bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of propranolol on indices of intermittent myocardial ischemia, assessed by exercise testing and ambulatory st‐segment monitoring
Authors: Khurmi N. S. , Bowles M. J. , O'Hara M. J. , Raftery E. B.
Published: February 2009

Seventy three patients (63 males and 10 females) aged 41–75 years with established stable exertional angina pectoris were studied in a double‐blind fashion to confirm the efficacy of 80 mg propranolol administered three times daily and also to examine its effect on ST‐segment changes in the electrocardiogram by ambulatory ST‐segment monitoring and exercise testing using on‐line computer analysis. During ambulatory monitoring, episodes of ST‐segment depression in lead CM5 were significantly reduced from 6.5±0.7 during placebo to 3.4±0.6 during propranolol therapy (p<0.001). The total duration of ST‐segment depression was also significantly reduced and the maximal depth of ST‐segment depression improved from 2.6±0.2 mm during placebo to 1.7±0.2 mm during propranolol therapy (p<0.001). The mean ± SEM exercise time of 5.5±0.2 minutes on placebo increased to 8.6±0.4 minutes on propranolol 240 mg daily (p<0.001). The 1 mm ST‐segment depression time of 3.5±0.2 minutes on placebo in lead CM5 was prolonged to 6.2±0.3 minutes during propranolol therapy (p<0.001). Propranolol treatment significantly reduced the resting and maximal heart rates (p<0.001). The maximal ST‐segment depression during exercise in lead CM5 was reduced from 2.3±0.1 mm on placebo to 1.9±0.1 mm with propranolol (p<0.01). Similarly, the rate‐pressure product at peak exercise of 188±5 units on placebo was reduced to 144±3 units with propranolol (p<0.001). Eleven patients were rendered angina free during treadmill testing. Two patients were withdrawn due to adverse effects. In conclusion, propranolol is confirmed to be an effective antianginal agent which improves the ST‐segment changes during controlled as well as uncontrolled conditions and acts by lowering the heart rate and rate‐pressure product.
Chest pain in acute myocardial infarction: A descriptive study according to subjective assessment and morphine requirement
Authors: Herlitz J. , Richterova A. , Bondestam E. , Hjalmarson Å , Holmberg S. , Hovgren C.
Published: February 2009

In 722 patients with suspected acute myocardial infarction (MI) we have tried to describe the course of chest pain according to their own assessment and morphine requirement. Patients were asked to score pain from 0‐10 every second hour after arrival in the coronary care unit (CCU) and also to score their maximal pain at home. A very high intensity of chest pain was observed at home (mean score 7.1). At arrival in the CCU the mean pain score already had declined to 1.8, although 51% still had chest pain. Pain score declined successively during the first 12 hours in the CCU. At 24 hours after arrival, 20% still had some chest discomfort. in one quarter of the series a score of more than 0 was observed later than 24 hours after arrival in CCU. Patients developing definite MI had, as expected, a longer duration of pain and a much higher requirement of morphine compared with those with no MI. The difference between MI and no MI patients regarding subjective assessment of the initial intensity of pain at home and in hospital was, however, surprisingly low.
Electrophysiologic effects of ethmozin on sinus node function in patients with and without sinus node dysfunction
Authors: Shugushev K. Kh. , Rosenshtraukh L. V. , Smetnev A. S.
Published: February 2009

To compare the effects of ethmozin on sinus node (SN) function in the presence (9 patients) and absence (17 patients) of SN dysfunction, sinus cycle length (SCL), maximal corrected sinus recovery time (CSRT), paced cycle length yielding peak SN suppression, and indirect sinoatrial SA conduction time (SACT) were determined before and after intravenous administration of ethmozin in the dose 2 mg/kg. The mean ± SD SCL were significantly shortened in patients with normal SN and were not changed in patients with SN dysfunction after ethmozin administration. The mean maximal CSRT was 252±72 before and 284±86 ms after ethmozin administration in patients with normal SN function (p<0.05). in patients with SN dysfunction (p<0.1) the mean maximal CSRT was found to be 1016±434 before and 2170±1756 ms after ethmozin administration. The mean SACT was 158±41 before and 174±51 ms after drug administration in patients with normal SN (p<0.05). Four out of nine patients with SN dysfunction developed second degree SA exit block after ethmozin administration, whereas SACT increased significantly in the remaining group of patients (180±35 to 210±32 ms; p<0.05). The PR, PA, AH, and HV intervals significantly lengthened and the valves of QRS and QT were not changed after ethmozin administration in either group. The conclusion is drawn that ethmozin should be administered cautiously to patients with SN dysfunction, particularly to patients with SA exit block, sinus pauses, or secondary pauses (in particular, with bradycardia‐tachycardia syndrome).
Rupture of the pericardium presenting as postpericardial trauma syndrome late after blunt chest injury
Authors: Kyriakidis M. , Vassiliadis J. , Kyriakidis C. Robinson , Toutouzas P.
Published: February 2009

A 40‐year‐old man presented with a clinical picture of postpericardial trauma syndrome six weeks after blunt injury to the chest. Posttraumatic pericardial rupture was diagnosed at exploratory thoracotomy. The presence of aortic regurgitation due to a previously undiagnosed congenital sinus of Valsalva aneurysm complicated the clinical picture. To our knowledge this is the first report of postpericardial trauma syndrome associated with pericardial rupture after blunt chest injury. It emphasizes the high index of suspicion required for diagnosis of pericardial rupture, a condition with potentially lethal complications.
Severe aortic regurgitation: A rare presentation of giant cell arteritis
Authors: Vered Z. , Pras M. , Horowitz A. , Rath S. , Neufeld H. N.
Published: February 2009

