bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transient reversal of blood flow in an internal thoracic artery to coronary artery graft during syncope
Authors: Mauric A. , Samani N. J. , De Bono D. P. 
Published: February 2009

AbstractTranscutaneous duplex ultrasound can be used to image and quantify blood flow in the proximal part of the internal thoracic artery to coronary artery bypass grafts. 1 In addition to providing information about graft patency and blood flow for follow‐up purposes, the technique also provides an opportunity to study the physiology and pharmacology of the coronary circulation. In this paper we describe and attempt to interpret an unusual pattern of internal thoracic artery graft blood flow observed during inadvertent nitrate‐induced syncope.
Dyslipidemia and coronary artery disease
Authors: T.KUO Peter 
Published: February 2009

AbstractGenetically determined and metabolically induced disturbances in lipid metabolism, as manifested in several types of dyslipidemia, have been shown to be causally related to the development of coronary artery disease (CAD). A diversity of clinical and angiographic studies has been made to evaluate the linkage between plasma lipid‐control therapy in the development of initial and recurrent cardiovascular events. The plan of treatment invariably begins with a low‐fat, low‐cholesterol diet before initiation of drug therapy. However, many patients have difficulty in adhering to the low‐fat diet. Fortunately, metabolic studies show that foods which contain fats rich in stearic (saturated) and oleic (monounsaturated) fatty acids may be given in limited amounts to boost patients' compliance to a low‐fat diet and to prevent their blood lipids from rising to abnormal levels. A bile acid sequestrant (cholestyramine or colestipol) is the first‐line drug for control of hypercholesterolemia. Either gemfibrozil or gemfibrozil plus niacin is prescribed to raise high‐density lipoprotein (HDL) levels of CAD patients. Approval of two HMG CoA reductase inhibitors, pravastatin and simvastatin, by the FDA gives physicians the additional flexibility of employing a single or a combination drug therapy for optimal control of dyslipidemia. The association of low serum cholesterol level (< 160mg/dl) with increase in noncardiac mortality has prompted health professionals to consider modifying the universal screening and treatment of serum cholesterol in children and young women and to use hypolipidemic drugs in patients judiciously.
Long‐term use of K‐strophanthin in advanced congestive heart failure due to dilated cardiomyopathy: A double‐blind crossover evaluation versus digoxin
Authors: Agostoni Pier Giuseppe , Doria Elisabetta , Berti Marco , Guazzi Maurizio D. 
Published: February 2009

AbstractK‐strophanthin or digoxin were added to diuretics (all cases) and vasodilators (most cases) for treating advanced congestive heart failure in 22 patients with dilated cardiomyopathy and sinus rhythm. K‐strophanthin (0.125 mg intravenously) or digoxin (0.25 mg orally) were administered daily in two 3‐month periods, during which vasodilators and diuretics were kept constant and patients received one of the two digitalis preparations in a double‐blind fashion, crossing over to, the alternative preparation in the next period. Blindness was assured throughout the trial with a daily intravenous injection of 10 ml normal saline solution either containing K‐strophanthin or not, and with daily oral administration of either placebo or active digoxin. At the end of the run‐in period, 15 days after starting active preparations, and thereafter every month for the next 6 months, we evaluated left ventricular pump function at rest and patients' functional performance by a cardiopulmonary exercise test. At Day 15, cardiac index and ejection fraction at rest, compared with run‐in, were significantly raised with both glycosides; during exercise while on K‐strophanthin, peak oxygen consumption was augmented by 1.4 ml/min/kg (p < 0.01) and oxygen consumption at anaerobic threshold by 2.2 ml/ min/kg (p < 0.01); corresponding variations on digoxin (0.1 and +0.3, respectively) were not significant versus run‐in. These patterns were duplicated at repeated tests during follow‐up. In the entire population Means for oxygen consumption at peak exercise and at anaerobic threshold were raised from run‐in values by 1.4 (p < 0.01) and 2.2 ml/min/kg (p < 0.01), respectively, after 3 months of K‐strophanthin treatment, and by 0.0 and 0.1 ml/min/kg, respectively, after treatment with digoxin for the same period of time. Results were similar in nine patients when they were given digoxin intravenously (0.25 mg/day) for 1 week after having completed the trial with the oral digoxin preparation. These results indicate that K‐strophanthin improved functional performance in patients with severe cardiac decompensation due to dilated cardiomyopathy; digoxin failed to provide the same results, independent of the drug sequence or the route of administration. The reasons for these differences are basically unknown and do not seem to be related only to changes in cardiac performance at rest, because both K‐strophanthin and digoxin significantly and persistently raised cardiac output and ejection fraction at rest.
A multinational study of the effects of low‐dose pravastatin in patients with non‐insulin‐dependent diabetes mellitus and hypercholesterolemia
Authors: Behounek Bruce D. , Mcgovern Mark E. , Kassler‐Taub Kenneth B. , Markowitz S. Jeffrey , Bergman Michael ,   THE PRAVASTATIN MULTINATIONAL STUDY GROUP FOR DIABETES
Published: February 2009

