Reverse Heart Disease Book

The Big Heart Disease Lie

The Big Heart Disease Lie is a book written by doctors who are members of the International Truth In Medicine Council they are also the authors of The Big Diabetes Lie. In this book you will be getting over 500 pages of scientifically proven, doctor verified information that you will not find anywhere else, not even bookstores.If you have high blood pressure or cholesterol, fatigue, shortness of breath, irregular heartbeat, swollen feet or ankles, chest pain, fainting, diabetes, asthma or allergies, pain, fatigue, inflammation, any troubling health issue, or simply want to discover the most powerful health and anti-aging program, then you really need to read this book. The book is a step by step guide that contains techniques scientifically verified and proven by doctors to reverse the symptoms of heart disease, and normalize blood pressure and cholesterol levels. These techniques have been used successfully by tens of thousands of people all over the world, and allowed them to take health into their own hands, ending the need for drugs, hospitals, doctors' visits, expensive supplements or grueling workouts. More here...

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Cardiovascular Disease

Although clinical trials are not available, the results from several in vivo studies have suggested a potential role for andrographis in cardiovascular disease. Prevention of atherosclerotic arterial stenosis and restenosis after angioplasty According to two animal studies, andrographis significantly improved atherosclerotic iliac artery stenosis induced by both de-endothelialisation and a high-cholesterol diet, and reduced the restenosis rate after experimental angioplasty (Wang & Zhao 1993, 1994).

Chest Pain and Myocardial Infarction

Cardiac Risk factors Hypertension, hyperlipidemia, diabetes, smoking, and a strong family history (coronary artery disease in early or mid-adulthood in a first-degree relative). PMH History of diabetes, claudication, stroke. Exercise tolerance history of peptic ulcer disease. Prior history of myocardial infarction, coronary bypass grafting or angioplasty.

Cardiovascular Diseases

Similar considerations apply to the relationship (if any) between myocardial infarction and ephedrine use. The report by Cockings and Brown described a 25-year-old drug abuser who injected himself with an unknown amount of cocaine intravenously (120). The only other published reports involved a woman in labor who was receiving other vasoactive drugs (121) and two pseudoephedrine users, one of whom was also taking bupropion, who developed coronary artery spasm (122,123). Three cases of ephedra-related coronary spasm in anesthetized patients have also been reported, but multiple agents were administred in all three cases, and the normal innervation of the coronary arteries was disrupted in two of the cases where a high spinal anesthetic had been administered (121,124). One case of alleged ephedrine-re-lated hypersensitivity myocarditis has been reported (125), but the patient was taking many other herbal supplements, and the responsible agent is not known with certainty. Although there...

HAART lipodystrophy syndrome and cardiovascular risk

The fat redistribution and disturbances in glucose and fat metabolism resemble a clinical situation that is known as the metabolic syndrome in HIV-negative patients. This condition includes symptoms such as central adipositas, insulin resistance and hyperinsulinemia, hyperlipidemia (high LDL, Lp(a) hypertriglyceridemia and low HDL) and hypercoagulopathy. Given the well-established cardiovascular risk resulting from this metabolic syndrome, there is growing concern about a potential therapy-related increased risk of myocardial infarction in HIV patients. These fears are further sustained by reports of arterial hypertension on HAART (Seaberg 2005), a high rate of smoking among HIV patients and increased levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in patients with lipodystrophy. Although many of the, mainly retrospective, studies dealing with this issue are inconclusive, data from a large international study (D A D study) provide evidence of...

Prevention Of Morbidity And Mortality Of Cardiovascular Disease

For over 25 years, fish and fish oils have been linked to cardiovascular health. This association was first recognised when significantly lower death rates from acute myocardial infarction (Ml) were found among Greenland's Inuit population, despite only moderate differences between the Inuits' blood cholesterol levels and those of other populations (Holub 2002). A high dietary omega-3 fatty acid intake in the form of marine mammals (seal, whale) and various fish were thought responsible for the protective effect (Bang et al 1980). In 1989, results from the first large, randomised, clinical trial investigating the effects of fatty fish consumption on survival and risk of secondary Ml confirmed a link to cardiovascular health (Burr et al 1989). The DART (Diet and Reinfarction study) found a modest intake of 2-3 portions weekly of fatty fish reduced mortality in men who had previously experienced a Ml and produced a relative reduction in total mortality of 29 during the 2-year follow-up,...

Reduced Mortality In Coronary Heart Disease

The most likely mechanism by which ALA may prevent coronary heart disease (CHD) mortality is by reducing cardiac arrhythmia. In Western populations, almost 50 of all deaths from cardiovascular disease can be attributed to sudden cardiac death and the majority of sudden deaths are directly caused by acute ventricular arrhythmia (Brouwer et al 2004). A review in 2001 (Lanzmann-Petithory) and a meta-analysis of three studies in 2004 (Brouwer et al) both found in favour of a protective effect from increased ALA consumption against fatal CHD (RR 0.24). The dose associated with this trend was small only 1-3 g day ALA higher than controls (Brouwer et al 2004). A study published in 2005, which derived data from the Nurses' Health Study (Albert et al), found that women consuming ALA in the highest two quintiles had a 38-40 lower risk of sudden cardiac death than women in the lowest quintile however, the protective effect did not extend to other fatal forms of CHD or non-fatal myocardial...

Cardiovascular Disease Protection Independent Of Homocysteine Status

In the absence of a causal relationship between homocysteine and cardiovascular disease, what remains most promising for folate are studies illustrating its protective 2007 Elsevier Australia Several studies show the cardiovascular protective effects of folic acid, including the predictive value of low folate status on stroke risk (Verhaar et al 2002, Bazzano et al 2002). Few interventional studies have been conducted and on the whole results have been disappointing, which may be because the trials are commonly looking at folate in secondary prevention rather than primary. One such study was an open label trial of 500 g day folate over 2 years in 593 patients, which failed to reduce cardiovascular events (Liem et al 2003).

Kawasaki Syndrome and Acquired Heart Disease

Summary This journal article provides health professionals with information on the etiology, clinical presentation, diagnosis, and management of Kawasaki syndrome (KS). This multisystem inflammatory disorder of unknown cause most commonly affects young children. Although the cause of KS is unknown, an underlying genetic predisposition is suspected based on familial cases and twin studies. When KS is not recognized and managed early, children with the condition may develop coronary artery aneurysms or associated cardiac abnormalities. KS is the leading cause of acquired heart disease in children. All of the signs and symptoms of KS are common and nonspecific, which complicates the diagnosis. Although the diagnosis often involves uncertainty, the following clinical features help distinguish KS from illnesses that mimic

Helicobacter Pylori Infection as a Risk Factor for Gastrointestinal Symptoms in Patients Using Aspirin to Prevent

Summary Aspirin use in the secondary prevention of ischemic heart disease may provoke gastrointestinal (GI) discomfort. This article reports on a study undertaken to register GI symptoms and complications in patients with cardiovascular disease using aspirin and to relate these symptoms to infection with H. pylori. Blood samples were obtained from 398 consecutive patients in the Coronary Care Unit at a hospital in the Netherlands samples were analyzed for serum antibody levels to H. pylori infection. Questionnaires were sent 2 weeks after discharge to assess GI symptoms. Questionnaires were returned by 314 patients (79 percent). A total of 183 out of 314 patients (46 percent) reported GI symptoms. Of the 238 patients using 80 to 100 milligrams of aspirin daily, 145 (61 percent) recorded GI symptoms. Besides aspirin, the use of calcium antagonists was correlated with GI symptoms. Of the 128 patients using calcium antagonists, 84 (66 percent) reported GI symptoms. The prevalence of GI...

Ischemic Heart Disease

The underlying pathogenesis of ischemic heart disease is the gradual development of an atherosclerotic plaque. Patients develop clinical symptoms either through diminution of blood flow through a stenotic vessel or with acute ischemia due to thrombus formation on a ruptured plaque. The realization that acute thrombus formation underlies most acute presentations of ischemic heart disease has revolutionized cardiology. Four of five clinical trials using aspirin have established that it is effective in primary prevention of myocardial infarction. The side effects of gastrointestinal bleeding and, more importantly, intracranial hemorrhage, occur more frequently with aspirin use. In the lowest risk patients the use of aspirin is not warranted. Patients with even modest risk factors should be on aspirin therapy unless there is a contraindication. Most men and women over 50 years of age are aspirin candidates. Patients under 50 years of age with evidence of atherosclerotic vascular disease...

