bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suspect myocardial infarction: Hospital management and prognosis
Authors: Morris A. L. , Reimer J. 
Published: February 2009

AbstractThe management of 442 consecutive patients admitted for suspect acute myocardial infarction (AMI) was compared at two urban hospitals. The community hospital utilized an unmonitored observation unit (OU) more frequently than did the university hospital (39% vs. 9%, respectively). Progression to acute myocardial infarction (AMI) occurred in 25% of admissions, 5‐7% of whom died. Mortality without AMI was rare. Availability of the OU appeared to result in reduced coronary care unit (CCU) utilization and in shorter hospital stays for low‐risk patients who comprised fully 37% of hospital admissions. Low‐ and high‐risk subgroups (12% vs. 34% risk of AMI) were identified by normal versus abnormal admission electrocardiograms (EKG). Two‐thirds of the low‐risk patients with AMI were diagnosed by the next hospital day. A normal EKG on both the day of admission and on the second hospital day identified a population with less than 1% risk of in‐hospital AMI. The increased use of non‐CCU facilities for many ?MI patients appears to be appropriate. However, only randomized allocation trials, which were never performed for patients with definite AMI, would establish the relative efficacy of CCU versus non‐CCU treatment.
Safety and effectiveness of a portable external automatic defibrillator‐pacemaker
Authors: Rozkovec A. , Crossley J. , Walesby R. , Fox K. M. , Maseri A. 
Published: February 2009

AbstractSudden cardiac death in the community can be reduced by early resuscitation. The commonest arrhythmia encountered in this setting is ventricular fibrillation. A portable external automatic defibrillator‐pacing machine for use by emergency services and laymen after basic training, has recently been introduced. This device has a tongue‐abdominal pathway for sensing the electrocardiogram and respiration, as well as delivery of current. In its automatic mode, the machine cannot defibrillate unless the patient's breathing and gag reflex are virtually absent. The decision‐making characteristics of the machine were defined in isolation from the patient using simulated ECG signals and recordings of arrhythmias obtained during cardiac surgery and during electrophysiological studies. The pathway was evaluated separately by attaching it to a conventional defibrillator and using it in the elective cardioversion of 15 patients. Electrode sites were examined and creatine phosphokinase (CPK) and creatinine phosphokinase isoenzyme (CPKMB) release determined following conversion. Repeated playback of the same 34 minutes of selected recordings showed that decisions were consistent 95% of the time. Automatic pacing always occurred with asystole. ECG signals less than 0.35 mV in amplitude were not recognized, but a manual override switch could be operated in those circumstances where there was failure to act upon fine ventricular fibrillation. Defibrillation of 50% of the recordings of supraventricular and ventricular tachycardia did occur, but this could not have happened in practice unless the patient was unconscious, and in addition, the operator failed to countermand this decision. The tongue‐abdominal pathway yielded good recordings of the ECG. There was no significant damage to the tongue and the defibrillator charges employed were comparable to those that would be used with conventional chest paddles. In conclusion, the tongue‐abdominal pathway was safe and the machine, although its ECG logic made some inappropriate decisions, had sufficient safeguards to recommend its use in the emergency setting of the victim collapsing out of hospital.
A noninvasive comparison of left ventricular performance in sickle cell anemia and chronic aortic regurgitation
Authors: Willens H. J. , Lawrence C. , Frishman W. H. , Strom J. A. 
Published: February 2009

AbstractAbnormalities of the cardiovascular system are common in patients with sickle cell anemia (SS). Noninvasive testing to document left ventricular dysfunction has yielded conflicting results. Left ventricular performance was evaluated in 27 patients with SS by M‐mode and 2‐D echocardiography, and systolic time intervals. Comparisons were made to 25 normal controls, and to 22 patients with chronic aortic regurgitation. Left ventricular diastolic diameter (LVDD) and cardiac index (CI) were significantly greater in the patients with SS than in controls (LVDD 5.3±0.4 vs. 4.7±0.5 cm; CI 4.2±1.3 vs. 3.1±0.8 liters/min/m2; both p<0.001). Left ventricular ejection fraction (EF) was slightly, but significantly less (62.9±7.3 vs. 67.0±5.4; p<0.05). In comparison to the patients with chronic aortic regurgitation, the LVDD in the patients with SS was slightly, but significantly lower (LVDD 5.3±0.4 vs. 5.9±0.6 cm; p<0.05). There was no significant difference between the patients in EF or CI (EF 62.9±7.3 vs. 63.3±4.4; CI 4.2±1.3 vs. 5.0±1.0 liters/min/m2; NS). Left ventricular EF was below 55 in three patients who also had hypertension at the time of examination. We conclude that patients with SS have resting left ventricular performance consistent with a high output state. Significant left ventricular dysfunction related to sickle cell disease alone was not demonstrated in this population, although the addition of hypertension appears to deleteriously affect resting left ventricular performance.
International symposium on coronary arteries in infants and children
Authors: Schneeweiss A. , Neufeld H. N. 
Published: February 2009

