bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise echocardiography after stabilization of unstable angina: Correlation with exercise thallium‐201 single photon emission computed tomography
Authors: Amanullah Aman M. , Lindvall Kaj , Bevegård Sture
Published: February 2009

The diagnostic usefulness of predischarge exercise echocardiography in 35 patients with unstable angina who responded to medical therapy was correlated with exercise thallium‐201 single photon emission computed tomography (TI‐SPECT) performed, on the average, three days after the exercise echocardiography. None of the patients had myocardial infarction prior to hospitalization or before TI‐SPECT and none had left bundle‐branch block on their rest electrocardiogram (ECG). Exercise echocardiography was positive in 21 patients and TI‐SPECT in 24. The results of the two techniques were concordant in 28 of 35 patients (agreement = 80%,k= 0.57±0.14, p<0.001). Wall‐by‐wall comparison of the distribution of exercise‐induced wall motion abnormalities with reversible thallium defects showed complete or partial correlation in all of 19 patients in whom both the tests were positive. A positive exercise ECG and positive exercise echocardiography identified 11 of 11 patients with angiographically verified significant coronary artery disease (CAD) and 11 of 12 patients (92%) with positive TI‐SPECT. Thus, exercise echocardiography is a valuable addition to routine predischarge exercise test in the noninvasive diagnosis of myocardial ischemia and shows a good correlation with TI‐SPECT in detecting and localizing ischemia in patients with unstable angina stabilized on medical therapy.
Benefits of the advances in cardiac pacemaker technology
Authors: Shakespeare Carl F. , Camm A. John , Camm A. John
Published: February 2009

Pacemaker technology has expanded rapidly in the last thirty years. Each phase of development has been marked by both improvements in clinical benefit and disadvantageous interactions of physiology and technology. Each phase of development has led to smaller, more reliable devices with greater programmability. Advances in generator technology and battery design have increased longevity of devices. The first devices used asynchronous pacing which had a significant effect in reducing the mortality of surgically induced complete heart block. Ventricular demand pacemakers overcame the problems of asynchronous competitive pacing, but exposed the pacemaker syndrome. Atrioventricular sequential pacing restored atrioventricular synchrony, resulting in hemodynamic improvement, but created the phenomenon of pacemaker‐mediated tachycardia. Alternative dual chamber modes and algorithms have largely resolved this. Adaptive‐rate devices have been of benefit to patients with chronotropic incompetence, and are now incorporating an increasing variety of biosensors. Almost all the problems of pacing have been overcome, but the increasing complexity of pacemaker technology is now a major limitation to its proper use.
The prevention of atherosclerosis with antioxidants
Authors: Harris William S.
Published: February 2009

Recent research findings have suggested a role for pharmacologic as well as nutritional antioxidants in the prevention of atherosclerosis. Data from animal studies as well as cell culture experiments have shown that the drug probucol, which has hypocholesterolemic and antioxidant properties, is able to prevent oxidative modification of low density lipoproteins (LDL). Such modification is now believed to play a major part in the initiation and progression of arterial lesions. Nutrients with antioxidant properties such as vitamins C and E, beta‐carotene, and monounsaturated fatty acids (when they replace polyunsaturated fatty acids) can reduce the susceptibility of LDL to oxidation. Antioxidant therapy, if proven useful, should be considered an adjunct to lipid‐lowering therapy in order to have the greatest impact on coronary heart disease.
A “lipo‐protective” effect of a fixed combination of captopril and hydrochlorothiazide in antihypertensive therapy
Authors: Ratheiser K. , Dusleag J. , Titscher G. , Klein W.
Published: February 2009

Increases of triglycerides and total cholesterol have been reported during treatment with antihypertensive drugs Most notably with beta blockers and diuretics. ACE inhibitors, on the other hand, are not known for having a negative effect on lipid profile. To evaluate the effects of a fixed combination of captopril and hydrochlorothiazide on lipid metabolism, blood pressure, and quality of life, we performed an open prospective study. A total of 2,154 patients with or without hypercholesterolemia, but not receiving lipid lowering drugs, were enrolled. Of the 1891 evaluable patients at baseline, 34.1% had a moderate risk with total cholesterol between 5.2 and 6.5 mmol/1 (mean 5.8 mmol/1) and 41.3% had a high coronary heart disease (CHD) risk with total cholesterol higher than 6.5 mmol/1 (mean 7.3 mmol/1). After six months of treatment, the median cholesterol level in the moderate risk group decreased from 5.8 to 5.4 mmol/1 (p<0.0003) and in the high risk group from 7.3 to 6.3 mmol/1 (p<0.0001). Triglycerides also decreased, whereas high density lipoprotein (HDL) increased in both risk groups. Systolic and diastolic blood pressure fell as expected and quality of life improved. The fixed combination was well tolerated. We observed a significant improvement of lipid profile in patients with mild to moderate hypertension while undergoing treatment with the fixed combination of captopril and hydrochlorothiazide. We suggest that captopril may balance the negative effects of hydrochlorothiazide on lipid metabolism in patients with hypertension and concomitant hyperlipidemia.
Myocardial alterations induced by prolonged noradrenaline administration in various doses
Authors: Popovich M. I. , Kobets V. A. , Kostin S. I. , Kapelko V. I.
Published: February 2009

