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This article reports the results of a pilot study that sought to merge two lines of scientific approach. Brief paper and pencil psychobehavioral assessment was completed on subjects to determine whether the psychobehavioral variables could differentiate between high and low risk subjects and subjects with previous documented myocardial infarction from those who are still healthy. Specifiable measures of behavior and coronary risk status appear to be related. Furthermore, a basic pattern of interpersonal recall was associated with coronary risk status.

A previously healthy 6-month-old male infant was admitted to our clinic for persistent high fever and an erythematous skin rash. Hyperemia of conjunctivae, redness of oral mucosa, and swelling of several cervical lymph nodes were also observed. Soon after admission he developed jaundice which continued for one week. Results of laboratory examinations revealed leukocytosis, elevated ESR, mild proteinuria, leukocytes in urinary sediment, hyperbilirubinemia, increased serum alpha-2-globulin and positive CRP. Serum ASO titer was less than 100 Todd units and complement fixation reactions for various viruses were not significant. Cultures of blood, urine, stool and throat were negative. He was treated with antibiotics and steroids and improved gradually, but then developed signs and symptoms of congestive heart failure. An ECG showed a pattern of extensive myocardial infarction. He died of congestive heart failure at the age of 21 months. Autopsy findings revealed focal aneurysmal dilatation and obstruction of the bilateral coronary arteries. The myocardial infarction involved the septum of the anterolateral wall of the left ventricle. The coronary arteries, distal aorta, iliac arteries and pulmonary arteries were also involved, but very slightly. The symptoms, laboratory findings and the course of this patient were compatible with those of acute febrile mucocutaneous lymph node syndrome (MLNS). MLNS has been accepted as a new syndrome by most Japanese pediatricians in recent years. Its etiology is still unknown. Some of the patients with this syndrome had died suddenly of coronary thromboarteritis after recovering from the acute illness. Although autopsy findings of the fatal cases have been similar to those describing infantile polyarteritis nodosa, the relationship between MLNS and infantile polyarteritis is controversial. [ABSTRACT FROM AUTHOR]

Myocardial infarction was produced in 21 anaesthetized dogs by ligation of the anterior descending branch of the left coronary artery and subsequent embolization with microspheres. Coronary antegrade and retrograde flow as well as coronary retrograde pressure were measured before and after embolization. Since nearly complete embolization of the terminal vascular bed of a ligated coronary artery was achieved by injecting plastic microspheres, it was possible to produce a completely ischaemic infarction area in which the microcirculatory influx via collateral vessels was also obstructed. Following embolization, retrograde flow increases by a factor of two or three. Thus, retrograde flow measured after tying a coronary artery without embolization will considerably underestimate the true collateral circulation. Collateral circulation can be important in keeping the occluded area in labile equilibrium after acute coronary occlusion, since if retrograde flow removes even a small amount of blood from the ischaemic zone, fatal ventricular fibrillation may develop. Both retrograde pressure and the microcirculation in the affected areas must be taken into account in determining collateral blood flow or resistance. It is concluded that in normal dog hearts coronary resistance proximal to the origin of the collateral vessels is comparable to that of the terminal vascular bed. [ABSTRACT FROM AUTHOR]

Copyright of Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Klinische Wochenschrift is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Eighty patients with aorto-iliac / femoro-popliteal atherosclerosis were collected to examine in detail their plasma cholesteryl ester fatty acid compositions and to compare them with the incidence of ischaemic heart disease through a 4-year follow-up. Various other biochemical and rheological parameters were also measured to see if these might explain any association between the abnormal fatty acid pattern and ischaemic heart disease. The abnormal fatty acid pattern was specifically and generally similar to that found in essential fatty acid (EFA) deficient animals and children as shown by the increase of the specific trienoic acid (C.20: 3ω9) by reduced linoleic acid concentrations, and by an increase of C.18 and C.16 monoenoic acids (oleic and palmitoleic), but not of their corresponding saturated forms, stearic and palmitic. The results suggest that the abnormal fatty acid composition resulted from an increased synthesis of monoenoic acids and monounsaturase activity, coupled with a relative inadequacy of linoleic acid. The patients with a reduced concentration of linoleic acid (<35%) subsequently had a higher incidence of myocardial infarction. No significant correlations were found between the fatty acid concentration and various other biochemical or rheological parameters except marginally between linoleic acid and platelet adhesiveness. Only the linoleic acid concentration distinguished between the patients with and without myocardial infarction. A marked inverse correlation was found, however, between the monoenoic and linoleic acid concentration, without parallel changes in other fatty acids. It seems that as in animals, a balance exists between EFA and monoenoic pathways which are known to compete for the same desaturase systems and acyl sites. It appears that human EFA requirements and effects need to be considered not only by their intake and metabolism, but also through individual factors which vary the monoenoic concentrations and monounsaturase activity. Since these factors include several currently associated with human atherosclerosis the question arises of whether the EFA-monoenoic balance is one link between them and the pathology of the arterial occlusions and myocardial infarction. [ABSTRACT FROM PUBLISHER]

