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Biomedical subjects

L Lemberg

Publications and source records attributed to L Lemberg.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1996

Management of congestive heart failure: is the role of positive inotropic therapy fading?

Significant strides have been made in the medical therapy of chronic CHF in the past two decades. Treatment has evolved from therapy based on the older concepts of the pathophysiology of CHF to evidence-guided therapy supported by results of major landmark studies that expand the understanding of the pathophysiology. Attenuation of neurohumoral activation is now a goal of pharmacological therapy, and we know that agents that offer hemodynamic and early clinical improvement may not necessarily prolong survival-unless they also modulate these neurohormonal systems. Positive inotropic therapy (e.g., use of a digitalis glycoside) is no longer considered essential in patients with CHF in sinus rhythm. Although impressive hemodynamic benefits can be observed with the use of positive inotropic agents, long-term treatment with these drugs has not produced clinical benefits and may increase mortality. Long before the current concerns about the use of positive inotropic therapy for CHF, cardiovascular physiologists had advised that contractility does not equate with overall cardiac performance. Stimulation of myocardial contractility is a property of digoxin therapy. However, cardiac function is governed by four determinants: preload, afterload, rhythm, and contractility. All four require control. Treatment aimed at reducing preload and afterload and improving arrhythmias can achieve cardiac compensation by reducing cardiac work without the need for digoxin therapy or other inotropic drugs.

Cardiotonic Agents↗
PubMed1995

Volume control: a reliable option in the management of 'refractory' congestive heart failure.

CAVH can be effective in severe hypervolemic states, which are generally major hemodynamic abnormalities associated with refractory congestive heart failure, and not infrequently may have a poor renal response to diuretics and vasodilators. Reduced vascular volume with CAVH is accompanied by lower preload and afterload and thus decreased heart size. As a result, cardiac efficiency and contractility improve and oxygen demand is reduced. The temporal progression of congestive heart failure from a mild to a severe state need not be a sign of progressive pathology of heart muscle but rather a result of feedback circuits in which failure begets failure and leads to progressive cardiac enlargement, progressive hypervolemia, and peripheral edema. An appreciation of this concept permits a more optimistic approach to the management of congestive heart failure. Thus, the effective use of CAVH in reducing vascular volume and peripheral edema may reverse "refractory" congestive heart failure and prolong life.

Acute Kidney Injury↗
PubMed1995

Sudden death in athletes.

HCM, as well as coronary and myocardial structural abnormalities, is the most common pathology leading to SCD in young athletes. Furthermore, SCD from fatal arrhythmia seems to be the most common mechanism of death. In this population, however, data are insufficient to support either invasive or noninvasive approaches to clarify risk stratification for SCD. Because of the large population, variants of normal found within the athletic population, and the rarity of the disease, screening for individuals at risk is neither practical nor cost-effective. Not all athletes with HCM are at the same risk for SCD; a thorough history and physical examination should alert the health professional to potential risk factors. Efforts are under way to stratify athletes at risk for SCD to determine who can participate in competitive sports and who should not. However, until research can accurately define variables of hemodynamic and electrical instability that permit reliable identification of athletes with HCM who are at risk for SCD, the recommendation is to disqualify athletes with confirmed HCM from moderate- to high-intensity competitive sports. This recommendation includes athletes with or without symptoms or left ventricular outflow obstruction. Due to the decreased risk of SCD in older athletes, individual judgment of eligibility may be used. Athletes thought to have had myocarditis should be withdrawn from all competitive sports for a convalescent period of approximately 6 months, with thorough cardiac assessment and testing performed before returning to training. Athletes with atrial or ventricular tachyarrhythmia must be screened for structural abnormality, heart response during exercise, and the frequency and duration of the arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Regression of coronary artery disease: the role of plaque biology.