Preventing Cardiovascular Disease

The cardioprotective properties of quercetin, demonstrated in animal and in vitro studies, provide a theoretical basis for the use of quercetin in the prevention of cardiovascular disease however, current human data is less encouraging. A double-blind, placebo-controlled study investigating the effects of a quercetin-containing supplement on plasma quercetin status, risk factors for heart disease and serum platelet fatty acid levels was conducted on 27 healthy men and women with cholesterol levels of 4.0-7.2 mmol L (Conquer et al 1998). The subjects consumed a quercetin-containing supplement (1 g quercetin day) or rice flour placebo for 28 days. Quercetin intakes were approximately 50-fold greater than dietary intakes previously associated with lower coronary heart disease mortality in epidemiologic studies. Plasma quercetin concentrations were approximately 23-fold greater in subjects consuming the quercetin capsules than in the placebo group. Quercetin supplementation did not alter...

Coronary heart disease CHD

In contrast to case reports and autopsy trials analyzing the influence of antiretroviral therapy on myocardial infarction rate, the results of clinical observations appear to be inconsistent. At present, two major clinical trials have been published, and in one of these trials, a retrospective analysis of 36,500 patients, no rise in cardiac or cardiovascular events was detected (Bozzette 2003). Nevertheless, in the second trial, the most extensive prospective study to date, including more than 23,000 patients, a 26 increase in the incidence of myocardial infarction was found with each year of antiretroviral therapy (Friis-Moller 2003). However, the total incidence of myocardial infarction was small in both trials. Therefore, current treatment regimens for HIV infection might have no considerable impact on myocardial infarction rate and the concerns of cardiovascular complications have to be balanced against the marked benefits of antiretroviral treatment. Nevertheless, prevention of...

Osteoporosis and Cardiovascular Disease in the Elderly

Osteoporosis and cardiovascular disease are common disorders that increase with aging. Accumulating evidence indicates that both disorders may share common pathophysiologic mechanisms as well as risk factors. Besides age and sedentary lifestyle, diabetes, hypertension, dyslipidemia, estrogen deficiency, and hyperhomo-cysteinemia are common risk factors for both disorders. Furthermore, therapeutic agents for osteoporosis have antiatherosclerotic properties and agents such as statins that are atheroprotective, and appear to increase bone mass and perhaps protect against fractures.

Valvular Heart Disease

Valvular heart disease of HIV-infected patients occurs as a bacterial or mycotic endocarditis. The most frequent germ is staphylococcus aureus, being detected in more than 40 of HIV-infected patients with bacterial endocarditis. Further pathogens include streptococcus pneumoniae and hemophilus influenzae (Currie 1995). Mycotic forms of endocarditis, which may also occur in patients who are not intra

Cardiovascular Disease Prevention

Selenium may decrease cardiovascular disease mortality however, epidemiological studies have produced mixed results. morbidity and mortality (Salonen et al 1982). A more recent study of just over 3000 middle-aged and elderly men also established an association between low serum selenium levels and a significantly increased risk of ischaemic heart disease (Suadicani et al 1992). Alternatively, no association was identified between serum selenium levels and coronary deaths or myocardial infarctions in a study of 1110 men however, a significant association with stroke mortality was detected (Virtamo et al 1985). No significant primary preventative effect was seen for selenium supplementation (200 g day) and incidence of cardiovascular disease, myocardial infarction, stroke or all cardiovascular disease mortality in the Nutritional Prevention of Cancer study (Stranges et al 2006). Lack of association was confirmed when analyses were further stratified by tertiles of baseline plasma...

Genetics of human coronary heart disease

Genome-wide studies for coronary heart disease The heritability of known risk factors that were included in this linkage study (including type 2 diabetes mellitus and hypertension) was high, suggesting that these intermediate phenotypes are genetically determined to a moderately high extent. However, whereas age, gender, diabetes and hypertension contributed significantly to the myocardial infarction phenotype, high cholesterol levels did not. Since many of the individuals in the study were on lipid-lowering therapy, this suggests that hypercholesterolemia now appears to be a less significant risk factor for myocardial infarction than diabetes and hypertension. The genome scan in Icelandic subjects localized a susceptibility gene for both myocardial infarction and stroke to chromosome 13 and identified the likely gene as 5-lipoxygenase activating protein (FLAP) (Helgadottir et al., 2004). The FLAP gene product converts 5-lipoxygenase to leukotriene B4, a powerful inflammatory...

NCEPDefined Metabolic Syndrome Diabetes and Prevalence of Coronary Heart Disease Among Nhanes Iii Participants Age 50

Summary Although the individual components of the metabolic syndrome are clearly associated with increased risk for coronary heart disease (CHD), the authors of this study wanted to quantify the increased prevalence of CHD among people with metabolic syndrome. The authors used the Third National Health and Nutrition Examination Survey (NHANES III) to categorize adults over 50 years of age by presence of metabolic syndrome, with or without diabetes. Metabolic syndrome is very common, with approximately 44 percent of the united States population over 50 years of age meeting the criteria. in contrast, diabetes without metabolic syndrome is uncommon (13 percent of those with diabetes). Older Americans over 50 years of age without metabolic syndrome, regardless of diabetes status, had the lowest CHD prevalence. The prevalence of CHD markedly increased with the presence of metabolic syndrome. Among people with diabetes, the prevalence of metabolic syndrome was very high, and those with...

Autoimmune Prone Mice as a Model of Chronic Inflammation and Heart Disease

Inflammation is a key component in the development of heart disease (Ross, 1999). The inflammatory process is propagated by immune cells like the T cell, which migrate to the site of inflammation. This is significant because the T cell plays a critical role in determining both the type and extent of immune response via the production of cytokines. Specifically, T cells have been shown to drive the inflammation found in atherosclerotic lesions (Benagiano et al., 2003). The inflammation in arterial walls is propagated by both the expression of adhesion molecules like ICAM-1 and VCAM-1, which recruit immune cells to the site of inflammation, and the production of cytokines by both nonimmune and immune cells. The autoimmune prone MRL-lpr has been used as an experimental system to examine chronic inflammation and heart disease (Qiao et al., 1993) primarily because many of the adhesion molecules and cytokines thought to be important in human atherosclerosis are up-regulated in this animal...

Myocardial Infarction

There is some reason to believe that activated platelet activity may play a role in plaque formation if the reaction is overresponsive and can also contribute to some instances of myocardial infarction. Thus, TX production by platelets would be balanced by PGI2 production. Sticky platelets could have a negative effect on the development of myocardial infarction over the long term, and some claims have been made that chronic aspirin users could have a lower incidence of myocardial infarction, the explanation being that TX

Heart Disease and Diabetes

Summary This brief fact sheet reminds readers of the connection between heart disease and diabetes. The fact sheet notes that many conditions that increase one's changes of getting heart disease are more common in people with diabetes. These conditions include cholesterol problems, high blood pressure (hypertension), overweight, and blood clotting problems. Heart attacks, known in the medical community as myocardial infarctions, are one of the most common heart conditions. For most people, a heart condition leads to symptoms such as chest pain or pressure, jaw pain, arm pain, shortness of breath, sweating, and pounding heartbeat. However, many people with diabetes and heart disease do not notice any symptoms at all. This is called silent ischemia. Silent ischemia is very dangerous because it may prevent patients with heart problems from seeking medical care and getting early treatment. The fact sheet lists common risk factors for heart disease, and encourages readers with those risk...

Metabolic Syndrome and Cardiovascular Risk

The disease most studied in relation to obesity is diabetes. The precursor to type 2 diabetes and to cardiovascular disease in many patients is the metabolic syndrome. By definition, this is said to be present if three or more of the following five conditions are met In a study of over 12,000 Japanese subjects (Hasegawa et al., 2005), factor analysis was used to examine the relationship between cardiovascular risk factors. In this extensive study, the major influence of BMI was in younger subjects. Similarly, in another Japanese study involving nearly 160,000 subjects (Wakabayashi et al., 2004), the influence of BMI on blood pressure was much weaker in the elderly. The concept of the metabolic syndrome has been useful in screening populations who are at risk from diabetes and cardiovascular disease. It is important to realize, however, that susceptibility to the individual risk factors and disease states that relate to the syndrome are caused by multiple factors, not all of which...

