Methods: Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may ... more Methods: Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk factor for stroke, particularly stroke of undetermined mechanism, but controls in prior studies were not balanced for vascular risk factors. We used TEE to evaluate aortic atherosclerosis in 60 patients with stroke compared with a high-risk control population of 46 subjects. We also examined the possible association of plasma viscosity and fibrinogen levels to aortic atherosclerosis. Results: The mean maximal plaque thickness (MMPT) was similar for the control (2.8 +/- 3.6 mm) and the stroke group (3.3 +/- 3.5 mm), but varied with stroke mechanism. The MMPT was similar in stroke of undetermined and atherosclerotic mechanism [3.5 +/- 4 mm (n = 25) and 4.2 +/- 4.3 mm (n = 16), respectively], significantly greater than in stroke of other mechanisms (1.7 +/- 1.2 mm, P < .05, n = 19). Patients with stroke of undetermined mechanism were four times more likely (95% confidence inter...
West Virginia leads the nation in mortality from coronary heart disease among both men and women ... more West Virginia leads the nation in mortality from coronary heart disease among both men and women aged 35 to 74. Although there has been some research with respect to behavioral risk factors, little is known about the prevalence of high serum cholesterol among West Virginia residents. The present paper begins this examination by reporting the results of a medical chart audit conducted recently in a rural medicine clinic in Matewan, West Virginia. Results revealed that only 17 per cent of the 501 charts reviewed reported serum cholesterol. Significant differences were noted between the local sample and a national comparison for two groups. The implications of these findings are discussed.
Two-dimensional echocardiography has had a significant impact on and is considered the technique ... more Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of endocarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study population of 101 patients. The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, ...
Nineteen consecutive patients with atrial fibrillation/flutter or other types of supraventricular... more Nineteen consecutive patients with atrial fibrillation/flutter or other types of supraventricular tachycardia were given intravenous (IV) calcium salts (1 g) followed by verapamil infusion at a rate of 1 mg/min. Successful treatment was defined as control of ventricular response to less than or equal to 100 beats per minute (bpm) or conversion to sinus mechanism in patients with atrial arrhythmias: 11 patients had atrial fibrillation; three had atrial flutter; four had reentrant supraventricular tachycardias (SVT); and one had paroxysmal SVT. Therapy was successful in all patients. The mean dose of verapamil required to achieve desired outcome was 20 mg. Heart rate showed no significant change as a result of calcium pretreatment (160 bpm v 151 bpm). However, heart rate was significantly decreased, to 95 bpm, after treatment with verapamil. Blood pressure showed no change from baseline with either calcium or verapamil therapy. Verapamil infusion following IV calcium successfully trea...
To assess the possible role of variables not related to early infarct artery reperfusion in predi... more To assess the possible role of variables not related to early infarct artery reperfusion in predicting late changes in ventricular function after infarction, paired early (mean 6.6 +/- 3.5 days after admission) and late (12.7 +/- 7.0 months later) cross-sectional echocardiograms from 54 infarction survivors were retrospectively reviewed. Ejection fraction was calculated from digitized biapical echocardiographic views on a graphics tablet. Changes of 0.10 or more in LVEF were correlated with 23 clinical variables. By stepwise regression analysis, Q-wave infarction and low early LVEF independently predicted late improvement in function. Early high LVEF and interval infarction were the only independent predictors of late declines in function. Overall, when patients were indexed by early left ventricular systolic function, a pronounced late "regression to the mean" was noted with initially high values tending to fall and low values to rise (r = -0.44, p less than 0.001). This ...
Abnormal blood rheology is a known characteristics of coronary artery disease. The authors evalua... more Abnormal blood rheology is a known characteristics of coronary artery disease. The authors evaluated the effects of pentoxifylline on the exercise capacity ejection fraction and symptoms of 9 patients with ischemic cardiomyopathy. All patients had signs and symptoms of left ventricular dysfunction. All had at least two major vessels obstructed as determined by coronary angiography. Pentoxifylline 400 mg three times daily was administered for twelve weeks. Seven of 9 patients responded with increases in ejection fraction and exercise tolerance. Exercise tolerance correlated with improvement or lack of improvement in ejection fraction. For all patients at twelve weeks post-therapy mean ejection fraction increased 9.8% over baseline (p = .07), total treadmill time increased 15% (p = .27), and mean double product increased 13% (p = .03). Anginal symptoms were significantly improved over baseline at twelve weeks of therapy (p greater than .001), as well as dyspnea on exertion (p = .03). ...
