bluuebunny/crossref_metadata_2025 huggingface dataset:
The acute electrophysiological effects of intravenous metoprolol
Authors: Camm A. J. , Whitmarsh V. B. , Ward D. E.
Published: February 2009

Summary: The cardiac electrophysiological effects of metoprolol were studied in ten patients (pts) aged 22–51 years undergoing intracardiac stimulation studies for paroxysmal palpitations. The following measurements were made: (1) basic sinus cycle length (SCL); (2) sinus node recovery time (SRT) following overdrive pacing; (3) atrio‐His (A‐H) and His‐ventricular (H‐V) conduction intervals during regular atrial pacing; (4) effective refractory periods of the atria (AERP), A‐V node (AVERP) and ventricular myocardium (VERP); and (5) A‐V nodal functional refractory period (AVFRP). All measurements were repeated 10–20 min after a slow bolus intravenous injection of metoprolol (0.2 mg/kg body weight). Results were analyzed by the Wilcoxon Signed Rank test. Highly significant increases in: SRT (932±166 to 1107±225 ms, p<0.001) and A‐H (72±14 to 103± 14 ms, p<0.001) were observed. There were also small increases of lesser significance in SCL (794± 160 to 898±190 ms, p<0.01), AVERP (308±46 to 341±66 ms, p<0.02), and AVFRP (376±43 to 416±59 ms, p<0.01). Metoprolol did not affect the H‐V interval, the AERP, or the VERP. These results are similar to those of other beta blockers.
PR Interval in middle‐aged men with overt and latent coronary heart disease compared to PR in angionegative and normal men of similar age
Authors: Erikssen J. , Amlie J. P. , Thaulow E. , Kjekshus J.
Published: February 2009

Summary: PR was measured prospectively in 2014 apparently healthy men ranging in age from 40 to 59 years (P subjects), and retrospectively in 652 hospitalized men with a diagnosis of coronary heart disease (CHD) (R subjects). A cardiovascular survey examination suggested CHD in 115 of the 2014 P subjects, coronary angiography of 105 of these confirmed this suspicion in 69. The following observations concerning PR were made: (1) the shortest PR was found in angiopositive P subjects, intermediate PR in 1832 normal P subjects, and PR was longest in 36 angionegative subjects. (2) PR was shortest in angiopositive P subjects with triple‐vessel disease, and longest in P subjects with single‐vessel disease. (3) PR increased with age, and an inverse association was found between PR and resting heart rate in P‐subjects. (4) In 98 of 1832 normal P subjects, all without signs or symptoms of heart disease, PR was ±0.22 s. (5) Prolonged PR was no more frequent among the 652 R subjects than among P subjects, despite significant CHD in 595, and a frequent use of drugs known to delay atrioventricular conduction. It is suggested that advanced stable clinical CHD only rarely gives rise to prolonged PR at rest, and that PR in subjects with latent CHD may have somewhat shorter PR than age counterparts without symptoms or signs of CHD. Conflicting data in the literature are probably related to differences in material and methods.
The Heart in Scleroderma: Noninvasive assessment
Authors: Montanes P. , Lawless C. , Black C. , Oakley C. M. , Hughes G.
Published: February 2009

Summary: Myocardial fibrosis is found at postmortem examination in up to 80% of patients with scleroderma, yet many such patients have an entirely normal cardiovascular examination. Isometric handgrip exercise is a useful provocative test for the detection of subclinical left ventricular abnormality. By this method 15 patients with scleroderma (American Heart Association criteria) were compared with 15 sex and age‐matched normals. Results showed that scleroderma patients had a depressed heart rate response to handgrip (p<0.05) and abnormal systolic and diastolic time intervals. They showed a decreased shortening of the ratio pre‐ejection period to ejection time (p<0.05) and a lengthening of the isovolumic relaxation time compared with the control group who steadily shortened this period (p<0.01). These findings indicate increased stiffness and impaired contractility of the left ventricle as would be caused by an underlying fibrotic process otherwise undetectable. Immunohistological studies give support to this concept. Staining with monospecific antibodies to collagens types I to V of cardiac muscle from patients who, in life, had no overt cardiac disease, showed an excess deposition of collagens type I, III, and IV. In conclusion isometric exercise may provide a noninvasive method of unmasking subclinical fibrosis of the left ventricle in scleroderma, and immunopathological studies support these findings.
Asymptomatic myocardial ischemia in patients with stable and typical angina pectoris
Authors: Cocco G. , Strozzi C. , Leishman B. , Chu D. , Rochat N. , Braun S.
Published: February 2009