AbstractThis multinational, 16‐week, randomized, doubleblind, placebo‐controlled study evaluated the efficacy and safety of low‐dose pravastatin in 325 patients with non‐insulindependent diabetes mellitus (NIDDM) and hypercholesterolemia [serum total cholesterol concentrations of 5.2‐7.8 mmol/1 (200 to 300 mg/dl)]. Patients were randomized to receive pravastatin 10 mg or matching placebo with doubling of the dose after 8 weeks if predefined target levels for total cholesterol [(i.e., < 5.2 mmol/1 (200 mg/dl) or > 15% decrease from baseline] had not been achieved. At Week 16, pravastatin‐treated patients showed a 21.4% decrease in serum low‐density lipoprotein cholesterol (LDL‐C) and a 13.5% reduction in serum total cholesterol (TC) concentrations (p < 0.001 compared with placebo). Levels of triglycerides (TG) were reduced 9.6% during pravastatin treatment (p < 0.05 compared with placebo) while high‐density lipoprotein cholesterol (HDL‐C) levels were increased 4.4% (p =NS). Adverse events and laboratory test abnormalities were similar among patients treated with pravastatin or placebo. Glycosylated hemoglobin (HbA1C) levels remained unchanged. The results of this study demonstrate that low‐dose pravastatin is effective and well tolerated for lowering elevated cholesterol concentrations during short‐term treatment of patients with NIDDM and hypercholesterolemia.
Enterovirus‐induced myocarditis: Hemodynamic deterioration with immunosuppressive therapy and successful application of interferon‐α
Authors: Heim Albert , Stille‐Siegener Michael , Kreuzer Heinrich , Figulla Hans R. , Kandolf Reinhard 
Published: February 2009

AbstractIn 1985Myocarditis was diagnosed by endomyocardial biopsy in a 53‐year‐old woman who was free of symptoms of heart insufficiency. Immunosuppressive therapy with azathioprine and prednisolone was prescribed as the patient had deteriorated to NYHA II heart insufficiency in March 1986. When application of immunosuppressive agents was terminated in 1987, serial endomyocardial biopsies revealed no signs of myocarditis, thus indicating effectiveness of immuno uppression. Nevertheless, the patient had worsened clinically and hemodynamically. At follow‐up in 1991, the patient had progressed to dilated cardiomyopathy resulting in NYHA III heart insufficiency. Enterovirus infection of the heart was detected by in situ nucleic acid hybridization. In addition, retrospective serology indicated a significant increase of coxsackievirus B2 antibodies between 1985 and 1991. Investigational antiviral therapy with recombinant interferon a‐2a was tolerated well and a favorable clinical, hemodynamic, and virologic response was observed. Thus, progression of biopsy‐proven myocarditis to dilated cardiomyopathy may have been facilitated by immunosuppressive therapy in enterovirus infection. Antiviral therapy might be advantageous in patients with enterovirus myocarditis and dilated cardiomyopathy.
Post‐traumatic pseudoaneurysm of the ascending aorta—an incidental finding two decades later
Authors: Prater Stephen P. , Mckiernan Thomas L. , Leya Ferdinand S. 
Published: February 2009

AbstractTraumatic rupture of the aorta following blunt trauma is a wel 1 described entity. Rupture of the ascending aorta is frequently associated with concomitant cardiac damage and immediate death with few long‐term survivors described in the literature. A case of traumatic pseudoaneurysm of the ascending aorta discovered two decades after the initial injury is reported.
Directional coronary atherectomy in women compared with men
Authors: Movsowitz Herman D. , Emmi Ronald P. , Manginas Athanassios , Wells Elizabeth , Ledley Gary S. , Kotler Morris N. , Nakhjavan Fred K. , Yazdanfar Shahriar 
Published: February 2009

