Showing papers in "Acta Cardiologica in 1980"

Pharmacokinetics and metabolism of diltiazem in man.

Abstract: Dilitazem, a coronary vasodilating agent, after oral administration of four different doses, was well and rapidly absorbed. The pharmacokinetics of the drug followed a two-compartment model, with a rapid distribution and an elimination with a half-life of 4-7 hours. After chronic treatment the pharmacokinetic parameters were practically unchanged and therefore no accumulation of the drug was observed. The comparison between capsule and tablet preparations showed that both forms had a similar bioavailability. Diltiazem was extensively metabilized and only a few percent of the drug was found in urine. Several metabolites, also present as conjugates, have been identified by means of gas chromatography-mass spectrometry.

Hemodynamic effects of physical training in established arterial hypertension.

Abstract: Six patients with established arterial hypertension have been studied before and after a three months period of regular intense physical training. After training the maximal oxygen uptake was 9.6% higher (P < 0.02) and the heart rate was lower at rest (-8 beats/min; NS) and during submaximal exercise (-12 beats/min; P < 0.001). This bradycardia was attended by a slight decrease in cardiac output and an increase in the arterio-mixed venous oxygen difference; the blood pressure was unchanged and, accordingly, the peripheral resistance were slightly increased after training (+ 17%, P < 0.005 at rest and + 6.5% NS during exercise). We concluded that physical training has no specific hypotensive effect in patients with established arterial hypertension; in these patients the changes induced by training are very similar to those observed in normal subjects or in patients with coronary artery disease.

Coronary risk factors predicting coronary and other causes of death in fifteen years.

Abstract: A multivariate analysis employing the multiple logistic function model has been performed for the prediction of coronary heart disease (CHD) deaths and of other causes of death as function of 14 coronary risk factors measured at entry examination in the pool of two Italian rural population samples, made of 1712 men aged 40-59 at entry and followed for 15 years. A limited number of factors--namely age, serum cholesterol, blood pressure, smoking habits, forced expiratory volume, diabetes--yielded significant coefficients variously associated each other in the different solutions. They were able to provide a satisfactory discrimination between cases and non cases, not only for CHD but also for other end-points including strokes, cancer and lung cancer in particular, chronic bronchitis, and all causes of death. A suggestive prediction of violent causes of death was possible thank to a significant coefficient attributable to blood pressure. Serum cholesterol was significantly contributory only in the prediction of CHD. The multipotentiality of some factors is stressed in view of the planning of community prevention programs directed towards several chronic conditions at the same time.

Internal mammary to pulmonary artery fistula associated with healed tuberculosis.

Abstract: An internal mammary to pulmonary artery fistula was diagnosed in a patient with a continuous machinery-like murmur over the right upper chest wall 23 years after she was treated for pulmonary tuberculosis.

Transient ECG changes during acute attacks of pancreatitis.

Abstract: Information on the prevalence of ECG abnormalities in patients with acute pancreatitis together with pertinent simultaneous laboratory data have been missing. This prospective study was undertaken in order to clarify these points. 54 patients with 72 acute attacks of pancreatitis were examined. 31 patients (57%) had transient ECG abnormalities. The ECG changes consisted mainly of unspecific T-wave changes (25 cases) and accelerated atrial or nodal rhythms (8 cases). The ECG changes were more common in patients with biliary etiology (80%) than in patients with alcoholic etiology (49%), probably partly due to the higher age of the patients with biliary disease. The laboratory data did not give any clue to the cause of the ECG changes. The authors believe that the ECG changes may be due to underlying ischemic heart disease unmasked by the stress of acute pancreatitis, and/or imbalance of the autonomous nervous system.

Right ventricular echocardiographic, vectorcardiographic and electrocardiographic study in cor pulmonale.

Abstract: An echocardiographic (echo), vectorcardiographic (VCG) and electrocardiographic (ECG) study of the right ventricle was carried out in 27 patients with chronic obstructive pulmonary disease and cor pulmonale. The subxiphoid echocardiographic approach was applied in all patients. The right ventricular internal diameter index (RVIDd), anterior right ventricular wall thickness (RVWT) and the ratio (R) intraventricular septum thickness/anterior right ventricular wall thickness were statistically different in the 27 patients compared to the 33 normals. All 27 patients had a RVIDd greater than 1.33 cm while in only 17 (63%, P less than 0.01) of these was right ventricular hypertrophy (RVH) detected with VCG or ECg criteria. In 20 patients the RVWT was measured and in 19 of these the RVWT was greater than 0.56 cm. In only one patient was the RVWT less than 0.56 cm. VCG or ECG criteria showed RVH in only 14 (70%) of these patients. The R was measured in 18 patients. All patients had R less than 1.99 and in only 12 (67%, P less than 0.01) of these was RVH diagnosed with VCG or ECG criteria. It seems that the RVIDd, the RVWT and the R are useful indexes for the detection of right ventricular dilatation and hypertrophy. Therefore echocardiography is superior to the conventional ECG and VCG in the recognition of right ventricular hypertrophy and dilatation.

