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

The aim of the present study was to evaluate the influence of right ventricular involvement on the magnitude of precordial ST segment depression during inferior acute myocardial infarction. For this reason 61 patients (55 M, 6 F; mean age 53 years--range 38-73 years) admitted in our CCU for inferior acute myocardial infarction were studied by coronary angiography within 3-5 days from the onset of symptoms. The angiography showed either occlusion or critical coronary stenosis ranging as follows: on right coronary artery proximal (Group 1) to the first branch for right ventricle in 22 patients, on right coronary artery distal to the first branch for right ventricle in 25 patients (Group 2) and on circumflex artery (Group 3) in 14 patients. No difference in LAD disease were noted between the 3 groups. Using myocardial scintigraphy (Tc-99m- pyrophosphate) we confirmed the presence or the absence of right ventricular involvement in the 3 groups. In the 3 groups the magnitude of ST segment depression in V2, selected as representative left-sided precordial lead, ranged as follows: Group 1: -0.25 +/- 1.34 mm; Group 2: -1.64 +/- 1.80 mm; Group 3: -2.00 +/- 1.97 mm. In patients with right ventricular involvement (Group 1) there was a statistically significant reduction of precordial ST segment depression either in comparison to Group 2 (p less than 0.01) or to Group 3 (p less than 0.005) but none between Group 3 and 2. (ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[ST segment depression in precordial leads in patients with inferior acute myocardial infarction: the role of right ventricular involvement]. 220 97

We presented two cases of acute coronary occlusion after successful percutaneous transluminal coronary angioplasty (PTCA) associated with a treadmill stress testing. Case 1: A 54-year-old man with effort angina was referred to our hospital for cardiac catheterization. At the time of cardiac catheterization, the proximal RCA had a 99% diameter narrowing, and the proximal LCX had a 90% diameter narrowing. PTCA was performed and both lesions were successfully dilated. Eight days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 173/min (103% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 140 mmHg. A few minutes after the end of exercise, he developed a severe chest pain and ECG changes, which showed ST elevation in leads II, III, aVF and ST depression in leads V4-V6. Emergency coronary angiography disclosed an acute coronary occlusion of RCA at the site of PTCA. Emergency PTCA was performed and the lesion was successfully re-dilated. Case 2: A 68-year-old man was referred to our hospital for cardiac catheterization a month after subendocardial anterior myocardial infarction. At the time of cardiac catheterization, the proximal LAD have a 99% diameter narrowing. PTCA was performed and the lesion was successfully dilated. 18 days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 158/min (102% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 218 mmHg. Ten minutes after the one of 218 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of acute coronary occlusion after successful coronary angioplasty associated with a treadmill stress testing]. 221 90

Coronary angioplasty was used as a human model of transient myocardial ischemia to evaluate the electrocardiographic characteristics and significance of "reciprocal" ST-segment depression and T wave changes. Continuous 12-lead ECGs were recorded before and during coronary angioplasty in 20 patients, 19 of whom had single vessel disease. In 12 of 14 patients, LAD occlusion produced ischemic changes (peaked T and/or ST elevation) in L1, AVL and at least two precordial leads. "Reciprocal" changes (ST depression and/or T inversion) were observed in at least two inferior wall leads. One patient had ST depression in V4-V6 with no change in the inferior leads and in the other the only ECG change was inferior ST depression with partial inversion of the T wave. In four of six patients, RCA occlusion produced ischemic changes in at least two inferior wall leads and "reciprocal" changes in L1, AVL and at least two anterior wall leads. In LAD as well as RCA occlusions "reciprocal" changes were characterized by inversion of the T wave or inversion of its ascending limb with or without ST depression. The magnitude of the ischemic changes tended to be proportional to the magnitude of the "reciprocal" changes. Our data suggest that: (1) "Reciprocal" changes are not a specific indicator of distant myocardial ischemia due to multivessel disease; (2) the magnitude of ischemic changes correlates with the magnitude of "reciprocal" changes; (3) "Reciprocal" changes may be the only manifestation of acute myocardial ischemia; and (4) "Reciprocal" changes may be represented by inversion of the T wave without displacement of the ST-segment.
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PMID:Twelve-lead electrocardiogram recording during percutaneous transluminal coronary angioplasty. Analysis of reciprocal changes. 238 24

