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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A technique for praecordial surface mapping of the exercise electrocardiogram is described. This showed the area, time course, and severity of ST segment depression as projected onto the front of the chest after exercise. Twenty normal volunteers and 20 patients with coronary artery disease have been studied. No changes were seen after exercise in the normal subjects but areas of ST segment depression appeared in all 20 patients with angina pectoris. In 5 of the 20 patients with coronary artery disease, the exercise test was repeated on a later date. There were no significant differences in the area of severity of electrocardiographic abnormalities recorded during the two tests. This technique may prove to be useful for diagnosis and assessing medical and surgical treatments in patients with ischaemic heart disease.
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PMID:A method for praecordial surface mapping of the exercise electrocardiogram. 73 91

In coronary artery disease the patients usually manifest both anxiety and depression disturbances. A controlled clinical study was conducted to test the efficacy of a new antidepressant agent, maprotiline, in the early stages of acute myocardial infarction. The sample consisted of 126 patients, sixty-three receiving orally 25 mg of maprotiline twice daily and the remainder 5 mg of diazepam twice daily. Treatment lasted on an average two weeks (ten days to eight weeks). The depressive and/or anxiety conditions were rated on the basis of a questionnaire administered before and after treatment. Depression improved markedly in patients receiving maprotiline, while the two drugs developed a comparable anxiolytic action. Tolerability was good. No clinical or ECG evidence of cardiotoxic signs was detected. The importance of a drug with these characteristics in the management of emotional disturbances in the early stages of coronary artery disease is emphasized.
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PMID:Antidepressant treatment with maprotiline in the management of emotional disturbances in patients with acute myocardial infarction: a controlled study. 79 78

With the use of a three-phase experimental design, the efficacy of oral nitroglycerin has been evaluated in a total of 53 patients with documented angina pectoris due to coronary artery disease. The study were a double-blind, randomized, and cross-over comparison of controlled-release nitroglycerin (2.6 mg. tablets administered three times daily) and an indistinguishable placebo. Sixteen patients recorded anginal symptoms by the diary method over a 6 month trial of randomly sequenced 1 month periods of drug or placebo. In 15 patients, ST segments were monitored with a Holter dynamic electrocardiograph for periods of 10 to 12 hours under normal life style and evaluated by matching activities during periods of drug and placebo. In 22 patients, a multistage treadmill exercise test was conducted to an endpoint of anginal pain. The three phases of the investigation were run in succession; each phase was completed before the next one was begun. Oral nitroglycerin reduced the incidence and severity of anginal attacks by 47.2 and 49.4 per cent, respectively, and decreased the number of sublingual nitroglycerin tablets used by 51.1 per cent in comparison to placebo (p less than 0.001). Eleven of 16 patients (69 per cent) decreased their need for sublingual nitroglycerin by over 50 per cent. Based on a polynomial trend analysis over a period of 8 weeks, no tolerance to the therapeutic effects of the drug was found. With DCG monitoring, drug decreased the ST segment depression from 1.76 mm. on placebo to 1.12 mm, with a significant difference of 0.64 mm. (p less than 0.001). ST segment depression was decreased more than 0.5 mm. by drug in comparison to placebo in 10 of 15 patients (66 per cent). Larger depressions of the ST segment noted with placebo at heart rates greater than 80 beats per minute were prevented by administration of the drug. During treadmill exercise, drug delayed the onset of pain by 83 seconds (64 per cent) over placebo (p less than 0.001) and decreased the duration of pain by 70 seconds (49 per cent) in comparison to placebo (p less than 0.001). Drug did not affect heart rate or systolic blood pressure at rest or after exercise, as well as rate-pressure product for production of angina following exercise (p less than 0.05). There was no side effects reported caused by the drug. The data demonstrate that oral nitroglycerin, given as controlled-release tablets, was absorbed from the gastrointestinal tract in quantities sufficient to provide statistically significant clinical improvement of angina pectoris.
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PMID:Oral nitroglycerin as a prophylactic antianginal drug: clinical, physiologic, and statistical evidence of efficacy based on a three-phase experimental design. 81 Nov 2

