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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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 Disease

Epidemiological studies support the idea that a diet rich in high carotenoid containing foods is associated with a reduced risk of heart disease (Kritchevsky 1999). A review of observational and intervention studies on beta-carotene and the risk of coronary heart disease found that seven cohort studies (Gaziano et al 1995b, Gey et al 1993, Knekt etal 1994, Manson etal 1991, Morris et al 1994, Rimm et al 1993, Street et al 1994) reported relative risks between 0.27 and 0.78 for high serum beta-carotene levels or high dietary intake and that this was supported by case-control studies (Bobak et al 1998, Bolton-Smith et al 1992, Kardinaal et al 1993, Torun et al 1994, Tavani et al 1997) that reported odds ratios between 0.37 and 0.71, with a possible stronger protection for current smokers (Tavani & La Vecchia 1999). These results contrast with those of four more recent cohort studies (Knekt et al 1994, Kushi et al 1996, Pandey et al 1995, Todd et al 1995) and five large RCTs (Buring...

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,...

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...

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...

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...

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...

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...

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

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...

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...

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).

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 chid.nih.gov 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...

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

Acknowledgements

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...

Forward

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 www.google.com 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.

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...

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.

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).

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...

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,

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).

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).

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.

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.

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

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

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 ecgene.net genecanvas . The site was set up to facilitate association analysis and research on how single nucleotide...

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).

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...

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...

Microscopic Description

The heart revealed extensive subendocardial myocardial infarction (SEMI) with granulation tissue, organizing myocytolysis, and focal immature connective tissue. All findings consistent with a 10-14 day old healing infarction. In addition, in the same region of subendocardial myocardial infarct, there was an acute myocardial infarction with extension toward the epicardial surface. This acute transmural infarction extension had predominantly occurred within the past 12-24 hours. Moreover, there were few foci with active neutrophilic inflammation, and thus consistent with 24-48 hours duration. This pattern of SEMI with acute transmural extension was apparent in multiple sections of the left ventricle. The pathologic findings consistently dated the subendocardial infarction between 10-14 days, and the acute transmural extension to 1-2 days. In addition to the acute and organizing necrosis, there was evidence of myocellular hypertrophy and multiple foci of interstitial and replacement...

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...

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...

Epidemiologic Approaches

Ecologic analyses consider associations between factors at the group or aggregate level. For example, ecologic analyses can consider the association between population density and all-cause mortality rates across cities. Simple correlations can suggest features of cities that co-vary with measures of population health at the city level while more sophisticated techniques such as regression analyses can consider how particular factors co-vary with others while accounting for the contribution of potentially important variables. Ecologic analyses provide an opportunity to document how characteristics of cities are related to population health in the aggregate and have historically been the primary method used in urban-rural and inter-urban comparisons discussed above (e.g., Schouten, et al., 1996 Douste-Blazy, et al., 1988 Hersh, et al., 1992). The primary current use of ecologic analyses in the study of urban health is to generate hypotheses about features of cities that may affect...

New Ischemic Syndromes

In the past, it was generally believed that extended periods of myocardial ischemia led to irreversible damage of the myocardial or infarcted (necrotic) tissue. However, more recently, between the clinical conditions of transient ischemia (angina pectoris) and myocardial infarction, five additional ischemic syndromes have been described (Figs. 2 and 3) (2,3). The stunned myocardium is characterized by postischemic impairment of myocardial function, but it is considered acute and completely reversible.

Penetrance expressivity and genetic modifiers

Some companies, misguidedly, are already offering the general public genetic profiling to determine whether they are at increased risk of, say, heart disease. Clearly even if the hunt for genetic risk factors is successful and one can account for most of the genetic contribution to susceptibility, the risk estimates will be broad and apply to the population but what will it mean for an individual Again we only have to look at single gene disorders to get an inkling of the much greater problems we will find in studying common diseases. There are very few single gene disorders that are completely penetrant, since the outcome is commonly influenced by genetic background and environmental factors. Even single gene disorders which are completely penetrant may show variation in expressivity, again dependent on unknown genetic and environmental factors.

