This study was designed to assess, by two-dimensional echocardiography, the effects of anticoagulant therapy on left ventricular thrombosis detected after acute myocardial infarction. Thirty-eight patients with left ventricular thrombi detected by two-dimensional echocardiology within 5 weeks (mean 4) of the onset of infarction were randomly assigned to the following groups: group A consisted of 19 patients who received oral anticoagulants (acenocoumarin 1-6 mg daily regulated to keep prothrombin time within the range of 25 to 35%) and group B which consisted of 19 non-treated control patients. Seventeen patients from both groups were restudied 15 days, 3 months and one year later to evaluate the changes in size of thrombi. Echocardiographic examinations were read blindly; a significant decrease in ventricular thrombus size was taken as a greater than or equal to 5 mm reduction of thickness in the apical views. In Group A, 9 patients showed a complete resolution of thrombus at the 15 day study; at one year, thrombus had resolved in 15 and persisted unchanged in size in 2 patients. The mean dimension of thrombi in patients of group A was 18 +/- 6.6 mm at the screening examination and decreased to 6.6 mm, 3.8 mm and 2.2 mm, respectively, at 15 days, 3 months and one year follow-up studies. Among 17 patients of group B at the 15 day study, two had resolution of thrombus and 15 were unchanged; at the one year examination thrombus was resolved in 4, decreased in size in 4 and persisted unchanged in 9 patients. Analysis of variance of the dimensional changes of thrombi in the two groups of patients confirmed a significant efficacy of anticoagulant therapy (P less than 0.001). On the basis of our results we conclude that full-dose anticoagulant therapy, started early (within 5 weeks) after acute myocardial infarction, is effective in the resolution of left ventricular thrombosis.

Acenocoumarol↗

PubMed1985

[Monooctanoin dissolving of post-cholecystectomy residual biliary calculi].

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Adult↗

PubMed1985

Diastolic abnormalities in patients with hypertrophic cardiomyopathy: relation to magnitude of left ventricular hypertrophy.

To investigate the relationship between diastolic abnormalities and left ventricular hypertrophy, 52 patients with hypertrophic cardiomyopathy (HCM) and 22 normal subjects were studied with digitized M mode echocardiography and two-dimensional echocardiography. Echocardiographic indexes of diastolic function were compared in patients with different extent of left ventricular hypertrophy. Time interval from minimum left ventricular internal dimension to mitral valve opening and time to peak rate of increase in left ventricular internal dimension were significantly prolonged (80 +/- 31 and 100 +/- 37 msec, respectively) in patients with HCM and the most extensive left ventricular hypertrophy compared with those in patients with mild left ventricular hypertrophy (59 +/- 25 and 74 +/- 34 msec, respectively; p less than .01). Furthermore, peak rate of posterior wall diastolic excursion was significantly reduced in those patients with HCM and posterior wall hypertrophy (8.3 +/- 4.0 cm/sec) compared with that in patients with HCM but normal posterior wall thickness (11.2 +/- 3.4 cm/sec; p less than .002). However, abnormal M mode echocardiographic indexes of diastolic function were also identified in a substantial proportion of patients (i.e., 73%) with HCM and only mild left ventricular hypertrophy. In these patients, time interval from minimum left ventricular internal dimension to mitral valve opening (59 +/- 25 msec), peak rate (12 +/- 4 cm/sec), and time to peak rate of increase in left ventricular internal dimension (74 +/- 34 msec) were significantly different from normal (25 +/- 12 msec, 21 +/- 3 cm/sec, and 49 +/- 12 msec, respectively; p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1985

[Correlation between ventriculo-coronarography and the exercise test in patients surviving a prior transmural myocardial infarct and without a Q wave].

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Adult↗

PubMed1984

Decreased blood levels of ethanol and acetaldehyde by S-adenosyl-L-methionine in humans.

