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 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Our objective was to examine the relationship of a self-reported physician diagnosis of arthritis with disability in elderly community dwelling women. Data from a representative sample of 1541 women aged 65 and above were analyzed to determine the prevalence and associations of a self-reported physician diagnosis of arthritis with other chronic conditions and difficulty performing physical activities. A history of physician diagnosed arthritis was reported by 902 (58.5%) women. Women with arthritis were significantly more likely to report fair or poor perceived health, as well as a physician diagnosis of angina, myocardial infarction, hypertension, diabetes, stroke, lung disease, and hearing and vision problems. After adjustment for age, race, education, marital status, and comorbid/geriatric conditions, arthritis was significantly associated with difficulty in the following 13 activities: raising arms, lifting < or = 10 pounds, walking 2-3 blocks, bathing or showering, climbing 10 steps, grasping, getting in or out of a bed or chair, dressing, using the toilet, preparing meals, doing personal shopping, heavy and light housework. We conclude that physician diagnosed arthritis is a common problem among elderly community dwelling women and is associated with difficulties in physical activity.
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PMID:The contribution of osteoarthritis to disability: preliminary data from the Women's Health and Aging Study. 775 25

Ninety-four consecutive patients (60 men and 34 women; mean age 68.5 +/- 11.5 years) with acute myocardial infarction (MI) were investigated retrospectively, in order to evaluate the prevalence, clinical features, and short-term course of the atypical forms (symptoms other than chest pain). An atypical MI was found in 30 patients, with a prevalence of 32% (95% confidence limits 27-36%). It was most prevalent in women above sixty-five years old (P < 0.05). Abdominal pain, paroxysmal dyspnea, and pulmonary edema were the most frequent symptoms (33%, 17%, 13%, respectively). No differences were observed between typical and atypical MI in regard to risk factors (hypercholesterolemia, arterial hypertension, diabetes mellitus, cigarette smoking) and history of MI, cerebrovascular disease, peripheral vascular disease, or chronic lung disease. Significantly fewer patients with atypical MI had a history of angina pectoris (P < 0.05). No differences were observed in regard to previous medication, except for antiarrhythmic drugs, more often used by atypical patients (P < 0.05). Location and severity of MI (as judged by ECG and peak levels of creatine kinase in the serum) were similar in both subgroups, as were the complications (34% typical and 50% atypical) and death rate (12.5% and 16.7%, respectively). In conclusion, atypical MI is not less severe than typical. This emphasizes the need for a high suspicion index in many different clinical settings, but particularly (although not exclusively) in elderly females, in the presence of abdominal pain or otherwise unexplained paroxysmal dyspnea.
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PMID:Prevalence, clinical features, and acute course of atypical myocardial infarction. 828 84

Many patients undergoing pharmacological stress echocardiography for assessing symptoms suggestive of coronary artery disease are found to have a normal test. This study was performed to evaluate whether asthma symptoms simulate angina pectoris. A total 41 consecutive patients who had a negative pharmacological stress echocardiography and had been evaluated for angina pectoris were studied. Patients with previously known coronary artery disease or obstructive lung disease were excluded. Lung function testing was performed and the authors proceeded either with the administration of a bronchodilator or with methacholine challenge testing. A questionnaire was applied to assess the symptoms dyspnoea, chest tightness and substernal burning at the end of the challenge test. In addition, patients were asked if they were experiencing those symptoms that made them seek medical attention. From the 41 patients tested, 26 patients showed a significant bronchial hyperreactivity (mean +/- SD provocative concentration causing a 20% fall in the forced expiratory volume in one second 5.93 +/- 4.50 mg x mL(-1)). A total of 20 patients confirmed having those symptoms that led to cardiac evaluation. It was concluded that symptoms suggestive of angina pectoris might represent bronchial asthma. This should be considered in the differential diagnosis of angina pectoris.
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PMID:Bronchial asthma causing symptoms suggestive of angina pectoris. 1266 4

Beta-adrenergic blocking agents, or beta-blockers, are indicated in the management of angina pectoris, myocardial infarction, hypertension, congestive heart failure (CHF), cardiac arrhythmias, and thyrotoxicosis, and are given to reduce perioperative complications. Despite clear evidence that they reduce morbidity and mortality, clinicians are often hesitant to administer them for fear of adverse reactions. Over the past several years, many of the contraindications traditionally listed for betablockers have been questioned and disproved. Beta-blockers were contraindicated in CHF because of their intrinsic negative inotropic activity, but have now been shown to be beneficial, partly due to their ability to enhance sensitivity to sympathetic stimulation. Beta-blockers have also been contraindicated for patients with obstructive lung diseases, such as asthma and chronic obstructive pulmonary disease, due to the potential risk for bronchospasm. However, new evidence has shown that cardioselective beta-blockers are safe in patients with obstructive lung diseases, and may actually be beneficial by enhancing sensitivity to endogenous or exogenous beta-adrenergic stimulation. This article will review the evidence concerning the safety of beta-blocker use in patients with CHF and concomitant obstructive lung disease, with specific attention to tracking the transition from myth to evidence- based practice.
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PMID:Beta-blocker use in patients with congestive heart failure and concomitant obstructive airway disease: moving from myth to evidence-based practice. 1472 18

