home *** CD-ROM | disk | FTP | other *** search
/ Year Books 1991 / Year Books 1991.iso / dp / 06 / 068.pkg < prev    next >
Unknown  |  1992-06-06  |  424.1 KB

open in: MacOS 8.1     |     Win98     |     DOS

view JSON data     |     view as text

This file was not able to be converted.
This format is not currently supported by dexvert.

ConfidenceProgramDetectionMatch TypeSupport
66% dexvert OS/2 Installation Package (archive/os2InstallPackage) ext Supported
1% dexvert BeOS Installation Package (archive/beOSInstallPackage) ext Unsupported
1% dexvert Newton Package (archive/newtonPackage) ext Unsupported
1% dexvert Independence War 2 mod Package (other/independenceWar2ModPackage) ext Unsupported
100% file data default



hex view
+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| 68 0f 00 00 30 31 00 00 | 00 01 04 15 00 00 e5 11 |h...01..|........|
|00000030| 00 00 30 32 00 00 00 01 | e9 26 00 00 0b 10 00 00 |..02....|.&......|
|00000040| 30 33 00 00 00 01 f4 36 | 00 00 0a 11 00 00 30 34 |03.....6|......04|
|00000050| 00 00 00 01 fe 47 00 00 | 6c 12 00 00 30 35 00 00 |.....G..|l...05..|
|00000060| 00 01 6a 5a 00 00 85 15 | 00 00 30 36 00 00 00 01 |..jZ....|..06....|
|00000070| ef 6f 00 00 6b 17 00 00 | 30 37 00 00 00 01 5a 87 |.o..k...|07....Z.|
|00000080| 00 00 c1 19 00 00 30 38 | 00 00 00 01 1b a1 00 00 |......08|........|
|00000090| 1d 15 00 00 30 39 00 00 | 00 01 38 b6 00 00 b0 10 |....09..|..8.....|
|000000a0| 00 00 31 30 00 00 00 01 | e8 c6 00 00 10 14 00 00 |..10....|........|
|000000b0| 31 31 00 00 00 01 f8 da | 00 00 9b 10 00 00 31 32 |11......|......12|
|000000c0| 00 00 00 01 93 eb 00 00 | 61 13 00 00 31 33 00 00 |........|a...13..|
|000000d0| 00 01 f4 fe 00 00 16 14 | 00 00 31 34 00 00 00 01 |........|..14....|
|000000e0| 0a 13 01 00 90 19 00 00 | 31 35 00 00 00 01 9a 2c |........|15.....,|
|000000f0| 01 00 75 10 00 00 31 36 | 00 00 00 01 0f 3d 01 00 |..u...16|.....=..|
|00000100| e1 14 00 00 31 37 00 00 | 00 01 f0 51 01 00 5d 1a |....17..|...Q..].|
|00000110| 00 00 31 38 00 00 00 01 | 4d 6c 01 00 0c 13 00 00 |..18....|Ml......|
|00000120| 31 39 00 00 00 01 59 7f | 01 00 65 16 00 00 32 30 |19....Y.|..e...20|
|00000130| 00 00 00 01 be 95 01 00 | d3 11 00 00 32 31 00 00 |........|....21..|
|00000140| 00 01 91 a7 01 00 68 0e | 00 00 32 32 00 00 00 01 |......h.|..22....|
|00000150| f9 b5 01 00 f0 17 00 00 | 32 33 00 00 00 01 e9 cd |........|23......|
|00000160| 01 00 0c 12 00 00 32 34 | 00 00 00 01 f5 df 01 00 |......24|........|
|00000170| 11 0c 00 00 32 35 00 00 | 00 01 06 ec 01 00 85 0a |....25..|........|
|00000180| 00 00 32 36 00 00 00 01 | 8b f6 01 00 97 0e 00 00 |..26....|........|
|00000190| 32 37 00 00 00 01 22 05 | 02 00 53 14 00 00 32 38 |27....".|..S...28|
|000001a0| 00 00 00 01 75 19 02 00 | 38 18 00 00 32 39 00 00 |....u...|8...29..|
|000001b0| 00 01 ad 31 02 00 50 12 | 00 00 33 30 00 00 00 01 |...1..P.|..30....|
|000001c0| fd 43 02 00 39 17 00 00 | 33 31 00 00 00 01 36 5b |.C..9...|31....6[|
|000001d0| 02 00 ab 0e 00 00 33 32 | 00 00 00 01 e1 69 02 00 |......32|.....i..|
|000001e0| 1a 0f 00 00 33 33 00 00 | 00 01 fb 78 02 00 1b 14 |....33..|...x....|
|000001f0| 00 00 33 34 00 00 00 01 | 16 8d 02 00 27 0f 00 00 |..34....|....'...|
|00000200| 33 35 00 00 00 01 3d 9c | 02 00 a0 0e 00 00 33 36 |35....=.|......36|
|00000210| 00 00 00 01 dd aa 02 00 | b0 11 00 00 33 37 00 00 |........|....37..|
|00000220| 00 01 8d bc 02 00 ea 10 | 00 00 33 38 00 00 00 01 |........|..38....|
|00000230| 77 cd 02 00 ec 0e 00 00 | 33 39 00 00 00 01 63 dc |w.......|39....c.|
|00000240| 02 00 b7 0b 00 00 34 30 | 00 00 00 01 1a e8 02 00 |......40|........|
|00000250| d8 0b 00 00 34 31 00 00 | 00 01 f2 f3 02 00 fa 11 |....41..|........|
|00000260| 00 00 34 32 00 00 00 01 | ec 05 03 00 7c 0d 00 00 |..42....|....|...|
|00000270| 34 33 00 00 00 01 68 13 | 03 00 32 15 00 00 34 34 |43....h.|..2...44|
|00000280| 00 00 00 01 9a 28 03 00 | 55 10 00 00 34 35 00 00 |.....(..|U...45..|
|00000290| 00 01 ef 38 03 00 2f 14 | 00 00 34 36 00 00 00 01 |...8../.|..46....|
|000002a0| 1e 4d 03 00 bb 10 00 00 | 34 37 00 00 00 01 d9 5d |.M......|47.....]|
|000002b0| 03 00 c2 12 00 00 34 38 | 00 00 00 01 9b 70 03 00 |......48|.....p..|
|000002c0| 0b 0e 00 00 34 39 00 00 | 00 01 a6 7e 03 00 d8 0e |....49..|...~....|
|000002d0| 00 00 35 30 00 00 00 01 | 7e 8d 03 00 25 0f 00 00 |..50....|~...%...|
|000002e0| 35 31 00 00 00 01 a3 9c | 03 00 38 0b 00 00 35 32 |51......|..8...52|
|000002f0| 00 00 00 01 db a7 03 00 | f0 0f 00 00 35 33 00 00 |........|....53..|
|00000300| 00 01 cb b7 03 00 5a 14 | 00 00 35 34 00 00 00 01 |......Z.|..54....|
|00000310| 25 cc 03 00 42 12 00 00 | 35 35 00 00 00 01 67 de |%...B...|55....g.|
|00000320| 03 00 7b 0d 00 00 35 36 | 00 00 00 01 e2 eb 03 00 |..{...56|........|
|00000330| ec 0d 00 00 35 37 00 00 | 00 01 ce f9 03 00 1c 14 |....57..|........|
|00000340| 00 00 35 38 00 00 00 01 | ea 0d 04 00 ad 13 00 00 |..58....|........|
|00000350| 35 39 00 00 00 01 97 21 | 04 00 8f 12 00 00 36 30 |59.....!|......60|
|00000360| 00 00 00 01 26 34 04 00 | 5b 14 00 00 36 31 00 00 |....&4..|[...61..|
|00000370| 00 01 81 48 04 00 03 15 | 00 00 36 32 00 00 00 01 |...H....|..62....|
|00000380| 84 5d 04 00 4e 13 00 00 | 36 33 00 00 00 01 d2 70 |.]..N...|63.....p|
|00000390| 04 00 12 13 00 00 36 34 | 00 00 00 01 e4 83 04 00 |......64|........|
|000003a0| 65 10 00 00 36 35 00 00 | 00 01 49 94 04 00 31 0d |e...65..|..I...1.|
|000003b0| 00 00 36 36 00 00 00 01 | 7a a1 04 00 1b 19 00 00 |..66....|z.......|
|000003c0| 36 37 00 00 00 01 95 ba | 04 00 0d 11 00 00 36 38 |67......|......68|
|000003d0| 00 00 00 01 a2 cb 04 00 | 51 0d 00 00 36 39 00 00 |........|Q...69..|
|000003e0| 00 01 f3 d8 04 00 9b 11 | 00 00 37 30 00 00 00 01 |........|..70....|
|000003f0| 8e ea 04 00 ed 0d 00 00 | 37 31 00 00 00 01 7b f8 |........|71....{.|
|00000400| 04 00 a3 0f 00 00 37 32 | 00 00 00 01 1e 08 05 00 |......72|........|
|00000410| 10 11 00 00 37 33 00 00 | 00 01 2e 19 05 00 cf 0f |....73..|........|
|00000420| 00 00 37 34 00 00 00 01 | fd 28 05 00 db 10 00 00 |..74....|.(......|
|00000430| 37 35 00 00 00 01 d8 39 | 05 00 23 10 00 00 37 36 |75.....9|..#...76|
|00000440| 00 00 00 01 fb 49 05 00 | 97 10 00 00 37 37 00 00 |.....I..|....77..|
|00000450| 00 01 92 5a 05 00 6b 0d | 00 00 37 38 00 00 00 01 |...Z..k.|..78....|
|00000460| fd 67 05 00 95 13 00 00 | 37 39 00 00 00 01 92 7b |.g......|79.....{|
|00000470| 05 00 96 0c 00 00 38 30 | 00 00 00 01 28 88 05 00 |......80|....(...|
|00000480| e6 0d 00 00 38 31 00 00 | 00 01 0e 96 05 00 f9 0f |....81..|........|
|00000490| 00 00 38 32 00 00 00 01 | 07 a6 05 00 c4 0d 00 00 |..82....|........|
|000004a0| 38 33 00 00 00 01 cb b3 | 05 00 a7 0d 00 00 38 34 |83......|......84|
|000004b0| 00 00 00 01 72 c1 05 00 | 67 0e 00 00 38 35 00 00 |....r...|g...85..|
|000004c0| 00 01 d9 cf 05 00 4d 0d | 00 00 38 36 00 00 00 01 |......M.|..86....|
|000004d0| 26 dd 05 00 69 0d 00 00 | 38 37 00 00 00 01 8f ea |&...i...|87......|
|000004e0| 05 00 39 13 00 00 38 38 | 00 00 00 01 c8 fd 05 00 |..9...88|........|
|000004f0| 9c 0f 00 00 38 39 00 00 | 00 01 64 0d 06 00 b2 0e |....89..|..d.....|
|00000500| 00 00 39 30 00 00 00 01 | 16 1c 06 00 41 0c 00 00 |..90....|....A...|
|00000510| 39 31 00 00 00 01 57 28 | 06 00 40 0e 00 00 39 32 |91....W(|..@...92|
|00000520| 00 00 00 01 97 36 06 00 | ed 0b 00 00 39 33 00 00 |.....6..|....93..|
|00000530| 00 01 84 42 06 00 d5 0b | 00 00 39 34 00 00 00 01 |...B....|..94....|
|00000540| 59 4e 06 00 f0 0e 00 00 | 39 35 00 00 00 01 49 5d |YN......|95....I]|
|00000550| 06 00 e3 0e 00 00 39 36 | 00 00 00 01 2c 6c 06 00 |......96|....,l..|
|00000560| db 0b 00 00 39 37 00 00 | 00 01 07 78 06 00 68 0c |....97..|...x..h.|
|00000570| 00 00 39 38 00 00 00 01 | 6f 84 06 00 15 0d 00 00 |..98....|o.......|
|00000580| 39 39 00 00 00 01 84 91 | 06 00 e2 0e 00 00 00 00 |99......|........|
|00000590| 00 00 00 00 66 a0 06 00 | 00 00 00 00 24 55 6e 69 |....f...|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 36 38 30 30 7d |que_ID{Y|RB06800}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 54 68 65 20 55 74 69 |..$Title|{The Uti|
|000005c0| 6c 69 7a 61 74 69 6f 6e | 20 6f 66 20 54 65 63 68 |lization| of Tech|
|000005d0| 6e 65 74 69 75 6d 2d 39 | 39 6d 20 43 50 49 20 61 |netium-9|9m CPI a|
|000005e0| 73 20 61 20 4d 79 6f 63 | 61 72 64 69 61 6c 20 50 |s a Myoc|ardial P|
|000005f0| 65 72 66 75 73 69 6f 6e | 20 49 6d 61 67 69 6e 67 |erfusion| Imaging|
|00000600| 20 41 67 65 6e 74 20 69 | 6e 20 45 78 65 72 63 69 | Agent i|n Exerci|
|00000610| 73 65 20 53 74 75 64 69 | 65 73 7d 0d 0a 24 41 75 |se Studi|es}..$Au|
|00000620| 74 68 6f 72 7b 53 69 61 | 2c 20 53 54 42 0d 0a 48 |thor{Sia|, STB..H|
|00000630| 6f 6c 6d 61 6e 2c 20 42 | 4c 0d 0a 43 61 6d 70 62 |olman, B|L..Campb|
|00000640| 65 6c 6c 2c 20 53 0d 0a | 4c 69 73 74 65 72 2d 4a |ell, S..|Lister-J|
|00000650| 61 6d 65 73 2c 20 4a 0d | 0a 45 6e 67 6c 69 73 68 |ames, J.|.English|
|00000660| 2c 20 52 4a 0d 0a 4b 72 | 6f 6e 61 75 67 65 2c 20 |, RJ..Kr|onauge, |
|00000670| 4a 46 0d 0a 44 61 76 69 | 73 6f 6e 2c 20 41 0d 0a |JF..Davi|son, A..|
|00000680| 4a 6f 6e 65 73 2c 20 41 | 47 7d 0d 0a 24 41 66 66 |Jones, A|G}..$Aff|
|00000690| 69 6c 69 61 74 69 6f 6e | 7b 48 61 72 76 61 72 64 |iliation|{Harvard|
|000006a0| 20 4d 65 64 20 53 63 68 | 6f 6f 6c 3b 20 42 72 69 | Med Sch|ool; Bri|
|000006b0| 67 68 61 6d 20 61 6e 64 | 20 57 6f 6d 65 6e 27 73 |gham and| Women's|
|000006c0| 20 48 6f 73 70 2c 20 42 | 6f 73 74 6f 6e 3b 20 4d | Hosp, B|oston; M|
|000006d0| 61 73 73 61 63 68 75 73 | 65 74 74 20 49 6e 73 74 |assachus|ett Inst|
|000006e0| 20 6f 66 20 54 65 63 68 | 6e 6f 6c 6f 67 79 2c 20 | of Tech|nology, |
|000006f0| 43 61 6d 62 72 69 64 67 | 65 7d 0d 0a 24 53 75 62 |Cambridg|e}..$Sub|
|00000700| 6a 65 63 74 7b 4d 79 6f | 63 61 72 64 69 75 6d 20 |ject{Myo|cardium |
|00000710| 70 65 72 66 75 73 69 6f | 6e 20 69 6d 61 67 69 6e |perfusio|n imagin|
|00000720| 67 20 77 69 74 68 20 74 | 65 63 68 6e 65 74 69 75 |g with t|echnetiu|
|00000730| 6d 2d 39 39 6d 20 43 50 | 49 2c 20 69 6e 20 65 78 |m-99m CP|I, in ex|
|00000740| 65 72 63 69 73 65 0d 0a | 73 74 75 64 69 65 73 3b |ercise..|studies;|
|00000750| 20 43 50 49 20 74 65 63 | 68 6e 65 74 69 75 6d 2d | CPI tec|hnetium-|
|00000760| 39 39 6d 20 43 50 49 20 | 66 6f 72 20 6d 79 6f 63 |99m CPI |for myoc|
|00000770| 61 72 64 69 61 6c 20 69 | 6d 61 67 69 6e 67 2c 20 |ardial i|maging, |
|00000780| 65 78 65 72 63 69 73 65 | 7d 0d 0a 24 4a 6f 75 72 |exercise|}..$Jour|
|00000790| 6e 61 6c 7b 43 6c 69 6e | 20 4e 75 63 6c 20 4d 65 |nal{Clin| Nucl Me|
|000007a0| 64 7d 0d 0a 24 56 6f 6c | 75 6d 65 7b 31 32 7d 0d |d}..$Vol|ume{12}.|
|000007b0| 0a 24 50 61 67 65 7b 36 | 38 31 2d 36 38 37 7d 0d |.$Page{6|81-687}.|
|000007c0| 0a 24 44 61 74 65 7b 53 | 65 70 74 65 6d 62 65 72 |.$Date{S|eptember|
|000007d0| 20 31 39 38 37 7d 0d 0a | 24 59 42 56 6f 6c 7b 31 | 1987}..|$YBVol{1|
|000007e0| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
|000007f0| 20 4d 65 64 69 63 69 6e | 65 2c 20 50 61 72 74 20 | Medicin|e, Part |
|00000800| 46 6f 75 72 7d 0d 0a 24 | 43 68 61 70 74 65 72 7b |Four}..$|Chapter{|
|00000810| 33 31 2d 32 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |31-2}..$|YBEditor|
|00000820| 7b 44 72 73 2e 20 52 6f | 67 65 72 73 2c 20 44 65 |{Drs. Ro|gers, De|
|00000830| 73 20 50 72 65 7a 2c 20 | 43 6c 69 6e 65 2c 20 42 |s Prez, |Cline, B|
|00000840| 72 61 75 6e 77 61 6c 64 | 2c 20 47 72 65 65 6e 62 |raunwald|, Greenb|
|00000850| 65 72 67 65 72 2c 20 57 | 69 6c 73 6f 6e 2c 20 45 |erger, W|ilson, E|
|00000860| 70 73 74 65 69 6e 2c 20 | 61 6e 64 20 4d 61 6c 61 |pstein, |and Mala|
|00000870| 77 69 73 74 61 7d 0d 0a | 24 54 61 62 6c 65 7b 7d |wista}..|$Table{}|
|00000880| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 45 |..$Comme|ntator{E|
|00000890| 2e 20 42 72 61 75 6e 77 | 61 6c 64 2c 20 4d 2e 44 |. Braunw|ald, M.D|
|000008a0| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|000008b0| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|000008c0| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|000008d0| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|000008e0| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|000008f0| 66 20 4d 65 64 69 63 69 | 6e 65 20 28 52 29 0d 0a |f Medici|ne (R)..|
|00000900| 0d 0a 50 61 72 74 20 46 | 6f 75 72 3a 20 20 54 68 |..Part F|our: Th|
|00000910| 65 20 48 65 61 72 74 20 | 61 6e 64 20 43 61 72 64 |e Heart |and Card|
|00000920| 69 6f 76 61 73 63 75 6c | 61 72 20 44 69 73 65 61 |iovascul|ar Disea|
|00000930| 73 65 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 33 31 |se....Ch|apter 31|
|00000940| 2d 2d 43 68 72 6f 6e 69 | 63 20 43 6f 72 6f 6e 61 |--Chroni|c Corona|
|00000950| 72 79 20 41 72 74 65 72 | 79 20 44 69 73 65 61 73 |ry Arter|y Diseas|
|00000960| 65 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |e....---|--------|
|00000970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009b0| 2d 2d 2d 2d 2d 0d 0a 54 | 68 65 20 55 74 69 6c 69 |-----..T|he Utili|
|000009c0| 7a 61 74 69 6f 6e 20 6f | 66 20 54 65 63 68 6e 65 |zation o|f Techne|
|000009d0| 74 69 75 6d 2d 39 39 6d | 20 43 50 49 20 61 73 20 |tium-99m| CPI as |
|000009e0| 61 20 4d 79 6f 63 61 72 | 64 69 61 6c 20 50 65 72 |a Myocar|dial Per|
|000009f0| 66 75 73 69 6f 6e 20 49 | 6d 61 67 69 6e 67 20 41 |fusion I|maging A|
|00000a00| 67 65 6e 74 20 69 6e 0d | 0a 45 78 65 72 63 69 73 |gent in.|.Exercis|
|00000a10| 65 20 53 74 75 64 69 65 | 73 0d 0a 0d 0a 53 69 61 |e Studie|s....Sia|
|00000a20| 20 53 54 42 2c 20 48 6f | 6c 6d 61 6e 20 42 4c 2c | STB, Ho|lman BL,|
|00000a30| 20 43 61 6d 70 62 65 6c | 6c 20 53 2c 20 4c 69 73 | Campbel|l S, Lis|
|00000a40| 74 65 72 2d 4a 61 6d 65 | 73 20 4a 2c 20 45 6e 67 |ter-Jame|s J, Eng|
|00000a50| 6c 69 73 68 20 52 4a 2c | 20 4b 72 6f 6e 61 75 67 |lish RJ,| Kronaug|
|00000a60| 65 20 4a 46 2c 0d 0a 44 | 61 76 69 73 6f 6e 20 41 |e JF,..D|avison A|
|00000a70| 2c 20 4a 6f 6e 65 73 20 | 41 47 0d 0a 28 48 61 72 |, Jones |AG..(Har|
|00000a80| 76 61 72 64 20 4d 65 64 | 20 53 63 68 6f 6f 6c 3b |vard Med| School;|
|00000a90| 20 42 72 69 67 68 61 6d | 20 61 6e 64 20 57 6f 6d | Brigham| and Wom|
|00000aa0| 65 6e 27 73 20 48 6f 73 | 70 2c 20 42 6f 73 74 6f |en's Hos|p, Bosto|
|00000ab0| 6e 3b 20 4d 61 73 73 61 | 63 68 75 73 65 74 74 20 |n; Massa|chusett |
|00000ac0| 49 6e 73 74 20 6f 66 0d | 0a 54 65 63 68 6e 6f 6c |Inst of.|.Technol|
|00000ad0| 6f 67 79 2c 20 43 61 6d | 62 72 69 64 67 65 29 0d |ogy, Cam|bridge).|
|00000ae0| 0a 43 6c 69 6e 20 4e 75 | 63 6c 20 4d 65 64 20 31 |.Clin Nu|cl Med 1|
|00000af0| 32 3a 36 38 31 2d 36 38 | 37 2c 20 53 65 70 74 65 |2:681-68|7, Septe|
|00000b00| 6d 62 65 72 20 31 39 38 | 37 0d 0a 2d 2d 2d 2d 2d |mber 198|7..-----|
|00000b10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000b50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00000b60| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00000b70| 54 68 61 6c 6c 69 75 6d | 2d 32 30 31 20 28 32 30 |Thallium|-201 (20|
|00000b80| 31 2d 54 6c 29 20 69 6d | 61 67 69 6e 67 20 69 73 |1-Tl) im|aging is|
|00000b90| 20 75 73 65 64 20 72 6f | 75 74 69 6e 65 6c 79 20 | used ro|utinely |
|00000ba0| 74 6f 20 61 73 73 65 73 | 73 20 6d 79 6f 63 61 72 |to asses|s myocar|
|00000bb0| 64 69 61 6c 0d 0a 70 65 | 72 66 75 73 69 6f 6e 20 |dial..pe|rfusion |
|00000bc0| 69 6e 20 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |in patie|nts with|
|00000bd0| 20 63 6f 72 6f 6e 61 72 | 79 20 61 72 74 65 72 79 | coronar|y artery|
|00000be0| 20 64 69 73 65 61 73 65 | 2e 20 20 48 6f 77 65 76 | disease|. Howev|
|00000bf0| 65 72 2c 20 62 65 63 61 | 75 73 65 20 32 30 31 2d |er, beca|use 201-|
|00000c00| 54 31 20 68 61 73 0d 0a | 6c 69 6d 69 74 61 74 69 |T1 has..|limitati|
|00000c10| 6f 6e 73 2c 20 74 68 65 | 72 65 20 68 61 73 20 62 |ons, the|re has b|
|00000c20| 65 65 6e 20 61 6e 20 65 | 66 66 6f 72 74 20 74 6f |een an e|ffort to|
|00000c30| 20 64 65 76 65 6c 6f 70 | 20 61 20 74 65 63 68 6e | develop| a techn|
|00000c40| 65 74 69 75 6d 2d 6c 61 | 62 65 6c 65 64 20 6d 79 |etium-la|beled my|
