bluuebunny/crossref_metadata_2025 huggingface dataset:
Separation of afterload reduction and a direct beneficial cardiac effect of nifedipine in congestive cardiomyopathy
Authors: Percy R. F. , Bass T. A. , Conetta D. A. , Miller A. B.
Published: February 2009

To assess whether the calcium antagonist nifedipine has a specific, direct effect on left ventricular diastolic function separate from its vasodilatory action, we studied 10 patients with idiopathic congestive cardiomyopathy (ages 28‐69, New York Heart Association Class III or IV) at 30 min, 2 h, and 6 h after administration of 10 mg of sublingual nifedipine. Hemodynamic parameters were assessed with Swan‐Ganz catheter and two‐dimensional echo images were processed with computer‐assisted analysis (Quantic 1200) to obtain left ventricular chamber areas and an index of rapid diastolic filling. Indices of left ventricular systolic performance (cardiac index and left ventricular area change fraction) improved during the early (30 min and 2 h) observation periods as afterload (estimated by systolic blood pressure and systemic vascular resistance) was reduced (p<.05 vs. baseline). Pulmonary capillary wedge pressure fell from 17 mmHg to 11 mmHg and rapid diastolic filling index increased from .28 (% area change/ms) to .37 (% area change/ms)(p<.05 vs. baseline) during the early observation periods. Indices of left ventricular systolic performance and afterload had returned to baseline at the late (6 h) observation period. However, pulmonary capillary wedge pressure remained reduced significantly at 10 mmHg after 6 h (p<.05 vs. baseline). Preload (estimated by left ventricular end‐diastolic chamber area) did not vary throughout the study period. Reduction of pulmonary capillary wedge pressure at 6 h, despite return of afterload reduction to baseline and no change in preload, suggests improved left ventricular chamber compliance after sublingual nifedipine, not related to alteration of left ventricular loading conditions.
Probable triggers of onset of acute myocardial infarction
Authors: Muller J. E. , Tofler G. H. , Edelman E.
Published: February 2009

Three cases of acute myocardial infarction are presented in which a probable triggering mechanism can be identified. The presence of triggering physical and mental stresses is consistent with recent documentation of a morning increase in frequency of acute myocardial infarction. This documentation suggests that the onset of acute myocardial infarction is not a random event. Recent advances in knowledge of the pathophysiology of acute myocardial infarction provide a background to the understanding of the probable triggering mechanism in these three cases. Further prospective study of patients with acute myocardial infarction in whom detailed information is collected sufficient to identify triggering activities may provide important insight into the pathophysiology of myocardial infarction and improved strategies for prevention.
Ventricular ectopy in cardiac rehabilitation patients on exercise training and nonexercising days
Authors: Lillis D. L. , Hanson P.
Published: February 2009

We evaluated the effect of routine exercise training sessions on the frequency of ventricular ectopic activity (VEA) in 18 coronary artery disease patients (mean age=60 years) who were active participants in a cardiac rehabilitation program. Nine patients were classified as high risk and nine patients were low risk according to clinical status and cardiac catheterization criteria. Five patients in each group were on beta blockade, but none were on antiarrhythmic agents. Serial 24‐h ECG monitoring was obtained on a routine supervised exercise day and nonexercise control day. VEA were compared during three time periods: (1) exercise training and recovery (4 h) and the corresponding 4 h during control, (2) activities of daily living (12 h), and (3) sleep (8 h). Both groups showed a moderate increase in total VEA during the three activity periods from control day to exercise day. However, this increase was only significant (p<0.05) in the high‐risk group during the 12‐h activity of daily living period postexercise. VEA was significantly greater (p<0.05) in the high‐risk group during all activity intervals except the sleep period on the exercise day. We conclude that VEA occurs with similar frequency during exercise training or corresponding control periods. High‐risk patients have significantly greater VEA on exercise and control days and show additional increased in VEA during activities of daily living (eating and driving) on exercise days.
Diabetic heart disease: The clinical and pathological spectrum—Part I
Authors: Van Hoeven K. H. , Factor S. M.
Published: February 2009

Diabetes mellitus is a significant condition affecting major segments of all population groups studied. With the introduction of insulin and oral hypoglycemic therapy, and with better understanding of diet and weight control over the past half century, the primary causes of diabetic morbidity and mortality have shifted in varying proportions from metabolic derangements, infection, and renal insufficiency to different types of cardiovascular disease. Despite extensive clinical and laboratory research on the etiology, pathogenesis, and even the existence of cardiovascular disease associated with diabetes mellitus, however, considerable debate is still apparent in this field. Our purpose is to present an overview of the subject of diabetic heart disease, with a critical analysis of epidemiologic, clinical, and pathological data. Some of this material will be addressed from the perspective of research in this area over the past decade by one of us (SMF), particularly in experimental hypertensive and diabetic cardiomyopathy. However, overall, an attempt will be made to provide an objective and balanced analysis, in order to answer the question: does diabetic heart disease exist?
Recurrence of two myocardial aneurysms infected with tuberculosis after a previous aneurysmectomy
Authors: Bennett J. M. , Naude D. F. , De Villiers J. S.
Published: February 2009

This case report concerns a patient who initially presented with an apparent congenital left ventricular aneurysm with successful aneurysmectomy. The patient had a recurrence of the aneurysm and, at reoperation, the diagnosis of cardiac tuberculosis was made.
Massive left atrial thrombus: A possible paraneoplastic complication of breast carcinoma
Authors: Wrisley D. , Giambartolomei A. , Lee I. , Brownlee W.
Published: February 2009

