bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic effect of taurine in congestive heart failure: A double‐blind crossover trial
Authors: Azuma J. , Sawamura A. , Awata N. , Ohta H. , Hamaouchi T. , Harada H. , Takihara K. , Hasegawa H. , Yamagami T. , Ishiyama T. , Iwata H. , Kishimoto S.
Published: February 2009

In a double‐blind, randomized, crossover, placebo‐controlled study, we investigated the effects of adding taurine to the conventional treatment in 14 patients with congestive heart failure for a 4‐week period. Compared with placebo, taurine significantly improved the New York Heart Association functional class (p>0.02), pulmonary crackles (p>0.02), and chest film abnormalities (p>0.01). A benefit of taurine over placebo was demonstrated when an overall treatment response for each patient was evaluated on the basis of clinical examination (p>0.05). No patient worsened during taurine administration, but four patients did during placebo. Preejection period (corrected for heart rate) decreased from 148 ± 14 ms before taurine treatment to 137 ± 12 ms after taurine (p>0.001), and the quotient pre‐ejection period/left ventricular ejection time decreased from 47 ± 9 to 42 ± 8 % (p > 0.001). Side effects did not occur in the patients during taurine. The results indicate that addition of taurine to conventional therapy is safe and effective for the treatment of patients with congestive heart failure.
Apical left ventricular asynergy in chronic aortic regurgitation
Authors: Di DONATO M. , Barletta G. A. , Mori F. , Dabizzi R. P. , Fantini F.
Published: February 2009

Apical left ventricular (LV) wall motion abnormalities have been described in chronic volume oveload. To evaluate if these abnormalities are due to an acual hypokinesia we analyzed the percent shortening of apical LV radiants (PS%) by an angiographic computerized method and the endocardial systolic movement (ESM) and thickening (%Th) of the same region using M‐mode echocardiographic technique in 11 patients affected by pure aortic regurgitation (AR). In these patients mean apical radii shortening was reduced with respect to normal values. Both %Th and ESM were significantly reduced in AR when compared to normal subjects (24.5 ±31.7% vs. 63.8 ±35.8%, p<0.01 and 4 ±7 vs. 10 ± 3 mm, p<0.01, respectively). In addition, %Th and ESM directly correlated with PS% (r=0.79, p<0.01 and r=0.77, p<0.01, respectively). PS% correlated positively with systolic eccentricity and inversely with end‐systolic volume index (r=0.64, p<0.05 and r=0.57, p<0.05, respectively). Finally, in AR %Th was related to a normalized peak rate of systolic wall thickening (r=0.85, p<0.01) and to a normalized peak rate of diastolic wall thinning (r=0.68, p<0.05). These results showed that in AR a reduced apical radii percent shortening was associated with a reduced apical wall thickening and with a reduced normalized peak rate of systolic wall thickening and of diastolic wall thinning, thus indicating an actual hypokinesis and an impaired contractility. Moreover, the observed abnormalities correlated with an altered LV dynamic geometry linked to chronic volume overload.
The “straight back” syndrome: Current perspective more often associated with valvular heart disease than pseudoheart disease: A prospective clinical, electrocardiographic, roentgenographic, and echocardiographic study of 50 patients.
Authors: Ansari A.
Published: February 2009

Fifty consecutive patients (36 male, 14 female, mean age 28 years) who had heart murmurs and clinical and radiographic evidence of straight upper dorsal spine (straight back syndrome, SBS) underwent detailed clinical, electrocardiographic, roentgenographic, and echocardiographic evaluation. Palpable systolic thrill noted in one (2%) and widened S2 with persistent splitting in 2 (4%) patients were uncommon. Murmurs were invariably systolic in nature. Those located at the base of the heart in 19 (38%) patients were ejection in type and best heard during expiration. Those located at the apex in 26 (52%) patients were either mid‐, late‐, or pansystolic, and often associated with midsystolic click. Five (10%) patients had both types of murmurs. Diastolic murmurs were not heard in any patient. EKGs were normal in the majority. Cardiomegaly (C:T>55%) was present in only 5 (10%) and dilatation of the main pulmonary artery in 2 (4%) patients. Thus the incidence of pseudoheart disease (PsHD) was small (14%). Echocardiograms were normal in 18 (36%) and abnormal in 32 (64%) patients. There was evidence of mitral valve prolapse (MVP) in 29 (58%) patients and 3 (6%) had evidence of bicuspid aortic valve (BAV). In a control group of 40 age‐ and sex‐matched patients (26 male, 14 female, mean age 29.5 years), who also had heart murmurs but lacked straight upper dorsal spine, only 7 (17.5%) had MVP and none had BAV. The difference is both clinically and statistically significant (p<0.001). It is concluded that SBS is more often associated with valvular heart disease (MVP and BAV) than PsHD. Therefore, the diagnosis of SBS should remain presumptive until echocardiography has been performed to exclude MVP and BAV. SBS patients who have valvular heart disease should receive infective endocarditis prophylaxis.
Catheter‐induced spasm during spontaneous attack of variant angina
Authors: Matsuda Y. , Takashiba K. , Hamada Y. , Hyakuna E. , Ebihara H.
Published: February 2009

The simultaneous occurrences of spontaneous spasm and catheter‐induced spasm during coronary angiography were obtained in 3 patients. Catheter‐induced spasm was seen in the right coronary artery in 3 patients: 1 patient had spontaneous spasm in the distal right coronary artery and 2 patients had spontaneous spasm in the proximal left anterior descending coronary artery. These findings suggest that patients with variant angina may be susceptible to mechanical induction of spasm.
Evaluation of flecainide acetate in rapid atrial fibrillation complicating wolff‐parkinson‐white syndrome
Authors: Kappenberger L. J. , Fromer M. A. , Shenasa M. , Gloor H. O.
Published: February 2009

