Cardiovascular Disease Reversed

Healthy Heart Network

Healthy Heart Network is the missing link you've been searching for a better and healthy heart. It's a great solution for heart diseases especially when they begin to mildly manifest. Therefore, don't take too long to sign up for this program. The earlier the better for you or you may soon realize that it's too late for you. I am sure you've heard of the quote It's better prevention than cure and this program is the prevention you need for better and strong heart health that is resistant to diseases. Still don't believe if it works. The inspiration behind this book is from a true-life story. It was a heart attack incidence that almost took the life of the victim. But thanks to this program, you no longer need to rash for cure but rather prevention that guarantees a healthy heart. It's backed by years of research, help from experts, and Dr. Warrick who is an acting cardiologist. So, sign up for this program today and protect yourself as well as save another life together with Dr. Warrick by referring this program to someone who needs it. Read more...

Healthy Heart Network Summary

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My Healthy Heart Network Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

All the modules inside this book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Table 17 A casecontrol study of Chlamydia infection and coronary atherosclerosis13

Confounding arises when exposed and unexposed subjects are not comparable for a variable which represents a risk factor for the outcome of interest. Tables 1.8 and 1.9 give an example. In Table 1.8, results of a cohort study of the association between radiotherapy to the chest for Hodgkin's disease and subsequent mortality from coronary artery disease are presented.14 The risk of coronary disease death was 2.0 in the exposed (70 3530), and 4.0 in the unexposed (54 1360). The relative risk was therefore 0.5 ( 2 4 ), indicating a reduced coronary disease mortality after radiation to the chest. This result was surprising, as the investigators' hypothesis, arising from previous research in other types of patients and also from animal models, was that exposure to radiation would increase, and not decrease, coronary disease mortality. Further analysis of these data revealed, however, that these results were biased because of the confounding effect of age. Table 1.9 presents results of the...

Blood Vessels and Flow

The pulmonary blood vessels also form a series of branching tubes from the pulmonary artery to the capillaries and back to the pulmonary veins. Initially, the arteries, veins, and bronchi run close together, but toward the periphery of the lung, the veins move away to pass between the lobules, whereas the arteries and bronchi travel together down the centers of the lobules. The capillaries form a dense network in the walls of the alveoli (Figure 1-6). The diameter of a capillary

Outcomes measurement basic principles and applications in stroke rehabilitation

The objective of this chapter is to give an overview of basic principles guiding the development and application of outcome measures. This chapter starts by introducing basic concepts related to the development of outcome measures, and demonstrates their applications in stroke rehabilitation. Specifically, the first section includes a theoretical discussion of reliability, validity and responsiveness, and how to approach interpretation. This discussion is based on classical test theory. For each property the theory is applied to development of a measure of participation . Future trends related to computer-adapted testing (CAT) are also briefly described. In the second section, the evaluation of walking competency after stroke is used to illustrate the selection of appropriate outcome measures for this population, as well as their relation to participation . These measures include self-reported scales, performance-based ratings and laboratory assessments. This chapter concludes with...

Correlation Between Taurine And Biochemical Markers Related To Atherosclerosis

Correlations between taurine and biochemical markers related to atherosclerosis in Toyama City and Inner Mongolia are showed in Table 3. Biochemical data obtained from four areas were combined in the analysis of correlation between taurine and biochemical markers for atherosclerosis. Table 2. The comparison of related factors of atherosclerosis among Toyama City and three areas in Inner Mongolia Table 2. The comparison of related factors of atherosclerosis among Toyama City and three areas in Inner Mongolia Table 3. Correlation coefficients between taurine and biochemical markers related to atherosclerosis Table 3. Correlation coefficients between taurine and biochemical markers related to atherosclerosis

Ischemic Heart Disease

The most common cause of death in Western culture is ischemic heart disease, which results from insufficient coronary blood flow. About 35 per cent of people in the United States die of this cause. Some deaths occur suddenly as a result of acute coronary occlusion or fibrillation of the heart, whereas other deaths occur slowly over a period of weeks to years as a result of progressive weakening of the heart pumping process. In this chapter, we discuss acute coronary ischemia caused by acute coronary occlusion and myocardial infarction. In Chapter 22, we discuss congestive heart failure, the most frequent cause of which is slowly increasing coronary ischemia and weakening of the cardiac muscle.

Risks for Heart Disease

The racing heart that is characteristic of thyrotoxicosis can complicate preexisting heart disease, or worsen risk factors that predispose you to heart disease, even in the absence of Graves' disease. If you have any of these conditions while thyrotoxic, you need to take steps to lower some of these other risk factors as soon as possible. In addition, heart rhythm problems can be induced by thyrotoxicosis in Graves' disease. While most young people with otherwise normal hearts have rapid regular heartbeats (called sinus tachycardia), older people or those with some heart problems may have an irregular rapid heart rhythm called atrial fibrillation. Atrial fibrillation requires the intervention of a cardiologist, particularly since it can cause blood clots that result in strokes. Thy- rotoxicosis is also a risk for these clots, and if it results in atrial fibrillation, blood thinners are usually necessary. (See Chapter 25 for more on heart complications.)

Function of the Heart After Recovery from Myocardial Infarction

Occasionally, a heart that has recovered from a large myocardial infarction returns almost to full functional capability, but more frequently its pumping capability is permanently decreased below that of a healthy heart. This does not mean that the person is necessarily a cardiac invalid or that the resting cardiac output is depressed below normal, because the normal heart is capable of pumping 300 to 400 per cent more blood per minute than the body requires during rest that is, a normal person has a cardiac reserve of 300 to 400 per cent. Even when the cardiac reserve is reduced to as little as 100 per cent, the person can still perform normal activity of a quiet, restful type but not strenuous exercise that would overload the heart.

Nutrition for a Healthy Heart

Many healthy-heart diets and foods have a reduced fat content but, in most instances, have replaced fat with sugar and, even worse, refined sugar. As fat intake has decreased, refined sugar and processed grain intake has skyrocketed. The average American consumes more than 150 pounds of added refined sugar every year. A healthy diet must address everything fats (triglycerides) carbohydrates (sugars) protein (amino acids) and fiber. Many people are aware of the harmful effects of too much fat and have taken appropriate steps. Now, people must look carefully at carbohydrate consumption. Attention to correct carbohydrates will involve not only sugar, but also fiber, which has been shown to have a beneficial effect on the cardiovascular system. Only through careful assessment of all foods eaten can anyone make a nutritional difference in their appearance and health. Attention to fat is not enough.

The evolution of cerebral reorganisation after stroke

Tasks after stroke is likely to engage such a mechanism, but the degree to which this is successful will depend on the degree of overall damage to the motor network. The role of error signal generation in a damaged motor system is clearly of interest, particularly as it may diminish with chronicity of impairment (Ward et al., in press Ward et al 2004). These important issues remain to be explored, and may have significant implications for rehabilitative interventions. downregulation of the a1-gamma-aminobutyric acid (GABA) receptor subunit and a decrease in GABAergic inhibition (Neumann-Haefelin et al., 1998) (see Chapter 14 of Volume I, pp. 18-21 for further discussion of these phenomena). This would be of particular interest to clinicians as it is easier to induce long-term potentiation (LTP) in hyperex-citable cortex, that is the cortex is more responsive to afferent input. In humans, acute limb deaf-ferentation leads to reduced levels of GABA within minutes (Levy et al., 2002). It...

Your Visit to the Cardiologist

Cardiologist Professor and Chairman Department of Internal Medicine Wayne State University School of Medicine Detroit, Michigan A CARDIOLOGIST IS A PHYsician who has graduated from an accredited medical school and completed three years of internal medicine residency training followed by three or four years of cardiology training. Most cardiologists are part of a larger group, which is sometimes contained within a broader group of medical specialists including primary care physicians. Besides general cardiologists, there are many different subspecialties in cardiology. Those with added knowledge in interpretation of diagnostics are called noninvasive cardiologists. Those with special certification in the use of radioisotopes are called nuclear cardiologists. Cardiologists may also specialize in intervention-al cardiology, meaning they are experts in the use of angioplasty and stenting. Additionally, cardiologists may specialize in elec-trophysiology, which is the study of rhythm...

Heart Problems of Infants and Children

CONGENITAL HEART DEFECT means an abnormality that is .present at birth. Congenital heart surgery started before the heart-lung machine was developed as surgeons started to work on abnormalities of the arteries that came out of the heart. Dr. John Streider at the Massachusetts General Hospital in Boston tied off a patent ductus arteriosus (an abnormal pathway between the aorta and the pulmonary artery) in a child on March 6, 1937. Unfortunately, the patient was quite sick at the time and died four days after the surgery. A year and a half later, in the same city, on August 16, 1938, Dr. Robert Gross at the Boston Children's Hospital operated on a girl seven and a half years old who was short of breath because of the same congenital defect. The patient made a successful recovery. Soon surgeons all over the world were performing this operation. The first patient was a fifteen-month-old girl who had suffered her first cyanot-ic spell (turning blue) at age eight months. Dr. Helen Taussig,...