The sensitivity of myocardial perfusion imaging (MPI) using thallium-201 injected both at rest and during peak exercise was compared to simultaneously recorded 12 lead electrocardiography (ECG) for the detection of transient ischemia in 20 normal subjects and 63 patients with coronary artery disease (CAD). No significant perfusion defects or ECG changes were seen on either the rest or exercise studies in any of the normal subjects. Fifty-six percent of patients with CAD developed new perfusion defects with exercise compared to 38% who developed ischemic ST-segment depression (P less than 0.02). However, when chest pain and/or ST depression were considered indices of ischemia, the sensitivity of exercise testing and thallium-201 MPI was similar. The increased sensitivity of MPI compared to ST-segment depression on the ECG was due to patients with baseline ECG abnormalities and those who failed to achieve 85% of predicted maximum heart rate with exercise. Analysis of the exercise results according to the extent of coronary artery disease revealed a progressive increase in both positive ECGs and MPI with the number of vessels involved. In patients with single vessel disease the MPI was more sensitive than the ECG (P less than 0.02). The combination of the rest and exercise ECG, MPI and chest pain during exercise failed to identify 11% of patients with CAD. Exercise thallium-201 MPI is a useful adjunct to conventional exercise testing particularly when evaluating patients with abnormal resting ECGs, those who develop ventricular conduction defects of arrhythmias during exercise, and those who fail to achieve their predicted heart rate because of fatigue or breathlessness.
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PMID:Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease. 83 Feb 22

To clarify the influence of propranolol-and particularly its heart-rate effects-on myocardial ischemia, coronary hemodynamics and metabolism were studied in 15 patients utilizing a protocol to control heart rate. Ten patients had significant coronary narrowing (CAD) and 5 were normal. Systemic pressure, coronary sinus blood flow (CSBF), left ventricular oxygen utilization (LVVO2), ST Segment depression, and myocardial lactate extraction were measured before and after propranolol (10 mg IV), at rest, during pacing-induced tachycardia stress. Propranolol-related reduction in CSBF and LVVO2 at rest was reversed when heart rate was controlled in both patient groups. Propranolol failed to alter heart-rate threshold, tension-time index (TTI), CSBF, or LVVO2 at angina in the CAD patients. Likewise, ischemic-type ST depression, decreases in lactate extraction, and coronary resistance were unchanged compared to values observed during tachycardia stress before propranolol. In normal coronary patients, propranolol also produced no significant change in LVVO2 or coronary resistance when its heart rate effects were controlled. These data imply that a major coronary and metabolic influence of propranolol relates to changes occurring secondary to its influence on heart rate. Furthermore, this agent's anti-ischemic effect is not prominent during tachycardia stress suggesting that this stress test may be clinically useful in patients taking propranolol.
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PMID:Effects of propranolol on coronary hemodynamic and metabolic responses to tachycardia stress in patients with and without coronary disease. 83 33

This study presents the results of maximal treadmill testing and cardiac catheterization in 40 asymptomatic and apparently healthy men with acquired right bundle-branch block. Eight of the men had significant angiographic coronary artery disease, and six of the eight only had single-vessel disease. The 40 men had normal maximal oxygen consumptions, normal maximal heart rates, and normal maximal blood pressure responses; none of the men had abnormal ST-segment changes in response to maximal treadmill testing. Thus, the sensitivity of exercise testing for coronary artery disease in men with right bundle branch block is uncertain. However, the apparently high specificity of exercise testing demonstrated by this study necessitates further evaluation for coronary artery disease in men with right bundle branch block who develop abnormal ST-segment depression in response to exercise testing.
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PMID:The electrocardiographic response to maximal treadmill exercise of asymptomatic men with right bundle branch block. 83 47

The submaximal treadmill exercise test is a valuable noninvasive tool for the diagnosis of overt or latent coronary artery disease (CAD). When submaximal heart rates of 80% to 90% of the predicted maximal rates are attained and when ST-segment depression of at least 1 mm is taken as a criterion of ischemia, testing by any of the various exercise protocols with continuous ECG monitoring affords reasonable specificity and sensitivity. The objectives of testing are to (1) diagnose and determine the severity of CAD, (2) assess functional capacity, (3) observe the natural history of disease, (4) evaluate the effects of medical and surgical treatment, and (5) evaluate responses to physical conditioning or to programs directed toward prevention of CAD. Proper precautions and safety standards minimize the risk of exercise testing.
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PMID:Submaximal treadmill exercise testing of patients with coronary artery disease. 85 49