In view of the protective effects of SAM on alcohol-induced fatty liver degeneration, an investigation has been carried out to see if this compound accelerates the clearance of ethanol and acetaldehyde in humans. Both parameters were significantly lower after SAM, indicating the capability of exogenous SAM to favour the inactivation of ethanol without increasing blood levels of acetaldehyde.

Acetaldehyde↗

PubMed1984

Is old age a contraindication to cardiac rehabilitation after acute myocardial infarction?

Fifty male patients older than 65 years of age (mean 66.3) underwent a symptom-limited exercise test on an average of 34 days after acute myocardial infarction. After 4 weeks of supervised rehabilitation training and after one-year follow-up, the patients underwent controlled exercise tests. The ergometric parameters were compared with respective values in 10 healthy males (mean age 66.4, range 65-75). The rehabilitation training induced a substantial improvement in physical capacity (total work from 3149 +/- 1326 to 4791 +/- 1403 kg; P less than 0.001) with a better cardiovascular response: increased maximum oxygen pulse (from 8.97 +/- 2 to 10.7 +/- 2; P less than 0.001), decreased heart rate (from 120.5 +/- 16.1 to 111.3 +/- 14.7 beats min-1; P less than 0.05) and a decreased double product at a 75 W work load (from 22 866 +/- 4005 to 20 472 +/- 3982 beats min-1 mmHg; P less than 0.05). The recovery of physical capacity and cardiovascular tolerance in the physical exercise was nearly complete as compared with healthy subjects of the same age. During the training period one patient died from heart failure. In all the other patients the same improvement was still maintained one-year later. In conclusion, old age does not seem to be per se a contraindication to cardiac rehabilitation. Physiological beneficial effects from cardiac rehabilitation can also be received by patients older than 65 years of age.

Age Factors↗

PubMed1984

Incidence and prognostic significance of symptomatic and asymptomatic exercise-induced ischemia in patients with recent myocardial infarction.

To determine the incidence and the significance of anginal chest pain during abnormal exercise testing (S-T greater than or equal to 0.1 mV) in patients with recent myocardial infarction we reviewed a series of 353 patients who underwent maximal bicycle exercise stress 4-8 weeks following acute myocardial infarction. Of the 353 patients, 26 had ischemic ECG changes and chest pain (group A); 85 patients had ischemic ECG changes but no chest pain (group B). The two groups differ significantly only in the frequency of a history of typical angina pectoris more than 6 months prior to acute myocardial infarction (group A 42.3% vs. group B 15.2%, p less than 0.01). Typical chest pain is more frequent in anterior versus inferior myocardial infarction (50 vs. 14.4%, p less than 0.001). The patients were followed up for 28.8 +/- 8.7 months with clinical and exercise testing controls. The incidence of exertional angina during the follow-up was significantly more frequent in group A patients than in group B patients (80.7 vs. 24.7%, p less than 0.001). Unstable angina pectoris was more frequent in group A (34.6 vs. 11.8%, p less than 0.01). There was no statistically significant difference in mortality (group A 3.8% vs. group B 5.9%) and cardiac events (group A 3.8% vs. group B 5.9%) between the two groups. Thus, we concluded that the occurrence of anginal pain associated with S-T segment depression during exercise testing does not increase the prognostic risk.

Adult↗

PubMed1984

The treatment of retained biliary stones with monooctanoin: report of 16 patients.

The aim of this study was to estimate efficacy, safety, and tolerance of monooctanoin in 16 patients with retained radiolucent biliary stones and indwelling biliary drainage. Monooctanoin was infused continuously at a rate of 3-4 ml/h. Monitoring of pressure with a manometer broken off at 20 cm prevented the development of excessive pressure in the common bile duct. The mean volume of the compound instilled (+/- SD) was 848 +/- 393 ml (range 80-1450) and the mean duration of treatment was 13 +/- 6 days (range 2-23). Monooctanoin induced disappearance of stones in 11 of 16 patients giving a success rate of 69%. Three patients exhibited a partial dissolution of stones which were then successfully removed through the postoperative T-tube. The two failures can be attributed to the type of stones mainly composed of bile pigments. Side effects from the infusion of monooctanoin were only minor and easily controlled by reducing the infusion rate of the solution. Laboratory tests, including hepatic and pancreatic enzymes, remained stable. In one subject endoscopic and histological evidence of mild duodenitis was found when pre- and posttreatment features were compared. On the basis of these data, we recommend monooctanoin to treat biliary-retained cholesterol stones.