Current National Cholesterol Education Program (NCEP) guidelines consider a desirable low-density... more Current National Cholesterol Education Program (NCEP) guidelines consider a desirable low-density lipoprotein cholesterol level to be < 100 mg/dl for an individual with coronary artery disease (CAD). To assess the affect of these cholesterol levels on endothelial cell functioning, flow-mediated brachial artery vasoactivity was measured non-invasively (7.5 MHz ultrasound) before and during Simvastatin (Zocor) therapy. Vasoactivity was expressed as a percent diameter change from baseline to hyperemic conditions and increased from 2.4 +/- 3.0% at baseline to 13.1 +/- 3.4% (p < .05) and 15.1 +/- 2.7% (p < .01) as cholesterol decreased from 243 +/- 24.7 to 221 +/- 27.3 and 213 +/- 22 mg/dl after three and six months, respectively, during therapy. LDL cholesterol subsequently decreased from 155 +/- 22.1 at baseline to 143 +/- 20.2 and 130 +/- 10.6 after three and six months of treatment, respectively. In conclusion, vasoactivity was found to correlate inversely with cholesterol l...
Catheterization and cardiovascular diagnosis, 1993
Synchronized coronary venous retroperfusion of autologous arterial blood was offered to patients ... more Synchronized coronary venous retroperfusion of autologous arterial blood was offered to patients referred for medically refractory unstable angina or evolving myocardial infarction with contraindications to thrombolytic therapy. Primary endpoints of angina, ST segment deviation, and two-dimensional echocardiographic systolic wall motion were followed to determine the efficacy of retroperfusion in patients prior to and then during angioplasty, surgical intervention, or pharmacological management, as the clinical picture warranted. Over a 12 month period, 21 patients were referred and 15 received retroperfusion. All experienced full relief of angina (p = 0.008). ST segment deviations and systolic wall motion of ischemic zones were observed to improve (p = 0.06 ST changes; p = 0.0001 wall motion changes) with synchronized retrograde perfusion. During attempts to remove patients from retroperfusion, statistically significant (p < 0.01) reproducible changes in these same endpoints wer...
Silent myocardial ischemia, an important contributor to myocardial infarction, sudden cardiac dea... more Silent myocardial ischemia, an important contributor to myocardial infarction, sudden cardiac death, ischemic arrhythmias, and other aspects of cardiac morbidity and mortality, requires treatment. Two pathophysiologic mechanisms have been proposed to explain transient, acute episodes of myocardial ischemia: an increase in myocardial demand in coronary obstructive disease and a transient dynamic stenosis or increase in tone within the epicardial coronary arteries. Epidemiologic data suggest a high prevalence of asymptomatic myocardial ischemia, and that these episodes are associated with the morbid events of ischemic heart disease. Several choices exist for the treatment of the condition: conservative (risk factor modification), moderate (medical intervention, percutaneous transluminal angioplasty), and aggressive (coronary artery bypass graft). Further research will elucidate the mechanisms by which the dormant atherosclerotic plaque is transformed to a complicated and activated pla...
A discrepancy exists in the medical literature as to what effect intravascular ultrasound (IVUS)-... more A discrepancy exists in the medical literature as to what effect intravascular ultrasound (IVUS)-guided stent deployment has on target vessel revascularization (TVR) at 6 months. The major endpoints of this study are the need for TVR, defined as clinically driven repeat interventional or surgical therapy of the index vessel at 6 months and major adverse cardiac events. One hundred interventional stent cases (50 IVUS-guided, 50 non-IVUS guided) were randomly selected in a 6-month period (January to June 2001) for review by measurement of minimal luminal diameter (MLD) pre- and post-intervention. Seventy males and 30 females were distributed among the 2 groups. There were a total of 135 lesions (70 IVUS-guided, 65 non-IVUS guided) in the 2 groups. A 6-month follow-up chart review was performed following the initial stenting. At 6-month follow-up, there were 2 deaths in the IVUS-guided group and 3 deaths in the non-IVUS guided group (p=NS). All deaths were cardiovascular in nature. Pos...
