bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapidly reversible cardiomyopathy associated with chronic ipecac ingestion
Authors: Ho Paul C. , Dweik Rifat , Cohen Mylan C. 
Published: February 2009

AbstractIpecac, an over‐the‐counter emetic agent, has been a drug of choice for abuse by patients with eating disorders. Its alkaloid emetine has been associated with serious cardiac toxicity; however, the dose effect has not been well established. We present a patient with anorexia and bulimia nervosa who ingested ipecac chronically and developed the characteristic manifestations of ipecac toxicity. Unexpectedly, her induced left ventricular dysfunction returned to normal after only 10 days of withholding the drug. This finding, in contrast with the findings of other reports, establishes that ipecac cardiomyopathy can be readily reversible. The cumulative experience thus far, nonetheless, provides no discernible pattern of the effect of ipecac on the myocardium. Thus, in the continuum of poisoning, the point at which the myocardium becomes irreversibly damaged is undetermined. With continued abuse, potentially lethal outcome, and limited experience with ipecac cardiotoxicity, further investigation and perhaps heightened restriction of the drug are warranted.
Optimum lead positioning for recording bipolar atrial electrocardiograms during sinus rhythm and atrial fibrillation
Authors: Waktare Johan E. P. , Gallagher Mark M. , Murtagh Annmarif, , Camm John , Malik Marek 
Published: February 2009

AbstractBackground: To date, Holter monitoring has been predominantly utilized in the investigation and monitoring of ventricular arrhythmias and myocardial ischemia. Whether currently employed lead configurations are optimal for recording atrial electrocardiograms (ECGs) is unknown.Hypothesis: This study was undertaken to determine which conventional and novel lead configurations are optimal for recording atrial electrical activity during sinus rhythm and atrial fibrillation.Methods: Recordings were performed on eight healthy volunteers in sinus rhythm and four patients in atrial fibrillation. Each subject had 10 ECGs of three bipolar and three augmented unipolar leads recorded during supine rest, while rising to upright, and during standing rest, yielding a total of 60 leads (30 bipolar leads). Each tracing was inspected by two observers, and parameters such as P‐wave amplitude and duration, whether the P‐wave onset was clearly seen, atrial fibrillatory‐wave amplitude, and amplitude of noise during standing were scored.Results: Leads recording interiorly and leftward orientated bipoles provided the best registration of sinus P waves. The Pwave amplitude in the standard bipolar C5 lead (0.12 d̊ 0.02 mV) was, however, inferior to others such as recordings between Cl and C6 positions (P‐wave amplitude 0.16 d̊ 0.02 mV) or from below the right clavicle to the left upper quadrant of the abdomen (0.16 d̊ 0.01 mV). Optimal recording of fibrillatory waves was from different leads, such as a bipole from below the left clavicle to a low C1 position (fibrillatory wave amplitude 0.27 d̊ 0.03 mV).Conclusion: When Holter recordings are performed for the investigation of atrial arrhythmias, nonstandard lead configurations provide superior recording of atrial electrical activity. We advocate the use of electrodes positioned from C1 to C6, from below the left clavicle to a low C1 position, and a vertically orientated lead from the manubium to the twelfth vertebra or the xiphisternum.
Diabetic cardiomyopathy
Authors: Spector Kenneth S. 
Published: February 2009

AbstractPrior to 1972, the increased cardiovascular morbidity and mortality that diabetics endure had been attributed to vascular disease. in 1972, Rubler et al. proposed the existence of a diabetic cardiomyopathy based on their experience with four adult diabetic patients who suffered from congestive heart failure (CHF) in the absence of discernable coronary artery disease, valvular or congenital heart disease, hypertension, or alcoholism. Alternative explanations for CHF, such as anemia and vascular and renal disease in these four patients, gave rise to criticisms, but a wave of subsequent studies in the 1970s and 1980s provided credence to this new disease entity. This review of the studies done since 1972 appears to support the concept of a diabetic cardiomyopathy independent of atherosclerotic cardiovascular disease. The exact mechanism is still questionable, and several mechanisms have been proposed including small and microvascular disease, autonomic dysfunction, metabolic derangements, and interstitial fibrosis. However, the weight of evidence leans toward the development of fibrosis, possibly caused by the accumulation of a peroxidase acid schiff (PAS)‐positive glycoprotein, leading to myocardial hypertrophy and diastolic dysfunction.
Early repolarization
Authors: Mehta Mahaveer , Jain Abnash C. , Mehta Anurag 
Published: February 2009

