bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypertrophic cardiomyopathy: Prognosis with medical or surgical therapy
Authors: Blanchard D. G. , Ross J. 
Published: February 2009

AbstractOver the past 30 years, knowledge of the natural history and effects of therapy in patients with hypertrophic cardiomyopathy has expanded greatly, but progress has been hampered by its variable patterns of expression. Many but not all patients show symptomatic improvement with medical treatment. Chronic beta blockage does not appear to affect long‐term survival, whereas results with calcium channel blockade by verapamil have been encouraging; however, they await confirmation, and verapamil may be hazardous in some patients with severe left ventricular (LV) outflow tract obstruction and elevated LV end‐diastolic pressure. Reported beneficial effects of amiodarone on survival also require further study. Surgical therapy has become the treatment of choice for medically refractory patients with proven outflow tract obstruction. In several centers, the operative risk is low, and long‐term follow‐up demonstrates prolonged symptomatic relief. It is hoped that work currently underway will provide more definitive information on the long‐term effects of the role of calcium channel blockers, antiarrhythmic medications, and the long‐term effects of surgical therapy on survival of patients with this disorder.
Cross‐sectional area index of left ventricular myocardium as a risk factor influencing early and late postoperative survival in aortic regurgitation
Authors: Okamura K. , Mitsui T. , Hori M. 
Published: February 2009

AbstractLate cardiogenic death after aortic valve replacement in aortic regurgitation is still a most important unresolved problem. We studied how the extent of cross‐sectional area index (CSAI) relates to early and late cardiogenic deaths after aortic valve replacement (AVR) in aortic regurgitation with normal coronary artery. Forty‐one patients were classified into two groups: Group I having CSAI >20 cm2/m2 (18 patients), and Group II, in whom CSAI was <20 cm2/m2 (23 patients). All preoperative factors in patients with CSAI ≥ 20 cm2/m2 showed poor values compared with patients with CSAI <20 cm2/m2 with a statistical difference of 63 ± 6 versus 56 ± 4% in cardiothoracic ratio, 72 ± 9 versus 64 ± 8 mm in diastolic dimension, 54 ± 9 versus 43 ± 7 mm in systolic dimension, 25 ± 7 versus 32 ± 6% in fractional shortening, 326 ± 60 versus 209 ± 63 ml/m2 in end‐diastolic volume index, 177 ± 52 versus 81 ± 29 ml/m2 in end‐ systolic volume index, and 47 ± 14 versus 58 ± 5% in ejection fraction (mean ± SD). In Group II, there were no postoperative cardiac deaths and no patient was subjected to intra‐aortic balloon pumping (IABP). In contrast, in Group I, 17% died from postoperative low output syndrome and 33% were subjected to IABP. Concerning late deaths, there was no cardiac death in any CSAI patient with <20 cm2/m2; however, 22% of the patients with CSAI ≥20 cm2/m2 died from cardiac causes. Survival at the end of the ninth year showed 78 ± 10 % in CSAI < 20 cm2/m2 in contrast with the poor results of CSAI ≥ 20 cm2/m2 as 38 ± 16% (p<0.05). Thus, we conclude that AVR in aortic regurgitation should be scheduled before CSAI levels reach 20 cm2/m2, and if the operation is to be performed in patients with CSAI above 20 cm2/m2, cautious observation and medication should be the rule in order to avoid late cardiogenic deaths.
What a clinician needs to know about the mechanisms of action of antiarrhythmic drugs
Authors: John Camm A. , Janse M. J. 
Published: February 2009

AbstractVaughan Williams' classifications of antiarrhythmic drugs are briefly discussed, including the fact that these drugs are classified based upon their effects on normal cardiac cells; that more and more subclassifications need to be introduced; that many drugs have actions belonging to different classes. A plea is made not to consider just one effect of an antiarrhythmic drug—that is, its effect on conduction velocity only or on refractory period only, but to evaluate its effect on wavelength, the product of refractory period and conduction velocity. Experimental studies on atrial arrhythmias induced by electrical stimulation in chronically instrumented dogs have shown a very good correlation between wavelength and type of arrhythmia induced. The predictive value of wavelength was much greater than that of refractory period alone or conduction velocity alone. It is emphasized that drugs that shorten wavelength especially at rapid rates may exhibit dangerous proarrhythmic effects.
Annular subaortic aneurysm resulting in sudden death
Authors: Normann Sigurd J. 
Published: February 2009

