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Biomedical subjects

M A Alpert

Publications and source records attributed to M A Alpert.

At least 55 records · Page 3Linked to original sources
PubMed1995

Continuous ambulatory peritoneal dialysis and the heart.

OBJECTIVE: To review clinical research pertaining to continuous ambulatory peritoneal dialysis (CAPD) and the heart. DATA SOURCES: A Medline computer search was employed to identify appropriate references from 1970 - 1994. Indexing terms were: continuous ambulatory peritoneal dialysis, hemodialysis, heart or cardiac, left ventricle, coronary artery disease, and survival. English and non-English language abstracts were scrutinized. STUDY SELECTION: Forty-six studies were reviewed and utilized. Numerical data extracted are reported in this review as they were reported in the original article. RESULTS: This review provides a broad-based survey of studies pertaining to CAPD and the heart. Most of the studies relate to CAPD and left ventricular structure or function. Little information exists concerning CAPD and coronary artery disease, valvular disease, pericardial disease, and cardiac arrhythmias. Studies pertaining to patient survival on CAPD identify coronary artery disease and congestive heart failure as major risk factors, but in-depth quantification of these cardiovascular disorders is lacking in the literature. CONCLUSIONS: CAPD is capable of decreasing left ventricular (LV) volume and improving LV systolic function in patients with LV enlargement and those with LV systolic dysfunction. The effect of CAPD on left ventricular hypertrophy (LVH) and LV diastolic function is variable. CAPD produces symptomatic improvement in patients with refractory congestive heart failure, but its effect on survival in such patients is uncertain. Atherogenic lipid abnormalities occur in CAPD patients. The clinical significance of these abnormalities is uncertain. Coronary artery bypass surgery can be performed safely and effectively on CAPD patients. CAPD is not arrhythmogenic. Survival of CAPD patients is similar to that of hemodialysis patients except in elderly diabetics for whom it is slightly lower.

Arrhythmias, Cardiac↗
PubMed1994

Pharmacotherapy of chronic pulmonary arterial hypertension: value and limitations. Part I: Primary pulmonary hypertension.

Efforts aimed at assessing pharmacotherapy of pulmonary arterial hypertension (PHT) have largely focused on patients with primary PHT, PHT associated with selected connective tissue diseases, and various forms of hypoxic secondary PHT. Part I of this review discusses the value and limitations of a wide variety of vasodilator drugs, oxygen, and warfarin in the treatment of primary PHT with special reference to their effects on pulmonary and systemic hemodynamics, functional capacity, and survival.

Acetylcholine↗
PubMed1993

Factors influencing left ventricular systolic function in nonhypertensive morbidly obese patients, and effect of weight loss induced by gastroplasty.

Heart rate and blood pressure were measured, and echocardiography was performed in 39 patients whose actual body weight was greater than twice their ideal body weight to identify factors influencing left ventricular (LV) systolic function in morbidly obese patients and assess the effect of weight loss on LV systolic function. Patients were studied before and after weight loss induced by gastroplasty. The study cohort was 133 +/- 8% overweight before weight loss and 39 +/- 7% overweight at the nadir of weight loss. Before weight loss, LV fractional shortening varied inversely with LV internal dimension in diastole (an indirect index of preload), LV end-systolic wall stress and systolic blood pressure (indexes of afterload). The weight loss-induced change in LV fractional shortening varied directly with the pre-weight loss LV internal dimension in diastole, LV end-systolic wall stress and systolic blood pressure, and inversely with the pre-weight loss LV fractional shortening. The weight loss-induced change in LV fractional shortening varied inversely with the weight loss-induced changes in LV end-systolic stress and systolic blood pressure. In patients with reduced LV fractional shortening (n = 14), weight loss produced a significant increase in LV fractional shortening that was accompanied by a significant decrease in LV internal dimension in diastole, LV end-systolic stress and systolic blood pressure. The results suggest that LV loading conditions have an important role in determining LV systolic function in morbidly obese patients. Improvement in LV systolic function in these patients is closely related to weight loss-induced alterations in LV loading conditions.

Adult↗
PubMed1993

When the lungs are involved by connective tissue disease.

Pulmonary involvement by a connective tissue disease can result in clinically important complications. Pathogenic mechanisms vary from granulomatous reaction and interstitial inflammation to primary vasculitis and immune complex-mediated disease. Understanding the pulmonary complications of connective tissue diseases is challenging in that several distinct patterns of involvement are associated with the same disease but the same lung abnormalities are found with several different diseases. Early recognition and treatment of pulmonary involvement may offer the patient a better chance of recovery from serious conditions that often carry a grim prognosis if undetected.

Arthritis, Rheumatoid↗
PubMed1993

Obesity and the heart.

