bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unexpected instant death following successful coronary artery bypass graft surgery (and other clinical settings): Atrial fibrillation, quinidine, procainamide, et cetera, and instant death
Authors: O'Neal HUMPHRIES J. 
Published: February 2009

AbstractPrimum non nocere. Atrial fibrillation (AF) occurs commonly following coronary artery bypass graft surgery, although new onset atrial fibrillation in this setting is usually transient. When AF reverts or is converted to sinus rhythm it is unlikely to recur, whether or not the patient takes preventive medication. As no benefit (and sometimes increased risk) associated with reduced mortality or morbidity in this setting has been reported for antiarrhythmic agents, standard treatment should consist of observation or control of ventricular response with an appropriate agent until AF relapses to sinus rhythm. If an antiarrhythmic agent, especially a class I agent, is used because of persistent or recurrent AF in the early postoperative period, heart rhythm should be monitored as long as the class I agent is administered and treatment initiated if an un‐dersirable rhythm develops. Atrial fibrillation in other clinical settings in patients with structural heart disease presents a more difficult management problem. Class I agents are reported to be associated with an increased risk of death, despite an efficacious effect of maintaining sinus rhythm. Amiodarone is reported to be well tolerated with respect to the cardiovascular system, but unacceptable noncardiac effects are reported. A safe amiodarone‐like agent is greatly needed. Atrial fibrillation in patients with no structural heart disease is not discussed in this presentation.
Current clinical applications of heart rate variability
Authors: Stys A. , Stys T. 
Published: February 2009

AbstractHeart rate variability (HRV) has become a popular method for the studies of physiologic mechanisms responsible for the control of heart rate fluctuations, in which the autonomic nervous system appears to play a primary role. Depression of HRV has been observed in many clinical scenarios, including autonomic neuropathy, heart transplantation, congestive heart failure, myocardial infarction (MI), and other cardiac and noncardiac diseases. However, it is important to realize that clinical implication of HRV analysis has been clearly recognized in only two clinical conditions: (1) as a predictor of risk of arrhythmic events or sudden cardiac death after acute MI, and (2) as a clinical marker of evolving diabetic neuropathy. Recently, its role in evaluation and management of heart failure has also been recognized. It is pertinent to recognize the limitations of HRV as far as its clinical utility at present is concerned. The methodology of HRV had remained poorly standardized until the recent publication of the Special Report of the Task Force of ESC/NASPE, and thus has been presenting difficulty in comparing earlier existing data. Also, determination of the exact sensitivity, specificity, and predictive value of HRV, as well as the normal values of standard measures in the general population, still require further investigation before better standards can be set for existing and future clinical applications. This article reviews the major concepts of HRV measurements, their clinical relevance, and the recent advances in this field.
Arrhythmic profile, ventricular function, and histomorphometric findings in patients with idiopathic ventricular tachycardia and mitral valve prolapse: Clinical and prognostic evaluation
Authors: Vecchia Luigi La , Ometto Renato , Centofante Paolo , Varotto Leonardo , Bonanno Carlo , Bozzola Loredana , Bevilacqua Pierantonio , Vincenzi Mario , Cardiologia Divisione Di 
Published: February 2009

