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Biomedical subjects

L Lemberg

Publications and source records attributed to L Lemberg.

At least 37 records · Page 2Linked to original sources
PubMed1999

Low-molecular-weight heparin: an antithrombotic agent whose time has come.

LMWH (enoxaparin) should be used in combination with aspirin in the early phase of non-Q wave MI and in patients with unstable angina. The benefit of LMWH in acute coronary syndromes has been validated in several clinical trials. In addition, the use of LMWH is cost-effective when compared with use of UFH. The incidence of minor bleeding may be greater with LMWH than with UFH, most frequently due to ecchymosis at the injection site. However, the frequency of major bleeding did not differ between the two heparins. LMWH has been used successfully for the past 4 years by orthopedic surgeons in the prevention of pulmonary emboli. LMWH should replace UFH in the management of acute coronary syndromes.

Angina, Unstable↗
PubMed1998

Coronary artery disease--ignored in women or inherently more lethal in women?

The leading cause of death in women is cardiovascular disease. The major cardiovascular risk factors have a greater impact on women. The prognosis for women with CAD is worse than for men. Women frequently present with symptoms of heart disease at a much later age and have a greater frequency of atypical chest pain. Noninvasive testing is less reliable in women. Do these facts indicate that CAD is inherently a more lethal disease in women? Or is CAD, as some would suggest, traditionally ignored in women? Stay tuned!

Adult↗
PubMed1998

Inflammation in plaque rupture: an active participant or an invited guest?

Numerous reports have established the association of inflammation with acute coronary events. Data have been presented that suggest that elevated levels of CRP indicate heightened risk of future MI and stroke. Thus CRP measurement is both predictive and prognostic of cardiovascular and cerebrovascular events. Is inflammation merely a marker, an invited guest so to speak, or is inflammation an active participant that influences the process of plaque rupture and thrombus formation? The beneficial effects of aspirin in reducing the risks of a first MI and stroke are directly related to high plasma concentrations of CRP, whereas small, nonsignificant reductions in risk occurred among patients with low or normal CRP levels. Thus inflammation is not only an uninvited guest but is actually an aggressive participant in the destabilization of the atheromatous endothelial plaque.

Coronary Artery Disease↗
PubMed1998

Fifty percent of patients with coronary artery disease do not have any of the conventional risk factors.

Prinzmetal's variant angina, primarily a vasospastic disease, is a glaring example of the gaps in our knowledge regarding the etiology of coronary heart disease. Half of all patients with coronary heart disease do not have any of the established coronary risk factors. Prinzmetal's variant angina, syndrome X, coronary embolization, and congenital coronary anomalies, are a few examples of conditions that may not be associated with established risk factors. New risk factors that are emerging in an attempt to establish an etiology in this group of patients are homocysteine plasma fibrinogen, estrogen-deficiency lipoprotein (a), C-reactive protein, Chlamydia pneumoniae, factor VII endogenous tissue plasminogen, and endogenous plasminogen activator/inhibitor type I. The battle against cardiovascular disease continues!

Adult↗
PubMed1998

The ECG in cardiac stress testing: a valuable, but unappreciated source of clues.

The ECG exercise stress test is a very potent aid to the clinical diagnosis of CAD. Thorough knowledge of the ECG abnormalities and clinical features related to the stress test are required for an accurate diagnosis. The ECG exercise stress test is not a substitute for clinical acumen. Proper evaluation of the stress test is a clinical art of the skilled clinician. ECG exercise stress testing can be done efficiently and effectively by trained emergency department physicians. As a result, the diagnosis of CAD can be greatly accelerated.

Adult↗
PubMed1997

Amiodarone: a late comer.

Amiodarone is useful in the treatment of patients with ventricular arrhythmias after acute myocardial infarction and was equally useful when these arrhythmias were associated with CHF. Amiodarone prolongs repolarization and lowers heart rate, actions that are beneficial in treating symptomatic arrhythmias. The absence of proarrhythmic effects distinguishes amiodarone from other antiarrhythmic agents. No excess mortality was seen in any of the amiodarone trials, and in fact, a definite trend toward a decrease in the number of sudden deaths was noted. For many years, amiodarone has been the antiarrhythmic drug of choice in Europe. Only in recent years has this drug gained respectability in the United States. Amiodarone is truly a late comer to our shores.