Flecainide is reported to be effective in patients with paroxysmal tachycardias, but its effect on rapid ventricular response over accessory atrioventricular pathway during atrial fibrillation is not known. The influence of flecainide on various electrophysiological properties of the accessory pathway with special emphasis on ventricular rate during atrial fibrillation was investigated in 9 patients with severe symptomatic Wolff‐Parkinson‐White syndrome. The shortest ventricular response during atrial fibrillation increased from 218 (190‐270) to 320 (240‐block) ms. In 4 patients sustained rapid atrial fibrillation converted to sinus rhythm. The rate of circus movement tachycardia decreased from 166/min to 130/min after flecainide, due to a lengthening of retrograde ventriculoatrial conduction time over the accessory pathway. Flecainide caused a significant prolongation of the effective refractory period of the accessory pathway in our subgroup with extremely fast AV conduction during atrial fibrillation and induced a depressant effect on retrograde accessory pathway conduction. This makes the drug very promising for the emergency treatment of dangerous rapid tachyarrhythias complicating this syndrome.
Systolic murmurs in pregnancy: Value of echocardiographic assessment
Authors: Northcote R. J. , Knight P. V. , Ballantyne D.
Published: February 2009

A systolic murmur discovered in antenatal care is the most common reason for cardiological assessment during pregnancy. We have assessed the value of clinical and echocardiographic assessment in 50 consecutive patients who were referred to our cardiac clinic following the discovery of a cardiac murmur at an antenatal clinic. Most of the murmurs occurred at 10‐12 weeks gestation; 46 subjects had cardiac murmurs confirmed at the cardiac clinic, of whom 16 gave a history suggestive of a previous cardiovascular disorder. Of the 16 patients, 13 had been found to have a murmur earlier in life which was thought to be of no clinical significance. Complications during pregnancy were infrequent. The most frequent murmur discovered was a soft midsystolic murmur heard with greatest intensity at the left sternal edge. The results of electrocardiography and echocardiography were not helpful in assisting with the diagnosis or substantially altering antenatal management in these patients. We do not feel that echocardiography has an important role in the assessment of systolic murmurs in pregnancy in the absence of other clinical or ECG abnormalities.
No adverse effects from high doses of felodipine to patients with coronary heart disease
Authors: Emanuelsson H. , Holmberg S.
Published: February 2009

Although vasodilators may be of value in treating hypertension and heart failure, excessive vasodilation may worsen poststenotic myocardial perfusion in patients with coronary artery disease. In this study, 11 patients with ischemic heart disease were given 0.010, 0.015, and 0.025 mg/min of felodipine, a potent arteriolar dilator, and hemodynamics and myocardial lactate extraction were measured. Plasma concentrations at the three dose levels (Dl, D2, and D3) were 11± 4, 22±5, and 40±8 nmol/1, respectively. Mean heart rate rose from 61 + 13 to 79±10 beats/min at D3 (p/0.01) and mean arterial pressure was reduced from 113±25 to 86+13 mmHg (p/0.01). There was a marked increase in cardiac index at all three dose levels (p/0.05 to p/0.01). The systemic vascular resistance was reduced by 47 % at D3 and coronary vascular resistance by 44% (both p/0.01). Myocardial oxygen consumption was not changed by felodipine. There were three patients with myocardial lactate production both before and after drug administration, but there were no ST‐segment shifts or chest pain in any patient. In conclusion, felodipine seems to be a potent vasodilator and deerioration of myocardial metabolic function occurs infrequently. OUr results suggest that felodipine can be safely administered even in high doses to patients with severe cononary artery diseases.
Nuclear medical determination of left ventricular diastolic function in coronary heart disease
Authors: Brugger P. , Lasser W. , Kullich W. , Stoiberer I. , Klein G.
Published: February 2009

In 64 patients with coronary heart disease, the left ventricular diastolic function was determined by means of a new nuclear medical method (nuclear stethoscope). The investigations revealed an abnormal diastolic filling in 85.9% of the cases on the basis of the parameters peak filling rate and time to peak filling rate as manifestation of a disturbed ventricular function.
Combination therapy with diltiazem and propranolol: Precipitation of congestive heart failure
Authors: Strauss W. E. , Mcintyre K. M. , Parisi A. F. , Egan T.
Published: February 2009

Although congestive heart failure has been reported with the combination of a beta blocker and either verapamil or nifedipine, it has not previously been reported for combination therapy that includes diltiazem. The following case documents the occurrence of clinical congestive failure in a patient with baseline left ventricular dysfunction and severe angina pectoris. Although the patients had tolerated propranolol therapy for years without difficulty, and high‐dose diltiazem monotherapy with an excellent clinical response, the combination of diltiazem and propranolol resulted in the development of congestive heart failure. Thus, although generally well tolerated, given the suitable scenario of reduced left ventricular function, the combination of diltiazem and a beta blocker may adversely affect left ventricular performance.
Hemodynamic advantage of combined administration of oral ibopamine and nitroprusside in patients with ischemic and idiopathic congestive cardiomyopathy
Authors: Dei Cas L. , Fappani A. , Riva S. , Metra M. , Cicogna R. , Manca C. , Visioli O.
Published: February 2009

