warfarin and Cardiomyopathy--Hypertrophic

A case showing reinforcement of the action of warfarin and potassium in a patient administered S-1 is reported.The patient was a 71-year-old man with left upper gingival cancer.He had ventricular tachycardia (VT), hypertrophic cardiomyopathy, and a cerebellar infarction.He underwent a pacemaker implantation, and was administered warfarin.After the operation, in mid-March 2010, he was administered with S-1 and warfarin. However, the international normalized ratio of prothrombin time (PT-INR) increased to an extremely high level of 5.82, and S-1 and warfarin were stopped. They were re-administered at the end of April, and the PT-INR stabilized to approximately 2.

Topics: Aged; Anticoagulants; Antimetabolites, Antineoplastic; Cardiomyopathy, Hypertrophic; Cerebral Infarction; Drug Combinations; Drug Interactions; Humans; Male; Mouth Neoplasms; Neoplasms, Squamous Cell; Oxonic Acid; Tachycardia, Ventricular; Tegafur; Warfarin

Hypertrophic cardiomyopathy (HCM), which was first described in 1958, occurs in approximately one in 500 people. Patients with HCM are at an increased risk of atrial fibrillation, which is not only poorly tolerated in this population, but also increases their risk of an embolic event. The incidence of stroke in HCM patients with atrial fibrillation is approximately 21-23%. Given the high risk of stroke, antithrombotic therapy with warfarin is recommended in national guidelines. This therapy should be used without regard to other risk factors for stroke that may be present. Anticoagulation with the new oral anticoagulants may be considered as an alternative; although, specific data for patients with HCM is not available. The purpose of this review is to remind practitioners of the importance of stroke prophylaxis with oral anticoagulants in this population.

Topics: Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Humans; Practice Guidelines as Topic; Risk Factors; Stroke; Vitamin K; Warfarin

Topics: Adrenergic beta-Antagonists; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Digitalis; Diuretics; Hemodynamics; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Warfarin

To determine the influence of a positive genetic test for hypertrophic cardiomyopathy (HCM) on clinical outcome.. A cohort of 203 unrelated patients with HCM (mean +/- SD age, 50+/-18 years) was enrolled from January 1, 2002, through December 31, 2003. They were followed up for a mean +/- SD time of 4.0+/-1.7 years after genetic testing of the 8 HCM-susceptibility genes that encode key sarcomeric/myofilament proteins. The clinical phenotype of those with a positive genetic test (myofilament-positive HCM) was compared with those with a negative genetic test (myofilament-negative HCM).. In this cohort of 203 patients, 87 mutations were identified in 126 patients (myofilament-positive HCM, 62%); the remaining 77 patients (38%) were myofilament-negative. Despite similar baseline features, patients with myofilament-positive HCM showed increased risk of the combined end points of cardiovascular death, nonfatal stroke, or progression to New York Heart Association class III or IV compared with the patients with myofilament-negative HCM (25% vs 7%, respectively; independent hazard ratio, 4.27; P=.008). These end points occurred at any age among patients with myofilament-positive HCM (range, 14-86 years), but only in those aged 65 years and older among patients with myofilament-negative HCM. Moreover, patients with myofilament-positive HCM showed greater probability of severe left ventricular systolic and diastolic dysfunction, defined as an ejection fraction of less than 50% and a restrictive filling pattern (P=.02 and P<.02, respectively, vs myofilament-negative HCM).. Screening for sarcomere protein gene mutations in HCM identifies a broad subgroup of patients with increased propensity toward long-term impairment of left ventricular function and adverse outcome, irrespective of the myofilament (thick, intermediate, or thin) involved.

Topics: Actin Cytoskeleton; Adult; Aged; Anticoagulants; Cardiomyopathy, Hypertrophic; Cardiovascular Diseases; Carrier Proteins; Cohort Studies; Coronary Artery Bypass; Endpoint Determination; Female; Genetic Testing; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mutation; Ultrasonography; Warfarin

