1/30. Cardiovascular involvement in a boy with Sweet's syndrome.Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a rare disease in infancy. It may present in an isolated manner or be associated with diverse conditions. Only two children with postinflammatory slack skin who developed cardiovascular disease have been described to date, both of whom died from coronary artery occlusion. We report a boy with Sweet's syndrome and diffuse vascular disease involving the aorta and the supraaortic vessels, the pulmonary trunk, and the right coronary artery but without signs of coronary obstruction.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/30. skin tags and the atherogenic lipid profile.This report details four patients who had skin tags, mainly on their torso, neck, and axillae, and who also displayed an abnormal lipid profile. All showed an increased serum triglyceride (fasting > 1.70 mmol/litre) and a decreased high density lipoprotein (HDL) cholesterol (< 1.1 mmol/litre in women and 1.0 mmol/litre for men) concentration. The displayed lipid profile is also known as the atherogenic profile and is associated with insulin resistance, type 2 diabetes mellitus, and an increased risk of cardiovascular disease. Two of the patients had impaired glucose tolerance and one had type 2 diabetes mellitus. Three of the individuals had coronary artery disease. skin tags might be a useful clinical sign that could alert clinicians to screen such individuals for abnormal lipids, type 2 diabetes mellitus, and cardiovascular disease.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
3/30. Keeping an eye on cardiovascular risk. A practical, case-study approach to assessment in office practice.Primary care physicians typically encounter patients who are not at obvious risk for CAD but who nonetheless need and can benefit from lipid-lowering therapy. Applying algorithms or scoring systems can be helpful in estimating an individual patient's risk, but the basic tools available in everyday clinical practice can be used to alert physicians to elevated CAD risk in their patients. Those patients whose LDL-C level is at or above 220 mg/dL (5.69 mmol/L) should routinely and deservedly get clinical attention, but they account for only 2.5% to 5% of the population. Those with an "average" LDL-C level number in the millions, and from this patient pool come the coronary events that fill clinics and hospitals. Aggressive treatment approaches are required to meet NCEP objectives, and every indication suggests that these goals are just the minimum. The third report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High blood Cholesterol in Adults (adult Treatment Panel III) has broadened the indications for drug therapy, reclarifying diabetes and peripheral vascular or cardiovascular disease equivalents and using a global evaluation concept, which will identify 30 million Americans in need of drug treatment. The statins safely and effectively lower LDL-C levels, which is the basis for instituting drug therapy, according to NCEP guidelines. Using these drugs also raises HDL-C levels, which is somewhat protective, and decreases triglyceride levels. The efficacy of statin therapy in both primary and secondary prevention of CAD is now well established. If used more often when dietary therapy fails, which happens quite often, and in doses sufficient to work effectively, statins have the power to turn the corner on the prevention and treatment of atherosclerotic coronary disease in the united states.- - - - - - - - - - ranking = 0.66666666666667keywords = coronary (Clic here for more details about this article) |
4/30. Prevention for the older woman. A practical guide to managing cardiovascular disease.American women are more likely to die from cardiovascular disease than from any other cause. Although hypertension is most prevalent, most deaths are attributed to coronary heart disease. heart disease in women manifests approximately 12 to 15 years later than in men, up until menopause. Then the severity of coronary artery lesions in women accelerates until it equals or surpasses that of men by the late 70s or early 80s. physicians can help older women reduce their risk for heart disease and stroke by managing hypertension and hypercholesterolemia and providing beta-blocker treatment when indicated after MI. Nonpharmacologic interventions may be effective as well. New guidelines for aspirin help identify women under age 80 who would benefit most from antiplatelet therapy.- - - - - - - - - - ranking = 0.66666666666667keywords = coronary (Clic here for more details about this article) |
5/30. Thrombotic thrombocytopenic purpura associated with ticlopidine.Thrombotic thrombocytopenic purpura is a syndrome characterized by hemolytic anemia, thrombocytopenia, neurological symptoms, fever and renal dysfunction. Although the syndrome is usually associated with various infections, vasculitis and pregnancy, rarely can it be associated with certain neoplasms and drugs such as ticlopidine. A 63-year-old woman, who had undergone coronary angioplasty and had been started on ticlopidine, was admitted to our clinic with a history of vomiting, fatigue, hematuria and deterioration in her cognitive abilities. Thrombotic thrombocytopenic purpura was diagnosed on the basis of neurological changes, an increase in LDH, urea, creatinine, indirect bilirubin levels, anemia and peripheral smear findings. Treatment was initiated with daily plasmapheresis and complete clinical and laboratory recovery developed. The patient was discharged after 14 days.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