AbstractThe influence of gender on the procedural outcome of directional coronary atherectomy (DCA) is controversial. This study of 373 consecutive patients (418 lesions) undergoing DCA demonstrates that the procedural success rate of DCA is significantly lower in women compared with men (72.7 vs. 82.9%, p = 0.011). Women have significantly smaller coronary arteries than men (2.5 mm vs. 2.7 mm, p = 0.028) and were older than men (66 vs. 61 years, p = 0.0001). Multivariate analysis identifies small coronary vessel size rather than female gender per se as an independent predictor of poor procedural outcome. Procedural success rates in women with coronary vessel size ≥ 2.5 mm is significantly higher (92.2%) than in women with coronary vessel size < 2.5 mm (73.1%), and parallels that in men with vessel size ≥ 2.5 mm (89.3%). Inability to engage the ostium of the coronary artery adequately with the guiding catheter and to cross the lesion with the atherectomy device is significantly more common in women compared with men. Major ischemic complication rates are similar in women and men (8.5 vs. 8.7%). Groin complications are significantly more common in women compared with men (13.5 vs. 2.9%). We conclude that procedural success rates in women may be improved by careful patient selection, with particular attention to small vessel size. DCA is best performed in vessels > 2.5 mm in diameter.
Is there a role for positive inotropic agents in congestive heart failure: Focus on mortality
Authors: Amidon Thomas M. , Parmley William W. 
Published: February 2009

AbstractCongestive heart failure (CHF) is a common clinical syndrome that may result from a variety of etiologies. Impaired contractility can lead to pump failure and a number of hemodynamic and neurohormonal alterations. Vasodilator therapy improves symptoms and survival in patients with CHF due to systolic dysfunction. Inotropic therapy, on the other hand, has not been shown to improve survival and may even worsen survival. This article reviews the mechanism of action and clinical trials of inotropic therapy in patients with CHF.
Cardiocirculatory and metabolic strain during rowing ergometry in coronary patients
Authors: Urhausen A. , Spieldenner J. , Gabriel H. , Schwarz L. , Schwarz M. , Kindermann W. 
Published: February 2009

AbstractTo investigate the suitability of rowing for cardiac rehabilitation, the Cardiocirculatory and metabolic reactions during rowing (RE) and cycle (CE) ergometry were compared. Ten male normotensive subjects of an outpatient heart group (age 56 ± 7 years, maximum performance on CE 2.0 ± 0.4 W‐kg ‐1) carried out a stepwise increasing test on an isokinetic rowing ergometer and a CE (increasing by 25 W every 3 min).In a 1‐min break after each step, heart rate and blood pressure, blood concentrations of lactate, and the free catecholamines adrenaline and noradrenaline were measured. Four patients showed signs of myocardial ischemia occurring almost one step earlier on RE than on CE. In RE, the endurance and maximum performance were about 20 W lower than on CE. At similar workloads, heart rate, blood pressure, and concentrations of lactate and catecholamines measured significantly higher on RE than on CE. At workloads above the individual anaerobic threshold, the increase in adrenaline and noradrenaline was significantly higher on RE than on CE. The results can be explained by the lower work efficiency, the higher isometric demands with increased cardiac pressure load, and the higher mental stress in RE. Rowing is only suitable in cardiac rehabilitation when well‐defined prerequisites have been considered.
Effects of atenolol and diltiazem‐SR on exercise and pressure load in hypertensive patients
Authors: Chrysant Steven G. , Miller Elinor 
Published: February 2009

AbstractThe effects of monotherapy with atenolol or diltiazem‐SR on blood pressure, 24‐h blood pressure (BP) load, and exercise capacity were tested in patients with mild to moderate (stages I and II) essential hypertension. After 3‐week single blind placebo therapy, patients with sitting diastolic blood pressure (SDBP) of 94‐114 mmHg were randomized to atenolol 50 mg/day (62 patients) or diltiazem‐SR 90 mg b.i.d. (60 patients) in a double‐blind parallel study. Depending on SDBP response, the dose was increased to 100 mg/day for atenolol and 180 mg b.i.d. for diltiazem‐SR. Twenty‐four‐hour ambulatory blood pressure measurements and exercise tolerance lest by the Bruce protocol were done at the end of placebo and active treatment. Compared with placebo, both atenolol and diltiazem‐SR significantly decreased heart rate (HR), sitting systolic blood pressure (SSBP), SDBP, ambulatory BP, BP load for waking and sleeping hours, area under the BP curve, rate‐pressure product (p < 0.001), and exercise time (NS). Atenolol exerted a greater effect on ambulatory BP, HR, rate‐pressure product, waking diastolic BP load, and area under the 24‐h BP curve. The drugs were well tolerated and caused no serious side effects necessitating discontinuation of treatment. These findings indicate that (1) monotherapy for hypertension with atenolol or diltiazem SR is effective and well tolerated, (2) it decreases the 24‐h BP load, (3) it does not interfere with exercise capacity.
Hereditary dilated cardiomyopathy
Authors: Mcminn Thomas R. , Ross John 
Published: February 2009