Prostaglandins & other lipid mediators, Jan 9, 2015
Myocardial infarction (MI) is complicated by ventricular fibrosis and associated diastolic and sy... more Myocardial infarction (MI) is complicated by ventricular fibrosis and associated diastolic and systolic failure. Emerging studies implicate Wnt1 signaling in the formation of new blood vessels. Epoxyeicosatrienoic acids (EETs)-mediated up-regulation of heme oxygenase-1 (HO-1) protects against the detrimental consequences of MI in several animal models, however, the mechanism(s) by which this occurs remains unclear. The aim of this study was to examine these mechanisms in the LAD ligation animal model of post infarcted heart failure. Specifically, we sought to clarify the mechanistic basis of the interactions of the Wnt1 canonical pathway, HO-1 and associated angiogenesis. Human microvascular endothelial cells (HMECs) were exposed to anoxia and treated with the EET agonist, NUDSA, in the presence and absence of tin mesoporphyrin (SnMP). Increased capillary density, and Wnt1 and HO-1 expression occurred in cells treated with NUDSA. Anoxic HMECs treated with NUDSA and Wnt1 siRNA, exhib...
This study examined the impact of a preventive cardiology curriculum on the knowledge and attitud... more This study examined the impact of a preventive cardiology curriculum on the knowledge and attitudes of first‐year medical students. Questionnaires assessing knowledge and attitudes were self‐administered to classes entering in 1988 and 1989 at the beginning and end of each academic year. Data from 54 students were analyzed. All statistical analyses were significant, indicating that students showed increases in both knowledge and attitudes regarding preventive cardiology. We concluded that the preventive cardiology curriculum had a significant impact on student learning. Future research is needed to address the long‐term effect of the increases in knowledge and attitudes on the future practice of medicine.
Journal of the American College of Cardiology, 1990
The signal averaged electrocardiogram (SAE) is predictive of future at-rhythmic events after a my... more The signal averaged electrocardiogram (SAE) is predictive of future at-rhythmic events after a myocardial infarction (Ml). However, it is unknown whether the !ype of MI, Q wave vs nonn of potential substrate for s within one with prior MI entials (LP), 13 (26%) of and without vs 49*17%
Journal of Stroke and Cerebrovascular Diseases, 1997
Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk... more Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk factor for stroke, particularly stroke of undetermined mechanism, but controls in prior studies were not balanced for vascular risk factors. We used TEE to evaluate aortic atherosclerosis in 60 patients with stroke compared with a high-risk control population of 46 subjects. We also examined the possible association of plasma viscosity and fibrinogen levels to aortic atherosclerosis. The mean maximal plaque thickness (MMPT) was similar for the control (2.8 +/- 3.6 mm) and the stroke group (3.3 +/- 3.5 mm), but varied with stroke mechanism. The MMPT was similar in stroke of undetermined and atherosclerotic mechanism [3.5 +/- 4 mm (n = 25) and 4.2 +/- 4.3 mm (n = 16), respectively], significantly greater than in stroke of other mechanisms (1.7 +/- 1.2 mm, P &lt; .05, n = 19). Patients with stroke of undetermined mechanism were four times more likely (95% confidence interval [CI] 1.2-12) to have plaques &gt;/=5 mm compared with controls. Ulcerated plaque was associated with plaque thickness (P &lt; .001) and plasma viscosity (P &lt; .001). Aortic atherosclerosis is associated with stroke of undetermined cause suggesting atherosclerosis is a cause of stroke of undetermined etiology. Plaque ulceration was associated with the thickness of aortic plaque and plasma viscosity.
