Bio

Clinical Focus


  • Cardiology (Heart)
  • Cardiovascular Disease
  • Cardiac Advanced Therapies
  • Heart Disease Risk Factor Reduction
  • Geriatric Cardiology
  • Coronary Artery Spasm (Prinzmetal's Angina)

Academic Appointments


Professional Education


  • Board Certification: Internal Medicine, American Board of Internal Medicine (1969)
  • Fellowship:Stanford University School of Medicine (1969) CA
  • Internship:Stanford University School of Medicine (1963) CA
  • Residency:Stanford University School of Medicine (1967) CA
  • Board Certification: Cardiovascular Disease, American Board of Internal Medicine (1973)
  • Medical Education:University of Michigan School of Medicine (1962) MI

Research & Scholarship

Current Research and Scholarly Interests


1. Clinical Pharmocology of Cardiovascular Drugs
(a) Calcium Channel Blockers
(b) Agents for Heart Failure
(c) Anti-atherosclerotic Effects of Cardiovascular Drugs, e.g. Calcium Channel Blockers

2. Cardiac Transplantation/Congestive Heart Failure

3. Coronary Artery Spasm

Teaching

2015-16 Courses


Publications

All Publications


  • Surgical Treatment of Heart Failure, Cardiac Transplantation, and Mechanical Ventricular Support. Hurst?s The Heart, 12th Edition, McGraw Hill Schroeder JS, Pham MX, Chen JM, Berry GJ, Rose EA 2008
  • Pharmacologic Options for Treatment of Ischemic Disease. Cardiovascular Therapeutics: A Companion to Braunwald?s Heart Disease, 3rd Edition, Elsevier Abram J, Schroeder JS, Frishman W, Freedman J 2007
  • Surgical Treatment of Heart Failure, Cardiac Transplantation, and Mechanical Ventricular Support. Hurst?s The Heart, 11th Edition, McGraw Hill Schroeder JS, Moffat SD, Berry GJ, Robbins RC 2004
  • Unstable Angina and Non-St Elevation Myocardial Infarction Cardiology for the Primary Care Physician, 4th edition Schroeder JS 2004
  • Multicenter InSync ICD II Study Group. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation Abraham WT, Young JB, Leon AR, Adler S, Bank AJ, Hall SA, Lieberman R, Liem LB, O'Connell JB, Schroeder JS, Wheelan KR 2004; 110: 2864-8.
  • HMG-CoA reductase inhibitors reduce transplant coronary artery disease and mortality - Evidence for antigen-independent mechanisms? CIRCULATION Valantine, H. A., Schroeder, J. S. 1997; 96 (5): 1370-1373

    View details for Web of Science ID A1997XU85600003

    View details for PubMedID 9315517

  • RECENT ADVANCES IN CARDIAC TRANSPLANTATION NEW ENGLAND JOURNAL OF MEDICINE Valantine, H. A., Schroeder, J. S. 1995; 333 (10): 660-661

    View details for Web of Science ID A1995RR84000013

    View details for PubMedID 7637732

  • THE COUNCIL-FOR-MYOCARDIAL-ISCHEMIA-AND-INFARCTION - ADVISORY GROUP REPORTS ON SILENT-MYOCARDIAL-ISCHEMIA, HEART-RATE CONTROL, AND POST MYOCARDIAL-INFARCTION MANAGEMENT Deedwania, P. C., Schroeder, J. S., Boden, W. E. EXCERPTA MEDICA INC. 1992: F39-F44
  • The Council for Myocardial Ischemia and Infarction: advisory group reports on silent myocardial ischemia, heart rate control, and post-myocardial infarction management. American journal of cardiology Deedwania, P. C., Schroeder, J. S., Boden, W. E. 1992; 70 (16): 39F-44F

    View details for PubMedID 1442601

  • THE INFLUENCE OF PREOPERATIVE PATIENT CHARACTERISTICS ON EARLY AND LATE SURVIVAL FOLLOWING CARDIAC TRANSPLANTATION CIRCULATION COSTARDJACKLE, A., Hill, I., Schroeder, J. S., Fowler, M. B. 1991; 84 (5): 329-337
  • The antiatherogenic effects of calcium antagonists. American journal of hypertension Keogh, A. M., Schroeder, J. S. 1991; 4 (7): 512S-518S

    Abstract

    Evidence that calcium antagonists can suppress diet-induced atherosclerosis in the thoracic aorta of animals has existed for a decade. Recently, the results of quantitative angiographic trials of calcium antagonists in humans have become available, confirming their beneficial effect on coronary artery disease. Nifedipine treatment reduces the rate of new lesion development in patients with mild-to-moderate coronary artery disease, reduces disease progression, and, in some cases, induces lesion regression. There is evidence that the use of verapamil may be associated with lesion regression and stenosis prevention, and that nicardipine may influence the progression of minimal coronary lesions. Theoretically, a wide range of explanations for an effect of calcium antagonists on atherogenesis is possible. Potential mechanisms include preventing calcium overload, upregulating LDL receptors with enhanced LDL clearance, inhibiting cell migration into the arterial wall, and antiplatelet effects. The exact mechanism remains unclear, but alteration of serum lipid levels and blood pressure does not appear to be the common pathway. Work with humans is still preliminary, and longer follow-up and further trials are required to determine the appropriate clinical application of calcium timing for their introduction.

    View details for PubMedID 1654938

  • THE ANTIATHEROGENIC EFFECTS OF CALCIUM-ANTAGONISTS AMERICAN JOURNAL OF HYPERTENSION Keogh, A. M., Schroeder, J. S. 1991; 4 (7): S512-S518
  • CHEST PAIN IN HEART-TRANSPLANT RECIPIENTS NEW ENGLAND JOURNAL OF MEDICINE Schroeder, J. S., Hunt, S. A. 1991; 324 (25): 1805-1807

    View details for Web of Science ID A1991FR68100009

    View details for PubMedID 2038369

  • PROGRESSIVE CORONARY LUMINAL NARROWING AFTER CARDIAC TRANSPLANTATION CIRCULATION Gao, S. Z., Alderman, E. L., Schroeder, J. S., Hunt, S. A., WIEDERHOLD, V., Stinson, E. B. 1990; 82 (5): 269-275
  • HEMODYNAMIC AND ADH RESPONSES TO CENTRAL BLOOD-VOLUME SHIFTS IN CARDIAC-DENERVATED HUMANS CLINICAL PHYSIOLOGY Convertino, V. A., Thompson, C. A., Benjamin, B. A., Keil, L. C., SAVIN, W. M., Gordon, E. P., Haskell, W. L., Schroeder, J. S., Sandler, H. 1990; 10 (1): 55-67

    Abstract

    Haemodynamic responses and antidiuretic hormone (ADH) were measured during body position changes designed to induce blood volume shifts in 10 cardiac transplant recipients to assess the contribution of cardiac and vascular volume receptors in the control of ADH secretion. Each subject underwent 15 min of a control period in the seated posture, then assumed a lying posture for 30 min at 6 degrees head-down tilt (HDT) followed by 30 min of seated recovery. Venous blood samples and cardiac dimensions (echocardiography) were taken at 0 and 15 min before HDT, 5, 15 and 30 min of HDT, and 5, 15 and 30 min of seated recovery. Blood samples were analysed for haematocrit, plasma osmolality, plasma renin activity (PRA) and ADH. Resting plasma volume (PV) was measured by Evans blue dye and per cent changes in PV during posture changes were calculated from changes in haematocrit. Heart rate (HR) and blood pressure (BP) were recorded every 2 min. In the cardiac transplant subjects, mean HR decreased (BP less than 0.05) from 102 b.p.m. pre-HDT to 94 b.p.m. during HDT and returned to 101 b.p.m. in seated recovery while BP was slightly elevated (P less than 0.05). PV was increased by 6.3% (P less than 0.05) by the end of 30 min of HDT but returned to pre-HDT levels following seated recovery. Plasma osmolality was not altered by posture changes. Mean left ventricular end-diastolic volume increased (P less than 0.05) from 90 +/- 5 ml pre-HDT to 105 +/- 4 ml during HDT and returned to 88 +/- 5 ml in seated recovery. Plasma ADH was reduced by 28% (P less than 0.05) by the end of HDT and returned to pre-HDT levels with seated recovery. PRA was also reduced by 28% (P less than 0.05) with HDT. These responses were similar to those of six normal cardiac-innervated control subjects and one heart-lung recipient. Therefore, cardiac volume receptors are not the only mechanism for the control of ADH release during acute blood volume shifts in man.

    View details for Web of Science ID A1990CH32400005

    View details for PubMedID 2302936

  • PREVALENCE OF ACCELERATED CORONARY-ARTERY DISEASE IN HEART-TRANSPLANT SURVIVORS - COMPARISON OF CYCLOSPORINE AND AZATHIOPRINE REGIMENS CIRCULATION Gao, S. Z., Schroeder, J. S., Alderman, E. L., Hunt, S. A., Valantine, H. A., WIEDERHOLD, V., Stinson, E. B. 1989; 80 (5): 100-105
  • DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS IN SILENT MYOCARDIAL ISCHEMIA AMERICAN JOURNAL OF CARDIOLOGY Schroeder, J. S. 1988; 61 (12): F41-F47
  • CLINICAL AND LABORATORY CORRELATES OF ACCELERATED CORONARY-ARTERY DISEASE IN THE CARDIAC TRANSPLANT PATIENT CIRCULATION Gao, S. Z., Schroeder, J. S., Alderman, E. L., Hunt, S. A., Silverman, J. F., WIEDERHOLD, V., Stinson, E. B. 1987; 76 (5): 56-61
  • POOR SURVIVAL OF PATIENTS WITH IDIOPATHIC CARDIOMYOPATHY CONSIDERED TOO WELL FOR TRANSPLANTATION AMERICAN JOURNAL OF MEDICINE Stevenson, L. W., Fowler, M. B., Schroeder, J. S., Stevenson, W. G., Dracup, K. A., FOND, V. 1987; 83 (5): 871-876

    Abstract

    Although the success of cardiac transplantation has encouraged earlier referral of potential candidates, those with mild symptoms of heart failure are frequently considered "too well" for transplantation. Outcome was investigated for 28 patients with non-ischemic dilated cardiomyopathy and ejection fraction of 25 percent or less who were denied transplantation due to lack of severe symptoms. One-year survival without transplantation was 46 percent. Low stroke volume and history of ventricular arrhythmias were independent predictors of early mortality. High risk, defined as either stroke volume of 40 ml or less or history of ventricular arrhythmia, identified 13 of 14 patients who did not survive one year and only one of 12 one-year survivors (p less than 0.001). Low stroke volume predicted hemodynamic failure (p less than 0.05) whereas arrhythmic history predicted sudden death (p less than 0.001). Clinical status improved in only six patients, all of whom had symptom duration of seven or less months at initial evaluation (p less than 0.001). Thus, patients referred to transplantation for dilated cardiomyopathy with an ejection fraction of 25 percent or less have a poor prognosis even if symptoms are mild. Patients with high hemodynamic risk may require early transplantation, whereas those with high arrhythmia risk may require other aggressive therapy in order to avoid transplantation until symptoms become severe.

