ISSN:0098-6569    

DOI:10.1002/ccd.1810020402

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

年代:1976

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810020403

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

年代:1976

数据来源: WILEY

摘要:

AbstractEighty‐four university cardiovascular laboratories responded to a questionnaire concerning premedication practice and observation of noncatheter‐induced coronary artery spasm during routine coronary angiography. Half of the laboratories stated that they had not observed the phenomenon. The data suggest that premedication practice may account in part for the relative rarity of this phenome

ISSN:0098-6569    

DOI:10.1002/ccd.1810020404

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

年代:1976

数据来源: WILEY

摘要:

AbstractEpisodes of chest pain are not uncommon in patients undergoing cardiac catheterization. The diagnostic implications of this symptom may be complicated by the occasional appearance of electrocardiographic changes mimicking those seen in acute myocardial infarction, and by the frequent elevation of conventionally measured serum enzymes. Exclusion of infarction is particularly important when coronary revascularization is contemplated. Since the MB CPK isoenzyme is relatively specific to myocardium, we assayed CPK isoenzymes in plasma samples from 184 patients undergoing cardiac catheterization to determine whether CPK elevations accompanying catheterization can be distinguished from those associated with myocardial infarction. Samples were obtained every 2 hr for 24 hr, and CPK isoenzymes quantified by a kinetic fluorometric method. Total plasma CPK increased in all patients (mean peak 0.238 ± 0.042 (SD) IU/ml) but MB CPK remained normal in 181 patients (<0.005 IU/ml). In the three remaining patients, MB CPK was elevated and myocardial infarction was confirmed by99mTc (SN) pyrophosphate scan. Twelve patients after catheterization, in whom no intramuscular premedication was given, exhibited only minimal elevation of total plasma CPK. In contrast, 100 control patients with acute myocardial infarction exhibited peak total CPK activity averaging 0.833 ± 0.037 (SD), and MB CPK was elevated in all cases (0.078 ± 0.027 (SD) IU/ml). Thus, CPK elevations after catheterization reflect release of enzyme from noncardiac sources rather than from injured myocardium. Furthermore, increased plasma MB CPK activity may be considered a reliable index of myocardial infarction in patients undergoing cardiac catheterizati

ISSN:0098-6569    

DOI:10.1002/ccd.1810020405

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

年代:1976

数据来源: WILEY

摘要:

AbstractThe contrast agents used for cardiac angiography have pharmacologic effects on the myocardium and on peripheral and coronary circulations. These effects are a stress to the left ventricle. We have studied the sequential changes in heart rate, LVEDP, positive and negative dP/dt in 34 patients following left ventriculography. These patients were divided into three groups: nine normal patients, 14 patients with valvular or coronary artery disease and abnormal left ventricular function at rest, and 11 patients with significant coronary artery stenosis but normal left ventricular function at rest. Changes in dP/dt most clearly defined the normal and abnormal response. In the normal group the mean positive dP/dt rose abruptly at 30 sec after the ventriculogram, whereas the abnormal group showed a mean decrease. The extent of change varied, however, for patients within each group. Negative dP/dt decreased in both groups but more so in the abnormal group. As did the other groups, patients with coronary artery disease but with normal ventricular function showed individual variation in response. Their mean changes in positive and negative dP/dt were intermediate. Positive dP/dt decreased at 30 sec (similar to, but less than, the group with abnormal ventricular function) and negative dP/dt also diminished at 30 sec with a mean value between the normal and abnormal groups. The results of this study support the concept that left ventricular dysfunction may be elicited by the stress of contrast injection. More importantly, such dysfunction seen both with abnormal and normal left ventricles at rest, may be reflected by the relatively simple measurement of positive dP/dt after ventriculography.

