bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler assessment of right ventricular filling dynamics during volume loading in ischemic heart disease
Authors: Odake M. , Takeuchi M. , Fukuzaki H.
Published: February 2009

To assess the effects of volume loading on right ventricular (RV) filling dynamics, the RV inflow pattern was recorded using pulsed Doppler echocardiography (PDE) during dextran infusion in 7 normal subjects (Group I) and 24 patients with ischemic heart disease. The patients with ischemic heart disease were divided into three groups according to the left ventricular (LV) and RV ejection fractions (EF). Group II consisted of 11 patients whose LVEF and RVEF exceeded 50%. Group III consisted of 7 patients whose LVEF was lower than 50% and RVEF was higher than 50%. Group IV was comprised of 6 patients whose LVEF and RVEF were lower than 50%. Peak flow velocity of the RV rapid filling wave in early diastole [R(T)] and that of the atrial contraction wave [A(T)] were measured, and the ratio of A(T) to R(T) [A(T)/R(T)] in each cardiac cycle was calculated. In some of the subjects, simultaneous right‐sided cardiac catheterization was performed with a Swan‐Ganz thermodilution catheter. The LV and RV function during volume loading were calculated according to the following formulae: $DL Stroke volume index (SVI)/$DL pulmonary artery wedge pressure (PAWP) and $DLSVI/$DLright atrial pressure (RAP), respectively. After dextran infusion, R(T) increased significantly in Groups I, II, and III, but not in Group IV. The A(T) and A(T)/R(T) ratio remained unchanged in all groups. The percent change of the R(T) correlated well with $DLSVI/$DLRAP (r=0.56, p>0.01). These results suggest that in patients with RV dysfunction, volume loading does not result in an increase in SVI, and this abnormality seems to be related to unchanged R(T) after volume loading because of impairment in RV early diastolic filling. Thus, the assessment of the RV inflow pattern by PDE during dextran infusion was useful in demonstrating RV diastolic dysfunction in IHD.
Left Ventricular Outflow Tract Obstruction in Atrioventricular Septal Defects: A Pathologic and Morphometric Evaluation
Authors: Gallo P. , Hokayem N. J. , D'Offizi F. , D'Alessandro  , Francalanci P. , D'Amati G. , Waller Bruce , Formigari R. , Colloridi V. , Pizzuto F.
Published: February 2009

Summary: Subaortic stenosis has been described with increasing frequency as an ominous feature of atrioventricular septal defect (AVSD), especially following surgical correction of the anomaly in non‐Down's syndrome patients. In order to study the surgical anatomy of the left ventricular outflow tract in this malformation, 48 hearts featuring AVSD were examined. Obstructive lesions were classified into unequivocal forms (class A, 13.5%) and potential ones (class B, 10.8%). In the remaining hearts (class C, 75.7%) no obstruction was noted. In class A, subaortic stenosis was due to exaggeration of the anticipated anomalous arrangement of atrioventricular valve tensor apparatus, to the persistence of a subaortic muscular infundibulum, and to a discrete fibrous diaphragm. A potential for subaortic stenosis is provided by the unwedged position of the aortic valve. The left ventricular outflow tract is transformed into a long, forward‐displaced fibromuscular channel. Morphometric analysis showed in AVSD (with both common annulus and separate orifices) a significantly (p>0.01) lower inflow/outflow tract ratio, and a significantly (p>0.01) lower right ventricular/left ventricular outflow length ratio than normal hearts. These results suggest that AVSD is characterized not only, as commonly stated, by inflow tract shortening, but by outflow tract lengthening as well. On these anatomical grounds, nearly all cases of AVSD could harbor the potential for subaortic stenosis; however, this becomes a real hazard (class B) only when associated with forward displacement of the left anterior papillary muscle, or direct insertion on the ventricular septum of the anterior bridging leaflet, and it may be converted to an actual obstruction by the effects of surgery. A short axis pathologic and echocardiographic plane is proposed to evaluate the potential subaortic stenosis and its possible transformation into an actual one.
Double Aortic Arch, Tetralogy of Fallot with Pulmonary Atresia and Atrioventricular Septal Defect
Authors: Gnanapragasam James P. , Keeton Barry R. , Fong Lance V.
Published: February 2009

Summary: A double aortic arch is usually an isolated abnormality. We describe a case with a previously undescribed combination of tetralogy of Fallot with pulmonary atresia, complete atrioventricular septal defect, and left patent arterial duct in association with a double aortic arch. A complete diagnosis was made by echocardiography. Meticulous suprasternal echocardiography must be employed to avoid overlooking an unsuspected aortic arch abnormality.
Unknown Extra Cardiac Echo‐Free Space: Diagnosis of a Left Ventricular Pseudoaneurysm by Color Flow Echocardiography
Authors: Weston Mark W. , Mckinnon Elizabeth , Donald Tommie , Vijayanagar R. , Canedo Mario
Published: February 2009

