bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary arterial morphology 10 years after “Endarterectomy”
Authors: Kragel A. H. , Mcintosh C. L. , Roberts W. C. 
Published: February 2009

AbstractLittle information is available regarding coronary artery morphology after endarterectomy. In this report, we describe coronary artery morphology seen at necropsy 10 years after coronary artery endarterectomy and compare it with the morphology of the original endarterectomy specimen. Surprisingly, in some areas, all of the internal elastic membrane and most of the media were observed in the “endarterectomy” specimen.
Acute myocardial infarction associated with intravenous dipyridamole for rubidium‐82 pet imaging
Authors: Marwick T. H. , Hollman J. 
Published: February 2009

AbstractThis report describes the occurrence of chest pain and electrocardiographic features of acute myocardial infarction following intravenous dipyridamole‐handgrip stress. Myocardial perfusion imaging (Rb‐82 PET) demonstrated a stress‐induced perfusion defect. Following failure to respond to medical therapy, urgent cardiac catheterization demonstrated total occlusion of the left anterior descending coronary artery. The vessel was revas‐cularized, with limitation of myocardial damage evidenced by failure to develop anterior Q waves and only modest elevation of cardiac enzyme levels. Complications of intravenous dipyridamole stress are rare, this case constituting the first major problem in over 500 such procedures at this institution. However, this experience demonstrates the importance of vigilant observation during the performance of this technique.
Prognosis during one year for patients with myocardial infarction in relation to the development of q waves: Experiences from the miami trial
Authors: Herlitz J. , Hjalmarson Å. , Karlson B. W. 
Published: February 2009

AbstractFrom a randomized multicenter trial with metoprolol in suspected acute myocardial infarction (n = 5778) we report on the outcome during a one‐year follow‐up in patients with confirmed infarction (n = 4106) in relation to whether or not they developed Q waves. Patients with Q waves had another pattern of risk factors, including lower age and a lower occurrence of previous infarction, angina pectoris, and congestive heart failure. After one year follow‐up, 14.3% of the patients with Q waves had died versus 9.0% of those without Q waves (p < 0.001). Reinfarction during the first year occurred in 8.2% of patients with Q waves and 12.5% of patients without Q waves (p < 0.001). After one year, other morbidity aspects appeared relatively independent of the original presence of Q waves. In conclusion, during the first year after development of acute myocardial infarction the appearance of Q waves during the first three days is associated with a higher mortality and a lower reinfarction rate, whereas other morbidity aspects appear to be relatively independent of its presence.
Cardiac surgery in patients over the age of 80 years
Authors: Bashour T. T. , Hanna E. S. , Myler R. K. , Mason D. T. , Ryan C. , Feeney J. , Iskikian J. , Wald S. H. , Antonini C. , Malabed L. L. 
Published: February 2009

AbstractThe risk‐benefit relationship of open heart surgery in octogenarians is not well established. Eighty consecutive patients over the age of 80 who underwent cardiac operations under cardiopulmonary bypass were evaluated. Twenty‐five patients were in functional class IV, 42 in class III, and 13 in class II. Forty‐four patients had only coronary artery bypass grafts (CABG), 12 only aortic valve replacement (AVR), 6 only mitral valve replacement (MVR), 12 CABG and AVR, 4 CABG and MVR, 1 CABG and aneurysmectomy, and 1 had resection of left atrial myxoma. Operative mortality (within 30 days) was 12.5% for the group. Mortality was related to bleeding, left ventricular failure, primary ventricular fibrillation, pulmonary failure, and renal failure. Mortality was higher in patients with (1) advanced functional class, (2) mitral valve replacement, (3) postoperative hemorrhage, and (4) associated pulmonary disease. While a generally conservative approach is recommended for octogenarian patients, many with life‐threatening cardiac disease, especially those free of major multisystem illnesses, should not be denied the benefit of surgical treatment.
Calcific deposits in the heart
Authors: Catellier M. J. , Chua G. T. , Youmans G. , Waller B. F. 
Published: February 2009

