bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlations of hemodynamic parameters with plasma catecholamines in patients with congestive cardiomyopathy
Authors: Lehmann M. , Wybitul K. , Kapp R. , Spielberger B. , Keul J.
Published: February 2009

Noradrenaline and adrenaline blood levels, as well as central hemodynamics (Swan‐Ganz semi‐floating balloon‐tipped catheter), were measured at rest and during moderate exercise in 8 male patients suffering with idiopathic congestive cardiomyopathy (COCM), and in 12 healthy male control subjects. The stroke volume and the cardiac output in COCM were, on the average, one‐half that of the control subjects; adrenaline, noradrenaline, pulmonary capillary wedge pressure, as well as the roentgenographically determined heart volume (at rest) in COCM were, on the average, increased more than twice the control values. The noradrenaline and adrenaline responses in COCM reached at the 25‐W exercise level the response of controls at the 150‐W level. Direct correlations were observed between the cate‐cholamine responses and the capillary wedge pressure as well as the heart volume; inverse correlations existed between the catecholamines and the stroke volume or the cardiac output. The results may be indicative of a causal relationship between the reduced function of the left heart and a compensatorily increased sympathetic activity, but they are not at all conclusive for a definite cause‐effect response. The differences in catecholamine levels and the correlations are more significant for noradrenaline during both exercise and rest, whereas for adrenaline significance only occurred during exercise. The noradrenaline and adrenaline levels may serve as indicators (especially in the chronic stage) in the diagnosis of reduced left ventricular function.
Interactions between a rapid atrial stimulator and a multiprogrammable ventricular demand pacemaker
Authors: Berman N. D.
Published: February 2009

A patient with drug‐resistant supraventricular tachycardia was well controlled for 8 years with a patient‐activated rapid atrial pacemaker until she developed symptomatic bradycardic episodes. A multiprogrammable ventricular pacemaker was implanted. Assessment of the interactions between the two pacemakers demonstrated inhibition of VVI pacing by the atrial stimulator initially. Two months after implant no interaction was seen. At no time was VVT pacing affected by the atrial stimulator. Thus, interactions between these two units can occur and a multiprogrammable pacemaker should be used in this situation as it offers the flexibility to minimize any interaction that might be present.
Accuracy of various techniques in the measurement of the duration of the q wave: A possible source of error in diagnosing myocardial infarction by electrocardiography
Authors: Mazzoleni A. , Demaria A. N.
Published: February 2009

The method of measuring the width of the Q wave on electrocardiogram is one of the variables contributing to conflicting findings regarding the accuracy of the ECG in the diagnosis of myocardial infarction. This study assesses the accuracy of a variety of methods of measuring the width of the Q wave recorded by direct‐writing electrocardiographic instruments. The assessment was made by comparing the width of the Q wave as inscribed by thermal direct‐writing electrocardiographs to the width of the Q wave as measured from an oscilloscopic display, the latter representing the “true” width of the Q wave. The measurement of the width as obtained from the upper edge of the tracing obtained with direct‐writing electrocardiographs underestimated the true width of the Q wave, while the opposite was the case by measuring the width along the lower edge of the tracing. The most reliable ways to obtain the true width of the Q wave are: (1) to average the measurements as obtained along the upper and lower edge, (2) to measure the width along an ideal line in the middle of the tracing, or (3) to measure the width along the trailing edge of the deflection.
Proximal left anterior descending coronary heart disease and complex ventricular arrhythmias
Authors: Koenig W. , Schinz A. , Hofmann H.
Published: February 2009

In this study, 87 consecutive patients with angiographically proven coronary artery disease (CAD, stenosis >75%) underwent 24‐h Holter monitoring, 76 of them having had transmural myocardial infarction, a mean of five months before evaluation. Of the total, 51 patients showed single‐vessel disease, in 31 (61%) of them with involvement of the left anterior descending (LAD) artery. In 26 patients with proximal LAD stenosis or occlusion and usually large aneurysms and subsequently impaired left ventricular function relatively low prevalence of significant ventricular premature contraction (VPC, Lown (III) was seen. On the contrary in 19 patients with multivessel disease and proximal LAD stenosis advanced forms of VPCs were present in 63% (p<0.01). Further both groups differed significantly in the frequency of postinfarction angina (30% vs. 100%; p<0.001) and their incidence in positive exercise stress tests (15% vs. 84%; p<0.001). Ejection fractions were comparable in both groups (mean 45% vs. 52%). Finally 17 patients with multivessel disease but without proximal LAD lesion did not differ in any of the above mentioned parameters, when compared to the patients with single‐vessel disease and proximal LAD stenosis. We conclude that impaired left ventricular function does not sufficiently explain the high risk of sudden death in postmyocardial infarction patients. The coronary and functional status of the surviving myocardium has to be taken into consideration as well.
Acute effects of alcohol on left ventricular dynamics during isometric exercise in normal subjects
Authors: Kupari M. , HeikkilÄ J. , Ylikahri R.
Published: February 2009