|00000c50| 6f 63 61 72 64 69 61 6c | 0d 0a 70 65 72 66 75 73 |ocardial|..perfus|
|00000c60| 69 6f 6e 20 61 67 65 6e | 74 2e 20 20 4d 79 6f 63 |ion agen|t. Myoc|
|00000c70| 61 72 64 69 61 6c 20 70 | 65 72 66 75 73 69 6f 6e |ardial p|erfusion|
|00000c80| 20 69 6d 61 67 69 6e 67 | 20 77 69 74 68 20 74 65 | imaging| with te|
|00000c90| 63 68 6e 65 74 69 75 6d | 2d 39 39 6d 0d 0a 28 39 |chnetium|-99m..(9|
|00000ca0| 39 6d 2d 54 63 29 2d 63 | 61 72 62 6f 6d 65 74 68 |9m-Tc)-c|arbometh|
|00000cb0| 6f 78 79 69 73 6f 70 72 | 6f 70 79 6c 69 73 6f 6e |oxyisopr|opylison|
|00000cc0| 69 74 72 69 6c 65 20 28 | 43 50 49 29 20 77 61 73 |itrile (|CPI) was|
|00000cd0| 20 63 6f 6d 70 61 72 65 | 64 20 77 69 74 68 20 32 | compare|d with 2|
|00000ce0| 30 31 2d 54 6c 20 69 6d | 61 67 69 6e 67 0d 0a 69 |01-Tl im|aging..i|
|00000cf0| 6e 20 32 32 20 70 61 74 | 69 65 6e 74 73 20 65 76 |n 22 pat|ients ev|
|00000d00| 61 6c 75 61 74 65 64 20 | 66 6f 72 20 63 6f 72 6f |aluated |for coro|
|00000d10| 6e 61 72 79 20 61 72 74 | 65 72 79 20 64 69 73 65 |nary art|ery dise|
|00000d20| 61 73 65 2e 20 20 45 69 | 67 68 74 20 70 61 74 69 |ase. Ei|ght pati|
|00000d30| 65 6e 74 73 20 68 61 64 | 20 61 0d 0a 63 6f 6e 66 |ents had| a..conf|
|00000d40| 69 72 6d 65 64 20 70 72 | 65 76 69 6f 75 73 20 69 |irmed pr|evious i|
|00000d50| 6e 66 61 72 63 74 69 6f | 6e 2c 20 31 31 20 77 69 |nfarctio|n, 11 wi|
|00000d60| 74 68 6f 75 74 20 69 6e | 66 61 72 63 74 69 6f 6e |thout in|farction|
|00000d70| 20 68 61 64 20 61 6e 67 | 69 6e 61 2c 20 61 6e 64 | had ang|ina, and|
|00000d80| 20 33 20 77 65 72 65 0d | 0a 61 73 79 6d 70 74 6f | 3 were.|.asympto|
|00000d90| 6d 61 74 69 63 2e 0d 0a | 20 20 20 20 20 54 68 65 |matic...| The|
|00000da0| 72 65 20 77 61 73 20 63 | 6f 6e 63 6f 72 64 61 6e |re was c|oncordan|
|00000db0| 63 65 20 62 65 74 77 65 | 65 6e 20 39 39 6d 2d 54 |ce betwe|en 99m-T|
|00000dc0| 63 2d 43 50 49 20 61 6e | 64 20 32 30 31 2d 54 6c |c-CPI an|d 201-Tl|
|00000dd0| 20 69 6d 61 67 69 6e 67 | 20 69 6e 20 74 68 65 0d | imaging| in the.|
|00000de0| 0a 64 65 74 65 63 74 69 | 6f 6e 20 6f 66 20 73 65 |.detecti|on of se|
|00000df0| 67 6d 65 6e 74 61 6c 20 | 6d 79 6f 63 61 72 64 69 |gmental |myocardi|
|00000e00| 61 6c 20 69 73 63 68 65 | 6d 69 61 20 61 6e 64 20 |al ische|mia and |
|00000e10| 66 69 78 65 64 20 64 65 | 66 65 63 74 73 20 69 6e |fixed de|fects in|
|00000e20| 20 39 33 25 20 6f 66 20 | 6c 65 66 74 0d 0a 76 65 | 93% of |left..ve|
|00000e30| 6e 74 72 69 63 75 6c 61 | 72 20 73 65 67 6d 65 6e |ntricula|r segmen|
|00000e40| 74 73 2e 20 20 54 68 65 | 20 32 20 74 72 61 63 65 |ts. The| 2 trace|
|00000e50| 72 73 20 61 6c 73 6f 20 | 63 6f 72 72 65 6c 61 74 |rs also |correlat|
|00000e60| 65 64 20 77 65 6c 6c 20 | 69 6e 20 74 68 65 20 64 |ed well |in the d|
|00000e70| 65 74 65 63 74 69 6f 6e | 20 6f 66 0d 0a 63 6f 72 |etection| of..cor|
|00000e80| 6f 6e 61 72 79 20 61 72 | 74 65 72 79 20 64 69 73 |onary ar|tery dis|
|00000e90| 65 61 73 65 2e 20 20 54 | 68 65 20 69 73 6f 6e 69 |ease. T|he isoni|
|00000ea0| 74 72 69 6c 65 20 63 6f | 6d 70 6c 65 78 20 63 6c |trile co|mplex cl|
|00000eb0| 65 61 72 65 64 20 74 68 | 65 20 6d 79 6f 63 61 72 |eared th|e myocar|
|00000ec0| 64 69 75 6d 20 73 6c 6f | 77 6c 79 0d 0a 61 6e 64 |dium slo|wly..and|
|00000ed0| 20 64 69 64 20 6e 6f 74 | 20 72 65 64 69 73 74 72 | did not| redistr|
|00000ee0| 69 62 75 74 65 20 69 6e | 74 6f 20 69 73 63 68 65 |ibute in|to ische|
|00000ef0| 6d 69 63 20 61 72 65 61 | 73 3b 20 65 78 63 72 65 |mic area|s; excre|
|00000f00| 74 69 6f 6e 20 77 61 73 | 20 72 61 70 69 64 2e 20 |tion was| rapid. |
|00000f10| 20 52 65 69 6e 6a 65 63 | 74 69 6f 6e 0d 0a 61 74 | Reinjec|tion..at|
|00000f20| 20 72 65 73 74 20 77 61 | 73 20 75 73 65 66 75 6c | rest wa|s useful|
|00000f30| 20 69 6e 20 64 69 73 74 | 69 6e 67 75 69 73 68 69 | in dist|inguishi|
|00000f40| 6e 67 20 74 72 61 6e 73 | 69 65 6e 74 20 69 73 63 |ng trans|ient isc|
|00000f50| 68 65 6d 69 61 20 66 72 | 6f 6d 20 69 6e 66 61 72 |hemia fr|om infar|
|00000f60| 63 74 69 6f 6e 2e 0d 0a | 20 20 20 20 20 49 6e 20 |ction...| In |
|00000f70| 74 68 65 20 64 65 74 65 | 63 74 69 6f 6e 20 6f 66 |the dete|ction of|
|00000f80| 20 63 6f 72 6f 6e 61 72 | 79 20 61 72 74 65 72 79 | coronar|y artery|
|00000f90| 20 64 69 73 65 61 73 65 | 2c 20 39 39 6d 2d 54 63 | disease|, 99m-Tc|
|00000fa0| 2d 43 50 49 20 73 63 61 | 6e 6e 69 6e 67 20 61 70 |-CPI sca|nning ap|
|00000fb0| 70 65 61 72 73 0d 0a 63 | 6f 6d 70 61 72 61 62 6c |pears..c|omparabl|
|00000fc0| 65 20 74 6f 20 32 30 2d | 31 54 6c 20 73 63 61 6e |e to 20-|1Tl scan|
|00000fd0| 6e 69 6e 67 2e 20 20 41 | 73 20 61 20 6d 79 6f 63 |ning. A|s a myoc|
|00000fe0| 61 72 64 69 61 6c 20 69 | 6d 61 67 69 6e 67 20 61 |ardial i|maging a|
|00000ff0| 67 65 6e 74 20 39 39 6d | 2d 54 63 2d 43 50 49 20 |gent 99m|-Tc-CPI |
|00001000| 6f 66 66 65 72 73 0d 0a | 74 68 65 20 61 64 76 61 |offers..|the adva|
|00001010| 6e 74 61 67 65 73 20 6f | 66 20 73 6c 6f 77 20 6d |ntages o|f slow m|
|00001020| 79 6f 63 61 72 64 69 61 | 6c 20 63 6c 65 61 72 61 |yocardia|l cleara|
|00001030| 6e 63 65 2c 20 61 62 73 | 65 6e 63 65 20 6f 66 20 |nce, abs|ence of |
|00001040| 6d 79 6f 63 61 72 64 69 | 61 6c 0d 0a 72 65 64 69 |myocardi|al..redi|
|00001050| 73 74 72 69 62 75 74 69 | 6f 6e 2c 20 61 6e 64 20 |stributi|on, and |
|00001060| 72 61 70 69 64 20 63 6c | 65 61 72 61 6e 63 65 20 |rapid cl|earance |
|00001070| 66 72 6f 6d 20 62 61 63 | 6b 67 72 6f 75 6e 64 20 |from bac|kground |
|00001080| 74 69 73 73 75 65 2e 0d | 0a 0d 0a 50 6f 73 74 2d |tissue..|...Post-|
|00001090| 43 6f 6d 6d 65 6e 74 0d | 0a 0d 0a 20 20 20 20 20 |Comment.|... |
|000010a0| 54 68 65 20 75 73 65 20 | 6f 66 20 39 39 6d 2d 54 |The use |of 99m-T|
|000010b0| 63 2d 43 50 49 20 66 6f | 72 20 6d 79 6f 63 61 72 |c-CPI fo|r myocar|
|000010c0| 64 69 61 6c 20 70 65 72 | 66 75 73 69 6f 6e 20 77 |dial per|fusion w|
|000010d0| 61 73 20 64 69 73 63 75 | 73 73 65 64 20 69 6e 20 |as discu|ssed in |
|000010e0| 74 68 65 20 31 39 38 38 | 0d 0a 59 45 41 52 20 42 |the 1988|..YEAR B|
|000010f0| 4f 4f 4b 20 4f 46 20 4d | 45 44 49 43 49 4e 45 20 |OOK OF M|EDICINE |
|00001100| 28 70 70 20 33 35 38 2d | 33 35 39 29 2e 20 20 44 |(pp 358-|359). D|
|00001110| 75 72 69 6e 67 20 74 68 | 65 20 70 61 73 74 20 79 |uring th|e past y|
|00001120| 65 61 72 20 74 68 65 72 | 65 20 68 61 73 20 62 65 |ear ther|e has be|
|00001130| 65 6e 0d 0a 69 6e 63 72 | 65 61 73 69 6e 67 20 61 |en..incr|easing a|
|00001140| 70 70 6c 69 63 61 74 69 | 6f 6e 20 6f 66 20 74 68 |pplicati|on of th|
|00001150| 69 73 20 69 6e 74 65 72 | 65 73 74 69 6e 67 20 6e |is inter|esting n|
|00001160| 65 77 20 69 6d 61 67 69 | 6e 67 20 61 67 65 6e 74 |ew imagi|ng agent|
|00001170| 2e 20 20 54 68 69 73 20 | 70 61 70 65 72 20 62 79 |. This |paper by|
|00001180| 20 53 69 61 0d 0a 65 74 | 20 61 6c 2e 20 64 65 6d | Sia..et| al. dem|
|00001190| 6f 6e 73 74 72 61 74 65 | 73 20 74 68 65 20 70 6f |onstrate|s the po|
|000011a0| 74 65 6e 74 69 61 6c 20 | 61 64 76 61 6e 74 61 67 |tential |advantag|
|000011b0| 65 20 6f 66 20 39 39 6d | 2d 54 63 2d 43 50 49 20 |e of 99m|-Tc-CPI |
|000011c0| 6f 76 65 72 20 32 30 31 | 2d 54 31 20 69 6e 20 74 |over 201|-T1 in t|
|000011d0| 68 65 0d 0a 61 73 73 65 | 73 73 6d 65 6e 74 20 6f |he..asse|ssment o|
|000011e0| 66 20 63 6f 72 6f 6e 61 | 72 79 20 61 72 74 65 72 |f corona|ry arter|
|000011f0| 79 20 64 69 73 65 61 73 | 65 2e 20 20 54 68 65 20 |y diseas|e. The |
|00001200| 61 62 73 65 6e 63 65 20 | 6f 66 20 72 65 64 69 73 |absence |of redis|
|00001210| 74 72 69 62 75 74 69 6f | 6e 20 77 6f 75 6c 64 20 |tributio|n would |
|00001220| 6d 61 6b 65 0d 0a 39 39 | 6d 2d 54 63 2d 43 50 49 |make..99|m-Tc-CPI|
|00001230| 20 75 73 65 66 75 6c 2c | 20 62 65 63 61 75 73 65 | useful,| because|
|00001240| 20 69 74 20 63 61 6e 20 | 62 65 20 61 64 6d 69 6e | it can |be admin|
|00001250| 69 73 74 65 72 65 64 20 | 64 75 72 69 6e 67 20 61 |istered |during a|
|00001260| 6e 20 61 63 75 74 65 20 | 65 76 65 6e 74 20 61 6e |n acute |event an|
|00001270| 64 0d 0a 6d 79 6f 63 61 | 72 64 69 61 6c 20 69 6d |d..myoca|rdial im|
|00001280| 61 67 69 6e 67 20 63 61 | 6e 20 62 65 20 70 65 72 |aging ca|n be per|
|00001290| 66 6f 72 6d 65 64 20 73 | 65 76 65 72 61 6c 20 68 |formed s|everal h|
|000012a0| 6f 75 72 73 20 6c 61 74 | 65 72 2e 20 20 49 6e 64 |ours lat|er. Ind|
|000012b0| 65 65 64 2c 20 74 68 65 | 20 61 67 65 6e 74 20 6d |eed, the| agent m|
|000012c0| 61 79 0d 0a 62 65 20 69 | 6e 6a 65 63 74 65 64 20 |ay..be i|njected |
|000012d0| 62 65 66 6f 72 65 20 74 | 68 72 6f 6d 62 6f 6c 79 |before t|hromboly|
|000012e0| 74 69 63 20 74 68 65 72 | 61 70 79 3b 20 69 6d 61 |tic ther|apy; ima|
|000012f0| 67 69 6e 67 20 63 6f 75 | 6c 64 20 74 68 65 6e 20 |ging cou|ld then |
|00001300| 62 65 20 63 61 72 72 69 | 65 64 20 6f 75 74 2c 0d |be carri|ed out,.|
|00001310| 0a 64 65 6d 6f 6e 73 74 | 72 61 74 69 6e 67 20 62 |.demonst|rating b|
|00001320| 6c 6f 6f 64 20 66 6c 6f | 77 20 64 69 73 74 72 69 |lood flo|w distri|
|00001330| 62 75 74 69 6f 6e 20 62 | 65 66 6f 72 65 20 74 68 |bution b|efore th|
|00001340| 65 72 61 70 79 20 69 73 | 20 69 6e 73 74 69 74 75 |erapy is| institu|
|00001350| 74 65 64 2e 0d 0a 20 20 | 20 20 20 4f 6b 61 64 61 |ted... | Okada|
|00001360| 20 65 74 20 61 6c 2e 20 | 5b 31 5d 20 68 61 76 65 | et al. |[1] have|
|00001370| 20 66 6f 75 6e 64 20 74 | 68 61 74 20 74 68 69 73 | found t|hat this|
|00001380| 20 6d 79 6f 63 61 72 64 | 69 61 6c 20 70 65 72 66 | myocard|ial perf|
|00001390| 75 73 69 6f 6e 20 69 6d | 61 67 69 6e 67 20 61 67 |usion im|aging ag|
|000013a0| 65 6e 74 20 69 73 0d 0a | 72 61 70 69 64 6c 79 20 |ent is..|rapidly |
|000013b0| 74 61 6b 65 6e 20 75 70 | 20 62 79 20 69 73 63 68 |taken up| by isch|
|000013c0| 65 6d 69 63 20 61 6e 64 | 20 6e 6f 6e 69 73 63 68 |emic and| nonisch|
|000013d0| 65 6d 69 63 20 6d 79 6f | 63 61 72 64 69 75 6d 20 |emic myo|cardium |
|000013e0| 69 6e 20 70 72 6f 70 6f | 72 74 69 6f 6e 20 74 6f |in propo|rtion to|
|000013f0| 0d 0a 72 65 67 69 6f 6e | 61 6c 20 62 6c 6f 6f 64 |..region|al blood|
|00001400| 20 66 6c 6f 77 2c 20 77 | 69 74 68 20 76 65 72 79 | flow, w|ith very|
|00001410| 20 73 6c 6f 77 20 77 61 | 73 68 6f 75 74 20 66 72 | slow wa|shout fr|
|00001420| 6f 6d 20 62 6f 74 68 20 | 6e 6f 6e 69 73 63 68 65 |om both |nonische|
|00001430| 6d 69 63 20 61 6e 64 20 | 69 73 63 68 65 6d 69 63 |mic and |ischemic|
|00001440| 0d 0a 6d 79 6f 63 61 72 | 64 69 75 6d 2e 20 20 54 |..myocar|dium. T|
|00001450| 68 69 73 20 70 72 6f 64 | 75 63 65 73 20 65 78 63 |his prod|uces exc|
|00001460| 65 6c 6c 65 6e 74 20 73 | 74 61 74 69 63 20 69 6d |ellent s|tatic im|
|00001470| 61 67 65 73 20 6f 76 65 | 72 20 73 65 76 65 72 61 |ages ove|r severa|
|00001480| 6c 20 68 6f 75 72 73 2e | 20 20 46 75 72 74 68 65 |l hours.| Furthe|
|00001490| 72 2c 0d 0a 39 39 6d 2d | 54 63 2d 43 50 49 20 73 |r,..99m-|Tc-CPI s|
|000014a0| 68 6f 75 6c 64 20 68 61 | 76 65 20 74 68 65 20 61 |hould ha|ve the a|
|000014b0| 64 64 69 74 69 6f 6e 61 | 6c 20 61 64 76 61 6e 74 |dditiona|l advant|
|000014c0| 61 67 65 20 6f 76 65 72 | 20 74 68 61 6c 6c 69 75 |age over| thalliu|
|000014d0| 6d 20 6f 66 20 6d 6f 72 | 65 20 72 65 61 64 79 0d |m of mor|e ready.|
|000014e0| 0a 61 76 61 69 6c 61 62 | 69 6c 69 74 79 2e 2d 2d |.availab|ility.--|
|000014f0| 45 2e 20 42 72 61 75 6e | 77 61 6c 64 2c 20 4d 2e |E. Braun|wald, M.|
|00001500| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00001510| 52 42 30 36 38 30 31 7d | 0d 0a 24 54 69 74 6c 65 |RB06801}|..$Title|
|00001520| 7b 54 68 65 20 52 6f 6c | 65 20 6f 66 20 49 6e 74 |{The Rol|e of Int|
|00001530| 72 61 63 6f 72 6f 6e 61 | 72 79 20 54 68 72 6f 6d |racorona|ry Throm|
|00001540| 62 75 73 20 69 6e 20 55 | 6e 73 74 61 62 6c 65 20 |bus in U|nstable |
|00001550| 41 6e 67 69 6e 61 3a 20 | 20 41 6e 67 69 6f 67 72 |Angina: | Angiogr|
|00001560| 61 70 68 69 63 20 41 73 | 73 65 73 73 6d 65 6e 74 |aphic As|sessment|
|00001570| 20 61 6e 64 20 54 68 72 | 6f 6d 62 6f 6c 79 74 69 | and Thr|ombolyti|
|00001580| 63 20 54 68 65 72 61 70 | 79 20 44 75 72 69 6e 67 |c Therap|y During|
|00001590| 20 4f 6e 67 6f 69 6e 67 | 20 41 6e 67 69 6e 61 6c | Ongoing| Anginal|
|000015a0| 20 41 74 74 61 63 6b 73 | 7d 0d 0a 24 41 75 74 68 | Attacks|}..$Auth|
|000015b0| 6f 72 7b 47 6f 74 6f 68 | 2c 20 4b 0d 0a 4d 69 6e |or{Gotoh|, K..Min|
|000015c0| 61 6d 69 6e 6f 2c 20 54 | 0d 0a 4b 61 74 6f 68 2c |amino, T|..Katoh,|
|000015d0| 20 4f 0d 0a 48 61 6d 61 | 6e 6f 2c 20 59 0d 0a 46 | O..Hama|no, Y..F|
|000015e0| 75 6b 75 69 2c 20 53 0d | 0a 48 6f 72 69 2c 20 4d |ukui, S.|.Hori, M|
|000015f0| 0d 0a 4b 75 73 75 6f 6b | 61 2c 20 48 0d 0a 4d 69 |..Kusuok|a, H..Mi|
|00001600| 73 68 69 6d 61 2c 20 4d | 0d 0a 49 6e 6f 75 65 2c |shima, M|..Inoue,|
|00001610| 20 4d 0d 0a 4b 61 6d 61 | 64 61 2c 20 54 7d 0d 0a | M..Kama|da, T}..|
|00001620| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 4f 73 61 |$Affilia|tion{Osa|
|00001630| 6b 61 20 55 6e 69 76 3b | 20 53 61 6b 75 72 61 62 |ka Univ;| Sakurab|
|00001640| 61 73 68 69 2d 57 61 74 | 61 6e 61 62 65 20 48 6f |ashi-Wat|anabe Ho|
|00001650| 73 70 2c 20 4f 73 61 6b | 61 2c 20 4a 61 70 61 6e |sp, Osak|a, Japan|
|00001660| 7d 0d 0a 24 53 75 62 6a | 65 63 74 7b 54 68 72 6f |}..$Subj|ect{Thro|
|00001670| 6d 62 6f 6c 79 73 69 73 | 20 64 75 72 69 6e 67 20 |mbolysis| during |
|00001680| 61 6e 67 69 6e 61 6c 20 | 61 74 74 61 63 6b 73 2c |anginal |attacks,|
|00001690| 20 61 6e 64 20 63 6f 72 | 6f 6e 61 72 79 20 74 68 | and cor|onary th|
|000016a0| 72 6f 6d 62 75 73 3b 20 | 54 68 72 6f 6d 62 69 0d |rombus; |Thrombi.|
|000016b0| 0a 69 6e 74 72 61 63 6f | 72 6f 6e 61 72 79 2c 20 |.intraco|ronary, |
|000016c0| 69 6e 20 75 6e 73 74 61 | 62 6c 65 20 61 6e 67 69 |in unsta|ble angi|
|000016d0| 6e 61 3b 20 49 6e 74 72 | 61 63 6f 72 6f 6e 61 72 |na; Intr|acoronar|
|000016e0| 79 20 74 68 72 6f 6d 62 | 75 73 20 69 6e 20 75 6e |y thromb|us in un|
|000016f0| 73 74 61 62 6c 65 20 61 | 6e 67 69 6e 61 3b 0d 0a |stable a|ngina;..|
|00001700| 43 6f 72 6f 6e 61 72 79 | 20 74 68 72 6f 6d 62 75 |Coronary| thrombu|
|00001710| 73 20 69 6e 20 75 6e 73 | 74 61 62 6c 65 20 61 6e |s in uns|table an|
|00001720| 67 69 6e 61 3b 20 41 6e | 67 69 6f 67 72 61 70 68 |gina; An|giograph|
|00001730| 79 20 64 75 72 69 6e 67 | 20 61 6e 67 69 6e 61 20 |y during| angina |
|00001740| 61 74 74 61 63 6b 73 2c | 20 61 6e 64 0d 0a 63 6f |attacks,| and..co|
|00001750| 72 6f 6e 61 72 79 20 74 | 68 72 6f 6d 62 75 73 3b |ronary t|hrombus;|
|00001760| 20 41 6e 67 69 6e 61 20 | 75 6e 73 74 61 62 6c 65 | Angina |unstable|
|00001770| 20 74 68 72 6f 6d 62 75 | 73 20 69 6e 2c 20 69 6e | thrombu|s in, in|
|00001780| 74 72 61 63 6f 72 6f 6e | 61 72 79 7d 0d 0a 24 4a |tracoron|ary}..$J|
|00001790| 6f 75 72 6e 61 6c 7b 43 | 69 72 63 75 6c 61 74 69 |ournal{C|irculati|
|000017a0| 6f 6e 7d 0d 0a 24 56 6f | 6c 75 6d 65 7b 37 37 7d |on}..$Vo|lume{77}|
|000017b0| 0d 0a 24 50 61 67 65 7b | 35 32 36 2d 35 33 34 7d |..$Page{|526-534}|
|000017c0| 0d 0a 24 44 61 74 65 7b | 4d 61 72 63 68 20 31 39 |..$Date{|March 19|
|000017d0| 38 38 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 38 39 |88}..$YB|Vol{1989|
|000017e0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4d 65 | Year Bo|ok of Me|
|000017f0| 64 69 63 69 6e 65 2c 20 | 50 61 72 74 20 46 6f 75 |dicine, |Part Fou|
|00001800| 72 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 33 31 2d |r}..$Cha|pter{31-|
|00001810| 33 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |3}..$YBE|ditor{Dr|
|00001820| 73 2e 20 52 6f 67 65 72 | 73 2c 20 44 65 73 20 50 |s. Roger|s, Des P|
|00001830| 72 65 7a 2c 20 43 6c 69 | 6e 65 2c 20 42 72 61 75 |rez, Cli|ne, Brau|
|00001840| 6e 77 61 6c 64 2c 20 47 | 72 65 65 6e 62 65 72 67 |nwald, G|reenberg|
|00001850| 65 72 2c 20 57 69 6c 73 | 6f 6e 2c 20 45 70 73 74 |er, Wils|on, Epst|
|00001860| 65 69 6e 2c 20 61 6e 64 | 20 4d 61 6c 61 77 69 73 |ein, and| Malawis|
|00001870| 74 61 7d 0d 0a 24 54 61 | 62 6c 65 7b 54 61 62 6c |ta}..$Ta|ble{Tabl|
|00001880| 65 20 4f 6d 69 74 74 65 | 64 7d 0d 0a 24 43 6f 6d |e Omitte|d}..$Com|
