bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right pulmonary artery occlusion secondary to a dissecting aortic aneurysm
Authors: Rau Aruna N. , Glass Mary N. , Waller Bruce F. , Fraiz Joseph , Shaar Carl J. 
Published: February 2009

AbstractThis report describes a case of right pulmonary artery obstruction caused by a dissecting aneurysm of the thoracic aorta. Initial ventilation‐perfusion (V/Q) scan revealed no perfusion to the right lung. Lack of right lung perfusion plus other clinical abnormalities led to an initial diagnosis of massive embolism in the right lung. Bilateral pulmonary arteriography of the thoracic and abdominal aorta revealed extrinsic compression of the right pulmonary artery near its origin and the suggestion of an ascending aortic dissection. Subsequent ascending aortography and computed tomography (CT) confirmed a dissection of the ascending aorta. Aortography in the true lumen of the aorta revealed trivial aortic insufficiency. These diagnostic procedures confirmed the presence of an acute dissecting aneurysm of the ascending aorta that caused compression of the right pulmonary artery. The finding of a massive unilateral segmental defect with normal ventilation upon lung scanning does not always ensure a diagnosis of acute pulmonary embolus. Patient presentation with massive unilateral perfusion defect merits further evaluation with pulmonary arteriography.
Cardiac rehabilitation and secondary prevention after a myocardial event
Authors: Cundey Paul E. , Frank Martin J. 
Published: February 2009

AbstractIn the current era, cardiac rehabilitation after a myocardial event involves physical training in conjunction with optimizing the use of medications to control myocardial ischemia and prevent cardiac complications. It is also the time to identify and treat concomitant psychiatric problems and to develop an individualized program in secondary risk factor modification through counseling, behavior modification, nutritional counseling, and a properly selected drug program. This review attempts to deal with the above matters pragmatically.
Normal left main coronary artery diameter can be predicted from diameters of its branch vessels
Authors: Laslett Lawrence 
Published: February 2009

AbstractAn uncommon though vexing problem exists when the left main coronary artery appears subjectively to be diffusely stenotic relative to its branch vessels, but the severity of such stenosis cannot be determined because of the lack of a normal reference. To overcome this problem, 20 coronary angiograms demonstrating no evidence of disease were quantitatively analyzed to determine the normal ratio of left main diameter to the sum of the diameters of its immediate branches. For bifurcating left mains, the mean ratio of diameter of left main to sum of diameters of its two immediate branches was 0.65 ± 0.04; for trifurcating left mains, the mean ratio of diameter of left main to sum of diameters of its three immediate branches was 0.56 ± 0.02. Thus, it appears feasible and practical to predict the normal diameter of the left main from the measured diameters of its immediate branches.
Hemodynamic response to hyperventilation test in healthy volunteers
Authors: Alexopoulos Dimitrios , Christodoulou John , Toulgaridis Theodoros , Sitafidis George , Klinaki Anna , Vagenakis Apostolos G. 
Published: February 2009

AbstractHyperventilation is well known to affect the electrocardiogram (ECG) in subjects without heart disease and produce spasm in patients with variant angina. The autonomic nervous system is thought to play a significant role in these effects. However, the normal hemodynamic response to hyperventilation is not well defined. We subjected 369 healthy volunteers (200 men, 169 women) to prolonged hyperventilation (30 respirations for 5 min and 10 min recovery) under continuous ECG monitoring and to exercise testing. Heart rate (HR), systolic and diastolic blood pressures (SBP, DBP) and rate‐pressure product were recorded. Hyperventilation resulted in an immediate (within the first min), significant increase in HR by 27.4%, a further small increase at min 2 of hyperventilation, and a subsequent small decrease in HR at mins 3‐5. An immediate drop of HR by 20.1% was observed with discontinuation of hyperventilation. Apart from a slightly higher HR increase in men, a similar pattern of HR changes was found in both genders. On multivariate analysis, younger age, absence of smoking, and male gender were associated with a higher HR increase with hyperventilation (p < 0.0001, p < 0.0001, and p < 0.001, respectively). SBP and DBP increased with hyperventilation, with their highest value at min 5 of hyperventilation and a subsequent drop to baseline levels. Age and gender did not affect the degree and pattern of BP changes. Absence of smoking and the presence of hypertension were associated with a higher SBP with hyperventilation (p < 0.003 and p < 0.007). The rate‐pressure product increased by 43.6% with hyperventilation, a change that was only 19.1% of the respective rate‐pressure product observed with exercise. Hyperventilation results in significant HR and BP increases, changes that are influenced by age, gender, smoking, and hypertension. Our study could serve as a standard for comparison of the hyperventilation effects in different disease states.
The predictive value of the electrocardiographic pattern of acute q‐wave myocardial infarction for recurrent ischemia
Authors: Benjaminov Fabiana Sclarovsky , Sclarovsky Samuel , Birnbaum Yochai 
Published: February 2009