Keep Your Heart Healthy

Cardiovascular disease (CVD) is the leading cause of death among New Yorkers, with 27,000 CVD-related deaths reported each year (New York City Department of Health and Mental Hygiene, 2004b). One quarter of New York City adults have been diagnosed with high blood pressure, and a similar number have been diagnosed with high cholesterol, with many more remaining undiagnosed. One-sixth of New York City adults are obese, and three-fourths of New Yorkers do not get at least 30 minutes of physical activity four or more days per week. More than 500,000 adult New Yorkers (9 ) have been diagnosed with diabetes, a 2 2-fold increase in the past decade. Another 250,000 New Yorkers may have diabetes and not know it, and close to a million more with pre-diabetes are likely to eventually develop diabetes. Blood pressure and cholesterol can be controlled with diet, exercise and medications. Control of blood pressure with medications significantly reduces the incidence of stroke, heart attack and...

Prevention Of Cardiovascular Disease

The association between vitamin C and cardiovascular disease prevention is still unclear, although several themes are emerging as evidence accumulates. In general, laboratory, epidemiological and observational follow-up studies suggest that vitamin C is associated with reduced incidence of cardiovascular disease although not all studies are positive (Houston 2005). Studies have looked at blood levels, dietary intake and supplemental vitamin C and in some studies, vitamin C is co-administered with other nutrients (often vitamin E) making it difficult to assess the contribution of vitamin C alone (Carr & Frei 1999, Khaw et al 2001, Knekt et al 2004, Kushi et al 1996, Lopes et al 1998, MRC BHF 2002, Ness et al 1996, Nyyssonen et al 1997, Osganian et al 2003). It appears that if a protective effect is observed with supplementation, it is most likely with doses above RDI, long-term use and in populations with a substantial proportion of persons who have low or deficient intakes of...

Prospective Study of Obesity and Risk of Coronary Heart Disease Among Diabetic Women

Summary This article reports on a study undertaken to examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes. The authors followed 5,897 women with type 2 diabetes in the Nurses' Health Study for up to 20 years. Women were aged 40 to 74 years and had no history of cardiovascular disease or cancer at the beginning of the follow up period. During follow up, the authors document 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI (body mass index) was strongly associated with increased risk of CHD among women with diabetes. Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes...

Cardiovascular Disease in the Medico Legal Era An Introduction

The United States is a litigious society, far more so than other regions of the world with sophisticated healthcare systems and economies comparable to ours, such as Canada, Western Europe and Great Britain, and Japan. A major focus of this litigation deals with medical malpractice, with patients or survivors suing healthcare providers for either a real or claimed injury. Cardiovascular disease represents a disproportionate number of these cases, along with failure or delay in the diagnosis of cancer, or complications following surgery. The defense of these cardiovascular law suits often requires knowledge of complex medicine, and a correlation with cardiac pathology and pathophysiology. Similarly, the plaintiff must be aware of mechanisms of cardiovascular disease and the actual pathology in order to make an effective argument to ajury. Other types of litigation such as personal injury (e.g. automobile accident), or product liability (e.g. adverse drug affects, or claims that cars or...

Heart Disease A Cardiologists POV

Summary This article, written by a cardiologist with a family history of diabetes, discusses the personal events that led to his interest in the cardiovascular effects of diabetes. The article begins with the author's recollections of his family's attitude about his grandfather's diabetes. This is followed by an account of his father's problems with high blood glucose and its effects on his heart. In addition, the author recounts his own experience with the effects of high blood glucose, its effects on his body, and his realization of the connection between diabetes and heart problems.

Focal Ischemic Stroke Models

Focal ischemic stroke models, whether in larger mammals such as cats, dogs, or nonhuman primates, or in small mammals such as rodents, usually involve occlusion of one MCA (Lipton 1999). Focal ischemia is differentiated from global ischemia in two ways. First, even at the core of the lesion, the blood flow is almost always higher than during global ischemia so that longer insults are required to cause damage. Second, there is a significant gradation of ischemia from the core of the lesion to its outermost boundary, and hence there are different metabolic conditions within the affected site. Because of its duration and heterogeneity, the insult is much more complex than global ischemia, but it is an invaluable model for stroke and is thus widely studied. There are two models of focal ischemic stroke transient focal ischemia and permanent focal ischemia. In transient focal ischemia models, vessels are blocked for up to 3 h, followed by prolonged reperfusion, whereas in permanent focal...

Heart Disease

Elevated homocysteine levels Elevated fasting plasma concentrations of homocysteine have a high prevalence in subjects with cardiovascular disease and have also been associated with an increased risk of atherothrombosis in most, but not all, prospective studies (van Guldener & Stehouwer 2001). Clinical studies have found that supplementation with vitamin B6 significantly reduces plasma homocysteine concentrations (Lakshmi & Ramalakshmi 1998). In practice, pyridoxine is typically recommended together with folic acid and vitamin B12. Improving outcomes after heart transplantation Cardiac transplantation represents a potentially life-saving procedure for patients with end-stage cardiac disease. Short-term survival is improving because of improved immunosuppression, but long-term survival remains limited by an aggressive form of atherosclerosis known as transplant coronary artery disease (Miner et al 2001 ).

The Combined Health Information Database

The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and heart disease, you will need to use the advanced search options. First, go to http index.html. From there, select the Detailed Search option (or go directly to that page with the following hyperlink The trick in extracting studies is found in the drop boxes at the bottom of the search page where You may refine your search by. Select the dates and language you prefer, and the format option Journal Article. At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display whole records. We recommend that you type heart disease (or synonyms) into the For these words box. Consider using the option anywhere in record to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this...


The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on heart disease. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the...

Table of Contents

Studies on Heart Federally Funded Research on Heart Chapter 2. Nutrition and Heart Finding Nutrition Studies on Heart Chapter 3. Alternative Medicine and Heart Chapter 4. Dissertations on Heart Dissertations on Heart Chapter 5. Clinical Trials and Heart Recent Trials on Heart Chapter 6. Patents on Heart Patents on Heart Patent Applications on Heart Chapter 7. Books on Heart Chapters on Heart Chapter 8. Multimedia on Heart Bibliography Multimedia on Heart Chapter 9. Periodicals and News on Heart Newsletters on Heart Academic Periodicals covering Heart The Genome Project and Heart Associations and Heart


In March 2001, the National Institutes of Health issued the following warning The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with heart disease is indexed in search engines, such as or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about heart disease, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and...

History and Physical Examination

Past Medical History (PMH) Past diseases, surgeries, hospitalizations medical problems history of diabetes, hypertension, peptic ulcer disease, asthma, myocardial infarction, cancer. In children include birth history, prenatal history, immunizations, and type of feedings.

Secondary ABCD survey

Consider possible causes hypoxia, hypovolemia, hyper- hypokalemia and metabolic disorders, hypothermia, hydrogen ion acidosis, tension pneumothorax, cardiac tamponade, toxic therapeutic disturbances (such as tricyclics, digitalis, beta-blockers, calcium channel blockers), pulmonary embolism, and acute myocardial infarction.

Clinical Development Of Hematopoietic Growth Factors

The clinical development of recombinant forms of HGF were directed by an extensive understanding of the biologic effects of these factors. The human gene encoding EPO was cloned in 1983 (22), and clinical development of epoetin alfa began soon after. Initial studies were focused on patients with an endogenous EPO deficiency, such as patients with severe chronic renal failure receiving dialysis. The effects of epoetin alfa were apparent in the first dose levels with an increase in hemoglobin concentration and hematocrit. A reduction in the requirement for red blood cell transfusions was ultimately proved in the pivotal phase 3 trial. Further studies focused on defining a safe rate of rise in hemoglobin and an appropriate target however, a conservative target rather than normalization of hematocrit was initially approved in the dialysis setting. In patients with underlying heart disease, the safety and benefits of correction to a normal hematocrit are still under investigation almost 20...

