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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Atrial fibrillation (AF) is an important risk factor for stroke. According to a pooled analysis of controlled clinical trials with warfarin, anticoagulation therapy reduces stroke risk by 62%. However, clinicians must decide whether the benefit of long-term anticoagulation therapy with available agents outweighs the risk of bleeding for individual patients. Guidelines issued by the American College of Chest Physicians and by the joint American College of Cardiology, American Heart Association, and the European Society of Cardiology task force recommend antithrombotic therapy to protect AF patients from stroke based on risk-stratification algorithms. Risk factors for stroke AF patients include age > or =75 years; hypertension; thyrotoxicosis; diabetes; cardiovascular disease; congestive heart failure; and history of stroke, transient ischemic attack, or thromboembolism. Patients at high risk for stroke experience greater absolute benefit from anticoagulation therapy than patients at low risk. The guidelines are consistent in recommendations for high-risk patients (warfarin therapy, international normalized ratio 2.0 to 3.0) and low-risk patients (aspirin 325 mg), but differ for intermediate-risk patients with diabetes or heart disease. The guidelines continue to evolve, and future guidelines are likely to incorporate new clinical data, including the CHADS(2) algorithm for determining risk and the results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management trial, the Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation study, and the Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation II to V trials.
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PMID:Comparing the guidelines: anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation. 1502 46

General internists and adult cardiologist are seeing adult congenital heart disease more frequently in their clinical practices. We report the case of a polycythaemic patient with the cerebral and pulmonary arteriovenous malformations (AVMs) who presents with a transient ischaemic attack (TIA). Treatment strategies such as antiplatelet drugs and vensection may at best be ineffective and at worst detrimental to the patient.
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PMID:Acute neurological events in a patient with secondary polycythaemia and arteriovenous malformations. 1572 14

Coronary artery aneurysms are uncommon and the prevalence in patients undergoing coronary artery angiography is 1.5-4.9%. The most common cause of coronary artery aneurysm is arteriosclerosis, followed by Kawasaki disease, periarteritis nodosa, systemic lupus erythematosus, syphilis, rheumatic fever, congenital heart disease and trauma. Most coronary aneurysms remain asymptomatic. Patients may present symptoms of angina or myocardial infarction due to thrombosis within the aneurysm. This would lead to occlusion of the coronary artery or to distal thromboembolisms. There is no consensus on how to manage coronary artery aneurysms. Medical therapies include aspirin as well as warfarin. Surgery may be performed in patients with a large aneurysm, i.e. when the risk of rupture or thrombosis is high. We present a 60-year-old female patient with symptoms of a transient ischaemic attack followed by a period of fever, nausea, vomiting and ecchymoses on the lower extremity. Transthoracic and transoesophageal echocardiography was suggestive of a tumour located at the basis of the lateral wall of the right atrium. Heart surgery revealed, however, a large right coronary aneurysm and an atrial septum defect of the secundum type.
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PMID:[A 60-year-old woman with asthenia and dyspnoea]. 1576 62

Transient ischemic attacks (TIAs) involve the sudden and brief loss of cerebral or ocular function, due to ischemic causes, with complete recovery at the moment of examination. TIAs, too often trivialized, require specialized emergency management. The risk of cerebral infarction within 7 days after TIA can reach 35%. All transient neurological signs are not TIAs. The principal causes of TIAs are atherosclerosis, cerebral arteriolopathy, and emboligenic heart disease. Treatment by platelet aggregation inhibitors (aspirin 160-300 mg) should begin immediately and be adjusted according to test results.
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PMID:[Transient ischemic attacks]. 1729 81

Over the past decade, statins have been proven to significantly decrease coronary events in primary and secondary prevention of coronary artery disease. Recent clinical trials have indicated that statins significantly reduce stroke risk in patients with vascular disease. The Cholesterol Treatment Trialists' Collaborators in a meta-analysis including 90,056 patients found that the use of statins determined a significant 17% proportional reduction in the incidence of first-ever stroke of any type per 1 mmol/l low-density lipoprotein (LDL) cholesterol reduction. During an average of 5 years of treatment, the reduction in the overall incidence of stroke was about one sixth per 1 mmol/l LDL cholesterol decrease meaning that 8 fewer participants have any stroke per 1,000 among those with preexisting coronary artery disease at baseline, compared with 5 fewer per 1,000 among the participants with no such history. It is not known whether these findings might be due to the cholesterol reduction effect of statins or to pleiotropic effects of statins, such as improved endothelial function, decreased platelet aggregability, and reduced vascular inflammation. In secondary prevention of stroke, the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study found that treatment with atorvastatin reduced the risk of recurrent cerebrovascular events in patients with recent stroke or transient ischemic attack but no history of heart disease. Combining the results of patients with no history of heart disease from the SPARCL study and Heart Protection Study in a mini meta-analysis, compared with placebo, statins were associated with a barely nonsignificant difference in recurrent stroke (OR = 0.87, 95% CI = 0.75-1.01, p = 0.07) and a significant difference in the occurrence of major vascular events (OR = 0.78, 95% CI = 0.68-0.88, p = 0.0001) at final follow-up.
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PMID:Statins and stroke prevention. 1759 85

