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Biomedical subjects

Peter S Rahko

Publications and source records attributed to Peter S Rahko.

9 recordsLinked to original sources
PubMed2007

Patchy myocardial fibrosis 20 years after radiation therapy.

We describe a case of a young woman diagnosed with Ewings sarcoma at age 8 and treated with adriamycin and radiation therapy. Twenty years later the patient has a cardiomyopathy and a focal area of patchy infiltration of fibrotic tissue along the left ventricle and atrium. Although fibrosis due to radiation exposure has been demonstrated on biopsy and autopsy studies, we are not aware of previous reports of echocardiographic demonstration of this finding. The most likely explanation for the fibrosis location is the left posterolateral direction of the radiation beam.

Adult↗
PubMed2005

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.

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Adult↗
PubMed2005

Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia.

STUDY OBJECTIVE: We evaluate the association between emergency physicians' fear of malpractice and the triage and evaluation patterns of patients with symptoms suggestive of acute coronary syndrome. METHODS: We surveyed 33 emergency physicians of 2 university hospitals during the preintervention phase of an implementation trial of the Agency for Health Care Policy and Research Unstable Angina guideline in 1,134 study patients. The survey included a 6-item instrument that addressed concerns about malpractice and a measure of general risk aversion. We used hierarchical logistic regression to model emergency department (ED) triage decisions and diagnostic testing as a function of fear of malpractice, with adjustment for patient characteristics, Agency for Health Care Policy and Research guideline risk group, study site, and clustering by emergency physician. RESULTS: Overall, emergency physicians in the upper tertile of malpractice fear were less likely to discharge low-risk patients compared with emergency physicians in the lower tertile (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.12 to 0.99; P=.05). Patients treated by emergency physicians in this group were also more likely to be admitted to an ICU or telemetry bed (adjusted OR 1.7; 95% CI 1.2 to 2.4). In addition, emergency physicians in the upper tertile of malpractice fear were more likely to order chest radiography, as well as cardiac troponin. Malpractice fear accounted for a similar amount of variance after controlling for emergency physicians' risk aversion. CONCLUSION: Malpractice fear accounts for significant variability in ED decisionmaking and is associated with increased hospitalization of low-risk patients and increased use of diagnostic tests.

Adult↗
PubMed2005

An echocardiographic analysis of the long-term effects of carvedilol on left ventricular remodeling, systolic performance, and ventricular filling patterns in dilated cardiomyopathy.

BACKGROUND: The long-term clinical benefit of beta blockade is well recognized, but data quantifying long-term effects of beta blockade on remodeling of the left ventricle (LV) is limited. METHODS: This consecutive series evaluates the long-term response of the LV to the addition of carvedilol to conventional therapy for dilated cardiomyopathy. There were 33 patients who had a LV ejection fraction <45%, LV enlargement and symptomatic heart failure. Quantitative Doppler echocardiography was performed at baseline 6, 12, 24, and 36 months after initiation of carvedilol to evaluate LV ejection fraction, LV volume, wall stress, mass, regional function, and diastolic performance. RESULTS: Compared to baseline there was a significant and sustained reduction in end-systolic volume and end-systolic wall stress with a corresponding improvement in LV ejection fraction. The LV mass did not decline but relative wall thickness increased toward normal. An analysis of regional wall motion responses showed an improvement in all areas, particularly the apical, septal, and lateral walls that was significantly more frequent in patients with a nonischemic etiology. Filling patterns of the LV remained abnormal throughout the study but changed with therapy suggesting a decline in filling pressures. These changes were sustained for 3 years. CONCLUSION: (1) The addition of carvedilol to conventional therapy for a dilated cardiomyopathy significantly improves LV ejection fraction and reduces LV end-systolic volume and wall stress for at least 3 years, (2) the response to 6 months of treatment predicts the long-term response, (3) the typical response is partial improvement of the LV, complete return to normal size, and function is uncommon, and (4) abnormalities of LV filling persist in virtually all patients throughout the course of treatment.

