Showing papers by "Elliott M. Antman published in 1988"
TL;DR: Patients at high risk of sudden cardiac death show evidence of nonlinear heartrate dynamics, including abrupt spectral changes (bifurcations) and sustained low frequency oscillations in heartrate.
Abstract: Patients at high risk of sudden cardiac death show evidence of nonlinear heartrate dynamics, including abrupt spectral changes (bifurcations) and sustained low frequency (.01-.04 Hz) oscillations in heartrate.
205 citations
TL;DR: Oral propafenone is a useful and well tolerated drug for long-term suppression of symptomatic recurrences of atrial fibrillation/flutter despite a history of unresponsiveness to prior antiarrhythmic drug treatment.
114 citations
TL;DR: The vasodilator effects of nitroglycerin (NTG) are mediated via activation of guanylate cyclase and interaction of NTG and NAC may lead to the formation of S-nitroso-NAC, which strongly inhibits platelet aggregation.
Abstract: The vasodilator effects of nitroglycerin (NTG) are mediated via activation of guanylate cyclase; this process is believed to require the availability of free sulfhydryl groups. Previous studies in man have shown that the sulfhydryl donor N-acetylcysteine (NAC) potentiates the systemic and coronary vasodilator effects of NTG. Furthermore, interaction of NTG and NAC may lead to the formation of S-nitroso-NAC, which strongly inhibits platelet aggregation. The effects of intravenous NTG combined with intravenous NAC (5 g 6 hourly) were compared with those of intravenous NTG alone in a double-blind trial in 46 patients with severe unstable angina pectoris unresponsive to conventional treatment, which included calcium antagonists and cutaneous nitrates in all but one patient. Treatment with NTG/NAC (24 patients) and that with NTG alone (22 patients) was associated with a similar frequency of episodes of chest pain and of increments in NTG infusion rate for pain control (10 vs 17; p = NS). The NTG/NAC group had a significantly lower incidence of acute myocardial infarction than the NTG/placebo group (three vs 10 patients; p = .013). Symptomatic hypotension occurred frequently in the NTG/NAC group (seven vs 0 patients; p = .006). Lactate-pyruvate ratios and venous NTG concentrations were not significantly affected by NAC. Subsequently, another 20 consecutive patients were treated with intravenous NTG and continuously infused NAC (10 g/day). Seven remained pain free during the first 24 hr of NTG infusion; 11 required increments in NTG infusion rate for pain control. Acute myocardial infarction occurred in one patient, while none developed symptomatic hypotension.(ABSTRACT TRUNCATED AT 250 WORDS)
104 citations
TL;DR: Analysis of clinical outcomes in 46 patients with ventricular septal rupture revealed that systolic blood pressure, right atrial pressure, and cardiopulmonary bypass time were strongly predictive of survival and identified a group of persons who wee much more likely to survive surgical intervention.
77 citations
TL;DR: Clinical, pathologic and radiologic findings in 5 patients who had aneurysms of atherosclerotic SVs used as conduits for CABG are described and patients were admitted to Brigham and Women’s Hospital for repeat cardiac catheterization 6 to 10 years after CABGs with SVs.
Abstract: 1 ate postoperative atherosclerosis of a saphenous vein [SV) used for coronary artery bypass grafting (CABG) is frequent. Only 40 to 45% of such SV grafts have a normal angiographic appearance 10 years after CABG.1-3 Saphenous vein graft aneurysms occurring 4 to 6 months after CABG are likely related to venous valves.4 Late graft aneurysms associated with atherosclerosis are unusual586 The present study describes clinical, pathologic and radiologic findings in 5 patients who had aneurysms of atherosclerotic SVs used as conduits for CABG. All patients were admitted to Brigham and Women’s Hospital for repeat cardiac catheterization 6 to 10 years after CABG with SVs. Multiple projections including the right and left anterior oblique [with both caudal and cranial angulation) and the anteroposterior views were obtained of the native coronary arteries and the SV grafts. All 5 patients subsequently underwent repeat CABG. The aneurysmal segments of the SV grafts were removed, fixed in formalin, embedded in paraffin, sectioned and stained with hematoxylin
57 citations
TL;DR: The hemodynamic responses to esmolol, an ultrashort-acting beta 1-adrenergic receptor antagonist, were examined in 16 patients with myocardial ischemia and compromised left ventricular function as evidenced by a mean pulmonary capillary wedge pressure of 15 to 25 mm Hg.
39 citations
TL;DR: Combined treatment with NTG and NAC in patients with unstable angina pectoris may augment the clinical efficacy of NTG, largely by reducing the incidence of acute myocardial infarction, but the high incidence of severe hypotension suggests that this regimen should be used with some caution.
Abstract: N-acetylcysteine (NAC) has been shown to potentiate the haemodynamic and antiplatelet effects of nitroglycerine (NTG) in man, and to limit the development of haemodynamic tolerance to NTG. These effects may be mediated. by the formation of S-nitroso-NAC, which induces vasodilation and strongly inhibits platelet aggregation. In a randomized double-blind study in 46 patients with severe unstable angina pectoris unresponsive to standard treatment (including cutaneous nitrates and calcium antagonists in 45 patients) we compared the effects of intravenous (IV) NTG with those of IV NTG combined with IV NAC (5 g 6 hourly). Treatment with NTG/NAC (24 patients) was associated with a similar frequency of episodes of chest pain as treatment with NTG alone (22 patients), but somewhat fewer increments in infusion rate for pain control (10 vs 17; P NS). The NTG/NAC group had a significantly lower incidence of acute myocardial infarction than the NTG/placebo group (3 vs 10 patients; P = 0.013). Symptomatic hypotension occurred frequently in the NTG/NAC group (7 vs 0 patients; P = 0.006). It is concluded that combined administration of NTG and NAC in patients with unstable angina pectoris may augment the clinical efficacy of NTG, largely by reducing the incidence of acute myocardial infarction. However, the high incidence of severe hypotension with NTG/NAC suggests that this regimen should be used with some caution.
22 citations
TL;DR: The absence of DSB should not rule out permanent pacing for symptomatic patients in any diagnostic group and future pacing guidelines should be revised to offer additional detail regarding the influence of symptoms, extent of asymptomatic bradycardia, and results of provocative tests.
Abstract: Recently, emphasis has been placed on documenting symptomatic bradycardia (DSB) before pacemaker placement can be justified in some patients. This study was designed to judge whether DSB improved the likelihood of symptom relief after pacing in 93 patients who had symptoms prior to pacing. Patients with complete heart block (Group A) had excellent symptomatic relief with or without pre-pacemaker DSB (100% vs 94%, P = NS). Patients with other diagnoses (Group B) also had a high incidence of symptomatic relief after pacing, regardless of whether or not DSB was present pre-implant (28/30 (93%) vs 23/28 (82%) P = NS). When evaluated as a test to predict the response to pacing for Group B patients, spontaneously occurring symptomatic bradycardia was neither highly sensitive (55%) nor highly specific (71%). Moreover, while the ability of a positive test to predict resolution of symptoms after pacing was high (93%), the ability of a negative test to predict a poor outcome after pacing was low (18%). The absence of DSB should not rule out permanent pacing for symptomatic patients in any diagnostic group. Future pacing guidelines should be revised to offer additional detail regarding the influence of symptoms, extent of asymptomatic bradycardia, and results of provocative tests in determining which implants should be classified as definitely indicated.
9 citations