bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventricular premature beats on holter monitoring in patients admitted with chest pain, in whom acute myocardial infarction is not confirmed. The prognostic value and relationship to scars or ischemia on thallium‐201 scintigraphy
Authors: Madsen J. K. , Sørensen J. N. , Kromann‐Andersen B. , Kjeldgaard K.‐M. , Christoffersen K. , Van Duijvendijk K. , Reiber J. H. C. 
Published: August 2009

AbstractAmbulatory 24‐h Holter monitoring was carried out in 198 patients who had been admitted because of suspected acute myocardial infarction (AMI) due to chest pain, but in whom AMI was not confirmed. During a follow‐up period of 12‐24 months (median 14 months) 16 cardiac events (i.e., nonfatal AMI or cardiac death) occurred. Ventricular premature beats (VPBs) were found in 65.2% of the patients, complex VPBs in 28.8%. Pairs of VPBs which were seen in 10.0% of the patients were the only important type of VPBs significantly related to an impaired prognosis. Thallium‐201 scintigraphy was performed in 144 of the patients. VPBs were significantly related to scar formation (i.e., to permanent defects, but not to ischemia, specifically, to transient defects). It is concluded that ventricular arrhythmias in this patient category indicate presence of chronic ischemic heart disease, and that pairs of VPBs seem to identify patients at risk for cardiac events.
Comparative diagnostic value of a new computerized vectorcardiographic method (cardiogoniometry) and other noninvasive tests in medically treated patients with chest pain
Authors: Meier A. , Høflin F. , Herrmann H. J. , Wolf C. , Gurtner H. P. , Røsler H. 
Published: August 2009

AbstractThe diagnostic value of cardiogoniometry (CGM), a new computerized vectorcardiographic method, for the identification of coronary artery disease was compared with other noninvasive tests in 48 medically treated patients with chest pain. Coronary angiography revealed one‐vessel disease in 18, two‐ or three‐vessel disease in 21, and normal coronary arteries in 9 patients. Cardiogoniometry was less sensitive (63%) than thallium‐201 (201TI) scanning (82%), but slightly more sensitive than the exercise ECG (50%) or a recently proposed parameter of exercise performance (50%). On the other hand, specificity was comparable among these tests (exercise ECG 78%, thallium‐201 scanning 72%, CGM 67%, new parameter of exercise performance 66%). Moreover, the false negative rate of noninvasive testing was reduced from 8 to 3% when CGM was added to thallium‐201 scanning and exercise ECG. Our findings indicate that in view of the easier feasibility with computerized technology, the future role of vectorcardiographic methods such as CGM in the noninvasive diagnosis of coronary artery disease should be redefined.
Intravenous flecainide acetate for the clinical management of paroxysmal tachycardias
Authors: Nathan A. W. , Hellestrand K. J. , Camm A. J. , Bexton R. S. , Hellestrand K. J. 
Published: August 2009

AbstractIntravenous flecainide acetate (2 mg/kg) was administered to 40 patients undergoing routine electrophysiological evaluation for the investigation of recurrent paroxysmal tachycardias. Ten patients had recurrent atrial flutter, 11 patients had recurrent atrial fibrillation, one of whom also had paroxysmal left atrial tachycardia, and 19 patients had recurrent ventricular tachyarrhythmias (17 with recurrent ventricular tachycardia and 2 with recurrent fascicular tachycardia). Flecainide was administered during tachycardia (over 5 to 10 minutes) to all patients with atrial flutter, to 10 patients with atrial fibrillation, and to 17 patients with ventricular tachyarrythmias. In the remaining 3 patients with illsustained arrhythmias flecainide was administered during sinus rhythm and reinitiation of tachycardia was then attempted. Flecainide restored sinus rhythm in only 2 patients with atrial flutter (20%), in 9 patients with atrial fibrillation (90%), in 12 patients with ventricular tachycardia (80%), and in one of the 2 patients with fasicular tachycardia. Flecainide also successfully terminated the left atrial tachycardia. Two patients experienced proarrhythmic side effects during flecainide administration, one of whom required intervention by cardioversion. Minor dose effects included oral paresthesia, transient drowsiness or dizziness, and occasional visual blurring. Flecainide acetate is an effective antiarrhythmic agent for the acute termination of recent onset paroxysmal atrial and ventricular tachyarrhythmias.
Hemodynamics and myocardial oxygen metabolism of pulsus alternans in patients with dilative cardiomyopathy
Authors: Hasenfuss G. , Holubarsch C. , Heiss H. W. , Bonzel T. , Funfack M. , Revenaugh M. , Meinertz T. , Just H. 
Published: August 2009

