bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic chagas' heart disease presenting as an impending myocardial infarction: A case favoring the neurogenic pathogenesis concept
Authors: Bestetti R. B. , Finzi L. A. , Oliveira J. S. M.
Published: February 2009

A 55‐year‐old Caucasian woman suddenly developed substermal chest pain at rest accompanied by pallor, diaphoresis, nausea, and vomiting. Physical examination was otherwise unremarkable. The resting ECG showed T‐wave inversion in all anterior leads which returned to normal 24 h after the onset of the symptoms. The pain was eliminated promptly by sublingual isosorbide dinitrate. “Impending” acute myocardial infarction was diagnosed. Coronary arteriography, however, failed to reveal any change in any major coronary artery but an apical aneurysm of the left ventricle was detected. As the complement‐fixation test for Chagas' disease was positive, the diagnosis of chronic Chagas' heart disease was then established. This unusual clinical manifestation of Chagas' disease is thought to be the consequence of a transient imbalance in the cardiac autonomic nervous system, which is considered to play a central role in the pathogenesis of chronic Chagas' heart disease. In addition, the present case may alert clinicians to the thus far neglected atypical chest pain, which is frequently seen in chagasic patients but whose etiology remains obscure.
Coronary artery bypass surgery in patients over age 70 years: Report from the milwaukee cardiovascular data registry
Authors: Dorros G. , Daley P. , Assa J. , Lewin R. F.
Published: February 2009

Between 1972 and 1985, 674 coronary bypass patients ≥ 70 years (70% male, mean age 73 years) were among 10,622 patients with both catheterization and operative data entered into the Milwaukee Cardiovascular Data Registry. These ≥ 70 years patients were analyzed regarding the operative morbidity, the 30‐day operative mortality, and the operative mortality's relation to coronary artery disease and ventricular wall motion abnormalities. The operative mortality was not different for the 174 patients operated upon before and the 500 patients after 1980. A mean of 3.4 grafts were placed during surgery. The complications encountered included a 7.1 % perioperative infarction rate, a 4.2% incidence of cerebrovascular accident, a 3.6% incidence of reoperation for bleeding, a 2.4% incidence of renal failure, and a 2.1 % incidence of pulmonary embolism. The overall operative mortality was 7.4%. The extent of coronary artery disease was distributed among patients such that 8.4% had single‐, 28.0% had double‐, and 63.6% had triple‐vessel disease. The operative mortality as related to the extent of coronary artery disease was 5.2% for single‐, 8.9% for double‐, and 7.0% for triple‐vessel disease. The operative mortality was 6.7% with no and 7.9% with left ventricular wall motion abnormalities. The operative mortality was 1.9% with 1 segmental wall motion abnormality, and increased to 13.3% (p<0.05) with 4–6 segmental wall motion abnormalities. The operative mortality for single‐vessel disease was 5.4% with normal and 4.3% with abnormal wall motion; for double‐vessel disease it was 4.3% with normal and 13.2% with abnormal wall motion, (p<0.05); and, for triple‐vessel disease, 8.3% with normal and 6.0% with abnormal wall motion. Actuarial life‐table analysis indicated that the probability of surviving at least 7 years is 64.6≥3.6%. There was no difference in the survival at 4 years regardless of the extent of coronary disease. After 4 years, the difference in survival between single‐ and triple‐vessel disease became significant (single, 91 % versus triple, 78%; p<0.05). The probability of survival at 7 years was affected by the presence of wall motion abnormalities (normal, 73% versus abnormal, 56%, p<0.05). These data suggest that coronary bypass surgery when performed in patients ≥ 70 years has a significant operative mortality which is probably not related to the extent of coronary artery disease, but to the severity of left ventricular wall motion abnormalities. Surviving patients have a relatively good long‐term outlook which, nevertheless, is adversely affected by the extent of coronary disease, and the severity of left ventricular wall motion abnormalities.
Effectiveness of intravenous streptokinase on infarct size and left ventricular function in acute myocardial infarction, prospective and randomized study
Authors: Durand P. , Asseman P. , Pruvost P. , Bertrand M. E. , Lablanche J.‐M. , Thery C.
Published: February 2009

Within 3 h after the onset of symptoms of myocardial infarction, 64 patients were randomly assigned to receive either a 1‐h intravenous infusion of 1,500,000 IU of streptokinase (SK) or a conventional therapy. Infarct size was estimated in CK gram equivalent (CKg) by measurement of CK‐MB every 3 hours during a 48‐h period. Enzymatic study revealed that myocardial infarction of the SK group was significantly smaller (61.4±45 vs. 89.4±56 CKg, p< .05). Angiograms were performed at early stage and five weeks after myocardial infarction. At first coronary angiogram, the infarct‐related vessel was open in 82% in the SK group versus 12% in controls. The SK group had higher global ejection fraction at second angiogram (57±11% vs. 49±11%, p<.02), but differences in regional wall motion were not significant. By analysis according to patency or occlusion of infarctrelated vessel, global and regional ejection fractions were significantly better at first and at second angiograms in all patients and in anterior infarctions with a patent infarctrelated coronary artery. There was no significant difference for inferior infarction. We conclude that intravenous streptokinase infusion early after the onset of myocardial infarction reduces infarct size and improves left ventricular function, chiefly in anterior infarction. This benefit appears to be closely correlated to patency of infarct‐related vessels.
Catheter ablation: Relationship of defibrillator waveform to the production of postshock ventricular tachyarrhythmias and myocardial damage
Authors: Chapman P. D. , Wetherbee J. N. , Troup P. J. , Klopfenstein H. S.
Published: February 2009

