Coronary Artery Disease Ebooks Catalog

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

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Natural Secrets For Healing Your Heart

This eBook is devoted to exposing the secrets that cardiologists and surgeons don't want you to know, and how to take control of your own heart and heal yourself. Eight out of every ten coronary bypasses will not actually help the patient. So why risk being in the 80% that will get no benefit from a bypass? Learn to heal your own heart and keep yourself healthy with this eBook guide. Bob Livingston has poured years of research into his findings, and is now sharing the methods that he has developed from careful, methodical research that the medical industry would never allow. It would make them go bankrupt! You will learn what supernutrient doctors don't want you to know about, and how to make an all-natural, chemical and drug-free blood thinner And even more information that doctors don't want revealed to the public. You don't have to be one of the 70% of Americans diagnosed with heart disease. You can heal your heart!

Natural Secrets For Healing Your Heart Overview


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Author: Bob Livingston
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Acute Coronary Syndromes Acute Myocardial Infarction and Unstable Angina

Acute myocardial infarction (AMI) and unstable angina are part of a spectrum known as the acute coronary syndromes (ACS), which have in common a ruptured atheromatous plaque. These syndromes include unstable angina, non-Q-wave MI, and Q-wave MI. The ECG presentation of ACS includes ST-segmentelevation infarction, ST-segment depression (including non-Q-waveMI and unstable angina), and nondiagnostic ST-segment and T-wave abnormalities. Patients with ST-segment elevation will usually developQ-wave MI. Patients with ischemic chest discomfort who do not have ST-segment elevation will develop Q-wave MI and non-Q-wave MI or unstable angina.

Cardiovascular Disease

Cardiovascular disease is the most common cause of death in the United States. Sudden cardiac death causes between 300,000 and 400,000 deaths a year. It is the leading cause of death in men between 20 and 65 years of age. Zipes and Wellens estimate that up to 80 of individuals dying suddenly of cardiac disease die of coronary artery disease.1 Of 853 individuals, 18 years of age or older, coming to autopsy in San Antonio, Texas, 591 (69.3 ) died of cardiovascular disease 76.3 (451) of the 591 of coronary artery disease. Cardiomyopathy accounted for a significant but smaller number (13 ), with occasional deaths from valvular heart disease, myocarditis, and other less common forms of cardiovascular disease.

Congenital Heart Disease Introduction

Congenital heart disease results from malformations of the heart that involve the septums, valves, and large arteries. They are classified as acyanotic or cyanotic defects. Acyanotic defects occur when a left-to-right shunt is present that allows a mixture of oxygenated and unoxygenated blood to enter the systemic circulation. The most common consequences of these defects in children are growth retardation and congestive heart failure (CHF).

Thrombolytic Therapy in Acute Myocardial Infarction

The beneficial effect of thrombolytic therapy in the treatment of acute myocardial infarction (AMI) is now well established 13-15 . Use of thrombolytic agents has become a standard emergency treatment in such situations to the extent that globally, such drugs are administered to over 500,000 patients each year. It has been estimated that three times that number could potentially benefit from such therapy 5,16 . Although effective, these products achieve complete reperfusion in, on an average, only 50 of patients, and side effects can include risk of hemorrhage (in particular intracranial bleeding) as well as hypertension.

Role of the reninangiotensin system in cardiovascular disease in diabetes

As reviewed elsewhere in this book, multiple factors, including hyperglycemia, insulin resistance, dyslipidemia, hypercoagulability, and inflammation contribute to the pathogenesis of atherosclerosis in DM. Although there is considerable evidence for a role of the RAS in vascular remodeling, inflammation, thrombosis, and atherogeneis (81-83), the role of this system in atherosclerosis in the context of the other diabetes-associated cardiovascular risk factors is not fully understood. There is a growing body of evidence from both clinical studies and experiments in diabetic rodent models suggesting that the RAS contributes to CVD in both type 1 and type 2 diabetes.

Focal Ischemic Stroke Models

Various stroke models have been developed in the past 20 years.8 However, those in use today include the unilateral middle cerebral artery occlusion (MCAO) model used in rats and mice. Since these models were first developed in the 1980s, the MCAO has been variably induced by surgical ligation or cauterization via a small craniotomy over the middle cerebral artery, passage of a intraluminal nylon suture up into the ipsilateral cerebral circulation via the external carotid in the neck, or injection of a small autologous thrombus into the common carotid artery. The latter two methods are the most commonly employed today, and the thromboembolic paradigm is the most clinically relevant, since the majority of human focal ischemic strokes involve a thromboembolic occlusion of the middle cerebral artery. The MCAO models come in two varieties temporary and permanent. The temporary MCAO involves removal of the vascular occlusion at varying times (30, 60, 90, 120, 180 min) after the onset in...

Coronary Artery Disease

Coronary artery disease, also called simply heart disease, is a condition in which the coronary arteries (the blood vessels that supply blood to the heart muscle) become blocked, cutting off blood flow and, therefore, oxygen to the heart muscle. This damages the heart, causing it to malfunction. Coronary artery disease is the leading cause of death in the United States for both men and women. Nearly 20 percent of men aged 65 to 69 have had a heart attack, and nearly 30 percent of men aged 80 to 84 have had a heart attack. Nearly half of all men who die of coronary artery disease are not aware that they have the disease. The following risk factors increase your risk of developing heart disease Family history. Your chances of having coronary artery disease are much greater if either of your parents had heart disease before age 65. Smoking. Smokers have a 70 percent greater chance of developing coronary artery disease than nonsmokers. Diabetes. More than 80 percent of people with...

Pathophysiology of Acute Myocardial Infarction

Acute coronary occlusion results in immediate systolic bulging (dyskinesia) of the ischemic muscle segment.15,17,10 Passive bulging occurs because the noncontracting ischemic region is stretched during systole by remote contracting muscle. In order to maintain a sufficient cardiac output to sustain life, remote myocardium not subject to infarction must hypercontract to compensate for dissipation of energy during passive stretching of the ischemic segment.15 Loss of more than 40 of contracting left ventricular muscle results in cardiogenic shock84,8 which can occur, e.g., with very proximal coronary occlusions. Survival after an acute coronary occlusion that renders less than 40 of the left ventricle nonfunctional depends upon the compensatory capacity of the remote nonischemic myocardium.15,17,27,77 Left ventricular power failure will develop even if the acute coronary occlusion leads to an ischemic region of the left ventricle less than 40 , if the mass of unaffected myocardium has...

Cardiovascular Diseases

No difference in absolute plasma concentration of ubiquinol-10 (expressed as mass volume) between patients with coronary artery disease (CAD) and healthy controls has been observed in any of the studies,24-27 including those performed in our laboratory,26,27 nor has any decrease in plasma ubiquinol-10 in CAD been found when its level is normalized to lipids or expressed as a percentage of total coenzyme Q10.24,26,27 Similarly, no difference in levels of ubiquinol-10 in LDL of patients vs. controls has been observed.24 The only study where a significant decrease in plasma ubiquinol-10 in CAD has been reported is that of Lagendijk et al.25 However, this difference is seen only when ubiquinol-10 is expressed as its ratio to ubiquinone-10, is moderate, and comprises about 0.5 when recalculated to a percentage of total coenzyme Q10. A comparable, but insignificant trend toward lower values of ubiquinol-10 in CAD has been observed in other studies24,26,27 where fewer subjects (than in 25 ),...

Heart Disease Imaging Methods

Since disease onset is unpredictable, early diagnosis is important. Several noninvasive testing procedures are frequently used in heart disease diagnosis, including resting electrocardiogram (ECG), echocardiogram, exercise stress test (with or without radiolabel tracer), IVUS, computed tomography (CT), and magnetic resonance imaging (MRI).2 All have their advantages and limitations. Unfortunately, no one test provides a complete, reliable assessment as to whether the observed atherosclerotic plaques are vulnerable to rupture. A more invasive procedure, coronary angiography, delivers imaging dyes through small tubes inserted in the artery. This technique has been especially helpful over the last two decades in identifying vessels with severe blockage. This procedure is often followed by either balloon angioplasty to widen the artery or by the placement of a small, expandable, hollow, wire mesh tube (stent) to widen the artery and restore blood flow. In the last few years, drug-eluting...

HRT and Risk of Cardiovascular Disease in Women With Diabetes

And ischemic heart disease (IHD), MI, and total number of deaths among a cohort of almost 20,000 Danish nurses aged 41 years and older (173). The data showed that current users of HRT smoked more, consumed more alcohol, had lower self-rated health, but were slimmer and had a lower prevalence of diabetes than never users. In current users without diabetes, HRT had no protective effect on IHD or MI compared with never users. However current users with diabetes had an increased risk of death, IHD and MI compared with never users with diabetes. These findings suggest that HRT does not protect women against IHD. Rather the effect of treatment is modified by diabetes, with an increased risk among women with diabetes using HRT.

