Search PubMed⌕ Search

Biomedical subjects

E Lichstein

Publications and source records attributed to E Lichstein.

At least 37 records · Page 2Linked to original sources
PubMed1989

Pericardial effusion early in acute myocardial infarction.

The incidence and significance of pericardial effusions early in acute myocardial infarction remain unclear. Using two-dimensional echocardiography, 172 patients with an acute myocardial infarction were evaluated within 72 h of presentation. Thirty patients (17%) had a pericardial effusion (29 small, 1 moderate) while 142 (83%) did not. No patient developed cardiac tamponade or required pericardiocentesis. Patients with pericardial effusions had higher peak creatine kinase as compared to patients without effusions (2036 +/- 1466 vs. 1483 +/- 1241, p less than 0.05) and a greater number of aneurysms (20% vs. 6%, p less than 0.05). In-hospital mortality was higher in the patients with pericardial effusions (10% vs. 2%, p less than 0.05). In conclusion, pericardial effusions are common in the early AMI period but are generally small and hemodynamically insignificant. They are associated with larger infarcts and greater mortality.

Aged↗
PubMed1989

Anticipation of bypass surgery: can it induce silent myocardial ischemia?

Psychological stress has been demonstrated to induce myocardial ischemia. To determine whether stressful events before a coronary artery bypass grafting procedure precipitate myocardial ischemia, silent or symptomatic, and whether this can have an effect on the prognosis, 26 patients were evaluated before a bypass operation with continuous Holter monitor recording. Specific events monitored were signing surgical consent, receiving preoperative medications, shaving and preparing, and transfer to the operating room. A positive Holter result was defined as an ST segment depression of 1 mm or more lasting one minute or longer. Six patients (23%) were found to have one or more episodes of substantial ST segment depression, with a total of ten episodes lasting 208 minutes recorded. All episodes were silent and not associated with an increase in mean heart rate. The majority of episodes occurred randomly, although three episodes did occur between 5 and 6 AM at the time of transport to the operating room. This appeared to be related more to the circadian rhythm than to the stress of transport. No perioperative or postoperative myocardial infarctions occurred, and all patients were alive at 30 days. In conclusion, silent myocardial ischemia present in the immediate preoperative period does not appear to be related to specific preoperative events. Frequency of early morning ischemia may warrant changes in the medication schedule to provide additional protection during these hours.

Aged↗
PubMed1989

Beta-adrenergic blocking drugs in the treatment of congestive heart failure.

Experimental and clinical data suggests that increased serum catecholamines may have predominantly detrimental effects in patients with congestive heart failure. Some investigators have proposed use of beta-blockers in heart failure as a means of ameliorating the harmful effects of the excess catecholamines. The clinical experience to date with use of these agents as therapy in congestive heart failure is limited but does suggest a future role for beta-blockers as adjunct therapy in a select population of patients with heart failure.

Adrenergic beta-Antagonists↗
PubMed1989

Full dose subcutaneous heparin therapy.

Anticoagulation is used extensively for the treatment and prevention of thromboembolic disease. Full dose anticoagulation with heparin is usually administered intravenously via continuous 24-hour infusion to avoid complications with intermittent intravenous administration. Continuous intravenous therapy is costly and cumbersome for nurses and patients. Subcutaneous administration of heparin in full dosage offers an attractive therapeutic alternative. This study examines the safety, efficacy, and cost considerations of this form of therapy. Fifteen patients admitted to the hospital for myocardial infarction were evaluated. After the patients were transferred from the cardiac intensive care unit, intravenous heparin was discontinued, while therapeutic anticoagulation was maintained via the subcutaneous route. Complications were limited to local hematoma formation. A cost comparison revealed substantial savings with subcutaneous administration.

Aged↗
PubMed1988

Septal rupture: effect of oxygen administration.

A patient with interventricular septal rupture as a complication of myocardial infarction was studied to determine whether varying the concentration of inspired oxygen would alter the magnitude of intracardiac shunt. A significant correlation was found showing that high concentration of inspired oxygen results in increased left to right shunting probably due to systemic vasoconstriction and pulmonary vasodilatation.

