bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unstable angina pectoris
Authors: Wallace W. A. , Richeson J. F. , Yu P. N. 
Published: August 2009

AbstractThe pathophysiology of unstable angina has been better elucidated in the past five years and has led to more rational therapy. Coronary arteries in patients with unstable angina have atherosclerotic plaques which are often complex and are the site of platelet activation and fibrin deposition. Nitrates, one of the oldest therapies, are efficacious and act not only by dilating coronary vessels but by reducing preload and afterload. Beta blockers have a salutary effect by decreasing myocardial oxygen demand. Calcium channel blockers attenuate smooth muscle contraction and thereby act to decrease coronary artery spasm. Beta blockers and calcium channel blockers are equally efficacious in unstable angina. The antiplatelet agent, aspirin, has been shown to reduce fatal or nonfatal myocardial infarction and probably overall mortality. The use of heparin acutely for unstable angina has been demonstrated to decrease refractory angina and myocardial infarction, and acutely is probably better than aspirin. For patients with reduced ejection fractions (0.30‐0.49), a prospective randomized trial has shown that coronary artery bypass graft surgery offers an improved three‐year survival compared with medical therapy; however, surgery does not prevent myocadial infarction. Percutaneous transluminal coronary angioplasty may be a reasonable therapeutic alternative for some patients with single‐vessel disease who are refractory to medical therapy but there are as yet no controlled trials of this question. To date a clinical benefit from thrombolytic therapy has not been demonstrated.
Does intensive medical therapy influence the outcome in unstable angina?
Authors: Mulcahy R. , Conroy R. , Katz R. , Fitzpatrick M. 
Published: August 2009

AbstractThree hundred and forty‐six patients of all ages and both sexes were admitted to coronary care with documented unstable angina. Management was conservative, without the routine use of beta‐blockers or calcium antagonists. Mortality was 3.2%, and the nonfatal myocardial infarction rate was 10.1% during the first 28 days. After one year, coronary mortality was 10.5% with a non‐fatal infarction rate of 13.1%. Twenty‐six patients were subjected to coronary artery bypass surgery, eleven during the first 28 days and fifteen subsequently. No patient underwent coronary angioplasty. The factors influencing immediate and long‐term prognosis in these patients were studied. Persistence of pain in hospital, previous chronic angina, and age had an adverse effect on outcome.A total of 143 patients complained of persistent pain lasting for 24 hours or more. The use of beta blockers or calcium antagonists in patients with persistent pain exceeding five days did not appear to influence outcome. The current widespread adherence to “intensive medical treatment,” including the routine use of beta blockers and calcium antagonists, is questioned.
Temperature monitoring during peripheral thermo‐optical laser recanalization in humans
Authors: Barbeau G. R. , Abela G. S. , Friedl S. E. , Tomaru T. , Giacomino P. P. , Seeger J. M. 
Published: August 2009

AbstractTo determine probe temperature required to achieve laser thermal recanalization of human peripheral arteries, temperature was monitored at the probe tip using a K‐type thermocouple and displayed on a computer screen in real‐time in 21 procedures. Recanalization was performed using a Spectraprobe‐PLR delivering both laser light and heat in patients with prolonged ischemic limb symptoms. Laser recanalization of totally occluded peripheral arteries (occlusion length = 5.3 ± 3.8 cm) was done percutaneously (17 procedures) or intraoperatively (4 procedures), after unsuccessful attempts of recanalization using standard guide wire and balloon angioplasty techniques. Probes were activated using argon laser irradiation starting at 5 W and increased by 1‐W increments until successful recanalization, or up to a maximum of 12 W. Laser recanalization was achieved in 16/21 (76%) procedures at a mean temperature of 178±120° (range 64–503°) and a mean time of 12.4±14.1 s. Eleven of the 16 (69%) recanalizations occurred at probe temperature lower than 160°. Recanalization was achieved at a mean power of 7±2 W. Perforation occurred in 6 arteries at peak probe temperatures ranging from 73 to 502°. Perforations occurred in 4 of 6 densely calcific vessels which required high probe temperatures (>250°). An important feature of temperature monitoring was the immediate detection of probe dysfunction. Although recanalization temperature had a wide range, the majority of recanalizations occurred at probe temperature below 160°. Initial use of low laser power irradiation and low temperature with incremental rises seems to be a rational strategy when attempting recanalization of totally occluded peripheral arteries. Perhaps this strategy will prevent complications related to high probe temperature.
Late potentials recording with a precordial signal‐averaged electrocardiogram in 53 consecutive patients with a first acute myocardial infarction: Incidence and early natural history
Authors: Strasberg B. , Abboud S. , Kusniec J. , Sclarovsky S. , Agmon J. 
Published: August 2009

