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Biomedical subjects

L W Ritzmann

Publications and source records attributed to L W Ritzmann.

11 recordsLinked to original sources
PubMed1979

Coronary bypass for stable angina: a prospective randomized study.

To evaluate the effects of coronary-artery bypass, 100 patients with stable, disabling angina were randomized to medical (49) or surgical (51) therapy. There was no statistical difference in major cardiac events after three years (death in five medical vs. four surgical, infarction in eight vs. 10, and unstable angina requiring operation or reoperation in eight vs. three cases). Surgical patients with three-vessel disease had fewer major events (P less than 0.05) than the comparable medical group and less unstable angina requiring operation (P less than 0.02). All unstable angina was less frequent in the surgical group (15 vs. six, P less than 0.01). Functional classification improved more in surgical patients at six months (P less than 0.01) and at late followup examination (P less than 0.05). After six months, surgical patients achieved significantly higher exercise work loads (P less than 0.01), exercise heart rates (P less than 0.05), maximum paced heart rates (P less than 0.01) and myocardial lactate extraction (P less than 0.01). On the basis of this interim report of a relatively small group of patients, we conclude that bypass results in greater functional improvement and less unstable angina than medical therapy. The likelihood of death and myocardial infarction is unchanged by operation.

Adult↗
PubMed1978

A prospective study of sudden death in "high-risk" bundle-branch block.

We prospectively followed 257 patients with bifascicular and trifascicular conduction-system disease and intact atrioventricular conduction who had undergone His-bundle studies. Forty-seven per cent had associated coronary-artery disease, and 23 per cent primary conduction-system disease. His-ventricular interval was moderately prolonged in 43 per cent and markedly prolonged in 12 per cent. During an average follow-up period of 25 months 50 patients died. However, death was sudden in only 27, and 17 of the sudden deaths were not due to bradyarrhythias. Actuarial analysis showed an overall mortality rate (mean +/- S.E.) of 19 +/- 2.6 per cent at two years, mortality from sudden death being 10 +/- 2.6 per cent. Permanent heart block occurred in 12. No clinical symptoms (including syncope), electrocardiographic findings, electrophysiologic data or their combination identified patients at high risk of sudden death. Sudden death due to bradyarrhythmia is uncommon in patients with bundle-branch block and intact atrioventricular conduction. Therefore, routine prophylactic use of permanent pacemakers in all such patients is inappropriate. Pacemaker implantation should be reserved for those with documented symptomatic bradyarrhythmias.

Adult↗
PubMed1977

The pathophysiologic basis of acute coronary insufficiency. Observations favoring the hypothesis of intermittent reversible coronary obstruction.

Clinical, coronary angiographic, and myocardial metabolic data were analyzed to test alternative hypotheses for the pathophysiologic basis of acute coronary insufficiency. The initial incidence of coronary collaterals was not low in relation to coexisting coronary obstructive disease; the early subsequent coronary occlusion rate was high; and in asymptomatic intervals during the acute illness, myocardial hypoxia was infrequent and coronary reserve substantial. These observations support the hypothesis that the acute coronary insufficiency syndrome is caused by reversible coronary ischemic episodes rather than by a new permanent atherosclerotic lesion.

Acute Disease↗
PubMed1977

Medical vs. urgent surgical therapy for acute coronary insufficiency: a randomized study.

Forty-two patients with acute coronary insufficiency (high risk subgroup) were randomly assigned to urgent coronary bypass surgery or to initial medical therapy followed by elective coronary bypass at four months if indicated at that time for relief of incapacitation angina pectoris. Coronary bypass performed on an urgent basis offered no advantage in preventing early myocardial infarction or death. The acute illness was resolved without permanent complications in most patients by either urgent bypass surgery or intensive medical therapy. The functional capacity at four months as assessed by objective testing was much greater in the urgent surgical group. Elective bypass surgery was carried out at that point in about half of the medical patients due to persistent incapacitating angina. Later serious complications have continued to occur in the medical patients but have not occurred up to the present time in the urgent surgical patients.

Angina Pectoris↗
PubMed1975

Medical versus surgical therapy for acute coronary insufficiency. A randomized study.

Forty patients with acute coronary insufficiency, including continued angina at rest and reversible ischemic electrocardiographic changes after hospitalization ("high-risk" subgroup), were randomly allotted to medical therapy or urgent surgical coronary bypass groups. In four months there were no deaths and two myocardial infarctions in 19 medical patients and one death and three myocardial infarctions in 21 surgical patients. Left ventricular ejection fraction did not change significantly in either group. The surgical patients had significantly higher functional capacities at four months as judged by lower symptomatic functional class (P less than 0.01), higher exercise angina threshold (P less than 0.001), higher pacing angina threshold (P less than 0.0001), and higher myocardial lactate extraction during pacing (P less than 0.0001). Initial medical management of patients with acute coronary insufficiency followed by elective coronary bypass in patients with continued disabling angina pectoris is a reasonable alternative to emergency bypass.

Acute Disease↗