bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventricular arrhythmias in patients recovering from myocardial infarction: Do residual myocardial ischemia and anti‐ischemic medical intervention influence the one‐month prevalence?
Authors: Jespersen Christian M. , Vaage‐Nilsen Merete 
Published: February 2009

AbstractThe relationship between myocardial ischemia revealed by exercise testing and ventricular arrhythmias on Holter monitoring, and the effect of anti‐ischemic intervention on the incidence of ventricular arrhythmias in patients with residual ischemia were studied in 125 patients recovering from myocardial infarction.Prior to discharge exercise testing and 24‐h Holter monitoring were carried out In patients with ST‐segment depression (n = 34), ventricular arrhythmias on Holter monitoring were seen in 7 (21%) compared with 20 (22%) patients without ST‐segment depression (NS). Patients were hereafter double‐blindly randomized to intervention with verapamil (n = 63) or placebo (n = 62). One month after discharge, 24‐h Holter monitoring was repeated. In the verapamil group ventricular arrhythmias increased from 25 to 33% (NS). In the placebo group the figures were 18 and 27%, respectively (NS). In patients with ST‐segment depression and verapamil treatment, the prevalence increased from 25 to 38% (NS). In the placebo group the figures were 17 and 22%, respectively (NS). The differences between the groups were not significant. A significantly increased prevalence of ventricular arrhythmias was found in patients with either heart failure or non‐Q‐wave infarct. In these patients myocardial ischemia during exercise did not correlate with ventricular arrhythmias either. ST‐segment depression during predischarge exercise testing correlated with neither the prevalence nor the incidence of ventricular arrhythmias, and anti‐ischemic intervention with verapamil did not influence the incidence of ventricular arrhythmias in both patients with and without myocardial ischemia.
Unstable angina: Relationship of clinical presentation, coronary artery pathology, and clinical outcome
Authors: Bertolet Barry D. , Dinerman Jay , Hartke Ralph , Richard Conti C. 
Published: February 2009

AbstractPatients with unstable angina are heterogeneous with respect to presentation, coronary artery morphology, and clinical outcome. Subclassification of these patients based on clinical history has been proposed as a means of identifying individuals at increased cardiac risk. We applied such a classification system to 129 patients discharged from a coronary care unit with a diagnosis of acute myocardial ischemia. Patients were then assessed for cardiac events (recurrent angina requiring revascularization, myocardial infarction, death) 12 months following hospital discharge. Patients were classified as recent onset unstable angina preinfarction (n = 42), crescendo unstable angina preinfarction (n = 48), and unstable angina postinfarction (n = 39). Within each of these groups, the patients were further subclassified based on the occurrence of angina on effort, at rest, or both. No attempt was made to subset patients taking antiischemic drugs at the time of clinical presentation to the physician. Coronary angiographic pathology (morphology and number of vessels involved) was similar in the subgroups, but coronary artery thrombus was statistically more likely to be found in patients with crescendo rest angina preinfarction or with frequent anginal episodes at rest postinfarction. Mortality was significantly higher for patients with unstable angina postinfarction (7.7%) than preinfarction (1.1%). No statistical differences were noted between the subgroups with respect to the occurrence of myocardial infarction or recurrent unstable angina requiring revascularization. These data suggest that subclassification of unstable angina patients based on clinical characteristics at presentation is not useful to predict subsequent myocardial infarction or recurrent angina requiring revascularization. However, as one might expect, patients with recurrent angina postinfarction have a higher mortality rate than patients with unstable angina preinfarction, and patients with recurrent rest angina, either pre‐ or postinfarction, are more likely to have intracoronary thrombus than patients with new onset angina or crescendo effort angina; however, the presence of thrombus did not predict a poor clinical outcome.
Efficacy of once‐daily lisinopril monotherapy in systemic hypertension
Authors: Hwang Yeo‐Shin , Yen Hsueh‐Wei 
Published: February 2009

