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Biomedical subjects

J Constant

Publications and source records attributed to J Constant.

At least 19 recordsLinked to original sources
PubMed1995

How to differentiate ejection murmurs from systolic regurgitant murmurs.

Although it is not possible to distinguish the shape of a murmur as being crescendo-decrescendo as in ejection murmurs from a plateau-shaped regurgitant systolic murmur by hearing the murmur alone, it is possible to distinguish them by auscultation with the use of other characteristics that give clues to their shape or their origin. With the use of accompanying heart sounds, the peak of the crescendo-decrescendo effect of ejection murmurs makes a recognizable rhythm which is absent in the plateau-shaped regurgitant murmur. When no heart sounds are present, the increase in loudness after a sudden long diastole of only the ejection murmur can help to separate the two types of murmur. The term "midsystolic" as applied to the ejection murmur is misleading and should be avoided because it is based on controversial hemodynamics and it obstructs teaching the significance of early, mid, and late peaks to ejection murmurs.

Diagnosis, Differential↗
PubMed1990

The diagnosis of nonanginal chest pain.

The term "atypical chest pain" is a waste-basket term that leads physicians to send any patient with chest pain to coronary angiography. In order to avoid this term, we must learn to distinguish atypical angina from nonanginal chest pain before angiography is considered in order to avoid unnecessary invasive procedures. A chest pain is very likely nonanginal if its duration is over 30 minutes or less than 5 seconds, it increases with inspiration, can be brought on with one movement of the trunk or arm, can be brought on by local fingers pressure, or bending forward, or it can be relieved immediately on lying down. There are also many presumptive signs of nonanginal chest pain such as localization with one finger, radiation to the nuchal area, an inframammary primary site, a pain that reaches maximum at the onset, or relief within a few seconds of swallowing food. Cervical root compression pain and esophageal spasm are the greatest mimics of angina since they can both be relieved by nitroglycerin but they have several features which help to rule out angina.

Angina Pectoris↗
PubMed1989

Present status of primary pulmonary hypertension.

More than a century has passed since the first description of pulmonary arteriosclerosis of unknown origin. The development of our understanding of primary pulmonary hypertension (PPH) can be divided into four periods. The first period, which extended from the introduction of the concept until about 1930, may be described as the dawn of this disease. In the second period (1930-1950) the morphological aspects of the disease were recognized and studied. In the third period (1950-1960), the advent of right heart catheterization made it possible to link pathological physiology with morphology and the disease entity as primary pulmonary hypertension was firmly established. Since 1960 (the fourth period) the etiology and therapy of this disease have been studied. This paper will review chronologically the history of PPH since the 19th century and then will discuss the etiologies, pathology, and clinical manifestation including symptoms and signs, laboratory findings, therapy, and prognosis based on the nationwide survey in Japan as well as the author's own experience.

Adolescent↗
PubMed1987

Accurate blood pressure measurement.

The most critical requirement for obtaining accurate blood pressure measurements is that the Korotkoff sounds be loud. Loudness can be enhanced by various techniques of cuff inflation and chest piece placement. The type of manometer, cuff size, and cuff placement are also important factors in obtaining accurate blood pressure readings. Correct systolic pressure measurement depends on proper inflation and deflation of the cuff. True diastolic pressure is usually closer to the disappearance point of Korotkoff sounds than to the muffling phase. Blood pressure should be recorded to the nearest 5 mm Hg because measurement to the nearest 2 mm Hg is not meaningful and is too difficult and time-consuming.

Aged↗
PubMed1986

Prognostic information from early post-infarction exercise testing.

Early post-myocardial infarction exercise testing has proved surprisingly safe. S-T elevations portended a bad prognosis as did also marked S-T segment depressions, especially if combined with premature ventricular contractions or short duration of exercise. A poor prognosis was also seen if, at low workloads, blood pressure could not reach 130 mm Hg, the heart rate did not rise above 130 beats per minute, or if there was angina. Complex arrhythmias were only of prognostic value as an independent variable with ambulatory monitoring. Negative findings were of more predictive value than positive results and have important therapeutic implications.

Electrocardiography↗
PubMed1983

The clinical diagnosis of nonanginal chest pain: the differentiation of angina from nonanginal chest pain by history.

For the first time an attempt has been made to systematize nonanginal pain questions so that physicians will ask the nonanginal questions and not simply divide all angina-like symptoms into the two categories of typical and atypical angina. A definite nonanginal chest pain category is defended with the possibility of avoiding diagnoses such as "atypical chest pain" or "atypical angina." Confidence in diagnosing chest pains as nonanginal can be attained if attention is paid to new criteria for duration, the effect of respiration, arm or chest movement, local compression, and body position. Because of this novel approach to the diagnosis of chest pain, it has become necessary to point out many of the pitfalls into which the unwary may fall with each nonanginal question.

Angina Pectoris↗