AbstractSignal‐averaged electrocardiograms were obtained in 53 consecutive patients with a first acute myocardial infarction (AMI) who survived the first 10 days of hospitalization. The recording was performed twice, at Day 1 and at Day 10 of hospitalization, in patients without bundle‐branch block and who did not receive antiarrhythmic therapy. Signal‐averaged ECGs were obtained with an instrument which analyzes the presence of late potentials (LP) in each individual precordial lead. There were 41 men and 12 women, mean age of 67 years. On Day 1, three patients had L.P (5.6%). On Day 10, LP was recorded in 11 patients (21%). In only one patient was LP transient. Patients who developed LP by Day 10 (absent in Day 1) had statistically significant lower root mean square (rms) voltage and higher QRS duration than patients who did not develop LP on Day 10. In conclusion, in patients with a first AMI who survive the initial hospitalization period and are not in need of antiarrhythmic therapy have an incidence of LP of 21%. A predischarge recording is preferable since this will maximize the chances of detecting LP.
Ergonovine maleate test detects anginal patients with poorly reproducible exercise tests
Authors: Brunelli C. , Spallarossa P. , Ghigliotti G. , Lantieri P. , Iannetti M. , Caponnetto S. 
Published: August 2009

AbstractThe aim of the study is to evaluate the reproductability of exercise testing and to determine whether there any correlation between the reproducibility of exercise and response to the ergonovine maleate test. Thirty‐ patients with mixed angina and documented artery disease underwent an ergonovine maleate test four exercise tests on consecutive days in the same conditions. The ergonovine test was positive in 20 patients (Group I) and negative in 18 patients (Group II). There were no significant differences in the clinical and angiographic data of the two groups. All 152 exercise tests were positive. The variability of the response of the repeated tests was assessed by means of an analysis of the following parameters: heart rate, blood pressure, rate‐pressure product, watts, and minutes were recorded at the onset of ischemia (ST| ≥ 0.1 mV). Range (maximal‐minimal obtained value), ratio between range and maximal obtained value, and coefficient of variation (standard deviation/mean of the four parameters) were calculated for each patient. The analysis of these values demonstrated that while the test was reproducible in some patients, a high individual variability was present in others. Moreover, the individual variability results were higher in Group I than in Group II, with a statistically significant difference for all considered parameters. In conclusion, it is possible to have a poorly reproducible exercise test in patients with mixed angina. The correlation between a positive ergonovine test and a poorly reporducible exercise test suggests that abnormal coronary vasomotion may sometimes be present during exercise and may affect the reproducibility of the test.
Quinidine treatment of chronic lone atrial fibrillation
Authors: De Noouer C. , Sparling C. M. 
Published: August 2009

AbstractPatients with chronic lone atrial fibrillation (LAF) were treated with quinidine according to a special schedule to establish sinus rhythm and prevent recurrences. Twenty‐seven patients following this schedule were identified retrospectively to prevent relapses, quinidine had been continued in 25 patients in doses 100 mg qid lower than those used for conversion. In 8 of the latter group, quinidine had to be discontinued or reduced. All patients converted to sinus rhythm. If well tolerated, quinidine prevented recurrence of LAF in 75% of those on long‐term (mean follow ‐ up 3.5 years) prophylaxis. After discontinuation of quinidine in 8 patients, LAF recurred in all but one patient. Side effects were observed in 22% of the patients and precluded continuation of the prophylaxis in 15%. No incidence of torsade de pointes was encountered.
Doppler assessment of interventricular pressure gradient across isolated ventricular septal defect
Authors: Garg A. , Shrivastava S. , Radhakrishanan S. , Dev V. , Saxena A. 
Published: August 2009