AbstractBackground: In patients with ventricular tachycardia (VT) and apparently normal hearts, mitral valve prolapse (MVP) is discovered fairly often, raising the question of whether or not it is an occasional finding.Hypothesis: This issue was analyzed in a series of patients with VT and apparently normal hearts in order to define the prevalence of MVP in this condition, the existence of specific diagnostic features suggesting a nonrandom association between idiopathic VT and MVP, and the prognostic implications of this finding.Methods: We studied 28 consecutive patients with documented VT and no history of heart disease. Two‐dimensional (2‐D) echocardiogram, cardiac catheterization, morphometric examination of endomyocardial biopsy and arrhythmologic evaluation (24‐h Holter monitoring, electrophysiologic study, and signal‐averaged electrocardiogram) were performed. Inclusion criteria for all patients were angiographically normal coronary arteries, normal biventricular function, and absence of histologic evidence of myocarditis. Data obtained in patients found to have MVP at 2‐D echo were compared with those of the remaining patients. Long‐term follow‐up data were also collected.Results: The prevalence of MVP in our study group was 25% (7 patients). It was not associated with leaflet dysplasia or significant regurgitation. Biventricular function (ventricular volumes and ejection fraction) was comparable in patients with and without MVP. Patients with MVP had a significantly higher prevalence of ventricular late potentials at signal‐averaged electrocardiogram (86 vs. 29%, p = 0.027), more interstitial fibrosis at morphometry (8.5 ± 3.7 vs. 5.4 ± 2.7% p = 0.028), and VT of right bundle‐branch block morphology (100 vs. 48%; p = 0.044). Other arrhythmologic findings were similar in the two groups. After a mean follow‐up of >5 years, no patient in either group died, and none developed heart failure or severe mitral regurgitation.Conclusions: Mitral valve prolapse is frequently detected in idiopathic VT. The distinguishing features of this association are (1) VT of right bundle‐branch block morphology, (2) high prevalence of ventricular late potentials, and (3) increased fibrosis on endomyocardial biopsy. Ventricular function and other arrhythmologic findings are not specific of this association. Prognosis remains substantially benign, as is true for most cases of idiopathic VT.
Hypotensive response during dobutamine stress echocardiography in coronary patients: A common event of well‐functioning left ventricle
Authors: Rallidis Loukianos S. , Moyssakis Ioannis E. , Nihoyannopoulos Petros 
Published: February 2009

AbstractBackground: Hypotensive response during dobutamine stress echocardiography (DSE) is a common complication, lacking the prognostic significance of hypotension during exercise treadmill test.Hypothesis: The present study aimed to assess the possible mechanisms of hypotensive response during DSE and to compare it with exercise treadmill test.Methods: In all, 91 patients with known coronary artery disease (CAD) underwent both DSE and exercise treadmill test. Dobutamine‐induced hypotension was defined as a systolic blood pressure drop ≥20 mmHg from baseline or from the previous level of infusion.Results: Twenty‐one (23%) patients, 10 of whom also had bradycardia, developed hypotension during dobutamine infusion. Five (5.5%) patients were severely symptomatic and the infusion was stopped prematurely, while in the remaining 16 the addition of atropine allowed the continuation of the test. Patients prone to hypotension were predominantly female (p = 0.0004). had smaller (p = 0.01) and better functioning left ventricles (p = 0.0004), were unlikely to have rest wall motion abnormalities (p = 0.0008) or multivessel CAD (p = 0.02), and had less ischemia (wall motion score difference) (p = 0.03). Hypotension during exercise treadmill test was observed in only one (1%) patient with left main disease.Conclusions: Hypotension during DSE is unrelated to the anatomical or functional extent of CAD and is frequent in the setting of a well‐functioning left ventricle. We suppose that vigorous contraction of a small chamber during dobutamine infusion results in an excessive stimulation of cardiac mechanoreceptors that mediate reflex hypotension and bradycardia.
Assessment of abnormal left atrial relaxation by transesophageal pulsed doppler echocardiography of pulmonary venous flow velocity
Authors: Oki Takashi , Tabata Tomotsugu , Yamada Hirotsugu , Fukuda Kazuyo , Abe Miho , Onose Yukiko , Wakatsuki Tetsuzo , Iuchi Arata , Ito Susumu 
Published: February 2009

