bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple coronary thrombosis in a patient with thrombocytosis
Authors: Hamada Y. , Matsuda Y. , Fujil B. , Ohno H. , Takashiba K. , Ebihara H. , Hyakuna E. 
Published: August 2009

AbstractA 59‐year‐old woman was admitted with acute inferior myocardial infarction. Cardiac catheterization revealed total occlusion in the right coronary artery and thrombus‐like filling defect in the left anterior descending coronary artery. With simultaneous intracoronary urokinase infusion to the right and left coronary arteries, the right coronary artery became patent and the thrombus in the left anterior descending coronary artery was released to the distal coronary artery. Thrombocytosis was disclosed by laboratory examination. The relationship between myocardial infarction and thrombocytosis is discussed.
Reversible dilated cardiomyopathy induced by methamphetamine
Authors: Jacobs L. J. 
Published: August 2009

AbstractThis brief report details the case of a woman who was thought, after extensive evaluation, to have idiopathic congestive cardiomyopathy. It was subsequently found that systolic ventricular dysfunction was due to amphetamine abuse, and that ventricular function normalized after discontinuation of this drug.
Umbilical catheter masquerading at echocardiography as a left atrial
Authors: Crie J. S. , Hajar R. , Folger G. 
Published: August 2009

AbstractThe case of a newborn who had an umbilical catheter inserted in the intensive care unit is discussed. This catheter was meant to be inserted into the umbilical artery, but was instead inadvertently inserted into the umbilical vein. It crossed a patent foramen ovale into the left atrium. This fact was not known at the time of echocardiographic evlaluation. At echocardiography, abnormal echoes within the left atrium were seen. Findings were typical for a catheter within the heart, and the umbilical catheter was subsequently withdrawn. There is a potential for mistaking the echocardiographic findings for a left atrial abnormality and echocardiographers should be alert to this possibility.
Update on intravenous dipyridamole cardiac imaging in the assessment of ischemic heart disease
Authors: Younis L. T. , Chaitman B. R. 
Published: August 2009

AbstractIntravenous dipyridamole is a relative selective coronary vasodilator which, when combined with thallium–201, provides a useful technique to assess myocardial perfusion. The intravenous dipyridamole is administered as an infusion at a rate of 0.14 mg/kg/min for 4 minutes. In the presence of significant coronary artery disease the increase of coronary blood flow is disproportionate between vessels with and without significant coronary lesions, providing the basis for detecting regional differences in flow using thallium–201. The test can be used alone or combined with low level exercise to increase test sensitivity. The test is safe when performed under medical supervision and when patient selection is done appropriately. Most of the side effects induced by dipyridamole infusion are well tolerated by patients and readily reversed with intravenous aminophylline and sublingual nitroglycerin. The average sensitivity and specificity of the dipyridamole thallium scintigraphy test from the major studies are 76% and 70%, respectively. The test is very useful in providing prognostic information in patients who are unable to exercise. A reversible thallium defect after dipyridamole infusion has been shown to be associated with signficant mortality and morbidity in patients with documented or suspected coronary artery disease. The use of intravenous dipyridamole has been extended into other modalities of imaging, including 2–dimensional and Doppler echocardiography, to study functional changes in the left ventricular induced by the infusion of intravenous dipyridamole. Like other noninvasive tests, intravenous dipyridamole thallium scintigraphy has its own limitations, including the absence of standard physiologic data which are acquired during exercise testing, the need to stop theophylline or its derivatives 48 hours prior to testing, and a relatively low yield of ischemic electrocardiographic changes. It is anticipated that intravenous dipyridamole will soon be commercially available.
Coronary revascularization: Influence on ventricular arrhythmias
Authors: Rotman B. , Eber B. , Dusleag J. , Klein W. , Rigler B. 
Published: August 2009