AbstractLisinopril is a new, long‐acting angiotensin‐converting enzyme inhibitor formulated for once‐daily treatment of hypertension. This study assessed the 24‐h efficacy and tolerability of lisinopril in Chinese patients with mild to moderate hypertension of World Health Organization Stages I to II. A total of 30 patients aged 30 to 60 years (mean 47 ± 9) entered a 2‐week washout period. All patients had ambulatory diastolic blood pressure (BP) > 90 mmHg and were given active treatment with lisinopril for 4 to 7 weeks. The dose of lisinopril was titrated from 10 to 40 mg daily (at 8‐9 A. M.). In each patient, 24‐h ambulatory blood pressure (BP) monitoring (SpaceLabs 90202) was performed twice, once before and once following treatment. Mean 24‐hour systolic/diastolic BPs after lisinopril were significantly decreased compared with baseline values (132 ± 12/86 ± 7 vs. 150 ± 11/98 ± 7 mmHg; p < 0.0005/ 0.0005). The average dose of lisinopril was 14.5 ± 5 mg daily after a titration period of 5 weeks of treatment. Mean daytime (6 A. M. to 6 P. M.) BP decreased from 152 ± 11/100 ± 8 to 134 ± 12/87 ± 8 mmHg (p < 0.0005/0.0005) and nighttime (6 P.M. to 6 A. M.) BP from 147 ± 14/95 ± 9 to 128 ± 14/83 ± 8 mmHg ( p < 0.0005/0.0005). BP reduction was more pronounced during the night. Before treatment, the circadian variation showed a peak BP at 11 A. M. and nadir at 3 P. M. After treatment, significant BP reduction (p < 0.0005/0.0005) was seen throughout the 24‐h period. The circadian rhythm of BP was preserved as indicated by similar BP standard deviations (14 ± 3/11 ± 2 vs. 13 ± 3/10 ± 2 mmHg). Mean heart rate increased from 76 to 80 beats/min (p < 0.05). Four patients reported having a nonproductive cough. Thus, lisinopril administered as once‐daily monotherapy provided effective BP control over a 24‐h period with preserved circadian rhythm.
Idiopathic verapamil‐sensitive sustained left ventricular tachycardia
Authors: Ohe Tohru 
Published: February 2009

AbstractIdiopathic verapamil‐sensitive left ventricular tachycardia (VT) has characteristic QRS configurations during VT: right bundle‐branch block with either left axis or right axis (less common) deviation. QRS duration is relatively narrow (0.13‐0.16s) and frequently endocardial activation prior to QRS is recorded during VT, which is the basis of its being called fascicular tachycardia. The mechanism is probably reentry, but the nature of the slow conduction necessary for the occurrence of reentry is quite different from that of other sustained monomorphic VT associated with structural heart disease. Chronic oral verapamil therapy is the drug of choice for alleviation of symptoms. Long‐term prognosis is good.
Electrocardiographic prediction of ejection fraction and site of LAD occlusion in anterior myocardial infarction
Authors: H. Strauss Bradley , Green Martin 
Published: February 2009

AbstractQ‐wave anterior myocardial infarctions due to occlusion of the left anterior descending artery (LAD) are generally associated with the most extensive left ventricular damage. The presence of abnormal Q waves on the electrocardiogram (ECG) provides important information to localize the site of left ventricular infarction. However, the relationship between abnormalities of the QRS morphology in the precordial leads and angiographic information such as ejection fraction and the site of LAD occlusion (before or after the first septal perforator) has not been studied extensively. Seventy‐three patients with single‐vessel disease with complete LAD occlusion, abnormal QRS morphology in leads V1‐V4 on ECG, and abnormal wall motion with contrast ventriculography were studied retrospectively. LAD occlusions were proximal to the first septal perforator in 33 patients and distal in 40 patients. Q waves were present in 59 patients, and the other 14 patients had either minimal R waves (<0.25 mm), poor R‐wave progression, or R‐wave regression. A significantly higher ejection fraction was associated with the presence of R wave in V2 (0.52 ± 0.18 vs. 0.39 ± 0.15 in the absence of R wave, p<0.003). LAD occlusion after and before the first septal perforator was associated with R wave in V2 in 67 and 36% of patients, respectively. Sensitivity and specificity of predicting occlusion after the first septal perforator based on R wave in V2 was 0.68 and 0.64, respectively. In patients with anterior myocardial infarctions, occluded LAD artery, and abnormal QRS morphology in the precordial leads, the presence of R wave in V2 is a useful predictor of higher ejection fraction. The prediction of site of LAD occlusion in relation to the first septal perforator based on ECG findings is limited and probably not sufficiently specific or sensitive to be of clinical use.
Electrocardiographic responses to jogging in middle‐aged and older men and women
Authors: Jetté M. , Blümchen G. , Treichel P. , Landry F. 
Published: February 2009

