bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute myocardial infarction with simultaneous occlusions of two major coronary arteries in a young man
Authors: Yoshitomi Yuji , Kuramochi Morio , Kojima Shunichi 
Published: February 2009

AbstractSimultaneous formation of the thrombi in two different coronary arteries is a very rare event. We present a 34‐year‐old man with acute myocardial infarction due to simultaneous occlusion of the two major coronary arteries. His only risk factor was smoking 40 cigarettes daily. Emergency arteriography revealed a total occlusion of the proximal left anterior descending artery (LAD) and the left circumflex coronary artery (LCx). We performed primary angioplasty to the LAD and instituted thrombolytic therapy to the LCx. During intra‐aortic balloon pumping and medical treatment, the patient had no symptoms of angina. He underwent a second catheterization 4 weeks after primary angioplasty. After intravenous ergonovine provocation, coronary arteriography revealed diffuse vasospasm of the LAD and the LCx. These data suggest that habitual heavy smoking and coronary spasm may have been causatory factors for myocardial infarction in this case.
Pathophysiologic bases for adjunctive therapies in the treatment and secondary prevention of acute myocardial infarction
Authors: Gutstein David E. , Fuster Valentin 
Published: February 2009

AbstractPostmyocardial infarction (MI) survival has been steadily improving. This improvement has been due, in part, to the actions of the adjunctive medical therapies for the treatment of MI. Aspirin, beta blockers, angiotensin‐converting enzyme (ACE) inhibitors, and lipid‐lowering agents have been shown to improve survival in the treatment and secondary prevention of MI. Nitrates have beneficial effects as well. These medications complement the reperfusion strategies through different mechanisms. Other adjunctive medical therapies, namely magnesium, antiarrhythmic agents, and calcium‐channel blockers, have not been shown to improve mortality with routine post‐MI use despite their theoretical benefits.
Differences between male and female patients with regard to baseline demographics and clinical outcomes in the asymptomatic cardiac ischemia pilot (acip) trial
Authors: Frishman William H. , Catanese James , Furia‐Palazzo Suzanne , Mueller Hiltrud , Gomberg‐Maitland Mardi , Hirsch Herbert , Steingart Richard , Forman Sandra ,   For the Asymptomatic Cardiac Ischemia Pilot (ACIP) Investigators
Published: February 2009

AbstractBackground: Coronary artery disease (CAD) is a common problem in men and women; however, men and women with similar clinical presentations of myocardial ischemia may receive different revascularization treatments.Hypothesis: Using the data base of the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial, this study was undertaken to compare by gender the baseline demographic data and the clinical outcome results in patients randomized to various treatments in the ACIP study.Methods: This randomized trial compared three treatment regimens [pharmacologic management of angina, pharmacologic management of angina and ambulatory electrocardiographic (ECG) evidence of ischemia, and revascularization—that is, angioplasty and coronary artery bypass surgery], in patients with known CAD, positive stress ECG tests, and ECG evidence of ischemia during 48 h ambulatory monitoring. In all, 558 patients were randomized, 79 of whom were women (mean age:men 61.6 years, women 60.6 years). Ambulatory ECG evidence of ischemia, clinical events, that is, death, myocardial infarction, hospital admission for coronary events, and exercise performance were monitored.Results: Although of the same age as men at baseline, women had a higher prevalence of hypertension and diabetes. Women had less severe CAD by angiography and higher left ventricular ejection fractions. Men had longer exercise tolerance times on the treadmill. However, men and women had similar numbers and duration of ambulatory ECG ischemic abnormalities. Regarding revascularization, men more commonly underwent coronary artery bypass surgery (p = 0.025) while women underwent percutaneous transluminal coronary angioplasty more frequently (p = 0.10). Clinical outcomes were comparable in men and women, although the numbers of events were relatively small.Conclusion: Men and women of comparable age manifest CAD with similar ischemic ECG abnormalities seen on both exercise tolerance and ambulatory ECG examinations. In ACIP, women tended to have more risk factors for CAD and less severity in anatomical disease, which may explain why women are less likely than men to have coronary bypass surgery.
The clinical implications (or lack thereof) of vegetations detected by echocardiography in patients not thought to have endocarditis
Authors: Ali Abbas S. , Rosman Howard , Alam Mohsin , Singireddy Sukhendar , Craven Betty , Lesch Michael 
Published: February 2009