The hemodynamic efffects of combined administration of ibopamine (Ib) (150 mg orally) with nitroprusside (NP) (50‐150/m̈g/min intravenously) were compared with those of NP alone in 17 patients with severe congestive heart failure due to coronary artery disease (7 patients) or idiopathic cardiomyopathy (10 patients). Hemodynamic measurements were obtained using a Swan‐Ganz thermodilution catheter and a bedside thermodilution cardiac output computer. Nitroprusside alone produced a significant decrease (—12.4%) in mean arterial pressure, mean pulmonary arterial pressure (‐28.3%), and systemic vascular resistance (‐22.6%), and a significant increase in stroke volume index (23.1 %). The administration of combined NP and Ib produced a further significant increase of stroke volume index (20.1 %) with a concomitant and significant reduction of systemic vascular resistance (‐19.4%); heart rate, mean systemic and pulmonary arterial pressures did not change significantly from the values observed with NP alone. Moreover, stroke work index, although not significantly modified with the vasodilator alone, was significantly increased over control values with NP+Ib association. Although NP alone induced similar effects in both the ischemic and idiopathic cardiomyopathies, the association of Ib gave a more favorable, though not significant, hemodynamic response in the subjects with primitive cardiomyopathy than in the ischemic ones. Thus, the association of Ib to NP therapy, in patients with congestive heart failure, further increases stroke volume index and stroke work index with a concomitant reduction of systemic vascular resistance, without any significant change in mean systemic and pulmonary arterial pressures, or heart rate. These results point out the possibility of associating Ib with other orally active vasodilators in the chronic treatment of congestive heart failure.
Ruptured abdominal aortic aneurysms: Experience with 70 cases
Authors: Crew J. R. , Bashour T. T. , Ellertson D. , Hanna E. S. , Bilal M.
Published: February 2009

During the period 1965–1983, 270 patients underwent resection of abdominal aortic aneurysm. In 70 patients (26%) the aneurysm was ruptured. Overall hospital mortality of patients with ruptures was 34%. Five patients died before the graft could be completed. Common denominators associated with mortality were hypotension, renal failure, cardiac arrest, and postoperative hemorrhage. The average age over the first 10 years was 68, but subsequently, has risen gradually, with a corresponding increase in mortality despite improved surgical technique and postoperative care. Only with more widespread elective resections and earlier diagnosis of rupture followed by prompt operative management, can the outlook for patients with abdominal aortic aneurysm be improved.
Primary sarcoma of the pulmonary trunk: Successful surgical intervention and prolonged survival
Authors: Klinke W. P. , Gelfand E. T. , Baron L.
Published: February 2009

We present a rare case of pulmonary trunk sarcoma in a young male in which the diagnosis was made antemortem. Total surgical removal of the tumor, including replacement of the pulmonary valve, was undertaken. This patient is the longest reported survivor of pulmonary trunk sarcoma and remains free of any signs or symptoms of recurrence. No adjuvant chemotherapy was required.
Myocardial infarction in the diabetic patient
Authors: Kereiakes D. J.
Published: February 2009

It has long been thought that the symptomatology and prognosis of coronary events in patients with diabetes may differ from those in nondiabetic persons. A review of recent data demonstrates a higher mortality during the acute phase of myocardial infarction for diabetic patients than for their nondiabetic counterparts, possibly related to a higher incidence of congestive heart failure and cardiogenic shock. The clinical course of diabetic patients with infarction and the role of insulin in myocardial adaptation to ischemia are both reviewed. Diabetic patients surviving the acute phase of myocardial infarction have a lower survival in follow‐up than nondiabetic survivors, although some improvement in survival has been noted following beta‐adrenergic‐blocker therapy.
Adenosine triphosphate and adenosine: Perspectives in the acute management of paroxysmal supraventricular tachycardia
Authors: Belhassen B. , Pelleo A.
Published: February 2009

Adenosine triphosphate (ATP) and adenosine exert strong and transient depressant effects on the sinoatrial and atrioventricular (AV) nodes of the human heart. The AV nodal effects of these drugs explain their high efficacy in either terminating AV re‐entrant supraventricular tachycardia or in slowing ventricular rate during atrial tachyarrhythmias. Their very short half‐life enables repeated administration of increased doses without reaching toxic effects and explains the transient character of their frequent but benign side effects. These agents represent a good alternative to verapamil in the acute management of paroxysmal supraventricular tachycardia both in infants and adults.
Cardiac Amyloidosis: Combined Use of Two‐Dimensional Echocardiography and Electrocardiography in Noninvasive Screening Before Biopsy
Authors: Sivaram C. A. , Jugdutt B. I. , Amy R. W. M. , Basualdo C. A. , Haraphongse M. , Shnitka T. K.
Published: February 2009

Cardiac amyloidosis (CA) presenting with intractable congestive heart failure, electrocardiographic (ECG) normal or low voltage, and conduction or rhythm disturbances, is rapidly fatal. During life, CA often mimics other cardiomyopathies so that definitive diagnosis depends on demonstration of amyloid on myocardial biopsy. On two‐dimensional echocardiography (2‐D echo), nonspecific features, such as increased ventricular wall thicknesses, predominant diastolic dysfunction, and diffuse myocardial “sparkling,” are consistently found in CA. The combined presence of these 2‐D echo features and normal or low voltage on ECG is highly suggestive of CA, allows differentiation from other cardiomyopathies, and might be useful in noninvasive screening before myocardial biopsy.
Incidence of complex ventricular arrhythmias in asymptomatic patients with recent myocardial infarction
Authors: Cocco G. , Strozzi C. , Pansini R. , Al Yassini K. , Padula A.
Published: February 2009