The aim of this study was to assess whether drinking social amounts of alcohol impairs myocardial contractility in normal humans. To that end, 17 healthy volunteers performed isometric handgrip exercise before and 60 minutes after an intake of 1 g/kg body weight of ethanol within 60 minutes. Left ventricular M‐mode echocardiogram, systolic time intervals, and sphygmomanometric arterial blood pressure were recorded before and at the end of 4‐min handgrip at 30% of maximum voluntary contraction. The blood ethanol concentration (mean±SD) was 24.4±2.0 mmol/liter. At rest, ethanol increased heart rate (p>0.05) and decreased left ventricular end‐diastolic diameter (p>0.05), end‐systolic diameter (p>0.01), and circumferential systolic wall stress (p>0.05). The indices of left ventricular performance were unchanged except for the maximum circumferential fiber shortening velocity which was increased after ethanol (p>0.001). The cardiac response to isometric exercise was similar before and after ethanol except that the handgrip‐induced rise in systolic wall stress was smaller postingestion (p>0.05). This study does not support the view that drinking small to moderate amounts of alcohol brings about myocardial depression in normal humans. Although preload, afterload, and heart rate were altered by ethanol at rest>d>Myocardial contractility was not impaired even during the afterload stress imposed by isometric exercise.
Fully automated ambulatory blood pressure in the diagnosis and therapy of hypertension
Authors: Corsi V. , GermanÓ G. , Appolloni A. , Ciavarella M. , De ZORZI A. , Calcagnini G.
Published: February 2009

Technical characteristics of a fully automatic apparatus* for ambulatory semicontinuous blood pressure monitoring are described. Initially, we ascertained the reliability and the fidelity in the reproduction of studied events (blood pressure, heart rate, ECG). Good results were obtained, even in comparison with other methods (blood pressure semiautomatic or invasive monitoring). We then studied the results of the research on 200 hypertensive subjects. The easy applicability of this method allowed us to demonstrate blood pressure variability over a 24‐h patient period. We now can evaluate the factors contributing to blood pressure variability and the alterations contributing to the meaning of circadian rhythm. We are now able to comment on the prevalent incidence of organic or neurogenic components in single hypertensive states, the possible coexistence of asymptomatic coronary heart disease, and on the choice and efficacy of hypotensive drugs.
Simultaneous assessment of segmental and global left ventricular function by two‐dimensional echocardiography in acute myocardial infarction
Authors: Charuzi Y. , Davidson R. M. , Barrett M. J. , Beeder C , Marshall L. A. , Loh I. K. , Prause J. A. , Meerbaum S. , Corday E.
Published: February 2009

Both segmental and global left ventricular performance were assessed simultaneously in 29 patients with acute myocardial infarction using two‐dimensional echocardiography. Comparisons were made between left ventricular wall motion versus peak CK‐MB, site of infarction, and occurrence of heart failure. Two‐dimensional echocardiography identified areas of dyssynergy which corresponded to electrocardiographic areas of infarction in 89% of all cases. Patients with heart failure had more dyssynergic segments, and these segments manifested more severe dyssynergy than patients without heart failure. Patients with severe global dysfunction manifested higher peak CK‐MB values, and those with anterior infarction had more global dyssynergy than did those patients with inferior infarction.

These observations suggest that two‐dimensional echocardiography is a useful technique for localization and assessment of segmental and global dyssynergy in acute myocardial infarction. Information so derived correlates with the clinical status of patients with acute myocardial infarction, and may offer important insights into both prognosis and treatment.
Mechanism of reduced cardiac stroke volume at high altitude
Authors: Alexander J. K. , Grover R. F.
Published: February 2009

Two postulates have been advanced to account for reduced stroke at high altitude: (1) diminished venous return secondary to contracted plasma volume and (2) left ventricular (LV) dysfunction secondary to hypoxia. To test these hypotheses, we assessed LV dimensions and contractility indices by M‐mode echocardiography and systolic time intervals in 11 young men at sealevel and serially for 10 days at 3100 m altitude. Mean LV end‐diastolic dimension fell 16% after 6‐8 days, with a 20% decrease in plasma volume reflected by hematocrit rise. Pre‐ejection period to LV ejection time (PEP/LVET) ratio was increased after 1‐2 days. All indices of contractility were unchanged at rest, and slightly enhanced during exercise. Thus stroke volume falls and PEP/LVET ratio rises at 3100 m because of diminished venous return despite preservation of LV systolic performance.
Ventricular tachycardia: Newer insights
Authors: Schwartz A. B. , Scheinman M. M.
Published: February 2009

Electrophysiology has provided insights into our understanding of ventricular tachycardia. The techniques of electrophysiology which were useful as a research tool have only recently come to be appreciated in clinical practice. As a result, we have expanded our knowledge of the mechanisms of ventricular arrhythmias; we can distinguish among tachycardias masquerading as ventricular tachycardia; we can predict the response to drug and pacemaker treatment, and we can select out those who require surgical management.
The value and limitation of radionuclide angiocardiography with stress in women
Authors: Greenberg P. S. , Berge R. D. , Johnson K. D. , Ellestad M. H. , Ilijas E. , Hayes M.
Published: February 2009

