How I Healed my Cardiovascular Disease

The Big Heart Disease Lie

The Big Heart Disease Lie is a book written by doctors who are members of the International Truth In Medicine Council they are also the authors of The Big Diabetes Lie. In this book you will be getting over 500 pages of scientifically proven, doctor verified information that you will not find anywhere else, not even bookstores.If you have high blood pressure or cholesterol, fatigue, shortness of breath, irregular heartbeat, swollen feet or ankles, chest pain, fainting, diabetes, asthma or allergies, pain, fatigue, inflammation, any troubling health issue, or simply want to discover the most powerful health and anti-aging program, then you really need to read this book. The book is a step by step guide that contains techniques scientifically verified and proven by doctors to reverse the symptoms of heart disease, and normalize blood pressure and cholesterol levels. These techniques have been used successfully by tens of thousands of people all over the world, and allowed them to take health into their own hands, ending the need for drugs, hospitals, doctors' visits, expensive supplements or grueling workouts. Continue reading...

The Big Heart Disease Lie Summary


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Acute Coronary Syndrome

Nearly a quarter of a million people each year in England and Wales suffer from an acute myocardial infarction (AMI) (Gerschlick 2001). Up to half of these will die within a month and over half of these deaths occur before the patient reaches hospital (NICE 2002a), many within the first few minutes of the onset of symptoms (DoH 2000a). It is well known that the chance of survival following an AMI is dramatically increased if treatment is initiated early. It is vital therefore that AMI is recognised promptly and treatment initiated immediately. This applies equally to patients who suffer AMI out of hospital and those who are already hospital inpatients. The term 'acute coronary syndrome' (ACS) has recently become popular to describe the three main clinical presentations of unstable coronary artery disease (Jones 2003). They are non-ST elevation myocardial infarction (NSTEMI) ST elevation myocardial infarction (STEMI).

Cardiovascular Disease

The most significant component of the mortality decline at older ages is the reduction of death rates due to cardiovascular disease (CVD), including both heart disease and stroke. In the United States, heart disease has been the leading cause of death since 1921, and stroke has been the third most common cause since 1938. From 1950 to 1996, age-adjusted death rates for these two causes declined by more than half (by 56 for heart disease and by 70 for stroke). It is estimated that 73 of the decline in total death rates over this time period was due to this reduction in CVD mortality (25). 5. Improvements in medical care, including better diagnosis and treatment of heart disease and stroke 6. The development of effective medications for treatment of hypertension and hypercholesterolemia, and an increase in coronary-care units and emergency medical services for heart disease and stroke (Chapters 3,15, and 16) (25)

Potential Use of This Technology in Understanding Complex Heart Disease

Hypertrophy is a universal adaptive response to increased cardiac workload, stress, and injury that can be induced by many different stimuli. Microarray expression profiling studies have been performed on models for pressure-overload induced hypertrophy 62, 63 hypertrophy induced by Isoproterenol and Angioten-sinll 58 hypertrophy induced by transgenic overexpression of Calsequestrin, Cal-cineurin, Gaq, and IFeRack 51 , as well as on models of myocardial infarction 25, 55-57 . Ideally, comparison of these (in some aspects) phenotypically similar, but pathophysiological dissimilar models would enable us to differentiate among the multiple processes that cause hypertrophy (and heart failure), and to identify patterns of gene expression that are either common for these diseases or specific for a certain subset of conditions. Unfortunately, direct comparison of results between these studies is nearly impossible due to substantial differences in the technology platforms being used, the...

Arrays and Cardiovascular Disease

An obvious application of the technology is to uncover the changes that precede, accompany and result from the expression of a primary genetic insult. Numerous catalogues now exist, both in real 41, 42 and virtual space (http resources pga ). The first point to consider is that even at this early stage of cardiovascular disease-based global genomics, we are drowning in data. At the authors' institution approximately 10 gigabytes of data are collected and archived every week. Second, because of the different methodologies, the different investigators and filters that are being applied both before and after data acquisition, there is depressingly little agreement concerning which genes are up and down regulated. As alluded to above, the lack of detail in published experimental protocols and post-data acquisition algorithms make it impossible to actually compare cardiovascular data sets that are posted in the literature or in virtual space. Third, very few, if any of...

Hypertensive disorders in pregnancy and ischemic heart disease in later life

A number of studies have demonstrated associations between a diagnosis of pre-eclampsia in pregnancy and ischemic heart disease (IHD) in later life. This association is plausible given the evidence outlined above for a relationship with hypertension, which is a well-recognized risk factor for IHD. However, IHD is relatively uncommon in young women. Consequently, the most feasible studies for addressing this question are register-based studies, since these can include a sufficient number of women to be powered to address the research question. In all but one of these studies, however, the definition of exposure is based on the coding of clinical records, which is open to misclassification.

Heart Disease and Immune Effects

Specific illnesses can also be caused or exacerbated by stress. For many years Americans have been aware of the relationship between stress and heart disease. The biochemical changes associated with stress lead to higher blood pressure, an increased heart rate, and a release of fat into the bloodstream. If the fat is completely consumed by the muscles through physical activity (for example, defending oneself from an attacker), no serious health consequences follow. If, however, a person experiences stress without engaging in The work of two cardiologists, Meyer Friedman and Ray Rosenman, is of particular importance to a discussion of heart disease and stress. Friedman and Rosenman demonstrated, based originally on personal observation and subsequently on clinical research, that there is a personality type that is particularly prone to heart disease. The personality type that is at the greatest risk was found to be one which is highly stressed impatient, hostile, hard-driving, and...

Data Rearranged to Convince Japanese People that High Total Cholesterol Is a Major Risk Factor for Coronary Heart

Adapted from the Japan Atherosclerosis Society Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases, 1997. Adapted from the Japan Atherosclerosis Society Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases, 1997. Conclusion (apart of the Summary) The complication rate with ischemic heart disease (IHD) was highly positively associated with TC, and that of cerebrovascular disease was also associated with TC to a lesser extent. The association was more prominent when LDL was a marker. Complication rate with IHD was higher in lower HDL-C groups, suggesting the anti-atherogenic activity of HDL. The complication rate with IHD was markedly higher in FH than in non-FH even when TC values were adjusted. Moreover, the complication rate in FH was not associated with TC, but rather with serum TG levels (translated). The Association of Total Cholesterol with Coronary Heart Disease Differs among Different Age Groups, Which Is Likely to Be...

Can dyslipidemia during pregnancy flag laterlife cardiovascular risk

Recent data have linked maternal vascular, metabolic, and inflammatory complications of pregnancy (including gestational diabetes, pre-eclampsia, and low birthweight) with an increased risk of cardiovascular disease in later life (Hubel et a ., 2000 Sattar and Greer, 2002). As mentioned previously, the insulin resistance syndrome is a key factor underlying non-pregnancy cardiovascular disease. The maternal physiologic response to normal pregnancy includes a transient excursion into several aspects of this metabolic syndrome, i.e. insulin resistance, hyper-lipidemia, and an increase in coagulation factors (Herrera et a ., 1988 Hubel et a ., 1998b Martin et a ., 1999 Montes et a ., 1984 Sattar and Greer, 2002). Normal pregnancy also involves upregula-tion of the inflammatory cascade including activation of peripheral white blood cells (Sacks et a ., 1998, 1999). Upregulation of the inflammatory cascade in non-pregnant women is a strong risk factor for adverse cardiovascular events and...

PDE Inhibitors and Cardiovascular Disorders

Cardiovascular disorders (Beavo, 1995). They are currently used in acute settings to treat patients during cardiac surgery or for patients awaiting heart transplantation. They have been also tested as a possible replacement of, or in conjunction with, digoxin in congestive heart failure. Although a large multicentric trial with milrinone was stopped prematurely because of increased death rate in patients receiving this drug, it is felt that adjustment of the dosage and the availability of new compounds will widen the use of these PDE3 inhibitors for this indication. Because of its inhibition of PDE3 activity in platelets, the PDE3 inhibitor cilostazol is currently prescribed in Japan as an antithrombotic agent and it has been recently approved for the treatment of vascular stenosis causing claudicatio intermittens (Sorkin and Markham, 1999).

