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Biomedical subjects

J Hilsenrath

Publications and source records attributed to J Hilsenrath.

12 recordsLinked to original sources
PubMed1984

Functional and anatomic correlates of markedly abnormal stress tests.

The functional state and coronary anatomy of 120 patients evaluated primarily because of a markedly positive ischemic exercise stress test (greater than 2 mm ST depression) is presented. Twenty-seven patients were asymptomatic (group A), 36 patients (group B) had type I angina (Canadian classification) and 57 patients (group C) had angina with only minor limitations (type II angina). All patients underwent exercise stress testing (Bruce protocol) within 2 months of cardiac catheterization. No significant intergroup differences were observed in exercise variables including time of onset of ischemia, maximal heart rate achieved, rate-pressure product, duration of exercise or mean change in blood pressure. Two patients in group A had normal coronary arteriograms. Comparison of the remaining asymptomatic patients in group A with patients in groups B and C revealed no significant differences in the number of coronary arteries involved, main left coronary artery disease, coronary score or the frequency of collateral circulation. In group A, 18% of collateral vessels were in jeopardy compared with 52% in groups B and C (p less than 0.05). Triple vessel disease was present in 57% and left main coronary artery disease in 16% of the total group. The only exercise variable useful in identifying patients with severe coronary disease was an abnormal exercise blood pressure response. This study indicates that a markedly ischemic stress test, regardless of the functional state of the patient, identifies patients, including those without symptoms, who have severe coronary disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1980

Aneurysm of main left coronary artery.

A 57-year-old man presented with exertional chest pain, and was found to have a saccular, lobulated aneurysm of the left main coronary artery associated with severe atherosclerotic vascular disease. This is the third similar case reported and the first case of atherosclerotic origin. All symptoms were relieved by coronary artery bypass surgery.

Aneurysm↗
PubMed1976

Vectorcardiographic, electrocardiographic, and angiographic correlations in apparently isolated inferior wall myocardial infarction.

Twenty-six patients with ECG evidence of localized inferior myocardial infarction and poor ejection fraction (less than 50 per cent) were compared with 26 patients with similar ECG's, but with normal ejection fraction (over 50 per cent). The poor ejection fraction group had significantly more frequent and more severe disease in left anterior descending artery and a higher incidence of triple coronary obstruction than the normal ejection fraction group. The poor ejection fraction group had a significantly greater incidence of ventricular asynergy in the anterior and apical segments of left ventricle. Vectorcardiography was available in 35 of the 52 patients studied and frequently supplied diagnostic information not available in the scalar ECG's. Of 18 patients with scalar ECG patterns of isols, vectorcardiography identified five cases with anterior infarction, three with left ventricular hypertrophy, and one with left anterior hemiblock. Vectorcardiography is a valuable supplementary tool in the clinical assessment of patients with apparently isolated inferior infarction. When extensive coronary and poor ventricular function exist, VCG clues may be expected in about half the patients.

Angiocardiography↗
PubMed1976

Anterior conduction delay: a possible cause for prominent anterior QRS forces.

Prominently anterior QRS forces often present a diagnostic dilemma. Frequently, right ventricular forces may be eliminated on clinical grounds and dorsal infarction is therefore suspected, especially in a clinical setting of coronary artery disease. In five such patients studied angiographically, the coronary disease was concentrated in the left anterior descending artery and the ventricular dysfunction confined to the anterior wall of the left ventricle. In a sixth case, the prominent anterior forces were observed intermittently together with left anterior hemiblock. These observations, in addition to serial studies following surgery, strongly suggest that the mechanism for prominent anterior QRS forces in these cases is conduction delay in an anterior division of the left bundle branch system.

Adult↗
PubMed1975

Relation of left ventricular contractile patterns in coronary artery disease to the electrocardiogram and vectorcardiogram.

Two hundred thirty patients with coronary artery disease (CAD) were studied with left ventriculography, coronary arteriography, electrocardiography (ECG) and vectorcardiography (VCG) to determine how well left ventricular (LV) contractile defects could be predicted from the ECG-VCG patterns and how this was related to the coronary disease location and severity. Of 124 patients with infarction patterns on ECG-VCG about 50% had LV contractile defects localized to the corresponding ECG-VCG abnormalities, i.e., antero-apical asynergy with anterior infarction patterns, inferior asynergy with inferior infarction patterns, or antero-apical plus inferior asynergy with anterior plus inferior patterns. About 20% in each infarction group had unexpected synergy on ventriculography except for patients with dorsal infarction patterns (synergy in 68%) who are discussed as a special problem. Another 25-30% of patients had more extensive contractile abnormality than indicated by the ECG-VCG patterns. In 106 patients with left ventricular hypertrophy, normal QRS-abnormal T and normal QRS-T on ECG-VCG, 65-70% had synergy. However, 30-35% had asynergy in various combinations not suspected from the ECG or VCG. Coronary artery disease severity was less pronounced in patients with synergy than with asynergy and single vessel disease was more common in the former, 47% versus 18-30% in the latter. However, coronary artery disease severity was the same for all ECG-VCG groups except for anterior plus inferior infarction patterns where it was most severe.

Coronary Disease↗