AbstractFour case reports are presented which illustrate various patterns of calcific deposits in the heart. Valvular, myocardial, intracavitary, and coronary calcific deposits are illustrated, with emphasis on pathology and clinicopathologic‐radiologic correlation. “Dystrophic” and “metastatic” calcification are terms used to describe calcific deposits in abnormal and normal soft tissues, respectively. These terms are somewhat confusing in relation to the myocardium, however, as the chronologic sequence of cardiac injury is often uncertain. We suggest that these terms be avoided in relation to the heart, in favor of simple descriptive terms such as “myocardial calcific deposits.” Many conditions, such as renal failure and hypercalcemia may contribute to the likelihood of soft tissue calcification, although a definite common etiology has not been identified. Likewise, soft tissue calcification has been difficult to diagnose premortem. The advent of ultrafast (cine) computed tomography may provide a quick, noninvasive, highly sensitive and specific method for diagnosis of soft tissue calcific deposits in the future.
Aortic and large artery stiffness: Current methodology and clinical correlations
Authors: Hickler R. B. 
Published: February 2009

AbstractCurrent methodology for the in vitro determination of aortic and large artery stiffness is reviewed and involves three approaches: (1) the estimation of distensibility by pulse wave velocity measurement; (2) the estimation of distensibility from the fractional diameter change of a given arterial segment by imaging techniques (e. g., angiography, Doppler ultrasound) against pressure change; (3) the estimation of compliance by determining volume change against pressure change in the arterial system during diastolic runoff from the Windkessel model of the circulation. Clinical correlations may be summarized as follows: (1) age: a progressive stiffening on aging due to structural changes up to the seventh decade; (2) sex: a lower degree of stiffness in women until menopause, after which they show an accelerated stiffening, catching up with men by the seventh decade; (3) atherosclerosis: a dissociation between degree of stiffness and extent of atherosclerosis, with a suggestion that in advanced atherosclerosis the extensive calcification may lead to increased stiffness; (4) coronary disease: an inconsistent correlation by pulse wave velocity studies, but a strongly positive correlation by angiographic study of the aortic root; (5) diabetes mellitus: a significant correlation by pulse wave velocity study, particularly in the presence of advanced peripheral vascular disease; (6) hypertension (both essential and elderly patients with systolic): positive correlation but only referable to the stiffening effect of a higher mean arterial pressure (i. e., unrelated to structural changes), although an experimental study did show a loss of compliance unrelated to the mean arterial pressure level in baboons with chronic renovascular hypertension.
The relationship between new cardiac conduction defects and extension of valve infection in native valve endocarditis
Authors: Weisse A. B. , Khan M. Y. 
Published: February 2009

AbstractNew conduction defects in the setting of native valve infective endocarditis (IE) are commonly believed to be associated with direct extension beyond the free valve area. At University Hospital in Newark, among 100 cases of IE, in none of five instances of associated conduction defects (excluding first‐degree heart block) was this the case. in neither of two instances of direct extension of valve infection was this accompanied by a new conduction defect. To explore this relationship, autopsy, surgical, and echocardiographic findings from other institutions were combined with these data. Among 47 instances of new conduction defects in IE, only 60% could be related to direct extension of valve infection. The cause was coronary embolization in 4% and unknown in 36%. Among 119 cases of complicated valve lesions, significant conduction defects were documented by ECG in only 15%. in IE the appearance of new conduction abnormalities may often result from causes other than extension of valve infection. Furthermore, complicated valve lesions may often be present without electrocardiographic evidence, indicating interruption of normal conduction pathways.
Limb leads of the electrocardiogram: Sequencing revisited
Authors: Dower G. E. , Nazzal S. B. , Bullington D. , Pahlm O. , Haistey W. K. , Marriott H. L. , Bullington R. H. 
Published: February 2009

AbstractThe six limb leads are normally presented in a format the logic of which is traditional rather than anatomical and does not allow visual interpolation such as is customary with the six chest leads. The sequence: aVL, I, ‐aVR, II, aVF, III was suggested years ago, and is used in some European countries, particularly Sweden. It provides a better impression of the extent of the changes of inferior infarction and makes the rather neglected lead aVR much more useful, though reversed in polarity. It also provides a more direct indication of the electrical axis, and simplifies comparisons with the frontal plane vectorcardiogram. Because modern digital electrocardiographs can provide the sequenced format, this seems a good time to review the advantages of adopting it.
Parkinson's disease and hypotension: 24‐hour blood pressure recording in ambulant patients
Authors: Brevetti G. , Bonaduce D. , Breglio R. , Perna S. , Simonelli P. , Marconi R. , Campanella G. 
Published: February 2009