Heart Disease Mortality

Cardiovascular disease (CVD) is the leading cause of death worldwide. According to statistics compiled by the World Health Organization (WHO), more than 13 million people die each year from coronary heart disease (CHD) and stroke.3 WHO statistics also show that more people have died worldwide since 1990 from CHD than from any other disease. Approximately 40 of the annual deaths in the US are attributed to CHD for both men and women. Thus, US death rates from CHD greatly exceed those from all types of cancers. The incidence of this disease in the US is expected to grow as a larger percentage of the population develops obesity and diabetes. As a result of lifestyle changes, primarily in reduced smoking, improved diet and exercise, more aggressive preventive medicine, as well as modern improvements in detection, diagnosis, and treatment, the mortality rates from CHD in both men and women are significantly decreasing in western Europe and the US. Nevertheless, despite these improvements,...

Polycystic Ovary Syndrome and Cardiovascular Risk

PCOS is associated with an increase in cardiovascular risk factors (189). In addition to obesity that is commonly present and independently associated with increased cardiovascular risk, women with PCOS have dyslipedemia, hypertension and elevated PAI-1 levels. Obesity is a prominent feature in women with PCOS as about half of the patients are obese. Also, obesity appears to confer an additive and synergistic effect on the mani Women with PCOS have higher serum triglycerides, total and LDL cholesterol and lower HDL cholesterol levels than weight-matched regularly menstruating women (190). These findings however, vary and depend on the weight, diet and ethnic background. In a large study of non-Hispanic white women, elevated LDL-C was the predominant lipid abnormality in women with PCOS (191). An additional parameter contributing to the elevated cardiovascular risk is hypertension. Obese women with PCOS have an increased incidence of hypertension and sustained hypertension is threefold...

Low Density Lipoprotein Cholesterol and Coronary Heart Disease Risk

Similarly, the Multiple Risk Factor Intervention Trial (MRFIT) monitored 300000 middle-aged males. Using a comparative baseline plasma cholesterol of 200 mgdL_ 1, subjects in this study having total cholesterol of 250 mgdL_ 1 had a twofold increased risk of death from CHD, while those with values of 300 mgdL_ 1 had a threefold higher risk. The Atherosclerosis Risk in Communities (ARIC) Study followed over 12 000 males and females who were free of CHD and monitored their incidence of coronary events over a 10-year period. The lowest incidence of events occurred in those subjects with the lowest LDLc levels (< 100mgdL_ 1) in both males and females. An associated 40 increased CHD risk occurred in both males and females for every 40mgdL_ 1 increase in LDLc. Based upon these and other studies, it appeared that cardiovascular risk increased significantly above a certain threshold value of total plasma cholesterol and LDLc.4

High Density Lipoprotein Cholesterol and Coronary Heart Disease Risk

In contrast to the elevated CHD risk associated with higher LDLc levels, several epidemiological studies have demonstrated an inverse relationship between serum HDLc levels and the incidence of ischemic heart disease in both middle-aged males and the elderly.16 In the Framingham cohort,24 a higher prevalence (19 ) of heart disease occurred in subjects due solely to low (< 35 mgdL_ 1) HDLc compared to the prevalence of disease (12 ) in those who only had elevated (> 130mgdL_ 1) LDLc. Thus, low levels of HDLc represent a significant independent risk factor in CHD irrespective of whether patients have elevated LDLc.26 A risk prediction model developed from the Framingham cohort showed that a nearly 50 higher cardiovascular risk was associated with male patients having HDLc levels below 35 mgdL_ 1 compared with those in the normal range (35-59 mgdL_ 1). An even higher (twofold) associated risk was observed in females with HDLc below 35 mgdL_ 1. In contrast, a significantly reduced...

Antioxidants as Monotherapy in Coronary Heart Disease

The clinical success of antioxidant-based therapies has been extremely limited.22 Several studies have explored the potential contribution that supplementation with antioxidant-based natural vitamins, such as vitamin C or vitamin E, might play in reducing cardiovascular risk, with inconsistent results. In primary prevention studies, the Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) trial followed subjects on supplemental vitamin E or vitamin C for 3 years. Supplementation with vitamin C or vitamin E did not reduce the progression of atherosclerosis compared to placebo. Instead, vitamin E appeared to produce a small disease-promoting effect. A recent examination of the combined data from secondary prevention trials treating over 81 000 patients with vitamin E concluded that vitamin E therapy produced no significant reduction in coronary events. Similar results were observed using vitamin E in combination with other antioxidants where the combination of antioxidant...

Economic Impact of Cardiovascular Diseases

The direct and indirect economic burden of CVDs in the USA has been estimated to be nearly 400 billion annually.1 Direct costs associated with CVD account for nearly 250 billion while the indirect costs (lost productivity in the case of morbidity and lost future earnings in the case of mortality) account for slightly more than 150 billion. Heart diseases (e.g., coronary heart disease (CHD), congestive heart failure (CHF), hypertension (see 6.32 Hypertension), cardiac arrhythmias, etc.) collectively account for nearly 65 of the total costs associated with CVD. Within the group of CVD, CHD represents the largest contributing disorder (56 of the group of heart diseases and 36 of the total economic burden) to both direct and indirect costs. Stroke accounts for nearly 14 of the total economic burden with the indirect costs associated with stroke (brain attack) being particularly burdensome.

Economic Opportunity of Cardiovascular Disease

The pharmaceutical industry devotes only slightly more than 80 million annually to develop new cardiovascular agents as opposed to nearly 200 million to market these agents.4 However, the cost of developing a new chemical entity (NCE) in the cardiovascular area is unlikely to be recovered unless the NCE is a 'blockbuster.' This results in a close monitoring of the science that surrounds cardiovascular disease to be able to respond quickly and effectively to new concepts in disease management. Cardiovascular products represent nearly 17 of total spending on phase IV budgets with nearly 34 of the total product budget used to launch a new cardiovascular compound compared to 26 for an oncology product.5

Impact and Distribution of Cardiovascular Diseases

CVDs include a number of diseases which can be and are interrelated in very complex ways and include CHD acute coronary syndrome (myocardial infarction (MI), angina pectoris, or unstable angina) stroke hypertension congestive heart failure (CHF) arrhythmias, peripheral artery disease, rheumatic heart disease, valvular heart disease, and venous thromboembolism.6 CVD is responsible for nearly one-third (approximately 16.7 million individuals) of the global mortality burden7 and, for 2005, was estimated to have a direct and indirect economic burden of nearly 400 billion in the USA alone (see above).1 In particular, CVD appears to be non-selective in the populations that are targeted with men, women, and children of all ethnic groups being nearly equally at risk for developing CVD but individuals older than 70 are the predominant age group who die from the effects of CVD.7 Socioeconomic status does not preclude any group from CVD as it appears to target both developing (low and middle...

Prevalence of Cardiovascular Diseases

Globally, CVD represents the second greatest disease burden in men and third largest disease burden in women. The percentage of disability-adjusted life years (DALY) lost was nearly 7 for men compared to human immunodeficiency virus acquired immune deficiency syndrome (HIV AIDS) which represented nearly 7.5 of the DALY lost worldwide. For women, the primary contributors to DALY lost were unipolar depressive disorders and HIV AIDS which represented 8.4 and 7.2 , respectively while CHD represented only 5.3 .8,9 Cardiovascular disease accounts for nearly 10 of the DALY lost in developing countries and nearly 18 in industrialized countries. The DALY is an indicator of the total burden of the disease and reflects the healthy years of life lost to a specific disease. Table 1 Prevalence of cardiovascular disorders in the USA Cardiovascular disease Population (millions) Table 1 Prevalence of cardiovascular disorders in the USA Cardiovascular disease Population (millions) Coronary heart...

Coronary Heart Disease

Coronary heart disease (CHD) is a set of syndromes that includes angina pectoris (comprising stable, unstable, and variant, or Prinzmetal's, angina), ischemic heart disease, and myocardial infarction (MI).10 CHD is the most common cause of death worldwide accounting for over 7 million deaths per year (approximately 45 of the total number of deaths due to cardiovascular disease). Worldwide, CHD generally affects males to a greater extent than females.9 However, in the USA, while MI has a greater prevalence among males, females have a greater propensity toward the development of angina.1 In the USA, CHD and 'acute coronary syndrome' that includes acute MI and unstable angina will present in about 700 000 new patients annually while another 500 000 patients will experience a recurrent episode. In addition, an additional 175 000 individuals in the USA will experience a first silent heart attack in the next year while 3-4 million Americans will have an ischemic attack without recognizing...

