bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complicated pericardial cyst: Atypical anatomy and clinical course
Authors: Bava Gian Lauro , Magliani Lucia , Bertoli Daniele , Gorrieri Pier Francesco , Rimini Alessandro , Zaccagnini Gianfranco , Bertolini Alberto 
Published: February 2009

AbstractPericardial cysts are usually detected by chance and are clinically silent in most cases. Nevertheless, symptoms and serious complications may occur. We describe a case of pericardial cyst diagnosed in an 8‐year‐old boy who was admitted with chest pain. Echocardiography revealed a mild to moderate pericardial effusion and a 7.5 × 5.5 cm intrapericardial echo‐free lesion consistent with a pericardial cyst. Surgery was carried out 3 days afterward because of the patient's worsening condition, the progressive increase of pericardial effusion, and the onset of initial signs of cardiac tamponade. The cyst showed a long and easily movable vascular pedicle and inflammatory areas involving the pericardial surface. Like the pericardial effusion, the contents of the mass appeared as serosanguineous fluid on aspiration. Histologic examination confirmed the diagnosis of pericardial cyst and showed findings according to ischemia‐related lesions of the cyst. The coexistence of pericardial cyst and cardiac tamponade is very unusual. The atypical anatomy and clinical course suggest a distinct and so far undescribed pathogenetic mechanism for this association: the torsion of a vascular pedicle and the subsequent development of ischemia‐related lesions of the cyst.
Effects of dichloroacetate in patients with congestive heart failure
Authors: Lewis Jannet F. , Dacosta Michelle , Wargowich Thomas , Stacpoole Peter 
Published: February 2009

AbstractBackground: Conventional approaches to management of congestive heart failure (CHF) rely on drugs that increase myocardial contractility or reduce ventricular afterload. These approaches often improve cardiac symptoms and survival, but may be associated with significant deleterious effects. An alternative approach is to enhance myocardial energy production. Dichloroacetate (DCA) stimulates pyruvate dehydrogenase activity and accelerates aerobic glucose, pyruvate, and lactate metabolism in myocardial cells. These alterations would be expected to improve myocardial function.Hypothesis: The purpose of the investigation was to assess the efficacy of DCA in patients with left ventricular systolic dysfunction and to examine the mechanism by which improvement occurs.Methods: A total of 25 patients (16 men, 9 women; age range 31‐72 years, mean 59) with CHF and ejection fraction ≤40% received an intravenous infusion of 50 mg/kg DCA over 15 min. Indices of systolic and diastolic function were obtained by two‐dimensional and Doppler echocardiography performed at baseline, 30 min, and 60 min following completion of DCA infusion.Results: Baseline ventricular ejection fraction was 27.3 ± 9.1%; 17 patients (68%) had nonischemic cardiomyopathy. Heart rate increased after DCA infusion from 73.9 ± 14.5 to 79.2 ± 14.9 beats/min at 60 min; p = 0.02. Left ventricular diastolic and systolic volumes increased at 30 min compared with baseline (248.7 ± 98.1 vs. 259.6 ± 99.6; p = 0.04, and 180.1 ± 80.4 vs. 192.2 ± 84.9; p = 0.002, respectively), but stroke volume (49.2 ± 19.1 vs. 48.9 ± 18.1; p = 0.9) and ejection fraction (27.3 ± 9.1 vs. 25.7 ± 9.8; p = 0.2) were un changed. Indices of diastolic function were also unchanged.Conclusion: Dichloroacetate infusion in patients with CHF is not associated with improvement in noninvasively assesse left ventricular function.
The impact of beta‐receptor blocker addition to high‐dose angiotensin‐converting enzyme inhibitor‐nitrate therapy in heart failure
Authors: Barry Levine T. , Levine Arlene B. , Keteyian Steven J. , Narins Barbara 
Published: February 2009

