Effect of nifedipine on exercise-induced left ventricular dysfunction and myocardial hypoperfusion in stable angina.

To assess the effects of nifedipine on left ventricular function and regional myocardial perfusion, exercise radionuclide ventriculography was performed in 15 men (median age 59 years) and exercise thallium-201 scintigraphy was done in 11 of them, before and 90 minutes after the oral administration of 20 mg of nifedipine. All patients had stable angina and angiographically proved coronary artery disease without evidence of spasm. Exercise tolerance after administration of nifedipine increased from 343 +/- 42 seconds to 471 +/- 50 seconds (p less than 0.

Comparison of cold pressor and exercise radionuclide angiocardiography in coronary artery disease.

To investigate the role of the cold pressor test (CPT) with radionuclide angiocardiography in the diagnosis of coronary artery disease (CAD), we performed angiocardiography in 52 patients (18 with angiographically normal coronary arteries and 34 with CAD) during the resting state, CPT, and supine bicycle exercise (EX). In normal subjects, left ventricular ejection fraction (EF) was unchanged between rest (58 +/- 9%) and CPT (59 +/- 9%, p = ns), but increased during maximal EX (69 +/- 9%, p less than 0.01).

Effects of digoxin on left ventricular function in coronary artery disease patients.

To assess whether digitalis modifies or prevents the deterioration of the left ventricular ejection fraction and wall motion during acute ischemia, we performed gated blood pool radionuclide ventriculograms in 15 patients with angiographically documented coronary artery disease. All patients were studied in the resting state and during maximal supine bicycle exercise, both before and 1 hour after 1 mg intravenous digoxin. There was no significant difference, pre-digoxin vs post-digoxin, in exercise tolerance (415 +/- 84 vs 418 +/- 107 seconds), number of segments with abnormal resting wall motion (12 vs 11) or exercise wall motion (21 vs 19).

Early post-myocardial infarction treadmill stress testing. An accurate predictor of multivessel coronary disease and subsequent cardiac events.

Limited (heart rate to less than or equal to 120 beats/min) standardized treadmill stress testing was done before hospital discharge in 40 survivors of uncomplicated acute myocardial infarction. Each patient had subsequent coronary arteriography. Twenty-one had inferior, 10, anterior, and nine, nontransmural infarctions; in 30 patients this was their first infarction.

Effects of exercise training on left ventricular performance and myocardial perfusion in patients with coronary artery disease.

To determine the effects of exercise training on left ventricular performance and myocardial perfusion in coronary artery disease, rest and exercise radionuclide angiocardiography and thallium-201 scintigraphy were performed before and after 12 weeks of training in 16 coronary patients. After training, 15 of the 16 patients had improved exercise tolerance; total treadmill exercise duration increased from (mean +/- standard error of the mean) 491 +/- 37 to 602 +/- 31 seconds (p less than 0.01), and the estimated rate of oxygen consumption (VO2 max) increased from 29.

Exercise-induced coronary arterial spasm: angiographic demonstration, documentation of ischemia by myocardial scintigraphy and results of pharmacologic intervention.

Exercise-induced coronary arterial spasm is an infrequently recognized phemonemon whose mechanism and management are not well established. In two patients with reproducible exercise-induced S-T segment elevation and angina pectoris thallium-201 scintigraphy showed areas of reversible anteroapical hypoperfusion, and gated radionuclide ventriculography revealed anteroapical hypokinesia with a decrease in left ventricular ejection fraction at peak exercise. During coronary arteriography supine exercise provoked occlusive spasm of the left anterior descending coronary artery, which at rest had only minimal plaques.

Regional pressure differences in the left ventricle.

Theoretically, if blood is to have directional flow and different magnitudes of velocity, pressure should be distributed in the left ventricle (LV) as a function of both space and time. Thus, regional pressure differences (RPD) were examined in the LV of 20 open-chested dogs. High-fidelity transducers were implanted through stab wounds at three positions in the LV: the base (B), equator (EQ), and apex (APX).

Demonstration of improved myocardial perfusion following aortic implantation of anomalous left coronary artery.

An adult with anomalous origin of the left coronary artery (originating from the pulmonary artery) had implantation of the anomalous vessel into the aorta. Exercise myocardial perfusion imaging with thallium-201, performed before and after the operation, disclosed a marked improvement in anterior-wall Tl-201 uptake. Postoperative isotope ventriculogram showed improved regional contraction in the revascularized anterolateral wall of the left ventricle.

Thallium-201 myocardial perfusion scintigrams in the evaluation of aorto-coronary saphenous bypass surgery.

The effect of aorto-coronary bypass graft surgery (CBG) upon regional myocardial perfusion (RMP) was studied in 23 patients using thallium-201 myocardial perfusing imaging after exercise. We compared the changes in RMP with the clinical status and ECG's during graded treadmill exercise (GTX) before and after CBG. After CBG, the New York Heart Association's "functional class" improved from 3.

Mönckeberg's arteriosclerosis revisited: or silver vessels among the old.

This study showed that Mönckeberg's arteriosclerosis was found in 23 patients over the age of 60. Diabetes or probable diabetes mellitus was found in 22 out of 23 of these patients. It is concluded that roentgenographic demonstration of MAS in this age group is highly specific for diabetes mellitus.

Mitral valve prolapse in coronary artery disease.

Mitral valve motion, left ventricular segmental contraction and severity of arterial stenosis were analyzed in 92 patients with coronary artery disease and 28 patients with "atypical chest pain" and normal coronary arterio-rams. Mitral valve motion was evaluated for the presence or absence of leaflet prolapse. Segmental contraction was evaluated by calculating the percent shortening of six chords of the left ventricle measured from right anterior oblique ventriculograms.

Echocardiographic findings in right coronary arterial-right ventricular fistula. Report of a neonate with fatal congestive heart failure.

Coronary arteriovenous fistula is a rare cause of congestive heart failure in the newborn. We describe a 2 day old infant with a large fistula between the right coronary artery and right ventricle that caused fatal congestive heart failure. An echocardiographic study revealed a large right ventricle, paradoxical motion of the interventicular septum and an enlarged aorta, suggesting an unusual location of a left to right shunt.