AbstractThe hemodynamic and myocardial energetic changes due to pulsus alternans were investigated by left and right heart catheterization and by oxygen consumption measurements in three patients with dilative cardiomyopathy. In all three patients, pulsus alternans developed after intravenous administration of the phosphodiesterase inhibitor enoximone. Following enoximone (Patients 1/2/3), left ventricular peak systolic pressure was reduced, in the respective patients, from 100/103/115 mmHg (normal beat) to 91/96/94 mmHg (strong beat) and further to 59/80/85 mmHg (weak beat); left ventricular end‐diastolic pressure was reduced from 24/23/22 mmHg (normal beat) to 5/10/6 mmHg (strong beat) and further to 3/7/4 mmHg (weak beat). Cardiac output increased by an average of 16%. Heart rate increased by an average of 12%. Stroke work (during pulsus alternans mean between strong and weak beats) did not change (<5%) in any of the three patients. Arterial‐coronary‐sinus oxygen content difference decreased by 5%/13%/22%, respectively. Myocardial oxygen consumption per beat decreased in Patient 1 by 18%, in Patient 2 by 8% and remained unchanged in Patient 3. It is concluded that pulsus alternans occurred in consequence of alternating systolic performance. The alternation in systolic performance most probably resulted from a disturbance in excitation‐contraction coupling induced by enoximone. The pronounced reduction of left ventricular preload following administration of enoximone may have augmented further the differences between the strong and the weak beat. A disturbance in myocardial oxygen metabolism was ruled out as the cause of pulsus alternans in these patients.
Maladaptation after successful revascularization in anginal patients without transmural infarction
Authors: Sato I. , Takaki H. , Keta K. , Haze K. , Ohe T. , Shimomura K. 
Published: August 2009

AbstractIn order to eluciate how peripheral or cardiac function maladaptations play a role in deconditioning after coronary bypass surgery, we have evaluated effects of successful coronary artery bypass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) on exercise capacity in anginal patients without myocardial infarction. Symptom‐limited treadmill exercise tests were performed in 46 patients before and after CABG and in 28 patients before and after PTCA. None of the patients carried out a cardiac rehabilitation program after their discharge. PTCA patients showed significant improvement of exercise capacity, from 6.4 ±1.6 to 10.5±2.5 METs in 4 weeks after PTCA, and even elderly PTCA patients showed improvement from 6.0±1.1 to 10.3±2.5 METs. However, the exercise capacity of CABG patients improved only from 5.9±1.4 to 8.5±3.1 METs in the first 6 months after CABG, and from 5.9±1.7 to 10.0±3.6 METs thereafter. The 15 elderly CABG patients showed only slight increase of physical activity, from 6.0±1.7 to 6.9±1.9 METs in the first 6 months after CABG and from 6.3±1.9 to 8.7±2.9 METs thereafter. Furthermore, 6 of 15 elderly CABG patients showed no improved exercise capacity after CABG. There was no correlation between the duration of anginal symptoms before CABG and exercise capacity before or after CABG. These findings suggest that CABG itself and/or physical restriction during admission produces peripheral function maladaptation and may be the main contributors to deconditioning after CABG, especially in elderly patients. This deconditioning can be treated by a rehabilitation program after the discharge.
Reproducibility of myocardial thallium‐201 washout in studies applying a standardized dipyridamole stress protocol
Authors: Siostrzonek P. , Dudczak R. , Schmoliner R. 
Published: August 2009