We describe a patient with long‐standing rheumatic mitral valve disease, left atrial dilatation, and a precommissurotomy history of left atrial thrombus. Following operation she was maintained on daily aspirin as an antithrombotic measure. For 6 years she had no evidence, echocardiographically, of left atrial thrombus. She underwent surgery for apparently nonmetastatic breast cancer in early 1986. In May 1986 the left atrium was echocardiographically clear. At approximately the same time, recurrence was found at the suture line. In October 1987, two metastatic lung lesions and a very large left atrial mass were detected by computed tomography. The atrial mass was surgically removed and found to be a thrombus. There was a striking temporal correlation between dissemination of carcinoma and development of a massive atrial thrombus.
Diabetic heart disease—Part II: The clinical and pathological spectrum
Authors: Van Hoeven K. H. , Factor S. M.
Published: February 2009

Diabetes mellitus is a significant condition, affecting major segments of all population groups studied. With the introduction of insulin and oral hypoglycemic therapy, together with better understanding of diet and weight control gained over the past half century, the primary causes of diabetic morbidity and mortality have shifted in varying proportions from metabolic derangements, infection, and renal insufficiency to different types of cardiovascular disease. Despite extensive clinical and laboratory research on the etiology, pathogenesis, and even the existence of cardiovascular disease associated with diabetes mellitus, however, considerable debate is still apparent in this field. Our purpose is to present an overview of the subject of diabetic heart disease, with a critical analysis of epidemiologic, clinical, and pathological data. Some of this material will be addressed from the perspective of research in this area over the past decade by one of us (SMF), particularly in experimental hypertensive and diabetic cardiomyopathy. However, overall, an attempt will be made to provide an objective and balanced analysis in order to answer the question: does diabetic heart disease exist?
Myocarditis: Unresolved issues in diagnosis and treatment
Authors: Maze S. S. , Adolph R. J.
Published: February 2009

Myocarditis is an enigmatic disease. Lymphocytic myocarditis is most commonly viral in origin. Considerable evidence suggests that myocardial damage is due to an immune‐mediated mechanism rather than to direct effects of the virus itself. The presentation is variable, ranging from a clinically inapparent or relatively benign illness to acute progressive heart failure and death. Although examination of the endomyocardial biopsy specimen is the “gold standard” for the diagnosis of myocarditis there are problems with this technique, relating particularly to sampling error and histologic interpretation. Considerable evidence, both animal and human, suggests that a link between viral myocarditis and dilated cardiomyopathy does exist. There is a rational basis for the use of immunosuppressive therapy in myocarditis. Although many favorable responses have been reported with the use of these agents, the results of more definitive studies are awaited to determine the role of immunosuppressive therapy in myocarditis more clearly. Recommendations for the practical management of patients with myocarditis are made. Whenever possible, patients with this diagnosis should be entered into the ongoing NIH trial.
Indications for heart valve replacement
Authors: Assey M. E. , Spann J. F.
Published: February 2009

Proper evaluation of the patient with valvular heart disease begins with a thorough history and physical examination. Today, sophisticated noninvasive tests—especially echocardiography with color flow Doppler imaging—complement the information gained at cardiac catheterization. Information previously available only through cardiac catheterization can now be obtained from these noninvasive techniques. Serial evaluations can be performed, which are important in managing lesions of borderline hemodynamic significance and in avoiding subclinical deterioration of left ventricular contractility.

Improvements in surgical expertise and intraoperative myocardial preservation allow postoperative improvement for patients with aortic stenosis and aortic insufficiency despite the presence of left ventricular systolic dysfunction. Many traditional indicators of a poor operative result in aortic insufficiency appear less reliable today. Consequently, these indicators should never be viewed in isolation or be given preeminence over clinical judgment.

The long‐term results following aortic valvuloplasty have been disappointing. However, mitral valvuloplasty—for technically suitable types of mitral stenosis—is an attractive alternative to surgery. Echocardiography may be helpful in selecting patients best suited for this technique. The timing of valve replacement in mitral insufficiency is made difficult by the altered loading conditions which can mask underlying contractile dysfunction. In this regard, the use of end‐systolic measurements (e.g., end‐systolic stress‐volume ratio) more accurately characterized left ventricular contractility. When mitral insufficiency patients with left ventricular systolic dysfunction require surgery, valve repair appears superior to traditional mitral valve replacement. With valve repair, the postoperative left ventricular ejection fraction is usually higher, as left ventricular contractile reserve is better maintained.
The effect of complete and incomplete revascularization on exercise variables in patients undergoing coronary angioplasty
Authors: Atwood J. E. , Myers J. , Colombo A. , Pewen W. , Grover‐Mckay M. , Lehmann K. , Sandhu S. , Sullivan M. , Hall P. , Froelicher V.
Published: February 2009