AbstractRecent jogging‐related sudden deaths rekindled the concern among health professionals as to the hazards of strenuous exercise. The purpose of this study was to evaluate the extent of rhythm disturbances and myocardial ischemia in older men and women during a typical strenuous jogging session. Twenty‐two members of a local jogging club (11 men and 11 women) between the ages of 50 and 66 years participated in the study. The CardioData PR3/ST monitor was employed to record heart rate, rhythm disturbances, J point and ST slope during the course of the run. The men ran a 10 km run and the women a 6 km run at a competitive pace. The mean maximal heart rate during the run was 170 ± 15 beats/min for the males and 176 ± 14 beats/min for the females. The mean J point during the run was ‐3.39 ± 1.21 mV for the males and ‐2.97 ± 0.96 mV for the females. Females showed a significantly lower mean ST slope (3.95 + 0.91 mV) during the run than the males (5.56 ± 1.37 mV, p < 0.05). A number of episodes of premature ventricular beats, both uni‐ and multifocal, were observed. Exercise testing of sufficient intensity is recommended to detect those persons susceptible to developing serious arrhythmias during strenuous exercise.
Transient left ventricular aneurysm in a patient with hypertrophic cardiomyopathy and myocarditis
Authors: Z. Fisher Daniel , G. DiSalvo Thomas , Dec G. William , W. DeSanctis Roman 
Published: February 2009

AbstractLeft ventricular wall motion abnormalities, aneurysm formation, and progression to global hypokinesis have been described in patients with myocarditis and in patients with hypertrophic cardiomyopathy. We document a case of reversible aneurysm formation, cardiogenic shock, and complete recovery in a patient with myocarditis and hypertrophic cardiomyopathy. Pathophysiologic mechanisms of myocardial injury and recovery are discussed.
Ethanol‐induced myocardial ischemia: Close relation between blood acetaldehyde level and myocardial ischemia
Authors: Ando Hiroshi , Abe Hirohiko , Hisanou Ryuuichi 
Published: February 2009

AbstractA patient with vasospastic angina who developed myocardial ischemia following ethanol ingestion but not after exercise was described. Myocardial ischemia was evidenced by electrocardiograms (ECGs) and thallium‐201 scintigrams. The blood acetaldehyde level after ethanol ingestion was abnormally high. The time course and severity of myocardial ischemia coincided with those of the blood ethanol and acetaldehyde level. Coronary arteriography showed ergonovine maleate‐induced coronary vasospasm at the left anterior descending coronary artery. ECG changes similar to those induced by ethanol ingestion were observed at the same time. These findings suggest that the high blood acetaldehyde level might be responsible for the development of coronary vasospasm and myocardial ischemia in this patient.
Sarcoidosis of the Heart
Authors: Shammas Rony L. , Movahed Assad 
Published: February 2009

AbstractMyocardial involvement in sarcoidosis occurs in about 27% of patients. Clinical manifestations include ventricular arrhythmias, conduction abnormalities, and sudden death. Diagnosis requires clinical suspicion and may be supported by electrocardiography, echocardiography, thallium imaging, gallium‐67 scanning, and myocardial biopsy. Steroids seem to be beneficial in the treatment of myocardial sarcoidosis. Those who do not respond to medical treatment may benefit from cardiac transplantation.
Ventricular arrhythmias late after myocardial infarction are related to hypomagnesemia and magnesium loss: Preliminary trial of corrective therapy
Authors: Ceremużyński Leszek , Van Hao Nguyen 
Published: February 2009

AbstractIt has been well established that in acute myocardial infarction (MI) many patients display low serum magnesium (Mg). This is associated with complex ventricular arrhythmias. The question arises whether predischarge arrhythmias occurring late after MI might also be related to Mg imbalance. In 118 patients subjected to heart rhythm 24 h Hotter monitoring in the second or third week after MI, we investigated (1) the relationship between serum Mg, urinary Mg loss, and ventricular arrhythmias, and (2) the effect of Mg supplementation on heart rhythm disturbances. In patients with undisturbed rhythm or monomorphic ventricular ectopic beats (VEB) (Lown 0‐2; n = 84), mean serum Mg level (mg% ± SD) was 1.83 ± 0.21, whereas in patients with multifocal VEB, pairs, or nonsustained ventricular tachycardia (VT) (Lown 3–4; n=34) serum Mg was decreased to 1.68 ± 0.27 (p < 0.01). Serum Mg normal range in our laboratory is 1.7–2.6 mg%. The lowest serum Mg reaching 1.55 ± 0.27 was found in nonsustained VT (Lown 4 b) subgroup (n = 14). Urinary Mg loss measured in 81 patients was more pronounced in those with Lown 3–4 arrhythmias (n=26) than with Lown 0–2 (n = 55). The daily values were 73 ± 22 and 54.4 ± 26 mg, respectively (p < 0.001). Thirteen patients with complex arrhythmias and low serum Mg received Mg supplementation (MgSO4, 8 g in 500 ml 5% glucose intravenously during 24 h). This resulted in restoration of almost undisturbed rhythm in 10 subjects. In conclusion, a number of patients in late phase of MI displayed hypomagnesemia concomitant with augmented Mg excretion. These alterations were related to the occurrence of arrhythmias: die most threatening heart rhythm disturbances were accompanied by the lowest serum Mg and the highest Mg excretion. Our preliminary observations suggest that supplementation with MgSO4 may be a reasonable approach to the treatment of predischarge complex ventricular arrhythmias after MI. This should be verified in a controlled trial.
Lone atrial fibrillation and anticoagulant therapy
Authors: More R. S. , Brack M. J. , Gershlick A. H. 
Published: February 2009

