bluuebunny/crossref_metadata_2025_split huggingface dataset:
EKG screening program for school athletes
Authors: Lacorte M. A. , Boxer R. A. , Gottesfeld I. B. , Singh S. , Strong M. , Mandell L. 
Published: August 2009

AbstractHypertrophic cardiomyopathy is the most common cardiovascular cause of sudden death in adolescent athletes. The electrocardiogram is abnormal in more than 90% of these individuals. An EKG screening program was developed in order to ascertain the role of the electrocardiogram in identifying athletes at risk for sudden death. A training program was created to instruct school nurses on how to perform electrocardiograms. A questionnaire/consent from was sent to the parents of the athletes. This form asked basic questions concerning the child's past medical history and family history. The electrocardiograms were interpreted by staff pediatric cardiologists. A total of 1,424 students, ages 13 to 18, had 12‐lead electrocardiograms performed. In 88.8% the electrocardiogram was normal and the health screening questionnaire revealed no abnormalities in family or personal medical history. In 6.5% of the students, the family history or screening blood pressure recording justified further evaluation. In 72 students abnormalities on the electrocardiogram were noted (5.1%). There were 87 abnormalities noted in the 72 students. Conduction disturbances and arrhythmias were the most common abnormalities noted. In 12 students evidence of ventricular hypertrophy was found. Echocardiograms and stress tests were normal in these individuals. No student was found to have hypertrophic myopathy and no student was restricted from participating in competitive athletic activities. Despite the apparent negative results of this program there were benefits of the screening project. The program resulted in a closer working relationship between school health officials and a major health care facility. The program also served as a useful teaching tool for the school nurses. The screening electrocardiogram also provided a measure of reassurance to families of youngsters participating in competitive athletics. The authors believe an EKG screening program for school athletes is a useful endeavor.
Hyperthyroid‐induced atrial flutter‐fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol
Authors: Talley J. D. , Wathen M. S. , Hurst J. W. 
Published: August 2009

AbstractAtrial fibrillation due to hyperthyroidism is characterized by a rapid ventricular reponse which is typically resistant to digoxin therapy. We report a patient with flutter‐fibrillation who developed cyclic sinus node dysfunction with profound ventricular pauses in response small doses of digoxin, verapamil, and propranolol, which resolved with discontinuation of the medications. Caution is necessary to avoid paradoxical ventricular when treating hyperthyroid‐induced atrial fibrillation.
Myxomatous mitral valve degeneration complicating asymptomatic cor triatriatum
Authors: Wong C.‐K. , Leung W. H. , Cheng C. H. , Lau C. P. , Cheung D. L. C. 
Published: August 2009

AbstractCor triatriatum presenting in adulthood is extremely rare. This paper reports a case of cor triatriatum initially masquerading as mitral stenosis, which was later complicated by myxomatous mitral valve degeneration with severe regurgitation, which necessitated mitral valvular replacement. To the authors' knowledge, such a combination has not been reported in the literature.
Atrial pacing and thallium‐201 scintigraphy in patients with chest pain: Correlation with coronary anatomy
Authors: Stratmann H. G. , Mark A. L. , Walter K. E. , Williams G. A. 
Published: August 2009

AbstractAtrial pacing and thallium‐201 scintigraphy were performed in 72 patients referred for evaluation of chest pain. Coronary artery disease (CAD) was present in 63 patients, as documented by cardiac catheterization performed at the same time or within 2 months of atrial pacing. Nine patients had no or insignificant (< 50% stenosis) CAD. The sensitivity of pacing‐induced angina for CAD was 51%, and was 49% for ST depression. Specificities were 89% and 78%, respectively. A reversible perfusion defect was seen in 54% of patients with CAD (specificity 89%), and a fixed defect in 29% (specificity 100%). The sensitivity of an abnormal thallium‐201 scan (one or more reversible or fixed defects) was 79% (p < 0.05 compared to angina or ST depression). Combined sensitivity of ST depression and/or an abnormal thallium‐201 scan was 87%. There were no significant changes in any of these sensitivities as the number of vessels with CAD increased. Thallium‐201 scintigraphy correctly identified 11 of 19 (58%) patients with single‐vessel disease as having CAD in only one vessel, but underestimated the extent of disease in all but a few patients with multivessel disease. The sensitivity of perfusion imaging to identify lesions in specific vessels ranged from 27% (circumflex) to 57% (right coronary artery). Specificities were 100% for circumflex, 78% for anterior descending, and 83% for right coronary artery lesions. The sensitivity of a reversible defect or an abnormal thallium‐201 scan did not change significantly as the degree of stenosis in the vessel perfusing a myocardial segment increased, nor did it differ between lesions involving the proximal or nonproximal segments of a vessel. Fixed perfusion defects were significantly more frequent in segments perfused by occluded vessels than those with subtotal stenoses. Addition of thallium‐201 scintigraphy to the atrial pacing test increases sensitivity for detection of CAD. The test is limited, however, in its ability to define the extent or severity of CAD, or to identify specific vessels with CAD.
Diagnostic value of atrial pacing and thallium‐201 scintigraphy for the assessment of patients with chest pain
Authors: Stratmann H. G. , Mark A. L. , Walter K. E. , Williams G. A. 
Published: August 2009