A 53‐year‐old patient with no past history of rheumatic fever or lues presented with severe aortic regurgitation, underwent hemodynamic evaluation, and subsequently, an uneventful aortic valve replacement. The initial pathological interpretation was nonspecific aortitis. Six months following surgery arthralgia, muscular pain, difficulty in mastication, and fatigue occurred. There was no fever, however, sedimentation rate was 100/130. Cardiac examination was normal. Review of the pathological specimens revealed granulomatous arteritis with giant cells, typical of giant cell arteritis. Though the association of aortic regurgitation and giant cell arteritis is well recognized, only two such cases of severe aortic regurgitation requiring valve replacements have yet been described, of them, one probably had Takayasu's arteritis. An accurate diagnosis is of importance since steroid treatment is effective, and if introduced early, the inflammatory process may be arrested.
Relationship between systolic time intervals and arterial blood pressure
Authors: Cinelli P. , De Scalzi M. , De Leonardis V. , Citi S.
Published: February 2009

It has been suggested that systolic time intervals (STI) can be used to monitor the cardiac effects of antihypertensive treatments and also to evaluate hypertensive patients. STI changes observed in hypertensives have been ascribed to myocardial disease, although they could be due to the existence of a relationship between STI and blood pressure. A group of 37 subjects (18 normotensives and 19 hypertensives) with no signs of heart failure and left ventricular dysfunction were studied to examine the relationship of STI to blood pressure. Pacing with an external battery pulse generator was performed at the rate of 95 beats/min in order to eliminate differences in heart rate. STI were measured from good quality high speed (100 mm/s) recordings and the average value of 10 consecutive cardiac cycles was used for statistical analysis. Normal subjects showed significantly lower values of preejection period (PEP), electromechanical systole (QS2), and pre‐ejection period/left ventricular ejection time ratio (PEP/LVET). Moreover, a significant inverse relationship between diastolic pressure and LVET and significant direct relationships between diastolic pressure and PEP, systolic pressure and PEP, diastolic pressure and PEP/LVET, and between systolic pressure and PEP/LVET were demonstrated. We suggest to consider the relation of STI to blood pressure to provide regression equations to best appreciate and use STI.
Ascending aorta aneurysm in isolated right aortic arch
Authors: Daruwala D. F. , Desai A. G. , Sharma S. , Mashru M. R. , Hansoti R. C.
Published: February 2009

A case of saccular ascending aorta aneurysm in isolated right aortic arch is reported, probably for the first time in the literature.
“Flipped” lactic dehydrogenase pattern in acute coronary insufficiency
Authors: Weinberger I. , Rotenberg Z. , Sagie A. , Fuchs J. , Sperling O. , Agmon J.
Published: February 2009

Serum lactic dehydrogenase (LDH) isoenzymes were measured 24, 48, and 72 hours after admission in 85 patients with acute coronary insufficiency (ACI) and 10 patients with stable angina pectoris who served as controls. The above patients did not develop myocardial infarction according to the criteria of development of new Q waves or elevation of cardiac enzymes. In 15 patients with ACI a “flipped” LDH pattern (LDH1 > LDH2) was found in the presence of normal total LDH activity and normal creatine kinase‐MB. The values of LDH 1:2 ratio ranged between 1.02 and 1.13 (normal values 0.45–0.75). In the 10 control patients, normal levels of total LDH and normal LDH enzyme distribution and creatine kinase‐MB were found. A possible explanation for the flipped LDH pattern in the ACI patients (indicating some myocardial damage) could be myocytolysis and coagulation necrosis found on postmortem examinations. The conclusion of our study is that LDH isoenzymes should be measured in patients with ACI to determine the LDH 1:2 ratio. The finding of a “flipped” LDH pattern demonstrating myocardial damage, lacking in stable angina, may also be helpful in patients who developed the clinical picture of ACI more than 24 hours before arrival at the hospital, since by that time the creatine kinase‐MB may have already returned to normal. An additional advantage of measuring LDH isoenzymes in these patients may be that patients with “flipped” LDH pattern may need a longer rest and earlier coronary angiographic evaluation.
QRS complex recovery during one year after acute myocardial infarction
Authors: Richter A. , Herlitz J. , Hjalmarson R.
Published: February 2009

The recovery of the ECG signs of anterior myocardial infarction has been studied in 70 patients. A significant increase in R‐wave amplitude and decrease in Q‐wave amplitude on 24‐lead precordial mapping was observed during one year after infarction. Patients with lower initial heart rate showed a greater recovery of R‐and Q‐wave amplitudes, as did patients with smaller infarcts, as assessed by peak heat‐stable lactate dehydrogenase (LDH).
Right ventricular infarction: Unusual electrocardiographic and electrophysiological manifestations
Authors: Kriwisky M. , Ackerman Z. , Mosseri M. , Gotsman M. S. , Hasin Y.
Published: February 2009