Oxygen free radicals have been suggested to cause the myocardial damage resulting in the prolonged contractile depression following brief periods of regional ischemia. In pigs, we infused the natural antioxidant alpha-tocopherol as its water-soluble acetate [0.3 g/kg intravenously (i.v.), n = 6] three times during 1 week, prior to thoracotomy, 8-min distal left anterior coronary artery (LAD) occlusion and 90-min reperfusion. Plasma levels of alpha-tocopherol [high-performance liquid chromatography (HPLC)] on the experimental day were 148.91 +/- 21.47 micrograms/ml as compared to preinfusion control of 0.51 +/- 0.14 micrograms/ml. Myocardial levels of alpha-tocopherol were elevated to 93.15 +/- 14.78 micrograms/g as compared to 4.08 +/- 0.60 microgram/g in the control group (n = 6). Malondialdehyde levels in ischemic-reperfused myocardium of the treatment group were insignificantly lower (441.96 +/- 59.55 nmol/g) as compared to the control group (500.9 +/- 72.72 nmol/g). Heart rate was significantly higher in the treatment group by the end of the experiments (135 +/- 10 vs. 105 +/- 4 beats/min, p less than 0.01). Regional segment shortening (SS, sonomicrometry) became normal within 1 min of reperfusion in both the treatment and the control group. During the following 10 min, SS decreased to 52 +/- 6% of preischemic control in the alpha-tocopherol group and to 54 +/- 7% in the control group (NS). SS remained at these depressed values throughout the reperfusion period. Pretreatment with the antioxidant alpha-tocopherol resulted in a tendency to lower lipid peroxidation products but did not prevent development of contractile depression in reversibly ischemic reperfused myocardium.
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PMID:Effect of alpha-tocopherol (vitamin E) in a porcine model of stunned myocardium. 247 14

To examine whether coronary occlusion causing transmural ischemia was accurately reflected by ST-segment elevation on routine electrocardiograms, intracoronary and surface electrocardiograms were simultaneously recorded during percutaneous transluminal coronary angioplasty (PTCA). The study group consisted of 54 patients who had intracoronary ST-segment elevation during transient coronary occlusion (left anterior descending [LAD]: 25 patients, left circumflex [LC]: 19 patients, right coronary artery: 12 patients). Elevation of the ST segment on the surface electrocardiogram (greater than or equal to 0.1 mV) was recorded in 84% of patients during LAD dilatation, in 32% of patients during LC dilatation (p less than 0.01 vs LAD and right), and in 92% of patients during right coronary dilatation (not significant vs LAD). The magnitude of intracoronary ST elevation was 1.10 +/- 0.8, 1.68 +/- 1.2 and 0.8 +/- 0.6 mV for the LAD, LC and right occlusions, respectively (not significant). Thus, despite the comparable magnitude of intracoronary ST elevation, LC occlusion resulted in ST-segment elevation on the surface electrocardiogram in significantly fewer patients than did LAD or right occlusion. During LC occlusion, 9 patients had no electrocardiographic changes and 4 had only precordial ST depression. Thus, in patients with transmural ischemia during right or LAD occlusions, concordant ST elevation on the surface electrocardiogram is common. In contrast, ST-segment elevation is an insensitive marker of LC occlusion. In patients with ongoing ischemic symptoms and isolated precordial ST depression or no repolarization abnormalities, LC occlusion should be considered in the differential diagnosis.
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PMID:Surface electrocardiogram in the detection of transmural myocardial ischemia during coronary artery occlusion. 252 Nov 94

The method of M-mode and 2-dimensional echocardiography was employed in 81 healthy persons to compare the difference in left ventricular structure and function between the elderly group (n = 41, aged 60-76 years) and the control group (n = 40, 22-58 aged years). The results revealed: 1) Aging of cardiovascular system was structurally as well as functionally reflected by echocardiogram, with echocardiographic findings appearing earlier than clinical manifestations. 2) Myocardial contractility and pump function of the elderly were often maintained in good status at rest. 3) Latent depression of left ventricular diastolic function was frequently seen in the elderly. LAD, AE, MVV and EPSS were found to be sensitive compared with the control group, (P less than 0.05, less than 0.001, less than 0.001, less than 0.001, respectively) and useful indices, which can be readily determined. Therefore, in order to evaluate the status of cardiac structure and function of the elderly accurately, it is important to refer to the normal values of relevant age group and draw conclusions from multi-parameters.
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PMID:Echocardiographic observation on changes of left ventricular structure and function in healthy elderly. 281 Apr 33