AbstractAtrial pacing was performed either alone (n = 23) or in combination with thallium‐201 scintigraphy (n = 113) in 136 patients referred for evaluation of chest pain. The presence of coronary artery disease (CAD) was excluded by cardiac catheterization in 12 patients and confirmed in 124. Both pacing‐induced ST depression and angina had sensitivities of 48% for CAD; specificities were 75% and 83%, respectively. An abnormal thallium‐201 scan (one or more reversible and/or fixed perfusion defects) was seen in 72% of patients with CAD (specificity 83%), and fixed defects in 36% (specificity 100%). Pacing was associated with either ST depression or an abnormal perfusion scan in 81% of patients (specificity 67%). There were no significant differences in the results of atria pacing or thallium‐201 scintigraphy in patients with or without a history of myocardial infarction, or in those with or without previous coronary artery bypass surgery. Pacing‐induced ST depression, or both ST depression and a reversible perfusion defect occurred significantly less frequently in patients with peripheral vascular disease than in those without this diagnosis (p <.05). With only one exception, there were no significant differences in the sensitivities of any indicators of ischemia (ST depression, angina, or perfusion scans), either individually or in combination, as the peak pacing rate or double product achieved increased. Patients paced to maximum double products in excess of 26,000 beats‐mmHg/min had a significantly increased incidence of ischemic ST depression compared to those paced to lower double products (p <.05). We conclude that atrial pacing and thallium‐201 scintigraphy, when used together, are useful for evaluating selected patients with chest pain for the presence of CAD.
Sudden cardiac death after aortic valve surgery: Incidence and concomitant factors
Authors: Föppl M. , Hoffmann A. , Amann F. W. , Roth J. , Stulz P. , Hasse J. , Grádel E. , Burckhardt D. 
Published: August 2009

AbstractA retrospective analysis of 599 consecutive patients after aortic valve surgery aged 7‐82 years (mean 56) was performed. During a follow‐up of 1‐14 years (mean 4.7 years) a 4‐week perioperative mortality of 6.9% and a late annual mortality of 3.6% were observed. Sudden cardiac death was the most frequent single cause of death, accounting for 24% of all deaths. Patients dying suddenly were younger than patients dying from other causes (51 ± 17 vs. 59 ± 14 years, p<0.05) and showed more left ventricular hypertrophy by electrocardiographic criteria when compared with matched survivors (mean Estes score 5.2 ± 2.4 vs. 2.8 ± 1.9; p<0.01) and with patients dying nonsuddenly (mean Estes score 5.2 ± 2.4 vs. 1.8 ± 1.8; p<0.01). Ventricular premature beats in the resting electrocardiogram were more prevalent in patients dying suddenly than in matched survivors (55 vs. 20%; p<0.025) as well as in patients dying from other causes (55 vs. 25%; p<0.05). In addition, there were more intracardiac conduction disturbances and more ungrafted coronary vessels with insignificant stenoses at the time of surgery in sudden death patients. Our findings suggest that after aortic valve replacement patients with left ventricular hypertrophy, bundle‐branch block, and ventricular premature beats in the resting electrocardiogram are at increased risk for sudden cardiac death. A possible etiological role of concomitant coronary artery disease must be considered.
Exercise‐induced pulmonary blood volume changes and diastolic dysfunction of the aged heart
Authors: Alexopoulos D. , Machac J. , Arora R. R. , Horowitz S. F. 
Published: August 2009

