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Biomedical subjects

R E Kleiger

Publications and source records attributed to R E Kleiger.

At least 73 records · Page 4Linked to original sources
PubMed1983

Long-term prognosis after first Q-wave (transmural) or non-Q-wave (nontransmural) myocardial infarction: analysis of 593 patients.

Follow-up results in 593 patients less than or equal to 7 years (mean 4.7) after hospital discharge for their first myocardial infarction (MI) are presented. Patients were grouped according to the presence or absence of Q waves on electrocardiograms after the MI and by peak serum glutamic oxalacetic transaminase (SGOT) level during hospitalization. Cardiac mortality varied. Patients with Q-wave infarcts and an SGOT level less than or equal to 240 IU/liter had a cardiac mortality of 3.1% per year, whereas patients with Q-wave MI and an SGOT level greater than 240 IU/liter had an 11% 6-month mortality and a 3.8% per year cardiac mortality thereafter. However, patients with non-Q-wave (nontransmural) MI had a excellent survival rate for 2 years (96.8%) which continued in patients aged less than or equal to 60 years thereafter. However, patients with non-Q-wave infarcts aged greater than 60 years had a 12% per year cardiac mortality in the third post-MI year and an additional 12% died each year thereafter. Early mortality was related to enzyme level, whereas late mortality was a function of type (Q-wave or non-Q-wave) and age.

Aged↗
PubMed1982

Effect of infarct location on the in-hospital prognosis of patients with first transmural myocardial infarction.

We studied the in-hospital prognosis of 1105 patients who had their first transmural myocardial infarction; 611 patients (55.3%) had anterior myocardial infarction (AMI) and 494 (44.7%) had inferior myocardial infarction (IMI). Patients with IMI had a significantly lower in-hospital mortality rate (9.1% vs 15.6%, p = 0.0014) and significantly lower prevalences of congestive heart failure (39.4% vs 47.6%, p = 0.0066), cardiogenic shock ( 8.7% vs 12.6%, p = 0.0384) and conduction defects (left anterior hemiblock, right bundle branch block and intraventricular conduction defect). The patients with AMI had significantly higher peak enzyme levels, and a greater percentage of them (40.1% vs 25.9%) had SGOT greater than 240 IU/l, whereas more patients with IMI (34.6% vs 27.8%) had SGOT less than 120 IU/l (p = 0.0001). When the parallel subgroups were compared according to the peak SGOT levels (less than 120, 120-240, and greater than 240 IU/l, the differences in the mortality and morbidity between the two infarct locations diminished. However, patients with AMI still had a less favorable outcome. Logistic regression analysis demonstrated that both the peak enzyme level and the infarct location had an independent influence on the in-hospital prognosis of patients with first transmural infarction.

Aged↗
PubMed1981

Cardiac arrhythmias in end-stage renal disease.

In 16 patients with end-stage renal disease (ESRD), 24-hour electrocardiographic recordings showed an incidence of supraventricular and ventricular arrhythmias similar to that in patients who had had myocardial infarction and in low-risk subjects. Eight patients (50%) with ESRD had supraventricular complexes. This incidence was significantly higher than that after myocardial infarction (P < .001). Fifteen ESRD patients (94%) had premature ventricular complexes (PVCs), including nine (56%) with complex PVCs (multiform PVCs, couplets, or runs). The incidence of PVCs as well as complex PVCs in patients with ESRD was comparable to that of the patients who had had myocardial infarction but was significantly higher than that found in low-risk subjects (P less than .005 for PVCs and P less than .05 for complex PVCs). The high incidence of complex PVCs in patients with ESRD may predispose them to increased cardiovascular death, and further investigation of this finding is indicated.

Adolescent↗
PubMed1981

Left ventricular function in end-stage renal disease: echocardiographic classification.

We used echocardiography (ECHO) to detect pericardial effusions and assess left ventricular (LV) function in 39 patients with end-stage renal disease (ESRD). Pericardial effusions were present in 24 patients (62%). Thirty-one patients (79%) had concentric hypertrophy and 20 patients (51%) had decreased LV compliance. The majority of patients with concentric hypertrophy and decreased LV compliance had normal LV internal dimensions and contractility. Six patients (15%) had ECHO results compatible with congestive cardiomyopathy. An echocardiographic distinction between congestive heart failure, decreased LV compliance, and salt and water overload in ESRD has allowed an appropriate therapeutic decision as to whether to administer cardiac glycosides or increase ultrafiltration as a treatment for pulmonary congestion. ECHO is a safe, convenient, and noninvasive method of assessing serial LV function, and it can be used to document progressive deterioration of LV function in ESRD.

Adolescent↗
PubMed1981

The effectiveness of antiarrhythmic agents on early-cycle premature ventricular complexes.