Summary: At times, visualization of a ventricular pseudoaneurysm by two‐dimensional echocardiography can be difficult. This case report describes the unique diagnostic potential of color flow echocardiography in the diagnosis of an unknown extra cardiac echo‐free space, a left ventricular pseudoaneurysm. Using color Doppler echocardiography flow can be seen communicating between the left ventricle and the pseudoaneurysm.
Prazosin's Effect in High Renin Hypertension Complicating Pheochromocytoma
Authors: Rechavia E. , Mager A. , Sagie A. , Strasberg B. , Sclarovsky S.
Published: February 2009

Summary: During three consecutive days of prazosin treatment in a patient with pheochromocytoma, urinary catecholamine metabolite levels were correlated with plasma renin activity. Suppression of renin plasma activity resulted in sustained hemodynamic and clinical improvement, while no remarkable changes were observed in urinary catecholamine metabolite levels. This suggests that prazosin may interrupt the vicious cycle of worsening hypertension provoked by further activation of the renin‐angiotensin system mediated by excessive circulating catecholamines.
Vasodepressor Syncope from Neck Cancer with Associated C‐6 Dermatome Neuralgia
Authors: Osborn Larry A. , Frierson John , Herzon Fred
Published: February 2009

An unusual case of neck cancer with associated C‐6 dermatome neuralgia causing vasodepressor syncope episodes is discussed. Pacemaker therapy proved not to be required. When evaluating syncope with bradycardia, it is important to search for underlying causes and to ascertain whether or not pacemaker therapy is indicated.
Sublingual Administration of Captopril in Patients with Acute Myocardial Ischemia
Authors: Haude Michael , Erbel Raimund , Steffen Wolfgang , Tschollar Werner , Meyer Jürgen
Published: February 2009

Summary: To investigate the anti‐ischemic capability of the angiotensin‐converting enzyme inhibitor captopril, 10 patients with acute myocardial ischemia (angina pectoris >1 h, ST‐segment depression ±0.1 mV, no rise in creatine phosphokinase) received 25 mg captopril sublingually after being treated with an intravenous infusion of nitroglycerin (3 mg/h) and heparin (1200 IU/h) for 1 hour. A control group of 10 patients received placebo instead of captopril. Results showed a decrease of the initial ST‐segment depression from 0.25±0.04 to 0.2±0.03 mV (p>0.01) with nitroglycerin for the captopril group and from 0.26±0.05 to 0.21±0.05 mV (p>0.01) for the control group. An additional decrease to 0.13±0.03 mV (p>0.001) was measured after sublingual captopril, while no significant change was found in the placebo group (0.19±0.04 mV). In both groups, 3 patients had no incidents of angina after 1‐h nitroglycerin infusion. An additional 6 patients resolved their complaints after captopril administration in contrast to only 1 after placebo. Two patients in the placebo group required increased doses of nitroglycerin because of impairment of anginal complaints. Hemodynamic measurements documented a significant drop of pulmonary vascular resistance after a 1‐h infusion of nitroglycerin (–12.9% and –13.1%, respectively, p>0.05), while all other parameters remained unchanged. After additional sublingual administration of captopril, a significant increase in cardiac index (+13.8%, p>0.05) was measured and decreases in diastolic pulmonary and blood pressures (–19.2%, p>0.05 and –14.6%, p>0.01), systemic and pulmonary vascular resistance (–17.7%, p>0.01 and –13.6%, p>0.05), and heart rate pressure product (–8.8%, p>0.05), while no significant changes were measured in the control group. No patient suffered acute myocardial infarction during the study period.
Static Versus Dynamic Exercise: Effects on Doppler Echocardiographic Indices of Left Ventricular Performance
Authors: Bamrah Virinderjit S. , Sagar Kiran B. , Sheldahl Lois M. , Wann L. Samuel
Published: February 2009

Summary: In order to compare the effects of static exercise with those of dynamic exercise on the Doppler echocardiographic measurements of ascending aortic blood flow velocity and acceleration, Doppler echocardiography was performed with sustained handgrip exercise and with supine bicycle exercise in 12 normal subjects, 12 patients with coronary artery disease, and 7 patients with heart failure. In normal subjects: peak velocity decreased by 16±11% with handgrip from the resting value and increased by 49±19% with bicycle exercise (p>0.01); mean acceleration decreased by 6±30% with handgrip and increased by 162±83% with bicycle exercise (p>0.01). In patients with coronary artery disease: peak velocity declined by 9±14% with handgrip and increased by 19± 18% with bicycle exercise (p>0.01); mean acceleration increased by 13±27% with handgrip and by 41 ±33% with bicycle exercise (NS). In patients with congestive heart failure: peak velocity decreased by 19±13% with handgrip and increased by 5±17% with bicycle exercise (p>0.01); mean acceleration decreased by 12±23% with handgrip and by 4±37% with bicycle exercise. A marked increase in afterload stress induced by static exercise presumably offsets the moderately increased contractility and accounts for the decline of peak velocity and mean acceleration with static exercise both in normals and cardiac patients. In contrast, marked increase in contractile state along with little change in afterload with dynamic exercise results in markedly increased peak velocity and mean acceleration in normal subjects. In cardiac patients, however, the increase in peak velocity and mean acceleration with dynamic exercise are blunted. The changes in peak velocity and mean acceleration with handgrip are similar in normal subjects and cardiac patients. On the other hand, changes in these variables with dynamic exercise are markedly different in normal subjects and cardiac patients. Doppler echocardiographically measured peak velocity and mean acceleration respond differently to static and dynamic exercise. Measurement of these variables with dynamic exercise is more useful in evaluating left ventricular systolic function than static exercise.
Improved diagnosis and characterization of postinfarction left ventricular pseudoaneurysm by cardiac magnetic resonance imaging
Authors: Harrity P. , Subramanian R. , Patel A. , Blanco J.
Published: February 2009

