Richard P. Lewis

ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction

The American College of Cardiology and the American Heart Association request that the following format be used when citing this document: Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD. ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Available at http://www.acc.org/clinical/guidelines and http://www.americanheart.org. Accessed on [insert date].

ACC/AHA Guidelines for the Clinical Application of Echocardiography

### Preamble It is clearly important that the medical profession plays a significant role in critically evaluation of the use of diagnostic procedures and therapies in the management or prevention of disease. Rigorous and expert analysis of the available data documenting relative benefits and risks of those procedures and therapies can produce helpful guidelines that …

Guidelines for the Evaluation and Management of Heart Failure Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure)

It is becoming more apparent each day that despite a strong national commitment to excellence in health care, the resources and personnel are finite. It is, therefore, appropriate that the medical profession examine the impact of developing technology and new therapeutic modalities on the practice of cardiology. Such analysis, carefully conducted, could potentially have an impact on the cost of medical care without diminishing the effectiveness of that care. To this end, the American College of Cardiology and the American Heart Association in 1980 established a Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (now the ACC/AHA Task Force on Practice Guidelines) with the following charge: The task force of the American College of Cardiology and the American Heart Association shall develop guidelines relative to the role of new therapeutic approaches and of specific noninvasive and invasive procedures in the diagnosis and management of cardiovascular disease. The task force shall address, when appropriate, the contribution, uniqueness, sensitivity, specificity, indications, contraindications and cost-effectiveness of such diagnostic procedures and therapeutic modalities. The task force shall emphasize the role and values of the developed guidelines as an educational resource. The task force shall include a chair and eight members, four representatives from the American Heart Association and four representatives from the American College of Cardiology. The task force may select ad hoc members as needed upon the approval of the presidents of both organizations. Recommendations of the Task Force are forwarded to the President of each organization. The members of the task force are Melvin D. Cheitlin, MD, Kim A. Eagle, MD, Timothy J. Gardner, MD, Arthur Garson, Jr, MD, MPH, Raymond J. Gibbons, MD, Richard P. Lewis, MD, Robert A. O’Rourke, MD, Thomas J. Ryan, MD, and James L. Ritchie, MD, Chair. The Committee to Develop Guidelines on the Evaluation …

Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure.

SUMMARY Thirteen patients with severe cardiac failure underwent a single crossover study of dopamine and dobutamine in order to compare the systemic and regional hemodynamic effects of the two drugs. The dose-response data demonstrated that dobutamine (2.5-10 μg/kg/min) progressively and predictably increases cardiac output by increasing stroke volume, while simultaneously decreasing systemic and pulmonary vascular resistance and pulmonary capillary wedge pressure. There was no change in heart rate or premature ventricular contractions (PVCs)/min at this dose range. Dopamine (2-8 μg/kg/min) increased the stroke volume and cardiac output at 4, g/kg/min. Dopamine at > 4, Ag/kg/min provided little additional increase in cardiac output and increased the pulmonary wedge pressure and the number of PVCs/min. At > 6 Ag/kg/min, dopamine increased heart rate. During the 24-hour maintenance-dose infusion of each drug (dopamine 3.7-4, dobutamine 7.3-7.7 μg/kg/min), only dobutamine maintained a significant increase of stroke volume, cardiac output, urine flow, urine sodium concentration, creatinine clearance and peripheral blood flow. Renal and hepatic blood flow were not significantly altered by the maintenance dose of either drug. Systemic and regional hemodynamic data suggest that dobutamine has many advantages over dopamine when infused in patients with cardiac failure.

Guidelines for clinical use of cardiac radionuclide imaging report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Radionuclide Imaging), developed in collaboration with the American Society of Nuclear Cardiology☆

Abstract It is becoming more apparent each day that despite a strong national commitment to excellence in health care, the resources and personnel are finite. It is therefore appropriate that the medical profession examine the impact of developing technology and new therapeutic modalities on the practice of cardiology. Such analysis, carefully conducted, could potentially affect the cost of medical care without diminishing the effectiveness of that care. To this end, the American College of Cardiology and the American Heart Association in 1980 established a Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures with the following charge: The Task Force of the American College of Cardiology and the American Heart Association shall develop guidelines relative to the role of new therapeutic approaches and of specific noninvasive and invasive procedures in the diagnosis and management of cardiovascular disease. The Task Force shall address, when appropriate, the contribution, uniqueness, sensitivity, specificity, indications, contra-indications and cost-effectiveness of such diagnostic procedures and therapeutic modalities. The Task Force shall emphasize the role and values of the developed guidelines as an educational resource. The Task Force shall include a Chairman and six members, three representatives from the American Heart Association and three representatives from the American College of Cardiology. The Task Force may select ad hoc members as needed upon the approval of the Presidents of both organizations. Recommendations of the Task Force are forwarded to the President of each organization.