Right ventricular infarction occurs in 19–43% of patients with acute inferior wall infarction (Lorell et al., 1979). Its clinical, hemodynamic, and anatomic features are well known and include associated inferior wall infarction, distended neck veins, clear lung fields, hypotension, and heart block (Cintron et al., 1981; Coma‐Canella et al., 1979; Lloyd et al., 1981; Lopez‐Sendon et al., 1981; Raabe and Chester, 1978; Rotman et al., 1974). Isolated right ventricular infarction is less frequent and occurs in 2.5–4.6% of autopsy studies of myocardial infarction (Cohn et al., 1974; Erhardt et al., 1976; Wartman and Hellerstein, 1948). This report describes a patient with isolated right ventricular infarction with unusual electrophysiological findings. Her initial electrocardiogram showed atrial escape rhythm with incomplete right bundle‐branch block and left posterior hemiblock. Later, she developed atrioventricular (AV) block with supra‐ and infra‐Hisian, “phase 4,” conduction defects. The sinus malfunction and high degree AV block persisted over 2 weeks and an atrioventricular sequential pacemaker was implanted. Hymodynamic study showed that her cardiac output was highly dependent on the heart rate and properly timed AV interval, and the pacemaker was programmed accordingly.
Laser‐assisted endocardiectomy for refractory ventricular tachyarrhythmias: preliminaRy intraoperative experience
Authors: Isner J. M. , Mark N. A. Estes , Payne D. D. , Rastegar H. , Clarke R. H. , Cleveland R. J.
Published: February 2009

Previous in vitro investigations utilizing necropsy specimens have suggested a potential role for laser irradiation in the treatment of refractory ventricular tachyarrhythmias associated with pathologically thickened endocardium. In the patient described in the present report, findings of these previous in vitro studies were applied intraoperatively to a patient undergoing surgery for ischemic heart disease associated with ventricular tachyarrhythmias. Aneurysm resection and manual subendocardial resection were performed using standard techniques. Laser irradiation was used to ablate pathologically thickened endocardium involving the papillary muscle and thereby avoid mitral valve replacement. Postoperatively, there was no auscultatory evidence of mitral regurgitation, and ventricular tachycardia could not be induced by electrophysiologic provocative testing. This preliminary experience confirms that laser irradiation is both a feasible and potentially advantageous means of accomplishing endocardial debridement in patients undergoing arrhythmiaablation procedures.
Predictors of the variation of the ejection fraction during exercise in patients with and without coronary heart disease
Authors: Peperstraete B. , Decoodt P. , Paternot J. , Dumont N. , Verhas M. , Telerman M.
Published: February 2009

The aim of this study was to determine the factors influencing the different response of the ejection fraction (EF) of the left ventricle at exercise observed in patients with and without significant coronary heart disease. We have studied 98 patients referred for coronary angiography (82 men, 16 women), of whom 49 patients had a previous myocardial infarction and 71 patients had significant coronary heart disease. Exercise testing was performed and combined with a cardiac blood pool imaging at equilibrium. The variation of the EF between rest and peak exercise (ΔEF) was measured. Twelve clinical, exercise‐related, isotopic, and coronary arteriographic variables were examined in a linear univariate and statistical analysis. In the univariate regression, seven variables were significant regressors on the ΔEF. In the multivariate regression, only four variables were significant regressors on the ΔEF. Three independent predictors were found: the rate‐pressure product, the ST depression, and the occurrence of a previous myocardial infarction. These three independent predictors reflect the myocardial functional reserve.
Pericardial effusion: Diagnostic value of the subcostal acoustic window (inferior vena cava‐right atrial projection)
Authors: Candell‐Riera J. , Garc‐a‐del‐castillo H. , Permanyer‐Miralda G. , Soler‐Soler J.
Published: February 2009

To validate the usefulness of the subcostal acoustic window (inferior vena cava‐right atrial projection) for the echocardiographic diagnosis of pericardial effusion we studied 40 patients with pericardial effusion detected through the parasternal approach. A group of 100 patients without evidence of effusion constitutes the control group. In all patients in the control group, a contact between the right atrial wall and the diaphragm was noted during the cardiac cycle (specificity: 100%). This had also been detected in 15 of 18 patients with mild effusion and in only 1 of 11 patients with moderate effusion, and in none of 11 patients with severe effusion (overall sensitivity: 60%). Therefore, moderate and severe pericardial effusions can be detected in most cases (95.4%) below the right atrial wall through the subcostal inferior vena cava‐right atrial projection. The echocardiographic criteria for its diagnosis is the lack of contact through the cardiac cycle between right atrial wall and the diaphragm.
Arrhythmogenic right ventricular dysplasia presenting with ventricular tachycardia in a father and son
Authors: B‐Lundqvist C. , Eneström S. , Edvardsson N. , Olsson S. B.
Published: February 2009

A father and his son presented with ventricular tachycardia of left bundle‐branch block configuration, two years apart. The patients had no clinical signs of right or left ventricular dysfunction. The diagnosis of arrhythmogenic right ventricular dysplasia was based on right ventricular angiographic and radionuclide findings. Microscopic sections obtained at surgery for the ventricular tachycardia in the father revealed abnormal infiltration of fat and focal fibrosis in the right ventricular myocardium, confirming the diagnosis. The importance of thorough evaluation of right and left ventricular function and structure in patients with ventricular tachycardia of right ventricular origin is emphasized. Currently available diagnostic techniques and management are presented.
Clinical significance of early diastolic time intervals for the differentiation of idiopathic dilative cardiomyopathy from ischemic cardiomyopathy
Authors: Sekiya M. , Hamada M. , Kokubu T.
Published: February 2009