AbstractDilated cardiomyopathy (DCM) is a common and important cause of morbidity and mortality. Many factors can contribute to the development of this disorder, although most commonly the etiology is unexplained. However, recent studies in individuals with idiopathic DCM now reveal a heritable cause in 20–30% of individuals. Diverse modes of inheritance have been demonstrated, encompassing an autosomal dominant type (by far the most common), together with recessive and X‐linked forms, and maternal inheritance through mitochondrial DNA. The hereditary forms of DCM (HDCM) predominantly affect the left ventricle, although inherited abnormalities affecting primarily the right ventricle also are described. HDCM may occur as a primary cardiomyopathy, or secondary to inherited systemic metabolic or neuromuscular disorders. The causative genes for primary HDCM of the autosomal dominant and recessive types have not yet been discovered, but the combination of family pedigree analysis and phenotyping by echocardiography, together with new genetic techniques, should now allow their identification. Knowledge of the gene or genes responsible for HDCM would improve diagnostic accuracy, facilitate genetic counseling, advance understanding of pathogenesis, and provide the starting point for new methods of treatment. Because of the frequently heritable nature of DCM, it is of great importance that a diligent search for all potentially affected family members be undertaken.
Effect of hydration on cavity obliteration during dobutamine stress echocardiography
Authors: Weissman Neil J. , Nidorf Stefan M. , Weyman Arthur E. , Picard Michael H. 
Published: February 2009

AbstractThe purpose of this study was to determine whether it is possible to prevent or delay the onset of midventricular cavity obliteration during a dobutamine stress test with standard hydration. Left ventricular (LV) intracavitary obstruction has been reported as the mechanism for hypotension seen in approximately 20% of patients undergoing dobutamine stress echocardiography. In addition, it has been proposed that administration of a normal saline bolus prior to dobutamine infusion may avert the dynamic ventricular obstruction. We performed a standard graded dobutamine stress echocardiogram before and after fluid loading with 10 ml/kg of normal saline in 10 mongrel dogs. Measurements were made of left atrial pressure, aortic pressure, and the area of the LV cavity at the papillary muscle level throughout each infusion. Although hydration produced an increase in baseline left atrial pressure (5.7 ± 3.2 to 8.1 ± 2.7 mmHg, p < 0.01) and systolic blood pressure (128 ± 18 to 139 ± 22 mmHg, p=0.03), there was no significant change in pre‐dobutamine heart rate or systolic area. With dobutamine infusion, there was a similar change in heart rate, systolic blood pressure, diastolic area, and systolic area (SA) at each dose of dobutamine regardless of hydration status. In addition, the dose at which cavity obliteration occurred was not altered by hydration (p = NS). Although all dogs developed cavity obliteration (SA<1.0 cm2) with dobutamine infusion, none experienced hypotension. In this canine model, cavity obliteration does not lead to systemic hypotension and cannot be prevented or delayed by volume loading.
Pathology of pulmonic valve stenosis and pure regurgitation
Authors: Waller Bruce F. , Howard Jane , Fess Stephen 
Published: February 2009

AbstractLittle morphologic information is available on operatively excised pulmonic valves. The causes of pulmonic stenosis are limited to a few conditions: (1) rheumatic and (2) non‐rheunatic (congenital, carcinoid, infective endocarditis). Congenital causes of pulmonic stenosis constitute well over 95% of these conditions. Congenital types of pulmonic stenosis include acommissural dome‐shaped, dysplastic, and bicuspid. Rare acquired causes of pulmonic stenosis include carcinoid, rheumatic, and infective endocarditis. Of the acquired causes of pulmonic stenosis, carcinoid is the most common condition. In contrast, causes of pure pulmonic regurgitation are multiple. Two major categories of pure pulmonic regurgitation include (1) conditions associated with anatomically abnormal valve cusps (congenital, rheumatic, carcinoid, trauma, and infective endocarditis) and (2) conditions associated with anatomically normal cusps (elevated pulmonary artery systolic pressures, idiopathic dilated pulmonary trunk, and Marfan's syndrome).
Cardiac complications of cocaine abuse
Authors: Chakko Simon , Myerburg Robert J. 
Published: February 2009

