bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wolff‐parkinson‐white syndrome type B and left bundle‐branch block: Electrophysiologic and radionuclide study
Authors: Rakovec P. , Kranjec I. , Fettich J. J. , Jakopin J. , Fidler V. , Turk J. 
Published: February 2009

AbstractCoinciding left bundle‐branch block and Wolff‐Parkmson‐White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cadiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right‐sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle‐branch block was seen. Left bundle‐branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combined electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates.
Delay in diagnosis of right atrial myxoma
Authors: Northcote R. J. , Ballantyne D. , Sethia B. 
Published: February 2009

AbstractClinical, echocardiographic, and nuclear angiographic findings in a 51‐year‐old woman who presented with a history of dyspnea are discussed. Initial echocardiography revealed no abnormality. However, a subsequent radionuclide angiogram revealed a filling defect on the right side of the heart. This represented a right atrial myxoma. Radionuclide angiography can provide a useful noninvasive tool in the diagnosis of intracardiac tumors when echocardiography has not been helpful.
Interaction of chronic cigarette and ethanol use on myocardium
Authors: Ahmed S. S. , Torres R. , Regan T. J. 
Published: February 2009

AbstractChronic cigarette use is common in persons who habitually use other cardioactive agents that have been causally associated with heart disease. This study was undertaken to determine if cigarette use intensifies the abnormalities of myocardial function and composition observed in experimental alcoholism over an 18‐month period. Young adult male beagles with tracheostomy were divided into four groups. There were 10 controls (group 1); 9 smoked seven cigarettes per day (group 2); 7 were fed ethanol as 20% of calories (group 3), and 6 received both ethanol and cigarettes (group 4). After a period of 18 months, left ventricular function was assessed under anesthesia. Heart rate, left ventricular end‐diastolic pressures, and volumes (indicator dilution) did not differ in the four groups. An index of contractility derived by normalizing peak dP/dt for pre‐ and afterload was reduced significantly below the level of 2.41 ±0.7 cm/s in controls to 1.41±0.35 in group 2, 1.19±0.38 in group 3, and 1.28±0.17 in the ethanol cigarette group (each p<0.002). Arterial pressures were moderately elevated above group 1 in all three experimental groups without evidence of left ventricular hypertrophy. In contrast to smoking, which elicited no abnormalities of myocardial composition, ethanol reduced myocardial potassium and sodium in group 3 without a gain of water content. In group 4, no further decline of tissue cations was observed. Thus, cigarette use when combined with ethanol over a relatively long period produced no greater myocardial abnormalities than ethanol alone and may not be essential to the genesis of cardiomyopathy in alcoholics.
Adverse effects of atrial fibrillation and syncope induced by calcium‐channel blockers in hypertrophic cardiomyopathy
Authors: Doiuchi J. , Hamada M. , Ochi T. , Ito T. , Kokubu T. 
Published: February 2009

AbstractCalcium‐channel blockers are useful for the treatment of hypertrophic cardiomyopathy (HCM), but, their adverse effects, especially, those of diltiazem, have not been of much concern. Forty patients with HCM were treated with calcium‐channel blockers such as nifedipine diltiazem, and verapamil. Atrial fibrillation was induced by diltiazem in two patients and verapamil induced syn cope in one patient. The clinical and hemodynamic characteristics of the patients were as follows. All of them had the obstructive type of HCM (HOCM). One of them had a high pressure gradient of the left ventricular outflow tract and the others had earlier onset. In these patients, the left atrial overload seemed to be severe. The vasodilating action of calcium‐channel blockers decreases the systemic pressure and in turn, may increase the pressure gradient and the left ventricular end‐diastolic pressure. The elevated left ventricular end‐diastolic pressure causes the left atrial overload which could be at risk of atrial fibrillation in patients with HCM. Therefore, calcium‐channel blockers should be used carefully in peculiar cases of HOCM.
Paroxysmal vagally mediated av block with recurrent syncope
Authors: Talwar K. K. , Edvardsson N. , Varnauskas E. 
Published: February 2009

