil, and pedal edema and transient flushing in 2 patients each using diltiazem. Thus, high‐dose verapamil and diltiazem have similar beneficial effects and are safe for the long‐term treatment of effort‐related angina pectoris.
Impact of thallium‐201 imaging on clinical assessment and management of patients with chest pain
Authors: Schmoliner R. , Dudczak R. , Kronic G. , Mösslacher H. , Zangeneh M. , Pollak C. , Schurz B. , Schoberwalter A.
Published: February 2009

The histories, rest, and exercise ECG results of 60 patients without myocardial infarction complaining of chest pain were submitted to 6 physicians (3 cardiologists and 3 noncardiologists) who were unaware of the angiographic findings. The physicians were requested to estimate the probability of coronary artery disease present in percentages and to assess the need for coronary angiography on a five‐point scale (1 = definitely not indicated, 5 = definitely indicated). After obtaining the results of thallium‐201 imaging following dipyridamole (0.50 mg/kg intravenously) administration, the physicians were again requested to estimate probability and need for angiography. In the 43 patients with coronary artery disease the judgment of probability was increased significantly after 201T1 from 75.6±20.2% to 82.9±23.2% (p<0.001) and the need for angiography from 4.3±0.9% to 4.5 ±0.9% (p<0.001). In the subgroup of patients with atypical angina the relative change in probability was higher than in other subgroups of patients with coronary artery disease. In the 17 patients with normal coronary arteries the probability estimation fell after 201Tl from 36.7±22.0% to 24.8±21.0% (p<0.001), the need for angiography was decreased from 2.7 ±1.1 % to 2.2± 1.2% (p<0.001). With the 201T1 information, cardiologists performed a better diagnostic differentiation of patients with and without coronary artery disease than noncardiologists. The study demonstrates the improvement of clinical diagnosis in patients with chest pain by thallium‐201 imaging and confirms the favorable influence of the method on the management of the patients in terms of indications for coronary angiography.
Tuberculous pericarditis in transkei
Authors: Strang J. I. G.
Published: February 2009

In the Transkei it was so frequently found that it was referred to as the “Transkei Heart.” The prognosis in tuberculous pericarditis is invariably bad and death may take place within one or two years but more often within a few months.

Michael Gelfand

The Sick African, Third Edition, 1957
Hemoptysis following mustard repair: A late complication
Authors: Sapire D. W. , Casta A. , Hayden K. , Swischuk L. E.
Published: February 2009

Hemoptysis was the presenting symptom in a 4‐year, 11‐month‐old male who had had a Mustard operation for hemodynamic correction of transposition of the great vessels at the age of five months. Chest roent‐genography demonstrated hyperlucency of the left lung and tomography showed compression and narrowing of left main stem bronchus. Angiography documented the absence of antegrade flow in the left pulmonary artery and no pulmonary venous drainage on the left. The left lung was supplied by bronchial collateral arteries which drained by retrograde filling of the left pulmonary artery. It is surmised that pulmonary venous drainage on the left was compromised at surgery and that the dilated main pulmonary artery compressed the left main stem bronchus. This combination promoted bronchial collateral ingrowth. Hemoptysis is a complication of enlargement of bronchial collateral vessels.
Two‐dimensional and M‐mode echocardiographic evaluation of fetal arrhythmia
Authors: Crowley D. C. , Dick M. , Rosenthal A. , Rayburn W. F.
Published: February 2009

Cardiac anatomy and rhythm were evaluated in the fetuses of 18 pregnant women (between 20 and 42 weeks of gestation) referred because of abnormal fetal heart rate or rhythm. Utilizing a 3 MHz two‐dimensional scan head with M‐mode capability, M‐mode recordings were obtained at paper speeds of 50 and 100 mm/s from 16 fetuses. The arrhythmia of two fetuses was diagnosed using two‐dimensional echo alone. Semilunar and atrioventricular valve opening and closing points, A waves, plus ventricular wall motion were used for timing purposes; and heart rate and rhythm were determined. Diagnoses made were atrial premature beats n=3, ventricular premature beats n=3, congenital heart block n=4, supraventricular tachycardia n=3, sinus bradycardia n=1, and blocked atrial beats n=1. In three fetuses no arrhythmia was identified. Cardiac anatomy was normal in 16 fetuses, with two (congenital heart block) felt to have univentricular hearts. Fourteen pregnancies went to term, two were delivered prematurely, and two fetuses with congenital heart block were stillborn. In three fetuses arrhythmia was confirmed during labor by fetal scalp electrode. Anhythmia was absent after birth in 11 of 16 infants, with congenital heart block persistent in two infants, and supraventricular tachycardia, atrial premature beats, and blocked atrial premature beats remaining in one each. Intervention with medical management was attempted in four pregnancies, with successful termination of arrhythmia (supraventricular tachycardia) in two fetuses. We conclude that combined two‐dimensional M‐mode capability is useful in the diagnosis of fetal rhythm distrubances, and perhaps in the selection of timing, and mode of intervention.
The apical impulse in coronary heart disease
Authors: Ranganathan N. , Juma Z. , Sivaciyan V.
Published: February 2009

