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1.
Bol. méd. postgrado ; 36(2): 31-36, dic.2020. graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1117897

RESUMO

La cardiopatía isquémica es la causa más frecuente de morbimortalidad a nivel mundial. La artritis reumatoide (AR) se asocia con el desarrollo prematuro de enfermedades cardiovasculares y la esperanza de vida se reduce principalmente debido a un incremento en la muerte cardiovascular. Se realizó un estudio retrospectivo de revisión de historias médicas con el objetivo de describir el perfil clínico de los pacientes con cardiopatía isquémica y AR que acudieron a la Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental desde enero 2013 hasta diciembre 2018. Se incluyeron 37 pacientes con diagnóstico de AR que presentaron algún evento coronario. Ell 62% de los pacientes eran del sexo femenino con una edad media de 59 ± 11 años; el 65% tenían menos de 10 años de diagnóstico de AR. El sedentarismo representó el factor más frecuente (92%), seguido de HTA (76%), tabaquismo (73%), DM (43%), antecedentes familiares de cardiopatía isquémica (24%), obesidad (22%), dislipidemia (16%) y ERC (11%); el tipo de evento coronario más frecuente fue el IMsEST (43%). El análisis multivariado no mostró relación estadísticamente significativa entre número de factores de riesgo y tiempo de duración de la AR con la presencia de lesiones coronarias. El sedentarismo fue el factor de riesgo más frecuente en esta población especial sin embargo el comportamiento de los factores de riesgo tradicionales para cardiopatía isquémica en los pacientes con AR no difiere del de la población general...(AU)


Ischemic heart disease is the most frequent cause of morbidity and mortality worldwide. Rheumatoid arthritis (RA) is associated with premature development of cardiovascular disease and life expectancy is mainly reduced due to an increase in cardiovascular death. A descriptive and retrospective review of medical charts was conducted with the objective of describing the clinical profile of patients with ischemic heart disease and RA who attended the Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental from January 2013 to December 2018. 37 patients with RA diagnosis who presented a coronary event were included. The results show that 62% of patients were female with a mean age of 59 ± 11 years; 65% had less than 10 years of diagnosis of RA. Sedentary lifestyle represented the most frequent factor (92%), followed by HTA (76%), smoking (73%), DM (43%), family history of ischemic heart disease (24%), obesity (22%), dyslipidemia (16%) and finally CKD (11%); the most frequent type of coronary event was the IMsEST (43%). The multivariate analysis showed no statistically significant relationship between the number of risk factors and the duration of RA with the presence of coronary lesions. Sedentary lifestyle was the most frequent risk factor in this population however the behavior of traditional risk factors for ischemic heart disease in patients with RA does not differ from the general population...(AU)


Assuntos
Humanos , Masculino , Feminino , Artrite Reumatoide , Fatores de Risco , Isquemia Miocárdica/fisiopatologia , Técnicas de Laboratório Clínico , Doenças Cardiovasculares , Reabilitação Cardíaca
2.
Kardiologiia ; 60(9): 134-148, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131484

RESUMO

This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.


Assuntos
Fibrilação Atrial , Isquemia Miocárdica , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco
3.
Rev. esp. cardiol. (Ed. impr.) ; 73(11): 910-918, nov. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192006

RESUMO

La pandemia producida por la infección por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes más vulnerables (aquellos con cardiopatías) y del personal sanitario, se han suspendido la mayoría de las consultas presenciales y se han puesto en marcha las consultas telemáticas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Española de Cardiología, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telemáticas, revisando las afecciones que el cardiólogo clínico atiende con más frecuencia en su consulta ambulatoria y proponiendo unos mínimos en ese proceso asistencial. Estas enfermedades son la cardiopatía isquémica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefónica, a qué pacientes habrá que atender en una consulta presencial y cuáles serán los criterios para su seguimiento en atención primaria. El documento también recoge distintas mejoras que pueden introducirse en la consulta telemática para mejorar la asistencia de nuestros pacientes


The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care


Assuntos
Humanos , Telecardiologia , Consulta Remota/métodos , Infecções por Coronavirus/epidemiologia , Isquemia Miocárdica/epidemiologia , Insuficiência Cardíaca/epidemiologia , Arritmias Cardíacas/epidemiologia , Padrões de Prática Médica/tendências , Pandemias/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Distância Social , Infecções por Coronavirus/transmissão , Melhoria de Qualidade/tendências
4.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169595

