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Biomedical subjects

T E Cuddy

Publications and source records attributed to T E Cuddy.

35 records · Page 2Linked to original sources
PubMed1975

Dose-response relation between therapeutic levels of serum digoxin and systolic time intervals.

A dose-response relation between cardiac glycosides and systolic time intervals has previously been established in short-term studies in which the glycoside was administered intravenously in these studies there was uncertainty regarding the steady state kinetics, and maintenance of the early serum levels would have resulted in toxicity. Accordingly, we studied the effect on systolic time intervals of small increments of serum digoxin within the therapeutic range. Serum digoxin concentration and systolic time intervals were measured in 21 patients receiving 0.25 mg of the glycoside daily. The daily dose was increased to 0.5 mg and measurements were repeated 5 to 7 days later. Serum digoxin concentration with the smaller dose was 0.56 plus or minus (standard error) 0.06 ng/ml and increased to 1.18 plus or minus 0.11 ng/ml with the larger dose. Associated with the increased serum digoxin was a mean decrease in duration of total electromechanical events of 6.3 plus or minus 2.9 msec (P smaller than 0.025), which resulted from a mean shortening of left ventricular ejection time of 5.6 plus or minus 3.0 msec (P smaller than 0.05). The mean decrease in preejection phase of 1.1 plus or minus 2.1 msec was insignificant (P larger than 0.2). Repeated measurements in control patients showed no change in serum digoxin concentration or systolic time intervals. In nine patients the digoxin dose was randomly varied between 0 and 0.75 mg and measurements were made 4 to 5 days after drug administration at each dose level. The correlation coefficient between changes in serum digoxin and changes in left ventricular ejection time was minus 0.55 (P smaller than 0.01) the data indicated that increasing the maintenance dose of digoxin while keeping the serum level within therapeutic range will result in improved ventricular function as assessed by determination of systolic time intervals.

Adult↗
PubMed1972

Ventricular septal defects due to penetrating injuries of the heart.

Four patients with traumatic ventricular septal defect following stab wound underwent successful open heart repair. All were symptomatic in spite of minimal hemodynamic disturbances. An additional lesion in the form of a fistulous tract between the aorta and the right atrium occurred in one case.

Adolescent↗
PubMed1969

Respiratory insufficiency in acute myocardial infarction.

Arterial blood gases and pH were assessed in 115 patients who had suffered a myocardial infarction, with or without complicating cardiogenic shock or cardiac standstill. In 11 of the 78 uncomplicated cases and in 16 of the 37 complicated cases, the arterial O(2) tension was much lower than would be expected on the basis of a three-fold drop in cardiac output, indicating considerable right to left shunting. The death rate in the patients with uncomplicated myocardial infarction was 32% and that of the complicated cases 65%. In both groups it was greatest when the arterial pH was low, indicating that correction of the acidosis is essential. In many instances administration of 100% oxygen is inadequate to restore the oxygen tension to normal levels, and controlled ventilation may be necessary to maintain adequate alveolar ventilation. The findings indicate the necessity for repeated assessment of the arterial blood gas tensions and pH in any patient who has suffered a myocardial infarction. If the management of such patients is designed to provide adequate oxygenation, to maintain adequate alveolar ventilation and to correct the acid-base disturbances, the patient may be tided over the stage of "cardiac pump failure".

Acid-Base Equilibrium↗
PubMed1965

Heart affairs.

Explore the source record for details and available documents.

Canada↗
PubMedDate not supplied

The role of perceived overprotectiveness in recovery 3 months after myocardial infarction.

PURPOSE: The purpose of this study was to test the hypothesis that overprotectiveness of patients after myocardial infarction (MI) by the spouse has a negative effect on recovery. METHODS: Subjects were 52 male patients who were admitted to one of four area hospitals with a first documented myocardial infarction (MI) and their wives. While in hospital, patients were interviewed by a research nurse who rated the patient's emotional distress on a scale from 1 to 10. Patients completed a Family APGAR and a self-efficacy scale for cardiac patients estimating their level of functioning in 3 months. Wives also completed a Family APGAR, an estimate of their husbands' functioning in 3 months using the self-efficacy scale, and Zung Depression and Anxiety scales. At 3 months post-MI, patients completed the following questionnaires: Family APGAR, self-efficacy scale for cardiac patients regarding current functioning, Zung Anxiety and Depression scales, and the Psychosocial Adaptation to Illness Scale. Perceived overprotectiveness and criticism were measured using the Influential Relationships Questionnaire. The Goldman Specific Activity Scale was used to quantify cardiac recovery. Wives completed the same questionnaires as at the first assessment. RESULTS: Perceived overprotectiveness was positively correlated with patients' anxiety and depression, with perceived criticism from their wives, and correlated negatively with quality-of-life. However, it was not related to the patients' confidence in their functional abilities or to cardiac functional classification at 3 months. Wives who were perceived as overprotective had been less optimistic about their husbands' functional recovery immediately after the MI. Patients who perceived themselves to be overprotected at 3 months had also been less optimistic about their functional recovery when assessed a few days post-MI. CONCLUSIONS: Although perceived overprotectiveness is part of a negative emotional experience for the male patients, it does not appear to be related to perceived functional abilities or cardiac functional classification at 3 months post-MI. Whether the perceived overprotectiveness studied here is a function of the patient's overall emotional state or the wife's actual behavior or a combination of both is an area for future research.

Adaptation, Psychological↗
PubMedDate not supplied

Selection bias in the use of thrombolytic therapy in acute myocardial infarction. The SAVE Investigators.

OBJECTIVE: To determine whether clinical selection for thrombolytic therapy for acute myocardial infarction results in a skewed population for subsequent adverse cardiovascular events. DESIGN: A comparison of the clinical features of the patients in the Survival and Ventricular Enlargement Study who either had or had not received thrombolytic therapy was conducted in both univariate and multiple logistic regression analyses. SETTING: Hospitalized patients experiencing acute myocardial infarction from 112 broadly representative, private, academic, and government hospitals in the United States and Canada. PATIENTS: All patients in the Survival and Ventricular Enlargement Study had had a recent myocardial infarction (less than 16 days) and had a left ventricular ejection fraction of 40% or less. INTERVENTION: Thrombolytic therapy was administered to 733 patients and was not given to 1498. MAIN OUTCOME MEASURES: The comparisons with respect to use of thrombolytic therapy were formulated after the completion of enrollment and indicated that the majority of patients did not receive thrombolytic therapy. RESULTS: The 1498 (67.1%) patients who did not receive thrombolytic therapy were at higher risk (older age, lower functional capacity, greater likelihood of a history of prior myocardial infarction, angina, diabetes, and hypertension) for subsequent cardiovascular events and, as anticipated, were more likely to have concomitant gastrointestinal and neurological diseases. A multiple logistic regression analysis indicated that older age, prior myocardial infarction, impaired functional status, employment status, diabetes, and neurological diseases were predictors of use of thrombolytic therapy. CONCLUSION: Although the Survival and Ventricular Enlargement Study population was selected for left ventricular dysfunction, the majority of patients who currently are judged clinically as unsuitable for thrombolytic therapy have a higher risk for adverse cardiovascular events.

Captopril↗