    View details for Web of Science ID A1987K745100010

    View details for PubMedID 3314498

  • CARDIAC TRANSPLANTATION - WHERE ARE WE NEW ENGLAND JOURNAL OF MEDICINE Schroeder, J. S., Hunt, S. A. 1986; 315 (15): 961-963

    View details for Web of Science ID A1986E294200011

    View details for PubMedID 3531855

  • CURRENT STATUS OF CARDIAC TRANSPLANTATION MODERN CONCEPTS OF CARDIOVASCULAR DISEASE Fowler, M. B., Schroeder, J. S. 1986; 55 (8): 37-40
  • DILTIAZEM AND PROPRANOLOL IN COMBINATION - HEMODYNAMIC-EFFECTS FOLLOWING ACUTE INTRAVENOUS ADMINISTRATION AMERICAN HEART JOURNAL Oesterle, S. N., Alderman, E. L., BEIERSCOTT, L., Baim, D. S., Rothman, M. T., Schroeder, J. S. 1986; 111 (3): 489-497

    Abstract

    Diltiazem and propranolol are independently useful antianginal agents with common negative chronotropic, dromotropic, and inotropic properties. Concern over the safety of the concurrent use of these two drugs led to an investigation of their intravenous combination in 19 patients with suspected coronary artery disease. Hemodynamics were recorded in both a sinus and atrial paced rhythms at baseline and again following administration of a loading dose of diltiazem (0.25 mg/kg) followed by continuous infusion (0.002 mg/kg/min). Propranolol was then added by intravenous bolus (0.07 mg/kg) and continuous infusion (0.0012 mg/kg/min), with reassessment of hemodynamics once steady state was achieved. Patients were stratified by left ventricular ejection fraction (LVEF): group 1 (LVEF = 62% to 69%), group 2 (LVEF = 49% to 59%), and group 3 (LVEF = 20% to 47%). The combination of drugs resulted in a 15% drop in heart rate (p less than 0.01) and a 15% prolongation in the PR interval (p less than 0.01) for the group of 19 patients. Left ventricular end-diastolic pressure (LVEDP) was not significantly changed by diltiazem or its combination except in group 3. Cardiac output was lowered in all groups following diltiazem and propranolol (p less than 0.05). Untoward reactions included marked vasovagal reactions at the conclusion of the procedure in six patients. The combination of drugs resulted in profound sinus bradycardia with attendant 2:1 atrioventricular (AV) block in one patient. Diltiazem and propranolol were hemodynamically well tolerated in patients with preserved left ventricular function. Because of the additive negative dromotropic activities of these two drugs, ECG monitoring is warranted when they are acutely combined.

    View details for Web of Science ID A1986A376900010

    View details for PubMedID 3953357

  • INTRAVENOUS DILTIAZEM FOR THE TREATMENT OF SUPRAVENTRICULAR TACHYCARDIA CLINICAL CARDIOLOGY Sternbach, G. L., Schroeder, J. S., ELIASTAM, M., BEIERSCOTT, L. 1986; 9 (4): 145-149

    Abstract

    To determine the effects of diltiazem hydrochloride on patients with paroxysmal supraventricular tachycardia, we administered intravenous diltiazem, 0.25 mg/kg to patients who presented to the Stanford Medical Center Emergency Department with this rhythm. Blood pressure was recorded prior to administration, and monitored for 20 min thereafter. Six of the ten patients converted to sinus rhythm a mean of 7.75 min (+/- 4.4) after drug administration. The remaining four experienced slowing of heart rates from a mean of 177 to 166 beats/min. Systolic blood pressure fell a mean of 12.4 mmHg during treatment, but returned to pretreatment level or higher within 20 min following diltiazem administration. This mean degree of blood pressure reduction compares favorably with effects produced by intravenous verapamil under comparable circumstances. Intravenous diltiazem appears to be a safe and effective drug for the conversion of paroxysmal supraventricular tachycardia.

    View details for Web of Science ID A1986A709500004

    View details for PubMedID 3720041

  • BLUE-LIGHT ACTIVATES ELECTROGENIC ION PUMPING IN GUARD-CELL PROTOPLASTS OF VICIA-FABA NATURE Assmann, S. M., Simoncini, L., Schroeder, J. I. 1985; 318 (6043): 285-287
  • DILTIAZEM AND PROPRANOLOL, ALONE AND IN COMBINATION, ON EXERCISE PERFORMANCE AND LEFT-VENTRICULAR FUNCTION IN PATIENTS WITH STABLE EFFORT ANGINA - A DOUBLE-BLIND, RANDOMIZED, AND PLACEBO-CONTROLLED STUDY ACTA PHARMACOLOGICA ET TOXICOLOGICA Schroeder, J. S., Hung, J., LAMB, I. H., Connolly, S. J., Jutzy, K. R., Goris, M. L. 1985; 57: 55-60

    Abstract

    Diltiazem and propranolol alone and in combination as antianginal agents were compared with placebo in 12 patients with stable exertional angina at Stanford University Medical Center. The patients performed symptom-limited, multi-stage upright bicycle ergometric exercise while undergoing radionuclide angiographic studies every two weeks while being treated with 90 mg of diltiazem four times daily, 60 mg of propranolol four times daily, a combination of 90 mg of diltiazem and 60 mg of propranolol four times daily, and placebo. Diltiazem, propranolol and a combination all significantly increased exercise duration compared to placebo (526 +/- 149, 525 +/- 115, and 549 +/- 129 vs 430 +/- 132 sec.). Although rate pressure product and heart rate decreased with diltiazem therapy at submaximal workloads, these values were unchanged at peak exercise in contrast to propranolol or the combination of propranolol or diltiazem. Diltiazem decreased the sub-maximal and maximal degree of exercise-induced ST segment depression by over 50% compared to placebo (P less than 0.01 vs placebo). Diltiazem resulted in a higher exercise left ventricular ejection fraction compared to placebo, propranolol or the combination of diltiazem or propranolol (all less than P less than 0.05). Sinus bradycardia or orthostatic hypertension occurred in four patients on the high-dose combination therapy and required dose reduction. We concluded that high-dose diltiazem, appeared to be even more effective than moderate-dose propranolol or the combination of diltiazem and propranolol in improving exercise tolerance, electrocardiographic evidence of myocardial ischaemia and left ventricular function in patients with stable effort angina due to occlusive coronary artery disease.

    View details for Web of Science ID A1985ARG3800008

    View details for PubMedID 4061105

  • EFFICACY OF DILTIAZEM FOR MEDICALLY REFRACTORY STABLE ANGINA - LONG-TERM FOLLOW-UP CLINICAL CARDIOLOGY Schroeder, J. S., BEIERSCOTT, L., Ginsburg, R., Bristow, M. R., McAuley, B. J. 1985; 8 (9): 480-485

    Abstract

    To assess the efficacy of long-term diltiazem therapy when added to beta blockers and nitrates, we prospectively studied patients with chronic exertional angina who were determined to have medically refractory angina pectoris which was too severe to enter placebo-controlled studies. The mean follow-up time was 24.6 months (8-47 months) and all patients were seen every 2-4 months. Angina frequency decreased from a prediltiazem frequency of 9.5 episodes per week (1-40 per week) to 3.3 attacks per week (0-21 per week) at 6 months and 3.3 attacks per week (0-40 per week) at the patients's last evaluation. Similar reductions in nitroglycerin consumption were reported. Five patients had an increase in angina frequency during the mean 24.6 months of follow-up, which necessitated coronary bypass surgery, 8, 10, 12, 19, and 23 months after study entry, respectively. Diltiazem daily dosage ranged from 120 to 480 mg/day, the mean daily dose was 298 mg/day. Twenty (65%) patients remained on beta-blocker therapy and 19 (61%) patients on nitrate therapy in an effort to achieve a completely pain-free state. New cardiovascular events were documented in 3 patients during the follow-up period, with one patient having an uncomplicated myocardial infarction at 6 months, one patient hospitalized for prolonged chest pain at 2 months, and one patient dying following cardioversion for unrelated atrial fibrillation at 14 months poststudy entry. Adverse effects were reported during 19 of the 354 patient visits, but no patient had to stop therapy because of these. Sinus bradycardia required reduction of beta-blocker dosage in three patients and prolonged PR interval was observed in two additional patients.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1985APQ8600004

    View details for PubMedID 2864152

  • COMBINATION THERAPY WITH ISOSORBIDE DINITRATE - CURRENT STATUS AND THE FUTURE AMERICAN HEART JOURNAL Schroeder, J. S. 1985; 110 (1): 284-291

    Abstract

    The excellent safety and predictable efficacy of isosorbide dinitrate (ISDN) have been demonstrated repeatedly during the past 25 years in a number of studies in which the agent has been used alone or in combination with other antianginal agents. Clinical studies to investigate the additive or synergistic effect of ISDN have been difficult to conduct because of the complexity of protocol design and length of studies required. However, combination therapy is well accepted in the clinical practice of medicine and cardiology and is used to obtain additive therapeutic effects while minimizing the side effects. The addition of ISDN not only to other standard and proven antianginal agents but also to calcium antagonists should prove to be a fruitful area for further clinical research benefiting patients with angina pectoris (caused by either coronary artery spasm or occlusive coronary artery disease), hypertension, and congestive heart failure. Noncardiovascular uses of ISDN may include the treatment of hyperspasticity of other smooth muscle beds, such as esophageal spasm and achalasia.

    View details for Web of Science ID A1985ALZ1200018

    View details for PubMedID 3893082

  • ACCELERATED ATHEROSCLEROSIS IN A CARDIAC TRANSPLANT PATIENT JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY NITKIN, R. S., Hunt, S. A., Schroeder, J. S. 1985; 6 (1): 243-245

    Abstract

    A cardiac transplant patient with rapidly progressive graft atherosclerosis is described. This case demonstrates the accelerated nature of this disease and problems in diagnosis, as well as an unexpected and previously unreported lack of sensitivity of exercise thallium scintigraphy in its investigation. This case also gives further support to the practice of routinely and frequently obtaining coronary arteriograms in the management of these patients.

    View details for Web of Science ID A1985ALK9200040

    View details for PubMedID 3891822

  • COMPARISON OF THE ELECTROCARDIOGRAPHIC EFFECT OF DOTHIEPIN AND AMITRIPTYLINE JOURNAL OF CLINICAL PSYCHIATRY Claghorn, J. L., Schroeder, J., Goldstein, B. J. 1984; 45 (7): 291-293

    Abstract

    Electrocardiograms of 65 patients treated with dothiepin, a sulphur substituted tricyclic antidepressant, were compared to those of 57 patients receiving amitriptyline and 62 patients given placebo. Amitriptyline produced an average heart rate increase of 10 beats/minute as compared to 5 beats/minute for dothiepin (p less than .02). Amitriptyline also produced a significant prolongation of the corrected QT interval as compared to both dothiepin and placebo (p less than .01 and p less than .001, respectively). Dothiepin had no significant effect on any index of myocardial conduction (PR interval, corrected QT interval, and QRS duration) as compared to placebo.

