bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic trends in the management of patients with acute myocardial infarction (1975–1984): the worcester heart attack study
Authors: Goldberg R. J. , Gore J. M. , Alpert J. S. , Dalen J. E. 
Published: February 2009

AbstractAs part of an ongoing community‐wide study of time trends in the incidence and case‐fatality rates of patients hospitalized with acute myocardial infarction (MI) in all 16 Worcester, Massachusetts, metropolitan hospitals during the years 1975, 1978, 1981, and 1984, changes over time in the therapeutic management of 3263 patients with validated acute myocardial infarction were examined. Beta‐blocker (21%, 1975; 52%, 1984) and nitrate (56%, 1975; 93%, 1984) therapy use increased dramatically over time. Use of antiplatelet agents was inconsistent over time, while use of digoxin remained stable, being used in approximately 40% of all patients over the four periods studied. Use of antiarrhythmic medications other than lidocaine decreased consistently over time (31%, 1975; 22%, 1984). Lidocaine use increased between 1975 (31%) and 1978 (52%) and then leveled off to being used in approximately 45% of hospitalized patients with acute MI in 1981 and 1984. A variety of demographic (e.g., age, sex, teaching hospital) and clinical characteristics (e.g., MI order, MI type, MI location, peak CPK findings, occurrence of acute clinical complications) were also associated with the use of these therapies for the combined study periods. The results of this population‐based study suggest considerable changes over time in the therapeutic management of patients hospitalized with acute myocardial infarction and of numerous patient demographic and clinical factors associated with their use.
Does the combination with handgrip increase the sensitivity of dipyridamole‐echocardiography test?
Authors: Picano E. , Lattanzi F. , Masini M. , Distante A. , L'Abbate A. 
Published: February 2009

AbstractThe aim of this study was to assess the possibility of increasing the sensitivity of dipyridamoleechocardiography testing (DET:2‐D echo monitoring during dipyridamole infusion) by combining this procedure with handgrip testing. Dipyridamole‐handgrip test (DHT) was therefore performed in 24 patients with rest/effort angina, negative DET, and negative handgrip‐echo (without dipyridamole pretreatment). DHT consisted of 4.5 min of sustained 25% maximum grip strength, started 4 min after the end of dipyridamole infusion (0.56 mg/kg for 4 min). Interpretable studies were obtained in all patients. Of the 24 patients tested (10 without and 14 with significant coronary artery disease, CAD), only one CAD patient had a positive DHT, which indicates an increased sensitivity of 7% versus DET alone. In conclusion, DHT is feasible in all patients and—if compared to DET—has the same specificity. However, in spite of the theoretical premises, it provides only a modest step up in sensitivity.
Paradoxical embolism to the superior mesenteric artery
Authors: Edoga J. K. , Widmann W. D. , Mclean E. R. 
Published: February 2009

AbstractParadoxical embolism occurs when venous thrombi embolize into the systemic arterial circulation by passage of clots through an intracardiac septal defect. This paper describes a case of paradoxical embolism to the superior mesenteric artery in a patient with recent myocardial infarction and pulmonary embolism. This phenomenon was first described in 1877 (Cohnheim, 1877) and many case reports have followed but most of these have been autopsy findings. We emphasize that this diagnosis should be suspected in all patients who suffer systemic arterial emboli without any evidence of left heart origin and/or in association with pulmonary emboli. One author has reviewed 19 cases since 1930, most of which were reported in the past 15 years (Johnson, 1951). This probably reflects an increased awareness of the diagnosis and more sophisticated diagnostic modalities. It also raises the possibility that paradoxical embolism may be more common than originally believed.
Transplacental passage of digoxin in the case of nonimmune hydrops fetalis
Authors: Mimura S. , Suzuki C. , Yamazaki T. 
Published: February 2009

AbstractSuccessful treatment of intrauterine fetal tachyarrhythmia was reported in several cases recently. It was also pointed out that placental transfer of digoxin is unsatisfactory under certain conditions. However, it has not been clearly shown in which cases fetal digoxin level does not reach the maternal level. We present a case of nonimmune hydrops fetalis due to congenital atrial flutter in which digoxin concentration in the sera of the mother and the neonate showed significant dissociation, and discuss perinatological matters about the digoxin treatment and the factor that obstructs the transplacental passage of digoxin. Conclusively, we recommend that maternal digoxin concentration should be raised to near toxic level if the resolution of fetal and placental hydrops is not attained in the initial digoxin loading.
Impaired left ventricular rapid filling during exercise in patients with hypertrophic cardiomyopathy
Authors: Iida K. , Yukisada K. , Sugishita Y. , Matsuda M. , Koseki S. , Iida K. , Ito I. 
Published: February 2009

