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Biomedical subjects

M E Silverman

Publications and source records attributed to M E Silverman.

At least 55 records · Page 3Linked to original sources
PubMed1987

Prognosis in survivors of acute myocardial infarction occurring at age 70 years or older.

To identify prognostic factors in elderly persons who have survived acute myocardial infarction, 113 patients, aged 70 to 91 years (median 76), were followed for an average of 122 months (range 94 to 170). Eighty-four patients died, 61 (73%) from coronary artery disease. Overall mortality rates were 20.4% at 1 year, 30.1% at 2 years, 31.9% at 3 years, 45.1% at 4 years, 51.3% at 5 years and 69% at 10 years. Almost half (44%) of all deaths from coronary causes occurred in the first 2 years. Univariate analysis of 21 historical and clinical variables found several of prognostic significance: age, prior myocardial infarction, previous diastolic hypertension, history of diabetes mellitus, history of heart failure, presence of rales above the scapula, ventricular gallop, Killip class, cardiomegaly on admission chest x-ray and prescribing digitalis or diuretic at discharge. When these prognostic factors were entered into multivariate analysis, only Killip class (p less than 0.001) emerged as an independent predictor of survival.

Age Factors↗
PubMed1985

Effects of continuous infusion of intravenous nitroglycerin on methemoglobin levels.

The effect of continuous infusion of intravenous nitroglycerin (NTG) on methemoglobin levels in 24 coronary care unit patients was studied. Fifteen patients were admitted with acute myocardial infarction, 5 patients with angina pectoris, 1 patient with congestive heart failure, 2 with chest pain of unknown origin and 1 with chest pain of musculoskeletal origin. Intravenous NTG therapy was initiated at a 5 micrograms/min dose and titrated at 5-micrograms increases until relief of symptoms or until the maximal dose tolerated by each patient. Successive methemoglobin levels were measured at baseline, at each 20 micrograms/min dose increase, at the maximal dose and immediately before weaning the patient from the maximal dose. Statistical analysis by the Student t test (paired samples, p less than 0.05) showed no significant difference between the mean methemoglobin levels at baseline and the mean methemoglobin levels drawn at 20, 40 and 60 micrograms, and before weaning from the maximal dose. No serious adverse effects associated with methemoglobinemia were encountered. It is concluded that intravenous NTG administration in a dose of 0.2 to 2.12 micrograms/min/kg body weight produces no significant methemoglobinemia.

Aged↗
PubMed1984

Value of radiotelemetry in a community hospital.

The use of radiotelemetry for continuous electrocardiographic monitoring of patients outside of special care units, although common practice in many community hospitals, has not been adequately studied. Two-hundred five consecutive patients placed on telemetry over a 3-month period were prospectively studied to determine the benefits of radiotelemetry. Fourteen episodes of significant arrhythmias in 12 patients who required specific intervention were detected over 608 patient-days of monitoring. Significant arrhythmias occurred only in patients with known or suspected coronary artery disease or in those with previously documented arrhythmias. Radiotelemetry in a community hospital, when available at a moderate daily fee and observed by trained personnel, appears to be a cost-effective and safe method of monitoring patients at moderate risk for life-threatening arrhythmias. Although the overall cost of the system appears justifiable because of better utilization of special care unit beds and the seriousness of the arrhythmias detected, there is no evidence showing an increase in either in-hospital or postdischarge survival in monitored patients. Any potential benefit is probably restricted to patients with definite or suspected coronary artery disease or previously documented arrhythmias. Telemetry in a community hospital can provide a valuable alternative to special care unit monitoring in selected cases, but its value in the assessment of syncope and palpitations in the absence of high clinical suspicion of arrhythmia is limited.

Arrhythmias, Cardiac↗
PubMed1982

Ventricular fibrillation complicating acute myocardial infarction: reasons against the routine use of lidocaine.

Because of recent recommendations that lidocaine be used prophylactically in all coronary care unit (CCU) patients with suspected myocardial infarction (MI), an approach not used in our CCU, we analysed our experience with ventricular fibrillation (VF) occurring in the setting of an acute MI. The frequency of VF in all patients was 3.2%. In MI patients 5.7%, of primary ventricular fibrillation (PVF) 2.8%, and of complicating ventricular fibrillation (CVF) 6.8%. All patients with PVF were resuscitated immediately. There was an increased in-hospital mortality for patients with VF compared to patients without VF; however, the increased mortality did not seem to result directly from VF. The long-term survival of PVF patients who survived to discharge was excellent (80% at 58 months). The routine use of prophylactic lidocaine would have been of no potential benefit in 96.8% of our patients, subjecting them to extra expense and possible toxicity. Since we have found no compelling evidence that the prophylactic administration of lidocaine can reduce mortality, we do not recommend this therapy for acute MI patients in our CCU.

Aged↗
PubMed1980

Acute myocardial infarction in hospitalized patients over age 70.

