Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The recent Institute of Medicine report "From Cancer Patient to Cancer Survivor: Lost in Transition" recommended the creation of survivorship care plans for patients as they complete primary therapy for cancer to ensure clarity for all involved about patients' diagnoses, treatments received, and surveillance plans. Any previously existing follow-up guidelines for cancer survivors have been largely restricted to surveillance for recurrence of the primary disease. An important message of the Institute of Medicine report is that survivorship care plans must surpass this and address the chronic effects of cancer (pain, fatigue, premature menopause, depression/anxiety), monitoring for and preventing late effects like osteoporosis, heart disease, and second malignancies, and promoting healthy lifestyles. It should explicitly identify the providers responsible for each aspect of ongoing care and provide information on resources available for psychosocial and other practical issues that may arise as a result of the prior cancer diagnosis. Although having some sort of a plan is clearly necessary to achieve high quality care, there are practical barriers to formal off-treatment consultations and the creation of written documents that may become part of the medical record. This article reviews the elements of the proposed survivorship care plan and discusses areas of research and development needed to make them part of standard oncology practice.
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PMID:Failing to plan is planning to fail: improving the quality of care with survivorship care plans. 1709 72

Flexible working hours can have several meanings and can be arranged in a number of ways to suit the worker and/or employer. Two aspects of "flexible" arrangement of working hours were considered: one more subjected to company control and decision (variability) and one more connected to individual discretion and autonomy (flexibility). The aim of the study was to analyze these two dimensions in relation to health and well-being, taking into consideration the interaction with some relevant background variables related to demographics plus working and social conditions. The dataset of the Third European Survey on working conditions, conducted in 2000 and involving 21,505 workers, was used. Nineteen health disorders and four psycho-social conditions were tested by means of multiple logistic regression analysis, in which mutually adjusted odds ratios were calculated for age, gender, marital status, number of children, occupation, mode of employment, shift work, night work, time pressure, mental and physical workload, job satisfaction, and participation in work organization. The flexibility and variability of working hours appeared inversely related to health and psycho-social well-being: the most favorable effects were associated with higher flexibility and lower variability. The analysis of the interactions with the twelve intervening variables showed that physical work, age, and flexibility are the three most important factors affecting health and well-being. Flexibility resulted as the most important factor to influence work satisfaction; the second to affect family and social commitment and the ability to do the same job when 60 years old, as well as trauma, overall fatigue, irritability, and headache; and the third to influence heart disease, stomachache, anxiety, injury, and the feeling that health being at risk because of work. Variability was the third most important factor influencing family and social commitments. Moreover, shift and night work confirmed to have a significant influence on sleep, digestive and cardiovascular troubles, as well and health and safety at work. Time pressure also showed a relevant influence, both on individual stress and social life. Therefore, suitable arrangements of flexible working time, aimed at supporting workers' coping strategies, appear to have a clear beneficial effect on worker health and well-being, with positive consequences also at the company and social level, as evidenced by the higher "feeling to be able to work until 60 years of age".
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PMID:Influence of flexibility and variability of working hours on health and well-being. 1719 Jul

Metabolic syndrome consists of a cluster of metabolic conditions, such as hypertriglyceridemia, hyper-low-density lipoproteins, hypo-high-density lipoproteins, insulin resistance, abnormal glucose tolerance and hypertension, that-in combination with genetic susceptibility and abdominal obesity-are risk factors for type 2 diabetes, vascular inflammation, atherosclerosis, and renal, liver and heart disease. One of the defects in metabolic syndrome and its associated diseases is excess cellular oxidative stress (mediated by reactive oxygen and nitrogen species, ROS/RNS) and oxidative damage to mitochondrial components, resulting in reduced efficiency of the electron transport chain. Recent evidence indicates that reduced mitochondrial function caused by ROS/RNS membrane oxidation is related to fatigue, a common complaint of MS patients. Lipid replacement therapy (LRT) administered as a nutritional supplement with antioxidants can prevent excess oxidative membrane damage, restore mitochondrial and other cellular membrane functions and reduce fatigue. Recent clinical trials have shown the benefit of LRT plus antioxidants in restoring mitochondrial electron transport function and reducing moderate to severe chronic fatigue. Thus LRT plus antioxidant supplements should be considered for metabolic syndrome patients who suffer to various degrees from fatigue.
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PMID:Metabolic syndrome and mitochondrial function: molecular replacement and antioxidant supplements to prevent membrane peroxidation and restore mitochondrial function. 1724 17

