W.V.R. Vieweg

Myocardial infarction before age 36: Risk factor and arteriographic analysis

One-hundred consecutive patients who were 35 years of age of younger underwent coronary arteriography after clinical myocardial infarction. Ninety-two percent were men. Four distinct subgroups were identified: Ninety-four patients (78 percent) had significant coronary artery disease (greater than 50 percent diameter narrowing of at least one major coronary artery), 20 (17 percent) had normal coronary arteries, 5 (4 percent) had major coronary arterial anomalies and 1 patient had coronary arteritis. Of the patients with obstructive coronary disease, risk factors were smoking in 89 percent, positive family history of coronary artery disease in 48 percent, hypertension in 21 percent and a history of lipid abnormality in 20 percent. Risk factors were distinctly less frequent in the groups without coronary atherosclerosis. In the group with coronary artery disease, the prevalence rate of one, two and three vessel disease was 32, 26 and 42 percent, respectively. Coronary arterial anomalies included anomalous origin of the left coronary artery from the pulmonary artery (three patients) and single right and single left coronary artery (one patient each). It is concluded that myocardial infarction before age 36 is a disease of men who smoke and who often have a family history of premature coronary artery disease. Twenty-two percent of patients will have normal coronary arteries, coronary arterial anomalies or coronary vasculitis. Coronary arteriography should be considered for patients who sustain a myocardial infarction before age 36 for purposes of diagnosis, management and prognosis.

Clinical Correlates in Hypertensive Patients With Left Ventricular Hypertrophy Diagnosed With Echocardiography

Seventy-three hypertensive patients were evaluated with M mode and two dimensional echocardiography. Left ventricular hypertrophy was found in 37 patients (51 percent); 29 had concentric hypertrophy and the remaining 8 had disproportionate septal thickening. Factors that did not influence the distribution of patients in the group with left ventricular hypertrophy and normal subjects included (1) duration of hypertension, (2) level of blood pressure, (3) age, (4) body surface area, and (5) race. More of the patients who had a normal left ventricular mass (32 or 89 percent) than of those who had hypertrophy (22 or 59 percent) were receiving two or more antihypertensive drugs. Electrocardiography was very insensitive in identifying left ventricular hypertrophy in these patients. The presence of increased left ventricular mass was associated with a greater incidence of other target organ disease.

Single left pulmonary vein with normal pulmonary venous drainage: A roentgenographic curiosity

Abstract An unusual case of a single left pulmonary vein draining the left lung with normal pulmonary venous return and without venous obstruction is reported. The characteristic appearance of the anomaly on routine roentgenograms should not be confused with more sinister pulmonary densities.

Idiopathic Prominence of Pulmonary Veins on Chest X-Ray

A 20 year old asymptomatic man was seen because of an abnormal chest roentgenogram. The physical examination and routine laboratory studies were normal. The electrocardiogram demonstrated sinus bradycardia. Routine chest roentgenogram (Figure 1) demonstrated prominent, smooth curvilinear densities bilaterally, best seen in the lower lobes. These densities were seen posterior to the cardiac silhouette on the lateral chest roentgenogram. A two-dimensional echocardiogram demonstrated a small left atrium on the

Semiautomated Method for Evaluation of Left Ventricular Regional Wall Motion in Coronary Artery Disease

Regional left ventricular wall motion was independently assessed in 436 patients using both subjective visual inspection of ventriculograms and objective computer-determined percent change in the square root of the area between systolic and diastolic outlines. Agreement between subjective and objective techniques was greatest at the ventricular apex and least at the base and partly dependent on the number of abnormal segments present. Objective analysis of regional wall motion provides a permanent quantitative record of wall motion and shows good agreement with meticulous subjective inspection of ventriculograms. As such, it has potential as an adjunct to ventriculography.