The radionuclide angiograms (RNA) with exercise of 64 females were reviewed. There were 30 patients with coronary artery disease, 5 normal controls, 6 patients with normal coronary arteries and hemodynamics, and 23 patients with cardiomyopathy (left ventricular end‐diastolic pressure ⩾15 or ⩾18 pre‐ and postangiogram). In the coronary artery disease group, 12 of the 30 (40%) had ST‐segment depression and another 12 (40%) had a wall motion abnormality with exercise. In the cardiomyopathy group, 8 of the 23 (35%) had ST‐segment depression, and (26%) developed wall motion abnormality with exercise. In the normal coronary group, 2 of the 6 (33%) had a positive ST‐segment response, and none had a wall motion abnormality with exercise. The ejection fraction (EF) response with exercise in the normal coronary group was 65.4‐72% (p<0.02), in the coronary artery disease group 59.1‐56.2% (p<0.025), and in the cardiomyopathy group 62‐58.8% (p<0.03). If °EF⩾5 units with exercise was the normal response, then 5 of 11 (45%) normals were misclassified. If °EF>0 was a normal response, then the specificity was 10 of 11 (91%) for normals or 5 of 6 (83%) for the normal coronary group at angiography. The sensitivity for coronary artery disease was 23 of 30 (77%) and 17 of 23 (74%) for cardiomyopathy. Of the cardiomyopathy patients 3 of 4 (75%) had a positive TL‐201 scan with exercise consistent with reversible ischemia. In summary, many females with chest pain have abnormal hemodynamics despite normal coronary arteries. Use of °EF>0 as the criteria for a normal response to exercise is more specific than °EF⩾5 with exercise for separating normals from abnormals. A wall motion abnormality that develops with exercise can be seen with cardiomyopathy or with coronary artery disease in females. The radionuclide angiographic studies with exercise can separate normal from abnormal, but not cardiomyopathy from coronary artery disease. The positive TL‐201 response with exercise in the cardiomyopathy group would suggest that a regional process could be present and only cardiac catheterization can separate cardiomyopathy from coronary artery disease.
Exercise two‐dimensional echocardiography: A technique for improving ultrasound images during exercise stress
Authors: Simard M. , Heng M. K. , Udhoji V. N. , Weber L.
Published: February 2009

A system of exercise stress echocardiography was developed in which, during exercise on a bicycle ergometer in a semirecumbent position, the echocardiographic transducer is held by a special device which maintains a relatively constant position between the transducer and the heart. The system was evaluated in 21 healthy subjects and technically satisfactory studies were obtained in 20. In these, the resolution and relative position of the cardiac image remained stable throughout exercise. Blood pressure and heart rate increased appropriately with our protocol with supine exercise; 95% of the subjects reached 90% of their predicted maximum heart rate for age. Ejection fraction measured by echocardiography increased from 54±1% to 70±1%. It is concluded that the use of our transducer‐holding device in subjects performing exercise in the supine position significantly improves ultrasonic image quality and should enhance the clinical usefulness of exercise stress echocardiography.
Report: Association of coronary artery disease and valvular heart disease in chile
Authors: Marchant E. , Pichard A. , Casanegra P.
Published: February 2009

This study analyzes the prevalence of coronary artery disease (CAD) among patients with rheumatic valvular heart disease (VHD) in Chile. Coronary angiography was performed in all patients referred to cardiac catheterization with VHD who were over age 50 years and who had angina or ECG signs of ischemia. A total of 100 patients entered the study. Significant CAD (greater than 50% obstruction) was found in 14% of the cases: 7% in patients with mitral valve disease (MVD), 18% in aortic valve disease (AVD), and 21% in combined mitral and aortic valve disease (MAVD). Angina was present in 14% of the patients with MVD, 63% with AVD, and 53% with MAVD. Only 57% of patients with CAD had angina pectoris; 20% with angina had CAD. Hemodynamic parameters and left ventricular ejection fraction were not correlated with the presence or absence of CAD. We conclude that in patients with valvular heart disease, the incidence of CAD is lower in Chile than previously reported in the English literature. We confirmed the fact that angina is often not associated with CAD, and that CAD is often present in the absence of angina.
Early and late morphologic changes in human coronary arteries after percutaneous transluminal coronary angioplasty
Authors: Waller B. F.
Published: February 2009

Certain clinical and morphologic observations are described in 6 men who had percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) or right (R) coronary artery early (4 hours to 7 days) or late (80, 90, and 150 days) before coronary endarterectomy and aortocoronary bypass grafting or death. Histologically, each of the 3 early patients had the site of PTCA narrowed 76–95% in cross‐sectional area by atherosclerotic plaque, and each had either coronary dissection or plaque hematoma or both at the site of PTCA. Each of the 3 late patients had a decrease in the mean trans‐stenotic coronary gradient (17, 38, and 43 mmHg, respectively) and an angiographic increase in the LAD luminal diameter (55, 60, and 65%, respectively) at the time of PTCA. At necropsy, 80, 90, and 150 days later, the LAD coronary artery in the area of the PTCA in each patient was narrowed 76–95% in cross‐sectional area by plaques. No cracks in plaques or other lesions which may have resulted from the PTCA procedure were identified histologically in the LAD coronary artery of any late patient.
A Double‐Blind Study of Oxprenolol Once and Twice Daily in Hypertensive Patients
Authors: Glazer N. , Friedman B. , Gerlings J. E. , Gross S. , Lowney C. , Solomon R.
Published: February 2009