Alzheimers Disease And Atherosclerosis

A second age-related pathology in which chronically-activated T cells may play a role is atherosclerosis. Immune involvement in cardiovascular disease (CVD) is suggested by both epidemiological data and experimental animal models. T cells are present in atherosclerotic lesions (Libby et al., 1995), and interaction of CD40 on T cells with vascular endothelial cells, smooth muscle cells, and macrophages has been documented (Mach et al., 1997). Importantly, several types of infections have been hypothesized to increase the risk of CVD by causing systemic inflammation, or by triggering autoimmunity, for example, by cross-reactivity of heat shock proteins (hsp) with bacterial antigens (Mayr et al., 1999). Indeed, clinically healthy volunteers with sonographically documented carotid artery atherosclerosis have significantly increased antibody titers to hsp 65 compared to controls with no lesions, and in follow-up studies, those with highest titers showed highest mortality. The blocking of...

Epidemiology Of Sexual Dysfunction

Numerous population surveys in this and other countries indicate a high prevalence of sexual problems in the general population. These surveys indicate that 40 of women have evidence of psychosexual dysfunction. The corresponding number for men is 30 (25). We have more evidence concerning the prevalence of sexual problems in men than women although the data base in both groups is rapidly growing. Correlates of erectile dysfunction in men include diabetes, vascular disease, age, and cigarette smoking. Serum dehydroepiandro-sterone and high-density lipoprotein cholesterol were found to be negatively correlated with erectile problems (26). Depression was correlated with erectile function in cross sectional studies, whereas passive personality traits tended to predict who would develop impotence in a prospective study (27). Studies in other countries have, in general, found somewhat similar rates of erectile dysfunction in the same age population and also that erectile dysfunction tends...

And Outflow Tract And Atrial And Ventricular Septation

Despite its clinical importance, to date almost nothing is known about the molecular pathways that determine cell lineages in the cardiac neural crest or that regulate outflow tract septation (14). However, it is known that if the cardiac neural crest is removed before it begins to migrate, the conotruncal septa completely fails to develop, and blood leaves both the ventricles through what is termed a persistent truncus arteriosus, a rare congenital heart anomaly in humans. Failure of outflow tract septation may also be responsible for other forms of congenital heart disease, including transposition of the great vessels, high ventricular septal defects, and tetralogy of Fallot (8,16,18).

Arterial Thrombosis

Lower limb artery thrombosis was the first recognized complication of HIT (Weismann and Tobin, 1958 Roberts et al., 1964 Rhodes et al., 1973, 1977). Arterial thrombosis most commonly involves the distal aorta (e.g., saddle embolism) or the large arteries of the lower limbs, leading to acute limb ischemia with absent pulses. Sometimes, platelet-rich thromboemboli from the left heart or proximal aorta explain acute lower limb arterial ischemia (Vignon et al., 1996). Other arterial thrombotic complications that are relatively common in HIT include acute thrombotic stroke and myocardial infarction. The relative frequency of arterial thrombosis in HIT by location, namely, lower limb artery occlusion > > stroke syndrome > myocardial infarction (Benhamou et al., 1985 Kappa et al., 1987 Warkentin and Kelton, 1996 Nand et al., 1997), is reversed from that observed in the non-HIT population (myocardial infarction > stroke syndrome > > lower limb artery occlusion).

Contribution To Heart Development

An understanding of the mechanisms of human heart development provides clues to the etiology of congenital heart disease. Nevertheless, to date, the genetic regulatory mechanisms of these developmental processes are just starting to be characterized. A molecular review of heart development is outside the scope of this chapter, but several interesting molecular heart reviews have been published (14,52,53). A better understanding of the embryological origins of the heart combined with the characterization of the genes that control heart development (54) may lead to many new clinical applications to treat congenital and adult heart disease.

Bundle of His and conduction bundles

The bundle of His and conduction fibers are composed of modified cardiac muscle tissue. The bundle of His crosses through the annulus at the base of the cardiac septum. Upon reaching the ventricle, it divides into left and right divisions. The left division skirts around the membranous septum, where it then divides further into an anterior and posterior branch. The right bundle branch extends over the base of the septum into the right ventricle, where it runs superficially in a muscle known as the moderator band between the ventricular wall and the anterior papillary muscle. All of the conduction bundles are susceptible to damage or disruption, because they run superficially just below the endocardium. The bundle of His may be interrupted if the annulus develops degenerative calcification, or if it is affected by infection spreading from endocarditis of an adjacent heart valve. Left ventricular septal ischemia or infarction, high in the base around the membranous septum, may lead to...

Pharmacological Effects

Banner et al. summarized studies where the effects of ephedrine and ephedra were compared to placebo in controlled studies in humans. None of the controlled trials disclosed any evidence of cardiovascular toxicity when ephedrine was given in doses as high as 1 mg kg, even when it was administered to severe asthmatics with known cardiac arrhythmias (57). The trial reported by Banner et al. studied the respiratory and circulatory effects of orally administered ephedrine sulfate, 25 mg, aminophylline, 400 mg, terbutaline sulfate, 5 mg, and placebo in 20 patients with ventricular arrhythmia by a double-blind crossover method. The study was comprised of 20 patients, with an average age of 60 years and a preexisting history of both asthma and heart disease (as evidence by the presence of frequent premature ventricular contractions). The bronchodilator effect of terbutaline was similar to that of aminophylline over 4 hours but superior to ephedrine at hour 4. Both terbutaline and ephedrine...

Cardiovascular Protection

There are a number of ways in which beta-carotene may act to protect against cardiovascular disease. Free radical scavenging may prevent cellular transformations leading to atherosclerosis and protection of LDL oxidation may further act to protect against atheroma formation (Halliwell 1993). Other mechanisms proposed for the possible favourable effect of antioxidants include an increase of HDL cholesterol and the preservation of endothelial functions (Tavani & La Vecchia 1999). Patients with acute myocardial infarction (AMI) have also been shown to have reduced plasma antioxidant vitamins and enhanced lipid peroxidation upon thrombolysis, suggesting that antioxidants may reduce free radical generation processes in reperfusion injury in AMI (Levy et al 1998).

Removal Of The Heart From The Chest

CHOOSING THE METHOD OF REMOVAL Normal hearts and most hearts with acquired disease can be excised separately. In the presence of extracardiac disorders such as pulmonary or esophageal carcinoma or ascending aortic dissection, the heart should be removed with the thoracic organs en bloc (see Chapter 1). For congenital heart disease, the thoracic contents should be removed en bloc, regardless of the age of the patient. DESCRIPTION OF THE HEART Cardiac size may be normal or enlarged (cardiomegaly) due to hypertrophy or dilatation (or both) and can involve one or more chambers. Overall cardiac shape may be conical (normal), globoid, or irregular (as with a ventricular aneurysm), and one or more chambers may be abnormal in shape. The color of the subepicardial myocardium may be gray with an old infarct, pale with chronic anemia, and mottled or hemorrhagic with an acute infarct or rupture. Left ventricular consistency can be firm (due to hypertrophy, fibrosis, amyloidosis, calcification, or...

Cardiac evaluation studies

Baseline EKG usually normal in 25-50 of patients with coronary artery disease but no prior myocardial infarction. EKG evidence of ischemia often becomes apparent only during chest pain. 3. Exercise stress testing gives estimate of functional capacity along with the ability to detect EKG changes and hemodynamic response. Highly predictive when ST-segment changes are characteristic of ischemia. A normal test does not exclude coronary artery disease but suggests that severe disease is not likely.

Issues In Diagnosis And Treatment

The Hachinski Ischemic Score (HIS Hachinski, Lassen, & Marshall, 1974) as modified by Rosen, Terry, Fuld, Katzman, and Peck (1980) is an autopsy-validated index for the diagnosis of vascular dementia. This scale includes a history of sudden onset, stepwise progression, stroke risk factors, stroke or transient ischemic attack, asymmetry or focal signs on examination, and so on. Again, patients may have a combined diagnosis of AD and vascular dementia. Finally, other potentially confounding diagnoses are the frontotemporal dementias linked to neurofibrillary tangles (the tauopathies). Phosphorylated tau is the major component of neurofibrillary tangles, and some familial frontotemporal dementias are linked to mutations and polymorphisms in the tau gene on chromosome 17. Frontotempo-ral dementia may be distinguishable from AD by consensus criteria (Neary, Snowden, Gustafson, Passant, Stuss, et al., 1998) such as early loss of personal and social awareness, hyperorality, stereotyped...