AbstractEarly repolarization (ER) is an enigma. The purpose of this review is to reemphasize the overall electrocardiographic (ECG) pattern of this normal ST variant which continues to challenge the clinician because of its similarity to the current of injury potential to myocardium or an acute pericarditis. The data were provided from the studies identified through computerized searches of Medline, Toxline, Oxford, Agricola, and Bios Afterdark, Cumulative index, and a review of bibliographies of relevant articles on the related subjects. Early repolarization has elevated, upward, concave ST segments, located commonly in precordial leads, with reciprocal depression in a VR, tall, peaked and slightly asymmetrical T waves with notch, and slur on the R wave. The other accompanying features in the ECG are vertical axis, shorter and depressed P‐R interval, abrupt transition, counterclockwise rotation, presence of U waves, and sinus bradycardia. Males dominate and patients are often younger than 50 years of age. The incidence of 1 to 2% is found equally common in all races. Degree and incidence of ST elevation decrease as age advances. Exercise or isoproterenol administration may normalize the ST segment. Early repolarization is a benign condition. If the ECG conforms to a classical pattern of ER on serial ECGs, it would exclude the unnecessary hazards of present day revascularization therapy for myocardial infarction such as primary angioplasty or thrombolytic therapy, or aggressive management of acute pericarditis, and so forth. This review concludes with a discussion of comparative ECG features of ER, pericarditis, and myocardial infarction, and provides an algorithm for diagnostic management of patients suffering from these conditions.
Early mitral regurgitation after acute myocardial infarction does not contribute to subsequent left ventricular remodeling
Authors: Nešković Aleksandar N. , Marinković Jelena , Bonjić Milovan , Popović Aleksandar D. 
Published: February 2009

AbstractBackground: It is well known that mitral regurgitation may lead to left ventricular dilation; however, the relationship between progressive left ventricular dilation after acute myocardial infarction (MI) and mitral regurgitation has not yet been clarified.Hypothesis: This study tested the hypothesis that early mitral regurgitation contributes to left ventricular remodeling after acute MI.Methods: We prospectively evaluated 131 consecutive patients by serial two‐dimensional and Doppler echocardiography on Days 1,2,3, and 7, after 3 and 6 weeks, 3 and 6 months, and 1 year following acute MI. Patients were divided into two groups: those with mitral regurgitation in the first week after acute MI (Group 1, n = 34) and those without mitral regurgitation (Group 2, n = 81).Results: Over 1 year, a significant increase in end‐diastolic volume index (from 62.1 ± 12.9 to 70.5 ± 23.6 ml/m2, p = 0.001) with a strong linear trend (F = 15.1, p<0.001) was noted. Initial end‐diastolic volume index was higher in Group 1 (65.6 ± 13.3 vs. 60.4 ± 12.5 ml/m2, p = 0.047), but this difference remained constant throughout the study (F = 1.76, p = NS). Therefore, the pattern of end‐diastolic volume changes was similar in both groups during the period of observation.Conclusions: These data indicate that early mitral regurgitation after acute MI does not contribute to subsequent left ventricular remodeling in the first year after myocardial infarction.
Effects of digoxin on electrocardiogram in patients with acute atrial fibrillation—a randomized, placebo‐controlled study
Authors: Hornestam Björn , Held Peter , Edvardsson Nils 
Published: February 2009

