Cardiac hypertrophy and how it may break an athlete's heart--the Cypriot case.

AIMS: This is a case report of an athlete whose professional football career was transiently terminated because of the presumed diagnosis of hypertrophic cardiomyopathy. METHODS AND RESULTS: The diagnosis was based on electrocardiographic repolarisation changes. The ECGs, treadmill exercise tests (Bruce protocol) and echo examinations at the time of his active training and several years after termination of his professional career are discussed. No hypertrophic cardiomyopathy was documented by ultrasound examination. CONCLUSIONS: The distinction between physiological athlete's heart and pathological conditions has critical implications for professional athletes. Criteria and guidelines for screening of athletes in competitive sports are recommended.

Familial discrete subaortic stenosis.

Discrete subaortic stenosis (DSS) accounts for 8 to 20% of all cases of congenital left ventricular outflow tract obstruction. There have been few scattered reports of left ventricular obstructive lesions occurring in immediate family members of patients with DSS. This is a report of four cases of DSS in one family: one brother with a fibrous ring, and two sisters and the son of one of the sisters with a fibrous membrane. The occurrence of multiple cases of DSS in this family suggests an autosomal dominant mode of inheritance.

Relation between changes in blood flow of the contralateral coronary artery and the angiographic extent and function of recruitable collateral vessels arising from this artery during balloon coronary occlusion.

OBJECTIVES: The purpose of this study was to investigate changes in the magnitude of blood flow through the contralateral coronary artery in relation to the development of recruitable collateral vessels arising from this artery to supply a balloon-occluded coronary vessel. BACKGROUND: Recruitable collateral vessels have been shown to emerge suddenly to supply an occluded coronary artery, but their physiologic effect cannot always be predicted angiographically. METHODS: Twenty-four patients were studied during four successive balloon dilations for single left anterior descending coronary artery stenosis. Before and during each balloon occlusion, blood flow in the proximal right coronary artery was measured by intracoronary Doppler flow velocimetry and quantitative coronary angiography. Estimates of chest pain and ST segment elevation were also obtained. RESULTS: Fourteen patients developed angiographically visible recruitable collateral vessels (high grade in 6 [group III], low grade in 8 [group II]), whereas 10 patients (group I) did not. During the four successive balloon occlusions, the right coronary artery flow showed transient reproducible increases in group III (first occlusion 66.4 +/- 36.8%, fourth occlusion 64 +/- 23.9%, all p = 0.036), progressive increases in group II (from first occlusion 17.9 +/- 26.6% [p = 0.08] to fourth occlusion 60.4 +/- 35.9% [p = 0.014]) and no significant changes in group I. Between the first and the fourth occlusion, the severity of chest pain and the magnitude of ST segment elevation declined significantly in group II but did not change in groups I and III. CONCLUSIONS: During balloon coronary artery occlusion, the transient appearance of recruitable collateral vessels is associated with a transient increase in blood flow through the collateral donor artery. This increase in coronary flow appears to reflect collateral function better than the angiographic assessment, especially in patients with poor collateral vessel recruitment.

Exercise testing for assessment of the significance of ST segment depression observed during episodes of paroxysmal supraventricular tachycardia.

Sixteen patients who had manifested ST segment depression during episodes of paroxysmal supraventricular tachycardia (PSVT) were studied with exercise testing in order to detect coronary artery disease and myocardial ischaemia. No ST segment depression was observed during exercise testing in 15 out of the 16 patients tested. Paroxysms of supraventricular tachycardia associated with ST segment depression occurred during exercise testing in three cases. The ST segment depression was immediately apparent, remained constant throughout the supraventricular tachycardia and was almost instantly abolished following conversion to sinus rhythm. Patients with heart rates greater than 250 beats min-1 during PSVT had marked ST segment depression associated with the tachycardia. These results suggest that coronary artery disease and myocardial ischaemia are not involved in the genesis of ST segment depression during PSVT. Tachycardia per se may be the cause of ST segment depression by altering the slope of phase 2 of the ventricular action potential. Retrograde atrial activation may also induce ST segment shifts in some of the cases.

The effect of coronary revascularization on exercise-induced ventricular ectopic activity.

The effect of coronary artery bypass graft surgery (CABGS) on the prevalence of exercise-induced ventricular ectopic activity was studied in 43 patients (42 male, 1 female). Their age was 53 +/- 7.8 (mean +/- SD) years. Treadmill exercise test (TET) was performed within a month prior to and three months post-CABPGS. An average of 2.8 grafts per patient were used. Nine of the 43 patients (20.9%) had premature ventricular contractions (PVCs) related to effort prior to CABGS, while 12 out of the 43 (27.9%) had PVCs post-surgery. Seven patients (16.3%) had PVCs for the first time after successful revascularization, four of whom had previous myocardial infarction. The haemodynamic parameters of the total group during TET showed significant improvement in the duration of the exercise test (37%), the double product heart rate X systolic blood pressure (36%)M and the cardiorespiratory fitness (31%). Our data indicate that the ventricular ectopic activity induced by exercise in patients with coronary artery disease is not affected by successful revascularization. On the contrary, a significant number of patients develop new ventricular ectopy after CABGS where a pre-existing myocardial infarction appears to be a determining factor.

Treatment of myocardial infarction in a community hospital coronary care unit. Experience with 1,246 patients.

The hospital mortality in 1,246 consecutive acute myocardial infarction patients treated in a large community hospital coronary care unit was 14.4%. Of the total, 52.3% showed no evidence of heart failure, 25.8% had mild to moderate failure, 9.9% had pulmonary edema, and 12% developed cardiogenic shock; the mortality in these groups was 2.2%, 7.4%, 8.9%, and 87.2%, respectively. The mortalitiy in the 1,097 patints who did not have cardiogenic shock was 4.5%. Only one patient died as a result of primary ventricular fibrillation (0.08%). The mortality of complete heart block in the absence of cardiogenic shock (8.3%) was not significantly different from that of comparable patients who did not have complete heart block (4.3%). These results are lower than those generally reported.