The myocardial damage and arrhythmogenicity of percutaneous transcatheter shocks utilizing two different defibrillator waveforms (truncated exponential and damped sinusoidal) were compared. Ten dogs (33.7±3.6 kg) were studied. Five received left ventricular damped sinusoidal R‐synchronous shocks during sinus rhythm and the other five received truncated exponential waveform shocks. Each dog received four energies (60, 120, 180, and 240 joules) randomly assigned to four left ventricular sites. The immediate postshock rhythms were recorded. Ventricular tachycardia occurred after 90% of the damped sinusoidal shocks compared to only 25 % of the truncated exponential shocks (p<0.005). The animals were sacrificed 14 days later. Infarct size as determined by planimetry was not significantly different for the two waveforms. Thus intracavitary shocks utilizing a truncated exponential waveform are less arrhythmogenic than damped sinusoidal waveform shocks but produce similar morphologic changes and therefore may offer a significant safety advantage for catheter ablation procedures.
Intermittent mitral regurgitation: An indicator of severe beall valve dysfunction
Authors: Coralli R. J. , Dorney E. R. , Walter P. F.
Published: February 2009

The Teflon disc of Beall valves is subject to extraordinary wear and tear. Clinical evidence of valvular dysfunction is critical in following patients who have implanted Beall valves. We describe 4 patients with the interesting auscultatory finding of intermittent mitral regurgitation. Each of these patients demonstrated severe wear of the Teflon disc with abnormal intermittent disc tilting noted at cardiac catheterization. Intermittent mitral regurgitation in patients with Beall valves in the mitral position heralds severe valvular dysfunction and should prompt urgent cardiac catheterization and valve replacement.
Shigella sonnei myocarditis
Authors: Caraco Y. , Raveh D. , Raz I.
Published: February 2009

A 19‐year‐old male was admitted to our department because of high fever, abdominal pain, and diarrhea. Electrocardiogram (ECG) on admission revealed diffuse ST‐T changes which persisted for 5 days. Stool culture grew Shigella sonnei. We conclude that the infection with Shigella sonnei was the cause for these findings which were most probably due to myocarditis. To the best of our knowledge myocarditis as a complication of shigella infestation has never been reported.
Supernumerary right coronary artery
Authors: Gupta S. K. , Abraham A. K. , Reddy N. K. , Moorthy S. J.
Published: February 2009

A rare case of a patient with supernumerary right coronary artery in whom the two vessels arose from the right coronary sinus from two separate ostia adjacent to each other is presented. The smaller vessel gave off the sinoatrial nodal branch and the posterior descending artery whereas the larger one gave off the conus branch, the right ventricular branches, and continued as acute marginal branch. This is the first case report in the English literature.
Plasma Atrial Natriuretic Peptide Level As an Index for the Severity of Congestive Heart Failure
Authors: Hara H. , Ogihara T. , Shima J. , Saito H. , Rakugi H. , Iinuma K. , Kumahara Y. , Minamino T.
Published: February 2009

Human atrial natriuretic peptide (hANP) is a vasodepressor and a natriuretic hormone. The levels of plasma hANP increase during extracellular volume expansion. In the present study, we investigated whether plasma levels of hANP were associated with the severity of congestive heart failure (CHF), and whether such an association could be used as a diagnostic aid. Plasma hANP levels in 102 patients with various heart diseases and correlation between the plasma hANP levels and the left ventricular ejection fraction (EF) determined from echocardiography in 43 patients were examined. The plasma levels of hANP were high during the state of extracellular fluid overloading and atrial distention as determined by high right atrial pressure and pulmonary capillary wedge pressure. The high plasma hANP levels decreased in CHF patients whose clinical state improved, but remained high in those patients who were refractory to treatment. Plasma hANP levels correlated inversely with left ventricular EF (r=‐0.41, p<0.01). In 9 patients re‐examined during the course of treatment the plasma hANP levels decreased with an increase in EF. These data indicate that the level of plasma hANP is a practical diagnostic indicator of the severity of CHF, and can also be used as a means for assessing the efficacy of the treatment.
Correlation of the Size of Isolated Right Ventricular Infarction with the Changes of ST Segment in Dogs
Authors: Aramaki Y. , Kuroiwa A. , Nakamura T. , Ninomiya K. , Fukuchi Y. , Fukumoto T. , Nakashima Y.
Published: February 2009

