European heart journal
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European heart journal · Dec 1988
Comparative Study Clinical Trial Controlled Clinical TrialEffect of physical exercise on pain thresholds and plasma beta-endorphins in patients with silent and symptomatic myocardial ischaemia.
In a double-blind study, eight patients with symptomatic myocardial ischaemia and nine with asymptomatic myocardial ischaemia were compared during physical exercise under naloxone (6 mg i.v.) or placebo. Plasma beta-endorphin, cortisol and catecholamines were measured before exercise, during maximal exercise, and 10, 20 and 60 min after exercise. A tourniquet pain test (on the forearm, under control of transcutaneous PO2), and an electrical pain test (intracutaneous electrode placed in the finger with the electrical stimulus under computer control and two-interval forced-choice psychophysical technique) were performed before exercise as well as immediately after, and 60 min after exercise. ⋯ Electrical pain thresholds, though on average higher in asymptomatic patients (2.21 mA vs. 0.79 mA), were not affected by exercise or naloxone. Asymptomatic patients required more time to reach pain thresholds in the tourniquet pain test (P less than 0.02). After exercise, tourniquet pain thresholds were significantly lower (P less than 0.01) under naloxone compared with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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European heart journal · Nov 1988
Case ReportsBreathlessness and hypoxaemia in the upright position after right pneumonectomy.
Dyspnoea after pneumonectomy is considered to be rarely the result of an intracardiac shunt. We report on four patients who were suffering from the rare syndrome of breathlessness and hypoxaemia in the upright position after right pneumonectomy because of an open foramen ovale with a right to left shunt, although pressures in the right heart were normal. All patients showed striking arterial desaturation which responded insufficiently to breathing 100% oxygen. The arterial saturation became normal after surgical closure of the defect.
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European heart journal · Sep 1988
Patterns of maximal spatial ST vector of S-T segment elevation in the right praecordial leads of the electrocardiogram in patients with acute inferior myocardial infarction.
Thirty patients with S-T segment elevation in the right praecordial leads during acute inferior myocardial infarction were studied by vectorcardiography. From the vectorcardiographic traces two types of maximal spatial ST vectors were seen. Their directions pointed either to: (1) the right-anterior-inferior, or (2) the right-posterior-inferior octant. ⋯ The direction of the vectors imply that in some patients there would be no S-T segment elevation in lead V4R. This study indicates that the use of S-T segment elevation in V4R, or several right praecordial leads, to claim that the maximal ST vector points to the right-anterior direction can be misleading. Without directional information, the use of single lead or several leads to detect the maximal spatial ST vector by a scalar electrocardiogram will give incomplete information.(ABSTRACT TRUNCATED AT 250 WORDS)
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European heart journal · Jul 1988
Case ReportsPercutaneous balloon valvuloplasty for calcific aortic stenosis. A treatment 'sine cure'?
Twenty-five elderly patients with calcific aortic stenosis, 12 male (48%) and 13 female (52%), mean age 74.8 +/- 7.6 years, underwent percutaneous aortic balloon valvuloplasty between March 1986 and September 1987. Twenty-two patients (88%) were in class III-IV of the New York Heart Association, 13 (52%) had a history of previous angina and 7 (28%) of syncopal attacks. All patients had been considered either unsuitable or high-risk candidates for aortic-valve replacement because of age or associated diseases. ⋯ At a mean follow-up of 13.0 +/- 5.0 months, an important functional improvement persisted in 14 patients (56%), no major changes in pre-valvuloplasty symptoms were observed in 3 patients (12%), while five patients (20%) required surgical treatment after a successful valvuloplasty because of recurrence of symptoms (late valve restenosis). Percutaneous aortic balloon valvuloplasty is a possible palliative therapy in elderly patients with calcific aortic stenosis. However, its inherent immediate risk, limited haemodynamic result and the possible development of valve restenosis at medium-term follow-up, suggest that the application of this technique should be limited to poor surgical candidates.
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European heart journal · Jan 1988
Clinical characteristics and survival experience of out-of-hospital cardiac arrest victims without coronary heart disease.
Of 270 patients successfully resuscitated from out-of-hospital cardiac arrest, 16% had no evidence of coronary heart disease. In these 43 patients, other forms of heart disease were found in 81% (35/43): cardiomyopathy in 18 patients, valvular disease in six, congenital heart disease in two, and primary arrhythmia in nine. ⋯ One- and two-year mortalities were 30% and 43%, respectively, for the group, which is similar to one-year (20%) and two-year (35%) mortalities of the 227 resuscitated patients with coronary heart disease. Patients who survive a sudden death experience and who have no evidence of coronary artery disease are a unique but heterogeneous group who usually have identifiable cardiac or pulmonary disease.