AbstractContinuous intra‐arterial blood pressure was recorded in 5 ambulatory patients with Parkinson's disease and in 5 control subjects. The 24‐h mean systolic blood pressure was 135±7.6 mmHg in controls and 123.8±8.1 mmHg (p<0.01) in the parkinsonian group. Similarly, diastolic blood pressure was 89±8.1 mmHg in the control group while in the parkinsonian patients it was lower, 69.4±5.8 (p<0.01). Averages were also calculated for 8‐h periods, the results of which indicate that both systolic and diastolic blood pressure were significantly lower in patients than in controls in all three 8‐h periods of the day. We normalized the blood pressure curve to mealtimes and arousal times and did not observe any difference between parkinsonian patients and controls. This first study reporting continuous intraarterial blood pressure measurements in ambulant parkinsonian patients demonstrates that blood pressure in such patients is lower than the mean for their age group. This finding may be of direct relevance in the management of idiopathic parkinsonism.
Improved diastolic LV filling after acute application of ajmaline in patients with coronary artery disease and normal systolic LV function
Authors: Hüiting J. , Thormann J. , Mitrovic V. , Schlepper M. 
Published: February 2009

AbstractTo determine whether ajmaline (A) can be safely applied in coronary artery disease (CAD), changes of left ventricular (LV) function after acute ajmaline application were analyzed by pulsed Doppler echocardiography in 10 CAD patients. LV pressures in systole and end‐diastole and LVEF remained normal and comparable. Doppler normalized peak filling rate (p < 0.02), peak early/atrial filling velocity (E/A) ratio (p < 0.01) and E‐deceleration (p<0.05) increased. The increase in E/A and in E‐deceleration relative to base values was directly correlated (p < 0.001). PEP increased, LVET remained unchanged. LV diastolic filling is improved after acute application of ajmaline in patients with CAD and normal systolic function; its application may be advised not only for therapy of arrhythmia but also to improve left ventricular diastolic mechanics in these patients.
Rare or unusual causes of chronic, isolated, pure aortic regurgitation
Authors: Waller B. F. , Taliercio C. P. , Dickos D. K. , Howard J. , Adlam J. H. , Jolly W. 
Published: February 2009

AbstractSix patients undergoing aortic valve replacement had rare or unusual causes of isolated, pure aortic regurgitation. Two patients had congenitally bicuspid aortic valves with a false commissure (raphe) displaced to the aortic wall (“tethered bicuspid aortic valve”), two had floppy aortic valves, one had a congenital quadricuspid valve, and one had radiation‐induced valve damage.
Thallium‐201 perfusion imaging with atrial pacing or dipyridamole stress testing for evaluation of cardiac risk prior to nonvascular surgery
Authors: Stratmann H. G. , Mark A. L. , Williams G. A. 
Published: February 2009

AbstractPreoperative assessment of cardiac risk using thallium‐201 scintigraphy and atrial pacing (n=42) or dipyridamole stress testing (n=35) was performed in 77 patients (mean age 65±7 years), who subsequently underwent elective nonvascular surgery. All patients were at low cardiac risk by clinical criteria; none could perform exercise stress testing due to physical limitations. ST depression consistent with ischemia occurred in 11 patients during atrial pacing and in 1 patient during dipyridamole stress testing (p<0.01). Nine patients had reversible perfusion defects with atrial pacing, and 10 patients with dipyridamole stress testing; fixed defects were present in 15 and 8 patients, respectively. Only one patient (fixed perfusion defect with atrial pacing, left main disease on coronary angiography) underwent preoperative coronary revascularization. Two patients subsequently had postoperative cardiac events. One patient (reversible perfusion defect with dipyridamole stress testing) experienced sudden death after a nonvascular procedure, while a second patient (normal thallium images with dipyridamole testing) had a nonfatal myocardial infarction. In patients having atrial pacing or dipyridamole stress testing, thallium‐201 scans that are normal or show only a fixed perfusion defect confirm a low risk of cardiac complications following nonvascular surgery. The presence of a reversible perfusion defect does not preclude a postoperative course free of cardiac complications in patients at low cardiac risk by clinical criteria.
T‐Lymphocyte subsets as noninvasive markers of cardiomyopathy
Authors: Kanda T. , Yokoyama T. , Suzuki T. , Murata K. , Ohshima S. , Yuasa K. , Watanabe T. 
Published: February 2009