AbstractThe influence of exercise on left ventricular diastolic filling was evaluated in 14 patients with hypertrophic cardiomyopathy (HCM) and 14 normal controls (NC) by dynamic exercise echocardiography. Using X‐Y digitizer and computer, normalized peak rate of change of the left ventricular dimension during systole (pVs) and the rapid filling phase (pVd) were determined from the left ventricular echocardiograms at rest and during exercise when heart rate reached 100 beats/min.At rest and during exercise, pVs was significantly higher in HCM (3.2$$0.4/s at rest, 4.3$$1.4/s during exercise) than in NC (2.4$$0.5/s at rest, 3.0$$0.4s during exercise) (p<0.001, p<0.001, respectively), but pVd in HCM (4.2$$1.0/s at rest, 5.8$$1.0/s during exercise) was not significantly different from that in NC (4.1$$1.0/s at rest, 6.0$$0.7/s during exercise). The ratio of pVd to pVs (pVd/pVs) in HCM did not show significant increment during exercise (1.35$$0.38 to 1.43$$0.35), though that ratio in NC was significantly increased by exercise (1.67$$0.22/s to 1.97$$0.19/s, p<0.001). There was no correlation between pVd and the degree of left ventricular hypertrophy. These results suggest that diastolic reserve to exercise is depressed in HCM and that other factors besides left ventricular hypertrophy may account for diastolic abnormality.
Effect of spontaneous reperfusion on myocardial infarct size
Authors: Hackworthy R. A. , Vogel M. B. , Harris P. J. 
Published: February 2009

AbstractThe effect of perfusion of the infarct artery on myocardial infarct size was studied in 39 patients who had not received interventive therapy. At predischarge coronary angiography, 19 patients had subtotal and 20 total occlusion of the infarct artery. The early ST‐segment elevation recorded on a 12‐lead electrocardiogram was used as an index of the amount of initially jeopardized myocardium. Infarct size was estimated by peak serum creatine kinase and, at discharge, by a QRS score, $$Q and $$R on a 12‐lead electrocardiogram, and by radionuclide global and infarct segment left ventricular ejection fraction. Despite a similar degree of initial ischemia ($$ST), infarct size was smaller in the 11 patients with anterior infarction and subtotal occlusion than in the 9 patients with anterior infarction and total occlusion when measured by peak serum creatine kinase (2114$$1192 U/l vs. 3653$$1059 U/l, p<0.02), QRS score (5.0$$2.7 vs. 9.6$$3.5, p<0.01), $$Q (3.25$$2.74 mV vs. 5.92$$3.56 mV, p<0.10), $$R (4.36$$1.25 mV vs. 2.16$$0.91 mV, p<0.001), global left ventricular ejection fraction (45.0$$12.2% vs. 33.4$$6.7%, p<0.05), and infarct segment ejection fraction (40.4$$8.2% vs. 30.3$$5.4%, p<0.05). In the inferior infarct patients, both the degree of initial ischemia and final infarct size were similar in the 8 patients with subtotal and in the 11 patients with total occlusion. Eight of the 11 patients with inferior infarction and total occlusion, but none of the 9 patients with anterior infarction and total occlusion had collaterals to the infarct artery. Spontaneous reperfusion, either antegrade or via collaterals, may reduce myocardial infarct size.
Isolated pulmonary valve prolapse: A sign of pulmonary hypertension
Authors: Arvan S. , Boscha K. 
Published: February 2009

AbstractIsolated pulmonary valve prolapse may be a sign of pulmonary hypertension. Three patients with pulmonary hypertension as a result of left ventricular failure, chronic obstructive pulmonary disease, and primary pulmonary hypertension, respectively, are described in the case reports. It is likely that the morphological change of the pulmonary valve is due to exaggeration of the normal convexity of the elastic pulmonary leaflets as a result of a high pulmonary artery diastolic pressure. This two‐dimensional echocardiographic sign may prove to be a useful qualitative hallmark for pulmonary hypertension. Present methods to detect pulmonary hypertension by two‐dimensional echocardiography rely on remote findings of right heart abnormalities or changes in systolic time intervals. Pulmonic valve prolapse is the first direct sign of pulmonary hypertension found on two‐dimensional echocardiography.
Double‐chambered right ventricle with pulmonary valve endocarditis
Authors: Shah V. K. , Daruwala D. F. , Karnik R. D. , Gandhi M. J. , Chaukar A. P. 
Published: February 2009