The incidence of ventricular extrasystoles (VES) was documented in 50 patients with recent uncomplicated myocardial infarction, with a 72‐h two‐channel ambulatory electrocardiogram. All patients were free of symptoms of arrhythmias; unstable angina pectoris and heart failure were absent. A total of 82% of the patients had VES: 23/50 patients had multiform or complex VES, 8/50 patients had ventricular tachycardia. VES were independent of heart rate and stable angina pectoris. Thus, frequent and complex VES are common in asymptomatic patients with uncomplicated recent myocardial infarction. Even in the absence of symptoms, ambulatory electrocardiography is useful. The prognostic significance of asymptomatic complex VES in these patients remains unsettled.
The erythrocyte aggregation value as a measure of the risk of myocardial infarction and arteriosclerosis of peripheral arteries
Authors: Ruhenstroth‐Bauer G. , Porz P. , Boss N. , Lehmacher W. , Stamm D.
Published: February 2009

The erythrocyte aggregation value (AW) has been determined in groups of patients with and without coronary heart disease (CHD) and in a group of apparently normal subjects, using the Metricell apparatus as described by Kachel et al. The following results were obtained: There was a close correlation between the AW and the existence of CHD or arteriosclerosis of peripheral arteries. The precision of the retrospective prediction of CHD by this noninvasive test in male subjects aged over 45 years (total CHD prevalence = 0.494) was: sensitivity = 0.571, specificity = 0.767. The predictive value of positive tests (PVpos) was 0.706, of negative test (PVneg) 0.647. The discriminatory ability of the AW test was superior to that of serum cholesterol determinations or measurement of other CHD risk factors made in the same population. The AW rises exponentially with the total score for risk factors for CHD hazard for the subject. It appears, however, from the insignificant correlations observed that there is no direct connection between the AW and any single risk factor.
Friedreich's ataxia associated with hypertrophic cardiomyopathy and coronary vasospasm
Authors: Sohi G. S. , Drake C. , Flowers N. C.
Published: February 2009

A rare patient with Friedreich's ataxia and hypertrophic obstructive cardiomyopathy who showed evidence of coronary artery vasospasm on ambulatory electrocardiographic monitoring is presented.
Purulent meningococcal pericarditis: Chronic percutaneous drainage with a modified catheter aided by echocardiography
Authors: Biancaniello T. M. , Anagnostopoulos C. E. , Bernstein H. E. , Proctor C.
Published: February 2009

A 7‐month‐old infant presented with suspected sepsis. On the third day of illness signs of cardiac tamponade developed. Tamponade was relieved by pericardiocentesis, and countercurrent immunoelectrophoresis (CIE) analysis of the fluid was positive for meningococcus group B. Antibiotic treatment was changed to penicillin G. After echocardiography demonstrated reaccumulation of fluid, a modified #16 gauge angiocatheter was placed percutaneously in the pericardial space. When drainage slowed it was repositioned using two‐dimensional echocardiography. After 24 h the catheter was removed and no further accumulation occurred. The antibiotics were continued an additional 10 days and the infant recovered uneventfully. Modification of the catheter and echographic repositioning may decrease the need for surgical drainage in such patients.
Nonsustained atrial flutter in a child without congenital heart disease
Authors: Casta A.
Published: February 2009

An 8 1/2‐year‐old child without heart disease developed nonsustained atrial flutter by programmed atrial stimulation. Atrial re‐entry was the underlying mechanism.
Nutrition and atherosclerosis: Some neglected aspects
Authors: Koumans A. K. J. , Wildschut A. J.
Published: February 2009

This article suggests that atherosclerosis is a plurideficiency disease. Increasing only linoleic acid intake in daily nutrition to counteract atherosclerosis has failed to give satisfactory results. The use of lecithin affects the metabolism and transportation of cholesterol in the blood more efficiently than do the polyunsaturated fats. Furthermore, insufficient quantities of vitamins B6 and C in the blood contribute to lesions of the arterial endothelium, which are indistinguishable from the first stages of atherosclerosis. It is recommended, therefore, that these factors should be combined, and that, together with a sufficient quantity of polyunsaturated fatty acids, the daily diet be supplemented with adequate doses of lecithin, vitamin B6 (in B complex), and vitamin C.
Noninvasive evaluation of intracardiac pressures using doppler ultrasound: A case study of panvalvular regurgitation
Authors: Yock P. G. , Popp R. L.
Published: February 2009

Doppler velocity signals from regurgitant valve flow can be used to calculate pressure gradients across incompetent valves by a modification of the Bernoulli equation. Analysis of these gradients provides clinically useful, noninvasive information about cardiac chamber pressures. This study presents an unusual case of cardiomyopathy with panvafvular regurgitation which demonstrates the major methods of pressure analysis using Doppler signals from regurgitant valves.
Percutaneous transluminal coronary angioplasty‐effect of the moveable guide wire on the complication rate
Authors: Glanelly R. E. J. , Schweiger M.
Published: February 2009