Other Types of Heart Disease

Less common forms of heart disease which cause sudden death include congenital and valvular heart disease, cardiomyopathy, and myocarditis. There are numerous congenital abnormalities of the heart which may cause sudden death. Single coronary arteries and abnormal anatomic distributions of the coronaries are relatively common. Many severe congenital problems may be discovered at birth or shortly thereafter. Abnormalities of the heart valves, such as narrowings or ballooning (prolapse of the mitral valve) can cause sudden death. Cardiomyopathies or heart muscle disease, such as asymmetrical hypertrophy of the heart and dilated idiopathic cardiomyopathy, may cause sudden death at a young age, often during exercise. Sudden unexpected death from myocarditis (infection of the heart wall) may follow a flu-like illness.

Atherosclerotic Cardiovascular Disease

Besides being the leading cause of death nationwide, atherosclerotic heart disease is also the leading cause of sudden unexpected natural death. Atherosclerosis (hardening of the arteries) refers to the fat and other deposits which build up on the inside lining of blood vessels. This can lead to a plugging of the vessel, preventing blood and oxygen from getting to the tissues. Atherosclerosis primarily affects the larger elastic arteries, such as the aorta, carotids, and iliacs, as well as smaller muscular arteries, such as the coronary arteries in the heart. Atherosclerotic coronary artery disease is the most common cause of death due to heart disease. Proper oxygenation of the heart wall (myocardium) is prevented because of the plugging of the vessel. When severe, this buildup leads to chest pain, heart attacks, and arrhythmias (abnormal heart beats). Arrhythmias are the main complication of atherosclerotic coronary artery disease, causing sudden death. They cannot be detected by...

Examination of the Myocardium in Ischemic Heart Disease

In the presence or absence of acute or healed myocardial infarction, the myocardium is best examined by slicing the ventricles in a manner similar to a loaf of bread. To evaluate the specimen, a series of short-axis cuts are made through the ventricles from apex to base (Figure This method is best accomplished using a long, sharp knife on the intact fixed specimen following examination of the coronary arteries. With the anterior aspect of the heart downward (against the cutting board), the cuts are made parallel to the posterior atrioventricular sulcus at 1- to 1.5-cm intervals from the apex of the heart to a point approximately 2 cm caudal to the sulcus or up to the mid-portion of the papillary muscles of the left ventricle. Figure The location and extent of myocardial infarction must be indicated by the size, that is, how much of the base to apex is infarcted basal one third, and or middle one third, and or apical one third or more than one third from base to...

Markers of Inflammation and Oxidant Stress in Coronary Heart Disease

Currently, there are no validated biomarkers of either inflammation or oxidant stress that can be used predictably for drug intervention in CHD patients. C-reactive protein (CRP), whose biological function is undetermined, has been proposed as a potential marker of inflammation, particularly in patients with acute coronary syndromes (ACS).6 Whether CRP is produced in response to inflammation or contributes directly to an inflammatory response is still unknown. However, elevated plasma CRP levels may represent an independent risk factor for CHD in the general population, even in subjects with near-normal cholesterol levels.1'6 Subjects with the lowest quintile of plasma cholesterol had a twofold higher risk of CHD when their plasma CRP levels fell in the highest CRP quintile. Similarly, subjects having plasma cholesterol levels in the highest quintile doubled their CHD risk as their CRP levels increased from the lowest to the highest quintile. Subjects with near-normal cholesterol...

The Benefits of Exercise

Along with a healthy diet, exercise is the cornerstone of good health. Physical activity produces a multitude of benefits for your overall health and well-being. Being active helps prevent heart disease and stroke by lowering cholesterol levels and making the heart pump more efficiently. It reduces the risk of dying prematurely, especially of heart disease. Physical activity helps control your weight and prevent obesity, which is a risk factor for high blood pressure and diabetes. Regular exercise also can improve your mood, reduce stress, and relieve depression, not to mention build muscular strength and tone, increase your flexibility, You don't have to aspire to be a long-distance runner or pump heavy iron to attain health benefits from exercise. Any type of physical activity washing the car, mowing the lawn, taking the stairs, even walking is good for you and will cut your risk of heart disease. Of course, the more exercise you engage in, the more benefits you gain. So once you...

The Dangers of Alcohol and Other Drugs

According to scientific research, the incidence of heart disease in men who consume a moderate amount of alcohol (two drinks a day or less) is lower than in men who do not drink. But there is not much difference between moderate drinking and heavy drinking. A typical drink is 5 ounces of wine, 1V 2 ounces of 80-proof distilled spirits, 12 ounces of wine cooler, or 12 ounces of beer (see page 24). Although moderate drinking may reduce your risk of heart disease, doctors do not recommend drinking alcohol because it carries many health risks, including cancer of the liver, mouth, throat, and esophagus. Excessive alcohol consumption also increases your chances of having an accident, makes you more prone to violence, and makes you more apt to engage in risky behaviors such as illicit drug use or unsafe sex (see page 111). Nutritional deficiencies and even malnutrition also can result from overconsumption of alcohol. Cocaine is a dangerous stimulant that boosts the heart rate while...

The Hazards of Tobacco

If you smoke, you will notice the gradual onset of a host of long-term problems. Your senses of smell and taste will weaken, you will get more frequent colds than before, facial wrinkling will intensify, and you will develop a nagging smoker's cough, which is actually a symptom of a serious disease called chronic bronchitis (see page 246). You also increase your chances of developing cancers of the lung and other organs, emphysema, high blood pressure, stroke, and heart disease. You also place your family at risk of the same health problems by exposing them to secondhand smoke (see page 31). Smoking also is a major contributor to the development of heart disease (see page 204), by reducing blood levels of high-density lipoprotein (HDL), the good cholesterol that protects against heart disease. Additionally, smoking adversely affects the arteries that supply the heart with blood and nutrients. Men who smoke have twice the risk of having a heart attack as do nonsmoking men. Nonsmokers...

Healthy Diet Guidelines

For example, if you have a high cholesterol level and a family history of heart disease, your doctor probably will recommend that you lower your intake of high-fat foods. On the other hand, if you have a family history of diabetes and are overweight, your doctor probably will advise that you go on a weight-loss diet. A family history of colon cancer might prompt your doctor to advise you to reduce your consumption of red meat. raises your risk for heart disease and stroke. Whole-grain foods that are high in fiber can help improve cholesterol levels and maintain a healthy digestive system. Grains, vegetables, and fruits contain an abundance of nutrients, such as essential vitamins and minerals, many of which have disease-preventing properties. It is important to eat a wide variety of foods to make sure that you are consuming as many of these nutrients as possible. Q. Are vegetarian diets healthy A. Yes, a vegetarian diet can provide all the nutrients you need. In fact, some research...

The Health Risks of Being Overweight or Underweight

More than half of all American men are overweight, and a third of all American men are obese (weigh more than 20 percent more than their ideal body weight). Being overweight is a major risk factor for a number of chronic diseases, including heart disease, high blood pressure, stroke, diabetes, and certain forms of cancer. Even a small reduction as little as 10 percent in body weight can decrease your chances of developing the most common chronic disorders as you get older. If you already have a health problem, losing weight can help you manage your condition. In some disorders, such as diabetes, weight loss can help reduce and even eliminate the need for medication. Heart disease is the number one cause of death in American men. High blood pressure is a major risk factor for stroke, which can lead to permanent disability and death. You can reduce your risk of developing heart disease, high blood Healthy where your body stores fat. If you are like most men, your body stores fat around...

Preventive Healthcare

The most common tests performed in men over 40 include the PSA (prostate-specific antigen) test for prostate cancer, the fecal occult blood test for colon cancer, and a series of tests that screen for the presence of heart disease or your risk of having it. Such tests may include measuring your blood pressure and the levels of cholesterol in your blood an electrocardiogram, which measures the electrical activity in your heart and a stress test, which evaluates the heart's response to physical exercise. If you have a family history of a certain disease that has a strong hereditary component, such as diabetes (see page 365), you also may undergo a screening for that disorder. For example, in the case of diabetes, the doctor would perform a test known as a glucose tolerance test (see page 367). Staying checkups because common disorders such as heart disease and cancer occur

Periodic Health Checkups for

Those at risk Men with a family history of high blood pressure, heart disease, kidney disease, or stroke men who are overweight or have diabetes men who smoke or use tobacco products. To measure the blood levels of cholesterol, which helps evaluate the risk of heart disease. Those at risk Men with a family history of heart disease men who have diabetes men who smoke or use tobacco products.