The existence of transient myocardial ischemia (TMI) and the value of the serial dynamic electrocardiogram (DCG) in patients with variant or unstable angina pectoris are known. However, less information is available on the frequency and characteristics of TMI in patients with stable angina pectoris. For this study, we selected 40 patients with stable and typical angina pectoris. The presence of coronary artery disease and the ejection fraction were evaluated by means of angiocardiography. The DCG monitoring was performed with bichannel portable recorders for three 24‐h periods at 7‐day intervals. The patients were on optimal doses of beta blockers and isosorbidilate throughout the study. We detected 788 episodes of TMI in 22 of the 40 patients. The ejection fraction was poorer in the 22 patients with ST‐T changes than in the 18 without such changes. The repolarization changes were: (1) ST elevation (55 symptomatic and 87 asymptomatic episodes, (2) ST depression (138 symptomatic and 236 asymptomatic episodes, and (3) T‐wave changes (83 symptomatic and 164 asymptomatic episodes). All 22 patients with TMI presented a combination of the above changes. It appears, therefore, that ST‐T changes are more frequent in patients with stable angina pectoris than was hitherto suspected. The DCG is valuable in assessing these changes, especially when one considers that the asymptomatic episodes are almost twice as frequent as the symptomatic ones. The asymptomatic episodes lasted a mean of 1.8±1.3 min (mean±SD), while the symptomatic episodes lasted 3.8±2.7 min (p <0.02, by sign test). Heart rate was unchanged during the episodes of TMI, and did not show any significant difference between asymptomatic and symptomatic episodes. Additional investigation is necessary, however, to determine the clinical implications of these findings.
Use of end‐systolic volume changes with exercise to detect left ventricular dysfunction in patients with coronary artery disease
Authors: Greenberg P. S. , Berge R. D. , Johnson K. D. , Bible M. , Ellestad M. H. , Hayes M. , Messenger J. C.
Published: February 2009

To determine if end‐systolic volume changes (ΔESV) in response to exercise were of value in detecting left ventricular dysfunction and compare it with other presently used criteria, 41 normal subjects and 122 patients with coronary artery disease (≥70 percent cross sectional luminal narrowing) were studied. All had upright maximal bicycle stress tests using equilibrium ra‐dionuclide imaging in the left anterior oblique (LAO) projection. The sensitivity, specificity, and predictive value were determined for several criteria which included the following defined as normal responses: ΔEF≤5 absolute units, ΔEF>0, ΔESV<0, and a combination criterion of ΔEF>0 and ΔESV<0. The ΔESV criterion had a greater sensitivity than the ΔEF>0 criterion at 83% (101/122) and 66% (80/122) (p≤0.001), respectively, and was comparable to the EF≥5 criterion at 85% (104/122). The specificity of the ΔESV criterion was superior to the ΔEF≥5 criterion at 93% (38/41) and 80% (33/41) (p<0.01), respectively, and comparable to the ΔEF>0 criterion at 95% (39/41). This relationship was also apparent when those patients with infarctions were excluded. The end‐systolic volume response to stress has a high sensitivity, specificity, and predictive value for detecting left ventricular dysfunction, perhaps due to the fact that it is a measure of left ventricular contractility. The end‐systolic volume response to stress is superior in specificity to the ΔEF≥5 criterion and superior in sensitivity to the ΔEF>0 criterion. A combination of ΔEF>0 and AESV<0 appears to be a promising criterion for detecting left ventricular dysfunction.
Titrated electrical cardioversion in patients on digoxin
Authors: Ali N. , Dais K. , Banks T. , Sheikh M.
Published: February 2009

Electrical cardioversion therapy in patients on digitalis maintenance who develop arrhythmias is still controversial. Our study reports a highly successful treatment rate using cardioversion therapy in 50 patients.
Postoperative monitoring of myocardial oxygen tension: Experience in 51 coronary artery bypass patients
Authors: Wiener L. , Santamore W. P. , Venkataswamy A. , Plzak L. , Templeton J.
Published: February 2009

Following a preliminary feasibility report, polarographic monitoring of myocardial tissue O2 tension (PmO2) in 51 coronary bypass patients has been accomplished. In this context, the influence of rapid atrial pacing (RAP), O2 inhalation, and intra‐aortic balloon assistance (IAB) was statistically analyzed using Wilcoxon sign‐rank and Student's t‐tests. Electrodes were implanted in revascularized and nonrevascularized areas for comparison (24.0 ± 1.1; and 26.3 ± 1.8 mmHg PmO2, p, not significant). Increasing myocardial O2 demand with RAP caused a 6% PmO2 drop (p<0.01). A 70% O2 inhalation increased Pmo2 by 30% (p<0.01). In 5 cases the benefit of IAB was confirmed by a 41% increase in Pmo2 (p = 0.02). These data support the clinical usefulness of polarographic PmO2 as a measure of regional myocardial oxygenation. In addition to early recognition of intraoperative or postoperative graft failure previously reported, the efficacy of various therapeutic interventions can be more precisely determined.
Ambulatory blood pressure monitoring in diabetic males: A method for detecting blood pressure elevations undisclosed by conventional methods
Authors: Rubler S. , Abenavoli T. , Greenblatt H. A. , Dixon J. F. , Cieslik C. J.
Published: February 2009

Twenty‐one diabetic males, ages 20 to 61 years (mean 48.4±10.5) and 14 healthy males, 22 to 59 years (mean 42.5±10.4) consented to participate in a study during which 24‐h recordings of systolic and diastolic blood pressures, heart rates, and rhythm were obtained. The diabetic subjects were considered nor‐motensive except for two patients, who had been observed to have rare insignificant elevations in blood pressure and were untreated. Diabetic subjects had a higher mean maximal systolic blood pressure (160.7±49.8 mmHg) than the normal controls (132.4±12.1 mmHg) (p<0.05). They also had a higher frequency (15.1%) of systolic blood pressure readings ≥ 150 mmHg compared to normal men (0.2%) (p<0.01). The frequency of diastolic blood pressure readings ≥90 mmHg was 22.1% in the former and 9.2% in the latter group (p<0.01). Of 21 diabetic males, 14 (66.7%) had systolic pressures ≥ 150 mmHg, diastolic pressures ≥100 mmHg, or both. In the normal men, 3 (21.4%) of the 14 had such pressures. Twenty‐four hour monitoring of ambulatory blood pressures revealed elevations not detected by routine casual readings in patients with diabetes.
Radionuclide ventriculographic findings in pericardial effusion
Authors: Hakki A‐H. , Iskandrian A. S. , Mintz G. S.
Published: February 2009

