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

Pulmonary arterial end-diastolic and mean right atrial pressures were compared in 25 patients with acute myocardial infarction and in one patient with unstable angina. No consistent relationship was observed between these pressures. Simultaneous ventricular function curves relating the stroke work of each ventricle to its respective filling pressure were constructed on 34 occasions, dextran infusion or diuresis being used to alter the filling pressure. The curves from each ventricle were described mathematically by a quadratic (parabolic) function as well as by a straight line function and then compared by canonical correlation analysis. Alterations in the left ventricular function curves occurred with and without depression or right ventricular function curves. These hemodynamic measurements demonstrate that acute myocardial infarction can alter the relationship between left and right ventricular function.
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PMID:Comparison of left and right ventricular function in acute myocardial infarction. 99 Dec 62

An analysis was made of differences in response to postinfarction exercise testing between patients with subsequent sudden and non-sudden death occurring during a 6-year follow-up period after acute myocardial infarction. In the 21 patients who died suddenly the ST-segment depression appeared earlier during exercise and was greater at the end of exercise than in those 25 patients whose death was not sudden (p-values less than 0.025). The physical working capacity of the sudden death group was insignificantly better and the work was performed with an insignificantly higher heart rate and lower systolic blood pressure than in the other group. The heart rate-blood pressure product during maximal work load was the same in both groups. The T-wave depression and P-terminal force negativity after exercise were greater in the sudden death group than in the non-sudden death group (p-values less than 0.025, less than 0.001, respectively). Ventricular ectopic beats, especially after exercise, were also more common in the sudden death group.
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PMID:Discrimination between subsequent sudden and non-sudden death by postinfarction exercise testing. 99 64

Fifty-seven patients with acute myocardial infarction were observed for early postmyocardial infarction angina and associated transient ST-segment changes. Nine patients had postinfarction angina with transient ST-segment elevation (group 1), seventeen patients had postinfarction angina with ST-segment depression or no ST-segment changes (Group 2), and 31 patients had no postinfarction angina (Group 3). The patients in Group 1 had a statistically significant increased incidence of early reinfarction and death, when compared with the other two groups, singly or combined. There was no significant difference in the incidence of reinfarction and death when Group 2 is compared with Group 3. Patients with transient ST-segment elevation associated with early postmyocardial infarction angina may be an appropriate group in whom to consider newer, more aggressive modes of postinfarction management.
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PMID:Transient ST-segment elevation with postmyocardial infarction angina: prognostic significance. 111 76

Hypercholesteremic medical students were different from their normocholesteremic classmates in a variety of ways. When students are grouped by cholesterol level in medical school, gradients across the means of biological, physiological, physical, and psychological characteristics are found. The hypercholesteremic students were older, shorter, and heavier, with younger mothers, less depression, less anxiety and less overall nervous tension under stress. Compared with their normocholesteremic classmates, youthful hypercholesteremics were more than 30 times as susceptible to episodes of acute myocardial infarction occurring 13 to 21 years after the high cholesterol levels were measured. Ten male medical students who subsequently sustained a myocardial infarction, most of whom were known to have had hypercholesteremia in youth, were significantly different at the outset from their 103 hypercholesteremic classmates who have not had such an episode. On the average, the precoronary individuals in medical school were shorter in stature, were older, had more overall nervous tension under stress, were more tired on awakening and had lower academic standing. The combination of hypercholesteremia and a personality profile denoting sensitivity and vulnerability to stress best characterizes this group of ten subjects who sustained a myocardial infarction at an early age. These findings suggest that it may be possible to differentiate young hypercholesteremics who are highly susceptible to myocardial infarction from their hypercholesteremic peers with relatively low susceptibility on the basis of personality profile.
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PMID:Youthful hypercholesteremia: its associated characteristics and role in premature myocardial infarction. 112 40

The effects of the positive-inotropic drug Canrenoat-Kalium (CRK) on the extent and severity of myocardial ischemic injury and on hemodynamic parameters were studied in 17 dogs following coronary occlusion. Acute myocardial infarction causes depression of left-ventricular function. There eas a significant decrease in dp/dtmax, stroke volume and cardiac output; average values for mean arterial pressure were reduced, but not significantly. There was a significant increase in left-ventricular enddiastolic pressure. Heart rate was unchanged. In the healing phase of myocardial infarction a significant elevation of left-ventricular enddiastolic pressure and a significant decrease of arterial pressure persisted, but the other parameters had returned toward normal. Intravenous administration of CRK (20 mg/kg) one hour after coronary occlusion causes a significant increase in left-ventricular dp/dtmax, cardiac output and stroke volume, but no significant change in arterial pressure, heart rate and left-ventricular enddiastolic pressure. Four days after myocardial infarction administration of CRK causes also a significant incrrease in left-ventricular dp/dtmax and -n 4 out of 5 animals an increase in stroke volume. Heart rate, arterial pressure and left-ventricular enddiastolic pressure are unchanged. There is a continuous deterioration of all hemodynamic parameters in the control group 1 hour and 96 hours after experimental myocardial infarction. This spontaneous deterioration has to be taken into consideration estimating the effect of CRK in experimental conditions. 120 epicardial electrocardiographic recordings were used to assess the extent and severity of myocardial ischemic injury. The average ST-segment elevation and the number of sites with abnormal ST-segments were significantly reduced 20 min after CRK administration. The study suggests a beneficial therapeutic role for CRK treatment of left-ventricular failure in the acute and healing phase after myocardial infarction.
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PMID:[Influence of canrenoate potassium (aldactone pro injections) on hemodynamics and myocardial ischemia in experimental myocardial infarct]. 116 92