Hypertension Relationships to Coronary Heart Disease and Stroke

Hypertension is positively correlated with CHD and stroke mortality, and is generally accepted as one of the major risk factors for eventual CHD mortality. The term 'risk factor' generally indicates an associated occurrence, but it does not automatically mean that reducing a risk factor will be beneficial, as it would be for a causal risk factor. Although hypertension has a logical causal relationship to hemorrhagic stroke, its relationship to thrombotic or ischemic events remains to be established. Both CHD and hypertension might independently be made worse by some processes initiated by some common dietary causes. By now, scientists can see that neither CHD nor hypertension is likely to be due to dietary cholesterol. However, both disorders may relate to an unbalanced dietary intake of 6 over 3 PUFAs that causes unbalanced signaling from 6 over 3 eicosanoids. A meta-analysis of 36 clinical trials involving 2,114 subjects showed that supplementing with high intakes of fish oil gave...

Preeclampsia laterlife dyslipidemia and cardiovascular risk

Preeclampsia And Heart Disease

Several studies have shown that an association between pre-eclampsia and later-life hypertension or ischemic heart disease is strongly supported, especially (but not only) when the hypertension in pregnancy was recurrent or developed before 30 weeks of gestation (Hannaford et al., 1997 Jonsdottir et al., 1995 Ness et al., 2003 Sattar and Greer, 2002 Sibai et al., 1986). On the other hand, there is some evidence of a decreased frequency of Figure 11.5 Intervention strategies against time-dependent progression of endothelial disease. F1, female 1 (high-risk) F2, female 2 (low-risk) CVD, cardiovascular disease. Genetic factors contribute to both the endothelial health baseline and the susceptibility to negative environmental factors (slope). Risk factors for endothelial disease are identifiable during the stress-test of pregnancy. Clinically evident disease manifests once a threshold is crossed (as is the case for F1 during first pregnancy and post-menopause). Interventions such as...

Plasma Nitrosospecies And Cardiovascular Disease

In order to examine the role of nitrosospecies in relation to cardiovascular risk factors, we determined RXNO levels (the sum of all nitrosospecies) of plasma in patients with one or more cardiovascular risk factors 74 . Levels of RXNOs were lower in such individuals compared to controls. It can therefore be concluded that endothelial dysfunction is associated with a depletion of circulating nitroso nitrosyl species in plasma, which is likely to contribute to the increased risk for major cardiovascular events in individuals with endothelial dysfunction. Measuring circulating nitroso nitrosyl species may help identifying individuals at risk and serve as a therapeutic surrogate marker in the future. Further studies are needed to establish whether the plasmatic RXNO pool represents a valuable parameter that allows optimal dose titration of therapeutic agents aimed at targeting endothelial dysfunction.

Potential Side Effects of Statins

Fatal heart attack and breast cancer rates in the CARE trial (Pravastatin) Death from heart attack Case of breast cancer Evaluation by Ravnskov 2000 The merits (a marginal reduction of death from coronary heart disease) and demerits (increased incidence of breast cancer) by statin treatment as shown in this table need to be critically evaluated. Men (n 2,804) and women (n 3,000) aged 70-82 years with a history of, or risk factors for, vascular disease were assigned to pravastatin (n 2,891) or placebo (n 2,913). Baseline TC ranged from 4 to 9 mmol l (154-347 mg dl). Follow-up was 3.2 years on average. Pravastatin lowered LDL-C by 34 and reduced the incidence of the primary endpoints, the hazard ratio being 0.81 (p 0.014). CHD death and nonfatal MI was also reduced (0.81, p 0.006). Stroke risk was unaffected (1.03, p 0.8). New cancer diagnoses were more frequent on pravastatin than on placebo (1.25, p 0.020). However, incorporation of this finding in a meta-analysis of all pravastatin...

Blindly Searching for Structure Function

Proteomic and Genomic Analysis of Cardiovascular Disease. Edited by Jennifer E. van Eyk, Michael J. Dunn Unfortunately, identifying the primary genetic etiology has led to only limited insight into understanding the resultant pathology, which is the result of and reflects the downstream changes in the transcriptome and proteome. The progression from functional cloning positional cloning candidate gene is all intellectually founded in a reductionist approach understanding the cause(s) of the disease by focusing on the primary genetic lesion. For cardiovascular disease, even those that are monogenically based, we now realize that reductionism has its limitations, particularly when it comes to understanding a disease pathology in terms of choosing potential therapeutic targets. In a paradigm shift it is now appreciated that, in order to understand the molecular pathologies at work, the overall regulatory networks and interplay of the different organ systems, cell types and even...

The Starting Line Garbage In Garbage

The field of cardiovascular biology appears, at first glance, to be particularly well suited for the types of comprehensive analyses needed for the technology's productive application to discovery-based research. After all, there are now close to 200 animal models of human cardiovascular disease, which have been produced through the use of genetic manipulation using either transgenesis or gene ablation. The use of these mouse-based genetic models where the primary etiology is known and the disease course can be closely monitored should, at first glance, easily provide the basic reagent - a relatively well defined disease in an organism with a well-defined genetic background, in which the disease's progression can be monitored closely. Thus, using large groups of animals, the longitudinal progression of disease development becomes a timeline along which points can be taken for global transcriptional analyses and indeed, large data sets are beginning to be gathered across a number of...

Filtering The Transcriptome Enhancing The Value

Gene arrays as applied to cardiovascular disease are inherently noisy experiments as even in a seemingly genetically homogenous population the severity and penetrance of the disease is not necessarily uniform. In order to raise the signal-to-noise ratio so that interpretable data are obtained, some form of filtering is essential. This can occur at either the back-end using bioinformatics, or at the frontend by careful selection of the sample population (http research churchill research expression in dex.html) 45 or by sub selection of only the most relevant portion of the transcriptome (see below). Additionally, the overall experimental design is critical and details are often overlooked or not reported so that it becomes problematic for another experimentalist to exactly repeat the procedure. Seemingly trivial matters can significantly affect a particular experiment. For example, how are the animals sacrificed If an animal smells the blood of another in the procedure...

Principles of cDNA Microarrays as Applied in Heart Failure Research

Symptomatic heart failure (HF) affects 4.7 million patients in the US with approximately 550,000 new cases of heart failure identified annually 1-3 . Proportionally, there are 428,000 patients in Canada, incurring 8 billion in annual hospital costs alone. This burden expected to double in the next 2 decades 4-6 . Other forms of cardiovascular disease are plateauing, but the incidence of heart failure is increasing. The one year mortality rate is between 25-40 5 . This is partly the consequence of our success in treating myocardial infarction and sudden deaths, and partly due to the aging population. Proteomic and Genomic Analysis of Cardiovascular Disease. Edited by Jennifer E. van Eyk, Michael J. Dunn

Guidelines from the American College of Physicians for Using Cholesterol Test

And triglyceride levels as screening tests for preventing coronary heart disease in adults - 2 In patients who are screened for the primary prevention of coronary heart disease, the total cholesterol level should be measured once measurement should be repeated periodically if the measured value is near a treatment threshold 3 Screening for total cholesterol levels is not recommended for young men (younger than 35 years of age) or women (younger than 45 years of age) unless the history of physical examination suggests a familial lipoprotein disorder or at least two other characteristics predict a risk for coronary heart disease

Anti Atherosclerotic Actions of w3 Fatty Acids

EPA and low levels of AA and they also have a low incidence of myocardial infarction and a tendency to bleed. It is possible that dietary enrichment with EPA will protect against thrombosis. Conclusion This study suggests that dietary m3 FAs are associated with levels of these biomarkers reflecting lower levels of inflammation and endothelial activation, which might explain in part the effect of these FAs in preventing cardiovascular disease.

Heart Failure A Genomics Approach

Cardiovascular Disease Mortality 2018

A significant and increasing cause of morbidity and mortality, heart failure is becoming a major heath care burden. Over the past two decades the condition has increased by more than 150 and will continue to increase as the population ages and as death rates from acute myocardial infarction decline 2 . Currently, about 4 to 5 million people in the United States suffer from heart failure, resulting in the hospitalization of two million patients each year 4 . Approximately Proteomic and Genomic Analysis of Cardiovascular Disease. Edited by Jennifer E. van Eyk, Michael J. Dunn A complex, multifactorial condition, heart failure occurs as a result of the interaction of environmental, physiological and genetic factors. In the United States, coronary artery disease and scarring from myocardial infarction are the most common factors leading to heart failure, followed by cardiomyopathy, and hypertension. Heart failure can also occur in patients with valvular heart disease or sustained...