Vectorcardiographic, electrocardiographic, and hemodynamic changes in isolated infarction (infarct confined to the right ventricular free wall) were studied in 19 mongrel dogs. An isolated right ventricular infarction was produced by embolizing the right coronary artery with Spongel under closed chest conditions. The size of the infarct, identified by TTC staining, accounted for 6–65% (35.9±22.0%, mean ± SD) of the right ventricular free wall. The STx, STy, STz, and the spatial magnitude of the ST segment (STM) were continuously recorded with an automated, real‐time vectorcardiographic ST‐segment analyzer (ST‐monitor) using the Frank lead system. The cardiac index (CI) ratio (CI after embolization/CI before embolization) of all dogs with larger infarcts (infarct > 35% of the right ventricle) was below 1.0. In dogs with smaller infarcts (% RVI±35%), there were no differences in the hemodynamic data before and 4 h after embolization. In dogs with larger infarcts, however, pulmonary arterial pressure and heart rate 4 h after embolization were significantly decreased compared with those before embolization. In addition, right atrial pressure 4 h after embolization in the larger infarct group was significantly elevated compared with that in the smaller infarct group. In dogs with larger infarcts, STx, STy, and STM were significantly larger than in those with smaller infarcts both 15 min and 4 h after embolization. There were no significant correlations between infarct size and change in vectorcardiographic ST segments in the smaller infarct group. There was, however, a significant correlation between the size of the infarct (percent of right ventricle infarcted, % RVI) and the vectorcardiographic ST‐segment changes in the larger infarct group and in all dogs. These results suggest that an infarct size larger than 35% or the right ventricular free wall can induce detrimental hemodynamic changes and that the RV infarct size can be determined by vectorcardiographic ST deviation with a real‐time ST monitor using the Frank lead system.
Dose of urokinase for intracoronary thrombolysis in patients with acute myocardial infarction
Authors: Ohyagi A. , Hirose K. , Watanabe Y. , Nakai T. , Tsujimoto S. , Doyama K. , Suzuki Y. , Okazaki S. , Hirai M.
Published: February 2009

Intracoronary thrombolysis is a logical therapeutic method and one of the challenging new treatments of acute myocardial infarction. However, a wide dose range of urokinase has been reported, and the optimal dose has not yet been established. In this study the fibrinolytic activity in patients with recanalized coronary arteries was compared with that in those with nonrecanalized arteries. The mean doses of urokinase in the recanalized and nonrecanalized groups were 910,700±161,730 international units (IU) and 1,008,000±151,800 IU, respectively. The fibrinolytic activity was measured with α2‐plasmin inhibitor, α2‐macroglobulin, fibrinogen, plasminogen, and fibrin degradation products. No significant difference was observed in the fibrinolytic activity between the recanalized and nonrecanalized groups. Because the fibrinolytic activity in the two groups was thought to be activated sufficiently and to a similar degree, it appears that 1,000,000 IU of urokinase is adequate for intracoronary thrombolysis and larger doses cannot be expected to result in a higher rate of recanalization.
Prediction of atrial and ventricular fibrillation complicating myocardial infarction from admission data: A Prospective Study
Authors: Flugelman M. Y. , Flugelman A. A. , Rozenman J. , Ben‐David J. , Shefer A. , Koren G. , Gotsman M. S.
Published: February 2009

This study set out to examine prospectively two logistic formulae based on admission clinical data to predict ventricular or atrial fibrillation complicating acute myocardial infarction. A prospective study of 87 consecutive patients with acute transmural myocardial infarction was conducted. The formula for predicting ventricular fibrillation from the diastolic blood pressure, degree of ST‐segment elevation, and QTc had a sensitivity of 93%, specificity of 83 %, and a predictive value for an abnormal test of 62% (13 of 14 patients who developed ventricular fibrillation were identified). The formula for predicting atrial fibrillation from the age of the patient, a history of heart failure, systolic blood pressure, and four electrocardiographic parameters had a sensitivity of 78%, specificity of 85%, and a predictive value of 67% (14 of 18 patients identified). Our study shows that patients with myocardial infarction who are liable to develop ventricular or atrial fibrillation can be identified on admission from simple clinical data.
Influence of left ventricular cavity dimension on electrocardiographic estimation of the extent of wall motion abnormalities
Authors: Giannuzzi P. , De Vito F. , Imparato A. , Tavazzi L.
Published: February 2009

To estimate the influence of left ventricular cavity dimension on the electrocardiographic estimation of the extent of wall motion abnormalities, two‐dimensional echocardiograms and standard 12‐lead electrocardiograms (ECG) were carried out on 221 patients within 3 months after acute myocardial infarction (MI). Among the patients with anterior MI (96 patients; 43.4%) both the extent of asynergy (% of asynergic segments, an echo index taking into account the type of asynergy) and the electrocardiographic signs of necrosis (number of Q waves ≥40 ms, Wagner's score) were significantly greater (p < 0.001) in those with left ventricular dilatation (60 patients) than in those with normal ventricular size (36 patients); within the latter group, the ECG‐asynergy correlations were good (r value 0.67–0.79). In patients with left ventricular dilatation no correlation was found. In inferior MI (108 patients, 48.9%), asynergy was more extensive in patients with left ventricular dilatation (p<0.001) than in those with normal left ventricle. However, the electrocardiographic extent of necrosis was similar in the two groups and no significant ECG‐asynergy correlation was found. Likewise, in anteroinferior MI (17 patients; 7.7%), the ECG‐asynergy correlations were statistically insignificant in both groups. In conclusion, the electrocardiographic patterns of necrosis are poorly related to the extent of asynergy and are greatly influenced by left ventricular dimensions.
Diverging effects of postextrasystolic potentiation on left ventricular segmental wall motion in coronary heart disease
Authors: Di Donato M. , Barletta G. A. , Maioli M. , Fantini F.
Published: February 2009

