bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time lapse from estimated onset of acute myocardial infarction to peak serum enzyme activity
Authors: Herlitz J. , Hjalmarson Å. , Waldenströ J. 
Published: February 2009

AbstractIn 581 patients with acute myocardial infarction (MI), the time lapse from estimated onset of infarction to estimated peak serum (S) enzyme activity was evaluated. Heat‐stable lactate dehydrogenase (LD; E.C. 1.1.1.27) was analyzed every 12 h for 48–108 h after arrival in hospital (n =581) and creatine kinase (CK; E.C. 2.7.3.2.; n=224), and creatine kinase subunit B (CK‐B; n=211) were analyzed every 6 h for 48 h. Peak S‐LD was observed between 14 and 110 h after estimated onset of MI (mean 46.6±0.6 h), peak S‐CK was observed between 8 and 58 h (mean 25.0±0.6 h), and peak S‐CK‐B was also observed between 8 and 58 h (mean 22.8 ±0.7 h) after onset. In 86% of patients, peak LD was reached within 60 h after onset of MI, in 78%, peak CK was reached within 30 h, and in 82%, peak CK‐B was observed within 30 h after onset of MI. A weak correlation was found between duration of pain and time lapse to S peak enzyme activity (r=0.25–0.27; p<0.001), while there was no correlation between S peak activity and time lapse from onset of MI to S peak activity. It is concluded, that although in the majority of patients with MI, peak serum‐enzyme activity is reached within a predictable amount of time after estimated onset of MI there is wide variation, difficult to establish from the clinical course, among individual patients.
Circulatory effects of mental stress during exercise in coronary artery disease patients
Authors: Siconolfi S. F. , Garber C. E. , Baptist G. D. , Cooper F. S. , Carleton R. A. 
Published: February 2009

AbstractWe examined the effects of mental stress during steady‐state exercise on heart rate, blood pressure, pressure‐rate product, and oxygen uptake in 10 coronary artery disease patients. Subjects walked at three mph with grade increases of 4% every two minutes until the target heart rate (60% peak heart rate from a previous symptom‐limited exercise test) was reached. A computerized Stroop‐Color‐Word Test (mental stress) was added one minute after the subject reached steady‐state exercise and lasted 11±4 minutes. When mental stress was added to steady‐state exercise it significantly (p<0.01) increased the heart rate (101 ±15 to 108± 19 beats per min), systolic (154±26 to 170 ±26 mmHg) and diastolic (86 ±10 to 92 ±13 mmHg) blood pressure, and pressure‐rate product (158 ±42 to 179±48 × 10‐‐2). This increase in the mean response during exercise and mental stress was not observed for oxygen uptake (17±6 to 18±5 ml/kg/min). The circulatory changes probably reflect increased sympathetic activity with both centrally mediated cardio‐acceleratory (and probably cardiac output) and vasoconstrictor effects during the combination of mental stress and steady‐state exercise. The altered hemodynamics without concomitant changes in oxygen uptake has major implications concerning the safety of competitive exercise for people with coronary artery disease.
Tetralogy of fallot in the elderly
Authors: Chin J. , Bashour T. , Kabbani S. 
Published: February 2009

AbstractTetralogy of Fallot was first diagnosed during life in this patient at the age of 61 years. He represents one of the oldest reported patients with this congenital heart anomaly. This report presents a case of a previously undiagnosed patient with tetralogy of Fallot.
Evaluation and treatment of fetal arrhythmias
Authors: Allan L. D. , Crawford D. C. , Tynan M. , Anderson R. H. 
Published: February 2009

AbstractIn a series of 31 cases referred for the evaluation of fetal arrhythmia, it was possible to identify the rhythm disturbance correctly using M‐mode echocardiography. Cross‐sectional echocardiography delineated structural abnormality where it occurred in association with an arrhythmia. Fifteen cases had premature atrial or ventricular contractions occurring in structurally normal hearts. These were not associated with perinatal mortality or morbidity in our series. Nine cases had complete heart block, three of which had structural cardiac anomalies. Seven cases were of atrial tachycardia, six were treated prenatally, one was delivered prematurely. Correct identification of an arrhythmia and appropriate prenatal therapy where indicated, was found to prevent unnecessary operative or premature deliveries.
Verapamil in chronic atrial fibrillation: Variable patterns of response in ventricular rate
Authors: Klein G. J. , Twum‐Barima Y. , Gulamhusein S. , Carruthers S. G. , Donner A. P. 
Published: February 2009

