home *** CD-ROM | disk | FTP | other *** search
Unknown | 1992-06-06 | 356.2 KB |
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MacOS 8.1
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Win98
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DOS
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Confidence | Program | Detection | Match Type | Support
|
---|
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
|
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hex view+--------+-------------------------+-------------------------+--------+--------+
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|00000500| 00 00 39 30 00 00 00 01 | 47 10 05 00 16 0d 00 00 |..90....|G.......|
|00000510| 39 31 00 00 00 01 5d 1d | 05 00 d3 0e 00 00 39 32 |91....].|......92|
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|00000550| 05 00 c3 0b 00 00 39 36 | 00 00 00 01 42 61 05 00 |......96|....Ba..|
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|00000580| 39 39 00 00 00 01 d7 83 | 05 00 11 0d 00 00 00 00 |99......|........|
|00000590| 00 00 00 00 e8 90 05 00 | 00 00 00 00 24 55 6e 69 |........|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 36 30 30 30 7d |que_ID{Y|RB06000}|
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|000005d0| 73 20 61 6e 64 20 4e 61 | 74 75 72 61 6c 20 48 69 |s and Na|tural Hi|
|000005e0| 73 74 6f 72 79 20 6f 66 | 20 50 61 74 69 65 6e 74 |story of| Patient|
|000005f0| 73 20 57 69 74 68 20 41 | 63 75 74 65 20 4d 79 6f |s With A|cute Myo|
|00000600| 63 61 72 64 69 61 6c 20 | 49 6e 66 61 72 63 74 69 |cardial |Infarcti|
|00000610| 6f 6e 20 53 65 6e 74 20 | 48 6f 6d 65 20 46 72 6f |on Sent |Home Fro|
|00000620| 6d 20 74 68 65 20 45 6d | 65 72 67 65 6e 63 79 20 |m the Em|ergency |
|00000630| 52 6f 6f 6d 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 0d |Room}..$|Author{.|
|00000640| 0a 4c 65 65 2c 20 54 48 | 0d 0a 52 6f 75 61 6e 2c |.Lee, TH|..Rouan,|
|00000650| 20 47 57 0d 0a 57 65 69 | 73 62 65 72 67 2c 20 4d | GW..Wei|sberg, M|
|00000660| 43 0d 0a 42 72 61 6e 64 | 2c 20 44 41 0d 0a 41 63 |C..Brand|, DA..Ac|
|00000670| 61 6d 70 6f 72 61 2c 20 | 44 0d 0a 53 74 61 73 69 |ampora, |D..Stasi|
|00000680| 75 6c 65 77 69 63 7a 2c | 20 43 0d 0a 57 61 6c 73 |ulewicz,| C..Wals|
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|000006a0| 61 2c 20 47 0d 0a 47 6f | 74 74 6c 69 65 62 2c 20 |a, G..Go|ttlieb, |
|000006b0| 4c 0d 0a 47 6f 6c 64 73 | 74 65 69 6e 2d 57 61 79 |L..Golds|tein-Way|
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|000006d0| 0a 44 61 6c 65 79 2c 20 | 4b 0d 0a 42 72 61 6e 64 |.Daley, |K..Brand|
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|00000740| 6e 64 20 48 61 72 76 61 | 72 64 20 4d 65 64 20 53 |nd Harva|rd Med S|
|00000750| 63 68 6f 6f 6c 2c 20 42 | 6f 73 74 6f 6e 3b 20 59 |chool, B|oston; Y|
|00000760| 61 6c 65 2d 4e 65 77 20 | 48 61 76 65 6e 20 48 6f |ale-New |Haven Ho|
|00000770| 73 70 20 61 6e 64 20 59 | 61 6c 65 20 55 6e 69 76 |sp and Y|ale Univ|