Adult↗

PubMed1984

Effect of cicloxilic acid on bile flow and biliary lipid secretion in humans.

Previous investigations have shown that cicloxilic acid, a hydrocholeretic drug, lowers bile cholesterol saturation without interfering with the intestinal absorption of cholesterol as well as with the hepatic synthesis of both cholesterol and bile acids. The mechanism whereby cicloxilic acid antagonizes lithogenic bile secretion is still unknown. However, most evidence favors the view of a relationship between choleretic and antilithogenic effects of the drug. To test this hypothesis the effects of a single oral dose (240 mg) of cicloxilic acid on bile flow and biliary lipid excretion rates have been examined in four nonobese cholecystectomized patients with balloon-occludable, reinfusion T-tubes. The results indicate that cicloxilic acid exerts a marked choleretic effect combined with a reduced output of bile cholesterol and an increase in bile acid excretion. Bile cholesterol saturation significantly decreases 90 min after cicloxilic acid in respect to control value. These data provide evidence of a link between choleretic and antilithogenic effects of cicloxilic acid and suggest its usefulness in the treatment of bile cholesterol supersaturation.

Adult↗

PubMed1984

Exertional hypotension after myocardial infarction.

A retrospective study was conducted on 488 patients admitted in our rehabilitation center after a recent acute myocardial infarction. Purpose of the study was to assess the incidence and prognostic value of exertional hypotension in these patients. Of 488 patients admitted to the study 33 (6%) were found to have exertional hypotension; 14 patients had an inferior myocardial infarction, 18 patients had an anterior myocardial infarction, 3 patients had a history of previous myocardial infarction. In the follow-up period (28.3 +/- 13.2 months) the worse prognosis (death or pulmonary oedema) was associated with the presence during exercise of hypotension, ST segment elevation in leads were Q waves were present and no ST depression in other leads. In conclusion, recent anterior myocardial infarctions associated with hypotension and ST segment elevation during exercise appear to be at risk for future cardiac events.

Exercise Test↗

PubMed1984

[Left ventricular aneurysm in recent myocardial infarction. Echocardiographic study].

UNLABELLED: Detection of post-infarction left ventricular aneurysm may have important clinical and therapeutic consequences. Differences in selection and in diagnostic criteria account for the wide range of incidence of left ventricular aneurysm in angiographic and autopsy series. To assess the incidence and related pathological features of ventricular aneurysm, 410 consecutive patients were studied by two-dimensional echocardiography 3 to 8 weeks after the onset of an acute myocardial infarction. In 395 patients (96.3%) technically adequate echograms were obtained: 42 patients (10.6%) had evidence of left ventricular aneurysm defined as a well demarcated bulge in diastole and in systole with a thinned, a-diskinetic walls. The incidence rate of left ventricular aneurysm was 17% in 188 anterior myocardial infarctions, 1.9% in 157 inferior ones, 25.9% in 27 anterior plus inferior infarctions; ventricular aneurysms were not found in any of 15 lateral and 8 posterior myocardial infarctions. Aneurysms were apical or apical-anterior in 25 patients (59.5%), apical-septal in 8 (19%), apical-diaphragmatic in 3 (7.1%), apical-septal-diaphragmatic in 3 (7.1%) and postero-basal in 3 (7.1%). Intraaneurysmal thrombi were detected in 24 patients (57.1%). In 12 cases echograms showed pericardial effusion; this was more frequent (28.6%) than in patients without an aneurysm (7.9%; p less than 0.001). Among patients with an aneurysm, heart failure was present in 19 (45.2%), mitral regurgitation in 3 (7.1%), of systemic emboly in 4 (9.5%), severe ventricular arrhythmias in 4 (9.5%) and angina in 5 (11.9%). IN CONCLUSION: left ventricular aneurysm is a frequent early complication of myocardial infarction. Two-dimensional echocardiography provides non-invasive direct information on localization, extent and related pathological features of ventricular aneurysm and thus appears to be a useful screening technique.

