Cardiology
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This study evaluates the prognostic value of ST-segment depression and angina pectoris occurring alone or in combination during exercise testing performed 3 weeks after myocardial infarction in 281 of 570 consecutive survivors of acute myocardial infarction. Neither angina pectoris (36 patients) nor ST-segment depression of at least 1 mm (46 patients) correlated with the occurrence of acute coronary events (cardiac death, myocardial infarction, unstable angina pectoris requiring hospitalization) during the subsequent year. ⋯ However, the presence of angina and/or ST-segment depression was strongly correlated with the subsequent performance of coronary arteriography. This study indicates that acute coronary events cannot be predicted by clinical or ECG evidence of myocardial ischemia during exercise tests performed 3 weeks after acute myocardial infarction.
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Clinical Trial Controlled Clinical Trial
Left atrial appendage function determined by transesophageal echocardiography in patients with rheumatic mitral valve disease.
Left atrial thrombi have been considered to be the major source of systemic arterial embolization in patients with rheumatic mitral valve disease. Almost half of the left atrial thrombi are found in the left atrial appendage (LAA). To investigate LAA size and LAA contractile function in patients with rheumatic mitral valve disease, transesophageal echocardiographic and Doppler studies were performed in 61 patients. ⋯ LAA ejection fraction and LAA peak emptying velocity were lower in this group, too. A higher incidence of LAA SEC formation was found in these patients with rheumatic mitral valve disease (4/15 vs. 0/22; p = 0.021). There was no significant difference, however, in LAA thrombus formation between group 2 and its control group (1/15 vs. 1/22; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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Supraventricular tachycardia (SVT) in pediatric patients is usually associated with a better prognosis than that in adults. However, late recurrence of SVT has been recently described. A total of 90 patients who had their initial SVT episode before 15 years of age were retrospectively studied (2-228 follow-up months; median, 215 months). ⋯ Even though, about 40% of the patients whose initial attacks occurred during infancy had recurrences 5 years later. Only those who had the initial attacks during the prenatal period remained free from SVT recurrences. Patients with initial SVT episodes during infancy have a longer period without SVT attacks and a lower chance of recurrences; nonetheless, a substantial number of them had recurrence at later childhood except those with initial SVT attacks during the prenatal period.(ABSTRACT TRUNCATED AT 250 WORDS)
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beta-Blockers are known to protect a vulnerable aorta from acute dissection, as well as reducing the risk of recurrent dissection. This case presentation reports the history of a 60-year-old male suffering from acute aortic dissection following discontinuation of beta-blocker therapy. The patient has shown arterial hypertension for about 20 years treated solely by beta-blockers. ⋯ During the procedure, tamponade of the left ventricle occurred followed by cardiogenic shock. Postoperative management was complicated by prolonged respiratory therapy and acute gastrointestinal bleeding; 1-year follow-up showed no evidence of disease. Thus, in this case acute dissection may be the consequence of discontinuing the use of metoprolol, possibly due to uncontrolled hypertension or specific response to the beta-blocker.
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The venoarterial carbon dioxide tension gradient (P[v-a]CO2) was studied in patients with acute myocardial infarction. Seven patients with congestive heart failure (CHF group) and 10 patients without heart failure (control) were enrolled in this study. In all patients, hemodynamics were continuously monitored. ⋯ This finding was due to the elevated mixed venous carbon dioxide tension in the CHF group, since arterial carbon dioxide tension was the same in both groups. Analysis of a total of 42 measurements obtained during the therapeutic course in the CHF group revealed a correlation of P[v-a]CO2 with cardiac index (r = -0.3, p < 0.05), OER (r = 0.57, p < 0.001), SvO2 (r = -0.56, p < 0.001) and lactate (r = 0.62, p < 0.001). The increase in P[v-a]CO2 observed in acute heart failure suggests the evidence of intracellular acidosis despite the absence of acidemia.(ABSTRACT TRUNCATED AT 250 WORDS)