A patient with a ruptured left ventricular pseudoaneurysm complicating an acute posteroinferior myocardial infarction is described. Left ventricular pseudoaneurysms are a rare complication of acute myocardial infarction, usually occurring with inferior and/or posterior infarction. In contrast to true aneurysms, pseudoaneurysms are much more likely to rupture, regardless of size, causing hemopericardium and death. Therefore, once the diagnosis has been confirmed, prompt surgical resection is the current accepted treatment. The most accurate noninvasive diagnostic method has been echocardiography, with recent reports suggesting improved diagnosis with color flow Doppler echocardiography. Ventriculography confirms the diagnosis with more accurate anatomic detail, but is an invasive procedure. In our patient, two‐dimensional and color Doppler echocardiography could not demonstrate the suspected pseudoaneurysm, which was demonstrated by ventriculography. However, magnetic resonance imaging (MRI) demonstrated the pseudoaneurysm, showing detailed anatomy not obvious on ventriculography. Before surgery could be performed, the patient died and was autopsied. Heart sections corresponding to MRI planes confirmed the MRI findings. A review of the literature has revealed no similar reports using MRI in the diagnosis of postinfarction pseudoaneurysms. Major advantages of MRI are generation of three‐dimensional soft tissue images non‐invasively, and generation of tissue contrast by rapid imaging sequences, obviating the need for contrast injection. Major disadvantages of MRI are the high cost of instrumentation, nonportability, and a requirement for patient immobility during the study. In cases of suspected pseudoaneurysm with equivocal echocardiography findings, MRI could provide early diagnosis, leading to early surgical intervention and increased patient survival.
Thrombolytic therapy in acute myocardial infarction following prolonged cardiopulmonary resuscitation
Authors: Neches Richard B. , Goldfarb Andrew M. , Saviano George J.
Published: February 2009

Thrombolytic therapy was administered to a 49‐year‐old woman with an acute anterior wall myocardial infarction after having prolonged cardiopulmonary resuscitation for 13 minutes. On admission, there was no clinical or radiographic evidence of gross trauma. There was no significant morbidity and the patient recovered to a completely functional status. The literature of thrombolytic therapy after cardiopulmonary resuscitation is reviewed. In the absence of gross trauma from cardiopulmonary resuscitation, thrombolytic therapy in acute myocardial infarction should not necessarily be excluded because of the duration of resuscitation. Further experience with such patients will shed additional light on efficacy and safety.
Effects of sublingual nitroglycerin in patients receiving transdermal nitroglycerin for coronary artery disease: Prevention of cross‐tolerance
Authors: Naito Hidetoshi , Mastsuda, Yasuo , Yorozu, Tadao , Shiomi, Kohtaro , Maeda, Toshiaki , Seki, Kohzabro , Tada, Toshihiko , Fujii, Hideo
Published: February 2009

The systemic hemodynamic and coronary dilative responses to sublingual nitroglycerin were studied in patients receiving transdermal nitroglycerin. A total of 48 patients with coronary artery disease were divided into 4 groups: 12 patients receiving 1 tablet of sublingual nitroglycerin without transdermal nitroglycerin (Group 1), 12 patients receiving 1 tablet of sublingual nitroglycerin with 12‐hour‐daily intermittent therapy of transdermal nitroglycerin (Group 2), 12 patients receiving 1 tablet of sublingual nitroglycerin with continuous therapy of transdermal nitroglycerin (Group 3), and 12 patients receiving 2 tablets of sublingual nitroglycerin with continuous therapy of transdermal nitroglycerin (Group 4). Before and during administration of sublingual nitroglycerin, aortic pressure, left ventricular pressure, and coronary artery diameter were examined at diagnostic cardiac catheterization in all patients. During sublingual nitroglycerin, the decreases of aortic systolic pressure and left ventricular end‐diastolic pressure were greater in Group 1, 2, and 4 than in Group 3. Dilation of coronary arteries by sublingual nitroglyerin tended to be greater in Group 1, 2, and 4 than in Group 3. Thus, the effects of sublingual nitroglycerin for the relief of ischemia might be more prominent in patients with intermittent therapy of transdermal nitroglycerin than in those with continuous therapy. The increased dose of sublingual nitroglycerin for the relief of ischemia might be more effective in patients with continuous therapy of transdermal nitroglycerin.
A large‐scale trial of captopril for mild to moderate heart failure in the primary care setting
Authors: Dibianco, Robert
Published: February 2009