To investigate the effects of complete and incomplete revascularization on the response to exercise, 25 patients underwent symptom‐limited exercise testing with continuous assessment of gas exchange a mean of 5 ± 4 days prior to and 18 ± 12 days following percutaneous transluminal coronary angioplasty. All antianginal medications were discontinued for testing. Revascularization was considered complete if all stenoses were reduced to less than 50% diameter (13 patients), and incomplete if one or more stenoses remained (12 patients). Consistent improvements in ST‐segment depression were observed after angioplasty at matched submaximal exercise levels (mean range 0.5‐0.8 mm; p < 0.05), and were accompanied by a reduction in angina. Significant increases in heart rate and systolic blood pressure were observed at peak exercise following angioplasty in both groups. Gas exchange variables were significantly improved at maximal exercise, with a similar increase in oxygen uptake observed in both groups following angioplasty (mean increase 3.3‐3.7 ml/kg/rnin; p < 0.01). Thus, incomplete revascularization following coronary angioplasty resulted in hemodynamic, electrocardiographic, symptomatic, and gas exchange responses to exercise that were comparable to complete revascularization.
Randomized double‐blind study of intravenous tocainide versus lidocaine for suppression of ventricular arrhythmias after cardiac surgery
Authors: Manolis A. S. , Smith E. , Payne D. , Rastegar H. , Cleveland R. , Mark Estes N. A.
Published: February 2009

To compare the therapeutic efficacy and safety of intravenous tocainide with that of intravenous lidocaine in patients with ventricular arrhythmias after cardiac surgery, 25 patients were randomized to either agent in a double‐blind manner. Tocainide was given in 16 patients as a 250 mg bolus followed by a loading infusion of 500 mg over 15 minutes and a maintenance infusion of 33.3 mg/min. Lidocaine was administered in 9 patients as a 100 mg bolus followed by a loading infusion of 60 mg over 15 minutes and a maintenance infusion of 1.4 mg/min. Therapy was continued for 24 hours in initially responding patients. With analysis of 24‐h taped electrocardiograms it was found that single premature ventricular complexes (PVCs) were suppressed by tocainide by more than 80% in 94% of patients and by lidocaine in 75% of patients (p = NS). Couplets and ventricular tachycardia events were eliminated in all patients by either drug. Multiform PVCs were abolished in 94% of the patients after tocainide and in 75% after lidocaine (p = NS). Average overall success over the 24 hours with more than 80% suppression of single PVCs and simultaneous elimination of higher forms of arrhythmia was 71% with tocainide and 59% with lidocaine (p = NS). Adverse effects were negligible, with only one patient in the lidocaine group developing diaphoresis without necessitating termination of therapy. Treatment rapidly produced and then maintained blood levels of 4‐10 mg/1 for tocainide and 1‐4 mg/1 for lidocaine. We conclude that intravenous tocainide is well tolerated and has comparable efficacy to lidocaine in the acute therapy of postcardiac surgery ventricular arrhythmias.
Value of notching and slurring of the resting QRS complex in the detection of ischemic heart disease
Authors: France R. J. , Formolo J. M. , Penney D. G.
Published: February 2009

The resting 12‐lead ECG has long been known to be an insensitive marker of underlying ischemic heart disease (IHD). The purpose of this study was to determine if QRS complex notching and slurring is of significant value as a diagnostic discriminator in the detection of IHD. The data from 205 consecutive patients coming to cardiac catheterization for evaluation of probable IHD were initially analyzed. Eighty‐three patients were excluded based upon ventricular hypertrophy, bundle‐branch block, lack of data, and pacemaker rhythm. The balance, 122 patients (mean age 61.7 years), were evaluated for angiographic evidence of IHD, ECG findings of QRS notching or slurring, and abnormal Q waves. The data revealed a high prevalence of QRS notching or slurring; 62.2% in those patients with IHD, double the prevalence of significant Q waves (33.3%). The two markers had an approximately equal prevalence (QRS notching or slurring 61.7% vs. Q waves 53.2%) in patients with angiographic evidence of infarction; however, in patients with less than infarct criteria for IHD, the prevalence of QRS notching or slurring was 62.8%, while only 11.6% showed abnormal Q waves. Analysis indicated that QRS notching or slurring has a sensitivity of 62.2% and a specificity of 93.8% for the detection of IHD. The study demonstrates that QRS notching or slurring is a moderately sensitive and a very specific marker of ischemic heart disease in selected patients when using the resting ECG, and is of greatest value in those patients with lesser degrees of ischemic myocardial injury where the prevalence of Q waves is low.
Repeat determination of left ventricular wall thickness from mass and volume during one cardiac cycle for the calculation of left ventricular wall stress parameters
Authors: Von Herrath M. , Hasenfuss G. , Holubarsch C. , Hofmann T. , Heiss H. W. , Just H.
Published: February 2009

Left ventricular end‐diastolic wall stress, end‐systolic wall stress, and systolic stress‐time integral are important parameters to characterize left ventricular load and function. To obtain these parameters, left ventricular pressure, volume, and wall thickness data must be determined at short time intervals throughout one cardiac cycle. However, the measurement of wall thickness at short intervals (i. e., 20 ms) throughout a cardiac cycle is tedious. Furthermore, measurements of wall thickness are less accurate at end‐systole compared with end‐diastole. For these reasons we developed a computer program for calculating wall thickness at short intervals (20 ms) throughout the cardiac cycle from one single determination of left ventricular wall mass and repetitive measurements of left ventricular (LV) volume.
Subclavian stenosis presenting as progressive exertional angina pectoris
Authors: Slutzker D. M. , Capeless M. A. , Brown K. A.
Published: February 2009

