bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery of ventricular late potentials from body surface using the signal averaging and high resolution ecg techniques
Authors: Hombach V. , Höpp H. W. , Kebbel U. , Trei Osterspey I. S. A. , Eggeling T. , Winter U. , Hirche H. , Hilger H. H.
Published: February 2009

In 70 patients (3 females and 67 males), aged 16–72 years (mean: 51±9 years), the low noise ECG was recorded from body surface by the signal averaging and the high resolution beat‐to‐beat techniques. We found 61 patients were suffering from coronary heart disease, 4 had atypical coronary heart disease (syndrome X), 4 had dilatative cardiomyopathy, and one had the long QT syndrome (Romano‐Ward syndrome). We found the following recovery rates for ventricular late potentials within the ST segment with the averaging technique: clearcut in 13/53 patients, doubtful in 16/53 patients, and late potentials absent in 26/53 patients. With the beat‐to‐beat technique the following recovery rates were found: clearcut late potentials in 27/70 patients, doubtful in 23/70 patients, none in 20/70 patients, and intermittently occurring late potentials in 18/70 patients (categorized as doubtful late potentials). When comparing the detection of late potentials with both methods in individual patients, we found concordant results in 39/53 patients studied (positive with both methods in 24/53 patients, negative with both methods in 15/53 patients), and discordant results in 14/53 patients (positive with the beat‐to‐beat technique and negative with the averaging technique in 12 individuals, negative with the beat‐to‐beat technique and positive with the averaging technique in the remaining 2 patients). The correlation between the incidence of late potentials and the presence of exercise‐induced myocardial ischemia (submaximal bicycle exercise) was higher when using the high resolution beat‐to‐beat technique, as holds also true for the correlation to complex ventricular arrhythmias. Dynamic changes of late potentials were only detectable by the beat‐to‐beat technique, which seems to be a considerable advantage over the averaging technique. In the clinical setting, both methods for retrieval of ventricular late potentials should be applied in order to increase the information and to provide the facilities of investigating larger patient populations for screening purposes.
Pirmenol in termination of paroxysmal supraventricular tachycardia
Authors: Toivonen L. K.
Published: February 2009

An assessment was made of the effect of pirmenol in the termination of paroxysmal supraventricular tachycardia (SVT). Sinus rhythm was restored by intravenous administration in 11 of 17 patients during a spontaneous attack. Another 8 patients were studied electrophysiologically. Pirmenol terminated an induced SVT in 3 of 5 patients having an atrioventricular (AV) intranodal re‐entry mechanism but in none of 3 patients having an atrioventricular bypass tract as one re‐entrant limb. The overall success in restoring sinus rhythm was 14 of 25 patients (56%). The drug was hemodynamically well tolerated even in cases of continued SVT. Pirmenol increased the atrial effective refractory period and had no obvious effect on AH and HV intervals. The functional refractory period of the AV node was decreased, probably by an anticholinergic effect. The effective and functional refractory periods of retrograde atrioventricular conduction via the AV node and bypass tract were increased in some patients. The mechanism terminating the AV intranodal SVT was a block in the retrograde part of the dual AV nodal pathway, a typical antiarrhythmic Class I effect.
Left predominant coronary circulation in patients with valvular aortic stenoses
Authors: Kober G. , Klepzig H. , Kaltenbach M.
Published: February 2009

This study was conducted to examine whether a correlation exists between the incidence of aortic stenosis and predominant left coronary perfusion. Therefore, coronary angiograms of 77 patients with mitral stenosis (Group 1), 50 patients with combined mitral valve disease and pure mitral insufficiency (Group 2), 61 patients with aortic insufficiency with or without mitral valve disease (Group 3), 49 patients with pure aortic stenosis (Group 4), and 69 patients with combined aortic valve disease and aortic stenosis with concomitant mitral valve disease (Group 5) were reviewed. Group 6 consisted of 20 patients with coronary heart disease. A statistically significant accumulation of left coronary circulation was found in patients with pure aortic stenosis (Group 4) (33%) as well as in patients with combined aortic valve disease (19%). The frequency of predominant left coronary circulation was comparable in all other patients (Group 1: 8%; Group 2: 10%; Group 3: 8%; Group 6: 7.5%). Thus, the presence of left predominance in a diagnostic coronary arteriogram performed in a patient with aortic stenosis could be a clue that the aortic stenosis is congenital.
Beta‐endorphins in acute myocardial infarction
Authors: Stoupel E. , Pinchas A. , Agmon J. , Gilad I. , Laron Z.
Published: February 2009

