Sinus node hibernation resolved by PTCA.
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
A O Molajo
Publications and source records attributed to A O Molajo.
Anistreplase in early acute myocardial infarction and the one-year follow-up.
Of consecutive patients seen with first myocardial infarction (88 of whom were treated out-of-hospital by mobile coronary care staff), 139 received 30 units of intravenous anistreplase at a mean of 101 minutes (range 35-180) from onset of symptoms. Thrombolysis in myocardial infarction patency grade 2 or 3 was found in 76/91 (83.5%) patients. At 3-4 months after hospital discharge, the mean global left ventricular ejection fraction and mean infarct-related regional third ejection fraction declined with increasing delay to anistreplase. For the first, second and third hour administrations, global ejection fraction was 54%, 50% and 45% (P = 0.002) and for regional third ejection fractions 49%, 43% and 41% (P = 0.02) respectively. Of the patients, 130 were reviewed at approximately 1 year: reinfarction had occurred in 9, 6 had undergone coronary angioplasty and 1 had coronary arterial bypass grafting performed since discharge. Mean global left ventricular ejection fraction was 52% and mean infarct-related regional third ejection fraction was 51%. Thus, intravenous anistreplase induces high rates of arterial patency. Global and regional third ejection fractions decline with increasing delay in the time of administration of anistreplase. Mortality and morbidity is low in the first year.
Adult↗
Ectopic right coronary artery to pulmonary artery fistula masquerading as patent arterial duct.
A patient is described in whom communication between an ectopic right coronary artery and the main pulmonary artery presented with clinical features of a patent arterial duct. Full clinical data documented by Doppler echocardiography, cardiac catheterisation and intra-operative findings are described.
Adult↗
Comparison of once and twice daily oral dosing schedules of bevantolol, a new beta-adrenoceptor antagonist with alpha-adrenoceptor partial antagonist activity in patients with angina of effort.
In a placebo controlled double-blind cross-over study following a dose titration phase, we compared the efficacy of benantolol, a new beta 1 adrenoceptor antagonist with alpha-adrenoceptor partial antagonist activity at 12 and 24 hours after dosing in patients with angina of effort. Twenty patients aged 43-65 years were studied. Each study phase lasted four weeks. Efficacy was determined by treadmill exercise testing using the standard Bruce protocol at the end of each phase. Fifteen patients satisfactorily completed the study. Data from five protocol violators were not analysed. In the four patients who received bevantolol 200 mg daily, exercise time increased from 395 +/- 192 (mean +/- 1 SD) sec on placebo to 468 +/- 171 sec at 10-12 hours and to 442 +/- 230 sec at 22-24 hours after dosing with bevantolol. In the eleven patients who received bevantolol 400 mg daily, exercise tolerance of 290 +/- 103 sec on placebo increased to 408 +/- 112 sec at 10-12 hours (P = 0.001) and to 400 +/- 98 sec at 22-24 hours (P = 0.001) after dosing with bevantolol. Maximum exercise capacity at 10-12 and 22-24 hours after dosing with bevantolol were comparable. Maximum exercise heart rate and systolic blood pressure on placebo and on bevantolol at 10-12 and at 22-24 hours after dosing were comparable. Thus, bevantolol has salutary effects on exertional angina up to 24 hours after dosing.
Administration, Oral↗
Accelerated atherosclerosis and myocardial infarction complicating anomalous origin of the right from the left coronary artery.
A patient is described in whom a previously unstenosed single coronary artery was complicated 12 months later by anterior myocardial infarction. Full clinical features documented by exercise thallium scintigraphy and coronary angiography before and after myocardial infarction are described.
Adult↗
Thallium-201 myocardial imaging in patients with angina pectoris and anomalous aortic origin of the circumflex coronary artery.
Anomalous aortic origin of the circumflex coronary artery is the commonest coronary artery anomaly. In this study, the significance of anomalous aortic origin of the circumflex coronary artery was investigated in seven patients with exertional chest pain using exercise thallium scintigraphy. Five patients with circumflex coronary arterial disease served as controls. Myocardial perfusion was normal in the five patients with a nonstenosed anomalous artery. In these patients, exercise heart rate and blood pressure response were normal. Two patients with a stenosed anomalous circumflex coronary artery and four of the five control patients had posterolateral myocardial perfusion defects. It is concluded that anomalous aortic origin of the circumflex coronary artery does not cause impairment of myocardial perfusion unless it is the site of significant coronary arterial stenosis.
Angina Pectoris↗
Actuarial analysis of late results after closed mitral valvotomy.
