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Biomedical subjects

J M Gore

Publications and source records attributed to J M Gore.

159 records · Page 9Linked to original sources
PubMed1984

Reversibility of hypotension and shock by atrial or atrioventricular sequential pacing in patients with right ventricular infarction.

Hypotension and shock associated with heart block and other forms of atrioventricular (AV) dissociation frequently accompany right ventricular infarction ( RVI ). Such patients do not invariably improve with ventricular pacing. We evaluated the relative effects of AV dissociated rhythms (ventricular pacing or nodal rhythm) and AV synchronous rhythms (atrial pacing, AV sequential pacing, or return to normal sinus rhythm) in seven patients with RVI complicated by AV dissociation, who had hypotension or shock. Hemodynamic monitoring demonstrated the characteristic features of RVI in all patients. Restoration of AV synchrony resulted in a highly significant (p less than or equal to 0.001) increase in systolic blood pressure (88.0 +/- 16.5 mm Hg to 133.0 +/- 21.8 mm Hg), cardiac output (3.8 +/- 0.9 L/min to 5.7 +/- 0.9 L/min), and stroke volume (40.5 +/- 6.9 cc to 61.0 +/- 10.0 cc). We conclude that restoration of normal AV synchrony has a marked effect on stroke volume in this setting and that atrial or AV pacing can reverse hypotension and shock in RVI complicated by AV dissociation.

Aged↗
PubMed1984

Layperson CPR--are we training the right people?

A case-control study was undertaken to examine differences in the extent of cardiopulmonary resuscitation (CPR) training among family members of patients with and without coronary heart disease. There were no significant differences in the proportion of family members of patients with coronary disease (22.0%) who had ever taken a CPR course compared to family members of patients seen in a primary care clinic (25.6%) or in randomly selected neighborhood controls (28.7%). Family members of patients with coronary disease, however, had not only taken fewer CPR courses but had taken these courses considerably further in the past than had respective comparison groups. Moreover only 9% of these family members had taken CPR due to their family member's coronary disease.

Adult↗
PubMed1984

Use of continuous monitoring of mixed venous saturation in the coronary care unit.

Recent advances in catheter technology that enable continuous measurement of mixed venous oxygen saturation (SvO2) have improved diagnostic and therapeutic capabilities in the critical care setting. The utilization of the Opticath has provided valuable information in the diagnosis and treatment of many critically ill patients in our coronary care unit. In many instances, a change in SvO2 supplied the first indication of a hemodynamic change in the patient. Specific clinical situations in which the Opticath was used are reviewed.

Cardiac Catheterization↗
PubMed1983

Evaluation of an emergency cardiac transport system.

A university-based cardiac transport system was developed for the safe transfer of critically ill cardiac patients from community hospitals to a tertiary care facility. During the first year of operation, 50 patients were transported, 41 (82%) by ambulance and 9 (18%) by helicopter, from 24 hospitals in four New England states. The average response time from hospital request to transport team arrival was 75 minutes. Seventy-eight percent of these patients were unstable at the time of transfer. Hypotension or cardiogenic shock (39%), ventricular tachycardia or fibrillation (16%), and severe and recurrent chest pain (12%) were the most common conditions for which the team was summoned. Forty-six percent required invasive procedures for stabilization prior to transport, and one-third of patients required active intervention, including defibrillation, during transfer to the tertiary care facility. The majority (62%) of transferred patients underwent significant hospital procedures, and 75% of admitted patients were discharged from the hospital. Our initial experience indicates that transport of critically ill cardiac patients in need of advanced care can be accomplished in a rapid and efficient manner with a relatively good short-term prognosis.

Emergency Medical Service Communication Systems↗
PubMed1982

Absence of secular changes in the prognosis of patients with an initial myocardial infarction.

A community-based study was conducted in metropolitan Baltimore in which secular trends in the in-hospital and long-term prognosis of 935 male and female patients hospitalized with an initial myocardial infarction were examined for the two periods of 1966-1967 and 1971. The in-hospital case fatality rate among males in both periods remained unchanged (19.0% vs 19.0%), whereas there was a decrease over time among women hospitalized in 1966-1967 as compared to those in 1971 (37.2% vs 26.6%) (p less than 0.10). For patients discharged alive from the hospital and followed up for as long as 10 years, no significant differences in overall survival were observed between male patients discharged in 1966-1967 and 1971 or between female patients discharged in these two periods. These findings may reflect the lack of major therapeutic advances in the care of the acute coronary patient between the two study periods and, therefore, support continuing efforts directed at the primary and secondary prevention of the atherosclerotic process.

Age Factors↗
PubMed1982

Occult cancer in patients with acute pulmonary embolism.

