European heart journal
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Both the hibernating and the stunned myocardium are characterized by reversible contractile dysfunction. In hibernating myocardium, perfusion is still reduced, whereas in stunned myocardium blood flow is fully or almost fully restored. Both the hibernating and the stunned myocardium retain an inotropic reserve. ⋯ Myocardial stunning per se requires no therapy at all, since, by definition, blood flow is normal and contractile function will recover spontaneously. If, however, myocardial stunning is severe, and it involves large parts of the LV and thus impairs global LV function, it can be reversed with inotropic agents and procedures. In the experimental setting, anti-oxidant agents, calcium antagonists and ACE inhibitors attenuate stunning, but most effectively when administered before ischaemia.
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European heart journal · Sep 1995
Randomized Controlled Trial Clinical TrialBeta adrenergic blockade does not improve effort tolerance in patients with mitral stenosis in sinus rhythm.
This study was designed to assess the effects of beta-blockade on cardiopulmonary exercise performance in symptomatic patients with tight mitral stenosis in sinus rhythm. ⋯ Beta-blocker therapy in tight mitral stenosis appears to have no beneficial effect on aerobic capacity, nor does it improve ventilatory performance. Adequate beta-blockade may adversely effect peak oxygen consumption.
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European heart journal · Sep 1995
Use of changes in ST segment elevation for prediction of infarct artery recanalization in acute myocardial infarction.
The role of the ECG in evaluating reperfusion status after thrombolytic treatment in acute myocardial infarction is not clear. Dramatic ST segment changes have been observed during recanalization of an infarct-related artery, but ST criteria have not been definitively established for prediction of coronary artery patency. Differences in ST segment changes in relation to infarct localization have not been evaluated, and further investigation is required into reciprocal ST depression, which provides information independent from ST elevation. Therefore, the aim of this study was to evaluate how early changes in ST segment elevations and depressions predict vessel patency after fibrinolysis for patients with anterior and inferior/lateral infarcts. ⋯ We conclude that analysis of ST segments on the standard 12-lead ECG offers valuable help in the early identification of successful recanalization of infarct-related arteries after thrombolytic therapy in patients with acute myocardial infarction. Use of the ratio of ST segment normalization according to the separate criteria for anterior and inferior/lateral infarcts gives the test a high sensitivity and specificity, even in the presence of interventricular conduction disturbances.
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European heart journal · Jul 1995
Multiplane transoesophageal echocardiography and morphology of regurgitant mitral valves in surgical repair.
An essential step in the surgical management of patients with mitral regurgitation, is a thorough understanding of the pathophysiological mechanism. This information can be obtained by multiplane transoesophageal echocardiography which displays all the components of the incompetent valve. ⋯ Multiplane transoesophageal echocardiography enabled components of the mitral valve to be examined systematically, and provided important information on the pathophysiological mechanism of mitral regurgitation before surgical repair. The method also allowed the surgical outcome to be assessed, offering the possibility of optimal repair.