Mitral annular calcification: clinical and echocardiographic features.

Abstract: One hundred records from patients with the single or two-dimensional echocardiographic (2DE) diagnosis of mitral annular calcification (MAC) were analyzed. 2DE manifestations of MAC included a characteristic bright structure located at the junction of the A-V groove and posterior mitral leaflet. Sixteen of the 100 patients had idiopathic hypertrophic subaortic stenosis (IHSS), a 44% (16/36) incidence in all patients with IHSS having echoes during the study period. IHSS patients with MAC were significantly older (mean 61 years vs. 43 years, p < .005) than 20 other IHSS patients without MAC studied during the same period. Both IHSS patients and non-IHSS patients with MAC had significantly lower serum calcium levels than normals or the IHSS patients without MAC. These observations support the view that the pathogenesis of MAC is related to degenerative changes from aging and increased stress on the mitral apparatus. Alterations in calcium metabolism possibly contribute to calcium deposition in the mitral annulus.

Serum myoglobin, total CK and MB CK isoenzyme after D.C. cardioversion and during the early phase of acute myocardial infarction.

Abstract: Myoglobin, total CK and MB CK isoenzyme were determined in the sera of 6 patients admitted with arrhythmias and treated with D.C. countershock and also in 37 patients with acute myocardial infarction or anginal syndrome. All the three tests were increased in patients with myocardial infarction. Serum myoglobin seems sufficiently sensitive and specific but the time required for the assay is a limiting factor for practical use in emergencies. After electrical cardioversion, myoglobin and CPK remain normal, although MB isoenzyme was increased in two of six patients. These results suggest that electrical cardioversion in itself does not influence serum levels of myoglobin. The occasional increase of MB CK observed after cardioversion seems to be the consequence of an easier release of the enzyme due to a myocardial injury.

Post-traumatic infarction due to blunt chest trauma. Report of two cases.

Abstract: A myocardial infarction may be caused by a blunt chest trauma. The myocardium may be directly contused or a coronary artery may be occluded. The present paper describes a patient in whom no obstructive lesions of the coronary arteries were found after a posttraumatic infarction and a second patient with a posttraumatic occlusion of the left anterior descendents. The first patient had an abnormal connection between the right coronary artery and the circumflex artery, which is also thought to be posttraumatic.

Effects of antiplatelet and calcium antagonist drugs on infarct size in rats.

Abstract: The authors performed the experimental model of infarct-like myocardial lesions in rats treated with large doses of ISP. Myocardial necrosis was assessed on the basis of serum enzyme changes as well as of gross and microscopic findings. The infarct size was measured by a direct enzymatic method assaying creatine kinase (CK) depletion in infarcted myocardium. Pretreatment of the infarcted rats with antiplatelet (Lysin Acetyl Salicylate) or calcium antagonist drugs (Verapamil or Nifedipine) allowed the reduction of the necrotic area. Since a smaller size of infarct was achieved through different types of interventions it should be suggested that ISP-myocardial damage is due to several effects of the drug involving metabolic, vascular and/or coagulative patterns.

Clinical evaluation of the antihypertensive effect of metoprolol in combination with hydrochlorothiazide and hydralazine in an unselected hypertensive population

Abstract: One hundred nineteen patients with essential hypertension (96 completing six months and 92 a one year study period) were randomized into four parallel groups and treated with one of four programs: 200 mg of metoprolol plus placebo; 200 mg of metoprolol plus 25 mg of hydrochlorothiazide; 200 mg of metoprolol plus 50 mg hydrochlorothiazide, or; 200 mg metoprolol plus 50 mg of hydralazine. Blood pressure reduction was significant in these all groups and no differences were observed in blood pressure reduction among the groups. During the one year therapy the levels of serum bilirubin, uric acid and triglycerides were significantly increased in all groups but the group treated with metoprolol and hydralazine. Serum cholesterol level did not increase in any group during the one year therapy. The results indicate that the combination therapy in mild to moderate hypertension should not be initiated before individual response to single drug therapy is evaluated. Antihypertensive drug treatment may cause some biochemical changes and those changes seem to be smallest patients treated with combination of beta-blocker and hydralazine.

