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Biomedical subjects

R Mulcahy

Publications and source records attributed to R Mulcahy.

At least 37 records · Page 2Linked to original sources
PubMed1990

Does intensive medical therapy influence the outcome in unstable angina?

Three hundred and forty-six patients of all ages and both sexes were admitted to coronary care with documented unstable angina. Management was conservative, without the routine use of beta-blockers or calcium antagonists. Mortality was 3.2%, and the nonfatal myocardial infarction rate was 10.1% during the first 28 days. After one year, coronary mortality was 10.5% with a nonfatal infarction rate of 13.1%. Twenty-six patients were subjected to coronary artery bypass surgery, eleven during the first 28 days and fifteen subsequently. No patient underwent coronary angioplasty. The factors influencing immediate and long-term prognosis in these patients were studied. Persistence of pain in hospital, previous chronic angina, and age had an adverse effect on outcome. A total of 143 patients complained of persistent pain lasting for 24 hours or more. The use of beta blockers or calcium antagonists in patients with persistent pain exceeding five days did not appear to influence outcome. The current widespread adherence to "intensive medical treatment," including the routine use of beta blockers and calcium antagonists, is questioned.

Adrenergic beta-Antagonists↗
PubMed1990

The health and risk factor status of industrial employees.

2,183 employees from 13 Irish industries volunteered to take part in a risk factor identification and health counselling programme. Data are presented about the risk factor profile of the group. Alcohol abuse, overweight and hyperlipidaemia were prevalent, particularly among men. Hypertension, although relatively infrequent, was commoner among men and, like hyperlipidaemia and obesity, increased significantly with age. The subjects who smoked cigarettes accounted for 33% of the population studied, while 21% were ex-smokers, with substantially more ex-smokers among men than women. Only 22% of subjects took adequate exercise. Work stress was unusual but personal stress common. Only 75% of subjects used their seat belts regularly and the majority received no regular dental care. The role of industrial health programmes in disease prevention and health education, and in providing benefit to industry, is examined. Recommendations are made about effective means of encouraging healthy living in an industrial environment.

Adult↗
PubMed1990

Heart block as a predictor of in-hospital death in both acute inferior and acute anterior myocardial infarction.

We investigated the relationship between atrioventricular block and in-hospital mortality in 705 successive patients admitted with a first Q-wave myocardial infarction of the anterior or inferior wall. Second- or third-degree atrioventricular block developed in 61 (8.6 per cent) patients and was more frequent in inferior (12.4 per cent) than anterior infarctions (4.9 per cent). A multiple logistic regression identified three factors which were independently correlated with block: inferior infarction, older age and larger infarct size as determined by cardiac enzymes. Mortality was 27.9 per cent in patients with block and 9.3 per cent in those without; it was significantly higher in both anterior (47.0 per cent vs 11.8 per cent) and inferior (20.4 per cent vs 6.7 per cent) infarction groups. When age, infarct size, infarct site and block were analysed simultaneously as predictors of death, block was a significant independent prognostic factor. The relative risk of death, corrected for age and infarct size, in patients showing block was similar for anterior and inferior infarction. Analysis of deaths revealed a higher incidence of unheralded death in inferior infarcts associated with high-degree block.

Age Factors↗
PubMed1989

Psychological factors in cardiac rehabilitation.

Patients who are recovering from myocardial infarction or coronary surgery may have psychological symptoms but they are not psychiatric patients. Their emotional responses are normal. With appropriate psychological support, they will be able to adapt to and master the changes in their lives.

Activities of Daily Living↗
PubMed1989

When does the risk of acute coronary heart disease in ex-smokers fall to that in non-smokers? A retrospective study of patients admitted to hospital with a first episode of myocardial infarction or unstable angina.