Prolonged noradrenaline administration to rats in steadily increasing dosages for a period of one to four weeks (cumulative doses 25–35 mg/kg) resulted in the development of focal necrotic areas with abundant collagen fibers and marked hypertrophy of cardiomyocytes. Cellular diameter was higher by 37–44% and extracellular space area by 70–100%. A combination of overcontracted and overdistended sarcomeres in some cardiomyocytes and a twofold rise in serum creatine kinase presumably reflected cellular calcium overload. Myocardial high energy phosphate content was depleted to 50–62% of the control level. The extent of this depletion positively correlated with a decrease in heart rate and cardiac output of the isolated heart. The latter may be attributed to limited left ventricular filling caused by elevated LV diastolic pressure and stiffness. Minimal metabolic and functional changes were observed after lowest noradrenaline dose (5 mg/kg for nine days) that was followed by only moderate depletion of myocardial phosphocreatine content and moderate rise in LV diastolic stiffness. Results suggest that energy‐deficient increase in myofibrillar stiffness may form the basis for decreased myocardial distensibility and cardiac pump failure.
His bundle ablation for supraventricular arrhythmias to avoid spurious shocks of an implanted defibrillator
Authors: Jordaens L. , Caenepeel A. , Calle P.
Published: February 2009

Atrial fibrillation with fast ventricular response remains a matter of concern in patients treated with an implantable cardioverter defibrillator (ICD). A patient with dilated cardiomyopathy, suffering from atrial arrhythmias and recurrent cardiac arrest due to both ventricular tachycardia and ventricular fibrillation, is presented. Ablation of the AV node by means of low‐energy direct‐current shocks with subsequent pacemaker implantation was performed before ICD implantation. The patient received shocks after four months, when he had recurrence of AV conduction with a slow ventricular rate. Pacemaker interaction was excluded, and no short ventricular arrhythmias were observed. During electrophysiologic study after electrical conversion of atrial fibrillation, persistent second degree heart block was documented, giving further evidence that atrial arrhythmias were not responsible for the shocks. The patient's functional status remains good after more than 18 months of follow‐up.
Splenic infarction: A complication of cardiac catheterization
Authors: Rose Michal , Dinour Dganit , Chisin Roland
Published: February 2009

Patients with extensive atherosclerosis are at increased risk of developing embolic complications during cardiac catheterization. We describe a 51‐year‐old man with unstable angina and bilateral leg claudication who developed fever and right upper abdominal pain shortly after cardiac catheterization. Liver‐spleen scintigraphy demonstrated a wedge‐shaped filling defect compatible with splenic infarction, and serial scans performed over a period of five months showed resolution of this finding. Splenic infarction tends to be under‐diagnosed, and physicians should be aware of this potentially serious complication of cardiac catheterization.
Progression of valvular sclerosis in end‐stage renal disease treated by long‐term peritoneal dialysis
Authors: Hüting Jürgen
Published: February 2009

While patients with end‐stage renal disease treated by intermittent hemodialysis have frequent and progressive valve disease, nothing is known of the prevalence and course of valvular abnormalities in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Therefore, valves of 24 CAPD patients (ages 55±11 years; CAPD duration: 29±28 months) were studied in a prospective echocardiographic and Doppler echocardiographic follow‐up analysis over 35 months. Most frequent findings were sclerosis of the aortic annulus (100% at both assessments) and of the anterior mitral valve leaflet (first vs. follow‐up assessment: 88 vs. 96%). Sclerosis of the mitral valve annulus (58% vs. 63%), right coronary (54 vs. 63%) and noncoronary (50 vs. 67%) cuspis of the aortic valve and of the posterior mitral valve leaflet (25 vs. 50%) were less frequent but tended to be progressive (p=NS). The moderate form of mitral and aortic valve sclerosis was more frequent than the severe form (p<0.01 each) at both assessments. Patients with progressive valve disease were older (60±9 vs. 50±11 years; p<0.025) and had a higher frequency angina pectoris than those without a progression (5 vs. 0 patients; p<0.05). The number of patients with regular sinus rhythm decreased (from 22 to 16; p<0.03), atrial fibrillation developed in four patients, atrioventricular node rhythm following atrioventricular conduction defect developed in one patient, and atrioventricular conduction defect required implantation of a pacemaker in one patient. It is concluded that valvular sclerosis is frequent and progressive in patients with end‐stage renal disease treated with long‐term CAPD and is associated with supraventricular arrhythmia.
Cardiac tamponade in a patient with gaucher's disease
Authors: Mester Stephen W. , Weston Mark W.
Published: February 2009

Gaucher's disease, a familial inborn error of metabolism associated with hepatosplenomegaly and hypersplenism, was first described by Earnest Gaucher in 1882. By 1959, Hsia1 found published reports on more than 300 cases. Most reports mentioned the bleeding tendencies of patients with Gaucher's, but show that major hemorrhagic complications are rare. We report a case of hemorrhagic pericarditis with cardiac tamponade in a patient with Type I Gaucher's disease.
Torsade de pointes complicating acute myocardial infarction: tHe importance of autonomic dysfunction as assessed by heart rate variability
Authors: Carter James E. , Childers Rory W.
Published: February 2009

