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R J Krone

Publications and source records attributed to R J Krone.

59 records · Page 4Linked to original sources
PubMedDate not supplied

Approach to reduction of vascular complications of percutaneous valvuloplasty.

The large-bore arterial sheaths required for balloon valvuloplasty and intraaortic balloon pumps may be associated with substantial morbidity when introduced into the superficial femoral artery in elderly people, especially women and those with peripheral atherosclerosis. We report a total occlusion of the superficial femoral artery by a large intravascular sheath requiring subsequent surgical intervention. A femoral arteriogram using less than 10 cc of contrast through a 5F catheter can assure placement of the puncture into the common femoral artery prior to introducing the large sheath or catheter, thus reducing morbidity.

Aged↗
PubMedDate not supplied

Psychological factors in silent myocardial ischemia.

To determine whether psychological factors differentiate patients with silent versus symptomatic myocardial ischemia, a battery of psychometric tests was administered to 68 patients with positive thallium stress tests. Compared with patients who became symptomatic (n = 25), patients with silent ischemia on the treadmill (n = 24) were less often aware of cardiac and other bodily sensations (p less than 0.005) and were less avoidant of harm or pain in general (p less than 0.05). They did not differ on variables associated with symptom reporting biases. To clarify the relationship between ischemia and symptom reporting, symptomatic patients were subgrouped on the basis of anginal pain latency. Psychologically, the patients with silent ischemia were most similar to patients with the longest pain latencies and most different from those who reported angina before the onset of ST depression. The psychological profile of patients with silent ischemia during exercise testing is consistent with a reduced sensitivity to pain and other bodily sensations.

Angina Pectoris↗
PubMedDate not supplied

Treatment of chronic ventricular arrhythmias [proceedings].

Treatment of ventricular arrhythmias at the present time is difficult and requires a strong commitment on the part of the physician and the patient. Adequate documentation of the arrhythmia with continuous ECG recordings (Holter recordings), preferably for 24 hours, should be performed in each case. Exercise testing can be utilized in selected patients, but is generally inferior to the Holter technique. Underlying cardiac pathology should be searched for, utilizing echocardiography in all patients and coronary angiography and left ventriculography in patients with more severe ventricular tachycardias. Estimation of the prognostic significance of the VPBs must be made in the context of the underlying disease, and goals for treatment must be set. Treatment in all cases first requires measures to avoid known precipitating factors. If antiarrhythmic therapy is utilized, a systematic empirical trial of available agents should be undertaken, utilizing repeated Holter monitoring to document effectiveness. Serum levels of the antiarrhythmic medications should be measured in most cases. Combinations of antiarrhythmic agents can be employed if the need is great, but the agents singly are ineffective. If treatment is determined to be ineffective, it should be discontinued. Surgical techniques may be useful in cases of refractory ventricular tachycardia, and they include overdrive pacing, surgical sympathectomy, or ventricular aneurysmectomy with or without coronary bypass. Coronary bypass alone or resection of a hypokinetic but not aneurysmal area of myocardium may be successful in some cases, but the results are less predictable than when a true aneurysm is resected. Electrophysiologic studies, performed as part of the preoperative evaluation and provoking a self-perpetuating ventricular tachycardia, may permit selection of patients suitable for ventriculotomy to interrupt the re-entry pathway. At present, this must be considered experimental and is performed in only a few centers equipped for the required complex epicardial mapping. Surgery has not been shown to affect complex VPBs outside the setting of acute ischemia. Control of ventricular arrhythmias requires a highly individualistic approach with documentation of effectiveness.

Adrenergic beta-Antagonists↗