Twelve patients completed a double-blind, crossover antiarrhythmic drug trial in which 300 mg of quinidine, 500 mg of procainamide, 100 mg of phenytoin, or placebo was given four times daily on subsequent weeks. Analysis of 24-hour Holter tapes with a computerized analysis system (Argus/H) permitted accurate counting of premature ventricular complexes (PVCs) subclassified according to coupling interval. No antiarrhythmic agent demonstrated a significant overall reduction in the number of PVCs, but both quinidine and procainamide showed a statistically significant (p less than 0.05) reduction of PVCs with coupling intervals less than 400 msec. This effect was noted both in isolated PVCs (quinidine only) and in PVCs that were part of a couplet or run (both drugs). These findings demonstrate that clinically important effects of procainamide and quinidine can occur in the absence of an overall reduction in the number of PVCs.

Aged↗
PubMed1980

In-hospital prognosis of patients with first nontransmural and transmural infarctions.

We studied the in-hospital mortality and morbidity of 745 patients who had suffered a first myocardial infarction. One hundred twenty-four patients (16.6%) had nontransmural infarction and 621 (83.4%) had transmural infarction. Both groups of patients were similar in the distribution of age, sex, and coronary risk factors. Patients with nontransmural infarction had a significantly lower mortality (3% vs 11%, p less than 0.01) and a lower prevalence of premature ventricular complexes (81% vs 88%, p less than 0.05). The patients with transmural infarction were distributed evenly among the three subgroups with peak SGOT levels less than 120 units, 120-240 units and more than 240 units (31%, 34% and 35%, respectively), while most patients with nontransmural infarction (60%) had peak SGOT levels less than 120 units (p less than 0.0001). When the in-hospital mortality and morbidity were compared between the parallel subgroups, the prognosis of patients with the two types of infarctions was similar. This study shows that the peak SGOT level is more important than the type of infarction in determining the acute mortality and morbidity of first myocardial infarction.

Acute Disease↗
PubMed1979

Epicardial pacemaker complicated by cardiac tamponade and constrictive pericarditis.

Following insertion of an epicardial pacemaker, our patient developed cardiac tamponade complicated by subacute constrictive pericarditis. Echocardiographic findings and intracardiac pressures were typical of constrictive pericarditis, which was confirmed at surgery. Although rare, these unusual complications should be considered in patients who develop evidence of reduced cardiac output following either transvenous or epicardial electrode placement.

Aged↗
PubMed1978

The echocardiographic diagnosis of rupture of a papillary muscle.

The echocardiographic diagnosis of acute rupture of a papillary muscle is described. The pertinent findings included (1) decreased systolic motion of the posterior wall, (2) exaggerated septal motion, (3) left ventricular enlargement and pattern suggesting left ventricular diastolic overload, and (4) bizarre fluttering of posterior leaflet of the mitral valve in diastole, suggesting an unhinging of the mitral valvular apparatus. The echocardiogram is a useful noninvasive tool in the diagnosis of this often fatal complication of myocardial infarction.

Aged↗
PubMed1977

Echocardiographic patterns in scleroderma.

The echocardiograms of two patients with sclerodermatous cardiac disease are described. In one patient the pattern was that of a congestive cardiomyopathy with ventricular dilatation and reduced wall motion. In the second patient the pattern was that of an infiltrative cardiomyopathy with thickened walls and reduced wall motion in the absence of ventricular dilatation. Echocardiographic studies are useful in the early detection of pericardial involvement and primary or secondary myocardial involvement by scleroderma and in following the progression of the disease process.

Adult↗
PubMed1977

Exit block of artificial pacemaker induced by carotid sinus massage.

Failure of the pacemaker is a common complication of pacemaker therapy. Identification of the disorder responsible for the failure to pace is often difficult. An increase in myocardial threshold can result in nonconduction of the artificial impulse, particularly near the end of the life of the battery, when the output of current has started to decline. This report demonstrates such an increase in myocardial resistance which was apparent only upon massage of the carotid sinus.

Aged↗
PubMed1977

Postoperative investigation of left ventricular aneurysm resection.

We reviewed 35 patients undergoing resection of a chronic postinfarction left ventricular aneurysm. There was 5.7% operative mortality. Of the long-term survivors, 80% are functional class I or II. Ten patients had postoperative left ventriculograms studied by means of a computerized analysis of endocardial motion using internal orthogonal and radial grids. Postoperative end-diastolic volumes were much greater than normal and large akinetic areas were present although there was good improvement in the patient's functional capacity. Grid analysis of endocardial motion correlated better with the patient's postoperative clinical status than did measurements of end-diastolic pressure and volume, ejection fraction, or visual inspection of the postoperative left ventriculogram.

Adult↗