We present a patient with a large pericardial effusion, in whom the first‐pass radionuclide ventricu‐logram demonstrated rocking motion of the left ventricle and apparent asynergy of the inferior wall. These abnormalities disappeared after removal of the fluid. Inspection of the cinematic display of the images was useful in explaining the apparent asynergy of the inferior wall.
A new formula for the measurement of diastolic mitral valve orifice area
Authors: Morise A. P.
Published: February 2009

This study evaluated the accuracy of a new formula for the calculation of mitral valve area. Fifty‐two patients with mitral stenosis who underwent cardiac catheterization were evaluated by the standard Gorlin and the new formulas. The correlation between the two formulas was excellent (r = 0.89) for valve areas of 0–1.5 cm2. When the new valve area formula yielded an area greater than 1.5 cm2, there was no correlation with the Gorlin formula. However, the likelihood of the Gorlin mitral valve area being less than 1.0 cm2 was low (10%). The results of the new formula do not appear to be affected by atrial fibrillation and are probably subject to the same limitations when used in the presence of a regurgitant lesion. Therefore, with moderate to severe mitral stenosis, this new formula shows a good correlation. However, with mild stenosis, further work is needed to determine the accuracy and limitations of the new formula.
The influence of heart rate on echocardiographic assessment of aerobic training
Authors: Conrad J. A. , Nagle F. J. , Corliss R. J.
Published: February 2009

The purpose of this investigation was to determine if echocardiographic measures of ventricular structure and function ascribed to aerobic training might be an artifact of heart rate (HR) differences between trained and untrained subjects. Comparisons were made at rest, of 10 young, male, aerobically well‐trained athletes [((VO2)max 65>ml/kg/min] and 10 young, healthy controls [((VO2)max<56ml/kg/min]. Additionally, the echocardiographic responses to low (HR=80 beats/min) and moderate intensity (HR=120 beats/min) supine cycling exercise were analyzed. Echocardiographic measures were made as described by Sahnet al. (1978). Results of echocardiographic comparisons between groups, both during supine rest and at a constant heart rate of 80 beats/min during supine cycling confirmed that athletes had significantly greater left ventricular mass (LV mass) and end‐diastolic size per square meter of body surface area (p<0.05). When supine cycling loads were increased to elevate HR to 120 beats/min in groups of 7 athletes and 5 controls, athletes exhibited a progressive and significant (p<0.05) enlargement of left ventricular end‐diastolic size (LVEDS), while left ventricular end‐systolic size (LVESS) showed negligible change. The control group showed little change in LVEDS, but decreased LVESS significantly (p<0.05). Contractility measures, i.e., estimated ejection fraction (EF) and velocity of circumferential shortening ( (Vcf) increased in both groups in a similar manner. It was concluded that echocardiographic differences in ventricular structure and function observed between aerobically trained and untrained subjects are not an artifact of heart rate differences. Clearly, aerobic training results in increased LV mass and diastolic size which allows for further dilitation with supine exercise. Aerobic training does not appear to alter indices of myocardial contractility.
Coronary paraganglioma
Authors: Levi B. , Cain A. S. , Dorzab W. E.
Published: February 2009

The clinical, angiographic, and anatomical features of an uncommon primary cardiac tumor, a paraganglioma, are presented. The angiographic appearance appears unique. These tumors are slow growing and troublesome primarily because of their firm adherence to underlying cardiac structures. Treatment is complete surgical excision.
Total coronary occlusion in chronic coronary artery disease
Authors: Buda A. J. , Dubbin J. D. , Orr S. A.
Published: February 2009

The hemodynamic consequence of chronic total occlusion of a coronary artery and the association of collaterals has not been well established. To examine this, 75 patients with at least one total occlusion of a major coronary artery were identified from among 267 patients undergoing selective coronary angiography. There was evidence of previous myocardial infarction in 49 (65%) of these patients. There was no intergroup (myocardial infarction versus no infarct) difference in terms of age, chronicity of angina prior to or stability of angina at selective coronary angiography, the number and distribution of total occlusions, or the extent of coronary disease. Furthermore, there was a high prevalence of angiographically demonstrated collaterals in both myocardial infarction and noninfarct patients (96% versus 98%). However, significantly greater left ventricular dysfunction, as determined by larger end‐diastolic and end‐systolic volumes (p<0.001), higher left ventricular end‐diastolic pressure (p<0.05), and lower ejection fraction (p<0.001) was found in the myocardial infarct group. We conclude that total occlusion of the major coronary artery occurs commonly in patients with chronic coronary disease, but is associated with myocardial infarction in only 65%. The presence of collaterals, the distribution of occlusion, and the extent of associated coronary disease do not distinguish patients with and without myocardial infarction. This suggests that the temporal course of oclusion and collateral development is a more important factor in the pathogenesis of iinfarction and its hemodynamic consequences.
Noninvasive markers of intravenous streptokinase coronary thrombolysis
Authors: Udall J. A.
Published: February 2009