    View details for Web of Science ID A1984TB30000002

    View details for PubMedID 6376479

  • FUNCTIONAL AND SOCIAL REHABILITATION OF HEART-TRANSPLANT RECIPIENTS UNDER AGE 30 SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY SAMUELSSON, R. G., Hunt, S. A., Schroeder, J. S. 1984; 18 (2): 97-103

    Abstract

    In the Stanford Heart transplant program, the functional and social rehabilitation of heart transplant recipients below the age of thirty has been investigated by using data from annual follow-ups with right and left heart catheterization, left ventricular (LV) and coronary angiograms and by a health survey questionnaire investigation. 24 out of 38 patients who received transplants in the period January 1, 1974 to April 1981 were still alive. The actuarial survival rates in this group of patients are: 3 months 74%; 1 year 71%, 3 years 67%, 5 years 50%. The figures are persistently higher than for the total number of heart transplant recipients in the Stanford program. 71% of the fatalities occurred during the critical first 3 months after transplantation. The hemodynamic and angiographic findings were normal in all but 2 patients where progressive coronary artery disease had been diagnosed. 23 out of the 24 patients completed the questionnaire. 9 patients were back at work, 4 went to school as required, 4 were now postgraduate students, 2 studied for self-satisfaction and 4 patients neither worked nor studied. All patients considered themselves able to do some kind of work. All patients were able to walk at least 1 mile and 70% 3 miles. 87% were able to do heavy domestic work. Hardly any restrictions in transportation ability and mostly minor restrictions in the activities of daily living were found. Marital satisfaction and sexual function were good in most of the patients; 57% were very satisfied, 30% moderately satisfied and 13% not really satisfied with their life.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1984SU60100001

    View details for PubMedID 6379865

  • THE EFFECT OF DILTIAZEM AND PROPRANOLOL, ALONE AND IN COMBINATION, ON EXERCISE PERFORMANCE AND LEFT-VENTRICULAR FUNCTION IN PATIENTS WITH STABLE EFFORT ANGINA - A DOUBLE-BLIND, RANDOMIZED, AND PLACEBO-CONTROLLED STUDY CIRCULATION Hung, J., LAMB, I. H., Connolly, S. J., Jutzy, K. R., Goris, M. L., Schroeder, J. S. 1983; 68 (3): 560-567

    View details for Web of Science ID A1983RD90200012

    View details for PubMedID 6872168

  • MYOCARDIAL-INFARCTION IN PATIENTS WITH CORONARY-ARTERY SPASM DEMONSTRATED BY ANGIOGRAPHY AMERICAN HEART JOURNAL Cipriano, P. R., Koch, F. H., Rosenthal, S. J., Baim, D. S., Ginsburg, R., Schroeder, J. S. 1983; 105 (4): 542-547

    Abstract

    Twelve cases of myocardial infarction (MI) were documented in 11 of 39 patients who had coronary artery spasm (CAS) that was observed by angiography either before MI (3 patients), after MI (5 patients), or both before and after MI (3 patients). MI corresponded in location to sites of ECG changes of myocardial ischemia during spontaneous angina pectoris in 7 of 7 patients and to the region of myocardium supplied by the vessel in which CAS was observed by angiography in each patient. MI occurred in the distribution of the right coronary artery in 8 patients and of the left coronary artery in 4 patients. Of 12 vessels that supplied infarcted regions of myocardium, 7 vessels had greater than or equal to 50% diameter fixed coronary artery narrowing (CAN), but the remaining 5 vessels had minimal (10%) or no fixed CAN. In those patients who were studied after MI, coronary angiography demonstrated that only 3 of 9 vessels in the distribution of infarcted regions of myocardium were completely occluded. Clinical follow-up for an average of 1.3 years after MI showed that 7 patients continued to have chest pain, 2 patients were asymptomatic, and 2 patients died suddenly 9 weeks and 1 year, respectively, after MI. Therefore, among our patients with CAS demonstrated by angiography, MIs (1) were frequent (28%), (2) occurred in the distribution of observed coronary spasm, (3) were frequently (5 of 12 arteries) in the distribution of vessels having minimal or no fixed narrowing, and (4) were often (6 of 9 arteries) in the distribution of vessels that were demonstrated to be patient after MI.

    View details for Web of Science ID A1983QJ63500002

    View details for PubMedID 6837408

  • CALCIUM-ANTAGONISTS SUPPRESS ATHEROGENESIS IN AORTA BUT NOT IN THE INTRAMURAL CORONARY-ARTERIES OF CHOLESTEROL-FED RABBITS LABORATORY INVESTIGATION Ginsburg, R., Davis, K., Bristow, M. R., MCKENNETT, K., Kodsi, S. R., Billingham, M. E., Schroeder, J. S. 1983; 49 (2): 154-158

    Abstract

    We tested the effects of the calcium antagonists lanthanum, diltiazem, and flunarizine on the development of atherosclerosis in rabbits fed a 2% cholesterol diet. The drugs were given orally and were well tolerated. In the cholesterol control animals, 52.2% of the thoracic aortic intimal surface was Sudan IV positive. This was reduced by 37% (p less than 0.05) with lanthanum, 37% (p less than 0.05) with diltiazem, and 34% (p less than or equal to 0.06) with flunarizine. In all cholesterol-fed animals, the intramural, but not subepicardial, coronary arteries were severely diseased. The extent and distribution of this disease were not altered by the various drug interventions. Thus, the calcium antagonists lanthanum, diltiazem, and flunarizine suppress atherogenesis of the rabbit aorta but have no effect on the extent or distribution of atherosclerosis in the intramural coronary arteries.

    View details for Web of Science ID A1983RD33900005

    View details for PubMedID 6876744

  • THE SHORT AND LONG-TERM EFFICACY OF DILTIAZEM FOR THE TREATMENT OF VARIANT ANGINA-PECTORIS ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX Ginsburg, R., Schroeder, J. S. 1983; 76: 149-152

    Abstract

    We studied 42 consecutive patients with coronary artery spasm (CS) who where treated with the Ca2+ entry blocker diltiazem for a mean period of 11 months (range 2-29 months). Patient population consisted of 26 females (age X = 52.1) and 16 males (age X = 59.1). ALl patients had diagnosis of CS confirmed by coronary arteriography (CA) with no patient having 70 per cent CAD. CS was equally distributed between LAD and RCA. 81 per cent of patients were cigarette smokers, 55 per cent had Raynaud's phenomenon, and 9 per cent had a history of migraine, 2 patients had previous MI, 2 previous bypass surgery (CABS), 1 previous angioplasty, 3 syncope with heartblock requiring pacemaker, and 2 with sudden death (VF-resuscitated). All patients were placed on diltiazem 240 or 360 mg/day to achieve pain free state. During follow-up there was no mortality. 2 patients hd uncomplicated inferior MI's. 1 patient had CABS for progressive 90 per cent LAD lesion, and 2 required hospitalization for dose adjustment due to frequent chest pain. No patient has drug-related side effects. Thus, long-term follow-up of patients with CS treated with diltiazem revealed no mortality, low morbidity (12 per cent) and no adverse drug side effects.

    View details for Web of Science ID A1983QF81900022

    View details for PubMedID 6407438

  • PREVENTION OF CARDIOVASCULAR EVENTS IN VARIANT ANGINA BY LONG-TERM DILTIAZEM THERAPY JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Schroeder, J. S., LAMB, I. H., Bristow, M. R., Ginsburg, R., Hung, J., McAuley, B. J. 1983; 1 (6): 1507-1511

    Abstract

    In 43 patients with variant angina, the cardiovascular event rate during diltiazem therapy was compared with that in an equal time period before initiation of therapy. Cardiovascular events, that is, myocardial infarction, sudden death and hospitalization for prolonged angina, were decreased significantly (p less than 0.01) during the initial 6 months and mean 19.6 months of therapy. Based on the binomial principle, there were 22 events during the mean 19.6 months before therapy and 2 events during the equal time period on therapy. No patient died during follow-up. The frequency of angina was decreased by 94%. Diltiazem was well tolerated by all patients and no patient had to discontinue therapy because of adverse effects. It is concluded that long-term diltiazem therapy reduces cardiovascular events in patients with variant angina.

    View details for Web of Science ID A1983QR88000020

    View details for PubMedID 6853903

  • DILTIAZEM - A CLINICAL AND PHARMACOLOGIC PROFILE JOURNAL OF CARDIOVASCULAR MEDICINE Schroeder, J. S., McAuley, B., Ginsburg, R. 1983; 8 (1): 41-?
  • LONG-TERM EFFICACY OF DILTIAZEM FOR CONTROL OF SYMPTOMS OF CORONARY-ARTERY SPASM CIRCULATION RESEARCH Rosenthal, S. J., LAMB, I. H., Schroeder, J. S., Ginsburg, R. 1983; 52 (2): 153-157
  • STUDY OF THE NORMAL AND FAILING ISOLATED HUMAN-HEART - DECREASED RESPONSE OF FAILING HEART TO ISOPROTERENOL AMERICAN HEART JOURNAL Ginsburg, R., Bristow, M. R., Billingham, M. E., Stinson, E. B., Schroeder, J. S., HARRISON, D. C. 1983; 106 (3): 535-540

    Abstract

    We evaluated the effects of isoproterenol in right ventricular papillary muscles derived from normal and failing isolated human hearts. Basal values for the peak force developed, rate of force development (dF/dt), and time to peak tension (TPT) were similar in both groups. Isoproterenol produced a significantly smaller (p less than 0.05) increase in peak force developed and dF/dt in failing papillary muscles. The half equivalent dose (ED50) of isoproterenol was fivefold higher in failing muscle as compared to normal muscle. We conclude that failing cardiac muscle demonstrates decreased responsiveness to beta-receptor mediated stimulation.

    View details for Web of Science ID A1983RE66300016

    View details for PubMedID 6308994

  • COMPARATIVE CLINICAL ELECTROPHYSIOLOGIC EFFECTS OF DILTIAZEM, VERAPAMIL AND NIFEDIPINE - A REVIEW AMERICAN JOURNAL OF CARDIOLOGY Mitchell, L. B., Schroeder, J. S., Mason, J. W. 1982; 49 (3): 629-635

    Abstract

    The slow channel blocking agents--diltiazem, verapamil and nifedipine--have generated clinical interest for the treatment of a variety of cardiovascular disorders. These agents, despite a similar basic mechanism of action, produce disparate clinical cardiac electrophysiologic effects in human beings. In usual doses, the acute administration of diltiazem slows heart rate. Verapamil and nifedipine, however, increase heart rate. Although diltiazem and verapamil produce equivalent slowing of atrioventricular (A-V) nodal conduction, verapamil prolongs A-V nodal refractoriness to a greater degree. In contrast, nifedipine facilitates A-V nodal conduction and shortens A-V nodal refractoriness. Knowledge of these differences may aid in the appropriate selection of specific slow channel blocking agents in specific clinical situations.

    View details for Web of Science ID A1982ND14800022

    View details for PubMedID 6277182

  • RANDOMIZED DOUBLE-BLIND COMPARISON OF NIFEDIPINE AND ISOSORBIDE DINITRATE THERAPY IN VARIANT ANGINA-PECTORIS DUE TO CORONARY-ARTERY SPASM AMERICAN HEART JOURNAL Ginsburg, R., LAMB, I. H., Schroeder, J. S., Hu, M., HARRISON, D. C. 1982; 103 (1): 44-48

    Abstract

    Twelve patients were entered prospectively into a randomized double-blind study comparing the efficacy of nifedipine and isosorbide dinitrate (ISDN) in the treatment of variant angina pectoris due to coronary artery spasm. Using the diary technique, both anginal episodes and nitroglycerin tablets consumed were recorded during the pretrial, no drug period, and both active drug phases. During the baseline pretrial period, an average of 1.1 anginal episodes/day occurred with reduction to 0.28/day during nifedipine treatment and 0.39/day during ISDN treatment. Headache was the major side effect during ISDN treatment, occurring in 9 of 11 (81%) patients; and nonheart failure related pedal edema during nifedipine treatment, occurring in 4 of 12 (33%) patients. Intolerable side effects necessitating cessation of treatment occurred in two patients during nifedipine treatment and in three patients during ISDN treatment. Patients preferred nifedipine over ISDN because of increased efficacy and fewer uncomfortable side effects. We conclude that both nifedipine and ISDN are effective therapy for coronary spasm, but that nifedipine was more effective and was preferred by the majority of patients.