Coronary Artery Disease and Mortality from All Cardiac Causes

Numerous studies demonstrate that Hodgkin's disease (HD) survivors treated with mediastinal irradiation have an increased risk of fatal CVD 68-71 . Relative risk estimates for all survivors range from 2.2-7.2, compared with age and gender-matched controls from the general population 68-70 . The absolute excess risk of fatal cardiovascular disease is 11.9-48.9 per 10,000 patient years, depending upon patient characteristics 70 . This increased risk becomes statistically significant 5-10 years after radiotherapy 71, 72 , and is largely due to fatal myocardial infarctions 70 . Myocardial infarction (MI) may be the most important cardiac concern for survivors treated with radiotherapy since the 1970s. While risk of death from cardiac causes other than myocardial infarction has decreased with the use of subcarinal blocking, the incidence of fatal MI has not changed significantly. This was demonstrated by a study of 2,232 HD patients treated at Stanford during 1960-1991. The study showed...

Of Coronary Artery Disease Risk Factors

All childhood cancer survivors should be screened regularly for coronary artery disease (CAD) risk factors. While those treated with mantle radiation are probably most at risk for CAD, survivors treated with anthracyclines and high-dose cyclophosphamide are also likely to have damaged hearts that can ill afford further damage from a myocardial infarction. Patients who received brain irradiation, especially those with proven growth hormone deficiency or other hypothalamic-pituitary axis dysfunction,may also be at higher risk, compared with other survivors. Risk factors for CAD, such as family history, hypertension, smoking, hyperlipidemia, obesity, diabetes mellitus and a sedentary life-style, should be evaluated at each long-term visit. Counseling to reduce such risk factors is not only appropriate, it is extremely important. Signs and symptoms of pericarditis (fever, dyspnea, pleuritic chest pain, friction rub, ST and T wave changes, decreased QRS voltage), cardiomyopathy, valvular...

Morphology Of Blood Vessels

The entire vasculature is lined by a single layer of specialized cells, the endothelial cells. They form a simple squamous epithelium which rests on a basement membrane and surrounds a lumen in which blood flows (Figure 1). The basement membrane contains collagen types I and IV, fibronectin, laminin, entactin and other non-collagen glycoproteins. Endothelial cells, together with their basement membrane, constitute the lamina intima of a blood vessel. The lamina intima is surrounded by pericytes, smooth muscle cells or cardiomyocytes, collectively described as mural cells. Pericytes lie within the basement membrane of the endothelial cells whereas the others surround larger vessels and the endocardium as an additional layer outside the basement membrane (as a part of the lamina media). Pericytes are recruited by endothelial cells during development and play an important role in vessel maturation and stabilization. They appear to suppress the turnover of endothelial cells. During...

Post Myocardial Infarction Ventricular Septal Defect

Another complication of coronary artery disease that requires heart surgery is called post-myocardial infarction ventricular septal defect. This happens when the common wall between the right and the left ventricle (the ventricular septum) ruptures after a heart attack. When the surgeon opens the heart to repair the hole, he may find that the heart muscle tissue around the hole is also dying or dead, which makes the hole technically challenging to repair. Nonetheless, the majority of the patients who undergo the repair survive. In some cases, coronary bypass grafting or other heart surgery procedures are done at the same time. Depending on the circumstances, about 70 percent or 80 percent of the patients undergoing this operation survive the procedure and do well. Another complication of a heart attack is that one of the papillary muscles, which is inside the left ventricle and helps control the mitral valve, may be involved in the heart attack. The entire muscle may Unfortunately,...

Chemokine Receptors in Atherosclerosis

Atherosclerosis is an inflammatory process that is strongly affected by chemokines that regulate the trafficking of inflammatory cells. A large amount of data from in vitro studies and murine models suggest an important role for chemokines in atherosclerosis. In man, genetic studies have revealed that specific polymorphisms in chemokine and chemokine receptor genes are associated with atherosclerotic diseases including coronary artery disease and carotid artery occlusive disease. Specifically, there are sound data supporting roles for the following receptors and their ligands CCR2 and MCP-1 (CCL2) CX3CR1 and fractalkine (CX3CL1) CCR1, CCR5, and RANTES (CCL5) CXCR2 and IL-8 (CXCL8) CXCR6 and CXCL16 and CXCR3 and its ligands MIG (CXCL9), IP-10 (CXCL10) and I-TAC (CXCL11). These chemokines and their receptors participate in vascular inflammation via T-cell and monocyte chemoattraction, adhesion of monocytes to the vessel wall, and vascular smooth muscle cell migration and proliferation....

Example 101 Pravastatin in preventing cardiovascular disease

Figure 10.1 is taken from Nakamura et al. (2006) who reported a large placebo-controlled randomised trial evaluating the effect of pravastatin in preventing cardiovascular disease. The overall treatment effect was positive, with a hazard ratio of 0.67 (p 0.01). We will cover hazard ratios and their use in survival analysis in Chapter 13 for the moment simply note that, like the odds ratio and the relative risk, a value of one corresponds to equal treatments. The homogeneity of the treatment effect was assessed by looking at the p-value for the treatment-by-covariate interaction and also by calculating the hazard ratio separately in various subgroups defined by baseline factors of interest as seen in Figure 10.1.

Staying Alert About Heart Disease

If you are past menopause, you must educate yourself about the signs and symptoms of heart disease, since you are at higher risk. Other risk factors, such as smoking, obesity, high blood pressure, and high cholesterol, can be reduced with lifestyle changes. For example, women who are physically active have a 60 to 75 percent lower risk of heart disease than inactive women. Heart disease is currently the number-one cause of death in postmenopausal women more women die of heart disease than lung cancer or breast cancer. Half of all North Americans who die from heart attacks each year are women. One of the reasons for such high death rates from heart attacks among women is medical ignorance. Most studies examining heart disease excluded women, which led to a myth that more men than women die of heart disease. In reality, more men die of heart attacks before age fifty, while more women die of heart attacks after age fifty. It remains unclear whether estrogen loss increases the risk, or...

Benefit of Alcohol in Cardiovascular Disease

In an early study on alcohol and coronary artery disease, Marmot et al. (3) screened 1422 middle-aged, male civil servants in and around London between 1967 and 1969 using a 3-day dietary recall format. Ten years later the investigators compared mortality rates of those who used various amounts of alcohol. Even correcting for smoking, systolic blood pressure, and serum cholesterol, the authors found the now-famous U-shaped curve. They grouped the men according to consumption of no alcohol per day, up to 9 g (approximately one alcoholic beverage) per day, 34 g (three to four beverages) per day, and over 34 g per day. Of note, the U-shaped curve was seen for all-cause mortality, with the cardiovascular death curve assigned a relative risk of 1.0 for the 0.1-9 g day group. They found a relative risk of 1.5 for the 9.1-34-g day group, and 0.9 for the over-34-g day group. The abstainer group had a relative risk of death due to coronary artery disease of 2.1. The London group, however, was...

Rheumatic fever and rheumatic heart disease

Map Deaths from rheumatic heart disease Rheumatic heart disease in children Deaths from rheumatic fever and rheumatic heart disease in the Aboriginal and non- Carapetis JR, Currie BJ. Mortality due to acute rheumatic fever and rheumatic heart disease in the Northern Territory a preventable cause of death in Aboriginal people. Australian and New Zealand journal Rheumatic fever and rheumatic heart disease report of a WHO Expert Committee. Geneva, WHO, 2003 (WHO Technical Report Series, No. 923). Veasy LG, Hill HR. Immunologic and clinical correlations in rheumatic fever and rheumatic heart disease. Pediatric infectious diseases journal, 1997, 16 400-407.

Ivhow Was Hsp Considered To Be Involved In Atherosclerosis

As mentioned above, atherosclerotic lesions bear many similarities to chronic inflammatory conditions, the most striking of which are accumulation of macrophages and T lymphocytes (reviewed in refs. 3-5). It was not known, however, which pathogens and or antigens might elicit the response of these immune cells in atherogenesis. Our theory that atherosclerosis might be immunologically mediated was aroused by the increasing reports in the literature, partially cited above, centering around the humoral and cellular immunological phenomena in this disease (14-21,26-39), including the involvement of antibodies to modified low-density lipoprotein (LDL) (40), and bacteria (41). Our approach to this issue was based on our previous experience with various animal models of experimentally induced and spontaneous autoimmune diseases (42), as well as the role of changes in lymphocyte lipid metabolism in the altered immune responsiveness during aging (43,44). We initially performed a series of...

Example 2 intravenous magnesium in acute myocardial infarction

The following table gives data from 16 randomised controlled trials of intravenous magnesium in the prevention of death following myocardial infarction. These trials are a well-known example where the results of a meta-analysis8 were contradicted by a single large trial (ISIS-4)9-11 (see also Chapters 3 and 11).

Viiiinfections Hsp And Atherosclerosis

Several lines of evidence point to infection as a possible contributor to atherosclerosis (66). Infection with Marek's disease virus (MDV) has been shown to induce atherosclerosis in chickens (67). Seroepidemiological studies have pointed to a higher prevalence of cytomegalovirus antibodies among several groups of patients with coronary heart disease as compared with controls (68), and immun-ohistological examination revealed the presence of herpesvirus in human atherosclerotic lesions (69). With regard to bacterial infections, it has been demonstrated that serum antibody titers against Chlamydia pneumoniae posivitely correlate with coronary atherosclerosis. The antibody titers increase rapidly from the age of 5 to 20 years, and then increase more slowly into old age. Men have a higher prevalence of these antibodies than women, reflecting the higher rate of atherosclerosis in males (41,70). Interestingly, C. pneumoniae was detected within atherosclerotic lesions of coronary arteries...