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Assuntos
Cardiomegalia/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Betacoronavirus , Cardiomegalia/fisiopatologia , Angiografia Coronária , Infecções por Coronavirus/fisiopatologia , Ecocardiografia , Edema/diagnóstico por imagem , Edema/fisiopatologia , Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Isquemia Miocárdica/fisiopatologia , Miocardite/fisiopatologia , Pandemias , Derrame Pericárdico/fisiopatologia , Pneumonia Viral/fisiopatologia , Radiografia Torácica , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia
5.
Kardiologiia ; 60(7): 115-124, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155950

RESUMO

The review focuses on upper gastrointestinal (GI) bleeding in patients with ischemic heart disease (IHD) receiving an antithrombotic therapy. Approaches to risk stratification for GI bleeding and correction of modifiable factors that determine the probability of such events are addressed in detail. Recommendations are provided for administration of stomach-protecting drugs. The interrelation of risk factors for thromboses and bleedings is stressed, and possible indications for a multicomponent antithrombotic therapy in patients with stable IHD are discussed.


Assuntos
Doença da Artéria Coronariana , Isquemia Miocárdica , Trombose , Anticoagulantes , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/tratamento farmacológico , Inibidores da Agregação de Plaquetas/efeitos adversos , Fatores de Risco , Trombose/tratamento farmacológico
6.
Kardiologiia ; 60(8): 46-53, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155958

RESUMO

Aim      To develop a model for evaluating the risk of stroke in patients after exacerbation of ischemic heart disease who were admitted to the hospitals included into a vascular program.Materials and methods This study included 1803 patients with acute coronary syndrome (ACS) from four institutions of Moscow, Kazan, Astrakhan, and Krasnodar where the vascular program was established. Mean age of patients was 64.9±12.78 years, 62,1 % of them were men. The patients were followed up for one year after the discharge from the hospital. External validation of the developed prognostic model was performed on a cohort of patients with ACS included into the RECORD-3 study.Results During the follow-up period, 42 cases of ischemic stroke were observed. The risk of ischemic stroke was associated with the presence of atrial fibrillation (odd ratio (OR) 2.640; р=0.037), diabetes mellitus (OR 2.718; р=0.041), and chronic heart failure (OR 7.049; р=0.011). Protective factors were high-density lipoprotein cholesterol >1 mmol/l (OR 0.629; р=0.041), percutaneous coronary intervention during an index hospitalization (OR 0.412; р=0.042), anticoagulant treatment (OR 0.670; р=0.049), and achieving the blood pressure goal (OR 0.604; р=0.023). The prognostic model developed on the basis of regression analysis showed a good predictive value (area under the ROC curve, 0.780), sensitivity of 80 %, and specificity of 64.6 %. The diagnostic value of other scales for risk assessment was somewhat lower. The area under the ROC curve was 0.692±0.0245 for the GRACE scale and 0.708±0.0334 for CHA2DS2­VASc. In the external validation of the scale based on data of the RECORD-3 study, the diagnostic value was lower although satisfactory as well (area under the ROC curve, 0.651); sensitivity was 78.9 %, and specificity was 52.3 %.Conclusion      The study resulted in development of a simple clinical scale, which will probably allow identifying groups at risk of stroke more precisely than with standard scales.


Assuntos
Isquemia Encefálica , Isquemia Miocárdica , Intervenção Coronária Percutânea , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Moscou , Isquemia Miocárdica/complicações , Isquemia Miocárdica/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
7.
J Assoc Physicians India ; 68(11): 46-50, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187037

