bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multivessel coronary thrombosis treated with abciximab (reopro®) in a patient with essential thrombocythemia
Authors: Michaels Andrew D. , Whisenant Brian , Macgregor John S. 
Published: February 2009

AbstractA 50‐year‐old man was admitted with acute inferior and anterior myocardial infarction. The patient was diagnosed with essential thrombocythemia (ET) based on the findings of marked thrombocytosis of 1,113 × 103/mm3, splenomegaly, and numerous clumping megakaryocytes on bone marrow biopsy. Emergent coronary angiography revealed extensive multivessel thrombosis involving the left main coronary artery and completely occluding the proximal right coronary artery. In addition to standard therapy with aspirin, heparin, and primary angioplasty of the right coronary artery, the patient received additional antiplatelet therapy with ticlopidine, hydroxyurea, and the platelet glycoprotein IIb/IIIa receptor‐inhibiting monoclonal antibody drug abciximab (ReoPro®). Serial coronary angiograms 1 and 5 days following the infarction showed progressive thrombus resolution. The pathophysiologic mechanisms and therapeutic challenges of ET‐associated coronary thrombosis are discussed in this report.
Current knowledge and significance of coronary artery ectasia: A chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations
Authors: Sorrell Vincent L. , Davis Michael J. , Bove Alfred A. 
Published: February 2009

AbstractCoronary artery ectasia is the abnormal enlargement of the coronary artery. The prognosis, treatment, and etiology of this disease remain an enigma. There is some evidence to suggest that the incidence of ectasia is increasing, and therefore understanding of this entity needs to improve. This article reviews the current literature on coronary artery ectasia and summarizes the findings. A treatment plan that targets each of the suggested clinical complications is provided. Using multiple indirect observations and current understanding of endothelium‐derived relaxation factor, a possible etiology that implicates overstimulation of endogenous nitric oxide is provided. Current literature suggests that ectatic coronary arteries, even without the presence of coronary stenosis, are subject to thrombus formation, vasospasm, and spontaneous dissection. Newer subgroups of ectasia are arising with the use of multiple interventional devices to dilate coronary artery stenosis. By design, these destroy the media of the coronary artery, and it is not clear whether these “iatrogenic” ectatic arteries are subject to the same complications as “idiopathic” coronary artery ectasia. Further investigation is necessary to help define the benefit of the proposed treatment regimen, to clarify the prognosis of these newer groups of “iatrogenic” ectasia, and to confirm or disprove the hypothesis targeting nitric oxide as an etiologic factor.
Validation of a decision support tool for the evaluation of cardiac arrest victims
Authors: Mccullough Peter A. , Thompson Richard J. , Tobin Kenneth J. , Kahn Joel K. , O'Neill William W. 
Published: February 2009

AbstractBackground: There is currently no well‐accepted model for early and accurate prediction of neurologic and vital outcomes after cardiac arrest. Recent studies indicate that individuals with acute myocardial ischemia as the etiology for the arrest may benefit from early revascularization.Hypothesis: This study was undertaken to examine whether the cardiac arrest score is valid for predicting outcomes upon arrival at the emergency department.Methods: We previously developed a cardiac arrest score based on time to return of spontaneous circulation, initial systolic blood pressure, and level of neurologic alertness in 127 patients (derivation set). This score was prospectively applied to 62 patients with similar clinical profiles (validation set). Utility of the score was evaluated by the area under the receiver operator characteristic curves (C) for both sets. Consistency was measured by using the alpha statistic applied to the cumulative survival at each ascending level of the score.Results: The derivation and validation sets were similar with respect to baseline characteristics and proportions at each level of score. The survival to discharge was 41.7 and 53.2% for the two sets, respectively. The value of C was 0.89 ± 0.03 and 0.93 ± 0.03 for neurologic recovery and 0.81 ± 0.04 and 0.92 ± 0.04 for survival to discharge in the two sets, respectively. The level of agreement between the sets across the levels of the score was 0.98 and 0.99 (both p<0.0001) for the two outcomes.Conclusions: The cardiac arrest score is a valid decision support tool in the evaluation of cardiac arrest victims. Patients with the most favorable scores may be considered for early angiography and revascularization if myocardial ischemia is the etiology of the arrest.
Unstable angina: Specialty‐related disparities in implementation of practice guidelines
Authors: Reis Steven E. , Zell Kathleen A. , Edmundowicz Daniel , Shapiro Alan H. , Feldman Arthur M. , Holubkov Richard 
Published: February 2009