Global burden of coronary heart disease

Map Healthy years of life lost to coronary heart disease Ounpuu S, Anand S, Yusuf S. The global burden of cardiovascular disease. Medscape cardiology, 24 January 2002 Nayha S. Cold and the risk of cardiovascular diseases. A review. International journal of circumpolar health,

Adhesion of Nanoparticles to Brain Blood Vessel Walls

Troster et al. (13) suggested that the adhesion of nanoparticles to the inner surface of the brain blood vessels might explain the observed higher brain radioactivity levels with polysorbate 80 coated, 14C-labeled nanoparticles. Adhesion of nanoparticles to another biological surface, the cornea and conjunctiva of rabbit eyes, had been reported previously (21, 22) and indeed led to enhanced delivery into the eye of some ophthalmic drugs (23-27). However, the increase in eye drug transport was very minimal in comparison to the above-reported drug transport enhancement observed in the brain. Additionally, in some cases ophthalmic drug transport was even reduced by binding to nanoparticles (28, 29). In addition, the shear forces that would remove adhering nanoparticles from the biological surface are probably much higher in the brain blood vessel than in rabbit eyes, especially since these animals blink very infrequently. Taking these observations together, it seems very unlikely that...

Deaths from coronary heart disease

Map Deaths from coronary heart disease Deaths from coronary heart disease compared with other causes Ounpuu S, Anand S, Yusuf S. The global burden of cardiovascular disease. Medscape cardiology, 24 January 2002 Khot UN, Khot MB, Bajzer CT et al. Prevalence of conventional risk factors in patients with coronary heart disease. Journal of the American Medical Association, 2003, 290 898-904. Chambless L, Keil U, Dobson A, Mahonen M, Kuulasmaa K, Rajakangas AM, Lowel H, Tunstall-Pedoe H. Population versus clinical view of case fatality from acute coronary heart disease results from the WHO MONICA Project 1985-1990. Multinational MONItoring of Trends and Determinants in CArdiovascular Disease. Circulation, 1997, 96(11) 3849-59.

Coronary artery bypass grafting CABG A

Coronary artery disease Referring to atherosclerotic heart disease, or a buildup of fatty substances or cholesterol in the walls of the coronary artery causing blockages and possibly even a heart attack. coronary insufficiency Refers to coronary artery disease or a condition in which the coronary arteries do not supply a sufficient amount of blood.

Endocytosis by the Brain Blood Vessel Endothelial Cells

At present the most likely mechanism for the brain transport of drugs seems to be endocytotic uptake by the endothelial cells lining the brain blood vessels. In our experiments with poly(butyl cyanocrylate) nanoparticles, an en-docytotic uptake of the particles by cultured rat (38), mouse, bovine, and human (unpublished results) brain blood vessel endothelial cells in vitro clearly was observed by laser confocal microscopy after coating with polysorbate 80, but not without this coating. Uptake did not occur at 4 C. In addition, in in vivo experiments FITC-dextran-labeled fluorescent polysorbate 80 coated na-noparticles were visualized by fluorescence microscopy in structures close to the brain blood vessels in mice 45 minutes after intravenous injection, whereas particles without polysorbate 80 appeared to remain in the lumen of the brain blood vessels (1). Structures resembling nanoparticles also were observed by transmission electron microscopy in the brain endothelial cells of...

Example 154 Meta Analysis of trials of magnesium and streptokinase in acute myocardial infarction

In the upper part of Figure 15.2 we see a funnel plot of trials evaluating the effect of intravenous magnesium in the treatment of myocardial infarction. Note the absence of small trials with odds ratios greater than one (which would indicate a lack of benefit for intravenous magnesium) this

Angina and myocardial infarction

Cardiac ischaemia is common in sleep, particularly during the second half of the night 7 . It is more often silent (asymptomatic) in sleep than during exercise. During sleep, cardiac output falls as a result of a slower heart rate rather than any change in stroke volume. In NREM sleep, blood pressure also falls and the drop in perfusing pressure reduces the coronary artery blood flow. An exaggeration of this hypotension (over-dipping), especially in stages 3 and 4 NREM sleep, may cause clinically significant cardiac ischaemia, especially in the presence of coronary artery disease. The peak time for myocardial infarction during NREM sleep is between 12.00 and 2.00 am when stages 3 and 4 are most likely. Despite this, NREM sleep is largely cardioprotective because of the low metabolic rate and the constant, but low, cardiac output. The process of awakening is probably even more of a risk for cardiac ischaemia than REM sleep. The chance of a myocardial infarction rises between 4.00 and...

Irregular Heart Rhythm Arrhythmia and Atrial Fibrillation

In people with underlying heart disease, thyrotoxicosis can lead to an irregular heart rhythm (arrhythmia), and atrial fibrillation. Normally, each heartbeat is stimulated by an electrical impulse starting in the upper heart chambers, the atria, carried through to the ventricles below through a conduction system in the heart muscle, much like the wiring of your house. There is a fuse box at the place where this impulse passes from the right atrium into the ventricle in an ordered fashion, the atrioventricular node (AV node). If the conduction system in the atria becomes diseased, electrical impulses in the atria become disordered and rapid, a condition called fibrillation. Instead of a one-to-one conduction of the impulses from the atria through the AV node to the ventricles, the AV node can't handle the rapid and erratic impulses, providing a slower, yet very irregular impulse to the ventricles. It's this irregular impulse that makes the ventricles beat in a very irregular rhythm....

Myocardial infarction See heart attack or

Myocarditis An inflammation of the heart muscle. myocardium The heart muscle. myxoid degeneration Degeneration of the middle layer of tissue in blood vessels and heart valves. nitroglycerin A drug used to dilate coronary arteries so more oxygenated blood can reach the heart muscle. This drug is generally used by patients with atherosclerotic coronary artery disease. occlusion Narrowing or blockage of a blood vessel. open heart surgery Heart operations in which the heart-lung machine is used and the heart is opened so various structures can be repaired or replaced. However, many people also use the term to refer to any heart operation in which the heart-lung machine is used, including coronary bypass surgery, in which only the surface of the heart is worked on. palliative A treatment that improves a condition but does not cure it. A palliative heart procedure would be one that would improve the patient's condition but not cure the heart disease. patent Patent means open. Usually it...

Stages of Recovery from Acute Myocardial Infarction

Stage Myocardial Ischemia

Top, Small and large areas of coronary ischemia. Bottom, Stages of recovery from myocardial infarction. Top, Small and large areas of coronary ischemia. Bottom, Stages of recovery from myocardial infarction. Replacement of Dead Muscle by Scar Tissue. In the lower part of Figure 21-8, the various stages of recovery after a large myocardial infarction are shown. Shortly after the occlusion, the muscle fibers in the center of the ischemic area die. Then, during the ensuing days, this area of dead fibers becomes bigger because many of the marginal fibers finally succumb to the prolonged ischemia. At the same time, because of enlargement of collateral arterial channels supplying the outer rim of the infarcted area, much of the nonfunctional muscle recovers. After a few days to three weeks, most of the nonfunctional muscle becomes functional again or dies one or the other. In the meantime, fibrous tissue begins developing among the dead fibers because ischemia can stimulate growth of...

Strategies Using Cell Therapy to Induce Cardiomyocyte Regeneration in Adults with Heart Disease

Congestive heart failure remains a major public health problem and is frequently the end result of cardiomyocyte apoptosis and fibrous replacement after myocardial infarction (MI), a process referred to as left ventricular remodeling. Cardiomyocytes undergo terminal differentiation soon after birth and are generally considered to withdraw irreversibly from the cell cycle. In response to ischemic insult, adult cardiomyocytes undergo cellular hypertrophy, nuclear ploidy, and a high degree of apoptosis. A small number of human cardiomyocytes retain the capacity to proliferate and regenerate in response to ischemic injury. However, whether these cells are derived from a resident pool of cardiomyocyte stem cells or from a renewable source of circulating bone marrow-derived stem cells that home to the damaged myocardium is at present not known. Replacement and regeneration of functional cardiac muscle after an ischemic insult to the heart could be achieved either by stimulating...

Types of cardiovascular disease

Types Cardiovascular Diseases

Deaths from cardiovascular diseases (CVD) coronary heart disease stroke other cardiovascular diseases hypertensive heart disease inflammatory heart disease rheumatic heart disease coronary heart disease stroke inflammatory heart disease 0.4m rheumatic heart disease 0.3m other forms of heart disease 2.4m inflammatory heart disease 0.4m rheumatic heart disease 0.3m other forms of heart disease 2.4m Coronary heart disease Disease of the blood vessels supplying the heart muscle. Major risk factors High blood pressure, high blood cholesterol, tobacco use, unhealthy diet, physical inactivity, diabetes, advancing age, inherited (genetic) disposition. Other risk factors Poverty, low educational status, poor mental health (depression), inflammation and blood clotting disorders. Rheumatic heart disease Damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria. Congenital heart disease Other cardiovascular diseases Tumours of the heart vascular tumours of...