RESUMO

Diabetes Mellitus (DM) is a global heath burden and the leading cause for cardiovascular (CV) disease. The differential presentation of CV disease in DM is related to the metabolic derangements leading to deterioration of myocardial cell function and its serious consequences. Therefore, there is a need for early and effective treatment intervention for this myocardial cell metabolic dysfunction. DM and myocardial ischemia (MI) share a common metabolic dysregulation mediated via increased fatty acid oxidation that makes the diabetic heart susceptible to myocardial ischemia and reduced myocardial performance during ischemia compared to non-diabetic heart. Modulation of myocardial free fatty acid metabolism should be the key target for metabolic interventions in patients with Diabetic CV complications. Trimetazidine, a fatty acid metabolic modulator, has shown to improve CV outcomes in diabetes. The present review summarizes the clinical evidence and relevance of trimetazidine as an anti-anginal and antiischemic agent in patients with DM. Evidence suggested that trimetazidine could significantly improve clinical outcomes in patients with angina or heart failure and diabetes. Administering trimetazidine in patients with diabetes undergoing re-vascularization could also provide significant clinical benefits. Current clinical practice guidelines also recommend trimetazidine as a first-line agent for selected patients or as a second-line treatment option for angina patients.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus , Isquemia Miocárdica , Trimetazidina , Diabetes Mellitus/tratamento farmacológico , Humanos , Isquemia Miocárdica/tratamento farmacológico , Trimetazidina/uso terapêutico , Vasodilatadores/uso terapêutico
8.
J Pharmacol Sci ; 144(4): 218-228, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33070841

RESUMO

Myocardial ischemia initiates a chain of pathological conditions leading to cardiomyocyte death. Therefore, pharmacological treatment to stop ischemia-induced damage is necessary. Fibrates, have been reported to decrease inflammatory markers and to modulate the renin-angiotensin system (RAS). Our aim was to explore if clofibrate treatment, administered one week after myocardial event, decreases MI-induced cardiac damage. Wistar rats were assigned to: 1. Sham or 2. Coronary artery ligation (MI). Seven days after, rats were subdivided to receive vehicle (V) or clofibrate [100 mg/kg (C)] daily for 7 days. Blood samples and left ventricle were analyzed. RAS components [angiotensin II, angiotensin converting enzyme (ACE), and AT1-receptor] decreased in MI-C compared to MI-V, while [Ang-(1-7), bradykinin, ACE-2, and AT2-receptor] raised in response to clofibrate treatment. Oxidative stress markers increased in MI-V rats, a profile reverted in MI-C rats. Nitric oxide (NO) pathway (Akt, eNOS, and NO) exhibits a lower participation in MI-V, but clofibrate raised NO-pathway components and its production. MI-induced fibrosis and structural damage was also improved by clofibrate-treatment. In conclusion, clofibrate administration to 7 days MI-rats exerts an antioxidant, pro-vasodilator expression profile, and anti-fibrotic effect suggesting that PPARα activation can be considered a therapeutic target to improve cardiac condition posterior to ischemia.


Assuntos
Clofibrato/administração & dosagem , Clofibrato/farmacologia , Ventrículos do Coração/metabolismo , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/metabolismo , Miocárdio/patologia , Óxido Nítrico/metabolismo , Sistema Renina-Angiotensina/efeitos dos fármacos , Angiotensina II/metabolismo , Animais , Fibrose , Ventrículos do Coração/patologia , Masculino , Isquemia Miocárdica/patologia , Estresse Oxidativo/efeitos dos fármacos , Peptidil Dipeptidase A/metabolismo , Ratos Wistar , Receptor Tipo 1 de Angiotensina/metabolismo , Fatores de Tempo
9.
Medicine (Baltimore) ; 99(43): e22893, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120837

RESUMO

Radical cystectomy is considered the standard treatment for patients with muscle-invasive bladder tumors and has high postoperative complication rates among urological surgeries. High-risk patients, defined as those ≥45 years of age with history of coronary artery disease, stroke, or peripheral artery disease or those ≥65 years of age, can have a higher incidence of cardiac complications. Therefore, we evaluated the incidence, risk factors, and outcomes of myocardial injury after non-cardiac surgery (MINS) in high-risk patients who underwent radical cystectomy.This retrospective observational study analyzed 248 high-risk patients who underwent radical cystectomy. MINS was defined as serum troponin I concentration ≥0.04 mg/L within postoperative 3 days. The risk factors for MINS were evaluated by multivariate logistic regression analysis. Postoperative outcomes were evaluated. The 1-year survival after radical cystectomy was also compared between patients who developed MINS (MINS group) and those who did not (non-MINS group) by Kaplan-Meier analysis.MINS occurred in 35 patients (14.1%). Multivariate logistic regression analysis showed that early diastolic transmitral filling velocity (E)/early diastolic septal mitral annular velocity (E') ratio (odds ratio = 1.102, 95% confidence interval [1.009-1.203], P = .031) and large volume blood transfusion (odds ratio = 2.745, 95% confidence interval [1.131-6.664], P = .026) were significantly associated with MINS in high-risk patients who underwent radical cystectomy. Major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group (17.1% vs 6.1%, P = .035; 28.6% vs 12.7%, P = .021, respectively). Kaplan-Meier analysis showed significantly lower 1-year survival in the MINS group than in the non-MINS group (P = .010).MINS occurred in 14.1% of patients. High E/E' ratio and large volume blood transfusion were risk factors for MINS in high-risk patients who underwent radical cystectomy. Postoperative major adverse cardiac events and 1-year mortality were significantly higher in the MINS group than in the non-MINS group. Preoperative evaluation of risk factors for MINS may provide useful information to detect cardiovascular complications after radical cystectomy in high-risk patients.