|00001890| 6d 65 6e 74 61 74 6f 72 | 7b 45 2e 20 42 72 61 75 |mentator|{E. Brau|
|000018a0| 6e 77 61 6c 64 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |nwald, M|.D.}....|
|000018b0| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|000018c0| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|000018d0| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|000018e0| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 39 20 59 |, 1989..|..1989 Y|
|000018f0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 4d 65 64 69 |ear Book| of Medi|
|00001900| 63 69 6e 65 20 28 52 29 | 0d 0a 0d 0a 50 61 72 74 |cine (R)|....Part|
|00001910| 20 46 6f 75 72 3a 20 20 | 54 68 65 20 48 65 61 72 | Four: |The Hear|
|00001920| 74 20 61 6e 64 20 43 61 | 72 64 69 6f 76 61 73 63 |t and Ca|rdiovasc|
|00001930| 75 6c 61 72 20 44 69 73 | 65 61 73 65 0d 0a 0d 0a |ular Dis|ease....|
|00001940| 43 68 61 70 74 65 72 20 | 33 31 2d 2d 43 68 72 6f |Chapter |31--Chro|
|00001950| 6e 69 63 20 43 6f 72 6f | 6e 61 72 79 20 41 72 74 |nic Coro|nary Art|
|00001960| 65 72 79 20 44 69 73 65 | 61 73 65 0d 0a 0d 0a 2d |ery Dise|ase....-|
|00001970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000019a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000019b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|000019c0| 0a 54 68 65 20 52 6f 6c | 65 20 6f 66 20 49 6e 74 |.The Rol|e of Int|
|000019d0| 72 61 63 6f 72 6f 6e 61 | 72 79 20 54 68 72 6f 6d |racorona|ry Throm|
|000019e0| 62 75 73 20 69 6e 20 55 | 6e 73 74 61 62 6c 65 20 |bus in U|nstable |
|000019f0| 41 6e 67 69 6e 61 3a 20 | 20 41 6e 67 69 6f 67 72 |Angina: | Angiogr|
|00001a00| 61 70 68 69 63 20 41 73 | 73 65 73 73 6d 65 6e 74 |aphic As|sessment|
|00001a10| 0d 0a 61 6e 64 20 54 68 | 72 6f 6d 62 6f 6c 79 74 |..and Th|rombolyt|
|00001a20| 69 63 20 54 68 65 72 61 | 70 79 20 44 75 72 69 6e |ic Thera|py Durin|
|00001a30| 67 20 4f 6e 67 6f 69 6e | 67 20 41 6e 67 69 6e 61 |g Ongoin|g Angina|
|00001a40| 6c 20 41 74 74 61 63 6b | 73 0d 0a 0d 0a 47 6f 74 |l Attack|s....Got|
|00001a50| 6f 68 20 4b 2c 20 4d 69 | 6e 61 6d 69 6e 6f 20 54 |oh K, Mi|namino T|
|00001a60| 2c 20 4b 61 74 6f 68 20 | 4f 2c 20 48 61 6d 61 6e |, Katoh |O, Haman|
|00001a70| 6f 20 59 2c 20 46 75 6b | 75 69 20 53 2c 20 48 6f |o Y, Fuk|ui S, Ho|
|00001a80| 72 69 20 4d 2c 20 4b 75 | 73 75 6f 6b 61 20 48 2c |ri M, Ku|suoka H,|
|00001a90| 20 4d 69 73 68 69 6d 61 | 20 4d 2c 0d 0a 49 6e 6f | Mishima| M,..Ino|
|00001aa0| 75 65 20 4d 2c 20 4b 61 | 6d 61 64 61 20 54 0d 0a |ue M, Ka|mada T..|
|00001ab0| 28 4f 73 61 6b 61 20 55 | 6e 69 76 3b 20 53 61 6b |(Osaka U|niv; Sak|
|00001ac0| 75 72 61 62 61 73 68 69 | 2d 57 61 74 61 6e 61 62 |urabashi|-Watanab|
|00001ad0| 65 20 48 6f 73 70 2c 20 | 4f 73 61 6b 61 2c 20 4a |e Hosp, |Osaka, J|
|00001ae0| 61 70 61 6e 29 0d 0a 43 | 69 72 63 75 6c 61 74 69 |apan)..C|irculati|
|00001af0| 6f 6e 20 37 37 3a 35 32 | 36 2d 35 33 34 2c 20 4d |on 77:52|6-534, M|
|00001b00| 61 72 63 68 20 31 39 38 | 38 0d 0a 2d 2d 2d 2d 2d |arch 198|8..-----|
|00001b10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001b50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00001b60| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00001b70| 54 68 65 20 72 65 70 6f | 72 74 65 64 20 69 6e 63 |The repo|rted inc|
|00001b80| 69 64 65 6e 63 65 20 6f | 66 20 63 6f 72 6f 6e 61 |idence o|f corona|
|00001b90| 72 79 20 74 68 72 6f 6d | 62 75 73 20 69 6e 20 70 |ry throm|bus in p|
|00001ba0| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 75 6e 73 |atients |with uns|
|00001bb0| 74 61 62 6c 65 0d 0a 61 | 6e 67 69 6e 61 20 76 61 |table..a|ngina va|
|00001bc0| 72 69 65 73 20 63 6f 6e | 73 69 64 65 72 61 62 6c |ries con|siderabl|
|00001bd0| 79 2c 20 66 72 6f 6d 20 | 31 25 20 74 6f 20 38 35 |y, from |1% to 85|
|00001be0| 25 2e 20 20 42 65 63 61 | 75 73 65 20 69 6e 74 72 |%. Beca|use intr|
|00001bf0| 61 63 6f 72 6f 6e 61 72 | 79 20 74 68 72 6f 6d 62 |acoronar|y thromb|
|00001c00| 75 73 20 63 61 6e 0d 0a | 66 6f 72 6d 20 72 61 70 |us can..|form rap|
|00001c10| 69 64 6c 79 20 61 6e 64 | 20 72 65 73 6f 6c 76 65 |idly and| resolve|
|00001c20| 20 73 70 6f 6e 74 61 6e | 65 6f 75 73 6c 79 2c 20 | spontan|eously, |
|00001c30| 74 68 65 20 70 6f 73 73 | 69 62 6c 65 20 72 6f 6c |the poss|ible rol|
|00001c40| 65 20 6f 66 20 63 6f 72 | 6f 6e 61 72 79 20 74 68 |e of cor|onary th|
|00001c50| 72 6f 6d 62 75 73 0d 0a | 69 6e 20 74 68 65 20 64 |rombus..|in the d|
|00001c60| 65 76 65 6c 6f 70 6d 65 | 6e 74 20 6f 66 20 75 6e |evelopme|nt of un|
|00001c70| 73 74 61 62 6c 65 20 61 | 6e 67 69 6e 61 20 73 68 |stable a|ngina sh|
|00001c80| 6f 75 6c 64 20 62 65 20 | 61 73 73 65 73 73 65 64 |ould be |assessed|
|00001c90| 20 64 75 72 69 6e 67 20 | 6f 6e 67 6f 69 6e 67 20 | during |ongoing |
|00001ca0| 61 6e 67 69 6e 61 6c 0d | 0a 61 74 74 61 63 6b 73 |anginal.|.attacks|
|00001cb0| 2e 20 20 54 6f 20 64 65 | 74 65 72 6d 69 6e 65 20 |. To de|termine |
|00001cc0| 74 68 65 20 6f 63 63 75 | 72 72 65 6e 63 65 20 6f |the occu|rrence o|
|00001cd0| 66 20 69 6e 74 72 61 63 | 6f 72 6f 6e 61 72 79 20 |f intrac|oronary |
|00001ce0| 74 68 72 6f 6d 62 75 73 | 20 64 75 72 69 6e 67 20 |thrombus| during |
|00001cf0| 6f 6e 67 6f 69 6e 67 0d | 0a 61 6e 67 69 6e 61 20 |ongoing.|.angina |
|00001d00| 70 65 63 74 6f 72 69 73 | 2c 20 63 6f 72 6f 6e 61 |pectoris|, corona|
|00001d10| 72 79 20 61 6e 67 69 6f | 67 72 61 70 68 79 20 77 |ry angio|graphy w|
|00001d20| 61 73 20 70 65 72 66 6f | 72 6d 65 64 20 64 75 72 |as perfo|rmed dur|
|00001d30| 69 6e 67 20 73 70 6f 6e | 74 61 6e 65 6f 75 73 20 |ing spon|taneous |
|00001d40| 69 73 63 68 65 6d 69 63 | 0d 0a 61 74 74 61 63 6b |ischemic|..attack|
|00001d50| 73 20 69 6e 20 33 37 20 | 70 61 74 69 65 6e 74 73 |s in 37 |patients|
|00001d60| 20 77 69 74 68 20 70 72 | 6f 6c 6f 6e 67 65 64 20 | with pr|olonged |
|00001d70| 72 65 73 74 20 61 6e 67 | 69 6e 61 2e 20 20 54 68 |rest ang|ina. Th|
|00001d80| 65 20 66 72 65 71 75 65 | 6e 63 79 20 6f 66 0d 0a |e freque|ncy of..|
|00001d90| 69 6e 74 72 61 63 6f 72 | 6f 6e 61 72 79 20 74 68 |intracor|onary th|
|00001da0| 72 6f 6d 62 75 73 2c 20 | 64 65 67 72 65 65 20 6f |rombus, |degree o|
|00001db0| 66 20 73 74 65 6e 6f 73 | 69 73 20 61 74 20 74 68 |f stenos|is at th|
|00001dc0| 65 20 74 69 6d 65 20 6f | 66 20 63 68 65 73 74 20 |e time o|f chest |
|00001dd0| 70 61 69 6e 2c 20 61 6e | 64 20 65 66 66 65 63 74 |pain, an|d effect|
|00001de0| 0d 0a 6f 66 20 74 68 72 | 6f 6d 62 6f 6c 79 74 69 |..of thr|ombolyti|
|00001df0| 63 20 74 68 65 72 61 70 | 79 20 77 65 72 65 20 65 |c therap|y were e|
|00001e00| 76 61 6c 75 61 74 65 64 | 20 61 74 20 74 68 65 20 |valuated| at the |
|00001e10| 74 69 6d 65 20 6f 66 20 | 63 68 65 73 74 20 70 61 |time of |chest pa|
|00001e20| 69 6e 2e 0d 0a 20 20 20 | 20 20 41 6c 6c 20 70 61 |in... | All pa|
|00001e30| 74 69 65 6e 74 73 20 68 | 61 64 20 6d 6f 72 65 20 |tients h|ad more |
|00001e40| 74 68 61 6e 20 35 30 25 | 20 73 74 65 6e 6f 73 69 |than 50%| stenosi|
|00001e50| 73 20 6f 66 20 61 74 20 | 6c 65 61 73 74 20 31 20 |s of at |least 1 |
|00001e60| 6d 61 6a 6f 72 20 63 6f | 72 6f 6e 61 72 79 0d 0a |major co|ronary..|
|00001e70| 61 72 74 65 72 79 2e 20 | 20 43 6f 72 6f 6e 61 72 |artery. | Coronar|
|00001e80| 79 20 61 6e 67 69 6f 67 | 72 61 70 68 79 20 77 61 |y angiog|raphy wa|
|00001e90| 73 20 70 65 72 66 6f 72 | 6d 65 64 20 61 74 20 74 |s perfor|med at t|
|00001ea0| 68 65 20 74 69 6d 65 20 | 6f 66 20 73 70 6f 6e 74 |he time |of spont|
|00001eb0| 61 6e 65 6f 75 73 20 69 | 73 63 68 65 6d 69 63 0d |aneous i|schemic.|
|00001ec0| 0a 61 74 74 61 63 6b 73 | 2e 20 20 41 20 74 79 70 |.attacks|. A typ|
|00001ed0| 69 63 61 6c 20 73 65 72 | 69 65 73 20 6f 66 20 61 |ical ser|ies of a|
|00001ee0| 6e 67 69 6f 67 72 61 6d | 73 20 73 68 6f 77 65 64 |ngiogram|s showed|
|00001ef0| 20 6f 62 73 74 72 75 63 | 74 69 6f 6e 2c 20 70 61 | obstruc|tion, pa|
|00001f00| 72 74 69 61 6c 20 72 65 | 6c 69 65 66 20 6f 66 0d |rtial re|lief of.|
|00001f10| 0a 74 68 65 20 6f 62 73 | 74 72 75 63 74 69 6f 6e |.the obs|truction|
|00001f20| 20 61 66 74 65 72 20 75 | 72 6f 6b 69 6e 61 73 65 | after u|rokinase|
|00001f30| 2c 20 61 6e 64 20 72 65 | 73 6f 6c 75 74 69 6f 6e |, and re|solution|
|00001f40| 20 34 20 77 65 65 6b 73 | 20 61 66 74 65 72 20 74 | 4 weeks| after t|
|00001f50| 68 72 6f 6d 62 6f 6c 79 | 73 69 73 20 28 46 69 67 |hromboly|sis (Fig|
|00001f60| 0d 0a 33 31 2d 31 29 2e | 20 20 54 77 65 6e 74 79 |..31-1).| Twenty|
|00001f70| 2d 6f 6e 65 20 70 61 74 | 69 65 6e 74 73 20 68 61 |-one pat|ients ha|
|00001f80| 64 20 61 6e 20 69 6e 74 | 72 61 63 6f 72 6f 6e 61 |d an int|racorona|
|00001f90| 72 79 20 74 68 72 6f 6d | 62 75 73 20 61 6e 64 20 |ry throm|bus and |
|00001fa0| 31 34 20 68 61 64 20 6f | 72 67 61 6e 69 63 0d 0a |14 had o|rganic..|
|00001fb0| 73 74 61 62 6c 65 20 6f | 62 73 74 72 75 63 74 69 |stable o|bstructi|
|00001fc0| 6f 6e 2e 20 20 49 6e 20 | 74 68 65 20 6c 61 74 74 |on. In |the latt|
|00001fd0| 65 72 20 70 61 74 69 65 | 6e 74 73 20 74 68 72 6f |er patie|nts thro|
|00001fe0| 6d 62 6f 6c 79 74 69 63 | 20 74 68 65 72 61 70 79 |mbolytic| therapy|
|00001ff0| 20 64 69 64 20 6e 6f 74 | 20 69 6d 70 72 6f 76 65 | did not| improve|
|00002000| 0d 0a 73 74 65 6e 6f 73 | 69 73 2e 20 20 57 69 74 |..stenos|is. Wit|
|00002010| 68 20 66 69 78 65 64 20 | 6f 62 73 74 72 75 63 74 |h fixed |obstruct|
|00002020| 69 6f 6e 73 20 74 68 65 | 20 72 61 74 65 2d 70 72 |ions the| rate-pr|
|00002030| 65 73 73 75 72 65 20 70 | 72 6f 64 75 63 74 20 77 |essure p|roduct w|
|00002040| 61 73 20 73 69 67 6e 69 | 66 69 63 61 6e 74 6c 79 |as signi|ficantly|
|00002050| 0d 0a 68 69 67 68 65 72 | 20 64 75 72 69 6e 67 20 |..higher| during |
|00002060| 61 20 70 65 72 69 6f 64 | 20 6f 66 20 61 63 74 69 |a period| of acti|
|00002070| 76 65 20 73 79 6d 70 74 | 6f 6d 73 2c 20 73 75 67 |ve sympt|oms, sug|
|00002080| 67 65 73 74 69 6e 67 20 | 74 68 61 74 20 61 20 74 |gesting |that a t|
|00002090| 65 6d 70 6f 72 61 72 79 | 20 69 6e 63 72 65 61 73 |emporary| increas|
|000020a0| 65 0d 0a 69 6e 20 6d 79 | 6f 63 61 72 64 69 61 6c |e..in my|ocardial|
|000020b0| 20 6f 78 79 67 65 6e 20 | 64 65 6d 61 6e 64 20 77 | oxygen |demand w|
|000020c0| 61 73 20 61 20 63 6f 6e | 74 72 69 62 75 74 69 6e |as a con|tributin|
|000020d0| 67 20 66 61 63 74 6f 72 | 20 69 6e 20 74 68 65 20 |g factor| in the |
|000020e0| 69 73 63 68 65 6d 69 63 | 20 61 74 74 61 63 6b 2e |ischemic| attack.|
|000020f0| 0d 0a 20 20 20 20 20 45 | 76 65 6e 20 74 68 6f 75 |.. E|ven thou|
|00002100| 67 68 20 74 68 72 6f 6d | 62 6f 6c 79 74 69 63 20 |gh throm|bolytic |
|00002110| 74 68 65 72 61 70 79 20 | 77 61 73 20 73 75 63 63 |therapy |was succ|
|00002120| 65 73 73 66 75 6c 2c 20 | 37 31 25 20 6f 66 20 70 |essful, |71% of p|
|00002130| 61 74 69 65 6e 74 73 20 | 77 69 74 68 0d 0a 69 6e |atients |with..in|
|00002140| 74 72 61 63 6f 72 6f 6e | 61 72 79 20 74 68 72 6f |tracoron|ary thro|
|00002150| 6d 62 75 73 20 65 78 70 | 65 72 69 65 6e 63 65 64 |mbus exp|erienced|
|00002160| 20 72 65 63 75 72 72 69 | 6e 67 20 73 79 6d 70 74 | recurri|ng sympt|
|00002170| 6f 6d 73 2e 20 20 54 68 | 65 73 65 20 70 61 74 69 |oms. Th|ese pati|
|00002180| 65 6e 74 73 20 61 6c 73 | 6f 20 68 61 64 0d 0a 61 |ents als|o had..a|
|00002190| 20 68 69 67 68 65 72 20 | 69 6e 63 69 64 65 6e 63 | higher |incidenc|
|000021a0| 65 20 6f 66 20 6d 79 6f | 63 61 72 64 69 61 6c 20 |e of myo|cardial |
|000021b0| 69 6e 66 61 72 63 74 69 | 6f 6e 20 61 66 74 65 72 |infarcti|on after|
|000021c0| 20 34 20 77 65 65 6b 73 | 20 28 32 34 25 29 20 74 | 4 weeks| (24%) t|
|000021d0| 68 61 6e 20 64 69 64 20 | 74 68 6f 73 65 0d 0a 77 |han did |those..w|
|000021e0| 69 74 68 6f 75 74 20 74 | 68 72 6f 6d 62 75 73 20 |ithout t|hrombus |
|000021f0| 28 37 25 29 2e 20 20 50 | 61 74 69 65 6e 74 73 20 |(7%). P|atients |
|00002200| 77 69 74 68 6f 75 74 20 | 74 68 72 6f 6d 62 75 73 |without |thrombus|
|00002210| 20 68 61 64 20 53 54 20 | 73 65 67 6d 65 6e 74 20 | had ST |segment |
|00002220| 64 65 70 72 65 73 73 69 | 6f 6e 2c 0d 0a 77 68 65 |depressi|on,..whe|
|00002230| 72 65 61 73 20 74 68 65 | 20 53 54 20 73 65 67 6d |reas the| ST segm|
|00002240| 65 6e 74 20 77 61 73 20 | 65 6c 65 76 61 74 65 64 |ent was |elevated|
|00002250| 20 69 6e 20 31 36 20 6f | 66 20 32 31 20 70 61 74 | in 16 o|f 21 pat|
|00002260| 69 65 6e 74 73 20 77 69 | 74 68 20 69 6e 74 72 61 |ients wi|th intra|
|00002270| 63 6f 72 6f 6e 61 72 79 | 0d 0a 74 68 72 6f 6d 62 |coronary|..thromb|
|00002280| 75 73 2e 0d 0a 20 20 20 | 20 20 49 6e 74 72 61 63 |us... | Intrac|
|00002290| 6f 72 6f 6e 61 72 79 20 | 74 68 72 6f 6d 62 75 73 |oronary |thrombus|
|000022a0| 20 6f 63 63 75 72 73 20 | 66 72 65 71 75 65 6e 74 | occurs |frequent|
|000022b0| 6c 79 20 64 75 72 69 6e | 67 20 61 74 74 61 63 6b |ly durin|g attack|
|000022c0| 73 20 6f 66 20 75 6e 73 | 74 61 62 6c 65 20 61 6e |s of uns|table an|
|000022d0| 67 69 6e 61 2e 0d 0a 54 | 68 65 20 70 72 6f 67 6e |gina...T|he progn|
|000022e0| 6f 73 69 73 20 66 6f 72 | 20 74 68 65 73 65 20 70 |osis for| these p|
|000022f0| 61 74 69 65 6e 74 73 20 | 69 73 20 6c 65 73 73 20 |atients |is less |
|00002300| 66 61 76 6f 72 61 62 6c | 65 20 74 68 61 6e 20 74 |favorabl|e than t|
|00002310| 68 61 74 20 66 6f 72 20 | 70 61 74 69 65 6e 74 73 |hat for |patients|
|00002320| 20 77 69 74 68 0d 0a 6f | 72 67 61 6e 69 63 20 73 | with..o|rganic s|
|00002330| 74 61 62 6c 65 20 6f 62 | 73 74 72 75 63 74 69 6f |table ob|structio|
|00002340| 6e 2e 0d 0a 0d 0a 50 6f | 73 74 2d 43 6f 6d 6d 65 |n.....Po|st-Comme|
|00002350| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 50 65 72 68 61 |nt.... | Perha|
|00002360| 70 73 20 74 68 65 20 62 | 65 73 74 20 65 76 69 64 |ps the b|est evid|
|00002370| 65 6e 63 65 20 74 68 61 | 74 20 75 6e 73 74 61 62 |ence tha|t unstab|
|00002380| 6c 65 20 61 6e 67 69 6e | 61 20 69 73 20 6f 66 74 |le angin|a is oft|
|00002390| 65 6e 20 63 61 75 73 65 | 64 20 62 79 20 63 6f 72 |en cause|d by cor|
|000023a0| 6f 6e 61 72 79 0d 0a 74 | 68 72 6f 6d 62 6f 73 69 |onary..t|hrombosi|
|000023b0| 73 20 77 61 73 20 6f 62 | 74 61 69 6e 65 64 20 62 |s was ob|tained b|
|000023c0| 79 20 53 68 65 72 6d 61 | 6e 20 65 74 20 61 6c 2e |y Sherma|n et al.|
|000023d0| 2c 20 5b 31 5d 20 77 68 | 6f 20 75 73 65 64 20 63 |, [1] wh|o used c|
|000023e0| 6f 72 6f 6e 61 72 79 20 | 61 6e 67 69 6f 73 63 6f |oronary |angiosco|
|000023f0| 70 79 20 61 74 0d 0a 74 | 68 65 20 74 69 6d 65 20 |py at..t|he time |
|00002400| 6f 66 20 73 75 72 67 65 | 72 79 20 61 6e 64 20 66 |of surge|ry and f|
|00002410| 6f 75 6e 64 20 61 20 68 | 69 67 68 20 69 6e 63 69 |ound a h|igh inci|
|00002420| 64 65 6e 63 65 20 6f 66 | 20 74 68 72 6f 6d 62 69 |dence of| thrombi|
|00002430| 2e 20 20 54 68 65 20 69 | 6e 74 65 72 65 73 74 69 |. The i|nteresti|
|00002440| 6e 67 0d 0a 70 61 70 65 | 72 20 62 79 20 47 6f 74 |ng..pape|r by Got|
|00002450| 6f 68 20 65 74 20 61 6c | 2e 2c 20 61 62 73 74 72 |oh et al|., abstr|
|00002460| 61 63 74 65 64 20 61 62 | 6f 76 65 2c 20 65 6d 70 |acted ab|ove, emp|
|00002470| 68 61 73 69 7a 65 73 20 | 74 68 61 74 20 74 68 65 |hasizes |that the|
|00002480| 20 69 6e 63 69 64 65 6e | 63 65 20 6f 66 0d 0a 74 | inciden|ce of..t|
|00002490| 68 72 6f 6d 62 69 20 69 | 6e 20 75 6e 73 74 61 62 |hrombi i|n unstab|
|000024a0| 6c 65 20 61 6e 67 69 6e | 61 20 69 73 20 61 20 66 |le angin|a is a f|
|000024b0| 75 6e 63 74 69 6f 6e 20 | 6f 66 20 68 6f 77 20 73 |unction |of how s|
|000024c0| 6f 6f 6e 20 61 66 74 65 | 72 20 74 68 65 20 6c 61 |oon afte|r the la|
|000024d0| 73 74 20 65 70 69 73 6f | 64 65 20 6f 66 0d 0a 69 |st episo|de of..i|
|000024e0| 73 63 68 65 6d 69 63 20 | 70 61 69 6e 20 74 68 65 |schemic |pain the|
|000024f0| 20 70 61 74 69 65 6e 74 | 20 69 73 20 73 74 75 64 | patient| is stud|
|00002500| 69 65 64 20 61 6e 67 69 | 6f 67 72 61 70 68 69 63 |ied angi|ographic|
|00002510| 61 6c 6c 79 3b 20 74 68 | 65 20 69 6e 63 69 64 65 |ally; th|e incide|
|00002520| 6e 63 65 20 76 61 72 69 | 65 73 0d 0a 69 6e 76 65 |nce vari|es..inve|
|00002530| 72 73 65 6c 79 20 77 69 | 74 68 20 74 68 69 73 20 |rsely wi|th this |
|00002540| 74 69 6d 65 20 69 6e 74 | 65 72 76 61 6c 2e 20 20 |time int|erval. |