The endogenous peptide B‐endorphin (B‐EP) is closely connected with different aspects of homeostasis, behavior, and in particular with the perception of pain. The purpose of this study was to investigate the correlation between: (a) the level of plasma B‐EP and the intensity of pain in acute myocardial infarction (AMI); and (b) the B‐EP and specific enzymes for AMI serum glutamic oxolo‐acetic transferase, lactate dehydrogenase, and creatine phosphokinase and some stress hormones (cortisol, growth hormone). Twenty‐six patients hospitalized in the CCU for acute MI were studied during the first 72 hours from the onset of symptoms. Seven normal subjects served as controls. Blood was taken for hormone and B‐EP evaluation before treating the patients by opiates. Plasma B‐EP levels were determined using the protocol of the Immunonuclear Corporation (Stillwater, MN). Statistical analysis of the results showed: (1) Nonsignificant differences between B‐EP levels of all MI patients and control group. (2) Unaltered B‐EP levels in patients with acute MI suffering from moderate pain. (3) Significant differences in drop of B‐EP in the group with most severe pain (p<0.025). (4) A tendency toward decreased B‐EP in patients suffering from more prolonged pain (>6 hours). Significant negative correlation was shown between B‐EP and (a) chest pain intensity (0‐4 graduation) (r=0.8, p<0.01); (b) lactate dehydrogenase (r=0.7, p<0.01); (c) serum glutamic oxolo‐acetic transferase (r=0.6, p<0.01); (d) creatine phosphokinase (r=0.6, p<0.05; (e) plasma cortisol level (r=0.5, p<0.05). (5) A higher level of B‐EP in group of MI with creatine phosphokinase above 1500 units (p<0.05). (6) A significant rise of cortisol level in acute MI patients with low B‐EP and suffering from extreme pain (p<0.0005). (7) A strong tendency to (a) adverse correlation between B‐EP and growth hormone (p‐0.07) and (b) rise of growth hormone in severe pain (p=0.08). in conclusion, our data confirmed an adverse correlation between B‐EP and pain intensity in acute MI. This study shows some prognostic significance of B‐EP levels by confirmed negative correlation with acute MI enzymatic changes reflecting the extent of myocardial damage. in cases with very high creatine phosphokinase level this relationship was absent.
Plasma‐free eicosapentaenoic acid/arachidonic acid ratio: A possible new coronary risk factor
Authors: Kondo T. , Ogawa K. , Satake T. , Kitazawa M. , Taki K. , Sugiyama S. , Ozawa T.
Published: February 2009

Seventy‐six effort angina patients who had typical angina on exertion documented by treadmill stress test with evidence of ischemic ST‐segment depression and 78 healthy volunteers in urban Japan were investigated in this study. Plasma free fatty acids (FFA) in both groups were determined using highperformance liquid chromatography. The relationships between the total cholesterol, high‐density lipoprotein (HDL), triglycerides in plasma, and the genesis of coronary heart disease were also examined. The ratio (0.08±0.08) of eicosapentaenoic acid (EPA)/arachidonic acid (AA) in plasma FFA was significantly lower in effort angina patients than that (0.15±0.12) in healthy volunteers. The lower ratio was due to significantly lower levels of EPA in the patients than in normals. in 42% of angina patients, the ratio is below 0.03. in all age subgroups except the age 30‐39 subgroup, the ratio of EPA/AA was significantly lower in patients than in normals, when divided into four subgroups by using a 10‐year age interval. Though the total cholesterol and triglycerides were not significantly different between the two groups, HDL was significantly lower and total cholesterol/HDL ratio was significantly higher in effort angina patients than in healthy volunteers. However, there was no correlation between EPA/AA ratio and HDL in individuals in either group. From these results, it could be concluded that lower EPA/AA ratio is a new coronary risk indicator other than HDL.
Improvement by oral metoprolol of exercise‐induced ischemic dysfunction in patients with coronary heart disease
Authors: Battler A. , Lieberman D. , Rath S. , Rotstein Z. , Rabinowitz B. , Neufeld H. N.
Published: February 2009

The effect of metoprolol on global left ventricular function during exercise was anlyzed with nuclear ventriculography in 17 patients with ischemic heart disease. All had stable angina pectoris and ST‐segment depression of more than 0.1 mV during treadmill exercise when not taking metoprolol. Each patient was stressed with supine bicycle exercise to the same load on a maintenance dose of metoprolol (100 mg × 2/day) and on a second occasion without the drug, the two being separated by 7 days. The mean heart rate and systolic blood pressure were significantly reduced both at rest and exercise with metoprolol. There was no significant difference of rest left ventricular ejection fraction with or without metoprolol. At exercise, however, every patient showed improvement of left ventricular function, the average left ventricular ejection fraction increasing by 14% (±6) relative to the same exercise without metoprolol (p<0.001). We conclude that chronic metoprolol treatment in patients with ischemic heart disease can ameliorate left ventricular dysfunction induced by exercise and may thereby reduce myocardial ischemia.
Two‐dimensional echocardiographic evaluation of ventricular asynergy induced by dipyridamole: Correlation with thallium scanning
Authors: Ferrara N. , Bonaduce D. , Leosco D. , Longobardi G. , Abete P. , Morgano G. , Rengo F. , Salvatore M.
Published: February 2009

Myocardial asynergies detected by two‐dimensional echocardiography during intravenous administration of Dipyridamole (0.75 mg/kg) were evaluated in 54 patients referred for angiographic evaluation of chest pain. Technically adequate two‐dimensional echocardiograms suitable for analysis were recorded in 42 of 54 (77.7%) patients studied. Thallium‐201 myocardial perfusion scintigraphy, during dipyridamole test was performed in the same patients. Thirty of the 42 patients studied showed significant coronary narrowing at cardiac catheterization. Dipyridamole‐induced wall motion abnormalities and myocardial perfusion defects were detected, respectively, in 19 (63.3%) and 21 (70%) of 30 patients with significant coronary artery disease. Wall by wall comparison of the distribution of dipyridamole‐induced echocardiographic asynergy with reversible thallium‐201 (201TI) perfusion defects demonstrated complete correlation in 42 segments examined. Three segments with perfusion defects at thallium scanning did not show asynergy during the test while two segments showing wall motion abnormalities during dipyridamole infusion did not manifest perfusion defects. Our study demonstrates that two‐dimensional echocardiography during dipyridamole testing is useful in detecting patients with coronary artery disease. Furthermore, ventricular asynergies detected during the test show a high correspondence with site of myocardial perfusion defects at thallium scanning.
Acute, short‐ and long‐term efficacy of oral bevantolol in patients with coronary artery disease: A placebo‐controlled, randomized, double‐blind study
Authors: Gimeno J. V. , Ferrer J. , Olague J. , Bordes P. , Serra J. , Estruch G. , Mainer V. , Algarra F. J.
Published: February 2009