AbstractA subvalvular aneurysm in a 34‐year‐old black woman developed beneath the left coronary cusp of the aortic valve and extended in the epicardium between the aortic root and left atrium. She was asymptomatic until she expired suddenly from myocardial ischemia caused by compression of the circumflex coronary artery by the aneurysm. A review of the literature reveals 13 reports of subaortic and 58 submitral aneurysms but only two instances of myocardial infarction secondary to coronary artery compression by spontaneous subvalvular aneurysms in either the subaortic or submitral position.
Emergency coronary revascularization using polytetrafluoroethylene conduits in a patient in cardiogenic shock
Authors: Hartman A. R. , Vlay S. C. , Dervan J. P. , Lawson W. E. , Mannisi J. , Anagnostopoulos C. E. 
Published: February 2009

AbstractThere is growing awareness that a particular subset of patients with coronary artery disease who need surgical revascularization do not have autologous vein or internal mammary artery available or surgically applicable. The polytetrafluoroethylene graft has had limited use in aortocoronary bypass procedures. We describe a case of cardiogenic shock secondary to severe coronary artery disease and aortic stenosis, where the use of this synthetic graft contributed to a successful outcome. Angiographic patency was documented at 3 months follow‐up. Our experience, plus a review of the literature, supports the use of polytetrafluoroethylene grafts during aortocoronary artery bypass to salvage infarcting or ischemic myocardium, when traditional autologous bypass conduits are not available or applicable.
Subendocardial arteriovenous malformation in a patient with unstable angina
Authors: Kemme D. J. , Rainer W. G. 
Published: February 2009

AbstractA variety of arteriovenous abnormalities of the heart have been previously described. Arteriovenous malformations are uncommon developmental abnormalities documented in almost every organ of the body. A subendocardial arteriovenous malformation in a patient with unstable angina is described which we believe to be the first reported case.
Well‐being (quality of life) in connection with hypertensive treatment
Authors: Dahlöf C. 
Published: February 2009

AbstractQuality of life is often considered to equate how the medical treatment is subjectively perceived by the patient, but ought to include the total impact of the disease/treatment on the patient's emotional, physical, and social well‐being. Recently, a proposal for a generally applicable definition of quality of life in health care was put forward. This definition includes general well‐being, health, and welfare (external factors), as three fundamental components, and the definition is based on both objective and subjective judgments. General well‐being is exclusively an expression of the individual's subjective experience and is based on his or her own qualitative evaluation of well‐being in relation to condition, treatments, and experiences. Health is according to the proposed definition, judged both objectively (signs) and subjectively (symptoms). Apart from health and well‐being, there is also reason to include objectively registrable factors at the welfare level (external factors) such as the consumption of medicines, number of days in hospital, length of sick leave, need of in‐home care, etc. This review is an attempt to elucidate the effects of antihypertensive pharmacotherapy on the patient's general well‐being. The topic will be discussed from several points of views (e.g., aims of antihypertensive treatment, occurrence of symptoms in the population, compliance with prescribed treatment, symptom inventories, the concept of quality of life).
Coronary Collateral Circulation
Authors: Pellinen T. J. , Virtanen K. S. , Toivonen L. , Heikkilä J. , Hekali P. , Frick M. H. 
Published: February 2009