Forty patients (36 with coronary artery disease), who had angiographic assessment of left ventricular function were studied using apexcardiography with a new method of standardization, the objective being to define the parameters of the apical impulse which reflect changes in the left ventricular function and correlate them with clinical assessment of the apical impulse. Based on measurements from patients with normal left ventricular function, abnormalities in apexcardiograms were identified. An increase in amplitude of percent A wave alone (greater than 13.3%) (palpable as an atrial kick in approximately half of these patients) was not associated with significant left ventricular dysfunction. An isolated abnormality in isovolumic slopes, although associated with mild left ventricular dysfunction, could not be detected clinically. Moderate to severe left ventricular dysfunction was always associated with abnormal ejection phase slopes and all had sustained apical impulses. The additional presence of a palpable atrial kick or an increased percent A wave on the apexcardiogram was more indicative of moderate rather than severe dysfunction. Thus this study clearly establishes that left ventricular function does in fact affect the nature of the apical impulse in patients with coronary artery disease and these can be easily defined.
The lowering of daytime blood pressures with a single daily dose of acebutolol in ambulant hypertensives
Authors: Mehta S. K. , Goldberg A. D. , Walsh J. T.
Published: February 2009

Intra‐arterial blood pressure recordings were studied in 10 ambulant subjects with essential hypertension to evaluate the effect of a single daily dose of acebutolol. Blood pressures and heart rates, measured on a beat‐to‐beat basis were averaged over every hour, for the daytime, night‐time, and for the total 24 hours. Acebutolol significantly lowered the average daytime systolic pressure (160 to 142 mmHg, p = <0.01), diastolic pressure (78 to 66 dg, p = <0.01), and the heart rate (92 to 77 beats/min, p = <0.001). Significantly lower pressures were demonstrated up to 11 hours after the last dose of acebutolol. The effect on heart rate lasted up to 13 hours. The observed lowering of pressures and heart rate during the remaining 11 hours did not reach statistical significance.
Significance of the Q wave in acute myocardial infarction
Authors: Goldberg R. K. , Fenster P. E.
Published: February 2009

Acute myocardial infarction may be associated with the development of Q waves on the electrocardiogram (ECG), or with changes limited to the ST segment or T wave. The ECG changes do not accurately differentiate transmural from nontransmural infarction. However, the presence or absence of a Q wave does correlate with some aspects of the clinical course of patients after myocardial infarction, and is therefore of prognostic value. Q‐wave infarctions are more likely to be complicated by congestive heart failure during hospitalization. The in‐hospital mortality is also higher after a Q‐wave infarction than after a non‐Q infarction. Both of these findings are probably due to the association of a Q wave with a larger mass of infarcted myocardium. The long‐term mortality, however, is the same for Q‐wave and non‐Q‐wave infarctions. This is probably due to an increased late mortality after non‐Q infarctions, related in part to a higher rate of reinfarction. The differences between Q‐wave and non‐Q‐wave infarctions are not due to obvious differences in extent and location of coronary artery obstructions. However, there may be differences in the collateral circulation, with more extensive collaterals associated with non‐Q infarcts. Appreciation of the prognostic significance of the ECG changes in acute myocardial infarction may help direct the evaluation and management of the patient after myocardial infarction.
Exacerbation of ventricular tachycardia by tocainide
Authors: Cheesman M. , Ward D. E.
Published: February 2009