AbstractImpaired diastolic function has been described in healthy elderly subjects. Pulmonary blood volume (PBV) changes with exercise have been associated with left ventricular dysfunction, but not directly related to diastolic abnormalities. Exercise‐induced relative changes in PBV were measured using gated blood pool imaging with count density comparisons over the lung in 20 healthy volunteers: 13 elderly, age 76 ± 5 years and seven young, age 27 ± 4 years. Serial (first exercise stage, peak exercise, and post exercise) PBV ratios were measured and correlated to peak early filling rate, peak late filling rate, and percent atrial filling obtained from the resting left ventricular timeactivity curve analysis. PBV ratios tended to be higher in elderly subjects, but reached significance only at the first stage of exercise (1.04 ± 0.07 vs. 0.93 ± 0.10, p<0.01). Significant correlations were found between PBV rations at first exercise stage and peak early filling rate (r= −0.64), peak late filling rate (r = 0.47), and percent atrial filling (r = 0.48). A significant correlation was found between PBV changes at peak exercise and resting diastolic parameters. Exercise‐induced PBV changes are associated with left ventricular diastolic dysfunction at rest. Diastolic abnormalities of the aged heart may explain the differential PBV response early into exercise between young and elderly healthy subjects.
Hemodynamic effects of continuous infusion of AR‐C 239 in left ventricular failure
Authors: Colle J. P. , Besse P. 
Published: August 2009

AbstractAR‐C 239 is a new specific alpha1 antagonist drug with an action similar to that of prazosin. In dogs it appears to be specific for the alpha1 adrenoreceptor. AR‐C 239 was tested in 11 patients (49 ± 11 years old) with left heart failure, who had not received any previous treatment. The drug was infused intravenously with a stepwise increase in dose, producing three stable plasma concentration plateaus: 10 ± 2, 51 ± 3, and 138 ± 55 ng/ml. Hemodynamic data were collected at time T0 before drug infusion, and half‐way through each infusion. Blood pressures and cardiac output were recorded using a Millar microtip manometer (left ventricle), a Swan‐Ganz catheter (pulmonary artery), and a femoral catheter, connected to a Syscomoram computer system which calculated the following parameters: work, resistances, tension—time index and contractility indices. Left ventricular ejection fraction and volumes were obtained from cineangiograms performed 30 min before drug infusion and at the end of the third infusion plateau. AR‐C 239 produces a dose‐dependent fall in systemic blood pressure (r=0.539, n=33, p<.001). Maximal beneficial effects are reached with the second infusion dose with a dramatic fall in systemic (peripheral) resistance (−30±21%, p±0.01), accompained by a decrease in pulmonary resistance (−22±24%, p<.05), leading to a drop in the tension‐time index (−22±16%, p<.01), a fall in LV filling pressure (−17±8%, p<.001), and an improvement in cardiac index (+20±18%, p<.02). Apart from a reflex‐related increase in heart rate (14±10%, p<.01), the drug does not affect contractility indices such as extrapolated Vmax. No adverse reactions were noted during the experiment. AR‐C 239 appears to be a powerful vasodilator via selective alpha1‐adrenoreceptor blockade. Its good tolerance together with the large range of available dose concentrations indicate that this drug could be useful in the acute management of left heart failure.
Long QT syndrome associated with inflammatory degeneration of the stel ganglia
Authors: Pfeiffer D. , Fiehring H. , Rostock K. J. , Rathgen K. , Henkel H. G. 
Published: August 2009

AbstractA well‐studied case of intermittent long QT syndrome in a 21‐year‐old female is presented. Electrophysiologic investigation repeated three times revealed changing sinoatrial and atrioventricular dysfunction and nonsustained ventricular tachycardia. The patient died 29 months after first hospitalization in a stage of electromechanical dissociation after runs of torsade de pointes although she had been treated with repeated anti‐inflammatory therapy as well as high doeses of propranolol. Postmortem examination demonstrated active inflammation of stellate ganglia. Myocardium appeared normal.
Lower than conventional doses of captopril in the initiation of converting enzyme inhibition in patients with severe congestive heart failure
Authors: Scott R. A. , Barnett D. B. 
Published: August 2009

