European journal of cardiology
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Hydralazine (Apresoline) was used to increase heart rate in 21 patients (14 hypertensive and 7 normotensive) suffering from symptomatic sinus bradycardia (SSB). Patients were assessed clinically and by 24-h ECG analysis before and after tailored increasing doses of the drug. Heart rates measured were resting (basal) rate, minimum rate during sleep, maximal rate during the day, and mean rate during the 24-h period (from hourly strips). ⋯ Hydralazine ameliorated symptoms and produced a 20% or greater increase in heart rate in just under two-thirds of the hypertensive and half of the normotensive patients. Blood pressure decreased slightly in hypertensive but not in normotensive patients, and there were no important side-effects. Hydralazine appears to be a useful and effective drug to increase heart rate in patients with SSB.
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Short- and long-term prognosis were analysed in 59 patients admitted in the coronary care unit with an acute myocardial infarction, complicated with acute intraventricular (IV) conduction defects. In-hospital mortality of patients with IV conduction disturbances was more than twice (30%) the mortality of patients without IV conduction defects (13%; P less than 0.001). Mortality rate was very high among patients with all forms of incomplete trifascicular block or complete right bundle-branch block. ⋯ Short-term prognosis of conduction defects in myocardial infarction depends on the extent of the necrosis. The conflicting results in long-term prognosis could be ascribed to variations in patient material and to different criteria used to define the acute nature of a block. Lastly the variable prognosis could correspond to differences in the site of the lesions within the conduction pathway.
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A 36-yr-old woman and a 46-yr-old man had infective endocarditis of the mitral valve. Examination by 2-dimensional dynamic echocardiography demonstrated large mobile vegetations in both patients, and the display pointed to an ominous risk of embolism. ⋯ It is suggested that the display of dynamic morphology of valvular vegetations by 2-dimensional echocardiography can be useful in identifying a subset of patients at high risk of embolism during infective endocarditis. However, more experience is needed before definite conclusions can be drawn regarding the role of early operation as prophylaxis against impending embolism.
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Case Reports
Cervical aortic arch with ventricular septal defect. A differential diagnosis from interrupted aortic arch.
A case of right cervical aortic arch with a large ventricular septal defect and a bicuspid aortic valve is reported. The angiographic diagnosis was interruption of the aortic arch type II, with aberrant right subclavian artery, a closed ductus arteriosus and retrograde vertebral-subclavian flow to the descending aorta. The cervical arch, demonstrated post mortem, was located high and deep in the neck. This differential diagnosis may have potential importance, as reported experience shows that a surgical aortic anastomosis is not required in cervical aortic arch.