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Biomedical subjects

S A Fein

Publications and source records attributed to S A Fein.

15 recordsLinked to original sources
PubMed1999

Clinical presentation, diagnosis, and hospital outcome of patients with documented aortic dissection: the Albany Medical Center experience, 1986 to 1996.

BACKGROUND: In recent years, the diagnostic approach to patients with suspected aortic dissection has changed dramatically. Noninvasive studies such as transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging have supplanted angiography as the initial tests of choice. The effect of this change in diagnostic approach has not previously been evaluated. METHODS AND RESULTS: The records of all patients discharged from Albany Medical Center Hospital between January 1, 1986, and December 31, 1996, were screened for an "aortic dissection" entry in the medical record database. For those records in which aortic dissection was confirmed, data concerning the diagnostic evaluation, treatment, and hospital course were recorded and analyzed. During the study period, there were 160 cases of documented aortic dissection discharged from the hospital. There were 100 type A and 60 type B dissections. The most commonly used diagnostic tests were TEE (83 of 160) and angiography (60 of 160). In patients who had TEE, diagnosis was made more quickly but overall mortality rate was not different from patients who had angiography. Renal dysfunction and neurologic events were less frequent in the TEE group. Hospital stay was significantly shorter in the TEE group (24.8 +/- 3.9 vs 14.0 +/- 1.8 days, P =.01). CONCLUSIONS: The use of TEE reduces morbidity rate and hospital stay in patients with aortic dissection but does not affect mortality rate.

Aged↗
PubMed1994

Approach to ischemic heart disease, coronary care, and severe heart failure (including cardiogenic shock).

Elderly patients with cardiovascular disease require slightly different management strategies compared with younger patients. Diagnosis is more difficult. Procedures, both diagnostic and therapeutic, are more dangerous. Despite higher risks, elderly patients have much to gain from aggressive therapies such as angioplasty, surgery, and thrombolysis. Decisions regarding these therapies are based on an incomplete data base and an understanding of the patients' needs. A review of the available data on cardiac surgery, angioplasty, myocardial infarction, and heart failure in the elderly is presented.

Aged↗
PubMed1988

The role of the chest X-ray in the evaluation of chronic severe heart failure: things are not always as they appear.

The chest x-ray has become a standard clinical test to aid in the evaluation of patients with chronic severe heart failure. To evaluate just how useful this tool is in the routine assessment of pulmonary venous hypertension secondary to heart failure, we compared the radiologist's interpretation of the chest x-ray with hemodynamic data obtained from right heart catheterization in a group of patients undergoing protocol evaluation of an experimental treatment for heart failure. Of 23 patients with pulmonary venous hypertension (pulmonary capillary wedge pressure greater than 20 mmHg) and a complete data base, only 11 had chest x-rays showing evidence of pulmonary venous congestion or interstitial or alveolar edema. The sensitivity of the chest x-ray in selecting patients with a pulmonary capillary wedge pressure over 20 mmHg in this setting was only 48%. In other studies, where the radiologist was aware that his or her reading was being compared to hemodynamic assessments, the sensitivity of the chest film has approached 85%. We feel our analysis more closely parallels routine clinical practice. Clinicians should be aware that the chest x-ray may not be a very sensitive tool for the assessment of pulmonary hemodynamics in patients with severe heart failure.

Adult↗
PubMed1987

Efficacy and safety of sustained (48 hour) intravenous infusions of milrinone in patients with severe congestive heart failure: a multicenter study.

Milrinone is a new bipyridine inotrope that has shown promise in initial clinical testing when administered intravenously or orally. The present multicenter study was designed to evaluate the clinical effectiveness and safety of sustained (48 hour) intravenous infusions of different doses of milrinone, as would be used clinically, in a controlled fashion using invasive hemodynamic monitoring. Entry was limited to adult patients with chronic heart failure of functional class III or IV, with a cardiac index less than or equal to 2.5 liters/min per m2 or a pulmonary capillary wedge pressure greater than or equal to 15 mm Hg, or both. After stable baseline hemodynamic recordings were obtained, milrinone was given as loading (microgram/kg per 10 min) and maintenance infusions (microgram/kg per min) to 189 patients in one of four loading/maintenance dosage regimens: 37.5/0.375 (low dose, n = 26), 50/0.50 (intermediate dose, n = 95), 75/0.75 (high dose, n = 15) and 50/0.25 (lowest dose, n = 53). The lowest dose was shown to be ineffective for maintenance therapy. Effective individual patient responses were defined as greater than or equal to 20% increase in cardiac index or decrease in pulmonary capillary wedge pressure, or both. During early therapy (less than or equal to 3 hour), 99% of patients showed an effective maximal response, and 90% an effective mean response. An effective mean response was observed during days 1 and 2 in 80% of patients, with a positive dose-response trend (69% response, low dose; 80%, intermediate dose; 93%, high dose; day 1). Each loading regimen was effective, with maximal mean response occurring at 15 minutes. Cardiac index initially increased by an average of 24 to 42% for all patients in the three groups, whereas pulmonary capillary wedge pressure decreased by 24 to 33%. Initial decreases in systemic vascular resistance averaged 15 to 31%. Initial changes in heart rate (+4 to +13%) and mean arterial pressure (-2 to -13%) were modest. Significant mean hemodynamic responses were maintained over the 48 hours. Increases in cardiac index for days 1 and 2 averaged 38 and 39% for those completing constant low dose drug, 34 and 37% for intermediate dose and 73 and 44% for high dose. Decreases in pulmonary capillary wedge pressure for all patients averaged 18 to 32% on days 1 and 2, with little dose response. Heart rate changes were modest and variable, averaging -9 to 9%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

The pathophysiology and management of primary pulmonary hypertension.

Primary pulmonary hypertension is a relatively rare disease with a poorly understood pathophysiology, limited therapeutic options, and a dismal prognosis. The advantages and disadvantages of different pharmacologic approaches for this condition are discussed in this article.

Adrenergic alpha-Antagonists↗
PubMed1981

Exercise testing soon after uncomplicated myocardial infarction. Prognostic value and safety.

Modified exercise testing within three weeks of an acute myocardial infarction has been shown to be both a safe and feasible means for identifying patients at greater risk for subsequent cardiac events. An abnormal ECG and symptomatic response to exercise correlates with a higher morbidity and mortality. An ST-segment depression as well as angina are associated with a higher risk of recurrent ischemia and death. Elevation of the ST segment as well as inappropriately high heart rates and early development of fatigue and dyspnea are seen in patients with compromised left ventricular function. Exercise-induced premature ventricular contractions raise the possibility of increased sudden death. Patients identified to be at increased risk can be considered for more intensive medical or surgical treatment to reduce their morbidity and mortality. Patients considered to be at low risk can be spared needless invasive studies and unwarranted restriction of their physical activity. Patients may also accrue psychological benefit from these stress-test procedures.

Adult↗
PubMedDate not supplied

Transesophageal echocardiographic diagnosis of cardiac rupture.

Cardiac rupture is a difficult pre-mortem diagnosis to make and is equally difficult to manage. Transesophageal echocardiography may be useful in expediting the diagnosis and in the management of cardiac rupture related to myocardial infarction.

Aged↗