AbstractThe occurrence and influence of coronary collateral circulation and obstruction of the supplying coronary arteries on left ventricular contractility, prevalence of myocardial infarction, and bicycle exercise ergometer test were studied in a random sample of 286 patients with angiographically documented coronary artery disease. Collaterals appeared increasingly in all three main coronary arteries with grade of obstruction. The highest prevalence of collaterals occurred in stenosis of the right coronary artery (60%), followed by the left descending artery (45%); they occurred least in the left circumflex artery (21%) (p<0.001). The frequency of intra‐arterial collateral circulation was 42%, 11%, and 12%, respectively (p<0.001). With total occlusion of the left anterior descending coronary artery, 22% of the patients had nor‐mokinetic anterior and apical left ventricular wall when collaterals were present. More often, the inferior wall showed normal contraction with total occlusion of the right coronary artery and collaterals [52%, p<0.001 compared with left anterior descending artery (LAD)]. The prevalence of inferior myocardial infarction was 39%, with collateral circulation to the totally occluded right coronary artery. The respective prevalence of anterior infarction and total occlusion in the left coronary artery was 58% (p<0.02). The presence or absence of collaterals had no obvious influence on ST‐segment response during bicycle ergometer test. In triple‐vessel disease, peak work capacity was better when collaterals to LAD were not jeopardized (427 kpm) than when jeopardized (321 kpm) (p.<0.02).
Stress‐induced changes in blood pressure and left ventricular function in mild hypertension
Authors: Lindvall K. , Kahan T. , De U. , Östergren J. , Hjemdahl P. 
Published: February 2009

AbstractLeft ventricular function was studied by M‐mode echocardiography at rest and during a mental arithmetic stress test and a cold‐pressor test in 14 patients with mild hypertension and in 14 matched normotensive subjects. The elevation of blood pressure at rest in the hypertensive group (154 ± 4/87 ± 3 vs. 120 ± 3/66 ± 3 mmHg in the control group) was due mainly to a higher cardiac output (6.0 ± 0.3 vs. 5.0 ± 0.3 L/min), which was related to elevations of stroke volume and heart rate (73 ± 2 vs. 66 ± 2 beats/min). Venous plasma catecholamines were similar in the two groups. Mental stress induced cardiac output‐dependent increases in blood pressure in both groups; systemic vascular resistence tended to decrease. The relative increases in diastolic and mean arterial blood pressure were smaller in the hypertensive group (15 vs. 26% and 15 vs. 21 %, respectively), which exhibited signs of a reduced cardiac compliance, possibly related to a left ventricular hypertrophy. Mental stress elevated venous plasma adrenaline similarly in the two groups; effects on noradrenaline were small. The cold‐pressor test increased blood pressure similarly in the two groups, largely due to increased systemic vascular resistence; plasma noradrenaline responses were also similar. Mental stress appears to elicit a differentiated sympathetic nerve activation pattern resembling the hypothalamic defense reaction. Mild hypertension seems to be associated with increased arousal and cardiac activation at rest. However, an attenuated blood pressure reactivity to mental stress may reflect reduced stroke volume responsiveness, which is related to structural changes, as heart rate reactivity tended to be enhanced in mild hypertension.
Subepicardial aneurysm of the left ventricle: Report of a case and review of the literature
Authors: Vossenberg F. , Amidi M. , Kormos R. , Labuda M. J. 
Published: February 2009

AbstractA case of subepicardial aneurysm is reported and 16 other cases found in the literature are reviewed. Although the subepicardial aneuryms are distinct from true and false aneurysms, their propensity for rupture is similar to false aneurysm. The incidence of this aneurysm is increasing due to the use of thrombolytic therapy in myocardial infarction. Early invasive diagnostic test is leading to its more frequent discovery.
Acute occlusion of left main coronary artery without ventricular damage
Authors: Prachar H. , Dittel M. , Enenkel W. 
Published: February 2009

AbstractWe report a patient with acute occlusion of left main coronary artery with only a small increase of cardiac enzymes but without electrocardiographic signs of acute myocardial infarction. Normal global and regional left ventricular function could be documented angiographically. Damage of myocardium was prevented by extensive collateral circulation from a large dominant right coronary artery.
Developing a rational management strategy for angina pectoris after coronary bypass surgery: A clinical decision analysis
Authors: Mills Roger M. , Kalan Jay M. 
Published: February 2009

