Charles Pollick

Muscular subaortic stenosis: hemodynamic and clinical improvement after disopyramide.

A quarter of a century has passed since Brocks original report1 of the condition characterized by asymmetric septal hypertrophy and a subaortic pressure gradient (muscular subaortic stenosis).2 Th...

Evidence for stunned myocardium in humans: a 2001 update.

This article describes clinical situations in which stunning occurs and updates previous reviews on the topic. Stunning following angioplasty, angina and exercise‐induced ischemia, infarction, and after cardiac surgery are described. In addition, newer concepts regarding stunning, including neurogenic stunned myocardium, are discussed. Left atrial stunning following cardioversion is a recently recognized phenomenon with important clinical implications, but differs from the original concept of post‐ischemic stunning.

Echocardiography in a district general hospital.

A referral service for echocardiography was established in a district general hospital. One hundred and three patients were studied and the benefits to defined groups of referrals were evaluated. It is concluded that the introduction of echocardiography into this setting is of advantage to many patients with cardiac disease and should therefore be encouraged.

Symptomatic and hemodynamic recovery following dobutamine stress echo: benefit of low-dose esmolol administration.

Objectives: We studied the use of esmolol in patients experiencing minor side effects of palpitations, anxiety, nervousness, and tremors associated with dobutamine stress echocardiography. Background: Dobutamine stress echocardiography is frequently used in the assessment of coronary artery disease. Esmolol administration may enhance patient comfort. Methods: Sixty consecutive patients who experienced minor side-effects during dobutamine stress echocardiography were given 0.3 mg/kg esmolol intravenously in the recovery period and compared retrospectively to sixty consecutive controls who underwent dobutamine stress echocardiography, who did not receive esmolol, during the same time period. Both groups were matched for age, ejection fraction, and peak dose of dobutamine. Heart rate and blood pressure were assessed during and after dobutamine administration.Results: Both groups had similar baseline blood pressure (mmHg) (142 ± 19/72 ± 14 vs 139 ± 20/72 ± 14) and heart rate (beats per minute) (75 ± 14 vs 75 ± 17) (esmolol and control respectively, p=ns), but peak heart rate was higher in the esmolol group (126 ± 14 vs. 116 ± 14, p<0.01). In the group who received esmolol, symptomatic relief paralleled the statistically significant decrease in heart rate which occurred within 1 minute of esmolol administration (99.7 ± 15.3 vs 108.5 ± 13.1 p<0.0001); the heart rate in the esmolol group remained significantly lower than the control group for 5 minutes following esmolol administration (92.0 ± 10.3 vs 96.7 ± 11.8 p<0.05). As a percentage of peak heart rate the esmolol group remained significantly lower than the control for 7 minutes (74% vs 80% p<0.05). Esmolol induced a significant reversal of dobutamine-induced diastolic hypotension (diastolic blood pressure at peak 66 ± 17 vs 8 min recovery 70 ± 12, p<0.03) that was not seen in controls (diastolic blood pressure at peak 64 ± 18 vs 8 min recovery 65 ± 14, p=ns). Systolic blood pressure and heart rate remained elevated in both groups 8 min into recovery compared to baseline, suggesting persistent dobutamine effect beyond the expected 2 min pharmacologic half-life of dobutamine. No side-effects from esmolol were seen despite it being used in 9 patients with EF

Routine Echocardiographic Views Miss Significant Pleural Effusions

lt; 35%. Conclusions: Esmolol is effective and well tolerated for the management of dobutamine-related minor side-effects. The mechanism of benefit, in addition to heart rate reduction, may involve a reversal of dobutamine- induced diastolic hypotension. Blood pressure and heart rate recovery are slower than expected from previously published pharmacokinetic data.

Aortic valve replacement with stentless porcine aortic bioprosthesis

Objectives: To determine the benefit of adding chest scanning to the routine echocardiographic examination to diagnose pleural effusions. Background: Pleural effusions are common in several cardiac disorders, yet routine echocardiography is insensitive in delineating pleural fluid. Methods: Bilateral chest scanning was performed in addition to the routine echo examination in 100 consecutive inpatients referred for echocardiography with recent chest X rays (CXRs). Detection and quantification of pleural effusion by sonographic chest scanning was compared blindly with CXRs. Identification of pleural fluid was analyzed for correlation with clinical diagnosis of congestive heart failure (CHF) and elevated pulmonary artery pressures if found by echo‐Doppler examination. Results: Agreement on presence or absence of pleural effusion occurred in 88 of 100 patients—in 5 patients bilateral chest scanning detected pleural effusion with negative CXRs; in 7 patients CXRs suggested pleural effusion with negative bilateral chest scanning (all 7 patients had minor blunting of the costophrenic angle). Routine echo views only detected 22 of 51 patients (43%) with pleural effusion detected by bilateral chest scanning. In 45 patients with CHF, 29 (64%) had pleural effusion by bilateral chest scanning (25 bilateral, 1 left, 3 right) vs 12 (27%) by routine echo (only left pleural effusion seen). Ejection fraction and estimated pulmonary artery pressure did not differ between CHF patients with and without pleural effusion. Conclusions: Routine echocardiographic views underestimate the presence of pleural effusion in patients referred for study. Bilateral chest scanning is equal to CXRs for pleural effusion detection and provides clinically useful information which may be of particular benefit to patients with CHF.