Cardiovascular risk: Natural remedies for your heart

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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Coronary Heart Disease

Figure 1-3 Prevalence of MI and angina pectoris by age and sex, United States, 1988-1994 (self-reported myocardial infarction and Rose angina from health interviews). MI, myocardial infarction. (From the Figure 1-3 Prevalence of MI and angina pectoris by age and sex, United States, 1988-1994 (self-reported myocardial infarction and Rose angina from health interviews). MI, myocardial infarction. (From the In the United States, CHD causes about 650,000 new heart attacks each year and 450,000 recurrent attacks.2 The incidence in women lags behind that in men by 10 years for total CHD and by 20 years for more serious clinical manifestations such as MI and sudden death Tables 1-1 and 1-3). Male Table 1-5 Six-Year Prognosis Following Myocardial Infarction Framingham Study, 44-Year Follow-Up of Cohort and 20-Year Follow-Up of Offsprings Table 1-5 Six-Year Prognosis Following Myocardial Infarction Framingham Study, 44-Year Follow-Up of Cohort and 20-Year Follow-Up of Offsprings

Congenital Heart Disease

About one million persons in the United States have congenital cardiovascular disease, and each year an estimated 32,000 babies, about 8 per 1000 live births, are born with this disease.2,43 Of the new cases, 8 to 13 percent have atrial sepal defects, 6 to 11 percent have patent ductus arteriosus, and 20 to 25 percent have ventricular sepal defects. The prevalence of congenital heart disease at birth as determined during the infant's brief stay in the hospital is likely to be underestimated, and recognition of specific lesions may be inaccurate.44 Most data are deficient for a diagnosis after the first week of life. Prevalence data based on autopsy findings are unreliable because they reflect a fraction of the deaths and relate only to fatal lesions. Most information comes from retrospective studies based extensively on referral practices. Except for the recent unexplained twofold increase in ventricular sepal defects and the threefold increase in patent ductus arteriosus, the...

Cardiovascular Disease In Type 2 Diabetes

Type 2 diabetes is very different from type 1 diabetes in its underlying etiology and its natural history. Insulin resistance, which is defined as a less than normal effect of insulin on in vivo glucose uptake and metabolism, occurs in a high proportion of the population of societies embracing western culture (10,26). Factors responsible for the development of insulin resistance are only partially understood. Fetal malnutrition predisposes to insulin resistance in postnatal life (27). Excess calorie intake and reduced physical activity lead to exaggerated lipid deposits and obesity. The proportion of excess calories deposited as lipids in subcutaneous adipose tissue relative to visceral adipose tissue is both genetically and hormonally determined (28). An increase in visceral adiposity but not subcutaneous adiposity is highly correlated with insulin resistance and the components of the metabolic syndrome (29,30). There is a significant correlation between visceral adiposity and both...

But Some People Get Coronary Heart Disease And Have No Risk Factors

Coronary heart disease is very uncommon in people who have no risk factors. The risk factors listed above account for the vast majority of cases of coronary heart disease. Smokers often know of someone who smoked all his life and lived to a ripe old age Maybe so, but he (or she) may have had a bad chest with bronchitis and emphysema and may have died from his lung problems or cancer of the lung or another part of the body, before dying from a heart attack. Most smokers know that if they continue, it will catch up with them sooner than they would like.

Importance Of Prevention Of Coronary Heart Disease In Childhood

Children should be educated about health matters by example at home and in school. This means that parents can do a lot to guide and educate their children. If parents smoke, drink too much alcohol or have a bad diet, their children are likely to inherit these habits and thus have a higher risk of getting coronary heart disease at a needlessly young age. likely to get coronary heart disease than children whose parents have an unhealthy lifestyle.

Physiological mechanisms increasing risk of cardiovascular disease from smoking

There are strong plausible hypotheses for the relation between exposure to tobacco and vascular disease. In animal and human studies, endothelial injury has been associated with carbon monoxide and nicotine. In contrast to healthy individuals, those with ischemic heart disease are affected by carbon monoxide during submaximal exercise, in part Fibrinogen has also been implicated in atherogenesis and thrombus formation, and has been found to be elevated in smokers (34,35). The Framingham Study has shown that risk of cardiovascular disease (CVD) and stroke increased with increases in fibrinogen levels. In this study, as well as in other studies, smokers had a higher risk of developing claudication compared with nonsmokers with similar risk factor profiles (17,36-40). Passive smoking is also associated with dose-related impairment of endothelium dependent dilatation, suggesting early arterial damage (49). Studies have concluded that the public health burden caused by environmental...

The Financial Social And Psychological Costs Of Coronary Heart Disease

Coronary heart disease is one ofthe most common cause of death in the world and is becoming increasingly widespread as life expectancy increases. It consumes a lot of a country's economy due to lost income and health benefits when young people can no longer work the costs of treatment - medicines and operations -are expensive. People of all ages die from a heart attack. Older people are more likely to die than younger people. Younger people Figure 1.3 The cause of heart attacks, unstable angina, and death Rupture of a plaque and clot, causing blockage of an artery with blood clot (platelet cells) and heart attack. are more likely to be able to return to work and live a normal life after a heart attack. Many more people of working age may survive a heart attack, but are left with a weakened heart muscle (heart failure), which may make it difficult for them to continue working. This affects their families, friends, and their businesses. Many of those who survive cannot work again due to...

We Are Living Longer With Coronary Heart Disease And After Heart Attacks

Because medical care and treatment have improved. We understand more about how these conditions develop and how we can reduce our risk of getting coronary heart disease. The medications we prescribe for patients with coronary heart disease - aspirin (which reduces the stickiness of the blood), beta blockers (which lower the blood pressure and the heart rate), statins (which lower the cholesterol level but have other useful effects, too), drugs that work on the kidneys and are good for the heart and the arteries (angiotensin converting enzyme inhibitors or ACE inhibitors) - are the drugs that, together, have made a big impact in prolonging life in patients who have coronary heart disease. Healthy eating and exercise are beneficial. Thinner people live longer and are more likely to survive longer after a heart attack. High blood pressure, high cholesterol level, and diabetes High blood pressure, and high cholesterol levels and diabetes, are treated better and more aggressively in...

Imaging In Cardiovascular Disease

Biomarkers have been used for decades as surrogates to support the approval of drugs for the treatment of atherosclerotic cardiovascular disease. A considerable body of corroborative angiographic and carotid ultrasound imaging data show that drugs which diminish low density lipoprotein cholesterol (LDL-C), nonHDL-C and atherogenic triglycerides can slow plaque progression and cause plaque regression, which has been demonstrated in outcome studies to lead to reduced morbidity and mortality. Recent progress in the pathophysiology and pharmacology of atherosclerosis has resulted in novel drug molecules with mechanisms of action that directly target specific processes happening in the vessel wall. As a result, there has been a surge in research to validate and qualify novel vessel wall imaging biomarkers that could potentially be used as surrogates, alongside soluble biomarkers, to increase the efficiency of selection and subsequent

National Heart Attack Alert Program

The new treatments and the synergistic effect of time on their effectiveness, coupled with ongoing patient and system delays, gave the impetus for the National Heart, Lung, and Blood Institute's (NHLBI's) consideration, in the late 1980s, of establishing a national education program dedicated to coordinating efforts to improve emergency care for patients with acute MI and their outcomes (9). The NHLBI launched the National Heart Attack Alert Program (NHAAP) in June 1991, with the first meeting of its Coordinating Committee comprised of approx 40 healthcare providers, voluntary, and federal liaison representatives involved in some aspect of care of the acute MI patient in the hospital or in the community. The NHAAP's overarching goal is to promote early identification and treatment of patients with acute MI and to reduce the incidence of (and improve survival from) sudden cardiac death in the community. The scope of program was expanded in 1997 to include all patients with acute...

Cyanotic Congenital Heart Disease

Thrombocytopenia frequently occurs in children with severe cyanotic congenital heart disease, usually when the hematocrit levels are more than 65 and when the arterial oxygen saturation is less than 65 . This may be due to margination of platelets in the small blood vessels, which may occur in the presence of a high he-matocrit level. Thrombocytopenia can occasionally be cyclic, occurring at intervals of 10-25 days. During periods of thrombocytopenia, there are high thrombopoietin levels in the plasma when platelet counts are normal, thrombopoietin levels are low. Cyanotic congenital heart disease may be associated with prolonged bleeding time in spite of normal platelet counts, which is related to an impairment in platelet

Perception of Heart Attack Risk

The majority of women in the focus groups believed heart attacks were a male problem. Older women (over age 65) did not link their health conditions to increased risk of a heart attack, especially after menopause. Men at higher risk due to the presence of one or more risk factors, discounted their personal risk if they were receiving regular health care for a chronic condition. Men were more likely than women to say that they were too young to experience a heart attack, perceiving it as a phenomenon of the elderly (53).

Myocardial infarction

Myocardial infarction causes pain which is similar 10 angina in site, radiation and character but differs in that it is not necessarily precipitated by exertion, persists at rest and is usually much more severe (Table 3.9). Autonomic symptoms such as sweating, nausea and vomiting may be associated with myocardial infarction. Patients may also be breathless, reslless and distressed and may experience a sensation of impending death, angor amini. Conversely, painless myocardial infarction is not uncommon particularly in elderly patients and those with diabetes. Such patients may present with complications such as cardiac failure or an arrhythmia.