AbstractBackground: Several studies on left ventricular relaxation have been undertaken in the past: however, left atrial (LA) relaxation has not been fully evaluated.Hypothesis: The purpose of this study was to assess abnormalities in LA relaxation by evaluating pulmonary venous flow velocity and interatrial septal motion using transesophageal echocardiography.Methods: The subjects were 56 untreated patients in sinus rhythm, including 25 with previous myocardial infarction, 9 with hypertrophic cardiomyopathy, 11 with dilated cardiomyopathy, as well as 11 with chest pain syndrome as controls. Peak first systolic velocity (PVS1), peak atrial systolic velocity (PVA), and their time‐velocity integrals (PVS1‐I and PVA‐I, respectively) were calculated from the pulmonary venous flow velocity.Results: The PVS1 and PVS1‐I correlated negatively with the maximum LA dimension and mean pulmonary capillary wedge pressure, and correlated positively with the amplitude of the interatrial septal motion during LA relaxation and percent fractional LA relaxation. The PVA and PVA‐I did not correlate with the mean pulmonary capillary wedge pressure. There was a weak positive correlation between PVA and PVS1, and a close positive correlation between the ratio of PVA to PVS1 and mean pulmonary capillary wedge pressure. Multiple regression analysis indicated that the PVS1 was most closely related to percent fractional LA relaxation, followed by mean pulmonary capillary wedge pressure.Conclusion: The PVS1 determined from the pulmonary venous flow velocity is closely related to parameters of LA relaxation which may be determined by transesophageal M‐mode echocardiography, and the ratio of PVA to PVS1 is useful for noninvasive evaluation of LA pressure..
Effect of aminophylline in patients with atropine‐resistant late advanced atrioventricular block during acute inferior myocardial infarction
Authors: Alton Armaǧan , Kirdar Celal , ÖZBAY GÜLTAÇ 
Published: February 2009

AbstractBackground: Advanced atrioventricular (AV) block is a frequent complication in patients with acute inferior myocardial infarction (AIMI). This conduction abnormality is associated with narrow QRS complex in conducted or junctional escape beats, suggesting that the site of block is the AV node; however, its pathophysiology has not been properly established.Hypothesis: This study investigated the effect of aminophylline in eight patients (5 men, 3 women, age range 51 to 78 years, mean 67.5 ± 8.8 years) with atropine‐resistant late advanced AV block during AIMI.Methods: Advanced AV block was late in appearance in all patients, starting 2 to 5 days after AIMI, and consisted of second‐degree Mobitz II type in two patients and of complete AV block in six patients; all patients had narrow QRS complexes. Before aminophylline administration, all patients had a temporary pacemaker installed which was switched off throughout the study. They were given intravenous atropine (1 mg) that was found to be ineffective. One‐half h after atropine, the first aminophylline injection (240 mg) was given intravenously over 10 min. One h following the first injection, a second aminophylline dose (240 mg) was administered. Electrocardiographic rhythm strips were obtained before and after drug administration, and the type of AV block and atrial and ventricular rate were noted.Results: Aminophylline restored 1:1 conduction with first‐degree AV block in six patients, Mobitz I AV block in one patient, and normal sinus rhythm in one patient. Mean atrial and ventricular rates before aminophylline were 104 ± 16 beats/min and 57 ± 9 beats/min. respectively, and after drug administration 95 ± 25 beats/min and 89 ± 17 beats/min, respectively, (p = 0.012).Conclusion: These results indicate that aminophylline improves AV conduction in atropine‐resistant late advanced AV block complicating AIMI.
Propafenone versus procainamide for conversion of atrial fibrillation to sinus rhythm
Authors: Mattioli Anna Vittoria , Lucchi Giulia Ricci , Vivoli Daniela , Mattioli Giorgio 
Published: February 2009

AbstractBackground and hypothesis: Antiarrhythmic drugs are widely used for treatment of atrial fibrillation (AF) and restoration off sinus rhythm. This prospective, randomized, and controlled study compared the efficiency and safety of propafenone versus procainamide for the treatment of acute AF.Methods: In all, 117 patients (55 women, 62 men, mean age 64.2 ± 13 years, median 63 years) who presented with AF were included in the study. Exclusion criteria were signs or symptoms of heart failure on physical examination, recent myocardial infarction or cardiac surgery, cardiogenic shock, or hypotension. Forty‐one patients spontaneously recovered sinus rhythm; the remaining 76 patients were randomized to receive propafenone or procainamide. Propafenone was given at a dose of 2 mg/kg body weight intravenously (IV) over 30 min. Patients randomized to receive procainamide received a bolus of 100 mg IV administered every 5 min up to a maximum dose of 1 g. The clinical characteristics of the two groups were comparable.Results: The number of patients who recovered sinus rhythm after the treatment was larger in the procainamide‐treated group (Group 1) (69.5%) than in the propafenone‐treated group (Group 2) (48.7%); p < 0.05. The time required for cardioversion was significantly lower in Group 1 (mean 4.1 ± 1.3 h). than in Group 2 patients (mean 7.3 ± 2.6 h) (p<0.01).Conclusion: In the present study, procainamide was more effective than propafenone for the treatment of AF of short duration.
Impairment of left atrial appendage function after spontaneous conversion of atrial flutter
Authors: Kontos Michael C. , Paulsen Walter H.J. 
Published: February 2009

