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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To confirm the usefulness of head-up tilt test (HUT) in neurocardiogenic syncope (NCS) with complicating clinical features, retrospective analysis were done on 12 selected children. The age at onset was 12.7 +/- 1.9 (mean +/- SD) years. Associated clinical features were postoperative congenital heart disease (PO CHD) in 3, coexistent arrhythmia in 8 (persistent ventricular arrhythmia during exercise in 3, premature ventricular contractions in 2, ventricular couplets in 1, sinoatrial exit block in 1 and resting sinus bradycardia in 1) and ST segment depression during exercise in 1. Four of them had a history of exercise-related syncope. All 3 patients with PO CHD had arrhythmia (ventricular tachycardia in 1, sinus bradycardia in 1 and atrioventricular block in 1). HUT provoked NCS in 8 (2 during baseline tilt, 6 during isoproterenol infusion). In one each, ventricular tachycardia and loss of consciousness without hypotension and bradycardia were induced. Atenolol was tried in 5 with improvement of NCS in 4 and aggravation of dizziness in 1. During follow-up, 7 became asymptomatic (2 with atenolol) and 5 were stationary. In conclusion, HUT was valuable in diagnosing NCS even in children with complicating clinical features such as arrhythmias or PO CHD. HUT could be done as apart of initial diagnostic tests if the past history suggests NCS, regardless of associated clinical features. In some cases, the unexpected results of the test turned out useful in managing children with syncope or dizziness.
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PMID:Head-up tilt test in complicated neurocardiogenic syncope in children. 914 59

This study analyzes changes in health-related quality-of-life (HQL) outcomes following myocardial infarction (MI) from a population-based perspective. Data came from a representative sample of 2812 men and women 65 years and older living in New Haven, CT. All subjects were interviewed at baseline in 1982, and again in 1985 and 1988. HQL outcomes included self-rated health, depressive symptoms, and physical and social functioning. Pooled logistic regression models were used to estimate the risk for decline in HQL outcomes due to MI. Of the 203 MIs during follow-up, 111 (55%) survived until the next interview to provide post-MI data on outcomes. In bivariate analysis, MI patients were more likely than subjects without MI to show a decline in physical functioning (26.4% vs. 11.9%, P = .001) and social functioning (31.4% vs. 20.8%), P = .06). There were no differences in self-rated health (26.3% vs. 26.9%), but MI patients were less likely to show an increase in depression (9.1%) vs. 15.8%, P = .08). These associations remained mostly unchanged after adjustment for CHD risk factors. The effect of MI on physical and social functioning was much stronger among patients with a recent MI (<1 year ago) than those whose MI had occurred more than a year before post-MI assessment. While a substantial proportion of MI patients experience a significant decline in quality of life-related outcomes, only some of these declines occur more frequently among MI patients than in the population at large. This effect may also be limited to the immediate post-MI period. Results from this analysis are discussed in terms of the "burden of illness" within a defined population due to MI.
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PMID:A population-based perspective of changes in health-related quality of life after myocardial infarction in older men and women. 967 68

