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Biomedical subjects

M A Alpert

Publications and source records attributed to M A Alpert.

At least 127 records · Page 7Linked to original sources
PubMed1984

Cardiac failure in the elderly.

Cardiac failure in the elderly is caused by many of the same factors that produce cardiac failure in younger individuals. However, cardiac decompensation may be attributable to certain abnormalities that occur predominantly or exclusively in the geriatric age group and certain physiologic alterations that are caused by the process of aging. Management incorporates most of the therapeutic measures used in younger individuals, with alterations designed to accommodate decreased renal function and enhance compliance.

Aged↗
PubMed1983

Ventricular septal rupture after acute myocardial infarction: diagnosis by two-dimensional echocardiography.

A 69-year-old woman had ventricular septal rupture after acute anterolateral myocardial infarction. The defect was demonstrated directly by two-dimensional echocardiography. The appearance of negative contrast in the right ventricle during systole and microbubbles traversing the defect from right to left during diastole further confirmed the rupture. Two-dimensional echocardiography also accurately characterized the nature and extent of associated myocardial damage.

Aged↗
PubMed1983

Circulating immune complexes: possible toxins responsible for serositis (pericarditis, pleuritis, and peritonitis) in renal failure.

In 71 patients (41 men, 30 women) with advanced renal failure maintained on hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), or within 8 weeks after the commencement of dialysis therapy (ED), studies were performed searching for evidence of serositis and the blood levels of circulating immune complexes (CIC), measured by the polyethylene glycol precipitation method. Mean CIC levels were elevated in these patients compared to the 58 healthy subjects (mean +/- SEM 725 +/- 40, and 260 +/- 34 micrograms/ml, respectively). Serositides were significantly more prevalent in ED patients compared to both remaining groups, and tended to occur less frequently in CAPD than in HD patients. CIC levels were significantly lower in CAPD than in ED patients. The levels of CIC were significantly higher in patients with serositis compared to those without evidence of serosal inflammation (mean +/- SEM 868 +/- 71 and 677 +/- 53 micrograms/ml, respectively). In addition, immune complex-like materials were found in all of 4 effusate samples and in 10 of 27 peritoneal dialysates. It is suggested that immune complexes may be the 'uremic toxins' responsible for the serositis of renal failure, and may be secreted into serous effusions. Immune complex-like material can be removed in peritoneal dialysate, which may contribute to the lower CIC levels and lower incidence of serositis in the CAPD patients.

Adult↗
PubMed1983

Cardiovascular manifestations of mixed connective tissue disease in adults.

To assess the nature and distribution of cardiovascular abnormalities associated with mixed connective tissue disease, we studied 38 patients with overlapping clinical manifestations of systemic lupus erythematosus, progressive systemic sclerosis and polymyositis, and circulating antibodies to nuclear ribonucleoprotein. The protocol included taking a medical history and a physical echocardiogram, and pulmonary function tests. Cardiac catheterization was performed on 17 patients. Postmortem examination was performed on four of the five patients who died during follow-up. Acute pericarditis and/or pericardial effusion was detected in 11 patients (29%) and mitral valve prolapse was identified in 10 patients (26%). Marked intimal hyperplasia of coronary arteries was observed in all four hearts that were autopsied and perivascular and myocardial leukocytic aggregates were present in two hearts. Pulmonary vascular resistance was elevated in 11 of the 17 patients who underwent cardiac catheterization. In summary, cardiovascular abnormalities associated with mixed connective tissue disease include acute pericarditis and/or effusion, mitral valve prolapse, intimal hyperplasia of coronary arteries, perivascular and myocardial leukocytic infiltrates, and pulmonary hypertension.

Adolescent↗
PubMed1983

Esophageal hemangioma: diagnosis with computed tomography and radionuclide angiography.

Esophageal hemangioma is a benign tumor that may cause dysphagia and upper gastrointestinal bleeding. Invasive measures such as endoscopic biopsy and surgical excision have been required for diagnosis in most reported cases. We have reported a case focusing on the use of two noninvasive techniques, contrast CT and radionuclide angiography, in the diagnosis of esophageal hemangioma.

