ECG signs of myocardial ischemia elicited by dipyridamole are frequent in patients with HCM and identify patients at higher risk of cardiac events, suggesting a potentially important pathogenetic role of inducible myocardial ischemia in determining adverse cardiac events in these patients.
A retrospective color flow analysis of 30 well-functioning Björk-Shiley prostheses in the mitral position
is presented. The blood flow pattern across the valve depends on the direction of valve rotation. In anteriorly
mounted prostheses the normal pattern seems more complex and more difficult to interpret than in posteriorly
orientated valves. In the latter the blood flow reproduces the physiological pattern as in the normal mitral valve,
while in the anteriorly rotated prostheses, the flow is distributed in the left ventricle ‘antiphysiologically’, being
initially directed towards the interventricular septum. New interests are suggested by the color Doppler study of
Björk-Shiley prostheses in the mitral position: these observations, though preliminary, seem necessary for correct
interpretation of normal and pathological cases.
Anti-ischaemic properties and tolerability of the calcium antagonist gallopamil were compared with those of nifedipine in a double-blind cross-over study performed in 20 patients affected by effort or mixed angina. The patients were of both sexes and aged 43-66 years; coronary angiography performed on 18 of them revealed at least one-vessel disease (stenosis greater than 70%). After a one week wash-out period the patients received placebo for 2 weeks; thereafter 10 patients were treated orally with gallopamil 150 mg daily and 10 patients with nifedipine 60 mg daily for 4 weeks. Before crossing-over to the alternate therapy a 2-week placebo period was allowed. The patients underwent cycloergometric exercise tests after each phase of treatment; workload was increased by 25 W every 3 min and the test was stopped in the presence of a typical angina or ST segment depression or age-predicted maximal heart rate. The results show that both exercise time and maximal workload were significantly increased by gallopamil and by nifedipine in comparison with placebo; also the maximal ST segment depression was significantly reduced by the two drugs. The number of patients developing angina and/or segment depression during exercise test was significantly reduced by both drugs compared to placebo. Time to onset of angina and time to ST depression greater than or equal to 1 mm were increased, though not significantly, by both calcium antagonists. No side effects were recorded with gallopamil while with nifedipine six patients reported side effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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