Selective coronary arteriography in congenitally corrected transposition of the great arteriest

Three cases of congenitally corrected transposition of the great arteries in adults who underwent selective coronary arteriography are presented. The morphologic features of the epicardial coronary anatomy are distinctive and are identifiable angiographically as morphologically right and left coronary arteries that are specifically concordant with the morphologically right and left ventricles. This relation is constant in the presented cases, in previously published coronary arteriograms of congenitally corrected transposition of the great arteries and in a review of the anatomic studies of congenitally corrected transposition of the great arteries that identify the coronary arterial pattern. Thus the angiographic characteristics of the epicardial coronary arterial pattern permit identification of the morphologic features of the underlying ventricle regardless of other spatial relations.

Distribution and severity of left ventricular wall motion abnormalities according to age and coronary arterial pattern in 500 patients with coronary artery disease and angina pectoris

Abstract Left ventriculograms of 500 patients with coronary artery disease and angina pectoris were compared with respect to coronary arterial pattern, left ventricular dyssynergy, and the patients age. The coronary arterial patterns were separated into Right, Mixed, and Left systems depending upon the blood supply to the inferior surface of the left ventricle. The left ventriculograms were divided into two regions and five areas. The anterior region consisted of the anterobasal area, anterolateral area, and the apical area. The posterior region consisted of the diaphragmatic area and the posterobasal area. Areas were scored as normal, hypokinetic, akinetic, or dyskinetic. The following relationships were noted: 1. 1. Forty percent of patients with coronary artery disease and angina pectoris have normal left ventricular wall motion. In the 60% of patients with left ventricular dyssynergy, wall motion abnormalities are divided evenly into three categories: anterior dyssynergy alone, posterior dyssynergy alone, and combined anterior and posterior dyssynergy. The mean age of patients with normal and dyssynergic wall motion is strikingly similar. 2. 2. Coronary arterial patterns of Right, Mixed, and Left systems have little, if any, influence on left ventricular wall motion abnormalities. 3. 3. Hypokinesis is the most common wall motion abnormality found in patients with coronary artery disease regardless of coronary arterial distribution or region of the left ventricle affected, with the exception of the apical area, where dyskinesis is found most commonly. Dyssynergy occurs most commonly in adjacent areas. In the anterior wall dyssynergy, the anterolateral and apical areas of the left ventricle are involved together most commonly. In posterior wall dyssynergy, the diaphragmatic and posterobasal areas of the left ventricle are involved most commonly. 4. 4. In patients with coronary artery disease and angina pectoris, left ventricular dyssynergy is similar from the third to the eighth decade of life.

On the relationship between Q waves in leads II and aVF and inferior-posterior wall motion abnormalities§

Twelve electrocardiographic criteria, based on various combinations of Q wave morphology in leads II and aVF, were tested in 235 cases for their diagnostic value in detecting inferoposterior wall motion abnormality (presumably reflecting infarction in the area) as demonstrated on left ventriculogram. The most reliable indicator of inferoposterior wall motion abnormality was found to to a QR complex with a Q wave width greater than or equal to .03 or greater than or equal to .04 sec associated with a Q/R ratio greater than .25. Using as criterion a QR complex with a Q wave width greater than or equal to .04 sec and a Q/R ratio greater than .25, the sensitivity was 41.9% in the cases with akinetic-dyskinetic wall motion and 3.7% in the cases with hypokinesis with an associated specificity of 100%. By lowering the Q wave duration to greater than or equal to .03 sec, the sensitivity increased to 51.6% and 9.3%, respectively, while retaining a very high specificity (96%). The exclusion of cases with a Q and R of less than 5 mm markedly lowered the sensitivity with a negligible increase in specificity. QS complexes in leads II or aVF were not found to be reliable indicators of inferoposterior wall motion abnormality.

Flutter of the mitral valve associated with a diastolic murmur in the absence of disease

Abstract A patient is presented with the unique combination of a low-pitched apical diastolic murmur auscultated on physical examination and corroborated by external phonocardiography in association with the echocardiographic and ventriculographic findings of mitral leaflet flutter in the absence of disease. This has not been documented previously in the literature. Possible mechanisms for the production of the diastolic murmur and mitral valve flutter are discussed.