bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of single versus multivessel disease following myocardial infarction using 201thallium scintigraphy and electrocardiographic stress testing
Authors: Weiss R. J. , Morise A. P. , Raabe D. S. , Sbarbaro J. A. 
Published: July 2009

AbstractWe evaluated 50 patients who suffered a single myocardial infarction with graded electrocardiographic stress testing, 201thallium myocardial perfusion imaging and coronary angiography to assess the role of noninvasive indices as predictors of single versus multivessel coronary artery disease. Multivessel involvement was defined angiographically as the presence of two or more major coronary arteries with at least a 70% intraluminal diameter narrowing. Multivessel disease was defined scintigraphically as the presence of stress and/or redistribution perfusion defects in the distribution of more than one coronary artery. The results of stress electrocardiography were not useful in differentiating patients with single (9/16 positive) versus multivessel (22/34 positive) disease. The degree of exercise‐induced ST‐segment depression was also not helpful. Stress 201thallium imaging did offer limited additional information with correct predictions of multivessel disease in 21 of 26 patients. Predictions of single‐vessel disease were accurate in 11 of 24 patients. Eleven of these 13 incorrect predictions of single‐vessel disease were due to the relative insensitivity of the thallium stress image to perceive defect in the anterior wall when the left anterior descending artery had significant obstruction at catheterization. Further refinements of stress perfusion imaging are needed before this method can be used to reliably separate patients with single and multivessel disease after myocardial infarction.
Reversal of left ventricular hypertrophy with captopril: Heterogeneity of response among hypertensive patients
Authors: Mujais S. K. , Fouad F. M. , Tarazi R. C. 
Published: July 2009

AbstractReversal of left ventricular hypertrophy (LVH) has been reported not to occur with all antihypertensive agents. Moreover, a dissociation between blood pressure response to medical therapy and reversal of ventricular hypertrophy has been previously observed. To evaluate the effects of captopril we studied the electrocardiographic (ECG) changes in 26 severe hypertensive patients who received the drug for more than one year. In 14 patients with normal pretreatment ECG, captopril controlled blood pressure effectively [132±2.9 (SE) to 104±3.9 mmHg, p<0.001], but had no effect on ECG voltage. In 12 patients with pretreatment LVH, two different response patterns were observed despite similar blood pressure control (144±4.9 to 102±3.1 mmHg and 148±7.3 to 109±7.3 mmHg, p<0.001 for both): seven had complete normalization of ECG while five had residual LVH pattern. No significant difference was found between the latter two groups in regard to age, sex, weight, etiology of hypertension, pretreatment ECG voltage, blood pressure, plasma renin activity, duration of treatment and duration of maintained blood pressure control. The reversal of LVH pattern occurred early (between 12 to 16 months) with no overall correlation between lowering of blood pressure and ECG voltage changes. The heterogeneity of response observed in this study suggests that factors other than blood pressure control modify the reversal of cardiac hypertrophy by antihypertensive therapy.
Endomyocardial biopsy with fluoroscopic and two‐dimensional echocardiographic guidance: Case report of a patient suspected of having multiple cardiac tumors
Authors: Copeland J. G. , Valdes‐Cruz L. , Sahn D. J. 
Published: July 2009

AbstractAn 18‐year‐old female with multiple intra‐cardiac masses was further evaluated using percutaneous endomyocardial biopsy of the right ventricle and right atrium. Fluoroscopy was used to visualize the course of the bioptome and simultaneous two‐dimensional echo‐cardiography was used to image the masses thus improving the surgeon' chance of obtaining diagnostic tissue.
Amrinone: A weaning agent in catecholamine dependence
Authors: Levene D. , Secter R. A. 
Published: July 2009

AbstractAmrinone, a new inotropic agent, has been used successfully in refractory chronic congestive heart failure. Intravenous and subsequently oral amrinone administered in a setting of acute myocardial infarction and dopamine dependence allowed the catecholamine to be successfully weaned after volume loading, digitalization and vasoconstrictors failed to terminate dopamine dependence. There was the expected fall in filling pressure and increase in cardiac index and ejection fraction. Intravenous amrinone may be tried in refractory catecholamine dependence after conventional weaning methods have failed.
The importance of pre‐ and postinfarction angina on timolol‐related reduction in mortality and reinfarction
Authors: Gundersen T. , Kjekshus J. 
Published: July 2009