|00002550| 4f 6e 65 20 64 69 73 61 | 70 70 6f 69 6e 74 69 6e |One disa|ppointin|
|00002560| 67 20 66 65 61 74 75 72 | 65 20 6f 66 20 74 68 69 |g featur|e of thi|
|00002570| 73 20 73 74 75 64 79 20 | 69 73 0d 0a 74 68 61 74 |s study |is..that|
|00002580| 2c 20 61 6c 74 68 6f 75 | 67 68 20 75 72 6f 6b 69 |, althou|gh uroki|
|00002590| 6e 61 73 65 20 77 61 73 | 20 73 75 63 63 65 73 73 |nase was| success|
|000025a0| 66 75 6c 20 69 6e 20 6c | 79 73 69 6e 67 20 74 68 |ful in l|ysing th|
|000025b0| 65 73 65 20 63 6c 6f 74 | 73 2c 20 70 61 74 69 65 |ese clot|s, patie|
|000025c0| 6e 74 73 20 77 69 74 68 | 0d 0a 75 6e 73 74 61 62 |nts with|..unstab|
|000025d0| 6c 65 20 61 6e 67 69 6e | 61 20 77 69 74 68 20 63 |le angin|a with c|
|000025e0| 6f 72 6f 6e 61 72 79 20 | 74 68 72 6f 6d 62 69 20 |oronary |thrombi |
|000025f0| 73 74 69 6c 6c 20 68 61 | 64 20 61 20 68 69 67 68 |still ha|d a high|
|00002600| 65 72 20 69 6e 63 69 64 | 65 6e 63 65 20 6f 66 20 |er incid|ence of |
|00002610| 6d 79 6f 63 61 72 64 69 | 61 6c 0d 0a 69 6e 66 61 |myocardi|al..infa|
|00002620| 72 63 74 69 6f 6e 2e 20 | 20 50 61 74 69 65 6e 74 |rction. | Patient|
|00002630| 73 20 77 69 74 68 20 74 | 68 72 6f 6d 62 69 20 74 |s with t|hrombi t|
|00002640| 65 6e 64 20 74 6f 20 68 | 61 76 65 20 61 6e 67 69 |end to h|ave angi|
|00002650| 6e 61 20 61 74 20 72 65 | 73 74 2c 20 77 68 65 72 |na at re|st, wher|
|00002660| 65 61 73 20 74 68 6f 73 | 65 0d 0a 77 69 74 68 6f |eas thos|e..witho|
|00002670| 75 74 20 63 6f 72 6f 6e | 61 72 79 20 74 68 72 6f |ut coron|ary thro|
|00002680| 6d 62 69 20 68 61 76 65 | 20 75 6e 73 74 61 62 6c |mbi have| unstabl|
|00002690| 65 20 61 6e 67 69 6e 61 | 20 70 72 65 63 69 70 69 |e angina| precipi|
|000026a0| 74 61 74 65 64 20 62 79 | 20 61 6e 20 69 6e 63 72 |tated by| an incr|
|000026b0| 65 61 73 65 20 69 6e 0d | 0a 6d 79 6f 63 61 72 64 |ease in.|.myocard|
|000026c0| 69 61 6c 20 6f 78 79 67 | 65 6e 20 64 65 6d 61 6e |ial oxyg|en deman|
|000026d0| 64 73 2e 2d 2d 45 2e 20 | 42 72 61 75 6e 77 61 6c |ds.--E. |Braunwal|
|000026e0| 64 2c 20 4d 2e 44 2e 0d | 0a 24 55 6e 69 71 75 65 |d, M.D..|.$Unique|
|000026f0| 5f 49 44 7b 59 52 42 30 | 36 38 30 32 7d 0d 0a 24 |_ID{YRB0|6802}..$|
|00002700| 54 69 74 6c 65 7b 46 69 | 62 72 69 6e 20 61 6e 64 |Title{Fi|brin and|
|00002710| 20 46 69 62 72 69 6e 6f | 67 65 6e 2d 52 65 6c 61 | Fibrino|gen-Rela|
|00002720| 74 65 64 20 41 6e 74 69 | 67 65 6e 73 20 69 6e 20 |ted Anti|gens in |
|00002730| 50 61 74 69 65 6e 74 73 | 20 57 69 74 68 20 53 74 |Patients| With St|
|00002740| 61 62 6c 65 20 61 6e 64 | 20 55 6e 73 74 61 62 6c |able and| Unstabl|
|00002750| 65 20 43 6f 72 6f 6e 61 | 72 79 20 41 72 74 65 72 |e Corona|ry Arter|
|00002760| 79 20 44 69 73 65 61 73 | 65 7d 0d 0a 24 41 75 74 |y Diseas|e}..$Aut|
|00002770| 68 6f 72 7b 4b 72 75 73 | 6b 61 6c 2c 20 4a 42 0d |hor{Krus|kal, JB.|
|00002780| 0a 43 6f 6d 6d 65 72 66 | 6f 72 64 2c 20 50 4a 0d |.Commerf|ord, PJ.|
|00002790| 0a 46 72 61 6e 6b 73 2c | 20 4a 4a 0d 0a 4b 69 72 |.Franks,| JJ..Kir|
|000027a0| 73 63 68 2c 20 52 45 7d | 0d 0a 24 41 66 66 69 6c |sch, RE}|..$Affil|
|000027b0| 69 61 74 69 6f 6e 7b 55 | 6e 69 76 20 6f 66 20 43 |iation{U|niv of C|
|000027c0| 61 70 65 20 54 6f 77 6e | 3b 20 47 72 6f 6f 74 65 |ape Town|; Groote|
|000027d0| 20 53 63 68 75 75 72 20 | 48 6f 73 70 2c 20 43 61 | Schuur |Hosp, Ca|
|000027e0| 70 65 20 54 6f 77 6e 3b | 20 56 61 6e 64 65 72 62 |pe Town;| Vanderb|
|000027f0| 69 6c 74 20 55 6e 69 76 | 7d 0d 0a 24 53 75 62 6a |ilt Univ|}..$Subj|
|00002800| 65 63 74 7b 46 69 62 72 | 69 6e 6f 67 65 6e 2d 72 |ect{Fibr|inogen-r|
|00002810| 65 6c 61 74 65 64 20 61 | 6e 74 69 67 65 6e 73 20 |elated a|ntigens |
|00002820| 69 6e 20 63 6f 72 6f 6e | 61 72 79 20 61 72 74 65 |in coron|ary arte|
|00002830| 72 79 20 64 69 73 65 61 | 73 65 3b 20 46 69 62 72 |ry disea|se; Fibr|
|00002840| 69 6e 2d 72 65 6c 61 74 | 65 64 0d 0a 61 6e 74 69 |in-relat|ed..anti|
|00002850| 67 65 6e 73 20 69 6e 20 | 63 6f 72 6f 6e 61 72 79 |gens in |coronary|
|00002860| 20 61 72 74 65 72 79 20 | 64 69 73 65 61 73 65 3b | artery |disease;|
|00002870| 20 43 6f 72 6f 6e 61 72 | 79 20 61 72 74 65 72 79 | Coronar|y artery|
|00002880| 20 64 69 73 65 61 73 65 | 20 61 6e 74 69 67 65 6e | disease| antigen|
|00002890| 73 20 69 6e 2c 20 66 69 | 62 72 69 6e 0d 0a 61 6e |s in, fi|brin..an|
|000028a0| 64 20 66 69 62 72 69 6e | 6f 67 65 6e 2d 72 65 6c |d fibrin|ogen-rel|
|000028b0| 61 74 65 64 3b 20 41 6e | 74 69 67 65 6e 2c 20 41 |ated; An|tigen, A|
|000028c0| 6e 74 69 67 65 6e 73 20 | 66 69 62 72 69 6e 6f 67 |ntigens |fibrinog|
|000028d0| 65 6e 2d 72 65 6c 61 74 | 65 64 2c 20 69 6e 20 63 |en-relat|ed, in c|
|000028e0| 6f 72 6f 6e 61 72 79 20 | 61 72 74 65 72 79 0d 0a |oronary |artery..|
|000028f0| 64 69 73 65 61 73 65 3b | 20 41 6e 74 69 67 65 6e |disease;| Antigen|
|00002900| 2c 20 41 6e 74 69 67 65 | 6e 73 20 66 69 62 72 69 |, Antige|ns fibri|
|00002910| 6e 2d 72 65 6c 61 74 65 | 64 2c 20 69 6e 20 63 6f |n-relate|d, in co|
|00002920| 72 6f 6e 61 72 79 20 61 | 72 74 65 72 79 20 64 69 |ronary a|rtery di|
|00002930| 73 65 61 73 65 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c |sease}..|$Journal|
|00002940| 7b 4e 20 45 6e 67 6c 20 | 4a 20 4d 65 64 7d 0d 0a |{N Engl |J Med}..|
|00002950| 24 56 6f 6c 75 6d 65 7b | 33 31 37 7d 0d 0a 24 50 |$Volume{|317}..$P|
|00002960| 61 67 65 7b 31 33 36 31 | 2d 31 33 36 35 7d 0d 0a |age{1361|-1365}..|
|00002970| 24 44 61 74 65 7b 4e 6f | 76 20 32 36 2c 20 31 39 |$Date{No|v 26, 19|
|00002980| 38 37 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 38 39 |87}..$YB|Vol{1989|
|00002990| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4d 65 | Year Bo|ok of Me|
|000029a0| 64 69 63 69 6e 65 2c 20 | 50 61 72 74 20 46 6f 75 |dicine, |Part Fou|
|000029b0| 72 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 33 31 2d |r}..$Cha|pter{31-|
|000029c0| 34 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |4}..$YBE|ditor{Dr|
|000029d0| 73 2e 20 52 6f 67 65 72 | 73 2c 20 44 65 73 20 50 |s. Roger|s, Des P|
|000029e0| 72 65 7a 2c 20 43 6c 69 | 6e 65 2c 20 42 72 61 75 |rez, Cli|ne, Brau|
|000029f0| 6e 77 61 6c 64 2c 20 47 | 72 65 65 6e 62 65 72 67 |nwald, G|reenberg|
|00002a00| 65 72 2c 20 57 69 6c 73 | 6f 6e 2c 20 45 70 73 74 |er, Wils|on, Epst|
|00002a10| 65 69 6e 2c 20 61 6e 64 | 20 4d 61 6c 61 77 69 73 |ein, and| Malawis|
|00002a20| 74 61 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ta}..$Ta|ble{}..$|
|00002a30| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 45 2e 20 42 |Commenta|tor{E. B|
|00002a40| 72 61 75 6e 77 61 6c 64 | 2c 20 4d 2e 44 2e 7d 0d |raunwald|, M.D.}.|
|00002a50| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 63 29 |...Copyr|ight (c)|
|00002a60| 20 59 65 61 72 20 42 6f | 6f 6b 20 4d 65 64 69 63 | Year Bo|ok Medic|
|00002a70| 61 6c 20 50 75 62 6c 69 | 73 68 65 72 73 2c 20 49 |al Publi|shers, I|
|00002a80| 6e 63 2e 2c 20 31 39 38 | 39 0d 0a 0d 0a 31 39 38 |nc., 198|9....198|
|00002a90| 39 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 4d |9 Year B|ook of M|
|00002aa0| 65 64 69 63 69 6e 65 20 | 28 52 29 0d 0a 0d 0a 50 |edicine |(R)....P|
|00002ab0| 61 72 74 20 46 6f 75 72 | 3a 20 20 54 68 65 20 48 |art Four|: The H|
|00002ac0| 65 61 72 74 20 61 6e 64 | 20 43 61 72 64 69 6f 76 |eart and| Cardiov|
|00002ad0| 61 73 63 75 6c 61 72 20 | 44 69 73 65 61 73 65 0d |ascular |Disease.|
|00002ae0| 0a 0d 0a 43 68 61 70 74 | 65 72 20 33 31 2d 2d 43 |...Chapt|er 31--C|
|00002af0| 68 72 6f 6e 69 63 20 43 | 6f 72 6f 6e 61 72 79 20 |hronic C|oronary |
|00002b00| 41 72 74 65 72 79 20 44 | 69 73 65 61 73 65 0d 0a |Artery D|isease..|
|00002b10| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00002b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002b60| 2d 2d 0d 0a 46 69 62 72 | 69 6e 20 61 6e 64 20 46 |--..Fibr|in and F|
|00002b70| 69 62 72 69 6e 6f 67 65 | 6e 2d 52 65 6c 61 74 65 |ibrinoge|n-Relate|
|00002b80| 64 20 41 6e 74 69 67 65 | 6e 73 20 69 6e 20 50 61 |d Antige|ns in Pa|
|00002b90| 74 69 65 6e 74 73 20 57 | 69 74 68 20 53 74 61 62 |tients W|ith Stab|
|00002ba0| 6c 65 20 61 6e 64 20 55 | 6e 73 74 61 62 6c 65 0d |le and U|nstable.|
|00002bb0| 0a 43 6f 72 6f 6e 61 72 | 79 20 41 72 74 65 72 79 |.Coronar|y Artery|
|00002bc0| 20 44 69 73 65 61 73 65 | 0d 0a 0d 0a 4b 72 75 73 | Disease|....Krus|
|00002bd0| 6b 61 6c 20 4a 42 2c 20 | 43 6f 6d 6d 65 72 66 6f |kal JB, |Commerfo|
|00002be0| 72 64 20 50 4a 2c 20 46 | 72 61 6e 6b 73 20 4a 4a |rd PJ, F|ranks JJ|
|00002bf0| 2c 20 4b 69 72 73 63 68 | 20 52 45 0d 0a 28 55 6e |, Kirsch| RE..(Un|
|00002c00| 69 76 20 6f 66 20 43 61 | 70 65 20 54 6f 77 6e 3b |iv of Ca|pe Town;|
|00002c10| 20 47 72 6f 6f 74 65 20 | 53 63 68 75 75 72 20 48 | Groote |Schuur H|
|00002c20| 6f 73 70 2c 20 43 61 70 | 65 20 54 6f 77 6e 3b 20 |osp, Cap|e Town; |
|00002c30| 56 61 6e 64 65 72 62 69 | 6c 74 20 55 6e 69 76 29 |Vanderbi|lt Univ)|
|00002c40| 0d 0a 4e 20 45 6e 67 6c | 20 4a 20 4d 65 64 20 33 |..N Engl| J Med 3|
|00002c50| 31 37 3a 31 33 36 31 2d | 31 33 36 35 2c 20 4e 6f |17:1361-|1365, No|
|00002c60| 76 20 32 36 2c 20 31 39 | 38 37 0d 0a 2d 2d 2d 2d |v 26, 19|87..----|
|00002c70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ca0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002cb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00002cc0| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00002cd0| 20 43 6f 72 6f 6e 61 72 | 79 20 61 72 74 65 72 79 | Coronar|y artery|
|00002ce0| 20 74 68 72 6f 6d 62 6f | 73 69 73 20 6d 61 79 20 | thrombo|sis may |
|00002cf0| 70 6c 61 79 20 61 20 72 | 6f 6c 65 20 69 6e 20 74 |play a r|ole in t|
|00002d00| 68 65 20 70 61 74 68 6f | 67 65 6e 65 73 69 73 20 |he patho|genesis |
|00002d10| 6f 66 20 75 6e 73 74 61 | 62 6c 65 0d 0a 61 6e 67 |of unsta|ble..ang|
|00002d20| 69 6e 61 20 61 74 20 72 | 65 73 74 2e 20 20 54 65 |ina at r|est. Te|
|00002d30| 72 6d 69 6e 61 6c 20 62 | 72 65 61 6b 64 6f 77 6e |rminal b|reakdown|
|00002d40| 20 66 72 61 67 6d 65 6e | 74 73 20 73 70 65 63 69 | fragmen|ts speci|
|00002d50| 66 69 63 20 66 6f 72 20 | 66 69 62 72 69 6e 20 61 |fic for |fibrin a|
|00002d60| 6e 64 20 66 69 62 72 69 | 6e 6f 67 65 6e 0d 0a 61 |nd fibri|nogen..a|
|00002d70| 6e 64 20 69 6e 74 65 72 | 6d 65 64 69 61 74 65 20 |nd inter|mediate |
|00002d80| 66 72 61 67 6d 65 6e 74 | 73 20 70 72 6f 64 75 63 |fragment|s produc|
|00002d90| 65 64 20 64 75 72 69 6e | 67 20 66 6f 72 6d 61 74 |ed durin|g format|
|00002da0| 69 6f 6e 20 6f 66 20 66 | 69 62 72 69 6e 20 77 65 |ion of f|ibrin we|
|00002db0| 72 65 20 6d 65 61 73 75 | 72 65 64 20 69 6e 0d 0a |re measu|red in..|
|00002dc0| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 73 74 |patients| with st|
|00002dd0| 61 62 6c 65 20 61 6e 64 | 20 75 6e 73 74 61 62 6c |able and| unstabl|
|00002de0| 65 20 61 6e 67 69 6e 61 | 20 61 6e 64 20 69 6e 20 |e angina| and in |
|00002df0| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 61 63 |patients| with ac|
|00002e00| 75 74 65 20 6d 79 6f 63 | 61 72 64 69 61 6c 0d 0a |ute myoc|ardial..|
|00002e10| 69 6e 66 61 72 63 74 69 | 6f 6e 20 28 4d 49 29 2e |infarcti|on (MI).|
|00002e20| 0d 0a 20 20 20 20 20 50 | 61 74 69 65 6e 74 73 20 |.. P|atients |
|00002e30| 77 69 74 68 20 63 61 72 | 64 69 61 63 20 63 68 65 |with car|diac che|
|00002e40| 73 74 20 70 61 69 6e 20 | 77 65 72 65 20 6d 61 74 |st pain |were mat|
|00002e50| 63 68 65 64 20 77 69 74 | 68 20 62 6f 74 68 20 68 |ched wit|h both h|
|00002e60| 65 61 6c 74 68 79 20 61 | 6e 64 20 69 6c 6c 0d 0a |ealthy a|nd ill..|
|00002e70| 63 6f 6e 74 72 6f 6c 73 | 20 77 68 6f 20 68 61 64 |controls| who had|
|00002e80| 20 70 61 69 6e 20 6f 66 | 20 6e 6f 6e 63 61 72 64 | pain of| noncard|
|00002e90| 69 61 63 20 6f 72 69 67 | 69 6e 2e 20 20 50 61 74 |iac orig|in. Pat|
|00002ea0| 69 65 6e 74 73 20 77 69 | 74 68 20 63 68 65 73 74 |ients wi|th chest|
|00002eb0| 20 70 61 69 6e 20 77 65 | 72 65 0d 0a 73 75 62 64 | pain we|re..subd|
|00002ec0| 69 76 69 64 65 64 20 69 | 6e 74 6f 20 67 72 6f 75 |ivided i|nto grou|
|00002ed0| 70 73 20 61 63 63 6f 72 | 64 69 6e 67 20 74 6f 20 |ps accor|ding to |
|00002ee0| 77 68 65 74 68 65 72 20 | 74 68 65 79 20 68 61 64 |whether |they had|
|00002ef0| 20 70 61 69 6e 20 61 74 | 20 72 65 73 74 20 6f 72 | pain at| rest or|
|00002f00| 20 6f 6e 0d 0a 65 78 65 | 72 63 69 73 65 2e 20 20 | on..exe|rcise. |
|00002f10| 41 20 66 69 66 74 68 20 | 67 72 6f 75 70 20 77 61 |A fifth |group wa|
|00002f20| 73 20 63 6f 6d 70 6f 73 | 65 64 20 6f 66 20 70 61 |s compos|ed of pa|
|00002f30| 74 69 65 6e 74 73 20 77 | 69 74 68 20 61 63 75 74 |tients w|ith acut|
|00002f40| 65 20 4d 49 2e 20 20 53 | 65 72 75 6d 0d 0a 63 6f |e MI. S|erum..co|
|00002f50| 6e 63 65 6e 74 72 61 74 | 69 6f 6e 73 20 6f 66 20 |ncentrat|ions of |
|00002f60| 66 69 62 72 69 6e 2d 72 | 65 6c 61 74 65 64 20 61 |fibrin-r|elated a|
|00002f70| 6e 74 69 67 65 6e 2c 20 | 44 20 64 69 6d 65 72 2c |ntigen, |D dimer,|
|00002f80| 20 61 6e 64 20 66 69 62 | 72 69 6e 20 6d 6f 6e 6f | and fib|rin mono|
|00002f90| 6d 65 72 20 77 65 72 65 | 0d 0a 6d 65 61 73 75 72 |mer were|..measur|
|00002fa0| 65 64 20 69 6e 20 61 6c | 6c 20 67 72 6f 75 70 73 |ed in al|l groups|
|00002fb0| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 63 6f 6e 63 |... |The conc|
|00002fc0| 65 6e 74 72 61 74 69 6f | 6e 20 6f 66 20 66 69 62 |entratio|n of fib|
|00002fd0| 72 69 6e 2d 72 65 6c 61 | 74 65 64 20 61 6e 74 69 |rin-rela|ted anti|
|00002fe0| 67 65 6e 20 77 61 73 20 | 6e 6f 72 6d 61 6c 20 69 |gen was |normal i|
|00002ff0| 6e 20 63 6f 6e 74 72 6f | 6c 73 20 77 69 74 68 0d |n contro|ls with.|
|00003000| 0a 6e 6f 6e 63 61 72 64 | 69 61 63 20 70 61 69 6e |.noncard|iac pain|
|00003010| 20 61 6e 64 20 69 6e 20 | 70 61 74 69 65 6e 74 73 | and in |patients|
|00003020| 20 77 69 74 68 20 63 68 | 72 6f 6e 69 63 20 73 74 | with ch|ronic st|
|00003030| 61 62 6c 65 20 61 6e 67 | 69 6e 61 3b 20 69 74 20 |able ang|ina; it |
|00003040| 77 61 73 20 69 6e 63 72 | 65 61 73 65 64 20 69 6e |was incr|eased in|
|00003050| 0d 0a 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |..patien|ts with |
|00003060| 61 63 75 74 65 20 4d 49 | 20 6f 72 20 75 6e 73 74 |acute MI| or unst|
|00003070| 61 62 6c 65 20 61 6e 67 | 69 6e 61 2e 20 20 43 6f |able ang|ina. Co|
|00003080| 6e 63 65 6e 74 72 61 74 | 69 6f 6e 73 20 6f 66 20 |ncentrat|ions of |
|00003090| 44 20 64 69 6d 65 72 20 | 77 65 72 65 20 6c 6f 77 |D dimer |were low|
|000030a0| 65 72 0d 0a 69 6e 20 62 | 6f 74 68 20 63 6f 6e 74 |er..in b|oth cont|
|000030b0| 72 6f 6c 20 67 72 6f 75 | 70 73 20 61 6e 64 20 69 |rol grou|ps and i|
|000030c0| 6e 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |n patien|ts with |
|000030d0| 73 74 61 62 6c 65 20 61 | 6e 67 69 6e 61 20 74 68 |stable a|ngina th|
|000030e0| 61 6e 20 69 6e 20 70 61 | 74 69 65 6e 74 73 20 77 |an in pa|tients w|
|000030f0| 69 74 68 0d 0a 75 6e 73 | 74 61 62 6c 65 20 61 6e |ith..uns|table an|
|00003100| 67 69 6e 61 20 6f 72 20 | 61 63 75 74 65 20 4d 49 |gina or |acute MI|
|00003110| 2e 20 20 54 68 65 20 68 | 69 67 68 65 73 74 20 63 |. The h|ighest c|
|00003120| 6f 6e 63 65 6e 74 72 61 | 74 69 6f 6e 73 20 6f 66 |oncentra|tions of|
|00003130| 20 66 69 62 72 69 6e 20 | 6d 6f 6e 6f 6d 65 72 20 | fibrin |monomer |
|00003140| 77 65 72 65 0d 0a 66 6f | 75 6e 64 20 69 6e 20 70 |were..fo|und in p|
|00003150| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 61 63 75 |atients |with acu|
|00003160| 74 65 20 4d 49 2e 20 20 | 50 61 74 69 65 6e 74 73 |te MI. |Patients|
|00003170| 20 77 69 74 68 20 75 6e | 73 74 61 62 6c 65 20 61 | with un|stable a|
|00003180| 6e 67 69 6e 61 20 68 61 | 64 20 6d 6f 64 65 72 61 |ngina ha|d modera|
|00003190| 74 65 0d 0a 63 6f 6e 63 | 65 6e 74 72 61 74 69 6f |te..conc|entratio|
|000031a0| 6e 73 2c 20 77 68 65 72 | 65 61 73 20 69 6c 6c 20 |ns, wher|eas ill |
|000031b0| 63 6f 6e 74 72 6f 6c 73 | 20 61 6e 64 20 70 61 74 |controls| and pat|
|000031c0| 69 65 6e 74 73 20 77 69 | 74 68 20 73 74 61 62 6c |ients wi|th stabl|
|000031d0| 65 20 61 6e 67 69 6e 61 | 20 68 61 64 20 6e 6f 72 |e angina| had nor|
