Showing papers by "Kim A. Eagle published in 1986"

Spectrum of conditions initially suggesting acute aortic dissection but with negative aortograms

Abstract: Between 1963 and 1983, 55 patients presented to our hospital with a clinical picture that suggested aortic dissection but with aortograms that were interpreted as negative for that entity. In 4 patients, the aortographic findings subsequently proved to be false negative. The remaining 51 patients had the following diagnoses: myocardial infarction in 9 patients; aortic regurgitation in 5; thoracic nondissecting aneurysm in 4; musculoskeletal pain in 4; mediastinal tumor in 4; pericarditis in 3; acute coronary insufficiency in 3; cholecystitis in 2; miscellaneous in 3; and unknown in 14. The clinical features in these patients were compared with those of 125 patients with true aortic dissection. Three features were significantly more prevalent in patients with than without dissection: prior systemic hypertension, pain for 24 hours or less, and migratory pain. Patients without dissection were younger than those with distal dissection and had significantly less systemic hypertension, posterior thoracic pain and migratory pain. Patients without dissection had significantly less frequent congestive heart failure, pulse deficits and aortic regurgitation, and more frequent hypertension and pain for more than 24 hours than patients with proximal dissection. This study defines the actual differential diagnosis of aortic dissection at our hospital, the frequency of false-negative aortographic findings and contrasts the clinical features of patients with and without dissection.

Atrial fibrillation while chewing nicotine gum.

Abstract: To the Editor.— Since 1984, nicotine chewing gum has been widely prescribed by physicians to aid cigarette smokers attempting to give up their habit. Many smokers who could benefit from smoking cessation have cardiovascular disease. Whether they can safely use the gum has not been established, because there are no published reports of gum use in cardiac patients. We report here a man with known cardiovascular disease who developed atrial fibrillation while chewing nicotine gum. Report of a Case.— A 52-year-old male smoker with known coronary artery disease sought help in order to stop smoking. He had smoked three packs of cigarettes per day for 35 years and made several unsuccessful attempts to quit. Following coronary artery bypass surgery in 1981 he did not smoke for three years, but relapsed during a time of stress. When seen, he was smoking one pack of low-tar and nicotine cigarettes daily, had rare

Single-Chamber and Dual-Chamber Cardiac Pacemakers: A Formal Cost Comparison

Abstract: Dual-chamber pacemakers, more sophisticated and costly than single-chamber pacemakers, are being used with increasing frequency, often with unclear indications. Proponents of dual-chamber devices have focused on initial differences in cost without considering additional induced costs. We examined the incremental cost of dual-versus single-chamber pacemakers over the expected lifetime of a pacemaker recipient. In addition to initial costs, we included the costs of pacemaker malfunction, reimplantation, generator replacement, and follow-up. Expected differences in cumulative costs per patient were calculated over a 12-year period. Dual-chamber pacing is $2500 more costly at implantation. The difference in cumulative cost increases to $5100 by year 12, reflecting shorter functional life for dual-chamber pacemaker generators and increased cost of follow-up. The incremental cost of dual-chamber pacemaking is neither short-term nor trivial. Dual-chamber pacemakers should be reserved for those who clearly benefit from its advanced technology.