AbstractThe importance of a history of angina pectoris on long‐term timolol treatment after myocardial infarction was studied with respect to mortality and reinfarction. The analyses were performed retrospectively using cohorts from the Norwegian timolol multicenter study. In patients without angina pectoris prior to the infarction, timolol treatment reduced mortality by 61 % and the occurrence of first nonfatal reinfarction by 16.9% as compared with placebo. Patients with preinfarction angina had a reduction in mortality of 21.8% and in first nonfatal reinfarction of 48.6%. The frequency of angina pectoris increased from 38% in both treatment groups before the infarction to 59% in the placebo group and 52% in the timolol group the first 6 months after the infarction. In patients without postinfarction angina pectoris, timolol treatment reduced mortality by 30.7% and the number of first nonfatal reinfarctions by 22.7%. The reductions in mortality and reinfarction in patients with postinfarction angina were 43.8% and 38.5%, respectively. Thus, the decision for timolol treatment after myocardial infarction should not be dependent on pre‐ and postinfarction angina.
Readability of literature written for cardiac patients
Authors: Conroy R. M. , Mulcahy R. 
Published: July 2009

AbstractThe readability of 28 books and leaflets available to cardiac patients at a Dublin hospital was assessed. Mean required reading age was 14.3 years, and only 21 % of the texts had a reading age of 12 or less. Fifty percent of 1088 cardiac patients attending the hospital had no more than an elementary school education and therefore would have been able to read at most one‐fifth of the available patient literature.
Early detection of diastolic impairment in long‐standing hypertension by a noninvasive volume challenge method
Authors: Marmor A. T. , Blondheim D. S. , Frankel A. , Satinger A. , Front D. 
Published: July 2009

AbstractA simple, easily reproducible, noninvasive, provocative test for the assessment of early diastolic impairment in long‐standing hypertension is presented. Volume challenge of the heart was produced by elevating the subject's legs to 45° for 5 minutes, thus increasing the venous return to the right heart. Using gated radionuclide ventriculography and Fourier analysis, the atrial structures were delineated and time‐activity curves were generated. Early diastolic emptying slope of the left atrium was used to assess left ventricular compliance changes in hypertensives. The left atrial early diastolic emptying rate was markedly reduced in 38 hypertensive patients (45.5±15.4 counts/s) when compared with 14 healthy subjects (78± 16 counts/s). The legs‐up procedure induced subsequent decrease in left atrial emptying rate in patients with long‐standing hypertension and left ventricular hypertrophy (‐27.4± 11 %). In patients with recent onset hypertension there was a depressed early diastolic emptying rate (55.79±10 counts/s), but a “normal” response to the legs‐up procedure (an increase in left atrial emptying rate: 12.84±7%). Global ejection fraction was normal in all subjects studied, decreasing after induction of augmented venous return in long‐standing hypertension. Reduction in left atrial early diastolic emptying rate, caused by the legs‐up manoeuvre appears to be an early and sensitive indicator of the left ventricular diastolic impairment in essential hypertension.
Poor responsiveness of heart rate to treadmill exercise in vasospastic angina
Authors: Sato I. , Tomobuchi Y. , Funahashi T. , Ohe T. , Kamakura S. , Matsuhisa M. , Haze K. , Shimomura K. 
Published: July 2009