Common Screening Tests

Blood increase your risk for heart disease. When the excess fats build up inside Preventive the walls of your arteries, they narrow the arteries, obstructing blood flow to your heart. When the heart receives less blood, it gets less oxygen, which is transported by red blood cells. Your heart sends out warning signals in the form of pain and discomfort known as angina. When the blockage in the arteries supplying blood to your heart causes severe obstruction, resulting in a heart attack (see page 207), the heart muscle can become permanently damaged. A desirable total blood cholesterol level falls under 200 milligrams per deciliter of blood. Doctors consider cholesterol levels above 200 to be high. One in five Americans has a total cholesterol level of 240 or greater, placing that person at risk of a heart attack. Your LDL cholesterol levels should be under 100, and HDL levels should be 40 or higher. The higher your HDL level, the lower your risk for heart disease. All men over 20 years...

Physical and Emotional Health How They Interact

There has been a recent surge of interest in the mind body connection by physicians to see if positive health effects can be obtained from relaxation techniques such as meditation. The increasing complexity and pace of life and the awareness that long-term stress has a negative physiological effect on the body have triggered the exploration of relaxation techniques. By combining knowledge of meditative techniques from Eastern cultures with Western scientific techniques, doctors have developed a form of meditation that may have positive effects on blood pressure and heart disease. Meditation appears to lower metabolism decreasing breathing rate, heart rate, and blood pressure. sibility of using mental techniques to strengthen the immune system. The immune system fights germs such as viruses and eliminates cells that are damaged, are turning cancerous, or have become cancerous. Researchers are trying to determine whether stress that accompanies major, life-changing events such as...

Sexually Transmitted Diseases

The rapid spread of STDs is sometimes referred to as a silent epidemic because many of the diseases often have no noticeable symptoms in the early stages. But some of the potential consequences of STDs are serious infertility, heart disease, liver and brain damage, blindness, cancer, and even death. Babies whose mothers are infected with STDs may have birth defects or developmental problems.

Disorders of the Esophagus

Heartburn is another symptom of esophageal disorders. This burning pain rises in the chest and can be felt in the neck, throat, or face. Heartburn usually occurs after meals, after taking certain medications, or while lying down. Some people also may feel a burning pain or tightness when swallowing solids or liquids. Heartburn can indicate a problem with a medication or with the lower esophageal sphincter, the muscular valve that prevents stomach acid from rising up into the esophagus. (Heartburn also may be a symptom of coronary artery disease see page 204.)

Disorders of the Stomach and the Duodenum

If you frequently experience indigestion, see your doctor so that he or she can examine you, determine the cause of your symptoms, and provide treatment. Contact your doctor promptly if your indigestion is accompanied by vomiting, weight loss, lack of appetite, blood in vomit or stool, pain when you eat, or severe pain in the upper abdomen. Symptoms of indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or left arm can be warning signs of heart disease or a heart attack (see page 207).

The Common Cold and the

The flu is a viral infection of the nose, throat, and lungs. It is usually mild in young and middle-aged adults but can be life-threatening in older people and people who have a chronic illness such as heart disease, emphysema, asthma, bronchitis, kidney disease, or diabetes. The flu also can lead to more serious, potentially life-threatening infections such as pneumonia (see page 250). Because pneumonia is one of the five leading causes of death among older people, it is important for older people to take steps to prevent the flu. The best preventive measure is a flu shot (see page 93), given each fall at the beginning of the flu season. A pneumonia shot (see page 252) is another preventive measure available for older people and people who have a chronic illness the pneumonia shot is given only once.

Keeping Your Teeth and Gums Healthy

Having a clean mouth is good for you in many ways. Not only does it give you fresh breath and a nice smile, but it also gives your self-esteem a lift. Thorough daily cleaning of your teeth and gums helps prevent tooth decay and periodontal disease (gum disease). Keeping your teeth and gums healthy also can improve your overall health. Periodontal disease may be a factor in the development of chronic conditions such as heart disease.

Maintaining a Healthy Weight

Being overweight is a major health problem in the United States, and there are many good reasons to keep your weight within a healthy range. You will feel better, look better, and have more energy than men who are overweight. Having more energy makes you more likely to exercise, which can help you fall asleep faster and sleep more restfully. But the most important reason to keep your weight within a healthy range is that you will lower your risk for certain chronic diseases, including heart disease, high blood pressure, diabetes, and certain forms of cancer. Doctors no longer believe that it is acceptable to gain a few pounds as you age. Maintaining your weight at a reasonable level throughout your life is key when it comes to reducing your risk for disease. Many overweight men have difficulty reaching their healthy body weight, and the more you weigh above your ideal weight, the harder it can be to lose the extra pounds. It is encouraging to learn, then, that losing even a relatively...

Healthy Diet

Good nutrition can help you achieve good health without having to sacrifice great-tasting food. Eating healthfully can help you work more productively, perform better athletically, maintain or reduce your weight, and dramatically lower your risk for heart disease and certain forms of cancer. A healthy diet is one that is well balanced, low in fat, high in fiber, and rich in whole grains, vegetables, and fruits. To consume a healthy diet, you need to choose foods that provide all the nutrients your body needs without an excess of fat, sugar, or calories. The second level (from the bottom) of the pyramid contains the vegetable and fruit groups. The Food Guide Pyramid recommends that you eat three to five servings of vegetables and two to four servings of fruits each day more vegetables than fruits because vegetables contain a wider variety of vitamins and minerals than do fruits. A serving is a cup of raw, leafy vegetables half a cup of other vegetables, either cooked or chopped raw one...

Healthy Weight

Carrying excess weight is a known health risk. Excess weight increases the heart's workload and can raise your chances of getting a number of serious medical conditions such as heart disease, high blood pressure, adult-onset diabetes, and certain forms of cancer. It also can adversely affect your self-image and make it difficult to exercise. But how can you find out what is your ideal weight percent over the upper ideal weight range for your height) contributes to the development of diabetes, heart disease, and gallbladder disease. Obesity also complicates the treatment of and lowers the chances of survival of people with stroke, kidney disease, and numerous other disorders. Although the idea that obesity results from a lack of willpower is outdated, doctors are still unsure exactly why some people are overweight while others are not. Losing weight and keeping it off for life can be extremely difficult, but you can control your weight if your motivation stays high. Where on your body...

Exercise and Fitness

The benefits of exercise are numerous and affect virtually every part of your body. One important benefit is that exercise can reduce your risk of developing certain common chronic diseases. For example, regular physical activity has been proven to reduce the risk of premature death from heart disease by preventing its development. Regular daily exercise can make your heart stronger, improve blood flow through the arteries that lead to your heart, and lower the level of cholesterol (see page 89) in your blood. Exercise even moderate exercise such as walking briskly can reduce your risk of major disorders such as heart disease, diabetes, and high blood pressure and can help you maintain a healthy weight. Make exercise a regular part of your life. Exercise even moderate exercise such as walking briskly can reduce your risk of major disorders such as heart disease, diabetes, and high blood pressure and can help you maintain a healthy weight. Make exercise a regular part of your life.


Influenza, commonly called the flu, is an infection caused by a virus that affects the respiratory system. Symptoms include fever, chills, headache, muscle aches, and a sore throat. Influenza is spread from person to person through direct contact, such as shaking hands, or by inhaling droplets containing the virus in the air after an infected person coughs or sneezes. New strains of influenza virus appear every year, so you must get a shot of the influenza vaccine yearly, in the fall, just before the flu season starts. Doctors recommend the influenza vaccine for all men over age 65 and for younger men who have medical problems such as heart disease, lung disease, or diabetes or who have close contact with high-risk people.

Blood Disorders

This extra water dilutes the blood and reduces the concentration of red blood cells in the blood. The body then increases red blood cell production in an attempt to correct the anemia. Before that occurs, however, the anemia may be so severe that blood pressure falls and the body's oxygen supply decreases to dangerous levels. Injuries, surgery, or a ruptured blood vessel are examples of possible causes of sudden blood loss that can lead quickly to a heart attack, stroke, or even death.

Pulmonary Embolism

The onset of symptoms of pulmonary embolism is sudden. As the level of oxygen in the blood decreases, the brain increases the respiratory rate, leading to hyperventilation (abnormally deep or rapid breathing). Even if the clot breaks up, a pulmonary embolism can lead to pulmonary hypertension, a condition in which high blood pressure in the pulmonary artery puts strain on the right side of the heart, which may cause it to fail. Over time, the left side of the heart also begins to fail. Heart disease that results from any pulmonary disease is called cor pul-monale. If you already have heart or lung disease, a pulmonary embolism that a healthy person could easily tolerate may be life-threatening or fatal. Diagnosing pulmonary embolism requires one of two imaging procedures a pulmonary arteriogram or a high-resolution CT scan. In both procedures, contrast medium (dye) is injected into the veins, and X rays are taken to locate the blockage. However, because symptoms of pulmonary embolism...