AbstractContinuous wave Doppler ultrasound was used to estimate the pressure gradient between the right and left ventricle for assessment of pulmonary arterial systolic pressure in 30 patients with isolated ventricular septal defect and for subsequent comparison with similar data obtained on cardiac catheterization. The age of the patients ranged from 8 months to 45 years (6.8± 8.6 years).No Patient had right or left ventricular outflow tract obstruction. Doppler measurements were done within 24 h of cardiac catheterization. Pressure gradient across ventricular septal defect on cardiac catheterization ranged from 7 to 95 mmHg (48 ± 24 mmHg) and that on Doppler assessment ranged from 8 to 78 mmHg (42 ± 20 mmHg).Doppler measurements of interventricular pressure gradient correlated well with those obtained on cardiac catheterization (r=0.90, P<0.001). Correlation was better in patients with pressure gradient across ventricular septal defect <075 mmHg (r=0.96). Correlation was poor in three of five patients with very small ventricular septal defects (interventricular pressure gradient >75 mmHg) because the jet used was not ideal. Thus continuous wave Doppler ultrasound is an accurate noninvasive means of measuring pressure gradient across ventricular septal defect, which is a useful parameter for assessment of pulmonary artery systolic pressure in patients with isolated ventricular septal defect without right and left ventricular outflow tract obstruction.
Frequency analysis of the first heart sound for patients on chronic hemodialysis
Authors: Ishizuka T. , Furuya N. 
Published: August 2009

AbstractAccording to Adolph et al., valuable information on the nature of myocardium can be obtained through frequency analysis of first heart sounds (SI) during the isometric contraction phase (ICP). We compared dominant frequencies (DF), which were defined as the frequency of maximum sound voltage, of SI among 37 outpatients undergoing chronic hemodialysis (HD group) and 28 outpatients with neurosis (control group). Heart sounds, which were obtained at apex by a sound microphone and polygraph, were analyzed into frequency spectra by the maximum entropy method through a computer. Left ventricular dimensions and wall thickness were measured by echocardiography. Histories of hemodialysis ranged from 4 to 164 months, with an average of 54 months. Age and body weight of patients before each hemodialysis were comparable with control subjects. Although systolic blood pressure, left ventricular mass (LVM), and combined left ventricular mass (CLVM), which means LVM and the blood it contains, showed higher values in the HD group, the ratio of LVM and CLVM and ejection fraction were almost equal in both groups. Therefore, if elastic tissue of myocardium of HD patients is less, lower DF is expected. However, DFs were 22.6 ± 7.8 Hz in the HD group and 22.6±9.6 Hz in the control group. It was concluded that (1) hypertension and overhydration were not primary causes of uremic cardiomyopathy, and (2) myocardium of HD patients received no significant damage if cardiac function remained intact, even through left ventricular hypertrophy and dilatation were induced.
Do antiarrhythmic drugs work? some reflections on the implications of the cardiac arrhythmia suppression trial
Authors: Singh B. N. 
Published: August 2009

AbstractDespite major advances in our understanding of the mechanisms of cardiac arrhythmias and how antiarrhythmic drugs appear to work, there remains much doubt whether these agents reduce arrhythmic mortality except in certain subsets of patients. The results of the Cardiac Arrhythmia Suppression Trial (CAST) have indicated that certain antiarrhythmic drugs not only “fail to work” but may substantially increase mortality. The effects of Class Ic agents in CAST and the meta‐analysis of randomized antiarrhythmic trials in the survivors of acute infarction suggest that drugs that act primarily by delaying conduction are particularly deleterious in the survivors of acute infarction. Whether these data have a wide applicability in terms of all ventricular arrhythmias is unclear, but beta‐blockers remain the only class of agents that in control trials have been shown to reduce sudden death. The effect appears to be related to beta‐blockade and not to suppression of premature ventricular contractions (PVCs). Beta blockers appear to act by preventing ventricular fibrillation. It is reasonable to assume that PVC suppression per se is unlikely to produce a reduction in sudden death. Uncontrolled data with amiodarone suggests that it has the potential to prolong survival by controlling arrhythmias. The effects of amiodarone and beta blockers, both significantly attenuating adrenergic stimulation, provide pharmacologic probes to define the crucial determinants of efficacy of a compound for mortality reduction in high risk survivors of myocardial infarction. The focus must now shift from antiectopic and antiarrhythmic agents that delay conduction to those that exert antifibrillatory actions by sympathetic antagonism and those that exhibit the added property of lengthening myocardial refractoriness.
Left ventricular free wall rupture following acute myocardial infarction and cardiac amyloid
Authors: Shirani J. , Bonin M. A. , Gould N. , Silver M. A. 
Published: August 2009

