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Biomedical subjects

K M McIntyre

Publications and source records attributed to K M McIntyre.

At least 37 records · Page 2Linked to original sources
PubMed1990

Persistent chest pain following oral dipyridamole for thallium 201 myocardial imaging.

A patient was admitted to the hospital with acute chest pain. After acute myocardial infarction was ruled out, he underwent a stress thallium 201 scintigraphy using oral dipyridamole and developed persistent angina with ST-segment elevation. This complication has not been reported previously. It is recommended that appropriate intervention be available if severe ischemia develops following administration of dipyridamole for diagnostic imaging.

Angina Pectoris↗
PubMed1990

Carotid endarterectomy for chronic retinal ischemia.

Carotid arterial disease may result in a variety of ischemic ocular problems that can eventually lead to permanent blindness. From 1984 to 1988, 18 patients underwent reconstruction of the carotid artery in an attempt to restore normal retinal arterial flow and, thereby, reverse or prevent progression of ischemic oculopathy. During a mean period of 21 months after carotid arterial reconstruction, subjective improvement in vision as well as a resolution in eye and periorbital pain was reported in 87.5 per cent of the patients. Measured visual acuity improved or stabilized in 94.4 per cent; macular photostress recovery times improved in 87.5 per cent, funduscopic examinations noted improvement or resolution in ischemic signs in 93.3 per cent and intraocular pressures improved in two of three patients. One patient experienced recurrent episodes of amaurosis fugax, which resolved after two weeks and did not recur. A second patient experienced an increase in intraocular pressures with visual deterioration, required laser photocoagulation after which the condition of the patient stabilized but only after significant visual impairment. Carotid arterial reconstruction is effective for the treatment of ischemic oculopathy and is most beneficial if performed early, before the onset of irreversible neovascular glaucoma.

Aged↗
PubMed1985

Combination therapy with diltiazem and propranolol: precipitation of congestive heart failure.

Although congestive heart failure has been reported with the combination of a beta blocker and either verapamil or nifedipine, it has not previously been reported for combination therapy that includes diltiazem. The following case documents the occurrence of clinical congestive failure in a patient with baseline left ventricular dysfunction and severe angina pectoris. Although the patients had tolerated propranolol therapy for years without difficulty, and high-dose diltiazem monotherapy with an excellent clinical response, the combination of diltiazem and propranolol resulted in the development of congestive heart failure. Thus, although generally well tolerated, given the suitable scenario of reduced left ventricular function, the combination of diltiazem and a beta blocker may adversely affect left ventricular performance.

Angina Pectoris↗
PubMed1985

Enhancement of visit adherence in the national beta-blocker heart attack trial.

Efforts were made in the Beta Blocker Heart Trial (BHAT), a double-blind study of 3837 post-MI patients, to enhance visit adherence, a measure of compliance that is not subjective and can be easily monitored. Of the required visits, 93.9% were completed in the window, 3.9% of the patients were classified as dropouts and 12 persons were lost to follow-up. Methods used to enhance compliance varied with circumstances but included appointment reminders, assistance with transportation, minimal waiting times, newsletters, continuity of care, involvement of family members, and close contact with private physicians. Comparisons of the BHAT visit adherence rates to those from other clinical trials are difficult to make because there are few reports in the literature regarding follow-up in large multicenter clinical trials. However, data obtained through personal communications, as well as published reports, indicate that adherence in primary prevention trials was generally less than that of secondary prevention trials. Adherence rates in the BHAT tended to be slightly higher than those of comparable trials.

Adult↗
PubMed1985

Biologic determinants of propranolol disposition: results from 1308 patients in the Beta-Blocker Heart Attack Trial.

Our objective was to identify biologic determinants of propranolol serum levels in 1308 patients after myocardial infarction (MI). Patients had had their MI within the previous month. A steady-state propranolol dosage of 40 mg every 8 hours produced a mean trough concentration of 42 ng/ml with extremely great (fiftyfold) interindividual variability. Univariate and multivariate analyses suggested that this variability was the result of many biologic factors. Serum levels were higher in women, in older patients, and in patients receiving concomitant therapy with other antiarrhythmic drugs. Serum levels were also higher in patients with elevated serum creatinine and lactate dehydrogenase levels. Serum levels were lower in black patients than in white patients. Also, serum levels in smokers were lower than those in nonsmokers, but only markedly so in the outpatient setting (6 months after the MI). The influence of sex and race on drug disposition has not previously been reported for beta-blocking drugs. Although a genetic deficiency in the oxidative metabolism of propranolol has been indicated, the frequency distribution of serum propranolol levels did not demonstrate a bimodal distribution for genetically distinct populations.