Torsade de pointes is a polymorphic ventricular tachycardia associated with QT‐interval prolongation rarely reported to occur in the setting of an acute myocardial infarction. Autonomic dysfunction has been implicated as a major stimulus for the development of this dysrhythmia. We describe the case of an 80‐year‐old woman who presented with an acute myocardial infarction and progressive QT‐interval lengthening. An 89‐beat run of torsade de pointes occurred during the time of the peak creatine phosphokinase (CPK) without electrolyte abnormalities or antiarrhythmic therapy. Assessment of autonomic tone using power spectral analysis of two consecutive 24‐h Holter recordings was performed indicating that a transient decrease in heart rate variability and increase in sympathetic tone preceded the tachyarrhythmia. This case shows the potential usefulness of heart rate variability analysis as a marker for autonomic dysfunction and arrhythmogenesis, particularly during myocardial ischemia.
Diagnosis of aortic pseudoaneurysm by echocardiography
Authors: Lasorda David M. , Power Thomas P. , Dianzumba Sinda B. , Incorvati Robert L.
Published: February 2009

The diagnosis of pseudoaneurysm of the ascending aorta is of paramount importance because of its propensity to rupture. As the frequency of surgical procedures involving the aortic root and valve increases, an increase in the incidence of aortic pseudoaneurysm may be anticipated. We recently studied a patient who developed pseudoaneurysm of the ascending aorta following repair of a Type I aortic dissection, utilizing a composite graft. Two‐dimensional echocardiography with color flow and pulsed Doppler imaging showed a large perigraft cavity communicating with the aorta. Echocardiography provides a safe noninvasive diagnostic tool for the evaluation of the aorta postoperatively and for screening for pseudoaneurysm formation in the follow‐up period.
Effective treatment of hypertension in patients with diabetes mellitus
Authors: Garber Alan J.
Published: February 2009

Atherosclerosis, presenting as macrovascular complications of diabetes mellitus, produces approximately 80% of all diabetic mortality, whether the patient has Type I insulin‐dependent diabetes (IDDM) or Type II non‐insulin dependent diabetes mellitus (NIDDM).' Specifically, 75% of this atherosclerotic macrovascular mortality flows as the outcome of coronary atherosclerosis, which is increased approximately two‐fold in men and four‐fold in women with diabetes as compared with otherwise matched populations with entirely normal carbohydrate tolerance.2,3The remaining 25% of this atherosclerotic mortality in patients with diabetes mellitus is the result either of accelerated cerebrovascular or of peripheral vascular complications of diabetes, both of which are increased four‐fold and five‐fold, respectively, in patients with diabetes mellitus, regardless of type. Furthermore, atherosclerosis is the principal cause of hospitalizations for patients with diabetes mellitus. Admissions for this complication account for approximately 77% of total hospitalizations for diabetes owing to complications. Aside from mortality data alone, atherosclerosis is obviously a leading cause of diabetic disability, since it produces patients who are chronic cardiovascular, peripheral or cerebrovascular cripples, perhaps for many years before their ultimate demise. Small blood vessel or microvascular complications of diabetes mellitus, while formerly thought to be the end‐stage in the unfolding of the diabetic process, do not appear to have the potential for mortality as do the atherosclerotic large blood vessel complications. On the other hand, microvascular complications are an important cause of diabetic disability since small blood vessel disease in the eye, as diabetic retinopathy, is now the leading cause of adult blindness in the United States, and small vessel disease in the kidney, as diabetic nephropathy, now exceeds hypertension as the leading cause of chronic renal failure and dialysis in the United States.
Is angiographic ventriculography necessary for the assessment of ischemic patients?
Authors: Katritsis D. , Shakespeare C. F. , Byrne C. , Watkins H. , Coltart D. J. , Webb‐Peploe M. M.
Published: February 2009

A total of 53 patients with a provisional diagnosis of ischemic heart disease and without any clinical evidence of valvular, congenital, or primary muscle heart disease were studied by echocardiography and biplane left ventricular cineangiography. For angiographic ejection fraction analysis, a program developed in our department for use on an Apple Macintosh computer interfaced to a digitizing tablet was employed. Echocardiographic outlines of systolic and diastolic images were traced with a digitizing system on the screen and ejection fractions were calculated by a program incorporated in the echo machine. Good echo windows allowing ejection fraction calculations were present in 35 patients. There was a good correlation between angiographic and echocardiographic ejection fraction (r=0.7, SEE=0.09), and wall motion assessment revealed no significant discrepancies between the two image modalities. The remaining 18 patients had poor echo windows, preventing accurate echocardiographic determination of the ejection fraction. However, limited assessment of left ventricular size and wall motion was possible in all patients and allowed the identification of those who had impaired left ventricular function as judged by angiography (angiographic ejection fraction < 35%). We conclude that even in patients with poor echo windows echocardiographic assessment of left ventricular function provides clinical information similar to angiography which should not be considered mandatory for the investigation of ordinary ischemic patients.
Combination of ramipril and hydrochlorothiazide in the treatment of mild to moderate hypertension: Part 1—a double‐blind, comparative, multicenter study in nonresponders to ramipril monotherapy
Authors: Heidbreder D. , Froer K.‐L. , Breitstadt A. , Cairns V. , Bender N. , Langley A.
Published: February 2009