Markers of inflammation in cardiovascular disease

In otherwise healthy individuals, cytokines that are generated by injured or atherosclerotic vessels do not produce systemic manifestations typically associated with inflammation (115). However, systemic effects are detectable biochemically. Numerous markers of inflammation, such as CRP, IL-1, IL-6, IL-18, serum amyloid A (SAA), TNF-a, soluble adhesion molecules (sICAM, sVCAM, sE-selectin, and sP-selectin), myeloperoxidase, CD 40 ligand, and macrophage inhibitory cytokine-1 are now being considered as predictors of clinical risk (144,145). Of these, high-sensitivity (hs) CRP is the most stable and powerful inflammatory marker of future cardiovascular risk. Prospective studies reported that CRP is an independent predictor of risks of future myocardial infarction, stroke, and peripheral vascular disease (144,149-151). In a recent study, a cohort from the Framingham Heart Study, in which the participants were free of cardiovascular disease, the relationship between CRP and coronary...

Does Everyone With Coronary Heart Disease Get Angina

Perhaps only half the patients who have coronary heart disease get angina. The reason for this is not understood. This is why a lot of people who have had a heart attack, and so have coronary heart disease, had no warnings of angina. Sometimes, a person's angina disappears after he has had a heart attack. So just because a patient has coronary heart disease does not mean that he has angina. Having coronary heart disease does not mean that a person needs angioplasty or heart bypass. He may need tablets.

Keeping An Eye On Patients With Coronary Heart Disease

Coronary heart disease is not curable, even with heart bypass (the patient doesn't change the arteries are bypassed and the arteries or veins used as bypasses can get blocked up). So we need to monitor the patient over the long term to decide whether we need to change treatment, to monitor and control risk factors, and encourage the patient to lead a full and active life. New treatments for heart disease come along all the time. It is helpful for patients to see their doctor so that they may get the benefit of new treatments and advice.

So How Do Doctors Find Out If People Have Coronary Heart Disease

Chest discomfort and breathlessness occurring during exercise or stress in a patient who has one or more cardiovascular risk factors is probably angina. These patients may need further tests, treatment, or referral to a specialist. Is it possible to know whether or not someone has coronary heart disease without doing any special tests 1. A young, fit person, less than 50 years old, who has no angina and no cardiovascular risk factors, would, 99 times out of 100, have normal heart arteries. 2. A person, who has definitely had a heart attack, would have coronary heart disease with at least some blockage in one of the three heart arteries. The artery may not necessarily be blocked because some people, particularly young people, may have a heart attack and the blocked heart artery may open up by itself soon afterwards. 3. Virtually everyone (98 ) with angina has some coronary heart disease.

Ischemic Heart Disease

Ischemic heart disease (IHD) is the leading cause of death in adults in industrial countries, where the annual incidence is generally high. For diagnostic purposes, coronary angiography is the current ''gold standard'', but due to a combination of X-ray exposure, adverse side effects and high cost, the method is restricted to those patients with very high pre-test likelihood of IHD. Despite the development of novel noninvasive diagnostic tests, including new imaging technology, 12-lead ECG and echocardiography at rest and under stress remain the most common methods in routine clinical use. Although these are fast and simple diagnostic procedures, their predictive value remains limited. Hence, there is a need for cost-effective diagnostic procedures for IHD that are easy and quick to perform and which deliver a reliable basis for subsequent clinical action. Diagnosis the early detection of patients with hemodynamically relevant stenoses of the coronary arteries with and without...

NonSTSegment Elevation Acute Coronary Syndromes

The history, physical examination, and baseline ECG all can be used to risk-stratify patients with non-ST-segment elevation acute coronary syndromes. Woodlief and colleagues developed a regression model in 1384 patients in the GUSTO-IIa trial that identified age, Killip class, systolic blood pressure, and previous hypertension as significant predictors of 30-d mortality (89). In 393 patients with unstable angina, Calvin and colleagues found previous infarction, lack of b-blocker or calcium-channel blocker therapy, ST-segment depression on the presenting ECG, and diabetes to be predictors of death or acute MI (90). As described previously, in the absence of ST-segment elevation on the initial ECG, the diagnosis of acute MI vs unstable angina is largely made, in retrospect, on the basis of serial CK-MB testing. However, because even small infarcts as measured by CK-MB sampling confer worse outcomes, and the best outcomes in these patients are likely to be obtained when specific...

Man with Coronary Heart Disease but a Normal Exercise Test Result

An example of a false negative test result would be of a 65-year-old man who has typical angina and an almost full house of cardiovascular risk factors (he smokes, he is very overweight, he has a high cholesterol level, and he has high blood pressure and diabetes). When he does the exercise test, there are no ECG changes and he does not get angina. This test is almost certainly wrong and misleading. The fact that he has angina means that he has at least a 95 chance of having coronary heart disease, even ignoring his risk factors.

How Do I Know If The Chest Pain Is Due To A Heart Attack And Not Indigestion Or Something Else

It can be difficult to distinguish between a heart attack and indigestion because both cause a similar type of chest discomfort. This is because the heart and the gullet develop from similar cells and have a similar a nerve supply. In the same way that we know if a finger has been burned (even without looking) because the sensation from the finger is represented in a certain area of the brain, so the heart and gullet are also represented in the same area of the brain. The brain finds it difficult to distinguish whether pain is from the heart or the gullet. They both feel the same That's why indigestion is often called heartburn. Therefore, people who have indigestion may think they have had a heart attack, and people who have had a heart attack may believe (and naturally would prefer to believe) that they have only indigestion.

Are There Anytruths In Superfoods Being Especially Beneficial To Patients Who Have Had A Heart Attack Or Who Have

There is no reliable evidence that any of the foods written about in the papers or magazines have any special benefits to people who have had a heart attack or who have coronary heart disease. Nevertheless, it is intuitively better to eat fresh fruit than a hamburger. There is also no evidence that any vitamin or folic acid prevents heart attacks. Psychologically many people feel that they should take some time off work after a heart attack. This can be useful to allow them to adjust their priorities. But leaving it too long is not a good idea.

What Is The Risk Of Having Another Heart Attack

The risk of another heart attack depends on the age of the patient, the state of their heart arteries, as well as all their cardiovascular risk factors. Information about the likelihood of further heart attacks can be obtained in many different ways. The number of narrowings in the heart arteries (other than the one that caused the heart attack) gives a very good idea of the future threat. This is most accurately assessed with a coronary angiogram. Patients who have had a heart attack are more likely to have another heart attack than people with a normal heart. Many patients enjoy a long and untroubled life after a heart attack. Some need further tests and replumbing of their heart using either angioplasty or bypass surgery. All patients should be on medication, but not everyone takes the same tablets.

Heart Disease And Prediabetic States

The duration of diabetes influences the development of CAD in patients with type 1 diabetes, but such a relationship has not been demonstrated in those with type 2. Therefore, it is unclear whether the duration of asymptomatic hyperglyce-mia, or the state of impaired glucose tolerance, may have an important role on the development of CAD preceding the overt manifestations of type 2 diabetes (31,32). Several studies have shown that the mortality rate due to CAD was higher in patients with impaired glucose tolerance compared to normoglycemic men, although it was smaller when compared to that of patients with overt diabetes. At least one study has demonstrated that the risk of CAD increases linearly with fasting blood glucose levels in patients with impaired glucose tolerance, whereas the fasting insulin level has been implicated as a possible independent risk factor for CAD mortality in another study. Early impairment of LV diastolic function has been documented not only in patients...

Is There A Relationship Between Job Stress And The Risk Of Coronary Heart Disease

It has been found that, for both men and women, stress at work causing high demands (job strain) increases the risk of coronary heart disease. The effects of stress are greatest among the young, more junior workers at a low level who are less powerful and less able to make decisions and delegate work. Job insecurity also increases the risk of coronary heart disease and heart attacks by increasing stress levels.

Does Stress On Its Own Increase The Risk For Heart Disease

Stress is thought to be an independent cardiovascular risk factor. This means that people who are stressed, even if they do not have any other risk factor, are more likely to develop heart disease than those people who are not stressed. It has taken many years for stress to be identified as an independent risk factor, because it is difficult to measure and the effects of stress acting alone were difficult to separate from the other well-established risk factors. Stressed people may have high blood pressure, may smoke, may eat fatty food and be inactive and overweight, and therefore have high cholesterol and high blood sugar, or come from a family affected by heart disease at a young age.

Can Life Events Or Stressors Trigger Heart Attacks

Severe stress and a feeling of utter frustration and lack of control may lead to a heart attack. Acute life stressors, including bereavement and sudden severe illness, breakdown in a relationship, physical trauma, significant financial and career events, and the much less common but catastrophic events of natural disasters, wars, or terrorist attacks can trigger heart attacks. People with coronary heart disease should go to the nearest Emergency Room if they experience severe, long-lasting chest pain, sweating, and breathlessness that do not pass quickly.