AbstractA rare case of isolated pulmonary valve endocarditis associated with a double‐chambered right ventricle in a nonaddict, was diagnosed on two‐dimensional echocardiography and cardiac catheterization and angiography. The patient was successfully operated and the above findings confirmed on the operation table.
William heberden and some account of a disorder of the breast
Authors: Silverman Mark E. 
Published: February 2009

AbstractBut there is a disorder of the breast marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare, which deserves to be mentioned more at length. The seat of it, and sense of strangling, and anxiety with which it is attended, may make it not improperly be called angina pectoris. They who are afflicted with it, are seized while they are walking, (more especially if it be up hill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life, it it were to increase or to continue; but the moment they stand still, all this uneasiness vanishes.
Method for noninvasive measurement of central aortic systolic pressure
Authors: Marmor A. T. , Blondheim D. S. , Gozlan E. , Navo E. , Front D. 
Published: February 2009

AbstractA method for noninvasive generation of central aortic systolic pressure curves is presented. The method is based on plotting the occlusive pressure values applied at the brachial artery level against the time intervals needed for the aortic pressure wave to equalize and break through the occlusive pressure at the brachial artery level. These time intervals were obtained by measuring the time from the beginning of depolarization (the QRS complex) to the detection of the pressure wave at the temporarily occluded brachial artery. The validity of the method was documented by 3 different approaches. The pressure values measured by a device developed by us were superimposed on the simultaneously measured central intra‐aortic pressure waves and all values were within one standard deviation from the central aortic recordings in 8 of the 10 patients studied. At the same time, the noninvasively recorded pressure waves were completely different from the peripheral artery pressure recorded simultaneously at the femoral artery site. The DP/DT values derived from the central aortic recordings and the noninvasive device correlated (r=0.83). These results indicate that the noninvasive device measures the central aortic pressure or a close approximation of it. By combining noninvasive pressure measurements with volume measurements obtained by radionuclide angiography. noninvasive pressure‐volume curves were generated in 10 subjects. Possible clinical application of the systolic noninvasive pressure‐volume curves is suggested.
Frequency analysis of first heart sound for the elderly
Authors: Ishizuka T. , Ishizuka A. 
Published: February 2009

AbstractFrequency analysis of first heart sound in elderly and expired cases was performed to reveal changes of the cardiovascular system accompanying aging. The vibration was analyzed for isometric contraction phase or 0.06 seconds following the main vibration of first sound by means of fast Fourier transform technique, and main frequency was compared. Mean main frequencies were 43.0±15.4 cps (mean±SD) in 21 cases from 54 years to 69 years, 41.4±12.6 cps in 34 cases from 70 years to 79 years, 40.0±14.4 cps in 19 cases from 80 years to 89 years, and 44.2±4.5 cps in 4 cases from 90 years to 94 years. It was 44.4±8.0 cps in 6 cases with left ventricular hypertrophy (LVH) on ECG, and 37.2±7.5 cps in 18 cases without LVH. It was 35.7±6.5 cps in 9 cases who expired and 32.6±5.8 cps in cases of those who died within a year. Though mean main frequencies were almost equal in these groups, it is higher than that of younger subjects, which suggests stiffness of the cardiovascular system of the aged. It was suggested that the stiffness of the cardiovascular system is greater than the increase in cardiac weight of elderly subjects with LVH. Mean main frequency was low in subjects who dies within a year, which may be due to cardiomegaly.
Cerebrospinal fluid creatine kinase isoenzyme BB levels do not predict the clinical outcome in patients unconscious following cardiac resuscitation
Authors: Clemmensen P. , Strandgaard S. , Rasmussen S. , Grande P. 
Published: February 2009

