Medical Specialties Commons^™

Sex And Race Differences In Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey), Amy L. Arnold, Kerry A. Milner, Viola Vaccarino

Nursing Faculty Publications

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain …

Mapping And Ablation Of Complex Cardiac Arrhythmia Guided By A Novel Three Dimensional Non-Contact Endocardial Activation Mapping System, Wing-Hong Fung, Chi-Kin Chan, Kam-Sang Woo, Wilson Wai-Man Chan

Journal of the Hong Kong College of Cardiology

Conventional cardiac activation mapping requires a sequentially-based method of positioning a catheter in contact with the endocardium to generate intracardiac electrograms at single points during sustained arrhythmia. Significant limitation of such point by point mapping may be encountered when applying to complex arrhythmia e.g. non-sustained arrhythmia or haemodynamically unstable arrhythmia. A novel non-contact mapping system (Ensite 3000 system) providing a three-dimensional simultaneous display of arrhythmia activation may offer a solution. The non-contact mapping system consists of a specially designed balloon catheter (Ensite EP catheter) with 64 insulated wires over the surface of the balloon for sensing electrical potentials on the …

The Use Of Wallstent And Smart Stents Incarotid Stent-Supported Angioplasty, Steven Siu-Lung Li

Journal of the Hong Kong College of Cardiology

In the endovascular approach of carotid stenosis treatment, stent-supported angioplasty is current state-of-the-art technique. Self-expandable stents are preferable to balloon-expandable stents due to the potential risk of deformation of the latter by external pressure. Wallstents and SMART stents are the more commonly used self-expandable stents. They appear to be of similar efficacy and safety but due to their different characteristics, their applications may be different according to different lesion characteristics.

Presentation And Symptom Predictors Of Coronary Heart Disease In Patients With And Without Diabetes, Marjorie Funk, Janice B. Naum, Kerry A. Milner, Deborah Chyun

Nursing Faculty Publications

The aims of this prospective, observational study were to compare: (1) symptom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and without diabetes. We directly observed 528 patients with symptoms suggestive of CHD as they presented to the ED of a 900-bed cardiac referral center in the northeastern United States. There were no significant differences in symptom presentation of CHD between patients with and without diabetes, although patients with diabetes were slightly more likely to present with shortness of breath (P =.056). Patients with diabetes reported …

Psychosocial Correlates Of Physiologlcal Improvement In Female Cardiac Patients: Improving Effectiveness Of Cardiac Rehabilitation Programs, Linda A. Halvorsen

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this study was to determine the relationship between a set or psychosocial variables and a set of physiological variables for a cohort of female cardiac rehabilitation patients. The independent variable set included initial denial, inlcnwl locus of control, perceived mental health status, and perceived physical health status. Dependent variables included change scores for metabolic equivalents and resting heat rate. The sample consisted of76 women who were enrolled in a Phase II cardiac rehabilitation program. Demographic information including number of completed rehabilitation sessions, age, martial status, and diagnosis was provided. A series of bivariate correlations were conducted to …

Arrhythmogenic Right Ventricular Cardiomyopathy, Wing-Hong Fung, Chi-Kin Chan, John E. Sanderson

Journal of the Hong Kong College of Cardiology

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a familial form of cardiomyopathy predominantly affecting the right ventricle but may progress to involve the left ventricle as well. At the late stage of the disease, it is sometimes difficult to differentiate with other forms of dilated cardiomyopathy. In most affected families, the mode of inheritance of the disease is autosomal dominant. Lately, the gene accounting for the autosomal recessive form of ARVC, which was associated with palmoplantar keratosis, was identified. ARVC can present with sudden cardiac death without any preceding symptoms in the young population. Therefore, ARVC must be included in the …

Post-Infarction Left Venticular Free Wall Rupture, S M. Nadeem, S A. Sami, G Khan, N Basir, K A. Kazmi

Section of Cardiology

No abstract provided.