Early creatine kinase (CK) enzyme peaking, rapid electrocardiographic (EKG) changes toward normal, reperfusion arrhythmias, pain disappearance, and201 thallium myocardial scintigraphy appear useful to identify the success or failure of intravenous (i.v.) thrombolytic therapy in patients with acute myocardial infarction (AMI). Most patients with AMI are treated currently in community hospitals which do not possess coronary angiographic capabilities. Recent evidence indicates that early intravenous Streptokinase results in coronary thrombolysis in the majority of patients treated. A composite of noninvasive markers of coronary reperfusion was assessed in two similar patients with transmural AMI. One received intravenous streptokinase (STK) 750,000 U 90 min after AMI onset; the other received intracoronary (i.c.) STK 4000 U/min 140 min after onset. Within one hour each showed a sudden change in elevated EKG ST segments toward normal, followed by frequent premature ventricular beats and pain disappearance. Posttreatment angiograms documented recanalization of each infarct‐related artery. Early CK peaking occurred at 10 hours after the onset of chest pain in the first patient and at 12 hours in the second. This contrasts with delayed CK peaking at 26.4 hours among 384 patients reviewed with untreated AMI. Early CK peaking appears the most accurate indirect marker of successful coronary thrombolysis.
Echocardiographic identification of prolapsing leaflet of a malfunctioning aortic porcine xenograft
Authors: Nicholson W. J. , Gracey J. G. , Martin C. E.
Published: February 2009

A patient with a Hancock aortic bioprosthetic valve presented with congestive heart failure and a murmur. M‐Mode and two‐dimensional echocardiography clearly delineated the diagnosis of prosthetic valve dysfunction with severe aortic regurgitation. Echocar‐diography can be a helpful technique in the diagnosis of prosthetic dysfunction. significant in children and in young adults (Ferrans et al., 1980). Prompt diagnosis of prosthetic dysfunction is extremely important in this group of patients so that corrective measures can be taken. M‐mode and two‐dimensional echocardiography promptly and accurately delineated the type of dysfunction present in this case of aortic porcine bioprosthesis malfunction.
Effect of metoprolol on cardiac and pulmonary function in chronic obstructive pulmonary disease
Authors: Fenster P. E. , Hasan F. M. , Abraham T. , Woolfenden J.
Published: February 2009

We evaluated the effects of oral metoprolol, 200 mg daily, on cardiac and pulmonary function in 6 patients with chronic reversible airways obstruction and no cardiac dysfunction. The patients were clinically stable. In all patients, baseline forced expiratory volume in 1 second (FEV1) was less than 60% predicted, and increased at least 15% after isoproterenol inhalation. Resting control first pass right and left ventricular radionuclide ejection fractions were normal or only slightly depressed. Compared to placebo Metoprolol did not significantly affect FEV1 or forced vital capacity. Metoprolol did not significantly alter left or right ventricular ejection fraction Measured by first pass radionuclide technique. One patient experienced increased dyspnea on metoprolol, which was not accompanied by changes in clinical exam, spirometry, or ejection fraction. We conclude that metoprolol may be safely administered to a subset of stable patients with chronic reactive airways disease.
Unusual cardiovascular manifestations in a case of pheochromocytoma
Authors: Sheikhzadeh A. , Fatourechi V. , Paydar D. , Nazarian I.
Published: February 2009

A case of proven pheochromocytoma is reported of a patient who presented with attacks of apparent hypotension, pulmonary edema, and myocardial injury with typical ECG and enzyme change. In spite of unmeasurably low peripheral blood pressure recordings during the attack, central aortic pressure was well above 240/140 mmHg. A clinical shocklike state was in effect due to severe arterial vasoconstriction. The pulmonary artery pressure was 48/26 mmHg during attacks, wedge pressure was 26 mmHg, and cardiac index 1.8 liters/min/m2. The coronary angiogram showed abnormal pooling of dye in the myocardial capillary network. It is concluded that: (1) Apparent hypotensive episodes in pheochromocytoma may be misleading and central arterial measurements may be needed to demonstrate the hypertensive crisis. (2) The abnormal coronary angiogram in our patient may be due to myocardial necrosis and damage to the intact arteriolar and microvascular system of the myocardium.
A comparison of conventional contrast ventriculography and digital subtraction ventriculography
Authors: Felix R. , Eichstädt H. , Kempter H. , Kewitz A. , Banzer D. , Schmutzler H. , Marhoff P.
Published: February 2009

We studied 46 patients with a history of transmural myocardial infarction or angiographic evidence of coronary artery stenosis with both conventional contrast ventriculography and digital subtraction ventriculography from May to September 1982. Urografin 76®, 30 ml, was administered at a flow rate of 18 ml/s, by means of a catheter in the superior vena cava during digital subtraction ventriculography (DSV). Results of the latter were compared with conventional contrast ventriculograms. The correlation coefficient was r = 0.938 (p<0.001) for determination of ejection fraction with both methods. The data in individual cases suggest that DSV is more sensitive than conventional contrast ventriculography in determination of severely reduced ejection fractions. The methods are practically identical in qualitative evaluation of disorders of regional wall motion in the anterolateral region, while DSV is more sensitive than conventional ventriculography in evaluating the apical region. Sensitivity was 85.7% when the two methods were compared in evaluation of the inferior region of the left ventricle. Both methods are identical in demonstration of severely deformed ventricles. Digital subtraction ventriculography may replace conventional contrast ventriculography in some of the situations discussed above.
The use of the hepatic pressure maneuver to identify the murmur of tricuspid regurgitation
Authors: Gooch A. S. , Cha S. D. , Maranhao V.
Published: February 2009

