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Biomedical subjects

E Lichstein

Publications and source records attributed to E Lichstein.

At least 55 records · Page 3Linked to original sources
PubMed1984

High mortality early reinfarction with first nontransmural myocardial infarction.

Thirty-eight patients with first nontransmural myocardial infarction were studied to determine prognosis and clinical markers of a high-risk subgroup. We found a high incidence of reinfarction (18%) at a median time of 16 days post nontransmural infarction (seven patients). Reinfarction was uniformly associated with death within 24 hours. A total of 14 patients (37%) either died (eight patients) or required urgent revascularization (six patients). Predominant ST segment depression with presenting nontransmural infarction and a history of prior angina were associated with increased mortality (p less than 0.05 and p = 0.05, respectively). We conclude that patients with nontransmural infarction are at high risk for early recurrent infarction. Patients with history of prior angina and predominant ST segment depression may be at particularly high risk. Reinfarction in these patients is frequently extensive. We recommend that these patients be considered for early coronary angiography.

Aged↗
PubMed1984

Effect of propranolol in postinfarction patients with mechanical or electrical complications.

In "post hoc" subgroup analyses, a simple classification system for patients, based on the presence or absence of findings indicative of electrical and/or mechanical complications early during short-term hospitalization, was applied to the data from the Beta-Blocker Heart Attack Trial (BHAT). In the largest subgroup of BHAT patients who had no reported complications, the 25 month mortality was low and the observed benefit of propranolol therapy small. Patients with electrical complications only had intermediate mortality and a pronounced effect of treatment was observed. Those with mechanical complications had the highest mortality and experienced an intermediate relative benefit of beta-blocker treatment. They also reported the most adverse effects. Post hoc analyses should always be interpreted cautiously. It is important to determine whether these findings are present in other completed beta-blocker trials. On the basis of these analyses alone it is suggested that the present practice of prescribing beta-blockers in postinfarction patients should not be altered.

Arrhythmias, Cardiac↗
PubMed1984

Dilated cardiomyopathy in identical twins.

Identical twins had dilated cardiomyopathy and evidence of an autoimmune process involving both the heart and thyroid gland. An inherited abnormality of immune regulation is suggested as a possible basis for these unusual findings.

Adult↗
PubMed1983

Single catheter technique for accurate cardiac outputs from left ventricle.

We report our experience in cardiac output measurements using a single catheter for left ventricular green dye injection with sampling from the side arm of a femoral artery introducer sheath. This technique is compared to thermal dilution (20 patients) and pulmonary artery green dye injection (20 patients). There were no significant differences between the single catheter left ventricular method and the other two accepted methods for measuring cardiac output.

Cardiac Catheterization↗
PubMed1983

Bundle branch block in acute myocardial infarction.

The management of patients with acute myocardial infarction complicated by bundle branch block is a significant clinical problem and represents 8% to 13% of patients with acute infarction. This study reviews the records of 606 patients with myocardial infarction admitted to our coronary care unit. Forty-seven (8%) had complete bundle branch block. The risk of developing high-degree AV block in these 47 patients was reviewed. There are no established therapeutic guidelines for patients with pre-existing bundle branch block and left bundle branch block in acute myocardial infarction. We found a high risk of progression in patients with pre-existing bifascicular block in the presence of anterior wall infarction (25%) as well as in patients with left bundle branch block with acute anterior wall infarction (100%). On the basis of our data and careful review of the literature, we recommend prophylactic pacemaker insertion in these high-risk groups.

Bundle-Branch Block↗
PubMed1983

Clinical significance of slow paroxysmal atrial tachycardia.

