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Biomedical subjects

D W Chapman

Publications and source records attributed to D W Chapman.

At least 19 recordsLinked to original sources
PubMed1994

The cumulative risks of prolapsing mitral valve. 40 years of follow-up.

Prolapsing mitral valve is a common cardiac condition, occurring in approximately 16 million people in the United States alone. Primary prolapsing mitral valve may be familial or nonfamilial and may be associated with myxomatous degeneration of the mitral valve leaflets, such as occurs in Marfan syndrome and other connective tissue disorders. Secondary forms may be associated with such entities as rheumatic fever (especially after commissurotomy) and coronary artery disease (in the presence of ruptured chordae tendineae), and with such congenital conditions as interatrial defect and primary cardiomyopathy with outflow tract obstruction. Prolapsing mitral valve is characterized by late systolic murmur, mid-systolic click, or both. Arrhythmias occur in the form of benign premature atrial contraction, premature nodal contraction, and paroxysmal atrial tachycardia. As the patient ages, atrial flutter and atrial fibrillation tend to develop. In some chronic cases, especially those involving atrial fibrillation, systemic emboli may occur. Rare premature ventricular contractions may be largely benign, whereas more frequent premature ventricular contractions may lead to severe arrhythmic complexes such as ventricular tachycardia or ventricular fibrillation. With advancing age, atrioventricular conduction defects of varying degrees or sick sinus syndrome may necessitate a pacemaker installation. About one quarter of prolapsing mitral valve cases progress, with increasing mitral insufficiency and increasing enlargement of the left atrium and left ventricle, which at times leads to congestive heart failure. Coronary artery disease may occur with the severity commensurate with the patient's age group. About three quarters of patients with prolapsing mitral valve syndrome lead normal lives.

Disease Progression↗
PubMed1985

College choice among prospective health professions majors: implications for nursing education.

Factors associated with high school students' decisions to pursue health-related fields of study were investigated using the "Survey of Future Plans of High School Seniors." Data from 10,878 seniors were analyzed using regression and discriminant analysis. Results indicated that: The applicant pool for health professions overlapped most with the applicant pool for education, but education majors were characterized by lower academic aptitude; the specific characteristics of a college were less important to those entering health professions than to those entering other majors; and, health profession applicants with higher academic aptitude purport life goals more consistent with professional advancement than do lower aptitude applicants.

Career Choice↗
PubMed1983

Acute myocardial infarction. Decision making in the first critical hours.

Decisions about early management of acute myocardial infarction require great care and astuteness, since the threat of sudden death is the greatest during the first few hours after onset of infarction. General measures of acute care include relief of pain and management of arrhythmia. Drug therapy with beta-adrenergic blocking agents or vasodilators may also be indicated. Other measures that may be considered (some of which are controversial) include hemodynamic monitoring, mechanical circulatory assistance, ambulatory electrocardiographic monitoring, exercise testing, modification of risk factors, and coronary angiography. Intracoronary administration of streptokinase, which is still investigational, has shown marked preservation of myocardial tissue in some cases.

Adrenergic beta-Antagonists↗
PubMed1982

Clinical results of coronary bypass in 500 patients at least 10 years after operation.

We determined the outcome of coronary artery bypass surgery in 500 consecutive patients followed for at least 10 years after operation. There were 446 males (89.2%). Angina pectoris was the major indication for operation. Four hundred six patients (81%) had multivessel coronary artery disease and 348 (69.9%) had good left ventricular function. At 10 years of follow-up, 48% of patients were asymptomatic and 41% were improved. Propranolol was being used by 36% of patients and nitrates by 49%. Of the 355 patients younger than 65 years of age at the time of follow-up, 57% were employed full time and 24% were working part-time. Reoperation was performed in 9% of patients. Analysis of survival by Kaplan-Meier curves indicated that overall 10-year survival rates were 78% for one-vessel disease, 69% for two-vessel disease, 48% for three-vessel disease and 67% for left main coronary artery disease. For patients with good left ventricular function, the 10-year survival rates were 83% for one-vessel disease, 73% for two-vessel disease, 53% for three-vessel disease and 73% for left main disease. For patients with poor left ventricular function, the rates were 56%, 59%, 40% and 54%, respectively. Cox multivariate analysis indicated that preoperative diuretic use, history of heart failure, the number of diseased vessels, and infarct on the preoperative ECG were all good predictors of survival. This study shows that the outcome of coronary artery bypass surgery 10 years operation is highly favorable.

Angina Pectoris↗
PubMed1977

Patterns of patency of 596 vein grafts up to seven years after aorta-coronary bypass.

The long-term behavior of vein grafts and their effect on the native circulation were studied by examining 596 vein grafts in 343 patients at a mean follow-up of 15.4 months, range zero to 84 months. Serial studies were performed on 27 patients with 38 grafts. The over-all graft patency rate was 84 per cent, and the rate after more than 5 years was 89 per cent. The patency rate in asymptomatic patients was 91 per cent compared with 81 per cent in the remainder. The patency of grafts attached distal to total occlusions was 82 per cent (78/82). The angle of origin of the grafts from the aorta did not appear to influence patency or the severity of intimal proliferative changes. In 76 patients with 126 grafts, pre- and postoperative cineangiograms were compared, and changes in the graft and underlying coronary artery classified as Groups 1 to to 6: Group 1, patent graft, bidirectional flow in the grafted vessel, proximal lesion unchanged; Group 2, patent graft, bidirectional flow, proximal lesion progressed to occlusion locally; Group 3; patent graft, distal flow only, occlusion of lesion and segment between graft and lesion; Group 4, graft occluded, native artery unaltered; Group 5, graft occluded, native artery now occluded at lesion and region of anastomosis; Group 6, new distal lesion. Results were as follows; Group 1, 58 per cent; Group 2, 21.2 per cent; Group 3, 5 per cent, Group 4, 12.5 per cent; Group 5, 2.5 per cent; and Group 6, 0.8 per cent. Native coronary arteries undergoing closure (Group 2) had lesions 95 per cent or greater in 93 per cent of patients. The rate of closure of ungrafted lesions was 2 per cent. We believe these results encourage the continued used of vein bypass grafts.

Coronary Artery Bypass↗