bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonatheromatous Ischemic Heart Disease following Withdrawal from Chronic Industrial Nitroglycerin Exposure
Authors: LANGE RAMON L. , REID MICHAEL S. , TRESCH DONALD D. , KEELAN MICHAEL H. , BERNHARD VICTOR M. , COOLIDGE GEORGE
Published: June 2012

This report describes the clinical, angiographic, and hemodynamic findings in nine patients who manifested nonatheromatous ischemic heart disease induced by chronic industrial exposure to nitroglycerin and subsequent withdrawal. They represent nearly 5% incidence in the group of 200 workers with similar exposure. One patient died suddenly, and the disease was commonly without premonitory symptoms. Of the eight survivors, five were studied and none showed evidence of significant organic obstructive disease. However, in one studied during the withdrawal state, coronary and digital arteriospasm was demonstrated, and was readily reversed by nitroglycerin. Survivors exhibited exercise symptomatology and hemodynamic impairment similar to other patients with myocardial dysfunction from ischemic heart disease. Complete left bundle-branch block with late sudden death occurred in one, and chronic recurrent atrial fibrillation is present in a second.

An attractive hypothesis suggests that chronic vasodilatation evokes homeostatic vasoconstriction, the latter persisting during the withdrawal period with cardiac ischemia. A more detailed study of the vasodilator action of organic nitrate and the homeostatic reaction is warranted. In addition, the effect of chronic administration of potent, longacting organic nitrate-based drugs should be examined in the light of this industrial experience.
Fate of Left Ventricular Contraction following Aortocoronary Venous Grafts
Authors: BOURASSA MARTIAL G. , LÉSPERANCE JACQUES , CAMPEAU LUCIEN , SALTIEL JACQUES
Published: June 2012

Changes in left ventriclar contraction were studied approximately two weeks and one year after surgery in 87 patients having 131 venous grafts. Nineteen out of 37 or 51% of the ventricular wall motion defects revascularized by patent and intact grafts were improved following surgery. Hypokinesis was improved in 17 out of 24 instances (70%) and a normal contraction was restored in nearly half of the cases. Akinesis was improved in two out of 13 instances (15%). Following inadequate venous grafts, 15 out of 35 or 42% of the normal wall segments and four out of 16 or 25% of the hypokinetic wall segments were worse after surgery and late akinesis was frequent. Aortocoronary bypass surgery is followed by significant improvement as well as deterioration of left ventricular contraction and function. The late result of surgery is determined by the fate of aortocoronary venous grafts.
Left Ventricular Ejection Time in Atrial Fibrillation
Authors: TAVEL MORTON E. , BAUGH DAVID O. , FEIGENBAUM HARVEY , NASSER WILLIAM K. , Stewart Janie
Published: June 2012

Left ventricular ejection time (LVET; indirect carotid pulse) was studied in 48 patients with atrial fibrillation. In comparison with normal individuals in normal sinus rhythm, ejection times for similar cycle lengths were usually short in patients with atrial fibrillation. Patients without mitral valve disease usually show increasing ejection times following increasing cycle lengths until a certain cycle length is reached (usually around 0.85 sec). Further prolongation of cycle length will not further lengthen the LVET. By contrast, patients with significant mitral stenosis show a continuously sloping curve, i.e. continue to show prolongation of ejection times with progressive lengthening of cycles, eventually reaching ejection times (if cycles are sufficiently long) which exceed those of patients without mitral stenosis. Conversion to normal sinus rhythm (six patients) produced variable results, usually lengthening of ejection time for similar cycle length. Postconversion lengthening of LVET was most pronounced in those cases which lacked progressive increase in LVET with longer cycles during atrial fibrillation. This effect was evident in those patients manifesting relatively slow sinus rates after conversion.

Our results indicate that in order to derive information from ejection times in atrial fibrillation one must plot these values against cycle lengths. Moreover, he cannot use data obtained from patients in normal sinus rhythm to interpret ejection times in those manifesting atrial fibrillation.
Effects of Blood Volume Expansion on Left Ventricular Hemodynamics in Man
Authors: SANGHVI V. R. , KHAJA F. , MARK A. L. , PARKER J. O.
Published: June 2012

The hemodynamic effects of acute blood volume expansion with low molecular-weight dextran were studied in 11 normal patients and 18 patients with coronary artery disease free of angina at the time of study and without evidence of heart failure. In the coronary artery disease group 350 ml (range 130-540 ml) was infused at the rate of 26.7 ml/min (range 19-36 ml/min). There was an increase in left ventricular end-diastolic pressure (LVEDP) from 10.3 to 18.7 mm Hg, brachial artery mean pressure (BAm) from 102 to 105 mm Hg, pulse pressure (PP) from 56.7 to 63.2 mm Hg, cardiac index (CI) from 3.1 to 3.8 liters/min/m
2
, stroke index (SI) from 37 to 44 ml/m
2
, and left ventricular stroke-work index (LVSWI) from 46 to 53 g-m/m
2
. There was no change in heart rate. In normal subjects, 387 ml (range 200-480 ml) was infused at the rate of 26.4 ml/min (range. 15-37 ml/min). There was an increase in LVEDP from 8.0 to 18.4 mm Hg, PP from 55.5 to 66.8 mm Hg, CI from 3.2 to 4.0 liters/min/m
2
, SI from 38 to 46 ml/m
2
, and LVSWI from 46 to 54 g-m/m
2
. Heart rate and BAm were unchanged. LVEDP increased to abnormal levels in every subject and was associated with small increases in SI and LVSWI. In the absence of myocardial ischemia the challenge of an acute volume did not differentiate left ventricular performance of patients with coronary artery disease from normal subjects.
Conversion of Supraventricular Tachyeardias with Rapid Atrial Stimulation
Authors: VERGARA GEORGE S. , HILDNER FRANK J. , SCHOENFELD CLYDE B. , JAVIER ROGER P. , COHEN LAWRENCE S. , SAMET PHILIP
Published: June 2012