Left subclavian stenosis is an uncommon cause of exertional left arm pain. In a patient who presented with exertional chest and left arm pain in an increasing pattern, clinical evaluation disclosed a discrepancy between right and left arm blood pressure. Exercise stress testing with thallium revealed normal myocardial perfusion. Aortic arch and selective angiography revealed a high‐grade proximal left subclavian stenosis. Subclavian angioplasty was performed with complete resolution of symptoms. This case demonstrates that ischemic left arm pain due to subclavian stenosis can present as accelerated angina, and highlights the importance of determining blood pressure in both arms in routine evaluation of patients at risk for atherosclerosis.
Current perspectives in hypertrophic cardiomyopathy: Diagnosis, clinical management, and prevention of disability and sudden cardiac death
Authors: Von Dohlen T. W. , Frank M. J.
Published: February 2009

Hypertrophic cardiomyopathy is a rare primary myocardial disease known for its dramatic morphologic and clinical manifestations. Sudden cardiac death and functional cardiac symptoms are common. However, differing pathologic mechanisms may be responsible for similar clinical symptoms and make a unified approach to therapy impossible. This review will discuss the genetics, criteria for diagnosis, relationship among pathophysiologic abnormalities and clinical symptoms, and management of hypertrophic cardiomyopathy.
Coronary angioplasty after intravenous streptokinase in acute myocardial infarction: Influence of restenosis on clinical outcome and left ventricular function
Authors: Leisch F. , Kerschner K. , Harringer W. , Schützenberger W.
Published: February 2009

The importance of recurrence of stenosis on clinical outcome and left ventricular function was studied in a consecutive series of patients with acute evolving myocardial infarction (maximal duration of pain 4 h) and thrombolysis (1.5 × 106 units of streptokinase intravenously over 60 min) with recanalized single‐vessel disease and subsequent successful coronary angioplasty. Coronary angioplasty was performed in 76 patients between 24 hours and 8 days (mean interval 3.3 days) after thrombolysis and was successful in 86s% (65/76). The in‐hospital reinfarction rate was 5.2% (2 acute and 2 in‐hospital reinfarctions). Repeat angiography after a mean interval of 5.9 months revealed a 39% (24/62) restenosis rate (21 restenoses, 3 reocclusions). Restenoses were associated with significantly more clinical complaints (21 % vs. 62%; p < 0.001). Left ventricular function analysis showed significant improvement in the mean global ejection fraction (6.6 ± 6.0%; p < 0.001) and mean regional wall motion of the infarct zone (6.2 ± 8.2%; p < 0.01) only in patients without restenosis. Recovery of left ventricular function was more evident in inferior than in anterior wall infarctions. In contrast, patients with restenosis had no change in left ventricular function. Thus, the present study demonstrates the adverse influence of restenosis on recovery of left ventricular function and clinical outcome.
Superior vena cava syndrome as a complication of ddd pacemaker implantation
Authors: MURAKAMI Y. , MATSUNO Y. , IZUMI S. , MURAKAMI R. , TANAKA K. , MORIOKA S. , MORIYAMA K.
Published: February 2009

A 75‐year‐old man was admitted to our hospital because of swelling of the face and neck 6 months after implantation of a two‐chamber pacemaker. Digital subtraction angiography showed total occlusion of the superior vena cava vein and well‐developed collateral channels. After thrombolytic therapy, facial swelling disappeared. Digital subtraction angiography performed after thrombolytic therapy revealed a recanalization of the superior vena cava.
Captopril improves hemodynamic response to static exercise in patients with congestive heart failure: A double‐blind, placebo‐controlled, randomized trial
Authors: Borgi C. , Costa F. V. , Ambrosioni E. , Magelli C. , Magnani B.
Published: February 2009

Systemic and peripheral hemodynamic response to isometric exercise by handgrip test at 30% maximal voluntary contraction (MVC) for 3 minutes was assessed in 16 patients with congestive heart failure (CHF) after short‐term treatment with either captopril or placebo given according to a double‐blind, randomized, crossover sequence. During placebo, isometric exercise increased blood pressure (BP) and total peripheral vascular resistance (TPVR) and decreased cardiac index (CI). Captopril reduced the pressor response to exercise (mean±SD) (% systolic: from 14.7±6 to 11.7±3; p<.05/% diastolic: from 12.4±4 to 8±3; p<.005) and increased CI (from 2.3 ± .6 to 2.6± .9 liters/min/m2; p<.01) whereas TPVR remained virtually unchanged (from 1479±597 to 1594±692 U; NS). The changes in mean BP after exercise were inversely related to the early increase in forearm blood flow (FBF) in exercising forearm during both placebo (r=.67) and captopril (r=.71). The extent of reduction in mean BP response after captopril was inversely related to the extra increase in exercising FBF determined by the drug when compared to placebo (r=.73). We conclude that captopril is able to improve the hemodynamic response to static exercise in patients with CHF, probably by increasing the blood supply to exercising muscles during contraction, thus blunting the extent of reflex pressor response.
External compression by metastatic squamous cell carcinoma: A rare cause of left main coronary artery narrowing
Authors: Weinberg B. A. , Pinkerton C. A. , Waller B. F.
Published: February 2009