AbstractParoxysmal complete atrioventricular (AV) block without associated electrocardiographic (ECG) abnormality is not a well recognized entity. A mother and her daughter had recurrent syncopal episodes, but a normal ECG. The episodes were preceded by nausea and vomiting. ECG during these episodes revealed complete heart block. In the mother, one episode was promptly reversed by atropine. Electrophysiological evaluation of the sinus and AV nodal function and atrial and ventricular effective refractory periods before and after autonomic blockade was normal. Provocative manoeuvres failed to induce AV block. Paroxysmal AV block was vagally mediated in one of the patients, as indicated by prompt response to atropine. In the second case, the vagal dependence could not be proved but appears to be the most likely explanation. It thus appears that paroxysmal, vagally mediated complete AV block should be seriously considered in patients with unexplained syncope.
Mitral valve prolapse in the ventriculogram: Scintigraphic, electrocardiographic, and hemodynamic abnormalities
Authors: Tebbe U. , Schicha H. , Neumann P. , Voth E. , Emrich D. , Neuhaus K.‐L. , Kreuzer H. 
Published: February 2009

AbstractPatients with mitral valve prolapse (MVP) frequently have chest pain, which may be difficult to differentiate from angina pectoris in coronary artery disease (CAD). We performed resting and exercise ECGs, pulmonary arterial pressure measurements, radionuclide ven‐triculography (99mmtechnetium), and perfusion scintigrams (20lthallium) in 56 patients with angiographically proven MVP and no CAD. Pathological results were obtained in 31% of exercise ECGs, 33% of pulmonary arterial pressure measurements during exercise, 22% of radionuclide ventriculographies, and in 75% of thallium perfusion scintigrams. A significant correlation in pathological results was found only between exercise ECG and both radionuclide ventriculography and pulmonary arterial pressure measurements. Because of the high prevalence of falsepositive perfusion scintigrams in patients with typical or atypical chest pain, the use of exercise 2 T1 imaging as a screening method to separate patients with MVP from those with CAD will not be appropriate. The variability of cardiac abnormalities in our patients with MVP and angiographically normal coronary arteries suggests that the MVP syndrome may represent a variable combination of metabolic, ischemic, or myopathic disorders.
Prevalence of mitral valve prolapse in presumably healthy korean adults
Authors: Lee W. R. , Sheikh M. U. , Lee K. J. 
Published: February 2009

AbstractThis cross‐sectional study on mitral valve prolapse (MVP) in Korean adults revealed a relatively low overall prevalence at 2.5% (5 of the 200 subjects). Three of 5 subjects with MVP were females and the majority (4 of 5 subjects) were under 30 years of age. All subjects with MVP had thoracic skeletal deformities (4 straight back syndrome and 1 pectus excavatum). All subjects with MVP did not have cardiac history and they were all asymptomatic except for one who had intermittent palpitation of mild degree.
Natural history of left anterior descending coronary artery obstruction: Significance of location of stenoses in medically treated patients
Authors: Samaha J. K. , Connor M. J. , Tribble R. , Kroetz F. W. , Sullivan J. M. , Ramanathan K. B. , Mirvis D. M. 
Published: February 2009

AbstractWe examined the prognostic significance of an obstructive lesion in the proximal left anterior descending (LAD) coronary artery. Five‐year or longer followup data were examined from 311 patients with >70% obstruction of the LAD treated without surgery. Mortality was compared in subsets with lesions proximal to and distal to the first septal perforating artery. Survival curves were worse in patients with proximal than with distal LAD disease (p<0.05); lesion location remained a significant determinant of survival when ejection fraction, age, and sex were controlled using a Cox regression model. However, when patient subsets were examined, survival with proximal LAD disease was worse than with distal obstruction only in the presence of an associated right coronary artery lesion and an ejection fraction of less than 40% (p<0.01). Patients with proximal LAD plus right coronary lesions had a 5‐year mortality rate (34.08 ± 8.9%) that was not significantly (p>0.05) different from that of a group of 66 patients with >50% narrowing of the left main coronary artery (24.02d̊4.3%). Thus, proximal LAD disease is more significant than is a distal lesion only in the presence of right coronary obstruction. This twovessel combination results in a mortality rate as high as that associated with left main coronary artery obstruction.
Rest‐exercise radionuclide angiographic assessment of left ventricular function in chronic aortic regurgitation: Significance of serial studies in medically versus surgically treated groups
Authors: Lumia F. J. , Macmillan R. M. , Germon P. A. , Kornberg B. , Fernandez J. , Maranhao V. 
Published: February 2009