Second-hand smoke (SHS) increases the risk of heart disease by approximately 30% in nonsmokers. Recent evidence from cities that have implemented 100% smoke-free laws has shown that myocardial infarction admissions rapidly declined after law implementation. This decline is, in part, explained by the acute and substantial cardiovascular effects of SHS, many of which are rapid and nearly as large as smoking. The cardiovascular effects of SHS include platelet activation, endothelial dysfunction, inflammation, atherosclerosis development and progression, increased oxidative stress, decreased energy metabolism, and increased insulin resistance. These effects are, on average, 80% to 90% that of chronic active smoking. However, cardiovascular function is partially recovered after SHS exposure ends. Given the evidence, cardiovascular nurses should advise their patients and relatives to avoid SHS exposure and demand smoke-free workplaces and homes.
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PMID:Cardiovascular effects of second-hand smoke help explain the benefits of smoke-free legislation on heart disease burden. 1729 35

The six-minute walk test (6-MWT) is widely used to assess functional status in patients with chronic heart failure (CHF). The aims of the present study were: (1) to compare metabolic gas exchange during the 6-MWT in older patients with left ventricular systolic dysfunction (LVSD) and in breathless patients with no major structural heart disease (MSHD); (2) to determine the exercise intensity of the 6-MWT relative to peak oxygen uptake; (3) to establish the accuracy and reproducibility of the Metamax 3B ergospirometer during an incremental workload. Twenty four older patients with LVSD (19 male; age 76 +/- 5 years; BMI 27 +/- 4), and 18 patients with no MSHD (12 male; age 75 +/- 8 years; BMI 27 +/- 4) attended on consecutive days at the same time. Patients completed a 6-MWT with metabolic gas exchange measurements using the Metamax 3B portable ergospirometer, and an incremental cycle ergometry test using both the Metamax 3B and Oxycon Pro metabolic cart. Patients returned and performed a second 6-MWT and an incremental treadmill test, metabolic gas exchange was measured with the Metamax 3B. In patients with LVSD, the 6-MWT was performed at a higher fraction of maximal exercise capacity (p = 0.02). The 6-MWT was performed below the anaerobic threshold in patients with LVSD (83 %) and in patients with no MSHD (61 %). The Metamax 3B showed satisfactory to high accuracy at 10 W and 20 W in patients with LVSD (r = 0.77 - 0.97, p < 0.05), and no MSHD (r = 0.76 - 0.94, p < 0.05). Metabolic gas exchange variables measured during the 6-MWT showed satisfactory to high day-to-day reproducibility in patients with LVSD (ICC = 0.75 - 0.98), but a higher variability was evident in participants with no MSHD (ICC = 0.62 - 0.97). The Metamax 3B portable ergospirometer is an accurate and reproducible device during submaximal, fixed rate exercise in older patients with LVSD and no MSHD. In elderly patients with LVSD and no MSHD, the 6-MWT should not be considered a maximal test of exercise capacity but rather a test of submaximal exercise performance. Our study demonstrates that the 6-MWT takes place at a higher proportion of peak oxygen uptake in patients with LVSD compared to those with no MSHD, and may be one reason why fatigue is a more prominent symptom in these patients.
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PMID:Cardiorespiratory requirements of the 6-min walk test in older patients with left ventricular systolic dysfunction and no major structural heart disease. 1743 92

While much is known about the negative health implications of insufficient sleep, relatively little is known about risks associated with excessive sleep. However, epidemiological studies have repeatedly found a mortality risk associated with reported habitual long sleep. This paper will summarize and describe the numerous studies demonstrating increased mortality risk associated with long sleep. Although these studies establish a mortality link, they do not sufficiently explain why such a relationship might occur. Possible mechanisms for this relationship will be proposed and described, including (1) sleep fragmentation, (2) fatigue, (3) immune function, (4) photoperiodic abnormalities, (5) lack of challenge, (6) depression, or (7) underlying disease process such as (a) sleep apnea, (b) heart disease, or (c) failing health. Following this, we will take a step back and carefully consider all of the historical and current literature regarding long sleep, to determine whether the scientific evidence supports these proposed mechanisms and ascertain what future research directions may clarify or test these hypotheses regarding the relationship between long sleep and mortality.
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PMID:Who are the long sleepers? Towards an understanding of the mortality relationship. 1762 32

