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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To clarify the clinical significance of a small heart; i.e., a small cardiac silhouette on chest radiography, an echocardiographic study was performed. Sixty persons with small heart according to cardiothoracic ratios less than or equal to 40%, and 23 age- and sex-matched normal controls (42% less than cardiothoracic ratio less than or equal to 50%) received two-dimensional and M-mode echocardiography. The body weights and body surface areas (BSA) in the small heart group were significantly less than those in the control group. On the lateral chest radiographs, numerous cases with small heart had straight spines and chests with decreased anteroposterior diameters. More than half of the small heart group had a variety of cardiovascular complaints, including chest pain, palpitation, dyspnea, and dizziness. Echocardiographic measurements were performed and hemodynamic indices were calculated. The results were as follows: Left ventricular dimension at end-diastole (LVDd), left ventricular dimension at end-systole (LVDs), left atrial dimension (LAD), and left ventricular mass (LV mass) of the small heart group were significantly less than those of the control group. There were, however, no differences in the values corrected by BSA (LVDd/BSA, LVDs/BSA, LAD/BSA and LV mass/BSA) between the two groups. We found no differences in hemodynamic indices (heart rate, stroke volume, ejection fraction, and cardiac output) at rest between the small heart and control groups. Nineteen cases (32%) had mitral valve prolapse (MVP) on echocardiography in the small heart group. Characteristic phonocardiographic findings were found in 11 cases with MVP (systolic click in four, mitral regurgitant murmur in three, and both in four).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Echocardiographic features of small heart]. 383 72

In a large machinery factory a cohort of 3754 men aged between 40 and 50 years have been studied for 5 years. Total and coronary mortality rates have been determined and also the incidence of certain non-fatal states which required hospitalization due to various types of coronary heart disease (CHD), hypertension, brain apoplexy, diabetes mellitus and malignancies. Among the subjects exposed to CHD risk factors (RF), i.e. among smokers, hypertensive and hypercholesterolemic subjects, and among those who had a positive coronary family history and a positive cardiovascular (chest pain) questionnaire, both total and coronary mortality rates were several fold higher and they increased almost exponentially with increasing numbers of RF. Among the RF it was the cardiovascular (chest pain) questionnaire which had the highest prognostic value. Workmen manifested a higher total and coronary mortality than did the employees in the technico-economical professions (TEP). The highest mortality rate was found among the workmen employed in heavy manual occupation. In contrast the lowest total coronary mortality rate was observed in the TEP having little responsibility in their vocation and also among qualified workmen and specialized technical and scientifical workers.
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PMID:Incidence and risk of coronary heart disease in an industrial population. A five-year prospective study. 392 16

The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the sole presenting symptom. Shortness of breath, although the most frequently reported symptom in the absence of chest pain, was equally common at all ages. Thus, in patients aged 85 years or over, "atypical" presentation of myocardial infarction became the rule, and in the very old the clinician must be prepared to screen for the diagnosis in most acutely ill patients.
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PMID:Changing presentation of myocardial infarction with increasing old age. 395 Feb 99

Dopexamine, a new compound with postjunctional dopamine receptor activating and beta adrenoceptor agonist properties, was given to 10 patients with chronic heart failure at diagnostic cardiac catheterisation to investigate its acute haemodynamic and metabolic effects. The drug was administered by intravenous infusion in three incremental doses and produced significant dose related increases in cardiac index, stroke volume index, and heart rate and falls in systemic vascular resistance and left ventricular end diastolic pressure; aortic and pulmonary artery pressures were unchanged. Isovolumic phase (max dP/dt and KVmax) and ejection phase (peak aortic blood velocity, maximum acceleration of blood, and maximum rate of change of power with time during ejection) indices of myocardial contractility were all increased by dopexamine but these changes were hard to interpret in the presence of an increase in heart rate. Myocardial efficiency and ejection fraction were both increased and left ventricular end diastolic and end systolic volumes fell. These largely beneficial changes were achieved without a statistically significant increase in myocardial oxygen consumption or disturbance of myocardial metabolic function. Dopexamine was well tolerated but tremor was reported by two patients at the intermediate dose and mild chest pain by two patients at the high dose.
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PMID:Acute haemodynamic and metabolic effects of dopexamine, a new dopaminergic receptor agonist, in patients with chronic heart failure. 404