The Real World of Health Policy

In addition, FDA today announced that it is requiring evaluation of all prevention studies that involve the Cox-2 selective agents Celebrex (celecoxib) and Bextra (valdecoxib) to ensure that adequate precautions are implemented in the studies and that local Institutional Review Boards reevaluate them in light of the new evidence that these drugs may increase the risk of heart attack and stroke. A prevention trial is one in which healthy people are given medicine to prevent a disease or condition (such as colon polyps or Alzheimer's disease). FDA is issuing an advisory because of recently released data from controlled clinical trials showing that the COX-2 selective agents (Vioxx, Celebrex, and Bextra) maybe associated with an increased riskof serious cardiovascular events (heart attack and stroke) especially when they are used for long periods of time or in very high risk settings (immediately after heart surgery).

Reaching beyond Researchers

Other resources explain particular age-related diseases. The Centers for Disease Control Cardiovascular Health site contains information for lay people such as fact sheets on topics that include cholesterol, heart attacks, and high blood pressure. Of particular interest to researchers are the interactive maps that supply heart attack and stroke mortality rates for the state, gender, and racial ethnic group of choice. The site includes a list of Morbidity and Mortality Reports that relate to cardiovascular disease as well as other statistical and public-health information. NIH's Osteoporosis and Related Bone Diseases-National Resource Center offers background articles on topics of interest to researchers as well as lay people these include ''Vitamin A and Bone Health,'' ''Phytoestrogens and Bone Health,'' and ''Bone Mass Measurement What the Numbers Mean.''

Intramyocardial Pump Model General Concept

Although coronary blood flow is phasic and the direction of flow varies with both vessel type and location in the myocardium, it is not necessary to take this fact into account at all levels of analysis of coronary flow. In general, one will use mean values of coronary flow and pressure to describe in global terms the distribution of blood flow across the ventricular wall, control of coronary blood flow, and hemodynamic consequences of an obstruction caused by coronary artery disease. However, one has to be aware of the fact that most of the elements are nonlinear and time dependent in their physical behavior, meaning that neglecting the time-varying nature of flow and pressure can result in erroneous conclusions.

Neurological Disorders

Many strokes attributed to ephedrine have actually been caused by the ingestion of ephedrine enantiomers, pseudoephedrine (82-85), phenylpropanolamine (86-93), and even methylephedrine (77). Two cases of ischemic stroke have been reported (94,95), but in neither case was their any toxicological testing to confirm the use of ephedrine. A decade-old report described the autopsy findings in three individuals with intracerebral hemorrhage and positive toxicology testing for ephedrine however, one had hypertensive cerbrovasular disease and the other had a demonstrable ruptured aneurysm (96). Intracerebral hemorrhage has also been described in suicide and attempted suicide victims who took overdoses of pseudoephedrine (97,98). There is also a report describing a patient who developed described arteritis following the intravenous administration of ephedrine during a surgical procedure (99). On the other hand, a large study to assess risk factors for stroke in young people (age 20-49) over a...

And Microscopic Examination

ISCHEMIC HEART DISEASE Coronary artery disease, ischemic myocardial changes, and, in some cases, the effects of surgical and nonsurgical interventions must be evaluated (2,15, 44,45). Postmortem coronary angiography is optional perfusion fixation is only necessary in research studies. The arteries are cut in cross sections at 3-5 mm intervals. Heavily calcified vessels should be removed and decalcified prior to sectioning. Microscopy may be performed to document chronic grade-4 obstructions and acute lesions such as plaque rupture and thrombosis (Table 3-1). Correlation Between Clinical Manifestation of Coronary Artery Disease and Pathologic Features of Atherosclerotic Plaquesa Myocardial infarction (MI) Acute myocardial ischemiab which have been nitro-blue tetrazolium (NBT) and triphenyl tetrazolium chloride (TTC) (46-49). Nevertheless, the best and least expensive method, within 4 h after injury, is a slide well-stained with hematoxylin-eosin. The microscopic features of acute and...

Health Burdens Experienced By Economically And Socially Deprived Urban Populations

Studies of individual and population health for those living in urban areas have consistently demonstrated the variation in health status by context, race, income, and gender. While patterns of disparity differ for various outcomes, a consistent relationship of increased morbidity and mortality has been observed for economically disad-vantaged urban populations compared to their less deprived counterparts for outcomes such as cardiovascular disease, homicide, mental health, asthma, and premature mortality (Brunner and Marmot, 1999 Geronimus, et al. 1999 Shaw, et al, 1999. Weil, 1999 Aligne, et al., 2000 Grant, et al., 2000 House, et al., 1978 Cooper, et al. 2001 Geronimus, 2003 Kreuger, et al., 2004 McGruder, et al, 2004).

Haemostatic genetic risk factors in arterial thrombosis

Heart disease, diabetes, and many cancers probably arise from the interaction of acquired and genetic factors. For arterial thrombotic diseases, such as, myocardial infarction and stroke a number of environmental risk factors are well-established, including smoking, diet, dyslipidaemia, hypertension, and impaired glucose metabolism. The role of haemostatic disorders in the development of arterial thrombosis is emerging.68--75 Arterial thrombogenesis results from atherosclerosis and thrombosis, while atherosclerosis is a disease of the vessel wall resulting from chronic changes in vessel wall cellular components, occurring gradually over many years. The thrombotic event is an acute event thought to be triggered by tissue factor interaction with factor Vila and almost certainly influenced by haemostatic factors, such as, fibrinogen, fibrinolytic factors, and platelet activation.86--88 How the atherosclerotic process might be influenced by haemostatic factors is less clear.72,77

The Realities Of Overweight

Overweight, central or abdominal fat, weight gain after age 20, and a sedentary lifestyle all increase health risks and increase economic costs of obesity. Intentional weight loss by overweight individuals, on the other hand, reduces these risks. Although data are not yet available, researchers widely believe that long-term intentional weight loss lowers overall mortality, particularly from diabetes, gallbladder disease, hypertension, heart disease, and some types of cancer.

Evaluation Of The Vasculature

AORTA AND OTHER MAJOR ARTERIES In general, the thoracic and abdominal portions of the aorta are opened posteriorly, between the origins of the right and left intercostal and lumbar arteries. In cases of congenital heart disease, the thoracic aorta is left attached to the heart. If an acute aortic dissection is suspected, the heart and the entire aorta should be removed intact transsection of the ascending aorta may distort or destroy the intimal tear. For the evaluation of renovascular disease, the kidneys and renal arteries are best kept together with the abdominal aorta.

Studies on health effects

A review ofthis evidence indicates that transport-related air pollution contributes to an increased risk ofdeath, particularly from cardiopulmonary causes. It increases the risk ofrespiratory symptoms and diseases that are not related to allergies. Experimental research indicates that the effects are linked to changes in the formation of reactive oxygen species, changes in antioxidant defence, and increased inflammation, thus providing some indication of mechanisms ofsusceptibility. Laboratory studies indicate that transport-related air pollution may increase the risk ofdeveloping an allergy and can exacerbate symptoms, particularly in susceptible subgroups. The evidence from population studies, however, does not consistently support this notion. While only a few studies have been conducted on the effects of transport-related air pollution on cardiovascular morbidity, they report a significant increase in the risk of myocardial infarction following exposure. Other studies and the...

Frequency of HIT in Medical Patients Treated with Porcine Mucosal UFH

Table 2 also lists the frequency of HIT observed in several prospective studies that have evaluated medical patients receiving intravenous, therapeutic-dose porcine UFH, usually for venous thromboembolism (VTE), myocardial infarction and acute coronary syndromes (MI ACS), or hemodialysis (HD). Excluding studies of HD, an overall frequency of HIT of slightly less than 1 is suggested. This is a relatively low number, particularly when one considers that, paradoxically, the frequency appears to be much higher in postoperative surgical patients who received lower (prophylactic) doses of porcine heparin (discussed subsequently).

Overview Of Racialethic Minority Health

Despite the fact that whites are the older group among the American population, blacks exhibit a 32 higher age-adjusted all-cause mortality rate, when compared to whites. American Indians or Alaska Natives, latinos and Asians or Pacific Islanders exhibit lower age-adjusted all-cause mortality rates by at least 28 than whites (Freid, et al., 2003). A similar scenario can be observed for selected causes of deaths such as heart disease, cancer and diabetes (Table 1). Blacks exhibit 28 and 26 higher age-adjusted mortality rates for disease of the heart and cancer,

Congestive Heart Failure

Past Medical History Past episodes of heart failure hypertension, excess salt or fluid intake noncompliance with diuretics, digoxin, antihypertensives alcoholism, drug use, diabetes, coronary artery disease, myocardial infarction, heart murmur, arrhythmias. Thyroid disease, anemia, pulmonary disease. Cardiac Risk Factors Smoking, diabetes, family history of coronary artery disease or heart failure, hypercholesterolemia, hypertension.

