Toward the optimal lead system and optimal criteria for exercise electrocardiography

To define the optimal lead system for exercise electrocardiography, data of the whole body surface potential distribution were analyzed in 25 normal subjects and in 25 patients with coronary artery disease at rest and during exercise. All patients had a normal electrocardiogram at rest. The sensitivity of the standard chest leads was 60 percent; it improved to 84 percent with the body surface map whereas both methods had a 100 percent specificity. On the basis of these data, and reports from other centers, it is concluded that a single bipolar lead from the right subclavian area to lead V5 is adequate in those laboratories that are restricted to testing subjects with a normal electrocardiogram at rest. In patients with a previous infarction or other abnormalities in the electrocardiogram at rest three (pseudo) orthogonal leads or several standard leads are necessary. Recommendations for optimal measurements from the exercise electrocardiogram are based on quantitative computer analysis of the selected leads in larger groups of patients. Best results were obtained with a combination of S-T amplitude, S-T slope and heart rate. The improvement in sensitivity from 50 percent with visual analysis to 85 percent with computer was similar to that obtained with body surface mapping. Changes of the P wave and QRS complex during exercise appeared to be of little diagnostic value. The pathophysiologic mechanisms that contribute to the changes of the electrocardiogram during exercise are discussed

A comparison of recombinant Hirudin with Heparin for the treatment of acute coronary syndromes. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIb Investigators

BACKGROUND: Thrombin has a pivotal role in the pathogenesis of acute coronary thrombosis. We compared the clinical efficacy of a potent, direct thrombin inhibitor, recombinant hirudin, with that of heparin (an indirect antithrombin agent) in patients with unstable angina or acute myocardial infarction. METHODS: At 373 hospitals in 13 countries, 12,142 patients with acute coronary syndromes were randomly assigned to 72 ho

Genezen is beter dan voorkomen

In de tweede helft van de vorige eeuw waren hart en vaatziekten de belangrijkste doodsoorzaak in Nederland. Dit is lang zo gebleven, maar na een piek rond 1970 is de sterfte aan hart en vaatziekten, gecorrigeerd voor de leeftijd, gedaald en sinds enkele jaren staan hart en vaatziekten op de tweede plaats wat betreft de sterfte percentages. (figuur 1) Dit is een verdienste van de cardiologie en de vasculaire geneeskunde. De levensverwachting in Nederland en in andere westerse landen is in die jaren belangrijk toegenomen. Dat komt vooral door enorme verbeteringen in de preventie en behandeling van hart en vaatziekten in 40 jaar. De helft van deze winst komt door betere preventie en de helft door betere behandeling van de ziekte. Afscheidsrede Prof. dr. Maarten L. Simoons hoogleraar Cardiologie Erasmus Universiteit Rotterdam, uitgesproken 17 december 201

Chronic stable coronary artery disease: drugs vs. revascularization

Coronary artery disease remains the leading cause of mortality in most industrialized countries, although age-standardized mortality related to coronary artery disease (CAD) has decreased by more than 40% during the last two decades. Coronary atherosclerosis may cause angina pectoris, myocardial infarction, heart failure, arrhythmia, and sudden death. Medical management of atherosclerosis and its manifestation aims at retardation of progression of plaque formation, prevention of plaque rupture, and subsequent events and treatment of symptoms, when these occur as well as treatment of the sequelae of the disease. Revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is performed as treatment of flow-limiting coronary stenosis to reduce myocardial ischaemia. In high-risk patients with acute coronary syndromes (ACS), a routine invasive strategy with revascularization in most patients provides the best outcome with a significant reduction in death and myocardial infarction compared with an initial conservative strategy. Conversely, the benefit of revascularization among patients with chronic stable CAD has been called into question. This review will provide information that revascularization exerts favourable effects on symptoms, quality of life, exercise capacity, and survival, particularly in those with extensive CAD and documented moderate-to-severe ischaemia. Accordingly, CABG and PCI should be considered a valuable adjunct rather than an alternative to medical therap

Faba bean as a novel brewing adjunct:consumer evaluation

The starch in the grains of legumes, such as faba bean (Vicia faba L.), offers an environmentally sustainable raw material for the brewing industry as their entire nitrogen fertiliser requirement can be provided by the natural process of biological nitrogen fixation. Faba bean is, therefore, distinguished from species such as spring barley (Hordeum vulgare L.), which require large amounts of synthetic nitrogen fertiliser. Consumer analysis of beer produced with faba bean as an adjunct compared with barley malt beers has not previously been assessed. This study evaluated the potential of beers brewed using 30% (w/w) dehulled bean (kernel) flour as an adjunct to malted barley, using a series of quantitative sensory tests. The first, a blind acceptance test with inferred preference, found no statistically significant difference in the taste score of the bean kernel flour adjunct beer when compared with conventional beer. In the second acceptance test, the knowledge that the beer was produced using beans did not affect the overall consumer impression of the beer, regardless of how this information was presented. These results suggest that the use of faba beans in brewing does not impact negatively on the taste or acceptability of the resultant bee