Hypertrophic cardiomyopathy (HCM) patients with nonvalvular atrial fibrillation (AF) have an increased risk of suffering thromboembolic events. Vitamin K antagonists (VKA) are recommended as therapy but there is still limited data regarding the efficacy of prescribing non-vitamin K antagonist oral anticoagulants (NOACs). This retrospective study investigates the effectiveness and safety of NOAC administration in patients with HCM and AF. A total of 124 patients with HCM and AF on an oral anticoagulant therapy were recruited between January 2015 and December 2019; these patients were followed up until March 31, 2020. Kaplan-Meier analysis was used to compare the clinical outcomes in patients treated with NOACs versus warfarin. The Cox model was used to estimate the risk of clinically relevant bleeding. Our study included 124 patients, of which 48 (38.7%) received warfarin and 76 (61.3%) received NOACs. Survival analysis showed the patients undergoing NOACs had a lower risk of clinically relevant bleeding (log-rank P = 0.039) over a period of 53.6 months. The median time in therapeutic range (TTR) score was 50% (interquartile range: 40.43 to 57.08%). A total of nine patients (18.75%) had a good TTR with a median score of 66.35% (interquartile range: 64.58 to 77.75%). The incidence of death by all causes, cardiovascular death and thromboembolism were similar between NOAC and warfarin-treated patients (log-rank P = 0.239, log-rank P = 0.386, and log-rank P = 0.257, respectively). Patients treated with NOACs showed a significant reduction in the risk of clinical (P = 0.011) and gastrointestinal bleeding (P = 0.032). Cox multiple regression analysis showed age (HR 1.13, 95% CI 1.03-1.24; P = 0.013) and warfarin therapy (HR 7.37, 95% CI 1.63-33.36; P = 0.010) were independent predictors of clinically relevant bleeding. Compared to warfarin, NOACs were associated with a lower incidence of clinically relevant bleeding in HCM patients with AF, as demonstrated by the similar incidence of death by all causes, cardiovascular death and thromboembolic events.

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Fibrinolytic Agents; Gastrointestinal Hemorrhage; Humans; Retrospective Studies; Stroke; Thromboembolism; Warfarin

Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy (HCM). An 80-year-old man was administered bisoprolol and warfarin therapies as treatment for MVOHCM with an apex aneurysm due to myocardial damage and intra-aneurysmal thrombus not complicated by atrial fibrillation. The pressure gradient in the midventricle successfully improved from 53.9 to 21.8 mmHg, and the intra-aneurysmal thrombus disappeared.

Topics: Aged, 80 and over; Anticoagulants; Bisoprolol; Cardiomyopathy, Hypertrophic; Heart Aneurysm; Humans; Male; Treatment Outcome; Ventricular Pressure; Warfarin

Chronic anticoagulation is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to warfarin, but there are limited data to support their use in patients with HCM and AF. We sought to compare thromboembolic events, bleeding, and mortality between NOAC and warfarin in patients with HCM and AF.. From the Korean National Health Insurance Service database during the period from January 1, 2011, to December 31, 2016, we identified a warfarin-treated group of patients with HCM and AF (n = 955) who were compared with a 1:2 propensity-matched NOAC treated group (n = 1,504).. After a median follow-up of 16 months, the incidence rates of ischemic stroke and major bleeding were similar between NOAC- and warfarin-treated patients with HCM and AF. NOAC-treated patients had lower incidence rates for all-cause mortality (5.11 and 10.13 events per 100 person-years for NOAC and warfarin groups) and the composite of fatal cardiovascular events (0.77 and 1.80 events per 100 person-years). Compared with warfarin, use of NOACs was associated with a significantly lower risk of all cause-mortality (hazard ratio, 0.43; 95% CI, 0.32-0.57) and composite fatal cardiovascular events (hazard ratio, 0.39; 95% CI, 0.18-0.82).. Compared with warfarin, patients with HCM and AF on NOACs had similar stroke and major bleeding risks, but lower all-cause mortality and composite fatal cardiovascular events. Our data suggest that patients with HCM and AF can be safely and effectively treated with NOACs.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Cohort Studies; Databases, Factual; Female; Humans; Incidence; Male; Middle Aged; Republic of Korea; Stroke; Thromboembolism; Treatment Outcome; Warfarin

Topics: Anticoagulants; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Echocardiography; Female; Heart Aneurysm; Humans; Magnetic Resonance Imaging; Middle Aged; Postoperative Complications; Treatment Outcome; Ventricular Outflow Obstruction; Warfarin

