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Biomedical subjects

B A Finkelmeier

Publications and source records attributed to B A Finkelmeier.

At least 19 recordsLinked to original sources
PubMed2001

Aortic dissection.

Aortic dissection is the most common catastrophic condition affecting the aorta. Its clinical presentation is variable and can mimic any number of medical and surgical conditions. The most prevalent symptom is excruciating chest pain. Essential treatment includes rapid initiation of pharmacologic agents to control hypertension. Aortic dissection involving the ascending aorta also necessitates immediate surgical repair. Surgical treatment of aortic dissection involving only the descending aorta generally is reserved for patients with persistent pain, intractable hypertension, or evidence of propagation of the dissection. Nursing management includes blood pressure monitoring, serial physical assessment, and postoperative care, as appropriate.

Aortic Dissection↗
PubMed1997

Dissection of the aorta: a clinical update.

Aortic dissection is a catastrophic condition that occurs precipitously and is most commonly associated with a history of hypertension or cystic medial necrosis. Although the clinical presentation is quite variable, the heralding symptom is almost always severe chest or back pain. Aortic dissection is categorized as Type A if it involves the ascending thoracic aorta and Type B if it involves only the aorta distal to the left subclavian artery. During the first 48 hours, acute Type A dissection has a mortality of greater than 1% per hour; it is treated as a surgical emergency. Surgical repair for Type B dissection is generally reserved for patients who have persistent pain, intractable hypertension, or evidence of dissection progression. In all patients with aortic dissection, pharmacologic antihypertensive and negative inotropic therapy is essential to control extension of the dissection process. Vigilant monitoring of blood pressure and serial assessment to detect dissection progression are the key components of nursing management.

Aortic Rupture↗
PubMed1994

Ablative therapy in the treatment of tachyarrhythmias.

Ablative therapy for treatment of tachycarrhythmias has developed rapidly in recent years due to an increased understanding of electrophysiologic mechanisms of arrhythmogenesis and improved modalities of destroying or isolating arrhythmogenic tissue. Radiofrequency catheter ablation is currently the most frequently performed type of ablative therapy. Less commonly, surgical procedures are performed to eradicate arrhythmogenic tissue. As more clinical experience is gained with these technologies for arrhythmia eradication, ablative therapy for treatment of tachyarrhythmias will continue to evolve.

Arrhythmias, Cardiac↗
PubMed1993

Influence of age on postoperative course in coronary artery bypass patients.

The average age of patients undergoing coronary artery bypass grafting (CABG) has increased. To determine influence of age on postoperative course, the authors reviewed the outcome of 199 consecutive patients who underwent primary, isolated, elective CABG. The 101 patients < 65 years (group I) and 98 patients > or = 65 years (group II) were similar in preoperative severity of symptoms, history of myocardial infarction, number of grafts received, and time on cardiopulmonary bypass. Comparison between the two groups revealed similar rates of operative mortality and morbidity. In group II patients, median rates of hospitalization and intensive or intermediate care unit stay were greater (P < 0.005), and there were significantly higher incidences of postoperative disorientation, transfusion of exogenous blood, and need for special discharge arrangements (P < 0.05). The authors conclude that CABG patients > or = 65 years of age have a longer and more complex postoperative course than younger patients and suggest that further nursing research be conducted to identify the specific needs of this patient population.

Aged↗
PubMed1991

Iatrogenic arterial injuries resulting from invasive procedures.

The many invasive arterial procedures that require cannulation of an artery with a large or traumatic catheter can be expected to produce iatrogenic injuries in a certain number of patients. While almost all arterial cannulation procedures are performed by physicians, nurses play a major role in performing baseline assessment of arterial blood flow, monitoring indwelling catheters, and detecting evidence of arterial injury. Clinical manifestations may appear during a procedure, while an indwelling arterial catheter is in place or after the catheter has been removed. Vigilant attention is essential to prevent serious injury or death due to a complication of an iatrogenic arterial injury.

Arteries↗
PubMed1989

Implications of prosthetic valve implantation: an 8-year follow-up of patients with porcine bioprostheses.

Nurses in cardiovascular critical care settings routinely care for patients with implanted valvular prostheses. The presence of an artificial valve substitutes a new disease state for the preexisting valvular disease. Five hundred nine patients who underwent cardiac valve replacement with porcine bioprostheses and who were followed for a total of 1633 patient-years provide the data base for discussion of long-term survival, functional capacity, and morbidity associated with valvular prostheses. Seventy-two percent of patients survived 5 years after operation. New York Heart Association functional class was improved in 84%. Three major types of morbidity were documented: thromboembolism, endocarditis, and valve failure. Cardiovascular nurses should be familiar with the implications of valvular prostheses to provide appropriate patient education and to facilitate the prompt detection and treatment of valve-related complications.

Actuarial Analysis↗
PubMed1988

Patients with heart rhythm disturbances: variables associated with increased psychologic distress.