Volume manipulations in 27 patients (volume loading n = 22; phlebotomy n = 5) with acute myocardial infarction (AMI) and 7 normal subjects has been performed in order to evaluate left ventricular performance in terms of cardiac index (CI) and pulmonary artery enddiastolic pressure (EDPAP). An EDPAP in the range of 18-22 mm Hg was in general associated with maximal cardiac output. In patients with AMI maximal cardiac performance was significantly lower compared to normal subjects (p less than 0.01). Volume loading that increased the EDPAP beyond the level of 18-22 mm Hg usually deteriorated cardiac performance in AMI. A phlebotomy in 5 subjects with severe pulmonary congestion decreased EDPAP significantly from 32 to 24 mm Hg (p less than 0.1) without a change of cardiac index (2.2 - 2.5 1/min/m2;NS). In 11 patients left ventricular performance was assessed during the acute and convalescent period. 4-6 weeks after AMI resting EDPAP decreased from initially 16 to 11 mm Hg (p less than 0.02), whereas cardiac index did not change significantly (3.1-3.3. 1/min/m2;NS) and even did not rise markedly after volume loading (3.3-3.4 1/min/m2;NS). By plotting the relative change of cardiac index after volume loading against the individual infarct size (n = 16), left ventricular hemodynamic reserve was assessed and revealed a significant depression compared to normal subjects (n = 7). A rough reverse relationship (r = -0.69) between left ventricular hemodynamic reserve and infarct size was observed.
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PMID:Assessment of left ventricular function and hemodynamic reserve by volume loading in acute myocardial infarction. 118 69

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

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby. One patient, who had total occlusion of the left main coronary artery, died during the study. Twenty-one of the remaining patients were considered surgical candidates, and were treated immediately after angiography with 1 to 3 vein bypass grafts. There was one late postoperative death and, of the 20 survivors, 2 had ECG evidence of acute myocardial infarction and one had mild angina at time of discharge. In contrast, of the 21 patients treated medically, 13 sustained acute MI, resulting in 8 instances of congestive heart failure and 4 cases of ventricular fibrillation. Four patients died in cardiogenic shock. With the use of rigid criteria, a small subgroup of patients with variant angina at high risk of developing AMI has been identified and categorized as having preinfarction angina. Our experience suggests that aggressive surgery immediately following coronary angiography offers a lower incidence of MI, morbidity, and death than does medical management.
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PMID:Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients. 124 46

In summary, although exercise is, as is every other procedure, imperfect with regard to sensitivity and specificity, it provides an invalualbe adjunct in the evaluation of patients with coronary disease. The test is simple, inexpensive, safe and rapidly performed and is an invaluable aid in screening patients with possible coronary disease. It is used in an asymptomatic population for industrial purposes, is useful in assessing the etiology of otherwise undiagnosed chest pain, helpful in evaluating the overall severity of ischemia [and therefore in culling-out those patients that might benefit from coronary angiography], is useful in following the course of patients with proven coronary disease [including those with acute myocardial infarction], and has found a place in the follow-up evaluation of individuals having aortocoronary bypass surgery. As a screening procedure, the treadmill test aids in seeking out that group of patients with coronary disease with potentially malignant lesions, i.e. main left coronary lesions, triple-vessel disease and [to a lesser extent] severe proximal left anterior descending coronary disease. Hence, the finding of marked depth of ST depression, prolonged duration of ischemia associated with deep ST segments, serious exercise-induced ventricular arrhythmias and hypotension produced during mild-to-moderate exercise might each be an indication of extensive coronary angiography. In many cases exercise testing is superior to coronary angiography, being a simpler, safer screening procedure, and a more functional test in documenting the presence or absence of coronary insufficiency.
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PMID:Interpretation and limitations in stress testing. 127 86

Study on 108 patients of acute myocardial infarction has shown the incidence of reciprocal ST depression in ECG in 58.3% patients. Those showing reciprocal changes had higher (65.0% Vs 15.5%) incidence of complication such as dysrhythmias, conduction disorders. hypotension, left ventricular failure or CCF which was more conspicuous in inferior myocardial infarction. There was higher incidence of complications (74.4% vs 18.7%) whenever ST depression was 2 mm or more (P < 0.001) and there was steep rise in complications whenever the ST depression persisted for 2 days and beyond.
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PMID:Prognostic significance of reciprocal changes in acute myocardial infarction. 130 28


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