Search PubMed⌕ Search

Biomedical subjects

J K Kahn

Publications and source records attributed to J K Kahn.

At least 37 records · Page 2Linked to original sources
PubMed1996

No-reflow no more?

Explore the source record for details and available documents.

Coronary Artery Bypass↗
PubMed1996

Delayed progression or regression of coronary atherosclerosis with intensive risk factor modification. Effects of diet, drugs, and exercise.

Until the mid 1980s, secondary prevention of coronary atherosclerosis focused primarily on early ambulation, exercise training, and a 'prudent' diet. These regimens generally resulted in improved functional capacity, reduced myocardial demands at submaximal workrates, and modest decreases in cardiovascular mortality. However, reinfarction rates and the course of atherosclerotic heart disease remained largely unchanged with traditional treatment or usual care. Contemporary studies now suggest that multifactorial risk factor modification, and especially more intensive measures to control hyperlipidaemia with diet, drugs, and exercise, may slow, halt, and even reverse the progression of atherosclerotic coronary artery disease. Added benefits include a reduction in anginal symptoms, decreases in exercise-induced myocardial ischaemia, fewer recurrent cardiac events, and a diminished need for coronary revascularisation procedures. Several mechanisms may contribute to these improved clinical outcomes, including partial (albeit small) anatomic regression of coronary artery stenoses, a reduced incidence of plaque rupture, and improved coronary artery vasomotor function. These findings suggest a new paradigm in the treatment of patients with coronary artery disease.

Anticholesteremic Agents↗
PubMed1995

Preoperative cardiac evaluation. Assessing risk before noncardiac surgery.

Primary care physicians are often asked to evaluate a surgical candidate's cardiovascular and general health status. In some patients, history taking and physical examination provide enough information to assess risk for the proposed procedure. In others--especially those with cardiac risk factors--more extensive testing is required, such as electrocardiography, stress testing, or angiography. Once clearance for surgery has been given, primary care physicians can suggest risk-reduction strategies that may help to minimize perioperative morbidity or mortality.

Algorithms↗
PubMed1995

Central venous catheters. Placement and monitoring tips.

Placement of a central venous catheter is not without risk. If the tip of the catheter either is inadvertently positioned within the heart or migrates into it, vascular erosions may develop and result in perforation and death. In this article, Dr Kahn gives the advantages and disadvantages of the usual routes of insertion and describes monitoring techniques. He also suggests methods of avoiding initial intracardiac placement.

Adult↗
PubMed1994

Initial and long-term outcome of 83 patients after balloon angioplasty of totally occluded bypass grafts.

OBJECTIVES: This study was designed to evaluate the safety and short- and long-term results of coronary angioplasty of totally occluded bypass grafts in patients with clinical conditions other than acute myocardial infarction. BACKGROUND: Total occlusion of bypass grafts after coronary artery surgery often causes recurrent ischemia. The safety and results of percutaneous transluminal coronary angioplasty in occluded bypass grafts are controversial. METHODS: All patients with dilation of a totally occluded bypass graft attempted between 1981 and 1991 were retrospectively identified from a data base. Patients treated in the setting of an acute myocardial infarction were excluded. Eighty-three patients met these criteria and constitute the study group. Hospital records, office charts and procedural reports were reviewed in all patients to supplement details available in the data base. RESULTS: The time from bypass surgery to attempted coronary angioplasty ranged from 1 to 226 months (mean time 88 months). The mean (+/- SD) duration of graft occlusion was 31 +/- 46 days (range 1 to 180). In 27 attempts the bypass graft was the only site dilated, and in 56 attempts (68%) one to six other sites (n = 101) were dilated. Angiographic success (< or = 40% residual lumen stenosis) was achieved in 61 grafts (73%) and 98 of the additional sites (97%) (p < 0.001). Major complications included one procedural death and two Q wave infarctions. Follow-up for a mean of 32 months demonstrated a 1- and 3-year actuarial survival rate of 94% and 80%, respectively. At 3 years, only 34% of patients were free of repeat angioplasty or surgery. CONCLUSIONS: Angioplasty of totally occluded bypass grafts can be successful in the majority of selected patients, although major complications can occur. Strategies for sustained patency are needed to improve the long-term results.

Aged↗
PubMed1993

Rapid development of left main disease after coronary artery bypass grafting for failed angioplasty: a rare cause of postoperative angina.

We report a case of failed coronary angioplasty requiring urgent coronary artery bypass graft surgery. The return of angina pectoris early after surgery led to repeat catheterization, demonstrating a rapidly progressive stenosis of the left main coronary artery. This was treated successfully with coronary angioplasty. In patients with recurrent angina early after bypass surgery in whom angioplasty preceded surgery, acceleration of left main disease should be considered.

Angina Pectoris↗
PubMed1993

Inadvertent thrombolytic therapy for cardiovascular diseases masquerading as acute coronary thrombosis.

We report three cases of inadvertent thrombolytic administration to patients with cardiovascular diagnoses masquerading as acute coronary thrombosis presenting to tertiary care private hospital. Despite a final diagnosis of myocarditis, aortic dissection, and pericarditis, the initial presentation and electrocardiogram were believed to indicate an acute myocardial infarction due to coronary thrombosis. Intravenous thrombolytic agents were administered early in their presentation. Cardiac catheterization in two of the patients revealed normal coronary arteriography and in the third patient confirmed an aortic dissection. The patient with an aortic dissection died while the other two recovered without adverse consequences of the thrombolytic agents. Prior reports of five patients, treated with intravenous thrombolytic agents for suspected coronary thrombosis, who proved to have a final diagnosis of pericarditis or aortic dissection are reviewed. Death or tamponade occurred in four of five. The consequences of inadvertently administering intravenous thrombolytic agents to patients with nonthrombolytic cardiac disorders can be serious. If the diagnosis of acute myocardial infarction due to coronary thrombosis is uncertain, serial electrocardiograms, bedside echocardiography, or urgent cardiac catheterization may be appropriate before administering these agents.

Adult↗
PubMed1993

Angiographic suitability for catheter revascularization of total coronary occlusions in patients from a community hospital setting.

To assess the frequency of totally occluded coronary arteries and their angiographic suitability for catheter-based revascularization in an unselected patient population, all coronary angiograms showing > or = 50% diameter stenosis obtained from patients in a community hospital setting, were reviewed during a 1-year period. There were 112 totally occluded arteries in 101 patients (35%). Based on coronary morphologic variables previously identified as predictive of successful revascularization, 52 (46%) totally occluded arteries were judged suitable for coronary angioplasty. Totally occluded arteries with unfavorable features for coronary angioplasty were present in 29% of patients with multivessel coronary artery disease and were more commonly present in the right coronary artery. Thus totally occluded coronary arteries are found in approximately one third of patients with suspected or known coronary artery disease studied by means of coronary arteriography in a community hospital setting. Approximately one half of the total occlusions have features favoring successful coronary angioplasty.

Aged↗