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Biomedical subjects

J L Vacek

Publications and source records attributed to J L Vacek.

At least 91 records · Page 5Linked to original sources
PubMed1987

The initial electrocardiogram during admission for myocardial infarction. Use as a predictor of clinical course and facility utilization.

The first electrocardiogram obtained on presentation for suspected myocardial infarction was examined for its usefulness in predicting clinical course and facility use. We studied 221 patients consecutively admitted to a nonuniversity hospital coronary care unit. High-risk patients were identified if the electrocardiographic diagnoses included myocardial infarction, ischemia, left ventricular hypertrophy, left bundle-branch block, or paced rhythm. These 63 patients (29% of total) had significantly greater incidences of serious events, need for procedures, and death than low-risk patients whose initial electrocardiograms did not carry the above diagnoses. Patients with a low-risk initial electrocardiogram may not require the facilities of a coronary care unit and perhaps could be safely observed in an intermediate care area. However, many hospitals do not have an intermediate care facility available, and in those that do, daily costs may not be markedly different than for treatment in a coronary care unit. Whether these low-risk patients could be safely treated in general medicine beds, where potential cost savings would be much greater, is unknown.

Coronary Care Units↗
PubMed1986

Factors predisposing to supraventricular tachyarrhythmias after coronary artery bypass grafting.

Supraventricular tachyarrhythmia (SVT) is a common complication of coronary artery bypass grafting. Four hundred twenty-four cases of coronary artery bypass grafting were retrospectively reviewed and 64 patients (15%) were identified who had clinically significant SVT. Sixty randomly selected arrhythmia-free patients served as controls. The arrhythmia group differed from the control group in age (62 +/- 8 years vs 57 +/- 8 years p less than 0.0001), radiographic cardiomegaly (19 of 64 patients with arrhythmia vs 6 of 60 control subjects, p less than 0.01), and echocardiographic left atrial enlargement (16 of 38 vs 6 of 37 control subjects, p less than 0.025). No significant differences existed regarding sex of the patient, prior myocardial infarction, reduced ejection fraction, history of congestive heart failure, occurrence of perioperative myocardial infarction or pericarditis, or pump time. The relative risk of SVT developing in patients 60 years or older was 1.91; in patients 60 years or older with cardiomegaly, 2.39; in patients 60 years or older with left atrial enlargement, 3.29; and in patients 60 years or older with cardiomegaly and left atrial enlargement, 3.47. Thus, it may be possible to select patients at relatively higher risk of having SVT who could especially benefit from preventive measures.

Age Factors↗
PubMed1986

Prolonged and functional survival with the asplenia syndrome.

Asplenia syndrome is a rare congenital complex of splenic agenesis, cardiac malformation, and malposition of the abdominal viscera. Prolonged functional survival is very uncommon, with death usually caused by severe infection or congestive heart failure. A 21-year-old man with typical asplenia syndrome who is currently asymptomatic and in his third year of college is described.

Abnormalities, Multiple↗
PubMed1986

Ethanol and heart disease. An underestimated contributing factor.

With the number of chronic heavy users of ethanol in the United States estimated to be 15 to 20 million and the evidence increasing that ethanol causes serious cardiac metabolic disturbances, ethanol abuse is obviously a serious problem and most likely is an important contributing factor to cardiac morbidity and mortality. However, a direct cause-and-effect relationship between the biochemical dysfunctions produced by ethanol and the clinical entity of alcoholic cardiomyopathy has not been clearly established. What is lacking is a method to differentiate the damage secondary to ethanol abuse from that secondary to other causes. Sorely needed is a biochemical or anatomic marker (perhaps evaluated by serial myocardial biopsy) for alcoholic cardiomyopathy and a study to detect which cases of dilated cardiomyopathy indeed are due to ethanol-induced damage. Further longterm studies are also needed to demonstrate the benefits of abstinence upon large groups of patients, the effects of abstinence upon sudden death, and the effects of discontinuance of ethanol use for patients in the early stages of alcoholic cardiomyopathy. Ethanol is probably an underestimated contributing factor to cardiac disease. The importance of determining ethanol's impact on cardiovascular morbidity and mortality is underscored by the facts that alcoholic heart disease is completely avoidable and is largely reversible by abstinence.