AbstractAtotal of 140 consecutive patients with acute Q‐wave myocardial infarction was evaluated to assess the relationship between different electrocardiographic patterns of evolution and the incidence of recurrent ischemia within 10 days of infarction. Patients were allocated to three groups according to the electrocardiogram at 12 h after admission: Group A: ST elevation of < 2 mm and negative T waves (75 patients); Group B: ST elevation of > 2 mm and negative T waves (35 patients); Group C: ST elevation of > 2 mm and positive T waves (30 patients). Patients in Group C had more anterior wall infarctions (82%) than Group A (40%) or Group B (58%) (p = 0.0001). Peak creatine kinase levels were lower in Group A (782 ± 115 IU) than in Groups B (1415 ± 257 IU) and C (1501 ± 287 IU) (p<0.0001). The occurrence of post‐infarction recurrent ischemia was more frequent in Group A (79.2%) than in Groups B (33.3%) and C (14.8%) (p<0.0001). Patients in Group A had relatively smaller infarctions and a higher incidence of recurrent ischemia, whereas patients in Group C had larger infarctions and a lower incidence of recurrent ischemia. The electrocardiographic pattern 12 h after admission for acute myocardial infarction is helpful in identifying a subgroup at high risk of recurrent ischemia.
This section edited by Bruce Waller, M.D. Usefulness of the 12‐lead electrocardiogram in detection of myocardial infarction: Electrocardiographic‐anatomic correlations—Part I
Authors: Parker Alton B. , Waller Bruce F. , Gering Lawrence E. 
Published: February 2009

AbstractThis two‐part review evaluates a 56‐year period (1938–1994) of electrocardiographic‐necropsy correlation studies. Part I focuses on definitions of infarct location and evaluates anterior infarctions. Part II will focus on lateral and posterior infarcts.
Importance of delaying balloon angioplasty in patients with unstable angina pectoris
Authors: Rozenman Youseph , Gilon Dan , Zeilingher Julian , Sapoznikov Dan , Lotan Chaim , Mosseri Morris , Teddy Weiss A. , Hasin Yonathan , Gotsman Mervyn S. 
Published: February 2009

AbstractAngioplasty in patients with unstable coronary artery disease is associated with higher complication rates compared with patients with stable disease. In this report we describe our results from a group of patients with unstable disease (unstable angina pectoris and postmyocardial infarction) where a strategy of delaying angioplasty for >5 days after admission was undertaken. Included are 2069 consecutive patients: 1197 treated for stable angina pectoris and 872 treated during admission for unstable angina or myocardial infarction. There was no difference between the two groups in angioplasty success (92.1% stable, 92.3% unstable), failure to dilate without complication (6.4% stable, 6.1 % unstable), or in the rate of major complications: death (0.5% stable, 1.1% unstable), Q‐wave myocardial infarction (0.9% stable, 1.1% unstable), and emergency coronary artery bypass (0.6% stable, 0.3% unstable). The duration of hospitalization following angioplasty was longer in the unstable group (5.6 ± 8.1 days vs. 4.2 ± 4.1 days; p < 0.001) because of longer duration of hep‐arin infusion. There was no difference between groups in minor complications such as groin hematoma and pseudoa‐neurysm, renal failure, or infections. It was concluded that delaying angioplasty in unstable patients for > 5 days after admission is a safe and effective therapeutic strategy for this group of patients. The need for prolonged heparin infusion after angioplasty is increased in unstable patients and thus the duration of hospitalization after the procedure is longer.
Cardiovascular and hormonal responses to a meal in hypertrophic cardiomyopathy: A comparison of patients with and without postprandial exacerbation of symptoms
Authors: Gilligan David M. , Marsonis Antonios , Joshi Jayshree , Bloom Stephen R. , Oakley Celia M. , Nihoyannopoulos Petros , Ghatei Mohammad A. 
Published: February 2009