AbstractForty consecutive asymptomatic patients with chronic aortic regurgitation who underwent three serial yearly rest and postexercise radionuclide angiograms were compared with 27 consecutive patients with chronic aortic regurgitation and aortic valve replacement who were studied preoperatively, 3 and 15 months postoperatively. Patients were divided into four subgroups based upon the resting left ventricular ejection fraction and the functional reserve on the initial study. Of the 40 medically treated patients, 19 (47.5%) and 24 (60%) demonstrated a response at least one type lower at 12 months and 24 months, respectively. Initial functional reserve, initial duration of exercise, and the change in exercise duration during the 24 months was not associated with changes in resting or postexercise left ventricular ejection fraction. A seesaw pattern was observed between the resting and the postexercise left ventricular ejection fraction as ventricular function deteriorated. We observed in the surgical groups a reversal of the seesaw interaction between the resting and postexercise ejection fraction seen in the medical patients. In the surgical groups the left ventricular end‐diastolic pressure, initial functional reserve, initial duration of exercise, and change in exercise duration postoperatively were not predictors of improvement in left ventricular function at 15 months. Comparing medical and surgical serial data, we suggest yearly radionuclide angiographic determination of rest left ventricular ejection fraction in asymptomatic patients with chronic aortic regurgitation. When the rest ejection fraction is <50%, exercise angiography should be performed to determine functional reserve. When functional reserve is also abnormal, surgery should be recommended.
Efficacy of diltiazem for medically refractory stable angina: Long‐Term follow‐up
Authors: Schroeder J. S. , Beier‐Scott L. , Ginsburg R. , Bristow M. R. , Mcauley B. J. 
Published: February 2009

AbstractTo assess the efficacy of long‐term diltiazem therapy when added to beta blockers and nitrates, we prospectively studied patients with chronic exertional angina who were determined to have medically refractory angina pectoris which was too severe to enter placebocontrolled studies. The mean follow‐up time was 24.6 months (8‐47 months) and all patients were seen every 2‐4 months. Angina frequency decreased from a prediltiazem frequency of 9.5 episodes per week (1‐40 per week) to 3.3 attacks per week (0‐21 per week) at 6 months and 3.3 attacks per week (0‐40 per week) at the patients's last evaluation. Similar reductions in nitroglycerin consumption were reported. Five patients had an increase in angina frequency during the mean 24.6 months of follow‐up, which necessitated coronary bypass surgery, 8, 10, 12, 19, and 23 months after study entry, respectively. Diltiazem daily dosage ranged from 120 to 480 mg/day, the mean daily dose was 298 mg/day. Twenty (65%) patients remained on beta‐blocker therapy and 19 (61%) patients on nitrate therapy in an effort to achieve a completely painfree state. New cardiovascular events were documented in 3 patients during the follow‐up period, with one patient having an uncomplicated myocardial infarction at 6 months, one patient hospitalized for prolonged chest pain at 2 months, and one patient dying following cardiover‐sion for unrelated atrial fibrillation at 14 months poststudy entry. Adverse effects were reported during 19 of the 354 patient visits, but no patient had to stop therapy because of these. Sinus bradycardia required reduction of betablocker dosage in three patients and prolonged PR inteval was observed in two additional patients. Five patients exhibited mild transient, and three patients chronic elevations in liver enzymes. We conclude that the addition of diltiazem in patients who have severe angina on combinations of beta blockers and nitrates results in a marked reduction in angina frequency. Furthermore, this agent is well tolerated with minimal adverse effects.
Antihypertensive effectiveness of terazosin: A new long‐acting alpha‐adrenergic inhibitor
Authors: Chrysant S. G. , Bal I. S. , Johnson B. , Mcpherson M. A. 
Published: February 2009