Exacerbation of ventricular arrhythmias by antiarrhythmic drugs the lignocaine‐type has not been reported previously. In this paper we describe three patients with a variety of ventricular arrhythmias who were treated with tocainide and developed worsening of the ventricular arrhythmias. In one patient, frequent ventricular ectopic beats were converted to sustained ventricular tachycardia (VT) in another, nonsustained VT was converted to sustained VT, and in a third, monomorphic VT was converted to multimorphic VT. These patients illustrate the need for careful supervision of antiarrhythmic therapy for VT, even when lignocaine‐like drugs are being used.
Idiopathic coronary artery dissection: A rare in vivo diagnosis
Authors: Ramamurti S. , Mahrer P. R. , Magnusson P. , Bowyer J. V. , Sasse L. , Shaperman M.
Published: February 2009

A 42‐year‐old white female, who had an acute myocardial infarction, developed post‐infarction angina and underwent coronary angiography seven weeks after the event. Coronary angiogram demonstrated a primary dissection of the left anterior descending artery. To our knowledge this is the sixth such report of a patient with primary dissection of a coronary artery demonstrated by angiogrdphy and the fourth such patient reported to achieve and maintain asymptomatic status without operative intervention.
Coronary artery atherosclerosis observed in men over 14 consecutive years
Authors: Murphy M. L. , De SOYZA N. , Doherty J. E. , Baker B. J. , Bissett J. K. , Watson J. W.
Published: February 2009

The incidence of cardiovascular death and myocardial infarction associated with ischemic heart disease has declined over the past 15 years. Whether this is associated with a decrease in the severity of coronary atherosclerosis is unknown. The extent of coronary atherosclerosis in men was determined by postmortem coronary angiography in 505 patients over an observation period of 14 years. Patients were divided into those with ischemic heart disease (42%) and those without (58%). Mean coronary scores showed no significant trends over the 14‐year period in those without ischemic heart disease and for the last 10 years in those with ischemic heart disease. In those few patients evaluated early in the study with ischemic heart disease, a significantly lower coronary score was found compared to subsequent years. This study was performed during an era of declining cardiovas cular death rates and a declining incidence of myocardial infarction, and suggests that this decline may relate to favorable changes in pathogenesis rather than to a decrease in extent of coronary atherosclerosis.
Treatment of perinfarction recurrent ventricular fibrillation by percutaneous pharmacological block of left stellate ganglion
Authors: Biagini A. , Severi S. , Contini C. , L'abbate A. , Sabino F. , Marraccini P. , Paladini G.
Published: February 2009

A patient suffering from an acute myocardial infarction presented on the seventh and eighth days of hospitalization recurrent episodes of ventricular fibrillation refractory to antiarrhythmic treatment. The life‐threatening ventricular fibrillation was suppressed by percutaneous pharmacological block of the left stellate ganglion.
Iatrogenic left main coronary artery stenosis following PTCA or valve replacement
Authors: Bashour T. T. , Hanna E. S. , Edgett J. , Geiger J.
Published: February 2009

We report three patients who developed iatrogenic severe left main coronary artery stenosis. In two, it was secondary to coronary cannulation during aortic valve replacement and in one it followed distention of the artery during balloon dilatation of a proximal lesion in the left anterior descending artery. In all three, the stenosis was clinically manifest a few months after the intervention. All were successfully treated by aortosaphenous coronary bypass. A common mechanism for the three cases may be mechanical distention of the left main coronary artery resulting in intimal damage with secondary fibro‐sis and stenosis. The percutaneous transluminal coronary angioplasty‐related stenosis is, to our knowledge, the first reported case of this nature, and represents a previously unrecognized complication of this procedure.
Clinical experience with two‐dimensional echocardiography to guide endomyocardial biopsy
Authors: Williams G. A. , Kaintz R. P. , Habermehl K. K. , Nelson J. G. , Kennedy H. L.
Published: February 2009

Two‐dimensional echocardiography was used to aid right ventricular endomyocardial biopsy during 163 procedures in 83 patients being evaluated for myocarditis, cardiac transplant rejection, or drug toxicity. Thirty procedures were performed using combined echocardiography and fluoroscopy and 133 using echocardiography alone. For 80 of the 83 patients (96%) the forceps could be adequately visualized entering the right atrium, crossing the tricuspid valve, and advancing to the right ventricular apex and free wall. The catheter could be guided to biopsy the septum and sample multiple, separate sites along the right ventricular walls. By opening the forceps prior to contact with the myocardium, the right ventricular free wall could be biopsied without perforation. We found two‐dimensional echocardiography to be a useful and safe technique for forceps visualization and manipulation in the right ventricle.
The relationship between the electrocardiographically estimated infarct size and 1 ‐ and 2‐year survival in acute myocardial infarction
Authors: Herlitz J. , Hjalmarson Å.
Published: February 2009