Rapid atrial stimulation (RAS) is a technic useful for converting the rapid ventricular response of atrial tachycardia, atrial flutter, or junctional tachycardia to a slower ventricular rate with normal sinus rhythm or atrial fibrillation. It is particularly useful when alternate methods such as DC cardioversion, carotid sinus massage, and drug therapy are either ineffective or undesirable. It is safe in patients with digitalis intoxication, does not require general anesthesia, documents atrial rhythm, and can be used repetitively without cumulative effects.

RAS was performed 129 times in 87 patients (45 males; 42 females) whose ages ranged from 33 to 90 years (mean 67 years). There were no major complications. Overall, including both initial and repeat attempts, RAS successfully converted supraventricular tachycardia in 71% of cases and failed in 29%.
Hemodynamic Data and Angiographic Findings after Mustard Repair for Complete Transposition of the Great Arteries
Authors: RODRIGUEZ-FERNANDEZ HECTOR L. , KELLY DAVID T. , COLLADO AGUSTIN , HALLER J. ALEX , KROVETZ L. JEROME , ROWE RICHARD D.
Published: June 2012

Eleven childrern with uncomplicated transposition of the great arteries repaired by the Mustard procedure were studied by atrial pacing, cardiac catheterization, and cineangiography. Nine had persistent postoperative ectopic cardiac rhythms. Atrial pacing in five suggested sinus node damage in four and A-V junctional conduction tissue damage in one.

In seven children dye-dilution curves indicated small right-to-left shunts. In all seven superior vena cava cineangiograms showed leaks in the baffle at the superior atrial junction. In the other 10, sequential pressures in the superior vena cava, physiologic right atrium, and inferior vena cava showed no evidence of obstruction to systemic venous return. The three complications related to placement of the atrial baffle seemed to be due in large part to technical difficulties in suturing the baffle in the vulnerable sinus node region.

There were no differences in the postoperative hemodynamics between the five patients repaired at a younger age because of severe cyanosis and the five larger children who had been repaired electively. Our results support the aim for early surgical correction in uncomplicated transposition of the great arteries.
Effects of Digoxin on Systolic Time Intervals of Neonates and Infants
Authors: LEVY ARTHUR M. , LEAMAN DAVID M. , HANSON JOHN S.
Published: June 2012

Systolic time intervals were measured in 27 normal newborn infants before and after administration of oral digoxin (30 µg/kg). Systolic intervals were also measured in 10 newborns and infants with congestive heart failure before and after this same 30 µg/kg dose of digoxin, but also after administration of a much larger "digitalizing dose" of 80 µg/kg. Preejection period (PEP) shortened significantly in the normal newborns following the smaller dose. Changes in ejection time (ET) were much less striking and appeared to be transient, lasting less than 8 hours. When small doses of digoxin were given to the babies with congestive failure, PEP again shortened significantly. In general, the larger doses of digoxin produced no further changes in PEP or ET, although there were individual exceptions. The demonstration that maximal inotropic effect, as measured by PEP changes, usually occurred with small doses of digoxin may have significant clinical implications in terms of present concepts of loading doses of digitalis in the pediatric age group.
Pseudocoarctation, Kinking or Buckling of the Aorta
Authors: SMYTH PETER T. , EDWARDS JESSE E.
Published: June 2012

Pseudocoarctation, buckling, and kinking of the aorta are terms used to describe a roentgenologic deformity of the aorta similar to that in classical coarctation but in which no obstruction is demonstrable. It is probable that the first three terms used are synonyms for subclinical coarctation. In this state, the lesion of classical coarctation of the aorta is present and the two show the same associated anomalies.
Use of Sublingual Nitroglycerin in Congestive Failure following Acute Myocardial Infarction
Authors: GOLD HERMAN K. , LEINBACH ROBERT C. , SANDERS CHARLES A.
Published: June 2012

The effect of 0.3 mg sublingual nitroglycerin (NTG) was evaluated by hemodynamic measurements and precordial S-T-segment mapping in 17 patients following acute myocardial infarction.

In all cases NTG produced a prompt reduction in mean pulmonary capillary wedge pressure (PCW) from an average of 19 ± 2 to 14 ± 1 mm Hg associated with a small fall in mean arterial pressure from a mean of 85 ± 4 to 82 ± 4 mm Hg. No significant change in heart rate occurred.

In patients without left ventricular failure (PCW 3-12 mm Hg) cardiac output (CO) fell 9%. By contrast, in patients with moderate left ventricular failure (PCW 13-22 mm Hg) CO rose 18%. In three patients with refractory left ventricular failure (PCW 25-31 mm Hg) CO rose 25%. Two of these patients were treated with repetitive NTG doses in addition to previously ineffective diuretic therapy with resolution of resistant pulmonary edema. No significant changes in the magnitude of S-T-segment elevations were noted.