6/30. The metabolic syndrome, type 2 diabetes, and cardiovascular disease: understanding the role of insulin resistance.The most common and clinically important complication in adults with diabetes is cardiovascular disease (CVD), which includes coronary heart disease, peripheral vascular disease, and stroke. Both type 2 diabetes and the insulin resistance syndrome are associated with a marked increase in the risk for CVD. The metabolic syndrome and the closely related insulin resistance syndrome have recently been recognized as important disorders, each being associated with an increase in CVD risk even in the absence of glucose intolerance. Given the significant public health burden of CVD, risk reduction has emerged as a significant clinical challenge for most practitioners. Diabetes and the insulin resistance syndrome are closely related disorders, with insulin resistance being more than a key pathogenic defect in type 2 diabetes. Even in the absence of glucose intolerance, these 2 disorders are both associated with a number of distinct pathologic findings, including hypertension, atherogenic dyslipidemia, a prothrombotic environment, and significant vascular and hemodynamic abnormalities that result from endothelial cell dysfunction. insulin resistance is now recognized to be closely associated with the development of each of these risk factors. This article uses a case-based approach to discuss the unique features of insulin resistance and type 2 diabetes considered to be key contributors to CVD risk. A systematic approach to both evaluation and management is proposed, with priority given to therapies of demonstrated clinical benefit. Because of its critical and central role in the development of many CVD risk factors, targeted treatment of insulin resistance will also be discussed as such therapy may prove to be a critical component of care in years to come.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
7/30. Post-mortem findings in familial partial lipodystrophy, Dunnigan variety.AIMS: Familial partial lipodystrophy, Dunnigan variety (FPLD), is an autosomal dominant disorder due to missense mutations in the lamin A/C gene and is characterized by gradual loss of subcutaneous fat from the extremities and trunk, fat accumulation in the head, neck and intra-abdominal areas, insulin resistance and its metabolic complications. We studied autopsy findings in two patients with FPLD to determine fat distribution and organ involvement. RESULTS: Patient 1, a 66-year-old woman with the R482Q mutation, had diabetes mellitus, dyslipidaemia, and coronary artery disease and died suddenly. autopsy confirmed the typical body fat distribution and further revealed excess fat deposition in the subpectoral regions extending to the axillae, in the axillary lymph nodes and in the retroperitoneum. Atherosclerotic vascular disease including old infarcts of the myocardium, temporal lobe and kidneys were noted. Severe amyloidosis of the pancreatic islets and grouped muscle atrophy of the quadriceps and diaphragmatic muscles were present. Patient 2, a 29-year-old woman belonging to a pedigree with the R62G mutation, died of hyperlipidaemia-induced acute pancreatitis. autopsy of patient 2 revealed extensive pancreatitis, hepatic steatosis and polycystic ovaries. CONCLUSIONS: Our study confirms typical body fat distribution and describes new sites of excess fat deposition. Our data show predisposition to atherosclerosis and polycystic ovaries and suggest that pancreatic amyloidosis may underlie development of hyperglycaemia in FPLD patients.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
8/30. Late cardiovascular and pulmonary complications of therapy in Hodgkin's disease: report of three unusual cases, with a review of relevant literature.With the advent of modern therapeutic approaches, even patients with advanced Hodgkin's disease have high cure rates today. Therefore, more attention is gradually being focused upon the late complications of chemotherapy and irradiation, appearing long after the patient is in remission and thought to be cured. In this report, we review the incidence and presentation of some of the cardiovascular and pulmonary complications which may appear later in the course of the disease. Cardiovascular mishaps reviewed include pericardial manifestations, conduction abnormalities, cardiomyopathy, and premature coronary artery disease. Pulmonary complications discussed are lung fibrosis, spontaneous pneumothorax, pulmonary veno-occlusive disease, and hyperlucent lung. Three instructive cases from our recent experience, are also presented. One fatal case was due to cardiac failure because of radiation-induced pericarditis and coronary artery disease. Another patient with an almost fatal complication required lung transplantation because of severe bilateral radiation fibrosis of the lung and pulmonary veno-occlusive disease. The third instance was also life-threatening in nature, with radiation-induced arterial changes in the major arteries of the chest and neck, resulting in recurrent cerebral and ophthalmic thromboembolic disease. It is suggested that potentially severe cardiopulmonary complications be considered during the planning of the initial and subsequent management of patients with Hodgkin's disease, particularly in an era employing autologous and allogeneic bone marrow transplantation as part of therapy in some cases.