AbstractBackground: The natural history of heart failure is one of continued worsening of cardiac function. Beta‐receptor blocker therapy has been effective in improving clinical status and left ventricular function in patients with heart failure. Similarly, high doses of angiotensin‐converting enzyme (ACE) inhibitors with nitrates partially reverse the ventricular remodeling of heart failure.Hypothesis: We tested the hypothesis that beta‐blocker therapy added to high‐dose ACE inhibitor‐nitrates would potentiate the reversal of heart failure.Methods: Thirteen patients, aged 52 ± 8 years, with moderate to severe heart failure, 12 of whom were referred for transplant consideration, with heart failure duration of 4.8 ± 2.2 years, were prospectively followed for 12 months. Baseline echocardiographic ejection fraction was 19 ± 8%, and presenting New York Heart Association class was 2.9 ± 0.7. Angiotensin‐converting enzyme inhibitors and nitrates were uptitrated over 6 months to a final dose of lisinopril 53 ± 31 mg/day, and isosorbide dinitrate 217 ± 213 mg/day. At 6 months, beta‐blocker therapy with atenolol was initiated and titrated to a final dose of 46 ± 23 mg/day. Two‐dimensional Doppler echocardiography and metabolic stress testing were performed at baseline, at 6 months on lisinopril‐nitrates only, and at 12 months on combined ACE inhibitor‐nitrate and beta‐blocker therapy.Results: New York Heart Association classification improved from 2.9 ± 0.7 to 1.8 ± 0.8 on lisinopril‐nitrates (p< 0.05), and to 1.5 ± 0.5 with the addition of beta blockade (p = NS). On follow‐up, peak oxygen consumption rose from 17 ± 7 ml O2/kg/min at baseline to 21 ± 5 ml O2/kg/min at 6 months on lisinopril‐nitrates (p = 0.06) without further change on beta blockade. Ejection fraction rose from 19 ± 8 to 33 ± 14% on lisinopril‐nitrates at 6 months (p = 0.005) and to 36 ± 18% on beta blockade at 12 months (p = NS).Conclusion: High‐dose ACE inhibitor‐nitrate therapy significantly improved patient clinical status and left ventricular systolic function in heart failure. The addition of beta‐receptor blockade over and above high‐dose ACE inhibitor‐nitrates was well tolerated but had no further impact on symptomatic status, exercise tolerance, or left ventricular systolic function. The potential for pharmacologic reversal of heart failure remodeling may be finite despite the use of complementary therapies. Larger placebo‐controlled and randomized trials of beta‐receptor blockade added to high‐dose ACE inhibitor‐nitrate therapy are needed to confirm these observations.
Characteristics of patients less than 45 years of age compared with older patients undergoing coronary artery bypass grafting
Authors: Nguyen Trung Duc , Virgilio Christian De , Kakuda James , Omari Bassam O. , Milliken Jeffrey C. , Robertson John R. , Baumgartner Fritz J. 
Published: February 2009

AbstractBackground: Coronary artery disease (CAD) was not recognized as common among young patients until the study by Yater in 1948. Subsequent studies further elucidated the nature of the disease, which had become more apparent in the younger groups.Hypothesis: The study was undertaken to determine the prevalence of risk factors and severity of coronary disease among young patients aged ≤ 45 years undergoing coronary artery bypass grafting (CABG) compared with older patients.Methods: in all, 112 young patients aged ≥ 45 years (Group 1) and 798 older patients aged > 45 years (Group 2) were analyzed for trends to hypertension, smoking, diabetes, family history of heart disease, hypercholesterolemia, obesity, and history of previous myocardial infarction (MI). The severity of disease was examined in terms of number of diseased vessels, vessel size, number of grafts performed, performance of endarterectomies, and left ventricular function.Results: Group 1 had a higher incidence of positive family history (68.5 vs. 51.2%, p < 0.05), and lower incidences of hypertension (62.7 vs. 81.5%, p < 0.05), obesity (42.9 vs. 83.9%, p<0.05), and history of previous MI (54.5 vs. 94.6%, p < 0.05). Group 2 had a higher incidence of left main disease (22.6 vs. 11.4%, p < 0.05). The distribution of the affected vessels of the young patients was most commonly the left anterior descending (90.4%) followed by the right coronary (79.8%) and circumflex arteries (69.2%). Group 2 had more grafts per patient (3.82 vs. 3.37, p< 0.05). The size of the diseased vessels measured intraoperatively was similar (1.56 vs. 1.58 mm, p = NS) in both groups. Endarterectomy was performed almost three times more often in Group 1 patients (8.2 vs. 3.0%, p>0.05). Operative mortality was less in Group 1 mean (1.8 vs. 6.3%, p < 0.05). Group 2 had a greater mean left ventricular ejection fraction (53.8 vs. 49.7%, p< 0.05).Conclusion: Compared with the older population, patients < 45 years of age who underwent CABG had (1) a higher incidence of positive family history of CAD, (2) a higher likelihood of requiring an endarterectomy, and (3) lower operative mortality rate despite a slightly poorer ventricular function.
Emergency department thrombolysis critical pathway reduces door‐to‐drug times in acute myocardial infarction
Authors: Cannon Christopher P. , Blair Johnson E. , Scirica Benjamin M. , Cermignani Monica , Sagarin Mark J. , Walls Ron M. 
Published: February 2009