AbstractBackground: The Agency for Health Care Policy and Research (AHCPR) has published practice guidelines to improve the quality of care of patients with unstable angina. Prior to publication, studies demonstrated that when compared with cardiologists, internists were less likely to use effective pharmacologic therapies or revascularization in patients with unstable angina.Hypothesis: The study was undertaken to determine whether the AHCPR guideline publication abolished specialty‐related disparities in care.Methods: We performed a chart review of consecutive patients hospitalized at a university‐affiliated institution with an admission diagnosis of chest pain in the absence of myocardial infarction and a noncardiac etiology. Treatment and diagnostic cardiac testing were compared between risk‐stratified patients cared for by a generalist (n = 125) and those whose care was guided by a cardiologist (n = 211).Results: In those with low‐risk unstable angina, generalists were less likely to prescribe recommended aspirin (71 vs. 88%, p<0.01) and beta blockers (9 vs. 37%, p<0.001), and heparin (20 vs. 49%, p<0.001), and to perform a recommended diagnostic stress test or cardiac catheterization (28 vs. 60%, p<0.001). In those with at least intermediate risk, generalists were less likely to prescribe beta blockers (19 vs. 52%, p<0.001), heparin (19 vs. 66%, p<0.001), and nitrates (77 vs. 96%, p<0.001), and to refer for diagnostic testing (19 vs. 65%, p<0.001). Generalists' care was associated with significantly lower hospital charges.Conclusions: AHCPR guidelines for the evaluation and treatment of unstable angina are implemented more effectively, but not uniformly, by cardiologists at our institution. Further studies are necessary to evaluate the barriers to implementation of the AHCPR guidelines.
Hormones and the cardiologist
Authors: Abrams Jonathan 
Published: February 2009

AbstractCardiologists must become more involved in discussing and recommending hormone replacement in postmenopausal women with established coronary artery disease, and those individuals at high risk of coronary events. A large amount of epidemiologic and observational data, as well as new research in vascular biology, strongly support the benefits of estrogen on the development and progression of coronary atherosclerosis. While breast and uterine cancer are valid concerns, selected high‐risk women with and without established coronary disease should be counseled by an informed cardiologist to consider hormone replacement therapy.
Patterns of angiotensin‐converting enzyme inhibitor prescriptions, educational interventions, and outcomes among hospitalized patients with heart failure
Authors: Mcdermott Mary Mcgrae , Lee Peter , Mehta Shruti , Gheorghiade Mihai 
Published: February 2009