NTG may have a special role in the management of acutely ill patients with myocardial infarction in whom pulmonary edema does not respond to conventional therapy.
Relationship of Anginal Symptoms to Lung Mechanics during Myocardial Ischemia
Authors: PEPINE CARL J. , WIENER LESLIE
Published: June 2012

The anginal syndrome (AP) typically includes sensations of chest tightness or difficulty in breathing. Left ventricular (LV) dysfunction during myocardial ischemia incident with AP is now well documented. Since secondary alterations in lung mechanics could relate to these symptoms, we examined airway resistance (Raw), lung volume (TGV), lung compliance (C
L
), and LV pressure-volume relations during pacing-induced AP.

LV end-diastolic pressure (EDP) increased suddenly with AP, (mean + 41%,
p
< 0.01), without change in end-diastolic volume (EDV). LV distensibility (EDV/EDP) decreased abruptly, (–37%,
P
< 0.01), with reduction in airway conductance (1/Raw/TGV), (–40%,
P
< 0.05), and C
L
(–27%,
P
< 0.05). When AP was relieved, these changes returned toward preangina levels.

Ischemia-induced LV dysfunction abruptly increases LVEDP. The resulting increased pulmonary capillary pressure effects an alteration of lung mechanics consisting of increasing Raw and reduced C
L
. The changes in ventilatory effort which ensue may be interpreted as chest tightness, heaviness, or constriction by the AP patient.
Myocardial Perfusion Scintigraphy after Intracoronary Injection of
99m
Tc-Labeled Human Albumin Microspheres
Authors: WELLER DANIEL A. , ADOLPH ROBERT J. , WELLMAN HENRY N. , CARROLL ROBERT G. , KIM ONJA
Published: June 2012

Myocardial perfusion scintigraphy was performed in 30 intact anesthetized dogs following intracoronary injection of
99m
Tc-labeled human albumin microspheres (HAM). The normal dog myocardial image pattern was established. This technic detected myocardial infarcts resulting from small vessel occlusions and flush coronary branch occlusions when the coronary angiogram appeared normal. Myocardial infarcts as small as 1½ cm were seen. Toxicologic studies in 47 dogs failed to demonstrate significant changes in blood pressure, heart rate, electrocardiogram, or serum CPK activity following intracoronary injections of HAM in doses up to 200 times that required for adequate myocardial scintigraphy. Gross and microscopic examination of hearts 1-6 weeks after HAM injection showed minor abnormalities also seen in matched controls receiving coronary arteriography alone. Preliminary results in 33 patients substantiate the safety of this technic. Human myocardial scintigrams reported here reveal anatomic detail not previously demonstrated by other external imaging methods.
Uses and Limitations of Stress Testing in the Evaluation of Ischemic Heart Disease
Authors: REDWOOD DAVID R. , EPSTEIN STEPHEN E.
Published: June 2012

The results of stress testing in patients being assessed for coronary artery disease have led to conflicting claims and conclusions. It seems reasonably clear that stress testing is of considerable predictive value in
epidemiologic studies;
i.e., patients manifesting or developing a positive exercise test have a much higher probability of subsequently experiencing coronary events (angina pectoris, myocardial infarction, or coronary death) than those individuals with normal stress tests. Moreover, the risk seems to be related to the degree of S-T segment depression. In contrast, despite earlier claims regarding the
diagnostic
accuracy with which single-load stress tests could predict the presence or absence of ischemic heart disease in individual patients, studies correlating the results of testing with the degree and extent of angiographically demonstrated coronary artery disease have not consistently shown either acceptable sensitivity or specificity. Although on theoretic grounds it would be anticipated that multistage stress tests would be superior to single-stage protocols, this has not been borne out in the few published studies in which the results are correlated with angiography. Thus, the available evidence suggests that there remain appreciable numbers of patients with documented coronary artery disease in whom no ECG abnormalities are detected despite relatively intense levels of exercise, and an appreciable number of patients with abnormal ECG responses but normal coronary arteries. Stresses other than exercise have been and are being utilized in the evaluation of patients with chest pain; however, no single test as yet offers the desired specificity and sensitivity.

We conclude that, in patients with typical angina pectoris or with chest pain which clearly does not resemble angina pectoris, stress testing appears to be superfluous since it provides little additional information beyond that which may be obtained from the patient's history. It is in those patients presenting with atypical anginal syndromes that a reliable noninvasive test would be of great value. Currently available technics are neither sufficiently sensitive nor specific to satisfactorily aid in solving this problem.
Medical Management of Angina Pectoris
Authors: LOGUE R. BRUCE , ROBINSON PAUL H.
Published: June 2012

The successful medical management of a patient with angina pectoris requires careful attention to many factors including omission of smoking, control of hypertension, and weight reduction for the obese person. Newer knowledge of the importance of the product of the systolic blood pressure and the pulse rate in determining the threshold of angina affords a more meaningful approach to therapy. Each individual must be educated regarding the factors that aggravate and precipitate his distress so that these can be minimized, or prophylactic nitrite therapy can be appropriately applied. Emotional stress is of equal importance to effort in the production of angina. The mainstay stay of treatment is nitroglycerin and sublingual nitrites combined with beta-blocking drugs. Each drug or combination must be properly readjusted for the individual to assure optimum benefit. Digitalis, diuretics, antiarrhythmic drugs, antihypertensive agents, and radioiodine may be useful in selected cases.
Effects of Surgery on Angina (Pre- and Postinfarction) and Myocardial Function (Failure)
Authors: MANLEY JACK C. , JOHNSON W. DUDLEY
Published: June 2012