A large‐scale, prospective, 8‐week, office‐based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (<70 years vs. <70 years), duration of heart failure (<1 year vs. >1 year), presence of digoxin treatment, or the dosing schedule employed. This large study showed that use of captopril in mild to moderate heart failure in the primary care setting has a favorable risk‐benefit profile and is associated with meaningful improvements in clinical status and functional capacity.
Electrophysiologic effects of blocking and stimulating the opioid system in patients with unexplained heart palpitations
Authors: Markiewicz K. , Kuś W. , Cholewa M. , Bubinński R.
Published: February 2009

The opioid system plays a role in the regulation of the cardiovascular system. Endogenic as well as egzogenic administration of opioids influences the heart rhythm. This work was undertaken in order to assess the influence of crossover activity of the heart opioid system on the heart conduction system in patients with various disturbances of rhythm having an efficient circulatory system and a normal 12‐lead stationary ECG. Subjects were 20 patients (9 men and 11 women of mean age of 38.7 years) reporting sudden heart palpitations. They were subjected to invasive programmable electrophysiological studies (PES). Naloxone was administered intravenously to 10 patients. Pentazocine was administered in the same way. In the remaining 10 patients the order of drug administration was reversed. PES was done in the basic state and after the administration of each drug. Study results were subjected to statistical analysis with no‐parameter Wilcoxon test assuming differences to be significant at p<0.05. Blocking of the opioid system resulted in significant lengthening of the sinoatrial (SACT), intra‐atrial (PA), and atrioventricular node (AH) conduction times, while no changes were induced in conduction in the His‐Purkinje system (HV) and automation of the sinus node. Naloxone lengthened the atrial (ERPA) and atrioventricular node (ERPA AVN) effective refractory periods. Stimulation of the opioid system resulted in decreases of the following values: SACT, PA, AH, ERPA, ERPA AVN, while no effect was exerted on the SNRT, HV, ERPV. Neither drug influenced the QRS time, although naloxone lengthened QTCperiod significantly. Opioids did not influence the time of conduction in concealed extranodal atrioventricular pathways. Results of the studies suggest that the opioid system has a significant influence on electrophysiological properties of the proximal part of the heart conduction system—blocking the opioid system renders the conduction difficult, while stimulating favors it.
Calcium antagonists in cardiology: Update on sustained‐release drug delivery systems
Authors: Michelson Eric L.
Published: February 2009

One limitation of standard oral formulations of calcium antagonists has been the need for multiple daily dosing. Sustained‐release dosage forms permit simpler regimens and a smoother therapeutic effect. Differences in drug pharmacokinetic and pharmacodynamic properties have led to development of several sustained‐release delivery systems. Three major types are available: the osmotic pump, coated pellet, and slow‐dissolving material released from a matrix. Each is currently utilized with specific calcium antagonists. The osmotic pump system with nifedipine (Procardia XL, Pfizer) allows once‐daily dosing as well as improvements in certain side effects. Verapamil is available in formulations employing dissimilar release systems. The original sustained‐action products (Calan SR, Searle; Isoptin SR, Knoll) utilize a matrix system; a subsequent product (Verelan; Lederle, Wyeth‐Ayerst, A. H. Robins) utilizes timed‐release pellets. Importantly, clinical efficacy appears to be maintained with these several drugs and formulations for their approved indications. Although a specific formulation may alter the absorption, metabolism, excretion, and blood levels of a drug, it does not alter basic drug properties. Thus, the major impact of sustained‐release drug delivery system lies in potential compliance improvement and possible reduction of side effects related to serum drug profiles.
Serial echocardiographic studies following thrombolytic treatment in myocardial infarction with special reference to the atrioventricular valve plane displacement
Authors: Alam Mahbubul , Höglund Christer
Published: February 2009

Echocardiographic recording of the atrioventricular (AV) valve plane displacement was used for serial studies of left ventricular (LV) function in 27 patients with first‐time acute myocardial infarction (MI) treated with a thrombolytic agent within 4 h of the onset of symptoms and showing noninvasive signs of early reperfusion. The recordings were made immediately before or during thrombolytic therapy and 24 h, 1 week, 1 month, and 2 months after attempted reperfusion. Regional LV function was assessed by recording the amplitude of systolic descent of the AV plane toward the apex at 4 different sites on left ventricle corresponding to the septal, anterior, lateral, and posterior walls from apical 4‐ and 2‐chamber views. Global LV function was assessed using the mean value of the AV plane displacement from the above 4 sites (AV mean). In 15 patients with anterior MI, the displacement at the septum and anterior wall was significantly decreased compared with the posterior and lateral walls at baseline. The displacement had increased significantly after 1 week, 1 month, and 2 months (p<0.01, p<0.01, andp<0.001). The AV mean also increased significantly (p<0.01) during the study period. A corresponding regional increase was observed in inferior MI. The AV mean remained unchanged, however, during the follow‐up period. It is concluded that the easy visualization and the simplicity of recording the AV plane displacement makes the method a valuable noninvasive tool for serial echocardiographic studies following acute MI treated with a thrombolytic agent.
Fibroelastic papilloma arising in a chiari network
Authors: Waller Bruce , Wasdahl Daniel A. , Wasdahl Walter A. , Edwards William D.
Published: February 2009