AbstractBackground: Rapid time to treatment with thrombolytic therapy is an important determinant of survival in acute myocardial infarction (AMI).Hypothesis: We hypothesized that establishment of an AMI thrombolysis critical pathway in the Emergency Department could successfully reduce the “door‐to‐drug” time, the time between patient arrival and start of thrombolysis.Methods and results: Before establishment of the AMI critical pathway, median door‐to‐drug time was 73 min, which was reduced to 37 min after critical pathway implementation (p<0.05). The percentage of patients treated within 30 min rose from 0% prior to establishment of the pathway to 43% (p = 0.03). Similarly, the percentage treated in within 45 min rose from 0 to 67% (p = 0.0005). Door‐to‐drug times were longer for women than for men (median 105 min for women vs. 70 min for men before pathway implementation). The pathway reduced door‐to‐drug time for both genders, but the median door‐to‐drug times were higher for women than for men (Mann‐Whitney p = 0.013). The difference between men and women was 35 min before establishment of the pathway to 10 min by the end of the study period.Conclusions: Our critical pathway was successful in reducing door‐to‐drug times. We observed a “gender gap” in door‐to‐drug times, with longer mean times for women, which was reduced by the AMI critical pathway. Thus, our data provide support for the use of critical pathways to reduce door‐to‐drug times, as recommended by the National Heart Attack Alert Program.
Randomized evaluation of four versus five french catheters for transfemoral coronary angiography
Authors: Metz Damien , Chapoutot Laurent , Brasselet Camille , Jolly Damien 
Published: February 2009

AbstractBackground and hypothesis: in coronary angiography there is a trend toward using smaller catheters to avoid puncture site complications. An increased utilization of outpatient facilities may result. This study was undertaken to determine whether using 4Fr diagnostic catheters in comparison with 5Fr catheters would reduce the vascular complication rate, after patient ambulation following 4 h bedrest, without altered technical performance and or procedural duration.Methods: The study population comprised 100 consecutive, unselected patients, who were randomly assigned for transfemoral coronary angiography with 4 or 5Fr diagnostic catheters. Procedural characteristics, quality of angiogram, and clinical assessment of puncture site at 4, 12, and 24 h were analyzed.Results: No significant difference was demonstrated concerning procedural characteristics, ventriculography, coronary contrast quality, or local vascular damage. However, two patients crossed over in the 4Fr group and one in the 5Fr group.Conclusion: As a consequence, the feasibility, reliability, and utility of catheter size on vascular complication rates must be considered to be similar with either 4Fr or 5Fr diagnostic catheters.
Cardiac and autonomic evaluation in a pediatric population with human immunodeficiency virus
Authors: Plein D. , Van Camp G. , Cosyns B. , Alimenti A. , Levy J. , Vandenbossche J.‐L. 
Published: February 2009

AbstractBackground: Cardiac involvement in children with human immunodeficiency virus (HIV) infection is a well‐known entity and occurs clinically more often in patients with advanced acquired immunodeficiency syndrome (AIDS). Autonomic dysfunction is less known, especially in children.Hypothesis: The aim of this study was to asses the prevalence of cardiovascular abnormalities in a pediatric population with HIV. We also aimed to evaluate whether autonomic involvement occurs in the same population and is dependent on echocardiographic abnormalities.Methods: The occurrence of echocardiographic abnormalities was evaluated in 22 children with HIV infection, and five noninvasive tests were performed to evaluate the presence of autonomic dysfunction.Results: We found cardiac lesions in four children (18%), consisting of pericardial effusion in three children, wall motion abnormalities in three children, and acute aortic endocarditis in one child. All cardiac abnormalities were found at Stage C by Center for Disease Control (CDC) revised classification. We also found left ventricular filling pattern abnormalities consisting of E‐wave maximal velocity decrease and prolonged deceleration time compatible with diastolic dysfunction. One of the five autonomic tests (Valsalva maneuver) was significantly altered, even in patients without abnormal echocardiography, suggesting mild autonomic dysfunction.Conclusion: The study demonstrated a high prevalence of cardiac lesions in children with HIV infection and indicated the presence of autonomic dysfunction even when there are no echocardiographically detected abnormalities.
Electrocardiographic patterns in acute inferior myocardial infarction with and without right ventricle involvement: Classification, diagnostic and prognostic value, masking effect
Authors: Willis Hurst J. , Correale Ernesto , Battista Rossano , Martone Angela , Pietropaolo Ferdinando , Ricciardiello Vincenzo , Digirolamo Domenico , Barlera Simona , Maggioni Aldo P. 
Published: February 2009