With the advent of direct bypass surgery, the dramatic clinical responses in some patients has been followed by enormous enthusiasm in many centers. Surgical technics have advanced to such a point that nearly all patients with obstructive coronary disease could have the obstructions bypassed to one or many areas. Criteria for evaluating surgery include mortality, operative infarction rate, patency of grafts, clinical response, and stress testing. Many reports fail to correlate results with angiographic studies of vein function and with completeness of revascularization. When cine studies are performed, a good correlation exists between patent veins and relief of angina and improved stress response. Different patterns of response to stress, sometimes independent of relief of angina, are obtained depending on the completeness of revascularization. Predictable relief of angina is found if revascularization is complete. At times dramatic, but much less predictable, relief of failure (improved ventricular function) follows revascularization. Angina is a valuable aid in selecting some patients for surgery. Stress testing (bicycle ergometry) can now define general groups of patients who are likely, and who are not likely, to show improved myocardial response to stress after surgery. These studies also demonstrate the need for the surgeon to provide complete revascularization whenever possible. The criteria for selection for surgery of patients with symptoms of gross heart failure remain unclear. While revascularization technics could be technically applied to nearly all coronary patients, present methods are unable accurately to define who really needs the surgery and, equally important, which hearts will respond once revascularization is completed.
Echocardiography in the Normal Neonate
Authors: SOLINGER ROBERT , ELBL FRANCISCO , MINHAS KAREEM
Published: June 2012

Utilizing the atrioventricular and semilunar valves as ultrasonic landmarks, a simple reproducible technic is described for the ultrasonic evaluation of the heart and its great vessels in the normal neonate. The importance of the clinical application of this method is discussed.

Echocardiographic studies were performed on 240 normal newborns. Qualitative assessment was made of the interrelationships of the pulmonary, aortic, tricuspid, and mitral valves, and of interventricular septal motion. Quantitative norms were obtained for the following parameters: amplitude of motion of anterior leaflets of tricuspid and mitral valves, anteroposterior diameter of the ventricular and left atrial cavities, thickness of ventricular walls and interventricular septum, outside diameter of aortic and pulmonary roots, and interaortic and interpulmonary cusp distances.
Prognosis of Surgically Corrected Coarctation of the Aorta
Authors: MARON BARRY J. , HUMPHRIES J. O'NEAL , ROWE RICHARD D. , MELLITS E. DAVID
Published: June 2012

A long-term retrospective analysis of 248 patients, 11-25 years after surgical correction of coarctation of the aorta, revealed a high incidence of premature cardiovascular disease. Twelve percent of patients with follow-up have died. It is suggested that premature death in patients with adequate surgical repair may be related to the duration of preoperative hypertension. Fifty-nine patients were evaluated on a standard hospital protocol. Seventy-eight percent had evidence of cardiovascular disease and over 40% had no change or had increased blood pressure over the preoperative value.

These data emphasize the importance of early diagnosis and treatment for patients with coarctation of the aorta as well as the need for close postoperative follow-up.
Correlation of the Antemortem Coronary Arteriogram and the Postmortem Specimen
Authors: VLODAVER ZEEV , FRECH ROBERT , VAN TASSEL ROBERT A. , EDWARDS JESSE E.
Published: June 2012

Correlative studies were carried out on the coronary arteriograms made during diagnostic procedures and on the specimens obtained at necropsy in 10 cases of coronary heart disease. Of the 134 segments of coronary arteries available for both studies, 44 (33%) were given false-negative arteriographic diagnosis of obstructive atherosclerosis.

Factors which may underlie this discrepancy include (1) radiographic technic, (2) projection used, (3) a slitlike lumen adjacent to the atheroma, (4) comparison of severely obstructed segments involved but less severely obstructed, and (5) misinterpretation from the specimen of obstruction present in life.
Long-Term Observations in Patients with Angina and Normal Coronary Arteriograms
Authors: BEMILLER CARL R. , PEPINE CARL J. , ROGERS ALBERT K.
Published: June 2012

Thirty-seven patients (mean age 42.7 years) with angina pectoris (AP), ischemic myocardial abnormalities, and normal coronary arteriograms were followed for 4.1 years (mean). Twenty patients had typical and 17 atypical AP. Ten had abnormal serum lipids, and eight had abnormal glucose tolerance tests. Rest-to-exercise hemodynamics revealed increased left ventricular (LV) end-diastolic pressure (mean 11.2 ± 2.6 mm Hg → 19.1 ± 3.6,
P
< 0.05), while stroke-work index increased (+29%). LV ischemia was detected by abnormal lactate extraction with atrial pacing in 10 or ≧1 mm S-T segment depression during exercise or pacing in 27 patients. After a mean follow-up period of 4.1 years, AP decreased in 80% of cases and remained stable in the other 20% of cases. One patient died suddenly, and autopsy revealed normal coronary arteries and myocardium. In the remainder, complications of ischemia, i.e. progression of symptoms, infarction, and heart failure were absent. Seven patients restudied 4.5 years (mean) later had no changes in their previously documented hemodynamic abnormalities and normal coronary arteriograms.