The effects of postextrasystolic potentiation (PESP) on regional left ventricular (LV) wall motion were evaluated in 40 coronary artery disease (CAD) patients. Of the 40 CAD patients, 20 had a prior myocardial infarction and 20 had a history of angina pectoris. PESP was obtained by applying programmed atrial stimulation during LV angiography, in a way that basal cycle length, premature beat, and postextrasystolic pause were almost identical in all patients. Segmental wall motion was evaluated by calculating regional ejection fraction (EF) of 5 different areas with a computerized method before and after the premature beat. The results were compared to those obtained in a group of 8 normal subjects. LV areas were classified as normokinetic, mildly hypokinetic, severely hypokinetic, and hyperkinetic, on the basis of their regional EF in respect to normals, and classified as “responder” (R) and “nonresponder” on the basis of the magnitude of the increase of regional EF with PESP. Of a total of 200 areas 129 were normokinetic (68% R), 45 were mildly hypokinetic (78% R), 17 severely hypokinetic (76% R), and 9 were hyperkinetic (78% R). Infarcted patients had a higher percentage of hypokinetic areas in basal conditions (p<0.001), however, the percentage of hypokinetic areas that responded to PESP was not significantly different from noninfarcted patients. In CAD patients, as a whole, a significant direct correlation was found between basal regional EF and regional EF after PESP (r=0.88, p<0.01). In conclusion, the results indicate: (1) normokinetic LV areas do not always respond to PESP; (2) while infarcted patients have a higher proportion of myocardial segments that are hypokinetic, the number of these areas that respond to PESP does not differ between infarcted and noninfarcted patients; (3) in CAD patients there is a direct relationship between the degree of basal regional function and the magnitude of the response to PESP.
Treatment of acute myocardial infarction with subcutaneous heparin at low doses
Authors: Ruggiero H. A. , Caprissi L. F. , Neuman J. , De Caprissi E. S.
Published: February 2009

Heparin has been used intensively in the treatment of acute myocardial infarction and preinfarction angina (PA) at full doses as a single drug by us. However, heparin may be used at smaller doses for similar purposes. These doses are not exactly anticoagulant, even though they reduce blood hypercoagulability, and act mainly in an antithrombotic capacity. We studied 529 patients with acute myocardial infarction, of whom 262 were treated with subcutaneous heparin at low doses (5000 IU every 12 h) and 267 received conventional therapy without antithrombotic drugs. Heparin used was Heparina (Abbott) and Liquemine (Roche), in vials with the equivalence 1 cm3=50 mg=5000 IU. Blood rheologic factors (thrombo‐elastography, platelet adhesiveness, total blood viscosity, and number of platelets) were determined in all patients, those treated with heparin at low doses and also the control group, before and after the 30‐day treatment period. Diagnosis was based on clinical symptoms, laboratory studies, and electrocardiogram examination. In both the 262 patients treated with heparin at low doses and in the control group of 267 patients, baseline values of rheological factors were high. After 30 days (i.e., after study completion) these high values which are statistically significant compared with normal values, with p<0.0001 for both groups, remained constant in the control group who did not receive heparin. On the contrary, in the group treated with heparin at low doses, all these factors changed. Heparin provides protection against thrombosis by increasing the negative charge of the vessel wall and by other reactions at the endothelial surface. Heparin requires a plasmatic component called antithrombine III. Another important action of heparin is its activity as anti‐Xa which is said to be reason for its antithrombotic effect. When low molecular weight heparin is administered subcutaneously, higher anti‐Xa levels are obtained in blood as compared with those obtained with heparin of high molecular weights. Heparin obtained from intestinal mucosa has a great capacity to potentiate anti‐Xa, which does not occur with heparin of pulmonary origin. Heparin at low doses prevents thrombosis by inhibiting the coagulation cascade, acting selectively on the Xa which join the intrinsic and extrinsic systems. Heparin neutralizes activation of complement in several stages. Treatment of actue myocardial infarction with heparin during 30 days with full anticoagulant doses provides a mortality rate of 6.1%. These high doses were considered to be the reason for bleedings, even though heparin does not produce bleeding when administered correctly, as was the case in our study. With the low heparin doses used in this study subcutaneously during 30 days, there were no cases of bleedings.
Hemodynamic effects of oral isosorbide‐5‐mononitrate and dinitrate in ischemic heart failure
Authors: Rabinowitz B. , Hod H. , Chouraqui P. , Rath S. , Agranat O. , Neufeld H. N.
Published: February 2009

Isosorbide‐5‐mononitrate (ISMN), the main metabolite of isosorbide dinitrate (ISDN) was recently introduced in clinical use. The hemodynamic effects of oral ISMN and ISDN, administered in equal doses, were studied in a randomized, crossover fashion in 20 patients with pump failure of ischemic etiology. Baseline hemodynamic criteria for admission into the study were: pulmonary capillary wedge pressure (PCW) of at least 20 mmHg and systolic arterial pressure (AP) above 90 mmHg. Hemodynamic parameters were serially measured and systemic vascular resistance was calculated up to 6 h postadministration of either ISMN or ISDN single dose (40 mg). Maximal effects obtained were statistically significantly different from baseline. While ISMN and ISDN appeared to be equipotent in reducing the filling pressure, with a maximum effect reached in 60–120 min, the mononitrate maintained its effects for a longer period.
Superior vena caval obstruction by lipomatous hypertrophy of the right atrium
Authors: Mcnamara R. F. , Taylor A. E. , Panner B. J.
Published: February 2009

A structural abnormality was suspected when passage of a Swan‐Ganz catheter was obstructed at the distal superior vena cava (SVC). At autopsy, lipomatous hypertrophy of the right atrium markedly narrowed the lumen at the SVC‐right atrial junction.
Pressor effects from daily events and laboratory complex stimuli relating personality factors
Authors: Germanó G. , Ferrucci A. , Strano S. , Molle G. , Napoleoni M. G. , Pecchioli V. , Germanó U. , Pistone A.
Published: February 2009