AbstractBackground: Studies of healthy volunteers or patients in sinus rhythm have indicated that treatment with digoxin produces characteristic changes in the electrocardiogram (ECG). No randomized, placebo‐controlled studies are available and no study has investigated the effect on ECG in patients with atrial fibrillation.Hypothesis: In a substudy to a trial comparing the therapeutic effect of intravenously administered digoxin with placebo in patients with acute atrial fibrillation, we investigated these effects as well as the relation between ECG changes and serum concentration of digoxin.Methods: In all, 167 patients were included. Standard ECGs recorded at baseline, and at 2,6,12, and 16 h after randomization were digitized, and changes in RR‐intervals, QRS width, ST‐segment amplitude at 60 ms after the J point, T‐wave amplitude, and QTc interval were calculated. Furthermore, the correlation between the serum concentration of digoxin at 16 h after inclusion and changes on the ECG was analyzed.Results: Compared with placebo, digoxin resulted in an increase in RR‐interval (p < 0.0001), a decrease in ST‐segment and T‐wave amplitude (p = 0.009 and p = 0.002, respectively), and in the QTc interval (p = 0.01). These changes were present 2 h after the first dose, but were more pronounced after 16 h. There was no significant correlation between serum concentration of digoxin and ECG changes at 16 h.Conclusion: Compared with placebo, digoxin produces significant changes on ECG in patients with acute atrial fibrillation. The changes are in accordance with previous findings in individuals in sinus rhythm. There was no correlation between serum concentration of digoxin and ECG changes.
Thrombolysis of mobile right atrial thrombi following severe pulmonary embolism
Authors: Cracowski Jean‐Luc , Tremel Fréderic , Baguet Jean‐Philippe , Mallion Jean‐Michel 
Published: February 2009

AbstractThrombolysis may favorably affect the clinical outcome of mobile right atrial thrombus following pulmonary embolism (PE). We report the case of three patients with mobile right atrial thrombus following PE, in whom fibrinolysis was performed. Atrial mass disappeared on the control echocardiogram, but control ventilation perfusion scan showed new perfusion defects in all patients. Thrombolysis seems successful for the treatment of patients with mobile right atrial thrombus following PE; however, recurrent PE may be induced by fibrinolysis. This may affect the benefit of such therapy and should be taken into account when using this therapeutic treatment.
Periprocedural creatine kinase‐mb elevations: Long‐term impact and clinical implications
Authors: Jennifer Adgey A. A. , Mathew T. P. , Harbinson M. T. 
Published: February 2009

AbstractSince the introduction of percutaneous transluminal coronary angioplasty (PTCA), percutaneous intervention with balloon catheters, stents, and atherectomy devices has become a widely accepted practice. The persistent complication of non‐Q‐wave myocardial infarction (MI), as evidenced by increased cardiac enzyme levels after intervention, has aroused only moderate concern because its incidence was perceived to be small and not clinically relevant. With more systematic assessments of cardiac enzymes—specifically, creatine kinase (CK) and its MB isoform—evidence has begun to clarify both the incidence and the prognosis of periprocedural non‐Q‐wave MI: It appears to occur nearly three times more often than is clinically evident across all device types (8 to 9% of all interventions) and is directly and continuously associated with adverse outcomes, including late death. Although directional and rotational atherectomy improve angiographic outcome compared with PTCA, periprocedural infarction occurs at least twice as often with these newer technologies; the incidence associated with stent placement is comparable to and possibly higher than that of PTCA. Factors that may cause elevated CK‐MB levels include distal embolization, side branch occlusion, thrombus, and coronary spasm. Analyses of the major trials of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors, a class of potent antiplatelet agents, show striking effectiveness of these drugs in reducing the incidence of “enzyme‐only” or “silent” MI and in improving long‐term clinical outcomes. The findings implicate platelet mediation in the occurrence of periprocedural infarction and suggest an important role for antiplatelet therapy, particularly GP IIb/IIIa receptor inhibition, in protecting patients undergoing percutaneous intervention.
Survival without surgical repair of acute rupture of the right ventricular free wall
Authors: Sherer Yaniv , Levy Yair , Leibovich Livio , Shoenfeld Yehuda , Shahar Amir , Konen Eli 
Published: February 2009