AbstractBackground: The clinical impact of echocardiographic demonstration of a vegetation (Veg) in patients in whom infective endocarditis (IE) is not suspected has not previously been analyzed.Hypothesis: In this study, an echocardiographic database was interrogated to test whether discovery of a vegetation by echocardiography should result in treatment for endocarditis if IE is not suspected.Methods: In all, 2,750 serial transthoracic echocardiograms (TTE) were reviewed to generate a list of reports containing the word Veg or thickening (Thk). A chart review of cases identified the impact the report had on patient management. To analyze reader bias due to echocardiographic requests, stating “rule out Veg or IE” as the reason for the study, an additional 1,000 serial TTE requests were segregated into two groups with and without this term. The incidence of the terms Veg or Thk in TTE reports of these groups was tabulated.Results: Of 2,750 reports, 20 contained the word Veg. Blood cultures were drawn in 16 of 20, with 7 of 16 being positive. Therapy for IE was initiated in 5 of 7 patients with positive cultures. Of 1,000 requests reviewed in the second phase, 24% of those with rule out Veg as the indication for TTE (n = 29) had Veg and 7% had Thk, while in 971 cases with other indications for TTE 0.2% had Veg and 9.3% had Thk.Conclusions: Clinicians disregard TTE demonstration of Veg if clinical suspicion for IE is low. It is not clear whether the initial echo request biases the interpretation.
QT‐interval dispersion in malnourished children
Authors: Fuenmayor Abdel J. , Fuenmayor Abdel M. , Mora Rosa E. , Fuenmayor Akbar C. 
Published: February 2009

AbstractBackground: Little is known about the electrocardiographic (ECG) QT interval and its variability in malnourished children.Hypothesis: The study of the QT interval and its dispersion in malnourished children was undertaken to determine whether the QT interval and its variability are increased in these children.Methods: In 40 children (20 malnourished and 20 controls) aged 12.2 ± 14.4 months (23 male) a conventional ECG was performed for computing heart rate, heart rate variability, corrected QT interval, and QT‐interval dispersion. A blood sample was obtained for measuring hemoblogin, hematocrit, plasma protein, and plasma electrolytic concentrations.Results: Corrected heart rate, heart rate variability, and QT interval were similar in both groups. When compared with the control group, the malnourished children had greater corrected QT‐interval dispersion, and that dispersion was more accentuated in the precordial leads. They also had repolarization abnormalities (flattened or inverted T waves and U waves). Hemoglobin, hematocrit, plasma protein, and plasma electrolytic concentrations were lower in the malnourished children. However, the ECG findings showed no statistically significant relationship with either the blood parameters, the severity or type of malnutrition, and the size or the weight of the children.Conclusions: QT‐interval dispersion is increased in malnourished children and the dispersion is more accentuated in the precordial leads.
Prinzmetal's variant angina
Authors: Mayer Susan , Hillis L. David 
Published: February 2009

AbstractAlthough the prevalence of variant angina pectoris is unknown, it appears to be substantially less common than typical, exertional angina and unstable angina at rest. The patient with variant angina typically complains of a pressure‐like, squeezing retrosternal chest discomfort of several minutes duration. The diagnosis is secured by the occurrence of transient ST‐segment elevation in association with chest pain, both of which resolve spontaneously or with nitroglycerin. After the diagnosis is made, the patient usually becomes symptom‐free on calcium‐channel blockers with or without long‐acting nitrates. Although the long‐term survival of these patients is excellent, an occasional individual with variant angina sustains a complication, most often myocardial infarction, a life‐threatening arrhythmia, or sudden cardiac death.
Comparison of transesophageal doppler coronary flow reserve measurements with thallium‐201 single‐photon emission computed tomography imaging in assessment of left anterior descending artery stenoses
Authors: Zehetgruber Manfred , Mörtl Deddo , Porenta Gerold , Mundigler Gerald , Christ Günter , Lengauer Roland , Stix Günter , Probst Peter , Maurer Gerald , Sochor Heinz , Siostrzonek Peter 
Published: February 2009