Our preliminary research has attempted to establish a series of methods to study the complex interactions occurring between pressor reactivity and personality profile. Ten untreated mild hypertensives (age 42.9±8) without damaged target organs were recruited from an outpatient hypertension center along with an equal number of normotensive volunteers (age 38.2±8.1). We performed a sequence of stressor types under laboratory conditions (sensory perceptual activities, psychomotor responses, and cognitive behavior) following an order ranging from inferior levels to superior levels of systemic integration. The subjects also underwent a 24‐h automatic noninvasive blood pressure recording which took into account the situational reactivity. They filled in MMPI and STAI questionnaires before and after the stressor batteries. Only the sensory‐perceptual test (Stroop color test modified), the arithmetic test, and the psychomotor test provoked a significant increase in blood pressure and, in the latter test, also a significant increase of the heart rate. The test batteries' mean differences were not significant between the two groups. Similarly, the answers to the trait‐anxiety questionnaires did not allow us to make a substantial division between normotensive and hypertensive subjects. On the contrary, the situational anxiety questionnaires showed a significant difference in the score reading preceding and following a task performed by the hypertensive subjects. We observed significant differences for both systolic and diastolic 24‐h blood pressure data in transition from a working situation to the sleeping period. However, there was not a significant difference in hypertensive blood pressure readings recorded during work and at home. The personality structures did not present remarkable differences between the two groups. With reference to the single personality dimensions, we found a number of higher scores expressing difficulty in adapting to social situations, a low capacity for self‐assertion, and a great sense of insecurity.
Dopamine‐induced increase in atrioventricular conduction in atrial fibrillation‐flutter
Authors: Gelfman D. M. , Ornato J. P. , Gonzalez E. R.
Published: February 2009

We report a patient with controlled atrial fibrillation‐flutter (AFF) and mitral stenosis who developed a marked increase in atrioventricular conduction during an infusion of low dose dopamine with development of hemodynamic compromise. This side effect has not been previously described in humans. Dopamine infusion should be used with caution in patients with AFF.
Nifedipine infusion in acute myocardial infarction: Experience in twelve patients
Authors: Heagerty A. M. , Bing R. F. , Pohl J. E. F. , Walley T. J. , Woods K. L. , Barnett D. B.
Published: February 2009

Studies of nifedipine have not shown that it reduces myocardial infarct size in humans. These studies did not consider the pharmacokinetics and dynamics of nifedipine. Oral doses of nifedipine cause high plasma concentrations and possibly harmful hemodynamic changes. Intravenous nifedipine infusion can rapidly achieve and maintain a steady concentration without repeated hemodynamic upsets. We studied 24‐h intravenous nifedipine infusion in 12 patients with acute myocardial infarct, starting within 6 (mean 4.0±0.7) h of onset of pain, to determine its safety, pharmacokinetics, and dynamics. An intravenous nifedipine bolus of 15 μg/kg was followed by an infusion of 0.9 mg/h for 24 h. After the bolus, pulse rate rose 12.5±8.0 p<0.01) and blood pressure fell (systolic by 20±34, p<0.05, and diastolic by 7.5±15.6, p<0.05). There were similar but lesser changes during the infusion. Myocardial oxygen requirements, as measured by the rate‐pressure product, did not increase. The mean nifedipine concentration at steady state was 17.2±4.2 ng/ml and mean elimination T1/2 3.57±2.70 h. Nifedipine was discontinued in 3 patients because of hypotension (SBP<90), rapid atrial fibrillation, and complete heart block in one patient each. Seven patients developed thrombophlebitis. Large studies of this preparation examining infarct size limitation and mortality are feasible, although in view of the problems of thrombophlebitis in peripheral veins, shorter infusion times or infusion via central lines would be more acceptable.
Effect of ibopamine on the failing heart at rest and during isometric exercise: A noninvasive study
Authors: Partanen J. , NIEMINEN M. S. , Lehto H.
Published: February 2009

Eleven patients suffering from heart failure were treated with oral ibopamine, a di‐isobutyric ester of N‐methyldopamine, 100 mg three times a day for 1 week and 200 mg three times a day for 3 weeks. Therapy was discontinued by one patient because of tachycardia. Left ventricular performance was evaluated with echocardiography and systolic time intervals at rest and after 3 minutes of isometric exercise using a handgrip. Six of 10 patients completing the study were in New York Heart Association (NYHA) functional class III, 2 in class IV, and 2 in class II. All patients, except one who remained stable in class II, improved their subjective condition by one functional class during 4 weeks of therapy (p<0.01). There were no changes in heart rate, blood pressure, rate‐pressure product, cardiac index, or total peripheral vascular resistance. The left ventricular end‐systolic diameter decreased after four weeks from 71.2±12.7 (SD) to 65.9±13.0 mm (p<0.001); the left ventricular end‐diastolic diameter did not change. The ejection fraction increased from 26±8 to 32±9% (p<0.01). Afterload, that is, left ventricular circumferential systolic wall stress, declined as a result of decreased systolic diameter. Systolic time intervals did not vary. There were no changes due to ibopamine during isometric exercise probably owing to increased beta‐adrenergic stimulation induced by the handgrip. Neither urine volume nor body weight changed. Side effects were mild except for tachycardia of one patient. It is suggested that ibopamine improves the performance of the compromised left ventricle and that it may be of value in therapy for patients with heart failure.
Exercise stress test in young hypertensive patients. response to vasodilators (prazosin) vs. beta‐blocker (atenolol) agents
Authors: Gascón J. V. Gimeno , De Ros J. Olague , REIG J. Ferrer , Martinez M. Hernandez , Siscar P. Bordes , Flores J. Serra , Catala G. Estruch , Vidal F. J. Algarra
Published: February 2009