A stroke (also called a cerebrovascular accident) occurs when brain tissue is deprived of its blood supply. A stroke is the equivalent of a heart attack, but in the brain. Strokes can result from a blockage of blood flow to the brain (called an ischemic stroke) or from a ruptured blood vessel that bleeds into the brain (called a hemorrhagic stroke). Damage to the brain from a stroke begins within seconds of the interruption in blood flow. About 80 percent of all strokes are ischemic strokes that result from a blockage in a blood vessel in the neck or the brain. Ischemic strokes can cause severe disability. There are three ways that blood flow can be blocked in an artery leading to the brain when a clot forms inside the blood vessel (called cerebral thrombosis), when a clot travels from another part of the body and becomes lodged in a blood vessel (called cerebral embolism), or when an artery becomes severely narrowed (called stenosis). Hemorrhagic strokes can result from rupture of an...

Periodontal Disease

Periodontal disease, also known as gum disease, is the number one cause of tooth loss in American adults. It may also be a risk factor for heart disease or other medical conditions. An estimated 75 percent of adults over age 35 in the United States have some form of periodontal disease, but the disorder is easily reversed in its early stages by consistent, daily toothbrushing and flossing. Because periodontal disease is painless, you may not know that you have it. If you notice any of the following signs of periodontal disease, see your dentist right away Not only is periodontal disease damaging to your teeth and gums, it also may adversely affect your overall health. Periodontal disease may contribute to the development of heart disease, the number one cause of death in the United States. Doctors are still not sure why there appears to be a connection between periodontal disease and heart disease, but research has shown that the bacteria responsible for periodontal disease can enter...

High Blood Pressure

High blood pressure, or hypertension, increases your chances of developing heart disease or kidney disease and of having a stroke. About one in every four American adults has high blood pressure but may not be aware of it. It is often called the silent killer because it usually causes no symptoms. However, high blood pressure is easy to diagnose, and there are practical steps you can take to bring your blood pressure under control. Because diastolic pressure represents the lower and more constant level of pressure in the arteries, physicians may emphasize it more, especially in younger people. However, the systolic blood pressure is more important for determining the risk of heart attack or stroke. Atherosclerosis. Uncontrolled high blood pressure causes the artery walls to thicken and lose elasticity. This encourages formation of fatty deposits on the artery wall, which narrow the channel and interfere with blood flow throughout the body. In time, atherosclerosis can lead to a heart...

Current Clinical Neurology

Attarian, 2006 Psychiatry for Neurologists, edited by Dilip V. Jeste and Joseph H. Friedman, 2006 Status Epilepticus A Clinical Perspective, edited by Frank W. Drislane, 2005 Thrombolytic Therapy for Acute Stroke, Second Edition, edited by Patrick D. Lyden, 2005 Parkinson's Disease and Nonmotor Dysfunction, edited by Ronald F. Pfeiffer

Preface to the First Edition

The cause of diabetes mellitus is metabolic in origin. However, its major clinical manifestations, which result in most of the morbidity and mortality, are a result of its vascular pathology. In fact, the American Heart Association has recently stated that, from the point of view of cardiovascular medicine, it may be appropriate to say, diabetes is a cardiovascular disease (1). But diabetic vascular disease is not limited to just the macrovasculature. Diabetes mellitus also affects the microcirculation with devastating results, including nephropathy, neuropathy, and retinopathy. Diabetic nephropathy is the leading cause of end-stage renal disease in the United States, while diabetic retinopathy is the leading cause of new-onset blindness in working-age Americans. The importance of this text on Diabetes and Cardiovascular Disease is evident by the magnitude of the population affected by diabetes mellitus. Over 10 million Americans have been diagnosed with diabetes mellitus, while...

Stroke and nervous system trauma

Cascade of biochemical events, glutamate-mediated excitotoxicity, intracellular calcium overload, and reactive oxygen species (ROS)-induced oxidative damage, which take place within the first minutes, hours, and days after the traumatic event. In stroke, when a arterial occlusion is only temporary, e.g., less than 24 h, a transient ischemic attack, recovery can be rapid.

Critical Care History and Physical Examination

History of present illness This section should included pertinent chronological events leading up to the hospitalization. It should include events during hospitalization and eventual admission to the ICU. Prior cardiac history Angina (stable, unstable, changes in frequency), exacerbating factors (exertional, rest angina). History of myocardial infarction, heart failure, coronary artery bypass graft surgery, angioplasty. Previous exercise treadmill testing, ECHO, ejection fraction. Request old ECG, ECHO, impedance cardiography, stress test results, and angiographic studies. Chest pain characteristics Cardiac risk factors Age, male, diabetes, hypercholesteremia, low HDL, hypertension, smoking, previous coronary artery disease, family history of arteriosclerosis (eg, myocardial infarction in males less than 50 years old, stroke).

Drosophila melanogaster

The zebrafish system has been particularly useful in the area of heart disease. Mutations in TBX5 result in congenital defects in cardiac development in both humans and fish,129,130 and mutations in the muscle filament titin, which cause familial cardiomyopathies in humans,131 exhibit a similar phenotype in zebrafish.132 Mutations in the ether-a-go-go related gene hERG cause arrhythmias in both humans and zebrafish, and drugs targeting the potassium channel encoded by hERG can induce arrhythmia in both organisms.133,134 Since many commonly used drugs have the side effect of causing arrhythmia via this mechanism, the zebrafish system may prove useful in screening out cardiotoxic drug candidates. A powerful strategy for identification of novel drugs in zebrafish uses a disease model to identify small molecules that suppress the disease phenotype. In this scenario, the target must still be identified by traditional means, so the advantage of using fish lies as much in the presumptive...

Vulnerable Populations

Difficulty getting to medical appointments, taking medications regularly, or obtaining laboratory tests and follow-up care. As a result, persons with AIDS and untreated psychiatric disorders may present with AIDS-related illnesses not usually encountered in developed countries since the advent of potent antiretrovirals or highly active antiretroviral therapy (HAART). In addition, among those persons who are adherent to care, there has been an increase in the prevalence of endocrine, pulmonary, cardiac, gastrointestinal, renal, and metabolic disorders, some of which may be comorbid and unrelated to HIV and AIDS while others may be related to HIV and AIDS or to its treatments. The life expectancy of persons with HIV and AIDS who are treated with potent antiretroviral therapy is now similar to that of the general population (Manfredi 2004a, 2004b). Among the 68,669 persons with AIDS who died in New York City from 1999 to 2004, the percentage of deaths from non-HIV-related causes...

With Subcortical Infarcts And Leukoencephalopathy

Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is associated with mutations in the NOTCH 3 protein, which maps to chromosome 19q12. NOTCH signaling is important in development, but in adults, NOTCH 3 expression is limited to vascular smooth muscle cells, where its function is unknown. Pathologically, there are granular deposits in small cerebral arteries producing ischemic stroke because of vessel wall thickening, fibrosis, and occlusion. These deposits are found in small arteries throughout the body, and diagnosis may be confirmed by the presence of the osmiophilic granules in the basement membrane of vascular smooth muscle cells on skin biopsies.

Coronary Sinus Techniques in Interventional Cardiology

PICSO follows a different concept of using venous blood to maintain cell viability during ischemic syndromes. The rationale of PICSO holds that the beneficial effects are mainly due to forced redistribution of venous blood flow into the coronary beds. In contrast to retroperfusion and its primary effect of oxygen delivery, the effect of PICSO appears to result from redistribution and washout of toxic metabolites.6 For a long time surgeons have been aware of the effect of oxygen toxicity and reperfusion injury and therefore it seems reasonable to start reperfusion with a modified reperfusate making use of the enormous metabolic and buffer potential of venous blood until ultimate reperfusion from the arterial side can be established, i.e., thombolysis in myocardial infarct. The concept of a substantial contribution of PICSO to myocardial metabolite washout resulting in improved tissue salvage and maintained function during acute ischemia is consistent with observations of Murry14 and...

