bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefits of the advances in cardiac pacemaker technology
Authors: Shakespeare Carl F. , Camm A. John , Camm A. John 
Published: February 2009

AbstractPacemaker technology has expanded rapidly in the last thirty years. Each phase of development has been marked by both improvements in clinical benefit and disadvantageous interactions of physiology and technology. Each phase of development has led to smaller, more reliable devices with greater programmability. Advances in generator technology and battery design have increased longevity of devices. The first devices used asynchronous pacing which had a significant effect in reducing the mortality of surgically induced complete heart block. Ventricular demand pacemakers overcame the problems of asynchronous competitive pacing, but exposed the pacemaker syndrome. Atrioventricular sequential pacing restored atrioventricular synchrony, resulting in hemodynamic improvement, but created the phenomenon of pacemaker‐mediated tachycardia. Alternative dual chamber modes and algorithms have largely resolved this. Adaptive‐rate devices have been of benefit to patients with chronotropic incompetence, and are now incorporating an increasing variety of biosensors. Almost all the problems of pacing have been overcome, but the increasing complexity of pacemaker technology is now a major limitation to its proper use.
The prevention of atherosclerosis with antioxidants
Authors: Harris William S. 
Published: February 2009

AbstractRecent research findings have suggested a role for pharmacologic as well as nutritional antioxidants in the prevention of atherosclerosis. Data from animal studies as well as cell culture experiments have shown that the drug probucol, which has hypocholesterolemic and antioxidant properties, is able to prevent oxidative modification of low density lipoproteins (LDL). Such modification is now believed to play a major part in the initiation and progression of arterial lesions. Nutrients with antioxidant properties such as vitamins C and E, beta‐carotene, and monounsaturated fatty acids (when they replace polyunsaturated fatty acids) can reduce the susceptibility of LDL to oxidation. Antioxidant therapy, if proven useful, should be considered an adjunct to lipid‐lowering therapy in order to have the greatest impact on coronary heart disease.
A “lipo‐protective” effect of a fixed combination of captopril and hydrochlorothiazide in antihypertensive therapy
Authors: Ratheiser K. , Dusleag J. , Titscher G. , Klein W. 
Published: February 2009

AbstractIncreases of triglycerides and total cholesterol have been reported during treatment with antihypertensive drugs Most notably with beta blockers and diuretics. ACE inhibitors, on the other hand, are not known for having a negative effect on lipid profile. To evaluate the effects of a fixed combination of captopril and hydrochlorothiazide on lipid metabolism, blood pressure, and quality of life, we performed an open prospective study. A total of 2,154 patients with or without hypercholesterolemia, but not receiving lipid lowering drugs, were enrolled. Of the 1891 evaluable patients at baseline, 34.1% had a moderate risk with total cholesterol between 5.2 and 6.5 mmol/1 (mean 5.8 mmol/1) and 41.3% had a high coronary heart disease (CHD) risk with total cholesterol higher than 6.5 mmol/1 (mean 7.3 mmol/1). After six months of treatment, the median cholesterol level in the moderate risk group decreased from 5.8 to 5.4 mmol/1 (p<0.0003) and in the high risk group from 7.3 to 6.3 mmol/1 (p<0.0001). Triglycerides also decreased, whereas high density lipoprotein (HDL) increased in both risk groups. Systolic and diastolic blood pressure fell as expected and quality of life improved. The fixed combination was well tolerated. We observed a significant improvement of lipid profile in patients with mild to moderate hypertension while undergoing treatment with the fixed combination of captopril and hydrochlorothiazide. We suggest that captopril may balance the negative effects of hydrochlorothiazide on lipid metabolism in patients with hypertension and concomitant hyperlipidemia.
Myocardial alterations induced by prolonged noradrenaline administration in various doses
Authors: Popovich M. I. , Kobets V. A. , Kostin S. I. , Kapelko V. I. 
Published: February 2009