Vertigo is one of the most common reasons for a patient to consult the general practitioner, and in the elderly in particular the underlying cause may be varied. Dizziness is not infrequently a side effect of medication, or may be associated with depression. Other possible causes include orthostatic dysregulation, hyperventilation, heart disease, equilibrium disorders, visual problems, paroxysmal positioning vertigo,TIA, cerebral infarction or the presence of a tumor.
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PMID:[Vertigo in the elderly]. 1761 64

It has been shown that HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) lower the incidence of a first stroke in patients with coronary heart disease, diabetes, or risk factors for cardiovascular disease. However, it is unknown whether statin therapy could reduce the incidence of a second stroke in patients without evidence of heart disease. This article reviews the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial, a prospective, randomized, multicentered, double-blind, placebo-controlled, international trial designed to examine the effect of high-dose atorvastatin on secondary stroke prevention. Trial participants (4,731) had experienced a stroke or transient ischemic attack within 1 to 6 months before randomization into the study. Over the 5-year follow-up period, incidence of second stroke or transient ischemic attack was significantly reduced in the atorvastatin treatment group compared with the placebo group. In addition, high-dose atorvastatin therapy significantly decreased major coronary artery and other negative cardiovascular events. The reduction in incidence of secondary stroke was specific to ischemic stroke as opposed to hemorrhagic stroke. Results of the trial are clinically significant and support extension of the latest secondary stroke prevention guidelines to include statin therapy for those patients without coronary heart disease.
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PMID:High-dose statin therapy for secondary prevention of stroke: stroke prevention by aggressive reduction in cholesterol levels study review. 1815

The risk of stroke in atrial fibrillation (AF) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis, with the aim of appropriate use of antithrombotic therapy. To achieve this, stroke risk factors in AF populations need to be identified and stroke risk stratification models have been devised on the basis of these risk factors. In this article, we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical, demographic and echocardiographic patient characteristics in AF populations. Secondly, we performed a systematic review of published stroke risk stratification models, in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk. Thirdly, we review the health economic evidence relating to the cost-effectiveness of anticoagulation and antiplatelet therapy as thromboprophylaxis in AF patients. The studies included in the systematic review of stroke risk factors identified history of stroke or TIA, increasing age, hypertension and structural heart disease (left-ventricular dysfunction or hypertrophy) to be good predictors of stroke risk in AF patients. The evidence regarding diabetes mellitus, gender and other patient characteristics was less consistent. Three stroke risk stratification models were identified that were able to discriminate between different categories of stroke risk to at least 95% accuracy. Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone. In patients at high risk of stroke, anticoagulation is cost effective, but not for those with a low risk of stroke. With the evidence available for stroke risk factors and the various alternative stroke risk stratification models, a review of these models in terms of the evidence on which they are devised and their performance in representative AF populations is important. The appropriate administration of thromboprophylaxis in AF patients would need to balance the risks and benefits of antithrombotic therapy with its cost-effectiveness.
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PMID:Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data. 1827 78

Over the past decade, statins have been proved to significantly decrease coronary events in the primary and secondary prevention of coronary artery disease. Recent clinical trials have indicated that statins significantly reduce stroke risk in patients with vascular disease. A meta-analysis of randomized trials of statins in combination with other preventive strategies, involving 165,792 individuals, showed that each 1-mmol/l (39 mg/dl) decrease in LDL-cholesterol equates to a reduction in relative risk for stroke of 21.1 (95% CI: 6.3-33.5; p = 0.009). It is not known whether these findings might be due to the cholesterol-reduction effect of statins or to the pleiotropic effects of statins, such as improved endothelial function, decreased platelet aggregability and reduced vascular inflammation. In the secondary prevention of stroke, The Stroke Prevention by Aggressive Reduction of Cholesterol Levels study found that treatment with atorvastatin reduced the risk of recurrent cerebrovascular events in patients with recent stroke or transient ischemic attack but no history of heart disease.
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PMID:Statins and stroke prevention. 1981 66

Most Health Services are not capable of offering expedited investigation and treatment to the majority of patients presenting with transient ischaemic attack (TIA) or minor stroke. The reasons for this are multifactorial. However, there is now compelling evidence that the risk of stroke after TIA/minor stroke is significantly higher than was previously thought, with one recent study suggesting the stroke risk might be as high as 17% at 72 hours in patients with a clinically significant carotid stenosis. There is also good evidence that TIA services offering 'walk in' access with single visit imaging, combined with antiplatelet, antihypertensive and statin therapy starting during the initial consultation, significantly reduce the early risk of stroke. For many years, stroke has been the 'poor relation' to cancer and heart disease in terms of political and fiscal priorities. Given the plethora of evidence now available to us, it is no longer acceptable to tolerate delays to treatment and, in particular, continued acceptance of the dogma that provided patients undergo carotid revascularisation within 6 months, the patient is receiving optimal care. This philosophy should now be considered obsolete. The only thing that benefits from undue delay to treatment (in order to minimise the procedural risk) is the surgeon/interventionist's ego. It is certainly not the patient.
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PMID:The importance of initiating "best medical therapy" and intervening as soon as possible in patients with symptomatic carotid artery disease: time for a radical rethink of practice. 1993 9


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