AbstractBackground: Among hospitalized patients with heart failure, we describe characteristics associated with prescription of angiotensin‐converting enzyme (ACE) inhibitors in the doses recommended by clinical practice guidelines. We also describe the impact of ACE inhibitor prescriptions, increases in ACE inhibitor dose, and nonpharmacologic educational interventions on readmission‐free survival rates.Hypothesis: We hypothesize that care by a cardiologist physician and higher mean arterial blood pressure on admission are associated with receipt of optimal ACE inhibitor doses. We hypothesize that receipt of an ACE inhibitor at discharge and an increase in ACE inhibitor dose during hospitalization are associated with superior readmission‐free survival.Methods: Between January 1, 1992, and December 31, 1993, medical records were reviewed for consecutively hospitalized patients with a principal diagnosis of heart failure at an academic medical center. Documented instructions and medications prescribed at discharge were abstracted. Deaths and readmissions through December 31, 1994, were identified with the National Death Index and the study institution's administrative data base, respectively.Results: During 1992 and 1993, 387 patients were discharged alive from hospitalization for heart failure. Among patients discharged on enalapril or captopril, 18% received doses recommended by heart failure clinical practice guidelines. Patients discharged on a recommended ACE inhibitor dose were more likely to be African‐American and had lower sodium levels and higher mean arterial pressures than patients discharged on lower ACE inhibitor doses. In survival analyses, an increase in ACE inhibitor dose was associated with improved readmission‐free survival, independent of left ventricular systolic function type. Receipt of an ACE inhibitor at discharge was also associated with superior readmission‐free survival, while nonpharmacologic educational instructions were not associated with improved outcomes.Conclusion: Interventions are needed to improve the frequency with which ACE inhibitors are prescribed at recommended doses to hospitalized patients with heart failure. We conclude that among these patients, receipt of an ACE inhibitor at discharge and an increase in ACE inhibitor dose during hospitalization are each associated with measurable effects on readmission‐free survival, while provision of educational instructions as currently practiced is not associated with better outcomes.
Comments about the electrocardiographic signs of right ventricular infarction
Authors: Hurst J. Willis 
Published: February 2009

AbstractThis manuscript was written in an effort to emphasize the points made by Porter et al. (Clin Cardiol 1997; 20:971‐973). Right ventricular infarction may be erroneously interpreted as an anteroseptal infarction because of elevation of the S‐T segments in leads V1‐V4. The two can be separated when, using the Grant method of analysis, the S‐T segments are represented as vectors: the mean S‐T vector is directed inferiorly, to the right, and anteriorly when there is an inferior‐right ventricular infarct, and superiorly, to the left, and anteriorly when there is an anteroseptal infarction. Other aspects of right ventricular infarction are also discussed.
Management Strategies for a Better Outcome in Unstable Coronary Artery Disease
Authors: Campbell R. W. F. , Wallentin L. , Verheugt F. W. A. , Turpie A. G. G. , Maseri A. , Klein W. , Cleland J. G. F. , Bode C. , Becker R. , Anderson J. , Bertrand M. E. , Conti C. R. 
Published: February 2009

AbstractUnstable coronary artery disease is a term encompassing both unstable angina and non‐Q‐wave (non‐ST‐segment elevation) myocardial infarction. Patients with these conditions are at risk of early progression to acute myocardial infarction and death. Thus, management of these conditions must aim to reduce long‐term mortality and morbidity. Risk stratification is crucial for the identification of patients whose risk of early progression is high; they may require coronary angiography and (if suitable) either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. No single variable can accurately predict risk, but considerable data are emerging to show that biochemical markers of myocardial injury, such as troponin‐T and troponin‐I, are valuable in combination with electrocardiographic findings and clinical features. Routine early invasive procedures (coronary angiography with or without revascularization) have not yet been shown to have any significant advantage over conservative regimens for the majority of patients. Antiplatelet, anticoagulant, and anti‐ischemic agents remain the mainstay of treatment in the acute phase. New agents, such as glycoprotein IIb/IIIa receptor inhibitors and low‐molecular‐weight heparins, as well as antithrombins and Factor Xa inhibitors add to the treatments currently available. Thrombolytic agents are contraindicated in the absence of ST‐segment elevation. After clinical stabilization, ongoing assessment should include exercise testing for all patients who are able; other imaging techniques should be used for patients unable to exercise. A profile indicating a high risk of future events is an indication for elective angiography and consideration for revascularization.
Importance of α1‐sympathetic activity for diurnal change in ischemic threshold in patients with stable angina
Authors: Fujita Masatoshi , Sasayama Shigetake , Tanaka Terumitsu , Nakae Izuru , Tamaki Shun‐Ichi , Kihara Yasuki , Nohara Ryuji 
Published: February 2009