In order to differentiate idiopathic dilative cardiomyopathy from ischemic çardiomyopathy noninvasively, systolic time intervals (STIs) and early diastolic time intervals were investigated in patients with idiopathic dilative cardiomyopathy (n = 11), patients with ischemic cardiomyopathy (n = 8), and normal controls (n = 17). Minimal left ventricular pressure and pulmonary capillary wedge pressure (PCWP) were also measured to clarify the relationship between early diastolic time intervals and early diastolic hemodynamics. Cardiac function estimated by STIs was markedly depressed both in idiopathic dilative cardiomyopathy and ischemic cardiomyopathy, and there was no difference between the two diseases. In early diastolic time intervals, IIA‐O time (the interval from the aortic component of the second heart sound to the O point of apexcardiogram) was significantly prolonged both in idiopathic dilative cardiomyopathy (144±31 (SD); p<0.01) and ischemic cardiomyopathy (153±15; p<0.01) compared to normal controls (126±11). IIA‐MVO time (the interval from IIA to the mitral valve opening) in idiopathic dilative cardiomyopathy (49±23) was significantly shorter than that in normal controls (70±8; p<0.05). On the contrary, IIA‐MVO time in ischemic cardiomyopathy (126±11) was markedly prolonged compared with normal controls (p<0.01) and idiopathic dilative cardiomyopathy (p<0.01). MVO‐O time was significantly prolonged in idiopathic dilative cardiomyopathy (94±18; p<0.01). However, it was conversely shortened in ischemic cardiomyopathy (25±15) compared with normal controls (54±7; p<0.01). Minimal left ventricular pressure in ischemic cardiomyopathy was significantly higher than that in idiopathic dilative cardiomyopathy and normal controls (each p<0.05). PCWP in idiopathic dilative cardiomyopathy was relatively higher than that in ischemic cardiomyopathy. The smaller value of pressure difference between PCWP and minimal left ventricular pressure in ischemic cardiomyopathy might contribute to the shortening of MVO‐O time. The different characteristics of early diastolic time intervals in idiopathic dilative cardiomyopathy and ischemic cardiomyopathy are of important diagnostic value in differentiating idiopathic dilative cardiomyopathy from ischemic cardiomyopathy noninvasively.
Short‐ and long‐term dobutamine treatment in chronic ischemic heart failure
Authors: Lewin R. F. , Davidson E. , Zafrir N. , Strasberg B. , Sclarovsky S. , Hellman C. , Agmon J.
Published: February 2009

This study was undertaken in order to characterize the short‐term (1 hour) and long‐term (72 hours) effect of dobutamine on hemodynamic and regional ejection fraction parameters measured by radionuclear angiography in patients with chronic congestive heart failure due to coronary artery disease. Baseline hemodynamic and radionuclear parameters were measured and then intravenous dobutamine (8.5 ±/kg/min) was administered. The above parameters were determined again after 1 hour and 72 hours of continuous dobutamine administration. Sixty minutes (short‐term) after dobutamine administration heart rate and cardiac index increased significantly (p<0.001 for both) and peripheral resistance decreased concomitantly (p<0.005). Global left ventricular ejection fraction (LVEF) as measured by multigated equilibrium nuclear angiography (MUGA) increased from 21.8±10.6% to 25±13.5 (p<0.02). Count‐based mean regional ejection fraction in the septal, inferoapical, posterolateral (45d̀ left anterior oblique view) and inferior, apical and anterolateral (30d̀ right anterior oblique gated first pass) regions increased also. At 72 hours (long‐term) after continuous dobutamine infusion, heart rate and cardiac index were still significantly higher and peripheral resistance lower than in the control study. However, global and count‐based regional ejection fraction decreased to control values in the right anterior oblique view (first‐pass analysis) and the left anterior oblique view (MUGA). Global LVEF measured in the right anterior oblique view by first‐pass technique was significantly higher than control in the longterm study (23±9.7 vs. 27.8±2.4; p<0.01). The improved global and regional ventricular performances observed in the short‐term, followed by a return to baseline values after long‐term treatment, concomitantly with improved hemodynamic parameters, suggest a relatively short positive inotropic effect of dobutamine and that the effectivity for long term seems to stem, most probably, from the combination of dobutamine's chronotropic effect and its influence upon reducing peripheral resistance (long‐term ventricular loading improved).
Endocardial fibroelastosis in mucopolysaccharidosis type VI
Authors: Fong L. V. , Menahem S. , Wraith J. E. , Chow C. W.
Published: February 2009

This case report describes two siblings less than 1 year of age who presented severely ill with a dilated cardiomyopathy. Full blood examination in both cases revealed marked granularity of neutrophils suggestive of mucopolysaccharidosis type VI. There were no physical features of a mucopolysaccharidosis but biochemical evaluation confirmed mucopolysaccharidosis type VI in both children. Autopsy in one patient confirmed endocardial fibroelastosis and electron microscopy of fibreblasts in the myocardium showed distention with membrane‐bound vacuoles, consistent with a mucopolysaccharidosis. These siblings developed endocardial fibroelastosis before other clinical manifestations of the mucopolysaccharidosis. Assessment for metabolic causes of a cardiomyopathy is important, as cardiac disease may be the initial manifestation of a metabolic disease.
Effect of amiodarone on sinus node function in patients with sick sinus syndrome
Authors: Hoffmann A. , Jost M. , Burckhardt D. , Kappenberger L.
Published: February 2009

The effect of amiodarone on sinus node function has been studied in 9 patients with symptomatic sick sinus node as documented by Holter‐ECG. All patients had programmable dual‐chamber pacemakers. Sinus node activity was assessed by intermittently inhibiting the pacemakers before and after four weeks of oral amiodarone treatment. Sinus node function was not altered by amiodarone in 5 patients but was severely depressed in 4 patients. Thus, it is concluded that amiodarone cannot be used safely in all patients with the tachybrady syndrome for the treatment of symptomatic tachyarrhythmias without concomitant pacing.
The value of right atrial emptying rate in predicting reduction in pulmonary artery pressure in patients with chronic obstructive pulmonary disease
Authors: Marmor A. T. , Michaeli S. , Plich M. , Frankel A. , Schneeweiss A.
Published: February 2009