AbstractThe symposium took place in Tel Aviv on October 17‐20th, 1982. Over 100 investigators and clinicians from Europe, the United States, Japan, and Israel participated. The first day was devoted to risk factors for atherosclerosis in childhood. New evidence, supporting the predominance of the genetic factor in determining the risk for coronary atherosclerosis was reviewed. It included a high incidence of preatherosclerotic changes in children of population groups with a high incidence of coronary artery disease (Eastern Finland, Caucasians in the United States, Ashkenazi Jews in Israel), compared with low incidence of preatherosclerotic changes in the coronary arteries of children of population groups with low incidence of coronary artery disease (Western Finland, Blacks in the United States, Yemenite Jews, and Bedouins in Israel). The risk factors that can be influenced, including hypertension, hyperlipemia, and smoking at a young age, were reviewed. In the discussion it was emphasized that the long‐term results of changing the lifestyle of whole population groups are not yet well recognized. Several studies of mass intervention aimed at primary prevention are now being performed.
Percutaneous transluminal coronary angioplasty in multivessel coronary disease patients: Short‐ and long‐term follow‐up in single and multiple dilatations
Authors: Dorros G. , Lewis R. F. , Mathiak L. M. 
Published: February 2009

AbstractTransluminal coronary angioplasty was successfully performed in 658 of 752 patients with multivessel disease. An angiographic success was achieved in 1198 of 1358 lesions (88%). One lesion was attempted in 338 patients (45%); 2 in 273 (37%); 3, in 101 (13%); and, 4 or more in 40 cases (5.3%). Significant complicatsions occurred in 39 patients (5.2%): 19 (2.5%) had a transmural infarction; 26 (3.5%) required urgent myocardial revascularization; and 14 (1.9%) died. An apparent lesion recurrence occurred in 233 of 658 (35%) patients with 162 of 171 (95%) having a successful second coronary angioplasty. A second apparent lesion recurrence occurred in 37 of 162 patients (23%) with 24 of 28 (86%) having a successful third coronary angioplasty. Clinical improvement (mean follow‐up: 31 ± 17 months) persisted in 81% of successful patients. The cumulative probability of survival was 91.5% at 72 months. Survival was adversely affected, at 63 months, by the presence of prior bypass surgery (no prior bypass surgery, 94% vs. prior bypass surgery, 86%; p<0.05): at 24 months by a low left ventricular ejection fraction (≤35%, 82% vs. left ventricular ejection fraction >35%, 95%; p<0.01) and, at 57 months, in the multiple dilatation group with prior bypass surgery (no bypass surgery 96% vs. prior bypass surgery 84%; p<0.05). Multiple dilatation had a beneficial effect upon survival, at 27 months, in patients with a left ventricular ejection fraction ≤35% [single dilatation, 74% vs. multiple dilatation, 93%; p<0.001], and in patients ≥70 years, at 39 months (79% vs. multiple dilatation, 92%; p<0.01). These data suggest that coronary angioplasty can be an effective treatment in patients with multivessel coronary disease without the need to dilate all diseased vessels, with good success, acceptable complication rates, and a reasonable expectation of satisfactory long‐term clinical improvement.
ST‐segment depression in inferior ECG leads during percutaneous transluminal coronary angioplasty for left anterior descending artery
Authors: Hiasa Y. , Wada T. , Hamai K. , Nakaya Y. , Mori H. 
Published: February 2009

