Heart disease (Hagerstown, Md.)最新文献

{"title":"Physicians' perceptions of the effect of nonclinical factors on coronary revascularization.","authors":"J Marie Barnhart,&nbsp;E Scott Monrad,&nbsp;Hillel W Cohen","doi":"10.1097/01.hdx.0000089868.93202.f0","DOIUrl":"https://doi.org/10.1097/01.hdx.0000089868.93202.f0","url":null,"abstract":"<p><p>The main objective of this study was to determine if physicians perceive that extracardiac or nonclinical factors such as patients' financial status, lifestyle, or trust in the physician impact coronary revascularization decisions. A self-administered questionnaire was developed and mailed to a random sample of 1200 family physicians, internists, cardiologists, and cardiothoracic surgeons who were active members of well-respected medical organizations in the United States. Survey questions were rated on a 4- and 5-point Likert scale to determine whether physicians perceive that nonclinical factors impede or facilitate coronary revascularization, respectively. The survey response rate was 70%. Family physicians were most likely to perceive that unhealthy lifestyle (51%), financial barriers (48%), and lack of social support (31%) probably or definitely precluded revascularization. White physicians (52%) were more likely to perceive that distrust in the physician affected revascularization, compared with black (33%), Hispanic (38%) and Asian (40%) physicians. Mean responses regarding how often (1 = rarely to 5 = most of the time) nonclinical factors facilitate revascularization revealed that women and Hispanic physicians were more likely to perceive male patients had easier access to the procedure (mean response, 2.8 for women versus 2.1 for men; 2.8 for Hispanics versus 2.4 for blacks and 2.1 for whites). Physicians perceived that nonclinical factors influence decision making for coronary revascularization. What needs to be further explored is whether such factors affect actual patient outcomes or contribute to disparities in the utilization of cardiac interventions.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"313-9"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000089868.93202.f0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of transesophageal echocardiographic findings with the site of arterial occlusion in patients with thromboembolic stroke.","authors":"Mohammad A Saleem,&nbsp;Wilbert S Aronow,&nbsp;John A McClung,&nbsp;Robert N Belkin","doi":"10.1097/01.hdx.0000080715.97676.1b","DOIUrl":"https://doi.org/10.1097/01.hdx.0000080715.97676.1b","url":null,"abstract":"<p><p>The authors investigated the association of transesophageal echocardiographic findings with the site of arterial occlusion in patients who underwent transesophageal echocardiography because of thromboembolic stroke and in whom the site of arterial occlusion was diagnosed by computerized axial tomography. The study population included 101 patients (mean age 59 +/- 15 years) with thromboembolic stroke and 101 randomly selected age-matched and sex-matched control without stroke. Transesophageal echocardiographic findings that were significantly higher in the patients with thromboembolic stroke than in the control group were vegetations on the aortic or mitral valve (9% versus 1%, P < 0.01), left atrial or left atrial thrombus or spontaneous echocardiographic contrast (20% versus 6%, P < 0.005), thrombus on a prosthetic valve or in the left ventricle (4% versus 0%, P < 0.05), and atherosclerosis in the thoracic aorta (37% versus 21%, P < 0.02). A higher prevalence of atherosclerosis in the thoracic aorta was found in patients with lacunar infarction compared with patients with middle cerebral artery occlusion (67% versus 25%, P < 0.02), as well as a higher prevalence of vegetations on the aortic or mitral valve in patients with occlusion of 2 arteries compared with patients with vertebrobasilar artery occlusion (28% versus 0%, P < 0.05).</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"320-2"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000080715.97676.1b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary management of \"high-risk\" patients with carotid stenosis.","authors":"Antonios P Gasparis,&nbsp;George L Hines,&nbsp;John J Ricotta","doi":"10.1097/01.hdx.0000089835.03588.26","DOIUrl":"https://doi.org/10.1097/01.hdx.0000089835.03588.26","url":null,"abstract":"<p><p>The concept of a \"high-risk\" carotid endarterectomy patient has been suggested in an effort to justify the application of carotid angioplasty and stenting outside of clinical trials. Contemporary results of carotid endarterectomy in this subgroup of patients would argue against the existence of a high-risk patient. Until randomized prospective trials establish the role of carotid angioplasty and stenting in carotid bifurcation disease, this new technology should be restricted to recurrent and radiation-induced disease.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"345-8"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000089835.03588.26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valvular heart disease and systemic lupus erythematosus: therapeutic implications.","authors":"Adrian Fluture,&nbsp;Shobhana Chaudhari,&nbsp;William H Frishman","doi":"10.1097/01.hdx.0000089834.97829.5e","DOIUrl":"https://doi.org/10.1097/01.hdx.0000089834.97829.5e","url":null,"abstract":"<p><p>Valvular involvement is the most encountered form of heart disease in systemic lupus erythematosus (SLE). Immunoglobulin and complement deposition in the valvular structure will subsequently lead to Libman-Sacks vegetations, valve thickening, and valve regurgitation. Valvular stenosis is rarely seen. Involvement of the mitral valve is most frequently encountered. Valve disease for most patients