AbstractBackground: in acute inferior myocardial infarction (AIMI), the ST depression from V1 to V4 has been the subject of many papers, while the ST changes in other leads, their association, and the right ventricular (RV) involvement have been studied less.Hypothesis: This study was performed to contribute to the meaning of the ST changes and RV involvement in AIMI.Methods: Seventy‐one patients, admitted within 6 h from symptom onset, all thrombolysed, were enrolled. We classified them according to ST patterns and RV involvement. We divided the right coronary artery into three segments, considering the origin of RV branch and the crux as dividing points. We established a coronary score attributing 2 points to each terminal branch. Comparisons were performed between the electrocardiographic (ECG) findings at onset, the creatine phosphokinase (CPK) peaks, the radionuclide ejection fractions, and the coronary angiographies.Results: We found that the ST changes give indications regarding the site, extension, and extent of AIMI; RV involvement can mask posterior extension, points to the right coronary as the culprit vessel (100%), and, with high probability, indicates the proximal segment as the site of the lesion; the ECG signs of isolated AIMI indicate a peripheral obstruction; and a collateral circulation may appear relatively early.Conclusions: Our findings prove the diagnostic and prognostic value of the ST changes and RV involvement at the onset of AIMI and suggest that the higher in‐hospital mortality and complication rates found with RV involvement and reported in the literature are related more to posterior extension, masked by RV involvement than to this involvement per se. Furthermore, these findings prove the clinical value of our classification of the AIMIs and distinction in segments of the right coronary artery.
Angiotensin‐Converting enzyme inhibitor‐induced pancreatitis
Authors: Muchnick J. S. , Mehta J. L. 
Published: February 2009

AbstractApproximately 2% of pancreatitis in adults is drug induced. Although some angiotensin‐converting enzyme (ACE) inhibitors have been associated with pancreatitis, to the knowledge of the authors this is the first reported case involving benazepril. This case report presents laboratory‐ and image‐proven pancreatitis in a noninsulin dependent 70‐year‐old man. The patient took benazepril at three different times and experienced the same epigastric symptoms 30 min after each dose. Possible mechanisms are reviewed. Clinicians should strongly consider discontinuing ACE inhibitors, including benazepril, in patients with pancreatitis of no identifiable source.
Circadian variations of qtc dispersion: Is it a clue to morning increase of sudden cardiac death?
Authors: Kemal Batur M. , Aksöyek Serdar , Oto Ali , Yildirir Aylin , Özer Necla , Atalar Enver , Aytemir Kudret , Kabakci Giray , Övünç Kenan , Özmen Ferhan , Kes Sirri 
Published: February 2009

AbstractBackground: Several studies related to cardiac events including sudden death have shown a peak incidence in the early morning hours. It has also been known that acute ischemia is a potent stimulus to increased dispersion of repolarization and development of malignant arrhythmias.Hypothesis: The purpose of the present study was to investigate diurnal variations of corrected QT dispersion (QTcD) in patients with coronary artery disease (CAD) (Group 1) compared with controls with normal coronary angiograms (Group 2).Methods: We investigated a total of 110 patients who had been referred for coronary angiography, of whom 62 (42 men, 20 women; age 55 ± 7 years) had double‐ or triple‐vessel disease, and of whom 48 (31 men, 17 women; age 54 ± 9 years) had normal coronary angiograms. QTcD measurements were calculated from a 12‐lead resting electrocardiogram (ECG) during sinus rhythm. These ECGs were obtained for each patient in the morning, at noon, in the evening, and at night on the day after performance of coronary angiography. QTcD was significantly greater in patients with abnormal coronary angiograms (Group 1) than in patients with angiographically documented normal coronary arteries (Group 2). This difference appeared to be more prominent in the morning hours (p < 0.001) than at other times. QTcD in the evening and night hours was not statistically different (p >0.05) between both groups. We also compared intragroup QTcD values: QTcD values were significantly increased in the morning hours and were more prominent in Group 1 than in Group 2.Conclusions: Our data suggest that QTcD has a circadian variation with an increase in the morning hours, especially in patients with coronary artery disease. This finding was thought to be an explanation for the role played by sympathetic nervous system in the occurrence of acute cardiac events and sudden death during these hours.
Deceleration‐dependent shortening of the qt interval: A new electrocardiographic phenomenon?
Authors: Liebl Nancy , Zimmerman Frank , Nouri Soraya , Willis Hurst J. , Gussak Ihor , Bjerregaard Preben , Chaitman B. R. 
Published: February 2009

