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Biomedical subjects

R C Becker

Publications and source records attributed to R C Becker.

At least 109 records · Page 6Linked to original sources
PubMed1991

Cardiovascular therapies in the 1990s. An overview.

Cardiovascular medicine has evolved steadily over the past two decades. Inspired by progressive declines in the overall incidence and mortality rates from cardiovascular diseases, emphasis has been placed on 3 specific areas: prevention, early diagnosis, and aggressive intervention. During the decade spanning the 1980s, impressive strides were made in many areas--diagnostic and therapeutic alike. However, an observed reduction in patient mortality stemming from acute myocardial infarction was particularly gratifying. Clearly, the large scale use of thrombolytic therapy and postinfarction strategies designed to prevent reinfarction, limit ventricular dilation, and reduce cardiac death figured prominently. Despite these encouraging facts, however, coronary heart disease remains the leading cause of death in Western society, and thrombolytic therapy is still not being utilised by the medical community to its full potential. Furthermore, adjuvant therapy, during both the early and the late phases of acute myocardial infarction, is being instituted inconsistently, and at times haphazardly. Arrhythmia management and the prevention of sudden cardiac death require further investigation, as does the treatment of chronic congestive heart failure, and the prevention of coronary atherosclerosis. This overview provides a state-of-the-art review and look into the future of 5 critical areas: acute myocardial infarction, adjuvant treatment strategies for acute myocardial infarction, cardiac arrhythmias, chronic congestive heart failure, and hyperlipidaemias.

Cardiovascular Diseases↗
PubMed1990

Intravenous nitroglycerin-induced heparin resistance: a qualitative antithrombin III abnormality.

An ability of intravenous nitroglycerin to interfere with the anticoagulant properties of intravenous heparin would have profound clinical implications. To investigation nitroglycerin-heparin interactions, the following pilot study was performed. Patients (N = 18) admitted to the coronary care unit with a diagnosis of either acute myocardial infarction or unstable angina were divided into four treatment groups: (1) intravenous nitroglycerin and intravenous heparin; (2) intravenous nitroglycerin alone; (3) intravenous heparin alone; or (4) neither intravenous nitroglycerin nor intravenous heparin. Serial determinations of activated partial thromboplastin time (APTT), serum heparin concentration, antithrombin III (ATIII) antigen (ATA), and ATIII activity (ATC) were obtained over a 72-hour period. Overall, patients receiving intravenous nitroglycerin did not differ significantly from other patients in APTT, heparin dose, heparin concentration, ATA, ATC, or ATA/ATC ratio (ATR). However, patients receiving intravenous nitroglycerin at a rate exceeding 350 micrograms per minute had a lower APTT (p less than 0.05), lower ATC (p = 0.02), higher ATR (p = 0.004), and a larger heparin dose requirement than patients receiving lower infusion rates. ATR correlated directly (r = 0.91; p less than 0.05) and ATC inversely (r = -0.78; p less than 0.05) with the intravenous nitroglycerin dose. Serum heparin concentration did not correlate with the intravenous nitroglycerin dose. Intravenous nitroglycerin-induced heparin resistance occurs at a critical nitroglycerin dose. A nitroglycerin-induced qualitative ATIII abnormality may be the underlying mechanism.

Adult↗
PubMed1990

Impact of atrial fibrillation on the in-hospital and long-term survival of patients with acute myocardial infarction: a community-wide perspective.

As part of an ongoing community-wide study examining changes over time in the incidence and survival rates of 4108 patients hospitalized with validated acute myocardial infarction (MI) in 16 hospitals in the Worcester, Massachusetts, metropolitan area during calendar years 1975, 1978, 1981, 1984, and 1986, we examined changes over time in the proportion of patients with acute MI developing atrial fibrillation (AF) and the impact of AF on in-hospital and long-term survival for up to a 10-year follow-up period. The overall percentage of patients with AF complicating acute MI was 16.0%; this proportion increased over time from 13.3% in 1975 to 14.8% in 1978, 14.9% in 1981, 20.3% in 1984, and to 17.7% in 1986. Patients with AF experienced consistently higher in-hospital case fatality rates than MI patients without AF overall (27.6% versus 16.6%), as well as during each of the 5 years under study. The independent effect of AF on in-hospital survival was not upheld, however, when a variety of potentially confounding prognostic factors were controlled for in a multivariate analysis resulting in an adjusted odds ratio (OR) of 1.18 (95% confidence interval 0.90, 1.52). Among discharged hospital patients, while the crude long-term survival rate for patients with AF was poorer than that of patients without AF for the combined as well as for individual study periods, similar to the in-hospital findings the independent effect of AF on long-term prognosis was not upheld after use of a multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1990

Cardiovascular disease in women: scope of the problem.

Coronary heart disease (CHD) is a major health problem in both men and women. Each year over 250,000 women in the United States alone die as a result of CHD, many of them suddenly. Women sustaining an acute myocardial infarction have a poor in-hospital and long-term prognosis, with a high incidence of stroke, congestive heart failure, nonfatal reinfarction and cardiac death.

Adult↗
PubMed1990

Coronary heart disease risk factors in women.