AbstractWe determined the effects of single intravenous (10 mg) and oral (80, 160 mg) doses of verapamil in 8 digitalized patients with chronic atrial fibrillation. The time course of drug effect was analyzed with computer assistance by considering several measures in atrial fibrillation, including average R‐R interval (ARR), shortest R‐R interval (SRR), longest R‐R interval (LRR), and variability of R‐R intervals. Peak plasma concentrations of verapamil were observed immediately after intravenous verapamil (mean elimination half‐life of 3.3 h) and 1 hour after oral verapamil (mean elimination half‐life 3.4 h, 80 mg; 3.1 h, 160 mg). In contrast to previous studies, we observed the maximum bradycardie effect of intravenous verapamil to occur at one‐half to 1 h, and this effect lasted for 2–4 h. Following oral verapamil the peak effect occurred at 3–4 h and lasted for 5–8 h. Analysise time course of changes in ARR, SRR, LRR, and variability of R‐R revealed two distinct “patterns” of ventricular response. In one group (4 of 8 patients), verapamil caused an increase in SRR but a decrease in LRR. R‐R intervals “regularized” in this group. In the remaining patients, verapamil increased the SRR but did not change or increase the LRR. This enhanced the observed increase in ARR intervals. We postulate that the decrease in LRR intervals after verapamil is due to reflex adrenergic discharge as a result of the vasodilator effect of the drug while the increase in SRR is a direct effect. These two opposing effects result in regularization of R‐R intervals in many patients. Patients demonstrating an increase in LRR intervals after verapamil may not get reflex adrenergic discharge or may be incapable of responding to the latter due to conduction disease; these patients may experience brady cardie complications after verapamil.
The use of encainide in atrial fibrillation
Authors: Vlay S. C. , Reid P. R. 
Published: February 2009

AbstractBased on its electrophysiologic characteristics, encainide, a new type 1 antiarrhythmic agent, was selected for a therapeutic trial in a case of refractory paroxysmal atrial fibrillation. This approach represents an attempt to manage the pathophysiologic disturbance of atrial fibrillation by selection of a drug that would be expected to have specific effects on the conduction system.
Cardiac rhythm disorders complicating coronary arterial spasm
Authors: Bashour T. 
Published: February 2009

AbstractPractically every known form of arrhythmia may complicate vasospastic ischemia. Of special importance are sinus node arrest and ventricular fibrillation. The high incidence of arrhythmia in this syndrome may be related to the usually severe profound ischemia or to the sudden massive reperfusion; both can frequently characterize transient severe segmental spasm of an artery without pre‐existing stenosis. Nitrates and calcium channel blockers may be effective in the control of vasospasm‐induced arrhythmia, but other traditional antiarrhythmic agents and pacemaker treatment may be required in some patients.
Sudden cardiac death recorded during ambulatory electrocardiographic monitoring
Authors: Hohnloser S. , Weiss M. , Zeiher A. , Wollschläger H. , Hust M. H. , Just H. 
Published: February 2009

AbstractTwo case reports of sudden cardiac death are detailed here. Holter monitoring plays an important role in documenting arrhythmias leading to sudden cardiac death. In addition, the importance of the Lown grading concept should not be underestimated. Our two case reports and a subsequent review of the literature demonstrate both points.A total of 57 patients with sudden cardiac death during Hotter monitoring have been reported. In this population bradyarrhythmias can be found in about 15%. Such arrhythmias can mainly be seen in elderly patients and are predictors of a very poor outcome for these individuals.Ventricular tachyarrhythmias in Holter recordings are the most common documented rhythm disturbances leading to sudden cardiac death. In patients with manifest cardiac diseases they are nearly always preceded by ventricular arrhythmias of the Lown grade III‐V which usually occur 3–5 h prior to the terminal event. Short coupled ventricular premature beats, so called R on T extrasystoles, were observed in more than one‐third of Holter recordings of patients suffering sudden death due to ventricular tachyarrhythmias; the importance of this phenomenon becomes obvious with this high incidence. The clinical value of these warning arrhythmias is, of course, limited because the arrhythmias were detected only after the fatal event by re‐evaluation of the Holter monitoring recordings. Nevertheless, these high‐grade ventricular arrhythmias demonstrate a marked degree of electrical instability within the heart. Furthermore, the high incidence of serious rhythm disturbances in the setting of sudden cardiac death underlines the importance of the Lown grading concept of ventricular arrhythmias (Lown and Wolf, 1971).Polymorphous ventricular tachycardia, commonly called torsade de pointes, must be considered as the cause of sudden cardiac death in approximately 20–25% of patients. This special kind of ventricular arrhythmia may play a dominant role in the origin of sudden death in patients treated with antiarrhythmic agents. (Deneset al, 1981; Hustet al, 1983; Kerenet al., 1981). Clinical recognition is of enormous importance because therapy of torsade de pointes differs from therapy of other forms of ventricular tachyarrhthmias.
Dihydroquinidine versus disopyramide: Efficacy in patients with chronic stable ventricular ectopy
Authors: Chimienti M. , Panciroli C. , Salerno J. A. , Previtali M. , Bobba P. , Regazzi‐Bonora M. , Cristiani D. , Rondanelli R. 
Published: February 2009