AbstractProlonged noradrenaline administration to rats in steadily increasing dosages for a period of one to four weeks (cumulative doses 25–35 mg/kg) resulted in the development of focal necrotic areas with abundant collagen fibers and marked hypertrophy of cardiomyocytes. Cellular diameter was higher by 37–44% and extracellular space area by 70–100%. A combination of overcontracted and overdistended sarcomeres in some cardiomyocytes and a twofold rise in serum creatine kinase presumably reflected cellular calcium overload. Myocardial high energy phosphate content was depleted to 50–62% of the control level. The extent of this depletion positively correlated with a decrease in heart rate and cardiac output of the isolated heart. The latter may be attributed to limited left ventricular filling caused by elevated LV diastolic pressure and stiffness. Minimal metabolic and functional changes were observed after lowest noradrenaline dose (5 mg/kg for nine days) that was followed by only moderate depletion of myocardial phosphocreatine content and moderate rise in LV diastolic stiffness. Results suggest that energy‐deficient increase in myofibrillar stiffness may form the basis for decreased myocardial distensibility and cardiac pump failure.
His bundle ablation for supraventricular arrhythmias to avoid spurious shocks of an implanted defibrillator
Authors: Jordaens L. , Caenepeel A. , Calle P. 
Published: February 2009

AbstractAtrial fibrillation with fast ventricular response remains a matter of concern in patients treated with an implantable cardioverter defibrillator (ICD). A patient with dilated cardiomyopathy, suffering from atrial arrhythmias and recurrent cardiac arrest due to both ventricular tachycardia and ventricular fibrillation, is presented. Ablation of the AV node by means of low‐energy direct‐current shocks with subsequent pacemaker implantation was performed before ICD implantation. The patient received shocks after four months, when he had recurrence of AV conduction with a slow ventricular rate. Pacemaker interaction was excluded, and no short ventricular arrhythmias were observed. During electrophysiologic study after electrical conversion of atrial fibrillation, persistent second degree heart block was documented, giving further evidence that atrial arrhythmias were not responsible for the shocks. The patient's functional status remains good after more than 18 months of follow‐up.
Splenic infarction: A complication of cardiac catheterization
Authors: Rose Michal , Dinour Dganit , Chisin Roland 
Published: February 2009

AbstractPatients with extensive atherosclerosis are at increased risk of developing embolic complications during cardiac catheterization. We describe a 51‐year‐old man with unstable angina and bilateral leg claudication who developed fever and right upper abdominal pain shortly after cardiac catheterization. Liver‐spleen scintigraphy demonstrated a wedge‐shaped filling defect compatible with splenic infarction, and serial scans performed over a period of five months showed resolution of this finding. Splenic infarction tends to be under‐diagnosed, and physicians should be aware of this potentially serious complication of cardiac catheterization.
Progression of valvular sclerosis in end‐stage renal disease treated by long‐term peritoneal dialysis
Authors: Hüting Jürgen 
Published: February 2009

AbstractWhile patients with end‐stage renal disease treated by intermittent hemodialysis have frequent and progressive valve disease, nothing is known of the prevalence and course of valvular abnormalities in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Therefore, valves of 24 CAPD patients (ages 55±11 years; CAPD duration: 29±28 months) were studied in a prospective echocardiographic and Doppler echocardiographic follow‐up analysis over 35 months. Most frequent findings were sclerosis of the aortic annulus (100% at both assessments) and of the anterior mitral valve leaflet (first vs. follow‐up assessment: 88 vs. 96%). Sclerosis of the mitral valve annulus (58% vs. 63%), right coronary (54 vs. 63%) and noncoronary (50 vs. 67%) cuspis of the aortic valve and of the posterior mitral valve leaflet (25 vs. 50%) were less frequent but tended to be progressive (p=NS). The moderate form of mitral and aortic valve sclerosis was more frequent than the severe form (p<0.01 each) at both assessments. Patients with progressive valve disease were older (60±9 vs. 50±11 years; p<0.025) and had a higher frequency angina pectoris than those without a progression (5 vs. 0 patients; p<0.05). The number of patients with regular sinus rhythm decreased (from 22 to 16; p<0.03), atrial fibrillation developed in four patients, atrioventricular node rhythm following atrioventricular conduction defect developed in one patient, and atrioventricular conduction defect required implantation of a pacemaker in one patient. It is concluded that valvular sclerosis is frequent and progressive in patients with end‐stage renal disease treated with long‐term CAPD and is associated with supraventricular arrhythmia.
Cardiac tamponade in a patient with gaucher's disease
Authors: Mester Stephen W. , Weston Mark W. 
Published: February 2009

