bluuebunny/crossref_metadata_2025_split huggingface dataset:
Massive left atrial thrombus: A possible paraneoplastic complication of breast carcinoma
Authors: Wrisley D. , Giambartolomei A. , Lee I. , Brownlee W. 
Published: February 2009

AbstractWe describe a patient with long‐standing rheumatic mitral valve disease, left atrial dilatation, and a precommissurotomy history of left atrial thrombus. Following operation she was maintained on daily aspirin as an antithrombotic measure. For 6 years she had no evidence, echocardiographically, of left atrial thrombus. She underwent surgery for apparently nonmetastatic breast cancer in early 1986. In May 1986 the left atrium was echocardiographically clear. At approximately the same time, recurrence was found at the suture line. In October 1987, two metastatic lung lesions and a very large left atrial mass were detected by computed tomography. The atrial mass was surgically removed and found to be a thrombus. There was a striking temporal correlation between dissemination of carcinoma and development of a massive atrial thrombus.
Diabetic heart disease—Part II: The clinical and pathological spectrum
Authors: Van Hoeven K. H. , Factor S. M. 
Published: February 2009

AbstractDiabetes mellitus is a significant condition, affecting major segments of all population groups studied. With the introduction of insulin and oral hypoglycemic therapy, together with better understanding of diet and weight control gained over the past half century, the primary causes of diabetic morbidity and mortality have shifted in varying proportions from metabolic derangements, infection, and renal insufficiency to different types of cardiovascular disease. Despite extensive clinical and laboratory research on the etiology, pathogenesis, and even the existence of cardiovascular disease associated with diabetes mellitus, however, considerable debate is still apparent in this field. Our purpose is to present an overview of the subject of diabetic heart disease, with a critical analysis of epidemiologic, clinical, and pathological data. Some of this material will be addressed from the perspective of research in this area over the past decade by one of us (SMF), particularly in experimental hypertensive and diabetic cardiomyopathy. However, overall, an attempt will be made to provide an objective and balanced analysis in order to answer the question: does diabetic heart disease exist?
Myocarditis: Unresolved issues in diagnosis and treatment
Authors: Maze S. S. , Adolph R. J. 
Published: February 2009

AbstractMyocarditis is an enigmatic disease. Lymphocytic myocarditis is most commonly viral in origin. Considerable evidence suggests that myocardial damage is due to an immune‐mediated mechanism rather than to direct effects of the virus itself. The presentation is variable, ranging from a clinically inapparent or relatively benign illness to acute progressive heart failure and death. Although examination of the endomyocardial biopsy specimen is the “gold standard” for the diagnosis of myocarditis there are problems with this technique, relating particularly to sampling error and histologic interpretation. Considerable evidence, both animal and human, suggests that a link between viral myocarditis and dilated cardiomyopathy does exist. There is a rational basis for the use of immunosuppressive therapy in myocarditis. Although many favorable responses have been reported with the use of these agents, the results of more definitive studies are awaited to determine the role of immunosuppressive therapy in myocarditis more clearly. Recommendations for the practical management of patients with myocarditis are made. Whenever possible, patients with this diagnosis should be entered into the ongoing NIH trial.
Indications for heart valve replacement
Authors: Assey M. E. , Spann J. F. 
Published: February 2009

AbstractProper evaluation of the patient with valvular heart disease begins with a thorough history and physical examination. Today, sophisticated noninvasive tests—especially echocardiography with color flow Doppler imaging—complement the information gained at cardiac catheterization. Information previously available only through cardiac catheterization can now be obtained from these noninvasive techniques. Serial evaluations can be performed, which are important in managing lesions of borderline hemodynamic significance and in avoiding subclinical deterioration of left ventricular contractility.Improvements in surgical expertise and intraoperative myocardial preservation allow postoperative improvement for patients with aortic stenosis and aortic insufficiency despite the presence of left ventricular systolic dysfunction. Many traditional indicators of a poor operative result in aortic insufficiency appear less reliable today. Consequently, these indicators should never be viewed in isolation or be given preeminence over clinical judgment.The long‐term results following aortic valvuloplasty have been disappointing. However, mitral valvuloplasty—for technically suitable types of mitral stenosis—is an attractive alternative to surgery. Echocardiography may be helpful in selecting patients best suited for this technique. The timing of valve replacement in mitral insufficiency is made difficult by the altered loading conditions which can mask underlying contractile dysfunction. In this regard, the use of end‐systolic measurements (e.g., end‐systolic stress‐volume ratio) more accurately characterized left ventricular contractility. When mitral insufficiency patients with left ventricular systolic dysfunction require surgery, valve repair appears superior to traditional mitral valve replacement. With valve repair, the postoperative left ventricular ejection fraction is usually higher, as left ventricular contractile reserve is better maintained.
The effect of complete and incomplete revascularization on exercise variables in patients undergoing coronary angioplasty
Authors: Atwood J. E. , Myers J. , Colombo A. , Pewen W. , Grover‐Mckay M. , Lehmann K. , Sandhu S. , Sullivan M. , Hall P. , Froelicher V. 
Published: February 2009

