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Biomedical subjects

A S Jaffe

Publications and source records attributed to A S Jaffe.

At least 55 records · Page 3Linked to original sources
PubMed1995

Major depression and medication adherence in elderly patients with coronary artery disease.

Little is known about the effects of depression on adherence to medical treatment regimens in older patients with chronic medical illnesses. Poor adherence may explain the increased risk of medical morbidity and mortality found in depressed medical patients. Ten of 55 patients over the age of 64 with coronary artery disease met the criteria for major depression from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987). All patients were prescribed a twice-per-day regimen of low dose aspirin to reduce their risk for myocardial infarction. Medication adherence was assessed for 3 weeks by an unobtrusive electronic monitoring device. Depressed patients adhered to the regimen on 45% of days, but nondepressed patients, on 69% (p < .02). Thus, major depression is associated with poor adherence to a regimen of prophylactic aspirin after the diagnosis of coronary artery disease.

Aged↗
PubMed1995

Rapid diagnosis of acute myocardial infarction.

At present the ideal method for the very early and very rapid diagnosis of acute infarction is still elusive, making it difficult to implement strategies in large numbers of patients. With further research and conjoint biochemical and imaging approaches, however, it is likely that the early diagnosis of infarction and detection of ischemia will be possible.

Biomarkers↗
PubMed1994

Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I.

BACKGROUND: Perioperative myocardial infarction is the most common cause of morbidity and mortality in patients who have had noncardiac surgery, but its diagnosis can be difficult. The present study was designed to determine whether the measurement of serum levels of cardiac troponin I, a highly sensitive and specific marker for cardiac injury, would help establish the diagnosis of myocardial infarction. METHODS: We obtained preoperative measurements of MB creatine kinase, total creatine kinase, and cardiac troponin I, in addition to base-line electrocardiograms and two-dimensional echocardiograms, in 96 patients undergoing vascular surgery and 12 undergoing spinal surgery. Blood samples were obtained every 6 hours for at least the first 36 hours after surgery, and electrocardiograms were obtained daily; a second echocardiogram was obtained approximately three days after surgery. The appearance of a new abnormality in segmental-wall motion on the postoperative echocardiogram (that is, an abnormality that had not been seen on the preoperative echocardiogram) was considered to be indicative of perioperative infarction. RESULTS: Eight patients who underwent vascular surgery had new abnormalities in segmental-wall motion and received a diagnosis of perioperative infarction. All eight had elevations of cardiac troponin I, and six had elevations of MB creatine kinase. Of the 100 patients without perioperative infarction detected by echocardiography, 19 had elevations of MB creatine kinase, and 1 had a slight elevation of cardiac troponin I. CONCLUSIONS: The measurement of cardiac troponin I is a sensitive and specific method for the diagnosis of perioperative myocardial infarction. It avoids the high incidence of false diagnoses associated with the use of MB creatine kinase as a diagnostic marker.

Creatine Kinase↗
PubMed1994

Conjoint use of MM and MB creatine kinase isoforms in detection of coronary recanalization.

To determine whether differences in the kinetics of isoforms of MM and MB creatine kinase affect their ability to detect coronary patency in patients treated with thrombolytic agents, we compared MM and MB isoform profiles in 33 consecutive patients. Results were discordant in 13 of the 33 at 1 hour. When the rates of increase of both isoforms were considered, discordance was present in only 10 of the 33 patients. In five patients %MM3 rose rapidly during the second hour and infarct-related vessels were patent. Four of the five without a rapid increase had occluded infarct-related vessels. These data suggest that criteria based on rates of change in %MB2 are more sensitive than those based on %MM3. However, criteria based on %MM3 are more likely to identify patients in need of interventions to maintain coronary patency.

Aged↗
PubMed1994

Increase in creatine kinase MB isoenzyme levels after spinal surgery.

Serial assays of creatine kinase (CK) and particularly its isoenzyme CK-MB are the tests of choice for the laboratory confirmation of myocardial tissue damage. However, elevations attributable to skeletal muscle injury also have been reported, and we noted elevated levels of total CK, CK-MB, and percent MB postoperatively following spinal surgery in some of our patients. To define prospectively the frequency of elevations and their clinical correlates, we studied 20 consecutive spinal surgical procedures in 17 adults. Postoperative elevations of CK-MB occurred in 55% of these procedures in the absence of overt clinical signs of myocardial injury. Elevations were correlated with operative time and the length of the surgical dissection. These data confirm that elevations in CK-MB and percent MB can occur after spinal surgery in the absence of overt clinical manifestations of myocardial injury. Thus, enzyme elevations should not be used in isolation to diagnose myocardial infarction in these patients.