This study examines the clinical setting, characteristics, and follow-up of 173 patients who had slow paroxysmal atrial tachycardia (SPAT) (greater than 4 beats, rate less than 150 bpm) during 24-hour Holter monitoring. These episodes were classified by probable mechanism according to recognized ECG criteria and included AV nodal reentry (AVNR), sinoatrial nodal reentry (SANR), and automatic (A). There were 76 males (44%) with a mean age of 72 years and 97 females (56%) with a mean age of 73 years. The indications for Holter recording revealed that the SANR and A subgroups had a higher frequency of cerebral symptoms compared to AVNR (p less than 0.01). Chest pain was more common in the SANR group as compared to the other two groups (p less than 0.01). There was no difference in the frequency of palpitation in the three subgroups. The mean rate of SPAT for the entire group was 115.2 +/- 14 and these episodes had a mean duration of 5.58 +/- 3.07 seconds. The SANR subgroup had a significantly slower rate (107.1 +/- 9.2) as compared to the AVNR subgroup (p less than 0.01). One hundred fourteen patients were available for follow-up. The average period of follow-up was similar for all three groups. At follow-up the frequency of sick sinus syndrome as determined clinically and permanent pacemaker insertion was significantly greater in the SANR subgroup (p less than 0.01) as compared to the other subgroups which did not differ from each other.

Aged↗
PubMed1983

Efficacy of sustained-release buccal nitroglycerin in patients with angina pectoris. New and long-acting therapy demonstrated by exercise.

The antianginal efficacy of a single sustained-release buccal nitroglycerin (BNTG) tablet was assessed in 16 patients with known coronary artery disease. Patients were trained in bicycle ergometry to induce angina pectoris within three to five minutes. A hemodynamically effective dose of BNTG was identified. Patients were tested at baseline and given placebo and BNTG in a randomized, double-blind manner on consecutive days. They were tested at 0.5, 1, 3, and 5 hours after drug administration. The average increase in exercise duration with BNTG compared with placebo at 0.5 hours was 40 percent (p less than 0.01); at 1 hour was 31 percent (p less than 0.01); at 3 hours was 27 percent (p less than 0.01); at 5 hours was 15 percent (p = NS). In a subset of ten patients in whom the tablet was maintained in the buccal pouch for five or more hours before dissolving, increase in exercise duration was significant at all times tested (p less than 0.05). We conclude that BNTG is an effective modality of administering nitroglycerin for rapid and prolonged effect with reduction in angina pectoris and increase in exercise duration which may persist for at least five hours.

Adult↗
PubMed1983

Effect of propranolol on ventricular arrhythmia. The beta-blocker heart attack trial experience.

The Beta-Blocker Heart Attack Trial (BHAT) was a multicenter, randomized, double-blind, placebo-controlled trial that tested the effectiveness of propranolol in reducing the mortality rate in patients after myocardial infarction (MI). Twenty-four hour ambulatory ECG monitoring was done on 3279 of the 3837 enrolled patients at baseline (5-21 days after hospital admission) and repeated after 6 weeks of therapy in a random sample of 25% of the study population. Ventricular arrhythmias were divided into seven different categories and the prevalence of each category is presented. Ventricular arrhythmia at baseline appears to increase with patient age, past history of myocardial infarction, and use of diuretics. Other selected variables--sex, CPK ratio and history of smoking, diabetes and hypertension--appear to be less clearly associated with ventricular arrhythmia. Paired data analysis performed on 826 patients who had ambulatory electrocardiograms both at baseline and after 6 weeks of treatment showed an increased prevalence of ventricular arrhythmia at 6 weeks. This increase was blunted by propranolol therapy.

Adult↗
PubMed1982

Current incidence of postmyocardial infarction (Dressler's) syndrome.

This study examines the current incidence of postmyocardial infarction (Dressler's) syndrome. During 1980, 282 patients with documented myocardial infarction were admitted to our coronary care unit. Early postmyocardial infarction pericarditis was present in 18 patients (6.4%). Six of these patients received steroids and the remainder were treated with salicylates or other anti-inflammatory drugs. Anticoagulation was used in 149 patients (53%) during hospitalization. One hundred forty-four (51%) were receiving heparin and 133 (47%) received no anticoagulation. Information on the patient's status at 6 months was available in 229 patients who were discharged alive. Sixteen patients had died within 6 months after discharge and 4 patients were lost to follow-up study. There were no documented cases of Dressler's syndrome. It is concluded that Dressler's syndrome has decreased in incidence and perhaps disappeared. This decrease is most likely related to decreased use of oral anticoagulants and to more aggressive treatment of postmyocardial infarction pericarditis.

Anti-Inflammatory Agents↗
PubMed1982

Relationship between QRS width and the presence of neoplasm.