Atherosclerosis as a Cause of Ischemic Heart Disease

Most frequent cause of diminished coronary blood flow is atherosclerosis. The atherosclerotic process is discussed in connection with lipid metabolism in Chapter 68. Briefly, this process is the following. In people who have genetic predisposition to atherosclerosis, or in people who eat excessive quantities of cholesterol and have a sedentary lifestyle, large quantities of cholesterol gradually become deposited beneath the endothelium at many points in arteries throughout the body. Gradually, these areas of deposit are invaded by fibrous tissue and frequently become calcified. The net result is the development of atherosclerotic plaques that actually protrude into the vessel lumens and either block or partially block blood flow. A common site for development of atherosclerotic plaques is the first few centimeters of the major coronary arteries. Acute occlusion of a coronary artery most frequently occurs in a person who already has underlying atherosclerotic coronary heart disease but...

Treatment of Decompensated Heart Disease with Digitalis

Digitoxin Heart

Treatment of decompensated heart disease showing the effect of digitalis in elevating the cardiac output curve, this in turn causing increased urine output and progressive shift of the venous return curve to the left. Graphical analysis of two types of conditions that can cause highoutput cardiac failure (1) arteriovenous (AV) fistula and (2) beriberi heart disease. Beriberi. Figure 22-8 shows the approximate changes in the cardiac output and venous return curves caused by beriberi. The decreased level of the cardiac output curve is caused by weakening of the heart because of the avitaminosis (mainly lack of thiamine) that causes the beriberi syndrome. The weakening of the heart has decreased the blood flow to the kidneys. Therefore, the kidneys have retained a large amount of extra body fluid, which in turn has increased the mean systemic filling pressure (represented by the point where the venous return curve now intersects the zero cardiac output level) from the normal value of 7...

Cardiovascular Risk Factors

More than 20 years ago the vascular surgeon Vaclav Michal from Prague recognized that chronic arterial disease, compromising the blood flow in the cavernous arteries, can be a significant cause of ED 11 . Atherosclerosis appears to be the most common cause of vasculogenic erectile dysfunction. Smoking, hypertension, diabetes mellitus and dyslipidemias have been shown to initiate the cascade of events resulting in atherosclerosis. These include endothelial injury, cellular migration, and smooth-muscle proliferation 12 . These same risk factors leading to the manifestation of ED are shared with coronary artery disease (CAD). Studies suggest ED as a strong predictive factor for CAD 13,14 . Vasculogenic impotence has been reported to be the first sign of a generalized arteriopathy suggesting that physicians should check ED patients for ischemic heart disease, which can be diagnosed by stress ECG or other investigations prior to starting treatment for ED 15,16 . The presence of silent...

Why do we need systematic reviews A patient with myocardial infarction in 1981

A likely scenario in the early 1980s, when discussing the discharge of a patient who had suffered an uncomplicated myocardial infarction, is as follows a keen junior doctor asks whether the patient should receive a beta-blocker for secondary prevention of a future cardiac event. After a moment of silence the consultant states that this was a question which should be discussed in detail at the Journal Club on Thursday. The junior doctor (who now regrets that she asked the question) is told to assemble and present the relevant literature. It is late in the evening when she makes her way to the library. The MEDLINE search identifies four clinical trials.23-26 When reviewing the conclusions from these trials (Table 1.1) the doctor finds them to be rather confusing and contradictory. Her consultant points out that the sheer amount of research published makes it impossible to keep track of and critically appraise individual studies. He recommends a good review article. Back in the library...

Hypothalamic Hypophysial Portal Blood Vessels of the Anterior Pituitary Gland

Hypothalamic-hypophysial portal blood vessels into the anterior pituitary sinuses. Figure 75-4 shows the lowermost portion of the hypothalamus, called the median eminence, which connects inferiorly with the pituitary stalk. Small arteries penetrate into the substance of the median eminence and then additional small vessels return to its surface, coalescing to form the hypothalamic-hypophysial portal blood vessels. These pass downward along the pituitary stalk to supply blood to the anterior pituitary sinuses.

Inherited Low Maximal Oxygen Uptake Cardiovascular Risk Profile and Metabolic Syndrome

A specific aim of our research has been to determine whether rats selected on the basis of low versus high intrinsic exercise performance also differed in VO2max, mitochondrial oxidativepathways, and cardiovascular risk factors linked to the metabolicsyndrome.After eleven generations of selective breeding based upon aerobic treadmill running, contrasting rat lines of Low Capacity Runners (LCR) and High Capacity Runners (HCR) were obtained 66, 67 . HCR were superior to the LCR for distance run to exhaustion (347 ) and VO2max (60 ). LCR demonstrated a cluster of risk factors for cardiovascular disease, i.e., higher levels of factors such as body mass, visceral adiposity, blood pressure, insulin, glucose, free fatty acids, and triglycerides. This risk profile resembles the metabolic syndrome as described in humans 66 thus, the LCR rat model serves as an experimental model for this condition that is not based upon single-gene, chemical, or physical manipulation, but on artificial...

The Coronary Bypass Operation and Recovery

Mammary Artery Gastric

The coronary artery bypass graft procedure is still the gold standard for patients suffering from left main or multiple coronary artery disease. The final determination that a coronary artery bypass graft operation is necessary is usually obtained from cardiac catheterization using coronary angiography. If the degree of blockage warrants surgery, a standard battery of tests is performed before surgery. These tests can be done on an outpatient basis and typically include an electrocardiogram, routine blood work studies, chest x-rays, and urinalysis. When I first became involved with heart surgery as a medical student more than thirty years ago, patients were routinely admitted for elective heart surgery about a week before the operation, and many, many tests were performed. By the time I became a faculty member at the Hospital of the University of Pennsylvania in 1978, patients were routinely admitted to the hospital one and a half days before heart surgery. Over the next several...

The First Coronary Artery Bypass Surgery

DUDLEY JOHNSON, WHO was one of a handful of doctors who popularized the modern coronary bypass operation, first knew he wanted to practice medicine while in seventh or eighth grade but he didn't know he wanted to be a surgeon until he got into medical school. And then I didn't really have any illusions about being a heart surgeon, Johnson said in a 1999 interview. But I figured if I had experience in the chest, I could get a little better job in a clinic somewhere, so I also trained to do lung surgery along with general surgery. As it turned out, the doctor in Milwaukee, Dr. Derward Lepley, Jr., who was in charge of the heart surgical realm, which was really in its infancy in the middle sixties, asked me to join him in practice, so I ended up staying in heart surgery. It was a fortunate decision for the field of heart surgery. At the time, surgical teams across the country were experimenting with various treatments for arteriosclerosis in the coronary arteries. Endarterectomy, or...

Pregnancy in the Woman with Heart Disease

Before becoming pregnant, a woman may have a congenital heart defect or acquired heart disease. Many congenital defects can now be surgically repaired in infancy, and the first generation of these patients has only recently reached childbear-ing age. They represent a new kind of patient for obstetricians and cardiologists. Acquired heart disease in pregnant women includes primarily rheumatic disease involving heart valves, heart failure, and coronary artery disease. Because many women are now delaying pregnancy until they are older, acquired heart disease is somewhat more common in pregnant women than earlier in this century. When considering pregnancy in the presence of heart disease, the most important factor is the severity of the heart-related symptoms. In general, patients without symptoms or those only slightly symptomatic enjoy a good outlook for both mother and fetus. Heart disease in adults generally develops later in life. Although heart disease is not completely...

Fibrillation of the Ventricles After Myocardial Infarction

Ischemia of the muscle causes an injury current, which is described in Chapter 12 in relation to electrocardiograms in patients with acute myocardial infarction. That is, the ischemic musculature often cannot completely repolarize its membranes after a heart beat, so that the external surface of this muscle remains negative with respect to normal cardiac muscle membrane potential elsewhere in the heart. Therefore, electric current flows from this ischemic area of the heart to the normal area and can elicit abnormal impulses that can cause fibrillation. 4. Cardiac muscle weakness caused by the myocardial infarction often causes the ventricle to dilate excessively. This increases the pathway length for impulse conduction in the heart and frequently causes abnormal conduction pathways all the way around the infarcted area of the cardiac muscle. Both of these effects predispose to development of circus movements because, as discussed in Chapter 13, excess prolongation of conduction...

Heart Muscle The Heart as a Pump and Function of the Heart Valves

Special mechanisms in the heart cause a continuing succession of heart contractions called cardiac rhythmicity, transmitting action potentials throughout the heart muscle to cause the heart's rhythmical beat. This rhythmical control system is explained in Chapter 10. In this chapter, we explain how the heart operates as a pump, beginning with the special features of heart muscle itself.

Heart Attack and Heart Failure

The medical term for heart attack is myocardial infarction. During a heart attack, a portion of the heart muscle dies. Patients usually survive small heart attacks. If the heart attack involves a significant portion of the heart, however, the victim will usually die due to arrhythmias during the beginning of the heart attack. In the event a patient survives a large heart attack, a considerable portion of heart muscle will turn into scar tissue and no longer contract. This can lead to heart failure. The patient will become short of breath and frequently fatigued because of the reduced amount of blood being pumped by the heart, resulting in a relative lack of oxygen and other nutrients getting to the body's tissues. The patient may develop swelling in the ankles or in the legs or abdomen as the heart fails and fluid backs up into the tissues. Myocardial Infarction When a portion of the heart muscle dies. Also referred to as a heart attack.

