Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Nov 1994
Balancing the circulation: theoretic optimization of pulmonary/systemic flow ratio in hypoplastic left heart syndrome.
This study examined the effects of the pulmonary (QP)/systemic (QS) blood flow ratio (QP/QS) on systemic oxygen availability in neonates with hypoplastic left heart syndrome. ⋯ This analysis provides a theoretic basis for balancing both the pulmonary and systemic circulation and suggests that evaluating both systemic arterial and venous oxygen saturation may be a useful way to determine the relative pulmonary and systemic flows. When high systemic arterial and low systemic venous oxygen saturation are present, pulmonary blood flow should be decreased; conversely, when both low systemic arterial and venous oxygen saturation are present, more flow should be directed to the pulmonary circulation.
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J. Am. Coll. Cardiol. · Nov 1994
Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race.
Utilization rates for cardiac catheterization and cardiac surgery in the Department of Veterans Affairs (VA) health care system were studied to determine whether racial differences existed in a delivery plan in which access is not determined by patient finances. ⋯ Racial differences in resource utilization exist in a health care system in which economic influences are minimized. The pattern of these differences depends on numerous variables and suggests both biologic and sociocultural factors as underlying causes.
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J. Am. Coll. Cardiol. · Oct 1994
Comparative Study Clinical Trial Controlled Clinical TrialHemodynamic effects of inhaled nitric oxide in heart failure.
This study was performed to assess the utility of inhaled nitric oxide as a selective pulmonary vasodilator in patients with severe chronic heart failure and to compare its hemodynamic effects with those of nitroprusside, a nonselective vasodilator. ⋯ Inhaled nitric oxide is a selective pulmonary vasodilator in patients with pulmonary hypertension due to left heart failure and may identify patients with reversible pulmonary vasoconstriction in whom agents such as nitroprusside cause systemic hypotension. Inhaled nitric oxide causes an increase in left ventricular filling pressure by an unknown mechanism.
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J. Am. Coll. Cardiol. · Oct 1994
Dobutamine stress echocardiography: detection of coronary artery disease in patients with dilated cardiomyopathy.
This study attempted to determine the safety and accuracy of dobutamine stress echocardiography for detection of coronary artery disease in patients with dilated cardiomyopathy. ⋯ Dobutamine stress echocardiography safely provides diagnostic information in patients with dilated cardiomyopathy. This technique has high sensitivity for multivessel coronary artery disease but only moderate specificity.
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J. Am. Coll. Cardiol. · Oct 1994
Clinical TrialT wave changes consistent with epicardial involvement in acute myocardial infarction. Observations in patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis.
This study was designed to evaluate the presence or absence of atypical T wave evolution in patients with a postinfarction pericardial effusion but without clinically recognized postinfarction pericarditis. A second purpose was to evaluate the frequency of atypical T wave evolution in a previous study of postinfarction pericarditis. ⋯ The high sensitivity of atypical T wave evolution in diagnosing regional postinfarction pericarditis was confirmed. However, similar T wave alterations were also observed when a postinfarction pericardial effusion existed in the absence of clinically recognized pericarditis. Fifteen percent of patients with atypical T wave evolution had a non-Q wave infarction with definite or inferred pericardial involvement. Thus, the presence of atypical T wave evolution may be a more sensitive indicator of a transmural infarction than the development of a Q wave.