The long-term results of closed mitral valvotomy performed between 1978 and 1985 in 198 patients with noncalcific mitral stenosis were analyzed. Follow-up data were available on 185 patients (93%); 1 patient died in the postoperative period, and 12 foreign patients were lost to follow-up. At the 4-year and 8-year intervals, 91% and 80% of patients, respectively, were event free (not in need of further operative procedures). By multivariate analysis, the factor preoperative mild mitral regurgitation showed a tendency to influence the event-free period. By univariate analysis, postoperative mitral regurgitation significantly reduced the event-free period. Twenty-one patients subsequently underwent mitral valve replacement; 8 for mitral regurgitation, 10 for mitral stenosis, and 3 for mixed mitral regurgitation and stenosis. By multivariate analysis, the reason for reoperation significantly influenced the length of the event-free period. The patients with mitral regurgitation required mitral valve replacement sooner than those with mitral stenosis. Advanced age, sex, previous valvotomy, preoperative New York Heart Association Functional Class, low mitral valve leaflet excursion, and pulmonary hypertension had no influence on the long-term result.
Actuarial Analysis↗
Cardiac lymphoma: an unusual case of myocardial perforation--clinical, echocardiographic, haemodynamic and pathological features.
A patient is described in whom lymphoma infiltrated the pericardium and myocardium resulting in right ventricular rupture. Pericardial blood and lymphoma deposit were demonstrated echocardiographically as echolucent and echodense areas respectively and confirmed at autopsy. The patient presented with the clinical and haemodynamic features of cardiac tamponade.
Cardiac Tamponade↗
The effects and dose-response relationship of xamoterol in patients with ischaemic heart disease.
1. In a double-blind placebo controlled four-way crossover study the effects and dose response relationships of xamoterol were studied in nine patients with angina and dyspnoea secondary to chronic left ventricular dysfunction. The duration of exercise on a treadmill and heart rate were measured at the end of each phase of the study at 2 h and 24 h after dosing. 2. Xamoterol at 200 mg and 400 mg orally once daily had no effect on the mean resting heart rate but there was a small (5.7 beats min-1) but significant reduction in resting heart rate on 600 mg at 2-2.5 h after dosing. All three doses of xamoterol significantly reduced the maximum exercise heart rate at 2-2.5 h after dosing. 3. Xamoterol at all three doses significantly increased exercise duration at 2-2.5 h after dosing but not at 24 h. 4. Mean plasma xamoterol concentration at both 2-2.5 h and 24 h after dosing were dose related. The EC50 for xamoterol is 33.5 ng ml-1, where EC50 is the effective plasma concentration required to produce 50% of the maximum effect on exercise heart rate.
Adrenergic beta-Agonists↗
Comparison of vitreous carbon and elgiloy transvenous ventricular pacing leads.
In a randomized prospective study of 150 patients, we compared two porous-tipped, finned leads, one with a vitreous carbon tip (surface area = 12 mm2) and the other with an Elgiloy tip (surface area = 8 mm2). We assessed the acute and chronic stimulation thresholds and the ease of implantation of the two leads. The acute current thresholds for the vitreous carbon and Elgiloy-tipped leads were 1.7 +/- 0.5 (+/- SD) mA vs. 1.1 +/- 0.4 mA (0.25 ms pulse width), 1.3 +/- 0.5 mA vs. 0.9 +/- 0.3 mA (0.5 ms), and 1.0 +/- 0.3 mA vs. 0.8 +/- 0.3 mA (0.75 ms), respectively (P less than 0.0005). Impedance at implantation was 473 +/- 121 ohms and 716 +/- 285 ohms (P less than 0.0005) for the carbon-tipped and Elgiloy-tipped leads, respectively. The R-wave amplitudes were 10.2 +/- 5.1 volts and 6.8 +/- 3.0 volts, respectively (P less than 0.0005). Both leads were easy to implant and showed low stable chronic thresholds from 3 weeks after implantation, at which time the stimulation threshold was 1.9 +/- 1.0 volts vs. 1.5 +/- 0.6 volts with the implanted voltage-variable generators and 1.8 +/- 0.8 mA vs. 1.6 +/- 0.6 mA with the implanted current-variable generators. Reoperation for displacement was required for two of the 87 (2.3%) carbon-tipped and 2 of the 67 (3.2%) Elgiloy-tipped leads. There was no exit block nor any other lead-related complication. We conclude that both leads have similar and satisfactory performance.
Aged↗
Effect of xamoterol (ICI 118587), a new beta1 adrenoceptor partial agonist, on resting haemodynamic variables and exercise tolerance in patients with left ventricular dysfunction.