In a parallel‐group multicenter study, the efficacy and safety of combination therapy with ramipril 5 mg plus hydrochlorothiazide 25 mg were compared double‐blind with those of 5 mg and 10 mg ramipril monotherapy in patients with mild to moderate hypertension who had not responded adequately to ramipril 5 mg alone. Patients were initially treated single‐blind for 1 week with ramipril 2.5 mg and 3 weeks with ramipril 5 mg. Of 240 patients enrolled, 165 were subsequently classed as nonresponders (diastolic blood pressure > 90 mmHg) and were randomized to one of the three double‐blind treatments for a further 4 weeks. In the double‐blind phase, the mean reductions in supine systolic and diastolic blood pressures at end point were significantly greater in the 5 mg plus 25 mg combination group (11.6/10.6 mmHg) than in the groups receiving ramipril 5 mg (6.2/5.9 mmHg; both p<0.01) and ramipril 10 mg (7.4/7.1 mmHg; both p<0.05). The proportion of responders at end point was also higher for combination therapy (72%) than for monotherapy (48% for ramipril 5 mg and 62% for ramipril 10 mg). All three treatments were well tolerated. Analysis of laboratory values revealed no clinically important changes.
The effect of chronic atrial overdrive suppression pacing on the incidence of supraventricular tachyarrhythmias
Authors: Shandling Adrian H. , Crump Randy , Nolasco Maria , Lorenz Linda M. , Li Curtis K.
Published: February 2009

Chronic overdrive suppression pacing has been suggested as an effective adjunctive method for reducing the incidence of cardiac tachyarrhythmias. Documentation of effectiveness during prolonged monitoring is lacking, however. To assess more accurately the long‐term utility of this treatment modality for medically refractory supraventricular tachyarrhythmias (SVTs), 10 patients with atrially implanted Intermedics Intertach pacemakers were randomly assigned to either a low or a high bradycardia (back‐up) pacing rate. SVT counts were performed during matching follow‐up periods both at the initial rate and after rate crossover. The primary antitachycardia modality of this pacemaker (P mod) provides burst pacing to terminate tachycardia episodes, and P mod counters were utilized to quantitate SVT episodes. Tachycardia termination algorithms were programmed to “no restart” and were not changed during the study. The P mod use counter, therefore, reflected the number of discrete episodes of SVTs. Pacemaker implantation diagnoses include atrial flutter, concealed bypass tract, AV nodal reentry, intraatrial reentry, and Wolff‐Parkinson‐White associated tachycardia. Patient age was 59 ± 18yrs. The average pacemaker backup low rate was 45.7±4 versus a back‐up high rate of 85.1 ±2 beats/min. Follow‐up was for 57.4 days±33 days at the low rate and 57.3 days ±34 days at the high rate (r=0.99). There was no difference in SVT incidence with a P mod usage of 98.4± 106 at the low rate and 100.8±94 at the high rate (p=NS). In this blinded, randomized crossover trial, chronic atrial overdrive suppression pacing did not reduce the overall incidence of SVT episodes during prolonged monitoring.
Asymmetrical septal hypertrophy in patients with hypertension: A type of hypertensive left ventricular hypertrophy or hypertrophic cardiomyopathy combined with hypertension?
Authors: Shimizu Masami , Sugihara Norihiko , Sffimizu Kuniyoshi , Yoshio Hiroyuki , Ino Hidekazu , Takeda Ryoyu , Nakajima Kenichi
Published: February 2009

To determine whether asymmetrical septal hypertrophy (ASH) in patients with essential hypertension (HT) is a type of hypertensive left ventricular (LV) hypertrophy or hypertrophic cardiomyopathy (HCM) combined with HT, we investigated a group of 7 hypertensive patients with ASH compared with 12 HCM patients and 10 healthy controls using radionuclide angiography and right ventricular endomyocardial biopsy. The LV time‐volume curve and its first and second derivative curves were constructed from cardiac output and time‐activity curves constructed by combined forward and reverse‐gating from the R wave. The LV wall thickness and ejection fraction were significantly greater in both the HT and HCM groups than in the control group, whereas there were no differences in these indices between the HT and HCM groups. Rapid filling volume index and rapid filling fraction showed significantly lower values in the HCM group than in the control group (p < 0.005). In contrast to the HCM group, these indices in the HT group did not differ from those in the control group. The time to peak filling rate was prolonged in the control, hypertension, and HCM groups in increasing order. Histopathological study revealed a higher incidence of myocardial cell disarray in the HCM than in the HT group. The above results suggest that ASH in hypertensive patients is a type of hypertensive LV hypertrophy.
Combination of ramipril and hydrochlorothiazide in the treatment of mild to moderate hypertension—part 2: An open long‐term study of efficacy and safety
Authors: Heidbreder D. , Froer K.‐L. , Bauer B. , Cairns V. , Breitstadt A. , Bender N.
Published: February 2009

In an open, multicenter extension of a short‐term study, 159 patients with mild to moderate hypertension were treated with either ramipril monotherapy or a combination of ramipril and hydrochlorothiazide for up to 1 year. Patients started with either 5 mg ramipril once daily (responders in the short‐term study) or a combination of ramipril 5 mg plus hydrochlorothiazide 25 mg once daily. The dose could be adjusted and nonresponders to ramipril monotherapy could have hydrochlorothiazide added. In the 38 patients treated with ramipril monotherapy, the largest drop in mean blood pressure (BP) had already occurred in the previous short‐term study; from Week 2 in the long‐term study, the BP remained stable with means below 150/90 mmHg. In the 83 patients treated with the combination for 50 weeks or more, mean BP continued to decrease until around Week 10 in the long‐term study while therapy was being adjusted. Thereafter, it also remained stable with means below 150/85 mmHg. Both treatment groups showed good mean reductions at end point, as did the group of 38 patients treated with the combination for less than 50 weeks. High response rates (84–95%) were seen in all groups at end point. The combination was well tolerated and the efficacy of ramipril in combination with hydrochlorothiazide was maintained over the 1‐year period of investigation.
Long‐term double‐blind evaluation of amlodipine and nadolol in patients with stable exertional angina pectoris
Authors: Singh Steven
Published: February 2009

