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Biomedical subjects

J M Felner

Publications and source records attributed to J M Felner.

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

An unusual echocardiographic finding in a ruptured sinus of Valsalva aneurysm.

A patient with a ruptured sinus of Valsalva aneurysm (RSVA) demonstrated an unusual two-dimensional echocardiographic manifestation of this entity. A discrete mass of echoes, appearing attached to a posterior leaflet of the tricuspid valve, moved to and fro into the right ventricle during diastole and into the right atrium in systole. This echocardiographic appearance mimics a vegetation of the tricuspid valve, a flail tricuspid leaflet, a right atrial myxoma or a pedunculated right atrial thrombus. Therefore, the differential diagnosis of this echocardiographic finding should include RSVA in addition to the above mentioned disorders.

Adult↗
PubMed1984

Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations.

In six patients with clinically unsuspected right atrial thromboemboli the diagnosis was made with two-dimensional echocardiography. Five patients had pulmonary emboli, and one had systemic embolization. Three patients had congestive cardiomyopathy, two with tricuspid regurgitation; of the remaining three, one had cor pulmonale complicated by tricuspid regurgitation, one had thrombophlebitis and one had no discernible cardiac illness. Four patients had dizziness or syncope, four had dyspnea, three had chest pain, three had hypotension and tow had cyanosis. Five patients were treated with thrombolytic or anticoagulant therapy, or a combination of the two. In three patients, surgical removal of the thrombus was undertaken because of recurrent pulmonary emboli or tricuspid regurgitation, or both, and progressive right heart failure. The thromboemboli were removed in all three, but one patient died. On two-dimensional echocardiography, four of the six patients' thromboemboli were snake-like, unattached to the right atrium and prolapsed freely across the tricuspid valve into the right ventricle in diastole and back into the right atrium in systole. The other two patients' thromboemboli were attached to the right atrium and did not prolapse across the tricuspid valve. Our cases, together with a review of other reports, suggest that right atrial thromboemboli: 1) can be accurately diagnosed by two-dimensional echocardiography; and 2) result from two different pathophysiologic mechanisms developing a) in situ, either on a foreign body or secondary to reduced cardiac output, or b) as a result of an embolus from systemic vein thromboses.

Adolescent↗
PubMed1983

Time course of regression of left ventricular hypertrophy in treated hypertensive patients.

In a prospective study, 32 hypertensive patients with echocardiographic evidence of left ventricular hypertrophy were treated with methyldopa, hydrochlorothiazide, or methyldopa and hydrochlorothiazide combined. Echocardiograms and electrocardiograms were obtained in each of the 32 patients before treatment, at the point of initial blood pressure control, and then one, three, and six months thereafter; in 27 patients these studies were also obtained after 12 and 18 months. Left ventricular end-diastolic posterior wall thickness decreased in seven patients whose blood pressure was controlled with methyldopa alone (p less than 0.01) and in 17 patients whose blood pressure was controlled with methyldopa and hydrochlorothiazide combined (p less than 0.01); in both groups, the reduction in left ventricular posterior wall thickness at end-diastole was apparent one month after blood pressure control was established (p less than 0.05). In contrast, no significant reduction in left ventricular posterior wall thickness at end-diastole was observed in eight patients who had equivalent control of blood pressure with hydrochlorothiazide alone (p = 0.34). During the 18-month follow-up period, ventricular septal thickness at end-diastole decreased in the group treated with methyldopa and hydrochlorothiazide combined (p = 0.03); whereas, ventricular septal thickness at end-diastole appeared to increase in the group treated with hydrochlorothiazide alone (p less than 0.01). These results suggest that evidence of regression of left ventricular hypertrophy may be detected as early as one month after blood pressure is controlled with methyldopa or methyldopa and hydrochlorothiazide combined; whereas, long-term control of hypertension with hydrochlorothiazide alone was not associated with evidence of regression of left ventricular hypertrophy. Although the patient number are small, these data suggest that there are differences in the long-term effects of diuretics and sympatholytic drugs on left ventricular anatomy, which may, in part, relate to divergent effects on the sympathetic nervous system.

Adult↗
PubMed1982

Echocardiography in patients with suspected cor pulmonale.

Echocardiography was used to evaluate left ventricular function in 43 consecutive patients with suspected cor pulmonale who clinically had no other heart disease or hypertension. Adequate echocardiographic evidence was obtained by either standard left parasternal position or subxiphoid position in 40 patients (93%). Echocardiographic evidence of either dilatation of the left ventricular cavity or thickening of the right ventricular free wall was present in 37 patients (93%). Small left ventricular end-diastolic cavities suggested that many of these patients had functional left ventricle volume depletion. Echocardiographic evidence of left ventricular dysfunction was present in only three patients (8%).

Adult↗
PubMed1981

Myocardial abscesses unassociated with infective endocarditis.

Review of 3,084 autopsies from 1967 to 1977 at Grady Memorial Hospital Yielded 14 cases of myocardial abscess unassociated with infective endocarditis acceptable for our study. No case was diagnosed ante mortem. Gram-negative organisms, fungi, and Staphylococcus aureus were isolated. Underlying conditions included alcoholic hepatitis, acute myocardial infarction, systemic lupus erythematosus, and various malignancies. The physical examination, chest roentgenogram, and electrocardiogram were not helpful in establishing a diagnosis. complications included pericarditis and congestive heart failure. A high index of suspicion in a debilitated patient not responding to conventional antimicrobial therapy appears to be the only clue to the antemortem diagnosis. Cardiac scintigraphy is promising as a possible means of earlier detection.