is mild and asymptomatic, but patients in whom severe mitral regurgitation develops will present with symptoms of congestive heart failure. A heart murmur will be heard in almost all patients with moderate or severe regurgitation. Transesophageal echocardiography is the most sensitive method to detect the valvular involvement. The valvular changes, the hemodynamic status, or the symptomatology have been shown to progress, remain stable, or sometimes improve. Severe regurgitation, infective endocarditis, and thromboembolic events (mostly stroke or transitory ischemic attacks) are complications of valvular involvement in SLE. In treatment of these patients, prophylaxis of infectious endocarditis, selective antiaggregant and anticoagulant medication, and valve replacement are currently offered. The role of corticosteroid treatment is still unclear in the outcome of SLE valvulopathy.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"349-53"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000089834.97829.5e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening coronary arteriography in the primary prevention of coronary artery disease.","authors":"Glenn Gandelman,&nbsp;Monty M Bodenheimer","doi":"10.1097/01.hdx.0000080717.15994.64","DOIUrl":"https://doi.org/10.1097/01.hdx.0000080717.15994.64","url":null,"abstract":"Recent studies indicate an expansion of the population eligible for primary prevention of coronary artery disease with lipid-lowering therapy. This change has led to the unnecessary treatment of many individuals and an overall decreased effectiveness of medication with potentially significant side effects. If instead, the asymptomatic population is screened for the presence of early coronary artery disease (CAD), lipid lowering can be targeted to those who can truly benefit. The prevalence of asymptomatic CAD in men older than 50 years of age approaches 20% and arteriography is currently the best available test to identify these men. The approximate complication rate of arteriography in such a population (1 or 2 per 10,000) approaches that of other screening tests. Although insufficient data exists for formal cost analysis, approximations indicate significant savings for arteriographically targeted treatment of at-risk asymptomatic individuals. The authors show that coronary arteriography is a potentially safe and cost-effective method of screening an asymptomatic adult population for presence of early CAD, allowing for the targeting of lipid lowering to those who can benefit most from this therapy.","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"335-44"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000080717.15994.64","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eplerenone: a selective aldosterone receptor antagonist for hypertension and heart failure.","authors":"Tera D Moore,&nbsp;James J Nawarskas,&nbsp;Joe R Anderson","doi":"10.1097/01.hdx.0000089783.30450.cb","DOIUrl":"https://doi.org/10.1097/01.hdx.0000089783.30450.cb","url":null,"abstract":"<p><p>Aldosterone has been implicated for many years as an important substance in the pathogenesis of heart disease. Elevated aldosterone concentrations have been documented in patients with hypertension and heart failure, leading to the use of aldosterone antagonists for the treatment of these conditions. Spironolactone has been used for nearly 2 decades for the treatment of hypertension, and more recently, has become a standard agent for the treatment of systolic heart failure. Spironolactone, however, is a nonselective antagonist of the aldosterone receptor, binding also to other steroid receptors and causing a significant percentage of patients to have sex hormone-related adverse effects such as gynecomastia. Eplerenone is the first of a new class of drugs known as selective aldosterone receptor antagonists, which selectively block the aldosterone receptor with minimal effect at other steroid receptors, thereby minimizing many of the hormonal side effects seen with spironolactone. Eplerenone has been shown to be beneficial both as monotherapy and combination therapy for lowering elevated blood pressure in patients with hypertension. The antihypertensive efficacy of eplerenone is roughly similar to that of other antihypertensive agents, although in 1 study black patients responded better with eplerenone than losartan. In addition, eplerenone has demonstrated some renoprotective effects in diabetic patients with hypertension. Recently, eplerenone was shown to significantly reduce mortality and cardiovascular morbidity in post-myocardial infarction patients with systolic heart failure currently taking standard heart failure medications. Eplerenone is generally well tolerated, although hyperkalemia with this agent is of some concern. Eplerenone is metabolized by CYP3A4 and administration with potent inhibitors of this enzyme is contraindicated because of the risk of hyperkalemia. In summary, eplerenone has proven to be beneficial in treating hypertension and post-myocardial infarction heart failure. Its exact place in therapy will in large part be determined by its cost and whether or not future studies will be able to demonstrate a clinical benefit of this agent over spironolactone or other currently available treatments.