|000031e0| 6d 61 6c 0d 0a 63 6f 6e | 63 65 6e 74 72 61 74 69 |mal..con|centrati|
|000031f0| 6f 6e 73 2e 0d 0a 20 20 | 20 20 20 49 74 20 61 70 |ons... | It ap|
|00003200| 70 65 61 72 73 20 74 68 | 61 74 20 74 68 65 72 65 |pears th|at there|
|00003210| 20 69 73 20 61 6e 20 61 | 63 74 69 76 65 20 74 68 | is an a|ctive th|
|00003220| 72 6f 6d 62 6f 74 69 63 | 20 70 72 6f 63 65 73 73 |rombotic| process|
|00003230| 20 69 6e 20 70 61 74 69 | 65 6e 74 73 20 77 69 74 | in pati|ents wit|
|00003240| 68 0d 0a 61 63 75 74 65 | 20 4d 49 20 6f 72 20 75 |h..acute| MI or u|
|00003250| 6e 73 74 61 62 6c 65 20 | 61 6e 67 69 6e 61 20 61 |nstable |angina a|
|00003260| 74 20 72 65 73 74 2e 20 | 20 49 66 20 75 6e 73 74 |t rest. | If unst|
|00003270| 61 62 6c 65 20 61 6e 67 | 69 6e 61 20 61 74 20 72 |able ang|ina at r|
|00003280| 65 73 74 20 69 73 20 69 | 6e 64 65 65 64 0d 0a 61 |est is i|ndeed..a|
|00003290| 73 73 6f 63 69 61 74 65 | 64 20 77 69 74 68 20 74 |ssociate|d with t|
|000032a0| 68 72 6f 6d 62 6f 73 69 | 73 20 61 6e 64 20 73 70 |hrombosi|s and sp|
|000032b0| 6f 6e 74 61 6e 65 6f 75 | 73 20 6c 79 73 69 73 2c |ontaneou|s lysis,|
|000032c0| 20 70 72 6f 67 72 65 73 | 73 69 6f 6e 20 74 6f 20 | progres|sion to |
|000032d0| 4d 49 20 6d 61 79 20 62 | 65 0d 0a 70 72 65 76 65 |MI may b|e..preve|
|000032e0| 6e 74 65 64 20 62 79 20 | 74 68 72 6f 6d 62 6f 6c |nted by |thrombol|
|000032f0| 79 74 69 63 2c 20 61 6e | 74 69 70 6c 61 74 65 6c |ytic, an|tiplatel|
|00003300| 65 74 2c 20 6f 72 20 61 | 6e 74 69 63 6f 61 67 75 |et, or a|nticoagu|
|00003310| 6c 61 6e 74 20 74 68 65 | 72 61 70 79 2e 0d 0a 0d |lant the|rapy....|
|00003320| 0a 50 6f 73 74 2d 43 6f | 6d 6d 65 6e 74 0d 0a 0d |.Post-Co|mment...|
|00003330| 0a 20 20 20 20 20 54 68 | 65 20 6e 6f 74 69 6f 6e |. Th|e notion|
|00003340| 20 74 68 61 74 20 61 20 | 70 61 72 74 69 61 6c 6c | that a |partiall|
|00003350| 79 20 6f 63 63 6c 75 73 | 69 76 65 20 74 68 72 6f |y occlus|ive thro|
|00003360| 6d 62 75 73 20 69 73 20 | 65 74 69 6f 6c 6f 67 69 |mbus is |etiologi|
|00003370| 63 61 6c 6c 79 20 69 6d | 70 6f 72 74 61 6e 74 0d |cally im|portant.|
|00003380| 0a 69 6e 20 75 6e 73 74 | 61 62 6c 65 20 61 6e 67 |.in unst|able ang|
|00003390| 69 6e 61 20 69 73 20 73 | 75 70 70 6f 72 74 65 64 |ina is s|upported|
|000033a0| 20 6e 6f 74 20 6f 6e 6c | 79 20 62 79 20 61 6e 67 | not onl|y by ang|
|000033b0| 69 6f 67 72 61 70 68 69 | 63 20 61 6e 64 20 61 6e |iographi|c and an|
|000033c0| 67 69 6f 73 63 6f 70 69 | 63 20 73 74 75 64 69 65 |gioscopi|c studie|
|000033d0| 73 0d 0a 28 73 65 65 20 | 41 62 73 74 72 61 63 74 |s..(see |Abstract|
|000033e0| 20 33 31 2d 33 29 2c 20 | 62 75 74 20 61 6c 73 6f | 31-3), |but also|
|000033f0| 20 62 79 20 74 68 65 20 | 6f 62 73 65 72 76 61 74 | by the |observat|
|00003400| 69 6f 6e 20 74 68 61 74 | 20 70 6c 61 74 65 6c 65 |ion that| platele|
|00003410| 74 20 61 63 74 69 76 61 | 74 69 6f 6e 20 61 6e 64 |t activa|tion and|
|00003420| 0d 0a 74 68 72 6f 6d 62 | 69 6e 20 67 65 6e 65 72 |..thromb|in gener|
|00003430| 61 74 69 6f 6e 20 6f 63 | 63 75 72 20 69 6e 20 74 |ation oc|cur in t|
|00003440| 68 65 73 65 20 70 61 74 | 69 65 6e 74 73 2e 20 20 |hese pat|ients. |
|00003450| 49 6e 20 74 68 65 20 31 | 39 38 38 20 59 45 41 52 |In the 1|988 YEAR|
|00003460| 20 42 4f 4f 4b 20 4f 46 | 20 4d 45 44 49 43 49 4e | BOOK OF| MEDICIN|
|00003470| 45 0d 0a 28 70 70 20 33 | 34 37 2d 33 34 38 29 20 |E..(pp 3|47-348) |
|00003480| 69 74 20 77 61 73 20 70 | 6f 69 6e 74 65 64 20 6f |it was p|ointed o|
|00003490| 75 74 20 74 68 61 74 20 | 66 69 62 72 69 6e 6f 70 |ut that |fibrinop|
|000034a0| 65 70 74 69 64 65 20 41 | 2c 20 61 20 70 65 70 74 |eptide A|, a pept|
|000034b0| 69 64 65 20 72 65 6c 65 | 61 73 65 64 20 66 72 6f |ide rele|ased fro|
|000034c0| 6d 0d 0a 74 68 65 20 61 | 6c 70 68 61 20 63 68 61 |m..the a|lpha cha|
|000034d0| 69 6e 20 6f 66 20 66 69 | 62 72 69 6e 6f 67 65 6e |in of fi|brinogen|
|000034e0| 20 6f 6e 20 74 68 65 20 | 73 70 65 63 69 66 69 63 | on the |specific|
|000034f0| 20 61 63 74 69 6f 6e 20 | 6f 66 20 74 68 72 6f 6d | action |of throm|
|00003500| 62 69 6e 2c 20 69 73 20 | 61 20 73 65 6e 73 69 74 |bin, is |a sensit|
|00003510| 69 76 65 0d 0a 6d 61 72 | 6b 65 72 20 6f 66 20 66 |ive..mar|ker of f|
|00003520| 69 62 72 69 6e 20 66 6f | 72 6d 61 74 69 6f 6e 20 |ibrin fo|rmation |
|00003530| 61 6e 64 20 74 68 65 20 | 72 65 63 65 6e 74 20 6f |and the |recent o|
|00003540| 63 63 75 72 72 65 6e 63 | 65 20 6f 66 20 74 68 72 |ccurrenc|e of thr|
|00003550| 6f 6d 62 6f 73 69 73 2e | 20 20 54 68 65 20 66 69 |ombosis.| The fi|
|00003560| 6e 64 69 6e 67 0d 0a 69 | 6e 20 74 68 65 20 73 74 |nding..i|n the st|
|00003570| 75 64 79 20 61 62 73 74 | 72 61 63 74 65 64 20 61 |udy abst|racted a|
|00003580| 62 6f 76 65 20 6f 66 20 | 65 6c 65 76 61 74 69 6f |bove of |elevatio|
|00003590| 6e 73 20 6f 66 20 66 69 | 62 72 69 6e 2d 72 65 6c |ns of fi|brin-rel|
|000035a0| 61 74 65 64 20 61 6e 74 | 69 67 65 6e 2c 20 44 20 |ated ant|igen, D |
|000035b0| 64 69 6d 65 72 2c 0d 0a | 61 6e 64 20 66 69 62 72 |dimer,..|and fibr|
|000035c0| 69 6e 20 6d 6f 6e 6f 6d | 65 72 2c 20 61 6c 6c 20 |in monom|er, all |
|000035d0| 70 72 6f 64 75 63 74 73 | 20 6f 66 20 74 68 72 6f |products| of thro|
|000035e0| 6d 62 6f 73 69 73 20 6f | 72 20 74 68 72 6f 6d 62 |mbosis o|r thromb|
|000035f0| 6f 6c 79 73 69 73 2c 20 | 73 74 72 6f 6e 67 6c 79 |olysis, |strongly|
|00003600| 20 73 75 70 70 6f 72 74 | 0d 0a 74 68 65 20 6e 6f | support|..the no|
|00003610| 74 69 6f 6e 20 74 68 61 | 74 20 75 6e 73 74 61 62 |tion tha|t unstab|
|00003620| 6c 65 20 61 6e 67 69 6e | 61 2c 20 6c 69 6b 65 20 |le angin|a, like |
|00003630| 61 63 75 74 65 20 4d 49 | 2c 20 69 73 20 61 73 73 |acute MI|, is ass|
|00003640| 6f 63 69 61 74 65 64 20 | 77 69 74 68 20 61 20 74 |ociated |with a t|
|00003650| 68 72 6f 6d 62 6f 74 69 | 63 0d 0a 73 74 61 74 65 |hromboti|c..state|
|00003660| 2e 20 20 54 68 65 73 65 | 20 6f 62 73 65 72 76 61 |. These| observa|
|00003670| 74 69 6f 6e 73 20 73 75 | 70 70 6f 72 74 20 74 68 |tions su|pport th|
|00003680| 65 20 72 6f 6c 65 20 6f | 66 20 61 63 74 69 76 65 |e role o|f active|
|00003690| 20 63 6c 6f 74 20 66 6f | 72 6d 61 74 69 6f 6e 20 | clot fo|rmation |
|000036a0| 61 6e 64 20 6c 79 73 69 | 73 0d 0a 69 6e 20 70 61 |and lysi|s..in pa|
|000036b0| 74 69 65 6e 74 73 20 62 | 6f 74 68 20 77 69 74 68 |tients b|oth with|
|000036c0| 20 61 63 75 74 65 20 4d | 49 20 61 6e 64 20 75 6e | acute M|I and un|
|000036d0| 73 74 61 62 6c 65 20 61 | 6e 67 69 6e 61 2e 2d 2d |stable a|ngina.--|
|000036e0| 45 2e 20 42 72 61 75 6e | 77 61 6c 64 2c 20 4d 2e |E. Braun|wald, M.|
|000036f0| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00003700| 52 42 30 36 38 30 33 7d | 0d 0a 24 54 69 74 6c 65 |RB06803}|..$Title|
|00003710| 7b 4d 65 6e 74 61 6c 20 | 53 74 72 65 73 73 20 61 |{Mental |Stress a|
|00003720| 6e 64 20 74 68 65 20 49 | 6e 64 75 63 74 69 6f 6e |nd the I|nduction|
|00003730| 20 6f 66 20 53 69 6c 65 | 6e 74 20 4d 79 6f 63 61 | of Sile|nt Myoca|
|00003740| 72 64 69 61 6c 20 49 73 | 63 68 65 6d 69 61 20 69 |rdial Is|chemia i|
|00003750| 6e 20 50 61 74 69 65 6e | 74 73 20 57 69 74 68 20 |n Patien|ts With |
|00003760| 43 6f 72 6f 6e 61 72 79 | 20 41 72 74 65 72 79 20 |Coronary| Artery |
|00003770| 44 69 73 65 61 73 65 7d | 0d 0a 24 41 75 74 68 6f |Disease}|..$Autho|
|00003780| 72 7b 52 6f 7a 61 6e 73 | 6b 69 2c 20 41 0d 0a 42 |r{Rozans|ki, A..B|
|00003790| 61 69 72 65 79 2c 20 43 | 4e 0d 0a 4b 72 61 6e 74 |airey, C|N..Krant|
|000037a0| 7a 2c 20 44 53 0d 0a 46 | 72 69 65 64 6d 61 6e 2c |z, DS..F|riedman,|
|000037b0| 20 4a 0d 0a 52 65 73 73 | 65 72 2c 20 4b 4a 0d 0a | J..Ress|er, KJ..|
|000037c0| 4d 6f 72 65 6c 6c 2c 20 | 4d 0d 0a 48 69 6c 74 6f |Morell, |M..Hilto|
|000037d0| 6e 2d 43 68 61 6c 66 65 | 6e 2c 20 53 0d 0a 48 65 |n-Chalfe|n, S..He|
|000037e0| 73 74 72 69 6e 2c 20 4c | 0d 0a 42 69 65 74 65 6e |strin, L|..Bieten|
|000037f0| 64 6f 72 66 2c 20 4a 0d | 0a 42 65 72 6d 61 6e 2c |dorf, J.|.Berman,|
|00003800| 20 44 53 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 | DS}..$A|ffiliati|
|00003810| 6f 6e 7b 43 65 64 61 72 | 73 2d 53 69 6e 61 69 20 |on{Cedar|s-Sinai |
|00003820| 4d 65 64 20 43 74 72 2c | 20 4c 6f 73 20 41 6e 67 |Med Ctr,| Los Ang|
|00003830| 65 6c 65 73 3b 20 55 6e | 69 76 20 6f 66 20 43 61 |eles; Un|iv of Ca|
|00003840| 6c 69 66 6f 72 6e 69 61 | 2c 20 4c 6f 73 20 41 6e |lifornia|, Los An|
|00003850| 67 65 6c 65 73 3b 20 55 | 6e 69 66 6f 72 6d 65 64 |geles; U|niformed|
|00003860| 20 53 65 72 76 69 63 65 | 73 20 55 6e 69 76 20 6f | Service|s Univ o|
|00003870| 66 20 48 65 61 6c 74 68 | 20 53 63 69 65 6e 63 65 |f Health| Science|
|00003880| 73 2c 20 42 65 74 68 65 | 73 64 61 2c 20 4d 64 7d |s, Bethe|sda, Md}|
|00003890| 0d 0a 24 53 75 62 6a 65 | 63 74 7b 53 74 72 65 73 |..$Subje|ct{Stres|
|000038a0| 73 20 6d 65 6e 74 61 6c | 2c 20 61 6e 64 20 73 69 |s mental|, and si|
|000038b0| 6c 65 6e 74 20 6d 79 6f | 63 61 72 64 69 61 6c 20 |lent myo|cardial |
|000038c0| 69 73 63 68 65 6d 69 61 | 3b 20 4d 79 6f 63 61 72 |ischemia|; Myocar|
|000038d0| 64 69 75 6d 20 69 73 63 | 68 65 6d 69 61 0d 0a 73 |dium isc|hemia..s|
|000038e0| 69 6c 65 6e 74 2c 20 61 | 6e 64 20 6d 65 6e 74 61 |ilent, a|nd menta|
|000038f0| 6c 20 73 74 72 65 73 73 | 3b 20 4d 65 6e 74 61 6c |l stress|; Mental|
|00003900| 20 73 74 72 65 73 73 2c | 20 61 6e 64 20 73 69 6c | stress,| and sil|
|00003910| 65 6e 74 20 6d 79 6f 63 | 61 72 64 69 61 6c 20 69 |ent myoc|ardial i|
|00003920| 73 63 68 65 6d 69 61 3b | 0d 0a 43 6f 72 6f 6e 61 |schemia;|..Corona|
|00003930| 72 79 20 61 72 74 65 72 | 79 20 64 69 73 65 61 73 |ry arter|y diseas|
|00003940| 65 20 6d 65 6e 74 61 6c | 20 73 74 72 65 73 73 20 |e mental| stress |
|00003950| 61 6e 64 20 73 69 6c 65 | 6e 74 20 6d 79 6f 63 61 |and sile|nt myoca|
|00003960| 72 64 69 61 6c 20 69 73 | 63 68 65 6d 69 61 20 69 |rdial is|chemia i|
|00003970| 6e 7d 0d 0a 24 4a 6f 75 | 72 6e 61 6c 7b 4e 20 45 |n}..$Jou|rnal{N E|
|00003980| 6e 67 6c 20 4a 20 4d 65 | 64 7d 0d 0a 24 56 6f 6c |ngl J Me|d}..$Vol|
|00003990| 75 6d 65 7b 33 31 38 7d | 0d 0a 24 50 61 67 65 7b |ume{318}|..$Page{|
|000039a0| 31 30 30 35 2d 31 30 31 | 32 7d 0d 0a 24 44 61 74 |1005-101|2}..$Dat|
|000039b0| 65 7b 41 70 72 20 32 31 | 2c 20 31 39 38 38 7d 0d |e{Apr 21|, 1988}.|
|000039c0| 0a 24 59 42 56 6f 6c 7b | 31 39 38 39 20 59 65 61 |.$YBVol{|1989 Yea|
|000039d0| 72 20 42 6f 6f 6b 20 6f | 66 20 4d 65 64 69 63 69 |r Book o|f Medici|
|000039e0| 6e 65 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 33 31 |ne}..$Ch|apter{31|
|000039f0| 2d 35 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |-5}..$YB|Editor{D|
|00003a00| 72 73 2e 20 52 6f 67 65 | 72 73 2c 20 44 65 73 20 |rs. Roge|rs, Des |
|00003a10| 50 72 65 7a 2c 20 43 6c | 69 6e 65 2c 20 42 72 61 |Prez, Cl|ine, Bra|
|00003a20| 75 6e 77 61 6c 64 2c 20 | 47 72 65 65 6e 62 65 72 |unwald, |Greenber|
|00003a30| 67 65 72 2c 20 57 69 6c | 73 6f 6e 2c 20 45 70 73 |ger, Wil|son, Eps|
|00003a40| 74 65 69 6e 2c 20 61 6e | 64 20 4d 61 6c 61 77 69 |tein, an|d Malawi|
|00003a50| 73 74 61 7d 0d 0a 24 54 | 61 62 6c 65 7b 7d 0d 0a |sta}..$T|able{}..|
|00003a60| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 45 2e 20 |$Comment|ator{E. |
|00003a70| 42 72 61 75 6e 77 61 6c | 64 2c 20 4d 2e 44 2e 7d |Braunwal|d, M.D.}|
|00003a80| 0d 0a 0d 0a 43 6f 70 79 | 72 69 67 68 74 20 28 63 |....Copy|right (c|
|00003a90| 29 20 59 65 61 72 20 42 | 6f 6f 6b 20 4d 65 64 69 |) Year B|ook Medi|
|00003aa0| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00003ab0| 49 6e 63 2e 2c 20 31 39 | 38 39 0d 0a 0d 0a 31 39 |Inc., 19|89....19|
|00003ac0| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|00003ad0| 4d 65 64 69 63 69 6e 65 | 20 28 52 29 0d 0a 0d 0a |Medicine| (R)....|
|00003ae0| 43 68 61 70 74 65 72 20 | 33 31 2d 2d 43 68 72 6f |Chapter |31--Chro|
|00003af0| 6e 69 63 20 43 6f 72 6f | 6e 61 72 79 20 41 72 74 |nic Coro|nary Art|
|00003b00| 65 72 79 20 44 69 73 65 | 61 73 65 0d 0a 0d 0a 2d |ery Dise|ase....-|
|00003b10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003b40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003b50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00003b60| 0a 4d 65 6e 74 61 6c 20 | 53 74 72 65 73 73 20 61 |.Mental |Stress a|
|00003b70| 6e 64 20 74 68 65 20 49 | 6e 64 75 63 74 69 6f 6e |nd the I|nduction|
|00003b80| 20 6f 66 20 53 69 6c 65 | 6e 74 20 4d 79 6f 63 61 | of Sile|nt Myoca|
|00003b90| 72 64 69 61 6c 20 49 73 | 63 68 65 6d 69 61 20 69 |rdial Is|chemia i|
|00003ba0| 6e 20 50 61 74 69 65 6e | 74 73 20 57 69 74 68 0d |n Patien|ts With.|
|00003bb0| 0a 43 6f 72 6f 6e 61 72 | 79 20 41 72 74 65 72 79 |.Coronar|y Artery|
|00003bc0| 20 44 69 73 65 61 73 65 | 0d 0a 0d 0a 52 6f 7a 61 | Disease|....Roza|
|00003bd0| 6e 73 6b 69 20 41 2c 20 | 42 61 69 72 65 79 20 43 |nski A, |Bairey C|
|00003be0| 4e 2c 20 4b 72 61 6e 74 | 7a 20 44 53 2c 20 46 72 |N, Krant|z DS, Fr|
|00003bf0| 69 65 64 6d 61 6e 20 4a | 2c 20 52 65 73 73 65 72 |iedman J|, Resser|
|00003c00| 20 4b 4a 2c 20 4d 6f 72 | 65 6c 6c 20 4d 2c 0d 0a | KJ, Mor|ell M,..|
|00003c10| 48 69 6c 74 6f 6e 2d 43 | 68 61 6c 66 65 6e 20 53 |Hilton-C|halfen S|
|00003c20| 2c 20 48 65 73 74 72 69 | 6e 20 4c 2c 20 42 69 65 |, Hestri|n L, Bie|
|00003c30| 74 65 6e 64 6f 72 66 20 | 4a 2c 20 42 65 72 6d 61 |tendorf |J, Berma|
|00003c40| 6e 20 44 53 0d 0a 28 43 | 65 64 61 72 73 2d 53 69 |n DS..(C|edars-Si|
|00003c50| 6e 61 69 20 4d 65 64 20 | 43 74 72 2c 20 4c 6f 73 |nai Med |Ctr, Los|
|00003c60| 20 41 6e 67 65 6c 65 73 | 3b 20 55 6e 69 76 20 6f | Angeles|; Univ o|
|00003c70| 66 20 43 61 6c 69 66 6f | 72 6e 69 61 2c 20 4c 6f |f Califo|rnia, Lo|
|00003c80| 73 20 41 6e 67 65 6c 65 | 73 3b 20 55 6e 69 66 6f |s Angele|s; Unifo|
|00003c90| 72 6d 65 64 0d 0a 53 65 | 72 76 69 63 65 73 20 55 |rmed..Se|rvices U|
|00003ca0| 6e 69 76 20 6f 66 20 48 | 65 61 6c 74 68 20 53 63 |niv of H|ealth Sc|
|00003cb0| 69 65 6e 63 65 73 2c 20 | 42 65 74 68 65 73 64 61 |iences, |Bethesda|
|00003cc0| 2c 20 4d 64 29 0d 0a 4e | 20 45 6e 67 6c 20 4a 20 |, Md)..N| Engl J |
|00003cd0| 4d 65 64 20 33 31 38 3a | 31 30 30 35 2d 31 30 31 |Med 318:|1005-101|
|00003ce0| 32 2c 20 41 70 72 20 32 | 31 2c 20 31 39 38 38 0d |2, Apr 2|1, 1988.|
|00003cf0| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00003d00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003d40| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00003d50| 0a 20 20 20 20 20 50 68 | 79 73 69 63 61 6c 20 73 |. Ph|ysical s|
|00003d60| 74 72 65 73 73 20 69 73 | 20 61 73 73 6f 63 69 61 |tress is| associa|
|00003d70| 74 65 64 20 77 69 74 68 | 20 6d 79 6f 63 61 72 64 |ted with| myocard|
|00003d80| 69 61 6c 20 69 73 63 68 | 65 6d 69 61 2c 20 62 75 |ial isch|emia, bu|
|00003d90| 74 20 74 68 65 20 65 66 | 66 65 63 74 73 20 6f 66 |t the ef|fects of|
|00003da0| 0d 0a 6d 65 6e 74 61 6c | 20 73 74 72 65 73 73 20 |..mental| stress |
|00003db0| 68 61 76 65 20 6e 6f 74 | 20 62 65 65 6e 20 73 74 |have not| been st|
|00003dc0| 75 64 69 65 64 2e 20 20 | 41 20 74 65 73 74 20 77 |udied. |A test w|
|00003dd0| 61 73 20 64 65 76 65 6c | 6f 70 65 64 20 74 6f 20 |as devel|oped to |
|00003de0| 65 76 61 6c 75 61 74 65 | 20 74 68 65 0d 0a 72 65 |evaluate| the..re|
|00003df0| 6c 61 74 69 6f 6e 73 68 | 69 70 20 62 65 74 77 65 |lationsh|ip betwe|
|00003e00| 65 6e 20 6d 65 6e 74 61 | 6c 20 73 74 72 65 73 73 |en menta|l stress|
|00003e10| 20 61 6e 64 20 69 73 63 | 68 65 6d 69 61 20 69 6e | and isc|hemia in|
|00003e20| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 63 | patient|s with c|
|00003e30| 6f 72 6f 6e 61 72 79 20 | 61 72 74 65 72 79 0d 0a |oronary |artery..|
|00003e40| 64 69 73 65 61 73 65 2e | 0d 0a 20 20 20 20 20 54 |disease.|.. T|
|00003e50| 77 6f 20 67 72 6f 75 70 | 73 20 6f 66 20 70 61 74 |wo group|s of pat|
|00003e60| 69 65 6e 74 73 20 65 6e | 74 65 72 65 64 20 74 68 |ients en|tered th|
|00003e70| 65 20 73 74 75 64 79 3a | 20 20 33 39 20 77 69 74 |e study:| 39 wit|
|00003e80| 68 20 64 69 61 67 6e 6f | 73 65 64 20 6f 72 20 68 |h diagno|sed or h|
|00003e90| 69 67 68 6c 79 0d 0a 70 | 72 6f 62 61 62 6c 65 20 |ighly..p|robable |