The spectrum of psychologic distress in patients with serious heart rhythm disturbances (HRD) has not been well defined. A survey of personal and clinical background data and general psychologic status was made of 136 patients with serious HRD defined as sustained or symptomatic ventricular tachycardia or fibrillation. Two questionnaires were used: the SCL-90-R, a standard self-report symptom inventory of present psychologic status, and a functional capacity and occupational status questionnaire developed by us. Of the 105 respondents, 89 completed both questionnaires, the results of which form the basis of this report. The patients with HRD were found to have significantly elevated SCL-90-R scores reflective of an increase in overall psychologic distress (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total) as well as significantly higher scores on the specific constructs. Within the HRD population, univariate analysis revealed three variables significantly correlated with increased psychologic distress: (1) requiring long-term antiarrhythmic medication, (2) being forced to modify work status, and (3) having more advanced cardiac impairment. Patients who had two or more of these variables, termed risk factors, reported significantly more symptoms and greater psychologic distress than those with zero or one risk factor. We conclude that patients with serious HRD have greater psychologic distress than do normal subjects. Within the HRD group, patients requiring long-term medical treatment for their arrhythmia, those forced to modify work status, and those with more advanced cardiac impairment are at greater risk for emotional sequelae, and patients with two or more of the identified risk factors are more likely to have elevated psychologic distress.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The adult ductus. Surgical results and long-term follow-up.

Surgical treatment for the adult patent ductus can be a safe procedure if adequate aortic control is obtained. Long-term results are satisfactory, except for patients with pulmonary hypertension, of whom only 50 per cent obtain a good result. We believe operative treatment is indicated in the asymptomatic adult patient with patent ductus arteriosus, because one cannot predict which patients will develop pulmonary hypertension. In our group pulmonary hypertension developed in patients whose average age was the same as those who were asymptomatic. Those patients who are New York Heart Association (NYHA) class III usually have pulmonary hypertension, large ductus, and calcification, all of which could cause operative complications. Therefore, it is relatively easy to predict by symptoms alone which patients have the highest operative risk.

Adult↗
PubMed1982

Chronic traumatic thoracic aneurysm. Influence of operative treatment on natural history: an analysis of reported cases, 1950-1980.

A total of 401 cases of chronic traumatic aneurysm reported during the past 30 years plus 12 cases from the University of Virginia Medical Center were analyzed. Forty-two percent of the patients developed signs or symptoms of aneurysm expansion within 5 years of injury: 85% within 20 years. Pain was the most frequently occurring sign or symptom, followed by serial enlargement on chest roentgenogram. Of the 60 patients who were followed without operative intervention, 20 died of their aortic lesions. For these patients, the combined risk of dying or developing signs or symptoms was 41% at 5 years. Over 300 patients underwent operative repair of the aneurysm. Operative mortality was 4.6%. Bleeding was the major cause of death as well as the most common major complication. When the survival probability of patients treated operatively was compared with that of patients treated nonoperatively, the operative group demonstrated a significantly higher survival probability.

Adolescent↗
PubMed1982

Analysis of the design and dynamics of aortic bioprostheses in vivo.

An understanding of the in vivo design and dynamics of the present bioprosthetic valves should provide the information necessary for an improvement in their efficiency and durability. Three types of commercially available bioprostheses were prepared with radiopaque markers and implanted in the aortic position in calves. One week later, under light general anesthesia, the animals were studied to determine the in vivo design, shape, configuration, and motion of the bioprostheses. This information was then compared to that previously obtained from the natural aortic valve in vivo. The following observations were made: (1) In all three types of bioprostheses, the three leaflets opened and closed simultaneously in less than one thirtieth of a second; (2) there was no detectable flexion of the stent posts in any of the three types of valves; (3) in all of the bioprostheses studied, the greatest flexion occurred along the attachment of the leaflets; (4) the systolic and the diastolic geometry of the three types of valves was completely different for each type of valve, and none duplicated the geometry of the natural aortic valve; (5) the open configuration of the leaflets was different for each type of prosthetic valve and different from the natural aortic valve; (6) the zone of leaflet bending varied in size and extent for each of the valves. It is concluded that the differences between the design of bioprosthetic valves and that of natural valves are probably a major factor in increasing the stresses in bioprostheses. Hence stress failures could be reduced and durability increased by redesigning bioprostheses to duplicate more closely the design of the natural aortic valve.

Aortic Valve↗
PubMed1981

Emergency carotid endarterectomy for fluctuating neurologic deficits.

The merit of emergency carotid endarterectomy for patients with fluctuating neurologic deficits remains controversial. Twenty-four patients with fluctuating neurologic deficits underwent emergency carotid endarterectomy and were compared to 31 patients managed nonoperatively. Both groups were similar in age and sex distribution, indicence of hypertension (50%), myocardial infarction (16%), and diabetes mellitus (12%). The two groups were subdivided into patients with crescendo transient ischemic attack (CTIA) and patients with stroke in evolution (SIE). Within the operative CTIA group, all seven patients recovered completely. Among the five nonoperative CTIA patients, one recovered, three sustained moderate or severe neurologic deficits, and one died. Within the operative SIE group of 17 patients, none had a worsening of the deficit, four remained unchanged (24%), and 12 patients (70%) had complete recovery or only a mild deficit. One patient (6%) died postoperatively. Among 26 nonoperative SIE patients, five recovered or sustained mild deficits (19%), 17 had moderate or severe deficits (66%), and four died (15%). The 12 patients with complete or near recovery of neurologic function represented more than a threefold improvement (P less than 0.01) in the quality of life with endarterectomy. When compared with the natural history of fluctuating neurologic deficits, these data suggest that immediate operative intervention will result in better salvage.

Carotid Arteries↗