AbstractA 74‐year‐old man died of left ventricular free wall rupture 6 days following an acute inferoposterior wall myocardial infarction. His hospital course was complicated by pump failure which proved resistant to inotropic support, diuresis, and percutaneous transluminal coronary angioplasty. At necropsy, extensive amyloid deposition was noted. This case constitutes an unusual clinical setting for myocardial rupture because of the severity of systolic left ventricular dysfunction as well as cardiac amyloidosis.
A case of biopsy‐proven myocarditis progressing to autopsy‐proven dilated cardiomyopathy
Authors: Matoba Y. , Matsumori A. , Ohtani H. , Tominaga M. , Fujiwara H. , Kawai C. , Toyokuni S. , Midorikawa O. , Takahashi K. 
Published: August 2009

AbstractA 22‐year‐old man presented with congestive heart failure following flulike symptoms. The diagnosis of acute myocarditis was confirmed by endomyocardial biopsy, which revealed mild infiltration of inflammatory cells. A favorable response to beta‐adrenergic receptor blockade was seen, and the patient was discharged without symptoms. Five months later, however, congestive heart failure recurred, and intracardiac thrombi were demonstrated. The patient died after two months. Postmortem examination revealed left ventricular dilatation with slight interstitial fibrosis; the diagnosis was dilated cardiomyopathy. Thus, progression of biopsy‐proven myocarditis to dilated cardiomyopathy 10 months after the onset of disease was documented.
Ventricular tachycardia and ventricular aneurysm due to unrecognized sarcoidosis
Authors: Jain A. , Starek P. J. K. , Delany D. L. 
Published: August 2009

AbstractCardiac involvement due to sarcoidosis is well recognized. Arrhythmias have been recognized in up to 50% of patients who have cardiac involvement. We report on two patients with no systemic manifestations of sarcoidosis who presented with refractory ventricular tachycardia. Evaluation demonstrated atypical left ventricular “aneurysms” with normal coronary arteries. Surgical pathology demonstrated granulomas consistent with sarcoidosis. Despite extensive surgical resection, they continued to have symptomatic ventricular tachycardia requiring implantation of a defibrillator. Recognition of sarcoidosis as an etiology for ventricular tachycardia and aneurysm is important for possible avoidance of surgery.
Nitroglycerin‐induced hypotension, bradycardia, and asystole: Report of a case and review of the literature
Authors: Brandes W. , Santiago T. , Limacher M. 
Published: August 2009

AbstractA 36‐year‐old man presented with a prolonged history of chest pain, and was given two sublingual nitroglycerin tablets. Subsequently, the patient became hypotensive, bradycardic, apneic, and lost consciousness. The bradycardia resolved spontaneously. No evidence for acute myocardial infarction or ischemic disease was found. Thirty‐four cases reported to date are reviewed, demonstrating that this response appears to be an independent effect of nitroglycerin taken in any form, in patients with and without myocardial infarction and to be unpredictable, especially without evidence of inferior or right ventricular infarction. Careful monitoring is warranted when administering nitroglycerin.
Role of lipoprotein peroxidation in the pathogenesis of atherosclerosis
Authors: Steinbrecher P. 
Published: August 2009

AbstractOxidative modification of low‐density lipoprotein (LDL) has been shown to alter its properties in a way that tends to increase its atherogencity. Cultured arterial endothelial cells and smooth muscle cells can promote LDL oxidation in vitro. Several recent studies have provided evidence for the presence of oxidized LDL in atherosclerotic lesions. Furthermore, treatment of atherosclerosisprone rabbits with an antioxidant was found to slow the progression of aortic lesions. Additional experimental work is required to determine if LDL oxidation is indeed an important causal step in atherogenesis in humans, but the preliminary data are encouraging and offer the potential for a new approach to the prevention and therapy of atherosclerosis.
The underlying coronary lesion in myocardial infarction: Implications f coronary angiography
Authors: Little William C. , Downes Thomas R. , Applegate Robert J. 
Published: August 2009