The objective of this study was to test the hypothesis that obesity increases the sensitivity of ... more The objective of this study was to test the hypothesis that obesity increases the sensitivity of rats to experimentally induced hypertension. To induce hypertension, unilaterally nephrectomized lean and obese Zucker rats were injected with 25 mg/kg of deoxycorticosterone acetate (DOCA) twice weekly for 5 weeks and given water containing 1% NaCl to drink. Unilaterally nephrectomized control rats were injected with vehicle and drank tap water. Systolic blood pressure (SBP) was measured by the tail cuff method. Renal histology and urinary albumin excretion were used to assess the effects of the experimental treatment on the kidney. Obese rats exhibited a significant rise in SBP at 4 days after the start of DOCA-salt treatment. In contrast, SBP of DOCA-treated lean rats was not significantly elevated from pretreatment measurements until day 22. Moreover, SBP was significantly higher during the plateau phase of blood pressure development in obese DOCA-salt treated rats (196 mmHg) than in correspondingly treated lean rats (150 mmHg). Both obesity and DOCA-salt treatment promoted glomerulosclerosis and mild tubulointerstitial damage in the kidney with DOCA-salt treatment exacerbating the effect of obesity. Urinary albumin excretion was significantly greater in obese control rats compared with lean controls and in DOCA-treated obese rats relative to vehicle-treated obese rats. Results of this study indicate that obese Zucker rats are more sensitive to mineralocorticoid-induced hypertension than lean rats. This study provides experimental evidence supporting the epidemiological findings that obesity is a risk factor for the development of hypertension.
In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial inf... more In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial infarction, which was repaired successfully, is described. A 62-year-old man, with a history of acute anterior wall myocardial infarction 6 months previously, was admitted with the complaints of acute dyspnea and palpitation. Echocardiography revealed an LV aneurysm, and ventriculography showed ventricular dysfunction and an LV pseudoaneurysm. Coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery with a very thin lumen and insufficient retrograde filling. Under cardiopulmonary bypass and beating heart, the pseudoaneurysm was resected and the defect on the ventricular free wall was closed by the remodeling ventriculoplasty method of Dor. Histopathologic examination of the resected material confirmed the diagnosis of pseudoaneurysm. The postoperative course of our patient was uneventful. He was discharged on the ninth postoperative day.
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Cr... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Critical Care Medicine. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but ...
Methods: Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may ... more Methods: Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk factor for stroke, particularly stroke of undetermined mechanism, but controls in prior studies were not balanced for vascular risk factors. We used TEE to evaluate aortic atherosclerosis in 60 patients with stroke compared with a high-risk control population of 46 subjects. We also examined the possible association of plasma viscosity and fibrinogen levels to aortic atherosclerosis. Results: The mean maximal plaque thickness (MMPT) was similar for the control (2.8 +/- 3.6 mm) and the stroke group (3.3 +/- 3.5 mm), but varied with stroke mechanism. The MMPT was similar in stroke of undetermined and atherosclerotic mechanism [3.5 +/- 4 mm (n = 25) and 4.2 +/- 4.3 mm (n = 16), respectively], significantly greater than in stroke of other mechanisms (1.7 +/- 1.2 mm, P < .05, n = 19). Patients with stroke of undetermined mechanism were four times more likely (95% confidence inter...
West Virginia leads the nation in mortality from coronary heart disease among both men and women ... more West Virginia leads the nation in mortality from coronary heart disease among both men and women aged 35 to 74. Although there has been some research with respect to behavioral risk factors, little is known about the prevalence of high serum cholesterol among West Virginia residents. The present paper begins this examination by reporting the results of a medical chart audit conducted recently in a rural medicine clinic in Matewan, West Virginia. Results revealed that only 17 per cent of the 501 charts reviewed reported serum cholesterol. Significant differences were noted between the local sample and a national comparison for two groups. The implications of these findings are discussed.
Two-dimensional echocardiography has had a significant impact on and is considered the technique ... more Two-dimensional echocardiography has had a significant impact on and is considered the technique of choice for the diagnosis and management of infective endocarditis. Over a thirty-six month period, 106 patients were evaluated by echocardiography for the possibility of endocarditis. The diagnosis of endocarditis was determined by strict clinical and laboratory criteria. All clinical histories, blood cultures, echocardiograms, and autopsy results were reviewed. Five echocardiograms were technically inadequate, resulting in a study population of 101 patients. The age of the patients ranged from forty-five days to eighty-eight years (mean fifty-seven years). The clinical manifestations of endocarditis included fever (83%), chills (60%), congestive heart failure (25%), and splenomegaly (18%). Twelve patients had preexisting valvular or congenital heart disease. Gram-positive cocci were the most common microorganisms. Complications included mitral regurgitation, subarachnoid hemorrhage, ...