Combined Modality Therapy↗
PubMed1988

Epoprostenol (prostacyclin) in unstable angina.

The purpose of this randomized, double-blind multicenter trial was to investigate the potential therapeutic effect of epoprostenol (prostacyclin, PGI2) in patients with unstable angina, as compared with placebo, and to investigate the safety of this agent. Of the 184 patients enrolled, 28 did not fit the study criteria; of the remaining 156 patients, 30 received prostacyclin in an open-label fashion. In the double-blind portion of the study, 63 patients each received prostacyclin or placebo. The drug or its vehicle was infused intravenously up to 5 ng/kg/min dose for 72 hours with a tapering off period for the last 12 hours. Both treatment groups from the double-blind portion were comparable in regard to the demographic data, length of infusion, and total dose received. There were no significant differences between the placebo and prostacyclin group in the following clinical endpoints: levels of cardiac enzymes throughout hospitalization period (with the exception of lower SGOT level in the prostacyclin group at day 2), and severity of angina (throughout the study), and at the end of the study (day 30). The number of patients who had congestive heart failure, new myocardial infarction, balloon pump insertion, coronary artery bypass grafting, or percutaneous coronary angioplasty was similar in both groups. Similar results in regard to the efficacy endpoints were also apparent in the prostacyclin group that was treated under open-label fashion. There was also no difference in the New York Heart Association (NYHA) functional status at the end of the double-blind study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Are 24 hours of ambulatory ECG monitoring necessary for a patient after infarction?

The Beta-Blocker Heart Attack Trial was a randomized clinical trial of propranolol versus placebo in 3837 patients after myocardial infarction. A 24 hour ambulatory ECG was obtained before therapy in 3290 patients 2 to 21 days after myocardial infarction. Sensitivity, specificity, positive and negative predictive values, and prevalence were calculated for four definitions of ventricular arrhythmia with either total or sudden death (death in less than 1 hour of observed symptoms) as an endpoint. These indexes were obtained using the first 1, 2, 4, 6, 12, and 24 hours plus a random hour, a random daytime hour, and a random nighttime hour of the 24-hour ECG of 1336 placebo patients. For both total death and sudden death, as the duration of monitoring increased, (1) prevalence increased, (2) sensitivity increased, (3) specificity decreased, (4) positive predictive value either changed very little or decreased, and (5) negative predictive value was high (greater than 90%) and increased slightly. None of the 3 random hours offered anything beyond the first hour. The Beta-Blocker Heart Attack Trial data, which were based on an average follow-up of 25 months, show that as the number of hours of ambulatory monitoring increase, the percentages of patients identified at risk or not at risk (the positive and negative predictive values) do not change much. Twenty-four hours of monitoring does not appear to be the optimal time duration for deciding whether to treat arrhythmias in patients after infarction.

Adult↗
PubMed1988

Relationship between location of chest pain and site of coronary artery occlusion.

Chest pain characteristics and site of coronary artery occlusion were evaluated in 148 patients having single-vessel coronary angioplasty and in 95 patients having double-vessel angioplasty. The locations of chest pain included substernal and left precordium, right precordium and epigastric. The possible sites of pain radiation were limited to neck/jaw, left arm, right arm, and interscapular. The patient described whether or not the pain was typical of previous angina, and the presence of ST segment deviation was noted to be certain that ischemia was present. The analysis showed that the occluded artery could not be reliably identified. However, it was possible to say which artery was most likely not diseased. Patients presenting with substernal or left chest pain with radiation to the left arm had a less than 10% chance of having right coronary artery disease. A patient presenting with epigastric pain radiating to the neck or jaw had a less than 13% chance of having left anterior descending disease. It is concluded that in patients with single- and double-vessel coronary disease, there is some relationship between chest pain pattern and disease location.

Angina Pectoris↗
PubMed1987

Reperfusion ventricular fibrillation during coronary artery bypass operations and its association with postoperative enzyme release.

