The effect of red wine on experimental atherosclerosis: lipid-independent protection.

To assess the effect of red wine on atherosclerosis, New Zealand rabbits were given 1% cholesterol diet for 12 weeks and compared to animals that received the diet plus either red wine or nonalcoholic wine products (NAWP). Diet induced marked increases in total and LDL cholesterol; yet no significant changes in HDL and triglyceride concentrations occurred. In the control group, plaque area was 69 +/- 9% of the aortic surface, while in the wine and NAWP groups it was only 38 +/- 9 and 47 +/- 12%, respectively (P < 0.0001). The average intima/media thickness ratio was 0.60 +/- 0.2 in control animals, 0.14 +/- 0.09 in the wine group, and 0.39 +/- 0.19 in the NAWP group (P < 0.0001). No significant differences were noted in LDL oxidizability among treatments. Thus, both red wine and NAWP can prevent plaque formation in hypercholesterolemic rabbits despite significant increases in LDL. We speculate that anti-platelet effect, blockade of expression of endothelial cell adhesion molecules, and/or NO stimulation by red wine flavonoids are possible explanations.

Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study.

To determine whether or not slow coronary flow (SF) depends on hemodynamic variables, we studied 17 patients (15 men, mean age = 47.8 years) with SF at coronariography. Exercise thallium-201 myocardial scintigraphy revealed perfusion abnormalities in 13 (76.4%) patients. We then selected 89 individuals submitted to cinecoronariography for comparison: 15 were normal and 74 had heart disease. The coronary flow velocity was evaluated by the number of heart beats (HB) needed for coronary artery dye filling. The patients in the SF group had normal hemodynamic variables which were significantly different from those of patients with heart disease (P = 0.001). Patients with heart disease needed no more than 4 HB to fill their arteries, in contrast to 6.88 +/- 1.68 (5 to 11) in the SF group (P < 0.0001). Thus, in our patients with myocardial scintigraphy suggesting ischemia, SF was found to be an event which did not depend on hemodynamic factors.

Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study

To determine whether or not slow coronary flow (SF) depends on hemodynamic variables, we studied 17 patients (15 men, mean age = 47.8 years) with SF at coronariography. Exercise thallium-201 myocardial scintigraphy revealed perfusion abnormalities in 13 (76.4 per cent) patients. We then selected 89 individuais submitted to cinecoronariography for comparison: 15 were normal and 74 had heart disease. The coronary flow velocity was evaluated by the number of heart beats (HB) needed for coronary artery dye filling. The patients in the SF group had normal hemodynamic variables which were significantly different from those of patients with heart disease (P = 0.001). Patients with heart disease needed no more than 4 HB to fill their arteries, in contrast to 6.88 ñ 1.68 (5 to 11) in the SF group (P<0.OOO1). Thus, in our patients with myocardial scintigraphy suggesting ischemia, SF was found to be an event which did not depend on hemodynamic factors.

Beneficial effect of long-term use of a beta-blocker in patients before acute myocardial infarction.

The outcome of 38 beta-blocker users (group BB, 28 men and 10 women with a mean age of 56 +/- 4 years) was compared to that of 100 non-users (group NU, 69 men and 31 women with a mean age of 57 +/- 8 years) after acute myocardial infarction (AMI). The two groups were compared in terms of electrocardiographic (EKG) location of the AMI (anterior, inferior and lateral), EKG Q and non-Q wave infarction, clinical functional class of Forrester, serum creatine phosphokinase MB fraction (CKMB) peak release and intrahospital mortality. There were no differences between groups concerning sex or severity of coronary artery disease but arterial hypertension was 2-fold more prevalent in group BB. The EKG location of the AMI was similar in the two groups. Non-Q infarction was significantly more prevalent in group BB (37%) than in group NU (6%). The incidence of clinical functional class IV of Forrester and the serum CKMB peaks were significantly lower in group BB (2.6% vs 16.0% and 53 +/- 3 vs 68 +/- 9 IU/l, respectively). Intrahospital mortality was also significantly lower in group BB (2.6%) than in group NU (10%). These data suggest the beneficial effect of previous long-term use of beta-blockers as indicated by a lower incidence of cardiogenic shock and a significant decrease in intrahospital mortality after AMI.