Background and Purpose- Hypertrophic cardiomyopathy patients with atrial fibrillation are at increased risk of stroke, and anticoagulation is strongly recommended. However, limited data are available regarding the safety and effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) for primary prevention of stroke. Methods- Using the Korean Health Insurance Review and Assessment Service database, we identified 2397 patients with hypertrophic cardiomyopathy and nonvalvular atrial fibrillation on oral anticoagulation from 2013 to 2016 without history of ischemic stroke, intracranial hemorrhage (ICH), or gastrointestinal bleeding (992 on warfarin and 1405 on NOACs). Inverse probability of treatment weighting with propensity scores was used to balance covariates between treatment groups. Risk for ischemic stroke, ICH, gastrointestinal bleeding, death, and their composite outcome associated with NOAC use was assessed with warfarin use as the reference. Results- During a mean follow-up of 1.6 years, the incidence rates of ischemic stroke, ICH, gastrointestinal bleeding, death, and composite outcome were all significantly lower in the NOAC than in the warfarin group (stroke, 2.8 versus 5.0; ICH, 0.5 versus 1.3; gastrointestinal bleeding, 2.3 versus 3.0; death, 3.0 versus 5.1; composite, 7.5 versus 12.5 events per 100 person-years). NOACs were associated with significantly lower risks of ischemic stroke (hazard ratio [HR], 0.47; 95% CI, 0.32-0.68), ICH (HR, 0.31; 95% CI, 0.14-0.69), gastrointestinal bleeding (HR, 0.62; 95% CI, 0.40-0.96), death (HR, 0.45; 95% CI, 0.31-0.65), and the composite outcome (HR, 0.48; 95% CI, 0.38-0.61) than warfarin. The same trend was observed regardless of the NOAC dose and across various high-risk subgroups. In analysis of individual NOACs, all NOACs were associated with lower risks of ischemic stroke and composite outcome. Conclusions- NOACs showed superior effectiveness and safety versus warfarin in the primary prevention of stroke versus warfarin in real-world Asian hypertrophic cardiomyopathy with atrial fibrillation.

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Gastrointestinal Hemorrhage; Humans; Intracranial Hemorrhages; Primary Prevention; Stroke; Treatment Outcome; Warfarin

Topics: Adrenergic beta-Antagonists; Anticoagulants; Aspirin; Cardiomyopathy, Hypertrophic; Dyspnea; Echocardiography, Transesophageal; Female; Humans; Middle Aged; Mitral Valve Insufficiency; Platelet Aggregation Inhibitors; Reoperation; Systole; Treatment Outcome; Ventricular Outflow Obstruction; Warfarin

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Humans; Stroke; Vitamin K; Warfarin

Topics: Aged; Anticoagulants; Atrial Appendage; Cardiomyopathy, Hypertrophic; Chronic Disease; Dyspnea; Echocardiography, Transesophageal; Heart Diseases; Heart Failure; Humans; Male; Thrombosis; Tomography, X-Ray Computed; Warfarin

Previous studies on the association between the distribution of left ventricle hypertrophy and the clinical features of hypertrophic cardiomyopathy (HCM) have yielded unclear results. The aim of this study was to investigate the differences in the prevalence, clinical features, management strategies, and long-term outcomes between patients with midventricular hypertrophic obstructive cardiomyopathy (MVHOCM) and patients with apical HCM (ApHCM).. A retrospective study of 60 patients with MVHOCM and 263 patients with ApHCM identified in a consecutive single-centre cohort consisting of 2068 patients with HCM was performed. The prevalence, clinical features, and natural history of the patients in these 2 groups were compared.. Compared with ApHCM patients, patients with MVHOCM tended to be much younger and more symptomatic during their initial evaluation. Over a mean follow-up of 7 years, the probability of cardiovascular mortality and that of morbidity was significantly greater in MVHOCM patients compared with ApHCM patients (log-rank, P < 0.001).. Our results suggest that, compared with ApHCM, MVHOCM represents an uncommon presentation of the clinical spectrum of HCM that is characterized by progressive clinical deterioration leading to increased cardiovascular mortality and morbidity. Our results also underscore the importance of the timely recognition of MVHOCM for the prediction of prognosis and the early consideration of appropriate management strategies.

Topics: Ablation Techniques; Adrenergic beta-Antagonists; Adult; Age Factors; Anticoagulants; Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Cohort Studies; Echocardiography; Echocardiography, Doppler, Color; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Pacemaker, Artificial; Phenotype; Retrospective Studies; Syncope; Tachycardia, Ventricular; Thrombosis; Warfarin

Hypertrophic cardiomyopathy is a complex and relatively common genetic disorder characterized by left ventricular (LV) hypertrophy, usually associated with a nondilated and hyperdynamic chamber with heterogeneous phenotypic expression and clinical course. On the other hand, LV noncompaction is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with a pattern of prominent trabecular meshwork and deep intertrabecular recesses, systolic dysfunction, and LV dilatation. We report a 29-year-old man with these two different inherent conditions. Our case raises the possibility of a genetic mutation common to these two clinical entities or different gene mutations existing in the same individual.