Viihsp 60specific T Cells In Atherosclerosis

T cells in atherosclerotic lesions of rabbits constitute up to 20 of total lesion cells, most of which express MHC class II (la) antigens, that is, are activated (6,12,26). To determine whether these T cells specifically respond to hsp 65 60, we isolated and cultured T cells from atherosclerotic lesions and compared them with peripheral blood lymphocytes from the same animal (12). A population of the T lymphocytes isolated from all forms of atherosclerotic lesions specifically responded to hsp 65 in vitro. IL-2-expanded T-cell lines derived from atherosclerotic lesions showed significantly higher hsp 65 reactivity than those from peripheral blood of the same donor, supporting the hypothesis that T cells reacting to hsp 65 60 may be involved in the development of atherosclerosis.

Cardiovascular Disease

A potentially deadly form of cardiovascular disease affecting the coronary arteries is currently being treated with stem cells in animal models. Coronary arteries carry blood to the cardiomyocytes, or heart muscle cells, and if they become blocked or otherwise damaged, the cardiomyocytes die from lack of oxygen. In serious cases, this can lead to a massive heart attack and death of the patient. In milder cases, damage to the heart is minimal, but coronary circulation is insufficient to allow the patient a normal lifestyle. Stem cells, stimulated to differentiate into cardiomyocytes, could be injected directly into the heart muscle in order to repair the damage. The stem cell transplants may be augmented with gene therapy by introducing a gene directly into the heart that codes for a blood vessel growth factor that stimulates the growth and repair of the coronary arteries, in order to reestablish an adequate blood flow. Stem cell therapy to treat cardiovascular disease is still in a...

Cant We Just Eat a Healthy Diet to Prevent Heart Disease

Some physicians argue that we do not have to use alcohol to prevent CAD because we know other ways (changes in lifestyle habits) that will prevent heart disease lose weight and change your diet. But they do not often appreciate how difficult it is for someone to lose 10 to 20 pounds (and keep it off) or how difficult it is for people to permanently adopt a very low-fat and low-cholesterol diet.

Coronary Artery Disease

A cardiologist should follow all patients with known coronary artery disease (CAD). Clinical evaluation includes both the regular workup for CAD and a full evaluation to look for other manifestations of cancer therapy-related cardiotoxicity. In the general work-up for CAD,resting ECG and ECHO are performed, as well as an ECG stress test (with or without an imaging study with exercise). The presence of ischemic changes and exercise-induced arrhythmias can be detected by an ECG stress test. However, ECG changes on a stress test may not correlate well with the presence of CAD in an already-damaged myocardium. As a result, in addition to the ECG stress test, an imaging study such as RNA or echocardiography may be needed to directly visualize areas of ischemic myocardium or abnormal wall motion that may indicate clinically significant CAD. A problem with RNA is that it lacks the specificity to differentiate ischemic myocardium due to the initial radiation damage from that of other causes....

Serum cholesterol reduction and risk of ischaemic heart disease

Log Odds Ratio

The randomised controlled trials of serum cholesterol reduction have been the subject of a number of meta-analyses1419 20 and much controversy. In conjunction with the review of the 10 prospective studies just described, the results of 28 randomised trials available in 1994 were summarised 14 this omits the results of trials of serum cholesterol reduction, notably those using statins, that have become available more recently. The aim was to quantify the effect of serum cholesterol reduction on the risk of ischaemic heart disease in the short term, the trials having an average duration of about five years. There was considerable clinical heterogeneity between the trials in the interventions tested (different drugs, different diets, and in one case surgical intervention using partial ileal bypass grafting), in the duration of the trials (0-3-10 years), in the average extent of serum cholesterol reduction achieved (0-3-1-5 mmol l), and in the selection criteria for the patients such as...

Serum cholesterol concentration and risk of ischaemic heart disease

An extreme example of heterogeneity was evident in a 1994 review14 of the 10 largest prospective cohort studies of serum cholesterol concentration and the risk of ischaemic heart disease in men, which included data on 19 000 myocardial infarctions or deaths from ischaemic heart disease. The purpose was to summarise the magnitude of the relation between serum cholesterol and risk of ischaemic heart disease in order to estimate the long term benefit that might be expected to accrue from reduction in serum cholesterol concentrations. The results from the 10 prospective studies are shown in Figure 9.2. These are expressed as proportionate reductions in risk associated with a reduction in serum cholesterol of 0-6 mmol l (about 10 of average levels in Western countries), having been derived from the apparently log-linear associations of risk of ischaemic heart disease with serum cholesterol concentration in individual studies. They also take into account the underestimation that results...

Suicidal thoughts after acute stroke

Our first investigation of patients with suicidal thoughts evaluated 301 patients with acute stroke in whom we had systematically asked them about the existence of suicidal thoughts or plans (Kishi et al. 1996a). Using the present state examination (PSE), a total of 20 patients (6.6 ) reported that they had deliberately considered suicide and that these death wishes were not simply passive death wishes or fleeting thoughts (Fig. 19.1). Background comparisons of the 20 patients who had suicidal intentions and the 281 patients without suicidal intentions are shown in Table 19.1. The suicidal patients were significantly younger than non-suicidal patients (p 0.03). In addition, the patients with suicidal thoughts had a greater frequency of alcohol abuse than non-suicidal patients (p 0.03). The suicidal patients also had a Figure 19.1 The frequency of depression among 301 patients with acute stroke. Note that suicidal patients have a significantly higher prevalence of major depression but...

How Does Alcohol Reduce the Risk of Heart Disease

We have identified many of the biologic and physiologic effects of wine and alcohol that relate to protection against CAD. Alcohol affects blood lipids it increases HDL-cholesterol, the good cholesterol that lowers the risk of heart disease. Alcohol also tends to slightly decrease LDL-cholesterol, the bad cholesterol that increases atherosclerosis. Thus, individuals who have consumed moderate amounts of alcohol for most of their adult years tend to have less atherosclerosis. Atherosclerosis The Great Riddle The progress in heart surgery and treatment of general heart disease has been remarkable over the last fifty years. Many conditions that doctors in the 1950s considered fatal are now routinely treatable with a variety of options including drugs (for hypertension, for example), surgery, and less invasive techniques. At the same time these surgical techniques have become accepted, our knowledge of cardiac disease prevention has made incredible leaps forward. What does the future hold...

Hypertrophy of the Heart in Valvular and Congenital Heart Disease

Hypertrophy of cardiac muscle is one of the most important mechanisms by which the heart adapts to increased workloads, whether these loads are caused by increased pressure against which the heart muscle must contract or by increased cardiac output that must be pumped. Some physicians believe that the increased strength of contraction of the heart muscle causes the hypertrophy others believe that the increased metabolic rate of the muscle is the primary stimulus. Regardless of which of these is correct, one can calculate approximately how much hypertrophy will occur in each chamber of the heart by multiplying ventricular output by the pressure against which the ventricle must work, with emphasis on pressure. Thus, hypertrophy occurs in most types of valvular and congenital disease, sometimes causing heart weights as great as 800 grams instead of the normal 300 grams. Brickner ME, Hillis LD, Lange RA Congenital heart disease in adults second of two parts. N Engl J Med 342 334,2000....

Example 142 ESTAT trial in acute stroke

This was a multi-centre, pan-European, randomised double-blind placebo-controlled clinical trial in acute stroke to evaluate the effect of ancrod, a natural defribrinogenating agent (Hennerici et al. (2006)). The primary endpoint was based on the Barthel Index a favourable score of 95 or 100 or a return to the pre-stroke level at three months was viewed as a success. The primary method of statistical analysis was based on a logistic model including terms for treatment, age category, baseline Scandinavian Stroke Scale and centre.

Coronary Artery Disease and Treatment Options

Main Arteries Groin Pictures

Little else happened in the dawning field until 1930, when a French surgeon named Dr. Rene Leriche developed a method to attach skeletal muscle to the heart in animals, in hopes that new blood vessels would form. This line of research was pursued by Dr. Claude Beck in Cleveland, who confirmed that new blood vessels did indeed grow into the heart muscle from tissues wrapped around the heart. In his first attempt to treat coronary disease in a human patient, Beck roughened the outer surface of the heart with a burr and sutured a graft of skeletal muscle from the chest to the heart. New vessels formed, and the patient recovered. The patient's angina also disappeared. Beck went on to perform variations of this operation in sixteen patients. patient's heart muscle but did not directly connect it to one of the heart's arteries. He was hoping new blood vessels would sprout from the mammary artery and connect with the blocked blood vessels in the heart. Over the next several months, new...

The Atlas of Heart Disease and Stroke

The Atlas of Heart Disease and Stroke World Health Organization 2004 The atlas of heart disease and stroke Judith Mackay and George Mensah with Shanthi Mendis and Kurt Greenlund. l.Heart diseases epidemiology 2.Cerebrovascular accident epidemiology 3.Risk factors 4.Atlases I.Mensah, George. II.Mendis, Shanthi. III.Greenlund, Kurt. IV.Title.


