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Biomedical subjects

L M Prisant

Publications and source records attributed to L M Prisant.

99 records · Page 6Linked to original sources
PubMed1984

Exercise stress testing.

Before performing stress testing, it is necessary to have a clear understanding of what question one wishes to answer. Although the exercise stress test can provide useful information to guide the physician in the management of patients, awareness of the limitations of this procedure and of the need for a probability approach to its interpretation is essential. In particular, one must ask whether stress testing will provide the information necessary to guide clinical decision-making. For example, although it is not necessary for diagnostic purposes to perform a stress test in a patient who has a high likelihood of coronary atherosclerotic disease, one might elect to obtain objective evidence of ischemia or diminished functional aerobic capacity before instituting medical or surgical therapy. This would provide reliable data for assessment of the effects of therapy. On the other hand, restricting attention to the ST segment response to exercise fosters neglect of other important diagnostic and prognostic information available from the exercise test. Attention to the blood pressure and heart rate response and to combinations of relevant variables, as described in this article, is necessary for more effective and enlightened clinical decision-making.

Adult↗
PubMed1983

Rhythm disturbances in hypertrophic cardiomyopathies: relationship to symptoms and the effect of 'complete' beta blockade.

Potentially lethal arrhythmias (PLA) are common in hypertrophic cardiomyopathies and are implicated in sudden death. We have demonstrated that propranolol is effective in controlling symptoms, but have not previously evaluated its effect on PLA. Our protocol for long-term management has been applied to 50 patients followed for 2 to 14 years (mean 5.9 years). No patient was excluded because of disease severity or complications. The only reason for exclusion was non-compliance with the protocol. At entry, Holter monitoring revealed 16 PLA in 13 patients (sustained supraventricular tachycardia (SSVT) in two, sinus node dysfunction (SSS) in three, paired beats (PB) in five, and ventricular tachycardia (VT) in six). All patients were initially begun on propranolol, unless a different beta blocker was indicated. Dosage was adjusted to a standing heart rate of 60 beats/min unless adverse drug effects developed. Holter monitoring during follow-up identified 24 new PLA in 21 patients (SSVT = 1, SSS = 4, His-Purkinje disease = 3, VT = 10, and PB = 6). The total number of identified PLA is now 40 in 30 patients. Concurrent symptoms of syncope, presyncope and palpitations were of limited value in identifying PLA because of a lack of predictive accuracy (76%, 64% and 29%, respectively). Invasive electrophysiologic study or dosage adjustment proved that beta blockade was not responsible for the conduction system disorders observed in 10 patients requiring pacemaker insertion. beta-Blockade completely suppressed VT in two patients, PB in five, and SSVT in two.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Oral nutritional supplements and heart disease: a review.

The use of nutritional supplements in the treatment of cardiovascular disease is rapidly growing in the United States. Many substances are marketed with anecdotal claims of efficacy. Most have not been scientifically studied. Excitement exists in the lay press about the homocysteine hypothesis of coronary artery disease and vitamin cures. A MEDLINE search and review of papers covering the study of popular nutritional supplements were undertaken. The papers were limited to peer-review journals using patient series reports, double-blinded prospective studies, and population studies. A compendium of the available data was obtained and an analysis of each paper's methodology was done. A review of the most popular and most studied oral nutritional supplements for the treatment of heart disease demonstrated relatively few well-founded indications for the widespread application of substances with the exception of the bioflavonoids. Some modest effects for endothelial dysfunction were noted for vitamins C and E. Red wines and beers were also noted to be beneficial. The majority of substances either had no effect or were deleterious.

Administration, Oral↗
PubMedDate not supplied

Verapamil revisited: a transition in novel drug delivery systems and outcomes.

