Journal of cardiology
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Journal of cardiology · Sep 1995
Multicenter Study[Electrocardiographic characteristics of patients with left circumflex-related myocardial infarction in the acute phase without tented T waves or definite ST elevation].
Acute myocardial infarction (AMI) causing ST depression and T wave inversion has been diagnosed as subendocardial or non-Q myocardial infarction. However, some patients eventually develop strictly posterior infarction with a lesion of the left circumflex coronary artery (LCX). This study attempted to determine the electrocardiographic (ECG) characteristics of such myocardial infarction in 32 patients with definite AMI in whom ECG showed no hyperacute T waves or ST elevation and the LCX was an infarct-related coronary artery. ⋯ From these results we identified new ECG criteria: 1) R/S ratio in leads V1 or V2 > or = 1, 2) R wave > or = 0.7 mV in lead V1, 3) T wave > or = 0.5 mV in lead V1. Considering any of the above criteria as positive, the sensitivity was 72.0%, the specificity 87.9%, and the diagnostic accuracy 86.7% on the 14th day. These new ECG criteria of strictly posterior myocardial infarction with the LCX as an infarct-related coronary artery apply at less than 6 hours or at 24 hours from the onset of the symptoms.
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Journal of cardiology · May 1994
Case Reports[Diagnosis of sinus venosus atrial septal defect by transesophageal color Doppler and two-dimensional echocardiography].
Diagnosis of sinus venosus atrial septal defect based on transthoracic color Doppler and two-dimensional echocardiography is often difficult. We recently experienced two cases of sinus venosus atrial septal defect which were correctly diagnosed using transesophageal color Doppler and two-dimensional echocardiography. Transthoracic color Doppler flow imaging did not demonstrate the atrial septal defect or the shunt flow across the defect in either case. ⋯ Transesophageal color Doppler flow mapping also demonstrated the flow signal of the right upper pulmonary vein into the right atrium near its junction with the superior vena cava in each case. The diagnoses of sinus venosus atrial septal defect and combined partial anomalous pulmonary venous return were confirmed by surgery in both cases. Transesophageal color Doppler and two-dimensional echocardiography are very useful in diagnosing sinus venosus atrial septal defect and combined partial anomalous pulmonary venous return.
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Journal of cardiology · May 1994
[Detection of right-to-left shunt flow in atrial septal defect using transesophageal color and pulsed Doppler echocardiography].
The clinical significance of right-to-left (R-L) shunt flow dynamics in atrial septal defects (ASD) were investigated using transesophageal color and pulsed Doppler echocardiography in 30 patients with ASD of the ostium secundum type, including 20 with systolic pulmonary artery pressures (sPA) less than 40 mmHg, 4 with sPA of 40 to 60 mmHg, 3 with sPA of 90 mmHg or greater, 2 with pulmonic stenosis and 1 with Ebstein's anomaly. R-L shunting was detected by a shunt flow signal across the defect during a cardiac cycle. The timing of the R-L shunt was compared with various parameters obtained by echocardiography or cardiac catheterization. ⋯ R-L shunt flow during atrial systole was detected in three patients with severe pulmonary hypertension and two with pulmonic stenosis. The severe pulmonary hypertension patients, in particular, showed the aliasing signal as a high speed shunt flow, and in two of these, R-L shunt flow continued from atrial systole to early ventricular systole, and was also observed in early diastole. R-L shunt flow was detected in ASD patients with and without pulmonary hypertension, and was influenced by right atrial pressure at the phase of tricuspid valve closing, volume or direction of tricuspid regurgitation, rebound flow due to massive left-to-right shunt flow, grade of right ventricular distensibility or pulmonary hypertension, and other cardiac complications.
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Journal of cardiology · Jan 1993
Comparative Study[A newly-devised nine-lead Holter system for diagnosing myocardial ischemia evaluated using Tl-201 exercise scintigraphy].
A 9-lead Holter monitoring apparatus was devised using a commercially-available 3-lead Holter recorder. The CM5 lead was monitored continuously on channel 1, and our apparatus was applied to channels 2 and 3. Channel 2 was switched serially to V1-like (CM1), V4-like (CM4), V2-like (CM2) and V3-like (CM3) leads every 20 sec. ⋯ Both the percent extent score and percent severity score in the latter group were significantly higher than those in the former group (p < 0.001, p < 0.01, respectively), suggesting that the degree of ST depression in the LB lead reflects the degree of myocardial ischemia. The HL and LL leads had high sensitivity and specificity for detecting lateral ischemia. It was concluded that the CM5 lead is necessary for screening global myocardial ischemia and that leads LB and HL (or LL) are mainly useful for detecting inferior and lateral ischemia.
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Journal of cardiology · Jan 1993
[Serial changes in hemostatic and fibrinolytic states induced by coronary thrombolytic therapy].
The effects of coronary thrombolytic therapy with urokinase on the intrinsic hemostatic and fibrinolytic states were investigated by determining several markers for hemostatic and fibrinolytic activities in 6 patients with acute myocardial infarction who underwent coronary thrombolysis with urokinase. The markers for hemostasis and fibrinolysis were: markers for plasmin generation [alpha 2-plasmin inhibitor (alpha 2-PI), plasminogen, plasmin alpha 2-PI complex (PIC)]; markers for fibrinolysis [fibrin/fibrinogen degradation products-E fragment (FDP-E), FDP D-D dimer (D dimer), fibrinogen]; markers for hemostatic activity (prothrombin time (PT), antithrombin III (AT-III), protein C); markers for thrombin generation [thrombin antithrombin III complex (TAT)]; markers for intrinsic fibrinolytic activity [tissue plasminogen activator plasminogen activator inhibitor complex (TPA PAI complex)]. These markers were measured before, at 1 to 2 hours intervals during first 6 hours, daily during the next 3 days, and subsequently on the 7th and the 14th day after urokinase therapy. ⋯ TAT increased from 13.1 +/- 15.4 to 70.8 +/- 65.8 ng/ml soon after fibrinolysis occurred, indicating that thrombin generation occurred at the same time as fibrinolysis. The TPA PAI complex level before urokinase administration (26.4 +/- 6.4 ng/ml) was greater than the normal upper limit, indicating increased intrinsic fibrinolytic activity, then decreased after urokinase administration. These findings suggested that urokinase administration might affect the intrinsic fibrinolytic activity.(ABSTRACT TRUNCATED AT 250 WORDS)