bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved diagnosis and characterization of postinfarction left ventricular pseudoaneurysm by cardiac magnetic resonance imaging
Authors: Harrity P. , Subramanian R. , Patel A. , Blanco J. 
Published: February 2009

AbstractA patient with a ruptured left ventricular pseudoaneurysm complicating an acute posteroinferior myocardial infarction is described. Left ventricular pseudoaneurysms are a rare complication of acute myocardial infarction, usually occurring with inferior and/or posterior infarction. In contrast to true aneurysms, pseudoaneurysms are much more likely to rupture, regardless of size, causing hemopericardium and death. Therefore, once the diagnosis has been confirmed, prompt surgical resection is the current accepted treatment. The most accurate noninvasive diagnostic method has been echocardiography, with recent reports suggesting improved diagnosis with color flow Doppler echocardiography. Ventriculography confirms the diagnosis with more accurate anatomic detail, but is an invasive procedure. In our patient, two‐dimensional and color Doppler echocardiography could not demonstrate the suspected pseudoaneurysm, which was demonstrated by ventriculography. However, magnetic resonance imaging (MRI) demonstrated the pseudoaneurysm, showing detailed anatomy not obvious on ventriculography. Before surgery could be performed, the patient died and was autopsied. Heart sections corresponding to MRI planes confirmed the MRI findings. A review of the literature has revealed no similar reports using MRI in the diagnosis of postinfarction pseudoaneurysms. Major advantages of MRI are generation of three‐dimensional soft tissue images non‐invasively, and generation of tissue contrast by rapid imaging sequences, obviating the need for contrast injection. Major disadvantages of MRI are the high cost of instrumentation, nonportability, and a requirement for patient immobility during the study. In cases of suspected pseudoaneurysm with equivocal echocardiography findings, MRI could provide early diagnosis, leading to early surgical intervention and increased patient survival.
Thrombolytic therapy in acute myocardial infarction following prolonged cardiopulmonary resuscitation
Authors: Neches Richard B. , Goldfarb Andrew M. , Saviano George J. 
Published: February 2009

AbstractThrombolytic therapy was administered to a 49‐year‐old woman with an acute anterior wall myocardial infarction after having prolonged cardiopulmonary resuscitation for 13 minutes. On admission, there was no clinical or radiographic evidence of gross trauma. There was no significant morbidity and the patient recovered to a completely functional status. The literature of thrombolytic therapy after cardiopulmonary resuscitation is reviewed. In the absence of gross trauma from cardiopulmonary resuscitation, thrombolytic therapy in acute myocardial infarction should not necessarily be excluded because of the duration of resuscitation. Further experience with such patients will shed additional light on efficacy and safety.
Effects of sublingual nitroglycerin in patients receiving transdermal nitroglycerin for coronary artery disease: Prevention of cross‐tolerance
Authors: Naito Hidetoshi , Mastsuda, Yasuo , Yorozu, Tadao , Shiomi, Kohtaro , Maeda, Toshiaki , Seki, Kohzabro , Tada, Toshihiko , Fujii, Hideo 
Published: February 2009

AbstractThe systemic hemodynamic and coronary dilative responses to sublingual nitroglycerin were studied in patients receiving transdermal nitroglycerin. A total of 48 patients with coronary artery disease were divided into 4 groups: 12 patients receiving 1 tablet of sublingual nitroglycerin without transdermal nitroglycerin (Group 1), 12 patients receiving 1 tablet of sublingual nitroglycerin with 12‐hour‐daily intermittent therapy of transdermal nitroglycerin (Group 2), 12 patients receiving 1 tablet of sublingual nitroglycerin with continuous therapy of transdermal nitroglycerin (Group 3), and 12 patients receiving 2 tablets of sublingual nitroglycerin with continuous therapy of transdermal nitroglycerin (Group 4). Before and during administration of sublingual nitroglycerin, aortic pressure, left ventricular pressure, and coronary artery diameter were examined at diagnostic cardiac catheterization in all patients. During sublingual nitroglycerin, the decreases of aortic systolic pressure and left ventricular end‐diastolic pressure were greater in Group 1, 2, and 4 than in Group 3. Dilation of coronary arteries by sublingual nitroglyerin tended to be greater in Group 1, 2, and 4 than in Group 3. Thus, the effects of sublingual nitroglycerin for the relief of ischemia might be more prominent in patients with intermittent therapy of transdermal nitroglycerin than in those with continuous therapy. The increased dose of sublingual nitroglycerin for the relief of ischemia might be more effective in patients with continuous therapy of transdermal nitroglycerin.
A large‐scale trial of captopril for mild to moderate heart failure in the primary care setting
Authors: Dibianco, Robert 
Published: February 2009