In 587 patients with acute myocardial infarction (AMI) and no previous MI, electrocardiographically estimated infarct size was related to 1 ‐ and 2‐year mortality. The overall mortality was higher in patients with transmural MI (Q‐ or R‐wave changes in standard ECG) than in patients with subendocardial infarction (ST‐T‐wave changes in standard ECG) after 1 year (18.8% compared to 6.5% p<0.001) and after 2 years (22.2% compared to 13.8%, p=0.049). When patients who were alive during primary hospitalization were analyzed separately, slightly higher mortality was found in patients with transmural MI than in subendocardial MI after 1 year (9.6% compared to 4.2%, p =0.076) while no difference was found after 2 years (13.4% as compared to 11.7%, p>0.2). In a subgroup of patients with anterior MI, precordial mapping with 24 chest leads was analyzed 4 days after arrival in hospital (n=197). Patients were divided into quartiles according to the sum of R waves, the sum of Q waves, and the number of Q waves. There was a similar overall mortality in each quartile after 1 year and after 2 years regardless of ECG parameters studied. Neither did we find any correlation between the sum of R waves in leads II, III, and a VF on the fourth day in patients with inferior MI and overall 1 ‐ or 2‐year mortality rate, although there was a trend towards higher mortality with more ECG changes.
Myocardial infarction and the weather: A significant positive correlation between the onset of heart infarct and 28 KHz atmospherics—A pilot study
Authors: Baumer H. , Ruhenstroth‐Bauer G. , Burkel E. M. , Sönning W. , Filipiak B.
Published: February 2009

The date of occurrence of a heart infarct was tabulated for 162 patients admitted to four Munich clinics with cardiology departments from January 1 to July 31, 1981. This occurrence calendar was correlated with the daily average density of 28 KHz and 10 KHz atmospheric (atm) impulses and several classic weather parameters. The occurrence of heart infarcts has a certain positive correlation with the increased appearance of “pure” 28 KHz impulses, the correlation with 10 KHz impulses is very slight. Among the classic weather parameters, the average daily humidity has the highest negative correlation coefficient.
Combined administration of propranolol and quinidine in the conversion of paroxysmal atrial fibrillation
Authors: Antonelli D. , Bloch L. , Barzilay J.
Published: February 2009

Quinidine was combined with propranolol to restore sinus rhythm in cases of paroxysmal artrial fibrillation (PAF) in 42 patients. The treatment was started with propranolol and quinidine at a test oral dose of 10 mg and 0.2 g, respectively, thereafter a dose of 0.4 g of quinidine and 10 mg of propranolol every two hours was added. The procedure was stopped when sinus rhythm was achieved, or when the administered quinidine reached the total dose of 1.6 g. Sinus rhythm was restored in 37 patients. The side effects were gastrointestinal disorders in 16 patients, atypical ventricular tachycardia in one case, and embolism of the left femoral artery in another patient.
Pentoxifylline treatment of moderate to severe chronic occlusive arterial disease
Authors: Lee B. Y. , Berkowitz P. , Savitsky J. P. , May G. S. , Brobst J. , Mccann W. J.
Published: February 2009

A pilot study of the effects of pentoxifylline in 19 patients with moderate to severe chronic occlusive arterial disease (COAD) is described. The severity of disease was assessed by the degree of limitation in the walking distance on the flat surface (< 100 m), the absence of peripheral pulses on palpation, the diminished Doppler tibial/brachial pressure (the ischemic index) at rest, and by contrast arteriography, when available. After a 2‐week washout phase, all subjects received pentoxifylline (1200 mg/day) in an open‐label manner for a total of 12 weeks. Twelve of the nineteen patients showed a definite increase in exercise tolerance by the end of the study, with a concomitant reduction in ischemic symptoms. All except 3 patients felt they had derived benefit from the medication. In contrast to the clear improvements in walking distance and symptoms, only small effects on noninvasive vascular laboratory measurements were noted. Platelet aggregation, induced by ADP, epinephrine, and collagen, gradually decreased over the study period. Pentoxifylline appears to be useful in the medical management of patients with moderate to severe chronic occlusive arterial disease; future controlled trials in such patients are now justified.
Combining left ventricular systolic time intervals and M‐mode echocardiography in the evaluation of primary pulmonary hypertension in women
Authors: Leier C. V. , Sahar D. , Hermiller J. B. , Unverferth D. V.
Published: February 2009