The efficacy and tolerability of amlodipine 2.5–10 mg once daily was compared with nadolol 40–160 mg once daily in a long‐term double‐blind parallel‐group study in patients with stable exertional angina pectoris. A total of 80 patients were randomized to receive amlodipine or nadolol for 26 weeks after a 2‐week single‐blind placebo run‐in period. The effects of amlodipine and nadolol on total exercise time were minimal and not significantly different. However, amlodipine produced a slightly but not significantly greater increase in time to onset of angina than nadolol (+21% amlodipine; +8% nadolol). No significant differences were noted between amlodipine and nadolol on ST‐segment depression, angina attack rate, or nitroglycerin consumption. A slightly greater improvement was attained after amlodipine on patient and investigator assessments of treatments. A statistically significant difference (p < 0.0001) was found between treatments on the effects on myocardial oxygen requirements (as assessed by the rate pressure product). Nadolol produced a reduction of 29% compared with a slight reduction of 4% with amlodipine. Fewer side effects were reported with amlodipine (43%) than with nadolol (83%) (p<0.0001), resulting in discontinuation of therapy in three amlodipine and four nadolol patients. Long‐term treatment with amlodipine and nadolol produced comparable effects in patients with angina pectoris, with fewer side effects being reported after treatment with amlodipine.
Effects of physical exercise training in syndrome x
Authors: Leaf David A. , Goldhaber Joshua
Published: February 2009

Syndrome X categorizes myocardial disease characterized by impaired myocardial flow without macrovessel injury.1,2 The pathogenesis of this condition remains obscure.3,4 Similarly, therapy is not well defined.5 We report the effects of physical exercise training in a patient with Syndrome X.
Cardioprotection with angiotensin‐converting enzyme inhibitors: Redefined for the 1990s
Authors: Kloner Robert A. , Przyklenk Karin
Published: February 2009

The concept of “cardioprotection” with ACE inhibitors has evolved over the last decade. In the 1980s, protective benefits of ACE inhibitors in hypertension were established, regression of left ventricular hypertrophy was demonstrated, and improved ventricular function and survival in mild‐to‐moderate and severe congestive heart failure was documented. A further “protective” role of ACE inhibitors in coronary artery disease is emerging as more attention is focused on the concept of local tissue reninangiotensin systems. Recent contributions to the literature describe significant benefits of ACE‐inhibitor therapy in acute myocardial infarction, including suppression of ventricular arrhythmias and reduction of both early and late ventricular dilation, preservation of left ventricular function, and improved survival. All of the above effects can be considered “cardioprotective.” However, as new benefits are reported in the 1990s, a broadened view of “cardiovascular protection” emerges from investigative studies in the literature. ACE inhibitors may reduce tolerance to nitrates, reduce angina in some but not all studies, and limit smooth muscle cell proliferation (and perhaps restenosis) induced by experimental balloon angioplasty. Local vascular effects may attenuate atherosclerotic changes in the arterial wall in experimental animals and may decrease the incidence of aneurysm formation in hypertensive animals. The effectiveness of ACE inhibitors in acute myocarditis, suggested by reports that captopril may reduce lesions of murine myocarditis when administered early after infection with coxsackievirus B3, requires clinical confirmation. Despite these apparently diverse “cardiovascular protective” consequences of ACE inhibitor therapy, the mechanism(s) of action of these agents remain to be elucidated. These agents affect not only the systemic renin‐angiotensin systems, but local tissue systems as well. Debate continues as to the significance of the sulfhydryl group in certain ACE inhibitors: at the present time it is not clear whether the thiol group provides a treatment benefit. Finally, stimulation of other vasodilator systems by ACE inhibitors (bradykinin, prostacyclin) may play an important role in the “cardiovascular protective” effects of these agents.
Differences of intravenous nitroglycerin responses in left ventricular systolic and end‐diastolic pressures and coronary artery diameters during long‐term treatment with cutaneous nitroglycerin patches
Authors: Naito Hidetoshi , Matsuda Yasuo , Yorozu Tadao , Maeda Toshiaki , Tada Toshmko , Shomi Kohtaro
Published: February 2009