AbstractAngiotensin converting enzyme (ACE) inhibitors are effective long‐term therapy for congestive heart failure, improving symptoms, exercise tolerance, biochemical anomalies, and mortality. Captopril, in doses of up to 150 mg daily is relatively free of serious adverse effects. A test dose of 6.25 mg normally precedes regular therapy in an attempt to avoid first‐dose hypotension which may also be prevented by reduction in diuretic dosage and by the avoidance of overdiuresis leading to volume depletion. We report two patients who, despite the above precautions developed symptomatic first‐dose hypotension with 6.25 mg, but were subsequently able to recommence captopril therapy by the initial oral administration of doses as low as 1 mg.
The cardiovascular abnormalities associated with duplicated segments of chromosome 7
Authors: Talley J. D. , Click L. A. , Dooley K. J. , Tuboku‐Metzger A. , Burgess G. H. , Wilcox W. D. , Blackston R. D. 
Published: August 2009

Abstractcongenital heart disease is an integral part of many genetic syndromes such as the major trisomies 13, 18, and 21. Little information, however, is available with reference to the incidence of cardiac anomalies in the trisomy 7 syndromes. Two patients with partial trisomy 7q, one of whom had congenital heart disease, are presented. A reviews of the literature reveals incomplete description of the cardiovascular abnormalities in the majority of case reports of patients with this syndrome, however, when described it appears that there are no specific defects associated with trisomy 7p and 7q, but only an increased frequency of occurrence. Further clinical and postmortem data regarding details of the congenital heart defects associated with trisomy 7 is requried to confirm this preliminary observation.
Dynamic cardiomyoplasty for treatment of heart failure
Authors: Hill A. B. , Chiu R. C‐J. 
Published: August 2009

AbstractDynamic cardiomyoplasty is a new surgical procedure proposed for treatment of the failing heart. Clinically, the latissimus dorsi muscle is raised as a pedicled flap and wrapped around the heart. The skeletal muscle is transformed to produce a myocardium‐like fatigueresistant muscle. It is stimulated to contract in synchrony with the heart in hope of assisting the myocardial contraction. An R‐wave synchronous pacemaker provides a pulse‐train form of stimulation to simulate, for the skeletal muscle, the contractile characteristics of the myocardial syncytium. We have undertaken a critical review of the clinical results of dynamic cardiomyoplasty reported to date. Objective evidence of clinical improvement after dynamic cardiomyoplasty resulting from the contractile assistance of the myoplasty has been modest. Many of the beneficial results reported could be explained by concomitant procedures done, such as aneurysmectomy or coronary artery bypass grafting. Hemodynamic studies have failed to demonstrate consistent and convincing improvement as a result of the cardiomyoplasty stimulation. We have, however, identified an interesting subgroup of patients, in whom a striking hemodynamic response to cardiomyoplasty stimulation has been reported. These patients all possess large resting heart volumes characteristic of dilated cardiomyopathy. Thus, case selection may ultimately be one of the most important factors in determining the success of dynamic cardiomyoplasty for the treatment of heart failure.
A multicenter randomized trial of ionic (ioxaglate) and nonionic (iopamidol) low‐osmolality contrast agents in cardiac angiography
Authors: Klinke W. P. , Grace M. , Miller R. , Naqvi S. Z. , Roth D. , Roy L. 
Published: August 2009

