Total plasma homocysteine concentrations in Puerto Rican patients with presumptive atherosclerotic coronary disease

BACKGROUND: In Puerto Rico, it has been established that although coronary heart disease is the leading cause of death, the population has a lower incidence of coronary disease than the continental United States. In addition, the severity of the disease is less aggressive in terms of a lower incidence of ventricular tachycardia and sudden death. A factor in the lower incidence of coronary disease in Puerto Rico could be a lower total plasma homocysteine concentration (tHcys) in our population. METHODS: We randomly measured tHcys concentrations in seventy-two Hispanic patients who were hospitalized for coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean (UPR Division). RESULTS: The mean tHCys concentration in our patient population is similar than that reported for the Framingham study when adjusted by age (11.2 mumol/L vs. 11.8 mumol/L). In the Puerto Rican population, males had a higher tHcys concentration than females but this difference was not statistically significant (10.9 mumol/L vs. 9.4 mumol/L, p = 0.09). In addition, we did not see an increase of tHcys concentrations in diabetic patients when compared with nondiabetics (10.1 mumol/L vs. 10.3 mumol/L, p = 0.73). Neither we saw a direct correlation between tHcys concentrations and atherosclerosis as measured by coronary angiography (normal = 10.9 mumol/L, mild = 8.6 mumol/L, moderate = 10.9 mumol/L, severe = 10.5 mumol/L; ANOVA = 0.29). CONCLUSIONS: These results suggest that tHcys concentration is not a good predictor of atherosclerotic coronary disease in our patient population.

Readmission in unstable angina

To determine the characteristics of patients re-admitted after unstable angina (UA) pectoris, 120 consecutive patients hospitalized due to primary UA pectoris were prospectively studied 22 +/- 3 months after discharge. The patients were grouped based on the readmission rate. Those in group A (50) had recurrent admissions (mean 2.6, range 2 to 5). Seventy patients (group B) did not have readmissions during the follow-up period. All patients underwent coronary angiogram and symptoms-limited exercise stress test before discharge. The univariate characteristics for readmission were: age over 70 years (p = 0.02), nondiagnostic exercise stress testing (p = 0.03), angiographically diffuse coronary artery disease (p = 0.004), and non-interventional management (P < 0.001). Patients readmitted had increased incidence of myocardial infarction (p = 0.004) but similar survival at 2 years. By regression analysis, important variables for readmission were non-interventional management (Chi-Square = 7.6, p = 0.01), non diagnostic treadmill test (Chi-Square = 6.9, p = 0.03) and diffuse coronary artery disease (Chi-Square = 6.2, p = 0.04). It is concluded that in the interventional era the most important factor for readmission after primary UA pectoris is non-interventional management. Coronary revascularization should not be denied solely on the basis of age

Transient elevation of pulmonary arterial pressure induced by sublingual angiotensin converting enzyme inhibitors

Twelve patients with ischemic heart disease had complete left and right catheterization before and after sublingual captopril. Hemodynamic measurements were ten (10) minutes apart and were monitored for thirty (30) minutes. The heart rate increased from 70 +/- 13 to 76 +/- 11 beats/minute (P = .04). There was no change in the arterial blood pressure, although the systemic vascular resistance decreased from 1500 +/- 400 to 1026 +/- 480 dynes-sec-cm-5 (P < .0001). The pulmonary artery pressure was increased 15 +/- 6 to 25 +/- 5mmHg (P = .005) and the pulmonary vascular resistance increased from 288 + 160 to 376 + 160 dynes-sec-cm-5 (P < .0001). The wedge pressure increased from 7 +/- 2 to 14 +/- 3 mmHg (P = .05). The cardiac output (CO) increased from 5.06 +/- 1.06 to 578 +/- 1.58 Lt/min. (P.05 =. The left ventricular end diastolic volume (LVEDV) increased from 128 +/- 40 to 145 +/- 37cc)P = .002), without change in the end systolic volume (ESV). The ejection fraction (EF) increased from 56 +/- 3 to 61 +/- 4 per cent (P = .02). These pressure changes appeared at two (2) minutes and disappeared after thirty (30) minutes. The study shows that, sublingual captopril produces a transient elevation of the pulmonary artery pressure and resistance

Lack of interaction of angiotensin converting enzyme inhibitors with muscarinic and neuropeptide Y receptors