AbstractEighteen patients aged 35‐70 years (mean + SEM 58+2) with poorly controlled hypertension on various regimens, participated in the present studies. After a 4‐week placebo‐controlled lead‐in period, 12 patients were randomized to terazosin treatment and 6 to placebo. They were followed in the clinic every 2 weeks for 13 weeks, where their supine (5 min) and the upright (2 min) arterial pressure and heart rate were measured. In addition, all patients had a complete laboratory evaluation at the beginning and end of the study. Depending on pressure response, the experimental drug was increased at each visit from 1.0 mg/day to 2.0, 5.0,15.0, and 20.0 mg/day, if the supine diastolic pressure was greater than 90 mmHg. Terazosin decreased the systolic and diastolic pressure in both the supine and upright positions, and had no significant effect on heart rate. Placebo did not exert any effects on either arterial pressure or heart rate. No adverse clinical or metabolic effects were observed with the administration of either terazosin or placebo. We conclude that: (1) Terazosin is a new effective long‐acting alpha blocker given in combination with other antihypertensive drugs, and (2) it is safe and well tolerated by the patients.
Cardiac arrhythmias during sleep in morbidly obese sleep‐apneic patients before and after gastric bypass surgery
Authors: Peiser J. , Ovnat A. , Uwyyed K. , Lavie P. , Charuzi I. 
Published: February 2009

AbstractFourteen morbidly obese patients scheduled for gastric bypass surgery were diagnosed preoperatively as suffering from sleep apnea syndrome. There were 13 males and 1 female aged 24 to 59 years. Mean preoperative excessive body weight was 222 ±38%; mean apnea index prior to surgery was 84 ±44. A whole night lead II ECG tracing was performed as part of the polyhypno‐graphic recordings and was evaluated for cardiac arrhythmias. Studies were performed in all patients preoperatively and 6 months thereafter. Statistical analysis was done using the Student's paired t‐test. In this group a high incidence of atrial and ventricular arrhythmias was found. Marked sinus arrhythmia was encountered in all patients and extreme sinus bradycardia in 4 of them. In a consecutive sleep study performed 6 months postoperatively most cardiac arrhythmias disappeared. Marked sinus arrhythmia persisted in only two patients and severe ventricular premature beats (Lown's grade III‐IV), found preoperatively in all patients, were still present postoperatively in only two, although in a much milder form. Surgical weight reduction, therefore, is a valuable method in the abolishment of life‐threatening cardiac arrhythmias of the morbidly obese sleep‐apneic patient.
Effect of Vitamin C on Platelet Adhesiveness and Platelet Aggregation in Coronary Artery Disease Patients
Authors: Bordia A. , Verma S. K. 
Published: February 2009

AbstractThe effect of oral administration of vitamin C on platelet adhesive index (PAI), platelet aggregate ratio (PAg R) and serum ascorbic acid levels was studied. Feeding 75 g of butter to healthy males (group I, n=10 cases), enhanced the tendency of platelet adhesiveness (PAd) and platelet aggregation (PAg) to a significant level at the end of 4 h, This was distinctly prevented when 1 g of vitamin C was added to the fatty meal. In coronary artery disease (CAD) patients (group II, n=20 cases) 10 days of vitamin C administration at 1 g every 8 hours decreased the PAd (p<0.001) and PAg (p<0.05) significantly. There was also a significant (p <0.001) rise in the vitamin C levels. The study brings out a property of vitamin C which may be of considerable importance in prevention of chronic thromboatherosclerotic disease of the arteries.
M‐Mode echocardiography in supine and standing position in control subjects and patients with auscultatory evidence of mitral valve prolapse but negative supine echocardiography: Does sensitivity improve?
Authors: Ansari A. 
Published: February 2009

