Robert E. Botti

A variant form of angina pectoris with recurrent transient complete heart block

Abstract A patient with a variant form of angina pectoris occurring after an acute nontransmural inferior myocardial infarction is described. A rare simultaneous manifestation of the myocardial ischemic episodes was the recurrence of transient complete A-V block, which on one occasion resulted in an Adams-Stokes attack. Concomitant with the administration of a longacting, oral, coronary vasodilator drug, isosorbide dinitrate, the episodes of chest pain, S-T segment elevation and heart block ceased.

Right ventricular infarction with tricuspid insufficiency and chronic right heart failure.

A patient with chronic right heart failure and probable tricuspid insufficiency associated with an inferior myocardial infartion is described. Angiograms demonstrated total occlusion of the right coronary artery at its origin, a patent venous bypass graft to the mid-right coronary artery and hypokinesia of the inferior wall of both the right and left vebtricles. Clinical data indicated a greater impairment of right than of left ventricular function. It is proposed that infarction of the right ventricle resulted in chronic right heart failure and tricuspid insufficiency.

Management of Aortocaval Fistula Due to Abdominal Aortic Aneurysm

Anasarca and intractable congestive heart failure were the presenting signs of an abdominal aortic aneurysm with aortocaval fistula. Management with careful monitoring of cardiovascular function using a Swan-Ganz catheter before, during, and after surgery resulted in an uneventful recovery.

Significance of isolated left anterior hemiblock and left axis deviation during acute myocardial infarction

Abstract Electrocardiographic signs of bifascicular block are known to be associated with a high mortality rate during the course of an acute myocardial infarction. However, isolated left anterior hemiblock or extreme left axis deviation does not increase mortality or complicate the course of an acute myocardial infarction. The incidence of arrhythmias or atrioventricular block is not increased by the presence of left axis deviation and, at times, left anterior hemiblock is a transient electrocardiographic finding during the course of acute myocardial infarction.

External monitoring of I131-Hippuran disappearance as a measure for renal blood flow

Abstract A method is presented for the determination of the renal blood flow by external monitoring of radiohippuran disappearance following the single injection technique. In fifteen normal individuals, the renal blood flow as determined by this method amounted to 1088 ± 121 ml/min/1.73 m2 (Mean ± 1SD).

Innominate arterial arteriovenous fistula complicating retrograde brachial arterial catheterization

Arteriovenous fistula of the innominate artery occurred in a patient 3 weeks after retrograde brachial arterial catheterization was performed 1 day before aortocoronary bypass surgery. Intramural dissection was noted at catheterization, and a mediastinal hematoma at operation. Exploration of the hematoma in the course of catheterization might have prevented the arteriovenous fistula, which necessitated a second operation 3 weeks after the first. To our knowlege this complication of retrograde brachial catheterization has not previously been described. We recommend that known injuries to cervical or thoracic arteries occurring just before operations requiring extracorporeal circulation be explored to prevent late complications. Recent injuries to the cervical and thoracic arteries that are not acessible to external compression should be exposed and treated during sternotomy to prevent late complications if heparinization is contemplated.

Analysis of Radiohippuran Renogram by Subtraction of Extrarenal Radioactivity

A method is presented for the simple, non-computerized analysis of the radiohippuran renogram by subtraction of the extrarenal radioactivity as monitored simultaneously by a detector centered over the manubrium sterni. This method requires the application of a calibration factor, relating the level of radioactivity recorded by the sternal detector to that over each kidney area at the end point of the phase of initial rise on each side separately. The results in 15 normal individuals showed a narrow range of values, indicating a high degree of resolution. Verification of the basis of this method of analysis was obtained by accounting for all of the counting rate as extrarenal sources in the tracings of nephrectomized subjects. A further advantage is that the tracing recorded by the sternal detector may be used to calculate renal blood flow.