AbstractLong‐term follow‐up of patients undergoing coronary artery bypass graft surgery indicates that as many as 50% eventually experience recurrent angina pectoris. Rational management of these individuals requires an understanding of the natural history of coronary bypass grafts, the risks and benefits of both reoperation and angioplasty, as well as a structure within which to integrate these data. This report reviews the literature and employs formal decision analysis to develop a strategy for management of recurrent angina. Our analysis supports the strategy that patients experiencing recurrent angina within 3 years alter surgery should undergo prompt angiographic re‐evaluation and angioplasty if anatomically suitable. Symptoms beginning more than 6 years after surgery should be managed medically, reserving surgery for refractory symptoms.
Electrocardiography and postextrasystolic potentiation: Utilization of the two methods to predict postrevascularization segmental myocardial function
Authors: Cooper M. W. , Mitchell R. , Lutherer L. O. , Lust R. 
Published: February 2009

AbstractWe previously reported that postextrasystolic potentiation (PESP) is a useful predictor of changes in systolic wall function (SWF) following coronary revascularization. In the current study we analyzed ECG changes related to corresponding myocardial segments to determine their correlation with PESP and SWF. We found: (1) The PESP response in a jeopardized segment was a valid predictor of improved SWF even when Q waves, ST‐segment changes, or T‐wave changes were present. (2) However, when Q waves were present in two or more of the corresponding leads, positive PESP was less likely to be observed. (3) Thus Q waves in two leads predicted the least postrevascularization improvement. (4) Segments with no corresponding Q‐wave postrevascularization usually improved SWF. (5) Furthermore, a continuum of responsiveness to PESP was found, ranging from T‐wave changes, ST‐segment changes to Q‐wave changes, indicating dissociation between electrical and mechanical events. In conclusion, the ECG together with PESP provide good predictive information relative to the efficacy of revascularization. PESP is a more valuable predictive indicator. ECG alone may be of value in that the occurrence of Q waves in two or more corresponding leads predicts a low probability of improved SWF. Further studies are indicated to investigate the dissociation between electrical and mechanical events.
Thrombolytic therapy in refractory unstable angina: The role of holter monitoring
Authors: Brunelli Claudio , Spallarossa Paolo , Ghigliotti Giorgio , Iannetti Mario , Caponnetto Salvatore , Lantieri Pasquale 
Published: February 2009

AbstractWe tested the safety and the usefulness of intravenous urokinase (2 million units administered over 30 min) in 44 patients with refractory unstable angina, defined as persistence of ischemic episodes during 48‐h Holter monitoring (Phase 1) despite maximal medical therapy. After thrombolysis, recurrence of ischemia was observed during a week of observation in the CCU, including two 24‐h Holter monitorings at the beginning and the end of the week (Phase 2). Seventeen patients completed the observation period without either symptomatic or asymptomatic ischemic episodes (Group A); the remaining 27 continued to manifest ischemia (Group B). No bleeding complications occurred. Within a 6‐month follow‐up, 2 patients of Group A had recurrence of unstable angina while in Group B, 19 patients had refractory angina or a major cardiac event [10 patients underwent coronary artery bypass surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for refractory angina (p>0.001), 6 other patients with refractory angina continued medical therapy, one patient had a myocardial infarction, and two patients died]. In Phase 1 the duration of total ischemia (min/24 h) was a relevant prognostic marker: higher duration correlated with adverse clinical outcome (p>0.01). In comparison to Phase 1, duration of total ischemia in Phase 2 was significantly reduced in both groups (16.9±19.6 vs. 25.4±17.7; p>.001). A percent value expressing this variation was calculated for each patient: the variation thus obtained again gave information on the clinical outcome—the greater the reduction, the lower the risk of cardiac events (p>.001). Our data suggest that (1) clinical stabilization may be obtained with the addition of urokinase to conventional treatment, (2) Holter monitoring bears prognostic information helpful in identifying patients who need further intervention.
Electrophysiologic effects of oral diltiazem before and after beta blockade
Authors: Kumar Krishna , Bajaj Rajiv , Kaul Upendra , Bahl Vinay K. 
Published: February 2009