Eight patients with primary pulmonary hypertension underwent systolic time intervals, M‐mode echocardiography, and direct hemodynamic studies in order to determine the correlation between noninvasive parameters and hemodynamic variables and to evaluate the utility of these noninvasive studies in primary pulmonary hypertension. The ratio of the pre‐ejection period to left ventricular ejection time (PEP/LVET) of the systolic time intervals was abnormally increased (>0.42) for each subject; the increase in the PEP/LVET was secondary to a shortening of the left ventricular ejection time in four patients, prolongation of the pre‐ejection period in one, or a combination of such, noted in three patients. In contrast, echocardiographic parameters of left ventricular function, specifically percent change in the minor axis of the left ventricle with systole, velocity of circumferential fiber shortening, and ejection fraction, were normal. In addition, a very good correlation was noted between PEP/LVET and total pulmonary resistance (r value = −0.89, p<0.05), while the echocardiographic parameters correlated well with stroke volume and cardiac output (r values ranged from 0.68 to 0.72, p<0.05). These results indicate that in primary pulmonary hypertension, the performance of both systolic time intervals and M‐mode echocardiography noninvasively provides useful information concerning the hemodynamic status of these patients. Systolic time intervals provide an estimation of overall cardiac‐cardiovascular performance, rather than left ventricular function alone, which in turn, is validly examined by M‐mode echocardiography.
Recurrent nontraumatic aortic tears resulting in valvular avulsion and aortic insufficiency
Authors: Jaworsky C. , Smith D. W. , Shindler D. , Kostis J.
Published: February 2009

A case of aortic insufficiency due to avulsion of two of three semilunar valves was remarkable because of the intimal and medial tears which caused it. The tears were in different stages of repair, suggesting repetitive injury. Antemortem steroid therapy and bouts of violent coughing may explain these unusual findings.
Echocardiographic findings in pompe's disease with left ventricular obstruction
Authors: Shapir Y. , Roguin N.
Published: February 2009

Two infants with Pompe's disease (type II glycogenosis) showing echocardiographic evidence of obstructive cardiomyopathy are described. On M‐mode and two‐dimensional (2‐D) echocardiography there was a severe hypertrophy of the interventricular septum, free, and posterior left ventricular wall with midsystolic closure of the aortic valve. The combined echocardiographic and electrocardiographic findings are helpful in the clinical diagnosis of this severe disease.
Pitfalls in the diagnosis of tricuspid atresia: Report of a new angiocardiographic sign
Authors: Hausdorf G. , Gravinghoff L. , Sieg K. , Keck E. W.
Published: February 2009

Two patients with the classical clinical, angiographic, and echocardiographic signs of tricuspid atresia are reported, where the correct diagnoses were made at operation; one child had cor triatriatum dexter, the other child total anomalous systemic venous drainage to the left atrium. The literature on cor triatriatum dexter and total anomalous systemic venous drainage is discussed and a new angiographic sign for the differentiation from tricuspid atresia is reported: nonopacification of the right atrial appendage with right atrial angiocardiography.
Potential prevention of myocardial rupture resulting from acute myocardial infarction
Authors: Nakano T. , Konishi T. , Takezawa H.
Published: February 2009

The clinical characteristics of 30 cases of myocardial rupture resulting from acute myocardial infarction were analyzed. Predisposing factors of myocardial rupture appeared to be the following (1) age 60 years or older, (2) female, (3) no previous history of angina or myocardial infarction, (4) hypertenstion on admission, (5) persistent or recurrent chest pain, (6) physical activity and/or emotional unrest, (7) less than 10 days since the onset of myocardial infarction. From 1979 to 1982, we tried to eliminate these risk factors in the acute stage of myocardial infarction, of which hypertension appeared to be the most important and main correlating factor. The incidence of myocardial rupture before elimination of risk factors was 31.2 % (26 of 84 patients) which was reduced to 8.8% after elimination. In the years 1981 and 1982, only two cases of myocardial rupture were found in each year, 4.3% and 5.6% of MI patients, respectively.
Improvement in exercise capacity and associated changes in hemodynamics and left ventricular function after the addition of metoprolol to nifedipine in patients with stable exertional angina
Authors: Choong C. Y. P. , Roubin G. S. , Shen W. F. , Tokuyasu Y. , Harris P. J. , Kelly D. T.
Published: February 2009

