Changing concepts in the management of congestive heart failure.
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Aged↗
Biomedical subjects
L Lemberg
Publications and source records attributed to L Lemberg.
Non-Q wave versus nontransmural infarction.
The classification of myocardial infarction into transmural and subendocardial types has previously been based on the presence or absence of abnormal Q waves. The pathologic anatomy of necrosis in myocardial infarction does not necessarily correspond to these electrocardiographic criteria. It is therefore more appropriate to describe these infarcts as Q wave or non-Q wave myocardial infarctions. 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.
Adult↗
Management of hyperlipidemia: an update.
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Adult↗
Update on nitroglycerin use.
Tolerance to nitrates occurs when this class of drugs is administered in a continuous around-the-clock regimen. Nitrate-free intervals from 10 to 12 hours are recommended to prevent nitrate tolerance. Full response with renewed administration occurs with interrupted nitrate therapy.
Administration, Sublingual↗
Nonthrombolytic therapy for acute myocardial infarction.
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Humans↗
The senescent heart.
There are changes in the elderly population that make them more vulnerable to disease, react differently to disease, and respond differently to drugs. The changes that occur in the geriatric population are (1) general physical deconditioning, (2) blunted physiologic response to change, (3) decreased resilience, and (4) degenerative changes common to aging. Appreciation of these changes helps in the diagnoses, management, and evaluation of prognosis in the senescent patient.
Aged↗
An acute cardiovascular event in an endurance-trained athlete.
In athletes, symptoms and electrocardiographic patterns may mimic an acute coronary event. In addition, endurance athletes show significantly elevated heart-specific serum CK-MB enzyme activity in the first week after athletic competition. Also, cellular control of the CK-MB enzyme is consistently elevated in skeletal muscles of trained endurance athletes. Thus, all three criteria used in diagnosis of acute myocardial infarction may be found in the athlete's heart. Awareness of these potential findings in athletes as "heart patients" and curtail unnecessary hospitalizations.
Adult↗
Electrolyte imbalances in cardiovascular disease: the forgotten factor.
Hypomagnesemia is not an infrequent finding in diuretic-induced hypokalemia. Potassium replacement therapy in these cases may be ineffective in raising serum potassium levels unless normal magnesium concentrations are restored.
Cardiovascular Diseases↗
Circadian influence on coronary events.
The circadian variation of major cardiovascular disorders, that is, TMI, AMI, SCD, and stroke, reflects an increased vulnerability to myocardial and cerebral ischemia and myocardial dysfunction in the early hours of the morning after awakening and rising. A comprehensive approach to treatment in patients with ischemic heart disease must take into consideration the chronobiology of the cardiovascular system and its relevance to the underlying disease process that affects the cardiovascular system.
Cardiovascular Diseases↗
A correctable complication of advanced congestive heart failure.
Hyponatremia is a common complication of chronic advanced CHF unresponsive to the usual therapeutic measures. Thus low levels of serum sodium are a significant marker for severe CHF refractory to the more conventional measures. The combined use of ACE inhibitors and diuretics is generally very effective in correcting the hyponatremic state and often helpful in reversing CHF.
Captopril↗
Problem solving for complications with the AICD.
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Equipment Failure↗
The Miami Vices in the CCU. Part I. Cardiac manifestations of cocaine use.
There is a widespread misconception that the social use of cocaine is not associated with serious medical complications. It is therefore necessary to reemphasize that cocaine use can precipitate life-threatening cardiac events even in the absence of underlying heart disease.
Adult↗
The Miami vices in the CCU. Part II. Cardiac manifestations of AIDS.
Cardiac manifestations of AIDS probably occur more frequently than is appreciated--despite autopsy reports indicating that more than 50% of deceased AIDS patients had myocarditis. A high index of suspicion and the echocardiogram will help in revealing the true incidence of cardiac involvement in AIDS.
AIDS-Related Complex↗
Effective technique of controlling volume in refractory congestive heart failure.
Continuous arteriovenous hemofiltration can be very effective in severe hypervolemic states associated with refractory CHF and limited renal response to diuretics and vasodilators. A reduced vascular volume is accompanied by a lower preload and afterload and thus a decrease in heart size. As a result cardiac efficiency and contractility improve, and oxygen demands are reduced. The temporal progression of CHF 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 where 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 CHF. Thus, the effective use of CAVH in reducing vascular volume and peripheral edema may in some patients reverse "refractory" CHF and prolong life.
Blood Volume↗
An unusual complication of intravenous nitroglycerin.
Intravenous nitroglycerin is frequently used in the treatment of acute myocardial infarction for its vasodilating effect on lowering both preload and afterload and in the control of ischemic heart pain. The end point for doses of nitroglycerin infusion is either relief of persistent or recurrent angina or controlling congestive heart failure by lowering left ventricular end diastolic pressure and volume. Nitroglycerin accomplishes these end points primarily through its venodilating property. Intolerable headaches or symptomatic hypotension may prevent achieving the clinical end point. Nevertheless, high doses of intravenous nitroglycerin may need to be administered to achieve a desired hemodynamic and therapeutic effect. Changes in mental status, i.e., lethargy and confusion, should be a warning sign of possible ethanol intoxication. An alcohol blood level verifies the clinical impression and gradually withdrawing the intravenous nitroglycerin is all that is necessary to effect a total recovery from this reaction.
Aged↗
Catecholamines, potassium, and beta-blockade.
Stress-induced hypokalemia represents a transient risk factor for malignant arrhythmias in patients with coronary artery disease. The adrenergic nervous system serves as a major control system for the transport of potassium across the cell membrane. Nonselective beta-blockade presents epinephrine-mediated hypokalemia. This helps explain a possible mechanism for the significant improvement in morbidity and mortality rates of patients taking long-term propranolol therapy in the Beta Blocker Heart Attack Trial report.
Aged↗