Interpretation and timing of death: The development and initial validation of the interpretation of death (IOD) scale and the attitudes toward medical interventions in the timing of death (AMITOD) scale.

Decreasing religious authority and increasing medical interventions at the end-of-life emphasize the importance of the interpretation and timing of death. Therefore, the three-dimensional interpretation of death scale (evaluating religious, rational, and personal interpretation of death) and the three-dimensional attitudes toward medical interventions in the timing of death scale (evaluating euthanasia, life prolongation and nonintervention) were constructed and assessed in a survey among 356 older Dutch adults. Religious interpretation of death was found to be associated with disapproval of euthanasia and approval of nonintervention, rational interpretation of death with approval of euthanasia, and personal interpretation of death with approval of nonintervention.

Hypertrophic and restrictive cardiomyopathies in the elderly.

Congestive heart failure (CHF) increases with age, but most CHF in the elderly is due to diastolic dysfunction with preserved systolic function. The etiology, pathophysiology, diagnosis, natural history, and treatment of hypertrophic and restrictive cardiomyopathies in the elderly are discussed as a paradigm for CHF with normal systolic function. Hypertrophic obstructive and hypertensive hypertrophic cardiomyopathies are compared and contrasted.

Severely symptomatic mitral stenosis with a low gradient: a case for low-technology medicine.

We have observed a group of patients with mitral valve disease and severe symptoms but also with low transmitral gradients and normal cardiac outputs who defy the traditional hemodynamic explanation of mitral stenosis. We performed a 10-year retrospective chart review of all mitral valve replacements at our institution to further characterize this population. The study group consisted of 16 of 132 patients (12%) with symptomatically severe (New York Heart Association [NYHA] class 3.

Calcium channel blockade in dialysis patients with left ventricular hypertrophy and well-preserved systolic function.

Echocardiographic evidence of left ventricular hypertrophy with well-preserved systolic function was established in 4 chronic hemodialysis patients with a history of refractory pulmonary congestion. In each patient a trial of treatment with verapamil (40 mg t.i.