The efficacy and safety of bevantolol (new cardioselective beta‐blocking agent without intrinsic sympathetic activity) were evaluated in chronic stable angina pectoris. Acute effects on heart rate (HR) and pulmonary function (forced expiratory volume in the first second, FEV1, and vital capacity, VC) (doubleblind placebo, propranolol, 80 mg, and bevantolol, 150 mg) and the antianginal efficacy during early (doubleblind placebo period) and chronic bevantolol therapy (long‐term follow‐up for 52 weeks) were studied. Bevantolol reduces HR in the same way as propranolol (both p<0.01). Pulmonary function is modified significantly only by propranolol (decreasing FEV1, p<0.05). Bevantolol reduces antianginal attacks and nitroglycerin consumption (p<0.01) and improves exercise tolerance (p<0.01) during early and chronic therapy.
Detection of electrocardiographically imperceptible ventricular pre‐excitation by phase imaging
Authors: Rakovec P. , Kranjec I. , Fettich J. J. , Fidler V. , Pohar B. , Porenta M. , Janežič A. , Varl B.
Published: February 2009

The sequence of ventricular contraction was studied by radionuclide phase imaging in 25 patients with Wolff‐Parkinson‐White syndrome. The studies were performed when no signs of precontraction were present in the electrocardiogram; in these cases pre‐excitation was either intermittent or suppressable by injection of ajmaline. In 11 of the 16 patients with free wall accessory pathways, precontraction could be detected in spite of electrocardiographically absent pre‐excitation. Discrete precontraction was seen also in 2 of the 9 patients with paraseptal accessory pathways. We conclude (1) that antegrade conduction through the accessory pathway does not need to be completely blocked if signs of pre‐excitation are absent on the electrocardiogram, and (2) that phase imaging is, at least in some patients (especially those with free wall accessory pathways), a more sensitive technique for detection of pre‐excitation (precontraction) than the electrocardiogram.
Platelet function and coagulation studies in patients with mitral valve prolapse
Authors: Zuppiroli A. , Cecchi F. , Ciaccheri M. , Italiani G. , Dolara A. , Longo G. , Matucci M. , Morfini M. , Rafanelli D.
Published: February 2009

Twenty‐eight consecutive patients with mitral valve prolapse (MVP), seven of whom had previous cerebrovascular disorders (CVD), were studied for platelet function and coagulation tests. While platelet function tests were found to be normal with the exception of platelet aggregation rate (PAR), there was a significant rise of factors VIII vWF:Ag (Von Willebrand) and (FPA) fibrinopeptide A. Six cases had high levels of both these factors, suggesting the existence of a particular subset of patients with MVP, with a higher risk of thromboembolic episodes, although only three out of seven patients with previous CVD had either FPA or VIII vWF:Ag levels. The broad spectrum of subjects with MVP probably explains the different results obtained when studying platelet function and coagulation factors. Therefore, larger population studies and prolonged follow‐up of cases with either coagulation abnormalities similar to the ones found in the present report and/or altered platelet function tests are suggested to discover if it is possible to detect patients with a potential for thromboembolism.
Studies on ergometer exercise testing II. Effect of previous myocardial infarction, digoxin, and β‐blockade on exercise electrocardiography
Authors: Pellinen T. J. , Virtanen K. S. , Valle M. , Frick M. H.
Published: February 2009

The results of exercise electrocardiography were studied in a random sample of 317 subjects with clinical suspicion of coronary artery disease. In 278 patients with coronary artery disease the rate of false negative tests was 18% with and 12% without previous myocardial infarction. If ST elevation was considered a negative response, the corresponding values were 25% and 13%, respectively, p<0.01. The greatest prevalence of negative tests was seen after anterior myocardial infarction: 27% or 42% when ST elevation was not included into positive responses. The sensitivity of exercise‐induced ST depression for the presence of multivessel disease was lower after anterior infarction (67%) than in other patients with previous infarction (86%), p<0.01. The corresponding specificities were 71% and 22%, respectively, p<0.005. If ST elevation was included into positive responses these differences were abolished. In subjects without myocardial infarction the sensitivity was 89% and specificity 43%. Digitalized patients had somewhat higher sensitivity in the exercise electrocardiogram than those without digoxin, 90% vs. 81% (p<0.05), but the difference was not seen with exclusion of ST elevation. The specificity was not influenced by digitalis. β‐blockade had no effect on the sensitivity or specificity, but the prevalence of postexercise ST evolution was lower with (11%) than without (30%) β‐blockade. The prevalence of slowly ascending ST depression was reduced by three factors: the presence of digitalis in patients without previous myocardial infarction, infarction itself, and the extent of coronary artery disease. We conclude that exercise electrocardiography has only a limited value in prediction of multivessel disease. Digitalis and β‐blockade do not influence the sensitivity or specificity of exercise eletrocardiography, but digitalis modifies the type of ST‐segment response.
Pseudopericardial effusion: Echocardiographic and computed tomographic correlations
Authors: Ansari A. , Rholl A. O.
Published: February 2009