Linoleic Acid and Stroke Epidemiological Studies

A cardiovascular risk survey was conducted during 1984-1992 for 7,450 participants aged 40-85 years (3 communities in Japan), and serum samples were stored at -80 C for 1-9 years. Three controls were selected for each of 197 stroke cases, matching for sex, age, community year of serum storage, and fasting status. Compared with controls, stroke cases (total n 197, hemorrhagic n 75, and ischemic n 122) had slightly (but significantly) higher blood pressure, BMI and serum TG. Conclusions A higher intake of LA may protect against ischemic stroke, possibly through potential mechanisms of decreased blood pressure, reduced platelet aggregation, and enhanced deformability of erythrocyte cells. Ischemic stroke Health professional men (n 43,732, 40-75 years old) were followed for 14 years. Total stroke cases (n 725), ischemic (n 455), hemorrhagic (n 125) and unknown (n 145) were observed. After adjustment for confounders, no evidence was found that the amount or type of dietary fat affects the...


24 I 1 Microarray Expression Profiling in Cardiovascular Disease 1.5 25 Jin H, Yang R, Awad TA, Wang F, et al. Effects of early angiotensin-converting enzyme inhibition on cardiac gene expression after acute myocardial infarction. Circulation 2001 103(5) 736-742. 57 Stanton LW, Garrard LJ, Damm D, Garrick BL, et al. Altered patterns of gene expression in response to myocardial infarction. Circ. Res. 2000 86(9) 939-945.


After World War II, Japanese intake of fats and oils increased gradually and so did blood TC values. In the typical town of Hisayama, CHD mortality was relatively unchanged, but the mortality from ischemic stroke actually decreased (fig. 43, 44). The PDAY study emphasizes the importance of starting prevention from younger ages, but relative contributions and causal relation w3 Fatty Acids Effectively Prevent Coronary Heart Disease and Other Late-Onset Diseases -The Excessive Linoleic Acid Syndrome

Sample Selection

Explanted failing hearts are often obtained from patients with ischemic heart disease and thus contain fibrotic areas. In sampling failing hearts, it is important to avoid areas of fibrosis. It is also important to perform histology on both failing and non-failing hearts in order to correlate gene expression changes against a phenotypic description. Another issue with human heart samples is that both non-failing and failing patients are commonly treated with numerous medications that could influence gene expression. As discussed, non-failing patients are typically on inotropic support. The heart failure patients are also typically on a variety of medications. Thus changes in gene expression due to these medications will be superimposed on any changes in gene expression related to heart failure.

Fdgpet Cost Effectiveness Studies

In addition to being subjected to careful scrutiny, more than any other diagnostic technology, PET imaging has been required to demonstrate that it delivers cost effective diagnoses. Cost effectiveness studies in Nuclear Medicine including FDG PET studies have been reviewed by Dietlein (1999) 5 and by Gambhir (2000) 6 . These reviews also provide a detailed critique of the individual studies and in the review by Gambhir only six studies in the nuclear medicine literature were found which met all ten of their quality criteria for cost effectiveness studies and only one of these 7 was an FDG PET study. The following is not a comprehensive or detailed analysis of every cost effectiveness study in the literature but a review of FDG PET related to the more important studies in the literature including some published since the two reviews mentioned above and some that have been completed and will be published shortly. Table 1.3 shows the clinical conditions that have been analysed to date...

Cardiorespiratory Problems

High altitude increases the work of the heart during the first days of acclimatisation. Patients who have symptomatic heart disease risk a deterioration of their symptoms at high altitude. A person who cannot walk at a fast pace or go up one single flight of stairs without shortness of breath at sea level will be likely to be in trouble at high altitude, including during air travel. Oxygen can be provided during the journey on most commercial flights, with no problem. Arrangements need to be made by an experienced physician at least 1 week in advance. A nasal cannula, when available, is often more comfortable than a mask. The level of 8000 feet (2400 m) should not be exceeded by patients with congestive heart failure.

Drugs Isolated From Plants A Artemisinin

Two of the Digitalis genus, D. purpurea L. (purple foxglove) and D. lanata Ehrh. (Grecian foxglove), are used for the extraction of digitoxin and di-goxin. The purple foxglove contains 0.2-0.4 cardenolide glycosides and is cultivated in the Netherlands for extraction of glycosides or, more rarely, collected from natural habitats. The Grecian foxglove is cultivated in the Netherlands and France. The leaves are collected and must be rapidly dried at a temperature as low as possible. The Grecian foxglove is used industrially for the extraction of digoxin and digitoxin as well as derivatives of its secondary glycosides, e.g., desacetyl-lanatoside C. Purple foxglove contains about 30 glycosides, divided into three series the A series, with digitoxi-genin as aglycone (primary glycoside is purpurea glycoside A) the B series, with gitoxigenin as aglycone and the E series, with gitaloxigenin as aglycone. Varieties in which series A predominates ( 50 ) are preferred. The constituents of the...

Myocyte Proliferation in Heart Failure

Myocyte proliferation compensates at least in part for the massive myocyte cell death that occurs after myocardial infarction and during the evolution of the ischemic myopathy (Fig. 1 refs. 25,28-30). Additionally, cell death characterizes idiopathic dilated cardiomyopathy,28'29'31 33 but cell regeneration maintains the number of myocytes relatively constant in the diseased heart.31 Myocyte hypertrophy constitutes another form of growth and cells can nearly double in size in terminal failure.31,34-36 However, both cellular growth processes are unable to normalize the elevated diastolic load on the myocardium and or decrease ventricular dilation.

Other Health Problems in Travellers

Cardiovascular disease is common in travellers indeed, it is the commonest cause of death abroad (Table 5.1), although this is usually because of pre-existing disease and not due to travel. The exception is the risk of venous thrombosis that sometimes accompanies long-haul air travel (Sarvesvaran, 1986), the so-called 'economy-class syndrome'.

Subacute Mountain Sickness

Five decades ago, Chinese investigators described in humans the counterpart of cattle brisket disease, with the name of High Altitude Heart Disease (HAHD) of the pediatric type 73 . This entity is mainly observed in infants of Chinese Han origin who are born at low altitude and then brought to high altitude where they develop PH and HF within a few weeks or months with a fatal outcome if the infants are not moved down to lower places. Pediatric HAHD is also observed in children from 2 to 14 years of age but the prevalence is lower than in infants. Prevalence of pediatric HAHD is higher in Han infants than in Tibetan infants 78 . The mechanism of SMS is ascribed to exaggerated hypoxic pulmonary reactivity of distal pulmonary arterial branches, which are muscularized in excess.

Soluble fmslike tyrosine kinase 1 sFlt1

Whereas healthy maternal endothelium is crucial for the physiological adaptation to normal pregnancy, widespread endothelial dysfunction is an integral part of the multi-organ involvement of preeclampsia (Roberts and Redman, 1993). Women with pre-existing medical disorders that are characterized by endothelial dysfunction, such as hypertension and diabetes, are at increased risk of pre-eclampsia. Indeed, many of the risk factors for cardiovascular disease (all except smoking) are also risk factors for pre-eclampsia. Poor placental implantation also plays an important but not yet

The Myth of the Myth of Mental Illness

Not be treated with medication because it deprives patients of the experience of their symptoms. His concern was that they would become out of touch with themselves. Given the growing evidence of the medical-biological nature of mental illness, such thinking is tantamount to saying that people suffering from heart disease should not be treated because it would interfere with their experience of angina (chest pain).

Answer Aortic stenosis

Causes of aortic stenosis include congentital stenosis, a bicuspid aortic valve, rheumatic heart disease and senile calcific valve degeneration. The gradient across the heart valve produces left ventricular hypertrophy with increased muscle mass which can cause relative myocardial ischaemia and the risk of cardiac arrhythmias. If untreated, left ventricular decompensation leads to left ventricular dilatation and pulmonary venous congestion. Ischaemic heart disease Valvular heart disease Congenital heart disease

Maximum Average Life Span

Let us consider whether there might be an upper limit to the average life span that could be achieved by a large human population. Average life span, or life expectancy at birth, refers to how long people live on average in a population. In the United States, life expectancy is currently around 75 years for men and 80 years for women (34). Accordingly, these numbers describe the average length of life that can be anticipated, given the mortality conditions of today. For example, baby boys born this year will live an average of 74 years, assuming that age-specific death rates (Fig. 4a) do not change in the future. Just as occurs today, some of these newborns will die in infancy from congenital ailments, some will be killed in car accidents as young adults, and some will succumb in old age to cancer or heart disease.