Association Of Viral Genome With Graft Loss In Children After Cardiac Transplantation., Girish S. Shirali, J Ni, R E. Chinnock, J K. Johnston, G L. Rosenthal, N E. Bowles, J A. Towbin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The survival of recipients of cardiac allografts is limited by rejection, lymphoproliferative disease, and coronary vasculopathy. The purpose of this study in children who had received heart transplants was to evaluate the cardiac allografts for myocardial viral infections and to determine whether the presence of viral genome in the myocardium correlates with rejection, coronary vasculopathy, or graft loss.

METHODS: We enrolled heart-transplant recipients 1 day to 18 years old who were undergoing evaluation for possible rejection and coronary vasculopathy. Endomyocardial-biopsy specimens were evaluated for evidence of rejection with the use of standard criteria and were analyzed for the presence …

Thrombolytic Therapy For Acute Myocardial Infarction In The Elderly, Bernard Bun-Lap Wong, Wai-Hong Chen

Journal of the Hong Kong College of Cardiology

Acute myocardial infarction (MI) is a leading cause of morbidity and mortality in developed countries. Patients ≥75 years constitute up to 30% of the acute MI population and are associated with a 50% in-hospital mortality. Thrombolytic therapy was shown in a metaanalysis of 9 largest randomized controlled trials to reduce 35-day mortality. However, the benefit was observed mainly among patients < 75 years old. For patients ≥ 75 years, the 35-day mortality was 24.3% in those treated with thrombolytic therapy and 25.3% in the placebo group, a difference not reaching statistical significance.

Cardiac Hypertrophy, Heart Failure, And Regulation Of Microtubule Stability, Kristie Lynn Beaton-Blade

MUSC Theses and Dissertations

This work focused on the regulation of the different isotypes of beta-tubulin during cardiac hypertrophy, with the specific hypothesis that increased levels of the beta I isotype leads to the increase in microtubule density seen during hypertrophy. Partial cDNAs for the three beta-tubulin isotypes expressed in the heart (I, II, and IV) have been cloned and used to show that there is a differential upregulation of the beta I and beta II isotypes during cardiac hypertrophy. Messenger RNA half-life studies of cells isolated from hypertrophied myocardium have shown that this upregulation is due to increased transcription of the genes encoding …

Gender Differences In Presenting Symptoms, Treatment, And Outcome In Myocardial Infarction, Alona Dalusung-Angosta

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purposes of this study were to compare the presenting symptoms, treatment, and outcome between men and women with MI. The study sample consisted of 300 patients (N = 300) who were diagnosed with MI in a county hospital in the Southwest area of the United States.

Chest pain, shortness of breath, sweating, and left arm pain were the most common symptoms reported by both genders. Men had more chest pain than their women counterparts (p = .022). No significant difference was found in the cardiac enzyme levels between both genders. Men had more Q wave changes during MI than …

Recognition Of Left Atrial Aneurysm By Fetal Echocardiography., R R. Fountain-Dommer, H B. Wiles, C O. Shuler, S M. Bradley, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Brachytherapy In The New Millennium Abstracts, Jilin Chen, Runlin Gao, Qiangjun Cai, Yuejin Yang

Journal of the Hong Kong College of Cardiology

In order to examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA), coronary stenting and to assess the factors affecting its efficacy, 790 patients who underwent successful PTCA and PTCS+Stent in this Hospital were followed by direct interview or letter.

Differences Between Blacks And Whites With Coronary Heart Disease In Initial Symptoms And In Delay In Seeking Care, Sally B. Richards, Marjorie Funk, Kerry A. Milner

Nursing Faculty Publications

BACKGROUND: Mortality rates for coronary heart disease are higher in blacks than in whites. OBJECTIVES: To examine differences between blacks and whites in the manifestation of symptoms of coronary heart disease and in delay in seeking treatment. METHODS: Patients were directly observed as they came to an emergency department with symptoms suggestive of coronary heart disease. The sample included 40 blacks and 191 whites with a final diagnosis of angina or acute myocardial infarction. RESULTS: After controlling for pertinent demographic and clinical characteristics, logistic regression analysis revealed that blacks were more likely than whites to have shortness of breath (odds …

Angiotensin Ii Promotes Atherosclerotic Lesions And Aneurysms In Apolipoprotein E-Deficient Mice, Alan Daugherty, Michael W. Manning, Lisa A. Cassis

