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Biomedical subjects

W C Roberts

Publications and source records attributed to W C Roberts.

At least 73 records · Page 4Linked to original sources
PubMed1995

Major cardiac findings at necropsy in 366 American octogenarians.

We examined the hearts of 366 octogenarians (184 women [50%], 264 white [72%], mean age 84 +/- 4 years). The cause of death was cardiac in 195 (53%), noncardiac but vascular in 47 (13%), and noncardiac and nonvascular in 124 patients (34%). Of the 195 patients with fatal cardiac disease, atherosclerotic coronary artery disease was the cause of death in 127 (65%): acute myocardial infarction in 87 (69%), sudden cardiac arrest outside the hospital in 19 (15%), chronic congestive heart failure with healed myocardial infarction in 15 (12%), and complications of coronary bypass surgery in 6 (4%). At least 1 of the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries was narrowed > 75% in cross-sectional area by atherosclerotic plaque in 218 patients (60%). The mean number of significantly narrowed major epicardial coronary arteries was 1.7, 1.3, and 0.7 in those who died of cardiac, peripheral vascular, or noncardiovascular causes, respectively. Among the 87 patients (33 men and 54 women) with fatal acute myocardial infarction, the women more often had ruptured ventricles (21 of 54 [39%] vs 3 of 33 [9%]), and fewer women had healed myocardial infarcts (11 of 54 [20%] vs 24 of 33 [73%], p < 0.05). Calcific deposits were present in the epicardial coronary arteries in 285 patients (78%), in the mitral annulus in 140 (38%), and in aortic valve cusps in 153 (42%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Preventing and arresting coronary atherosclerosis.

The good news about coronary atherosclerosis is that it takes an awful lot of plaque before symptoms of myocardial ischemia occur. The bad news is that despite the need for large quantities of plaque for symptoms to occur, nevertheless nearly half of us in the United States eventually have the necessary quantity. Atherosclerosis is infrequently hereditary in origin. Most of us get atherosclerosis because we consume too much fat, cholesterol, and calories. The consequence is an elevated ( > 150 mg/dl) serum total cholesterol level, and the higher the number is above 150, the greater is the quantity of plaque deposited in our arteries. If the serum total cholesterol level can be prevented from rising to more than 150 mg/dl, plaques are not laid down; if elevated levels are lowered to 150 mg/dl, further plaque does not form, and parts of those present may vanish. A fruit-vegetarian-starch diet is necessary as a rule to achieve the 150 mg/dl level in most adults. Lipid-lowering drugs are required in the patients with familial hypercholesterolemia and in most patients with atherosclerotic events. The best news about atherosclerosis is that it can be prevented in those without the hereditary form, and it can be arrested by lowering elevated serum total (and LDL) cholesterol to the 150 mg/dl level.

Acute Disease↗
PubMed1995

Morphologic features of fossa ovalis membrane aneurysm in the adult and its clinical significance.

OBJECTIVES: This study evaluated morphologic features of fossa ovalis membrane aneurysm and associated cardiac abnormalities that may predispose to systemic embolism. BACKGROUND: An increasing number of fossa ovalis membrane aneurysms are diagnosed by echocardiography. Higher frequencies of such aneurysms have been reported in patients with embolic stroke. METHODS: The hearts of 20 adults with fossa ovalis membrane aneurysms (mean [ +/- SD] age 62 +/- 19 years, range 24 to 87; 12 women [60%], 8 men [40%]) were examined. The areas of excised atrial septum, fossa ovalis membrane and fossa ovalis were measured. An aneurysm was defined as the ratio of the fossa ovalis membrane to fossa ovalis area > or = 1.5. RESULTS: Compared with a control group of 20 adults (mean age 58 +/- 21 years, range 18 to 86; 12 women [60%], 8 men [40%]), the 20 patients with fossa ovalis membrane aneurysm had larger (711 +/- 240 vs. 203 +/- 105 mm2, p < 0.0001) and thinner fossa ovalis membranes (0.6 +/- 0.1 vs. 1.9 +/- 0.9 mm2, p < 0.0001). The mean ratio of the fossa ovalis membrane to fossa ovalis area was 2.1 +/- 0.4 in patients with and 1.2 +/- 0.1 in those without fossa ovalis membrane aneurysm. Patent foramen ovale was seen in 14 (70%) of 20 patients with fossa ovalis membrane aneurysm and in 4 (20%) of 20 control subjects (p = 0.0005). CONCLUSIONS: Fossa ovalis membrane aneurysm is characterized by thinning and marked redundancy without adherent thrombi or fibrin tags. Mitral valve prolapse, dilated atria, intracardiac thrombi and patent foramen ovale are frequently seen in association with fossa ovalis membrane aneurysm and may explain the increased frequency of embolic stroke in patients with such aneurysms.

Adult↗
PubMed1994

Circadian variability in the occurrence of sudden cardiac death in patients with hypertrophic cardiomyopathy.

OBJECTIVES: The present study examined whether sudden death in patients with hypertrophic cardiomyopathy occurred with a particular pattern of frequency throughout the day. BACKGROUND: Previous investigators have shown a circadian distribution in the occurrence of sudden death and other cardiovascular events in patients with atherosclerotic coronary artery disease. Sudden death is also an important feature of the natural history of patients with hypertrophic cardiomyopathy. METHODS: The study group comprised 94 patients with a time of death (or cardiac arrest) that could be ascertained accurately to the nearest hour. This hourly distribution was analyzed by harmonic regression. RESULTS: Sudden death did not occur uniformly or randomly throughout the day. Rather, it was distributed in a bimodal pattern that conformed to a two-harmonic regression model. A disproportionate number of sudden deaths (43 [46%] of 94) occurred in the first peak in midmorning between 7 AM and 1 PM. The second peak of sudden death was less distinct but was in the early evening, between 8 PM and 10 PM. This periodicity in occurrence of sudden cardiac death was not evident for the days of the week or months of the year and, furthermore, did not appear to be influenced by other clinical variables, such as age, gender, severity of symptoms, subaortic gradient or left ventricular wall thickness. Sudden death occurred most commonly during periods of severe exertion (37 [39%] of 94). CONCLUSIONS: Sudden death in hypertrophic cardiomyopathy demonstrates a bimodal pattern of circadian variability over the 24-h day, with a prominent midmorning peak similar to that described in patients with coronary artery disease, and a less striking early-evening peak of occurrence. These findings suggest that temporally related physiologic changes, possibly in the electrical vulnerability of the myocardial substrate, may play a role in the sudden death of patients with hypertrophic cardiomyopathy.

Adolescent↗