Amiodarone↗
PubMed1997

SGOT, LDH, HBD, CPK, CK-MB, MB1MB2, cTnT, cTnC, cTnI.

The troponin assay is the "new kid on the block." cTnI is currently the most sensitive, specific marker for cardiac damage and will replace the other less specific cardiac markers. This is a result of continued search for measures that provide the earliest diagnosis, which in turn ensures the greatest positive influence on morbidity and mortality in acute MI. Is the cTnI assay the ultimate marker for cardiac injury? It is doubtful. Only time will tell.

Angina, Unstable↗
PubMed1997

Harnessing the platelet.

Appreciation of the critical role of platelets in cardiovascular disease came when it was shown that aspirin, by virtue of its ability to block platelet aggregation, reduced the combined incidence of MI, stroke, and vascular death by 25%. Understanding the key role played by platelets in acute thrombotic vascular events prompted the development of a new class of drugs to control platelet action. Platelet aggregation is mediated exclusively by the platelet fibrinogen receptor GP IIb/IIIa. The binding of the receptor with fibrinogen is the final common pathway leading to platelet aggregation and thrombus formation. Abciximab, the first GP IIb/IIIa platelet receptor inhibitor, effectively reduces the thrombotic complications in acute coronary vascular events. The newer GP IIb/IIIa inhibitors, the synthetic peptide antagonists, have been shown to be more specific, to be nonimmunogenic, and to cause less bleeding. It is predictable that an oral GP IIb/IIIa inhibitor will become part of the standard repertoire in patients with unstable angina. The platelet has taken center stage in the battle against arterial thrombosis. The direction of our medical attack on acute coronary events is clear: harness the platelet.

Angioplasty, Balloon, Coronary↗
PubMed1997

Sudden cardiac death--preventable--reversible.

SCD is defined as unexpected death due to cardiac causes that occurs within 1 hour of acute symptoms. SCD can be reversed with the use of an ICD. These devices now can be implanted by catheter techniques, obviating thoracotomy. SCD is preventable. The incidence of SCD can be significantly reduced by addressing the fundamental pathophysiology of SCD, which primarily is CAD. Our combined and aggressive implementation of preventive regimens to reduce the risk of cardiac events will save lives. These measures include diet, weight reduction, smoking cessation, regular exercise, and therapeutic drugs. Amiodarone, although effective in preventing lethal ventricular arrhythmias, has not matched the long-term results of the ICD in the successful management of SCD.

Death, Sudden, Cardiac↗
PubMed1996

Smoking: a burden to patient and society.

Smoking prevalence had been steadily decreasing in the United States until 1993 when the rate stabilized. In 1993 there were 46 million adult smokers, which represented 25% of adults aged 18 years and older. Between 1983 and 1993, smoking prevalence among white men declined from 34% to 27% and from 41% to 32% in black men. Smoking prevalence among women declined from 30% to 27%. Currently, smoking prevalence is still higher for men than women, 28% and 23% respectively. More than 70% of adults began their daily habit of smoking by the age of 18 years. The frequency of this habit is highest among Native Americans/Native Alaskans (39%) compared with that of other ethnic groups. It is interesting that smoking prevalence is highest among men who are high-school dropouts (42%). Our role as healthcare providers is clear. We must protect our patients and society from the consequences of smoking. But healthcare professionals must first lead by example. Although the frequency of smokers is decreasing in this segment of society, it was still 18% for RNs and 27% for licensed practical nurses in 1991. Among physicians, the frequency of smokers has decreased from 19% in 1976 to 3% in 1991. With respect to effects on human health and the costs of tobacco use, our direction, responsibility, and duty to our patients and society are very clear.

Adult↗