Clinical Features and Pathology

Friedreich ataxia (FA) is the most common of the early-onset hereditary ataxias in Indo-European and North African populations. The disease was first described in 1863 by Nickolaus Friedreich, Professor of Medicine at Heidelberg. Although Friedreich's papers described the essential clinical and pathological features of the disease as degenerative atrophy of the posterior columns of the spinal cord leading to progressive ataxia, sensory loss and muscle weakness, often associated with scoliosis, foot deformity and heart disease, subsequent descriptions of atypical cases and of clinically similar diseases clouded classification for many years. Diagnostic criteria were established in the late 1970s, after a renewed interest in the disease prompted several rigorous clinical studies (Geoffroy et al. 1976 Harding 1981). The following clinical features were considered essential to establish the diagnosis (1) autosomal recessive inheritance, (2) onset before 25 years of age, (3) progressive...

Arrhythmogenesis and Changes in Impulse Propagation

Experimentally, fractionated electrograms have been be recorded from the surface of a myocardial infarction in a dog 8 weeks following the acute event. These fractionated electrograms are the fingerprint of delayed conduction of the type that underlies reentry. Interestingly, action potentials recorded from myocytes within these zones are normal (Gardner et al., 1985 Ursell et al., 1985). When looked at under the microscope, the muscle fibers were widely separated and disoriented by connective tissues. The slow, fragmented activation that gave rise to the fractionated electrograms, therefore, occurred in the presence of normal action potentials, indicating that the fragmentation and fractionation were not due to changes in the active generator properties of the tissue, but rather to disruption in the integrative electrotonic interaction between cells caused by fibrosis that physically disconnected the cells.

Stimulation of Thrombocytosis and Thrombosis

In none of the closely followed animal or human studies with TPO has there been any evidence for increased thrombotic events, but three potentially prothrombotic attributes of TPO deserve attention. These molecules are extremely potent growth factors and can markedly increase the platelet count in a short period. The deposition of platelets in an extravascular shunt in baboons is directly related to the platelet count after PEG-rHuMGDF administration (50,51). Since the extravascular shunt mimics an ulcerated atheroma in humans, these results show that except for its ability to increase the platelet count, PEG-rHuMGDF does not synergize with or exacerbate platelet deposition. Nonetheless, increasing the platelet count in individuals with active arterial thrombotic disease may exacerbate the cardiovascular disease.

HDACs In Smooth Muscle

MEF2 is required for vascular development (78) and mediates endothelial cell survival (79). In addition, genetic studies in humans implicate MEF2 in protection from coronary artery disease and myocardial infarction (80). Studies to determine the interplay between HDAC7 and MEF2 in the control of these developmental and pathophysi-ological processes are forthcoming.

Sites and Mechanisms of Drug Action

State-dependent duality of drug action has demonstrated itself dramatically in the clinical situation. That antiarrhythmics could exacerbate rather than control arrhythmias has long been known. Proarrhythmia was initially thought to be relatively uncommon, but awareness increased. More recently, the class IC drugs flecai-nide and encainide proved to have an unacceptably high association with fatal ventricular arrhythmias in the CAST CAST Investigators, 1989 Cardiac Arrhythmia Suppression Trial II (CAST-II) Investigators, 1992 . Patients in CAST had coronary artery disease and existing ventricular arrhythmias that had been well suppressed by these drugs. These patients were randomized either to placebo or to treatment with the drug that had suppressed the ventricular arrhythmia. An interesting observation was that the deaths were distributed equally throughout the period of drug treatment. As the task force of the working group on Arrhythmias of the European Society of Cardiology wrote...

Familial hypercholesterolemia and statins

Perhaps the most dramatic example of monogenic diseases leading to treatments for common disease concerns familial hypercholesterolemia (FH) and the development of statins (Goldstein et al., 2001). FH is a relatively common dominant condition affecting 1 500 of the population. Individuals with FH have high levels of cholesterol at birth and will develop atherosclerosis and vascular disease in childhood. The risk of fatal heart disease before the age of 40 years is significantly higher than among the general population. Approximately one-third of patients with FH show no symptoms until sudden cardiac death. Through the pioneering work of Brown and Goldstein, we know that FH is caused by loss of function mutations in the LDL receptor gene (LDLR). The LDL receptor removes cholesterol from the blood stream. This piece of genetic detective work proved that high cholesterol is the cause of coronary disease in these patients. Extrapolating from this monogenic condition, these findings...