AbstractThe mechanism of inferior ST depression during percutaneous transluminal coronary angioplasty (PTCA) for the left anterior descending artery (LAD) was studied in 108 patients with isolated LAD lesion. in 49 patients (Group I) ST depression in inferior leads was observed, and 59 patients (Group II) showed no inferior ST depression. in the lateral lead (I or aVL), the incidence (43 cases; 88% vs. 5 cases; 9%) and degree (1.5±0.8 mm vs. 0.2 ±0.4) of ST elevation were significantly greater in Group I than in Group II. There was a significant inverse correlation (r=‐0.57, p<0.01) between ST depression in the inferior lead and ST elevation in the lateral lead, but no correlation was found between anterior leads (V 2–4) and the inferior leads. Elevation of diastolic pressure of the pulmonary artery (8.7±4.8 vs. 5.7±2.8 mmHg) and lowering of systolic pressure of the femoral artery (‐25.7±24.3 vs. ‐11.8±8.3 mmHg) were significantly greater in Group I. These findings suggest that ST depression in the inferior leads during LAD angioplasty was due to a purely electrical phenomenon and not to the concomitant ischemia of the inferior wall. However, this change was more frequently seen in patients with larger myocardial ischemia and, presumably, was more often related to ST elevation in the lateral lead, which is reciprocal in position.
Cardiac manifestations of noncardiac tumors. Part I: Direct effects
Authors: Weinberg B. A. , Conces D. J. , Waller B. F. 
Published: February 2009

AbstractCardiac manifestations of secondary tumors of the heart may exert their effects directly by endocardial, myocardial, epicardial, or cavitary deposits (metastatic lesions), indirectly via tumor products such as in carcinoma, or mediated by therapy (chemotherapy, radiation) to treat the primary neoplasm. Part I of this review summarizes the frequency of metastatic cardiac involvement by various tumors and discusses pericardial manifestations (effusion, tamponade, constriction), one of the most common consequences of direct cardiac involvement by secondary tumors.
Implantable cardioverter‐defibrillators (ICDs) 1989: How close are we to the ideal device?
Authors: De Belder M. A. , Camm A. J. 
Published: February 2009

AbstractMajor technical advances over the last few years have led to significant improvements in implantable cardioverter‐defibrillators. Tachycardias can be detected using a number of criteria which include rate, rate of onset, duration, and stability of tachycardia. A number of target tachyarrhythmias can be distinguished in the same patient and differentiated from sinus or other benign tachycardias. Different tachycardias can then be treated with different electrical therapies. Therapies now incorporated in the latest generation of implantable devices include comprehensive antitachycardia pacing techniques, low‐energy cardioversion and high‐energy cardioversion‐defibrillation. Bradycardia support pacing is also incorporated. Improvements in the electrodes used for sensing tachycardia and delivering therapy have resulted in the first implants of devices without the need forthoracotomy. Improvements in capacitor technology have resulted in a gradual reduction in the size of devices in spite of their increasing sophistication. Further research is needed to evaluate different shock charges and waveforms. Tachycardia prevention by implanted devices is also a field of much current research. Thus, though not yet ‘ideal,’ the latest generation of implantable cardioverter‐defibrillators represents an important therapeutic option in the treatment of ventricular tachyarrhythmias.
Drug‐related syncope
Authors: Davidson E. , Fuchs J. , Rotenberg Z. , Weinberger I. , Agmon J. 
Published: February 2009

AbstractThe records of 483 patients admitted to the emergency room because of syncope were reviewed. Forty‐one patients were found to have drug‐related syncope. Thirty‐nine experienced syncope related to drugs administered for cardiovascular disease. The most frequently associated diseases were anginal syndrome (22 patients), hypertension (13 patients), and a history of myocardial infarction (6 patients). Thirty‐eight patients experienced symptomatic orthostatic hypotension following drug taking (nitrates in 19 patients, beta blockers in 10 patients, nifedipine in 3 patients, prazosin and quinidine in 2 patients each, methyldopa and verapamil in 1 patient each). One patient developed complete heart block as a result of digoxin intoxication. Two patients developed the characteristic picture of anaphylactic reaction (1 with ampicillin, 1 with dipyrone). During one‐year follow‐up, without the offending medications, no further syncopal episodes were reported by these patients. We conclude that drug‐related syncope was more common among our patients with syncope than had been reported previously. It is suggested that drug‐related syncope should be taken into consideration in any patient with syncope who is treated by any of the above‐mentioned drugs.
Reperfusion therapy in acute myocardial infarction: Present status and controversy
Authors: Mueller H. S. 
Published: February 2009