A 69‐year‐old male with carcinoma of the lung developed unstable angina pectoris during his last few months of life. At necropys, the coronary arteries were free of atherosclerotic plaque, but the left main artery was severely narrowed by external compression from neoplastic metastases. Persistent anterior ST‐segment elevation without evolutionary changes of myocardial infarction was a clue to cardiac involvement by tumor. Direct and indirect effects of metastatic tumors upon the coronary arteries include tumor or thrombi, emboli, wall invasion, or extrinsic wall compression. Extrinsic compression of the left main coronary artery is rare among congenital and acquired conditions producing severe left main disease.
Balloon aortic valvuloplasty in children
Authors: Rao P. S.
Published: February 2009

The technique of balloon aortic valvuloplasty has been used in infants, children, and adults since its first description in 1983. Immediate results reported by several workers and intermediate‐term results by a few workers appear encouraging. Complications are minimal although potential for arterial complications and aortic insufficiency should be recognized. Significant restenosis rates at intermediate‐term follow‐up have been reported and could be minimized by reducing the risk factors associated with recurrence. Echo‐Doppler studies are useful in follow‐up evaluation of balloon valvuloplasty. The results seem to compare favorably with those following surgical valvotomy. The indications are essentially the same as those used for surgery: a gradient in excess of 80 mmHg irrespective of symptoms or a gradient ≥ 50 mmHg with symptoms or ST‐T wave changes. Previous surgical valvotomy is not a contraindication for balloon valvuloplasty. The technique is applicable to subaortic membranous stenosis as well. Thus far only one‐ to two‐year follow‐up results are available. Five‐ to ten‐year follow‐up results to document long‐term effectiveness of balloon aortic valvuloplasty are needed. Miniaturization of currently bulky dilating catheter systems and improving rapidity of inflation/deflation of balloons are necessary to increase safety and effectiveness of these techniques in infants and children. Meticulous attention to the details of the technique and further refinement of the procedure may further increase effectiveness and reduce the complication rate.
Acute hemodynamic and arrhy thmogenic effects of high‐dose intravenous salbutamol in patients with chronic left ventricular dysfunction
Authors: Rotstein Z. , Battler A. , Rath S. , Perek J. , Eldar M.
Published: February 2009

The short‐term hemodynamic and possible arrhythmogenic effects of intravenous salbutamol at a dose of 30 or 60 m̈g/min were evaluated in 14 patients with severe chronic left ventricular dysfunction using equilibrium radionuclide angiocardiography and electrocardiographic monitoring. Salbutamol infusions at a dose of 30 m̈g/min did not cause significant hemodynamic changes; however, at a dose of 60 m̈g/min there was a significant increase in stroke volume, cardiac output, and left ventricular ejection fraction. Heart rate increased significantly while systemic peripheral resistance decreased significantly. Two patients developed ventricular premature beats and another two supraventricular tachycardia, but none were associated with adverse consequences. Thus, high‐dose intravenous salbutamol is effective and safe, and may be used in the acute management of patients with poor left ventricular function.
Prediction of left ventricular function during supine bicycle ergometer exercise in angina‐free patients with old myocardial infarction
Authors: Kamihara S. , Inagaki H. , Iwase M. , Yokota M. , Matsunami T. , Yoshida J. , Miyahara T. , Koide M. , Hayashi H.
Published: February 2009

We investigated whether or not left ventricular function during dynamic exercise in angina‐free patients with old myocardial infarction could be estimated using resting left ventricular function and noninvasive parameters determined during exercise. We studied 70 patients with old myocardial infarction by measuring hemodynamic parameters during supine multistage bicycle ergometer exercise. Coronary arteriography and left ventriculography were performed: then the left ventricular ejection fraction and left ventricular end‐diastolic volume were measured. The parameteric changes (Δ) between rest and peak exercise were determined. Significant positive correlations were observed between cardiac index (CI) at rest and at peak exercise (r = 0.62, p < 0.001), as well as between pulmonary artery wedge pressure (PAWP) at rest and at peak exercise (r = 0.72, p < 0.001). Multiple regression analysis indicated that CI and PAWP at peak exercise as dependent variables were best described by the equations: CI at peak exercise = 1.074 [CIrest] + 0.031 [ΔHR] + 0.004 [ExD] + 0.018 [LVEF] – 1.560 (r = 0.79, p < 0.001), PAWP at peak exercise=0.994 [PAWPrest] – 0.181 [LVEF] + 0.203 [ΔDBP] – 0.076 [ΔHR] – 21.488 (r = 0.80, p < 0.001). These data suggested that CI and PAWP during dynamic exercise in angina‐free patients with old myocardial infarction could be predicted using noninvasive parameters, such as increments of blood pressure and heart rate as well as exercise duration, together with data on resting left ventricular function, such as resting CI, resting PAWP, and resting left ventricular ejection fraction (LVEF).
Congenital tricuspid valve stenosis with atrial septal defect and left anterior fascicular block
Authors: Cohen M. L. , Spray T. , Gutierrez F. , Barzilai B. , Bauwens D.
Published: February 2009

Congenital tricuspid valve stenosis in the absence of other valvular abnormalities is rare. In this report we describe a patient with congenital tricuspid valve stenosis, ostium secundum atrial septal defect, and electrocardiographic left anterior fascicular block, who presented with paradoxical emboli. This case, as well as previous case reports, suggests that congenital tricuspid stenosis with ostium secundum atrial septal defect is associated with left anterior fascicular block.
Intracardiac fibroma in an asymptomatic infant
Authors: Tahernia A. C. , Bricker J. T. , Ott D. A.
Published: February 2009