Nine cases of retroperitoneal haemorrhage complicating anticoagulant therapy are reported. Six cases were receiving heparin for myocardial infarction: an incidence of 4·3% of patients on such treatment. All the cases presented with pain, six had neurological involvement and one patient died. The incidence of this complication is higher than previously noted. Retroperitoneal haemorrhage requires a high index of clinical suspicion for early diagnosis and treatment if serious sequaelae are to be prevented. [ABSTRACT FROM PUBLISHER]

Presents the results of a case study on thrombolytic therapy with intravenous streptokinase in a 16 year-old girl with recurrent bilateral deep-vein thrombophlebitis. Effect of streptokinase on reinfarction rates in acute myocardial infarction; Routine methods performed in coagulation studies including quantitative fibrinogen; Effect of streptokinase thrombolytic therapy on the coagulation system.

, , 530-533. The clinical presentation and morphological findings in eight cases of annular injury associated with the insertion of prosthetic heart valves are discussed. The lesions presented as a separation of the left atrium and ventricle at the mitral annulus (one patient), a sinus or false aneurysm in the left posterior atrioventricular groove (two patients), or as a separation of the aortic root from the base of the heart (five patients). The pathogenesis of the lesions is similar. Annular tissue was weakened either by the removal of excess tissue or by an abnormal stress placed on normal tissue or by a slight stress placed on tissue altered by disease, and, as a result, it separated or tore. The resultant haemorrhage either caused the patient's death or, with time, produced the other morphological findings. Factors predisposing patients to the injuries are discussed and a differential diagnosis of annular pseudoaneurysms is provided. [ABSTRACT FROM PUBLISHER]

, , 690-694. The respiratory effects of breathing with a positive expiratory pressure plateau (PEPP) was studied in 24 spontaneously breathing, alert, nonsedated patients with pulmonary oedema following myocardial infarction. When 20 patients breathed room air with PEPP a small rise in arterial oxygen tension (a) with a fall in alveolar to arterial oxygen gradient (A—a) occurred. Arterial carbon dioxide tension did not change significantly. When PEPP was used in six patients after breathing 100% oxygen for 20 minutes there was no significant change in a, A—a or anatomical shunt (Q/Q). Expired air collection in a further six of the patients demonstrated that although PEPP produced an increase in tidal volume (V), alveolar ventilation (V) fell slightly as a result of a decrease in respiratory rate, and oxygen consumption (V) did not change. In 10 normal subjects functional residual capacity (FRC), measured continuously in a whole-body volume displacement plethysmograph, decreased by a small amount when these subjects breathed with PEPP. Positive expiratory pressure plateau breathing in spontaneously breathing conscious patients with pulmonary oedema produced a small improvement in ventilation/perfusion matching not by an increase in FRC but by an increase in V. The increase in V probably altered the ventilation/perfusion relationships by a redistribution of inspired gas. [ABSTRACT FROM PUBLISHER]

Infantile arterial calcification is a rare disorder of unknown etiology which is usually generalized and leads to death from coronary artery occlusion. The involved arteries show calcification of the internal elastic lamina and marked intimal proliferation. Vascular calcifications were demonstrated radiographically in 9 previously recorded cases. Three new patients are reported who presented with congestive heart failure. The visualization of faint vascular calcifications in the extra-thoracic soft tissues presented an opportunity to establish the diagnosis radiologically. [ABSTRACT FROM AUTHOR]

Altered LV performance in cardiogenic shock (CS) may be describe by considering 5 variables: preload, after load, contractility, heart rate, and synergy of contraction. In addition, two fundamental relations of importance are (i) the function cardiac output (CO) vs. preload—the length-tension or Starling curve—and (ii) CO vs. afterload—the force-velocity relation. Increases in the first four of the above variables and dysynergy are all associated with augmented myocardial oxygen (O2) consumption (MVO2), but to different extents. Hemodynamic patterns in CS are heterogeneous, but ↓ coronary blood flow (CBF), stroke volume and CO, ↑ myocardial O2 extraction (A-CSO2) and ↑ peripheral vascular resistance are relatively constant findings. LV compliance is reduced and hence LV end-diastolic pressure (LVKDP) may be elevated without other evidence of poor LV function. Such an augmented LV filling pressure in fact defends the CO via ‘Starling compensation.’ O2 available to the myocardium is given by the product of CBF and A-CSO2. A-CSO2 is in turn directly proportional to arterial O2 content. The difference in alveolar-arterial O2 tension is proportional to both LV mass infarcted and resultant elevation in LVEDP. In the coronary arterial bed, blood flow is negligible below the ‘critical closing pressure,’ increases rapidly as the pressure bead rises, then levels. Undue rises in mean arterial pressure are not matched by meaningful increases in CBF beyond a given value of arterial pressure. Survival of marginally viable myocardium in an ischemic zone depends upon the balance between O2 available and O2 demand. Maneuvers which inordinately increase intramyocardial tension, contractility or heart rate further the imbalance between (CBF × A-CSO2) and MVO2 and may result in further cell death. Hence although CO may be enhanced short-term during the therapy of CS, the O2 cost may extract an unacceptable metabolic price. The management of CS—medical and surgical—should be primarily directed al restoration of myocellular oxygenation and nutrition. To this end, unnecessary elevations in heart rate and contractility are to be avoided. The heart may be unloaded during diastole by intra-aortic balloon counterpulsation, a technique which also improves coronary blood flow. The use of other agents, such as glucose-insulin-potassium, corticosteroids, hyaluronidase, and the beta-blockers, are currently being investigated. [ABSTRACT FROM AUTHOR]