The fate of patients with AP and normal coronaries with ischemic LV abnormalities (ECG, metabolic, or hemodynamic) appears favorable. AP responds to nitrate and propranolol therapy. These long-term clinical observations with angiographic and hemodynamic restudies suggest a nonprogressive disorder.
Hypertension in the Inner City
Authors: FINNERTY FRANK A. , MATTIE EDWARD C. , FINNERTY FRANCIS A.
Published: June 2012

Sixty dropouts from hypertensive clinics were interviewed in depth to determine reasons for noncompliance. Waiting time and a poor doctor-patient relationship were the major reasons given. The average waiting time prior to examination by the doctor was 2.5 hours, and the average waiting time at the pharmacy was 1.8 hours. In contrast the average time spent with the doctor was 7.5 min. The poor doctor-patient relationship deteriorated further since patients were examined by a different physician on each visit. A physician was not essential for compliance, however, since 54% of the patients readily accepted a health aide. In order to enhance compliance our group reorganized its hypertensive clinic using the patients' complaints as guidelines. Operating the clinic with emphasis on a personalized doctor-patient relationship and utilizing a meaningful appointment system has reduced the number of dropouts from 42% in 1966-69 to 8% in 1970-71.
Asymmetric Septal Hypertrophy
Authors: HENRY WALTER L. , CLARK CHESTER E. , EPSTEIN STEPHEN E.
Published: June 2012

Idiopathic hypertrophic subaortic stenosis (IHSS) is characterized by subaortic obstruction to left ventricular (LV) outflow. However, the obstruction is variable and many patients have no resting gradient and no clinical evidence of IHSS. Although a characteristic systolic movement of the anterior mitral valve leaflet can be demonstrated echocardiographically in many patients with IHSS, this may be absent in patients without obstruction under baseline conditions. Several necropsy studies of patients with IHSS have demonstrated that the ventricular septum characteristically is asymmetrically hypertrophied in relation to the posterior left ventricular wall. Since echocardiography can measure the thickness of the ventricular septum and the posterior LV free wall during life, we have evaluated the sensitivity and specificity of asymmetric septal hypertrophy (ASH) in diagnosing IHSS. The ventricular septum and posterior LV free wall were measured in 15 patients with IHSS documented by catheterization, 11 patients with other forms of fixed LV outflow obstruction, 52 patients with miscellaneous forms of heart disease, and 16 normal subjects. The mean septal-free wall ratio in normal subjects was 1.03, in fixed LV outflow obstruction 1.03, in miscellaneous heart disease 1.03, while in IHSS it was 1.68. The ratio exceeded 1.3 in all 15 patients with IHSS (including seven patients without a gradient under baseline conditions), and it was less than 1.3 in 78 of 79 patients without IHSS. Thus ASH (1) can be diagnosed noninvasively, (2) appears specific for IHSS, and (3) is independent of the degree of obstruction. Moreover, since our findings indicate that the detection of ASH identifies the pathognomonic anatomic abnormality in IHSS and includes a wider spectrum of patients (i.e. those without obstruction as well as clinically normal family members of patients with IHSS), we suggest that a more appropriate term for this disease entity is asymmetric septal hypertrophy or ASH.
Saphenous Vein Coronary Artery Bypass in Patients with "Preinfarction Angina"
Authors: MILLER D. CRAIG , CANNOM DAVID S. , FOGARTY THOMAS J. , SCHROEDER JOHN S. , DAILY PAT O. , HARRISON DONALD C.
Published: June 2012

Among the first 400 patients undergoing saphenous vein coronary artery bypass at Stanford Medical Center, 67 (18%) met criteria for "preinfarction angina". Angina was alleviated and possible myocardial infarction was prevented utilizing these surgical technics. The overall operative mortality rate in the preinfarction angina patients was 10.4%, which contrasted strikingly with a 1.5% operative mortality for elective coronary artery bypass at Stanford. Six of the seven operative deaths resulted from myocardial infarction, two of which were related to technical factors. Operative mortality appeared to be related to degree of preoperative congestive heart failure and hypotension, pump time, sex, and number of atherosclerosis risk factors present. Fifty-two of the 60 patients leaving the hospital (87%) received good symptomatic benefit from surgery, including no late infarction, over a 6.8 month mean follow-ulp period. The late death rate was 3.3%, and the late infarction rate was 10% during the follow-up period. Angina can be alleviated and impending myocardial infarction may be prevented with aggressive surgical intervention.
Left Ventricular Performance after Myocardial Infarction Assessed by Radioisotope Angiocardiography
Authors: KOSTUK WILLIAM J. , EHSANI ALI A. , KARLINER JOEL S. , ASHBURN WILLIAM L. , PETERSON KIRK L. , ROSS JOHN , SOBEL BURTON E.
Published: June 2012