AbstractGaucher's disease, a familial inborn error of metabolism associated with hepatosplenomegaly and hypersplenism, was first described by Earnest Gaucher in 1882. By 1959, Hsia1 found published reports on more than 300 cases. Most reports mentioned the bleeding tendencies of patients with Gaucher's, but show that major hemorrhagic complications are rare. We report a case of hemorrhagic pericarditis with cardiac tamponade in a patient with Type I Gaucher's disease.
Torsade de pointes complicating acute myocardial infarction: tHe importance of autonomic dysfunction as assessed by heart rate variability
Authors: Carter James E. , Childers Rory W. 
Published: February 2009

AbstractTorsade de pointes is a polymorphic ventricular tachycardia associated with QT‐interval prolongation rarely reported to occur in the setting of an acute myocardial infarction. Autonomic dysfunction has been implicated as a major stimulus for the development of this dysrhythmia. We describe the case of an 80‐year‐old woman who presented with an acute myocardial infarction and progressive QT‐interval lengthening. An 89‐beat run of torsade de pointes occurred during the time of the peak creatine phosphokinase (CPK) without electrolyte abnormalities or antiarrhythmic therapy. Assessment of autonomic tone using power spectral analysis of two consecutive 24‐h Holter recordings was performed indicating that a transient decrease in heart rate variability and increase in sympathetic tone preceded the tachyarrhythmia. This case shows the potential usefulness of heart rate variability analysis as a marker for autonomic dysfunction and arrhythmogenesis, particularly during myocardial ischemia.
Diagnosis of aortic pseudoaneurysm by echocardiography
Authors: Lasorda David M. , Power Thomas P. , Dianzumba Sinda B. , Incorvati Robert L. 
Published: February 2009

AbstractThe diagnosis of pseudoaneurysm of the ascending aorta is of paramount importance because of its propensity to rupture. As the frequency of surgical procedures involving the aortic root and valve increases, an increase in the incidence of aortic pseudoaneurysm may be anticipated. We recently studied a patient who developed pseudoaneurysm of the ascending aorta following repair of a Type I aortic dissection, utilizing a composite graft. Two‐dimensional echocardiography with color flow and pulsed Doppler imaging showed a large perigraft cavity communicating with the aorta. Echocardiography provides a safe noninvasive diagnostic tool for the evaluation of the aorta postoperatively and for screening for pseudoaneurysm formation in the follow‐up period.
Effective treatment of hypertension in patients with diabetes mellitus
Authors: Garber Alan J. 
Published: February 2009

AbstractAtherosclerosis, presenting as macrovascular complications of diabetes mellitus, produces approximately 80% of all diabetic mortality, whether the patient has Type I insulin‐dependent diabetes (IDDM) or Type II non‐insulin dependent diabetes mellitus (NIDDM).' Specifically, 75% of this atherosclerotic macrovascular mortality flows as the outcome of coronary atherosclerosis, which is increased approximately two‐fold in men and four‐fold in women with diabetes as compared with otherwise matched populations with entirely normal carbohydrate tolerance.2,3The remaining 25% of this atherosclerotic mortality in patients with diabetes mellitus is the result either of accelerated cerebrovascular or of peripheral vascular complications of diabetes, both of which are increased four‐fold and five‐fold, respectively, in patients with diabetes mellitus, regardless of type. Furthermore, atherosclerosis is the principal cause of hospitalizations for patients with diabetes mellitus. Admissions for this complication account for approximately 77% of total hospitalizations for diabetes owing to complications. Aside from mortality data alone, atherosclerosis is obviously a leading cause of diabetic disability, since it produces patients who are chronic cardiovascular, peripheral or cerebrovascular cripples, perhaps for many years before their ultimate demise. Small blood vessel or microvascular complications of diabetes mellitus, while formerly thought to be the end‐stage in the unfolding of the diabetic process, do not appear to have the potential for mortality as do the atherosclerotic large blood vessel complications. On the other hand, microvascular complications are an important cause of diabetic disability since small blood vessel disease in the eye, as diabetic retinopathy, is now the leading cause of adult blindness in the United States, and small vessel disease in the kidney, as diabetic nephropathy, now exceeds hypertension as the leading cause of chronic renal failure and dialysis in the United States.
Is angiographic ventriculography necessary for the assessment of ischemic patients?
Authors: Katritsis D. , Shakespeare C. F. , Byrne C. , Watkins H. , Coltart D. J. , Webb‐Peploe M. M. 
Published: February 2009