Atherosclerosis is a disease of the large and intermediate-sized arteries in which fatty lesions called athero-matous plaques develop on the inside surfaces of the arterial walls. Arteriosclerosis, in contrast, is a general term that refers to thickened and stiffened blood vessels of all sizes. One abnormality that can be measured very early in blood vessels that later become atherosclerotic is damage to the vascular endothelium. This, in turn, increases the expression of adhesion molecules on endothelial cells and decreases their ability to release nitric oxide and other substances that help prevent adhesion of macromolecules, platelets, and monocytes to the endothelium. After damage to the vascular endothelium occurs, circulating monocytes and lipids (mostly low-density lipoproteins) begin to accumulate at the site of injury (Figure 68-6A).The monocytes cross the endothelium, enter the intima of the vessel wall, and

Heart Disease

Both untreated hypothyroidism (see Chapter 3) and thyrotoxicosis (see Chapter 4) can lead to cardiovascular complications (complications involving the heart, arteries, and veins) or a worsening of risk factors for cardiovascular disease. The term heart disease generally refers to any type of heart trouble, including irregular or rapid heart rhythms blockages of the blood supply to the heart muscle causing chest pain (angina) or a heart attack (myocardial infarction) or weakening of the pumping of the heart, causing congestive heart failure. Atherosclerotic cardiovascular disease (ASCVD) refers to fatty blockages of blood vessels anywhere in the body. When it occurs in the coronary arteries that feed the heart muscle, it puts you at risk for a heart attack. When ASCVD occurs in blood vessels in the brain, it puts you at risk for having a stroke, in which part of the brain fed by the blocked blood vessel dies. When ASCVD affects arteries that feed your arms or your legs, it causes a...

Heart Surgery Tables

Within a few years in the mid- to late 1950s, surgeons corrected thirteen types of congenital heart defects. Congenital heart surgery later evolved into its own subspecialty. Thus, within a seven year period, three congenital cardiovascular defects patent ductus arteriosus, coarctation of the aorta, and vascular ring were all attacked surgically and treated successfully. However, the introduction of the Blalock-Taussig shunt was probably a much more powerful stimulus to the development of open heart surgery because the operation palliated a complex intracardiac defect and focused attention on the abnormal physiology of cardiac disease. The next major step forward in heart surgery needed to wait for the development of the heart-lung machine, which occurred in the middle 1950s. With the advent of techniques to support the circulation and oxygenate the blood, using either the cross circulation technique of Dr. C. Walton Lillehei or the modified Gibbon-IBM heart-lung machine of Dr. John...

Atrial Fibrillation

Atrial fibrillation may occur in any CHD patient with repetitive episodes of atrial flutter or IART, or may occur de novo. Patients predisposed to developing this arrhythmia more commonly have unrepaired defects or residual left-sided obstruction. The recognition that, in patients with structurally normal hearts, rapidly firing triggers, usually in the pulmonary veins (Haissaguerre et al., 1998), initiate and drive atrial fibrillation has led to similar efforts to identify the source of fibrillation in the CHD population. Ablation targeting a single source

The Coronary Arteries

As the heart rate increases and more blood is required by the body, the heart muscle itself needs more oxygen. Coronary arteries are the arteries that supply the heart muscle with oxygenated blood. Typically, there are two coronary arteries that branch off the aorta (Fig. 2.1). The right coronary supplies blood to the right ventricle and usually a portion of the interventricular septum. The left coronary or left main coronary immediately divides into two large branches, the left anterior descending coronary and the left circumflex coronary, which supply blood to the left ventricle. Unoxygenated blood is drained from the heart muscle by a network of coronary veins. Most of these gather in a larger vein called the coronary sinus, which empties the unoxygenated blood into the right atrium. Much of the heart disease in the United States is caused by blockages of the coronary arteries, and therefore maintaining healthy coronary arteries is a major means of preventing this type of heart...

What You Should Know About Your Heart During Pregnancy

PREGNANCY POSES A SPEcial challenge to the mother's cardiovascular system. Unlike other vital organs such as the brain or the kidneys, the mother's heart must increase the amount of blood pumped to provide blood to the growing fetus and placenta. The increase is tremendous during the pregnancy and becomes intense during labor and delivery. Pregnancy is also associated with symptoms that mimic heart disease. Pregnant women often complain of chest pain, leg swelling, and shortness of breath. In women who are not pregnant, these may signal an underlying cardiac problem. For the woman born with heart disease or who develops heart disease in young adulthood, pregnancy-related risks may increase from the extra demands on the heart. Pregnancy may also unmask a previously undi-agnosed heart problem. However, with few exceptions, the majority of women, even those with heart disease, are able to safely com-

High Blood Pressure Hypertension

High blood pressure (hypertension) is dangerous. If blood pressure is high, the heart has to work harder to pump the same amount of blood, which puts a great stress on the cardiovascular system. Patients with high blood pressure are more prone to heart attacks, heart failure, kidney failure, and strokes. Fortunately, blood pressure can be controlled with appropriate medications and lifestyle modifications, greatly reducing the risk of complications.

The Insulin Connection

Insulin is now recognized as an important factor in the development of cardiovascular disease. It is known to act directly on the walls of arteries to produce atheroma atherosclerotic plaques that can narrow the blood vessels, limit blood flow and oxygen delivery, and result in strokes and heart attacks. Insulin can also cause left ventricular hypertrophy (enlargement of the heart).

Is the French Paradox Real

There have been many studies from countries throughout the world connecting the consumption of alcohol to the risk of heart disease. The results have been remarkably consistent individuals who consume alcohol moderately have fewer heart attacks. In most studies, moderate drinkers experience death rates from CAD that are 20 percent to 50 percent lower than those of people of the same age who are similar in other characteristics except that they do not consume any alcohol. We also see reduced risk of the most common stroke, the ischemic or thrombotic type, which (like CAD) is related to atherosclerosis.

Not the Amount Is More Important

Unlike alcohol's effect on atherosclerosis, which develops over many years, the effect of alcohol on thrombosis only lasts for a day or so. For example, after consumption of alcohol, the platelets are less sticky for only a day or two before going back to their usual state or maybe even becoming abnormally sticky. Scientific data now suggest that alcohol is best consumed with meals. For any given amount of alcohol, the blood alcohol level rises only about one-half as high when the alcohol is consumed with food as when it is consumed on an empty stomach. Not only does the blood alcohol level remain lower, but combining the fat in a meal with small amounts of alcohol may also have other beneficial effects on the development of atherosclerosis. In a recent study in Italy, the overall mortality for people who consumed wine with their meals was much less than that

Is Wine the Preferable Beverage for Health

Many studies cannot show any important differences in heart disease rates on the basis of the type of alcohol usually consumed. On the other hand, we are accumulating new data that suggest that many of the biologically active substances in wine, particularly red wine substances such as tannins, phenols, resveratrol, and quercetin are powerful antioxidants, tend to reduce blood clotting, and have other effects that should reduce heart disease risk. A number of studies have shown that wine drinkers do better than beer and spirits drinkers in terms of disease outcomes. For example, in a large study from the Kaiser Permanente Medical Center in California, researchers found less heart disease among wine drinkers, and not just red wine drinkers, than among drinkers of other beverages. Similar results have been reported from studies in Copenhagen and Scotland. However, at least in some countries, wine drinkers may be different in many ways from beer or spirits drinkers. For example, in the...

Few Words About the Dangers of Alcohol

In addition, consumption of large quantities of alcohol over prolonged periods of time can actually cause serious damage to the heart muscle itself. Recently, however, there has been mounting evidence to indicate that alcohol, and particularly wine, when consumed in moderation, may be beneficial to your heart, particularly in controlling the progression of coronary artery disease. I am not suggesting that all non-drinking women should rush out and start consuming alcohol. Because other studies have shown an increase in risk of breast cancer from even moderate drinking, younger women and women who may be at increased risk for breast cancer should discuss their decision regarding drinking with their own doctors before making changes in their lifestyle. We must keep in mind, however, that a post-menopausal woman in the United States is much more likely to die from heart disease or stroke diseases for which she would be at a lower risk if she consumed a little alcohol than she...

Antibiotic Protection for Dental Surgery

SOME TYPES OF HEART CONDItions put people at a higher risk to develop infectious endocarditis, or an infection of the heart that can damage heart valves. To protect these patients, cardiologists often recommend antibiotic protection before undergoing surgery, including dental surgery. Your dentist or dental surgeon, in addition to any other doctors, should be made aware if you have one of these conditions before you undergo surgery. y People with most types of congenital heart defects y Patients with mitral valve prolapse with mitral valve regurgitation and or thickened leaflets y Patients with acquired valvular disease, such as from rheumatic heart disease y Patients with abnormally thickened heart muscle Patients who have had coronary artery bypass grafting, however, do not generally need antibiotic protection during dental procedures. As always, though, if you have a heart problem, check with your cardiologist and it is recommended to remind your dentist and other doctors about...