The findings of small anterior and posterior relatively echo‐free spaces adjacent to the epimyocardium by echocardiography is more often indicative of pseudopericardial effusion due to subepicardial fat deposition rather than true pericardial effusion (PE), at least in older obese and Type II diabetic patients. This conclusion was based on the echo and computed tomography (CT) correlation performed in 10 consecutive patients (8 women, 2 men). The mimicry of various extracardiac and cardiac causes resulting in confusion with anterior and posterior PE is emphasized. Subepicardial fat depostion is one of the most common causes which mimic presence of small PE on echo and can be confirmed easily by limited CT of the chest. Age, sex, obesity, and diabetes mellitus (Type II) appear to be the most common predisposing factors for the accumulation of excess subepicardial fat.
The acute effect of sublingual nifedipine and isosorbide dinitrate on plasma viscosity in patients with acute myocardial infarction
Authors: Weinberger I. , Fuchs J. , Rotenberg Z. , Rappaport M. , Agmon J.
Published: February 2009

The effect of sublingual nifedipine 10 mg (pierced capsule) and isosorbide dinitrate (ISDN) 5 mg on plasma viscosity (Pl.V) was investigated in 60 consecutive patients 7–10 days after hospitalization for acute myocardial infarction (AMI), who were randomized for either nifedipine (30 patients) or ISDN (30 patients). Pl.V, hematocrit (Htc), and erythrocyte sedimentation rate (ESR) were measured 20 minutes before and thereafter at 5, 10, and 30 min after drug administration while in the recumbent position. Blood pressure (BP) and heart rate (HR) were determined before each blood sample. In 18 patients (60%) Pl.V decreased by >.05 centipoise (Cp) after nifedipine (0.0953±0.033 Cp p <.001 vs. initial values). After ISDN, Pl.V decreased by >.05 Cp (0.0933±0.036 Cp) in only 7 patients (23%). Systolic blood pressure (SBP) fell by 11.7 ± 14.6 mmHg after nifedipine and by 16±14 mmHg after ISDN (nifedipine vs. ISDN = NS). Diastolic blood pressure (DBP) fell by 8±9.6 mmHg after ISDN and by 6.6±19.3 mmHg after nifedipine (nifedipine vs ISDN = NS). HR, ESR, and Htc did not change after drug administration. It is thus concluded from our study that nifedipine 10 mg sublingual has a significant PI. V‐lowering activity compared to sublingual ISDN 5 mg in patients with AMI.
Effects of furosemide and slow‐release furosemide on thoracic fluid volumes
Authors: Brodin L.Å , Jogestrand T. , Larsen F. , Walldius G. , Tedner B.
Published: February 2009

Transthoracic electrical impedance (TEI) was used to assess the relative effectiveness of a 60 mg sustained‐release furosemide preparation (FR) and a 40 mg standard furosemide tablet (F), in reducing the fluid content in the thoracic cavity. A double‐blind crossover study was performed, in which 12 men with a history of one or more myocardial infarctions and mild left heart failure treated with 40 mg furosemide once daily participated. The trial, lasting 28 days, was divided into two 14‐day periods. Each participant received one active drug and one placebo preparation daily, the same regimen being maintained for 14 days, when the active substances were switched. TEI, body weight, serum potassium, sodium, creatinine, and urate were measured immediately prior to the start of the study, after 14 days, and at the end of the study. TEI was measured at frequencies of 1 and 100 kHz with a constant current of 100 m̈Å, during a period of one hour following an intravenous injection of 40 mg furosemide, when the urine volumes were measured also. TEI and urine production after the furosemide injections were similar irrespective of the drug preparation. No evidence of treatment period interaction was seen. No significant differences were demonstrated in body weight and blood chemistry during the trial. These results suggest clinical equipotency of the two preparations in mild left heart failure.
Diastolic time intervals before and after nadolol in patients with hypertrophic cardiomyopathy
Authors: Cecchi F. , Favilli S. , Dolara A. , Squillantini G. , Zuppiroli A. , Ciaccheri M.
Published: February 2009

In 9 patients with hypertrophic cardiomyopathy, diastolic function was evaluated by noninvasive measurements of diastolic time intervals before and after nadolol administration. No significant variation of the intervals was observed after therapy. The method therefore appears scarcely useful in the evaluation of beta‐blocker therapy in these patients.
Anterograde conduction of a concealed accessory pathway after transvenous electric catheter ablation
Authors: Pfeiffer D. , Rostock K.‐J. , Rathgen K.
Published: February 2009

An 18‐year‐old woman with a concealed right midseptal accessory pathway and refractory supraventricular tachycardia with a cycle length of 280–400 ms and a wide echo zone of 280–520 ms is reported. The transvenous electric catheter ablation with two shocks of 200 and 300 J, each on a separate occasion, was followed by anterograde and retrograde atrioventricular block. The patient received an implantable pacemaker (VVI). Four weeks later we observed a stable anterograde conduction of the pathway in spite of a persisting retrograde block. It is concluded that the site of unidirectional block in this patient is at the origin of the concealed accessory pathway in the ventricular septal muscle. The necrosis after ablation changed conduction conditions at the site of unidirectional block. Presently, the patient has been free of tachycardia for 19 months. This observation is of importance for the patient because another mechanism of tachycardia might be possible after ablation.
Fatal outcome of aortocoronary bypass grafting in a 62‐year‐old man with unsuspected coronary arteritis
Authors: Sciagrga R. , Tebbe U. , Rahlf G. , Kreuzer H. , Neuhaus K.‐L.
Published: February 2009