What About Anger In Young Men And Heart Disease

Men aged 30 to 50 who become angry at certain situations in their life have been shown to develop heart disease and heart attacks at a younger age (younger than 55). Therefore, ways to reduce anger and stress in young men may prevent premature heart disease and heart attack. Certainly, angry young men are more likely to die early from heart problems than men who are calm. It is well known that severe anger and rage increase blood pressure and heart rate, and it is thought that this may trigger heart attacks. Generally speaking, a cool and calm personality is healthier than a highly charged emotion. Young children and young adults can be taught to control stress, and react to stress and provocative life events in a more measured and calm way.

Is Effort Reward Imbalance A Cardiovascular Risk Factor

Disenfranchised from their organization. This leads to poor performance. Office politics are common and, for some, a major cause of stress, which may lead to serious heart disease. This may lead to depression and physical illness. The victims of workplace prejudice very often adopt the attitude of if they treat me like this, then I will have no respect for them and will not be committed to the organization. Appraisals at work are intended to be a useful, productive, positive, two-way exchange of views between colleagues or employers and employees. This should reduce stress and have very beneficial results in reducing heart disease. There is no doubt that effort reward imbalance is of considerable public health importance. High job demands predict the likelihood of heart disease. Therefore, employees put under stress with deadlines and overburdened with work they realize is unrealistic and unreasonable, are likely to get stressed and depressed. This is more likely among younger workers...

Cardiovascular Disease

Coronary Artery Disease The Framingham Study showed in 2005 men and 2521 women that the 28-year age-adjusted rates (per 100) of CHD was 26.3 for a mean BMI of 21.6kg m2 and 42.2 for a mean BMI of 31 in men, and 19.5 for a BMI of 20.4 and 28.8 for a BMI of 32.3 in women, respectively (82). The 28-year age-adjusted relative risks and their 95 confidence intervals for the highest quintile compared to the lowest were 1.9 (1.4-2.5) for CHD and 1.8 (1.4-2.4) for CHD excluding angina pectoris for men and 1.7 (1.3-2.3) and 1.6 (1.2-2.3) for women, respectively. The Gothenburg study, in a 12-year incidence period, showed in a multivariate analysis, that the WHR was the strongest predictor (84) of myocardial infarction in 1462 women. In 1990, the Nurses Health Study, during an 8-year observation, clearly showed in a population of 121700 females that obesity is a determinant of CHD after control for cigarette smoking, which is essential to assess the true effect of obesity, even mild-to-moderate...

What Are Some Common Causes Of Stress And Potential Causes Of Depression As Risk Factors For Coronary Heart Disease

Failed or broken relationships are a very common cause of stress, disappointment, and pain in people of all ages. One of the most painful experiences is divorce and marital breakdown, particularly when children are involved. It is stressful for the children, too, and can trigger major psychological disorders in any party. Some people never get over it. This chronic stress is recognized as a cause of heart disease.

Coronary artery disease and CEA

Atherosclerosis is a generalized disease affecting not only the carotid arteries but often concomitantly the coronary arteries, the abdominal aorta and the peripheral arteries. This is especially true for the elderly, a population segment which is rapidly growing. Many patients who initially presented for carotid artery stenosis actually have significant morbidity or mortality due to diseases of other vascular beds mandating a more comprehensive evaluation by additional imaging studies. In three months of admission for TIA or cerebral infarction the risk for myocardial infarction and cerebrovascular death is 2 to 5 and about 30 within two years. Asymptomatic coronary artery disease in this population is high with about 20-40 and up to 25-60 of patients with symptomatic and asymptomatic carotid artery stenosis having inducible myocardial ischemia

Cardiovascular disorders Hypertension

Coronary artery disease Patients suffering from recent infarctions, i.e. within the previous 6 months, should not have surgery. Patients with coronary artery disease and angina require careful monitoring of the amount of lignocaine and adrenaline administered. Glyceryl trinitrate tablets or sublingual spray should be readily available when undertaking the surgery in the case of patients with angina.

Exercise Has a Role in Preventing and Recovering From Several Cardiovascular Diseases

Changes in the ratio of HDL to total cholesterol that take place with regular physical activity reduce the risk of atherogenesis and coronary artery disease in active people, as compared with those who are sedentary. A lack of exercise is now established as a risk factor for coronary heart disease similar in magnitude to hypercholesterolemia, hypertension, and smoking. A reduced risk grows out of the changes in lipid profiles noted above, reduced insulin requirements and increased insulin sensitivity, and reduced cardiac (-adrenergic responsiveness and increased vagal tone. When coronary ischemia does occur, increased vagal tone may reduce the risk of fibrillation.

Why Does Coronary Heart Disease Occur Later In Women And Develop So Rapidly After The Menopause

Coronary heart disease symptoms usually start around 10 years after the menopause, but the process of clogging of the arteries (atheroma) starts much earlier. It is thought to start in some people during childhood, particularly in those with an unhealthy lifestyle. It has been suggested that women are protected by the hormone estrogen while they still have periods. After the menopause, when women go through their change, the estrogen levels fall, and women become vulnerable to coronary heart disease. After the menopause, coronary heart disease can progress very rapidly, particularly in women with cardiovascular risk factors. After the menopause, the levels of cholesterol, the bad LDL cholesterol, triglycerides, glucose, and blood clotting factors (fibrinogen) increase. All the substances increase the fat

Pathophysiology Of Acute Coronary Syndromes

Plaque rupture with thrombus formation is the primary pathophysiologic mechanism behind acute coronary syndromes (1-5). This process is complex and starts with exposure of subendothelial constituents like collagen, von Willebrand factor, fibronectin, and vitronectin. These elements are recognized by platelet surface receptor glycoprotein Ib and lead to platelet activation and adhesion to the vessel wall. Activated platelets release from their a-granules substances such as thromboxane A2, thrombin, adenosine diphosphate, and serotonin. These are vasoconstrictor substances, and they cause a physiological obstruction superimposed on the mechanical disruption. More important, they lead to further platelet activation and aggregation. The final common pathway of platelet aggregation involves activation of the GP IIb IIIa surface receptors, which cross-link platelets via fibrinogen bridges. Aggregated platelets facilitate the conversion of pro-thrombin to thrombin, and this leads to...

Thrombolytic Therapy For Acute Coronary Syndromes

Because of the high incidence and detrimental role of intracoronary thrombus in acute coronary syndromes, much attention has been focused on the potential use of thrombolytic agents to improve outcomes. Several randomized trials (12-25) were undertaken in the late 1980s and early 1990s to assess the effect of thrombolytic therapy on angiographic and clinical outcomes in patients with unstable angina and non-ST-elevation MI. These studies involved relatively small numbers of patients and used a variety of thrombolytic agents including tissue-type plasminogen activator, streptoki-nase, or urokinase. The findings of these studies were not consistent, and most, but not all, showed angiographic and clinical benefits (Table 1). Because of their small size and the conflicting results, no definitive conclusions could be reached about the efficacy of thrombolytic therapy in unstable angina and non-ST-elevation MI. The Thrombolysis in Myocardial Infarction (TIMI) III trial was the first large...

Effect Of Hypoglycaemia On Cardiovascular Disease

Acute hypoglycaemia provokes an intense haemodynamic response secondary to activation of the autonomic nervous system with the secretion of epinephrine (adrenaline) (DeRosa and Cryer, 2004). The heart rate increases over a period of 15 to 20 minutes, but rarely rises above 100 beats minute. A modest but significant increase in systolic blood pressure is accompanied by a slight but significant fall in diastolic blood pressure (Fisher et al., 1987 Russell et al., 2001). The pulse pressure widens, with a substantial increase in cardiac output and a fall in total peripheral vascular resistance (Figure 12.5). These haemodynamic changes are relatively short-lived, and exert no significant after-effects on the 24-hour heart rate or blood pressure (Avogaro et al., 1994). In a person with a normal heart these haemodynamic changes are probably of no great significance, but in a patient who has underlying coronary heart disease the profound increase in cardiac workload may provoke a cardiac...

Will you die of cardiovascular disease

Cardiovascular disease is responsible for about half of all deaths each year in the United States and Europe it is by far the largest single killer in those countries. The immediate cause of most of these deaths is heart attack or stroke, but those events are frequently the end result of a disease called atherosclerosis (hardening of the arteries) that begins many years before symptoms are detected. Hence atherosclerosis is called the silent killer. The blood supply to the heart itself flows through the coronary arteries, which are highly susceptible to atherosclerosis. As these arteries narrow, blood flow to the heart muscles decreases. Chest pain and shortness of breath during mild exertion are symptoms of this condition. A person with atherosclerosis is at high risk of forming a thrombus in a coronary artery. This condition, called coronary thrombosis, can totally block the vessel, causing a heart attack, or myocardial infarction (MI). The most effective approach to cardiovascular...

