Biomedical subjects
Publications and source records attributed to I M Herling.
A single coronary artery is a rare cause of cardiac ischemia, congestive heart failure, and sudden death. We report the second known antemortem diagnosis of a single right coronary artery supplying the entire myocardium.
As patients survive to advanced age, they commonly develop degenerative valvular heart disease as well as degenerative diseases of other organ systems. In addition, a reservoir of patients with other forms of valvular heart disease develop progressive symptomatology with advancing age. These patients often present a challenge to the cardiologist in both diagnosis and management. Inasmuch as these patients tolerate cardiovascular surgery less well than their younger counterparts, criteria for surgical intervention may often need modification. Chronologic age must be recognized as but one of many factors affecting physiologic function. Knowledge of aging-related alterations in function must be employed in both diagnostic and therapeutic algorithms. At times, input from other health-care providers who specialize in the care of the elderly may assist in the assessment of these patients. Surgery should be reserved for higher-risk patients who are severely symptomatic or for those in whom severe symptoms are likely to soon develop based on the natural history of the disease process involved. Those less symptomatic elderly patients with otherwise preserved physiologic functions also may be offered valvular surgery. The availability of nonsurgical, albeit at times palliative, techniques to relieve aortic or mitral stenosis provides an alternative therapeutic option to cardiothoracic surgery. Advances in understanding the pathophysiology and medical therapy of heart failure will continue to contribute to an improved quality of life for those for whom only medical options exist.
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Fungal endocarditis has become increasingly frequent in the past decade and invariably occurs in association with predisposing factors. We report a case of Candida parapsilosis in a patient with no predisposing cause.
Twenty patients with refractory rest angina pectoris were treated with intravenously (IV) administered nitroglycerin (mean dosage, 72.4 micrograms/min; range, 15 to 226 micrograms/min). There was a considerable reduction or abolition in the number of ischemic episodes in 85% of patients without overall substantial changes in heart rate, mean arterial BP, pulmonary capillary wedge pressure (PCWP), and pulmonary arterial mean pressure. However, those patients with an initial PCWP of more than 12 mm Hg or a systolic pressure of more than 130 mm Hg had a substantial reduction in PCWP and systolic BP following IV nitroglycerin. We conclude that IV nitroglycerin may relieve rest angina by different pathophysiologic mechanisms. In some patients, IV nitroglycerin favorably altered the hemodynamic determinants of myocardial oxygen consumption. In others, however, no change in these determinants occurred, suggesting a direct effect on the coronary circulation.
A case of timolol-associated heart failure in a 73-year old white man is reported. The patient, with a history of cardiovascular disease and glaucoma, was admitted to the hospital because of complaints of shortness of breath, orthopnea, and reduced exercise tolerance. Chest roentgenogram showed interstitial congestive failure, and an EKG demonstrated sinus bradycardia. The patient's medications before admission included quinidine, isosorbide dinitrate, dipyridamole, aspirin, pilocarpine eyedrops 4%, timolol eyedrops 0.5%, and nitroglycerin ointment and sublingual tablets. On the second day of hospitalization, it was noted that the patient's dyspnea and sinus bradycardia could be related to a recent increase in his timolol dosage. The timolol was discontinued, and the patient's heart rate increased. As the patient's pulse rate increased, the symptoms of congestive heart failure disappeared. This case demonstrated the importance of obtaining complete drug histories from patients. The potential for adverse system reactions resulting from topical medications should be considered.
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Patients with unstable angina should first be medically managed with the maximally effective drug regimen. Cardiac catheterization is called for if the angina continues. Surgical intervention may be more effective if preceded by intensive medical management. You should be aware, however, that patients with unstable angina and significant left main coronary disease require immediate coronary bypass surgery.
Intravenous injection of pyran copolymer (divinyl ether-maleic anhydride) 24 h prior to intravenous injection of B16 melanoma in C57/BL6 mice greatly decreased the number of liver metastases. If the pyran copolymer was administered 3 days after injection of tumor cells, the number of metastases was not significantly decreased. Pyran copolymer has been reported to stimulate interferon production and increase clearance of particulate matter by the reticuloendothelial system. The results of this experiment suggests an important role played by the reticuloendothelial system in experimental liver metastasis.