bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systolic honk in heart failure: Its origin and mechanism of production
Authors: Sheikh M. U. , Ali N. 
Published: October 2013

AbstractSystolic honks have so far been synonymous with prolapse of the mitral valve leaflet. Evidence of tricuspid valve involvement in two cases is presented. These patients developed systolic honk during the deterioration of their congestive heart failure. Simultaneous recordings of echocardiograms and phonocardiograms showed fluttering of the tricuspid valve, coinciding with the systolic honk. This fluttering was not seen when honk was absent. The mechanism of production of this honk is discussed.
Persistence of improved exercise tolerance and degree of revascularization after coronary bypass surgery. A prospective randomized study
Authors: Frick M. H. , Harjola P.‐T. , Valle M. 
Published: October 2013

AbstractExercise tolerance was repeatedly determined over a 2‐year period in a series of 100 patients with coronary heart disease randomly allocated for medical therapy and coronary bypass surgery. The surgical group had a consistently better exercise tolerance than the medical group during the whole follow‐up. Completeness of the revascularization, assessed by repeated graft and native vessel angiography, resulted in a marked improvement whereas incompletely revascularized patients exhibited only a marginal improvement which, nevertheless, to some degree exceeded the result of medical management alone.It is concluded that coronary bypass surgery and medical therapy, when indicated, result in markedly better exercise tolerance than medical management alone. This improvement persists up two years after the operation and is largely dependent on the completeness of the revascularization.
Beneficial effect of continuation of propranolol through coronary bypass surgery
Authors: Boudoulas H. , Lewis R. P. , Snyder G. L. , Karayannacos P. , Vasko J. S. 
Published: October 2013

AbstractThe safety and beneficial effect of continuation of propranolol (Pr) through coronary bypass surgery (CBS) was studied in two groups of patients. In the control group (50 patients) Pr was discontinued 24 h before CBS without reinstitution afterwards. In the propranolol group the drug was maintained up to 4 to 10 h before surgery and was restarted within 24 h afterwards. The incidence of subendocardial myocardial infarction was significantly lower in the Pr group (1 out of 30 vs 10 out of 50, p < 0.05) while the incidence of transmural infarction was the same in both groups (3 out of 30, 10 %, vs 5 out of 50, 10%). The incidence of supraventricular tachycardias during the first three postoperative days was significantly lower in the propranolol group compared to control (5% vs 30%, p < 0.01). The 24 h urinary epinephrine and norepinephrine excretion was significantly greater than normal the day before surgery (136 ± 12 vs 39 ± 4 μg/24 h, p < 0.01), and was still high two weeks after surgery (115.1 ± 14 μg/24 h). There were no complications related to propranolol. The left ventricular function as measured from the systolic time intervals was the same pre‐and postoperatively in both groups. The results of this study show that administration of propranolol up to 4 h before coronary bypass and reinstitution immediately afterwards is safe and beneficial.
Exercise 201thallium myocardial scans in patients with disease limited to the secondary branches of the left coronary system
Authors: Iskandrian A. S. , Scherer H. , Croll M. N. , Bemis C. E. , Segal B. L. , Kimbiris D. , Wallner R. 
Published: October 2013

AbstractCoronary disease (≥ 50% narrowing) confined to only the diagonal branch of the left anterior descending artery or to the marginal branch of the left circumflex artery, or both, is uncommon. Only 19 patients with disease as defined above were identified in a group of 1000 consecutive patients with an angiographic diagnosis of coronary heart disease. All 19 patients were studied because of angina pectoris and all underwent stress myocardial perfusion scintigraphy with 201Tl (20lthallium) during maximal treadmill exercise testing (exercise electrocardiogram: E/ECG). Ten patients (52%) had positive E/ECG's; seven patients (36%) had positive 201Tl and 13 patients (68%) had one or both tests positive. In 12 patients, the diseased branch was small, i.e. it supplied a comparatively small portion of myocardium, and in seven patients it was determined to be large. The 201Tl test results were positive in four out of seven patients (57%) with large diseased branches, as compared with three out of 12 (25%) with small diseased branches (p: NS). Also, three out of seven patients (42%) with large diseased branches had positive E/ECG's as compared with seven out of 12 patients (58%) with small diseased branches (p: NS). Patients with branch disease may present with typical angina pectoris, however, they are rare and thus not likely to account for the majority of false‐negative 201Tl test results among symptomatic patients with CHD. Approximately one‐third of the patients with branch disease have positive 201Tl test results, one‐half have positive E/ECG's, and in two‐thirds, one or both tests are positive.
Beneficial effects of prolonged low dose dopamine in hospitalized patients with severe refractory heart failure
Authors: White D. H. , Crawford M. H. , O'Rourke R. A. 
Published: October 2013