Demographics and cardiology, 1950–2050

Changing demographics, in particular the aging of the North American population, contribute to the understanding of trends in such diverse areas as education, housing, crime, marketing, unemployment, recreation, and health care [(1,2)][1]. Although annual changes in many of these sectors are

Changes in diastolic time with various pharmacologic agents: implication for myocardial perfusion.

Diastolic time (DT) is calculated as the cycle length (RR) minus electromechanical systole (QS2). The ratio of DT (RR-QS2) to RR interval times 100, or the percent diastole (%D), varies nonlinearly with heart rate (HR), increasing rapidly with decreasing HR. The effect of commonly used cardioactive agents on %D was studied in five groups of normal subjects.In group I (n = 12), propranolol (160 mg daily) increased %D from 55.9 ± 1.7 to 64.7 i 1.3 (p < 0.001) by slowing HR. In group 2 (n = 12), dobutamine (2.5 Ag/kg/min) increased %D from 56.4 i 1.4 to 61.8 1.3 (p < 0.005) by shortening the QS2. In group 3 (n = 10), Cedilanid-D (1.6 mg i.v.) increased %D from 55.5 ± I to 63.2 ± 0.7 (p < 0.001), both by slowing the HR and shortening the QS2. In group 4 (n = 12), isoproterenol (2 Ag/min) increased HR and shortened the QS2 significantly. The net result was a significant reduction of%D from 56.1 ± 1.4 to 53.5 ± 1.1, (p < 0.05). In group 5 (n = 15), a 100-mg bolus of i.v. lidocaine did not have a significant effect on %D. This study indicates that cardiovascular drugs may have significant effects on the relative duration of diastole either by affecting HR or the duration of systole. This may have clinical implications for patients with coronary artery disease and patients with left ventricular hypertrophy, since in both cases coronary flow is mostly diastolic.

Adriamycin Cardiotoxicity in Man

Abstract Noninvasive methods to detect early adriamycin-induced cardiac injury and to follow the course of the injury were prospectively studied. Serial physical examinations, chest X rays, electro...

Detection of Hypokinesis by a Quantitative Analysis of Left Ventricular Cineangiograms

A method for detecting left ventricular hypokinesis is proposed. It involves superimposition of left ventricular silhouettes traced from 30 degree right anterior oblique cineangiograms, correcting for thoracic cage motion, descent of the aortic valve and rotation of the apex. Normal values for the percent of systolic motion of seven endocardial segments have been established from measurements in 20 patients, permitting a statistical definition of hypokinesis. The use of this quantitative method has been compared with visual inspection of ventriculograms (qualitative method), resulting in differences in definition of hypokinetic segments by the two methods in 13 of 16 patients with coronary heart disease. When the quantitative method was used, only one hypokinetic segment was found which did not correspond to an obstructive coronary lesion while six such segments were defined using the qualitative method. In four patients segments thought to be hypokinetic (qualitative method) appeared to be akinetic (quantitative method). In six patients with cardiomyopathy, thought to have diffuse hypokinesis, all seven left ventricular segments were hypokinetic in only three patients. The use of a quantitative method appears to be essential to the proper interpretation of left ventricular wall motion and particularly to the detection of hypokinetic segments.

Hypersensitivity to Adrenergic Stimulation after Propranolol Withdrawal in Normal Subjects

The cardiac response to isoproterenol after propranolol withdrawal was studied in six normal persons. Serial isoproterenol infusions were done before and after oral propranolol administration, 160 mg daily for 2 days. Changes in electromechanical systole corrected for heart rate (QS2I) and pulse pressure were used to assess the inotropic response to isoproterenol, and changes in heart rate were used to assess the chronotropic response. As shown in previous studies, the negative inotropic effect of propranolol lasted only 12 to 15 h, while the negative chronotropic effect lasted 24 to 36 h. After the disappearance of blockade a hypersensitivity to isoproterenol was found 24 to 48 h after propranolol withdrawal in all three measured determinants. The explanation of this phenomenon most likely lies in the nature of adrenergic receptors that become activated during long-term blockade.