Acute systolic hypertension after acute myocardial infarction: prognostic and therapeutic significance.

Abstract: In this study, the incidence of acute systolic hypertension (ASH) after acute myocardial infarction and the effects of this complication on the clinical course and prognosis of the disease were studied retrospectively in 950 cases. ASH was characterized as an elevation of systolic blood pressure over 170 mmHg for at least 30 minutes in a previously normotensive subject. There were 50 cases with ASH (5.3%) and 370 (38.9%) with normal blood pressures among the studied 950. The incidences of acute left ventricular failure and of arrhythmias such as sinus tachycardia, atrial and ventricular premature beats and ventricular tachycardia were significantly higher in the group with ASH in comparison with those with normal blood pressures. The group with ASH had also a greater average number of recurrent ventricular fibrillation attacks. The peak SGOT levels were found to be significantly increased in cases in whom the ASH sustained for more than 12 hours. The results suggested that the ASH which occurred predominantly in the early period of acute myocardial infarction was associated with more extensive myocardial damage resulting in a poor clinical course complicated by frequent ventricular arrhythmias and left ventricular failure. It is our conclusion that ASH after myocardial infraction is associated with relatively poor prognosis.

Transient right bundle branch block unmasking anteroseptal infarction concealed by left posterior fascicular block.

Abstract: A case of acute anteroseptal myocardial infarction (MI) associated with transient right bundle branch block (RBBB) and a probably persistent left posterior fascicular block is reported. When the RBBB disappeared, small initial r waves were present in the right precordial leads concealing the evidence of MI. Finally, the electrocardiographic pattern evolved to an atypical form of incomplete left bundle branch block. An hypothetic role of the middle septal fascicle in this electrocardiographic evolution is discussed.

Hemodynamic effects of parenteral and oral mexiletine.

Abstract: Intravenous mexiletine (250 mg in 10 min) given to patients at the acute stage of a myocardial infarction was responsible of a mild decrease of the left ventricular function; two of our patients presented bradycardia with hypotension, immediately corrected by atropine (i.v.). Adverse hemodynamic effects are seldom reported after oral administration.

Mitral valve replacement in a patient with mitral valve prolapse complicated by severe ventricular arrhythmias.

Abstract: A 52 years old woman with mitral valve prolapse and a history of 3 cardiac syncopes occurring during antiarrhythmic therapy underwent mitral valve replacement. Antiarrhythmic drugs had to be continued postoperatively but no major ventricular arrhythmias occurred after surgery.

Abnormal platelet aggregation measured by screen filtration pressure (sfp) in coronary heart disease: a new risk factor?

Abstract: Platelet aggregate filtration pressure PAFP) has been measured in 38 male coronary heart disease patients (CHD) free from "risk factors" for the development of arteriosclerosis. Significantly (p less than 0.05) higher mean PAFP values (mmHg) were found in the CHD group as compared to the "control" group. Such finding suggests, though does not demonstrate, the "independent" role of platelet hyperaggregation in the development of CHD.

Exercise tolerance as evidence of quality of life in CAD patients after coronary artery bypass by comparison with medical treatment.

Abstract: The effects of coronary artery bypass (CAB) by comparison with medical treatment were evaluated on exercise tolerance in 68 patients with stable angina on effort, who underwent coronary and left ventricular cineangiography. Stress tests were performed by bicycle ergometer before medical and surgical treatment, and 6 and 12 months thereafter. Thirty-five patients (31 males and 4 females; 7 with one 70% stenosed vessel, 12 with two, 16 with three) underwent CAB; 33 (30 males and 3 females; 9 with one 70% stenosed vessel, 11 with two, 13 with three), having refused CAB, only underwent medical treatment. Both groups were given long-acting oral nitrates, none received digitalis and/or propranolol; antiarrhythmic drugs were only administered in 5% of medical and 4% of surgical patients. Both groups at 6 and 12 months follow-up showed a significant improvement in exercise tolerance. Surgical patients showed a significant increase in exercise tolerance with lower angina incidence (from the preoperative 100% to 26% and 22%, respectively), higher work load (P < .001), and a significant reduction of S-T segment depression (P < .001). Medical treatment induced an increase of exercise tolerance; angina on effort decreased (from 100% to 74% and 72%, respectively) with higher work load, and a significant reduction of S T depression (in both cases P < .001). Comparing the data of the two groups, we observed that surgical patients showed higher exercise tolerance (P < .01), lower S-T depression (P < .001) and angina incidence. Our results suggest that surgical treatment is able to improve exercise tolerance more remarkably than medical treatment.