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"354-63"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000089783.30450.cb","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40896681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JNC 7: has the definition of hypertension changed?","authors":"Domenic A Sica","doi":"10.1097/01.hdx.0000089784.35027.8a","DOIUrl":"https://doi.org/10.1097/01.hdx.0000089784.35027.8a","url":null,"abstract":"","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"305-7"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000089784.35027.8a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The activation pattern of the antioxidant enzymes in the right ventricle of rat in response to pressure overload is of heart failure type.","authors":"Aline Ecarnot-Laubriet,&nbsp;Luc Rochette,&nbsp;Catherine Vergely,&nbsp;Pierre Sicard,&nbsp;Jean-Raymond Teyssier","doi":"10.1097/01.hdx.0000089836.03515.a9","DOIUrl":"https://doi.org/10.1097/01.hdx.0000089836.03515.a9","url":null,"abstract":"<p><p>In the left ventricle subjected to pressure overload activity, the antioxidant enzymes increased at the hyperfunctional stage. During the transition to heart failure, these enzymes are down-regulated, oxidative stress increases, and apoptosis progresses. Maladaptative activation of the antioxidant enzymes at an early stage may contribute to the intrinsic vulnerability of right ventricle to pressure overload. The authors studied changes in expression and activity of the enzymes manganese and copper-zinc superoxide dismutases, glutathione peroxidase, and catalase in the right ventricle of rat following induction of pulmonary hypertension by injection of monocrotaline. Increase in the manganese superoxide dismutase was delayed to the late failing stage, activity of glutathione peroxidase was depressed throughout, and only catalase was activated at the early stage before returning to control levels. This inability to activate antioxidant enzymes may contribute to the deleterious consequences of pressure overload on right ventricle systolic function.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 5","pages":"308-12"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000089836.03515.a9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40818979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, pathophysiology, prognosis, and treatment of systolic and diastolic heart failure in elderly patients.","authors":"Wilbert S Aronow","doi":"10.1097/01.hdx.0000080714.87750.48","DOIUrl":"https://doi.org/10.1097/01.hdx.0000080714.87750.48","url":null,"abstract":"<p><p>American College of Cardiology/American Heart Association class I recommendations for treating patients with heart failure (HF) and abnormal left ventricular ejection fraction are diuretics in patients with fluid retention, an angiotensin-converting enzyme (ACE) inhibitor unless contraindicated, a beta-blocker unless contraindicated, digoxin for the treatment of symptoms of HF, and withdrawal of drugs known to precipitate or aggravate HF such as nonsteroidal anti-inflammatory drugs, calcium channel blockers, and most antiarrhythmic drugs. Class II(a) recommendations for treating HF with abnormal left ventricular ejection fraction are spironolactone in patients with class IV symptoms, preserved renal function, and normal serum potassium; exercise training as an adjunctive approach to improve clinical status in ambulatory patients; an angiotensin receptor blocker in patients who cannot be given an ACE inhibitor because of cough, rash, altered taste sensation, or angioedema; and hydralazine plus nitrates in patients being treated with diuretics, a beta-blocker, and digoxin who cannot be given an ACE inhibitor or an angiotensin receptor blocker because of hypotension or renal insufficiency. Patients with diastolic HF should be treated with cautious use of diuretics and with a beta-blocker. An ACE inhibitor should be added if HF persists or an angiotensin receptor blocker if the patient cannot tolerate an ACE inhibitor because of cough, angioedema, rash, or altered taste sensation. Isosorbide dinitrate plus hydralazine should be added if HF persists. A calcium channel blocker should be added if HF persists. Digoxin should be avoided in diastolic HF if sinus rhythm is present.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 4","pages":"279-94"},"PeriodicalIF":0.0,"publicationDate":"2003-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000080714.87750.48","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22496602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular manifestations of substance abuse: part 2: alcohol, amphetamines, heroin, cannabis, and caffeine.","authors":"William H Frishman,&nbsp;Alexander Del Vecchio,&nbsp;Shirin Sanal,&nbsp;Anjum Ismail","doi":"10.1097/01.hdx.0000080713.09303.a6","DOIUrl":"https://doi.org/10.1097/01.hdx.0000080713.09303.a6","url":null,"abstract":"<p><p>The abuse of alcohol is associated with chronic cardiomyopathy, hypertension, and arrhythmia. Abstinence or using alcohol in moderation can reverse these cardiovascular problems. Alcohol is also distinguished among the substances of abuse by having possible protective effects against coronary artery disease and stroke when used in moderate amounts. Amphetamines (eg, speed, ice, ecstasy) have many of the cardiovascular toxicities seen with cocaine, including acute and chronic cardiovascular diseases. Heroin and other opiates can cause arrhythmias and noncardiac pulmonary edema, and may reduce cardiac output. Cardiovascular problems are less common with cannabis (marijuana) than with opiates, but major cognitive disorders may be seen with its chronic use. It is still controversial whether caffeine can cause hypertension and coronary artery disease, and questions have been raised about its safety in patients with heart failure and arrhythmia.</p>","PeriodicalId":83724,"journal":{"name":"Heart disease (Hagerstown, Md.)","volume":"5 4","pages":"253-71"},"PeriodicalIF":0.0,"publicationDate":"2003-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hdx.0000080713.09303.a6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22496605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}