American heart journal
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American heart journal · Oct 1976
Case ReportsAcute coronary occlusion following blunt injury to the chest in the absence of coronary atherosclerosis.
A 35-year-old man suffered transmural diaphragmatic wall infarction immediately after receiving a nonpenetrating trauma to his chest. During subsequent months crippling angina pectoris developed and coronary arteriography was performed. ⋯ In contrast to most cases previously published, in this case no signs of atherosclerosis were observed in the other coronary arteries. It must be assumed, therefore, that blunt trauma can induce complete coronary occlusion with infarction, even in subjects with normal coronary arteries.
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American heart journal · Aug 1976
Comparative StudyLiving with prosthetic heart valves. Subsequent noncardiac operations and the risk of thromboembolism or hemorrhage.
A total of 111 survivors of prosthetic valve insertion were followed an average of 4 years to assess the risk of thromboembolism or hemorrhage. Non-cloth-covered ball and/or disc valve prostheses were used, and all patients received long-term anticoagulant therapy. During the follow-up period the patients with mitral or combined valve replacement suffered four times more thromboembolic episodes and had a poorer survival rate than the patients with isolated aortic valve replacement. ⋯ Unanticipated hemorrhage was encountered in four of nine patients in whom anticoagulation was maintained during surgery. Cessation of anticoagulation for 3 to 5 days appears safe in patients with aortic prostheses who require subsequent noncardiac operations. The incidence of thromboembolism in patients after mitral or combined valve replacement is high and constitutes a major risk whether or not a subsequent operation is required.
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American heart journal · Sep 1975
Hemodynamic and metabolic effects of isosorbide dinitrate in chronic congestive heart failure.
To assess the potential beneficial effects of a nonparenteral vasodilator, sublingual isosorbide dinitrate (5 to 15 mg.) was administered in 12 patients with chronic congestive heart failure refractory to conventional therapy. Hemodynamic measurements were performed before and at 15 minute intervals after drug administration for 90 minutes. Venous capacitance was measured at 5 minute intervals. ⋯ These data demonstrate that the objectives of therapy in congestive heart failure, namely improved forward output and decreased ventricular filling pressures, can be achieved without metabolic deterioration by using sublingual isosorbide. The mechanisms responsible are related to diminished impedence to ventricular ejection and peripheral pooling of blood. Since the duration of action does not usually exceed 90 minutes, frequent drug administration may be a source of patient inconvience.