Left ventricular function after coronary artery bypass. Non-invasive study by systolic time intervals.

Abstract: Left ventricular function was evaluated with serial recording of STI intervals in 78 patients with stable angina on effort undergoing coronary and left ventricular cineangiography. On the basis of these data the patients were divided into four groups: OV) nor or mild coronary disease (n. 11); 1V) 70% stenosed vessel; 2V) two significantly affected vessels (n. 32); 3V) three significantly affected vessels (n. 18). Thirty-six patients (9 with one stenosis, 17 with 2, 10 with 3) underwent coronary artery bypass. Thirty-one 8 with one, 15 with 2, 8 with 3) refused the treatment in spite of the same clinical situation and were medically treated. Recordings were performed before medical and surgical treatment and after 6 and 12 months. Initial average values of the patients of 2V and 3V groups showed a shorter LVETI, longer PEPI and higher PEP/LVET ratio than those of 1V and 0V groups. Subjects of 2V group and abnormal left ventricular wall motion showed longer PEPI and higher PEP/LVET than patients of 2V without abnormal wall motion. On first evaluation no differences were observed between surgical and medical groups. The latter did not show any difference after 6 and 12 months. Surgical patients of 2V and 3V showed a longer LVETI, shorter PEPI and a lower PEP/LVET than the medical group. In the surgical group PEPI and PEP/LVET were significantly decreased after surgery while LVETI was prolonged. Our results suggest an improvement of left ventricular performance by coronary artery bypass in patients with coronary artery disease.

Prinzmetal's angina with Torsade de Pointes ventricular tachycardia.

Abstract: Two cases of Prinzmetal's angina with Torsade de Pointes Ventricular Tachycardia are described. The patients had severe obstructive coronary disease and developed the arrhythmias while on large doses of conventional antiarrhythmic therapy. Each patient developed multiple episodes of Torsade de Pointes which had to be terminated with defibrillation or right ventricular endocardial pacing. Both patients underwent successful aortocoronary by-pass graft surgery. The possible relationship of prolonged repolarization by the antiarrhythmic therapy and coronary occlusion to the development of Torsade de Pointes is discussed.

Bundle branch block in acute myocardial infarction. Current concepts and indications.

Abstract: The blood supply to the conducting system is reviewed. As a result of discrete lesion in individual coronary arteries, specific patterns of conduction disturbances arise during myocardial infarction. Inferior wall infarctions produce relatively benign arrhythmia with blocks proximal to the bundle of His. Anterior infarctions tend to produce malignant arrhythmias, with blocks distal to the bundle of His. The appearance of intraventricular conduction blocks and bundle branch blocks may often be the only indication of the development of high grade atrioventricular block. The mortality of patients post-myocardial infarction with different conduction disorders increases but varies according to the nature of the conduction disturbance. Based upon such information, recommendations for temporary and permanent pacing are developed.

Effect of temperature and calcium on the diastolic length-tension relationship of rat heart muscle.

Abstract: Experiments were performed on strips from the right ventricle of the rat in order to investigate the influence of temperature and Ca++-removal on the length-tension relationship. Temperature change (22-38 degrees) had no effect on the resting, non-stimulated muscle. The isometric minima curves of the electrically stimulated preparations at 18 degrees and 38 degrees (diastolic length-tension relationship), however, were shifted to the right compared to those at 28 degrees. When temperature decreased (at fixed muscle length), the diastolic tension surmounted a maximum at the optimal temperature (28 degrees) and declined with further cooling. Moreover the electrolyte exchange characteristics (Ca, K, Na), which follow upon a variation in temperature, were studied. The calcium content of the stimulated preparations showed a similar dependence on temperature as the diastolic tension, indicating that calcium might play a role with respect to the influence of temperature on the diastolic length-tension relationship. Indeed an addition of EDTA to the bath solution caused a parallel shift of the isometric minima curve to the right. These results show that an active mechanism might contribute to the increase of diastolic tension in response to stretch.

Preliminary clinical trial with a new hypotensive, guanabenz, in a group of hypertensive patients.