This study is concerned with twelve patients presenting a triad of symptoms characterized by migraine headaches, anginoid chest pain and symptoms suggestive of functional hypoglycemia. A positive family history for migraine headache, hypertension and myocardial infarction was found in over two-thirds of the cases. Baseline electrocardiographic abnormalities, positive exorcise electrocardiogram, positive Valsalva-EKG test and a functional hypoglycemic glucose curve was obtained in all cases. In five patients, electroencephalographic abnormalities were noted but were not consistent in repeated studies. In six patients a selective coronary arteriography with left ventriculogram was performed. In all the cases with exception of one, normal coronary arteriogram and normal left ventricular hemodynamics were found. An exaggerated sympathetic overactivity was noted during the study. In four out of the six cases this was characterized by segmental coronary spasm which was more pronounced on the right than on the left coronary arterial system. This was associated with the onset of anginoid chest pain which promptly subsided with the use of sublingual nitroglycerin. It is inferred from this study that the underlying pathophysiology causing both the migraine headache and chest pain is probably due to arterial vasoconstriction most likely resulting from an exaggerated sympathetic overactivity (cardiac migraine). The beneficial effect obtained by the use of propranolol and the use of other therapeutic modalities directed in curtailing exaggerated sympathetic influence in the cardiovascular system, support this proposed contention. [ABSTRACT FROM AUTHOR]

The effects of treadmill exercise on cardiac mechanism were studied in 34 dogs, two to eight days following ligation of the anterior descending coronary artery. Physical exercise abolished all ventricular arrhythmias which were present at rest. Some of the animals displayed return of ventricular rhythm disorders towards the end of exercise when studied as early as 48 hours after the coronary occlusion. In experiments carried out on the second and third days, a transient intensification of ventricular arrhythmias during recovery was ob- served. Physical exertion beyond the third day after infarction did not provoke ventricular arrhythmias during or after the exercise. However, isoproterenol and epinephrine infusions resulted in reappearance of ventricular arrhythmias up to four days after coronary ligation. The effects of exercise on cardiac mechanism are probably a result of diverse factors; the faster rate during exercise tends to abolish ventricular arrhythmias whereas other unidentified factors, perhaps related to myocardial oxygen requirement, catecholamines or the appearance of left heart, failure, tend to provoke ventricular arrhythmias especially after the exercise as the sinus rate slows. These results may have implications in the interpretation of exercise tests and in assessing the role of physical activity in patients with ischemic heart disease. [ABSTRACT FROM AUTHOR]

In 35 survivors of myocardial infarction and in 38 control subjects serum cholesterol and triglyceride concentrations and the serum lipoprotein pattern were determined. In the group with myocardial infarction serum cholesterol and triglyceride concentrations were increased in 15 [43%] and 18 [51%] cases, respectively. Serum pre-beta lipoproteins were increased in 23 [65.7%] survivors of myocardial infarction and showed a negative correlation with age. Beta-lipoproteins were increased in 9 [2.5.7%] cases. The significance of the increase in pre-beta lipoproteins, as a risk factor in myocardial infarction, is discussed. [ABSTRACT FROM AUTHOR]

Discusses the incidence and mechanisms of myocardial infarction following coronary artery surgery. Determination of the symptomatic improvement; Quality of subsequent life; Effect of coronary surgery on life span.