Beginning with the first percutaneous transluminal coronary angioplasty (PTCA) performed at Baystate Medical Center, 152 consecutive procedures were analyzed. Sixty were done using USCI‐G (nonsteerable) series catheters. In two patients both a G and S (steerable) catheter were used. In 90 procedures the S system was used exclusively. Among the attempted angioplasties with the G series catheter, the percutaneous transluminal coronary angioplasty was successful in 47 (78%). Eight coronary occlusions were induced and all these patients underwent coronary bypass surgery. There were no deaths, but three patients (5%) had acute myocardial infarctions (MI). The two patients in whom both G and S catheters were used had occlusions. One went to surgery and died postoperatively of uncontrollable ventricular arrhythmias. The other patient had a myocardial infarction and recovered. Of the 90 attempts with the exclusive use of the steerable system, 75 were successful (83%). Three coronary occlusions were induced in the 90 attempts and two of the patients had coronary artery bypass surgery. None of the three sustained a myocardial infarction. In summary, the proportion of patients requiring emergency surgery was significantly reduced from 13.3% (8 of 60) to 2.2% (2 of 90) (p=0.02), the incidence of myocardial infarction was reduced from 5 to 0%, and there was a slight increase in the siccess rate of the procedure after the introduction of the steerable system. It is concluded that the steerable system increases the safety of PTCA.
Effect of oral alcohol on left ventricular ejection fraction, volumes, and segmental wall motion in normals and in patients with recent myocardial infarction
Authors: Gould L. , Gopalaswamy C. , Yang D. , Patel D. , Klm B. S. , Patel C. , Becker W. H.
Published: February 2009

A first‐pass nuclear angiogram and a multiple‐gated acquisition study were obtained in 10 normal physicians and in 10 patients with a 7‐to‐10 day old transmural myocardial infarction. After the scan the subjects drank 2 oz. of whiskey. After 60 minutes, the multiple‐gated acquisition study was repeated. In the normal group the left ventricular ejection fraction was 68% before and 72% after alcohol. The left ventricular end‐diastolic volume increased from 89 to 97 ml while the left ventricular end‐systolic volume decreased from 29 to 27 ml. The stroke volume rose from 61 to 70 ml/beat (p<0.05). The cardiac output increased from 4.0 to 5.0 l/min (p<0.05). In the infarction group, the left ventricular ejection fraction was 58% before and 56% after alcohol administration. The left ventricular end‐diastolic volume fell from 111 to 96 ml, while the left ventricular end‐systolic volume declined from 50 to 44 ml. The stroke volume fell from 61 to 52 ml/beat, while the cardiac output fell from 4.5 to 3.8 l/min. In the left ventricular infarction zones, alcohol produced in 9 of the 10 cardiac patients a decline in the left ventricular regional ejection fraction. In the normal group, alcohol produced no significant changes in the regional ejection fraction. The normal and the postinfarction patients responded differently to alcohol.
Hemodynamic and metabolic effects of enalapril in patients with heart failure
Authors: Chrysant S.G. , Gollub S. , Dunn M.I. , Bal I.S. , Dreiling R. , Konijeti J.R.
Published: February 2009

Placebo and enalapril were added on a double‐blind basis to conventional treatment in 14 patients with congestive heart failure (CHF), New York Heart Association class II‐III. The patients were followed for 14 weeks and their performance was evaluated by a treadmill test, ejection fraction by nuclear scan, cardiothoracic ratio, and Yale Scale score. Metabolic studies were done to test any adverse effects of the drugs. Enalapril decreased arterial pressure and cardiothoracic ratio, and increased ejection fraction. Placebo exerted no significant effects. However, both drugs improved treadmill time and Yale Scale score. No adverse metabolic or clinical effects were observed with either drug. Based on these limited observations we conclude that: (1) Enalapril is a useful ancillary agent to conventional treatment of CHF; (2) it exerts its effects through afterload and preload reduction; and (3) it is safe and well tolerated and has a prolonged duration of action.
Successful management of atrial flutter in a newborn with verapamil
Authors: Casta A. , Wolf W. J. , Richardson C. J. , Sapire D. W.
Published: February 2009

Verapamil has become a popular antiarrhythmic drug for the acute management of supraventricular tachycardia in infants and children. A full‐erm, 1‐hour‐old infant presented with supraventricular tachycardia and hypotension that did not respond to vagal maneuvers and direct current cardioversion. After intravenous verapamil, the heart rate slowed and the underlying rhythm was atrial flutter.
Intravenous versus intracoronary streptokinase in acute myocardial infarction
Authors: Lo Y. S. A.
Published: February 2009

Nine studies specifically dealing with the comparison of intravenous Streptokinase (IVSK) and intracoronary Streptokinase (ICSK) in the treatment of acute myocardial infarction (MI) were analyzed to determine if IVSK is as efficacious as ICSK in achieving thrombolysis. Pooled data from the studies yielded success rates of 73% for IVSK and 72% for ICSK. Considering that the studies which did not perform preintervention angiogram may have overestimated the thrombolytic success rate in IVSK patients, there is a possibility that ICSK may be slightly more effective in achieving acute reperfusion. Bleeding complications were similar, and a systemic lytic state was observed in both treatment groups. No definitive conclusions can be drawn regarding the differences between groups in improvements of left ventricular function and mortality rates. ICSK has the advantage of direct documentation of reperfusion and spares the patient the risk of anticoagulation should the attempt fail. On the other hand, IVSK is cheaper, easier to administer, and can logistically be given earlier (even in the emergency room or ambulance) than ICSK; it is therefore more widely available, and may be the preferred mode of treatment in community hospitals where cardiac catheterization facilities are not readily available, if Streptokinase is to be given at all.
Relationship between electrocardiographically estimated infarct size and morbidity during a two‐year follow‐up
Authors: Herlitz J. , Hjalmarson Å
Published: February 2009