Arrhythmias and Coronary Heart Disease

Occasional cardiac arrhythmias have been demonstrated in normal subjects during experimental hypoglycaemia studies. It would now be considered unethical to perform hypogly-caemia studies in patients with known heart disease, but many studies were performed in an earlier era both in diabetic and non-diabetic patients with coronary heart disease to examine the effects of acute hypoglycaemia (Fisher and Frier, 1993). Sinus bradycardia has been reported in a very small number of cases (Pollock et al., 1996 Navarro-Gutierrez et al., 2003). Atrial fibrillation has been described in some patients and in addition there are several case reports of atrial fibrillation following hypoglycaemia in insulin-treated patients who had no overt evidence of heart disease (Collier et al., 1987 Baxter et al., 1990 Odeh et al., 1990 Navarro-Gutierrez et al., 2003). There is a single report of a transient ventricular tachycardia occurring during experimental hypoglycaemia in a non-diabetic patient with...

Crosssectional And Prospective Studies Relating Testosterone To Cardiovascular Disease Endpoints

There has been considerable interest during the past two decades regarding the importance of endogenous testosterone to the development of cardiovascular disease in middle-aged and elderly men (71-77). Studies evaluating the relationship between endogenous testosterone and cardiovascular morbidity and mortality in men have yielded inconclusive results. Most of these studies were hospital-based, case-control studies, in which cases were either men with acute myocardial infarction or men who had survived an infarction. Of the 31 cross-sectional studies, 19 (61 ) found lower plasma total or free-testosterone levels in men with myocardial infarction or coronary artery disease compared with controls (21,78,79-95), whereas the remaining studies reported no significant difference in hormone levels between cases and controls (96-107). Cross-sectional studies have also analyzed the relationship between endogenous testosterone levels and the presence of angiographically defined coronary artery...

Is It Dangerous to Have Sex if Patients Have Angina or Have Had a Heart Attack

Active sex is like other forms of exercise that increase the heart rate and blood pressure. Sex for men without heart problems may cause breathlessness. In men with coronary heart disease, it may cause angina and rarely cause heart attacks. It is difficult to know if, or how often, sex has caused death due to a heart attack because it is difficult to find out and not the sort of question that is volunteered or asked at the time. Although theoretically, vigorous sex can trigger a heart attack (like severe exercise or stress), heart attacks occur for many reasons we do not understand. Most heart attacks do not occur during or shortly after sex.

Antibiotics In Medical Settings For Diseases Not Traditionally Viewed As Infections The Example Of Cardiovascular

Chlamydia pneumoniae has been associated with atherosclerotic cardiovascular disease in seroepidemiologic studies, by detection of the organism in atherosclerotic plaque, and in animal model studies (25-28). The proposed mechanism for atherosclerosis would be a response to injury wherein the infection may trigger and aggravate endothelial damage, or alternatively, may create local inflammation of the arterial wall. Indirect effects of the infectious agent such as systemic inflammation with a corresponding increase in C-reactive protein, leukocyte count, and cytokines may also be important. Retrospective studies have attempted to see if patients who were treated with antibiotics, for whatever indication are at lower risk for developing cardiovascular disease events like acute myocardial infarctions. These studies have yielded mixed results with some finding positive associations (29) and others finding no relationship (30). Two clinical trials to assess the effect of treatment with...

NonSTSegment Elevation Myocardial Infarction

Few studies have specifically addressed the influence of gender differences on the outcome of patients who present with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization procedures. Women who present with non-ST-segment elevation myocardial infarction that undergo angioplasty are consistently older, and have an increased incidence of hypertension with a preserved left ventricular ejection fraction when compared men. In one study, 941 women who underwent coronary angioplasty had a similar success, in-hospital mortality, and emergency coronary artery bypass surgery rate as men and overall survival during a mean follow-up period of 4 yr was comparable. Although women were more likely to experience severe angina than men, women were less likely to undergo coronary artery bypass grafting during this time (141). Women with unstable angina or non-Q wave myocardial infarction enrolled in the TIMI-IIIB trial were older with a higher prevalence of...

Are Depression Loneliness And Lack Of Social Support Cardiovascular Risk Factors

Depression, social isolation (loneliness), lack of emotional support from family and friends are independently associated with heart disease and the risk of heart attack and death. This is very difficult to treat, as these people are invisible and unlikely to seek help. They may resort to drugs, alcohol, and, in extreme cases, suicide. These conditions are common in the elderly, especially after the death of their partner or spouse. There are few things more depressing than loneliness, to a person who is frail and medically unwell and who has major financial problems. The bereavement may trigger a heart attack in an elderly, vulnerable person.

Introduction Of Myocardial Infarction

Pgi2 Cell Cycle

Fifteen years ago the Gruppo Italialono per lo Studio della Streptochianasi nell'Infarto Miocardico (GISSI) trial firmly established the benefit of fibrinolytic therapy in acute myocardial infarction (1). Several years later, the importance of adjunctive antiplatelet therapy with aspirin was demonstrated in the Second International Study of Infarct Survival (ISIS-2) (2). The need for concomitant anticoagulant therapy with heparin remains less clear, but indirect evidence in the setting of fibrin-specific lytics has led to widespread adoption (3,4). However, pharmacologic reperfusion for acute ST-elevation myocardial infarction is limited by the fact that infarct-related artery patency is achieved in only 60-80 of patients at 90 min, and Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 is achieved in only 30-55 of patients (5). Moreover, even after successful thrombolysis, reocclusion occurs in 5-10 of patients and is associated with increased morbidity and mortality (5,6)....

Coronary Artery Disease and Heart Attacks

In coronary artery disease, changes in one or more of the coronary arteries causes insufficient blood flow (ischemia) to the heart. The result may be myocardial damage in the affected region and, if severe enough, death of that portion of the heart a myocardial infarction, or heart attack. Many patients with coronary artery disease experience recurrent transient episodes of inadequate coronary blood flow, usually during exertion or emotional tension, before ultimately suffering a heart attack. The chest pain associated with these episodes is called angina pectoris (or, more commonly, angina). The symptoms of myocardial infarction include prolonged chest pain, often radiating to the left arm, nausea, vomiting, sweating, weakness, and shortness of breath. Diagnosis is made by ECG changes typical of infarction and by measurement of certain proteins in plasma. These proteins are present in cardiac muscle and leak out into the blood when the muscle is...

Patients With Minimal Structural Heart Disease or With LVH

In patients with minimal or no significant structural heart disease, any antifibrillatory agent can be employed. A specific agent should be selected by its side-effect profile. Class IC agents such as propafenone and flecainide have an extremely low incidence of ventricular proarrhythmia in normal hearts, and are generally well-tolerated. Sotalol and class IA agents such as disopyramide and procainamide can be used safely in this setting if careful attention is given to the dose-dependent QT-prolonging effects of these drugs. Quinidine is the exception, because it has both a dose-dependent and an idiosyncratic QT-prolonging effect in certain individuals. Periodic complete blood counts should be performed on patients who are taking either procainamide or quinidine because of the rare occurrence of blood dyscrasias. Disopyramide is well-tolerated in younger patients, but because of its significant anticholinegic effects, caution should be used in men with symptoms of an enlarged...

Can We Get Rid Of Coronary Heart Disease

Once fat has been deposited inside an artery it cannot be removed completely. Modern treatments, such as the cholesterol-lowering drugs called statins, combined with a low-fat diet and vigorous daily exercise, may help reduce the amount of fat inside the artery. Statins (which can now be bought, like aspirin, over the counter) reduce the cholesterol level, reduce the inflammation in the arteries, and convert a lump of soft, inflammed fat which is likely to crack (an unstable fatty plaque) into a stable plaque. So even though there maybe fat in an artery, it can be changed into a relatively harmless type of fat. This reduces the risk of heart attacks and can improve symptoms of angina. We now give statins to everyone who has had a heart attack and has coronary or any other form of vascular disease.

If We Dont Die From A Heart Attack Or A Stroke What Are We Likely To Die From

Not all old people die from coronary heart disease. Many die from old age worn-out kidneys, dementia, an infection (for example, a bad chest infection or pneumonia) or cancer. Cancer is not as common a cause of death as heart attacks, heart failure, and stroke. Elderly people who develop cancer frequently die from cardiovascular disease rather than their cancer because many forms of cancer grow slowly in the elderly.

How To Reduce Your Chance of a Heart Attack

To find your risk for a heart attack, check the boxes that apply to you A family history of early heart disease One or more previous heart attacks, angina, bypass surgery or angioplasty, stroke, or blockages in neck or leg arteries The more risk factors you have, the greater your risk for a heart attack Reduce Your Risk of a Heart Attack by Taking Steps To Prevent or Control Risk Factors

Risk Stratification In Acute Coronary Syndromes

Several analyses have been performed attempting to identify prognostic risk factors in patients with unstable angina and non-ST-elevation wave MI. Traditional risk factors associated with worse outcomes have included increased age, accelerated or rest angina, associated pulmonary edema, mitral regurgitation murmur or S3 sound, ischemic ECG changes, elevated creatinine kinase levels, and a positive stress test. More recently identified risk factors include elevated troponin (40-42), fibrinogen (43), and C-reactive protein levels (44,45). The most comprehensive risk assessment model to date is the TIMI risk score proposed by Antman at al. (46). In that analysis, the test cohort was the unfractionated heparin group in TIMI 11B trial and the 3 validation cohorts were the unfractionated heparin group from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events (ESSENCE) trial and both enoxaparin groups from the TIMI 11B and ESSENCE trials. The TIMI risk score was...