The differences of intravenous nitroglycerin responses in left ventricular (LV) systolic and end‐diastolic pressures and in coronary artery diameters (cross‐tolerance) were investigated in patients receiving nitroglycerin patches. During diagnostic cardiac catheterization, graded doses of 50,100, and 150 meg of intravenous nitroglycerin were given. Left ventricular systolic and end‐diastolic pressures and left coronary arteriograms were obtained during each dose. Twenty patients with coronary artery disease were studied. Before cardiac catheterization, 10 received nitroglycerin patch (patch group), and 10 did not (control group). In the control group, graded intravenous nitroglycerin doses of 50,100, and 150 meg caused decrease in LV systolic pressure of 18 ± 7%, 20 ± 5%, and 23 ± 6%, respectively. In the patch group, the same intravenous nitroglycerin doses decreased LV systolic pressure by 12 ± 6% (p < 0.05), 19 ± 7% (NS), and 18 ± 6% (p<0.05), respectively, (p value: vs. control group). At the same intravenous nitroglycerin doses, LV end‐diastolic pressures were decreased by 48 ± 14%, 52 ± 17%, and 56 ± 9%, respectively, in the control group. However, there were no significant differences in LV end‐diastolic pressure between the two groups for any of the three intravenous nitroglycerin doses. The same intravenous nitroglycerin doses caused increase in diameter of the left anterior descending coronary artery and circumflex coronary artery in the control group, which was attenuated significantly in the patch group. Tolerance may develop in LV systolic pressure and coronary artery diameters, whereas it may not develop in LV end‐diastolic pressure. These results suggest that tolerance to nitroglycerin in relieving ischemic manifestations may be different for each system, depending on the dose of nitroglycerin.
Limited value of anaerobic threshold for assessing functional capacity in patients with heart failure
Authors: Miyagi Kyoko , Asanoi Hidetsugu , Ishizaka Shinji , Kameyama Tomoki , Sasayama Shigetake
Published: February 2009

Exercise tolerance was assessed in 146 patients with cardiac dysfunction in terms of anaerobic threshold (ATge). Patients were divided into four classes according to the peak oxygen uptake: Class A (72 patients) exceeding 1000 ml/min; Class B (27 patients) 800‐999 ml/min; Class C (37 patients) 500‐799 ml/min; and Class D (10 patients) below 500 ml/min. An incidence of the ATge breakpoint was lower in patients of Class C (38%) than in those of either Class B (70%, p < 0.05) or Class A (87%, p < 0.05). The ATge could not be determined in any patients in Class D. The V‐slope method improved the ability to determine ATge by 20%. In Classes C and D, ATge detection was precluded considerably by the fact that the initial workloads of exercise test involved oxygen uptake levels already close to or above the ATge. An oscillatory hyperventilation pattern was also significantly related to failure in defining ATge in Class C patients. Of the 51 patients whose ATge was undetermined, 9 had an atrial septal defect In two of these, exercise‐induced right‐to‐left shunting led to progressive arterial hypoxemia, and the consequent hyperventilation masked the appearance of ATge. Thus, ATge is virtually undetectable in patients with severe heart failure largely because of the early onset of anaerobic metabolism or abnormal ventilatory responses to exercise. Accordingly, the clinical application of ATge in the assessment of functional capacity would be limited to patients with mild to moderate heart failure.
Acute myocardial infarction with ventricular septal rupture
Authors: Hackel Donald B. , Wagner Galen S.
Published: February 2009

The interventricular septum is one of the three main sites at which the myocardium can rupture. The features of the interventricular septal rupture that occurred in a 72‐year‐old woman are characteristic of interventricular septal ruptures in general: (1) they occur most commonly in elderly women; (2) the most common site is the midportion of an acute, transmural anteroseptal apical infarct; (3) they are also most common during the patient's first heart attack; (4) the clinical diagnosis of acute myocardial infarct is confirmed by both ECG and by serum enzyme levels; (5) the usual time of the rupture is 3–10 days after the onset of the infarction (it occurred after 3 days in our patient); (6) a new cardiac murmur usually is heard and the patient frequendy goes into shock; (7) the diagnosis can be confirmed by a step‐up in pO2 levels from right atrium to right ventricle; (8) the usual cause is severe old coronary atherosclerosis with a recent thrombotic occlusion as the final precipitating event.
Transesophageal echocardiography in the diagnosis of acquired aneurysms of the left atrial appendage
Authors: Culver Deborah L. , Bezante Gian Paolo , Schwarz Karl Q. , Meltzer Richard S.
Published: February 2009

We report a patient with what appeared to be a pericardial cyst by transthoracic echocardiography but was, in effect, an aneurysm of the left atrial appendage as documented by transesophageal echocardiography.
Cardiogenic shock: Elements of etiology, diagnosis, and therapy
Authors: S. Alpert Joseph , C. Becker Richard
Published: February 2009

Cardiogenic shock usually is the result of marked depression in myocardial function. Rapid recognition and stabilization are essential if the patient is to survive. A variety of cardiovascular conditions can lead to cardiogenic shock; the most common of these is acute myocardial infarction. Once stabilization of the cardiogenic shock patient has been effected, hemodynamic monitoring and definitive therapy should be attempted if appropriate. Intra‐aortic balloon counterpulsation is effective in stabilizing these patients temporarily. Definitive therapy may include surgical or catheterization interventions. Mortality, even under the best of circumstances, remains high.
Functional health status in male patients without restenosis following successful ptca
Authors: Franzen Damian , Nicolay Claudia , Maria Schannwell Mira , Albrecht Dirk , Wilhelm Höpp Hans , Herman Hilger Hans
Published: February 2009

In a prospective pilot study, subjective and objective parameters of the health status were assessed in 148 male patients (mean age 56 ± 8.4 years) before and 4 months after successful coronary angioplasty (PTCA). Restenosis was defined as residual diameter stenosis >50%. Although 96 patients (65%) had not developed restenosis at 4 months' invasive follow‐up, subjective asessment of general well‐being was unchanged in 26% or worse in 71%; overall anginal status and exercise performance had however improved. Of 71 men younger than 60 years who had no restenosis at follow‐up, 4 men retired and 13 remained on medical leave. The striking disparity between subjective and objective parameters was not related to significant differences of age, exercise capacity, and left ventricular ejection fraction, as well as to baseline characteristics (previous myocardial infarction, extent of coronary heart disease, comorbidity) compared with 52 patients with restenosis. Thus, despite documented sustained success after PTCA, the majority of patients failed to resume the status of subjective well‐being.
Isolated left posterior fascicular block: A reliable marker for inferior myocardial infarction and associated severe coronary artery disease
Authors: J. Godat François , Gertsch Marc
Published: February 2009