AbstractSome patients with hypertrophic cardiomyopathy experience postprandial exacerbation of symptoms. The aim of this study was to determine whether the hemodynamic and/or hormonal responses to a meal differ between patients with and without postprandial symptoms. Ten hypertrophic cardiomyopathy patients with postprandial symptoms, 10 patients without postprandial symptoms, and 10 normal subjects ate a 740 Kcal meal, following which heart rate, blood pressure, and echocardiographic and gastrointestinal hormone changes were compared among the three groups. Heart rate increased (p<0.001) and diastolic blood pressure fell (p < 0.001) to a similar degree in the three groups. Left ventricular outflow tract velocity increased (p< 0.01) and some patients had substantial increases in outflow tract pressure gradient; however, this was independent of the presence or absence of postprandial symptoms. The atrial contribution to filling increased in normal subjects and in both groups of hypertrophic cardiomyopathy patients. There was no significant difference in the gastrointestinal hormone changes in the three groups. In summary, there is no evidence for a distinctive hemodynamic or hormonal response to food in hypertrophic cardiomyopathy patients with postprandial symptoms. These symptoms more likely reflect differences in underlying cardiac disease characteristics and severity.
Angioplasty balloon compliance: Can in vivo size be predicted from in vitro pressure profile measurements?
Authors: More Ranjit S. , Brack Michael J. , Gershlick Anthony H. 
Published: February 2009

AbstractBackground and hypothesis: This study was undertaken to determine whether the behavior of angioplasty balloons within coronary arteries may differ from that anticipated from data provided by the manufacturers. In particular, the in vitro pressure‐diameter profiles may not truly represent in vivo sizes.Methods: Thus, we assessed the degree of correlation of in vitro with in vivo measurements obtained during routine angioplasty practice. In vivo size of 2.5 mm compliant (n = 8) and 3 mm semicompliant (n = 8) balloons was assessed using quantitative angiography for first, second, and third inflations.Results: In vivo size was less than expected from in vitro measurements. In general balloon diameter increased with inflation pressures up to 8 atmospheres, and some degree of elastic recoil was evident with both balloon types after the last inflation.Conclusion: In vivo balloon size may not be accurately predicted from manufacturers' published data. Size is more likely to be affected by factors such as lesion characteristics and elasticity of the vessel wall than by balloon material compliance characteristics.
Pacing therapy for atrial tachyarrhythmias
Authors: Zhu Dennis Wei‐Xi , Spencer William H. 
Published: February 2009

AbstractThe use of pacing techniques for the treatment of atrial tachyarrhythmias has been advocated for more than 30 years. Although it has played a beneficial role in the management of paroxysmal supraventricular tachycardia (PSVT) in drug‐refractory patients, tachycardia acceleration and development of atrial fibrillation has been the major drawback. With the availability of radiofrequency catheter ablation therapy, the use of implantable antitachycardia devices for PSVT is currently negligible. From retrospective and small control studies it has been shown that atrial or dual‐chamber pacing in patients with sick sinus syndrome has been associated with a lower incidence of paroxysmal atrial flutter or fibrillation than in those who received a ventricular pacemaker. Furthermore, recent studies have reported the potential benefit of reducing frequency of paroxysmal atrial flutter and fibrillation with multisite atrial pacing. As a result, there is a resurgence of research interest in antitachycardia pacing for prevention of atrial tachyarrhythmias. This paper briefly describes the basic aspects of antitachycardia pacing, reviews the data on the use of implantable antitachycardia devices for PSVT and the selection of patients, and assesses the current status of research on atrial pacing for prevention of paroxysmal atrial flutter and fibrillation.
Factors associated with the release of cardiac troponin T following percutaneous transluminal coronary angioplasty
Authors: Abbas Syed A. , Glazier James J. , Pears ALL Lisa A. , Waters David D. , Mckay Raymond G. , Wu Alan H. B. , Green Sol F. , Dupont Charles 
Published: February 2009