To enhance the bedside diagnosis of tricuspid regurgitation, the influence of manual pressure applied below the liver on lower left sternal border murmurs was determined in 23 patients. All 23 subjects had right ventriculograms and right atrial phonocardiograms. The sign was positive in 13 cases, including 3 who were without a Carvallo sign. The application of manual pressure below the liver is a simple and valid additional maneuver for identifying the murmur of tricuspid regurgitation.
Detection of diastolic left ventricular function abnormalities in patients with coronary artery disease and normal systolic function
Authors: Schabelman S. E. , Schabelman F. , Brundage B. H. , Willis W. H.
Published: February 2009

We angiographically calculated left ventricular (LV) filling in 50 patients, all of whom had normal systolic LV function and 21 (42%) of whom had coronary artery disease. Five volume determinations were made: at end systole (ESV), first third (DV 1/3, half (DV 1/2), and second third of diastole (DV 2/3), and at the end of diastole (EDV). To assess different modalities of filling, we calculated filling fractions in the first third (FF 1/3) as the ratio of volume filled in the first third diastole (DV 1/3‐ESV) over total diastolic filling (EDV‐ESV). Similar filling fractions (FF) were calculated at half (FF 1 /2), second third (FF 2/3), and last third (FF 3/3) of diastole. We found significant differences between normal and coronary artery disease patients as follows: FF 1/3: 37.4± 14.9 versus 23.8±11.9%, respectively (p<0.002); FF 1/2: 58.6±14.7 versus 45.3±15.1% (p<0.005); FF 2/3: 33.8±15.2 versus 39.0±10.4% (NS), and differences in the opposite direction in the FF 3/3: 28.8± 15.2 versus 37.2±11.9% (p<0.02), respectively. We conclude that LV filling is accomplished differently in patients with coronary artery disease even if they have normal systolic function.
The mechanism of mitral regurgitation in dilated left ventricle
Authors: Ballester M. , Jajoo J. , Rees S. , Rickardsm A. , Mcdonald L.
Published: February 2009

To assess the mechanism of mitral regurgitation in ventricular dilatation, 24 patients with dilated cardiomyopathy (13 with and 11 without mitral regurgitation) and 10 normal individuals were studied by two‐dimensional echocardiography. Left ventricular dimensions and mitral ring diameters in systole and diastole were measured in the long‐axis section, and systolic interpapillary muscle distance in the short‐axis section. The results showed: (1) Mitral ring diameter is increased in most patients with dilated cardiomyopathy. (2) Neither increased ring diameter, reduced ring contraction, nor decreased interpapillary muscle distance determine the presence of mitral regurgitation. (3) The only difference between those patients with and without mitral regurgitation was the degree of left ventricular dilatation (p<0.05).
Continuous electrocardiographic monitoring in patients with sickle‐cell anemia during pain crisis
Authors: Maisel A. , Friedman H. , Flint L. , Koshy M. , Prabhu R.
Published: February 2009

Electrocardiographic studies in patients with sickle‐cell anemia have been performed during the normal resting state with routine twelve‐lead ECGs. We studied 30 patients with sickle‐cell disease in acute crisis with 24‐hour continuous electrocardiographic monitoring. The standard ECG demonstrated a high incidence of abnormalities, but only three patients had arrhythmias. These findings contrasted sharply with the results of continuous monitoring, during which arrhythmias were detected in 24 of 30 patients. They were fairly evenly split between atrial (60%) and ventricular (67%). Nine of the patients had “complex arrhythmias” including two with episodes of ventricular tachycardia. Seventeen patients subsequently underwent equilibrium gated‐blood pool scans. Eight patients had abnormal contractility and tended to have more arrhythmias on monitoring than those with normal contractility. Thus, continuous electrocardiographic monitoring of sickle‐cell patients during crisis revealed a higher incidence of arrhythmias than previously thought.
Effects of laser irradiation on human erythrocytes: Considerations concerning clinical laser angioplasty
Authors: Theis J. H. , Ikeda R. M. , Stobbe D. , Ogata C , Lui H. , Mason D. T. , Lee G.
Published: February 2009

Recent studies demonstrate the potential use of laser to vaporize human coronary atherosclerotic plaques. The laser energy is transmitted through flexible quartz fiber and discharged intravascularly. Since red blood cells could be exposed to intense heat, we examined effects of laser irradiation on human erythrocytes. Blood was obtained and placed in 5 ethylene diaminetetracidic acid (EDTA) vials for each normal donor. A flexible 400 diameter core quartz fiber coupled to an argon‐ion laser source was positioned 1 cm above the surface of 1.5 ml blood. Four vials were exposed to 5 W laser beam for 5, 10, 15, or 20 s; the remaining vial was left untreated. Packed cell volume fell primarily during the first 5 s of laser exposure (p<0.01) and plateaued beyond 5 s. Plasma hemoglobin (Hgb) rose progressively with each increased duration of exposure (p<0.01). This study indicates that lysis of erythrocytes occurs in cells exposed directly to the laser beam. However, beyond the direct beam, damage to red cell membrane took place as evident by progressive Hgb leakage into plasma despite no further cell lysis. These observations require consideration during clinical laser angioplasty.
The time course in acute myocardial infarction evaluated with precordial mapping and standard ecg
Authors: Herlitz J. , Hjalmarsson Å , Waagstein F. , Waldenström A. , Swedberg K.
Published: February 2009

