John L. Caplin

Femoral complications and bed rest duration after coronary arteriography

This randomized study using a pneumatic compression device found no significant difference in the femoral complication rate between 4 and 6 hours of bed rest after Judkins coronary arteriography. The positive implications for the organization of an efficient service in busy tertiary centers include reduced patient discomfort, earlier ambulation and discharge, efficient staff deployment, and enhanced throughput.

Dipyridamole is superior to dobutamine for thallium stress imaging: a randomised crossover study.

OBJECTIVE--To assess the value of dobutamine over dipyridamole as a pharmacological stressing agent in myocardial perfusion imaging with thallium-201. DESIGN--Stress and redistribution tomographic images were taken in a group of patients in a randomised crossover study of both agents. The scans were scored to give a value for the stress and redistribution images and a reversibility score (redistribution--stress). All patients had coronary angiography that was also scored. Differences between the two agents were compared by a paired t test. PATIENTS--30 patients aged 51-70 years with chest pain thought to be caused by myocardial ischaemia. 11 had had previously myocardial infarction. RESULTS--Dipyridamole caused adverse symptoms in six patients whereas dobutamine caused symptoms in 21 patients (chi 2 = 15.15, p < 0.0001). Dobutamine stress took considerably longer than dipyridamole (31 v 6 minutes) and cost more (17 pounds v 1.50 pounds). There were no significant differences between the agents in terms of total stress or redistribution scores, but regional analysis showed that dipyridamole showed significantly more defects during stress at the apex and lateral wall (p < 0.05), with no significant difference at redistribution. Dipyridamole stress also caused significantly more reversible defects at the apex (p < 0.05) and gave a better correlation than dobutamine with coronary score (dipyridamole r = 0.80, p < 0.001 v dobutamine r = 0.64, p < 0.001). In six patients who had continued to take beta blockers the results of dobutamine stress did not correlate with coronary score, r = 0.34 (NS), whereas dipyridamole studies were not affected. CONCLUSION--Compared with dobutamine, dipyridamole was as effective in producing overall perfusion defects and more effective in provoking defects at the apex and lateral segment. The dipyridamole study correlated better with coronary score and was not affected by concurrent beta blocker treatment. It was also better tolerated by the patients, was less time consuming, and was much cheaper.

Clinical Evaluation of a Dual Sensor, Rate Responsive Pacemaker

Dual sensor pacemakers should respond more appropriately during differing exercise modes than a single sensor device. The Topaz™ models 515 (QT and activity count [ACT] sensing) pacemaker shows appropriate rate response during treadmill exercise testing. We postulated that adjustments to relative sensor contribution should allow fine tuning of the onset of rate response. Eleven patients with this pacemaker were studied. Three standard exercise tests were performed with adjustment of sensor blending and activity threshold between each one. We also assessed the response to isometric exercise and a false positive activity signal. Results: Times to 100 ppm (3.7 ± 1.3, 4.4 ± 2.0, 5.3 ±1.5 mins), times to peak rate (6.1 ± 1.6, 5.6 ± 1.4, 6.5 ± 1.3 mins) and accelerations to peak (9.0 ± 2.4, 9.2 ± 5.3, 7.7 ± 2.8 ppm/min) were measured in all three different sensor settings (QT = ACT, QT

The hibernating heart: reversible left ventricular dysfunction in chronic heart failure.

A patient with severe heart failure secondary to coronary heart disease is presented. Following investigation he was thought to have significant areas of myocardial hibernation and was therefore treated with coronary revascularisation, with major clinical benefit.

Small ductus arteriosis.

on the fourth day to a peak on day 14. Thereafter titres (mean (SEM) gradually declined but remained significantly raised for two years after treatment presentation, 14-63 (4); day 14; 3192 (771); 2 years, 86 (24); 2j years, 65 (26)) (figure). No evidence of IgM antibody was found in our study indicating that the immunological response was a secondary one. We also found that specific antibody significantly impairs the action of streptokinase in vitro.6 We agree with Buchalter et al that it would be prudent to avoid repeat treatment with streptokinase for a period after the initial 72 hours of therapy, until the significance of these antibodies has been evaluated in vivo. Our findings suggest this period may be for 2j years or more. MARY LYNCH Prince Charles Hospital, Chermside, Queensland 4032, Australia BRIAN PENTECOST WILLIAM A LITTLER ROBERT A STOCKLEY The General Hospital, Steelhouse Lane, Birmingham B4 6NH