Abstract: In a small preliminary clinical trial of guanabenz in 16 hypertensives also under treatment with diuretics (hydrochlorothiazide and amiloride), blood pressure was safely and completely controlled in 10 (64%), the criterion for "control" being a reduction to the strict level specified by the Society of Actuaries (130/85 m lambda Hg). The dosage of guanabenz was adjusted upward from 16 mg/day until blood pressure normalized or side effects intervened. The 16 patients accumulated 97 months of guanabenz treatment. The 6 unsuccessful cases included only 2 outright therapeutic failures; the other 4 patients discontinued treatment for various reasons: dry mouth and nausea (with good blood pressure reduction); aggravation of existing depression; or generalized urticaria. The fourth patient discontinued for reasons unknown.

Tricuspid valve prolapse: Two-dimensional echocardiographic aspects

Abstract: Three patients with prolapse of the mitral and tricuspid valve are presented. The tricuspid valve prolapse was revealed by two-dimensional echocardiography and simultaneous M-mode echocardiogram.

Evaluation by multivariate analysis of changes in systolic time intervals during exercise in the supine and upright positions.

Abstract: In this study multivariate analysis was adopted to establish how simultaneous changes in heart rate (HR), blood pressure (BP) and work load (W) can affect systolic time intervals (STI). Thus, 13 normal volunteers underwent two consecutive exercise stress tests in the supine and upright position on a bicycle ergometer. By multivariate analysis it was shown that, while in the supine position left ventricular ejection time (LVET) is influenced by HR and W (LVET) = 330.6 - 0.76 HR - 0.41 W, F = 224, P is less than 0.001), in the upright position LVET changes are due only to HR variations (LVET = 309 - 0.88 HR, P is less than 0.001). Pre-ejection period (PEP) in both positions is related to HR and W, but this latter has a non-linear influence (supine: PEP = 110.9 - 0.15 HR -0.34 W + 0.0012 W(2), F = 56.4, P is less than 0.001; upright: PEP = 119 - 0.16 HR - 0.5 W + 0.0025 W(2), F = 86.7, P is less than 0.001). Finally, PEP/LVET ratio is correlated both in the supine and upright position with maximal BP, HR and W; however, the influence of HR and BP is different in the two positions (supine: PEP/LVET = 0.259 + 0.00047 BP + 0.00068 HR - 0.00167 W + 0.000013 W(2), F = 5.68, P is less than 0.01; upright: PEP/LVET = 0.201 + 0.0011 HR - 0.00371 W + 0.00016 W(2), F = 4.79, P is less than 0.01).

[The relation between polyunsaturated fatty acids and cardio-vascular accidents. I. Study of fatty acid components phospholipids].

Abstract: Blood plasma lipids of women about seventy years old who had suffered from cardiovascular diseases (AVC) were studied and compared with the plasma lipids of women of about the same age without cardiac troubles. A great difference appears in the unesterified fatty acids of the phospholipids from cardiac women: we have observed a decreasing level of polyunsaturated fatty acids with a carbon chain of more than 18 carbons, and a decreasing ratio between the total concentration of the two precursors (linoleic acid omega and alpha-linolenic acid omega 3) and the total concentration of their long chain polyunsaturated derived fatty acids. On the contrary, we did not observe any significant variation of the unesterified fatty acid level in the plasma. The triglyceride and cholesterol levels also were not different between the two groups of patients. The hypothesis of a lack of elongation and of desaturation of linoleic and alpha-linolenic acids by competitive inhibition with oleic acid seems improbable, since the plasmatic concentration of oleic acid was not statistically different.

Hemodynamic complication of ventricular stimulation in a patient with moderate aortic stenosis

Abstract: This report is concerned with a patient aged 76 with mild to moderate aortic stenosis and transient A-V block who was treated by stand-by intracardiac pacing. In spite of this, the patient continued to present syncopal attacks. It is demonstrated that these episodes were related to dramatic decreases of systolic blood pressure and cardiac output occurring whenever the right ventricle was paced. These hemodynamic alterations were secondary to the loss of atrial contribution to ventricular filling. They were suppressed by insertion of a sequential auriculoventricular pacemaker.

Complete obstruction of the common trunk of the left coronary vessel. Observation of a case

Abstract: A case of complete left main coronary artery obstruction is described. After an anterolateral and inferior subendocardial myocardial infarction, the patient remained symptomatic and underwent an angiographic investigation. Complete left main artery obstruction was disclosed and an important coronary collateral circulation was evidenced. This collaterality explains the absence of extensive transmural myocardial infarction of some patients with left main coronary artery thrombosis.

Bacterial endocarditis and echocardiography

Abstract: The authors present a case of enterococcal bacterial endocarditis in which a high degree of correlation was found between the echocardiographic findings and the anatomical lesions found at autopsy. They review the value of echocardiography as a simple non-invasive technique in the diagnosis and assessment of bacterial endocarditis.