The purpose of this study was the determination of whether hemodynamic and pharmacologic factors influence the extent and severity of myocardial necrosis produced by coronary occlusion. In 48 dogs, 10 to 14 epicardial leads were recorded on the anterior surface of the left ventricle in the distribution and vicinity of the site of occlusion of a branch of the left anterior descending coronary artery. The average S-T segment elevation for each animal was determined at 5-min intervals after occlusion. This elevation was used as an index of the presence and severity of myocardial ischemic injury. The number of sites showing this elevation provided an additional measure of the size of the injured area. Occlusion alone raised the average S-T segment elevation from 0.22 ± 0.04 to 3.32 ± 0.37 mv (SEM). Isoproterenol, ouabain, glucagon, bretylium, and tachycardia given prior to a repeated occlusion increased the severity and extent of ischemic injury, while propranolol decreased it. Elevation of arterial pressure ...

Factors Influencing Infarct Size Following Experimental Coronary Artery Occlusions

The hibernating myocardium

http://www.saudident.com/album/data/media/2/valvular_heart_disease.pdf

ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)

ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease).

Cardiac tumors are a rare, but potentially curably form of heart disease A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic a variety of other cardiac and noncardiac diseases Presently, M-mode and two-dimensional echocardiography are utilized as safe, reliable, and noninvasive imaging modalities Seventy-five per cent of these tumors are benign, with myxoma accounting for 50% and rhabodomyoma comprising 20% of lesions Various histologic types of sarcoma are the predominant malignant cardiac neoplasms With strict attention to avoiding perioperative tumor embolization, surgical resection of these lesions can be accomplished with minimal morbidity and mortality Sixteen consecutive primary tumors of the heart have been surgically treated at Duke University Medical Center since 1966 with no perioperative deaths and no late recurrences

Primary cardiac tumors

Propranolol may offer an approach to the treatment of anginal pain which is refractory to conventional modes of therapy. Its efficacy may result from (1) lowering both left ventricular mechanical and metabolic requirements, (2) interference with sensory perception of anginal pain, or (3) blockade of adrenergic coronary vasoconstrictor activity which may precipitate angina in some subjects. Neither clinical nor resting physiologic data seem to be of value in predicting the response of a given patient to the drug.

Propranolol and Angina Pectoris

Idiopathic prolapse of the mitral valve is a common disorder, but many cases are clinically subtle. Thoracic skeletal abnormalities, reported recently to accompany the syndrome, may serve as an easily identifiable clinical indicator. The prevalence of these abnormalities was defined in 24 patients with proved prolapse of the mitral valve. The valvular syndrome was defined clinically, by echocardiography and, in seven cases, by left ventricular angiography. The skeletal deformities were defined clinically and radiographically. Pectus excavatum was present in 62 percent of the patients, “straight back” in 17 percent and severe scoliosis in 8 percent. Eighteen of the 24 patients (75 percent) had a definite thoracic skeletal deformity. The association of idiopathic prolapse of the mitral valve with these skeletal deformities may represent a forme fruste of Marfan's syndrome. Patients with “straight back” and pectus excavatum should be examined clinically and perhaps by echocardiography to exclude idiopathic prolapse of the mitral valve; when murmurs are present, a diagnosis of “pseudoheart disease” should not be made before mitral valve prolapse has been excluded.

Thoracic skeletal abnormalities in idiopathic mitral valve prolapse

Stimulation and sensing thresholds for cardiac pacing: Electrophysiologic and technical aspects

Familial cardiac myxoma: Emphasis on unusual clinical manifestations

This report describes inhibition of a normally functioning bipolar demand pulse generator by diaphragmatic myopotentials. Transient pacemaker suppression occurred repeatedly with deep respiration, straining, the Valsalva maneuver, coughing, sneezing and laughing. When the magnet was applied, none of these maneuvers inhibited the pacemaker. Extensive investigations ruled out an intermittent electrode problem such as a wire fracture or insulation break. Sensing of diaphragmatic myopotentials should be considered in the differential diagnosis of unexplained pacemaker pauses.

Robert A. Heinle

Papers

Propranolol and Angina Pectoris

Thoracic skeletal abnormalities in idiopathic mitral valve prolapse

Stimulation and sensing thresholds for cardiac pacing: Electrophysiologic and technical aspects

Familial cardiac myxoma: Emphasis on unusual clinical manifestations

Inhibition of bipolar demand pacemaker by diaphragmatic myopotentials.