The occurrence of fibroelastic papilloma arising in a Chiari network in an 85‐year‐old man is described. Occurrence of this tumor in this location has not been previously reported, and should be added to the differential diagnosis of intracardiac masses arising in the right atrium.
Encainide dosing in patients with severe renal dysfunction: Report of a case and literature review
Authors: Fronc Henry , Stephen Porter R. , Nydegger Charles C. , Hessen Scott E. , Kutalek Steven P.
Published: February 2009

Dosage of encainide for patients with lethal ventricular arrhythmias is based on pharmacodynamic effects and efficacy of arrhythmia suppression, coupled with metabolizer phenotype and extent of renal and hepatic dysfunction. Decreased clearance in patients with renal dysfunction necessitates a reduction in dosage to avoid toxic and dose‐related proarrhythmic effects. This case represents a patient with severe renal dysfunction and sustained ventricular tachycardia who achieved electrophysiologically guided suppression of induced ventricular tachycardia at a steady‐state encainide dose of only 25 mg daily, significantly lower than package insert or compendial recommendations for initial dosage in patients with renal insufficiency. Documented “therapeutic” metabolite concentrations correlated to electrophysiologic response. Literature review illustrates the complexity of encainide dosage in such individuals and underscores the need for therapeutic drug monitoring to individualize dosage.
Predictors of spontaneous predischarge ischemia following acute myocardial infarction
Authors: Piérard Luc A. , Albert Adelin , Kulbertus Henri E.
Published: February 2009

To determine if the occurrence and the consequences of spontaneous predischarge postinfarction ischemia could be predicted early after hospital admission, a consecutive series of patients with acute myocardial infarction was studied and followed for 3 years. No patient was treated by thrombolysis. Spontaneous predischarge ischemia was defined as angina that occurred at rest before hospital discharge, at least 3 days after the acute event, and that was accompanied by electrocardiographic changes, but not by an increase in cardiac enzymes. Patients who died within the first 3 days were excluded from analysis. Among the 943 patients who survived at least 3 days, 165 (17.5%) had spontaneous ischemia before discharge. They had a higher 1‐year post‐hospital mortality (16 vs. 10%), but did not have significantly higher total 3‐year mortality rates. Four independent, early available variables predictive of the occurrence of spontaneous ischemia were selected from a stepwise logistic discriminant analysis: history of angina before infarction, non‐Q‐wave infarct, absence of smoking, and higher age. Among the 165 patients with spontaneous ischemia, 3 independent variables predictive of 3‐year mortality were selected stepwise: left ventricular function score, history of previous infarction, and absence of smoking.
Improved neurological outcome following early anatomical correction of transposition of the great arteries
Authors: Veelken N. , Grävinghoff L. , Keck E.W. , Freitag H.J.
Published: February 2009

The incidence of neurological residuals following anatomical correction of transposition of the great arteries (d‐TGA) has not been described so far. Clinical examination, EEG recordings, and computed tomography (CT) scans were carried out in a consecutive series of 38 children with d‐TGA surviving anatomic corrective surgery. The patients were classified into one of three groups according to the type of operation: 15 patients after two‐stage approach (TSA) (Stage 1: pulmonary artery banding + aortopulmonary shunt; Stage 2: anatomic correction); 12 patients with primary anatomic correction within the first 2 weeks of life (early switch, ES); 11 patients with primary anatomic correction later in infancy (later switch, LS). In 26 patients (68%) we found no abnormalities on neurologic examination, CT scan, or EEG. Four patients suffered from spastic hemiplegia, 3 of these had cortical brain damage visible on CT scan, and 3 had focal epilepsy as well. In 2 otherwise clinical normal patients cortical infarction could be seen on a CT scan. Thus, in 5 cases (13% of 38 patients) cerebral infarcts were diagnosed by CT scan. The cortical vascular infarction was seen in 4 patients after TSA and in 1 after LS. In 6 patients we found other neurological abnormalities. Early anatomic correction in patients with d‐TGA reduces the risk of cortical vascular infarction.
Propionibacterium acnes prosthetic valve endocarditis: A case of severe aortic insufficiency
Authors: Lazar Jason M. , Schulman Douglas S.
Published: February 2009

Propionibacterium acnes rarely causes systemic disease. Few cases of P. acnes endocarditis have been reported. This report describes a 63‐year‐old man who presented with severe congestive heart failure. He had prosthetic valve endocarditis which resulted in severe acute aortic insufficiency. During surgery he was found to have complete disruption of the aorta and left ventricle with a false aneurysm encompassing the circumference of the aortic annulus. Cultures of the valve grew P. acnes. Thus, although P. acnes is a rare cause of endocarditis, it may pursue a very aggressive course, especially in the setting of a prosthetic valve.
Pericardial tamponade in juvenile dermatomyositis
Authors: Pereira Rosa Maria R. , Lerner Sergey , Maeda Wilma T. , Goldenstein‐Schainberg Claudia , Cossermelli Wilson
Published: February 2009

Cardiac involvement in dermatomyositis has been well described; myocarditis and cardiac arrhythmias are the most frequent manifestations. An 8‐year‐old girl is presented, who developed pericardial tamponade in the course of the disease. It is the first time this association has been reported.
Coronary thrombosis postpartum in a young woman with still' disease
Authors: Parry Gareth , Goudevenos John , Williams David O.
Published: February 2009