Elevated creatine kinase MB level is the most common marker of myocardial infarction in patients who have had a recent coronary bypass operation. This study was performed to determine whether there is any relationship between reperfusion rhythms, their treatment, and postoperative creatine kinase MB concentrations. Twenty patients were monitored during coronary bypass operations. Four patients had no reperfusion ventricular fibrillation and no elevation of creatine kinase MB postoperatively. Of the 16 remaining patients, all had ventricular fibrillation and 12 had an elevation of postoperative creatine kinase MB (p less than 0.015). There was also a 75% correlation between the time in ventricular fibrillation and postoperative creatine kinase MB level. There was no correlation between other measured parameters, such as cross-clamp time, bypass time, or the number of defibrillations. It is concluded that reperfusion ventricular fibrillation is associated with release of creatine kinase MB, and the time in ventricular fibrillation is correlated with the postoperative creatine kinase MB level.

Aged↗
PubMed1986

A fatal poisoning from an amatoxin containing Lepiota.

The mushroom Lepiota josserandii Bon and Boif. has been identified as the cause of an unintentional, fatal intoxication in New York. The course of the symptoms, beginning with a 9 h latent period, was similar to what would be expected in a case of Amanita phalloides-type intoxication. Despite supportive medical care the victim expired 110 h after ingestion. Thin layer chromatography detected the presence of alpha- and gamma-amanitin and radioimmunoassay confirmed a level of 3.5 mg/gm dry weight of amatoxins in mushrooms from the same location.

Agaricales↗
PubMed1986

Etiology and clinical significance of new fascicular conduction defects following coronary bypass surgery.

Two hundred consecutive patients undergoing only coronary bypass surgery were studied. Forty-five patients (group A) developed new fascicular conduction blocks and 155 patients (group B) did not. The 45 patients in group A developed the following fascicular conduction blocks: right bundle branch block 47%, right bundle branch block and left anterior hemiblock 8%, right bundle branch block and first-degree atrioventricular block 2%, left anterior hemiblock 11%, left bundle branch block 18%, right bundle branch block-left anterior hemiblock and first-degree atrioventricular block 5%. There were no significant differences in sex, incidence of diabetes, number of grafts performed, ejection fraction (less than 55%), and perioperative infarction. Group A patients were older (p less than 0.01). Hypertension was found frequently in group A (27 vs 45 patients; p less than 0.01) and was present for a mean of 12.4 years in group A and 4.9 years in group B (p less than 0.01). Preoperative use of digitalis was found in 14 (31%) patients in group A and in 18 (12%) patients in group B (p less than 0.01). Twenty-one (47%) patients in group A had significant disease (greater than 70%) of the left main coronary artery as compared to 17 (10.9%) in group B (p less than 0.001). There was no difference in the recurrence of angina or the survival rate at 14 months. In conclusion, the incidence of new fascicular conduction block after bypass surgery is 22.5%. Long-standing hypertension, left main coronary disease, and the preoperative use of digitalis appear to be predisposing factors. New fascicular conduction block does not affect prognosis.

Age Factors↗
PubMed1986

Effect of propranolol in patients with myocardial infarction and ventricular arrhythmia.

The Beta-Blocker Heart Attack Trial was a placebo-controlled, randomized, double-blind clinical trial of the long-term administration of propranolol hydrochloride to patients who had had at least one myocardial infarction. Among 3,837 patients followed up for an average of 25 months, 3,290 (85.7%) had 24 hour ambulatory electrocardiograms performed at the baseline examination. Four classifications of arrhythmia were examined. One of these, the presence of complex ventricular arrhythmias (at least 10 ventricular premature beats/h, or at least one pair or run of ventricular premature beats or multiform ventricular premature beats) was the subgroup of major interest. Regardless of the classification, the presence of arrhythmia identifies a group of patients with a higher risk of total mortality, coronary heart disease mortality, sudden cardiac death and instantaneous cardiac death. The a priori subgroup hypothesis that sudden death would be preferentially reduced by propranolol in patients with complex ventricular arrhythmias was not supported. The relative benefit of propranolol in reducing sudden death for this subgroup was 28 versus 16% for the subgroup without ventricular arrhythmia (relative risk of 0.72 versus 0.84, a nonsignificant relative difference of 14%). There were similar findings for two of the three other classifications of arrhythmia and for the other response variables. Although propranolol does not appear to be of special relative benefit in patients with ventricular arrhythmia, the presence of the arrhythmia does identify a high-risk group. The mechanism by which propranolol reduces mortality is still unclear, but is probably not solely an antiarrhythmic one.