The effect of xamoterol, a beta1 adrenoceptor partial agonist, on resting haemodynamic measurements and exercise tolerance was studied in 10 patients with dyspnoea of effort. All patients had poor left ventricular function due to myocardial infarction with ejection fractions ranging from 15% to 35% (mean 28%). The cardiac index and stroke work index both rose significantly. The mean pulmonary artery pressure fell from 20(2) mm Hg to 16(2) mm Hg and pulmonary artery wedge pressure from 14(2) mm Hg to 10(2) mm Hg within the first four hours. Exercise tolerance, measured on the treadmill, increased significantly in seven patients but was unchanged in the three who had the lowest left ventricular ejection fractions. Exercise heart rate response was attenuated by the drug in all patients. It is concluded that xamoterol may be beneficial in patients with poor left ventricular function but can be harmful in extremely poor left ventricular function where high sympathetic drive may be important.
Adrenergic beta-Agonists↗
Effect of percutaneous transluminal coronary angioplasty on arrhythmias complicating angina.
Four patients who had stenosis of a single major coronary artery which was treated by percutaneous transluminal coronary angioplasty are described. Three had exercise induced myocardial ischaemia complicated by ventricular tachycardia, fibrillation, and sinus bradycardia, respectively. Asystole developed in a fourth patient who had spontaneous chest pain. After successful percutaneous transluminal coronary angioplasty these arrhythmias did not recur spontaneously or on treadmill exercise testing. Percutaneous coronary angioplasty can be effective in preventing arrhythmias complicating acute myocardial ischaemia secondary to stenosis of a single major coronary artery.
Adult↗
Effect of Corwin (ICI 118587) on resting and exercise heart rate and exercise tolerance in digitalised patients with chronic atrial fibrillation.
The effect of Corwin, a new oral beta, partial agonist, on the ventricular response to atrial fibrillation was studied in digitalised patients during 24 hour ambulatory electrocardiography and during exercise on a treadmill in a double blind placebo controlled crossover trial. Corwin reduced the maximum heart rate during exercise from 162(16) beats/min to 120(9) beats/min and reduced the peak heart rate during ambulatory electrocardiography from 113(11) to 90(6) beats/min consistent with a beta adrenoreceptor antagonist action at higher levels of sympathetic nervous system activity. Minimum heart rate during ambulatory electrocardiography was increased from 62(5) to 70(5) beats/min indicating that at lower levels of sympathetic activity the drug acts as a beta agonist. The drug increased exercise tolerance significantly. Serum digoxin concentrations were not affected by the drug. Thus Corwin appears to be effective in stabilising heart rate during atrial fibrillation both at rest and during exercise in digitalised patients.
Adrenergic beta-Agonists↗
Clinical implication of inadvertent monitoring of pulmonary artery pressure via a "left atrial" catheter.
A patient is described in whom a left atrial catheter was inadvertently wedged in a pulmonary vein following mitral valve replacement. The pulmonary vein wedge pressure obtained approximated the pulmonary artery pressure and was suggestive of paraprosthetic mitral valve regurgitation.
Cardiac Catheterization↗
Comparison of the performance of superflow (5F) and conventional 8F catheter for cardiac catheterization by the femoral route.
In order to determine whether the use of a smaller catheter would allow day-case cardiac catheterization by the femoral route, the performance of the Superflow (5F) and the 8F catheters was compared in 34 adults who underwent left ventriculography and coronary angiography. As shown by the significantly lower fluoroscopy time [2.8 +/- 1.2 min vs 4.5 +/- 2.7 min, (m +/- SD), p = 0.027] the 8F catheter was more maneuverable than the Superflow (5F) catheter. Poor left ventriculograms were obtained in a higher proportion of patients in whom the Superflow (5F) catheter was used. There was no significant difference in the time to achieve hemostasis at the puncture site in the two groups of patients (13 +/- 5 min vs 10 +/- 3 min, p = 0.09). It is concluded that the use of the Superflow (5F) catheter confers no advantage, while it is associated with longer screening time and poorer left ventriculograms.
Adult↗
Angiographic, electrocardiographic and surgical features of single coronary artery producing myocardial ischaemia.
A patient is described in whom an unstenosed single coronary artery was associated with angina and syncope. Full clinical documentation of the patient with ambulatory electrocardiography, angiography, surgical findings and stress testing before and after bypass grafting are described.
Adult↗
Surgical implications of anomalous aortic origin of the left coronary artery.
We report a patient with exertional chest pain and anomalous aortic origin of the left coronary artery from the right coronary sinus. This patient also had circumflex coronary and right coronary artery stenoses. Following coronary bypass grafting of the circumflex and right coronary arteries in this patient, angina persisted and there was abnormal septal perfusion shown on the exercise thallium imaging despite patent grafts. The angina and perfusion defect were improved by bypass grafting of the unstenosed left anterior descending coronary artery in this patient. Thallium imaging may be useful in the preoperative assessment of patients with this anomaly.
Angina Pectoris↗