AbstractApproximately 10–20% of patients with auscultatory evidence of mitral valve prolapse (MVP) have “false negative” echocardiograms. Pharmacological maneuvers do not significantly improve the sensitivity and may cause side effects. It is well known that auscultatory features of MVP change and not uncommonly can be heard only in the standing position. Therefore M‐mode echo was performed in both supine and standing positions in 10 normal control subjects and 25 patients of comparable age and sex who had auscultatory evidence of MVP but negative echo in supine position. All 10 control subjects had normal echo in both supine and standing positions. No instance of false positive MVP was noted. Of the 25 patients with “false negative” supine echo, 5 showed evidence of MVP (3 pansystolic and 2 late systolic) in standing position. Based on these results the following conclusions were reached. (1) In normal individuals the MVE remains uninfluenced by change in posure. (2) There is modest (20%) improvement in sensitivity of detecting MVP when M‐mode echo is performed in standing position in addition to supine position. (3) Change in posture is preferable to the use of pharmacological maneuver to improve the sensitivity of detecting MVP because it is physiological, devoid of any cost, and does not produce side effects. (4) M‐mode echo in standing position or two‐dimensional echo in supine position can be used to confirm the diagnosis of MVP in those patients who have “false negative” and/or nondiagnostic supine echo in the presence of auscultatory features of midsystolic click and mid‐ or late‐systolic murmurs.
Balloon pump support of the failing right heart
Authors: Gold J. P. , Shemin R. J. , Disesa V. J. , Cohn L. , Collins J. J. 
Published: February 2009

AbstractThis report reviews a clinical experience with pulmonary artery counterpulsation with a balloon pump in a patient with pulmonary embolization superimposed upon severe trivalvular rheumatic heart disease. This patient underwent a pulmonary embolectomy and triplevalve replacement requiring a pulmonary artery balloon pump for bypass discontinuation and postbypass hemo‐ynamic support. The field of right heart counterpulsation is briefly reviewed, and the technical details of the implantation and management of the device are elaborated.
Interaction between clonidine and alpha blockers
Authors: Jounela A. J. , Kanniainen E. , Lilja M. 
Published: February 2009

AbstractThis report reviews the available evidence for and against the combined use of clonidine and prazosin in treating hypertension. Clinical studies have resulted in modest or no enhancement of the antihypertensive effects when prazosin has been added to clonidine. This report discusses the possible mechanisms of an interaction of clonidine and prazosin, which may show cause that the antihypertensive effects of these drugs are not additive.
Role of coronary spasm in the genesis of myocardial infarction: Study of a case treated by isosorbide dinitrate in situ then by transluminal angioplasty
Authors: Grollier G. , Scanu P. , Commeau P. , Foucault J. P. , Potier J.C. 
Published: February 2009

AbstractWe report the observation of a 62‐year‐old patient who was admitted for unstable angina. A prolonged chest pain (more than two hours) with a major electrocardiographic lesion in the posterior leads needed an urgent coronary arteriography in order to attempt a recanalization. Antecedents of arteriopathy of the lower limbs with aortobifemoral bypass required an axillary artery right side approach. A selective right coronary opacification showed complete occlusion at the junction of segments 1 and 2. An intracoronary injection of isosorbide dinitrate relieved a coronary spasm and allowed a complete visualization of the right coronary artery. This appeared to be very atherosclerotic with several severe narrowings, and a subocclusive lesion at the site of the initial occlusion. Percutaneous transluminal coronary angioplasties (PTCA) were performed and led to a real ‘restructuring’ of the right coronary artery. The clinical outcome was excellent without recurrent angina pectoris. An angiographic control performed 6 months after PTCA demonstrated the persistence of the coronary recanalization and an evident improvement of the segmental contractility. This report emphasizes the role of coronary spasm in the genesis of my‐cardial infarction and shows that PTCA may be performed as a first approach at the acute phase of myocardial infarction; to our knowledge it is the first PTCA performed by an axillary approach at the acute stage of myocardial infarction.