ISSN:0098-6569    

DOI:10.1002/ccd.1810020406

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

年代:1976

数据来源: WILEY

摘要:

AbstractTrue mixing of venous blood in the absence of shunt occurs in the pulmonary artery. In the presence of left to right shunt at a level proximal to the pulmonary artery, mixed venous blood for oxygen saturation (MVO2) is estimated by using an average of blood samples taken from the chamber proximal to the shunt. In atrial septal defect, the determination of MVO2is calculated by using blood samples from the superior vena cava (SVC) and the inferior vena cava (IVC). Several formulas have been proposed, utilizing varying combinations of blood samples taken from the SVC and IVC. In the present investigation, 100 patients without evidence of shunt were studied during routine cardiac catheterization. Duplicate blood samples were taken from the pulmonary artery (PA), the SVC, and the IVC, and were analyzed for oxygen‐saturation. If one assumes that the PA blood sample represents true venous blood mixing (TMVO2), the following formulas were used for comparison: (1) PA = SVC; (2) PA = IVC; (3) PA = (SVC + IVC)/2; (4) PA = (2SVC + IVC)/3; (5) PA = (3SVC + IVC)/4; and (6) PA = (2IVC + SVC)/3.When one uses the standard two variable regression equations, this study shows that the 90% confidence limits are wide. The correlation, however, is somewhat better if one uses the formulas (3‐6). Therefore, the error that may be introduced in calculating the TMVO2may be substantial and can critically alter the estimation of the shunted blood vol

ISSN:0098-6569    

DOI:10.1002/ccd.1810020407

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

年代:1976

数据来源: WILEY

摘要:

AbstractCineangiographic measurements of cardiac structures require knowledge of the magnification factor due to nonparallelity of the X‐ray beams. A new method is presented to determine the magnification factor from cineangiograms based on the patient's height and the height of three vertebral bodies and the adjacent intervertebral distances. The method enables measurement of cardiovascular structures from projected cineangiographic films where the appropriate magnification factor is missing. Furthermore, doubtful magnification factors can be checked out as to their accurac

ISSN:0098-6569    

DOI:10.1002/ccd.1810020408

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

年代:1976

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810020409

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

年代:1976

数据来源: WILEY

摘要:

AbstractThe hemodynamic effects of nifedipine and propranolol administered intravenously were studied in 17 patients with angina pectoris. Nine patients received nifedipine and eight received propranolol. The hemodynamic parameters were compared at rest and during supine bicycle exercise at work loads known to produce angina. Exercise‐induced angina improved in four out of nine patients following nifedipine and in one out of eight patients following propranolol. Nifedipine significantly reduced the increment of left ventricular end‐diastolic pressure and Vmaxduring exercise. Intravenous propranolol significantly suppressed the increment of heart rate, max dp/dt, tension time index, and Vmaxduring exercise. Although the exact mode of action of nifedipine remains uncertain, it is suggested that it decreases myocardial oxygen requirements primarily through a reduction of left ventricular volume, whereas propranolol suppresses the positive chronotropic and inotropic responses of the heart muscle to exerc

ISSN:0098-6569    

DOI:10.1002/ccd.1810020410

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

年代:1976

数据来源: WILEY

摘要:

AbstractClinical and hemodynamic benefits have been documented after giving diazepam to patients with coronary heart disease. The mechanisms by which this agent produces its hemodynamics effects are poorly understood. Partial autonomic blockade was induced in 10 patients by the intravenous administration of 5 mg propranolol and 0.8 mg atropine. Coronary and systemic hemodynamics were normal before and unchanged (p>0.05) after propranolol and atropine administration. However, myocardial extraction of lactate improved in 9 out of 10 patients (from 11% to 24%, p<0.05). The patients then received 0.1 mg/kg diazepam intravenously. Diazepam had no effect on the coronary sinus blood flow and resistance while myocardial extraction of lactate further improved in all but one patient (from 24% to 35% at 5 min and 34% at 15 min, p<0.05). Heart rate increased by a mean of 4 beats at 5 min (p<0.01). Cardiac output was unchanged. Systolic arterial pressure (SAP) decreased significantly (p<0.001) at 5 and 15 min (6–10%) and left ventricular end‐diastolic pressure (LVEDP) also diminished significantly (p<0.001) at 5 and 15 min (18–19%). These changes occurred despite autonomic blockade. These findings suggest, in the absence of change of myocardial blood flow and contractility, a direct peripheral action of the drug on arteries and/or

ISSN:0098-6569    

DOI:10.1002/ccd.1810020411

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

年代:1976

数据来源: WILEY