Radioisotope angiocardiography was performed by peripheral venous or pulmonary arterial injection of
99m
Tc pertechnetate in 64 patients with acute myocardial infarction. End-diastolic volume determined with this technic averaged 101 ± 7 (±
sem
) ml/m
2
and was elevated (> 90 ml/m
2
) in 47 patients. Initial ejection fraction (EF) averaged 0.38 ± 0.03 and was reduced (<0.52) in 58 patients. The extent of diameter shortening at the minor left ventricular equator determined from the isotope angiocardiograms was depressed in 51 patients, a reduction which was not consistently related to the site of infarction determined electrocardiographically. In 53 survivors EF averaged 0.40 ± 0.02, compared to 0.26 ± 0.07 (
P
< 0.05) in 11 patients who died within 1 month. EF correlated inversely with infarct size estimated by analysis of serial changes in serum CPK activity (r = 0.71, n = 42). Of the 64 patients with acute infarction, 47 exhibited abnormal wall motion detectable by the radionuclide technic and confirmed by radarkymography. Serial radioisotope angiocardiograms (6 hours-1 month) showed improvement of cardiac function in 30 of 55 patients, with no change in 12, and deterioration in 13 patients. Results obtained indicate that radioisotope angiocardiography performed by peripheral intravenous injection of
99m
Tc pertechnetate can be performed safely, rapidly, and serially without hemodynamic perturbation to assess left ventricular performance in patients critically ill with acute myocardial infarction.
The Importance of Identification of the Myocardial-Specific Isoenzyme of Creatine Phosphokinase (MB Form) in the Diagnosis of Acute Myocardial Infarction
Authors: WAGNER GALEN S. , ROE CHARLES R. , LIMBIRD LEE E. , ROSATI ROBERT A. , WALLACE ANDREW G.
Published: June 2012

Serial plasma determinations of the isoenzymes of CPK were performed in all patients (376) admitted to a coronary care unit during a 12-month period with diagnosis of possible acute myocardial infarction. Results were compared with data from other enzyme studies and from the electrocardiogram. An attempt was made to determine the incidence of falsely positive CPK-MB (myocardial-specific form). "No acute infarction" was diagnosed in all patients in whom neither total CPK nor the isoenzymes of LDH indicated myocardial necrosis, and in whom there were no QRS changes on ECG. Incidence of falsely negative CPK isoenzyme data was also determined. All patients, in whom total CPK was transiently elevated, and LDH
1
exceeded LDH
2
, and new QRS changes occurred, were termed "definite" acute infarction. CPK-MB form was present in all 55 of these (0% false negative). Therefore, determination of the isoenzymes of CPK by this method provides both a sensitive and specific indication of acute myocardial infarction.
Influence of Direct Myocardial Revascularization on Left Ventricular Asynergy and Function in Patients with Coronary Heart Disease
Authors: CHATTERJEE KANU , SWAN H. J. C. , PARMLEY WILLIAM W. , SUSTAITA HECTOR , MARCUS HAROLD S. , MATLOFF JACK
Published: June 2012

The influence of successful aortocoronary artery bypass surgery on left ventricular asynergy and dysfunction was studied by hemodynamic and angiographic methods in 29 patients with coronary artery disease. Eight patients had the preinfarction syndrome, 10 patients had chronic ischemia without previous infarction, and 11 patients had chronic ischemia with previous infarction. LV asynergy was present preoperatively in 12 of the 18 patients in the first two groups. Marked improvement occurred in all and a normal wall motion was restored in the majority following surgery. More pronounced improvement was noted in the preinfarction syndrome as compared to the group with chronic ischemia and no previous infarct. The ejection fraction was reduced in 12 of the 18 patients in these two groups and significant improvement was observed postoperatively [0.45 ± 0.03 (
sem
) to 0.74 ± 0.03]. Increase in ejection fraction was primarily due to a decrease in the end-systolic volume (71 ± 12 to 23 ± 4 ml/m
2
). The end-diastolic volume was only slightly reduced (114 ± 12 to 97 ± 9 ml/m
2
). Left ventricular end-diastolic pressure fell from 15 ± 1 to 10 ± 1 mm Hg.

In nine of 11 patients who had previous myocardial infarction, abnormal wall motion was present preoperatively. Following surgery, some abnormalities of wall motion persisted in the areas of known infarction, although significant improvement of wall motion occurred in the noninfarcted segments. The ejection fraction was reduced in seven of these 11 patients and improved postoperatively. (0.44 ± 0.05 to 0.59 ± 0.05). The end-systolic volume decreased from 57 ± 5 to 41 ± 6 ml/m
2
, and the end-diastolic volume was unchanged (106 ± 5 to 108 ml/m
2
). Left ventricular end-diastolic pressure fell from a mean value of 17 ± 3 to a mean value of 10 ± 2 mmHg following successful surgery. These findings are consistent with improved pump function and were associated with improvement in indices of contractile state. The observations indicate that significant improvement in ventricular wall motion and pump function occurs in patients with obstructive coronary disease following successful aortocoronary artery bypass surgery even in the presence of old myocardial infarction. Since the patients of the present study all had normal initial end-diastolic volumes, however, similar beneficial results might not occur in patients with cardiomegaly and more severe heart failure.
Thirty-Month Follow-up of Maximal Treadmill Stress Test and Double Master's Test in Normal Subjects
Authors: ARONOW WILBERT S.
Published: June 2012

One hundred normal subjects who had a double Master's test and a maximal treadmill stress test (MTST) were clinically evaluated 30 months later. Ninety-nine of these 100 subjects (99%) had a follow-up treadmill test at 30 months. One of four subjects (25%) with initially an abnormal double Master's test developed coronary heart disease within 30 months. Three of 96 subjects (3.1%) with initially a normal double Master's test developed coronary heart disease within 30 months. Three of 13 subjects (23.1%) with initially an abnormal MTST developed coronary heart disease within 30 months. One of 87 subjects (1.1%) with initially a normal MTST developed coronary heart disease within 30 months. The MTST correlated better than the double Master's test in predicting subsequent coronary heart disease.
Ventriculographic Patterns and Hemodynamics in Primary Myocardial Disease
Authors: KREULEN THOMAS H. , GORLIN RICHARD , HERMAN MICHAEL V.
Published: June 2012

