George Kouvaras

Angiographic study of coronary artery disease in diabetic patients in comparison with nondiabetic patients.

Diabetes mellitus is known to be a major risk factor for the development of coronary artery disease (CAD). The aim of this study was to investigate angiographically the coronary arteries of diabetic persons, focusing on the type and distribution of CAD, sex differences in CAD anatomy, and the size of the coronary vessels. This was a randomized study and included two groups of patients with angiographically demonstrated CAD. Group A included 463 diabetics, aged 60.3 years, and Group B 210 nondiabetic patients, aged 58.5 years. The two groups were matched by age, sex, weight, and classic risk factors. The authors evaluated the regional location of CAD, left ventricular (LV) function, and the width of the lumen of coronary arteries. The diabetics had three-vessel disease more frequently (p < 0.001) and one-vessel disease less frequently (p < 0.001). The CAD was more extensive in Group A (mean 2.2 vessels, compared to 1.8 vessels in Group B, p < 0.01). The right coronary artery was affected more often in diabetics (p < 0.01), as was the anterior descending artery in three-vessel disease (p < 0.05). The male diabetics had the same angiographic CAD severity as the females, although the latter had a better LV ejection fraction (p < 0.05). The female diabetics < 55 years old had CAD findings comparable with those from women 4 years older in Group B. Diabetics show more diffuse and severe CAD than the general population. There are no sex-related differences in the severity of CAD.

The Significance of a Persistent Precordial ST Segment ≥ 0.1 mV Depression in Acute Inferior Myocardial Infarction (Coronary Angiographic and Ventriculographic Findings)

40 patients with acute inferior myocardial infarction (MI) associated with persistent precordial ST segment depression ≥ 0.1 mV underwent coronary arteriography and left ventriculography within 5-6 days of their admission. The inferior MI was the result of complete occlusion of the right coronary artery (RCA) in 38 patients and the result of complete occlusion of the posterior descending artery (PDA) coming off the cicrumflex artery (Cx) in two patients. 36 (90%) of the 40 patients showed one or more severe stenoses in the left anterior descending artery (LAD). 12 of the 36 patients had severe triple vessel disease. The 36 patients whose coronary arteriograms showed significant LAD stenosis had an emergency coronary artery by pass graft (CABG) operation. Soon afterwards the precordial leads were normal and the patients free of angina till their discharge from hospital. We conclude that a persistent precordial ST segment ≥ 0.1 mV depression in acute inferior MI is highly predictive of significant LAD disease.

Effects of alcohol on the heart: current views.

Chronic and heavy alcohol consumption has deleterious effects upon the car diovascular system and may cause congestive cardiomyopathy. Evidence of car diac malfunction has been found in chronic alcoholics without overt heart fail ure by invasive and noninvasive methods. Ethanol is the incriminated factor having a direct cardiotoxic effect. Elec tron microscopy and cardiac muscle biopsies show that ethanol may cause changes on plasmalemmal, mitochondrial, and sarcoplasmic membranes. The clinical picture and general management of alcoholic cardiomyopathy do not differ substantially from those of congestive cardiomyopathies of any type. It has, however, been demonstrated that cessation of alcohol consumption may lead to an improved prognosis, even to restoration of normal cardiac func tion, in individuals with preclinical and mild manifestations of cardiac dysfunc tion. The literature on the possible association of coronary heart disease with alco hol seems to be ambiguous. It has, however, been postulated recently that mod erate alcohol intake may have a protective role against coronary heart disease, in contrast to alcoholic intemperance, which may be a factor favoring coronary heart disease.

Inhospital prognosis of patients with their first transmural or subendocardial infarction and comparison of their coronary arteriogram and ventriculogram.

The inhospital clinical course and early prognosis were studied prospectively in 500 patients who suffered their first transmural or subendocardial myocar dial infarction, and were admitted in the coronary care unit of our hospital over the last four years. The coronary arteriogram and left ventriculogram of 300 patients out of the 500 was also compared. 434 patients developed transmural and 66 subendocardial infarction, as judged by electrocardiographic criteria. Both groups of patients had the same range of sex, age, coronary risk factors and history of previous angina. There was no statistical difference in in-hospital prognosis and early clinical course. There was no difference in prevalence of single, double or triple vessel coronary artery disease. The hemodynamic pa rameters (ejection fraction, left ventricular end-diastolic pressure), as well as the number of hypokinetic, akinetic or dyskinetic segments did not show any significant statistical difference between the two categories of patients. The same extent of coronary artery lesions and degree of left ventricular dysfunction may explain the similarity of early clinical course. 12% of patients who were admitted with subendocardial infarction developed transmural infarction dur ing their hospitalization.