AbstractBackground and hypothesis: Recent studies demonstrate the feasibility of coronary flow reserve measurements by transesophageal echocardiographic (TEE) Doppler recordings of coronary sinus or left anterior descending (LAD) coronary artery flow velocity for detecting stenoses of the LAD artery. This study compares coronary flow reserve measurements by Doppler TEE with thallium‐201 (201T1) single‐photon emission computed tomography (SPECT) in patients with proximal single‐vessel LAD stenosis.Methods: Nineteen patients with various degrees of LAD stenosis (mean area stenosis 71 ± 24%; range 24‐96%) were studied. Area stenosis by quantitative coronary angiography was < 75% in 7 patients and > 75% in 12 patients. Transesophageal LAD and coronary sinus Doppler measurements were performed at baseline and after intravenous dipyridamole. Coronary flow reserve was calculated as the ratio of hyperemic to baseline average peak velocities. Predefined coronary flow reserve cut‐off values of 1.8 for the coronary sinus method and of 2.0 for the LAD method were used for diagnosis of significant LAD stenosis. Results were compared with qualitative 201T1 dipyridamole SPECT.Results: Overall predictive accuracy for diagnosis of > 75% LAD stenosis was 79% for 201T1 SPECT, 77% for the transesophageal LAD and 79% for the transesophageal coronary sinus technique. Concordant results between 201T1 SPECT and the LAD and coronary sinus Doppler methods were observed in 79% and 71% of patients, respectively.Conclusions: Thallium‐201 SPECT and transesophageal Doppler assessment of coronary flow reserve have similar accuracy for diagnosing significant proximal LAD stenosis. Therefore, both transesophageal Doppler techniques might constitute another widely available, noninvasive method for assessment of left coronary artery disease, if disease location is proximal.
Prognostic value of predischarge radionuclide ventriculography at rest and exercise after acute myocardial infarction treated with thrombolytic therapy or primary coronary angioplasty
Authors: Gosselink A. T. Marcel , Liem Ay Lee , Zulstra Felix , Reiffers Stoffer 
Published: February 2009

AbstractBackground: Previous studies have demonstrated the prognostic value of radionuclide ventriculography at rest and exercise in patients post myocardial infarction (MI). The number of studies in patients treated with modern reperfusion techniques, including thrombolysis or primary angioplasty, however, is limited.Hypothesis: The aim of this study was to evaluate the prognostic significance of predischarge radionuclide ventriculography at rest and exercise in patients with acute MI treated with thrombolysis or primary angioplasty.Methods: A total of 272 consecutive patients with acute MI who were randomized to thrombolysis or primary coronary angioplasty underwent predischarge resting and exercise radionuclide ventriculography. Left ventricular ejection fraction at rest, decrease in ejection fraction during exercise >5 units below the resting value, angina pectoris, ST‐segment depression, and exercise test ineligibility were related to subsequent cardiac events (cardiac death, nonfatal reinfarction) during follow‐up.Results: During a mean follow‐up of 30 ± 10 months, cardiac death occurred in 11 (4%) patients and nonfatal reinfarction in 14 (5%) patients. Resting left ventricular ejection fraction was the major risk factor for cardiac death. In patients with an ejection fraction <40%, cardiac death occurred in 16% compared with 2% in those with an ejection fraction ≥ 40% (p = 0.0004). In addition, cardiac death tended to be higher in patients ineligible than in those eligible for exercise testing (11 vs. 3%, p = 0.08). None of the other exercise variables (decrease in ejection fraction during exercise >5 units below the resting value, angina pectoris or ST‐segment depression) were predictive for cardiac death. When all exercise test variables in each patient were combined and expressed as a risk score, a low risk (n = 185) and a higher risk (n = 87) group of patients could be identified, with cardiac death occurring in 1 and 10%, respectively. As the predictive accuracy of a negative test was high, radionuclide ventriculography was of particular value in identifying patients at low risk for cardiac death. Radionuclide ventriculography was not able to predict recurrent nonfatal MI.Conclusion: In patients with MI treated with thrombolysis or primary angioplasty, radionuclide ventriculography may be helpful in identifying patients at low risk for subsequent cardiac death. In this respect, left ventricular ejection fraction at rest was the major determinant. Variables reflecting residual myocardial ischemia were of limited prognostic value. Identification of a large number of patients at low risk allows selective use of medical resources during follow‐up in this subgroup and has significant implications for the cost effectiveness of reperfusion therapies.
Long‐term outcome of spinal cord electrical stimulation in patients with refractory chest pain
Authors: Bagger Jens Peder , Jensen Bent Skov , Johannsen Gunnar 
Published: February 2009