Anticoagulants↗
PubMed1986

The value of standardized exercise testing in the noninvasive evaluation of mitral stenosis.

The determination of functional impairment is an important portion of the evaluation of patients with mitral stenosis and frequently is instrumental in the determination to proceed with invasive testing. To test the hypothesis that patients with slowly evolving disability from mitral stenosis frequently do not recognize the degree of their limitations and to determine the utility of formal exercise testing, 24 consecutive patients with pure or predominant mitral stenosis were evaluated for NYHA functional category (NYHA class) by historical determination of functional impairment, echocardiographic mitral valve area (echo MVA), exercise duration, estimated maximum oxygen consumption, and functional aerobic impairment during a symptom-limited Bruce protocol exercise test and multiple catheterization-derived parameters. The data revealed no difference in exercise duration or mitral valve area between NYHA classes, but demonstrated an excellent correlation between exercise duration and severity of mitral valve stenosis determined at cardiac catheterization (cath MVA). This relationship was similar to that of echo MVA to cath MVA and exceeded that of exercise time to any other parameter measured during catheterization. Estimation of maximum oxygen consumption or functional aerobic impairment did not improve the exercise duration to valve area relationship. The data presented thus demonstrate that Bruce protocol exercise testing is a valuable adjunct to other noninvasive tests in the initial evaluation of selected patients with mitral stenosis. By virtue of being easily repeated at low risk, exercise testing may also be useful in long term follow-up of medically treated mitral stenosis patients.

Adult↗
PubMed1985

Sarcoidosis mimicking cor triatriatum. Echolucency of adenopathy due to sarcoidosis.

A 20-year-old man with sarcoidosis presented with the echocardiographic findings of cor triatriatum. Computed tomography of the chest and digital subtraction angiography of the heart revealed that the patient had massive retrocardiac lymphadenopathy and normal cardiac anatomy. This is the first report demonstrating the echolucency of sarcoid lymphadenopathy and the mimicking of cor triatriatum by such adenopathy fortuitously positioned.

Adult↗
PubMed1985

Right-to-left shunting after lobectomy through a patent foramen ovale.

Hypoxia and dyspnea after lung resection may be caused by a variety of factors. One entity that has been rarely described is right-to-left shunting across an interatrial communication in the absence of elevated right-sided pressures. We describe the occurrence of clinically evident right-to-left shunting after lobectomy in a patient with a patent foramen ovale and suggest that two-dimensional contrast echocardiography is a useful and minimally invasive means of diagnosing what may be a more common entity than was previously recognized.

Adult↗
PubMed1984

Aberrant origin of the right ventricular coronary artery: a report of two cases.

Aberrant origin of coronary arteries is a not uncommon entity found on cardiac catheterization, at the time of surgery, and on post mortem examination. We present two cases of origin of a right ventricular (or atypical large conus) branch of the right coronary artery originating from a separate ostium in the right coronary cusp, which to our knowledge has been only rarely previously described. We feel that this may be a relatively frequent coronary varient that has important implications regarding patient assessment and care.

Cardiac Catheterization↗
PubMed1984

The inaccuracy of aortic valve systolic flutter as a screening test for significant aortic stenosis.

The noninvasive assessment of the severity of aortic stenosis is difficult. A recent description of systolic flutter of aortic valve leaflets as a screening test for severe aortic stenosis was applied to a group of patients who had undergone catheterization. As opposed to the previous report, we found this an inaccurate, nonspecific, and insensitive aid for the differentiation of significant versus nonsignificant aortic stenosis; and feel that its validity should be studied further before wide application.

Aortic Valve Stenosis↗
PubMed1984

Prolonged survival in tricuspid atresia with Eisenmenger's physiology.

Survival to adulthood is very rare in tricuspid atresia, particularly in certain subtypes and in the presence of Eisenmenger's physiology. We report a 32-year-old woman who has the type IC variant of tricuspid atresia and who has had documented Eisenmenger's physiology for over 10 years.

Adult↗