Risk Factors For Atherosclerotic Cardiovascular Disease In Obesity

Clerotic cardiovascular disease (ACVD), obese people often present well-recognized coronary risk factors such as hypertension, lipid abnormalities, and type 2 diabetes (Table 25.2). There is now evidence that fat distribution rather than excess fatness is more commonly associated with these risk factors for ACVD. Abdominal fat deposition, which is principally observed in males and in postmenopausal females, is not only independently associated with ischaemic heart disease, but is a clinical condition in which the traditional risk factors for atherosclerosis are determined by the presence of insulin resistance which has likewise been associated with increased cardiovascular risk (11). The clinical aggregation of all these risk factors is also called the '(pluri)meta-bolic syndrome or syndrome X'. Regardless of these linguistic bagatelles, these patients will be exposed throughout their life to an excess risk for ACVD.

Lipids and Coronary Artery Disease Risk

As discussed more thoroughly in Chapter 17, epidemiological studies have shown that men with lower serum total testosterone levels are at higher risk for cardiovascular events (56,57). In men undergoing coronary angiograms, those with evidence for coronary artery disease had significantly lower serum free androgen index and bioavailable testosterone levels than did those without apparent coronary artery disease (58,59). Older studies described a lessening of ST segment depression and reduced anginal symptoms in men with coronary artery disease after testosterone treatment (60,61). Acute administration of testosterone in men with exercise-induced myocardial ischemia reduced ST segment depression and increase exercise testing time compared to placebo (62,63). Because of this acute action of testosterone, the effect may be ascribed to a direct coronary vasodilatory effect of the steroid. A subsequent study confirmed this hypothesis by showing that acute testosterone infusion increased...

Amiodarone in Patients with Structural Heart Disease

Since many of the patients who have AF have significant structural heart disease, attempts should be made to use drugs with mortality-neutral effects. Currently, amiodarone has the largest clinical experience in patients with structural heart disease. The South American GESICA trial (78) demonstrated a reduced morbidity and mortality in patients treated with amiodarone who had severe CHF. Although CAMIAT (79) and EMIAT trials (80) demonstrated a reduced risk of sudden death in patients treated with amiodarone, there was no significant difference in overall mortality compared to patients treated with placebo. The CASCADE trial (81) demonstrated an improved survival in patients who survived sudden death when treated with amiodarone vs electrophysiologic-guided standard antiarrhythmic therapy. In a meta-analysis (82) of over 6500 patients in 20 trials utilizing amiodarone, post-MI or in CHF, there was a 13 decrease in total mortality in treated patients. Although these trials were not...

Measures Of Androgenicity In Men At Risk For Coronary Artery Disease

Because the portion of circulating testosterone that is not bound to SHBG is generally believed to represent the biologically active fraction, many laboratory methods for determining non-SHBG-bound testosterone or free testosterone have been developed. Because SHBG levels are low with obesity or hyperinsulinemia, established risk factors for the development of coronary artery disease, such methods are essential for research seeking to link testosterone to cardiovascular endpoints. Of the methods available, there is a high positive correlation between the level of free testosterone by equilibrium dialysis, the gold-standard, non-SHBG testosterone (bioavailable testosterone), and the free-testosterone level calculated from the levels of total testosterone and SHBG (171,172).

Why Is Coronary Heart Disease More Difficult To Diagnose In Women And Why Is Diagnosis Delayed

Doctors make a diagnosis of angina from the patient's description of her symptoms. Nearly everyone with angina has coronary heart disease. Very rarely, patients with other conditions may have angina but have normal heart arteries. Whereas men with coronary heart disease are more likely to have the typical angina symptoms of chest pain and breathlessness when they exercise, symptoms of angina in women are more often atypical and include back pain, burning in the chest, nausea, and fatigue symptoms that would not usually prompt doctors to consider a heart problem. In women, symptoms of both angina and a heart attack are more likely to be atypical and less obvious. Therefore, there may be a delay in diagnosis. Women with chest pain are less likely to be referred to a heart specialist and less likely to have further tests. If women's angina or heart attacks are not diagnosed, then patients will not have the right treatment. Unless angina and heart attacks are suspected, the diagnosis and...

Cardiovascular Diseases

Coronary Artery Disease Statistics

The most common cardiovascular diseases are hypertension and heart disease, but the basis for most cardiovascular diseases is atherosclerosis, which is almost universally present in U.S. adults and is manifest clinically as coronary heart disease (CHD), cerebrovascular disease (stroke), or peripheral arterial disease. The likelihood of developing one of these diseases is high, and they affect the health of nearly 59 million Americans.2 In 1999, these diseases were projected to account for 178 billion in health care expenditures in the United States-2 percent of the gross domestic product (Fig. 1-1). These diseases also account for an estimated 108 billion in lost productivity due to illness and premature mortality. These expenditures and indirect costs are by far the largest for any diagnostic group. Figure 1-1 Health expenditures for cardiovascular diseases, United States, 1999 (includes expenditures for hospital, home, and nursing home care physician and other professionals and...

Diagnosis and Treatment of Acute Stroke and Underlying Etiology Based on MRI

On T2-WI, ischemic infarction appears as a hyperintense lesion. Definite signal changes, however, are at the earliest seen 2 h after stroke onset in animal experiments and 6 to 8 h after stroke onset in human stroke 9 . Neither a diagnosis of parenchymal ischemia nor the differentiation of ischemic core from penumbral tissue is possible with T2-WI. On the other hand, T2-WI provides a good anatomical definition of the brain, and depicts microangiopathic changes, edema, old infarcts, or other pathologies 10 (Figure 9.1). FLAIR demonstrates hyperintense vessel sign 11 (Figure 9.2). MRA demonstrates vessel occlusion or patency 12 (Figure 9.3). T2-WI (e.g., source images from PWI) shows the presence or absence of acute and chronic intracranial hemorrhages. The advent of perfusion-(PWI) and diffusion-(DWI) weighted imaging in the early 1990s has added another dimension to diagnostic imaging in stroke 13-15 . During the last years a growing body of evidence has accumulated, documenting the...

Cardiovascular Diseases In The United States And Prevention Approaches

The large and long-term decline in mortality from the cardiovascular diseases accounted for almost 4 of the 5.6-year increase in life expectancy in the United States attained between 1965 and 1995.1 The 55 percent decline in the age-corrected death rate for total cardiovascular disease between 1950 and 1996 indicates the extent to which these leading causes of death are subject to preventive and therapeutic measures. These diseases, however, still account for 41 percent of all deaths and are leading causes of morbidity and health care utilization. Control of these diseases should focus on prevention because of its inherent benefits, its apparent role in the mortality reductions, and its potential given the presence of modifiable risk factors in millions of Americans.

Specific Activities as Potential Triggers of Acute Myocardial Infarction

Trigger Worksheets For Mental Health

Morning and awakening appears to trigger acute coronary syndromes. Other environmental changes, such as the transition from weekend to work week and changes in weather cycles, may also function as triggers. Many investigators have sought specific events identifiable by patients as triggers. Studies using interview techniques to determine the fraction of patients reporting a suspected triggering activity in the time period immediately preceding the onset of symptoms have found that 25 to > 50 of patients describe moderate to heavy physical exertion, unusual emotional stress, lack of sleep, overeating or use of alcohol, noncardiac illness or surgery, or some other activity as ongoing at the time of, or in the 24 h preceding, the onset of infarction (82-85). However, these data are limited by recall bias and by the difficulty of obtaining appropriate control data, i.e., the frequency with which the activity occurs without an acute event following. New epidemiological techniques have...

Dietary fats and the risk of coronary heart disease 141 Epidemiological studies and clinical trials

Cardiovascular diseases comprise many different disorders related to impaired blood flow, including disease of the heart (mostly coronary heart disease), the brain (ischaemic and haemorrhagic stroke) and peripheral blood vessels (e.g. deep vein thrombosis). Effects of dietary fats on the risk of coronary heart disease have been most widely studied and are established by both epidemiological studies and randomised controlled clinical trials. Of all cardiovascular diseases, a causal relationship with blood lipid levels is most clear for coronary heart disease. Although cholesterol lowering by drug treatment (HMG-CoA-reductase inhibitors, statins) lowers both the risk of coronary heart disease and that of stroke, the epidemiological data on dietary fats and stroke are very limited and show no clear associations with the amount or type of dietary fats (He et al., 2003). In contrast, for CHD there are several epidemiological studies that addressed the associations with dietary fats as well...

What Are The Chances Of Surviving A Heart Attack

Thirty percent of people who have a heart attack die before reaching hospital. This is usually because the normal heart rhythm changes into an abnormal heart rhythm called ventricular fibrillation (sometimes called a VF arrest). Sometimes the heart just stops beating and there is no electricity in the heart muscle (called an asystolic no heart action - cardiac arrest). Around 10 of patients who reach the hospital, die in the hospital. The risk of dying is greatest in the elderly, those who have had a lot of damage to their heart, and those with cardiovascular risk factors, or who get a chest infection, a clot in their lungs (pulmonary embolus), or have bad kidney function. Young, fit people can have heart attacks but they generally do well afterwards.