AbstractThis paper reports a patient in atrial flutter who spontaneously converted to sinus rhythm while undergoing a transesophageal echocardiogram. Atrial appendage flow velocities were noted to be significantly decreased after conversion to sinus rhythm. Spontaneous contrast also developed in the left atrium shortly after conversion. Spontaneous cardioversion may be associated with decreased mechanical activity of the left atrium and appendage, resulting in “stunning.” This provides a possible explanation for the occurrence of thromboembolic events in patients without apparent thrombus before cardioversion.
Anomalous origin of the right coronary artery from the main pulmonary artery: Diagnosis and management
Authors: Hekmat Vahid , Rao Sudha M. , Chhabra Manoj , Chiavarelli Mario , Anderson John E. , Nudel Dov B. 
Published: February 2009

AbstractAnomalous origin of the right coronary artery (ARCA) from the main pulmonary artery (MPA) is a rare congenital anomaly, with only 18 reported cases in the pediatric age group. More than half of these had associated cardiac anomalies that masked the presence of ARCA. Conversely, in many patients with ARCA as an isolated anomaly, the diagnosis has been missed during lifetime. The only patient with an isolated ARCA who was diagnosed in infancy presented with congestive heart failure. Asymptomatic infants with ARCA from the MPA have not been previously reported. Three additional cases, two infants and a child with ARCA from the MPA, are reported in this paper. The diagnostic dilemmas and the prognosis are discussed and management is recommended.
Relationship between joint national committee‐VI classification of hypertension and ambulatory blood pressure in patients with hypertension diagnosed by casual blood pressure
Authors: Inden Yasuya , Tsuda Makoto , Mayashi Hiroshi , Takezawa Hiroto , Iino Shigeo , Kondo Takahisa , Yoshida Yukihiko , Akahoshi Makoto , Terasawa Masayuki , Itoh Teruo , Saito Hdehiko , Hirai Makoto 
Published: February 2009

AbstractBackground: White‐coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee‐VI (JNC‐VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time.Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC‐VI classification, and the prevalence of white‐coat hypertension diagnosed by using JNC‐VI normal ABP criteria.Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC‐VI classification, and their casual BP was compared with ABP. The criterion of white‐coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC‐VI criteria (< 135/85 during daytime and < 120/75 during nighttime).Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased.There were considerable overlaps in the distribution of ABP among stages. The prevalence of white‐coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3.Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC‐VI is very useful for the evaluation of hypertension to differentiate white‐coat hypertension from true hypertension.
Clinical characteristics of ruptured chordae tendineae in hospitalized patients: Primary tear versus infective endocarditis
Authors: Portugese Shirley , Amital Howard , Tenenbaum Alexander , Bar‐Dayan Yaron , Levy Yair , Afek Arnon , Shemesh Joseph , Shoenfeld Yehuda 
Published: February 2009

AbstractBackground: Several etiologies have been associated with the rupture of chordae tendineae. The leading causes are infective endocarditis, primary rupture, and the association with various connective tissue disorders.Hypothesis: In order to define the attributes of these patients, a retrospective study was conducted that investigated the medical files of hospitalized patients in the Sheba Medical Center, Tel‐Hashomer, Israel.Methods: Twenty patients (17 men, 3 women) with ruptured chordae were detected. Primary rupture of the chordae tendineae had been diagnosed in 11 patients, while infectious endocarditis was the cause for the tear of the chordae tendineae in 9 patients. The patients who had primary rupture of the chordae were older than the patients with endocarditis (67.4 ±11.3 vs. 57 ± 9.3 years, respectively, p < 0.05).Results: The posterior mitral valve cusp was more commonly involved (15 patients). Six of the patients with posterior mitral valve cusp involvement manifested atrial fibrillation. Mitral valve prolapse (MVP) was detected among seven patients, six of whom belonged to the group with infective endocarditis.Conclusion: Primary tear and infective endocarditis are leading etiologies of ruptured chordae tendineae in hospitalized patients. Particularly among the patients with infective endocarditis, concomitant MVP was frequently detected. It is the authors' opinion that this coexistence implies that MVP may predispose to the rupture of chordae tendineae.
Association of genetic polymorphisms in the ace, apoe, and tgfβ genes with early onset ischemic heart disease
Authors: Biggart S. , Chin Mrcp, D. , Fauchon M. , Cardew G. , Du Fou L. , Harker N. , Quinn E. , Keller C. , Vincent R. , Mayne L. 
Published: February 2009