Target Discovery and Validation

Probably the foremost expectation that accompanied the advent of large-scale expression-profiling methods was that completely novel biological insights would be generated at a much higher speed, including a better understanding of disease mechanisms, especially in complex diseases, where current therapies are often unspecific or only symptomatic. A good example of such a disease is schizophrenia.105 Schizophrenia has a notable genetic disease component and hence a significant number of chromosomal 'hot spots' have been identified in families with a distinct prevalence of the disease. However, because of the complexity and heterogeneity of the disease, none of these hot spots has yielded a clear connection to a disease mechanism. A plausible reason for these inconsistencies is that those linkage studies are limited to the genetic predisposition for the disease, not taking the important environmental aspect into account. And of course schizophrenia is just one, albeit highly complex,...

The Diagnosis of Kidney Failure

In a recent review, the records of 155,076 patients who started dialysis between 1995 and 1997 were examined. Sixty percent of them had subnormal serum albumin concentrations, indicating malnutrition, and 51 percent had severe anemia. Only a small minority were treated by erythropoietin hormone injections, despite this drug being indicated for renal anemia (see Chapter 11). Heart disease was also prevalent and undertreated. The authors concluded that their data revealed

Gender Ethnicracial And Life Span Considerations

The risk of ischemic heart disease increases with age and when predispositions to atherosclerosis (smoking, hypertension, diabetes mellitus, hyperlipoproteinemia) are present. Nearly 10 of myocardial infarctions (MI) occur in people under age 40, however, and 45 occur in people under age 65. Men are at greater risk for MI than women are, but the differential progressively declines with advancing age. Because women live longer than men in the United States, angina has a prevalence of 3.9 million in U.S. women and 2.3 million in U.S. men. In addition, atypical presentations of angina are also more common among women compared with men.

Discharge And Home Healthcare Guidelines

Teach the patient factors that may precipitate anginal episodes and the appropriate measures to control episodes. Teach the patient the modifiable cardiovascular risk factors and ways to reduce them. Manage risk factors, including hypertension, diabetes mellitus, obesity, and hyperlipidemia.

Coronary Atherosclerosis

The most common cause of death from cardiovascular disease is coronary atherosclerosis. Approximately half the individuals with coronary artery disease die suddenly. Sudden death is, in fact, the initial symptom in approximately 25 of individuals dying of coronary atherosclerosis. In the authors' experience, coronary artery disease accounts for 76.3 of adults' dying suddenly and unexpectedly of cardiovascular disease who come to autopsy. The frequency will change to some degree depending on the population handled by a particular office and the criteria used for selection of cases for autopsy. In contrast to the number of individuals who die in the hospital of coronary artery disease, in a medical examiner's office, acute coronary thrombosis and acute myocardial infarcts are the exception rather than the rule. In a study of 500 consecutive autopsies of individuals aged 20-99 years who died suddenly and unexpectedly of coronary artery disease, only 67 (13.4 ) showed acute thromboses,...

Palliative and Causative Acting Drugs

By far the largest fraction of today's pharmacopoeia does not target disease at its cause - as these causes are largely unknown - but by modulating a pathway that affects the disease-relevant phenotype or function. We refer to such drugs as symptomatic or palliative agents. The pathways they target are known from more than a century of physiological, biochemical, and pharmacological research. The pathways they modulate are disease phenotype-relevant (albeit not disease cause-relevant), and while they are not dysfunctional, their modulation can effectively be used to counterbalance the effect of a dysfunctional, disease-causing pathway. Thus signs and symptoms of the disease can be alleviated, often with striking success, notwithstanding the fact that the real cause of the disease remains untouched. A classical example of such an approach is the acute treatment of thyrotoxicity with b-adrenergic-blocking agents even though in this case the sympathetic nervous system does not contribute...

Common Features Of Cognitive Vulnerability Models A Framework Encapsulating Relationships

A critical element of many cognitive models is that specific biases of information processing and proximal cognitions are assumed to differ with different disorders (Beck & D. A. Clark, 1997 J. M. G. Williams et al., 1988). For example, the bias in social phobia is for information relevant to the threat of public humiliation, and is accompanied by proximal thoughts like I'll make a fool of myself (see chap. 10, this vol.). The specific bias in panic disorder is for information relevant to unusual bodily sensations that might signal impending heart attacks or other feared calamities, and is accompanied by thoughts such as I'm having a heart attack (see chap. 8, this vol.). Such disorder-specific information-processing biases are presumably instigated when cognitive vulnerabilities (the distal factors) are put into play or engaged that were present long before the symptoms or episode. Hence, the specific vulnerability hypothesis of cognitive models is that the vulnerabilities to...

Mechanism of Sudden Death

The mechanism of sudden death in most individuals with coronary artery disease is the sudden onset of ventricular tachycardia, which either is sustained or, in most cases, progresses to ventricular fibrillation (approximately 80 ). This has been demonstrated in individuals wearing portable cardiac monitors who collapsed and died with the terminal event's being recorded. Asystole or a bradyarrhythmia accounts for the remaining 20 of cases of sudden cardiac death.14,15

Sudden Death Exercise and Climate

Sudden death in association with coronary artery disease can occur at any time of the day, during any activity. The individual might be sleeping or participating in strenuous activity. Severe climatic conditions such as heat and cold may stress the heart, predisposing to anginal attacks and sudden deaths.18 However, there is no doubt that strenuous activity predisposes a person to sudden cardiac death.19-21 In individuals over the age of 35, coronary atherosclerosis is the most common cause of death in exercise-related deaths.19 In younger individuals, the most frequent causes are hyper-trophic cardiomyopathy and congenital anomalies of the coronary arter-ies.22 The most common coronary anomaly is anomalous origin of the left coronary artery from the right sinus of Valsalva.22

Calcium Channel Blocking Agents

Special Concerns Abrupt withdrawal may result in increased frequency and duration of chest pain. Hypertensive clients treated with immediate-release dose forms of calcium channel blockers have a higher risk of heart attack than clients treated with diuretics or beta-adrenergic blockers. Safety and effectiveness of bepridil, diltiazem, felodipine, and isradipine have not been established in children.

Health Benefits of Complex Carbohydrates

The modern fiber era was launched with a paper by Cleave (1) that attributed many of the diseases of developed countries to consumption of refined sugar and refined flour. Burkitt, Trowell and Walker, all of whom worked in Africa, noticed the low incidence of large bowel cancer, ischemic heart disease, diabetes, and The possible influence of dietary fiber on heart disease in man cannot be studied directly but there have been numerous studies of fiber effects on hyper-

Medical Implications of OSA

Severe cardiovascular disease is also common in patients with OSA. Hypertension, cardiac arrhythmia, left ventricular dysfunction, myocardial infarction, pulmonary hypertension, stroke, and sudden death are all more common in patients with this condition.10 Systemic hypertension has been reported in up to 50 of patients with OSA, and one report implicated undiagnosed OSA in as many as 40 of patients with essential systemic hypertension.11 In an often quoted study by He et al.12 in 1988, a large cohort of patients with OSA were evaluated at the Henry Ford Hospital Sleep Disorders Center and followed for up to 9 years. Untreated subjects with an AHI of > 20 had significantly increased mortality compared with those with less severe AHI scores. Aggressive treatment with nasal continuous positive airway pressure (CPAP) appeared to reverse this trend, clearly implicating OSA for the increased mortality.

Overview of Modes of Action A

The pumping capacity of the heart is regulated by sympathetic and parasympathetic nerves (pp. 84, 105). Drugs capable of interfering with autonomic nervous function therefore provide a means of influencing cardiac performance. Thus, anxiolytics of the benzodiazepine type (p. 226), such as diaze-pam, can be employed in myocardial infarction to suppress sympathoactiva-tion due to life-threatening distress. Under the influence of antiadrenergic agents (p. 96), used to lower an elevated blood pressure, cardiac work is decreased. Ganglionic blockers (p. 108) are used in managing hypertensive emergencies. Parasympatholytics (p. 104) and p-blockers (p. 92) prevent the transmission of autonomic nerve impulses to heart muscle cells by blocking the respective receptors.

Findings that make MI unlikely

Wrong age in the absence of known heart disease, strong family history, or risk factors for coronary artery disease (CAD), a patient under the age of 40 is extremely unlikely to have had an ML 2. Risk factors a SO-year-old marathon runner who eats well and. has a high HDL without other risk factors for coronary heart disease is unlikely to have had an MI.

Community Health Education

Example The Pawtucket Health Heart Program in Rhode Island is a com-munitywide cardiovascular disease prevention program employing a variety of community-based interventions, targeting worksites, restaurants, schools, grocery stores, individuals, small groups, and the community at large in an effort to reduce the incidence of heart disease through screening, health education, and counseling programs directed toward risk factors such as high blood pressure, elevated cholesterol, cigarette smoking, obesity, and sedentary lifestyle (Hunt et al., 1990 Lasater et al., 1991).