AbstractIn clinical cardiology, deceleration‐dependent QT interval shortening is considered to be an extraordinary electrocardiographic phenomenon. We present an early premature born 4‐year‐old African‐American girl with complications related to her premature birth, developmental delay, and several episodes of cardiac arrest. An episode of severe transient bradyarrhythmia was documented on Holter monitoring. The unique feature of the rhythm strips was paradoxical gradual shortening of the QT interval to 216 ms with accompanying transient T‐waves abnormalities. The activation of the Ik, ACh due to an unusually high vagal discharge to the heart is proposed as a possible mechanism responsible for both slowing of the heart rate and shortening of the QT interval.
Myotonic dystrophy associated with qt prolongation and torsade de pointes
Authors: Umeda Yuji , Ikeda Uichi , Yamamoto Jun , Fukazawa Hiroshi , Hayashi Yuji , Fujikawa Hideyuki , Shimada Kazuyuki 
Published: February 2009

AbstractA rare case of myotonic dystrophy (MD) with congestive heart failure, associated with QT prolongation and torsade de pointes (TdP) is reported. A 53‐year‐old woman was admitted to the hospital because of congestive heart failure. Electrocardiograph (ECG) showed first‐degree atrioventricular block and QT prolongation. During hospitalization, TdP appeared but returned to sinus rhythm spontaneously. As the patient had quadriplegia, a myopathic face, cataracts, diabetes mellitus, and an increased number of cytosine‐thymineguanine (CTG) repeats (760 repeats), she was diagnosed as having MD. Electrocardiographic analysis of her family also revealed abnormal QT(U) prolongation in her daughter and brother who both had MD, while ECG findings of other family members without MD were normal. Thus, the presence of QT(U) prolongation was associated with MD in this family.
Coronary stent deployment in a young adult with kawasaki disease and recurrent myocardial infarction
Authors: Ueno Takafumi , Kai Hisashi , Ikeda Hisao , Ichiki Kazuya , Hashino Tatsuya , Imaizumi Tsutomu 
Published: February 2009

AbstractA 19‐year‐old man developed a huge coronary aneurysm and stenosis in the right coronary artery as a sequela of Kawasaki disease (KD) that resulted in recurrent episodes of myocardial infarction. Coronary ischemic events were successfully prevented after balloon angioplasty followed by coronary stent implantation into the stenotic lesion. The stent deployment may have an advantage compared with balloon angioplasty and other new devices for the treatment for patients with KD showing stenotic lesions without dense calcification.
Sudden death in dilated cardiomyopathy
Authors: Wu Audrey H. , Das Sunil K. 
Published: February 2009

AbstractThe purpose of this review is to examine the potential contribution of arrhythmia to the occurrence of sudden death in dilated cardiomyopathy (DCM) and to discuss current treatment options. We performed a search of the MEDLINE database from 1985 to the present and the reference citations of selected articles pertaining to the prognostic significance, management, and pathophysiology of arrhythmias in DCM. A large proportion of patients with DCM die suddenly, most secondary to ventricular arrhythmia and a smaller proportion due to bradyarrhythmia. The presence and severity of ventricular ectopy may predict risk for sudden death, but the role of electrophysiologic study and signal‐averaged electrocardiography in further risk stratifying patients remains uncertain. Abnormalities of the autonomic nervous system and renin‐angiotensin‐aldosterone axis appear to promote the occurrence of ventricular arrhythmias. Angiotensin‐converting enzyme inhibitors improve overall mortality in congestive heart failure, and the use of direct angiotensin‐receptor antagonists is currently being studied. In addition, beta‐receptor antagonists appear to improve morbidity and may prove to improve mortality in heart failure as well. Other interventions still under investigation include amiodarone and the implantable cardioverter‐defibrillator. The underlying pathophysiology of sudden death in DCM involves primarily ventricular tachyarrhythmia. Angiotensin‐converting enzyme inhibitors remain a mainstay of improving overall mortality, while further study on the roles for newer drugs and devices is ongoing.