AbstractRupture of the myocardial free wall is an infrequent complication of acute myocardial infarction. Unless it occurs in a space confined by pericardial adhesions, only surgical emergency repair of ruptured myocardium can prevent death. In this paper we report the case of an 81‐year‐old woman who was admitted to the emergency room with cardiac tamponade, resulting from inferolateral acute myocardial infarction and a subsequent rupture of the right ventricular free wall, with the formation of pericardial thrombus and effusion. The patient refused to undergo any surgical or invasive intervention, and therefore she was only treated conservatively. Nevertheless, her condition improved dramatically, as her blood pressure increased and echocardiography abnormalities almost disappeared. Follow‐up echocardiography 7 months post discharge was unremarkable. We believe that this rare case emphasizes that in special circumstances, such as creation of a thrombus that prevents more blood from extravasating, free‐wall rupture without surgical repair is compatible with long‐term survival.
Diagnosis and management of cardiac tamponade in the era of echocardiography
Authors: Tsang Teresa S. M. , Oh Jae K. , Seward James B. 
Published: February 2009

AbstractCardiac tamponade is a life‐threatening condition. Accurate diagnosis and prompt intervention are necessary. Classically, clinical features of tamponade include pulsus paradoxus, tachycardia, increased jugular venous pressure, and hypotension. With the advent of echocardiography, confirmation of an effusion and accurate assessment of its hemodynamic impact can be achieved, frequently in the absence of overt clinical manifestations. The decision regarding treatment and timing of intervention must take into account the clinical presentation and echocardiographic findings, along with careful weighing of risks and benefits to the individual patient. Echocardiographically guided pericardiocentesis is the best available therapy for initial management of cardiac tamponade. It is simple, safe, and effective for removing pericardial fluid and reversing hemodynamic instability, and the use of a pericardial catheter for extended drainage has been associated with significant reduction in recurrence of fluid accumulation.
Examining the psychosocial impact of implantable cardioverter defibrillators: A literature review
Authors: Camm A. John , Sears Samuel F. , Todaro John F. , Lewis Tara Saia , Sotile Wayne , Conti Jamie B. 
Published: February 2009

AbstractBackground: The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life‐threatening ventricular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well understood.Hypothesis: The purposes of this paper are (1) to review the available literature documenting the psychosocial impact of the ICD on patients, (2) to hypothesize possible mechanisms for this psychosocial impact, and (3) to suggest clinical risk profiles and indications for psychological consultation.Methods: Electronic and library searches (e.g., MEDLINE, PsychLit) were used to gather studies examining the psychosocial impact of the ICD. Only studies investigating psychosocial outcomes (e.g., psychological distress, quality of life, social and role functioning), either prospectively or cross‐sectionally, were admitted into the review. No literature reviews or secondary sources were included.Results and Conclusions: Current research suggests that ICD‐specific fears and symptoms of anxiety (e.g., excessive worry, physiological arousal) are the most common psychological symptoms experienced by ICD recipients, with approximately 13–38% of recipients experiencing diagnosable levels of anxiety. Depressive symptoms are reported at rates that are generally consistent with other cardiac populations. Although the incidence of psychological disorders appears to be similar to that found in general cardiac populations, specific ICD‐related concerns such as fear of shock, fear of device malfunction, fear of death, and fear of embarrassment have been identified. Selected psychological theories such as classical conditioning, learned helplessness, and a cognitive appraisal model help to explain the occurrence of psychological symptoms post implantation. Psychosocial adjustment risk profiles indicate that young ICD recipients and those with high discharge rates may experience the most adjustment difficulties.
Different prognostic significance of right and left ventricular diastolic dysfunction in heart failure
Authors: Yu Henry C. M. , Sanderson John E. 
Published: February 2009