Fifty‐six patients with acute transmural anterior wall myocardial infarction (MI) were investigated with a 24‐electrode grid and 34 patients with an acute transmural inferior wall MI were investigated with standard ECG leads II, III, and a VF in order to study the length of time after the onset of pain during which the development of Q waves and reduction of R waves progress. These ECG changes continued for 18‐26 h after onset of pain but the majority appeared during the first 12 h.
Atrial septal defect in adult identical twins: A variation in theme
Authors: Macdonald I. L. , Mcmurtry T. J. , Dodek A.
Published: February 2009

The diagnosis of atrial septal defect was established in monozygotic twin females at age 63. Each patient mimicked a different acquired heart disease. One twin had congestive heart failure and atrial fibrillation and was diagnosed as having rheumatic mitral insufficiency. The other twin had atypical chest pain and systemic hypertension and was thought to have arteriosclerotic heart disease. In each case the correct diagnosis was made at cardiac catheterization. Although the same basic congenital heart lesion was present in both patients, the symptoms and findings differed. Symptomatic improvement was achieved by different therapeutic modalities. One patient had open heart surgery, while the other twin improved with medical therapy.
The modern diagnosis of cardiac myxoma: Role of two‐dimensional echocardiography
Authors: Mcgarry K. M. , Jugdutt B. I. , Rossall R. E.
Published: February 2009

We reviewed our experience with the diagnosis of cardiac myxoma in 10 patients seen between 1960 and 1981. At surgery, large myxomas (>5 cm) were found in the left atrium in 6 patients, right atrium in 3, and right ventricle in 1. The correct preoperative diagnosis was made in 9 patients: clinically in 3 and at catheterization and angiocardiography in 6. Diagnoses were falsely negative in 3/13 (23%) catheterizations and 2/10 (20%) angiocardiograms. Echocardiography (echo) was positive in 5/5 (100%). Gated blood‐pool scans confirmed a right atrial myxoma in 1 patient. The interval between onset of symptoms and surgery was 30.5 months, (range, 2‐120) and was not significantly different in the eras before and after echo. The age at diagnosis exceeded 40 years in 9 patients and was not significantly less in the echo era. The size and site of the tumor at surgery agreed with findings on M‐mode echo (n=5) or two‐dimensional (2‐D) echo (n=2), but the size (85 vs. 88 cm3) and mass (81 vs. 88 g) of the tumors were similar in the 2 eras. Although 2‐D echo facilitates the preoperative diagnosis of cardiac myxoma, earlier patient referral of suspicious cases for 2‐D echo is still necessary.
Correction of intraoperative diastolic myocardial dysfunction with nifedipine
Authors: Lee T. H. , Lilly L. S. , Antman E. M. , Disesa V. J. , Cohn L. H.
Published: February 2009

We report the case of a 62‐year‐old man with severe aortic stenosis and hypertrophic cardiomyopathy, who could not be weaned from cardiopulmonary bypass after aortic valve replacement until buccal administration of the calcium‐blocking agent nifedipine led to achievement of adequate hemodynamics. These observations demonstrate the importance of diastolic dysfunction in patients with hypertrophic cardiomyopathy, and suggest an important peri‐ and intraoperative role for calcium‐blocking agents in their management.
M‐mode and two‐dimensional contrast echocardiography in adult patients with atrial septal defects
Authors: Grenadier E. , Alpan G. , Keidar S. , Palant A.
Published: February 2009

M‐mode and two‐dimensional echocardiographic studies, with and without contrast injection, were performed in 14 adult patients with clinical and radiological signs of atrial septal defects. Two‐dimensional contrast echocardiography was found to be the most sensitive technique, allowing a definitive diagnosis to be made noninvasively in 12 patients (86%) of those patients studied. M‐mode contrast echocardiography demonstrated an atrial shunt in 6 patients (43%). Regular two‐dimensional echocardiography produced a high proportion of false‐positive and false‐negative results, while the findings on M‐mode echocardiography are sensitive but nonspecific. All 14 patients described had the diagnosis confirmed on cardiac catheterization. Performance of the Valsalva maneuver during contrast echocardiography was found to be diagnostically unhelpful. The findings suggest that contrast echocardiography, particularly two‐dimensional, is an effective, noninvasive diagnostic technique to be applied on clinical suspicion of atrial septal defects.
Surgical treatment of ventricular septal rupture and mitral regurgitation complicating acute myocardial infarction: Report of a case and review of the literature
Authors: Gonzalez‐Lavin L. , Friedman J. P.
Published: February 2009

Coexisting ventricular septal rupture (VSR) and severe mitral regurgitation following myocardial infarction is rare; only ten cases have been documented in the English literature. Present refinements in myocardial preservation and surgical techniques have markedly improved the results of surgery in this group of desperately ill patients. Early repair of both lesions is advocated and exemplified by a case report.
Q‐T prolongation and torsades de pointes in a patient with subarachnoid hemorrhage
Authors: Hust M. H. , Nitsche K. , Hohnloser S. , BöHM B. , Just H.
Published: February 2009

An extreme Q‐T prolongation in a patient with subarachnoid hemorrhage was observed. Multiple torsades de pointes occurred. Lidocaine, metoprolol, and atropine were not effective in controlling the arrhythmia, whereas shortening the Q‐T interval by intravenous administration of orciprenaline or overdrive ventricular pacing was successful. The occurrence of T wave alternations was a sign of increased sympathetic activity.
Unloading the right ventricle in the crest syndrome variant of progressive systemic sclerosis (scleroderma)
Authors: Morrison D. , Goldman S. , Alepa F. P.
Published: February 2009