A 62‐year‐old man was admitted to our hospital with unstable angina. The coronary arteriography showed the occlusion of the left anterior descending artery and other stenotic lesions. The patient underwent an aortocoronary bypass operation, but unfortunately he did not survive. Surprisingly, the necropsy revealed him to be affected by an inflammatory process, involving the aorta and the coronary arteries. According to the clinical history and examination, the findings at necropsy and the histologic picture, the diagnosis of Takayasu's arteritis appears the most probable. Coronary arteritis has to be considered as a possible etiology of ischemic symptoms also in subjects who appear affected by typical atherosclerotic ischemic heart disease.
Two‐Dimensional doppler color flow mapping in congenital heart disease
Authors: Ritter S. B.
Published: February 2009

The development of a system that images intracardiac anatomy cross‐sectionally while simultaneously displaying intracardiac blood flow in realtime has the potential of increasing diagnostic capabilities in the evaluation of congenital heart lesions. This would translate into the ability to visualize intracardiac lesions not identified by standard M‐mode, two dimensional (2‐D), pulsed, and continuous wave Doppler modalities. A review of 1000 consecutive studies in our laboratory was performed. Doppler color flow mapping was performed in each case after complete segmental analysis by 2‐D and Doppler echo. Identification of intracardiac lesions or abnormalities of blood flow by Doppler color flow mapping, not appreciated on routine 2‐D/Doppler studies included ventricular septal defect (VSD) (n=24), atrial septal defect (n=4), mitral regurgitation (n=13), tricuspid regurgitation after VSD closure (n=5), tricuspid regurgitation in association with atrial septal defect (ASD) (n=7), residual ventricular septal defect after surgery (n=10), pulmonary insufficiency (n=4), aortic insufficiency (n=4), and patent Blalock‐Taussig shunt (n=2). Identification of multiple ventricular septal defects in two patients and the presence of a large left‐to‐right shunt across an atrial septal defect in the presence of septal aneurysm formation was also aided by Doppler color flow. Use of color flow to identify areas of maximal velocity and turbulence greatly enhanced continuous wave Doppler measurements by directing placement of the Doppler beam within the flow areas.
Midventricular obstruction—A form of hypertrophic obstructive cardiomyopathy—and systolic anterior motion of the mitral valve
Authors: Sheikhzadeh A. , Diederich K. W. , Eslami B. , Stierle U. , Langbehn A. F.
Published: February 2009

Hypertrophic cardiomyopathy (HCM) has various manifestations with respect to the localization of the hypertrophy. In this study we report clinical, electrocardiographic (ECG), echocardiographic (echo), and hemodynamic findings in midventricular obstruction (MO), an uncommon form of hypertrophic obstructive cardiomyopathy (HOCM) in 9 patients. The prevalence of systolic anterior motion of anterior mitral leaflet (SAM) in MO, an echocardiographic diagnostic hallmark in HOCM, was another purpose of this study. All patients had complete clinical, ECG, echo, and hemodynamic workup, including left ventricular (in 4 patients simultaneous biventricular, SBVA) and coronary angiograms. All patients had dyspnea and palpitations, chest pain, 2 had syncope. In the ECG, atrial fibrillation was present in 2, and left ventricular hypertrophy in 9 patients. Septal and left ventricular free wall thickening was significantly present in all patients in echo, and SAM in 1 patient. The intraventricular gradient (IVG) was 40–176 mmHg, in 1 case 40 mmHg by provocation, Brockenbrough was positive in all patients. Two patients had right ventricular IVG. A positive beta‐blocking agent effect was present in 6 cases. The best localization of the obstruction was possible with SBVA and 2D‐echo. We conclude that MO has all the signs of HOCM, but SAM in echocardiography is uncommon. SAM is occasionally present and is not a necessary factor to produce an intraventricular pressure gradient in HOCM, especially in MO. It seems that hypertrophic right ventricular obstruction is relatively common in MO (2 of 9 cases), and may have the same obstructive mechanism.
Therapeutic trends in the management of patients with acute myocardial infarction (1975–1984): the worcester heart attack study
Authors: Goldberg R. J. , Gore J. M. , Alpert J. S. , Dalen J. E.
Published: February 2009

As part of an ongoing community‐wide study of time trends in the incidence and case‐fatality rates of patients hospitalized with acute myocardial infarction (MI) in all 16 Worcester, Massachusetts, metropolitan hospitals during the years 1975, 1978, 1981, and 1984, changes over time in the therapeutic management of 3263 patients with validated acute myocardial infarction were examined. Beta‐blocker (21%, 1975; 52%, 1984) and nitrate (56%, 1975; 93%, 1984) therapy use increased dramatically over time. Use of antiplatelet agents was inconsistent over time, while use of digoxin remained stable, being used in approximately 40% of all patients over the four periods studied. Use of antiarrhythmic medications other than lidocaine decreased consistently over time (31%, 1975; 22%, 1984). Lidocaine use increased between 1975 (31%) and 1978 (52%) and then leveled off to being used in approximately 45% of hospitalized patients with acute MI in 1981 and 1984. A variety of demographic (e.g., age, sex, teaching hospital) and clinical characteristics (e.g., MI order, MI type, MI location, peak CPK findings, occurrence of acute clinical complications) were also associated with the use of these therapies for the combined study periods. The results of this population‐based study suggest considerable changes over time in the therapeutic management of patients hospitalized with acute myocardial infarction and of numerous patient demographic and clinical factors associated with their use.
Does the combination with handgrip increase the sensitivity of dipyridamole‐echocardiography test?
Authors: Picano E. , Lattanzi F. , Masini M. , Distante A. , L'Abbate A.
Published: February 2009