Assuntos
Cistectomia/efeitos adversos , Isquemia Miocárdica/etiologia , Troponina I/sangue , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Casos e Controles , Cistectomia/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/metabolismo , Estadiamento de Neoplasias/métodos , Complicações Pós-Operatórias/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/patologia
10.
Yonsei Med J ; 61(11): 942-950, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107237

RESUMO

PURPOSE: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM. MATERIALS AND METHODS: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated. RESULTS: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0-78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10-1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97-17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30-3.53). CONCLUSION: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).


Assuntos
Cardiomiopatias/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Isquemia Miocárdica/prevenção & controle , Prevenção Primária/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/epidemiologia , Cardiomiopatias/terapia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Prevenção Primária/métodos , Estudos Prospectivos , Sistema de Registros , República da Coreia/epidemiologia , Fatores de Risco , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(42): e22654, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080705

RESUMO

Both ischemic heart disease (IHD) and stroke are major causes of death worldwide. We investigated the effects of combined Traditional Chinese medicine (TCM) and western medicine (WM) on stroke risk in IHD patients.Taiwanese patients with IHD were enrolled in the TCM study during their outpatient visit. Stroke events after TCM or non-TCM treatment were examined. Chi-square tests and Student t-tests were used to examine differences between patients using and not using TCM. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs). Sex, age, and comorbidities were included in a multivariable Cox model to estimate the adjusted HR (aHR). The survival probability and the probability free of stroke were calculated by the Kaplan-Meier method.There were 733 IHD patients using TCM and 733 using non-TCM treatment, with the same proportion of sex and age within each cohort. Using single Chinese herb such as Dan Shen, San Qi, or Chuan Xiong would have lower stroke events and lower aHR than non-TCM in IHD patients. There was 0.3-fold lower stroke risk in IHD patients with combination TCM and non-TCM treatment (95% CI = 0.11-0.84, P = .02). Moreover, the survival rate was higher (P < .001) and the incidence of hemorrhagic stroke was significantly lower (P = .04) in IHD patients with TCM treatment.IHD patients using combined TCM and WM had a higher survival rate and lower risk of new onset stroke, especially hemorrhagic stroke than those who did not use TCM treatment.


Assuntos
Medicina Tradicional Chinesa , Isquemia Miocárdica/complicações , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Adulto Jovem
12.
Mymensingh Med J ; 29(4): 945-950, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116100

RESUMO

Heart failure (HF) is becoming an increasingly prevalent healthcare problem. Besides, Ischemic heart disease (IHD) and Hypertension (HTN), there is a number of other factors that continue to evolve as risk factors for heart failure. The aim of the study was to identify the different risk factors of heart failure patients. This case-control study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2014 to July 2015. It was included 75 patients of heart failure (cases) and 75 age and sex matched adult individuals (friends and relations of heart failure cases) as controls. The risk factors studied were grouped into demographic, clinical, behavioral and biochemical variables. The age distribution between case and control groups was almost identical with mean ages of either group being 55 years (p=0.922). The sex distribution was also fairly comparable with male being predominant in both the groups (p=0.574). In this study IHD followed by uncontrolled hypertension (p=0.001) are came out to be the predominant risk factors of heart failure followed by smoking and obesity (p<0.001). From the findings of the study, it can be concluded that a number of risk factors are involved in heart failure cases. Of them ischemic heart disease and uncontrolled hypertension are the predominant ones followed by smoking and obesity. The best strategy would, therefore, be to treat and control ischemic heart disease, hypertension, obesity, diabetes and smoking habit in the population. However, as the risk factors in the population continue to change; ongoing surveillance is important to guide right preventive strategy in future.