Abscess↗
PubMed1981

A cardiology patient simulator for continuing education of family physicians.

"Harvey," the cardiology patient simulator (CPS), is the result of a new type of simulation technology that allows for repetitive practice of bedside cardiology skills and provides feedback to the learner. "Harvey" is able to realistically simulate an essentially unlimited number of both common and rare cardiac disease. This report describes the use of the CPS in continuing medical education programs conducted for members of the American Academy of Family Physicians. Cardiovascular disorders constitute a significant percentage of the practice of family physicians. The CPS teaching system has great potential for helping them keep their cardiovascular diagnostic skills current and for promoting better understanding of recent advances in the diagnosis and treatment of heart disease. The participants in this study were nearly unanimous in their feeling that the CPS accurately simulates cardiology bedside findings and is a valuable teaching tool with which they would like to again be taught in the future.

Cardiovascular Diseases↗
PubMed1980

The influence of early repolarization variant on the exercise electrocardiogram: a correlation with coronary arteriograms.

Sixteen adult patients with S-T segment elevation in their resting electrocardiograms characteristic of early repolarization variant (ERV) and chest pain syndromes of possible myocardial ischemia were evaluated with both treadmill exercise electrocardiography and coronary arteriography. Of 14 patients with normal coronary arteriograms, 13 had their resting S-T elevation return ("normalize") to the isoelectric baseline with physical exercise, while one patient with normal arteriograms and normal left ventricular contractility but moderately elevated left ventricular end-diastolic pressure of unknown etiology developed significant S-T depression with exercise. Two patients with significant coronary atherosclerotic occlusive lesions developed "ischemic" S-T depression during treadmill testing. Symptoms developed during treadmill exercise did not distinguish patients with coronary artery disease from those without. Thus, while ERV at rest may be "normalized" by graded physical exercise in the absence of significant coronary atherosclerosis, the presence of ERV does not prevent the usual electrocardiographic manifestations of exercise-induced myocardial ischemia.

Adult↗
PubMed1980

Mitral valve prolapse.

Mitral valve prolapse (MVP) now is a commonly recognized syndrome with an apparent prevalence of approximately 4-6%. It appears to occur more frequently in females and occasionally it is familial. In most instances, the syndrome is idiopathic, although it occurs in association with many other conditions, particularly Marfan's syndrome, rheumatic heart disease, coronary heart disease, congestive cardiomyopathy, ostium secundum atrial septal defect, Ehlers-Danlos syndrome or abnormalities of the thoracic cage. The majority of patients with the syndrome have minimal, if any, symptoms and have a benign course. When symptoms do occur, more frequently they are palpitations, chest pain, dyspnea on exertion or fatigue. Neuropsychiatric symptoms or even transient ischemic episodes may occur rarely. Very rarely, complications such as severe mitral regurgitation, arrhythmias or infective endocarditis may occur. Characteristically, patients have a midsystolic click, occasionally followed by a systolic murmur. The timing of the click and the onset of the murmur usually is variable, depending on the ventricular volume. The electrocardiogram frequently shows ST-T wave changes. The diagnosis usually can be confirmed by echocardiography or left ventricular angiography. Most patients with MVP require no treatment other than reassurance. If a systolic murmur is present, prophylaxis against infective endocarditis during dental work probably is useful. Patients with palpitations or chest pain usually respond well to treatment with propranolol. Patients with progressive severe mitral regurgitation require mitral valve replacement.

Death, Sudden↗
PubMed1979

The echocardiographic association of mitral valve prolapse and mitral anulus calcification.

Mitral anulus calcification (MAC) and mitral valve prolapse (MVP) are frequently diagnosed conditions. We studied two patients with mild or moderate mitral regurgitation who demonstrated both MAC and MVP on angiography and echocardiography. M-mode echocardiography is probably the definitive test for confirming the presence of MVP. Echocardiography is moderately sensitive in the diagnosis of cardiac calcification, such as MAC, but M-mode echocardiography may not detect the MAC in the majority of patients with both MVP and MAC demonstrated by angiography.

Calcinosis↗
PubMed1979

Management of the patient with myocardial infarction.

Coronary atherosclerotic heart disease and myocardial infarction constitute an epidemic in this century, mandating that the primary care physician be familiar with their recognition and management. However, in recent decades, an improved understanding of pathophysiologic alterations, an enormous advance in technology and significant accomplishments in pharmacology and operative procedures have virtually revolutionized the management of patients with myocardial infarction. Although patterns of care described in this monograph may well be obsolete a few years hence, to be superseded by safer, more precise, more efficient and more cost-effective therapeutic modalities, nevertheless basic principles underlying the management of the patient with myocardial infarction remain as appropriate guidelines. In the hospital phase, efforts should be directed toward enhancing survival, saving myocardium and restoring function. The long-term ambulatory care should be designed to maintain functional capacities, to control symptoms, to retard or arrest the atherosclerotic process thus decreasing the likelihood of recurrent myocardial infarction and/or of sudden cardiac death and to restore the patient to a normal or near-normal life style.

Acute Disease↗