|00000780| 3b 20 55 6e 69 76 20 6f | 66 20 43 69 6e 63 69 6e |; Univ o|f Cincin|
|00000790| 6e 61 74 69 20 48 6f 73 | 70 20 61 6e 64 20 55 6e |nati Hos|p and Un|
|000007a0| 69 76 20 6f 66 20 43 69 | 6e 63 69 6e 6e 61 74 69 |iv of Ci|ncinnati|
|000007b0| 3b 20 44 61 6e 62 75 72 | 79 20 48 6f 73 70 2c 20 |; Danbur|y Hosp, |
|000007c0| 44 61 6e 62 75 72 79 2c | 20 43 6f 6e 6e 3b 20 4d |Danbury,| Conn; M|
|000007d0| 69 6c 66 6f 72 64 20 48 | 6f 73 70 2c 20 4d 69 6c |ilford H|osp, Mil|
|000007e0| 66 6f 72 64 2c 20 43 6f | 6e 6e 3b 20 65 74 20 61 |ford, Co|nn; et a|
|000007f0| 6c 7d 0d 0a 24 53 75 62 | 6a 65 63 74 7b 4d 79 6f |l}..$Sub|ject{Myo|
|00000800| 63 61 72 64 69 61 6c 20 | 69 6e 66 61 72 63 74 69 |cardial |infarcti|
|00000810| 6f 6e 20 70 61 74 69 65 | 6e 74 73 20 73 65 6e 74 |on patie|nts sent|
|00000820| 20 68 6f 6d 65 20 66 72 | 6f 6d 20 65 6d 65 72 67 | home fr|om emerg|
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|00000870| 75 72 6e 61 6c 7b 41 6d | 20 4a 20 43 61 72 64 69 |urnal{Am| J Cardi|
|00000880| 6f 6c 7d 0d 0a 24 56 6f | 6c 75 6d 65 7b 36 30 7d |ol}..$Vo|lume{60}|
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|000008a0| 0d 0a 24 44 61 74 65 7b | 41 75 67 20 31 2c 20 31 |..$Date{|Aug 1, 1|
|000008b0| 39 38 37 7d 0d 0a 24 59 | 42 56 6f 6c 7b 31 39 38 |987}..$Y|BVol{198|
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|00000950| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|00000960| 65 72 73 2c 20 49 6e 63 | 2e 2c 20 31 39 38 39 0d |ers, Inc|., 1989.|
|00000970| 0a 0d 0a 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |...1989 |Year Boo|
|00000980| 6b 20 6f 66 20 45 6d 65 | 72 67 65 6e 63 79 20 4d |k of Eme|rgency M|
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|000009d0| 20 49 73 63 68 65 6d 69 | 61 2c 20 49 6e 66 61 72 | Ischemi|a, Infar|
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|00000a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 43 6c 69 6e 69 |--------|-..Clini|
|00000a40| 63 61 6c 20 43 68 61 72 | 61 63 74 65 72 69 73 74 |cal Char|acterist|
|00000a50| 69 63 73 20 61 6e 64 20 | 4e 61 74 75 72 61 6c 20 |ics and |Natural |
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|00000a70| 6e 74 73 20 57 69 74 68 | 20 41 63 75 74 65 20 4d |nts With| Acute M|
|00000a80| 79 6f 63 61 72 64 69 61 | 6c 0d 0a 49 6e 66 61 72 |yocardia|l..Infar|
|00000a90| 63 74 69 6f 6e 20 53 65 | 6e 74 20 48 6f 6d 65 20 |ction Se|nt Home |
|00000aa0| 46 72 6f 6d 20 74 68 65 | 20 45 6d 65 72 67 65 6e |From the| Emergen|
|00000ab0| 63 79 20 52 6f 6f 6d 0d | 0a 0d 0a 4c 65 65 20 54 |cy Room.|...Lee T|
|00000ac0| 48 2c 20 52 6f 75 61 6e | 20 47 57 2c 20 57 65 69 |H, Rouan| GW, Wei|
|00000ad0| 73 62 65 72 67 20 4d 43 | 2c 20 42 72 61 6e 64 20 |sberg MC|, Brand |
|00000ae0| 44 41 2c 20 41 63 61 6d | 70 6f 72 61 20 44 2c 20 |DA, Acam|pora D, |
|00000af0| 53 74 61 73 69 75 6c 65 | 77 69 63 7a 20 43 2c 20 |Stasiule|wicz C, |
|00000b00| 57 61 6c 73 68 6f 6e 20 | 4a 2c 0d 0a 54 65 72 72 |Walshon |J,..Terr|
