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

Although the number of cardiovascular deaths associated with environmental tobacco smoke cannot be predicted with absolute certainty, the available evidence indicates that environmental tobacco smoke increases the risk of heart disease. The effects of environmental tobacco smoke on cardiovascular function, platelet function, neutrophil function, and plaque formation are the probable mechanisms leading to heart disease. The risk of death due to heart disease is increased by about 30% among those exposed to environmental tobacco smoke at home and could be much higher in those exposed at the workplace, where higher levels of environmental tobacco smoke may be present. Even though considerable uncertainty is a part of any analysis on the health affects of environmental tobacco smoke because of the difficulty of conducting long-term studies and selecting sample populations, an estimated 35,000-40,000 cardiovascular disease-related deaths and 3,000-5,000 lung cancer deaths due to environmental tobacco smoke exposure have been predicted to occur each year. The AHA's Council on Cardiopulmonary and Critical Care has concluded that environmental tobacco smoke is a major preventable cause of cardiovascular disease and death. The council strongly supports efforts to eliminate all exposure of nonsmokers to environmental tobacco smoke. This requires that environmental tobacco smoke be treated as an environmental toxin, and ways to protect workers and the public from this health hazard should be developed. According to a 1989 Gallup survey commissioned by the American Lung Association, 86% of nonsmokers think that environmental tobacco smoke is harmful and 77% believe that smokers should abstain in the presence of nonsmokers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Environmental tobacco smoke and cardiovascular disease. A position paper from the Council on Cardiopulmonary and Critical Care, American Heart Association. 163 35

To evaluate the effectiveness, tolerance and safety of simvastatin (MK 733), a new HMG-CoA reductase inhibitor, a 28-week, single blind study with placebo was carried out on 10 patients suffering from primary hypercholesterolaemia. All patients followed the AHA Phase 1 or Phase 2 diet and underwent active treatment for 24 weeks with increasing doses of simvastatin from 10 to 40 mg in a single evening administration. A reduction in plasma levels of total cholesterol (-29%, p less than 0.001 and -41%, p less than 0.001), LDL cholesterol (-35%, p less than 0.001 and -49%, p less than 0.001), VLDL cholesterol (-9%, ns and -38%, ns), Apo-B (-27%, p less than 0.005 and -37%, p less than 0.001), Apo-A2 (-3%, ns and -3%, ns), and triglycerides (+2%, ns and -10%, ns), was obtained in the VIth and XXIVth week. There was also an increase in HDL cholesterol (+4%, ns and +17%, p less than 0.05), HDL2 subfractions (+9%, p less than 0.05 and +36%, p less than 0.05), HDL3 (+3%, ns and +11%, ns) and Apo-A1 (+7%, ns and +4%, ns). In all patients, simvastatin was generally tolerated and there were no clinical, laboratory or ophthalmological side-effects related to the drug. If long-term studies confirm its safety, simvastatin will offer excellent prospects for the prevention of ischaemic cardiopathy.
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PMID:[Effects of simvastatin on plasma levels of lipids, lipoproteins and apolipoproteins in primary hypercholesterolemia]. 269 57

Diets low in saturated fat and cholesterol are recommended to the American public for improving plasma lipoprotein patterns and reducing the risk of heart disease. However, since dietary intake cannot always be controlled, the effects of different degrees of dietary saturated fat lowering and occasional high saturated fat and cholesterol meals on the expected lipoprotein pattern improvement of these diets needs to be defined. In the current study, we compared lipid, lipoprotein, and apolipoprotein levels in 14 young normal volunteers on a metabolic ward when they were consuming a high saturated fat diet (42% fat), an AHA Phase II diet (25% fat), and a third diet which approximated the AHA Phase I diet (30% fat). The latter actually consisted of intermittent ingestion of meals high in saturated fat and cholesterol on the background of an AHA Phase II diet (Intermittent Saturated Fat diet). When compared to the high saturated fat diet, the AHA Phase II diet significantly reduced total, low density lipoprotein (LDL), and high density lipoprotein (HDL) cholesterol, apoB, and apoA-I levels, and improved the LDL/HDL cholesterol ratio, whereas the intermittent saturated fat diet lowered total and LDL cholesterol and apoB levels, and also improved the LDL/HDL cholesterol ratio. When compared to the AHA Phase II diet, the intermittent saturated fat diet raised total and HDL cholesterol levels. Thus, in these normal volunteers, intermittent saturated fat ingestion, in the context of an overall 30% fat diet and a 25% fat diet, did not differ with respect to the effect on improving the LDL/HDL cholesterol ratio.
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PMID:Effects of a low fat diet with and without intermittent saturated fat and cholesterol ingestion on plasma lipid, lipoprotein, and apolipoprotein levels in normal volunteers. 341 Dec 52

