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ACUTE MYOCARDIAL INFARCTION: Reaction and Recovery
Patients who were extensive scanners or highly anxious or both were more likely to have another MI within 12 weeks.
The lengths of stay in the coronary unit and in the hospital were strongly affected by a factor referred to here as information coupling. Although this factor was revealed in different ways, its common element concerned how an individual was given information about his cardiac condition. If the information was coupled with chores for him to do to foster his recovery, then his stays in the hospital and in the coronary unit were short. If, on the other hand, the patient was given information not coupled with other procedures, that is without participation in the treatment or without diversion, his stays in the coronary unit and the hospital were much longer. (p. 94).
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Death from another MI within 12 weeks of admission was more frequent among paints who departed from the coronary unit with a low mood for social affection. Whether this psychological factor is a crucial mediator or whether underlying physiological states lead to the unfavorable mood and to death remains to be seen.
NEFA elevation in response to a psychologically stressful period is associated with subsequent death from MI within 12 weeks after leaving the hospital.
In the prediction of subsequent hospitalization with another MI within 12 weeks, as with the prediction of death psychological factors were surprisingly predominant and more powerful than blood, electrocardiographic, and clinical symptomatic measures. As noted earlier, the most powerful predictor of an early recurrent MI is the extensiveness of scanning Second, to this is sedimentation rate.
At a less strict [but statistically significant] criterion of inference, rehospitalizations with subsequent MIs within 12 weeks were also predicted by elevated plasma -- hydroxy-corticosteroids -- hours after a psychologically stressful event. High anxiety, high depression, and a low level of maximum-recorded blood pressure during coronary unit stay were also predictive of rehospitalizations with subsequent MI within 12 weeks. These findings, together with those in the comparison and prognosis search study, suggest that the coronary-prone and coronary-recurrent individual may ruminate about a psychologically stressful event long after it is over.
Combining those patients who died and those who were rehospitalized with another MI within 12 weeks, additional findings emerged. This combined group entered the coronary cunit with moods of high anxiety, sadness, and skepticism. They departed with moods of high anxiety. They had more cardiac episodes while on the coronary unit. Lactate dehydrogenase, as well as sedimentation rate, was higher. The total severity rating was higher. On the coronary proneness scale the death and/or rehospitalizations" group was high on reported scanning and perfectionism.
Temperature level is the key factor associated with clinical symptoms of myocardial infarction during the first 24 hours on the coronary unit. In fact, the severity level at that time is useful in predicting the number of days with elevated temperature thereafter. (Temperature is also the major index that determines the patient's reported level of comfort.) On the other hand, severity of clinical symptoms after the first 24 hours is associated more with the direct manifestation of cardiac disturbance; such as arrhythmias and cardiac episodes here the patient requires assistance.(p. 96-97).
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The severity of a myocardial infarction [as judged from clinical symptoms] is minimally related to recurrence within 12 weeks. Besides this relative independence of severity and prognosis, severity of myocardial infarction is a complex concept. Different indices of severity were independent. One type of severity (cardiac episodes, arrhythmias) and the clinical symptoms related to it (circulatory symptoms, prostration, cardiogenic shock). This type of severity seems to reflect how well the heart is performing as a blood pump. A second type of severity seems to assess the extent of myocardial lesion. Thus, the two enzymes, LDH and SGOT, are centrally involved. (p. 98).
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A major comparison of acute MI and non-MI patients was made during a mildly stressful psychological task. This task, although not as stressful as an exciting bridge game or television program, was sufficiently stressful to produce measurable elevation in plasma -- hydroxycorticosteroids. The acute MI group, after showing no immediate response, gave a delayed (70 minutes later) but highly elevated hydroxycorsticosterid response. By contrast, nonMI patients had an immediate and mild response but no delayed response.
The acute MI patients also had a higher steroid level throughout the day than non-MI patients, this level decreasing with increasing days of hospitalization. The on-ward non-MI patients (those with suspected but disconfirmed MIs and still on the coronary unit) had higher steroid levels than the non-MI patients elsewhere in the hospital.
No differences between MI and non-MI patients were found in the pattern of circadian rhythm of plasma 17-0H-CS. Also, no differential plasma 17-OH-CS response resulted from failing vs. succeeding on the psychological task; both showed the stress response of plasma elevation. (p. 98)