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Biomedical subjects

R Mulcahy

Publications and source records attributed to R Mulcahy.

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

Predictors of sudden death up to 18 years after a first attack of unstable angina or myocardial infarction.

Factors related to the occurrence of sudden death were examined in 551 men aged less than 60 years who survived a first attack of unstable angina or myocardial infarction by at least 28 days. There were 301 deaths over an average follow up period of 9.4 years and 138 (46%) of these were sudden. Life table techniques permitted the estimation of mortality up to 18 years after the index event. The proportion of sudden deaths showed a decrease with length of follow up. In those who were non-smokers and in those aged less than 45 years on admission sudden deaths in the first two years were very common (80% (95% confidence interval: 69%-91%) and 79% (95% confidence interval: 68%-90%) respectively). The proportion of sudden deaths in the remaining 16 years of follow up was related inversely to age at initial attack. After the first two years of follow up sudden death rates were similar in those who continued to smoke and those who stopped smoking, although those who continued to smoke had a significantly higher overall mortality. The risk of sudden death should be borne in mind when planning the investigation and rehabilitation of young and non-smoking subjects presenting with a first coronary event.

Age Factors↗
PubMed1987

Nutrient intakes and dietary compliance in cardiac patients: 6-year follow-up.

Changes in nutrient intakes which were recorded in the diets of cardiac patients at 1-year follow-up were maintained at 6-year follow-up, with the exception of fibre intake. Twenty-three patients, 60 per cent of the original study, were available for assessment at 6-year follow-up. The majority of these patients (74 per cent) had been classified as good compliers at 1-year follow-up. They had maintained the nutrient intakes observed at 1-year follow-up, except for fibre intake which had been reduced. Nutrient intakes of the small number of poor compliers (26 per cent) tended to deteriorate between 1- and 6-year follow-up. Body weight, which was reduced at 1-year follow-up, had increased to initial levels at 6-year follow-up for the total group. Poor compliers showed the greatest increase in weight. Serum cholesterol levels showed little change throughout the study for all patients. Compliance at 1-year follow-up appeared to determine compliance over the longer follow-up period for the study patients and especially for good compliers. More attention needs to be given to evaluating the factors which influence compliance, in particular dietary compliance.

Cardiovascular Diseases↗
PubMed1986

Course of angina pectoris after an acute coronary event.

The course of postcoronary angina pectoris was examined in 555 men who had survived a first attack of myocardial infarction or unstable angina. Patients were aged less than 60 and were followed up yearly for up to 17 years. Only 25 (4.5%) had coronary artery bypass surgery. Most patients with angina were treated by nitrates alone. One year after infarction 24.1% of survivors (124/515) reported the presence of angina pectoris, and the proportions at five, 10, and 15 years were 29.9%, 30.4%, and 43.5% respectively. Seventeen years after the initial event 35.3% of the survivors had never reported postcoronary anginal symptoms. The patients who experienced anginal symptoms in the year after their coronary attack had a poorer long term survival than the group who were symptom free over the first year. These patients also had longer subsequent periods with angina, though in 41.7% angina resolved before death after a median of 2.9 years. Throughout follow up mortality during periods in which patients experienced angina was higher than in the symptom free periods. This long term follow up study of patients after a coronary event confirms that the presence or absence of angina may vary considerably over time in patients treated medically and that the presence of angina is associated with a poorer prognosis. These findings have important implications when assessing the effects of various treatment modalities on postcoronary angina, including coronary artery bypass surgery.

Angina Pectoris↗
PubMed1986

The aetiology and prognostic implications of reciprocal electrocardiographic changes in acute myocardial infarction.

The relations between reciprocal ST segment depression in the electrocardiogram and infarct size and 10 year prognosis were studied in 315 patients who survived for at least 28 days after a first anterior or inferior myocardial infarction. ST depression was more common in inferior infarcts (72%) than in anterior (37%) ones. It occurred more frequently in complicated infarcts and in the presence of considerable ST elevation. Patients experiencing second or third degree heart block were significantly more likely to show reciprocal changes. The rise in peak cardiac enzyme concentration was higher in patients showing ST depression. In patients with ST depression, peak creatine kinase concentration was 46% higher, aspartate aminotransferase was 39% higher, and lactate dehydrogenase 29% higher after correction for site and complications. A discriminant function analysis selected infarct site, peak aspartate aminotransferase, and magnitude of ST elevation as predictors of the occurrence of ST depression. Age, severity, and smoking status did not significantly improve discrimination. Despite larger increases in peak enzyme concentrations patients with ST depression had marginally fewer subsequent episodes of unstable angina or fatal or non-fatal infarction and a marginally lower 10 year death rate. Neither difference was statistically significant. ST depression occurring early in the acute phase of myocardial infarction is likely to be a reflection of electrophysiological changes taking place at the site of the infarct that is manifested in the contralateral surface of the heart. Other causes, however, such as transient ischaemia at the site of the reciprocal changes or extension of the infarct to contiguous areas cannot be excluded in all cases.

Electrocardiography↗
PubMed1986

The relation of social class to risk factors, rehabilitation, compliance and mortality in survivors of acute coronary heart disease.

We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality.

Angina, Unstable↗
PubMed1985

Does stopping smoking delay onset of angina after infarction?

This study was designed to determine the relation between stopping smoking and angina after infarction in survivors of an acute coronary attack. The study population comprised 408 men aged under 60 who survived a first attack of unstable angina or myocardial infarction by 28 days and were smoking cigarettes at the time of their attack. These patients were followed up for an average of nine years. Three hundred and eighty four were alive at the one year follow up examination, when the presence or absence of angina together with habits of smoking were recorded. The prevalence of angina at one year was 19.5% in the 241 who had stopped smoking cigarettes compared with 32.2% in those who had continued (p less than 0.01). Six years later, however, the prevalence of angina after infarction was the same in the two groups. It is concluded that the onset of angina after infarction can be delayed by stopping smoking cigarettes but that this effect is not maintained in the long term.

Angina Pectoris↗