AbstractBackground: Although ischemic threshold reportedly is lower in the early morning than in the afternoon, the mechanisms that account for the diurnal change in minimal coronary vascular resistance in the potentially ischemic area are unknown.Hypothesis: We hypothesized that calcium‐channel blockers and α1 blockers may affect the ischemic threshold in the early morning and afternoon in patients with stable angina.Methods: Before and after the administration of the calcium antagonist amlodipine (5 mg) alone and combined with the α1 blocker prazosin (1 mg), a treadmill exercise test using the Balke‐Ware protocol was undertaken in the morning (8:00 A.M.) and repeated in the afternoon (1:00 P.M.) with 15 stable angina patients. The ischemic threshold was defined as a reciprocal of minimal coronary vascular resistance in the presence of comparable levels of myocardial ischemia indicated by 0.1 mV ST depression. Minimal coronary vascular resistance was calculated as mean blood pressure divided by coronary blood flow. Since the coronary blood flow is closely related to myocardial oxygen consumption, which can be replaced by the double product of heart rate and systolic blood pressure, minimal coronary vascular resistance was approximated to 1/heart rate.Results: At baseline, minimal coronary vascular resistance was significantly higher in the early morning than in the afternoon (8.5 ± 0.3×10−3 min/beats vs. 7.8 ± 0.4×10−3 min/beats, p<0.01). Although treatment with amlodipine alone did not abolish the circadian pattern of minimal coronary vascular resistance (8.0 ± 0.6×10−3 min/beats vs. 7.7 ± 0.6×10−3 min/beats, p<0.05), the addition of prazosin virtually eliminated the diurnal difference in minimal coronary vascular resistance (7.4 ± 0.5×10−3 min/beats vs. 7.5 ± 0.5×10−3 min/beats, p = NS).Conclusions: These findings indicate that α1‐sympathetic activity may play a role in the pathogenesis of the diurnal change of ischemic threshold in patients with stable angina.
Reversal of dilated to hypertrophic cardiomyopathy after alcohol abstinence
Authors: Stöllberger Claudia , Finsterer Josef 
Published: February 2009

AbstractLeft ventricular dilatation and systolic dysfunction develop in 14‐16% of patients with hypertrophic cardiomyopathy. Such findings may easily be misdiagnosed as dilated cardiomyopathy. It is unknown whether left ventricular dilatation and systolic dysfunction in patients with hypertrophic cardiomyopathy are reversible. A 35‐year‐old man had been a heavy drinker for 13 years and was abstinent for 1 year. Five years previously he suffered cardiac arrest and, based on echocardiographic, radionuclide, and cardiac catheterization findings, the diagnosis of alcohol‐induced dilated cardiomyopathy was established. At presentation the heart was of normal size, with concentric left ventricular hypertrophy and only slightly reduced systolic function. Hypertrophic cardiomyopathy was diagnosed since no other cause for left ventricular hypertrophy could be detected. In hypertrophic cardiomyopathy, alcohol may induce reversible systolic dysfunction and left ventricular dilatation.
Successful conserative treatment of nontyphoid salmonella endocarditis involving a bioprosthetic valve
Authors: Goerre Stefan , Aeschbacher Beat C. , Malinverni Raffaele 
Published: February 2009

AbstractWe report a first case of Salmonella enteritidis endocarditis involving a bioprosthetic aortic valve. Despite additional native tricuspid valve involvement, the clinical course was favorable using an antibiotic regimen of ciprofloxacin and netilmicin. Although Salmonella prosthetic valve endocarditis is considered an indication for surgical replacement of the prosthesis, this case indicates that prolonged treatment with fluoroquinolones may be an alternative provided that the hemodynamic situation is stable.
Comparison of the diagnostic performance of two rapid bedside biochemical assays in the early detection of acute myocardial infarction
Authors: Panteghini M. , Pagani F. , Cuccia C. , Turla C. 
Published: February 2009