    View details for Web of Science ID A1982MX22600006

    View details for PubMedID 7034513

  • INTRACARDIAC ELECTROPHYSIOLOGIC STUDY OF INTRAVENOUS DILTIAZEM AND COMBINED DILTIAZEM-DIGOXIN IN PATIENTS AMERICAN HEART JOURNAL Mitchell, L. B., Jutzy, K. R., Lewis, S. J., Schroeder, J. S., Mason, J. W. 1982; 103 (1): 57-66

    Abstract

    Fifteen patients without sinoatrial (SA) or atrioventricular (AV) node dysfunction underwent electrophysiologic study (EPS) before and after intravenous diltiazem: 0.20 mg/kg bolus followed by 0.0007 mg/kg/min infusion (seven patients) or 0.25 mg/kg bolus followed by 0.0012 mg/kg/min infusion (eight patients). In six patients intravenous digoxin (0.018 mg/kg) was given and 45 minutes later EPS was repeated while the diltiazem infusion continued. Diltiazem prolonged sinus cycle length (+7%, p less than 0.01), lengthened AH conduction time (+22% in constant rate atrial paced rhythm, p less than 0.001), prolonged AV node functional and effective refractory periods (+6%, p less than 0.01 and +16%, p less than 0.05, respectively), lengthened AV node Wenckebach cycle length (+13%, p less than 0.001), shortened atrial functional refractory period (-3%, p less than 0.05), and reduced mean arterial pressure (-8%, p less than 0.005 in constant rate atrial paced rhythm). Subsequently, intravenous digoxin further prolonged sinus cycle length (+12%, p less than 0.05), AH conduction time (+17%, p less than 0.05), AV node Wenckebach cycle length (+9%, p less than 0.05), and AV node functional refractory period (+7%, p less than 0.05), shortened atrial effective refractory period (-7%, p less than 0.05) and ventricular effective refractory period (-6%, p less than 0.05), and increased systolic arterial pressure (+6%, p less than 0.05). Diltiazem and digoxin have additive depressant effects on SA and AV node function without significant adverse effects.

    View details for Web of Science ID A1982MX22600009

    View details for PubMedID 7055046

  • CORRELATION OF AN ABNORMAL REST TL-201 MYOCARDIAL IMAGE - PATHOLOGICAL FINDINGS IN CARDIAC TRANSPLANT RECIPIENTS EUROPEAN JOURNAL OF NUCLEAR MEDICINE McKillop, J. H., Billingham, M., Schroeder, J. S., McDougall, I. R. 1982; 7 (6): 243-247

    Abstract

    Rest myocardial 201T1 scintigraphy was undertaken in 15 males mean age 39 years (22-54) who had been accepted for cardiac transplantation. Complete pathological correlation was obtained in 14 after transplantation and in 1 who died before a suitable donor heart became available. The average time from scintigraphy to pathological evaluation was 42 days (9-103). All the 201T1 images were grossly abnormal and on the basis of these studies it was not possible to differentiate ischemic from idiopathic cardiomyopathy. Each of the three views of the 201T1 study was divided into three segments, therefore 135 areas were available for comparison (3 x 3 x 15). Eighty-eight of these were abnormal on scan and 78 of these were abnormal pathologically. The right ventricle was seen on all rest images but the degree of uptake bore no relationship to the measured thickness of the right ventricular wall. Structures such as the atrial wall and the enlarged papillary muscle were visualized in some patients. In two patients there was an improvement of the rest 201T1 image in delayed views and histologically these areas showed a mixture of muscle and fibrous tissue. The sensitivity of 201T1 imaging in this study was 89% and there was close correlation of the images with gross and microscopic pathological findings.

    View details for Web of Science ID A1982NU10000001

    View details for PubMedID 7106150

  • MULTICLINIC CONTROLLED TRIAL OF DILTIAZEM FOR PRINZMETALS ANGINA AMERICAN JOURNAL OF MEDICINE Schroeder, J. S., Feldman, R. L., Giles, T. D., Friedman, M. J., DeMaria, A. N., Kinney, E. L., Mallon, S. M., Pitt, B., Meyer, R., Basta, L. L., Curry, R. C., Groves, B. M., MacAlpin, R. N. 1982; 72 (2): 227-232

    Abstract

    To assess the efficacy of a new calcium entry blocker, diltiazem (Cardizem), for prophylaxis of Prinzmetal's angina, 48 patients were studied in randomized, multiple crossover multiclinic study (2 weeks single-blind, 8 weeks double-blind). Diltiazem dosage in one crossover phase was 120 mg per day; in the other, 240 mg per day. Therapeutic response was measured by patients' diary records of angina frequency and nitroglycerin tablet consumption. Treatment with 120 mg of diltiazem per day reduced angina by 41 percent from the entry placebo period and 20 percent from the paired placebo period (p less than 0.005). Treatment with 240 mg of diltiazem per day reduced angina frequency by 68 percent from the entry placebo period and 43 percent from the paired placebo period (p less than 0.01). There were similar reductions in nitroglycerin consumption. Adverse experiences that may have been related to the medication were noted in only 5 percent of patients. There were no alterations in blood pressure or heart rate. The PR interval increased 3 percent at the 240 mg dosage level. We conclude that diltiazem is an effective and safe agent for control of symptoms of Prinzmetal's angina.

    View details for Web of Science ID A1982NB85700009

    View details for PubMedID 7036726

  • THE USE OF DILTIAZEM HYDROCHLORIDE IN CARDIOVASCULAR DISORDERS PHARMACOTHERAPY McAuley, B. J., Schroeder, J. S. 1982; 2 (3): 121-133

    Abstract

    Diltiazem, a calcium channel blocking agent, has potent cardiovascular effects that are directly related to its influence on vascular smooth muscle, ventricular myocardium, and specialized conducting tissue. It causes coronary and peripheral vasodilation, has a negative chronotropic and dromotropic effect, and little to no negative inotropic effect in patients with normal ventricular function. Diltiazem has potential use in a wide variety of cardiovascular disorders. It has been shown extremely effective in relieving the coronary artery spasm associated with variant angina. When compared with nitrates in patients with exertional angina, diltiazem has similar efficacy. Preliminary work indicates it will have a therapeutic role in the treatment of unstable angina. Because of its ability to improve the balance between myocardial oxygen supply and demand and reduce cellular injury secondary to ischemia, it is likely that diltiazem will be of benefit in the treatment of acutely ischemic myocardium during cardiopulmonary bypass and possibly acute myocardial infarction. It has proven efficacy in treating re-entrant supraventricular tachycardia. Adverse effects are seen in less than 5% of patients, indicating that it is well tolerated.

    View details for Web of Science ID A1982NT94900001

    View details for PubMedID 6763199

  • DILTIAZEM FOR LONG-TERM THERAPY OF CORONARY ARTERIAL SPASM AMERICAN JOURNAL OF CARDIOLOGY Schroeder, J. S., LAMB, I. H., Ginsburg, R., Bristow, M. R., Hung, J. 1982; 49 (3): 533-537

    Abstract

    The first 36 patients with coronary arterial spasm treated with diltiazem and followed up at the Stanford University Coronary Artery Spasm Clinic for 6 months or longer are described. There were 13 men and 23 women with a mean age of 50.2 years; the mean duration of angina was 36.1 months. All patients had angina at rest with a good or fail response to sublingual nitroglycerin. During a mean of 17.5 months of diltiazem therapy, the frequency of angina was reduced from a mean of 21.5 to 1.3 attacks/week. This 94 percent reduction in pain frequency occurred when either 240 or 360 mg of diltiazem was administered daily. Sixteen patients required the addition of isosorbide dinitrate to achieve a painfree state. Pain breakthrough occurred a mean of 1.7 times during the 17.5 month follow-up period but tended to be of short duration. Six patients had trace to 1+ pedal edema and no other adverse effects occurred. It is concluded that diltiazem is highly effective and well tolerated for the long-term prophylaxis and treatment of angina in patients with coronary spasm.

    View details for Web of Science ID A1982ND14800008

    View details for PubMedID 7058764

  • CALCIUM-ANTAGONISTS - INCREASING IMPORTANCE MUNCHENER MEDIZINISCHE WOCHENSCHRIFT Schroeder, J. S. 1982; 124 (8): A18-?
  • CALCIUM-ENTRY BLOCKADE, BETA-ADRENERGIC-BLOCKADE AND THE REFLEX CONTROL OF CIRCULATION CIRCULATION Oesterle, S. N., Schroeder, J. S. 1982; 65 (4): 669-670

    View details for Web of Science ID A1982NG44900005

    View details for PubMedID 6120768

  • HEART LUNG TRANSPLANT - CYCLOSPORIN-A IMPROVES PROGNOSIS MUNCHENER MEDIZINISCHE WOCHENSCHRIFT Schroeder, J. S. 1982; 124 (10): A15-A16
  • CORONARY-ARTERY SPASM - PATHO-PHYSIOLOGY, CLINICAL PRESENTATIONS, DIAGNOSTIC APPROACHES AND RATIONAL TREATMENT WESTERN JOURNAL OF MEDICINE Ginsburg, R., Schroeder, J. S., HARRISON, D. C. 1982; 136 (5): 398-410

    View details for Web of Science ID A1982NQ15100004

    View details for PubMedID 6125054

  • THE EFFECTS OF DILTIAZEM AND REDUCED SERUM IONIZED CALCIUM ON ISCHEMIC VENTRICULAR-FIBRILLATION IN THE DOG CIRCULATION RESEARCH Clusin, W. T., Bristow, M. R., Baim, D. S., Schroeder, J. S., Jaillon, P., Brett, P., HARRISON, D. C. 1982; 50 (4): 518-526

    Abstract

    Calcium influx blockers reportedly suppress ventricular arrhythmias during acute ischemia. We therefore studied the effects of diltiazem and reduced serum ionized calcium on ventricular fibrillation (VF) in a reversible ligation model. VF was produced at 15-minute intervals by simultaneous occlusion of the left anterior descending and circumflex arteries of 31 dogs. Time from coronary occlusion to onset of VF showed no significant variation during 15 consecutive trials in six dogs that received saline alone. Intravenous infusion of diltiazem (0.02 mg/kg per min) markedly delayed the onset of VF in each of 10 dogs (P less than 0.0001). Mean VF latency increased from 138 to 295 seconds during a 45-minute diltiazem infusion, declined exponentially when the infusion ceased, and was strongly correlated with serum diltiazem concentration (r = 0.96, P less than 10(-6)). In five dogs, hemodynamic measurements, including coronary venous blood flow, were performed during each occlusion. The increase in VF latency by diltiazem was not due to increased coronary flow during occlusion or to reduction of left ventricular (LV) mechanical work. In six dogs, mean serum ionized calcium, [Ca++], was reduced from 1.11 to 0.59 mM by infusion of sodium citrate. Citrate infusion increased mean VF latency from 155 to 243 seconds, and the increase observed in each dog was correlated (r = 0.84, P less than 10(-6)) with the reduction in [Ca++]. VF latency was unaffected by lidocaine in nine dogs. The antifibrillatory effect of diltiazem during global LV ischemia may be an electrophysiological phenomenon related to reduction of cellular calcium influx.