AbstractMyocardial ischemia may cause severe cardiac arrhythmias. In the present study, the influence of revascularization on ventricular arrhythmias was investigated. A total of 68 patients (61 male, 7 female; mean age 53 years) with coronary artery disease was divided into three groups: Group A (21 patients) underwent percutaneous transluminal coronary angioplasty (PTCA); Group B (37 patients) had coronary artery bypass grafting (CABG); and Group C were 10 patients who served as controls, who had simple coronary angiography. All patients had a Holter ECG on the day before angiography. PTCA patients and controls were restudied on the day after the procedure, while in Group B, Holter ECG was repeated three weeks after surgery. Groups A and B were again studied 18 months after the first Holter ECG. The PTCA group showed a slight reduction in complex arrhythmias immediately following PTCA, which increased again after 18 months; the CABG group, however, revealed a significant increase in complex arrhythmias three weeks after bypass surgery, but a decrease after 18 months. There was no significant change in the control group before or after ngiography. Thus, successful revascularization has no influence on ventricular arrhythmias after 18 months.
Dipyridamole thallium imaging may not be a reliable screening test for coronary artery disease in patients undergoing vascular surgery
Authors: Marwick T. H. , Underwood D. A. 
Published: August 2009

AbstractDipyridamole thallium imaging has been proposed for cardiac risk stratification in patients undergoing peripheral vascular surgery. The purpose of this study was to define the benefit of this investigation in routine preoperative evaluation of these patients. The outcome of 86 patients undergoing vascular surgery procedures was examined in light of preoperative clinical assessment and dipyridamole SPECT thallium imaging (DST). Fifty–one patients (59%) were considered at high risk on clinical grounds, and 22 patients (26%) had perfusion defects. Ten patients suffered a perioperative coronary event, including unstable angina, myocardial infarction, or cardiac death. Seven of the patients with such events were among the 51 clinically high–risk subjects (14%). Three perioperative events occured in the group of 19 patients with positive DST images who underwent surgery (16%), but the DST test failed to identify 7 patients who suffered coronary events. The frequency of abnormal thallium imaging was similar to the prevalence of angiographically significant coronary disease reported previously at this center, but considerably less than the rate of abnormal thallium imaging in past studies of vascular surgery patients. The application of the test to a low to moderate risk population is probably responsible for its lower predictive accuracy for coronary events. DST is not an ideal routine noninvasive technique for risk stratification in patients undergoing vascular surgery.
The slope of the end–systolic pressure–volume relationship compared with the global end–systolic pressure–volume ratio in humans
Authors: Abboud L. , Sideman S. , Battler A. , Rath S. , Beyar R. 
Published: August 2009

AbstractThe slope of the end–systolic pressure–volume relationship (Emax), which is generated clinically by load manipulation, as well as the “absolute” peak systolic pressure end–systolic volume ratio (denoted as pressure–volume ratio), have been suggested as indices defining left ventricular function. This study represents an attempt to determine the relationship between these two indices by studying 20 patients (16 with coronary artery disease and 4 with normal coronary arteries) undergoing cardiac catheterization. Left ventriculography was performed three times in each patient: (1) in the control baseline state, (2) after rapid intravenous infusion of 250–300 cc of saline, and (3) after sublingual administration of 5 mg isosorbide dinitrate. Emax was approximated by linear regression using the peak left ventricular pressure (replacing endsystolic pressure) and the smallest left ventricular (endsystolic) volume for these three different loads. Actue ischemia with typical chest pain and ECG changes developed in 4 patients during saline loading. The pressure–volume ratio showed no change with load manipulation in patients who developed acute ischemia, the pressure–volume ratio dropped from 4.4±1.3 to 2.9±0.9 mmHg/ml (p < 0.001). In all of the patients, the pressure–volume ratio, but not the Emax, correlated with the ejection fraction (r = 0.6; p<0.05). In addition, the Emax line demonstrated a markedly nonphysiological Vo. There was no correlation between Emax and pressure–volume ratio. Generally, there was a significant disparity between Emax and the peak systolic pressure–volume ratio, with the latter having the advantage of simplicity, sensitivity to acute ischemia, and a correlation with the well–established EF index.
Identification of patients prone to infarct expansion by the degree of regional shape distortion on an early two–dimensional echocardiogram after myocardial infarction
Authors: Jugdutt B. J. 
Published: August 2009