Analysis of our data indicates confusion about, and lack of compliance with, the AHA recommendations. Clinician level of knowledge varies with issues of risk management and by specialty group membership. Patient groups that are particularly problematic include children and all patients with congenital heart disease, those receiving a continuing antibiotic regimen for secondary prevention of rheumatic fever, those with a penicillin allergy, and those with prosthetic heart valves. Another area of clinician uncertainty concerns dental procedures which may or may not be associated with the possible causation of bacterial endocarditis. The biodynamic principles involved in endocarditis are central to the structure of the AHA recommendations. These principles, as well as those which provide theoretical support for the loading dose, timing, sequence, and duration recommended by the AHA, have been presented with the hope that clinician compliance with these recommendations will be increased.
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PMID:Clinician compliance and the prevention of bacterial endocarditis. 659 29

In view of the increased prevalence of so-called "ischemic cardiomyopathy" ( Burch ) in Japan, we attempted to clarify the clinical manifestations of this condition and to investigate the medical treatment in comparison with the surgical therapy. Eighteen patients (17 males and one female) were identified as having "ischemic cardiomyopathy" according to the following criteria: These include (i) an ejection fraction of 30% or less with asynergy on all segments of AHA classification, (ii) significant coronary stenosis (75% or more) of one or more major coronary branches, and (iii) no other coexisting lesion, such as primary valvular disease or congenital heart disease. In the history, distinct myocardial infarction or angina pectoris was observed in 10 cases (56%), and in the remaining eight cases (44%) only symptoms of cardiac failure was shown. On the ECG, all cases showed pathologic Q waves. Moreover, 10 cases (56%) of these had Q waves in five leads or more. Cardiomegaly on the chest X-ray film (CTR greater than or equal to 60%) was evident in 10 cases and that on echocardiogram ( LVDd greater than or equal to 60 mm) in 16 cases. Physical examinations demonstrated gallop sounds in 89% and a B-B' step formation on echocardiograms in 50%. The LVEDP was greater than 12 mmHg in 13 cases, and the systolic pressure of the pulmonary artery was higher than 35 mmHg in 13 cases. On the other hand, the reduced cardiac index (less than or equal to 2.21/min/M2) was observed in only one case. Selective CAG revealed multiple vessel disease in 78%. Ten of the 18 cases had mitral regurgitation demonstrated by left ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical manifestations, therapeutic methods and prognosis of patients with ischemic cardiomyopathy]. 661 4

A single education program for teaching principles of the Prudent Diet was assessed for its effectiveness in producing compliance to dietary recommendations. The study population consisted of 50 free-living adults between the ages of 20 and 75. Each adult was a member of a club or organization that had requested to view the program via a local chapter of the AHA. A pretest/post-test format was used for the study. Individuals completed a questionnaire prior to viewing the program and again eight weeks after viewing the program. The questionnaire was designed to measure attitudes, knowledge, and compliance to recommendations. Demographic data regarding age, sex, and exposure to heart disease were also obtained. Results indicated that the study population changed their beliefs about their perceived susceptibility to CHD, becoming more concerned after viewing the program. Attitudes toward diet and CHD became slightly more positive but not significantly so. An overall gain in knowledge occurred that was highly significant. The study group consumed skim milk, lean meats, and broiled meats more often after viewing the program. In addition, they reported trimming all visible fat from meat before preparation and/or consumption. It was concluded that this education program has potential for producing an attitude change and knowledge acquisition and for motivating positive changes in dietary habits toward the recommendations of the Prudent Diet.
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PMID:Assessment of a cardiovascular education program. 663 Aug 19