Adult↗
PubMed1984

Clinical and hemodynamic correlates in pulmonary embolism.

The clinical presentation of pulmonary embolism may be dominated by manifestations of pulmonary infarction or by the signs and symptoms of an acute hemodynamic disturbance. Most often, some manifestation is present along with hemodynamic abnormalities, which may range from shock or cardiac arrest to tachycardia.

Blood Pressure↗
PubMed1984

Pulmonary embolism.

It is estimated that 600,000 or more symptomatic episodes of pulmonary embolism occur each year in the United States, and this diagnosis is one that may often be missed. This article provides an appraisal of currently used diagnostic procedures, including laboratory tests, arterial oxygen tension, chest radiography, electrocardiography, lung scanning, and selective pulmonary angiography, and examines the available therapeutic options and their indications.

Angiography↗
PubMed1982

Safety and efficacy of diltiazem hydrochloride for the treatment of stable angina pectoris: report of a cooperative clinical trial.

Sixty-three patients completed a multicenter 10 week, double-blind, parallel group protocol evaluating the efficacy of diltiazem versus placebo with respect to rate of attacks of angina, nitroglycerin consumption and duration of treadmill exercise. An additional 36 patients were evaluated for drug safety. A 4 week placebo lead-in phase was followed by a 2 week dose titration period and two treatment evaluation periods of 2 weeks each. Both diltiazem and placebo were associated with a significant reduction in weekly frequency of angina from the baseline rate. Intergroup comparison disclosed a significantly greater reduction for the patients receiving diltiazem than for those receiving placebo. A similar reduction was noted for nitroglycerin consumption. Total exercise duration at week 10 was statistically greater in patients treated with diltiazem. Diltiazem was well tolerated. No abnormalities in hematologic profiles or in routine serum chemistry values were observed; electrocardiographic P-R and QRS intervals were unaffected. Adverse effects that could have been related to drug administration were reported in 11 patients who received diltiazem and in 12 patients who received placebo. Of the 17 episodes in the diltiazem group only 3 were considered significant and drug-related, and only one of these resulted in discontinuation of the drug.

Aged↗
PubMed1982

Hyperstress and outcomes in a long-term smoking intervention program.

A group of 182 smokers in a CHD risk factor intervention program were prospectively followed for 4 years to note the relationship of selected psychosocial factors to long-term outcomes in smoking cessation. The results of the study suggest that the combined effects of high levels of presumed stress and low self-reliance (measured by a multimode method) have predictive value in determining failure in long-term follow-up. The results were linked to a possible treatment-person interaction and to current theory on conditioned emotional states and addictive smoking.

Adult↗
PubMed1982

Considerations in evaluating new antianginal drugs.

Diseases that cause symptoms incompletely relieved by available modes of treatment stimulate search for new therapies. Chronic disease processes, in which interventions are palliative rather than curative provide a particular challenge in determining the value of therapeutic intervention. Management of patients with angina pectoris is an example of this challenge.

Angina Pectoris↗
PubMed1982

Clinical use of thrombolytic agents in venous thromboembolism.

The use of thrombolytic agents in venous thromboembolism has been shown to be highly effective. Patients treated with lytic agents show more rapid clot resolution and lung reperfusion and more rapid and greater reversal of the abnormal hemodynamic responses to pulmonary embolism than patients receiving heparin. Moreover, lytic therapy removes thromboemboli more completely from the pulmonary microcirculation, whereas residual thromboemboli tend to accumulate with heparin therapy. In addition, lytic therapy tends to preserve the venous valves, whereas distortion and destruction occur with heparin therapy. Hence, lytic therapy confers a number of short- and long-term benefits not observed with heparin therapy.

Fibrinolytic Agents↗