CHD: When medical therapy fails.
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Contraindications↗
Biomedical subjects
E L Coodley
Publications and source records attributed to E L Coodley.
Bioelectrical impedance analysis as an assessment of diuresis in congestive heart failure.
OBJECTIVE: To compare changes in bioimpedance parameters and calculated total body water (TBW) with conventional measurements used to assess the efficacy of diuretic therapy in the treatment of heart failure. SETTING: A Veterans Affairs tertiary care, teaching hospital. SUBJECTS: Twelve patients with New York Heart Association (NYHA) class III congestive heart failure (CHF). DESIGN: Prospective, consecutive sample, cohort, open label. INTERVENTIONS: Parenterally administered furosemide; clinically dictated, outcome-oriented, adjunctive therapy of CHF. OUTCOMES: Bioelectrical impedance analysis (BIA) parameters, measured volume of diuresis and changes in body weight, defined clinical endpoints (NYHA criteria). RESULTS: Three days of diuretic therapy with furosemide (oral and/or intravenous) for CHF was associated with a measured weight loss of 4.1 +/- 0.6 kg and statistically significant increases in resistance and reactance of 20.8% +/- 2.7% and 22.7% +/- 6.1%, respectively (p < 0.005). Calculated TBW using BIA parameters and standard equations decreased on average by 6.1 +/- 0.6 L or 11.2% +/- 1.1% (p < 0.001). A significant inverse correlation was observed between change in measured body weight and total body reactance (p = 0.02). CONCLUSIONS: Single-frequency BIA appears to have limited clinical usefulness as a method of assessing diuretic therapy in the management of CHF. Its greatest usefulness appears to lie in the assessment of serial changes in individual patients and patient populations that are physiologically or metabolically homogeneous. Further studies are needed to establish the validity of BIA in patients with decompensated CHF.
Administration, Oral↗
Pleural effusion as the major manifestation of actinomycosis.
Pleural effusion represents an unusual but significant manifestation of actinomycosis, as illustrated in this case presentation. The diagnosis was made after bronchoscopy and examination of bronchoalveolar fluid and culture. No parenchymal abnormality was noted on the chest film.
Actinomycosis↗
Coronary artery disease in the elderly.
Clearly, management of heart disease is quite different in the elderly than in younger patients, and it represents a significant problem in light of the increasing numbers of elderly patients. For physicians, the challenges are to recognize the many cardiac entities, to avoid the problems that can result from prescribing drugs in dosages similar to those given to younger patients, and to acquire a better understanding of cardiac anatomy and physiology associated with the aging process.
Aged↗
Laboratory tests in the elderly. What is abnormal?
Comparison of studies on the elderly is difficult. This study is one of the largest done on healthy, ambulatory persons aged 65 and up. Findings indicate that most laboratory values in elderly persons fall in the normal range. A significantly abnormal test result should raise the suspicion of underlying disease. A small percentage of patients show an abnormality on specific tests (ie, for glucose, calcium, serum lipids). Changes in a few test values are to be expected with aging: These include an increase in alkaline phosphatase, a decrease in serum phosphorus, a decrease in creatinine clearance without a concomitant rise in serum creatinine, and an increase in postprandial glucose level. Vitamin deficiencies and decrease in serum albumin are usually the result of chronic malnutrition rather than aging.
Aged↗
Clinical spectrum and diagnostic techniques of coronary heart disease in the elderly.
Coronary heart disease is a major cause of morbidity and mortality in the older population. The recognition of such disease in the elderly varies in a number of parameters from that noted in younger patients. There are a number of physiologic changes in cardiac function as a result of aging, and they have an important bearing on the recognition of cardiac disease in the elderly. This review stresses the particular features of coronary disease in the aged and contrasts them with features more readily recognized in younger patients. Changes in the development of angina pectoris, heart failure, and the diagnosis of myocardial infarction vary significantly in the elderly population. The role of diagnostic modalities varies considerably in sensitivity and specificity when comparing younger and older patients. Potential areas for further research are stressed.
Age Factors↗
Cardiac arrhythmias. An update on identification and therapy.
Cardiac arrhythmias result from conduction block, abnormal impulse formation, or a combination of both. The decision to treat arrhythmias depends on symptoms, hemodynamic problems, the presence or absence of organic heart disease, and the presence of malignant arrhythmias. Holter monitoring, treadmill exercise testing, and electrophysiologic stimulation can facilitate identification. Control involves correction of precipitating or contributing factors and selection of an appropriate antiarrhythmic drug or surgical technique.