AbstractThallium‐201 (201T1) washout analysis was proposed as an adjunctive tool to improve the detection of coronary artery disease (CAD). Since reproducibility of 201T1 washout in dipyridamole (DPM) stress studies is unknown, this item was evaluated in 32 patients (24 with CAD, 8 without CAD), who were scintigraphed twice within 1–2 weeks. At 2 minutes following DPM infusion (0.5 mg/kg/5 min), 2 mCi 201T1 were injected. Global and segmental washout were calculated by comparing circumferential profiles of respective background‐corrected stress (left anterior oblique (LAO) 45°: 8 min postinfusion (p.i.), 35 min p.i.; anterior (ANT): 17 min p.i.; LAO 70°: 26 min p.i.) and redistribution (4 h p.i.) images. Whereas visual findings were comparable for study I and II, reproducibility of 201T1 washout was low, indicated by comparing variances among patients with variance between studies, which were 28.8 and 71.2% of total variance, respectively. Mean differences of segmental washout between the studies ranged from 9.75 to 19.24% with only minor differences with regard to the different views and segments evaluated. Variability was lower using the intermediate instead of the initial scintigram as reference for the redistribution image (12.87±11.64% vs. 18.59±14.43%, n = 85; p<0.01). Variability was higher for nonstenosed compared to stenosed segments (14.54 ± 11.41%, n=32 vs. 9.89±8.03%, n=28, p<0.05). Correspondent with results of visual interpretation, variance of relative differences of washout values between neighboring segments was lower than variance statistically expected from variability of washout values between study I and II (12.79%, n=216 vs. 21.55%, n=270; F=2.76, p<0.01). It is suggested, that considerable washout variability might explain the controversially discussed diagnostic value of 201T1 washout analysis in DPM stress studies.
The possible etiology of the vibratory systolic murmur
Authors: Darazs B. , Butterworth A. M. , Hesdorffer C. S. , Ziady F. 
Published: August 2009

AbstractBetween January and September 1985, 476 patients underwent two‐dimensional and M‐mode echocardiography. Left ventricular bands were noted in 104 of these individuals. Of these patients, 89 (85.6%) were referred for evaluation of a systolic murmur. In view of this high incidence of association between left ventricular bands and systolic murmurs, we decided to perform a prospective analysis on patients with the classical vibratory systolic murmur (Still's murmur) which is commonly found in children and young adults. The incidence of left ventricular bands would be compared with a group of individuals in whom no cardiac murmurs could be detected. It was hoped in this way to possibly determine whether there was a definite relationship between the vibratory systolic murmur and left ventricular bands. Echocardiographs were performed using an Advanced Technical Laboratories machine and gain settings were adjusted such that all artefacts and normal structures could easily be distinguished from the ventricular bands. The ventricular bands were divided into two types. Of significance, we felt, were those which crossed the left ventricular outflow tract and which could therefore have been responsible for the production of turbulence and thus a murmur reminiscent of the Still's murmur. This type of left ventricular band was noted in 76% of our patients with Still's murmurs as opposed to only 14% of the individuals without any murmur (p<0.001). This statistically significant difference led us to conclude that left ventricular bands might be the cause of the Still's murmur. Further investigation, particularly with Doppler studies would be required to confirm this interesting association.
Serum myoglobin in detection of myocardial necrosis in patients with “coronary insufficiency”
Authors: Almog C. , Isakov A. , Burke M. , Shapira I. , Ayalon D. 
Published: August 2009

AbstractMyoglobin, an oxygen‐binding protein, is synthesized exclusively in striated and cardiac muscle, and is normally found in blood. Serum myoglobin determination has been used in the diagnosis of acute myocardial infarction. Experimental work has shown that myoglobin is released only after muscular necrosis. This prospective study included 101 patients: 62 with acute coronary insufficiency, 16 with acute myocardial infarction, and 23 controls. In all the patients with infarction the serum myoglobin levels were elevated. None of the controls showed serum myoglobin above normal. In patients with coronary insufficiency the peak serum myoglobin ranged from normal to 280 ng/ml. Half of all the patients with coronary insufficiency had a significant elevation of serum myoglobin (p<0.001). The obvious explanation of this finding is that myocardial necrosis to some extent develops in cases of so‐called coronary insufficiency. Furthermore, this study confirms previous findings that serum myoglobin assessment constitutes a very early marker of myocardial damage.
Pulmonary atresia with ventricular septal defect in adult patients
Authors: Sudhir K. , Gupta S. Krishna , Abraham A. K. , Cherian M. P. , Reddy N. K. , Cherian M. K. 
Published: August 2009