We used an improved noninvasive radio‐nuclide method, recently developed by us, to evaluate changes in pulmonary artery pressure induced by sublingual nifedipine in patients with chronic obstructive pulmonary disease and pulmonary hypertension. The new method enhances the predictive power of right ventricular ejection fraction by using the right atrial emptying rate as an index of reduced right ventricular compliance. The results were compared to those of invasively measured pulmonary arterial pressure. In the 21 patients studied 20 mg of nifedipine sublingually reduced pulmonary arterial pressure by 13.35% from 36.95±13.95/12.71±6.24 (mean 20.79±8.19) mmHg to 32.67±12.17/10.9±6.2 (mean 18.16±7.3) mmHg (p<0.05 for all pressures). Cardiac index increased and the pulmonary and systemic resistances decreased. The percent changes in right atrial emptying rate showed an excellent correlation with the percent change in pulmonary pressure. An increase of 12% or more in right atrial emptying rate predicted in all patients a reduction in pulmonary arterial pressure of at least 8%, the specificity and positive predictive accuracy being 100%. The sensitivity and the predictive accuracy of a negative test were 93% and 80%, respectively. The new method is useful for long‐term evaluation of drug therapy in patients with pulmonary hypertension.
Echocardiographic documentation of atrial mechanical systole after dual‐chamber pacemaker implantation in a patient without electrically evident atrial activity
Authors: Butman S. M. , Mechling E. , Copeland III J. G.
Published: February 2009

Documentation of synchronized atrial transport mechanical systole, after dual‐chamber pacemaker implantation is generally not sought clinically. In this patient, no electrical atrial activity was seen after elective revision to dual‐chamber from single‐chamber pacing. M‐mode echocardiography provided definitive proof of proper pacemaker function with intact mechanical atrial systole. Echocardiography should be considered in the postoperative evaluation of patients in whom proper atrial or ventricular mechanical function is in doubt.
Attenuation of nitroglycerin‐induced coronary hyperemic blood flow in patients with left anterior descending coronary collaterals
Authors: Kern M. J. , Miller J. T. , Henry R. L.
Published: February 2009

Although intracoronary nitroglycerin (NTG) is frequently administered to patients having occluded coronary arteries undergoing invasive procedures such as percutaneous transluminal coronary angioplasty or thrombolysis, the extent of NTG‐induced augmentation of myocardial blood flow in patients with collaterally filled occluded arteries is incompletely understood. To examine NTG‐induced increases in coronary blood flow in patients with occluded left anterior descending coronary arteries (LAD), coronary and systemic hemodynamics were measured during bolus administration of NTG into the left coronary artery in 10 patients with normal LAD (Group 1), 11 patients with >70% and <100% narrowing of the LAD (Group 2), and 10 patients who had total occlusion of the LAD with angiographic collateral filling and anterior ventricular wall motion abnormalities (Group 3). NTG increased anterior regional great vein flow (thermodilution) from 72±19 to 140±60 ml/min (p< 0.05), 67 ± 27 to 108±66 ml/min (p< 0.05), and 59±27 to 74±36 ml/min (p = NS vs. control, p< 0.05 vs. peak flow for Group 1) with relative increases from control of 91±41%, 56±34%, and 25±22% for the three groups, respectively. The percent change for Group 3 was significantly lower than both Groups 1 (p< 0.01) and 2 (p< 0.05). These data indicate that myocardial hyperemic blood flow responses to intracoronary NTG are markedly attenuated in patients with occluded but collaterally supplied vessels. During invasive procedures in these patients, although significantly attenuated, intracoronary NTG may potentially provide a beneficial effect by augmenting blood flow through collaterals or in adjacent regions.
Pathophysiology in malignant hypertension: With special reference to the renin‐angiotensin system
Authors: Kawazoe N. , Onoyama K. , Abe I. , Takishita S. , Ueno M. , Fujishima M. , Kobayashi K. , Muratani H. , Kimura Y. , Tomita Y. , Tsuchihashi T. , Uezono K. , Kawasaki T. , Eto T. , Fukiyama K. , Omae T.
Published: February 2009

Pathophysiology of malignant hypertension, of which underlying disease was essential hypertension (EHT) in 33 cases and chronic glomerulonephritis (CGN) in 26 cases, was studied with reference to the renin‐angiotensin system. Plasma renin activity (PRA) was significantly higher in the EHT than in the CGN group, and angiotensinII antagonist [Sar1, Ile8] angiotensin II (AIIA) induced a significant lowering of blood pressure only in the former group. PRA was linearly correlated with both pretreatment mean blood pressure (MBP, r=0.474, n=29, p< 0.01)and serum creatinine (r=0.540, n=29, p< 0.01) in the EHT group but not in CGN patients, although there was an inverse correlation between PRA and serum sodium in both groups. Multiple regression analysis revealed that PRA was independently related to MBP, serum creatinine, and serum sodium in the EHT group, but not in the CGN group. These results suggest that the renin‐angiotensin system plays a significant role in elevating blood pressure and deteriorating renal function in malignant hypertension derived from EHT, but it is less important in CGN related hypertension.
Baroreceptor reflex in a patient with coarctation of the aorta
Authors: Matsuyama K. , Sonoda E. , Nakao K. , Horio Y. , Yasue H.
Published: February 2009