In a randomized double‐blind study of 175 patients with mild‐to‐moderate hypertension, oxprenolol hydrochloride (160‐480 mg) given once daily was compared with the same drug given twice daily for efficacy, safety, and tolerability. Of these patients, 123 (58 receiving the once daily regimen and 65 receiving the twice daily regimen) were included in the analysis of efficacy. Both groups showed similar significant (p<0.01) reductions in mean blood pressure during the 6‐week titration period and for the remainder of the trial. A comparison of mean standing diastolic blood pressure and supine systolic and diastolic blood preses showed no significant difference between groups during the fixed dosage period. The number of patients reporting adverse experiences was not significantly different for the two regimens. Plasma triglycerides increased in both groups, but there were no other laboratory abnormalities related to treatment. This study shows that oxprenolol given once daily is effective, safe, and well tolerated in the treatment of mild‐to‐moderate hypertension.
Effect of calcium antagonists on cardiac performance in patients with dilatative cardiomyopathy evaluated by noninvasive methods
Authors: Maurer E. , Nicoletti R. , Brandt D. , Klein W.
Published: February 2009

We present 14 patients with dilatative cardiomyopathy, proven by hemodynamic and angiographic assessment who received in a single‐blind, randomized study, equipotent doses of the three calcium blockers: verapamil (0.1 mg/kg i.v., followed by an infusion of 0.01 mg/kg/min), nifedipin (20 mg sublingually), or diltiazem (0.2 mg/kg i.v., followed by infusion of 0.02 mg/kg/min). Before and after treatment in 8 patients systolic time intervals were recorded with an AVL‐Myocard‐Check (Q‐S2, pre‐ejection period, left ventricular ejection time, and pre‐ejection period/left ventricular ejection time) and end‐systolic and end‐diastolic diameter, fractional shortening, and circumferential fiber shortening velocity were measured by M‐mode echocardiography. In another 6 patients radionuclide ventriculography was performed before and after each treatment (ejection fraction, cardiac index). PEP/LVET increased slightly after verapamil (+15%) and decreased after nifedipin (—5%) and diltiazem (—3%), the changes being not significant. Fractional shortening and circumferential fiber shortening velocity however, decreased after verapamil (‐5%, resp. ‐15%) and increased after nifedipin (+14%, resp. +25%) and after diltiazem (+23%, resp. +16%). In the radionuclide studies ejection fraction increased after verapamil (+9%), nifedipin (+14%), and diltiazem (+13%), while cardiac index remained unchanged with verapamil and nifedipin and increased with diltiazem (+14%). In conclusion there are no significant changes in myocardial performance with the calcium blockers verapamil, nifedipin, and diltiazem. However, under verapamil there is a tendency to deterioration of myocardial performance, while it was slightly improved after nifedipin and diltiazem. Calcium antagonists may be used safely, therefore, also in patients with impaired myocardial performance.
Electrophysiological effects of quinidine alone and of the combination quinidine‐verapamil on av conduction in humans
Authors: Theisen K. , Scheininger M.
Published: February 2009

The influence of 320 mg quinidine administered intravenously (i.v.), as well as subsequent administration of 5 mg verapamil i.v. on atrioventricular conduction was studied in 8 patients during sinus rhythm and atrial stimulation with the aid of His bundle electrography. Among the electrophysiologic parameters of the atrium the sinus rate increased significantly after quinidine and again increased slightly after subsequent administration of verapamil. During sinus rhythm the PA interval was not influenced by either substance. Conversely, during atrial stimulation the STA interval increased significantly under the effect of quinidine, while verapamil had no further influence. As an indicator of conduction time in the AV node, the AH interval was decreased significantly by quinidine during sinus rhythm and atrial stimulation. This effect was significantly counteracted by the additional administration of verapamil. The HV interval as a measure of the His‐Purkinje conduction was not significantly affected. The QRS duration was increased significantly by quinidine and was not further influenced by verapamil. The QTCand QT intervals increased significantly after administration of quinidine and were again slightly, but significantly shortened by verapamil. Our investigations show that the combination of quinidine and verapamil, which has clinically been found to have a higher conversion rate than quinidine alone, is well justified from an electrophysiologic point of view and that undesirable quinidine‐related effects, such as rapid AV conduction in cases of atrial fibrillation and flutter, can be avoided by the subsequent administration of verapamil.
Value of treadmill exercise test in pre‐ and postoperative children with valvular aortic stenosis
Authors: Barton C. W. , Katz B. , Schork M. A. , Rosenthal A.
Published: February 2009

To determine the utility of graded treadmill exerise test (ETT) in estimating severity of obstruction in postoperative patients with aortic stenosis, we compared results to a nonoperated aortic stenosis group. Cardiac catheterization was performed in all patients. The interval between surgery and ETT in the postoperative group was 7.5 years (range 1.1–12.9). Mean and range values for postoperative versus nonoperative aortic stenosis groups respectively were: age 14.5 (7.9–20.8) versus 12.5 years (5.9–19.7); peak left ventricular pressure 150 (101–190) versus 144 mmHg (100–183); peak systolic ejection gradient (PSEG) 41 (15–75) versus 38 mmHg (14–80); left ventricular end‐diastolic pressure (LVEDP) 13.4 (7–20) versus 13.5 mmHg (8–20); and cardiac index 3.7 (2.4–5.6) versus 3.8 liters/min/m2 (2.6–4.9) (p for each = NS). ETT in the nonoperated patients correctly identified all those with PSEG ≥ 50 mmHg (sensitivity 100%), but specificity was 56%, (i.e., the proportion correctly identified with PSEG <50 mmHg). By contrast, sensitivity and specificity for postoperative aortic stenosis patients were 67% and 63%, respectively. Furthermore, among nonoperated aortic stenosis patients ST depression on ETT identified those with increased left ventricular end‐diastolic pressure. For LVEDP ≥ 12 mmHg, sensitivity was 75% and specificity 100%; corresponding values for postoperative aortic stenosis patients were 45% and 33%, respectively. In the nonoperated aortic stenosis group with a PSEG ≥50 mmHg, sensitivity and specificity for ETT‐induced change in systolic blood pressure of ≤30 mmHg were 100% and 56%, respectively. The data suggest that in patients with valvar aortic stenosis, ETT‐induced ST depression and systolic blood pressure change ≤30 mmHg are excellent indicators of obstruction (PSEG ≥50 mmHg) or diminished compliance (LVEDP ≥12 mmHg) in the nonoperated state but less sensitive indicators of severity in the postoperative state.
Left ventricular dysfunction in rocky mountain spotted fever
Authors: Marin‐Garcia J.
Published: February 2009

