Spontaneous coronary arterial dissection causing acute myocardial infarction.

We report the case of a middle-aged female who presented with an acute inferior myocardial infarction treated with intravenous thrombolytics. Immediate coronary angiography demonstrated the presence of a spiral dissection and a large thrombus. After 1 week of anticoagulation the thrombus had resolved, but a large spiral dissection persisted.

Transvalvular left ventricular assistance in cardiogenic shock secondary to acute myocardial infarction. Evidence for recovery from near fatal myocardial stunning.

Objectives: The purpose of this study was to test the hypothesis that transvalvular left ventricular assistance would support the circulation in patients with cardiogenic shock secondary to acute myocardial infarction and allow recovery of function in patients with a reversibly damaged (stunned) left ventricle.

Background: Cardiogenic shock occurs in 7.5% of patients presenting with acute myocardial infarction, resulting in survival of only 20%.

Improved regional myocardial blood flow, left ventricular unloading, and infarct salvage using an axial-flow, transvalvular left ventricular assist device. A comparison with intra-aortic balloon counterpulsation and reperfusion alone in a canine infarction model.

Background: It has been suggested that left ventricular unloading at the time of reperfusion provides superior infarct salvage over reperfusion alone. The purpose of this study was to show that the Hemopump transvalvular axial-flow left ventricular assist device provides superior left ventricular unloading, ischemic zone collateral blood flow, and infarct size reduction compared with intra-aortic balloon counterpulsation and reperfusion alone.

Methods And Results: Eighteen dogs were instrumented with regional myocardial function sonomicrometers in the ischemic and control zones.

Comparison of silent and symptomatic ischemia during exercise testing in men.

Objective: To compare angina and ST-segment depression during exercise testing, as markers for coronary artery disease.

Design: Retrospective analysis of exercise test responses and cardiac catheterization results.

Setting: A U.

Comparison of ST segment/heart rate index to standard ST criteria for analysis of exercise electrocardiogram.

The objective of our study was to compare the discriminating power of a proposed ST segment/heart rate index with that of a standard method of assessing exercise-induced ST segment depression for diagnosing coronary artery disease. We used a cross-sectional retrospective analysis of exercise test and coronary angiographic data. The study took place in a 1,200-bed Veterans Affairs Medical Center; participants were 328 male patients who had undergone both a sign and symptom-limited treadmill test and coronary angiography.

"Recovery only" ST-segment depression and the predictive accuracy of the exercise test.

Study Objective: To clarify the predictive value of exercise-induced ST-segment depression occurring in recovery only, and to determine whether the addition of recovery data improves the interpretation of the exercise test.

Design: Retrospective analysis of data collected during exercise testing and coronary angiography.

Setting: A 1000-bed Veterans Affairs Medical Center.

Optimal sampling interval to estimate heart rate at rest and during exercise in atrial fibrillation.

To investigate the ideal sampling interval for the estimation of heart rate (HR) at rest and during exercise in atrial fibrillation (AF), maximal exercise testing with continuous electrocardiographic acquisition was performed in 10 patients with chronic AF (mean age 66 +/- 4 years) and 10 subjects in normal sinus rhythm (mean age 31 +/- 6 years). Measurements of HR were obtained at 9 different sampling intervals (1, 2, 3, 6, 10, 15, 20, 30 and 60 seconds) at rest and 7 different sampling intervals (1, 2, 3, 6, 10, 15 and 20 seconds) during the last 30 seconds of each minute during exercise. The HR obtained from each interval was compared with true HR (determined by a 4-minute sample at rest and by the last 30 seconds of each minute during exercise).