|00000b10| 61 6e 6f 76 61 20 47 2c | 20 47 6f 74 74 6c 69 65 |anova G,| Gottlie|
|00000b20| 62 20 4c 2c 20 47 6f 6c | 64 73 74 65 69 6e 2d 57 |b L, Gol|dstein-W|
|00000b30| 61 79 6e 65 20 42 2c 20 | 43 6f 70 65 6e 20 44 2c |ayne B, |Copen D,|
|00000b40| 20 44 61 6c 65 79 20 4b | 2c 20 42 72 61 6e 64 74 | Daley K|, Brandt|
|00000b50| 20 41 41 2c 0d 0a 4d 65 | 6c 6c 6f 72 73 20 4a 2c | AA,..Me|llors J,|
|00000b60| 20 4a 61 6b 75 62 6f 77 | 73 6b 69 20 52 2c 20 43 | Jakubow|ski R, C|
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|00000b80| 4c 0d 0a 28 42 72 69 67 | 68 61 6d 20 61 6e 64 20 |L..(Brig|ham and |
|00000b90| 57 6f 6d 65 6e 27 73 20 | 48 6f 73 70 20 61 6e 64 |Women's |Hosp and|
|00000ba0| 20 48 61 72 76 61 72 64 | 20 4d 65 64 20 53 63 68 | Harvard| Med Sch|
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|00000bc0| 65 2d 4e 65 77 20 48 61 | 76 65 6e 20 48 6f 73 70 |e-New Ha|ven Hosp|
|00000bd0| 0d 0a 61 6e 64 20 59 61 | 6c 65 20 55 6e 69 76 3b |..and Ya|le Univ;|
|00000be0| 20 55 6e 69 76 20 6f 66 | 20 43 69 6e 63 69 6e 6e | Univ of| Cincinn|
|00000bf0| 61 74 69 20 48 6f 73 70 | 20 61 6e 64 20 55 6e 69 |ati Hosp| and Uni|
|00000c00| 76 20 6f 66 20 43 69 6e | 63 69 6e 6e 61 74 69 3b |v of Cin|cinnati;|
|00000c10| 20 44 61 6e 62 75 72 79 | 20 48 6f 73 70 2c 0d 0a | Danbury| Hosp,..|
|00000c20| 44 61 6e 62 75 72 79 2c | 20 43 6f 6e 6e 3b 20 4d |Danbury,| Conn; M|
|00000c30| 69 6c 66 6f 72 64 20 48 | 6f 73 70 2c 20 4d 69 6c |ilford H|osp, Mil|
|00000c40| 66 6f 72 64 2c 20 43 6f | 6e 6e 3b 20 65 74 20 61 |ford, Co|nn; et a|
|00000c50| 6c 29 0d 0a 41 6d 20 4a | 20 43 61 72 64 69 6f 6c |l)..Am J| Cardiol|
|00000c60| 20 36 30 3a 32 31 39 2d | 32 32 34 2c 20 41 75 67 | 60:219-|224, Aug|
|00000c70| 20 31 2c 20 31 39 38 37 | 0d 0a 2d 2d 2d 2d 2d 2d | 1, 1987|..------|
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|00000cf0| 74 65 6e 74 69 61 6c 6c | 79 20 73 65 72 69 6f 75 |tentiall|y seriou|
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|00001b50| 6e 7b 55 6e 69 76 20 6f | 66 20 4d 69 63 68 69 67 |n{Univ o|f Michig|
|00001b60| 61 6e 2c 20 41 6e 6e 20 | 41 72 62 6f 72 7d 0d 0a |an, Ann |Arbor}..|
|00001b70| 24 53 75 62 6a 65 63 74 | 7b 56 65 73 73 65 6c 20 |$Subject|{Vessel |
|00001b80| 69 6e 66 61 72 63 74 2c | 20 73 74 61 74 75 73 20 |infarct,| status |
|00001b90| 61 66 74 65 72 20 49 56 | 20 74 68 72 6f 6d 62 6f |after IV| thrombo|
|00001ba0| 6c 79 73 69 73 20 61 6e | 64 20 63 6f 72 6f 6e 61 |lysis an|d corona|
|00001bb0| 72 79 20 61 6e 67 69 6f | 70 6c 61 73 74 79 3b 0d |ry angio|plasty;.|
|00001bc0| 0a 50 6c 61 73 6d 69 6e | 6f 67 65 6e 20 69 6e 66 |.Plasmin|ogen inf|
|00001bd0| 61 72 63 74 20 76 65 73 | 73 65 6c 20 73 74 61 74 |arct ves|sel stat|
|00001be0| 75 73 20 61 66 74 65 72 | 3b 0d 0a 4d 79 6f 63 61 |us after|;..Myoca|
|00001bf0| 72 64 69 61 6c 20 69 6e | 66 61 72 63 74 69 6f 6e |rdial in|farction|
|00001c00| 20 69 6e 66 61 72 63 74 | 20 76 65 73 73 65 6c 20 | infarct| vessel |
|00001c10| 73 74 61 74 75 73 20 61 | 66 74 65 72 20 49 56 20 |status a|fter IV |