Rocky Mountain spotted fever is a serious infectious disease that continues to occur with increasing incidence in various areas of the United States. A high case‐fatality ratio (11%) persists in spite of availability of adequate chemotherapeutic agents, and the cardiac involvement may play an important role in the final outcome of some cases. To assess the effect of the disease on left ventricular function 13 patients underwent Mmode echocardiographic examination on admission to a children's hospital. Increased left ventricular dimension was found in 3 patients and decreased left ventricular shortening fraction in 9. Diminished mean velocity of circumferential fiber shortening and increased left ventricular systolic time interval ratios were found in 8 patients and increased mitral valve E point to ventricular septal separation in 9. One patient died and biventricular dilatation with diffuse myocarditis was seen at autopsy. Repeat echo examination was available in 11 patients at follow‐up (mean 5 months). Abnormal E mitral point to ventricular septal separation remained in 4 patients and decreased left ventricular shortening fraction in 2. The long‐term prognosis for this group is unknown. Myocardial involvement is frequently present in Rocky Mountain spotted fever; close monitoring and aggressive therapeutic approach are essential if the high case‐fatality ratio is to be reduced.
Continuous intracoronary nitroglycerin infusion for spasm after angioplasty
Authors: Kern K. B. , Temkin L. P. , Fenster P. E.
Published: February 2009

A patient with reversible coronary artery spasm superimposed on fixed atherosclerotic coronary disease was treated with percutaneous transluminal angioplasty. The procedure successfully dilated the atherosclerotic lesion. However, 20 minutes later, the patient developed coronary artery spasm at the angioplasty site. Sublingual nitroglycerin, sublingual nifedipine, intravenous nitroglycerin, and repeated boluses of intracoronary nitroglycerin alleviated episodes of spasm, but failed to prevent recurrence. The patient was successfully treated with a continuous intracoronary infusion of nitroglycerin. Patients with coronary artery spasm in addition to fixed obstructive coronary disease may be at higher risk for spasm after percutaneous transluminal angioplasty. Continuous intracoronary infusion of nitroglycerin may be an effective therapy for recurrent coronary artery spasm occurring in the catheterization laboratory.
Acute massive (pericardial effusive) pulmonary thromboembolism‐pulmonary embolectomy revisited
Authors: Stang J. M. , Vanaman M. E. , Magorien R. D. , Wooley C. F. , Ruff P. D. , Mcenany M. T.
Published: February 2009

The most recent patient in a 13‐year experience with 14 patients suffering massive pulmonary thromboembolism requiring pulmonary thromboembolectomy is the focus of this report. This 40‐year‐old woman not only survived life‐threatening acute hypoxemia and right heart failure, but was also found to have developed a unique transudative 700 cc pericardial effusion. Pulmonary artery pressure was 90/30 (mean 50 mmHg), accompanied by 17 mm right ventricular alternans. Systemic alternans and tamponade physiology were absent. This unusual natural model for acute right heart failure illustrates a novel mechanism for pericardial effusion physiology.
Mitral annular calcification and coarctation of aorta
Authors: Nair C. K. , Ahmed I. , Sketch M. H.
Published: February 2009

Although coarctation of the aorta is associated with various cardiac abnormalities, its association with mitral annular calcification (MAC) is not reported. We therefore report a 37‐year‐old patient with postductal coarctation of the aorta and MAC. Considered to be a degenerative process, MAC is usually seen in elderly patients. It is uncommon in patients less than 50 years old and rare before the age of 40 years. Previous studies have reported increased frequency of cardiac conduction disturbances in patients with MAC compared to age‐ and sex‐matched controls. This is in agreement with complete right bundle‐branch block noted on the electrocardiogram of our patient. Clinicopathologic correlative studies and long‐term follow‐up may determine how such conduction distrubances develop and progress.
Intravenous Labetalol for the Control of Hypertension Following Repair of Coarctation of the Aorta
Authors: Bojar R. M. , Weiner B. , Cleveland R. J.
Published: February 2009