Definition and a Brief History of Biomarker Research

A reasonable starting point for any discussion of biomarkers applications is with a general definition of the term 'biomarkers.' In recent years a formal definition has been crafted by a committee termed the Biomarkers and Surrogate Endpoint Working Group the definition of 'biological marker (biomarker)' they have put forth reads as follows a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.1 This definition is broad by necessity, as the field has impacts across biological systems and disease areas and can incorporate any of the technologies that are applicable in basic biological or clinical research. Although there has been an increase in attention to and formalization of the biomarkers field, in practice biomarkers have been an integral component of biomedical research for decades. The primary focus has historically been on biomarkers of disease...

Physiological Background

Einthoven Triangle

During the last few decades, the quest for knowledge of the heart has been motivated, not only by a desire to uncover the secrets of this vital organ, but also by its growing clinical importance. In the western world, heart failure is by far the most frequent cause of death, and the related financial and personal costs are huge. An improved understanding of how the heart works may lead to new techniques for the diagnosis and treatment of heart problems, and this serves as motivation for the enormous resources that are invested in heart-related research. The pumping function of the heart is the result of a rhythmic cycle of contraction and relaxation of about 1010 muscle cells, a process that is controlled by a complex pattern of electrical activation. Electrical activity is essential for the function of the heart, and many heart problems are closely linked to disturbances of the electrical activity. In fact, most serious heart problems either result from, or cause, abnormalities in...

Risk Management in Physical Activity Promotion

Physical activity-related risks are low and largely lower than the health benefit of regular moderate-intensity physical activity. For example, for sport, it is important that someone who wishes to increase their training is well informed and counselled, that he structures his progress and that he adequately organizes his contests and training sessions in order to avoid any overloading. More than 90 of myocardial infarction events did not follow a physical activity however, the risk may increase for a while immediately after exercising, although this risk concerns almost exclusively non-trained people. This underlines the preventive role of being regularly active. Every healthy person can have a daily physical activity of moderate intensity without visiting a physician first.

Prophylaxis and Therapy of Thromboses

Upon vascular injury, the coagulation system is activated thrombocytes and fibrin molecules coalesce into a plug (p. 148) that seals the defect and halts bleeding (hemostasis). Unnecessary formation of an intravascular clot - a thrombosis - can be life-threatening. If the clot forms on an atheromatous plaque in a coronary artery, myocardial infarction is imminent a thrombus in a deep leg vein can be dislodged, carried into a lung artery, and cause complete or partial interruption of pulmonary blood flow (pulmonary embolism).

Acute Rheumatic Fever Introduction

Acute rheumatic fever is an autoimmune disease responsible for cardiac valve disease or rheumatic heart disease. It is associated with infections caused by the group A streptococcus and occurs about 2 to 6 weeks following a streptococcal upper respiratory infection. It is prevented by adequate treatment of the infection with appropriate antibiotic therapy within 9 days of onset of streptococcal infection before further complications can occur. Because rheumatic heart disease does not occur after only one attack and children are susceptible to recurrent attacks of rheumatic fever, it is vital that an initial episode is diagnosed and treated, and that long-term prophylactic therapy (5 years or more) is given following the acute phase. There is no specific test for rheumatic fever the diagnosis is based upon the manifestations using the revised Jones criteria as a guideline. Jones criteria consist of major manifestations (polyarthritis, carditis, chorea, subcutaneous nodules, and...

Intraarterial Thrombus Formation A

Platelet aggregation increases like an avalanche because, once activated, platelets can activate other platelets. On the injured endothelial cell, a platelet thrombus is formed, which obstructs blood flow. Ultimately, the vascular lumen is occluded by the thrombus as the latter is solidified by a vasoconstriction produced by the release of serotonin and thromboxane A2 from the aggregated platelets. When these events occur in a larger coronary artery, the consequence is a myocardial infarction involvement of a cerebral artery leads to stroke.

Implementation Of Randomization

Note that the randomization procedure described above is probably the most frequently employed procedure for conducting clinical trials in the pharmaceutical industry with sample sizes smaller than a few thousands. For most clinical trials sponsored by the NIH or other cooperative groups, the sample size can be quite large. For example, the ISIS-2 (1988) study randomized 17,187 patients with suspected acute myocardial infarction to four treatment groups and 22,071 male physicians were enrolled to receive one of the four treatments in the U.S. Physician's Health Study (1989). An even larger study is the GUSTO (1993) study which enrolled a total of 41,021 patients with evolving myocardial infarction. As a result, it may not be feasible to adopt the randomization procedure described above. As an alternative, a centralized randomization center may be established for random assignment of treatments either by mail or by telephone. If the time between the screening and request for random...

Initial treatment of atrial fibrillation

In patients without rheumatic heart disease who are younger than 75 years of age, warfarin therapy should be initiated if risk factors are present, including previous transient ischemic attack or stroke, hypertension, heart failure, diabetes, clinical coronary artery disease, mitral stenosis, prosthetic heart valves, or thyrotoxicosis. In patients

Generalization Of Controlled Randomized Trials

In early 1970s, a high cholesterol level was known to be a risk factor for developing coronary heart disease. To confirm this, a trial known as the Lipids Research Clinics Coronary Primary Prevention Trials (CPPT) was initiated by the National Heart, Lung, and Blood Institute to test the hypothesis whether lowering cholesterol can prevent the development of coronary heart disease. In the CPPT trial, a total of 4000 healthy, middle-age males were randomized to receive either the cholesterol-lowering agent cholestyramine or its matching placebo (Lipids Research Clinics Program, 1984). The primary endpoint was the incidence of coronary heart disease after a seven-year follow-up. A statistically significant reduction of 1.7 in 7-year incidence of coronary heart diseases was observed for the cholestyramine group as compared to the placebo (8.1 versus 9.8 ). An expert panel recommended to extrapolate the results for the treatment of high cholesterol in populations that had never been...

The Problem with Dialysis

The death rate of patients on dialysis in the United States is still alarmingly high, over 20 percent per year, although it has fallen steadily since 1988. Part of this high mortality is attributable to the fact that a significant number of new dialysis patients are near death from other causes. Most of these deaths are apparently from cardiovascular disease, but the proportion is difficult to pin down from the available government reports. The 1999 summary, entitled U.S. Renal Data System, stated that 1 out of 5 dialysis patients withdraws from dialysis before death. In other words, these patients voluntarily stopped treatment. This depressing cause of death has disappeared in the more recent summaries. Sad as it may seem, withdrawal from dialysis is reported to be a good death, meaning that suffering is minimized.

Primary Nursing Diagnosis

The treatment needs to be initiated rapidly, within 6 hours of the onset of symptoms. Medical management for patients with CVAs typically includes support of vital functions and ongoing surveillance to identify early neurological changes as the patient's condition evolves. Although the hallmark of stroke is the abrupt onset of neurological symptoms and deficits due to the interruption of the vascular supply to a specific brain region, therapeutic intervention may save tissue that is at risk for infarction. Recombinant tissue-plasminogen activator (rt-PA) can improve outcome for some patients with acute nonhemorrhagic ischemic stroke if it is given within 3 hours of the onset of symptoms.

Features of coronary blood flow

The epicardial arteries give rise to small vessels that supply the outer third of the myocardium. They also give off penetrating vessels that anastomose with the subendocardial capillary plexus, which functions as an end-arterial system. There is no significant collateral circulation at the microcirculatory level, explaining the discrete nature of ischaemic lesions following myocardial infarction.

Selective Estrogen Receptor Modulation

The laboratory principle of selective estrogen receptor modulation translated to the clinic with the findings that tamoxifen maintained bone density198 and lowered circulating cholesterol.199 These were extremely important findings because there were justifiable concerns that tamoxifen, an 'antiestrogen,' might prevent breast cancer but increase risks for osteoporosis and coronary heart disease. The beneficial effects of SERM action on bones and circulating cholesterol were important to advance clinical studies testing the worth of tamoxifen as a chemopreventive in high-risk women. Additionally, the recognition that tamoxifen increases the risk of endometrial cancer was an advantage for screening volunteers for trials. Nevertheless, the reports of carcinogenicity associated with tamoxifen naturally created major problems for recruitment to chemoprevention trials.

Tamoxifen and Breast Cancer Prevention

Tamoxifen also reduced the incidence of osteoporotic fractures of the hip, spine, and radius by 19 . However, the difference approached, but did not reach, statistical significance. This reduction was greatest in women aged 50 and older at study entry. No difference in the risk of myocardial infarction, angina, coronary artery bypass grafting, or angioplasty was noted between the groups.

