Seventeen patients with severe ischaemic heart failure without angina were studied prospectively to determine the effects of surgical revascularization on exercise tolerance, peak oxygen consumption and left ventricular function at rest and during inotropic stimulation at 3 months after surgery. Suitability for surgery was assessed by the presence of ischaemia identified by thallium scintigraphy and stress electrocardiographic (ECG) testing and the left ventricular response to dobutamine measured by radionuclide ventriculography. One patient died awaiting surgery and one required cardiac transplantation. Fifteen patients underwent coronary artery surgery with two perioperative deaths. Thirteen patients were restudied 3 months after surgery. Mean treadmill exercise time (362 +/- 204 s to 562 +/- 303 s, P < 0.05) and peak oxygen consumption (14.9 +/- 3.5 ml/kg per min to 20.8 ml/kg per min, P < 0.01) increased significantly. Resting ejection fraction was not changed after surgery (20 +/- 5% to 21 +/- 6%) but ejection fraction during derived from thermodilution Swan-Ganz catheter data both at rest during dobutamine stimulation were unchanged after surgery. At 13 +/- 3 months after surgery there had been three sudden deaths and one patient had undergone successful cardiac transplantation. Of the remaining nine patients, three had improved to NYHA symptomatic class I, three were in NYHA class II and three in NYHA class III. Repeat treadmill exercise testing in seven patients showed that the improvement in exercise capacity evident in the first follow-up visit was maintained during long-term follow-up.
No abstract
Glagovian remodelling, plaque composition, and stenosis generation Necropsy and intravascular ultrasound (IVUS) studies in vivo show that while the angiogram is good at detecting high grade stenosis it is very insensitive for demonstrating the actual extent of atherosclerosis. Segments of an angiographically normal coronary artery can harbour many occult plaques. 1 There are two reasons for this insensitivity. The first is that behind the plaque itself the media may vanish allowing the plaque to bulge into the adventitia rather than toward the lumen. 2 In extreme cases the internal elastic lamina breaks allowing the plaque to be extruded from the artery wall. The second process is that of arterial remodelling (compensatory dilatation) described by Glagov. 3 In this process when a plaque develops the arterial media remodels to allow the vessel to increase its cross sectional area and thereby accommodate the plaque without any reduction in lumen area. At the site of a plaque the vessel cross sectional area can be increased by anything up to twice that found at an adjacent reference segment of normal artery. What is interesting, and not well understood, is that the degree of remodelling varies widely from plaque to plaque. Within one coronary artery there may be a plaque with no remodelling, while in another segment of the same artery at the site of a plaque there may be a 100% increase in the artery cross sectional area. 1 Remodelling is plaque specific rather than patient specific.
The nursing role in the monitoring and measurement of blood pressure is shown on the 60 cent stamp from British Virgin Islands issued in 1983 as part of a four stamp set marking Nursing Week. The 10 cent stamp in this set features Florence Nightingale and the 75 cent stamp Peebles Hospital. The United Nations issue stamps for use on mail posted at their New York, Geneva, and Vienna headquarters. Whereas the stamps from each site share a common theme the designs are frequently very diVerent. Six stamps (two from each site) were issued in 1988 for the International Volunteer Day. The stamps from the UN Headquarters in New York and Geneva featured teaching in various areas including fruit growing and animal husbandry. One of the Vienna HQ stamps carried a health theme showing nursing services and blood pressure measurement.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.