Topics: Adrenergic beta-Antagonists; Adult; Anticoagulants; Carbazoles; Cardiomyopathy, Hypertrophic; Carvedilol; Diagnosis, Differential; Heart Defects, Congenital; Humans; Male; Propanolamines; Treatment Outcome; Warfarin

A 50-year-old male patient with hypertrophic cardiomyopathy and atrial fibrillation was anticoagulated, with warfarin following insertion of a cardioverter defibrillator. He became markedly over anticoagulated after standard moderate induction doses of warfarin. His baseline prothrombin time was prolonged and further investigation showed the patient to have a mild factor VII deficiency. He was restarted on low-dose warfarin and successfully stabilized with a target international normalized ratio (INR) of 3.0 (range 2.5-3.5). We used the data from factor VII levels and thrombin generation studies before and after anticoagulation to control dosage and to decide on a suitable therapeutic range for the INR. Molecular studies showed him to have two separate mutations in the factor VII gene. This report highlights the importance of noting the baseline prothrombin time before initiating oral anticoagulation and describes how well tolerated anticoagulation can be achieved in a patient with congenital factor VII deficiency.

Topics: Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Drug Monitoring; Factor VII; Factor VII Deficiency; Humans; International Normalized Ratio; Male; Middle Aged; Mutation; Prothrombin Time; Warfarin

Little is presently known regarding whether a rhythm-control or a rate-control strategy is more frequently used in patients hospitalized for atrial fibrillation (AF). This study was conducted to assess patient and physician characteristics associated with each treatment strategy and with the use of anticoagulants. Hospitalizations for primary diagnoses of AF were examined using hospital claims from January 2000 to December 2004. Patients who received antiarrhythmic drugs, ablation, or cardioversion for AF were categorized as receiving rhythm control. Patients managed only with beta blockers, calcium channel blockers, or digoxin were categorized as receiving rate control. Characteristics associated with rhythm compared with rate control and anticoagulant use with CHADS(2) score were determined. The study cohort included 155,731 hospitalizations from 464 hospitals. Of these, 75,397 (48%) were categorized as involving rhythm control and 80,334 (52%) as involving rate control. Care by a noncardiologist (adjusted odds ratio [OR] 0.33, 95% confidence interval [CI] 0.31 to 0.36) and increasing age >65 years (adjusted OR 0.87, 95% CI 0.86 to 0.88) were associated with lower odds of rhythm versus rate control; hypertrophic cardiomyopathy was associated with greater odds (adjusted OR 2.3, 95% CI 1.81 to 2.84) of rhythm control. Warfarin use was greater in the rhythm-control group compared with the rate-control group (adjusted OR 1.56, 95% CI 1.52 to 1.60), and warfarin use was greater with a CHADS(2) score > or =2 (unadjusted OR 1.21, 95% CI 1.19 to 1.24). In conclusion, rhythm- and rate-control strategies were used equally in patients hospitalized for AF. Some observations, such as greater use of the rate-control strategy with increasing age, were consistent with recommendations, but others, such as lower use of warfarin in the rate-control group, were not.

Topics: Adrenergic beta-Antagonists; Age Factors; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Anticoagulants; Aspirin; Atrial Fibrillation; Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Catheter Ablation; Digoxin; Drug Utilization; Electric Countershock; Female; Hospitalization; Humans; Male; Medicine; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Retrospective Studies; Severity of Illness Index; Specialization; United States; Warfarin; Wolff-Parkinson-White Syndrome

We report a patient with apical hypertrophic cardiomyopahty (AHCM) complicated by a cardiogenic cerebral embolism. A 56-year-old man was admitted to our hospital because of a transient ischemic attack. He had been diagnosed as having AHCM at the age of 39 years. The intravenous administration of heparin was immediately started; however, he developed a weakness in his right fingers on the second day. A brain MRI examination showed multiple small infarctions in the cortex of the left frontal and temporal lobes. Transthoracic echocardiography revealed the hypokinetic movement of the myocardium and a thrombus in the apex. We suspected that the hypertrophic apex had become dilated, causing the formation of the thrombus. He then developed a cardiogenic cerebral embolism. The thrombus in the apex disappeared after the continuous administration of heparin intravenously. Here, we emphasize that patients with AHCM in the dilatation phase must receive warfarin therapy to prevent cardiogenic cerebral embolism.