Adrenergic beta-Antagonists↗
PubMed2002

Relation of "inotropic reserve" to functional capacity in heart failure secondary to ischemic or nonischemic cardiomyopathy.

Exercise capacity in patients with dilated cardiomyopathy, measured by peak oxygen consumption (VO(2)) during exercise, has virtually no relation to resting left ventricular (LV) function. We hypothesized that exercise-induced inotropic reserve may explain some of the variation between peak VO(2) and resting LV function. Treadmill stress echocardiography was performed simultaneously with peak VO(2) measurements in 35 patients with dilated cardiomyopathy. Resting and immediate postexercise echocardiographic images were scored for change in segmental contractility using the American Society of Echocardiography 16-segment system. Segment scores were summed and divided by 16 to determine the wall motion index. Right ventricular (RV) function was quantified on a 4-point scale. Patients had a mean age of 52 +/- 12 years (8 women) and a mean ejection fraction of 30 +/- 10 (25 nonischemic patients). Average peak VO(2) was 17.0 +/- 6 ml/kg/min. Patients were divided into 2 groups by peak VO(2): a high VO(2) group, >17 ml/kg/min (17 patients) and a low VO(2) group, < or =17 ml/kg/min (18 patients). LV ejection fraction was similar between the high and low VO(2) groups (31 +/- 9% vs 28 +/- 11%, p = NS) as were etiology of heart failure, medications used, and LV volume. In the high VO(2) group, wall motion index improved from 2.28 +/- 0.20 to 2.12 +/- 0.31 during exercise (p = 0.009). There was no improvement in the low VO(2) group. Resting RV function was significantly better in the high VO(2) group (1.4 +/- 0.8 vs 0.6 +/- 0.6 p = 0.004). Therefore, in patients with dilated cardiomyopathy and similar resting LV function, the presence of demonstrable LV inotropic reserve and preserved RV function partially account for variation in exercise performance.

Cardiomyopathies↗
PubMed2002

Apnea-hypopnea threshold for CO2 in patients with congestive heart failure.

To understand the pathogenesis of central sleep apnea (CSA) in patients with congestive heart failure (CHF), we measured the end-tidal carbon dioxide pressure (PET(CO2)) during spontaneous breathing, the apnea-hypopnea threshold for CO2, and then calculated the difference between these two measurements in 19 stable patients with CHF with (12 patients) or without (7 patients) CSA during non-rapid eye movement sleep. Pressure support ventilation was used to reduce the PET(CO2) and thereby determine the thresholds. In patients with CSA, 1.5-3% CO2 was supplied temporarily to stabilize breathing before determining the thresholds. Unlike patients without CSA whose eupneic PET(CO2) increased during sleep (37.7 +/- 1.4 mm Hg versus 40.2 +/- 1.5 mm Hg, p < 0.01), patients with CSA showed no rise in PET(CO2) from wakefulness to sleep (37.5 +/- 0.9 mm Hg versus 38.2 +/- 1.0 mm Hg, p = 0.2). Patients with CHF and CSA had their eupneic PET(CO2) closer to the threshold PET(CO2) than patients without CSA (DeltaPET(CO2) [eupneic PET(CO2) - threshold PET(CO2)] was 2.8 +/- 0.3 mm Hg versus 5.1 +/- 0.7 mm Hg for apnea, p < 0.01; 1.7 +/- 0.7 versus 4.1 +/- 0.5 mm Hg for hypopnea, p < 0.05). In summary, patients with CHF and CSA neither increase their eupneic PET(CO2) during sleep nor proportionally decrease their apnea-hypopnea threshold. The resultant narrowed DeltaPET(CO2) predisposes the patient to the development of apnea and subsequent breathing instability.

Analysis of Variance↗
PubMed2002

Heart failure: new data and guidelines.

Heart failure is a common clinical problem, affecting at least 5 million Americans. There have been substantial advances in the understanding and treatment of heart failure in the last several years. We review current concepts for the evaluation and treatment of the various manifestations of patients with heart failure.

Algorithms↗