Anti-Arrhythmia Agents↗
Hypertension in the elderly.
Hypertension in the older population has a serious prognosis and this is true even for isolated systolic hypertension. There is a markedly increased risk of stroke, cardiovascular disease and central nervous system in such patients. The hemodynamics in hypertension of the elderly differs in a number of parameters from hypertension in the younger patient. In addition, drug metabolism is markedly altered by the aging process. This combination of factors requires a selective choice of agents for the management of hypertension in the elderly. The role of various drug modalities and their efficacy is reviewed in this presentation.
Adrenergic beta-Antagonists↗
Pizotyline-induced cholestatic jaundice.
We treated a case of drug-induced cholestatic jaundice in which the causative agent was pizotyline (Pizotifen), a phenothiazine-related drug. The patient's symptoms were compatible with either hepatitis or biliary obstruction. Diagnostic laboratory studies were performed to exclude both of these entities. The history of drug ingestion plus the clinical and histologic features established pizotyline as the causative agent.
Aged↗
Correlating thyroid and parathyroid function with age.
A double dilemma faces the clinician who suspects thyroid disease in the elderly--both lab tests and treatment protocol were developed using younger patients. Reviewing the literature and their own recent data, the authors suggest how to evaluate thyroid-related lab data, taking age into account.
Aged↗
Hyperkalemia associated with indomethacin.
Substantial hyperkalemia with ECG abnormalities developed in a patient. None of the common causes of hyperkalemia was found, eg, acidosis, hemolysis, rhabdomyolysis, renal failure, hypoadrenalism, leukocytosis, or thrombocytosis. The patient had been receiving indomethacin, a drug known to inhibit renin production, aldosterone excretion, and prostaglandin synthetase. The patient was rechallanged with indomethacin, and measurements of serum potassium and renin, urinary potassium, aldosterone, and creatinine levels were done. The study period clearly showed a hyporeninemic-hypoaldosterone states with diminished renal potassium excretion, leading to hyperkalemia associated with the indomethacin therapy. The development of hyperkalemia caused by indomethacin is probably unusual; however, we believe it is important to report this potentially serious pathophysiologic occurrence associated with a commonly used medication.
Adult↗
Survival with severe hypernatremia.
In a 74-year-old woman, excessive insensible water loss developed secondary to a period of hot, humid weather, associated with an underlying inability to obtain adequate water replacement. On admission to the hospital she was comatose, clinically dehydrated, and had laboratory values consistent with a water deficit of approximately 30% (9 L) of body water. Serum sodium concentration was 202 mEq/L. Serum osmolality was 430 mOsm/L. The patient remained comatose for seven days, during which time she was vigorously treated with fluids, and she gradually recovered. This case represents what we believe is a unique report in the literature of the severity of hypernatremia developing via this pathogenic mechanism and survival in an adult with this degree of disturbance of sodium and water homeostasis.
Aged↗
Serum glycoproteins in coronary artery disease.
Serum glycoprotein levels were compared in two groups of age- and sex-matched patients, 15 with coronary artery disease and 14 normal controls. While total glycoprotein levels were increased in the coronary group, significantly higher levels were found in only five of 16 glycoproteins--C3c haptoglobin, GC-globulin, alpha1-acid glycoprotein, and C3 activator--with no change in 10 other glycoproteins and significant decrease in transferrin. This study demonstrates what appears to be a glycoprotein profile in coronary artery disease and reviews possible interactions of glycoproteins with known risk factors in atherogenesis.
Arteriosclerosis↗
Diagnosis and management of opportunistic infections. Part I. Pathogenesis.
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Aspergillosis↗
Diagnosis and management of opportunistic infections. Part II. Diagnosis and therapy.
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Amphotericin B↗
Inhibition of platelet aggregation by alpha1-acid glycoprotein.
In view of known abnormalities of plasma proteins in diseases showing changes in platelet aggregation, the effect of one of the major serum proteins, alpha1-acid glycoprotein, on platelet aggregation was evaluated. This protein, when added to platelet-rich plasma, markedly inhibited platelet aggregation induced by both adenosine diphosphate (ADP) and epinephrine. Transferrin, similarly studied, had no effect. These results are consistent with the hypothesis that the relative concentration of alpha1-acid glycoprotein may influence platelet aggregation in diseases associated with abnormal concentrations of this protein.
Adenosine Diphosphate↗