AbstractA large‐scale, prospective, 8‐week, office‐based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (<70 years vs. <70 years), duration of heart failure (<1 year vs. >1 year), presence of digoxin treatment, or the dosing schedule employed. This large study showed that use of captopril in mild to moderate heart failure in the primary care setting has a favorable risk‐benefit profile and is associated with meaningful improvements in clinical status and functional capacity.
Electrophysiologic effects of blocking and stimulating the opioid system in patients with unexplained heart palpitations
Authors: Markiewicz K. , Kuś W. , Cholewa M. , Bubinński R. 
Published: February 2009

AbstractThe opioid system plays a role in the regulation of the cardiovascular system. Endogenic as well as egzogenic administration of opioids influences the heart rhythm. This work was undertaken in order to assess the influence of crossover activity of the heart opioid system on the heart conduction system in patients with various disturbances of rhythm having an efficient circulatory system and a normal 12‐lead stationary ECG. Subjects were 20 patients (9 men and 11 women of mean age of 38.7 years) reporting sudden heart palpitations. They were subjected to invasive programmable electrophysiological studies (PES). Naloxone was administered intravenously to 10 patients. Pentazocine was administered in the same way. In the remaining 10 patients the order of drug administration was reversed. PES was done in the basic state and after the administration of each drug. Study results were subjected to statistical analysis with no‐parameter Wilcoxon test assuming differences to be significant at p<0.05. Blocking of the opioid system resulted in significant lengthening of the sinoatrial (SACT), intra‐atrial (PA), and atrioventricular node (AH) conduction times, while no changes were induced in conduction in the His‐Purkinje system (HV) and automation of the sinus node. Naloxone lengthened the atrial (ERPA) and atrioventricular node (ERPA AVN) effective refractory periods. Stimulation of the opioid system resulted in decreases of the following values: SACT, PA, AH, ERPA, ERPA AVN, while no effect was exerted on the SNRT, HV, ERPV. Neither drug influenced the QRS time, although naloxone lengthened QTCperiod significantly. Opioids did not influence the time of conduction in concealed extranodal atrioventricular pathways. Results of the studies suggest that the opioid system has a significant influence on electrophysiological properties of the proximal part of the heart conduction system—blocking the opioid system renders the conduction difficult, while stimulating favors it.
Calcium antagonists in cardiology: Update on sustained‐release drug delivery systems
Authors: Michelson Eric L. 
Published: February 2009

AbstractOne limitation of standard oral formulations of calcium antagonists has been the need for multiple daily dosing. Sustained‐release dosage forms permit simpler regimens and a smoother therapeutic effect. Differences in drug pharmacokinetic and pharmacodynamic properties have led to development of several sustained‐release delivery systems. Three major types are available: the osmotic pump, coated pellet, and slow‐dissolving material released from a matrix. Each is currently utilized with specific calcium antagonists. The osmotic pump system with nifedipine (Procardia XL, Pfizer) allows once‐daily dosing as well as improvements in certain side effects. Verapamil is available in formulations employing dissimilar release systems. The original sustained‐action products (Calan SR, Searle; Isoptin SR, Knoll) utilize a matrix system; a subsequent product (Verelan; Lederle, Wyeth‐Ayerst, A. H. Robins) utilizes timed‐release pellets. Importantly, clinical efficacy appears to be maintained with these several drugs and formulations for their approved indications. Although a specific formulation may alter the absorption, metabolism, excretion, and blood levels of a drug, it does not alter basic drug properties. Thus, the major impact of sustained‐release drug delivery system lies in potential compliance improvement and possible reduction of side effects related to serum drug profiles.
Serial echocardiographic studies following thrombolytic treatment in myocardial infarction with special reference to the atrioventricular valve plane displacement
Authors: Alam Mahbubul , Höglund Christer 
Published: February 2009

AbstractEchocardiographic recording of the atrioventricular (AV) valve plane displacement was used for serial studies of left ventricular (LV) function in 27 patients with first‐time acute myocardial infarction (MI) treated with a thrombolytic agent within 4 h of the onset of symptoms and showing noninvasive signs of early reperfusion. The recordings were made immediately before or during thrombolytic therapy and 24 h, 1 week, 1 month, and 2 months after attempted reperfusion. Regional LV function was assessed by recording the amplitude of systolic descent of the AV plane toward the apex at 4 different sites on left ventricle corresponding to the septal, anterior, lateral, and posterior walls from apical 4‐ and 2‐chamber views. Global LV function was assessed using the mean value of the AV plane displacement from the above 4 sites (AV mean). In 15 patients with anterior MI, the displacement at the septum and anterior wall was significantly decreased compared with the posterior and lateral walls at baseline. The displacement had increased significantly after 1 week, 1 month, and 2 months (p<0.01, p<0.01, andp<0.001). The AV mean also increased significantly (p<0.01) during the study period. A corresponding regional increase was observed in inferior MI. The AV mean remained unchanged, however, during the follow‐up period. It is concluded that the easy visualization and the simplicity of recording the AV plane displacement makes the method a valuable noninvasive tool for serial echocardiographic studies following acute MI treated with a thrombolytic agent.
Fibroelastic papilloma arising in a chiari network
Authors: Waller Bruce , Wasdahl Daniel A. , Wasdahl Walter A. , Edwards William D. 
Published: February 2009