Beneficial effect of long-term use of a beta-blocker in patients before acute myocardial infarction

The outcome of 38 beta-blocker users (group BB, 28 men and 10 women with a mean age of 56 ñ 4 years) was compared to that of 100 non-users (group NU, 69 men and 31 women with mean age of 57 ñ 8 years) after acute myocardial infarction (AMI). The two groups were compared in terms of electrocardiographic (EKG) location of the AMI (anterior, inferior and lateral), EKG Q and non-Q wave infarction, clincial functional class of Forrester, serum cratine phosphokinase MB fraction (CKMB) peak release and intrahospital mortality.There were no differences between groups concerning sex or severity of coronary artery disease bath arterial hypertension was 3-fold more prevalent group BB. The EKG location of the AMI was similar int he two groups. Non-Q infarction was significantly more prevalent in group BB (37 percent) than in group NU (5 percent). The incidence of clinical functional class IV of Forrester and the serum CKMB peaks were significantly lower in goup BB (2.6 percent vs 16.0 percent and 53 ñ 3 vs 68 ñ 9 UI/1, respectively. Intrahospital mortality was also significantly lower in group BB (2.6 percent) than in group NU (10 percent). These data suggest the beneficial effect of previous long-term use of beta-blockers as indicated by a lower incidence of cardiogenic shock and a significant decrease in intrahospital mortality after AMI

Prognostic significance of right ventricular dysfunction in patients with acute inferior myocardial infarction and right ventricular involvement.

Little is known about the influence of right ventricular (RV) dysfunction on prognosis of patients with acute inferior myocardial infarction (IMI) and RV involvement. Therefore, 99 consecutive patients (mean age 56.6 +/- 3.4 years) with RV involvement during acute IMI were followed for a 12-month period to clarify the influence of acute RV dysfunction on short- and long-term survivals. Forty-one patients with IMI evolved with severe arterial hypotension due to RV dysfunction, while 58 patients had no hemodynamic impairment due to RV involvement. Basal hemodynamic data (mean +/- SD) for patients with RV dysfunction were blood pressure (BP) 92/59 +/- 22/20 mmHg, systemic vascular resistance (SVR) 2314 +/- 252 dynes.s.cm-5, and cardiac index (CI) 1.3 +/- 0.3 l/min/m2. Patients without RV dysfunction demonstrated BP 113/74 +/- 20/16 mmHg (p < or = 0.05), SVR 1324 +/- 354 dynes.s.cm-5 (p < or = 0.01), and CI 2.6 +/- 0.5 l/min/m2 (p < or = 0.05). Angiographic differences noted were that hemodynamically compromised patients showed lower RV ejection fractions (0.27 +/- 0.08) than patients without hemodynamic disturbance [0.41 +/- 0.11 (p < or = 0.05)]; however, left ventricular ejection fractions were 0.48 +/- 0.10 and 0.52 +/- 0.12, respectively. Short- and long-term mortality rates were assessed during the follow-up period. Patients with hemodynamic impairment due to RV infarction had a higher mortality rate for the first month and for 11 subsequent months post MI than patients without hemodynamic impairment, that is 24.4 vs. 6.9 and 14.6 (p

[Hemodynamic behavior of the right ventricle in acute inferior wall myocardial infarction: comparison between patients with and without cardiogenic shock]. / Comportamento hemodinâmico do ventrículo direito no infarto agudo de parede inferior. Comparação entre pacientes que evoleum com e sem choque.

PURPOSE: To evaluate the hemodynamic profile of patients (pts) with acute inferior wall myocardial infarction (AMI) and dysfunction of right ventricle (RV). METHODS: Ninety nine consecutive pts (aged 56.6 +/- 3.4 years), 47 men, with inferior AMI and RV dysfunction were studied. RV infarction was diagnosed based on ST segment elevation (> lmm) in precordial V4R lead and RV abnormalities found in echocardiography. All pts were undergone to bedside hemodynamic studies, by measuring mean right atrial (RAP), pulmonary artery (PAP), wedge pulmonary (PWP), and radial artery (AP) pressures and cardiac output (CO). Cardiac index (CI), pulmonary (PAR) and systemic arterial resistance (SAR) were calculated in dynes x sec x cm-5. Left ventricle (LV) ejection fraction (EF) and RV-EF were obtained by contrast ventriculography. Cardiogenic shock was diagnosed based on AP < or = 70 mmHg, RAP > or = 7 mmHg, PWP < or = 20mm Hg, CI < or = 1.8l/min/m2 and oliguria. Pts were then subdivided in 2 groups: with cardiogenic shock (group A, n = 41) with a mean age of 55.4 +/- 2.1 and without shock (group B, n = 58) with a mean age of 57.2 +/- 1.7. RESULTS: No significant differences between groups regarding RAP, PWP, AP and LVEF were observed, but compared to group B, group A had lower CI (1.3 +/- 0.3 vs 2.6 +/- 0.5 l/min/m2, p < 0.05), higher SVR (2314 +/- 252 vs 1324 +/- 324 dynes.sec.cm-5, p < 0.01), and lower RVEF (0.27 +/- 0.08 vs 0.41 +/- 0.11%, p < 0.05). CONCLUSION: Pts with inferior AMI and RV dysfunction, cardiogenic shock depends on of RV failure and is independent of a preserved LV function.

[Efficacy of and tolerance to buspirone hydrochloride in the treatment of psychosomatic symptoms in clinical cardiology]. / Eficácia e tolerabilidade do cloridrato de buspirona no tratamento dos sintomas psicossomáticos na clínica cardiológica.