The aim of this study was to assess the possibility of increasing the sensitivity of dipyridamoleechocardiography testing (DET:2‐D echo monitoring during dipyridamole infusion) by combining this procedure with handgrip testing. Dipyridamole‐handgrip test (DHT) was therefore performed in 24 patients with rest/effort angina, negative DET, and negative handgrip‐echo (without dipyridamole pretreatment). DHT consisted of 4.5 min of sustained 25% maximum grip strength, started 4 min after the end of dipyridamole infusion (0.56 mg/kg for 4 min). Interpretable studies were obtained in all patients. Of the 24 patients tested (10 without and 14 with significant coronary artery disease, CAD), only one CAD patient had a positive DHT, which indicates an increased sensitivity of 7% versus DET alone. In conclusion, DHT is feasible in all patients and—if compared to DET—has the same specificity. However, in spite of the theoretical premises, it provides only a modest step up in sensitivity.
Paradoxical embolism to the superior mesenteric artery
Authors: Edoga J. K. , Widmann W. D. , Mclean E. R.
Published: February 2009

Paradoxical embolism occurs when venous thrombi embolize into the systemic arterial circulation by passage of clots through an intracardiac septal defect. This paper describes a case of paradoxical embolism to the superior mesenteric artery in a patient with recent myocardial infarction and pulmonary embolism. This phenomenon was first described in 1877 (Cohnheim, 1877) and many case reports have followed but most of these have been autopsy findings. We emphasize that this diagnosis should be suspected in all patients who suffer systemic arterial emboli without any evidence of left heart origin and/or in association with pulmonary emboli. One author has reviewed 19 cases since 1930, most of which were reported in the past 15 years (Johnson, 1951). This probably reflects an increased awareness of the diagnosis and more sophisticated diagnostic modalities. It also raises the possibility that paradoxical embolism may be more common than originally believed.
Transplacental passage of digoxin in the case of nonimmune hydrops fetalis
Authors: Mimura S. , Suzuki C. , Yamazaki T.
Published: February 2009

Successful treatment of intrauterine fetal tachyarrhythmia was reported in several cases recently. It was also pointed out that placental transfer of digoxin is unsatisfactory under certain conditions. However, it has not been clearly shown in which cases fetal digoxin level does not reach the maternal level. We present a case of nonimmune hydrops fetalis due to congenital atrial flutter in which digoxin concentration in the sera of the mother and the neonate showed significant dissociation, and discuss perinatological matters about the digoxin treatment and the factor that obstructs the transplacental passage of digoxin. Conclusively, we recommend that maternal digoxin concentration should be raised to near toxic level if the resolution of fetal and placental hydrops is not attained in the initial digoxin loading.
Impaired left ventricular rapid filling during exercise in patients with hypertrophic cardiomyopathy
Authors: Iida K. , Yukisada K. , Sugishita Y. , Matsuda M. , Koseki S. , Iida K. , Ito I.
Published: February 2009

The influence of exercise on left ventricular diastolic filling was evaluated in 14 patients with hypertrophic cardiomyopathy (HCM) and 14 normal controls (NC) by dynamic exercise echocardiography. Using X‐Y digitizer and computer, normalized peak rate of change of the left ventricular dimension during systole (pVs) and the rapid filling phase (pVd) were determined from the left ventricular echocardiograms at rest and during exercise when heart rate reached 100 beats/min.

At rest and during exercise, pVs was significantly higher in HCM (3.2$$0.4/s at rest, 4.3$$1.4/s during exercise) than in NC (2.4$$0.5/s at rest, 3.0$$0.4s during exercise) (p<0.001, p<0.001, respectively), but pVd in HCM (4.2$$1.0/s at rest, 5.8$$1.0/s during exercise) was not significantly different from that in NC (4.1$$1.0/s at rest, 6.0$$0.7/s during exercise). The ratio of pVd to pVs (pVd/pVs) in HCM did not show significant increment during exercise (1.35$$0.38 to 1.43$$0.35), though that ratio in NC was significantly increased by exercise (1.67$$0.22/s to 1.97$$0.19/s, p<0.001). There was no correlation between pVd and the degree of left ventricular hypertrophy. These results suggest that diastolic reserve to exercise is depressed in HCM and that other factors besides left ventricular hypertrophy may account for diastolic abnormality.
Effect of spontaneous reperfusion on myocardial infarct size
Authors: Hackworthy R. A. , Vogel M. B. , Harris P. J.
Published: February 2009