|00003ea0| 63 6f 72 6f 6e 61 72 79 | 20 61 72 74 65 72 79 20 |coronary| artery |
|00003eb0| 64 69 73 65 61 73 65 20 | 61 6e 64 20 31 32 20 77 |disease |and 12 w|
|00003ec0| 69 74 68 20 61 20 6c 6f | 77 20 6c 69 6b 65 6c 69 |ith a lo|w likeli|
|00003ed0| 68 6f 6f 64 20 6f 66 20 | 63 6f 72 6f 6e 61 72 79 |hood of |coronary|
|00003ee0| 20 61 72 74 65 72 79 0d | 0a 64 69 73 65 61 73 65 | artery.|.disease|
|00003ef0| 2e 20 20 54 68 65 20 70 | 61 74 69 65 6e 74 73 20 |. The p|atients |
|00003f00| 77 65 72 65 20 65 76 61 | 6c 75 61 74 65 64 20 77 |were eva|luated w|
|00003f10| 69 74 68 20 72 61 64 69 | 6f 6e 75 63 6c 69 64 65 |ith radi|onuclide|
|00003f20| 20 76 65 6e 74 72 69 63 | 75 6c 6f 67 72 61 70 68 | ventric|ulograph|
|00003f30| 79 20 64 75 72 69 6e 67 | 0d 0a 34 20 74 61 73 6b |y during|..4 task|
|00003f40| 73 20 64 65 73 69 67 6e | 65 64 20 74 6f 20 65 76 |s design|ed to ev|
|00003f50| 6f 6b 65 20 6d 65 6e 74 | 61 6c 20 73 74 72 65 73 |oke ment|al stres|
|00003f60| 73 3a 20 20 6d 65 6e 74 | 61 6c 20 61 72 69 74 68 |s: ment|al arith|
|00003f70| 6d 65 74 69 63 3b 20 74 | 68 65 20 53 74 72 6f 6f |metic; t|he Stroo|
|00003f80| 70 0d 0a 63 6f 6c 6f 72 | 2d 77 6f 72 64 20 74 65 |p..color|-word te|
|00003f90| 73 74 3b 20 61 20 35 2d | 6d 69 6e 75 74 65 2c 20 |st; a 5-|minute, |
|00003fa0| 73 65 6c 66 2d 72 65 76 | 65 6c 61 74 6f 72 79 20 |self-rev|elatory |
|00003fb0| 73 70 65 65 63 68 3b 20 | 61 6e 64 20 6f 72 61 6c |speech; |and oral|
|00003fc0| 20 72 65 61 64 69 6e 67 | 2e 20 20 49 6d 61 67 65 | reading|. Image|
|00003fd0| 73 0d 0a 77 65 72 65 20 | 61 6c 73 6f 20 6f 62 74 |s..were |also obt|
|00003fe0| 61 69 6e 65 64 20 61 74 | 20 72 65 73 74 20 61 6e |ained at| rest an|
|00003ff0| 64 20 61 66 74 65 72 20 | 62 69 63 79 63 6c 65 20 |d after |bicycle |
|00004000| 65 78 65 72 63 69 73 65 | 2e 20 20 41 20 73 79 73 |exercise|. A sys|
|00004010| 74 65 6d 20 6f 66 20 77 | 61 6c 6c 20 6d 6f 74 69 |tem of w|all moti|
|00004020| 6f 6e 0d 0a 73 63 6f 72 | 69 6e 67 20 69 6e 74 65 |on..scor|ing inte|
|00004030| 72 70 72 65 74 65 64 20 | 74 68 65 20 70 61 74 69 |rpreted |the pati|
|00004040| 65 6e 74 73 27 20 72 65 | 61 63 74 69 6f 6e 73 20 |ents' re|actions |
|00004050| 74 6f 20 74 68 65 20 76 | 61 72 69 6f 75 73 20 73 |to the v|arious s|
|00004060| 74 72 65 73 73 66 75 6c | 20 73 69 74 75 61 74 69 |tressful| situati|
|00004070| 6f 6e 73 2e 0d 0a 20 20 | 20 20 20 4f 76 65 72 61 |ons... | Overa|
|00004080| 6c 6c 2c 20 37 34 25 20 | 6f 66 20 74 68 65 20 70 |ll, 74% |of the p|
|00004090| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 63 6f 72 |atients |with cor|
|000040a0| 6f 6e 61 72 79 20 61 72 | 74 65 72 79 20 64 69 73 |onary ar|tery dis|
|000040b0| 65 61 73 65 20 65 78 70 | 65 72 69 65 6e 63 65 64 |ease exp|erienced|
|000040c0| 20 77 61 6c 6c 0d 0a 6d | 6f 74 69 6f 6e 20 61 62 | wall..m|otion ab|
|000040d0| 6e 6f 72 6d 61 6c 69 74 | 69 65 73 20 64 75 72 69 |normalit|ies duri|
|000040e0| 6e 67 20 65 78 65 72 63 | 69 73 65 20 61 6e 64 20 |ng exerc|ise and |
|000040f0| 37 32 25 20 6f 66 20 74 | 68 65 6d 20 65 78 70 65 |72% of t|hem expe|
|00004100| 72 69 65 6e 63 65 64 20 | 61 62 6e 6f 72 6d 61 6c |rienced |abnormal|
|00004110| 69 74 69 65 73 0d 0a 64 | 75 72 69 6e 67 20 6d 65 |ities..d|uring me|
|00004120| 6e 74 61 6c 20 73 74 72 | 65 73 73 20 61 73 20 77 |ntal str|ess as w|
|00004130| 65 6c 6c 2e 20 20 4f 6e | 6c 79 20 32 20 63 6f 6e |ell. On|ly 2 con|
|00004140| 74 72 6f 6c 73 20 68 61 | 64 20 61 62 6e 6f 72 6d |trols ha|d abnorm|
|00004150| 61 6c 69 74 69 65 73 3b | 20 74 68 65 73 65 20 77 |alities;| these w|
|00004160| 65 72 65 0d 0a 62 72 6f | 75 67 68 74 20 61 62 6f |ere..bro|ught abo|
|00004170| 75 74 20 62 79 20 70 68 | 79 73 69 63 61 6c 20 63 |ut by ph|ysical c|
|00004180| 68 61 6c 6c 65 6e 67 65 | 20 69 6e 20 31 20 61 6e |hallenge| in 1 an|
|00004190| 64 20 62 79 20 6d 65 6e | 74 61 6c 20 63 68 61 6c |d by men|tal chal|
|000041a0| 6c 65 6e 67 65 20 69 6e | 20 74 68 65 20 6f 74 68 |lenge in| the oth|
|000041b0| 65 72 2e 0d 0a 41 6d 6f | 6e 67 20 74 68 65 20 32 |er...Amo|ng the 2|
|000041c0| 31 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |1 patien|ts with |
|000041d0| 63 6f 72 6f 6e 61 72 79 | 20 61 72 74 65 72 79 20 |coronary| artery |
|000041e0| 64 69 73 65 61 73 65 20 | 77 68 6f 20 77 65 72 65 |disease |who were|
|000041f0| 20 66 6f 75 6e 64 20 74 | 6f 20 68 61 76 65 20 77 | found t|o have w|
|00004200| 61 6c 6c 0d 0a 6d 6f 74 | 69 6f 6e 20 61 62 6e 6f |all..mot|ion abno|
|00004210| 72 6d 61 6c 69 74 69 65 | 73 20 64 75 72 69 6e 67 |rmalitie|s during|
|00004220| 20 62 6f 74 68 20 70 68 | 79 73 69 63 61 6c 20 61 | both ph|ysical a|
|00004230| 6e 64 20 6d 65 6e 74 61 | 6c 20 65 78 65 72 74 69 |nd menta|l exerti|
|00004240| 6f 6e 2c 20 74 68 65 20 | 6d 6f 73 74 0d 0a 73 74 |on, the |most..st|
|00004250| 72 65 73 73 66 75 6c 20 | 73 69 74 75 61 74 69 6f |ressful |situatio|
|00004260| 6e 20 77 61 73 20 74 68 | 65 20 73 70 65 65 63 68 |n was th|e speech|
|00004270| 20 74 61 73 6b 2c 20 77 | 68 69 63 68 20 61 70 70 | task, w|hich app|
|00004280| 72 6f 78 69 6d 61 74 65 | 64 20 70 68 79 73 69 63 |roximate|d physic|
|00004290| 61 6c 20 65 78 65 72 63 | 69 73 65 20 69 6e 0d 0a |al exerc|ise in..|
|000042a0| 74 68 65 20 66 72 65 71 | 75 65 6e 63 79 20 61 6e |the freq|uency an|
|000042b0| 64 20 64 65 67 72 65 65 | 20 6f 66 20 61 62 6e 6f |d degree| of abno|
|000042c0| 72 6d 61 6c 20 72 65 61 | 64 69 6e 67 73 2e 20 20 |rmal rea|dings. |
|000042d0| 54 68 69 73 20 66 69 6e | 64 69 6e 67 20 77 61 73 |This fin|ding was|
|000042e0| 20 63 6f 72 72 6f 62 6f | 72 61 74 65 64 20 62 79 | corrobo|rated by|
|000042f0| 0d 0a 62 6f 74 68 20 65 | 6c 65 63 74 72 6f 63 61 |..both e|lectroca|
|00004300| 72 64 69 6f 67 72 61 70 | 68 69 63 20 72 65 73 70 |rdiograp|hic resp|
|00004310| 6f 6e 73 65 73 20 61 6e | 64 20 74 68 65 20 69 6e |onses an|d the in|
|00004320| 63 69 64 65 6e 63 65 20 | 6f 66 20 63 68 65 73 74 |cidence |of chest|
|00004330| 20 70 61 69 6e 2e 0d 0a | 20 20 20 20 20 54 68 65 | pain...| The|
|00004340| 20 70 72 65 73 65 6e 74 | 20 73 74 75 64 79 20 73 | present| study s|
|00004350| 68 6f 77 73 20 72 61 64 | 69 6f 6e 75 63 6c 69 64 |hows rad|ionuclid|
|00004360| 65 20 76 65 6e 74 72 69 | 63 75 6c 6f 67 72 61 70 |e ventri|culograp|
|00004370| 68 79 20 74 6f 20 62 65 | 20 61 20 73 65 6e 73 69 |hy to be| a sensi|
|00004380| 74 69 76 65 0d 0a 74 65 | 73 74 20 66 6f 72 20 64 |tive..te|st for d|
|00004390| 65 74 65 63 74 69 6f 6e | 20 6f 66 20 69 73 63 68 |etection| of isch|
|000043a0| 65 6d 69 61 20 62 72 6f | 75 67 68 74 20 61 62 6f |emia bro|ught abo|
|000043b0| 75 74 20 62 79 20 6d 65 | 6e 74 61 6c 20 73 74 72 |ut by me|ntal str|
|000043c0| 61 69 6e 2e 20 20 42 65 | 63 61 75 73 65 20 74 68 |ain. Be|cause th|
|000043d0| 69 73 0d 0a 69 73 63 68 | 65 6d 69 61 20 69 73 20 |is..isch|emia is |
|000043e0| 6f 66 74 65 6e 20 73 69 | 6c 65 6e 74 20 28 77 69 |often si|lent (wi|
|000043f0| 74 68 6f 75 74 20 63 68 | 65 73 74 20 70 61 69 6e |thout ch|est pain|
|00004400| 29 2c 20 74 68 65 20 70 | 72 65 73 65 6e 63 65 20 |), the p|resence |
|00004410| 6f 66 20 6d 65 6e 74 61 | 6c 20 73 74 72 65 73 73 |of menta|l stress|
|00004420| 20 69 6e 0d 0a 64 61 69 | 6c 79 20 6c 69 66 65 20 | in..dai|ly life |
|00004430| 63 6f 75 6c 64 20 77 65 | 6c 6c 20 62 65 20 61 20 |could we|ll be a |
|00004440| 63 6f 6e 74 72 69 62 75 | 74 69 6e 67 20 66 61 63 |contribu|ting fac|
|00004450| 74 6f 72 20 69 6e 20 6d | 6f 72 65 20 73 65 72 69 |tor in m|ore seri|
|00004460| 6f 75 73 20 63 61 72 64 | 69 61 63 20 64 69 73 74 |ous card|iac dist|
|00004470| 72 65 73 73 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |ress....|.Post-Co|
|00004480| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 4f 6e |mment...|. On|
|00004490| 65 20 69 6d 70 6f 72 74 | 61 6e 74 20 66 69 6e 64 |e import|ant find|
|000044a0| 69 6e 67 20 6f 66 20 74 | 68 69 73 20 73 74 75 64 |ing of t|his stud|
|000044b0| 79 20 69 73 20 74 68 61 | 74 20 69 73 20 73 68 6f |y is tha|t is sho|
|000044c0| 77 73 20 74 68 61 74 20 | 74 68 65 20 73 6f 2d 63 |ws that |the so-c|
|000044d0| 61 6c 6c 65 64 0d 0a 73 | 70 6f 6e 74 61 6e 65 6f |alled..s|pontaneo|
|000044e0| 75 73 20 65 70 69 73 6f | 64 65 73 20 6f 66 20 73 |us episo|des of s|
|000044f0| 69 6c 65 6e 74 20 69 73 | 63 68 65 6d 69 61 20 77 |ilent is|chemia w|
|00004500| 69 74 68 20 53 54 20 73 | 65 67 6d 65 6e 74 20 64 |ith ST s|egment d|
|00004510| 65 70 72 65 73 73 69 6f | 6e 73 20 6f 6e 0d 0a 65 |epressio|ns on..e|
|00004520| 6c 65 63 74 72 6f 63 61 | 72 64 69 6f 67 72 61 70 |lectroca|rdiograp|
|00004530| 68 79 20 6d 61 79 20 62 | 65 20 72 65 6c 61 74 65 |hy may b|e relate|
|00004540| 64 20 74 6f 20 6d 65 6e | 74 61 6c 20 73 74 72 65 |d to men|tal stre|
|00004550| 73 73 2e 20 20 4f 66 20 | 74 68 65 20 76 61 72 69 |ss. Of |the vari|
|00004560| 6f 75 73 20 6d 65 6e 74 | 61 6c 0d 0a 74 65 73 74 |ous ment|al..test|
|00004570| 73 20 74 68 61 74 20 70 | 72 6f 76 6f 6b 65 64 20 |s that p|rovoked |
|00004580| 69 73 63 68 65 6d 69 61 | 2c 20 69 74 20 69 73 20 |ischemia|, it is |
|00004590| 69 6e 74 65 72 65 73 74 | 69 6e 67 20 74 68 61 74 |interest|ing that|
|000045a0| 20 22 65 6d 6f 74 69 6f | 6e 61 6c 6c 79 20 63 68 | "emotio|nally ch|
|000045b0| 61 72 67 65 64 20 70 75 | 62 6c 69 63 0d 0a 73 70 |arged pu|blic..sp|
|000045c0| 65 61 6b 69 6e 67 22 20 | 77 61 73 20 74 68 65 20 |eaking" |was the |
|000045d0| 6d 6f 73 74 20 73 74 72 | 65 73 73 66 75 6c 2e 0d |most str|essful..|
|000045e0| 0a 20 20 20 20 20 44 61 | 76 69 65 73 20 65 74 20 |. Da|vies et |
|000045f0| 61 6c 2e 20 5b 31 5d 20 | 6d 65 61 73 75 72 65 64 |al. [1] |measured|
|00004600| 20 6c 65 66 74 20 76 65 | 6e 74 72 69 63 75 6c 61 | left ve|ntricula|
|00004610| 72 20 76 6f 6c 75 6d 65 | 20 63 6f 6e 74 69 6e 75 |r volume| continu|
|00004620| 6f 75 73 6c 79 20 77 69 | 74 68 20 61 0d 0a 70 72 |ously wi|th a..pr|
|00004630| 65 63 6f 72 64 69 61 6c | 20 73 63 69 6e 74 69 6c |ecordial| scintil|
|00004640| 6c 61 74 69 6f 6e 20 70 | 72 6f 62 65 20 61 66 74 |lation p|robe aft|
|00004650| 65 72 20 62 6c 6f 6f 64 | 20 70 6f 6f 6c 20 6c 61 |er blood| pool la|
|00004660| 62 65 6c 69 6e 67 20 77 | 69 74 68 20 74 65 63 68 |beling w|ith tech|
|00004670| 6e 65 74 69 75 6d 2d 39 | 39 6d 2e 0d 0a 54 68 65 |netium-9|9m...The|
|00004680| 79 20 6f 62 73 65 72 76 | 65 64 20 74 68 61 74 20 |y observ|ed that |
|00004690| 61 6c 6c 20 69 73 63 68 | 65 6d 69 63 20 65 70 69 |all isch|emic epi|
|000046a0| 73 6f 64 65 73 2c 20 73 | 70 6f 6e 74 61 6e 65 6f |sodes, s|pontaneo|
|000046b0| 75 73 20 6f 72 20 69 6e | 64 75 63 65 64 2c 20 70 |us or in|duced, p|
|000046c0| 61 69 6e 66 75 6c 20 6f | 72 0d 0a 70 61 69 6e 6c |ainful o|r..painl|
|000046d0| 65 73 73 2c 20 77 65 72 | 65 20 61 73 73 6f 63 69 |ess, wer|e associ|
|000046e0| 61 74 65 64 20 77 69 74 | 68 20 64 69 6c 61 74 61 |ated wit|h dilata|
|000046f0| 74 69 6f 6e 20 6f 66 20 | 74 68 65 20 6c 65 66 74 |tion of |the left|
|00004700| 20 76 65 6e 74 72 69 63 | 6c 65 2c 20 77 68 69 63 | ventric|le, whic|
|00004710| 68 20 61 6c 77 61 79 73 | 0d 0a 70 72 65 63 65 64 |h always|..preced|
|00004720| 65 64 20 74 68 65 20 6f | 6e 73 65 74 20 6f 66 20 |ed the o|nset of |
|00004730| 53 54 20 73 65 67 6d 65 | 6e 74 20 73 68 69 66 74 |ST segme|nt shift|
|00004740| 73 20 61 6e 64 20 61 6e | 67 69 6e 61 6c 20 70 61 |s and an|ginal pa|
|00004750| 69 6e 2e 20 20 54 68 75 | 73 20 74 65 63 68 6e 69 |in. Thu|s techni|
|00004760| 71 75 65 73 20 66 6f 72 | 0d 0a 63 6f 6e 74 69 6e |ques for|..contin|
|00004770| 75 6f 75 73 6c 79 20 6d | 6f 6e 69 74 6f 72 69 6e |uously m|onitorin|
|00004780| 67 20 6c 65 66 74 20 76 | 65 6e 74 72 69 63 75 6c |g left v|entricul|
|00004790| 61 72 20 76 6f 6c 75 6d | 65 73 20 61 70 70 65 61 |ar volum|es appea|
|000047a0| 72 20 74 6f 20 62 65 20 | 6d 6f 72 65 20 73 65 6e |r to be |more sen|
|000047b0| 73 69 74 69 76 65 0d 0a | 69 6e 64 69 63 61 74 6f |sitive..|indicato|
|000047c0| 72 73 20 6f 66 20 69 73 | 63 68 65 6d 69 61 20 74 |rs of is|chemia t|
|000047d0| 68 61 6e 20 65 6c 65 63 | 74 72 6f 63 61 72 64 69 |han elec|trocardi|
|000047e0| 6f 67 72 61 70 68 79 2e | 2d 2d 45 2e 20 42 72 61 |ography.|--E. Bra|
|000047f0| 75 6e 77 61 6c 64 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |unwald, |M.D...$U|
|00004800| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 36 38 30 |nique_ID|{YRB0680|
|00004810| 34 7d 0d 0a 24 54 69 74 | 6c 65 7b 41 6d 62 75 6c |4}..$Tit|le{Ambul|
|00004820| 61 74 6f 72 79 20 4d 6f | 6e 69 74 6f 72 69 6e 67 |atory Mo|nitoring|
|00004830| 20 6f 66 20 74 68 65 20 | 44 69 67 69 74 69 7a 65 | of the |Digitize|
|00004840| 64 20 45 6c 65 63 74 72 | 6f 63 61 72 64 69 6f 67 |d Electr|ocardiog|
|00004850| 72 61 6d 20 66 6f 72 20 | 44 65 74 65 63 74 69 6f |ram for |Detectio|
|00004860| 6e 20 61 6e 64 20 45 61 | 72 6c 79 20 57 61 72 6e |n and Ea|rly Warn|
|00004870| 69 6e 67 20 6f 66 20 54 | 72 61 6e 73 69 65 6e 74 |ing of T|ransient|
|00004880| 20 4d 79 6f 63 61 72 64 | 69 61 6c 20 49 73 63 68 | Myocard|ial Isch|
|00004890| 65 6d 69 61 20 69 6e 20 | 41 6e 67 69 6e 61 20 50 |emia in |Angina P|
|000048a0| 65 63 74 6f 72 69 73 7d | 0d 0a 24 41 75 74 68 6f |ectoris}|..$Autho|
|000048b0| 72 7b 42 61 72 72 79 2c | 20 4a 0d 0a 43 61 6d 70 |r{Barry,| J..Camp|
|000048c0| 62 65 6c 6c 2c 20 53 0d | 0a 4e 61 62 65 6c 2c 20 |bell, S.|.Nabel, |
|000048d0| 45 47 0d 0a 4d 65 61 64 | 2c 20 4b 0d 0a 53 65 6c |EG..Mead|, K..Sel|
|000048e0| 77 79 6e 2c 20 41 50 7d | 0d 0a 24 41 66 66 69 6c |wyn, AP}|..$Affil|
|000048f0| 69 61 74 69 6f 6e 7b 42 | 72 69 67 68 61 6d 20 61 |iation{B|righam a|
|00004900| 6e 64 20 57 6f 6d 65 6e | 27 73 20 48 6f 73 70 2c |nd Women|'s Hosp,|
|00004910| 20 42 6f 73 74 6f 6e 3b | 20 48 61 72 76 61 72 64 | Boston;| Harvard|
|00004920| 20 4d 65 64 20 53 63 68 | 6f 6f 6c 7d 0d 0a 24 53 | Med Sch|ool}..$S|
|00004930| 75 62 6a 65 63 74 7b 4d | 79 6f 63 61 72 64 69 75 |ubject{M|yocardiu|
|00004940| 6d 20 69 73 63 68 65 6d | 69 61 20 74 72 61 6e 73 |m ischem|ia trans|
|00004950| 69 65 6e 74 2c 20 69 6e | 20 61 6e 67 69 6e 61 2c |ient, in| angina,|
|00004960| 20 61 6d 62 75 6c 61 74 | 6f 72 79 20 6d 6f 6e 69 | ambulat|ory moni|
|00004970| 74 6f 72 69 6e 67 20 6f | 66 0d 0a 64 69 67 69 74 |toring o|f..digit|
|00004980| 69 7a 65 64 20 45 43 47 | 20 66 6f 72 20 64 65 74 |ized ECG| for det|
|00004990| 65 63 74 69 6f 6e 20 61 | 6e 64 20 65 61 72 6c 79 |ection a|nd early|
|000049a0| 20 77 61 72 6e 69 6e 67 | 20 6f 66 3b 20 45 6c 65 | warning| of; Ele|
|000049b0| 63 74 72 6f 63 61 72 64 | 69 6f 67 72 61 70 68 79 |ctrocard|iography|
|000049c0| 20 6d 6f 6e 69 74 6f 72 | 69 6e 67 0d 0a 6f 66 20 | monitor|ing..of |
|000049d0| 64 69 67 69 74 69 7a 65 | 64 20 45 43 47 2c 20 66 |digitize|d ECG, f|
|000049e0| 6f 72 20 64 65 74 65 63 | 74 69 6f 6e 20 61 6e 64 |or detec|tion and|
|000049f0| 20 65 61 72 6c 79 20 77 | 61 72 6e 69 6e 67 20 6f | early w|arning o|
|00004a00| 66 20 74 72 61 6e 73 69 | 65 6e 74 20 6d 79 6f 63 |f transi|ent myoc|
|00004a10| 61 72 64 69 61 6c 0d 0a | 69 73 63 68 65 6d 69 61 |ardial..|ischemia|
|00004a20| 20 69 6e 20 61 6e 67 69 | 6e 61 3b 20 41 6e 67 69 | in angi|na; Angi|
|00004a30| 6e 61 20 69 73 63 68 65 | 6d 69 61 20 69 6e 2c 20 |na ische|mia in, |
|00004a40| 74 72 61 6e 73 69 65 6e | 74 20 6d 79 6f 63 61 72 |transien|t myocar|
|00004a50| 64 69 61 6c 2c 20 61 6d | 62 75 6c 61 74 6f 72 79 |dial, am|bulatory|
|00004a60| 0d 0a 6d 6f 6e 69 74 6f | 72 69 6e 67 20 6f 66 20 |..monito|ring of |
|00004a70| 64 69 67 69 74 69 7a 65 | 64 20 45 43 47 20 66 6f |digitize|d ECG fo|
|00004a80| 72 20 64 65 74 65 63 74 | 69 6f 6e 20 61 6e 64 20 |r detect|ion and |
|00004a90| 65 61 72 6c 79 20 77 61 | 72 6e 69 6e 67 20 6f 66 |early wa|rning of|
|00004aa0| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 41 6d 20 4a |}..$Jour|nal{Am J|
|00004ab0| 20 43 61 72 64 69 6f 6c | 7d 0d 0a 24 56 6f 6c 75 | Cardiol|}..$Volu|
|00004ac0| 6d 65 7b 36 30 7d 0d 0a | 24 50 61 67 65 7b 34 38 |me{60}..|$Page{48|