AbstractHemodynamic data and angiograms of 15 adult patients with pulmonary atresia and ventricular septal defect were reviewed to assess the pulmonary circulation and other associated features. The most common variety of pulmonary atresia was that of pulmonary valve, main pulmonary artery, and the confluence of pulmonary arteries (6 cases, 40%). The collateral vessels to the lungs were well developed in all cases; selective injections into the collateral vessels were of great value in their delineation. The left ventricle was well developed in 11 cases (73.3%). Congestive heart failure was seen in 8 (53.3%), tricuspid regurgitation in 10 (66.7%), and aortic regurgitation in 7 (46.7%) cases. The long survival in these patients was related to the favorable anatomy of central pulmonary arteries (12 cases, 80%) and adequate pulmonary collateral circlation.
Long‐term treatment of hypertension with the calcium channel blocker diltiazem
Authors: Klein W. 
Published: August 2009

AbstractA group of 48 patients with essential mild to moderate hypertension were treated with the calcium‐channel blocker diltiazem (90–270 mg/day) for one year. Adequate blood pressure control was achieved in all patients. No tolerance developed during the one‐year treatment period. The drug is almost free from side effects. Very few patients develop fluid retention, which can be controlled by adding a diuretic.
Torsade de pointes due to coxsackie B3 myocarditis
Authors: Sareli P. , Schamroth C. L. , Passias J. , Schamroth L. 
Published: August 2009

AbstractViral myocarditis may present with a variety of electrocardiologic aberrations. Torsade de pointes, a potentially malignant ventricular arrhythmia associated with prolongation of the QT interval has not been described in patients with acute viral myocarditis. This report details this finding in a patient with coxsackie B3 myocarditis in whom symptomatic torsade de pointes was documented.
Combined unilateral pulmonary artery agenesis and contralateral peripheral pulmonary artery stenosis
Authors: Schamroth C. L. , Sareli P. , Dean H. 
Published: August 2009

AbstractUnilateral absence of a pulmonary artery is a rare congenital malformation. This report details the finding in two cases of this anomaly associated with peripheral stenosis of the contralateral pulmonary artery.
“Three‐level shock” in ablation‐refractory paroxysmal atrial fibrillation
Authors: Pop T. , Treese N. , Erbel R. , Von OLSHAUSEN K. , Meyer J. 
Published: August 2009

AbstractHis‐bundle ablation is a very effective method to control drug‐refractory supraventricular arrhythmias. We present a 69‐year‐old woman with paroxysmal atrial fibrillation, in whom several attempts of unipolar and bipolar His‐bundle ablation were ineffective. Ultimately a stable 2/1 atrioventricular block was induced when three successive shocks of 400 W were applied. The first shock was given in that position with the largest His‐potential deflection. The other two shocks were applied at catheter positions more distal and more proximal from the first one, respectively. We suppose that the initial lack of success was due to an atypical atrioventricular junction anatomy.
An unusual complication of the le veen shunt: A right atrial ventricular chamber pseudotumor
Authors: Gosse P. , Guez S. , Roudaut R. , Deville C. , Dallocchio M. 
Published: August 2009

AbstractWe report the case of a right atrial‐ventricular chamber thrombus discovered four years after insertion of a Le Veen shunt for treatment of refractory ascites. A two‐dimensional echocardiogram, performed after the discovery of an isolated systolic murmur, demonstrated a ‘tumorlike’ mass seated in both the right atrium and the right ventricle. The mass was surgically removed and histologic examination confirmed that it was a thrombu developed at the tip of the catheter. We propose that two dimensional echocardiography should be performed periodically for the survey of such intracardiac devices.
Left ventricular aneurysm: A review
Authors: Ba'Albaki H. A. , Clements S. D. 
Published: August 2009