AbstractIn 10 hospitalized patients with severe congestive heart failure refractory to standard medical therapy for three days, low dose intravenous dopamine (2‐4 μg/kg/min) was infused for 48 h. Heart rate and systolic blood pressure were unchanged throughout the study. Mean pulmonary artery wedge pressure decreased significantly during the dopamine infusion from 27 ± 6 (SD) to 18 ± 6 mmHg (p < 0.01) and cardiac output increased from 3.2 ± 1.1 to 4.6 ± 0.8 l/min (p < 0.001). A diuresis was initiated in all patients and there was a significant weight loss during the study which averaged 5 lbs (p <0.01). All patients improved symptomatically from class IV (NYHA) to class III and were more responsive to conventional therapy after the study. No adverse reactions were noted in this dose range. We conclude that low dose intravenous dopamine is efficacious in improving hemodynamics and initiating a diuresis in patients with severe refractory congestive heart failure.
Studies on digitalis. 23. Blood‐brain barrier of digitoxin in humans
Authors: Storstein L. , Nore A. K. , Sjaastad O. 
Published: October 2013

AbstractData on the cerebrospinal fluid concentrations of digitoxin in man have been lacking. Aim of the present study was to investigate serum and cerebrospinal fluid concentrations of digitoxin. Eleven patients with normal cerebrospinal fluid composition, normal serum albumin values, normal renal and hepatic function and normal hematologic tests were given a single dose of 0.6 mg digitoxin. Serum and cerebrospinal fluid were collected 16 h after the dose, and assayed by radio‐immunoassay, serum digitoxin protein binding was measured with equilibrium dialysis.Mean serum digitoxin concentration was 12.4 ng/ml (SD 2.6) and mean CSF concentration 0.84 ng/ml (SD 0.22) giving a CSF/serum ratio of 0.07 (SD 0.03). Serum digitoxin protein binding was 97.4% (SD 0.4) and the calculated CSF/free serum digitoxin ratio was thus 2.94 (SD 1.43).Free serum digitoxin concentrations are more relevant for pharmacologic effect than total serum digitoxin concentrations and also for passage into the central nervous system. Using free drug concentrations the ratio between digitoxin in serum and CSF is lower than reported values for digoxin indicating a higher penetrance of digitoxin into the central nervous system. This corresponds well with the higher lipid solubility of digitoxin. Post mortem studies have shown that concentrations are higher in cerebral tissue than in CSF for digoxin. Determination of CSF concentrations thus probably underestimates the penetrance of digitalis glycosides into the central nervous system, but may serve as a useful indicator of variance among digitalis glycosides.
Cardiac emission tomography in patients using 201Thallium. A new technique for perfusion scintigraphy
Authors: Dymond D. S. , Stone D. L. , Elliott A. T. , Britton K. E. , Spurrell R. A. J. 
Published: October 2013

AbstractThe distribution of 201thallium (Tl) in the myocardium has been studied by the new technique of emission tomography, and compared with standard gamma camera images in 5 patients. Tomographic imaging was carried out using a dual‐detector scanner operating under the single‐photon technique. Initial results have been promising, with visualisation of resting perfusion defects in patients with recent infarction and those with ventricular aneurysms. Emission tomography has also been performed at exercise, and has shown tracer deficits in the distribution of significant coronary stenoses. This new approach to myocardial perfusion scintigraphy may lead to improved sensitivity for detecting apical and inferior wall abnormalities by providing depth information not available from a conventional two‐dimensional image.
The echocardiographic association of mitral valve prolapse and mitral anulus calcification
Authors: McLean J. , Felner J. M. , Whipple MD R. , Morris D. , Schlant R. C. 
Published: October 2013