Cognitive Therapy in Health Psychology Settings

A cognitive model of stress examines the role of beliefs in illness and proposes that aperson's beliefs about illness determine both emotional reactions to illness health and to health behaviours (Beck, 1984 Pretzer, Beck & Newman, 1989). This formed the basis for forms of cognitive therapy for a range of problems in health psychology and behavioural medicine, including pain, HIV AIDS, cancer, heart disease and health-related behaviours like exercise and smoking. For example, a link has been established between anger and hostility and coronary heart disease (Emmelkamp, & Van Oppen, 1993). Cognitive therapy to reduce anger and hostility therefore suggests a way of reducing the rates of heart disease. R. Beck and Fernandez (1998) analysed 50 studies, over two decades, incorporating 1 640 angry subjects treated with cognitive therapy. Using meta-analysis, it was found that cognitive therapy had a mean-effect size of 0.70, which indicated that the average individual treated with...

Environmental Justice And Health

Air pollution, another environmental threat, has been identified as a risk factor for hospitalization for lung and heart disease, as well as respiratory disorder (Arif, et al., 2003 Zanobetti, et al., 2000). In general, results from multiple community sites suggest a positive relationship between outdoor air pollution smog and asthma (Clean Air Task Force, 2002 National Campaign Against Dirty Power, 1999). Outdoor air pollution has been implicated as a major trigger in increased respiratory-related emergency room visits and hospital admissions (Bullard, et al., 2000 National Campaign Against Dirty Power., 1999). Urban metropolitan areas, such as Atlanta, Georgia, have been found to be repeatedly in violation of the Clean Air Task Force, with cars, trucks and buses being the greatest source of air pollution (Bullard, et al., 2000).

Systems Planning Fire Safety And Emergency Medical Services

During a wildland fire, the emergency departments should maintain close contact with medical support at the scene of the fire. This will help assess civilian risk and guide resource utilization. The most common injuries seen are respiratory complaints, heat stress, burns, and minor trauma. However, serious trauma associated with involvement or responses to these events, as well as heart attack and stroke, are also seen. Emergency visits increase during these events, but hospitalization rates do not appear to be significantly increased.

Interventional Studies Experimental Study Designs

Once risk factors have been identified by observational studies, the impact of their reduction or elimination on health outcomes may be assessed in randomized trials, and positive results of such studies are commonly regarded as the definitive (and sometimes necessary) proof of causality of epidemiological associations. Well-known examples include reduction of cardiovascular disease endpoints by lipid lowering or antihypertensive medication in randomized trials after hyperlipidemia and hypertension had been identified as major risk factors in observational epidemiologic studies (e.g., Hebert et al., 1997 Psaty et al., 1997) or randomized clinical trials to prevent falls in elderly patients as summarized by Tinetti (2003).

General Methodological Considerations Of Observational Studies

Selection bias occurs when the association between exposure and disease differs for those who participate and those who do not participate in the study and it is mainly due to systematic differences in characteristics between participants and nonparticipants. For example, a hospital-based study on cases with myocardial infarction will exclude those cases who die before admission to hospital, and such a selection may invalidate conclusions and generalizations.

Reducing the risk of thromboembolism

Primary prophylaxis of ATE is most commonly undertaken in patients with atrial fibrillation (AF), valvular heart disease, and recent myocardial infarct. Secondary prophylaxis is undertaken after patients (with or without the above conditions), have had an ATE event (usually stroke). Previous thromboembolism is a major risk factor for 183

Clinical manifestations

Cardiovascular increased circulating blood volume, increased cardiac output, increased oxygen consumption, systemic hypertension, coronary artery disease, congestive heart failure, and pulmonary hypertension. Cardiac output increases by 0.1 L min kg of adipose tissue.

Differential Diagnosis of Atrial Fibrillation

Lone Atrial Fibrillation No underlying disease state. Cardiac Causes Hypertensive heart disease with left ventricular hypertrophy, heart failure, mitral valve stenosis or regurgitation, pericarditis, hypertrophic cardiomyopathy, coronary artery disease, myocardial infarction, aortic stenosis, amyloidosis. Noncardiac Causes Hypoglycemia, theophylline intoxication, pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolism, heavy alcohol intake or alcohol withdrawal, hyperthyroidism, systemic illness, electrolyte abnormalities. Stimulant abuse, excessive caffeine, over-the-counter cold remedies, illicit drugs.

Community Preparation And Public Education

Specific measures should be emphasized before the arrival of a winter storm. These measures include the following monitoring of a National Oceanic Atmospheric Administration (NOAA) weather radio, local radio, or TV station for forecast updates and information including emergency instructions avoid going outdoors unless absolutely necessary dress appropriately when going outside, including multiple layers of loose-fitting, lightweight dry clothing, a hat to minimize heat loss through the head, as well as gloves or mittens, and a scarf beware of overexertion and recognize that shoveling snow can induce a heart attack be cautious of structural damage to homes due to snow and ice buildup have an adequate supply of home staples, including bottled water and canned foods and develop an emergency survival kit for the home and car.

Behavior Change Paradigms

Stokols, a proponent of Social Ecological Theory, emphasizes the critical influence of the context in which behaviors occur on the potential for behavior change (88). Referring to cardiovascular risk reduction programs such as the Multiple Risk Factor Intervention Trial (MRFIT) and the Minnesota Heart Health Program, he suggests that the ''modest impact of these interventions reveals some potential limitations that are inherent in behavior change models of health pro

Hispanic Americans

The Hispanic population in the United States has steadily increased over the years. Between 1970 and 1980, the Hispanic population in the United States increased by 61 , between 1980 and 1990 there was a 53 increase, and between the intercensal period of 1990 and 1996 by 27 . From 1970-1996, the Puerto Rican proportion of U.S. Hispanics decreased from 16 to 11 . The three major Hispanic subgroups vary in terms of Infant Mortality Rates (IMR) calculated as the number of deaths within the first year of life for every 1000 live births. The Puerto Rican IMR at 78 is the highest among the Cuban, Mexican American, and Puerto Rican subgroups whose rates are, respectively, 51, 59, and 78. A paradoxical finding is that the IMR for Texas border counties (32 in total) is actually lower than the average IMR for the rest of the state of Texas (Texas-Mexico Border Health Coordination Office, 1998). There are other paradoxical health findings, wherein surprisingly lower rates of some diseases and...

Summary And Future Directions

Better methods have to be developed to evaluate the physiological significance of coronary artery disease and the success of clinical inteventions. Since all intracoro-nary interventions carry a risk of serious negative side effects, it is important to provide the cardiologist with tools that facilitate the differentiation between needed and unneeded procedures. In the development of diagnostic tools we have to arrive at the ability to separately evaluate the characteristics of a stenosed conduit artery and that of the microcirculation. The assessment of the hemodynamic behavior of a stenosis requires at least two measurements flow (or velocity) through the lesion and pressure drop across it. Such a combined measurement would automatically provide additional information on microvascular resistance because both distal pressure and flow are known. In addition, knowledge about the perfusion of the subendocardium, which is the most vulnerable part of the myocardium, is essential. Clinical...

Mortality and morbidity considerations

It is worth focusing on the changes in disease indices during the past generation in order to evaluate the effect of preventive and health promotion programs during this period (Table 9.2). 3 The messages are to harness and promote with renewed vigour those strategies that are working, such as prevention of death from coronary artery disease and motor vehicle accidents, and to reevaluate those important areas such as Aboriginal mortality, HIV infection, cancer, suicide and asthma which are bad news

A global strategy for good health

Ischaemic heart disease 25 A considerable amount of epidemiological information has emerged to support what general practitioners have known for a long time that a common-sense healthy lifestyle not only promotes good health but also reduces the risk of the main causes of mortality and morbidity in this country, including cardiovascular disease and cancer. Overall mortality Heart attack Stroke

Physical Examination

Differential Diagnosis Idiopathic pericarditis, infectious pericarditis (viral, bacterial, mycoplasmal, mycobacterial), Lyme disease, uremia, neoplasm, connective tissue disease, lupus, rheumatic fever, polymyositis, myxedema, sarcoidosis, post myocardial infarction pericarditis (Dressler's syndrome), drugs (penicillin, isoniazid, procainamide, hydralazine).