Pre Autopsy Evaluation and Analysis

Crucial clinical information can be derived from the first sentence of the history 1) a 45 year old woman, 2) a smoker, 3) seropositive for hepatitis B, 4) affected by migraine headaches, and 5) someone who had experienced multiple episodes of syncope (although the time frame is not indicated). Her presentation was suggestive for acute ischemic heart disease. The quality and characteristics described are very specific for coronary pain ( 95 specificity, and a high positive predictive value). Electrocardiograms at first revealed ST segment elevations in II, III, and avF and then diffuse ST elevations across the precordium. Her death was rapid, and it was not associated with cardiac enzyme increases. Thus, we are trying to establish the cause of apparent ischemic heart disease in a relatively young woman. Several questions about this case can easily be raised 1. Is this really ischemic heart disease

Ischemia vs Nonischemia

It would certainly appear that the presentation is most consistent with ischemic heart disease. The acute onset of chest pain with radiation to the left arm is strongly suggestive of this conclusion. She did not have diaphoresis, nausea, or vomiting, all signs and symptoms of ischemic heart disease, but very variable in their presence. Furthermore, as described below, the ischemia may not have been persistent. Although one must consider other causes of chest pain, it is difficult to explain the nature of these complaints with chest wall disease (e.g. costochondritis, or myositis), muscle strain, pericarditis, pleuritis, or parenchymal pulmonary disease (including pulmonary embolism). When one adds the electrocardiographic findings to the clinical complaints, it strengthens the association even further with ischemia. The fact that the cardiac enzymes were within normal limits, simply indicates that the ischemia was transient and did not persist for sufficient time to irreversibly...

Environment as determinant of i genotype and ii disease

Second, the environment presents many exposures that directly alter the probability of occurrence of various diseases. Ionizing radiation contributes to the risks of breast cancer and leukemia. Asbestos causes asbestosis and mesothelioma. Environmental tobacco smoke increases the risks of lung cancer and coronary heart disease. Heavy metals induce various forms of organ dysfunction, for example, environmental lead exposure in early childhood impairs neurocogni-tive development. Patterns of exposure to various antigens in early childhood influence the maturation path of the young immune system, and also

Major Mendelian genes versus minor polygenes as predisposers

Most genetic influences on disease risks, however, occur in polygenic situations where any single contributory gene may shift the probability by no more than a few percentage points. Further, it is likely that it is the interacting set of alleles that is most relevant in determining the level of innate susceptibility of an individual to developing a disorder or disease in response to a particular environmental exposure. In recent years it has become apparent that there are multiple genetic loci which contribute to the occurrence of hypertension, a tendency to rapid weight gain, coronary heart disease, colon cancer, lung cancer and so on. This is hardly surprising. After all, the complex metabolism and physiology of the mammalian organism is, fundamentally, under genetic control, in that all proteins and other active molecules are genetically coded for, and the resultant slight interindividual variations in the molecular structure of proteins affect their biological activity.

Prevention strategies whole populations highrisk groups or selected individuals

That second issue goes further than that. As Rose eloquently pointed out, those factors that best explain the occurrence of cases within a population may not best account for the rate of the disease within the population at large. For example, if the population, overall, consumes a high-fat diet, then whether or not an individual smokes cigarettes may best explain whether he she develops coronary heart disease. Meanwhile, the population-wide dietary behavior may be the main source of the elevated rate of coronary heart disease within that population. Consider another example, admittedly extreme, but it helps to make the point. If within a population everyone smoked 20 cigarettes per day, then the prime determinant of individual risk of lung cancer might well be one or more genetic polymorphisms which determine the fate of inhaled carcinogens. Yet it is the smoking that accounts for the overall high rate of lung cancer in that hapless population.

Epidemiological Triad

Another way to visualize these influences is using the classic epidemiological triad (Fig. 2), which has proved to be a robust model with epidemics such as infectious diseases, smoking, coronary heart disease, and injuries (25-27). The Host in Figure 2 encompasses the biological and behavioral influences and the physiological moderators of weight change from the ecological model. The Agent is defined as positive energy balance, and its Vectors are energy-dense food, large portion sizes, timesaving machines (e.g., cars) and time-using machines (e.g., television). These are analogous to the mediators. The Environment is the same in both models. The strategies for intervention are different for each corner of the triad however, the main lesson learned from other epidemics is that all three corners need to be addressed together. For the host, the intervention strategies encompass both prevention and treatment and range from education (awareness raising to intensive counseling), through...