Assuntos
Insuficiência Cardíaca , Isquemia Miocárdica , Adulto , Bangladesh , Estudos de Casos e Controles , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
13.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5980-5983, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019334

RESUMO

The increasing rate of cardiac ailments has led to the rise in the scrutinization of ones cardiac health. The prevalent techniques for detecting heart diseases are costly and require expert supervision as well as modern equipment. Thus there is a need for an alternative low cost and easily available technique. Finger-tip photoplethysmography (PPG) signals can be used for identifying Ischemic Heart Disease (IHD). This technique of screening the disease will be very helpful to the inhabitants of remote, underdeveloped and unprivileged areas. Time-domain analysis of the signal was done for extracting different features. Segregation of diseased and healthy subjects was performed using Decision Trees, Discriminant Analysis, Logistic Regression, Support Vector Machine, KNN, and Boosted trees. Ten different performance metrics was studied using the confusion matrix. After analysis, the accuracy, sensitivity, specificity, and precision of 0.94, 0.95, 0.95 and 0.97 respectively was obtained using Boosted tress classifier. ROC and AUC were calculated to establish the robustness of the classification methods for determining IHD patients.


Assuntos
Isquemia Miocárdica , Fotopletismografia , Humanos , Aprendizado de Máquina , Programas de Rastreamento , Isquemia Miocárdica/diagnóstico , Máquina de Vetores de Suporte
14.
Int J Occup Environ Med ; 11(4): 179-187, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33098402

RESUMO

BACKGROUND: Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence. OBJECTIVE: To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population. METHODS: We followed 2134 men aged 35-65 years for 14 years during the Isfahan Cohort Study (2001-2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor. RESULTS: The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables. CONCLUSION: There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.


Assuntos
Angina Instável/epidemiologia , Isquemia Miocárdica/epidemiologia , Doenças Profissionais/epidemiologia , Ocupações/classificação , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Estudos de Coortes , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
15.
Medicine (Baltimore) ; 99(38): e22296, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957388

RESUMO

RATIONALE: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. PATIENT CONCERNS: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. DIAGNOSES: Chest x-ray and computed tomography indicated PE. INTERVENTIONS: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 µg/kg/min dobutamine was infused intravenously. OUTCOMES: On postoperative day 2, the patients' vital signs were stable and there were no signs of respiratory disturbance. LESSONS: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.


Assuntos
Complicações Pós-Operatórias/etiologia , Edema Pulmonar/etiologia , Vitrectomia/efeitos adversos , Idoso , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem
16.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(7): 958-964, 2020 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895155

RESUMO

OBJECTIVE: To investigate the protective effect of melatonin against myocardial ischemia reperfusion (IR) injury in isolated rat hearts and explore the underlying mechanisms. METHODS: The isolated hearts from 40 male SD rats were randomly divided into 4 groups (n=10): the control group, where the hearts were perfused with KH solution for 175 min; IR group, where the hearts were subjected to global ischemia for 45 min followed by reperfusion for 120 min; IR+melatonin (Mel+IR) group, where melatonin (5 µmol/L) was administered to the hearts 1 min before ischemia and during the first 5 min of reperfusion, followed by 115 min of reperfusion; and IR+2, 3-butanedione monoxime (IR+BDM) group, where the hearts were treated with BDM (20 mmol/L) in the same manner as melatonin treatment. Myocardial injury in the isolated hearts was assessed based on myocardial injury area, caspase-3 activity, and expressions of cytochrome C and cleaved caspase-3 proteins. Cardiac contracture was assessed using HE staining and by detecting lactate dehydrogenase (LDH) activity and the content of cardiac troponin I (cTnI) in the coronary outflow, measurement of left ventricular end-diastolic pressure (LVEDP) and electron microscopy. The content of ATP in the cardiac tissue was also determined. RESULTS: Compared with those in the control group, the isolated hearts in IR group showed significantly larger myocardial injury area and higher caspase-3 activity and the protein expressions of cytochrome C and cleaved caspase-3 with significantly increased LDH activity and cTnI content in the coronary outflow and elevated LVEDP at the end of reperfusion; HE staining showed obvious fractures of the myocardial fibers and the content of ATP was significantly decreased in the cardiac tissue; electron microscopy revealed the development of contraction bands. In the isolated hearts with IR, treatment with Mel or BDM significantly reduced the myocardial injury area, caspase-3 activity, and protein expressions of cytochrome C and cleaved caspase-3, obviously inhibited LDH activity, lowered the content of cTnI and LVEDP, reduced myocardial fiber fracture, and increased ATP content in the cardiac tissue. Both Mel and BDM inhibited the formation of contraction bands in the isolated hearts with IR injury. CONCLUSIONS: Mel can alleviate myocardial IR injury in isolated rat hearts by inhibiting cardiac contracture, the mechanism of which may involve the upregulation of ATP in the cardiac myocytes to lessen the tear of membrane and reduce cell content leakage.