In 587 patients with a first myocardial infarction (MI) the electrocardiographically (ECG) estimated infarct size was related to morbidity during a two‐year follow‐up. Patients with transmural MI (Q‐ or R‐wave changes in standard ECG) were more often treated for heart failure and returned to work less frequently than patients with subendocardial MI (ST‐T‐wave changes only). There were trends indicating a higher reinfarction rate in patients with subendocardial MI, whereas angina pectoris was observed as frequently in both groups. In a subset of patients with anterior MI, infarct size was estimated from the total Q‐ and R‐wave amplitude in 24 precordial leads 4 days after arrival in hospital. A positive relationship was observed between ECG‐estimated infarct size and treatment for heart failure, and patients with smaller infarctions according to ECG criteria returned to work less frequently. A higher reinfarction rate was observed in patients with smaller infarctions. In patients with inferior MI there were mostly weaker correlations between ECG‐estimated infarct size (Q‐ and R‐wave changes in leads II, III, and aVF) and morbidity during the two‐year follow‐up.
Effect of exercise training and diet modification on serum lipids and lipoproteins in coronary artery disease patients treated with thiazides
Authors: Kahrs S. J. , Weinstein C. , Douwes J. , Alexander J. , Weinstein S.
Published: February 2009

The effects of chronic exercise training and diet modification on serum lipids and lipoproteins were measured in 17 hypertensive males and 41 normotensive males with documented coronary artery disease (CAD). Exercise consisted of aerobic activities which were performed at approximately 75‐85% of the symptom‐limited maximum heart rate for 30‐40 minutes, three times weekly for 3 months. Each participant's diet was also controlled, the recommended daily intake of fat and cholesterol was no more than 40 g/day and 200 mg/day, respectively. Significant increases in estimated VO2max and total cholesterol/high density lipoprotein (HDL) and a significant decrease in serum triglycerides were documented after training. Significant differences in serum cholesterol and triglycerides between the nondiuretic and diuretic patients were also noted. No significant changes were found in low density lipoprotein (LDL), HDL, or body weight. Vigorous aerobic training and diet modification can favorably modify the deleterious effects of diuretic medications on serum triglycerides and total cholesterol/HDL in patients with documented CAD.
Flecainide: A new antiarrhythmic drug
Authors: Mueller R. A. , Baur H. R.
Published: February 2009

Flecainide acetate is a new class 1 antiar‐rhythmic drug. It slows conduction in the working myocardium and the specialized conduction system and may depress sinus node activity in patients with pre‐existing sinus node disease. Its hemodynamic effects are minimal. The drug is completely absorbed and shows a half‐life of 7–22 hours. Elimination is mainly through the kidneys. Flecainide is highly effective in the treatment of ventricular arrhythmias, pre‐excitation syndromes and AV reentry tachycardias. Side effects are mild and consist mostly of dizziness, visual disturbances, and nervousness. They rarely require discontinuation of therapy. Proarrhythmic effects have been reported. Caution is required in patients with congestive heart failure, AV block, and/or bundle‐branch block or sinus node dysfunction.
Heart involvement in metastatic carcinoid disease
Authors: TöRNEBRANDT K. , Eskilsson J. , Nobin A.
Published: February 2009

Sixteen patients with metastatic carcinoid tumors of ileal or cecal origin were studied in order to evaluate the frequency and degree of cardiac involvement in a nonselected patient group. We have also studied the correlation between plasma hormone levels (e.g., 5‐hydroxytryptamine (5‐HT) and substance P) and the degree of cardiac involvement. The patients underwent physical examinations, electrocardiograms, chest x‐rays, cardiac catheterization, and echocardiography, Plasma levels of 5‐HT and substance P were analyzed. Carcinoid heart involvement was found in 3 of 16 patients (19%) but no patient had subjective symptoms associated with heart disease. Four patients (25%) had slight pulmonary hypertension. No left‐sided heart lesions were seen. No correlation between blood levels of 5‐HT or substance P and heart involvement was found. Eight patients died during the follow‐up period, but in none of these was the cause of death cardiac failure. Carcinoid heart disease is not as common in our patients as in patients selected on a cardiological basis described in earlier studies. Echocardioraphy appers to be the most efficient technique for detection of even subclinical heart involvement and a useful tool for following its progress.
Arm exercise testing for coronary artery disease in patients with peripheral vascular disease
Authors: Hanson P. , Pease M. , Berkoff H. , Turnipseed W. , Detmer D.
Published: February 2009

We evaluated 74 peripheral vascular disease (PVD) patients (54 men, age 61 ± 7 years and 17 women, age 63 ± 7 years) for potential coronary heart disease (CAD) using an arm exercise test (AET) protocol. All patients performed upright two‐arm cranking using discontinuous stages of 2 minutes of exercise separated by 2 minutes of rest. Exercise intensity was increased by + 100 or 200 kpm (kilopond meters) with each stage. ECG was monitored continuously and blood pressure and 12‐lead ECG tracings were obtained at the end of each exercise stage. All patients reached an endpoint of subjective exhaustion. Men achieved 91 ± 14% of age‐predicted heart rate at 597 ± 167 kpm, while women achieved 86 + 14% of age‐predicted heart rate at 335 ± 117 kpm. Ischemic ECG responses (+AET) defined as new or additional ST depression > 1.0 mm × 80 ms, occurred in 35 men (65%) and 7 women (42%). Coronary angiography was performed in a subset of 22 patients (15 males and 7 females). CAD (>70% stenosis) was found in 11 of 12 men and 4 of 5 women who showed positive or strongly positive AET responses (overall predictive value for AET = 88%). We conclude that arm exercise stress testing is safely performed in PVD patients who cannot complete treadmill exercise. In this limited series of PVD patients, the predictive value of a + AET response for diagnosis of CAD is similar to established values for treadmill exercise.
Effect of localized surface cooling of the heart muscle on the high‐frequency content of ecg waveforms in dogs
Authors: Akselrod S. , Mor‐Avi V. , Oz O. , David D.
Published: February 2009