|00001c20| 74 69 73 73 75 65 20 70 | 6c 61 73 6d 69 6e 6f 67 |tissue p|lasminog|
|00001c30| 65 6e 20 61 63 74 69 76 | 61 74 6f 72 20 61 6e 64 |en activ|ator and|
|00001c40| 20 63 6f 72 6f 6e 61 72 | 79 20 61 6e 67 69 6f 70 | coronar|y angiop|
|00001c50| 6c 61 73 74 79 3b 0d 0a | 43 6f 72 6f 6e 61 72 79 |lasty;..|Coronary|
|00001c60| 20 61 6e 67 69 6f 70 6c | 61 73 74 79 20 69 6e 66 | angiopl|asty inf|
|00001c70| 61 72 63 74 20 76 65 73 | 73 65 6c 20 73 74 61 74 |arct ves|sel stat|
|00001c80| 75 73 20 61 66 74 65 72 | 7d 0d 0a 24 4a 6f 75 72 |us after|}..$Jour|
|00001c90| 6e 61 6c 7b 41 6d 20 48 | 65 61 72 74 20 4a 7d 0d |nal{Am H|eart J}.|
|00001ca0| 0a 24 56 6f 6c 75 6d 65 | 7b 31 31 35 7d 0d 0a 24 |.$Volume|{115}..$|
|00001cb0| 50 61 67 65 7b 31 2d 37 | 7d 0d 0a 24 44 61 74 65 |Page{1-7|}..$Date|
|00001cc0| 7b 4a 61 6e 75 61 72 79 | 20 31 39 38 38 7d 0d 0a |{January| 1988}..|
|00001cd0| 24 59 42 56 6f 6c 7b 31 | 39 38 39 20 59 65 61 72 |$YBVol{1|989 Year|
|00001ce0| 20 42 6f 6f 6b 20 6f 66 | 20 45 6d 65 72 67 65 6e | Book of| Emergen|
|00001cf0| 63 79 20 4d 65 64 69 63 | 69 6e 65 7d 0d 0a 24 43 |cy Medic|ine}..$C|
|00001d00| 68 61 70 74 65 72 7b 33 | 2d 32 31 7d 0d 0a 24 59 |hapter{3|-21}..$Y|
|00001d10| 42 45 64 69 74 6f 72 7b | 44 72 2e 20 57 61 67 6e |BEditor{|Dr. Wagn|
|00001d20| 65 72 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |er}..$Ta|ble{}..$|
|00001d30| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 4a 2e 54 2e |Commenta|tor{J.T.|
|00001d40| 20 4e 69 65 6d 61 6e 6e | 2c 20 4d 2e 44 2e 7d 0d | Niemann|, M.D.}.|
|00001d50| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 63 29 |...Copyr|ight (c)|
|00001d60| 20 59 65 61 72 20 42 6f | 6f 6b 20 4d 65 64 69 63 | Year Bo|ok Medic|
|00001d70| 61 6c 20 50 75 62 6c 69 | 73 68 65 72 73 2c 20 49 |al Publi|shers, I|
|00001d80| 6e 63 2e 2c 20 31 39 38 | 39 0d 0a 0d 0a 31 39 38 |nc., 198|9....198|
|00001d90| 39 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 45 |9 Year B|ook of E|
|00001da0| 6d 65 72 67 65 6e 63 79 | 20 4d 65 64 69 63 69 6e |mergency| Medicin|
|00001db0| 65 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |e (R)...|.Chapter|
|00001dc0| 20 33 2d 2d 4f 72 67 61 | 6e 20 53 79 73 74 65 6d | 3--Orga|n System|
|00001dd0| 20 45 6d 65 72 67 65 6e | 63 69 65 73 0d 0a 0d 0a | Emergen|cies....|
|00001de0| 4d 79 6f 63 61 72 64 69 | 61 6c 20 49 73 63 68 65 |Myocardi|al Ische|
|00001df0| 6d 69 61 2c 20 49 6e 66 | 61 72 63 74 69 6f 6e 0d |mia, Inf|arction.|
|00001e00| 0a 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |...-----|--------|
|00001e10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001e50| 2d 2d 2d 0d 0a 49 6e 66 | 61 72 63 74 20 56 65 73 |---..Inf|arct Ves|
|00001e60| 73 65 6c 20 53 74 61 74 | 75 73 20 41 66 74 65 72 |sel Stat|us After|
|00001e70| 20 49 6e 74 72 61 76 65 | 6e 6f 75 73 20 54 69 73 | Intrave|nous Tis|
|00001e80| 73 75 65 20 50 6c 61 73 | 6d 69 6e 6f 67 65 6e 20 |sue Plas|minogen |
|00001e90| 41 63 74 69 76 61 74 6f | 72 20 61 6e 64 20 41 63 |Activato|r and Ac|