We report the case of a 23‐year‐old man with coarctation of the aorta whose baroreceptor sensitivity was extremely reduced. Antihypertensive therapy was effectively performed after coarctectomy. Only one month after coarctectomy, baroreflex sensitivity had recovered. The present case is believed to be the first in which reduced baroreceptor sensitivity in coarctation of the aorta was reversible in the early phase after coarctectomy.
Aneurysm of patent ductus arteriosus in an adult case: Findings of cardiac catheterization, angiography, and pathology
Authors: Ohtsuka S. , Kakihana M. , Ishikawa T. , Noguchi Y. , Kuga K. , Ishimitsu T. , Sugishita Y. , Ito I. , Ijima H. , Hori M. , Kimura Y.
Published: February 2009

A 42‐year‐old male was admitted to our hospital for evaluation of a left precordial continuous murmur. Results of catheterization revealed a step‐up of oxygen content in the pulmonary arteries and the calculated left‐to‐right shunt flow was 40% of the pulmonary arterial flow. Furthermore, aortography unexpectedly revealed an aneurysm of the patent ductus arteriosus. During surgery, the aneurysm was discovered to arise from the frontal wall of the ductus arteriosus, and histological observation showed focal necrosis and mucoid degeneration of the media of the aneurysmal wall in contrast to a thickened intimal fibroelastosis of the adjacent ductal wall. This is presumed to be the first adult case of patent ductal aneurysm ever reported in which antemortem diagnosis and surgical treatment were successfully conducted. Our case may suggest that the fragility of the ductal wall following the structural change in an incomplete closing process is considered as a potential pathogenesis of ductal aneurysm formation.
Endomyocardial fibrosis with massive endocardial calcific deposits
Authors: Chan. W. L. , Chiang B. N. , Kong C. W. , Lee J. B. , Wang S. P. , Hsu T. L.
Published: February 2009

Massive endocardial calcific deposits in the left ventricular chamber is such an uncommon lesion that only three cases have been reported previously. This report describes an apparently asymptomatic patient with endomyocardial fibrosis and massive endocardial calcific deposits. The results of electrocardiography, echocardiography, angiography, and endomyocardial biopsy findings are presented, and the pathogenesis of massive endocardial calcification is speculated upon. The interesting point is that the clinical history and manifestation of this patient suggests that endomyocardial fibrosis may occur in a benign form and long‐term survival may be expected.
The effects of beta‐adrenergic blocking agents on blood lipid levels
Authors: Wolinsky H.
Published: February 2009

This review examines the effects of beta‐adrenergic blocking agents on blood lipids. These agents have been effective in the treatment of angina and hypertension and in the reduction of recurrence of ischemic cardiac disease, such as myocardial infarction. Many beta blockers, however, have an adverse effect on blood lipids, especially by reducing high‐density lipoprotein (HDL) cholesterol and increasing triglycerides. One result is an unfavorable influence on the cholesterol ratio (expressed either as low‐density lipoprotein [LDL]/HDL or total cholesterol/HDL). These cholesterol parameters have been shown to have a strong influence on coronary heart disease (CHD) risk. Studies have shown that antihypertensive therapy has reduced the incidence of cerebrovascular disease but, in many instances, has not reduced the incidence of CHD. A hypothesis for this lesser effect on coronary disease is that antihypertensive agents may be adversely affecting blood lipids. Thus, while one major risk factor for CHD is reduced, another may be somewhat enhanced. Pharmacologic properties of some beta blockers such as peripheral alpha blockade (e.g., with labetalol) or intrinsic sympathomimetic activity (ISA) (e.g., with pindolol) may counteract some of these negative lipid effects. An investigational beta blocker, bevantolol, which will be marketed shortly in the United States, has been effective in antihypertensive therapy. Bevantolol has been shown to lower LDL cholesterol and not adversely affect HDL cholesterol; in this way, bevantolol favorably influences the serum lipoprotein profile. Whether this effect will have clinical significance remains to be seen.
Comparison of nitroglycerin‐tts and long‐acting nitroglycerin tablets in the treatment of angina pectoris: A double‐blind controlled study
Authors: Karlson B. W. , Henning R.
Published: February 2009

A cohort of 99 patients with severe, stable angina pectoris participated in a 26‐week double‐blind, between‐patient trial of a transdermal therapeutic system (TTS) Nitroglycerin‐TTS 5 mg/24 h and long‐acting nitroglycerin tablets, 10.4 mg daily. The variables registered included daily sublingual nitroglycerin requirement, daily anginal attack rate, exercise test performance with ECG recordings, and a subjective patient evaluation on a visual analogue scale. There were no significant differences in the efficacy of the treatment between the two groups. Nor could we find any difference in the efficacy between the initial single‐blind placebo treatment and the active nitroglycerin treatments.
Echocardiographic findings in pannus ingrowth on an omniscience mitral prosthesis
Authors: Evangelista Masip A. , Bruguera Cortada J. , Serrat Serradell R. , Robles Castro A.
Published: February 2009

Serial echocardiographic findings in a patient with an Omniscience mitral prosthesis presenting progressive perivalvular pannus ingrowth are described. The first echocardiographic study was carried out one year after prosthesis implantation and showed decreased prosthetic opening velocity. As prosthetic thrombosis was suspected, hemodynamic study was performed, which proved normal. The patient remained in functional grade II for a year and a half prior to the onset of progressive dyspnea and dizzy spells. Echocardiogram was thus repeated and revealed the presence of multiple dense echoes behind the prosthetic disc. Three months after this last study, the patient presented acute pulmonary edema and reduction of disc excursion and opening and closing velocities. Hemodynamic study suggested prosthetic obstruction. Surgery revealed the presence of perivalvular pannus trapping the prosthetic disc. The prosthesis was subsequently replaced by a Björk‐Sorin. This case emphasizes the usefulness of echocardiography in the early detection of perivalvular pannus ingrowth revealing prosthetic mobility anomalies, even before hemodynamic changes occur.
Analysis of ambulatory electrocardiograms in 14 patients who experienced sudden cardiac death during monitoring
Authors: Savage H. R. , Kissane J. Q. , Becher E. L. , Maddocks W. Q. , Murtaugh J. T. , Dizadji H.
Published: February 2009