The effects of dilazep, a drug which potentiates the actions of adenosine, were examined in a canine preparation that enabled simultaneous measurements to be made of blood flow both in ischaemic areas, and in essentially normal areas, of the canine myocardium. In doses which caused marked and sustained increases in blood flow to the normal myocardium, dilazep did not change either blood flow in the developing infarct or the trans-ventricular perfusion pressure (diastolic peripheral coronary pressure minus left ventricular end-diastolic pressure). Despite the lack of effect on infarct blood flow, the oxygen tension of the blood draining the infarcting area was markedly elevated. It is concluded that dilazep may open up blood vessels in an acutely ischaemic area which do not take part in tissue exchange, and may therefore decrease the efficiency of the myocardial circulation. [ABSTRACT FROM AUTHOR]

Reports on data from the Kaiser-Permanente Epidemiologic study that showed a negative association between alcohol consumption and a subsequent first myocardial infarction. Questionnaire used in the study; Amount of alcohol consumed by patients with myocardial infarction and controls; Difference in response between the patients who had a myocardial infarction and the risk of control groups.

Presents a study that measured the changing patterns of inputs into the care of patients hospitalized with myocardial infarction over a 30-year interval period. Role of physicians in the use, mix and intensity of patient treatment; Relationship between the increased cost of hospitalization and change in the inputs of care; Factors that affect hospitalization cost.

Discusses the use of myocardial revascularization for acute and chronic coronary heart disease. Indications for myocardial revascularization; Indications for bypass surgery; Hemodynamic and angiographic evaluation of candidates for myocardial revascularization; Selection of patients for revascularization during the acute phase of myocardial infarction.

Provides information on the concept of reduction in myocardial infarction size after coronary occlusion. Factors that influence myocardial oxygen consumption; Details on the effect of myocardial oxygen consumption on infarct size; Description on the effects of glucose-insulin-potassium on infarct size; Effects of hyaluronidase on infarct size; Conclusions.

Presents information on several clinical trials of thrombolytic agents in myocardial infarction. Details on the German-Swiss trials; Description on the European Working Party trials; Overview on the Frankfurt short-term study; Result of the coronary care unit study.

The article focuses on the children with rheumatic fever and heart disease in the U.S. Children with possible heart disease establish a very important group because of the harm which can be done through improper handling. Children with congenital defects of the heart make up the second group of children named to as cardiac in the school. Rheumatic fever is a repeating chronic disease which happens in attacks which normally starts in the early elementary school years. Once a child who had successive attacks will increase the chance of permanent heart damage but by no means all attacks of rheumatic fever are accompanied by cardiac involvement.

This article focuses on the sociological considerations in patients with myocardial infraction. Many considerations which might be labeled sociological are best applied to medical situations when viewed in the context of their interaction with physiological, biological, psychological, cultural, and environmental determinants of behavior. The cardiologist describes myocardial infarction as a condition in which a portion of the heart muscle has been damaged or destroyed. To recover, the patient not only requires medicines, but also emotional and psychological support. A relationship between the patient's organic and emotional condition has long been recognized. In the presence of myocardial damage the individual's ability to withstand emotional stress is compromised. Emotional conditions such as anxiety can have a marked impact on coronary circulation and can greatly increase the amount of cardiac work required to achieve given tasks. Within the hospital a patient's ability to avoid anxiety depends greatly upon his interpersonal relationships and channels of communication.

Presents case studies on the association of thrombocytosis, central nervous system disease and myocardial infarction pattern in infancy. Symptoms and manifestations of thrombocytosis; Diagnosis of myocardial infarction; Release of various enzymes into the blood.

The article focuses on a medical research that deals with the diagnosis of coronary heart disease in women under 65 at the time of a first myocardial infarction (MI) or diagnosis of angina without previous infarction. The incidences of coronary heart disease (CHD) among women are relatively low compared to men. Combined data from both the Ml and angina cohorts were used to examine the role of specified medical factors in prognosis. The patients from a specific group who received medical care for symptoms concerned with coronary disease were included in the study. It was deduced that early mortality after a first Ml was practically the same among women and men. The presence of hypertension and severe clinical episodes were associated with increased early mortality in women and in men.

The article presents abstracts of several studies on public health. They include "Current Estimates from the Health Interview Survey, United States—1969," "Surgical Operations in Short-Stay Hospitals for Discharged Patients, United States—1965," and "Streptokinase in Recent Myocardial Infarction: A Controlled Multicentre Trial."

This article focuses on case studies related to thrombocytopenic skin purpura following treatment with trinitrin. Thrombocytopenic purpura is known to occur after medication with many drugs. A man gave a history of having suffered from hypertension for five years. One year before, he had had a myocardial infarction and from that time on he took trinitrin for recurrent attacks of angina of effort. He took up fifteen 0.5 mg. tablets daily. The evidence here in favor of trinitrin thrombocytopenia was clear. Stopping trinitrin was followed by the disappearance of the purpura and the return of the platelet count to normal. Taking 0.5 mg. of trinitrin produced marked platelet reduction in 15 minutes and very marked reduction in 45 minutes in two tests. The reduction was temporary.

Copyright of Diabetologia is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)