Hypothermia is known to affect the electrophysiology of the myocardium in various ways. A marked increase in action potential duration, combined with a decrease in rate of depolarization and conduction velocity, has been observed. We studied the effect of localized hypothermia of the ventricular myocardium on the high‐frequency (HF) components of the ECG waveform. Signals were obtained from 6 anesthetized dogs using simultaneous recording of three orthogonal body surface leads before, during, and following surface cooling of different areas of the epicardium. Computer analysis included digital averaging and filtering in a frequency range of 150–250 Hz. For each intervention in each animal, the variance of the average nonfiltered QRS complex was used for a quantitative estimate of the total power, whereas the variance of the derived filtered wave (HF QRS complex) expressed the power content in the HF range. The total power increased during localized cooling of the anterior as well as the inferior epicardial surface, while a clear reduction of power was observed in the HF range. This reduction was shown to be lead dependent and nonuniformly distributed during the course of the QRS. In all cases, hypothermia of either anterior or inferior ventricular epicardium produced a zone of reduced amplitude in the HF QRS complex of at least one lead. Thus, typical changes in the morphology of the HF QRS complex are reliable markers for cooling‐induced localized electrophysiological (EP) variations. Therefore, the HF analysis of the body surface ECG may provide noninvasive insight into the EP properties of the myocardium.
Takayasu's arteritis and mitral stenosis
Authors: Doi Y. L. , Seo H. , Hamashige N. , Jin‐Nouchi Y. , Ozawa T.
Published: February 2009

A 44‐year‐old housewife was found to have coarctation of the abdominal aorta secondary to Takayasu's arteritis. Since she also had mitral stenosis, possible etiological relation between Takayasu's arteritis and mitral stenosis is suspected.
Angiographic morphology and response to therapy in unstable angina
Authors: Sansa M. , Cernigliaro C. , Bolognese L. , Bongo S. A. , Rossi L. , Rossi P.
Published: February 2009

The coronary anatomy of 69 patients with unstable angina, subgrouped according to response to medical therapy, was investigated. All patients received oral treatment with nitrates, calcium antagonists, and beta‐blocking agents. When combined oral treatment was not effective, an intravenous infusion of nitrates (10–100 m̈g/min) was subsequently administered. Coronary arteriography was performed within hours (14±9 h) from the last episode of chest pain in 28 patients refractory to medical treatment, while in 41 patients who became asymptomatic during medical therapy, angiography was performed after an observation period of several days (8 ± 6 days). On angiography, the nonresponder group was characterized by a prevalence of eccentric and multiple lesions, and by a 46% incidence of thrombi (p <0.001). Recurrent symptoms requiring emergency bypass operation were common in this group. In patients responsive to medical treatment, a high percentage of concentric lesions (37%) and totally occluded (34%) coronary arteries was found (p <0.05). No infarcts and low rate of recurrent angina were noted in these patients during hospitalization. In conclusion, the finding of intracoro‐nary thrombotic material and eccentric or multiple lesions can be an accurate markers of the active phase of the disease, while “silent” occlusion of the involved vessel may be accompanied by relief of symptoms during medical therapy.
The role of ischemia and ventricular asynergy in the genesis of exercise‐induced ST elevation
Authors: Arora R. , Ioachim L. , Matza D. , Horowitz S. F.
Published: February 2009

Sixty‐five patients with ST elevation were retrospectively studied in order to evaluate the clinical significance and underlying mechanisms of ST‐segment elevation during exercise. Of these, 50 patients had previous myocardial infarction (Group I) and 15 patients did not (Group II). Exercise thallium‐201 imaging was performed on 30 patients, resting gated blood pool imaging was performed on 33 patients, and 23 underwent cardiac catheterization for clinical indications. When the two groups were compared, patients in Group I had more frequent multivessel disease (9/13 vs. 3/10, p<0.05), anterior infarctions (33/50 vs. 4/10, p<0.02), while Group II patients had more frequent single‐vessel disease (7/10 vs. 4/13, p<0.05). For Group I patients, the most common reason for termination of exercise was fatigue and/or dyspnea (35/50 vs. 0/15, p<0.05), with an irreversible defect noted in both stress and delayed views on thallium imaging (20/24 vs. 1/6, p<0.05). In Group II, the most common reason for termination was angina (15/15 vs. 2/50, p<0.001), with reversible thallium defects noted more frequently (4/6 vs. 3/24, p<0.01). Thus, we conclude that in patients with Q waves, left ventricular dysfunction rather than ischemia is the mechanism for ST elevation. In these patients angina is rare, but fatigue, dyspnea, multivessel disease, and fixed thallium defects are common. In patients with non‐Q‐wave exertional ST elevation, ischemia is the rule, manifested by frequent chest pain and reversible thallium defects.
Evidence of anaerobic metabolism during low‐level exercise testing in high‐risk postmyocardial infarction patients
Authors: Hossack K. F. , Wolfel E.
Published: February 2009