The Holter monitors of 14 patients (out of 58,000 Holter recordings performed between 1978 and 1984) who experienced cardiac arrest and expired during the recording period were analyzed. Tachyarrhythmic arrest patients frequently had coronary heart disease, congestive heart failure, and prolonged QTc intervals. The highest incidence of intermediately frequent premature ventricular complexes (PVCs) occurred between 15 and 6 hours prior to death. The frequency of ventricular couplets increased toward the time of arrest. The hours with greatest frequency of ventricular tachycardia (VT) were found to be the last 5 hours of life. An increasing incidence of ST‐segment changes greater than 2 mm was noted throughout all of the risk periods until the third hour prior to arrest when the incidence diminished. Conversely, the incidence of lower amplitude ST‐segment changes (usually elevation) increased over the final 6 hours. The mean time of death was 0228 hours ± 5:20. In conclusion, we observed two patterns of Holter‐monitored changes which usually occurred prior to death and may represent predictors of sudden death: (1) an increasing incidence of intermediately frequent isolated PVCs followed by increased ventricular couplets and runs of VT; (2) return of high amplitude ST‐segment changes toward baseline. To our knowledge, the temporal relationship of the degree of ST‐segment deviation to sudden death and the time of sudden death have not been reported in large studies of Holter‐monitored sudden death patients.
Role of infarct expansion in rupture of the ventricular septum after acute myocardial infarction: A two‐dimensional echocardiographic study
Authors: Jugdutt B. I. , Michorowski B. L.
Published: February 2009

To verify the role of infarct expansion (IE) in ventricular septal rupture (VSR) after transmural acute myocardial infarction (TAMI), topographic parameters were measured using tomographic imaging with two‐dimensional echocardiography (2‐D echo) and computer‐aided analysis in four groups of patients: 8 patients with VSR (Group 1); 24 patients with TAMI but no mechanical complications (Group 2); 11 normal athletes (Group 3); 5 adults with congenital ventricular septal defect (Group 4). Measurements made on end‐diastolic outlines of mid‐left ventricular (LV) short‐axis images included: LV asynergy (akinesis and/or dyskinesis), expansion index (asynergy/nonasynergy‐containing endocardial segment length), thinning ratio (asynergic/nonasynergic wall thickness), and new indexes of regional shape distortion (RSD) by quantifying the deviation of the actual asynergic segment from the ideal asynergic arc constructed using the nearly circular nonasynergic contour. In Group 1, clinical IE (hypotension, congestive heart failure, no signs of new infarction) preceded detection of the VSR and portable 2‐D echo showed the VSR associated with LV asynergy, marked IE, and RSD. Although Groups 1 and 2 had similar LV asynergy (28.7 vs. 26.9% LV) and ejection fraction (38.9 vs. 41.8%), Group 1 had higher expansion index (1.50 vs. 1.17, p<0.05), lower thinning ratio (0.54 vs. 0.67, p<0.005), and higher RSD parameters (e.g., peak distortion, Pk or maximum radial distance from the ideal arc, 19.3 vs. 3.9 mm, p<0.01; area of distortion, Ad, 7.4 vs. 1.1 cm2, p<0.05) than Group 2. Groups 3 and 4 had normal regional and global function and no evidence of expansion, thinning, or RSD. Thus, IE with marked diastolic RSD on an early 2‐D echo after TAMI might identify patients at risk for VSR.
Comparison of arm and treadmill exercise at 85% predicted maximum heart rate
Authors: Coplan N. L. , Gleim G. W. , Scandura M. , Nicholas J. A.
Published: February 2009

Both treadmill exercise and arm exercise are used for evaluating coronary artery disease, but arm exercise has lower diagnostic sensitivity. We compared the two exercise modalities with respect to the rate‐pressure product at 85% predicted maximal heart rate, a parameter frequently used to denote performance of sufficient exercise to derive clinical conclusions. At this heart rate, treadmill exercise resulted in a significantly greater systemic oxygen consumption (2.7±.8 vs. 2.1±.6 l/min) and rate‐pressure product (30.6±4.4x103 vs. 28±3.3x103) than arm ergometry. An inability to generate sufficient imbalance of myocardial oxygen supply and demand may account for the relatively higher incidence of false negative exercise tests seen with arm ergometry, especially if the exercise test is stopped when the patient attains 85% predicted maximal heart rate.
Distribution of amiodarone and desethylamiodarone in a patient with acute myocardial infarction after intravenous administration
Authors: Latini R. , D'Aranno V. , Barbieri E. , Fabbri A. , Zampieri P. , Trevi G. P. , Zardini P.
Published: February 2009

The autopsy tissues concentration of amiodarone and desethylamiodarone of a man with acute myocardial infarction treated acutely with intravenous amiodarone is reported. Our data indicate that amiodarone is quickly distributed into all highly perfused tissues after intravenous administration with a high amiodarone/desethylamiodarone ratio. We also report here the autopsy case of a woman who died after 30 days of oral therapy with amiodarone. The increase in heart/plasma ratio of amiodarone and desethylamiodarone concentrations and the decrease in amiodarone/desethylamiodarone ratio after one month of therapy could explain the latency in the antiarrhythmic action of the drug.
Prevention and elimination of heart arrhythmias by adaptation to intermittent high altitude hypoxia
Authors: Meerson F. Z. , Ustinova E. E. , Orlova E. H.
Published: February 2009