AbstractA total of 53 patients with a provisional diagnosis of ischemic heart disease and without any clinical evidence of valvular, congenital, or primary muscle heart disease were studied by echocardiography and biplane left ventricular cineangiography. For angiographic ejection fraction analysis, a program developed in our department for use on an Apple Macintosh computer interfaced to a digitizing tablet was employed. Echocardiographic outlines of systolic and diastolic images were traced with a digitizing system on the screen and ejection fractions were calculated by a program incorporated in the echo machine. Good echo windows allowing ejection fraction calculations were present in 35 patients. There was a good correlation between angiographic and echocardiographic ejection fraction (r=0.7, SEE=0.09), and wall motion assessment revealed no significant discrepancies between the two image modalities. The remaining 18 patients had poor echo windows, preventing accurate echocardiographic determination of the ejection fraction. However, limited assessment of left ventricular size and wall motion was possible in all patients and allowed the identification of those who had impaired left ventricular function as judged by angiography (angiographic ejection fraction < 35%). We conclude that even in patients with poor echo windows echocardiographic assessment of left ventricular function provides clinical information similar to angiography which should not be considered mandatory for the investigation of ordinary ischemic patients.
Combination of ramipril and hydrochlorothiazide in the treatment of mild to moderate hypertension: Part 1—a double‐blind, comparative, multicenter study in nonresponders to ramipril monotherapy
Authors: Heidbreder D. , Froer K.‐L. , Breitstadt A. , Cairns V. , Bender N. , Langley A. 
Published: February 2009

AbstractIn a parallel‐group multicenter study, the efficacy and safety of combination therapy with ramipril 5 mg plus hydrochlorothiazide 25 mg were compared double‐blind with those of 5 mg and 10 mg ramipril monotherapy in patients with mild to moderate hypertension who had not responded adequately to ramipril 5 mg alone. Patients were initially treated single‐blind for 1 week with ramipril 2.5 mg and 3 weeks with ramipril 5 mg. Of 240 patients enrolled, 165 were subsequently classed as nonresponders (diastolic blood pressure > 90 mmHg) and were randomized to one of the three double‐blind treatments for a further 4 weeks. In the double‐blind phase, the mean reductions in supine systolic and diastolic blood pressures at end point were significantly greater in the 5 mg plus 25 mg combination group (11.6/10.6 mmHg) than in the groups receiving ramipril 5 mg (6.2/5.9 mmHg; both p<0.01) and ramipril 10 mg (7.4/7.1 mmHg; both p<0.05). The proportion of responders at end point was also higher for combination therapy (72%) than for monotherapy (48% for ramipril 5 mg and 62% for ramipril 10 mg). All three treatments were well tolerated. Analysis of laboratory values revealed no clinically important changes.
The effect of chronic atrial overdrive suppression pacing on the incidence of supraventricular tachyarrhythmias
Authors: Shandling Adrian H. , Crump Randy , Nolasco Maria , Lorenz Linda M. , Li Curtis K. 
Published: February 2009