AbstractBackground: Left (LV) and right (RV) ventricular diastolic dysfunction is common in heart failure but the prognostic value of RV diastolic dysfunction is not known.Hypothesis: As a follow‐up to a previously undertaken study, this study was carried out to investigate whether LV and RV diastolic dysfunction affect prognosis differently and, in addition, whether changes in diastolic filling patterns over time correlate with clinical outcome.Methods: We studied a cohort of 105 patients (mean age 62.7± 1.3 years, 66% male) with heart failure (ejection fraction < 50%) by Doppler echocardiography in both RV and LV.Results: An LV restrictive filling pattern (RFP) was present in 48% of the patients and, when compared with non‐RFP subgroups, it was associated with poorer systolic function, higher New York Heart Association functional class, and higher cardiac mortality at 1 year (all p < 0.001). The coexistence of an LV‐RFP and poor LV systolic function (ejection fraction < 25%) markedly decreased the 1‐year survival that was significant when compared with other subgroups (p = 0.001). In contrast, RV diastolic dysfunction that occurred in 21% of patients was not a prognostic factor for mortality either alone or in combination with LV diastolic dysfunction, but predicted nonfatal hospital admissions for heart failure or unstable angina (p = 0.016).Conclusion: An LV restrictive filling pattern is a powerful predictor of a poor prognosis, especially when combined with low ejection fraction, but in this study RV diastolic dysfunction did not appear to be an independent predictor of subsequent mortality.
Effects of acute alcohol infusion on duration and dispersion of QT interval in male patients with coronary artery disease and in healthy controls
Authors: Rossinen Juhani , Sinisalo Juha , Nieminen Markku S. , Vittasalo Matti , Partanen Juhani 
Published: February 2009

AbstractBackground and hypothesis: Alcohol consumption may have advantageous epidemiologic effects but ethanol also increases the risk of sudden coronary death. Prolongation of QT interval has been reported in chronic alcoholics. Long QT period predisposes to serious arrhythmias, and therefore we studied whether acute alcohol intoxication prolongs repolarization in patients with stable coronary artery disease (CAD).Methods: The effects of acute ethanol steady‐state intravenous infusion (0.72 g/kg body weight within 60 min) on QT interval and QT dispersion, assessed by 12‐lead electrocardiograms (ECG), were studied in 22 men with stable CAD and in 10 controls. Heart rate variability was measured by Holter recordings.Results: Mean blood alcohol rose to 26.1 ± 4.3 mmol/l (1.2 ± 0.2%), and was maintained for 2 h. Heart rate was 56 ± 7 beats/min before and 54 ± 8 beats/min during ethanol infusion (NS). The heart rate‐adjusted QT interval increased on the average 13–23 ms over the 12‐lead ECG (p < 0.005). The QT dispersion remained unaltered. The was no difference in the repolarization response in the patients with CAD compared with the controls. The high‐ and low‐frequency components of heart rate variability remained unaltered.Conclusions: in middle aged men, regardless of the presence of CAD, moderate amounts of alcohol cause prolongation of ventricular repolarization. Changes in the activity of the autonomic nervous system do not seem to explain the observed phenomenon.
Use of QT dispersion measured on treadmill exercise electrocardiograms for detecting restenosis after percutaneous transluminal coronary angioplasty
Authors: Koide Yasushi , Yotsukura Masayuki , Tajino Kazuhiro , Yoshino Hideaki , Ishikawa Kyozo 
Published: February 2009

AbstractBackground: Treadmill exercise electrocardiography (ECG) has been used to detect restenosis in patients following percutaneous transluminal coronary angioplasty (PTCA). However, the level of sensitivity achieved using conventional criteria of ST‐segment depression is too low to be clinically useful in this population.Hypothesis: QT dispersion is a sensitive method for detecting myocardial ischemia and may improve the accuracy of treadmill exercise ECG testing for detecting restenosis after PTCA.Methods: We evaluated 104 patients who underwent PTCA for the treatment of single‐vessel coronary artery disease and who had no history of myocardial infarction. Treadmill exercise ECG and coronary angiograms were performed 3 months after PTCA to determine the accuracy of diagnosing restenosis based on standard ST‐segment depression and QT dispersion criteria.Results: Restenosis was observed in 37 of the 104 patients (36%) 3 months after PTCA. QT dispersion immediately after exercise was significantly greater in patients with than in those without restenosis, as was the difference in QT dispersion before and immediately after exercise. The sensitivity, specificity, and accuracy of ST‐segment depression criteria were 59, 64, and 63%, respectively. Measurements of QT dispersion immediately after exercise (≥50 ms: positive, <50 ms: negative) improved the sensitivity, specificity, and accuracy of treadmill ECG for predicting restenosis to 81, 87, and 85%, respectively.Conclusions: This novel diagnostic method using QT dispersion‐based criteria significantly improves the clinical usefulness of treadmill exercise ECG for detecting the presence of restenosis after PTCA.