AbstractCoronary thrombolysis revolutionized the treatment of acute myocardial infarction. Most of the experience was obtained with intravenous use of streptokinase and tissue‐type plasminogen activator, the latter being superior to streptokinase in regard to coronary recanalization. Numerous other promising thrombolytic agents are being investigated. Both streptokinase and tissue‐type plasminogen activator decreased mortality in large trials; comparison studies in terms of efficacy are presently being performed (GISSI 2). Aspirin is an important adjunct to thrombolytic therapy; it decreased mortality by itself (ISIS 2). Heparin is conventionally used together with thrombolysis. Its efficacy is under study (GISSI 2). Intracranial hemorrhage is the most devastating complication of thrombolysis. With the present dosage regimens, the incidence is approximately 0.5%. Percutaneous transluminal coronary angioplasty in conjunction with thrombolysis accomplished frequent and persistent recanalization of the infarct artery with low mortality, including high risk patients. The TIMI IIB study demonstrated that the results of a “conservative strategy” with aggressive management of recurrent ischemic events were comparable to those of an “invasive strategy.” Subgroup analysis should, however, be awaited. High risk patients with low ejection fraction or with shock benefit by early mechanical coronary recanalization. The role of throm bolysis in the “late” stage of transmural myocardial infarction or in the acute ischemic syndrome (unstable angina/non‐Q‐wave myocardial infarction) is unclear and presently under investigation.
Are antiarrhythmic drugs safe?
Authors: Katritsis D. , Camm A. J. 
Published: February 2009

AbstractThe indications for antiarrhythmic therapy are far from clearly defined and the choice of treatment is usually based on empiric strategies. Antiarrhythmic agents can have serious side effects. Systemic adverse effects are usually use‐related and reversible with withdrawal of the drug. Impairment of left ventricular function is considerable in patients with heart failure. The most important, life‐threatening side effect of antiarrhythmic drugs is their proarrhythmic tendency which gives rise to certain concern about their clinical use. Aggravation of arrhythmia often occurs without symptoms, goes unrecognized by the patient, and is exposed only by monitoring, exercise testing, or invasive electrophysiological testing. Patient monitoring with electrolyte measurement, Holter recording, and electrophysiological reassessment can reveal or reduce the proarrhythmic risk but cannot eliminate the problem completely. The institution of antiarrhythmic therapy should be considered in highly symptomatic or life‐threatening arrhythmias after careful consideration of the benefit‐risk ratio.
Hypertrophic cardiomyopathy evolving into a hypokinetic and dilated left ventricle: Coronary embolization as a probable pathogenetic mechanism
Authors: Gravanis M. B. , Robinson P. H. , Hertzler G. L. 
Published: February 2009

AbstractA long‐term follow‐up (9 years) in a patient with hypertrophic cardiomyopathy revealed an evolution to a hypokinetic and dilated left ventricle. The patient underwent heart transplantation, and therefore the native heart was available for morphologic studies. Gross and microscopic stigmata of hypertrophic cardiomyopathy were present, as well as evidence of left ventricular dilatation. Multiple myocardial scars in both ventricles indicated past ischemic episodes, most probably due to coronary embolization from left ventricular mural thrombi. Other possible pathogenetic mechanisms for the progression of hypertrophic cardiomyopathy to a dilated one are discussed.
Managing the pregnant patient with heart disease
Authors: Burlew B. S. 
Published: February 2009

AbstractPregnancy and its associated hemodynamic challenge presents potential risks to the patient with cardiac disease, whether acquired or congenital. The hematologic changes which occur during pregnancy include alterations in blood volume, hematocrit, and blood viscosity. There are also alterations in cardiac output and regional blood flow patterns. These hemodynamic alterations are associated with signs and symptoms which can be impressive yet benign, or can suggest poor outcome, depending on the underlying cardiovascular disorder. The clinician is faced with the sometimes difficult task of differentiating the benign from the dangerous while making appropriate management decisions. In this article, diagnosis and current management of many of the more common acquired and congenital cardiac abnormalities are discussed as they pertain to the gravid female. The effects of common cardiovascular medications in pregnancy are also briefly reviewed.
A comparison of heparinized low osmolality ionic and nonionic contrast media in 500 patients undergoing cardiac angiography
Authors: Feldman R. L. 
Published: February 2009