AbstractChronic overdrive suppression pacing has been suggested as an effective adjunctive method for reducing the incidence of cardiac tachyarrhythmias. Documentation of effectiveness during prolonged monitoring is lacking, however. To assess more accurately the long‐term utility of this treatment modality for medically refractory supraventricular tachyarrhythmias (SVTs), 10 patients with atrially implanted Intermedics Intertach pacemakers were randomly assigned to either a low or a high bradycardia (back‐up) pacing rate. SVT counts were performed during matching follow‐up periods both at the initial rate and after rate crossover. The primary antitachycardia modality of this pacemaker (P mod) provides burst pacing to terminate tachycardia episodes, and P mod counters were utilized to quantitate SVT episodes. Tachycardia termination algorithms were programmed to “no restart” and were not changed during the study. The P mod use counter, therefore, reflected the number of discrete episodes of SVTs. Pacemaker implantation diagnoses include atrial flutter, concealed bypass tract, AV nodal reentry, intraatrial reentry, and Wolff‐Parkinson‐White associated tachycardia. Patient age was 59 ± 18yrs. The average pacemaker backup low rate was 45.7±4 versus a back‐up high rate of 85.1 ±2 beats/min. Follow‐up was for 57.4 days±33 days at the low rate and 57.3 days ±34 days at the high rate (r=0.99). There was no difference in SVT incidence with a P mod usage of 98.4± 106 at the low rate and 100.8±94 at the high rate (p=NS). In this blinded, randomized crossover trial, chronic atrial overdrive suppression pacing did not reduce the overall incidence of SVT episodes during prolonged monitoring.
Asymmetrical septal hypertrophy in patients with hypertension: A type of hypertensive left ventricular hypertrophy or hypertrophic cardiomyopathy combined with hypertension?
Authors: Shimizu Masami , Sugihara Norihiko , Sffimizu Kuniyoshi , Yoshio Hiroyuki , Ino Hidekazu , Takeda Ryoyu , Nakajima Kenichi 
Published: February 2009

AbstractTo determine whether asymmetrical septal hypertrophy (ASH) in patients with essential hypertension (HT) is a type of hypertensive left ventricular (LV) hypertrophy or hypertrophic cardiomyopathy (HCM) combined with HT, we investigated a group of 7 hypertensive patients with ASH compared with 12 HCM patients and 10 healthy controls using radionuclide angiography and right ventricular endomyocardial biopsy. The LV time‐volume curve and its first and second derivative curves were constructed from cardiac output and time‐activity curves constructed by combined forward and reverse‐gating from the R wave. The LV wall thickness and ejection fraction were significantly greater in both the HT and HCM groups than in the control group, whereas there were no differences in these indices between the HT and HCM groups. Rapid filling volume index and rapid filling fraction showed significantly lower values in the HCM group than in the control group (p < 0.005). In contrast to the HCM group, these indices in the HT group did not differ from those in the control group. The time to peak filling rate was prolonged in the control, hypertension, and HCM groups in increasing order. Histopathological study revealed a higher incidence of myocardial cell disarray in the HCM than in the HT group. The above results suggest that ASH in hypertensive patients is a type of hypertensive LV hypertrophy.
Combination of ramipril and hydrochlorothiazide in the treatment of mild to moderate hypertension—part 2: An open long‐term study of efficacy and safety
Authors: Heidbreder D. , Froer K.‐L. , Bauer B. , Cairns V. , Breitstadt A. , Bender N. 
Published: February 2009

AbstractIn an open, multicenter extension of a short‐term study, 159 patients with mild to moderate hypertension were treated with either ramipril monotherapy or a combination of ramipril and hydrochlorothiazide for up to 1 year. Patients started with either 5 mg ramipril once daily (responders in the short‐term study) or a combination of ramipril 5 mg plus hydrochlorothiazide 25 mg once daily. The dose could be adjusted and nonresponders to ramipril monotherapy could have hydrochlorothiazide added. In the 38 patients treated with ramipril monotherapy, the largest drop in mean blood pressure (BP) had already occurred in the previous short‐term study; from Week 2 in the long‐term study, the BP remained stable with means below 150/90 mmHg. In the 83 patients treated with the combination for 50 weeks or more, mean BP continued to decrease until around Week 10 in the long‐term study while therapy was being adjusted. Thereafter, it also remained stable with means below 150/85 mmHg. Both treatment groups showed good mean reductions at end point, as did the group of 38 patients treated with the combination for less than 50 weeks. High response rates (84–95%) were seen in all groups at end point. The combination was well tolerated and the efficacy of ramipril in combination with hydrochlorothiazide was maintained over the 1‐year period of investigation.