Congenital And Perinatal Infection

Anecdotal reports have suggested that embryopathy may occur in very rare cases of primary maternal EBV infection in early gestation (9,10). However, the exact risk of congenital infection with EBV is not known. Various congenital defects have been described in the few reported infants with documented congenital EBV infection or whose mothers had infectious mononucleosis during pregnancy (11). No specific pattern has been recognized. Reported abnormalities include micrognathia, congenital heart disease, cataract, microphthalmia, hip dysplasia, biliary atresia, and central nervous system abnormalities. Other studies of women with infectious mononucleosis or primary asymptomatic EBV infection in early pregnancy failed to document serologic or virologic evidence of EBV infection in their offspring (7). Although intrauterine transmission of EBV has been documented in a study using PCR, none of infants with positive PCR had clinical abnormalities (12). Maternal human immunodeficiency virus...

Terzo Fantasiaaffairs Of The Heart Crescendo

His friend was with the patient during the analytic session lying next to the patient on the couch. There were other people in the room too, quite a few of them. Somebody seemed to have a heart attack. The patient sprang into action to help that man an older person doing mouth-to-mouth resuscitation. (Kohut, 1984, p. 116)

Treatment of menopausal symptoms with estrogen

Data from the WHI and the HERS trials has determined that continuous estrogen-progestin therapy increases the risk of breast cancer, coronary heart disease, stroke, and venous thromboembolism over an average follow-up of 5.2 years. As a result, the primary indication for estrogen therapy is for control of menopausal symptoms, such as hot flashes.

Temporary pacemakers

Temporary pacing may also be used in a prophylactic fashion in patients at risk of symptomatic bradycardia during a surgical procedure or high-degree AV block in the setting of an acute myocardial infarction. ACC AHA Guidelines for Management of Patients with Acute Myocardial Infarction. Segment Elevation Myocardial Infarction. Circulation 2000 102 1193-1209. Acute Coronary Syndromes (Acute Myocardial Infarction). Circulation 2000 102 (supp I) I172-I203. resynchronization Companion Trial. J of Cardiac Failure, 2000 6 276-284. Yeghiazarians, Y. et al Unstable Angina Pectoris NEJM 2000 342 2 101-112. Wright, RSet al Update on Intravenous FibrinolyticTherapy for Acute Myocardial Infarction.

Group Sequential Designs

Patients with reduced left ventricular function after myocardial infarction (MI) are at risk of congestive heart failure (CHF) and life-threatening ventricular arrhythmia. Moss et al. (2002) reported the results of the Multicenter Automatic Defibrillator Implantation Trial II that was designed to evaluate the potential survival benefit of a prophylactically implanted defibrilla-tor (in the absence of electrophysiological testing to induce arrhythmia) in patients with a prior myocardial infarction and a left ventricular ejection faction of 0.30 or less. Over a period of 4 years, a total of 1,232 patients were randomized in a 3 2 ratio to receive an implanted defibrillator (742 patients) or conventional medical therapy (490 patients). The defibrillator was implanted using the standard technique. Every effort was made to achieve defibrillation within a 10-J safety margin. The primary endpoint was all causes death. This trial employed a triangular sequential design (Whitehead, 1997) that...

Medical Circulatory Disorders Except AMI with Cardiac Catheter without Complex Diagnosis

Coronary artery disease (CAD) is the leading cause of death and illness in Western societies. A number of conditions result from CAD, including angina, congestive heart failure, and sudden cardiac death. CAD results when decreased blood flow through the coronary arteries causes inadequate delivery of oxygen and nutrients to the myocardium. The lumens of the coronary arteries become narrowed from either fatty fibrous plaques or calcium plaque deposits, thus reducing blood flow to the myocardium, which can lead to chest pain or even myocardial infarction (MI) and sudden cardiac death. Coronary Artery Disease Coronary Artery Disease (Arteriosclerosis) 249

Efficacy in Models of Ischemic Injury

APC has been shown to be effective in models of ischemic stroke in both the rabbit 131 and mouse 92,132 . Reduced ICAM-1 expression and reduced tissue CD11b were observed in the murine model, indicating the likelihood of reduced neutrophil extravasation 132 . Moreover, efficacy was demonstrated to be dependent on both EPCR and PAR-1 or PAR-3

Background and Introduction

The female sex hormone estrogen plays an essential role in reproduction and is important for the overall maintenance of physiologic homeostasis in a woman's body.1'2 During menopause, which occurs in women at an average age of 51, the amount of estrogen produced by the ovaries decreases and this estrogen deficiency causes menstrual periods to become less frequent and then stop.3-5 The loss of estrogen is responsible for many of the uncomfortable symptoms associated with menopause, including hot flashes, mood swings or depression, sleep disorders, vaginal dryness, and urinary dysfunction.6 Osteoporosis or bone loss is another consequence of reduced estrogen levels after menopause.7-11 In women, bone density increases until ages 30-35,12 but slowly declines after menopause.13 Postmenopausal women are also at increased risk for coronary heart disease (CHD)14,15 and Alzheimer's disease,16-18 as a result of estrogen deficiency. The realization that the symptoms reported by postmenopausal...

Outcomes in Diabetic Patients

Meta-analyses of ACE inhibitor trials provide compelling evidence that ACE inhibitors reduce cardiovascular events and mortality related to acute myocardial infarction (MI) and heart failure (90,91). Because diabetes is an independent risk factor for CVD (92) and the RAS and diabetes appear to interact at multiple levels, it is possible that diabetes may affect the efficacy of ACE inhibition on CVD. Several recent reports have provided retrospective analyses of data from diabetic subgroups, which participated in large ACE inhibitor trials. Although some of these trials were not designed to specifically address the effects of ACE inhibition in diabetes, comparison of the relative effects of ACE inhibition in the diabetic and nondiabetic subgroups may provide important insight into the role of the RAS in CVD in diabetes.

Raloxifene and Lipids

First 3 months of therapy and were maintained thereafter. Notably, none of the treatment groups showed any changes in serum concentrations of HDL cholesterol and triglycerides. The effect of raloxifene on serum lipid levels was also assessed in 390 healthy postmenopausal women.175 In this study, raloxifene (60 and 120 mg day_ 1) was compared with HRT (0.625 mg day-1 of conjugated estrogen and 2.5 mg day_ 1 of medroxyprogesterone given continuously) and placebo. Assessments were made at baseline, 3 months, and 6 months. Over the 6-month study period, both dosages of raloxifene lowered serum LDL cholesterol levels by about 12 compared with placebo (P < 0.001). This finding was similar to the 14 reduction that occurred with continuous HRT.78 The effect of raloxifene on cardiovascular events was also examined in osteoporotic postmenopausal women from the MORE trial. In the study design, patients were randomly assigned to receive raloxifene 60mgday_ 1 (n 2557), or 120 mg day_ 1 (n 2572),...

Rank order of hazards from food components

In general, in developed countries food safety is adequate. However, it should be noted that the information on the (chronic) toxicity of natural food components is insufficient. Further, a number of important health problems such as cardiovascular disorders, diabetes, osteoporosis, obesity, allergy, and cancer are believed to be related to nutrition. Nutritional interventions could drastically reduce the incidence of these diseases.

Description Medical Diabetes

Long-term complications such as disease of the large and small blood vessels lead to cardiovascular disease (coronary artery disease, peripheral vascular disease, hypertension), retinopa-thy, and renal failure. Diabetic patients also have nerve damage (neuropathy) that can affect the peripheral nerves, resulting in numbness and pain of the hands or feet.

Hypolipidemic 3thia Fatty Acids

High serum levels of triglyceride (TG)-rich lipoproteins, i.e. very low density lipoproteins (VLDL) and its remnants are important risk factors for coronary artery disease.1 Serum TGs can be lowered either by dietary treatment with fish oils or by pharmacological treatment with drugs of the fibrate class. Classically, the decrease in plasma TG concentrations upon fibrate treatment (Table 1) are thought to be the result of a decreased hepatic secretion of VLDL accompanied by an enhanced plasma TG clearance, possibly due to the induction of lipoprotein lipase (LPL) activity in peripheral tissues.2

Clinical Manifestations

CNS Mydriasis, seizures, greater risk of cerebrovascular accidents (CVAs) subarachnoid hemorrhage, intracranial hemorrhage, transient ischemic attacks. Acute cardiovascular Tachycardia, hypertension, tachyarrhythmias, myocardial infarction (MI), vascular endothelial damage and platelet aggregation and adhesion, subacute bacterial endocarditis (SBE) from septic emboli. Chronic cardiovascular Coronary artery disease (CAD) and left ventricular hypertrophy