In 10 men with stable exertional angina, the changes in exercise capacity, hemodynamics, and left ventricular (LV) function were measured after 20 mg sublingual nifedipine (N) and again after adding 100 mg oral metoprolol (M). Nifedipine alone did not significantly improve exercise workloads (+18%) and duration (+21 %), but the addition of metoprolol increased both parameters by a further 37 and 32%, respectively (both p< 0.005 vs. N). After nifedipine the onset of angina was slightly delayed (5.14±2.41 min placebo (P), 6.00±2.31 min N, p<0.1) and occurred at higher workloads (36±17 W P, 43±8WN, p<0.1). After the addition of metoprolol, the onset of angina was delayed substantially more (9.57±2.22 min, p<0.001 vs. P and N) and occurred at much higher workloads (62±20 W, p < 0.001 vs. P and N). At rest (R) and during exercise (E), nifedipine decreased systemic vascular resistance (‐36% R, ‐27% E, both p<0.001) and mean arterial pressure (‐18% R, ‐21% E, both p<0.001), and increased heart rate (+15% R, +11% E, both p<0.001), Pulmonary artery wedge pressure on exercise increased less (22 ±7 mmHg P, 13±5 mmHg N, p<0.001). After adding metoprolol, the major change was a reduced heart rate (‐25% vs. N at R and E, both p <0.001), and arterial pressure was unaltered. Pulmonary artery wedge pressure on exercise increased to 18±5 mni Hg (p<0.05 vs. N). Exercise LV ejection fraction and volume did not change significantly after adding metoprolol despite marked improvement in angina. In this acute exercise study in patients with stable exertional angina, metoprolol added to nifedipine markedly improved exercise capacity by preventing the increase in heart rate seen with nifedipine. In our patients with relatively normal LV function at rest, the combination was safe and produced no deleterious effects on LV function.
Detection of different blood flow patterns in the true and false lumina with aortic root dissection by pulsed doppler echocardiography
Authors: Mohri M. , Nagata Y. , Hisano R. , Koyanagi S. , Hirata T. , Nakamura M.
Published: February 2009

We report a 53‐year‐old man with aortic dissection, in whom pulsed Doppler echocardiography showed two different flow patterns within the dilated aorta. Although two‐dimensional echocardiography has been successful in making the diagnosis of aortic root dissection, several conditions producing false positives have also been noted. Simultaneous recording of pulsed Doppler echocardiography may be useful to provide additional diagnostic clues in selected cases.
Right‐to‐left interatrial shunt secondary to an extensive right ventricular myocardial infarction
Authors: Wendel C. H. , Dianzumba S. , Jyner C. R.
Published: February 2009

This case report describes a rare complication of right ventricular myocardial infarction. Hypoxemia in this setting has only been described in two previous cases with a right‐to‐left interatrial shunt. This is suprising, given the high incidence of probe patent foramen ovale in randomly selected necropsy cases. Two‐dimensional echocardiography with contrast is the method of choice for detecting this abnormality.
Elevated CK‐MB and CK‐BB in serum and tumor homogenate of a patient with lung cancer
Authors: Lee B. I. , Bach P. M. , Horton J. D. , Hickey T. M. , Davis W. A.
Published: February 2009

Elevated serum levels of creatine kinase (CK) were found in a patient with small‐(oat) cell carcinoma of the lung. Fractionation of the enzyme showed markedly elevated CK‐MB and CK‐BB isoenzymes. Clinical and subsequent pathological examination showed no evidence of infarction, inflammation, or tumor involvement of the heart; however, analysis of tumor tissue for CK showed predominance of CK‐MB and CK‐BB isoenzymes, thus implicating tumor as the source of the circulating levels of CK‐MB and CK‐BB. Our case is the first to document CK‐MB from neoplastic tissue homogenates, and illustrates that markedly elevated circulating levels of CK‐MB, or increased levels of CK‐MB in combination with CK‐BB may point away from a myocardial source, and toward the existence of a malignancy.
Psychosocial aspects of surviving sudden cardiac death
Authors: Vlay S. C. , Fricchione G. L.
Published: February 2009