Nine hundred and seventy eight patients admitted with a first myocardial infarction or episode of unstable angina were studied to determine for how long after they gave up smoking did the risk in ex-smokers continue to resemble those of current smokers. Logistic regression was used to calculate a score, based on a combination of age, cholesterol, and hypertension, that separated current smokers from lifetime non-smokers. When this function was applied to ex-smokers, only those who had given up at least 15 years before the attack had a risk factor profile similar to that of non-smokers. Those who had given up less than five years before the ischaemic attack had a significantly higher level of other risk factors than current smokers; those who had stopped for between five and 15 years had levels similar to those of current smokers. Ex-smokers are at higher risk of acute coronary disease for at least 15 years after stopping, but some immediate reduction in risk is possible.

Angina Pectoris↗
PubMed1988

Risk factors and in-hospital course of first myocardial infarction in the elderly.

We studied 980 patients with a first episode of unstable angina or myocardial infarction (MI), to examine age-related differences in risk factors and in-hospital complications and mortality. Of the total group, 52.9% were over 60 years of age and 24.3% over 70 years. The proportion of females rose with increasing age, as did the proportion of ex-smokers, while the proportion of current smokers fell. Age correlated negatively with total cholesterol levels, and positively with high-density lipoprotein cholesterol levels. The proportion of hypertensives rose with age, as did in-hospital systolic, but not diastolic, blood pressure. Older patients were more likely to have diabetes, and to have had chronic angina. There was no relation between age and either size or site of infarction. the proportion admitted with unstable angina fell with age, and, among infarctions, the proportion developing complications rose. Mortality rose from 3.1% in the under 60 subjects to 20.0% in those over 70. Cardiogenic shock tended to become more lethal with advancing age, but the outcome of ventricular fibrillation was not influenced by age. With the current aging coronary care population, management and secondary prevention methods derived from studies confined to younger subjects may be inappropriate.

Age Factors↗
PubMed1988

Risk factors and in-hospital course of first episode of myocardial infarction or acute coronary insufficiency in women.

This study examines the risk factor profile, in-hospital course and outcome of 337 women and 643 men admitted with a first episode of acute coronary insufficiency or myocardial infarction. The women were older than the men and had a risk factor profile dominated by hypertension and hypercholesterolemia rather than smoking. Women had a higher rate of unstable angina than did men after adjustment for age distribution. Women with acute infarction showed a higher rate of complications, which was associated with their greater age. They had a higher in-hospital mortality rate (12.6%) than did men (6.6%, p = 0.002). A logistic regression was used to adjust mortality and complication rates for differences in age between the sexes. When this was done, women and men had similar in-hospital prognoses. It is concluded that differences in risk factor profile may result in differences between the sexes in the expression of acute coronary heart disease, but that gender as such does not exert an independent influence on short-term prognosis in this disease.

Adult↗
PubMed1988

Aetiological and prognostic correlates of site of myocardial infarction.

This is a study of the relationship between the site of infarction and both risk factors and in-hospital outcome in 745 consecutive patients admitted with a first myocardial infarction. Patients with anterior infarctions were significantly more likely never to have smoked than patients with inferior infarctions. They had a higher prevalence of hypertension and a higher mean cholesterol level. In-hospital prognosis was worse in anterior infarctions, with significantly higher rates of death and complications. Atrioventricular blocks were more common in inferior infarctions. Non-Q-wave infarctions had a lower incidence of complications than Q-wave infarctions. There was no difference in risk factor levels between Q-wave and non-Q-wave infarctions. Anterior and inferior infarctions were of similar size. Non-Q-wave infarctions were significantly smaller. A logistic regression showed a negative relationship between in-hospital mortality and smoking, and a positive one with peak cardiac enzyme levels. Any effect of site of infarction on mortality was eliminated when corrected for these factors. Our data indicate that the adverse prognosis associated with anterior myocardial infarction is related to differences in aetiology rather than to infarction size.

Cholesterol↗
PubMed1988

Opening remarks.

Explore the source record for details and available documents.

Coronary Disease↗
PubMed1988

The long-term work record of post-infarction patients subjected to an informal rehabilitation and secondary prevention programme.