AbstractCardiac complications of cocaine abuse and a rational approach to evaluating and managing them are described. Cardiac abnormalities reported among asymptomatic cocaine abusers include echocardiographic left ventricular hypertrophy and segmental wall motion abnormalities. Electrocardiogram may reveal increased QRS voltage, ST‐T changes, and pathologic Q waves. Episodes of ST elevation may be seen during Holter monitoring. The management of cocaine‐abusing patients who present to an emergency room with acute chest pain is controversial because the two reported studies yielded conflicting results regarding the incidence of myocardial infarction (MI). Even in the absence of infarction, electrocardiographic abnormalities are common among these patients, which complicates the decision‐making regarding hospitalization. Pathophysiology of cocaine‐related MI is discussed. Distinct clinical features of cocaine‐related MI make it clear that the association between the two is not just temporal. However, considering the number of persons abusing cocaine, it is a rarity. Beta‐adrenergic blockers should be avoided in the treatment of cocaine‐induced myocardial ischemia which is best treated with nitrates and calcium‐channel blockers. Reports of cocaine‐induced myocarditis and cardiomyopathy are reviewed. Experimental studies and clinical case reports suggest that cocaine may cause lethal arrhythmias. Cocaine prolongs repolarization by a depressant effect on potassium current and may generate early afterdepolarizations. It is possible that cocaine‐associated arrhythmias are secondary to vasospasm‐related ischemia and reperfusion as well.
The effects of intracoronary adenosine on preconditioning during coronary angioplasty
Authors: Kerensky Richard A. , Kutcher Michael A. , Braden Gregory A. , Applegate Robert J. , Solis Gustavo A. , Little William C. 
Published: February 2009

AbstractThere is evidence that the first balloon inflation during coronary angioplasty provides a preconditioning stimulus leading to decreased ischemia during subsequent balloon inflations. Endogenous adenosine release may play a role in ischemic preconditioning. Therefore, intracoronary adenosine administration prior to the first balloon inflation during percutaneous transluminal coronary angioplasty (PTCA) might modify the preconditioning response to the first balloon inflation. Forty‐one patients underwent double‐blind randomization to treatment with 100 mcg of intracoronary adenosine or placebo prior to coronary angioplasty. Twenty patients (11 adenosine, 9 placebo) had complete resolution of ischemia between inflations allowing comparison between the first and second inflation. An angioplasty guidewire was used to obtain an intracoronary electrocardiogram. The mean reduction in ST elevation during the second inflation compared with the first was 4.8 mm in the placebo group and ‐0.8 in the adenosine group (p<0.05 placebo vs. adenosine). Seven of 9 placebo patients had a decrease in ischemia during the second inflation compared with the first, while only 2 of 11 adenosine patients showed a reduction. It was concluded that (1) the first inflation during PTCA is a preconditioning stimulus leading to a decrease in ischemia during later inflations, and (2) intracoronary adenosine administration prior to PTCA modifies the preconditioning effect of the first inflation. These data suggest that adenosine plays a role in ischemic preconditioning in humans.
Hydrochlorothiazide‐induced pulmonary edema with severe acute myocardial dysfunction
Authors: Frierson John H. , Marvel Steven L. , Thomas Gregory M. 
Published: February 2009

AbstractA 73‐year‐old woman presented with acute pulmonary edema and hypotension less than 1 h after taking hydrochlorothiazide 50 mg, a reaction which has been reported as a rare but classic adverse drug response. Though prior cases have supported a noncardiogenic pulmonary edema syndrome, hemodynamic monitoring in this patient demonstrated a refractory low cardiac output state for more than 24 h. In the absence of other etiologies, this represents a new finding.
Heart failure: Lessons learned over the past 25 years
Authors: Weber Karl T, 
Published: February 2009

AbstractOver the past 25 years, a great deal has been learned about the pathophysiology and management of heart failure—a major health problem whose prevalence and incidence have not declined, unlike other cardiovascular disorders. Several of these lessons are reviewed herein. However, despite these advances, important issues remain to challenge both the practicing physician and the research scientist.