Ileana L. Pina

Cardiovascular findings in quadriplegic and paraplegic patients and in normal subjects

Abstract Seven normal, 7 paraplegic and 7 quadriplegic patients underwent cross-sectional cardiovascular evaluation, including recording of sitting heart rate, blood pressure and echocardiography. Quadriplegic patients had a 26% lower left ventricular (LV) mass index (75 ± 13 g/m 2 , p 2 ) or paraplegic patients (110 ± 26 g/m 2 ). Six quadriplegic patients and 3 paraplegic patients had an unusual pattern of LV posterior wall asynergy, which was associated with a significant rightward shift of the frontal-plane QRS axis (92 ± 22 ° vs 42 ± 41 °, p

Cerebral ischemia and mitral valve prolapse: case-control study of associated factors.

We evaluated 36 patients with cerebral ischemia and mitral valve prolapse and compared them with 36 age-matched controls with cerebral ischemia who had similar attributes but who did not have mitral valve prolapse. Stepwise logistic regression analysis revealed an inverse relation between cerebral ischemia in the presence of mitral valve prolapse and hypertension, diabetes mellitus, occlusive cerebrovascular disease, and completed stroke at p less than 0.01. We also found, by correlation analysis, a negative correlation between both hypertension and diabetes mellitus versus mitral valve prolapse at p less than 0.05. Overall, 10 study patients compared with two control patients had no risk factors for cerebrovascular disease detected (chi 2 = 4.9, p less than 0.05). These data indicate that the association of mitral valve prolapse and cerebral ischemia is of special importance in patients who do not have other detected risk factors for cerebrovascular disease.

A medical evaluation of the effects of computer assisted muscle stimulation in paraplegic patients.

An examination of the medical and physiological effects of functional electrical stimulation (FES) applied to the quadriceps muscle of five paraplegic male volunteers with complete spinal cord injuries was performed. FES training was provided three days a week over a 12-week period using a progressive resistive exercise protocol. Stimulation was applied through use of a closed-loop microprocessor-based FES system. Prior to the start of and immediately following the 12-week training period, subjects were assessed on several measures, including quadriceps muscle bulk and histochemistry, laboratory studies, echocardiography, and arm ergometry exercise. Results of the study indicated substantial increases in muscle strength and muscle bulk. At the outset of the study one patient suffered a patellar fracture. No significant changes in pretraining and posttraining general examinations, laboratory studies, echocardiography, or arm ergometry exercise testing were noted.

Low-dose acebutolol given once daily in the treatment of chronic angina pectoris

Acebutolol, a beta‐1 selective beta blocker with intrinsic sympathomimetic activity has been shown to be an effective agent in chronic angina pectoris therapy, with twice or three times daily dosing. The long‐term effects of 400 mg of acebutolol given only once a day versus placebo on exercise hemodynamics, ST segment depression, and rate pressure product were studied. Eleven patients (mean age, 60 ± 12 years) with hypertension and chronic angina pectoris were enrolled. Resting heart rate was not significantly altered after therapy, (80 vs 72 bpm). Objective measurements from exercise treadmill tests showed significant reduction in peak heart rate from 130 to 103 bpm, systolic blood pressure from 197 to 167 mm Hg, rate pressure product (from 25 to 18 bpm‐mm Hg × 1000), and ST depression in patients receiving acebutolol compared with those receiving placebo. No significant adverse effects were reported. These data indicate that acebutolol may be efficacious as once daily therapy for chronic stable angina pectoris.

Reversal of ST depression and low maximal oxygen uptake after verapamil with normal coronary arteries and pulmonary disease

angioplasty or coronary artery bypass surgery was recommended, but the patient was not willing to undergo these procedures. Doses of isosorbide dinitrate and diltiazem were increased to ZOO mg and 450 mg, respectively. In addition, propranolol was added, but it had to be discontinued because of profound hypotension during hemodialysis. Although we were able to gradually decrease the dose of intravenous nitroglycerin, it was still required to control the patient’s anginaJ attack during hemodialysis. It took 3 months to withdraw the patient from intravenous nitroglycerin during hemodialysis. Subsequently his anginal attacks were controlled with oral medications. He was discharged home and has been doing well under outpatient hemodialysis without intravenous nitroglycerin.