Ivwhy The Focus On Environments

Obesity, like diabetes and coronary heart disease, has higher prevalence rates among the lower-socioeconomic status (SES) populations in developed countries. Low income and low educational attainment bring reduced options for low-SES groups and a lower uptake of health messages about behavioral changes for a healthy future. One of the key strengths of an environmental focus is its potential impact among lower-SES groups. By influencing the ''default'' choices in key environments, there is a much greater potential to affect overall diet and physical activity patterns in lower-SES groups than by education strategies alone. Education-based campaigns are complementary to the environmental approach, but the priority needs to be on ensuring that the healthy choices are available first, before embarking upon such campaigns to educate people about taking up those choices.

Peter A Mayes PhD DSc Kathleen M Botham PhD DSc

Unsaturated fatty acids in phospholipids of the cell membrane are important in maintaining membrane fluidity. A high ratio of polyunsaturated fatty acids to saturated fatty acids (P S ratio) in the diet is a major factor in lowering plasma cholesterol concentrations and is considered to be beneficial in preventing coronary heart disease. Animal tissues have limited capacity for desaturating fatty acids, and that process requires certain dietary polyunsaturated fatty acids derived from plants. These essential fatty acids are used to form eicosanoic (C20) fatty acids, which in turn give rise to the prostaglandins and thromboxanes and to leukotrienes and lipoxins known collectively as eicosanoids. The prostaglandins and thromboxanes are local hormones that are synthesized rapidly when required. Prostaglandins mediate inflammation, produce pain, and induce sleep as well as being involved in the regulation of blood coagulation and reproduction. Nonsteroidal anti-inflammatory drugs such as...

The Hypoxic Tumor Microenvironment Angiogenesis And Edema

Maintaining the body's pO2 constant is absolutely essential for mammalian life. A highly developed, multilevel physiological system is devoted to the body's oxygen homeostasis. One of the first physiological systems to be established during development is the blood circulation. Failure in cardiac, erythroid, or vascular development leads to early embryonic lethality, suggesting that in multicellular organisms, oxygen as well as nutrients need to be delivered by a functional circulatory system. Mammalian cells are located within a distance of 100-200 mm (the diffusion limit of oxygen) from blood vessels. To grow beyond this size, multicellular organisms and tissues need to recruit new blood vessels by vasculogenesis and angiogenesis. The establishment of a highly branched vascular system is regulated by a balance between pro- and anti-angiogenic factors. This finely tuned balance is disturbed in various diseases including some of the leading causes of mortality in the West such as...

Contraindications And Precautions

Some authors suggest that high-dose Siberian ginseng should be avoided by those with cardiovascular disease or hypertension (BP > 80 90 mmHg) (Mahady et al 2000). Others merely suggest a caution, as reports are largely unsubstantiated (Holford & 2007 Elsevier Australia

Problems Associated With Adenoviral Retargeting In The Field Of Cancer Gene Therapy And Current Efforts

In 1995, the National Institutes of Health (NIH) director designated a special advisory panel headed by Drs. Orkin and Motulsky which produced a report about the limiting issues in the field of gene therapy and the points in the report are still valid (81). One of the main points was that vector systems still have problems and need to be improved to realize the benefit of gene therapy. Recently there have been several promising reports indicating the clinical benefits of gene therapy in severe combined immunodeficiency mice (SCID) (82) and cardiovascular disease (83,84), yet, the realization of the clinical therapeutic potential of the cancer gene therapy has not been achieved.

Applications for Transient Gene Therapy

The technical innovations described above are at best laboratory proofs that will require extensive animal studies before clinical testing. However, the clinical data to date suggests that success with currently available Ad vectors is possible in applications where transient expression might be sufficient. For example, studies of therapeutic angiogenesis for coronary artery disease described above are a prototype of this type of application. Medical indications such as cancer, infectious disease, tissue remodeling (angiogenesis, recovery from surgery, stroke, or injury) are areas where development might be most appropriate. In contrast, metabolic and genetic disease, autoimmune disease, and other chronic conditions would seem to need substantial advances in adenoviral vector design or more likely some kind of hybrid vector before they become treatable on a persistent basis. Importantly, the knowledge of the cellular and host response to Ad infection in humans is still quite...

