PubMed Health⌕ Search

Biomedical subjects

A D Forker

Publications and source records attributed to A D Forker.

At least 19 recordsLinked to original sources
PubMed1992

Antihypertensive therapy. Current issues and challenges.

Choosing antihypertensive agents that protect patients against cardiovascular and other complications is a growing trend in the treatment of mild to moderate hypertension. Calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are favored because they have neutral or positive effects on lipid levels and insulin resistance. The alpha 1 blockers, especially doxazosin mesylate (Cardura), are enjoying a resurgence in popularity because they have a beneficial effect on lipid levels. In terms of preserving patients' quality of life, the ACE inhibitors in particular have been shown to have a positive impact. It has been shown that systolic hypertension in elderly patients should definitely be treated, but the most appropriate agent has yet to be defined. Therapy should be tailored to the individual. The following questions should be considered when choosing an antihypertensive agent: (1) What are its side effects (especially metabolic ones)? (2) Does it require only once- or twice-a-day dosing? (3) Does it cause regression of left ventricular hypertrophy? (4) Does it prevent death from coronary artery disease? (5) How will it affect quality of life? (6) How much does it cost? The goal of therapy should be to provide adequate blood pressure control throughout the day, enhance compliance, and protect the heart, brain, and kidneys without adversely affecting metabolic state.

Adrenergic beta-Antagonists↗
PubMed1979

Isolated gonococcal pulmonary valve endocarditis: diagnosis by echocardiography.

The perplexing clinical course of a 23-year-old black male with isolated gonococcal pulmonary valvular endocarditis is presented. M-mode echocardiography provided the first clue to the presence of pulmonary valvular vegetations and the proper diagnosis. Since Neisseria gonorrhea appears to have a particular affinity for the pulmonary valve, the presence of isolated pulmonary valvular endocarditis should raise the strong possibility that Neisseria gonorrhea is the offending organism. This case report of pulmonary valvular vegetations detected by echocardiography strongly emphasizes that all four cardiac valves must be visualized in order to rule out the presence of echocardiographically detectable valvular vegetations.

Adult↗
PubMed1977

Intermittent complete atrioventricular block masquerading as epilepsy in the mitral valve prolapse syndrome.

A 24-year-old white man had a history of "epilepsy" since the age of eight years. Prolapse of the mitral valve was documented by auscultation and echocardiographic and left ventriculographic studies. At 120 hours after stopping therapy with phenobarbital and diphenylhydantoin (Dilantin) sodium, continuous electrocardiographic monitoring (Holter monitor) revealed episodes of complete atrioventricular block lasting up to 23 seconds. The results of hemodynamic studies were normal. The patients' symptoms were all totally corrected by implantation of an epicardial demand pacemaker. This report raises the possibility that sudden death in association with the mitral valve prolapse syndrome may be due to intermittent severe disturbances in conduction, in addition to ventricular arrhythmias.

Adult↗
PubMed1977

Temporary transvenous cardiac pacemaking in rural family practice.

Interested family physicians with proper training and minimal extra equipment can now employ transvenous pacemaking. Some cardiac centers have developed training programs for general internists and family physicians. We believe that this valuable procedure can, with proper physician training, be offered to patients in rural areas as well as in cardiac centers. While the number of patients in this rural family practice who require this procedure has not been great (ten patients in four years), the need is often urgent when it does occur. Use of this treatment modality with consultation in a 44-bed hospital was found to be safe and practical, although sometimes technically difficult. This paper describes the training, techniques used, results, and complications in a rural community in southeastern Nebraska. It is suggested that every hospital caring for seriously ill cardiac patients should have at least one physician trained to perform this emergency procedure.

Aged↗
PubMed1976

Selective coronary arteriography. Risk in a community hospital.

Over a 33-month period, selective coronary arteriography was performed in 627 consecutive patients in a 385-bed, non-university-affiliated community hospital. Mortality was 0.16% (one death); there was also one nonfatal myocardial infarction. No deaths or myocardial infarctions occurred in the last 369 consecutive patients in this series when routine systemic heparinization was introduced. Substantially greater risk of mortality (2.6%) and nonfatal myocardial infarction (2.6%) was encountered in an earlier series of 78 consecutive patients for whom a different protocol was used. It included extensive exercise hemodynamic studies with the use of percutaneous arterial angiographic catheters, without systemic heparinization. This indicates that coronary arteriography can be carried out with acceptable risk in a community hospital. Protocols should be designed to minimize the time that catheters are in the arterial system. Systemic heparinization may reduce the risk of procedure-related death and myocardial infarction.

Angiography↗
PubMed1976

Echocardiographic features of combined hypertrophic and membranous subvalvular aortic stenosis: a case report.

Combined hypertrophic and membranous subvalvular aortic stenosis was detected by echocardiography. The diagnosis was established by the discovery of severe asymmetric septal hypertrophy, a membrane in the left ventricular outflow tract, narrowing of the left ventricular outflow tract, as well as high frequency fluttering and premature systolic closure of the aortic valve leaflets.

Aortic Stenosis, Subvalvular↗
PubMed1976

Aerobic exercise as a therapeutic modality in the relief of stress.

This paper reviews the pathophysiologic influences of 20th century emotional stress. The physiologic consequences of cardiovascular conditioning by aerobic techniques are also reviewed. It would appear that cardiovascular conditioning has physiologic characteristics which would counterbalance those induced by such stress. Accordingly, it appears logical that cardiovascular conditioning by aerobic exercise techniques is an effective therapeutic and prophylactic tool. Future investigative efforts must take two directions. First, the extent to which exercise may be used in ameliorating the pathologic consequences of chronic stress must be scientifically documented. Secondly, in those instances where exercise is undertaken imprudently, evidence must be gathered as to the extent that physical activity precipitates maladaptive responses in humans.

Adaptation, Physiological↗
PubMed1975

Correlation between segmental early relaxation of the left ventricular wall and coronary occlusive disease.

Fifty of 305 patients studied angiographically had segmental early relaxation phenomenon (SERP) of the anterolateral or apical left ventricular wall. Fourteen of the 50 patients had cardiac abnormality other than, or in addition to, coronary occlusive disease. Of the remaining 36 patients, 35 had significant lesions in the left anterior descending artery (LAD) and one had occlusion of the proximal left circumflex artery. SERP was noted in 35 (37.2 per cent) of 94 patients with LAD disease who did not have severe anteroapical contraction abnormality. SERP was found in none of 49 patients who had neither significant coronary occlusive disease nor other cardiac abnormality. Eight patients were restudied after bypass grafting of the LAD. Three patients with patent grafts no longer demonstrated SERP. Five had persistent SERP, but four of these had occluded LAD grafts or nongrafted disease in other vessels supplying the anterolateral wall. Myocardial ischemia appears to be one cause, but probably not the only cause, of SERP.

Angiocardiography↗