Mortality Among African Americans

African Americans have excess death because of seven conditions. Excess deaths are defined as the number of deaths among minorities that would not have occurred had mortality rates for minorities equaled that of nonminorities. These conditions are (1) heart disease and stroke (2) homicide and accidents (3) cancer (4) infant mortality (5) cirrhosis (6) diabetes and (7) AIDS (U.S. Department of Health and Human Services,

Indications and Testing

The evaluation of candidates follows a similar pattern to that of the kidney patient, with emphasis in the diabetic complications that can threaten successful transplantation. Consequently, great emphasis is placed on the cardiac and peripheral vascular workup. Cardiologic workup and clearance usually entails a peripheral vascular evaluation, chest X-rays, an EKG, a dobutamine stress echocardio-gram, and frequently a coronary angiogram. Other common tests with other transplant recipients include serologic testing (i.e., CMV, HIV, HCV, etc.), HLA, blood group testing, complete blood count (CBC), and coagulation studies, to mention a few. Ophthalmologic, neurologic, and urologic workups are performed on a case-by-case basis (Table 4.2). Absolute contraindications include active infection, recent or current history of malignancy, positive crossmatch, and HIV infection. Relative contraindications include advanced age, obesity, and cardiovascular disease. Many centers consider that, in...

Mental Disorders and Public Health

The World Development Report and associated publications 7-9 have provided the first estimates that have allowed comparison between depression, other mental disorders and physical illness leading to death. The report estimated that neuropsychiatric disorders led to 8 of the Global Burden of Disease (GBD). For adults aged 15 to 44, mental disorders are estimated to account for 12 of the GBD. Mental disorders are projected to increase to 15 of the GBD and major depression is expected to become second only to ischaemic heart disease in terms of disease burden by the year 2020 8 . The Global Burden of Disease Study 7 has succeeded in putting depression on the public health map. What has proved more difficult is to persuade policy makers to attend to depression or to encourage research that will lead to a better understanding of the aetiology of depression. Depression is as big a potential public health issue as ischaemic heart disease. For the latter, some major risk factors are well...

Carotid endarterectomy

Pre-op Carotid duplex is first-line investigation to quantify extent of stenosis. Carotid angiogram may be necessary to assess the extent of the disease and the superior extent of the stenosis. Concomitant coronary artery disease is common, so an echocardiogram, a coronary angiogram, and serum cholesterol levels may be necessary. Baseline ECG. CT head (for evidence of previous CVAs). Post-op Frequent neurologic assessment should be carried out as well as haemodynamic and ECG monitoring. Observe the patient for a haematoma that may compromise the airway. Antiplatelet therapy is necessary. Follow-up care Re-evaluation should be done 2 weeks post-op for complications. Carotid duplex is performed after 6 months and then annually.

Osyndrome HRD Sanjad Sakati

Has been reported from the Middle East in children of consanguineous parents. Facial features include deep-set eyes, depressed nasal bridge with beaked nose, long philtrum, thin upper lip, micrognathia, and large floppy earlobes. Medullary stenosis and other skeletal defects may be present. Reduced numbers of T-cell subsets have been reported. The hypocalcaemia is associated with hyperphosphataemia and low concentrations of immuno-reactive parathyroid hormone. The syndrome is not associated with congenital heart disease.

Folinic acid 5formyltetrahydrofolate

In many countries, food is fortified with folic acid (in grain or flour) to prevent neural tube defects. Prophylactic folic acid is being increasingly used to reduce homocysteine levels to prevent cardiovascular disease. As yet there is no definite proof of this benefit, although circumstantial evidence does support this approach (see p. 64).

Ai Balanced multimodal analgesia

* At the time of writing, COX-2 inhibitor drugs are subject to scrutiny by international regulatory bodies with regard to adverse outcomes when used for long-term oral prescription or for pain relief in patients with cardiovascular problems such as myocardial infarction, angina pectoris, hypertension. Rofecoxib has been withdrawn from sales and prescription of valdecoxib has been suspended pending further research into its adverse events profile for cardiovascular morbidity and the occurrence of severe muco-cutaneous side effects. The injectable COX-2 inhibitor, parecoxib remains available for short-term use in treating postoperative pain. All NSAIDs should be used with care in patients with cardiovascular disease.

Factors Related To Health Care Adherence Among African Americans With Disabilities

For persons with any chronic illness or debilitating condition, regular medical appointments to follow the progression of the disease may be necessary and circumvent potential problems. For an obese person, eating the wrong foods and failure to exercise increase the risk of several diseases, including cardiovascular disease, diabetes, and cancer. As noted in chapter 1, African Americans are at increased risk for several of these diseases. Lack of adherence may be a larger concern when the individual has a chronic illness or a disability and recommendations aimed at decreasing the deleterious effects of the chronic illness and disability are not followed.

Pharmaceutical Therapies

It is important to reduce cerebrovascular risk factors such as hypertension, diabetes, smoking, hyperlipidemia, and coronary artery disease in patients with vascular dementia. Dementia resulting from neurologic conditions (Parkinson's disease, normal-pressure hydrocephalus, brain lesions, carotid artery disease) requires a neurological workup. Dementia related to a hereditary condition requires referral for genetic counseling.

Obesity and Spontaneous Preterm Birth

Even though obesity is detrimental for numerous aspects of human health and disease, high BMIs are associated with better outcomes of both congestive heart failure and atherosclerotic heart disease among people with chronic renal disease (Beddhu, 2004 Kalantar-Zadeh et al., 2004). It has been hypothesized that these epidemiological paradoxes may be the result of obesity-related changes in systemic inflammation (Beddhu, 2004 Kalantar-Zadeh et al., 2004).

Disease As A Tool For The Study Of Aging

Hutchinson-Gilford syndrome occurs in the twenties, usually consequent to coronary heart disease. The adult form of WS resembles more closely the changes associated with aging, with respect to both the affected individual's physical appearance and the disease pattern. The onset of this premature aging syndrome occurs between the ages of 20 and 30 years, and death ensues a few years from the onset, usually due to cardiovascular disease. Tissue culture studies of fibroblasts in infantile and adult syndromes reveal that the period during which cells replicate shortens, which is interpreted as being supportive of accelerated aging (Chapter 4).

The Select Trial And Aspirin Nsaids

Does it seem adequate at this time to spend such a large sum of money on a prospective 12-year study of vitamin E and or selenium to reduce prostate cancer risk Some laboratory and observational studies would suggest that this is a reasonable study. However, after closely evaluating the sum of the previous prospective data in prostate cancer and cardiovascular disease, this conclusion is not necessarily reasonable. There are several reasons for this concern, as listed below. Some may argue that higher dosages of vitamin E is what has looked promising in other prospective studies of vitamin E and prostate cancer. However, these specific dosages were not tested but only observed to be effective after the data were analyzed, and smokers were the only group of men who benefited. Non-smokers actually had a higher risk of prostate cancer, including aggressive disease or vitamin E at the higher dosages had little to no impact on risk. Regardless, where is the clinical data to precisely...

Aspirinnsaids And Prostate Cancer

Again, there are some investigations, albeit preliminary, that aspirin may have a potential role in preventing prostate cancer or the progression of this disease. Studies have suggested that men with ischemic heart disease may be at an increased risk for prostate cancer.69,71 Thus, the potential for investigating this agent for both conditions concurrently seems worthwhile.72,73 A variety of laboratory studies have noted an increased production of prostaglandins in human prostate cancer tissue,74-82 and an overall inhibitory effect of NSAIDs on the cellular growth of both androgen-sensitive and androgen-insensitive human prostate cancer cell lines.83-86 Collectively, these studies suggest that NSAIDs may have a favorable role in the early or latter stages of carcinogenesis.83 Two cohort studies investigating the use of aspirin in relation with multiple cancer sites observed weak inverse relationships for prostate cancer risk (RR 0.90-0.95).87,88 A third cohort studied aspirin use and...

Advances and Insights from Pharmacological Studies

Study was carried in a double-blind, placebo-controlled fashion in monkeys exposed to an intense social stressor namely, placement of two unfamiliar males in adjacent cages separated only by a transparent Plexiglas screen. Antalarmin significantly inhibited a repertoire of behaviours associated with anxiety and fear such as body tremors, grimacing, teeth gnashing, urination and defecation. In contrast, antalarmin increased exploratory and sexual behaviours that are normally suppressed during stress. Moreover, antalar-min significantly diminished the increases in cerebrospinal fluid CRH as well as the pituitary-adrenal, sympathetic and adrenal medullary responses to stress. Use of this pharmacological tool revealed that CRH plays a broad role in the physiological responses to psychological stress in primates. Furthermore, it is possible that a CRH1 receptor antagonist may be of therapeutic value in human psychiatric, reproductive and cardiovascular disorders associated with CRH system...