Thirty-four patients with primary myocardial disease were studied and classified into three distinct types based on their left ventriculogram. Each had unique ventriculographic characteristics and findings. Type I are patients with a normal contraction pattern and an elevated left ventricular end-diastolic pressure. Type II A are patients with a hypertrophic pattern without obstruction to outflow while type II B patients have outflow obstruction. Type III A are patients with generalized hypokinesis. Type III B have a similar contraction pattern but in addition show asynergy. Analysis of the right ventriculogram in seven patients showed changes paralleling those seen in the left ventricle, including asynergic patterns of contraction. The electrocardiogram and chest roentgenogram were found to be sensitive but nonspecific indicators of disease. The short-term prognosis was excellent with type I and poor with type III while type II patients had an intermediate prognosis.
Light-Pen Computer Processing of Video Image for the Determination of Left Ventricular Volume
Authors: ALDERMAN EDWIN L. , SANDLER HAROLD , BROOKER JEFF Z. , SANDERS WILLIAM J. , SIMPSON CARL , HARRISON DONALD C.
Published: June 2012

A volume angiography system for on-line computation of left ventricular angiograms has been developed utilizing a video disc recorder, a light-pen unit, and a digital computer. The video disc recorder allows for immediate replay and stop-motion of ventricular angiograms on a video monitor. The light-pen is used by a technician/physician operator to define the margins of the ventricular chamber and input the data directly to the digital computer. The computer, utilizing the arealength method, applies preset magnification factors and calculates the ventricular volume. Comparison of this light-pen computer system with conventional manual processing of cine film yielded a correlation coefficient of 0.99. The equipment configuration employed in this system offers the advantages of available hardware components and operational simplicity. The major benefit has been avoidance of the logistic delays involved in cine film processing and handling, which have been obviated by the on-line capability of the video disc, light-pen, and computer combination.
Relationship between Pulmonary Artery End-Diastolic Pressure and Left Ventricular Filling Pressure in Patients in Shock
Authors: SCHEINMAN MELVIN , EVANS G. THOMAS , WEISS ALAN , RAPAPORT ELLIOT
Published: June 2012

Bedside catheterization permitted 56 simultaneous measurements of left ventricular end-diastolic pressure (LVEDP) and pulmonary artery end-diastolic pressure (PAEDP) in 25 patients in shock. Measurements were made over a wide range of heart rates (60-160 beats/min), arterial oxygen tension (P

o
o2

; 33-562 mm Hg), stroke volumes (9-105 ml), and systolic arterial pressures (65-250 mm Hg), and before and during various therapeutic interventions. There was good correlation between PAEDP and LVEDP (r = +0.85) and PAEDP and left ventricular pre-a pressure (r = +0.82). In 16 patients breathing room air, mean arterial P

o
o2

was 58 ± 15 mm Hg and rose significantly to 282 ± 16 mm Hg after breathing oxygen (P<0.01), but there was no significant change in the correlation between PAEDP and LVEDP before (r = +0.80) or during oxygen breathing (r = +0.80). Similarly, in seven patients treated with inotropic agents there was excellent correlation between PAEDP and LVEDP before (r = +0.96) and during inotropic therapy (r = +0.86). A PAEDP in excess of 15 mm Hg nearly always reflected increased LVEDP while a PAEDP less than 10 mm Hg was always associated with normal LVEDP. Thus in our patients with shock PAEDP represented a good estimate of LVEDP during a variety of therapeutic interventions and therefore represents a useful tool in guiding the therapy of patients in shock.
Response of Resistant Ventricular Tachycardia to Bretylium
Authors: COHEN H. C. , GOZO E. G. , LANGENDORF R. , KAPLAN B. M. , CHAN A. , PICK A. , GLICK G.
Published: June 2012

Ventricular tachycardias were determined to be of either right-or left-sided origin in 25 patients whose arrhythmias were life-threatening and resistant to lidocaine and other antiarrhythmic drugs. All five patients with right ventricular tachycardia responded well to bretylium and survived. Eleven of 20 patients with left ventricular tachycardia did not do well. Four did not respond to bretylium but survived, five had no response and died, and two responded but died when hypotension prevented continued treatment. Eight of these 11 had acute anterior myocardial infarction or ischemia. Of nine patients with left ventricular tachycardia who responded well to bretylium and survived, only two had anterior infarction, and none had anterior ischemia. Because bretylium was efficacious in all patients with right ventricular tachycardia or inferior myocardial infarction in this study, it seems warranted to investigate further the relationship between drug responsiveness and the site of ectopic impulse formation and the location of myocardial disease.
Serum Digitalis and Arrhythmia in Patients Undergoing Cardiopulmonary Bypass
Authors: MORRISON JOHN , KILLIP THOMAS
Published: June 2012