Aged↗
PubMed1983

Aortic dissection.

Explore the source record for details and available documents.

Aortic Dissection↗
PubMed1982

Sensitivity and specificity of M mode echocardiographic signs of mitral valve prolapse.

To assess the sensitivity and specificity of previously described M mode echocardiographic signs of mitral valve prolapse, 100 subjects with a mobile mid systolic click and 100 matched normal control subjects were prospectively studied. Late systolic posterior motion and holosystolic hammocking of the mitral leaflets were common, highly specific signs of mitral valve prolapse. When these signs were combined as a single criterion, sensitivity was 85 percent and specificity was 99 percent. Other signs, including systolic echoes in the mid left atrium, systolic anterior motion, early diastolic anterior motion of the posterior mitral leaflet and shaggy or heavy cascading linear diastolic echoes posterior to the mitral valve, were highly specific but uncommon. They occurred only in combination with late systolic posterior motion or holosystolic hammocking. The remaining signs tested did not differentiate subjects with mitral valve prolapse from normal persons.

Adult↗
PubMed1982

Natural history of high-grade atrioventricular block following permanent pacemaker implantation.

We followed 120 patients 4-14 yr after permanent pacemaker implantation for high-grade atrioventricular block to assess the effect of sex, age at implantation, date of implantation and various chronic co-existent illnesses on survival. The overall survival rates were 91% at 1 yr, 63% at 5 yr and 41% at 10 yr. Patients with congestive heart failure demonstrated the lowest survival rates of all cohorts studied. Survival rates of patients with congestive heart failure were significantly lower than survival rates of patients without congestive heart failure and were also significantly lower than those of patients with conduction system disease only. Similarly, patients with coronary heart disease demonstrated significantly lower survival rates than both patients without coronary heart disease and patients with conduction system disease only. The presence of hypertension, valvular heart disease, diabetes mellitus or cerebral infarction influenced survival less adversely than congestive heart failure or coronary heart disease. Survival decreased progressively with increasing age; however, the differences were not significant. Sex and date of implantation had no apparent effect on survival. Thus, coronary heart disease and the presence of congestive heart failure appear to be the major determinants of survival following permanent pacemaker implantation for high-grade atrioventricular block.

Aged↗
PubMed1982

Natural history of sinus node dysfunction after permanent pacemaker implantation.

To explore the natural history of symptomatic sinus node dysfunction after permanent pacemaker implantation, we followed up 71 patients (27 with sinus arrest, 27 with unexplained sinus bradycardia, 14 with the bradycardia/tachycardia syndrome, and three with sinoatrial block) for four to 14 years after placement of a permanent ventricular pacemaker. Survival rates at one, five, and ten years were 88%, 75%, and 70%, respectively. Overall mortality was 31%. Patients with congestive heart failure had significantly lower survival rates than those without (P less than .03). Survival rates were significantly lower in patients with coronary artery disease than in those with conduction system disease only (P less than .01). Fourteen of the 19 patients whose cause of death was known died of cardiovascular disease, ten of complications of coronary artery disease. Thus, survival after pacemaker implantation is adversely and profoundly influenced by underlying cardiovascular disease, particularly coronary artery disease and its complications.

Adult↗
PubMed1982

Increased left ventricular mass in idiopathic mitral valve prolapse.

We performed M-mode echocardiography on 100 subjects with idiopathic mitral valve prolapse (IMVP) and on 100 normal control subjects to determine if differences exist between the two groups in cardiac chamber size, left ventricular performance or left ventricular mass. Subjects with IMVP demonstrated significantly greater left ventricular mass than normal control subjects. There were no significant differences in fractional shortening of the left ventricle or left ventricular end-diastolic volume. There was no significant difference in left ventricular mass between asymptomatic subjects with IMVP and those with chest pain, palpitations, syncope or presyncope. Subjects with and without mitral regurgitation showed no significant difference in mass. The results indicate that subjects with IMVP demonstrate subtle left ventricular hypertrophy which does not appear to be caused by underlying organic heart disease, mitral regurgitation or sustained hypercontractility. This suggests that myocardial involvement is an integral part of the IMVP syndrome.