The influence of R-wave amplitude on the degree of ST-segment depression in exercise electrocardiography in the individual patient.

Many factors have been found to influence the magnitude of ST-segment depression in the exercise electrocardiogram. We investigated whether R-wave amplitude is a significant factor. We studied the exercise electrocardiogram of 20 patients with angiographically documented coronary artery disease, including ≥ 70% stenosis of the left anterior descending artery, who had an ischemic response to exercise but no previous anterior myocardial infarction. Precordial leads V1-6 were taken into account. When all 120 leads were measured, those with ST-segment depression ≥ 2.0mm at peak exercise had a mean resting R-wave amplitude of 19.03±5.81mm; those with ST-segment depression 2.0-1.0mm, R 11.42±5.99mm; and those with ST-segment depression < 1.0mm, R 5.9±5.21mm (p < 0.001 between groups). When the R-wave amplitude was correlated with the ST-segment depression in each precordial lead, the correlation was 1.0. In leads V1-6, when 67 tracings with ST-segment depression > 0.5mm were measured, the correlation was 0.537 (p < 0.001). In each precordial lead the t values of R-wave differences correlated very strongly (r < 0.883) with the differences in ST-segment depression. We conclude that precordial R-wave amplitude significantly influences the magnitude of ST-segment depression.

Marfan's syndrome and coarctation. Coincidence or association? A case report.

The case of a patient with coexisting Marfans syndrome and coarctation of the aorta is presented. The relevant literature is reviewed and the possible association between the two lesions is discussed.

Effect of Nifedipine on the Sick Sinus Syndrome

The effect of nifedipine (N) on sinus node (SN) function was studied in 15 patients (9 males, 6 females) sixty-two to seventy-six (mean 68.1 ±11) years old, with sick sinus syndrome (SSS). SSS was characterized electrophysiologically by a prolonged corrected sinus node recovery time (CSNRT > 535 msec) and/or prolonged sinoatrial conduction time (SACT > 125 msec), assessed by applying premature atrial stimulation. Ten mg N was given sublingually, and CSNRT and SACT were again evaluated sixty minutes after N administration, and again ten minutes after 1.5 mg atropine (A) was given IV. Heart rate increased significantly after N (p < 0.005), systolic blood pressure (SBP) diminished sig nificantly (p < 0.005), and CSNRT and SACT shortened significantly (p < 0.005, p < 0.005) and became normal in 7 and 5 patients respectively. After A administration, a further significant increase of heart rate (p < 0.005) and decrease of CSNRT (p < 0.005) and SACT (p < 0.005) were observed. CSNRT and SACT became normal in 8 and 7 patients respectively. SBP remained sta ble.

Cardiac Metastasis of an Ovarian Adenocarcinoma Diagnosed by two Dimensional Echocardiography: A Case Report and Review of the Literature on Cardiac Masses Diagnosed by Cardiac Ultrasounds

The first case of right ventricular metastatic ovarian adenocarcinoma diagnosed by two dimensional echocardiography is described. A detailed review of the literature on cardiac tumors diagnosed echocardiographically is given.

Use of the subclavian vein by percutaneous puncture for permanent cardiac pacing

One hundred and fifty patients, 85 males and 65 females with a mean age of sixty-six years (range thirty-five to eighty-five years) were paced permanently by use of the subclavian venipuncture technique. The indication for pacing was documented high-grade A-V block (80 patients), sick sinus syndrome (60 pa tients) and carotid hypertensitivity with recurrent syncope (10 patients). In 142 patients multiprogrammable VVI pacemakers and in 8 DDD pacemakers were implanted. The procedure lasted from twenty to fifty-five minutes (mean thirty minutes). Apart from a partial dislodging of the electrode tip in 1 patient, which resulted in intermittent exit block and was corrected by increasing the pulse width of the generator current, no other early complication was observed. The patients have been followed up from three to twenty-six months (mean eleven months). One patient has had the wire repositioned deeper in the subcutaneous tissue owing to imminent skin erosion. No other late complication has been noticed.