AbstractBackground and hypothesis: Treatment of patients with refractory chest pain remains a challenge. In this study, the long‐term clinical effects of spinal cord electrical stimulation were evaluated in 10 consecutive male patients (mean age 53.7 years) with chronic chest pain in a prospective observational study.Methods: After placement of the electrode in an epidural position and before implantation of the device, patients were subjected to clinical evaluation, including atrial pacing, in order to document significant antianginal effects.Results: Spinal cord electrical stimulation abolished or improved pacing time to angina by more than 50% in seven of the patients who subsequently had the device implanted. In three of these patients, the system was ineffective after a period of 3‐9 months despite paresthesia in the area of anginal pain with electrical stimulation. The effects of treatment remained satisfactory in the remaining patients (40%) after a mean follow‐up of 60 (45‐72) months. Thus, a long‐lasting clinical response was able to be predicted in 57% of the patients.Conclusion: Spinal cord electrical stimulation is one of the few therapeutic options in inoperable patients with refractory chest pain.
Severe transmural myocardial ischemia after dipyridamole administration implicating coronary steal
Authors: Hansen Christopher L. , Williams Eric 
Published: February 2009

AbstractMyocardial perfusion imaging with coronary vasodilators is routinely used for patients with suspected coronary disease who are unable to exercise. Since these agents work by increasing blood flow without significantly changing myocardial oxygen demand, they generally do not produce ischemia. A minority of patients show evidence of ischemia which some investigators suggest is due to a coronary steal phenomenon, but this has been challenged by several investigators. We present the case of a patient who developed severe transmural myocardial ischemia manifested by ST‐segment elevation and severe perfusion defects which occurred after dipyridamole administration and which were reversed with aminophylline and nitroglycerin. This case supports the notion that coronary vasodilation with dipyridamole can induce a coronary steal.
Cerebral infarction in a patient with congenital complete heart block
Authors: Hayabuchi Yasunobu , Matsuoka Suguru , Nii Masaki , Suzuya Hiroko , Kuroda Yasuhiro 
Published: February 2009

AbstractStokes‐Adams attacks are fairly common in children with congenital complete heart block, but the occurrence of cerebral infarction is quite unusual. We present the case of a 13‐year‐old boy with congenital heart block and an embolic stroke involving the cerebral artery. Echocardiography revealed no valvular regurgitation, hypokinetic segments, mural thrombus, or myxoma. Electrocardiographic monitoring demonstrated good response of ventricular rate to exercise and no episodes of atrial or ventricular dysrhythmia. It is assumed that embolism occurred due to bradycardia.
Ticlopidine‐induced neutropenia mimicking sepsis early after intracoronary stent placement
Authors: Ochoa Anthony B. , Wolfe Mark , Lewis Peter , Lenihan Daniel J. 
Published: February 2009

AbstractWe report a case of ticlopidine‐induced profound neutropenia early in the course of therapy, which was manifest as a febrile systemic illness mimicking sepsis. This clinical presentation was potentially indicative of a contaminated intracoronary stent. The patient's signs and symptoms of illness promptly resolved with removal of ticlopidine, and no infection was documented. Review of indications for ticlopidine use, potential adverse effects, and monitoring recommendations are discussed.
Significance of prominent atrial‐wave and diastasis deflection in radionuclide diastolic volume curve during exercise in detection of coronary artery disease
Authors: Klainman E. , Lebzelter J. , Weisenberg D. , Fink G. 
Published: February 2009

AbstractBackground: Exercise testing with multigated acquisition technetium radionuclide cineangiography (MUGA) is a useful modality that can discriminate systolic and diastolic performance in patients with ischemic heart disease. However, some patients may have abnormal left ventricular filling dynamics with normal regional and global systolic function.Hypothesis: The purpose of the study was to assess exercise‐induced diastolic dysfunction as expressed by a prominent atrial (A) wave or diastasis deflection at the left ventricular volume curve, in patients with different degrees of ischemic heart disease.Methods: In all, 32 men and 7 women aged 35‐70 years (mean 54 ± 8.6 years) underwent MUGA at rest and during exercise for analysis of the radionuclide volume curve. Within 6 weeks, thallium‐201 scintigraphy and coronary angiography were performed and the patients were categorized into three groups: (1) disease‐free (n = 10), (2) single‐vessel disease (> 50% stenosis) (n = 19), and (3) double‐vessel disease or more (n = 10). A waves or diastasis deflections were compared among the groups.Results: Significant differences (p<0.01) were noted in A‐wave deflection relative to peak diastolic volume curve during exercise (Aexe/T) between Group 1 and Groups 2 and 3. Group 1 manifested only a mild rise in A‐wave deflection from rest (20.20 ± 8.49%) to exercise (25.85 ± 8.49%), whereas Groups 2 and 3 exhibited a significant increase from 25.89 ± 9.55% and 28.40 ± 12.6%, respectively, to 60.21 ± 22.5% and 63.0 ± 22.86%, respectively. Group 2 had a significantly (p<0.05) higher maximal heart rate than Group 3.Conclusions: The addition of prominent A‐wave or diastasis deflection to a normal systolic response during exercise testing with multigated radionuclide cineangiography might be a sensitive marker of coronary artery disease. The A wave represents diastolic dysfunction of the left ventricle, considered an early event in the ischemic cascade.
Sensitivity and long‐term prognostic value of cardiac troponin‐i increase shortly after percutaneous transluminal coronary angioplasty
Authors: Attali P. , Aleil B. , Depoli F. , Mossard J. M. , Wiesel M. L. , Petitpas G. , Wuillermin A. , Cazenave J. P. 
Published: February 2009