AbstractTo investigate the effects of complete and incomplete revascularization on the response to exercise, 25 patients underwent symptom‐limited exercise testing with continuous assessment of gas exchange a mean of 5 ± 4 days prior to and 18 ± 12 days following percutaneous transluminal coronary angioplasty. All antianginal medications were discontinued for testing. Revascularization was considered complete if all stenoses were reduced to less than 50% diameter (13 patients), and incomplete if one or more stenoses remained (12 patients). Consistent improvements in ST‐segment depression were observed after angioplasty at matched submaximal exercise levels (mean range 0.5‐0.8 mm; p < 0.05), and were accompanied by a reduction in angina. Significant increases in heart rate and systolic blood pressure were observed at peak exercise following angioplasty in both groups. Gas exchange variables were significantly improved at maximal exercise, with a similar increase in oxygen uptake observed in both groups following angioplasty (mean increase 3.3‐3.7 ml/kg/rnin; p < 0.01). Thus, incomplete revascularization following coronary angioplasty resulted in hemodynamic, electrocardiographic, symptomatic, and gas exchange responses to exercise that were comparable to complete revascularization.
Randomized double‐blind study of intravenous tocainide versus lidocaine for suppression of ventricular arrhythmias after cardiac surgery
Authors: Manolis A. S. , Smith E. , Payne D. , Rastegar H. , Cleveland R. , Mark Estes N. A. 
Published: February 2009

AbstractTo compare the therapeutic efficacy and safety of intravenous tocainide with that of intravenous lidocaine in patients with ventricular arrhythmias after cardiac surgery, 25 patients were randomized to either agent in a double‐blind manner. Tocainide was given in 16 patients as a 250 mg bolus followed by a loading infusion of 500 mg over 15 minutes and a maintenance infusion of 33.3 mg/min. Lidocaine was administered in 9 patients as a 100 mg bolus followed by a loading infusion of 60 mg over 15 minutes and a maintenance infusion of 1.4 mg/min. Therapy was continued for 24 hours in initially responding patients. With analysis of 24‐h taped electrocardiograms it was found that single premature ventricular complexes (PVCs) were suppressed by tocainide by more than 80% in 94% of patients and by lidocaine in 75% of patients (p = NS). Couplets and ventricular tachycardia events were eliminated in all patients by either drug. Multiform PVCs were abolished in 94% of the patients after tocainide and in 75% after lidocaine (p = NS). Average overall success over the 24 hours with more than 80% suppression of single PVCs and simultaneous elimination of higher forms of arrhythmia was 71% with tocainide and 59% with lidocaine (p = NS). Adverse effects were negligible, with only one patient in the lidocaine group developing diaphoresis without necessitating termination of therapy. Treatment rapidly produced and then maintained blood levels of 4‐10 mg/1 for tocainide and 1‐4 mg/1 for lidocaine. We conclude that intravenous tocainide is well tolerated and has comparable efficacy to lidocaine in the acute therapy of postcardiac surgery ventricular arrhythmias.
Value of notching and slurring of the resting QRS complex in the detection of ischemic heart disease
Authors: France R. J. , Formolo J. M. , Penney D. G. 
Published: February 2009