Assuntos
Contratura , Isquemia Miocárdica , Traumatismo por Reperfusão Miocárdica , Animais , Masculino , Melatonina , Miocárdio , Miócitos Cardíacos , Ratos , Ratos Sprague-Dawley
17.
Zhongguo Zhong Yao Za Zhi ; 45(16): 3784-3789, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32893571

RESUMO

Ischemic heart disease(IHD) is a common and frequently-occurring disease that causes serious harm to human health. Autophagy is a life process that maintains cell homeostasis by degrading macromolecules such as damaged organelles in cells. In the process of ischemic heart disease development, on the one hand, cardiomyocytes degrade macromolecules such as damaged organelles by autophagy to provide material basis for energy synthesis and maintain cell homeostasis; on the other hand, over-activated autophagy can also increase cardiomyocyte death. Ischemic heart disease has a complex pathological mechanism, and the occurrence of autophagy is closely related to the survival or death of myocardial cells, so the regulation of autophagy may be an important therapeutic target for ischemic heart disease. Traditional Chinese medicine(TCM) with obvious effects, unique advantages and great potential has been widely used in the treatment of ischemic heart disease. In recent years, more and more studies have found that TCM can protect myocardium by regulating autophagy of cardiomyocytes. In this review, we summarized recent studies on the regulation of autophagy in myocardial cells by traditional Chinese medicine in ischemic heart disease. The pharmacological mechanism of Chinese medicinein regulating autophagy to protect cardiomyocytes was reviewed through different ways(promoting or inhibiting autophagy) from three levels, i.e. active ingredient, as well as drug pair and compound. The specific mechanism of Chinese medicine in regulating autophagy to protect ischemic heart disease was explored to provide references or new ideas for clinical treatment and drug development of ischemic heart disease.


Assuntos
Autofagia , Isquemia Miocárdica , Humanos , Medicina Tradicional Chinesa , Miocárdio , Miócitos Cardíacos
18.
Zhongguo Zhong Yao Za Zhi ; 45(16): 3797-3804, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32893573

RESUMO

Mountain-agarwood plays an important role in ethnic medicine in China for its pharmaceutical value. Modern pharmacological researches demonstrated that mountain-agarwood was effective for its anti-myocardial ischemia, antibacterial, anti-inflammatory, antitumor and analgesic effects. Mountain-agarwood derives from the peeled roots, stems or twigs of Syringa pinnatifolia which belongs to Syringa genus. It often depends on the purple substance and fragrance to estimate the formation of mountain-agarwood. However, the mechanism of mountain-agarwood formation has not been reported. To observe the microcosmic change in the process during the formation of mountain-agarwood, this study described the microscopic and histochemical characteristics of mountain-agarwood formation through histochemical staining. Our results showed that a significant difference of the distribution of tyloses existed during mountain-agarwood formation. It was observed that inchoate mountain-agarwood had more starch granules and viable cells than mountain-agarwood formed with high level or low level. The amount of polysaccharide and degree of lignification were increased during the mountain-agarwood formation. The results indicated that the mountain-agarwood, which meets the quality requirements for pharmaceutical use, contained the following characteristics: a large amount of purple tyloses in heartwood; yellow-brown tyloses distributing in heartwood and sapwood which were less in the latter; lignification with high level; a few viable cells; lots of polysaccharide and few starch granules in xylem rays cell. This study is aimed to reveal the change of histochemical characteristics during mountain-agarwood formation, and lay the foundation for exploring the mechanism of mountain-agarwood formation.