STElevation Myocardial Infarction Thrombolytic Therapy

While aggressive reperfusion therapy with pharmacologic agents has been shown to reduce in-hospital mortality by as much as 25-30 , women are more likely to have a contraindication to thrombolysis and, therefore, not receive thrombolytic therapy (122). This observation was confirmed in a series of1059 patients who presented with an acute myocardial infarction, which revealed that women were less likely to receive throm-bolytic agents than men (126). Moreover, it has been shown that only 55 of eligible women compared with 78 of eligible men receive tissue plasminogen activator. In contrast to these observations, a recent retrospective review of women age 50 yr or younger, who presented with an acute myocardial infarction, determined that 94 of women met eligibility criteria for thrombolytic agents, and 91 of these women were treated with drug. The most common reasons for withholding thrombolytic agents were nondiagnostic electrocardiogram and late presentation (> 12 h after symptom...

Rheumatic Fever And Rheumatic Heart Disease

Rheumatic fever is a prominent cause of serious valvular heart disease. Acute rheumatic fever and subsequent rheumatic heart disease remain important cardiovascular problems in the tropical and subtropical developing countries of South America, Africa, the Middle East, and Asia, and there have been outbreaks in the United States in recent years.37 Although preventable, rheumatic fever occurs more frequently because of overcrowding, the deceptive self-limited nature of symptoms in streptococcal pharyngitis, and the mild and often clinically inapparent nature of streptococcal infections. The availability of penicillin to treat these infections, living conditions that are less crowded than formerly, and evolution of different strains of Streptococcus have made rheumatic fever uncommon in the United States, although the incidence remains high in subgroups such as blacks, Puerto Ricans, Mexican Americans, and Native Americans (see Chap. 62). Because this disease has not been eradicated in...

When Is It Safe to Have Sex after a Heart Attack

It is probably safe to have sex after a heart attack as soon as the person is able to walk half a mile or up a flight of stairs without angina or breathlessness. The time it takes for people to feel in the mood for sex and self-confident varies a lot, from a few weeks to months. Patients and or their partners who are scared to have sex because they think it would be dangerous should speak to their internist or cardiologist.

Fatty acids and cardiovascular risk clinical epidemiology

NEFAs may be a common denominator linking diverse entities such as central obesity, physical inactivity, and familial combined hyperlipidemia to elevated blood pressures and greater cardiovascular risk. In the Paris Prospective Study, e.g., elevated fasting NEFA concentrations were independently predictive of the development of hypertension and sudden death (8,9). In the same study, hypertensive men had higher fasting NEFA concentrations than normotensive men with the greatest differences evident in leaner than more obese subjects (10). Moreover, in 50-yr-old Swedish men, higher serum levels of saturated fatty acids and oleic acid were independently predictive of left ventricular hypertrophy assessed at age 70 (11). Collectively, these data suggest that abnormalities of NEFA metabolism characterized by relatively high plasma concentrations that do not suppress normally in response to insulin may participate in increasing metabolic and hemodynamic risk factors for cardiovascular...

Factor For The Development Of Cardiovascular Disease Coronary Disease And Lower Extremity Arterial Disease

Regular physical activity is an independent factor in delaying sudden (premature) cardiac death among middle-age men. The relation of self-selected leisure-time physical activity to first major coronary event and overall mortality was studied in 12,13 8 middle age men who participated in the Multiple Risk Factor Intervention Trial (MRFIT) (36). The basic methodology of the MRFIT study was a questionnaire requesting the leisure-time physical activity for the preceding year quantified in minutes per day. The study participants were categorized as low, moderate, or high, according to the leisure-time physical activity performed. The combined rate of fatal coronary heart disease, sudden cardiac death, and all-cause mortality in the moderate category was 64 , whereas the same rate in the low leisure-time physical activity group was 73 (p < 0.01). Interestingly, the mortality rates of subjects with high leisure-time physi- cal activity were similar to that of subjects with moderate...

Expectations about Heart Attack Symptoms

REACT focus groups found that, overwhelmingly, participants expected that heart attack symptoms would correspond to common Hollywood movie portrayals as sharp crushing chest pain or collapse, such as a cardiac arrest. They thought there would be no doubt about the nature of the event that was occurring. This was in sharp contrast to the actual experience of heart attack symptoms described by participants (53). In addition to expecting a dramatic chest clutching presentation, knowledge of the complex array of heart attack symptoms, even the more common ones, is lacking in the American public. A random-digit-dialed telephone survey conducted among 1294 adult respondents in 20 communities from the REACT research program revealed that knowledge of chest pain as a presenting heart attack symptom was high and relatively uniform (89.7 ). However, knowledge of some of the other associated symptoms was suboptimal. Only two-thirds (67.3 ) identified arm pain as a symptom shortness of breath was...

Coronary Artery Disease and Atherosclerosis

Despite advances in both treatment and prevention, complications of atherosclerotic disease remain the leading cause of morbidity and mortality in the Western World 56 .More than 50 of atherosclerotic deaths can be attributed to coronary heart disease with estimated socioeconomic costs of 112 billion in the year 2002 in the United States alone. While atherosclerosis may progress slowly over years or decades, the occurrence of thrombosis as a consequence of sudden plaque rupture often leads to abrupt life threatening complications. Such acute events may explain why many people who die from coronary artery disease die suddenly without manifestation of typical symptoms. As reported by Glagov et al 3 , the initial response to endothelial injury and initial development of atherosclerosis is outward remodeling of the artery, with relative preservation of lumen diameter. Such findings have been confirmed in living patients with invasive 57 and non-invasive techniques 58, 59 . Over 50 of all...

MUFA and cardiovascular risk

Diet, and especially its fat content, can have a varying influence upon cardiovascular risk factors and on mechanisms related to the onset and progression of atheroma plaques. The final aim of preventing and treating coronary arteriosclerosis is to reduce the risk of new heart attacks and mortality from them. In spite of this, research studies into the effects of dietary intervention on the clinical course of the disease are few in number and have only provided significant results in secondary prevention of the disease (Brousseau and Schaefer, 2000). Intervention studies researching the preventive effects of the traditional Mediterranean dietary model, i.e. a high concentration of total fat from MUFA, do not exist . In a trial conducted on patients with coronary heart disease, the effect of a diet rich in n-3 alpha-linolenic acid, referred to as the Mediterranean diet, was studied (de Lorgeril et al., 1994). This diet was accompanied by a 70 reduction in cardiovascular risk, much...

Exclusion of Other Causes of Acute Stroke Symptoms

Nontraumatic intracranial hemorrhage (ICH) accounts for 10 to 15 of all strokes and up to 25 of more severe strokes 45,46 . Hyperacute stroke does not only demand an all-round diagnostic work-up, with which all the important pathophysiologic aspects can be investigated, but also the differentiation between ischemic stroke and ICH by the radiologist, which is impossible to achieve by clinical means only. Although early deterioration of vigilance, vomiting in anterior circulation as opposed to posterior circulation syndrome, coumadine therapy, or hypertensive crisis may hint towards ICH, these symptoms can also be seen in ischemic stroke. Noncontrast CT imaging is still the current diagnostic standard for imaging of acute stroke mainly due to its close to 100 sensitivity to confirm or exclude ICH 15,42,47 . Until recently, MRI was considered to be of little value for the diagnosis of ICH or subarachnoid hemorrhage (SAH). As opposed to CT, due to the complexity of the ICH appearance in...

Some People Die Suddenly from a Heart Attack without Having Had Angina

A heart attack occurs if one of the three heart arteries blocks off (coronary thrombosis). For many people with coronary heart disease, their first symptom is a heart attack or sudden death, without ever having had any warning symptoms of angina. Heart attacks are very dangerous and unpredictable. 30 of patients die before reaching hospital. The sudden lack ofblood and oxygen to the heart causes a fatal heart rhythm called ventricular fibrillation the heart stops beating and the circulation of blood around the body stops. Even with prompt medical care and attempts to resuscitate the patient, these attacks are usually fatal. The other half of patients recover from their heart attack. Modern medical treatments continue to improve the chances of a longer, more active life for survivors of heart attacks.

Should Women Beconcerned About Coronaryheart Disease

Many people think that coronary heart disease is a male disease. This is not true. Although coronary heart disease affects women around 10 years later than men, in people over 65 years old, it is as common in women as in men. It is not understood why it occurs later in women. 2. Most women believe that they are more likely to die from cancer (breast cancer is the most common). This is not true. Women are four times as likely to die from a heart attack than from breast cancer. Coronary heart disease affects women as much as men in people over 60 years old.

Whatis A Heart Attack

A heart attack is death and damage to the heart muscle. This is caused by a blood clot in one of the three main heart arteries, blocking the supply of blood to the heart muscle. The clot in the heart artery blocks the supply of blood, oxygen, and nutrients to the heart muscle. Without blood and oxygen, the heart muscle cells die within one hour. Unless the blood supply to the heart muscle is restored within one hour, the muscle cells will not recover. Some recovery of some of the cells may occur if their blood supply is restored within six hours. After 12 hours, the cells cannot recover. This is the reason why it is crucial for patients with heart attacks or suspected heart attacks to phone for an emergency ambulance so that the diagnosis can be confirmed and the condition treated immediately. Patients with heart attacks are now being taken directly to the cardiac catheter laboratory for angiography to see if a heart artery is blocked and where it is blocked. The cardiologist will...