AbstractIt has recently been claimed that an increase in creatine kinase isoenzyme BB(CK‐BB) in cerebrospinal fluid (CSF) is well correlated with the cerebral outcome in patients resuscitated after cardiac arrest. Twentyone such patients consecutively admitted from outside this hospital participated in the study. The patients were divided into two groups: 6 survivors and 15 nonsurvivors. The median CSF‐CK‐BB value was 5 U/L among nonsurvivors and below detection limit among survivors (NS). However, the predictive value of a positive test is limited, since only 6 of 15 nonsurvivors (40%) had an increase in CSF‐CK‐BB (predictive value of positive test=67%). The predictive value of a negative test is limited, since 3 of 6 survivors (50%) showed no rise in CSF‐CK‐BB (predictive value of negative test=25%). No relationship between cerebral dysfunction and CSF‐CK‐BB values was revealed. Thus, CSF‐CK‐BB does not predict the clinical outcome in patients resuscitated after cardiac arrest.
Control of supraventricular tachycardia by VVI pacing in a patient with drug‐induced enhanced atrioventricular conduction
Authors: Aizawa Y. , Shibata A. 
Published: February 2009

AbstractA 56‐year‐old male with atrial fibrillation developed rapid ventricular response up to 200 beats/min or more in the postoperative stage of emergency aortocoronary bypass surgery. Resuscitation for cardiac arrest triggered this rapid ventricular rate. The idea that retrograde conduction into atrioventricular node may prevent ventricular capture of atrial fibrillation was tested. The ventricle was then paced at rapid rate followed by a gradual decrease in the pacing rate to 120 beats/min. By this method, ventricular rate was controlled and hemodynamics stabilized, with more efficiency of intra‐aortic balloon counterpulsation. VVI pacing may be used in this manner to control irregular and rapid ventricular response of atrial fibrillation.
Vasospastic angina mimicking graft failure and spontaneously appearing after left ventriculography
Authors: Fournier J. A. , Ández C. , F‐Cortacero J. A. P. , Pi ñero C. 
Published: February 2009

AbstractA 49‐year‐old female with significant (75%) left main coronary artery stenosis was initially considered to have developed early obstruction of a saphenous vein graft to the left anterior descending coronary artery, because of recurrent postoperative angina. In a second catheterization study, left ventriculography showed normal contractility of all segments and was immediately followed by the onset of angina and angiographic demonstration of diffuse spasm of the entire left coronary artery system beyond the stenosis. Vasospasm of the left coronary artery before or during ventriculography was unlikely in the absence of regional contractility impairment. The close temporal association between the left ventricular angiogram and the angiographic demonstration of vasospasm suggested a direct cause and effect relationship.
Coronary spasm producing coronary thrombosis in a patient with acute myocardial infarction
Authors: Naito H. , Yorozu T. , Matsuda Y. , Yamaguchi M. , Tanabe Y. , Nakashima H. , Kusukawa R. 
Published: February 2009

AbstractA 62‐year‐old man had an acute myocardial infarction with successful thrombolysis. Coronary spasm was documented in the following angiographic study. This case demonstrated that coronary spasm is implicated in the pathogenesis of coronary thrombosis and subsequent myocardial infarction.
The murmur of double‐chambered right ventricle: Phonocardiographic evaluation
Authors: El Tohami E. T. A. , Hajar R. , Folger G. M. 
Published: February 2009

AbstractThirteen patients undergoing complete evaluation for double‐chambered right ventricle were subjected to phonocardiographic evaluation. Each of these individuals revealed a holosystolic ejection‐type murmur which exhibited a similarity of appearance unaltered by the degree of physiologic derangement or associated cardiac abnormalities. This finding is considered to be caused by the obstructive elements in double‐chambered right ventricle and appears to be a characteristic finding for this condition.
Noninvasive demonstration of underlying severe coronary disease in patients with vasospastic angina
Authors: Kawashima S. , Yokoyama M. , Sakamoto S. , Akita H. , Fujitani K. , Kobayashi K. , Mizutani T. , Fukuzaki H. 
Published: February 2009

AbstractDipyridamole test, isoproterenol test, and treadmill exercise test were performed in two groups of patients with vasospastic angina (Group 1: 10 patients with 70% or greater coronary narrowings, Group 2: 8 patients with narrowings less than 70%. The results were correlated with coronary anatomy. In Group 1, vasodilation of resistance vessels by dipyridamole elicited ischemic episodes in 9 patients and an increase in myocardial oxygen consumption by isoproterenol caused anginal attacks in 7 patients. None of patients of Group 2 showed positive responses to either drug. All patients of Group 1, and 3 patients of Group 2 gave positive responses to treadmill test. These observations show that several different mechanisms are involved in the pathogenesis of my ocardial ischemia in patients with vasospastic angina. Pharmacological interventions have higher specificity than exercise tests in predicting coronary anatomy and are useful for the choice of therapy in these patients.
Sinus arrest caused by atenolol‐verapamil combination
Authors: Misra M. , Thakur R. , Bhandari K. 
Published: February 2009