Background And Introduction

The primary goal of epidemiological investigation is to determine risk factors for disease causation or prevention. Once these risk factors are determined, primary prevention programs can be initiated in order to limit disease incidence. The tremendous success over the past two decades with respect to cardiovascular disease prevention is an excellent example of this. Other epidemiologically discovered risk factors cannot be modified (e.g. family history) however, their importance in disease causation is still relevant as they can lead to early detection and treatment of disease (so-called 'secondary prevention') for individuals at high risk. Non-preventable risk factors can also provide clues for basic science endeavors that aim to discover disease mechanisms (e.g. BRCA11).

Associated Medical Problems

Self-induced vomiting can lead to erosion of tooth enamel, gum abscesses, and swelling of the parotid glands in front of the ear and over the angle of the jaw. About one-third of women with bulimia have abnormal changes in their menstrual cycles. Some bulimics consume so much food in such a short period of time that their stomachs rupture. More than 75 percent of these individuals die. Use of ipecac and laxatives can lead to heart damage. Symptoms include chest pain, skipped heartbeats, and fainting, and these heart problems can lead to death. In addition, bulimics are at increased risk for ulcers of the stomach and small intestine and for inflammation of the pancreas.

Shortterm complications

Other major operative complications are fortunately far less common. The rate of operative mortality is extremely low, with a rate of 11 in 3834 patients (0.3 ) pooled from five contemporary series worldwide,22 including Washington University, Baylor, the Mayo Clinic, University of Ulm (Germany) and Toulouse (France).24-28 Similarly, the rates of rectal injury and colostomy were very low in these pooled studies at 0.7 and 0 , respectively.22 Non-urologic complications were also very rare. Myocardial infarction occurred in 22 patients

Longterm complications

The Medicare claims, 19.5 of patients identified to have had RRP by claim underwent one or more procedures for bladder neck obstruction or stricture after RRP.37 This contrasts with other studies reporting lower rates of postoperative BNC after RRP.38-40 Several studies have reported risk factors for the development of postoperative BNC, including previous prostate procedures or transurethral resections, excessive intraoperative blood loss, postoperative urinary extravasation and asymptomatic bacteriuria.39,41,42 In contrast, other studies found no relationship between development of BNC and previous transurethral resection of the prostate (TURP), or pathologic features including cancer volume, positive surgical margins, lymph node or seminal vesicle involvement.36'42 Patient comorbidities have also been implicated as risk factors for the development of BNC after RRP, including cigarette smoking, coronary artery disease, diabetes mellitus and hypertension, suggesting a microvascular...

Small bowel infarction

Predisposing factors include cardiovascular disease, acute hypotension, arrhythmia and thrombotic states. Noradrenaline can be associated with small bowel infarction as it may divert blood flow away from the bowel. Signs include abdominal pain, diarrhoea (often blood stained), persistent acidosis with an increasing base deficit despite fluid resuscitation, a rising lactate and an elevated white blood count with left shift.

Pneumococcal Infection

Pneumoccocal infection may occur anywhere in the world but is of particular concern to those at high risk of infection in whom invasive disease may be a serious cause of morbidity and mortality. This group includes those who are over the age of 65 years, are immunocom-promised, have an underlying chronic medical condition, e.g. diabetes mellitus or chronic respiratory or cardiovascular disease or have asplenia or have undergone a sple-nectomy. Asplenic individuals, travelling or otherwise, are advised to receive influenza, meningococcal and Hib vaccine as well as pneumococcal vaccine.

Possible mechanisms of association between preeclampsia and later disease

Clearly, insulin resistance is just one of many possible mechanisms linking pre-eclampsia and cardiovascular disease in later life. Another is thrombophilia. There are reports that women with inherited thrombophilias are at increased risk of pregnancy complications (Gharavi et al., occult cardiovascular, microvascular or hemostatic dysfunction. Since these will also make her susceptible to hypertension, atherosclerosis and throm-botic disorders, a woman's reproductive history may, therefore, also become informative in assessing her future risk of cardiovascular disease. The true nature and mechanism of these associations will only be resolved by large-scale prospective studies.

Problem Of Betweenpopulation Differences In Mean Phenotype

First, in Chapter 8 we examined the role of the amino acid replacement alleles at the ApoE locus in a Canadian population of men from the mid-1980s upon the phenotype of total serum cholesterol level. The mean phenotype in that population was 174.2 mg dl. Hallman et al. (1991) studied the role of the same ApoE polymorphisms in nine different human populations, whose mean total serum cholesterol levels varied from 144.2 mg dl (Sudanese) to 228.5 mg dl (Icelanders). These mean differences in cholesterol levels span a range of great clinical significance, as values above 200 mg dl are considered an indicator of increased risk for coronary artery disease. Hence, these nine populations are greatly different in their phenotypic distributions in a manner that is highly significant both statistically and biologically. Despite these large differences in mean total serum cholesterol levels, a Fisherian analysis of the ApoE polymorphism within each of these populations results in estimates of...

Biological Markers Of Drug Effect

In a number of clinical trials, initial conclusions based on the response of candidate surrogate endpoints were not borne out by the subsequent clinical response. These unexpected results have fueled concerns that many proposed surrogate endpoints may not accurately predict meaningful clinical outcomes (2-4). One of the most notable examples is provided by the Cardiac Arrhythmia Suppression Trial (CAST) in which a dichotomy was found between suppression of ventricular ectopy and increased mortality in patients who received long-term therapy with antiarrhythmic drugs (5). The impetus for the trial was provided by the fact that patients who have sustained a myocardial infarction, and subsequently have ventricular ectopy with more than 10 premature ventricular depolarizations per hour, have a fourfold increase in mortality rate. A total of 1498 patients were entered in the trial and were randomized to receive encainide, flecainide, or placebo. However, after a mean treatment period of 10...

Identification And Evaluation Of Biomarkers

Statistical criteria have played an important role in assessing the predictive utility of biomarkers (criterion validity), but it is always hazardous to equate causation with statistical association. For that reason, increasing emphasis has been placed on establishing the biological plausibility, or construct validity, of biomarkers. Thus, clinical and epidemiological observations led to the conclusion that elevated blood pressure was associated with an increased risk of atherosclerotic cardiovascular disease, heart failure, stroke, and kidney failure (16). Subsequent pathophysiologic studies in humans and in animal models then were particularly helpful in establishing a firm linkage between hypertension and cerebral hemorrhage and infarction (17). A later epidemiologic study demonstrated that the risk of stroke and coronary heart disease is correlated with the extent of diastolic blood pressure elevation (18). In the aggregate, this considerable evidence supports the biological...

Inflight Medical Emergencies

An inflight medical emergency is defined as a medical occurrence requiring the assistance of the cabin crew. It may or may not involve the use of medical equipment or drugs, and may or may not involve a request for assistance from a medical professional travelling as a passenger on the flight. Thus it can be something as simple as a headache, or a vasovagal episode, or something major such as a myocardial infarction or impending childbirth.

Differences in Disease Presentations

A report from the National, Heart, Lung and Blood Institute (NHLBI, 1996), showed that the age and incidence (1988-1993) of onset of heart disease between genders were different 24 of the 65-74 year-old males compared to about 18 of females in the same age group. This incidence rose in both genders at 75-84 years to about 28 males and 30 females. Not only do women develop heart disease later, but they also present differently. The signature symptom of a heart attack, severe chest pain, is often absent in women, and pain in the upper back or neck, or breathlessness and nausea, may present either as a single symptom or as multiple symptoms. The American Heart Association states that 44 of women are likely to die in the first year of their heart attack, compared to 27 of men. It is not surprising that heart attack and angina are misdiagnosed more commonly in women than men during emergency room visits. The range be tween hospitals of misdiagnosis was 0-11 , with an average 2.3 for angina...

PET in Clinical Practice and Medical Research

In neurology, metabolic tracers are used for monitoring of the brain's residual function in stroke patients and for differential diagnosis and treatment monitoring in Alzheimer's disease 45 . Specific tracers for the dopaminergic pathways are used in Parkinson's disease 46 and other movement disorders as well as in schizophrenia 47 . Enzymatic activity in vivo (i.e., aromatic amino acid decarboxylase) can be assessed via position-specific labeling of L-DOPA, as shown in Fig. 10.13.