AbstractWe conducted electrophysiologic (EP) studies and estimated the sinus node function and atrioventricular (AV) conduction in 10 patients with suspected coronary arterial disease (age range 35–55 years) before and during diltiazem therapy (60 mg thrice daily for 5–7 days). The effect of beta blockade (0.1 mg/kg of intravenous propranolol) was evaluated in both EP studies. The mean spontaneous sinus cycle length (SCL) and the AV nodal Wenckebach cycle lengths (AVWB) were significantly higher (p<0.05) after propranolol alone (913±131 and 504±197 ms, respectively) compared with baseline values (SCL: 827±149 ms, AVWB: 439±173 ms). Diltiazem alone failed to influence the SCL and AVWB significantly. Following the combination (diltiazem + propranolol), SCL (945 ± 147 ms) and AVWB (533 ± 148 ms) were significantly higher (p<0.05) than baseline and post diltiazem values (SCL: 840 ± 150 ms; AVWB 457 ± 103 ms). None of the other parameters (sinoatrial conduction time, corrected sinus node recovery time, AH and HV intervals, AV nodal and atrial effective refractory periods) were significantly influenced by propranolol, diltiazem, or the combination. No patient developed AV block, sinus arrest/sinoatrial exit block, or symptomatic sinus bradycardia following beta blockade after diltiazem administration. Oral diltiazem therapy alone and after beta blockade does not appear to adversely influence the sinus node function and AV conduction in patients below the age of 55 years. The combination of diltiazem and beta blocker thus appears safe in selected patients with coronary arterial disease.
Improvement of left ventricular aneurysm after myocardial infarction: Report of three cases
Authors: Iwasaki Khoichirou , Kita Toshimasa , Taniguchi Gyou , Kusachi Shoza 
Published: February 2009

AbstractWe report on the disappearance of a left ventricular aneurysm after myocardial infarction in three cases. Coronary blood flow was restored by spontaneous recanalization in two cases and by angioplasty in one case. When the aneurysm was observed, the findings in these cases were (1) no or limited abnormal Q wave in surface electrocardiography, (2) total or subtotal stenosis of the proximal coronary artery without adequate distal filling through collaterals, (3) no ST shift in exercise electrocardiography, and (4) decreased but not absent thallium‐201 uptake in myocardial scintigraphy. In Cases 1 and 2, respectively, 3 years and one year and 8 months after the myocardial infarction, an anginal episode occurred and the ventricular aneurysm disappeared. In Case 3, the aneurysm disappeared after coronary angioplasty. These cases suggest that even without a demonstration of reversible ischemic myocardium and/or severe stenosis without distal tilling through collaterals, the myocardium presenting a ventricular aneurysm would be hibernating. These cases were also informative about the detection of hibernating myocardium.
Doppler echocardiography versus cardiac catheterization in the evaluation of valvular heart disease: Do we have a gold standard?
Authors: Schwinger Matthew E. 
Published: February 2009

AbstractDefinitive evaluation of valvular heart disease is traditionally accomplished by cardiac catheterization. Recent advances in Doppler echocardiography allow noninvasive assessment of valvular heart disease with a high degree of accuracy compared to the cardiac catheterization gold standard. Doppler echocardiography may occasionally yield erroneous results due to technical difficulties in the performance of the study. A number of patient related and echo‐machine related factors may also affect the Doppler measurements independent of the severity of the lesion. Thus, a discrepancy between Doppler and catheterization data is generally considered to be a failure of Doppler methods. However, catheterization data may also be flawed due to errors in the measurement of pressure and cardiac output, as well as the known shortcomings of qualitative angiography. The Gorlin equation itself suffers from several limitations, including the substitution of pressure gradient for velocity in the basic hydrodynamic equation, and the use of a constant which may not be appropriate in all circumstances. Therefore, when Doppler echocardiography and cardiac catheterization yield discordant results, both studies should be carefully reviewed and correlated with other clinical data in order to elucidate the sources of the discrepancy and ascertain the actual severity of the valvular lesion.