Broad etiological groups

Genes identified as mutated in syndrome congenital heart disease Rapid progress has been made over the last 15 years in identifying the genes underlying many monogenic malformation syndromes giving clues to some of the genes critical for development of specific organs (Donnai and Read, 2003). As an example, genes known to underlie the pathogen-esis of syndromic congenital heart disease are given in Table 13.3. Although numerically small in terms of their contribution towards morbidity and mortality, description of their pathogenesis has contributed disproportionately to the understanding of normal embryogenesis and has consequently set the stage for investigation of more complex disorders. The roles that epigenetic mechanisms play in the genesis of malformations remain a relatively unexplored and unappreciated area although they are implicated in disorders characterized by defects in imprinting (Paulsen and Ferguson-Smith, 2001) and underlying some developmental defects...

Suggested Readings

Cardiovascular disease in diabetic patients. Med Clin North Am. 2000 84 81-93. diabetic cardiomyopathy. There is left ventricular hypertrophy, extensive multifocal myocytolytic necrosis (the darker areas in the subendocardium and mid-wall), and multifocal fibrosis (the paler areas involving the papillary muscle, trabeculae, and ventricular wall). The recent and organizing necrosis, together with remote scarring, leads to replacement of large areas of functional myocardium, equivalent to myocardial infarction. diabetic cardiomyopathy. There is left ventricular hypertrophy, extensive multifocal myocytolytic necrosis (the darker areas in the subendocardium and mid-wall), and multifocal fibrosis (the paler areas involving the papillary muscle, trabeculae, and ventricular wall). The recent and organizing necrosis, together with remote scarring, leads to replacement of large areas of functional myocardium, equivalent to myocardial infarction.

Thrombolytic Therapy

Early-onset thrombocytopenia occurs in about 1 of patients with acute coronary syndrome whether treated by heparin or non-heparin anticoagulants (Eikelboom et al., 2001). The frequency of thrombocytopenia is even higher in patients treated with streptokinase, especially when this thrombolytic agent is combined with heparin (Balduini et al., 1993) (Fig. 6). This could represent a direct, activating stimulus of heparin on platelets that perhaps is exacerbated by procoagulant

Applying the Framework for Comparing Cities Health Services and Health to Four World Cities

WCP has applied elements of the framework presented earlier to study four dimensions of health and access to health care in four world cities infant mortality, coronary artery disease (CAD), avoidable hospital conditions (AHC), and patterns of aging, quality of life and use of long-term care services. Our study on the prevalence and treatment of CAD examined mortality, morbidity and treatment patterns for acute myocardial infarction, and other forms of CAD in New York, London, and Paris (Gusmano, et al., 2004). We explored the relationship between the health system and neighborhood characteristics and the

Infective Endocarditis

Infective endocarditis is frequently complicated by thrombocytopenia. These patients are also at risk for septic emboli manifesting as thrombotic or hemorrhagic stroke, myocardial infarction, renal infarction, or even acute limb ischemia (de Gennes et al., 1990). Thus, the profile of macrovascular thrombosis and thrombocy-topenia characteristic of HIT can be mimicked, especially as heparin is often used to anticoagulate patients with septic endocarditis (Delahaye et al., 1990). Micro-embolization leading to multiple small infarcts or microabscesses, in such organs as muscles, adrenal glands, and spleen, is an additional feature of endocarditis (Ting et al., 1990) that is not seen in HIT. When endocarditis-associated thrombocytope-nia is unusually severe, potential explanations include platelet-reactive autoantibo-dies (Arnold et al., 2004) or procoagulant monocyte-stimulating factors secreted by microorganisms from within large vegetations (Selleng et al., 2006).

Cardioprotective Effects

Considering that GSE demonstrates antioxidant, antiplatelet and anti-inflammatory actions, it may have a role in the prevention of cardiovascular disease. A number of researchers have investigated this issue further, mainly using animal models. One series of studies was conducted by Bagchi et al (2003) using a natural, standardised, water-ethanol extract made from California red grapeseeds, which contained Grapeseed extract 646

Body Fat Distribution

In a recent study in Singapore we found that the relative risk for having at least one cardiovascular risk factor (e.g., elevated cholesterol, hypertension, diabetes mellitus) is elevated at levels of WC or WHR far below the WHO cutoff points (50). Using WHO cutoff points for classification of abdominal obesity (30) would miss a large part of the population at risk. This elevated risk could be due to a higher amount of visceral fat at low WC or to other factors, e.g., genetic factors. Further studies in Singapore are needed to determine the relationship between anthro-pometric measurements (WC and WHR) and the amount of visceral fat by CT or MRI.

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