Much debate on the benefits and risks of cholesterol lowering to prevent coronary heart disease has focused on excess non-CHD mortality rates reported in some trials. Because of the wide variation in design of cholesterol-lowering trials and because the non-CHD mortality rate was not a controlled endpoint of statistical power in most published studies, it has been difficult to determine whether any excess mortality was due to certain therapies, to other mechanisms, or to chance. As a result, some investigators have performed retrospective analyses of pooled trial data in order to augment statistical power. Some investigators have hypothesized that the human brain is dependent on a constant supply of cholesterol from the circulation and that cholesterol loss in neuronal membranes, with the possible consequences of behavioral disorders and increased risk of accident and violent death. Indeed Weidner and Griffin suggest that low cholesterol is a marker for poor underlying health; physical illnesses are likely to cause depression and other negative emotional states, which are often accompanied by suppressed appetite and weight loss causing reduction in cholesterol levels. Such mental states may also increase the risk of non-CHD death, for example suicide. Rossouw reviews the evidence concerning non-CHD mortality in cholesterol-lowering trials and reports metaanalyses carried out for all trials combined. The findings indicated a significant (15%) increase in non-CHD mortality in all trials combined. However, this was not related to cholesterol lowering itself, because there was no increased risk in trials with > 10% cholesterol reduction, whereas there was a significant (22%) increase in trials with lesser degrees of cholesterol lowering. The publication of a large secondary prevention trial (4S) employing Simvastatin for cholesterol lowering supports the idea that cholesterol reduction itself does not have adverse effects on non-CHD mortality. The overview of all published trials demonstrates their effectiveness in reducing cholesterol and provides clear evidence of benefits on stroke and total mortality. A 10% reduction in cholesterol yielded about a 20% decrease in CHD mortality, which would be expected to result in about a 6% reduction in total mortality. Endothelium-dependent relaxations are reduced in hyperlipidemia and atherosclerosis. Exogenous L-arginine improves or restores the reduced endothelium-dependent relaxations. Moreover inflammation is associates with the initiation and progression of atherosclerosis. The fact of the matter is the Cardiovascular drugs already in clinical use or in development are able to interfere with certain aspects of endothelial function and may be useful in protecting the vessels and, hence, in preventing the development of cardiovascular disease.
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PMID:[All mortality by cause of death. The challenge of coronary prevention]. 1005 Jan 41

CHD in the elderly population will continue to be a source of major concern because of the increasing costs entailed and uncertainties about how the widespread array of diagnostic and therapeutic interventions, often expensive and sometimes hazardous, should be applied. Financial, political, and health policy decisions will continue to occupy much attention, but it is likely that philosophic considerations about aging and death, both from the individual and the societal perspective, will be of paramount importance of deciding how the substantial resources available to the elderly will be used. Randomized, controlled trials are unlikely to play a major role in resolution of management dilemmas in the elderly because of the extraordinary heterogeneity in this population. Registries (databases) involving carefully prospectively collected key variables are likely to be a more effective approach. Critical characterization of complications of procedures, adverse drug reactions, and collection of follow-up data on functional status are among the critical questions, and these can be answered by registry studies. Algorithms and clinical rules developed in younger cohorts are not directly transferable to the elderly cardiovascular patients, further emphasizing the need for prospectively collected, syndrome-specific data. Treatments convincingly demonstrated to reduce mortality in absolute terms more in the elderly than in the young are underused. The heterogeneity of aging emphasizes the wide variability in patients' ability to withstand the stress of procedures and complications of disease and makes clear the need to consider physiologic reserve and biologic age rather than chronology. With better characterization of biologic age and physiologic reserve, more precise estimates of outcomes of therapies and interventions can be made, and patients can be given better information and with their families have more realistic expectations. Better-informed decisions will result. Biologic age will be multifactorial, involving cognitive, emotional, physical, and nutritional attributes as well as specific organ function (lung, kidney, liver) because no single feature can characterize the total elderly patient. The concept of competing risks among the cardiovascular disease being treated, comorbidity, risks of study, and life expectancy will evolve because even the most successful therapy will have limited effect on longevity in the very old. Although important research at the cellular and molecular level will characterize and provide better understanding of the aging process, it is not likely that this basic information will be immediately useful in the management of the large number of elderly patients with major cardiovascular disease. Preventive measures, including physical exercise, mental stimulation, avoidance of depression, good nutrition, and abstinence from tobacco use, are useful approaches to postpone or ameliorate the consequences of aging and allow patients to tolerate cardiovascular diseases better when they become manifest.
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PMID:Coronary heart disease. Stable and unstable syndromes. 1009 68

