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Showing papers by "Elliott M. Antman published in 1989"


Journal ArticleDOI
TL;DR: Although these predictors are likely to be of little therapeutic value for free wall rupture, since most patients with that complication die within minutes of its onset, they may aid in alerting physicians to the early diagnosis and timely surgical correction of ventricular septal rupture.

204 citations


Journal ArticleDOI
TL;DR: The present study was undertaken to examine the efficacy and safety of intravenous propafenone in the acute management of AF in a less restricted patient population.
Abstract: Propafenone is a new class IC antiarrhythmic agent that is potentially useful for the management of patients with atrial fibrillation (AF). Recent studies demonstrate that oral propafenone is effective for maintaining sinus rhythm after electrical conversion from AF. 1–3 Intravenous propafenone is effective in rapidly terminating supraventricular tachycardia due to reentrant mechanisms. 4,5 Recently, intravenous propafenone was also reported to be useful in the acute management of AF in patients after cardiac surgery. 6 The present study was undertaken to examine the efficacy and safety of intravenous propafenone in the acute management of AF in a less restricted patient population.

56 citations


Journal Article
TL;DR: The development of digoxin-specific Fab fragments has led to improvement in treatment of advanced and refractory digitalis toxicity and opens up the possibility of improvement in diagnosis of less clinically obvious cases of digitalis intoxication.
Abstract: After more than two centuries of administration of digitalis glycosides to patients with cardiac disease, empirical observation and tradition remain the basis for much of the clinical application of these drugs. Many questions remain, and the role of digitalis in the management of congestive heart failure and cardiac rhythm disturbances is changing with improvement in our understanding of the pathophysiology of these conditions and the availability of newer effective agents that may have less potential to cause life-threatening toxicity. Nevertheless, digitalis glycoside therapy is a familiar therapeutic intervention for the majority of physicians and remains appropriate in carefully selected patients. The development of digoxin-specific Fab fragments has led to improvement in treatment of advanced and refractory digitalis toxicity and opens up the possibility of improvement in diagnosis of less clinically obvious cases of digitalis intoxication. The role of digitalis glycosides in the management of supraventricular tachyarrhythmias and congestive heart failure in the presence of sinus rhythm should now be revised. In each of these clinical circumstances, alternative drugs or other modes of therapy have been developed that reduce the dependence of clinicians on digitalis as the sole or primary approach to management. In the immediate management of paroxysmal reentrant supraventricular tachyarrhythmias, verapamil has largely replaced digoxin as the drug of choice, although digoxin has an ancillary role, especially in patients with impaired ventricular function. In the management of patients with atrial fibrillation or atrial flutter with a rapid ventricular response, verapamil or diltiazem and beta-adrenergic-blocking drugs will effectively slow the ventricular response, thus reducing the likelihood of approaching the threshold of digitalis toxicity to achieve adequate rate control. In the treatment of patients with congestive heart failure and normal sinus rhythm, one must now recognize a subset of patients with diastolic rather than systolic dysfunction who are best treated by correcting underlying causes of left ventricular hypertrophy or ischemia rather than inotropic support with cardiac glycosides. Symptomatic patients with dilated ventricles and impaired contractile function should undergo correction of abnormalities of preload with vasodilators acting on the venous bed as well as diuretics, and reduction of elevated afterload with vasodilators that reduce arteriolar resistance and thus improve ventricular emptying.(ABSTRACT TRUNCATED AT 400 WORDS)

5 citations


Journal ArticleDOI
TL;DR: It appears that there is no appreciable increase in mortality or morbidity when metoprolol is used in the community practice of acute coronary care.

5 citations