Nineteen consecutive patients with atrial fibrillation/flutter or other types of supraventricular... more Nineteen consecutive patients with atrial fibrillation/flutter or other types of supraventricular tachycardia were given intravenous (IV) calcium salts (1 g) followed by verapamil infusion at a rate of 1 mg/min. Successful treatment was defined as control of ventricular response to less than or equal to 100 beats per minute (bpm) or conversion to sinus mechanism in patients with atrial arrhythmias: 11 patients had atrial fibrillation; three had atrial flutter; four had reentrant supraventricular tachycardias (SVT); and one had paroxysmal SVT. Therapy was successful in all patients. The mean dose of verapamil required to achieve desired outcome was 20 mg. Heart rate showed no significant change as a result of calcium pretreatment (160 bpm v 151 bpm). However, heart rate was significantly decreased, to 95 bpm, after treatment with verapamil. Blood pressure showed no change from baseline with either calcium or verapamil therapy. Verapamil infusion following IV calcium successfully trea...
To assess the possible role of variables not related to early infarct artery reperfusion in predi... more To assess the possible role of variables not related to early infarct artery reperfusion in predicting late changes in ventricular function after infarction, paired early (mean 6.6 +/- 3.5 days after admission) and late (12.7 +/- 7.0 months later) cross-sectional echocardiograms from 54 infarction survivors were retrospectively reviewed. Ejection fraction was calculated from digitized biapical echocardiographic views on a graphics tablet. Changes of 0.10 or more in LVEF were correlated with 23 clinical variables. By stepwise regression analysis, Q-wave infarction and low early LVEF independently predicted late improvement in function. Early high LVEF and interval infarction were the only independent predictors of late declines in function. Overall, when patients were indexed by early left ventricular systolic function, a pronounced late "regression to the mean" was noted with initially high values tending to fall and low values to rise (r = -0.44, p less than 0.001). This ...
Abnormal blood rheology is a known characteristics of coronary artery disease. The authors evalua... more Abnormal blood rheology is a known characteristics of coronary artery disease. The authors evaluated the effects of pentoxifylline on the exercise capacity ejection fraction and symptoms of 9 patients with ischemic cardiomyopathy. All patients had signs and symptoms of left ventricular dysfunction. All had at least two major vessels obstructed as determined by coronary angiography. Pentoxifylline 400 mg three times daily was administered for twelve weeks. Seven of 9 patients responded with increases in ejection fraction and exercise tolerance. Exercise tolerance correlated with improvement or lack of improvement in ejection fraction. For all patients at twelve weeks post-therapy mean ejection fraction increased 9.8% over baseline (p = .07), total treadmill time increased 15% (p = .27), and mean double product increased 13% (p = .03). Anginal symptoms were significantly improved over baseline at twelve weeks of therapy (p greater than .001), as well as dyspnea on exertion (p = .03). ...
Current National Cholesterol Education Program (NCEP) guidelines consider a desirable low-density... more Current National Cholesterol Education Program (NCEP) guidelines consider a desirable low-density lipoprotein cholesterol level to be < 100 mg/dl for an individual with coronary artery disease (CAD). To assess the affect of these cholesterol levels on endothelial cell functioning, flow-mediated brachial artery vasoactivity was measured non-invasively (7.5 MHz ultrasound) before and during Simvastatin (Zocor) therapy. Vasoactivity was expressed as a percent diameter change from baseline to hyperemic conditions and increased from 2.4 +/- 3.0% at baseline to 13.1 +/- 3.4% (p < .05) and 15.1 +/- 2.7% (p < .01) as cholesterol decreased from 243 +/- 24.7 to 221 +/- 27.3 and 213 +/- 22 mg/dl after three and six months, respectively, during therapy. LDL cholesterol subsequently decreased from 155 +/- 22.1 at baseline to 143 +/- 20.2 and 130 +/- 10.6 after three and six months of treatment, respectively. In conclusion, vasoactivity was found to correlate inversely with cholesterol l...