Dynamic response of arterial blood pressure during exercise has been studied in 40 normotensive young subjects and 20 mild hypertensive young patients (20–40 years of age). Hypertensive patients were treated with atenolol (beta blocker) and prazosin (vasodilator). Both groups underwent maximal exercise stress test. A double‐blind nonrandomized study was practiced in hypertensive patients with placebo, prazosin (3 mg/12 h), and atenolol (100 mg/24 h). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and exercise duration (ED) were analyzed. All parameters remained stable in both groups. The hypertensive patients showed an increase in maximum SBP more than 230 mmHg during the placebo phase. This same group showed a significant increase in HR at rest two hours after administration of prazosin. Atenolol produced a significant reduction in HR both during rest and exercise. Both drugs produced a significant decrease in SBP and DBP (at rest and exercise). We conclude that exercise test is a noninvasive procedure that could distinguish mild arterial hypertension. The dynamic changes of arterial blood pressure can be controlled with prazosin (3 mg/12 h) or 1 daily intake of 100 mg atenolol.
Is localization of acute myocardial infarction time related?
Authors: Stoupel E. , Shimshoni M. , Agmon J.
Published: February 2009

A total of 1744 patients admitted to the ICCU with acute myocardial infarction (AMI) were studied in 1462 consecutive days (1982–1986). The aim of the study was to check whether the localization of the AMI was time related. Anterior (anterolateral) (AW) (n=834) versus inferior‐posterior (inferolateral) (IPW) (n=823) AMI were compared: a third group with isolated lateral wall (LW) AMI (n=87) was included in the study. Significant differences between monthly AMI localizations were registered, but no rhythmicity (monthly, seasonal) was found. A small absolute prevalence of AW localizations was found in all four seasons, but monthly differences made those differences not statistically significant. Some significant correlation (p<0.01) was found between AW AMI domination and daily geomagnetic activity (GMA level I‐IV). Only on days with low (quiet) levels of GMA were there more IPW AMIs. Adverse relationship was seen with LW AMI, relatively benign in AMI, was adversely correlated with GMA level (p<0.01). Differences in AW/IPW and left/right coronary artery autonomic receptors distribution and flow regulation and/or changes in cardiovascular homeostasis/coagulation, aggregation, viscosity, microcirculation, and so on connected with AMI expansion may be involved in these differences of AMI localization.
An infant with suspected right ventricular dysplasia presenting unique ventriculograms
Authors: Matsuoka Y. , Kawaguchi K. , Okishima T. , Hayakawa K.
Published: February 2009

Angiocardiography was performed twice in a male infant at ten days after birth due to cyanosis during crying and at 4 years and 10 months of age for close examination of the heart prior to an operation for cerebral abscess. Outpouchings resembling multiple diverticula were observed in both ventricles, though more notably in the right ventricle, as well as slight enlargement and reduced ejection fraction of both ventricles. Evaluation of oxygen saturation indicated right‐to‐left shunt at the atrial level. Electrocardiography suggested a marked superior axis deviation, and chest roentgenography and two‐dimensional echocardiography revealed enlargement of the right atrium and right ventricle. Soon after the examinations, the patient died suddenly during sleep at home. Since autopsy was not performed, a definitive diagnosis could not be made, but right ventricular dysplasia appeared likely. The unique angiocardiographic findings and clinical course of this rare patient are described.
Comparative use of cold blood potassium cardioplegia in coronary bypass patients necessitating long (2.5–6 h) versus short (< 1.5 h) aortic cross‐clamp times
Authors: SOMMERHAUG R. G. , WOLFE S. F. , REID D. A. , LINDSEY D. E. , PRATO S. J. , FROUNFELKNER L. E. , DEROCHER R.A.
Published: February 2009

In symptomatic patients with severe diffuse multivessel coronary disease undergoing bypass surgery, complete revascularization with multiple bypass grafts using saphenous vein and internal mammary conduits, and multiple endarterectomies may be necessary. Such complex surgeries may require long aortic cross‐clamp times in excess of 2.5 h. To evaluate the myocardial preservation provided by cold potassium blood cardioplegia, two groups of consecutive patients using nearly similar surgical techniques were compared. Group A consisted of 100 patients who received an average of 3.8 grafts per patient and had a mean aortic cross‐clamp time of 66 (range 15‐90) min. Group B was comprised of 100 patients who received an average of 9.3 grafts per patient and had a mean cross‐clamp time of 187 (range 150‐351) min. Operative mortality and perioperative myocardial infarction were low (0‐2%) and were not significantly different between the groups. In addition, the postoperative creatine kinase‐MB isoenzyme levels, use of pharmacologic and/or mechanical (i.e., intra‐aortic balloon) support, and follow‐up exercise treadmill tests were not significantly different in the two groups. These findings suggest that cold potassium blood cardioplegia is equally protective of the myocardium during surgical revascularization in patients with short aortic cross‐clamp times (less than 1.5 h) as in those with severe diffuse multivessel coronary artery disease requiring long cross‐clamp times exceeding 2.5 h and up to 6 h.
Severe aortic stenosis in systemic lupus erythematosus and mucopolysaccharidosis type II (hunter's syndrome)
Authors: Zimmermann B. , Lally E. V. , Sharma S. C. , Schoen F. J. , Kaplan S. R.
Published: February 2009