AbstractAssessment of risk of thromboembolism and potential benefit of prophylaxis with long‐term anticoagulant therapy in lone atrial fibrillation is hampered by a lack of consensus regarding definition of lone atrial fibrillation. In general, patients less than 60 years of age with normal left ventricular function and left atrial size have a low risk of thromboembolic events and are unlikely to gain any significant benefit with anticoagulants; however, patients older than 60 years with impaired left ventricular function, enlarged left atrium, and/or associated conditions such as hypertension have an increased risk of thromboembolism and would benefit from long‐term anticoagulant therapy. Decisions regarding anticoagulant usage would be simplified by using a scoring system containing clinical and investigational variables.
Anatomy, histology, and pathology of the cardiac conduction system—Part IV
Authors: Waller Bruce F. , Gering Lawrence E. , Branyas Nancy A. , Slack John D. 
Published: February 2009

AbstractMetastatic tumor involvement of the heart as a basis for the genesis of various cardiac arrhythmias is reviewed. The morphologic basis of pre‐excitation syndromes and right ventricular dysplasia are also reviewed.
Hypothyroid cardiac tamponade presenting with severe systemic hypertension
Authors: Machado Christian , Bhasin Surjit , Nona Wassim , Steinman Russell T. 
Published: February 2009

AbstractHemodynamic data are presented which not only depict typical tamponade physiology, but demonstrate that hypotension may not necessarily be present with slow accumulation of pericardial fluid in myxedema patients. This case is unique in that severe hypertension, as part of the presentation of hypothyroid tamponade, has never been reported.
Stress‐induced polymorphous ventricular tachyarrhythmias in two brothers: Unusual pattern of inheritance in the long QT syndrome
Authors: Pfammatter J. P. , Weber J. W. , Stocker F. P. , Gertsch M. , Moser H. , Kappenberger L. 
Published: February 2009

AbstractTwo brothers, 10 and 9 years old, are reported who were treated for years with antiepileptic drugs until the cardiac origin of their syncopal attacks was discovered. Our findings are consistent with the diagnosis of long QT syndrome, although no other family members are affected and only intermittent and mostly borderline QT prolongation could be found. Diagnostic difficulties and genetic implications are discussed.
Interventional techniques for the management of coronary artery lesions: An update
Authors: De Feyter Pim J. , Macleod Donald C. , Foley David , De Jaegere Peter P. T. , Serruys Patrick W. 
Published: February 2009

AbstractCoronary balloon angioplasty has become standard treatment for ischemic coronary artery disease. Major limitations of angioplasty are the inferior results obtained with unfavorable lesions, the occurrence of abrupt occlusion responsible for in‐hospital mortality and morbidity, and the high restenosis rate at 6 months. New techniques for stents, laser, and atherectomy have been developed to overcome these limitations. Until now, although the initial results are encouraging, these new techniques have not as yet shown to be clearly superior to balloon angioplasty. However, due to the limitations of balloon angioplasty, further development of new techniques should be stimulated so that nonsurgical treatment of coronary artery disease will become safer, more effective, and applicable to a wider spectrum of coronary artery disease.
Transesophageal echocardiography: Increased risk by repeated attempts to insert the transducer in patients with coronary artery disease?
Authors: Grosse‐Hettmeyer Wolfgang , Engberding Rolf 
Published: February 2009

