Comprehensive therapy
-
The ECG is useful in diagnosing acute myocardial infarction and unrecognized Q-wave myocardial infarction in the elderly. Unrecognized myocardial infarction and myocardial infarction associated with clinical symptoms have a similar incidence of new coronary events. Ischemic ST-segment depression on the resting ECG is associated with an increased incidence of new coronary events. ⋯ In the elderly, atrial fibrillation is associated with an increased incidence of thromboembolic stroke and new cardiac events. Premature atrial complexes and paroxysmal supraventricular tachycardia are not associated with an increased cardiac risk. Complex ventricular arrhythmias on the resting ECG are associated with an increased incidence of cardiac events in elderly patients with heart disease but not in elderly patients without heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Comprehensive therapy · Jul 1992
ReviewVentricular/vascular interaction in health and heart failure.
In summary, the concept of aortic input impedance, which has been examined in detail, requires evaluation of the flow and pressure pulsations within the ascending aorta to determine an input impedance spectrum. This function describes the load imposed on the ejecting left ventricle by the systemic vasculature in terms of pulsatile and steady-flow components and is independent of changes in ventricular performance. The components contain information about the mechanical properties of the large vessels (elastance), arteriolar bed (resistance), and waves reflected (reflectance) within the arterial system. ⋯ With vasorelaxation, all components of vascular loading decrease and result in markedly improved generation of left ventricular power and cardiac output. Recent evidence suggests that agents inducing vasorelaxation can influence various regions of the aorta and large vascular beds in a different manner. This would result in the ability to alter elastance, resistance, and reflectance selectively to affect pulsatile and steady-flow components of load.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Comprehensive therapy · Apr 1992
ReviewPriorities and diagnostic studies in the management of the injured patient.
The traumatized patient is best served by an orderly and sequential resuscitation and evaluation. Primary priorities include the establishment of a secure airway, adequate ventilation and hemodynamic status. These considerations should be followed by a brief history, systemic physical examination and radiographic studies. ⋯ In penetrating trauma, traversing missiles mandate surgical exploration. Stab wounds may be managed by several alternative methods. Emergency thoracotomy has a limited role in the blunt trauma patient but may be life saving in those suffering penetrating trauma.