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

Eleven elderly patients with idiopathic pericarditis are reported. All but one were older than 60 yr. Evidence of ischemic cardiovascular disease was present in 8 patients. The initial diagnosis was heart failure with pulmonary complications in 4 cases and myocardial infarction in 3. Respiratory infection preceded the onset of pericarditis in 5 cases. Presenting symptoms were typical precordial pain, fever and dyspnea. Pericardial friction was found in 7 cases and transient rhythm disturbances in 5. Four patients had ST elevation and 3 had ST depression in their electrocardiograms. Other findings included an increased sedimentation rate, leukocytosis, elevated venous pressure and normal SGOT levels. Antibiotics were of no avail but prednisone had a dramatic effect. Two patients had a relapsing course lasting 2 yr or more. One patient, who died at the age of 75 from bleeding ulcer, had patent coronary arteries and mild perimyocardial fibrosis. The diagnosis of idiopathic pericarditis in the aged is difficult because the disease simulates ischemic heart disease in patients who frequently have evidence of arteriosclerotic cardiovascular involvment.
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PMID:Acute idiopathic pericarditis in the aged. 114 70

To study the efficacy of isosorbide dinitrate in prevention of myocardial ischemia, 20 patients with angiographically proved coronary artery disease underwent atrial pacing (mean rate 138/min) before (P1), 10 minutes after (P2) and 65 minutes after (P3) sublingual administration of 5 mg of isosorbide dinitrate. The symptomatic, hemodynamic and metabolic responses were evaluated at rest and during each pacing period. Angina occurred in all subjects during P1. Angina did not recur or was less severe in 17 of 19 patients during P2 and in 19 of 20 patients during P3. Resting left ventricular end-diastolic pressure for the group was normal at 11 plus or minus 4 mm Hg (mean plus or minus standard deviation). On interruption of pacing at 4.5 minutes during P1, average end-diastolic pressure during sinus rhythm was abnormal (18 plus or minus 6 mm Hg). After administration of isosorbide dinitrate mean left ventricular end-diastolic pressure was significantly decreased at rest and remained normal when pacing was interrupted during P2 and P3. Brachial arterial pressure, cardiac index, tension-time index, left ventricular stroke work index and maximal rate of rise of left ventricular pressure were all diminished at rest before and during P2 and P3. S-T segment depression was less during P2 and P3 than during P1. Before isosorbide dinitrate was given, resting myocardial lactate extraction was 15 plus or minus 11 percent during P1 lactate extraction decreased to minus2 plus or minus 25 percent. Lactate extraction was significantly greater during P2 and P3 than during P1. This study demonstrates that sublingual administration of 5 mg of isosorbide dinitrate has a significant protective effect against pacing-induced myocardial ischemia at 10 and 65 minutes after administration.
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PMID:Effects of isosorbide dinitrate on the response to atrial pacing in coronary heart disease. 115 42

Changes in the heart rate, blood pressure, ECG, occurring at the time of endoscopy of the stomach were studied in a group of 59 cases of cardiovascular disease and in a control group of 27 cases. With regard to arrythmias appearing at the time of endoscopy of the stomach, ventricular and atrial premature beats were the most numerous. Atrial fibrillation, as well as ventricular bigeminy were encountered. Two cases of atrial fibrillation continued even after the end of the examination. ST-T changes during endoscopy were found most frequently in the ischemic heart disease group and the valvular heart disease group. There were three cases in which severe ST depression made it necessary to stop the examination. The cardiovascular changes generally occurred at the beginning of the endoscopy examination. Two milligrams of propranolol i.v. seemed to be effective in preventing changes of heart rate.
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PMID:Arrythmias and ischemic changes of the heart induced by gastric endoscopic procedures. 115 24

The sensitivity of rest and stress myocardial perfusion studies using scintillation camera imaging of intravenously administered rubidium-81 (81Rb) in the detection of myocardial ischemia was compared to that of stress electrocardiography by relating results in 40 patients to the degree of stenosis delineated by coronary arteriography. Of 33 patients with greater than 75% stenosis of at least one of the three major coronary vessels (significant stenosis), rest and stress 81Rb imaging detected ventricular ischemia in 29 (88%) whereas simultaneous stress electrocardiography was positive (1 mm or greater horizontal ST-segment depression) in only 19 (58%) of the same patients. Five of the 29 patients who developed stress-induced scintigraphic evidence of ischemia did not develop angina or a positive electrocardiogram with stress. In 31 of the 33 patients with significant coronary stenosis, either the stress scintigram or the stress electrocardiogram was positive. In seven patients with less than 50% narrowing of a major coronary vessel on coronary arteriography, the stress scinitigrams were negative, whereas the stress electrocardiograms were positive in the two of these patients with the syndrome of angina with normal coronary arteriograms. It is concluded that high resolution images of the myocardium can be obtained with 81Rb using the scintillation camera with special shielding, and that rest and stress 81Rb scintigraphy appears to provide greater sensitivity and specificity when compared to stress electrocardiography in the nininvasive identification of significant coronary stenosis.
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PMID:Noninvasive detection of regional myocardial ischemia using rubidium-81 and the scintillation camera: comparison with stress electrocardiography in patients with arteriographically documented coronary stenosis. 115 74

Seventeen subjects ranging from 36 to 58 years of age presented with chest pain suggestive of myocardial ischemia. Each patient had a positive double Master's two-step test with ST segment depression of 0.5 mm. or more in the postexercise ECG. In each case coronary angiography and left ventriculography were normal. Hemodynamic and metabolic investigations were carried out during sinus rhythm and atrial pacing. Thirteen patients experienced pain during pacing but only one showed an abnormal hemodynamic response. Two patients showed abnormal myocardial lactate metabolism during the control period and four during pacing-induced tachycardia. The increase in ejection fractions in this group suggests hyperdynamic ventricular contraction which could result in increased oxygen requirements and thus induce ischemic pain in the absence of arteriographically demonstrable coronary artery disease.
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PMID:Angina pectoris with normal coronary arteriograms: hemodynamic and metabolic response to atrial pacing. 119 32