AbstractEarly detection of potential expanders (patients who develop clinically significant infarct expansion with acute left ventricular (LV) dilation and failure but no necrosis) after acute myocardial infarction (AMI) is necessary in order to apply preventive therapy. To determine whether the degree of regional shape distortion (RSD), or dilatation, on early two–dimensional echocardiogram (2–D echo) after AMI can identify potential expanders, serial clinical and echocardiographic data were studied prospectively in 244 consecutive patients with a first Q–wave AMI. Initial (mean 2 days) and final (mean 10 days) two–dimensional echocardiograms were compared for regional LV asynergy, RSD, and conventional indices of expansion measured on endocardial diastolic outlines of mid–LV short–axis sections. Analysis of clinical and 2–D echo data revealed 51 expanders and 193 nonexpanders. Expanders showed greater LV dysfunction and more inhospital deaths (27% vs. 8%, p<0.001) compared with nonexpanders; conventional indices of expansion showed more marked increase between initial and final two–dimensional echo in expanders, but initial indices were not predictive. In contrast, the new RSD index Pk, a measure of the outward bulge, was markedly greater in expanders than nonexpanders on both initial (16.5 vs. 2.4 mm, p<0.001) and final echo. Furthermore, expanders with ≥ 30% increase in Pk (to 21 mm) developed rupture of the ventricular septum (n=10) or free wall (n=2). Also 50 of 51 expanders compared with 3 of 193 nonexpanders had a Pk ≥ 10 mm on the initial echo. A simpler index, the depth of RSD (rd), provided similar discrimination as Pk. Thus, the degree of diastolic RSD on an early 2–D echo after AMI can identify potential expanders.
Atrial pacing for sick sinus syndrome
Authors: Rosenqvist M. 
Published: August 2009

AbstractAtrial pacing is the most physiological way to pace patients with sinus node disease, as it provides both AV synchrony and a normal ventricular activation pattern. Long–term studies comparing atrial and ventricular pacing imply that atrial pacing results in fewer cardiac complications and, possibly, reduced mortality. Ventricular pacing should thus, if possible, be avoided in patients with sinus node disease. The potential risk of impending high–grade AV block during atrial pacing is low, with an annual incidence around 1% if patients are selected appropriately. Approximately 40–50% of patients with sinus node disease show signs of chronotropic incompentence during physical exercise, and are thus candidates for atrial rate responsive pacing. A preoperative evaluation of candidates for atrial pacing should include longterm Holter/telemetry, exercise test, carotid sinus stimulation, and an electrophysiological study excluding significant AV conduction disturbances.
Coronary occlusion: Cause or consequence of acute myocardial infarction?
Authors: Baroldi G. , Marzilli M. , L'Abbate A. , Arbustini E. 
Published: August 2009

AbstractA 45–year–old man with unstable angina developed persistent ECG changes of myocardial ischemia during coronary angiography. Occlusion of the left anterior descending branch (LAD) was documented 20 minutes after these changes. Intracoronary nitrate, Ca antagonist, urokinase, removal by percutaneous transluminal coronary angioplasty (PTCA) of atherosclerotic obstructions, and emergency bypass surgery failed to restore myocardial perfusion. Only short periods of reflow were obtained by urokinase and PTCA. The repeated coronary injections demonstrated a progressive disappearance of the left anterior descending artery (LAD) starting from the distal portion and progressing retrogradely up to the origin of the vessel. The patient developed a transmural anterolateral myocardial infarction and 12 months later underwent cardiac transplantation for untractable failure. His heart was examined and the infarct confirmed. Analysis of this case suggests that coronary occlusion in acute myocardial infarction can be an event secondary to increased intramyocardial resistance rather than the cause of reduced coronary blood flow in subepicardial coronary arteries.
Coronary artery spasm during cardiac angiography
Authors: Satoh A. , Matsuda Y. , Sakai H. , Nakatsuka M. , Ogawa H. , Katayama K. , Fujii T. , Moritani K. , Kusukawa R. 
Published: August 2009

AbstractUnexpected occurrence of coronary artery spasm is sometimes observed during cardiac catheterization. We report here two cases of coronary artery spasm with hypotension and urticaria subsequent to administration of contrast material. The etiology of coronary artery spasm is discussed.
Future directions in plasminogen activator therapy
Authors: Bode  , Runge M. S. , Haber E. 
Published: August 2009

