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Biomedical subjects

L Lemberg

Publications and source records attributed to L Lemberg.

At least 235 records · Page 13Linked to original sources
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Arterial blood gases in the coronary care unit. Part I.

Blood gas analyses are frequently helpful and at times vital in the management of patients who develop complications during an acute myocardial infarction. This vignette discusses the arterial blood gases when congestive heart failure complicates an acute myocardial infarction. Blood gas measurements are generally obtained for two principle reasons: (1) to determine if the patient is well oxygenated--Po2 and O2 arterial gas measurements, and (2) to determine the patient's acid base status (a) using respiratory component of acid base status--PCO2 measurement, (b) using metabolic component of acid base status--HCO-3 measurement, and (c) using both a and b. Arterial blood gases are preferred over venous blood gases. Venous blood gives information relative to the extremity it drains and may be misleading if the extremity is cold, clammy, or underperfused.

Arteries↗
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Arterial blood gases in the coronary care unit. Part II.

This vignette discusses the use of blood gas determination in the diagnosis and management of cardiogenic shock complicating an acute MI. Both arterial and venous samplings are used to assess cardiac output. Results of therapy can be followed by noting directional changes in cardiac output, i.e., changes in A-VDO2.

Blood Gas Analysis↗
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Intravenous nitroglycerin in acute infarction. Part II.

Intravenous nitroglycerin is helpful as an adjunct to the judicious use of diuretics in the management of CHF complicating an acute MI. The clinical end point when using intravenous nitroglycerin is a reduced LVEDP, 16 mm Hg, measured either by PA diastolic pressure or PCWP, provided peripheral perfusion is not compromised, i.e., as blood pressure adequate for peripheral needs (absence of signs of hypovolemic shock). The reduction in cardiac work plus the improvement in coronary flow to the ischemic area can help reduce infarct size, especially if intravenous nitroglycerin is started within the first 6 hours of the onset of an acute MI.

Adult↗
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Digitalis-quinidine interaction.

An interaction between quinidine and digoxin is known to occur with toxic concentrations of digoxin in the serum resulting when the two drugs are administered together. The effects can be very dangerous, especially in those patients with advanced and severe cardiac disease. When prescribing quinidine for patients who are taking digoxin, the dose of digoxin should be reduced by half. The patient should be followed carefully, and the electrocardiogram and serum digoxin concentration monitored in order to adjust the digoxin dose.

Aged↗
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Sudden death in the six-month postinfarction period.

Complex ventricular arrhythmias that appear during convalescence following an MI and up to a period of 6 months post MI are known to increase the risk of sudden death. The majority of subjects with this complication have above-normal left ventricular filling pressures, a hemodynamic measure of congestive heart failure. In this clinical setting, it is therefore important to consider and search for evidence of congestive heart failure. Drug therapy for arrhythmias is more effective in patients whose congestive heart failure has been adequately treated. Not infrequently, after cardiac compensation the arrhythmia subsides without any further intervention.

Arrhythmias, Cardiac↗
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Torsade de pointes.

Prolonged QT or QU intervals can be caused by a variety of conditions which include drugs, electrolyte imbalance, and acquired and congenital diseases. This finding is associated with life-threatening ventricular arrhythmias that, at times, have unusual morphologies characteristically named "torsade de pointes." Treatment, when iatrogenic, is obvious--when due to acute acquired diseases, therapy is supportive until the acute phase passes. In congenital prolonged QT syndromes, primidone (Mysoline) recently has been found to be successful in long-term management.

Electrocardiography↗
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An unusual complication of acute myocardial infarction.

Right ventricular infarction occurs exclusively as a complication of a transmural inferoseptal left ventricular infarction. Up to 50% of patients with transmural inferoseptal infarction may have associated right ventricular involvement. In the majority of cases, however, the right ventricular involvement is clinically silent. However, significant right ventricular infarction is being recognized with greater frequency. Clinically, distended neck veins and hypotension are frequent findings in acute right ventricular infarction and their presence should suggest the diagnosis. Damage to the right ventricle causes poor contractility and output, and thus the right ventricle functions more as a passive conduit to the left ventricle. The patient should lie with the bed flat to improve volume return to the right and left ventricles. Volume expansion is used when left ventricular filling pressure is low and there is clinical evidence of poor peripheral perfusion.

Aged↗
PubMedDate not supplied

Acute myocardial infarction and left bundle branch block.

Complete left bundle branch block often masks old as well as acute myocardial infarctions. However, a diagnosis of acute myocardial infarction in the presence of complete left bundle branch block can be made when the acute injury current is large enough to modify the secondary repolarization abnormalities of left bundle branch block. Under these circumstances the classical ST-T changes of an acute infarction may evolve in serial electrocardiograms.

Angina Pectoris, Variant↗
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Acute myocardial infarction and fascicular block.

Left anterior fascicular block may mask an IWMI. On the other hand, a narrow QS deflection in a VF is often misinterpreted as evidence of extensive inferior wall infarction. Vectorcardiographic analysis usually establishes the coexistence of LAFB and IWMI. Standard Lead II of the ECG is the most valuable in differentiating the etiology of ALAD: (1) rS pattern in LAFB, (2) Qr or QR in IWMI, or (3) a QS pattern or a smaller or slurred r wave with a deep S wave in combined IWMI and LAFB.

Bundle-Branch Block↗