AbstractBackground: The genetic factors that contribute to ischemic heart disease (IHD) are poorly understood, and it is likely that multiple genes acting independently or synergistically contribute to the risk of IHD and outcome. The genes for angiotensin‐converting enzyme (ACE) and apolipoprotein E (ApoE) have been implicated independently in the risk of IHD.Hypothesis: This study examined whether genetic polymorphisms in the ACE and ApoE genes are associated with early onset IHD. Polymorphisms in a third gene, transforming growth factor β2 (TGF β2), with a known role in wound repair and cardiac development, are also examined with respect to early onset IHD.Methods: In all, 101 patients with IHD and onset of disease before 55 years for men and 60 years for women, and 100 controls with angiographically confirmed normal coronary arteries were recruited for this study. The ACE, ApoE, and TGF β2 genotypes were determined by polymerase chain reaction amplification or Southern blotting and were compared with the patient's clinical and family histories.Results and Conclusion: The frequency of the ACE D allele was significantly lower in the patient group (0.475) than in the control group (0.59, p = 0.03), which was attributed to a reduction in the number of patients with the DD genotype (patients: 24% DD, controls: 33% DD). Sudden cardiac death was also associated with the DD genotype. These data are consistent with the ACE D allele contributing to a fatal outcome. No association between the DD genotype and risk of myocardial infarction, presenting age, extent of vessel disease, family history, hypertension, or hypercholesterolemia was seen. Analysis of the ApoE genotype showed no association with early onset IHD. There was no evidence for a synergistic effect between the ACE and ApoE genotypes on the risk of early onset IHD. A polymorphism in the TGF (32 gene was rare and not associated with early onset IHD.
Uncommon electrocardiographic changes corresponding to symptoms during recurrent pulmonary embolism as documented by computed tomography scans
Authors: Watanabe Takuya , Kikushima Shuji , Tanno Kaoru , Geshi Eiichi , Kobayashi Youichi , Takeyama Youichi , Katagiri Takashi 
Published: February 2009

AbstractElectocardiographic (ECG) findings of pulmonary embolism (PE) include S1Q3T3 pattern, right bundlebranch block, right‐axis deviation, and T‐wave inversion in medial precordial leads. We report other uncommon ECG changes associated with various symptoms during recurrent PE as documented by computed tomography (CT) scans in a single patient. An 83‐year‐old woman was admitted with PE secondary to deep venous thrombosis in the left leg. During episodes of chest pain, ECG showed QTc prolongation (480 ms) with new T‐wave inversion in leads III, aVF, and V1‐V3, and ST‐segment depression in leads V5‐V6. Despite adequate anticoagulant therapy, recurrent episodes of PE occurred in the hospital. When the patient experienced sudden chest tightness, ECG showed a new S‐wave notch in lead V1 and clockwise rotation with sinus tachycardia. She also experienced transient syncope with hypotension. At this time, ECG showed transient atrioventricular junctional rhythm followed by sinus arrest, and CT scan showed a new massive embolus in the main pulmonary trunk with right ventricular dilatation, as demonstrated by echocardiography. The mechanism responsible for QTc prolongation with ST‐T changes, the S‐wave notch in lead V1 with clockwise rotation, or atrioventricular junctional rhythm with sinus arrest during PE may be associated with myocardial ischemia, acute right ventricular overload, or vagal reflex, respectively.