AbstractThe resting 12‐lead ECG has long been known to be an insensitive marker of underlying ischemic heart disease (IHD). The purpose of this study was to determine if QRS complex notching and slurring is of significant value as a diagnostic discriminator in the detection of IHD. The data from 205 consecutive patients coming to cardiac catheterization for evaluation of probable IHD were initially analyzed. Eighty‐three patients were excluded based upon ventricular hypertrophy, bundle‐branch block, lack of data, and pacemaker rhythm. The balance, 122 patients (mean age 61.7 years), were evaluated for angiographic evidence of IHD, ECG findings of QRS notching or slurring, and abnormal Q waves. The data revealed a high prevalence of QRS notching or slurring; 62.2% in those patients with IHD, double the prevalence of significant Q waves (33.3%). The two markers had an approximately equal prevalence (QRS notching or slurring 61.7% vs. Q waves 53.2%) in patients with angiographic evidence of infarction; however, in patients with less than infarct criteria for IHD, the prevalence of QRS notching or slurring was 62.8%, while only 11.6% showed abnormal Q waves. Analysis indicated that QRS notching or slurring has a sensitivity of 62.2% and a specificity of 93.8% for the detection of IHD. The study demonstrates that QRS notching or slurring is a moderately sensitive and a very specific marker of ischemic heart disease in selected patients when using the resting ECG, and is of greatest value in those patients with lesser degrees of ischemic myocardial injury where the prevalence of Q waves is low.
Repeat determination of left ventricular wall thickness from mass and volume during one cardiac cycle for the calculation of left ventricular wall stress parameters
Authors: Von Herrath M. , Hasenfuss G. , Holubarsch C. , Hofmann T. , Heiss H. W. , Just H. 
Published: February 2009

AbstractLeft ventricular end‐diastolic wall stress, end‐systolic wall stress, and systolic stress‐time integral are important parameters to characterize left ventricular load and function. To obtain these parameters, left ventricular pressure, volume, and wall thickness data must be determined at short time intervals throughout one cardiac cycle. However, the measurement of wall thickness at short intervals (i. e., 20 ms) throughout a cardiac cycle is tedious. Furthermore, measurements of wall thickness are less accurate at end‐systole compared with end‐diastole. For these reasons we developed a computer program for calculating wall thickness at short intervals (20 ms) throughout the cardiac cycle from one single determination of left ventricular wall mass and repetitive measurements of left ventricular (LV) volume.
Subclavian stenosis presenting as progressive exertional angina pectoris
Authors: Slutzker D. M. , Capeless M. A. , Brown K. A. 
Published: February 2009

AbstractLeft subclavian stenosis is an uncommon cause of exertional left arm pain. In a patient who presented with exertional chest and left arm pain in an increasing pattern, clinical evaluation disclosed a discrepancy between right and left arm blood pressure. Exercise stress testing with thallium revealed normal myocardial perfusion. Aortic arch and selective angiography revealed a high‐grade proximal left subclavian stenosis. Subclavian angioplasty was performed with complete resolution of symptoms. This case demonstrates that ischemic left arm pain due to subclavian stenosis can present as accelerated angina, and highlights the importance of determining blood pressure in both arms in routine evaluation of patients at risk for atherosclerosis.
Current perspectives in hypertrophic cardiomyopathy: Diagnosis, clinical management, and prevention of disability and sudden cardiac death
Authors: Von Dohlen T. W. , Frank M. J. 
Published: February 2009

AbstractHypertrophic cardiomyopathy is a rare primary myocardial disease known for its dramatic morphologic and clinical manifestations. Sudden cardiac death and functional cardiac symptoms are common. However, differing pathologic mechanisms may be responsible for similar clinical symptoms and make a unified approach to therapy impossible. This review will discuss the genetics, criteria for diagnosis, relationship among pathophysiologic abnormalities and clinical symptoms, and management of hypertrophic cardiomyopathy.
Coronary angioplasty after intravenous streptokinase in acute myocardial infarction: Influence of restenosis on clinical outcome and left ventricular function
Authors: Leisch F. , Kerschner K. , Harringer W. , Schützenberger W. 
Published: February 2009