Adult↗
PubMed1994

Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I.

Although measurement of cardiac troponin I (cTnI) is, in some situations, more specific for detection of cardiac injury than is measurement of the MB isoenzyme of creatine kinase (MBCK), its sensitivity and specificity relative to MBCK for detection of myocardial infarction has not been established. Accordingly, we studied prospectively 199 consecutive patients admitted to the coronary care unit. Values of MBCK and cTnI mass were determined in all samples. Of the 188 patients admitted with a suspicion of acute myocardial ischemia, 89 were diagnosed as having an acute myocardial infarction on the basis of the patterns of MBCK values. Eighty-six of these patients also had increased cTnI (concordance, 96.6%); three did not. Of the patients diagnosed as without infarction, five with unstable angina and symptoms in the day(s) prior to admission had increased cTnI, for a cTnI specificity of 94.9%. Receiver operating characteristic curve analysis indicated that cTnI and MBCK had statistically indistinguishable diagnostic accuracies for the detection of acute myocardial infarction.

Aged↗
PubMed1993

Ventricular tachycardia and psychiatric depression in patients with coronary artery disease.

PURPOSE: The purpose of this study was to examine the relationship between psychiatric depression and ventricular arrhythmias in patients with coronary artery disease (CAD). The hypothesis was that depressed patients with CAD would have a higher prevalence of ventricular tachycardia (VT) than nondepressed patients with CAD. PATIENTS AND METHODS: One hundred three patients who were found to have significant CAD by elective diagnostic cardiac catheterization were administered a standardized psychiatric interview and underwent 24-hour Holter monitoring. RESULTS: Twenty-one patients (20%) met the criteria for either major or minor depression. There were no significant differences between depressed and nondepressed patients with CAD in severity of CAD or in ventricular function. Five (23.8%) of the depressed patients and three (3.7%) of the nondepressed patients exhibited episodes of VT during 24 hours of Holter monitoring (p < 0.008). This difference remained significant even after controlling for relevant covariates. CONCLUSIONS: We conclude that there is a higher prevalence of VT among patients with CAD and depression than among those CAD patients without depression. This may help to explain the increased risk for cardiac mortality in depressed patients with CAD.

Aged↗
PubMed1993

The use of antiarrhythmics in advanced cardiac life support.

Antiarrhythmic agents have been used to treat malignant ventricular arrhythmias in the setting of acute myocardial ischemia with proven efficacy for many years. Thus, it has been presumed that these agents would be efficacious for the treatment of cardiac arrest. Unfortunately, hard data supporting this contention are unavailable to date. Furthermore, some of the experimental data in this area are conflicting, especially regarding the relative effects of lidocaine and bretylium. Thus, little definitive can be said based on experimental information. In two randomized patient studies, lidocaine and bretylium performed comparably. Because of the frequent use of lidocaine and thus the familiarity of most health care professionals with its use, it makes educational sense to utilize lidocaine as the antiarrhythmic drug of first choice during the cardiac arrest sequence. Recent data suggesting that amiodarone may be efficacious in patients with recurrent arrhythmias require additional confirmation. Although antiarrhythmic agents have been shown to be effective in the treatment of malignant arrhythmias in patients with acute myocardial infarction, their use prophylactically for patients with suspected infarction (advocated in the past) has recently undergone reevaluation. It is now clear that despite a reduction in ventricular fibrillation, overall mortality may be increased. This may be because the prophylactic treatment of patients with suspected infarction includes a large number of patients not at risk for ventricular fibrillation who still may be at risk for drug toxicity. Thus, prophylactic administration of lidocaine to all patients with suspected acute myocardial infarction can no longer be recommended. There are inadequate data upon which to base a recommendation concerning the use of lidocaine in patients receiving thrombolytic therapy. The group most likely to benefit from lidocaine are patients with ST segment elevation who present early after the onset of acute myocardial infarction. The use of lidocaine in this group requires additional study. At present, despite enthusiasm for the prophylactic use of magnesium for the treatment of arrhythmias, data are inadequate to support its routine administration. However, given the importance of magnesium and potassium levels in the genesis of malignant arrhythmias, their levels in plasma should be assessed, and abnormalities should be promptly corrected. The potential uses of antiarrhythmic agents during advanced cardiac life support span a remarkably diverse number of applications. For the purpose of this review, only the use of these agents during CPR and during the early hours of acute or suspected acute myocardial infarction will be considered.