Topics: Anticoagulants; Cardiomyopathy, Hypertrophic; Heparin; Humans; Intracranial Embolism; Male; Middle Aged; Warfarin

Topics: Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Humans; Japan; Risk Factors; Severity of Illness Index; Stroke; Thromboembolism; Warfarin

Mechanical valves are inherently thrombogenic and require meticulous anticoagulation. Pregnancy produces a hypercoagulable state and achieving adequate anticoagulation is difficult. We present a pregnant patient who had a nonobstructive thrombus of mechanical mitral valve causing embolic acute myocardial infarction. Issues surrounding management of anticoagulation and use of thrombolytic therapy during pregnancy are discussed. Education regarding the critical nature of adequate anticoagulation in these patients is important.

Topics: Adult; Anticoagulants; Cardiomyopathy, Hypertrophic; Echocardiography, Transesophageal; Embolism; Endocarditis; Female; Fibrinolytic Agents; Heart Valve Diseases; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Myocardial Infarction; Pregnancy; Pregnancy Complications, Cardiovascular; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator; Warfarin

Atrial fibrillation (AF) has been treated with DC shocks delivered transthoracically, but in 5-30% of patients, the procedures fail to restore sinus rhythm (SR). We hypothesized that applying high energy shock waves to the chest may overcome the inadequate penetration of electrical shock to the atrium. The aim of this study was to evaluate the efficacy of higher energy external DC shock for the treatment of refractory AF coexisting with cardiovascular disease using a synchronized double external defibrillator. Fifteen patients (mean age 65 +/- 8) with refractory AF to standard DC cardioversion (CV) underwent higher energy DC shock using a double external defibrillator. Concomitant heart disease was present in all patients. Warfarin and amiodarone (600 mg/day), were administered for at least three weeks duration before DC CV. Sedation was performed with IV midazolam. Two defibrillator paddles were positioned on the anterior and posterior chest wall in a right lateral decubitus position. Defibrillators were synchronized to the R waves and simultaneously 720 joules of energy was administered to the patients. Amiodarone (200 mg/day) was continuously administered after DC shock to maintain SR. Sinus rhythm was obtained in 13 patients. Sinus rhythm was persistent in 11 patients for six months duration. Creatine kinase MB fractions were normal at 4 (22 +/- 4 IU/L) and 12 hours (18 +/- 4 IU/L). None of the patients developed significant hemodynamic compromise or congestive heart failure, higher AV block, stroke, or transient ischemic cerebral events. The results indicate that higher energy DC shock application using a double external defibrillator is an effective and safe method for the cardioversion of refractory AF. We believe this procedure should be performed before internal atrial cardioversion.

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Defibrillators; Electric Countershock; Humans; Middle Aged; Mitral Valve Insufficiency; Rheumatic Heart Disease; Warfarin

We sought to assess the occurrence and clinical significance of stroke and peripheral arterial embolizations at non-central nervous system sites in a large, community-based cohort with hypertrophic cardiomyopathy (HCM).. Such vascular events are insufficiently appreciated complications of HCM for which there is limited information on occurrence, clinical profile and determinants.. We assessed the clinical features of patients with stroke and other peripheral vascular events in a consecutive group of patients with HCM from four regional cohorts not subject to significant tertiary referral bias.. Of the 900 patients, 51 (6%) patients experienced stroke or other vascular events over 7 +/- 7 years, including 44 patients with stroke; 21 (41%) of these 51 patients died or were permanently disabled. The overall incidence was 0.8%/year and 1.9% for patients >60 years old. Age at first event ranged from 29 to 86 years (mean 61 +/- 14 years). Most (n = 37; 72%) events occurred in those >50 years, although 14 (28%) younger patients (< or = 50 years) also had events. Multivariate analysis showed stroke and other peripheral vascular events to be independently associated with congestive symptoms and advanced age, as well as with atrial fibrillation (in 45 [88%] of 51 patients), at the initial evaluation. The cumulative incidence of these events among patients with atrial fibrillation was significantly higher in non-anticoagulated patients as compared with patients receiving warfarin (31% vs. 18%; p < 0.05).. Stroke and peripheral embolizations showed a 6% prevalence rate and an incidence of 0.8%/year in a large, unselected HCM group. These profound complications of HCM, which may lead to disability and death, were substantially more common in the elderly, occurred almost exclusively in patients with paroxysmal or chronic atrial fibrillation and appeared to be reduced in frequency by anticoagulation.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Cardiomyopathy, Hypertrophic; Embolism; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Assessment; Stroke; Warfarin