Gill Heart & Vascular Institute Faculty Publications

Increased plasma concentrations of angiotension II (Ang II) have been implicated in atherogenesis. To examine this relationship directly, we infused Ang II or vehicle for 1 month via osmotic minipumps into mature apoE^–/– mice. These doses of Ang II did not alter arterial blood pressure, body weight, serum cholesterol concentrations, or distribution of lipoprotein cholesterol. However, Ang II infusions promoted an increased severity of aortic atherosclerotic lesions. These Ang II–induced lesions were predominantly lipid-laden macrophages and lymphocytes; moreover, Ang II promoted a marked increase in the number of macrophages present in the adventitial tissue underlying lesions. Unexpectedly, pronounced abdominal …

Regulation Of Acetylated Low Density Lipoprotein Uptake In Macrophages By Pertussis Toxin-Sensitive G Proteins, Stewart C. Whitman, Alan Daugherty, Steven R. Post

Gill Heart & Vascular Institute Faculty Publications

Class A scavenger receptors (SR-A) mediate the uptake of modified low density lipoprotein (LDL) by macrophages. Although not typically associated with the activation of intracellular signaling cascades, results with peritoneal macrophages indicate that the SR-A ligand acetylated LDL (AcLDL) promotes activation of cytosolic kinases and phospholipases. These signaling responses were blocked by the treatment of cells with pertussis toxin (PTX) indicating that SR-A activates G_i/o-linked signaling pathways. The functional significance of SR-A-mediated G_i/o activation is not clear. In this study, we investigated the potential role of G_i/o activation in regulating SR-A-mediated lipoprotein uptake. Treatment of mouse …

Chapter 4: Normal And Anomalous Coronary Arteries In Humans. Part 2: Angiographic Atlas Of Coronary Anomalies, Paolo Angelini, Salvado Vilason, Albert V. Chan, Jr., Jose' G. Diez

Coronary Artery Anomalies

No abstract provided.

Contributors

Coronary Artery Anomalies

No abstract provided.

Foreward, William C. Roberts

Coronary Artery Anomalies

No abstract provided.

Preface

Coronary Artery Anomalies

No abstract provided.

Title Pages

Coronary Artery Anomalies

No abstract provided.

Chapter 4: Normal And Anomalous Coronary Arteries In Humans. Part 1: Historical Background, Paolo Angelini, Salvado Villason, Albert V. Chan, Jr., Jose' G. Diez

Coronary Artery Anomalies

No abstract provided.

Contents

Coronary Artery Anomalies

No abstract provided.

Dobutamine Stress Echocardiography For Assessing Coronary Artery Disease After Transplantation In Children., R L. Larsen, P M. Applegate, D A. Dyar, P A. Ribeiro, S D. Fritzsche, N F. Mulla, Girish S. Shirali, M A. Kuhn, R E. Chinnock, P M. Shah

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: The purpose of this study was to determine the feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) in children, and to determine the frequency of selected cardiac events after normal or abnormal DSE.

BACKGROUND: Posttransplant coronary artery disease is the most common cause of graft loss (late death or retransplantation) after cardiac transplantation (CTx) in children. Coronary angiography, routinely performed to screen for TxCAD, is an invasive procedure with limited sensitivity. The efficacy of DSE for detecting atherosclerotic coronary artery disease is established, but is unknown in children after CTx. …

Cardiac Rehabilitation: Gender Differences In Factors Influencing Participation, Lani Lieberman, Marta Meana, Donna E. Stewart

Psychology Faculty Research

This study investigates gender differences in the barriers and incentives that are most influential in the coronary patient's decision to participate in cardiac rehabilitation (CRPs) and suggests strategies to counter these barriers. Patient surveys were administered to consecutive English-speaking attenders and referred nonattenders to a cardiac rehabilitation center at a university healthcare system in Toronto, Canada. A survey questionnaire, constructed from a literature review and advice from key informants, examined potential factors affecting decisions to engage in CRPs. One129 attenders at a CRP and 61 referred nonattenders completed the questionnaire. Physician recommendation was reported to be the most important factor …

Posttransplant Recoarctation Of The Aorta: A Twelve Year Experience., Girish S. Shirali, C E. Cephus, M A. Kuhn, K K. Ogata, L K. Vander Dussen, R E. Chinnock, N F. Mulla, J K. Johnston, L L. Bailey, S R. Gundry, A J. Razzouk, R L. Larsen

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation.