AbstractDihydroquinidine (DQ) is contained in substantial amounts in quinidine salts, but its direct antiar‐rhythmic action has not been studied. The efficacy of oral DQ (300 mg t.i.d.) compared to disopyramide (D) (200 mg t.i.d.) was thus investigated using a double‐blind crossover placebo‐controlled protocol in 12 patients, aged 13 to 67 years, with chronic stable high frequency premature ventricular beats (PVB), defined as > 100 PVB/h during 48‐72‐h control Holter monitoring. The protocol included three 72‐h treatment periods: DQ, D, and placebo at random. On days 2 and 3 of each period a 24‐h Holter recording was carried out; drug blood levels were determined at peak (days 2 and 3) and trough time (day 3). No significant difference in the mean PVB/h was found between control (735±400) and placebo periods (564 ±388), or between the two Holter recordings of each period. Compared to placebo both DQ (106±113, p<0.005) and D (240±263, p<0.05) reduced the mean PVB/h, but the decrease was significantly higher with DQ (78 versus 53%, p<0.02). Nine patients (75%) on DQ and 5 (42%) on D had a >70% decrease in mean PVB/h; complex PVBs were abolished in 3 of 6 patients on both treatments. On day 3, DQ plasma levels were 1.31 ±0.44 (peak) and 0.92 ±0.45 (trough) mg/1; D plasma levels were 2.88±0.64 (peak) and 2.02±0.31 (trough) mg/1; no significant difference was found between day 2 and day 3 samples. Side effects were cutaneous rashes in one patient on DQ and pyrosis in one patient on D. The conclusion is that DQ at the doses used is a very effective and well‐tolerated antiarrhythmic agent. In this study it appeared to be superior to average doses of D for suppressing chronic ventricular arrhythmias.
Superiority of supine bicycle over isometric handgrip exercise in the assessment of ischemic heart disease: An evaluation of left ventricular ejection fraction response using radionuclide angiography
Authors: Kaul S. , Hecht H. S. , Hopkins J. , Siedman R. I. , Singh B. N. 
Published: February 2009

AbstractLeft ventricular ejection fraction (LVEF) response to supine bicycle and isometric handgrip exercise was evaluated in 15 patients with documented coronary artery disease (CAD) and stress‐induced ischemia using radionuclide angiography. For purposes of analysis, the patients were divided into two groups: group I (n=7) with single‐vessel disease and group II (n = 8) with multiple‐vessel disease including 3 with left main artery disease. The studies were repeated 18 days later at similar external workloads to assess reproducibility of both tests. LVEF response to bicycle exercise was different for the two groups. The change in LVEF from rest to peak exercise was +0.04±0.02 for group I and ‐0.07±0.04 for group II (p <.001). LVEP response to isometric handgrip exercise was not different between the two groups. The change from rest to end of handgrip exercise was ‐0.02+0.02 for group I and ‐0.05 ±0.02 for group II. The reproducibility of LVEF response to bicycle exercise at similar workloads on day 1 and day 19 was good (r=0.85) while it was poor for isometric handgrip testing (r=0.67). Our data demonstrate that radionuclide angio‐graphic measurement of LVEF response to supine bicycle exercise testing is superior to LVEF response to isometric handgrip testing in the evaluation of patients with CAD.
Prolonged survival in tricuspid atresia with eisenmenger's physiology
Authors: Hart A. S. , Vacek J. L. 
Published: February 2009

AbstractSurvival to adulthood is very rare in tricuspid atresia, particularly in certain subtypes and in the presence of Eisenmenger's physiology. We report a 32‐year‐old woman who has the type IC variant of tricuspid atresia and who has had documented Eisenmenger's physiology for over 10 years.
Left ventriculography induced coronary artery spasm
Authors: Fleming G. , Shanes J. G. 
Published: February 2009

