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

Sixty-five patients, convalescent from a first myocardial infarction (anterior in 24 cases; inferior in 41 cases), underwent an effort electrocardiogram on a treadmill and coronary arteriography. In the anterior infarcts, coronary arteriography showed single vessel disease (anterior descending artery) in 54% of cases and double or triple vessel disease in the others. The effort test was positive in only 25% of patients with an anterior infarct. The presence of stenotic lesions of the circumflex artery and/or right coronary artery was unsuspected in 63% of patients. In the inferior infarcts, there was a significant stenosis of the anterior descending artery in 51% of the cases. The effort test was positive in 54% of patients and in 77% of those the anterior descending artery showed a significant stenosis. The appearance (or increase) of ST elevation greater than or equal to 1 mm in the leads facing the infarcted zone was an indication of more severe deterioration in left ventricular function as shown by a more marked reduction in ejection fraction and a more extensive akinetic region. The co-existence of ST elevation in the leads facing the infarcted zone and of ST depression greater than or equal to 1 mm in the reciprocal leads always indicated that another major vessel was involved, but this was only found in 25% of cases in this series.
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PMID:[Effort electrocardiography and coronary arteriography following a 1st myocardial infarction. Critical study of the effort test]. 10 91

Left ventricular (LV) myocardial function and the influence on LV pump performance of associated coronary arterial disease, of outflow obstruction and its consequences, and of altered ventricular pressure-volume characteristics were examined in a representative group of 28 adult patients with symptomatic severe aortic stenosis (valvular orifice area less than 0.50 sq cm/sq m). Eighteen patients (64%) exhibited depressed LV pump performance with levels of ejection fraction less than 0.50. In seven patients, coronary arterial disease documented by either arteriographic studies or postmortem analyses was associated with a segmental (i.e., nonhomogeneous) LV contractile disorder consistent with previous myocardial infarction. In the remaining 11 patients a homogeneous LV contractile disorder was the result of chronic outflow obstruction and its consequences. The possibility that reduced ventricular performance might be accounted for by increased afterload could not be supported by significant correlation between LV contractile characteristics (estimated from the ejection fraction and the mean circumferential fiber shortening rate) and indices of afterload (including LV systolic pressure, aortic valvular orifice area, and mean systolic wall tension). This observation suggested that myocardial hypertrophy and other consequences of longstanding obstruction to outflow played a primary role in depression of LV performance in these patients. Left ventricular end-diastolic volume was abnormal in all but three patients with depressed LV function; this increase was accompanied by a disproportionately greater increment in end-diastolic pressure, suggesting that reduced distensibility limited the ability of the ventricle to compensate for reduced contractile performance by means of the Starling mechanism.
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PMID:Determinants of cardiac performance in severe aortic stenosis. 12 19

In two patients with primary Type V hyperlipoproteinemia with typical clinical features including recurrent bouts of abdominal pain a myocardial infarction was diagnosed. In both cases coronary angiography revealed a severe three vessel disease. The case reports demonstrate that the incidence of ischemic heart disease in patients with Type V hyperlipoproteinemia is higher than reported in the literature. In each case of severe abdominal pain, even in younger Type V patients, a myocardial infarction has to be excluded, In both patients a selective depression in the activity of lipoprotein lipase was found. The possible pathogenetic implication of this finding will be discussed.
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PMID:[Coronary heart disease in patients with primary type V hyperlipoproteinemia (author's transl)]. 20 63

The use of antiarrhythmie drugs in combination has been limited because of possible side effects secondary to myocardial depression in the acute myocardial infarction patient. Therefore, we investigated in intact dogs (group I) the hemodynamic interaction of propranolol plus procainamide (subgroup A) or quinidine (subgroup B) and in dogs after experimental myocardial infarction produced by coronary artery ligation (group II). Infusion of procainamide (30 mg/kg over 5 min) in animals of group IA produced a significant (P less than 0.05) decrease of 30% in mean aortic pressure, a decrease of 40% in left ventricular dp/dt and 29% in cardiac output. When procainamide was reinfuse after propranolol (1 mg/kg), its hemodynamic effects were not significantly different from those observed before propranolol in both groups IA and IIA. Infusion of quinidine (10 mg/kg over 5 min) in animals of group IB (intact dogs) also produced significant decreases of 24% in mean aortic pressure and 38% in dp/dt while cardiac output was unchanged. However, these hemodynamic changes were seen only after beta-blockade and were significantly different from those obtained before propranolol, where heart rate increased by 14%, dp/dt by 30%, and cardiac output by 35%. These changes occurred despite a similar reduction in mean aortic pressure. This drug combination produced similar response in animals after coronary artery ligation (group IIB). In conclusion, we feel that the administration of propranolol does not prevent the depressive circulatory effects of procainamide. The combined use of quinidine and propranolol also has a negative circulatory effect although not as marked as the effects observed after procainamide with propranolol.
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PMID:Hemodynamic effects of procainamide and quinidine and the influence of beta-blockade before and after experimental myocardial infarction. 24 Oct 83