AbstractHeart rate response to submaximal graded treadmill exercise was measured in 45 patients with vasospastic angina, 31 with effort angina, and 40 normal controls. There was no difference of resting heart rate among the three groups. Vasospastic angina showed significantly poor responsiveness of heart rate to exercise at every stage: stage 1, 2.5 km/h (10%), stage 3, 4.5 km/h (10%), stage 5,5.5 km/h (14%), stage 7, 5.5 km/h (22%), when compared with those in normal controls. The effort angina group also showed lower heart rates at stages 3 and 5 than those in control subjects, although their heart rate at stage 1 was not different from that in normals. When abnormal response suggesting vasospastic angina was defined as heart rate at each stage lower than values of mean heart rate ± 1 SD in normal controls, positive test results were obtained in 15 of 45 patients (33%). The use of heart rate criteria in addition to ischemic criteria raises sensitivity from 27 to 51% (p<0.02).
Chest pain and electrocardiographic ST‐segment elevation occurring in the recovery phase after exercise in a patient with normal coronary arteries
Authors: Caplin J. L. , Banim S. O. 
Published: July 2009

AbstractExercise‐induced ST‐segment elevation usually occurs in patients with coronary artery disease. We report a case in which ST‐segment elevation occurred during the recovery phase of exercise in a patient with normal coronary arteries.
Diffuse hypoplasia of the aorta as a possible cause of cardiac hypertrophy
Authors: Hada Y. , Ikeda H. , Oku J. , Goto A. , Ohya T. , Iizuka M. , Ishii M. , Sakamoto T. , Sugimoto T. 
Published: July 2009

AbstractLeft ventricular hypertrophy is caused by a wide variety of cardiovascular conditions, including systemic hypertension, aortic valvular disease, and hypertrophic cardiomyopathy. This paper describes a case of diffuse hypoplasia of the aorta in left ventricular hypertrophy. This condition has not previously been well documented. We emphasize the need for evaluation of aortic dimension when systolic hypertension and vascular bruits are observed in association with myocardial hypertrophy.
Left ventricular function after elective aneurysmectomy
Authors: Lumia F. J. , Makam S. , Macmillan R. M. , Germon P. A. , Maranhao V. , Strong M. D. 
Published: July 2009

AbstractEmploying rest and exercise first‐pass radionuclide angiography before and 3 months after surgery, we studied patients with hemodynamically stable left ventricular aneurysm (LVA) undergoing both coronary artery bypass surgery to relieve angina pectoris and elective aneurysmectomy. There were 15 patients, 14 men and 1 woman with a mean age of 54 ± 7 years. All patients had anterior and/or apical LVA. After surgery the postexercise mean left ventricular ejection fraction (LVEF) for the whole group improved significantly (p<0.004) compared with the preoperative value, but the resting LVEF did not change. The duration of exercise improved (p< 0.01) after surgery, but not the double product. However, based upon the preoperative LVEF response to exercise, two groups were seen: Group A (n=5) had ≥5% increase in their LVEF with exercise versus Group B (n=10), who had <5% increase or a decrease in their LVEF. Postoperatively, Group A decreased their LVEF with exercise and failed to improve exercise capacity or double product. Postoperatively, Group B increased the LVEF by ≥5% as well as increasing exercise capacity (p<0.01), and double product (p<0.03). Group A had lower preoperative LVEF than Group B (p<0.01) and larger LVA. Patients with hemodynamically stable LVA who require coronary artery bypass surgery for angina should not have aneurysmectomy. The presence of hemodynamically stable LVA is not a contraindication to deriving benefit from myocardial revascularization.
Mechanism underlying the absence of ischemic changes on the exercise electrocardiogram in patients with abnormal exercise thallium‐201 imaging and coronary artery disease
Authors: Coplan N. L. , Horowitz S. F. , Hoffman D. P. , Goldman M. E. , Machac J. 
Published: July 2009