Assuntos
Isquemia Miocárdica , Syringa , Thymelaeaceae , China , Humanos
19.
Zhongguo Zhong Yao Za Zhi ; 45(16): 3852-3856, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32893580

RESUMO

The components of traditional Chinese medicine(TCMCs) are the basic unit of raw materials for Chinese medicines, and their physical and chemical properties directly affect the choice of dosage forms and the optimization of prescriptions. However, most of TCMCs are multi-component complex systems, and the characterization of their overall properties is still in the exploration stage. On the basis of biological activity, the representative components are determined, and then the individual characteristics are fitted with the weight coefficient of efficacy contribution rate, which may provide reference for characterizing the overall properties of TCMCs. In this study, with the pharmacological effects of isoproterenol(ISO)-induced myocardial ischemia in rats as the indicators, the pharmacodynamic contribution rates of three representative components of chishao terpene glucoside components(CSTGCs) were evaluated by the normalization weighting method. The contribution rates of paeoniflorin, paeoniflorin and benzoylpaeoniflorin were 54.87%, 32.46% and 12.67%, respectively. The oil-water partition coefficients of paeoniflorin, albiflorin, benzoylpaeoniflorin in water and buffer solutions with different pH values were measured, and the oil-water partition coefficients of CSTGCs were characterized by the weight of their pharmacodynamics contribution rate. The results showed that the apparent oil-water partition coefficient(log P) of CSTGCs in the phosphate buffer system such as n-octanol-water(pH 2.0, 2.5, 5.0, 5.8, 6.8) were 0.18-0.22, indicating that CSTGCs have common absorption and low permeability, providing basis for the preparation of CSTGCs.


Assuntos
Doença da Artéria Coronariana , Isquemia Miocárdica , Animais , Glucosídeos , Medicina Tradicional Chinesa , Ratos , Terpenos , Água
20.
J Stroke Cerebrovasc Dis ; 29(10): 105173, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912507

RESUMO

BACKGROUND: Diabetes and obesity are established risk factors for stroke. The current study aimed to assess risk factors of ischemic stroke recurrence in diabetic patients based on their body mass index (BMI). METHODS: A total of 4005 diabetic patients who had a history of ischemic stroke were identified in a retrospective cross-sectional dataset from the Malaysian National Neurology Registry. Patients were classified based on BMI, and multivariable regression analysis was used to evaluate the association between risk factors and recurrent ischemic stroke. RESULTS: Among obese patients, those with ischemic heart disease (aOR, 1.873; 95% CI, 1.131-3.103), received formal education (aOR, 2.236; 95% CI, 1.306-3.830), and received anti-diabetic medication (aOR, 1.788; 95% CI, 1.180-2.708) had a higher stroke recurrence risk, while receiving angiotensin receptors blockers (aOR, 0.261; 95% CI, 0.126-0.543) lowered the odds of recurrence. Overweight patients with hypertension (aOR, 1.011; 95% CI, 1.002-1.019) for over 10 years (aOR, 3.385; 95% CI, 1.088-10.532) and diabetes prior to the first stroke (aOR, 1.823; 95% CI, 1.020-3.259) as well as those received formal education (aOR, 2.403; 95% CI, 1.126-5.129) had higher odds of stroke recurrence, while receiving angiotensin-converting enzyme inhibitors (aOR, 0.244; 95% CI, 0.111-0.538) lowered the recurrence risk. Normal weight East Malaysians (aOR, 0.351; 95% CI, 0.164-0.750) receiving beta-blockers (aOR, 0.410; 95% CI, 0.174-0.966) had lower odds of stroke recurrence. CONCLUSIONS: Ischemic heart disease, hypertension, receiving anti-hypertensive agents, and educational level were independent predictors of recurrent stroke in obese patients. Managing the modifiable risk factors can decrease the odds of stroke recurrence.


Assuntos
Isquemia Encefálica/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Obesidade/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Anti-Hipertensivos/uso terapêutico , Índice de Massa Corporal , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/enzimologia , Isquemia Encefálica/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Escolaridade , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Incidência , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Obesidade/complicações , Obesidade/mortalidade , Recidiva , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo
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