It is recommended that patients with acute myocardial infarction be able to perform activities of daily living at approximately 3 METs at the time of hospital discharge. Implementation of this recommendation requires that the hemodynamic responses at the 3 METs level be assessed prior to discharge. Symptoms, blood pressures, heart rates, and electrocardiographic responses of 41 AMI patients (eight women and 33 men, mean age, 60 years) during a low-level treadmill test were studied 11 days after acute myocardial infarction. Twenty-nine of 41 patients (71 per cent) completed the test. Fatigue was the most common reason for stopping the test early. Between rest and maximum exercise there were increases of 13 per cent in systolic blood pressure, 25 per cent in heart rate, and 40 per cent in pressure-rate product. The resting systolic blood pressures, heart rates, and pressure-rate products were significantly higher (p less than or equal to 0.05) in the patients who were unable to finish the test. ST-segment elevation or depression larger than or equal to 1 mm. was seen in 14 patients. This low-level treadmill test was safe under well supervised conditions; it provided objective information about the patient's readiness for discharge. This type of information can be used for patient teaching and discharge planning.
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PMID:Low-level treadmill testing of 41 patients with acute myocardial infarction prior to discharge from the hospital. 24 26

Two questionnaires totalling 370 questions were used to compare 61 male patients who had survived a first myocardial infarction with a group controlled for age and social status who had not had an infarction. The questionnaires included the Edwards Personal Preference Schedule, providing a measure of 15 personality variables, the Anxiety and Depression Sub-Scales of the MMPI, and the Cochrane and Robertson Life Events Inventory, as well as originally-designed questions based on known risk factors. Significant differences were found in several dimensions of personality as well as in the family histories of myocardial infarction and in certain life styles. The patient group showed a greater sense of independence, greater difficulty in relaxing, and a sence of personal inferiority. Suggestions are offered for the modification of life styles in susceptible individuals as a possible aid to prevention.
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PMID:Psychosocial factors and myocardial infarction. 26 28

Forty-six men under age 70, without clinical congestive heart failure or unstable angina pectoris, performed treadmill tests 3, 5, 7, 9 and 11 weeks after myocardial infarction. Patients were more frequently able to perform moderate exertion (2 mph, 14% grade) at 7 and 11 weeks than at 3 weeks following infarction. Ischemic ST-segment depression, usually unaccompained by angina pectoris, occurred in 45% of patients and was associated with a significantly increased incidence of subsequent coronary events. The presence of exercise-induced ventricular ectopic activity provided little independent prognostic information. No serious complications occurred in 210 tests. Exercise testing soon after myocardial infarction provides objective information concerning the capacity to resume physical activity, including return to work. Two tests, at 3-5 weeks and at 7-11 weeks, appear to provide most of the information contined in five tests performed during this time.
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PMID:Exercise testing soon after myocardial infarction. 30 Oct 68

Because of previous reports of the beneficial effect of vitamin E in angina pectoris patients, 48 patients, with both stable angina and positive (chest pain plus ishemic ST depression) maximal exercise treadmill tests, participated in a double-blind cross-over study of 6 months of vitamin E and 6 months of placebo therapy, separated by a 2 month no treatment period. All 48 patients had positive selective coronary arteriograms (75 per cent obstruction of at least a major coronary artery) and/or Q wave ECG evidence of previous myocardial infarction (Minnesota criteria). Evaluation of drug effectiveness was based on performance of serial maximal exercise treadmill tests, serial systolic time interval measurements, and daily angina diaries. No statistically significant differences between the two treatment studied. It is concluded that a large dose of vitamin E (1,600 I.U. of d-alpha-tocopherol succinate daily) for 6 months in patients with stable angina pectoris fails to increase the exercise capacity, improve left ventricular function, or reduce the frequency of chest pain.
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PMID:Quantitative evaluation of vitamin E in the treatment of angina pectoris. 32 Aug 56

The National Exercise and Heart Disease Project (NEHDP) was funded by the Rehabilitation Services Administration (RSA) of the Department of Health, Education and Welfare, to determine the effects of regular physical activity on the rehabilitation, morbidity and mortality of patients with healed myocardial infarctions. Planning and development lasted from June 1972 through September 1974. Since 1974, 932 subjects were referred for evaluation. At randomization, 651 subjects were assigned to exercise treatment (323) or control (328) groups. Those who qualified for randomization had to complete an initial evaluation, attend 14 of 18 consecutively scheduled, low-level physical activity sessions during a period of 6 weeks, and complete a second evaluation. This prerandomization phase was accompanied by significant alterations in work capacity, heart rate levels at rest and during three levels of physical stress, systolic blood pressure reductions during stress but not at rest, and by changes in the level of anxiety and depression. The subjects will be followed for a minimum of 2 years at regular intervals to determine if regularly performed physical activity is beneficial to the rehabilitation of myocardial infarction survivors.
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PMID:The National Exercise and Heart Disease Project. The pre-randomization exercise program. Report number 2. 35 40

Mianserin is a tetracyclic compound advocated for the treatment of depressive illness and depression associated with anxiety. It combines antidepressant activity with a sedative effect and has an EEG and clinical activity profile similar to that of amitriptyline. It has an overall efficacy comparable with amitriptyline and imipramine in depressive illness, but at dosages which have achieved a similar overall clinical improvement, mianserin causes significantly fewer anticholinergic side effects than amitriptyline or imipramine and also appears less likely than these drugs to cause serious cardiotoxicity on overdosage. Mianserin also has anti-anxiety activity, but its role in treating patients with anxiety associated with primary depression has still to be clarified. Mianserin appears to be well tolerated by the elderly and by patients with cardiovascular disease, including those recovering from a recent myocardial infarction, and does not appear to antagonise the action of adrenergic neurone blocking antihypertensive drugs or affect the anticoagulant action of phenprocoumon.
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PMID:Mianserin: a review of its pharmacological properties and therapeutic efficacy in depressive illness. 35 11


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