An outpatient Sexual dysfunction

Impotence is reported in 20-50 of men following EBRT, depending upon the definition of potency and the time frame of assessment.47 More contemporary series have revealed that 60-70 of men who are potent prior to radiation retain potency following treatment.50'51 However, deterioration of potency with age, intercurrent diseases, such as hypertension, cardiovascular disease and diabetes, and the use of medications all compromise erectile function in this population of older men with prostate cancer.

Sources for Further Study

Behavior and Medicine. 3d ed. Seattle Hogrefe & Huber, 2001. This large volume covers an extensive area of behavior and medicine, which include stress and various behaviors which may affect physiological health. The articles cover such behavioral issues as substance abuse, stress management, pain, placebos, AIDS, cardiovascular risk, and adherence to medical regimens. Other behavioral issues are covered which relate to love and work, as well as developmental issues from infancy to death, dying and grief. The book is readable and includes illustrations, bibliographies, summaries, and study questions at the end of each article.

Cardiovascular Function

The pharmacodynamic consequences of these age-related cardiovascular changes are quite diverse. With initial administration of a nonselective b-adrenoceptor blocking drug, the decrease in heart rate is diminished. However, one would predict as well that the b2-adrenoceptor blockade-mediated increase in peripheral vascular resistance would be diminished simultaneously. Clinical data indicate that b-blocker therapy for hypertension may indeed be somewhat less effective in older hypertensive patients. However, the limited data available indicate that b-blocker therapy is as efficacious in older as in younger patients after myocardial infarction and for the treatment of congestive heart failure. Administration of an a-adrenergic blocking drug (e.g., tera-zosin for the treatment of urinary retention due to prostate hypertrophy) results in greater hypotensive response in the older individual due to lack of reflex b-adrenergic stimulation (54).

Nitrite And Diagnostics

Taking into account that endothelial dysfunction is at least in part reversible 105 , an early diagnosis of this disorder by assessing eNOS activity may have prognostic and therapeutic consequences. While direct biochemical evidence for an impaired eNOS activity has been obtained in experimental models, this approach is difficult in humans so far. It has recently been shown that plasma nitrite levels decrease with increasing numbers of cardiovascular risk factors 106 . In order to improve sensitivity and to get a higher discriminatory power, in the next step stimulation of eNOS activity has been chosen.

Endocrine imaging findings

American College of Obstetricians and Gynecologists. (1996). Hypertension in Pregnancy. ACOG Technical Bulletin 219. Washington, DC ACOG. American College of Obstetricians and Gynecologists. (1999). Thrombocytopenia in Pregnancy. ACOG Practice Bulletin 6. Washington, DC ACOG. Barker, D.J. and Osmond, C. (1986). Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet, 1, 1077-81. Baron, F., Sprauve, M. E., Huddleston, J. F. and Fishe, A. J. (1995). Diagnosis and surgical treatment Zimmerman, J., Fromm, R., Meyer, D., et al. (1999). Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation, 99, 1671-7.

Renal artery stenosis 169

A R Atherosclerotic form is commonly associated with peripheral vascular disease, aortic aneurysm and coronary artery disease. Rarer associations of RAS are neurofibromatosis, Marfan's syndrome, Takayasu's disease, systemic vasculitis, idiopathic hypercalcaemia, renal artery aneurysms. M Medical Pharmacological control of hypertension. In atherosclerotic cases, medical treatment is often preferred together with modulation of other cardiovascular risk factors. Avoidance of ACE inhibitors and other nephrotoxic agents.

Implementation Intentions in the Real World

Implementation intentions are also effective at producing desired outcomes outside of the laboratory. Health behaviors are more likely to be completed when people have formed implementation intentions about them, and this effect has been shown experimentally by studies concerning breast examinations even when participants have equivalent goal strengths (Orbell et al., 1997) and attendance of screenings for cervical cancer when motivation to attend is equivalent (Sheeran & Orbell, 2000). Maintaining regular exercise regimens, an important goal that many people find quite difficult to achieve, can also be made easier through the use of implementation intentions. In one study, when people were told the risks of heart disease and the preventative benefits of exercise, the formation of implementation intentions was the strongest predictor for increased amounts of exercise (Milne, Orbell, & Sheeran, 2002). Similarly, people who wrote down when and where they intended to watch and follow an...

Vascular Diseases 941 Introduction

Atherosclerosis is defined as the deposition of fatty substances, cellular waste products, cholesterol, calcium and other substances in the inner lining of an artery, called plaque. Plaque can be hard and stable, or soft and unstable. Hard plaque causes artery walls to thicken and harden. Soft plaque is more likely to break apart from the walls and enter the bloodstream. This can cause a clot that can partially or totally block the flow of blood in an artery and cause heart conditions or stroke (reviewed by Lusis 2000). The main consequences of vascular diseases to the heart are angina pectoris (the heart needs more blood), congestive heart failure (the heart cannot pump enough blood to the body's other organs) and heart attack (sudden interruption or insufficiency of the blood supply to the heart). Cerebrovascular accident, or stroke, is the third most frequent cause of death and a leading cause of disability in industrialised countries. About 10-20 of all stroke patients will suffer...

The Genetic Connection

Other observations suggest an association with elevated homocysteine levels in some AD patients, perhaps related to a decreased level of folate (Chapter 15), prior viral infections, exposure to chemicals, or aluminum, or any correlation with neoplasms. However, still other data associate AD with head trauma, cardiovascular disease, and a less convincing association with thyroid disease (Chapter 12). There is a definite association of AD with Down syndrome.

Etiology of erectile dysfunction after radical retropubic prostatectomy

Another etiology of post-radical prostatecomy erectile dysfunction is the physiologic development of erectile dysfunction in the aging man. The risk of erectile dysfunction is estimated at 26 1000 men annually and increases with age, lower educational status, diabetes, heart disease and hypertension.29 It is not clear as to how much of the erectile dysfunction is secondary to the prostate surgery verus the patients' comorbid conditions.

Disaster Research As An Application Of Psychiatric Epidemiology

There have been some notable exceptions, however, in which a population happened to have been studied prior to the disaster, and then a postdisaster follow-up was performed. One example involved a population in Puerto Rico who had participated in a psychiatric epidemiologic study modeled on the Epidemiologic Catchment Area (ECA) study 30 in 1984 31 . The following year, torrential rains hit the island, causing extensive mudslides and leaving 180 people dead, 4000 in shelters, and 19000 with serious property damage. In 1987, the investigators re-evaluated a group of disaster survivors (n 77) and controls (n 298), using a Spanish-language version of the Diagnostic Interview Schedule Disaster Supplement 32 . At approximately the same time, an area in St. Louis, Missouri, that was also part of the ECA study, was struck by a series of disasters. First devastating floods swept through the area, causing five deaths and necessitating the evacuation of about 25000 people. Evacuees from the...

Insulin Products for Travel

Populations that have a relatively high prevalence of this disease. One in five Indo-Asians over the age of 65 is diabetic (Roshan et al., 1996), with a high prevalence of obesity, insulin resistance and complications, including diabetic nephropathy and myocardial infarction. During travel they may also be fasting for religious reasons.

Prospective Cohort Studies

Anced, and homogeneous groups of people. While the experimentalist uses exclusions, randomization and blinding as tools to control for unseen biases, the epidemiologist is, rather, required to measure and document attributes and control for those that may lead to skewed results, by selection in ascertainment and stratification in analysis. Furthermore, like others calling themselves drug surveillance specialists, the epidemiologist will be well aware that the size of the groups that must be studied increases with the rarity of the phenomenon that is sort. The latency of the effect (e.g. the duration between exposure to an unsuspected atheromatous stimulus and coronary artery disease) can define the desirable duration of follow-up, in a manner analogous to the study of the probability of adverse events arising only after prolonged multiple-dose drug exposure. Often, rather, the size of the available population and the duration for which it has already been followed (e.g. for other,...

Dietary Supplement Health And Education Act Of 1994

'There is a link between the ingestion of certain nutrients or dietary supplements and the prevention of chronic diseases such as cancer, heart disease, and osteoporosis'. 2. 'Healthful diets may mitigate the need for expensive medical procedures, such as coronary bypass surgery or angioplasty'.