Primary tumors of the heart are rare in infancy and childhood. A one‐year‐old, asymptomatic, male infant with unimpressive physical findings in whom an echocardiogram demonstrated a large, encapsulated, solid fibroma filling the right ventricle without obstruction of either the inflow or outflow tract is presented. Successful complete surgical excision of the tumor was accomplished. The histological examination was compatible with a benign fibroma. The infant has remained asymptomatic postoperatively with subsidence of the heart murmur. He has not shown any evidence of recurrence of the tumor during a follow‐up period of 29 months. This represents an unusual case of a huge right ventricular fibroma and only the fifth youngest patient, to our knowledge, to undergo successful surgical removal.
Management of the patient with a low HDL‐cholesterol
Authors: Leighton R. F.
Published: February 2009

While there is epidemiologic evidence linking a low high‐density lipoprotein (HDL) cholesterol level with coronary disease events, and interventions that raise HDL while lowering low‐density lipoprotein (LDL) cholesterol levels have been shown to reduce subsequent coronary events, there are no studies showing benefit from raising HDL when a low HDL level is the sole lipid abnormality. HDL is thought to play a key role in reverse cholesterol transport, removing lipids from peripheral cells, but the precise role of HDL in cholesterol metabolism is not understood. The measurement of HDL levels has not been well standardized. Reliance on ratios relating HDL to LDL or to total cholesterol may be misleading in the management of patients. It has not been shown that measuring HDL subfractions or apolipoprotein levels is superior to measuring total HDL levels in predicting coronary risk. HDL levels may be raised by hygienic measures such as smoking cessation and exercise, but a considerable amount of exercise over a long period of time is required. Alcohol consumption and weight loss through dieting inconsistently raise HDL. Estrogen therapy raises and progestational agents lower HDL. Certain beta‐blocking drugs lower HDL levels. For the patient with an isolated low HDL level the hygienic measures may be advised, but drug therapy such as nicotinic acid or gemfibrozil should be prescribed only when low HDL is accompanied by elevated LDL levels that are unresponsive to diet and hygienic measures.
The value of transesophageal echocardiography in the investigation of acute prosthetic valve dysfunction
Authors: Scorr P. J. , Ettles D. F. , Wharton G. A. , Williams G. J.
Published: February 2009

When patients present with suspected prosthetic valve dysfunction, investigation is usually instituted to delineate the site and cause thereof. Precordial cross‐sectional echocardiography is often helpful in this respect, but in the patient with acute pulmonary edema, imaging may be impaired because of discomfort and respiratory distress. The information obtained may also be suboptimal as a result of concomitant obesity, chest wall deformity, and pulmonary disease.1 In addition, further difficulties may relate to the acoustic shadowing produced by the metallic portion of the valve and its sewing ring, especially with valves in the mitral position.2 In such patients, cardiac catheterization may cause further decompensation and is associated with a recognized increase in morbidity and mortality.3 Angiography does not accurately site regurgitant jets in relation to the prosthetic valve concerned and will not detect the presence of vegetations. Transesophageal echocardiography circumvents many of these imaging difficulties and we evaluated its use in five patients with prosthetic heart valves who presented acutely ill, in severe pulmonary edema and suspected prosthetic heart valve failure. In each case, the diagnosis of valve dysfunction was established, and precise information regarding the site and cause of the failure was obtained. No complications or deterioration in patient condition resulted from the procedure and the findings were confirmed at surgery performed within 24 hours in all five patients. Transesophageal echocardiography should be included in the assessment of acute prosthetic heart valve failure.
Recreational swimming in CHD patients and healthy control subjects in relation to left heart function
Authors: Lehman Samek M. N. L.
Published: February 2009

We examined the influence on heart rate, blood pressure, lactate, glucose, and catecholamine levels of moderate recreational swimming at a mean time of 5.2 to 9 minutes with mean speed of 0.33 to 0.49 m/s in 25 CHD patients and 8 healthy control subjects. During swimming, changes in these exercise‐related parameters were observed such as were only found in seated ergometry trials at levels above 100 to 175 W. We consider these changes tolerable for patients with mild left heart damage (n= 13; ejection fraction 54±7%; exercise capacity 2.1±0.4 W/kg). They may indicate overexertion in patients with marked damage to the left heart (n=12; ejection fraction 44±5%; exercise capacity 1.3±0.4 W/kg). Six of the 12 patients with marked left heart damage stopped swimming before the planned time had elapsed for subjective (overexertion) or objective (arrhythmia) reasons.
Comparison of atrial contribution to cardiac hemodynamics in patients with normal and severely compromised cardiac function
Authors: Mukharji J , Rehr R. B. , Hastillo A. , Thompson J. A. , Hess M. L. , Paulsen W. J. , Vetrovec G. W.
Published: February 2009

