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Biomedical subjects

J R Margolis

Publications and source records attributed to J R Margolis.

47 records · Page 3Linked to original sources
PubMed1976

Delay in the prehospital phase of acute myocardial infarction. Lack of influence on incidence of sudden death.

Prehospital delay is considered to be an important cause of out-of-hospital coronary mortality. Behavior of patients and physicians in response to the symptoms of myocardial infarction (MI) or impending out-of-hospital death (OHD) was studied for 107 consecutive acute coronary events in Framingham, Mass. Delay due to inappropriate patient behavior was the most important component of total delay. Delay related to patient-physician contact occurred in two thirds of MI cases and was more than 30 minutes in half of these. Office visits and inappropriate triage by nurses and receptionists were important factors in physician delay. However, 60% to 75% of OHDs occur so rapidly that their prevention by reduction of prehospital delay seems impossible. A strategy for reduction of delay that might be of benefit in preventing some of the remaining OHDs is described.

Acute Disease↗
PubMed1975

Digitalis and the sick sinus syndrome. Clinical and electrophysiologic documentation of severe toxic effect on sinus node function.

Digoxin, in a common clinical dose and at a low serum level, brought out severe manifestations of sinus node dysfunction in a patient who had previously undergone successful mitral valve replacement. This report presents the results of extensive clinical and electrophysiologic studies of this patient before and after a digoxin challenge. In the absence of cardiac glycoside, the only demonstrable abnormalities of sinus node function were mild resting sinus bradycardia and failure to respond to atropine administration. Responses to isoproterenol administration, programmed premature atrial stimulation, and overdrive pacing at several cycle lengths were normal. Following the administration of intravenous digoxin, 1.025 mg/24 hrs, the resting sinus cycle length increased and the response to overdrive pacing became markedly abnormal. The latter was followed by sinus pauses in excess of six seconds, even at relatively slow overdrive pacing rates. The electrophysiologic and clinical implications of these data are discussed. It is suggested that despite previous reports that digitalis preparations are relatively well tolerated by patients with sick sinus syndrome, caution should be used when administering these drugs to this group of patients.

Arrhythmia, Sinus↗
PubMed1975

Sudden death due to coronary artery disease. A clinical, hemodynamic, and angiographic profile.

The authors followed 536 medically managed patients with angiographically documented coronary artery disease for up to 4 years, and examined antemortem clinical, anatomical, and hemodynamic characteristics of the 29 patients who died suddenly during the follow-up period. These patients are compared in terms of hemodynamic characteristics to those who survived and those who died non-suddenly of coronary heart disease. Of the 29 patients who died suddenly, more than 80% had evidence of moderate to severe impairment of myocardial function many months prior to death. Only a single patient had the combination of relatively mild coronary artery disease and normal ventricular function. This single patient would be the ultimate target of a program designed to prevent sudden death. However, it has been necessary to follow 536 patients with angiographically documented coronary artery disease in order to find this one potential benefactor of sudden death prophylaxis. This study demonstrates that there are patients with coronary artery disease who die suddenly, despite relatively mild disease; however, these patients appear to represent only a small proportion of all sudden deaths.

Adult↗
PubMed1974

Community surveillance for coronary heart disease: the Framingham Cardiovascular Disease Survey. Methods and preliminary results.

The Framingham Cardiovascular Disease Survey was undertaken to test the hypothesis that a short-term surveillance study of a defined population could yield incidence data comparable to those obtained by an elaborate longitudinal study of the same population, at a fraction of the cost. New cases of coronary heart disease (CHD), congestive heart failure (CHF) and stroke occurring from June 15, 1970 through June 14, 1971, were detected by monitoring admissions to hospitals and nursing homes, reporting of new events by local physicians and perusal of death certificates, Necessary data on each case were collected and reviewed by a panel of physicians using strict diagnostic criteria. Incidence rates based on 332 CHD or CHF events were calculated and were found to be consistent with findings of the Framingham Heart Study. A one-year community surveillance study is an economical and reasonably accurate method of determining the incidence of CHD and CHF.

Adult↗
PubMedDate not supplied

PTCA, thrombolysis or atherectomy: rational treatment of recently occluded saphenous vein grafts.

Recently occluded saphenous vein grafts (SVG) contain abundant thrombus. Distal embolization and myocardial infarction often occur when recanalization of such SVG is attempted. In 80 patients with occluded SVG, we employed transcatheter devices to lyse, compress or extract thrombus. Primary treatment for these SVG was performed in the following manner; PTCA 29, intragraft urokinase 12, TEC atherectomy 39. Following urokinase or atherectomy, adjunctive PTCA was performed to diminish the residual stenosis. All patients had class III or IV angina. Clinically, SVG occlusions were 3 days to 3 months old. TIMI flow was grade 0, and occlusion length was greater than 6 cm for all SVG. Each strategy resulted in a similar procedure success rate. However, when used as a primary treatment, TEC may be associated with lower rates of distal embolization and myocardial infarction.

Angioplasty, Balloon, Coronary↗