AbstractThrombotic disorders such as myocardial and stroke are the leading causes of death and dis in industrialized nations. Timely institution of therapy can achieve a reduction of infarct, a preservation of left ventricular function, and a in mortality. The administration of streptokinase, and acylated plasminogen‐streptokinase acti‐ complex (APSAC) can be associated with a complete breakdown of the hemostatic system. Tissue‐type activator (t‐PA) and single‐chain urokinase‐ plasmiogen activator (scu‐PA, prourokinase) are fibrin specific; however, at the large dosages of ac‐ needed for therapeutic efficacy, bleeding compli‐ are still a problem. New approaches to optimizing the risk/benefit ratio for the patient by improving without sacrificing specificity include the use of combinations of plasminogen activators, of t‐PA and scu‐PA, chimeric molecules, and ‐targeted thrombolytic agents. The last approach the possibility of targeting several different com‐ of the clot with either fibrinolytic or antiplatelet functions in one optimized molecule.
Primary pulmonary hypertension in adults
Authors: Hawkins J. W. , Dunn M. I. 
Published: August 2009

AbstractPrimary pulmonary hypertension is an enigmatic disease found predominantly in young women, but it also affects a significant number of middle‐aged and elderly males and females. Its onset, characterized by progressively worsening dyspnea, fatigue, and chest pain, is insidious. Three distinct histopathologic subtypes have been identified, and the natural history of the disease process has been well‐defined. Pharmacologic treatment options have, in general, been disappointing, and it appears that heart‐lung transplantation will be applied only to a small minority of young patients with primary pulmonary hypertension in the near future. We review the histopathology, evaluation, treatment, and prognosis of primary pulmonary hypertension.
Thrombolytic therapy for acute myocardial infarction: Evaluation of a selective approach to invasive diagnosis and therapy in a community hospital
Authors: Burks J. M. , Kirby J. C. , Keating E. C. , Calder J. R. 
Published: August 2009

AbstractTo investigate the effectiveness of selective catheterization and revascularization after thrombolytic therapy for myocardial infarction, we studied the early and late clinical course of 100 consecutive patients treated with streptokinase and an intensive medical regimen. Catheterization was performed because of recurrent angina or evidence for reperfusion and myocardial salvage. Fifty‐six patients were catheterized, and 37 underwent revascularization. Hospital mortality was 8%. Among the 92 hospital survivors, after 1 year follow‐up there was no significant difference between the revascularized and nonrevascularized groups in total survival (97% and 100%, respectively) or in infarct‐free survival (97% and 95%, respectively). During total follow‐up of 34 (±13) months, late clinical events (death, reinfarction, late revascularization, and severe angina) occurred in 16% of 37 revascularized patients and in 27% of 55 patients not revascularized (p=0.31). Cumulative hospital and late survival for the entire group was 91% at 1 year and 86% at final evaluation. Excellent long‐term survival and a low incidence of recurrent infarction may be achieved after thrombolytic therapy, using selective catheterization and revascularization based on widely available clinical estimates of further ischemic risk.
Malignant restenosis after primary successful excimer laser coronary angioplasty
Authors: Buchwald A. , Werner G. , Unterberg C. , Wiegand V. , Voth A. 
Published: August 2009

AbstractIn a series of 20 coronary excimer laser, two patients presented with a peculiar type malignant restenosis 6 and 8 weeks after a successful angioplasty procedure. One patient had a successful of an occluded left anterior descending (LAD) coronary artery and the second patient had a successful angioplasty of a subtotal proximal stenosis of the left anterior descending coronary artery. After the procedure, no ischemia could be demonstrated by exercise ECG and thallium scintigraphy. Both patients were free of angina until the sudden development of nocturnal anginaseveral hours before reangiography, which showed subtotal restenosis in both cases. One patient had a mammaria graft on the LAD and the second patient underwent a successful balloon angioplasty. This uncommon sudden and malignant development of restenosis seems to be related to the excimer laser angioplasty procedure and warrants some caution with the indiscriminative use of this new angioplasty procedure.
Percutaneous transluminal angioplasty in patients ≥ 5 years after their last coronary bypass graft surgery
Authors: Dorros G. , Lewin R. F. , Mathiak L. 
Published: August 2009