The effect of perfusion of the infarct artery on myocardial infarct size was studied in 39 patients who had not received interventive therapy. At predischarge coronary angiography, 19 patients had subtotal and 20 total occlusion of the infarct artery. The early ST‐segment elevation recorded on a 12‐lead electrocardiogram was used as an index of the amount of initially jeopardized myocardium. Infarct size was estimated by peak serum creatine kinase and, at discharge, by a QRS score, $$Q and $$R on a 12‐lead electrocardiogram, and by radionuclide global and infarct segment left ventricular ejection fraction. Despite a similar degree of initial ischemia ($$ST), infarct size was smaller in the 11 patients with anterior infarction and subtotal occlusion than in the 9 patients with anterior infarction and total occlusion when measured by peak serum creatine kinase (2114$$1192 U/l vs. 3653$$1059 U/l, p<0.02), QRS score (5.0$$2.7 vs. 9.6$$3.5, p<0.01), $$Q (3.25$$2.74 mV vs. 5.92$$3.56 mV, p<0.10), $$R (4.36$$1.25 mV vs. 2.16$$0.91 mV, p<0.001), global left ventricular ejection fraction (45.0$$12.2% vs. 33.4$$6.7%, p<0.05), and infarct segment ejection fraction (40.4$$8.2% vs. 30.3$$5.4%, p<0.05). In the inferior infarct patients, both the degree of initial ischemia and final infarct size were similar in the 8 patients with subtotal and in the 11 patients with total occlusion. Eight of the 11 patients with inferior infarction and total occlusion, but none of the 9 patients with anterior infarction and total occlusion had collaterals to the infarct artery. Spontaneous reperfusion, either antegrade or via collaterals, may reduce myocardial infarct size.
Isolated pulmonary valve prolapse: A sign of pulmonary hypertension
Authors: Arvan S. , Boscha K.
Published: February 2009

Isolated pulmonary valve prolapse may be a sign of pulmonary hypertension. Three patients with pulmonary hypertension as a result of left ventricular failure, chronic obstructive pulmonary disease, and primary pulmonary hypertension, respectively, are described in the case reports. It is likely that the morphological change of the pulmonary valve is due to exaggeration of the normal convexity of the elastic pulmonary leaflets as a result of a high pulmonary artery diastolic pressure. This two‐dimensional echocardiographic sign may prove to be a useful qualitative hallmark for pulmonary hypertension. Present methods to detect pulmonary hypertension by two‐dimensional echocardiography rely on remote findings of right heart abnormalities or changes in systolic time intervals. Pulmonic valve prolapse is the first direct sign of pulmonary hypertension found on two‐dimensional echocardiography.
Double‐chambered right ventricle with pulmonary valve endocarditis
Authors: Shah V. K. , Daruwala D. F. , Karnik R. D. , Gandhi M. J. , Chaukar A. P.
Published: February 2009

A rare case of isolated pulmonary valve endocarditis associated with a double‐chambered right ventricle in a nonaddict, was diagnosed on two‐dimensional echocardiography and cardiac catheterization and angiography. The patient was successfully operated and the above findings confirmed on the operation table.
William heberden and some account of a disorder of the breast
Authors: Silverman Mark E.
Published: February 2009

But there is a disorder of the breast marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare, which deserves to be mentioned more at length. The seat of it, and sense of strangling, and anxiety with which it is attended, may make it not improperly be called angina pectoris. They who are afflicted with it, are seized while they are walking, (more especially if it be up hill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life, it it were to increase or to continue; but the moment they stand still, all this uneasiness vanishes.
Method for noninvasive measurement of central aortic systolic pressure
Authors: Marmor A. T. , Blondheim D. S. , Gozlan E. , Navo E. , Front D.
Published: February 2009

A method for noninvasive generation of central aortic systolic pressure curves is presented. The method is based on plotting the occlusive pressure values applied at the brachial artery level against the time intervals needed for the aortic pressure wave to equalize and break through the occlusive pressure at the brachial artery level. These time intervals were obtained by measuring the time from the beginning of depolarization (the QRS complex) to the detection of the pressure wave at the temporarily occluded brachial artery. The validity of the method was documented by 3 different approaches. The pressure values measured by a device developed by us were superimposed on the simultaneously measured central intra‐aortic pressure waves and all values were within one standard deviation from the central aortic recordings in 8 of the 10 patients studied. At the same time, the noninvasively recorded pressure waves were completely different from the peripheral artery pressure recorded simultaneously at the femoral artery site. The DP/DT values derived from the central aortic recordings and the noninvasive device correlated (r=0.83). These results indicate that the noninvasive device measures the central aortic pressure or a close approximation of it. By combining noninvasive pressure measurements with volume measurements obtained by radionuclide angiography. noninvasive pressure‐volume curves were generated in 10 subjects. Possible clinical application of the systolic noninvasive pressure‐volume curves is suggested.
Frequency analysis of first heart sound for the elderly
Authors: Ishizuka T. , Ishizuka A.
Published: February 2009

Frequency analysis of first heart sound in elderly and expired cases was performed to reveal changes of the cardiovascular system accompanying aging. The vibration was analyzed for isometric contraction phase or 0.06 seconds following the main vibration of first sound by means of fast Fourier transform technique, and main frequency was compared. Mean main frequencies were 43.0±15.4 cps (mean±SD) in 21 cases from 54 years to 69 years, 41.4±12.6 cps in 34 cases from 70 years to 79 years, 40.0±14.4 cps in 19 cases from 80 years to 89 years, and 44.2±4.5 cps in 4 cases from 90 years to 94 years. It was 44.4±8.0 cps in 6 cases with left ventricular hypertrophy (LVH) on ECG, and 37.2±7.5 cps in 18 cases without LVH. It was 35.7±6.5 cps in 9 cases who expired and 32.6±5.8 cps in cases of those who died within a year. Though mean main frequencies were almost equal in these groups, it is higher than that of younger subjects, which suggests stiffness of the cardiovascular system of the aged. It was suggested that the stiffness of the cardiovascular system is greater than the increase in cardiac weight of elderly subjects with LVH. Mean main frequency was low in subjects who dies within a year, which may be due to cardiomegaly.
Cerebrospinal fluid creatine kinase isoenzyme BB levels do not predict the clinical outcome in patients unconscious following cardiac resuscitation
Authors: Clemmensen P. , Strandgaard S. , Rasmussen S. , Grande P.
Published: February 2009