AbstractMyocardial infarction is usually caused by sudden thrombotic occulusion of a coronary artery at the site of a fissured atherosclerotic plaque. Recent evidence suggests that coronary angiography may be insensitive in detecting and quantitaing atherosclerosis. Serial angiographic studies demonstrate that the majority of myocardial infarctions occur due to occlusion of arteries that previously did not contain angiographically significant (>50%) stenoses. Similarly, quantitative angiography performed after thrombolytic therapy indicates that the coronary lesion underlying the clot is frequently not severely stenotic. Thus, an angiographically apparent stenosis is not necessary for the development of a thrombotic occlusion resulting in an MI. These observations suggest that coronary angiography does not accurately predict the site of a subsequent, occlusion that will produce a myocardial infarction.
Prognosis in acute myocardial infarction in relation to development of Q waves
Authors: Karlson Biorn W. , Herlitz Johan , Richter Arina , Hjalmarson Åke 
Published: August 2009

AbstractIn a totally nonselected group of patients with acute myocardial infarction (AMI) (n=921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non‐Q‐wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty‐two percent had AMI without new Q waves. Patients with a non‐Q‐wave AMI differed from patients with Q‐wave AMI, more frequently having a previous history of AMI (p<0.001), angina pectoris (p<0.01), diabetes mellitus (p<0.05), congestive heart failure (p<0.001), and a higher mean age (p<0.001), whereas smoking was more common in Q‐wave AMI. Patients with non‐Q‐wave AMI had a 1‐year mortality of 31% compared with 26% in Q‐wave AMI (p>0.2) and a reinfarction rate of 20% compared with 12% for Q‐wave AMI (p<0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1‐year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non‐Q‐wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow‐up is not associated with development of Q waves.
Different hemodynamic (24‐h ambulatory blood pressure monitoring) and renin‐inhibiting effect of a 1‐week treatment with enalapril and lisinopril
Authors: Cocco G. , Hari J. 
Published: August 2009

AbstractAmbulatory blood pressure and heart rate monitoring were used for comparing the antihypertensive effect of a 1‐week treatment with enalapril and lisinopril 10 mg once daily (double‐blind crossover placebo‐controlled study). Twelve outpatients with mild to moderate hypertension were treated. Both drugs had a significant and identical hypotensive effect. Neither drug affected the diurnal rhythm of blood pressure or heart rate. Therefore the two drugs are equipotent antihypertensive agents. Both drugs inhibited ACE activity to a highly significant extent, but in this regard lisinopril was more effective than enalapril. However, lisinopril's greater ACE inhibition was not accompanied by a greater hypotensive effect. The clinical value of this difference is not yet established.
Painless myocardial ischemia in elderly patients compared with middle‐aged patients and its relation to treadmill testing and coronary hemodynamics
Authors: Kurita Akira , Takase Bonpei , Uehata Akimi , Maruyama Toshiharu , Nishioka Toshihiko , Sugahara Hiroko , Mizuno Kyoichi , Isojima Kazushige , Satomura Kimio 
Published: August 2009

AbstractWe compared painless ST‐segment depression (1 mm ≥ 80 ms and lasting ≥ 60 s) in elderly patients with coronary artery disease (≥ 65 years, mean 67 years; n = 22) and that of middle‐aged patients (<60 years, mean 54 years; n = 20) by Holter monitoring for 24 hours to determine the relationship between episodes of painless myocardial ischemia, findings of treadmill testing, and coronary hemodynamics. Coronary arteriographic findings (Gensini score) and ejection fraction (EF) did not differ between the two groups. Painless ST‐segment depression was found to be 77% in the older age group versus 45% in the middle‐aged group (p<0.05). However, treadmill exercise score, ST‐segment depression, and ST‐segment integral achieved did not differ significantly between the two groups. Within 2 weeks after the above testing, coronary hemodynamic study was performed. The increment of coronary sinus flow in the older age group was 1.4±0.3 versus 1.8±0.3 in the middle‐aged group (p<0.05), and the change of lactate extraction ratio from the basal condition in the older age group was −50±40% versus −2±15% in the middle‐aged group (p<0.05). We conclude that episodes of painless myocardial ischemia in elderly patients with aging may be associated with the impairment of the coronary vascular reserve and easier anaerobic myocardial metabolism by pacing stress despite similar findings of coronary artery disease and EF in both groups.