Cardiac manifestations of the mucopolysaccharidoses often include valvular regurgitation, but stenotic lesions are quite rare. This report describes a 30‐year‐old man with mucopolysaccharidosis type II (Hunter's syndrome) and systemic lupus erythematosus who developed severe progressive aortic stenosis and died. Autopsy examination revealed evidence of various cardiac mucopolysaccharide disease including valvular leaflets thickened and distorted with fibrocalcific nodules. A brief review of previously reported valvular disease in Hunter's syndrome and other mucopolysaccharidoses is presented. This is also the first report of a patient with both systemic lupus and a mucopolysaccharidosis.
The effect of oral diltiazem on left ventricular performance in postinfarction patients
Authors: Boström P.‐Å. , Lilja B. , Johansson B. W. , Meier K.
Published: February 2009

The purpose of the present study was to evaluate the effect of diltiazem on the left ventricular function in postinfarction patients. Twelve patients without cardiac decompensation at rest began diltiazem therapy beginning 3 months after an acute myocardial Q‐wave infarction. Oral diltiazem was administered on the first day in a single dose (120 mg) and the following 2 weeks in a 60 mg three times a day (tid) regimen. The therapeutic effect was studied by isotope angiocardiography at rest using equilibrium measurements with technetium‐99m. Acute as well as continuous treatment improved left ventricular function in terms of increased synergy of the contraction (decreased phase deviation from a median of 20.0° to median of 12.4° and 13.0°, respectively, p<0.01) and increased ejection fraction from a median of 46% to a median of 50% and 51%, respectively, p<0.05. It is suggested that the improvement of left ventricular function may be due in part to decreased pressure rate product. This improved left ventricular function during diltiazem treatment may explain the improved prognosis induced by diltiazem in postinfarction patients.
Relation between serum digoxin concentration and the electrocardiogram
Authors: Saner H. E. , Lange H. W. , Pierach C. A. , Aeppli D. M.
Published: February 2009

The relation between serum digoxin concentration and the electrocardiogram was assessed by correlating computerized measurements of electrocardiographic parameters (PR, QRS, QT and QTc intervals, ST segment, and T‐wave amplitude) with the serum digoxin concentration in 97 patients on digoxin maintenance therapy and in 40 nondigitalized control subjects. None of the patients had unstable ischemic heart disease, electrolyte disorders, medication known to influence the ST segment, and/or the presence of a bundle‐branch block or ventricular hypertrophy. We found a trend toward lengthened PR interval and shortened QT and QTc intervals in digitalized versus nondigitalized patients. Increasing serum digoxin concentrations were associated with progressive depression of the ST segment and decreased T‐wave amplitude (p<0.001). A normal ST segment in four leads (I, aVF, V5, V6) excluded the presence of a serum digoxin concentration > 1.3 ng/ml in our patients, whereas severe ST‐segment depression with aJpoint of > 100 m̈V was a strong indicator for the presence of a serum digoxin concentration >2.0 ng/ml in our selected patient population (specificity 99%, sensitivity 30%, predictive accuracy 85%). We conclude that computerized electrocardiographic analysis of the ST segment may provide clinically useful information for the management of selected patients on digitalis therapy and may therefore increase the diagnostic yield of the electrocardiogram in predicting the presence of higher serum digoxin concentrations in a small but significant percentage of patients.
Evaluation of left ventricular contractile performance from baseline stress‐shortening data in humans: comparison with pharmacological afterload challenge
Authors: Hausdorf G. , Rettig T. , Keck E. W.
Published: February 2009

The purpose of this study was to evaluate whether the baseline stress‐shortening data reflect the contractile state adequately and give results comparable to the evaluation of the end‐systolic stress‐shortening relationships using pharmacological manipulation of afterload. Five groups were studied (total 152 patients): a control group of 30 healthy volunteers, 32 patients after surgical correction of infantile tetralogy of Fallot, 50 patients treated for childhood malignancies with doxorubicin, 17 patients with left ventricular hypertrophy due to systemic hypertension, and 23 patients with congestive cardiomyopathy. In all patients except those with congestive cardiomyopathy, afterload was altered pharmacologically to evaluate the individual stress‐shortening relationship. In all patients the baseline stress‐shortening data were evaluated, as well as their relative positions to two predefined normal ranges for the relationship between end‐systolic stress and shortening. Additionally, a slope value was calculated from the baseline data of the five groups studied and compared with the data obtained by pharmacological afterload increment. Our data show that the comparison of individual baseline data of end‐systolic wall stress and fractional shortening with predefined normal ranges for the relationship between end‐systolic stress and shortening is inadequate. The appropriate normal range to compare with is the 95% confidence interval of baseline stress‐shortening data in normal subjects. Also the calculation of a slope value from the baseline stress‐shortening data of a group of patients seems to be inappropriate. Such a slope value does not necessarily reflect the contractile state, as the specific conditions leading to variations of end‐systolic wall stress are undefined and not standardized, and the correlation between baseline stress‐shortening data depends largely on the influence of the end‐systolic dimension on both parameters.
A system approach to intravenous thrombolysis in acute myocardial infarction in community hospitals: The influence of paramedics
Authors: Hartmann J. , Mckeever L. , Bufalino V. , Marek J. , Brown A. , Goodwin M. , Colandrea M. , Stamato N. , Cahill J. , Amirparviz F.
Published: February 2009