Heart Attacks Are Due To Cracking Of The Surface Of A Layer Of Fat Cholesterol

The crack in the surface of the fat layer causes a blood clot to form at the site of the crack. The blood clot may, if big enough, and if not broken down or dissolved by the body's own clot dissolving mechanism, block off the artery completely. If no blood and oxygen get to the heart muscle cells, they die. This is called a heart attack.

So What Should Girls And Young Women Do To Reduce Their Risk Of Heart Disease

Young women should do everything they can to reduce their risk of getting coronary heart disease and make sure that they stop or do not start smoking that their blood pressure is normal that they do not have diabetes or high cholesterol that they are slim and fit. They should adopt good habits when they are young. After the menopause, women should be especially careful and have a healthy lifestyle. Prevention of coronary heart disease should start in childhood, and young women should be aware of the risks they face if prevention is left too late. All women, particularly those who have had a heart attack and who are all their risk factors checked. They may need medication and will need to be careful about their diet and their weight, and take advice about regular exercise.

Case 7 A Patient with Congenital Heart Disease and Therapies for a Short Arrhythmia

Initiation Strip

Patient 29-year-old male with surgically corrected complex congenital heart disease (double outlet right ventricle malposition of the great arteries, VSD, and coarctation), left ventricular dysfunction, and superior vena cava syndrome, uses salbutamol inhalatorbecause he is asthmatic. QRS width 170 ms.

Heart Disease

Patent Ductus Arteriosus Surgery Scar

CORONARY ARTERY DISEASE Coronary artery disease (CAD), which results from atherosclerosis of the vessels that supply blood to the heart muscle, is a leading cause of death in industrialized countries (see Fig. 9-8). An early sign of CAD is the type of chest pain known as angina pectoris. This is a feeling of constriction around the heart or pain that may radiate to the left arm or shoulder, usually brought on by exertion. Often there is anxiety, diaphoresis (profuse sweating), and dyspnea (difficulty in breathing). Degenerative changes in the arteries predispose a person to thrombosis and sudden occlusion (obstruction) of a coronary artery. The resultant area of myocardial necrosis is termed an infarct (Fig. 9-12), and the process is known as myocardial infarction (MI), the heart attack that may cause sudden death. Symptoms of MI include pain over the heart (precordial pain) or upper part of the abdomen (epigastric pain) that may extend to the jaw or arms, pallor (paleness),...

Contemporary o Cardiology

Management of Acute Coronary Syndromes, Second Edition, edited by Christopher P. Cannon, md 2003 Aging, Heart Disease, and Its Management Facts and Controversies, edited by Niloo M. Edwards, CD, Second Edition, by Jules Constant, md, 2003 Primary Angioplasty in Acute Myocardial Infarction, edited by James E. Tcheng, md, 2002 Cardiogenic Shock Diagnosis and Treatment, edited by David Hasdai, md, Peter B. Berger, md, Alexander Battler, md, and David R. Holmes, Jr., md, 2002 Management of Cardiac Arrhythmias, edited by Leonard I. Ganz, md, 2002 Diabetes and Cardiovascular Disease, edited by Michael T. Johnstone, md and Aristidis Veves, md, dsc, 2001 Preventive Cardiology Strategies for the Prevention and Treatment of Coronary Artery Disease, edited Platelet Glycoprotein IIb IIIa Inhibitors in Cardiovascular Disease, edited by A. Michael Lincoff, md, and Eric J. Topol, md, 1999 Minimally Invasive Cardiac Surgery, edited by Mehmet C. Oz, md and Daniel J. Goldstein, md, 1999 Management of...

Clinical Spectrum Of

It is useful to note that there are several other groups of patients who fall on this spectrum of myocardial ischemia (Fig. 2) Among patients with stable coronary artery disease, many apparently stable patients have active lesions, which are prone to rupture over the subsequent months and years (17). Although most patients remain clinically stable (18), it is estimated that nearly all of these patients with stable coronary artery disease have subclinical plaque rupture events (19,20). At the extreme right of the spectrum of ischemic heart disease (Fig. 2) are patients with sudden cardiac death. Many patients have an acute coronary occlusion as the etiology of the cardiac arrest. However, with aggressive emergency medical services which respond rapidly and treat with advanced cardiac life support (ACLS) procedures, more patients are presenting with resuscitated sudden cardiac death (27). Indeed, the National Heart Attack Alert Program (NHAAP) has as one of its major goals the...

Markers of Thrombosis

Eisenberg and colleagues (157) reported previously that thrombin activity was increased among patients with acute coronary thrombosis. Our group has shown that both thrombin activity and platelet activity (determined by the expression of surface proteins using flow cytometry) are increased in acute coronary syndromes and that heightened activity persists even after the acute clinical symptoms have resolved (158). Plasma markers of thrombin activity and generation may provide useful information during the early assessment of patients with MI at rest in whom electrocardiographic changes are either absent or nondiagnostic. In this setting, elevations in FPA, thrombin-antithrom-bin complexes, and prothrombin activation fragment 1.2 may identify patients with active coronary artery disease (159). D-Dimer, a breakdown product of fibrin, has shown promise as a diagnostic marker among patients with venous thromboembolic disease and is currently being evaluated in the setting of acute coronary...

Linking Triggers And Acute Coronary Events Circadian Changes in Physiologic Variables

Daily activities and experiences, which act as triggers of acute coronary syndromes, must act through the perturbation of the physiologic milieu in which a vulnerable atherosclerotic plaque exists (Fig. 11). Circadian variation in hemodynamic variables has been studied to explain the circadian variation of acute cardiac events. The morning hours are associated with a rise in arterial blood pressure and an increase in heart rate, both of which are reduced during sleep (109,110). This hemodynamic surge appears to be related to assumption of the upright posture (111). Most studies have shown that episodes of ambulatory ischemia are related to an increase in rate-pressure product (111), and that ambulatory myocardial ischemia is more frequent and more prolonged in the morning (42-47). Angina patients and normal subjects have a significantly greater blood pressure and heart rate response during an exercise test in the morning compared to the response during an afternoon exercise test...

Therapeutic Considerations bAdrenergic Blocking Drugs

Given the pivotal role of the sympathetic nervous system as a mediator of the triggering process, close attention has been paid to the effects of b-adrenergic blocking agents on the onset of acute coronary syndromes. Several studies of the circadian variation of the time of onset of acute myocardial infarction reported that the morning excess of events was attenuated in patients taking b-blockers compared to patients not taking these

Calcium Channel Blocking Agents and Nitrates

In the Physician's Health Study, the significant (p < 0.001) morning increase among 211 nonfatal myocardial infarctions (top panel) was preserved in patients randomized to placebo (p < 0.001) (middle panel) and attenuated (p 0.16) in patients randomized to aspirin, 325 mg every other day (bottom panel). Reprinted with permission from ref. 169. Fig. 15. In the Physician's Health Study, the significant (p < 0.001) morning increase among 211 nonfatal myocardial infarctions (top panel) was preserved in patients randomized to placebo (p < 0.001) (middle panel) and attenuated (p 0.16) in patients randomized to aspirin, 325 mg every other day (bottom panel). Reprinted with permission from ref. 169. of the circadian variation in the time of onset of acute myocardial infarction identified a subset of patients taking calcium channel blockers and found a persistent morning increase in infarctions in these patients (27,35) (Fig. 14). On the other hand, some smaller trials...

Angiotensin Converting Enzyme Inhibitors and Angiotensin II Type 1 Receptor Antagonists

These agents have effects beyond their simple hemodynamic benefits. Angiotensin-converting enzyme inhibitors influence the intravascular hemostatic environment to favor fibrinolysis (165) and improve endothelial function (166). The recent Heart Outcomes Prevention Evaluation (HOPE) study (167) found that treatment with ramipril significantly reduced the rates of acute myocardial infarction, stroke, and cardiac arrest in over 9000 patients with coronary and other vascular disease. A recent clinical study found that irbesartan, an antagonist of the angiotensin II type 1 receptor, significantly reduced levels of several substances recognized as markers of inflammation, which are elevated in patients with coronary artery disease (168).- Thus, angiotensin-converting enzyme inhibitors and related agents may also be considered as having a role in preventing the triggering of acute coronary disease.

DVTs can cause clots in the lungs pulmonary emboli

Many of the deaths of people who had heart attacks 50 years ago were not due to a heart problem but to clots in the legs traveling to the lungs (pulmonary emboli). Many of these deaths are now avoided by getting people out ofbed and walking around within a day or two of the heart attack.

Antithrombotic Agents

The effect of aspirin on the circadian pattern of myocardial infarction is also uncertain. In the TIMI Phase II and the International Study of Infarct Survival (ISIS) 2 patient populations, a history of aspirin use or nonuse at the time of infarction did not affect the morning increase in infarction incidence (27,35). In contrast, the Physician's Health Study followed 22,071 healthy middle-aged men randomized to aspirin or placebo over 5 yr (169). The aspirin group had a 44.8 reduction in the incidence of nonfatal infarction, with an additional 25.2 reduction between 4 am and 10 am (Fig. 15). One other study of consecutive myocardial infarction admissions reported a beneficial effect of aspirin similar to that in the Physician's Health Study (69). The Myocardial Infarction Onset Study also found that regular users of aspirin had a reduction in the relative risk of myocardial infarction induced by episodes of anger (103).