Research has lead to a better understanding of the pathophysiology and history of atherosclerotic heart disease, which has reached epidemic proportions in industrialized countries in this century. Atherosclerosis should be seen as a chronic, protracted process that encompasses complex and dynamic interactions between cellular, biochemical, and biophysical factors in the microcosmos of the arterial vessel wall and blood circulation. In this context, the ultimate consequences of this disease process, namely coronary artery disease, must be seen as the "tip of the iceberg." The most dramatic manifestation of coronary artery disease, the acute coronary syndrome, usually occurs as the result of different forces and factors, which lead to abrupt plaque disruption, rupture, and vessel thrombosis. In contrast, the genesis of this atherosclerotic lesion is a slow process. Despite considerable experimental clinical evidence accrued during the past decade, atherosclerosis remains a complex pathophysiological process that is not fully understood. It is clear, however, that the interaction between the cellular elements of the vessel wall and the circulation are the determinants of atheroma formation. In this regard, the vascular endothelium appears to play a pivotal role because of its strategic location and metabolic activity. Antilipidemic therapy influences the outcome of coronary disease through a variety of mechanisms, including direct and indirect effects on the endothelium.

Coronary Artery Disease↗
PubMed1994

Heart rate variability: prognostic implications.

HRV offers information about sympathetic and parasympathetic autonomic function and thus can serve as a measure of risk stratification for serious cardiac arrhythmias and sudden cardiac death. HRV appears to be altered in patients with acute myocardial infarction or diabetic neuropathy and is affected by other physiologic and pathophysiologic processes. Use of HRV measurements requires continued investigation to determine optimal methods and tools by which HRV indices and its variables are analyzed. Long-term studies are required to help correct for differences in values pertaining to age and disease process. Also, studies are needed to determine how patient management strategies will be affected by knowledge gained through HRV analysis and to determine which patient populations should be monitored for HRV analysis and to identify those at risk for sudden cardiac death.

Age Factors↗
PubMed1994

Unexplained syncope: diagnostic value of tilt-table testing.

Vasovagal syncope is a common syncope in patients who have no structural heart disease and occurs more often in young adults. It typically occurs in the erect posture, either standing or sitting. Upon recognition of the prodrome associated with NCS, subjects may avert syncope by lying down or putting the head between the knees. Use of head-up tilting is a recognized diagnostic tool and widely used for the evaluation of vasovagal syncope. However, cardiac diagnostic tests are not 100% accurate. This fact was recently underscored by what occurred in the recent tragic loss, due to ventricular fibrillation, of basketball star Reggie Lewis of the Boston Celtics. It is alleged that the tilt-table test was positive but that he also had structural heart disease. The most important diagnostic tool is the physician's clinical judgment.

Adult↗
PubMed1994

Radiofrequency catheter ablation for supraventricular tachycardias: Part II.

Use of percutaneous catheter ablation with radiofrequency current for cardiac arrhythmias is expanding rapidly. Technical ease, high success and low complication rates have allowed RFCA to become standard treatment for accessory AV connections and is the therapeutic procedure of choice for patients with atrioventricular node reentry tachycardias. Techniques still being investigated and evaluated for the treatment of supraventricular tachycardias include laser catheter ablation, cryocatheter ablation and microwave catheter ablation. With further clinical experience, the efficacy and safety of these and other procedures can be determined.

Adolescent↗
PubMed1994

Q and non-Q wave myocardial infarctions.

Previously, the classification of MI into transmural and subendocardial types has been based on the presence or absence of abnormal Q waves. The pathologic anatomy of necrosis in MI does not necessarily correspond to these ECG criteria. Thus, it is more appropriate to describe myocardial infarcts as Q wave or non-Q wave infarcts. The importance of this classification is underscored by their clinical and pathologic differences and the tendency for more serious prognosis in the non-Q wave infarcts. It should be noted that in Q wave infarcts the volume of necrosis is usually greater than that in non-Q wave infarcts.

Electrocardiography↗
PubMed1993

Syndrome X: fact or fancy?

Syndrome X continues to be a puzzle to the profession. A consensus as to the definition, etiology, pathology, prognosis and treatment has still to be developed.

Behavior Therapy↗
PubMed1993

Radiofrequency catheter ablation for supraventricular tachycardias: Part I.

Ablative therapy in the treatment of arrhythmias is an exciting development of the last decade. Although direct-current, high-energy shock can be effective treatment for many supraventricular tachycardias, clinicians are concerned about potential problems associated with its use. Drug therapy for arrhythmias has been inadequate, ineffective, poorly tolerated and fraught with toxic or proarrhythmic reactions. Because of its relative technical ease, high success rate and low complication rate, RFCA remains the therapeutic procedure of choice for patients with atrioventricular nodal reentrant supraventricular tachycardia. Other catheter ablation techniques such as laser, cryocatheter and microwave catheter are still being tested.

Adult↗