AbstractThe occurrence of fibroelastic papilloma arising in a Chiari network in an 85‐year‐old man is described. Occurrence of this tumor in this location has not been previously reported, and should be added to the differential diagnosis of intracardiac masses arising in the right atrium.
Encainide dosing in patients with severe renal dysfunction: Report of a case and literature review
Authors: Fronc Henry , Stephen Porter R. , Nydegger Charles C. , Hessen Scott E. , Kutalek Steven P. 
Published: February 2009

AbstractDosage of encainide for patients with lethal ventricular arrhythmias is based on pharmacodynamic effects and efficacy of arrhythmia suppression, coupled with metabolizer phenotype and extent of renal and hepatic dysfunction. Decreased clearance in patients with renal dysfunction necessitates a reduction in dosage to avoid toxic and dose‐related proarrhythmic effects. This case represents a patient with severe renal dysfunction and sustained ventricular tachycardia who achieved electrophysiologically guided suppression of induced ventricular tachycardia at a steady‐state encainide dose of only 25 mg daily, significantly lower than package insert or compendial recommendations for initial dosage in patients with renal insufficiency. Documented “therapeutic” metabolite concentrations correlated to electrophysiologic response. Literature review illustrates the complexity of encainide dosage in such individuals and underscores the need for therapeutic drug monitoring to individualize dosage.
Predictors of spontaneous predischarge ischemia following acute myocardial infarction
Authors: Piérard Luc A. , Albert Adelin , Kulbertus Henri E. 
Published: February 2009

AbstractTo determine if the occurrence and the consequences of spontaneous predischarge postinfarction ischemia could be predicted early after hospital admission, a consecutive series of patients with acute myocardial infarction was studied and followed for 3 years. No patient was treated by thrombolysis. Spontaneous predischarge ischemia was defined as angina that occurred at rest before hospital discharge, at least 3 days after the acute event, and that was accompanied by electrocardiographic changes, but not by an increase in cardiac enzymes. Patients who died within the first 3 days were excluded from analysis. Among the 943 patients who survived at least 3 days, 165 (17.5%) had spontaneous ischemia before discharge. They had a higher 1‐year post‐hospital mortality (16 vs. 10%), but did not have significantly higher total 3‐year mortality rates. Four independent, early available variables predictive of the occurrence of spontaneous ischemia were selected from a stepwise logistic discriminant analysis: history of angina before infarction, non‐Q‐wave infarct, absence of smoking, and higher age. Among the 165 patients with spontaneous ischemia, 3 independent variables predictive of 3‐year mortality were selected stepwise: left ventricular function score, history of previous infarction, and absence of smoking.
Improved neurological outcome following early anatomical correction of transposition of the great arteries
Authors: Veelken N. , Grävinghoff L. , Keck E.W. , Freitag H.J. 
Published: February 2009

AbstractThe incidence of neurological residuals following anatomical correction of transposition of the great arteries (d‐TGA) has not been described so far. Clinical examination, EEG recordings, and computed tomography (CT) scans were carried out in a consecutive series of 38 children with d‐TGA surviving anatomic corrective surgery. The patients were classified into one of three groups according to the type of operation: 15 patients after two‐stage approach (TSA) (Stage 1: pulmonary artery banding + aortopulmonary shunt; Stage 2: anatomic correction); 12 patients with primary anatomic correction within the first 2 weeks of life (early switch, ES); 11 patients with primary anatomic correction later in infancy (later switch, LS). In 26 patients (68%) we found no abnormalities on neurologic examination, CT scan, or EEG. Four patients suffered from spastic hemiplegia, 3 of these had cortical brain damage visible on CT scan, and 3 had focal epilepsy as well. In 2 otherwise clinical normal patients cortical infarction could be seen on a CT scan. Thus, in 5 cases (13% of 38 patients) cerebral infarcts were diagnosed by CT scan. The cortical vascular infarction was seen in 4 patients after TSA and in 1 after LS. In 6 patients we found other neurological abnormalities. Early anatomic correction in patients with d‐TGA reduces the risk of cortical vascular infarction.
Propionibacterium acnes prosthetic valve endocarditis: A case of severe aortic insufficiency
Authors: Lazar Jason M. , Schulman Douglas S. 
Published: February 2009