|00001ea0| 75 74 65 0d 0a 43 6f 72 | 6f 6e 61 72 79 20 41 6e |ute..Cor|onary An|
|00001eb0| 67 69 6f 70 6c 61 73 74 | 79 3a 20 20 50 72 65 64 |gioplast|y: Pred|
|00001ec0| 69 63 74 69 6f 6e 20 6f | 66 20 43 6c 69 6e 69 63 |iction o|f Clinic|
|00001ed0| 61 6c 20 4f 75 74 63 6f | 6d 65 0d 0a 0d 0a 47 72 |al Outco|me....Gr|
|00001ee0| 69 6e 65 73 20 43 4c 2c | 20 54 6f 70 6f 6c 20 45 |ines CL,| Topol E|
|00001ef0| 4a 2c 20 42 61 74 65 73 | 20 45 52 2c 20 4a 75 6e |J, Bates| ER, Jun|
|00001f00| 69 20 4a 45 2c 20 57 61 | 6c 74 6f 6e 20 4a 41 20 |i JE, Wa|lton JA |
|00001f10| 4a 72 2c 20 4f 27 4e 65 | 69 6c 6c 20 57 57 0d 0a |Jr, O'Ne|ill WW..|
|00001f20| 28 55 6e 69 76 20 6f 66 | 20 4d 69 63 68 69 67 61 |(Univ of| Michiga|
|00001f30| 6e 2c 20 41 6e 6e 20 41 | 72 62 6f 72 29 0d 0a 41 |n, Ann A|rbor)..A|
|00001f40| 6d 20 48 65 61 72 74 20 | 4a 20 31 31 35 3a 31 2d |m Heart |J 115:1-|
|00001f50| 37 2c 20 4a 61 6e 75 61 | 72 79 20 31 39 38 38 0d |7, Janua|ry 1988.|
|00001f60| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00001f70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001fa0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001fb0| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00001fc0| 0a 20 20 20 20 20 49 6e | 74 72 61 76 65 6e 6f 75 |. In|travenou|
|00001fd0| 73 20 74 68 72 6f 6d 62 | 6f 6c 79 73 69 73 20 69 |s thromb|olysis i|
|00001fe0| 73 20 75 73 65 64 20 69 | 6e 63 72 65 61 73 69 6e |s used i|ncreasin|
|00001ff0| 67 6c 79 2c 20 6d 61 6b | 69 6e 67 20 70 61 74 69 |gly, mak|ing pati|
|00002000| 65 6e 74 20 73 65 6c 65 | 63 74 69 6f 6e 20 66 6f |ent sele|ction fo|
|00002010| 72 0d 0a 65 61 72 6c 79 | 20 64 65 66 69 6e 69 74 |r..early| definit|
|00002020| 69 76 65 20 72 65 76 61 | 73 63 75 6c 61 72 69 7a |ive reva|sculariz|
|00002030| 61 74 69 6f 6e 20 69 6d | 70 6f 72 74 61 6e 74 2e |ation im|portant.|
|00002040| 20 20 41 6e 67 69 6f 67 | 72 61 70 68 69 63 20 70 | Angiog|raphic p|
|00002050| 72 65 64 69 63 74 6f 72 | 73 20 6f 66 0d 0a 61 64 |redictor|s of..ad|
|00002060| 76 65 72 73 65 20 6f 75 | 74 63 6f 6d 65 20 77 65 |verse ou|tcome we|
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|00002180| 2e 20 20 41 6e 67 69 6f | 67 72 61 70 68 79 20 77 |. Angio|graphy w|
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|00003090| 20 4d 65 64 20 33 31 37 | 3a 31 36 31 33 2d 31 36 | Med 317|:1613-16|
|000030a0| 31 38 2c 20 44 65 63 20 | 32 34 2c 20 31 39 38 37 |18, Dec |24, 1987|
|000030b0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
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|000030d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000030e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000030f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003100| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
|00003110| 0d 0a 20 20 20 20 20 49 | 6e 74 72 61 76 65 6e 6f |.. I|ntraveno|
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|00005830| 43 61 72 64 69 6f 6d 79 | 6f 70 61 74 68 79 20 72 |Cardiomy|opathy r|