AbstractMitral anulus calcification (MAC) and mitral valve prolapse (MVP) are frequently diagnosed conditions. We studied two patients with mild or moderate mitral regurgitation who demonstrated both MAC and MVP on angiography and echocardiography. M‐mode echocardiography is probably the definitive test for confirming the presence of MVP. Echocardiography is moderately sensitive in the diagnosis of cardiac calcification, such as MAC, but M‐mode echocardiography may not detect the MAC in the majority of patients with both MVP and MAC demonstrated by angiography.
Coronary artery spasm: Its role in the pathogenesis of myocardial ischemia
Authors: Chahine R. A. 
Published: October 2013

AbstractThe role of coronary artery spasm in the production of myocardial ischemia has recently become the focus of increased attention. This phenomenon is now well established as a causative mechanism underlying the resting chest pain attacks in Prinzmetal's variant angina. There is also evidence that coronary spasm may play a more significant role in the broad spectrum of ischemic heart disease than can be documented by current techniques. The autonomous nervous system constitutes a major element in the pathophysiology of spasm. Coronary arteriography, in spite of important limitations, remains the only technique for final documentation of this phenomenon, but radionuclide scintigraphy appears to be promising. Nitroglycerin is effective for the relief of the acute attack, while long acting nitrates and the calcium antagonists: nifedipine, perhexiline and verapamil are useful in the prevention of recurrences.
Aorta—Saphenous vein anastomoses markers
Authors: Halseth W. L. , Elliott D. P. , Walker E. L. , Meza F. 
Published: October 2013

AbstractI have read with interest the article by Drs. Halseth, Elliott, Walker, and Meza, “Angiographic Restudy of Coronary Artery Bypass Grafts Simplified by a Marker.”We have had the opportunity to study 1,093 postoperative vein bypass patients using both the Sones and the Judkins techniques since January, 1970. Since that time, our surgeons have used both a stainless steel ring and metallic clips to mark the site of anastomoses of the proximal portion of the saphenous vein bypass graft to the aorta. We have had no difficulty in locating the bypass with either marker in place and support the findings of Drs. Halseth et al. in this regard.
The altered baroreceptor response to nitroglycerin in congestive heart failure
Authors: Faxon D. P. , Gross S. , Tilney C. , Ryan T. J. 
Published: October 2013

AbstractThe use of nitroglycerin as a vasodilator in the treatment of congestive heart failure has demonstrated that the hemodynamic response is related to the degree of left ventricular dysfunction. Little emphasis has been placed on the mechanisms responsible for the variability in heart rate response to nitroglycerin. To study this problem, 33 patients with a variety of chronic cardiac disorders were given 0.4 mg of nitroglycerin sublingually. An increase in heart rate of <3 beats/min to sublingual nitroglycerin allowed a clear identification of a group of patients who had a left ventricular end‐diastolic pressure >18 mmHg or pulmonary artery mean pressure >22 mmHg, and who had improvement in hemodynamic parameters following nitroglycerin. This alteration in baroreceptor sensitivity appears to be related to the level of left ventricular filling pressure, and can be used as a simple bedside means of identifying a group of patients who benefit the most from the vasodilator action of nitroglycerin.
Long‐term comparison of metoprolol and methyldopa in the treatment of hypertension
Authors: Lorimer A. R. , Barbour M. , Hillis W. S. , Lawrie T. D. V. , Stoker J. B. , Sreeharan N. , Leanage R. U. , Linden R. J. 
Published: October 2013