Obesity can result in alterations in cardiac structure and function even in the absence of systemic hypertension and underlying organic heart disease. Increased total blood volume creates a high cardiac output state that may cause ventricular dilatation and ultimately eccentric hypertrophy of the left (and possibly the right) ventricle. Eccentric left ventricular (LV) hypertrophy produces diastolic dysfunction. Systolic dysfunction may ensue due to excessive wall stress if wall thickening fails to keep pace with dilatation. This disorder is referred to as obesity cardiomyopathy. The presence of systemic hypertension in obese individuals facilitates development of LV dilatation and hypertrophy. Congestive heart failure may occur in such individuals, and may be attributable to LV diastolic dysfunction or to combined LV diastolic and systolic dysfunction. The sleep apnea/obesity hypoventilation syndrome occurs in 5% of morbidly obese individuals and is potentially life-threatening. Treatment of obesity cardiomyopathy consists of weight loss, salt restriction, and diuretics. Digitalis and vasodilators may be useful in selected cases. Central obesity is probably a risk factor for the development of coronary heart disease. Alterations in lipid and insulin metabolism may facilitate development of coronary heart disease in obese patients.

Heart Diseases↗
PubMed1993

Chest pain and angiographically normal coronary arteries. Implications for treatment.

Approximately 20% to 30% of patients who undergo coronary arteriography for the evaluation of chest pain are found to have normal coronary arteries. These patients have a survival rate comparable to that of the normal population, yet they continue to complain of symptoms on extended follow-up, and about half of this group are disabled on account of chest pain. Once other clinically obvious disorders have been ruled out, common diagnostic considerations include microvascular angina, esophageal dysfunction, and perhaps fibromyalgia. Panic disorder, however, is the most common condition affecting these patients and can be diagnosed in at least one third of the group, with or without the presence of the other conditions mentioned. Appropriate diagnosis and treatment can reduce the psychosocial morbidity so frequently seen in these patients.

Chest Pain↗
PubMed1993

Options in dialysis therapy: significance of cardiovascular findings.

Most patients receiving renal replacement therapy have cardiovascular disease. The most frequent conditions are left ventricular hypertrophy and coronary artery disease. Hemodialysis is associated with a characteristic spectrum of acute complications (such as hypotension, sudden death) that can be explained by typical dialysis-induced effects on the heart. With continuous ambulatory peritoneal dialysis (CAPD) some of those cardiovascular complications are ameliorated due to slow ultra-filtration and absence of an arteriovenous fistula. It is concluded that CAPD might be the preferable option in patients with cardiovascular disease when hemodialysis can only be performed in a standardized and often aggressive manner. However, achievement of medically-defined goals appears to be more important than technique in dialysis therapy.

Cardiovascular Diseases↗
PubMed1993

Course of left ventricular diastolic dysfunction in end-stage renal disease on long-term continuous ambulatory peritoneal dialysis.

To determine factors contributing to abnormal left ventricular (LV) diastolic filling in patients on long-term continuous ambulatory peritoneal dialysis (CAPD), 11 (age: 55 +/- 13 years; CAPD duration: 33 +/- 32 months) out of 42 originally studied CAPD patients were followed over 35 months with echocardiography and pulsed Doppler echocardiography. LV dimensions and systolic function remained normal. Doppler parameters indicated diastolic LV dysfunction in 9/11 patients in the initial study. Despite a significant increase in LV mass (234 +/- 54 vs. 299 +/- 65 g; p < 0.05) and a decrease in LV volume/mass ratios (0.78 +/- 0.18 vs. 0.54 +/- 0.12 ml/g; p < 0.001), no change was observed in any of the diastolic LV filling parameters such as peak early and atrial filling velocities and their ratios, atrial filling fractions and peak filling rate normalized for mitral stroke volume. Individual changes of E/A-max were inversely correlated with systolic blood pressure (p < 0.01), alterations of normalized peak filling rate were inversely correlated with serum creatinine (p < 0.01). No influence on individual changes of LV diastolic filling parameters was observed for LV volume, muscle mass, volume/mass ratios, ejection fractions, patient age, dialysis duration, and hemoglobin concentration. These findings suggest that arterial hypertension and the quality of blood purification play a central role in the development of LV diastolic dysfunction in patients on CAPD, while LV muscle mass and LV volume/mass relations have no relevant influence on changes of LV diastolic function in these patients.

Adult↗
PubMed1992

Acute myocardial infarction associated with intravenous injection of pentazocine and tripelennamine.

This case report describes the evolution of an acute anteroseptal myocardial infarction in a 27-year-old man following intravenous injection of pentazocine and tripelennamine. Subsequent coronary angiography showed normal coronary arteries. Based on the known mechanism of action of these drugs, it is postulated that myocardial infarction resulted from coronary artery spasm secondary to excessive catecholamine stimulation.

Adult↗