Harold S. Marcus

Bio: Harold S. Marcus is an academic researcher from Cedars-Sinai Medical Center. The author has contributed to research in topics: Cardiac catheterization & Myocardial infarction. The author has an hindex of 9, co-authored 16 publications receiving 2922 citations. Previous affiliations of Harold S. Marcus include University of California, Los Angeles & Memorial Hospital of South Bend.

Catheterization of the Heart in Man with Use of a Flow-Directed Balloon-Tipped Catheter

Abstract: Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 Fr double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 seconds in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.

Failure of Intracoronary Nitroglycerin to Alleviate Pacing-Induced Angina

Abstract: Relief of angina by nitroglycerine has been attributed to two possible mechanisms: (1) Increase in myocardial blood supply by direct action of the drug on the coronary arteries. (2) Reduction in myocardial oxygen demand by action of the drug on the systemic circulation. Sublingual application of nitroglycerin in previous studies did not allow the ruling out of the operation of either or both mechanisms. This study was, therefore, designed in such a way that the effect of the direct action of nitroglycerin on the coronary bed on angina could be studied in the absence of changes in the systemic circulation. In 25 patients undergoing cardiac catheterization and coronary arteriography as possible candidates for revascularization surgery, nitroglycerin, 0.075 mg in 1 ml of 5% dextrose, was injected into the left coronary artery through the angiographic catheter during angina pectoris induced by pacing. Coronary sinus blood flow by the continuous thermodilution method, femoral artery blood pressure, and lead V5...

The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

Abstract: ContextAcute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting.ObjectiveTo assess the presentation, management, and outcomes of acute aortic dissection.DesignCase series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records.SettingThe International Registry of Acute Aortic Dissection, consisting of 12 international referral centers.ParticipantsA total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection.Main Outcome MeasuresPresenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records.ResultsWhile sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%.ConclusionsAcute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction)...

Abstract: Angina/Non-ST-Elevation Myocardial Infarction : ACC/AHA 2007 Guidelines for the Management of Patients With Unstable ISSN: 1524-4539 Copyright © 2007 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online 72514 Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX doi: 10.1161/CIRCULATIONAHA.107.18194

Plaque fissuring--the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina.

Abstract: The clinical management of acute myocardial infarction and crescendo angina as well as the prevention of sudden ischaemic death require accurate knowledge of the underlying arterial pathology. It is on just this aspect that until recently there has been disagreement particularly among pathologists. In brief, this controversy was concerned with whether coronary artery thrombi were or were not directly responsible for all three clinical pictures of acute ischaemia. Resolution of the controversy has been derived from coronary angiography in life in patients with acute infarction and crescendo angina and from detailed pathological studies. These latter studies differ from many carried out previously by the use of postmortem coronary angiography and histological reconstruction of the microanatomy of occlusive lesions.

Thrombosis and Acute Coronary-Artery Lesions in Sudden Cardiac Ischemic Death

Abstract: The nature of the pathologic lesion in sudden cardiac ischemic death is in dispute. Among 100 subjects who died of ischemic heart disease in less than six hours, coronary thrombi were found in 74. There was no difference in incidence between those who died in less than 15 minutes, those who died in 15 to 60 minutes, and those who died after one hour. Among 26 cases without an intraluminal thrombus, plaque fissuring was found in 21; thus, in only 5 cases was no acute arterial lesion demonstrated. No intraluminal thrombi were found in age-matched controls. Forty-eight of the 74 thrombi were found at sites of preexisting high-grade stenosis; 14 were found at points of previous stenosis of less than 50 per cent of the diameter of the lumen. Forty-seven per cent of the thrombi were found in the right coronary artery. Only 30 per cent were found in the left anterior descending coronary artery. The pathologic process in sudden ischemic death involves a rapidly evolving coronary-artery lesion in which plaque fissuring and resultant thrombus formation are present. These findings have implications for the prevention of sudden cardiac death by antithrombotic therapy.