    View details for Web of Science ID A1982NM08900009

    View details for PubMedID 7067059

  • DO CALCIUM-DEPENDENT IONIC CURRENTS MEDIATE ISCHEMIC VENTRICULAR-FIBRILLATION AMERICAN JOURNAL OF CARDIOLOGY Clusin, W. T., Bristow, M. R., Karagueuzian, H. S., KATZUNG, B. G., Schroeder, J. S. 1982; 49 (3): 606-612

    Abstract

    Calcium ions mediate the adverse effects of myocardial ischemia and have been implicated in the genesis of arrhythmias. Calcium influx blocking drugs protect against early ventricular arrhythmias during experimental coronary occlusion, and recent studies suggest that this effect is at least partly due to inhibition of myocardial cell calcium influx. Most of the pharmacologic maneuvers used to simulate acute ischemic arrhythmias in vivo also produce intracellular calcium overload. Production of calcium overload in small myocardial cell clusters causes fibrillatory electrical and mechanical activity similar to that recorded from fibrillating hearts. Fibrillation in these cell clusters is mediated not by reentrant conduction, but by the same subcellular processes that give rise to depolarizing afterpotentials and abnormal automaticity. Agents favoring calcium influx, such as beta adrenergic agonists, accentuate these processes, while agents that depress calcium influx inhibit them. Although the relation of these experimental models to clinical ischemic arrhythmias has not been fully delineated, calcium influx blocking drugs may prove useful in reducing the incidence of sudden cardiac death.

    View details for Web of Science ID A1982ND14800019

    View details for PubMedID 6277181

  • Cardiovascular responses to handgrip isometric exercise in patients following cardiac transplantation. Circulation research Haskell, W. L., SAVIN, W. M., Schroeder, J. S., Alderman, E. A., Ingles, N. B., Daughters, G. T., Stinson, E. B. 1981; 48 (6): I156-61

    Abstract

    The effects of cardiac denervation on the hemodynamic responses to isometric handgrip contraction were studied in patients 1--5 years after allograft cardiac transplantation. The objective of these studies was to determine the role of cardioacceleration and myocardial contractility on the increase in systemic arterial pressure during isometric exercise. Initially, noninvasive measurement of brachial artery pressure and heart rate during 60 seconds of isometric exercise at 50% of maximal voluntary contraction (50% MVC) were recorded in 23 cardiac transplant patients, 18 ischemic heart disease patients, and 15 healthy controls. While the increases in arterial pressure were not significantly different among the three groups and the heart rate response for the healthy controls and ischemic heart disease patients were similar, the transplant patient's heart rate remained essentially unchanged. In an attempt to determine the mechanisms for the increase in arterial pressure, despite any increase in heart rate in transplant patients, we recorded left ventricular volumes before and at the end of 50% MVC using fluoroscopy of tantalum midwall myocardial markers in seven cardiac transplant recipients and seven nontransplant cardiac surgery patients. The rise in arterial pressure during isometric exercise in both groups of patients resulted from a significant increase in peripheral vascular resistance but not in stroke volume or cardiac output. These data demonstrate that the rise in arterial pressure observed during isometric exercise can be achieved by increased peripheral vascular resistance alone in patients who lack the capacity to increase heart rate or stroke volume.

    View details for PubMedID 7014021

  • LONG-TERM TRANSTELEPHONIC ELECTROCARDIOGRAPHIC MONITORING IN THE DETECTION AND EVALUATION OF VARIANT ANGINA AMERICAN HEART JOURNAL Ginsburg, R., LAMB, I. H., Schroeder, J. S., HARRISON, D. C. 1981; 102 (2): 196-201

    Abstract

    To facilitate the outpatient diagnosis of variant angina by documenting transient ST segment evaluation during chest pain, we studied the feasibility of transtelephonic ECG monitoring during angina episodes. Eight patients with known coronary artery spasm underwent simultaneous continuous ambulatory and transtelephonic ECG monitoring during a 24-hour period. Five patients (62%) had transient diagnostic ST segment shifts on both continuous ambulatory and transtelephonic monitoring. Another eight patients with coronary spasm underwent 24-hour continuous ambulatory monitoring and separate 14-day period of transtelephonic monitoring. The addition of this longer monitoring period provided diagnostic ST segment shifts in three patients. We conclude that transtelephonic monitoring in patients with suspected coronary artery spasm can provide important additional diagnostic information to continuous ambulatory monitoring, particularly in the patient with infrequent or predictable chest pain.

    View details for Web of Science ID A1981MB29100009

    View details for PubMedID 7258093

  • APPLICATION AND SAFETY OF OUTPATIENT ERGONOVINE TESTING IN ACCURATELY DETECTING CORONARY SPASM IN PATIENTS WITH POSSIBLE VARIANT ANGINA AMERICAN HEART JOURNAL Ginsburg, R., LAMB, I. H., Bristow, M. R., Schroeder, J. S., HARRISON, D. C. 1981; 102 (4): 698-702

    Abstract

    We analyzed the results of 61 consecutive outpatient ergonovine provocation tests to determine the safety and efficacy of such outpatient testing for detecting coronary artery spasm (CAS). Criteria for outpatient testing included: clinical history suggestive of variant angina, noncritical coronary artery disease documented by coronary arteriography, normal exercise treadmill test, no symptomatic arrhythmias, and no history of recent myocardial infarction. All antianginal medications were tapered and stopped. Ergonovine maleate was given as a bolus at 3-minute intervals in consecutive doses of 0.05, 0.10, and 0.25 mg. A positive test was defined as chest pain accompanied by greater than 0.1 mV ST segment elevation of 12-lead ECG. If pain and ST-segment elevation occurred, intravenous and sublingual nitroglycerin were immediately administered for relief of myocardial ischemia. Of the 61 patients studied, 10 had positive tests; there were no complications. Follow-up the 51 patients with negative studies has not revealed cardiac etiology for their chest pain. We conclude that outpatient ergonovine testing is a safe and accurate diagnostic test for identifying CAS in a highly selected population of patients with possible variant angina when performed under carefully controlled conditions.

    View details for Web of Science ID A1981MJ59000007

    View details for PubMedID 7282514

  • CLINICAL COURSE OF PATIENTS FOLLOWING THE DEMONSTRATION OF CORONARY-ARTERY SPASM BY ANGIOGRAPHY AMERICAN HEART JOURNAL Cipriano, P. R., Koch, F. H., Rosenthal, S. J., Schroeder, J. S. 1981; 101 (2): 127-134

    Abstract

    The clinical course of 25 patients was determined during an average of 2.7 years following the angiographic demonstration of coronary artery spasm (CAS). Seventeen patients received medical treatment after the demonstration of coronary spasm and six patients had cardiac surgery. Twenty-three patients were living and two patients had died at the time of follow-up. Twenty-one of the 23 surviving patients has either no chest pain or markedly reduced symptoms. However, the demonstration of CAS by angiography was associated with a high incidence of subsequent cardiac complications, which included myocardial infarct (four patients), cardiac arrest (four patients), and death (two patients). We concluded from this study that after the demonstration of CAS by angiography: (1) the clinical course was variable, with most patients (21 of 25 patients, 84%) having improvement of symptoms at the time of follow-up; (2) major cardiac complications were frequent (11 out of 25 patients, 44%) and; (3) although clinical and coronary angiographic features were of limited use in predicting major cardiac complications, most of the patients who had an uncomplicated course (11 of 14 patients, 79%) had either less than 50% fixed coronary artery luminal diameter narrowing (CAN) or coronary artery bypass graft operations, the majority of patients with less than 50% CAN (8 of 11 patients, 73%) had no major cardiac complications, and myocardial infarction or death usually occurred during periods of increased angina pectoris.

    View details for Web of Science ID A1981LB33700001

    View details for PubMedID 7468413

  • LONG-TERM SURVIVAL AND FUNCTION AFTER CARDIAC TRANSPLANTATION ANNALS OF SURGERY Gaudiani, V. A., Stinson, E. B., Alderman, E., Hunt, S. A., Schroeder, J. S., Perlroth, M. G., BIEBER, C. P., Oyer, P. E., Reitz, B. A., Jamieson, S. W., CHRISTOPHERSON, L., Shumway, N. E. 1981; 194 (4): 381-385

    Abstract

    Cardiac transplantation now permits prolonged survival for some patients with otherwise fatal heart disease. This report summarizes the hemodynamic and clinical characteristics of 25 patients who have survived five or more years after cardiac replacement. The average age of the patients at the time of operation was 40 +/- 10 (SD) years; 23 were men. The average duration of survival is 6.7 years, and ranges from five to 10.5 years. Annual cardiac catheterization and clinical follow-up were performed to assess systolic cardiac function, coronary anatomy, and quality of extended rehabilitation. We found that among these long-term survivors, the left ventricular ejection fraction remained constant (0.59 +/- 0.08 one year postoperatively, 0.57 +/- 0.09 at most recent study, p = ns). Segmental wall motion measured by fluoroscopic examination of midwall intramyocardial markers also remained normal. Four of 21 (19%) patients with complete longitudinal studies developed significant graft coronary artery disease. Clinical evaluation revealed that the long-term survivors required fewer than one unscheduled admission to the hospital per year. Sixteen of 25 patients (64%) were gainfully employed, and 22 of 25 (88%) enjoyed substantial benefit in terms of extended rehabilitation. These 25 long-term survivors represent 27% of 92 patients transplanted between 1968 and 1975. The actuarial survival rate at five years, of patients transplanted since 1975, is 40 +/- 5%. This increase in survival rate reflects improved techniques of early postoperative management. Cardiac transplantation now offers prolonged survival with good quality of life for selected patients with terminal heart disease.

    View details for Web of Science ID A1981ML08000002

    View details for PubMedID 7025768

  • ABNORMALITIES OF PULMONARY-ARTERY WEDGE PRESSURES IN SLEEP-INDUCED APNEA INTERNATIONAL JOURNAL OF CARDIOLOGY Buda, A. J., Schroeder, J. S., Guilleminault, C. 1981; 1 (1): 67-74

    Abstract

    Six patients with sleep apnea syndrome were studied with continuous hemodynamic monitoring during sleep. Sleep apnea had been previously documented with an average number of apneas per hour of sleep ranging from 23 to 93 ((mean 63). There was significant decrease in heart rate during sleep (82 +/- 5 to 69 +/- 6, P less than 0.01). There was a significant rise in systemic blood pressure (103 +/- 2 mn Hg to 116 +/- 6 mm Hg, P less than 0.05) and pulmonary artery pressure (20 +/- 1 mm Hg to 32 +/- 5 mm Hg) during sleep. In addition, pulmonary artery wedge pressure increased (12 +/- 2 mm Hg to 20 +/- 3 mm Hg, P less than 0.05) during sleep and 5 of the 6 patients developed an abnormal pulmonary wedge pressure. There was a significant decrease in PO2 during sleep (71 +/- 3 mm Hg to 49 +/- 2 mm Hg, P less than 0.005). These findings suggest that increases in pulmonary wedge pressures may be contributing to increase in pulmonary artery pressures in these patients during sleep.

    View details for Web of Science ID A1981MQ04400008

    View details for PubMedID 7333716

  • CORONARY-ARTERY SPASM IN THE DENERVATED TRANSPLANTED HUMAN-HEART - A CLUE TO UNDERLYING MECHANISMS AMERICAN JOURNAL OF MEDICINE Buda, A. J., Fowles, R. E., Schroeder, J. S., Hunt, S. A., Cipriano, P. R., Stinson, E. B., HARRISON, D. C. 1981; 70 (5): 1144-1149

    Abstract

    The mechanism of coronary artery spasm has been poorly understood but there has been some suggestion that cardiac autonomic innervation may play an important role. We report coronary artery spasm in a 43 year old man two years after he had received a transplant. Provocative pharmacologic testing suggested functional denervation of the patient's heart. Thus, coronary artery spasm can occur in the transplanted, denervated human heart. Autonomic innervation of the heart is not essential in all cases of coronary spasm, and circulating catecholamines and/or metabolic of hormonal products may play an important role.

    View details for Web of Science ID A1981LP92100027

    View details for PubMedID 7015853

  • OBSTRUCTIVE SLEEP-APNEA SYNDROME AND TRACHEOSTOMY - LONG-TERM FOLLOW-UP EXPERIENCE ARCHIVES OF INTERNAL MEDICINE Guilleminault, C., SIMMONS, F. B., Motta, J., Cummiskey, J., Rosekind, M., Schroeder, J. S., Dement, W. C. 1981; 141 (8): 985-989

    Abstract

    Obstructive sleep apnea syndrome (OSAS), a disabling disorder that leads to life-threatening cardiorespiratory events during sleep, has been treated by tracheostomy. This article reports long-term follow-up data of 50 patients who have undergone this procedure, and the indications for surgery are summarized. Surgery may result in secondary local and general acute and subacute complications, but, on a long-term basis, patients were completely relieved of clinical symptoms, returned to full activity, and adapted normally to social and familial life. Temporary closure of the tracheostomy during sleep led to recurrence of obstructive sleep apnea.

    View details for Web of Science ID A1981LY00900005

    View details for PubMedID 7247605

  • CARDIOVASCULAR-RESPONSES TO HANDGRIP ISOMETRIC-EXERCISE IN PATIENTS FOLLOWING CARDIAC TRANSPLANTATION CIRCULATION RESEARCH Haskell, W. L., SAVIN, W. M., Schroeder, J. S., Alderman, E. A., INGLES, N. B., Daughters, G. T., Stinson, E. B. 1981; 48 (6): 156-161
  • UNSTABLE ANGINA-PECTORIS - NATIONAL COOPERATIVE STUDY-GROUP TO COMPARE MEDICAL AND SURGICAL THERAPY .4. RESULTS IN PATIENTS WITH LEFT ANTERIOR DESCENDING CORONARY-ARTERY DISEASE AMERICAN JOURNAL OF CARDIOLOGY Russell, R. O., MORASKI, R. E., Kouchoukos, N. T., Karp, R. B., MANTLE, J. A., Rogers, W. J., Rackley, C. E., RESNEKOV, L., FALICOV, R. E., ALSADIR, J., Brooks, H., Anagnostopoulos, C. E., Lamberti, J., Wolk, M., Gay, W., Killip, T., ROSATI, R. A., Oldham, H. N., Wagner, G. S., Peter, R. H., Conti, C. R., Curry, R. C., Daicoff, G., Becker, L. C., Plotnick, G., Gott, V. L., BRAWLEY, R. K., Donahoo, J. S., Ross, R. S., Hutter, A. M., DeSanctis, R. W., Gold, H. K., Leinbach, R. C., Buckley, M. J., AUSTIN, W. G., Biddle, T. L., Yu, P. N., DeWeese, J. A., Schroeder, J., STINSON, E., Silverman, J., Kaplan, E. M., GILBERT, J. P., Hutter, A. M., Louis, T. A., MOSTELLER, D. F., Mock, M. B., FROMMER, P. L. 1981; 48 (3): 517-524
  • AFTER A TIME, ARRHYTHMIAS EMERGENCY MEDICINE Schroeder, J. S. 1980; 12 (3): 34-?
  • CARDIORESPIRATORY RESPONSES OF CARDIAC TRANSPLANT PATIENTS TO GRADED, SYMPTOM-LIMITED EXERCISE CIRCULATION SAVIN, W. M., Haskell, W. L., Schroeder, J. S., Stinson, E. B. 1980; 62 (1): 55-60

    Abstract

    The electrocardiographic and ventilatory responses of 15 denervated heart patients who had undergone cardiac transplantation and 14 age-matched, normally innervated men were compared to assess the pattern of response to graded treadmill exercise. A 5-minute postexercise venous lactate sample was also obtained. Respiratory exchange ratio and ventilation (Ve) were higher in denervated patients than in normals during submaximal exercise. Peak values (normals vs denervated) for heart rate (172 vs 159 beats/min), blood pressure (189 vs 167 mm Hg), oxygen uptake (37 vs 25 ml/kg/min), oxygen pulse (0.22 vs 0.16 ml/kg/beat) and work time (26.2 vs 18.0 minutes) were higher in normals than in cardiac transplant recipients. Peak ventilatory equivalent (2.14 vs 3.13 l/ml/kg) and lactate values were higher for transplants than for normal subjects, but there were no significant intergroup differences in peak Ve or in the respiratory exchange ratio. In cardiac transplant recipients, work time correlated inversely with a measure of rejection history (r = -0.59, p less than 0.01). The response of cardiac transplant recipients to treadmill work differs from that of normal men and reflects a diminished ability to meet the oxygen demands of the exercising periphery.

    View details for Web of Science ID A1980JX59200009

    View details for PubMedID 6991158

  • DO PATIENTS IN WHOM MYOCARDIAL-INFARCTION HAS BEEN RULED OUT HAVE A BETTER PROGNOSIS AFTER HOSPITALIZATION THAN THOSE SURVIVING INFARCTION NEW ENGLAND JOURNAL OF MEDICINE Schroeder, J. S., LAMB, I. H., Hu, M. 1980; 303 (1): 1-5

    Abstract

    To determine the prognosis after hospitalization of patients hospitalized with acute chest pain in a coronary-care unit, we undertook a prospective study of 211 consecutive admissions to the Stanford Coronary Care Unit. On the basis of predetermined criteria, 16 patients were found to have noncardiac chest pain, and myocardial infarction was ruled out in 89, one of whom died in the hospital. Infarction was documented in 84 others, six of whom died in the hospital. Prospective follow-up after hospitalization was carried out in the 88 patients in whom infarction was ruled out and in the 78 patients who survived infarction. The rate of myocardial infarction or death was 8.0 per cent at six months and 21.6 per cent at a mean of 27.8 months of follow-up for patients who had infarction ruled out, as compared with 7.7 per cent at six months and 21.8 per cent at a mean of 27.8 months of follow-up for those who had a documented infarction during the initial hospitalization. Cardiomegaly, congestive heart failure, and angina after discharge from the hospital tended to increase the risk of morbidity and mortality in both groups. The patient hospitalized with acute ischemic chest pain without evolution of a myocardial infarction has a six to 24-month prognosis similar to that of the patient hospitalized with an acute infarction, and therefore requires similar diagnostic and therapeutic assessment.

    View details for Web of Science ID A1980JX57100001

    View details for PubMedID 7374727

  • EFFICACY OF DILTIAZEM FOR CONTROL OF SYMPTOMS OF CORONARY ARTERIAL SPASM AMERICAN JOURNAL OF CARDIOLOGY Rosenthal, S. J., Ginsburg, R., LAMB, I. H., Baim, D. S., Schroeder, J. S. 1980; 46 (6): 1027-1032

    Abstract

    To evaluate the efficacy of the calcium antagonist diltiazem for therapy of active coronary arterial spasm, 13 patients with clinical variant angina attributed to documented coronary arterial spasm completed a prospective randomized double-blind crossover trial of diltiazem (120 and 240 mg/day) versus placebo. Response was assessed with the diary technique measuring frequency of angina, consumption of nitroglycerin and percent of pain-free days. When 120 mg of diltiazem/day was compared with the paired placebo period there was a significant increase in percent of pain-free days (from 43 to 71 percent [p = 0.03]), but no significant decrease in frequency of angina (p = 0.06) or consumption of nitroglycerin (p = 0.32). When 240 mg of diltiazem/day was compared with the paired placebo period there was a significant increase in percent of pain-free days (from 50 to 79 percent [p = 0.03]) and a significant decrease in both frequency of angina (from 1.6 to 0.4 episodes/day [p = 0.03]) and consumption of nitroglycerin (from 1.3 to 0.4/day [p = 0.01]). Diltiazem was found to be a highly effective drug for control of symptoms of active coronary arterial spasm, without side effects and with excellent patient tolerance.

    View details for Web of Science ID A1980KT61100019

    View details for PubMedID 6778197

  • LEFT-VENTRICULAR RESPONSE TO ISOMETRIC-EXERCISE IN PATIENTS WITH DENERVATED AND INNERVATED HEARTS CIRCULATION SAVIN, W. M., Alderman, E. L., Haskell, W. L., Schroeder, J. S., Ingels, N. B., Daughters, G. T., Stinson, E. B. 1980; 61 (5): 897-901

    Abstract

    Patients with cardiac denervation resulting from allograft transplantation have been observed to increase their diastolic and systolic blood pressure during isometric exercise without concomitant cardioacceleration. To determine the mechanism for the blood pressure increase, heart rate, blood pressure, and ventricular volumes (measured using fluoroscopy of tantalum midwall myocardial markers) were recorded before and after a 50% maximal voluntary contraction. Seven cardiac transplant recipients (denervated heart) and seven nontransplant patients (innervated heart) were studied. Innervated and denervated heart patients increased systolic blood pressure by 16% and 21% and total peripheral resistance by 20% and 12%, respectively. The percentage responses were not significantly different between groups, except for heart rate, which increased 17% in innervated heart patients and 2% in denervated heart patients (p less than 0.05). Neither group had enhanced contractility or increases in cardiac output, suggesting that the blood pressure increases resulted in both groups from increased peripheral resistance.

    View details for Web of Science ID A1980JP65500006

    View details for PubMedID 6988102

  • UNSTABLE ANGINA-PECTORIS - NATIONAL COOPERATIVE STUDY-GROUP TO COMPARE SURGICAL AND MEDICAL THERAPY .3. RESULTS IN PATIENTS WITH S-T SEGMENT ELEVATION DURING PAIN AMERICAN JOURNAL OF CARDIOLOGY Russell, R. O., MORASKI, R. E., Kouchoukos, N., Karp, R., MANTLE, J. A., Rogers, W. J., Rackley, C. E., RESNEKOV, L., FALICOV, R. E., ALSADIR, J., Brooks, H., Anagnostopoulos, C. E., Lamberti, J., Wolk, M., Gay, W., Killip, T., ROSATI, R. A., Oldham, H. N., Wagner, G. S., Peter, R. H., Conti, C. R., Curry, R. C., Daicoff, G., Becker, L. C., Plotnick, G., Gott, V. L., BRAWLEY, R. K., Donahoo, J. S., Ross, R. S., Hutter, A. M., DeSanctis, R. W., Gold, H. K., Leinbach, R. C., Buckley, M. J., Austen, W. G., Biddle, T. L., Yu, P. N., DeWeese, J. A., Schroeder, J., Stinson, D., Silverman, J., Kaplan, E. M., GILBERT, J. P., Hutter, A. M., Newell, J. B., FROMMER, P. L., Mock, M. B. 1980; 45 (4): 819-824
  • CALCIUM, CALCIUM-ANTAGONISTS, AND CARDIOVASCULAR-DISEASE CHEST Zelis, R., Schroeder, J. S. 1980; 78 (1): 122-122
  • EFFECT OF DILTIAZEM HYDROCHLORIDE CAPSULES ON CARDIAC HEMODYNAMIC AND ELECTROCARDIOGRAPHIC FUNCTION CURRENT THERAPEUTIC RESEARCH-CLINICAL AND EXPERIMENTAL Rosenthal, S. J., Baim, D. S., LAMB, I. H., Schroeder, J. S. 1980; 28 (3): 319-325
  • MEDICAL THERAPY OF PRINZMETAL VARIANT ANGINA CHEST Schroeder, J. S., Rosenthal, S., Ginsburg, R., LAMB, I. 1980; 78 (1): 231-233

    Abstract

    Medical therapy for Prinzmetal's variant angina has been treatment of the acute attack with sublingual nitroglycerin. Prophylactic therapy has been more difficult, utilizing long-acting vasodilators that are limited because of their short half-life and side effects when therapeutic doses are used. Alpha-adrenergic blockade has been effective in some patients but is frequently associated with intolerable side effects or apparent development of tolerance to the drug. Preliminary experience from a randomized double-blind trial of diltiazem, a new calcium antagonist, has demonstrated a 90% reduction in pain episodes, with many patients becoming pain-free on the 240-mg daily dose. These data and the lack of adverse side effects demonstrate a dramatically effective therapy for patients with coronary artery spasm.

    View details for Web of Science ID A1980KF18900017

    View details for PubMedID 6772386

  • EXERCISE RESPONSE OF THE DENERVATED HEART IN LONG-TERM CARDIAC TRANSPLANT RECIPIENTS AMERICAN JOURNAL OF CARDIOLOGY Pope, S. E., Stinson, E. B., Daughters, G. T., Schroeder, J. S., Ingels, N. B., Alderman, E. L. 1980; 46 (2): 213-218

    View details for Web of Science ID A1980KC27400004

    View details for PubMedID 6773405

  • SPONTANEOUS PHASIC ACTIVITY OF ISOLATED HUMAN CORONARY-ARTERIES CARDIOVASCULAR RESEARCH Ross, G., STINSON, E., Schroeder, J., Ginsburg, R. 1980; 14 (10): 613-618

    Abstract

    The functional behaviour and pharmacological responses of ring segments of large coronary arteries removed from five patients undergoing cardiac transplantation were studied in vitro. All segments showed spontaneous rhythmic contractions which were markedly dependent on external calcium and were rapidly abolished in calcium-free solutions and by verapamil. The contractions were inhibited by cooling and by anoxia. Phasic activity was enhanced by increasing the external potassium concentration over the range 5 to 20 mmol.litre-1 but was abolished by 120 mmol.litre-1 potassium. Noradrenaline and ergonovine enhanced or induced phasic activity. The behaviour of human coronary arteries resembles that of the portal-mesenteric veins of many species and our results suggest that the activation mechanisms of these two tissues may be similar.

    View details for Web of Science ID A1980KR90700009

    View details for PubMedID 6783306

  • CURRENT STATUS OF CARDIAC TRANSPLANTATION, 1978 JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Schroeder, J. S. 1979; 241 (19): 2069-2071

    View details for Web of Science ID A1979GU91000029

    View details for PubMedID 372605

  • HEMODYNAMIC PERFORMANCE OF THE HUMAN TRANSPLANTED HEART TRANSPLANTATION PROCEEDINGS Schroeder, J. S. 1979; 11 (1): 304-308

    View details for Web of Science ID A1979GQ02500067

    View details for PubMedID 377649

  • TRACHEOSTOMY AND HEMODYNAMIC CHANGES IN SLEEP-INDUCED APNEA ANNALS OF INTERNAL MEDICINE Motta, J., Guilleminault, C., Schroeder, J. S., Dement, W. C. 1978; 89 (4): 454-458

    Abstract

    Because pulmonary hypertension and systemic hypertension occur during sleep-induced obstructive apnea, six patients underwent overnight hemodynamic monitoring before and after tracheostomy. Variables studied included heart rate, pulmonary artery pressure, femoral artery pressure, and arterial oxygen tension (Po2). After tracheostomy, significant reductions were noted during sleep in mean pulmonary artery pressure from 45 +/- 6 mm Hg (mean +/- SEM) to 22 +/- 2 mm Hg (P less than 0.05) and in mean femoral artery pressure from 137 +/- 6 mm Hg to 97 +/- 3 mm Hg (P less than 0.005). There was also a significant increase for the group in arterial Po2 recorded during the apneic episodes from 38 +/- 3 mm Hg before tracheostomy to 71 +/- 2 mm Hg (P less than 0.001) after tracheostomy. We conclude that tracheostomy improves the hemodynamic abnormalities and hypoxemia that occur during sleep in patients with sleep-induced obstructive apnea.

    View details for Web of Science ID A1978FR76800003

    View details for PubMedID 697223

  • PREHOSPITAL COURSE OF PATIENTS WITH CHEST PAIN - ANALYSIS OF PRODROMAL, SYMPTOMATIC, DECISION-MAKING, TRANSPORTATION AND EMERGENCY ROOM PERIODS AMERICAN JOURNAL OF MEDICINE Schroeder, J. S., LAMB, I. H., Hu, M. 1978; 64 (5): 742-748

    View details for Web of Science ID A1978EZ47900003

    View details for PubMedID 645739

  • NEWER ANTIARRHYTHMIC AGENTS FOR PATIENTS WITH CORONARY-ARTERY DISEASE ANGIOLOGY Schroeder, J. S. 1978; 29 (1): 22-32

    View details for Web of Science ID A1978EM88500004

    View details for PubMedID 343649

  • SLEEP APNEA SYNDROME IN A PATIENT WITH SHY-DRAGER SYNDROME ARCHIVES OF INTERNAL MEDICINE LEHRMAN, K. L., Guilleminault, C., Schroeder, J. S., Tilkian, A., FORNO, L. N. 1978; 138 (2): 206-209

    Abstract

    A patient with autonomic insufficiency and extrapyramidal signs (Shy-Drager syndrome) and sleep apnea syndrome (SAS) underwent hemodynamic studies. In comparison to patients with SAS and intact autonomic reflexes, systemic hypertension was absent and marked sinus arrhythmia during sleep was blunted. Cyclical pulmonary hypertension associated with frequent apneic episodes during sleep persisted, reflecting a minor role of autonomic reflexes in the generation of this abnormality. Autopsy confirmed the Shy-Drager syndrome and multiple areas of degeneration were observed in areas of the CNS outside the medullary respiratory centers, suggesting their importance in the origin of the respiratory abnormalities in SAS.

    View details for Web of Science ID A1978EV05400008

    View details for PubMedID 626549

  • SUCCESSFUL RETRANSPLANTATION OF HUMAN HEART JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Copeland, J. G., Griepp, R. B., BIEBER, C. P., Billingham, M., Schroeder, J. S., Hunt, S., Mason, J., Stinson, E. B., Shumway, N. E. 1977; 73 (2): 242-247

    Abstract

    Cardiac retransplantation has been performed in five patients at Stanford University Medical Center. Long-term survival and rehabilitation have been achieved in two cases. In the first case retransplantation was performed 57 days after the initial procedure because of persistent acute graft rejection. The second patient underwent retransplantation 27 months postoperatively because of documented accelerated graft atherosclerosis. The major indications for cardiac retransplantation consist of intractable acute rejection and late postoperative graft atherosclerosis. These complications should prompt consideration of cardiac retransplantation in carefully selected cases.

    View details for Web of Science ID A1977CV61800014

    View details for PubMedID 319302

  • HEMODYNAMIC CHANGES AT ONSET OF SPONTANEOUS VERSUS PACING-INDUCED ANGINA AMERICAN JOURNAL OF CARDIOLOGY BERNDT, T. B., FitzGerald, J., HARRISON, D. C., Schroeder, J. S. 1977; 39 (6): 784-788

    Abstract

    To determine the origin of angina pectoris at rest hemodynamic monitoring was performed for 24 to 72 hours in 25 patients with unstable angina who had pacing-induced angina during cardiac catheterization. During the monitoring period, seven patients had spontaneous epidsodes of angina at rest that could be compared with the pain-free periods and periods of pacing-induced angina. At the onset of spontaneous angina, the patients had a significantly lower mean double product (P is less than 0.005) and triple product (P is less than 0.025) than at the onset of pacing-induced angina. The mean double product (heart rate x systolic blood pressure) was 9,411 +/- 2,815 mm Hg/min during pain-free rest, 10,635 +/- 2,587 at the onset of spontaneous angina and 16,623 +/- 3,904 during pacing-induced angina. The mean resting pain-free triple product (heart rate x systolic blood pressure x ejection time) was 3,023 +/- 703 and 3,536 +/- 931 mm Hg/sec per min during, respectively, pain-free rest and spontaneous angina, and 4,350 +/- 938 mm Hg/sec per min during pacing-induced angina. These marked differences in the double and triple products were associated with a mean increase in pulmonary arterial diastolic pressure (from 10.7 mm Hg at rest to 14 mm Hg) at the onset of both spontaneous and pacing-induced angina. Although indirect, these data suggest that transient changes in coronary blood flow, rather than changes in myocardial work, may be primarily responsible for spontaneous angina at rest in certain patients with the syndrome of unstable angina.

    View details for Web of Science ID A1977DH82100003

    View details for PubMedID 860691

  • SLEEP-INDUCED APNEA SYNDROME - PREVALENCE OF CARDIAC-ARRHYTHMIAS AND THEIR REVERSAL AFTER TRACHEOSTOMY AMERICAN JOURNAL OF MEDICINE TILKIAN, A. G., Guilleminault, C., Schroeder, J. S., LEHRMAN, K. L., SIMMONS, F. B., Dement, W. C. 1977; 63 (3): 348-358

    Abstract

    Cardiac arrhythmias during wakefulness and sleep in 15 patients with sleep-induced obstructive apnea, and the effect of atropine and tracheostomy on these arrhythmias were studied by continuous overnight Holter electrocardiographic, respiratory and electroencephalographic recordings. Sleep was characterized by marked sinus arrhythmia in 14, extreme sinus bradycardia ( less than 30 beats/minute) in six, asystole of 2.5 to 6.3 seconds in five, second degree atrioventricular (A-V) block in two, and ventricular arrhythmias--complex premature ventricular beats in 10 and ventricular tachycardia in two. Arrhythmias during wakefulness were limited to premature ventricular beats in six. Atropine administration was partially and tracheostomy highly effective in preventing the majority of these arrhythmias during sleep. Marked sinus arrhythmia during sleep is characteristic of the syndrome of obstructive sleep apnea and is frequently accompanied by potentially life-threatening tachy- and bradyarrhythmias. Possible mechanism of production of these arrhythmias, the mode of action of tracheostomy and atropine, and the probable role of similar arrhythmias in the sudden infant death syndrome are discussed.

    View details for Web of Science ID A1977DV42100005

    View details for PubMedID 331948

  • CARDIOVASCULAR EFFECTS OF LITHIUM IN MAN - REVIEW OF LITERATURE AMERICAN JOURNAL OF MEDICINE TILKIAN, A. G., Schroeder, J. S., Kao, J. J., Hultgren, H. N. 1976; 61 (5): 665-670

    Abstract

    The medical literature since 1900 has been reviewed to determine the nature of lithium's cardiovascular effects. In therapeutic doses, lithium produces reversible T wave flattening and inversion in the electrocardiogram: rarely, it may cause sinus node dysfunction or ventricular arrhythmias. Patients with lithium toxicity almost always present with neurologic signs and symptoms. "Hypotension and cardiovascular collapse," alleged cardiotoxic manifestations of lithium, invariably follow days of coma. Given the possible cardiotoxic effect other psychopharmacologic agents and the hazards of withholding effective therapy in mania, it is concluded that lithium may be used safely in patients with cardiac disease if the dose is adjusted to the rate of lithium excretion and if serum levels of lithium are followed carefully. When used in patients with cardiac arrhythmias, frequent electrocardiographic monitoring is advised.

    View details for Web of Science ID A1976CL02900011

    View details for PubMedID 790953

  • EFFECT OF LITHIUM ON CARDIOVASCULAR PERFORMANCE - REPORT ON EXTENDED AMBULATORY MONITORING AND EXERCISE TESTING BEFORE AND DURING LITHIUM-THERAPY AMERICAN JOURNAL OF CARDIOLOGY TILKIAN, A. G., Schroeder, J. S., Kao, J., Hultgren, H. 1976; 38 (6): 701-708

    Abstract

    To assess the effect of long-term lithium therapy on cardiac arrhythmias and cardiovascular performance, extended ambulatory electrocardiographic monitoring was performed in 12 patients, and rest and exercise electrocardiograms in 10 of 12, before and during lithium therapy. Lithium increased the frequency of premature ventricular contractions in three patients, decreased it in one, and produced no change in eight. Three of four patients with atrial arrhythmias showed improvement during lithium therapy. Exercise performance was unchanged. Although 7 of the 12 patients manifested T wave flattening in the resting electrocardiogram, none had S-T segment displacement at rest or on treadmill exercise. Before lithium therapy, arrhythmias on exercise included premature atrial contractions in four patients, ventricular arrhythmias in four (premature ventricular contractions in four, with couplets in two and with ventricular tachycardia in one). During lithium therapy, exercise did not provoke premature atrial contractions or ventricular tachycardia in any of the patients, but three patients had premature ventricular contractions (with couplets in one case). We conclude that lithium at therapeutic levels may precipitate or aggravate ventricular arrhythmias. When administered to patients with heart disease, factors that interfere with renal clearance of lithium (heart failure, salt restriction, long-term diuretic therapy) must be recognized and doses must be adjusted accordingly. Careful follow-up and electrocardiographic monitoring are advisable if lithium is to be used in the presence of ventricular arrhythmias. Cardiovascular performance as assessed by treadmill exercise testing was not affected by long-term lithium therapy.

    View details for Web of Science ID A1976CM63900005

    View details for PubMedID 998508

  • HEMODYNAMICS IN SLEEP-INDUCED APNEA - STUDIES DURING WAKEFULNESS AND SLEEP ANNALS OF INTERNAL MEDICINE TILKIAN, A. G., Guilleminault, C., Schroeder, J. S., LEHRMAN, K. L., SIMMONS, F. B., Dement, W. C. 1976; 85 (6): 714-719

    Abstract

    Twelve patients with predominantly obstructive type sleep apnea underwent cardiac catheterization, hemodynamic monitoring, and arterial blood gas analysis during wakefulness and sleep. Abnormalities during wakefulness included systemic hypertension in four of 12, exercise-induced mild pulmonary hypertension in five of 12, and alveolar hypoventilation in one. During sleep nine patients had cyclic elevations of arterial pressure with each apneic episode, exceeding 200 mm Hg systolic in three of 12. Pulmonary artery pressures increased in 10 of 12, exceeding 60 mm Hg systolic in five. Marked degrees of hypoxemia (arterial P02, less than 50 mm Hg in eight of 12) and moderate hypercapnia with respiratory acidosis were associated with these hemodynamic changes. Cyclic upper airway obstruction during sleep may result in hypercapnia, acidosis, and pronounced hypoxemia, which can lead to hemodynamic abnormalities during sleep. Sustained pulmonary hypertension and possibly systemic hypertension may follow. Tracheostomy is an effective therapy and is recommended to symptomatic patients who have predominantly obstructive apnea but no relievable anatomic cause of upper airway obstruction.

    View details for Web of Science ID A1976CP46600002

    View details for PubMedID 999107

  • SPONTANEOUSLY AND PHARMACOLOGICALLY PROVOKED CORONARY ARTERIAL SPASM IN PRINZMETAL VARIANT ANGINA RADIOLOGY Higgins, C. B., Wexler, L., Silverman, J. F., HAYDEN, W. G., Anderson, W. L., Schroeder, J. H. 1976; 119 (3): 521-527

    Abstract

    Eleven of 21 consecutive patients with Prinzmetal angina (PMA) exhibited no significant fixed stenoses of the coronary arteries. Spontaneous coronary arterial spasm was demonstrated in 3 patients. Ergonovine maleate produced near-total occlusion of a major vessel in 3 of 4 other patients with PMA, but did not provoke spasm in 10 without PMA. The current study documents spasm as the mechanism of myocardial ischemia in some patients with normal coronary arteries and provides initial and favorable diagnostic results with provocative pharmacoangiography in this entity.

    View details for Web of Science ID A1976BR92300002

    View details for PubMedID 935383

  • CLINICAL AND ARTERIOGRAPHIC FEATURES OF PRINZMETALS VARIANT ANGINA - DOCUMENTATION OF ETIOLOGIC FACTORS AMERICAN JOURNAL OF CARDIOLOGY Higgins, C. B., Wexler, L., Silverman, J. F., Schroeder, J. S. 1976; 37 (6): 831-839

    Abstract

    Coronary arteriography performed in 17 patients with Prinzmetal's variant angina demonstrated high grade fixed obstructions in 9 patients (Group I) and insignificant or no fixed lesions in 8 patients (Group II). Group I consisted mostly of middle-aged or elderly men with S-T segment elevations in various sites; Group II included five younger women with S-T segment elevations in inferior electrocardiographic leads. In Group I patients, arteriography revealed a discrete high grade lesion located proximally in a major coronary artery in four patients and multivessel involvement in five patients. In Group II patients, spontaneous spasm was documented in three patients and spasm was pharmacologically provoked in two others during arteriography. The current study indicates that spasm is the responsible pathogenetic mechanism of myocardial ischemia in some patients with Prinzmetal angina and that this mechanism may be suspected from the clinical characteristics of these patients.

    View details for Web of Science ID A1976BQ73700002

    View details for PubMedID 1266748

  • UNSTABLE ANGINA-PECTORIS - NATIONAL COOPERATIVE STUDY-GROUP TO COMPARE MEDICAL AND SURGICAL THERAPY .1. REPORT OF PROTOCOL AND PATIENT POPULATION AMERICAN JOURNAL OF CARDIOLOGY Russell, R. O., MORASKI, R. E., Kouchoukos, N., Karp, R., MANTLE, J. A., Rackley, C. E., RESNEKOV, L., FALICOV, R. E., ALSADIR, J., Brooks, H., Anagnostopoulos, C. E., Lamberti, J., Wolk, M., Gay, W., Killip, T., Ebert, P., Rosati, R., Oldham, N., MITTLER, B., Peter, R., Conti, C. R., Ross, R. S., BRAWLEY, R. K., Plotnick, G., Gott, V. L., Donahoo, J. S., Becker, L. C., Hutter, A. M., DeSanctis, R. W., Gold, H. K., Leinbach, R. C., MUNDTH, E. D., Buckley, M. J., Austen, W. G., Hodges, M., Biddle, T. L., DeWeese, J. A., Yu, P. N., Schroeder, J., STINSON, E., Silverman, J., WILLMAN, V., CORNFIELD, J., REEVES, T. J., FROMMER, P. L., Kaplan, E., GILBERT, J. P., Newell, J. 1976; 37 (6): 896-902
  • AMBULATORY ELECTROCARDIOGRAPHIC MONITORING - TECHNIQUE AND CLINICAL INDICATIONS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Schroeder, J. S. 1976; 236 (5): 494-495

    View details for Web of Science ID A1976BZ10600031

    View details for PubMedID 947075

  • CARDIAC AMYLOIDOSIS - DIAGNOSIS BY TRANSVENOUS ENDOMYOCARDIAL BIOPSY AMERICAN JOURNAL OF MEDICINE Schroeder, J. S., Billingham, M. E., RIDER, A. K. 1975; 59 (2): 269-273

    Abstract

    Endomyocardial tissue, obtained from two patients presenting with restrictive cardiomyopathies, demonstrated amyloid infiltration. The percutaneous transvenous cardiac biopsy technic, using a modified Konno-Sakakibara cardiac bioptome, was safe and quick. Physical examination and catheterization data may not provide a definite differential diagnosis between restrictive and constrictive myocardial disease. Confirmation by biopsy of the cardiac amyloidosis assisted in providing optimum diagnostic and therapeutic care for these patients.

    View details for Web of Science ID A1975AM28400015

    View details for PubMedID 1098458

  • DIAGNOSIS AND QUANTIFICATION OF ARRHYTHMIAS IN AMBULATORY PATIENTS USING AN IMPROVED R-R INTERVAL PLOTTING SYSTEM AMERICAN JOURNAL OF CARDIOLOGY Lopes, M. G., FitzGerald, J., HARRISON, D. C., Schroeder, J. S. 1975; 35 (6): 816-823

    Abstract

    An improved technique for identification, diagnosis and quantification of arrhythmias during rest or ambulatory electrocardiographic recording is described. With simultaneous plotting of the R-R interval and the QRS duration and QRS vector measurement of each beat versus time, all periods of arrhythmias or abnormal complexes can be identified and characterized. Analog electrocardiographic samplings are used to confirm the diagnosis of the arrhythmia and to exclude artifact. The availability of a permanent record for the characterization of each QRS complex enables the physician to check the technician's analysis of the recording and to relate all events to the patient's heart rate and clinical symptoms. This technique also provides data for quantification of ventricular arrhythmias.

    View details for Web of Science ID A1975AE53700008

    View details for PubMedID 48334

  • OSTIUM PRIMUM DEFECT IN ADULT - POSTOPERATIVE FOLLOW-UP STUDIES CHEST GOODMAN, D. J., HARRISON, D. C., Schroeder, J. S. 1975; 67 (2): 185-189

    Abstract

    Twelve adult patients with ostium primum atrial septal defects (incomplete endocardial cushion defect) who underwent surgical repair of their lesions were evaluated in the late postoperative period. All had closure of the low-lying atrial septal defect, with suturing of the mitral valve cleft in 11 patients. Although the patients benefited symptomatically from the surgery, all had residual cardiac murmurs. Postoperative cardiac catheterization and left ventriculography in eight revealed successful closure of the atrial septla defect, but three demonstrated residual mitral insufficiency. In spite of the successful surgical repair in these patients, bacterial indocarditis prophylaxis should be continued in view of the residual murmurs and valvular abnormalities.

    View details for Web of Science ID A1975V416900013

    View details for PubMedID 123190

  • VENTRICULAR ARRHYTHMIAS DURING UNSTABLE ANGINA-PECTORIS ARCHIVES OF INTERNAL MEDICINE Lopes, M. G., HARRISON, D. C., Schroeder, J. S. 1975; 135 (12): 1548-1553

    Abstract

    In order to study the occurrence and frequency of ischemia-induced ventricular arrhythmias, we analyzed 105 episodes of spontaneous angina pectoris occurring at rest in 28 hospitalized patients with unstable angina pectoris and proved coronary artery disease. Of 24 patients with serious ventricular arrhythmias during pain, 17 (57%) were arrhythmia-free during monitoring. In the other four patients, 17 of 29 (59%) pain episodes were associated with serious ventricular arrhythmias, and three of these four had serious ventricular arrhythmias during pain-free periods. Each patient tended to manifest the same type of arrhythmia during repeat episodes of pain. It appears that continuous electrocardiogram (ECG) monitoring is important during the initial hospitalization of the patient with unstable angina. The presence of ventricular arrhythmias during pain-free periods indicates a high risk for serious ventricular arrhythmias during episodes of spontaneous pain. These patients should be considered for continued ECG monitoring and antiarrhythmic therapy.

    View details for Web of Science ID A1975AZ11300002

    View details for PubMedID 54051

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