AbstractBackground: New biochemical markers have been recently proposed as potential aids in the diagnosis of myocardial infarction. Assessment of these markers in real time by near‐patient testing would allow more rapid decisions regarding critical therapeutic interventions.Hypothesis: The diagnostic performance of two qualitative, whole blood assays for measurement of myoglobin/creatine kinase (CK)‐MB mass (CARDIAC STATusTM) and cardiac troponin T (TropT$$) was compared. Their potential in optimizing the rule‐in of patients with infarction in order to initiate revascularization therapies was also evaluated.Methods: A group of 101 patients admitted to the hospital within 12 h from onset of symptoms suggestive of myocardial infarction was studied. A first blood sample was drawn in all patients immediately after admission. In patients not receiving reperfusion therapy (n = 61), three additional samples were also obtained 2,4, and 6 h later.Results: CARDIAC STATus showed good performance in patients with an admission time > 2 h from onset of pain (diagnostic efficiency, 71‐100%). Conversely, TropT was not sensitive enough for acceptable efficiency. In a subset of 39 patients admitted within 6 h who did not meet standard enrollment criteria for thrombolysis, CARDIAC STATus allowed early detection of almost 50% of infarcts, enabling a significant implementation of alternative revascularization therapies.Conclusions: In patients admitted to the coronary care unit on the basis of case history and clinical examination, CARDIAC STATus assay is more effective than TropT in the early diagnosis of infarction, providing a valuable aid to cardiologists for confirming a suspected infarction rapidly, thus allowing, if indicated, recourse to revascularization therapy in clinically uncertain cases.
Occurrence, characteristics, and outcome of patients hospitalized with a diagnosis of acute myocardial infarction who do not fulfill traditional criteria
Authors: Herlitz Johan , Karlsson Thomas , Karlson Bjöurn , Engdahl Johan , Sandén Wanja , Dellboirg Mikael 
Published: February 2009

AbstractBackground: The diagnosis of acute myocardial infarction (AMI) is traditionally based on clinical history, elevation of serum enzyme activity, and typical changes in the electrocardiogram (ECG); however, not all patients who develop AMI fulfill these criteria on discharge from hospital.Hypothesis: The aim of the study was to evaluate (1) the frequency with which the traditional criteria for AMI are not fulfilled among patients diagnosed with AMI on discharge, and (2) whether patients with and without these criteria differ in terms of characteristics, treatment, and outcome.Methods: All patients aged < 75 years and hospitalized in the municipality of Göteborg with a discharge diagnosis of AMI were included. Fulfillment criteria for AMI were two of the following three points: (1) chest pain, (2) increase in cardiac enzymes, and (3) development of Q waves.Results: In all, 1,188 admitted patients, 27% of whom were women, were included in the analysis. Of these, 193 (16%) did not fulfill the traditional criteria for AMI. These patients had an in‐hospital mortality rate of 48%; of these, 59% died a sudden death, and of those who were autopsied (62%), 96% showed signs of a fresh AMI. The most common symptom on admission to hospital in patients who did not fulfill the traditional criteria was chest pain (34%), followed by dyspnea (27%) and fatigue (14%). Of those who died suddenly, fewer than half had been admitted to the coronary care unit.Conclusion: Patients diagnosed with AMI who do not fulfill the traditional diagnosis criteria have high mortality. On admission to hospital, the initial suspicion of AMI is often vague. Measures for earlier detection of life‐threatening coronary artery disease among these patients are warranted.
Streptococcal mural endocarditis and myocardial abscess occurring in a left ventricular aneurysm—case report and review
Authors: Lo S.S.S. , Sheppard M.N. , Frcpath J.G. , Bennett M.J. , Poole Wilson R.A. , Weinbren M.J , Ong Y.E. 
Published: February 2009

AbstractInfection of the mural endocardium within a left ventricular aneurysm without valvular involvement is exceedingly rare. The presenting clinical features can be non‐specific, and a high index of suspicion is required for its diagnosis. Delay in diagnosis invariably leads to a fatal out‐come. Although no controlled studies are available to guide therapy and management of these patients, appropriate antibiotic therapy and early surgical resection of the infected ventricular aneurysm remain the cornerstone of therapy.