AbstractThe importance of recurrence of stenosis on clinical outcome and left ventricular function was studied in a consecutive series of patients with acute evolving myocardial infarction (maximal duration of pain 4 h) and thrombolysis (1.5 × 106 units of streptokinase intravenously over 60 min) with recanalized single‐vessel disease and subsequent successful coronary angioplasty. Coronary angioplasty was performed in 76 patients between 24 hours and 8 days (mean interval 3.3 days) after thrombolysis and was successful in 86s% (65/76). The in‐hospital reinfarction rate was 5.2% (2 acute and 2 in‐hospital reinfarctions). Repeat angiography after a mean interval of 5.9 months revealed a 39% (24/62) restenosis rate (21 restenoses, 3 reocclusions). Restenoses were associated with significantly more clinical complaints (21 % vs. 62%; p < 0.001). Left ventricular function analysis showed significant improvement in the mean global ejection fraction (6.6 ± 6.0%; p < 0.001) and mean regional wall motion of the infarct zone (6.2 ± 8.2%; p < 0.01) only in patients without restenosis. Recovery of left ventricular function was more evident in inferior than in anterior wall infarctions. In contrast, patients with restenosis had no change in left ventricular function. Thus, the present study demonstrates the adverse influence of restenosis on recovery of left ventricular function and clinical outcome.
Superior vena cava syndrome as a complication of ddd pacemaker implantation
Authors: MURAKAMI Y. , MATSUNO Y. , IZUMI S. , MURAKAMI R. , TANAKA K. , MORIOKA S. , MORIYAMA K. 
Published: February 2009

AbstractA 75‐year‐old man was admitted to our hospital because of swelling of the face and neck 6 months after implantation of a two‐chamber pacemaker. Digital subtraction angiography showed total occlusion of the superior vena cava vein and well‐developed collateral channels. After thrombolytic therapy, facial swelling disappeared. Digital subtraction angiography performed after thrombolytic therapy revealed a recanalization of the superior vena cava.
Captopril improves hemodynamic response to static exercise in patients with congestive heart failure: A double‐blind, placebo‐controlled, randomized trial
Authors: Borgi C. , Costa F. V. , Ambrosioni E. , Magelli C. , Magnani B. 
Published: February 2009

AbstractSystemic and peripheral hemodynamic response to isometric exercise by handgrip test at 30% maximal voluntary contraction (MVC) for 3 minutes was assessed in 16 patients with congestive heart failure (CHF) after short‐term treatment with either captopril or placebo given according to a double‐blind, randomized, crossover sequence. During placebo, isometric exercise increased blood pressure (BP) and total peripheral vascular resistance (TPVR) and decreased cardiac index (CI). Captopril reduced the pressor response to exercise (mean±SD) (% systolic: from 14.7±6 to 11.7±3; p<.05/% diastolic: from 12.4±4 to 8±3; p<.005) and increased CI (from 2.3 ± .6 to 2.6± .9 liters/min/m2; p<.01) whereas TPVR remained virtually unchanged (from 1479±597 to 1594±692 U; NS). The changes in mean BP after exercise were inversely related to the early increase in forearm blood flow (FBF) in exercising forearm during both placebo (r=.67) and captopril (r=.71). The extent of reduction in mean BP response after captopril was inversely related to the extra increase in exercising FBF determined by the drug when compared to placebo (r=.73). We conclude that captopril is able to improve the hemodynamic response to static exercise in patients with CHF, probably by increasing the blood supply to exercising muscles during contraction, thus blunting the extent of reflex pressor response.
External compression by metastatic squamous cell carcinoma: A rare cause of left main coronary artery narrowing
Authors: Weinberg B. A. , Pinkerton C. A. , Waller B. F. 
Published: February 2009

AbstractA 69‐year‐old male with carcinoma of the lung developed unstable angina pectoris during his last few months of life. At necropys, the coronary arteries were free of atherosclerotic plaque, but the left main artery was severely narrowed by external compression from neoplastic metastases. Persistent anterior ST‐segment elevation without evolutionary changes of myocardial infarction was a clue to cardiac involvement by tumor. Direct and indirect effects of metastatic tumors upon the coronary arteries include tumor or thrombi, emboli, wall invasion, or extrinsic wall compression. Extrinsic compression of the left main coronary artery is rare among congenital and acquired conditions producing severe left main disease.
Balloon aortic valvuloplasty in children
Authors: Rao P. S. 
Published: February 2009