Persons with chronic SCI have several metabolic disturbances. As a consequence of inactivity and the body compositional changes of decreased skeletal muscle with a relative increase in adiposity, a state of insulin resistance and hyperinsulinemia has been demonstrated to exist, associated with abnormalities in oral carbohydrate handling. Elevated plasma insulin levels in persons with SCI probably contribute to the cause of frequent dyslipidemia and hypertension. This constellation of metabolic changes represents an atherogenic pattern of CHD risk factors with many of the distinctive features of a cardiovascular dysmetabolic syndrome that is called syndrome X. Reduction in modifiable risk factors for CHD should decrease the occurrence of catastrophic cardiovascular events. There is evidence to suggest that endogenous anabolic hormone levels are depressed in a proportion of individuals with SCI. Depression of serum testosterone and growth hormone/IGF-I levels may exacerbate the adverse lipid and body compositional changes, reduce exercise tolerance, and have deleterious effects on quality of life. Because of immobilization, individuals with paraplegia have osteoporosis of the pelvis and lower extremities, and those with tetraplegia also have osteoporosis of the upper extremities. In addition, there is evidence to suggest that bone loss progresses with time in persons with chronic SCI. This may be caused by chronic immobilization per se or may be a consequence of adverse hormonal changes, including deficiency of anabolic hormones or deficiency of vitamin D and calcium with secondary hyperparathyroidism. Serum thyroid function abnormalities resembling the euthyroid sick "low T3 syndrome" have been reported in those with acute and chronic spinal cord injury. Depressed serum T3 and elevated rT3 in chronic SCI may be caused by associated illness. Current practice has been hesitant to treat abnormal serum thyroid chemistries associated with nonthyroidal illness. Recognition of metabolic abnormalities in individuals with SCI is vital as a first step in improving clinical care. The application of appropriate interventions to correct or ameliorate these abnormalities promises to improve longevity and quality of life in persons with SCI.
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PMID:Metabolic changes in persons after spinal cord injury. 1068 Jan 61

While aerobic endurance training has been a substantial part of international recommendations for cardiac rehabilitation during the last 30 years, there is still a rather reserved attitude of the medical community to resistance exercise in this field. Careful recommendations for resistance exercise in cardiac patients was only published a few years ago. It has been taken for granted that strength exercise elicits a substantial increase in blood pressure and thus imposes, especially in cardiac patients, a risk of potentially fatal cardiovascular complications. Results of the latest studies show that the existing recommended overcaution is not justified. Strength exercise can indeed result in extreme increases of blood pressure, but this is not the case for all loads of this kind. The actual blood pressure response to strength exercise depends on the isometric component, the exercise intensity (load or resistance used), muscle mass activated, the number of repetitions in the set and/or the duration of the contraction as well as involvement of Valsalva maneuver. Intra arterially performed blood pressure measurements during resistance exercise in patients with heart disease showed that strength training carried out at low intensities (40-60% of MVC) and with high numbers of repetitions (15-20) only evokes a moderate increase of blood pressure comparable with blood pressure measures induced by moderate endurance training. If used properly and performed accurately, individually dosed, medically supervised and controlled through experienced sport therapists, a dynamic resistance exercise is-at least for a certain group of patients-not associated with higher risks than an aerobic endurance training and can in addition to endurance training improve muscle force and endurance, have a positive influence on cardiovascular function, metabolism, cardiovascular risk factors as well as psychosocial well-being and overall quality of life. However, with respect to currently available data, resistance exercise cannot be generally recommended for all groups of patients. The appropriate kind and execution of training is highly dependent on current clinical status, cardiac capacity as well as possible accompanying diseases of the patient. Most of the studies carried out up to date included small samples of middle-aged male patients with almost normal levels of aerobic endurance performance and good left ventricular function. Data is missing for risk groups, older patients and women. Therefore, an integration of dynamic resistance exercises in cardiac rehabilitation can only be recommended without hesitation for CHD patients with high physical capacity (good myocardial function, revascularized). Since patients with myocardial ischemia and/or low left ventricular functioning might develop wall motion disturbances and/or dangerous ventricular arrhythmia when performing resistance exercises, prevalence of the following conditions is recommend: moderate to high LV-function, high physical performance (>5-6 metabolic equivalents= >1.4 watts/kg body weight) in absence of angina pectoris symptoms or ST-depression, by maintained current medication. In the proposed recommendations, a classification of risks for resistance training in cardiac rehabilitation is being made based on current data and is complemented by specific recommendations for particular groups of patients and detailed guidelines for setup and completion of the therapy program.
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PMID:[The stakes of force perseverance training and muscle structure training in rehabilitation. Recommendations of the German Federation for Prevention and Rehabilitation of Heart-Circulatory Diseases e.v]. 1516 Feb 71