AbstractThe vast majority of left ventricular aneurysms (LVA) are secondary to corondary artery disease. The natural history of LVA is now better understood. The increasing use of noninvasive techniques has allowed earlier recognition and better appreciation of LVA genesis and pathophysiology. Improvements in surgical anesthesia and techniques have resulted in more successful LVA surgery. This article reviews the pathogenesis, natural history, and complications of LVA. Surgical indications and available treatment options in the management of patients with LVA and severe symptoms are presented. Left ventricular pseudoaneurysm (false aneurysm) will also be discussed.
A new device for balloon inflation during valvuloplasty: A perliminary reoport
Authors: Hill J. A. , Martin D. B. , Carr A. M. 
Published: August 2009

AbstractA new device using a lever concept has been designed to facilitate rapid inflation and deflation of balloons during valvuloplasty. This report summarizes and illustrates the design features of the balloon inflation device as well as in vitro results of testing of times for balloon inflation, deflation, and bursting.
Lymphocyte subsets in acute rheumatic fever and rheumatic heart disease
Authors: Bhatia R. , Narula J. , Reddy K. S. , Koicha M. , Malaviya A. N. , Pothineni R. B. , Tandon R. , Bhatia M. L. 
Published: August 2009

AbstractLymphocyte subsets in 53 patients with acute rheumatic fever and 78 patients with chronic rheumatic heart disease were compared with 20 normal control subjects and 39 patients suffering from uncomplicated streptococcal pharygitis to obtain information about the pathogenesis of the disease. Twenty patients with rheumatic fever were followed for 24 weeks to evaluate changes occuring over the course of the disease. Total leukocyte and lymphocyte counts were increased in patients with rheumatic fever and to a lesser extent in those with rheumatic heart disease, when compared with controls. The difference between the two groups was significant. Patients with acute rheumatic fever had an increased number of B cells and a smaller increase in total T and T‐helper‐inducer (CD‐4) cells. The proportion of B cells increased, while that of T‐suppressor‐cytotoxic (CD‐8) cells fell. An increased number and proportion of B cells was also seen in patients with rheumatic heart disease. Total T and T‐helper lymphocyte percentages and numbers were significantly higher in patients with rheumatic fever compared with those of patients with rheumatic heart disease. Follow‐up studies at 6, 12, and 24 weeks revealed no significant differences from the entry point studies, although there was a trend toward reduction in the degree of derangement from normal values. Patients with uncomplicated streptococcal pharyngitis, however, did not show perturbations in the T‐cell and T‐subset counts. Our study suggests that the immunoregulatory defect in acute rheumatic fever is characterized by a relative reduction of suppressor T cells with an absolute increase in helper T cells and B cells, resulting in an increased cellular as well as humoral immune response. The persistent alteration in B cells in the patients with chronic rheumatic heart disease suggests an ongoing immunoinflammatory process during the apparently quiescent phase.
Exercise time: A possible source of misleading results during long‐term pharmacological studies by multiple stress testing in coronary artery disease
Authors: Romano  , Carella G. , Di Maro T. , Caiazzo M. R. , Chiariello  , Condorelli M. , Cotecchia M. R. , De Arcangelis  
Published: August 2009

AbstractThe assessment of chronic pharmacological of stable angina requires serial exercise stress. It is well known that exercise tolerance can be by the training effect of performing repeated. Our study investigated the values of heart rate, blood pressure, rate‐pressure product, and of exercise at 0.1 mV ST depression during exercise the same parameters plus the maximal ST‐segment at peak exercise, collected from three tests. The first and second were performed at one‐week before, and the third (75 days after the first), was after a double‐blind study with a drug versus. We found a significant increase of exercise at 0.1 mV ST depression and at peak exercise, while of 12 patients increased exercise duration from the to the third test. Individual variability of exercise showed increasing values, ranging from 0 to 71% vs. third test). In contrast, the ratio of heart rate and blood pressure did not differ between the tests. data criticized the use of mean values of exercise time pharmacological studies; moreover, individual could affect results independently of drug or placebo. These findings should be taken into in order to exclude misleading results.