Anti-Arrhythmia Agents↗
PubMed1993

Thrombolytic therapy.

All patients with symptoms and ECG findings suggestive of acute myocardial infarction (AMI) should be considered for treatment with thrombolytic agents. The decision to use thrombolytic therapy is a clinical judgment based upon a weighing of the potential benefits versus the possible risks. The physician must take into account relative contraindications, age of the patient, area of jeopardized myocardium, and duration of symptoms. Health professionals involved in the care of AMI patients should develop written plans and protocols addressing the following matters: identification of patients with chest pain in the prehospital setting (this applies to hospitals that receive patients from emergency medical services systems), triage of patients in the emergency department, obtaining the 12-lead electrocardiogram, determination of contraindications, authority for ordering thrombolytic therapy, and consultation for atypical cases. There also should be agreed standards for the time interval from arrival in the ED to administration of the thrombolytic agent, as well as a commitment to the prospective monitoring of procedures and times to assure continuous improvement. A time interval for treatment (arrival in ED to administration of drug) of 30 to 60 minutes should be achievable for patients who present with typical symptoms and ECG findings.

Acute Disease↗
PubMed1993

Hemodynamic effects of atrial interaction.

BACKGROUND: Ventricular pressure and volume overload may induce hemodynamically important ventricular interactions mediated by the thick interventricular septum. The purpose of this study was to determine whether analogous hemodynamically manifest atrial interactions occur across the thinner interatrial septum. METHODS: Right atrial (RA) and left atrial (LA) pressures were measured with micromanometer-tipped catheters before and after atrial pressure and volume overload elicited by sequential right ventricular (RV), RA, and septal ischemia induced in nine open-chest dogs. RESULTS: Following RV ischemia, RA pressure increased and RA contraction and relaxation were enhanced, as indicated by an augmented A wave and X descent. Despite decreased LV diastolic size, LA pressure increased, with similar increases in its A wave and X descent. RA ischemia depressed RA contraction and relaxation, resulting in diminished A wave and X descent. Parallel changes occurred in the LA waveform. Following septal ischemia, LA contraction and relaxation were enhanced, as reflected in an augmented A wave and X descent. Despite persistent RA ischemia, the RA A wave and X descent increased. CONCLUSIONS: These findings demonstrate interatrial transmission of pressure and waveform changes that may influence hemodynamic evaluation and cardiac function.

Animals↗
PubMed1993

Cardiac troponin I. A marker with high specificity for cardiac injury.

BACKGROUND: Levels of MBCK can be increased in patients with skeletal muscle injury or renal failure in the absence of myocardial injury, causing diagnostic confusion. This study was designed to determine whether measurement of cardiac troponin I (cTnI), a myocardial regulatory protein with comparable sensitivity to MBCK, has sufficient specificity to clarify the etiology of MBCK elevations in patients with acute or chronic skeletal muscle disease or renal failure. METHODS AND RESULTS: Of the patients (n = 215) studied, 37 had acute skeletal muscle injury, 10 had chronic muscle disease, nine were marathon runners, and 159 were chronic dialysis patients. Patients were evaluated clinically, by ECG, and by two-dimensional echocardiography. Total creatine kinase (normal, < 170 IU/L) was determined spectrophotometrically, and cTnI (normal, < 3.1 ng/mL) and MBCK (normal, < 6.7 ng/mL) were determined with specific monoclonal antibodies. Values above the upper reference limit were considered "elevated." Elevations of total creatine kinase were common, and elevations of MBCK occurred in 59% of patients with acute muscle injury, 78% of patients with chronic muscle disease and marathon runners, and 3.8% of patients with chronic renal failure. Some of the patients were critically ill; five patients were found to have had myocardial infarctions and one had a myocardial contusion. cTnI was elevated only in these patients. CONCLUSIONS: Elevations of cTnI are highly specific for myocardial injury. Use of cTnI should facilitate distinguishing whether elevations of MBCK are due to myocardial or skeletal muscle injury.

Adult↗
PubMed1993

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Clinical Trials as Topic↗