AbstractFifty‐eight patients with symptomatic congestive heart failure were examined for T‐lymphocyte subsets in the peripheral blood using two‐color laser flow cytometry as a noninvasive diagnostic procedure. The final diagnoses established by catheterization and endomyocardial biopsy were dilated cardiomyopathy (DCM, n=24), myocarditis (MC) by the Dallas criteria (n=12), and coronary heart disease (CHD, n=16). The CD8+CD11‐ (cytotoxic T) subset was significantly low in patients with DCM (13.9±4.4 vs. controls, p<0.05) in comparison with MC (20.7 + 10.9) and CHD (22.3±5.9). Moreover, the CD4+2H4+ (suppressor/inducer T) subsets were higher in patients with DCM (27.3±6.9 vs. controls, p<0.01) than in those with MC (17.3±7.8) and CHD (15.6+7.9). The CD4/CD8 and CD4+2H4+/CD8+CD11‐ ratios were examined and compared with those of normal controls (NC n=16). The CD4+2H4+/CD8+CD11‐ ratio was clearly higher in patients with DCM (2.2+0.9 vs. controls, p<0.01) than in those with MC (1.1±0.6) CHD (0.9±0.7). A CD4+2H4+/CD8+CD11‐ ratio of > 1.6 was considered to facilitate diagnosis of dilated cardiomyopathy with 79% sensitivity and 70% specificity. There was no significant increase in the ratios between MC and CHD. However, the proportion of the CD8+Leu7+ (natural suppressor) subset of circulating T lymphocytes in patients with MC was statistically higher (19.1±6.3% vs. controls, p<0.05) than in DCM or CHD. An elevated ratio of CD4+2H4+/CD8+CD11‐ among peripheral blood lymphocytes may thus be a useful marker for differential diagnosis of dilated chronic cardiomyopathy from myocarditis and coronary heart disease.
Dynamic arm exercise during cardiac catheterization in the assessment of stenotic valvular disease
Authors: Balady G. J. , Jacobs A. K. , Faxon D. P. , Ryan T. J. 
Published: February 2009

AbstractAssessment of hemodynamic responses during some form of exertion or stress during cardiac catheterization is useful among patients suspected of having valvular stenosis who demonstrate normal or borderline valve gradients at rest. Leg raising exercise and drug administration are commonly used for this purpose, but each has inherent limitations. To evaluate the usefulness of dynamic arm raising exercise as a means of altering hemodynamics during cardiac catheterization, 23 such patients were studied. Measurements obtained during arm raising exercise were compared with those at rest. Heart rate rose by 34±4 beats/min (p<0.001), while cardiac output increased by 1.4±0.2 1/min (p<0.001). Stroke volume decreased slightly, although left ventricular filling pressures and pulmonary capillary wedge pressures rose in nearly all subjects. The change in valvular gradients was variable. These data were compared with those obtained in 11 similar patients receiving either dopamine or isoproterenol as an intervention. The changes in heart rate and cardiac output from the resting state were similar between the groups, with fewer side effects occurring during arm exercise. Dynamic arm exercise is a safe and effective maneuver which can be performed during cardiac catheterization in patients undergoing diagnostic evaluation of stenotic valvular disease.
Variant angina due to deficiency of intracellular magnesium
Authors: Tanabe K. , Noda K. , Kamegai M. , Miyake F. , Mikawa T. , Murayama M. , Sugai J. 
Published: February 2009

AbstractA 51‐year‐old man was diagnosed as having variant angina by documentation of typical ST elevation during anginal attack and also by showing coronary arterial spasm (#2 and #12) during hyperventilation on coronary arteriography. Large quantities of calcium blocking agents and nitrates could not improve his symptoms. Lack of intracellular magnesium was suspected from a daily excretion of urine magnesium (5.3 mEq) and magnesium tolerance test (56.7%). After hourly infusion of magnesium sulfate (80 mEq), coronary spasm could not be induced by ergonovine.
Clinical characteristics affecting success or failure of PTCA in patients with multiple vessel disease and poor candidates for surgery
Authors: Colle J. ‐P. , Delarche N. , Chague F. , Casteight F. , Choussat A. , Besse P. 
Published: February 2009