Verapamil, the oldest calcium-channel blocker, is now being rediscovered and reevaluated in the light of new novel drug delivery systems and new evidence-based trials. Verapamil, a phenylalkylamine, is useful in the treatment of hypertension, stable angina, and narrow QRS supraventricular arrhythmias. This calcium antagonist is effective in both young and old, and both black and white hypertensive patients, and is free of metabolic side effects. Verapamil has a well-documented history as an effective antianginal agent when directly compared with a beta-blocker, and is more effective in reducing myocardial ischemia compared with amlodipine monotherapy. Because of the short half-life of verapamil, drug delivery systems are used to prolong the duration of action. Novel drug delivery systems using encapsulated beads or a modified osmotic pump have been designed to be taken at nighttime to provide maximal blood pressure reduction in the early morning hours and effective 24-hour blood pressure control, and to avoid excessive blood pressure reduction during sleep. The Verapamil in Hypertension and Atherosclerosis Study has documented equivalent effectiveness of verapamil compared with chlorthalidone, but showed superior plaque regression and reduced events in subjects with the greatest plaques with verapamil treatment. The Angina Prognosis Study in Stockholm, comparing verapamil and metoprolol for stable angina, found no difference in total cardiovascular mortality or combined cardiovascular events. Other large ongoing randomized, multicenter trials, including Controlled-Onset Verapamil Investigation of Cardiovascular Endpoints and the International Verapamil-Trandolapril Study, will expand our knowledge of the role of verapamil in the treatment of hypertension.

Angina, Unstable↗
PubMedDate not supplied

Angioneurotic edema.

Angioneurotic edema is nonpitting edema involving the face, lips, tongue, larynx, and other locations. It may occur with use of angiotensin- converting enzyme inhibitors, vasopeptidase inhibitors, and, less frequently, angiotensin receptor blockers. Most episodes occur within the first 6 months of therapy. Predisposing factors for converting enzyme inhibitor angioedema include previous idiopathic angioedema, African American race, and transplant-related immunocompromise. Treatment is directed to preventing airway compromise. (c)2001 Le Jacq Communications, Inc.

Angioedema↗
PubMedDate not supplied

Detection of hypertensive left ventricular hypertrophy.

The risk of adverse cardiovascular events is higher in persons with electrocardiographic evidence of left ventricular hypertrophy, and the decision to treat patients with antihypertensive drugs is often determined by the presence of hypertrophy. In this study a number of electrocardiographic criteria for detection of left ventricular hypertrophy were applied to a population of 85 hypertensive subjects in an ongoing outpatient hypertension evaluation and treatment program. Included were one set of criteria in common use and three sets of criteria employed in prospective clinical trials. The results were compared with those obtained by M-mode echocardiography and left ventricular wall thickness of 12 mm or more, which was taken as an indicator of hypertrophy. By this criterion, 34 patients (40%) had left ventricular hypertrophy. The most sensitive of the electrocardiographic criteria allowed detection of only 13 (38%) of those hypertensive subjects with anatomical-echocardiographic left ventricular hypertrophy. Although the echocardiogram is more time-consuming to obtain and more expensive than the electrocardiogram, its superior sensitivity suggests that the echocardiogram should be used for evaluating patients with high blood pressure, especially those without electrocardiographic evidence of left ventricular hypertrophy, to detect anatomical left ventricular hypertrophy.

Adult↗
PubMedDate not supplied

Hypertension images: electrocardiographic left ventricular hypertrophy.

The electrocardiogram is an inexpensive adjunct for assessing target organ damage in hypertensive patients. The gender-specific Cornell voltage criteria (men: R(aVL) + S(V3) >35 mm; women: R(aVL) + S(V3) >25 mm) have better overall accuracy than the often-used Sokolow-Lyon or Romhilt-Estes criteria. One of the earliest electrocardiographic findings of hypertensive heart disease is a duration of the negative phase of the P wave in chest lead V1 of >0.04 seconds, a manifestation of left atrial enlargement or abnormality. There is no other cardiovascular risk factor more potent than left ventricular hypertrophy with a "strain pattern." Despite limitations in determining hypertensive heart disease, the electrocardiogram provides other information that is useful in the management of patients with hypertension.

Electrocardiography↗