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|00005890| 7b 31 32 39 2d 31 33 33 | 7d 0d 0a 24 44 61 74 65 |{129-133|}..$Date|
|000058a0| 7b 4a 61 6e 20 32 31 2c | 20 31 39 38 38 7d 0d 0a |{Jan 21,| 1988}..|
|000058b0| 24 59 42 56 6f 6c 7b 31 | 39 38 39 20 59 65 61 72 |$YBVol{1|989 Year|
|000058c0| 20 42 6f 6f 6b 20 6f 66 | 20 45 6d 65 72 67 65 6e | Book of| Emergen|
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|000058f0| 42 45 64 69 74 6f 72 7b | 44 72 2e 20 57 61 67 6e |BEditor{|Dr. Wagn|
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|00005910| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 53 2e 20 4c |Commenta|tor{S. L|
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|00005930| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|00005940| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|00005950| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00005960| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 39 20 59 |, 1989..|..1989 Y|
|00005970| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 45 6d 65 72 |ear Book| of Emer|
|00005980| 67 65 6e 63 79 20 4d 65 | 64 69 63 69 6e 65 20 28 |gency Me|dicine (|
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|000059a0| 2d 4f 72 67 61 6e 20 53 | 79 73 74 65 6d 20 45 6d |-Organ S|ystem Em|
|000059b0| 65 72 67 65 6e 63 69 65 | 73 0d 0a 0d 0a 4d 79 6f |ergencie|s....Myo|
|000059c0| 63 61 72 64 69 61 6c 20 | 49 73 63 68 65 6d 69 61 |cardial |Ischemia|
|000059d0| 2c 20 49 6e 66 61 72 63 | 74 69 6f 6e 0d 0a 0d 0a |, Infarc|tion....|
|000059e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a30| 0d 0a 52 69 67 68 74 20 | 56 65 6e 74 72 69 63 75 |..Right |Ventricu|
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|00005a60| 61 74 68 20 69 6e 20 59 | 6f 75 6e 67 20 50 65 6f |ath in Y|oung Peo|
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|00005a80| 20 4e 61 76 61 20 41 2c | 20 43 6f 72 72 61 64 6f | Nava A,| Corrado|
|00005a90| 20 44 2c 20 52 6f 73 73 | 69 20 4c 2c 20 50 65 6e | D, Ross|i L, Pen|
|00005aa0| 6e 65 6c 6c 69 20 4e 0d | 0a 28 55 6e 69 76 20 6f |nelli N.|.(Univ o|
|00005ab0| 66 20 50 61 64 75 61 2c | 20 50 61 64 75 61 2c 20 |f Padua,| Padua, |
|00005ac0| 49 74 61 6c 79 29 0d 0a | 4e 20 45 6e 67 6c 20 4a |Italy)..|N Engl J|
|00005ad0| 20 4d 65 64 20 33 31 38 | 3a 31 32 39 2d 31 33 33 | Med 318|:129-133|
|00005ae0| 2c 20 4a 61 6e 20 32 31 | 2c 20 31 39 38 38 0d 0a |, Jan 21|, 1988..|
|00005af0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005b40| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|00005b50| 20 20 20 20 20 52 69 67 | 68 74 20 76 65 6e 74 72 | Rig|ht ventr|
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|00005b70| 70 61 74 68 79 20 69 73 | 20 61 20 72 61 72 65 20 |pathy is| a rare |
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|00005ba0| 72 69 73 6b 20 6f 66 20 | 73 75 64 64 65 6e 20 64 |risk of |sudden d|
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