A young woman with Still' disease sustained a small myocardial infarction 12 weeks after the delivery of a healthy male infant. This pregnancy was complicated by late onset proteinuric hypertension. Coronary angiography nine days after infarction revealed intracoronary thrombus which had resolved by 3 months with antithrombotic therapy. The angiographic appearances at 3 months suggested that a local vasculitis may have been the precipitating cause.
A critical appraisal of indications for the implantable cardioverter defibrillator (ICD)
Authors: Cannom David S.
Published: February 2009

The implantable cardioverter defibrillator (ICD) is a remarkably effective therapy for reducing sudden cardiac death in patients with malignant ventricular arrhythmias. The indications for implantation of the ICD were approved in 1985 by the United States Food and Drug Administration; it could be implanted in patients who have experienced cardiac arrest or in those with recurrent ventricular arrhythmias which are not suppressed by antiarrhythmic drugs in the electrophysiology laboratory. These established indications have not changed in the last seven years. In the near future, the release of third‐generation ICDs (with antitachycardia pacing) will likely further expand indications for the device. Many patients with stable ventricular tachycardia who have not had syncope or cardiac arrest will receive a third‐generation defibrillator. Also, three clinical trials now in progress—CABG‐PATCH, Multicenter Automatic Defibrillator Implantation Trial (MADIT) and Multicenter Unsustained Tachycardia Trial (MUSTT)—are studying “pre‐event” patients with low ejection fraction and electrical instability; some of the patients in each trial are being prospectively randomized to the ICD. Within the next five years we will have a better understanding of the role of ICD therapy in such patients. Until these studies are completed, it is important that the indications for the ICD not be expanded.
The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis
Authors: Stoddard Marcus F. , Liddell Norman E. , Korfhage Linda , Arce Javier , Kupersmith Joel
Published: February 2009

We report a case of left atrial myxoma simulating a thrombus on transthoracic echocardiography, but correctly diagnosed using transesophageal echocardiography. As this tumor is usually fatal unless surgically resected, a correct diagnosis is essential. Myxomas which do not prolapse between the mitral valve leaflets and coexist with mitral stenosis may be difficult to diagnose accurately using transthoracic echocardiography. The advantages of transesophageal compared with transthoracic echocardiography in the diagnosis of nonclassical left atrial myxoma are discussed.
The value and promise of echocardiography in acute myocardial infarction and coronary artery disease
Authors: Katz Alan S. , Harrigan Pamela , Parisi Alfred F.
Published: February 2009

Two‐dimensional and Doppler echocardiography have become extremely useful in the management of patients with acute myocardial infarction (AMI). Echocardiography is noninvasive, relatively inexpensive, and has no known biohazards. It offers unequaled information about cardiac anatomy and function. In the acute setting it is useful in the diagnosis of AMI and its complications. It is an excellent tool for monitoring therapy. Echocardiography has been shown to be useful in risk stratification upon presentation to the emergency ward and prior to hospital discharge. Stress echocardiography has broadened and sharpened the diagnostic and prognostic information. Contrast echocardiography has promise for demonstrating coronary artery flow. Research in ultrasonic myocardial tissue characterization shows potential for differentiating ischemic myocardium from infarcted myocardium. Thus, echocardiography is likely to become increasingly important in the future management of patients with AMI.
Comparative effects of pravastatin and lovastatin on nighttime sleep and daytime performance
Authors: Richardson Gary R. , Sullivan Jason P. , Lee Richard M. , Roth Thomas , Merlotti Lori , Roehrs Timothy
Published: February 2009

Pravastatin and lovastatin, two HMG‐CoA reductase inhibitors with similar cholesterol‐lowering effects, differ in their lipid solubility. The hydrophilic characteristics of pravastatin may explain why the drug has not been detected in cerebrospinal fluid. On the other hand, lovastatin, a lipophilic compound, has been detected in the cerebrospinal fluid. Previous reports have suggested that lovastatin administration may be associated with insomnia, which reflects an action in the central nervous system. The effects of the two drugs on nocturnal sleep and daytime performance in young, healthy men have been assessed in randomized, double‐blind, placebo‐controlled studies. Computer‐based performance tests were administered on two consecutive days before drug administration and at the end of a 3‐week active drug or placebo treatment period. Results from both sites were combined for analysis. Neither pravastatin nor lovastatin significantly affected nocturnal sleep or daytime sleepiness in this study population, but lovastatin significantly affected daytime performance. In subjects treated with lovastatin, the results showed that two measures of performance, divided attention (p<0.05) and vigilance (p<0.01), worsened significantly from baseline as did global performance (p<0.01). Performance was not affected in the pravastatin and placebo groups. These results provide preliminary evidence of an adverse effect of lovastatin on daytime performance.
Use of transesophageal echocardiography to visualize an anomalous right coronary artery arising from the left main coronary artery (single coronary artery)
Authors: Henson Kenneth D. , Geiser Edward A. , Billett Jeanette , Alexander James A. , Akins E. William , Bopitiya Chandana
Published: February 2009