AbstractPropionibacterium acnes rarely causes systemic disease. Few cases of P. acnes endocarditis have been reported. This report describes a 63‐year‐old man who presented with severe congestive heart failure. He had prosthetic valve endocarditis which resulted in severe acute aortic insufficiency. During surgery he was found to have complete disruption of the aorta and left ventricle with a false aneurysm encompassing the circumference of the aortic annulus. Cultures of the valve grew P. acnes. Thus, although P. acnes is a rare cause of endocarditis, it may pursue a very aggressive course, especially in the setting of a prosthetic valve.
Pericardial tamponade in juvenile dermatomyositis
Authors: Pereira Rosa Maria R. , Lerner Sergey , Maeda Wilma T. , Goldenstein‐Schainberg Claudia , Cossermelli Wilson 
Published: February 2009

AbstractCardiac involvement in dermatomyositis has been well described; myocarditis and cardiac arrhythmias are the most frequent manifestations. An 8‐year‐old girl is presented, who developed pericardial tamponade in the course of the disease. It is the first time this association has been reported.
Coronary thrombosis postpartum in a young woman with still' disease
Authors: Parry Gareth , Goudevenos John , Williams David O. 
Published: February 2009

AbstractA young woman with Still' disease sustained a small myocardial infarction 12 weeks after the delivery of a healthy male infant. This pregnancy was complicated by late onset proteinuric hypertension. Coronary angiography nine days after infarction revealed intracoronary thrombus which had resolved by 3 months with antithrombotic therapy. The angiographic appearances at 3 months suggested that a local vasculitis may have been the precipitating cause.
A critical appraisal of indications for the implantable cardioverter defibrillator (ICD)
Authors: Cannom David S. 
Published: February 2009

AbstractThe implantable cardioverter defibrillator (ICD) is a remarkably effective therapy for reducing sudden cardiac death in patients with malignant ventricular arrhythmias. The indications for implantation of the ICD were approved in 1985 by the United States Food and Drug Administration; it could be implanted in patients who have experienced cardiac arrest or in those with recurrent ventricular arrhythmias which are not suppressed by antiarrhythmic drugs in the electrophysiology laboratory. These established indications have not changed in the last seven years. In the near future, the release of third‐generation ICDs (with antitachycardia pacing) will likely further expand indications for the device. Many patients with stable ventricular tachycardia who have not had syncope or cardiac arrest will receive a third‐generation defibrillator. Also, three clinical trials now in progress—CABG‐PATCH, Multicenter Automatic Defibrillator Implantation Trial (MADIT) and Multicenter Unsustained Tachycardia Trial (MUSTT)—are studying “pre‐event” patients with low ejection fraction and electrical instability; some of the patients in each trial are being prospectively randomized to the ICD. Within the next five years we will have a better understanding of the role of ICD therapy in such patients. Until these studies are completed, it is important that the indications for the ICD not be expanded.
The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis
Authors: Stoddard Marcus F. , Liddell Norman E. , Korfhage Linda , Arce Javier , Kupersmith Joel 
Published: February 2009

AbstractWe report a case of left atrial myxoma simulating a thrombus on transthoracic echocardiography, but correctly diagnosed using transesophageal echocardiography. As this tumor is usually fatal unless surgically resected, a correct diagnosis is essential. Myxomas which do not prolapse between the mitral valve leaflets and coexist with mitral stenosis may be difficult to diagnose accurately using transthoracic echocardiography. The advantages of transesophageal compared with transthoracic echocardiography in the diagnosis of nonclassical left atrial myxoma are discussed.
The value and promise of echocardiography in acute myocardial infarction and coronary artery disease
Authors: Katz Alan S. , Harrigan Pamela , Parisi Alfred F. 
Published: February 2009

AbstractTwo‐dimensional and Doppler echocardiography have become extremely useful in the management of patients with acute myocardial infarction (AMI). Echocardiography is noninvasive, relatively inexpensive, and has no known biohazards. It offers unequaled information about cardiac anatomy and function. In the acute setting it is useful in the diagnosis of AMI and its complications. It is an excellent tool for monitoring therapy. Echocardiography has been shown to be useful in risk stratification upon presentation to the emergency ward and prior to hospital discharge. Stress echocardiography has broadened and sharpened the diagnostic and prognostic information. Contrast echocardiography has promise for demonstrating coronary artery flow. Research in ultrasonic myocardial tissue characterization shows potential for differentiating ischemic myocardium from infarcted myocardium. Thus, echocardiography is likely to become increasingly important in the future management of patients with AMI.