Sporadic and chronic fatigue are common, but an underlying etiology is identified in only up to 10% of cases. Under-reporting makes fatigue's prevalence unknown. Some estimate up to 50% of elders suffer from mild fatigue. Causes vary, but prevailing theory links most fatigue as a secondary consequence to illness and medication. Fatigue is prominently linked to sleep disorders, depression, heart disease, Parkinson's disease, anemia, and cancer. Fatigue and its consequences should be assessed routinely. Empiric treatment is the norm, focusing on managing fatigue, and, when possible, selecting agents with fewer side effects. Exercise, diet, and promoting good sleep hygiene have beneficial effects in symptom management.
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PMID:Fatigue: implications for the elderly. 1771 1

Late onset of complete heart block is a potentially dangerous complication after open heart surgery for congenital heart disease. The characteristics of patients with late-onset heart block have not been well described. A retrospective review of a pacemaker database was done to identify patients who presented with new onset heart block between 1988 and 2006, after they had been discharged from the hospital after open heart surgery with normal AV conduction. Fifteen patients were identified. The age at the time of the last surgery before the onset of heart block was 2.0 +/- 3.2 years (range: 3 days to 10 years). Nine had a ventricular septal defect repair, four had an atrioventricular canal, and two other patients had other types of heart defect. The last EKG available for analysis before the onset of heart block had been obtained 5.1 +/- 6.5 years (range: 7 days to 16 years) after surgery. The symptoms at the time of presentation were variable. Four patients presented with fatigue or exercise intolerance, two with syncope, two with congestive heart failure, and one with irritability, and the remaining six patients were diagnosed during routine follow-up. The time between open heart surgery and placement of a permanent pacemaker was 6.8 +/- 7.3 years (range: 2 months to 19 years). There were seven patients in whom the onset of heart block was more than 6 years after surgery. Late onset of complete heart block after open heart surgery could be dangerous when presenting without warning. These data would support the notion that patients should be followed for life after repair of congenital heart defects, with special attention to the conduction system, particularly after repair of septal defects.
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PMID:Late onset of heart block after open heart surgery for congenital heart disease. 1776 49

Pulmonary hypertension (PH) is a hemodynamic state characterized by elevation in the mean pulmonary arterial pressure and pulmonary vascular resistance leading to right ventricular failure and premature death. PH can be the result of a variety of diseases of different etiologies. Pulmonary arterial hypertension (PAH) should be distinctly differentiated from pulmonary venous hypertension (PVH) as a result of left heart disease. PAH is commonly caused by or associated with an underlying pulmonary, cardiac, or systemic disease (APAH). In the absence of an identifiable etiology or associated underlying disease, PAH is referred to as idiopathic (IPAH). IPAH, formerly known as primary pulmonary hypertension (PPH), is a rare disease most commonly seen in women of childbearing age. Presenting symptoms and signs are nonspecific and include dyspnea on exertion, fatigue, and a loud pulmonary component of the second heart sound. Transthoracic Doppler echocardiography is an excellent noninvasive test to detect the presence of pulmonary hypertension, although every patient should receive a right heart catheterization to confirm the diagnosis. A detailed work up, including laboratory tests and imaging studies, is also indicated to rule out known causes of pulmonary hypertension. Several targeted treatment options have become available in recent years and include parenteral and inhaled prostanoids, oral endothelin receptor antagonists, and oral phosphodiesterase type-5 inhibitors. As a result of their complex care, patients should be referred to centers with expertise in pulmonary hypertension.
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PMID:Pulmonary hypertension: evaluation and management. 1800 30

Organisms of the genus Gemella can, on occasion, cause serious systemic illness. The present paper reports a successfully treated case of endocarditis in a 12-year-old girl with congenital heart disease caused by species of Gemella. The child presented with cough, fatigue and decreased appetite without fever. Echocardiogram demonstrated marked mitral insufficiency with flail posterior mitral valve leaflet, mitral valve vegetations, and an enlarged left atrium and ventricle. While being treated with vancomycin, the child initially had persistent bacteremia, which resolved after the addition of gentamycin; the course of therapy was completed with penicillin G and gentamycin once antimicrobial susceptibilities were available. Attempts to identify the species of Gemella were unsuccessful in the local laboratory, and at reference laboratories in Canada and the United States. The isolate is undergoing further evaluation to determine its taxonomic status.
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PMID:Gemella species endocarditis in a child. 1815 56


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