Who Is a Candidate for TMLR

Not every person with coronary artery disease is a candidate for TMLR. In many cases, bypass surgery and balloon angioplasty produce good short-term and long-term results. However, in an increasing number of persons, coronary artery disease has progressed to such an advanced and severe form that surgery is no longer possible. These patients typically acquire coronary artery disease at a younger age, are more likely to be diabetic with multiple risk factors, and are more likely to have already had numerous bypass and balloon procedures.

Policies and legislation

The first international convention that relates specifically to cardiovascular disease is the WHO Framework Convention on Tobacco Control. It was adopted without dissent by the World Health Assembly in Geneva in May 2003, and is currently in the process of ratification. Once 40 countries have ratified the Convention, it will come into effect as a legally binding treaty among those countries. The Convention includes clauses on advertising bans, smoke-free areas, health warnings, taxation, smoking cessation and smuggling. Cardiovascular disease plans worldwide

Postoperative Estrogen in Women Patients

Because coronary artery disease is more prevalent in post-menopausal women (young diabetic women are the exception). Many studies suggest that women at high risk for coronary artery disease or those who already have the disease will benefit from estrogen therapy. This group includes women who have undergone CABG or angioplasty. Hormone therapy is a secondary intervention (as opposed to a primary intervention, in which hormones are used to prevent coronary artery disease). There are seven published studies showing that hormone therapy results in a lower rate of death or complications in women who already have coronary artery disease. One study of 1,091 women, 92 of whom took estrogen after surgery, showed that survival at five and ten years was statistically sig

Modern Heart Valve Therapy

Patients with rheumatic fever can also develop an inflammation of the heart muscle called carditis, which can result in shortness of breath and fatigue. Fever can also be present. A second episode of rheumatic fever can further damage the heart, particularly the heart valves. Patients with damaged heart valves may need heart surgery relatively soon after their rheumatic fever. However, most people who need heart surgery will require it much later, sometimes late in life, even though they contracted rheumatic fever as a child. About half of all patients who require heart valve surgery as adults because of rheumatic Bacterial and fungal infections are another threat to both the heart and the heart valves (Fig. 10.5). In many cases, the exact reason for the infection is unknown. During a dental procedure, for example, bacteria may gain access to the bloodstream. Antibiotics should be given before a dental procedure to those who have a diseased or artificial heart...

Tricuspid Valve Disease

Degeneration of the middle layer of tissue in blood vessels and heart valves. to require heart surgery, is relatively uncommon. If the valve is severely stenotic, blood returning from the veins to the heart will have difficulty getting into the right ventricle. As a result, the liver may become engorged, and fluid can build up in the abdomen. This fluid buildup is known as ascites. The legs and ankles may swell. If there's a small hole in the heart between the right and the left atrium, some unoxygenated blood may pass through this hole, and a patient may appear blue (cyanotic). Heart surgery may be required to correct this problem. During an episode of endocarditis, bacteria or fungi can destroy the leaflets of the tricuspid valve. Depending on the severity of the condition, heart surgery may be required, and the valve may be repaired or replaced. This combination is usually related to rheumatic heart disease, and the problem is similar to mitral and aortic valve incompetence...

Heart Valve Surgery Repair versus Replacement

Most heart surgeons believe that If a heart valve can be repaired with the likelihood of relatively good long-term results, repair should be attempted rather than valve replacement. Although many excellent artificial heart valves are currently available, the perfect heart valve substitute has yet to be developed. If any one of the four valves is stenotic, physicians may be able to open the closed valve with a scalpel by carefully opening the fused leaflets, or commissures. This is called commissurotomy or valvotomy (Fig. 10.6). It is most commonly done in patients who require heart surgery for congenital pulmonary stenosis and those requiring mitral valve surgery for mitral valve stenosis related to rheumatic fever. The short-term and long-term results in both cases are quite good.

The Heart Valve Operation

The pericardium is opened, and the patient is connected to the heart-lung machine. The heart or a major blood vessel is opened, and the heart valve is repaired or replaced. After that, the heart or blood vessel is sutured closed, and the patient is disconnected from the heart-lung machine. The chest incisions are closed in layers with stitches, and the skin is closed with stitches or staples. walking a mile or two a day. Some cardiologists feel that all of their patients should be enrolled in a cardiac rehabilitation program, whereas others feel that only more sedentary people need a formal rehabilitation program. Professional athletes might be able to resume normal strenuous activities, depending on a number of variables, about three months after heart surgery. Cardiologists determine when and what level of activity can be resumed and when it can be started after heart surgery.

Transplants Heart Assist Devices and the Future

This first transplant captivated the world's imagination, and Barnard's name quickly became one of the most recognizable names in medicine. Interestingly, Barnard himself did not think the operation was revolutionary. Not a single picture was taken during the entire procedure. In a recent interview, Barnard talked about the conditions that led to the first transplant Heart transplantation was successful because it was virtually just another heart operation. We had experience in major heart surgery. We knew how to prepare a patient for it. We know how to care for a patient during such an operation and how to care for the patient postoperatively. All we had to do was work out the surgical technique

Risk factor obesity

Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. European heart journal, 2002,23 706-713 (cited in Sowers JR. Obesity as a cardiovascular risk factor. American journal of medicine, Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes care, 2001, 24 683-689 (cited in Sowers JR. Obesity as a cardiovascular risk factor. American journal of medicine, Eckel RH, Krauss RM. American Heart Association call to action obesity as a major risk factor for coronary heart disease. Circulation, 1998, 97 2099-2100.

Risk factor socioeconomic status

Choiniere R, Lafontaine P, Edwards AC. Distribution of cardiovascular disease risk factors by socioeconomic status among Canadian adults. Canadian Medical Association journal, 2000, 162(9 Suppl) S13-24. Note Definitions used Physical inactivity leisure exercise less than once per week during previous month. Elevated cholesterol 5.2 mmol l after fasting 8 hours or more. Giampaoli S, Palmieri L, Dima F, Pilotto L, Vescio MF, Vanuzzo D. Socioeconomic aspects and cardiovascular risk factors experience at the Cardiovascular Epidemiologic Observatory. Italian heart journal, 2001, 2(3 Suppl) 294-302. Steptoe A, Feldman PJ, Kunz S, Owen N, Willemsen G, Marmot M. Stress responsivity and socioeconomic status a mechanism for increased cardiovascular disease risk European heart journal, 2002, 23(22) 1757-63. Terris M. The development and prevention of cardiovascular disease risk factors socioenvironmental influences. Preventive medicine, 1999, 29(6 Pt 2) S11-17. Rao SV, Kaul P, Newby K et al....

Cardiovascular surgeon See cardiac surgeon

CCU Cardiac care unit or, in some cases coronary care unit, where patients with conditions such as heart attacks and other types of heart conditions are placed for close monitoring. cholesterol ratio Ratio of the total cholesterol measured in the blood to the amount of high-density lipoproteins (HDL). A high ratio of total cholesterol to HDL-cholesterol usually indicates greater risk for having coronary disease or a more rapid progression of existing coronary artery disease. cineangiography Similar to an arteriography or an angiography. It is the process of making a movie of the blood vessel as radiopaque dye moves through the vessel and helps to identify blockages. This is commonly done in the coronary arteries and referred to as a coronary cinean-giogram. circulation The circulation of blood through the heart, lungs, and blood vessels. collateral circulation Referring to tiny blood vessels that are used to carry blood around blockages in arteries or veins. conduit In heart surgery,...

Coronary thrombosis A clot in one of the

Distal Meaning beyond or the farther end. When referring to a blood vessel, it's the portion that's farthest from the heart. Doppler ultrasonography A technique using high frequency sound waves to detect blood flow through the heart and blood vessels. It is somewhat like the sonar used to detect submarines. ejection fraction Referring to the percentage of blood ejected out of the heart ventricles, usually the left ventricle, during a single contraction. With a single normal heartbeat, about 50 percent to 60 percent of the blood in the left ventricle is ejected. With some degree of heart damage due to a heart attack or other causes, the amount of blood ejected may be only 30 percent or 40 percent. When the left ventricle embolism The complete blocking or partial blocking of a blood vessel by an embolus. embolus An object (usually a blood clot) traveling through the bloodstream that should not be in the bloodstream. It frequently blocks off a blood vessel. endothelium The inner lining...

Guanosine monophosphate cyclic GMP A

Graft Insertion of one thing into another, and making it an integral part of the latter. An example is grafting a living branch onto a tree until it becomes part of the host tree. In heart surgery, it refers to attaching vessel grafts onto arteries. HDL, high-density lipoprotein. This is known as the good type of cholesterol. A higher HDL level is good and indicates one is less likely to suffer from a heart attack. heart attack When a portion of the heart muscle dies. Doctors refer to this as a myocardial infarction, infarction, or MI. heart disease A term used to indicate any type of abnormal heart condition, whether acquired or congenital. hemodynamics The circulation and the function of the heart, blood, and blood vessels.

Heterograft See xenograft

Hypothermia Lowering the body temperature. This technique is used in heart surgery, usually with the heart-lung machine, so the body's demand for oxygen will be less during certain types of surgical procedures. intima The inner lining of a blood vessel that is in contact with the blood. It includes the endothelial cell layer.