The electrocardiographic (ECG) pattern of isolated left posterior fascicular block (LPFB) is a rare condition. It seems that true LPFB is often not recognized, whereas in cases of simple QRS axis of +60d̀ to+100d̀ in the frontal plane, the diagnosis of LPFB is made erroneously. Both facts rely on controversial and partially misleading opinions in the literature. Therefore, a retrospective and prospective study was performed in order to determine the prevalence of LPFB and to correlate its presence to the underlying disease. Retrospective study: Of a cohort of 830 patients referred in 1988 to a cardiologic laboratory for invasive investigation of certain or suspected coronary artery disease (CAD), 163 patients had an old inferior myocardial infarction (IMI). Nine patients (5.5%) showed the typical pattern of LPFB; eight of these had three‐vessel disease. The diagnosis of IMI had been made only in one case before entry of the patient into the hospital, since LPFB generally masks IMI. Prospective study: 2502 ECGs were investigated, 1710 from a department of cardiology and 792 from two departments of internal medicine. Six LPFBs were detected (0.24%), all associated with IMI and four of them with three‐vessel CAD. It is concluded that LPFB is a rare but clinically important intraventricular conduction disturbance. Its appearance is reliably connected with IMI and generally reflects severe three‐vessel CAD, requiring invasive investigation.
Myocardial infarction in qatar: The first 2515 patients
Authors: Chaikhouni A. , Chouhan L. , Pomposiello C. , Banna A. , Mahrous F. , Thomas G. , Abu Al‐Hassan N. , Khalifa S. , Jaddan A. , Bsata M. W. , Hajar H. A.
Published: February 2009

The data registry of all patients admitted between 1982 and 1990 to the Coronary Care Unit at Hamad General Hospital with the diagnosis of documented acute myocardial infarction is reviewed. We report a total of 2,515 patients (86.6% men and 13.4% women) with a mean age of 51 years (range 18‐99). Of these, 62% were smokers, 29% had diabetes, and 20% had hypertension. The hospital mortality rate was 10%. The most significant factors associated with higher mortality were older age, female gender, and anteroseptal infarction. The age of 23% of the patients was 40 years or younger. Comparison between these younger patients (Group I) and those over 40 years (Group II) demonstrated that Group I had lower mortality (3.6%) than Group II (12%) (p<0.001). Group I patients were predominantly men (96.8%), of Asian nationalities (71 %), and usually smokers (78%). The observation that myocardial infarction occurs frequently in young Asian men needs further evaluation to identify specific risk factors.
Hemodynamic response to intravenous enalaprilat in patients with severe congestive heart failure and mitral regurgitation
Authors: Varriale Philip , David William , E. Chryssos Basil
Published: February 2009

The hemodynamic response 1 hour after 1.25 mg of intravenous (IV) enalaprilat was examined in 20 patients (mean age 75 years) with severe congestive heart failure (CHF) and mitral regurgitation (MR), secondary to ischemic heart disease (NYHA Class IV). Patients were classified into two groups based upon the magnitude of MR as derived from Doppler color flow imaging: Group I (n = 13) had severe MR and Group II (n = 7) had moderate MR. Acute therapy significantly reduced systemic vascular resistance index in both groups and provided effective afterload reduction. Although cardiac and stroke volume indices increased in both groups, an improved forward flow was significant only for Group I (cardiac index 2.2 ± 0.5 to 2.7 ± 0.51/min/m2, p < 0.02). The magnitude of MR, acutely reduced in all patients, was similarly significant only for Group I (56 ± 10% to 31 ± 12%, p < 0.01). The reduction of both pulmonary capillary wedge pressure and mean arterial pressure was significant for both groups. This study supports the use of IV enalaprilat, a parenteral angiotensin‐converting enzyme (ACE) inhibitor, as an effective and rapidly acting vasodilator in the management of selected patients with chronic heart failure and MR who require immediate hemodynamic improvement.
Polymorphism of the cardiac manifestations in dermatomyositis
Authors: Tami Luis F , Bhasin Surj
Published: February 2009

Cardiac involvement in polymyositis and dermatomyositis usually is asymptomatic and rarely the principal clinical feature at the time of initial presentation. We describe a patient with dermatomyositis who presented with overt acute pericarditis which has not, to our knowledge, been previously reported. Acute pulmonary edema resulting from documented acute myocarditis developed during a second exacerbation. Long‐term follow‐up failed to demonstrate new cardiac complications during subsequent exacerbations, adding to the known polymorphism of the heart involvement in these systemic disorders.
Exercise‐induced ventricular tachycardia: A rare manifestation of digitalis toxicity
Authors: Gosselink A. T. Marcel , J. G. M.Crijns Harry , Wiesfeld Ans C. P. , Lie Kong I.
Published: February 2009