AbstractBackground: Recent studies have suggested that immunoassay of cardiac troponin T (cTnT) provides a more sensitive measurement of myocardial necrosis than creatine kinase MB (CK‐MB) mass concentration.Hypothesis: The purpose of this study was to compare the release of cTnT and CK‐MB isoenzyme in patients undergoing percutaneous coronary angioplasty, and to investigate the clinical, procedural, and angiographic correlates of abnormal elevations of both of these markers.Methods: Total creatine kinase (total CK), CK‐MB, and cTnT levels were measured immediately before and 12 h following intervention in 110 patients, including 100 consecutive patients undergoing coronary angioplasty and 10 control patients undergoing diagnostic cardiac catheterization. All patients had normal levels of all three markers at baseline. A postintervention total CK level >225 U/l, an increase in CK‐MB >5.0 ng/ml, and/or an increase in cTnT >0.04 ng/ml were considered indicative of myocardial injury.Results: Coronary angioplasty was successfully performed in all 100 patients without emergency bypass surgery or death, although six patients required emergent placement of an intra‐coronary stent for threatened closure. Eight patients demonstrated an abnormal increase in total CK, including six who were undergoing primary angioplasty for an acute myocardial infarction. One of these patients sustained a Q‐wave infarction. Post angioplasty, 18 patients had elevations of both CK‐MB and cTnT, 23 had elevations of only cTnT, and the remaining 59 patients had elevations of neither. All patients with CK‐MB elevation also had cTnT elevation. Neither serologic marker increased in the diagnostic catheterization control patients. In comparison with patients without postintervention cTnT rise, patients with abnormal cTnT levels had a higher incidence of complex lesion morphology (p<0.01) and intra‐coronary thrombus (p ≤0.0001) prior to coronary angioplasty, and a higher incidence of coronary dissection (p≤0.01), abrupt closure (p≤0.05), and side‐branch occlusion (p≤0.01) during angioplasty. In patients with elevation of both cTnT and CK‐MB, postintervention CK‐MB levels were 12‐fold higher and cTnT levels were 21‐fold higher than in patients with isolated elevation of only cTnT (p<0.01).Conclusions: These data indicate that >40% of patients undergoing coronary angioplasty have evidence of minor degrees of myocardial damage, as evidenced by cTnT release. High‐risk coronary lesions and both minor and major complications of angioplasty are associated with cTnT release. cTnT appears to be a more sensitive marker of myocardial injury than CK‐MB under these circumstances. In comparison with isolated cTnT rise, elevation of both CK‐MB and cTnT may be indicative of greater levels of myocardial injury.
The appearance of gallop rhythm after exercise stress testing
Authors: Tavel Morton E. 
Published: February 2009

AbstractBackground and hypothesis: Although it is generally assumed that the appearance of an early diastolic gallop, or third heart sound, appearing immediately after exercise during treadmill stress testing, indicates the presence of serious myocardial disease, no systematically collected data are available to test this hypothesis.Methods: The author performed auscultation on 3,679 patients undergoing routine treadmill testing together with thallium‐201 perfusion scans. Exercise‐induced diastolic sounds were related to the available clinical information and electrocardiographic and nuclear test results. These findings were compared with those of 665 randomly selected patients undergoing stress testing in whom such sounds were absent.Results: A total of 165 patients had audible third heart sounds (Group 1). In comparison with those patients lacking such sounds (Group 2), there was a considerably greater prevalence of myocardial scarring (68.5 vs. 26.9%), abnormal lung uptake of thallium (40 vs. 12.8%), diabetes mellitus (20.6 vs. 6.2%), and left bundle‐branch block on the resting electrocardiogram (ECG) (15.1 vs. 1.2%). In addition, 65 patients (39.3%) had dilatation of the left ventricle after exercise;31 (18.8%) of these were also dilated at rest, but only 2 (1.2%) had a drop in blood pressure during stress. In those individuals also subjected to nuclear ventriculography, the average resting ejection fraction was 35%. Estimated exercise capacity was generally reduced in Group 1 (average peak of 6.6 METs), but 29 (17.6%) exceeded 9 METs. Sensitivity and specificity of electrocardiographic ST depression were relatively poor in the detection of perfusion defects within this group (36 and 62%, respectively). Of the 39 patients in Group 1 with a normal resting ECG, 19 (48.7%) had scar (usually posterior or lateral) on nuclear scans. In an additional 10 of this group, nuclear evidence of ischemia (often extensive) was found.Conclusions: An early or mid‐diastolic gallop sound developing after exercise virtually always signifies myocardial disease with reduced myocardial function. Common associated findings are prior infarction (with or without associated ischemia), diabetes, and left bundle‐branch block. When found in the presence of a normal resting ECG, this sound commonly signals the presence of an occult left ventricular scar and, less commonly, extensive myocardial ischemia. In those patients manifesting such sounds, electrocardiographic ST changes in response to exercise appear limited in the detection of coronary ischemia.
Chylothorax following median sternotomy
Authors: Zaidenstein R. , Cohen N. , Dishi V. , Alon I. , Golik A. , Modai D. 
Published: February 2009