AbstractThe technique of balloon aortic valvuloplasty has been used in infants, children, and adults since its first description in 1983. Immediate results reported by several workers and intermediate‐term results by a few workers appear encouraging. Complications are minimal although potential for arterial complications and aortic insufficiency should be recognized. Significant restenosis rates at intermediate‐term follow‐up have been reported and could be minimized by reducing the risk factors associated with recurrence. Echo‐Doppler studies are useful in follow‐up evaluation of balloon valvuloplasty. The results seem to compare favorably with those following surgical valvotomy. The indications are essentially the same as those used for surgery: a gradient in excess of 80 mmHg irrespective of symptoms or a gradient ≥ 50 mmHg with symptoms or ST‐T wave changes. Previous surgical valvotomy is not a contraindication for balloon valvuloplasty. The technique is applicable to subaortic membranous stenosis as well. Thus far only one‐ to two‐year follow‐up results are available. Five‐ to ten‐year follow‐up results to document long‐term effectiveness of balloon aortic valvuloplasty are needed. Miniaturization of currently bulky dilating catheter systems and improving rapidity of inflation/deflation of balloons are necessary to increase safety and effectiveness of these techniques in infants and children. Meticulous attention to the details of the technique and further refinement of the procedure may further increase effectiveness and reduce the complication rate.
Acute hemodynamic and arrhy thmogenic effects of high‐dose intravenous salbutamol in patients with chronic left ventricular dysfunction
Authors: Rotstein Z. , Battler A. , Rath S. , Perek J. , Eldar M. 
Published: February 2009

AbstractThe short‐term hemodynamic and possible arrhythmogenic effects of intravenous salbutamol at a dose of 30 or 60 m̈g/min were evaluated in 14 patients with severe chronic left ventricular dysfunction using equilibrium radionuclide angiocardiography and electrocardiographic monitoring. Salbutamol infusions at a dose of 30 m̈g/min did not cause significant hemodynamic changes; however, at a dose of 60 m̈g/min there was a significant increase in stroke volume, cardiac output, and left ventricular ejection fraction. Heart rate increased significantly while systemic peripheral resistance decreased significantly. Two patients developed ventricular premature beats and another two supraventricular tachycardia, but none were associated with adverse consequences. Thus, high‐dose intravenous salbutamol is effective and safe, and may be used in the acute management of patients with poor left ventricular function.
Prediction of left ventricular function during supine bicycle ergometer exercise in angina‐free patients with old myocardial infarction
Authors: Kamihara S. , Inagaki H. , Iwase M. , Yokota M. , Matsunami T. , Yoshida J. , Miyahara T. , Koide M. , Hayashi H. 
Published: February 2009

AbstractWe investigated whether or not left ventricular function during dynamic exercise in angina‐free patients with old myocardial infarction could be estimated using resting left ventricular function and noninvasive parameters determined during exercise. We studied 70 patients with old myocardial infarction by measuring hemodynamic parameters during supine multistage bicycle ergometer exercise. Coronary arteriography and left ventriculography were performed: then the left ventricular ejection fraction and left ventricular end‐diastolic volume were measured. The parameteric changes (Δ) between rest and peak exercise were determined. Significant positive correlations were observed between cardiac index (CI) at rest and at peak exercise (r = 0.62, p < 0.001), as well as between pulmonary artery wedge pressure (PAWP) at rest and at peak exercise (r = 0.72, p < 0.001). Multiple regression analysis indicated that CI and PAWP at peak exercise as dependent variables were best described by the equations: CI at peak exercise = 1.074 [CIrest] + 0.031 [ΔHR] + 0.004 [ExD] + 0.018 [LVEF] – 1.560 (r = 0.79, p < 0.001), PAWP at peak exercise=0.994 [PAWPrest] – 0.181 [LVEF] + 0.203 [ΔDBP] – 0.076 [ΔHR] – 21.488 (r = 0.80, p < 0.001). These data suggested that CI and PAWP during dynamic exercise in angina‐free patients with old myocardial infarction could be predicted using noninvasive parameters, such as increments of blood pressure and heart rate as well as exercise duration, together with data on resting left ventricular function, such as resting CI, resting PAWP, and resting left ventricular ejection fraction (LVEF).
Congenital tricuspid valve stenosis with atrial septal defect and left anterior fascicular block
Authors: Cohen M. L. , Spray T. , Gutierrez F. , Barzilai B. , Bauwens D. 
Published: February 2009

AbstractCongenital tricuspid valve stenosis in the absence of other valvular abnormalities is rare. In this report we describe a patient with congenital tricuspid valve stenosis, ostium secundum atrial septal defect, and electrocardiographic left anterior fascicular block, who presented with paradoxical emboli. This case, as well as previous case reports, suggests that congenital tricuspid stenosis with ostium secundum atrial septal defect is associated with left anterior fascicular block.