AbstractA special form of complex coronary angioplasty is represented by the extension of indications for percutaneous transluminal coronary angioplasty (PTCA) to patients with multivessel disease (MVD) for whom surgery is not indicated, and thus for whom surgical standby is not available. Over a two‐year period, 254 consecutive coronary patients with multivessel disease underwent PTCA under such conditions. These patients could not benefit from surgery for various reasons. Of the 612 arteries involved, 155 were occluded, 47 had been previously bypassed. A distal nonbypassable lesion in one of the three major arteries was found in 244 patients, 61 had suffered from a previous infarct, 24 demonstrated an ejection fraction below 0.40, and in 19 a single patent vessel was found. Fifteen patients were in cardiogenic shock and 69 procedures were undertaken for unstable angina. Of this latter group, 25 emergency PTCA were attempted for refractory unstable angina, and 44 additional emergency procedures were directed to the treatment of acute infarct. A total of 40 intra‐aortic counterpulsations were needed. As far as possible the procedure aimed at full revascularization. Immediate outcome is strongly affected by the clinical context, and despite a rather constant initial success rate (88–95%), the procedural mortality (directly related or not) can change dramatically with clinical factors. Respective definitive success and mortality rates are: 93% and 0% when a complete revascularization is attempted, 89% and 0% in double‐vessel disease with stable angina, 80% and 2.8% with stable triple‐vessel disease, 85% and 3.2% in the overall elective procedures, 77% and 19% in emergency cases, 60% and 40% in cadiogenic shock, and 47% and 47% in cases of single patent vessel. In such nonsurgical MVD patients, some situations entail very high risks and clinical characteristics are powerful predictive factors. These clinical factors must be taken into account, isolated and associated, and included when weighing carefully the risks before any decision to treat.
Differentiation between left circumflex and right coronary artery occlusions: Studies on ST‐segment deviation during percutaneous transluminal coronary angioplasty
Authors: Hiasa Y. , Morimoto S. , Wada T. , Hamai K. , Nakaya Y. , Mori H. 
Published: February 2009

AbstractTo distinguish between acute occlusion of the right coronary artery (RCA) and the left circumflex artery (LCx) by electrocardiography, we studied ST‐segment deviation during balloon inflation in percutaneous transluminal angioplasty. The composite electrocardiographic criteria based on ST‐segment deviations increased the diagnostic specificity: that is, the finding of inferior infarction (ST‐segment elevation in leads II, III, aVF) without lateral infarction (ST‐segment elevation in leads V5, 6) was highly suggestive of RCA occlusion (sensitivity and specificity: 35 of 43 cases, 81.4%; and 33 of 36cases, 91.7%), whereas ST‐segment elevation in leads V5,6 (LCx: 23 of 36 cases; 63.9%, RCA: 5 of 43 cases; 11.6%) or isolated ST‐segment depression in leads V2‐4 (LCx: 9 of 36 cases; 25.0%, RCA: none of 43 cases) was highly suggestive of LCx occlusion. These results indicated that the composite electrocardiographic criteria were useful in predicting the artery involved in acute myocardial infarction, although any single criterion was not sensitive or specific enough to differentiate right from left circumflex coronary artery occlusion.
Apical hypertrophic cardiomyopathy presenting with sustained monomorphic ventricular tachycardia and electrocardiographic changes simulating coronary artery disease and left ventricular aneurysm
Authors: Wilson P. , Marks A. , Rastegar H. , Manous A. S. , Mark Estes N. A. 
Published: February 2009

AbstractA 52‐year‐old male presented with sustained monomorphic ventricular tachycardia as the initial manifestation of apical hypertrophic cardiomyopathy. The electrocardiogram during normal sinus rhythm showed a pattern of an old anterior wall myocardial infarction with aneurysm formation. Cardiac catheterization documented angiographically normal coronary arteries. Apical hypertrophic cardiomyopathy was documented at cardiac catheterization and by echocardiogram and Doppler studies. Monomorphic ventricular tachycardia was reproducibly initiated and terminated during electrophysiological studies and antiarrhythmic drugs failed to control the tachycardia. At the time of implantation of a cardioverter defibrillator, left ventricular apical biopsy revealed pathologic findings characteristic of hypertrophic cardiomyopathy.