A patient with severe pulmonary hypertension secondary to the CREST syndrome variant of scleroderma is described. Acute reductions in both pulmonary artery pressure and total pulmonary resistance were seen with nifedipine and oxygen administration. Reductions in resistance were maintained for over one month with this combination. These results raise the possibility that some of the pulmonary hypertension seen in this condition is reversible.
Embolus to the right atrium simulating myxoma
Authors: Buckingham T. A. , Williams G. A. , Aker U. T. , Kennedy H. L.
Published: February 2009

A space‐occupying mass of the right atrium was found by two‐dimensional echocardiography and angiography in a 68‐year‐old woman whose clinical diagnosis indicated multiple pulmonary emboli. Since right heart myxomas frequently cause pulmonary thrombo‐embolism, the patient was initially diagnosed by noninvasive and invasive techniques as having a right atrial myxoma. Surgery, however, revealed the pathologic findings of large thrombi of the right atrium, femoral and iliac veins, and pulmonary arteries. This case vividly demonstrates that deep venous thrombosis may embolize and lodge in the right atrial cavity simulating a right atrial myxoma.
Hypertension and stress
Authors: Hudzinski L. G. , Frohlich E. D. , Holloway R. D.
Published: February 2009

This study explores the relationship of chronic stress to hypertension. The study included 127 hospitalized and 134 outpatients of a stress treatment program and 129 “normal” persons in the general population. All subjects were matched for age, sex, and race. After three days of hospitalization, there was a 17.3% incidence of hypertension in the hospitalized patients when hypertension was defined as blood pressure levels greater than 140/90 mmHg. These data compare with a 5% and 13% incidence of hypertension in the outpatient stress and “normal” groups, respectively. The National Health Survey of 1962 indicated that 18% of the population were hypertensive. Our data indicate that the incidence of hypertension was no greater in a diagnostically established group of hospitalized stress patients than in the less stressed outpatient or an otherwise “normal” group. The frequently expressed notion that tension and chronic stress predispose a population to essential hypertension is not confirmed by this analysis.
Increase in bicycloprostaglandin E2 metabolite in congestive heart failure in response to captopril
Authors: Stanek B. , Punzengruber C. , Silberbauer K.
Published: February 2009

Vasodilating prostaglandins may be increased in patients with chronic congestive heart failure (CHF) to balance out the effects of vasoconstricting forces. Significant increases in plasma levels of bicycloprostaglandin E2 metabolite (PGEm), a chemically stable degradation product of the vasodilating prostaglandin E2, were found in response to captopril (39.4±7.8 vs. 46.2±8.2 pg/ml; p<0.01). With chronic captopril treatment bicyclo‐PGEm remained elevated for 12 h after the last dose after 1 and 2 months (75.5±5.5; p<0.05 and 72.1±6.3 pg/ml; p < 0.05, respectively). Upon readministration of captopril during chronic captopril treatment the significant increase of bicyclo‐PGEm in response to captopril was sustained, as were changes in plasma renin activity, angiotensin II, and blood pressure. Plasma catecholamines were unchanged with captopril or decreased slightly, vasopressin remained moderately increased throughout. Taken together, the results suggest that vasodilating prostaglandin E2 production might play a part in captopril's beneficial action in chronic congestive heart failure.
Left ventricular tamponade: Echocardiographic and hemodynamic manifestations
Authors: Lee R. T. , Bhatia S. J. S. , Kirshenbaum J. M. , Friedman P. L.
Published: February 2009

A patient with progressive systemic sclerosis was evaluated for dyspnea. Echocardiography revealed enlarged right heart chambers, a moderate pericardial effusion, and diastolic collapse of the left ventricle. Hemodynamic studies before and after removal of pericardial fluid were consistent with compromise of left, but not right, heart filling by the pericardial fluid.
Right ventricular pacing wire thrombus presenting as pyrexia of unknown origin
Authors: Grunewald R. A. , Nihoyannopoulos P. , Playford R. J. , Levi S. , Hodgson H. J. F. , Smith P. L. C.
Published: February 2009

Pacing wire thrombosis may be invisible echocardiographically while producing severe symptoms. We report a patient whose pacing wire thrombosis presented as a pyrexial illness 5 months after its insertion. Treatment with tissue plasminogen activator provoked cardiovascular collapse; therefore, we recommend that such thrombosis be treated surgically.
Predictors of left ventricular hypertrophy in patients with essential hypertension
Authors: Glasser S. P. , Koehn D. K.
Published: February 2009

The purpose of this study was to assess clinical variables which might be predictive of echocardiographic left ventricular hypertrophy in mildly hypertensive patients. Eighteen patients (mean age 51) were studied following four weeks of hydrochlorothiazide monotherapy. Variables assessed included age, duration of hypertension, body surface area, serum cholesterol, alcohol consumption, smoking, maximum systolic and mean blood pressures, and variability of blood pressure determined from hourly measurements taken 12 hours after hydrochlorothiazide dosing. Using stepwise multiple linear regression (with left ventricular mass index analyzed as a continuous variable), the variability of blood pressure was predictive of an eleveated left ventricular mass index (p < 0.0003, r2=0.61). The duration of hypertension added significantly to the variability in predicting an elevated left ventricular mass index (p < 0.004, multiple r=0.74). In conclusion, echocardiographic left ventricular hypertrophy was significantly related to the variability of blood pressure recorded hourly for 12 h after subjects received 50 mg of hydrochlorothiazide.
Optimal management of patients with complete atrioventricular septal defect
Authors: Fox L. S.
Published: February 2009