An association between venous thrombosis and cancer was first suggested by Trousseau, and has been confirmed by multiple postmortem studies. Clinical studies have shown that thrombophlebitis migrans may occur before malignancies become clinically evident, and therefore serves as a clue to occult cancer. A relation between occult cancer and the commoner deep venous thrombosis and pulmonary embolism has not been established. We ascertained the incidence of cancer before and after pulmonary embolism was diagnosed by pulmonary angiography in 128 patients. The incidence of cancer before pulmonary embolism (12%) was essentially the same as that in a comparison group of patients without pulmonary embolism (10%). In the 2 years after pulmonary angiography, however, cancer was diagnosed in 13 patients with pulmonary embolism in contrast to no patients in the comparison group (p less than 0.001). The most frequent cancers involved the lung, gastrointestinal tract, breast, and uterus. The malignancies were nearly always occult when pulmonary embolism occurred. These findings indicate that pulmonary embolism with or without overt deep venous thrombosis should alert the clinician to consider occult cancer.

Adolescent↗
PubMed1982

Acute spontaneous failure of a porcine aortic valve.

The performance of the porcine bioprosthetic heart valve has been well characterized in terms of thrombogenicity, susceptibility to infection, and hemodynamic characteristics. There has been some concern about the frequency and mechanism of late dysfunction of this valve. To date, cases of valve failure have been progressive and gradual. We saw a case of acute, catastrophic, spontaneous failure of a porcine bioprosthetic heart valve. We suggest that in the differential diagnosis of acute aortic insufficiency acute spontaneous failure of a porcine aortic prosthesis be included.

Acute Disease↗
PubMedDate not supplied

Temporal trends and associated factors of inpatient cardiac rehabilitation in patients with acute myocardial infarction: a community-wide perspective.

PURPOSE: Cardiac rehabilitation (CR) has been shown to be an important therapeutic intervention after the development of acute myocardial infarction (AMI), but historically has been underused. Inpatient CR often represents cardiac patients' first exposure to risk factor modification education and acts as a gateway to outpatient programs. METHODS: The authors performed a longitudinal study of the use of inpatient CR in 5204 Worcester residents hospitalized with validated AMI in seven 1-year periods between 1986 and 1997. RESULTS: The overall rate of referral to inpatient CR was 68%, with a slight decline in use to less than 60% in the authors' most recent study year of 1997. Referred patients were significantly more likely to be younger, male, or enrolled in a health maintenance organization; they were less likely to have a history of heart failure or stroke. They were significantly more likely to receive medications shown to be of benefit in the management of AMI and to undergo cardiac interventional procedures. In 1997, patients participating in inpatient CR were more likely to have documented inpatient counseling about nutrition, exercise, smoking, and stress reduction. DISCUSSION: The results of this multihospital community-wide study suggest relatively stable, but recently decreasing, use of inpatient CR over the past decade. Women and the elderly are underrepresented in these programs. Patients not referred to inpatient rehabilitation were less likely to be prescribed effective cardiac medications and undergo risk factor modification counseling prior to discharge. Further studies are needed to better understand the reasons for patient exclusion from the benefits of inpatient CR.

Aged↗
PubMedDate not supplied

Treatment options for acute myocardial infarction complicated by cardiogenic shock.

Hospital survival of patients with acute myocardial infarction complicated by cardiogenic shock has improved during recent years. Before the 1990s, emphasis on a medical and supportive approach to treatment of these high-risk patients (including thrombolytic therapy) was not clearly associated with improving outcomes. However, in the past decade, the interventional approach to treatment of acute myocardial infarction complicated by cardiogenic shock (mainly acute infarct angioplasty) has led to an improving prognosis across a broad spectrum of patients with cardiogenic shock.

Catheterization↗
PubMedDate not supplied

Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981). The Worcester Heart Attack Study.

A communitywide study was conducted in all 16 acute general hospitals in the metropolitan Worcester, Mass, area during the calendar years 1975, 1978, and 1981 to examine time trends in the attack and case-fatality rates of patients hospitalized with validated acute myocardial infarction as well as of the occurrence of out-of-hospital coronary heart disease (CHD) deaths. Between 1975 and 1981, there was an increase in the age-adjusted attack rates of initial events of acute myocardial infarction (1975, 254/100,000; 1981, 280/100,000) as well as recurrent events (1975, 133/100,000; 1981, 156/100,000). These overall increases were due to an increase among those 65 years of age and older, with no significant changes observed in those less than 65 years old. The age-adjusted in-hospital case-fatality rates declined from 22.1% in 1975 to 20.3% in 1978 and 17.4% in 1981. In examining long-term prognosis, no significant differences were seen over an eight-year follow-up period between patients discharged in 1975, 1978, and 1981. The age-adjusted mortality rates of out-of-hospital CHD deaths significantly declined between 1975 (229/100,000) and 1981 (147/100,000). The results of this population-based survey suggest that recently observed declines in the mortality rates of CHD may reflect decreases in out-of-hospital coronary deaths and improving trends in the in-hospital survival of patients with acute myocardial infarction.

Adult↗