AbstractAngioplasty (PTCA) was successfully performed in 257 of 304 patients (85%) ≥ 5 years after their last bypass surgery. A lesion was successfully dilated in 496 of 566 vessels attempted (88%): 332/386 coronary arteries (86%) and 164/180 vein grafts (91%). Significant complications included: 8 (2.6%) mortalities, 4 (1.3%) emergency surgeries, 13 (4.3%) Q‐wave myocardial infarctions, and 14 (4.6%) distal embolizations. Distal embolization occurred in 13/180 (7%) vein graft lesions dilated and usually resulted in a non‐Q‐wave infarction (4/13 distal embolizations). A second PTCA was performed on 89 (35%) patients: 44% of them had lesion recurrence; 20% a new lesion requiring dilatation; and 30% both recurrence and new lesion. Follow‐up (mean 3.7 years) revealed 78% of patients having an improved anginal status, and 58% no angina. The cumulative probability of survival at 60 months was 88± 3%. Angioplasty can be effectively employed in patients ≥ 5 years remote from their last bypass surgery in native arteries or saphenous vein grafts with good procedural and long‐term success. Vein graft age inherently does not appear to be a contraindication to angioplasty.
Energy‐conserving programming of vvi pacemakers: A telemetry‐supported, long‐term, follow‐up study
Authors: Klein H. H. , Knake W. 
Published: August 2009

AbstractThirty patients with VVI pacemakers (Quantum 253‐09, 253‐19, Intermedics Inc., Freeport, TX) were observed for a mean of 65 months. Within 12 months after implantation, optimized output programming was performed in 29 patients. This included a decrease in pulse amplitude (22 patients), pulse width (4 patients), and/or pacing rate (11 patients). After 65 months postimplantation, telemetered battery voltage and battery impedance were compared with the predicted values expected when the pulse generator constantly stimulates at nominal program conditions (heart rate 72.3 beats/min, pulse amplitude 5.4 V, pulse width 0.61 ms). Instead of an expected cell voltage of 2.6 V and a cell impedance of 10 kΩ mean telemetered values amounted to 2.78 V and 1.4 kΩ, respectively. These data correspond to a battery age of 12‐15 months at nominal program conditions. This longterm follow‐up study suggests that adequate programming will extend battery longevity and thus pulse generator survival in many patients.
Chronic vasodilator therapy with flosequinan in congestive heart failure
Authors: Hass G. J. , Binkley P. E. , Leier C. V. 
Published: August 2009

AbstractThis study was conducted to determine the long‐term effect of flosequinan, a new orally administered arterial and venous dilator, on the clinical course of patients with moderate to severe congestive heart failure. Seventeen patients on chronic digitalis and diuretic therapy were randomized to receive either flosequinan (n = 9) or placebo (n = 8) in a double‐blind fashion. Changes in symptomatology, exercise performance, and left ventricular function were assessed serially during the two‐month treatment period. During the course of therapy, a modest improvement in the symptom scores and functional classification of the flosequinan‐treated patients was observed. Flosequinan evoked a significant increase in maximal exercise capacity. While long‐term flosequinan administration also effected a progressive increase in resting heart rate, it did not consistently improve indices of left ventricular systolic function. The addition of chronic vasodilator therapy with flosequinan to standard digitalis—diuretic regimens is capable of inducing clinical improvement in patients with moderate to severe chronic heart failure. Trials involving larger patient populations will be necessary to confirm the results of this preliminary study and to determine the extent of clinical improvement, subpopulations benefited, role in heart failure therapeutics, and so forth.
Biophysical and anatomical considerations for safe and efficacious catheter ablation of arrhythmias
Authors: Bardy G. H. , Sawyer P. L. 
Published: August 2009

AbstractThe development of catheter ablation techniques for therapy of cardiac arrhythmias continues to evolve. Although many patients have benefited from catheter ablation procedures, failure to ablate the arrhythmogenic substrate and complications from the pulse used in these procedures remain too frequent occurrences. The purpose of this review is to focus on these problems of inefficacy and safety with attention directed to the role various direct current and radiofrequency pulses have had in the genesis of these difficulties.