Elderly patients are significantly less likely to receive statins than younger patients possibly because of doubts regarding compliance or concerns regarding the increased likelihood of adverse events and drug interactions. Poor compliance can be expected especially in patients suffering from dementia or depression as well as those whose stage of cardiovascular disease exhibits few symptoms. On the other hand, the clinical significance of CHD events is high in the elderly, and 80% of coronary deaths occur in patients aged over 65 years. The average statistical life expectancy of elderly and old patients is often underestimated. The HPS and PROSPER studies showed that statins reduce mortality and morbidity even in very elderly individuals with a high global cardiovascular risk and/or CAD. Patients up to the age of 79 years should be treated according to the same guidelines as younger patients. Statin therapy should only be considered for patients aged 80 years and older who are at a very high risk for cardiovascular events.
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PMID:[Recommendations for statin therapy in the elderly]. 1534 Jun 98

The purpose of the study was to develop specific angiographic criteria of stable exertional angina (SEA) in patients with possible old myocardial infarction (MI). The subjects were 23 patients with uncertain signs of old MI. In 16 patients SEA was excluded after performing maximal loading test (LD). In 7 patients SEA was verified by LD (angina-like discomfort and ST segment depression by at least 0.2 mV). All the patients underwent selective coronarography. The specificity of conventional angiographic criteria of CHD (stenosing of any magistral coronary artery with the reduction of its lumen by at least 50-75%) in diagnostics of SEA in patients with possible old MI is not higher than 56.3 +/- 12.8%. The authors developed angiographic criteria system, which allows detection of SEA with a diagnostic precision of 95.7 +/- 4.3% in patients with uncertain signs of old MI. These criteria significantly increase accuracy of differential diagnosis between SEA and isolated painless myocardial ischemia in patients with hemodynamically significant lesions of the vascular system.
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PMID:[Criteria for stable angina verification in cases of difficult diagnosis]. 1611 21

District nurses deal with many overweight and obese clients on their caseloads. Many of these people have various co-morbities; their weight issues are often glossed over, prioritizing more pressing clinical issues. This however is a mistake, in this article the issue of obesity in the elderly is mapped out. It starts with looking at the reasons behind the epidemic and looking at individual factors. The elderly suffer from sarcopenia as a result of ageing which leads to changes in body morphology. If not tackled early, such changes lead to considerable increases in cardiometabolic risk. Widespread increases in BMI have been shown to promote CHD, hypertension, type 2 diabetes and certain types of cancers. Clinical depression can be a manifestation of obesity. An overview of the prevalence and non-conservative clinical management is given.
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PMID:Understanding obesity in the older person: prevalence and risk factors. 1855 67

The purpose of the research was to evaluate the age-related androgenic state in men with CHD and its relations with some risk factors. In this research 118 patients were included (average age 51.1 +/- 4.2 years). Testosterone and cholesterol serum levels were estimated. The presence and type of adiposity, depression level were determined. It has been established that the average testosterone level in patients (272 +/- 23.4 ng/dl) corresponded to androgen deficiency condition. Direct correlation of serum testosterone level with abdominal type of adiposity and inverse one with atherogenic lipoprotein level and depressions has been revealed.
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PMID:[Age-related androgen deficiency in men with ischemic heart disease]. 1894 79


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