Benjamin Goldfarb

Spontaneous Closure of a Traumatic Ventricular Septal Defect after Blunt Trauma Documented by Serial Echocardiography

A ventricular septal defect (caused by blunt chest trauma) that closed spontaneously over a period of 5 years was documented by serial echo-Doppler examinations. The shunt was relatively small and the patient was without symptoms from the time the lesion was discovered until its closure. In the absence of cardiac decompensation or pulmonary hypertension, a conservative approach, including serial echo-Doppler examinations, can be justified.

QRS prolongation: A sensitive marker of ischemia during percutaneous transluminal coronary angioplasty

The purpose of this study is to measure QRS duration changes in the human model of ischemia during percutaneous transluminal coronary angioplasty (PTCA) and compare these results to the commonly used ischemia markers, chest pain, and classical ST‐T changes. Using a computerized method, QRS duration was measured in 51 patients undergoing elective PTCA. Three milliseconds (msec) or more prolongation of the QRS at peak inflation was considered to be an ischemic response. The results were compared to chest pain and ST‐T changes and were analyzed for inflation site within individual coronary arteries. Forty‐two patients had a pathological prolongation of the QRS during PTCA. Thirty‐two patients developed chest pain, while 19 had ischemic ST‐T changes. QRS duration was more prolonged in PTCA to proximal or middle segments of major arteries or their large branches, while it was less prolonged in distal segments or smaller branches. Using our method, QRS prolongation was an ischemia marker in most patients during PTCA and was more sensitive than chest pain or ST‐T changes. QRS duration was more prolonged with occlusion of proximal and middle segments of major arteries. Cathet. Cardiovasc. Intervent. 50:177–183, 2000.

Atrial tachycardia as the presenting sign of a left atrial appendage aneurysm.

A patient presented with atrial tachycardia. The work‐up, guided by the tachycardia morphology, led to the diagnosis of left atrial appendage aneurysm. Surgical removal of the atrial appendage resulted in cure of the tachycardia and associated symptoms.

Angiographic Follow-Up of Coronary Artery Ectasia

Of 1,125 patients catheterized over a period of 8 years, 68 (6%) had coronary ectasia. Twenty-five of them were catheterized at least twice and constituted the study group. The time between the first and last catheterization ranged from 2 to 8 years (mean +/- SD = 4.2 +/- 1.6). Coronary ectasia was more frequent in males (88%). The frequency of involvement was: the right coronary (47%), the left circumflex (30%), the left anterior descending (21%) and the left main arteries (2%). Proximal segments were most frequently involved (48%). Diffuse involvement was found in 29%. Severity of ectasia progressed in 6 segments (14%) and 2 new ectatic segments appeared over the follow-up period. During that period, 2 patients had myocardial infarction, 1 of them due to a total occlusion of an ectatic segment. There were no deaths. In conclusion, coronary ectasia has a relatively benign course.

Concomittant ST elevation in inferior and anterior leads in acute myocardial infarction: Clinical and Anatomical Significance

Various instances of acute myocardial infarction that may cause concomittant ST-segment elevation in inferior and anterior leads are presented. Among the situations that produce this phenomenon are: (1) multivessel coronary artery disease or isolated disease of a dominant left anterior descending artery causing combined inferior and anterior myocardial infarction; and (2) isolated disease of a right coronary artery causing combined infarction, or isolated right ventricular myocardial infarction. The mechanisms responsible for the electrocardiographic patterns in each instance are discussed.

The Predictive Value of Exercise QRS Duration Changes for Post-PTCA Coronary Events

Background: The sensitivity and predictive values of exercise ECG testing using ST‐T criteria after percutaneous transluminal coronary angioplasty (PTCA) are low, precluding its routine use for screening for restenosis. The predictive value of QRS duration criteria during exercise testing (ET) ECG after PTCA for future coronary events has not been reported. The aim of the study was to compare QRS duration changes with ST‐T criteria during ET, as a predictor of coronary events after PTCA.

Ischemia detection after myocardial infarction: Diagnostic value of exercise-induced qrs duration changes evaluated by a new computerized method

A new computerized optical scanner was used to measure QRS complex duration during exercise stress testing, both pre- and postdischarge, as a means of ischemia detection after acute myocardial infarction. Thallium stress testing was used as a standard of comparison. Each patient underwent predischarge exercise testing (while receiving anti-ischemic drug therapy) and a postdischarge test 1 month later (without anti-ischemic drug therapy), as well as thallium stress testing within 4 months of infarction. In the population of 68 patients, 42 of the predischarge tests and 43 of the postdischarge tests showed an ischemic response of QRS prolongation. When compared with thallium testing for QRS prolongation criteria, the sensitivity was 95% with a specificity of 77% predischarge and 89% with a specificity of 65% postdischarge. According to ST-T criteria, only 12 of 68 patients were positive for ischemia predischarge; this number increased to 29 postdischarge (predischarge sensitivity 24% and specificity 90%, with postdischarge sensitivity 68% and specificity 87%), when compared with thallium testing. Measuring QRS duration during exercise increased the sensitivity of detection of ischemic patients over that of ST-T criteria by 71% predischarge and 21% postdischarge, with a 22-23% loss of specificity, and was apparently not influenced by anti-ischemic drug therapy.

ST Elevation in Leads V1 to V4 Caused by Isolated Right Ventricular Ischemia and Infarction

A patient with isolated right ventricular ischemia and infarction is presented. ST elevation in leads V1 to V4 mimicking anteroseptal myocardial infarction was recorded at admission and during episodes of chest pain later on. Noninvasive and invasive workup suggested isolated right ventricular infarction and ischemia due to an occluded small and nondominant right coronary artery.

Skin thickening and sensory loss of the feet during diltiazem therapy

Abstract We describe a patient in whom skin thickening and sensory loss of the skin of the feet appeared during diltiazem treatment and resolved when the drug was discontinued.

Pseudoaneurysm of the left ventricular outflow tract with reentry into the ascending aorta: an iatrogenic left ventricular ascending aortic fistula

We report a patient with an iatrogenic pseudoaneurysm of the left ventricular outflow tract with reentry into the ascending aorta above the level of a prosthetic aortic valve. This pathology has not been previously described and was well demonstrated by transthoracic echocardiography.