AbstractA case on concomitant atenolol‐verapamil therapy for hypertension and angina pectoris, developing sinus arrest and life‐threatening bradycardia is described. The complication occurred with low doses of both the agents and normal electrophysiologic status of the heart. The example suggests that pharmacodynamic synergism contributes more than pharmacokinetic interaction in causing adverse reactions during beta blocker‐verapamil therapy.
Chronic chagas' heart disease presenting as an impending myocardial infarction: A case favoring the neurogenic pathogenesis concept
Authors: Bestetti R. B. , Finzi L. A. , Oliveira J. S. M. 
Published: February 2009

AbstractA 55‐year‐old Caucasian woman suddenly developed substermal chest pain at rest accompanied by pallor, diaphoresis, nausea, and vomiting. Physical examination was otherwise unremarkable. The resting ECG showed T‐wave inversion in all anterior leads which returned to normal 24 h after the onset of the symptoms. The pain was eliminated promptly by sublingual isosorbide dinitrate. “Impending” acute myocardial infarction was diagnosed. Coronary arteriography, however, failed to reveal any change in any major coronary artery but an apical aneurysm of the left ventricle was detected. As the complement‐fixation test for Chagas' disease was positive, the diagnosis of chronic Chagas' heart disease was then established. This unusual clinical manifestation of Chagas' disease is thought to be the consequence of a transient imbalance in the cardiac autonomic nervous system, which is considered to play a central role in the pathogenesis of chronic Chagas' heart disease. In addition, the present case may alert clinicians to the thus far neglected atypical chest pain, which is frequently seen in chagasic patients but whose etiology remains obscure.
Coronary artery bypass surgery in patients over age 70 years: Report from the milwaukee cardiovascular data registry
Authors: Dorros G. , Daley P. , Assa J. , Lewin R. F. 
Published: February 2009

AbstractBetween 1972 and 1985, 674 coronary bypass patients ≥ 70 years (70% male, mean age 73 years) were among 10,622 patients with both catheterization and operative data entered into the Milwaukee Cardiovascular Data Registry. These ≥ 70 years patients were analyzed regarding the operative morbidity, the 30‐day operative mortality, and the operative mortality's relation to coronary artery disease and ventricular wall motion abnormalities. The operative mortality was not different for the 174 patients operated upon before and the 500 patients after 1980. A mean of 3.4 grafts were placed during surgery. The complications encountered included a 7.1 % perioperative infarction rate, a 4.2% incidence of cerebrovascular accident, a 3.6% incidence of reoperation for bleeding, a 2.4% incidence of renal failure, and a 2.1 % incidence of pulmonary embolism. The overall operative mortality was 7.4%. The extent of coronary artery disease was distributed among patients such that 8.4% had single‐, 28.0% had double‐, and 63.6% had triple‐vessel disease. The operative mortality as related to the extent of coronary artery disease was 5.2% for single‐, 8.9% for double‐, and 7.0% for triple‐vessel disease. The operative mortality was 6.7% with no and 7.9% with left ventricular wall motion abnormalities. The operative mortality was 1.9% with 1 segmental wall motion abnormality, and increased to 13.3% (p<0.05) with 4–6 segmental wall motion abnormalities. The operative mortality for single‐vessel disease was 5.4% with normal and 4.3% with abnormal wall motion; for double‐vessel disease it was 4.3% with normal and 13.2% with abnormal wall motion, (p<0.05); and, for triple‐vessel disease, 8.3% with normal and 6.0% with abnormal wall motion. Actuarial life‐table analysis indicated that the probability of surviving at least 7 years is 64.6≥3.6%. There was no difference in the survival at 4 years regardless of the extent of coronary disease. After 4 years, the difference in survival between single‐ and triple‐vessel disease became significant (single, 91 % versus triple, 78%; p<0.05). The probability of survival at 7 years was affected by the presence of wall motion abnormalities (normal, 73% versus abnormal, 56%, p<0.05). These data suggest that coronary bypass surgery when performed in patients ≥ 70 years has a significant operative mortality which is probably not related to the extent of coronary artery disease, but to the severity of left ventricular wall motion abnormalities. Surviving patients have a relatively good long‐term outlook which, nevertheless, is adversely affected by the extent of coronary disease, and the severity of left ventricular wall motion abnormalities.