AbstractPatients with coronary artery disease may have reversible abnormalities on a thallium myocardial perfusion study without simultaneous ischemic changes on the exercise electrocardiogram, but the mechanisms responsible for this disparity have not been fully elucidated. A group of 37 patients with angiographically demonstrated coronary artery disease and abnormal thallium perfusion imaging were divided into two groups on the basis of their exercise electrocardiographic ST segment response. Thirteen patients (Group A) had no significant electrocardiographic changes with exercise, while 24 patients (Group B) had ST changes consistent with ischemia during the test. There were no significant differences in clinical or angiographic characteristics between the two groups. Stress test results showed a similar mean duration of exercise in the two groups (6.2 ± 1.8 versus 6.7 ± 2.5 min, p=NS), but the patients in Group A achieved a significantly lower mean maximal heart rate (117 ± 26 versus 132 ± 21 beats/min, p<0.05) and mean maximal double product (19,650 ± 5116 versus 22,650 ± 4871, p<0.05). There was no consistent pattern of thallium perfusion abnormality noted in Group A to suggest that a particular region of electrically silent myocardium was responsible for ischemia in the absence of electrocardiographic changes. These results suggest that exercise thalliumelectrocardiogram discordance is mediated by the level of myocardial workload achieved. An abnormal perfusion scan accompanying an exercise electrocardiogram which does not demonstrate any ischemic ST change may occur when there is sufficient increase in myocardial oxygen demand to result in differential augmentation of myocardial blood flow, but insufficient imbalance of supply and demand to result in signs of ischemia on the surface electrocardiogram.
Is the blood pressure the same in both arms?
Authors: Gould B. A. , Hornung R. S. , Kleso H. A. , Altman D. G. , Raftery E. B. 
Published: July 2009

AbstractIt is generally believed that there are blood pressure differences between the right and left arms, but most of the validation studies have used nonsimultaneous measurements. It is important to know whether there is a difference, as methodological comparisons are often made using a different technique on each arm. We have measured the blood pressure simultaneously in both arms in 91 patients, using two observers and two cuffs to provide eight measurements in a fully balanced design. The mean difference in blood pressure between the arms (left/right) was ‐1.3 (SE 0.4)/1.1 (SE 0.3) mmHg. Mean differences of the same magnitude were found between the two observers, and between the cuffs. Thus, no systematic difference of any consequence was found, although individual patients had mean between‐arm differences in blood pressure of up to 10 mmHg. These results suggest that no significant bias is introduced in methodological comparisons that use both arms.
Management of the prolonged QT syndrome and recurrent ventricular fibrillation with an implantable automatic cardioverter‐defibrillator
Authors: Platia E. V. , Griffith L. S. C. , Watkins L. , Mirowski M. , Mower M. M. , Reid P. R. 
Published: July 2009

AbstractTwo patients with the prolonged QT syndrome and recurrent ventricular tachyarrhythmias are presented, one of them refractory to combination antiarrhythmic drug therapy and bilateral stellate ganglion blockade. We implanted and tested in vivo an automatic cardioverter‐defibrillator to provide a cardiac monitoring system with the capability of delivering a 25 J electrical discharge to the heart if rapid ventricular tachycardia or ventricular fibrillation is detected. Arrhythmia induction in the electrophysiology laboratory confirmed the appropriate recognition of the arrhythmias in each patient, with prompt discharge of the device and resultant termination of the tachycardias. We suggest that implantation of such a device may provide an effective adjunct to antiarrhythmic drug therapy in the management of infrequent, but potentially lethal, ventricular arrhythmias occurring in patients with the prolonged QT syndrome.
Prediction of rupture in acute myocardial infarction
Authors: Herlitz J. , Samuelsson S. O. , Richter A. , Hjalmarson Å 
Published: July 2009

AbstractIn two patient series including 809 and 327 patients, respectively, with acute myocardial infarction we have compared those who died in myocardial rupture (verified at autopsy, Group A) with those who died without rupture (autopsied, Group B), and those who survived hospitalization (Group C) with regard to previous history and clinical course in hospital. Rupture among autopsied patients was observed in 45% and 40% of the cases in the respective studies. Previous infarction was observed in each study as 0% and 0% in Group A compared with 25% and 31% in Group B, and 20% and 34% in Group C. Previous angina pectoris was observed in 26% and 22% in Group A compared with 50% and 54% in Group B and 52% and 54% in Group C. Maximum serum enzyme activity in Group A did not differ from Group B, but was higher than in Group C (p>0.001). Group A patients tended to have a higher initial pain score and a higher requirement of analgesics compared with other groups, whereas initial heart rate or systolic blood pressure did not differ in these patients compared to others. We thus conclude that patients with myocardial rupture have a very low occurrence of previous myocardial infarction and angina pectoris, and that their pain course appears to be particularly severe in the acute phase.
QT intervals as an index of high serum calcium in hypercalcemia
Authors: Saikawa T. , Tsumabuki S. , Nakagawa M. , Takakura T. , Tamura M. , Maeda T. , Ito S. , Ito M. 
Published: July 2009