To assess the possible role of digitalis in the etiology of arrhythmia following cardiopulmonary bypass, serum digoxin or digitoxin was determined serially by radioimmunoassay in 24 chronically digitalized patients undergoing open-heart surgery. After an initial fall during bypass probably secondary to intraoperative fluid, serum digitalis rebounded, rising to or surpassing the preoperative value in 21 of the 24 patients studied. Peak rebound serum digitalis occurred an average of 13 hours following onset of bypass. Eight patients receiving maintenance digoxin developed arrhythmia postbypass at or near the peak of the rebound. The arrhythmia subsided as the peak was passed. Mean serum digoxin at the time of arrhythmia was 1.3 ± 0.2 (
sd
) ng/ml. A significantly higher (
P
< 0.001) value than the value of 0.07 ± 0.03 ng/ml found in patients without arrhythmia. Occurrence of arrhythmia could not be correlated with diagnosis, clinical status, cardiac size, blood gas, or serum electrolyte values. In 77 control subjects with ECG evidence of digoxin toxicity, mean serum digoxin level was 3.1 ± 0.9 (
sd
) ng/ml. Since arrhythmia occurred at serum levels of digitalis lower than those observed in patients toxic to the drug who had not undergone cardiopulmonary bypass, and since the arrhythmia subsided as the serum level declined, and since the levels were higher in patients who had arrhythmia postbypass than in those who did not, this study suggests that myocardial sensitivity to the toxic effects of digitalis is increased in the first 24 hours following cardiopulmonary bypass.
Racial Frequencies in Congenital Heart Disease
Authors: MARON BARRY J. , APPLEFELD JUDITH M. , KROVETZ L. JEROME
Published: June 2012

A retrospective population study of racial frequencies in three congenital heart malformations, transposition of the great vessels, coarctation of the aorta, and aortic atresia with left heart hypoplasia, indicated no significant difference in incidence among Negroes and Caucasians in the Baltimore metropolitan area.
Absence of Anatomic Origin from Heart of Pulmonary Arterial Supply
Authors: EDWARDS JESSE E. , MCGOON DWIGHT C.
Published: June 2012

Among certain patients with cardiovascular malformations, a common phenomenon is a ventricular septal defect and absence of anatomic origin of the pulmonary arterial supply from the heart. In this situation, true pulmonary arteries may be present or absent. In the latter case, the pulmonary arterial supply comes through bronchial arteries. When true pulmonary arteries are present, the left and right pulmonary arteries either may be in continuity at their origins (confluence) or they may arise from separate sites (nonconfluence).

When confluence is present, the two pulmonary arteries may arise either from an atretic pulmonary trunk or from certain forms of persistent truncus arteriosus. Pulmonary atresia may be localized to the proximal end of the pulmonary trunk or diffuse in this vessel. When nonconfluence is present, each pulmonary artery arises separately from one of three possible sources as follows: (1) a form of persistent truncus arteriosus, (2) through ducti arteriosi from the aortic arch system, or (3) through bronchial arteries from the descending aorta.
Hemodynamic Sequelae of Cardiac Arrhythmias
Authors: SAMET PHILIP
Published: June 2012

The hemodynamic consequences of cardiac arrhythmias depend on various factors, including the ventricular rate and the duration of the abnormal rate, the temporal relationship between atrial and ventricular activity, the sequence of ventricular activation, the functional state of the heart, the irregularity of the cycle length, associated drug therapy, the peripheral vascular vasomotor system, disease in organ systems other than the heart, and the degree of anxiety caused by the disease processes. Sinus bradycardia, even with rates as low as 40 beats/min, may not be associated with significant hemodynamic consequences unless the stroke volume is limited by myocardial or valvular disease, as in acute myocardial infarction. Cardiac output usually, but not invariably, falls when atrial fibrillation replaces normal sinus rhythm, even at comparable ventricular rates, both at rest and during exercise. Similar observations have been made during the development of atrial flutter despite the persistence of effective mechanical atrial activity in at least some cases. Marked hemodynamic changes are frequent in the course of ventricular tachycardia with systemic arterial hypotension, a decrease in cardiac output, and evidence of cerebral, coronary, and renal vascular insufficiency. Cyclic variations in systemic and pulmonary arterial pressures are common during atrioventricular dissociation. Cardiac output is generally depressed during the severe bradycardia of acquired complete heart block with evidence of atrioventricular valvular insufficiency. Increase of the heart rate by ventricular pacing reverses all or some of these abnormalities. The changes in congenital complete heart block are considerably less severe because myocardial insufficiency is less frequently seen in congenital complete heart block.
Relation of Electrolyte Disturbances to Cardiac Arrhythmias
Authors: FISCH CHARLES
Published: June 2012

While a number of electrolytes play a role in the genesis of the transmembrane action potential (AP), the changes in the action potential most clearly related to arrhythmias are dependent to a large extent on K
+
. Potassium gradient is a major determinant of the magnitude of transmembrane resting potential (TRP), and secondarily the rate of rise (dV/dt) of phase 0, and consequently the speed of conduction. The cell membrane conductance for K
+
, or a decrease therein, is most likely the major determinant of spontaneous slow depolarization during phase 4. Thus K
+
has a pronounced effect on both conduction and automaticity. Furthermore, these electrophysiologic properties are altered within levels of K
+
encountered in clinical medicine, a situation which, with rare exceptions, is not seen with Ca
++
, Mg
++
, or Na
–
. These latter ions affect the action potential and induce experimental arrhythmias at concentrations which are unphysiologic and frequently incompatible with life. Consequently, of all the electrolytes, disturbed K
+
metabolism accounts for the vast majority of clinical arrhythmias. For the same reasons, with the exception of the ability of Na
+
and Ca
++
to reverse the K
+
-induced depression of conduction, K
+
is the only electrolyte with clinacally significant antiarrhythmic properties.