Myocardial imaging with intravenous thallium-201 (201Tl) was performed at rest and following maximal treadmill exercise in 101 patients with suspected coronary artery disease. Results were interpreted from Polaroid scintiphotos by three independent observers with complete interobserver agreement in 79%. Of 25 patients with no or insignificant coronary artery disease (less than 50% diameter stenosis), one (4%) had a resting 201Tl image defect, one (4%) had an exercise 201Tl defect, none had an ECG Q wave, and four (16%) had exercise ST-segment depression. Among 76 patients with coronary artery disease (greater than or equal to 50% diameter stenosis), 58 (76%) had a defect on either the rest or exercise 201Tl image. The proportion of patients with an exercise image defect (50/76, 66%) was greater than the proportion with exercise ST depression alone (34/76, 45%; P less than 0.02). Overall, 69 of the 76 (91%) patients with coronary artery disease had either a positive rest or exercise myocardial image and/or a positive rest (ECG Q waves) or exercise (ST depression) electrocardiogram. This exceeded the proportion with only rest or exercise electrocardiographic abnormalities (50/76, 65%; P less than 0.001). We conclude that rest and exercise myocardial imaging with 201Tl is easily accomplished with readily available imaging equipment. The image data enhanced the diagnostic sensitivity of stress electrocardiography, and provided spatial identification of the abnormal segment(s) of myocardium.
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PMID:Myocardial imaging with thallium-201 at rest and during exercise. Comparison with coronary arteriography and resting and stress electrocardiography. 86 73

Stress testing is by no means perfect as far diagnosing coronary artery disease, but at this time it is the single best noninvasive method for establishing the presence of ischemic heart disease. From the data shown here, one can see that it adds some important prognostic features as well. The American Heart Association has published a "Coronary Risk Handbook" which can be used to predict the likelihood of a future coronary event by means of accepted risk factors such as hypertension, cholesterol level, and smoking. If we include a positive stress test as a risk factor and compare it to the others, it is clear that a positive stress test has a much higher correlation with future coronary events than any of the other risk factors alone or in combination (Figure 12). Physicians should pay close attention to all of the mentioned factors while carrying out a stress test rather than just looking for ST depression alone. The occurrence of anginal pain, the time of onset, the degree of ST depression, and the patient's pulse and blood pressure response are all useful in assessing the degree of coronary involvement and in predicting an individual's chances of suffering some form of coronary event.
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PMID:Stress testing in the prognosis and management of ischemic heart disease. 86 78

To access left ventricular function and compare pulmonary capillary wedge pressure and left ventricular end-diastolic pressure in the supine and sitting positions, 20 men with angina pectoris secondary to coronary artery disease underwent hemodynamic studies at rest and during exercise in the two positions. At rest the values for cardiac index, stroke index, systolic ejection rate index and left ventricular stroke work index were lower in the sitting position; heart rate, left ventricular end-diastolic pressure and pulmonary capillary wedge pressure were similar in the two positions. All patients experienced angina during both exercise periods. At angina during supine exercise, stroke index, systolic ejection rate index and left ventricular stroke work index did not increase significantly from the resting values. In contrast, during sitting exercise, significant increases in these variables were observed. Comparison of data during exercise revealed higher values for heart rate, mean systemic pressure, cardiac index, systolic ejection rate index, left ventricular stroke work index and rate-pressure product and lower values for mean pulmonary capillary wedge pressure (20 +/- 3 versus 27 +/- 3 [mean +/- standard error of the mean] mm Hg, P is less than 0.001), and left ventricular end-diastolic pressure (24+/- 3 versus 31 +/- 3 mm Hg, P is less than 0.02) in the sitting position; stroke index and S-T segment depression were similar during the two exercise periods. Four patients had insignificant increases in left ventricular filling pressure during both exercise periods. Of the 16 patients with abnormal left ventricular filling pressure during supine exercise, only 10 had a similar response during exercise in the sitting position. There was a good correlation between left ventricular end-diastolic pressure and mean pulmonary capillary wedge pressure at rest and during exercise in the two postures.
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PMID:Hemodynamics at rest and during supine and sitting bicycle exercise in patients with coronary artery disease. 87 Nov 6


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