Paradoxical hypertension is a relatively common complication of surgical repair of coarctation of the aorta. An early phase of systolic hypertension has been ascribed to elevated levels of norepinephrine. Activation of the renin‐angiotensin system from sympathetic stimulation has been implicated in a later phase of systolic and diastolic hypertension that can result in mesenteric arteritis. The use of a rapidly acting, titratable intravenous alpha‐ and beta‐adrenergic blocker, such as labetalol hydrochloride, addresses both of these neurohormonal mechanisms. in the intravenous form, it would appear to be an excellent choice for the management of early postoperative hypertension and it can be converted to the oral form in cases of persistent hypertension. We report for the first time the use of labetalol in two young patients for the control of paradoxical hypertension following coarctation repair.
Echocardiographic findings of left ventricular hypertrophy and normalization of parameters of left ventricular function in patients with previous evidence of dilated and poorly contracting left ventricle and coexisting systemic hypertension
Authors: Dall'Aglio V. , Nicolosi G. L. , Burelli C. , Zardo F. , Pavan D. , Lestuzzi C. , Zanuttini D.
Published: February 2009

We report 6 cases of dilated left ventricle with poor left ventricular function and coexisting systemic hypertension in whom left ventricular hypertrophy and normalization of left ventricular function and dimensions have been subsequently documented by M‐mode and two‐dimensional echocardiographic follow‐up studies. Four patients were in New York Heart Association functional Class IV, one in Class III, and one in Class II when first seen. Normalization of left ventricular function and dimensions and features of left ventricular hypertrophy (fractional shortening from 15.0±5.2 to 39.7±5.4, left ventricular end‐diastolic diameter from 6.6±0.6 to 4.6±0.6 cm, left ventricular end‐systolic diameter from 5.6±0.8 to 2.8±0.6 cm, left ventricular end‐diastolic radius/posterior wall thickness from 3.1±0.5 to 2.0±0.4, interventricular septum thickness from 1.2±0.3 to 1.5±0.3 cm, left atrium from 4.6±0.6 to 3.5±0.9 cm) were achieved after adequate medical treatment at the end of the follow‐up (11–39 months). It appears from this study that normalization of left ventricular dimensions and function with features of left ventricular hypertrophy can occur after adequate treatment in patients with echocardiographic findings of dilated and poorly contracting left ventricle and coexisting systemic hypertension. It is conceivable, in such cases, to classify the dilatation of the left ventricle as secondary and to suggest the hypothesis of a cause‐effect relationship between therapy and normalization of left ventricular parameters with findings of left ventricular hypertrophy. Further studies are needed to clarify this phenomenon.
Balloon valvuloplasty 1988: A review
Authors: Hill J. A. , Conti C. R.
Published: February 2009

Catheter balloon valvuloplasty is a procedure which has been applied in stenotic lesions of all four cardiac valves in the last several years. This review discusses available data regarding the mechanism of effect, risks, and clinical utility of balloon valvuloplasty as it is applied to stenotic lesions of the pulmonic, mitral and aortic valves.
Echocardiography abnormalities in chronic asymptomatic alcoholics
Authors: Cregler L. L. , Worner T. M. , Mark H.
Published: February 2009

Alcohol abuse is a frequent contributor to elevated blood pressure, but the literature is ambiguous about the role of hypertension in producing left ventricular dysfunction. Fifty asymptomatic male alcoholics admitted for detoxification were studied using echocardiograms and systolic time intervals. Alcoholics were separated into Group I (28 with hypertension) and Group II (22 without hypertension). Forty‐four patients had analyzable echocardiograms and were compared to 29 nonalcoholics. Group III consisted of 14 nonalcoholics with hypertension. Group IV consisted of 15 normotensive nonalcoholics (controls). The ejection fraction and shortening fraction were reduced in Group I (p < 0.05). Hypertensive alcoholics had increased left ventricular mass indices but less than hypertensive nonalcoholics. Left ventricular wall stress was compared to mass as an index of ventricular compensation. The wall stress to mass index for hypertensive alcoholics was 1.65 as compared to 1.43 for the controls. Alcoholics without hypertension had a wall stress to mass ratio of 1.54. Hypertensive patients had a reduced wall stress to mass ratio of 1.38 when compared to controls. These data suggest an inappropriate compensatory response to afterload. Alcohol and hypertension combined may be more harmful to left ventricular function than either disease alone.<
Serum reverse T3 and amiodarone efficacy
Authors: Haberman R. J. , Ladenson P. W. , Griffith L. S. Cameron , Veltri E. P.
Published: February 2009

The use of serum reverse T3 (rT3) levels in the assessment of amiodarone efficacy is controverstal. We prospectivly studied 10 patients with frequent ventricular ectopy and symptomatic ventricular tachycardia (VT) treated with amiodarone. Serial 24‐h Holter monitor, thyroid function studies incliding serum rT3, and 12‐lead electrocardiogram were performed on each patient at baseline, and at 1, 4, 12, and 24 weeks of oal amiodarone therapy. Serial Holter moniotors on therapy were analysed for 100% suppression of VT, 90% suppression of couplets, and 85% suppression of ventricular ectopic beats (VEBs) compared with baseline Holter, defining patient groups VT−, Co−, and VEB−, respectively. Lack of arrhythmia suppression to this degree defined groups as VT+, Co+, and VEB+. These were no statistically significnat differneces in rT3 levels between VT+ and VT− groups, Co+ and Co− groups, or the VEB+ and VEB− groups. VT suppression could not be predicted at any rT3 level. We conclude than serum rT3 is an insensive means of assessing amiodarone efficacy.
Myocardial rupture in expanded infarcts: Repair using pericardial patch
Authors: Carey J. S. , Cukingnan R. A. , Eugene J.
Published: February 2009