A retrospective analysis of 38 patients undergoing cardiac catheterization with the diagnoses of hypothyroidism and chest pain revealed 23 to be euthyroid while receiving replacement therapy and 15 to be hypothyroid. Cardiac index was significantly reduced (p less than 0.01) in hypothyroid and euthyroid patients with thyroxine values between 4 and 7 micrograms/dl (2.8 +/- 0.7 and 3.0 +/- 0.9 L/min/m2, respectively), compared to euthyroid patients with thyroxine values greater than 7 micrograms/dl with or without coronary artery disease (4.0 +/- 1.2 and 4.0 +/- 0.7 L/min/m2, respectively). Ten hypothyroid patients underwent coronary artery bypass. There were no deaths, and only one patient required prolonged postoperative intubation. With a mean follow-up of 36 months, there have been no myocardial infarctions and one late death, which occurred at 7 years secondary to stroke. We conclude that preoperative thyroid replacement therapy is theoretically dangerous and may not significantly improve hemodynamics until full replacement is achieved. Coronary bypass grafting can be performed safely despite hypothyroidism with excellent early results.
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PMID:Diagnosis and management of the hypothyroid patient with chest pain. 660 15

The effects of atrioventricular (AV) sequential pacing-induced left bundle branch block (LBBB) on left ventricular (LV) performance were evaluated during cardiac catheterization in 9 randomly selected patients being investigated for chest pain. All patients were in normal sinus rhythm with a normal P-R interval and QRS duration. LV performance was assessed by both hemodynamic and angiographic measurements. The maximal rate of LV pressure increase (dP/dt), rate of maximal LV pressure decrease (-dP/dt), LV end-diastolic pressure (LVEDP), end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume and percent ejection (EF) were measured during right atrial and AV sequential pacing at a constant pacing rate. The average pacing rate was 97 +/- 3 beats/min (mean +/- standard error of the mean). In each patient, both dP/dt and -dP/dt decreased significantly (p less than 0.001) during AV sequential pacing compared with atrial pacing at the same rate, from 1,541 +/- 68 to 1,319 +/- 56 mm Hg/s for dP/dt and from 1,506 +/- 86 to 1,276 +/- 92 for -dP/dt. LVEDP did not change significantly when atrial (17 +/- 3 mm Hg) and AV sequential pacing (16 +/- 2 mm Hg) were compared. Mean LVEDV did not change during atrial (135 +/- 13 ml) or AV sequential pacing (137 +/- 14 ml). In contrast, the LVESV during AV sequential pacing was higher by 15 ml (23%) (from 48 +/- 10 to 63 +/- 12 ml) (p less than 0.001); as a result, the stroke volume was lower by 13 ml (15%) and the EF decreased by 10%, from 66 to 56% (-15%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Alteration of left ventricular performance by left bundle branch block simulated with atrioventricular sequential pacing. 669 Dec 84

We evaluated the effects of intravenous verapamil, a calcium antagonist, on hemodynamics and regional left ventricular (LV) performance in patients with acute myocardial infarction (AMI). Twenty patients having uncomplicated infarction or moderate heart failure were randomized to receive either verapamil or placebo and were studied a mean of 12 hours after onset of symptoms. Verapamil, 7.5 mg intravenously, acutely reduced systolic arterial pressure (p less than 0.0005), systemic vascular resistance, and LV stroke work (p less than 0.005) and rate-pressure product (p less than 0.05); the heart rate did not alter. The Frank-Starling relationship by Swan-Ganz catheter did not change for 1 hour. Segmental wall motion amplitudes were recorded from eight standardized segments around the left ventricle by a multidirectional M-mode echocardiographic technique. The systolic wall motion of the uninvolved LV segments and LV cavity size did not change after verapamil. Verapamil improved mechanical performance in the ischemic segments (p less than 0.005). Therefore, the overall regional contractile function of the left ventricle improved as well (by 11% to 13%, p less than 0.05). This echocardiographic improvement continued after the acute vasodilatory response of intravenous verapamil subsided and was preserved for 1 week, the patients having had oral verapamil, 240 mg daily. Chest pain was relieved in five of the six patients having ongoing slight pain before verapamil injection. No sequential hemodynamic or echocardiographic changes occurred in the placebo-treated patients. Thus, in patients with uncomplicated AMI, verapamil improve contractile function of the acutely ischemic LV segments by hemodynamic unloading and/or by direct myocardial effect, without manifest depression of the uninvolved myocardium.
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PMID:Effects of verapamil in patients with acute myocardial infarction: hemodynamics and function of normal and ischemic left ventricular myocardium. 669 58