Controversy still persists as to whether patients with complete atrioventricular septal defect should be treated by primary total correction or a two‐stage approach utilizing initial pulmonary artery banding. We believe a selected management program dictated by each individual patient's anatomy, presentation (size and preoperative functional class), and associated anomalies should be practiced, but with a strong preference toward initial total repair incorporating modern techniques to construct left and right atrioventricular valves, correct valvular incompetence, and close ventricular and atrial defects. Utilizing this management program, 23 consecutive patients (age 5 days to 51 months) with complete forms of atrioventricular septal defect were surgically corrected from July 1, 1984 through June 30, 1988. Fourteen patients were 12 months of age or less at the time of complete repair. Five patients (22%) had initial pulmonary artery banding, but only 2 were performed by us. Both had very extenuating circumstances making complete repair inappropriate. Only 2 of these 23 patients having complete repair died (hospital mortality 9%) and one had pulmonary artery banding 3 years previously. Of the 5 patients with initial pulmonary artery banding, 3 (60%) required right ventricular outflow tract reconstruction and/or repair of pulmonary artery bifurcation stenosis. We believe these good results support our continued practice of selective management of patients with complete forms of atrioventricular septal defect, but we maintain a strong preference toward initial complete repair.
Diastolic atrioventricular valve closure and regurgitation following atrial contraction: Their relation to timing of atrial contraction
Authors: Okamoto M. , Tsubokura T. , Kajiyama G. , Miyatake K. , Kinoshita N. , Sakakibara H. , Nimura Y.
Published: February 2009

Some authors have proposed that atrial contraction per se is able to close the atrioventricular (AV) valves. To determine whether tight closure of the AV valves can be accomplished solely by atrial contraction, the existence of diastolic regurgitation following atrial contraction and its relation to the PQ interval were examined in 13 patients with AV block (2 of the first degree, 4 of the second degree, and 7 of the third degree), using pulsed Doppler echocardiography, which allowed noninvasive estimation of valvular regurgitation in the physiological state. Diastolic mitral and tricuspid regurgitations were detected in the left and right atria near the respective AV valves in all 13 patients despite different degrees of AV block, while these valves were observed to be in an apparently closed position during regurgitation on the two‐dimensional and M‐mode echocardiograms. The duration of regurgitant signals was prolonged with an increase in the PQ interval in the electrocardiogram, but it became short again as the P wave approached the preceding rapid filling wave. These results suggest that atrial contraction may initiate the closure of the AV valves but is not capable of closing the valves tightly, and atrial contraction with long PQ interval may contribute little to augmentation of cardiac output in patients with AV block.
Temporary pacing catheter placement in patients requiring continuous external pacing
Authors: Tilkemeier P. , Hakim KHAN A.
Published: February 2009

Electrocardiographic features of temporary transvenous pacemaker have been discussed and have been used to guide insertion of pacemaker without fluoroscopic aid. The following is a description of the electrocardiographic features of temporary endocardial pacemaker insertion in a patient who is chronically dependent on external temporary transthoracic pacing.
The application of radionuclide ventriculography to cardiac screening
Authors: Lindsay J. , Milner M. R. , Goldstein S. A. , Chandeysson P. L. , Rodman D. J. , Okin P. M.
Published: February 2009

Screening asymptomatic individuals for latent coronary disease often requires sequential testing because exercise electrocardiography typically produces more false positive than true positive results in a population with a low prevalence of coronary disease. Cardiac scintigraphy is a technique that may be employed as a confirmatory test in lieu of coronary arteriography to further evaluate the significance of a positive exercise electrocardiogram.

Radionuclide ventriculography was employed in 98 asymptomatic individuals who were considered to be at moderate risk of heart disease after risk factor analysis and exercise electrocardiography. Seventeen (17%) patients had an abnormal study and underwent cardiac catheterization. Seven had coronary artery disease, two had cardiomyopathy, and eight were normal. Eighty‐one (83%) patients had a normal study. Because the sensitivity of radionuclide ventriculography is 63–80%, it was postulated that 2 to 5 individuals with disease were missed. Thus, from a population with an H‐14% prevalence of disease, two subsets were identified. A large subset in which a prevalence of 2–6% could be estimated was separated from a much smaller one in which a prevalence of approximately 50% was demonstrated.
Percutaneous (nonsurgical) supported angioplasty in unprotected left main disease and severe left ventricular dysfunction
Authors: Vogel J. H. K. , Ruiz C. E. , Jahnke E. J. , Mc FADDEN R. B. , Setty R. , West C. , Fink S. B. , Avolio R. , Stafford J. , Klein J. L.
Published: February 2009

A 69‐year‐old patient with the equivalent of severe, unprotected left main coronary artery disease associated with marked left ventricular dysfunction with ventricular aneurysm who had Class IV angina, underwent suppported angioplasty utilizing a total percutaneous approach. The patient tolerated occlusion of his main left coronary artery for a total of 7 minutes without difficulty, during dilatation of left anterior descending and two circumflex lesions. He was discharged the following day, symptom free.