AbstractThe relationship between QT interval and serum calcium concentration (s‐Ca) was examined in 9 hypercalcemic (s‐Ca > 11 mg/dl) patients. Three QT intervals corrected by Bazett's formula were used for the analysis: the intervals from the beginning of the QRS to the onset (QoTc), the apex (QaTc), and the end of T wave (QeTc). The measurements of s‐Ca and other electrolytes were made on the blood sample taken on the same day of the electrocardiogram (ECG) recordings. The normal range of s‐Ca and three QTc intervals was determined in 50 outpatients with no cardiac disease. Three QT intervals in the hypercalcemic patients were significantly shortened with a diminution in the s‐Ca. The QTc intervals showed significant negative correlation with s‐Ca. Sensitivity of QoTc, QaTc, and QeTc in predicting high s‐Ca was 83%, 57%, and 39%, respectively, and specificity was 100%, 100%, and 89%. The PQ interval tended to be prolonged in the case of hypercalcemia, but the change was statistically insignificant. These observations suggest that QT intervals can serve as an indicator of high s‐Ca and that the QoTc seems to be a good indicator of the three QTc's.
Iatrogenic cardiac tamponade after central venous catheter
Authors: Chabanier A. , Dany F. , Brutus P. , Vergnoux H. 
Published: July 2009

AbstractMyocardial perforations with a central venous catheter are rare in adults (67 cases published since 1968). These accidents are fatal in more than two‐thirds of the cases owing to confusion caused by misleading symptoms which suggest pulmonary embolism. The perforation is generally localized in the right atrium (29 cases), less frequently in the right ventricle (18 cases). The superior vena cava is rarely affected (3 cases). The site of the perforation was not found in the other published cases. Clinical symptoms are signs of tamponade with disorders of cardiac rhythm. An enlargement of the cardiac shadow and an abnormal position of the catheter, buckled or openly intrapericardial, make the diagnosis radiologically. Echocardiography provides some information, but this is often too late for practical application. The diagnosis is made with right catheterization when it shows an equalization of the diastolic pressures. This allows the patient to be watched closely following the pericardial tap, after which a surgical approach may be indicated and performed. Prevention of these iatrogenic accidents must be systematic and strictly controlled for.
Incidence of exertional right ventricular wall motion abnormalities in patients with coronary artery disease
Authors: Ratner S. J. , Friedman M. I. , Pierson R. N. , Baum M. S. , Wolinsky D. G. 
Published: July 2009

AbstractTo evaluate the role of analysis of right ventricular function with exercise in patients with presumed coronary artery disease referred for radionuclide ventriculography, the records of 55 patients referred to our laboratory over a 19‐month period were reviewed. All underwent rest and exercise first‐pass radionuclide stress testing and cardiac catheterization within a period of four months. Three groups were identified: (1) patients with normal exercise right ventricular function (n = 24); (2) patients with exercise‐induced right ventricular regional wall motion abnormalities (n = 15); and, (3) patients with abnormal resting right ventricular function without new exercise abnormalities (n = 16). Patients in each group were similar in age, sex, baseline left ventricular function, medication usage, and indication for study. The incidence of right coronary artery disease was identical in the three groups, as was the incidence of left ventricular functional abnormalities with exercise. Patients with proximal right coronary artery disease were more likely to have reduced left ventricular ejection fraction and more extensive coronary artery disease than those without disease at this site. We conclude that: (1) analysis of rest and exercise right ventricular function does not allow prediction of coronary anatomy in an unselected group of patients; (2) normal right ventricular function with exercise is compatible with extensive coronary artery disease, including proximal right coronary artery disease; and (3) abnormal exercise right ventricular function may be due to exertional left ventricular dysfunction in the absence of proximal right coronary artery disease.