Discussion and Concluding Remarks

Although PET will continue to provide insights into biochemical and physiological processes in vivo, access to PET is limited due to the requirement of a cyclotron and high operation costs. Recent advances in quantitative SPECT and the widespread application of multidetector SPECT systems with improved sensitivity and dynamic imaging capabilities have made absolute physiological parameter estimation possible with the much more widely available SPECT. One of the major applications of dynamic SPECT is to quantify myocardial perfusion, which is important for the diagnosis and clinical management of patients with coronary artery disease where a perfusion defect after an intervention may indicate incomplete reperfusion or persistent coronary occlusion. Similar to dynamic PET, compartmental modeling is used in dynamic SPECT to quantify physiologic

Vnonimmune Heparinassociated Thrombocytopenia

Streptokinase therapy for acute myocardial infarction compared with control patients who received streptokinase alone. The heparin-treated patients also showed greater ex vivo spontaneous platelet aggregation, suggesting that heparin may have had a direct proaggregatory effect.

Asthma and other respiratory diseases

The death rate and morbidity rate for asthma and other respiratory diseases is unacceptable and much of it can be prevented. 15 A recent report claims that at an estimated cost of 585 to 720 million per year the cost of asthma to the Australian community compares with the total cost of coronary artery disease ( 623 million). 15 The report also claimed that there is evidence that a significant proportion of diagnosed asthmatics are currently receiving treatment that does not provide the best possible control of the disease.

Preoperative Coagulation Defects

Many patients who present for surgery are already anticoagu-lated, most often for the underlying heart disease (Table 10.1). If needed, rapid reversal (4-6 hours) of warfarin can be achieved with the use of vitamin K, given as 5 mg over one hour slow intravenous infusion. Alternatively, fresh frozen plasma can be used to prime the cardiac bypass machine. If clinically feasible, patients should stop warfarin one week before the procedure. A therapeutic dose of low molecular weight heparin can be used for anticoagulation. The last dose of heparin should be given the night before surgery. Congenital heart disease patients have several potential coagulation defects. Patients with cyanotic heart disease and high hematocrits will have spurious elevation of the PT-INR PTT due to alteration of the plasma anticoagulant ratio. This occurs with hematocrits of more than 60 . The coagulation laboratory needs to be notified before testing is done. The laboratory can prepare a...

Receptor Gene Polymorphisms

Most human GPCR genes appear to be polymorphic, and the significance of receptor mutations for cardiovascular disease risk and as determinants of therapeutic responses constitutes another rapidly expanding area of research. Genetic polymorphism is defined as the occurrence within a population of two or more allelic variants of a given gene sequence, in such proportions that the rarest cannot be maintained merely by recurrent mutations. Genetic variation may influence one or more aspects of the function of a given GPCR, which may provide the basis for individual variability in clinical phenotypes and pharmacological responses.32 Several databases have been established to catalogue human gene polymorphisms and make this information available to researchers. One example in cardiovascular medicine is the Gene Canvass (cardiovascular candidate gene polymorphisms) web site genecanvas . The site was set up to facilitate association analysis and research on how single nucleotide...

Causes and symptoms

The disorder sometimes runs in families, but most people with narcolepsy have no relatives with the disorder. Researchers believe that the inheritance of narcolepsy is similar to that of heart disease. In heart disease, several genes play a role in being susceptible to the disorder, but it does not usually develop without an environmental trigger of some sort.

STI at the Patients Wish for Reduction of Toxicity

Interruption of therapy can have psychological advantages (Tuldra 2001). Quality of life improves (Moreno 2003), and many patients are relieved of the burden of continuous, lifelong therapy. Clinicians should take the wish for treatment interruption seriously. Presumably most patients expressing such a wish will interrupt sooner or later anyway so the interruption may as well be structured What about side effects Increased lipid levels (cholesterol, triglycerides) drop quite rapidly after stopping treatment (Hatano 2000, Jaeger 2002). However, the reduction of drug exposure during interruptions is unlikely to be so significant as to affect the cardiovascular risk profile.

Number of genetic variants contributing to genetic etiology implications for study strategy

Coronary artery disease is a highly complex multidimensional trait with an exponentially increasing lifetime risk which is influenced by more than 280 risk factors (Wright et al., 2002). Secondly, the distribution of gene effects is clearly important, since if most of the variance is determined by a handful of potentially detectable genes, the total number is irrelevant.

Management of hypothalamic dysfunction

Hypoestrogenic women are at risk for osteoporosis and cardiovascular disease. Oral contraceptives are appropriate in young women. Women not desiring contraception should take estrogen, 0.625 mg, with medroxyprogesterone (Provera) 2.5 mg, every day of the month. Calcium and vitamin D supplementation are also recommended.

Laboratory data and other tests

Hospital course a diagnosis of anterior myocardial infarction was made. The patient was given the thrombolytic agent TPA (tissue plasminogen activator), aspirin (ASA) and nitroglycerin, with which he had an initial improvement. No cardiac arrhythmias were recorded. At 7 30 am, he suddenly went into cardiopulmonary arrest. Resuscitation efforts were unsuccessful.

The Health Of Older Adults

In older adults, prevention has demonstrated to be effective in reducing death from conditions including cardiovascular disease, colon cancer, and influenza. Prevention strategies such as physical activity have also improved quality of life in older adults of varying health status and appear to be important in prevention of frailty and loss of independence with aging, improving both physical function and well-being and cognitive function. The U.S. Preventive Services Task Force recommends a variety of screening and counseling interventions for older adults. Although individual-level prevention is often practiced effectively by clinicians, these strategies are not sufficient to benefit all urban seniors. The reason that these strategies are designed for periodic screenings of asymptomatic older adults, and some case findings. These need to be coupled with community-based health education and screening and secondary and tertiary prevention of progression of disease and of disability....

Relationship to Classical Indexes

It is important to analyze whether the previous analysis methodology for parameterizing the vessel behavior during the flow-mediated dilation test is linked to other clinical parameters and CVD risk factors traditionally used in the medical literature. Serum lipids, particularly cholesterol and the cholesterol fraction carried by low-density lipoproteins (LDL cholesterol) are recognized as a main causal factor of atherosclerosis 34 . In this disease lipids accumulate in the vessel wall, disturbing the vascular function of delivering sufficient blood flow to the affected territories, which ends with the manifestation of a vascular clinical event like heart attack or stroke. Moreover, knowing patients' lipid levels and modifying them with drugs and diet is the main preventive tool against cardiovascular diseases. From this point of view, cholesterol and LDL cholesterol are considered as risk factors, as higher levels identify individuals with higher risk whereas the cholesterol fraction...

Therapeutic Influence Of Concomitant Disease

Existing disease states can influence drug therapy. Patients with decreased renal function require appropriate dose adjustments. The use of NSAIDs requires additional care and monitoring of patients with decreased renal function (72,112-115) or with compromised cardiovascular function. If patients are taking antihypertensive medications such as angiotensin-converting enzyme inhibitors and diuretics, the use of NSAIDs can interfere with their pharmacological effects (116-122). Also, patients with cardiovascular disease such as congestive heart failure requires special care for the use of NSAIDs because, in this patient population, they are most susceptible to the decreased renal perfusion effect associated with NSAIDs (123-126).

Power Of Decision Making

The primary health resource is your physician. Select wisely based on your health history. For example, if you have a history of heart disease, find a physician with special skills in treating that problem. Ask your physician for information on drugs, treatment alternatives, second opinions, and use of consultants. Health professionals have personal and professional guidelines of conduct based on professional codes of ethics. Beyond the code is a sense of personal commitment to the patient. Relationship at this level leads to a sense of loyalty and mutual trust, or a covenant.