This study examines the relationship between QRS width and the presence of neoplasia. The QRS width was measured in 236 consecutive ambulatory patients. The patients' body surface area, CBC, SMA 6, and SMA 12 were also recorded. There were 17 out of 34 (50%) patients with neoplasia in the group with QRS less than 0.08 seconds. There were only 19 out of 78 (24%) with neoplasia in the group with QRS greater than or equal to 0.08 seconds (P less than 0.01). We conclude that there is a higher incidence of neoplasia in patients with a QRS less than 0.08 seconds than in patients with a QRS greater than or equal to 0.08 seconds. This difference cannot be explained by age, body surface area, hemoglobin, or any variable in SMA 6 or SMA 12.

Aged↗
PubMed1982

Natural history of severe sinus bradycardia discovered by 24 hour Holter monitoring.

This study follows patients with severe sinus bradycardia (40 beats per minute for 6 seconds or greater) in order to evaluate mortality and the effectiveness of permanent pacemaker insertion. Severe sinus bradycardia was noted on a 24-hour Holter in 95 patients. There were 64 males and 31 females with a mean age of 69 +/- 10 years. All were available for follow-up at 26 +/- 13 months. Twenty-eight required a permanent pacemaker at an average of 2 +/- 3 months after the Holter. Of this group 12 had the Holter for arrhythmia, 11 for cerebral symptoms, 4 for palpitations and 1 for chest pain. Only 1 was taking digitalis and no patients were taking Inderal. Six (21%) died at a mean interval of 21 +/- 15 months following pacemaker insertion. Sixty-seven did not require pacemaker insertion. The indications for Holter monitoring were arrhythmia in 16, palpitations in 19, cerebral symptoms in 20 and chest pain in 12. Four of these patients were on digitalis, 8 on Inderal, and 4 on both. Eleven (16%) died at a mean interval of 12 +/- 7 months after the initial Holter recording. Dizziness and/or syncope reoccurred in 22. Five had these symptoms even after pacemaker insertion. We conclude that severe sinus bradycardia is associated with a significant mortality. Insertion of a permanent pacemaker may decrease recurrent symptoms and slightly increase time of survival, but does not appear to influence the overall survival rate.

Aged↗
PubMed1982

Coronary artery spasm appearing as syncope.

A 56-year-old man had coronary artery spasm. The initial manifestation of the disease was syncope that occurred at night. Coronary artery spasm was documented by Holter recording and cardiac catheterization. The patient was effectively treated with nitrates and calcium-blocking agents.

Angina Pectoris, Variant↗
PubMed1981

Heparin-induced thrombotic thrombocytopenia.

Following subcutaneous therapy with heparin, the patient developed signs and symptoms of vascular occlusion in both legs. This was accompanied by thrombocytopenia and platelet aggregation when the patient's platelets were incubated with heparin. The clinical features and implications of this syndrome are discussed.

Aged↗
PubMed1980

Site of origin of ventricular premature beats in patients with mitral valve prolapse.

This study examines the site of origin and possible etiology of ventricular premature beats (VPB) in patients with mitral valve prolapse. Ten patients with mitral valve prolapse documented by echocardiogram from the study group. All patients had prolapse of the posterioir leaflet and three additionally had anterior prolapse. There were eight females and two males, with a mean age of 29.1 +/- 11.1 years. All patients were having unifocal VPBs at rest. A vectorcardiogram (VCG) was taken of the VPB by a technique which allowed all VCG loops to be written from the same beat. The VCG analysis indicated that the VPB forces were directed anteriorly, inferiorly, and to the left in six patients. In two patients the VPB was directed posteriorly, inferiorly, and to the left, consistent with right ventricular origin. One of these patients had episodes of ventricular tachycardia. One was anterior, superior, and to the left, and one was markedly anterior, superior, and to the right. In all patients the initial portion of the QRS was inscribed slowly. The three patients with additional anterior prolapse did not show a common difference from those with isolated posterior prolapse. It is concluded that: (1) The majority of these VPBs originate from the posteriorbasal portion of the left ventricle. (2) They originate in the myocardium and not in the Purkinje tissue. (3) There is no relationship between the location of prolapse and the VPB morphology.

Adolescent↗