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Biomedical subjects

A N Brest

Publications and source records attributed to A N Brest.

At least 19 recordsLinked to original sources
PubMed1992

Congestive heart failure in the elderly.

Congestive heart failure is in large part a disease of patients with advancing age. As our population ages, the incidence and prevalence of this disorder will continue to rise. The etiology of CHF in the elderly is multifactorial and one must take into account normal changes associated with aging, the heterogeneity of the elderly population, and possible noncardiac as well as cardiac disorders. Therapy must be aimed at the primary pathophysiologic process affecting the heart. Despite a number of therapeutic advances with medical therapy, CHF usually signals a generally irreversible process with a high mortality, especially in those patients with advanced disease. Therefore preventive measures should assume a paramount role in this disorder. Modification of risk factors such as diabetes, smoking, obesity, sedentary life style, and hypercholesterolemia should be aggressively stressed and pursued in patients of all ages. These preventive measures may have a substantial impact on the incidence of CHF in the elderly.

Aged↗
PubMed1989

Risk profiling the patient after acute myocardial infarction.

Patients surviving acute myocardial infarction form a large, heterogeneous group at risk for few or many varied complications with widely varied prognoses. By examining fundamental aspects of cardiac function such as left ventricular function, electrical instability, and residual ischemia as well as comorbid factors such as diabetes, a patient's risk for subsequent morbidity and mortality may be predicted. It is hoped that by identifying patients at increased risk, one may be able to alter the natural history of their disease.

Arrhythmias, Cardiac↗
PubMed1988

Rest and exercise radionuclide ventriculography in the ambulatory monitoring of patients with valvular heart disease.

Radionuclide angiography serves as a valuable adjunct in the noninvasive evaluation and monitoring of patients with valvular heart disease. Although estimations of regurgitant fractions and the differences between left and right ventricular stroke volumes can be made, the limitations of the techniques do not enable adequate quantitation of the severity of valvular insufficiency to warrant routine use in ambulatory management. The importance of radionuclide ventriculography, however, lies in its ability to examine global ventricular function both at rest and with exercise, thus enabling assessment of the functional reserve of the left and right ventricles. Such data are of considerable value in determining the need for invasive evaluation and the timing of valve replacement in patients with valvular heart disease.

Aortic Valve Insufficiency↗
PubMed1987

Tricuspid valve prolapse.

Tricuspid valve prolapse is an infrequent echocardiographic finding that is most commonly associated with mitral valve prolapse. When compared with patients exhibiting isolated prolapse of the mitral valve, patients with tricuspid valve prolapse are somewhat older individuals with a slightly higher frequency of neurologic symptoms, fatigue, weakness, supraventricular arrhythmias (especially atrial fibrillation) and skeletal deformities. Tricuspid valve prolapse may serve as a marker of more-diffuse connective tissue abnormalities, and its identification also should prompt an echocardiographic search for evidence of prolapse and regurgitation of the other heart valves.

Adult↗
PubMed1985

Management of angina pectoris.

Management of angina pectoris begins with recognition of the disorder and with an assessment of the extent and severity of the underlying disorder. Management includes adjunctive measures, antianginal drug therapy, and mechanical (surgery, angioplasty) options.

Angina Pectoris↗
PubMed1977

Pathophysiology and medical management of angina pectoris.

Myocardial oxygen demand is a function of the product of heart rate and blood pressure. Agents such as nitroglycerin not only produce coronary vasodilatation, which increases oxygen supply, but also reduce myocardial oxygen demand secondary to a reduction in both preload and afterload. Beta-adrenergic blockers are useful in angina because they reduce myocardial work and, hence, oxygen demand. A heart rate in the 50s does not preclude an increase in the dosage of propranolol when necessary.

Angina Pectoris↗
PubMed1976

Spectrum of coronary arterial spasm. Clinical, angiographic and myocardial metabolic experience in 29 cases.

A relationship of coronary arterial spasm to variant angina pectoris, subendocardial ischemia, major ventricular arrhythmias and myocardial infarction has been demonstrated. In 29 patients, spasm was angiographically observed in normal-appearing coronary arteries (7 patients) as well as superimposed on various degrees of coronary atherosclerotic obstruction (22 patients). All patients experienced an atypical anginal syndrome;16 patients also experienced typical exertional angina. Coronary spasm appeared to be a major contributory factor in eight occurrences of myocardial infarction and in 11 incidents of ventricular tachycardia, ventricular fibrillation and heart block. Coronary spasm in the 29 cases was distributed in the following fashion: left main trunk, 6 cases; right main trunk, 12 cases; proximal left anterior descending artery, 13 cases; proximal circumflex artery, 1 case; distal left anterior descending artery, 1 case; and distal circumflex artery, 2 cases. In 5 cases coronary spasm was noted at multiple sites.

Adult↗
PubMed1975

Comparative hemodynamic effects of placebo and oral isosorbide dinitrate in patients with significant coronary artery disease.

Comparative hemodynamic effects of placebo and 10 mg of oral isosorbide dinitrate were studied in patients with significant coronary artery disease (larger than or equal to 75 per cent lumen narrowing) proved angiographically. Isosorbide dinitrate or placebo was given to eight and 10 patients, respectively, in a double-blind fashion. Cardiac performance at rest and during supine leg exercise was evaluated before and 60 minutes after drug administration. In the resting state, isosorbide dinitrate compared to placebo significantly reduced the left ventricualr (systolic and diastolic), mean pulmonary artery and mean aortic pressures, cardiac index, stroke index, left ventricular work index, stroke work index, and mean systolic ejection rate. Isosorbide dinitrate also significantly reduced left ventricular (systolic and diastolic and mean pulmonary artery pressures during exercise. This study indicates that 10 mg of isosorbide dinitrate has a significant influence on ischemic left ventricular dysfunction 60 minutes after its oral administration.

Adult↗
PubMed1975

Correlation of abnormal Q waves, coronary pathology, and ventricular contractility.

Four hundred and ninety-two patients with coronary artery disease underwent analysis of their electrocardiograms, coronary arteriograms, and ventriculograms. Significant Q-waves were correlated with critical coronary occlusions (greater than or equal 75 per cent obstruction) and ventricular contractility. It was found that Q-waves correlate equally well with ventriculographic abnormalities and critical coronary occlusions. The Q-wave correlation varied from 77 to 87 per cent, depending on the area of myocardium under consideration, except for true posterior myocardial infarction, which correlated 55 per cent with ventriculographic abnormalities and 55 per cent with critical coronary occlusions. Significant Q-waves in Leads II, III, and aVF are better indicators of ventriculographic abnormality than in Leads III and aVF alone, whereas Q-waves in the latter two leads are more definitive than in Lead III alone. Patients who have critical coronary occlusions and normal electrocardiograms have normal ventriculograms in 71 to 78 per cent of the cases, again depending on the area of the myocardium under consideration. Thus, the normal electrocardiogram correlates better with the ventriculogram than with coronary pathology. The abnormal electrocardiogram correlates equally well with both.

Coronary Angiography↗