In studies conducted in patients undergoing cardiac catheterizations, some hemodynamic changes were observed after the acute sublingual administration of the angiotensin converting enzyme inhibitors (ACEI) captopril, enalapril, and lisinopril. These changes consisted of an increase in pulmonary artery pressure, pulmonary vascular resistance (PVR) and induction of hypoxia. The pressure changes were transitory and disappeared after 25 min. The possible mechanisms involved in these changes may relate to interactions of the ACEI with peripheral receptor systems for hormones and neurotransmitters. We have thus undertaken the task of evaluating the potential effect of ACEI on biological receptor molecules. We have begun with studies on muscarinic receptors, and the recently characterized neuropeptide Y (NPY) receptors of endothelial cells. Equilibrium binding assays with 3H-QNB have been conducted for muscarinic receptors using rat brain synaptosomes, due to its expression of multiple muscarinic receptors subtypes. In addition 125BH-NPY binding assays were conducted on intact adrenal medullary endothelial cells. Enalapril and captopril, 10(-7) to 10(-3) M, were not able to produce significant inhibition of either muscarinic or NPY receptor probes. The paradoxical changes elicited by sublingual ACEI seems not to involve interaction with muscarinic or NPY receptors

Cocaine induced myocardial ischemia

We report a case of myocardial ischemia induced by cocaine. The ischemia probably induced by coronary artery spasm was reversed by nitroglycerin and calcium blocking agents

The use of biosensors in pacemaker technology: experience with a ventricular rate responsive pacemaker

Ten elderly patientes each had a ventricular rate responsive pulse generator (Activitrax) placed in then to help correct severe conduction abnormalities; none had suspected ischemic heart disease. The pulse generator was programmed to a maximal pacing rate of 125 ppm, a medium activity threshold, and a rate response of 6. Six weeks after implantation of the pulse generator, the patients were evaluated before exercing and again when the pacing rate reached 125ppm. The evaluation protocol included an M-mode echocardiogram from which the following measurements were taken; the left ventricular end-diastolic volume (EDV), the end-systolic volume (ESV), the ejection fraction (EF), and the peak systolic pressure/end-systolic volume (PSP/ESV). The numerical values were recorded, clculated, and compared statically with the following results: the EDV increased from 91 ñ 10 to 125 ñ 20 cc (p < .05); the ESV decreased from 64 ñ 10 to 24 ñ 6cc (p < ..005); the EF increased from 41 ñ 5 to 61 ñ 10% (p < .05); and the PSP/ESV ratio increased from 1.70 ñ 1 to 4.10 ñ 2mm Hg/cc (p = 10). Also, during the maximal pacing rate, the septum of all patients showed paradoxical septal motion. All patients in our study have been asymptomatic and have shown an increase in their exercise capacity. We conclude that during exercise the left ventricular function ins influenced more by heart rate than by AV synchrony, as indicated by an elevated EDV in most patients

Left, ventricular function in adults with atrial septal defect

Dieciseis pacientes con un defecto interatrial fueron cateterizados enfatizando el análisis cuantitativo del ventrículo al final de sístole y a mitad de expulsión. La fracción de expulsión promedio estuvo reducida 57 + 8% cuando fue comparada con un grupo control (71 + 10%) P < .005. Ocho pacientes tuvieron volumenes diastólicos elevados (156 + 10cc) al compararles con el grupo control (95 + 100cc) P <.005. Un total de 32 áreas hipoquinéticas y 35 tardoquinéticas se encontraron. Ocho pacietnes fueron reestudiados después de nitroglicerina sublingual (4mg). Se encontró un aumento en la fracción de expulsión de 54% a 70% (P <.005). La mayoria de las áreas hipoquinéticas fueron normalizadas. No se encontró una correlación entre la fracción de expulsión o movimiento sistólico total y el tamaño del corto circuito. Probablemente estas anormalidades son primarias y no debidas al cortocircuito intracardíaco

Sinus node dysfunction: the role of hypervagotomia and its treatment

Dos pacientes con historial de mareos y síncope fueron evaluados en nuestra institución. Estudios electrofisiológicos demostraron valores normales para la función de los nódulos sinusal y atrio ventricular. Grabaciones del Holter de 24 horas, electroencefalograma, tolerancia de glucosa fueron normales. El diagnóstico de disfunción sinusal por hypervagotonia fue hecho y tratado con marcapasos fisiológicos. Ambos han permanecido sin síntomas

Pulmonary hypertension and congestive heart failure due to an intracerebral arteriovenous malformation

Se presenta el caso de una malformación cerebral arteriovenosa produciendo hipertensión pulmonar con fallo del ventrículo derecho. Esta es una manifestación rara de esta enfermedad