This case report demonstrates a role for transesophageal echocardiography in defining the course of anomalous coronary arteries. Origin of the right coronary artery (RCA) from the left main (LM) (single coronary artery) is an exceedingly rare congenital anomaly. It is not always benign and may result in myocardial infarction. This may be due to compression between the aorta and the pulmonary artery. Transesophageal echocardiography offers a low‐risk, noninvasive means of imaging the proximal coronary arteries. In the majority of patients, the proximal segments of the three major coronaries can be clearly visualized. With the addition of color flow, it is possible to visualize flow in most patients. Proximal obstructive lesions can be seen in some patients although sensitivity thus far seems low.
Amlodipine combined with beta blockade for chronic angina: Results of a multicenter, placebo‐controlled, randomized double‐blind study
Authors: Dibianco Robert , Schoomaker Fred W. , Singh Jang B. , Awan Najam A. , Bennett Tyson , Canosa Frank L. , Kawanishi David T. , Bamrah Virinderjit S. , Glasser Stephen P. , Barry William
Published: February 2009

Amlodipine, a potent long‐acting dihydropyridine calcium antagonist, was compared with placebo in a parallel, randomized, double‐blind study in 134 patients with chronic stable angina pectoris maintained on betaadrenergic blocking agents. After a single‐blind, two‐week placebo period, patients were randomized to receive either amlodipine (2.5, 5, and 10 mg) or placebo once daily for four weeks. The effects of amlodipine on maximal exercise time, work, time to angina onset, and subjective indices including angina frequency, nitroglycerin tablet consumption, and patient and investigator ratings were assessed. Each dose of amlodipine produced increases in exercise time and calculated total work accomplished compared to baseline. Improvements at 5 and 10 mg were significantly greater than placebo which produced no significant change (p<0.05). Qualitative improvements in the severity of angina were produced by amlodipine at 5 and 10 mg daily assessed by patient‐rating questionnaires (p<0.05). Reductions in angina frequency attacks per week and weekly nitroglycerin tablet consumption occurred but were not statistically significant when compared with placebo. Adverse effects observed during amlodipine treatment prompted discontinuation of treatment in only 2 out of 100 patients. Three patients discontinued treatment for reported lack of efficacy. No laboratory abnormalities prompted treatment discontinuation and minor side effects of dizziness, nausea, headache, and fatigue were observed infrequently. The results of this controlled, large‐scale multicenter trial suggest that amlodipine significantly increased exercise capacity and was well tolerated when added to the antianginal regimen of patients remaining symptomatic while receiving beta‐blocking agents.
Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques—Part II
Authors: Waller Bruce F. , Orr Charles M. , Slack John D. , Pinkerton Cass A. , Van Tassel James , Peters Thomas
Published: February 2009

In the last 15 years, intense interest has focused on various interventional, pharmacologic, and mechanical forms of therapy for the treatment of atherosclerotic coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part II of this four‐part review will focus on aging changes seen in the epicardial coronary arteries and will review selected features of atherosclerotic plaque, including fissure and topography.
Magnesium disorders and cardiovascular diseases
Authors: Purvis John R. , Movahed Assad
Published: February 2009

The evidence linking magnesium disorders with the pathogenesis and treatment of various cardiovascular diseases will be reviewed.
The effects of beta blockade with (epanolol) and without (atenolol) intrinsic sympathomimetic activity in stable angina pectoris
Authors: Boberg Jonas , Larsen Flemming F. , Pehrsson S. Kenneth
Published: February 2009

Beta blockade constitutes efficient therapy for stable angina pectoris. The effects of lowering blood pressure and heart rate with such treatment are not always desired. Epanolol is a beta1‐selective partial agonist with minor effects on blood pressure and heart rate at rest. Atenolol is a pure beta1‐selective antagonist with more pronounced effects on blood pressure and heart rate at rest. The effects of epanolol, 200 mg o.d., and atenolol, 100 mg o.d., were compared in 173 middle‐aged patients with stable angina pectoris in a randomized, double‐blind, parallel group‐controlled study for one year. No significant differences were shown in angina attack rate, nitrate consumption, or exercise performance. Resting heart rate and blood pressure were significantly lower on atenolol. Epanolol tended to be better tolerated than atenolol, as shown by visual analogue scales of well‐being, activity, energy, and warm extremities, further supported by fewer reports on possible adverse reactions. In conclusion, epanolol appears to be as effective as atenolol and better tolerated in patients with stable angina pectoris.
A case of neurofibromatosis associated with a coronary artery aneurysm and myocardial infarction
Authors: Daly Mel P. , Rubinstein Michael N.
Published: February 2009

Aneurysms of the aorta, vertebral arteries, carotid artery, thyrocervical trunk, and mesenteric and celiac arteries have been described in patients with neurofibromatosis. These aneurysms may have part of the vessel wall replaced by neurofibromatosis tissue. One previous case reports a coronary artery aneurysm in a patient with neurofibromatosis who suffered a myocardial infarction due to thrombosis formation within the aneurysm. We document a second case of aneurysmal dilatation of a coronary artery in a patient with neurofibromatosis. This patient also had a myocardial infarction in a vascular distribution not involved by the aneurysm. The vascular changes associated with neurofibromatosis are reviewed. Aneurysmal dilatation of the coronary arteries may be a further vascular manifestation of this condition.
A case of accessory mitral valve leaflet associated with solitary mitral cleft
Authors: Kanemoto Nariaki , Shiina Yutaka , Goto Yuichiro , Inamura Schunichi , Suzuki Ichiro , Koide Shirosaku , Shohtsu Akira
Published: February 2009