Selective Interventions

Appropriate selective interventions for other target conditions, such as diabetes mellitus, coronary artery disease, some types of cancer, osteoporosis and sexually transmitted diseases, should be recommended in accordance to the standard of care in the applicant's country of

Outofhospital Arrests

Cardiac disease accounts for more than 50 of out-of-hospital cardiac arrests and death is usually caused by a lethal tachy-arrhythmia, which in turn is usually precipitated by anterior myocardial infarction (AMI) (Rosen et al. 2001). Tachyarrhyth-mias are fast unstable heart rhythms which may also be caused by electrolyte imbalance, drug toxicity and cardiomyopathies though these are much less common (Engdahl et al. 2002).

Taking the defibrillator to the casualty

Sudden cardiac death frequently happens to those with no previous history of heart disease and two-thirds of deaths from coronary artery disease occur in the community (Engdahl et al. 2002). If an AMI patient suffers a cardiac arrest in the presence of a paramedic they have a 40 or greater chance of survival to discharge (Norris 1998).

Periarrest Arrhythmias

Peri-arrest rhythms are those that may present as emergency situations. Many of these adverse arrhythmias occur following a myocardial infarction, resuscitation or other factors. In such instances, if standard measures to manage or prevent arrhythmias are ineffective, expert help should be sought promptly (ERC 2001).

Ischaemic lower limb Acute 119

E Atrial fibrillation, recent MI, valvular heart disease, aneurysms, atrial myxoma may also occur during interventional radiological procedures. Immediate Analgesia, heparin anticoagulation to prevent thrombus propagation. Appropriate medical treatment for associated cause. Surgical Revascularisation within 6 h in order to salvage limb. Operative risk is often high due to underlying heart disease.

C677T Polymorphism of Methylenetetrahydrofolate Reductase Gene

The MTHFR C677T, causing hyperhomocysteinemia, is an important genetic risk factor for cardiovascular disorders 65 . This is the most common mutation and has prevalence in the general population, 5-10 as TT and up to 40 as CT genotype 35,46 . Nevertheless, due to the high incidence in the general population and its physiological role, the 677C-T mutation may represent an important risk factor of homocystein associated vascular disease 35 . A generally accepted hypothesis is that TT-genotype leads to hyperhomocysteinemia, with a consecutive premature vascular disease and heterozygous carriers have mild hyperhomocysteinemia with a predisposition for accelerated atherosclerosis 18,46 .

Serum methylmalonate and homocysteine levels

Also higher in serum than in plasma, in men than in premenopausal women, women taking hormone replacement therapy or oral contraceptive users and in elderly subjects and patients with several inborn errors of metabolism affecting enzymes in trans-sulphuration pathways of homocysteine metabolism. Thus, homocysteine levels are not widely used for diagnosis of cobalamin or folate deficiency. Homocysteine levels are useful, however, in thrombophilia screening and in assessing for cardiovascular risk factors (see Chapter 58).

Categories of Weight Loss Drugs

Affect catecholamines dopamine and norepinephrine. These noradrenergic agents are useful for short term treatment and include the drugs phenteremine, diethylpropion, phendimetrazine and benzphetamine. Stimulants act via catecholamine neurotransmitters, such as amphetamines and phenylpropanolamine. Phenylpropanolamine, which was an over-the-counter medication, was removed secondary to an association with hemorrhagic stroke. Side effects of this class of medications include insomnia, dry mouth, constipation, euphoria, palpitations and hypertension. 2. Affect serotonergic Fenfluramine and dexfenfluramine are included in this class. These medications have been associated with valvular heart disease and pulmonary hypertension. In 1997, the Phen fen combination was withdrawn from the market after reports of valvopathy after as little as one month's use of this medication. The mechanism apparently involves serotonin stimulation of fibroblast growth and fibrogenesis. The newly discovered...

Therapeutic Response Cumulative Drug Effects And Schedule Dependence

Lasix Pharmacokinetics

Many clinical responses are described in terms of events. An event might be death, a stroke, a myocardial infarction, an epileptic seizure, admission to hospital, need for supplementary treatment, and so on. The occurrence of an event or the time to an event can be modeled using a survival function. The word survival relates most obviously to a death event, but the term is commonly used in a much broader context to describe the probability that the event under study will not occur. where B is a set of parameters describing the hazard as a function of X (time, dose, etc). Potential time-varying covariates for the hazard are cholesterol concentrations (heart attack event), blood pressure (stroke event), or concentration of an anticonvulsant drug (seizure event). The chances of an event are related both to the size of the hazard and the time that the patient is exposed to the hazard. The cumulative hazard from 0 to t H(t) can be related to the probability of an event, as illustrated by...

Other Biological Psychological and Social Responses and Consequences

Research has consistently shown that individuals diagnosed with PTSD have higher rates of medical services use and increased levels of fatigue, headaches, chest pains, gastrointestinal disorders, cardiovascular disorders, and impaired For ex-POWs, higher rates of tuberculosis, cardiovascular disease, respiratory disease, and both gastric and duodenal ulcers (Eitinger, 1973)

Mechanisms of altered lipid metabolism in preeclampsia

It is likely that both maternal and placental factors cause dyslipidemia in pre-eclampsia. The insulin resistance syndrome, a cluster of metabolic abnormalities associated with reduced insulin sensitivity, is a strong predisposing factor for cardiovascular disease (Kahn and Flier, 2000 Reaven, 1994). Pre-eclampsia is associated with accentuation of many features of the metabolic syndrome, including insulin resistance, hypertri-glyceridemia, elevated FFA, low HDL cholesterol, hyperuricemia, and abnormalities in the fibrinoly-tic system, usually in the absence of frank diabetes (Kaaja, 1998 Kaaja et al., 1995 Lorentzen et al., 1998 Solomon et al., 1994 Solomon et al., 1999 Sowers et al., 1995 Wolf et al., 2002). Accompanying abnormalities include increased serum concentrations of leptin, C-reactive protein, tumor necrosis factor-a, testosterone, and plasminogen activator-inhibitor-1 (Sattar and Greer, 2002 Wolf etal., 2001).

Effects Of Pathological Conditions

Chronic renal disease may also affect metabolism, not necessarily because of impaired metabolism in the kidney, but because of an indirect effect of renal failure on liver metabolism. For example, in animals with renal failure it was observed that there was a decrease in hepatic cytochromes P-450 content, and consequently zoxazolamine paralysis time and ketamine narcosis time were prolonged. Cardiac failure may also affect metabolism by altering hepatic blood flow. However even after heart attack without hypotension or cardiac failure, metabolism may be affected. For example, the plasma clearance of lidocaine is reduced in this situation. Other diseases such as those which affect hormone levels hyper- or hypo-thyroidism, lack of or excess growth hormone, and diabetes can alter the metabolism of foreign compounds.

The Self as a Regulator of Individual Processes

Social cognitive theory has also directed research on self-efficacy, the belief that one will be capable of using one's own behavior, knowledge, and skills to master a situation or overcome an obstacle. For example, Bandura showed in 1986 that people in recovery from a heart attack were more likely to follow an exercise regimen when they learned to see themselves as having physical efficacy. Perceived self-efficacy was demonstrated throughout the 1980's and 1990's as contributing to a wide range of behaviors, from weight loss to maternal competence to managerial decision making.

Inhibition Of Cholesterol Synthesis And Cancer Therapy

HMG-CoA reductase catalyzes the rate-limiting step of cholesterol biosynthesis (Fig. 1). HMG-CoA reductase inhibitors are cholesterol-lowering drugs used in the treatment of lipid disorders, especially hypercholesterolemia. The statin family of HMG-CoA reductase inhibitors includes simvastatin, lovastatin, atorvastatin, fluvastatin, cerivastatin, and pravastatin. Recent clinical data from studies on cardiovascular disease and cancer chemoprevention suggest that prolonged statin therapy may reduce the risk of prostate and other cancers. Results of a large-scale study of patients taking statins compared with other cardioprotective agents (48) showed a 20 reduction in total cancer incidence with statin treatment, with prostate and kidney cancers showing the largest reductions. Interestingly, patients who terminated statin therapy returned to a baseline level of risk within 6 months. Another randomized, placebo-controlled study of cause-specific mortality rates in patients on long-term...

