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Biomedical subjects

H D McIntosh

Publications and source records attributed to H D McIntosh.

At least 37 records · Page 2Linked to original sources
PubMed1985

The stabilizing and unstabilizing influences of neurogenic and vascular activities of the heart as related to sudden cardiac death.

Despite the frequency with which sudden cardiac death occurs in affluent societies, little is known about the precise mechanisms by which it is caused. Practically nothing is known about why sudden cardiac death occurs in one but not another person. It is difficult to escape the conclusion that in many instances, the final events occur almost by chance. Therefore, it would appear that every effort should be made by the physician to assist in preventing the changes, that is, cardiomegaly and myocardial ischemia, that appear to be potential markers of sudden cardiac death in many persons. Attention should be directed toward identifying and facilitating stabilizing neurogenic and vascular activities and identifying, controlling and reversing unstabilizing influences likely to foster sudden cardiac death. In the absence of a more complete knowledge of precise mechanisms, the efforts of the physician should be directed toward behavior modifications that appear to reduce the clinical manifestations of coronary heart disease which contribute to the development of cardiomegaly and myocardial ischemia.

Animals↗
PubMed1982

Aortocoronary bypass grafting: an internist's perspective.

Seven hundred fifty thousand to 1 million persons in this country have undergone aortocoronary bypass grafting since 1968, but many questions regarding the indications for the procedure and its advantages and disadvantages persist. Based on this surgical experience and on observations made during the last decade regarding nonoperative therapy and changes in the natural history of coronary heart disease, at least eight considerations should influence attitudes regarding the role of surgery: (1) The operation is a significant addition to the management of some patients with coronary heart disease. (2) The operative mortality in many centers is gratifyingly low. (3) Mortality from coronary heart disease in this country has declined strikingly during the past decade. (4) Because of the declining mortality from coronary heart disease, the prognosis of patients with the disease seen in 1980 is uncertain. (5) Coronary heart disease is a progressive disease and surgery does not prevent the progression of the disease in the native circulation. (6) Reports of therapeutic results, whether surgical or medical, are often biased toward the positive side. (7) Aortocoronary bypass does appear to postpone premature death in symptomatic patients with stenosis of the left main coronary artery, and possibly in symptomatic patients with three-vessel disease and modest impairment of left ventricular contractility. (8) Conclusions of meetings of "experts" regarding therapy may not by applicable to the country at large. The profession and the general public should be so informed.

Coronary Artery Bypass↗
PubMed1979

Aortocoronary bypass grafting in the management of patients with coronary artery disease.

There is widespread agreement that aortocoronary bypass grafting generally lessens the symptoms and functional limitations of patients with angina pectoris. Evidence for prolongation of life or prevention of myocardial infarction, arrhythmias and ventricular dysfunction is inconclusive. Harmful effects associated with surgical management of coronary artery disease can be documented in terms of operative mortality, perioperative myocardial infarction, graft occlusion and progression of occlusive disease in the native circulation. In this review of published experience, the accomplishments and the limitations of myocardial revascularization are considered in various clinical settings. Critical assessment of evolving information leads to the conclusion that widespread application of this procedure beyond the alleviation of symptoms refractory to medical therapy is not justified by present data.

Angina Pectoris↗
PubMed1978

Benefits from aortocoronary bypass graft.

The first aortocoronary bypass graft (ACBG) for coronary heart disease (CHD) was performed in 1964. From 1967 to the summer of 1977, between 250,000 and 300,000 such procedures were performed in this country. With such extensive experience, the patient might expect that most questions regarding the effectiveness of the procedure in the treatment of CHD would have been answered. Unfortunately, this is not the case. After a decade of experience, all that is truly known about the procedure is that for most patients, it does improve the quality of life and, if present practices continue, will add greatly to the cost of medical care in this country. It appears that there is still a need for more randomized, controlled studies.

Arrhythmias, Cardiac↗
PubMed1978

The first decade of aortocoronary bypass grafting, 1967-1977. A review.

Despite a decade of experience with aortocoronary bypass grafting embracing 300,000 or more operations, indications for its use remain controversial. The controversy persists because of a lack of adequate controls with which to compare the clinical course of operated patients; only 1248 have been reported who have been studied in a carefully controlled and random manner. Benefit has been claimed frequently by comparing the course of patients treated surgically with medically treated patients followed the decade before. Such comparisons are not valid in view of the well documented changes in the natural history of coronary artery disease that have been occurring during the last decade. Despite a low operative mortality and rate of graft closure, available data in the literature do not indicate that initial symptomatic improvement necessarily persists, or that myocardial infarctions, arrhythmias, or congestive heart failure will be prevented, or that life will be prolonged in the vast majority of operated patients.

Angina Pectoris↗