Fourteen mongrel dogs were anesthetized and instrumented to measure arterial pressure (AP), left ventricular pressure (LVP), aortic blood flow, and heart rate (HR). Hydraulic occluders were placed around the left anterior descending (LAD, n = 9) and left circumflex (LCC, n = 14) coronary arteries. A bilateral carotid occlusion (BCO) was made before and during either anterior (LAD occlusion) or posterior (LCC occlusion) ischemia. Posterior ischemia significantly (P less than 0.01) reduced the BCO-induced increases in mean AP (by 44.3 +/- 7.3%), systolic LVP (by 65.5 +/- 6.9%), first derivative of LVP (dLVP/dt, by 95.7 +/- 44.3%), and aortic resistance (by 117.7 +/- 26.9%). In contrast, anterior ischemia failed to alter significantly the hemodynamic response to BCO. Bilateral vagotomy attenuated or eliminated many of the effects of posterior ischemia on the BCO response. In fact, the change in aortic resistance was no longer affected by the ischemia and increased to the same extent, as noted during the control BCO. However, mean AP (38.7 +/- 6.8%), systolic LVP (40.3 +/- 8.7%), and dLVP/dt (62.4 +/- 11.0%) remained significantly reduced when compared with the control (no coronary occlusion) response. These data suggest that 1) posterior ischemia elicits a greater reduction in the BCO response than anterior ischemia, and 2) vagal afferents as well as depression of contractile function may both contribute to the BCO response inhibition noted during posterior ischemia.
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PMID:Effect of myocardial ischemia on hemodynamic response to carotid occlusion. 292 33

Regional myocardial dysfunction is a very sensitive and early parameter of myocardial ischemia. One minute occlusion of the left anterior descending (LAD (n = 8) and circumflex coronary artery (CCA) (n = 8) by means of hydraulic occluders was performed in 10 chronically instrumented conscious dogs. In a left ventricular cross-section diastolic and systolic area (DA, SA) and area shortening (AS) as well as regional function of 6 radial sectors were evaluated with 2D echocardiography. After occlusion of the LAD, SA increased by 33% (p less than 0.05), AS decreased by 22% (p less than 0.05) while the DA remained unchanged. In 2 of 6 radial sectors (anteroseptal) shortening decreased by 41% (p less than 0.01) and 54% (p less than 0.001) respectively. Occlusion of the circumflex coronary artery CCA caused an increase in DA (18%) and SA (33%) and a reduction of AS by 24% (p less than 0.01). Contraction of the anterior wall (sectors 2 and 3) was reduced by 61% and 57% (p less than 0.001). In the same animal 10 one minute occlusions of the LAD with 5 min intervals of reperfusion caused a reproducible depression of sector 6 (septal) from 63.2 +/- 5.4% to 16.3 +/- 3.4%. In another animal 11 one minute CCA occlusions with 5 min intervals of reperfusion reproducibly decreased the contraction of sector 3 (anterior) from 85.2 +/- 6.7% to 21.4 +/- 17.0%. 2D-E allows a reproducible estimation of regional left ventricular dysfunction during ischemia. Our model has the advantage that numerous studies can be performed in the same animal, so that the results can be compared intraindividually.
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PMID:[Regional myocardial ischemia in the conscious dog under echocardiography control]. 378 63

We report on 11 pts affected by acute inferior myocardial infarction (group A: 4 pts without precordial ST-segment depression; group B: 7 pts with ST precordial ST-segment depression). These pts underwent left and right coronarography and left ventriculography in the course of intracoronary thrombolysis. We did not observe, in the group B pts, an involvement of the LAD branch of the left coronary, neither contractility abnormalities of the left ventricular anterior wall. ST depression in the precordial leads was associated with severe and extensive abnormalities of left ventricular inferior wall contractility.
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PMID:[Lower myocardial infarct with depression of the ST segment in anterior precordial leads. Correlation of the electrocardiogram, coronarography and ventriculography performed in the acute phase]. 383 Jul 60

We studied the mechanisms of ST segment displacement in the ECG recorded from the epi- and subendocardium of ischemic ventricles in the isolated and perfused canine heart. ST segment changes were observed in association with a relatively large area of ischemia produced by occlusion of the left anterior descending and septal arteries (LAD + Sept.) or of the left circumflex artery (LCx). Contrary to previous reports, we found that the amount of subendocardial ST elevation was not always greater than that in the epicardial ECG recorded at the center of ischemia. Also, in the non-ischemic area, the degree of the ST depression in the subendocardial record was nearly the same as the epicardial record. On the other hand, the degree of the epicardial ST elevation on the border zone was always smaller than that at the ischemic center, which seemed to be due to the broadness of the border zone. The amplitude of the ST depression in the non-ischemic area was greater when the recording electrode was near the ischemic border, which supports the solid angle theory. The degrees of both ischemic ST elevation and reciprocal ST depression in the LCx perfused area were always greater than in the LAD + Sept. perfused area. These results strongly suggest that ST segment displacement depends on the relative position of the recording electrode to the electric double layer which exists at the border between the ischemic and non-ischemic area.
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PMID:ST segment changes under occlusion of the proximal portion of major coronary arteries in the isolated canine heart. 383 15


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