AbstractLow osmolar contrast media (CM) cause less hemodynamic and electrical changes than conventional CM, and many cardiologist have switched to the newer agents. Recently, concerns about a possible increased frequency of thromboembolic complications with low osmolar CM have been raised. This study compared two low osmolar heparinized CM, one ionic (Hexabrix) and the other nonionic (Isovue), in 500 consecutive patients undergoing either diagnostic catheterization (417) or coronary angioplasty (83). Adverse effects were uncommon (37 patients), but were more frequent with Hexabrix (12%) than Isovue (3%); p < 0.05. The most common adverse effects were nausea or vomiting. Death, related to abrupt occlusion of a severe left main stenosis occurred in one patient who received Hexabrix, and acute pulmonary edema occurred in one patient who received Isovue. No apparent thromboembolic complication occurred. In conclusion, both low osmolar CM were well tolerated, but Hexabrix caused more transient nausea or vomiting. Both CM were safe and the incidence of thromboembolic complications when prospectively looked for was very low.
Tomographic views of normal and abnormal hearts: The anatomic basis for various cardiac imaging techniques. Part I
Authors: Waller B. F. , Taliercio C. P. , Slack J. D. , Orr C. M. , Howard J. , Smith M. L. 
Published: February 2009

AbstractRecent developments have taken place in the diagnosis of cardiovascular disorders in the area of cardiac imaging techniques. From a previous era of imaging by silhouettes (chest roentgenography, fluoroscopy, angiocardiography), we have emerged into an era of imaging by tomographic scanning (echocardiography, radionuclide tomography, computed tomography, magnetic resonance). A basic understanding of tomographic cardiac anatomy is the foundation for proper use and interpretation of these new imaging modalities. The present report provides a description of the techniques of tomographic cutting of necropsy cardiac specimens and illustrates some of the pathologic cardiac abnormalities cut in these tomographic planes. Part I of this report describes position of the heart and tomographic axis planes, preparation of the heart and methods of cutting at necropsy, and the short‐axis, two‐chamber, and four‐chamber views of the heart.
Economic reprioritization of PET
Authors: Gleason John. M. , Frickm Mathis. P. 
Published: February 2009

AbstractIn a previous issue of the journal Gould, Mullani and Williams wrote an editorial entitled“PET, PTCA and Economic Priorities.”1 The whole subject of positron emission tomography and its use with rubidium to diagnose coronary artery disease vis‐à‐vis thallium imaging is a controversial issue of current interest. As of this writing, scientists and clinicians have vocalized strong views for each imaging technique as the best clinically suitable method to diagnose hemodynamically significant coronary artery disease. I do not pretend to know who is right, but I can assure the reader of the emotionally charged nature of this controversy. The article by Gould and colleagues generated a response by an economist, Dr. Gleason, which subsequently generated a reply by Gould. I thought this topic was of sufficient interest to the readers of Clinical Cardiology that it should be given special article status because of the important issues raised.
Sinus of valsalva aneurysms
Authors: Goldberg N. , Krasnow N. 
Published: February 2009

AbstractSinus of Valsalva aneurysms are rare cardiac anomalies which may be acquired or congenital. The congenital aneurysm is more common than the acquired form, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Acquired aneurysms may result from trauma, endocarditis, syphilis, Marfan's syndrome, and senile‐type dilatation in which the three sinuses dilate as a result of the normal aging process. This review focuses on both congenital and acquired aneurysms with particular attention to the noninvasive diagnosis of this anomaly.
A new cardiac auscultation simulator
Authors: Takashina T. , Masuzawa T. , Fukui Y. 
Published: February 2009

AbstractWe have successfully developed a new cardiac auscultation simulator by applying recently developed digital and computer technology, which digitally records, stores, modifies, and plays back heart sounds and murmurs characteristic of various heart diseases. The simulator is capable of playing back different heart sounds or murmurs at each auscultatory site (aortic, pulmonic, tricuspid, and mitral) of a human chest‐sized mannequin (made of urethane foam), through four built‐in speakers. We were able to listen to accurate reproductions of heart sounds and murmurs at the same timing as in real patients by any type of stethoscope used in routine medical practice. This compact and portable educational apparatus, which simulates realistic auscultatory sounds, will impact greatly on the medical training of cardiac auscultation for physicians, medical students, nurses, and paramedicals.