The history and clinical course of 175 patients aged 70 and older (Group A) with acute myocardial infarction (MI) was studied to determine the hospital mortality rate in this population group and to determine the clinical factors that influenced the hospital mortality rate. The mortality rate of a second group of 772 patients below age 70 years (Group B) admitted during the same time period was determined for comparison with the mortality rate of Group A. The hospital mortality rate in Group A (32%) was 3.9 times the hospital mortality rate in Group B (8.2%). Advanced age was associated with a significantly higher mortality rate, even when so called "good risk" patients from Group A were compared with patients in Group B. The major causes of death in this hospitalized group of patients aged 70 and older were shock (33.9%) and cardiac rupture (28.6%). Factors that significantly influenced hospital mortality rate in the elderly group were the development of shock, pulmonary edema on chest x-ray, a clinical diagnosis of congestive heart failure, and the development of complete heart block or new bundle branch block during the hospital course.

Adult↗
PubMed1980

Clinical characteristics, electrocardiographic and enzyme correlations, and long-term prognosis of patients with chest pain associated with ST depression and/or T wave inversion.

The clinical characteristics, electrocardiographic changes, and long-term prognosis were studied in 50 patients suffering nontransmural myocardial infarctions. It is concluded that nontransmural myocardial infarcts tend to occur in older patients with known coronary atherosclerosis and these infarctions are frequently preceded by a period of unstable angina. The clinical course is often complicated with congestive heart failure and other major management problems. Three different groups of electrocardiographic changes were noted and all four in-hospital deaths showed the same pattern of electrocardiographic changes. The prognosis of patients suffering nontransmural myocardial infarctions is not good, as evidenced by a death rate similar to reported patients suffering transmural myocardial infarction and a significant incidence of cardiovascular disability in those who survive.

Adult↗
PubMed1980

Torsade de pointe atypical ventricular tachycardia complicating subarachnoid hemorrhage.

We report the findings in a patient in whom prolongation of the Q-T interval and torsade de pointe ventricular tachycardia occurred as a complication of intracerebral and subarchnoid hemorrhage. The dysrhythmia did not recur after treatment with propranolol. Prolongation of the Q-T interval occurs frequently in patients with subarachnoid hemorrhage, causing a predisposition to torsade de pointe ventricular tachycardia. Propranolol, by blocking excessive sympathetic stimulation and shortening the Q-T interval, may be effective therapy for ventricular dysrhythmias associated with subarachnoid hemorrhage.

Electrocardiography↗
PubMed1978

Isolated acquired pulmonary valve regurgitation. Report of long-term follow-up.

A patient is reported with isolated pulmonary valvular regurgitation acquired probably as a result of endocarditis at age 22 years. The patents remained essentially asymptomatic with physical findings compatible with haemodynamically significant pulmonary regurgitation until death at age 85 years. A necropsy confirmed the presence of isolated severe pulmonary valvular destruction. This long-term follow-up lends further support to the concept that significant volume overload of the right ventricle from pulmonary regurgitation is well tolerated and usually does not require surgical intervention.

Adult↗
PubMed1976

A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis.

Janeway's lesions and Osler's nodes are regarded as excellent clues to the diagnosis of infectious endocarditis; however, very few physicians have actually witnessed these findings, and there is some confusion in distingushing between the two. This article concerns a patient with infectious endocarditis due to Diplococcus pneumoniae, who had tender vesicular lesions thought to be Osler's nodes and a nontender erythematous nodule on the foot compatible with a Janeway's lesion. The original comments by William Osler and Edward Janeway are presented, and the literature following their descriptions is reviewed. It is concluded that the only essential diagnostic difference between the two is the tenderness that is associated with an Osler's node but not with a Janeway's lesion.

Adolescent↗
PubMed1975

Pericarditis of acute myocardial infarction.

Forty patients with acute myocardial infarction and pericarditis (AMI-P) were encountered over a three-year period. The incidence of AMI-P was 7.2 percent (40 of 554 patients). Fifty consecutive patients with acute transmural infarction without pericarditis (AMI-C) were used as a control group. There were no significant differences between the AMI-P and AMI-C groups regarding age, sex, infarct location, hospital stay or mortality. Painful symptoms of pericarditis were experienced by 37 patients (92 percent), all of whom had developed symptoms by the fourth hospital day. The pericardial friction rub lasted three days or less in 34 patients (85 percent), but an occasional rub could be heard for up to eight days. Twenty patients with AMI-P (50 percent) developed pleural effusions and/or parenchymal pulmonary infliltrates. Twenty-eight AMI-P patients (70 percent) were thought to have had congestive heart failure (CHF) on the basis of their symptoms and physical findings. Radiographic examination could confirm only 13 cases of CHF among the 28 patients in whom the diagnosis was made clinically. Glucocorticoids were given parenterally to 31 of the 37 patients (84 percent) who had symptomatic pericarditis and was felt to be effective in ameliorating painful symptoms. Followup data was obtained on 28 of the 32 surviving patients. Five patients (15 percent) had seven episodes of the postmyocardial infarction syndrome (PMIS). Pericarditis is generally a shortlived complication of acute myocardial infarction. Pleural and parenchymal pulmonary abnormalities are common and probably account for the tendency to "overdiagnose" CHF in patients with AMI-P. PMIS appears to occur more frequently in patients who have had pericarditis at the time of the acute myocardial infarction.

Administration, Oral↗