Neurophysiological Factors

As discussed in Chapter 3, organic brain disorders can have a pronounced effect on behavior and abilities. This is particularly evident in Alzheimer's disease, a disorder that afflicts approximately 20 of individuals in the 75- to 84-year age range and about 47 of those over 85 (Evans et al., 1989). An even greater percentage of older Americans suffer from hypertension, another disorder that is associated with reduced intellectual functioning (Hertzog, Schaie, & Gribbin, 1978 Sands & Meredith, 1992) and which can lead to cardiovascular disease and stroke. By interfering with the oxygen flow to the brain, a major stroke can affect not only intellectual abilities but also speaking, walking, and other skills. The brain's blood supply can also be temporarily reduced by emphysema, acute infection, poor nutrition, injuries, and surgery. The loss of neuronal tissue, changes in metabolic rate, and a decline in blood circulation also have depressing effects on cognitive functioning....

Genetic Information Is

The first claim which can be brought forward is that genetic information is predictive. First, it is worth pointing out that a lot of genetic information is non-predictive. One could look into the genes to discover the colour of the eyes of a specific person, but this information would not be predictive in any meaningful sense of that word. We could obviously predict the colour of the eyes, but since this is directly observable it would not be much of a prediction. A lot of health related information which is non-genetic is highly predictive. Knowing that a person has cancer of the stomach is highly predictive of death in the not too distant future. Similarly knowing the LDL-cholesterol level or the homo-cystein level in the blood of a person can be very predictive of the person's risk of coronary heart disease. It could be objected that the examples offered above are examples of persons already suffering from a disease, whereas genetic information is predictive of future disease and...

Microscopic Description

Sections from the heart revealed a recent apical-lateral myocardial infarction involving the papillary muscle. Remote infarcts in both anterior and posterior walls were also noted. Sections from the left circumflex showed plaque hemorrhage with associated inflammation. Significant findings in the lungs included moderate emphysematous change, early focal bronchopneumonia and intimal vascular proliferation consistent with pulmonary hypertension. The kidneys, adrenals, pancreas, intestines and bladder revealed diffuse hemorrhage in keeping with shock. The brain was remarkable for acute anoxic changes and multiple, old areas of encephalomalacia involving cerebellum, cortex and white matter.

Is achieving extreme old age worthwhile the centenarian phenotype

Independently functioning at age 92 (Hitt et al., 1999). Most subjects experienced a decline in their cognitive function only in the last three to five years of their lives (Perls, 1997 Silver et al., 1998). Upon further examination of the ages of onset for ten common age-associated diseases (hypertension, heart disease, diabetes, stroke, non-skin cancer, skin cancer, osteoporosis, thyroid condition, Parkinson's disease, chronic obstructive pulmonary disease and cataracts) among 424 centenarians (323 males and 101 females), the subjects were noted to fit into three morbidity profiles ''survivors,'' ''delayers'' and ''escapers'' (Evert et al., 2003). Survivors, individuals who were diagnosed with age-related illness prior to age 80, accounted for 24 of the male and 43 of the female centenarians (p 0.0009). Delayers, individuals who delayed the onset of age-related diseases until at least age 80, accounted for 44 of the male and 42 of female centenarians. Escapers, individuals who...

Specific interventions

Coronary heart disease (CHD) includes history of myocardial infarction, unstable angina, stable angina, coronary artery procedures, or evidence of clinically significant myocardial ischemia. CHD risk equivalents include clinical manifestations of non-coronary forms of atherosclerotic disease, diabetes, and > 2 risk factors with 10-year risk for hard CHD > 20 . Risk factors (RF) include age (male > 45 years, female > 55 years or premature menopause without hormone replacement), positive family history for premature CHD (in first-degree relatives < 55 years and first-degree female relatives < 65 years), cigarette smoking, hypertension (blood pressure > 140 90 mmHg or taking antihypertension drugs), HDL < 40 mg dl (1.0 mmol l). If HDL cholesterol is over > 60 mg dl (1.6 mmol l), subtract one risk factor from the total (adapted from Dub 2000 and Schambelan 2002). Coronary heart disease (CHD) includes history of myocardial infarction, unstable angina, stable angina,...

Discussion and Conclusions

Arterial tree morphometry is an important application of image processing and analysis in clinical practice and the biomedical sciences. The severity of coronary artery disease is routinely assessed in the clinic with the aid of sophisticated image processing software to quantify stenoses. Presurgical planning for vascular abnormalities such as cerebral aneurysms is facilitated by segmentation and visualization of the intracerebral vasculature. Clinical studies provide information about arterial morphology on a macro scale. On the other end of the scale continuum, histological and electron microscopic methods have a long history of providing valuable insights into the cellular makeup and ultrastructure of vessel walls, and the many forms of medial hypertrophy. Micro-CT techniques such as those developed in our laboratory and others 120,121 and micro-MR methods under development have the potential to shed further light on the mechanisms implicated in diseases such as pulmonary and...

Genes predisposing to exceptional longevity

It is practically intuitive to state that centenarians outlive those who are relatively predisposed to age-related fatal illnesses and that they are less likely to have environmental and genetic exposures that contribute to death at earlier ages. This selection phenomenon, called demographic selection, is exemplified by the fact that the apolipoprotein E e4 allele, associated with heart disease and Alzheimer's disease, is rare in centenarians, whereas the prevalence of an alternative allele, e2, is relatively high (Schachter et al., 1994). Along the same lines, it is likely that there are certain environmental exposures that are rare among centenarians as well, such as tobacco, obesity and bullets. Richard Cutler, in what is now a classic paper in gerontology, proposed that persons who achieve extreme old age do so in great part because they have genetic variations that affect the basic mechanisms of aging and that result in a uniform Dr Nir Barzilai and his colleagues studying...

Specific Ocular Beta Blockers

The side effects associated with carteolol can be expected to be similar to those of other OBBs, although the intrinsic sympathomimetic activity (ISA) of carteolol may confer some advantages. As noted above, in some studies, the effect on heart rate and lipid profile with carteolol was more favorable than that with timolol. However, in stark contrast with other beta blockers, those with ISA in fact are not favored systemically because the ISA component results in a significant reduction in the survival advantage that beta blockers as a class have in patients with a history of myocardial infarction.121

Health and Health Care

Before this transition most people died of infectious diseases (smallpox, scarlet fever, tuberculosis, influenza, and pneumonia, etc.), which affected all ages. The young were especially vulnerable, and most people did not survive to old age (Caldwell 2001 Riley 2001). With the conquest of infectious diseases, mortality is concentrated in the older ages, and the primary causes of death are chronic degenerative diseases (heart disease, cardiovascular disease, and cancer). Therefore, population aging may have significant implications for population health, as a growing proportion of the total population is comprised of older people with chronic diseases. Growth in the prevalence of chronic disease in a population raises concerns about declining vitality of its members, the overall burden of care for those with physical and cognitive limitations, and the health care costs to society. For example, the health care cost per capita is three to five times greater for the population over age...

Cardiovascular Effects

FSO and ALA have been studied as possible agents in the prevention or treatment of cardiovascular disease because ALA can be converted to long-chain (n-3) PUFA in humans and may potentially reproduce the beneficial effects of fish oils on risk factors. The numerous studies available have suggested that FSO and ALA exert a myriad of different mechanisms in the body, which can be beneficial in cardiovascular disease however, inconsistent results have meant that much is still unknown and more research is required.

What Is Epidemiology And What Role Can It Play In Urban Health Research

Second, epidemiology plays a critical role in understanding disease etiology, or identifying causes of diseases. Classically, epidemiology has concerned itself with identifying different factors, often called exposures or risk factors that are associated with categorical disease outcomes. Both observational and experimental methods have been employed to this end. Historic examples of this include the identification of smoking as a risk factor for lung cancer and cardiovascular disease and the absence of folic acid as a risk factor for neonatal neural tube defects. In the context of public health practice, epidemiology contributes methods that aid in the search for causes of infectious disease epidemics. For example, outbreak investigations include both the description of the increase in incidence of a particular disease and also the search for the cause, or of the mechanisms of transmission of a well-known cause, of the same disease. Both these traditional roles of epidemiology have...

Anterior or Frontal or Volitional Saccadic Center

Destruction of the frontal cortex or its connections through the internal capsule, the eyes are forced, by the opposite healthy cortex, to the side of the lesion and away from the side of the paretic arm and leg. As the lesion becomes chronic, the eyes will again be in the primary position and will move to the side of the lesion, but for a time will not cross the midline to the side of the paretic arm and leg. In short, the stroke patient will not look toward his paretic arm and leg, whereas the convulsing patient must look toward his twitching arm and leg (usually).

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