AbstractAngiographic contrast material is generally considered a vasodilator, although in vitro experiments have documented a spasmogenic effect. In this report we describe a patient with exercise and rest angina who developed spasm of the right coronary artery immediately following left ventricular angiography. The patient was treated successfully with calcium channel blockers. This is the first reported case of left ventricular angiography‐induced coronary artery spasm.
Clinical and echocardiographic features of isolated severe pure mitral regurgitation
Authors: Pizzarello R. A. , Turnier J. , Dworkin P. , Goldman M. A. , Oka M. , Tortolani A. J. , Padmanabhan V. T. 
Published: February 2009

AbstractRecent studies have shown that rheumatic heart disease is no longer the main cause of isolated severe pure mitral regurgitation. In this study, we evaluated various clinical and echocardiographic features found in the syndrome of mitral regurgitation. Our data is consistent with recent reports that mitral valve prolapse and coronary artery disease are now the predominant causes of mitral regurgitation and that rheumatic heart disease is a much less common etiology. In addition, our data suggest that clinical evaluation alone is usually very accurate in identifying the correct etiology. Various clinical and echocardiographic features found in the subsets of acute and chronic mitral regurgitation are described. Specifically, patients with acute mitral regurgitation were more likely to have echocardiographic evidence of segmental left ventricular dysfunction and flail mitral valve leaflet. In chronic mitral regurgitation, atrial fibrillation and left atrial dilatation were more commonly present. Echocardiography was found to be more useful in the detection of the complications of coronary artery disease rather than in identifying its presence. Patients with a New York Heart Association classification of IV and those with echocardiographic evidence of an increased left ventricular end‐systolic dimension or left ventricular hypertrophy had a worse prognosis.
Global left ventricular function and regional wall motion in pure mitral stenosis‐Left ventricular function in pure mitral stenosis
Authors: Colle J. P. , Rahal S. , Ohayon J. , Bonnet J. , Le Goff G. , Besse P. , Bricaud H. 
Published: February 2009

AbstractGlobal left ventricular function (LVF) and scgmental wall motion of the left ventricle are registered in 113 patients presenting a pure mitral stenosis (MS) and in a control group of 50 individuals. The segmental wall motion is measured on the end‐diastolic‐end‐systolic frames of the left ventricle, obtained from right anterior oblique (RAO) monoplane cineangiography. Measurement of the segmental wall shortening is performed using the Stanford method. Group 1 includes 68 patients (60% of the total number of patients studied). These patients show no pathological contraction abnormality. In this group, the global LVF is not different from the control group. Group 2 includes 45 patients (40% of the total) for whom contraction abnormalities are present: anterior hypokinesis in 20% of the cases (anterior area mean shortening (AAS) = 18±8%; p<0.001 vs. group 1 and control group), and posterior hypokinesis in 20% of the cases (posterior area mean shortening (PAS) = 9.8 ±5.8%, p<0.001 vs. group 1 and control group). In this group, global LVF is impaired; ejection fraction (EF) = 0.57±0.1% (p<0.001 vs. group 1); velocity of circumferential fiber shortening (Vcf) = l±0.3 circ/s (p<0.001 vs. group 1); end‐diastolic pressure (EDP) = 11±5 mmHg (p<0.01 vs. group 1). Segmental contraction abnormalities appear to be the main factor involved in the global LVF impairment. Segmental wall motion abnormalities could be related to subvalvular fibrosis, or LV filling difficulties, or principally, to a possible interplay between the right and the left ventricles.
Intracoronary streptokinase therapy in the coronary care unit for acute myocardial infarction
Authors: Natarajan N. , Karlekar K. , Turkevich D. , Herschman A. , Weisfogel G. , Stahl T. , Jennings P. B. , Pessolano J. , Larson V. , Burke P. 
Published: February 2009

AbstractIntracoronary streptokinase was offered and preliminary coronary angiography performed in 14 patients who were seen with the clinical diagnosis of acute myocardial infarction within 4 h of onset of symptoms. The procedure was performed in the Coronary Care Unit (CCU) of St. Peter's Medical Center with the use of a portable C‐arm fluoroscope. Angiography was recorded on video tape. Service was provided by an “on‐call” team consisting of two physicians, a CCU nurse, and a radiology technician, on a 24‐h service basis. Adequate visualization of coronary anatomy was obtained in all patients. Patency of occluded vessels was achieved in 10 of 11 patients who received intracoronary streptokinase. The initial streptokinase bolus was administered at a mean interval of 4.1 h from onset of symptoms. It is concluded that speedy and effective coronary thrombolytic therapy can be provided in the CCU on a 24‐h service basis by an on‐call team. The use of CCU for this purpose will make this therapy widely available across the country, without the need for Cardiac Catheterization Laboratory.
Systolic and diastolic time intervals during spontaneous angina
Authors: Ferro G. , Piscione F. , Carella G. , Betocchi S. , Spinelli L. , Chiariellom M. 
Published: February 2009