AbstractBackground: After successful coronary interventions, minor elevations of creatine kinase MB (CK‐MB) identified a population with a worse long‐term prognosis than that in patients without enzyme elevations. In that setting, cardiac troponin‐I (cTn‐I), a highly specific marker for myocardial injury, was considered for a small study; the results did not support the view that significant myocardial damage occurred during successful percutaneous transluminal coronary angioplasty (PTCA).Hypothesis: The present study was designed to assess the rate of elevated values of cTn‐I after successful PTCA and to determine its prognostic value.Methods: CTn‐I and CK‐MB were measured in 44 patients before and daily for 3 days after PTCA. Two groups of patients were considered according to the presence or absence of elevated levels of cTn‐I. The rate of free‐event survival was estimated for the two groups using the Kaplan‐Meier method and was compared with the log rank test.Results: Globally, 36% of patients had an increase in cTn‐I (normal values 0.35 ng/ml) and 9% had an increase in CK‐MB, p = 0.002. The mean time to maximal enzyme level was 1.8 days for cTn‐I and 2.2 days for CK‐MB. Over a follow‐up of 1375 ± 416 days, 18% of patients experienced adverse events, and cTn‐I did not identify a population of worse longterm prognosis.Conclusion: These results suggest that cTn‐I is more sensitive than CK‐MB in identifying minor myocardial damage after PTCA, but these elevated concentrations of cTn‐I in the short‐term aftermath of angioplasty do not seem to be a marker of worse long‐term prognosis.
Acute anterior wall myocardial infarction entailing st‐segment elevation in lead v1: Electrocardiographic and angiographic correlations
Authors: Bengal Tuvia , Herz Itzhak , Solodky Alejandro , Birnbaum Yochai , Sclarovsky Samuel , Sagie Alex 
Published: February 2009

AbstractBackground: The correlation between ST elevation in lead V1 during anterior wall acute myocardial infaction (AMI) and the culprit lesion site in the left anterior descending (LAD) coronary artery is poor.Hypothesis: The study was undertaken to assess the electrocardiographic (ECG) characteristics and angiographic significance of ST‐segment elevation in lead V1 during anterior wall acute myocardial infarction (AMI).Methods: Data from 115 patients with anterior wall AMI, who underwent coronary angiography within 14 days of hospitalization, were studied. The admission 12‐lead ECG was examined and the coronary angiogram was evaluated for the nature of the conal branch of the right coronary artery (RCA) and for the culprit lesion site in the left anterior descending (LAD) coronary artery.Results: Mean ST‐segment deviation and the frequency of patients with ST‐segment elevation > 0.1 mV were significantly lower in lead V i than in lead V2 (0.136 $$ 0.111 mV vs. 0.421 $$ 0.260 mV, and 37 vs. 96%, for leads Vi and Vi, respectively). A small conal branch not reaching the interventricular septum (IVS) was more prevalent among patients with ST‐segnicni elevation >0.1 mV in lead Vi (67%), whereas a large conal branch was more prevalent in patients with ST‐segment deviation (1 mV in that lead (83%, p<0.001). No relation was found between ST‐segment deviation in lead V i during anterior wall AMI and the culprit lesion site in the LAD.Conclusion: ST‐segment elevation in lead V1 during first anterior wall AMI was found in one third of the patients, and its magnitude was lower than that in the other precordial leads. ST‐segment elevation in lead V1 favors the presence of a small conal branch of the RCA that does not reach the IVS.