Digitalis intoxication is one of the most common adverse drug reactions. Although some arrhythmias are seen more frequently than others, virtually any rhythm disturbance, including ventricular tachycardia, may occur. However, to our knowledge, exercise‐induced ventricular tachycardia as a complication of digitalis therapy has never been described before. This case presents a patient with a digitalis‐induced ventricular tachycardia occurring exclusively during exercise.
Characteristics of reactive electropermeable points on the auricles of coronary heart disease patients–K. Saku et al.: Reactive electropermeable points in CHD
Authors: Saku Keijko , Mukaino Yoshtto , Ying Hong , Arakawa Kikuo
Published: February 2009

In oriental medicine there is a hypothesis related to acupuncture that the auricle is a projection of the functional anatomy of the whole human body. In this study reactive electropermeable points (REPP), that is, points on the skin with low electrical resistance, on the auricle were measured on patients with coronary heart disease using a neurometer LC‐M. Our findings correlated positively with the particular points—heart I (shin) and heart II (shinzo)

Here, as throughout this paper, these readings represent the Japanese readings of the Chinese characters used to represent the various parts of the auricle.

—named by the Chinese group as being related to the functional anatomy of the heart. The incidence of positive REPP test results at the shin and shinzo points for subjects with acute myocardial infarction (AMI) were extremely high, and positive test results for patients with old myocardial infarction (OMI) and angina pectoris (AP) were also significant. There was no significant difference in the incidence rates of REPP at the shin and shinzo points between the OMI and AP groups. High incidence of positive REPP test results at the lung and heart III (shinyu) points occurred only in the AMI group, and this was significantly high when compared with the control group.
The effect of magnesium versus verapamil on supraventricular arrhythmias
Authors: Gullestad Lars , Birkeland Kare , Vanberg PÅL , Mølstad Per , Høyer Marit Moen , Kjekshus John
Published: February 2009

Magnesium has previously been used in the treatment of various arrhythmias, but few randomized and prospective studies are available. In a single‐blind study, the efficacy and safety of intravenous magnesium sulfate (bolus doses of 5 + 5 mmol followed by infusion of 0.04 mmol/min) versus verapamil (5 + 5 mg followed by 0.1 mg/min) was evaluated in 57 patients with supraventricular arrhythmias (supraventricular tachycardia, atrial fibrillation, and atrial flutter) of recent onset (less than 1 week). Fifteen (58%) of the patients receiving magnesium (n = 26) converted to sinus rhythm within 4 h, and 16 (62%) within 24 h. Verapamil caused a lower ventricular rate, but only six (19%) of the patients (n = 31) converted to sinus rhythm within 4 h (p < 0.01) and 16 (52%) within 24 h (NS). No side effects were observed during magnesium infusion, whereas six patients receiving verapamil had to be withdrawn from further study medication due to symptomatic side effects (hypotension in three, cardiac failure in three). Magnesium appears to be an effective and safe drug for the treatment of supraventricular arrhythmias. The overall efficacy for conversion to sinus rhythm is at least as effective as with verapamil, and its action is more rapid.
Anatomy, histology, and pathology of the cardiac conduction system—part III
Authors: Waller Bruce F. , Gering Lawrence E. , Branyas Nancy A. , Slack John D.
Published: February 2009

The cardiac conduction system may be affected by various pathologic changes. Some of these changes are general and affect the nonconduction system tissues of the heart (atrophy, fibrosis, necrosis, segment deposition, mineral) and others are more localized to the conduction system (Lev and Lenegre disease). Pathologic conditions associated with atrial, junctional, and ventricular arrhythmias are reviewed.
Systolic apical filling in a patient with progressive apical hypertrophic cardiomyopathy and giant negative T waves
Authors: Joseph Waldo , Spellberg Richard D.
Published: February 2009

A relatively asymptomatic 58‐year‐old nonhyper‐tensive male developed changes of remarkable apical hypertrophic cardiomyopathy associated with deep negative T‐wave change and marked ventricular dyssynergy without apparent precipitating cause over a nine‐year period.
Determinants of immediate and follow‐up results of pulmonary balloon valvuloplasty
Authors: Shrivastava S. , Krishna Kumar R. , Dev V. , Saxena A. , Das Gladwin
Published: February 2009

The data of 93 patients (age 11.4 ± 9.4 years, range 8 months ‐ 56 years) who underwent pulmonary balloon valvuloplasty (PBV) for valvular pulmonic stenosis (PS) in our institution are reviewed. The patients were classified into three groups: Group I (34 patients) had a right ventricular (RV) to aortic systolic pressure ratio of < 1, Group II (39 patients) had suprasystemic RV systolic pressures, and Group III (20 patients) included patients with elevated mean right atrial (RA) pressures irrespective of the RV systolic pressures. The percentage drop in immediate postdilatation peak systolic gradients (PSG) and the follow‐up PSG were similar in the three groups and were not influenced by any predilatation patient characteristics. A balloon‐annulus ratio < 1 predicted a poorer follow‐up outcome. Nine patients, eight of Group III and one of Group II, experienced difficult procedures requiring sequential use of progressively larger balloon catheters. Eleven patients, six of Group II and five of Group III, experienced procedure‐related events (hypotension, bradycardia/asystole, hypoxia, apnea, tachyarrhythmias, and seizures) and one patient (Group II) died. Although changes in immediate and follow‐up gradients after PBV are not influenced by the severity of PS, difficult procedures and procedure‐related events are particularly common in patients with severe PS and elevated RA pressures. A cautious and planned approach is therefore indicated in these patients.