Myocardial rupture is found in approximately 20% of fatal infarctions, but the diagnosis is rarely made before death. Rupture occurs in “expanding” transmural infarctions. The diagnosis should be considered in any patient who develops recurrent chest pain and cardiovascular instability within the first week after infarction. Echocardiographic evidence of a dilated infarct with pericardial effusion is confirmatory. Three cases are described, and previous reports are reviewed. Because most patients have multivessel disease, we recommend pericardiocentesis and rapid cardiac catheterization. Infarctectomy may be appropriate when the edges of the lesion are obvious, but the more typical diffuse, serpiginous defects should be closed with dacron‐bolstered sutures covered with a wide autologous pericardial patch. Myocardial rupture is a treatable condition, and a high index of suspicion is necessary in order to recognize it more frequently.
A rare case of recurrent vasodepressive attacks of 2‐hours duration: Analysis of the mechanism by muscle sympathetic nerve activity recording
Authors: Yatomi A. , Iguchi A. , Uemura K. , Sakamoto N. , Iwase S. , Mano T.
Published: February 2009

Muscle sympathetic nerve activity was recorded in a 57‐year‐old male patient suffering from severe hypotensive attacks with bradycardia for 10 years. Continuous blood pressure recording demonstrated frequent drastic falls in pressure. Disappearance and reappearance of muscle sympathetic nerve activity coincided with the onset and termination of attacks. Awakening from sleep or emotional and/or cardiovascular stress seems to trigger hypotension. Cardiac pacemaker was not useful in limiting the attack, because right ventricular pacing caused abrupt falls in both blood pressure and heart rate.
Percutaneous transluminal coronary angioplasty in patients with reduced left ventricular ejection fraction: Effects on myocardial perfusion and left ventricular response to exercise
Authors: Singh A. , Chandler S. , Pears D. , Perry R. , Murray R. G. , Shiu M. F.
Published: February 2009

Many patients with coronary artery disease treated by percutaneous transluminal coronary angioplasty (PTCA) have a history of previous myocardial injury resulting in a reduced left ventricular ejection fraction (EF). The effects of successful PTCA on myocardial perfusion and left ventricular function in these patients were compared to treatment in patients with normal left ventricular EF. There were 21 patients with a normal EF (mean EF 59 2%) (Group I) and 15 patients with reduced EF (mean EF 43 1%) (Group II). Before PTCA a similar degree of reversible myocardial ischemia was present on thallium scintigraphy. At peak exercise left ventricular EF in the Group I patients decreased by 4 1 % compared to 8 1 % in Group II. At one month following succesful PTCA there was resolution of reversible myocardial ischemia in both groups. No changes in EF at rest were observed. At the same level of exercise as before PTCA the mean EF was 5 1% higher than the pretreatment value in Group I and 10 1% higher in Group II. Thus in this study reversible myocardial ischemia was associated with severe compromise in the left ventricular response to exercise which was substantially improved by PTCA.
Signal‐averaged electrocardiography and the significance of late potentials in patients with ‘idiopathic’ ventricular tachycardia: A review
Authors: Mehta D. , Camm A. J.
Published: February 2009

High‐frequency, low‐amplitude electrical activity during and in continuation with the ventricular electrogram in sinus rhythm is now accepted as an indirect marker for reentrant pathways in ventricular muscle. Because the amplitude of these signals is low, much effort has recently been directed toward finding methods of recording these noninvasively. This essentially involves averaging the electrocardiogram, amplifying it, and filtering out the low frequency and nonrepetitive signals. This review discusses the methods presently available for signal‐averaged electrocardiography and their background. The clinical application of signal‐averaged electrocardiograms in patients with or suspected to have ventricular tachycardia is summarized. Data regarding the incidence of abnormal signal‐averaged electrocardiography in patients with ‘idiopathic’ ventricular tachycardia compared with normal subjects and patients with ventricular tachycardia related to ischemic heart disease are presented.
Tocainide and metoprolol: An efficacious therapeutic combination in the treatment of premature ventricular beats
Authors: Capucci A. , Frabetti L. , Gubelli S. , Boriani G. , Magnani B. , Marchesini B. , Boschi S. , Ambrosioni E.
Published: February 2009

A double‐blind crossover study was performed in 20 patients to verify the efficacy of tocainide plus metoprolol in patients with premature ventricular contractions (PVCs) class Lown ≥2 (mean frequency ≥30/h) judged as being ‘stable’ by at least three basal 24‐h Holter ECGs with PVC variation of less than ≥ 25 %. All 20 patients were submitted to a placebo period; and all were subsequently randomized to therapy with tocainide 1800 mg/day or metoprolol 200 mg/day for 15 days and then to tocainide 1800 mg + metoprolol 200 mg/day or tocainide 1200 mg + metoprolol 200 mg/day for 15 days, followed by a crossover of the two combination treatments. At steady state in every stage we controlled for plasma levels of the drugs, a 24‐h Holter recording, and a 12‐lead ECG. A modified Lown score was evaluated together with the Lown class. Tocainide (mean plasma level 3.3±0.7 μg/ml) was efficacious in 3 of 8 patients, the modified Lown score decreased from 63±32 (placebo period) to 42±27 (p<0.01) and Lown 4B arrhythmias were abolished in 3 of 4 patients. Metoprolol (mean plasma level 97.4±89.6 ng/ml) was efficacious in 2 of 10 patients; the modified Lown score and Lown classes did not change significantly. Administration of tocainide 1200 mg + metoprolol 200 mg obtained a positive response in 9 of 12 patients, the modified Lown score decreased significantly compared with placebo (from 53±31 to 32±30, p+0.01) and Lown 4B arrhythmias were abolished in 2 of 5 cases. Tocainide 1800 mg plus metoprolol 200 mg was scarcely tolerated owing to neurologic and gastroenteric side effects, and only three patients completed this stage with no better antiarrhythmic results compared to the lower dose. in conclusion, the combination of tocainide at 1200 mg and metoprolol 200 mg is well tolerated, efficacious in a high percentage of patients, and superior to single drug therapy in patients with stable PVCs.
Cardiac manifestations of noncardiac tumors. Part II: Direct effects
Authors: Weinberg B. A. , Conces D. J. , Waller B. F.
Published: February 2009