It was shown that adaptation to intermittent hypoxia in altitude chamber prevented the poststress fall of the electrical threshold of heart fibrillation. In acute ischemia, the number of fibrillation episodes and the death rate of preadapted animals were 2‐3 fold lower than in controls. The adaptation to hypoxia resulted in a significant increase in concentration of opioid peptide β‐endorphin in adrenal glands while stress‐induced changes in β‐endorphin in brain structures of adapted animals were much less pronounced. In animals with postinfarction cardiosclerosis, the course of hypoxic actions resulted in restoration of the decreased heart fibrillation threshold, reduced the heart ectopic activity which had developed on the background of vagal bradycardia, and eliminated depression of the heart contractile function. Simultaneously, the adaptation induced a decrease of the postinfarction scar by one‐third and an increase of vascularization of the myocardial zone adjacent to the scar.
Coronary collateral vessels in patients with previous myocardial infarction
Authors: Nakatsuka M. , Matsuda Y. , Ozaki M. , Ogawa H. , Moritani K. , Khono M. , Miura T. , Shimizu T. , Furutani Y. , Kusukawa R.
Published: February 2009

To assess the degree of collateral vessels after myocardial infarction, coronary angiograms, left ventriculograms, and exercise thallium‐201 myocardial scintigrams of 36 patients with previous myocardial infarction were reviewed. All 36 patients had total occlusion of infarct‐related coronary artery and no more than 70% stenosis in other coronary arteries. In 19 of 36 patients with transient reduction of thallium‐201 uptake in the infarcted area during exercise (Group A), good collaterals were observed in 10 patients, intermediate collaterals in 7 patients, and poor collaterals in 2 patients. In 17 of 36 patients without transient reduction of thallium‐201 uptake in the infarcted area during exercise (Group B), good collaterals were seen in 2 patients, intermediate collaterals in 7 patients, and poor collaterals in 8 patients (p<0.025). Left ventricular contractions in the infarcted area were normal or hypokinetic in 10 patients and akinetic or dyskinetic in 9 patients in Group A. In Group B, 1 patient had hypokinetic contraction and 16 patients had akinetic or dyskinetic contraction (p<0.005). Thus, patients with transient reduction of thallium‐201 uptake in the infarcted area during exercise had well developed collaterals and preserved left ventricular contraction, compared to those in patients without transient reduction of thallium‐201 uptake in the infarcted area during exercise. These results suggest that the presence of viable myocardium in the infarcted area might be related to the degree of collateral vessels.
accessory atrioventricular pathway, supra ‐, and infrahisian conduction impaired due to mitral annulus calcification
Authors: Kriwisky M. , Goldstein J. , Gotsman M. S.
Published: February 2009

Disorders of conduction occurring simultaneously in both normal and accessory pathways of patients with Wolff‐Parkinson‐White (WPW) syndrome have only rarely been observed. To our knowledge this is the first report of impaired conduction in both pathways in WPW syndrome due to mitral annulus calcification (MAC). This case of WPW syndrome type A presented the following conduction abnormalities: (1) right bundle‐branch block; (2) transient second‐degree AV block with prolonged PR interval of the conducted beats; (3) during electrophysiological study, induction of tachycardia, dependent (phase 3) second‐degree AV block, and occasionally conduction of two consecutive beats, the second showing an increased H‐V interval (from 25 to 60 ms) and left bundle‐branch block (LBBB) pattern, due to (4) infrahisian conduction abnormality.
Three‐week beta‐adrenergic blockade does not impair or improve general intellectual function in young healthy males
Authors: Brooks B. , Danielsen U. , Kayser L. , Jørgensen B. , Hansen J. E. M. , Perrild H.
Published: February 2009

The widespread use of beta blockers in treatment of both cardiovascular and nonvascular conditions has generated interest in changes in functions of the central nervous system during treatment. We studied the effect of 3 weeks of beta blockade on learning and memory ability, concentration, and verbal abstraction in 32 young normotensive healthy men. We chose healthy males to exclude the possible influence of changes related to a hypertensive state. Subjects were randomized into a 3‐week treatment protocol with either atenolol 50 mg × 2 (cardioselective, hydrophilic), metoprolol 100 mg × 2 (cardioselective, lipophilic), propranolol 80 mg × 2 (noncardioselective, lipophilic), or placebo × 2. Each subject underwent two neuropsychological testing sessions. We found no significant enhancement or impairment of intellectual or psychomotor performances after the 3‐week treatment with beta‐adrenergic‐blocking agents compared to a placebo‐treated control group. Differences in pharmacokinetic profiles of the drugs (e.g., central nervous system penetrability, lipophilicity, or membranestabilizing effect) did not influence the test outcome. Antihypertensive treatment with beta blockers over a prolonged period does not affect young peoples' learning and memory abilities or reasoning powers, nor their ability to concentrate and perform psychometric tasks.
Refractory swallowing‐induced paroxysmal supraventricular tachycardia
Authors: Ransbottom J. C. , Mirro M. J.
Published: February 2009

A 51‐year‐old female with a two‐year history of palpitations associated with swallowing was evaluated by intracardiac electrophysiologic studies. Intracardiac recordings documented the presence of an ectopic left atrial focus induced by swallowing with no evidence of accessory pathway conduction. Gastrointestinal evaluation did not demonstrate any significant disorder. The tachycardia was refractory to all pharmacologic therapy including investigational therapy with mexiletine and amiodarone.