Angiology

In contrast to previous reports from our own laboratory utilizing systolic time intervals (STI) and by others using ultrasound, no evidence of acute myocardial depression was observed in response to an ethanol (ETOH) dose of 1.25 ml/lb consumed over a period of 60 minutes by 6 young women (22.7 ± 7 years; 133 ± 6 lbs) who were monitored for 3 hours thereafter. Specifically, there was no significant change in fractional shortening (%ΔD), ejection frac tion, or mean circumferential fiber shortening velocity. Cardiac index and stroke index also remained stable, although heart rate increased (P < 0.005) and systolic and diastolic blood pressure fell (P < 0.01 and 0.25 respectively).

To examine further this unanticipated cardiac resistance to ETOH, we re- examined the sex-specific difference of STI response to acute ETOH exposure in a previously reported group of 32 normal subjects (20 men and 12 women). Significant increases in PEP, PEPI, ICT, and PEP/LVET (P < 0.005, 0.005, 0.005, and 0.001 respectively) were observed in men only. Because we have previously observed that chronic ETOH consumption blunts acute myocardial depression, and because only 1 of 7 STI subjects historically consuming the least ETOH (< 1 oz/day) was a woman, STIs, were reassessed only in those subjects with a chronic consumption of 1 or more oz/day (14 men and 11 women). Myocardial depression as estimated by an increased ICT (P < 0.05) and PEP/ LVET (P < 0.02) was again observed in men only.

We concluded that women are less susceptible than men to acute ETOH induced myocardial depression, as has recently been suggested for chronic ETOH consumption as well.

This study evaluated the effectiveness of oral bronchodilator therapy using theophylline in patients with nonreversible chronic obstructive pulmonary dis ease. Twelve chronic obstructive pulmonary disease patients were entered into a doubleblind crossover study using either active drug theophylline in 200 mg capsules (Elixophyllin) or placebo for 3 months, followed by 3 months of the alternate capsule. At baseline and monthly visits, data were recorded, including history, physical examination, and pulmonary function testing.

Clinically, 7 of 11 patients responded favorably to theophylline, 3 were unchanged, and 1 improved on placebo. Comparison of each sign and symptom individually revealed no statistically significant differences. Pulmonary function (FEV₁ and FVC) showed slight deterioration with placebo, but not with active drug therapy.

These findings suggest that nonasthmatic patients may improve clinically during theophylline therapy whereas their pulmonary function may deteriorate during placebo therapy.

The amplitudes of the first and second heart sounds were recorded during quiet natural breathing in 31 normal subjects. A total of 3,656 and 3,016 heart beats were available at the apex and pulmonic areas respectively. The in tensities of the first and second heart sounds were found to be increased during expiration. This respiratory tendency in the heart sounds was less prominent during the transitional phase between expiration and inspiration. Therefore we suggest that respiratory changes in heart sounds should be evaluated with a heart beat located at or close to the center of each inspiration and expiration. Respiratory alteration in the intensity of heart sounds is one of the commonest auscultatory pitfalls. Auscultatory evaluation of the intensity of heart sounds should thus be performed carefully, with the respiratory changes kept in mind.

Accelerated idioventricular rhythm (AIVR) has been reported in patients with acute myocardial infarction, digitalis excess, and subarachnoid hemorrhage, and in pa tients with rheumatic, primary myocardial, and hypertensive heart disease. Discovery of AIVR in 2 patients without heart disease led us to review reports from 700 Holter monitor studies.

Seven patients without recent myocardial infarction were studied retrospectively. Three of the 7 had no evidence of heart dis ease ; 5 of the 7 had abnormalities of the cen tral nervous system. Examples of AIVR show approximation of the sinus rate and ectopic rate; onset and offset occur abruptly or with sinus rate slowing and fusion beats. One patient remained in AIVR for up to 10 minutes accompanied by retrograde atrial capture. The rhythm's acceleration with ex ercise suggests that it is under autonomic in fluence, a phenomenon also seen in CNS stimulation studies in dogs.

AIVR occurs infrequently in patients without demonstrable heart disease. Our ex perience suggests a good prognosis, but fur ther study is needed on the natural history of AIVR in asymptomatic patients and on the necessity of treatment.

Our improvement on Turner's technique enabled more accurate plain x-ray estima tion of pulmonary venous pressure (PVP) up to 60 mm and of systolic pulmonary arterial pressure (PAP) up to 150 mm in 215 patients catheterized for mitral valvular disease. Our improvement comprises (1) five main pul monary artery (MPA) grades 0 to IV accord ing to its area and volume; (2) modified pres sure values assigned for MPA and kinetic energy of the right ventricle (required to pump blood into the pulmonary arterial bed) according to MPA grades; and (3) nine PVP grades from 0 to 8 with corresponding assigned PVP values. These modifications have enhanced the accuracy of the technique up to 85 to 95%.