|00004ad0| 33 2d 34 38 38 7d 0d 0a | 24 44 61 74 65 7b 53 65 |3-488}..|$Date{Se|
|00004ae0| 70 74 20 31 2c 20 31 39 | 38 37 7d 0d 0a 24 59 42 |pt 1, 19|87}..$YB|
|00004af0| 56 6f 6c 7b 31 39 38 39 | 20 59 65 61 72 20 42 6f |Vol{1989| Year Bo|
|00004b00| 6f 6b 20 6f 66 20 4d 65 | 64 69 63 69 6e 65 2c 20 |ok of Me|dicine, |
|00004b10| 50 61 72 74 20 46 6f 75 | 72 7d 0d 0a 24 43 68 61 |Part Fou|r}..$Cha|
|00004b20| 70 74 65 72 7b 33 31 2d | 36 7d 0d 0a 24 59 42 45 |pter{31-|6}..$YBE|
|00004b30| 64 69 74 6f 72 7b 44 72 | 73 2e 20 52 6f 67 65 72 |ditor{Dr|s. Roger|
|00004b40| 73 2c 20 44 65 73 20 50 | 72 65 7a 2c 20 43 6c 69 |s, Des P|rez, Cli|
|00004b50| 6e 65 2c 20 42 72 61 75 | 6e 77 61 6c 64 2c 20 47 |ne, Brau|nwald, G|
|00004b60| 72 65 65 6e 62 65 72 67 | 65 72 2c 20 57 69 6c 73 |reenberg|er, Wils|
|00004b70| 6f 6e 2c 20 45 70 73 74 | 65 69 6e 2c 20 61 6e 64 |on, Epst|ein, and|
|00004b80| 20 4d 61 6c 61 77 69 73 | 74 61 7d 0d 0a 24 54 61 | Malawis|ta}..$Ta|
|00004b90| 62 6c 65 7b 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |ble{}..$|Commenta|
|00004ba0| 74 6f 72 7b 45 2e 20 42 | 72 61 75 6e 77 61 6c 64 |tor{E. B|raunwald|
|00004bb0| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00004bc0| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 20 42 6f |ight (c)| Year Bo|
|00004bd0| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00004be0| 73 68 65 72 73 2c 20 49 | 6e 63 2e 2c 20 31 39 38 |shers, I|nc., 198|
|00004bf0| 39 0d 0a 0d 0a 31 39 38 | 39 20 59 65 61 72 20 42 |9....198|9 Year B|
|00004c00| 6f 6f 6b 20 6f 66 20 4d | 65 64 69 63 69 6e 65 20 |ook of M|edicine |
|00004c10| 28 52 29 0d 0a 0d 0a 50 | 61 72 74 20 46 6f 75 72 |(R)....P|art Four|
|00004c20| 3a 20 20 54 68 65 20 48 | 65 61 72 74 20 61 6e 64 |: The H|eart and|
|00004c30| 20 43 61 72 64 69 6f 76 | 61 73 63 75 6c 61 72 20 | Cardiov|ascular |
|00004c40| 44 69 73 65 61 73 65 0d | 0a 0d 0a 43 68 61 70 74 |Disease.|...Chapt|
|00004c50| 65 72 20 33 31 2d 2d 43 | 68 72 6f 6e 69 63 20 43 |er 31--C|hronic C|
|00004c60| 6f 72 6f 6e 61 72 79 20 | 41 72 74 65 72 79 20 44 |oronary |Artery D|
|00004c70| 69 73 65 61 73 65 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |isease..|..------|
|00004c80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004c90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004ca0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004cb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004cc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 41 6d 62 75 |--------|--..Ambu|
|00004cd0| 6c 61 74 6f 72 79 20 4d | 6f 6e 69 74 6f 72 69 6e |latory M|onitorin|
|00004ce0| 67 20 6f 66 20 74 68 65 | 20 44 69 67 69 74 69 7a |g of the| Digitiz|
|00004cf0| 65 64 20 45 6c 65 63 74 | 72 6f 63 61 72 64 69 6f |ed Elect|rocardio|
|00004d00| 67 72 61 6d 20 66 6f 72 | 20 44 65 74 65 63 74 69 |gram for| Detecti|
|00004d10| 6f 6e 20 61 6e 64 20 45 | 61 72 6c 79 0d 0a 57 61 |on and E|arly..Wa|
|00004d20| 72 6e 69 6e 67 20 6f 66 | 20 54 72 61 6e 73 69 65 |rning of| Transie|
|00004d30| 6e 74 20 4d 79 6f 63 61 | 72 64 69 61 6c 20 49 73 |nt Myoca|rdial Is|
|00004d40| 63 68 65 6d 69 61 20 69 | 6e 20 41 6e 67 69 6e 61 |chemia i|n Angina|
|00004d50| 20 50 65 63 74 6f 72 69 | 73 0d 0a 0d 0a 42 61 72 | Pectori|s....Bar|
|00004d60| 72 79 20 4a 2c 20 43 61 | 6d 70 62 65 6c 6c 20 53 |ry J, Ca|mpbell S|
|00004d70| 2c 20 4e 61 62 65 6c 20 | 45 47 2c 20 4d 65 61 64 |, Nabel |EG, Mead|
|00004d80| 20 4b 2c 20 53 65 6c 77 | 79 6e 20 41 50 0d 0a 28 | K, Selw|yn AP..(|
|00004d90| 42 72 69 67 68 61 6d 20 | 61 6e 64 20 57 6f 6d 65 |Brigham |and Wome|
|00004da0| 6e 27 73 20 48 6f 73 70 | 2c 20 42 6f 73 74 6f 6e |n's Hosp|, Boston|
|00004db0| 3b 20 48 61 72 76 61 72 | 64 20 4d 65 64 20 53 63 |; Harvar|d Med Sc|
|00004dc0| 68 6f 6f 6c 29 0d 0a 41 | 6d 20 4a 20 43 61 72 64 |hool)..A|m J Card|
|00004dd0| 69 6f 6c 20 36 30 3a 34 | 38 33 2d 34 38 38 2c 20 |iol 60:4|83-488, |
|00004de0| 53 65 70 74 20 31 2c 20 | 31 39 38 37 0d 0a 2d 2d |Sept 1, |1987..--|
|00004df0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00004e40| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct.... |
|00004e50| 20 20 20 50 61 74 69 65 | 6e 74 73 20 77 69 74 68 | Patie|nts with|
|00004e60| 20 63 6f 72 6f 6e 61 72 | 79 20 61 72 74 65 72 79 | coronar|y artery|
|00004e70| 20 64 69 73 65 61 73 65 | 20 28 43 41 44 29 20 66 | disease| (CAD) f|
|00004e80| 72 65 71 75 65 6e 74 6c | 79 20 68 61 76 65 20 65 |requentl|y have e|
|00004e90| 70 69 73 6f 64 65 73 20 | 6f 66 0d 0a 69 73 63 68 |pisodes |of..isch|
|00004ea0| 65 6d 69 63 20 53 54 20 | 73 65 67 6d 65 6e 74 20 |emic ST |segment |
|00004eb0| 64 65 70 72 65 73 73 69 | 6f 6e 20 69 6e 20 64 61 |depressi|on in da|
|00004ec0| 69 6c 79 20 6c 69 66 65 | 2c 20 6d 6f 73 74 20 6f |ily life|, most o|
|00004ed0| 66 20 77 68 69 63 68 20 | 61 72 65 20 61 73 79 6d |f which |are asym|
|00004ee0| 70 74 6f 6d 61 74 69 63 | 2e 0d 0a 54 68 65 20 61 |ptomatic|...The a|
|00004ef0| 63 63 75 72 61 63 79 20 | 61 6e 64 20 63 6c 69 6e |ccuracy |and clin|
|00004f00| 69 63 61 6c 20 76 61 6c | 75 65 20 6f 66 20 61 20 |ical val|ue of a |
|00004f10| 73 6f 6c 69 64 2d 73 74 | 61 74 65 20 70 6f 72 74 |solid-st|ate port|
|00004f20| 61 62 6c 65 20 65 6c 65 | 63 74 72 6f 63 61 72 64 |able ele|ctrocard|
|00004f30| 69 6f 67 72 61 70 68 69 | 63 0d 0a 28 45 43 47 29 |iographi|c..(ECG)|
|00004f40| 20 61 6e 61 6c 79 7a 65 | 72 20 74 6f 20 64 65 74 | analyze|r to det|
|00004f50| 65 63 74 20 61 6e 64 20 | 71 75 61 6e 74 69 66 79 |ect and |quantify|
|00004f60| 20 65 70 69 73 6f 64 65 | 73 20 6f 66 20 69 73 63 | episode|s of isc|
|00004f70| 68 65 6d 69 63 20 53 54 | 2d 73 65 67 6d 65 6e 74 |hemic ST|-segment|
|00004f80| 20 64 65 70 72 65 73 73 | 69 6f 6e 0d 0a 69 6e 20 | depress|ion..in |
|00004f90| 61 6e 64 20 6f 75 74 73 | 69 64 65 20 6f 66 20 74 |and outs|ide of t|
|00004fa0| 68 65 20 68 6f 73 70 69 | 74 61 6c 20 77 65 72 65 |he hospi|tal were|
|00004fb0| 20 73 74 75 64 69 65 64 | 2e 0d 0a 20 20 20 20 20 | studied|... |
|00004fc0| 54 68 65 20 70 6f 72 74 | 61 62 6c 65 20 61 6e 61 |The port|able ana|
|00004fd0| 6c 79 7a 65 72 2c 20 4d | 6f 6e 69 74 6f 72 20 4f |lyzer, M|onitor O|
|00004fe0| 6e 65 2c 20 77 61 73 20 | 63 6f 6d 70 61 72 65 64 |ne, was |compared|
|00004ff0| 20 77 69 74 68 20 73 74 | 61 6e 64 61 72 64 20 65 | with st|andard e|
|00005000| 71 75 69 70 6d 65 6e 74 | 0d 0a 64 75 72 69 6e 67 |quipment|..during|
|00005010| 20 65 78 65 72 63 69 73 | 65 20 74 65 73 74 69 6e | exercis|e testin|
|00005020| 67 20 61 6e 64 20 61 6d | 62 75 6c 61 74 6f 72 79 |g and am|bulatory|
|00005030| 20 6d 6f 6e 69 74 6f 72 | 69 6e 67 20 69 6e 20 70 | monitor|ing in p|
|00005040| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 43 41 44 |atients |with CAD|
|00005050| 2e 20 20 4d 6f 6e 69 74 | 6f 72 0d 0a 4f 6e 65 20 |. Monit|or..One |
|00005060| 63 61 6e 20 61 6c 73 6f | 20 62 65 20 70 72 6f 67 |can also| be prog|
|00005070| 72 61 6d 6d 65 64 20 74 | 6f 20 70 72 6f 64 75 63 |rammed t|o produc|
|00005080| 65 20 61 20 74 6f 6e 65 | 20 61 74 20 74 68 65 20 |e a tone| at the |
|00005090| 6f 6e 73 65 74 20 6f 66 | 20 69 73 63 68 65 6d 69 |onset of| ischemi|
|000050a0| 63 20 53 54 0d 0a 64 65 | 70 72 65 73 73 69 6f 6e |c ST..de|pression|
|000050b0| 3b 20 74 68 69 73 20 74 | 6f 6e 65 20 69 73 20 75 |; this t|one is u|
|000050c0| 73 65 64 20 74 6f 20 69 | 6e 69 74 69 61 74 65 20 |sed to i|nitiate |
|000050d0| 74 68 65 20 73 65 6c 66 | 2d 61 64 6d 69 6e 69 73 |the self|-adminis|
|000050e0| 74 72 61 74 69 6f 6e 20 | 6f 66 0d 0a 6e 69 74 72 |tration |of..nitr|
|000050f0| 6f 67 6c 79 63 65 72 69 | 6e 20 61 6e 64 20 74 6f |oglyceri|n and to|
|00005100| 20 63 6f 6e 74 72 6f 6c | 20 6d 79 6f 63 61 72 64 | control| myocard|
|00005110| 69 61 6c 20 69 73 63 68 | 65 6d 69 63 20 65 76 65 |ial isch|emic eve|
|00005120| 6e 74 73 2e 20 20 4d 6f | 6e 69 74 6f 72 20 4f 6e |nts. Mo|nitor On|
|00005130| 65 20 68 61 64 20 61 0d | 0a 73 65 6e 73 69 74 69 |e had a.|.sensiti|
|00005140| 76 69 74 79 20 6f 66 20 | 31 30 30 25 20 61 6e 64 |vity of |100% and|
|00005150| 20 61 20 73 70 65 63 69 | 66 69 63 69 74 79 20 6f | a speci|ficity o|
|00005160| 66 20 39 32 25 20 64 75 | 72 69 6e 67 20 65 78 65 |f 92% du|ring exe|
|00005170| 72 63 69 73 65 20 66 6f | 72 20 64 65 74 65 63 74 |rcise fo|r detect|
|00005180| 69 6f 6e 20 61 6e 64 0d | 0a 71 75 61 6e 74 69 74 |ion and.|.quantit|
|00005190| 61 74 69 6f 6e 20 6f 66 | 20 65 70 69 73 6f 64 65 |ation of| episode|
|000051a0| 73 20 6f 66 20 69 73 63 | 68 65 6d 69 63 20 53 54 |s of isc|hemic ST|
|000051b0| 20 73 65 67 6d 65 6e 74 | 20 64 65 70 72 65 73 73 | segment| depress|
|000051c0| 69 6f 6e 2e 20 20 41 6c | 73 6f 2c 20 4d 6f 6e 69 |ion. Al|so, Moni|
|000051d0| 74 6f 72 20 4f 6e 65 0d | 0a 61 63 63 75 72 61 74 |tor One.|.accurat|
|000051e0| 65 6c 79 20 6d 65 61 73 | 75 72 65 64 20 74 68 65 |ely meas|ured the|
|000051f0| 20 64 75 72 61 74 69 6f | 6e 20 6f 66 20 69 73 63 | duratio|n of isc|
|00005200| 68 65 6d 69 63 20 65 76 | 65 6e 74 73 20 64 75 72 |hemic ev|ents dur|
|00005210| 69 6e 67 20 65 78 65 72 | 63 69 73 65 20 74 65 73 |ing exer|cise tes|
|00005220| 74 69 6e 67 20 61 6e 64 | 0d 0a 74 68 65 20 6e 75 |ting and|..the nu|
|00005230| 6d 62 65 72 20 61 6e 64 | 20 64 75 72 61 74 69 6f |mber and| duratio|
|00005240| 6e 20 6f 66 20 69 73 63 | 68 65 6d 69 63 20 65 76 |n of isc|hemic ev|
|00005250| 65 6e 74 73 20 64 75 72 | 69 6e 67 20 61 6d 62 75 |ents dur|ing ambu|
|00005260| 6c 61 74 6f 72 79 20 6d | 6f 6e 69 74 6f 72 69 6e |latory m|onitorin|
|00005270| 67 2e 20 20 57 68 65 6e | 0d 0a 74 68 65 20 61 75 |g. When|..the au|
|00005280| 64 69 62 6c 65 20 74 6f | 6e 65 20 77 61 73 20 75 |dible to|ne was u|
|00005290| 73 65 64 20 74 6f 20 69 | 6e 69 74 69 61 74 65 20 |sed to i|nitiate |
|000052a0| 73 65 6c 66 2d 61 64 6d | 69 6e 69 73 74 72 61 74 |self-adm|inistrat|
|000052b0| 69 6f 6e 20 6f 66 20 6e | 69 74 72 6f 67 6c 79 63 |ion of n|itroglyc|
|000052c0| 65 72 69 6e 2c 20 74 68 | 65 0d 0a 64 75 72 61 74 |erin, th|e..durat|
|000052d0| 69 6f 6e 20 6f 66 20 65 | 70 69 73 6f 64 65 73 20 |ion of e|pisodes |
|000052e0| 6f 66 20 69 73 63 68 65 | 6d 69 63 20 53 54 20 73 |of ische|mic ST s|
|000052f0| 65 67 6d 65 6e 74 20 64 | 65 70 72 65 73 73 69 6f |egment d|epressio|
|00005300| 6e 20 77 61 73 20 64 65 | 63 72 65 61 73 65 64 20 |n was de|creased |
|00005310| 66 72 6f 6d 20 61 20 6d | 65 61 6e 0d 0a 6f 66 20 |from a m|ean..of |
|00005320| 31 30 35 20 6d 69 6e 75 | 74 65 73 20 70 65 72 20 |105 minu|tes per |
|00005330| 32 34 20 68 6f 75 72 73 | 20 74 6f 20 35 38 20 6d |24 hours| to 58 m|
|00005340| 69 6e 75 74 65 73 20 70 | 65 72 20 32 34 20 68 6f |inutes p|er 24 ho|
|00005350| 75 72 73 2e 20 20 41 20 | 73 6f 6c 69 64 2d 73 74 |urs. A |solid-st|
|00005360| 61 74 65 20 45 43 47 0d | 0a 72 65 63 6f 72 64 65 |ate ECG.|.recorde|
|00005370| 72 20 63 61 70 61 62 6c | 65 20 6f 66 20 6c 6f 6e |r capabl|e of lon|
|00005380| 67 2d 74 65 72 6d 20 6d | 6f 6e 69 74 6f 72 69 6e |g-term m|onitorin|
|00005390| 67 20 6d 61 79 20 61 63 | 63 75 72 61 74 65 6c 79 |g may ac|curately|
|000053a0| 20 64 65 74 65 63 74 20 | 61 6e 64 20 71 75 61 6e | detect |and quan|
|000053b0| 74 69 66 79 0d 0a 65 70 | 69 73 6f 64 65 73 20 6f |tify..ep|isodes o|
|000053c0| 66 20 69 73 63 68 65 6d | 69 63 20 53 54 20 73 65 |f ischem|ic ST se|
|000053d0| 67 6d 65 6e 74 20 64 65 | 70 72 65 73 73 69 6f 6e |gment de|pression|
|000053e0| 20 69 6e 20 70 61 74 69 | 65 6e 74 73 20 77 69 74 | in pati|ents wit|
|000053f0| 68 20 43 41 44 2e 20 20 | 50 61 74 69 65 6e 74 73 |h CAD. |Patients|
|00005400| 20 63 61 6e 0d 0a 75 73 | 65 20 61 6e 20 61 75 64 | can..us|e an aud|
|00005410| 69 62 6c 65 20 74 6f 6e | 65 20 74 6f 20 62 65 67 |ible ton|e to beg|
|00005420| 69 6e 20 73 65 6c 66 2d | 61 64 6d 69 6e 69 73 74 |in self-|administ|
|00005430| 72 61 74 69 6f 6e 20 6f | 66 20 74 68 65 72 61 70 |ration o|f therap|
|00005440| 79 20 74 6f 20 63 6f 6e | 74 72 6f 6c 0d 0a 61 73 |y to con|trol..as|
|00005450| 79 6d 70 74 6f 6d 61 74 | 69 63 20 65 70 69 73 6f |ymptomat|ic episo|
|00005460| 64 65 73 20 6f 66 20 74 | 72 61 6e 73 69 65 6e 74 |des of t|ransient|
|00005470| 20 6d 79 6f 63 61 72 64 | 69 61 6c 20 69 73 63 68 | myocard|ial isch|
|00005480| 65 6d 69 61 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |emia....|.Post-Co|
|00005490| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 49 6e |mment...|. In|
|000054a0| 20 74 68 69 73 20 73 74 | 75 64 79 20 61 20 70 6f | this st|udy a po|
|000054b0| 72 74 61 62 6c 65 20 73 | 6f 6c 69 64 2d 73 74 61 |rtable s|olid-sta|
|000054c0| 74 65 20 45 43 47 20 61 | 6e 61 6c 79 7a 65 72 20 |te ECG a|nalyzer |
|000054d0| 77 61 73 20 75 73 65 64 | 20 74 6f 20 77 61 72 6e |was used| to warn|
|000054e0| 20 74 68 65 0d 0a 70 61 | 74 69 65 6e 74 73 20 74 | the..pa|tients t|
|000054f0| 68 61 74 20 74 68 65 79 | 20 68 61 64 20 69 73 63 |hat they| had isc|
|00005500| 68 65 6d 69 61 2c 20 77 | 68 69 63 68 20 77 61 73 |hemia, w|hich was|
|00005510| 20 75 73 75 61 6c 6c 79 | 20 61 73 79 6d 70 74 6f | usually| asympto|
|00005520| 6d 61 74 69 63 2e 20 20 | 54 68 65 20 61 75 64 69 |matic. |The audi|
|00005530| 62 6c 65 0d 0a 74 6f 6e | 65 20 69 6e 64 69 63 61 |ble..ton|e indica|
|00005540| 74 69 6e 67 20 74 68 65 | 20 70 72 65 73 65 6e 63 |ting the| presenc|
|00005550| 65 20 6f 66 20 53 54 20 | 73 65 67 6d 65 6e 74 20 |e of ST |segment |
|00005560| 64 65 70 72 65 73 73 69 | 6f 6e 20 61 6c 65 72 74 |depressi|on alert|
|00005570| 65 64 20 74 68 65 20 70 | 61 74 69 65 6e 74 20 74 |ed the p|atient t|
|00005580| 6f 20 74 68 65 0d 0a 70 | 72 65 73 65 6e 63 65 20 |o the..p|resence |
|00005590| 6f 66 20 69 73 63 68 65 | 6d 69 61 20 61 6e 64 20 |of ische|mia and |
|000055a0| 6c 65 64 20 74 6f 20 74 | 68 65 20 73 65 6c 66 2d |led to t|he self-|
|000055b0| 61 64 6d 69 6e 69 73 74 | 72 61 74 69 6f 6e 20 6f |administ|ration o|
|000055c0| 66 20 6e 69 74 72 6f 67 | 6c 79 63 65 72 69 6e 0d |f nitrog|lycerin.|
|000055d0| 0a 73 75 62 6c 69 6e 67 | 75 61 6c 6c 79 2e 20 20 |.subling|ually. |
|000055e0| 41 73 20 61 20 63 6f 6e | 73 65 71 75 65 6e 63 65 |As a con|sequence|
|000055f0| 2c 20 74 68 65 20 74 6f | 74 61 6c 20 64 75 72 61 |, the to|tal dura|
|00005600| 74 69 6f 6e 20 6f 66 20 | 6d 79 6f 63 61 72 64 69 |tion of |myocardi|
|00005610| 61 6c 20 69 73 63 68 65 | 6d 69 61 20 77 61 73 0d |al ische|mia was.|
|00005620| 0a 72 65 64 75 63 65 64 | 2e 0d 0a 20 20 20 20 20 |.reduced|... |
|00005630| 53 6f 6c 69 64 2d 73 74 | 61 74 65 20 61 6e 61 6c |Solid-st|ate anal|
|00005640| 79 7a 65 72 73 20 68 61 | 76 65 20 6d 61 6e 79 20 |yzers ha|ve many |
|00005650| 70 6f 74 65 6e 74 69 61 | 6c 20 61 64 76 61 6e 74 |potentia|l advant|
|00005660| 61 67 65 73 20 6f 76 65 | 72 20 63 6c 61 73 73 69 |ages ove|r classi|
|00005670| 63 20 48 6f 6c 74 65 72 | 0d 0a 45 43 47 73 20 72 |c Holter|..ECGs r|
|00005680| 65 63 6f 72 64 65 64 20 | 6f 6e 20 74 61 70 65 20 |ecorded |on tape |
|00005690| 62 65 63 61 75 73 65 20 | 74 68 65 79 20 63 61 6e |because |they can|
|000056a0| 20 62 65 20 61 6e 61 6c | 79 7a 65 64 20 63 6f 6e | be anal|yzed con|
|000056b0| 74 69 6e 75 6f 75 73 6c | 79 20 22 6f 6e 2d 6c 69 |tinuousl|y "on-li|
|000056c0| 6e 65 22 20 61 6e 64 0d | 0a 63 61 6e 20 70 72 6f |ne" and.|.can pro|
|000056d0| 76 69 64 65 20 74 68 65 | 20 70 61 74 69 65 6e 74 |vide the| patient|
|000056e0| 20 77 69 74 68 20 69 6d | 6d 65 64 69 61 74 65 20 | with im|mediate |
|000056f0| 66 65 65 64 62 61 63 6b | 2e 20 20 41 6c 73 6f 2c |feedback|. Also,|
|00005700| 20 74 68 65 79 20 63 61 | 6e 20 62 65 20 75 73 65 | they ca|n be use|
|00005710| 64 20 74 6f 0d 0a 73 74 | 6f 72 65 20 6d 75 63 68 |d to..st|ore much|
|00005720| 20 6d 6f 72 65 20 69 6e | 66 6f 72 6d 61 74 69 6f | more in|formatio|
|00005730| 6e 20 74 68 61 6e 20 61 | 20 32 34 2d 68 6f 75 72 |n than a| 24-hour|
|00005740| 20 74 61 70 65 20 63 61 | 6e 20 61 63 63 6f 6d 6d | tape ca|n accomm|
|00005750| 6f 64 61 74 65 2c 20 61 | 6e 64 20 69 74 20 69 73 |odate, a|nd it is|
|00005760| 0d 0a 6c 69 6b 65 6c 79 | 20 74 68 61 74 20 74 68 |..likely| that th|