American practitioners were surveyed about the role of self-care materials in the management of cardiology patients. Respondents indicated their patients commonly use self-care materials and seek recommendation of appropriate readings. Over half those responding had reviewed 'some' popular works, but few had been able to keep up with this literature. The great majority of responders found self-care materials sometimes helpful to patients, considered certain works particularly helpful, and made recommendations to patients; many agreed that certain published works might be harmful. AHA publications were most frequently endorsed, followed by Dr Dean Ornish's Program for Reversing Heart Disease and The New American Diet. Patients were cautioned by some physicians to avoid certain other titles. Greater professional effort to evaluate the appropriateness of popularized self-care works for cardiology patients is needed.
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PMID:Self-care materials in the practice of cardiology: an explorative study among American cardiologists. 786

The evaluation and management of heart disease in patients about to undergo noncardiac surgery begins with a careful history and physical examination, including an assessment of clinical risk for perioperative myocardial infarction and/or death. Patients can be categorized into major, intermediate, minor or low clinical risk groups, based on clinical markers such as past myocardial infarction, congestive heart failure, angina or diabetes. Additional evaluation includes estimation of surgery-specific risk, prior coronary evaluation and/or revascularization, and level of functional capacity. Based on these parameters, physicians can decide to engage in further noninvasive testing to assess left ventricular function and/or risk of perioperative ischemia in a small, selected group of patients. Rarely, patients may meet criteria for perioperative coronary revascularization followed by noncardiac surgery. Perioperative medical therapy relies heavily on the use of beta blockers. Postoperative cardiac surveillance must be tailored to the individual patient. The use of pulmonary arterial catheters, the type of anesthesia and the assessment of long-term cardiac risk are also discussed in this summary of the ACC/AHA Guidelines.
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PMID:Surgical patients with heart disease: summary of the ACC/AHA guidelines. American College of Cardiology/American Heart Association. 930 74

"Stunned myocardium" was defined by Braunwald et al in 1982 as reversible postischemic myocardial dysfunction. We report a case of a 57-year-old woman for cholesystectomy who developed stunned myocardium during endotracheal intubation. She was free of any risks of heart disease. While the endotracheal tube was smoothly inserted after rapid induction, the blood pressure was remarkably elevated and electrocardiogram (ECG) showed ST segment elevations in leads I, aVL, as well as V2-V6, and ST segment depressions in leads II, III and aVF. The coronary angiography, performed 2 weeks later, revealed a normal coronary finding, but the left ventriculogram showed asynergy in its anterior and apical walls (AHA segments 2, 3 and 6). Left ventricular dysfunction in this case was possibly due to a direct effect of excessive cathecholamines secreted during an acute episode of hypertension triggered by intubation.
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PMID:[A case of stunned myocardium concomitant with endotracheal intubation]. 1055 8

Regular aerobic exercise provides many health benefits regardless of age, and should be promoted by health care providers to all patients. In older athletes, coronary artery disease is the most common cause of sudden death. There is widespread consensus, however, that the overall health benefits derived from exercise outweigh the risks of participation. Screening should focus on identifying signs and symptoms of underlying cardiovascular disease by obtaining a personal and family history and performing a focused physical examination according to the recommendations of the AHA. Exercise testing is recommended in males older than 40 and females older than 50, and individuals with cardiac risk factors. Cardiovascular PPE screening in young athletes remains a challenge, because potentially fatal abnormalities are uncommon and in some cases are undetectable without sophisticated testing. Most sudden cardiac deaths in athletes are caused by anomalies that are clinically silent, are rare, or are difficult to detect by history and physical examination. Many athletes may not experience symptoms consistent with heart disease or may not report family histories of sudden cardiac death. Important clues to a cardiac abnormality include history of syncope, chest pain, and family history of sudden death. Any underlying condition suspected on the basis of history or physical examination requires further diagnostic evaluation before the athlete can be cleared for activity. Currently there is considerable variability and inconsistency among state requirements for PPEs. A national adoption of a more uniform PPE screening process should be encouraged. The screening process should include the AHA's cardiovascular screening recommendations, as this would assist in closing the gap between screening practices recommended by sports medicine experts and the reality of current screening practices. Although the extent of screening continues to be debated, clinical guidelines for performing PPEs and determining clearance have been established. Without a uniform implementation of the current guidelines, it will not be possible to assess the value of the current cardiovascular screening recommendations in detecting and preventing cardiovascular death in young athletes. Physicians should be aware of the emerging role of genetic testing for cardiovascular diseases in athletes with a family history of heart disease or sudden death. Advances in the diagnosis and understanding of cardiovascular disease may provide better tools for preventing sudden death of young athletes in the future [11].
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PMID:Preparticipation cardiovascular screening. 1261 84


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