Catheterization and cardiovascular diagnosis, 1993
Synchronized coronary venous retroperfusion of autologous arterial blood was offered to patients ... more Synchronized coronary venous retroperfusion of autologous arterial blood was offered to patients referred for medically refractory unstable angina or evolving myocardial infarction with contraindications to thrombolytic therapy. Primary endpoints of angina, ST segment deviation, and two-dimensional echocardiographic systolic wall motion were followed to determine the efficacy of retroperfusion in patients prior to and then during angioplasty, surgical intervention, or pharmacological management, as the clinical picture warranted. Over a 12 month period, 21 patients were referred and 15 received retroperfusion. All experienced full relief of angina (p = 0.008). ST segment deviations and systolic wall motion of ischemic zones were observed to improve (p = 0.06 ST changes; p = 0.0001 wall motion changes) with synchronized retrograde perfusion. During attempts to remove patients from retroperfusion, statistically significant (p < 0.01) reproducible changes in these same endpoints wer...
Silent myocardial ischemia, an important contributor to myocardial infarction, sudden cardiac dea... more Silent myocardial ischemia, an important contributor to myocardial infarction, sudden cardiac death, ischemic arrhythmias, and other aspects of cardiac morbidity and mortality, requires treatment. Two pathophysiologic mechanisms have been proposed to explain transient, acute episodes of myocardial ischemia: an increase in myocardial demand in coronary obstructive disease and a transient dynamic stenosis or increase in tone within the epicardial coronary arteries. Epidemiologic data suggest a high prevalence of asymptomatic myocardial ischemia, and that these episodes are associated with the morbid events of ischemic heart disease. Several choices exist for the treatment of the condition: conservative (risk factor modification), moderate (medical intervention, percutaneous transluminal angioplasty), and aggressive (coronary artery bypass graft). Further research will elucidate the mechanisms by which the dormant atherosclerotic plaque is transformed to a complicated and activated pla...
A discrepancy exists in the medical literature as to what effect intravascular ultrasound (IVUS)-... more A discrepancy exists in the medical literature as to what effect intravascular ultrasound (IVUS)-guided stent deployment has on target vessel revascularization (TVR) at 6 months. The major endpoints of this study are the need for TVR, defined as clinically driven repeat interventional or surgical therapy of the index vessel at 6 months and major adverse cardiac events. One hundred interventional stent cases (50 IVUS-guided, 50 non-IVUS guided) were randomly selected in a 6-month period (January to June 2001) for review by measurement of minimal luminal diameter (MLD) pre- and post-intervention. Seventy males and 30 females were distributed among the 2 groups. There were a total of 135 lesions (70 IVUS-guided, 65 non-IVUS guided) in the 2 groups. A 6-month follow-up chart review was performed following the initial stenting. At 6-month follow-up, there were 2 deaths in the IVUS-guided group and 3 deaths in the non-IVUS guided group (p=NS). All deaths were cardiovascular in nature. Pos...
Prostaglandins & other lipid mediators, Jan 9, 2015
Myocardial infarction (MI) is complicated by ventricular fibrosis and associated diastolic and sy... more Myocardial infarction (MI) is complicated by ventricular fibrosis and associated diastolic and systolic failure. Emerging studies implicate Wnt1 signaling in the formation of new blood vessels. Epoxyeicosatrienoic acids (EETs)-mediated up-regulation of heme oxygenase-1 (HO-1) protects against the detrimental consequences of MI in several animal models, however, the mechanism(s) by which this occurs remains unclear. The aim of this study was to examine these mechanisms in the LAD ligation animal model of post infarcted heart failure. Specifically, we sought to clarify the mechanistic basis of the interactions of the Wnt1 canonical pathway, HO-1 and associated angiogenesis. Human microvascular endothelial cells (HMECs) were exposed to anoxia and treated with the EET agonist, NUDSA, in the presence and absence of tin mesoporphyrin (SnMP). Increased capillary density, and Wnt1 and HO-1 expression occurred in cells treated with NUDSA. Anoxic HMECs treated with NUDSA and Wnt1 siRNA, exhib...
This study examined the impact of a preventive cardiology curriculum on the knowledge and attitud... more This study examined the impact of a preventive cardiology curriculum on the knowledge and attitudes of first‐year medical students. Questionnaires assessing knowledge and attitudes were self‐administered to classes entering in 1988 and 1989 at the beginning and end of each academic year. Data from 54 students were analyzed. All statistical analyses were significant, indicating that students showed increases in both knowledge and attitudes regarding preventive cardiology. We concluded that the preventive cardiology curriculum had a significant impact on student learning. Future research is needed to address the long‐term effect of the increases in knowledge and attitudes on the future practice of medicine.