|00005770| 65 79 20 77 69 6c 6c 20 | 72 65 70 6c 61 63 65 20 |ey will |replace |
|00005780| 63 6c 61 73 73 69 63 20 | 48 6f 6c 74 65 72 20 74 |classic |Holter t|
|00005790| 61 70 65 20 45 43 47 2e | 0d 0a 20 20 20 20 20 54 |ape ECG.|.. T|
|000057a0| 68 65 20 72 65 61 73 6f | 6e 73 20 74 68 61 74 20 |he reaso|ns that |
|000057b0| 73 6f 6d 65 20 65 70 69 | 73 6f 64 65 73 20 6f 66 |some epi|sodes of|
|000057c0| 20 69 73 63 68 65 6d 69 | 61 20 61 72 65 20 73 79 | ischemi|a are sy|
|000057d0| 6d 70 74 6f 6d 61 74 69 | 63 20 61 6e 64 20 6f 74 |mptomati|c and ot|
|000057e0| 68 65 72 73 20 61 72 65 | 0d 0a 73 69 6c 65 6e 74 |hers are|..silent|
|000057f0| 20 69 73 20 6e 6f 74 20 | 79 65 74 20 63 6c 65 61 | is not |yet clea|
|00005800| 72 2e 20 20 49 6e 20 70 | 61 74 69 65 6e 74 73 20 |r. In p|atients |
|00005810| 77 68 6f 20 68 61 76 65 | 20 62 6f 74 68 20 74 79 |who have| both ty|
|00005820| 70 65 73 20 6f 66 20 65 | 70 69 73 6f 64 65 73 2c |pes of e|pisodes,|
|00005830| 0d 0a 73 79 6d 70 74 6f | 6d 61 74 69 63 20 65 70 |..sympto|matic ep|
|00005840| 69 73 6f 64 65 73 20 6f | 6e 20 74 68 65 20 61 76 |isodes o|n the av|
|00005850| 65 72 61 67 65 20 61 72 | 65 20 6c 6f 6e 67 65 72 |erage ar|e longer|
|00005860| 20 61 6e 64 20 6d 6f 72 | 65 20 73 65 76 65 72 65 | and mor|e severe|
|00005870| 2c 20 61 73 20 72 65 66 | 6c 65 63 74 65 64 20 69 |, as ref|lected i|
|00005880| 6e 0d 0a 74 68 65 20 6d | 61 67 6e 69 74 75 64 65 |n..the m|agnitude|
|00005890| 20 6f 66 20 53 54 20 73 | 65 67 6d 65 6e 74 20 63 | of ST s|egment c|
|000058a0| 68 61 6e 67 65 73 2c 20 | 74 68 61 6e 20 61 72 65 |hanges, |than are|
|000058b0| 20 73 69 6c 65 6e 74 20 | 65 70 69 73 6f 64 65 73 | silent |episodes|
|000058c0| 2e 20 5b 31 5d 20 20 41 | 6c 73 6f 2c 0d 0a 70 61 |. [1] A|lso,..pa|
|000058d0| 74 69 65 6e 74 73 20 77 | 69 74 68 20 70 72 65 64 |tients w|ith pred|
|000058e0| 6f 6d 69 6e 61 6e 74 6c | 79 20 73 79 6d 70 74 6f |ominantl|y sympto|
|000058f0| 6d 61 74 69 63 20 69 73 | 63 68 65 6d 69 61 20 74 |matic is|chemia t|
|00005900| 65 6e 64 20 74 6f 20 68 | 61 76 65 20 61 20 6c 6f |end to h|ave a lo|
|00005910| 77 65 72 20 74 68 72 65 | 73 68 6f 6c 64 0d 0a 66 |wer thre|shold..f|
|00005920| 6f 72 20 73 6f 6d 61 74 | 69 63 20 70 61 69 6e 20 |or somat|ic pain |
|00005930| 74 68 61 6e 20 64 6f 20 | 70 61 74 69 65 6e 74 73 |than do |patients|
|00005940| 20 77 69 74 68 20 6f 6e | 6c 79 20 73 69 6c 65 6e | with on|ly silen|
|00005950| 74 20 69 73 63 68 65 6d | 69 61 2e 20 20 41 73 79 |t ischem|ia. Asy|
|00005960| 6d 70 74 6f 6d 61 74 69 | 63 0d 0a 69 73 63 68 65 |mptomati|c..ische|
|00005970| 6d 69 61 20 69 73 20 61 | 20 70 72 65 64 69 63 74 |mia is a| predict|
|00005980| 6f 72 20 6f 66 20 63 61 | 72 64 69 61 63 20 65 76 |or of ca|rdiac ev|
|00005990| 65 6e 74 73 20 69 6e 20 | 61 20 76 61 72 69 65 74 |ents in |a variet|
|000059a0| 79 20 6f 66 20 63 69 72 | 63 75 6d 73 74 61 6e 63 |y of cir|cumstanc|
|000059b0| 65 73 2c 0d 0a 69 6e 63 | 6c 75 64 69 6e 67 20 61 |es,..inc|luding a|
|000059c0| 66 74 65 72 20 63 6f 72 | 6f 6e 61 72 79 20 61 72 |fter cor|onary ar|
|000059d0| 74 65 72 79 20 62 79 70 | 61 73 73 20 73 75 72 67 |tery byp|ass surg|
|000059e0| 65 72 79 2c 20 5b 32 5d | 20 62 75 74 20 69 74 20 |ery, [2]| but it |
|000059f0| 68 61 73 20 6e 6f 74 20 | 79 65 74 20 62 65 65 6e |has not |yet been|
|00005a00| 0d 0a 65 73 74 61 62 6c | 69 73 68 65 64 20 74 68 |..establ|ished th|
|00005a10| 61 74 20 73 75 63 63 65 | 73 73 66 75 6c 20 74 72 |at succe|ssful tr|
|00005a20| 65 61 74 6d 65 6e 74 20 | 6f 66 20 73 69 6c 65 6e |eatment |of silen|
|00005a30| 74 20 69 73 63 68 65 6d | 69 61 20 69 6d 70 72 6f |t ischem|ia impro|
|00005a40| 76 65 73 20 74 68 65 20 | 70 72 6f 67 6e 6f 73 69 |ves the |prognosi|
|00005a50| 73 2e 0d 0a 2d 2d 45 2e | 20 42 72 61 75 6e 77 61 |s...--E.| Braunwa|
|00005a60| 6c 64 2c 20 4d 2e 44 2e | 0d 0a 24 55 6e 69 71 75 |ld, M.D.|..$Uniqu|
|00005a70| 65 5f 49 44 7b 59 52 42 | 30 36 38 30 35 7d 0d 0a |e_ID{YRB|06805}..|
|00005a80| 24 54 69 74 6c 65 7b 45 | 66 66 65 63 74 20 6f 66 |$Title{E|ffect of|
|00005a90| 20 43 61 70 74 6f 70 72 | 69 6c 20 6f 6e 20 50 72 | Captopr|il on Pr|
|00005aa0| 6f 67 72 65 73 73 69 76 | 65 20 56 65 6e 74 72 69 |ogressiv|e Ventri|
|00005ab0| 63 75 6c 61 72 20 44 69 | 6c 61 74 61 74 69 6f 6e |cular Di|latation|
|00005ac0| 20 41 66 74 65 72 20 41 | 6e 74 65 72 69 6f 72 20 | After A|nterior |
|00005ad0| 4d 79 6f 63 61 72 64 69 | 61 6c 20 49 6e 66 61 72 |Myocardi|al Infar|
|00005ae0| 63 74 69 6f 6e 7d 0d 0a | 24 41 75 74 68 6f 72 7b |ction}..|$Author{|
|00005af0| 50 66 65 66 66 65 72 2c | 20 4d 41 0d 0a 4c 61 6d |Pfeffer,| MA..Lam|
|00005b00| 61 73 2c 20 43 41 0d 0a | 56 61 75 67 68 61 6e 2c |as, CA..|Vaughan,|
|00005b10| 20 44 45 0d 0a 50 61 72 | 69 73 69 2c 20 41 46 0d | DE..Par|isi, AF.|
|00005b20| 0a 42 72 61 75 6e 77 61 | 6c 64 2c 20 45 7d 0d 0a |.Braunwa|ld, E}..|
|00005b30| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 42 72 69 |$Affilia|tion{Bri|
|00005b40| 67 68 61 6d 20 61 6e 64 | 20 57 6f 6d 65 6e 27 73 |gham and| Women's|
|00005b50| 20 48 6f 73 70 2c 20 42 | 6f 73 74 6f 6e 3b 20 57 | Hosp, B|oston; W|
|00005b60| 65 73 74 20 52 6f 78 62 | 75 72 79 20 56 41 20 4d |est Roxb|ury VA M|
|00005b70| 65 64 20 43 74 72 2c 20 | 42 6f 73 74 6f 6e 7d 0d |ed Ctr, |Boston}.|
|00005b80| 0a 24 53 75 62 6a 65 63 | 74 7b 56 65 6e 74 72 69 |.$Subjec|t{Ventri|
|00005b90| 63 6c 65 20 64 69 6c 61 | 74 61 74 69 6f 6e 20 61 |cle dila|tation a|
|00005ba0| 66 74 65 72 20 61 6e 74 | 65 72 69 6f 72 20 69 6e |fter ant|erior in|
|00005bb0| 66 61 72 63 74 69 6f 6e | 2c 20 65 66 66 65 63 74 |farction|, effect|
|00005bc0| 20 6f 66 20 63 61 70 74 | 6f 70 72 69 6c 20 6f 6e | of capt|opril on|
|00005bd0| 3b 0d 0a 4d 79 6f 63 61 | 72 64 69 61 6c 20 69 6e |;..Myoca|rdial in|
|00005be0| 66 61 72 63 74 69 6f 6e | 20 61 6e 74 65 72 69 6f |farction| anterio|
|00005bf0| 72 20 63 61 70 74 6f 70 | 72 69 6c 20 66 6f 72 20 |r captop|ril for |
|00005c00| 76 65 6e 74 72 69 63 75 | 6c 61 72 20 64 69 6c 61 |ventricu|lar dila|
|00005c10| 74 61 74 69 6f 6e 20 61 | 66 74 65 72 3b 0d 0a 43 |tation a|fter;..C|
|00005c20| 61 70 74 6f 70 72 69 6c | 20 65 66 20 61 6e 74 65 |aptopril| ef ante|
|00005c30| 72 69 6f 72 20 69 6e 66 | 61 72 63 74 69 6f 6e 66 |rior inf|arctionf|
|00005c40| 65 63 74 20 6f 6e 20 76 | 65 6e 74 72 69 63 75 6c |ect on v|entricul|
|00005c50| 61 72 20 64 69 6c 61 74 | 61 74 69 6f 6e 20 61 66 |ar dilat|ation af|
|00005c60| 74 65 72 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 4e |ter}..$J|ournal{N|
|00005c70| 20 45 6e 67 6c 20 4a 20 | 4d 65 64 7d 0d 0a 24 56 | Engl J |Med}..$V|
|00005c80| 6f 6c 75 6d 65 7b 33 31 | 39 7d 0d 0a 24 50 61 67 |olume{31|9}..$Pag|
|00005c90| 65 7b 38 30 2d 38 36 7d | 0d 0a 24 44 61 74 65 7b |e{80-86}|..$Date{|
|00005ca0| 4a 75 6c 79 20 31 34 2c | 20 31 39 38 38 7d 0d 0a |July 14,| 1988}..|
|00005cb0| 24 59 42 56 6f 6c 7b 31 | 39 38 39 20 59 65 61 72 |$YBVol{1|989 Year|
|00005cc0| 20 42 6f 6f 6b 20 6f 66 | 20 4d 65 64 69 63 69 6e | Book of| Medicin|
|00005cd0| 65 2c 20 50 61 72 74 20 | 46 6f 75 72 7d 0d 0a 24 |e, Part |Four}..$|
|00005ce0| 43 68 61 70 74 65 72 7b | 33 31 2d 37 7d 0d 0a 24 |Chapter{|31-7}..$|
|00005cf0| 59 42 45 64 69 74 6f 72 | 7b 44 72 73 2e 20 52 6f |YBEditor|{Drs. Ro|
|00005d00| 67 65 72 73 2c 20 44 65 | 73 20 50 72 65 7a 2c 20 |gers, De|s Prez, |
|00005d10| 43 6c 69 6e 65 2c 20 42 | 72 61 75 6e 77 61 6c 64 |Cline, B|raunwald|
|00005d20| 2c 20 47 72 65 65 6e 62 | 65 72 67 65 72 2c 20 57 |, Greenb|erger, W|
|00005d30| 69 6c 73 6f 6e 2c 20 45 | 70 73 74 65 69 6e 2c 20 |ilson, E|pstein, |
|00005d40| 61 6e 64 20 4d 61 6c 61 | 77 69 73 74 61 7d 0d 0a |and Mala|wista}..|
|00005d50| 24 54 61 62 6c 65 7b 54 | 61 62 6c 65 20 4f 6d 69 |$Table{T|able Omi|
|00005d60| 74 74 65 64 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |tted}..$|Commenta|
|00005d70| 74 6f 72 7b 45 2e 20 42 | 72 61 75 6e 77 61 6c 64 |tor{E. B|raunwald|
|00005d80| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00005d90| 69 67 68 74 20 28 63 29 | 20 59 65 61 72 20 42 6f |ight (c)| Year Bo|
|00005da0| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00005db0| 73 68 65 72 73 2c 20 49 | 6e 63 2e 2c 20 31 39 38 |shers, I|nc., 198|
|00005dc0| 39 0d 0a 0d 0a 31 39 38 | 39 20 59 65 61 72 20 42 |9....198|9 Year B|
|00005dd0| 6f 6f 6b 20 6f 66 20 4d | 65 64 69 63 69 6e 65 20 |ook of M|edicine |
|00005de0| 28 52 29 0d 0a 0d 0a 50 | 61 72 74 20 46 6f 75 72 |(R)....P|art Four|
|00005df0| 3a 20 20 54 68 65 20 48 | 65 61 72 74 20 61 6e 64 |: The H|eart and|
|00005e00| 20 43 61 72 64 69 6f 76 | 61 73 63 75 6c 61 72 20 | Cardiov|ascular |
|00005e10| 44 69 73 65 61 73 65 0d | 0a 0d 0a 43 68 61 70 74 |Disease.|...Chapt|
|00005e20| 65 72 20 33 31 2d 2d 43 | 68 72 6f 6e 69 63 20 43 |er 31--C|hronic C|
|00005e30| 6f 72 6f 6e 61 72 79 20 | 41 72 74 65 72 79 20 44 |oronary |Artery D|
|00005e40| 69 73 65 61 73 65 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |isease..|..------|
|00005e50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 45 66 66 65 |--------|--..Effe|
|00005ea0| 63 74 20 6f 66 20 43 61 | 70 74 6f 70 72 69 6c 20 |ct of Ca|ptopril |
|00005eb0| 6f 6e 20 50 72 6f 67 72 | 65 73 73 69 76 65 20 56 |on Progr|essive V|
|00005ec0| 65 6e 74 72 69 63 75 6c | 61 72 20 44 69 6c 61 74 |entricul|ar Dilat|
|00005ed0| 61 74 69 6f 6e 20 41 66 | 74 65 72 20 41 6e 74 65 |ation Af|ter Ante|
|00005ee0| 72 69 6f 72 0d 0a 4d 79 | 6f 63 61 72 64 69 61 6c |rior..My|ocardial|
|00005ef0| 20 49 6e 66 61 72 63 74 | 69 6f 6e 0d 0a 0d 0a 50 | Infarct|ion....P|
|00005f00| 66 65 66 66 65 72 20 4d | 41 2c 20 4c 61 6d 61 73 |feffer M|A, Lamas|
|00005f10| 20 43 41 2c 20 56 61 75 | 67 68 61 6e 20 44 45 2c | CA, Vau|ghan DE,|
|00005f20| 20 50 61 72 69 73 69 20 | 41 46 2c 20 42 72 61 75 | Parisi |AF, Brau|
|00005f30| 6e 77 61 6c 64 20 45 0d | 0a 28 42 72 69 67 68 61 |nwald E.|.(Brigha|
|00005f40| 6d 20 61 6e 64 20 57 6f | 6d 65 6e 27 73 20 48 6f |m and Wo|men's Ho|
|00005f50| 73 70 2c 20 42 6f 73 74 | 6f 6e 3b 20 57 65 73 74 |sp, Bost|on; West|
|00005f60| 20 52 6f 78 62 75 72 79 | 20 56 41 20 4d 65 64 20 | Roxbury| VA Med |
|00005f70| 43 74 72 2c 20 42 6f 73 | 74 6f 6e 29 0d 0a 4e 20 |Ctr, Bos|ton)..N |
|00005f80| 45 6e 67 6c 20 4a 20 4d | 65 64 20 33 31 39 3a 38 |Engl J M|ed 319:8|
|00005f90| 30 2d 38 36 2c 20 4a 75 | 6c 79 20 31 34 2c 20 31 |0-86, Ju|ly 14, 1|
|00005fa0| 39 38 38 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |988..---|--------|
|00005fb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005fc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005fd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005fe0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ff0| 2d 2d 2d 2d 2d 0d 0a 0d | 0a 41 62 73 74 72 61 63 |-----...|.Abstrac|
|00006000| 74 0d 0a 0d 0a 20 20 20 | 20 20 49 6e 20 70 61 74 |t.... | In pat|
|00006010| 69 65 6e 74 73 20 77 69 | 74 68 20 63 6f 72 6f 6e |ients wi|th coron|
|00006020| 61 72 79 20 61 72 74 65 | 72 79 20 64 69 73 65 61 |ary arte|ry disea|
|00006030| 73 65 2c 20 6c 65 66 74 | 20 76 65 6e 74 72 69 63 |se, left| ventric|
|00006040| 75 6c 61 72 20 76 6f 6c | 75 6d 65 20 69 73 20 74 |ular vol|ume is t|
|00006050| 68 65 0d 0a 6d 6f 73 74 | 20 70 6f 77 65 72 66 75 |he..most| powerfu|
|00006060| 6c 20 70 72 65 64 69 63 | 74 6f 72 20 6f 66 20 73 |l predic|tor of s|
|00006070| 75 72 76 69 76 61 6c 2e | 20 20 54 68 65 20 6c 65 |urvival.| The le|
|00006080| 66 74 20 76 65 6e 74 72 | 69 63 6c 65 20 62 65 67 |ft ventr|icle beg|
|00006090| 69 6e 73 20 74 6f 20 64 | 69 6c 61 74 65 20 73 6f |ins to d|ilate so|
|000060a0| 6f 6e 0d 0a 61 66 74 65 | 72 20 6d 79 6f 63 61 72 |on..afte|r myocar|
|000060b0| 64 69 61 6c 20 69 6e 66 | 61 72 63 74 69 6f 6e 20 |dial inf|arction |
|000060c0| 28 4d 49 29 3b 20 69 6e | 20 74 68 65 20 61 63 75 |(MI); in| the acu|
|000060d0| 74 65 20 70 68 61 73 65 | 2c 20 74 68 69 73 20 69 |te phase|, this i|
|000060e0| 73 20 63 61 75 73 65 64 | 20 70 72 69 6d 61 72 69 |s caused| primari|
|000060f0| 6c 79 0d 0a 62 79 20 65 | 78 70 61 6e 73 69 6f 6e |ly..by e|xpansion|
|00006100| 20 6f 66 20 74 68 65 20 | 69 6e 66 61 72 63 74 2e | of the |infarct.|
|00006110| 20 20 41 20 64 6f 75 62 | 6c 65 2d 62 6c 69 6e 64 | A doub|le-blind|
|00006120| 2c 20 70 6c 61 63 65 62 | 6f 2d 63 6f 6e 74 72 6f |, placeb|o-contro|
|00006130| 6c 6c 65 64 20 74 72 69 | 61 6c 20 77 61 73 0d 0a |lled tri|al was..|
|00006140| 63 6f 6e 64 75 63 74 65 | 64 20 74 6f 20 64 65 74 |conducte|d to det|
|00006150| 65 72 6d 69 6e 65 20 77 | 68 65 74 68 65 72 20 76 |ermine w|hether v|
|00006160| 65 6e 74 72 69 63 75 6c | 61 72 20 64 69 6c 61 74 |entricul|ar dilat|
|00006170| 61 74 69 6f 6e 20 63 6f | 6e 74 69 6e 75 65 73 20 |ation co|ntinues |
|00006180| 64 75 72 69 6e 67 20 74 | 68 65 20 6c 61 74 65 0d |during t|he late.|
|00006190| 0a 63 6f 6e 76 61 6c 65 | 73 63 65 6e 74 20 70 68 |.convale|scent ph|
|000061a0| 61 73 65 20 61 66 74 65 | 72 20 4d 49 2c 20 61 6e |ase afte|r MI, an|
|000061b0| 64 20 77 68 65 74 68 65 | 72 20 63 61 70 74 6f 70 |d whethe|r captop|
|000061c0| 72 69 6c 20 74 68 65 72 | 61 70 79 20 63 68 61 6e |ril ther|apy chan|
|000061d0| 67 65 73 20 74 68 69 73 | 20 70 72 6f 63 65 73 73 |ges this| process|
|000061e0| 2e 0d 0a 20 20 20 20 20 | 46 69 66 74 79 2d 6e 69 |... |Fifty-ni|
|000061f0| 6e 65 20 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |ne patie|nts with|
|00006200| 20 61 20 66 69 72 73 74 | 20 61 6e 74 65 72 69 6f | a first| anterio|
|00006210| 72 20 4d 49 20 61 6e 64 | 20 61 20 72 61 64 69 6f |r MI and| a radio|
|00006220| 6e 75 63 6c 69 64 65 20 | 65 6a 65 63 74 69 6f 6e |nuclide |ejection|
|00006230| 0d 0a 66 72 61 63 74 69 | 6f 6e 20 6f 66 20 34 35 |..fracti|on of 45|
|00006240| 25 20 6f 72 20 6c 65 73 | 73 20 75 6e 64 65 72 77 |% or les|s underw|
|00006250| 65 6e 74 20 63 61 72 64 | 69 61 63 20 63 61 74 68 |ent card|iac cath|
|00006260| 65 74 65 72 69 7a 61 74 | 69 6f 6e 20 31 31 2d 33 |eterizat|ion 11-3|
|00006270| 31 20 64 61 79 73 20 61 | 66 74 65 72 0d 0a 69 6e |1 days a|fter..in|
|00006280| 66 61 72 63 74 69 6f 6e | 20 77 68 65 6e 20 74 68 |farction| when th|
|00006290| 65 79 20 77 65 72 65 20 | 6e 6f 74 20 69 6e 20 6f |ey were |not in o|
|000062a0| 76 65 72 74 20 63 6f 6e | 67 65 73 74 69 76 65 20 |vert con|gestive |
|000062b0| 68 65 61 72 74 20 66 61 | 69 6c 75 72 65 2e 0d 0a |heart fa|ilure...|
|000062c0| 43 61 74 68 65 74 65 72 | 69 7a 61 74 69 6f 6e 20 |Catheter|ization |
|000062d0| 77 61 73 20 72 65 70 65 | 61 74 65 64 20 61 74 20 |was repe|ated at |
|000062e0| 31 32 20 6d 6f 6e 74 68 | 73 20 74 6f 20 65 76 61 |12 month|s to eva|
|000062f0| 6c 75 61 74 65 20 63 68 | 61 6e 67 65 73 20 69 6e |luate ch|anges in|
|00006300| 20 68 65 6d 6f 64 79 6e | 61 6d 69 63 0d 0a 66 75 | hemodyn|amic..fu|
|00006310| 6e 63 74 69 6f 6e 20 61 | 6e 64 20 6c 65 66 74 20 |nction a|nd left |
|00006320| 76 65 6e 74 72 69 63 75 | 6c 61 72 20 76 6f 6c 75 |ventricu|lar volu|
|00006330| 6d 65 2e 20 20 54 68 69 | 72 74 79 2d 65 69 67 68 |me. Thi|rty-eigh|
|00006340| 74 20 6d 65 6e 20 77 65 | 72 65 20 73 74 75 64 69 |t men we|re studi|
|00006350| 65 64 20 77 69 74 68 0d | 0a 6d 61 78 69 6d 61 6c |ed with.|.maximal|
|00006360| 2d 65 78 65 72 63 69 73 | 65 20 74 72 65 61 64 6d |-exercis|e treadm|
|00006370| 69 6c 6c 20 74 65 73 74 | 73 20 61 74 20 33 2d 6d |ill test|s at 3-m|
|00006380| 6f 6e 74 68 20 69 6e 74 | 65 72 76 61 6c 73 2e 0d |onth int|ervals..|
|00006390| 0a 20 20 20 20 20 41 74 | 20 31 20 79 65 61 72 20 |. At| 1 year |
|000063a0| 74 68 65 20 6d 65 61 6e | 20 61 72 74 65 72 69 61 |the mean| arteria|
|000063b0| 6c 20 70 72 65 73 73 75 | 72 65 20 69 6e 20 74 68 |l pressu|re in th|
|000063c0| 65 20 63 61 70 74 6f 70 | 72 69 6c 20 67 72 6f 75 |e captop|ril grou|
|000063d0| 70 20 77 61 73 20 72 65 | 64 75 63 65 64 0d 0a 66 |p was re|duced..f|
|000063e0| 72 6f 6d 20 62 61 73 65 | 6c 69 6e 65 2e 20 20 43 |rom base|line. C|
|000063f0| 61 70 74 6f 70 72 69 6c | 2d 74 72 65 61 74 65 64 |aptopril|-treated|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.