Accessory mitral valve leaflet is a rare congenital anomaly.1–19 More than half of the cases show other congenital cardiac defects and almost all of the cases show subaortic obstruction.1–9,11–13,18,19 We report a case of an accessory mitral valve tissue without outflow obstruction associated with mitral cleft of the posterior mitral leaflet. To our knowledge, this is the first reported case of the combination of these two congenital anomalies.
Single moving dipole obtained from magnetic field of the heart in patients with left ventricular hypertrophy
Authors: Nomura Masahiro , Nakaya Yutaka , Miyoshi Yukiko , Wakatsuki Tetsuzo , Saito Ken , Bando Shigenobu , Ito Susumu , Nakayasu Kimiko
Published: February 2009

Magnetocardiograms (MCGs) were recorded by means of a second‐derivative SQUID (superconducting quantum interference device) magnetometer in 20 normal subjects and 28 patients with left ventricular overload to analyze the activation sequence of the heart and amplitude of estimated current source. In the normal subjects, the dipole was directed to the left and gradually superiorly 40 ms after the beginning of the QRS wave mainly due to the activation of the left ventricle. In the patients with hypertension, the direction and location of the dipoles were similar to those of the normal subjects, but their dipole moments were increased. In the patients with mitral regurgitation, the dipoles of late QRS were directed more inferiorly than in the normal subjects and their amplitude was increased. In the patients with aortic valve disease, the amplitude of the dipoles was increased markedly and their location was deviated more to the left than the dipoles of the normal subjects. We established the criterion for diagnosis of LVO from the dipole moment of 50 ms of 3.13×10–3A or more. The sensitivity of this criterion is significantly higher in the diagnosis of left ventricular overload than the electrocardiogram (ECG). The present study shows that the moving dipole method is useful to determine the increased electromotive force in patients with left ventricular overload and that sensitivity in diagnosis of left ventricular overload is increased.
Delayed presentation of a mitral annular perforation complicating staphylococcus aureus infective endocarditis
Authors: Quigley Robert L. , Peter Robert H. , Lowe James E.
Published: February 2009

This report describes a patient who presented with congestive heart failure secondary to a mitral annular‐left atrial fistula. There was a remote history of Staphylococcus aureus endocarditis involving the mitral valve which was treated medically 30 years previously. The sterile fistula was managed surgically with an annuloplasty.
Recurrent myocardial infarction in a postpartum patient receiving bromocriptine
Authors: Eickman Francis Michael
Published: February 2009

Myocardial infarction in puerperium is infrequently reported. Spasm, coronary dissection, or atheromatous etiology has been described. Bromocriptine has been implicated in several previous case reports of myocardial infarction in the puerperium. Our case (including an inadvertent rechallenge) suggests such a relationship. Although generally regarded as “safe,” possible serious cardiac effects of bromocriptine should be acknowledged.
Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse
Authors: Śniez̊ek‐Maciejewska M. , Dubiel J. P. , Piwowarska W. , Mroczek‐Czernecka D. , Mazurek S. , Jaśkiewicz J. , Kitliński M.
Published: February 2009

The aim of this study was to evaluate a possible relation between the autonomic tone determined by daily urine catecholamine excretion and the incidence of ventricular arrhythmias (VA) in patients with mitral valve prolapse (MVP). The study included 53 patients (31 women and 22 men) aged 19–52 years (mean age 32.7). The diagnosis of MVP was based on medical history, physical examination, and echocardiography. Cardiac arrhythmias were detected by Holter monitoring and classified according to Lown grades. Daily heart rate and duration of corrected QT interval using Basett's formula were also analyzed. Daily urine adrenaline and noradrenaline levels were determined fluorometrically by Von Euler and Lishajko's method. The patients with Lown's grade III‐V VA were evaluated with particular consideration. Student's t‐test was used for statistical analysis. On Holter monitoring 26 patients showed VA, including 6 with grade I, 11 with grade II, 2 with grade III, 4 with grade IV, and 3 with grade V according to Lown's classification. The remaining 27 patients were free of cardiac arrhythmias. Mean daily heart rate ranged from 54–93 beats/min (73±8.44, mean±SD) and corrected QT from 336–494 ms (411±37.17). Daily adrenaline and noradrenaline excretion for the whole group of patients were 0.01–16.2 μg (2.1±2.38) and 1.6–31.0 μg (13.1±7.27), respectively, which was within normal range. However, the patients with serious ventricular arrhythmias showed significantly higher daily adrenaline excretion. Individual analysis of two‐thirds of patients with ventricular arrhythmias grade III‐V showed daily urine noradrenaline levels exceeding mean values for the whole group. Our results suggest that in patients with MVP and serious VA, increased autonomic tone may be of great importance.