Journal of the American College of Cardiology, 1990
The signal averaged electrocardiogram (SAE) is predictive of future at-rhythmic events after a my... more The signal averaged electrocardiogram (SAE) is predictive of future at-rhythmic events after a myocardial infarction (Ml). However, it is unknown whether the !ype of MI, Q wave vs nonn of potential substrate for s within one with prior MI entials (LP), 13 (26%) of and without vs 49*17%
Journal of Stroke and Cerebrovascular Diseases, 1997
Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk... more Studies using transesophageal echocardiography (TEE) suggest aortic atherosclerosis may be a risk factor for stroke, particularly stroke of undetermined mechanism, but controls in prior studies were not balanced for vascular risk factors. We used TEE to evaluate aortic atherosclerosis in 60 patients with stroke compared with a high-risk control population of 46 subjects. We also examined the possible association of plasma viscosity and fibrinogen levels to aortic atherosclerosis. The mean maximal plaque thickness (MMPT) was similar for the control (2.8 +/- 3.6 mm) and the stroke group (3.3 +/- 3.5 mm), but varied with stroke mechanism. The MMPT was similar in stroke of undetermined and atherosclerotic mechanism [3.5 +/- 4 mm (n = 25) and 4.2 +/- 4.3 mm (n = 16), respectively], significantly greater than in stroke of other mechanisms (1.7 +/- 1.2 mm, P &lt; .05, n = 19). Patients with stroke of undetermined mechanism were four times more likely (95% confidence interval [CI] 1.2-12) to have plaques &gt;/=5 mm compared with controls. Ulcerated plaque was associated with plaque thickness (P &lt; .001) and plasma viscosity (P &lt; .001). Aortic atherosclerosis is associated with stroke of undetermined cause suggesting atherosclerosis is a cause of stroke of undetermined etiology. Plaque ulceration was associated with the thickness of aortic plaque and plasma viscosity.
The objective of this study was to test the hypothesis that obesity increases the sensitivity of ... more The objective of this study was to test the hypothesis that obesity increases the sensitivity of rats to experimentally induced hypertension. To induce hypertension, unilaterally nephrectomized lean and obese Zucker rats were injected with 25 mg/kg of deoxycorticosterone acetate (DOCA) twice weekly for 5 weeks and given water containing 1% NaCl to drink. Unilaterally nephrectomized control rats were injected with vehicle and drank tap water. Systolic blood pressure (SBP) was measured by the tail cuff method. Renal histology and urinary albumin excretion were used to assess the effects of the experimental treatment on the kidney. Obese rats exhibited a significant rise in SBP at 4 days after the start of DOCA-salt treatment. In contrast, SBP of DOCA-treated lean rats was not significantly elevated from pretreatment measurements until day 22. Moreover, SBP was significantly higher during the plateau phase of blood pressure development in obese DOCA-salt treated rats (196 mmHg) than in correspondingly treated lean rats (150 mmHg). Both obesity and DOCA-salt treatment promoted glomerulosclerosis and mild tubulointerstitial damage in the kidney with DOCA-salt treatment exacerbating the effect of obesity. Urinary albumin excretion was significantly greater in obese control rats compared with lean controls and in DOCA-treated obese rats relative to vehicle-treated obese rats. Results of this study indicate that obese Zucker rats are more sensitive to mineralocorticoid-induced hypertension than lean rats. This study provides experimental evidence supporting the epidemiological findings that obesity is a risk factor for the development of hypertension.
In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial inf... more In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial infarction, which was repaired successfully, is described. A 62-year-old man, with a history of acute anterior wall myocardial infarction 6 months previously, was admitted with the complaints of acute dyspnea and palpitation. Echocardiography revealed an LV aneurysm, and ventriculography showed ventricular dysfunction and an LV pseudoaneurysm. Coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery with a very thin lumen and insufficient retrograde filling. Under cardiopulmonary bypass and beating heart, the pseudoaneurysm was resected and the defect on the ventricular free wall was closed by the remodeling ventriculoplasty method of Dor. Histopathologic examination of the resected material confirmed the diagnosis of pseudoaneurysm. The postoperative course of our patient was uneventful. He was discharged on the ninth postoperative day.
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Cr... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Critical Care Medicine. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but ...
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