In the framework of the programme on the multi-factorial prophylaxis of myocardial infarction and cerebral stroke in males aged 40-59 years, the authors studied the relationship between type A behaviour pattern as a risk factor for coronary heart disease and somatic and history indices. A study of 5698 men showed that group A was characterized by a greater percentage of subjects with elevated cholesterol and triglyceride levels and with hypercoagulatory changes in the hemostatic system. Group A subjects more frequently complained of chest pain and had a larger proportion of relatives with cardiovascular disease.
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PMID:[Various characteristics of persons with behavior-related risk of ischemic heart disease]. 671 83

In previous studies from this laboratory, we found that approximately 30% of women with chest pain and normal coronary arteries demonstrated either a decrease in or a failure to increase radionuclide ejection fraction during exercise. To examine the hypothesis that this apparent abnormality in left ventricular function represents a physiologic difference between men and women, we prospectively studied central and peripheral cardiovascular responses to exercise in 31 age-matched healthy volunteers (16 women and 15 men). A combination of quantitative radionuclide angiography and expired-gas analysis was used to measure ejection fraction and relative changes in end-diastolic counts, stroke counts, count output, and arteriovenous oxygen difference during symptom-limited upright bicycle exercise. Normal male and female volunteers demonstrated comparable baseline left ventricular function and similar aerobic capacity, as determined by weight-adjusted peak oxygen consumption (22.1 +/- 5.1 and 22.6 +/- 4.3 ml/kg/min, respectively). However, their cardiac responses to exercise were significantly different. Ejection fraction increased from 0.62 +/- 0.09 at rest to 0.77 +/- 0.07 during exercise in men (p less than .001), but was unchanged from 0.63 +/- 0.09 at rest to 0.64 +/- 0.10 during exercise in women. The ejection fraction increased by 5 points or more in 14 of 15 men, but in only seven of the 16 women. End-diastolic counts increased by 30% in women (p less than .001), but was unchanged in men. Because decreases in ejection fraction were matched by increases in end-diastolic counts, relative increases in stroke counts and count output were the same for men and women. These data demonstrate a basic difference between men and women with respect to the mechanism by which they achieve a normal response of stroke volume to exercise; these differences must be taken into account when measurements of cardiac function during exercise stress are used for diagnostic purposes.
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PMID:Sex-related differences in the normal cardiac response to upright exercise. 674 40

The hemodynamic monitoring of acute myocardial infarctions has been carried out in patients less than 75 y.o. who showed: a) extensive anterior myocardial infarction; b) inferior myocardial infarction and ST segment depression of the anterior chest leads; c) acute myocardial infarction and cardiac failure. The hemodynamic measurement were carried out at the 12 hours (mean) from the beginning of chest pain on 65 patients who suffered the first myocardial infarction and were protracted to 60 hours (mean). The hemodynamic findings were classified according to the relationship between the stroke work index of the left ventricle (LVSWI) and the mean pulmonary artery pressure (MPAP) as following: normals: 6 pts; hypovolemia: 15 pts; reduced compliance: 2 pts; mild LV failure: 19 pts; severe LV failure or shock: 23 pts. 35 pts have carried out a complete rehabilitation programme has shown an inverse linear relationship to the MPAP of the first recording in CCU. The incidence of death was 29% one year after the myocardial infarction and showed a significant relationship to the hemodynamic findings. The LVSWI resulted more sensitive than MPAP; 90% of patients who showed a LVSWI less than 20 gmb/m2 died.
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PMID:[Correlations among the haemodynamic effects in acute myocardial infarction. Function evaluation and prognosis 12 months later (author's transl)]. 732 21


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