International journal of cardiology
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This study examines the use of conductance catheters to assess human right ventricular volume. Ten patients undergoing diagnostic cardiac catheterisation underwent right heart catheterisation with a conductance catheter and micromanometer, and a thermodilution catheter before and after fluid loading. Parallel wall conductance (Vc), and the multiplication factor relating conductance and thermodilution derived stroke volumes (å) were derived at each steady state. ⋯ D. 0.16). Serial cycles recorded during volume loading defined an end systolic pressure-volume relation more reliably than a stroke work end diastolic volume relation. Thus, a conductance derived volume signal can be obtained in the human right ventricle which can be interpreted as a continuous and instantaneous index of right ventricular volume, allowing the construction of real time pressure-volume cycles.
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In inferior wall acute myocardial infarction, maximal ST-segment depression in left precordial leads (V4-V6) has been shown to be associated with increased in-hospital mortality, presumably due to coronary artery disease involving the left anterior descending coronary artery system. ⋯ In patients with inferior wall acute myocardial infarction, maximal precordial ST-segment depression in leads V4-V6 is suggestive of severe coronary artery disease involving the left anterior descending coronary artery or its diagonal branch.
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I describe a patient with bilateral trapezius myalgias as a presenting manifestation of group B streptococcal endocarditis. Diffuse myalgias occur in association with bacterial endocarditis. However, localized trapezius myalgias have not been reported. Physicians should consider the diagnosis of endocarditis in patients with this compliant.
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Comparative Study
Regression of left ventricular dilatation and hypertrophy after aortic valve replacement.
The aim of the study was to assess the influence of aortic valve replacement on left ventricular size and muscle hypertrophy according to the type of preexisting valve disease (aortic stenosis, insufficiency or combined disease). The study group consisted of 143 consecutive patients (pts) after aortic valve replacement (109 men, 34 women, mean age 48.1 +/- 10.9 years). Reason for the operation was aortic stenosis in 35 pts, aortic insufficiency in 64 pts and combined disease in 44 pts. ⋯ In patients with aortic valve disease the greatest hemodynamic improvement is observed 1 year after valve replacement. This is expressed by marked reduction of the left ventricular dimensions and wall thickness, without significant improvement of the ejection fraction. Further regression of left ventricle dimensions occurs in patients operated on due to predominant valve insufficiency, whereas regression of left ventricular hypertrophy is observed in patients with preexisting valvular stenosis.
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We retrospectively analyzed the clinical features of patients with non-rheumatic atrial fibrillation to identify risk factors of ischemic stroke. Non-rheumatic atrial fibrillation is associated with an increased risk of ischemic stroke. However, the predictors of ischemic stroke in non-rheumatic atrial fibrillation are unclear. ⋯ A Cox analysis revealed that endpoint 1 was significantly associated with age (risk ratio (RR) = 1.106, P = 0.0052), end-diastolic left ventricular dimension (RR = 0.882, P = 0.0393), end-systolic left ventricular dimension (RR = 1.149, P = 0.0323) and the thickness of the interventricular septum (RR = 1.493, P = 0.0111). Endpoint 2 was associated with age (RR = 1.122, P = 0.0004), left atrial dimension (RR = 1.057, P = 0.0666), end-diastolic left ventricular dimension (RR = 0.935, P = 0.0426), fractional shortening (RR = 0.880, P = 0.0001) and the thickness of the left ventricular posterior wall (RR = 1.644, P = 0.0004). The present results suggest that, in addition to left ventricular dimensions and left atrial dimension, left ventricular hypertrophy may be associated with ischemic stroke.