Dennis Battock

Effects of Propranolol and Isosorbide Dinitrate on Exercise Performance and Adrenergic Activity in Patients with Angina Pectoris

Twelve patients with angina pectoris were evaluated in a single blind crossover study with respect to objective changes in exercise performance on the treadmill and subjective, clinical improvement on oral administration of propranolol, isosorbide dinitrate (ISD), and a combination of propranolol and ISD. Combined objective and subjective evaluations showed that nine of 12 patients improved on propranolol, seven of 10 on ISD, and all 10 on the combination of drugs. The differences in objective improvement between the various drug regimens were not significant. However, subjectively all patients on the combination of drugs improved markedly. The patients on propranolol or the combination had a decrease in pressure-rate index of about 30% both at rest and during exercise, while these values did not change on ISD. A significant reduction in exercise-induced S-T depression was observed with propranolol alone and in combination with ISD at grade 3+ pain. Adrenergic activity, estimated from plasma and urinary catecholamines, appeared to be increased in these patients before drug treatment and was not altered during treatment. It is concluded that propranolol, ISD, and the combination of these drugs all improve exercise performance in patients with angina. Although the combination of drugs could not be shown to produce a greater increase in exercise performance than either drug alone, the combination effected a greater overall clinical improvement.

Effect of pulsatile and nonpulsatile flow during cardiopulmonary bypass on left ventricular ejection fraction early after aortocoronary bypass surgery

Abstract Although aortocoronary bypass graft has successfully relieved angina in most patients, concern has been expressed about possible deterioration or failure of improvement of left ventricular performance. With use of intraaortic balloon pumping to produce pulsatile flow during cardiopulmonary bypass, left ventricular ejection fraction and end-diastolic volume index were compared in a consecutive series of 40 men undergoing elective aortocoronary bypass, 20 of whom had pulsatile flow and 20 who had mean flow during cardiopulmonary bypass. Left ventricular ejection fraction and end-diastolic volume index were measured before and 1 to 12 days after operation using a collimated scintillation probe and indium113m. In the group receiving nonpulsatile flow the ejection fraction decreased from 52.2 ± 2.9 percent (mean ± standard error of the mean) to 38.7 ± 3.2 percent on the first postoperative day and 43.0 ± 3.4 percent on the 10th day (P

Correlation of platelet survival time with occlusion of saphenous vein aorto-coronary bypass grafts.

Platelet survival time is frequently shortened in patients with coronary artery disease, and it is one of several factors that might contribute to graft occlusion after saphenous vein coronary artery bypass (CAB). In 35 patients with CAB, average platelet survival (autologous labeling with 51Chromium) was shortened in 20 with one or more saphenous vein grafts occluded and normal in 15 with all grafts open. Of 15 with all grafts open, individual levels of platelet survival were normal in 10 while in 20 with one or more grafts occluded platelet survival was normal in only one. Platelet survival was not altered by coronary surgery and nine of ten with shortened platelet survival pre-operatively had graft occlusion. Platelet survival did not correlate with either parent artery occlusion or serum lipoproteins. These findings suggest a relationship between shortened platelet survival and saphenous vein graft occlusion and suggest that platelet suppressant therapy might be useful in preventing graft occlusion.

Effects of isosorbide dinitrate and nitroglycerin on central circulatory dynamics in coronary artery disease

This study compares the effects and duration of the effects of 5 mg. of sublingual (SL) isosorbide dinitrate (ISD), 20 mg. of oral ISD, and 0.4 mg. of SL nitroglycerin (TNG) on central circulatory dynamics. Twenty-seven patients with coronary artery disease were evaluated with radioisotope techniques and determinations made of heart rate (HR), blood pressure (BP), cardiac index (CI), stroke volume index (SVI), left ventricular enddiastolic volume index (LVEDVI), and left ventricular ejection fraction (LVEF). There were significant and equivalent reductions in BP, SVI, LVEDVI, and CI 15 minutes after TNG, 1 hour after SL ISD, and 4 hours after oral ISD in addition to comparative increases in HR and EF by all drugs at these same time intervals. The effects of TNG were gone at 30 minutes while changes in LVEDVI, LVEF, and CI were present 4 hours after SL ISD and persistent changes in LVEDVI and SVI present 6 hours after oral ISD. We conclude that nitrates have significant effects on both preload and afterload and that the duration of effects of sublingual and oral ISD are truly long acting as compared to TNG.

Familial atrial myxoma

This report of a 14 year old boy with a left atrial myxoma and his 16 year old brother with a right atrial myxoma documents the familial occurrence of cardiac myxoma. The noninvasive techniques utilized to help establish the diagnosis of intracardiac tumor are described.

Effect of parent coronary arterial occlusion on left ventricular function after aortocoronary bypass surgery

In 62 men with open parent coronary arteries who underwent saphenous vein aortocoronary bypass to either the right or left anterior descending coronary artery, or both, left ventricular ejection fraction and wall motion of the anterior and inferior segments of the left ventricle were measured before and after (average 11 months) the operation. Of 34 left ventricular segments with open vein grafts and open parent coronary arteries, 91 percent were unaltered by the operation, none were in worse condition and 9 percent showed improved wall movement. Among 33 segments with open grafts but new total occlusion of the parent coronary arteries, 67 percent were unaltered, whereas the condition of 18 percent was worse and of 15 percent was improved. Among 21 segments with closed grafts but patent parent arteries, the condition of 29 percent was unchanged and of 71 percent was worse; among 14 segments with occlusion of both grafts and parent arteries the condition of 29 percent was unchanged and of 71 percent was worse. In 10 men with patency of all vein grafts and parent arteries, left ventricular ejection fraction was not altered (0.55 +/- 0.03 to 0.53 +/- 0.04 [average +/- standard error of the mean]) and in 11 with all grafts open but all parent arteries occluded left ventricular ejection fraction was unchanged (0.51 +/- 0.02 to 0.54 +/- 0.03). Left ventricular ejection fraction was decreased in eight men with occlusion of all vein grafts whether or not occlusion of the parent coronary arteries had occurred. The results suggest that occlusion of the parent coronary arteries in the presence of a patent vein graft does not unfavorably alter left ventricular ejection fraction or segmental wall motion, whereas graft occlusion is associated with deterioration of left ventricular ejection fraction and segmental motion whether or not the parent artery is also occluded.

The Square Left Ventricle: an Angiographic and Radionuclide Sign of Left Ventricular Thrombus

The association of mural thrombus with left ventricular aneurysm is well documented, though angiographic documentation of left ventricular thrombus can be difficult. The authors describe the unique appearance of the left ventricular cavity in 5 patients. In all cases, ventriculograms obtained in the right anterior oblique position showed a squared apex. In 2 patients this phenomenon was also demonstrated by radionuclide angiocardiography. All 5 patients were found to have left ventricular thrombus at operation or autopsy.