It has recently been claimed that an increase in creatine kinase isoenzyme BB(CK‐BB) in cerebrospinal fluid (CSF) is well correlated with the cerebral outcome in patients resuscitated after cardiac arrest. Twentyone such patients consecutively admitted from outside this hospital participated in the study. The patients were divided into two groups: 6 survivors and 15 nonsurvivors. The median CSF‐CK‐BB value was 5 U/L among nonsurvivors and below detection limit among survivors (NS). However, the predictive value of a positive test is limited, since only 6 of 15 nonsurvivors (40%) had an increase in CSF‐CK‐BB (predictive value of positive test=67%). The predictive value of a negative test is limited, since 3 of 6 survivors (50%) showed no rise in CSF‐CK‐BB (predictive value of negative test=25%). No relationship between cerebral dysfunction and CSF‐CK‐BB values was revealed. Thus, CSF‐CK‐BB does not predict the clinical outcome in patients resuscitated after cardiac arrest.
Control of supraventricular tachycardia by VVI pacing in a patient with drug‐induced enhanced atrioventricular conduction
Authors: Aizawa Y. , Shibata A.
Published: February 2009

A 56‐year‐old male with atrial fibrillation developed rapid ventricular response up to 200 beats/min or more in the postoperative stage of emergency aortocoronary bypass surgery. Resuscitation for cardiac arrest triggered this rapid ventricular rate. The idea that retrograde conduction into atrioventricular node may prevent ventricular capture of atrial fibrillation was tested. The ventricle was then paced at rapid rate followed by a gradual decrease in the pacing rate to 120 beats/min. By this method, ventricular rate was controlled and hemodynamics stabilized, with more efficiency of intra‐aortic balloon counterpulsation. VVI pacing may be used in this manner to control irregular and rapid ventricular response of atrial fibrillation.
Vasospastic angina mimicking graft failure and spontaneously appearing after left ventriculography
Authors: Fournier J. A. , Ández C. , F‐Cortacero J. A. P. , Pi ñero C.
Published: February 2009

A 49‐year‐old female with significant (75%) left main coronary artery stenosis was initially considered to have developed early obstruction of a saphenous vein graft to the left anterior descending coronary artery, because of recurrent postoperative angina. In a second catheterization study, left ventriculography showed normal contractility of all segments and was immediately followed by the onset of angina and angiographic demonstration of diffuse spasm of the entire left coronary artery system beyond the stenosis. Vasospasm of the left coronary artery before or during ventriculography was unlikely in the absence of regional contractility impairment. The close temporal association between the left ventricular angiogram and the angiographic demonstration of vasospasm suggested a direct cause and effect relationship.
Coronary spasm producing coronary thrombosis in a patient with acute myocardial infarction
Authors: Naito H. , Yorozu T. , Matsuda Y. , Yamaguchi M. , Tanabe Y. , Nakashima H. , Kusukawa R.
Published: February 2009

A 62‐year‐old man had an acute myocardial infarction with successful thrombolysis. Coronary spasm was documented in the following angiographic study. This case demonstrated that coronary spasm is implicated in the pathogenesis of coronary thrombosis and subsequent myocardial infarction.
The murmur of double‐chambered right ventricle: Phonocardiographic evaluation
Authors: El Tohami E. T. A. , Hajar R. , Folger G. M.
Published: February 2009

Thirteen patients undergoing complete evaluation for double‐chambered right ventricle were subjected to phonocardiographic evaluation. Each of these individuals revealed a holosystolic ejection‐type murmur which exhibited a similarity of appearance unaltered by the degree of physiologic derangement or associated cardiac abnormalities. This finding is considered to be caused by the obstructive elements in double‐chambered right ventricle and appears to be a characteristic finding for this condition.
Noninvasive demonstration of underlying severe coronary disease in patients with vasospastic angina
Authors: Kawashima S. , Yokoyama M. , Sakamoto S. , Akita H. , Fujitani K. , Kobayashi K. , Mizutani T. , Fukuzaki H.
Published: February 2009

Dipyridamole test, isoproterenol test, and treadmill exercise test were performed in two groups of patients with vasospastic angina (Group 1: 10 patients with 70% or greater coronary narrowings, Group 2: 8 patients with narrowings less than 70%. The results were correlated with coronary anatomy. In Group 1, vasodilation of resistance vessels by dipyridamole elicited ischemic episodes in 9 patients and an increase in myocardial oxygen consumption by isoproterenol caused anginal attacks in 7 patients. None of patients of Group 2 showed positive responses to either drug. All patients of Group 1, and 3 patients of Group 2 gave positive responses to treadmill test. These observations show that several different mechanisms are involved in the pathogenesis of my ocardial ischemia in patients with vasospastic angina. Pharmacological interventions have higher specificity than exercise tests in predicting coronary anatomy and are useful for the choice of therapy in these patients.
Sinus arrest caused by atenolol‐verapamil combination
Authors: Misra M. , Thakur R. , Bhandari K.
Published: February 2009

A case on concomitant atenolol‐verapamil therapy for hypertension and angina pectoris, developing sinus arrest and life‐threatening bradycardia is described. The complication occurred with low doses of both the agents and normal electrophysiologic status of the heart. The example suggests that pharmacodynamic synergism contributes more than pharmacokinetic interaction in causing adverse reactions during beta blocker‐verapamil therapy.