摘要:

AbstractSubendocardial, nontransmural, or non‐Q‐wave myocardial infarction (NQMI) carries a serious prognosis. Many previous studies of NQMI include only patients withoutnewQ waves at the time of infarction. Since the site oftransmuralMI (by Q waves) has implications concerning extent of coronary disease (CAD) and left ventricular (LV) dysfunction, we wondered what the extent of CAD and LV dysfunction is among acute MI patients who have neithernewnoroldQ waves. Furthermore, we sought to determine whether ST‐T wave patterns or resting LV ejection fraction (EF), alone or combined, could separate NQMI patients with significant CAD from those with normal or nearly normal coronaries. Therefore, we retrospectively examined angiographic and electrocardiographic data in 55 symptomatic patients with NQMI.ST‐T wave patterns on admission were classified as either ischemic (transient ST elevation, persistent horizontal ST depression, or persistent deep T wave inversion) or nonspecific.Eleven patients (20%) had normal or nearly normal coronaries (N); ten patients (18%) had one, seven patients (13%) had two, and 19 patients (34%) had three vessel CAD; eight patients (15%) had left main (LM) disease. Six of the 11 N patients had ergonovine tests and all six were negative.Segmental LV wall motion abnormalities (WMA) were commonly observed; however, diffuse LVWMA were present only among patients with three vessel and LM disease. EF was below 0.50 in 48% of patients with three vessel or LM disease.Although ischemic ST‐T wave patterns were more common (P<0.05) among patients with significant CAD than among N patients, neither the ST‐T wave pattern nor EF, alone or in combination, allowed confident separation of N patients from significant CAD patients.We conclude 1) A large proportion of NQMI patients have LM disease, three vessel disease,ornormal or nearly normal coronaries. 2) Despite the absence of Q waves, LV dysfunction is common and the degree of LV impairment is worse among patients with more extensive CAD. 3) NQMI patients who may have normal or nearly normal coronaries cannot be reliably separated from NQMI patients with significant CAD on the basis of ST‐T wave patterns or resting LVEF. 4) Coronary angiography appears warranted to assess the extent of CAD in symptomatic

ISSN:0098-6569    

DOI:10.1002/ccd.1810110302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractWe studied the incidence of reversibility of coronary obstructions in a consecutive series of 313 patients with nonoperated coronary artery disease catheterized twice 3 to 118 (mean 38) months apart. Recanalization was observed in three patients and regression from an initial<100% obstruction in six patients. Progression in a different location occurred in six of the nine patients who demonstrated one recanalized or one regressive lesion. We conclude that true regression is an infrequent event in the natural history of medically treated patients with coronary artery disease; moreover, the pathophysiology and clinical relevance of angiographic regression remain poorly defined.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractPlatelet function and prostaglandin activity were evaluated in nine patients with coronary artery disease undergoing percutaneous left anterior descending coronary artery angioplasty (PTCA) and compared to nine normal controls. Transcoronary measurements (arterial‐coronary sinus) of platelet counts, mean platelet volume, platelet factor 4 (PF4), beta thromboglobulin, thromboxane (B2), and 6‐keto‐PGF were made. When compared to normal controls, the patients with coronary artery disease had higher circulating baseline levels of PF4 in the coronary sinus. There was no transcardiac production of any factor at baseline or immediately after infusion of nitroglycerin or performance of PTCA. These results suggest that PTCA does not grossly alter arachidonic acid metabolism or platelet act

ISSN:0098-6569    

DOI:10.1002/ccd.1810110304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractThe isovolumic relaxation period of the left ventricular pressure curve in man has been assumed to be best represented by an exponential decay. To determine which model most closely approximates the empiric pressure data of isovolumic relaxation in man, several models were compared. They included linear, exponential with a zero mmHg pressure asymptote, exponential with a variable asymptote, and second‐to fifth‐order polynomials. In addition, four different methods of computing parameters of isovolumic relaxation by the exponential model with a variable asymptote were tested. It was found that the isovolumic relaxation period approximates an exponential, that the theoretic asymptote is variable, and that the Levenburg‐Marquardt algorithm can be used efficiently to model this p

ISSN:0098-6569    

DOI:10.1002/ccd.1810110305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractA patient with acute occlusion of the left main coronary artery in whom streptokinase thrombolysis was successful in reestablishing antegrade flow is reported. A discussion of factors influencing survival and a review of the literature is presented.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractCongestive heart failure, unstable angina, and moderate mitral regurgitation improved after double‐vessel angioplasty in a 41‐year‐old woman who was considered inoperable because of high risk of bypass surgery. With the concomitant use of balloon counterpulsation, angioplasty reduced the cross‐sectional stenosis in the left anterior descending coronary artery from 98 to 20% and in the left circumflex coronary artery from 90 to 0%. The right coronary artery was completely occluded and angioplasty was not attempted. The ejection fraction was 17% prior to angioplasty and 50% 2 months later at fo

ISSN:0098-6569    

DOI:10.1002/ccd.1810110307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractA 56‐year‐old male with right ventricular dysplasia underwent right atrial angiography. Though the catheter tip appeared to be in the right atrial cavity, an appreciable amount of contrast medium dissected the interatrial septum, resulting in unusual radiologic and ultrasonic patte

ISSN:0098-6569    

DOI:10.1002/ccd.1810110308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractA case of arterial sheath kinking is reported. Radiographically, sheath kinking has some features which mimic sheath fracture. The radiographic appearance of sheath kinking is, however, distinctive and clearly separable from sheath fracture, the hallmark of which is extravasation of contrast at the fracture site.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractA review of the literature relating to endomyocardial biopsy (EMB) is presented. This is considered important at this time since EMB is being utilized with increasing frequency, particularly for the diagnosis of myocarditis. The development of the technique is briefly outlined. Emphasis is placed on the clinical application of EMB in the various primary cardiomyopathies (dilated, hypertrophic, restrictive, and obliterative), the infiltrative secondary cardiomyopathies (amyloidosis, sarcoidosis, hemochromatosis), myocarditis, as well as such conditions as adriamycin cardiotoxicity, cardiac transplant rejection, and Kawasaki disease. More controversial application of EMB in primary mitral valve prolapse (Barlow's syndrome), idiopathic ventricular arrhythmias, and the elucidation of the enigmatic finding of angina with angiographically normal coronary arteries is detailed. Experience with immunological and biochemical investigation of biopsy material, as well as with virus isolation and drug assays in the myocardium, is alluded to. Complications encountered with this procedure are also discussed, and its future role is contemplated.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractPercutaneous coronary angioplasty guiding catheters occasionally wedge in the coronary orifice and obstruct blood flow, making completion of the balloon dilatation difficult. Side holes may be made in the catheter, but when created free‐hand may not be ideal. This report describes a device for creating side holes of small size, with uniform shape, and without rough edges. The disadvantages of dye extravasation and loss of strength in the catheter are minimize

ISSN:0098-6569    

DOI:10.1002/ccd.1810110311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY