Rate-dependent left bundle branch block (LBBB) occasionally occurs during anaesthesia when the heart rate exceeds a critical value. While it is usually a benign disorder, it may mask the electrocardiographic manifestations of myocardial ischaemia and the ST-T wave pattern associated with LBBB may be mistaken for those of ischaemia. This case report presents two cases in which rate-dependent LBB...

Autonomic neuropathy is associated with an increased incidence of silent myocardial infarction and sudden death. The purpose of this study was to investigate the prevalence of silent myocardial ischaemia in diabetic patients with autonomic neuropathy and without. Five standard autonomic function tests were performed on 41 men with diabetes: postural change in blood pressure, postural change in ...

AIMS Doppler myocardial imaging (DMI) has been suggested as a method of quantifying induced ischaemia during dobutamine stress echocardiography (DSE). The aim of the present study was to investigate both standard systolic and diastolic parameters, but more specifically to address the phenomenon of post-systolic motion (PSM) as a marker of acquired ischaemia during DSE using pulsed-wave DMI. M...

Introduction In a normovolemic patient, low cardiac output after cardiac surgery may be a result of myocardial ischaemia and/ or pericardial tamponade. However, without any objective evidence of ischaemia alongwith no signs of pericardial tamponade or regional wall motion abnormality on transthoracic echocardiogram (TTE), the diagnosis remains ambiguous. Computed tomography (CT scan) of the che...

The ischaemic cascade is the concept that progressive myocardial oxygen supply-demand mismatch causes a consistent sequence of events, starting with metabolic alterations and followed sequentially by myocardial perfusion abnormalities, wall motion abnormalities, ECG changes, and angina. This concept would suggest that investigations that detect expressions of ischaemia earlier in the cascade sh...

The expanded ability to detect myocardial injury using very sensitive and specific biomarker assays has been a major factor in the evolution of the definition of acute myocardial infarction (MI). This is clearly evident in the ‘Universal Definition of Myocardial Infarction’ recently developed by a joint task force of experts on behalf of the ESC, ACCF, AHA, and WHF (European Society of Cardiolo...

Coronary artery disease (CAD) remains a significant cause of morbidity and mortality worldwide [1]. Myocardial ischemia results when myocardial blood flow is insufficient to meet demand; this causes symptoms and affects patient outcome [2]. According to current guidelines for the management of stable CAD, revascularisation should be guided by the presence of myocardial ischaemia. The treatment ...

This study was performed to determine whether depletion of myocardial glutathione would impair recovery of left ventricular function of blood-perfused, isolated hearts after reversible ischaemic injury. Cats were treated with either vehicle or buthionine sulfoximine (BSO), an inhibitor of gamma-glutamylcysteine synthetase, the rate-limiting enzyme in the synthesis of glutathione. The feline iso...

OBJECTIVE In myocardial ischaemia, slow conducting capsaicin-sensitive C-fibres are activated. Apart from the mediation of pain, activation of these fibres causes release of various peptides, such as calcitonin gene-related peptide (CGRP), which is a potent vasodilator. The aim of this study was to investigate the role of CGRP in the context of myocardial ischaemia in vivo. METHODS The left a...

We have determined the effects of alterations in preload on ischaemia-induced diastolic dysfunction in anaesthetized beagles instrumented to measure left ventricular pressure and regional dimensions. Low-flow regional ischaemia decreased peak lengthening rates in ischaemic (mean -26 (SEM 6) mm s-1, P < 0.01) and non-ischaemic (-8.6 (3.4) mm s-1, P < 0.05) myocardium. Peak lengthening rates and ...