In 50 patients with ischaemic heart disease prospective analyses of the reproducibility of exercise tests at 3-month intervals were performed. The same method of testing was used repeatedly in a smaller group of patients 3 or more times at 6- to 8-week intervals. No significant differences were found in maximal heart rate, maximal systolic blood pressure, rate-pressure product, and total work. Symptoms resulting in the discontinuation of exercise were unchanged in 94 per cent of patients. The evaluation of the electrocardiographic recordings revealed good agreement in 94 per cent of patients. The evaluation of the electrocardiographic recordings revealed good agreement in ST segment depression and ST segment elevation. The reproducibility of arrhythmic events was very poor. The standardized electrocardiographic exercise test is, therefore, recommended for objective evaluation of various interventions in patients with manifest ischaemic heart disease, both in short-term and long-term follow-up studies.
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PMID:Reproducibility of exercise tests in patients with symptomatic ischaemic heart disease. 119 40

Fibrinolytic activity and platelet adhesiveness are normal in cases of angina pectoris and healed myocardial infarction, whereas fibrinolytic activity is diminished in acute myocardial infarction. Exercise increases fibrinolytic activity in normal people but the effect on it of submaximal exercise in patients with ischaemic heart disease is not known. Resting platelet adhesiveness and fibrinolytic activity were determined in 20 patients suffering from ischaemic heart disease and eight healthy controls. Both groups were then subjected to submaximal exercise on a motor-driven treadmill. The ST segment of the electrocardiogram and the heart rate were monitored during exercise by an on-line digital computer. Fibrinolytic activity determinations were repeated immediately after exercise. There was a significant increase in fibrinolytic response in both groups but it was significantly less in the ischaemic groups (36-2%) compared with the controls (55-9%) (P less than 0-01). The ST segment depression was 2-3 mm in the ischaemic group and 0-52 mm in controls--also a significant difference (P less than 0-01). There was no correlation, however, between the ST change and the fibrinolytic response. A diminished response in the ischaemic group may favour their predisposition to thrombotic episodes.
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PMID:Effect of submaximal exercise on fibrinolytic activity in ischaemic heart disease. 122 43

In 18 patients with coronary artery disease and in 12 control subjects, left ventricular function was studied by means of rapid artial pacing. The results were compared with the cardiac dynamics, as determined by left ventricular dysfunction although the angiograms portrayed normal contractility at rest. It has to be assumed, that abnormal myocardial function was only evident during the pacing stress. On the other hand, if the angiogram showed local hypokinesis, the hemodynamic effect of this slightly abnormal contraction could be determined by atrial pacing. Moreover, rapid atrial pacing often produced myocardial ischemia and anginal pain in patients with coronary heart disease. In these cases the transient "anginal" depression of left ventricular function could be separated from the chronic hypoxic "preanginal" dysfunction. This may be of vale in terms of surgical revascularisation.
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PMID:[Evaluation of the left ventricular function in patients with coronary disease by means of atrial pacing]. 122 25

Seventy-two healthy young individuals were subjected to controlled, moderate hyperventilation with room air and with 4.9 percent CO2 in air, and monitored electrocardiographically. Significant summed frontal T-wave changes with hyperventilation (sigmaT1,2,3 larger than or equal to 1.5 mm) were observed in 12 patients. Six subjects (8.3 percent) showed T-wave depression. It was reversed in five patients by hyperventilation with 4.9 percent CO2 in air. T-wave elevation, observed in six subjects, was reversed in four patients by hyperventilation with 4.9 percent CO2. A short period of hyperventilation with an air mixture containing 4-5 percent CO2 is suggested as a means of screening patients under suspicion of ischemic heart disease exclusively on the basis of ECG changes.
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PMID:Hyperventilation-induced T-wave changes in the limb lead electrocardiogram. 123 20

To evaluate possible cardiovascular effects of emotional stress, a specially designed 12 minute tape-recorded stress quiz was administered to 43 subjects while blood pressure and the electrocardiogram were monitored. For the entire group, the heart rate and blood pressure rose from respective control levels of 76 beats/min and 136/87 mm Hg to a mean during the quiz of 87 beats/min and 158/94 mm Hg. This difference was highly significant. Of the 43 subjects, 33 were classified as executives and 10 as nonexecutives. There were three groups of executives: control and angina with and without a history of hypertension. Both groups of executives with angina responded with a significantly higher heart rate than that of the executive control group. Blood pressure response was significantly greater in executives with angina and hypertension than in the other groups. Heart rate and systolic blood pressure responses to the quiz were lower in nonexecutives with angina than in executives with angina. During the quiz, 10 of 14 executives with angina had S-T segment depression greater than 0.5 mm; of these, 7 evidenced greater than 1.0 mm depression, andin 3 of these the depression was greater than 1.5 mm and in 2 greater than or equal to 2.0 mm. None of the executive control subjects had S-T depression greater than 0.5 mm Among nonexecutives, 2 had S-T depression greater than 0.5 mm but none greater than 1.0 mm S-T depression. Seventeen of the patients also were given a bicycle exercise tolerance test. There was a significant correlation between S-T depression in response to exercise and to the quiz (r = 0.63; P less than 0.01). The quiz electrocardiogram is presented as a new research technique and diagnostic test for evaluating the relation of emotional stress to ischemic heart disease.
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PMID:The quiz electrocardiogram: a new diagnostic and research technique for evaluating the relation between emotional stress and ischemic heart disease. 124 33


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