PURPOSE: To evaluate the efficacy of buspirone hydrochloride in patients of the cardiologic clinic with generalized anxiety. METHODS: Fifty out-patients with psychosomatic cardiovascular symptoms in cardiology were treated for six weeks with initial dose of 5mg of buspirone hydrochloride t.i.d. RESULTS: The results obtained were good in 76% of the patients, fair in 18% and ineffective in 6% of the cases. Thirteen patients (26%) reported at least one adverse event, the side effects reported were: somnolence, headache, flatulence, tinnitus, nasal congestion and dry mouth. No interruption of the treatment was needed. CONCLUSION: Buspirone hydrochloride is a valid alternative for treating pathological anxiety in patients in which the state of alertness and good psychomotor skills must be preserved.

[Primary angiosarcoma of the right atrium with a patent foramen ovale and severe hypoxemia]. / Angiossarcoma primário de atrio direito com forame oval pérvio e hipoxemia severa.

A 19-years-old female with a primary right atrial angiosarcoma partially obstructing the tricuspid valve, developed severe hypoxemia due to right-to-left shunting through a patient foramen ovale. This is the first report of such clinical situation with this type of tumor. A complete resection of the tumor was attempted, and the right atrium had to be rebuilt with a bovine pericardium patch. Post-operative cranial, thoracic and abdominal CT scans and bone scintigraphy did not show metastatic spread. Chest radiation therapy was started on the third postoperative week. Chemotherapy was not used. The patient died five months after surgery due to disseminated metastatic disease but no evidence of the tumor was found in the necroscopic study of the heart.

Acute hemodynamic effects of hypertonic (7.5%) saline infusion in patients with cardiogenic shock due to right ventricular infarction.

The hemodynamic effects, after infusion of 4 ml/kg of hypertonic (7.5%) saline solution (HS), were evaluated in six patients (mean age = 56.6 years) with cardiogenic shock (CS) due to right ventricular infarction (RVI). Basal condition data (mean +/- SEM) were as follows: cardiac index (CI) = 1.9 +/- 0.1 1/min/m2, arterial pressure (AP) = 66.5 +/- 0.9 mmHg, and systemic vascular resistance (SVR) = 31.3 +/- 1.0 mmHg/1/min/m2. Five- and 240-minute post-HS infusion data (respectively) revealed: CI = 3.3 +/- 0.1* and 2.9 +/- 0.1* 1/min/m2, AP = 87.7 +/- 1.6* and 80.7 +/- 2.2* mmHg, and SVR = 22.5 +/- 0.6* and 24.5 +/- 1.1* mmHg/1/min/m2 (*P less than 0.05 compared to baseline values). These data suggest that small-volume infusion of HS induced an important acute and sustained hemodynamic improvement in these patients with CS due to RVI.

[Clinical and Doppler echocardiographic follow-up of elderly patients subjected to aortic balloon valvuloplasty]. / Seguimento clínco e ecodopplercardiográfico de idosos submetidos a valvuloplastia aórtica por cateter-balão.

PURPOSE: To evaluate the evolution of patients with critical aortic stenosis (AS) submitted to balloon aortic valvuloplasty (BAV). PATIENTS AND METHODS: sixteen patients (mean age 74.0 +/- 5.1 years), 11 (68.7%) women. The study periods consisted during the 3 rd (post-1) and 15th month (post-2) after dilatation. RESULTS: The functional class of angina and dyspnea persisted in all patients during period post-1, in 75% of the patients, during period post-2 in relation to intra-hospital evaluation. However, in period post-1, 53% of the patients had significant reduction of aortic valve area, trend which remained in period post-2. Simultaneously, progressive (insignificant) elevation of the left ventricular aortic peak to peak gradient was noticed in the periods post-1 and post-2. Two deaths and two aortic valve replacements occurred during the study. CONCLUSION: BAV is associated to maintenance of functional class improvement obtained immediately after dilatation despite the aortic valve restenosis registered by echodopplercardiography.

[Rupture of the interventricular septum after acute myocardial infarction in the absence of typical symptoms and electrocardiographic changes. A case report]. / Rotura do septo interventricular pós-infarto agudo do miocárdio na ausência de sintomas típicos e de alterações electrocardiográficas. Relato de caso.

A 79 year old man with sudden dyspnea, syncope and third degree heart block underwent a pacemaker (PM) implantation. He persisted with these symptoms and on the third day after the procedure it was detected a precordial holosystolic murmur. A ventricular septal rupture consequence of PM implantation was suspected. The coronary-ventriculography revealed a 99% stenosis in right coronary artery, inferior myocardial infarction and an interventricular communication. Previously, there were no other clinical manifestations nor electrocardiographic alterations suggestive of myocardial ischemia or infarction in this patient. We discuss about the rare association of an unrecognized acute myocardial infarction complicated by ventricular septal rupture.