The psychosocial problems faced by the survivor of “sudden cardiac death” are discussed from the point of view of the patient, the family, and the physician. The patient faces a battery of intensive diagnostic tests, as well as concern for future capability to resume function as “spouse, parent, and citizen.” Emotions such as depression, anger, anxiety, frustration, and fear must be dealt with in a constructive manner. Management includes education, support, encouragement of adaptive denial, anxiolytic medication if necessary, and relaxation techniques when helpful. Our approach begins with education of the patient and family in regard to the medical aspects of the illness. Next, we provide support for the patient and allow the patient to express his or her concerns at an individual pace. Adaptive denial is encouraged and maladaptive denial addressed. Appropriate medication is prescribed when necessary, and finally, relaxation techniques may have a role in some patients. A strong physician‐patient relationship is necessary for successful evaluation and therapy. The unique stresses of the cardiologist and the electrophysiology team are described.
Secondary prevention after myocardial infarction: Subgroup analysis of patients at risk in the norwegian timolol multicenter study
Authors: Gundersen T.
Published: February 2009

Timolol treatment after myocardial infarction is generally related to a significant reduction in both morality and reinfarction compared with placebo. Retrospective analyses of the timolol study are performed on subgroups of patients with a high placebo mortality. The present study shows that these patients are target groups for secondary prevention, as they benefit most from timolol treatment after myocardial infarction. In patients 65‐75 years of age, the number of cardiac deaths and reinfarctions prevented by timolol treatment is twice as high as that of patients below 65 years of age. Timolol treatment is well tolerated in the older age group and the contraindications for timolol treatment are independent of age up to 75 years. The reduction in mortality and reinfarction is independent of heart size at baseline. However, in patients with cardiomegaly and compensated heart failure on treatment with digitalis and diuretics, timolol treatment may be of special importance because of the very high incidence of cardiac death in this group of patients. In patients with compensated heart failure on treatment with digitalis and diuretics, timolol treatment does not precipitate heart failure. Patients with stable diabetes mellitus basically behave like nondiabetic patients regarding inclusion rate, side effects, and timolol‐related reduction in mortality and reinfarction. Decisions concerning secondary prevention with timolol should be independent of preinfarction and postinfarction angina. In conclusion, 70‐80% of all the patients below 75 years of age surviving myocardial infarction, without contraindication to betablocker treatment, can be treated with timolol 10 mg twice daily to reduce mortality and reinfarction. In contrast to previous routines, secondary prevention with beta blockers should be especially directed to high‐risk patients.
Values of electrocardiography and two‐dimensional echocardiography to identify myocardial infarction due to left circumflex and right coronary artery disease
Authors: Ogawa S. , Fujii I. , Yoshino H. , Tani M. , Ohnishi S. , Nagata M. , Chino M. , Handa S. , Nakamura Y.
Published: February 2009

To investigate the value of the 12‐lead ECG and two‐dimensional echocardiography (2DE) in the distinction of left circumflex (LCX) from right coronary artery (RCA) disease, we analyzed the location of Q waves, infarct lesions, and coronary artery narrowings in 26 patients with angiographically documented single‐vessel disease. Q waves in leads II, III, and aVF were associated with the posterior wall (PW) lesions at the papillary muscle level. Extensive lesions from the PW to the posterior septum (PS) identified RCA disease, while extension to the lateral wall (LW) identified LCX disease. Eleven of 12 patients with high posterior infarction (tall R wave in V1) were found to have extensive LW lesions and 10 of these had coronary narrowings in or proximal to the obtuse marginal branch of LCX. All 6 patients with high posterior infarction and high lateral infarction (Q in I or aVL) had infarct lesions extending from the LW to the anterior wall (AW) and were associated with LCX disease with a large obtuse marginal branch. Of 10 patients with Q waves in V6, the apical LW and PW were involved in 7 and either segment in 3. Nine of these 10 patients had LCX disease. It is concluded that the location of Q waves in inferior infarction could aid in recognizing infarct extension and underlying coronary artery disease.