BACKGROUND: Patients with aortic arch hypoplasia require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta.

METHODS: This was a retrospective review of all children (ageyears) who underwent cardiac transplantation over a 10-year period. Collected data included pretransplant diagnosis, details of the transplant procedure and posttransplant data including development of recoarctation of the aorta, interventions for recoarctation and the …

The Relationship Between Health Locus Of Control And Health Behaviors Of Women Who Have Undergone Coronary Artery Bypass Grafting, Heather Ferrillo

Nursing Master’s Theses and Projects

Due to the increasing number of women who are diagnosed with heart disease and who are undergoing coronary artery bypass grafting, it is important to explore the psychosocial aspects involved in the recovery process of these women. This study examined the relationship between locus of control and health behaviors of women who underwent coronary artery bypass grafting.

The Optimal Fontan Connection: A Growing Extracardiac Lateral Tunnel With Pedicled Pericardium., S R. Gundry, A J. Razzouk, M J. Del Rio, Girish S. Shirali, L L. Bailey

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The concept of a lateral tunnel for the Fontan operation is now widely accepted. Most lateral tunnels are constructed intraatrially with the use of aortic crossclamping. Construction of extracardiac lateral tunnels with the use of homografts or other nonviable tubes eliminates aortic crossclamping but lacks growth potential in length or width. The native pericardium, which is "sealed" posteriorly along the pulmonary artery, atrium, and inferior vena cava, could be turned down onto the right atrium to form a viable extracardiac lateral tunnel.

METHODS: We designed and successfully constructed extracardiac lateral tunnels using viable autologous pericardium, pedicled on its lateral …

Stent Placement Compared With Balloon Angioplasty For Obstructed Coronary Bypass Grafts. Saphenous Vein De Novo Trial Investigators., M P Savage, J S Douglas, D L Fischman, C J Pepine, S B King, J A Werner, S R Bailey, P A Overlie, S H Fenton, J A Brinker, M B Leon, S Goldberg

Department of Medicine Faculty Papers

BACKGROUND: Treatment of stenosis in saphenous-vein grafts after coronary-artery bypass surgery is a difficult challenge. The purpose of this study was to compare the effects of stent placement with those of balloon angioplasty on clinical and angiographic outcomes in patients with obstructive disease of saphenous-vein grafts.

METHODS: A total of 220 patients with new lesions in aortocoronary-venous bypass grafts were randomly assigned to placement of Palmaz-Schatz stents or standard balloon angioplasty. Coronary angiography was performed during the index procedure and six months later.

RESULTS: As compared with the patients assigned to angioplasty, those assigned to stenting had a higher rate …

Ventricular Remodeling Following Infant-Pediatric Cardiac Transplantation. Does Age At Transplantation Or Size Disparity Matter?, Girish S. Shirali, F Lombano, W L. Beeson, D A. Dyar, N F. Mulla, A Khan, J K. Johnston, R E. Chinnock, S R. Gundry, A J. Razzouk

Manuscripts, Articles, Book Chapters and Other Papers

Early left ventricular (LV) remodeling following pediatric cardiac transplantation has not been described. To identify patterns and determinants of change in left ventricular mass and volume posttransplant, we studied 125 consecutive children who underwent cardiac transplantation between January 1, 1989 and July 31, 1993. Two-dimensional imaging-directed M-mode echocardiograms were studied weekly until 26 weeks post-transplant. LV mass and volume (indexed to BSA1.5) were measured. LV mass index increased until 3 weeks post-transplant, and then decreased. The mean decrement in LV mass index after 8 weeks post-transplant (relative to baseline) was significantly larger in patients with donor-recipient weight ratio > 1.5 compared …