AbstractThe effect of the cardioselective beta‐adrenoreceptor blocking compound, metoprolol, was compared with methyldopa in the long‐term management of hypertension. Thirty patients given metoprolol and twenty‐six given methyldopa were treated for 2 years. The maximum dose of metoprolol was 200 mg twice daily (average 308 mg) and of methyldopa 1,000 mg twice daily (average 1,120 mg). Blood pressure was similar at entry to the study (metoprolol 177/110 mmHg and methyldopa 181/111 mmHg). After 2 years of treatment the blood pressure levels were again similar (metoprolol 149/91 mmHg and methyldopa 148/91 mmHg). Erect pressures were lower in the methyldopa group, but there was no difference between supine and erect blood pressure levels in those on metoprolol. At an exercise load of 300 and 600 kpm the increase in systolic pressure was significantly less in the metoprolol group. The proportional increase in systolic and diastolic pressure in response to a standardized stress situation was reduced by treatment with metoprolol but not by methyldopa. Tolerance to therapy did not develop in either group.The main difference between metoprolol and methyldopa was in the incidence and severity of side effects. Four patients were withdrawn from the metoprolol group. Seventeen were withdrawn from methyldopa mainly because of side effects including drowsiness, depression, skin rash, and impotence. Six patients on metoprolol and seventeen on methyldopa continued on therapy although side effects were present.It is concluded that metoprolol and methyldopa lower blood pressure to the same extent, but metoprolol is advantageous because of a lower incidence of side effects.
Clinical and hemodynamic results of extracardiac conduit reconstruction of the pulmonary artery
Authors: Clarkson S. , Sade R. M. , Hohn A. 
Published: October 2013

AbstractTo evaluate the efficacy of pulmonary artery construction with a prosthetic conduit we have reviewed 25 operations in 22 of our patients. Early mortality was 12.0%, late mortality 5.3%. Up to 13 years postoperatively, 93.8% of the survivors are asymptomatic. Of 12 patients surviving more than 1 year, 11 have been catheterized after 1‐11 years. Five had prior aortopulmonary shunts (mean duration 7.3 years); highest postrepair pulmonary artery pressure was 40 mmHg. Of seven recatheterized xenograft conduits, none had severe and four had mild obstruction. Reconstruction of pulmonary artery with xenograft conduit produced good clinical results. Long duration of aortopulmonary shunt prior to repair did not result in severe pulmonary artery hypertension. Obstruction of xenograft conduit has not been a major problem in our patients, but when necessary, reoperation for obstruction can be carried out safely as late as 11 years after the operation.
Coronary arterial spasm in angina at rest associated with transient ST‐segment changes
Authors: de Servi S. , Specchia G. , Angoli L. , Bramucci E. , Mussini A. , Marinoni G. P. , Salerno J. , Bobba P. 
Published: October 2013

AbstractIn order to clarify the role of coronary arterial spasm in the pathogenesis of angina at rest, coronary arteriography was performed during spontaneous chest pain or following intravenous administration of ergonovine maleate in 40 patients with angina at rest. Coronary vasospasm was demonstrated in 23 patients with ST‐segment elevation during chest pain (group I), in 7 with ST‐segment depression (group II), and in 4 with both ST‐segment depression and elevation (group III).Complete spastic occlusion of the proximal or of the midportion of the left anterior descending artery was always associated with ST‐segment elevation in anterior leads. In contrast, transient ST‐segment depression in anterior leads was associated with diffuse narrowing of the left anterior descending artery with slow progression of the contrast medium, or complete occlusion of a small branch or of the distal segment of the left anterior descending artery. ST‐Segment elevation in inferior leads was associated with complete spastic occlusion or with significant spastic narrowing of the right coronary artery or of the circumflex artery.We conclude that coronary spasm can be demonstrated in a selected cohort of patients with angina at rest associated with transient ST‐segment changes. In some cases the site and the severity of the spasm may produce varying degrees of ischemia, thus determining the direction of the ST‐segment shift.
Changes in coronary anatomy and left ventricular function from the acute to the chronic stage of myocardial infarction
Authors: Blanke H. , Karsch K. R. , Kreuzer H. , Rentrop P. 
Published: October 2013