AbstractThe question of whether several attempts at transducer insertion increase the risk of performing transesophageal echocardiography (TEE) in patients with coronary artery disease (CAD) has not been addressed to date. In the course of performing TEE in 45 patients with CAD, two or more attempts to insert the transducer were necessary in 9 cases. During various attempts, heart rate, blood pressure and ST‐segment depression were recorded and correlated with the findings of the exercise electrocardiogram (ECG) and coronary angiography. Insertion was successful in six patients after two attempts and in three other patients after three, four, and five attempts, respectively. Heart rate rose significantly (p<0.005) with the increase of insertion attempts. In one patient, it continued to rise at the fourth attempt, reaching 216% compared with the initial heart rate. Systolic blood pressure rose by 5%, whereas there was hardly any change in diastolic blood pressure. As the number of insertion attempts increased, we recorded a continuous ST‐segment depression in eight patients with angiographic changes of the coronary artery system. The depression was already significant at the first attempt (p<0.05). Compared with the initial reading (0.053 mV), the increase was 335% (p<0.01) after the second attempt (0.231 mV). One patient whose angiographic findings were normal had no ST‐segment depression during TEE. In all eight patients with CAD ST‐segment depression during TEE was > 0.2 mV. Since none of the patients complained of angina pectoris, the ST‐segment depressions satisfied all the criteria of silent myocardial ischemia. Thus, in the performance of TEE in patients with CAD, ST‐segment depression is consistently intensified with each additional attempt to insert the transducer and must be taken as an indicator of myocardial ischemia. Investigators should consider systemic analgesia (conscious sedation) when performing TEE in patients with CAD.
Interobserver variation in interpretation of electrocardiographic signs of atrial infarction
Authors: Christensen Jeppe Hagstrup , Nielsen Finn Erland , Falste‐Jensen Niels , Schmidt Erik Berg 
Published: February 2009

AbstractThe electrocardiogram (ECG) is the only means of diagnosing atrial infarction antemortem. Certain ECG changes (PR‐segment displacements) have been taken earlier as signs of atrial infarction. The purpose of this study was to assess the interobserver variation on suggested ECG signs of atrial infarction in patients admitted with acute myocardial infarction. The ECGs from 290 patients were evaluated by three physicians with respect to the occurrence of each of the following seven criteria suggestive of atrial infarction: (1) PR‐segment elevation > 0.5 mm in lead I; (2) PR‐segment depressions > 0.5 mm in leads II and III; (3) PR‐segment depressions > 1.2 mm in leads I, II, and III; (4) PR‐segment depressions > 0.5 mm in leads V1 and V2; (5) PR‐segment elevations > 0.5 mm in leads V5 and V6; (6) PR‐segment depressions > 1.5 mm in precordial leads; and (7) abnormal P waves. Kappa values ranged from 0.00–0.86. Of the seven criteria tested only criteria 2, 4, and 7 could be detected in a reasonable number of patients. The interobserver variations of these criteria were considerable, although the strength of agreement could be designated as fair to moderate.
Ventricular tachycardia due to sustained bundle branch reentry: Diagnostic and therapeutic considerations
Authors: Blanck Zalmen , Akhtar Masood 
Published: February 2009

AbstractWe have identified bundle‐branch reentry (BBR) as the mechanism of ventricular tachycardia (VT) during electrophysiologic studies in 48 patients at our institution. All but three patients had significant structural heart disease, that is, dilated ischemic or idiopathic cardiomyopathy, the most common of anatomic substrates. Syncope and sudden death were the modes of presentation in up to 70% of these patients. The critical prerequisite for the development of this arrhythmia is conduction delay in the His‐Purkinje system, which was present in all patients and manifests as a nonspecific conduction delay or a left bundle‐branch block (LBBB) in the surface electrocardiogram (ECG) and a prolonged HV interval in the intracardiac recordings. VT with an LBBB morphology is the most common form of BBR, present in 98% of patients. Transcatheter ablation of the right bundle branch (RBB) with the use of radiofrequency current is the treatment of choice, as it effectively eliminates BBR. During long‐term follow‐up, recurrent tachycardia due to BBR was not documented in any patient; however, congestive heart failure was a common cause of death in this population.
Anatomy, histology, and pathology of the cardiac conduction system—part VI
Authors: Waller Bruce F. , Gering Lawrence E. , Branyas Nancy A. , Slack John D. 
Published: February 2009

AbstractVarious pathologic conditions producing atrioventricular block are reviewed. Calcific atrioventricular block (aortic stenosis, mitral valve annular calcium), active infective endocarditis (“ring” abscess), acute and healed myocarditis, various collagen‐vascular diseases, amyloidosis, and tumors are reviewed as causes of atrioventricular block. Various diseases producing bundle‐branch block are also discussed.