The Veterans Health Study (VHS) was designed to produce patient-based measures of health status suitable for monitoring the health of men served by the Veterans Health Administration. This article summarizes the objectives, conceptual framework, and results of 6 substudies of the VHS that were designed to develop disease-focused measures of illness severity, that is, patient-perceived, clinically significant manifestations of disease processes that are associated with decrements in health-related quality of life. Developmental psychometric studies used cross-sectional survey data from the baseline comprehensive evaluations conducted in the VHS. Patients who screened positive for the 6 study medical conditions in the VHS (osteoarthritis of the knee, n = 511; type 2 diabetes, n = 425; chronic lung disease, n = 352; hypertension, n = 996; chronic low-back pain, n = 574; and alcohol-related disorder, n = 175) were administered structured interview modules that assessed symptoms and complications of these chronic diseases. Psychometric analyses were conducted to identify internally coherent and reliable indices, which were validated with respect to their correlations with measures of health-related quality of life (eg, Short Form-36) and the utilization of health services. We constructed 6 indices of illness severity. The severities of osteoarthritis of the knee and chronic lung disease were defined by brief (12 and 6 items, respectively) assessments of symptoms (eg, knee pain and dyspnea). Since diabetes and hypertension are largely asymptomatic, illness severity for these conditions was assessed by ascertaining complications such as angina and vascular disorders. Alcohol-related disorder, which involves both behavioral symptoms and physical complications, was assessed by separate scales for these 2 dimensions of its severity. Chronic low-back pain required a unique solution. Rather than assessing the intensity of back pain, it is more productive to construct a measure that focuses on manifestations of radiculopathy, that is, whether back pain radiated down the leg to below the knee. The 5 symptoms or complication indices and the assessment of radiculopathy in chronic low-back pain were significantly correlated with Short Form-36 scores and intensity of recent use of health services. The 6 measures may complement measures of health-related quality of life in providing more comprehensive assessments of health status in Veterans Affairs patients.
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PMID:Patient-based measures of illness severity in the Veterans Health Study. 1596 20

The predictors of prolonged mechanical ventilation and subsequent morbidity after cardiac surgery are ill defined. Our aim was to evaluate them. Four hundred and seventy consecutive patients undergoing coronary artery bypass grafting on cardiopulmonary bypass (CPB) between January and June 2002 were retrospectively analysed for preoperative predictors of prolonged ventilation, which included age, gender, ejection fraction (EF), renal function, diabetes, angina status, severity of the disease (New York Heart Association class), number of vessels diseased and chronic lung disease. Intraoperative variables such as prolonged CPB, aortic cross clamp time, intra-aortic balloon pump (IABP) usage, inotropes and postoperative variables like temperature on arrival at intensive care unit(ICU), IABP usage, organ dysfunction, inotropes and reintervention (reintubation and re-exploration) were also analysed. Prolonged ventilation was defined as > or = 24 hours and these patients were included in group I (n=22). Patients requiring less than 24 hours ventilation (n=448) were included in group II. Stepwise logistic regression analysis was performed. The average age of patients was 56.9 +/- 8.8 years with male predominance (88.4%). The overall perioperative mortality was 2.1% (10 patients) with Group I showing mortality rate of 36.3% (8 patients). In multivariate analysis, predictors of prolonged ventilation were found to be EF <40% (odds ratio, (OR) 13.38), preoperative renal dysfunction [OR 4.06 (serum creatinine > 1.2 mg%)], prolonged CPB, > 120 min (OR 9.6) and reintervention in the form of re-exploration or reintubation in the ICU (OR 13.8). Identification of perioperative variables, which may lead to prolonged ventilation may allow the development of strategies to optimize the patient's condition and ICU management.
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PMID:Predictors of prolonged mechanical ventilation after on-pump coronary artery bypass grafting. 1769 5

Angina pectoris (AP) often responds to treatment, but in some, it becomes chronic or recurs over time. Identifying patients with continued AP is a necessary to understand its associations and implications. A baseline cohort with coronary disease and AP were surveyed 6 months and 1 year after catheterization for self-reported symptoms and quality of life. Patients were divided into 3 groups: chronic AP, recurrent AP, and AP free. Baseline characteristics, medications, revascularization, and quality of life are described. Regression analysis determined independent associations with chronic AP. Of the 1,109 patients with complete 1-year follow-up, 19% (n = 207) had chronic AP, 11% (n = 126) had recurrent AP, but most (70%, n = 776) were AP free. Patients with chronic and recurrent AP had similar cardiac histories, had more single vessel coronary disease, and underwent revascularization less often. Patients with recurrent AP had lower educational status and more often smoked. Patients with chronic AP were younger, were women, had higher body mass index, had more depression and lung disease, and had more frequent baseline AP. They also took more antianginals and other medications and had reduced physical function and health-related quality of life in relation to the persistence and frequency of symptoms (p <0.001). In conclusion, patients with chronic and recurrent AP represent unique populations in whom AP continues to negatively impact quality of life despite contemporary care.
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PMID:Profile of chronic and recurrent angina pectoris in a referral population. 1899 45