The importance of atrial contribution to cardiac function in patients with congestive heart failure is controversial. Ten patients with severe congestive failure (Group A) and 10 patients with normal ventricular function (Group B) were studied during atrial and ventricular pacing. Left ventricular ejection fraction, baseline pulmonary capillary wedge pressure, and baseline cardiac index were different between Group A and Group B patients: 22±10 vs. 65±11 (p<0.01); 21±5 vs. 8±4, (p<0.01); and 2.8±0.5 vs. 3.5±1.0 (p=0.05). Compared with atrial pacing, cardiac index decreased from 2.8±0.6 to 2.2±0.5 (p<O.01) in Group A and from 3.6±0.7 to 2.9±0.5 (p<0.01) in Group B, during ventricular pacing. Pulmonary capillary wedge pressure increased by similar amounts in both groups during ventricular pacing. The change in cardiac index, % change in cardiac index, and change in pulmonary capillary wedge pressure from atrial to ventricular pacing, were not different between Group A and Group B patients. By logistic regression analysis, no association was found between the % change in cardiac index and the following variables: left ventricular ejection fraction, left ventricular end‐diastolic volume, baseline pulmonary capillary wedge pressure, change in pulmonary capillary wedge pressure, and baseline cardiac index. The atrial contribution to resting steady‐state cardiac function is similar between patients with severe congestive failure and those with preserved ventricular function.
Myocardial energetics in dilated cardiomyopathy
Authors: Thierfelder L. , Holubarsch CH. , Hasenfuss G. , Just H. J.
Published: February 2009

To assess hemodynamic and energetic effects of different drug interventions on idiopathic dilated cardiomyopathy (IDCM), we determined hemodynamic variables of myocardial oxygen consumption (MVO2) in 37 patients with IDCM. Hemodynamics were measured during routine left and right heart catheterization. MVO2 was analyzed from myocardial blood flow (measured by the argon method) and aortocoronary sinus blood oxygen difference. The hemodynamic variable which correlated best with MVO2 was shown to be the systolic stress time integral (STI). Four different representative compounds were tested with respect to their acute effects on myocardial energetics (MVO2/STI) in patients with IDCM who were in compensated heart failure (NYHA class II–III). The drug interventions were performed at rest. Intravenous injection of the vasodilator nitroprusside yielded a 35% reduction in STI and a 30% reduction in MVO2; in other words, the ratio MVO2/STI was not altered. Injection of the calcium sensitizer and phosphodiesterase inhibitor pimobendan also did not alter this ratio, as both STI (36%) and MVO2 (33%) were lowered. The profound reduction in STI (60%) seen with the phosphodiesterase inhibitor enoximone was accompanied by a much smaller decrease in MVO2 (19%); therefore, the ratio of MVO2/STI increased significantly. An increase of this ratio was also seen with the partial beta‐, receptor agonist xamoterol. However, in this case STI did not change, whereas MVO2 increased by 26%. In summary, vasodilation has energy‐saving effects, whereas positive inotropism is an energy‐consuming process. We conclude that the overall effect on myocardial energetics of a drug which possesses both positive inotropic and vasodilating properties depends on the balance of the two properties.
Anatomic basis for and morphologic results from catheter balloon valvuloplasty of stenotic mitral valves
Authors: Waller B. F. , Vantassel J. W. , Mckay C.
Published: February 2009

This report provides the anatomic basis for catheter balloon valvuloplasty procedures. The morphologic hallmark of mitral stenosis is commissural fusion and the major mechanism of successful balloon valvuloplasty is commissural splitting. Single and double dilating balloons are used to increase the cross‐sectional orifice area of stenotic mitral valves. Double balloons appear to improve the luminal diameter and cross‐sectional area compared with single balloons. This report also illustrates the anatomic basis for single and double balloon catheter placement and position using the transseptal approach.
Embolic mononeuropathy in subacute bacterial endocarditis
Authors: Andreas S. , Tebbe U. , Kreuzer H. , Holzgraefe M.
Published: February 2009

A 49‐year‐old man presented with temperature up to 39.5°C, a sudden peroneal nerve lesion, and a cardiac murmur. The peroneal nerve lesion was likely caused by an embolic occlusion of an artery supplying the nerve. Until now, six cases of embolic mononeuropathy in endocarditis have been reported in the literature. Embolic mononeuropathy is a very rare manifestation of subacute bacterial endocarditis and quite often complicates, as do other more common embolic manifestations, the correct diagnosis.
“Pseudo reinfarction”: A consequence of electrocardiogram lead transposition following myocardial infarction
Authors: Chanarin N. , Caplin J. , Peacock A.
Published: February 2009

Unexpected or bizarre new electrocardiographic changes should alert the physician to the possibility of lead transposition and, if in doubt, the electrocardiogram should be repeated. The classic form of limb lead transposition leading to the appearance of dextrocardia is well recognized. We report a patient with myocardial infarction where lead transposition led to a diagnosis of reinfarction and to the inappropriate use of thrombolytic therapy.
Tomographic views of normal and abnormal hearts: The anatomic basis for various cardiac imaging techniques. Part II
Authors: Waller B. F. , Taliercio C. P. , Slack J. D. , Orr C. M. , Howard J. , Smith M. L.
Published: February 2009

Recent developments have enhanced the diagnosis of cardiovascular disorders in the area of cardiac imaging techniques. From an era of imaging by silhouettes (chest roentgenography, fluoroscopy, angiocardiography), we have emerged into an era of imaging by tomographic scanning (echocardiography, radionuclide tomography, computed tomography, magnetic resonance). A basic understanding of tomographic cardiac anatomy is the foundation for proper use and interpretation of these new imaging modalities. The present report provides a description of the techniques of tomographic cutting of necropsy cardiac specimens and illustrates some of the pathologic cardiac abnormalities cut in these tomographic planes. Part II of this report describes the long‐axis method, methods using the body rather than the heart as the reference axis, and includes transverse, frontal, and parasagittal methods of imaging the heart.
Management of acute myocardial infarction 1990: A perspective
Authors: Vogel John H. K.
Published: February 2009