Adult↗
PubMed1986

Postoperative ST-segment elevation in coronary artery bypass surgery.

Using Holter monitors, 50 patients were monitored for vasospasm following coronary artery bypass surgery. Transient 2 mm ST-segment elevation was considered to be diagnostic or coronary vasospasm. Four patients (8 percent) had evidence of coronary vasospasm. Over 30 variables, including preoperative demographic information and medication, intraoperative technique, and postoperative medication, were subjected to multiple stepwise regression analysis. This analysis failed to show any association between preoperative prophylaxis with either nifedipine or nitrates (or other variables) and the postoperative development of coronary vasospasm. We conclude that the incidence of coronary vasospasm is more common than previously thought, and that a nifedipine or nitrate withdrawal, in this study, was not associated with an increased incidence of postoperative coronary vasospasm.

Aged↗
PubMed1985

Beta-Blocker Heart Attack Trial: impact of propranolol therapy on ventricular arrhythmias.

The natural history of and the effect of propranolol on ventricular arrhythmias post-myocardial infarction were analyzed using data from the Beta-Blocker Heart Attack Trial (BHAT). The Beta-Blocker Heart Attack Trial was a multicenter, randomized, double-blind, placebo-controlled trial among 3,837 patients entered from 5 to 21 days after hospitalization for acute myocardial infarction. At baseline, prior to randomization, 3,290 (85.7%) patients underwent 24-hr ambulatory ECG monitoring which was repeated in approximately 25% of a randomly selected subset of the study population at 6 weeks. Ventricular arrhythmias were divided into eight different categories which defined the prevalence of ventricular arrhythmias in terms of frequency and/or complexity. Ventricular arrhythmias at baseline were associated with age, past history of myocardial infarction, and use of diuretics and digitalis. Paired data (baseline and 6-week) were available for 428 patients on propranolol and 412 on placebo. Propranolol markedly blunted the two- to threefold increase in ventricular arrhythmias that occurred from baseline to 6 weeks in the placebo group. Propranolol decreased the proportion of patients having ventricular arrhythmias during waking hours compared with sleep. These data show that propranolol has an antiarrhythmic effect and suggest that an antiarrhythmic mechanism may in part be responsible for the observed reduction in sudden cardiac death mortality in BHAT.

Adult↗
PubMed1984

Methemoglobin levels produced by organic nitrates in patients with coronary artery disease.

To determine if ordinary doses of nitrates produce a significant increase in methemoglobin, methemoglobin levels were measured in 59 randomly selected patients with coronary artery disease and unstable angina pectoris who were receiving organic nitrate therapy. Patients were taking isosorbide dinitrate, 2% nitroglycerin ointment, or a combination of the two. Patients were subdivided according to whether they were using one (group A) or more than one (group B) organic nitrate preparations. These results were compared with 17 control patients. Mean methemoglobin levels in group B were 1.78 +/- 1.29%, and this differed significantly (P less than 0.05) from both group A mean methemoglobin, 1.13 +/- 0.92%, and controls, 0.99 +/- 0.55%. The proportion of patients with elevated methemoglobin concentration increased from the control to group A to group B. It is concluded that commonly used dosages of nitrates are capable of causing elevations of methemoglobin which are probably not of routine clinical significance. However, these elevations may be of import in certain patient populations such as those with coronary insufficiency or anemia.

Aged↗