Rex N. MacAlpin

Nifedipine Therapy for Coronary-Artery Spasm: Experience in 127 Patients

We report clinical experience with the coronary vasodilator nifedipine in 127 patients with symptoms of myocardial ischemia associated with electrocardiographic or angiographic evidence, or both, of coronary-artery spasm. In the majority of patients conventional antianginal therapy including nitrates and beta-adrenergic blockers failed, and in one third of the patients at least one episode of ventricular tachycardia developed during an attack of angina. Nifedipine (40 to 160 mg every 24 hours) significantly reduced the mean weekly rate of anginal attacks from 16 to two (P less than 0.001). Similar marked reductions in the nitroglycerin requirement were noted. In 63 per cent of the patients complete control of anginal attacks was achieved, and in 87 per cent the frequency of angina was reduced by at least 50 per cent. Nifedipine was generally well tolerated, with only 5 per cent of the patients requiring termination of the drug because of intolerable side effects. This experience with nifedipine suggests that it is a highly effective drug for the treatment of coronary-artery spasm and variant angina.

Human coronary artery size during life. A cinearteriographic study.

The diameters of large epicardial coronary arteries were measured by quantitative cinearteriography in 99 patients. Average coronary size was larger than normal in patients with lesions associated with left ventricular hypertrophy and∕or dilation. The size of the coronary arteries supplying the left ventricle was normal in patients with pure mitral stenosis and in those with the “floppy mitral valve syndrome” (when mitral regurgitation was slight or absent). The left coronary artery was larger than the right coronary artery in 83% of cases. Measurement of coronary artery size is a simple and useful extension of coronary arteriography.

Left Ventricular Hypertrophy Diagnosed by Echocardiography

Abstract Echocardiography was used to differentiate left ventricular hypertrophy due to hypertrophic cardiomyopathy (20 cases) from that due to aortic valvular stenosis (10 cases) or systemic hypertension (10 cases). In aortic stenosis or hypertension symmetrical left ventricular hypertrophy was demonstrated with greater than normal thickness of both the ventricular septum and the posterior ventricular wall. The ratio of septal-to-posterior ventricular-wall thickness (mean ± S.D.) was the same as normal (1.2 ± 0.1). In hypertrophic cardiomyopathy, asymmetrical left ventricular hypertrophy was demonstrated with gross septal thickening (22.5 ± 3.4 mm) and a normal or slightly increased thickness of the posterior left ventricular wall (10.4 ± 2.0 mm). The ratio of septal-to-posterior left-ventricular-wall thickness (2.2 ± 0.2) was greater than that in aortic stenosis or systemic hypertension (p<0.005). The ventricular septum was disproportionately hypertrophied in hypertrophie cardiomyopathy regardless of th...

Coronary Spasm as a Cause of Angina

For over 100 years there has been controversy about the role of coronary-artery spasm in the production of angina pectoris. In classic, effort-induced Heberdens angina, a number of observations, i...

Percutaneous transaxillary selective coronary angiography.

The basic premise of optimal angiography is to deliver the contrast material selectively to the arterial bed under investigation. This applies to the coronary arterial bed as well as other areas of the body. In 1959, Mason Sones reported his technic of selective catheterization of the coronary arteries with a specially designed catheter (9). The coronary angiograms Sones produced are of such excellence that all other methods must be compared and evaluated with reference to his results. We have modified his basic technic (7–9) by omitting the surgical exposure of the brachial artery and open arteriotomy and substituting instead the percutaneous transaxillary Seldinger approach (2, 6). Advantages of the percutaneous transaxillary approach include those of the Seldinger technic versus open arteriotomy: the ability to re-examine the patient via the same artery, if necessary, after review of the angiogram and on an annual basis to evaluate therapeutic programs. A technical advantage is the fact that the axilla...

Dose reduction low pulse-rate fluoroscopy.

Dose reduction low pulse-rate fluoroscopy may be accomplished by integrating a magnetic video disk recorder into an x-ray system. Playback of the stored television image between x-ray pulses results in a flicker-free continuous image with actual dose reduction ranging from 2 to 60 times, depending on the pulse rate used. This system was applied successfully to cardiac catheterization and selective coronary arteriography, resulting in an estimated average dose reduction of over 2 times.

Prevention of Recurrent Ventricular Tachycardia with Oral Bretylium Tosylate

Abstract A patient with coronary artery disease had at least 77 episodes of ventricular tachycardia over a 4-year period, all of which required electroconversion. The usual therapies, including atr...

Guided Coronary Arteriography and Left Ventriculography

Selective coronary arteriography is accepted by most angiographers as the technic of choice for the reliable demonstration of the coronary arterial system. Previously we reported the use of a percutaneous transaxillary application of the Sones technic (6) which we have now modified even further by use of a tip-deflecting system. The technic and results of guided coronary arteriography will be reported below. In addition, the advantages of a combined approach of coronary arteriography with left heart catheterization and left ventriculography for a more complete evaluation of coronary artery disease will be emphasized. Instrumentation and Technics A modification of the Muller-USCI deflector guide system is utilized. Unfortunately, the catheter supplied with this guide system has the disadvantage of poor delivery time of contrast agent, preventing satisfactory use of the catheter with the guide wires maintained in position. A thin-walled polyethylene catheter has therefore been designed for use with the Mull...

Angiographic demonstration of the ventricular septum. A new technic.

In the cardiac disease, idiopathic hypertrophic subaortic stenosis (IHSS) (1), there is hypertrophy of the myocardium which is often asymmetrically distributed. Although published descriptions appeared earlier, it was not until a clinical report by Brock (3) in 1957 and a pathologic report by Teare (10) in 1958 that the disease became well known. Since that time many other papers have appeared. The disease is much more common than was first realized. Most of the authors describing their cases emphasize that the often massive myocardial hypertrophy may primarily involve the ventricular septum (2, 4, 8, 10, 11), although usually the free wall of the left ventricle and sometimes the right ventricle are involved as well. Frequently the first manifestation of the disease is a heart murmur. The most common symptoms are dyspnea and angina. The patient is often asymptomatic, however. The electrocardiogram is almost always abnormal (2). At catheterization the demonstration of a pressure gradient within the left ve...

Diagnosis, medical and surgical management of coronary insufficiency.

Abstract Coronary artery injections of radio-opaque material into the vessels of autopsy hearts first disclosed that angina pectoris in most cases is due to extensive narrowing and occlusion of the...