AbstractA multicentered double‐blind randomized study was performed comparing the electrocardiographic and hemodynamic changes induced by two new low osmolar contrast agents used for cardiac angiography. The low osmolar ionic (ioxaglate) contrast agent was compared with a low osmolar nonionic (iopamidol) contrast agent in 150 patients with angina pectoris undergoing angiography. Systolic blood pressure, left ventricular enddiastolic pressure, heart rate, and QT interval were measured just before and for 90s following the left ventricular angiography and selective coronary angiography. Each group was also evaluated for adverse events and quality of radiographic images. Following left ventricular angiography, the systolic blood pressure dropped slightly in both groups with a greater decrease seen in the iopamidol group at 5 s (p<0.05). After selective right and left coronary angiography, systolic blood pressure decreased transiently and equally in both treatment groups. The left ventricular end‐diastolic pressure increased after the ventriculogram in both groups (15.9±6.3 to 18.9±8.6 mmHg in the ioxaglate group and 16.1±6.7 to 20.1±7.8 mmHg in the iopamidol group), the change being significant only in the iopamidol group (p<0.05). Heart rate increased slightly but significantly in the ioxaglate‐treated patients following left ventricular angiography (71.4±15.2 to 74.4±13.7 beats/min) (p<0.01). QT interval transiently increased following left ventriculography with ioxaglate (407±59.5 to 420±58.3 ms) (p<0.05) compared with iopamidol. Following coronary angiography the QT interval increased transiently but significantly in the ioxaglate group compared to iopamidol (p<0.05) for right coronary artery, p<0.01 for left coronary artery). However, no significant change from baseline was observed at 90 s. No significant change in QT interval or heart rate was seen with iopamidol‐treated patients. Side effects were infrequent in both groups. Nausea was more frequent with ioxaglate injection than with iopamidol (10 patients versus 1 patient) (p<0.01) as was hives (8 patients versus 1 patient) (p<0.05). No severe life‐threatening adverse effects occurred. There was no difference in the quality of radiographic images obtained with either contrast agent. Electrocardiographic and hemodynamic changes are minimal with both contrast agents and no clinically important changes were seen with either group. In conclusion, both low osmolar contrast agents are safe for use in cardiac angiography although the incidence of nausea and hives occurs more frequently with the use of ioxaglate.
Systolic tricuspid leaflet prolapse in asymptomatic young men
Authors: Froom P. , Ribak J. , Shochat I. , Tamir A. , Krivisky M. , Lewis B. S. 
Published: August 2009

AbstractThe degree of systolic movement of the tricuspid valve (TV) leaflets was measureds in 100 consecutive apparently healthy men 18‐20 years old at the time of maximum posterosuperior motion toward or into the right atrium. Backward bowing of >0.20 mm2 of the anterior leaflet, and >0.15 mm2 of either the posterior or septal leaflets beyond the plane of the tricuspid annulus was found in 5% or less of the cohort irrespective of the echocardiographic view in which it was recorded. The upper 5% of these young men had >0.80 mm2 of backward bowing when the leaflet motion was summed from all three views. The anterior leaflet demonstrated more bowing than either the septal or posterior leaflets. The systolic TV prolapse area correlated highly with the degree of mitral leaflet prolapse (r=0.654, p<0.001). We conclude that there is a wide continuous spectrum of tricuspid valve leaflet prolapse area in healthy young men. This quantitative approach may help standardize the echocardiographic evaluation of tricuspid leaflet motion.
Sudden coronary death
Authors: Warnes C. A. 
Published: August 2009

AbstractMany reports have described the amounts of atherosclerotic plaque in victims of sudden coronary death, defining the number of coronary arteries narrowed at some point > 75% in cross‐sectional area (XSA). In order to quantitate more precisely the amount and distribution of plaque, 70 victims of sudden coronary death aged 22‐81 years (mean 50) were studied. The four major epicardial coronary arteries (left main, left anterior descending, left circumflex, and right) from each of 70 victims were cut into 5‐mm segments (average 50 per patient) and a histologic section prepared from each segment. The amount of lumnial narrowing by plaque was categorized into five groups (0‐25%, 26‐50%, 51‐75%, 76‐95%, 96‐100%). Of 3,484 five‐mm segments, 950 (27%) were narrowed 76‐100% in XSA. Comparison of 31 previously symptomatic victims (angina pectoris and/or myocardial infarction) to 39 victims who had been asymptomatic disclosed a higher mean percent of severely narrowed segments (30% vs. 25%, p = <0.005) and a lower mean percent of minimally narrowed segments in the symptomatic group. Comparison of the 31 patients with a healed myocardial infarction at necropsy with 39 patients with no left ventricular scar disclosed a higher mean percent of segments severely narrowed (33% vs. 24%, p = <0.001) and a lower mean percent of segments narrowed minimally in those with a left ventricular scar (13% vs. 26%, p= <0.001). Those patients with higher heart weights (>450 grams) compared with those with lower heart weights had a higher mean percent of segments severely narrowed (23% vs. 19%, p = <0.01) and a lower percent of minimally narrowed segments (24% vs. 29%, p = <0.005) in the large heart group. Patients in each decade had similar mean percents of severely narrowed segments. Thirteen patients had a coronary artery thrombus, and in each the thrombus occurred at a site narrowed >50% by plaque. Seven patients had disrupted fibrocellular caps at the site of thrombus, and the role of “plaque fissuring” is examined.