The St Vincent's Cardiac Rehabilitation Programme is based on an out-patient non-institutionalized service with long-term follow-up and home-based exercise programmes. Return to work rates of more than 90% in the 1960s and 1970s were reported but these rates have not been sustained in the past seven years. These secular changes in return to work rates are attributed to recent changes in the social and economic climate in Ireland. Medical, social, demographic, and psychological factors which may influence successful return to work were studied. The previously employed, young patients and those in the higher social groups, patients with less severe attacks and those free from post-infarction angina, reported the best return to work rates. Reasons for failure to return to work could be attributed equally to organic and functional causes. Factors affecting secondary preventive measures, including smoking cessation, desirable dietary and weight changes, and aerobic exercise programmes, were also studied. These changes were best achieved by young patients, white-collar workers, the better educated and urban dwellers. It is concluded that informal out-patient rehabilitation programmes aimed at early return to a normal life, active secondary prevention measures and home-based exercise programmes, are effective and safe in the great majority of patients recovering from myocardial infarction and coronary bypass surgery.

Coronary Artery Bypass↗
PubMed1988

Smoking and acute coronary heart disease: a comparative study.

Nine hundred and seventy eight patients with a first documented myocardial infarction were studied to detect smoking related differences in clinical profile and in-hospital outcome. The distribution of infarct sites differed significantly between smokers and non-smokers. Smokers had higher peak cardiac enzyme concentrations. In spite of this, smokers had a better prognosis than non-smokers. There are important differences between smokers and non-smokers, both in clinical profile and in-hospital outcome, which may reflect a difference in the nature of the underlying coronary disease.

Age Factors↗
PubMed1988

Relation of infarct site to 15 year prognosis in patients who survived for 28 days after a first myocardial infarction.

Six hundred and eighty four patients (629 men), all aged under 60 years, who had survived for 28 days after a first acute myocardial infarction were studied to determine the influence of the site of infarction on long term prognosis. The infarct site was not significantly related to age nor to extent of infarct at the time of the acute episode. Mechanical complications were more common in patients with anteroseptal infarctions, while atrioventricular conduction disturbances were more commonly found in those with inferior infarction. The site of infarction was not related to smoking habits or angina before the infarction or at 2 year follow up. Life table methods did not show any relation between infarction site and morbidity or mortality either two years or 15 years after the initial infarction.

Age Factors↗
PubMed1988

Secular changes in mortality among survivors of unstable angina and myocardial infarction.

Seven hundred and ninety-four males under 60 years who survived a first episode of unstable angina or myocardial infarction by 28 days were admitted to St. Vincent's Hospital between 1965 and 1981 inclusive. They were followed for at least 4 years: 1-, 2- and 4-year mortality during the follow-up period did not alter significantly during the 17 years. Significant changes did take place over time in the severity of the coronary attacks and in the risk profile of the patients. A greater number of complicated infarcts occurred in the later years and there were fewer smokers and more hypertensives. There was a significant increase over time in the number of initial cigarette smokers who stopped after the coronary attack. Changing methodology made secular changes in cholesterol levels difficult to interpret.

Adult↗
PubMed1987

Psychological response to an acute coronary event and its effect on subsequent rehabilitation and lifestyle change.

We assessed anxiety, depression, body image, motivation, and coping ability in 264 patients admitted with a first myocardial infarction. They were followed over 1 year to determine the relationship between psychological factors and subsequent return to work, smoking cessation, weight reduction, and adoption of a leisure exercise program. Females showed a poorer reaction to illness than did males. The better-educated, and patients in white-collar occupations showed less depression and expressed greater motivation. Anxiety and poor body image, however, tended to be least common in the intermediate educational and occupational group. All psychological factors predicted leisure exercise change, and all but anxiety predicted smoking cessation. Poor body image was linked with failure to reduce weight. Low expressed motivation was the only factor predicting delayed return to work.

Adaptation, Psychological↗