Adult↗

PubMed1984

[History of pre-existing angina and post-infarct myocardial ischemia (symptomatic and asymptomatic)].

353 patients enrolled in a cardiac rehabilitation program underwent a bicycle-ergometric test 28-60 days after an acute myocardial infarction. Twenty-nine patients (8.2%) had a previous history of chronic angina pectoris (more than 6 months before an acute myocardial infarction): 3 of these subjects did not develop myocardial ischemia after infarction; 26 (89.6%) (Group A) had an ischemic response on effort with horizontal or downsloping S-T segment depression of 2 mV. Ninety-four of 324 Patients without history of chronic angina pectoris had an ischemic response at exercise test (Group B) (p less than 0.001). In Group A the association of ischemic electrocardiographic changes and pain during the test was more frequent than in Group B (42.3% vs. 16%) p less than 0.01). During rehabilitation and follow up period (27.2 +/- 14 months) we observed that only 11.5% of Group A Patients remained symptomatic compared to 69.1% Group B Patients (p less than 0.001). In conclusion, a history of chronic pre-infarction angina pectoris appears to be a predictor of symptomatic ischemia after myocardial infarction.

Adult↗

PubMed1983

[Hypotensive response to the exercise test after recent myocardial infarct: prognostic implications].

The incidence and the prognostic value of exertional hypotension was studied in 488 consecutive patients admitted to the Montescano Rehabilitation Center after acute myocardial infarction. During a symptom-limited bicycle ergometric test performed 28 to 60 days after acute myocardial infarction 33 patients (6.8%) showed exertional hypotension. These patients were grouped according to effort S-T segment modifications: Group A (n = 13) with S-T segment depression in ECG-leads without Q waves; Group B (n = 11) with S-T segment elevation in leads where Q waves were present; Group C (n = 9) with no exercise S-T changes. Group B patients had a larger infarct size by ECG criteria and a lower maximal work capacity at the functional stress test. The follow-up of the patients after discharge was 28.3 +/- 13.2 months. During rehabilitation and follow-up, 2 patients of Group B died and 5 suffered an acute pulmonary oedema; 3 patients of Group A and 1 of Group B had angina at rest. Group C patients had no complications. Thus, exertional hypotension and S-T elevation appear to be predictive of future cardiac event.

Exercise Test↗

PubMed1983

[Ergospirometric evaluation of 53 physical exercises used in cardiological rehabilitation].

Fifty-three calisthenics used in a cardiac rehabilitation program were evaluated in a group of patients who, 30-60 days after myocardial infarction, had undergone a multistage symptom-limited bicycle exercise test without S-T segment modifications or arrhythmias. The following measurements were made oxygen uptake (VO2), oxygen uptake/Kg (VO2/Kg), ventilation/m' (VE), heart rate/m' (HR), systolic blood pressure (sBP) and METS. A good correlation was observed during the physical exercises between HR and VO2 (r = 0.59; p less than 0.001) and between HR and VO2/Kg (r = 0.64; p less than 0.001). Such correlation was similar to that observed during bicycle ergometric test. Lower values were obtained for the correlations between sBP and both VO2 and VO2/Kg, but they were still statistically significant (p less than 0.001). Heart rate and sBP were lower during calisthenics than during bicycle exercise from a VO2 level of 600-800 ml up. It is therefore possible to tailor a safe training program based on calisthenics whose level of energy expenditure is known: HRxsBP reached during such physical exercises will be lower than during bicycle ergometric test, VO2 being equal.

Adult↗