Convincing evidence of the decline of mortality has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. The beta-blockers are also the most efficient antianginal medications for the decrease of ischemia in outpatients. They are highly efficient as a monotherapy for angina and are also a medication of choice for angina after the coronary. The objective of this work was an estimate of the use of beta-blockers in secondary prevention of the ischemic heart disease and eliminating doubts concerning their prescription. The method of the analysis sums up the results of a twenty-five-year study on of the outcome of the treatment with beta-blockers in secondary prevention of the ischemic heart disease. The method of the work implies an examination of the professional literature and the data-bases, such as MEDLINE, Pub-Med and KOBSON. The first studies concerned non-selective beta-blockers, used orally. The following studies concerned cardioselective beta-blockers, metoprolol and atenolol. Several studies followed also the effect of beta-blockers and heparin, or beta-blockers and antagonists of calcium towards placebo, in patients with an unstable angina pectoris. Beta-blockers are an essential drug in secondary prevention of the myocardial infarction and in chronic heart failure. The necessary condition for the efficiency of beta-blockers is an early use. Beta-blockers should be given within 12 hours after the appearance of pain. The continuation of the therapy with beta-blockers after the acute phase is considered to be important in the decrease of the infarction zone expansion. Prophylactic use of beta-blockers after the coronary has an excellent effect, above all in patients with a minor, uncomplicated coronary. Though certain groups of beta-blockers have some special characteristics, when it comes to the treatment of angina pectoris, all beta-blockers are efficient. Generally, patients react well to them. Preference is given to cardioselective remedies, in patients with diabetes or lung disease. Exhaustive controlled clinical studies affirm beta-blockers as drugs that reduce mortality in secondary prevention of the ischemic heart disease.
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PMID:[Studies of the outcome of the treatment with beta-blockers in secondary prevention of the ischemic heart disease]. 2039 41

Pulmonary hypertension (PH) is defined as an increase in mean pulmonary arterial pressure > or = 25 mmHg at rest as assessed invasively by right heart catheterisation. It can affect patients at any age and presents with non-specific symptoms. Accurate diagnosis is important as while PH is a potentially lethal disease it is treatable. Identification of the cause of PH is crucial to ensure that the patient receives appropriate management. The most common causes are heart and lung disease; specialist drug therapies for PH are contraindicated in these patients. However, PH is also associated with a diverse group of diseases. The most common symptom of PH is breathlessness on exertion. Syncope may be the presenting symptom especially in children. Other PH symptoms include: angina pectoris, palpitations, dry cough, exertional nausea and vomiting. Lack of response to conventional treatment for dyspnoea should alert the GP to search for another cause of the patient's symptoms, one of which could be PH. Patients should have an ECG, a chest radiograph and a full blood count, renal and liver function as well as thyroid function tests. When PH is suspected, referral to the local cardiology or respiratory department is recommended. Referral should be urgent if the patient is syncopal, has rapidly progressing symptoms or is in heart failure. Echocardiogram is the investigation of choice for detecting elevated pulmonary pressures. If the echocardiogram shows signs of PH then the patient should be referred to a designated PH centre if pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension are suspected or if PH is of uncertain cause.
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PMID:Diagnosing and managing pulmonary hypertension. 2347 17

Background: The incidence of restenosis in patients suffering from coronary artery disease after undergoing angioplasty is of paramount importance. Accordingly, this study aimed to investigate factors affecting the time of the first incidence of restenosis in patients undergone angioplasty in the city of Zanjan, Iran. Methods: This retrospective cohort study was conducted on 421 patients who referred to Ayatollah Musavi hospital in Zanjan for angioplasty during 2009 to 2012. The time of the incidence of restenosis after angioplasty constituted the dependent variable of the study. Independent variables of the study included signs of diabetes, hypertension, hyperlipidemia, kidney disease, carotid stenosis, lung disease, anemia, angina history, and MI. The Cox regression model with the significance level of 0.05 was deployed for the statistical analysis. Results: According to the Cox regression model, hazard ratio of the first incidence of restenosis in patients with hypertension and angina was 22.8% and 29.5% less than other patients, respectively. However, hazard ratio of the first incidence of restenosis was 7.4 times more in patients suffering from carotid stenosis than other patients (p<0.05). Conclusion: The results of this study revealed that as time goes on, the risk of the incidence of restenosis in angioplasty patients increases such that patients' survival decreases dramatically after a year. To determine the role of effective factors on the incidence of restenosis, conducting a prospective interventional study is highly recommended.
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PMID:Investigation factors affecting the first recurrence of coronary artery disease in patients undergone angioplasty using cox survival model. 2821 Jun 6


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