Lowdensity lipoprotein cholesterol See LDL

Lumen Inner open area of the blood vessel through which blood flows. magnetic resonance imaging Also called MRI. Radio waves and magnetic fields are used to form images of the internal portions of the body. The MRI is particularly good for studying blood vessels and blood flow through the heart. MI Myocardial infarction, or heart attack.

Patent ductus arteriosus See ductus arteriosus

Pediatric cardiologist A physician who specializes in heart diseases of children. pediatric heart surgeon A heart surgeon who specializes in heart surgery in children. percutaneous transluminal coronary angioplasty (PTCA) A procedure using a balloon-tipped catheter that is inflated and crushes atherosclerotic plaque or other material against the inside wall of the coronary artery, opening the blockage and allowing more blood flow to the heart muscle. This is done by introducing a catheter through a needle stick in the

Pericardial tamponade See cardiac tamponade

Proximal A point closer to the point of reference. When referring to a blood vessel, it's the portion that's closest to the heart. pulmonary embolism This happens when an abnormal piece of material, such as a blood clot, lodges in one of the blood vessels in the lungs, usually causing damage and possible shortness of breath. A large lung embolism can cause sudden death. radionuclide A small amount of a nuclear substance that is used during some diagnostic tests to help physicians better see the heart and blood vessels.

Thoracic surgeon See cardiac surgeon

Thromboembolism A blood clot that has broken loose from one area of the blood vessels or heart and traveled to another area. thrombosis The development of a blood clot in the blood vessels or heart. transient ischemic attack Also referred to as a TLA A condition in which a portion of the brain temporarily does not get enough oxygenated blood. It may result in temporary conditions such as slurred speech, partial loss of vision, weakness of an arm or a leg, or other neurologic conditions. transposition of the great arteries A severe form of congenital heart defect in which the aorta, which normally comes off the left ventricle, instead originates from the right ventricle, and the pulmonary artery, which normally originates from the right ventricle, originates from the left ventricle. As a result of this condition, children are usually cyan-otic or bluish in color. This condition requires heart surgery to correct it. triglyceride A form of lipid that is obtained in the diet through...

Risk factors start in childhood and youth

Although cardiovascular diseases typically occur in middle age or later, risk factors are determined to a great extent by behaviours learned in childhood and continued into adulthood, such as dietary habits and smoking. Markers of CVD can be seen in young children. Post-mortems of children who died in accidents have found fatty streaks and fibrous plaques in the coronary arteries. These early lesions of atherosclerosis were most frequently found in children whose risk factors included smoking, elevated plasma lipids, high blood pressure and obesity.

Adrian Kantrowitz Intra Aortic Balloon Pump

Adrian Kantrowitz

ADRIAN KANTROWITZS MANY (contributions to heart surgery early pacemakers and heart transplantation, for instance include the most practical heart assist device in use today the intra-aortic balloon pump. This novel device likely saves more than one hundred thousand lives every year worldwide. The first artificial heart in a human was implanted in 1969 by Denton Cooley, who used it as a bridge to heart transplantation for a patient who would most likely have died if Cooley hadn't used it to support the patient's failing heart until a donor heart was found. Cooley's team performed the operation on a patient who could not be weaned from the heart-lung machine after heart surgery. After sixty-four hours of support with the artificial heart, heart transplantation was performed, but the patient died of an infection thirty-two hours after the heart transplant.

Vitamin E and the Heart

A number of recent studies have attempted to determine whether taking vitamin E supplements lowers the risk of atherosclerotic heart disease and heart attacks by inhibiting low-density lipoprotein (LDL, the bad type of cholesterol). In the early 1990s, three studies found no correlation between the naturally occurring level of vitamin E in the blood and heart attacks or cardiovascular deaths. In a randomized, double-blind study, a relatively low dose of vitamin E was tested for lung cancer prevention effects. No effect on cardiovascular mortality was found. Anti-Oxidant Study (CHAOS). One thousand thirty-five patients were assigned to receive vitamin E in relatively large doses (400 to 800 IU), and 960 patients received an identical placebo. All of the patients in the study had coronary atherosclerosis proven by coronary angiogram. The patients were studied for about eighteen months. There were fourteen nonfatal heart attacks in the group receiving vitamin E and forty-one in the...

Milestones in knowledge of heart and vascular disorders

Mid-1600s Switzerland Jacob Wepfer found that patients who died with apoplexy had bleeding in the brain. He also discovered that a blockage in one of the brain's blood vessels could cause apoplexy. 1745-1827 Italy Alessandro Volta discovered that electric energy was produced by heart muscle contractions. 1785 England William Withering described the use of digitalis in coronary heart disease in his monograph An Account of the Foxglove. Foxglove had been used for centuries by American Indians. 1815 England London surgeon Joseph Hodgson claimed inflammation was the underlying -cause of atherosclerosis and it was not a natural degenerative part of the ageing process. 1907 England First case report of atrial fibrillation by Arthur Cushny, professor of pharmacology at University College, London. 1912 James B. Herrick described heart disease resulting from hardening of the arteries. 1920 USA First ECG of acute myocardial infarction by Harold Pardee. 1928 Apoplexy divided into categories...

Risk factor blood pressure

Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. New England journal of medicine, 2001, 345 1291-1297. He J, Ogden LG, Vupputuri S, Bazzano LA, Loria C, Whelton PK. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. Journal of the American Medical Association, 1999, 282 2027-2034.

Risk factor tobacco

Cardiovascular risks of smoking Price JF, Mowbray PI, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Smoking and cardiovascular risk factors in the development of cardiovascular disease and coronary artery disease Edinburgh Artery Study. European heart journal, 1999, 20 344-353. Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men longitudinal population study. British medical journal, 1998, 316 1043-1047. Cardiovascular risks of passive smoking Smokers don't know the risks of heart attack Ayanian JZ, Cleary PD. Perceived risks of heart disease and cancer among cigarette smokers. Journal of the American Medical Association, 1999, 281 1019-1021. Bonita R, Duncan J, Truelsen T, Jackson RT, Beaglehole R. Passive smoking as well as active smoking increases the risk of acute stroke. Tobacco control, 1999, 8 156-160. Humphries SE, Talmud PJ, Hawe E, Bolla M, Day INM, Miller GJ. Apolipoprotein E4 and coronary heart disease in middle-aged men...

Denton Cooley Inventor and Pioneer Surgeon

DENTON COOLEY, ONE OF heart surgery's most noteworthy pioneers, originally planned on becoming a dentist and taking over his father's practice. The open era of heart surgery is credited to the heart-lung machine, an exciting innovation that Cooley studied in development. His laboratory re His first chance to use it in a human came when a desperately ill forty-nine-year-old man was referred to him. The patient had a ruptured ventricular septum caused by a heart attack. Cooley successfully repaired the hole in the ventricular septum on April 6, 1956. This marked the beginning of open-heart surgery in Texas. In time, other patients began to follow. Within an eight-month period, I had done ninety-five open-heart operations, which far exceeded what anyone else had done anywhere in the world, Cooley said. At that time, we enjoyed almost a monopoly on open-heart surgery in that there were only two other institutions that were really active in the field, and they were both in Minnesota at...

Price 6f weekly dose of medication

P If just 10 of adults began walking regularly, Americans could save US 5.6 billion in costs related to heart disease. - President George W. Bush, 2002. Health problems related to obesity, such as heart disease and type 2 diabetes, cost the USA an estimated US 177 billion a year. Global costs of heart disease medication The number of people who die or are disabled by coronary heart disease and stroke could be halved with wider use of a combination of drugs that costs just US 14 a year. WHO, 2002 abnormal electrocardiograms, a history of diabetes or previous heart attacks

The First Heart Transplant

Heart Transplant Stitches

It immediately fascinated me that we now had the ability to work inside the heart. I switched to cardiac surgery, and that's how I got involved in heart surgery. I trained under Dr. C. Walton Lillehei in Minneapolis, and I often went to Rochester, Minnesota, to watch Dr. John Kirklin work. the hospital and became a celebrity for the several months he lived after the transplant. This highly visible success signaled that a heart transplantation was possible for humans suffering from endstage heart disease. ure. Because donors are hard to locate, candidates for heart transplant have to meet certain standards. They should be psychologically stable. Their other organ systems, such as their kidneys, liver, and lungs, should be in good condition. It is possible, however, for some patients with severe lung disease and heart disease to undergo heart lung transplantation. Candidates for heart transplantation cannot have long-standing insulin-dependent diabetes with organ damage. They are...

Prevention personal choices and actions

Good control of blood pressure, blood cholesterol and blood sugar levels, and other cardiovascular risk factors is the key to reducing risks of heart disease and stroke. Personal behaviour and lifestyle choices can make a big difference to the risk of coronary heart disease and stroke. It is estimated that having a high-risk lifestyle may account for 82 of coronary events in women. Here, we identify personal choices that can lower individual risk for heart disease and stroke. The choices apply to young people and adults alike. 5 Know the signs and symptoms of heart attack and stroke and remember that both conditions are medical emergencies. Actions and choices for children and adolescents with cardiovascular disease, or risk factors, should be discussed with a paediatrician or health care provider. Probability of heart attack begins to decrease. Excess risk of coronary heart disease is half that of a continuing smoker. Risk of coronary heart disease is similar to that of people who...

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