Adult↗
PubMed1982

Rapid control of severe hypertension with minoxidil.

We studied nine symptomatic patients whose diastolic BP exceeded 120 mm Hg two hours after receiving a combination of 40 mg of oral propranolol hydrochloride and 40 mg of oral furosemide. Systemic and pulmonary hemodynamics were measured before and after a 20-mg loading dose of oral minoxidil. A booster dosage of 5 to 20 mg of minoxidil was given at four hours if the diastolic BP exceeded 100 mm Hg. There was a progressive and significant reduction of systemic vascular resistance and systolic diastolic BP during the period of hemodynamic monitoring. The decrease in systemic vascular resistance occurred without notable change in cardiac output or pulmonary wedge pressure. The results indicate that an orally administered regimen of propranolol, furosemide, and loading-booster doses of minoxidil produces prompt, progressive, and sustained BP reduction due to vasodilation in patients with severe hypertension who require prompt (but not immediate) BP control.

Adult↗
PubMed1980

Rapid reduction of severe hypertension with minoxidil.

Five patients presenting with severe hypertension who failed to exhibit diastolic blood pressures less than 120 mm Hg following the oral administration of propranolol (60--80 mg) and furosemide (40 mg) received minoxidil (20 mg, p.o.). Systemic blood pressure, heart rate, and cardiac output were measured prior to and hourly following the addition of minoxidil to the regimen of propranolol and furosemide. One hour following the addition of minoxidil, systemic blood pressure decreased from 204/126 to 186/114 mm Hg (mean systolic/mean diastolic blood pressure). Four hours after minoxidil administration, systemic blood pressure was 175/105 mm Hg. Four of the 5 subjects exhibited diastolic blood pressures greater than 100 mm Hg at 4 hr and were given a booster dose of minoxidil (5--20 mg). Systemic blood pressure subsequently decreased to 153/92 mm Hg at 8 hr and to 142/86 mm Hg at 12 hr following the initial dose of minoxidil. The reduction of systemic blood pressure was achieved without significant change in heart rate or cardiac output. These data indicate that stepped-care therapy utilizing a diuretic, a beta-blocking agent, and minoxidil produces prompt, significant, and sustained reduction of systemic blood pressure in patients with severe, potentially life-threatening hypertension.

Adult↗
PubMed1979

Pulmonary hemodynamics in systemic hypertension. Long-term effect of minoxidil.

To assess the effect of minoxidil on pulmonary hemodynamics, we performed cardiac catheterization on ten patients, prior to the administration of minoxidil, at six months after its addition to their existing drug regimens, and on seven patients following 12 or more months of minoxidil therapy. Systemic blood pressure and systemic vascular resistance were significantly reduced at six months and following 12 or more months of minoxidil therapy. Before receiving minoxidil, nine of ten patients had elevated pulmonary vascular resistance. There were no significant changes in pulmonary vascular resistance following the initiation of minoxidil. The data suggest that pulmonary hypertension is common in patients with long-standing poorly controlled systemic hypertension, and that minoxidil, in doses sufficient to significantly reduce systemic blood pressure, does not cause or aggravate pulmonary hypertension.

Adult↗
PubMedDate not supplied

Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity.

Cardiac side effects from aspirin are uncommon; however, severe acid-base imbalance, pulmonary edema, ventricular ectopic activity and cardiopulmonary arrest have been reported in patients with toxic serum salicylate concentrations. We saw a patient with salicylate toxicity who developed a variety of sinus and atrioventricular nodal conduction disturbances and atrial arrhythmias with a relatively low toxic serum salicylate concentration. The cardiac rhythm returned to normal as the serum salicylate concentration decreased, and results of subsequent electrophysiologic testing and Holter monitoring were normal. A low serum albumin level may have resulted in altered salicylate binding in this patient, thereby increasing the availability of unbound (active) drug for toxic effects.

Aged↗