During a 3‐year period, intravenous streptokinase (IV STK) was given to 110 consecutive patients ages 34–78 in the course of acute myocardial infarction (AMI) in three community hospitals served by the same paramedic system. 1.5 million units of IV STK was given over 30 minutes. Half of the patients were brought to the hospital by paramedics. The average time from onset of pain to administration of IV STK was 107 minutes in the paramedic group and 182 minutes for the others. Of 110 patients, 98 (89%) showed clinical evidence of reperfusion and 94 of 106 patients (89%) showed angiographic reperfusion. Angiography was performed from 1 to 10 days post‐AMI. Mean time to angiography was 6 days for the first 58 patients and 2 days for the last 52 patients. In‐hospital mortality was 2 of 110 patients and there was 1 late death at 8 months for an overall 3‐year mortality 2.7%. Of 86 patients, 83 (96%) working before their infarct are working now. Of 107 survivors, 96 (90%) are Functional Class I. Conclusions: (1) IV STK is safely administered in a high percentage of AMI patients. (2) IV STK is safely administered in community hospitals. (3) Paramedics act as an early warning system and allow for earlier treatment than patients presenting without paramedic involvement. (4) Successful coronary reperfusion with IV STK results in low mortality rates and minimizes functional disability. (5) A systemwide approach to reducing time to treatment in AMI may be the most influential factor in affecting morbidity and mortality.
Morphologic correlates of coronary angiographic patterns at the site of percutaneous transluminal coronary angioplasty
Authors: Waller B. F.
Published: February 2009

Over the last 10 years considerable interest has been paid in the angiographic recognition of successful percutaneous transluminal coronary artery angioplasty (PTCA), complication of the technique, and angiographic predictors of restenosis. This report summarizes various angiographic patterns visualized at the site of angioplasty and correlates these patterns with morphologic findings. Of 66 patients undergoing PTCA for chronic or unstable angina pectoris, 76 PTCA sites were available for analysis. The two most common angiographic patterns at the angioplasty site (intimal flap=43%, intraluminal haziness=38%) correlated morphologically with intimal‐medial splits with localized dissections (79%). Shallow, superficial intimal lesions, laminated thrombus, and adventitial tears accounted for the remaining morphologic changes. Eight PTCA sites without morphologic injury corresponded to smooth wall changes and spasm at angiography.
Hemodynamic effects of intravenously administered magnesium on patients with ischemic heart disease
Authors: Rasmussen H. S. , Larsen O. G. , Meier K. , Larsen J.
Published: February 2009

Central hemodynamic parameters were registered by right‐side heart catheterization before and after intravenous administration of 12 mmol magnesium chloride (MgCl) in 15 patients with chronic ischemic heart disease and heart failure, New York Heart Association classes II and III. Serum magnesium concentrations increased from 0.76±0.03 (mean ± SD) to 1.54±0.05 mmol/1, which resulted in a reduction in mean arterial as well as pulmonary artery pressure by 10% (p<0.0001) and 7% (p<0.05), respectively. This reduction was caused by a marked decrease in systemic as well as pulmonary vascular resistance (from 1323 ±205 to 1132 ± 158 dyn•s/cm5, p<0.001 and from 156±73 to 133±72 dyn•s/cm5 (p<0.05). Heart rate, cardiac index, stroke volume index, and stroke work index increased slightly, although these differences did not reach statistical significance. Right and left ventricular filling pressures were not influenced, which indicates that the dilatory effect of magnesium, at the dosages used in the present study, is pronounced only at the arterial side of the vascular bed. The observed hemodynamic effects of the magnesium infusions may be beneficial in the setting of an acute myocardial infarction by reducing left ventricular afterload, which, together with the antiarrhythmic effect of magnesium may contribute to the positive effect of magnesium infusions on mortality in patients with acute myocardial infarction.
Heart rate, pr, and qt intervals in normal children: A 24‐hour holter monitoring study
Authors: Romano M. , Clarizia M. , Onofrio E. , Caiazzo M. R. , Adinolfi L. , Cutillo S. , Chiariello M. , Condorelli M.
Published: February 2009

A dynamic electrocardiographic Holter monitoring study was performed in 32 healthy children (20 males and 12 females, age range 6–11 years old), without heart disease, according to clinical and noninvasive instrumental examination. We evaluated atrioventricular conduction time (PR), heart rate (HR), and QT interval patterns defining the range of normality of these electrocardiographic parameters. The PR interval ranged from 154± 10 ms (mean±SD) for HR≤60 to 102±12 ms for HR ≥ 120 (range 85–180). The absolute mean HR was 87 ± 10 beats/min (range 72–104), the minimum observed HR being 61 ± 10 (range 51–79), the maximum 160±20 beats/min (range 129–186). Daytime mean HR gave a mean value of 93 ± 10 (range 71–148), while during night hours it was 74 ± 11 (range 54–98). The minimum QT interval averaged 261 ± 10 ms for HR> 120 and the maximum 389 ± 9 ms for HR ≤ 60; the corresponding mean value of QTc (i.e., QT corrected for HR) ranged from 388 ±8 for HR≤60 beats/min to 403 ±14 ms for HR> 120 beats/min. The results of the present study provide data of normal children which can be readily compared against those of subjects in whom cardiac abnormalities are suspect or patent. Some of the data reported here differ from those currently available, as for PR and HR, obtained from standard resting electrocardiogram, and cast doubt on the usefulness of correcting for HR in the QT interval in these subjects.