The Heart Rate Changes from Minute to Minute Depending on What We Are Doing or Thinking about

This test is done for several reasons, most commonly in patients with known or suspected coronary heart disease. If we want to see whether a patient may have coronary heart disease and insufficient blood getting to his heart, we exercise him to his age-predicted maximal heart rate. If he does not get angina or develop changes in the electrical recording of the heart (ECG), this suggests that there is enough blood and oxygen getting to their heart and, therefore, the heart arteries are probably not narrowed.

What Are Risk Factors

Risk factors are conditions that make it more likely that a person will get a certain illness. Smoking is a risk factor for cancers, particularly lung cancer, as well as coronary heart disease. There are several other risk factors for coronary heart disease. A person with a risk factor is more likely to get coronary heart disease compared to someone who does not have that risk factor. But just because a person has a risk factor, for example, being a smoker or having high cholesterol, does not mean that he will definitely get coronary heart disease. This explains why some people, albeit only a tiny minority, live to a good age, even if they smoke or have high cholesterol. Also, people without risk factors still get angina and die from a heart attack.

What Makes a Condition a Risk Factor

Whole communities of young people have to have their blood pressures, blood sugar levels, and cholesterol examined and tested , and then observed over many years to see if they get heart attacks or die earlier compared to those without these risk factors. Recently, it has been reported that small babies who become overweight after the age of two years are more likely to die from heart attacks when they are adults than children who remain the correct weight for their age. It is important for babies and young children to be given a healthy, low-fat, low-sugar, low-salt diet, as well as staying physically fit. They should also stay slim and not become overweight. If children get into good eating habits, they are less likely to die young from a heart attack. It has been known for 100 years that people who died from a heart attack had fat (cholesterol) in their arteries. Over the last 50 years, it has been confirmed that people with a lot of cholesterol in their blood are more likely to...

Coronary Blood Flow In The Assessment Of Thrombolytic Agents

In an effort to improve upon this 60 rate of TIMI grade 3 flow, variants of tPA have been developed such as recombinant plasminogen activator (rPA) (57), which is a nong-lycosylated deletion mutant of wild-type tPA, novel plasminogen activator (NPA), and a genetically engineered mutant of tPA (TNK) (54). The Reteplase vs Alteplase Patency Investigation during Myocardial Infarction (RAPID-2) trial was a small angiographic patency study which demonstrated a higher 90-min rate of TIMI grade 3 flow for rPA compared to tPA (60 vs 45 , p 0.01). It should be noted that this 45 rate of TIMI grade 3 flow for front-loaded tPA was significantly lower than the rates reported in many of the trials in Fig. 7. Consistent with the 60 rate of TIMI grade 3 flow observed for rPA, the results of the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) III trial demonstrated no significant difference in mortality at 30 d (7.47 for rPA vs 7.24 for tPA, p 0.54) or the combined endpoint of...

Adjunctive Mechanical Intervention To Further Improve Flow

Direct or primary angioplasty in acute MI has been demonstrated to achieve high rates of patency and TIMI grade 3 flow in several small angiographic trials (63-71). In the initial study in this area, the Primary Angioplasty in Myocardial Infarction (PAMI) investigators reported a success rate of 97.1 for primary angioplasty (64). There was a trend for patients treated with primary angioplasty to have a lower mortality rate than patients treated with thrombolysis alone (2.6 vs 6.5 , respectively, p 0.06) in this trial. However, other randomized trials of primary angioplasty at the time, each involving less than 100 patients per treatment arm, revealed no significant difference in mortality between the two strategies (65-67).

Electrocardiogram Standard 12Lead ECG

Fourth, ECG waveforms are frequently difficult to interpret causing disagreement among readers, so-called missed ischemia. In a study of AMI patients sent home, ECGs tended to show ischemia or infarction not known to be old, with 23 of the missed diagnoses owing to misread ECGs (8). Jayes et al. (63) compared ED physician readings of ECGs with formal interpretations by expert electrocardiographers and calculated sensitivities of 0.59 and 0.64 and specificities of 0.86 and 0.83 for ST-segment and T-wave abnormalities, respectively. Both McCarthy et al. (18) and a review of litigation in missed AMI cases (64) emphasized this factor of incorrect ECG interpretation. In the largest study to date of ACI in the ED, Pope et al. (3) found that although the rate of missed diagnoses of ACI (2.1 AMI, 2.3 UAP) was low, there was a small but important incidence of failure by the ED clinician to detect ST-segment elevations of 1 to 2 mm in the ECGs of patients with myocardial infarction (11 )....

How Does A Doctor Know That A Person Has Angina

Patients with angina should see their GP, who may refer them to a cardiologist (a consultant specialising in heart problems) for tests and further treatment. Heart attack - what causes it and what does it feel like If the blood supply to the heart muscle is cut off for more than 30 minutes, this may damage, scar, and weaken the area of heart muscle supplied by the blocked artery. The cells of the heart muscle die because they cannot live without oxygen and nutrients. Death of heart muscle cells is called a heart attack (myocardial infarct). A heart attack is diagnosed from the patient's description of what he felt, by a blood test, and by an electrical recording of the heart (ECG).

Identifying Acute Cardiac Ischemia In Patient Subgroups Gender Minorities

Blacks have high levels of risk factors for coronary artery disease but how this finding influences diagnosis in patients presenting to the ED with symptoms suggesting ACI is not well understood (107,108). Studies that have included only patients with chest pain and not other symptoms suggestive of ACI, have found no significant differences in presentation, natural history, or final diagnosis of AMI between black and white patients (109). Evaluating chest pain and establishing the diagnosis of coronary heart disease in blacks is often difficult given the presence of excess hypertension and left ventricular hypertrophy and the increased occurrence of out-of-hospital cardiac arrest in blacks (110-113). Furthermore, the paradoxical finding of severe chest pain without significant angiographic coronary artery disease complicates diagnosis and treatment of blacks with symptoms suggestive of ACI (107,110). In another analysis of the ACI-TIPI Trial data, Maynard et al. (114) found that black...

Can Young People Get Angina

Yes, but it is unusual in people under 40 years of age unless they have risk factors for coronary heart disease. Nowadays, most people with angina are over 60, although some young people may get it. It affects men and women equally although it affects women when they are older. Angina symptoms have different characteristics in women (atypical angina). We do not understand why. It may have something to do with female hormones. This is controversial because hormone replacement treatment (HRT) does not protect women from coronary heart disease and angina.

Analyzing the Process of Care in the Emergency Department the Four Ds

While substernal chest pain remains the cornerstone of patient history for acute MI diagnosis, two recent reports from a large series of patients provide rich additional information as to how patients may present. Goldberg et al. (27) reported on the symptom profiles of patients presenting with a complaint of chest pain and a hospital-admission diagnosis of suspected acute myocardial ischemia and a discharge diagnosis of acute MI or unstable angina in 43 hospitals in 20 communities throughout the United States during collection of baseline data for a larger community intervention trial. They noted that four other cardinal symptoms of a heart attack or unstable angina dyspnea (49 ), Furthermore, in nearly 435,000 patients with confirmed MI from the National Registry of Myocardial Infarction (NRMI) 2 (enrolled from June 1994 to March 1998), 33 (one in three) did not have chest pain on presentation to the hospital. This group of MI patients was on average 7 yr older than those with chest...

Is It True That The Worse The Angina The Worse The Heart Arteries

But many people with bad angina have surprisingly good arteries and many people with verybad arteries have no angina at all. For example, 50 of people with coronary heart disease have no angina, and the first they know about it is when they have a heart attack or die from a heart attack. The other 50 of people with coronary heart disease may get very severe angina, whereas others whose coronary arteries are just as bad may get only very mild, occasional attacks, and only when doing very vigorous exercise. Therefore, there is an inconsistent relationship between symptoms and the severity of coronary heart disease. For reasons that are not understood, some people appear to have a defective anginal warning system or a numb heart. The elderly and diabetics are well known to have this condition. During a routine examination or before they have a non-cardiac operation (for example, a hip replacement), the electrical recording of the heart (ECG) may show the signs of a...

Prehospital Actions And Reducing Treatment Delays

How patients with acute MI symptoms get to the hospital has ramifications on how quickly they are evaluated and treated at the hospital. Surprisingly, calling an ambulance for heart attack symptoms is not frequently done. The Atherosclerosis Risk in Communities study reported that the percentage of MI patients arriving at the hospital by ambulance changed little from 1987 to 1998, going from 36 to 40 (41). The REACT research program revealed that the average rate of EMS use was only 33 in both the 10 intervention and 10 control communities at the study's baseline assessment (42). The NRMI-2 compared the baseline characteristics and initial management for 772,586 patients from April 1994 to March 1998 presenting by ambulance vs self-transport (excluding those in cardiogenic shock, over 6 h from symptom onset to hospital arrival, or who were transferred in). Only one of two patients with MI was transported to the hospital by ambulance (43).