The Stress Test.

I felt good about myself, driving to the free medical clinic that evening. A full professor at a medical school, leaving my warm home on a cold night after a day at the hospital, seeing patients in clinic in the morning and teaching second-year students medical ethics in the afternoon (autonomy was the theme; we'd covered beneficence and maleficence earlier in the week). Once a month, patients with cardiac problems come to the clinic, and this was the night.

When I Take Off My White Coat….

Lay persons might think physicians spend all their time in hospitals or clinics or that physicians fly their private jets to exclusive resorts for long weekends. But physicians are regular people just like their patients, and, when not on the job, they do many of the same things for the same reasons: playing with pets and doing sports, music, and art. Physicians might not have a blue-ribbon dog, might not have played varsity basketball in college, might not have gone to Julliard before medical school, might not have had one-person exhibits at the Metropolitan Museum of Art, but what they do when they are not wearing their white coats can make them better physicians when they put the coats back on again.

Transradial right and left heart catheterizations: a comparison to traditional femoral approach.

Objectives: This study compares the transradial versus transfemoral approach to combined right- and left-heart catheterization.

Background: Central venous access from peripheral veins has been a historically useful technique. Although the need for right-heart catheterization has been considered an exclusion for transradial catheterization, we have combined a peripheral approach to the central venous system with radial arterial access which permits bilateral heart catheterization using a transradial approach.

Differential release of cardiac enzymes after percutaneous coronary intervention.

We hypothesized that using calcium channel blockers (CCBs) that dilate microvasculature during percutaneous coronary intervention (PCI) would result in lower postprocedural creatine phosphokinase (CPK). PCI can be complicated by elevated CPK that has been associated with impaired microvascular perfusion. Nitroglycerin (NTG), the conventional PCI vasodilator, dilates epicardial arteries but does not affect the microvasculature.

Usefulness of hyperglycemia in predicting renal and myocardial injury in patients with diabetes mellitus undergoing percutaneous coronary intervention.

A retrospective analysis of 165 patients who had diabetes mellitus and underwent percutaneous coronary intervention (PCI) between 1998 and 2003 demonstrated that those whose plasma glucose levels were >/=200 mg/dl before PCI exhibited greater creatine phosphokinase release and serum creatinine increases after PCI. These observations identified hyperglycemia as a potentially modifiable mediator of myocardial and renal injuries in patients who have diabetes and have undergone PCI.

Cardiac catheterization in morbidly obese patients.

The safety and findings of cardiac catheterization and coronary angiography in morbidly obese patients with suspected coronary heart disease (CHD) have not been fully examined in the modern era. From a database of 4,978 patients undergoing diagnostic cardiac catheterization, we identified 110 with morbid obesity (body mass > or = 145 kg and body mass index > or = 40 kg/m(2)). Relative to all the other patients in this database, morbidly obese patients had a lower prevalence of CHD (45% vs.

Endothelium-derived nitric oxide reduces baseline venous tone in awake instrumented rats.

To determine whether nitric oxide, which is likely endothelium-derived relaxing factor (EDRF), modulates baseline venous tone, the effects of intravenous NG-monomethyl-L-arginine (L-NMMA) (3-25 mg/kg), an EDRF inhibitor, on mean circulatory filling pressure (MCFP) were determined in 10 awake instrumented rats. MCFP, the equilibrated systemic pressure occurring when the circulation is arrested by transient inflation of a balloon in the right atrium, is a measure of total venous capacitance. L-NMMA caused a dose-dependent increase in mean arterial pressure and a dose-dependent decrease in heart rate.

Aging increases venous compliance in awake instrumented rats.

To determine the effects of aging on total venous compliance, mean circulatory filling pressure (MCFP) was determined at several different blood volumes in 10 young (10-mo-old) and 10 older (30-mo-old) awake instrumented male Fischer 344/Brown Norway hybrid rats. Baseline weight and mean arterial pressure were similar in the two groups; heart rate was higher in the young (426 +/- 9 beats/min) than in the older rats (376 +/- 8 beats/min). Although MCFP was similar in the two groups at baseline blood volume, MCFP rose less with transient volume expansion and fell less with transient volume depletion in the older rats.

Adenosine increases total venous capacitance in awake instrumented rats.

To determine the effect of adenosine on the venous system, mean circulatory filling pressure (MCFP) was determined during infusion of intravenous (i.v.) adenosine (66.

Ischemia-induced depressed systolic thickening is transiently augmented by remote coronary occlusion.

To determine if ischemia-induced depressed myocardial thickening can be augmented by remote coronary occlusion, posterior wall function (pulsed Doppler crystal) was measured before and after left anterior descending coronary artery occlusion in the presence of reduced circumflex coronary artery flow (of sufficient severity to reduce resting function) in an anesthetized open-chest canine preparation in which the circumflex was pump-perfused with carotid arterial blood. Left anterior descending coronary occlusion elicited an immediate significant increase in posterior bed thickening fraction (TF%) (3.7 +/- 1.

Intracoronary adenosine and papaverine do not increase myocardial systolic thickening.

Study Objective: The aim was to determine if myocardial systolic thickening increases when coronary flow is augmented by infusing intracoronary vasodilators (adenosine and papaverine).

Design: Systolic thickening fraction was measured with pulsed Doppler crystals and sonomicrometer crystals before and during the intracoronary infusion of adenosine and papaverine.

Subjects: Sixteen anaesthetized mongrel dogs were studied.

Effects of environmental temperature on the venodilatory response to nitroglycerin.

The venodilatory response to nitroglycerin (0.8 mg sublingually) was measured in 10 healthy young male volunteers in a cool [24.3 +/- 0.

Relation between anterograde blood flow through a coronary artery and the size of the perfusion bed it supplies: experimental and clinical implications.

The relation between anterograde blood flow through a coronary artery and the size of the perfusion bed it supplies is not known. Accordingly, the left circumflex coronary artery was cannulated and perfused with arterial blood in 12 open chest mongrel dogs. In Group I dogs (n = 7), the goal was to correlate the size of the perfusion bed with the magnitude of anterogradely derived myocardial blood flow.