- - - - - - - - - - ranking = 0.66666666666667keywords = coronary (Clic here for more details about this article) |
9/30. Multisection CT evaluation of the reoperative cardiac surgery patient.Development of electrocardiographically (ECG) gated multisection computed tomography (CT) has had a significant, immediate impact in cardiovascular imaging. The capabilities of this new technique have become particularly important in the preoperative assessment of the cardiac surgery patient. Cardiac surgery in the 21st century has become increasingly complex because of an aging population needing multiple procedures. As patients live longer, reoperative surgery is often needed, requiring further complicated intervention. Recent research in cardiac surgery patients has linked atherosclerotic disease of the aorta to the risk of perioperative stroke. Multisection CT has been effective in evaluations of the atherosclerotic aorta, minimizing perioperative stroke risk in these often elderly patients. By using the capabilities of ECG gating, improved CT imaging of the aortic valve has helped guide the surgeon in decisions of aortic valve replacement. Injury to preexisting coronary artery grafts is associated with significant perioperative morbidity and mortality. The superior imaging features of ECG-gated CT have enabled preoperative identification of coronary grafts, preventing injury to these important structures during reoperative surgery. Assessment of normal anatomic structures is also important in preoperative planning. Proximity of the aorta, pulmonary artery, and native coronary arteries to the sternum is an important potential cause of morbidity and mortality, and it can be preoperatively assessed with multisection CT. The advancement of ECG gating has enabled accurate assessment of the coronary arteries, which is particularly important in the preoperative identification of congenital and acquired abnormalities. With continued advances, ECG-gated multisection CT will play an increasingly important role in the evaluation of patients with cardiovascular disease.- - - - - - - - - - ranking = 1.3333333333333keywords = coronary (Clic here for more details about this article) |
10/30. Serious adverse incidents with the usage of low molecular weight heparins in patients with chronic kidney disease.BACKGROUND: The aim of the study is to describe serious adverse events in patients with renal insufficiency administered low molecular weight heparins (LMWHs). methods: Systematic case note review from July 2002 to March 2003, hope Hospital, Salford, UK, was used. RESULTS: Ten patients experienced an adverse incident on LMWH therapy. Five patients were on maintenance hemodialysis therapy, and 1 patient was on continuous ambulatory peritoneal dialysis therapy. Three patients had calculated creatinine clearances of 5, 11, and 33 mL/min (0.08, 0.18, and 0.55 mL/s), and 1 patient had an estimated glomerular filtration rate of 12 mL/min. Age range was 45 to 89 years. Indications for anticoagulation were suspected pulmonary embolism (1 patient), acute coronary syndrome (7 patients), severe nephrotic syndrome (1 patient), and postoperative venous thromboembolic prophylaxis (1 patient). Three patients also were administered aspirin; 1 patient, clopidogrel; and 3 patients, aspirin and clopidogrel. LMWHs used were enoxaparin (6 patients), tinzaparin (3 patients), and dalteparin sodium (1 patient). Bleeding sources were retroperitoneal (1 patient), spontaneous soft tissue (3 patients), gastrointestinal (2 patients), dialysis catheter and cannula sites (2 patients), hemorrhagic pericardial effusion (1 patient), and intracranial (1 patient). Activated partial thromboplastin time was prolonged in 7 of 10 patients, with no other identifiable cause found. Three patients died despite aggressive resuscitation, including packed red blood cell infusions and protamine sulfate administration. Eight of the 10 prescriptions for LMWHs were either started or continued within our directorate, giving an approximate incidence of major hemorrhagic events in patients with chronic kidney disease of 7.8%. CONCLUSION: LMWHs administered at fixed-weight doses and without monitoring show unpredictable anticoagulant effects in patients with chronic kidney disease stages 4 and 5, leading to serious and even fatal adverse incidents.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
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