Rising costs have reached a point at which physicians must assume a major role in dealing with the cost of medicine. Little information is available regarding actual practice at the community hospital level. In order to develop some insight on this issue, a survey of cardiovascular specialists was conducted regarding management of acute myocardial infarction in 1990. The results indicate a major lack of correlation between efficacy, cost, and practice patterns in terms of current knowledge. Perhaps legal concerns have contributed to these current practice patterns. Clearly, aside from choice of thrombolytic agent and/or PTCA, early treatment of acute myocardial infarction has emerged as a most important factor in reducing mortality.
Detection of coronary artery disease by vasodilator thallium imaging of the heart with amyl nitrite inhalation: A pilot study
Authors: Rifkin R. D. , Sharma S. C. , Spraragen S. , Claunch B. , Shackford H. , Patton R.
Published: February 2009

Thallium imaging of the heart using dipyridamole‐induced coronary arteriolar vasodilation has proven to be an effective means of detecting significant coronary stenosis. However, intravenous dipyridamole has not yet been made available for general use. We therefore examined the feasibility of substituting amyl nitrite inhalation as an arteriolar vasodilator prior to thallium imaging. Seventeen patients, all of whom had catheterization‐proven coronary stenosis, inhaled amyl nitrite for 2–5 min. Thallium was injected after 45–60 s of inhalation. Completion of inhalation was followed immediately by planar imaging. Of 6 patients who inhaled amyl nitrite for at least 4 min, 5 had moderate or severe image defects on immediate scans which completely resolved on delayed scans. Only 3 of 11 who inhaled amyl nitrite for 2 min or less prior to scanning had similarly positive tests. Overall sensitivity for significant stenosis was 8 of 17 (47%). Inhalation was well tolerated with only one episode of angina and hypotension. We conclude that amyl nitrite inhalation for at least 4 min may offer an effective and readily available alternative to intravenous dipyridamole for vasodilator imaging of the heart.
Efficacy and safety of clentiazem in patients with essential hypertension: Results of an early pilot test
Authors: Kawakita S. , Kinoshita M. , Ishikawa H. , Kagoshima T. , Katori R. , Ishikawa K. , Hirota Y.
Published: February 2009

The purpose of this study was to evaluate the antihypertensive effect of a new calcium antagonist, clentiazem, on inpatients or outpatients with essential hypertension. After blood pressure was stable and > 160/95 mmHg with placebo for at least a 2‐week observation period, oral clentiazem was administered once daily and dosage was increased stepwise from 10 to 40 mg over 10 weeks. Blood pressure significantly decreased by the second week of the study, and this hypotensive effect was maintained until the eighth week. Cumulative effective rate (percent of patients whose blood pressure decreased in 20/10 mmHg) in 62 outpatients were as follows; 10.3% at 10 mg, 39.6% at 20 mg, 70.2% at 30 mg, 76.6% at 40 mg. There was no significant postural change observed in the blood pressure from supine to standing position. Side effects such as dizziness, general malaise and gait disturbances were observed in 3 (3.9%) of 76 patients. No abnormal changes in clinical laboratory examinations or electrocardiograms were caused by clentiazem. Thus these data demonstrated that clentiazem produces certain antihypertensive effects with sufficient safety.
Effects of dibutyryl cyclic AMP on ventricular vulnerability during atrioventricular block in dog
Authors: Kumagai K. , Tashiro E. , Tashiro N. , Moroe K. , Hiroki T. , Arakawa K.
Published: February 2009

The effects of dibutyryl cyclic AMP (DBcAMP) on ventricular vulnerability during complete atrioventricular block (CA VB) were studied one week after transarterial electrical ablation of the AV junction in 18 closed‐chest dogs. All dogs exhibited CAVB and a stable ventricular escape rhythm with a mean cycle length of 1812 ± 638 ms. After the administration of DBcAMP at a rate of 0.1 mg/kg/min for 30 min, the ventricular cycle length was significantly shortened, and the QTc interval was slightly prolonged, although the QT interval did not change. The ventricular fibrillation threshold after the administration of DBcAMP was significantly increased (from 12.2 ± 3 84 to 18.4 ± 5.08 mA, p<0.01). Thus, it was demonstrated that DBcAMP exhibited suppressive effects on the ventricular vulnerability in the experimentally induced CAVB.
Unusual form of coronary artery fistula of left anterior descending and right coronary artery in an adult patient
Authors: Sionis D. G. , Margaris N. G. , Mandellou A. I. , Tavernarakis A. G.
Published: February 2009

An unusual morphologically tortuous, common fistulous communication of the left anterior descending and right coronary artery with the right ventricle was found in a 55‐year‐old male patient with severe aortic and mild mitral regurgitation. The angiographic features of this lesion are discussed because of the rarity of this doubly rare coronary artery fistula.
Letters to the Editor
Authors: Diethrich Edward B. , Abela George S.
Published: February 2009

Temperature Monitoring during Peripheral Thermo‐Optical Laser Recanalization in Humans Barbeau GR, Abela GS, Seeger JM, Friedl SE, Tomaru T, Giacomino PP: Clin Cardiol 13, 690–697 (1990)