Alterations in repolarization following prolonged periods of ventricular pacing, termed "cardiac memory," have been well documented. Postpacing changes in cardiac function have also been noted in hypertrophic cardiomyopathy. This study was designed to evaluate the effects of ventricular pacing on postpacing diastolic function and its relationship to repolarization changes. Eight subjects (mean age, 76 yr) with permanent pacemakers were enrolled in this study. Each subject was evaluated at a fixed pacing rate with recording of electrocardiographic and echocardiographic data. Seven sets of measurements were performed in the same sequential pattern: 1) after 1 wk of atrial pacing, 2) within 10 min after initiation of atrioventricular sequential pacing (ventricular pacing), 3) within 10 min after termination of 1 h of ventricular pacing, 4) after 1 wk of ventricular pacing, and 5) within 10 min, at 1 h, and at 24 h after termination of ventricular pacing. All subjects had repolarization changes characteristic of cardiac memory only after 1 wk of ventricular pacing. Changes in repolarization parameters were accompanied by changes in peak left ventricular filling rate (dD/dt/D; P = 0.02) and isovolumic relaxation time (IVRT; P = 0.03) that at 24 h approached baseline values. Correlations existed between changes in the Q-T interval and IVRT (r = 0.53, P = 0.007) and between changes in T wave amplitude and dD/dt/D (r = 0.48, P = 0.018) after long-term ventricular pacing. Thus changes in both repolarization and diastolic function persist after cessation of ventricular pacing and lend support to the concept of electrical and mechanical cardiac memory.

Topics: Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Atenolol; Cardiomyopathy, Hypertrophic; Diastole; Echocardiography; Electrocardiography; Equipment Design; Female; Heart; Humans; Male; Memory; Middle Aged; Models, Cardiovascular; Pacemaker, Artificial; Sotalol; Time Factors; Ventricular Function, Left; Warfarin

A 10-year-old male cat was presented with sudden onset of respiratory difficulties. Clinical examination revealed an acute dyspnoea with cyanosis associated with a left systolic heart murmur. Standard thoracic radiographs excluded pulmonary oedema and showed very few pulmonary changes given the intensity of the respiratory compromise. Echocardiographic examination revealed hypertrophic cardiomyopathy and a thrombus in the right pulmonary artery. Pulmonary scintigraphy confirmed a pulmonary thromboembolism with hypovascularisation of the left cranial lobe and of the ventral segment of the right lobe. Conservative treatment was instituted using an antibiotic (doxycycline), anticoagulants (heparin, coumadine) and a calcium inhibitor (diltiazem). The cat was given absolute rest. The general condition of the animal improved.

Topics: Animals; Anti-Bacterial Agents; Anticoagulants; Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Cat Diseases; Cats; Diltiazem; Doxycycline; Echocardiography; Heparin; Lung; Male; Pulmonary Artery; Pulmonary Embolism; Radiography, Thoracic; Radionuclide Imaging; Respiration; Warfarin

Histological and anthropometric studies were made of the hands and face of a 17-week-old (postmenstrual) human fetus that was exposed to warfarin throughout gestation. The fetus had marked nasal hypoplasia and the facial cartilages contained discrete foci of abnormal cartilage. When compared with age-matched control fetuses hand pattern profile analysis showed that the brachydactyly was due to shortening of the terminal phalanges. Histologically chondrogenesis was disordered in the carpals and phalanges, with the most deviant development occurring at the distal ends of the terminal phalanges. In none of the areas of abnormal cartilage was there evidence of hemorrhage or hemosiderin deposition. It is our contention that warfarin is teratogenic in human beings and that its teratogenicity is not due to focal hemorrhage.

Topics: Abnormalities, Drug-Induced; Abortion, Induced; Anthropometry; Cardiomyopathy, Hypertrophic; Cartilage; Face; Female; Fingers; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Warfarin