Low‐level exercise testing was performed on 31 patients 7.4±2.7 days following an acute myocardial infarction. Measurements of oxygen consumption (VO2) and arterial serum lactate were made at rest and during exercise in these patients and 15 normal subjects. The patients were subdivided into finishers (F) and nonfinishers (NF) of the low‐level protocol. The NF group had 2.5 ±. 6 stenosed vessels and an ejection fraction of 44 ± 11% compared to F subjects, who had 1.4 ± 1 vessels stenosed (p <.001) and an ejection fraction of 54 ± 14% (p <.05). Finishers had significantly higher VO2 than the nonfinishers (14.5±2.5 ml/kg/min vs. 11.2+3.5 ml/kg/min p< .01). At the end of exercise serum lactate level was 1.18±.59 mM in normals, 1.43±.52 mM in finishers, and 2.15±.9 mM in nonfinishers. The change in serum lactate from rest to end exercise divided by the change in VO2 from rest to end exercise was .039±.038 mM/ml kg per min in normals, .075±.045 mM/ml kg per min in finishers (p<.03 vs. normal), and .210±.189 mM/ml kg per min for nonfinishers (p <.001 vs. normal). These results indicate that nonfinishers produce more lactate and use less oxygen during low‐level exercise, suggesting that working muscles are deriving energy by anaerobic metabolism. This may be necessary because these patients have more severe coronary artery disease and worse left ventricular function, and consequently are unable to adequately provide the oxygen requirements for the working muscles because of reduced cardiac output.
Percutaneous pulmonary angioscopy using a guiding balloon catheter
Authors: Uchida Y. , Tomaru T. , Kato S.
Published: February 2009

The applicability of angioscopy for observation of the pulmonary arterial lumen was examined in 7 anesthetized dogs and in 10 patients with various heart diseases during cardiac catheterization. A novel guiding balloon catheter (#11F shaft diameter and 1.5 cm in balloon diameter) was introduced through the right femoral vein into the pulmonary artery by Seldinger's method. Then, a fiberscope (1.3 or 1.8 mm in diameter) was introduced through the guiding catheter into the desired portion of the artery. The balloon was inflated, saline was infused, and the pulmonary arterial lumen was photographed on 16‐mm color cinefilms. In all dogs and patients examined, an increase in diameter of the pulmonary artery during systole and the backflow of blood from the pulmonary vein were clearly demonstrated. Also, pulmonary thrombi or emboli experimentally induced in dogs could be observed. No complications were observed in the patients. The results indicate the experimental and clinical applicability of angioscopy using a guiding balloon catheter for observation of the pulmonary arterial lumen.
Pathomorphological changes in experimentally induced canine myocardial infarction
Authors: Tomaru T. , Uchida Y. , Sugimoto T.
Published: February 2009

We performed a pathological study of experimental canine myocardial infarction (MI) induced by coronary thrombosis which was made by endothelial denudation and induction of luminal stenosis in 20 dogs (Group I). Another model of experimental MI by coronary ligation was also evaluated in Groups II and HI. Thirteen dogs of Group I and 7 of Group II underwent persistent coronary occlusion for 6‐8 h (Group IA and Group IIA), and 7 of Group I and 7 of Group II underwent coronary reper‐fusion with intravenous urokinase (UK) (20,000 IU/kg) in Group IB for 5 h following temporary coronary occlusion for 3 h (Groups IB and IIB). The remaining 5 dogs underwent coronary reperfusion for 5 h following intravenous 20,000 IU/kg UK after 3 h ligation. Microscopically, myocardial hemorrhage was present in 6 (86%) Group IB, 4 (31 %) Group IA and in no Group IIA dogs (p<.025 and p<.005 vs. IB). Four Group IIB and 3 Group III dogs also showed myocardial hemorrhage. Moderate hemorrhage was present only in Group I and slight hemorrhage was frequently observed in reperfused hearts. Contraction band necrosis (CBN) was present in 8 (62%) Group IA, all Group IB, all Group IIB, and 4 (80%) Group III dogs. However, there was no hemorrhage with CBN in Group IIA (p <.005 vs. IIB). Marked CBN was present only in Group I. Thus, CBN and myocardial hemorrhage were prominent in reperfused hearts, especially in those with thrombolysis. However, they were also present in the hearts which had undergone persistent coronary occlusion with thrombi.
Nonischemic changes in right ventricular function on exercise. Do normal volunteers differ from patients with normal coronary arteries?
Authors: Caplin J. L. , Maltz M. B. , Dymond D. S. , Flatman W. D.
Published: February 2009

Factors other than ischemia may alter right ventricular function both at rest and on exercise. Normal volunteers differ from cardiac patients with normal coronary arteries with regard to their left ventricular response to exercise. This study examined changes in right ventricular function on exercise in 21 normal volunteers and 13 patients with normal coronary arteries, using first‐pass radionuclide angiography. There were large ranges of right ventricular ejection fraction in the two groups, both at rest and on exercise. Resting right ventricular ejection fraction was 40.2 ± 10.6% (mean ± SD) in the volunteers and 38.6±9.7% in the patients, p = not significant, and on exercise rose significantly in both groups to 46.1 ±9.9% and 45.8 ±9.7%, respectively. The difference between the groups was not significant. In both groups some subjects with high resting values showed large decreases in ejection fraction on exercise, and there were significant negative correlations between resting ejection fraction and the change on exercise, r = ‐0.59 (p<0.01) in volunteers, and r = ‐0.66 (p<0.05) in patients. Older volunteers tended to have lower rest and exercise ejection fractions, but there was no difference between normotensive and hypertensive patients in their rest or exercise values. In conclusion, changes in right ventricular function on exercise are similar in normal volunteers and in patients with normal coronary arteries. Some subjects show decreases in right ventricular ejection fraction on exercise which do not appear to be related to ischemia.