AbstractIn 5 patients who suffered spontaneous angina during cardiac catheterization, aortic pressure and electrocardiographic lead (V5) were recorded at rest, at the onset of anginal pain, 5 and 10 min after 0.6 mg sublingual nitroglycerin (NTG). Heart rate, systemic arterial pressure, systolic, and diastolic time intervals were measured. Heart rate and systemic arterial pressure rose significantly immediately after the onset of angina and declined progressively within 10 min from NTG administration. Pre‐ejection period did not change during angina, while left ventricular ejection time and electromechanical systole lengthened. As a consequence, diastolic time, expressed as percent of cardiac cycle, shortened sharply. All parameters considered went back to basal values within 10 min from NTG administration, and were preceded by relief or reduction of anginal pain. We concluded that a fall in diastolic time, secondary to a prolongation of electromechanical systole occurring during angina, may further increase the degree of ischemia resulting in a vicious cycle that can be interrupted by NTG administration.
Echocardiographic evaluation of cardiovascular effects of amrinone
Authors: Modena M. G. , Benassi A. , Mattoli G. 
Published: February 2009

AbstractAmrinone, a new inotropic drug, was infused at a dosage of 2.5 mg/kg body weight in 14 patients affected by dilatative cardiomyopathy in New York Heart Association (NYHA) functional class III and IV. Cardiac index, mean arterial pressure, and some echocardiographic parameters were evaluated. Cardiac index (CI) increased from 2.03±0.24 to 2.82±0.43 1/min/m2 (p<0.001). Fractional shortening (FS) increased from 16.4 ± 5.2 to 21.5±5.3% (p<0.05). End‐diastolic and end‐systolic diameters showed a significant reduction. Mean arterial pressure decreased from 90.7±8.8 to 87.3±8.4 mmHg (p<0.001), the end‐systolic stress (ESS) decreased from 5.8±1 to 5.2±1 g/cm (p<0.001). Analyzing the relationship between FS and ESS, it was possible in some cases to suppose the presence of an important vasodilator effect of the drug. The afterload in 7 patients was therefore modified before and after infusion of the drug to analyze FS at the same levels of afterload. This was done to evaluate the vasodilator effect of amrinone. Examining the regression line of FS/ESS ratio it was possible to observe a predominant vasodilator effect in some patients, but in most, a sinergic action was noted. This may be useful for chronic treatment of congestive heart failure, reducing amrinone doses, and using it in association with other vasodilator drugs.
Asymmetric septal hypertrophy in kearns‐sayre syndrome
Authors: Kupari M. 
Published: February 2009

AbstractKearns‐Sayre syndrome was diagnosed in a 40‐year‐old female patient admitted for evaluation of symptomatic bradycardia. In addition to the classic triad—external ophthalmoplegia, pigmentary retinopathy, and heart block—she also had secondary amenorrhea, hearing loss, diabetes, and increased concentrations of blood lactate and pyruvate as manifestations of this multisystem disease. The echocardiographic examination disclosed asymmetric septal hypertrophy with a septal diastolic thickness of 17 mm and a septum to free wall ratio of 1.5. The left ventricular size and function were normal. Thus, asymmetric' septal hypertrophy may represent subclinical heart muscle involvement in Kearns‐Sayre syndrome.
Secondary mania associated with diltiazem
Authors: Palat G. K. , Hooker E. A. , Movahed A. 
Published: February 2009

AbstractDiltiazem, a calcium‐channel blocker, is an effective antianginal agent, particularly in treating the vasospastic type of angina pectoris. This drug has recently been released for use in the United States. Noncardiac untoward effects of diltiazem are few. We describe a case of mania with psychotic features that occurred while a patient was on diltiazem.
The use of calcium gluconate priorto verapamil in infants with paroxysmal supraventricular tachycardia
Authors: Roguin N. , Shapir Y. , Blazer S. , Zeltzer M. , Berant M. 
Published: February 2009

AbstractVerapamil is a useful drug for treating supraventricular tachycardia; however, severe side effects occasionally have been reported in infants. We describe here our experience with the use of a 10 percent solution of intravenous calcium gluconate prior to the use of verapamil in infants with paroxysmal supraventricular tachycardia. In all the attacks verapamil converted the supraventricular tachycardia to sinus rhythm. We feel that calcium gluconate injected previous to verapamil can avoid the negative inotropic effects without interfering with the antiarrhythmic properties of verapamil.