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Biomedical subjects

J A Spittell

Publications and source records attributed to J A Spittell.

At least 19 recordsLinked to original sources
PubMed1988

Chest pain in a young woman.

Chest pain in a young person is often caused by chest wall tenderness, associated with mitral valve prolapse, or attributed to psychologic factors. Ischemic cardiac pain may be overlooked because of its rare occurrence in this age group. A 35-year-old woman complained of substernal chest pressure precipitated by exertion and relieved by rest. The symptom had been noted for 15 years. Worsening of the symptom during dancing prompted her to seek medical advice. She had no other illnesses, was taking no medications, was a nonsmoker, and had no family history of coronary disease. Physical examination disclosed a grade 1 (on the basis of 1 to 6) systolic ejection murmur, an ejection click, and a grade 2 diastolic murmur. An exercise test produced symptoms at 4 minutes. Coronary arteriography showed the absence of a left coronary ostium and filling of the entire coronary system from the right ostial injection through collateral vessels from the right coronary artery. Surgical repair was recommended. Operative intervention showed a dysplastic bicuspid aortic valve with a membrane that covered the left coronary ostium. Excision of the membrane reestablished antegrade blood flow to the left coronary system. A follow-up exercise test revealed normal findings. Because chest pain in a young person is rarely ischemic in origin, benign or noncardiac causes are usually considered; however, if the history suggests ischemic pain, the possible presence of unusual cardiovascular abnormalities should not be disregarded.

Adult↗
PubMed1985

Evaluation of the patient with intermittent claudication.

The most common cause of intermittent claudication is atherosclerotic occlusive arterial disease. Differentiation of the common musculoskeletal and neurologic conditions that may mimic intermittent claudication is often possible with a careful history, but when insufficient detail is provided or multiple conditions exist, the findings on physical examination and noninvasive studies are useful. While physical examination provides a rough estimate of the degree of ischemia, assessment of functional impairment produced by occlusive arterial disease is best made with noninvasive studies before and after standard exercise. Arteriography is reserved for the patient for whom restoration of pulsatile flow is planned.

Angiography↗
PubMed1983

Hypertension and arterial aneurysm.

The rather common coexistence of arterial aneurysm and systemic hypertension may be attributed to their respective frequency as clinical findings. The development of hypertension secondary to renal ischemia that can occur as a complication of certain types of aneurysmal disease is well recognized. Less well appreciated is the evidence to implicate hypertension as a factor in the pathogenesis of arterial aneurysms, perhaps in their progressive enlargement, and even in rupture. Furthermore, after resection of an aneurysm, systemic hypertension adversely influences survival, and it is an important contributing factor in the development of false aneurysms. A relation between hypertension and aortic dissection has received more recognition. Just how systemic hypertension contributes to the occurrence of aortic dissection is not clear, but the effective control of hypertension has the potential for decreasing the incidence of aortic dissection. The curious clinical association of hypertension with the location of the primary tear in the proximal part of the descending aorta (type III or type B) has several plausible explanations.

Aneurysm↗