Showing papers by "Kim A. Eagle published in 1988"

Clinical and hemodynamic comparison of VVI versus DDD pacing in patients with DDD pacemakers.

Abstract: To identify better those subgroups of pacemaker recipients who will benefit from dual chamber pacing, 19 patients with DDD pacemakers that were physiologically paced were entered into a blinded, randomized protocol comparing long-term VVI versus DDD pacing. Patients were evaluated in each of the pacing modes for exercise performance, cardiac chamber size, cardiac output, functional status and health perception. Eight patients (42%) insisted on early crossover, from VVI to DDD pacing, after only 1.8 ± 1.4 weeks because of symptoms consistent with pacemaker syndrome. Overall, 12 patients preferred DDD pacing and no patient preferred VVI pacing (p = 0.001). Percent fractional shortening (30 ± 8 vs 24 ± 6%, p = 0.009) and cardiac output (6.3 ± 2.6 vs 4.4 ± 2.2 liters/min, p = 0.0001) where significantly greater in the DDD mode. Exercise duration was greater during DDD compared with VVI pacing (11.3 ± 3.7 vs 10.1 ±3.7 minutes, p = 0.006). However, it was only in the crossover subgroup that DDD pacing resulted in significant improvement in exercise performance and health perception compared with VVI pacing. This subgroup of patients was characterized by an intrinsic sinus rate of

What is inappropriate care

Abstract: Though wide variations in the application of medical technologies have been recognized for decades, they have only recently become the object of intense scrutiny and debate. Such variations have important implications for the cost and quality of medical care. But these variations also raise specific questions about the process of clinical decision making for patients, physicians, and those charged with the responsibility to gather and disseminate information on which clinical decisions are based. The focus on the decision-making process has been sharpened by the professional uncertainty hypothesis that holds that variations can largely be explained by differences in physicians' beliefs about the value of procedures and practices for meeting patient needs. 1 The professional uncertainty hypothesis has sparked its own controversy. Patients have been told by informed commentators that medicine is an imprecise science "at its base, more gamble and guesswork than certainty" ( The Boston Globe , Feb 3, 1986). Physicians

Left ventricular ejection fraction. Physician estimates compared with gated blood pool scan measurements.

Abstract: • Gated blood pool scanning (GBPS) is an expensive, frequently used test to assess the left ventricular ejection fraction (LVEF). To determine whether a simpler method of evaluating LVEFs was reliable, we compared the LVEFs derived by GBPS with those estimated in a cardiologist's examination in 125 hospitalized patients. Of the physician estimates, 56% were accurate to within 7.5%, while 17% were underestimates and 27% were overestimates. The variables that were most predictive of reduced LVEF included cardiomegaly and pulmonary venous congestion on chest roentgenogram and S3gallop, hypotension, and sustained left ventricular apex beat on examination. Prior hypertension was correlated with an increased LVEF. Variables associated with physician error in estimating the LVEF included a history of hypertension, bron-chodilator therapy, and right bundle-branch block seen on the electrocardiogram. These data suggest that although qualitatively accurate estimates of the LVEF can sometimes be made on the basis of clinical findings, GBPS should be performed when management decisions hinge on a precise knowledge of this value. (Arch Intern Med1988;148:882-885)

Case 40-1988

Abstract: Presentation of Case A 62-year-old woman was admitted to the hospital because of increasing peripheral edema. There was a four-year history of Sjogren's syndrome, with a dry mouth and Raynaud's phe...