AbstractCoronary angiography was performed in the acute stage of myocardial infarction in 65 patients. The infarct‐related vessel was occluded in 50 patients; it was narrowed >90% in the remaining 15 patients.Control angiography was performed 55±46 d after acute myocardial infarction in 18 patients. In the chronic stage, five of thirteen previously occluded vessels showed antegrade filling of the distal segment. The narrowing at the site of previous obstruction was 80‐95%. In two of five patients with a subtotal stenosis, the lumen of the infarct‐related vessel was clearly larger in the chronic stage. The end‐diastolic volume index increased significantly from 86±23 ml/m2 in the acute stage to 110±35 ml/m2 in the chronic stage (p<0.001). The increase in the end‐systolic volume index from 42±15 ml/m2 to 63±31 ml/m2 was also statistically significant (p<0.005). Stroke volume index, ejection fraction, and the length of the akinetic segment (AKS) did not change significantly. There was a weak correlation between the end‐systolic volume index and the length of the AKS in the acute stage (r = 0.489, p<0.05) and a better correlation in the chronic stage (r = 0.602, p<0.01). The ejection fraction and the length of the AKS correlated in the chronic stage only (r = 0.795, p<0.001).In contrast to the total group, three patients showed improvement in left ventricular pump function. In all three patients there was a collateral flow to the infarct area during the acute stage of myocardial infarction. In two of these patients there was spontaneous recanalization of the infarct vessel. However, vascularity of the infarct area during the acute stage was also found in eleven patients without improvement of left ventricular pump function. Two of these showed recanalization of the infarct vessel. In all four patients with a proximal occlusion of a major coronary artery and avascularity of the infarct area, there was impairment of left ventricular function and an increase in the length of the AKS.
Triple origin of left coronary arteries from right coronary artery: Unusual case of single coronary artery
Authors: Vuthoori S. , Waisser E. , Angelini P. 
Published: October 2013

AbstractA rare case of coronary anomaly is presented: all of the coronary arteries originated from a single ostium located in the right coronary cusp. No clinical evidence of coronary pathology was recognized until the age of 57 years when the patient was found to have coronary obstructive disease. The single coronary artery had a main branch corresponding to the usual dominant right coronary artery. Three other branches separated from this and vascularized the areas normally receiving the circumflex and ramus medianus, the left anterior descending, and a large septal branch.
Right ventricular obstruction secondary to intracardiac metastatic osteosarcoma
Authors: Wise N. K. , Peter R. H. , Wechsler A. S. , Moore J. O. , Saltzman H. A. 
Published: October 2013

AbstractA 30‐year‐old female with a history of surgically treated osteosarcoma 2 years prior to admission presented with progressive dyspnea and cyanosis. Physical examination was otherwise negative. Cardiac catheterization demonstrated a right ventricular mass lesion. At surgery, a metastatic osteosarcoma filling the entire right ventricle and extending from the pulmonary valve across the tricuspid valve and into the right atrial cavity was partially excised. Despite marked improvement postoperatively, she died 33 d after surgery. Postmortem findings were unusual in that the heart represented the sole site of metastasis. The diagnostic approach to cardiac symptoms from malignancy is discussed in relation to this patient.
Myoglobin or enzymes for a rapid evaluation of infarction diagnosis?
Authors: Mezger V.A. , Kahles H. , Stellwaag M. , Spieckermann P. G. 
Published: October 2013

AbstractRecently published clinical studies on patients with acute myocardial infarction (AMI) have documented that radioimmunologically determined serum peak concentrations of myoglobin (Mb) precede enzyme peak values. It has, therefore, been concluded that Mb (molecular weight 17,600) is liberated earlier from damaged myocardium than, for example, creatine kinase (CK, molecular weight 80,000). As rapid diagnosis is essential in the management of patients suffering from AMI, we have studied the liberation of cardiac enzymes and Mb using a nonrecirculating perfusion system. The release of malate dehydrogenase (MDH), lactate dehydrogenase (LDH), CK, and Mb from isolated guinea pig heart preparations was induced by anaerobic coronary perfusion at a constant flow rate. Thirty minutes after onset of anoxia there was a simultaneous increase in MDH, LDH, and Mb release. Maximum levels were reached between 120 and 180 min. The release curves for enzymes and Mb were approximately parallel. Close correlations exist between LDH/MDH (r = 0.94), CK/MDH (r = 0.98), LDH/Mb (r = 0.89), and MDH/Mb (r = 0.91). Based on these results and on calculations related to invasion and elimination kinetics, we suggest that the early peak of serum Mb in patients with AMI does not reflect a prior Mb release but depends on the more rapid rate of elimination of Mb from serum in comparison to enzymes.