Angiotensinases in normal and preeclamptic pregnancy

Angiotensin-converting enzyme (ACE) is a specialized angiotensinase. Concentrations of circulating ACE fall in the first half of normotensive human pregnancy, and then rise significantly over the third trimester towards non-pregnant levels (Oats et al., 1981). In pre-eclamptic pregnancy, levels remain low in the third trimester (Rasmussen et al., 1983). Plasma ACE is of endothelial origin, and these depressed concentrations may relate to the generalized endothelial dysfunction of pre-eclampsia. It is, however, usually assumed that ACE is not rate-limiting in the generation of AngII. There is a functional polymorphism in the ACE gene, the Insertion Deletion (I D) polymorphism, DD homozygotes having circulating ACE some 40 higher than the II homozygotes (Rigat et al., 1990). Although this has been strongly associated with non-pregnant heart disease in a number of studies, studies in relation to pre-eclampsia have failed to show any association (Heiskanen et al., 2001 Morgan et al.,...

Phenylephrine Prodrugs

Phenylephrine (1) is an a-adrenergic agent that is used clinically for pupil dilation either in eye examinations or in ocular surgery. It has a low ocular bioavailability due to its hydrophilic nature (log Dj,4t -1.89) (Schoenwald et al., 1987) and, therefore, concentrated eyedrops (up to 10 ) are required to produce mydriasis. The large topical dose of phenylephrine may cause adverse systemic side effects, such as severe hypertension, ventricular arrhythmia, and possible myocardial infarction (Miller-Meeks et al., 1991 and references cited therein).

Ischaemic lower limb Chronic

E Examine the cardiovascular system, looking for signs of hyperlipidaemia, carotid bruits, signs of ischaemic heart disease, abdominal aortic aneurysm. If ischaemia is severe in lower limbs, there is shiny atrophic skin with hair loss or atrophic nails, ulcers tend to be painful and have a 'punched out' appearance (e.g. under toes or classically over lateral malleolus). Peripheries cool to the touch with prolonged capillary return time, weak or absent pulses. Listen for bruits. Buerger's test Elevation of the leg results in pallor, venous guttering, followed by dependent rubor. M Medical Stop smoking and exercise, supervised programs have been shown to be effective. Treatment of other cardiovascular risk markers, e.g. statins, control of hypertension (but p-blockers should be avoided as they tend to peripheral circulation), aspirin. Prostacyclin infusions are sometimes used in those with critical ischaemia unable to tolerate other interventions but this can cause severe hypotension.

Introduction About Cardiac Arrest

Despite its popular portrayal, cardiorespiratory arrest is often neither sudden nor unpredictable (Resuscitation Council UK 2000). Studies over several years have shown that most cardiac arrests are avoidable if signs and symptoms are recognised and responded to (Franklin & Mathew 1994, Hodgetts et al. 2002a, Smith & Wood 1998). Patients with coronary artery disease are more likely to have a sudden cardiac arrest, often precipitated by an unstable area of ischaemic myocardium. Such events will be heralded by the onset of symptoms in many cases. At least 80 of individuals who suffer sudden cardiac death have coronary artery disease (Zipes & Wellens 1998) and so any strategy to prevent cardiac arrest must begin here. Recognising and responding to patients at risk of deterioration and cardiac arrest is a clinical priority. understanding how to recognise and respond to acute coronary syndromes

General Adaptation Syndrome

Selye's general adaptation syndrome involves three stages of physiological response alarm, resistance, and exhaustion. During the alarm stage, the organism detects a stressor and responds with SNS and hormonal activation. The second stage, resistance, is characterized by the body's efforts to neutralize the effects of the stressor. Such attempts are meant to return the body to a state of homeostasis, or balance. (The concept of homeostasis, or the tendency of the body to seek to achieve an optimal, adaptive level of activity, was developed earlier by Walter Cannon.) Finally, if the resistance stage is prolonged, exhaustion occurs, which can result in illness. Selye referred to such illnesses as diseases of adaptation. In this category of diseases, he included hypertension, cardiovascular disease, kidney disease, peptic ulcer, hyperthyroidism, and asthma.

Special Considerations For Altitude Travel

Heart Disease Ascent to high altitude is associated with activation of the sympathetic nervous system and an increase in heart rate, cardiac output and blood pressure, which return to sea-level values by 3 months. In addition, hypoxic pulmonary vasoconstriction results in pulmonary hypertension. The physiological stress of hypoxia and cold has important implications for patients with coronary artery disease, who may experience new or worse angina, hypertension which may be harder to control, and heart failure and pulmonary vascular disease which may deteriorate. Risks can be minimised with appropriate medical advice. Coronary Artery Disease Patients with coronary artery disease may experience an increase in symptoms. Nevertheless, neither acute ECG changes of myocardial ischaemia at rest (Yaron et al., 1995 Levine et al., 1997) nor symptomatic deterioration (Yaron et al., 1995) have been reported in patients aged over 65 years with coronary artery disease who visited 2500 m for 5...

Theoretical models and psychodermatology

Contextualing a review of any discipline requires that the discipline be placed within a theoretical and historical framework, and this approach is appropriate for psychodermatology. By the 1950s, the incidence of contagious diseases had declined rapidly and non-contagious diseases were on the increase. These included diseases that are related to lifestyle variables such as lung cancer and heart disease. Improved hygiene, vaccines and general medical treatment led to longer-life expectancy and the effects of health-compromising behaviours such as smoking, drinking, alcohol and poor diet had a growing effect on health. As a consequence of the limitations of the biomedical model and the change in disease statistics, researchers in the fields of health, psychology and medicine had begun to focus on the biopsychosocial model, a model that posits the fundamental assumption that health and illness are consequences of the interplay between psychological, biological and social factors (Engel,...

Removing Protein Heterogeneity by Point Mutation

They are a first line of therapy for hypertension, heart failure, myocardial infarction and diabetic nephropathy. ACE is a highly glycosylated protein and has proved hard to crystallize for more than two decades. Unglycosylated ACE was shown to be inactive. There are two ACE isoforms, one in somatic tissues and one in sperm cells. The testis ACE (tACE) is identical to the portion of somatic ACE that is sufficient for its cardiovascular function, except for the N-terminal 36 residues. A 2.0 A resolution structure of a truncated and chemically modified form of tACE recently became available 16, 17 . The mutant tACE (tACE3A6NJ) lacks the N-terminal 36 residues and the C-terminal hydrophobic transmembrane domain, was expressed in the presence of the a-glucosidase I inhibitor N-butyl-deoxynojirimycin and was treated with endoglycosidase H to remove all but the terminal N-acetylglucosamine residues. It was homogeneous on SDS-PAGE and retained full enzymatic activity, but the expression...

Definition and Nomenclature

Various authors use different terms to denote identical altitude illnesses. Since Wu and Liu in 1955 37 first used the term pediatric high altitude heart disease, PHAHD , it is now well accepted for this syndrome in China 44 . After that, in the year 1988, Sui GJ, a Chinese pathologist and his colleagues, in collaboration with an English research group in Lhasa, Tibet, noted that it is an often fatal disease affecting infants and manifesting itself over a period of weeks and months rather than days or years, it came to be designated as subacute infantile mountain sickness 35 . Otherwise, because it is known that mild pulmonary hypertension without symptoms is one of the common features of altitude residents, to draw a clear distinction between physiologic and pathologic pulmonary hypertension, a term symptomatic high altitude

Hematopoietic System and the Treatment of Cancer

However, these findings must be coupled with the known increased risk of hematopoietic toxicity in older patients undergoing cancer chemotherapy. The risk of myelosuppression is increased in patients over the age of 70 (76), leading to the recommendation that these patients receive hematopoietic growth factor treatment during cancer chemotherapy (76, 77). Such treatment has been associated with a decrease in febrile neutropenia and sepsis-related mortality (76, 78, 79). Anemia, defined as a hemoglobin concentration of less than 13 g dL in men and 12 g dL in women, is common in older adults (80), and its presence is an independent risk factor for myelotoxicity associated with anthracycline, epipodophyllotoxin, and comp-tothecin chemotherapy (81). This is at least in part due to changes in the tissue distribution of these drugs, which are highly bound to red blood cells. These findings have led to a recommendation that hemoglobin level should be maintained at 12 g dL in older patients...

Interrater Reliability

Table 3.13 Agreement between patient and proxy SIP scores in stroke survivors (Based on Sneeuw KCA, Aaronson NK, de Haan RJ and Limburg M (1997). Assessing quality of life after stroke the value and limitations of proxy ratings. Stroke, 28, 1541-1549) Table 3.13 Agreement between patient and proxy SIP scores in stroke survivors (Based on Sneeuw KCA, Aaronson NK, de Haan RJ and Limburg M (1997). Assessing quality of life after stroke the value and limitations of proxy ratings. Stroke, 28, 1541-1549)

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