AbstractReports of chylothorax (CT) following median sternotomy are rare, amounting so far to 16 cases in the English literature, of which 6 were cases of postcoronary artery bypass grafting (CABG). This report deals with an additional case of a 70‐year‐old woman who developed left pleural chylous effusion following CABG. It is suggested that the incidence of this type of pleural effusion is considerably greater than the few cases hitherto reported. Moreover, as CT may produce serious pulmonary and/or pleural functional impairment, it is proposed that a diagnostic tap be performed more often in cases of post CABG pleural effusion and that preventive drainage be instituted when CT is diagnosed.
Heart transplantation—An update
Authors: Blum Arnon , Aravot Dan 
Published: February 2009

AbstractCardiologists caring for heart transplant recipients must be familiar with the pharmacology, drug interactions, and drug toxicity of those agents used extensively in clinical practice (cyclosporine, prednisone, azathioprine, polyclonal and monoclonal anti‐T‐cell agents) and the newer treatments [methotrexate, FK‐506, rapamycin, mycopheno‐late mofetil (RS61443), deoxyspergualin, anti‐CD4 monoclonal antibodies, total lymphoid irradiation, and photophoresis]. Another important aspect of medical follow‐up is the detection, differential diagnosis, and treatment of allograft dysfunction. Hemodynamic abnormalities that occur as a result of rejection or a direct drug effect must be differentiated from physiologic changes. Cardiac allograft vasculopathy is the primary impediment to the long‐term survival of heart transplant recipients. Immunopathogenesis, prevention, early detection, and treatment of allograft vasculopathy should be the major focus of heart transplantation research.
Abnormal signal‐averaged electrocardiograms in patients with incomplete right bundle‐branch block
Authors: Manolis Antonis S. , Chiladakis John A. , Malakos John S. , Vassilikos Vassilis , Maounis Themos , Cokkinos Dennis V. 
Published: February 2009

AbstractBackground and hypothesis: A hypothesis was formulated that regional delayed activation of the right ventricle, as seen in incomplete right bundle‐branch (IRBBB) aberrancy, may simulate late potential activity and may be responsible for abnormal signal‐averaged electrocardiograms (SAECGs). No previous studies have specifically addressed this issue in this particular group of patients (with IRBBB). Therefore, the aim of the present study was to investigate the incidence of abnormal SAECGs in patients with IRBBB. If this were confirmed, our purpose would further be to investigate ways of reducing the false positive results.Methods: The study group included 53 patients (28 men and 25 women), aged 53 ± 13 years, with no history of previous myocardial infarction or ventricular tachycardia and who had an electrocardiogram (ECG) showing IRBBB. An SAECG was also performed in a control group of 19 age‐matched individuals with a normal ECG. Time domain analysis was performed using a band pass filter of 40–250 Hz. The following parameters were considered normal: filtered QRS duration (QRSD) < 114 ms, root mean square of the voltage of the last 40 ms of the QRS complex (RMS) > 20 μV, and the duration of the low amplitude signal (< 40 μV) at the terminal portion of the QRS (LAS) < 38 ms. An SAECG was considered abnormal if any two of these criteria were abnormal.Results: The mean values of the SAECG parameters were: QRSD 101 ± 11 ms, RMS 32 ± 20 μV, LAS 32 ± 12 ms, and noise 0.29 ± 0.13 μV. Abnormal SAECGs with at least two criteria satisfied were present in 16 of 53 (30%) patients compared with 0 (0%) of 19 individuals in the control group (p = 0.02). Abnormal values included the combination of RMS and LAS in 12 patients and all three parameters in 4 patients. However, if the definition of late potentials were limited to the combination of abnormal QRSD and either RMS or LAS values, the incidence of false positive results (4 patients) (7.5%) would be significantly decreased (p = 0.007). At 21 months of follow‐up, no arrhythmic events occurred.Conclusions: Delayed terminal conduction observed in IRBBB may cause a high incidence of false positive late potentials on SAECGs. Based on this study, we propose that this can be largely remedied if the optimal criteria for the presence of late potentials in patients with IRBBB always include the combination of QRSD and either RMS or LAS.