Cardiac manifestations of secondary tumors of the heart exert their effects directly by endocardial, myocardial, epicardial or cavitary deposits (metastatic lesions); indirectly via tumor products such as carcinoma; or mediated by therapy (chemotherapy, radiation) to treat the primary neoplasm. Part II of this review summarizes certain direct effects of noncardiac tumors on the heart including superior and inferior vena cava syndromes, pulmonary artery and vein obstruction or compression, myocardial implants, and intracavitary metastases. Many of these direct effects may be noninvasively diagnosed by computed tomography, magnetic resonance imaging and/or two‐dimensional echocardiography.
The effects of adenosine on sinus node reentrant tachycardia
Authors: Griffith M. J. , Garratt C. J. , Ward D. E. , Camm A. J.
Published: February 2009

The effects of adenosine given during sinus node reentrant tachycardia were investigated in two patients. Both patients received intravenous bolus doses of 0.1 mg/kg and 0.15 mg/kg. Adenosine slowed the atrial rate in both patients and terminated the tachycardia in one. These effects of adenosine on sinus node reentrant tachycardia suggest that sinus nodal tissue (as opposed to perinodal atrial tissue) is involved in the tachycardia circuit and that these effects should be considered when adenosine is used as a diagnostic agent in narrow‐complex tachycardia.
Reduction in coronary heart disease: Clinical and anatomical considerations
Authors: Satler L. F. , Pearle D. L. , Rackley C. E.
Published: February 2009

Coronary artery bypass surgery, percutaneous transluminal coronary angioplasty and thrombolytic therapy in acute myocardial infarction have relieved symptoms, preserved myocardium, and prolonged life but have not modified the progression of atherosclerosis in the coronary arteries. In the last 10 years, however, progress has been made in establishing the cholesterol‐atherogenesis hypothesis. Epidemiologic studies have demonstrated that the higher the total plasma cholesterol and low density lipoprotein cholesterol (LDL‐C), the greater the risk that coronary artery diesase will develop. Recently, clinical trials including the Coronary Drug Project, the Lipid Research Clinics Coronary Primary Prevention Trial (LRC‐CPPT), and the Helsinki Heart Study provided evidence that lowering cholesterol reduces the frequency of fatal and nonfatal coronary events. In addition, the National Heart, Lung, and Blood Institute (NHLBI) Type II Coronary Intervention Study and the Cholesterol Lowering Atherosclerosis Study demonstrated that lowering of cholesterol was associated with a decreased incidence of progression of coronary disease, as well as with the potential for reduction in the atherosclerotic plaque. Beneficial effects of diet and lifestyle changes also have an important effect on atherosclerosis. The impact of lowering cholesterol has been limited primarily by pharmacologic programs which lower cholesterol only 10–20% and are associated with a high incidence of intolerable side effects. With the recent introduction of the HmG co‐A reductase inhibitors and their more profound effect on serum lipids, it may be possible to further promote plaque regression. The future of all these interventions, however, must still be assessed by overall mortality; studies to date have demonstrated beneficial effects on cardiovascular mortality but age‐adjusted total mortality has remained unchanged. Future management of patients with acute and chronic coronary artery disease will involve a collaboration of cardiologists, endocrinologists, and epidemiologists to coordinate screening, recognition, and treatment of this disease.
Long‐term efficacy of percutaneous transluminal angioplasty on incidence of myocardial infarction, relief of symptoms and survival
Authors: Sahni R. , Maniet A. R. , Banka V. S.
Published: February 2009

This study was conducted to determine the long‐term effects of percutaneous transluminal coronary angioplasty (PTCA) on the incidence of myocardial infarction, survival, and relief of symptoms. A total of 124 patients were included in the study and were followed for 16 to 25 months. The success rate of PTCA was 91.2% and 160 stenoses were dilated. Fifty‐nine patients had multivessel disease (MVD) and 54 had single‐vessel disease (SVD). There was no difference in survival when patients with SVD were compared with those with MVD. The cardiac survival rate for both groups was greater than 98%. Nine patients had myocardial infarction in the area of the dilated artery: 3 patients (5.5%) with SVD and 6 patients (10.1%) with MVD. Ninety‐six patients (84.9%) remained free of symptoms: 46 patients (85.2%) with SVD and 50 patients (84.7%) with MVD. These data demonstrate the long‐term efficacy of PTCA in patients with SVD and MVD with regard to control of symptom of angina, improved survival, and prevention of myocardial infarction.