Although men and women share a number of coronary risk factors including age, hypertension, cigarette smoking, diabetes, obesity, plasma lipoprotein concentration, and family history, the overall impact of these factors on the incidence and clinical manifestations of coronary heart disease (CHD) may differ. Additional risk factors which solely impact upon women include the use of oral contraceptives, menopause, and postmenopausal hormones. The impact of psychosocial and behavioral factors on CHD risk in women requires further investigation given that our current knowledge of traditional risk factors alone inadequately predicts all cases of CHD.

Coronary Disease↗
PubMed1990

Noninvasive diagnosis of coronary heart disease in women.

Coronary heart disease (CHD) is the leading cause of death in the United States accounting for over 600,000 deaths and 1 million hospital admissions each year. Although the overall prevalence of disease is lower in women than in men, one quarter of all deaths in women is caused by CHD. Observations in clinical practice have uncovered a number of interesting facts regarding CHD in women. Despite pathoanatomic similarities in atherosclerotic coronary arteries of men and women, the clinical presentation of CHD frequently differs. Furthermore, the diagnostic approach and interpretation of findings, particularly those yielded from noninvasive tests, may be different, at times drastically so. In this review, the authors discuss the current noninvasive strategy for diagnosing CHD in women.

Coronary Angiography↗
PubMed1990

Coronary thrombolysis in women.

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality throughout the world. Although the incidence of AMI is higher in men than women, it is responsible for more than 250,000 annual deaths among women within the United States alone. Coronary thrombolysis is the treatment of choice for AMI and reduces mortality rates in both men and women. However, the absolute benefit may be less in women and, in addition, may not be maintained beyond the early postinfarction period. Bleeding complications, including intracranial hemorrhage, may be more common in women, particularly those more than 65 years of age. The author reviews the topic of coronary thrombolysis in women.

Female↗
PubMed1990

Recombinant t-PA and platelet activity.

Platelet-rich coronary arterial occlusions are relatively resistant to thrombolysis with recombinant tissue-type plasminogen activator, or rt-PA, while erythrocyte-rich thrombi are lysed at low doses. The combined administration of rt-PA with a platelet antagonist enhances thrombolysis and can prevent reocclusion, which suggests that platelet activation predominates during thrombus formation and after thrombolysis. In addition to direct effects on platelet activity, rt-PA also acts indirectly through generation of plasmin, which degrades fibrin.

Blood Platelets↗
PubMed1989

Postinfarction unstable angina. Pathophysiologic basis for current treatment modalities.

Unstable angina is an acute coronary syndrome characterized by the rapid progression of clinical symptoms which may culminate in acute myocardial infarction, infarct extension or sudden death. The pathologic substrate involves atherosclerotic plaque rupture with platelet deposition, thrombus formation and coronary arterial spasm. Patients with postinfarction angina represent a high-risk subgroup with severe multivessel disease, compromised collateral vessels and/or partially occlusive thrombi; their risk of infarct extension and death is significantly increased. Initial therapy includes nitrates, beta-adrenergic blockers, calcium channel antagonists, aspirin and possibly i.v. heparin, as well as prompt identification and control of exacerbating factors. Thrombolytic therapy may assume a more central role based on its ability to achieve rapid clinical stabilization. Percutaneous transluminal coronary angioplasty and coronary artery bypass grafting may be used emergently in patients refractory to medical therapy, or electively when clinically indicated.

Adrenergic beta-Antagonists↗
PubMed1989

Rapid resolution of acute cor pulmonale with recombinant tissue plasminogen activator.

A case of massive pulmonary embolism complicated by acute cor pulmonale and shock is presented. The IV administration of recombinant tissue-type plasminogen activator (rt-PA) was associated with prompt reversal of clinical, ECG, and nuclear radiographic findings. The role of thrombolytic therapy with rt-PA for massive pulmonary embolism associated with hemodynamic decompensation deserves further investigation.

Acute Disease↗
PubMed1989

Circadian variations in cardiovascular disease.

Circadian variations have been observed for a number of hemodynamic and cardiovascular events including heart rate, systemic blood pressure, coronary artery blood flow, ischemic cerebrovascular accidents, myocardial ischemia, myocardial infarction, and sudden cardiac death. In addition, circadian variations in platelet response to aggregating stimuli, plasma fibrinogen, coagulation factor concentration, and intrinsic fibrinolytic activity (as determined primarily by inhibitors of plasminogen activation) have been documented. Observed periodicities in thrombogenic capacity and cardiovascular events seem to correlate directly, suggesting a cause-effect relationship. Circadian variations in thrombotic tendency may influence the therapeutic response to anticoagulants and thrombolytic agents, particularly rt-PA. This area of cardiovascular disease is of profound clinical importance and warrants further investigation.

Cardiovascular Diseases↗
PubMed1988

Coronary artery bypass surgery in women.

Coronary bypass surgery is performed more frequently in men than in women. A selection bias in favor of men may exist in currently utilized evaluation precesses for patients with both chest pain syndromes and documented coronary artery disease. Surgery should be considered in women with significant left main coronary artery stenosis, "left main equivalent" coronary disease, severe three-vessel coronary disease with/without left ventricular dysfunction, two-vessel coronary disease (including a proximal left anterior descending artery stenosis), and unstable angina pectoris with decreased left ventricular function. Women and men undergoing coronary bypass surgery seem to benefit from internal mammary artery grafts used alone or in combination with saphenous vein grafts. Surgical mortality, incomplete revascularization, early and late graft occlusion, and recurrent angina are more prevalent in women who undergo surgery. However, long-term mortality following surgery is similar in men and women.

Adult↗